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Republic of Costa Rica
National Institute of Statistics and Censuses
IX National Population Census
V Housing Census
2000

The confidentiality of the information provided is guaranteed by Article 4 of the National Statistical System Law number 7839 of 1998.

Location

____Province
____ Address
____ Canton
____ District
____ Telephone
_ _ _ _ _ _ _ _ Segment
_ _ _ Dwelling
_ _ Household

Characteristics of the Dwelling

1. Dwelling type

[] 1 Independent house
[] 2 In a building
[] 3 Small room/shack (tugurio)
[] 4 Other

[] 5 Homeless
[] 6 Collective (name) ____
For answers 5 and 6, skip to the Identification of Households and Individuals

3. What is the predominant material in the exterior walls?

[] 1 Cinder block or brick
[] 2 Socle with facing
[] 3 Socle without facing
[] 4 Wood with lining
[] 5 Wood without lining
[] 6 Prefabricated
[] 7 Other
[] 8 Waste material

4. What is the predominant material in the roof?

[] 1 Metal or zinc sheet
[] 2 Fibrocement (fibrocemento)
[] 3 Other
[] 4 Waste material

5. Does the dwelling have interior ceiling paneling?

[] 1 Yes
[] 2 No

6. What is the predominant material in the floor?

[] 1 Tile, linoleum flooring, ceramic, etc
[] 2 Cement (polished or not)
[] 3 Wood
[] 4 Other
[] 5 None (dirt floor)

7. Condition of:

Exterior walls
[] 1 Poor
[] 2 Fair
[] 3 Good
Roof
[] 1 Poor
[] 2 Fair
[] 3 Good
Floor
[] 1 Poor
[] 2 Fair
[] 3 Good

8. How many rooms, exclusively for sleeping, does the dwelling have?

_ _ Number

9. Not counting bathrooms, hallways nor garage, how many rooms total does this dwelling have?

_ _ Number

10. This dwelling is supplied with water via

[] 1 Pipe inside the dwelling
[] 2 Pipe outside the dwelling but within the lot or building
[] 3 Pipe outside the lot or building
[] 4 Doesn't have piped water

11. The water used for drinking comes from

[] 1 an aqueduct of the Water and Sewer Company (A y A)
[] 2 a rural or municipal aqueduct
[] 3 a well
[] 4 a river, stream or spring
[] 5 rain or others

12. Does this dwelling have toilet facilities

[] 1 connected to the public sewer?
[] 2 connected to a septic tank?
[] 3 pit toilet or latrine?
[] 4 other system?
[] 5 Doesn't have (skip to 14)

13. The toilet facilities are

[] 1 only for this dwelling
[] 2 for this and other dwellings

14. In this dwelling, electricity comes from

[] 1 the C.N.F.L. or the I.C.E. [Public enterprises]
[] 2 Other
[] 3 There is no electric light

15. What is the principal fuel used for cooking?

[] 1 Electricity
[] 2 Wood or charcoal
[] 3 Gas
[] 4 Other
[] 5 None (no cooking)

16. Does this dwelling have a

color television?
[] 1 Yes
[] 2 No
telephone?
[] 1 Yes
[] 2 No
refrigerator?
[] 1 Yes
[] 2 No
microwave oven?
[] 1 Yes
[] 2 No
hot water heater in showerhead?
[] 1 Yes
[] 2 No
hot water heater with tank?
[] 1 Yes
[] 2 No
washing machine
[] 1 Yes
[] 2 No
microcomputer?
[] 1 Yes
[] 2 No
car (not for work)?
[] 1 Yes
[] 2 No

Comments: ____

Enumerator: ____
Supervisor: ____

Population Characteristics

Identification of Households and Individuals

How many people habitually reside in this dwelling?
(Do not forget children or elderly people and include domestic servants who habitually live in the dwelling)
_ _

Number of households

In this dwelling, how many families or groups of people buy and cook food separately?
(mark the circle of the number of households)

[] 1 (continue with the List of Individuals)
[] 2
[] 3 or more
Enumerator:
- Use one form for each additional household
- Fill in the Location and continue with the List of Individuals
- Do not fill in the Characteristics of the Dwelling on the additional forms

List of Individuals

What are the names and surnames of each of the members of this household, beginning with the head? [Note: "head" is explicitly either male or female, "jefe o jefa" throughout this census.]

(Head: the person recognized by the members of the household, or who contributes the most income, or the oldest person)

[This item consists of a table. The left-hand column shows the person number 01 through 10, then the following blanks for each:]

Name and surnames ____

Sex
[] Male
[] Female
Enumerator:
- Put the head on the first line and continue with the rest of the member, according to their relationship to the head, if possible, in the following order:
spouse or partner
unmarried children
married children, their partners and children
other relatives
domestic servants and their families
other non-relatives
- Copy each person number and name onto the respective population questionnaires

If there are more than 10 people, use another form, and repeat the segment number, dwelling number, and household number. Assign lowercase letters (a, b, c, etc.) in the box of each line indicated according to the number of additional forms. Correct, as appropriate, the printed person number.

Household summary

Write the total number of people in the household, by sex:
_ _ Males
_ _ Females
_ _ Total

[The following question on quantity of land owned/rented within an indigenous territory appears in the enumeration form for Indigenous Territories, only.]

