Literal question
INTERVIEWER VISITS
DATE
DAY __
MONTH __
YEAR ____
INTERVIEWER'S NAME ___________
INT. CODE ________
RESULT* ___
*RESULT CODES
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) ___________________
NEXT VISIT
DATE ________
TIME ________
LANGUAGE
LANGUAGE OF QUESTIONNAIRE: ENGLISH
LANGUAGE OF INTERVIEW*** ___________________
HOME LANGUAGE OF RESPONDENT *** ___________________
WAS A TRANSLATOR USED
YES 1
NO 2
***LANGUAGE CODES
1 NEPALI
2 BHOJPURI
3 MAITHILI
4 THARU
5 OTHER