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Questlonna~r9 R-f<br />

Q1(A)<br />

Qumstaon No<br />

CHECK A<br />

CNECK B<br />

REcORD TYPE<br />

Codzng Shmet<br />

Rafarmncm<br />

21(A)<br />

CHK A<br />

CNK B<br />

FS TYPE<br />

No of<br />

Boxms/<br />

;haractars<br />

,<br />

)<br />

2<br />

2<br />

Coding Instructions/ Remarks<br />

values -5-20<br />

Personal Ldmal<br />

Enter number.<br />

number 7<br />

OK ........... .. ....... -1<br />

Nono ........ . ....... .. -4<br />

All that come/God’s WL1l. -5<br />

Valuas -3-4<br />

self completion not<br />

of farad ... . ..... . 01<br />

Self compaction offer-d,<br />

refus*d ... ........... 02<br />

self complatlon off-red,<br />

accapted<br />

SLnCjh WOCOOn .. ......... os<br />

Marr LOd/ cohabit ing women 04<br />

W ~dowed, dlvorcmd,<br />

separated women ... . . 05<br />

Man . .. ... .... ...... 06<br />

~,s . .4<br />

Marr>ed . . . . . . . . . . . . . . 01<br />

W~dow9d , 0 Lvoxcmd ,<br />

.Saparated . . . ..-. . . . . . . 02<br />

Cohabltmg ... ........ 03<br />

Sulgle ..................04<br />

Record Tvua Ce% co-w<br />

Aged 60 or ovmr ...... . . 00<br />

Fam~ly Lnformation amct Lon<br />

applies ............ ... 20<br />

.salf cOmpl*t LOn . .<br />

s ~ngla womon .......... 21<br />

MarrLad/COhabLtlng Wommn. 22<br />

Widowed/dLvorced/ sepazatod<br />

wommn ....... .. ...... 23<br />

Man ........ ...... 24<br />

143

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