Questionnaire Text

Questionnaire form view entire document:  text  image

V. Information on members of the household


1. All persons


4. What is your date of birth?

____ Day
____ Month
____ Year

Questionnaire instructions view entire document:  text  image

3. Age
What is your age?
Age will be recorded in the box and in years exactly as told by the informant, without suggesting or calculating ages.