Survey Text

1996 1987 1978 1969
1995 1986 1977 1968
1994 1985 1976 1967
1993 1984 1975 1966
1992 1983 1974 1965
1991 1982 1973 1964
1990 1981 1972 1963
1989 1980 1971
1988 1979 1970
top
1996
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1995
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1994
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1993
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1992
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1991
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1990
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1989
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with [his/her] personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling [his/her] routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part at all in the usual kinds of play activities done by most children [his/her] age?

[] Yes
0[] No (13)

b. Is -- limited to the kind or amount of play activities [he/she] can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem now keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of [his/her] health?

4[] Yes (13)
5[] No

12a. Is -- limited in any way in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited? Record limitation, not condition.

Limitation ____

top
1988
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1987
Survey form view entire document:  text  image

Refer to age

0 [] Under 5 (10)
1 [] 5-17 (11)
2 [] 18-69 (NP)
3 [] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1 [] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2 [] Yes (13)
3 [] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0 [] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1 [] Yes (13)
2 [] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1 [] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2 [] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3 [] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4 [] Yes (13)
5 [] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1 [] Yes
2 [] No (NP)

top
1986
Survey form view entire document:  text  image

Refer to age

0 [] Under 5 (10)
1 [] 5-17 (11)
2 [] 18-69 (NP)
3 [] 70 and over (8)

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1 [] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2 [] Yes (13)
3 [] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0 [] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1 [] Yes (13)
2 [] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1 [] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2 [] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3 [] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4 [] Yes (13)
5 [] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1 [] Yes
2 [] No (NP)

b. In what way is -- limited? Record limitation, not condition. ____


top
1985
Survey form view entire document:  text  image

Refer to age

0 [] Under 5 (10)
1 [] 5-17 (11)
2 [] 18-69 (NP)
3 [] 70 and over (8)

8. What was -- doing MOST OF THE PAST 12 MONTHS; working at a job or business, keeping house, going to school, or something else?

Priority if 2 or more activities reported: (1) Spent the most time doing; (2) Considers the most important.

1 [] Working
2 [] Keeping house
3 [] Going to school
4 [] Something else

9a. Because of any impairment or health problem, does -- need the help of other persons with [his/her] personal care needs, such as eating, bathing, dressing, or getting around this home?

1 [] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling [his/her] routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2 [] Yes (13)
3 [] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children [his/her] age?

[] Yes
0 [] No (13)

b. Is -- limited to the kind OR amount of play activities [he/she] can do because of any impairment or health problem?

1 [] Yes (13)
2 [] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1 [] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2 [] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3 [] Yes (13)
[] No

d. Is -- limited in school attendance because of [his/her] health?

4 [] Yes (13)
5 [] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1 [] Yes
2 [] No (NP)

b. In what way is -- limited? Record limitation, not condition. ____


top
1984
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

8. What was -- doing most of the past 12 months; working at a job or business, keeping house, going to school, or something else?
Priority if 2 or more activities reported: (1) Spent the most time doing; (2) Considers the most important.

1[] Working
2[] Keeping house
3[] Going to school
4[] Something else

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part at all in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind or amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem now keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in any way in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited? Record limitation, not condition.

Limitation ____

top
1983
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

8. What was -- doing MOST OF THE PAST 12 months; working at a job or business, keeping house, going to school, or something else?
Priority if 2 or more activities reported: (1) Spent the most time doing; (2) Considers the most important.

1[] Working
2[] Keeping house
3[] Going to school
4[] Something else

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1982
Survey form view entire document:  text  image

Refer to age

0[] Under 5 (10)
1[] 5-17 (11)
2[] 18-69 (NP)
3[] 70 and over (8)

8. What was -- doing MOST OF THE PAST 12 months; working at a job or business, keeping house, going to school, or something else?
Priority if 2 or more activities reported: (1) Spent the most time doing; (2) Considers the most important.

1[] Working
2[] Keeping house
3[] Going to school
4[] Something else

9a. Because of any impairment or health problem, does -- need the help of other persons with -- personal care needs, such as eating, bathing, dressing, or getting around this home?

1[] Yes (13)
[] No

b. Because of any impairment or health problem, does -- need help of other persons in handling -- routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?

2[] Yes (13)
3[] No (12)

10a. Is -- able to take part AT ALL in the usual kinds of play activities done by most children -- age?

