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DANE
Census '85
Republic of Colombia

XV National Population
and IV Dwelling
Censuses

Extended Form for Individual Dwelling
(Usual Residence)

Additional form
If this is an additional form, make an X here []

Form number
(Should be completed in the office)

I. Geographic location

Fill this section with the information from the form "assignment and identification of the census area".

1. Department, Intendancy, Commissary, or Special District _ _
2. Municipality _ _ _
3. Population Center _ _ _
4. Sector _ _ _ _
5. Section _
6. Block _ _
7. Number of the enumerator _ _

II. Identification of the dwelling

8. Neighborhood, road, or location (if there is more than one name, write all of the names) ____

9. Complete address of the dwelling ____

10. Write the order number of the dwelling _ _ _
Read all of the following instructions and then continue with chapter III (information about the dwelling)

Observations: ____

Instructions
Instructions for completing the chapter about the dwelling.

* For the purposes of the Census, dwelling is a separate space, with independent access and that provides human housing.

The questions in chapter III (Information about the dwelling) refer to the dwelling identified for each case, for example, the room, the house, etc.

Who should be registered in the form?

Take census information for the following persons:

* Members of the family, renters, and the household workers who usually sleep in this dwelling, even if they have been absent from the household for les than six months. Include the guests who have been in the household for more than six months. Do not forget small children and the elderly.
* People who sleep in the dwelling most of week for reasons of work or school, even if they have a home somewhere else.

Do not include the following people in the census:

* Members of the family, who for reasons of work or school, have another dwelling where they sleep most of the week.
* Members of the family that are in prison, permanently confined in an institution (such as a nursing home or sanatorium), serving in the military or living elsewhere for work or study. Do not include family members who have been absent for more than six months.

What should be done for households that have more than fourteen persons?

*Use an additional form and make an x in the box for "additional form" (in the upper corner of the first page).
*Repeat the information in chapters I (geographic location), II (identification of the dwelling) and leave chapter III blank (information about the dwelling)
* For persons in the second form, complete the information in chapter IV (persons in the dwelling) starting with person 02 and the information for chapter V (information about the population) starting with the page marked "person 02"

Table of codes or numbers of the departments

Use this table to complete questions 33 and 36.

Name of the Department, Intendancy, or Precinct [Code]

5 Antioquia
8 Atlantico
13 Bolivar
15 Boyaca
17 Caldas
18 Caqueta
19 Cauca
20 Cesar
23 Cordoba
25 Cundinamarca
27 Choco
41 Huila
44 La Guajira
47 Magdalena
50 Meta
52 Nariño
54 Norte de Santander
63 Quindio
66 Risaralda
68 Santander
70 Sucre
73 Tolima
76 Valle
81 Arauca
85 Casanare
86 Putumayo
88 San Andrés
91 Amazonas
94 Guamia
95 Guaviare
97 Vaupes
99 Vichada

Table of the number of months

Use this table for question 50

Number / Month

1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December

Summary of persons
When you finish the form, complete the following data.

____ Total
____ Men
____ Women

If you used two or more forms, write the totals on the first form only.

____ Name of the census taker
____ Name of the group leader

III. Information about the dwelling

Complete 11, 12, 13, and 14 by observation (in case of doubt, ask).

11. Type of dwelling

[] 1 House, shack, hut or dwelling of discarded material
[] 3 Apartment, rooms
[] 5 Mobil home, natural refuge, bridge
[] 7 Dwelling in a structure destined for use other than housing

12. Condition of occupancy of the dwelling

[] 2 Occupied, persons present, continue with 13
[] 4 Occupied, persons absent, stop here and come back
[] 6 Unoccupied, finish here

13. Principal material in the exterior walls.

[] 1 Brick, tile, adobe, prefabricated, stone, marble
[] 2 Cane with earth (bahareque)
[] 3 Bamboo or cane
[] 4 Wood
[] 5 Fabric or discarded material
[] 6 No walls

14. Principal material in the floors.

[] 2 Wood
[] 4 Cement or brick tiles, synthetic material
[] 6 Dirt

15. How many total rooms are there in the dwelling, including the living room, dining room, bedrooms, and servants' rooms (do not include kitchen, bathroom, or garage) _ _

16. Does this dwelling have electricity?

[] 1 Yes
[] 3 No

17. Does this dwelling have a water connection?

[] 2 Yes
[] 4 No

18. What type of sanitary service is available to the household?

[] 1 Toilet connected to a sewage system (continue with number 19)
[] 3 Toilet connected to septic tank (continue with number 19)
[] 5 Latrine (continue with number 19)
[] 7 Not available (continue with number 20)

19. The toilet is

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

20. Where do the persons of this household cook?

(Answers 1, 2, 3, and 4: continue with number 21)

[] 1 In a bedroom or living room without a sink
[] 2 In a bedroom or living room with sink
[] 3 In a room designated as a kitchen
[] 4 In a patio, hallway

(Answer 5: continue with number 23)

[] 5 Nowhere

21. Is the kitchen

[] 2 For the exclusive use of the persons in the household?
[] 4 Shared with other units?

