IS THIS A GOOD TIME FOR CHILD? |
YES |
01 |
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GO TO SECTION 0 |
NO |
00 |
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START
INTERVIEW, RETURN TO SECTION 0 WHEN CHILD IS READY |
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SECTION
0 CHILD ASSESSMENT
AND VIDEOTAPE |
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INTERVIEWER: WHEN ARE YOU
DOING THE BAYLEY? |
AT START OF VISIT |
01 |
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AFTER START OF QUESTIONNAIRE |
00 |
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Which section? |
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WHEN YOU DO THE
BAYLEY OR AT ANY TIME WHEN THE CHILD IS PRESENT, PRAISE
(HIM/HER) AND NOTE PARENT’S REACTION.
YOU WILL CODE PARENT’S
REACTION IN QUESTION 10.12. |
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INTRODUCTION TO THE BAYLEY: |
0.1 |
Now I would like to give (CHILD)
a chance to show us some of the skills (he/she) has been learning.
These activities are designed to be fun for toddlers and we
think (he/she) will enjoy most of them. I
will need a few minutes to get my materials set up. Would
you please see if (CHILD) needs anything such as changing
or a snack so that (he/she) will be comfortable. (Also, we
need to make sure that the other children let (CHILD) do these
tasks by (him/her)self). |
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0.2 |
All the toys we will use are non-toxic,
clean and safe, and have been thoroughly washed. We don’t
expect (CHILD) to be able to do all the tasks. They are designed
for a wide range of children. Please don’t try and
help (him/her) out. |
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PROCEED
WITH BAYLEY BOOKLET. |
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0.3 |
AFTER BAYLEY IS COMPLETED
ASK PARENT: |
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A. |
How typical was your child’s
behavior? Did (CHILD) play the way (he/she) usually does? Was
(he/she) as happy or upset as usual? As alert and active as
usual? |
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CIRCLE ONE |
VERY ATYPICAL; PARENT NEVER SEES THIS TYPE
OF BEHAVIOR |
01 |
MOSTLY ATYPICAL |
02 |
SOMEWHAT ATYPICAL; PARENT SEES THIS TYPE
OF
BEHAVIOR ON SOME OCCASIONS |
03 |
TYPICAL |
04 |
VERY TYPICAL; PARENT ALWAYS SEES THIS TYPE
OF BEHAVIOR |
05 |
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B. |
Do you think (CHILD) did as well
as (he/she) could? Have you seen (CHILD) do better or worse
on the type of things we worked on? |
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CIRCLE ONE |
POOR INDICATOR OF CHILD'S OPTIMAL PERFORMANCE;
CHILD ALWAYS PERFORMS MUCH BETTER |
01 |
BARELY ADEQUATE |
02 |
ADEQUATE; CHILD PERFORMS AS WELL, ON AVERAGE |
03 |
GOOD |
04 |
EXCELLENT; CHILD NEVER PERFORMS BETTER |
05 |
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0.4 |
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COMPLETE SECTIONS 1 (BAYLEY DISRUPTION
RATINGS) AND 2 (BEHAVIOR RATING SCALE) IN CHILD ASSESSMENT
AND VIDEOTAPE PROTOCOL--CHILD RECORD BOOKLET. |
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0.5 |
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START VIDEOTAPE PROTOCOL. |
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- READ GENERAL INTRODUCTION
- SET UP EQUIPMENT
- OBTAIN CONSENT
- CONDUCT TASKS
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SECTION
1 RAISING A BABY |
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1.1 |
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ITEMS DELETED FROM THIS VERSION
TO PROTECT
AUTHOR/PUBLISHER COPYRIGHT. SEE PAGE ii FOR FULL CITATION. |
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1.2 |
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ITEMS DELETED FROM THIS VERSION
TO PROTECT
AUTHOR/PUBLISHER COPYRIGHT. SEE PAGE ii FOR FULL CITATION. |
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1.3 |
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ITEMS DELETED FROM THIS VERSION
TO PROTECT
AUTHOR/PUBLISHER COPYRIGHT. SEE PAGE ii FOR FULL CITATION. |
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1.4 |
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ITEMS DELETED FROM THIS VERSION
TO PROTECT
AUTHOR/PUBLISHER COPYRIGHT. SEE PAGE ii FOR FULL CITATION. |
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SECTION
2 CHILD'S HEALTH |
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The next questions are
about (CHILD)’s health. |
2.1 |
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Overall, since (THIS MONTH)
of last year, would you say (CHILD)'s health has been . .
.
PROBE: In the last 12 months. |
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CIRCLE ONE |
Excellent, |
01 |
Very good, |
02 |
Good, |
03 |
Fair, or |
04 |
Poor? |
05 |
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2.2 |
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Has (CHILD) had a cold or other
kind of respiratory infection in the past week? |
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2.3 |
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Last night, how did (CHILD) sleep?
