Questionnaire Text

Questionnaire form view entire document:  text  image
3. What is Person 1's sex?

Mark (X) one box.

[] Male
[] Female

[Repeat for persons X = 2 - 5.]

3. What is Person X's sex?

Mark (X) one box.

[] Male
[] Female
If there are more than five people living or staying here, print their names in the spaces for Person 6 through Person 12. We may call you for more information about them.

[Repeat for Persons Y = 6 - 12.]

Sex

[] Male
[] Female
Questionnaire instructions view entire document:  text  image
Person questions 1-6

Answer questions 1-6 for the first five people living or staying at this address.

  • Include everyone who is living or staying here for more than 2 months.
  • Include yourself if you are living here for more than 2 months.
  • Include anyone else staying here who does not have another place to stay, even if they are here for 2 months or less.
  • Do not include anyone who is living somewhere else for more than 2 months, such as a college student living away or someone in the Armed Forces on deployment.

P3. Mark one box to indicate this person's biological sex.