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Census of Population of Ireland 2006

Census Day Sunday 23 April, 2006 - Central Statistics Office

A. Household Form
For office use only:
County code__
Enumeration area code__
ED code__
Street/townland code__
D no.__

Number of persons present

Males__
Females__
Total__
Absent persons__

H1. What type of accommodation does your household occupy? Check one box only.
A whole house or bungalow that is:

[] 1 Detached
[] 2 Semi-detached
[] 3 Terraced (including end of terrace)

A flat or apartment (including duplexes) that is self-contained:

[] 4 In a purpose-built block
[] 5 As part of a converted house or commercial building

A bed-sit:

[] 6 Bed-sit (with some shared facilities - e.g., toilet)

A mobile or temporary structure:

[] 7 A caravan or other mobile or temporary structure

H2. What year was your house or other building containing your accommodation first built? Check the year in which first built even if the building was subsequently converted, extended or renovated.

[] 1 Before 1919
[] 2 1919- 1940 inclusive
[] 3 1941- 1960 inclusive
[] 4 1961- 1970 inclusive
[] 5 1971- 1980 inclusive
[] 6 1981- 1990 inclusive
[] 7 1991- 1995 inclusive
[] 8 1996- 2000 inclusive
[] 9 2001 or later

H3. What is the nature of occupancy of your household's accommodation? Check one box only.

[] 1 Owner occupied where load or mortgage repayments are being made
[] 2 Owner occupied where no loan or mortgage repayments are being made
[] 3 Being purchased from a local authority under a tenant purchase scheme
[] 4 Rented from a local authority
[] 5 Rented from a voluntary body
[] 6 Rented unfurnished other than from a local authority or voluntary body
[] 7 Rented furnished or part furnished other than from a local authority or voluntary body
[] 8 Occupied free of rent (caretaker, company official, etc.)

H4. If your accommodation is rented, how much rent does your household pay? Enter amount to the nearest Euro: ___

[] 1 Per week
[] 2 Per month
[] 3 Per year

H5. How many rooms do you have for use only by your household? Do not count bathrooms, toilets, kitchenettes, utility rooms, consulting rooms, offices, shops, halls or landings, or rooms that can only be used for storage such as cupboards. Do count all other rooms, for example kitchens, living rooms, bedrooms, conservatories you can sit in, and studies. If two rooms have been converted into one, count them as one room.

Number of rooms__

H6. Does your accommodation have central heating? Check yes if you have central heating in some or all rooms whether or not you use it.

[] 1 Yes
[] 2 No

H7. What type of piped water supply does your accommodation have? Check one box only.

[] 1 Connection to a public main
[] 2 Connection to a group water scheme with a local authority source of supply
[] 3 Connection to a group water scheme with a private source of supply (e.g., borehole, lake, etc)
[] 4 Connection to other private source (e.g. well, lake, rain-water tank, etc.)
[] 5 No piped water supply

H8. What type of sewerage facility does your accommodation have? Check one box only.

[] 1 Public sewerage scheme
[] 2 Individual septic tank
[] 3 Individual treatment system other than a septic tank
[] 4 Other sewerage facility
[] 5 No sewerage facility

H9. How many cars or vans are owned or are available for use by one or more members of your household? Include any company car or van if available for private use. Check one box only.

[] 1 One
[] 2 Two
[] 3 Three
[] 4 Four or more
[] 5 None

H10. Does your household have a personal computer (PC)?

[] 1 Yes
[] 2 No

H11. Does your household have access to the internet? Check yes if you have access to the internet in your home.

[] 1 Yes, broadband connection
[] 2 Yes, other connection
[] 3 No

B. Person Form

Persons present in the household on the night of Sunday 23 April
List every person who spent the night of Sunday 23 April in the household or who arrived the following morning not having been enumerated elsewhere.

List 1: First name and surname
1_____
2_____
3_____
4_____
5_____
6_____
7_____
8_____

Persons temporarily away from the household on the night of Sunday 23 April.
List any household members who usually live at this address but who were absent on the night of Sunday 23 April.

