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The Central Census Steering Committee
Population and Housing Census Questionnaire
Vietnam

Time: 00:00am, April 01, 2009

(Long form)
All information herein will be kept strictly confidential.
Place "X" into the small box to indicate the respective answer.

Identification
Province/city: ____ _ _
District/quarter/town/provincial city: ____ _ _ _
Commune/ward/district town: ____ _ _ _ _ _

Enumeration area (EA) number: _ _ _
Name of EA: ________
Urban/rural (urban=1, rural=2): _
Household number: _ _ _

Full name of household head: ____
Address of the household: ________

Results
_ _ Number of usual residents in this set of questionnaire
_ _ Number of males
_ _ Number of females

This is set _ _ in _ _ sets of the household.

Certification

Household head/respondent

____ Full name
____ Signature

Enumerator

____ Full name
____ Signature

Team supervisor

____ Full name
____ Signature

Part I: Population information
Serial number: _
[Questions 1-7 were asked of all persons]

1. Full name of each person usually residing in the household, starting with the household head.

____

2. What is [the respondent's] relationship to the household head?

[] 1 Household head
[] 2 Spouse
[] 3 Biological child
[] 4 Grandchild
[] 5 Parent
[] 6 Other relative

3. Is [the respondent] male or female?

[] 1 Male
[] 2 Female

4. In what solar month and year was [the respondent] born?

Month: _ _
Year: _ _ _ _
[] 9999 Not stated year

5. What is [the respondent's] age as of his/her last birthday? (If age is 95 years or more, write "95")

Age: _ _

6. To what ethnic group does [the respondent] belong?

[] 1 Kinh
[] 2 Other ethnic group
Name of ethnic group ____

7. Does [the respondent] follow any faith/religion? If yes, what is [the respondent's] faith/religion?

[] 1 Yes
Name of religion ____
[] 2 No

8. Check if the respondent was born before April, 2004 (5 years or older). [If yes, go to] Q9; otherwise, ask the next [person][Questions 9-16 were asked of persons age 5 or older]
9. Where did [the respondent] reside, five years ago (on April 1, 2004)?

[] 1 Same commune/ward [go to Q11]
[] 2 Another commune/ward in same district/quarter
[] 3 Another district/quarter in same province
Name of district ____ _ _ _
[] 4 Another province/city
Name of province ____ _ _
[] 5 Abroad [go to Q11]

10. Is the above mentioned place of usual residence a ward, a district town or a commune, five years ago?

[Question 10 was asked of persons age 5 or older living in a different commune/ward in Vietnam on April 1, 2004, as per question 9.]
[] 1 Ward/district town
[] 2 Commune

11. Does [the respondent] have any difficulty:If yes, how difficult is it? A little, very difficult, or unable.

a) Seeing (even if wearing glasses)?
[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable
b) Hearing?
[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable
c) Walking?
[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable
d) Remembering or paying attention?
[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable

12. At present, has [the respondent] been attending, ever attended or never attended schools?

[] 1 Attending
[] 2 Ever attended
[] 3 Never attended (go to Q16)

13. What is the highest level of education/training [the respondent] is attending or has attained?

[Questions 13 was asked of persons age 5 or older who are attending or have ever attended schools, as per question 12]
[] 00 Pre-school (go to Q16)
[] 01 Primary
[] 02 Lower secondary education
[] 03 Short-term training
[] 04 Higher secondary education
[] 05 Trade vocational school
[] 06 Vocational school
[] 07 Trade college
[] 08 College
[] 09 University
[] 10 Master
[] 11 Doctorate

14. What is the highest grade/year of education/training [the respondent] is attending or has completed at the above mentioned grade?

[Question 14 was asked of persons age 5 or older who are attending or have ever attended schools and whose highest grade of education/training is primary or higher, as per questions 12 and 13]
(Grade is converted into 12-year general education level)
Grade/year: _ _

15. Check Q 13: If Q 13 = 1, [go to] Q 16; otherwise, [go to] Q 17.
16. At present, can [the respondent] read and write?

[Question 16 was asked of persons age 5 or older who have never attended school, or whose highest education grade is primary or lower, per questions 12 and 13]
[] 1 Yes
[] 2 No

17. If the respondent was born before April 1994 (15 years or older), [go to] Q 18; otherwise, ask the next [person][Questions 18-30 were asked of persons aged 15 years and over]
18. What is the current marital status of [the respondent]?

