Questionnaire Text

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Note: Please answer both Questions 5 and 6.
5. Is this person Spanish/Hispanic/Latino? Mark [X] the "No" box if not Spanish/Hispanic/Latino.
[] No, not Spanish/Hispanic/Latino
[] Yes, Mexican, Mexican American, Chicano
[] Yes, Puerto Rican
[] Yes, Cuban
[] Yes, other Spanish/Hispanic/Latino -- Print group.

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