List 2: first name and surname
1_____
2_____
3_____
4_____
5_____
6_____
7_____

1. What is your name (Person 1)?

_____

2. Sex

[] 1 Male
[] 2 Female

3. What is your relationship to Person 1? See example on back page. Check one box only.

[] 1 Husband or wife
[] 2 Partner
[] 3 Son or daughter
[] 4 Step-child
[] 5 Brother or sister
[] 6 Mother or father
[] 7 Step-mother/-father
[] 8 Son-/daughter-in-law
[] 9 Grandchild
[] 10 Other related
[] 11 Unrelated (including foster child)
[] 12 NIU (person 1)

4. What is your date of birth?

Day__
Month__
Year____

5. What is your place of birth? Give the place where your mother lived at the time of your birth. If Ireland (including Northern Ireland), write in the county.

______

If elsewhere abroad, write in the country.

______

6. What is your nationality? If you have more than one nationality, please declare all of them.

[] 1 Irish
[] 2 Other nationality, write in:
______
[] 3 No nationality

7. Where do you usually live?

[] 1 Here at this address
[] 2 Elsewhere in Ireland (including Northern Ireland), write in the county:
______
[] 3 Elsewhere abroad, write in the country:
______

8. Where did you usually live one year ago? Answer if aged 1 year or over.

[] 1 Same as now
[] 2 Elsewhere in Ireland (including Northern Ireland), write in the county:
______
[] 3 Elsewhere abroad, write in the country: ______

9. Have you lived outside the Republic of Ireland for a continuous period of one year or more? Answer if aged 1 year or over and living in Ireland.

[] 1 Yes
[] 2 No
If yes, write in the year of last taking up residence in the Republic of Ireland: _ _ _ _
And the country of last previous residence: ______

10. What is your current marital status? Answer if aged 15 years or over. Check one box only.

[] 1 Single (never married)
[] 2 Married (first marriage)
[] 3 Re-married (following widowhood)
[] 4 Re-married (following divorce/annulment)
[] 5 Separated (including deserted)
[] 6 Divorced
[] 7 Widowed

11. How many children have you given birth to? This question is for women only. Write in the number of children born alive:

___

[] 1 None

12. Can you speak Irish?

Answer if [the person is] age 3 or older

[] 1 Yes
[] 2 No

If yes, do you speak Irish?

Check the box that applies

[] 1 Daily, within the education system
[] 2 Daily, outside the education system
[] 3 Weekly
[] 4 Less often
[] 5 Never

13. What is your religion?

Check one box only

[] 1 Roman Catholic
[] 2 Church of Ireland
[] 3 Presbyterian
[] 4 Methodist
[] 5 Islam
[] 6 Other, write in your religion
______

14. What is your ethnic or cultural background? Choose one section from A to D, and then check the appropriate box.

A White

[] 1 Irish
[] 2 Irish traveler
[] 3 Any other White background

B Black or Black Irish

[] 4 African
[] 5 Any other black background

C Asian or Asian Irish

[] 6 Chinese
[] 7 Any other Asian background

D Other, including mixed background

[] 8 Other, write in description: _____________

15. Do you have any of the following long-lasting conditions?

a) Blindness, deafness or a severe vision or hearing impairment?
[] 1 Yes
[] 2 No
b) A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting or carrying?
[] 1 Yes
[] 2 No
c) A learning or intellectual disability?
[] 1 Yes
[] 2 No
d) A psychological or emotional condition?
[] 1 Yes
[] 2 No
e) Other, including any chronic illness
[] 1 Yes
[] 2 No

16. If yes to any of the conditions specified in question 15, do you have any difficulty in doing any of the following activities?

a) Learning, remembering or concentrating?
[] 1 Yes
[] 2 No
b) Dressing, bathing or getting around inside the home
[] 1 Yes
[] 2 No
c) Going outside the home alone to shop or visit a doctor?
[] 1 Yes
[] 2 No
d) Working at a job or business or attending school or college?
[] 1 Yes
[] 2 No
e) Participating in other activities, for example leisure or using transport?
[] 1 Yes
[] 2 No

17. How do you usually travel to work, school or college? Check one box only, for the longest part, by distance, of your usual journey to work, school or college.