[] 1 Never married
[] 2 Married
[] 3 Widowed
[] 4 Divorced
[] 5 Separated

19. What is the highest qualification that [the respondent] has attained?

[] 1 No qualification
[] 2 Short-term training
[] 3 Trade vocational school
[] 4 Vocational school
[] 5 Trade college
[] 6 College
[] 7 University
[] 8 Master
[] 9 Doctorate

20. Now, let me ask about work in the last 7 days:During the last 7 days, did you do any work to earn income?

[] 1 Yes (go to Q23a)
[] 2 No
[] 3 Do not know (go to Q31)

21. Did you still receive a wage/salary without working?

[Question 21 was asked of persons age 15 or older who did not work during the last 7 days, as per question 20]
[] 1 Yes (go to Q23b)
[] 2 No

22. Do you have a job that you will return to work during the next 30 days?

[Question 22 was asked of persons age 15 or older who did not work and did not receive a wage/salary during the last 7 days, as per questions 20 and 21.]
[] 1 Yes (go to Q23b)
[] 2 No (go to Q28)

[Questions 23-27 was asked of persons aged 15+ who worked (answer 23a) or received a wage/salary without working (answer 23b) during the previous 7 days, or had a job to return to during the following 30 days (answer 23b), as per questions 20-22]
23a. During the last 7 days, what was the main type of work you did and what position did you hold for the mentioned work (if available)?

________

23b. During the 7 days before having break from work, what was the main type of work you did and what position did you hold for the mentioned work (if available)?

________ _ _ _

24. With the above mentioned work, are you a contributing family worker, employee or work as another role?

[] 1 Family worker
[] 2 Employee
[] 3 Other

25. Does the establishment where you did the above mentioned work belong to an individual, household of individual production and trade, collective, private, state, or foreign investment economic enterprise?(Household of individual production and trade includes agriculture/forestry/fishery and non-agriculture/forestry/fishery households)

[] 1 Individual (go to Q31)
[] 2 Household of individual production and trade (go to Q27)
[] 3 Collective
[] 4 Private
[] 5 State
[] 6 Foreign investment economic enterprise

26. What is the name of the establishment where you did the above mentioned work and the name of its direct supervision organization (if available)?

[Question 26 was asked of persons age 15 or older who worked in a collective, private, state or foreign investment economic enterprise, as per question 25]
________

27. What are the main responsibilities/products of the establishment where you did the above mentioned work?

[Question 27 was asked of persons age 15 or older who did not work for his or herself, as per question 25]
________ _ _ _ (go to Q31)

28. During the last 30 days, did you look for any work?

[Question 28 was asked of persons age 15 or older who did not work nor receive a wage/salary without working during the previous 7 days, and did not have a job to return to during the following 30 days, as per questions 20-22]
[] 1 Yes
[] 2 No (go to Q30)

29. During the last 7 days, would you have been available for work if you had found suitable work?

[Question 29 was asked of persons age 15 or older who did not work nor receive a wage/salary without working during the previous 7 days, did not have a job to return to during the following 30 days, and who were looking for work during the previous 30 days, as per questions 20-22 and 28]
[] 1 Yes (go to Q31)
[] 2 No

30. If Q28 = 2: Why didn't you look for work? If Q29 = 2: Why weren't you available for work?

[Question 30 was asked of persons age 15 or older who did not work nor receive a wage/salary without working during the previous 7 days, who did not have a job to return to during the following 30 days, and who did not look for work during the previous 30 days or weren't available for work during the previous 7 days, as per questions 20-22, 28, 29]
[] 1 No suitable work / don't know where
[] 2 Illness / personal matter / waiting for job application's result
[] 3 Bad weather / off-season
[] 4 Attending school
[] 5 Housework
[] 6 Disabled
[] 7 Not willing to work
[] 8 Other (specify) ____

31. Check: If respondent is female born between April 1959 to March 1994 (between 15 to 49 years of age), [go to] Q32; otherwise, ask the next [person]
32. Have you ever given birth?

[Question 32 was asked of females between 15 and 49 years of age]
[] 1 Yes
[] 2 No (go to the next person)

[Questions 33-34 were asked of females between 15 and 49 years of age who have ever given birth, as per question 32]
33a. How many children to whom you have given birth are currently living with you in this household?

_ _ Children in the same household

33b. How many children to whom you have given birth aren't currently living with you in this household (living elsewhere)?

_ _ Children in other household

33c. Have you ever given birth to a boy or girl who was born alive but later died? If yes, ask number of dead child(ren).

_ _ Children dead

34a. In what solar month and year did you have the last birth?

Month: _ _
Year: _ _ _ _

34b. How many sons and daughters did you give birth to in the last birth?

_ Son(s)
_ Daughter(s)

Part 2: Mortality information

35. From the 1st of Lunar New Year - Mau Ty (February 7, 2008 on the solar calendar) to 0:00am on April 1, 2009, were there any adult or infant deaths in your household?

