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

(10) Type of handicap

[] 1 Blind
[] 2 Deaf
[] 3 Mute
[] 4 Visually impaired
[] 5 Mentally disabled
[] 6 Paralyzed upper member
[] 7 Paralyzed lower member
[] 8 Other handicaps
[] 0 No handicaps

_ _ _ Write down the codes for the three main declared handicaps
Questionnaire instructions view entire document:  text  image
Column (10): Type of handicap
Ask the following question: "Does (respondent) suffer from any infirmities?" If the answer is NO, report "0" in each of the three boxes and go to column (11). If you obtain YES for an answer, ask the following question: "Of what infirmities does [the respondent] suffer?"
Given the response obtained, write down in the corresponding box or boxes, the code or codes corresponding to the type or types of handicap declared according to the following:

[] 1. Blind
[] 2. Deaf
[] 3. Mute
[] 4. Visually impaired
[] 5. Mental handicap
[] 6. Lower member paralysis
[] 7. Upper member paralysis
[] 8. Other handicap
[] 0. No handicap

Begin writing down the codes from the left.
If the interviewee suffers from one infirmity, write down the appropriate code in the first box, and "0" in the second and third boxes. Never leave an empty box in column (10).
If the interviewee suffers from two infirmities, write down the appropriate codes for the types of handicap in the first two boxes, and "0" in the last (third) box.
Note:
1) One can thus report at most three main declared handicaps for a person suffering from several infirmities. [2 examples omitted]
2) When a census agent encounter a case of hemiplegia (complete or incomplete paralysis of a lateral half of the body), he must use the code 7 corresponding to other handicap.
3) For a counted person suffering from one infirmity (example mental handicap), the registered answer shall be: 4|0|0|
4) For a counted person suffering from no infirmities, the registered answer shall be: 0|0|0|