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Republic of Panama
Comptroller General
Directorate of Statistics and Census

CPV-01-1960

Form No. ____

Sixth National Population Census and Second Housing Census
11th December, 1960

Family Form

I. Location Identification

For Office Use Only:
____ Segment No.
____ Locality
____ Block Number
____ Form Number

1. ____ Province
2. ____ District
3. ____ Judicial Precinct (Corregimiento)
4. ____ Locality (City, Town or Hamlet)
5. ____ Segment No.
6. ____ Street name
7. ____ Building number
8. ____ Apartment or room number
9. ____ Census Sector No. (Only for the cities of Panamá and Colón)
10. ____ Block No. (Only for the cities of Panamá, Colón and David)

II. Dwelling

1. Classification of the housing units:

[] 1 Dwelling with occupants present at the moment of the census (occupied)
[] 2 Dwelling without occupants at the moment of the census
[] 3 Place not intended for habitation but used as a dwelling

Get data for questions 2 - 14 only for an occupied dwelling

2. Predominant material in the exterior walls of the building:

[] 1 Cement block, brick, stone
[] 2 Wood
[] 3 Clay-covered plant fiber (quincha), adobe
[] 4 Straw, palm leaves, cane
[] 5 Other (zinc, cardboard, etc.)

3. Floor material in the dwelling:

[] 1 Concrete [cement], tile
[] 2 Wood
[] 3 Brick
[] 4 Dirt
[] 5 Other

4. Toilet facilities:

[] 1 Private connected to sewer
[] 2 Private connected to a septic tank
[] 3 Private pit toilet
[] 4 Communal connected to sewer
[] 5 Communal connected to a septic tank
[] 6 Communal pit toilet
[] 7 Without toilet facilities

5. Drinking water:

[] 1 Public aqueduct
[] 2 Deep well, public or private (the water is extracted via pump)
[] 3 Other (shallow well, uncovered spring brocal, rain, river, etc.)

6. Type:

[] 1 Private house
[] 2 Apartment
[] 3 Room(s) in a tenement (casa de vecindad)

7. Number of Rooms: ____

8. Ownership:

[] 1 Owned (completely or partially paid for)
[] 2 Rented
[] 3 Other form

9. Monthly rent (only for rented dwellings):

B/. ____

10. Electricity:

[] 1 Yes
[] 2 No

11. Radio:

[] 1 Yes
[] 2 No

12. Refrigerator:

[] 1 Yes
[] 2 No

13. Stove

[] 1 Gas
[] 2 Electric
[] 3 Kerosene

14. Sale of articles and products made in the dwelling: (Clothing, cheeses, meals, etc.)

Write the name of the principal articles and products.
________

For office use:

____ Total number of people
____ Number of people per room

A. General Characteristics:

[Sidebar] Read each question before asking it

[The form has two columns for the first and second individuals. Except as noted, the questions and response options are identical for both individuals.]

[Person] No.

1st Person (Data for the Head)
2nd Person

Applicability

1. Name and surname of persons who slept in the dwelling the night of the 10th to 11th of December and of persons who passed the night outside of the dwelling, if they did not pass the night in a different dwelling. Do not forget newborns.

____
2. Relationship to the head of the family:

Mark the box corresponding to the relationship of the person to the head.

1st Person 1
[] Head

2nd Person
[] 2 Spouse or partner
[] 3 Son
[] 4 Other relatives
[] 5 Other

3. Sex:

Mark the appropriate box.

[] 1 Male
[] 2 Female

4. Age in years completed:

Write the age completed at last birthday. If under 1 year write the date of birth: (day, month and year)

____

5. Marital status:

Mark the appropriate box: Consensual union: lives in a marital union without being married. Single: has never been married and does not live in a marital union. Married: has contracted matrimony, whether living with the spouse or not. Widowed: has neither remarried nor lives in a marital union. Divorced: legally separated.

