Questionnaire Text

Questionnaire form view entire document: text image

A. General Information

For all individuals regardless of age (including newborn infants)
[Questions 1-8 were asked of all persons.]

4. What is your age in completed years?
For those under 1 year, write 00.

____ Years

Questionnaire instructions view entire document: text image

Question 4. How old are you in complete years?

Write down on the corresponding line the number of completed years at the last birthday, and not how old they will be.

For minors less than one year old, write down 00.