Republic of the Philippines
National Statistics Office
2010 Census of Population and Housing
Sample Household Questionnaire
Certification
I hereby certify that the data set forth were obtained/ reviewed by me personally and in accordance with the instructions given.
____ Enumerator (Signature over printed name)
____ Date Accomplished
____ Team supervisor (signature over printed name)
____ Date reviewed
____ Census area supervisor (Signature over printed name)
____ Date reviewed
____ RD/PSO/DSO/SCO/CO (signature over printed name)
____ Date reviewed
Geographic Identification
Booklet [] of [] booklets
Province _ _
City/Municipality_ _
Barangay _ _ _
Enumeration area number _ _ _ _
Building serial number _ _ _ _
Housing unit serial number _ _ _ _
Household serial number _ _ _ _
Line number of respondent _ _
Cluster Number _ _ _
Name of household head
Address
Household definition: A household is a social unit consisting of a person living alone or a group of persons who sleep in the same housing unit and have a common arrangement in the preparation and consumption of food.
Household membership
Please list the persons or household members in this order
Spouse of the head
Never-married children of head/spouse from the oldest to the youngest
Ever-married children of head/ spouse and their families form the oldest to the youngest
Other relatives of head
Non relatives of head
[Interview record and number of visits omitted.]
Summary of visit
Enumerator's code _ _
Number of visits made _
Final result of Visit
[] 2 Partly completed
[] 3 Refused
[] 4 Postponed
[] 5 Household not around/ no respondent around
[] 6 Others, specify ____
_ _ Number of household members
_ _ Number of males
_ _ Number of females
P1. Name -Who is the head of this household? Who are the persons usually residing here as of May 1, 2010?
____ Last name
____ First name
For all persons.
[Question 2 through 12 were asked of all persons.]
P2. Relationship to head-What is [the respondent]'s relationship to the head of the household?
Specify____
[] 01 Head
[] 02 Spouse
[] 03 Son
[] 04 Daughter
[] 21 Stepson
[] 22 Stepdaughter
[] 23 Son-in-law
[] 24 Daughter-in-law
[] 31 Grandson
[] 32 Granddaughter
[] 33 Father
[] 34 Mother
[] 41 Brother
[] 42 Sister
[] 43 Uncle
[] 44 Aunt
[] 55 Nephew
[] 56 Niece
[] 57 Other relative
[] 58 Nonrelative
[] 65 Boarder
[] 66 Domestic help
P3. Sex - Is [the respondent] a male or female?
[] 1 Male
[] 2 Female
P4. Date of Birth - In what month and year was [the respondent] born?
Year _ _ _ _
P5. Age - What is [the respondent]'s age as of his/her last birthday?
Age _ _ _
P6. Birth Registration -Was [the respondent]'s birth registered with the Civil Registrar Office?
[] 1 Yes
[] 2 No
[] 3 Don't know
P7. Marital Status -Is [the respondent] single, married, widowed, divorced/separated, or in a common-law/live-in arrangement?
[] 1 Single
[] 2 Married
[] 3 Widowed
[] 4 Divorced / separated
[] 5 Common-law / Live-in
[] 6 Unknown
P8. Religious Affiliation - What is [the respondent]'s religious affiliation?
Religious Affiliation ____
P9. Citizenship- Is [the respondent] a citizen of the Philippines?
[] 1 Yes, (Filipino citizen)
[] 2 Yes, (Filipino with dual citizenship)
[] 3 No
P10. Citizenship- What country/other country is [the respondent] a citizen of?
Country / other country of citizenship ____
P11. Ethnicity- What is [the respondent]'s ethnicity by blood? Is he/she a/an ____?
Ethnicity ____
P12. Disability - Does [the respondent] have any physical or mental disability?
[] 1 Yes
[] 2 No
For all 5 years old and over.
[Questions P13 to P16 were asked of persons 5 years or over.]
P13. Functional difficulty
Does [the respondent] have any difficulty/problem in ...?
[] No
[] No
[] No
[] No
[] No
[] No
1. Are there any other persons such as small children or infants and overseas workers who were not yet listed?
[] 2 No
2. If there are more than 6 members in this household, write an X mark in the box for Yes. Otherwise, write X in the box for No.
[] 2 No
P14. Residence 5 years ago - In what city/municipality did [the respondent] reside on May 1, 2005?
[] 0000 Same city/municipality
[] 8887 Foreign Country
____ Province
____ City / Municipality
P15. Literacy- Can [the respondent] read and write a simple message in any language or dialect?
[] 1 Yes
[] 2 No
P16. Highest grade/ year completed- What is the highest grade/year completed by [the respondent]?
