Federal Statistical Office (FSO)
Czech Statistical Office
Slovak Statistical Office

Approved by FSO No. Vk 268/90

Population and housing census 1991

Housing sheet 1

Do not write any data into the thickly framed fields (questions 1, 3, 4. 8)!

Fill in using a ballpoint pen (not red); circle only one answer for each question.
[Example of how to fill in the form.]

_ _ _ _ District
_ _ _ _ Census circuit

____ Municipality
____ Municipal section
____ Registration number
____ Reference number
____ Local section
____ Street (square) house number (if applicable)
____ For dwellings without house number, more detailed description of the type and location

1. Cadastral (reference) number _ _ _ _ _
Serial number of the building _ _

1. Number of all dwelling units _ _ _

2. Owner of the house

[] 1 National committee (housing authority, housing company)
[] 2 Other state organization (enterprise, authority, institute)
[] 3 Housing building cooperative
[] 4 Communal housing cooperative
[] 5 JRD (agricultural cooperative)
[] 6 Other cooperative organization
[] 7 Czechoslovak citizen (private person)
[] 8 Foreign organization or a foreign national

3. Type of the house

[] 1 Family house
[] 2 Dwelling house
[] Other (please specify) _ _

4. Occupancy

[] 1 Permanently occupied
[] 2 Accommodation facility without units
[] Unoccupied, reason _ _

5. House built during the period

[] 1 Up to and including 1899
[] 2 1900-1919
[] 3 1920-1945
[] 4 1946-1960
[] 5 1961-1970
[] 6 1971-1980
[] 7 1981-1985
[] 8 1986-1989
[] 9 1990

6. House restored in the period

[] 1 Was not [restored]
[] 2 Prior to 1960
[] 3 1961-1970
[] 4 1971-1980
[] 5 1981-1985
[] 6 1986-1990

7. Material or supporting walls or construction

[] 1 Stone
[] 2 Bricks (blocks, cinder blocks)
[] 3 Stone and bricks
[] 4 Wall panels
[] 5 Frame
[] 6 Wood
[] 7 Adobe bricks

8. Number of above-ground floors _ _

9. Elevator in house

[] 1 Yes
[] 2 No

10. Water supply

Installed in the house

[] 1 From the public network
[] 2 Domestic

Outside the house

[] 3 From the public network
[] 4 Domestic

[] 5 Not installed

11. Sewerage

[] 1 Public sewerage connection
[] 2 Septic tank (cesspool)
[] 3 Without sewerage and without septic tank

12. Gas from network

[] 1 Connected
[] 2 Not installed

13. Central heating

Boiler room in the house

[] 1 For solid fuels
[] 2 For gas
[] 3 For other fuels

Block boiler room

[] 4 For solid fuels
[] 5 For other fuels

District heating

[] 6 For solid fuels
[] 7 For other fuels

[] 8 No central or district heating

14. Dwelling facilities and amenities in dwelling houses

(All dwellings of category 1)

[] 1 Gas, water supply, central heating, bathroom (shower) and flushing toilet
[] 2 Without gas, water supply, central heating, bathroom (shower corner) and flushing toilet
[] 3 Different amenities in the units and dwellings in other than dwelling buildings

____ Number of census sheets attached
____ Number of persons in the accommodations facility outside units
____ Number of census sheets attached

____ Owner of the house (signature, stamp)
I verify the accuracy and completeness of the form

____ Signature of census commissioner
____ Signature of census controller

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Summary of data on persons
[To be completed by census commissioner.]

Data on persons
[Table that allows for information on up to 10 serial numbers for dwellings and a total across all of the dwellings.]

Person by type of residence

_ 1. Permanent residents in total
_ 2. Present
_ 3. Absent
_ 4. Of the total, those residing away from the dwellings
_ 5. Persons present temporarily, in total
_ 6. Of those, number of foreigners
_ 7. Persons present, in total

Permanently resident men, born

_ 8. 1976-1991
_ 9. 1931-1975
_ 10. 1930 and earlier
_ 11. Not ascertained
_ 12. Total

Permanently resident woman, born

_ 13. 1976-1991
_ 14. 1936-1975
_ 15. 1935 and earlier
_ 16. Not ascertained
_ 17. Total

Permanent residents economically active

_ 18. Men
_ 19. Women
_ 20. Total
_ 21. Of those, working outside the municipality of residence

Permanently resident persons by nationality

_ 22. Czech
_ 23. Slovak
_ 24. Ukrainian (Rusyn)
_ 25. Russian
_ 26. Polish
_ 27. Hungarian
_ 28. German
_ 29. Roma
_ 30. Other, and not ascertained
_ 31. [blank]

Summary of data on dwelling, furnishings and amenities
[To be completed by census commissioner.]

