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Republic of Costa Rica
General Directorate of Statistics and Censuses
VIII Population Census
IV Housing Census
1984

____Province
____ Canton
____ District
____ Address

_ _ _ _ _ _ _ _ Segment
_ _ _ Dwelling number
_ _ Household
[] 1

Fourth Housing Census

1. Type

Private Dwelling
[] 1 Regular
[] 2 Mobile
[] 3 Small room/shack (tugurio)
[] 4 Temporary
[] 5 Collective dwelling (Name) ____

2. Occupancy-Tenure-Rent

Occupied
[] 1 Rented
_ _ _ _ _ (monthly)
[] 2 Owned
[] 3 Other
Unoccupied
[] 4 For rent or sale
[] 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

Wood
[] 01 Good
[] 02 Fair
[] 03 Poor
Brick-cement block
[] 04 Good
[] 05 Fair
[] 06 Poor
Adobe-cane with earth (bahareque)
[] 07 Good
[] 08 Fair
[] 09 Poor
Other
[] 10 Good
[] 11 Fair
[] 12 Poor

4. Roof

Clay tiles
[] 01 Good
[] 02 Fair
[] 03 Poor
Metal sheet
[] 04 Good
[] 05 Fair
[] 06 Poor
Asbestos - cement
[] 07 Good
[] 08 Fair
[] 09 Poor
Other
[] 10 Good
[] 11 Fair
[] 12 Poor

5. Floor

Wood
[] 01 Good
[] 02 Fair
[] 03 Poor
Tile
[] 04 Good
[] 05 Fair
[] 06 Poor
Other
[] 07 Good
[] 08 Fair
[] 09 Poor
None (earth) [] 10

6. Number and use of rooms

_ _ Total rooms
_ _ Exclusively for sleeping
_ _ Living-dining
_ _ Exclusively kitchen
_ _ Kitchen-dining
_ _ Other uses

7. Water supply

By pipe
Public system
[] 1 Only for this dwelling
[] 2 For this and other dwellings
Private system
[] 3 Only for this dwelling
[] 4 For this and other dwellings
By other means
[] 5 Well with pump
[] 6 Well without pump
[] 7 River or stream
[] 8 Public tap
[] 9 Rain and other means

8. Continuity of water supply

All day
[] 1 Summer
[] 2 Winter
During the morning
[] 2 Summer
[] 2 Winter
During the afternoon
[] 3 Summer
[] 3 Winter
At night
[] 4 Summer
[] 4 Winter
Almost never arrives
[] 5 Summer
[] 5 Winter

9. Bath facilities

[] 1 Only for this dwelling
[] 2 For this and other dwellings
[] 3 None

10. Type and use of toilet facilities

Sewer or septic tank
[] 1 Only for this dwelling
[] 2 For this and other dwellings
Concrete pit toilet
[] 3 Only for this dwelling
[] 4 For this and other dwellings
Wooden pit toilet
[] 5 Only for this dwelling
[] 6 For this and other dwellings
Other
[] 7 Only for this dwelling
[] 8 For this and other dwellings
[] 9 None

11. Type of lighting

[] 1 Electricity from public system
[] 2 Electricity from private generator
[] 3 Kerosene/petrol (canfín)
[] 4 Other
[] 5 None

12. Fuel used for cooking

[] 1 Electricity
[] 2 Gas
[] 3 Kerosene/petrol (canfín)
[] 4 Charcoal
[] 5 Wood
[] 6 Other
[] 7 None (no cooking)

13. Appliances in the dwelling

Radio
[] 1 Has
[] 2 Does not have

Stove
[] 1 Has
[] 2 Does not have

Electric iron
[] 1 Has
[] 2 Does not have

Black and white television
[] 1 Has
[] 2 Does not have

Color television
[] 1 Has
[] 2 Does not have

Refrigerator
[] 1 Has
[] 2 Does not have

Washing machine
[] 1 Has
[] 2 Does not have

Hot water heater for bath (in shower head)
[] 1 Has
[] 2 Does not have

Telephone
[] 1 Has
[] 2 Does not have

Vacuum cleaner
[] 1 Has
[] 2 Does not have

Hot water tank
[] 1 Has
[] 2 Does not have

Vehicle (not for work)
[] 1 Has
[] 2 Does not have

Does any person in this household:

1. Have a farm or grow crops between May 1st 1983 and April 30th 1984?
[] 1 Yes
[] 2 No

2. Own livestock (cattle or pork), or poultry?
[] 1 Yes
[] 2 No

If at least one of the two responses is affirmative, use as many of the National Agricultural Census forms as necessary.

Household Summary

_ _ Total
_ _ Males
_ _ Females

Eighth Population Census

[] 2

_ _ Person number
____ Name and surnames

1. Relationship to head

[] 1 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

2. Sex

[] 1 Male
[] 2 Female

3. Age in years completed

[] 00 Under one year
_ _ Years

4. Place of birth

[] 8 Here
____ District
____ Canton
____ Province
If born abroad:
____ Country
_ _ _ _ Year of arrival in Costa Rica

[a five-character box also appears in the top area of this item]

5. Nationality

Costa Rican by:
[] 7 Birth
[] 8 Naturalization
[] 9 Other nationality ____

[a three-character box also appears in the top area of this item]

6. Social Security (Insurance?)

[] 1 Direct
[] 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

Where did you live in June of 1979?
[] 8 Here
Canton ____
Province ____
[] 988 Abroad

[a three -character box also appears in the top area of this item]

8. School enrollment

Are you enrolled in any institution of regular schooling?
[] 1 Yes
[] 2 No

9. Educational level

What is the last year or grade of regular schooling completed?
[] 0 None
[] 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?

[] 1 Yes
[] 2 No

11. Marital Status

[] 1 Consensual union
[] 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

What did you do the week of the 3rd to the 9th of June?

[] 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

What occupation or type of work did you perform during the week of the 3rd tot the 9th of June, or in your last job?
____ [3 blank lines]

[a three-character box also appears in the top area of this item]

14. Occupational category

[] 1 Salaried
[] 2 Self-employed
[] 3 Owner/Employer
[] 4 Unpaid family worker

15. Industry

What does your place of work (or where you worked the last time) primarily do?
____ [4 blank lines]

[a four-character box also appears in the top area of this item]

16. Hours worked

How many hours do you usually work per week?
_ _ Hours

Only for women 15 years of age and older
[Applies to questions 17 - 18]

17. Children born alive

[] 00 None
_ _ Children

18. Children currently alive

[] 00 None
_ _ Children

Comments: ____