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XIII General Population Census
II Housing Census

November 29th, 1960

Read the instructions on the other side before filling out this form

República de Chile
Ministerio de Economía
Dirección de Estadística y Censos

For office use:

____ Province
____ Zone
____ Revision
____ Department
____ Form
____ Code
____ County
____ Urban or Rural
____ Suburbs
____ District
____ Part or Complete
____ Verify

A. Geographic Location

1. ____ Province

2. ____ Department

3. ____ Municipality

4. ____ District____ Number

5. ____ Zone number

[] 1 Urban
[] 2 Rural

6. ____ Form number

7. ____ Control sheet line number

8.

[] 1 Private or family household
[] 2 Non-family group or collective

9. Place or locality

a) ____ Name
b) ____ Category

Indicate whether a city, town, village, hamlet, farm, mine, camp, fishermen wharf, island, lighthouse, sulfur mine, nitrate mine, station, railroad station, station, indigenous settlement, etc.

10. Address:

Urban:
____ Street
____ Number
____ Floor
____ Apartment


Rural:

____ Route

B. Dwelling

1. Dwelling type

Places intended for habitation:
a) Family dwellings
[] 01 Private house
[] 02 Apartment in an apartment building
[] 03 Shack (casita de cité)
[] 04 Apartment or room in a house
[] 05 Apartment or room in a school, factory, workshop, collective dwelling, etc.
[] 06 Room in a high-density slum dwelling
[] 07 Improvised dwelling (callampa, squatter settlements)
[] 08 Shack in a farm (rancho), Indian dwelling, rustic huts
[] 09 Trailer, boat, boxcar
[] 10 Others (tents, parked cars, etc.)
b) Collective dwellings
[] 11 Boardinghouse or guesthouse
[] 12 Hotel
[] 13 Lodge
[] 14 Hospitals and asylums
[] 15 Convent
[] 16 Boarding school
[] 17 Regiment or military camp
[] 18 Prison
[] 19 Workers' camps, cabins, etc.
[] 20 Others
Other places used as dwellings:
[] 21 ____ Granaries, warehouses, garages, etc.

2. Predominant material

a) Exterior walls

Material

[] 1 Concrete
[] 2 Brick, cement block or stone
[] 3 Mortared adobe
[] 4 Wood
[] 5 Exterior brick covered with galvanized, asbestos/cement or other type of siding boards bricks.
[] 6 Bricks placed on edge. Flat adobe, or cement brick
[] 7 Stick-and-mud, clay, straw, waste materials, tin, cardboard
[] 8 Other material

Condition

[] 1 Very good
[] 2 Acceptable
[] 3 Poor

b) Roof covering

Material

[] 1 Zinc, copper, or galvanized iron
[] 2 Clay or cement roof-tile
[] 3 Asbestos/Cement boards
[] 4 Wooden tile
[] 5 Tar corrugated paper sheets
[] 6 Reeds stick-and-mud, cardboard, tin or wood waste material
[] 7 Other material

Condition

[] 1 Very good
[] 2 Acceptable
[] 3 Poor

c) Floor

Material

[] 1 Wood floor or parquet
[] 2 Paving stone or polished cement
[] 3 Brick
[] 4 Plastic, linoleum, rubber, etc
[] 5 Other material
[] 5 Earth

Condition

[] 1 Very good
[] 2 Acceptable
[] 3 Poor

3. Water supply

a) The dwelling is supplied with water:

[] 1 By pipe
[] 2 By tank truck

b) The water comes from:

[] 1 Public potable water system
[] 2 Well or chain pump
[] 3 Other source

4. Bath facilities

a) The dwelling has an installed bath with:

[] 1 Hot water
[] 2 Cold water only
[] 3 Doesn't have a bath

b) The bath is used:

[] 1 Exclusively by this family
[] 2 By two or more families

5. Toilet facilities

a) System of waste removal

[] 1 Sewer installation
[] 2 Septic tank
[] 3 Pit/latrine
[] 4 Drain to irrigation canal (acequia)
[] 5 Other system
[] 6 None

b) The toilet is used:

[] 1 Exclusively by this family
[] 2 By two or more families

6. Lighting

[] 1 Electric
[] 2 Other

Does this dwelling have a radio receiver?

[] 1 Yes
[] 2 No

7. Cooking

a) Fuel

[] 1 Piped gas
[] 2 Liquid gas
[] 3 Electricity
[] 4 Paraffin (kerosene)
[] 5 Charcoal
[] 6 Wood
[] 7 Other

b) Is the cooking stove in a room or place where people sleep?

