Questionnaire Text

Questionnaire form view entire document:  text  image
12. Does [the respondent] have a permanent limitation?? (You can mark multiple options)

[] 1 Seeing, even with glasses or contacts on
[] 2 Hearing
[] 3 Speaking
[] 4 Walking or going up steps
[] 5 Using arms or hands
[] 6 Intellectually (retarded, Down?s syndrome, other)
[] 7 Mentally (bipolar, schizophrenic, other)
[] 8 None of the above
Questionnaire instructions view entire document:  text  image
Question 12: Population with disability

12. Does [name] have a permanent limitation...? (You can mark multiple options)

[] 1 seeing, even with glasses or contacts on
[] 2 hearing
[] 3 speaking
[] 4 walking or going up steps
[] 5 using arms or hands
[] 6 intellectually (retarded, Down's syndrome, other)
[] 7 mentally (bipolar, schizophrenic, other)
[] 8 none of the above

This question is asked of all the habitual residents of the household. In the case of the babies, it should be considered that they do not have permanent limitations if there is no medical opinion that indicates otherwise.

As can be observed in this question you can mark various responses that refer to the following permanent limitations.

Seeing, even with glasses or contacts on: in this category are considered people with permanent visual difficulties that, even with glasses or contacts on, claim having

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limitations seeing, either partially or fully.

This also includes the people that claim to have problems seeing and for some economic reason do not have the glasses they need.