21. Is any member of the household blind, mute, deaf, or have any physical impediment, or other disability?

If "yes," ask who the disabled persons are and mark an X in the box [under the column for that person] corresponding to each response.

IV. For the head of household or main informant

Question 21. Is any member of your family blind, dumb, deaf, or do they have any physical impediments or other deficiencies?

If you have marked the box corresponding to Yes, ask who?, and in the column pertaining to each affected person, make an X in the box or boxes corresponding to the situation, or specify the situation under other. If you marked the box corresponding to no, continue with the next person.

[A depiction of question 21 to the right of the preceding text is omitted here.]

[P. 54]

Keep in mind the following definitions:

Blind: Without the ability to see. Example: unable to recognize written words, colors, persons, or objects.

Deaf: Without sensibility in the ear or the ability to hear.

Dumb: Unable to speak

Paralytic: Without the capacity to move one or various body parts.

Other: This category includes mental deficiency, that is to say, a person who has alterations in their mental functioning, memory, comprehension, capacity to learn, or ability to calculate. Example: Down syndrome, mental retardation, demented, etc.

[A drawing of men with some disability is omitted here.]