Part I: Address
____Name or number of road or street
____Number of building
____Flat or apartment number
Part II: Type of place
1 [] Tent, hollow, hut, cave, etc.
2 [] Hotel, motel, boarding house
3 [] Boarding school, hostel, etc.
4 [] Nursing home, penitentiary, etc.
5 [] Hospital
6 [] Military quarters, garrison, officer's club, etc.
7 [] Train, ship, bus, terminal, etc.
8 [] Others (factory, government office, etc.)
[Responses 2-8 do not fulfill the census criteria of a household [housing unit], and therefore are not enumerated in Part III: Household questions]
Part III: Household questions
[Questions 1-7 (Part III) were asked of places that constitute households (housing units), as per Part II: Type of place.]
1. Name and surname of the household head: ____
2. Is the household head at home?
2 [] No
3. How many persons are there in the house now including guests?____
4. How many guests are there in the house now?____
5. How many household members are absent now?
Abroad____
6. Is the household the owner of this dwelling?
2 [] No
7. Does the household own any other dwelling, whether or not it owns this one?
4 [] No
To enumerator's attention
1. Enter name and surname and all other characteristics of the household head in the first line of part IV in places where there are households, whether the household head is at home or not.
If the household head is not at home, obtain the information on his/her characteristics from one of the household members who may reply for him/her.
Obtain the information on other persons from them personally as much as possible, and in cases this is not possible ask the household head or one of the household members who may reply for them.
2. Write in block letters.
3. Put an (X) in the appropriate box in case the questions are with multiple boxes.
4. Do not enter anything in places reserved for coding.
5. To complete the questionnaire, use a pencil only.
Part IV: Questions on individual characteristics
Serial number
2 []
3 []
4 []
5 []
6 []
7 []
9. Sex
F Female
1 [] M
2 [] F
10. Age completed____
11. Relationship to the household head____
Place of birth
12. The present name of the province to which your birthplace is linked: ____
13. Is your place of birth now administratively a province, a district center, a subdistrict or a village?
1 [] Province center
2 [] District center
3 [] Sub-district, village
14. Citizenship
1 [] T.C.
If not T.C. specify ____
Permanent residence
15. Name of the province and/or the district of your permanent residence
____Name of province
____Name of district
16. Is your permanent residence located in a province, a district center, a sub-district or a village?
2 [] District center
3 [] Sub-district, village
Permanent residence on the census day in 1985
(Ask persons age 5 or older)
[Questions 17-18 were asked of persons age 5 or older]
17. Name of the province and/or the district of your permanent residence on the previous (1985) Census Day.
____Name of province
____Name of district
18. Was your permanent residence located in a province, a district center, a sub-district or a village?
2 [] District center
3 [] Sub-district, village
19. Can you read and write?
N-No
Ask persons age 6 or older
4 [] Y
5 [] N
20. Last school completed: ____
Ask persons age 6 or older who responded "Yes" to question 19
21. Marital status
1 [] Never married
2 [] Married
3 [] Divorced
4 [] Widowed
Fertility
(Ask married, widowed, and divorced females age 12 or older)
[Questions 22-26 were asked of married, widowed, and divorced females age 12 or older]
22. Have you given birth to any live child, whether dead or alive now?
If "Yes", how many live male or female children did you give birth to?
M. Male
0 [] Did not give birth
____ F
____ M
23. How many of the children you have given birth are alive now?____
24. Have you given birth to live children, now alive or dead, in the preceding two years (since October, 1988)?
N. No
Do not ask those [women] age 51 or older
1 [] Y
2 [] N
Ask those who have responded "Yes" to question 24
[Questions 25-26 were asked of ever-married women age 12-50 who gave birth in the preceding two years, as per question 24.]
25. Is your latest child born still alive or dead?
4 [] Dead
26. What is the full date of birth and sex of this child?
1 [] Female
2 [] Male
Employment status in the last week
[Questions 27-33 were asked of persons age 12 or older]
27. Did you work last week in any job for money or for payment in kind? If you didn't, do you continue to hold a job?
3 [ ] Worked
4 [ ] Didn't work but has attachment to a job
5 [ ] Didn't work
Ask those who answer question 27 as "Worked" or "Didn't work but has attachment to a job". For those "Didn't work" skip to question 32.
[Questions 28-31 were asked of persons age 12 or older who worked or didn't work but has attachment to a job, as per question 27.]
28. Kind of work you did last week or the job you continue to hold: ____
29. Kind of work place where you worked last week or where you continue to hold a job: ____
30. Nature of work done at the work place where you worked last week or where you continue to hold a job: ____
31. Employment status in the job you worked last week or where you continue to hold a job
1 [] Employer
2 [] Self-employed
3 [] Unpaid family worker
Ask those who answer question 27 as "Didn't work"
[Questions 32-33 were asked of those not working or having an attachment to a job, as per question 27.]
32. Reason for not working, if you didn't work or discontinued working
3 [ ] Retired
4 [ ] Student
5 [ ] Housewife
6 [ ] Rentier
7 [ ] Other
8 [ ] Unemployed
33. Are you looking for a job?
N. No
1 [] Y
2 [] N
34. What is your main profession?
(Farmer, farm worker, construction worker, brick layer, carpenter, lathe operator, auto mechanic, electrician, medical doctor, nurse, pharmacist, teacher, lawyer, economist, agricultural engineer, shoe repairman, barber, typist, police, driver, etc.)
0 [] None
If you have one, specify_____