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Republic of Belarus
Ministry of Statistics and Analysis of the Republic of Belarus
Population Census
1999

Enumeration Questionnaire: Form 3
Approved by order # 223 of the Republic of Belarus 02.10.98
____ No. of the census division
____ No. of the instructor district
____ No. of the enumeration district
____ No. on the list of residents in the dwelling
____ Name
____ No. of the person within dwelling
____ No. of the form within the portfolio

1. Relationship to the reference person (No. 1) in the household

[] 1 Reference person (No. 1) in the household
[] 2 Wife, husband
[] 3 Daughter, son
[] 4 Mother, father
[] 5 Sister, brother
[] 6 Mother-in-law, father-in-law
[] 7 Daughter-in-law, son-in-law
[] 8 Grandmother, grandfather
[] 9 Granddaughter, grandson
[] 10 Other relatives
[] 11 Non-relative

____ No. of mother (father) in the list of residents in the dwelling

2. Sex

[] 1 Male
[] 2 Female

3. Date of birth

___ Day
___ Month
___ Year
___ Age (completed years)

4. Place of birth

___ (specify country; for those born in the Republic of Belarus specify region, Minsk-City)

5. Language

___ Mother tongue
___ What language do you usually speak at home?
___ Other language you speak fluently

6. Citizenship

[] 1 Republic of Belarus
[] 2 Without citizenship
[] 3 Other country (specify)

7. Nationality

___

8. Marital status (for persons aged 15 and over)

[] 1 Never married
[] 2 Registered marriage
[] 3 Common law marriage
[] 4 Widowed
[] 5 Divorced
[] 6 Separated

___ No. of the spouse in the list of residents in the dwelling

9. Do you attend any general educational, vocational, secondary specialized or higher institution? (for persons aged 6-60 years)

[] 1 Yes
[] 2 No

For children of preschool age, specify whether they attend any preschool institution

[] 1 Yes
[] 2 No

10. Education (for persons aged 15 and over)

[] 1 Higher vocational (higher)
[] 2 Secondary vocational (secondary specialized)
[] 3 Primary vocational (vocational)
[] 4 Secondary general
[] 5 Basic general (incomplete secondary)
[] 6 Primary general
[] 7 Illiterate

For those having an academic degree, specify:

[] 1 Candidate of science
[] 2 Doctor of science

11. Sources of livelihood (Specify all sources available)

[] 1 Work (other than work in own personal subsidiary plot)
[] 2 Work in own personal subsidiary plot
[] 3 Pension
[] 4 Scholarship
[] 5 Benefits (other than unemployment benefits)
[] 6 Unemployment benefits
[] 7 Other government support
[] 8 Rental income
[] 9 Interest on deposits and securities, dividends
[] 10 Savings
[] 11 Dependent
[] 12 Other source

12. Did you have a job or business for profit in the period from February 8 through February 15, 1999? (for persons aged 15 and over)

[] 1 Yes
[] 2 No

[Persons working multiple jobs respond to items 13-14 on their main activity]

13. What is your position at your main activity?

___ (Specify in detail the name of your position, your occupation and duties)
___ (Specify the name of the enterprise and its economic activity)

14. At your main activity, are you:

[] 1 An employee (under labor agreement or contract)
[] 2 A member of a producers' cooperative
[] 3 Running your own enterprise (farm) or business with permanent use of employees' labor
[] 4 Working on your own-account running a farm or business without hiring employees
[] 5 An unpaid family worker (working without payment in a shop, farm or enterprise owned by a relative)

15. For those not having a job or business for profit, ask: Did you look for a job or try to organize your own business (for persons aged 15-65)

[] 1 Yes
[] 2 No

[If yes to question 15]
a) If you found a job, could you start working in the next 2 weeks?

[] 1 Yes
[] 2 No

b) Are you registered with the employment agency as unemployed?

[] 1 Yes
[] 2 No

[If no to question 15] Why not?

[] 1 Have got a job and will start working in the next 2 weeks
[] 2 Have organized own business and will start activity in the near future
[] 3 Discouraged about finding a job
[] 4 Have no necessity or wish to work
[] 5 Run the house
[] 6 Other reason

16. Have you been living permanently in this urban settlement or rural area of this district since birth?

[] 1 Yes
[] 2 No
[If no to question 16 specify]

___ a) The year in which you permanently started living here

___ b) Previous place of residence (specify country; for the Republic of Belarus specify region, Minsk-City)

c) What type of settlement did you come from?
[] 1 Urban
[] 2 Rural

17. For a woman aged 15 and over specify:

___ a) Number of children ever born alive
___ b) Children surviving
___ c) Children living separately

___ For a married woman aged 15-49, specify how many children she is planning to have (including those surviving)

List of those permanently (usually) residing in the dwelling and their housing conditions: Form 2
(Required for all households in a dwelling)
___ No. of census division
___ No. of instructor district
___ No. of enumeration district
___ List No.
___ Form No. within portfolio
___ Region
___ Avenue, street, by-street
___ District
___ House No. or name of house owner
___ Apt. No.
___ Rural Council
___ Settlement
___ Institution

I. List of those residing in dwelling

___ No. within the dwelling
___ No. within the household
___ Name

For those temporarily absent specify

___ Reason for absence
___ Duration of absence

II. Housing Conditions (Questions 1 - 4 to be completed for the dwelling)

1. Type of dwelling

[] 1 Detached house
[] 2 Part of detached house
[] 3 Separate flat
[] 4 Shared flat
[] 5 Hostel
[] 6 Boarding house for the aged and invalid, children's home, etc.
[] 7 Other institution
[] 8 Other dwelling
[] 9 Non-residential premises used for human habitation
[] 10 Homeless

2. Period of house construction

[] 1 Before 1945
[] 2 1945-1960
[] 3 1961-1980
[] 4 1981-1990
[] 5 1991-1995
[] 6 1996 and later

3. Material used in outer walls

[] 1 Brick, stone
[] 2 Concrete, reinforced concrete, blocks, panels
[] 3 Wood
[] 4 Mixed materials
[] 5 Other material

4. Availability of essential facilities

[] 1 Electricity
[] 2 Floor electric cooker
[] 3 Piped gas
[] 4 Bottled condensed gas
[] 5 Central or district heating
[] 6 Heating from individual installation
[] 7 Stove heating
[] 8 Piped water
[] 9 Flush toilet
[] 10 Bath or shower
[] 11 Central hot water supply
[] 12 Hot water from individual boiler
[] 13 Telephone
[] 14 No specified facilities

Questions 5 - 7 to be completed for the household

___ No. of the reference person (no 1) of the household within the dwelling
(col. 1 of the list of residents in the dwelling)

5. Ownership of the dwelling

[] 1 Private ownership of residents
[] 2 Local Councils
[] 3 Other owners
[] 4 Dwelling rented from individuals

6. Number of occupied rooms

___
___ 99 (part of room)

7. Floor space (m2)

[] a) Useful
[] b) Living