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The information solicited is confidential
Decree-law No. 7, February 25th, 1960


Republic of Panama
Comptroller General
Directorate of Statistics and Census

Form No. ____

Eighth National Census of Population and Fourth of Housing
May 11th, 1980

Family Form

For office use:

____ Region number
____ Segment number
____ Form number
____ Locality
____ Block number

I. Location of the dwelling

1. ____ Segment No.
2. ____ Province
3. ____ District
4. ____ Judicial Precinct (Corregimiento)
5. ____ Locality
6. ____ Segment No. (number of name)
7. ____ Building number or name
8. ____ Apartment or room number
Only for the cities of Panamá and Colón, also write
9. ____ Block No.

II. Dwelling information

1. Type of dwelling

[] Private house
[] 1 Permanent
[] 2 Semi-permanent
[] 3 Improvised
[] 4 Apartment
[] 5 Room in a tenement (casa de vecindad)
[] 6 Place not intended for habitation but used as a dwelling
[] 7 Collective (group quarters)

2. Condition of the dwelling (occupancy)

[] 1 With inhabitants present
[] 2 With inhabitants absent (closed)
Unoccupied:
[] 3 For rent
[] 4 For sale
[] 5 Under repair
[] 6 Summer home
[] 7 Other reason

Ask questions 3 through 14 only for those dwellings, with inhabitants present, that are classified in boxes 1, 2, 3, 4, or 5 of question number 1, Type of Dwelling.

3. Rooms in this dwelling

How many rooms does the dwelling have? ____
Of these, how many are bedrooms? ____

Is there an area used exclusively for cooking?
[] 1 Yes
[] 2 No

4. Ownership

[] 1 Owned
[] 2 Owned, mortgaged
Monthly mortgage payment B./ ____
[] 3 Rented
Monthly rent B./ ____
[] 4 Ceded
[] 5 Condemned

5. Predominant material in the exterior walls of the building or house

[] 1 Cement block, brick, stone, concrete
[] 2 Fibro-cement, wood (planks, boards)
[] 3 Clay-covered plant fiber (quincha), adobe
[] 4 Straw, palm leaves, cane, sticks
[] 5 Other material or without walls

6. Predominant material in the roof of the building or house

[] 1 Cement
[] 2 Tile
[] 3 Fibro-cement
[] 4 Metal (zinc, aluminum, etc)
[] 5 Treated [coated] wood
[] 6 Straw or palm leaves
[] 7 Other

7. Material in the floor of the dwelling

[] 1 Pavement (concrete, tile, brick, etc.)
[] 2 Wood
[] 3 Earth
[] 4 Other

8. Source of drinking water

Public or private aqueduct (piped system):
Connected inside the dwelling
[] 1 Public IDAAN aqueduct
[] 2 Public community aqueduct
[] 3 Private aqueduct
Connected outside the dwelling
[] 4 Public IDAAN aqueduct
[] 5 Public community aqueduct
[] 6 Private aqueduct
Sanitary well:
[] 7 Public
[] 8 Private
[] 9 Unprotected well edge
[] 10 Rainwater
[] 11 Surface (superficial) well
[] 12 River or stream

9. Sewer facilities

Private:
[] 1 Connected to sewer
[] 2 Connected to septic tank
[] 3 Pit or latrine
Shared use:
[] 4 Connected to sewer
[] 5 Connected to septic tank
[] 6 Pit or latrine
[] 7 Without toilet facilities

10. Availability of bathroom

Private:
[] 1 Supplied with water by aqueduct
[] 2 Supplied with water by another method
Shared use:
[] 3 Supplied with water by aqueduct
[] 4 Supplied with water by another method
[] 5 Without bath

11. Lighting

With electric lighting:
[] 1 From the IRHE
[] 2 From a private utility
With another type of lighting:
[] 3 Gas
[] 4 Kerosene
[] 5 Other

