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Republic of Bolivia

Population and Housing Census
1976

____ Form number

I. Geographic Location

____ 1. Department

____ 2. Province

____ 3. Canton

____ 4. City or locality

____ 5. Zone number

____ 6. Sector number

____ 7. Segment number

____ 8. Block number

____ 9. Residential address of the dwelling

____ Street
____ Number
____ Floor number
____ Apartment number
____ Route or Highway

____ Dwelling number

____ Number of households in this dwelling

____ Household number

II. Dwelling

1. Dwelling type

1.1 Private dwelling
[] 11 Independent house
[] 12 Apartment
[] 13 Room(s) in a tenement
[] 14 Shack or hut (pahuichi)
[] 15 Improvised dwelling
[] 16 Place not intended for use as a dwelling
[] 17 Other
1.2. Collective dwelling (group quarters)
[] 21 Hotel, boarding house
[] 22 Barracks, military or police establishment
[] 23 Hospital, sanatorium, clinic
[] 24 Prison, correctional institution
[] 25 Convent, religious institution
[] 26 Boarding school
[] 27 Other (specify) ____
For answers 21 through 27, skip to the questions on population.

2. Occupancy status

[Question 2 was asked of persons in private dwellings, per Question 1.]

[] 1 With occupants present
[] 2 With occupants absent
[] 3 Unoccupied

3. Predominant materials in the dwelling

[Question 3 was asked of persons in private dwellings, per Question 1.]

3.1 Roof
[] 1 Corrugated iron (Calamina)
[] 2 Tiles (cement, clay, fibro-cement, etc.)
[] 3 Reinforced concrete slab
[] 4 Straw, cane, palm
[] 5 Others (specify) ____

3.2 Exterior walls
[] 1 Plastered adobe
[] 2 Abode without plaster or mud-wall construction
[] 3 Brick, cement block, etc.
[] 4 Stone
[] 5 Wood
[] 6 Cane, palm, logs
[] 7 Others (specify) ____

3.3 Floors
[] 1 Wood
[] 2 Tile or paving
[] 3 Brick
[] 4 Cement
[] 5 Dirt
[] 6 Others (specify) ____

From this topic forward, the information refers to each household within the dwelling.

4. Availability of water service

[Question 4 was asked of persons in private dwellings, per Question 1.]

4.1 Water supply system
[] 1 Piped inside the dwelling
[] 2 Piped outside the dwelling, but inside the building, lot, or grounds
[] 3 Piped outside the lot or grounds
[] 4 Does not get piped water

4.2 Source of the water
[] 1 Public system
[] 2 Private system
[] 3 Well or pump
[] 4 Rain water tank
[] 5 River, lake, spring or stream
[] 6 Delivery vehicle
[] 7 Other (specify) ____

5. Availability of hygienic facilities (toilet, latrine)

[Question 5 was asked of persons in private dwellings, per Question 1.]

[] 1 Has, for exclusive use by this household
[] 2 Has, shared or common use
[] 3 None

6. Wastewater elimination system

[Question 6 was asked of persons in private dwellings, per Question 1.]

[] 1 Public sewer
[] 2 Septic tank
[] 3 Latrine or pit
[] 4 None

7. Shower or bathtub

[Question 7 was asked of persons in private dwellings, per Question 1.]

[] 1 Has, for exclusive use by this household
[] 2 Has, shared or common use
[] 3 None

8. Electric energy

[Question 8 was asked of persons in private dwellings, per Question 1.]

Is there electricity?
[] 1 Yes
[] 2 No

9. Number of rooms in the household

[Question 9 was asked of persons in private dwellings, per Question 1.]

9.1 How many rooms do you have in your household? (Not counting bathrooms and kitchen)
____ Number

9.2 Of these, how many are used only for sleeping? (bedrooms)
____ Number

10. Kitchen

[Question 10 was asked of persons in private dwellings, per Question 1]

Is there are special room for cooking?
[] 1 Yes
[] 2 No

11. Tenure

[Question 11 was asked of persons in private dwellings, per Question 1]

[] 1 Owned
[] 2 Rented
[] 3 Sharecropping
[] 4 Mixed contract
[] 5 Ceded for services
[] 6 Other form (specify) ____

12. Language spoken most often within the family

[Question 12 was asked of persons in private dwellings, per Question 1]

[] 1 Quechua
[] 2 Aymara
[] 3 Spanish
[] 4 Other national (Bolivian) language
[] 5 Foreign language

Summary of population

____ Number of males

____ Number of females

____ Total
____ Enumerator's signature
____ Date
____ Sector head's signature
____ Date

Comments

________

III. Population

[This section is in tabular format in the original scanned form. Questions 1 through 17 are to be answered by three or more different people.]

A. General Information

For all individuals regardless of age (including newborn infants)
[Questions 1-8 were asked of all persons.]

