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Population and Housing Census

Questionnaire Form

Dwelling, Building

To be field in for each dwelling and for the building in which the dwelling is located

____ Country
____ Municipality/city/commune
____ Component locality/village
____ Street
____ No.
____ Block
____ Entrance
____ Floor
____ Apartment
____ District

Folder number _ _ _ _ _ _ _ _ _ _ _
Order number of building within the folder _ _ _
Order number of the dwelling within the building _ _ _
Number of the LC form within the folder _ _ _
Number of SC form under which the dwelling was recorded _ _ _ (only if the dwelling is the collective living space).

Data confidentiality
All information on this form is confidential and shall be used for exclusive statistical purposes.

Data Provision is compulsory
All person shall be required to provide data in accordance with Art. 2 of Government Ordinances No 36/2007 on the conducting of the 2011 Population and Housing Census. Refusal to provide data shall be deemed a contravention and shall be punishable under the Art 21 of the Government Decision No 1502/2009 on the organization and carrying out of the Romanian Population and housing census in 2011.

Dwelling

1. Number of the households in the dwelling

_ [households]

2. Number of persons in the dwelling

_ _

of which:

_ _ Present
_ _ Temporarily absent
_ _ Away for long period of time
_ _ Temporarily present

3. Type of dwelling

[] 1 Conventional dwelling
Another housing unit [question 2 to 5 go directly to question 8]
[] 2 Mobile housing unit
[] 3 Provisional housing unit
[] 4 Another unit designed for habitation
[] 5 Another unit not designed for habitation

Questions 4, 5, 6 and 7 apply only to conventional dwellings

4. Dwelling status

[] 1 Permanent (main)
[] 2 Secondary
[] 3 Holiday house

5. Dwelling occupancy status

[] 1 Occupied
[] 2 Reserved for seasonal or secondary use
Vacant
[] 3 For sale
[] 4 For rent
[] 5 For demolition
[] 6 Another situation
[] 7 Only foreign citizen who are temporarily present are inside the dwelling.

6. Position of the dwelling in the building

[] 30 Basement
[] 40 Semi basement
[] 50 Ground floor
[] 60 Mezzanine: Number of the floor _ _
[] 70 Attic

7. How many levels do the dwelling has _ _

8. Type of ownership

[] 1 Individual private
[] 2 Public
[] 3 Shared private
[] 4 Co- operative
[] 5 Associative
[] 6 Owned by a religious cult

9. Residential rooms

9.1 Number _ _

9.2 Area _ _ _ (in sq. m, without decimals)

10. Of which: Rooms used only for professional commercial purposes etc.

10.1 Number _ _
10.2 Area _ _ _ (in sq m, without decimals)

11. Kitchen / kitchenette

11.1 There is a kitchen / kitchenette

[] 1 Inside the dwelling

Outside the dwelling
[] 2 Within the building
[] 3 Outside the building
[] 4 No kitchen/kitchenette
[] 5 Cooking facilities in a different room

11.2 Area _ _ (in sq. m., without decimals)

12. Bathroom (with bathtub and/ or shower)

There is bathroom

[] 1 In the dwelling
[] 2 Outside the dwelling, within the building
[] 3 Outside the dwelling, outside the building
[] 4 No bathroom

13. Flush toilet (WC)

There is flush toilet
[] 1 In the dwelling
[] 2 Outside the dwelling, within the building
[] 3 Outside the dwelling, outside the building
No flush toilet there is another type of flush toilet
[] 4 In the dwelling
[] 5 Outside the dwelling, within the building
[] 6 Outside the dwelling, outside the building
[] 7 No flush toilet

14 Water supply system

There is piped water
In the dwelling
[] 1 From the public network
[] 2 From its own system
Outside the dwelling
[] 3 Within the building from the public network
[] 4 Within the building from its own system
[] 5 Outside the building from the public network
[] 6 Outside the building from its own system
[] 7 No piped water

15. Hot water supply system

In the dwelling
[] 1 From the public network
[] 2 From its own system
Outside the dwelling
[] 3 Within the building from the public network
[] 4 Within the building from its own system
[] 5 Within the building outside the building
[] 6 No hot water

