Republic of Venezuela
Ministry of Development
Head Office of National Statistics and Census
X General Population and Housing Census
Questionnaire Sample "A"
Section I -- Dwelling identification
____ 1. Municipality
____ 2. District
____ 3. Federal entity
____ 4. Sector number
A. Urban: Type
[] 2 Suburban
[] 3 Peripheral slum (De Ranchos)
____ Block number
____ Locality
____ 5. Order number
For office use only
____ Entity
____ Reg.
____ S.R.
____ Sector
____ Number
____ Populated center number
____ Size
Section II -- Dwelling information
1. Dwelling type
[] 02 Apartment in a building, house or quinta
[] 03 Room in a house, quinta, or apartment
[] 04 Room in a tenement (Casa de vecindad)
[] 05 Peasant hut (rural type) (rancho campesino)
[] 06 Urban hut/improvised dwelling (rancho urbano improvisado)
[] 07 Other type
____ Name
2. Occupancy
B. Unoccupied:
[] 3 For sale
[] 4 For rent or sale
[] 5 Occasional use
[] 6 Other condition
3. Is the dwelling located in an area of agricultural production?
[] 2 No
4. Water supply
[] 2 Outside the dwelling but within the building
[] 4 Public tap
[] 5 Well, cistern or manual pump (jaguey)
[] 6 River, stream or spring
[] 7 Other source
5. Wastewater elimination
[] 2 Toilet or W.C. to septic tank
[] 3 Pit toilet or latrine
[] 4 Without any toilet facilities
6. Number of rooms
____ How many are used for sleeping?
7. Number of occupants
____ Males
____ Females
8. Predominant material in the exterior walls
[] 2 Blocks or brick
[] 3 Adobe or mud wall (tapia)
[] 4 Bamboo-and-mud wall (bahareque)
[] 5 Cane, palm, straw and similar
[] 6 Waste material (cardboard, metals, planks, etc.)
[] 7 Other materials
9. Predominant material in roof
[] 2 Tile
[] 3 Asbestos or similar
[] 4 Metal sheet (zinc)
[] 5 Straw, palm, or similar
[] 6 Waste material (cardboard, metals, planks, etc.)
[] 7 Other materials
10. Predominant materials in floors
[] 2 Cement
[] 3 Wood board (sawed)
[] 4 Brick
[] 5 Earth
11. Is there a bath with piped running water (by aqueduct)?
[] 2 No
12. Type of lighting used
[] 2 Private company
[] 3 Private generator
[] 5 Other type
13. Place for cooking
[] 2 Where people sleep
[] 3 In another place
14. Fuel used for cooking
[] 2 Kerosene or gasoline
[] 3 Electrical
[] 4 Wood
[] 5 Other type
[] 2 No
[] 1 Refrigerator or freezer
[] 1 Automatic washing machine
[] 1 Hot water heater
[] 1 Television
[] 1 Telephone
[] 1 Air conditioning
[Repetition of response code 1 is in the original]
[page 2]
1. Person number [heading at top of this page] ____
Section III -- General and educational characteristics
2. Surnames and name of this person ____
3. Relationship to the head of household ____
5. - 6. Date of birth or age in years
____ Month
____ Year
____ Years
[] 00 Under 1 year
7. Current marital status
[] 2 Consensual union
[] 3 Widowed
[] 4 Divorced
[] 5 Single
8. Were you born in this country or abroad?
[] 3 Abroad (skip to 8d)
8a. In what state were you born?
In another state, which ____
8b. In what district?
In another, which ____
8c. In what municipality?
In another municipality, which (skip to 10) ____
8d. In what country were you born? ____
9. What is your legal nationality?
[] 2 Born abroad to Venezuelan parents
[] 3 Foreign
10. How long have you lived in this municipality?
[] 2 Less than 1 year
[] 3 1 to 4 years
[] 4 5 or more years
11. In which state did you live before living in this municipality?
In another, which ____
[] 3 Abroad
Only for individuals 5 years of age and older
(See Question 5-6)
12. Are you enrolled or do you regularly attend any center of learning?
[] 2 No -- Skip to 15
13. Is the establishment you attend part of an official entity or private? -- Answer this question if response to 12 is "yes" --
[] 2 Private
14. What are the year or grade and the branch of studies you are pursuing? -- Answer this question if response to 12 is "yes" --
____ Branch of studies
[Skip to 16]
15. If the person is between 7 and 14 years old, what is the reason for not attending school? -- Answer this question if response to 12 is "no" --
[] 2 There are no higher grades
[] 3 There is no school
[] 4 The school is very far away
[] 5 There are no places open
[] 6 Without economic resources
[] 7 Working
[] 8 Chronic illness or disability
16. What are the highest year or grade and branch of studies completed?
____ Branch
[] None
17. Are you able to read and write?
[] 2 No
18. Have you obtained a title or certificate from an institution of regular schooling?
____ Which?
[] 2 No
Only for individuals 15 years of age and older
19. In which of these activities did [the respondent] spend the most time during the last week?
[] 1 Did not work but had a job (Skip to 26)
[] 2 Looking for work (unemployed) (Skip to 20)
[] 3 Household duties (Skip to 20)
[] 4 Study (Skip to 20)
[] 5 Rentier (Skip to 20)
[] 6 Pensioner or retiree (Skip to 20)
[] 7 Interned in an institution (End)
[] 8 Disabled for purposes of work (End)
[] 9 Other situation [arrow points to question 20]
20. Did [the respondent] do any work for pay in money during the last week?
[] 2 No
21. Did [the respondent] do any work during the last week, for which he/she did not receive payment in money, in any company (business, industry, farm, etc) belonging to a member of your family?
[] 2 No [arrow points to question 23]
22. How many hours were spent on this activity during the entire week?
[] 2 15 or more
Write in question 26 the number of hours stated and go on to question 27.
23. Did [the respondent] engage in any effort or diligence to find work during the last month?
[] 2 No
24. Has [the respondent] previously worked full or part time in return for payment in money?
[] 2 No (End)
25. In what month and year did [the respondent] last work?
____ Year
26. How many hours did [the respondent] work during the last week in all jobs (or, how many hours were regularly worked per week in the last job held?)
27. For whom did [the respondent] principally work during the last week (or in the last job held)?
____ For a private company, family home, or a person
[] On your own
28. Describe the kind of activity that the hiring institution, company or person does (or the activity you work on your own)?
29. Describe the occupation, position or type of work performed in this job or in the last job?
30. Occupational category in this job (or in the last job)
[] 2 Professional employee or manual laborer for a private company (Go on to 31)
[] 3 Owner (Skip to 32)
[] 4 Own-account worker (Skip to 32)
[] 5 Member of a cooperative or similar (Skip to 32)
[] 6 Unpaid family worker (Skip to 34)
31. Estimate the total income in Bs. obtained last month (or in the last month worked) from wages or salaries, commissions, tips and bonuses.
[] 2 Other payment in kind
32. Estimate the total income in Bs. received last month from work (or during the last month worked).
33. Did you receive any additional income in any of the following forms, and approximately how much?
[] 2 No
[] 2 No
[] 2 No
34. How many weeks did you work full or part-time during 1970 (not excluding leaves or vacations)?
[] Did not work
35. During the time worked in 1970, how many jobs or positions were held?
[] 2 Two
[] 3 Three
[] 4 Four or more
Only for women age 15 and older:
36. Have you had any children born alive?