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Facial palsy
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Motor arm
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Motor leg
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Limb ataxia
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Sensory
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Best language
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Dysarthria
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Extinction and Inattention
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Amputation, joint fusion explain
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Amputation, joint fusion explain
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Amputation, joint fusion explain
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Intubated or other physical barrier, explain
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What is your best estimate of the total income of all family members from all sources, before taxes, in [last calendar year in 4 digit format]?
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Was your total family income from all sources less than $50,000 or $50,000 or more?
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Was your total family income from all sources less than $35,000 or $35,000 or more?
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Was your total family income from all sources less than [fill based on poverty threshold] or [fill based on poverty threshold] or more?
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Was your total family income from all sources less than $100,000 or $100,000 or more?
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Was your total family income from all sources less than $75,000 or $75,000 or more?
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Where were you born?
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In the United States- Print name of state