[] Yes
0[] No (13)

b. Is -- limited to the kind OR amount of play activities -- can do because of any impairment or health problem?

1[] Yes (13)
2[] No (12)

11a. Does any impairment or health problem NOW keep -- from attending school?

1[] Yes (13)
[] No

b. Does -- attend a special school or special classes because of any impairment or health problem?

2[] Yes (13)
[] No

c. Does -- need to attend a special school or special classes because of any impairment or health problem?

3[] Yes (13)
[] No

d. Is -- limited in school attendance because of -- health?

4[] Yes (13)
5[] No

12a. Is -- limited in ANY WAY in any activities because of impairment or health problem?

1[] Yes
2[] No (NP)

b. In what way is -- limited?
Record limitation, not condition.

_______
limitation

top
1981
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

28a. About how long has he {been limited in --, been unable to --, had to go to a certain type of school?}

000[] Less than 1 month
1 ____ Mos
2 ____ Yrs.

top
1980
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

28a. About how long has he {been limited in --, been unable to --, had to go to a certain type of school?}

000[] Less than 1 month
1 ____ Mos
2 ____ Yrs.

top
1979
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

28a. About how long has he {been limited in --, been unable to --, had to go to a certain type of school?}

000[] Less than 1 month
1 ____ Mos
2 ____ Yrs.

top
1978
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

28a. About how long has he {been limited in --, been unable to --, had to go to a certain type of school?}

000[] Less than 1 month
1 ____ Mos
2 ____ Yrs.

top
1977
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

top
1976
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

top
1975
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

top
1974
Survey form view entire document:  text  image

Ages 17+
19a. What was -- doing most of the past 12 months -(For males): working or doing something else? (For females): keeping house, working or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If 'something else" ask:
b. What was -- doing?

If 45+ years and was not "working," "keeping house," or "going to school." ask:
c. Is -- retired?

d. If "retired," ask: Did he retire because of his health?

Ages 6-16
20a. What was -- doing most of the past 12 months - going to school or doing something else?

1[] Working (24a)
2[] Keeping house (24b)
3[] Retired, health (23)
4[] Retired, other (23)
5[] Going to school (26)
6[] 17+ something else (23)
7[] 6-16 something else (25)

If "something else," ask:
b. What was -- doing?

Ages under 6

0[] 1-5 years (21)
0[] Under 1 (22)

21a. Is -- able to take part at all in ordinary play with other children?

[] Y
1[] N (28)

b. Is he limited in the kind of play he can do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of play because of his health?

2[] Y (28)
[] N (27)

22a. Is -- limited in any way because of his health?

1[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________ (28)

23a. Does -- health now keep him from working?

1[] Y (28)
[] N

b. Is he limited in the kind of work he could do because of his health?

2[] Y (28)
[] N

c. Is he limited in the amount of work he could do because of his health?

2[] Y (28)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

24a. Does -- NOW have a job?

[] Y (24c)
[] N

b. In terms of health, is -- NOW able to (work - keep house) at all?

[] Y
1[] N (28)

c. Is he limited in the kind of (work-housework) he can do because of his health?

2[]Y (28)
[] N

d. Is he limited in the amount of (work-housework) he can do because of his health?

2[] Y (28)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3[] Y (28)
[] N (27)

25. In terms of health would -- be able to go to school?

[] Y
1[] N (28)

26a. Does (would) -- have to go to a certain type of school because of his health?

2[] Y (28)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2[] Y (28)
[] N

c. Is he limited in the kinds or amount of other activities because of his health?

3[] Y (28)
[] N

27a. Is -- limited in ANY WAY because of a disability or health?

4[] Y
5[] N (NP)

b. In what way is he limited? Record limitation, not condition.

________

top
1973
Survey form view entire document:  text  image

Ages 17+
18a. What was -- doing most of the past 12 months -- (For males): working or doing something else? (For females): keeping house, working or doing something else?

1 [] Working (23a)
2 [] Keeping house (23b)
3 [] Retired, health (22)
4 [] Retired, other (22)
5 [] Going to school (25)
6 [] 17+ something else (22)
7 [] 6-16 something else (24)
0 [] 1-5 yrs. (20)
0 [] Under 1 (21)

If "something else," ask:

b. What was -- doing? ____

If 45+ years and not "working," "keeping house," or "going to school," ask:

c. Is -- retired? ____

d. If "Retired," ask: Did he retire because of his health? ____

Ages 6-16
19a. What was -- doing most of the past 12 months - going to school or doing something else?