Data on dwellings, furnishings, and amenities

Dwelling number
[Table constructed of between 1 and 10 dwellings and a place to indicate a total across all dwelling included on the form.]

_ 8. Dwellings in total

Dwellings permanently occupied

_ 9. Total
_ 10. Of which in family homes
_ 11. Built 1981-1989
_ 12. Built 1990-1991
_ 13. Floor space, m2
_ 14. Number of habitable rooms over 8 m2

Facilities and amenities of permanently occupied dwellings (households)

_ 15. Three or more habitable rooms over 8 m2
_ 16. Automatic washing machine
_ 17. Color TV
_ 18. Telephone
_ 19. Cottage, recreational house, village house
_ 20. Passenger car
_ 21. Central (single story) heating
_ 22. Bathroom - shower cubicle

Vacant dwellings

_ 23. Total
_ 24. Includes: still unoccupied, post inspection approval
_ 25. Sale, different tenant
_ 26. Legal proceedings etc.
_ 27. Restoration, reconstruction
_ 28. Unallocated recreational village house
_ 29. No interest in the dwelling
_ 30. Unfit for occupation
_ 31. Unit in a house slated for demolition
_ 32. Other or not ascertained reasons

Other dwellings

_ 33. Total

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Part A - Information about persons
Instructions for completing Part A - Information about persons
[Instructions include an example that is omitted here.]

1. Name and surname ____

Write in block letters - list the persons in the following order: tenant of the dwelling, wife (partner), husband (partner), single children, other single family members, members of another family (families), sublets, guest, wife etc.

2. Birth number _ _ _ _ _ _ _ _ _ _

Copy from page 14 or 1 of identity document, birth certificate or birth number document; write from the first window from the left; in the case of a nine-digit number, enter zero in the tenth box

3. Type of occupancy

Enter one of the answers

[] Permanent - Present
[] Permanent - Temporarily absent
[] Temporary

4. Relation to the tenant ____

E.g., dwelling tenant, wife (partner, common law), husband (partner, common law), son, daughter, son-in-law, daughter-in-law, grandson, grandmother, father, mother-in-law, brother, sister-in-law, niece, uncle) subtenant, wife or child of the subtenant, guest, wife of a guest

5. Date of birth ____

Day, month (Arabic numerals), year

6. Gender

[] Man
[] Woman

7. Marital status

[] Single
[] Married
[] Divorced
[] Widowed

8. The date of wedding ____

Month and year of solemnization of current or last marriage

9. Marriage number _

Order of current or last marriage

10. Number of live-born children

To be completed only by women aged 15 or older

____ A. Number of all live born children
____ B. Number of live born children of the current or last marriage

11. Citizenship ____

Czech Republic, Slovak Republic, foreign (specify country), stateless

12. Nationality ____

e.g., Slovak, Czech, Ukrainian, Ruthenian, Hungarian, Polish, Roma etc.

13. Mother tongue ____

E.g. Slovak. Czech, Hungarian, Ukrainian. Ruthenian, Roma, etc.

14. Religion (faith) ____

Enter the religious faith that you follow, or "no religion"

15. Permanent residence at the time of birth

Means the permanent residence of the mother at the time of birth of the enumerated person; specify...

____ a) Municipality and
____ b) District, for foreign born, the name of the country

16. Highest completed level of education ____

The type and name of the school at the time when the enumerated person completed it (also the primary and apprentice school, or secondary vocational school); specify the length of studies and the leaving examination, for universities the name of the faculty; if appropriate, enter "no formal education"

17. Economic activity ____

Economically active (including soldiers in active service, persons in custody and in prison), women on maternity leave, person seeking employment, helping (free of charge) in a family business; working and non-working pensioner, person with another kind of income (please specify), primary school pupil secondary vocational school attendee, student, housewife, cared for by family, etc.

18. Occupation ____

Economic active persons (including helpers and working pensioners) enter the work or function performed. Non-working pensioners, women on maternity leave, soldiers in active service, persons in custody or in prison, and persons seeking employment enter their last occupation

19. Social category ____

Filled by the econ. active persons and all pensioners; laborers and employees will also specify the sector (state, private, cooperative, mixed); laborer, employee, member of agricultural cooperative, member of production cooperative, employer (with one or more employees), privately operating farmer, self-employed tradesman, person in a liberal profession, helper in a family business, etc.

