Survey Text

2018 2004 1990 1976
2017 2003 1989 1975
2016 2002 1988 1974
2015 2001 1987 1973
2014 2000 1986 1972
2013 1999 1985 1971
2012 1998 1984 1970
2011 1997 1983 1969
2010 1996 1982 1968
2009 1995 1981 1967
2008 1994 1980 1966
2007 1993 1979 1965
2006 1992 1978 1964
2005 1991 1977 1963
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2018

No questionnaire text is available for this sample.


top
2017

No questionnaire text is available for this sample.


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2016
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

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2015
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

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2014
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

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2013
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

top
2012
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

top
2011
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

top
2010
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

top
2009
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

top
2008
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

top
2007
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

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2006
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

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2005
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

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2004
Survey form view entire document:  text  image

Question ID: HHC.120_01.000

Instrument Variable Name: AGEDOB_1
QuestionText:
1 of 5 What is [fill: your/ALIAS's] age?
* Enter number for age.
01-120 Age in years
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(001-120) [go to AGEDOB_2]
(R,D) [go to AGEDOB_3]
Question ID: HHC.120_02.000

Instrument Variable Name: AGEDOB_2
QuestionText:
2 of 5 * Enter number for age time period.
1 Days
2 Weeks
3 Months
4 Years
UniverseText: Valid age - number entered
SkipInstructions:
(1-4) [go to AGEDOB_3]
Question ID: HHC.120_03.000

Instrument Variable Name: AGEDOB_3
QuestionText:
3 of 5 And what is [fill: your/ALIAS's] date of birth? Please give month, day, and year for the date of birth.
* Enter month of birth.
01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-12,R,D) [go to AGEDOB_4]
Question ID: HHC.120_04.000

Instrument Variable Name: AGEDOB_4
QuestionText:
4 of 5 * Enter day of birth
01-31 Day of the month
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1-31,R,D)
Only allow valid days for month entered.
If days not valid, [go to ERR_AGEDOB_4]
ELSE [go to AGEDOB_5]

Hard Edit: ERR_AGEDOB_4

[fill1: AGEDOB_4] is not a valid day for [fill2: AGEDOB_3].
Question ID: HHC.120_05.000

Instrument Variable Name: AGEDOB_5
QuestionText:
5 of 5 * Enter year of birth.
1880-2030 Year of birth
9997 Refused
UniverseText: All nondeleted persons in parent cases or all nondeleted persons being added in spawn cases.
SkipInstructions:
(1880 - 2030, R,D) [go to AGECAL]

Hard Edit: ERR1_AGEDOB_5

Future month invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR2_AGEDOB_5
Future day invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR3_AGEDOB_5
Invalid date:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5
ERR4_AGEDOB_5
Future year invalid:(space)AGEDOB_3(space)AGEDOB_4(,)(space) AGEDOB_5

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2003
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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2002
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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2001
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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2000
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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1999
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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1998
Survey form view entire document:  text  image

HHC.120

What is {your/name} age and date of birth? Please give month, day, and year for the date of birth.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
(97) Refused
(99) Don't know

Age:
AGEDOB_1 [ ] Number
AGEDOB_2 [ ] Time Period
(1) Day(s)
(2) Week(s)
(3) Month(s)
(4) Year(s)

Date of Birth:
DOB_M MONTH: ______________________
DOB_BDAY DAY: ______________________
DOB_Y_P YEAR: ______________________

Check item AGECAL:AGE1 takes information entered in AGEDOB_1 and AGEDOB_2 and calculates an age.
AGE2 takes the date-of-birth information entered in AGEDOB and calculates an age.
AGE3 = current year - birth year -1, AGE4 = AGE3 + 1. If not enough DOB information was given to calculate an age,AD@ will be assigned to AGE2.

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1997
Survey form view entire document:  text  image

HHC.050

What is {FULLNAME}'s date of birth? Month, day and year, please.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
DOB_M MONTH: ____________________________
DOB_BDAY DAY: ____________________________
DOB_Y_P YEAR: ____________________________
[If the year is known at HHC.050, goto Check item HHC01; Else goto HHC.080.]
Check item HHC01: Check item HHC01: Calculate AGE by subtracting reported Birth Year (before top coded to DOB_Y_P) (HHC.050) from CURRENT YEAR. If the birth month, day, and year are valid and if current date is less than birth date - subtract 1 from AGE, and goto HHC.070. If the birth month and year are valid, day is missing, and if current month is less than birth month- subtract 1 from AGE and goto HHC.070. If the birth month is missing then AGE1 = (AGE-1) and AGE2 = (AGE) and goto HHC.060.

