Questionnaire Text

Questionnaire form view entire document:  text  image

For all individuals 12 years of age and older
[Applies to question 23.]


23. Are you currently: In a consensual union, single, married, divorced, widowed or separated? Mark only one box.

[] 1 Consensual union
[] 2 Single
[] 3 Married
[] 4 Divorced
[] 5 Widowed
[] 6 Separated
[] 9 Unknown

Questionnaire instructions view entire document:  text  image

Question 23. Currently, are you: in a consensual union, single, married, divorced, widowed, or separated?

This question is the last question on the form and is for all persons 14 years old or more.

Always ask the question, under no condition should you suppose the civil or marital status of the persons being enumerated. Remember that you are finding out the current civil or marital status. For example: if a person was married and currently is in a consensual union, mark an X in box 1, consensual union.

Currently, are you: in a consensual union, single, married, divorced, widowed, or separated?
Mark only one box.


[ ] 1 In a consensual union
[ ] 2 Single
[ ] 3 Married
[ ] 4 Divorced
[ ] 5 Widowed
[ ] 6 Separated
[ ] 9 Don't know