Approved by the order No. 01/135 of the Chairman of the National Statistical Office of Mongolia in 2009.
Form HAOST-1
2010 Population and Housing Census of Mongolia
Questionnaire form
All responses in this questionnaire form are kept in secret in accordance with section 4 of Article 5 of Mongolian Law on Privacy of Individuals, and Article 18.3 of Law on Population and Housing Census of Mongolia.
____ Street name
____ Building number
____ Fence / door number
?1. Census committee number _ _ _
?2. Aimag/ capital city name and code _ _
?3. Soum/ district name and code _ _
?6. Questionnaire form number _ _ _
[] 2 Aimag center
[] 3 Village
[] 4 Soum center
[] 5 Countryside
[] 2 Sharing household
[] 3 Non-household
?10. Number of persons enumerated _ _
?11. Number of additional sheets _ _
?12. Are there any family members of this household who reside abroad for work or study for over six months? If yes, please state the number.
Section II. Information of persons residing abroad for over 6 months
[] 2
[] 3
[] 4
[] 5
[] 6
____ Given name
1. Relationship to head of the household _ _
[] 2 Female
4. Country presently residing _ _
[] 2 Contractual employment
[] 3 Regular employment
[] 4 Business / official mission
[] 5 Health / hospital
[] 6 Other
6 Duration of residence in abroad (in years) _ _
Whether the section II has further questions?
[] 2 No
Section III. Summary of the enumerated persons
1. Total number of persons enumerated
_ _ _ Male
_ _ _ Female
_ _ _ 15-59
_ _ _ 60+
_ _ _ 15-59
_ _ _ 60+
_ _ _ Male
_ _ _ Female
_ _ _ 15-59
_ _ _ 60+
_ _ _ 15-59
_ _ _ 60+
3. Number of temporarily absent persons
_ _ _ Male
_ _ _ Female
_ _ _ 15-59
_ _ _ 60+
_ _ _ 15-59
_ _ _ 60+
4. Number of temporarily present persons
_ _ _ Male
_ _ _ Female
_ _ _ 15-59
_ _ _ 60+
_ _ _ 15-59
_ _ _ 60+
5. Number of persons residing abroad
_ _ _ Male
_ _ _ Female
_ _ _ 15-59
_ _ _ 60+
_ _ _ 15-59
_ _ _ 60+
Population questionnaire
[The same questions were repeated for each person]
____ Clan name
____ Surname
____ Given name
To be asked from all ages.
[Questions 1-10 and 12-13 are asked of all persons. Question 11 was asked of persons aged 5 and older. Question 14 was asked of persons aged 2-39.]
1. Are you the head of the household?
[] 01 Yes
[] 11 No
1. What is your relationship to head of household?
[] 02 Wife / husband
[] 03 Son / daughter
[] 04 Parent
[] 05 Brother / sister
[] 06 Parent in law
[] 07 Son / daughter in law
[] 08 Grandparent
[] 09 Grandchild
[] 10 Other relative
[] 11 Non relative
[] 2 Female
3. What is your date of birth?
Month _ _
Day _ _
4. How old are you in complete years? _ _ _
[] 02 Stateless
[] Foreign. Specify country ____ _ _
If stateless or foreign, skip to question 7.
[] Other, specify ____ _ _
7. What is your residency status?
[] 2 Temporarily absent
[] 3 Temporarily present
(Place of usual residence for temporary present or place of current residence for temporary absent persons)
Soum / District (City) name: ____ _ _
8. What is your place of birth?
9. In the present place of usual residence, have you lived since birth or moved in?
[] 2 Returned back after usually residing in different place
[] 3 Moved in from different place
10. What was the place of your previous residence?
Year you last resided: _ _ _ _
11. What was the place of your usual residence in January 2005?
Aimag / Capital city (foreign country) name and locality: ____ _ _ _
12. Do you have any disability? If yes, please specify.
[] 2 Yes, congenital
[] 3 Yes, acquired
13. If you have any disability, please specify the type.
[] 2 Speaking
[] 3 Hearing
[] 4 Mobility
[] 5 Cognitive
[] 6 Other
14. Are you currently attending school (including preschool or kindergarten)?
[] 1 Yes
[] 2 No
To be asked from age 6 and above.
