Questionnaire Text

Questionnaire form view entire document:  text  image
Fill out pages 2 - 7 for everyone, including yourself, who is living or staying at this address for more than 2 months. Then complete the rest of the form.
Questionnaire instructions view entire document:  text  image
P1. Print the name of the household member living or staying here in whose name the house or apartment is owned, being bought, or rented. If there is no such person, any adult household member can be Person 1.

Print the person's Last Name, First Name, and Middle Initial (MI) in the spaces provided.

If there are more than 5 people in your household, please provide the name, sex and age of each additional person on page 7. An interviewer may telephone to obtain information for the additional persons.