Questionnaire Text

Questionnaire form view entire document:  text  image

[Questions 1 - 9 were asked of all individuals.]

Ask this question if, on the list of occupants of the dwelling (Chapter IV), the name of the person who has the circle number 1 marked (Yes) in question 4 (disability). In the case to the contrary, mark circle 8, None.

7. What type of physical or mental disability do you have?

[] 1 Blindness
[] 2 Deafness
[] 3 Mental retardation
[] 4 Cerebral paralysis
[] 5 Physical deficiency
[] 6 Mental problems
[] 7 Other (Specify)
[] 8 None.

Questionnaire instructions view entire document:  text  image

[For persons of all ages]
[Questions 1 to 12a]


Question No. 7: What type of physical or mental impediment do you have? (Mark the most serious)
[For persons who stated they have any mental or physical disability in question 4.]
This question is asked in order to capture the population that suffers from some type of physical or mental impediment, which prevents them to function normally.
[p. 142]
Disability: Any restriction or lack (due to impairment) of ability to perform an activity in a way or within a range considered as normal for a human being.
Ask this question, if in the list of occupants (Chapter IV), the name of a person has been marked with circle 1 in question 4, otherwise mark circle 8 "None".
Consider [as a physical or mental impediment] the following:

Blindness: The person who completely lacks vision or see very little (visually impaired), an impairment that cannot be normalized using lenses, treatments and other optical aids. Include people who are blind from birth, or who suffer from diseases such as glaucoma, toxoplasmosis, and infections caused by various accidents (hit in the eye, various injuries, among others).

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Deafness: The person who cannot hear nor talk, even with the help of hearing aids, and who communicates through signs but with normal intelligence.

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Mental retardation: A person with intellectual capacity below normal. This is evidenced by a poor school performance, adaptive and behavioral problems, and delayed mental and social development. A typical case is a "mongoloid" (Down's syndrome).

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Cerebral Paralysis: The persons who at birth or during the first three years of life suffered an injury or brain damage that prevent them from moving normally, having stiff muscles or coordinating movements. They usually have problems with hearing or vision, mental or speech problems, or have convulsions.

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Physical disability: Person who has difficulty performing skillfully activities, activities of daily living or move independently because of an accident, illness, stroke or amputation. Also, those persons having malformations that physically limit them or, those who were born lacking a limb.

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[p. 143]
Mental problems (mental disorder): this refers to person with impaired general and specific mental functions that are originated in organic mental disorders, autism, schizophrenia, psychosis, personality disorders, Alzheimer, Parkinson's disease, among others; and people with all types of dementia; any deficiency that prevents them from carrying out activities of daily living, socializing with other people, among others. This person has difficulties interacting with others (family, friends and strangers), because she has mental or nervous problems.
Other: Mark this box if the person has developmental disorders, it also applies to children who, according to their age, do not crawl, do not walk or do not speak when that is expected and do not have a definite diagnosis that would allow them to be placed in one of the above categories. That is, include the person who does not have any kind of disability described in the above categories (circles 1-6).
None: Mark this circle when the person in the list of occupants stated to not have any physical or mental disability, circle 2 of Chapter IV of the list of occupants. Remember in this case, not to ask the question.

Example: The head of the house said that his son Arturo, age 9, was born blind.
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