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Republic of Iraq
Board of Ministers
Planning Commission
Central Statistical Organization

1997 Population Census Questionnaire

1. Governorate ____

2. Qadah ____

3. Nahiya ____

4. Environment

[] 1 Urban
[] 2 Rural

5. District name or mahalla name ____

District number ____

6. Village name ____

Village number ____

7. Zone number ____

8. Street number ____

9. House census number ____

10. Household series number in zone ____

11. Number of households in the residential unit ____

12. Number of bedrooms ____

Mark with an [x] the correct answer.

13. Ownership of the residential unit

Private sector

[] 1 Possession
[] 2 Rent
[] 3 Other

Government sector

[] 4 Rent
[] 5 Other

14. Size of the rented residential unit

[] 1 All unit
[] 2 One room
[] 3 Two rooms
[] 4 Three rooms and more

15. Monthly rent (I. D.) ____
[The following instructions apply to questions 16 to 26]Fill for each household living alone in the residential unit, if occupied by more than one household, only one of the households should respond.

16. Type of residential unit

[] 1 House
[] 2 Flat
[] 3 Hut
[] 4 Tent
[] 5 Caravan
[] 6 Other

17. Wall construction material

[] 1 Bricks
[] 2 Stone
[] 3 Blocks
[] 4 Concrete blocks
[] 5 Mud
[] 6 Other

18. Total number of rooms in the residential unit ____

19. Is there any bathroom in the occupied unit?

[] 1 Yes
[] 2 No

20. Is there any water closet?

[] 1 Yes
[] 2 No

21. Are the bathroom and the water closet in the same place?

[] 1 Yes
[] 2 No

22. Is there any kitchen?

[] 1 Yes
[] 2 No

23. Is the living unit equipped with electricity?

[] 1 Yes
[] 2 No

24. Is the living unit equipped with a telephone?

[] 1 Yes
[] 2 No

25. Source of drinking water in the residential unit

[] 1 Water nets
[] 2 Public tap
[] 3 Well
[] 4 River or waterwheel
[] 5 Other

26. Drainage of waste water

[] 1 Sewer system
[] 2 Septic tank
[] 3 Other

27. To be filled by people living in establishments (hotels, clinics, prisons, etc.)

[] 1 Hotel or rest house
[] 2 Hostels (for students)
[] 3 Social care unit
[] 4 Medical establishment
[] 5 Mosques or churches
[] 6 Prisons, police stations
[] 7 Residential units (living with non-relatives and hence not a part of the household)
[] 8 Others

Name of the establishment ____

[Personal Questionnaire]

[Questions 28-75 were to record for each person in a household.]

28. Person's series number ____

29. Name ____

30. Father's name ____

31. Grandfather's name ____

32. Family name (surname)____

33. Mother's name and her father's name ____

34. Residential status

[] 1 Resident present (permanent)
[] 2 Visitor present
[] 3 Absent (inside the country)
[] 4 Absent (outside the country)
[] 5 Prisoner
[] 6 Lost

35. Relationship to the head of the household

[] 1 Household head
[] 2 Spouse
[] 3 Son or daughter
[] 4 Daughter/son-in-law
[] 5 Grandson/granddaughter
[] 6 Parent
[] 7 Brother/sister
[] 8 Rest of relatives
[] 9 Not related

36. Sex

[] 1 Male
[] 2 Female

37. Date of birth

Day ____
Month ____
Year ____

To be filled by people age 12 and older [Applies to questions 38-45]

38. Marital status

[] 1 Never married
[] 2 Married
[] 3 Divorced
[] 4 Widowed

For married, divorced or widowed persons (both sexes) [Applies to questions 39-40]

39. Date of first marriage____

40. Number of marriages____

For married males only
41. Number of wives legally under his protection ____

For married, divorced and widowed women

[Questions 42 to 45 are for married, divorced and widowed women]

42. Duration of marriage

[] Less than one year
[] One year and more
Number of years ____

43. Total number of live births during married life

Male ____
Female ____

44. Total number of living children

Male ____
Female ____

45. Total number of live births during the period 10/17/1996-10/16/1997

Male ____
Female ____

For persons six years old and more[Applies to questions 46-52]

