National Household Survey 2011 - N1
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For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- STEP A
- STEP B
- STEP C
- STEP D
- Activities of daily living
- Sociocultural information
- Mobility
- Place of birth of parents
- Education
- Labour market activities
- Income in 2010
- STEP E: Answer Questions E1 to E10 about this dwelling.
- STEP F: If you are answering on behalf of other people, please consult each person.
Introduction
Purpose
Complementing the data collected by the census, the National Household Survey (NHS) is designed to provide information about people in Canada by their demographic, social and economic characteristics as well as provide information about the housing units in which they live.
Authority
This information is collected under the authority of the Statistics Act, R.S.C. 1985, c. S-19.
Confidential when completed
Confidentiality
THE LAW PROTECTS WHAT YOU TELL US
The confidentiality of your responses is protected by law. All Statistics Canada employees have taken an oath of secrecy. Your personal information cannot be given to anyone outside Statistics Canada without your consent. This is your right.
Assistance
ANY QUESTIONS?
- www.nhs.statcan.gc.ca
- Call us free of charge 1-877-308-2777
- TTY users call 1-866-753-7083
Ce questionnaire est disponible en français 1-877-308-2777
Introduction statement
Message from the Chief Statistician of Canada
Statistics Canada is seeking your participation in this national survey. It is important that you complete this survey so that your community has the information it needs for planning services such as child care, schooling, family services, housing, roads and public transportation, and skills training for employment.
Use the secure access code and website address to complete your questionnaire online or complete the paper version.
By law, your responses will be kept confidential. Your information may be used by Statistics Canada in support of our other surveys or for analysis.
Thank you for your cooperation.
Reporting instructions
Complete your questionnaire:
- Online by using the secure access code at www.nhs.statcan.gc.ca.
OR
- ON PAPER, please print using CAPITAL LETTERS.
STEP A
STEP A - Question identifier:1.
Print your telephone number
- 1: Area Code, Telephone Number
STEP A - Question identifier:2.
Complete this section if there is no printed address on the front page or if the printed address does not correspond to this dwelling
- 1: No. and street or lot and concession
- 2: Apt. no
- 3: City, municipality, town, village, Indian reserve
- 4: Province/territory
- 5: Postal code
STEP B
STEP B - Question identifier:1.
How many persons usually live at this address on May 10, 2011, including yourself?
- 1: Number of Persons
STEP B - Question identifier:2.
Including yourself, list below all persons who usually live here.
- 1: Family Name, Given Name
STEP C
Did you leave anyone out of Step B because you were not sure the person should be listed? (For example, a person living at this address who has another home, a person temporarily away, etc.)
- 1: No
- 2: Yes. See the instructions for Step B. Add the additional names in Step B, if applicable.
STEP D
Copy the names in Step B to Question 1. Keep the same order. Then answer the following questions for each person.
STEP D - Question identifier:1.
NAME
- 1: Family Name, Given Name
STEP D - Question identifier:2.
SEX
- 1: Male
- 2: Female
STEP D - Question identifier:3.
DATE OF BIRTH AND AGE
- 1: Day, Month, Year
- 2: Age
STEP D - Question identifier:4.
MARITAL STATUS
- 1: Never legally married
- 2: Legally married (and not separated)
- 3: Separated, but still legally married
- 4: Divorced
- 5: Widowed
STEP D - Question identifier:5.
Is this person living with a common-law partner?
- 1: No
- 2: Yes
STEP D - Question identifier:6.
RELATIONSHIP TO PERSON 1
- 1: PERSON 1
- 2: Opposite-sex husband or wife of Person 1
- 3: Opposite-sex common-law partner of Person 1
- 4: Same-sex married spouse of Person 1
- 5: Same-sex common-law partner of Person 1
- 6: Son or daughter of Person 1 only
- 7: Son-in-law or daughter-in-law of Person 1
- 8: Grandchild of Person 1
- 9: Father or mother of Person 1
- 10: Father-in-law or mother-in-law of Person 1
- 11: Brother or sister of Person 1
- 12: Son or daughter of both Persons 1 and 2
- 13: Son or daughter of Person 2 only
- 14: Foster child
- 15: Room-mate, lodger or boarder
- 16: Other - Specify
Activities of daily living
Activities of daily living - Question identifier:7.
Does this person have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?
- 1: Yes, sometimes
- 2: Yes, often
- 3: No
Activities of daily living - Question identifier:8.
