Questionnaire Text

Questionnaire form view entire document: text image

15.

a. Did this person live in this house or apartment 1 year ago?

[] Person is under 1 year old - skip to question 16
[] Yes, this house - skip to question 16
[] No, outside Puerto Rico and the United States - print name of foreign country, or US Virgin Islands, Guam, etc, below, then skip to question 16 ______
[] No, different house in Puerto Rico or the United States

b. Where did this person live 1 year ago?

Address
Development or condominium name
Number and street name
_______
_______

Name of city, town, or post office
_______

Name of municipio in Puerto Rico or US county
_______

Enter Puerto Rico or name of US state
______

ZIP code
_ _ _ _ _

Questionnaire instructions view entire document: text image

Answer person questions 7 through 17 for all persons on pages 2, 3, and 4.

Questions 7-48 are a continuation of the questions for each person. Questions 7-48 are a continuation of the questions for each person. (Questions 1-6 appear on pages 2, 3, and 4 of the questionnaire.)

15a. If the person did not live in the United States one year ago, mark the "no, outside the United States and Puerto Rico" box and print the name of the foreign country, or U.S. Virgin Islands, Guam, etc., where the person lived. Be specific when printing the name of the foreign country; for example, specify Czech Republic or Slovakia, not Czechoslovakia; North or South Korea not Korea. Specify the particular country, not region. For example, specify Jamaica, not West Indies; Kenya, not East Africa. Then skip to question 16.

If the person lived somewhere else in Puerto Rico or the United States one year ago, mark the "no, different house in Puerto Rico or the United States" box.