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[Logo: National Institute of Statistics and Informatics (INEI)]
National census 2017: 12th census of population, 7th census of housing and 3rd census of indigenous communities
Census questionnaire
Statistical privacy: confidential information protected by supreme decree no. 043-2001-PCM
Additional questionnaire
____ Continued from:
____ Main Questionnaire No.
Section I. Location of the housing unit and number of households
Name ____
2. Province
Name ____
3. District
Name ____
4. Populated area
Name ________
Urban area
5. Zone No. _ _ _ - _
6. Section No. _ _ _
7. AEU (Urban census area) No. _ _ _
8. Block No. _ _ _ - _
9. Front No. _ _
10. Section No. _ _ _
11. AER (Rural census area) No.
_ _ _ Final
12. Housing unit address (In type of road, fill in only one oval)
[] 2 Street
[] 3 Jirón [street]
[] 4 Passage
[] 5 Highway
[] 6 Other
Door No. _ _ _ _ - _
Block _ _ _ _ _ _
Interior _ _ _ _ - _
Floor _ _
Block _ _ _ _ _
Lot _ _ _ _
Kilometer _ _ _ _
C. Number of households
(Begin interview with the head of household)
13. Sir/madam, if a household is the person or group of persons who share the same food and other basic needs, how many households occupy this housing unit?
Section II. Characteristics and services of the housing unit
1. Type of housing unit: by direct observation
A. Private housing unit
[] 2 Apartment in building
[] 3 Housing unit in a house
[] 4 Housing in a tenement house (Alley, lot, backyard)
[] 5 Shack or hut
[] 6 Makeshift dwelling
[] 7 Room not intended for human habitation
[] 8 Other type
[] 9 Hotel, hostel, lodging, boarding house
[] 10 Health care facility
[] 11 Prison
[] 12 Residential care center for the elderly
[] 13 Residential care center for children and adolescents
[] 14 Convents, monasteries or similar
[] 15 Barracks, camp, base of the Armed Forces or National Police
[] 16 Other type (specify) ____
[] 17 On the street (homeless)
[] 18 Gatehouse, port, airport or similar
2. Occupancy status of the housing unit: by direct observation
A. Occupied
[] 2 With people not present
[] 3 Occasional use
[] 5 Under construction or repair
[] 6 Abandoned or closed
[] 7 Other cause
Continue interview with the head of the home
3. In the housing unit, is the predominant construction material in the exterior walls:
[] 1 Brick or cement block?
[] 2 Stone or masonry block with lime or cement?
[] 3 Adobe brick?
[] 4 Tapia [Rammed earth]?
[] 5 Quincha (cane with mud)?
[] 6 Stone with mud?
[] 7 Wood (pona, tornillo, etc.)?
[] 8 Plywood, zinc, or matting?
[] 9 Other material?
4. In the housing unit, is the predominant construction material of the roof:
[] 1 Reinforced concrete?
[] 2 Wood?
[] 3 Shingles?
[] 4 Sheets of zinc, fiber cement or similar?
[] 5 Cane or mat with mud or cement?
[] 6 Plywood / matting / reed?
[] 7 Straw, palm leaves and similar?
[] 8 Other material?
5. In the housing unit, is the predominant construction material in the floors:
[] 1 Parquet or polished wood?
[] 2 Vinyl, asphalt sheets or similar?
[] 3 Tiles, terrazzo, ceramic or similar?
[] 4 Wood (pona, tornillo, etc.)?
[] 5 Cement?
[] 6 Dirt?
[] 7 Other material?
Section II. Characteristics and services of the housing unit (continued)
6. Does the water used in the housing unit come mainly from:
[] 1 Public network inside the unit?
[] 2 Public network outside the unit, but inside the building?
[] 3 Fountain or basin for public use?
[] 4 Cistern-truck or similar?
[] 5 Well (groundwater)?
[] 6 Spring or pond?
[] 7 River, irrigation canal, lake, lagoon?
[] 8 Other? (specify) ________
[If you fill in any number between 4 and 8, go to question 8]
7. Does the housing unit have water service every day of the week?
[] 1 Yes
7C. How many hours a day? _ _
8. Do you pay for water service?
[] 2 No -- Go to question 10
9. Which company or entity do you pay for the water service?
[] 1 Utility company (EPS - SEDA - EMAPA)
[] 2 Municipality
[] 3 Community organization
[] 4 Cistern-truck (direct payment)
[] 5 Other? (specify) ________
10. Is the bathroom or toilet in the housing unit connected to the:
[] 1 Public sewage network inside the unit?
