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.

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

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

Questions to be answered by all persons

1. Sex

2. Is he/she

3a. Month of birth

3b. Year of birth (First three digits)


3c. Year of birth (last digit)

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

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

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

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?

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

b. If not, is he/she

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

b. If so, aid involves

c. Does this imply continuous confinement to bed?

8. Is he/she

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

10. What is his/her nationality?

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

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


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


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

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

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

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

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

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

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)

If presently married

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

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

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

Month of marriage

Year of marriage (First three digits)

Year of marriage (last digit)

d. Formerly married?

Questions to be answered for persons of 12 years and older only

1a. Does he/she still attend school full-time?

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


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?


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


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


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








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


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


Fill in these columns only when study is followed


Certificate obtained


Studies followed


Fill in these columns only when study is followed


Certificate obtained


Studies followed


Fill in these columns only when study is followed


Certificate obtained


Studies followed


Fill in these columns only when study is followed


Certificate obtained


Studies followed

Fill in these columns only when study is followed


Certificate obtained


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


b. In yes, which type?


















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

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


b. If yes, at what university ____

c. Department and principal subject ____

d. Examinations passed

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

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?

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?

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

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

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

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

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

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

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

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

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

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

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

Questions to be answered by temporarily unemployed persons only

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

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

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

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

Questions to be answered for head of households only

1. Is he/she

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

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

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

b. Has he/she

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?

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

1. Is the housing unit

2. Is the housing unit

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?

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

b. If not, is it owned by

c. Is the housing unit

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

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

c. Does this amount include costs for consumption of

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

6a. Is the dwelling a one family house

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

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

8. In what period was the dwelling build?

9. Is the dwelling connected to a public scheme for

10a. The dwelling has a (living) kitchen

b. And besides the following number of rooms

11a. Where is the toilet situated?

b. If a toilet is available is it

12a. Does the dwelling have a

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

13a. Does the dwelling have

b. Which is the principal heating fuel used?