46. Labor force information

[] 1 Working
[] 2 Unemployed seeking work
[] 3 Housewife with part-time work
[] 4 Full-time student
[] 5 Housewife
[] 6 Pensioner
[] 7 Have income but not working
[] 8 Others

47. Main occupation ____

48. Economic activity ____

49. Employment status

[] 1 Employer
[] 2 Own-account worker
[] 3 Employee
[] 4 Unpaid family worker

50. Sector

[] 1 Government
[] 2 Mixed
[] 3 Cooperative
[] 4 Private
[] 5 Arabic
[] 6 Foreigner

51. Work time

[] 1 Full-time
[] 2 Part-time

52. Main source of living

[] 1 From work
[] 2 Retirement (all kinds of pension)
[] 3 Scholarship
[] 4 Assistance
[] 5 Investment
[] 6 By the help of others
[] 7 By the help of social care

53. Survival status of parents

[] 1 The father is dead
[] 2 The mother is dead
[] 3 The parents are dead
[] 4 The parents are alive

54. Place of birth

[] 1 In this governorate
[] 2 In another governorate ____
[] 3 Abroad ____

Residential status

55. Residential period in the recent place of residency
[] 1 From birth
[] 2 Less than a year
[] 3 One year or more ____
Previous place of residence:
56. Governorate or abroad
[] 1 In this governorate ____
[] 2 Abroad ____
57. Administrative unit
[] 1 Urban
[] 2 Rural
58. Reason for changing the place of residency
[] 1 Job
[] 2 Transfer of posting
[] 3 Appointment
[] 4 War
[] 5 Marriage or divorce or windowed
[] 6 Study or finishing studies
[] 7 Accompanying family
[] 8 To get a better living
[] 9 Other

For those who were born before the 10/17/1987[Applies to questions 59-61]

Usual place of residence before the population census in 1987

59. Governorate or abroad
[] 1 In this governorate
[] 2 In other governorate ____
[] 3 Abroad ____
60. Administrative unit
[] 1 Urban
[] 2 Rural
61. Nationality
[] 1 Iraqi
[] Arabic or foreigner
(Give the nationality) ____

For Iraqis only [Applies to questions 62-64]

62. Ethnicity ____

63. Religion ____

64. Local and foreign languages spoken by the person ____
Questions 65-67 are for students continuing their studies

65. Educational level

[] 1 Primary
[] 2 Intermediate and secondary
[] 3 Vocational
[] 4 Institutes
[] 5 College
[] 6 High diploma
[] 7 M.SC
[] 8 Ph.D.
[] 9 Highest degree acquired
[] 10 Others

66. Class or level ____

67. Specialization (for vocational schools, institutes, colleges and high studies students) ____
The fields (68-70) are filled for those who are more than (10) years old, excluding the students who were born in 1987 or earlier.

68. Persons without certificate

[] 1 Reading and writing
[] 2 Reading only
[] 3 Illiterate

69. For persons with certificates (mark with an [x] the highest certificate)

[] 1 Primary
[] 2 Intermediate
[] 3 Secondary
[] 4 Vocational
[] 5 Diploma
[] 6 B.A. or B.SCB
[] 7 Higher diploma
[] 8 M.A. or MSC
[] 9 Ph.D.
[] Higher degree acquired
[] Others

70. Specialization (for graduates of institutes, vocational schools, colleges and post graduates) ____

The fields (71, 72) are filled for all handicapped persons without recognition to the sex or age.

71. Type of disability

[] 1 No hearing
[] 2 Dumb
[] 3 No hearing and dumb
[] 4 Lost one eye
[] 5 Lost both eyes
[] 6 Lost one leg
[] 7 Lost both legs
[] 8 Lost one hand
[] 9 Lost both hands
[] 10 Insane
[] 11 Paralysis
[] 12 Others ____

72. Reasons for disability

[] 1 From birth
[] 2 War
[] 3 Traffic accident
[] 4 Work
[] 5 Illness
[] 6 Many reasons
[] 7 Others____

Information about private certificates

73. Name of office ____

74. Number of register book ____

75. Number of page ____