Questionnaire Text

Questionnaire form view entire document: text image

A11a Supplementary completed

[] Yes
[] No

A11b If yes in 11a, mark X in the appropriate box

[] Original
[] Continuation Forms

Questionnaire instructions view entire document: text image

(A11a) Supplementary completed: If more than one questionnaire is used for a household mark X in the Yes box, otherwise mark No.

(A11b) Continuation Form: If A11a is Yes, mark X in the appropriate box to distinguish original from continuation form.