Dominican Republic
Ministry of Economy, Planning and Development
National Office of Statistics
IX National Population and Housing Census 2010
ONE - National Office of Statistics, according to law 5096 of March 6th, 1959, all information solicited is strictly confidential
Instructions
Only use provided pencil to fill in the bubbles of the survey. Only write in capital letters. Do not mark accents nor cross or erase, write with clear letters and numbers.
[Examples of how to fill in the circles are omitted]
Section I - Geographic location
Folder Number: _ _ _ _ _ _
Surveyed housing number: _ _ _
Household number within dwelling: _
Neighborhood/region: ____
Block: _ _ _ _
If this survey is a continuation of the previous one please fill in:
Household address: ________ (street, avenue, path, road, km, etc.)
House No.____ Apt. No. ____
Section II - Dwelling characteristics
Private dwellings
[] 2 Apartment
[] 3 Room in a bunkhouse or in the back of the premises
[] 4 Room in barracón
[] 5 Housing shared with business
[] 6 Premises not intended for habitation
[] 7 Other type of private dwelling
[] 9 Military quarters (go to Section V)
[] 10 Prison (go to Section V)
[] 11 Hospital or health center (go to Section V)
[] 12 Religious institution or boarding school (go to Section V)
[] 13 Other type of collective household (go to Section V)
[] 14 Homeless (go to Section V)
[] 1 Occupied with residents
[] 2 Occupied with absent residents (go to next house and return later)
[] 3 Vacant (fill in questions 3 and 4 and go to the next house)
Remember that if the dwelling is occupied, but with absent residents, you should return to it later.
3. What is the main material of the exterior walls of this dwelling?
[] 2 Wood
[] 3 Palm planks
[] 4 Wood planks
[] 5 Palm leaves
[] 6 Other
4. What is the main material of the roof of this dwelling?
[] 2 Tin
[] 3 Asbestos cement
[] 4 Reeds
[] 5 Palm leaves
[] 6 Other
5. What is the main material of the floor of this dwelling?
[] 2 Cement
[] 3 Granite
[] 4 Marble
[] 5 Ceramic
[] 6 Wood
[] 7 Dirt
[] 8 Other
6. Does this dwelling have a kitchen or cooking room either inside or outside the house?
[] 2 Yes, outside the dwelling
[] 3 No
7. How many rooms does the dwelling have, not counting bathrooms, kitchen, hallways or garage?
Section III - Household identification
Read to the interviewee: A household is a single person or group of people that share food and living expenses and live under the same roof.
8. So, how many households are in this dwelling?
[] 2
[] 3
[] 4
[] 5
[] 6 or more
[If there is more than one household] use one survey per household and proceed this way:
B) Use a new survey for each additional home and fill in section I geographical location and leave blank sections II and III, then continue filling in sections IV, V and VI
Section IV - Household characteristics
9. Which of the following articles or services does your household have?
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
10. This household (or part of it) is:
[] 1 Owned, paid off?
[] 2 Owned, paying mortgage?
[] 3 Rented?
[] 4 Given or lent?
[] 5 Other?
11. How many rooms (bedrooms) are in this household?
12. What kind of toilet facility does your household have?
[] 2 Latrine
[] 3 None (skip to question 14)
13. Does your household share a bathroom with other households?
[] 2 It is shared with other households
14. How does the garbage get disposed of in this household?
[] 2 Collected by private sanitation service
[] 3 Burned
[] 4 Thrown in the backyard or lot
[] 5 Put in the garbage dump
[] 6 Thrown in the river or ravine
[] 7 Other
15. What is the principal source of water used to wash, scrub, shower, etc. in this household?
[] 2 Water conduit on patio
[] 3 A neighbor's tap
[] 4 Public tap
[] 5 Pipe from the street
[] 6 Spring, river, stream
[] 7 Rainwater
[] 8 Well
[] 9 Water truck
[] 10 Other
16. What type of fuel does your household mainly use for cooking?
[] 2 Coal
[] 3 Wood
[] 4 Electricity
[] 5 Other
[] 6 Never cooks
17. What type of electricity does your household use?
[] 2 Propane lamp
[] 3 Kerosene lamp
[] 4 Electricity from own generator
[] 5 Other
18. Including all newborn babies and elderly people, has any household member has died as of 2009, meaning between January 1st and December 31st of 2009?
[] 2 No (go to question 19)
01: ____
02: ____
03: ____
18a. What is the sex of [this person]?
[] 2 Female
18b. When did [this person] die?
_ _ Month
18c. How old was [this person] when he/she died?
19. Do any of the members of this household have sown field, uncultivated land, fallow land (either owned, rented or half-half, etc.) or have they harvested within the last 12 months?
[] 2 No (go to question 20)
How many tareas?
_ _ _ _ Did [the respondent] harvest in the last 12 months?
20. Do any of the members of this household have animals for household consumption or for sale?
[] 2 No (go to question 21)
How many?
_ _ _ _ Ducks, turkeys, geese does [the respondent] have?
_ _ _ _ Hens, chickens, roosters does [the respondent] have?
