Questionnaire Text

Questionnaire form view entire document: text image

[Questions 1-10 were asked of all persons.]

3. What is his or her current age in completed years? _ _

For those younger than one year old mark 00. For those older than 99 years old mark 99.

Questionnaire instructions view entire document: text image

3. What is his/her current age in completed years?

Question No. 3 refers to the current age. In the case of less than a year, we fill out 00 in the corresponding box and if it is a person 99 or older, we fill out 99.