Republic of Indonesia
Central Bureau of Statistics
1985 Inter Census Population Survey
Household member characteristics
Confidential
I. Identification
Q.1. Province ____
Q.2. Regency/municipality _____
Q.3. District ____
Q.4. Village ____
Q.5. Area ____
2 Rural
Q.6. Enumeration area number ____
Q.7. Census block number ____
Q.8. Sample code number ____
Q.9. Sample serial number (RBS) ____
Q.10. Selected household serial number (RBS) ____
II. Recapitulation
Q.1. Number of household members ____
Q.2. Number of household members age 5 or older ____
Q.3. Number of household members age 10 or older ____
Q.4. Number of births (Code 1 at Q.9 and Q.20 Block X) _____
Q.5. Number of infant mortalities (Code 2 at Q.11 and Q.22 Block X) ____
Q.6. Total number of mortalities (from block XII B) _____
III. Enumerator's characteristics
Q.1. Enumerator name ____
Q.2. Date of enumeration ____
Q.3. Signature of enumerator ____
Q.4. Name of supervisor ____
Q.5. Date of supervision ____
Q.6. Signature of supervisor ____
Q.7. Name of informant ____
Q.1 No.____
Q.2 Name of household member_____
Q.3 Relation to the head of household
Q.4 Sex
2 Female
Q.5 Age (years) _____
Q.6 Marital status
2 Married
3 Divorced
4 Widowed
Q.7 Check mark
[Province codes for questions 7 and 10 in block VII.A. and question 1 in code VII.B.1 are not presented here]
V. Household characteristics
Questioning to household head
Q.1. Is the income of this household from:
2 Agriculture sector
3 Mixture, agriculture as the main source
4 Mixture, non-agriculture as the main source
Q.2. Does this household own farmland?
2 No
Q.3. How much farm land area [does the household] have?
Q.4. How much are [the household's] average expenses in a month?
VI. Building construction
Q.1. Type of physical structure
2. Single story
2. Duplex
2. Single story
3. Multiplex
2. Single story
Q.2. Number of census buildings in this building
Q.3. Number of households in this census building
Q.4. House ownership status
2 Lease (skip to Q.6)
3 Rent (skip to Q.6)
4 Rent-purchase (skip to Q.6)
5 Official (skip to Q.6)
6 Other (skip to Q.6)
Q.5 Land ownership status
2 Right to build
3 Right to use
4 Other
Q.6 Main material of roof
2 Wood
3 Asbestos/corrugated zinc
4 Tile
5 Palm fiber
6 Leaves
7 Other
Q.7 Main material of wall
2 Wood
3 Bamboo
4 Other
Q.8 Main material of floor
2 Cement/concrete
3 Wood
4 Bamboo
5 Earth
6 Other
Q.9 Floor area size
Q.10 Lot size
Q.11 Lighting used
2 Pump lamp
3 Kerosene
4 Other
Q.12 Fuel used for cooking
2 Gas
3 Kerosene
4 Wood
5 Charcoal
6 Other
Q.13 Source of drinking water
2 Pump
3 Well
4 Spring
5 River
6 Rain
7 Other
Q.14 If used pump or well, distance to closest sewage disposal
____ [meters]
Q.15 Source of water for bathing/washing
2 Pump
3 Well
4 Spring
5 River
6 Rain
7 Other
Q.16 Bathing facilities
2 Shared bathroom
3 Public bathroom
4 Other
Q.17 Place of toilet
2 Private toilet without septic tank
3 Shared/public/other toilets
Q.18 Does this household possess:
2 Stove
4 Bicycle
8 Radio/cassette player
16 Television
00 Not possessed
VII. General characteristics of household members
VII. A. All ages
[Questions 1-13 were asked of persons of all ages]
Serial number of household member ____
Q.1 Relation to the head of household
2 Husband/wife
3 Children
4 Son/daughter in law
5 Grandchild
6 Parent/parent in-law
7 Other relative
8 Housemaid
9 Other
Q.4 Marriage status
2 Married
3 Divorced
4 Widowed
Q.5 Religion
2 Protestant/other Christian
3 Catholic
4 Hindu
5 Buddhist
6 Other religion
