<fieldset class="usa-fieldset">
  <legend class="usa-legend">Date of Birth</legend>
  <span class="usa-hint" id="mdHint">For example: January 19 2000</span>
  <div class="usa-memorable-date">
    <div class="usa-form-group usa-form-group--month usa-form-group--select">
      <label class="usa-label" for="date_of_birth_month">Month</label>
      <select class="usa-select" id="date_of_birth_month" name="date_of_birth_month" aria-describedby="mdHint"
        {% if disabled_state == 'disabled' %} disabled
        {% elseif disabled_state == 'aria-disabled' %} aria-disabled="true" {%- endif %}
      >
        <option value>- Select -</option>
        <option value="1">January</option>
        <option value="2">February</option>
        <option value="3">March</option>
        <option value="4">April</option>
        <option value="5">May</option>
        <option value="6">June</option>
        <option value="7">July</option>
        <option value="8">August</option>
        <option value="9">September</option>
        <option value="10">October</option>
        <option value="11">November</option>
        <option value="12">December</option>
      </select>
    </div>
    <div class="usa-form-group usa-form-group--day">
      <label class="usa-label" for="date_of_birth_day">Day</label>
      <input class="usa-input" aria-describedby="mdHint" id="date_of_birth_day" name="date_of_birth_day"
        maxlength="2" pattern="[0-9]*" inputmode="numeric" value="" 
        {% if disabled_state == 'disabled' %} disabled
        {% elseif disabled_state == 'aria-disabled' %} aria-disabled="true" {%- endif %}
      />
    </div>
    <div class="usa-form-group usa-form-group--year">
      <label class="usa-label" for="date_of_birth_year">Year</label>
      <input class="usa-input" aria-describedby="mdHint" id="date_of_birth_year" name="date_of_birth_year"
        minlength="4" maxlength="4" pattern="[0-9]*" inputmode="numeric" value="" 
        {% if disabled_state == 'disabled' %} disabled
        {% elseif disabled_state == 'aria-disabled' %} aria-disabled="true" {%- endif %}
      />
    </div>
  </div>
</fieldset>
