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Republic of El Salvador, Central America
Ministry of Economics
General Directorate of Statistics and Censuses
V Population and IV Housing
National Censuses
Census Form

[] Continuation form

I. Geographic location

1. ____ Department _ _

2. ____ Municipality _ _

3. ____ Head town or canton _ _

4. ____ Zone _ _

5. ____Sector _ _

6. ____Segment _ _ _

7. ____Block _ _ _

8. ____Dwelling order number within the segment _ _ _

9. ____ Hamlet (caserio) _ _

10. ____ Address of the house, street, number, passage

The National Statistical Service Law establishes that: Art. 18 "The information collected by the Dirección General de Estadística y Censos is strictly reserved. It cannot be used for purposes of taxation or judicial investigations".

II. Household information
1. Dwelling type

a. Private
[] 1 Independent house
[] 2 Apartment
[] 3 Room in a house
[] 4 Room in a boarding house (pieza de meson)
[] 5 Rustic shack or hut (rancho or choza)
[] 6 Improvised dwelling
[] 7 Place not designed for human habitation
[] 8 Other (mobile home, tent, settlement (refugio), etc.)
[] 9 Homeless
b. Collective
[] 10 Hotel
[] 11 Hospital or clinic
[] 12 Contract housing for students (pupilaje)
[] 13 Home for elderly
[] 14 Guesthouse
[] 15 Prison
[] 16 Barracks
[] 17 Convent or monastery
[] 18 Other (specify) ____

Comments [5 blank lines]
____ Date

Total population residents in this household[This is a table where a response for each item can be written for each form number, 1-5, in the case of multiple forms for a dwelling]

____ Males
____ Females
____ Total

____ Sector head's name
____ Enumerator's name

2. Characteristics of the dwelling

[Section 2 was asked of non-homeless private households, per Section 1]

1. What is the predominant material in the exterior walls of the dwelling?

[] 1 Concrete or mixed cement
[] 2 Wattle and daub (bahareque)
[] 3 Adobe
[] 4 Wood
[] 5 Metal sheet
[] 6 Straw, palm, or other plant material
[] 7 Waste materials
[] 8 Other (specify) ____

2. What is the predominant material used in the roof of the dwelling?

[] 1 Concrete roof
[] 2 Asbestos sheet
[] 3 Clay tile
[] 4 Metal sheet
[] 5 Straw, palm or other plant material
[] 6 Waste materials
[] 7 Other (specify) ____

3. Occupancy

a) Occupied dwelling
[] 1 With people present - continue
[] 2 With people absent - return
b) Unoccupied dwelling
[] 3 For rent or sale
[] 4 Occasional use
[] 5 Under repair or construction
[] 6 Other reason

For responses 3 - 6, end the interview here.

[Questions 4-15 were asked of occupied private households, per question 3 and Section 1.]

4. What is the predominant material used in the floor of the dwelling?

[] 1 Cement slabs
[] 2 Cement blocks
[] 3 Clay brick
[] 4 Wood
[] 5 Earth
[] 6 Other ____

5. What type of toilet facilities does the dwelling have?

a) Flush toilet
[] 1 For private use
[] 2 For shared use
b) Latrine
[] 3 For private use
[] 4 For shared use
c) [] 5 Other type
d) [] 6 None

6. Does the dwelling have a wastewater removal system connected to

[] 1 Sewer
[] 2 Septic tank
[] 3 Ground outside the dwelling
[] 4 River, stream or lake
[] 5 None

7. Where does the water used come from?

[] 1 Community piped water system
Well:
[] 2 Public
[] 3 Private
[] 4 River
[] 5 Spring
[] 6 Other (specify) ____

8. Are there water supply fixtures?

[] 1 Inside the dwelling
[] 2 Outside of the dwelling but within the property
[] 3 Public tap
[] 4 None

9. What is the principal fuel used for cooking?

[] 1 Electricity
[] 2 Propane gas
[] 3 Kerosene (gas)
[] 4 Wood
[] 5 Charcoal
[] 6 Other (specify) ____
[] 7 None

10. What type of lighting is used in the dwelling?

[] 1 Electricity
[] 2 Kerosene (gas)
[] 3 Other (specify) ____

11a. How many rooms does the household have, not counting bath, hallway, kitchen or garage?

____ Number

11b. Of the total rooms, how many are used as bedrooms?

____ Number

11c. Is there a separate room exclusively for cooking?

