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Republic of Costa Rica
10th National Population and
6th National Housing Census
Census 2011

INEC National Institute of Statistics and Census

Block I: Location

Registered area _ _ _ _ _ _ _
Minimal geostatistic unit _ _ _
Dwelling _ _
Household _ _

[] If this questionnaire is a continuation of the same household, mark here. This mark is only applied following the second questionnaire of households of more than 6 people.
_____ Address
_____ District
[Instructions for how to write letters in form boxes were removed]

Block II: Characteristics of the dwelling

1. Observe, investigate, and mark the type of dwelling:

Individual
[] 1 Independent house
[] 2 Independent house in condominium
[] 3 Apartment building
[] 4 Apartment building in condominium
[] 5 Traditional indigenous dwelling (tipi or ranch)
[] 6 Room in bunkhouse
[] 7 Shanty
[] 8 Other (premise, mobile home, boat, truck)
Collective
[] 9 Barracks for workers
[] 10 Children’s shelter
[] 11 Home for the elderly
[] 12 Prison
[] 13 Other (guesthouse, convent)
[] 14 Person without dwelling

[Question 2 through 20 were asked of private dwellings]

2. Investigate and mark if the dwelling is occupied or unoccupied.

Occupied
[] 1 With present habitual residents
[] 2 With absent habitual residents (return later)
Unoccupied
[] 3 For rent or sale (end of the interview)
[] 4 Under construction or repairs (end of the interview)
[] 5 Seasonal vacation home (end of the interview)
[] 6 Temporary dwelling for workers or students (end of the interview)
[] 7 Other (end of the interview)

3. Is this dwelling...?

[] 1 Owned and totally paid
[] 2 Owned and making payments
[] 3 Rented
[] 4 Borrowed for work purposes
[] 5 Borrowed for other reasons (without pay)
[] 6 In a precarious condition
[] 7 Other

4. The exterior walls are made primarily of...?

[] 1 Block or brick
[] 2 Plinth (cement with wood or fibrolite)
[] 3 Wood
[] 4 Prefabricated materials or tile
[] 5 Fibrolite, Ricalite (sheet of fiber cement)
[] 6 Natural fibers (bamboo, cane, chonta)
[] 7 Waste material
[] 8 Other (zinc, adobe)

5. The roof is made primarily of...?

[] 1 Zinc
[] 2 Fibrolite, Ricalite, or asbestos (fiber cement)
[] 3 Natural material (palm, straw, woody grass, and others)
[] 4 Waste material
[] 5 Other (clay tile, etc.)

6. Does the dwelling have a ceiling?

[] 1 Yes
[] 2 No

7. The floor is made primarily of...?

[] 1 Ceramic, mosaic, terrazzo
[] 2 Cement (ochre, shiny or not)
[] 3 Wood
[] 4 Natural material (chonta or logs)
[] 5 Other material
[] 6 Dirt floor

8. The condition of…

The exterior walls are…?
[] 1 Bad
[] 2 Fair
[] 3 Good

The roof is…?
[] 1 Bad
[] 2 Fair
[] 3 Good

The floor is…?
[] 1 Bad
[] 2 Fair
[] 3 Good

9. How many rooms in this dwelling are used only for sleeping?

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10 or more

10. Including the bedrooms, how many rooms does this dwelling have in total? (excluding bathrooms or laundry rooms)

[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 10 or more

11. Water comes to the dwelling from…?

[] 1 Rural or communal aqueduct (ASADAS or CAAR)
[] 2 Municipal aqueduct
[] 3 A and A aqueduct
[] 4 Business or cooperative aqueduct
[] 5 Well
[] 6 River or gorge
[] 7 Other source (rain, cistern tank, hydrant)

12. Does the water arrive by plumbing to the interior of the dwelling?

[] 1 Yes
[] 2 No

13. The sanitary service is connected to…?

[] 1 Sanitary sewer system
[] 2 Septic tank
[] 3 Direct connection to ditch, trench, river, or estuary
[] 4 Hole, cesspit, or latrine
[] 5 No sanitary service

14. The electric lighting of the dwelling comes from…?

[] 1 ICE or the CNFL
[] 2 ESPH or the JASEC
[] 3 Cooperative
[] 4 Solar panel
[] 5 Other source
[] 6 No electric lighting