_ _ _ _ Bees does [the respondent] have?
_ _ _ _ Pigs does [the respondent] have?
_ _ _ _ Goats, sheep, rabbits does [the respondent] have?
Section V - List of household members
Order number [01, 02, 03, 04, 05, 06... 20]
21. Please give all the names of the permanent residents of this household, starting with the head of household: ____
[] Male
[] Female
Circle the order number of the interviewee or the person that provides the data
23. Is there a newborn or child that was not included?
[] 2 No
24. Besides all people mentioned, is there any household member that is not present and is travelling for leisure, business, and study or has been in the hospital, etc.?
[] 2 No
25. Household population summary
_ _ _ Female
_ _ _ Total
Section VI - Personal characteristics
Number of person _ _ _
Name ____
26. What is the relationship of [the respondent] to the head of household?
[] 2 Spouse or partner
[] 3 Son/daughter
[] 4 Stepson/stepdaughter or foster son/daughter
[] 5 Father/mother
[] 6 Grandchild
[] 7 Father in law/mother in law
[] 8 Grandfather/grandmother
[] 9 Brother/sister
[] 10 Maid or household worker
[] 11 Other relative
[] 12 Son or daughter in law
[] 13 Other non-relative
27. Is [the respondent] male or female?
[] 2 Female
28. When was [the respondent] born?
Month_ _
Year _ _ _ _
29. How old is [the respondent]?
_ _ _ Years
30. Where was [the respondent] born?
[] 2 In another municipality
[] 3 Abroad (Skip to question 32)
31. In which municipality of the Dominican Republic was [the respondent] born?
32. In which country was [the respondent] born?
33. In which year did [the respondent] arrive to the Dominican Republic?
34. Does [the respondent] have permanent difficulty with any of the following?
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
35. Does [the respondent] know how to write and read?
[] 2 No
36. Has [the respondent] attended school, high school or university?
[] 2 Does not currently attend but attended school
[] 3 Never attended school
37. What is the highest level of school [the respondent] has attended: Preschool, primary/basic, secondary/high school, university?
[] 2 Primary/elementary
[] 3 Secondary/high school
[] 4 University or higher (skip to question 39)
38. What is the last level of school [the respondent] has completed?
39. What is/was the university course [the respondent] studied or studies?
40. Did [the respondent] complete his/her degree?
[] 2 No
41. How many years did [the respondent] studied at the college, master's or doctorate level, including a specialty?
For people age five and older (check from question 29)
42. Where did [the respondent] reside in November 2005?
[] 2 In another municipality
[] 3 Abroad (skip to question 44)
43. In November 2005, in what municipality did [the respondent] live?
44. In November 2005, in what country did [the respondent] live?
45. During the past week (seven days) has [the respondent] done any type of work in which he/she received any kind of payment, even if he/she was not working because of time-off, illness or other reason?
[] 2 No
46. During the past week (seven days) has [the respondent] done any type of work for at least one hour such as selling food or clothes, sewing, motorcycle taxi, selling tickets, etc. in which he/she received any kind of payment?
[] 2 No
47. During the past week did [the respondent] help in a business, farm or a family activity, in which he/she did not receive any remuneration?
[] 2 No
48. During the last four weeks, has [the respondent] looked for a paid job or tried to establish his/her own business or company?
[] 2 No
49. What has [the respondent] been doing during the last week?
[] 2 Studying
[] 3 Rentier
[] 4 Retired or receiving pension
[] 5 Not working due to disability
[] 6 Not working due to old age
[] 7 Other
[] 8 None
50. Last week, would [the respondent] have had the time and necessary conditions to get to work if he/she had been offered a job?
[] 2 No
51. Has [the respondent] worked before for a remunerated work?
[] 2 No (skip to question 55)
52. What was [the respondent]'s main occupation, last week (or in his/her last job)?
53. In that job [the respondent] was (or is)?
[] 1 Salary or waged employee?
[] 2 Employer or owner?
[] 3 Family worker or unpaid worker?
[] 4 Self-employed?
[] 5 Other?
54. What is the goal of the business, company or institution where [the respondent] works (or last worked)?
55. Currently, is [the respondent]: (Read all answers and mark only one)
[] 2 Divorced
[] 3 Widow/widower
[] 4 Separated from a civil union
[] 5 Married
[] 6 Living together
[] 7 Single (Never married or in a civil union)
For women age 15 and older (check from questions 27 and 29)
56. In total, how many live births has [the respondent] had, even if the baby died a few hours or days after being born?
_ _ Male children
[] None (go to next person)
57. Of all the children, how many are currently living?
_ _ Female children
_ _ Male children
[] None
58. In what month and year was the last child born alive of [the respondent]?
Year _ _ _ _
59. Is the last child of [the respondent] alive?
[] 2 No
60. How old was the child when he/she died?
Age _ _
[Person form is repeated six times]
Observations ________
Instructions
Only use provided pencil to fill in the bubbles of the survey. Only write in capital letters. Do not mark accents nor cross or erase, write with clear letters and numbers.
[Examples omitted.]
Name of interviewer: ____
Name of supervisor: ____