INDEX SURREYG.H.S.lY+~FI~ 1979 - · PDF fileNU.lSERW GiIIDm UNOm 16 INHWS-LO derivedvariable....
Transcript of INDEX SURREYG.H.S.lY+~FI~ 1979 - · PDF fileNU.lSERW GiIIDm UNOm 16 INHWS-LO derivedvariable....
LOCATION INDEX
IDUSJN3Hw.selmld
PJZICNHmA-dd
UP.M.NWmsehold
AIUn
WA-p:
Knin
Hm.ehlad
YFAR
Hausehold
museh~$NPPHR3LD
HousepyIKHII.ZHH
lhls Is,?
NAEHHOIJ3Household
NPERFAM ‘Ttns M a
‘mls lsfHK5TRm
‘llnsIS aNFAMIH
!nlls,lsaKHU5F
llns is aNcrlU16F
lhis M a
SURREYG.H.S.lY+~ FI~
1979
ECUSEHOJIIILWWIFICAW WSRS
Sckdule,p.1.G=P.APHIC4L REGI@j$F M2K~S&sdule,p.1.wlETHERURBANcRRln?ALARE3Schedule,p.1.G= ~ NIMB~Sch&3ule,p.1.Mmmim ‘Im’ERvIp,Schedule,p.1.“WAR OF INmFwImSchedule,p.1.NO. OF i+3W5KIUX R1’S?W31AIY)~S-Khedule,p.l.TQTALNO. OF P- IN HCUSEl+3LD.Whedule,p.l.NU.lSERW GiIIDm UNOm 16 IN HWS-LOderivedvariable.‘lWIAL,AIYJLTS~6@4 IN H3JSH+3L0Schedule,p.1.NO. OF P~ IN FAMILYLBUTderIvedvarlaple.,=~= ‘S HCUSE133111~E’derivedvarlaple.SmmmE a? mUSm3mderlvd varl~le.NO. OF FAYHX ll?I’lSIN IKUSQK)LOderlvadvariable.M3.OFUiILDFUlj,UJOER 5 IN FM4JLYWITderivedvari~le.,NO. W CHI~RE2J~Ei7 16 IN FAMILYWITderivedvariable.
NPEF.INr N3. OF PEPKNS‘ ‘hmwqiED %fMS.PmxI&4Hmsehold Sckdule,p.1.
FAMILY ‘ WSEAND Ah) WIFE m FAMILYWIT‘lInsM a derived‘hrkle:
PmtmHmeehold
Hms+oldKSEMIFE ‘
!ioueelmldStx
IKmseholdME
Hms@oldKtIKJ?”
‘Ilns,1saHUSm?”
‘llms.l+~aWIF14SS
llns M a
rNDlvIlxmLIm. m Uw31 PIIBcNm H-mmSchedule,p.1.RFIATICNSHIP‘k HE4D q KllSE-K)LDSchedule,p.1. “ , (
RES~ IS H’KILD’SHCIJSWIFEL ~S&edule,p.1.SExca?m Km&’Sckdule,p.1.WE IA91’BIIUMW.YSchdule,p.1.AGE [email protected]@HJSmNpaosalmk varleble.XEOFWIIEaosslti varl~le.
,,..,..“,. , > /L_, ~7wT~ ~-, ,, \. ..h, ..
}mw~!mld Schedule,p.1.FMIJNIT FAMILYUNIT T3 WI~ RESPWDE?W BEUW3S
FkxsetildSchedule,p.1.INOIV.KQ4HERKS. @ FAMILYUNIT
This is a derivedvariable.a3LouR mTIHwIwER ASSESWSNI’FlO! CX3SERVATICN
Housdwld Schedule,p.1.KIIJIW=@ REL4TIVE LIVES NFARBY ~IIWJZ,60+ H-w,
Fbusehold Sch@5ule,p.2.,Q.l.K_Itm+ol RELATIVELIVINjNEWW’i- 1
IbusehcldSchedule,p.2.,Q.2.KIwiH02 RE2ATIVELIVIIGNEWSY - 2
Hmsehold Sckdule,p.2.,Q.2.KIlwm3 FEIATIVELIVII?3NEARBY- 3
HouseholdSchedule,p.2.,Q.2.KIwim4 RELATIVELIVIN3NEARHY- 4
Hmsehold Schedule,p.2.,Q.2.cAFJwAN IJVIN3 IN uw+v.w w W5mAT
Household.S&sdule. PresentAcccmmdationSecticn.AGEIXJJSS PERI~ W PF&3E2?TACC@MXXTIIIJE?IJILT
HouseholdSchedule. ~eaent Acc@mdation Secticn- Q.3.mln BWH WI’IWW WVFER IN P~Ffr?TAC?XM.
Hmsehold S&e&de. Fresentk~aticn Sectim - Q.4.Lm FIUSH!lUIIJ,TIN PRES.AOXFI. - I.CCATION
I+wsehcldSChedule. FTesentAammrdation Section- Q.5.sEnIwms NO. OF BEERMIS IN PRESE2WA(XCM.
HcuseholdSchedule. Presentk~atim Section- Q.6.EmXmK wHETHERBEoRom5usEo mRoxxmJ3
HcuseholdSchedule. FresentAcommdation Section- Q.7.KITCHEN wETHERHAs sEPAR4TERcm FORm3KIK
Wusehold Schedule. FresentAxomm3ation Section- Q.8.KITSIZE SIZEOF KI~
HcuseholdSchedule. FresentAxc+mwdationsection- Q.8(a).KITEAT WHEXIERKI’fCHENFOR NEALS;SI’ITIFGF02.I
FiwseholdSchedule. FresentAxcmmx3ationSection- Q.8(b).Flxr’lS MM8ER OF “OIHER’RCU.!.5
HouseholdSchedule. Present kxmmdation Section- Q.9.NPFRar.1 NU4HEROF PIKMJ?,PER FKXM
This is a derivedvariable.hTIEIHSRANY “I+XMS’SHARED
HouseholdSchedule. PresentAxomrcdation Section- Q.10.BATHSHRE WE113ERJYWliSHAREDWI’IHUIllD? H-H
Hwsehold Sckdule. PresentAxcxmcdationSection- Q.4.LfxHiRE hHEIllRRFLUSHU13~WI’IH UI’H&RH-H
Hcmehold Schedule. PresentAxOmrcdaticmSection- Q.5.mDSHARE -ER OF BEOFKlliSSHARED
Hwsehold Schedule. Fresent.Wxnmm3ationSection- Q.6.KITSHAFE WW31HERSHARESKJKHENWIIICJIHFR H-H
FkmseholdSchedule. Present.%xwmo3ationSection- Q.8.NlM8EROF “OIHER’KXXS SHAF@
HcuseholdSchedule. FresentFcmmcdaticn Secticm- Q.9.CE2WPALHW+TIW IN Af.XIlW3JAlTl@J
Emsehold schedule. FTesentFxxxmKdatim Section- Q.12.TYPE OF FUEL FOR CENIWILHEA.TING-1
fixeeholdSchedule. Presant?fxcmwdaticmSection- Q.12(a).TYPE OF FUl?LFGR CDJI’$ALHIY+TIIW-2
HouseholdSchedule. FresentAccsxmxxlaticm.%ction– Q.12(a).CHIWWN CRWRAL HEATINGMUN NL4T IN WIM’El?
HouseholdSchedule. Presentkcmmdation Section- Q.13.IwEU M4rNHlmTIFmcE2mRAL HmTll?s-1
HcuseholdSchedule. Fresentkcmmdation Section- Q.14.iwEL2 WIN HE4T IF NOT (2EtWRALHEATING-2
Hwsehold Schedule. BeSent ?kmfmrdaticmSection- Q.14.FUSL3 MUNHEAT IF NOT’G2WRA.LHFATIIW-3
liouselmld-iUOm
muaeholdTvi34
Hws.eholdFRICCiE
tbuae?mldFWE%SI?
kXISehOl dVAclm
Fkme.eholdWASmAm
HouseholdDFU~
HouaekldDISWUEW
HouseholdFfm?E
Houa.eimldlwAizS
Mxeelkald
FkmaelmldmEFIM1’1
mxisdmld
Houeelmldmm
WuselmldKlwImNl
MmaeholdalwVALl
WuaeholdmNErNsl
Ikuseholdmmml
I+mseholdYlwmPIA
I?ouaelmldYNcYrI?PIB
Schedule. Freaentkmmmmlatlcm *ctlcm - Q.14.lvsErcmLm
Schedule. Present A2cxrmmdatlrn Sectlcn - Q,15.l’VSEl’~ANDWI~ C:P(Schedule. Preeentkcxmmdaticm Sectlcm- g.15.-GER4~ IN ~TI@Jtihsdule. Resent Accmmxiatmm Sectnm - Q.15.FREEZERIN A~TICNSchedule. FreaentA2.3mmdatlon sectlcm - Q. 15.VAClJU4CLGWER IN ACCU+13MTICIJS@edule. PresentA2ccmm3atxm SectIon- Q.15.klAwI.tGUwiIta3 IN ~TI~ ‘Mule. Fresent Pcamrcdaticn Sectmn - Q.15.TLMBU DRIER IN MDM43MTIcNschedule. Present?kxomcdatlcm*tlon - Q.15.DISWi?k5HSRIN AOxmmMTImJSdedule. PresentAcOxmxlaticmSectlcm- Q.15.TEMPFKhISIN AOXI+KDWICNSckdule. PresentAcaimmdatlcm sectmn - Q.15.hW?EERW~AWIAPDZFCR USE BY H-HSchedule. FTeeent ~atlcn SectIon- Q.16 6t?wBmwmmISxNm YmitSckdule. F!reaentAcccmmdatifm .%ctlm - Q.17 &KNIHWFIIfE71?TmimSchedule. Resent ~atmm Sectlm - Q.18.~ OF FIIWI’THEFT
3’7
16(a).
17(a).
S@edule. PresentAxcmncdationsectlcn- Q.18.hWEl%IRM’ THEFT SUXESSTUSckdule. presentkxxmnmdatlcmSection- Q.19.kHEIHERCASH U1-TAl@@T lliETT+Schedule. PresentAfxcmmdatlcnSection- Q.19(a).VALUEOF 002~ TAKEN ~lST m,schedule. Resent Axxmm5at.mn Section- Q.19(b).WHEIWERIIW’REDCZXiXTAKEN~Sr _ScFedule. Resent Acammdatvm Section - Q.19(b)(1).WEllilRFWKEWEDTO=ICE$J.ST_ScYedule. Present?cccmdaticn Sectmn - Q.20.A. KE%SUJNOT REKRTEO $1S3’e,Schedule. PresentImxmm5aticm Sectmn - Q.20(a).B.IWWIJ~REKnUEO%l=’IHEFI%
Hmselwld Schedule. PresentJk2mm%3atimMw1131xsxrxm THEm
Householdschedule. PresentAxcmmcdatlcmYFARoFs-mEm
Muaehald Schedule. Pre*nt Jkcmum3atlcmwliEIHm2mmEFI’8UcCESSFUL
Ehsehold Schedule. PresentAeccmmdatmn
S&txm - Q.20(a).
Section
Sect Ion
sectlcmlwmscN2 WiEIHEXC2SHCRGCXXETH@D m
Fkmaeho.ldSchedule. Resent AccmmcdationSectumVAIJJEOFGCIXSTAKIN@Dm
l+xsekld Sckdule. Resent kccxmcdaticmSectionGoNErNs2 KHETWt IN50FEl_TAKEN#@lTl_EZ@
Howeimld Schedule. PreeentAmxmmxlationsectmnhmm+EllFmwU’ED m POUc!l!a -
Homelmld Schedule. Resent Axxmmdatikm Se&tim
- Q.18.
