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 C$?HEAO@MUSRKLOcrosslinkvarmble.xE@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 $&SEEAPPEND.A+crosslink varieble.CXYIWRYOF BIIUM -HUS.@liXAPPEND.A$crosslink variable.~ OF BIRIM -WIFE@E23APPllJD.A~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 E2@.OFFICESchedule. 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 aP.7@.E @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 CHI@.j.j1Indlvldcal=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 UN@F.NHIARIN+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&lth 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@.@.e...FeJnilylnfomatlon %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 - WYSCh@Ule.i 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 AVEF@.CiEl?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.