30-44 45-64 65-84 85+ Do you have any long-term illness, disability or health problem that limits your daily activities or the work you can do? Yes No How would you describe your ethnic background? Please select one only White British White Irish White other Mixed Asian or Asian British Black or Black British Chinese Other ethnic background - please describe below Please return this form to: Environment Team, Floor 6, County Hall, Norwich, NR1 2SG 0344 800 8020
30-44 45-64 65-84 85+ Do you have any long-term illness, disability or health problem that limits your daily activities or the work you can do? Yes No How would you describe your ethnic background? Please select one only White British White Irish White other Mixed Asian or Asian British Black or Black British Chinese Other ethnic background - please describe below Please return this form to: Environment Team, Floor 6, County Hall, Norwich, NR1 2SG 0344 800 8020