12. Cooking fuel

[] 1 Electricity
[] 2 Gas
[] 3 Kerosene
[] 4 Charcoal
[] 5 Wood
[] 6 No cooking

13. Domestic appliances

Television
[] 1 Yes
[] 2 No

Radio
[] 1 Yes
[] 2 No

Telephone
[] 1 Yes
[] 2 No

Refrigerator
[] 1 Yes
[] 2 No

Washing machine
[] 1 Yes
[] 2 No

Sewing machine
[] 1 Yes
[] 2 No

14. Was this dwelling built between 1970 and 1980?

[] Yes
[] No
[] Doesn't know

If "Yes", write the year of construction ____

Comments on the dwelling: ________

For Office Use

____ Total
____ Males
____ Females

III. Population Data

[The following sections A, B, C, D, and E consist of a form with three columns, for the answers referring to the first, second and third individuals. Except for questions 1 and 4, the questions and the response options are identical for all three individuals.]

[4 Column headings across top of table:]
Individual information
Person 01
Person 02
Person 03

A. General Characteristics

1. Name and surname.

Begin with the head. Do not forget to include newborn infants and elderly persons.

________
2. What relationship or relation do you have with the head of dwelling?

Mark the appropriate box.

Person 01
[] 1 Head
Persons 02 - 03
[] 2 Spouse or partner of head
[] 3 Son or daughter
[] 4 Other relative (specify) ____
[] 5 Not related (specify) ____

3. Sex: Mark the appropriate box.

[] 1 Male
[] 2 Female

4. How old are you?

Write the age in years. If under 1 year of age, mark the appropriate box. If the age is unknown, ask the person to make an approximate guess.

Person 01
Years _ _
Persons 02 and 03
Years _ _
[] 00 Under 1 year

5. What is your current marital status?

Mark the appropriate box. For those under 15 years of age, mark box 8.

Consensual union: One who lives in a consensual union without being legally married. Single: One who has never married nor lived in a consensual union. Married: One who has contracted legal matrimony and lives in that state. Divorced: a person who is legally separated and who has neither remarried nor lives in a consensual union. Widow(er): a person whose spouse or partner has died and who has neither remarried nor lives in a consensual union. Separated: One who lives separately from a spouse or partner.

[] 1 Consensual union
[] 2 Single
[] 3 Married
[] 4 Divorced
[] 5 Widowed
Separated:
[] 6 From a marriage
[] 7 From a consensual union

6. Where were you born?

Mark the box "here" if born in the same locality or hamlet where enumerated. If born in another locality or hamlet, write the name of the place, the Judicial Precinct (corregimiento) and the District and the district to which it belongs. If born in the Panama Canal Zone, write "Canal Zone" in the space designated for "locality." If born abroad, write only the name of the country.

[] Here
Place or locality ____
Judicial Precinct (corregimiento) ____
District ____
In another country ____

7. How long have you lived in this locality or hamlet?

This refers to the place or hamlet of enumeration. Mark the appropriate box. If marking none of the boxes, write the month and year.

[] Always
[] Temporarily (de paso)
[] In transit (en tránsito)

[In the case of these three options,] skip to question 9.

Since ____ (month), 19_ _ (year)

8. Where did you live before settling yourself in this locality or hamlet?

Write the response given in the appropriate blank.

Locality ____
Judicial Precinct (corregimiento) ____
District ____
In another country ____

9. Is your mother currently alive?

Mark the appropriate box.

[] 1 Yes
[] 2 No
[] 3 Doesn't know

B. Educational Characteristics

10. What is the highest grade or school year of regular education you completed?

Write the number in the corresponding box, or mark in the box "No grade."
[The first three options have two boxes with the first digit (1, 2 or 3) already filled in and a second blank box to be filled in indicating the grade.

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

11. Do you know how to read and write?

When the person has approved at least the third grade of primary, do not ask this question and mark "yes."

[] 1 Yes
[] 2 No

12. What diploma, certificate or title (degree) do you have?

Write down the corresponding answer. In case the person possesses many degrees, register the one that corresponding to the highest level attained.

Title [degree] ____
School ____
[] None

13. Do you attend school currently?

Write the number in the appropriate box, according to the grade or year attending. If attending another type of irregular schooling or not attending school, mark X in the appropriate box.

