Questionnaire Text

Questionnaire form view entire document: text image

III. List of household numbers

No._ _

301. Name____

(Please give me the names of the persons who usually live in [the respondent's] household, starting with the head of the household.)

Questionnaire instructions view entire document: text image

Serial numbers of household members
The serial numbers provided are from numbers 01-15. If the number of household members is more than 15 people, add a new list of SUPAS95-S. Write the word "Continued" in the upper right hand corner of the cover of the first SUPAS95-S list and "Continuation" in the upper right hand corner of the extra SUPAS95-S list. Copy the characteristics on identification of location in the extra SUPAS-95-S list. The serial number in Column (1), Block III extra SUPAS95-S list is changed into 16, 17 and so on.