Within the [indigenous] territory, what amount of land do the members of this household . . .

. . . own? _____ (quantity)
. . . rent? _____ (quantity)
Total _____ (quantityl)

The quantities above are in:
[] 1 Hectares
[] 2 Blocks

Person number _ _
Name ____

[Questions 1 - 8 are] For all individuals

1. What is ____ 's relationship to the head of household?

[] 1 Head
[] 2 Spouse or partner
[] 3 Son or daughter or stepson or stepdaughter
[] 4 Son- or daughter-in-law
[] 5 Grandchild
[] 6 Parent or parent-in-law
[] 7 Other relative
[] 8 Domestic servants or their relatives
[] 9 Other non-relative

2. Male or female?
[] 1 Male
[] 2 Female

3. How old is ____?

[] 00 Under one year
_ _ Years

4. When ____ was born, where did the mother live?

[] 1 In this same canton
[] 2 In another canton
____ Canton or place
____ Province
[] 3 In another country:
____ (Name of the country)

[a 3-character box appears here]

4a. In what year did ____ arrive to live in Costa Rica?
_ _ _ _ Year

5. What is the nationality of ____?

[] 1 Costa Rican by birth
[] 2 Costa Rican by naturalization
[] 3 Other (specify) ____

[a 3-character box appears here]

6. Does ____ belong to any of the following cultures?

[] 1 Indigenous
[] 2 Afro-Costa Rican or Black
[] 3 Asian (China)
[] 4 None of the above

[Questions 6 a-c appear in the enumeration form for Indigenous Territories, only. Therefore, they apply to respondents who reside in such territories.]

6.a. To which indigenous group does ____ belong to?

[] 1 Bribri
[] 2 Boruca or brunca
[] 3 Cabécar
[] 4 Chorotega
[] 5 Guaymí (ngöbe or sabanero)
[] 6 Maleku or guatuso
[] 7 Teribe or térraba
[] 8 Huetar
[] 9 Other ____ (specify)

6.b. Does ____ speak any indigenous language?

[] 1 Yes
[] 2 No

6.c. In which tongue or indigenous language did ____ learn to speak?

[] 1 Indigenous language
[] 2 In Spanish only
[] 3 Another tongue or language

[End of questions that only appear in the form for Indigenous Territories.]

7. What type of insurance (seguro social) does ____ have?

[] 1 Salaried
[] 2 Self-employed or by agreement (convenio)
[] 3 Pensioner
[] 4 Family member
[] 5 Government account (por cuenta del Estado)
[] 6 Other
[] 7 None

8. Does ____ have any permanent disability, such as

[] 1 partial or total blindness?
[] 2 partial or total deafness?
[] 3 mental retardation?
[] 4 paralysis or amputation?
[] 5 mental illness?
[] Other (specify) ____
[] 7 None

[Questions 9 - 12 are] For those 5 years of age and older

9. Where did ____ live in June of 1995?

[] 1 In this same canton
[] 2 In another canton
____ Canton or place
____ Province
[] 3 In another country:
____ (Name of the country)

[a 3-character box appears here]

10. Does ____ attend preschool, primary school, high school, or university?

[] 1 Yes
[] 2 No

11. What is the last grade or year of regular schooling that ____ completed?

level - year completed

[] 0 - 0 No grade
[] 1 - 1 Preschool or kindergarten
[] 2 - Primary ____
[] 3 - Academic secondary ____
[] 4 - Technical secondary ____
[] 5 - Technical college ____
[] 6 - University ____
For responses 3 - 6, skip to 13

12. Able to read and write?

[] 1 Yes
[] 2 No

For those 12 years of age and older [Applies to questions 13-18]

13. Currently, is ____

[] 1 in a consensual union?
[] 2 married?
[] 3 separated?
[] 4 divorced?
[] 5 widowed?
[] 6 single?

14. Last week, did [was] ____

[] 1 work?
[] 2 work for or help a family member without receiving payment?
[] 3 not work, but have a job?
[] 4 look for work having worked before?
[] 5 look for work for the first time?
[] 6 retired or live from investments and not work?
[] 7 a student and did not work?
[] 8 work only on household duties?
[] 9 Other?
For responses 4 - 9, skip to 19

For the principal job
[Applies to questions 15-18]

15. What is the name of the place that ____ works? (business, institution, farm)

____ [2 blank lines. A blank box also appears in the corner of this item]

16. What does this place of work principally do?

____ [2 blank lines. A 5-character box also appears in the corner of this item]

17. What is the occupation or position that ____ holds in this job?

____ [2 blank lines. A 4-character box also appears in the corner of this item]

What are the principal tasks that ____ carries out?

____ [2 blank lines]

18. In this job, is ____ a(n)

[] 1 employer or owner (hires workers)?
[] 2 own-account worker?
[] 3 salaried worker?
[] 4 unpaid family worker?

For women 12 years of age or older [Applies to questions 19 - 20]

19. How many daughters and sons born alive has ____ had?

[] 00 None
_ _ Total

20. Of these, how many are currently alive?

[] 00 None
_ _ Total