Survey Text
2021
No questionnaire text is available for this sample.
2020
No questionnaire text is available for this sample.
2019
No questionnaire text is available for this sample.
2018
Survey form
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Date completed:
Who completed this form?
1 Person named on front of this form
2 Someone else,
If Someone Else, what is person?s relationship to the person named on the front of this form?
1 Husband or wife
2 Unmarried partner
3 Mother, father, or guardian
4 Son or daughter
5 Other relative
6 Not related
2017
Survey form
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Date completed: MONTH / DAY / YEAR
Thank you for completing this survey. Please place this survey in the envelope provided to you and give it to the MEPS interviewing team member.
If the interviewer is no longer available, place the survey in the return envelope provided to you by the interviewer. If the envelope is missing, mail this survey to:
MEPS
c/o Westat
1600 Research Blvd, Room GA51
Rockville, MD 20850
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2016
Survey form
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Date completed: MONTH ____ / DAY ____ / YEAR __________
If this booklet was not completed by the person named on the front, who completed it:
What is this person?s relationship to the person named on the front:
2015
Survey form
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2014
Survey form
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2013
Survey form
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2012
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2011
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2010
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2009
Survey form
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2008
Survey form
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2007
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2006
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2005
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2004
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2003
Survey form
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1:
2002
Survey form
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If this booklet was not completed by the person named on page 1, who completed it:
What is this person's relationship to the person named on page 1: