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Republic of El Salvador, Central America
National Statistics and Census Bureau
Treasury Department
National Censuses
Sixth population and fifth housing censuses

Additional form /___/

I. Geographical localization

1. Department ____________________ /_/_/
2. Municipality ____________________ /_/_/
3. Municipal capital [cabecera municipal] or canton ________________ /_/_/
4. Zone [sector] __________________________ /_/_/_/
5. Section [segmento] __________________________ /_/_/_/_/

6. Block _________________ /_/_/_/

7. Settlement [caserío]

8. Order number of the dwelling within the section____________ /_/_/_/

9. Order number of the household within the dwelling ______________/_/_/

10. Address of the dwelling:

Neighborhood [barrio] _____________
Development [colonia] __________________
Subdivision [urbanización] _______________
Suburb [reparto] ___________
Street/avenue ____________________
Small street [pasaje] _________
Path [senda]
Number_______________
Building [block] __________________

The statistical service law, article 18, states: "Information compiled by the General Statistics and Census Bureau is completely confidential and may not be used for taxation purposes or legal investigations".

II. Dwelling information

1. The dwelling is:

A) Private

[] 01 Independent house [casa independiente]
[] 02 Apartment
[] 03 Room in a house
[] 04 Room in a tenement [mesón]
[] 05 Hut or shack
[] 06 Improvised house
[] 07 Premise not intended for human habitation
[] 08 Other (mobile dwelling, tent, etc.)
[] 09 Homeless (go to Chapter VI)

B) Institutional

[] 10 Home for children or orphanage
[] 11 Retirement home
[] 12 Jail/prison
[] 13 Guest house or student boarding house [pupilaje]
[] 14 Juvenile correctional facility
[] 15 Convent or boarding school
[] 16 Barracks
[] 17 Other

[If the respondent answers options 10-17, go to Chapter VI]

2. What material are most of the walls made of?

[] 1 Concrete or mixed [mixto]
[] 2 Wattle and daub
[] 3 Adobe
[] 4 Wood
[] 5 Metal laminate [lámina metálica]
[] 6 Straw, palm or other vegetable matter
[] 7 Discarded materials
[] 8 Other


3. What material is most of the roof made of?
[] 1 Concrete slab
[] 2 Asbestos laminate
[] 3 Fiber-cement laminate
[] 4 Tile
[] 5 Metallic laminate
[] 6 Straw, palm or other vegetable matter
[] 7 Discarded materials
[] 8 Other
4. The dwelling is:
A. Occupied

[] 1 With people present
[] 2 With people absent (return to this dwelling)

B. Vacant

[] 3 Occasional use
[] 4 For rent
[] 5 For sale
[] 6 Under repair/construction
[] 7 Other reason

[End the interview if the respondent selects any of options 3-7]

5. What material is most of the floor made of?

[] 1 Ceramic tile
[] 2 Cement slab
[] 3 Cement brick
[] 4 Clay brick
[] 5 Wood
[] 6 Dirt
[] 7 Other


6. How many persons live in this dwelling, including small children, seniors, and domestic employees who sleep here? Write the number /_/_/
7. Do all the people who live in this dwelling share food expenses?
[] 1 Yes (go to Chapter III)
[] 2 No
8. Then how many households or groups of persons, including yours, have separate food expenses? Write the number /_/_/
Total number of persons who make up this household
Description
Form 1

Males ___
Females ___
Total ___
Form 2
Males ___
Females ___
Total ___

Form 3
Males ___
Females ___
Total ___

Form 4
Males ___
Females ___
Total ___

Form 5+
Males ___
Females ___
Total ___

Total persons
Males ___
Females ___
Total ___

[Next page]

III. Household characteristics

1. How many rooms does this household have, not including the bathroom, hallway, kitchen or garage? Number /_/_/
2. How many of the rooms are used exclusively as bedrooms? Number /_/_/
3. Does this household have a room used only for cooking?

