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14th Census of Population
Netherlands Central Bureau of Statistics

Annex Census of Housing

Questionnaire A

For a Head of a Household

The data to be filled in on this cover page will be used for control and correction of the municipal population register.

The data to be filled in on page 1 and subsequent pages will be used by the Central Bureau of Statistics for statistical purposes only.

Family name ____

For married and formerly married women please fill in maiden name as well.

Initials: ____
Sex (M or F) _
Date and year of birth: ____

Address: _________
Municipality: ____

When filling up this questionnaire please stick to the following rules:

1. Mark the applicable by blacking fully the little red box under the right answer.
2. Use black pencil only. Don't use pen or ballpoint please.
3. Please don't cross out wrong marks, but rub these out thoroughly.
4. Look through the detached explanatory notes.

Questions to be answered by all persons

1. Sex

[] Male
[] Female

2. Is he/she

[] Single
[] Married
[] Legitimately separated
[] Divorced
[] Widowed

3a. Month of birth

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December

3b. Year of birth (First three digits)

[] 186
[] 187
[] 188
[] 189
[] 190
[] 191
[] 192
[] 193
[] 194
[] 195
[] 196
[] 197

3c. Year of birth (last digit)

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

4a. Was he/she born in the present municipality or residence?

[] Yes
[] No

4b. When did he/she take residence in the present municipality of residence for the last time?

[] At birth
[] Before 1930
[] 1930-1939
[] 1940-1944
[] 1945-1949
[] 1950-1954
[] 1955-1959
[] 1960-1964
[] 1965-1969
[] After 1969

5. If not born in the present municipality of residence, in what province was he/she born?

If born abroad please turn to question 5 at the back of this page.

[] GR
[] FR
[] DR
[] OV
[] GLD
[] UTR
[] N-H
[] Z-H
[] ZLD
[] N-B
[] L

N.B. The following question is to be answered only if none of the answers preprinted in question 5 at the front of this page is applicable

5. What country and what municipality was he/she born in?

As country of birth should be regarded the country in which the municipality of birth is situated presently.

Municipality of birth: ____
Country of birth: ____

6a. Is he/she engaged in economic activity?

[] Yes
[] No

b. If not, is he/she

[] Homemaker in own household or in that of own parents
[] Pensioned, living from interest
[] Pupil or student
[] Unemployed, looking for job
[] No job for other reasons

7a. Is he/she disabled by illness, accident, age, congenial defect or the like.

Dependent on:
[] Human aid
[] Special expediencies

b. If so, aid involves

[] Personal care
[] Home-duties
[] Duties or transfer outside the home

c. Does this imply continuous confinement to bed?

[] Yes
[] No

8. Is he/she

[] Head of a multi-person household
[] Spouse of the head
[] Never married child of the head
[] Having a one-person household (living alone)

If he/she has another relation to the head of the household, please turn to question 8 at the back of this page.

9. What is the religious denomination he/she belongs to?

[] Dutch Ref.
[] Roman Cath.
[] Ref. Churches
[] Ref. Churches (free)
[] None

If belonging to another denomination (or humanist) please turn to question 9 at the back of this page.

10. What is his/her nationality?

[] Dutch
[] Belgian
[] German
[] Italian
[] None (stateless)

If he/she has another nationality please turn to question 10 at the back of this page.

N.B. Each of the following questions is to be answered only if none of the preprinted answers to the corresponding question at the front of this page is applicable.
8a. Describe the relation to the head of the household, to which he/she belongs

Fill in e.g. father, son-in-law, grand-daughter, servant living with the household, aunt, friend, boarder or the like. ______

b. Is he/she living together with never-married own and/or stepchildren?

[] Yes
[] No

c. If married: does he/she live together with spouse/husband?

[] Yes
[] No

d. If single: does he/she live together with own father and/or mother (stepfather and/or mother)?

[] Yes
[] No

9. Describe the religious denomination to which he/she belongs accurately?See detached explanatory notes. ________

10. Describe his/her nationality accuratelyIf more than one nationality, please fill in all nationalities concerned. ______

11. What has been his/her main source of livelihood in 1970?

[] Income from
[] Economic activity
[] Property or other investment
[] Pension (of any kind)
[] Benefit or assistance
[] Support by husband, parents or the like (alimony)

12. If drawing state pension: Has he/she on of that

[] Additional state aid
[] Income from other sources
[] No other income

13. In what class is his/her present own total gross income to be classified?

See explanatory notes

Class
[] A
[] B
[] C
[] D
[] E
[] Has no income of his/her own, no pension, no benefit or the like.

Questions to be answered for married and formerly married women only

1. How many babies has she ever had, not counting still births? (include deceased live-born children)

0
[up to]
18+

If presently married

2a. How many of these babies were born from her present marriage?

0
[up to]
18+

b. Do all of last meant children still live with her in the same household?

[] Yes
[] No

c. When did she get married (for the last time)?

Month of marriage

[] January
[] February
[] March
[] April
[] May
[] June
[] July
[] August
[] September
[] October
[] November
[] December

Year of marriage (First three digits)

[] 186
[] 187
[] 188
[] 189
[] 190
[] 191
[] 192
[] 193
[] 194
[] 195
[] 196
[] 197

Year of marriage (last digit)

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9

d. Formerly married?

Herself
[] Yes
[] No
Her husband
[] Yes
[] No

Questions to be answered for persons of 12 years and older only
1a. Does he/she still attend school full-time?

Also for students please fill in "yes"

[] Yes
[] No

b. If yes, what type of school does he/she attend?

Type of education ____

Department or subject ____

Class or grade ____

c. If he/she does not attend school full-time (anymore) has he/she after primary school attended any other school for longer than one year?

[] Yes
[] No

If question 1c is answered with "yes", please answer in any case fully the following questions 2 and 3

2a. Has he/she attended junior secondary school, secondary grammar school or junior seminary

[] Yes
[] No

b. If so, did he/she successfully pass the third year of study?

[] Yes
[] No

c. Which of the following certificates is he/she holding?

Junior secondary school
[] A
[] B
[] Modern Grammar school- 3 years
[] Commercial school
[] Senior secondary school
Modern Grammar School 5/6 years
[] A
[] B
Grammar school
[] A
[] B

3a. Did he/she undertake any other studies having a duration of at least one year?

[] Yes
[] No

b. If yes please proceed with question 4 at the back of this page

Which of the following studies did he/she follow?

N.B. Please add studies followed, which are not mentioned.

Studies followed

Junior Technical School

Fill in these columns only when study is followed

Department or subject ____

Certificate obtained

[] Yes
[] No

Studies followed

Apprentice Ship scheme

Fill in these columns only when study is followed

Department or subject ____

Certificate obtained

[] Yes
[] No

Studies followed

Technical evening classes

Fill in these columns only when study is followed

Department or subject ____

Certificate obtained

[] Yes
[] No

Studies followed

Domestic science school

Fill in these columns only when study is followed

Department or subject ____

Certificate obtained

[] Yes
[] No

Studies followed

Commercial evening school

Fill in these columns only when study is followed

Department or subject ____

Certificate obtained

[] Yes
[] No

5a. Has he/she attended a training college for teachers?

[] Yes
[] No

b. In yes, which type?

[] Nursery school teacher

Certificate obtained
[] Yes
[] No
[] Primary school teacher

Certificate obtained
[] Yes
[] No
[] Primary school head teacher

Certificate obtained
[] Yes
[] No
[] Primary school special subject teacher

Certificate obtained
[] Yes
[] No
[] Vocational school teacher

Certificate obtained
[] Yes
[] No
[] Secondary school teacher

Certificate obtained
[] Yes
[] No

c. Please describe below secondary school teachers' certificates held. ________

6a. Has he/she studied at a university?

[] Yes
[] No

b. If yes, at what university ____

c. Department and principal subject ____

d. Examinations passed

Intermediate
Yes
No
Final
[] Yes
[] No
Thesis submitted
[] Yes
[] No

Questions to be answered for economically active persons only (if looking for a job or on lay off from a job, turn to page 7)

1a. In what kind of occupation/function is he/she active? ________(See explanatory notes)

b. Please describe the activities, performed in this occupation/function ________

2. Is he/she active in this occupation/function as

[] Employee for salary, wages or commissions
[] Self-employed person in own business
[] Working in family business or farm (e.g. as spouse, child, brother)

If he/she is self-employed in his/her own business or is employed as managing or supervising employee:

3a. How many paid workers does he/she employ?
Or
How many workers does he/she (directly and/or indirectly) manage or supervise?

