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National Population and Dwelling Census
Strictly confidential and reserved

Geographic Location of the Dwelling

[] When it is necessary for a household to use more than one form, fill in this circle, starting with the second form used.


Street ____
Number ____
Floor ____
Apartment ____
Locality or Place ____
Department or Fraction ____
Province ____
Fraction _ _
Radius _ _
Segment _ _
Block number _ _ _
Order number of the dwelling _ _
Order number of the household in the dwelling _ _

Dwelling

I. Characteristics of the dwelling for the only household or for the first household
[Questions 1-9]

1. Condition of occupation

Occupied (people live in one or more household)
[] With occupants present
[] With occupants absent - end of form [the enumeration terminated]
Unoccupied (no persons live in household) - end of form [the enumeration terminated]
[] Used for summer or weekend
[] For rent or for sale
[] Construction
[] Used for purposes other than occupancy
[] Other reason
[] Unanswered

[Questions 2-16 were addressed only in case of an occupied dwelling, with occupants present, per Question 1.]

2. Type of dwelling

Collective - continue with population [skip questions 3-16]
[] Home for the elderly
[] Home for children
[] Boarding school
[] Labor camp
[] Hospital
[] Prison
[] Barracks
[] Religious household
[] Hotel
Individual
[] House
[] Rural dwelling or cabin
[] Apartment
[] Rented room/s
[] Pension or hotel
[] Space not built for occupation
[] Mobile dwelling

[Questions 3-16 were asked only in case of an individual dwelling with occupants present, per questions 1 and 2]

3. Number of households in the individual dwelling

Household is a group of persons that live together and share their food expenses. The people that live alone are each counted as a household.

[] One household
[] Two households or more:
For the first household, continue with question 4. For the second and subsequent households, complete another form: fill in the geographic location and continue on the other side.

4. What is the predominant material of the outer walls?

[] Brick, stone, cinder block, reinforced concrete
[] Adobe
[] Wood
[] Metal sheeting or cement/fiber sheeting
[] Plant material, cardboard, discarded materials
[] Other

5. What is the predominant material of the outer covering of the roof?

[] Tile, asphalt, or membrane.
[] Clay roofing tile
[] Metal sheeting
[] Cement fiber sheeting
[] Cardboard
[] Cane, wood (boards), straw with clay, straw
[] Other
[] Unanswered

6. What is the predominant material of the floors?

[] Ceramic, tile, mosaic, wood, carpet, or plastic
[] Cement or permanent brick
[] Dirt
[] Other

7. Electrical service?

[] With electricity from a public or private network
[] With electricity generated by household
[] No electricity

8. Water service?

[] With tubing inside the dwelling
[] Outside the dwelling, but inside the property
[] Outside the property

9. Household obtains water through?

[] Running water from a public system
[] Perforated well with a motorized pump
[] Perforated well with a hand pump
[] Well
[] Rain water
[] Supplied by a water-tank truck
[] River, canal, ditch, etc.

II. Habitational Characteristics of the Dwelling- for each household
[Questions 10-16]

10. How many rooms are for the exclusive use of the household, excluding the bathroom or kitchen?

[] None
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8 or more

11. What is the principal combustible used for cooking?

[] Gas from a network
[] Packaged gas (tank, tube, etc)
[] Kerosene
[] Electricity
[] Wood or charcoal
[] Other

12. In the bathroom, does the dwelling have a toilet or lavatory with flushing water (with a button, chain, etc)?

[] For the exclusive use of the members of the household
[] Shared with another household
[] Does not have a toilet or lavatory with flushing water [skip question 13]

13. The drain for the flush toilet has:

[Question 13 was asked only in the case of a household with toilet, per question 12.]

