[] 1. Head
[] 2. Spouse
[] 3. Son
[] 4. Daughter
[] 5. Stepson
[] 6. Stepdaughter
[] 7. Son-in-law
[] 8. Daughter-in-law
[] 9. Grandson
[] 10. Granddaughter
[] 11. Father
[] 12. Mother
[] 13. Brother
[] 14. Sister
[] 15. Uncle
[] 16. Aunt
[] 17. Nephew
[] 18. Niece
[] 19. Other relative
[] 20. Non-relative
[] 21. Boarder
[] 22. Domestic helper

_ _ Month
_ _ Year

P5. What is [respondent]'s age as of his/her last birthday?
___

Was [respondent]'s birth registered with the LCR?
If yes, check line

___ Reg?

[] 1. Male
[] 2. Female

[] 1. Single
[] 2. Legally Married
[] 3. Widowed
[] 4. Separated/Divorced
[] 5. Common-Law/Live-in
[] 6. Unknown

[] 1. Yes
[] 2. No. Skip to P10.

[] 01. Cannot see with both eyes (TOT-BLIND)
[] 02. Absence of one eye with low vision on the other eye (PART-BLIND)
[] 03. Can see form or movement but not details of objects (color, surface, lines) (LOW VISION)
[] 04. Cannot hear with both ears (TOT-DEAF)
[] 05. Cannot hear with one ear but with moderate hearing loss on the other ear (PART-DEAF 1)
[] 06. Can hear speech but cannot discriminate the words (PART-DEAF 2)
[] 07. Cannot say words (MUTE)
[] 08. Can say words but stammers (includes cleft-palate and hare-lip with speech defect) (SPEECH DEFECT)
[] 09. Loss of one or both arms/hands (NO ARM)
[] 10. Loss of one or both legs/feet (NO LEG)
[] 11. Paralysis of one or both upper extremities (PARA-ARMS)
[] 12. Paralysis of one or both lower extremities (PARA-LEGS)
[] 13. Paralysis of one arm and one leg (PARA-COM)
[] 14. Paralysis of all four limbs (QUADRIP)
[] 15. Can learn simple communication, elementary health and safety habit and simple manual skills, but does not progress in functional reading or arithmetic (REGARDED)
[] 16. Mentally ill (INSANE)
[] 17. Others, specify (includes multiple disabilities and other combination of arm-leg impairment/paralysis) (OTHER)

[] 1. Yes
[] 2. No. Skip to P10.

[] 01. Cannot see with both eyes (TOT-BLIND)
[] 02. Absence of one eye with low vision on the other eye (PART-BLIND)
[] 03. Can see form or movement but not details of objects (color, surface, lines) (LOW VISION)
[] 04. Cannot hear with both ears (TOT-DEAF)
[] 05. Cannot hear with one ear but with moderate hearing loss on the other ear (PART-DEAF 1)
[] 06. Can hear speech but cannot discriminate the words (PART-DEAF 2)
[] 07. Cannot say words (MUTE)
[] 08. Can say words but stammers (includes cleft-palate and hare-lip with speech defect) (SPEECH DEFECT)
[] 09. Loss of one or both arms/hands (NO ARM)
[] 10. Loss of one or both legs/feet (NO LEG)
[] 11. Paralysis of one or both upper extremities (PARA-ARMS)
[] 12. Paralysis of one or both lower extremities (PARA-LEGS)
[] 13. Paralysis of one arm and one leg (PARA-COM)
[] 14. Paralysis of all four limbs (QUADRIP)
[] 15. Can learn simple communication, elementary health and safety habit and simple manual skills, but does not progress in functional reading or arithmetic (REGARDED)
[] 16. Mentally ill (INSANE)
[] 17. Others, specify (includes multiple disabilities and other combination of arm-leg impairment/paralysis) (OTHER)

[] 00. No Grade Completed
[] 01. Pre-school
[] 11. Grade 1
[] 12. Grade 2
[] 13. Grade 3
[] 14. Grade 4
[] 15. Grade 5
[] 16. Grade 6
[] 17. Grade 7
[] 21. 1st Year High School
[] 22. 2nd Year High School
[] 23. 3rd Year High School
[] 24. 4th Year High School
[] 25. High School Graduate
[] 31. Postsecondary 1 year
[] 32. Postsecondary 2 years
[] 41. 1st Year College
[] 42. 2nd Year College
[] 43. 3rd Year College
[] 44. 4th Year College
[] 45. 5th Year College
[] 46. 6th Year College
[] 47. College Graduate
[] 51. Post-Baccalaureate

[] 1.Schooling/Training
[] 2.Experience/Apprenticeship
[] 3.Other