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Republic Of Indonesia
Central Bureau of Statistics
1990 Population Census

I. Identification
1. Province ____
2. Regency/municipality ____
3. District ____
4. Village/Kelurahan ____
5. Area

[] 1 Urban
[] 2 Rural

6. Enumeration area number ____
7. Sample code number ____
8. Sample serial number ____
9. Physical building number ____
10. Census building number ____
11. Selected household number ____

12. Household

[] 1 Ordinary
[] 2 Institutional

13. Number of household members ____

For an institutional household, please fill in the number of selected household members

14. Total of all household members in institutional household ____

15. Total of all household members in enumeration area

Ordinary _ _
Particular _ _
II. Worker characteristics

1. Name of workers

Enumerator ____
Supervisor ____

2. NIP/NMS

Enumerator ____
Supervisor ____

3. Date of enumeration/supervising

Enumerator ____
Supervisor ____

4. Signature

Enumerator ____
Supervisor ____
III. Household members composition

1. Number _ _

2. Name of household members

(Write anybody who usually lives and eats in this household; adult, children, baby, etc.)

________

3. Relation to the head of household

____
Other than registered names
[The following five questions are to ensure the enumerator has correctly registered all household members.]

1. Is there a baby or child who is not registered yet?

[] Yes, please write in the list
Name ____
[] No

2. Are there other people who are not relatives, such as a housemaid or friend, but they usually live here?

[] Yes, please write in the list
Name ____
[] No

3. Is there a guest who has stayed here for six months or more?

[] Yes, please write in the list
Name ____
[] No

4. Is there a person who usually lives here but has been away for fewer than six months?

[] Yes, please write in the list
Name ____
[] No

5. Is there a person who is registered but has been away for six months or more?

[] Yes, please cross out from the list
Name ____
[] No
IV. Dwelling construction

To be asked to the head of household

1. Type of physical structure

[] 1 Single dwelling construction
[] 1 Multi-storied
[] 2 Single story
[] 2 Duplex construction
[] 3 Multi-dwelling construction
[] 1 Multi-storied
[] 2 Single story

2. Number of census buildings in this physical structure

____ census buildings

3. Number of households in census building

_ _ households

4. Dwelling ownership status:

[] 1 Self-owned
[] 2 Installments (rent-to-buy)
[] 3 Contract
[] 4 Rent
[] 5 Official residence
[] 6 Others ____

5. Type of roof (majority):

[] 1 Concrete
[] 2 Wood/shingle
[] 3 Tile
[] 4 Asbestos
[] 5 Zinc
[] 6 Palm fiber
[] 7 Leaves

6. Type of outside wall (majority):

[] 1 Concrete
[] 2 Wood
[] 3 Bamboo
[] 4 Other

7. Type of floor (majority):

[] 1 Ceramic/marble/granite
[] 2 Tile/tekhel/teraso
[] 3 Cement/brick
[] 4 Wood
[] 5 Bamboo
[] 6 Earth
[] 7 Other

8. Floor area

____ square meters

9. Lighting used:

[] 1 Electricity
[] 2 Gas
[] 3 Pressure lantern
[] 4 Kerosene
[] 5 Other ____

10. Fuel for cooking:

[] 1 Electricity
[] 2 Gas
[] 3 Kerosene
[] 4 Wood
[] 5 Charcoal
[] 6 Other ____

11. Source of drinking water:

[] 1 Pipe
[] 2 Well pump
[] 3 Well
[] 4 Spring
[] 5 River
[] 6 Rain water
[] 7 Other ____

12. Source of water for bathing and washing

[] 1 Piped
[] 2 Pump
[] 3 Well
[] 4 Spring
[] 5 River
[] 6 Rain water
[] 7 Other ____

13. Bathroom:

[] 1 Private bathroom
[] 2 Shared bathroom
[] 3 Public bathroom
[] 4 Other ____

14. Toilet

[] 1 Private with septic tank
[] 2 Private without septic tank
[] 3 Share toilet
[] 4 Public toilet
[] 5 Other ____

