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.

e) TRICARE or other military health care
[] 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.)

23. Write the four-digit year when the person last got married, even if the person is now widowed, divorced, or separated.