Does a physical condition or mental condition or health problem reduce the amount or the kind of activity this person can do:
(a) at home?
- 1: Yes, sometimes
- 2: Yes, often
- 3: No
(b) at work or at school?
- 1: Yes, sometimes
- 2: Yes, often
- 3: No
- 4: Not applicable
(c) in other activities, for example, transportation or leisure?
- 1: Yes, sometimes
- 2: Yes, often
- 3: No
Sociocultural information
Sociocultural information - Question identifier:9.
Where was this person born?
- 1: Nfld.Lab.
- 2: P.E.I.
- 3: N.S.
- 4: N.B.
- 5: Quebec
- 6: Ontario
- 7: Manitoba
- 8: Sask.
- 9: Alberta
- 10: B.C.
- 11: Yukon
- 12: N.W.T.
- 13: Nunavut
- 14: Born outside Canada - Specify country
Sociocultural information - Question identifier:10.
Of what country is this person a citizen?
- 1: Canada, by birth
- 2: Canada, by naturalization
- 3: Other country - Specify
Sociocultural information - Question identifier:11.
Is this person now, or has this person ever been, a landed immigrant?
- 1: No. Go to Question 13.
- 2: Yes
Sociocultural information - Question identifier:12.
In what year did this person first become a landed immigrant?
- 1: Year
Sociocultural information - Question identifier:13.
Can this person speak English or French well enough to conduct a conversation?
- 1: English only
- 2: French only
- 3: Both English and French
- 4: Neither English nor French
Sociocultural information - Question identifier:14.
What language(s), other than English or French, can this person speak well enough to conduct a conversation?
- 1: None
- 2: Specify other language(s)
Sociocultural information - Question identifier:15.
(a) What language does this person speak most often at home?
- 1: English
- 2: French
- 3: Other - Specify
(b) Does this person speak any other languages on a regular basis at home?
- 1: No
- 2: Yes, English
- 3: Yes, French
- 4: Yes, Other - Specify
Sociocultural information - Question identifier:16.
What is the language that this person first learned at home in childhood and still understands?
- 1: English
- 2: French
- 3: Other language - specify:
Sociocultural information - Question identifier:17.
What were the ethnic or cultural origins of this person's ancestors?
- 1: Specify as many origins as applicable using capital letters.
Sociocultural information - Question identifier:18.
Is this person an Aboriginal person, that is, First Nations (North American Indian), Métis or Inuk (Inuit)?
- 1: No, not an Aboriginal person
- 2: Yes, First Nations(North American Indian)
- 3: Yes, Métis
- 4: Yes, Inuk (Inuit)
Sociocultural information - Question identifier:19.
Is this person:
- 1: White
- 2: South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
- 3: Chinese
- 4: Black
- 5: Filipino
- 6: Latin American
- 7: Arab
- 8: Southeast Asian (e.g., Vietnamese, Cambodian, Malaysian, Laotian, etc.)
- 9: West Asian (e.g., Iranian, Afghan, etc.)
- 10: Korean
- 11: Japanese
- 12: Other - Specify
Sociocultural information - Question identifier:20.
Is this person a Status Indian (Registered or Treaty Indian as defined by the Indian Act of Canada)?
- 1: No
- 2: Yes, Status Indian (Registered or Treaty)
Sociocultural information - Question identifier:21.
Is this person a member of a First Nation/Indian band?
- 1: No
- 2: Yes, member of a First Nation/Indian band (Specify name of First Nation/Indian band.)
Sociocultural information - Question identifier:22.
What is this person's religion?
- 1: Specify one denomination or religion only.
- 2: No religion
Mobility
Mobility - Question identifier:23.
Where did this person live 1 year ago, that is, on May 10, 2010?
- 1: Born after May 10, 2010
- 2: Lived at the same address as now
- 3: Lived at a different address in the same city, town, village, township, municipality or Indian reserve
- 4: Lived in a different city, town, village, township, municipality or Indian reserve in Canada (Specify)
- 5: Lived outside Canada (Specify country)
Mobility - Question identifier:24.
Where did this person live 5 years ago, that is, on May 10, 2006?
- 1: Born after May 10, 2006
- 2: Lived at the same address as now
- 3: Lived at a different address in the same city, town, village, township, municipality or Indian reserve
- 4: Lived in a different city, town, village, township, municipality or Indian reserve in Canada (Specify)
- 5: Lived outside Canada (Specify country)
Place of birth of parents
Place of birth of parents - Question identifier:25.