15. Household possessions:

a. Sideboard/buffet
[] 1 Yes
[] 2 No
b. Stove
[] 1 Yes
[] 2 No
c. Bicycle/boat
[] 1 Yes
[] 2 No
d. Radio/cassette player
[] 1 Yes
[] 2 No
e. TV
[] 1 Yes
[] 2 No
f. Motorcycle/speed boat
[] 1 Yes
[] 2 No
g. Automobile/motor boat
[] 1 Yes
[] 2 No

V. Ownership/agriculture land possessions

16. Own property:

____ Ha.

17. Came from other party (rents, pawns, sharecrops, works on, etc.)

____ Ha.

18. Being used by other party

____ Ha.

19. Possessions (Q16 + Q17 + Q18)

____ Ha.

VI. Household member characteristics

VI-A: All ages
[Questions 1-13.]

Name ____
Number of household member: _ _

1. Relation to the head of household:

[] 1 Head of household
[] 2 Wife/husband
[] 3 Children
[] 4 Son/daughter in-law
[] 5 Grandchildren
[] 6 Parent/in-law
[] 7 Other relative
[] 8 Household servant
[] 9 Other

2. Sex

[] 1 Male
[] 2 Female

3. Day, month and year of birth

Day ____
Month ____
Year ____

4. Age

_ _ years

5. Marital status

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

6. Religion

[] 1 Islam
[] 2 Catholic
[] 3 Protestant/other Christian
[] 4 Hindu
[] 5 Buddhist
[] 6 Other

7. Nationality

[] 1 Indonesian
[] 2 Foreigner: China, Taiwan, stateless China
[] 3 Other foreigner

8. Place of birth

Province: ____

9. Ever lived in another province?

[] 1 Yes
[] 2 No (skip to question 12)

10. Last dwelling before moving to this province

[Question 10 was asked of persons who have lived in another province, per question 9.]

Province: ____

11. Duration of living in this province

[Question 11 was asked of persons who have lived in another province, per question 9.]

_ _ years

12. Biological mother lives in this household?

[] 1 Yes
[] 2 No (skip to question 14)

13. Name of biological mother: ____

[Question 13 was asked of persons whose biological mother lives in the same household, per question 12.]

Serial number of biological mother: ____

VI-B. Persons age 5 or older
[Questions 14-23.]

14. Dwelling of [respondent] five years ago

Province: ____

15. School status

[] 1 No school (skip to question 20)
[] 2 In school
[] 3 No longer in school

16. Highest education ever or currently attending

[Question 16 was asked of persons age 5 or older who have ever attended school, as per question 15.]

[] 1 Primary school
[] 2 Junior high school
[] 3 Senior high school
[] 4 Vocational junior
[] 5 Vocational senior
[] 6 Diploma I/II
[] 7 Academy/Diploma III
[] 8 University/Diploma IV

17. Level/grade of education ever attended

[Question 17 was asked of persons age 5 or older who have ever attended school, as per question 15.]

[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8 (completed)

18. Level of education ever completed

[Question 18 was asked of persons age 5 or older who have ever attended school, as per question 15.]

[] 1 Not completed
[] 2 Primary school
[] 3 Junior high school
[] 4 Senior high school
[] 5 Vocational junior school
[] 6 Vocational senior school
[] 7 Diploma I/II
[] 8 Academy/diploma III
[] 9 University/diploma IV

19. Field of study:

[Question 19 was asked of persons age 5 or older who have completed vocational education, diploma, academy or university level, as per questions 15 and 18.]

____

20. Mother tongue used:

[] 1 Indonesian language
[] 2 Local language
____
[] 3 Foreign language

21. Daily language used at home:

[] 1 Indonesian language (go to question 23)
[] 2 Local language
____
[] 3 Foreign language

22. Can speak Indonesian?

[Question 22 was asked of persons age 5 or older who do not speak Indonesian at home, as per question 21]

[] 1 Yes
[] 2 No

23. Can write and read?

[] 1 Latin
[] 2 Other alphabets
[] 3 Cannot

VII. Activity of persons age 10 or older
Household members age 10 or older
[Questions 24-38.]

24. The main activity done during previous week

[] 1 Working
[] 2 Attending school
[] 3 Housekeeping
[] 4 Other

25. Besides [answers] 2, 3, and 4 [in question 24], also worked at least 1 hour during the previous week

[Question 25 was asked of persons age 10 or older who did not work last week, as per question 24.]

