Questionnaire Text

Questionnaire form view entire document: text image

3. What is your date or birth and age?

____ Day
____ Month
____ Year
____ Age
____ Under one year (months)

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.3

[Date of birth]
[The instructions refer to a graphic of section VI, question 3 on the census form.]

-- Write down the day, month and year of birth and the age completed by the person.

-- In the case of children under 1 year, write down the number of months completed in the space for less than one year (months).

-- If the complete date or age is not known, write down whatever may be known.