2019 Census Test: Form 3A

2019 Census Test

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  • CD
  • CU
  • VR line No.
  • CLD
  • Questionnaire No.
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Message from the Chief Statistician of Canada

The census paints a portrait of Canada's population and the places where we live. It provides high-quality information for communities across the country and is used to plan services that support employment, education and health care.

Preparations for the next census have begun, and Statistics Canada is seeking your participation in this important test.

By law, every person must complete a 2019 Census Test questionnaire. Your answers are collected under the authority of the Statistics Act and will be kept strictly confidential.

Statistics Canada employs a number of mechanisms to manage the response burden on Canadians by using existing administrative data sources such as immigration records and personal income tax and benefit data. For more information, please visit 2019 Census Test.

The information that you provide will be used by Statistics Canada for statistical purposes.

Be part of this new portrait of Canada and complete your census questionnaire today.

Thank you for your co-operation.

Anil Arora
Chief Statistician of Canada

Complete your census questionnaire:

  • Please print using capital letters.
  • Mark circles with " X ".

Any questions?

Confidential when completed

This information is collected under the authority of the Statistics Act, R.S.C. 1985, c. S-19.

Step A

1. What is your telephone number?

2. What is the address where you received this questionnaire?

  • Number (and suffix, if applicable) (e.g., 302, 151 B, 16 1/2)
  • Street name, street type (e.g., DR = Drive), direction (e.g., N = North)
  • Apartment/unit/room
  • City, municipality, town, village, Indian reserve
  • Province/territory
  • Postal code

3. What is the mailing address of this dwelling, if different from above?

(e.g., Rural Route, PO Box, General Delivery)

Step B

What is your name?

  • Family name(s)
  • Given name(s)

Step C

The following questions refer to each person's situation on May 14, 2019.

If you are:

  • a Canadian citizen
  • a landed immigrant (permanent resident)
  • a person who has claimed refugee status (asylum seeker) in Canada
  • a person from another country with a work or study permit

Continue with step D

If you are:

  • a resident of another country visiting Canada, for example, on vacation or on a business trip
  • a government representative of another country

Mark "X" here

Stop here - See instructions in step E on page 5.

Step D

Is this your main residence?

  • Yes
    • Continue with question 1a) on the next page
  • No, but I have no other residence in Canada
    • Continue with question 1 a) on the next page
  • No, it is somewhere else in Canada

Stop here - You should be included on the household questionnaire for the above address. See instructions in step E on page 5.

Specify complete address

  • Number (and suffix, if applicable) (e.g., 302, 151 B, 16 1/2)
  • Street name, street type (e.g., DR = Drive), direction (e.g., N = North)
  • Apartment/unit
  • City, municipality, town, village, Indian reserve
  • Province/territory
  • Postal code
  • Telephone number

1. a) Is there any other address in Canada where someone may include you on the census form for that household?

For example, at the home of a parent, relative or friend, or a place where you live while working, or a vacation home.

  • No
    • Go to question 2
  • Yes

Specify complete address

  • Number (and suffix, if applicable) (e.g., 302, 151 B, 16 1/2)
  • Street name, street type (e.g., DR = Drive), direction (e.g., N = North)
  • Apartment/unit
  • City, municipality, town, village, Indian reserve
  • Province/territory
  • Postal code
  • Telephone number

1. b) Please give the name of another adult (if any) living at this other address.

  • Family name(s)
  • Given name(s)
  • No other adult

2. What was your sex at birth?

Sex refers to sex assigned at birth.

  • Male
  • Female

3. What is your gender?

Refers to current gender which may be different from sex assigned at birth and may be different from what is indicated on legal documents.

  • Male
  • Female
  • Or please specify your gender

4. What are your date of birth and age?

If the exact date of birth is not known, enter the best estimate. For children less than 1 year old, enter 0 for age.

  • Day/Month/Year
  • Age

5. What is your marital status?

Mark " X " one circle only.

  • Never legally married
  • Legally married (and not separated)
  • Separated, but still legally married
  • Divorced
  • Widowed

6. Are you living with a common-law partner?

Common-law refers to two people who live together as a couple but who are not married, regardless of the duration of the relationship.

  • Yes
  • No

7. What is your status here (at the address you entered on the front cover)?

Mark " X " or specify one response only.

  • Resident under care or custody (e.g., patient, inmate)
  • Roommate, lodger or boarder
  • Employee
  • Employee's family member
  • Other status — specify:

8. Can you speak English or French well enough to conduct a conversation?

Mark " X " one circle only.

  • Yes, English only
  • Yes, French only
  • Yes, both English and French
  • No (neither English nor French)

9. a) What language(s) do you speak on a regular basis at home?

  • English
  • French
  • Other language(s) — specify:

If you indicate only one language in question 9 a), go to question 10.

9. b) Of these languages, which one do you speak most often at home?

Indicate more than one language only if they are spoken equally at home.

  • English
  • French
  • Other language — specify:

10. What is the language that you first learned at home in childhood and still understand?

Please report two languages or more only if those languages were learned at the same time at home before you started school.

If you no longer understand the first language learned, indicate the second language learned.

  • English
  • French
  • Other language — specify:

11. Have you ever served in the Canadian military?

Canadian military service includes service with the Regular Force or Primary Reserve Force as an Officer or Non-Commissioned Member. It does not include service with the Cadets (COATS), the Supplementary Reserve or the Canadian Rangers.

Mark " X " one circle only.;

  • Yes, currently serving in the Regular Force or the Primary Reserve Force
  • Yes, but no longer serving in the Regular Force or the Primary Reserve Force
  • No

Step E

You have now completed your questionnaire.

Please see instructions on the envelope.

Thank you for your co-operation.

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.

Reasons why we ask the questions

Steps A to D and question 1 are used to collect contact information and determine who should be included on the questionnaire. They help us ensure that we have counted everyone we need to count and that no one is counted twice.

Questions 2 to 7 provide information about the living arrangements of people in Canada, the family size, the number of children living with one parent or two parents, and the number of people who live alone. This information is used for planning social programs, such as Old Age Security and the Canada Child Benefit. It is also used by municipalities to plan a variety of services such as day care centres, schools, police, fire protection and residences for seniors.

Questions 8 to 10 are used to provide a profile of the linguistic diversity of Canada's population. This information is used to estimate the need for services in English and French, and to better understand the current state and the evolution of Canada's various language groups.

Question 11 provides information on the number of people with Canadian military experience. Governments can use this information to develop programs and services to meet the changing needs of the veteran population.

Comments

Please use the space provided below if you have concerns, suggestions or comments to make about:

  • the steps to follow or the content of this questionnaire (for example, a question that was difficult to understand or to answer)
  • the characteristics of the questionnaire (for example, the design, the format, the size of the text, etc.).