2006 General Census of Population and Housing Items and Questions

Form No. 2 - Household Questionnaire - General Types

Province ________

County ________

District ________

City/rural region _______

Zone's code _______

Block number/village code _______

Village _______

Type of household

[] Normal settled
[] Collective

Order number of household in form 1 _ _ _ _

Is the household's questionnaire two or more sheets? ____

Mailing address of the household residence _______

Date of the interview _______

First and last name of surveyor _______
First and last name of group's expert _______
First and last name of inspector _______
First and last name of inspecting specialist _______

Person questions

1. Ranking number _ _

For all members of household
[Questions 2-13 were asked of all persons]

2. First and last name

For babies without a name, put "boy" or "girl" instead of the first name.
Consider children's age in the order.
_______

3. Relationship to head of the household

[] 1 Head of household
[] 2 Spouse
[] 3 Son/daughter
[] 4 Son/daughter-in-law
[] 5 Grandchild/great-grandchild
[] 6 Father/mother
[] 7 Brother/sister
[] 8 Father/mother-in-law
[] 9 Brother/sister-in-law
[] R Other relatives
[] B Non-relatives

4. Is the mother a member of the household?

[] 1 Yes
[] 2 No

5. Mother's rank in column 1

For code 1 in column 4
Rank _ _

6. Residential status

[] 1 Present
[] 2 Temporarily absent
[] 3 Abroad (for work/study)
[] 4 Other

7. Gender

[] 1 Male
[] 2 Female

Date of birth

8. Month _ _
9. Year _ _

10. Age

Age at last birthday? _ _
For younger than 1 year, include (- -)

11. Place of birth

[] 1 This city or village
Other place:

[] 2 City
[] 3 Village
[] 4 Abroad (name of the country) ________

12. Religion

[] 1 Muslim
Christian:

[] 2 Assyrian or Chaldean
[] 3 Armenian
[] 4 Other Christians

[] 5 Jew
[] 6 Zoroastrian
[] 7 Other

13. Citizenship

[] 1 Iran
[] 2 Afghanistan
[] 3 Iraq
[] 4 Pakistan
[] 5 Turkey
[] 6 Turkmenistan
[] 7 Azerbaijan
[] 8 Armenia
[] 9 Other countries ________

For present and temporarily absent individuals (codes 1 and 2 from column 6)
[Questions 14-15 were asked of present and temporarily absent individuals]

14. Have you changed your city/village of residency since October 1996?

[] Yes
[] No

15. Duration of residence in this city/village

For code 1 in column 14
For less than 1 year, include --.

Duration _ _

16. The reasons for changing the previous place of residence

[] 1 Seeking work
[] 2 Seeking better work
[] 3 Job transferring
[] 4 Education
[] 5 End of education
[] 6 Completing military service
[] 7 End of military service
[] 8 Accompanying the family
[] 9 Other

17. Place of previous residence

Elsewhere in the same Shahrestan (sub-province)

[] 1 City
[] 2 Village

Other Shahrestan (sub-province)

[] 3 City
[] 4 Village

[] 5 Abroad

18. Shahrestan (sub-province) of previous residence

For codes 3, 4, or 5 in column 17
For abroad, name of the foreign country.

Previous residence ________

Literacy and education
For 6 years old and older
[Questions 19-20 were asked of persons 6 years and older]

19. Is the individual in school?

[] 1 Yes, in Iran
[] 2 Yes (abroad)
[] 3 No

20. Literacy status

[] 1 Literate
[] 2 Illiterate

For code 1 in column 20
[Questions 21-22 were asked of literate persons]

21. Grade, course or degree ________

For school students: grade; for university students: course of study; for others: highest certificate or degree attained.

22. Field of study ________

For grade, course or degree.

For 10 years old and older

23. Working status

[] 1 Has worked at least 1 hour in the past 7 days
[] 2 Has a job, but hasn't worked for some reason in the past 7 days
[] 3 Has been seeking for a job in the past 30 days and is available to work
[] 4 Waiting for the new job to begin or to return to the old job and is available to work
[] 5 Student
[] 6 Has income, without a job
[] 7 House keeper
[] 8 Other

For codes 1 or 2 in column 23
[Questions 24-27 were asked of persons who are employed]

24. Occupation ________

25. Main activity of the work place ________

Name of the organization, for government organizations, and Islamic Revolution institutions

26. Status in employment

[] 1 Employer
[] 2 Own account worker
Wage and salary earner:

[] 3 Public sector
[] 4 Private sector

[] 5 Unpaid family worker

27. Place of work / education

For present and temporary absent individuals (codes 1 and 2 from column 6) who have codes 1, 2 or 5 in column 23.