[] 010 Pre-School
Elementary
[] 220 Grade 2
[] 230 Grade 3
[] 240 Grade 4
[] 250 Grade 5
[] 260 Grade 6
[] 270 Grade 7
[] 280 Elementary graduate
[] 320 2nd year
[] 330 3rd year
[] 340 4th year
[] 350 High school graduate
[] 420 2nd year
[] 430 3rd year
If graduate, specify course____
[] 820 2nd year
[] 830 3rd year
[] 840 4th year
[] 850 5th year
[] 860 6th year or higher
[] 900 Post baccalaureate
If graduate, specify course____
For all 5 to 24 years old.
[Questions 17 and 18 were asked of persons 5-24 years old]
P17. School attendance- Did [the respondent] attend school at any time from June 2009 to March 2010?
[] 1 Yes
[] 2 No
P18. Place of school- In what city/municipality is [the respondent] attending school?
[] 0000 Same city/municipality
[] 8887 Foreign Country
____ Province
____ City / Municipality
P19. Overseas workers
Is [the respondent] an overseas worker?
[] 1 Yes
[] 2 No
For all 15 years old and over.
[Questions 20 to 23 were asked of persons 15 years and over]
P20. Usual occupation - During the past 12 months, what was [the respondent]'s usual activity/occupation?
Occupation____
P21. Kind of Business or Industry- In what kind of business or industry did [the respondent] work during the past 12 months?
Industry____
P22. Class of worker- What kind of worker is [the respondent]?
[] 1 Worked for private household (domestic services) -PHH
[] 2 Worked for private business/enterprise/firm -PVT
[] 3 Worked for government/government corporation - GOV
[] 4 Self-employed without any paid employees -SELF
[] 5 Employer in own farm or business -EMP
[] 6 Worked with pay in own family-operated farm or business -PAID
[] 7 Worked without pay in own family-operated farm or business -UNPAID
P23. Place of Work - In what city/municipality did [the respondent] work during the past 12 months?
[] 0000 Same city/municipality
[] 8887 Foreign Country
____ Province
____ City / Municipality
Fertility indicators.
For all females 15 to 49 years old.
[Questions 24 through 27 were asked of females 15 to 49 years old]
P24. How many children have been born alive to [the respondent]?
Children born alive _ _
P25. How many children are still living?
Children still living _ _
P26. How many children were born alive to [the respondent] from May 1, 2009 to April 30, 2010?
Children born_
P27. What is [the respondent]'s age at first marriage?
Age _ _
B1 to B4 are to be answered by mere observation, if doubtful, ask the respondent.
[] 1 Single house
[] 2 Duplex
[] 3 Multi-unit residential (three units or more)
[] 4 Commercial / industrial/agricultural (office, factory, and others)
[] 5 Institutional living quarters (hotel, hospital, and others)
[] 6 Other housing units (boat, cave, and others)
B2. Construction material of the roof
[] 1 Galvanized iron / aluminum
[] 2 Tile concrete / clay tile
[] 3 Half galvanized iron and half concrete
[] 4 Wood
[] 5 Cogon / nipa / anahaw
[] 6 Asbestos
[] 7 Makeshift / salvaged / improvised materials
[] 8 Others, specify ____
B3. Construction materials of the outer walls
[] 1 Concrete/brick / stone
[] 2 Wood
[] 3 Half concrete / brick / stone and half wood
[] 4 Galvanized iron / aluminum
[] 5 Bamboo / sawali / cogon / nipa
[] 6 Asbestos
[] 7 Glass
[] 8 Makeshift/salvaged/improvised materials
[] 9 Other, specify ____
[] 10 No walls
B4. State of repair of the building/ house
[] 1 Need no repaid / needs minor repair
[] 2 Need major repairs
[] 3 Dilapidated / condemned
[] 4 Under renovation/ being repaired
[] 5 Under construction
[] 6 Unfinished construction
[] 7 Not applicable
B5. Year building / house was built- When was this building/house built?
[] 01 2010
[] 02 2009
[] 03 2008
[] 04 2007
[] 05 2006
[] 06 2001-2005
[] 07 1991-2000
[] 08 1981-1990
[] 09 1971-1980
[] 10 1970 or earlier
[] 12 Don't know
D1. Floor area of this housing unit. - What is the estimated floor area of this housing unit?
[] 01 Less than 5 square meters / less than 54 square feet
[] 02 5-9 square meters / 54-107 square feet
[] 03 10-19 square meters / 108-209 square feet
[] 04 20-29 square meters / 210-317 square feet
[] 05 30-49 square meters / 318-532 square feet
[] 06 50-69 square meters / 533-748 square feet
[] 07 70-89 square meters / 749-963 square feet
[] 08 90-119 square meters / 964-1286 square feet
[] 09 120-149 square meters / 1287-1609 square feet
[] 10 150-199 square meters / 16010-2147 square feet
[] 11 200 square meters and over / 2148 square feet and over
[] 12 Not applicable
H1. Fuel for lighting- What type of fuel does this household use for lighting?
