Data Cart

Your data extract

0 variables
0 samples
View Cart



Central Bureau of Statistics
Intercensal Population Survey 1976

Phase I
[] K Urban
[] P Rural

I. Information on location
1. Province ____
2. District ____

Domain _ _ _

3. Sub-district ____ _
4. Village ____ _
5. Cluster no. ____
6. Census block no. ____
7. Building no. ____
8. Household no. ____ _ _ _
9. Address or location ____

II. Information on interviewer/supervisor

1. Name of interviewer ____
2. Date of interview ____
3. Name of supervisor ____
4. Date checked by supervisor ____

Household questionnaire

Ask of the head of household or other eligible respondent

A1. Name

What are the names of the members of this household?

Write in the names of household members. After writing all the names given, read the names that you have written again and ask:

Are there any other household members who have not yet been mentioned, such as:
1. Young children or new-born babies?
2. Household members who are temporarily away from home?
3. Other household members such as other relatives or servants who live with you?

If yes, enter their names.
____

A2. Sex

Are you:

[] L Male
[] P Female

A3. Date of birth

In what month and year were you born?

Fill in month and year of birth in the Western or Islamic calendars or other ____.

Month:
Western_ _
Islam/Java ____
Other____

Year:
Western_ _
Islam/Java ____
Other____

A4. Age

How old are you?

Write age in years: _ _

A5. Marital status

Are you currently:

[] 1 Single
[] 2 Married
[] 3 Widowed
[] 4 Divorced
[] 5 Separated

A6. Relationship to head of household

What is the name of the head of this household? What is the relationship of each person with the head of this household?

Write in the relationship with the head of household: ____

Fill in the code showing the relationship to the head of household.

[] 1 Head
[] 2 Wife of head
[] 3 Own child of head
[] 4 Non-own child of head
[] 5 Grand child
[] 6 Parent of head
[] 7 Parent of wife of head
[] 8 Son/daughter-in-law
[] 9 Other family
[] 0 Non-family such as servants, etc.

A7. Status of mother

Does your mother live in this household, outside of this household, or is she already dead?

[] 1 Lives in this household
[] 2 Lives outside this household
[] 3 Already dead
[] 4 Don't know

If the mother lives in this household (code 1), write in mother's line [person] number: _ _

Phase II

[] K Urban
[] P Rural

I. Information on location

1. Province ____
2. District ____

Domain _ _ _

3. Sub-district ____ _
4. Village ____ _
5. Cluster no. ____
6. Census block no. ____
7. Building no. ____
8. Household no. ____ _ _ _
9. Address or location ____
10. Total no. of household members _ _

A. Demographic information

Ask the head of household or other eligible respondent. Ask questions column by column.

A1. Name

What are the names of the members of this household?

Write in the names of household members. After writing all the names given, read the names that you have written again and ask:

Are there any other household members who have not yet been mentioned, such as:
1. Young children or new-born babies?
2. Household members who are temporarily away from home?
3. Other household members such as other relatives or servants who live with you?

If yes, enter their names.
____

A2. Sex

Are you:

[] L Male
[] P Female

A3. Date of birth

In what month and year were you born?

Fill in month and year of birth in the Western or Islamic calendars or other ____.

Month:

Year:
Western_ _
Islam/Java ____
Other____

A4. Age

How old are you?

Write age in years: _ _

A5. Marital status

Are you currently:

[] 1 Single
[] 2 Married
[] 3 Widowed
[] 4 Divorced
[] 5 Separated

A6. Relationship to head of household

What is the name of the head of this household? What is the relationship of each person with the head of this household?

Write in the relationship with the head of household: ____

Fill in the code showing the relationship to the head of household.

[] 1 Head
[] 2 Wife of head
[] 3 Own child of head
[] 4 Non-own child of head
[] 5 Grand child
[] 6 Parent of head
[] 7 Parent of wife of head
[] 8 Son/daughter-in-law
[] 9 Other family
[] 0 Non-family such as servants, etc.

A7. Religion

What religion do you follow?

[] 1 Islam
[] 2 Catholicism
[] 3 Protestant
[] 4 Other Christian
[] 5 Hindu
[] 6 Buddhism
[] 7 Confucianism
[] 8 Other

A8-9. Education

A8. Are you still in school?

[] Y Yes
[] T No

A9a. What level of school are you currently attending?