[] With drainage to a public system
[] A septic tank or pit
[] Only a pit
[] Unanswered

14. The occupants:

[] Own the dwelling and the land
[] Own the dwelling only
[] Renter
[] Other dependant relationship
[] Occupancy through loan, grant or permission
[] De facto occupation
[] Other
[] Unanswered

15. What are the names of each of the persons who spent the night in the household? (do not forget the children under one year of age)

Include:
- All persons that spent the night in the household and are present.
- Persons who spent the night in the household but are temporarily absent and will not be listed on a census for another place.
- Persons who did not spend the night but are present and will not be listed on a census for another place.
- Persons who died after midnight.
Do not include:
- Babies born after midnight even if they are present.
Put the persons in order, starting with the head of household and continuing with the other persons in the following order:
a) Spouse or companion
b) Son/daughter; step-son/daughter
c) Parent or parent -in -law
d) Son in law/ daughter in law
e) Grandson/ daughter
f) Other relative
g) Domestic servants and their relatives
h) Other non-relatives
Complete the population forms using this same order.

[5 separate lines for each individual in the household are provided.]

Order Number ____
Name ____

[] If there are more than six persons in the household, fill in this circle and use another form according to the instruction. In this case, complete the question 16 in the last form that you use.

16. What is the total number of persons in the household? _ _

Population

Person number _ _ _ _ _

For all of the persons (do not forget the children).

[Questions 1-10 were asked of all persons.]

1. What is the relationship with the head of household?

[] Spouse or companion
[] Son, daughter; step-son, step-daughter
[] Parent or parent-in-law
[] Son-in-law, daughter-in-law
[] Grandson, granddaughter
[] Other relative
[] Domestic servants and their relatives
[] Other non-relatives
[] Resident in a collective dwelling

2. Sex

[] Male
[] Female

3. What is his or her current age in completed years? _ _

For those younger than one year old mark 00. For those older than 99 years old mark 99.

4. Does the person receive a pension or retirement payment?

[] Yes
[] No
[] Unanswered

5. Where does the person usually live?

The place where the person has lived for the last six months or more or has decided to reside.

[] In this locality
[] In another locality in Argentina
____ Locality or place
____ Department or Fraction
____ Province (consider the Federal Capital as a province)
[] In another country: name of the country ____
[] Unanswered

6. Where did the person usually live five years ago?

[] In this locality
[] In another locality in Argentina
____ Locality or place
____ Department or Fraction
____ Province (consider the Federal Capital as a province)
[] In another country: name of the country ____
[] Unanswered

7. Where he or she was born?

[] In this province
[] In another province in Argentina: Province (consider the Federal Capital as a province) ____
[] In Bolivia, Brazil, Chile, Paraguay, or Uruguay
Name of the country ____
Year of arrival in Argentina (if before 1900, write 00) 19_ _
[] Unanswered
[] In another country
Name of the country ____
Year of arrival in Argentina (if before 1900, write 00) 19_ _
[] Unanswered
[] Unanswered

8. Does the person have any social services?

[] Yes
[] No
[] Unanswered

9. Is the person affiliated with a medical plan or a mutual plan?

[] Yes
[] No
[] Unanswered

10. Does the person know how to read and write?

[] Yes
[] No
[] Unanswered

For all persons 3 years old and more
[Questions 11- 16 were asked of persons age 3 years or older.]

11. Do you attend some educational establishment?

[] Attends a public establishment
[] Attends a private institution
[] Does not attend, but attended [skip questions 12-13]
[] Never attended [skip questions 12-16]
[] Unanswered [skip questions 12-16]

12. What level does the person attend?

[Question 12 was asked of persons age 3+ who currently attended an educational establishment, per question 11.]

[] Preschool or kindergarten [finished, skip questions 13-28]
[] Elementary
[] Secondary
[] Tertiary
[] University
[] Unanswered

13. What year or grade is the person attending?

[Question 13 was asked of persons age 3+ who currently attend an educational establishment at a level higher than preschool or kindergarten, per questions 11-12.]

[After responding to question 13, skip questions 14-16.]

[] 1st
[] 2nd
[] 3rd
[] 4th
[] 5th
[] 6th
[] 7th
[] Unanswered

14. What is the highest level that the person attended?

[Question 14 was asked of persons age 3+ who do not currently attend an educational establishment but attended one in the past, per question 11.]

