Questionnaire Text

Questionnaire form view entire document: text image

Section I: Mortality in the last 12 months - (between February 2006 and March 2007)

Read out: I am now going to ask for information on any member of the household who has passed away in the last 12 months between February 2006 and March 2007.

M-00 Has any member of this household passed away in the last 12 months between February 2006 and March 2007?

Mark appropriate box with an X
If no, the questionnaire is completed. Thank the respondent(s).
[] Yes
[] No

Questionnaire instructions view entire document: text image

(M-00) Has any member of this household passed away in the last 12 months?
If "No", the questionnaire is complete. Thank the respondent(s).