[] 2 Public sewage network outside the unit, but inside the building?
[] 3 Soak pit, septic tank or biodigester?
[] 4 Latrine (treated)?
[] 5 Cesspit?
[] 6 River, irrigation canal, canal or similar?
[] 7 Open field or outdoors?
[] 8 Other?
11. Does the housing unit have electricity lighting from the public grid?
[] 2 No
12. How many rooms in total does the housing unit have excluding the bathroom, kitchen, corridors and garage?
13. Is the housing you occupy:
[] 1 Rented?
[] 2 Owned, without property title?
[] 3 Owned, with property title?
[] 4 Leased?
[] 5 Other form? (Specify) ____
Section III. Characteristics of the household
1. In your household, is the energy or fuel you use to cook food:
[] 1 Electricity?
[] 2 Gas (LPG balloon)?
[] 3 Natural gas (pipeline system)?
[] 4 Coal?
[] 5 Wood?
[] 6 Dung, manure?
[] 7 Other (agricultural waste, etc.)?
[] 8 No cooking
2. Does your home have:
(Read each alternative and fill in only one oval)
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
3. During the last 5 years, from October 2012 to now, did any person who was a member of this household permanently move to another country?
Section IV. Persons composing the household (only for the head of the household)
1. How many people slept in this household the night before census day?
Total persons _ _
2. What are the names and surnames of each of the people who slept here the night before census day?
Write down the persons in the order indicated below:
- Head of household
- Spouse or partner
- Unmarried children, stepchildren and/or adopted children
- Unmarried children, stepchildren and/or adopted children with children
- Married or cohabiting children, stepchildren and/or adopted children and their families
- Son-in-law/daughter-in-law
- Grandchild
- Parents and/or in-laws
- Other relatives (aunts, uncles, siblings, etc.)
- Household worker
- Retired person
- Other people not related to the head of household (friends, close relations, etc.)
No. _ _
Names ____
Paternal surname ____
Maternal surname ____
[This question is to be completed for all persons in the household]
If there are more than 10 people in the household, use one or more additional forms, as appropriate.
In private housing units: At the end of the interview in the household, review the census questionnaire and verify that the number of people counted in Section V. "Characteristics of the Population" is equal to the number of people registered in Section IV. "Persons composing the household." Then add up the total number of people in the fifth section by sex and write it in the respective boxes.
In collective or other type of housing: At the end of the interview, review Section V. "Characteristics of the Population" of the census questionnaires used, add up the total number of persons by sex and write it in the respective boxes.
_ _ _ _ _ Total
_ _ _ _ _ Males
_ _ _ _ _ Females
Section V. Characteristics of the population
Name ____
For all persons
[Questions 1-10 were asked of all persons]
1. What is the relationship to the head of household?
[] 1 Head of household
[] 2 Spouse or partner
[] 3 Child or stepchild
[] 4 Son-in-law or daughter-in-law
[] 5 Grandchild
[] 6 Father- or mother-in-law
[] 7 Sibling
[] 8 Other relative
[] 9 Household worker
[] 10 Boarder or guest
[] 11 Other non-relative
[] 2 Female
Month _ _
Year _ _ _ _
(If younger than 1 year old, write 0)
5. Does he/she live permanently in this district?
[] 2 No
____ Province / Country
If living abroad, write the name of the country only.
6. 5 years ago, as of October 2012, was he/she living in that district?
[] 2 Yes
[] 3 No
____ Province / Country
If living abroad, write the name of the country only
7. When you were born, did your mother live in that district?
[] 2 No
____ Province / Country
If living abroad, write the name of the country only
[] 1 Comprehensive Health Insurance (SIS)?
[] 2 ESSALUD?
[] 3 Military or police insurance?
[] 4 Private health insurance?
[] 5 Other insurance?
[] 6 None
9. The following are some questions to find out if you have any permanent difficulty or limitation that prevents you from carrying out your daily activities normally. Do you have any permanent difficulty or limitation for:
[] 1 Seeing, even when wearing glasses?
[] 2 Hearing, even with hearing aids?
