Questionnaire Text
Questionnaire form
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Households at the selected dwelling
Household number of this household _ _
Total number of households at the selected dwelling _ _
Was this questionnaire subjected to quality control (or checks) by any Community Survey personnel other than the supervisor? Mark the appropriate box with an X.
[] 1 Yes
[] 2 No
Questionnaire instructions
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Total number of households at the selected dwelling
If one household is found at the selected dwelling record "01" in the blocks provided. When more than one household is found at one dwelling, write the total number of households in the provided blocks.