16. Sewage disposal system

There is a sewage disposal system

[] 1 Connected to a public sewage disposal plant
[] 2 Connected to private sewage disposal plant
[] 3 Another situation
[] 4 No sewage disposal system

17. Electrical lighting

[] 1 Yes
[] 2 No

18. Air condition system

[] Yes
[] No

19. Fuel for cooking

[] 1 Gas from public network
[] 2 Liquefied gas (gas cylinder)
[] 3 Solid fuel
[] 4 Electric energy
[] 5 Other

20. Type of heating

Central heating
[] 1 From a public heating centre
From an installation in the dwelling with
[] 2 Gas from the public network
[] 3 Liquefied gas (gas cylinder)
[] 4 Solid fuel
[] 5 Liquid fuel
[] 6 Another type of energy used.
No central heating, the heating is provided by
A cooker with
[] 7 Gas from the public network
[] 8 Liquefied gas (gas cylinder)
A stove (fireplace) with
[] 9 Gas from public network
[] 10 Liquefied gas (gas cylinder)
[] 11 Solid fuel
[] 12 Liquid fuel
[] 13 Electric energy
[] 14 Another type of heating
[] 15 No heating at all

Questions 21, 22 and 23 apply only to conventional dwellings

21. Window carpentry of

[] 1 Wood
[] 2 Thermo- insulating material (thermo pane -PVC aluminum glass fibre, mixed
[] 3 Another material (iron, etc.)

22. Thermal rehabilitation

[] 1 Yes
[] 2 No
[] 3 New dwelling already thermally insulated (built this way) [go directly to question 24]

Question 23 applies only to thermal rehabilitated dwellings (code 1- question 22) more than one option can be selected

23. The dwelling has been thermally rehabilitated by:

[] 1 Thermal insulation of the external walls (coating of polystyrene)
[] 2 Replacing the balcony window and doors
[] 3 Closing the balcony with thermo pane windows
[] 4 Thermo hydro insulation of the roof

24. Number of dwellings in the building _ _ _

Questions 25-29 are to be answered only if at least one conventional dwelling in the building

25. Type of building

Residential building

[] 1 Individual house
[] 2 Duplex house
[] 3 Row or terraced house
[] 4 Block of flats
[] 5 Designed for the collective living space (in which there are dwellings)

26. Building construction period (year)

[] 1 Before 1919
[] 2 1919-1945
[] 3 1946- 1960
[] 4 1961- 1970
[] 5 After 1970, year _ _ _ _

27. Number of floors of the building _ _

28 Construction materials of the building's outer walls

[] 1 Reinforce concrete
[] 2 Prefabricated units

Masonry of brick, stone or substitute (gas-formed concrete), with floors of

[] 3 Reinforced concrete (iron beams)
[] 4 Wood
[] 5 Wood (beams, boards etc.)
[] 6 Framework, adobe
[] 7 Other materials (fiberboard, OSB, glass, etc.)
[] 8 Mixed Materials

29. Location of the building

[] 1 In a continuously built up area along a street
[] 2 In a group of building having a locally recognized name
[] 3 In group of neighboring buildings (less than 200 m)
[] 4 In an area with isolated buildings.

Summary of the Personal Records in the Dwellings

Number of the G form of the dwelling____

Persons recorded in the dwelling

Total
[] 1 Male
[] 2 Female
Persons who are present (to be taken from the P form)

Total
[] 3 Male
[] 4 Female
Of which: Foreign citizens
[] 5 Male
[] 6 Female

Person's temporarily absent (to be taken from the P form)

Total
[] 7 Male
[] 8 Female
Gone: to place within the country
[] 9. Male
[] 10 Female
Abroad
[] 11 Male
[] 12 Female
Of which: foreign citizen
[] 13 Male
[] 14 Female

Persons away for long period of time (to be taken from the PPI form)

Total
[] 15 Male
[] 16 Female
Gone: to place within the country
[] 17 Male
[] 18 Female
Abroad
[] 19 Male
[] 20 Female
Of which: foreign citizen
[] 21 Male
[] 22 Female

Persons temporarily present (to be taken from the TP form)