[] 1 Yes
[] 2 No

12. What is the form of tenure of the dwelling?

[] 1 Owned
[] 2 Owned, paying in installments
[] 3 Rented
[] 4 Other tenure

13. Which of the following appliances and/or vehicles are there in the dwelling?

Radio
[] 1 Yes
[] 2 No

Television
[] 1 Yes
[] 2 No

Telephone
[] 1 Yes
[] 2 No

Refrigerator
[] 1 Yes
[] 2 No

Washing machine
[] 1 Yes
[] 2 No

Sewing machine
[] 1 Yes
[] 2 No

Blender
[] 1 Yes
[] 2 No

Stereo equipment
[] 1 Yes
[] 2 No

Fan
[] 1 Yes
[] 2 No

Automobile
[] 1 Yes
[] 2 No

Motorcycle/motor scooter
[] 1 Yes
[] 2 No

14. How is garbage removed?

[] 1 Municipal service
[] 2 Private service
[] 3 Incinerated
[] 4 Buried
[] 5 Thrown anywhere

15. Does anyone living here do artisan (handicraft) activities or home-based industry in the dwelling?

[] 1 Yes
[] 2 No

III. Composition of the family(ies) who live in the household1. Who habitually lives in this household?
Write the name and surname of each person who lives in the dwelling, including children, elderly people, newborns, disabled people, and those members of the family who habitually live in this dwelling but are absent due to vacation, work, business or illness and those domestic employees (male or female) who sleep here.
Column 1
Person number [1 - 8]

Column 2
Follow this order closely when listing the habitual residents

  • Head of the family (list on the first line)
  • Husband/wife, companion of the head
  • Single children (list in order of age)
  • Married children
  • Husband/wife, companion of the children
  • Grandchild or great-grandchild
  • Parents or parents- in-law
  • Other relatives (cousin, uncle, etc.)
  • Brother/sister
  • Domestic employee who sleeps here
  • Other non-related person

Also list married children who habitually live here, in order, along with their wives and children

Column 3
Write the relationship or link to the head of the family

Head - Person number 1
____ - Person numbers 2-8

Column 4
Sex:

[] Male
[] Female

____ Total people listed on this form (*)

Check to make sure you listed: children, elderly persons, newborns, disabled persons and members of the family who habitually live here but who are absent due to vacation, business or illness and those domestic employees (male or female) who sleep here.
(*) Transfer these totals to the table "Total population resident in this dwelling" on the first page, and when using more than one form, transfer them to that same table on the first form.

IV. Mortality and migration[Section IV was asked of occupied private households, per question 3 and Section 1.]

1. Mortality1. Did any member of this household die during the last year or this year?
(Do not forget to ask about children and elderly persons)

[] 1 Yes - give details in table below
[] 2 No - skip to migration
[] 3 Unknown - skip to migration
Person number ____
Name and surnames ____
Date of death:
Day ____
Month____
Year ____

Sex
[] 1 Male
[] 2 Female

____ Age at death (put "00" for those younger than 1 and "98" for those 98 or older)

2. Migration1. Does any member of this household live in another country?

[] 1 Yes
[] 2 No

2. How many live in another country?

____ Males
____ Females

[There are two versions of part V: one for the head of the household and one for other members. The only question that is different is question 1 in part 1. This English translation does not replicate both versions entirely, but only question 1]

V. Information on members of the household

Person ____ of the list
____ Write the names and surnames

1. All persons

[Version 1: Head of the household - starts on page 4 of the original language document]1. [] 0 Head
(Do not use on continuation forms nor for people in a collective dwelling)
[Version 2: Other members of the household - starts on page 6 of the original language document]
1. What is your relationship with the head of the household?

[] 1 Spouse or partner
[] 2 Son or daughter
[] 3 Son or daughter in-law
[] 4 Grandchild or great grandchild
[] 5 Parent or parent in-law
[] 6 Other relative
[] 7 Domestic worker
[] 8 Other non-relative
[] 9 Person in collective dwelling

2. Male or female?

[] 1 Male
[] 2 Female

3. How old are you in years completed?

____
(write "00" for those younger than 1, and "98" for those 98 or older)

4. What is your date of birth?

____ Day
____ Month
____ Year

5. What is your current marital status?

[] 1 Under 12 years old
[] 2 Consensual union
[] 3 Married
[] 4 Widowed
[] 5 Separated
[] 6 Divorced
[] 7 Single

6. Is your mother alive?

[] 1 Yes
[] 2 No
[] 3 Unknown

7. Do you have any of the following disabilities?(You may mark more than one)

[] 1 Blindness
[] 2 Deafness
[] 3 Muteness
[] 4 Mental retardation
[] 5 Paralysis or loss of use of an upper extremity
[] 6 Paralysis or loss of use of a lower extremity
[] 7 No disability

8. Where were you born?

[] 1 Here
[] 2 In another part of the country:
Head town or canton _ _
Municipality _ _
Department _ _
[] 3 In another country:
Name of the country ______
Year of arrival in El Salvador _ _ _ _

9a. How long have you lived here?

