Questionnaire Text

Questionnaire form view entire document:  text  image
4. What is Person X's age and what is Person X's date of birth? Please report babies as age 0 when the child is less than 1 year old.
Print numbers in boxes.

Age (in years)
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Month
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Day
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Year of birth
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Questionnaire instructions view entire document:  text  image
4. For each person, print this person's age and month, day, and year of birth. Print the age at the last birthday. Do not round the age up if this person is close to having a birthday. If the exact age is not known, provide an estimate. Print "0" for babies less than 1 year old.