Questionnaire Text

Questionnaire form view entire document:  text  image

4. Date of birth:
Day /_/_/
Month /_/_/
Year /_/_/_/_/

Questionnaire instructions view entire document:  text  image

Question 4: On what date were you born?
The day, month and year of the date of birth should be written in numeric form. For example, if the respondent says that he/she was born on May tenth, nineteen-fifty, write as follows:
Day: "10"
Month: "05"
Year: "1950"

Do not ever change the age by relating it to the date of birth.