[] 1 On foot
[] 2 Bicycle
[] 3 Bus, minibus or coach
[] 4 Train, DART, or LUAS
[] 5 Motor cycle or scooter
[] 6 Driving a car
[] 7 Passenger in a car
[] 8 Lorry or van
[] 9 Other means
[] 10 Work mainly at or from home
[] 11 Not applicable

18. What time do you usually leave home to go to work, school or college?

[] 1 Before 6:30am
[] 2 6:31- 7:00
[] 3 7:01- 7:30
[] 4 7:31- 8:00
[] 5 8:01- 8:30
[] 6 8:31- 9:00
[] 7 9:01- 9:30
[] 8 After 9:30
[] 9 Not applicable

19. What distance is your journey from home to work, school or college and how long does it usually take? Write in distance to the nearest kilometer and journey time in minutes.

Kilometers __
Minutes __

20. If you are younger than 15, skip to question 34.

21. Do you provide regular unpaid personal help for a friend or family member with a long-term illness, health problem or disability? Include problems which are due to old age. Personal help includes help with basic tasks such as feeding or dressing.

[] 1 Yes, 1-14 hours a week
[] 2 Yes, 15-28 hours a week
[] 3 Yes, 29-42 hours a week
[] 4 Yes, 43 or more hours a week
[] 5 No

22. Have you ceased your full-time education?

[] 1 Yes
[] 2 No

If yes, write in age at which education ceased: __

23. What is the highest level of education (full-time or part-time) which you have completed to date? Check only one box.

[] 1 No formal education
[] 2 Primary education
Secondary level:
[] 3 Lower secondary: Junior/intermediate/Group certificate, "O" levels/GCSEs, NCVA Foundation Certificate, Basic Skills Training Certificate or equivalent
[] 4 Upper secondary: Leaving certificate (including Applied and Vocational Programmes), "A" levels, NCVA Level 1 Certificate or equivalent
[] 5 Technical or vocational qualification: Completed Apprenticeship, NCVA Level 2/3 Certificate, Teagasc Certificate/Diploma or equivalent
[] 6 Both Upper Secondary and Technical or Vocational qualification
Third level:
[] 7 Non degree: National Certificate, Diploma NCEA/Institute of Technology or equivalent, nursing diploma
[] 8 Primary degree (Third level Bachelor degree)
[] 9 Professional qualification (of degree status at least)
[] 10 Both a degree and a professional qualification
[] 11 Postgraduate certificate or diploma
[] 12 Postgraduate degree (Masters)
[] 13 Doctorate (PhD)

24. Do you hold any third level qualification(s) which you attained after completing 2 or more years of study?

[] 1 Yes
[] 2 No

If yes, please indicate the main subject area(s) in which the qualification(s) is held. Check all boxes that apply.

[] 1 Education
[] 2 Humanities and Arts (including foreign languages, history, philosophy, fine arts, music and performing arts, design)
[] 3 Social sciences/business/law (including psychology, economics, journalism, Finance, accounting)
[] 4 Life science, physical science, mathematics and statistics
[] 5 Computing
[] 6 Engineering, manufacturing and construction
[] 7 Agriculture and veterinary (including forestry, fishery, horticulture)
[] 8 Health (including medicine, nursing, dental studies, therapy and rehabilitation, pharmacy)
[] 9 Social services (including child care and youth services, social work and counseling)
[] 10 Services (including hotel, catering, sports, transport, environmental protection, security, occupational health and safety, military and defense)

25. In the last 4 weeks have you done any of the following activities without pay? Check all that apply.

[] 1 Helping or voluntary work with a social or charitable organization
[] 2 Helping or voluntary work with a religious group or church
[] 3 Helping or voluntary work with a sporting organization
[] 4 Helping or voluntary work with a political or cultural organization
[] 5 Any other voluntary activity
[] 6 No voluntary activity

26. How would you describe your present principal status? Check one box only.

[] 1 Working for payment or profit
[] 2 Looking for regular job
[] 3 Unemployed
[] 4 Student or pupil
[] 5 Looking after home/family
[] 6 Retired from employment
[] 7 Unable to work due to permanent sickness or disability
[] 8 Other, write in: ________

27. If you are:

- working for payment or profit (Q26 box 1)
- unemployed (Q 26 box 3)
- retired (Q26 box 6)

Answer the following questions about your main job or your last main job if you are not currently employed. Otherwise, skip to Q34.

