Questionnaire Text

Questionnaire form view entire document:  text  image
Section IV. Population information


5. Do you have any physical or mental disability?

Mark more than one response if appropriate
(Blind = doesn't see)
(Deaf = doesn't hear)
(Mute = doesn't speak)
(Paralyzed = doesn't walk)

[] 1 Yes

[] 1 Blind
[] 2 Deaf
[] 3 Mute
[] 4 Paralyzed
____ Other

[] 6 No

Questionnaire instructions view entire document:  text  image

Question 5: Does he/she have any physical or mental impediment?

5. Does he/she have any physical or mental impediment?
Mark more than one answer if it corresponds.
(Only blind=does not see)
(Deaf=does not hear)
(Mute=does not speak)
(Paralyzed=does not walk)

[] 1 Yes

[] 1 Blind
[] 2 Deaf
[] 3 Mute
[x] 4 Paralyzed
Other ____


No []


This question had as its objective the number of disabled persons in the population.

This question is difficult and we request special attention and care on the part of the enumerators.

You should not omit any person, whatever his/her age or sex.

This question can have various answer for one persons. This means that one person can be deaf, mute, and have difficulty for walking, in which case you should mark all of the disabilities.

A disability, as the name indicates, impedes that a person fulfill a function, such as speech, walking, listening, communicating his/her ideas, take care of him/herself, work independently without help, etc.

After asking the question, you should wait a moment, it can be that it is difficult to decide whether or not to tell about a defect of a relative. If the enumerator observes a person with a disability in the home, he/she should note the information when he/she is sure of the information for this person, without needing to ask the question.

[page] 26

This question has 4 pre-established specified answers and an open option: Others. The pre-established answers are:

1. Blind. Person who cannot see, whether since birth or because he/she lost his/her sight due to illness or accident. Do not include persons who can see, but with difficulty.
2. Deaf. Person who is totally deaf, since birth or due to illness or accident. Do not include persons who hear with difficulty.
3. Mute. Person who cannot speak, since birth or due to illness or accident. Do not include persons who speak with difficulty.
4. Paralyzed. All person who has difficulty, cannot move arms and/or legs, needs help for many of his/her normal activities.
5. Other. If the person presents an impediment that is not established above, you should mark this box. The options are the following:
a. Mental retardation. Person who habitually does not learn what is taught, does not understand what is said to him/her, does not speak well. This includes mongoloid persons.
b. Does not hear well: Persons who, without being deaf, have serious hearing problems that make it difficult to study and/or work.
c. Behavior: Persons who have visible behavior problems that does not permit him/her to study and/or work. They are persons who are normally categorized as crazy or trarova [local term that is synonymous with crazy].
d. Physical Deficiency: All persons who have some physical impediment that, without being paralyzed, such as minor paralysis, deformed arms and/or legs, hydrocephalus (large head).
e. Other impediments: If the impediment found cannot be classified in one of the above groups, you should specify it.