Questionnaire Text

Questionnaire form view entire document: text image

3. What is this person's date of birth and age?

If exact date is not known, enter best estimate. For children under the age of 1, enter 0. If born before May 10, 1996, mark "x" in the "15+" box under the person's name.

Date of birth
Day: _ _ Month: _ _ Year: _ _ _ _
Age: _ _ _

Questionnaire instructions view entire document: text image

The Questions
Basic population information
Question 1 (on the paper survey) asks for the name of each person in the household so that the Questions can be asked person by person.

Questions 2 to 6 provide information about the living arrangements of people in Canada, family size, the number of children living with one parent or two parents, and the number of people who live alone. This information is used for planning social programs. It is also used by communities to plan services such as daycare centers, schools and senior citizens' residences.

Your NHS questionnaire contains all the information needed to answer questions 1 to 6. If you still have questions or require further information, please visit the NHS website at www.nhs.statcan.gc.ca or phone the StatCan Help Line at 1-877-308-2777.

Question 3 -- Date of birth
Enter the date of birth and age of each person in the boxes provided.