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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

Last name, First name________

Address

Household number and street or name of site

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

Head
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

[] 1 Completed
[] 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

Population Census Questions

P1. Name -Who is the head of this household? Who are the persons usually residing here as of May 1, 2010?

Please list the persons or household members in the order specified on page 3A.

____ 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?

Write description on the space provided. Please see codes at the bottom.

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?

Write X in the box.

[] 1 Male
[] 2 Female

P4. Date of Birth - In what month and year was [the respondent] born?

Month _ _
Year _ _ _ _

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

Write the age in the boxes.

Age _ _ _

P6. Birth Registration -Was [the respondent]'s birth registered with the Civil Registrar Office?

Write X in the box.

[] 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?

Write X in the box corresponding to answer. For persons 0 to 9 years old, write an X mark in the box for single.

[] 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?

Write the answer on the space provided. See codebook.

Religious Affiliation ____

P9. Citizenship- Is [the respondent] a citizen of the Philippines?

Write X in the box. If code "1", skip to P11.

[] 1 Yes, (Filipino citizen)
[] 2 Yes, (Filipino with dual citizenship)
[] 3 No

P10. Citizenship- What country/other country is [the respondent] a citizen of?

Write the answer on the space provided. See codebook.

Country / other country of citizenship ____

P11. Ethnicity- What is [the respondent]'s ethnicity by blood? Is he/she a/an ____?

Mention the predominant/common IP or non-IP groups in the area. Write the answer on the space provided. See codebook.

Ethnicity ____

P12. Disability - Does [the respondent] have any physical or mental disability?

Write X in the box.

[] 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 …?

Write X in the box corresponding to the answer for each difficulty/problem.

a. Seeing, even when wearing eyeglasses
[] Yes
[] No

b. Hearing, even when using a hearing aid
[] Yes
[] No

c. Walking or climbing stairs
[] Yes
[] No

d. Remembering or concentrating
[] Yes
[] No

e. Self-caring (bathing or dressing)
[] Yes
[] No

f. Communicating using his/her usual language
[] Yes
[] No

Household size

1. Are there any other persons such as small children or infants and overseas workers who were not yet listed?

[] 1 Yes, please add in the list
[] 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.

[] 1 Yes, please use additional booklet
[] 2 No

P14. Residence 5 years ago - In what city/municipality did [the respondent] reside on May 1, 2005?

If same city/municipality, write "same" on the space provided. If another city/municipality, specify the name of city/municipality and province on the space provided.

[] 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?

Write X in the box.

[] 1 Yes
[] 2 No

P16. Highest grade/ year completed- What is the highest grade/year completed by [the respondent]?

Write the answer on the space provided. If graduate in post-secondary or college, specify the course. See codes at the bottom.
[] 000 No Grade Completed
[] 010 Pre-School

Elementary
[] 210 Grade 1
[] 220 Grade 2
[] 230 Grade 3
[] 240 Grade 4
[] 250 Grade 5
[] 260 Grade 6
[] 270 Grade 7
[] 280 Elementary graduate
High school
[] 310 1st year
[] 320 2nd year
[] 330 3rd year
[] 340 4th year
[] 350 High school graduate
Post-secondary
[] 410 1st year
[] 420 2nd year
[] 430 3rd year
If graduate, specify course____
College
[] 810 1st year
[] 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?

If no, skip to P.19. Write X in the box.

[] 1 Yes
[] 2 No

P18. Place of school- In what city/municipality is [the respondent] attending school?

If same city/municipality, write "same" on the space provided. If another city/municipality, specify the name of city/municipality and province on the space provided.

[] 0000 Same city/municipality
[] 8887 Foreign Country

____ Province
____ City / Municipality

P19. Overseas workers
Is [the respondent] an overseas worker?

Write X in the box. For all 10 years old and over.

[] 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?

Write detailed description on the space provided. If student, housekeeper, dependent, or other non-gainful activity, skip to P24.

Occupation____

P21. Kind of Business or Industry- In what kind of business or industry did [the respondent] work during the past 12 months?

