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Family Makeup. Enter the number of elderly (62 years or older) in family. Enter the number of severely disabled adults in the family. Indicate by checking Yes or No if the head of the family is female. Date. Enter the date the form was completed. Signature of Person Conducting the Interview. If the survey forms are mailed, this line is to be ... Fetch This Document

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6. Family Makeup Enter the number of elderly (62 years or older) in family. Enter the number of severely disabled adults in the family. Indicate by checking Yes or No if the head of the family is female. 7. Date Enter the date the form was completed. 8. Signature of Person Conducting the Interview ... Return Doc

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