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National Institute of Statistics
III General Population and Housing Census: The Republic of Mozambique


Section A: Geographic Location of the Dwelling
____ _ _ 1. Province
____ _ _ 2. District
____ _ _ 3. Administrative Post
[] 4. Urban area
5. Locality/Town/Village _ _
Name ____
6. Neighborhood ____ _ _
7. Enumeration Area No. _ _ _
8. Communal Unit _ _
Name ____
9. Block No. _ _ _

12. House No. _ _ _
13. No. of households in this dwelling _
14. No. of this household _
[] 4. Rural area
5. Locality ____ _ _
7. Enumeration Area No. _ _ _
10. Name of Village/ Settlement ____ _ _
11. Name of Zone/ Neighborhood ____ _ _
12. House No. _ _ _
13. No. of households in this dwelling _
14. No. of this household _
Enumerator: Write the home address that can be used by the National Institute of Statistics (INE) to locate and identify the household.

15.Home address:
Street: _______
No.: ____
Floor: ____
Apt: ____
Description: ________

Section B: To be filled out after Interview
1. Name of Head of Household
__________________________
2. No. of people in this household (Dwelling Population only):
_ _ 1 Male
_ _ 2 Female
_ _ 3 Total
3. No. of visits:
[] 1
[] 2
[] 3
[] 4

4. Declaration: I declare that the information in this Form is true and accurate.

Enumerator No.: _ _ _
Name (legible): _______
Signature: ________
Date: _ _-08-2007
Controller No.: _ _
Name (legible): ________
Signature: ________
Date: _ _-08-2007

Introduction: Good morning, I am (name). I work for the Census and here is my identification (show your badge/I.D). We are conducting our III General Population and Housing Census and I need to ask you some statistical data.

Section C: Persons' Names
Enumerator: Write the first and last names of the people in the space below. As you list them, start with the head of household followed by his/ her spouse and finally the rest of the members. Do not forget about the BABIES.

1. Please tell me the names of all the people who regularly live in this dwelling, whether or not they present:

1. _________________ R V
...
9. ________________ R V

2. In addition to these, please tell me the names of the people who spent the night of July 31 – Aug 1, 2007 in this dwelling:

1. _________________ R V
...
9. ________________ R V

Section D: Questions about the Population
Enumerator: Ask questions to all of the people listed in Section C.

1. Person No./ Name:

_ _ (from section C)
Name: ________

2. What is (the person)'s relationship to the head of the household?

[] 1 Head

3. Gender

[] 1 Male
[] 2 Female

4. What is (the person)'s age?
_ _write the age in completed years

5. Say whether at 12:00a.m. of August 1, 1997 in this household, (the person) was a/an:

[] 1 Permanent resident
[] 2 Absent resident
[] 3 Visitor

[Question 6 through 36 were asked to the residents]

6. What is (the person)'s race/origin?

[] 1 Black
[] 2 Mixed
[] 3 White
[] 4 Indian
[] 5 Pakistani
[] 6 Other

7. Where was (the person) born?

________ _ _ Province
________ _ _ District
________ _ _ City/Village
________ _ _ Foreigner

8. What is (the person)'s nationality?

[] 1 Mozambican
[] Foreigner - Indicate which one
____ _ _ _

9. Does [the person] have any disability?

[] 1 No- Go to question 11
Yes:
[] 2 Blind
[] 3 Deaf
[] 4 Amputated/ Atrophied arms(s)
[] 5 Amputated/ Atrophied legs(s)
[] 6 Paralysis
[] 7 Mental
[] 8 Other

10. What has caused the disability?

[] 1 Birth
[] 2 Disease
[] 3 Landmines/ War
[] 4 Military Service
[] 5 Labor accident
[] 6 Car accident
[] 7 Other


11. What is (the person)'s religion/belief?
[] 1 Catholic
[] 2 Anglican
[] 3 Islamism
[] 4 Zion
[] 5 Christian/ Pentecostal
[] 6 No religion (atheist, animist, agnostic, etc)
[] 7 Other ____ _ _ _ _

12. Is (the person)'s biological mother alive?

[] 1 Yes
[] 2 No
[] 3 Does not know
12. Is (the person)'s biological father alive?
[] 1 Yes
[] 2 No
[] 3 Do not know

For people aged 1-17 only.

14. Has [the person] been registered in the Civil Registry?

[] 1 Yes - Go to P16
[] 2 No

15. Why hasn't [the person] been registered in the Civil Registry?

[] 1 It is far
[] 2 It is not important
[] 3 Lack of information
[] 4 It is complicated
[] 5 It is expensive
[] 6 Other

For people aged 1+ only.

16. Where was (the person) living 1 year ago, in August 2006?

________ _ _ Province
________ _ _ District
________ _ _ City/Village
________ _ _ Foreigner

For peopled aged 5+ only.

17. Where was (the person) living 5 years ago, in 2002?

________ _ _ Province
________ _ _ District
________ _ _ City/Village
________ _ _ Foreigner

18. Say whether (in any language) the person:

[] 1 Can read and write
[] 2 Can read only
[] 3 Cannot read nor write

19. Does (the person) know how to speak Portuguese?

[] 1 Yes
[] 2 No

20. In what language did (the person) learn to speak?

________

21a. What language is most frequently used at home?

________
21b. Besides the ones mentioned, what other language does [the person] use in communication?
________

22. Say whether [the person]:

[] 1 Is attending school
[] 2 Has attended school
[] 3 Has never attended school - Go to question 26

23. What level of education does (the person) attend or, if no longer studying, the highest level they have attended.

[] 1 Literacy
[] 2 Primary School (1st – 5th grade)
[] 3 Primary School (6th – 7th grade)
[] 4 General Secondary School – 1st Cycle (8th – 10th grade)
[] 5 General Secondary School – 2nd Cycle (11th – 12th grade)
[] 6 Elementary Technical School
[] 7 Basic Technical School
[] 8 Upper Technical School
[] 9 Primary Teacher Training Course
[] 10 Higher Education

24. Has [the person] completed the level indicated in the previous question?

[] 1 Yes
[] 2 No- Go to question 26

25. If [the person] has completed Higher Education, please indicate the highest level.

[] 1 Bachelor's degree
[] 2 Licensure
[] 3 Mater's
[] 4 Doctor's


For people aged 7+ only

26. What activity did (the person) do in the last week of July, this year?

[] 1 Worked- Go to question 28
[] 2 Did not work, but had a job- Go to question 28
[] 3 Helped a relative- Go to question 28
[] 4 Looked for a new job- Go to question 28
[] 5 Domestic - Go to question 27
[] 6 Looked for a job for the first time- Go to question 32
[] 7 Served the FADM- Go to question 32
[] 8 Studied only- Go to question 32
[] 9 Retired/reserve- Go to question 32
[] 10 Was unable to work
[] 11 Other ____

27. If domestic, say whether on the week of July 25-31 this year, [the person]:
[Note: The word machamba refers to small plots of land used for agricultural practices].

[] 1 Has been to the Machamba
[] 2 Has produced or sold goods
[] 3 Has looked after the house/children only- Go to 32

28. What was [the person]'s main occupation/duty this week or the last time he/she worked? ____

29. What kind of activity is performed at the place where [the person] currently works? ____

30. Say whether [the person] is a (worker of):

[] 1 The Public Administration/ Government Agency
[] 2 The Local Autarchies
[] 3 A Government-owned Corporation
[] 4 The Private Sector
[] 5 The Cooperative sector
[] 6 A Non-profit Institution
[] 7 Domestic worker in a Private House
[] 8 Self-employed worker with Employees
[] 9 Self-employed worker without Employees
[] 10 Home worker without pay
[] 11 International Organizations/ Embassies
[] 12 The General Population and Housing Census

31. How many hours a day did [the person] work in the last week of July (25-31), this year? _ _

For people aged 12+ only.

32. What is [the person]'s marital status?

[] 1 Single
[] 2 Married
[] 3 Living together as married partners
[] 4 Divorced/Separated
[] 5 Widowed

For women aged 12- 50 only.

33. How many children born alive has [the person] had?

_ _ 1 No. of Male
_ _ 2 No. of Female

34. How many of [the person]'s children are alive?

_ _ 1 No. of Male
_ _ 2 No. of Female

35. How many children born alive has [the person] had in the past 12 months?

_ _ 1 No. of Male
_ _ 2 No. of Female

36. From those children born alive in the past 12 months, how many are alive?

_ _ 1 No. of Male
_ _ 2 No. of Female


Section E: Characteristics and Condition of the Dwelling
Enumerator: Fill out the Enumeration Form using the question about the dwelling. If there is more than one household within the dwelling, fill out questions 1-11 only, for the first household.

1. Type of dwelling:

Private:
[] 11 House
[] 12 Flat/apartment
[] 13 Hut
[] 14 Precarious Dwelling (shack, tin, cardboard)
[] 15 Mixed dwelling
[] 16 Basic dwelling (train house)
[] 17 Part of a commercial building
[] 18 Other: ________
Collective:
[] 21 Hospital unit
[] 22 Hotel/ Boarding house
[] 23 Barracks/ Military camp
[] 24 Boarding School/ Seminary/ Student residence
[] 25 Prison unit
[] 26 Other: ________
Homeless:
[] 27 Homeless people
Enumerator: If you have not checked off anything under “Private”, please finish the interview and turn to the last page of the Enumeration Form.

2. This dwelling is:

[] 1 Occupied- Go to question 4
[] 2 Vacant

3. Why is the dwelling vacant?

[] 1 It is for sale
[] 2 It is for rent
[] 3 It is under construction- Finish the interview
[] 4 It is for occasional use
[] 5 Other

[Questions 4 through 6 were asked those in private dwellings]

4. The dwelling is

[] 1 Owned
[] 2 Rented
[] 3 Lent/borrowed temporarily
[] 4 Other

5. The walls of the dwelling are made of:

[] 1 Cement blocks
[] 2 Bricks
[] 3 Wood/ zinc
[] 4 Adobe blocks
[] 5 Reed/ sticks/ bamboo/ palm tree leaves
[] 6 Weaved sticks (mud and wattle)
[] 7 Tin/cardboard/ paper/ canvas/ bark
[] 8 Other

6. The dwelling is roofed with:

[] 1 Concrete slab (cement)
[] 2 Tiles
[] 3 Asbestos plates
[] 4 Zinc plates
[] 5 Grass/ culms/ palm tree leaves
[] 6 Other
Enumerator: If you checked “Vacant” for question 12, finish the interview and turn to the last page of the Enumeration Form.

[Question 7 through 11, section F and G were asked those in private occupied dwellings]

7. The house floor is made of: (excluding kitchen and bathrooms)

[] 1 Wood/ parquet
[] 2 Marble/ granite
[] 3 Cement
[] 4 Mosaic/ ceramic
[] 5 Adobe (dirt floor)
[] 6 Nothing
[] 7 Other

[] Others

8a. How many rooms is the dwelling divided into? (excluding kitchen and bathrooms)_ _

8b. From those, how many are used for persons to sleep? _ _

9. What is the main source of water used to drink by this household?

[] 1 Piped water inside the dwelling
[] 2 Piped water outside the dwelling
[] 3 Water from fountain
[] 4 Water from well/ covered borehole with hand pump
[] 5 Water from well/ covered borehole without hand pump
[] 6 River/ Lake water
[] 7 Rain water
[] 8 Bottled water
[] 9 Other

10. The dwelling has:

[] 1 Flush toilet linked to septic tank
[] 2 Improved latrine
[] 3 Traditional improved latrine
[] 4 Non-improved latrine
[] 5 Does not have flush toilet/latrine

11. What is the main source of energy used for lighting in this dwelling?

[] 1 Electricity
[] 2 Generator/ Solar panel
[] 3 Gas
[] 4 Oil/ Paraffin/ Kerosene
[] 5 Candles
[] 6 Storage Battery
[] 7 Firewood
[] 8 Other

Section F: Durable Goods and Access to Information and Communication Technologies.

1. Does the household have? (admits more than one answer)

[] 1 Radio
[] 2 TV
[] 3 Telephone (landline)
[] 4 Computer
[] 5 Car
[] 6 Motorcycle
[] 7 Bicycle
[] 8 None of the above

2. In the past 12 months, how many members of this household used: Regardless of the place of use (e.g. at work, internet café, home, etc.)

[] 1 Computer: _ _ members
[] 2 Internet: _ _ members

3. How many people in this household have a cellular phone?

No. of People _ _

Section G: Agriculture and Fishing Activity

1. Does any member of this household practice agricultural activity on their own initiative?

[] 1 Yes
[] 2 No

2. Does this household have an aquaculture tank?

[] 1 Yes
[] 2 No

3. Does any member of this household practice artisanal fishing?

[] 1 Yes
[] 2 No

4. Does this household have cashew trees?

[] 1 Yes _ _ _
[] 2 No

5. Does this household have coconut trees?

[] 1 Yes _ _ _
[] 2 No

6. How many of the following animals does this household raise?

_ _ _ _ Cows/Oxen
_ _ _ _ Goats
_ _ _ _ Sheep
_ _ _ _ Pigs
_ _ _ _ Chickens
_ _ _ _ Ducks

Section H: Mortality
Enumerator: Get information about the deceased in the household. Do not forget about the deceased children.

1. In this household, has anybody passed away in the past 12 months? (from August 1, 2006 to July 31, 2007)

[] 1 Yes- Go to H2
[] 2 No (To make sure, ask whether in that period any newborn or infant has passed away)

2. If so, please specify:

Name of deceased people: ________
Sex
[] 1 Male
[] 2 Female
Age: ____
For Women aged 12-50 only:
Did death occur during pregnancy?
[] 1 Yes
[] 2 No
Did death occur during delivery?
[] 1 Yes
[] 2 No
Did death occur within 2 months after pregnancy or delivery?
[] 1 Yes
[] 2 No

Enumerator: Before you move on to the next household, make sure that:

1. There is information in Sections A and B (questions from Section A question 1 to Section B question 4) from the first page of the Enumeration Form
2. The names of all the members of the household are listed in Section C, on the first page of the Enumeration Form
3. You have collected all the information regarding the Household and the Dwelling.
4. The information is clear and legible
5. You have signed the Enumeration Form
6. You have stuck a tag for Enumerated Dwelling or Non-enumerated Dwelling
Thank the people for their cooperation and move on to the next household.
Notes: ________