If A8 = code Y
[Question A9a was asked of persons still in school, per question A8.]

____

A9b. What level of school did you last attend?

If A9 = code T
[Question A9b was asked of persons not in school, per question A8.]

[] 1 Never attended school
[] 2 Elementary school
[] 3 Junior high - general
[] 4 Junior high - vocational
[] 5 Senior high - general
[] 6 Senior high - vocational
[] 7 Academy
[] 8 University

If ever/currently attending school, write in number of highest class ever/currently attended. If completed, write in code 8.
[Question asked of persons ever/currently attending school]
[Highest class]: _

A10. Literacy

Can you read and write in Latin characters?

For persons with no school or only elementary school, A9 = code 1 or 2.

If "No": Can you read and write in any other characters?

[] 1 Latin
[] 2 Other
[] 3 Unable to read and write

A11-13 Status of mother

A11. Does your mother live in this household, outside of this household, or is she already dead?

[] 1 Lives in this household
[] 2 Lives outside this household
[] 3 Already dead
[] 4 Don't know

A12. If the mother lives in this household (code 1), write in mother's line [person] number.

_ _

A13a. Are you your mother's eldest child?

[] Y Yes
[] T No

A13b. Do you have any older brothers or sisters who are still living?

If not the eldest child (A13a = code T)
[Question A13b was asked of persons who are not the eldest of siblings, per question A13a.]

[] Y Yes
[] T No

A14-15. Status of father

A14. Does your father live in this household, outside of this household, or is he already dead?

[] 1 Lives in this household
[] 2 Lives outside this household
[] 3 Already dead
[] 4 Don't know

A15. If the father lives in this household (code 1), write in father's line [person] number.

_ _

A16. Place of birth

In which district (kabupaten/kotamadya) were you born?

____

Kabupaten or kotamadya? Cross incorrect answer.
Kab. / Kod.


Coded by central office: _ _ _

A17. Recent migration

Were you living in this district five years ago?

[] Y Yes
[] T No

If code Y, end section A for this person.

[Questions A17a and A17b were asked of persons not living in the same district five years ago]

A17a. In which village, sub-district, and district were you living in five years ago?

If "No" (A17 = code T).

Write in the name of the village: ____

Was this village part of a city, a town, or a rural area?
[] B City
[] K Town
[] P Rural area
Write in the name of the sub-district: ____

Write in the name of the district: ____

Kabupaten or koyamadya? Cross incorrect answer.
Kab. / Kod.
Coded by central office: _ _ _

A17b. What was the reason for your move?

[] 1 Looking for work
[] 2 Transferred
[] 3 Other work-related reason
[] 4 School
[] 5 Marriage
[] 6 Following family
[] 7 Going home
[] 8 Other

B. Economic condition of the household

Ask the head of household or other eligible respondent. Circle the code of the correct answer.

B1. What is the means of livelihood for this household?

[] 1 Agriculture only
[] 2 Non-agriculture only
[] 3 Mixture, with agriculture the primary means
[] 4 Mixture, with non-agriculture the primary means

If the above is agriculture or mixture (B1 = code 1, 3, or 4) ask B2. If the above is non-agriculture (B1 = code 2) go to B3.

[Question B2 was asked of households that indicated some involvement in agriculture, per question B1.]

B2a. How much land do you farm?

_ _ . _ _ ha [hectares] (two digits after the decimal)

B2b. Do you have any of the following animals in this household?

a) Milk cows
[] Y Yes
[] T No

If yes, how many? _ _

b) Beef cattle
[] Y Yes
[] T No

If yes, how many? _ _

c) Buffalo
[] Y Yes
[] T No

If yes, how many? _ _

d) Horses
[] Y Yes
[] T No

If yes, how many? _ _

e) Goats/sheep
[] Y Yes
[] T No

If yes, how many? _ _

f) Pigs
[] Y Yes
[] T No

If yes, how many? _ _

g) Chicken/poultry
[] Y Yes
[] T No

If yes, how many? _ _

B2c. Do you use any of the following farming/fishing implements in your work?

