Questionnaire Text

Questionnaire form view entire document:  text  image
16. Is this person currently covered by any of the following types of health insurance or health coverage plans?
Mark "Yes" or "No" for each type of coverage in items a - h.

a) Insurance through a current or former employer or union (of this person or another family member)
[] Yes
[] No
Questionnaire instructions view entire document:  text  image
Answer person questions 7 through 17 for all persons on pages 2, 3, and 4.

Questions 7-48 are a continuation of the questions for each person. (Questions 1-6 appear on pages 2, 3, and 4 of the questionnaire.)

20. Mark the "Now married" box for a married person regardless of whether his or her spouse is living in the household unless they are separated. If the person's only marriage was annulled, mark the "Never married" box.