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.


Total blindness:

The person cannot see anything at all.


Total deafness:

The person cannot hear anything at all.


Mute:

The person does not speak.


Mental retardation:

The person has learning or behavioral difficulties when compared to people of the same age.


Loss or disablement of upper extremities

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


Loss or disablement of lower extremities

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


None of the above

The person does not suffer any of the above mentioned disabilities.