Questionnaire Text

Questionnaire form view entire document:  text  image
Person 1 (reference person)

5. Does person 1 live with his/her mother?

1 [] Yes. Indicate the reference number attributed to the mother _ _
2 [] No/Not applicable
Questionnaire instructions view entire document:  text  image
Household Identification
Proceed as indicated in chapter 4.
The questions in part a, b and c must be filled out by the household representative or a resident of the dwelling that belongs to the household!

B-Write the name of everyone in the household who resides in this dwelling and answer questions 2, 3, 4 and 5

5. Does person X live with his/her mother?
[There is an image of question 5]
If the answer is Yes you must indicate the number given to the mother. This number is the one that is at the beginning of each column (person 1 or person 2, etc.). If the person's mother does not live in the household you must record the option "No/Not Applicable".