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Republic of Colombia
National Administrative Department of Statistics
XIV National Population Census and III Dwelling Census

October 24, 1973
Census Form

Form no. _____

Important
The information solicited by DANE is confidential. Decree 1633 of 1960 establishes statistical secrecy: the personal information cannot be used in fiscal, judicial, or other cases.

I. Geographic location

1 Department, Administration, Precinct ____
2 Municipality ____
3 Administrative unit

a. Name of town ____
b. Type or class of town
[] 1 Head town
[] 2 Administrative center
[] 3 Small village
[] 4 Other

4 Zone

[] 1 Urban
[] 2 Rural

5 Sector number ____
6 Section number ____
7 Block number ____
8 Enumeration area ____

II. Identification of the house

1. Neighborhood ____
2. Address of the house ____
3. Order number of the house in the census route []

III. Information about the dwelling.

Complete the following by observation

1. Type of dwelling

[] 1 Independent house
[] 2 Apartment
[] 3 Room(s)
[] 4 Tenant quarters
[] 5 Dwelling made out of waste materials
[] 6 Structure not meant for habitation
[] 7 Shack, hut, cabin
[] 8 Tent, cave
[] 9 Dwelling under construction

Complete 2, 3, 4, and 5 observation (in case of doubt, ask)

2. Condition of occupation of the dwelling

Occupied
[] 1 persons present
[] 2 persons absent
Unoccupied
[] 3 for sale or rent
[] 4 other

If you marked 2, 3, or 4, this form is complete.

3. Predominant material in the roof

[] 1 Concrete or cement slab
[] 2 Zinc or synthetic [asbestos] tile
[] 3 Clay tile
[] 4 Straw or grass, palm or similar
[] 5 Discarded materials
[] 6 Other

4. Predominant material in the exterior walls

[] 1 Brick or tile
[] 2 Adobe
[] 3 Prefabricated
[] 4 Pressed mud [similar to adobe]
[] 5 Cane with earth (Bahareque)
[] 6 Bamboo or cane
[] 7 Wood
[] 8 Discarded materials
[] 9 Other

5. Predominant material in the floors

[] 1 Wood
[] 2 Cement or brick tiles
[] 3 Synthetic material
[] 4 Dirt

6. Connection to public services

Is this house connected to:

a) Running water?
[] 1 yes
[] 2 no
b) Sewer?
[] 1 yes
[] 2 no
c) Electricity?
[] 1 yes
[] 2 no

7. Rooms in the dwelling

How many rooms are in the house (do not include the kitchen or bathroom)
__ __

8. Number of households in the dwelling

Do all of the people who live in the house generally eat together?
[] 1 Yes, consider this one household
[] 2 No

9. How many groups of persons (households) that eat separately are there in this dwelling?

__ __

Instructions
1. When there is only one household in the house, continue with parts IV, V, and VI.
2. When there is more than one household proceed in this manner:

a) For the first household complete all of the form.
b) Fill out a form for each of the other households;
Complete I and II, and fill out IV, V, and IV for each of them.

3. When there are more than nine people:

a) Use an additional form
b) Repeat parts I, II, and IV.
c) Do not fill out III and V.
d) List the persons in part VI.

IV. Identification of the household

1. Name of the head of household: ____
2. Number of the household in the house []

V. Data for the household

1. Persons in the household

How many people spent the night here on the night of 23 to 24 October?

(Include only the persons who belong to the census household) __ __

2. Rooms

How many total rooms does this household have?

(Do not include the kitchen or bathroom) __ __

3. Bedrooms

In how many rooms do the persons of this household sleep? __ __

4. Kitchen

Does this household have a room that serves only as a kitchen?

Yes
[] 1 For this household exclusively?
[] 2 Shared with other households?
[] 3 No

5. Water

What type of water service is available to this household?

By pipe
[] 1 Exclusively for this household
[] 2 Shared with others
[] 3 River or spring
[] 4 Well or cistern, reservoir
[] 5 Public trough
[] 6 Tanked in by car or truck
[] 7 Rainwater
[] 8 Other

6. Toilet

What type of toilet is available to this household?

[] 1 Toilet connected to a sewage system
[] 2 Toilet connected to septic tank
[] 3 Latrine
[] 4 No toilet

7. Use of toilet

Is the toilet for the exclusive use of the household or is it shared with other households?

[] 1 Exclusively for household
[] 2 Shared with others

8. Location of toilet

Where is the toilet located?

[] 1 Inside the house
[] 2 Away from the house

9. Lighting

What type of lighting does the household have?

[] 1 By electricity
[] 2 By gasoline
[] 3 By candle

10. Occupancy

What is the means of occupancy?

By owner
[] 1 Totally paid
[] 2 Still paying on it
[] 1 Renting
[] 2 Subletting
[] 3 Occupied de facto (invader)
[] 4 Usufruct (is not owner and does not pay rent)

11. Financing (only for owners)

How did you acquire this house?

