Question 4: Is there anyone with a disability, that is, a person with a permanent physical or mental impairment which limits one or more of his/her activities of daily living? Does anyone in this household have a permanent impairment or restriction?
In option 5, "Other impairment or restriction," include Down syndrome, mental retardation, senile dementia, Alzheimer's, autism, psychiatric disturbance, etc.
Option 6, "No one with a disability," should not be read out loud. Circle this option only if no one in the household has a permanent impairment or restriction.
Disability. This is when a person has permanent physical, visual, auditory or mental impairments that substantially limit one or more of the activities of daily living in the manner or within the range considered normal for his/her age.