Republic of Indonesia
2010 Population Census
Complete Enumeration for Household and Population
[Directions and an example of how to fill the form in the original document are not presented here.]
I. Identification
_ _ Province
_ _ Regency/municipality
_ _ _ Sub-district
_ _ _ Village
_ _ _ Census block no.
_ _ _ Local administrative unit serial no.
_ _ _ Physical building no.
_ _ _ Census building no.
_ _ _ Household serial no.
An ordinary household is a group of persons who usually live together in a building or housing unit who make common provision for food and other living essentials. A household could consist of only one household member.
Please ask about all persons who usually live and eat in this household; adults, children and/or persons who are away for fewer than six months and do not intend to move out of the household.
Record the numbers and names of all household members on the list of household members below.
Usual residents
1. No. _ _ _
2. [Name]: ____
3. Relationship to head of household
[] 2 Spouse
[] 3 Child
[] 4 Adopted/step child
[] 5 Son/daughter in-law
[] 6 Grandchild
[] 7 Parent/parent in-law
[] 8 Other family
[] 9 Housemaid
[] 0 Others
4-5. Sex
[] 4. Male
[] 5. Female
Total males: _ _ _
Total females: _ _ _
Total of household members: _ _ _
Serial number of the informant: _ _ _
[The following questions are used for a check to ensure the enumerator has correctly included household members.]
Included household members:
[] 1. Are there an infants or small children who have not been recorded?
[] 2. Are there any other persons who may not be family members such as housemaids, boarders, or friends who usually live here but have not been recorded?
[] 3. Are there any guests or temporary visitors in this household who already have left their house for six months or more but have not been recorded?
[] 4. Are there any persons who usually live here but currently are away for fewer than six months who have not been recorded?
Not included household members:
[] 1. Are there any persons who have been recorded but have been away for six months or more?
[] 2. Are there any persons who have been recorded but have been away and intend to move?
[] 3. Are there any persons who have been recorded but have died during the enumeration period?
[] 4. Are there any children who have been recorded but currently working/studying and live in other places (ex.: rent a room)?
[The identification of the enumerator and related information in the original document are omitted here]
201. Name of household member? ____
202. What is the relationship of [the respondent] to the head of household?
[] 2 Spouse
[] 3 Child
[] 4 Adopted child/stepchild
[] 5 Son/daughter in-law
[] 6 Grandchild
[] 7 Parent/parent in-law
[] 8 Other family
[] 9 Housemaid
[] 0 Others
203. Is [the respondent] male or female?
[] 2 Female
204. On what day, month, and year was [the respondent] born?
_ _ Month
_ _ _ _ Year
Age: _ _ years
205. What is [the respondent's] place of birth?
b. Regency/municipality: ____ _ _ _
206. What is [the respondent's] religion?
[] 2 Christian
[] 3 Catholic
[] 4 Hindu
[] 5 Buddhist
[] 6 Khonghucu
[] 7 Others (specify)
207. Does [the respondent] have difficulties in:
[] 2 Some
[] 3 Total
[] 2 Some
[] 3 Total
[] 2 Some
[] 3 Total
[] 2 Some
[] 3 Total
[] 2 Some
[] 3 Total
208. What is [the respondent's] citizenship and ethnicity?
b. Foreigner, specify country of citizenship: ____ _ _ _
For persons age 5 or older
[Questions 209-214 were asked of persons aged 5+.)
209. In which regency/city and province did [the respondent] live 5 years ago (May 2005)?
b. Regency/municipality: ____ _ _ _
210. What language does [the respondent] usually speak at home?
211. Is [the respondent] able to speak Indonesian?
[] 2 No
212. What is the schooling status of [the respondent]?
[] 2 Attending school
[] 3 No longer attending school
[Questions 213-214 were asked of persons age 5 or older who have ever attended school.]
213. What is [the respondent's] highest level of education completed?
[] 2 Primary school
[] 3 Junior high school
[] 4 Senior high school
[] 5 Vocational high school
[] 6 Diploma I/II
[] 7 Diploma III/Academy
[] 8 Diploma IV/Undergraduate
[] 9 Postgraduate
214. Is [the respondent] able to read and write:
[] 2 No
[] 2 No
For persons age 10 or older
[Questions 215-218 were asked of persons age 10 or older.]
215. What is [the respondent's] marital status?
[] 2 Married
[] 3 Divorced
[] 4 Widowed
216. [The respondent's] activities during the previous week:
[] 1 Yes (to Q217)
[] 2 No
[] 1 Yes (to Q217)
[] 2 No
[] 2 No
[] 2 No (to Q219)
[Questions 217-218 were asked of persons age 10 or older who worked or were on temporary leave during the previous week.]
