Questionnaire Text

Questionnaire form view entire document: text image

15.

a) Did this person live in this house or apartment 1 year ago?

[ ] Person is under 1 year old -> SKIP to question 16.
[ ] Yes, this house ->SKIP to question 16
[ ] No, outside the United States and Puerto Rico - Print name of foreign country, or U.S. Virgin Islands, Guam, etc., below; then SKIP to question 16.

______________________________
[ ] No, different house in the United States or Puerto Rico

Questionnaire instructions view entire document: text image

14a. If the person is a baby under one year of age, mark the "Person is under 1 year old" box. Then skip to the questions for the next person. Do not complete any more questions for the baby.

If the person lived in the same house or apartment one year ago, mark the "Yes, this house" box and then go to instruction F.

If the person did not live in the United States one year ago, mark the "No, outside the United States" box and print the name of the foreign country, or Puerto Rico, Guam, etc., where the person lived. Be specific when printing the name of foreign countries, for example, specify whether Northern Ireland or the Republic of Ireland (Eire); North or South Korea; England, Scotland or Wales (not Great Britain or United Kingdom). Specify the particular country or island in the Caribbean (not, for example, West Indies). Then go to instruction F.

If the person lived somewhere else in the United States one year ago, mark the "No, different house in the United States" box. Then in items 14b and 14c, provide the city, county, state and ZIP code where the person lived one year ago.