(RB, PG 64)
(Think about the month or longer in the past 12 when your frequent concerns about separation from (PERSON/this person) were most severe. Using the 0 to 10 scale, where 0 means no interference and 10 means very severe interference, what number describes how much your frequent concerns about separation from (PERSON/this person) interfered with each of the following activities during that time?)
Your ability to work?
(IF NEC: How much did your concerns about separation interfere with your ability to work during that time?)
(IF NEC: You can use any number between 0 and 10 to answer.)
IF 'DOES NOT APPLY', CODE 97