Q.6 Citizenship
2 People's Republic of China (PRC), Taiwan, and stateless China citizen
3 Other foreign citizen
Q.7 Place of birth
Regency/municipality ____
Q.8 Ever lived in another regency/municipality
2 No
Q.9 Duration of time living in the current regency/municipality
Q.10 Previous residence
Regency/municipality ____
Q.11 Reason moved
2 Employment
3 Education
4 Other
Q.12 Living with biological mother
2 No (go to block VII. B)
Q.13 Serial number of biological mother
VII. B. Persons age 5 or older
[Questions 1-6 were asked of persons age 5 or older]
Q.1 Residence in October 1980
Regency/municipality ____
Q.2 School attendance status
[] 2 Attending school
[] 3 No longer in school
Q.3 Type of highest education ever or being attended
[] 2 Junior high
[] 3 Vocational junior high school
[] 4 High school
[] 5 Vocational high school
[] 6 Diploma I/II
[] 7 Academy/Diploma III
[] 8 University
Q.4 Highest level/class ever or being attended
[] 2 Class 2
[] 3 Class 3
[] 4 Class 4
[] 5 Class 5
[] 6 Class 6
[] 7 Class 7
[] 8 Completed
Q.5 Highest education ever completed
[] 2 Less than primary school
[] 3 Primary school
[] 4 Junior high school
[] 5 Vocational junior high school
[] 6 High school
[] 7 Vocational high school
[] 8 Diploma I/II
[] 9 Academy/diploma III
[] 0 University
Q.6 Can write and read
[] 2 Other alphabet
[] 3 Cannot [read and write]
VII.C. Person age 10 or older
[Questions 1-5 were asked of persons age 10 or older]
Q.1 What kind of activity [was] done during the previous week?
[] 2 School
[] 3 Homemaking
[] 4 Unable to work
[] 5 Other
Q.2 Did [the respondent] work at least 1 hour during the previous week?
[] 2 No
Q.3 Does [the respondent] have a permanent job but is temporarily not working during the previous week?
[] 2 No
Q.4 Has [the respondent] ever worked before?
[] 2 No
Q.5 Did [the respondent] look for work during the previous week?
[] 2 No (go to Q.14, section VIII)
VIII. Work force
(Persons age 10 or older)
[Questions 1-17 were asked of persons age 10 or older]
Q.1 Number of hours worked in the previous week
Day 2 ____ hours
Day 3 ____ hours
Day 4 ____ hours
Day 5 ____ hours
Day 6 ____ hours
Day 7 ____ hours
Total ____ hours
Q.3 Main work status
[] 2 Self-employed assisted by family members/temporary workers
[] 3 Employer with permanent workers
[] 4 Worker/employee
[] 5 Family worker
Q.4 Total number of hours worked in main occupation during the previous week
Q.5 Describe the type of activity/field of work of the working place/company/office of the [respondent's] main occupation
Q.6 Does [the respondent] have any additional work?
[] 2 No (go to Q.10)
Q.7 Number of hours worked in additional work during previous week
Q.8 Describe the type of activity/field of work of the working place/company/office of the additional work
Q.9 Besides the two kinds of work, does [the respondent] still have other work?
[] 2 No
Q.10 Did [the respondent] look for work during the previous week?
[] 2 No (go to Q.14)
Q.11 How long [has the respondent] been looking for work?
Q.12 Kind of work looked for:
[] 2 Part-time
Q.13 What kinds of effort has [the respondent] been putting into looking for work?
[] 2 Applied from advertisements
[] 4 Contacted some companies/offices (go to Q. 16)
[] 8 Registered at Ministry of Manpower
[] 16 Other
Q.14 Reason for not looking for work last week
[] 2 Waiting for outcome of job application
[] 3 Schooling
[] 4 Housekeeping
[] 5 Unable to work
[] 6 Other
Q.15 [Is the respondent] willing to accept any type of work?
