Do you have a spouse that lives with you?

*How many of your and/or your spouse's children under 21 live with you?

*How many other children under 21 live with you?

*How many other adults, age 21 or older, live with you?

Note: Include all children 21 and older, but do not include your spouse.

Does everyone in your household share food?

Does anyone in your household have a disability or is anyone blind?