- Q.18.
- Q.19.
- Q.19(a)
- Q.19(b)
- Q.19(a)
- Q.20.YNOTRF2A A. RIXXNNOT FSFOR2ED$2N)HZI$ “
Mmaeimld Schedule. PresentAcccmmlatlm *ctmm - 0.20(a).
1).
YNY13W2B. .
B.IW.WF?NXHZXUTIO%~W4IkxaeholdSchedule. Resent Amxxmdatmn Sectlcm- Q.20(a).
Atil Lbsi iti>L>r~ A_’.il!.illA’l’ia 0$,?3; IX RC\TtljHm.zsehold Sckdule. Tenure & busing Costs Section - Q.21.
awl IN Wlix+zMPFs3PEKIYckUim - 1‘Ibisis a derivedvariable
0dWd+02 xNWkixE WM3P$tWEKlYUWm-2mis is a derivedvariable.
G@Wxl’ A03M9XWT@&WNlXl CUITUGH1’OR M3KIWAGEWxsekdd Schedule. lknure& kxaing CostsSection- Q.22,
CM’JH5JWusehold
@NREPAYlbueehold
HouseholdMmIWIOl
HousetildM3RW2
HousetildM3mllm
HcuselxidWmrEMPL
IbuseholdMxlMxr
FkmseholdM9mmm?
WuseholdMmrE2iDP
13mseholdMxl’Am
HouseholdM3Kr.kml
mis is aImrrrm
HouseholdRATEREM
HW UWE17 OE?l’AIIWlPmPERIYSck?dule. Tenure & busing @sts %ction - Q.23.REP.WMENIGF LAANIMmmAGE NlmSSAWSchedule. Tenure&I-busingCnstsSection- Q.23(a).TIME SINCE 8MJMIIW CU1’RIGKl’~schedule. ‘lknuce& Musing restsSectim - Q.24.lsr SOURCEOF LmN, MxIW@Schedule. ‘lknme& musing CostsSection- Q.25.2ND WJRcE OF LmN,mKmlGESckdule. Tenure& Ikn?sirqCostsSection- Q.25.3RD SCURCEOF IA4N,M3RIWGESckdule. Tenure& Wusing Oxts Section- Q.25.PAR3’OF 1.lW@3UYMiE FTKM E?@=schedule. ‘IknWe& musing restsSecticm- Q.25(a).MWOYER PIKWIDESK41N I.MN@?ltiAGESchedule. Tenure& IimsingCostsSection- Q.25(a)(i).M3RIG%GEPAYMENTS03VER INTEREST& PRIIWSchedule. ‘knure & m~ing coats%ction - Q.26.ENOMW1’ FOLICYFOR M3RIGAGEPRIN3PALSchedule. ‘Iknure& musing CostsSection- Q.26(a)(i).AMUNl?OF I.ASl’m~ PAWENTSchedule. TenureG m~ing CostsSection- Q.27A,270.A}~~ OF ~~GE pm ~~ mderivedvariable.~ OF TIMS COVEREDBY M3RTGAGSPAYME2WSchedule. Tenme & EimsingCostsSection- Q.28.h!HEIHERRATE REB%’IEIASW lYR ~II?3
HcusekoldSckhle. Tenure& IbusingCostssection- Q.29.RATEREm AMxm RATE REexlEPm cAL.MI’H.*Im
This is a d~ived variable.Rmrm RENTEOAO.2UW3MTlm FURNISRED
musehold Sckdule. Tenure& musing Costs.SeCtim- Q.30.REcnHm
musehcldRFNI’JC8
IkxxseholdREmFRcM
museholdmNDIJxD
FbuseholdPAYRRW’
MuseholdlWrES
museholdWATERRAT
WuseWld
museholdnmmr
Musehold
FwJNFsS PREMISIS~INRlmSckdule. ‘Mwxe & musing CostsSection- Q.31.AOXM.LINKEDWIm JOB OF H-H31JIMNBERSckdule. ‘lknure& m~ing CostsSectim - Q.32.LANDLORDOF ACCOMV311kTIm?Schedule. Tenure& musing Costs%ction - Q.33.LANDLORDLIm m SIT%Sckdule. TStUKe& IbusingCostsSection- Q.33(a).WHETHERPAYS RENT FW AOXl@W!TICNSchedule. Tenure& musing CostsSection- Q.34.WEIHERRJM’ IKUJDESRWESschedule. mnuCe & busing Costs“Section- Q.34(a).MEmm OF PAY FoRWU’ERRATEs;Schedule. ‘lknuce& m~ing CostsSection- Q.34(a)(i).iiHEmimPAYszWfmmsmpMs mmSctedule. Tenure & musing @sts Section- Q.34(b).wHYIWREmm FUlrBPAIDSchedule. ‘MIWe & Rxsaiq ChstsSection- Q.35.
liEXTIWI MAT OF MUCIWIW’lCNWw+old Schedule. Tenure& Musing Costs sectlca- Q.36.
REmwlTl AMx.NroF RENr PER CMmmRr.KNIliltm 1s a derived varleble.
NEI’RIIW~AIDPFX CAMNIMRm?_IYI‘llusIS a derlvd veriable.
REmAurc NEr mm’ CnARGEnPER CkL.Kt?rH‘1’hIs1s a derivedmrmble.
RmITIME IJ+WYIOF TIMSCOVFREO BY W PAkUE??l’I+xsehold Schedule. Tenure& tbuslrrgCosts *ct]on - 0.37.
NO.WS. FUN! H31.JIMY-FfZllFUELICALmi.l-kxseholdSchedule. Tenure& W=mq Cbsts Section- Q.38,38(a).
Rmv-rEx ~ RSBVE FKFl L.A. b RWIRATFSBxsehold Schedule. TenWe & I+3wingCosts *ctmn - Q.39.
P.EWTE mSAm, AUCMANm Em RWr, -Hcw+old Sck3ule. mnure & musing ~ts Sectmn - Q.39(a
PxlzRm KHEmLERRAmmB. IAsrlYRIF NmmHmsehold =hedule. Tenure& I+msmg Cbsts Section- Q.39(b
AWUt?rm REW+TzPER CAL. t.ntiln‘11-nsIS a derivedvarmble.
A$mrm RATE REB4m PER CAL.ME4.-FU2?MMThis 1s a derivedvarmble.
WHEm.m RE2t1’PmAm IxL. mGPC6S Ffm?’rHmsehold Schedule. TenIre& b~mg Costs sectim - Q.42.
REBTRATE PAllZH’IE D~ FR1.lR12?l’AMWNTWxs.ehcldSchedule. ‘Denue& Wmslq COsts SectIon- Q.42.
TYPE OF A0X?4.CIXUPI~ BY HCUSH+C)LDI+xseholdSchedule. Eack Paae - O.A.
NFums FUXR LEVHL OF M4h IJi& PMU’IX ACflMHcusehdd Schxhle. Eack Page - Q.B.
FoU’mGE ~Y RATE ~GE FOR mm~ UNITWmsehold Schedule. Back Page
GRSPATVA GFOSSVALUE OF R4TULSLSllJITHousehcldSci-edule.Pack Page
NEI’RAIWA NE1’RATEmLE VAIAIF,OF PRES.ACU4.FlxseholdSchedule. mck PacJs
RATEPAID AM2UIWOF FWITSPAIDPm C4UMV+R MM1l-1,
‘lYnsM a derivedvariable.WATK)UND wATsRRATE FUJNOWEWmNI.IW. mm
*
‘11-nsis a derivedvarmble.~.,
HCH’S ~ @ R51D~-YWLRB ,,
Wxs.eholdSchedule. ‘femxe& Wmsing Costs Sect.mm- Q.43.LAST ACCM4XXTICN
I+msehold.SdefMe. Tenuceh FkJuslngCosts SectIon- Q.44. “PR?m43R1’ IMN, M3171W+GEFCR Ll!71’~,BUYIM-AW14. ,.
I+msehdd schedule. Tervxe& musmg Ckxts .sectim- Q.44(a).1PP.EWm WHEIWERH.O.H.~ ~ AClX+M2DiTICN
HouseholdSchedule. Tenure6 hum-q Cbsts Section- (2.44$)’. ‘PRWmm FIJFfNIsHEol lNllTWISHED ~ A(XOF1. Pm
I+mseholdSchedule. ‘lMuue& musing Cbsts !3sctlm- Q.44(6)(1)~PIWV.~ A~ Im PmVICED BY
IbuaeholdSchedule. Tenure & timlrq Cbsts Sectxm - Q.4+(b)(Il).LIVRFS lm.xmiWRESIDEXE-= ,
Hxselmld Schedule. mgratlcn Sectim ,.
l?+mm kW. CFc2i?W3m cFmIrmK3%,3N LWi?5YRlimseholdsc~de. figratlonSection.
Wm3m CCXl?IWW BIRTH~ APFEND.A~Hmsddd SAedule. Migratim Saction.
ARRIvEaK YEAR FIRSTARRIVEZIIX -BXW E3SWHEREIbuseholdSckdule. MigraticmSecticm.
39
, .... ...!..
Fbusek)ldi-DlwiBlm
This is aHU.5WBRN
‘l%isis a
This is aMAWFN
Housetil d
L.k. ..i. i C, ..’..,,,,,0 D..fi.:, .*,,;_ ,.., L \ u ....,~
Sched d e. Migraticm Section.CDNITW OF BIRIH -HOH $&SEEAPPEND.A+crosslink varieble.CXYIWRYOF BIIUM [email protected]$crosslink variable.~ OF BIRIM [email protected]~crosslinkvariable.cxMJMmYoFMYIHERS BIRTH%SEE APPlllD.A+Sctidule. MicrrationSection.
Eh~~~ hORMNS FOR ~AY CR PROFITti MS WEEKl.divid~ ~&~A~=t Section- Q.1 h Q.25
SIXItiividtxilsc~ule. Mplopent Section- Q.2 & Q.29.
UD.IPATI- UASS-Q2UAPSED VEFS. SEGIndividual.SclMule. EmploymentSection- Q.2 h Q.29.
INDJST SIYNXRD INMHRIAL CLASSIFICATION1968IndividualScMMe. El@oysent Section- Q.2 & Q.29.
mm CL4SS.OFOX.ANO DIRD2113KYOF CXX.TITLFSIndividualSchedule. DeploymentSection- Q.2 h Q.29.
CKIIJPATI~OF TFACHERIrx3ividualSchedule. Ilnployment.Ssrtion- Q.2.
SELFE?4P sELF-EMPLoiEDOR 12mATm?ItiividualSchedule. DeploymentSection- Q.2.
HCMSEG 9xlo-ixOtKMIcGRixlPOF mThis is a aosslink v=i~le.
HUSSEG S0210-~C @3XJPCl?HI.!SBWDl%is is a crosslink variable.
WU-SIX SXIO-ECCXCMICGRCWPCF WIFEThis is a rxossl.ink variable.
HCHIN32 HoH’s sTANmRD IMXISTRIALCLASSIFICATIONmiS is a uosslink variable.
HusIm HUSEAND’SsrAND.lNwSTRmL CIASSIF.This is a crosslinkvariable.
WIFIND wlFE’s sTANmRD ~ CMS.SIF.This is a crosslink variable.
Kl+mlxlr HCH‘S CL4SSOF CKUJPATICIJmis is a ~osslink vari~le.
HuSmxn? HUSBAND’S UASS OF CCKIJPATION‘l%isis a crosslinkvariable.