Write detailed description on the space provided.

Industry____

P22. Class of worker- What kind of worker is [the respondent]?

Mention the categories at the bottom. Write the answer on the space provided. See codes at the bottom.

[] 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?

If same city/municipality, write "same" on the space provided. If another city/municipality, specify the name of city/municipality and province on the space provided.

[] 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]?

Write the number in the boxes.

Children born alive _ _

P25. How many children are still living?

Write the number in the boxes.

Children still living _ _

P26. How many children were born alive to [the respondent] from May 1, 2009 to April 30, 2010?

Write the number in the boxes.

Children born_

P27. What is [the respondent]'s age at first marriage?

If answer in P7 is single, go to next household member. Write the age in the boxes.

Age _ _

B1 to B4 are to be answered by mere observation, if doubtful, ask the respondent.

B1. Type of building/house

Write X in the box.

[] 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

Write X in the box.

[] 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

Please write an X mark in one of the boxes below.

[] 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

Write X in the box.

[] 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?

B5 is to be asked from any household in the building. Write X in the box.

[] 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?

D1 is to be asked from any household in this housing unit. Write X in the box.

[] 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?

Write X in the box.

[] 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?

Write X in the box.

[] 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?

Write X in the box.

Drinking
[] 01 Own use, faucet community water system
[] 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 ____

Cooking
[] 01 Own use, faucet community water system
[] 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 ____

Laundry/bathing
[] 01 Own use, faucet community water system
[] 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?

Write X in the box.

[] 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?

Write X in the box.

[] 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?

Write X in the box, then skip to H8.

a. Own resources/ interest-free loans from relatives/friends
[] Yes
[] No

b. Government assistance, PAG-IBIG, GSIS, SSS, DBP, and others
[] Yes
[] No

c. Private banks/ foundations/ cooperatives
[] Yes
[] No

d. Employer assistance
[] Yes
[] No

f. Private persons
[] Yes
[] No

f. Others, specify ____
[] Yes
[] No

H7. Monthly rental of the housing unit- How much is the monthly rental of this housing unit?

Write X in the box.

[] 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?

Please write an X mark in one of the boxes below.

[] 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?

Write X in box.

[] 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?

Write X in the box.

[] 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?

Write X in the box.

a. Other residential land/s
[] Yes
[] No

b. Agricultural land/s
[] Yes
[] No

c. Agricultural land/s acquired through CARP, Agrarian Reform Beneficiary
[] Yes
[] No

d. Other land/s
[] Yes
[] No

H12. Language/dialect generally spoken at home - What is the language/dialect generally spoken at home by members of this household?

Specify answer on the space provided. See codebook.

_ _ _

H13. Residence five years from now - In what city/municipality does this household intend to reside on May 1, 2015?

Province ____
City/municipality ____
0000 Same city/municipality
8887 Foreign country
9999 Unknown

If same city/municipality, write "same" on the space provided. If another municipality, specify city/municipality and province. See codebook.

H14. Presence of household conveniences/devices - Does this household have the following household conveniences/deceives in working condition?

Write X in the box corresponding to the answer for each household convenience/device.

a. Radio/radio cassette
[] Yes
[] No

b. Television set
[] Yes
[] No

c. CD/DVD/VCD player
[] Yes
[] No

d. Component/stereo set
[] Yes
[] No

e. Landline/wireless telephone
[] Yes
[] No

f. Cellular phone
[] Yes
[] No

g. Personal computer (desktop, laptop, notebook, netbook, and others)
[] Yes
[] No

h. Refrigerator/freezer
[] Yes
[] No

i. Cooking range
[] Yes
[] No

j. Washing machine
[] Yes
[] No

k. Car/jeep/van
[] Yes
[] No

l. Motorcycle/tricycle
[] Yes
[] No

m. Motorized boat/banca
[] Yes
[] No

H15. Internet access- Does this household have access to internet?

Write X in the box.
a. From home
[] Yes
[] No
b. From elsewhere
[] Yes
[] No