20. Employer, school or secondary vocational school (SVS)

Self-employed and helpers in a family business will also specify the field of activity: agriculture, restaurant, car repair

____ A. Name of factory, cooperative, agency, institute, organization, school, SVS (do not abbreviate)
____ B. Address of employer, school, SVS (district, municipality)

21. Commute to work, school or SVS

Do you travel or walk from your place of residence to work school or apprenticeship:

[] Daily
[] Other than daily
[] Do not commute

Accommodation at the place of employment (school, SVS)

[] Yes
[] No

22. Time spent in daily commute to work (school, SVS) ____

Enter time in minutes from leaving residence or place of accommodation to reporting at the place of work (school, SVS)

23. Address of place of employment, school or SVS

____ a) District - urban ward
____ b) Municipality, municipal section, cadastral (reference) number
____ c) Street (square), house number

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Enumeration sheet 2

Before filling in, please read the instructions and explanations carefully!
The enumeration sheet shall be filled in accurately and truthfully by the tenant of the dwelling, or on his behalf by an adult member of the household, for all persons permanently residing in the dwelling and for persons temporarily present there at the crucial moment of the census. If the dwelling is administratively divided, each dwelling tenant completes a separate census sheet.

The crucial moment of the census is midnight from March 2 to March 3, 1991.

Complete the census sheet using a ballpoint pen (not red). On the census sheet, first complete part A, then part B and finally part C ? data on the dwelling and household facilities and amenities. Do not write in the thickly framed fields, with the exception of the birth number.

Part B - Other information on persons

1. Data on persons temporarily present in the dwelling at the crucial moment of the census

Name and surname ____

Address of permanent residence

____ District
____ Municipality, municipal section, local section, cadastral/reference number
____ Street (square) house number

Reason for presence ____

2. Data on persons permanently living in the dwelling but temporarily absent at the crucial moment of the census

Name and surname ____
Address of temporary residence

____ District
____ Municipality, municipal section, local section, cadastral/reference number
____ Street (square) house number

Reason for absence ____

3. If only one of the spouses is registered as permanent resident on this census sheet, enter about the other spouse

____ Name and surname
____ Date of birth
____ Address of permanent residence
____ Occupation

The reason why the spouses do not live together

[] 1 Do not have their own dwelling
[] 2 Other reason

4. Joint household

If not all the permanent residents share a common household, enter the number of persons who share the common household from part A

Sample completion [Example omitted]

Record of the number of persons ____

I confirm that I have filled out the census sheet truthfully
____ Signature of tenant of the dwelling or of the person who completed the census sheet

I verify the review of data entered in all parts of the census sheet
____ Signature of the census commissioner
____ Signature of the census reviewer

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Part C - Data on dwelling and household facilities and amenities

Part C of the census sheet shall be completed for each unit. Before filling in, please read the instructions and explanations carefully! [Example of a correct and incorrect way to fill in the answers.]
Do not write any data into the thickly framed fields (questions 1, 2, 3)!

Dwelling number (do not fill in) _ _ _ _
Number of persons living in the dwelling (do not fill in) _ _

1. Occupancy of the unit

Permanently occupied

[] 1 Used by a single tenant
[] 2 Administratively divided
Unoccupied because _ _

2. Legal ground for occupancy

[] 1 Dwelling in own house (family house)
[] 2 Personal property (in an apartment house)
[] 3 Other free use
[] 4 Rental dwelling (also people's housing cooperatives)
[] 5 Cooperative dwelling (housing cooperatives only)
[] 6 Janitor's, service (in-kind) dwelling
[] Other reason

3. Size of dwelling

Individual parts of the dwelling

If you do not know the dimensions of the rooms, measure them! If the room is not rectangular or square, please specify only its floor area. Report each room separately, in order of size. Regarding the concept of a living space, read the explanatory notes to question 3 in part C!

[For each part of the dwelling and each room, report in a table the length measured in meters, the width, and the total floor area in meters squared out to 1 decimal place.]

a. Kitchen or kitchenette

_ Length
_ Width
_ Floor area in meters squared

b. Rooms and other residential spaces of 8 m2 or larger

[Up to 6 rooms specified.]