WIimmm WIFS’SCLASSCf?~ATImThis is a crosslinkvari+le.
HCliDID PAIDkUU( LAST WD3KThis is a =osslink variable.
HUSEMPL HUSBANDDID PAIDW3RK MST WSEKmis is a crosslinkvaxiable.
WIIW.DID PAID ~F?K LASTWEEK‘Ibisis a crosslinkvariable.
APPRJ3JN2Individual
W3FKDWSIndividual
As% ,Individual
ABSWicilIndividual
Individual
IndividualAMWUY4
Individual&MYS
Individual
T~ Rmm. mE APPRE2?I’ICESHIPschedule. EX@oyment Section- Q.3.USUALkm?KIMrxwSPERWEmSchedule. 13@qment Section- Q.4.?J’RYFRCMW 3RKMSTWEEXschedule. D@oymnt Section- Q.4(a).lsl’FUYx%mlmrUCmlzSSmYSm?N WllmMule. @luynent Section- Q.4(a)(i).2ND RFASCNWJF+ODLESSIMYS’ITFNUSU%S&x?dule. E@oyment Section- Q.4(.)(i).3RD REwaJwRKEQLE5SQU’SmAN Usw.%hedule. @loynent Section- Q.4(a)(i).4mREMCN wmKmUiSSAwsTm N UswScMdule. En@oyxnent%ction - Q.4(a)(i).MI. OF WXUUt.GlMYSMISSED‘IHISABSENCESchedule. E2@oynent Section- Q.4(a)(ii).
-+-v
..
--
JOBYP.SD4Individual
JOBYRSSZIndividual
WMmlPLYIrx3ividti
JCEaiANIn3ivid=l
cnYPmSIndividti
JOi#YI’DYIndividti
JOi3tUTIrr3ividd
UNEMPBIMIrxiividua.1
IndividmlWKmFM
IndividualWICmV!ml’
IndividualWKmm.OY
Individ@W&JoE!Cm
IndividualWKF!BULT
IndividualWKorHER
Individual
IndividualUNExPYl
Individul
IndividualONEt@Pm
IndividualUNmFfm3
IndividualkZUYmm
IndividualmYm3
MlividualWKt?miYl
Individu4WIUU4Y2
Icdivid@Fimu#
In3ividuaJEIONEYPB
Individual
IndividualEVERhOFK
IndividualWF.SmPYl
Irx5ividualWF..m3Pr2
IndividualWK5-IOFY3
Individual
JN’.TR3W TIME W1’lMPF.ESWI’FMPIKXERkhedule. D@oyment Section- Q.13k.J2G’EiOF TIME SFJJ?-IMPUIYEIMv2dule. ~loynent Section- Q.13B.MPIDYEE m PASTYEAR-SEU?-EMl.mm m5chedule. E@loynent Secticm- Q.13B(a).WF?ESROF CHAtG~OFJC81NP~ YEAR*kdule. E@oyment %cticn - Q.14.m.mai N GHTS FSiFjml’ mmmis JOB3ct@ule. EmploymentSection- Q.15.‘+3.OFIYWS WAIT m SWAM’W JCF3Schedule. D@owent Section- Q.16 & 17.iHEIHERWIITtiti SrARTFEJfJQ% PRSF.*hedule. @Joyment Secticn- Q.18.IF UNEMPLOYM2W’BEN.UA~ PAETWEZKSchedule. @loyment Section- Q.19./?HEmmcN i3mKSQFmPI.K)mmT ExCHmGE3ckdule. @loyment Section- Q.19(a).IF CN BCXXS OF PRIV?SIER.iPLOYM.AGENCYScMule. Fl@oynent ~tion - Q.20.mEx’HERusEa)ADVERrS’rQ14xlKmR W3RKSchedule. En@oynent Section- Q.2Q.~CCi?l’FkCI’ID EMPLOYSISm FINDW3RKSchedule. DnploynentSection- Q.20.WEIWJIRUKKEDmWKS.INJC9CR?I’RESchedule. D@crymnt Section- Q.2Q.WHEIHERWAITINGRESULT@ J(I3APPLIC.ScMule. EmploymentSection- Q.20.WHETHERECNEMJYTHIM-TO FINOW3RKSckdule. EmploymentSection- Q.20.h~ DID N3NS OF THESIm FINDWRKSchdule. EX@oyment Section- Q.20.RE%SCNFOR LEAVI=IAST JOB-1Schedule. Enplopent section- Q.21.Rl?+30NFOR LEAVIMIAST JOB-2Schedule. D@oynent Section- Q.21.RETMNED PENSIUiFUGHISFRfllPREV.JOBSchedule. Eb@oynent Section- Q.22.TIME CUZOFWIE?KBWWI MSWORK~~e. Ei@oyment Section- Q.23.WHETHERmmm lYR Z4m-~ilYRm PPJ+3.Om.Schedule. 12@cynent Section- Q.24.RIT+SCNIF NOTFZX+UNS?+YEARAG3Schedule. EmploymentSection- Q.24(a).RUASCNVKX?KIKGE3WIFN9TAYE4R M32-1ScMdule. BnploymentSection- Q.24(a)(iREASCNMXKINSMWIFNOTA= M-2Sckdde. Fjuployrentsection- Q.24(a)(iREW30NW3MIK Ii@ilFNOI’AYEAR ~-3Sckdule. 13@oynent Section- Q.24(a)(iM IK171UM& REGISTEREDW17W [email protected]. I@loynent Section- Q.26.WHmHERNC?N-W3xE.RswJF.KmrNI.A.sr12Kr*~fie. Il@cynent Secticn- Q.27.EVER W.317KlZIFOR PAY-AEULTE$20N.INACTIVESchedule. Ih@oynent Secticn- Q.28.Rm.5CNsroPPEnKMUm’?3IxJFmzYFAR - 1~~e. Ih@Oymnt Section- Q.28.IWASm.S’mPPEDhmKImEURIt43YmR -2schedule. ~lcymnt Sectlcm- Q.28.REASm sIoPPEnW3FJUm DORIN3YE4R-3schedule. IQ@cynent Section- Q.28.
42
.
.
.
43PmsRm RETAINIIOPmSIm RIGWISFF124PP.EV.J@
I~lvld~ ~~e. Emhwent sectlm ;.~.30.RErIRso RETIRED+EMR mJC13WM MAiN Jm
ItilvldualMule, i3@_t Sectim .~’Q.31.RErIREBSEG CFWWJm IFti kCNE
ItilvldualScFedule.PASm
WOywnt Secticm- ~.31.FAlliER’SS1210-ETXMMIC~
mls 1s a crosalmk variable.AGEMTS AGE LEFT -L
IndlvldualSch.?chde.EZkatlm Sectvm. Q.1.ACiSHFAD(W H’l13W~SZHYX
!lYnsis a cross.linkvarlebleoHL!sI.mS AGs HusMNDLzFrmxxlL
mls 1s a cxoaalmk vari*le.wIF1.mS ffiEWIF13LEFTSC103L
‘llnsM a crosalmk varmble.wD?mmmO ANY FUZIYEXEtlJ2ATION
ItilvldualSchedule. EHmatlon .%ctlon. Q.2.F.EIZEIVIN3EIXKY+TICNAT P~
In5ivldualschedule. Mmatim Sectmnj Q.2(a).EDU2AT EUK!. ~. BEIN3A‘rlmimwxr F@ISEm
IrdlvlduslSchedule. m~tim secticm.’Q.3 & 3(a).TYPEOFS31.20L,~H~ F+
IndividualSchedule. ~watim Section. Q.4 & 4(a).AGSLAC AGE LEm Cm#miE
Irx51vxdualSchedule. Mxatlon Sectmn. Q.5.HCHIFIC AGE H++ LEFT 03ULEQ
‘lTusis a mose.lmk variable.HUSH AGEHUSRIND=m=E
‘I%IsIS a CXOSSJink v=mble.wIm?.TC AGE WIFE UYiWm~
‘IhlsIs a mosslmk vmlable.A~ 013TAINEDMY CU4LIFICATIONS
IndlvldualSchdule. mwatmn Ssetim. Q.6.Q1’IYFE MI’ Mml’IctimCUUIFIC%TIUJ
IndlvldA Schedule. Mmatmn Secticn. Q.6(a).IK21TYFE NI.MEERW MT M.ENl’IONErJ~.FI@TIONS
Im3iv~dualSchedule. EHuatlcm Ssctim., Q.6(a)(I). ,Q21YPE 2ND ~ICNED uI.FICATi#
IndividualS.cYedule.Mxaticm sectiqnl~’~.L6(a).tx?2rYPs NU4BEROF 2NI -I- CUALIFXCATICM
IndlvldualScMule. D3watim Section. Q.6(a)(I).Q3TYm 3F.DMQ?lTONEDiXllLIFICATId
IndlvldualSchedule. mucatmn Sectlcn.,‘A.66(a).NwfrYPE NLMBEROF 3RD ~1~ ~F~~:TIONS
IndlvldualSchedule. Mmatlm .$.ectmn.Q.6(a)(l).Q4TYF?3 4’11-1MEI?I’ICNEDQ.!AL~IC+TICN
IndlvldualSchedule. D3ucatlonSectim. Q.6(a).IQ4TYPS NU4BEROF 4’IUMENI’ICNIDCUALtiI,~ICtlS
IrdlvldualSchdule. mwatmn .%ctim’~’Q.6(a)(x).Q5TYPE 5TH MINI’1~ mIFImTICN
IndlvldualSchsdule. Edmtlon Sectimi Q.6(al.M25m NU4BEROF 5TH ML!?TICNH3~?~TlCN3
IndlvldualSchedule. mmatl~ ~$~cp: Q.6(a)(1).6TH m2?rI@m !XIUIFICATI~,.,,,,),.
Irkhvldml Schedule. W.ratlm ~t~~~i Q:6(a).+ OF 61H MENT~~ ~FI~ICNS
IrdlvldualSclizkhle.EH~ti~ “SeCtiUI. (I.6(a)(I).Q?lYPE ?IH MQ?l’ICtWDCLALIFICATICN
ltilvldualSclusdule.Edwaticm Sectim.,,’Q.6(a).NQim’PE NU4EER OF ?IllME2?l’ICtJiDCUALIFICATI~
Irx51vldwlSchedule. 133matlm Sectim. Q.6(a)(1).
HIGHES’EUXM’l(XZL CU4L1F1CATICN‘l%isis a derivedvariable.
m’s HIGHI13TED.m. am ED.UU,Y‘lhisis a crosslinkvariable.
HllmEm HUSRW4KSHIQiES1’ED.C#.L.-HIGHEXED.CNLY‘l’hisis a aosslink variable.
wImEm WIFS’SHIGHESTED.~.-HlGHER ED.cNLY‘his is a aosslink variable.
mLLYmJA
Individualmwl’FJB
IndividualCliUHUA
IndividualCHwlLIB
Individual
Individual
Individual
Individu?ilschedule. D3watim Section.- Q.11. -CmtZmDl WHEmm7 Cmm I.mlEmSY UrHE@lsr Clm@
Icdividml Schedule.
OSUAL TmifrD’ri [email protected] @l- CHID, - 1Schedule. Ilhx2ationSection. Q.?.L!SU%LTIH?fl’IF!ECH+14P.SUST CHI@4 - 2Sch@ule. mwation Section. Q.7.UStAL 92H.HOISCH+%RS @3T CHIIJ2+- 1Schedule. EZlwaticoSection. Q.7.USW SCT3.lxxsClH3RE %wl’(nlti - 2Schedule. lliwationSection. Q.7.OAYs Pm WER( en-CAREUSE.D%15-IcnlI.D#Sckdule. Elitx!ationSection. Q.9.TIMl?PERVNWUKARE%l.S TCHIl.@Schedule. @UitiOO Section. Q.1O.WHErHERCH-CARE IN wwK-PIACS%lSrQUIJA
mV2atiOn Section. Q.12.MIm6 C21J.LD%slsrCHUr+ 1EdU2dtiOnSection. Q.12(a).