[] 0
[] 1-4
[] 5-9
[] 10-19
[] 20-49
[] 50+

N.B. Proceed with question 3b at the back of this page.

3b. What kind of managing or supervising function is he/she active in? ________
Fill in e.g. general manager, production, financial, research manager, head of personnel department, foreman, supervisor or the like.

4. If he/she is self-employed in his/her own business and apart from managing or supervising it, is assisting in its basic activity, in what kind of activity is he/she active? ________

5a. For whom does he/she work? ________(Please fill in name of company, business, organization or other employer)

b. What kind of industry, business, professional practice, school or other institution is this? ________
(Fill in, e.g. factory of steel windows, accountant's office, grocery, doctor's practice, primary school, secretariat of municipality, home for elderly people or the like)

c. What department (branches) does he/she work in? ________

d. Is the industry or institution he/she works for owned by the government, a province or municipality, an ecclesiastical organization, a corporation, a private person or the like? ________

6. What is the address where he/she is employed or where he/she reports daily before or after the work?

If having no fixed working or reporting address please give address of employer

Street ____
NR ____
Municipality ____

If working abroad please state name of country below
Country: ____

7. Is the address given in question 6 his/her

[] Fixed working address
[] Fixed reporting address (i.e. the address where he/she reports daily before or after the work)
[] He/she has no fixed working or reporting address

If he/she has a fixed working address or a fixed reporting address:

8a. What time does he/she usually need to get there?

[] He/she works at home
[] Less than 15 min
[] 15-29 min
[] 30-44 min
[] 45-59 min
[] 60-89 min
[] 90-119 min
[] 2 hours or more

b. What means of conveyance does he/she generally use to cover the greater part of the distance?

[] Bicycle
[] Motorized bike
[] Motorcycle scooter
[] Train
[] Tramway, subway
[] Motorbus
[] Public line
[] Provided for by employer

Private car or car provided for by employer
[] As driver
[] As passenger
[] Other means of conveyance
[] No means of conveyance

c. Does he/she usually go usually to and fro his/her working or reporting address at least four days a week?

[] Yes
[] No

9. Where does he/she exercise his/her occupation mainly?

[] In the municipality of residence
[] In one other fixed municipality
[] In various municipalities, at sea or the like

10. If he/she disposes of a car where does he/she park this car overnight?

In the open air
[] On the public road
[] Otherwise in the open air
Covered
[] In a hired garage
[] In a garage belonging to the dwelling
[] Otherwise covered

11. How many hours a week does he/she work on an average in the main occupation given in question la on page 5A?

[] Less than 10 hours a week
[] 10-14 hours a week
[] 15-19 hours a week
[] 20-24 hours a week
[] 25-29 hours a week
[] 30-34 hours a week
[] 35-39 hours a week
[] 40-44 hours a week
[] 45 hours or more a week

12a Does he/she exercise regularly one or more paying secondary occupations?

[] Yes
[] No

b. If yes, how many hours a week does he/she work therein on an average?

[] Less than 5 hours a week
[] 5-9 hours a week
[] 10-14 hours a week
[] 15-19 hours a week
[] 20-24 hours a week
[] 25-29 hours a week
[] 30 hours or more a week

c. Does he/she exercise the (principal) secondary occupation as

[] Salaried worker
[] Worker on own account
[] Family worker

Questions to be answered by temporarily unemployed persons only

1a. Is he/she looking for a job?

[] Yes
[] No

b. If yes, is he/she looking for his/her first job?

Don't regard as job activities performed during school time, holidays or the like

[] Yes
[] No

2. Is he/she registered at a labour exchange office?

[] Yes
[] No

3. What kind of a job is he/she looking for? ________
Or if not looking for a job:

In what job was he/she occupied lastly?

