Questionnaire Text

Questionnaire form view entire document:  text  image
Birth date

_ _ 5. Month
_ _ 6. Year

7. Age at last birthday _ _

[] Lunar calendar (check if date of birth is stated in the lunar calendar)
[] Under one year
[] Aged 100 or over
Questionnaire instructions view entire document:  text  image
Columns 5and 6 - Date of birth

Ask the respondent to report day, month, and year of the birth of each individual according to their birth certificates or other official documents. If there is discrepancy between the actual date of birth and what is on the birth certificate, accept the latter.
? If the individual lacks birth certificate or other official document, accept the date that respondent gives. If the respondent is not informative, for individuals less than 100-year old [except the lunar hidjri calendar] enter MM in columns 5 and 6.
? For individuals 100-year or older, put X in the "100-year and older" box.
Column 5 -Month
? For individuals 100-year or older, whether or not the month of birth is clear even in lunar hidjri calendar, just put X in the "100-year and older" box and leave the rest blank.
? For individuals less than 100-year old:
[] If age is expressed in calendars rather than the lunar hidjri and month of birth is clear, document it as a two-digit number and leave the rest blank. See below.
[] For calendars rather than the lunar hidjri if the month is no clear print MM in the boxes in column 5 and leave the rest blanks.
[] When the date of birth is in lunar hidjri calendar, whether or not the month of birth is clear, write X in the lunar hidjri calendar box and leave the rest blank.
Follow the table on page 84 to turn the non-Iranian months to the Iranian ones.