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Republic of Peru

National Institute of Statistics and Informatics
IX Population and IV Housing
National Censuses

1993

Census Questionnaire

Protected by Statistical Secrecy, Legislative Decree No. 604

____ Form number

[] 1 Additional form

First Section: Location of the Dwelling
1. Geographic location

____ Province
____ District

Populated area [centro poblado]

____ Name
____ Category

2. Urban area

Is the dwelling included in the list of dwellings?
[] 1 Yes
[] 2 No
____ Dwelling address: (street, avenue, route, etc.)
____ Door number
____ Floor number
____ Interior
____ Zone number
____ Section number
____ Urban Census Area [A.E.U.] number
____ Block number
____ Dwelling number
____ Household number

3. Rural area

____ Section number
____ Rural Census Area [A.E.R.] number
____ Dwelling number
____ Household number

Second Section: Dwelling Characteristics and Services

[Sidebar bracketing items 1 and 2]

Fill in these questions by direct observation.
1. Dwelling type:

Circle the appropriate number:

A) Private dwelling
[] 2 Independent house
[] 3 Apartment in a building
[] 4 Dwelling in a quinta (dwelling that is part of a group of one- or two-story dwellings located along an open-air patio)
[] 5 Dwelling in a tenement [Vivienda en casa de vecindad (callejón, solar o corralón)]
[] 6 Shack or cabin
[] 7 Improvised dwelling
[] 8 Place not intended for human habitation
[] 9 Other type (specify) ____
B) Collective dwelling
[] 11 Hotel, hostel, inn
[] 12 Hospital, clinic
[] 13 Boarding house
[] 14 Prison, reformatory
[] 15 Retirement home or hospice
[] 16 Other type (specify) ____
For collective dwellings, skip to the fifth section

2. Occupancy of the dwelling

Circle the appropriate number:
A) Occupied
[] 1 With people present
[] 2 With people absent
[] 3 Occasional use
B) Unoccupied, due to being:
[] 4 For rent or sale
[] 5 Under repair
[] 6 Other reason (specify) ____
In the case of responses 2 through 6, end the interview here.

[Sidebar: Beginning of interview]

If number 1 was circled in question 2, begin the interview with the person responsible for the dwelling.
3. The dwelling you occupy is:

Circle the appropriate number:

[] 1 Rented
[] 2 Owned, bought in installments
[] 3 Owned, completely paid for
[] 4 Used with the authorization of the owner, without payment
[] 5 De facto occupied (squatted)
[] 6 Other form (specify) ____

4. Construction material of the dwelling

Circle the appropriate number:

A) The predominant material in the exterior walls is:
[] 1 Brick or cement block
[] 2 Limed or cemented stone or ashlar, [piedra o sillar con cal o cemento]
[] 3 Adobe or mud wall (tapia)
[] 4 Cane sticks with clay (quincha o caña con barro)
[] 5 Stone with clay
[] 6 Wood
[] 7 Woven straw or reeds (estera)
[] 8 Other material (specify) ____

B) The predominant material in the roof is:
[] 1 Reinforced concrete
[] 2 Wood
[] 3 Tile
[] 4 Calamina [type of roof tile], fibrocement or other sheet material
[] 5 Cane sticks or woven plant material with clay
[] 6 Straw, palm leaves, etc.
[] 7 Other material (specify) ____

C) The predominant material in the floor is:
[] 1 Parquet or polished wood
[] 2 Asphalt membrane, vinyl or similar
[] 3 Paving stone [losetas], terrazzo, ceramic tile, or similar
[] 4 Wood (planks)
[] 5 Cement
[] 6 Earth
[] 7 Other material (specify) ____

5. The water supplied in the dwelling comes from:

Circle the appropriate number:

[] 1 Public network, inside the dwelling
[] 2 Public network, outside the dwelling but within the building
[] 3 Public tap
[] 4 Well
[] 5 Water tanker or similar
[] 6 River, irrigation ditch, spring or similar
[] 7 Other (specify) ____

6. The dwelling has toilet facilities (Water, toilet, latrine, etc.), connected to:

Circle the appropriate number:

[] 1 Public system, inside the dwelling
[] 2 Public system, outside the dwelling but inside the building
[] 3 Cesspit, latrine
[] 4 An irrigation ditch or canal
[] 5 Doesn't have toilet facilities

7. Is there electric lighting?

Circle the appropriate number:

[] 1 Yes
[] 2 No

8. Not counting the bathroom, kitchen, or hallways, how many total rooms are there in the dwelling?

Write the answer in the box: ____

9. Sir (Madam): If a household is a group of people who cook their food separately and sleep in the same dwelling, how many households are there in this dwelling?

