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Government of the Nation
National Statistics Institute

Republic of Honduras
Census, Secretary of the Office of the President


National Statistics Institute
7th Population census and 6th Dwelling Census

Requested information is confidential.
Additional ballot Fill out the geographic location, skip section D, and continue in section F

Legislative Directive 86-2000, 8/7/2000.
Ballot for another home Fill out the geographic location, skip section D, and continue in section F.

Section A. Geographic location

1. Department _ _
2. Municipality _ _
3. Area _
4. Zone _ _
5. Sector _ _
6. Segment _ _ _
7. Village _ _
8. City or town _ _ _
9. Neighborhood/borough _ _ _
10. Block _ _ _
11. Street address _ _ _
12. House number _ _
Exact address (street, avenue, road, path, etc.)
________

Section B. Dwelling information

1. Type of dwelling

Private
[] 01 Independent house
[] 02 Apartment
[] 03 Inn or Hotel
[] 04 Location not made for living
[] 05 Ranch
[] 06 Improvised home
[] 07 Another type of private home
Collective
[] 08 Hotel, boarding house, guesthouse
[] 09 Hospital, institution, or clinic
[] 10 Orphanage or asylum center
[] 11 Barracks, battalion or police post
[] 12 Prison or reformatory
[] 13 Another type of collective housing
[If selected 08-13], skip to section F.

2. What is the predominant material in the exterior walls of the dwelling?

[] 1 Brick
[] 2 Cracked or quarry stone
[] 3 Cement or concrete block
[] 4 Adobe
[] 5 Wood
[] 6 Bahareque
[] 7 Stick or cane
[] 8 Waste material
[] 9 Other

3. What is the predominant material in the interior walls of the dwelling?

[] 1 Clay tiles
[] 2 Asbestos sheets
[] 3 Zinc sheets
[] 4 Concrete
[] 5 Wood
[] 6 Palm leaves, straw, similar
[] 7 Waste material
[] 8 Aluzinc sheet
[] Other

4. Occupancy status of the dwelling

Occupied
[] 1 With people present
[] 2 With people absent -- After three visits, finalize the form here.
Unoccupied
[] 3 For rent or sale
[] 4 For temporary use
[] 5 In repair
[] 6 Under construction
[] 7 Other
[If selected 3-7], finalize the ballot, go to another dwelling.

Only for occupied private dwellings with people present
[Questions 5-12 are asked of occupied private homes with people present]

5. What is the predominant material in the floor of the dwelling?

[] 1 Earth
[] 2 Cement slab
[] 3 Wood
[] 4 Cement brick
[] 5 Terrazzo or granite bricks
[] 6 Mud bricks
[] 7 Tile
[] 8 Other

Basic services of the dwelling

6. How does the dwelling obtain water?

[] 1 Pipes within the dwelling
[] 2 Pipes outside the dwelling but within another building, lot, or property
[] 3 Pipes outside the building, lot, or property
[] 4 Receives water by other means

7. Where does the water that is used in the dwelling come from?

[] 1 Public system
[] 2 Private system
[] 3 Winch well
[] 4 Well with a pump
[] 5 Creek, river, or stream
[] 6 Lake or lagoon
[] 7 Street salesman
[] 8 Other

8. What is the main type of lighting used?

[] 1 Public electricity
[] 2 Private electricity
[] 3 Electric generator
[] 4 Oil or gas lamp (kerosine)
[] 5 Candle
[] 6 Ocote [firewood]
[] 7 Solar panel
[] 8 Other

9. Waste elimination: How is trash eliminated, mainly?

[] 1 Public home collection
[] 2 Private home collection
[] 3 Deposited in containers
[] 4 Buried
[] 5 Prepared as fertilizer
[] 6 Burned
[] 7 Thrown in the street, river, ravine, lake, sea
[] 8 Paid to have others take it
[] 9 Other

10. Not counting bathrooms or hallways, how many rooms does the dwelling have?

Total rooms _ _

11. Is there a person or group of people in the dwelling that buys or consumes separate foods?

[] 1 Yes
[] 2 No (If no, move on to section C)

12. Including their own, how many groups or households are there in total?

Total households _ _

Starting with a second house, use another form and check the box "form for other household"

Summary
Remember to fill in this summary once the interview is concluded.

_ _ _ Total persons
_ _ _ Men
_ _ _ Women

[p.2]

Section C. Data about the household

Rooms of the household

1.How many rooms does the household use for sleeping? _ _

2. Does the home have a room for cooking?

[] 1 Yes
[] 2 No (If no, move to question 4)

3. Is the room used for cooking only used by this household?

[] 1 Yes
[] 2 No

Energy for cooking

4. What is the main source of energy for cooking?

[] 1 Firewood
[] 2 Kerosene gas
[] 3 Propane gas (chimbo)
[] 4 Electricity
[] 5 Other
[] 6 No cooking

Sanitation services

5. What kind of sanitation is used?

[] 1 Toilet connected to a sewer
[] 2 Toilet connected to a septic tank
[] 3 Toilet that empties into a river, ravine, lagoon, sea, or lake
[] 4 Latrine with simple pit
[] 5 Latrine with hydraulic closure
[] 6 Other
[] 7 Doesn't have sanitation [Go to question 7]

