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Household Occupant <br />53. Occupant Grid: <br />Note: Names for ALL adults MUST be as they appear on I.D. that shows signature <br />and will be used to cash benefit checks. (Submit copies ofLD. as soon as possible) <br />NAME <br />RELATIONSHIP <br />EMPLOYMENT <br />STUDENT <br />Nombre <br />(to head of household) <br />Empleo <br />Estudiante <br />Parentesco <br />Begin with Heads of Household (HOH)- circle groups <br />of numbers to indicate separate families: <br />4 John Smith <br />5 Ana Smith <br />= <br />m <br />6 Alex Smith <br />3 <br />— <br />v <br />� <br />7 Bob Gates <br />a <br />8 Kim Gates <br />o <br />a <br />am <br />- <br />O <br />S <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />11 <br />12 <br />13 <br />14 <br />15 <br />Initials of Respondent (iniciales del entrevistado): <br />Page 7 of 8, Residential Survey /Interview 55B -60 <br />Initials of Interviewer. <br />rev.09 /15 <br />