[] 1 Yes (go to question 28)
[] 2 No

26. Having a job/business but temporarily not working during previous week

[Question 26 was asked of persons age 10 or older who did not work at least one hour last week, as per questions 24 and 25.]

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

27. Ever worked before?

[Question 27 was asked of persons age 10 or older who did not work at least one hour last week and did not have a job or business to return to, per questions 24, 25 and 26.]

[] 1 Yes (go to question 35)
[] 2 No (go to question 35)

28. Number of daily hours worked in the previous week

[Question 28 was asked of persons age 10 or older who worked at least one hour last week, per questions 24 and 25.]

Day 1 _ _ hours
Day 2 _ _ hours
Day 3 _ _ hours
Day 4 _ _ hours
Day 5 _ _ hours
Day 6 _ _ hours
Day 7 _ _ hours
Total _ _ hours

29. Total hours of main work during previous week

[Question 29 was asked of persons age 10 or older who worked at least one hour last week, as per questions 24 and 25.]

_ _ hours

30. Type of main work during previous week (write down completely)

[Question 30 was asked of persons age 10 or older who worked at least one hour last week or had a job/business to return to, as per questions 24, 25 and 26.]

________

31. Field of main work during previous week (write down completely)

[Question 31 was asked of persons age 10 or older who worked at least one hour last week or had a job/business to return to, as per questions 24, 25 and 26.]

________

32. Status of main work during previous week

[Question 32 was asked of persons age 10 or older who worked at least one hour last week or had a job/business to return to, as per questions 24, 25 and 26.]

[] 1 Self-employed without other people's assistance

Self-employed with assistance from:
[] 2 Family members/temporary workers
[] 3 Employer with permanent workers
[] 4 Worker/employee
[] 5 Unpaid worker

33. During previous week, have additional work?

[Question 33 was asked of persons age 10 or older who worked at least one hour last week or had a job/business to return to, as per questions 24, 25 and 26.]

[] 1 Yes
[] 2 No

34. Additional field of business:

[Question 34 was asked of persons age 10 or older who worked at least one hour last week or had a job/business to return to, and had an additional work last week, as per questions 24, 25, 26 and 33.]

[] 1 Agriculture
[] 2 Mining and quarrying
[] 3 Industry
[] 4 Electricity, gas and water
[] 5 Construction
[] 6 Trading and transportation
[] 7 Communication
[] 8 Finance
[] 9 Service
[] 0 Other ____

35. Looking for a job during previous week

[] 1 Yes (go to question 37)
[] 2 No

36. Reason not looking for a job

[Question 36 was asked of persons age 10 or older who were not looking for a job last week, as per question 35.]

[] 1 Unnecessary
[] 2 Hopeless/gave up
[] 3 Attending school
[] 4 Housekeeping
[] 5 Incapable
[] 6 Other ____

37. Worked during previous year

[] 1 Yes
[] 2 No (go to section VIII)

38. Field of business during previous year (write down completely)

[Question 38 was asked of persons age 10 or older who worked during the previous year, as per question 37.]

________

VIII. Women with status of married, divorced, widowed
[Questions 39-46 were asked of women who indicated being married, divorced, or widowed, as per question 5.]

39. Month and year of first marriage

Month ____
Year ____

40. Age at first marriage

____ years

41. Number of marriages ever had

_ times

42. Number of children born alive

_ _

43. Number of children still alive

a. Total: _ _
b. In the household: _ _
c. Outside household: _ _

44. Number of children who have passed away:

_ _

45. Month and year of birth of the last child born alive

Month ____
Year ____

46. The last born alive child is still alive

[] 1 Yes
[] 2 No