Questionnaire Text

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Questions 1-9 should be completed for all persons, regardless of their age. (Mark the answers by filling in an X in the appropriate space, wherever applicable.)

6. Year of birth: Fill in the last three digits of the year of birth. For persons born in 1979, 1980, or 1981, also fill in the month of birth (e.g., for October, fill in "10"; for December, fill in "12")

_ _ _ _ Person with line number 101-householder: Year of birth
_ _ _ _ Persons with line numbers 102-107 and 201-202: Year of birth
_ _ If born in 1979, 1980 or 1981, specify the month of birth