28. Do (did) you work as an employee or are (were) you self-employed in your main job? Your main job is the job in which you usually work(ed) the most hours.

[] 1 Employee
[] 2 Self-employed, with paid employees
[] 3 Self- employed, without paid employees
[] 4 Assisting relative (not receiving a fixed wage or salary)

29. What is (was) your occupation in your main job? In all cases, describe the occupation fully and precisely giving the full job title. Use precise terms such as "Retail store manager" or "Secondary teacher". Civil servants and local government employees should state their grade e.g. "Senior administrative officer".

Write your main occupation______

If a farmer or worker, write in the size of the farm: ___ hectares

30. If you are retired, skip to Q 34.

31. What is (was) the full name of the organization you work(ed) for in your main job? If you have (had) your own business, write in the name of the business: ______

32. What is (was) the full address at which you actually work(ed)? ______

[] 1 Work mainly at or from home
[] 2 No fixed place of work

33. What is (was) the business of your employer at the place where you work(ed) in your main job? If you are (were) self-employed answer in respect of your own business. Describe the main product or service provided by your employer. For example, "Making computers", "Repairing cars", "Secondary education".

34. If there are more than 6 persons present in the household on the night of Sunday 23 April, you will need an Individual Form for each additional person. Please ask your Enumerator for additional forms. Otherwise, go to next page.

Persons temporarily away from the household on the night of Sunday 23 April

Answer questions A1 to A8 for any household members who usually live here at this address but who are not present on the night of Sunday 23 April. Include in particular students who are living away from home during term time who are not present at this address on the night of Sunday 23 April.

A1. What is this person's name?

First name and surname: _______

A2. Sex

[] 1 Male
[] 2 Female

A3. What is the relationship of this person to Person 1 on page 4?

[] 1 Husband or wife
[] 2 Partner
[] 3 Son or daughter
[] 10 Other related, write in relationship: ______

A4. What is this person's date of birth?

Day: __
Month: __
Year: ____

A5. What is this person's current marital status? Answer only if aged 15 years or over. Check one box only.

[] 1 Single (never married)
[] 2 Married (including re-married)
[] 5 Separated (including deserted)
[] 6 Divorced
[] 7 Widowed

A6. How long altogether is this person away for?

[] 1 Less than 3 months
[] 2 3 months or more

A7. Was this person in the Republic of Ireland on Sunday 23 April?

[] 1 Yes
[] 2 No

A8. Is this person a student away at school or college?

[] 1 Yes
[] 2 No

If there are more than 6 persons temporarily absent from the household on the night of Sunday 28 April, please ask your Census Enumerator for a Continuation Form.

Declaration to be signed by the householder after completing the census form:

Before you sign the declaration, please check:

- That you have completed the questions about your accommodation on page 2.
- That in List 1 on page 3, you have accounted for all persons (including visitors) who spent the night of Sunday 23 April in the household (if there are more than 6 persons present, please complete the relevant number of Individual Forms).
- That you have answered all questions which should have been answered fo reach person who spent the night of Sunday 23 April in the household (pages 4-21)
- That in List 2 on page 3, you have accounted for all household members who were temporarily away from this household on the night of Sunday 23 April (if there are more than 6 absent persons, please ask your Enumerator for guidance).
- That you have answered all questions on pages 22-23 for all household members temporarily away from the household on the night of Sunday 23 April.
- That no person has been double counted on the form.

Declaration to be completed by the person responsible for completing the form

I declare that this form is correct and complete to the best of my knowledge and belief.

Signature: ______________________