[] 1 Consensual union
[] 2 Single
[] 3 Married
[] 4 Widowed
[] 5 Divorced

6. Where were you born?

Write the name of the district of birth. If born in the Panama Canal Zone, write "Canal Zone". If born abroad, write the name of the country of birth.

____

7. Since when have you lived in this city, town or hamlet?

Write the year. If the person has always lived here or is in transit mark the appropriate box and do not ask question number 8.

[] X Always
[] Y In transit
Since ____ (year)

8. Where in the country did you live before settling here?

Write the name of the city, town or hamlet and the district to which it belongs. If in the Panama Canal Zone, write "Canal Zone". If directly from abroad, write the name of the country of origin.

Place ________
District ________

9. Nationality.

If born abroad write the nationality declared by the respondent. If born in the Republic of Panama mark a diagonal line.

____

10. Social Security:

If at any time you have made a Social Security payment, write the month and year of the last payment.

Month ____
Year ____

B. Educational Characteristics

Only for persons 7 years of age and older
[Questions 11-13 were asked only of persons aged 7 and older.]

11. What is the highest grade or year of schooling completed?

Write the number [of the grade or year] in the line corresponding to the class of schooling. If no grade was completed mark the box 04.

[] 1 Primary ____
[] 2 Secondary ____
[] 3 University ____
[] 4 No grade

12. Are you currently attending school?

If attending primary, secondary or university, write the grade or year in the corresponding blank. If attending another type of school, mark the box 04. If not attending school, write the box 05.

[] 1 Primary ____
[] 2 Secondary ____
[] 3 University ____
[] 4 Other type of school
[] 5 Not currently attending

13. Do you know how to read and write?

[] 1 Yes
[] 2 No

C. Economic Characteristics

Only for those 10 years of age and older.
[Questions 14-22 were asked only of persons aged 10 and older.]

[Sidebar] Read the explanation

[The form has two columns for the first and second individuals. Except as noted, the questions and response options are identical for both individuals.]

14. General classification:

Mark only one box as appropriate. Working: has a job or is employed. Looking for work: does not have work and is looking for work. Housewife: she who dedicates her time exclusively to the care of her home. Other: when none of the pervious terms applies to the person being enumerated (student, retired, etc.).

[] 1 Working
[] 2 Looking for work
[] 3 Homemaker [housewife]
[] 4 Other

15. For one who is working: Did you work during all of 1960? Mark the appropriate box.

[] 1 Yes
[] 2 No

16. For one who is looking for work:

If this person worked before write the number of months out of work. If this person has never worked before mark a diagonal line.

Months ____

17. Occupation:

For a person who is working write the occupation, position, job or class of work. For someone who has worked before and is seeking work, write the last occupation had.

____

18. For one who has never worked before and is looking for employment:

Write the degree, diploma, or certificate received. If no degree, write "without degree."

____

[Questions 19-22 were asked only of persons who were employed.]

19. Where do you work? (for those who are working) or where did you last work?

(for those who are looking for employment).

Write the name of the business, establishment, company, Federal or Municipal Government department.

____

20. What does this business (establishment or company) do?

Write grocery, agricultural plantation, clothing manufacture, bar, sale of food, etc., as the case may be.

____

21. Occupational category [employment status]:

(Only for one who is working) Mark the appropriate box. Owner: operates own company and supervises one or more employees. Employee: works for an owner and is remunerated. Own-account worker: operates own company and has no employees to supervise. Family worker: engages in unremunerated work in a company operated by a member of the family.

[] 1 Owner
[] 2 Employee
[] 3 Own-account
[] 4 Family worker

22. Wage or salary:

If a wage or salary is received, how much is earned? Write the amount in the appropriate space, according to whether the salary is set by the hour, day, week, or month.

[] 1 Per hour B/. ____
[] 2 Daily B/. ____
[] 3 Weekly B/. ____
[] 4 Monthly B/. ____

[The following three items appear to be the headings for this table, even though they appear at the bottom of the table]:

Number

1st Person (Data for the head of the household)
2nd Person

Date this form was filled in ____ of December, 1960
Signature of the Enumerator ____