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

Residents only
[Questions in columns 12 - 15 were asked of residents only]

(13) Location of previous residence

Write down department/township for Benin___
And the country for locations abroad___

Questionnaire instructions view entire document: text image

Columns (12) and (15): Ask these questions only to residents.

Column (13): Place of previous residency
Ask the following question: "where did you live before moving into this township?" only to the household's present members and absent members.
Report the department/township if the place residency was in Benin, or the country for persons who were living outside of Benin on the corresponding horizontal line and leave the boxes empty. For those who never left their township of birth, write down on the line the name of the department/township of birth.