[] 3 Speaking or communicating, even using sign language or other language?
[] 4 Moving or walking to use arms and/or legs?
[] 5 Understanding or learning (concentrating and remembering)?
[] 6 Relating to others based on thoughts, feelings, emotions, or behaviors?
[] 7 None
10. What is your national identity card number (DNI)?
[] 1 Only has birth certificate
[] 2 Only has a Foreigners ID card
[] 3 Does not have any documents
[] 4 Does not remember
For persons of 3 years of age and older
[Questions 11-15 were asked of persons age 3 years or older only]
11. Which language or mother tongue did you first learn to speak when you were a child?
[] 1 Quechua
[] 2 Aimara
[] 3 Ashaninka
[] 4 Awajún / Aguaruna
[] 5 Shipibo ? Konibo
[] 6 Shawi / Chayahuita
[] 7 Matsigenka / Machigueng
[] 8 Achuar
[] 9 Other native or indigenous language
[] 10 Spanish
[] 11 Portuguese
[] 12 Other foreign language
[] 13 Peruvian sign language
[] 14 Cannot speak / hear
12. Are you able to read and write?
[] 2 No
13. What is the last level and grade or year of study you passed?
[] 1 No level
[] 2 Initial
[] 3 Elementary school
[] 7 Complete non-university higher education
[] 8 Incomplete university education
[] 9 Complete university education
[] 10 Master's / doctorate degree
14. Are you currently attending an educational institution, school, high school, or university?
[] 2 No -- Go to question 16
15. Is the educational institution, school, high school, or university you attend located:
[] 1 Here, in this district?
[] 2 In another district (Specify)
____ Province / Country
Section V. Characteristics of the population (continued)
For persons of 5 years of age and older
[Questions 16-23 were asked of persons age 5 years or older only]
16. Last week, did you work to earn an income or to help with production at home?
[] 1 Yes -- Go to question 19
[] 2 No
[] 1 You did not work, but had a job (due to vacation, strikes, work stoppage, etc.)?
[] 2 Although you did not work, do you have any business of your own to which you will return?
[] 3 Did you do any occasional work (casual) for payment in cash or in kind?
[] 4 Did you work on a farm or in raising animals?
[] 5 Were you helping in a family member's store or business?
[] 6 Did you do chores at home and did not work?
[] 7 Did not work
[If responded 1-5, go to question 19]
18. Last week, were you actively looking for work?
[] 1 Yes
[] 2 No
[If answered, go to question 24]
19. Last week, what was your primary occupation?
(Specify) ____
20. Last week, what activity did you perform in the business, organization, or company in which you work?
(Specify) ____
21. Last week, at your place of employment did you work as:
[] 2 An independent or self-employed worker?
[] 3 An employee?
[] 4 A laborer?
[] 5 A worker in a family member's business?
[] 6 As a domestic worker?
[] 7 Other? (specify) ____
22. Last week at your place of employment, including yourself, were there:
[] 1 From 1 to 5 people working?
[] 2 From 6 to 10 people working?
[] 3 From 11 to 50 people working
[] 4 From 51 or more people working?
23. Is your workplace located:
[] 1 Here, in this district?
[] 2 In another district (Specify)
____ District
____ Province / Country
For persons of 12 years of age and older
[Questions 24-26 were asked of persons age 12 years and older]
24. Currently, what is your marital status?
[] 1 Cohabitant
[] 2 Separated
[] 3 Married
[] 4 Widowed
[] 5 Divorced
[] 6 Single
25. By your customs and your ancestors, do you feel or consider yourself to be:
[] 1 Quechua
[] 2 Aimara
[] 3 Amazonian native or indigenous? (specify) ____
[] 4 Belonging to or part of another indigenous or native people? (specify) ____
[] 5 Black, brown, zambo, mulato, Afro-Peruvian or Afro-descendant?
[] 6 White?
[] 7 Mixed-race (mestizo)?
[] 8 Other? (specify) ____
[] 1 Catholic
[] 2 Evangelical
[] 3 Other (specify) ____
[] 4 None
For women of 12 years of age and over
[Questions 27-29 were asked of women age 12 years and older]
27. How many total live births have you had?
[] 1 None -- Conclude the interview
28. How many of your children are currently alive?
[] 1 None
29. In what month and year was your last live-born child born?
Year _ _ _ _