HHC.060

Would you say {FULLNAME}:
RPAGEPIC
(1) {AGE1} years of age? (Check item HHC02)
(2) {AGE2} years of age? (Check item HHC02)
(7) Refused (HHC.080)
(9) DK (HHC.080)
(N) Neither is correct (HHC.080)

HHC.070

That would make {FULLNAME} {AGE} years old. Is that correct?
RPAGEVER
(1) Yes (Check item HHC02)
(2) No (HHC.080)
(7) Refused (HHC.080)
(9) DK (HHC.080)

HHC.080

What is {FULLNAME}'s age?

FR: ASK IF APPROPRIATE; OTHERWISE, ENTER YOUR BEST ESTIMATE OF THE PERSON'S AGE. ENTER "0" IF UNDER 1. ENTER (C) FOR COMPUTE IF THE RESPONSE IS A RANGE OF AGES.
RPAGEGES
________________ (0-120) years old (Check Item HHC02)
(C) Compute from range (HHC.090)

HHC.090

FR: ENTER FIRST AND LAST NUMBERS OF THE RANGE.
RPRANGE1 First/lower _________________________________
RPRANGE2 Last/higher _________________________________
[Store (RPRANGE1 + RPRANGE2)/2 in RPAGEGES]
Check item HHC02:
If HHC.060 equals 1, store AGE1 in AGE; Else
If HHC.060 equals 2, store AGE2 in AGE; Else
If HHC.070 equals 1, set AGE equals AGE; Else store RPAGEGES in AGE.

Check item MORCK: If Person number (PX) less than 30: Append 1 more member into the roster, goto Check item SET; Else set HHC.240 equal to 2, and goto Check item MAXPER.

HHC.150

What is {FULLNAME}'s date of birth? Month, day and year, please.

(1) January
(2) February
(3) March
(4) April
(5) May
(6) June
(7) July
(8) August
(9) September
(10) October
(11) November
(12) December
DOB_M MONTH: ____________________________
DOB_BDAY DAY: ____________________________
DOB_Y_P YEAR: ____________________________
[If the year is know at HHC.150, goto Check item HH15; Else goto HHC.180]
Check item HH15: Calculate AGE by subtracting reported Birth Year (HHC.150) from CURRENT YEAR. If the birth month, day, and year are valid and are known, and if current month is less than birth month - subtract 1 from AGE and goto HHC.170. If current month is the same as birth month and current day is less than birth day - subtract 1 from AGE and goto HHC.170. If the birth month is missing; then AGE1= (AGE - 1) and AGE2 = (AGE) and goto HHC.160.

HHC.160

Would you say {FULLNAME} is:
AGEPIC
(1) {AGE1} years of age? (Check item HHC09)
(2) {AGE2} years of age? (Check item HHC09)
(7) Refused (HHC.180)
(9) DK (HHC.180)
(N) Neither is correct (HHC.180)

HHC.170

That would make {FULLNAME} {AGE} years old. Is that correct?
AGEVER_A
(1) Yes (Check item HHC09)
(2) No (AGEVER_B)
(7) Refused (HHC.180)
(9) DK (HHC.180)

[If answer equals 2, ask:]
Would you like to correct {his/her} date of birth?
AGEVER_B
(1) Yes (HHC.150)
(2) No, not remember for sure. (HHC.180)

HHC.180

What is {FULLNAME}'s age?