6. Is the sanitation service used only by members of the household?

[] 1 Yes
[] 2 No

Comfort and equipment

7. Does the household have its own car?

[] 1 One car
[] 2 More than one car
[] 3 No car

8. Does the home have any of the following apparatus, equipment, or services?

1. Refrigerator
[] Yes
[] No

2. Electric washer
[] Yes
[] No

3. Radio, radio recorder, sound equipment
[] Yes
[] No

4. Entertainment consoles: Play station, Wii, Nintendo
[] Yes
[] No

5. Sewing machine
[] Yes
[] No

6. Television
[] Yes
[] No

7. Air conditioning
[] Yes
[] No

8. Computer
[] Yes
[] No

9. Landline
[] Yes
[] No

10. 4-burner stove
[] Yes
[] No

11. Microwave
[] Yes
[] No

12. Cable television
[] Yes
[] No

13. Internet service
[] Yes
[] No

9. Tenancy: The dwelling that this household occupies is:

[] 1 Owned
[] 2 Owned, paying mortgage
[] 3 Rented
[] 4 Loaned without payment
[] 5 Loaned for work

Section D. Household composition

1. Including infants, children, elderly, domestic workers who sleep within the grounds, how many people in total live in this home?

_ _Total
_ _ Men
_ _ Women

2. What is the first and last name of each person who lives in the home?

Begin with the head of household and continue in order:
1. Head of household
2. Partner
3. Child or stepchild
4. Son/daughter-in-law
5. Grandchild
6. Mother or father
7. Mother or father-in-law
8. Brother or sister
9. Brother or sister-in-law
10. Niece or nephew
11. Other relative
12. Domestic employee
13. Other, non-relative
____ Order number
____ First and last name
____ Relationship to head of household
____ Age in years

If there are more than 9 people, use the other ballot and check the box additional ballot.

Note: Be sure to include in the list any newborns, children, elderly, domestic employees, and other people that live in the home and who might be temporarily absent. If there are more than 9 people, use another ballot, and check the box that says additional ballot.

Section E. International migration and mortality

1. In the past 10 years (beginning in 2003), does any person belonging to this household currently live in another country?

[] 1 Yes -- How many people? _ _
[For each person, fill out the following information]

Order number ____
Gender
[] 1 Male
[] 2 Female
____ Year they left
____ Age when they left
____ Current country of residence
[] 2 No

[p.3]

2. Including children and the elderly. From January 1 - December 31 2012, Has anyone belonging to the household died?

[] 1 Yes -- How many people? _ _
[For each person, fill out the following information]

____ Order number
____ First and last name of the deceased
The person was:
[] 1 Male
[] 2 Female
Was the death registered with the National Registry?
[] 1 Yes
[] 2 No
If the person was a woman between the ages of 12-49 was the death?
[] 1 During pregnancy
[] 2 During birth
[] 3 During the two months of postpartum
[] 4 Due to other cause
[] 2 No (Go to Section F)

Section F. Person characteristics

Person order number _ _
First and last name: ________

For all people
[Questions 1-8 are asked of all persons]

1.What relation does [the respondent] have with the head of the household?

[] 01 Head of the household
[] 02 Spouse or partner
[] 03 Child or stepchild
[] 04 Son/daughter-in-law
[] 05 Grandchild
[] 06 Mother or father
[] 07 Mother or father-in-law
[] 08 Brother or sister
[] 09 Brother or sister-in-law
[] 10 Niece or nephew
[] 11 Other relative
[] 12 Domestic employee and their relatives
[] 13 Other, non-relative
[] 14. Residents of a collective dwelling

2. Gender

[] 1 Male
[] 2 Female

3. How old is [the respondent]? _ _ _

Less than one year, mark 000

4. Is [the respondent] registered in the National Registry?

[] 1 Yes
[] 2 No

5. How does [the respondent] self-identify?

[] 1 Indigenous
[] 2 Afro-Honduran
[] 3 Black
[] 4 Mixed
[] 5 White
[] 6 Other. Specify ____

For 4, 5, 6, go to question 7.

6. To which community does [the respondent] belong?

[] 1 Maya-Chortí
[] 2 Lenca
[] 3 Miskito
[] 4 Nahua
[] 5 Pech
[] 6 Tolupán
[] 7 Tawahka
[] 8 Garifuna
[] 9 Black, English speaking
[] 10 Other. Specify ____

7. Does [the respondent] have a permanent disability regarding:

1. Moving or walking
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

2. Use of arms or hands
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

3. Sight, even with glasses
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

4. Hearing, even with hearing aid
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

5. Speaking
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

6. Developmental disability
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

7. Self-care (bathing, clothing, feeding themselves)
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

8. Other disability
[] 1 Yes

Cause of disability
[] 1 Birth
[] 2 Disease
[] 3 Accident
[] 4 Age
[] 2 No

8. Where was [the respondent] born?

[] 1 In this municipality? (Go to question 9)
[] 2 In a different municipality of the country?
Municipality ____
INE use _ _ _

Department ____
INE use _ _ _
[] 3 In another country?
Country ____
INE use _ _ _
Year arrived in Honduras _ _ _ _
If the person is under 3 years of age, proceed to the next person.

