Survey Text

2021 2016 2011 2006
2020 2015 2010 2005
2019 2014 2009 2004
2018 2013 2008 2003
2017 2012 2007 2002
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2021

No questionnaire text is available for this sample.


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2020

No questionnaire text is available for this sample.


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2019

No questionnaire text is available for this sample.


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2018
Survey form view entire document:  text  image
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

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2017
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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
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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:

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2015
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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:

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2014
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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:

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2013
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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:

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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:

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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:

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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:

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2009
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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:

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2008
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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:

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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:

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2006
Survey form view entire document:  text  image
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:

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2005
Survey form view entire document:  text  image
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:

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2004
Survey form view entire document:  text  image
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:

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2003
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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:

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2002
Survey form view entire document:  text  image
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: