Questionnaire Text

Questionnaire form view entire document:  text  image
For all persons
[Questions in columns 1 to 11 were asked of all persons]

Now we would like to ask for information on you and the persons habitually living in your household or currently residing in your home

(5) Date of birth

In which month and year is [the respondent] born? Write in the grid the declared month and year of birth

Month _ _
Year _ _ _ _
Questionnaire instructions view entire document:  text  image
i) Socio-demographic characteristics

Column (5): Date of birth
Ask the following question: "In which month and year is [the respondent] born?" Report, in the grids, the number corresponding to the month and to the year declared. For the year of birth, write down the full year number.
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 grids |0|3| |1|9|8|2|. For a birth date of "around 1954," write down in the grid |9|8| |1|9|5|4|
In the case where the interviewee presents no identification documents, politely ask the following question: "In which month and year was [the respondent] born?" Write down the answer in the same manner in the designated grids. If the person has no information on his/her birthdate, leave the grids empty.