Data given in this questionnaire will serve for statistical purposes only, except the items: name, address and identity number, which are required by the registration clerks, according to the law of Population Registration- 1965. The answer to the question about a shelter is not required according to the Statistics Ordinance 1947 and will be reported to the civil defense authorities.
____ First name
____ Year of birth
1. No. of enumeration district _ _ _ _ _ _ _
2. Identity No. _ _ _ _ _ _ _
3. Auxiliary No. _ _ _ _
4. Number of household in enumeration district _ _ _
5. Number of person _ _
6. Relation to household head
 2. Spouse of household head
 3. Son/daughter
 4. Son/daughter in law
 5. Grandson/daughter
 6. Parent of household head
 7. Parent of the spouse
 8. Other relation
 9. No relative
13. [Country of origin]
For born abroad, [specify] country of birth.
 01. Israel
 02. Iran (Persia)
 03. Bulgaria
 04. U.S.S.R
 05. Germany
 06. Hungary
 07. Tunisia
 08. Turkey
 09. Libya
 10. Egypt
 11. Morocco
 12. Iraq
 13. Poland
 14. Rumania
 15. Yemen
 Other county ____
 2. Yes; mark address ________
 2. No
 1. Yes
 2. No
 1. Deceased
 2. Emigrated
 3. Abroad more than 1 year
 4. Live outside enumeration district; give address ____
 5. Other cause ____
 6. Mark and fill out another questionnaire.
21. Number of house _ _ _
22. Sub-number _
23. Apartment number _ _
24. Number of rooms in apartment _
25. Type of apartment
 2. Unusual
 2. Apartment whose dwellers are not enumerable
30. [Bomb] Shelter
 2. No
 2. Concrete blocks, concrete, mortar
 3. Tin, earth, wood, asbestos
Please fill in answers in the following manner:
Make a circle around the number or corresponding sign to the right of the questions. If there is a square, write down your answer within it. If there is a dotted line, record your answer on the appropriate line. In some questions, there is a note. This note refers only to the question preceding it and not to other questions.
Look at the "Sample Questionnaire" and the explanations, before filling out this questionnaire.
This questionnaire should be filled out with pencil only.
2. What is the principal arrangement for heating the apartment in the winter?
 2. Other fixed installation- kerosene stove, gas, fuel oil, heat storage
 3. Movable stove (electric, gas, kerosene)
 4. No arrangement for heating apartment
4. Is there a bath or a shower and is it solely for your use?
 2. Bath, used jointly with others
 3. Only shower, solely for the use of the family
 4. Only shower, used jointly with others
 5. No bath and no shower
5. What is the principal arrangement for heating of water in the bath, or shower?
 2. Solar heater
 3. Electric or gas boiler
 4. Kerosene, wood, coal, etc.
 5. No arrangement for heating water
 6. No bath and no shower
14. Do you have a car?
 1. Car in possession of family
 2. Car for use of family, but not in its possession
 3. No car
16. Is the apartment in your possession, or is it rented?
 2. Rented. Mark and pass on to question 18.
 3. Not in possession and not rented. Pass on to next page. [Skip questions 17-20.]
Pass on to next page. [Skip questions 18-20.]
[Questions 18 to 20 were asked only of persons in rented apartments.]
19. Will you be getting key money (or pay on vacating) should you vacate the apartment?
 2. Entitlement to key money or pay on vacating (for those living in "Amidar" apartments)
 3. Entitled to key money (for those not living in "Amidar" apartments)
Enumerator: Record here data only for those born in 1958 or before:
_ _ Number of person in Stage A questionnaire
_ _ Year of birth
3. Did you marry and when?
 Married once -- Mark year of marriage: 19_ _
 Married more than once -- Mark years of marriages:
Last: 19_ _
4. To how many children did you give birth?
 No children born. Mark and pass to question 6 [skip question 5]
 Number of children born (Mark 1, 2, 3 and so on) ____
6. Do you study or have you studied at a school before?
 Studies in a school in the past and does not study at present. Mark and pass to question 8.
 Studies at present at school. Mark name and type of school and its address.
____ Address of school: Settlement Street/Quarter Number of house
7. What is the principal means of transportation for going to school?
 1. Special bus for conveying pupils
 2. Public bus
 3. Bicycle
 4. Motorcycle, scooter, or bicycle with auxiliary motor
 5. Private or commercial vehicle
 6. Taxi, including mini-bus
 7. Train, or carmelit
 8. Other vehicle
 9. Walking
8. How many years altogether did you study at school? ____
9. What is the type of the school you attended last, or where you are studying at present?
 2. Intermediate classes (between primary and secondary schools)
 3. Yeshiva, "Madrassa Diniyyah"
 4. Vocational, agricultural secondary school
 5. Secondary school
 6. Teachers training college (post primary)
 7. Other post-secondary school, such as school for qualified nurses, surveyors' school
 8. University, technion
 9. Other school, mark _________
10. What is the highest certificate (degree) that you received?
 2. Certificate and completion of post-secondary school
 3. Matriculation or other certificate [illegible]
 4. Other certificate of completing secondary studies
 5. None of those certificates
12. What is the language, or languages, that you speak in everyday life?
____ Mark single or principal language
____ Mark second language
____ Mark third language
In questions 13-21, full or part-time work for payment, profit, or other remuneration, and also work of a family member without pay in a family business will be considered as "work". Not considered as "work": work of woman in her own household.
13. Did you work during the last week at least one hour?
 2. Worked
 3. Did not work.
14. Did you actively look for work during the last week?
 1. Yes
 2. No
15. Do you have a job, a business, or an agricultural farm that you were absent from in the last week (for reasons of leave, sickness, army reserve duty, or other cause)?
 2. No
16. For how many weeks did you work in Israel in all places of work during the last 12 months?
 00. Did not work for a single day. Mark and pass to question 24.[skip questions 17-23]
 If worked less than one year, indicate for how many weeks worked: ____
 99. Worked the whole year
If you worked last week, please mark details of your main work. If you did not work last week, but worked in Israel during the last 12 months, give details of your last work.
18. Where did you work?
b. Description of principal activity of the place of work ____
c. Branch or division (if existing) in which you work ____
d. Address of your place of work
____ Number of house (or identifiable adjacent place)
19. What is the principal means of transportation by which you reach the above place of work?
 2. Private or commercial vehicle
 3. Taxi, including mini-bus
 4. Motorcycle, scooter, or bicycle with auxiliary motor.
 5. Bicycle
 6. Truck
 7. Train, or carmelit
 8. Other vehicle
 9. Not traveling
20. What is the principal work at your place of work?
21. What is your position at the place of work?
 2. Self-employed, not employing hired personnel
 3. Self-employed, employing 1-2
 4. Self-employed, employing 3 and more
 5. Member of a cooperative
 6. Member of qibbuz (not employee)
 7. member of family working without pay in family business or farm
22. What was your gross income (before deductions) from wages and salary in all places of work?
A. Last month ____
B. In the last 12 months ____
C. Is the last amount noted gross?
 2. No
23. What was your gross income in 1970/71 from your work as self-employed? ____
24. What were your and your family's income not from work during the last 12 months? ____
Record: regular income. Do not record: one-time income, such as: inheritance, severance pay, lottery win, etc.
A. Pensions, locally and from abroad. ____
B. Assistance, or allowances such as: national insurance, ministry of defense, Malben. ____
C. Assistance by relatives who do not live with you. ____
D. Gross income, from letting apartment, leasing property, interest, dividends, and non-active partnership in a business. ____
E. Other current income, not marked above. ____