Questionnaire Text

Questionnaire form view entire document: text image

11. Does the home have any of the following appliances?

[] Water heater [gas]
[] Instant heater [electric]
[] Simple refrigerator
[] Refrigerator with freezer
[] Freezer
[] Color TV
[] Black and white TV
[] Telephone
[] Microwave oven
[] Video cassette player
[] Common washer
[] Programmed washer
[] Computer

Questionnaire instructions view entire document: text image

Question 11. Does this household have any of the following appliances?

[Part of the text is illegible]

Microwave oven

[] Has
[] Does not have

Videocassette player

[] Has
[] Does not have

Common washing machine

[] Has
[] Does not have

Programmed washing machine

[] Has
[] Does not have

Computer

[] Has
[] Does not have

You should read one by one the appliances listed, waiting for a response and filling in each one of the boxes that corresponds to [whether] a household "Has" or "Does not have".

For appliances that were out of service being repaired, you should mark the box corresponding to "Has".