MIhm CHILD;@ CHILD+ 2Fdu!ationSection. Q.12(a).h’EEXCHID MINEED21STCHIU%lll~tion Section. Q.12(b).TERmIml SCH.HUS $.lWCm@Fdu=ationSection. Q.12(c).
P-mmKDA UrmF7wm
IndividualSchdule.l-lwM301B UI?HSRWHO
IndividualS5edule.MmoHP.Sl HwFS PER
Individwl Schedule.MIIC#31.1 IF MINDED
Irx3ividualSchedule.MINDPAYl WHETHERPAYS FQH mm am aim,
In3ividwl Sclr?dule.EHwation Section. Q.13.cHIm’F.2A USUALTEmrlME m-mm m Cm@- 1
IndividualSclx?dule.E3maticm Section. Q.7.CHun’m USU4L‘rtm’frmsCIH?+RE%?rlDCHII@- 2
IrxlividualSchedule. D5mation Section. Q.7.USOAL SCH.HOIScH-#QU3%ZNDCHIU+ 1
IndividualSchedule. 133ucationSection. Q.7.USUAL EJ2H.HQLScl-l-mm%2NDCHID+ 2
IndividualSchedule. E1.hx2ationSection. Q.7.mYs PER Wmx~ ~@D CHI@4
IndividualSchedule. mtcation Sectioo. Q.9.TIME PER IYCfOF CX-J3RE@4DCHI~
IndividualSchedule. m-tion Section. Q.10.mLmRK2 WHErHERCH-mm m W3RK-PmC@mD cHI@
Individual.%hdule. m_tiOII SectiOA. Q.11.cHLm2 WHEIHERCHILD MINIX?OBYQlliER%~ GUIJ%
Individual SA=dole. 131mationSection.-Q.12. -F2wiHo2A orHERWm MINR3mILD%mDc Him+ 1
IndividualSdv=dule. Edu!atim Section. Q.12(a).mmHCL?El cmIERWm MINR3mII.D @NDcHrm+= 2
IndividualSchsdule.MllmiRS2
mwation Section. Q.12(a).ImJRSPER m CHILDMINCED*ZN3 a-lI@4
IndividualSckdule.MINmx2
mmatim Section. Q.12(b).IF MINDED TEK?frD.lsjscH.iK3M$@?Da-l-
IndividualSch=lule. EHm.sticnSection. Q.12(c).mwm WHimiERPliYSm MINDIt$3m QiIL@
IndividualSchedule. EHmaticm Segtion. Q.13.
Qiwm3A USUAL ‘n2wl’IMEC3HxP.E%3R13Clmr+ 1Indlvldual.%kdule. EHmtion Section. ().7.‘
a3UmUB Usw mm GwmRE %3RD auI@- 2Irxhvldml Schdule. @watim S.ectlm. Q.7.
WW+L SCfi.H31S Ui+2AIw~31UlCliI~ 1I~lvld~ -de. EHwatmn sect~on. 0.7.
CHLWL3B USUAL SCH.FKLS CH-C4RE33RD GlIm4- 2hdlvldual Schedule. ti~tmn Sectmn. Q.7.
CHI.mm3 DwS PER WEm m-mm USED %3RD aI@Indlvldml Schedule. mmation Eisctmn. Q.9.
TIME P-m M CF QI-C%RE#3~ QlIti4ItilvldualSckh-de. EHwatlcn Sectmn. C?.10.
C!tlLmw3 WHEmiERma IN wRl+m3RD c-u@Irdlvldualsc~de. L3h2atlcmSection. Q.11.
CtUJrFrm3 WHETHERCHIIIIM.INEOW QlHFR5_83N)CHI@4IrdlvldualSchedule. EHucatlonSectIon. Q.12.
UmiFKB4 OTHERWF13MINJX C-IUD~3m [email protected]=kdule. Dimatlcm S.ectim. Q.12(a).
PNIWi+33B umERymuINrs rnLLD331u)cnIm+ 2~lvldual Schedule. m=tion Sectmn.
MxtmiRS3Q.12(a).
~ ~ = ~ILD MINlX3D~3RD 1331@4IrxllvldualSchedule. m=tlon .%ctlm. Ch12(b).
FmUxxx3 IF MINIEOTEF3?TIME]Sill.I+%S~3RD CHII@4Indlvldualschedule. =matlm Section. Q.12(c).
M.INDPAY3 WHETHER PISS FQR MINDIK ~3m CHI~4ItilvldualSchedule. ??dwatlonSectmn. Q.13.
MINlmfr TCllY&PAYMENTFOR C3ULBCARE PER WEEKIndlvldualSchedule. E5ccatlon%ctlon. Q.13(a).
WHEIHERANY CHIU3C4REDFCRBY 0TH@~4IndlvldualS%hedie. D5ccatmn sect~on. CHECK D - p. 21.
W%THCRM311G3R CR UINEFATHERK)RKS.ItilvldualSchedule. D5ucatlonsectmn. ~ E - p. 21.
cF14AwFK ~ IF M3THERILONEFATHER~RKSIrdlvldm.1Schedule. EHwation s.ectlon.Q.14.
ClwrOFt’W WHErHERWRX txSPEk’lJxCN GmwmREIrdlvldml Schedule. Ilhxdticm.%ctlon. Q.14(a).
HE4L’m HmLIHmwuoVm mYTARIrdlvldml Schedule. HealthSectim. Q.1.
Cl-Elm INFO~ W LCM-STANDIFU ILLNESSIndividualSchedule. ~alth .%ctmn. Q.2. & Q.14.
ANnIMIT IF lllK-~Il?3 IIJIW?ESLXM;TSM7?3VITYIndlvldualSchedule. H=3th Section. ,Q.2(b). & Q.14(b).
wSmACT RESTRICTM1l’IVITYIN I.A.Sl’2 V/KS-I~Smdlvldual Schedule. I+=JtiSection. Q.3. s Q.15.
RmwS NO. OF DkYSDEBILIm’ITDIN LWI’ 2WEEK.SIndlvldml ScSExlule.I_%3thSectmn. Q.3(a).&‘Q.15(a).
GL?.SSES wErHERh’mm GLAssESCRCm?l’ml’UNSESItilvldualSchdule. I_lsalthsectmn. Q.4.
R4D31GHI’ WHEIHERANY DIEFIU. WIm S1=Indlv]dua.1Sckdule. Walth section. Q.5.
~ MY DIFFIC!UMYWITH HlY+RW3IrdlvldualSched&e. Mth Section. Q.6.
HFABAID WElTiER~HE4RIN3 AIDIrdlvldualSchedtile.F%lth Secticn. Q.6(a).
WEI’HIRDIFF.WI’IHHE4RIN3WFUN HEAR-AXDIndividualSchedule. I+?alth.Sectmn. Q.6(a)(I).
NUmmoFHmFUNGAIEmRNIrdlvldualScl?sdule.*alth Secticn. Q.7 & 7(a).
AIDYRl W!?iiKiJiRIN+AID1 - YGiRCETMI!WEIndividualScMdule. W?althSection. Q.7(b).
AIENiSl WJRN HE4RIW-AID 1 - IF FR1-1N.H.S.Irx5ividual.S&edule. EkalthSecticm. Q.7(c).
AIMYPEl W3Ri HEARRW-AID l-lYPECF H-AIDItiividualSchedule. Walt-hSection. Q.7(d).
AIDREG1 hORNHE4RmG-AID l-xFRFx3JURusEIndividualSchedule. Raa.lthSecticm. Q.7(e).
AIDYR2 hOm HFARIM-AID 2 - YEAR CBTAINEDIndividualSchedule. *alth Section. Q.7(b).
AIlxHS2 hCFN HFARINGAID 2 - IF FRll N.H.S.Irdividcalschedule. -alth Section. Q.7(c).
AIMYPE? WmNHEARIw-AID2 -T YPEm H-AIDItiividml Sckdule. fkalthSection. Q.7(d).
AIDF@32 WF3?HEAMNG—AID 2— IRREGULAR USSIndividual.$cbdule. ~alth Section. Q.7(e).
NAIDXW NU%ER OF H-AIIXHAS %T ARRi’ThORNIndividml Sckedule. IkalthSection. Q.8. & Q.8(a).
xmxm UNX2FNHEARIM-AID 1 - YEW? OBTAINEDIndividualSckdule. HealthSection. Q.8(b).
xAmNHSl UN9?JmHEAIUM-AI.D1 - IF FRU4 N.H.S.IndividualSchedule. lkdth Secticm Q.8(c).
xAIDrYPl UFW3U.IHEWINS-AID1-TYPEW H-AIDIndividualSchedule. Walth Section. Q.8(d).
YNI’XAID1 lJIwmNHE4RINGAID1 -R EA.5mIwT’ WmIiIndividualScl_ed&e. FkalthSection. Q.8(e).
XJ.IDYR2 UN/$3RNHEkUNG-AID 2- YEAR QBTAINEDIndividualSchedule. IkalthSection. Q.8(b).
mImHS2 U1’%ORNHEWUtK-AID 2 - IF FRU4 N.H.S.Individti Sch=dule. Hmlth Section. Q.8(c).
xAmTYP2 [email protected]+AID 2 - TYPE @ H-AIDIndividualSchedule. I_kalthSection. Q.8(d).
YNTX%ID2 IJFWmUiHEAFmw-AID 2-rw+Sm Iwl’W3RNIn3iVidti Schedule. Walq Section. Q.8(e).
AIDEVER WHEIHERHSARUW-AIDSVERWJRNIndividti Sck?dule. HealthSection. Q.9.
AIDrHxNK WEI’HFREVER CONSIDEREDWU+RItCHEAR-AIDIndividml ScMdule. Malth Section. Q.10.
A.IDYNT REISYJFOR hX3T03NSID.WE+RIN3HE?JR-AIDIndividualSckdule. Wth Section. Q.10(a)& (b).
T4UEDm A~INLA81’2WF311C5IndividualSchxiule. FkalthSectim. Q.11. & Q.16.
NO.T~’IYdJ@D’ID llXTORINLASl’2NKSIndividualSchedule. Fk?althSection. Q.ll(a)& Q.16(a).
Ixxsw31 1ST a)NSULTATICNWIm ~R-FOR WI-KUItiividualSckdule. lk?althSection. Q.ll(b).
mCPmNl PKRSm Nu.18ERFOR MT.mNsuLTATImIndividualschedule. FkaalthSection. Q.11(b).
D3mH.51 2ST CCNSUIJC4TICNUTO13?EWEIndividualSchedule. IkalthSection. Q.11(c)& Q.16(b).
IxlxPl lsT.mNSUmATIQN,TYPE w IxmCRIr@ividualschedule. FkalthSection. Q.ll(d)& Q.16(c).
MEllCDOF1.Sl’c33WSDLTATICNIndivid@ sch=d~e. I+=lt.hSection. Q.ll(e)& Q.16(d).
2ND CDNSULTATI~ WITH lxxmR-FoR Wlirr4Irxlividual~kdule. Walth Section. Q.ll(b).
PERSCNNLM8ERKU 2?0 ~TATIONIndividualSchedule. I-kalthSection. Q.n(b) .
