a survey data collecting system includes a booklet having front and back covers and a plurality of intermediate pages . the back cover is perforated to form a negotiable check , the face of which is on the outer surface of the back cover . the inner surface of the check has several columns of spaces thereon for indicating answers to questions which are written on the intermediate leaves and on the remaining portion of the back cover . the intermediate leaves decrease in width so that each succeeding leaf covers one less column of spaces than the preceding one .