Mail Survey
Instructions
This questionnaire contains six sections (B through G). Sections B, F, and G ask about
the persons living in your household. The remaining sections (C, D, and E) ask
specifically about one person living there.
The questions appear in bold type. Definitions, clarifications, and special instructions
(such as instructions to skip over questions) appear in italic type.
Please answer every question unless the questionnaire instructs you to "skip" to another
question. Use a dark (No. 2) pencil or pen to enter your answers.
Return your completed questionnaire in the enclosed, postage-paid envelope.
If you cannot locate the envelope, please mail your completed questionnaire
for processing to:
Westat
1650 Research Blvd
RW3665
Rockville, MD 20850
If you have any questions about how to complete the questionnaire, please call:
Jean Wilson at 1-800-937-8281 EXT 2836
Thank you so much for your time and participation. We greatly appreciate your help!
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This voluntary collection of information is authorized by Title 49 of the United States
Code (section 111(c)(2)). According to the Paperwork Reduction Act of 1995, no persons
are required to respond to a collection of information unless it displays a valid OMB
control number.
The time required to complete this information collection is estimated to average less
than 15 minutes.
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