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Republic of the Philippines
National Statistics Office
Manila

1995 Census of Population
September 1, 1995

CP Form 1. Listing sheet

Appendix D
NSCB Approval No. A0477-R162-PN
Expires on - May 8, 1996

Page ___ of ___ pages.

Confidentiality
This census is authorized by Commonwealth Act No. 591 and Executive Order 121. All information is held strictly CONFIDENTIAL.

Certification
I hereby certify that the listing of households specified below was completed and the data set forth were obtained by me personally in accordance with the instructions.

___ Signature over printed name of EN
___ Date signed

Geographic Identification
__ __ Province
_____ City/Municipality
__ __ __ Barangay
__ __ EA No.

[There follows a table with 25 rows to record information for these 12 items:]

___ Date of Visit
___ Building Serial Number
___ Housing Unit Serial Number
___ Household Serial Number [Col. 5]
___ Institutional Serial Number [Col. 6]
___ Name of Household Head or Name/Type of Institution
If vacant housing unit, write VHU.
If vacant building, write VBLDG.

Address
___ Enter house number and street name or name of Sitio.

Population count

Encircle entries in Cols. 9, 10 and 11 [Total/Male/Female] for institutional population.

_ _ Total
_ _ Male
_ _ Female

___ Remarks

[Cols. 5 and 6 totals are entered at the bottom of the table.]
Total [Household Serial Number]
Total [Institutional Serial Number]

[Cols. 9, 10 and 11 totals are entered at the bottom of the table for each population group:]
Total household population
Total Institutional population


Republic of the Philippines
National Statistics Office
Manila

1995 Census of Population

Household Questionnaire

Page ___ of ___ pages.

CP Form 2.

September 1, 1995
NSCB Approval No. A0477-R162-PN
Expires on - May 8, 1996

Geographic Identification

__ __ Province
___ City/Municipality
__ __ __ Barangay
__ __ Enumeration Area No.
__ __ __ Household Serial No.
___ Address
House Number and Street Name or Name of Sitio

Interview Record

[There follows a table with three columns to record the following information:]

___ Date of Visit
___ Time Began
___ Time Ended
___ Result of Visit

[Enter code:]
1 Completed
2 Partly Completed
3 Refused
4 Postponed
5 SAQ
6 Household Not Around/No Respondent Around
7 Others, specify

___ Next Visit:

___ Date
___ Time

Summary

___ Total No. of Visits
___ Final Result of Visit [Uses same codes as "Result of Visit"]
___ Line No. of Respondent
___ Total HH Members

___ Total Males
___ Total Females

___ Children Below 15 Yrs. Old

Certification

I hereby certify that the enumeration of the household specified below was completed and the data set forth were obtained by me personally in accordance with the instructions.

___ Signature over printed name of EN
___ Date signed

Attested to and reviewed by:

___ Signature over printed name of TS
___ Date reviewed

All Persons
[Applies to questions P1-P10]

P1. Name

Who is the head of this household?

Who are the persons usually residing here as of September 1, 1995?

List in the following order (Write family name first)

Head
Spouse of the head
Never-married children of head/spouse (Oldest to youngest)
Ever-married children of head/spouse (Oldest to youngest)
Other members

Relationship to Head

P2. What is [respondent]'s relationship to the household head?
Enter code. (See codes sheet)

[] 1. Head
[] 2. Spouse
[] 3. Son
[] 4. Daughter
[] 5. Stepson
[] 6. Stepdaughter
[] 7. Son-in-law
[] 8. Daughter-in-law
[] 9. Grandson
[] 10. Granddaughter
[] 11. Father
[] 12. Mother
[] 13. Brother
[] 14. Sister
[] 15. Uncle
[] 16. Aunt
[] 17. Nephew
[] 18. Niece
[] 19. Other relative
[] 20. Non-relative
[] 21. Boarder
[] 22. Domestic helper

Overseas Worker

P3. Is [respondent] an overseas worker?
Encircle code.

[] 1.Yes
[] 2. No

Age

P4. What was [respondent]'s date of birth?

_ _ Month
_ _ Year

P5. What is [respondent]'s age as of his/her last birthday?
___

Was [respondent]'s birth registered with the LCR?
If yes, check line

___ Reg?

Sex

P6. Is [respondent] male or female?
Enter code. (See codes sheet)

[] 1. Male
[] 2. Female

Civil Status

P7. What is [respondent]'s civil status?
Enter code. (See codes sheet)

[] 1. Single
[] 2. Legally Married
[] 3. Widowed
[] 4. Separated/Divorced
[] 5. Common-Law/Live-in
[] 6. Unknown

Disability

P8. Does [respondent] have any problem with his/her eyes, ears, speech, communication, legs, arms or any combination of these impairments?
Encircle code.