1 [] Working (23a)
2 [] Keeping house (23b)
3 [] Retired, health (22)
4 [] Retired, other (22)
5 [] Going to school (25)
6 [] 17+ something else (22)
7 [] 6-16 something else (24)
0 [] 1-5 yrs. (20)
0 [] Under 1 (21)

If "something else," ask:

b. What was -- doing? ____

Ages under 6
20a. Is -- able to take part at all in ordinary play with other children?

[]Y
1 [] N (27)

b. Is he limited in the kind of play he can do because of his health?

2 [] Y (27)
[] N

c. Is he limited in the amount of play because of his health?

2 [] Y (27)
[] N (26)

21a. Is -- limited in any way because of his health?

[] Y
5 [] N (NP)

b. In what way is he limited? ____ (27)

22a. Does -- health now keep him from working?

1 [] Y (27)
[] N

b. Is he limited in the kind of work he could do because of his health?

2 [] Y (27)
[] N

c. Is he limited in the amount of work he could do because of his health?

2 [] Y (27)
[] N

d. Is he limited in the kind or amount of other activities because of his health?

3 [] Y (27)
[] N (26)

23a. Does -- NOW have a job?

[] Y (23c)
[] N

b. In terms of health, is -- NOW able to (work -- keep house) at all?

[] Y
1 [] N (27)

c. Is he limited in the kind of (work -- housework) he can do because of his health?

2 [] Y (27)
[] N

d. Is he limited in the amount of (work -- housework) he can do because of his health?

2 [] Y (27)
[] N

e. Is he limited in the kind or amount of other activities because of his health?

3 [] Y (27)
[] N (26)

31. In terms of health would -- be able to go to school?

[] Y
1 [] N (27)

25a. Does (would) -- have to go to a certain type of school because of his health?

2 [] Y (27)
[] N

b. Is he (would he be) limited in school attendance because of his health?

2 [] Y (27)
[] N

c. Is he limited in the kind or amount of other activities because of his health?

3 [] Y (27)
[] N (26)

26a. Is -- limited in ANY WAY because of a disability or health?

4 [] Y
5 [] N (NP)

b. In what way is he limited? Record limitation, not condition ________


top
1972
Survey form view entire document:  text  image


Ages 17+
25a. What was -- doing most of the past 12 months -- (For males): working or doing something else? (For females): keeping house, working or doing something else?

If "something else," ask:

b. What was -- doing? ____

If 45+ years and not "working," "keeping house," or "going to school," ask:

c. Is -- retired? ____

d. If "Retired," ask: Did he retire because of his health? ____

Ages 6-16
26a. What was -- doing most of the past 12 months -- going to school or doing something else?

If "something else," ask:

b. What was -- doing?


Ages under 6
27a. Is -- able to take part at all in ordinary play with other children?

[] Y
1 [] N (34)


b. Is he limited in the kind of play he can do because of his health?
2 [] Y (34)
[] N


c. Is he limited in the amount of play because of his health?
2 [] Y (34)
[] N (33)


28a. Is -- limited in any way because of his health?
[] Y
5 [] N (NP)


b. In what way is he limited? ________ (34)

29a. Does --'s health now keep him from working?
1 [] Y (34)
[] N


b. Is he limited in the kind of work he could do because of his health?
2 [] Y (34)
[] N


c. Is he limited in the amount of work he could do because of his health?
2 [] Y (34)
[] N


d. Is he limited in the kind or amount of other activities because of his health?
3 [] Y (34)
[] N (33)


30a. Does -- NOW have a job?
[] Y (30c)
[] N


b. In terms of health, is -- NOW able to (work - keep house) at all?
[] Y
1 [] N (34)


c. Is he limited in the kind of (work - housework) he can do because of his health?
2 [] Y (34)
[] N


d. Is he limited in the amount of (work -- housework) he can do because of his health?
2 [] Y (34)
[] N


e. Is he limited in the kind or amount of other activities because of his health?
3 [] Y (34)
[] N (33)


31. In terms of health would -- be able to go to school?
[] Y
1 [] N (34)


32 a. Does (would) -- have to go to a certain type of school because of his health?
2 [] Y (34)
[] N


b. Is he (would he be) limited in school attendance because of his health?
2 [] Y (34)
[] N


c. Is he limited in the kind or amount of other activities because of his health?
3 [] Y (34)
[] N (33)