Give the answer to this question in question 1a, on page 5A

4. Is he/she employed temporarily

[] At a social workshop
[] At works for additional employment
[] He/she is not employed temporarily

Questions to be answered for head of households only

1. Is he/she

[] Main occupier
[] Without sub-tenants
[] With sub-tenants
[] Sub-tenants
[] Looking for separate dwelling
[] Not looking for separate dwelling

2. Has he/she a telephone connection in the house?

[] Yes, one connection
[] Yes, two connections
[] No connection

3. How many rooms are used by the household for business purposes only?

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9+

For sub-tenants only
4a. How many rooms has he/she rented from the main tenant?

(Please include kitchen and shared rooms, if any)

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9+

b. Has he/she

[] A free kitchen
[] The share of a kitchen
[] No use of a kitchen

c. How many rooms does he/she share apart from the kitchen with the main-tenant or with one or more of the other sub-tenants if any?

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9+

End of filling in by the population
To be filled in further by the enumerator

1. Is the housing unit

[] Occupied by one household
[] Occupied by two or more households
[] A dwelling without main tenant
[] A secondary dwelling
[] A vacant dwelling

2. Is the housing unit

[] A conventional dwelling
[] A dwelling with business premises
[] A farm or market gardeners house

If another kind of housing unit please turn to question 2 at the back of this page

B. The following question is to be answered only if none of the answers preprinted in question 2 at the front of this page is applicable.

2. Please describe kind of the housing unit?

Fill in e.g. condemned dwelling, hotel, boarding house, seasonal dwelling, barn or the like ________

3a. Is the housing unit occupied by the owner?

[] Yes
[] No

b. If not, is it owned by

[] The municipality
[] A building corporation
[] The state, a province or a polder
[] A private person
[] A private institution

c. Is the housing unit

[] Built according to the housing act
[] An official residence
[] A charity dwelling

4a. What is the rent (rental value) of the housing unit?

f _ _ _ _. _ _

Per
[] Week
[] Month
[] Quarter
[] Year

b. Encode the amount just given (Omit dimes and cents)

c. Does this amount include costs for consumption of

Water
[] Yes
[] No
Fuel
[] Yes
[] No
Other costs
[] Yes
[] No

5. Does the dwelling form part of a complex of at least 4 units for the housing of

Elderly people
[] Yes
[] No
Students, single women or the like
[] Yes
[] No

6a. Is the dwelling a one family house

[] Detached
Attached on
[] One side
[] Two sides
[] Part of a multi-family house
[] Part of a non-residential building

b. Where is the (main) living room situation?

[] In the basement
[] On the ground floor
On floor number
[] 1
[] 2
[] 3
[] 4
[] 5+

7. Has the dwelling an entrance door of its own?

[] Yes
[] No

8. In what period was the dwelling build?

[] Before 1906
[] 1906-1918
[] 1919-1930
[] 1931-1944
[] 1945-1949
[] 1950-1954
[] 1955-1959
[] 1960-1964
[] 1965-1969
[] After 1969

9. Is the dwelling connected to a public scheme for

Water
[] Yes
[] No
Electricity
[] Yes
[] No
Gas
[] Yes
[] No

10a. The dwelling has a (living) kitchen

[] Of less than 4 m2
[] Of 4-12 m2
[] Of 12 m2 or more
[] (Living) kitchen is lacking

b. And besides the following number of rooms

[] 0
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8
[] 9+

11a. Where is the toilet situated?

[] Inside the dwelling
[] Outside the dwelling, inside the building
[] Outside the building
[] Toilet is lacking

b. If a toilet is available is it

Connected to a public sewage disposal system?
[] Yes
[] No
A flush toilet
[] Yes
[] No

12a. Does the dwelling have a

[] Wash basin (eventually with shower)
[] Bath tub
[] Shower (without bathtub)
[] Bathing facilities are lacking

b. If bathing facilities are available, are these located in a separate room which is especially built for the purpose?

[] Yes
[] No

13a. Does the dwelling have

[] Own central heating
[] Central block heating
[] Central quarter/town heating
[] Central heating is lacking

b. Which is the principal heating fuel used?

[] Coal
[] Oil
[] Gas
[] Other fuel