Where was each of this person's parents born?
- a): Father
- 1: Born in Canada
- 2: Born outside Canada - specify country
- b): Mother
- 1: Born in Canada
- 2: Born outside Canada - specify country
(a) Father
- 1: Born in Canada
- 2: Born outside Canada (Specify country)
(b) Mother
- 1: Born in Canada
- 2: Born outside Canada (Specify country)
Place of birth of parents - Question identifier:26.
Answer Questions 27 to 55 for each person aged 15 years and over (born before May 10, 1996).
Education
Education - Question identifier:27.
Has this person completed a secondary (high) school diploma or equivalent?
- 1: Yes, secondary (high) school diploma
- 2: Yes, secondary (high) school equivalency certificate
- 3: No
Education - Question identifier:28.
Has this person completed a Registered Apprenticeship or other trades certificate or diploma?
- 1: Yes, Registered Apprenticeship certificate (including Certificate of Qualification, Journeyperson's designation)
- 2: Yes, other trades certificate or diploma
- 3: No
Education - Question identifier:29.
Has this person completed a college, CEGEP, or other non-university certificate or diploma? (Other than certificates or diplomas reported in Question 28.)
- 1: Yes, certificate or diploma from a program of less than 3 months
- 2: Yes, certificate or diploma from a program of 3 months to less than 1 year
- 3: Yes, certificate or diploma from a program of 1 year to 2 years
- 4: Yes, certificate or diploma from a program of more than 2 years
- 5: No
Education - Question identifier:30.
Has this person completed a university certificate, diploma or degree?
- 1: Yes, university certificate or diploma below bachelor level
- 2: Yes, bachelor's degree (including LL.B.)
- 3: Yes, university certificate or diploma above bachelor level
- 4: Yes, master's degree
- 5: Yes, degree in medicine, dentistry, veterinary medicine
or optometry - 6: Yes, earned doctorate
- 7: No
Education - Question identifier:31.
What was the major field of study of the highest certificate, diploma or degree that this person completed?
- 1: Major field of study of highest certificate, diploma or degree
- 2: No certificate, diploma or degree (higher than high school). Go to Question 33
Education - Question identifier:32.
In what province, territory or country did this person complete his or her highest certificate, diploma or degree?
- 1: In Canada (Specify province or territory)
- 2: Outside Canada (Specify country)
Education - Question identifier:33.
At any time since September 2010, has this person attended a school, college, CEGEP or university?
- 1: Yes, attended elementary, junior high school or high school
- 2: Yes, attended trade school, business school, community college, technical institute, CEGEP or other non-university institution
- 3: Yes, attended university
- 4: No, did not attend school at any time since September 2010
Labour market activities
Labour market activities - Question identifier:34.
During the week of Sunday, May 1 to Saturday, May 7, 2011, how many hours did this person spend working for pay or in self-employment?
- 1: Number of hours (to the nearest hour)
- 2: None
Labour market activities - Question identifier:35.
During the week of May 1 to May 7, was this person on temporary lay-off or absent from his / her job or business?
- 1: No
- 2: Yes, on temporary lay-off from a job to which this person expects to return
- 3: Yes, on vacation, ill, on strike or locked out, or absent for other reasons
Labour market activities - Question identifier:36.
During the week of May 1 to May 7, did this person have definite arrangements to start a new job within the next four weeks?
- 1: No
- 2: Yes
Labour market activities - Question identifier:37.
Did this person look for paid work during the four weeks from April 10 to May 7, 2011?
- 1: No (Go to Question 39)
- 2: Yes, looked for full-time work
- 3: Yes, looked for part-time work (less than 30 hours per week)
Labour market activities - Question identifier:38.
Could this person have started a job during the week of Sunday, May 1 to Saturday, May 7, 2011 had one been available?
- 1: Yes, could have started a job
- 2: No, already had a job
- 3: No, because of temporary illness or disability
- 4: No, because of personal or family responsibilities
- 5: No, going to school
- 6: No, other reasons
Labour market activities - Question identifier:39.
When did this person last work for pay or in self-employment, even for a few days?
- 1: In 2011
- 2: In 2010
- 3: Before 2010
- 4: Never
Labour market activities - Question identifier:40.
For whom did this person work?
- 1: Name of firm, government agency, etc.
- 2: Section, plant, department, etc. (if applicable)
Labour market activities - Question identifier:41.
What kind of business, industry or service was this?