1. Plow (animal driven)
[] 1 Yes
[] 2 No

2. Hoe/rake
[] 1 Yes
[] 2 No

3. Sprayer
[] 1 Yes
[] 2 No

4. Hand tractor
[] 1 Yes
[] 2 No

5. Water pump
[] 1 Yes
[] 2 No

6. Motor boat
[] 1 Yes
[] 2 No

7. Sail or other boat
[] 1 Yes
[] 2 No

8. Drag net
[] 1 Yes
[] 2 No

9. Tunnel net
[] 1 Yes
[] 2 No

B3. What is the average monthly expenditure of this household?

Rp. _ _ _ (in thousands)

B4. What is the main building material of the wall?

[] 1 Brick
[] 2 Wood
[] 3 Bamboo
[] 4 Other: ____

B5. What is the main building material of the floor?

[] 1 Tile
[] 2 Cement
[] 3 Wood
[] 4 Bamboo
[] 5 Earth
[] 6 Other: ____

B6. What is the main source of lighting for this household?

[] 1 Electricity
[] 2 Pump lamp
[] 3 Oil lamp
[] 4 Other: ____

B7. In what type of structure is this household located?

[] 1 Single family
[] 2 Combined residence and business
[] 3 Room(s) in single living quarters
[] 4 Separate apartment
[] 5 Shared living quarters
[] 6 Row housing
[] 7 Other: ____

B8a. What is the source of bathing/washing water for this household?

[] 1 Piped water
[] 2 Electric pump
[] 3 Hand pump
[] 4 Private well
[] 5 Public well
[] 6 Spring
[] 7 River water
[] 8 Rain water
[] 9 Other: ____

B8b. Is this source located inside or outside the yard?

[] D Inside the yard
[] L Outside the yard

B9a. What is the source of drinking water for this household?

[] 1 Piped water
[] 2 Electric pump
[] 3 Hand pump
[] 4 Private well
[] 5 Public well
[] 6 Spring
[] 7 River water
[] 8 Rain water
[] 9 Other: ____

B9b. Is this source located inside or outside the yard?

[] D Inside the yard
[] L Outside the yard

B10. Does this household possess any of the following goods?

1. Lounge set
[] Y Yes
[] T No

2. Buffet
[] Y Yes
[] T No

3. Iron
[] Y Yes
[] T No

4. Stove
[] Y Yes
[] T No

5. Bicycle
[] Y Yes
[] T No

6. Sewing machine
[] Y Yes
[] T No

7. Radio/cassette
[] Y Yes
[] T No

8. Clock/wristwatch
[] Y Yes
[] T No

9. Television
[] Y Yes
[] T No

10. Refrigerator
[] Y Yes
[] T No

11. Stereo set
[] Y Yes
[] T No

12. Motorcycle
[] Y Yes
[] T No

13. Automobile
[] Y Yes
[] T No

C. Health

Ask the head of household or other eligible respondent. Circle the code of the correct answer.

C1. Seeing difficulties

Is there anyone in this household who has difficulty seeing so that he/she needs assistance in walking around outside during the daytime?

[] 1 Yes
[] 2 No

C2. Mortality

Did any deaths occur in this household during the past two years, that is, from about January 1974 to the present time?

Be sure to include deaths to new babies, or to persons who usually lived in this household but who died while away from home.

[] Y Yes
[] T No

If "No", go to section D. If "Yes", ask the following questions about each person who died:

[Questions C3-C7 were asked of households with at least one death during the past two years, per question C2.]

C3. Name

Can you tell me the name of the person who died?

Write in name of decedent: ____

C4. Sex

Was this person male or female?

[] L Male
[] P Female

C5. Relationship

What was the relationship of this person to the current head of household?

Write in complete relationship: ____ _

C6. Age

How old was this person when he/she died?

Fill in age in years: _ _

C7. Month and year of death

In what month and year did this person die?

Month:
Western _ _
Islam/Java____
Other ____

Year:
Western _ _
Islam/Java____
Other ____

D. Information on economic activity

Ask of household members age 10 or older. Ask questions person by person.

D1-D2. Economic activity during the past week

D1. What was your primary activity during the past week?

[] 1 Working
[] 2 Temporarily away from work but with a job
[] 3 Looking for work
[] 4 Housekeeping
[] 5 Attending school
[] 6 Unable to work
[] 7 Other

If code 1, go to D3.

D2. Did you do any work for one hour or more during the past week?

[Question D2 was asked of persons age 10 or older primarily not working during the past week, per question D1.]

[] Y Yes
[] T No

If D2 = code "T" go to D10. If D1 = code 3, go to D11.

