Fill OUT ONCE A YEAR PER FAMILY
Please list all children living in the home:
Add another child
Respond to the following questions by selecting the appropriate answer
( Y = YES, N = NO, DK = DON'T KNOW )
Does anyone in your family (1st and 2nd generation) has a history of:
(Mother, Father, Grandparents, Aunts, Uncles and 1st cousins)
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