Disability Income, or Veteran’s Disability Benefits? Have you ever been physically, emotionally, or sexually abused by a Yes No Yes No Yes No Yes No Yes No □ □ □ □ □ □ □ □ □ □ relative or another person you have DK/REF DK/REF DK/REF DK/REF DK/REF □ □ □ □ □ stayed with, such as a spouse, partner, brother or sister, or parent? [IF MORE ADULTS IN HH GO BACK TO Q16 TO COMPLETE COLUMNS FOR Thanks for taking the survey! PERSONS 2-5.]
Disability Income, or Veteran’s Disability Benefits? Have you ever been physically, emotionally, or sexually abused by a relative or another person you have stayed with, such as a spouse, partner, brother or sister, or parent? □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF □ Yes □ No □ DK/REF Thanks for taking the survey! [IF MORE ADULTS IN HH GO BACK TO Q16 TO COMPLETE COLUMNS FOR PERSONS 2-5.]
Sheltered-Count-form-2016.docx