[] 1 Electricity
[] 2 Kerosene (gaas)
[] 3 Liquefied petroleum gas (LPG)
[] 4 Oil (vegetable, animal, and others)
[] 5 Others, specify____
[] 0 None
H2. Fuel for cooking - What kind of fuel does this household use most of the time for cooking?
[] 1 Electricity
[] 2 Kerosene (gaas)
[] 3 Liquefied petroleum gas (LPG)
[] 4 Charcoal
[] 5 Wood
[] 6 Others, specify ____
[] 0 None
H3. Source of water supply for drinking, cooking, and laundry/bathing - What does this household's main source of water supply for drinking, cooking, and laundry/bathing?
[] 02 Shared, faucet community water system
[] 03 Own use, tubed / piped deep well (at least 100 ft/30m deep)
[] 04 Shared, tubed / piped deep well
[] 05 Tubed / piped shallow well
[] 06 Dug well
[] 07 Protected spring
[] 08 Unprotected spring
[] 09 Lake, river, rain, and others
[] 10 Peddler
[] 11 Bottled water
[] 12 Other, specify ____
[] 02 Shared, faucet community water system
[] 03 Own use, tubed / piped deep well ( at least 100 ft/30m deep)
[] 04 Shared, tubed / piped deep well
[] 05 Tubed / piped shallow well
[] 06 Dug well
[] 07 Protected spring
[] 08 Unprotected spring
[] 09 Lake, river, rain, and others
[] 10 Peddler
[] 11 Bottled water
[] 12 Other, specify ____
[] 02 Shared, faucet community water system
[] 03 Own use, tubed / piped deep well ( at least 100 ft/30m deep)
[] 04 Shared, tubed / piped deep well
[] 05 Tubed / piped shallow well
[] 06 Dug well
[] 07 Protected spring
[] 08 Unprotected spring
[] 09 Lake, river, rain, and others
[] 10 Peddler
[] 11 Bottled water
[] 12 Other, specify ____
H4. Tenure status of the housing unit- Do you own or amortize this housing unit occupied by your household or do you rent it, or do you occupy it rent-free with consent of owner, or rent-free without consent of the owner?
[] 1 Owned/ Being amortized/ owner-like possession
[] 2 Rented [Skip to H7]
[] 3 Rent-free with consent of owner [Skip to H8]
[] 4 Rent-free without consent of owner [Skip to H8]
H5. Acquisition of the housing unit- How did you acquire this housing unit?
[] 1 Inherited [Skip to H8]
[] 2 Gift [Skip to H8]
[] 3 Company benefit [Skip to H8]
[] 4 Purchased
[] 5 Other, specify____
H6. Source of financing of the housing unit- Did you avail of the following source of financing in the construction/ purchase of this housing unit?
[] No
[] No
[] No
[] No
[] No
[] No
H7. Monthly rental of the housing unit- How much is the monthly rental of this housing unit?
[] 1 PhP 500 or less
[] 2 PhP 501-1,000
[] 3 PhP 1,001-1,500
[] 4 PhP 1,501-2,000
[] 5 PhP 2,001-4,000
[] 6 PhP 4,001-6,000
[] 7 PhP 6,001-7,500
[] 8 PhP 7,501-10,000
[] 9 PhP 10,000 and over
H8. Tenure status of the lot - Do you own or amortize this lot occupied by your household, do you rent it, or do you occupy it rent-free with consent of owner, or rent-free without consent of the owner?
[] 1 Owned/ Being amortized / owner-like possession
[] 2 Rented
[] 3 Rent-free with consent of owner
[] 4 Rent-free without consent of owner
[] 5 No applicable, specify ____
H9. Usual manner of garbage disposal - How does your household usually dispose of your kitchen garbage such as leftover food, peeling of fruits and vegetables, fish and chicken entrails, and others?
[] 1 Picked up by garbage truck
[] 2 Dumping in individual pit (not burned)
[] 3 Burned
[] 4 Composting
[] 5 Burying
[] 6 Feeding to animals
[] 7 Others, specify____
H10. Kind of toilet facility - What type of toilet facility does this household use?
[] 1 Water-sealed, sewer septic tank used exclusively by household
[] 2 Water-sealed, sewer septic tank used shared with other households
[] 3 Water-sealed, other depository, used exclusively by household
[] 4 Water-sealed, other depository, shared with other households
[] 5 Closed pit
[] 6 Open pit
[] 7 Others (pail system, and others)
[] 0 None
H11. Land ownership - Does any member of this household own the following?
[] No
[] No
[] No
[] No
H14. Presence of household conveniences/devices - Does this household have the following household conveniences/deceives in working condition?
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
H15. Internet access- Does this household have access to internet?
[] No
[] No