15. Do you cook primarily with…?

[] 1 Electricity
[] 2 Gas
[] 3 Firewood or coal
[] 4 Other
[] 5 None (does not cook)

16. The trash is eliminated primarily by…?

[] 1 Garbage truck
[] 2 Thrown in a hole or buried
[] 3 Burned
[] 4 Thrown in a vacant lot
[] 5 Thrown in a river, gorge, or sea
[] 6 Other

17. In this dwelling, do you separate from the rest of the garbage…?

Plastic, glass, aluminum
[] 1 Yes
[] 2 No

Paper
[] 1 Yes
[] 2 No

Food leftovers (fruits, vegetables, peels, bones)
[] 1 Yes
[] 2 No

18. In this dwelling do you have…?

Radio or sound equipment
[] 1 Yes
[] 2 No

Fixed (landline) telephone line
[] 1 Yes
[] 2 No

TV screen (plasma, LCO, or LED)
[] 1 Yes
[] 2 No

Conventional television
[] 1 Yes
[] 2 No

Satellite or cable television
[] 1 Yes
[] 2 No

Hot water system for the entire house
[] 1 Yes
[] 2 No

Water supply tank
[] 1 Yes
[] 2 No

Desktop computer
[] 1 Yes
[] 2 No

Laptop computer
[] 1 Yes
[] 2 No

Internet
[] 1 Yes
[] 2 No

Car (not a work vehicle)
[] 1 Yes
[] 2 No

Motorcycle (not a work vehicle)
[] 1 Yes
[] 2 No

19. How many cellular phone lines do you have in this dwelling?

[] 0
[] 1
[] 2
[] 3
[] 4
_ _ 5 or more, note

20. Residential or cellular telephone number:
_ _ _ _ _ _ _ _

Block III: Identification of total people and households

1. How many persons live here, in this dwelling?
_ _ Total number of persons. Note: Count persons that have lived in the dwelling for six months or longer, or persons who have lived in the dwelling for less than six months but intend to stay to live in the dwelling.
2. Do all the people that live here share a common food budget and prepare shared meals?

[] Yes… 1 single household (go to 3)
[] No… Then how many households are in the dwelling?
[] 2
[] 3
[] 4
[] 5
[] 6 or more.

Note: when you finish filling out Household 1, open a new questionnaire for each additional household, transcribe block 1 (page 1) changing the name of the household according to that which corresponds (2, 3,…) and continue on to Block III question 3.

List of people in the household

3. What are the first and last names of each member of this household, starting with the head of the household or reference person?

Person No. / (1 to 12)
_ _

First and Last name:
________

Sex (man or woman):

[] 1 Yes
[] 2 No

Note: Continue with the rest of the household members, according to the kinship relationship with the person 01, in the following order:

Spouse or partner
Single children
Married children, their partner and children
Other relatives
Domestic employees and their relatives
Other nonrelatives

Note: if there are more than 12 people in the household use a new questionnaire, transcribe Block 1 (page 1), mark the oval that indicates that it is a continuation of the same household and continue completing the list.

4. [] If the headship of the household is shared by the couple, mark here.

5. In summary, how many people constitute this household?

_ _ Men
_ _ Women
_ _ Total

Only collective dwellings
[Question 6 was only answered by collective dwellings]

6. How many people live here, in this collective dwelling?

_ _ _ _ Men
_ _ _ _ Women
_ _ _ _ Total (continue on the Block IV)

7. Does any member of this household live in another country?

[] 1 Yes


How many?
[] 1
[] 2
[] 3
[] 4
_ 5 or more, note

[] 2 No

8. In the past year, did any member of this household…

Receive money or goods from someone that lives abroad, for the use of this household?
[] 1 Yes
[] 2 No

Send money or goods to someone that lives abroad, for the use of that household?
[] 1 Yes
[] 2 No

9. Did any member of this household

[] 1 Has a plot or a farm
[] 2 Cultivate during the last year (in owned, rented, or borrowed territory)
[] 3 Has cattle, pigs, chicken, ducks, wild turkey, geese, others (for sale or self-consumption)
[] 4 None of the above