- 1: Kind of business, industry or service
Labour market activities - Question identifier:42.
What was this person's work or occupation?
- 1: Occupation
Labour market activities - Question identifier:43.
In this work, what were this person's main activities?
- 1: Main activities
Labour market activities - Question identifier:44.
In this job or business, was this person mainly:
- 1: working for wages, salary, tips or commission?
- 2: working without pay for his/her spouse or another relative in a family farm or business?
- 3: self-employed without paid help (alone or in partnership)?
- 4: self-employed with paid help (alone or in partnership)?
Labour market activities - Question identifier:45.
If self-employed, was this person's farm or business incorporated?
- 1: No
- 2: Yes
Labour market activities - Question identifier:46.
At what address did this person usually work most of the time?
- 1: Worked at home (including farms) Go to Question 49
- 2: Worked outside Canada (Go to Question 49)
- 3: No fixed workplace address
- 4: Worked at the address specified below
(Specify complete address: Street, City, Prov/Terr, Postal Code)
Labour market activities - Question identifier:47.a)
How did this person usually get to work?
- 1: Car, truck or van - as a driver
- 2: Car, truck or van - as a passenger
- 3: Bus
- 4: Subway or elevated rail
- 5: Light rail, streetcar or commuter train
- 6: Passenger ferry
- 7: Walked to work
- 8: Bicycle
- 9: Motorcycle, scooter or moped
- 10: Other method
Labour market activities - Question identifier:b)
How many people, including this person, usually shared the ride to work in this car, truck or van?
- 1: Drove alone
- 2: 2 people
- 3: 3 or more people
Labour market activities - Question identifier:48.a)
What time did this person usually leave home to go to work?
- 1: Time in hours and minutes. (a.m. or p.m.)
Labour market activities - Question identifier:b)
How many minutes did it usually take this person to get from home to work?
- 1: Number of minutes
Labour market activities - Question identifier:49.a)
In this job, what language did this person use most often?
- 1: English
- 2: French
- 3: Other - Specify
Labour market activities - Question identifier:b)
Did this person use any other languages on a regular basis in this job?
- 1: No
- 2: Yes, English
- 3: Yes, French
- 4: Yes, Other - Specify
Labour market activities - Question identifier:50.
In how many weeks did this person work in 2010?
- 1: None (Go to Question 53)
- 2: Number of weeks
Labour market activities - Question identifier:51.
During most of those weeks, did this person work full time or part time?
- 1: Full time (30 hours or more per week)
- 2: Part time (Less than 30 hours per week)
Labour market activities - Question identifier:52.
In 2010, did this person pay for child care, such as day care or babysitting, so that this person could work at his or her paid job(s)?
- 1: Yes (Enter the total amount for 2010)
- 2: No
Labour market activities - Question identifier:53.
In 2010, did this person pay child or spousal support payments to a former spouse or partner?
- 1: Yes (Enter the total amount for 2010)
- 2: No
Income in 2010
Income in 2010 - Question identifier:54.
Does this person give Statistics Canada permission to use the income information available in his / her income tax files for the year ending December 31, 2010?
- 1: Yes (Go to STEP E)
- 2: No
Income in 2010 - Question identifier:55.
During the year ending December 31, 2010, did this person receive any income from the sources listed below?
INCOME FROM EMPLOYMENT:
Income in 2010 - Question identifier:(a)
Total wages and salaries, including commissions, bonuses, tips, taxable benefits, research grants, royalties, etc., before any deductions
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(b)
Net farm income (gross receipts minus expenses and capital cost allowance), including grants and subsidies, marketing board payments, gross insurance proceeds
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(c)
Net non-farm income from unincorporated business, professional practice, etc.(gross receipts minus expenses)
- 1: Yes (Enter the amount)
- 2: No
INCOME FROM GOVERNMENT:
(d) Child benefits, such as child tax benefits, universal child care benefits, family allowances (federal, provincial and territorial)
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(e)
Old Age Security Pension, Guaranteed Income Supplement, Allowance and Allowance for the Survivor from federal government only (provincial income supplements should be reported in (h))
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(f)
Benefits from Canada or Quebec Pension Plan
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(g)
Benefits from Employment Insurance, including maternity and parental benefits paid under the federal employment insurance plan and the Quebec Parental Insurance Plan (total benefits before tax deductions)
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(h)
Other income from government sources, such as provincial income supplements and grants, the GST/ QST / HST credit, provincial tax credits, workers' compensation, veterans' pensions, welfare payments
- 1: Yes (Enter the amount)
- 2: No
OTHER INCOME:
(i) Dividends, interest on bonds, deposits and savings certificates, and other investment income, such as net rents from real estate, interest from mortgages
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(j)
Capital gains or losses, including those from mutual funds. Do not include non-taxable capital gains on the sale of a principal residence. Report the full amount, not just the taxable portion.
