Questionnaire Text

Questionnaire form view entire document:  text  image

20. Do you have any physical or mental disability?
[] 1 Yes
[] 2 No (Go to question 22)


21. What kind of disability do you have?

[Question 21 was asked of persons who had physical or mental disability, per question 20.]

(More than one choice may be marked.)

[] 1 Disability of seeing
[] 2 Disability of hearing
[] 3 Disability of speaking
[] 4 Physical/orthopedic disability
[] 5 Mental disability
[] 6 Other

Questionnaire instructions view entire document:  text  image

Question 20. Do you have any physical or mental handicap (disability)?


Attention! To categorize someone as handicapped, care must be taken to conform to the definition of disability provided below.

Handicapped (disabled):
Resulting from any illness or accident originating at birth or thereafter,

Being unable to adapt to the normal requirements of living, due to some degree of physical, mental, psychological, emotional and social loss of capacity,

An individual requiring training, protection, care, rehabilitation, counseling and support services.


While those handicapped (disabled) temporarily on a short-term basis due to a broken leg or some other such disorder are not to be covered by this question, those handicapped (disabled) for more than six months are to be considered.

In this question, an "X" is to be entered into the "Has" box for those with a physical or mental handicap, and into the "None" box for those without such a handicap. If the answer is "Has", one is to continue from question 21, whereas if the answer is "None", one should skip over to question 22.


Question 21. What kind of handicap (disability) do you have?

(More than one option may be marked)


This [question] seeks to reveal the type of disability that the person being administered the census is suffering from. An "X" is to be marked for the option applicable to the person's type of disability.

In this question, the type of handicap individuals have is to be marked keeping the definitions below in mind:

Visually impaired: Refers to individuals who cannot see at all or have limited sight in one or both eyes, or have no eyes at all.

Hearing impaired: Inability or limited ability to hear in one or both ears, or under some circumstances, only barely able to hear using a hearing aid.

Speech impaired: Refers to individuals who have experienced loss of the lower or upper jaw, of the tongue, palate, those with cleft or defective tongue, palate, lips, who while they may be able to hear cannot speak or who can in some circumstances [only] speak using a device held up to their larynx.

Physically/orthopedically handicapped: Refers to individuals with a deficiency, redundancy, or abnormality visible in the body and in the organs. Those belonging to this group are characterized by a deficiency, disrepair or absence of arms, legs and feet, as well as to paralyzed people -- suffering from childhood paralysis or paralyzed later in life.

Mentally impaired: Refers to people whose learning and comprehension develop later or are slowed down, due to a mental deficiency (retardation). The mentally handicapped (retarded), may vary in the degree of their ability to be taught and to learn, ranging from mild, intermediate, difficult, and very difficult.

People with mental handicaps, may not be able to adjust to their environment, may suffer from difficulties in establishing social relationships, and depending on the severity of their mental handicap (mentally retardation), and may not be able to handle their daily routine needs without the help of others.

If the person suffers from a type of handicap not encompassed by the options provided above, the option of "Other" is to be marked.