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National Institute of Statistics
Bolivian Republic of Venezuela
XIII General Census of Population and Dwelling
Census 2001
Protected under Statistical Secret.
Section I. Identification of the dwelling
1. Federal entity ____
2. Municipality ____
3. Parish ____
4. Population Center ________
5. Segment number _ _
6. Section number _ _
7. Block number _ _
8. Order number of the dwelling _ _ _
9. Subdivision or neighborhood ____
10. Street or avenue ____
11. Name or number of the dwelling ____
12. Date of the interview:
Month _ _
Year 2001
13. Is this the continuation of another questionnaire?
[] No
Section II. Information about the dwelling
1. Type of dwelling
[] Ranch or primary house on a ranch
[] House
[] Apartment in building
[] Apartment in a ranch, a primary house on a ranch, or a house
[] Neighborhood house [attached urban housing]
[] Farmhouse
[] Refuge
[] Other type
Total number of persons in the collective dwelling [_ _ _ _ ]
2. Condition of occupancy
[] Occupied with the inhabitants absent
[] Unoccupied (end of the interview)
[] Under construction (end of the interview)
[] Occasionally (end of the interview)
4. Predominant construction materials of the exterior walls
[] Un-plastered block or brick
[] Concrete
[] Lumber, Formica, fiberglass and similar
[] Plastered adobe, mud brick, mud/cane
[] Un-plastered adobe, mud brick, mud/cane
[] Other (palm, boards, or similar)
5. Predominant material of the roof
[] Clay tiles
[] Asphalt tiles
[] Metal sheeting [zinc and similar]
[] Asbestos and similar
[] Other (palm, boards, or similar)
6. Predominant flooring materials
[] Cement
[] Dirt
[] Other
7. The kitchen is located in:
[] Living room, dining room
[] Other location
8. The fuel normally used for cooking is:
[] Electricity
[] Kerosene
[] Other (firewood, charcoal, etc.)
9. Water is delivered to this dwelling by:
[] Tank truck
[] Public faucet or tank
[] Well with pipes or pump
[] Protected well or spring
[] Other means (creeks or streams, rivers, ditches, rainwater)
10. How many rooms does this dwelling have in total? _ _
11. How many bathrooms with a tub or shower does this dwelling have? _ _
12. This dwelling has:
[] A toilet connected to a septic tank
[] A toilet not connected to a sewer or septic tank
[] An outhouse with a hole or a latrine
[] Does not have a toilet or outhouse
13. This dwelling has the following available:
[] No
[] No
14. In this dwelling, the trash:
[] Is deposited in a collective container
[] There is not urban trash service
Section III. Number of households
1. How many persons reside in this dwelling?
2. Do these persons maintain separate expenses for buying food?
[] No
3. How many groups of persons maintain separate budgets for buying food? _ _
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Section IV. Composition of the household
Only for habitual residents of this household.
1. Households in this dwelling:
2. How many persons in this household reside in the dwelling, whether they are present or not at this moment?
3. What is the last name and given name of each of the persons in this household?
Head of household (male or female).
Spouse or companion.
Sons/daughters/ or stepson/stepdaughters who are unmarried and do not have children, in order from eldest to youngest.
Sons/daughters or stepsons/stepdaughters who are divorced, separated, or widowed, with children living with him/her, writing each of these children next.
Sons/daughters or stepsons/stepdaughters who are married or in a consensual union, and who live in this household, writing the name of the spouse next and then their children.
Other relatives of the head of household (male or female) (father, mother, father/mother-in-law, brothers/sisters, uncles/aunts, nephews/nieces, brother/sister-in-law, and then their family members.
Persons not related to the head of household, male or female, (friends, etc.) and then their relatives.
Domestic servants and then their children.
Lasts names and name____
Relationship to the head of household (male or female) ____
What is the sex?
[] Woman
Total _ _
4. I have listed the following persons (read the names out loud).
[] Yes
5. Is there any person that I have not noted who habitually resides here, but who is not present at the moment because of vacations, work, illness, or any other cause?
Section V. Information about the household
1. For this household, the dwelling is:
[] Owned and mortgaged: monthly payment _. _ _ _. _ _ _. 00
[] Rented: monthly payment _. _ _ _. _ _ _. 00
[] Loaned
[] Other condition
2. How many rooms are used by this household for sleeping? _ _
3. Does the head of household have a partner?
[] No
4. How many persons aged one year old or more sleep in the same room as the head of household and his/her partner? _ _
5. How many bathrooms with tubs or showers are available for exclusive use of this household? _ _
6. Does this household have any of the following vehicles for personal use?
[] Motorcycle
[] Car
7. In this household, are there persons under 18 years old?
[] No
8. How many of these persons under 18 years old have not been registered in any civil registry, legal court, municipal registry, consulate, hospital, clinic, walk-in-clinic, etc.? _ _
9. This household has the following:
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
[] No
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Section VI. Individual characteristics
Person number: __ of __
Last name and given name: ________
1. Relationship to the head of household (male or female); transcribe from question 3, Section IV.
[] Spouse or companion (male or female)
[] Son/daughter or stepson/stepdaughter
[] Grandson or granddaughter
[] Son-in-law or daughter-in-law
[] Father, mother, father/mother-in-law
[] Brother/sister, brother/sister-in-law
[] Nephew/niece
[] Other relative
[] Not related
[] Domestic service
[] Relative of domestic service
[] Person in a collective dwelling
2. Sex (transcribe from question 3, Section IV)
[] Woman
3. What is his/her date of birth and completed age in years?
Month _ _
Year _ _ _ _
4. Was he/she born in Venezuela?
[] In this same state
[] In another state in the country. Which?