22. The persons in this household cook with

(Mark the most used)

[] 1 Electricity
[] 2 Cocinol [local subsidized cooking fuel]
[] 3 Petroleum, gasoline, or kerosene
[] 4 Propane gas
[] 5 Charcoal
[] 6 Firewood
[] 7 Discarded material

23. This dwelling is

[] 1 Owned (even if mortgaged)
[] 3 Rented
[] 5 Loan or other

24. What is the source of the drinking water for this dwelling?

(Mark only the main source)

[] 1 Aqueduct, public pipe
[] 2 Well, cistern
[] 3 From a river, spring, canal
[] 4 Tanked in by car or truck
[] 5 From rainwater

IV. Persons in the household.

-Start with the head of the household and continue with the other persons in the following order: spouse or companion, children (from eldest to youngest), sons and daughters-in-law, grandchildren, parents or parents-in-law, other relatives of the head of household or spouse, employees, other non-relatives.
-Include newborns, minors, and elderly who usually sleep in the household.
-the number of persons listed should be the same as the number of people interviewed.

25. What is the name of each person who usually sleeps in this household?

Person, name, relationship to the head of household.

01 ____ Head of household.
02 ____ ____
03 ____ ____
04 ____ ____
05 ____ ____
06 ____ ____
07 ____ ____
08 ____ ____
09 ____ ____
10 ____ ____
11 ____ ____
12 ____ ____
13 ____ ____
14 ____ ____

If there are more than 14 persons, continue on an additional form.

V. Population data

[] Person Number

A. For all of the persons in the dwelling
[Applies to questions 26 - 33]

26. Name ____

27. What is your relationship to the head of dwelling?

[] 1 Head of household
[] 2 Spouse/companion
[] 3 Child or stepchild
[] 4 Son-in-law or daughter-in-law
[] 5 Grandson/daughter
[] 6 Parents or parents-in-law
[] 7 Other relative
[] 8 Employee
[] 9 Other unrelated person

28. Man or woman?

[] 2 Man
[] 4 Woman

29. Age in complete years.

(For minors less than one, write 00, for persons more than 99, write 99)
_ _

30. Is your mother still alive?

[] 1 Alive
[] 3 Dead
[] 5 Do not know

31. Do you attend an educational center--preschool, elementary, secondary, university?

[] 2 Yes
[] 4 No

32. Were you born in this municipality?

[] 1 Yes (continue with 35)
[] 3 No (continue with 33)

33. In which department were you born?

(Write the name of the department where the person was born and the corresponding code according to the table on the first page. If the person was born in another country, write an X in the "other country" box and write the name of the other country)

Name of the department, intendancy, or precinct ____ (Code) _ _
Other country (name of other country) ____ _ 01

B. For persons born in a different country.

34. What year did you arrive in Colombia?

Year of arrival 19 _ _

C. For persons five years old or more.
[Applies to questions 35 - 41]

35. Where did you live in October 1980?

[] 1 In this municipality (continue with 38)
[] 2 In another municipality (continue with 36)

(Answers 3, 4, 5, and 6, continue with 39)

[] 3 In Venezuela
[] 4 In Ecuador
[] 5 In the United States
[] 6 Other country

36. In which department did you live in 1980?

(Write the name of the department and the corresponding code according to the table on the first page.)

Name of the department, intendancy, or precinct ____ (Code) _ _

37. Did you live in the capital of the department?

[] 2 Yes
[] 4 No

38. In October of 1980, did you live in

[] 1 Magistracy, streets, country-side (no shelter)
[] 3 in an urban center with a municipal mayor

39. Do you know how to read and write?

[] 2 Yes
[] 4 No

40. What is the last year of education you completed?

(If the person did not complete any years of schooling, write 0) _

41. What education level does the last year correspond to?

[] 1 None
[] 3 Primary
[] 5 Secondary
[] 7 College or university

D. For persons ten years old or more.
[Applies to questions 42 - 45]

42. Actually you are:

[] 1 Consensually united
[] 2 Separated or divorced
[] 3 Married
[] 4 Widowed
[] 5 Single

43. How many months was he/she occupied in paid work or a family business this year (1985)?

[] 00 Did not work
Months worked _ _

44. Read all of the options in order and as soon as you get an affirmative response, make an X in the box
Last week:

[] 1 Worked
[] 2 Did not work but had a job
[] 3 Looked for work and have worked before

(Answers 1, 2, and 3 continue with 45)

[] 5 Looked for work for the first time
[] 6 Lived from investments and did not work or look for work
[] 7 Lived on a pension and did not work or look for work
[] 7 In school and did not work or look for work
[] 8 Did domestic work in the home and did not work or look for work
[] 9 Was without activity

(Answers 4, 5, 6, 7, 8, and 9 continue with question 46)

45. In the work, you were:

[] 1 Laborer or journeyman
[] 2 Employee
[] 3 Boss or employer
[] 4 Independent worker or self-employed
[] 5 Unpaid family worker
[] 6 Domestic worker

E. For women fifteen years old or older.
[Applies to questions 46 - 50]

46. How many children (live-births) have you had?

[] 00 None (continue with the next person)
Number of live births (continue with number 47) _ _
[] 98 Does not know (continue with number 47)

47. How many of your children are still alive?

[] 00 None (continue with number 50)
Number of live births (continue with number 48) _ _
[] 98 Does not know (continue with number 48)

48. Of the children that are still alive, how many live in another country?

(If none, write '0' in both spaces)

Men_ _
Women _ _

49. The last child born alive is now :

[] 1 Dead
[] 3 Alive
[] 5 Does not know

50. When was your last child born (live-birth)?

Month _ _
Year 19 _ _
[] 98 Does not know