33a. Is -- limited in ANY WAY because of a disability or health?
4 [] Y
5 [] N (NP)


b. In what way is he limited? Record limitation, not condition ________


top
1971
Survey form view entire document:  text  image


Ages 17+
23a. What was -- doing most of the past 12 months - (For males): working or doing something else? (For females): keeping house, working or doing something else?
1 [] Working (28a)
2 [] Keeping house (28b)
3 [] Retired, health (27)
4 [] Retired, other (27)
5 [] Going to school (30)
6 [] 17+ something else (27)


If "something else," ask:

b. What was -- doing? ____

If 45+ years and not "working," "keeping house," or "going to school," ask:

c. Is -- retired? ____

d. If "Retired," ask: Did he retire because of his health?

Ages 6-16
24a. What was -- doing most of the past 12 months - going to school or doing something else?
5 [] Going to school (30
7 [] 6-16 something else (29)


If "something else," ask:

b. What was -- doing?
1 [] Working (28a)
2 [] Keeping house (28b)
3 [] Retired, health (27)
4 [] Retired, other (27)
5 [] Going to school (30)
6 [] 17+ something else (27)
7 [] 6-16 something else (29)


Ages under 6
0 [] 1-5 yrs. (25)
0 [] Under 1 (26)

25a. Is -- able to take part at all in ordinary play with other children?

[] Y
1 [] N (32)


b. Is he limited in the kind of play he can do because of his health?
2 [] Y (32)
[] N


c. Is he limited in the amount of play because of his health?
2 [] Y (32)
[] N (31)


26a. Is -- limited in any way because of his health?
[] Y
3 [] N (NP)


b. In what way is he limited? ________ (32)

27a. Does -- health now keep him from working?
1 [] Y (32)
[] N


b. Is he limited in the kind of work he could do because of his health?
2 [] Y (32)
[] N


c. Is he limited in the amount of work he could do because of his health?
2 [] Y (32)
[] N


d. Is he limited in the kind or amount of other activities because of his health?
3 [] Y (32)
[] N (31)


28a. Does -- NOW have a job?
[] Y (28c)
[] N


b. In terms of health, is -- NOW able to (work - keep house) at all?
[] Y
1 [] N (32)


c. Is he limited in the kind of (work - housework) he can do because of his health?
2 [] Y (32)
[] N


d. Is he limited in the amount of (work - housework) he can do because of his health?
2 [] Y (32)
[] N


e. Is he limited in the kind or amount of other activities because of his health?
3 [] Y (32)
[] N (31)


29. In terms of health would -- be able to go to school?
[] Y
1 [] N (32)


30a. Does (would) -- have to go to a certain type of school because of his health?
2 [] Y (32)
[] N


b. Is he (would he be) limited in school attendance because of his health?
2 [] Y (32)
[] N


c. Is he limited in the kind or amount of other activities because of his health?
3 [] Y (32)
[] N (31)


31a. Is -- limited in ANY WAY because of a disability or health?
4 [] Y
5 [] N (NP)


b. In what way is he limited? Record limitation, not condition ________


top
1970
Survey form view entire document:  text  image


Ages 17+
17 a. What was -- doing most of the past 12 months (For males): working or doing something else? (For females): keeping house, working or doing something else?
1 [] Working (22a)
2 [] Keeping house (22b)
3 [] Retired, health (21)
4 [] Retired, other (21)
5 [] Going to school (24)
6 [] 17+ something else (21)
7 [] 6-16 something else (23)


If "something else," ask:
b. What was -- doing? ____

If 45+ years and not "working," "keeping house," or "going to school," ask:
c. Is -- retired? ____

d. If "Retired," ask: Did he retire because of his health?


Ages 6-16
18a. What was -- doing most of the past 12 months - going to school or doing something else?