For people 3 years old and older
[Questions 9-13 are asked of persons aged 3 or more years old]

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

[] 1 Yes
[] 2 No

10. Is [the respondent] currently studying in a preschool, elementary school, high school, or university?

[] 1 Yes
[] 2 No

11. What was the last grade, course, or year that [the respondent] finished in this

[] 1 None
Year: 0
[] 2 Literacy
Year: 0
[] 3 Pre-basic school
Year:
[] 0
[] 1
[] 2
[] 3
[] 4 Basic school
Year:
[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9
[] 5 Secondary school, common cycle
Year:
[] 1
[] 2
[] 3
Go to question 14. For minors less than 5 years old, complete the interview.
[] 6 Secondary school, diversified
Year:
[] 1
[] 2
[] 3
[] 4
[] 7 Higher tech school
Year:
[] 1
[] 2
[] 3
[] 8 Higher non-university school
Year:
[] 1
[] 2
[] 3
[] 4
[] 9 University
Year:
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 10 Postgraduate school
Year:
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6

12. Did [the respondent] finish their major field?

[] 1 Yes
[] 2 No

13. What was the name of the career or major in the last year that was completed? ____

INE use _ _ _ _ _

[p.5]

For people 5 years old and older
[Questions 14-21 are asked of persons aged 5 or more years old]

14. Where did [the respondent] live 5 years ago?

[] 1 In this hamlet, town, or city (Go to question 15)
[] 2 In another part of the country
Hamlet, town, or city ____
INE use _ _ _

Municipality ____
INE use _ _

Department ____
INE use _ _
[] 3 In another country?
Country ____
INE use _ _ _

15. Did [the respondent] work at least one hour during the past week?

(Exclude household chores)

[] 1 Yes (Go to question 17)
[] 2 No

16. During last week [the respondent]:

A.
[] 1 Did you tend agricultural crops, forestry, or raise animals owned by you or by a family member?
[] 2 Did you attend or help in any of your own or family businesses or workshops?
[] 3 Did you prepare food or make items for sale?
[] 4 Did you have a job, but didn't work because you were on vacation, sick leave, etc.?
[] 5 Did you look for a job and have you worked before?
B.
[] 6 Did you look for a job and have never worked?
[] 7 Did you live off your retirement or pension?
[] 8 Did you live off your income?
[] 9 Did you justify?
[] 10 Did you only do household chores?
[] 11 Are you permanently unable to work?
[] 12 Other ____

If selected any option from B, go to question 22.

17. What is the name of the main occupation, trade or position [the respondent] holds or held in this work?

Example: Corn farmer, furniture carpenter, bus driver, etc.

[Main occupation, trade, or position] ____
INE use _ _ _ _

18. In that job, does or did [the respondent] work as:

[] 1 Private employee or worker
[] 2 Public employee or worker
[] 3 Employer with employees
[] 4 Independent worker
[] 5 Unpaid family worker
[] 6 Domestic employee
[] 7 Unpaid worker
[] 8 Other. Specify ____

19. How many hours did [the respondent] work the past week or during the last week the person worked?

Number of hours _ _ _

20. What activity do they do or what does the company, institution or place where [the respondent] work or worked the last time do?

Example: Corn cultivation, furniture manufacturing, passenger transportation, etc.

[Activity] ________
INE use _ _ _ _

21. In which municipality is the company, institutions or place where [the respondent] work or worked the last time located?

[] 1 In this municipality (Go to question 22)
[] 2 In another municipality in the country
Municipality ____
INE use _ _

Department ____
INE use _ _

For persons 12 years old or more
[Questions 22-24 are asked of persons aged 12 or more years old]

22. What is [the respondent] current marital status?

[] 1 Common-law marriage
[] 2 Married
[] 3 Separated
[] 4 Divorced
[] 5 Widowed
[] 6 Single

23. Does [the respondent] have an email account?

[] 1 Yes
[] 2 No

24. Has [the respondent] got a cellphone?

[] 1 Yes
[] 2 No

[If you are a man and you are 18 years of age or older, go to question 30.]

For women 12 years old or more
[Questions 25-29 are asked of women aged 12 or more years old]

25. Has [the respondent] had any son or daughter born alive?

[] 1 Yes
[] 2 No (Go to question 30)

26. How many sons and daughters born alive have [the respondent] had in total?

Total _ _

27. How many sons and daughters are currently alive?

Total _ _

28. On what date was your last son or daughter born alive?

Day _ _
Month _ _
Year _ _ _ _

29. Is your last son or daughter born alive currently living?

[] 1 Yes
[] 2 No

For persons 18 years old or more
[Question 30 is asked of persons aged 18 or more years old]

30. Has [the respondent] got an identity card?

[] 1 Yes
[] 2 No