[] Preschool or kindergarten - continue on the other side [skip questions 15-16]
[] Elementary
[] Secondary
[] Tertiary
[] University
[] Unanswered

15. What was the highest year or grade that the person passed at this level?

[Question 15 was asked of persons age 3+ who did not currently attend an educational establishment but attended one in the past, at a level higher than preschool or kindergarten, per questions 11 and 14.]

[] Did not complete 1st - continue on the other side [skip question 16]
[] 1st
[] 2nd
[] 3rd
[] 4th
[] 5th
[] 6th
[] 7th
[] Unanswered

16. Did the person complete this level?

[Question 16 was asked of persons age 3+ who do not currently attend an educational establishment but attended one in the past, at a level higher than preschool or kindergarten, and completed at least the 1st year at that level, per questions 11, 14, and 15.]

[] Yes
[] No
[] Unanswered

For all women and men fourteen years of age or older.
[Questions 17-25 were asked of persons age 14 years +.]

17. During the past week, did you work, even if it was for just a few hours?

[] Yes [skip questions 18-20]
[] No
[] Unanswered [skip questions 18-24]

18. Did you do anything in the house that was for outside or help anyone in a business, small farm, or work?

[Question 18 was asked of persons age 14+ who did not formally work last week, per question 17.]

[] Yes [skip questions 19-20]
[] No
[] Unanswered [skip questions 19-24]

19. Were you off work because of illness, vacation, etc?

[Question 19 was asked of persons age 14+ who did not formally work last week, per question 17, and did not do any informal work last week, per question 18.]

[] Yes [skip question 20]
[] No
[] Unanswered [skip questions 20-24]

20. During the past four weeks, did you look for work?

[Question 20 was asked of persons age 14+ who did not do any work last week due to reasons other then sickness, vacation, etc., per questions 17-19.]

[] Yes [skip questions 21-24]
[] No [skip questions 21-24]
[] Unanswered [skip questions 21-24]

[Questions 21-24 were asked of persons age 14+ who had a job last week (did formal or informal work or did not work due to sickness, vacation, etc.), per questions 17-19.]

21. In your main job, the one where you work the most hours, what position did you have in this occupation?

[] Owner or partner (has employees)
How many workers or employers are there in the establishment where you work?
[] 1 to 5
[] 6 or more
[] Unanswered
[] Employee or worker in the private sector
How many workers or employers are there in the establishment where you work?
[] 1 to 5
[] 6 or more
[] Unanswered
[] Employee or worker in the public sector
[] National
[] Provincial
[] Municipal
[] Unanswered
[] Domestic employee
[] Self-employed (does not have employer)
[] Family worker without regular income
[] Unanswered

22. What does the establishment or place where the person works do or produce? ____

For example: stove factory, collective passenger transportation, leather shoe factory, elementary education, preparation and sale of cakes, etc.

23. What do you do in this job? ____

For example: Administrative: payroll; Chauffeur: drive collective buses; Machine sewing: sew leather shoes with an electric sewing machine; Doorman: clean and take care of school; Pastry chef: makes cakes and pastries to sell.

24. In this work, do you contribute to a retirement fund?

[] Yes
[] No
[] Unanswered

25. [Marital status]

Currently, you are:

[] In a consensual union
[] Married in a legal union
[] Separated from a union or marriage
[] Divorced from a marriage
[] Widowed from a consensual union or marriage
[] Single, never formed a union or married
[] Unanswered

For women 14 years old and older (do not forget the single women).
[Questions 26-28 were asked of women 14 years of age and older.]

26. How many children have you had born alive?

[] None [end of questions for this person]
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10
[] 11
[] 12
[] 13
[] 14
[] 15
[] 16 or more
[] Unanswered [end of questions for this person]

27. How many are currently alive?

[Question 27 was asked of women age 14+ who ever had children born alive, per question 26.]

[] None
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10
[] 11
[] 12
[] 13
[] 14
[] 15
[] 16 or more
[] Unanswered [end of questions for this person]

28. Have you had any children born alive in the past twelve months?

Only for women ages 14 to 49.
[Question 28 was asked of women of age 14-49 who ever had children born alive, per question 26.]

[] Yes, 1
[] Yes, 2 or more
[] No
[] Unanswered