Survey Text

1977
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1977
Survey form view entire document:  text  image
14a. During the past 12 months, did anyone in the family receive any disability payments or disability benefits from -

1. Social Security Administration? ____
2. Veterans Administration? ____
3. State public welfare or assistance? ____

If "Yes," ask 14b.
b. Was this because of a disability?

1 [] SSA
2 [] VA
3 [] Welfare

If "Yes," ask 14c and d, otherwise continue with list.

c. Who was this? ____
Mark appropriate box in person's column.

d. Anyone else? ____