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Brazilian Institute of Geography and Statistics
Demographic Census 2000
Enumeration Form

1 - Identification
1.01 Questionnaire Number

_ _ _ _
1.02 State
_ _
1.03 Municipality
_ _ _ _ _
1.04 District
_ _
1.05 Subdistrict
_ _
1.06 Sector Number
_ _ _ _

1.07 Number of the page of Census collection form

_ _ _
1.08 Number on the Census collection form
_ _ _ _
1.09 Number on the Group Housing form
_ _ _ _

1.10 Total number of men (in household)

_ _

1.11 Total number of women (in household)

_ _

1.12 Household questionnaire

[] 1 only this one
[] 2 there are others
[] 3 this is a continuation

1.13 Total number of questionnaires used for this household

_ _

1.14 Locality

____

1.15 Complete address (Logradouro)

____

2 - Household Characteristics

2.01 Class of household dwelling

[] 1 Private permanent (go to 2.02)
[] 2 Private improvised (go to List of Residents)
[] 3 Collective (go to List of Residents)

2.02 Type (of household/dwelling)

[] 1 house
[] 2 apartment
[] 3 room

2.03 How many rooms in this dwelling?

_ _

2.04 How many rooms are used as bedrooms in this dwelling?

_
If 9 or more, write 9.

2.05 This dwelling is:

[] 1 owned- paid for (go to 2.06)
[] 2 owned- still paying (go to 2.06)
[] 3 rented (go to 2.07)
[] 4 ceded by employer (go to 2.07)
[] 5 ceded other (go to 2.07)
[] 6 other (go to 2.07)

2.06 The land where the domicile is located is

[] 1 owned
[] 2 ceded
[] 3 other

2.07 The water supply in this dwelling is:

[] 1 general system
[] 2 well or spring (on the property)
[] 3 other

2.08 The water used in domicile house arrives :

[] 1 piped into at least one room
[] 2 piped on the property or land
[] 3 is not piped

2.09 Number of bathrooms in home (consider only those that have a shower or bathtub and a toilet). If 0 (zero) go to question 2.10. If 1+, skip to 2.11.

_
If 9 or more, write 9.

2.10 In this domicile, plot or property, does there exist a toilet used by the residents?

[] 1 yes (go to 2.11)
[] 2 no (go to 2.12)

2.11 The sewage system of this bathroom or toilet is connected to:

[] 1 general sewage system or pluvial
[] 2 septic tank
[] 3 rudimentary septic tank
[] 4 trench/ditch
[] 5 river, lake, or ocean
[] 6 other

2.12 The trash from this household :

[] 1 is collected by a sanitation service
[] 2 is deposited into caçamba of sanitation service
[] 3 is burned (on property)
[] 4 is buried (on property)
[] 5 is thrown onto vacant lot or public park (logradouro)
[] 6 thrown in river, lake, or ocean
[] 7 other destination

2.13 Does the household have electricity?

[] 1 yes
[] 2 no

In this dwelling, is there:

2.14 Radio

[] 1 yes
[] 2 no

2.15 Refrigerator or Freezer

[] 1 yes
[] 2 no

2.16 VCR

[] 1 yes
[] 2 no

2.17 Washing Machine (don't count washboard/tank)

[] 1 yes
[] 2 no

2.18 Microwave oven

[] 1 yes
[] 2 no

2.19 Telephone line installed

[] 1 yes
[] 2 no

2.20 Computer

[] 1 yes
[] 2 no

In this household, what is the number of:
(If none, mark 0 (zero). If 9 or more, write 9.)