[] 1 Yes
[] 2 No

8. Tenure

[] 1 Owner
[] 2 Renter or subletter
[] 3 Usufructuary
[] 4 Other

9. Rooms

____ Write the number of rooms in the dwelling, but without including the kitchen, bathroom, porches, garage, nor rooms used exclusively for commercial or industrial purposes.

10. Monthly rent

1. Unfurnished
____ $ (in pesos)
2. Furnished
____ $ (in pesos)

11. Home-based industry (family production done at home)
____ Write the articles produced for sale. [3 lines]

12. For office use
[12 empty boxes]

C. Population

[The following section, questions, 1 -- 18, are in the format of a table. The question appears as a column heading, with blank spaces below to write the answers for a series of individuals. Thus only the questions are translated here.]

I. -- Personal characteristics

1. Person order number ____

Name and surnames ____

If a family dwelling, write the names and surnames of the Head of the Household and the other people who spent the night of the 28th to the 29th of November in the dwelling.

Write them in the following order:
Head of family, wife, single children, married children and their family members, other relatives, guests, boarders, domestic employees, others.

Do not forget to include infants born before 12 midnight on the 28th of November and those deceased after that time.

If a person's name is unknown, write N.N.

If a collective dwelling, write the people down in the order given by their category within the dwelling. For example, in a hospital: Director, Doctor, Nurse, Patient.

Be sure that no person is left unenumerated.
2. Sex. ____

Write H if male and M if female.

3. Relationship ____

On the first line the word "head" is already printed following the spaces for name and sex of the person recognized as head of the family. For the rest, write the relationship that person has to the above-specified head. Examples: wife, son, uncle, guest, boarder, domestic servant, etc.

4. Age. ____

Write the age in years completed. For those under 1 year write the months completed. For those under 1 month write 0 months.

Example:
0 months
1 month
2 months
3 months

5. Marital status ____

Write as appropriate: S single, C married, CV consensual union, V widowed, SP separated de facto or legally, A annulled.

6. Number of children. ____

For women 12 years of age and older.

Write the number of children born alive, excluding those stillborn.

7. Place of birth. ____

If the person was born in Chile, write the province where born. If born abroad, write the name of the country where born.

II. -- Migration

8. Year ____

Write the year in which the person came to live in the place of enumeration. If the person has always lived in the place of enumeration, write "always." If the person is a resident in transit, write "in transit."

9. Previous residence ____

Write the name of the province or country of where you came from.

Examples:
Valdivia
Tarapacá
Magallanes
Argentina
España

If the person changed residence due to earthquakes add the letter "D."

10. Area ____

If migrating from a city, town or village, write "U." If migrating from a rural area (countryside), write "R."

III -- Religion and Education

11. Religion ____

Write the religion as given by the informant. If the person doesn't have a religion, write "none."

12. Literacy ____

If able to read and write, write "yes." If unable to read and write, write "no."

13. Educational level ____

For all individuals, write the highest course completed and the type of instruction received.

Examples:
2nd year Feminine technical
1st year High school or primary
2nd year Business school
4th year Medical
2nd year Social sciences
3rd year Law

14. School attendance ____

For those currently attending an educational establishment, write the level and type of instruction receiving.

Examples:
3rd year High school or primary
2nd year Technical or trade school
3rd year Social sciences
3rd year Civil engineering
3rd year Business school
2nd year Metallurgy/mining technician

IV -- Occupational characteristics.

For all individuals 12 years of age and older. [applies to questions 15-18]

15. Type of activity ____

Write as appropriate:

OC = Employed
CE = Unemployed
BT = Looking for work for the first time
QH = Domestic duties
ES = Student
RT = Rentier (rentista)
JB = Retired or pensioner
IR = Disabled or confined
OT = Others

16. Occupation ____

Only for those Employed, Unemployed, and Looking for work for the first time.

If an Employed person has more than one job, write the one that produces the greatest income.

For those Unemployed, write the last occupation held.

For those Looking for work for the first time, write the profession, or if none, write "none."

Avoid using vague terms, like "professional," "worker," and so on. Give concrete occupations such as Lawyer, Bricklayer, Taxi driver, Doctor, Soldier, Cashier, etc.

17. Industry ____

Only for those Employed and Unemployed.

Specify clearly the type of establishment in which the employed person works or, if unemployed, the last place of employment, such as:

Boys' school, wool blanket factory, commercial bank, general store, nail factory, livestock ranch, children's hospital, postal and telegraph office, armed forces, police, etc.

Avoid vague terms such as: factory, office, workshop, etc.

18. Occupational category [employment status] ____

Only for those Employed and Unemployed.

Write the Occupational category in the following manner:
ER = Employer
TCP = Own-account worker
EM = Professional employee
OB = Manual laborer
ED = Domestic employee
FR = Paid family worker
FNR = Unpaid family worker
OT = Other