[] 1 Yes
[] 2 No


4. What is the ownership status [forma de tenencia] of the dwelling occupied by this household?
[] 1 Own dwelling
[] 2 Own dwelling paid in installments to a public institution
[] 3 Own dwelling paid in installments to a private institution
[] 4 Own dwelling being paid in installments to NGOs
[] 5 Rented
[] 6 Occupied for free
[] 7 Other status
5. What type of sanitary service is available?
[] 1 Toilet connected to sewer
[] 2 Toilet connect to septic tank
[] 3 Latrine
[] 4 Fertilizing latrine
[] 5 Does not have (go to question 7)
6. Is the sanitary service:
[] 1 Exclusively for use of the household
[] 2 Shared with other households
7. How is waste water [aguas grises o servidas] disposed of?
[] 1 Sewage system
[] 2 Septic tank
[] 3 Sump hole
[] 4 Gully/stream, river or lake
[] 5 Street or outside
[] 6 Other
8. What is the source of the water used by the household?
[] 01 Pipes inside the dwelling
[] 02 Pipes outside the dwelling but on the property
[] 03 Neighbor's pipes
[] 04 Basin or public tap
[] 05 Public well
[] 06 Private well
[] 07 Truck, cart or tanker
[] 08 Spring, river or stream
[] 09 Rain water
[] 10 Other

[Go to question 10 if any of options 05-10 are circled]
9. How many days per week do you get water?
A) Daily

[] 1 More than four hours
[] 2 Fewer than four hours

B) On some days

[] 3 Every other day
[] 4 Every three days
[] 5 Once a week
[] 6 From time to time
10. What is the main fuel used for cooking?
[] 1 Electricity
[] 2 Propane gas
[] 3 Kerosene
[] 4 Wood
[] 5 Wood charcoal
[] 6 Straw, palm
[] 7 Discarded material
[] 8 Other
[] 9 Do not cook
11. What type of lighting do you have?
[] 1 Electricity
[] 2 Kerosene
[] 3 Candle
[] 4 Solar panel
[] 5 Car battery
[] 6 Other
12. How is trash disposed of?
[] 1 Municipal service
[] 2 Private service
[] 3 Burned
[] 4 Buried
[] 5 Put in dumpsters/bins
[] 6 Thrown into street, ravine or empty lot
[] 7 Thrown into a river, lake or sea
[] 8 Other
13. Does this household have appliances and services that belong to it?
Television
[] 1 Yes
[] 2 No
Landline phone
[] 1 Yes
[] 2 No
Cell phone
[] 1 Yes
[] 2 No
Refrigerator
[] 1 Yes
[] 2 No
Washing machine
[] 1 Yes
[] 2 No
Video-cassette player
[] 1 Yes
[] 2 No
Sound equipment
[] 1 Yes
[] 2 No
Microwave oven
[] 1 Yes
[] 2 No
Computer
[] 1 Yes
[] 2 No
Auto
[] 1 Yes
[] 2 No
Motorcycle
[] 1 Yes
[] 2 No
Cable service
[] 1 Yes
[] 2 No
Internet service
[] 1 Yes
[] 2 No
14. Does any member of the household perform any economic activity within the dwelling, such as:
Making tortillas, bread, clothes, shoes, furniture, hammocks, crafts, etc.?
[] 1 Yes
[] 2 No
Selling products or articles (which they do not produce or make), such as rice, corn, beans or sorghum [granos básicos], soft drinks, clothes, shoes, etc.?
[] 1 Yes
[] 2 No
Providing a service, such as radio, TV or refrigerator repair; medical service; beauty salon, etc.?
[] 1 Yes
[] 2 No
15. Does any member of the household perform the following as his/her principal activity:
Growing rice, corn, beans or sorghum [granos básicos], vegetables, coffee, etc.?
[] 1 Yes
[] 2 No

Raising animals?
[] 1 Yes
[] 2 No

If at least one of the answers is "Yes", continue. If the answer to both questions is "No", go to Chapter IV.
16. Is the land you cultivate, or where you raise animals:
[] 1 Your own
[] 2 Rented
[] 3 Other
[Next page]

IV. Characteristics of the persons who make up the household

1. How many people are there normally in this household? /_/_/
Write the first and last name of each person who is part of this household, including children, seniors, newborns and any other members who might be absent due to vacation, work, business or illness. Also include domestic employees (male or female) who sleep here.