DXNHS2 2ND =UL’IATICN ~ WIndividualSckedule. HealthSecticn. Q.ll(c)& Q.16(b).
mOx2 2ND CXNSULTXI’IQN,TYPECF ECX21YRItiividml Sckdule. I-kalthSection. Q.ll(d)& Q.16(c).
MElli2DQFm CCNSULTATICNIndividual8Ched~e. Eklth *tiOn. Q.ll(e)& Q.16(d).
OJL?it+m N) CCNAILTATICNh’1’IMD.L..R-tTXi hXFlIrdlvldualSckdcie. Welth Sectl.m. Q.ll(b).
Pm NLMBER~ 3RDCS2+FWETAT1CMIndlvldml schedule. HealthSection. Q.ll@) ,
01miS3 3RD mlJLTATICN = N-SIndlvldml Schedule. Hm.lthSectiaa. Q.ll(c)& 0.16(b).
rxmiP3 3RDCCt13UETATl~,lYPEa ID2’IKRIndlvldualSchedule. I-kalthSectlm. Q.ll(d)s Q.16(c).
Mmmo oF 3m 02t5mTATImIndlvldu?-1Schedule. i+althSectmn. Q.ll(e)& Q,16(d).
mmHCM 4m CflLSULTATICNWI’lH~R-FCi7 W?KNIndlvldcal.Schchle. FkalthSectlm. Q.ll(b).
03CPERN4 Pm NU+Em FOR 4TH ~TATImIndlvldual.ScFehle. Wth Sectmn. Q.ll(b).
4m CCNSULTATICNU’IOE27HItilvldti schedule. HeelthSectlcn. Q.ll(c)& Q.16(b).
mUiP4 4m CKXWJLTATION,TYRQ IXX21U7ItilvldualSctedule. l+eelthSectIon. Q n(d) s Q.16(c).
rJxlwx4 MEE+Ci3OF 4TH Q2.6UL’L4TICNIrdlvldualSchedule. i-lealthSectmn. Q.ll(e)6 Q.16(d).I
5TH CNSOLmTI@J WI’13iLCX210R-FCRMItiivldualSchedule. I-kelthSection. Q.ll(b).
P= NLMBERFU/ 5TH ~ULTATIU4Indivldml Sckhle. lkalth=ctmn. Q.ll(b).
lxxNHS5 5’lYlCOt?3ULtiTImUNOm Ni_E]rdlvldualSchedule. I+alth.%ctlm. (2.11(c)& (2.16(b).
lxx?GP5 5TH.~WJETATION, TYFE m ID21YXIndlvldud Sclx+dule.H=lth .%ctmn. Chll(d)& Q.16(c).
oxrAlxS MEIIKDOF 5m =ULTATImIndlvldualSchedule. Wal.th Section. t2.ll(e)& Q.16(d).
DxI’lllx 6m CONSUL’IYJTICNhTTH ~R-FCR Wl+C?4IndlvldA Schedule. 13ealtiSectIon. Q.11(b).
IxCPERN6 PEECN NU+lSERFOR 6’IHm=TATIONIrx51vidmlScYedule. Keith Section. Q.11(b).
DxNHs, 6’IH=ULTATICN UNDER Nl?sIndiwdual Scl_edule.I-kelthSectmn. Q.ll(c)& Q.16[b).
rlxGF6 6TH. ~ULWION,’IYFF, @ Kx21UtIn5~vldualScMule. ~elth Section. Q.ll(d)& Q.16(c).
CIXTALX6 Mrmm3 oF Em+ ~TATImIrdlvidml Schedule. I-ke3.thSectmn. Q.ll(e)& Q.16(d).
Dxw107 ?IH CCNULTATICN WIm ~R-FCR WKt4IndlvldualScl_edule.FkelthSectmn. Q.n(b) .
0XPSRN7 PERSCNNU4EERFOR 71H ~ULTATIUJIndlvldA Schedule. l-kelthSection. Q.ll(b).
rxxNliS7 7TH CCNSULmTICN WOER M-EIndlvldud Schedule. Health.Sectmn. o.ll(c)&Q.16(b).
DxGP7 7TH.~TATION, TYF?ZCF ID21CIRIndlvldml Schedde. walth Section. Q.ll(d)& Q.16(c).
DxrAlx7 MEIflXJOF ill-l~TATICNIndlvldualSchedule. HealthSectmn. Q.ll(e)& Q.16(d).
81H 03NSOlJmTI~ WIm DX?IOft-lWiIWK?4IndlvldualSchedule. I+2elthSectlcm.+IA(b).
lTxPEf@ PERSliNU4SERFOR 81W CCN3.ILTATIONIndivldti Schedule. I+althSection. Q.11(b).
m mNSuLTA!rIm W= wIcdlvldml .ScWule. t-k.alth.%ctmm
mKKwSQ.ll(c)& Q.16(b).
8111.CCIHILTATION,~ ~ DX!lT17IndlvldualScbdule. HealthSectmn. Q.ll(d)& Q.16(c).
FtEllXDOF EIH ~TATSU4IrdlvldualSchedule. Fkdth Sectlm. 9.ll(e)& 0.16(d).
9111=ULTATION WIm EWl_CF+Ft.RVilK14Inchvldti Sckdule. HealthSectlm. Q.ll(b).
P~ NU4EERFOR 91H ~mTATIU.1IndlvldualSchedule. Mth Sectlcm. Q.ll(b).
48
u:”: LJY ‘>’,:1 ctisuu~”.<i’ldkUiuw Mis
Individual SchAule. &al th Section. ~.~l(C) & Q.16(b).rCCGP3 WI+.OXWLTATION,TYFE OF W2TCU
IndividualSchedule. F<h Section. Q.ll(d)& Q.16(c).Ilxrw ~ OF 91H 03tWJLTATIm
Individti Schxlule. I+?althSection. Q.ll(e)& Q.16(d).clrrPAT cur-PATIlmrAT lmSPImL IN IAST’3 rmrms
IndividualSchedule. HealthSection. Q.12. & Q.17.NY.TrPAT N@lBm CU1’PATI~ VISITS - PA.SC3 MNlliS
IndividualSchedule. W?Jth Section. Q.12(a). & 17(a).WELFARE IF USED HLTH,WELF.SERV.FST.MI’H.%WER 6@
IndividualSchedule. HealthSection. Q.13.kimimml lSI’HS4LTH,F7LIIARSSERVIC5USSD
I~ividA sckdule. fbilthsection. Q.13(a).WSIJ%RE2 2ND HE4LTH,WELmRESERvIa UssD
IndividualSch+ule. HealthSection. Q.13(a).NSLFARE3 3RD HmIxH,NELFARESERVIO?Usso
IndividualSckdule. I%?althSection. Q.13(a).WELFAFm 4’m HmLTH,WELFAREsERvIcxWED
IndividualSckdule. HealthSection. Q.13(a).NELFARE5 5TH HEWI’H,WEU?ARESERVI(3ZLEiSD
IndividczdSchedule. I+x+lthSection. Q.13(a).WELFARE% 61YlEIRWTH,WELFAKESERVI(Y3USED
Itiividualschedule. Walth .Secticn.Q.13(a).CHU)RESP INFOF@PiN1’RESP.FUR CHILDRININ H-HOLD
IndividualSchedule. =alth Section. CHECKB - Page 27.hOiENF7+M MARITALS71’ATVSOF hW4EN
IndividualSchedule. FanIilyInformationSection. CHEX2KA - P.31.KFASCNHUSBWD NOT IN H-H31.D
Individti Sckdule. FamilyInformation”Section. Q.1.FISEW WIETHERSEI1-CCY4PLETE0Q ‘PJREFORWtl14N
IndividualSchedule. Family InformationSection. CHD2KB - P.31.FISELFPR WHErHERPEOPLEP-ml’ IF SELP-CCMPLETSO
IndividualSckedule. Family InformationSection. CHECK C - P.31.FISELF1 PERSCNPRESENTWHEN SEI.E~IITICN - 1
IndividualSchedule. Fmily InformationSection. CHECK D - P.31.FKEL.F2 PF.RSCNPRfS~ - S~~I(li - 2
Irx3ividualSchedule. FamilyInformationSection. CHi52KD - P.31.FISF.LE’3 PEFSCNP~E2?l’~ SEW-Cf.MPG5TICN- 3
IndividualSckdtde. I+mily InformationSecticn. C2iD2KD - P.31.FISEIJ?4 PEWCtiPRISES1’W SEI.F-CCMPMTIm- 4
IndividualSchedule. Family InformationSection. CHECK D - P.31.WHERE t.m.RRxEo@RFSmr,!.Km RmEm MAR.*
Individual.S=h?@ie. FamilyInformation.%ction. Q.2.CLLIk+?IH Nmmli BEGANLIVINGm - CU4. W.MAR.
IndividualSchedule. Family InformationSection. Q.2(a).CILIVYR YFAR !3mANLIVI.N3% - cxl.l.Lw.mR.
IndividualSchedule. Family InformationSection. Q.2(a).cLPAKrm IF PARINSRLEGALMAR. BF.mFU?-Cm.w.mR
Individml Sckdule. Runily InformationSection. Q.2(b).CIMAR IF ViCX4ANIJYG?LW+R. BEFORE- Cti.1.13si.14%R
Individ@ Scbsdule. Family InformationSection. Q.2(c).N3.M13 Nwi6EltoFUG?+LMAP.RXPGES- CCM.IAW.M.
IndividualSclx?dule.FamilyInformationSection. Q.2(c)(i).NIE@lm Nu.s13moF~ MARRIAGES- LJ32w.t.lm.
IndividualScl_edule. Eunily InformationSection. Q.3. & Q.3(a).141?lIiOF~M%R.—~ MARWAGE
IndividualSckdule. Family InformationSection. Q.4.YEAR CM?I.EG4LMAR.-CURREmmRRIAGE
Individml ScMule. Emily ~-tion Secticn. Q.4.Hw.mG.MAR. BEFORE-CuRRu?rmRP.IAGE
Iru3ividmlScFx=dule.Family InformationSection. Q.5.t.mrmc??LEGlLt4AR.-lsrtmSl’REml?I’MAR.
Ir@ividml schedule. Family InformationSection. Q.4.mRIYR YmRoFIJm% mR. -lsrt4xr Iw2ENrMAR.
IrrlividualSc@dole. i%ntilyInformationE+ction. Q.4.
HL!s’wzl HUS LEG.MR. 8iamRE-lsr m RlZ?2irMMIrxflvldualSch?dule. l%mly InfcrnbatlonSectum. Q.5.
!’rxmiwmm.-mm~ W.IrdlvldualSchedule. l%mly Inform+tim sec,t+~. Q.4.
Mm2n H OF m M.-m m RECEw%MAR.Individual-ule. l%mily Informtmn Section. Q.4.
tnts.lm3.MAR.BmtxU2-m FKm ~wdtIndlvldualSchedule. Fannly Informtlcm sectlm. Q.5.
MAmm MQ’?ll+OF~MAR-3RD~RECml’ MM.Indlvldml Schedule. Famly InformationSectIon. Q 4,
F14mYR YEAR wl.EmLl.?AR.-3R13lc6’TRmE2a’MAR.IndlvldualSchdule. Emily Infornatim Sectmn. Q.4.
M IJSG.MAR.BEKx?E-3FU3FK!STF@2EN1’MARIrdivldualschedule. l%m.ly InformationSectlm. Q.5.
LIwOmG WHEIIERLIVE)~EIWE+ BEIOm ~ li4R.ItiivldualSchedule. Famly Intimtion Section. Q.6.