Block IV: Socioeconomic characteristics

_ _ Person No.
Name: ____

For all people

1. What is this person's relationship with the head of the household (person 1)?

[] 1 Head of household
[] 2 Spouse or partner
[] 3 Child or stepchild
[] 4 Son or daughter in law
[] 5 Grandchild or great grandchild
[] 6 Sibling
[] 7 Brother or sister in law
[] 8 Father or mother
[] 9 Father or mother in law
[] 10 Other relative
[] 11 Domestic help and their family
[] 12 Other non-relative

2. Is he/she a male or female?

[] 1 Male
[] 2 Female

3. How old, in completed years, is [the respondent]?

[] 1 less than 1 year
_ _ years

4. On what date was [the respondent] born?

Day_ _
Month _ _
Year _ _ _ _

5. When [the respondent] was born, where was his/her mother living?

[] 1 In this canton
[] 2 In another canton

_____ In which canton?
In which province?

[] 1 San José
[] 2 Alajuela
[] 3 Cartago
[] 4 Heredia
[] 5 Guanacaste
[] 6 Puntarenas
[] 7 Limón

[] 3 In another country

Which country?
[] Nicaragua
[] United States
[] Colombia
[] El Salvador
[] Panamá
[] Cuba
[] Another country

6. In what year did [the respondent] arrive to live in Costa Rica?

_ _ _ _ If the year is unknown, ask:

Did he/she arrive to live in Costa Rica
[] 1 before 1980
[] 2 between 1980 and 1989
[] 3 between 1990 and 1999
[] 4 in 2000 or later

7. Does [the respondent] consider himself/herself indigenous?

[] 1 Yes
[] 2 No (go to 10)

[Question 8 and 9 are only answered by persons who consider themselves indigenous]

8. To what indigenous community does [the respondent] belong?

[] 1 Bribri
[] 2 Brunca o Boruca
[] 3 Cabécar
[] 4 Chorotega
[] 5 Huetar
[] 6 Maleku or Guatuso
[] 7 Ngobe or Guaymí
[] 8 Teribe or Terraba
[] 9 From another country
[] 10 No community

9. Does [the respondent] speak an indigenous language?

[] 1 Yes (go to 11)
[] 2 No (go to 11)

10. Does [the respondent] consider himself/herself…?

[] 1 Black or of African descendant
[] 2 Mulatto
[] 3 Chinese
[] 4 White or mestizo
[] 5 Other
[] 6 None

11. What type of social security does [the respondent] have?

[] 1 Salaried
[] 2 Self-employed, voluntary work, or contract
[] 3 Non contributive agreements (receives a pension)
[] 4 Pensioned by the CCSS, Magisterium, or other
[] 5 Family insurance
[] 6 State insurance
[] 7 Other forms
[] 8 Does not have social security from the CCSS

12. Does [the respondent] have a permanent limitation…? (You can mark multiple options)

[] 1 Seeing, even with glasses or contacts on
[] 2 Hearing
[] 3 Speaking
[] 4 Walking or going up steps
[] 5 Using arms or hands
[] 6 Intellectually (retarded, Down’s syndrome, other)
[] 7 Mentally (bipolar, schizophrenic, other)
[] 8 None of the above

13. Does [the respondent] attend…?

[] 1 Daycare, nursery school, or preschool
[] 2 Kindergarten, elementary or secondary school
[] 3 Open education (MEP exams)
[] 4 University prep school or university
[] 5 Special education
[] 6 Day center for elderly
[] 7 Does not attend (go to 15)

14. The center that [the respondent] attends is...?

[] 1 Public
[] 2 Private or semi-private

Only for people 5 years or older
[Questions 15-17 are only applied to persons aged 5 and older]

15. Does [the respondent] know how to read and write?

[] 1 Yes
[] 2 No

16. What is the last grade or year that [the respondent] passed?
Level

[] 60 No grade
[] 70 Special education
[] 80 Kindergarten or school prep
[] 1 Elementary school, last grade passed
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 2 Secondary school
[] 1
[] 2
[] 3
[] 4
[] 5
[] 3 Secondary technical school
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 4 University prep school (go to 17)
[] 1
[] 2
[] 3
[] 5 University (go to 17)
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

[Question 17 only applies to persons who have studied at university or university prep school]
17. Does he/she have a degree at that level?

