Questionnaire Text

Questionnaire form view entire document:  text  image
For all persons
[Questions in columns 1 to 9 asked of all persons.]

(5) Date of birth _ _ _ _

Write in the grid the numbers corresponding to the declared month and year
Example: August 13th, 1950 written as 0850
Questionnaire instructions view entire document:  text  image
II. How to fill out the questionnaire (Document RGPH 2 Number 1).

Column (5): Date of birth
Try to obtain as much specificity as possible. Identification cards are very helpful. If the interviewees have one, write down the date of birth figuring on the card in the appropriate grid.
The numbers corresponding to months are:

[] 01= January
[] 02 = February
[] 03 = March
[] 04 = April
[] 05 = May
[] 06 = June
[] 07 = July
[] 08 = August
[] 09 = September
[] 10 = October
[] 11 = November
[] 12 = December

Example: for March 1982, write down in the grid 0382. For a birth date of "around 1954," write down 1954 in the grid.
In the case where the interviewee presents no identification documents, politely ask the following question "what is your date of birth?" Write down the answer in the same manner in the designated grid.