2.21 Televisions

_

2.22 Automobiles for private use

_

2.23 Air conditioning units. (If there is central AC, write the number of rooms served)

_

3 - List of Residents in Household on July 31, 2000
[Table for 12 individuals' names]

Order number ____
Complete Name ____

4 - Individual Characteristics

4.01 Sex

[] 1 male
[] 3 female

4.02 Family relationship or relationship with head of dwelling?

[] 1 head (person responsible)
[] 2 spouse or partner
[] 3 child or stepchild
[] 4 father, mother, mother- or father-in-law
[] 5 grandchild, great-grandchild
[] 6 brother, sister
[] 7 other relative
[] 8 person who has permanent residence in the domicile, without being a relative, boarder or employee (agregado)
[] 9 boarder
[] 10 domestic servant
[] 11 relative of domestic servant
[] 12 individual in collective household

4.03 Family relationship or relationship with head of household?

[] 1 head (person responsible)
[] 2 spouse or partner
[] 3 child or stepchild
[] 4 father, mother, mother- or father-in-law
[] 5 grandchild, great-grandchild
[] 6 brother, sister
[] 7 other relative
[] 8 person who has permanent residence in the domicile, without being a relative, boarder or employee (agregado)
[] 9 boarder
[] 10 domestic servant
[] 11 relative of domestic servant
[] 12 individual in collective household

4.04 Number of family (if individual in collective dwelling, mark 0 [zero])

_

Attention: Note the month and year of birth (Question 4.05) and the age on 31 July 2000 (Question 4.06). If it is not possible to obtain the month and year, after exhausting all possibilities, note the presumed age (Question 4.07) in years (if the age is greater than or equal to 1 year), or in months (if the age is less than one year), leaving questions 4.05 and 4.06 blank.

4.05 Month and year birth

_ _ month
_ _ _ _ year

4.06 Age on July 31, 2000

2 _ _ _ years old
4 _ _ months old

4.07 Presumed age

2 _ _ _ years old
4 _ _ months old

4.08 Color or race

[] 1 white
[] 2 black
[] 3 yellow
[] 4 mixed (parda)
[] 5 indigenous

4.09 Religion

____

4.10 Do you have a permanent mental handicap that limits your daily activities? (Like to work, go to school, play, etc.)

[] 1 yes
[] 2 no

4.11 How do you evaluate your ability to see? (If you use glasses or contact lenses, make your evaluation based on when you're using them)

[] 1 incapable
[] 2 severe permanent difficulties
[] 3 some permanent difficulties
[] 4 no difficulty

4.12 How do you evaluate your ability to hear? (If you use a hearing aid, make your evaluation based on when you're using it)

[] 1 incapable
[] 2 severe permanent difficulties
[] 3 some permanent difficulties
[] 4 no difficulty

4.13 How do you evaluate your ability to climb stairs? (If you use a prosthesis, cane, or other facilitating device, make your evaluation based on when you're using them)

[] 1 incapable
[] 2 severe permanent difficulties
[] 3 some permanent difficulties
[] 4 no difficulty

4.14 Do you have any of the following handicaps? (Choose only one alternative, prioritizing them in the order given)

[] 1 total permanent paralysis
[] 2 permanent paralysis of the legs
[] 3 permanent paralysis of one side of the body
[] 4 loss of leg, arm, hand, foot or thumb
[] 5 none of the above

4.15 Have you lived in this municipality since birth? (Mark "yes" only if person has never lived in another municipality)

[] 1 yes (go to 4.27)
[] 2 no

[Question 4.16 follows a "No" answer to 4.15]

4.16 How many years lived in municipality without interruption?

_ _ years

4.17 Born in this municipality

[] 1 yes (go to 4.22)
[] 2 no

4.18 Born in this state

[] 1 yes (go to 4.22)
[] 2 no

4.19 What is your nationality

[] 1 native Brazilian (go to 4.21)
[] 2 naturalized Brazilian
[] 3 foreigner

4.20 In what year did you become a resident of Brazil?

_ _ _ _

4.21 What is the Brazilian state or foreign country of birth?

____

4.22 How long have you lived without interruption in this state?

_ _
if less than 10 go to 4.23, if not go to 4.24.

