Questionnaire Text

Questionnaire form view entire document:  text  image

For all individuals:
[Questions 1-10 -- are for all person]


10. Do you have any of the following disabilities?

[] Total blindness
[] Total deafness
[] Muteness
[] Mental retardation
[] Loss or disability of upper extremities
[] Loss or disability of lower extremities
[] None of the above

Questionnaire instructions view entire document:  text  image

Questions 1-10 -- are for all persons

Every person in the household should be asked these questions.

-- In the case of people who are absent or of small children, ask the Head of Household or the person who can give the most reliable information.


Question No.10

[Disabilities]
[The instructions refer to a graphic of section VI, question 10 on the census form.]

-- Read the question and the possible answers and fill in the corresponding cell.


Loss or disablement of lower extremities

Paralysis, amputation or limited movement in one or both legs.