!rCG’lTS YEAF6~VH3’RX. BEFWJ21.E.GAL~hdlvld~ Scl-edule.Famly Informtlon section.
mim—iSL.IVm~ BEmRE -M. *“6(a)”Indlvldml Schedule. Family InformationSectlcn. Q.6(a).
FC?ASml.KSI’Rmx2J1’14AR.mEmIrr31vldwJSchedule. Family InformationSectlcm. 0.7.
DEP3J.YTtI mt?IHH2S1’RmE2il’~mIlmIn51vidtd Schedule. Family InformationSectmn. Q.7(a) & (b).
DEPIYR YEARt.Km’~MARwxSENlx13Indivldml Schedule. Famly InformationSection. Q.7(a) & (b).
DBX1.MIM FIWlliOF DK!RE3AB931JTIE+.DS1’RECE2?TMARIrx5ividcalSchedule. Fanuly InformationSectmn. Q.7(c).
DEG’JYR YE4ROFDECRE3 ~W1’E-tKSI’RECENl’ MARIndlvldml Schdule. Family InformationSectIon. Q.7(c).
P.EP.9x2NDt.KlSrm12ENrImR. ~
IrrdlvldualSchedule. Family Informtlon Sectim. Q.7..DFWMTT3 t.rl?m2.NDtK6-rRECmrt.wLRIAGEmlxtl
Indlvldua.1Schedule. Fa.mly Informtlon Section. Q.7(a) & (b).DEP2YR YmRmDmSI’ RDZEr7rm.RRmm mom
IndivlduelScl_edule.Ftmnly InfcmationSection. Q.7(a) & (b).Enxm fWNTH,DK.ABS3DIE-ZND KS’ ~ MAR
Indlvldud Schedule. Family Informtlon Section. Q.7(c).Di+?CR2YR YHiR W DD.2.ABS31JJIE-2NDFC6T ~ MN.R
Indlvldua.1Schedule. Family Informtlm Secticn. Q.7(c). ‘t44R3mD RmEm3RD hfxl’RECEm K4R. mlxD
Indlvldml Sckdule. Family Infcrmtion Section. Q. 7.
DEP3FtI13 KNrH3RDFcScl’ REr2ENrFmRMAGEmtED
Indlvldwl Sckdule. Famly Infmroationfiactmn. Q.7(a) & (b).DEP3YR YmR3RDtKxr Fm2mr MAmLAGSmDm
ItilvldualSchedule. Family Informtlon Sectim. Q.7(a) & (b).DBCl@ll13 mN1’FLDD2.AB.%UJE-3RDPrxl’REzx2n’MAR
Irdlvldti’Schedule. Family Informtlon Sectmn. Q.7(c).DECR3YR YEAR CF DD2.AB%WJIE-3RDt4H’ ~ FRR
Itilvldoal.%kdule. Famly Informationf?ecticn.Q.7(c).FIHH311 UtRE3.A= W m H-IK3LD- WID,Dm, ~
IndivlduelSchedule. Family Informtlon Sectmn. CHExx E - P.34.SFIFRKXD UNFEIATEDAllJUTPPU.EIN H-HOLD- S~
Itiividual.5&edul.e. Family Informatmn Section. C%lErxF - P.35.xSLIVm2 WHElxER LnnNGwI’IHw!NIFu+l%RRIim
Indlvldual schedule. l%miLy InformatlcnSectlcn. Q.8 & Q.11.xsLIwfIH Fm?m BEG4?LIVmGTa3EmEx
IndividualSchdule. Rmily Infarratmn Secticn’.Q.8(a) & Q.ll(a).=IVYR YEARmIJ~’lmWmlx
Indlvldual@&3ule. I@rdy, Informtlon Section. Q.8(a) & Q.11(a).sPAKlt43 WflEmm PAKIY+mMARRIEDBmORE-LwNx
IrdlvldcalSci=dule. l%nily’InformationSection. Q.8(a) & Q.ll(a).
49
CHIIJ)Individual
-I IlX7NItiividual
IrxiividualC2-lDnu
IndividualCmm.1
IndividualcHLXJVl
IndividualCHD4GEl
Individual
Individti
IndividualCHDYR2
IndividualCHLSEX2
Irr3ividualCHDLIV2
IndividualCHlYiGS2
IndividualCHlx-m
Individml
Individualmm
IndividualCmSEx3
IndividualCHOLIV3
IndividualCHI14GE3
Individual
Individual
IndividualCHDYR4
IndividualCmSEx4
IndividualctmLlv4
IndividmlCHIYJGE4
Individtx+lCHmHR4
Individual
IndividualCHmR5
IndividualCHmm5
IndividualCHmIv5
IndividualCHIMGE5
Individual
Irdividml
.. ... .
1
1
1
\HEIYER w2-lAN tiA5 ZVtIi GIVEN BIh~-ule. I%nilyInfcm’ationSection. Q.12.0M3ER @ T= kZIWt+GIVEN BIRIHSchedule. FamilyInformationSecticn. Q.12(a).~ OF ~ CHILD’SBIiUli5c&ule. %mily InformationSectim. Q.12(b).f12AR@ 1= C3+ID’SBIRIHSchedule. FamilyInfonmtion Section. Q.12(b).Sm OF 1ST~1~%lx?dule. F2unilyInformationSection. Q.12(b).wcmsRlsr aiIH3LIvIN2wI’nimTHsRSckdule. hmily InformationSection. Q.12(c).w OF lsrCHID N3r LIVIM WI’m MmiERSchsdule. Family Informationsection. CHIXKG - P.36.mEmlsr CHILDNOI’wmliNr31’HmLIVESSchedule. Family InformationSection. GlE2K G(i) -kX3ttH3OF 2WDrlIII.D’SBIRTHSchedule. FamilyInformationSection. Q.12(b).YEW OF 2KD~IIJ)’SBIRIwSckiule. ~ilY Infcmr.ationSection. Q.12(b).SllYOF 2N0~ILOSckdule. Emily InformationSectim. Q.12(b).wHEmm2110mIID LIVImwIm MYmSRSch3dule. FamilyInfmm.ationSection. Q.12(c).A@ OF 2N0CHIIDNOT LIVIN3WITH I@l’HSRSchx3ule. F%ily InformationSection. CHEZXG - P.36.wHmEmCHIDNJI’wI’IHmlTfm IJVFSSct@ule. Family InformationSection. CHECK G(i) -MNfH OF 3RD CHI~’S BIRTHSckdule. FamilyInformationSection.YWR OF 3R0CHILD’SBIRIYlSdr+ule. FamilyInformationSection.SEX OF 3RDCHIDSck.3ule. FamilyInformationSection.WHtm3m 3RDmII.DIJVIN3WITH f4mliERsc~ule. l?milyInforIMtion Section.PGEoF3RD cHIIJ3kor LIvmGw11’H MYIHm
Sckdule. Familv Infomation,Section.
Q.12(b).
Q.12(b).
Q.12(b).
Q.i2(C).
C?fD2KG - P.36.wHERE3RD cliIID&wImmmER LImSchedule. Family InformationSection. ~ G(i) -ESl?lHOF 411iQfIID’SBIRTHSdedule. FamilyInformationSection. Q.12(b).mm OF 4m CHID’S BIFUI-ISctAule. RirnilyInformationSection. Q.12(b).SEX OF m CHIDSchedule. Wily InformationSection. Q.12(b).WHETHER4m CHID LIVII.Gmm mrHERScl_Aule. -ily Infcmmtion SeCtiOn. Q.12(c).?GSoF4mclirmt wrLIVINGw Im mmmSchedule. %nily InformationSection. CHECKG - P.36.wHsRE4m c-iIIDEUl$wImmmER LIVmSckdule. Rmily In~tion Section. CIiEr2KG(i) -M21?lHOF 5’IHCHILD’SBII?I13Sckdule. F?UuilyI.nfom.ationSection. Q.12(b).YEAR OF ~ CHILD’SBIKIHSchxiule. RNnilyInformationSection. Q.12(b).SEX OF S’If+CHIIllSckdule. FamilyInfrmrationS?CtiOn. Q.12(b).wHmliER91HciiILDLJVIIW3wImt4YmERSclxidule. Familylnformtion %tiOn. Q.12(c).AGE 0F5’1HCliIIJ3NJI’LIVXEX3WIml@lWERSCl_xxlule.Family InformationSection. CHIXKG - P.36.WHSR.F,5’1HQIILDIWJI’WIT HM3THERLI~Sc-ule. Faily Infornvition Section. QfE.CKG(i) -M31?IHOF 61YCHIIJ3’SBIKIH
ImlvlcllalSct+xq$. FamilyInfor=tlon Sectvm. , Q.12(b) .QWYW YEW OF fi UiII.D’S BIRIM {c
Irdlvidi.mlSd@$~. I%mly Informamx Secticm. Q.12(b).CHWEt6 SIX 13q,6maiIIx)
Irdlvldml Scl@@e. l%milyInfomatxn sectmn. Q.12(b).mlxJV6 ~ ,m Cl-ml)LIvIm WITH FKmlER
IndlvldualSche@@e. Famly .InformtlonSection. Q.12(C),Qin4GF% KS 0FIfil?i.,$2i+U)~ ~~~ mm ~
Indlvldml SC&de. ,.-Feu@y Infwrn?@m Section. ~ G - F’.36.tiLJ -
ClIAR6 wHEREm CHxIDKmwx’m HxHER LIV5
Irrllvld@ ~~~e. Pamlly Information sectmn. C-lEXK G(l) -Qlmrml f9X?IHOF 7’11+QKIID’S BIR2YI
Irdlvld@ Schx@le_. Famly Informatim sectmn. Q.12(b).CHOYR7 YEAR OF ?lllQiIID’SBI~
Indlvidm.1Schdule. Family Infmneticm Sectlm. Q.12(b).?..,,CHlMx7 SEX QFc~ C-IIUI
Indlvld+alSchedule.,-lly Informtlon sectmn. Q.12(b)..-.,.CHnLlv7 WFDrmSR,7m CHILD LIVING wI’m KJrHER
I+vldtpl ~~~. ~,”~y .Intimtmn Sectim. Q.12(c).C+LME7 xEko~L&q ,qm m LIVT.W3Wlrn mlwm
, lndlyldti Sc@@ul_e. Famly I.nfmmtmo .secticm.Q31K% G - P.36.cui.lHR7 _~iIiILDNOTWIm~ IlV5
Indlvldml ,Sche@e. ~Famly Information Ssction. GIEx2KG(I) -CHmm9 W3t?lHOF &Hi CHILD’SBIKlli
IndlvldualScl@@e.. Fa.mlyInformtlon Sectmn. Q.12(b).CHOYR8 YEAR OF 81jj=ID’S BNKIH ,,
Itiivldual~l@[email protected] %cticn. Q.12(b).cmx3w8 SEX OF 8111.CHILD
Irdlvldml Schedule..Famly Informtlon .sectlon.Q.12(b).CHILIVB WxErqF$m CHID LIVING WITH MJTHER
InchvldualSch@qle. Famly InformationSection. Q.12(c).aimGEs A= OF,e@l”ql.CliIIDW LIVINGWIm !@TliER
IndlvldualSchedqle. Famly Informtlon Section. QllXX G - P.36.mnms8mcmmmrmmf0mm Mwm,
Indlvldu?.1$i+@~<~,a.Fa!mly Informtlon Sectmn. CHM!K G(I) -F@NlliOF ~ QI.LI.D’SBIFOYI
Irdlvldml Scl@@Je. FamilyInformetlm Sectmn. Q.12(b).mom YAR OF 911iCUID’S BIKIH
Indlvldml schedule. FamilyInformtlon Section. Q.12(b).Cncsm SEX.OF{9111(111~
Indlvldml SChedvle. FennlyInformtmn Sectmn. Q.12(b).CHDLIV9 ~ 911iCliIm LIVImwI’mmmER
Irdlvldual,=hedule.<+FamilyInformtlon Section. Q.12(c)..,....CHIRGE9 AGE 0F911i.CHlm FJJTL~WIm ~
IndlvldualSchedule. 1%.mly Infomatmn sectlcn. CHET2J(G - P.36.cnmHR9 Wmmmcmmwwmwmlim I.JVES
Indlvidti ,Scl@@le. Family Information Section. GD3X G(l) -CIWMlnlo M2N1’H (X 10IHQIII.D’SBIRlll
IndlvldualSchedule. FamilyInfcrmtion Sectmn. Q.12(b).CHmRlo ~. QF 1~ C2i.IID’SBIKE+
IrdlvldA, .Sd@@e. ltumlyInformtlon Section. Q.12(b).Q31HXlo SEX Lm.,lon’l(sum
Indlvldu?d,sch@.@e. Family Infcmation sectmn. Q.12(b).cHoLIvlo kmmxmmmammummmmmm
Indlvldti”’-tie. l%rdy Infomatma Section. Q.12(c).C1-IDlGF20 lK3SoF101ylQiIIJ3twJrLIVT.tJ3wI’mt’mwm
Indlvldml Schq@le. Family InfcumationSection. CHECK G - P.36.QiuinRlo kiHEPElolliCH.IIJINJI’wI’IliM3mm LIV15
Indlvldml Sckedule. Family Infornatlcxlsect.lm. C2aYX G(i) -“ ‘IJ4
‘, rr![.