[] 1. Yes
[] 2. No. Skip to P10.
P9. What type of disability does [respondent] have?
[] 01. Cannot see with both eyes (TOT-BLIND)
[] 02. Absence of one eye with low vision on the other eye (PART-BLIND)
[] 03. Can see form or movement but not details of objects (color, surface, lines) (LOW VISION)
[] 04. Cannot hear with both ears (TOT-DEAF)
[] 05. Cannot hear with one ear but with moderate hearing loss on the other ear (PART-DEAF 1)
[] 06. Can hear speech but cannot discriminate the words (PART-DEAF 2)
[] 07. Cannot say words (MUTE)
[] 08. Can say words but stammers (includes cleft-palate and hare-lip with speech defect) (SPEECH DEFECT)
[] 09. Loss of one or both arms/hands (NO ARM)
[] 10. Loss of one or both legs/feet (NO LEG)
[] 11. Paralysis of one or both upper extremities (PARA-ARMS)
[] 12. Paralysis of one or both lower extremities (PARA-LEGS)
[] 13. Paralysis of one arm and one leg (PARA-COM)
[] 14. Paralysis of all four limbs (QUADRIP)
[] 15. Can learn simple communication, elementary health and safety habit and simple manual skills, but does not progress in functional reading or arithmetic (REGARDED)
[] 16. Mentally ill (INSANE)
[] 17. Others, specify (includes multiple disabilities and other combination of arm-leg impairment/paralysis) (OTHER)

Ethnicity

P10. What is [respondent]'s citizenship?
If not Filipino, enter "97"
If Filipino, ask

What was [respondent]'s dialect/language spoken at home at earliest childhood?
[82 categories are specified in the CP Form 2A Codes Sheet: see image]

5 Years Old and Over

Highest Grade Completed

P11. What is the highest grade completed by [respondent]?
Enter code. (See codes sheet)

[] 00. No Grade Completed
[] 01. Pre-school
[] 11. Grade 1
[] 12. Grade 2
[] 13. Grade 3
[] 14. Grade 4
[] 15. Grade 5
[] 16. Grade 6
[] 17. Grade 7
[] 21. 1st Year High School
[] 22. 2nd Year High School
[] 23. 3rd Year High School
[] 24. 4th Year High School
[] 25. High School Graduate
[] 31. Postsecondary 1 year
[] 32. Postsecondary 2 years
[] 41. 1st Year College
[] 42. 2nd Year College
[] 43. 3rd Year College
[] 44. 4th Year College
[] 45. 5th Year College
[] 46. 6th Year College
[] 47. College Graduate
[] 51. Post-Baccalaureate

Trade Skills

P12. What trade skills does [respondent] possess?
If none, enter "00" and skip to P14.
[41 categories are specified in the CP Form 2A Codes Sheet: see image]

P13. How was the trade skill acquired?
Encircle code.

[] 1.Schooling/Training
[] 2.Experience/Apprenticeship
[] 3.Other

Economic Activity

P14. Is/Was [respondent] engaged in any economic activity currently/at any time in the past twelve months?
Encircle code.

[] 1. Yes
[] 2. No. Go to the next household member.

P15. For whom or where does/did [respondent] work?
Enter code. (See codes sheet)

[] 1. Worked for private household
[] 2. Worked for private business/enterprise/farm
[] 3. Worked for government/government corporation
[] 4. Self-employed without employee
[] 5. Employer in own farm or business
[] 6. Worked with pay on own family-operated farm or business
[] 7. Worked without pay on own family operated farm or business

P16. In what kind of business or industry is/was [respondent]'s current/last employer engaged in?
[37 categories are specified in the CP Form 2A Codes Sheet: see image]


Republic of the Philippines
National Statistics Office
Manila

1995 Census of Population

Institutional Population Questionnaire

Page ___ of ___ pages.

CP Form 3.

September 1, 1995
NSCB Approval No. A0477-R162-PN
Expires on - May 8, 1996

[CP Form 2 - Household Questionnaire - and CPForm 3 - Institutional Population Questionnaire - are very similar forms. Geographic Identification, Interview Record, Certification and most questions are identical. Only questions unique to CP Form 3 are included here. Note that while the common questions are worded the same, the question numbers are different.]

Geographic Identification


__ __ __ Institutional Living Quarter (ILQ) SN
____ Type of ILQ (See Codes)

[] 1. Hotels, lodging houses, dormitories, etc.
[] 2. Hospitals and nurses' home
[] 3. Welfare institutions
[] 4. Corrective and penal institutions
[] 5. Convents, nunneries, seminaries and boarding schools
[] 6. Military camps and stations
[] 7. Logging, mining and construction/ public works camp
[] 8. Ocean-going and inter island/coastal vessels
[] 9. Refugee camps
[] 0. Others

___ Name of ILQ
___ Address
House Number and Street Name or Name of Sitio

Residence Status

P2. What is [respondent]'s position or status?

Enter Code. (See Codes Sheet)

[] 1. Manager, director, in-charge
[] 2. Staff member/employee, including physicians and nurses
[] 3. Officer, enlisted man, trainee
[] 4. Officer or crew member in merchant vessel
[] 5. Priest, seminarian, nun
[] 6. Lodger or boarder
[] 7. Patient (Hospital, sanitarium, etc.)
[] 8. Inmate, ward (Home for the aged, orphanage, etc.)
[] 9. Prisoner/detainee
[] 0. Others, specify ____


1995 Census of Population

CP Form 2A (Codes Sheet)

[CP Form 2A is a two-page form with codes for variables on CP Form 2 (Household Population) and CP Form 3 (Institutional Population Questionnaire). Codes for responses to the following questions are included:

Relationship to HH Head
Civil Status
Disability
Ethnicity
Highest Grade Completed
Trade Skills
Class of Worker
Industry
Institutional Living Quarter
Residence Status (Institutional Population)

With the exception of Ethnicity, Trade Skills and Industry, these codes have been embedded beneath the relevant question in the preceding text.]