Did (he/she) sleep through the night or wake up? |
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CIRCLE ONE |
SLEPT THROUGH THE NIGHT |
01 |
WOKE UP DURING THE NIGHT AND NEEDED
CHANGING OR FEEDING |
02 |
DID NOT SLEEP WELL |
03 |
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2.4-2.9 |
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DELETED FROM THIS VERSION
- MOVED TO PSI. |
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2.10 |
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Since (CHILD) was released from
the hospital after (he/she) was born, has (he/she) stayed overnight
in a hospital? |
YES |
01 |
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NO |
00 |
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GO TO Q2.12 |
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A. |
Up until (his/her) first
birthday, how many different times has
(CHILD) stayed in a hospital for at least one night?
PROBE: Please do not include
time spent in hospital at birth.
|___|___| TIMES |
NONE |
00 |
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GO TO Q2.11A |
DON'T KNOW, DID NOT HAVE CUSTODY THEN |
-1 |
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B. |
Altogether, up until (his/her)
first birthday, how many nights did (CHILD)
stay in a hospital? PROBE: Please
do not include time spent in hospital at birth.
|___|___|___| NIGHTS |
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C. |
(Was this/Were any of these) hospitalization(s)
because of an accident or injury? |
YES |
01 |
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NO |
00 |
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GO TO D(2) |
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D. |
CODE WITHOUT ASKING IF ONLY
ONE HOSPITALIZATION: |
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How many of the (NUMBER IN Q2.10A)
hospitalizations were because of . . . |
1) An accident or injury? |
|___|___|___| TIMES |
2) Dehydration? |
|___|___|___| TIMES |
3) Pneumonia? |
|___|___|___| TIMES |
4) Jaundice (yellowing of skin)? |
|___|___|___| TIMES |
5) Something else? (SPECIFY) |
|___|___|___| TIMES |
_____________________________________________ |
|___|___| |
6) Bronchitis/respiratory stress/lung or
breathing problems |
|___|___|___| TIMES |
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2.11 |
A. |
And since (his/her)
first birthday, how many different times has (CHILD)
stayed in a hospital for at least one night? |___
|___| TIMES
NONE |
00 |
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GO TO Q2.12 |
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B. |
Altogether, since (his/her)
first birthday, how many nights did (CHILD) stay in a hospital?
|___ |___|___| NIGHTS |
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C. |
(Was this/Were any of these) hospitalization(s)
because of an accident or injury? |
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YES |
01 |
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NO |
00 |
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GO TO D(2) |
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D. |
CODE WITHOUT ASKING IF ONLY ONE
HOSPITALIZATION: |
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How many of the (NUMBER IN Q2.11A)
hospitalizations were because of . . . |
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1) An accident or injury? |
|___|___|___| TIMES |
2) Dehydration? |
|___|___|___| TIMES |
3) Pneumonia? |
|___|___|___| TIMES |
4) Jaundice (yellowing of skin)? |
|___|___|___| TIMES |
5) Something else? (SPECIFY) |
|___|___|___| TIMES |
_____________________________________________ |
|___|___| |
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2.12 |
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Since (CHILD) was born, how many
times has (he/she) gone for well-baby checkups? Was it . . . |
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PROBE: |
These are visits to the doctor when (he/she)
isn’t sick, but to get (him/her) checked over or
to get vaccinations. |
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CIRCLE ONE |
Never, |
01 |
Once or twice, |
02 |
3-4 times |
03 |
5-9 times, or |
04 |
10 times or more? |
05 |
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2.13 |
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The next few questions are about
ways in which children can get hurt.
If (CHILD) swallows something dangerous or poisonous,
do you have anything in the house to make (him/her) vomit? |
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PROBE: |
Dangerous or poisonous products such as
drain opener, cleansers, dish detergents, floor cleaners,
rug cleaners, disinfectants, adult medications, etc. |
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YES |
01 |
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NO |
00 |
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GO TO Q2.14 |
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A. |
What do you use? |
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IPECAC |
01 |
OTHER (SPECIFY) |
00 |
_____________________________________________ |
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FINGER/TONGUE DEPRESSOR |
03 |
MILK |
04 |
CASTOR OIL |
05 |
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2.14 |
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If you had to get the phone number
of the poison control center in an emergency, do you know how
to find it? |
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PROBE: |
This is a hotline that provides information
to callers on what to do for specific types of poisoning. |
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YES |
01 |
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NO |
00 |
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GO TO Q2.15 |
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A. |
What would you do? |
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B. |
Where do you keep the number? |
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2.15 INTERVIEWER CODE: FAMILY
LIVES:
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IN AN APARTMENT |
01
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A. WHAT
FLOOR?
|__|__| FLOOR |
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IN A HOUSE |
02 |
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PUBLIC SHELTER |
03 |
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2.16 |
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CODE WITHOUT ASKING IF OBSERVED: |
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Do you use gates for the top of
the stairs or use something else so (CHILD) stays off them? |
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2.17 |
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CODE WITHOUT ASKING IF OBSERVED: |
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Do you use guards or gates for your
windows? |
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PROBE: Do not include
gates for burglars. |
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2.18 |
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Do you have covers on all
your electrical outlets that don’t have plugs in them?
