Republic of Indonesia
2000 Population Census
Province _ _
Regency/municipality _ _
Sub-district _ _ _
Village _ _ _
Census block no. _ _ _ _
PB no. _ _ _
Household serial no. _ _ _
Characteristics of Individual Household Members
Included: 1. Baby; 2. Guests or visitors who have been staying for the past six months or fewer than 6 months but intended to stay; 3. Servants who staying in this household.
Not included: 1. Persons who have been away for the past six months, or fewer than 6 months and intended to move away; 2. Servants who are not staying in this household.
Total number of household members ____
Description
1. Name: ____
Serial number: ____
2. Relationship to head of the household
[] 2 Spouse
[] 3 Children
[] 4 Other
4. Place of birth
Regency/city: ____
5. Month and year of birth and age
Year: ____
b. How old are you? (in years): ____
6. Marital status
[] 2 Married
[] 3 Divorced
[] 4 Widowed
7. Religion
[] 2 Catholic
[] 3 Protestant
[] 4 Hindu
[] 5 Buddhist
[] 6 Other
8. Citizenship/ethnicity
[] 2 Other
Specify ethnic group/citizenship: _ _ _ _
Household members age 5 or older
[Questions 9-13 were asked of persons age 5 or older]
9. Place of residence 5 years ago
Regency/city: ____
10. Highest education completed
[] 2 Primary school
[] 3 Junior high school
[] 4 Senior high school
[] 5 College [1-2 year. diploma]
[] 6 Academy [3 year diploma]
[] 7 Undergraduate/graduate [diploma in 4 or more years]
11. What kind of activities during the previous week?
[] 2 Looking for work
[] 4 School
[] 8 Other
[Questions 12 to 13: for persons age 5 or older who are employed during the previous week.]
12. If Q11 code 1, type of main industry
[] 2 Plantation
[] 3 Fishery
[] 4 Animal husbandry
[] 5 Other agriculture
[] 6 Manufacturing
[] 7 Trade
[] 8 Services
[] 9 Transportation
[] 0 Others
13. Employment status
[] 2 Self-employed/[employer] assisted by temporary employees
[] 3 Employer
[] 4 Employee
[] 5 Unpaid worker
Ever married women age 10 or older
[Questions 14-15 were asked of ever married women age 10 or older]