Column 1: Order number _____

Column 2: Strictly follow the order below to record household residents:

[] Head of household
[] Spouse or partner
[] Single child
[] Married child
[] Son-in-law or daughter-in-law
[] Grandchild or great grandchild
[] Brother or sister
[] Nephew or niece
[] Father or mother
[] Father-in-law or mother-in-law
[] Other relatives (uncle, etc.)
[] Domestic employee
[] Other non-related person

Column 3: Connection or family relationship to head of household

Column 4: Male (1)

Column 5: Female (2)

[The following line is at the bottom of the page, underneath the eighth row]
Total number of persons recorded on this form (1) ________________________
Check to make sure you wrote down children, seniors, newborns and normal household residents who might be absent due to vacation, business or illness. Also include domestic employees (male or female) who sleep here.
(1) Transfer these totals to the "Total persons who make up this household" box on the first page. If you use more than one page, transfer the totals to same box of the first form.

V. Mortality and emigration

1. Did anyone in this household die in the past 12 months?
[] 1 Yes

How many persons? /_/_/
Write the information related to each person who died in the following box.

[] 2 No (go to question 2)

Person _____

How old was the person when he/she died? (If younger than 1, write "00") /_/_/

[] 1 Male
[] 2 Female
(If it is a girl or woman between the ages of 12 and 49, go to the next box)

The girl or woman died:

For deceased girls and women between the ages of 12 and 49
[] 1 During pregnancy
[] 2 Giving birth
[] 3 Within 40 days of giving birth
[] 4 Other

2. Did any member of this household go live permanently in another country?
[] 1 Yes

How many persons? /_/_/ Write the information related to each person in the box.

[] 2 No (go to Chapter VI -- Information about persons in the household)

Person

[] 1 Male
[] 2 Female

Current age /_/_/

Country where the person currently resides ______

Year in which the person left El Salvador /_/_/_/_/

[Next page]

VI. Information about persons in the household

Person _____ of the list

Write first and last names _____________________________

For all persons

1. What is the connection or family relationship to the head of household?

[] 01 Head of household
[] 02 Spouse or partner
[] 03 Child
[] 04 Son-in-law or daughter-in-law
[] 05 Grandchild or great-grandchild
[] 06 Brother or sister
[] 07 Nephew or niece
[] 08 Father or mother
[] 09 Father-in-law or mother-in-law
[] 10 Other relatives
[] 11 Domestic employee
[] 12 Other non-related person
[] 13 Person in institutional dwelling
[] 14 Homeless person


2. Is this person male or female?
[] 1 Male
[] 2 Female
3a. How old is this person in completed years?
Write "00" if younger than 1, and "98" if age 98 or older
/_/_/
3b. Do you have a national identity card?
[Persons age 18 or older]
[] 1 Yes
[] 2 No
4. Date of birth:
Day /_/_/
Month /_/_/
Year /_/_/_/_/
5. Do you/does the person have any permanent limitation in:
Moving or walking
[] 1 Yes
[] 2 No
Using his/her/your arms or hands
[] 1 Yes
[] 2 No
Seeing, even when using glasses
[] 1 Yes
[] 2 No
Hearing, even when using hearing aids [aparatos especiales]
[] 1 Yes
[] 2 No
Speaking
[] 1 Yes
[] 2 No
Does the person have a mental delay or impairment?
[] 1 Yes
[] 2 No
Bathing, dressing or eating without assistance
[] 1 Yes
[] 2 No
Other permanent limitation
[] 1 Yes
[] 2 No
6a. Are you:
[] 1 White
[] 2 Mixed race (a mix of white and indigenous)
[] 3 Indigenous (go to question 6b)
[] 4 Black (by race)
[] 5 Other
6b. If you are indigenous, what group do you belong to?
[] 6 Lenca
[] 7 Kakawira (Cacaopera)
[] 8 Nahua-Pipil
[] 9 Other ___________________ (specify)
7. Where was your mother living when you were born?
A) In this municipal capital [cabecera municipal] or canton (go to question 8)
B) Someplace else in this country

Municipal capital or canton ________________
Municipality ________________
Department ________________

