Questionnaire Text

Questionnaire form view entire document:  text  image
35. Does [the respondent] have any of the following disabilities? Read each option and mark cases where the answer is yes.

[] a Blind in one eye
[] b Blind in both eyes
[] c Deaf
[] d Mute
[] e Loss or permanent limitation in arm movement
[] f Loss or permanent limitation in leg movement
[] g Mental retardation or deficiency
[] h Other disability
[] I No disability (Skip to question 37)
Questionnaire instructions view entire document:  text  image
Question 35: Does (NAME) have any of the following disabilities?

Read to the interviewee each option and fill in the answer every time the person says "YES". If the person answers "None", fill in the corresponding bubble and then skip to question 37.
If the person said another disability different than the ones previously read, fill in the bubble with "other disability".