Questionnaire Text

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C5. What is your date of birth?

Date _ _
Month _ _
Year _ _ _ _

(If no information for C5, ask C6.)

C6. How old are you? _ _

[Question C6 is asked of persons who have no information for C5.]

(In completed years)

(If age is less than 1 year, write "00". If age is 99 years or more, write "99".)