Questionnaire Text

Questionnaire form view entire document:  text  image
15a. Did this person live in this house or apartment 1 year ago?

[] Person is under 1 year old -- Skip to question 16.
[] Yes, this house -- Skip to question 16
[] No, outside the United States and Puerto Rico -- Print name of foreign country, or U.S. Virgin Islands, Guam, etc., below; then skip to question 16. ____
[] No, different house in the United States or Puerto Rico

15b. Where did this person live 1 year ago?

Address, development or condominium name, number and street name ________

Name of city, town, or post office ________

Name of U.S. county or municipio in Puerto Rico ________

Name of U.S. state or Puerto Rico ________

ZIP Code _ _ _ _ _
Questionnaire instructions view entire document:  text  image
Person questions 12-18

P15.a. If the person did not live in the United States or Puerto Rico one year ago, mark the "No, outside the United States and Puerto Rico" box and print the name of the foreign country, or U.S. Virgin Islands, Guam, etc., where the person lived. Be specific when printing the name of the foreign country; for example, specify Czech Republic or Slovakia, not Czechoslovakia; North or South Korea, not Korea. Specify the particular country, not region. For example, specify Jamaica, not West Indies; Kenya, not East Africa. Then skip to question 16.

If the person lived somewhere else in the United States or Puerto Rico one year ago, mark the "No, different house in the United States or Puerto Rico" box.