V. Information on members of the household
1. All persons
7. Do you have any of the following disabilities?
(You may mark more than one)
[] 1 Blindness
[] 2 Deafness
[] 3 Muteness
[] 4 Mental retardation
[] 5 Paralysis or loss of use of an upper extremity
[] 6 Paralysis or loss of use of a lower extremity
[] 7 No disability
7. Physical conditions
Does anyone suffer from one of the following conditions?
This question should be responded to affirmatively when the impediment is total in the case of blindness, deafness and muteness, and when the loss of limbs is partial or total. If a person has more than one condition, all can be marked without limiting to one answer.