Loan
[] 1 Credit institution
[] 2 Lending/mortgage institution
[] 3 Other official entity
[] 4 Private body
[] 5 Private resources (inheritance, pension etc.)
[] 6 Other

12. Family industry

Does the household in this house produce any article or articles to sell?

[] 1 Yes (continue with 13 and 14)
[] 2 No (continue with the population section)

13. Articles produced

What article or articles are produced by family industry? ____

14. Employed personnel

How many persons are usually occupied in the production of these articles?

Total __ __

____ Observations
____ Name of census taker
____ Name of block leader

VI. Population information

Additional from []

Mark with an X if you are using this form to continue with the census of a household with more than nine persons.

Do not forget to register the newborns, children, and the elderly who spent the night in this household.

[The information displayed in the part of the form is in table form. The column headers are listed below, followed by the questions]

Questions
Number
First Person 01
Second Person 02
Third Person 03

A. General characteristics (for all the persons in the household).
[Applies to questions 1 - 9]

1. What are the given names and last names of each of the persons who spent the night here on the night of 23 to 24 October?

____

2. What is his/her relationship to the head of the household?

[] 1 For the first person, the only answer is head of household
For persons 2-9, the answers are:
[] 2 Spouse
[] 3 Son (daughter)
[] 4 Parent or parent-in-law
[] 5 Grandchild
[] 6 Other relative
[] 7 Domestic employee
[] 8 Pensioner
[] 9 Other unrelated person

3. Man or woman?

[] 1 Man
[] 2 Woman

4. How old is the person? (For children under one, write 00)

Years completed __ __

5. What is his/her current marital status?

[] 1 Consensual union
[] 2 Married
[] 3 Separated or divorced
[] 4 Single
[] 5 Widowed

6. In which municipality was he/she born?

-If he/she was born in this municipality, make an X in the box that says "here"
-If he/she was not born here, write the name of the municipality and department where he/she was born.
-If he/she was born outside of Colombia, write the name of the country.
[] 1 Here
Municipality ____
Department or country: _____

7. In which municipality does he/she live currently?

-If he/she currently lives in this municipality, make an X in the box that says "here"
-If he/she does not currently live here, write the name of the municipality and department where he/she lives.
-If he/she lives outside of Colombia, write the name of the country.
[] 1 Here
Municipality ____
Department or country: _____

8. How long has he/she lived in this municipality?

(Where the person is answering the census)

[] 99 Always (all of his/her life)
If more than one year: how many? __ __
[] 00 Less than one year

9. In which municipality did he/she live before moving to the current municipality?

-If he/she lived in this municipality, make an X in the box that says "here"
-If he/she did live here, write the name of the municipality and department where he/she lived.
-If he/she lived outside of Colombia, write the name of the country.
[] 1 Here
Municipality ____
Department or country: _____

B. Educational characteristics (for persons five years old or more).
[Applies to questions 10 - 13]

10. Do you know how to read and write?

[] 1 Yes
[] 2 No

11. Do you currently attend an elementary school, secondary school, or higher?

[] 1 Yes
[] 2 No

12. What is the highest level of education reached?

[] 1 None
[] 2 Primary
Secondary
[] 1 Bachelor (bachillerato)
[] 2 Technical/vocational
[] 3 Normal (teaching) school
[] 4 College or university
[] 5 Other

13. What is the highest year completed at this level?

Last year completed ___
[] 0 None

C. Economic characteristics (For persons 10 years old or more)
[Applies to questions 14 - 19]

14. What did you do the week before the census (14 to 20 October)

[] 1 Work
[] 2 Did not work but has a job
[] 3 Looking for work and has worked before
[] 4 Looking for work for the first time
[] 5 Lives on rent payments
[] 6 Has a pension
[] 7 In school
[] 8 Home business, self-employed
[] 9 No work

If the answer is 1, 2, or 3, continue with question 15. If the answer is 4, 5, 6, 7, 8, or 9, continue with question 18.

15. What was your occupation, profession, or work during this week? ____

16. What is the principal economic function of the business, factory, or agricultural business where you worked? ____

17. What position or category did you have at work?

-Read all the choices in order until you get an affirmative response.

[] 1 Laborer or journeyman
[] 2 Employee
[] 3 Employer/Boss
[] 4 Independent worker
[] 5 Unpaid family worker
[] 61 Domestic worker
[] 7 Other

18. How many months did you work for pay or in a family business this year (1973)?

[] 00 Didn't work
Months worked __ __

19. How much did you earn - in pesos - last month?

$_____
[] 0 No income
[] 1 No information

D. Fertility characteristics (only for females fifteen years old or more)
[Applies to questions 20 -22]

20. How many live births have you had (during your entire life)?

[] 00 none
number __ __

21. How many of your children are still alive?

[] 00 none
number __ __

22. When did you have your last child (live birth)?

(Only for women who are 15 to 49)

Month____
Year: 19 __ __

If this household has more than nine persons, mark an X here [ ]
Register the other persons on an additional form.