Questionnaire Text

Questionnaire form view entire document:  text  image
Form 2H: Personal Questionnaire

1. Please, tell the date of your birth

Date _ _
Month _ _
Year _ _ _ _
Years old _ _ _
Questionnaire instructions view entire document:  text  image
33.1. In question 1 "What is the date of your birth?", the day, month and year of birth are to be entered in numbers in designated boxes. For example, if a respondent was born on May 7, 1946, the numbers "7", "5", and "1946" should be entered respectively.

After the date of birth has been entered, the enumerator without asking any additional questions is to determine with the help of the "Supporting table for determining the number of years by the known year of birth as of October 14, 2009" provided in the Enumerator's notebook and enter in a special box the number of complete years. For children under one year, "0" should be entered;