1. What is your name and surname?

Mark answers for each person who spent the night before the census date in the dwelling being studied.
____ Name and surname

2. What is your relationship to the head of the household?

Person 1
[] 1 Head
Person 2, 3
[] 2 Spouse or live-in partner
[] 3 Child or stepchild
[] 4 Son- or daughter-in-law
[] 5 Grandchild
[] 6 Parent or parent-in-law
[] 7 Other relative
[] 8 Domestic employees (live-in)
[] 9 Not related

3. Male or female?

[] 1 Male
[] 2 Female

4. What is your age in completed years?
For those under 1 year, write 00.

____ Years

5. Where were you born?

If born in this same locality, mark "Here," if born in another place, first write as concretely as possible the locality and then the province and department. If born outside of Bolivia write only the name of the country.
[] Here
____ Other locality
____ Province
____ Department or other country

6. Where do you habitually reside?

If habitually residing in this same locality, mark "Here," if residing in another place, first write as concretely as possible the locality and then the province and department. If residing outside of Bolivia write only the name of the country.
[] Here
____ Other locality
____ Province
____ Department or other country

7. Where did you habitually reside 5 years ago? (1971)

If habitually residing in this same locality, mark "Here," if residing in another place, first write as concretely as possible the locality and then the province and department. If residing outside of Bolivia write only the name of the country.
[] Here
____ Other locality
____ Province
____ Department or other country

8. What Bolivian languages are you able to speak?

"Able" means the ability to communicate ideas in this language; it is not sufficient to merely understand. If able to speak more than one language mark one of the boxes 5-9.
[] 0 Does not speak yet or none
[] 1 Spanish
[] 2 Aymara
[] 3 Quechua
[] 4 Other
[] 5 Spanish-Aymara
[] 6 Spanish-Quechua
[] 7 Spanish with other
[] 8 Aymara-Quechua
[] 9 Spanish-Aymara-Quechua

B. Educational Information

Only for those 5 years of age and older
[Questions 9-11 were asked of persons 5 years of age or older.]

9. Are you able to read and write?

If only able to read or sign name, mark No.
[] 1 Yes
[] 2 No

10. Do you attend school or a center of learning?

[] 1 Yes
[] 2 No

11. What is the last grade completed and in which level?

Write the last grade completed on the corresponding line. For those who respond according to the old system, mark primary or secondary and write the last grade completed on the corresponding line.
[] 00 None
[] 01 Literacy only
[] 1 Basic ____
[] 2 Intermediate ____
[] 3 Middle [secondary]
[] 4 Primary [old system] ____
[] 5 Secondary [old system] ____
[] 6 Normal [teacher training] ____
[] 7 University ____
[] 8 Other (specify) ____

C. Economic Information

Only for those 7 years of age and older

12. What did you do for the largest amount of your time during the last week (the week before the census date)?

Questions 13, 14 and 15 should be answered only by those who marked boxes 1, 2 or 3. If marking one of the remaining boxes, skip directly to question 16.
[] 1 Worked
[] 2 Did not work, but had a job (vacation, illness, etc.)
[] 3 Unemployed
[] 4 Looked for work for the first time [skip to Question 16]
[] 5 Only household tasks [skip to Question 16]
[] 6 Only student [skip to Question 16]
[] 7 Retired and/or rentier [skip to Question 16]
[] 8 Other (specify) ____ [skip to Question 16]

[Questions 13, 14 and 15 should be answered only by those who marked boxes 1, 2 or 3, per Question 12]

13. What was the principal occupation or job that you performed during the last week, or in your last job if unemployed?

[Question 13 was asked of persons aged 7 years and older who worked, did not work but had a job, or were unemployed, per Question 12.]

Write, for example: farmer, sugar cane cutter, retail vendor, mine worker, tailor, doctor, domestic servant, etc.
____ Occupation

[Questions 13, 14 and 15 should be answered only by those who marked boxes 1, 2 or 3, per Question 12]

14. What does the place, establishment or business where you carried out that job primarily produce or do?

[Question 14 was asked of persons aged 7 years and older who worked, did not work but had a job, or were unemployed, per Question 12.]

Ex, write: Tin mining, raises agricultural crops, dairy, shoe making, radio repair, automotive passenger transportation, retail sales, public sector service, etc.
____ Industry

[Questions 13, 14 and 15 should be answered only by those who marked boxes 1, 2 or 3, per Question 12]

15. What was your category or position in the occupation indicated above?

[Question 15 was asked of persons aged 7 years and older who worked, did not work but had a job, or were unemployed, per Question 12.]

[] 1 Manual laborer (Rural peasant, agricultural manager, day laborer)
[] 2 White-collar/professional employee
[] 3 Unpaid family worker
[] 4 Own-account worker (does not have paid employees or laborers)
[] 5 Owner or employer (has paid employees or laborers)

D. Fertility Information

Only for women 12 years of age and older

16.

a) How many children have you had who were born alive? (Even if they died later.)
____ Number
[] 00 None
[] 99 Unknown

b) Of these, how many are currently alive?
____ Number
[] 00 None
[] 99 Unknown

c) What are the month and year of birth of your last child born alive?
____ Month and year of birth

E. Marital Status Information

Only for those 12 years of age and older

17. What is your current marital status?

[] 1 Single
[] 2 Married or cohabiting
[] 3 Widowed
[] 4 Divorced or separated