Questionnaire Text

Questionnaire form view entire document:  text  image
Person 1
(Person 1 is the person living or staying here in whose name this house or apartment is owned, being bought, or rented. If there is no such person, start with the name of any adult living or staying here.)

3. What is person 1's sex?

Mark (X) one box.

[] Male
[] Female

[Repeat for persons X = 2 - 5.]

3. What is Person X's sex?

Mark (X) one box.

[] Male
[] Female
If there are more than five people living or staying here, print their names in the spaces for Person 6 through Person 12. We may call you for more information about them.

[Repeat for Persons Y = 6 - 12.]

Sex

[] Male
[] Female
Questionnaire instructions view entire document:  text  image
Person questions 1-6

Answer questions 1-6 for the first five people living or staying at this address.

  • Include everyone who is living or staying here for more than 2 months.
  • Include yourself if you are living here for more than 2 months.
  • Include anyone else staying here who does not have another place to stay, even if they are here for 2 months or less.
  • Do not include anyone who is living somewhere else for more than 2 months, such as a college student living away or someone in the Armed Forces on deployment.

P3. Mark one box to indicate this person's biological sex.