Questionnaire Text

Questionnaire form view entire document:  text  image
Section C. For all persons - Disability

18. Is (the respondent) disabled?

Note: State the main disability

[] 1 Amputation of fingers
[] 2 Amputation of arms
[] 3 Amputation of hands
[] 4 Amputation of toes
[] 5 Amputation of foot/leg
[] 6 Lame/ paralyzed limb
[] 7 Blind (total/ partial)
[] 8 Deaf (total/ partial)
[] 9 Speech problem
[] 10 Mental illness
[] 11 Mental retardation
[] 12 Not disabled [Skip to Question 21.]
[] 13 Other, specify ____
[] 99 Don't know [Skip to Question 21.]
Questionnaire instructions view entire document:  text  image
Part C of the questionnaire for all persons (Disability)

87. Column 18: Is (name) disabled.

Ask for the main disability and code according to the list.