V. Information on members of the household
1. All persons
7. Do you have any of the following disabilities?
(You may mark more than one)
[] 1 Blindness
[] 2 Deafness
[] 3 Muteness
[] 4 Mental retardation
[] 5 Paralysis or loss of use of an upper extremity
[] 6 Paralysis or loss of use of a lower extremity
[] 7 No disability