(Enter the number of members in your household who are presently living together under the same roof or on the same lot.)
__ __ persons
For each member of your family, enter their personal relationship to you, their sex, age, student or worker status, living with you or separately, and marital status.
(Please include here your husband and any children living separately from you due to work, schooling, living with their spouse or in-laws, or being hospitalized.)
Personal relationship to you | Personal relationship to you | Sex | Age | Student or worker status | Living together or separately | Marital status | |
---|---|---|---|---|---|---|---|
1. | ME | = 0 | 1. male 2. female |
1. Together 2. Separately |
1. Single 2. Married |
||
2. | 1. male 2. female |
1. Together 2. Separately |
1. Single 2. Married |
||||
10. | 1. male 2. female |
1. Together 2. Separately |
1. Single 2. Married |
00 Me 01 My first child 02 My second child 03 My third child 04 My forth child 05 Fifth or later child subsequent 06 My parent |
07 My grandparent 08 My brother or sister 09 My child’s spouse 10 My grand child 11 Other relative 12 Other |
The following code table is not included in the questionnaire.
1. Preschooler 2. Student in grades 1 to 3 of primary school 3. Student in grades 4 to 6 of primary school 4. Junior-high school student 5. Senior-high school student |
6. University or college student 7. Vocational school student 8. Worker 9. Unemployed 10. Other |