Total
[] 23 Male
[] 24 Female
Of which: foreign citizen
[] 25 Male
[] 26 Female

Steady population

Column 3 + column 7
[] 27 Male
Column 4 + column 8
[] 28 Female

Total households of the dwelling (the forms contains personal present and/ or personal temporarily absent (i.e. persons from whom column 3, 4 and /or 7, 8 were filled in ) shall be summed up)

Total number of M form of the dwelling _ _
Column 1=column 3 + column 7 + column 15 + column 23
Column 2=column 4 + column 8 + column 16 + column 24

G. Households.

To be filled in for every household in the dwelling, starting with the households where at least one persons in the present or temporarily absent (if no persons is present or temporarily absent (all persons are away for long period of time and /or all persons are temporarily present), in order to link the G, PPI and PT forms the first part of the G shall be completed without the list of the persons in the household.

____ Country
____ Municipality/city/commune
____ Component locality/village
____ Street
____ No.
____ Block
____ Entrance
____ Floor
____ Apartment
____ District

____ Folder number
____ Number of the LC form within the folder (to be taken from the LC form corresponding to the dwelling it belong to)
____ Number of G form of the dwelling
____ Number of persons in the household (present and temporarily absent)
____ Number of persons' way for long period of time (from the PPI form)
____ Number of the persons temporarily present (from the TP form)
____ Number of M forms in the household

Arrangement under which the household occupies the dwelling
The household occupies the dwelling as:

[] 1 Owner
[] 2 Tenant
[] 3 Another situation (free of charge, etc.).

List of persons in the household.

Present temporarily absent, away for less than 12 months

[] Order number of persons 1, 2, 3, 4, 5, .......
[] Surname and the first name (initials of the father's name or of the mothers first name (if the father is unknown) shall also be written)

Relationship to the head of the household

[] 1 Household head
[] 2 Husband/wife
[] 3 Partner
[] 4 Son/daughter
[] 5 Son-in-law/daughter-in-law
[] 6 Grandchild
[] 7 Father/mother
[] 8 Grandparent
[] 09 Brother/sister
[] 10 Brother-in-law/sister-in-law
[] 11 Nephew/niece
[] 12 Parent-in-law
[] 13 Other relative
[] 14 Non relative (including foster children)

Order number which they are recorded

[] Husbands/wife (partner)
[] Father
[] Mother

P. Persons

To be filled in for persons present in the household or who are temporarily absent.

____ Country
____ Municipality/city/commune
____ Component locality/village
____ Street
____ No.
____ Block
____ Entrance
____ Floor
____ Apartment
____ District

Folder number _ _ _ _ _ _ _ _ _ _ _
Number of the LC/SC form within a folder ( to be taken from the LC form corresponding to the dwelling the person belong to or from the SC from) _ _ _
Number of the G form in the dwelling (for the persons in the households) _

1. Persons order number_ _ _ _

2. Personal numeric code _ _ _ _ _ _ _

Surname and first name____

[] 1 Homeless person

Demographic Characteristics

3. Gender

[] 1 Male
[] 2 Female

4. Date of birth

[] Year _ _ _ _ Month _ _ Day_ _

5. Legal marital status

[] 1 Single (go directly to question 7)
[] 2 Married
[] 3 Widow(er)
[] 4 Divorced

[Go direct to question 7 for the responses in question 5 codes 1, 3 and 4]

6. Year of marriage

[] 6.1 First marriage_ _ _ _

[] 6.2 Current marriage (remarried women only) _ _ _ _

Questions 7 and 8 do not apply to persons residing in collective living spaces (for whom the G form was not completed)

7. De facto marital status.

Does the person live in a consensual union?

[] 1 Yes
[] 2 No (go directly to question 9 for females and to question 10 for males)

Question 8 apples only to women who live in a consensual union

8. Year of entering the consensual union_ _ _ _

Question 9 applies only to the females aged 15 years or over

9. Number of live-born children _ _

Internal and International Migration

10. Situation of the person on census day

[] 1 Present (go directly to question 14)
[] 2 Temporarily absent

Questions 11, 12 and 13 apply only to persons who are temporarily absent (i.e. persons who are away from the household for less than 12 months)

11 For how many months has the person been away or is expected to be away from the enumeration locality? _ _

12. Where does the person currently live?

[] In another locality____
[] ____county
[] Municipality/city/commune________
_ _ _ _ _ _
[] In another country____
_ _ _