D3-D7. Primary occupation during the past week
[Questions D3-D8 were asked of persons age 10 or older who worked at least one hour during the past week, as per questions D1 and D2.]

D3. Occupation

In what occupation was your primary job during the past week?

Write in complete occupation: ____

Coded by central office: _ _ _

D4. Industry

In what industry was that work?

Write in complete industry: ____

Coded by central office: _ _

D5. Status

In this work were you a:

[] 1 Own account worker
[] 2 Employer
[] 3 Employee
[] 4 Unpaid family worker

D6. Locus of activity

Was this work a:

[] 1 Household enterprise
[] 2 Non-household enterprise

D7. Hours worked

How many hours did you work last week at this job?

_ _

D8-D9. Secondary jobs

D8. Besides your primary job, did you do any other work during the past week?

[] Y Yes
[] T No

If code "T" go to D10, except if D1 = code 3 go to D11.

D9. If you had additional work last week, how many different kinds of additional work did you do?

[Question D9 was asked of persons 10+ who worked at least two jobs during the past week, per question D8.]

Write in total number of jobs: _

If D1 = code 3 go to D11.

D10-12. Looking for work

D10. Are you also looking for work?

[Question D10 was asked of persons 10+ whose primary activity (Question D1) during the past week was not "Looking for work" (code 3)]

[] Y Yes
[] T No

If D10 = code "T", go to D13. If D1 = code 1 or 2, go to D14.

[Questions D11-D12 was asked of persons age 10 or older who were looking for work during the past week.]

D11. For how many months have you been looking for work?

Write in number of months: _ _

D12. What steps have you taken in looking for work?

Circle all codes that apply and then go to D14.

[] 1 Asked family or friends
[] 2 Looked in the newspaper
[] 3 Applied to a factory or office
[] 4 Registered with an employment exchange
[] 5 Other

D13. If there was work available, would you want to take it?

[Question D13 was asked of persons age 10 or older who were not working, temporarily away from work, nor looking for work during the past week.]

[] Y Yes
[] T No

D14-20. Usual activity during the past year

D14. What was your usual activity during the past year?

[] 1 Working
[] 2 Looking for work
[] 3 Housekeeping
[] 4 Attending school
[] 5 Unable to work
[] 6 Other

If code "1", go to D16.

D15. Did you do any work for more than two months?

[Question D15 was asked of persons age 10 or older whose usual activity was not "Working" during the past year, per question 14.]

[] Y Yes
[] T No

If D15 = code "T", end Section D for this person.

[Questions D16-D19 were asked of persons age 10 or older who worked for at least two months during the past year.]

D16. Occupation

In what occupation as your usual job during the past year?

Write in complete occupation. If same as last week, write "Same".
____

Coded by central office: _ _ _

D17. Industry

In what industry was that work?

Write in complete industry. If same as last week, write "Same".
____

Coded by central office: _ _ _

D18. Status

In this work were you a:

[] 1 Own account worker
[] 2 Employer
[] 3 Employee
[] 4 Unpaid family worker

D19. Locus of activity

Was this work a:

[] 1 Household enterprise
[] 2 Non-household enterprise

If D18 = code 1, 2, or 4, end section D for this person.

D20. Monthly income

What was your average monthly income during the past year, including wages and salaries and other income both in money and in kind?

[Question D20 was asked of persons 10 or older who worked at least two months in the past year as an employee]

Write in amount in thousands of rupiah: Rp. _ _ _

E. Marriage and fertility
Ask of all ever-married women. Ask questions person by person.
[Questions E1-E11]

E1-E2. Number of marriages.

E1. Is this (was your previous) marriage also your first marriage?

[] Y Yes
[] T No

If E1 = code "Y", go to E3a.

E2. How many times have you been married?

If not the first marriage (E1 = code "T").
[Question E2 was asked of women who have been married more than once, per question E1.]

Write in number of times married, then skip to question E3b: _

E3. Date of first marriage

E3a. In what month and year were you and your husband married?

If married only once (E1 = code "Y").

Month:
Western_ _
Islam/Java/____
Other ____

Year:
Western_ _
Islam/Java/____
Other ____

E3b. In what month and year were you and your first husband married?

If married more than once (E1 = code "T").

Fill in month and year of marriage in the Western or Islamic/Javanese calendars or other ____.