1 [] Working (22a)
2 [] Keeping house (22b)
3 [] Retired, health (21)
4 [] Retired, other (21)
5 [] Going to school (24)
6 [] 17+ something else (21)
7 [] 6-16 something else (23)


If "something else," ask:
b. What was -- doing? ____

Ages under 6
0 [] 1-5 yrs. (19)
0 [] Under 1 (20)


19a. Is -- able to take part at all in ordinary play with other children?
[] Y
[] 1 N (26)


b. Is he limited in the kind of play he can do because of his health?
[] 2 Y (26)
[] N


c. Is he limited in the amount of play because of his health?
[] 2 Y (26)
[] N (25)


20a. Is -- limited in any way because of his health?
[] Y
[] 5 N (NP)


b. In what way is he limited? ____ (26)

21a. Does -- health now keep him from working?
[] 1 Y (26)
[] N


b. Is he limited in the kind of work he could do because of his health?
[] 2 Y (26)
[] N


c. Is he limited in the amount of work he could do because of his health?
[] 2 Y (26)
[] N


d. Is he limited in the kind or amount of other activities because of his health?
[] 3 Y (26)
[] N (25)


22 a. Does -- now have a job?
[] Y (22c)
[] N


b. In terms of health, is -- able to (work -- keep house) at all?
[] Y
[] 1 N (26)


c. Is he limited in the kind of (work -- housework) he can do because of his health?
[] 2 Y (26)
[] N


d. Is he limited in the amount of (work -- housework) he can do because of his health?
[] 2 Y (26)
[] N


e. Is he limited in the kind or amount of other activities because of his health?
[] 3 Y (26)
[] N (25)


23. In terms of health would -- be able to go to school?
[] Y
[] 1 N (26)


24 a. Does (would) -- have to go to a certain type of school because of his health?
[] 2 Y (26)
[] N


b. Is he (would he be) limited in school attendance because of his health?
[] 2 Y (26)
[] N


c. Is he limited in the kind or amount of other activities because of his health?
[] 3 Y (26)
[] N (25)


25 a. Is -- limited in ANY WAY because of a disability or health?
[] 4 Y
[] 5 N (NP)


b. In what way is he limited? Record limitation, not condition ____


top
1969
Survey form view entire document:  text  image


Ages 17+

18 a. What was -- doing most of the past 12 months --
(For males): working or doing something else?
(For females): keeping house, working or doing something else?
1 [] Working (NP-23)
2 [] Keeping house (NP-23)
3 [] Retired (NP-22)
4 [] Going to school (NP-25)
5 [] 17+ something else (NP-22)
6 [] 6-16 something else (NP-24)
0 [] 1-5 yrs. (NP-20)
0 [] Under 1 (NP-21)


If "something else," ask:

b. What was -- doing?
1 [] Working (NP-23)
2 [] Keeping house (NP-23)
3 [] Retired (NP-22)
4 [] Going to school (NP-25)
5 [] 17+ something else (NP-22)
6 [] 6-16 something else (NP-24)
0 [] 1-5 yrs. (NP-20)
0 [] Under 1 (NP-21)


If 45+ years and not "working," "keeping house," or "going to school, ask:

c. Is -- retired?

Ages 6-16

19 a. What was -- doing most of the past 12 months - going to school or doing something
else?
1 [] Working (NP-23)
2 [] Keeping house (NP-23)
3 [] Retired (NP-22)
4 [] Going to school (NP-25)
5 [] 17+ something else (NP-22)
6 [] 6-16 something else (NP-24)
0 [] 1-5 yrs. (NP-20)
0 [] Under 1 (NP-21)


If "something else," ask:

b. What was -- doing? ____
1 [] Working (NP-23)
2 [] Keeping house (NP-23)
3 [] Retired (NP-22)
4 [] Going to school (NP-25)
5 [] 17+ something else (NP-22)
6 [] 6-16 something else (NP-24)
0 [] 1-5 yrs. (NP-20)
0 [] Under 1 (NP-21)


Ages under 6

20 a. Is -- able to take part at all in ordinary play with other children?

[] Yes
1 [] No (27)


b. Is he limited in the kind of play he can do because of his health?
2 [] Yes (27)
[] No


c. Is he limited in the amount of play because of his health?
2 [] Yes (27)
[] No (26)


21 a. Is -- limited in any way because of his health?
[] Yes
5 [] No (NP)


b. In what way is he limited? ________ (27)

22 a. Does -- health keep him from working?
1 [] Yes (27)
[] No


b. Is he limited in the kind of work he could do because of his health?
2 [] Yes (27)
[] No


c. Is he limited in the amount of work he could do because of his health?
2 [] Yes (27)
[] No


d. Is he limited in the kind or amount of other activities because of his health?
3 [] Yes (27)
[] No (26)


