Questionnaire Text

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Identification

____ Province
____ Canton
____ District
____ Agricultural Region number
____ Zone number
____ Section number
____ Segment number

[] Urban
[] Rural

____ Census household number (visit order)
____ Institution (name)
____ Neighborhood or hamlet (caserĂ­o)
____ Avenues (numbers)
____ Streets (names)
____ Highway, route, etc.