FR: ASK IF APPROPRIATE; OTHERWISE, ENTER YOUR BEST ESTIMATE OF THE PERSON'S AGE. ENTER "0" IF UNDER 1. ENTER (C) FOR COMPUTE IF THE REPONSE IS A RANGE OF AGE.
AGEGES
__________ (0-120) years old (Check item HHC09)
(C) Compute from range

HHC.190

FR: ENTER FIRST AND LAST NUMBERS OF THE RANGE.
AGEGES_1 First/lower:____________________
AGEGES_2 Last/higher:____________________
[Store (AGEGES_1 + AGEGES_2)/2 in AGEGES]
Check item HHC09:
If HHC.160 equals 1 and AGE is not equal to zero, store AGE1 in AGE; Else
If HHC.160 equals 2 and AGE is not equal to zero, store AGE2 in AGE; Else
If HHC.170 equals 1, set AGE equal to AGE; Else set AGE equal AGEGES in HHC.180.

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1996
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1995
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3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1994
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1993
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1992
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1991
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1990
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3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1989
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3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1988
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3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1987
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1986
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3. What is -- date of birth? (Enter date and age and mark sex.)
Date of birth

Month ___
Date ___
Year ___

Age ____

Sex

1[] M
2[] F

top
1985
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3. What is -- date of birth? (Enter date and age and mark sex.)

Month ____
Date ____
Year ____

top
1984
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)

Month ____
Date ____
Year ____

top
1983
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)

Month ____
Date ____
Year ____

top
1982
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and age and mark sex.)

Month ____
Date ____
Year ____

top
1981
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and Age and circle Race and Sex.)

____ Month
____ Date
____ Year
Race
1[] W
2[] B
3[] OT
Sex
1[] M
2[] F

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1980
Survey form view entire document:  text  image

3. What is -- date of birth? (Enter date and Age and circle Race and Sex.)

____ Month
____ Date
____ Year
Race
1[] W
2[] B
3[] OT
Sex
1[] M
2[] F

top
1979
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3. What is -- 's date of birth? (Enter date and Age, and circle Race and Sex)

Age ____

Race
1 [] W
2 [] B
3 [] OT
Sex
1 [] M
2 [] F
Month ____
Date ____
Year ____

top
1978
Survey form view entire document:  text  image

3. What is -- 's date of birth? (Enter date and Age, and circle Race and Sex)

Age ____

Race
1 [] W
2 [] B
3 [] OT
Sex
1 [] M
2 [] F
Month ____
Date ____
Year ____

top
1977
Survey form view entire document:  text  image

3. What is -- 's date of birth? (Enter date and Age, and circle Race and Sex)

Age ____

Race
1 [] W
2 [] B
3 [] OT
Sex
1 [] M
2 [] F
Month ____
Date ____
Year ____

top
1976
Survey form view entire document:  text  image

3. What is -- 's date of birth? (Enter date and Age, and circle Race and Sex)

Age ____

Race
1 [] W
2 [] B
3 [] OT
Sex
1 [] M
2 [] F
Month ____
Date ____
Year ____

top
1975
Survey form view entire document:  text  image

3. What is -- 's date of birth? (Enter date and Age, and circle Race and Sex)

Age ____

Race
1 [] W
2 [] B
3 [] OT
Sex
1 [] M
2 [] F
Month ____
Date ____
Year ____

top
1974
Survey form view entire document:  text  image

3. What is -- 's date of birth? (Enter date and Age, and circle Race and Sex)

Age ____

Race
1 [] W
2 [] B
3 [] OT
Sex
1 [] M
2 [] F
Month ____
Date ____
Year ____

top
1973
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3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

top
1972
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3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

top
1971
Survey form view entire document:  text  image

3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

top
1970
Survey form view entire document:  text  image

3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

top
1969
Survey form view entire document:  text  image

3. How old was -- on his last birthday? (Enter Age and circle Race and Sex)

AGE ____
RACE
1 [] W
2 [] N
3 [] OT
SEX
1 [] M
2 [] F
C

top
1968
Survey form view entire document:  text  image

3. How old was --on his last birthday?
Also mark Race and sex

Age ____
Race
0[] W
1[] N
2[] OT
Sex
0[] M
1[] F

top
1967
Survey form view entire document:  text  image

3. How old was --on his last birthday?
Also mark Race and sex

Age ____
Race
0[] W
1[] N
2[] OT
Sex
0[] M
1[] F

top
1966

No questionnaire text is available for this sample.


top
1965

No questionnaire text is available for this sample.


top
1964

No questionnaire text is available for this sample.


top
1963

No questionnaire text is available for this sample.