_ Length
_ Width
_ Floor area in meters squared

7. And other rooms and residential spaces in total. _

c. Floor area of the kitchen, rooms, and other residential spaces together (in meters squared) _

d. Floor area of other rooms in the dwelling in total (in meters squared) _

f. Number of rooms 8 meters squared or larger _

g. Number of rooms 4.0 - 7.9 meters squared floor areas _

4. Position of the dwelling

[] 1 On the ground floor
[] 2 On the ground floor and 1st floor
[] 3 On the 1st floor
[] 4 On the 2nd floor
[] 5 On the 3rd floor
[] 6 On 4 - 6th floor
[] 7 On the 7th or higher floor
[] 8 In the basement (in the cellar)

5. Freezer

[] 1 Separate freezer
[] 2 Fridge with freezer
[] 3 No

6. Own automatic washing machine

[] 1 Yes
[] 2 No

7. Television

Please provide one answer only

[] 1 Color
[] 2 Black and white
[] 3 None

8. Phone

[] 1 Yes
[] 2 No

9. Do you own a recreational cottage, house or village house (own or on permanent lease)?

[] 1 Yes
[] 2 No

10. Do you own a passenger car?

[] 1 Yes
[] 2 No

11. Water supply

Plumbing reaches...

[] 1 Inside the dwelling
[] 2 Inside the house only
[] 3 Outside the house, no water supply

12. Running hot water

[] 1 From an off-premises source, central or floor heating
[] 2 From a water heater
[] 3 No running hot water

13. Gas (from network)

Supplied...

[] 1 To the dwelling
[] 2 No gas plumbing

14. Main type of heating

[] 1 Central, district heating

Single story heating

[] 2 Gas
[] 3 Electricity

Solid fuels

[] 4 Within the dwelling
[] 5 Outside the dwelling

Stove

[] 6 For solid fuels
[] 7 Electric (Accumulation)
[] 8 Gas (WAW, Gamat, and others)
[] 9 Combined or other

15. Bathroom (shower cubicle)

[] 1 Within the dwelling
[] 2 Outside the dwelling: own
[] 3 Outside the dwelling: shared
[] 4 No bathroom or shower

16. Toilet

[] 1 Flushing inside the dwelling
[] 2 Flushing outside the dwelling: own
[] 3 Flushing outside the dwelling: shared
[] 4 Non-flushing

Accommodation outside the dwelling

17. Type of accommodation away from the dwelling

[] 1 Recreational cottage, house
[] 2 Recreational village house, not considered part of allocated housing stock
[] 3 Emergency dwelling (non-approved building)
[] 4 Emergency accommodation at the place of work
[] 5 Caravan, boat

18. Reason for accommodation away from the dwelling

[] 1 Short term accommodation
[] 2 Accommodation associated with the employment duties
[] 3 No dwelling - the person is registered for permanent residence elsewhere
[] 4 Other reason

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Enumeration sheet 3

Anyone who spends midnight from March 2 to March 3, 1991in an accommodation or inpatient treatment facility or finds there his/her first accommodation after midnight is required to complete the census form and hand it over to the facility management during March 3.

When several family members are living together, another family member should fill in the census forms for children and people who are not able to do so or who cannot write. For persons with permanent residence in an accommodation (treatment) facility, who are temporarily absent at the time of census and for persons who are unable or incapable to fill in the census form, the facility administration will do so.

Fill in the census form, using a ballpoint pen (not red), legibly, accurately and truthfully. Do not write in the pre-printed fields on the back, except for the birth number

1. Details of an accommodation facility or inpatient treatment facility

____ Name and type of facility
____ Room (pavilion) number

2. Reason for temporary (interim) stay in the accommodation or inpatient treatment facility

Circle that which applies.

[] 1 Place of employment
[] 2 Place of study, school, apprenticeship
[] 3 Business trip
[] 4 Medical treatment
[] 5 Vacation, recreation
[] 6 Visit
[] 7 Another reason

3. Information on the place where the person is registered for permanent residence

Not to be filled by persons which permanent residence in the accommodation or inpatient treatment facility

____ District
____ Municipality, municipal section, local section, house/registration number
____ Street (square), house number

____ Name and surname of the tenant of the dwelling
____ Relation to the tenant of the dwelling (e.g., dwelling tenant, wife (partner, common law), husband (partner, common law), son, daughter, son-in-law, daughter-in-law, grandson, grandmother, father, mother-in-law, brother, sister-in-law, niece, uncle)

4. Information on a person permanently residing in an accommodation or inpatient treatment facility but temporarily absent at the time of the census

Address of the temporary residence

____ District
____ Municipality, municipal section, local section, house/registration number
____ Street (square), house number

____ Reason for absence

5. Married persons with different permanent residences of both spouses providing the other spouse's

____ Name and surname
____ Date of birth
____ Address of permanent residence
____ Occupation

The reason why the spouses do not live together

[] 1 Do not have their own dwelling
[] 2 Other reason

I verify the review of data entered in the census sheet
____ Signature of the census commissioner or a representative of the facility administration

I verify the correctness and completeness of the census card completion
____ Signature of the person enumerated or person who completed the census sheet

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