23 a. In terms of health, is -- able to (work - keep house) at all?
[] Yes
1 [] No (27)


b. Is he limited in the kind of (work - housework) he can do because of his health?
2 [] Yes (27)
[] No


c. Is he limited in the amount of (work - housework) he can do because of his health?
2 [] Yes (27)
[] No


d. Is he limited in the kind or amount of other activities because of his health?
3 [] Yes (27)
[] No (26)


24. In terms of health would -- be able to go to school?
[] Yes
1 [] No (27)


25 a. Does (would) -- have to go to a certain type of school because of his health?
2 [] Yes (27)
[] No


b. Is he (would he be) limited in school attendance because of his health?
2 [] Yes (27)
[] No


c. Is he limited in the kind or amount of other activities because of his health?
3 [] Yes (27)
[] No (26)


26 a. Is -- limited in ANY WAY because of a disability or health?
4 [] Yes
5 [] No (NP)


b. In what way is he limited?
Record verbatim response ________


top
1968
Survey form view entire document:  text  image


Ages 17+
17a. What was -- doing most of the past 12 months --
(For males): working or doing something else?
(For females): keeping house, working or doing something else?
1[] Working (22)
2[] Keeping house (22)
3[] Retired (21)
4[] Going to school (24)
5[] 17+ something else (21)
6[] 6-16 something else (23)

If "something else," ask:
b. What was -- doing?
1[] Working (22)
2[] Keeping house (22)
3[] Retired (21)
4[] Going to school (24)
5[] 17+ something else (21)
6[] 6-16 something else (23)


If 45+ years and not "working," "keeping house," or "going to school, ask:
c. Is -- retired?

Ages 6-16

18a. What was -- doing most of the past 12 months - going to school or doing something
else?

1[] Working (22)
2[] Keeping house (22)
3[] Retired (21)
4[] Going to school (24)
5[] 17+ something else (21)
6[] 6-16 something else (23)

If "something else," ask:
b. What was -- doing? ____

1[] Working (22)
2[] Keeping house (22)
3[] Retired (21)
4[] Going to school (24)
5[] 17+ something else (21)
6[] 6-16 something else (23)
Ages 1-5

19a. Is -- able to take part at all in ordinary play with other children?

[] Yes (19b)
1[] No (25)

b. Is he limited in the kind of play he can do because of his health?

2[] Yes (25)
[] No (19c)

c. Is he limited in the amount of play because of his health?

2[] Yes (25)
4[] No (NP)
Ages Under 1 yr.

20a. Is -- limited in any way because of his health?

[] Yes (20b)
4[] No (NP)

b. In what way is he limited? ________ (25)

21a. Does -- health keep him from working?

1[] Yes (25)
[] No (21b)

b. Is he limited in the kind of work he could do because of his health?

2[] Yes (25)
[] No (21c)

c. Is he limited in the amount of work he could do because of his health?

2[] Yes (25)
[] No (21d)

d. Is he limited in the kind or amount of other activities because of his health?

3[] Yes (25)
[] No (NP)

22a. In terms of health, is -- presently able to (work - keep house) at all?

[] Yes (22b)
1[] No (25)

b. Is he limited in the kind of (work - housework) he can do because of his health?

2[] Yes (25)
[] No (22c)

c. Is he limited in the amount of (work - housework) he can do because of his health?

2[] Yes (25)
[] No (22d)

d. Is he limited in the kind or amount of other activities because of his health?

3[] Yes (25)
[] No (NP)

23. In terms of health would -- be able to go to school?

[] Yes (24a)
1 [] No (25)

24a. Does (would) -- have to go to a certain type of school because of his health?

2[] Yes (25)
[] No (24b)

b. Is he (would he be) limited in school attendance because of his health?

2[] Yes (25)
[] No (24c)

c. Is he limited in the kind or amount of other activities because of his health?

3[] Yes (25)
[] No (NP)

25a. What condition causes this limitation?
If "old age," ask:
Is this limitation caused by any specific condition?

Enter condition in item C and ask 25b.
[] Old age (NP)

b. Is this limitation caused by any other conditions?

[] Yes (25c)
[] No (25d)

c. What conditions?

[] Only one condition

If 2+ conditions reported in 25, ask:
d. Which of these conditions would you say is the MAIN cause of his limitation?

_______Enter main condition

top
1967

No questionnaire text is available for this sample.


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.