M.WITAL STATUS: 



Marr'.ed 



Single 



Widowed, divorced, etc.- 



CUSSIFICATION DATA 

 5 



-70-1 



- -2 



- li 



la. 



How many people eat. dinner at home 

 with you'; (CIHCLE ONE) 



123U56789 10or more 



71-1 -2 -3 -it -5 -6 -7 -8 -9 ^ 



I IF NOT SINGLE, ASK QUESTIONS lb ASP Ic [ 



lb. How many children eat dinner at 

 home? (CIHCLE ONE) 



1 23U56789 10or more 



Ic . What are their approximate ages? 



I IF MAHBIED, ASK QUESTION Id | 



Id . What Ij^ your husband ' s J ob ? 



Executive, professional, mer- 

 chant or own business — ' 72-1 



Clerical or sales personnel -2 



Manual skilled, semi-skilled 



or unskilled worker -3 



Retired, unemployed, or student -k 



Other (SPECIFY) 



Yes- 

 No-- 



Do you work? 



I IF "YES , " ASK QUESTION 2a | 

 2a. What Is your Job? 



Executive, professional, mer- 

 chant or own business 



Clerical or sales personnel 



Manual skilled, semi-skilled 



or unskilled worker 



Retired, unemployed, or student 



Other (SPECIFY) 



-73-1 

 - -2 



riiAJg) RESPONDENT CARD fT] 



3. Would you tell me which letter indicates 

 the age you are? (CIRCLK ORE) 



A B C D K 



71* -1 -2 -3 -^ zl 



fUXD RESPONDENT CARD #T] 



k. Would you tell me into which group your 

 total family income falls? (CIRCLE ONE) 



75-1 



E 



What was the last grade you completed in 

 school? 



Less than 8th 76-I 



8th through 12th- 

 College- 



I ASKED ONLY OF COLORED HOUSEHOLDS | 



How long have you lived in this city? 



1 year or less 



More than 1 to 5 years 



• More than 5 to 10 years 



More than 10 to 15 years 



More than I5 years 



I IF LESS THAN 1? YEARS , ASK QUESTION 6a | 



6a. Where did you come from? 



Northern state-- 

 Southern state -- 

 Foreign country- 



ASK ALL RESPONDENTS 



Where were you born? 



Northern state 



Southern state 



Foreign country (SPECIFY) 



-77-1 

 - -2 



IF NATIVE BORN 



Were both of your parents Yes 



born in this country? No 



I IF "NO" I 

 8a. In what country (s) were they born? 



(SPECIFY) 



Father 



-78-1 

 - -2 



Mother 



9. Ten years ago did you live in. 



open country, ■ 



suburbs, 



city? 



-79-1 



- -2 



- -3 



The religious backgroupd of a family at 

 times influences eating habits. With what 

 religion is your family most closely asso- 

 ciated? 



Protestant -'* 



Catholic -5 



Jewish 6 



Other (SPECIFY) 



AUTOMATIC CLASSIFICATION 



RACE: White 80-I 



Negro -2 



Other non-white -3 



12. LOCATION OF DWELLING: 



City — - 

 Suburb - 



-k 



Clty_ 



Interviewer's Slgnature_ 



Time Interview Coapleted: 

 A.M. ^P-M. 



6k 