52~~~fl.~1 ,WN7H OF 11’IwCHIli3’SBIN};
In3ividA ScFedule. Wily InformationSecticn. Q.12(b).CHmRll YFARCf 11’IMCHILD’SBIRIM
Irr3ividmlSckdule. ilmilyIntim.ticmsecticm. Q.12(b).mlxzx.11 SEX OF 11’IMGiILD
Ifiividml Schedule. FamilyInformationSecticm. Q.12(b).CHDLIV1l WHmtiERLlm CHID LIVIN3 WI’lfl KnMER
ItiividualSchedule. Family InformationSectim. Q.12(c).CHEAGEll PG5 OF llm CHID NOT LIVLN3WITH MmIER
IndividualSchedule. FaM1ly InfO~tiOn Section. CHIXK G - p. 36.
cHIMdRll wHEFEINIHc HH.DIWrwImlW IHER IJV15Individul Sckdule. Family InformationSection.
Ciimrm2CliE12KG(i) -
m OF 121%CHID’S BIKIHIndividualSchedule. Family InformationSection. Q.12(b).
cHDYR12 YEAROF 12m CHILD’SBII?fHIrxlividualSclxlde. FamilyInformationSection. Q.12(b).
cHrsm.12 s= OF 121H mIIDIndividualSckedule. FamilyInformationSection. Q.12(b).
CHEKJV12 WHETHER121wCHIID LJVINSWITHM71’HSRIndividualScltxhle. FamilyInformationSection. Q.12(c).
cHmGE12 lGF,0F1211iCHII.DWLIVIN3WIm PK71HKRIrkiividd Schxlule. mfiY ~f~tim section. CYiEfXG - P.36.
CHmHR_12 wHf2zE12m c-lIIA)mwI’ml@mm LIVEIndividualschedule. I%mily InformationSe&ion. mECx G(i) -
STEKm.D wHm’mRANY SmP, FCm’ERCRAmPxm CmmIrKiividmlSchedule. Family InformationSection. Q.13.
STEP.2Hl 1STCHID LIVIN3WITH IIWOF@lAN’fIndividualSdedule. wily Info-tion Section. Q.13(a).
E71’Er%ml f@NIHOF lST STEP-CHILD’SBIKI’HIndividual.Sckdule. Emily InformationSection. Q.13(a).
STEPBYRl YEAROF 1ST STEP-CHIID’SBIRIHIndividualSckdule. ~ily InformationSection. Q.13(a).
SrEPIMTl M3hTtllSTCHIIIIFIRSTLIVEOWITdM3TtU31IndividualSchedule. wily Inf=~tion Section. Q.13(a).
SrEPLYRl YEW ISI’CHILDFIFSI’LIVm WIm M3rHERIndividualSchedule. I%nnilyInfcumtionSection. Q.1.3(a).
STEFCH2 m CHILDLIVINGWI’inmFOmANTIndividualSchedule. Family InformationSection. Q.13(a).
STEFfwr2 1431?IHOF2WOS~ III’SBIRIHIndividualScl=dule. =ily k~tion Section. Q.13(a).
STEPBYP.2 YEAROF2N0 ~’S BIRIHIndividualSc.Fedule.l%unilyInformationSection. Q.13(a).
srEPLM12 M2hlli2N0 CHIm FIRSI’LIVEDWI’lTiWXRNindividualSchsdule. Family InformationSecticn. Q.13(a).
STEPLxR2 YEAR2N0 CHIIJ)FIPSI’LIVEOWI’IH_Itiividml Scbdule. -ily InfOr~tiOnSection. Q.13(a).
sl’EFCm 3RDCHID LIvxl?GWI’m IwRxmNrIndividualSchsdule. Fa!ni.lyInfooyt~m~ction. Q.13(a).
mFml’r3 t4WlHOF 3R0 S~Individml Sckdule. F%ily InformationSection. Q.13(e).
SI’EPBYIt3 YEW OF 3RD frIEP~’S BIl?lflIndivid@ Sckdule. Rnrily,InformationSection. Q.13(a).
srEPmrr3 ‘ M3Nlli3RD ~ILD FIFc3TLI~ WI’IRVKl@NIndividualScl_edule.Wily InforratimSz?cticn.Q..
SIEPLYR3 YlY!R3RD~Ul FIRS1’LIVEOWIm ~Individualschedule. FamilyInformationSection. Q.
sl’sP.m4 4m mm LIVIIWwmn mmmmrIntiividmlSckdule. FamilyInfonmtion Section. Q.
srEPFMr4 lm?!IliaF41u~’S BIKIH
3(a).
3(a) .
3(a) .
IndividualSckdule. ~=~a~~Section. Q.13(a).STEPBYR4 Ymu OF 4’in
Individual .5d’edtie.l%nilyInfcrmticnSection. Q.13(a).sTF.PI.m4 P$2?lIi411iCHILD FI=IJVEDWIm VK1.?7W
IndividualSchxiule. wily Infi~tiOn Section. Q.13(a).
W’VLYR4
IndlvldtiSl?.2FCH5
I.ndlvldm.lsrsP13tY5
IndlvldualSmPBYRs
mdlvld~srEPLm5
IrdlvldualfirsPL4Ym
IndlvldA
IndlvldualCHLtxxw
Itilvldusl
IndlvldualAGRCUGl
IndlvlduslPAYNET
IndlvldoalPAYrIm
ItiIvldtiTAXtJfl’1
Itilvldcal
IndlvldualTPXUSIAL
IndlvldualN~
IndlvldualPms.’wl’
Indlvldw.1DWCCAMT
IndlvldtiPAYGmSS
IndlvldualPmwEm
YEAR 411-1GUUI FIRST LIVEDWI’R-lW3i%NSdsdule. i%mly Informatxm section.5TH mIIJl LXVIM WIm ~Scheflule.r Famly Informtlm sectickio’r41?lMOF~ STEP+iIID’S BIRIW A,r,’schedule.:1%.mlyInfomatmn Se&mmYE%ROF51M SEP-GUD’S BIRIliSchedule. Famly In fornbstlon Secticm.KNIFI YItl CHID FIW LIVEDWIm WCM3?Nschedule. Famly Infornatmn Section.YI%RYIliGiILDFIPS’ LI~WI’AihU4ANSchedule. FamilyI.nformltlcrlSectlcrl.wlmmERw14?NPr@m4Nr AT TIFE ‘schedule.,FamilyInformationSection.wHEllim-wAN’ISmREQulJ3Rm.Scb3_ie. FamilyInforumticmSection.‘TwrALNo.CFcnIMJRmwANlmSchedule. Famly Informtlon section.XiEM’Wl-lICl+kXlW+NWAN15NDi CHIIIJSchedule. 1%.mlyInfmmatmn Sectmn.AEmE7rm IA8r NEr PAYSchedule. LnxxlteSection. Q.2.PERImmVERH3 SYMNBI’ PAY (Schedule. IncareSection. Q.3.AmUm Pm TPxtE?xmmlSch2dule. Inccrnesectlm. Q.4.WHETHHITAX~IFm PAYETN PAIDschedule. Incc.me.Sectmn. Q.4(a).WHEIHHtUS1.PJUPAYS TAX LEJDm PAYEsc~ule. LnccxneSectIon. Q.4(b).AtKM4TN.1.CCN.l’RIBUl’I@-lASTPAYSchedule. Incme SectIon. Q.5.AMYJNTDEIU21XDFtX?- ICW-UU31’PAYSckdule. I.nccmsectmm. Q.6(1).SW Cmim EmLtx3-LZ?.Sl’PMSchedule. InconaSection. Q.6(11).At@UNTOF IAEl’PKi BEFORBDXXJTI’ICIJSschedule. IrcaneSection. Q.7.GIWSSWEEKLYEi41U+ItESFIKBlR4PI.13YMENT
mis is a d=ivsd variable. rKliPAYld( HCH’SGRCS WSEKWPAY~~
‘Ihls1s a crosslinkvariable.HUSPAYWK =-’S GKSS WEIYJ.YPM - EMPLOYED
Q.13(a).
Q.13(a).
Q.13(a).
0.13(a).
Q.13(a).
0.13(a).
Q.14.
Q.15.
Q.15(a).
Q.15(b).
‘IlnsIS a crosslmk varl~le.WIFPAYWK WH12’s- WEEKci PAY Flm4 EMPLOY?41WI’
llns 1s a aoselink variable.PA!rCHllX
IndlvlduslSchedule. Irmzm Section. P.41iPAYSLIP WHEmm PAYSLIP~Tm BY INI’ERVIEWER
IndlvldwslSchedule..Irmme Section. P.41.PAYusmL wliErHmIAS1’NErmYUSmL
IrdlvldtiPAYNEIVS
Itilvld~PAYGPSJS
IrdlvldualPAYrIki.rS
IfilvldtiPAYDIFF1
xtilvlddPAYDLFR
ItilvldtiPAYDIFF3
Itilvldws.1
Schedule. InOxE Sectloi’1.Q.8.AmUNroF IMmL.NErPAY-r.Asl’PAY lKTrSchdule. Incme Section. Q.8(a)(i).N4XN’I’(X ImmL GK= PAY-LA!=PAY W1’schedule..I.MCXUSSectmn. Q.E(a)(11).PEFuccJmF@lALLYlxwERmBYPAY Jschedule. ~ secticm. Q.8(b).FUY!S14~MDIFFET=?T FlU41.SIIw-lSckduLe. IncuneSectim. Q.8(c).~1.ASTPAYD~ FFGllEIAL-2.scl-edule.IllxZEEectlm. Q.8(c).REASCNLAS1’PAYD~ FTGIUSmL-3Scl-edule.~ SectIon. Q.8(c).
53
PAYiKl$JS WHERiDl03.2ASIWALADOITIOm ‘IOPAYIndividual.Sckdule. Incme Section. 9.9.