[] 1 Yes
[] 2 No

18. In the last 3 months has [the respondent] used...?

Cell phone
[] 1 Yes
[] 2 No

Computer
[] 1 Yes
[] 2 No

Internet
[] 1 Yes
[] 2 No

19. Where did [the respondent] live five years ago? (May 2006)

[] 1 In this canton (go to 20)
[] 2 In another canton
_____ In which canton? (go to 20)
In which province? (go to 20)
[] 1 San José
[] 2 Alajuela
[] 3 Cartago
[] 4 Heredia
[] 5 Guanacaste
[] 6 Puntarenas
[] 7 Limón
[] 3 In another country
Which country?
[] Nicaragua
[] United States
[] Colombia
[] El Salvador
[] Panamá
[] Honduras
_____ Another country
Only for people 12 years or older
[Questions 20 through 23 are asked only of persons aged 20 and older]

20. [The respondent] is currently...?

[] 1 In a consensual union or partnership
[] 2 Married
[] 3 Separated
[] 4 Divorced
[] 5 Widowed
[] 6 Single

21. Last week [the respondent]...?

[] 1 Worked for an hour or more (excluding domestic tasks) (go to 24)
[] 2 Did not work but has employment (go to 24)
[] 3 Helped with a family business or farm without payment (go to 24)
[] 4 None of the above

22. Last week, in exchange for payment, [the respondent]...?

[] 1 Carried out agricultural labor, raised animals, fished (go to 24)
[] 2 Sold products (go to 24)
[] 3 Cared for people, cleaned, or ironed for a private household (go to 24)
[] 4 Did various tasks (odd jobs) (go to 24)
[] 5 Did not do any of the above

23. Last week [the respondent]...?

[] 1 Looked for work and had worked previously (go to 30)
[] 2 Looked for work for the first time (go to 30)
[] 3 Is pensioned or retired (go to 30)
[] 4 Makes a living by renting (go to 30)
[] 5 Only studies (go to 30)
[] 6 Dedicates time to domestic chores of the household (go to 30)
[] 7 Another situation (go to 30)

About the main job

[This question is asked of persons who worked for an hour or more, had employment or helped with family business or farm]

24. What is the occupation or profession that [the respondent] has at this job? ____

For question 24 from Block IV, about the main occupation, you can detail the responses like in the following examples: school director, hospital director, farmer, peon farmer, construction worker, school teacher, art teacher, dental mechanic, vehicle mechanic, domestic employee, waitress, store worker, store owner, fish raiser, bank cashier, supermarket cashier, bus chauffeur, truck driver.

25. What is the main task completed? Explain. ________

26. What is the name of the company, institution, or business where [the respondent] works? ________

27. What does the company, institution, or business where [the respondent] works produce? ____

For question 27 from Block IV, about the branch of activities, you can initiate with responses such as: cultivation of…, fabrication of ..., furniture, construction of…, retail sale of.…, wholesale of…, domestic services, sale of repair parts for..., ground transportation of..., fabrication of..., repairs of..., elementary education, secondary education.

28. In this job [the respondent] is...?

[] 1 Employer (has permanent employees)
[] 2 Self-employed worker
[] 3 Employee of a private company
[] 4 Employee of the public sector
[] 5 Employee of a private households
[] 6 Unpaid worker

29. The place where [the respondent] works is...?

[] 1 Within or adjacent to the dwelling (go to 30)
[] 2 In this canton (go to 30)
[] 3 In another canton. (go to 30)

_____ In which canton? (go to 30)
In which province? (go to 30)

[] 1 San José
[] 2 Alajuela
[] 3 Cartago
[] 4 Heredia
[] 5 Guanacaste
[] 6 Puntarenas
[] 7 Limón


[] 4 In multiple cantons
[] 5 Abroad

Only for women 12 years or older
[Questions 30 and 31 were only asked of women aged 12 and older]

30. How many live-birth children has [the respondent] had?

_ _ Total (go to 31)
[] 00 None (go to the next person)

31. Of these, how many are currently alive?

[] 00 None
_ _ Total

[Information was removed from subsequent pages of the questionnaire that repeat questions 1-31 of block IV for different members of the family. The final page has information regarding the confidentiality of the questionnaire, a list of all the provinces and cantons of Costa Rica, and a description of occupations and activity branches. The details for question 24 and 27 are listed below.]

Observations: ______