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República de Chile
Dirección de Estadística y Censos

XIV National Census of Population and III of Housing

April 22nd, 1970

____ Census form number
____ Control page number

____ Dwelling order number

Office Use:
____ Province
____ Department
____ Municipality
____ District
____ Census Zone
____ Sector of Enumeration
____ Dwelling order number
____ Form order number
____ Area
____ Locality
____ Category
____ Household type

Form number 51

A. Geographic location

____ 1. Province

____ 2. Department

____ 3. Municipality

____ 4. District ____ Number

____ 5. Census zone number

____ 6. Sector of enumeration

7. Area:

[] 1 Urban
[] 2 Rural

8. Place or locality

a) ____ Name
b) ____ Category (indicate whether a city, town, hamlet, agricultural estate (fundo), nitrate mine, encampment, outpost, etc.)

9. Address:

Urban:
____ Street
____ Number
____ Floor number
____ Apartment number

Rural:
____ Route

10. Household type:

[] 1 Private
[] 2 Collective

B. Dwelling

I. General Dwelling Information

1. Dwelling type

A. Private dwellings

[] 01 House
[] 02 Apartment
[] 03 Room in a high-density slum dwelling (conventillo)
[] 04 Shack in a farm (rancho), Indian dwelling, rustic huts
[] 05 Emergency (government-provided) shelter or pre-fabricated shack
[] 06 Squatter camp dwelling (callampa)
[] 07 Dwelling in a structure or other place not intended for use as a residence
[] 08 Boxcar, boat, tent, etc.
[] 09 ____ Other (specify)

B. Collective dwellings

[] 10 Hotel, motel, inn
[] 11 Boardinghouse or rooming house
[] 12 Guesthouse
[] 13 Institution (hospital, convent, etc.)
[] 14 ____ Other (specify)

2. Dwelling occupancy

A. The dwelling is:
[] 1 Occupied
[] 2 Occupied with inhabitants absent
[] 3 Unoccupied

B. For occupied dwellings:
____ Number of households

C. For unoccupied dwellings:

The dwelling is:
[] 90 Seasonally unoccupied
[] 91 New, awaiting the first occupants
[] 92 Unoccupied for other reasons

3. Predominant material and condition of the dwelling

A. Principal walls

Construction material

[] 1 Concrete, brick or cement block, stone
[] 2 Wood, plank (with iron, slate or other siding)
[] 3 Mortared adobe
[] 4 Bricks placed on edge, flat adobe or cement brick, mud-and-stick, flat straw, stone
[] 5 Waste material (tin, cardboard box, and/or various other waste materials)
[] 6 ____ Other materials (specify)

State of preservation

[] 1 Good
[] 2 Acceptable
[] 3 Poor

B. Roof covering

Construction material

[] 1 Sheet (zinc, copper, aluminum, slate), cement or clay tile, wooden tile, waterproof ceramic
[] 2 Tar corrugated paper sheets, clay-covered straw
[] 3 Waste material (tin, cardboard box, and/or various other waste materials)
[] 4 ____ Other materials (specify)

State of preservation

[] 1 Good
[] 2 Acceptable
[] 3 Poor

C. Floors

Construction material

[] 1 Wooden board or parquet, plastics, floor tiles, brick, stone
[] 2 Earth

State of preservation

[] 1 Good
[] 2 Acceptable
[] 3 Poor

4. Number of rooms in the dwelling

A) ____ Number of rooms used for residential purposes (excluding kitchen and bath)

B) ____ Number of rooms used exclusively for commercial purposes
5. Water service for the dwelling

A. Water supply

[] 1 Has piped water inside the dwelling
[] 2 Has piped water outside the dwelling at a distance of ____ meters
[] 3 Does not have piped water supply

B. Source of water

[] 1 Public system
[] 2 Well or water wheel
[] 3 ____ Other source (specify)

6. Availability of shower or bath in the household

A) Shower or bath, for the exclusive use

[] 1 with hot water
[] 2 without hot water

B) Shower or bath, shared use

[] 3 with hot water
[] 4 without hot water

C) [] 5 Has neither shower nor bath

7. Availability of Toilet (W.C.) in the household

A) Toilet, exclusive use

[] 1 With flushed water
[] 2 Without flushed water

B) Toilet, shared use

[] 3 With flushed water
[] 4 Without flushed water

C) [] 5 Does not have a toilet

8. Toilet wastewater removal system

[] 1 Sewer
[] 2 Septic tank
[] 3 Pit/latrine
[] 4 ____ Other system (specify)
[] 5 None

9. Electric lighting in the household

[] 1 Has electric lighting
[] 2 Does not have electric lighting

10. Availability of a kitchen and fuel use in the household

A. Room used for kitchen

[] 1 Has a kitchen
[] 2 Does not have a kitchen

B. Fuel used for cooking

[] 1 Gas
[] 2 Electricity
[] 3 Paraffin (kerosene)
[] 4 Other

11. Number of rooms used by the household for residential purposes (excluding kitchen and bath)

____ Number

12. Condition of tenure (ownership)

A. Tenure

[] 1 Owner
[] 2 Renter
[] 3 Sub-letter
[] 4 Usufructuary
[] 5 ____ Other (specify)

