4. What is Person 1's age and what is Person 1'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) _ _ _
Month _ _
Day _ _
Year of birth _ _ _ _
2. How is this person related to Person 1?
[] Husband or wife
[] Biological son or daughter
[] Adopted son or daughter
[] Stepson or stepdaughter
[] Brother or sister
[] Father or mother
[] Grandchild
[] Parent-in-law
[] Son-in-law or daughter-in-law
[] Other relative
[] Roomer or boarder
[] Housemate or roommate
[] Unmarried partner
[] Foster child
[] Other nonrelative
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) _ _ _
Month _ _
Day _ _
Year of birth _ _ _ _
Age (in years)_ _ _