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Household Composition cont'd <br />13. Primary nationality: Caucasian L3 <br />13. Nacionalidad Japanese❑ <br />14. Primary language spoken: <br />14. ldioma principal: <br />Hispanic❑ African - American❑ Chinese❑ Korean❑ <br />American Indian E3 Other: <br />a. Will an interpreter be needed: Yes❑ No❑ <br />a. Sera neeesario ohtener un inteiprete? <br />15. Does someone in the household understand and speak English ?: Yes❑ No❑ a. Name: <br />15. Alguna persona en el hogar entiende y hahla ingles? <br />a. Nomhre de la persona gue hahla ingles: <br />16. Are there individuals with disabilities living in the household(s): Yes No❑ <br />16 Hay miemhro(s) del hogar gue Henen discapacidadea ftaicas? <br />a. Please describe disability: <br />a. Por favor descriha la discapacidadea ftaicas? <br />b. Is this a work - related disability (did it happen on your job): Yes❑ No❑ <br />h. Eata discapacidad ocur i6 o eat6 relacionada con su trahajo? <br />17. Types and number of pets in household: <br />17. Cantiidad y tiipo de maaeotm gue se encuenb,an en el hogar: <br />JLength of Occu ane <br />18. Is this your primary residence? Yes❑ No❑ <br />18. Es esta su vivienda principal? <br />19. How long have you lived at this address? Years — Months a. Date of original occupancy: <br />19. Cuanto Hempo ha vivido en esta direcci6n9 Anos Meses a. Fecha en gue ocupo la vivienda: <br />20. How long have you live in the area? Years Months <br />20. Cuanto fiempo ha vivido en esta area ? Anos Meses <br />JProperty Description <br />21. What type of dwelling do you occupy: Single family residence❑ Condominium❑ Duplex❑ Mobile home❑ <br />21. Que Hpo de vivienda ocupa: <br />3 -4 unit apartment❑ 5+ unit apartment❑ Rooming house❑ Hotet/motel❑ Other <br />22. Dwelling rooms/ facilities (number): <br />22. Hahitacionea/instalacionea hdsicas (cantiidad): <br />Bedrooms Living Room <br />Hahitaeiones Comedor <br />Baho ano <br />B <br />Kitchen <br />Cocina <br />Dining Room <br />Sala <br />Garage <br />Gmraje <br />Additional <br />Comments: <br />Family Room <br />Cuarto Familiar <br />Den <br />Ante Sala <br />Utility Room <br />Cuarto de utiilidades <br />Storage <br />Almacen <br />Parking Other <br />Estacionamiento otro <br />Total Number of Rooms <br />Cmaidad total de martos <br />1; 111caoavrofi, a, iaaraaaa: arargaa. l.: rIVaalaraartBqa „asarrrsm;i;ads°e tt N„ <br />e aasade^ ed �a� �f ark the s^rrom ar ease /far 1paa) aes ��' <br />c alculdaang 2 2 aaah )Zgrmeaarta. <br />Initials of Respondent (iniciales del entrevistado): Initials of Interviewer:_ <br />Page 2 of 8, Residential Survey /Interview 55B -55 rev.09 115 <br />