Republic of Costa Rica
General Directorate of Statistics and Censuses
VIII Population Census
IV Housing Census
1984
____ Canton
____ District
____ Address
_ _ _ _ _ _ _ _ Segment
_ _ _ Dwelling number
_ _ Household
[] 1
1. Type
[] 2 Mobile
[] 3 Small room/shack (tugurio)
[] 4 Temporary
2. Occupancy-Tenure-Rent
_ _ _ _ _ (monthly)
[] 2 Owned
[] 3 Other
[] 5 Under construction or repair
[] 6 Summer home
[] 7 Other
If 4 - 7 are selected, end the interview here
Predominant Material and Condition
3. Exterior walls
[] 02 Fair
[] 03 Poor
[] 05 Fair
[] 06 Poor
[] 08 Fair
[] 09 Poor
[] 11 Fair
[] 12 Poor
4. Roof
[] 02 Fair
[] 03 Poor
[] 05 Fair
[] 06 Poor
[] 08 Fair
[] 09 Poor
[] 11 Fair
[] 12 Poor
5. Floor
[] 02 Fair
[] 03 Poor
[] 05 Fair
[] 06 Poor
[] 08 Fair
[] 09 Poor
6. Number and use of rooms
_ _ Living-dining
_ _ Exclusively kitchen
_ _ Kitchen-dining
_ _ Other uses
7. Water supply
[] 2 For this and other dwellings
[] 4 For this and other dwellings
[] 6 Well without pump
[] 7 River or stream
[] 8 Public tap
[] 9 Rain and other means
8. Continuity of water supply
[] 2 Winter
[] 2 Winter
[] 3 Winter
[] 4 Winter
[] 5 Winter
9. Bath facilities
[] 2 For this and other dwellings
[] 3 None
10. Type and use of toilet facilities
[] 2 For this and other dwellings
[] 4 For this and other dwellings
[] 6 For this and other dwellings
[] 8 For this and other dwellings
11. Type of lighting
[] 2 Electricity from private generator
[] 3 Kerosene/petrol (canfín)
[] 4 Other
[] 5 None
12. Fuel used for cooking
[] 2 Gas
[] 3 Kerosene/petrol (canfín)
[] 4 Charcoal
[] 5 Wood
[] 6 Other
[] 7 None (no cooking)
13. Appliances in the dwelling
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
[] 2 Does not have
Does any person in this household:
[] 2 No
[] 2 No
Household Summary
_ _ Males
_ _ Females
_ _ Person number
____ Name and surnames
1. Relationship to head
[] 2 Spouse or partner
[] 3 Son or daughter
[] 4 Son- or daughter-in-law
[] 5 Grandchild
[] 6 Parents or parents-in-law
[] 7 Other relatives
[] 8 Domestic servants and their families
[] 9 Other non-relatives
3. Age in years completed
_ _ Years
4. Place of birth
____ District
____ Canton
____ Province
If born abroad:
_ _ _ _ Year of arrival in Costa Rica
[a five-character box also appears in the top area of this item]
5. Nationality
[] 8 Naturalization
[] 9 Other nationality ____
[a three-character box also appears in the top area of this item]
6. Social Security (Insurance?)
[] 2 Volunteer
[] 3 Family member
[] 4 Other
[] 5 Not insured
Only for those 5 years of age and older
[Applies to questions 7 - 9]
7. Place of residence 5 years ago
Canton ____
Province ____
[] 988 Abroad
[a three -character box also appears in the top area of this item]
8. School enrollment
[] 2 No
9. Educational level
[] 1 Primary ____
[] 2 Secondary ____
[] 3 University ____
Only for those 10 years of age and older
[Applies to question 10 - 11]
10. Are you able to read and write?
[] 2 No
11. Marital Status
[] 2 Separated
[] 3 Married
[] 4 Widowed
[] 5 Divorced
[] 6 Single
Only for those 12 years of age and older
[Applies to questions 12-16]
12. Economic activity
[] 1 Worked or had a job
[] 2 Was unemployed
[] 3 Looked for work for the first time
[] 4 Pensioned or rentier
[] 5 Student
[] 6 Household duties
[] 7 Other
If 4 - 7 are selected, end the interview here
13. Principal occupation
____ [3 blank lines]
[a three-character box also appears in the top area of this item]
14. Occupational category
[] 2 Self-employed
[] 3 Owner/Employer
[] 4 Unpaid family worker
15. Industry
____ [4 blank lines]
[a four-character box also appears in the top area of this item]
16. Hours worked
_ _ Hours
Only for women 15 years of age and older
[Applies to questions 17 - 18]
17. Children born alive
_ _ Children
18. Children currently alive
_ _ Children
Comments: ____