PAYENGI= PRE-TAXSIFlOF ~ICNAL ACCS -IJ@ lYRindividualSche&le. InctmeSection. Q.9(a).
PAYBNNET =-TAX SLM IX OXAS.ICN4LJUXE -L4S1’lYIrxlividtalSchedule.
sEPmmTIncme Section. Q.9(a).
SELF-EMPLOYED- NET P=IT %JWF@IndividualSchedule. Inane Section. Q.10,
SEN31NC sELF-mPu)YEo- WmrHER m PRQFITMADEIndividualScb@ule. Incme Section. Q.10.
SEINCYCU G@ INXFfEFEG FIUllBUSINESS-SSLP-~IndividualSchsdule. ~ section. Q,1O(FJ).
SEI!KY!MT S@l OF CYiNllJ2CMIF’RCr4B’NESS-SE2F’.DlP.IndividualScFedule. IrxxmeSection. Q.lO(b)(i).
SEIKTIM TIMI.N3~@ti IXQ4EPAYMElWS -SEU?-E24PIndividual.%hedde. Inome Section. Q.10(b)(ii).
sEPmFsI-1 PF?3FImIESS EXPf2JSES+?NCCFfE-= lYRIrxiividualSckdule. 1~ =ction. Q.lO(b)(iii).
Ilc5Exl AMT. sEm-R’lPlc)YmINxr’EIN lxirWEEKmis is a derivedvariable.
13Clmw2sE HCH GROSS IIK.FT6?4SEI.F-Q4P.-LJK3TWRmis is a crosalinkvari~le.
HUSIKSE HUSB.- IIK.FIOISEIJ?+24P.-= WKmis is a crosslinkvariable.
WIFI.K.5E WIFE GROSS INC’.FRU4SW–R.lP-L4Sl’WKmis is a crosslinkvariable.
NIOl?i”RB WHERi?RSEIl?-E14PPAYS N.1. CON1’RIBUl’IONIndividualSchedule. Incme Section. Q.11.
NLV4TSE AWYJNI’OF LASCTN.I.~ II?SELF-mindividualSchedule. InccxESection. Q.ll(a).
NITIME PERIODOVERED SY IAS1’N.1. mNITUB-SEIndividualScMdule. Ixxe= Section. Q.ll(b).
sIzIIw wmmSRllw@rE FIimi2NDwxUZIrx3ividualschedule. IncuneSsction. Q.12.
sFzE?fPIY WHEIHEREMPLOYEEIN 2ND PAIDPT3RKIndividualSchedule. Incme Section. Q.12(a).
SI%RD3 WHETHER2ND PAIDW3FKRIXULARIndividualSclAule. Imme Section. Q.12(a)(i).
smNm’ Ixm NEr INxr4EFriCt42NDw3RK-mPLOYEEIrr3ividmlSch=dule. hccrneSection. Ch12(a)(i)(2).
Smlm 2ND JOB-PERIODFCR M PAY-DQLOYESIndividualschedule. kjcme %Ctim. Q.12(a)(i)(3).
SECEDE wHEmm2NDPAYmSmDmrS -EMPI.DYEEIndividualSckdule. ~ section. Q.12(a)(i)(4).
sExxiRCs G= PAY FOR 2NDWOFK -MIK3YEEIndividual.W_edule. IncuneSection. Q.12(a)(i)(4).
SEcl%ci? GROSS IN2Q4EF- 2ND JoB-S.WP:IFWIX3.E?4Individml Schdule. bxxne Section. Q.12(a)(ii).
mFmFIT ~N3PFOFITFCEiZNDhWi(~ 1*IndividualSckdul.e. 1~ ~tim. Q.12(a)(ii).
PRoFrIm TJME FOR I@KaiNPIOFIT-SELF-W 2NDW3RXIndividualScFedule. IR-XXESection.
sD21NCGRQ.12(a)(ii).
GROSSWE2HCLYItxXllEFRCMSmCND JC!3This is a derivedvariable.
cHLtBm WHETHERRECEIVESCHIU) BENJIPITIndividualSckdule. Inmne section. Q.13(a).
AmUNr OF CnILwBmEFIT RD2EIVFD-wmYIxiiividualschedule. InctmeSection. Q.13(a).
CHBENIN2 IFmDcH-Bm w.ulEwEEx QF ImmVlmIrxiividmlSchedule. InccxES@ction. Q.13(a)(i).
CBIN2MfT AmUNr CF CH-BEN INCm%SERx. mRwKIrxlividualScNule. Inccme.sectim. Q.13(a)(i).
FMImllvldul
FI.SM4TIrdlvldm.1
NIRIrdlvldcal
NIF.hYl’Iti]vldual
sumItilvldual
SBwl’I.rdlvldual
NISI~1.m51vldml
NISMfrIrx51vldusl
UNmPIrdlvld&
llm4PMfrIrdlvldusl
CmiEl%ENIrdlvld=l
Irdlv]dudLmGRw’lr
IndlV ldualDISC?t4T
Irdlvldwd02cm
Ir.dlvldualrxCPm4Y
Indlvldml
IMlvldus.1OmENml’
~ =IVFS FAMILYINCCNESUP’KE?JTschedule. IncuoeSectlm. 0.13(b).PKXJN1’OF F.l. S. RDX1~ - WYmde,--l~ *ctlcn. Q. 13(b).WHETHER~ N.I.,W31XkSm O.A. ~ICNSchedule.-:..lncaneSection. Q.13(c).AWUIVTOF-PE2JSICNRIXSIW - [email protected] IncaneSection. CL13(C).WHEm-iG,liASsuP.BEN,PSm.m ALLm..%h?ddk!.:InO.XE%Ctim. Q.13(d).~ @ SUP. -IT, FE2SION,AILLM.+%Schedule.’In2areSe&mm Q.13(d).IF HAS Si~ CR INIXEI’RULINJURYBENEFITSchedule.’Irbme Bectmn. Q.13(e).A?SWN1’~’ SICK;JNUJST.INJURYEENEFIT+iKLSclisdiile.‘LInccm Secticn. Q.13(e).WHETHERRD2EIVLN3UNEMPLOYMF.Nl’BENEFITSchsduIe’.b Sectmn. Q.13(f).MI OF UNFMPIDYMENTBDJEPITREC3?JVE0—WKLSchdule:?‘~ sec~m. Q.13(f).HHEmIERANYOmER-ITsschedule. ImcsD9Section. Q.13(g).?!MYa?r@ OIHER “Smm ‘rEm’=.+KLYschedule.-” Incme sactlm. Q.13(g).A14WlW’@ OTHER “= TER4’BENS.-WKlYScI_eduley’ImcaneSection. Q.13(g).IlW2~,DISPBW+Dm IF REN1’FEWI?ilAWl+ScFedtiei Irmms Section. CL13(g).W—ETHERRI12EIVT.tK~PATIW PIX.SICNSchdule. ImxrreSectIon. Q.14(a).NET AMOUNr CF anlP. PEmIm P.ICEIVESSckdule.’ Incme .%ctlon. Q.14(a)(l).TIME W~ BY LAST C03JP.Fi?hE.PAIMEN1’Sckedule. ‘IfdcmeSectmn. Q.14(a)(ii).Ml! @ @32.PEIH~ RIX!EIVEDPER WQK
‘Ihs IS a derivedvtiieble.axPENrx
ImilvldualPlvPEKIY
Indlvldus.1PmPJ44
Ifilvldualm3Pm
IrdlvldtimPlt4r
WHETHERCKXVP.P=. TAXEDAT .%UXESchedule. hcma sect-la. Q.14(a)(lll).IF ANY INxttSFRCi.lRR?rLtZ3CRSin-mSchsdule. Irsmne.%ction. Q.14(b).AMxNrcF NEr ItKmlEFKm PFQPEm’YScl_e5ulerk1 1~ Section. Q.14(b)(1).TIME COVEREDBY IAS1’PR3P.Il?XFIEPAYMENSchdule. InccareSection. Q.14(b)(ll).Awxt?roF wmKLYrwmE FTum PmPExrY
‘xhs IS a derivedvarl~le.WHEE-ER~I.N2@lEFFf14~ SCIJR2E
Irdlvldml Schdule. Inccste!?.ectlon.Q.14(c).AM2JNrcFcmiER~xKxME
I.dlvlduslSctedule. 1~ %ctlon. Q.14(c)(Ii).TIMSLASI’IM2ClfE~SOUKE- COVEIEII
Indlvldml Schdule. Incme SectIon. Q.14(c)(lil).MzUN’roF wEEIUx RJxr’ISFKr.10llim%%
‘Ihns1s a derivedvmiable.WHEIHERTAX CEaxmlm FRm+l’Hm-Imm.E
J.rriivldualSchdule. Incme Section. Q.14(c)(1v).WHETHER BUxmm SWIETY AC$xlrm
IndividualSchedule. Incme secticm Q.15(a).MiEITImR?NK m P.o. SAVImS Amxr?r
ItilvldualSchedule. ~ Sectmn. Q.15(b).IxSAw wliEmER -OIT+m-S4VIKciRINVEm MxCm?I’
IndlvldualSchedule. InccxreSectlm. Q.15(b).
~ m DIVI.RECSImB.=-ISI’ YRIrx5ividualScl-edule.IncuoeSection. Q.15(d).
BmK?wl’ ~ OR DIVI.RD2EImB4NR, FO-I.SWYRIndividml Schedule. InccmeSection. Q.IS(d).
SA~ GR~ =lPTS~ SAVE:~-W YR
Individti Sdedule. Incaw Section. Q.15(d).SAVI??MIN = RECEIP1’SUIYIERSAVE;INvEsT-15rYR
Itiividml ScI_edule.I.mma Section. Q.15(d).INTI’AX IF PAID I14XPfETAX DI~ m I.R.
IndividualSdedule. ImcxneSection. Q.16.NKXJNI’OFlt?X14ETAX PAID DIREC1’m 1.R.
Individual.%l=dul.e. InccxESection. Q.16(a).‘lwrIN21D ~’IwrAL mxr.fSm INDIvItx14LPmwR
mis is a derivedvariable.lwr.INCm lWl!ALIIWCFfECPALLINFAM. t?AIT~WK
‘Ibisis a crosslinkvarieble.‘riJT’IIK!HH lwmLm2mEoFAu IN ImJSmxD PER WK
This is a crosslinkvariable.hf.mxxD MISSIIGINIUW.TICN IN ‘IUI’I1421D
mis is a derivd variable.MVINSFU MISSIN INFO. IN TXINCEU -NO.@ INDIVS.
mis is a derivedvariable.MvINmH MISSI~ ~. Ili ‘TW1’m *.@ INDIVS .
fiis is a d=ived variable.PAYHOOR AVER?K43HODRLYFXUJ~-FMP. &SEW-~.
‘l’hisis a derivedvariable.FKxPAYHR H+++ ‘S AVER4GEHOJRLYEWUJLNGS
mis is a crosslinkvariable.HusPAYnR HUSEANO‘S [email protected]?llRLYEARNINGS
mis is a crosslinkvaridole.WIFPAYHR WIFE’SAVERAGEkKIJRIJYE%RNII$GS
mis is a crosslinkvariable.Sm3E2flw lUTJLhKLY S7?tl13MN. ECR FAM.U41T
This is a deriv~ variable.lWTALWKLY IJNWRN.IN2.FCR FAM.UTIT
‘l%isis a derivedVa.rizfole.UNEARNID ‘mmLwEEiuY UNmRNEDIN2rmE
This is a derivedvariable.JOINI’INT WkETHERCDIP123TEJITHRU JOIlll’INTERVIEW
Irx3ividualSchedule. Incwne%tion. P.47.