[] 2 No
Q.16 Did [the respondent] work during the previous year?
[] 2 No (end of this block)
Q.17 Describe the type of activity/field of work of the working place/company
IX. Ever married women
[Questions 1-5 were asked of married women.]
Name____
No. household member ____
Q.1 Number of marriages
Q.2 Year and month of first marriage
Year 19_ _
Q.3 Age when first married
Q.4 Number of total children born alive of married women:
____M
____F
____M+F
____M
____F
____M+F
a.2 Live outside of this household
____M
____F
____M+F
Total
____M
____F
____M+F
____M
____F
____M+T
c. Born alive (a+b)
____M
____F
____M+F
Q.5 Age when first gave birth
X. For a woman [who] ever gave birth younger than 55
[Questions 1-23 were asked of women who ever gave birth and younger than 55 years.]
Q.1 Name of the last child ____
Q.2 After the birth of that child, has [the respondent] ever been pregnant again?
[] 2 Yes, pregnant (go to Q.5)
[] 3 Yes, miscarried (go to Q.5)
[] 4 Yes, born alive (go to Q.5)
[] 5 Yes, stillborn
Q.3 Age of pregnancy when gave birth
[] 2 7 months or more
Q.4 Did the baby show signs of life? (such as breathing, crying)
[] 2 No
[] 2 Twins
(If twins, write down [both] names)
[] 2 Female
Q.8 When was the last child born?
Year ____
Q.13. Has [the respondent] ever been pregnant before the last pregnancy?
[] 1 No (go to block XI)
[] 2 Yes, miscarried (go to block XI)
[] 3 Yes, born alive (go to Q.16)
[] 4 Yes, still born
Q.14 Age of pregnancy when gave birth?
[] 2 7 months or more
Q.15 Did the baby show signs of life? (such as breathing, crying)
[] 2 No (go to block XI)
[] 2 Twins
(If twins, write down both names)
[] 2 Female
Year____
Q.20 [Is missing]
Q.21 Does the child live in this household?
[] 2. No, 00
Q.22 [Is missing]
[] 2 30 days or more (in months)
XI. For a woman younger than 50 years and married
[Questions 1-3 were asked of women younger than 50 years and married]
Q.1 Type of contraceptive currently used:
[] 2 Vasectomy
[] 3 I.U.D.
[] 4 Injection
[] 5 Oral pill
[] 6 Condom
[] 7 Other
[] 8 Not used
Q.2 Has [the respondent] ever used contraceptive?
[] 2 No
Q.3 Source of contraceptive/service:
[] 2 FP field workers/other field workers
[] 3 FP post/FP group/Banjarvillage FP field worker assistance
[] 4 FP mobile team
[] 5 Safari (special event)
[] 6 Pharmacy
[] 7 Private doctor/midwife
[] 8 Other
XII.A. Born after June 30, 1984
Q.1 Name____
Household member's number ____
[] 2 No
Q.3 Duration of breast-feeding
[] 2 Midwife/paramedics
[] 3 Traditional birth attendant
[] 4 Other
Q.5 [Child] has [received] vaccination/immunization
[] 2 No (go to Q.7)
Q.6 Type of vaccination/immunization
[] 2 DPT
[] 3 Polio
[] 4 Measles
Q.7 Reason not to have vaccination/immunization
[] 2 Don't know about vaccination
[] 3 Afraid of fever
[] 4 Too far from vaccination's place
[] 5 Too expensive
[] 6 Don't know
[] 7 Other
XII. B. Death after June 30, 1984
Q.1 Name____
[] 2 Female
Q.3 Relation to the head of household
Year____
In years (if one year or older)
[] 2 Diarrhea
[] 3 Convulsions
[] 4 Accident
[] 5 Delivery/giving birth
[] 6 Other
[Instructions on how to fill the form are not included here]