Questionnaire Text

Questionnaire form view entire document: text image

16. Do you have any of the following long-lasting conditions or difficulties?

(a) Blindness or a serious vision impairment

[] Yes
[] No

(b) Deafness or a serious hearing impairment

[] Yes
[] No

(d) An intellectual disability

[] Yes
[] No

(e) A difficulty with learning, remembering or concentrating

[] Yes
[] No

(f) A psychological or emotional condition

[] Yes
[] No

(g) A difficulty with pain, breathing, or any other chronic illness or condition

[] Yes
[] No

Questionnaire instructions view entire document: text image

Appendix H. Detailed notes on the household form

The results of questions 16 and 17 coupled with other questions will provide important data on the number of people whose activities are reduced because of a disability and the effect of the disability on their lives. In question 16, vision and hearing impairments have been separated and there is a separate category for intellectual disabilities.

[Question 16: Do you have any of the following long-lasting conditions or difficulties?]

All persons should mark 'yes' or 'no' to each of the categories in question 16.

[Question 17: If 'yes' to any the categories specified in question 16, do you have any difficulty in doing any of the following?]

People who answered 'yes' to one of the categories in question 16 should answer 'yes' or 'no' to each of the categories in question 17.