[1] Primary ____
[2] Secondary ____
[3] University ____
[] 04 Preschool or daycare
[] 05 Other school
[] 06 Not attending

C. Economic Characteristics

14. During the last week, did you do any work or have a job?

Mark the appropriate box.

[] 1 Yes (Skip to question 17)
[] 2 No (Go on to question 15)

15. Were you looking for work last week?

Mark the appropriate box.

[] 1 Yes (Skip to question 17)
[] 2 No (Go on to question 16)

16. What was the reason for not looking for work last week?

Mark the appropriate box

[] 1 Does casual/occasional jobs
[] 2 Has been looking for more than three months
[] 3 Has looked before and is now waiting to hear
[] 4 Impossible to find work
(in the case of the above responses, go on to question 17)

[] 5 Housewife [homemaker]
[] 6 Student
[] 7 Disabled
[] 8 Retiree [reached retirement age/work years]
[] 9 Pensioner, rentier
[] 10 Retired [removed from workforce]
[] X Other condition
(in the case of responses 5 through X, skip to question 25)

17. What occupation, position, or type of work did you perform during the last week, or the last time you worked?

Example: auto mechanic, furniture-maker, doctor of dentistry. For one who has never worked, mark the box "new worker" and skip to question 25.

Occupation ________
[] New worker

_ _ _ _ [4-character blank for unspecified use appears here]

18. Where do you worked or where did you last work?

Example: "El Sol Supermarket," "Rita Industries," "Plantation Ranch," private home, in the street, etc.

Name of the Company or Institution ________

19. What does this business establishment or company do?

Example: Sales of foodstuffs, clothing manufacture. For those who state they work on an agricultural plantation, in the street, or in a private home, make a line through the space.

Principal Activity ________

_ _ _ _ [4-character blank for unspecified use appears here]

20. You work or worked last as:

Mark the appropriate box.

Employee
[] 1 of the government
[] 2 of a private company
[] 3 of a Canal Zone agency
[] 4 of a cooperative of communal organization
[] 5 Own-account worker
[] 6 Owner (boss)
[] 7 Member of a production cooperative or of a communal organization
[] 8 Family worker

21. Are you currently employed permanently or temporarily?

Mark the appropriate box.

[] 1 Permanent
[] 2 Temporarily [occasionally]

22. In which locality or hamlet is your job located?

(For all currently employed.)

[] Here
In another place:
Place ____
Judicial precinct ____
District ____
[] In another country

23. How many hours did you work last week?

(For all currently employed.)
Write the response given by the respondent.

Hours worked _ _

24. What wage or salary do you currently earn?

(Only for those currently employed.)
Write the response given by the respondent.

1 Per hour B/. ____
2 Daily B/. ____
3 Weekly B/. ____
4 Monthly B/. ____
5 Commission B/. ____

25. What was your total money income last month?

Include: Wage or salary, income from businesses and companies, sale of agricultural products, lottery winnings, polla [a type of lottery], pensions, retirement income, scholarships, real estate rents, etc. Write the amount in the appropriate blank.

B/. ____
[] No income

D. Fertility and Mortality

26. How many sons and daughters born alive have you had?

For women who have not had children, mark the box "none" and skip to question 30.

Total sons and daughters _ _
[] 00 None

27. Of these, how many are currently alive?

Write the response given by the respondent.

Total sons and daughters _ _

28. On what date was your last born-alive child born?

Write the response given by the respondent.

Day ____
Month ____
Year ____

29. Is your last son or daughter currently alive?

Mark the appropriate box.

[] 1 Yes
[] 2 No

E. Physical or mental disability

30. Do you have, from birth or other cause, any physical or mental disability?

Mark one or more boxes, as appropriate

Blind
[] 1 From birth
[] 2 Other cause
Deaf-mute
[] 3 From birth
[] 4 Other cause
Mental retardation
[] 5 From birth
[] 6 Other cause
Paralysis or other physical disability
[] 7 From birth
[] 8 Other cause
[] 9 No disability

Write your name and the date when you finish the interview.

Name of enumerator ____
Date ____