Circle the appropriate number:

[] 1
[] 2
[] 3
[] 4
[] 5

Enumerator's instructions:
a) If the dwelling has only one household or is the principal household of a dwelling with various households, continue with the third section.

b) For secondary households, proceed as follows:
- For each household use one or more forms as necessary
- List the same information in the first section as for the principal household
- Leave the second section blank
- Begin the interview with the third section

Third Section: Household Characteristics
1. How many rooms in this household are used exclusively for sleeping?

Write the number in the box: ____

2. The separate room used for cooking is:

Circle the appropriate number:

[] 1 For the exclusive use of this household
[] 2 For shared use with another household
[] 3 There is no separate room for cooking

3. The sanitary facilities (water, toilet, latrine) are:

Circle the appropriate number:

[] 1 For the exclusive use of this household
[] 2 For shared use with another household
[] 3 There are no sanitary facilities

4. Is any part of the dwelling used to carry out activities which bring income to the household?

Circle the appropriate number:

[] 1 Yes
[] 2 No

5. Equipment in the household

Circle one or more numbers, as appropriate:

A) Does the household have any of the following domestic appliances?
[] 1 Radio
[] 2 Black and white television
[] 3 Color television
[] 4 Stereo equipment
[] 5 Video recorder
[] 6 Washing machine
[] 7 Refrigerator
[] 8 Vacuum cleaner
[] 9 Floor polisher

B) Does the household have any of the following machines or equipment?
[] 1 Sewing machine
[] 2 Knitting machine
[] 3 Computer
[] 4 Telephone

C) Does the household have any of the following means of transportation?
[] 1 Car or light truck for personal use
[] 2 Car for work use
[] 3 Light truck for work use
[] 4 Motorcycle/motor scooter
[] 5 Bicycle
[] 6 Tricycle for work

Fourth Section: People who make up the household

[Only for the head of the household]

1. In this household, including newborns and elderly people, how many people spent the night here the night before the day of the census?

Write the answer in the box: ____

2. What are the names and surnames of each person?

Enumerator's instructions:
According to the informant's response, list in the box labeled "Total Account of the People in the Household":

In column (B), the name and surnames of each person, following this order:

- Head
- Spouse or partner
- Single, childless children and stepchildren
- Married or partnered children and stepchildren and their families
- Parents or parents-in-law
- Other relatives (uncles, brothers, etc.)
- Household workers
- Boarders
- Other people not related to the head (friends, compadres, and
their families)

Use of forms:
a) Each form has room for 6 people
b) If there are more than 6 people in the household, use one or more Additional Census Forms.
c) On each Additional Form, repeat the same form number and circle the number 1 in the "Additional Form" box.
d) Then, copy the information from the first section: location of the dwelling and leave the second, third, and fourth sections blank.

"Total Account of the People in the Household" [table]:
[Column headings:]
(A) Order number (01 through 14)
(B) Name and surnames of the person

For enumerator use only:
Upon completing the interview in this household, review each census form used, then add up the total number of people enumerated according to sex (Question 2, fifth section) and list them in the following figure:

Total people enumerated in the household, according to sex
Total ____
Males____
Females____

Fifth Section: Population Characteristics

Person number____
Name: ____
For all individuals
[Applies to questions 1 - 6]

1. What relationship do you have with the head of household?

Circle the appropriate number:

[] 1 Head
[] 2 Spouse/partner
[] 3 Son/daughter
[] 4 Son-in-law/daughter-in-law
[] 5 Grandchild
[] 6 Parents/parents-in-law
[] 7 Other relatives
[] 8 Household workers
[] 9 Boarders
[] 0 Other non-relative

2. Sex

Circle the appropriate number:

[] 1 Male
[] 2 Female

3. What is your age in years completed?

Years completed _ _

For those under 1 year, write the number of months, for those under 1 month write 00.

Months completed _ _

4. In what district and province were you born?

If born in the district of enumeration, circle number 1.