4.23 Prior Brazilian state or foreign country of residence

____

4.24 Where did you live on July 31, 1995

[] 1 this municipality, urban zone (go to 4.27)
[] 2 this municipality, rural zone (go to 4.27)
[] 3 another municipality, urban zone (go to 4.25)
[] 4 another municipality, rural zone (go to 4.25)
[] 5 another country (go to 4.26)
[] 6 wasn't born (go to 4.27)

4.25 In which municipality did you live on July 31, 1995?

____

4.26 In which Brazilian state or foreign country did you live on July 31, 1995?

____

4.27 In which municipality and state or foreign country do you work or study?

[] 1 this municipality
[] 2 don't work, don't study
_ _ 3 (state abbreviation) If you fill in a foreign country name, mark XX in the spaces for state abbreviation
____ 4

4.28 Do you know how to read and write?

[] 1 yes
[] 2 no

4.29 Attend school or child care (creche)?

[] 1 yes, private (go to 4.30)
[] 2 yes, public (go to 4.30)
[] 3 no, have been (go to 4.32)
[] 4 never went (if 10 years old or older, go to 4.36. If not, end the interview)

For the person who attends school
[Applies to questions 4.30 - 4.31]

4.30 What course do you attend?

[] 1 child care
[] 2 preschool
[] 3 literacy class
[] 4 adult literacy class
[] 5 basic instruction or 1st level - regular graded
[] 6 basic instruction or 1st level - regular non-graded
[] 7 supplemental (basic instruction or 1st level)
[] 8 midlevel instruction or 2nd level - regular graded
[] 9 midlevel instruction or 2nd level - regular non-graded
[] 10 supplemental (midlevel instruction or 2nd level)
[] 11 college entrance exam preparation course (pre-vestibular)
[] 12 superior - undergraduate
[] 13 masters or doctorate

4.31 What level do you attend?

[] 1 first
[] 2 second
[] 3 third
[] 4 fourth
[] 5 fifth
[] 6 sixth
[] 7 seventh
[] 8 eight
[] 9 course non-graded
(If 10 years old or older, go to 4.36. If not, end interview.)

For person who is not attending, but has in the past
[Applies to questions 4.32 - 4.35]

4.32 The highest course attended, in which you completed at least one grade?

[] 1 adult literacy course
[] 2 former primary
[] 3 former junior high (ginásio)
[] 4 former classical, scientific, etc. [senior high school]
[] 5 elementary instruction or 1st level
[] 6 secondary instruction or 2nd level
[] 7 higher - undergraduate
[] 8 masters or doctorate
[] 9 none

4.33 What was the last grade passed?

[] 1 first
[] 2 second
[] 3 third
[] 4 fourth
[] 5 fifth
[] 6 sixth
[] 7 seventh
[] 8 eight
[] 9 non-graded course
[] 10 none

4.34 Did you conclude the course you studied?

[] 1 yes (go to 4.35)
[] 2 no (if person 10 years old or older go to 4.36, if not end interview)

4.35 What was highest course you completed?

Post high school (superior) (undergraduate, master's or doctorate) - specify
[] 1 [write out]
[] 2 _ (non-post high school [superior])
(If person 10 years old or older, go to 4.36, if not end interview.)

For persons 10 years old or older (born until July 31, 1990)
[Applies to questions 4.36 - 4.61]

4.36 Do you live in the company of a spouse or partner?

[] 1 yes
[] 2 no, but did live with one
[] 3 never lived with one

4.37 What was the nature of the last union?

[] 1 civil and religious marriage
[] 2 only civil marriage
[] 3 only religious marriage
[] 4 consensual union
[] 5 never lived

4.38 What is your marital status?

[] 1 married
[] 2 abandoned or legally separated
[] 3 divorced
[] 4 widowed
[] 5 single

4.39 During the week of July 23-29, 2000, did you work in any remunerated activity? (Including the activity of the preparation of any product, sale or supply of any service in your own home)

[] 1 yes (go to 4.44)
[] 2 no

4.40 During the week of July 23-29, 2000 did you have any remunerated work from which you were temporarily absent? (Because of vacation, leave, voluntary leave, bad weather conditions or for another reason)

[] 1 yes (go to 4.44)
[] 2 no

4.41 During the week of July 23-29, 2000 did you help, without remuneration, in the work of a member of the household who is self-employed or an employer, or as a apprentice or intern?

[] 1 yes (go to 4.44)
[] 2 no

4.42 During the week of July 23-29, 2000, did you help without remuneration, in the work of a member of the household employed in the activity of cultivation, plant extraction, raising of animals, hunting, fishing or mining?