13. Reasons for the persons absence from the enumeration locality

[] 1 Work
[] 2 Job
[] 3 Studies
[] 4 Business
[] 5 Family reasons
[] 6 Visit, tourism
[] 7 Other reasons

14. Place of birth (the mother's residence at the moment of the enumerated person's birth)

[] 900 In the enumeration locality
[] In another locality____
[] ____county
[] Municipality/city/commune____
_ _ _ _ _ _
[] In another country____
_ _ _

15. Residence

[] 900 In the enumeration locality
[] In another locality____
[] ____county
[] Municipality/city/commune____
_ _ _ _ _ _
[] In another country____
_ _ _

16. Has the person ever had a different residence than the enumeration residence?

[] 1 Yes
[] 2 No (go directly to question 22)

17. Previous residence

17.1

[] In the country, in a locality of ____
[] ____county
[] Municipality/city/commune________
_ _ _ _ _ _

17.2 [] In another country____ _ _ _ (go directly to question 22)

18. Has the person ever had his or her residence in another country? (before settling in the enumeration locality)

[] 1 Yes. In what country? ____
[] 2 No (go directly to question 22)

Questions 19 and 20 apply only to persons who settled in the enumeration locality after September 2010

19 Date on which the person last settled in Romania

[] Year _ _ _ _ Month _ _

20. Date in which the person settled in the enumeration locality

[] Year _ _ _ _ Month _ _

21. Reasons for settling in the enumeration locality

[] 1 Work
[] 2 Job
[] 3 Studies
[] 4 Business
[] 5 Family reasons (marriage, family reunification, inheritance, etc.)
[] 6 Visit/ tourism
[] 7 Asylum seeker
[] 8 Refugees
[] 9 Beneficiary of subsidiary protection
[] 10 Other reasons

22. Citizenship (country of citizenship)

22.1 [] 642 Romania
[] Another citizenship ____

Question 22.2 applies only to persons who declare they have more than one citizen ship

22.2 Second citizenship _ _ _

Ethnic and Cultural Characteristics

Each Person Is Free to Express His or Her Opinion, Without Any Constraints.

23. What ethnic group does the person consider he/she belongs to? _ _ _ _

24. What is the person's mothers tongue? _ _ _ _

25. What religion does the person consider he/she belongs to? _ _

Educational Characteristics

Questions 26 and 27 apply only to persons born before January 2002

26. Highest educational institution from which the person graduated (receiving a certificate or a diploma)

26.1 Name and profile (the masters and PhD studies are not included: they will be written further below)
____ _ _

26.1.1 Bologna system

[] 1 Yes
[] 2 No

26.2 Masters studies (including post graduate studies) -- name of the educational institution____

26.3. PHD studies -- name of the educational institution_____

27. Ownership of the educational institution from which the person graduated

[] 1 State ownership
[] 2 Private ownership

Questions 28 and 29 apply only to persons who were born before January 2006

28. Educational institution the persons is attending

28.1. Name and profile (the masters and PhD studies are not included: they will be written further below)
____

28.2. Masters studies (including post graduate studies) -- name of the educational institution____

28.3. PHD studies -- name of the educational institution____

29. Does the person use the internet?

[] 1 Yes
[] 2 No

Economic Characteristics

30. Current activity status (performed during the reference week 13 to 19 October 2011)

[] 01 Employed
[] 02 Unemployed looking for another job
[] 03 Unemployed looking for his/her first job
[] 04 Pupil/student
[] 05 Pensioner
[] 06 Housewife
[] 07 Supported by another person
[] 08 Supported by state or by private organization
[] 09 Supported from other sources
[] 10 Another economic situation

31. Working hours (during the reference week)

31.1 Total number of hours actually worked _ _

31.2. Of which: dedicated to the main activity _ _

Questions 32-36 refer to the main activity. And apply only to a persons whose answer to question 31.1 was different from 0 and persons whose answer to question 30 was "unemployed looking for another job" (code 2). For the latter, the characteristics corresponding to their last job shall be recorded

32. Occupation____

33. Occupational status

[] 1 Employee
[] 2 Employer
[] 3 Self -employed
[] 4 Member of an agricultural company/co-operative
[] 5 (Unpaid) family helper
[] 6 Another situation