Month:
Western_ _
Islam/Java/____
Other ____

Year:
Western_ _
Islam/Java/____
Other ____

E4. Age at first marriage

How old were you at the time of this marriage?

Write age in years: _ _

E5-E8. Children ever born

E5. Total children

Now, we want to ask about the children you have given birth to. What is the total number of children you had who were born alive?

Write in total (if none, write in "0"). Then, if has never had a live birth, go to E12.
_ _

[Questions E6-E11 were asked of women who have ever married and who have ever had a live birth, as per question E1.]

E6. Children living at home.

What is the total number of children you had who were born alive and are living here with you now?

Write in total (if none, write in "0").
_ _

E7. Children living away from home.

What is the total number of children you had who were born alive and are living away from home?

Write in total (if none, write in "0").
_ _

E8. Children who have died.

What is the total number of children you had who were born alive and have since died, including any babies who lived even for only a few minutes?

Write in total (if none, write in "0").
_ _

Check that E6+E7+E8 = E5. If not, correct where necessary.

E9. Date of last live birth

In what month and year was your last child born?

Fill in month and year of marriage in the Western or Islamic/Javanese calendars or other ____.

Month:
Western_ _
Islam/Java/____
Other ____

Year:
Western_ _
Islam/Java/____
Other ____

E10. Sex of baby

Was your last baby male or female?

[] L Male
[] P Female

E11. Status of baby

Is this baby still living or has he/she already died?

[] 1 Still alive
[] 2 Already dead

For currently married women (A5=code 2 or 5) who are 50 years of age or under.
[Questions E12-E19.]

E12. Additional child

Do you still want an additional child?

[] Y Yes
[] T No

E13. Ever heard of family planning

Now we want to find out about something else. Perhaps you have heard that there are ways a woman can keep from becoming pregnant?

[] Y Yes
[] T No

If "No", stop section E for this person.

E14-E15. Knowledge of method of family planning

E14. Do you know of any specific methods that a woman can use to prevent pregnancy?

[Question E14 was asked of women age 50 or younger who are currently married and have heard of family planning, as per question E13.]

[] Y Yes
[] T No

If "No", stop section E for this person.

[Questions E15-E16 was asked of women age 50 or younger who are currently married and know of specific family planning methods, per question E14.]

E15. What methods do you know? (probe) Any others?

If yes (code Y) in E14.

Circle code numbers of all methods known. To interviewer: Do not read methods aloud to the respondent.

[] 1 Pill
[] 2 I. U. D.
[] 3 Condom
[] 4 Withdrawal
[] 5 Sterilization (female)
[] 6 Rhythm
[] 7 Abstinence
[] 8 Sterilization (male)
[] 9 Other (jamu, massage, douche, etc.)

E16-E17. Ever use methods of family planning

E16. Have you ever used any of these methods of family planning?

If knows of methods (E14 = code "Y").

[] Y Yes
[] T No

If "No", stop section E for this person.

[Questions E17-E18 were asked of women age 50 or younger who are currently married and have used family planning methods, as per question E16.]

E17. What methods have you used?

If yes (code Y) in E16).

Circle code numbers of all methods ever used.

[] 1 Pill
[] 2 I. U. D.
[] 3 Condom
[] 4 Withdrawal
[] 5 Sterilization (female)
[] 6 Rhythm
[] 7 Abstinence
[] 8 Sterilization (male)
[] 9 Other (jamu, massage, douche, etc.)

E18-E19. Current use of methods of family planning

E18. Are you currently using a method of preventing pregnancy?

If ever used (E16 = code "Y").

[] Y Yes
[] T No

If "No" stop section E for this person.

E19. What methods are you currently using?

If yes (code Y) in E18.
[Question E19 was asked of women age 50 or younger who are currently married and currently use family planning methods.]

Circle code number of methods being currently used.

[] 1 Pill
[] 2 I. U. D.
[] 3 Condom
[] 4 Withdrawal
[] 5 Sterilization (female)
[] 6 Rhythm
[] 7 Abstinence
[] 8 Sterilization (male)
[] 9 Other (jamu, massage, douche, etc.)

Information on respondents

If the person answering sections D or E is not the person concerned, enter the name and relationship to the head of household of that person below.

Name: ____
Relationship to head of household: ____

If the person answering sections A, B, or C is not the head of household, enter the name and relationship to the head of household of that person below.

Name: ____
Relationship to head of household: ____