[] 1 yes (go to 4.44)
[] 2 no

4.43 During the week of July 23-29, 2000, did you work in the activity of cultivation, plant extraction, raising of animals or fish that was meant to feed members of the household?

[] 1 yes
[] 2 no (go to 4.45)

4.44 How many jobs did you have during the week of July 23-29, 2000? (The work of production for own consumption should be counted if it was the only job)

[] 1 one
[] 2 two or more

Attention: Criteria for defining the week's principal job:

1.- Most hours usually worked during the week;
2.- Work that takes up the most time; and
3.- Highest monthly income

4.45 What was the principal job done during the week of July 23-29, 2000?

___

4.46 What was the principal activity in business, company, firm, institution or organization where you worked during the week of July 23-29, 2000?

____

4.47 The work was

[] 1 domestic work with signed worker's card (carteira de trabalho assinada) (go to 4.51)
[] 2 domestic work with no signed worker's card (go to 4.50)
[] 3 employee with signed worker's card (go to 4.51)
[] 4 employee with no signed worker's card (go to 4.48)
[] 5 employer (go to 4.49)
[] 6 self-employed (go to 4.50)
[] 7 apprentice or intern without remuneration (go to 4.51)
[] 8 unpaid help for member of household (go to 4.51)
[] 9 worker in production for own consumption (go to 4.53)

4.48 In this job, were you employed as a public servant of the justice department (regime juridico) or in the military?

[] 1 yes (go to 4.51)
[] 2 no (go to 4.50)

4.49 How many employees worked in this business, firm, institution or organization in July 2000?

[] 1 one
[] 2 two
[] 3 3 to 5
[] 4 6 to 10
[] 5 11 or more

4.50 In this job, did you contribute to Social Security (Instituto de Previdencia Oficial)?

[] 1 yes
[] 2 no

What was your gross income during the month of July 2000:
[Applies to questions 4.51 - 4.52]

4.51 In your principal job?

[] 0 don't have
[] 1 only benefits
R$ _ _ _ _ _ _.00

4.52 In your other jobs? When person only has one job, mark don't have other jobs.

[] 0 don't have
[] 1 only benefits
R$ _ _ _ _ _ _.00

How many hours do you typically work per week

4.53 In your principal job?

_ _

4.54 In your other jobs? When person only has one job, mark don't have other jobs.

_ _
[] 0 don't have
Go to question 4.56

4.55 During the period June 30 and July 29, did you do anything to get a job?

[] 1 yes
[] 2 no

4.56 In July 2000, were you retired according to Social Security (Instituto de Previdencia Oficial)?

[] 1 yes
[] 2 no

Did you have income in July 2000 from any of the following:

4.57 Retirement, pension?

[] 0 didn't have
R$ _ _ _ _ _ _.00

4.58 Rent?

[] 0 didn't have
R$ _ _ _ _ _ _.00

4.59 Support in the form of food, monthly stipend, donation, received from a nonmember of the household?

[] 0 didn't have
R$ _ _ _ _ _ _.00

4.60 Minimum Income, School Subsidies (Bolsa-Escola), unemployment benefits, etc.? (Official aid programs)

[] 0 didn't have
R$ _ _ _ _ _ _.00

4.61 Others?

[] 0 didn't have
R$ _ _ _ _ _ _.00

For women 10 years old and older (born up to July 7, 1990)
[Applies to questions 4.62 - 4.67]

4.62 How many children born alive did you have by July 31, 2000?

_ _ 1 male
_ _ 3 female
[] 0 none

4.63 Of the children you had, how many were still alive on July 31, 2000?

_ _ 2 male
_ _ 4 female
[] 0 none

4.64 What was the sex of the last child born alive by July 31, 2000?

[] 1 male
[] 2 female

4.65 What was the date of birth (or presumed age) of the last child born alive by July 31, 2000?

_ _ 1
_ _ _ _ 2
_ _ 3

4.66 Was this child still alive on July 31, 2000?

[] 1 yes
[] 2 no
[] 3 don't know

4.67 How many children were born dead by July 31, 2000?

_ _ 2 males
_ _ 4 females
_ _ 6 total
[] 0 none