- 1: Yes (Enter the amount)
- 2: No
Income in 2010 - Question identifier:(k)
Retirement pensions, superannuation and annuities, including those from RRSPs and RRIFs. Do not include withdrawals from a pension plan or RRSP.
- 1: Yes (Enter the amount)
- 2: No
Other money income, such as alimony, child support, scholarships
- 1: Yes (Enter the amount)
- 2: No
TOTAL INCOME in 2010 from all sources
- 1: Yes (Enter the amount)
- 2: No
INCOME TAX PAID on 2010 income (federal, provincial and territorial)
- 1: Enter total amount
STEP E: Answer Questions E1 to E10 about this dwelling.
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E1
Who pays the rent or mortgage, taxes, electricity, etc., for this dwelling?
- 1: Person 1
- 2: Person 2
- 3: Person 3
- 4: Person 4
- 5: Person 5
- 6: A person who is listed on another questionnaire for this dwelling
- 7: A person who does not live here
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E2
Is this dwelling:
- 1: owned by you or a member of this household (even if it is still being paid for)?
- 2: rented (even if no cash rent is paid)?
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E3
Is this dwelling part of a condominium development?
- 1: Yes
- 2: No
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E4a)
How many rooms are there in this dwelling?
- 1: Number of rooms
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:b)
How many of these rooms are bedrooms?
- 1: Number of bedrooms
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E5
When was this dwelling originally built?
- 1: 1920 or before
- 2: 1921-1945
- 3: 1946-1960
- 4: 1961-1970
- 5: 1971-1980
- 6: 1981-1985
- 7: 1986-1990
- 8: 1991-1995
- 9: 1996-2000
- 10: 2001-2005
- 11: 2006-2011
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E6
Is this dwelling in need of any repairs?
- 1: No, only regular maintenance is needed (painting, furnace cleaning, etc.)
- 2: Yes, minor repairs are needed (missing or loose floor tiles, bricks or shingles, defective steps, railing or siding, etc.)
- 3: Yes, major repairs are needed (defective plumbing or electrical wiring, structural repairs to walls, floors or ceilings, etc.)
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E7
Is this dwelling located on an agricultural operation that is operated by a member of this household?
- 1: Yes (Go to Step F)
- 2: No (Continue this section)
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E8
For this dwelling, what are the YEARLY payments (last 12 months) for:
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:a)
Electricity?
- 1: None
- 2: Included in rent or other payments; OR Enter the amount per year
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:b)
Oil, gas, coal, wood or other fuels?
- 1: None
- 2: Included in rent or other payments; OR Enter the amount per year
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:c)
Water and other municipal services?
- 1: None
- 2: Included in rent or other payments; OR Enter the amount per year
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E9
For RENTERS only, answer parts (a) and (b):
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:a)
What is the monthly rent paid for this dwelling?
- 1: Rented without payment of cash rent; OR
- 2: Enter the amount per month
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:b)
Is this dwelling subsidized?
- 1: Yes
- 2: No
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:E10
For OWNERS only, answer parts (a) through (e):
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:a)
What are the total regular monthly mortgage or loan payments for this dwelling?
- 1: None. Go to part c); OR
- 2: Enter the amount per month
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:b)
Are the property taxes (municipal and school) included in the amount shown in part a)?
- 1: Yes. Go to part d).
- 2.: No
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:c)
What are the estimated yearly property taxes (municipal and school) for this dwelling?
- 1: None; OR
- 2: Enter the amount per year
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:d)
If you were to sell this dwelling now, for how much would you expect to sell it?
- 1: Enter the amount
STEP E: Answer Questions E1 to E10 about this dwelling. - Question identifier:e)
What are the monthly condominium fees?
- 1: None; OR
- 2: Enter the amount per month
STEP F: If you are answering on behalf of other people, please consult each person.
STEP F: If you are answering on behalf of other people, please consult each person. - Question identifier:F1
Does this person agree to make his or her 2011 National Household Survey information available in 2103 (92 years after the National Household Survey)?
- 1: Yes
- 2: No
- Date modified: