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Questionnaire of Population Census

At 0 hour 1 April, 1999

____ Province/City____ District/Quarter
____ Commune/Ward
_ _ EA number
Name of the EA

____
____

_ _ _ Household number

____ Name of the head of household

Household address

____
____
____

This is the ___ set in the total number of questionnaire sets of the household as ___

_ _ Total number of household members

_ _ No. of males
_ _ No. of females
_ _ Total number of deceased

Signature of head of household ____ Enumerator ____ (signature and name)

PART I

(Note: Questions with asterisk (*) should be asked using the interviewing chart)

CONFIDENTIAL

[There is a table with columns for 3 people in this page and 5 in the next]

[Rows]

1. Please give the full name of each person actually residing in the household, beginning with the head of household? ([Write] In capital letters)

____
____

2. What is the relationship of (Name) to the household head?

[] 1 Head of household [Only for the first person]
[] 2 Spouse
[] 3 Son/Daughter
[] 4 Parents
[] 5 Others

3. Is (Name) male or female?

[] 1 Male
[] 2 Female

4. In what solar calendar month and year was (Name) born? ________

Month _ _

Year 1_ _ _

5. To what ethnic group does (Name) belong?

____ (Specify)

6. a. Is (Name) following any religion?If yes, what religion?

[] 1 Yes
____

[] 2 No [Go on to question 7]

b. If the answer in Q.6a is one of the following 6 religions, further ask:

1. Buddhist
2. Catholic
3. Protestant
4. Muslim
5. Cao da'I
6. Ho'a ha'o
_ [1 digit]

Has been accepted?

[] 1 Yes
[] 2 No

7. On the census night (31/3/1999), was (Name) present in this province, in another province or overseas?
If he/she was present in other province, record the name of that province

[] 1 Same province
[] 2 Different province
____ (Name of Province)
_ _ _
[] 3. Overseas

Persons born before 4/1994 (5 years old and over) answer the following questions:
[Respond questions 8 to 12]

8. Where was the place of usual residence of (Name) 5 years ago (on 31st March 1994)
Person with no place of usual residence on 31/3/1994 record the place where she/he was present on 31/3/1994

[] 1 Same Commune
[] 2 Different Commune in the same district
[] 3 Different District in the same province
____ (Name of District)
_ _
[] 4 Different Province
____ (Name of Province)
_ _ _
[] 5 Overseas [Go on to question 10]

9. Was the above-recorded place a commune, a ward or district town?

[] 1 Ward/District Town
[] 2 Commune
[] 9 Not stated

10. Is (Name) attending school now, or has (Name) stopped or never attended?
School: Only record persons currently attending/attended general schools (or equivalent) and institutions of higher education.

[] 1 Attending now
[] 2 Attended in the past
[] 3 Never attended [Go on to question 12]

11*. What is the highest educational level that (Name) is attending or has completed?
For persons who have completed/ are attending secondary vocational schools or lower, record his/her general education grades

[] 1 General school
_ _ Grade system
[] 2 Undergraduate
[] 3 Graduate
[] 4 Post-Graduate

Check Q.11:

Under grade 5: [Go to] Q.12
Grade 5 or higher: [Go to] Q.13

12. Is (Name) currently able to read and write?

[] 1 Yes
[] 2 No

Persons born before 4/1986 (13 years old or over) answer the following questions:

13*. What is the highest qualification or trade that (Name) had attained?
If one of the codes from "4" to "8" is circled in Q. 13, Q.11 must be circled with "2" or "3" or "4".

[] 1 No qualification and certificate [Go on to question 15]
[] 2 Technical worker with certificate
[] 3 Secondary Vocational
[] 4 Undergraduate
[] 5 Graduate/Diploma
[] 6 Master
[] 7 Candidate
[] 8 Ph.D.

14. What field of study has (Name) completed with the highest degree?

____
____
____

(Specify)
_ _ _ _ _ _

15. What is the marital status of (Name)?

[] 1 Single
[] 2 Married
[] 3 Widowed
[] 4 Divorced
[] 5 Separated

16. What type of work has (Name) spent most of his time at during the last 12 months?

[] 1 Worked
[] 2 Household work [Go on to question 19]
[] 3 Student [Go on to question 19]
[] 4 Invalid [Go on to question 19]

Unemployed:
[] 5 Wanted to work [Go on to question 19]
[] 6 Did not want to work [Go on to question 19]

17. What was the main job that (Name) performed during the last 12 months and what position did (Name) hold (if any)?

____
____
____
(Specify)
_ _ _

18. a. Did (Name) work for the government or for other organization?

[] 1 Government
[] 2 Collective
[] 3 Capital
[] 4 Private [Go on to question 19]
[] 5 Mix
[] 6 Foreign

18. b. What is the name of the office/enterprise where (Name) works?

Record the name of the office/enterprise where (Name) works and the name of its higher management institution

____
____
____

18. c. What is the main function/product of the office/enterprise where (Name) works?

____
____
Industry [code]
_ _ _

Women born 4/1949 to 3/1984 (aged 15-49 years old) answer following questions:

19*. Now, I would like to ask you about children that you have ever born. Please tell me:

____ a. No. of children living with you
____ b. No. of children living elsewhere
_ _ c. No. of children died
_ _ d. Total number of children ever born
if d = 00 (ask next person)
[Compare d with SUM a+b+c; if different ask again and correct recorded information].

20. About the last live birth:

a. Solar calendar month and year of the most recent live birth?
_ _ Month
19 _ _ Year

b. Is that a son or a daughter?
_ (No. of) sons
_ (No. of) daughters

c. Are they still living now?
_ (No. of ) sons died
_ (No. of) daughters died

No. of deceased in household from Mau Dan year 30th tet day (27/1/1998) to now

1. Were there any adult or infant deaths in your household from last MAU DAN 30th Tet day (27/1/1998) to now?

[] 1 Yes
[] 2 No [go to Part II: Housing Census]

About deceased in household [There are columns for up to 3 deceased persons]

2. Please give me the name of (each) deceased person?

____ [Name of deceased]

3. Is (Name) male or female?

[] 1 Male
[] 2 Female

4. In what solar calendar month and year did (Name) die?

_ _ Month
199_ Year

5. In what solar calendar month and year was (Name) born?

_ _ Month
199 _ Year

Check Q.5:

Remember year of birth: (Ask about the next deceased. If there are no more deaths move to part II, Housing Census.)

If do not remember year of birth: (Go on to question 6)

6. How old was [Name] when he/she died?

If less than 12 months, record "000"

_ _ _
[In completed years]

Part II

Housing census form

1. Do you have a house to live in?

[] 1 Yes
[] 2 No [End interview]

2. Do you share a common house/flat with other households?
If share a house with other household (hh), then record the whole house/flat for a representative household.

[] 1 Yes
[] 1 This is representative hh [Go on to question 3]
[] 2 Sharing house with hh
____ Full name of hh head
_ _ _ Rep. household number
[] 2 No

3. What is the type of this (main) house/flat?
Combine with observation to record

[] 1 Permanent
[] 2 Semi-permanent
[] 3 Wood frame or durable-use lief roof
[] 4 Simple house [Go on to question 7]

4. How many square meters is the total living area of this house/flat?
Include the area of bedroom, dining room, guestroom, study room. For garret used for living count 50% only.

_ _ _ Total living area (Sq. Meters)

5. Who is the holder of this (main) house/flat?

[] 1 Self-owned
[] 2 Hired from government
[] 3 Hired/borrowed from private party
[] 4 Collective/religion
[] 5 Joint state and individual
[] 9 Not clear about ownership

6. In what year was this [main] house/flat put into use?

[] 1 Before 1976
[] 2 From 1976 up to now
19 _ _
7. Does your household use electricity for lighting?

[] 1 Having electricity
[] 2 Not having

8. What (main) drinking water source is your household using?
A hygienic well should ensure: no color, no smell, no taste and far away from pollution source at least 7 meters.

[] 1 Running water
[] 2 Raining water
[] 3 Other source having filter system or hygienic well
[] 4 Other water source

9. What type of toilet facility is your household using?

[] 1 Flushing toilet
[] 2 Suilabh toilet
[] 3 Simple toilet
[] 4 No toilet

10. Does your household have a television?

[] 1 Yes
[] 2 No

11. Does your household have a radio?

[] 1 Yes
[] 2 No

[End of the form]