Republic of Colombia
National Administrative Department of Statistics
XIV National Population Census and III Dwelling Census
October 24, 1973
Census Form
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.
1 Department, Administration, Precinct ____
2 Municipality ____
3 Administrative unit
b. Type or class of town
[] 2 Administrative center
[] 3 Small village
[] 4 Other
4 Zone
[] 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
[] 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
[] 2 persons absent
[] 4 other
If you marked 2, 3, or 4, this form is complete.
3. Predominant material in the roof
[] 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
[] 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
[] 2 Cement or brick tiles
[] 3 Synthetic material
[] 4 Dirt
6. Connection to public services
a) Running water?
[] 2 no
[] 2 no
[] 2 no
7. Rooms in the dwelling
__ __
8. Number of households in the dwelling
[] 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:
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:
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 []
1. Persons in the household
How many people spent the night here on the night of 23 to 24 October?
2. Rooms
How many total rooms does this household have?
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?
[] 2 Shared with other households?
5. Water
What type of water service is available to this household?
[] 2 Shared with others
[] 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?
[] 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?
[] 2 Shared with others
8. Location of toilet
Where is the toilet located?
[] 2 Away from the house
9. Lighting
What type of lighting does the household have?
[] 2 By gasoline
[] 3 By candle
10. Occupancy
What is the means of occupancy?
[] 2 Still paying on it
[] 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?
[] 2 Lending/mortgage institution
[] 3 Other official entity
[] 4 Private body
[] 6 Other
12. Family industry
Does the household in this house produce any article or articles to sell?
[] 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?
____ Observations
____ Name of census taker
____ Name of block leader
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?
For persons 2-9, the answers are:
[] 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?
[] 2 Woman
4. How old is the person? (For children under one, write 00)
5. What is his/her current marital status?
[] 2 Married
[] 3 Separated or divorced
[] 4 Single
[] 5 Widowed
6. In which municipality was he/she born?
-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.
Municipality ____
Department or country: _____
7. In which municipality does he/she live currently?
-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.
Municipality ____
Department or country: _____
8. How long has he/she lived in this municipality?
[] 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 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.
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?
[] 2 No
11. Do you currently attend an elementary school, secondary school, or higher?
[] 2 No
12. What is the highest level of education reached?
[] 2 Primary
Secondary
[] 2 Technical/vocational
[] 3 Normal (teaching) school
[] 5 Other
13. What is the highest year completed at this level?
[] 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)
[] 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?
[] 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)?
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)?
number __ __
21. How many of your children are still alive?
number __ __
22. When did you have your last child (live birth)?
Month____
Year: 19 __ __
If this household has more than nine persons, mark an X here [ ]
Register the other persons on an additional form.