PROBE: Covers can be
plastic safety covers, tape or other coverings. |
YES |
01 |
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NO |
00 |
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GO TO Q2.19 |
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A. |
Do you have covers on
the electrical outlets that (CHILD) can reach? |
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CIRCLE ONE |
HAS OUTLET COVERS |
01 |
DOESN’T HAVE OUTLET COVERS |
02 |
PARENT STATES ALL OUTLETS ARE INACCESSIBLE |
03 |
PARENT STATES DOESN’T NEED COVERS |
04 |
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2.19 INTERVIEWER CODE: DOES
HOME HAVE SMOKE ALARMS?
YES |
01 |
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GO TO Q2.20A |
NO |
00 |
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DON’T KNOW, NOT OBSERVED |
-1 |
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2.20 |
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Does your (house/apartment) have
smoke alarms? |
YES |
01 |
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NO |
00 |
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GO TO Q2.21 |
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A. |
As far as you know, are the batteries
working in the smoke alarms? |
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CIRCLE ONE |
YES |
01 |
HARD WIRED TO ELECTRICAL SYSTEM |
02 |
NO |
00 |
DON’T KNOW |
-1 |
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2.21 |
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How often does (CHILD) ride in a
private car? Would you say . . . |
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CIRCLE ONE |
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Every day, |
01 |
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A few times a week, |
02 |
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A few times a month, or |
03 |
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Never? |
04 |
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GO TO Q3.1 |
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A. |
When you take (CHILD) in a car,
do you usually put (him/her) in a car seat, booster seat, in
the regular seat with a seatbelt on, or does (he/she) just sit
in the car? |
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CIRCLE ONE |
CAR SEAT |
01 |
BOOSTER SEAT |
02 |
REGULAR SEATBELT |
03 |
PARENT'S LAP |
04 |
NO RESTRAINT |
05 |
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SECTION
3 HOUSEHOLD COMPOSITION |
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3.1 |
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Not including
you and (CHILD), how many other people lived in this (house/apartment)
with you last month? PROBE:
In the last 30 days.
|___ |___| |
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NO ONE ELSE--ONLY SELF AND (CHILD) |
01 |
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GO
TO Q3.4 |
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3.2 |
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Are any of these people (your/MOTHER’S)
spouse or partner? |
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3.3 |
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How (are these people/is this
person) related to (CHILD)? CIRCLE
CODE THEN RECORD NUMBER OF PEOPLE IN BOXES. |
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FATHER |
1 |
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|___|___| |
STEPPARENT |
2 |
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|___|___| |
AUNT, UNCLE, GREAT-AUNT OR GREAT-UNCLE |
3 |
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|___|___| |
GRANDPARENT OR GREAT GRANDPARENT |
4 |
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|___|___| |
SIBLING (BROTHER OR SISTER) |
5 |
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|___|___| |
STEPBROTHER OR STEPSISTER |
6 |
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|___|___| |
NEPHEW OR NIECE |
7 |
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|___|___| |
COUSIN |
8 |
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|___|___| |
OTHER RELATIVE OR IN-LAW |
9 |
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|___|___| |
NON-RELATIVE ADULT (INCLUDE MOTHER’S
PARTNER, BOYFRIEND) |
10 |
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|___|___| |
NON-RELATIVE CHILD |
11 |
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|___|___| |
OTHER (SPECIFY) |
12 |
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|___|___| |
__________________________________________________________________ |
|___|___| |
MOTHER |
13 |
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|___|___| |
TOTAL SHOULD EQUAL NUMBER IN Q3.1 |
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________ |
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3.4 |
A. |
(Do/Does) (READ
PERSON) live in this state, in another state or outside of mainland
USA? FOR CATEGORIES WITH MULTIPLE
PEOPLE, CIRCLE ALL THAT APPLY |
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THIS
STATE |
OTHER
STATE |
OUTSIDE
MAINLAND
USA |
DECEASED/
NO SUCH
RELATIVE |
a. |
Your mother |
01 |
02 |
03 |
-4 |
b. |
Your father |
01 |
02 |
03 |
-4 |
c. |
Any of your brothers
or sisters |
01 |
02 |
03 |
-4 |
d. |
A present or past husband |
01 |
02 |
03 |
-4 |
e. |
Any other of your children
|
01 |
02 |
03 |
-4 |
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f. |
Any other family members who you are close
to |
01 |
02 |
03 |
-4 |
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