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2022 ACS

Questionnaire form view entire document: text image

17.

a) Is this person deaf or does he/she have serious difficulty hearing?

[ ] Yes
[ ] No

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2022 ACS

Questionnaire form view entire document: text image

b) Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?

[ ] Yes
[ ] No

[G] - Answer question 18a-c if this person is 5 years old or over. Otherwise, SKIP to the questions for PERSON 2 on page 12.

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2021 ACS

Questionnaire form view entire document: text image

17.

a) Is this person deaf or does he/she have serious difficulty hearing?

[ ] Yes
[ ] No

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2021 ACS

Questionnaire form view entire document: text image

b) Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?

[ ] Yes
[ ] No

[G] - Answer question 18a-c if this person is 5 years old or over. Otherwise, SKIP to the questions for PERSON 2 on page 12.

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2016 ACS

Questionnaire form view entire document: text image

17.

a) Is this person deaf or does he/she have serious difficulty hearing?

[ ] Yes
[ ] No

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2016 ACS

Questionnaire form view entire document: text image

b) Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?

[ ] Yes
[ ] No

[G] - Answer question 18a-c if this person is 5 years old or over. Otherwise, SKIP to the questions for PERSON 2 on page 12.

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2011 ACS

Questionnaire form view entire document: text image

17.

a) Is this person deaf or does he/she have serious difficulty hearing?

[ ] Yes
[ ] No

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2011 ACS

Questionnaire form view entire document: text image

b) Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?

[ ] Yes
[ ] No

[G] - Answer question 18a-c if this person is 5 years old or over. Otherwise, SKIP to the questions for PERSON 2 on page 12.

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2006 ACS

Questionnaire form view entire document: text image

15. Does this person have any of the following long-lasting conditions:

a) Blindness, deafness, or a severe vision or hearing impairment?

[ ] Yes [ ] No

Questionnaire instructions view entire document: text image

15. Mark the "Yes" or "No" box for both parts a and b of question 15 to indicate whether the person has any of the conditions listed.

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2000 1%

Questionnaire form view entire document: text image

16. Does this person have any of the following long-lasting conditions:

a. Blindness, deafness, or a severe vision or hearing impairment?
[] Yes
[] No

Questionnaire Text