217. What was the type of main industry of [the respondent] during the previous week?
____
Filled by Kortim in the field:
[] 01 Agriculture, rice, corn, other grains
[] 02 Agriculture, horticulture (vegetables, fruits, etc.)
[] 03 Agriculture, estate (palm, tea, tobacco, rubber, etc.)
[] 04 Agriculture, fishery (fishing, fish cultivation, etc.)
[] 05 Agriculture, animal husbandry (animals farming, dairy, etc.)
[] 06 Agriculture, other (forestry, hunting, etc.)
[] 07 Mining and quarrying
[] 08 Manufacturing
[] 09 Electricity and gas
[] 10 Construction (buildings, roads, bridges, etc.)
[] 11 Trade (wholesale and retail)
[] 12 Hotel and restaurant
[] 13 Transportation and storage
[] 14 Information and communications
[] 15 Finance and insurance
[] 16 Educational services
[] 17 Health services
[] 18 Other services (government, private, and individual)
[] 19 Others (real estate, water supply, etc.)
218. What was [the respondent's] employment status during the previous week?
[] 2 Self-employed, assisted by unpaid temporary employees
[] 3 Employer, assisted by paid permanent employees
[] 4 Employee
[] 5 Casual worker
[] 6 Unpaid family worker
Ever married women age 10 or older
[Questions 219-221 were asked of ever-married women age 10 or older.]
219. Has [the respondent] ever had a live birth?
[] 2 No (go to the next household member)
[Questions 220-221 were asked of ever-married women age 10 or older who had a live birth.]
220. How many of [the respondent's] children are:
_ _ Daughters
_ _ Daughters
_ _ Daughters
221. Has [the respondent] had a live birth since 1 January 2009?
[] 2 No
301. Have there been any deaths in this household since 1 January 2009?
[] 2 persons
[] More than 3 persons (use additional SP2010-C1 questionnaire)
302. Record the names of the deceased: ____
303. Sex of the deceased [person]?
[] 2 Female
304. In which month and year did [the person] die?
[] 2009
[] 2010
305. How old was [the person] when he/she died?
_ _ years
306. See Q303 and Q305: Was [the person] a woman age 10 or older?
[] 1 Yes
[] 2 No
307. Did [the person] die during pregnancy, delivery, or within 2 months of pregnancy?
If "No", skip to other [deceased person] or to Q401.
[] 1 Yes
[] 2 No (go to Q401)
308. If Q307 = "Yes": Did [the person] die during:
[] 1 Pregnancy
[] 2 Childbirth
[] 3 Within two months of pregnancy
401. What is the primary floor material?
[] 2 Tiles/terrazzo
[] 3 Cement/bricks
[] 4 Wood/board
[] 5 Bamboo
[] 6 Dirt/earth
[] 7 Others
402. Floor area of this living quarter?
403. What is the primary source of lighting?
[] 2 State Electricity Company without meter
[] 3 Electricity not from the State Electricity Company
[] 4 No electricity
404. What is the main source of energy for cooking?
[] 2 LPG/National Gas
[] 3 Kerosene
[] 4 Charcoal
[] 5 Wood
[] 6 Others
[] 7 None
405. What is the main source of drinking water?
[] 2 In-house piped water system
[] 3 Piped water outside dwelling/retail
[] 4 Pumped water
[] 5 Protected well
[] 6 Unprotected well
[] 7 Protected spring
[] 8 Unprotected spring
[] 9 River
[] 10 Rain water
[] 11 Others
406. What type of toilet facility?
[] 2 Shared toilet
[] 3 Public toilet
[] 4 No toilet facility (go to Q408)
407. What kind of excreta disposal does the toilet use?
[] 1 With septic tank
[] 2 Without septic tank
[] 3 No disposal facility
408. What kind of telephone does this household have?
[] 2 Cellular telephone
[] 3 Land line and cellular telephone
[] 4 No telephone
409. Is there any household member who accessed the Internet during the last three months?
[] 2 No
410. What is the ownership status of this dwelling/living quarter?
[] 2 Rented
[] 3 Leased
[] 4 Others
[If responses 2-4, stop].
411. Does this household have proof of land ownership of this dwelling unit?
[] 1 Yes
[] 2 No (stop)
412. What kind of proof of land ownership of this dwelling unit?
[] 1 Ownership Certificate (SHM) belonging to HH member
[] 2 Ownership Certificate (SHM) not belonging to HH member
[] 3 Other Certificate (SHGB, SHP, SSRS)
[] 4 Others (Girik, Akte Jual Beli Notaris/PPAT, etc.)