C) In another country

Name of country______________
Year of arrival in El Salvador /_/_/_/_/
8. How long have you lived in this municipal capital [cabecera] or canton?
A)
[] 1 Always (go to question 9)
Since the year /_/_/_/_/
B)
[] 2 Where did you live before?
Municipal capital or canton______________
Municipality ________________
Department ________________
C)
[] 3 In another country
Name of country _______________
[Questions 9-12 are for persons age 5 or older]
9. Do you know how to read and write?
[] 1 Yes
[] 2 No
10. Do you attend or did you attend a school?
[] 1 Currently attends
[] 2 Not attending but attended
[] 3 Never attended (go to question 12)
11a. What is the last grade or highest school year passed?
[] 1 Nursery/kindergarten (go to questions 11d.) ____
[] 2 Primary or basic (go to questions 11d.) ____
[] 3 Secondary education [educación media] ____
[] 4 Short course of studies after the sixth grade leading to a degree ____
[] 5 Non-university, higher education ____
[] 6 University-level technical studies [técnico universitaria] ____
[] 7 Advanced university [superior universitaria] ____
[] 8 Master's ____
[] 9 Doctorate ____

11b: Have you completed your high school, technical, university, master's or doctorate degree?
[] 1 Yes
[] 2 No
11c: What is the name of your major? ______________________
11d. Do you speak another language in addition to Spanish?
[] 1 Yes (specify) ______________
[] 2 No
12. Do you or did you attend a vocational school in the non-formal educational system [dentro de la educacion no formal]?
[] 1 Yes
[] 2 No
[Next page]
[Questions 13-24 are for persons age 10 or older]
13. What is your marital status?
[] 1 Partnered [acompañado]
[] 2 Married
[] 3 Widowed
[] 4 Separated
[] 5 Divorced
[] 6 Single
14. Do you have an email account?
[] 1 Yes
[] 2 No
15: Did you receive help in cash or kind from a family member outside the country in the last 12 months?
[] 1 Yes
The person who sent the help was:

[] 1 Male
[] 2 Female

[] 2 No
16a. Did you work for payment in cash or kind during the week prior to the start of the census?
[] 1 Yes (go to question 20)
[] 2 No
16b. Did you have a job, business, company, or your own farm, at which you did not work (for reasons of illness, strike, vacations, bad weather, etc.)?
[] 1 Yes (go to question 20)
[] 2 No
16c. Even though you told me that you did not work, did you perform in or out of the house any of the following activities which brought you income in cash or in kind?
[] 1 Selling articles such as clothes, flowers, lottery tickets, food, handicrafts, papers, candy, etc. (go to question 20)
[] 2 Shoemaking, plumbing, bricklaying, car washing, etc. (go to question 20)
[] 3 Making bread, tortillas, food and other items for sale (go to question 20)
[] 4 Washing, ironing, sewing or other domestic services (go to question 20)
[] 5 Helping with agricultural jobs (go to question 20)
[] 6 Other (specify) _______________ (go to question 20)
[] 7 No activity
17. Did you look for job and had already worked?
[] 1 Yes (go to question 20)
[] 2 No
18. Did you look for work for the first time?
[] 1 Yes (go to Section 4)
[] 2 No
19. Why didn't you work the week prior to the census?
[] 1 Performed housework
[] 2 Is a full-time student
[] 3 Is retired, has a pension, or is living off investment income
[] 4 Imprisoned
[] 5 Permanent disability
[] 6 Other reasons (specify) __________

[Go to Section 4 if any of options 1-6 are marked]
20. What is your job or what do you or the company you work for or last worked for produce?
________
21. What is the occupation, job or position which you perform or used to perform at work?
________
22. Are you or were you the following in this job:
[] 1 Employee or worker in the public sector
[] 2 Employee or worker in the private sector
[] 3 Boss or employer
[] 4 Unpaid family worker
[] 5 Unpaid non-family worker
[] 6 Independent worker (self-employed)
[] 7 Domestic employee
23. How many total hours did you work in the week prior to the beginning of the census, or in your last job? /_/_/
24. What is the location of the business, company or place where you worked in the week prior to the beginning of the census?
A) In this municipal capital [cabecera] or canton (go to section 4)
B) Some other place in this country

Municipality____________
Department_____________

C) In another country

Name of country______________

End the interview if the respondent is a male or a girl between the ages of 0 and 11.

[Questions 25-30 are for females age 12 or older]
25. Have you had a live-born child?

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


26. How many live-born children have you had?
Males /_/_/
Females /_/_/
27. How many of your children currently live with you? /_/_/
28. How many of the live-born children have died? /_/_/
29. What was the date of birth of your last child?
Day /_/_/
Month /_/_/
Year /_/_/_/
30. Is your last child alive?
[] 1 Yes
[] 2 No