[] 1 This city or village
Other place:

[] 2 City _______
[] 3 Village

28. Marital status

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

29. Number of changes in marital status:

For codes 1, 2 and 3 in column 20
Number _

For women who have codes 1, 2 or 3 in Column 20
[Questions 30-34 were asked of ever married women]

30. Have ever given birth to live-born children?

[] 1 Yes
[] 2 No

For code 1 in column 30
[Questions 31-34 were asked of ever married women who gave birth]

Number of live-born children

Total

31. Boy _ _

32. Girl _ _

Alive at present: living with this or another household

33. Boy _ _

34. Girl _ _

[Questions 35-39 were asked of ever married women between 10 and 54 years old]

35. Have given birth to live-born children in the past 365 days?

[] 1 Yes
[] 2 No

For code 1 in column 35
[Questions 36-39 were asked of ever married women between 10 and 54 years old who gave birth in the past 365 days]

Number of children born alive in the past 365 days

Total

36. Boy _ _

37. Girl _ _

Alive at present

38. Boy _ _

39. Girl _ _

40. Physical disability
[For all members of the household]

Does any member of the household have at least one of the following?
[Question 40 provides three columns to insert up to three disabilities for each household member]

[] 0 None
[] 1 Blindness
[] 2 Deafness
[] 3 Speech and voice disorder
[] 4 Hand amputation
[] 5 Hand impairment
[] 6 Leg amputation
[] 7 Leg impairment
[] 8 Torso impairment
[] 9 Mental disorder

Household questions

Question 41 should be filled out only for normal settled households.

41. Does the household have one of the following items?

1. Motorcycle (with gearbox and moped)

[] Yes
[] No

2. Light automobile (car, pick-up)

[] Yes
[] No

3. Computer

[] Yes
[] No

3.1. Does at least one of the household members use Internet in the place of residence?

[] Yes
[] No

Questions 42-55 should be filled out for collective and normal settled households.

42. Main fuel type consumed by household

Cooking

[] Kerosene
[] Gas oil
[] Liquid gas
[] Natural gas (public network)
[] Electricity
[] Solid fuel (firewood, charcoal)
[] Other
[] None

Heating

[] Kerosene
[] Gas oil
[] Liquid gas
[] Natural gas (public network)
[] Electricity
[] Solid fuel (firewood, charcoal)
[] Other
[] None

Providing hot water

[] Kerosene
[] Gas oil
[] Liquid gas
[] Natural gas (public network)
[] Electricity
[] Solid fuel (firewood, charcoal)
[] Other
[] None

43. Main water supply used by household

Drinking

[] Public water network in city/village
[] Improved well, spring, aqueduct, water reservoir
[] Unimproved well, spring, aqueduct, water reservoir
[] Water tank (fixed, mobile)
[] Packed water (bottle, gallon)
[] River, pond, brook, rain water
[] Other

Cooking

[] Public water network in city/village
[] Improved well, spring, aqueduct, water reservoir
[] Unimproved well, spring, aqueduct, water reservoir
[] Water tank (fixed, mobile)
[] Packed water (bottle, gallon)
[] River, pond, brook, rain water
[] Other

Other uses

[] Public water network in city/village
[] Improved well, spring, aqueduct, water reservoir
[] Unimproved well, spring, aqueduct, water reservoir
[] Water tank (fixed, mobile)
[] Packed water (bottle, gallon)
[] River, pond, brook, rain water
[] Other

44. Type of housing unit

[] 1 Conventional residential unit
[] 2 Tent
[] 3 Lodge
[] 4 Hut
[] 5 Slum or similar instances

Questions 45-55 should be filled out for households residing in Conventional residential unit (number 1 in Question 44)

45. Number of rooms available to household _ _

46. Type of tenure of the housing unit

[] 1 Owned land and building
[] 2 Owned building
[] 3 Rented
[] 4 Against service
[] 5 Rent-free
[] 6 Other

47. Facilities and utilities:

1. Electricity