[] Always - skip to question 10
[] Since _ _ _ _ (year)

9b. Where did you live before?

Head town or canton _ _
Municipality _ _
Department _ _
Other country:
Name of the country _ _ _

2. Persons age 5 or older[Questions 10-13 were asked of persons age 5 or older]

10. Are you able to read and write?

[] 1 Yes
[] 2 No

11. Do you or did you attend an institution of formal schooling?

[] 1 Currently attending
[] 2 Not currently attending but did attend
[] 3 Never attended - skip to question 13
[] 4 Unknown - skip to question 13

12a. What is the highest level of formal schooling completed?

[] 1 Preschool
[] 2 Primary or basic
[] 3 Vocational course (carrera corta) following sixth grade
[] 4 Secondary education
[] 5 Post-secondary, non-university
[] 6 Technical college
[] 7 Post-secondary, university
[] 8 Unknown
12b. What was the highest year completed at this level?
____

12c. In what type of studies or career was this highest year completed?

____ [Two blank lines. A 4-character box sits below the lines in this item.]

13. Do you or did you attend any place of vocational, technical or commercial education within the informal educational system?

[] 1 Yes
[] 2 No

2. Persons age 10 or older[Questions 14-21 were asked of persons age 10 or older]

14. The week prior to the census you:

[] 1 Worked in exchange for wage in money or kind
[] 2 Worked for somebody else without receiving a wage
[] 3 Had a job, business, enterprise, owned a farm, but did not work (due to sickness, strike, vacation, bad weather, etc.)
(If 1, 2, or 3 are selected, continue with question 16)
[] 4 Looked for a job and had previously worked
[] 5 Looked for a job for the first time (i.e., had not worked previously)
[] 6 Did not look for a job because you though none were available
[] 7 Was a "housewife" exclusively
[] 8 Studied exclusively
[] 9 Were a retiree, pensioned, or renter
[] 10 Were institutionalized [imprisoned]
[] 11 Were permanently unable to work [disabled]
[] 12 Other (specify) ____
(For options 4-12, continue with question 15)

15. During the week prior to the census, did you perform any of the activities listed below and received a wage in money or kind?

[Question 15 was asked of persons age 10 or older without employment in the previous week, per question 14.]

[] 1 Washed, ironed, sewed, or provided any other domestic services
[] 2 Made or baked bread, tortillas, food, or other items to sell
[] 3 Sold items such as cloths, flowers, lottery tickets, food, craftsmanship, newspaper, candy, etc.
[] 4 Collaborated in agricultural activities
[] 5 Other (specify) ____
(Continue with question 16)
[] 6 No activity (continue with question 21)

[Questions 16-20 were asked of persons age 10 or older with employment or who performed some other activity, per questions 14 and 15.]

16. Where do you work or worked?
For example: in the fields, in a factory, a mechanical workshop, a private or public office, on the street, etc.

____

17. What does the establishment where you work or where you worked for the last time do or make?

____
_ _ _ _

18. What is the occupation, job or position that you hold or held in the establishment?

____
_ _ _ _

19. In this job, are or were you:

[] 1 Public sector employee or worker
[] 2 Private sector employee or worker
[] 3 Owner or employer
[] 4 Unpaid family worker
[] 5 Independent worker (own-account worker)
[] 6 Domestic worker
[] 7 Worker in a production cooperative
[] 8 Unknown

20. How many total hours did you work during the last week?

____ Number of hours

21. Did you receive family support in money or kind from abroad in the past twelve months?

[] 1 Yes
[] 2 No

4. Women age 12 or older[Questions 22-28 were asked of women age 12 or older]

22. Have you had children born alive?

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

[Questions 23-28 were asked of women age 12 or older who have ever had children, as per question 22.]

23. How many children born alive have you had?

____

24. How many of your born alive children live with you?

____

25. How many of your born alive children do not live with you?

____

26. Out of those born alive, how many have passed away?

____

27. What was the date of birth of your last child?

Day ____ / Month ____ / Year ____

28. Is your last child born still alive?

[] 1 Yes
[] 2 No