[Questions 15-18 are asked of persons aged 6 and older]
15. What is the highest level of education you completed?
[] 02 Primary school
[] 03 Secondary school
[] 04 High school
[] 05 Technical and vocational
[] 06 Specialized secondary
[] 07 Undergraduate
[] 08 Postgraduate
[] 09 Doctorate and above
If 02-09, go to question 17.
[] 2 No
17. Are you a mobile phone user?
[] 2 No
[] 2 Yes, always - other places
[] 3 Yes, when necessary
[] 4 No
To be asked from ages 15 and over.
[Questions 19-25 are asked of persons aged 15 and over]
19. What is your present marital status?
[] 2 Married
[] 3 Living together
[] 4 Separated
[] 5 Divorced
[] 6 Widowed
[] 2 Buddhism
[] 3 Christianity
[] 4 Islam
[] 5 Shaman
[] 6 Other
21. Last week, did you have a job of any kind?
[] 2 No, skip to question 25.
22. What is your occupation? ________ _ _ _ _
23. What is the main economic activity of your work (organization)? ________ _ _ _ _
24. What is your employment status?
[] 2 Employer
[] 3 Own-account worker
[] 4 Member of a cooperative
[] 5 Contributing to family work / business without payment
[] 6 Other
If 2 - 6, finish population questionnaire
25. What is the reason of your unemployment?
[] 2 On pension / retired
[] 3 Disabled
[] 4 Homemaker
[] 5 No suitable work available
[] 6 Looking for a job
[] 7 Not interested in working
[] 8 Other
1. What type of living quarter does your household occupy?
[] 2 House / building
[] 3 Living quarter not intended for human habitation, skip to question 11.
[] 4 Other, skip to question 11.
To be asked from households living in house / building.
[Questions 2-8 are asked of households living in house / building]
2. What is the type of your house / building?
[] 2 Convenient single family house
[] 3 Single family house
[] 4 Students' dormitory
[] 5 Staff dormitory
[] 6 Other public dwelling, skip to question 11.
3. How many rooms are there in this dwelling? _ _
4. What is the size of the total floor space? _ _ _ square meters.
5. Do you have a kitchen in this dwelling?
[] 2 Shared
6. Do you have a bath or shower in this dwelling?
[] 2 Mobile bath or shower
[] 4 No bath or shower available
7. What is your water supply system?
Non-central water supply system
[] 3 Portable system, skip to question 11.
8. Do you have hot or cold water?
[] 2 Cold only, skip to question 11.
To be asked from households living in gers.
[Questions 9-10 are asked of households living in gers.]
9. How many gers does your household have?
10. How many walls does your main ger have?
To be asked from all households
[Questions 11-21 are asked of all households]
11. What is the main source of drinking water?
[] 2 Water station connected with central water supply system
[] 3 Protected dug well
[] 4 Protected spring
[] 5 Bottled water
[] 6 Water station not connected with central water supply system
[] 7 Tanker trucks
[] 8 Unprotected dug well, spring, river, stream, lake or pond
12. How far do you usually get your drinking water from?
[] 2 200 to1000 metres
[] 3 Over 1000 metres
13. What is the main source of electricity of this dwelling?
[] 2 Diesel generating plants
[] 3 Renewable energy system
[] 4 Small-sized generators
[] 5 No electricity
14. What is the main source of heating of this dwelling?
[] 2 Low pressure stove
[] 3 Electric heaters
[] 4 Fire stove
15. What is the main type of fuel used for cooking?
[] 2 Gas
[] 3 Wood
[] 4 Coal
[] 5 Dung
[] 6 Other
16. What type of toilet facility do you have?
[] 2 Outside housing unit
[] 3 No toilet available, skip to question 18.
17. Do you share your toilet facility with others?
[] 2 Yes
18. What type of sewage disposal system do you have?
[] 2 Individual sewage disposal system / septic tank
[] 3 Pit latrine
[] 4 None
19. How do you dispose of household solid waste?
Dispose in a local dump area:
[] 3 Not authorized
20. What is the type of ownership for this dwelling?
Private:
[] 3 Individuals'
21. Under what kind of tenure is this dwelling?
[] 2 Rental
[] 3 Occupied free of rent
[] 4 Other arrangement
____ Signature
____ Date
____ Controller name
____ Signature
____ Date
____ Signature
____ Date
____ Data entry operator name
____ Signature
____ Date