CPH Form 1. Listing sheet

May 1, 2000
NSCB Approval No. NS0-9920-01
Expires on: Dec. 31, 2000

Serial Number [prenumbered, 6-digit sheet number and capital letter "A"]

Guidelines

General Instructions:
[Each line of instruction text is preceded by an instructional symbol.]

The Census 2000 form will be processed by a computerized imaging system.

Please write neatly and legibly; use only NSO-supplied pencils when filling-up this form.

Use clean erasers when making corrections.

Complete all information to maintain data accuracy and consistency.

Do not make unnecessary folds and creases on the form.

Do not write unnecessary marks or comments on the form.

Write the appropriate digits (0...9) in the designated boxes. Please make sure each digit is written neatly inside each box as shown here.

Please make sure the cross mark is written neatly inside the circle as shown here.

__ __ Month of Visit

Geographic Identification

__ __ Page of __ __ Pages.
__ __ Province
__ __ City/Municipality
___ Barangay
__ __ __ Enumeration Area
__ __ Random Start

Cerification

I hereby certify that the data set forth were obtained/reviewed by me personally and in accordance with the instructions given.

___ Enumerator (Signature over printed name)
___ Date signed

Interview Record

[There follows a table with 11 columns and 5 rows per page. Some columns have two lines per row: boxes to enter numbers with a fill-in circle underneath to check the "Indicator." The eleven columns record information for these 11 items:]

Population count

Remarks

Page 2:

The members of the household are:

1. Those who live or intends to live in the housing unit.
2. The overseas workers who are away at the time of the census.
3. Those who are temporarily away but are expected to be back after time of departure.

List the household members in this order:
Head
Spouse of the head
Never-married children of head/spouse from the oldest to the youngest
Ever-married children of head/spouse and their families from the oldest to the youngest.
Other relatives of head
Non-relative of head

Household Size

Are there more than 8 members in this household? (Please cross out one of the selections below)

Are there any other persons such as small children or infants who were not listed? (Please cross out one of the selections below)

Demographic information for all persons

P1. Who is the head of this household?

Who are the persons usually residing here as of May 1, 2000?

(Please enter the column number of the person or household number)
___ Last name
___ First name

P2. What is [respondent]'s relationship to the head of the household?
(Please see code book)

P3. Family Nucleus
(Please cross out one of the selections)

P4. In what month and year was [respondent] born?

P5. Was [respondent]'s birth registered with the LCR?

P6. What is [respondent]'s age as of his/her last birthday?

P7. Is [respondent] male or female?

P8. Is [respondent] an overseas worker?
(For persons below 10 years old, mark No)

P9. What is [respondent]'s marital status?
(Please cross out one of the selections)
(For persons below 10 years old, cross out single)

P10. What is [respondent]'s religious affiliation?
(Please see code book)

[There are no questions P.11 or P.12]

P13. Does [respondent] have any physical or mental disability? (If no skip to P15)

P14. What type of disability does [respondent] have?
(Please see code book)

P15. How does [respondent] classify himself/herself? Is he/she an Ibaloi, Kankanaey, Mangyan, Manobo, Chinese, Ilocano or what?
(Please see code book)

For Persons 5 years Old and Over

P16. Can [respondent] read and write a simple message in any language or dialect?

P17. Is [respondent] able to speak Filipino/Tagalog?

P18. Is [respondent] able to speak English?

P19. Did [respondent] attend school at anytime from June 1999 to March 2000? ( If no, skip to P22)

P20. In what city/municipality did [respondent] attend school?

P21. In what type of school?
(Please cross out one of the selections)

P22. What is the highest grade/year completed by [respondent]?
(Please see code book)

P23. Residence 5 years ago

For Persons 10 Years Old and Over

P24. Residence 10 years ago

P25. What was [respondent]'s usual activity/occupation during the past 12 months?
(Please see code book)
If housewife, student or retiree, skip to P29.

P26. In what kind of business or industry did [respondent] work during the past 12 months?
(Please see code book)

P27. In what city/municipality did [respondent] work during the last 12 months?

P28. For whom or where did [respondent] work? (Please see code book)

Females 15-49 Years Old

P29. How many children have been born alive to [respondent]?

P30. How many are still living?

P31. How many children have been born alive to [respondent] from May 1, 1999 to April 30, 2000?

P32. What is [respondent]'s age at first marriage? (If answer in P9 = single, leave blank).

[Summary totals at the end of 30 records.]
Total

Vacant

Total Household Population

Total Institutional Population

Total Population

B1 to B4 are to be answered by mere observation. If doubtful, ask the respondent.

B1. Type of building/house
(Please cross out one of the selection below)

B2. Construction material of the roof
(Please cross out one of the selections below)

B3. Construction material of the outer walls
(Please cross out one of the selections below)

B4. State of repair
Determine the current condition of the building/house
(Please cross out one of the selections below)

B5 is to be Asked from Any Household in the Building

B5. Year building/house was built
When was this building/house built?
(Please cross out one of the selections below)

D1 is to be Asked from Any Household in the Housing Unit

D1. Floor area of the housing unit
What is the estimated floor area of this housing unit?
(Please cross out one of the selections below)

H1 to H16 are to be Answered by All Households

H1. Fuel for lighting
What kind of fuel does this household use for lighting?
(Please cross out one of the selections below)

H2. Fuel for cooking
What fuel does this household use most of the time for cooking?
(Please cross out one of the selections below)

H3. Source of water supply for drinking and/or cooking
What is this household's main source of water supply for drinking and/or cooking?
(Please cross out one of the selections below)

H4. Source of water supply for laundry and/or bathing
What is this household's main source of water supply for laundry and/or bathing?
(Please cross out one of the selections below)

H5. Tenure of the housing unit
Do you own or amortize this housing unit occupied by your household or do you rent it, do you occupy it rent-free with consent of owner or rent-free without consent of owner?
(Please cross out one of the selections below)

H6. Acquisition of housing unit
How did you acquire this housing unit?
(Please cross out one of the selections below)

H7. Souce of financing
Do you avail of the following sources of financing in the construction/purchase of this housing unit?
(Please cross out yes or no on the selections below)

H8. Tenure status of the lot
Do you own or amortize this lot occupied by your household or do you rent it, do you occupy it rent-free with consent of owner or rent-free without consent of owner?
(Please cross out one of the selections below)

H9. Monthly rental of the housing unit or lot
How much is the monthly rental?
(Please cross out one of the selections below)

H10. Usual manner of garbage disposal
How does your household usually dispose of your kitchen garbage such as leftover food, peeling of fruits and vegetables, fish and chicken entrails, etc.?
(Please cross out one of the selections below)

H11. Kind of toilet facility
What type of toilet facility does this household use?
(Please cross out one of the selections below)

H12. Presence of household conveniences

Does this household have the following household conveniences in working condition?
(Please cross out yes or no on the selections below)

H13. Land ownership
Does any member of this household own the following?
(Please cross out yes or no on the selections below)

H14. Language/dialect generally spoken
What is the language/dialect generally spoken at home by members of this household?
(Please see code book)

H15. Residence five years from now
In what city/municipality does this household intend to reside on May 1, 2005?

If another city/municipality, specify city/municipality and province (Please see code book)