[] 1 Born in this district
If born in another district or another country, specify their names in the appropriate blank.

Name of the district ____
Name of the province or country ____

5. Do you have any of the following disabilities?

Circle one or more numbers, as appropriate:

[] 1 Total blindness
[] 2 Total deafness
[] 3 Muteness
[] 4 Mental retardation
[] 5 Mental illness
[] 6 Polio
[] 7 Loss or paralysis of upper extremity
[] 8 Loss or paralysis of lower extremity
[] 9 Other (specify) ____
[] 0 No disability

6. Is your mother alive?

Circle the appropriate number:

[] 1 Yes
[] 2 No
[] 3 Do not know

For those 5 years of age and older[Applies to questions 7 - 11]

7. In what district and province did you usually live in July, 1988?

If living in the district of enumeration, circle number 1.

[] 1 Lived in this district
If living in another district or another country, specify their names in the appropriate blank.

Name of the district____
Name of the province or country____

8. The mother tongue, language or dialect you learned as a child is:

Circle the appropriate number:

[] 1 Quechua
[] 2 Aymara
[] 3 Other indigenous (native) language
[] 4 Spanish
[] 5 Foreign language

9. Are you able to read and write?

Circle the appropriate number:

[] 1 Yes
[] 2 No

10. Do you or did you attend any educational institution of regular instruction?

Circle the appropriate number:

[] 1 Not currently attending, but did attend
[] 2 Currently attending
[] 3 Never attended - Skip to question 12

11. What is the last year, grade of study, or level completed?

Circle the appropriate number:

[] 0 No level
[] 1 Initial or preschool
[] 2 Primary
[] 3 Secondary
[] 4 Basic regular
[] 5 Basic vocational (craftsmanship)

[Bracket around responses 2-5:] ____ Write the year or grade completed

Higher non-university:
[] 6 Incomplete
[] 7 Complete
Higher university:
[] 8 Incomplete
[] 9 Complete

For those 6 years of age and older[Applies to question 12 - 17]

12. What profession or trade do you have?

Examples: civil engineer, teacher of secondary education, electrician, secretary, carpenter, etc.
Specify____

13. Last week, you were:

("Last week" is the week prior to the census day.)
Circle the appropriate number:

[] 1 Working for an income
[] 2 Did not work but had a job
[] 3 Helping a relative without any payment
[] 4 Looking for a job, having worked before
[] 5 Looking for work for the first time
[] 6 Taking care of your home and not working
[] 7 Studying and not working
[] 8 Living from a pension or retirement and not working
[] 9 Living from investment income and not working
[] 0 Other, specify ____ (child, elderly, recruit, disabled, etc.)

[Bracket around responses 5-0:] Skip to question 18, if appropriate.
Questions 14 to 17 refer to last week, or to the last time employed.

14. What is the main occupation that you performed?

Examples: dentist, lawyer, agricultural laborer, food sales in the street, etc.
Specify____

15. What does the business, organization, or company in which you work do?

Examples: manufacture clothing, rice growing, raising cattle, wholesale grocery sales, etc.
Specify____

16. In your place of work, were you a:

Circle the appropriate number:

[] 1 Laborer
[] 2 White-collar or professional employee
[] 3 Unpaid family worker
[] 4 Domestic worker
[] 5 Self-employed worker
[] 6 Employer or owner

17. In your workplace, how many people work?

Circle the appropriate number:

[] 1 Fewer than 5 people
[] 2 Between 5 and 10 people
[] 3 More than 10 people

For those 12 years of age and older[Applies to questions 18 -19]

18. Your marital status is:

Circle the appropriate number:

[] 1 Cohabiting
[] 2 Married
[] 3 Widowed
[] 4 Divorced
[] 5 Separated
[] 6 Single

19. What is your religion?

Circle the appropriate number:

[] 1 Evangelical Christian
[] 2 Catholic
[] 3 Other (specify) ____
[] 4 None

For women 12 years of age and older[Applies to questions 20 -23]

20. How many live-born children have you had in total?

____
If she hasn't had children, write 0 and conclude the interview with this person.

21. How many of your children are currently alive?

____

22. In what month and year was your last live-born child born?

_ _ Month
_ _ Year

23. Is this last child currently alive?

Circle the appropriate number:

[] 1 Yes
[] 2 No