34. Workplace
34.1 Full name of the unit/subunit where the person is employed ____

34.2 Main activity of the unit/subunit where the person is employed ____

35. Geographic location of the workplace

[] 900 In the enumeration locality
[] In another locality, county: ____
[] Municipality/city/commune ____
[] In another country____

36. Type of sector in which the person works

[] 1 Non financial and financial companies
[] 2 Public administration
[] 3 Nonprofit institutions serving the population
[] 4 Households

Questions 37 and 38 apply only to persons who declared they are "unemployed" (question 30 code 02 or code 03)

37. The person has been looking for a job since

[] Year _ _ _ _ Month _ _

38. Forms of social protection for unemployed

[] 1 Unemployment allowance
[] 2 Unemployment allowance for educational institution graduates
[] 3 Compensatory payment
[] 4 Other compensations
[] 5 No longer receives any aid
[] 6 Has never received aid

Difficulties to performing the current activity

To be filled by persons born January 2006.

I. Does the person encounter any difficulties in carrying out his /her daily activities (at school, at work, at home, etc.)?

[] 1 Yes
[] 2 No (end the form)

39. Eyesight difficulties, (even if the person wear glasses (contact lenses))

a) Level of difficulties

[] 1 No difficulties (go direct to question 40)
[] 2 Not too significant
[] 3 Significant
[] 4 Complete inability

b) Causes of the difficulties ( only for the persons who declared they have difficulties in question 39 (a) codes 2,3,or 4)

[] 1 Hereditary
[] 2 At birth
[] 3 Following illness
[] 4 Work accident
[] 5 Road accident
[] 6 Other

40. Hearing difficulties (even if the person use hearing aid)

a) Level of difficulties

[] 1 No difficulties (go direct to question 41)
[] 2 Not too significant
[] 3 Significant
[] 4 Complete inability

b) Causes of the difficulties ( only for the persons who declared they have difficulties in question 39 (a) codes 2,3,or 4)

[] 1 Hereditary
[] 2 At birth
[] 3 Following illness
[] 4 Work accident
[] 5 Road accident
[] 6 Other

41. Difficulties to walk, to climb stairs
a) Level of difficulties

[] 1 No difficulties (go direct to question 42)
[] 2 Not too significant
[] 3 Significant
[] 4 Complete inability

b) Causes of the difficulties ( only for the persons who declared they have difficulties in question 39 (a) codes 2,3,or 4)

[] 1 Hereditary
[] 2 At birth
[] 3 Following illness
[] 4 Work accident
[] 5 Road accident
[] 6 Other

42. Memory of concentration difficulties
a) Level of difficulties

[] 1 No difficulties (go direct to question 43)
[] 2 Not too significant
[] 3 Significant
[] 4 Complete inability

b) Causes of the difficulties ( only for the persons who declared they have difficulties in question 39 (a) codes 2,3,or 4)

[] 1 Hereditary
[] 2 At birth
[] 3 Following illness
[] 4 Work accident
[] 5 Road accident
[] 6 Other

43. Self-care difficulties (to dress or wash himself/herself)

a) Level of difficulties

[] 1 No difficulties (go direct to question 44)
[] 2 Not too significant
[] 3 Significant
[] 4 Complete inability

b) Causes of the difficulties ( only for the persons who declared they have difficulties in question 39 (a) codes 2,3,or 4)

[] 1 Hereditary
[] 2 At birth
[] 3 Following illness
[] 4 Work accident
[] 5 Road accident
[] 6 Other

44. Communication difficulties (to understand or make his/her meaning clear)
a) Level of difficulties

[] 1 No difficulties
[] 2 Not too significant
[] 3 Significant
[] 4 Complete inability

b) Causes of the difficulties ( only for the persons who declared they have difficulties in question 39 (a) codes 2,3,or 4)

[] 1 Hereditary
[] 2 At birth
[] 3 Following illness
[] 4 Work accident
[] 5 Road accident
[] 6 Other

II. Does the persons has any of these difficulties receive aid from someone else (a person who accompanies hi/her on a regular basis?

[] 1 Yes
[] 2 No