Questionnaire Text

Questionnaire form view entire document: text image

[Questions 7 - 14 were asked of all households.]

8. Does this house, apartment, or mobile home have:

Indicate with "yes" or "no"

a) Hot and cold running water?

[] Yes
[] No

b) A flush toilet?

[] Yes
[] No

c) A bathtub or shower?

[] Yes
[] No

d) A sink with a faucet?

[] Yes
[] No

e) A stove or range?

[] Yes
[] No

f) A refrigerator?

[] Yes
[] No

g) Telephone service from which you can both make and receive calls? (Include cell phones)

[] Yes
[] No

Questionnaire instructions view entire document: text image

Answer questions 1 through 21 for the house, apartment, or mobile home at the address on the mailing label.

8a. Mark "Yes" to "hot and cold running water" even if the unit has hot water only part of the time.

8d. Mark "Yes" to "sink with a faucet" if the sink is inside the house, apartment, or mobile home and the water can be turned on and off with a faucet.

8e. Mark "Yes" to "a stove or range" if the stove or range is inside the house, apartment, or mobile home. Portable cooking equipment is not considered a stove or range.

8g. Mark "Yes" to "telephone service..." if (1) there is a telephone in working order, and someone receives service at this house, apartment, or mobile home; or (2) if someone has a cell phone from which you can both make and receive calls. If service has been discontinued because of nonpayment or any other reason, mark the "No" box.