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Dominican Republic
Fourth National Census of Population
1960

____ Form number
____ For office use

A. Location of the Census Household
____ Province
____ Municipality or Municipal district
____ City or Section
____ Neighborhood or settlement
____ Rural location (paraje)
____ D. E. (Enumeration district)
____ Block number
____ Building or house number
____ Floor
____ Dwelling in a patio or farm
____ Census household number

For Office Use

Municipality or Municipal district

____

City or Section

____

Neighborhood or settlement (poblado)

____

Block

____

Patio or farm

____

B. Information on the dwelling occupied
(Mark an X in the appropriate box)

I. Category

[] 1 Private
[] 2 Collective [group quarters]
____ Name if collective

II. Type

[] 1 Independent
[] 2 Tenement (Vecindad)
[] 3 Apartment
[] 4 Other

III. Water

[] 1 Running water inside
[] 2 Running water outside
[] 3 Tank, well or cistern
[] 4 River, stream or spring
[] 5 Other

IV. Sanitary facilities

[] 1 Private toilet
[] 2 Shared toilet
[] 3 Private latrine
[] 4 Shared latrine
[] 5 Other
[] 6 None

V. Lighting

[] 1 Electric
[] 2 Gas
[] 3 Other

VI. Rooms

____ Number of rooms

VII. Ownership/tenure

[] 1 Owned
[] 2 Rented
[] 3 Ceded
[] 4 Other

VIII. Rent

____ $RD per month
____ Code

Comments

____

C. Family Questionnaire

1. Complete name and surnames.

Write those of the head of the family in the first column. Do not forget children under one year of age.
____

2. Relationship to the head of the family (Wife, partner, son, brother, boarder, servant, etc.)

[1st person]
Head of the family

[2nd person]
____

3. Sex

M = Male
F= Female
____

4. Age in years completed

Under one year, in months; under one month, in days.
____

5. Color [race]

B = white
M = mulatto
N = black
A = Asian
____

6. Marital status (For those 12 years of age and older)

S = single
C = married
U.L. = consensual union
V = widowed
D = divorced
S.L. = legally separated
____

7. Religion

Write the religion he/she professes.
____

Place of birth [Applies to questions 8 and 9]

8. For those born in the Dominican Republic, the name of the municipality. For foreigners, the name of the country.

____

9. (Only for those born in the Dominican Republic) For those born in a city, the name of the city. For those born in a section, its name.

____

10. Nationality (Only for those born abroad). Write the current nationality of the informant.

____

11. Able to read and write?
Write yes or no.

____

12. Last year of schooling completed.
Add the letter P when the last year corresponds to primary, the letter S when secondary, the letter U when university.

____

13. School attendance (For those 5 years of age and older.)
The year underway or just completed, followed by the letter P, S or U. Write U.A. for those who attend a literacy center.

____

For those individuals 10 years of age and older
[Applies to questions 14 - 18]

14. Total time working

Write the total time worked this year.
____

15. Profession, position or occupation.

The profession, position or occupation performing or performed this year.
____

16. Place of work.

Write the type of business, industry, commercial establishment, etc. where performing this occupation.
____

17. Occupational category.

E = employer, T. P. = self-employed, A = salaried employee, T. F. = family worker
____

18. Monthly income from wages or salary.

Write the total salary in $RD.
____

For Office Use
____ Card number
____ Total
____ Males
____ Females