[] Amazonas
[] Anzoátequi
[] Apure
[] Aragua
[] Barina
[] Bolívar
[] Barabobo
[] Cojedes
[] Delta Amacuro
[] Falcón
[] Guárico
[] Lara
[] Mérida
[] Miranda
[] Monagas
[] Nueva Esparta
[] Portuguesa
[] Sucre
[] Táchira
[] Trujillo
[] Vargas
[] Yaracuy
[] Zulia
[] Federal Dependencies
5. Born in another country:
Year of arrival in Venezuela? _ _ _ _
Which country?
[] Bolivia
[] Brazil
[] Chile
[] Columbia
[] Ecuador
[] Spain
[] Guyana
[] Italy
[] Peru
[] Portugal
[] Dominican Republic
6. His/her current legal nationality is:
[] Venezuelan, by naturalization (naturalized): Continue with question 9
[] Venezuelan, born in another country, son/daughter of father and/or mother who is/are Venezuelans by birth or naturalization: Continue with question 9
[] Foreigner: Continue with question 9
7. Are you a member of any indigenous population?
8. Do you speak the language of this indigenous population?
[] No
9. Do you have any of the following deficiencies, problems, or disabilities?
[] Total deafness
[] Mental retardation
[] Loss or disability in upper extremities
[] Loss or disability in lower extremities
[] Other
[] None
10. Do you require the use of a wheelchair?
[] No
Only for persons three years old or more
[Questions 11- 19 were asked of persons age 3 and older.]
11. In October, 1996, where did you reside?
[] In this same municipality: Continue with question 14
[] In another municipality in the country
[] In another country: Continue with question 13
12. In which municipality and state did you reside in October, 1996?
State: ____ Continue with question 14
13. In which country did you reside in October, 1996?
14. Do you know how to read and write?
[] No
15. Do you currently attend, as a student, any preschool, basic, middle, technical middle, special, upper technical, or university level educational establishment?
[] No: Continue with question 17
16. The educational establishment that you attend is:
[] Official
[] Private
17. What was the highest grade, year, or semester that you passed and at what educational level?
[] Grade or year
[] Basic (1-9)/ Elementary (1-6): Continue with question 20
[] Special education: Continue with question 20
[] Middle (1-2): Continue with question 20
[] Technical middle (1-3): Continue with question 20
[] Baccalaureate [college preparatory] (1-5): Continue with question 20
Semester _ _
Semester _ _
18. Have you obtained any higher education degree?
19. Have you done any post-graduate studies?
[] No
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Only for persons 10 years old and more
[Questions 20- 35 were asked of persons age 10 and older.]
20. You current marital status is:
[] Married
[] Single
[] Separated from a consensual union or marriage
[] Divorced
[] Widowed from a consensual union or marriage
21. Last week you were:
[] Not working, buy had a job ? Continue with question 23
[] Looking for work, having worked previously ? Continue with question 23
[] Looking for work for the first time
[] Doing housework
[] Studying and not working
[] As a pensioner or retiree
[] Permanently incapacitated for work
[] Other situation
22. During last week, in your house or outside of your house, did you carry out any activity for which you received or will receive a payment in money or in kind? (for example: sewed, cooked, sold clothing, washed cars, cleaned shoes, etc)?
[] No: Continue with question 35
[Questions 23-34 were asked of persons age 10+ who currently carry out activity for which they received or will receive payments, per question 22.]
23. What is the principal job or type of work that you do (or did) in the company, organism, or business where you work (or worked)? (For example: taxi driver, lawyer, farmer, medical visitor (representative of pharmaceutical companies), teacher, secretary, etc.) ____
24. What is the primary activity of the company, organism or business, where you carried out your primary work? (For example: passenger transportation, furniture factory, coffee farming, higher education, etc.) ____
25. How many persons work (or worked) in this company, organism, or business?
[] From 2 to 4
[] 5
[] From 6 to 10
[] From 11 to 20
[] From 21 to 100
[] More than 100
26. What is the name of the company, organism, or business where you work (or worked)? ____
27. This business, organism, or company where you work (worked) is:
[] Public administration: Continue with question 29
28. Does this business or company where you work (or worked) have a Mercantile Registration?
[] No
[] Don't know
29. In this work, you are (or were):
[] On contract
[] Occasional
[] Employer or owner
[] Member of a cooperative
[] Unpaid family helper
[] Domestic service
30. You do your work (or did your work):
[] In a space next to your dwelling
[] In an exclusive space or location
[] In the street (hawker or sidewalk stall)
[] In a kiosk
[] In the market
[] In a vehicle
[] Door-to-door service
31. Do you receive or have you received any occupational training for the job that you do (or did)?
[] No
32. How many hours did you work last week in all of your jobs (or the last week that you worked)?
Total hours: _ _
33. How much did you earn in all of your jobs in the past month (or the last month that you worked)?
[] Did not receive income: Continue with question 35
34. Under which payment system do you receive (did you receive) your income in your principal job?
[] Weekly
[] Daily
35. Did you receive income last month for any of the following concepts, and how much?
For all women 12 years old or more
[Questions 36- 38 were asked of women age 12 and older.]
36. How many children who were born alive have you had in total?
[] None: end of interview
37. In what month and year was your last son or daughter born (born alive)?
Year _ _ _ _
38. Of the total number of sons and daughters born alive, how many are currently alive?
[] None
[] Don't know
[Pages 3 and 4 are repeated as pages 5-6, 7-8, 9-10, 11-12, 13-14, 15-16. The only change is that each two-page form for the persons 2 through 7 has different serial numbers.]