Questionnaire Text

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10. Social Security:
If at any time you have made a Social Security payment, write the month and year of the last payment.

Month ____
Year ____
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(Applicable to persons of all ages)
(Questions 1-10)


Question 10 Social Security:

For those who have paid or have had Social Security fees deducted, write down the last month and year in which the deduction was made. If the person never has made a Social Security payment, draw a diagonal line.