Republic of Argentina
Presidency of the Nation
Secretariat of the Council of National Development
National Institute of Statistics and Censuses
A -- Geographic Location
____ Department or division [partido]
____ Fraction [fracción]
____ Area
____ Block or sector
____ Segment
____ Locality or place [paraje]
____ Street or route
____ Number
____ Floor
____ Apartment
Dwelling -- Household Relationship
[The form contains a table to indicate the number of household in the dwelling and the number of males and females within each household. Below, we show an English translation of the column and row headings is provided.]
Households in the dwelling [column headings]
Two
[] 21
[] 22
Three
[] 31
[] 32
[] 33
Four or five
[] ____
Renter [inquilinato]
[] 61
[] 69
Office use ____
Occupants [row headings]
____ Females
____ Total
B -- Dwelling
[Questions 1-12.]
[] 2 Temporarily occupied
[] 3 Uninhabited
2. Dwelling type
[] 2 Apartment
[] 3 Tenement [inquilinato: crowded urban dwelling, usually rooms rented out in a converted older house]
[] 4 Precarious dwelling
[] 5 Shack [Rancho]
[] 6 House, apartment, or room in a school, factory, office, etc.
[] 7 Mobile home, tent, boat, truck, boxcar/container, etc.
[] 8 Dwelling in a place not intended for habitation
[] 9 Others
[] 2 Barracks, military or police post
[] 3 Hospital, sanatorium, health center
[] 4 Prison, reformatory, etc.
[] 5 Boarding school
[] 6 Convent, religious institution
[] 7 Encampment
[] 8 Other
3. Exterior walls -- Predominant materials
[] 2 Adobe
[] 3 Straw mixed with clay [chorizo]
[] 4 Wood
[] 5 Metal: corrugated or flat sheets
[] 6 Fibrocement: corrugated or flat sheets
[] 7 Corrugated cardboard
[] 8 Others (waste material: tin, straw, hay [malhoja], branches, etc.)
4. Roofs -- Predominant materials in the exterior roof covering
[] 2 Tiles
[] 3 Metal: corrugated or sheet
[] 4 Fibrocement: corrugated or sheet
[] 5 Corrugated cardboard
[] 6 Wood, cane or palm
[] 7 Others (waste material: tin, straw, hay [malhoja], branches, etc.)
5. Floors -- Predominant materials
[] 2 Wood
[] 3 Plastic flooring
[] 4 Cement or brick
[] 5 Others (loose brick, other waste materials, etc.)
[] 6 Earth
6. For office use ____
7. Rooms ____
[] 1 Piped within the dwelling
Outside the dwelling:
[] 3 By tap, spout, or faucet outside the lot
[] 4 Other
b) Source:
[] 1 Running water from the residential system
[] 2 Well
[] 3 Rain
[] 4 River, stream, lake, lagoon, irrigation canal, etc.
[] 2 Does not have
[] 2 Shared
[] 2 Bottled gas
[] 3 Other
10. Toilet facilities
Type:
[] 1 Connected to public wastewater system
[] 2 With another wastewater system (septic tank, pit)
[] 3 Without running water (latrine, etc.)
[] 4 Does not have
[] 2 Shared
Type:
[] 2 With cold water only
[] 3 Does not have
[] 2 Shared
[] 2 Other
12. Tenure
[] 2 Renter or leaser
[] 3 Dependent occupant
[] 4 Free occupant
[] 5 Other; specify ____
Comments: ________
Enumerator
____ Printed name
Area head
____ Printed name
For office use [8 blank boxes]
Strictly confidential and restricted (Art. 10 Law 17.622)
[pg. 2]
[Questions 1-19.]
General characteristics -- For all individuals
[Questions 1-8 were asked of all persons.]
1. What is your relationship or tie to the head of the household?
[] 2 Spouse
[] 3 Child
[] 4 Parents or parents-in-law
[] 5 Grandchild
[] 6 Other relatives
[] 7 Domestic servants
[] 8 Boarder
[] 9 Others
2. What is your name and surname? ____
3. Male or female?
[] 1 Male
[] 2 Female
4. What is your date of birth?
____ Day
____ Month
____ Year
____ [Box for age]
5. Where were you born?
[] Here
____ Locality or place
____ Department or division
____ Province or foreign country
6. Where do you habitually live?
[] Here
____ Locality or place
____ Department or division
____ Province or foreign country:
7. Where was your place of habitual residence in September, 1965?
If the place of habitual residence in 1965 was the locality or place where enumerated, simply mark the box "here." Otherwise, write the name of the locality or place, the department, and province, respectively. If living abroad simply write the name of the country.
[] Here
____ Locality or place
____ Department or division
____ Province or foreign country:
8. In what year did you arrive to live in the country? ____
Write the year of arrival.
Educational Characteristics -- For all individuals five years of age and older
[Questions 9-12 are asked of persons 5 years of age and older.]
9. Do you or did you attend any educational institution?
[] 1 Currently attending?
[] 2 Not attending, but used to attend?
[] 3 Never attended?
[] 4 Unanswered
10. [Educational attainment]
[Questions 10A-10C are asked only of persons who had ever attended an educational institution.]
[] 1 Primary
[] 2 High school
[] 3 Commercial
[] 4 Teacher training [normal]
[] 5 Technical or industrial
[] 6 Other secondary schooling
[] 7 University and higher
[] 8 Unanswered
[] 1 Yes
[] 2 No
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9 Unanswered
11. What specialization or career did you study or are you studying?
[Question 11 was asked of persons with education level of "Technical or industrial," "Other secondary," or "University and higher."]
Write the specialization or career ____
12. Are you able to read and write?
[] 1 Yes
[] 2 No
Economic Characteristics -- for all individuals ten years of age and older
[Questions 13-17 were asked of all persons 10 years and older.]
13. What did you do during the greater part of the week of September 21st to 26th?
The concept of "the greater part of the week" refers to four normal work days according to the occupation the person carries out, or if the person worked more than 35 hours.
[] 1 Worked?
[] 2 Did not work, but had a job?
[] 3 Looked for work, having worked before?
[] 4 Looked for work for the first time?
[] 5 Retired or pensioner and did not work?
[] 6 Received investment income and did not work?
[] 7 Studied and did not work?
[] 8 Took care of the home?
[] 9 Other
[] 0 Unanswered
Only those people who responded 1, 2 or 3 in question number 13 should answer these questions.
[Questions 14-16 are asked only of persons who responded 1, 2 or 3 to question 13. The questions referred to the activity carried out between Monday and the Sunday before the day of the census.]
14. What is the occupation, position, or profession that provides the greatest part of your income? ____
15. What does the establishment in which you work primarily do or make? ____
16. What is the category or position you hold in the exercise of your profession?
[] 1 Worker?
[] 2 Employee?
[] 3 Own account (does not have employees)?
[] 4 Owner or partner (has employees)?
[] 5 Family worker without a fixed wage?
[] 6 Unanswered
17. Are you the person who earns the most in the household?
[] 1 Yes
[] 2 No
Other Characteristics
[Questions 18-19.]
18. How many children born alive have you had? Of these, how many are currently alive? How many have died?
Verify that the total of parts (a) and (b) matches the total "number of children born alive."
[] Has not had any children born alive
Total number of children born alive ____
____ b) Number of children deceased
19. What is your current marital status?
Ask each question in the order given and upon receiving an affirmative response, mark the appropriate box.
[] 1 Consensual union?
[] 2 Married?
[] 3 Separated or divorced?
[] 4 Widowed?
[] 5 Single?
[] 6 Unanswered