It is, of course, the standard-issue run-of-the-Complex statement to the effect that you are not now nor have you ever been a Commie Mutant Traitor.  There is also a series of check-boxes...<br/><br/>Was this form administered fairly?  Yes/No<br/>Were the office personnel who issued the form clean and courteous?  YES/<del>No</del><br/>The Commie mutant Traitor threat is worse now than ever before.  Yes/No<br/><br/>Check the box below which best describes your feelings about the following statement: 'I think the new taste of Bouncy Bubble Beverage is...'<br/>...a marked improvement over the old B<sup>3</sup><br/>...great!<br/>..I was unaware of any change.<br/>...super scrubdillyitious!<br/>...yucky.  Loyal citizens prefer the taste of old Bouncy Bubble Beverage.