B. If owner, the dwelling occupied by this household is:

[] 1 Completely paid for
[] 2 Partially paid for

C. If a renter or sub-letter

____ Escudos Monthly rent

13. Vehicles and Household equipment

[] 1 Auto, truck, light truck
[] 2 Motorcycle
[] 3 Bicycle
[] 4 Radio receptor
[] 5 Television
[] 6 Refrigerator
[] 7 Sewing machine
[] 8 None

Summary of population in the census household

____ Males
____ Females
____ Total

____ Enumerator's Signature

C. Persons in the census household

[Translator's note: This section consists of a table with columns for the answers pertaining to two separate people. The questions are phrased in such a way that they could be asked of the person directly (are you?) or about the person (is he/she?). I have translated them as if asked directly of the person.]

I. - General Characteristics

1. Name and surnames
What are the name and surnames of each of the people who spent the night here from the 21st to the 22nd of April?

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

[] 0 Head
[] 1 Wife or husband
[] 2 Live-in Partner
[] 3 Child
[] 4 Parents or parents-in-law
[] 5 Grandchild
[] 6 Other relative
[] 7 Other non-relative
[] 8 Unknown

3. Sex:

Are you a man or a woman?

[] 1 Male
[] 2 Female

4. Age:

How old are you in years completed? ____

For those less than one year old, write "00."

5. Current marital status: Only for those 12 years of age and older.

What is your current marital status?

[] 1 Married
[] 2 Consensual union
[] 3 Widowed
[] 4 Separated or annulled
[] 5 Single
[] 6 Unknown

6. Religion:

What is your religion?

[]1 Catholic

____ Other (specify)

7. Place of birth:

Where were you born?
If born in this same municipality, write "here;" otherwise, write the municipality or place and the province or country where born.

[] 1 Here

____ Municipality or place

____ Province or country

[A blank box appears in the corner of the space for these responses]

8. Current habitual residence:

In what municipality do you habitually live?
If living in this same municipality, write "here;" otherwise write the municipality or place and the province or country of residence.

[] 1 Here

____ Municipality or place

____ Province or country

[A blank box appears in the corner of the space for these responses]

9. Residence in 1965: Only for those persons five years of age and older.

Where was your habitual or permanent residence in April, 1965?

[] 1 Here

____ Municipality or place

____ Province or country

[A blank box appears in the corner of the space for these responses.]

II -- Educational Characteristics

For all individuals 5 years of age and older.

10. Level of instruction (educational level):

What is the last year of regular schooling completed, and in what type of schooling?

[Year:]
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8

Type of schooling:

[] 00 None
[] 01 Primary
[] 02 Basic
[] 03 Secondary
[] 04 Middle
[] 05 Commercial
[] 06 Industrial
[] 07 Agricultural
[] 08 Feminine technical
[] 09 Teacher-training
[] 10 University
[] 11 Unknown

11. School attendance:

Do you currently attend an institution of regular schooling?

____ Attending (indicate the course of studies)
[] 2 Not attending
[] 9 Unknown

12. Literacy:

Only for those who answered "none" or "primary" in question number 10.

Are you able to read and write?
If "only" able to real or "only" able to write, mark "no."

[] 1 Yes
[] 2 No

III Economic Characteristics

Only for those 12 years of age and older.

13. Type of activity:

What did you do during the greater part of the week of April 13th to the 18th?

[] 0 Worked?
[] 1 Did not work but had a job?
[] 2 Looked for work and had worked before?
[] 3 Looked for work for the first time?
[] 4 Retired or pensioner?
[] 5 Rentier?
[] 6 Student?
[] 7 Household duties?
[] 8 Other?
[] 9 Unknown?

14. Principal occupation: For those who answered 0, 1 and 2 in question number 13.

What occupation, position, profession or type of work did you engage in the week of April 13th to the 18th, or before in the case of an unemployed person?
(Examples: bricklayer, doctor, auto mechanic, tractor driver, etc.)

____ (Give maximum possible detail)

[A blank box also appears in the corner of the space for these responses]

15. Occupational category:

For those who answered 0, 1 and 2 in question number 13.

What position did you have in the occupation or job indicated above?

[] 1 Employer or owner
[] 2 Own-account worker
[] 3 Employee (professional or white-collar)
[] 4 Manual laborer or day laborer
[] 5 Domestic employee
[] 6 Unpaid family worker
[] 7 Unknown

16. Industry:

For those who answered 0, 1 and 2 in question number 13.

What does the establishment, industry, factory, workshop, service, etc. where you work or worked before do?
(Examples: poultry farm, gasoline pumping station, etc.)

____ (Give maximum possible detail)

[A blank box also appears in the corner of the space for these responses]

IV -- Fertility

Only for women 15 years of age and older

17. Number of children:

A) How many children have you had, born alive and stillborn?
____

B) How many were stillborn?
____

C) How many were born alive?
____

D) How many are alive?
____

E) How many have died of those born alive?
____