[] 1 Yes
[] 2 No (go to Part 3: Housing information)

[Questions 36-42 were asked of households with a person who died between February 7, 2008 and April 1, 2009, as per question 35.]

Serial number of the deceased: _

36. Let me know about the full name of each deceased person? ____

37. Is [the deceased] male or female?

[] 1 Male
[] 2 Female

38. In what solar month and year did [the deceased] die?

Month: _ _
[] 1 Year 2008
[] 2 Year 2009

39. What was the solar completed age of [the deceased] when he/she died?
If age is less than 12 months, write "00". If age is above 95, write "95"

Solar age: _ _

40. What was the cause of [the deceased's] death?

[] 1 Diseases
[] 2 Working accident
[] 3 Traffic accident
[] 4 Other accident
[] 5 Other (specify) ____

41. Check Q 37, 39, 40: If deceased is woman aged between 15 and 49 who didn't die of accident, [go to] Q42; otherwise, ask for the next deceased

42. Did [the woman] die during pregnancy?
If not: did [the woman] die during childbirth?
If not: did [the woman] die after miscarriage/abortion?
If not: did [the woman] died within 42 days after childbirth/lost pregnancy?

[Question 42 was asked of households with a woman aged between 15 and 49 who died between February 7, 2008 and April 1, 2009 of a non-accident related cause, as per questions 35, 37, 39 and 40.]
[] 1 Pregnancy
[] 2 Childbirth
[] 3 Miscarriage/abortion
[] 4 42 days after childbirth/lost pregnancy
[] 5 No

Part 3: Housing information
43. Household has the dwelling or not

[Question 43 was asked of all households]
[] 1 Yes
[] 2 No (go to Q53)

44. Is your household sharing the dwelling with others?[Question 44 was asked of households that have the dwelling, as per question 43]

[] 1 No
[] 2 Yes
[] 1 This is the representative households
[] 2 Be recorded with other households (go to Q53)
[Households number]: _ _ _
Name of head of representative households: ____

[Questions 45-52 were asked of households that have and are representing the dwelling, as per questions 43 and 44.]
45. Is the dwelling of your household in an apartment building or a single detached house?(Combination of observation in order to record)

[] 1 Apartment building
[] 2 Single detached house

46. How many of the following rooms are there in this house/flat?

a) Dwelling rooms? _ _
b) Bedrooms, in which? _ _
[Bedrooms are a subset of dwelling rooms]

47. How many square meters is the total floor space of the house/flat?

Floor space (square meters): _ _ _

48. What is the main construction material of the pier (or the pivot or the load-bearing wall)?

[] 1 Concrete
[] 2 Brick/stone
[] 3 Steel/iron/durable wood
[] 4 Wood of low quality/bamboo
[] 5 Other (specify) ____

49. What is the main construction material of the roof?

[] 1 Concrete
[] 2 Tile (cement, terra-cotta)
[] 3 Slab (cement, metal)
[] 4 Leaf/straw/oil paper
[] 5 Other (specify) ____

50. What is the main construction material of the outer walls?

[] 1 Concrete
[] 2 Brick/stone
[] 3 Wood/metal
[] 4 Clay/straw
[] 5 Wattle/plywood
[] 6 Other (specify) ____

51. What year did the dwelling start to be used?

[] 1 Before 1975
[] 2 From 1975 to 1999
[] 3 From 2000 to now
200_
[] 4 Not stated

52. To whom does this dwelling belong?

[] 1 Household owned
[] 2 Rented/borrowed from the state
[] 3 Rented/borrowed from the private sector
[] 4 Collective
[] 5 Religious organization
[] 6 Joint state and individual
[] 7 Unclear ownership

[Questions 53-57 were asked of all households]
53. What is the main kind of fuel (energy) your household is using for lighting?

[] 1 Electricity
[] 2 Electric generator
[] 3 Kerosene
[] 4 Gas
[] 5 Other (specify) ____

54. What is the main kind of fuel (energy) your household is using for cooking?

[] 1 Electricity
[] 2 Paraffin
[] 3 Gas
[] 4 Coal
[] 5 Firewood
[] 6 Other (specify) ____
[] 7 Not using fuel

55. What is the main source of cooking/drinking water for your household?

[] 1 Indoors tap water
[] 2 Public tap water
[] 3 Drilled well
[] 4 Protected dig well
[] 5 Unprotected dig well
[] 6 Protected slot water
[] 7 Unprotected slot water
[] 8 Rain water
[] 9 Other (specify) ____

56. What kind of toilet facility is your household using most?

[] 1 Indoor flush/semi-flush toilet
[] 2 Outdoor flush/semi-flush toilet
[] 3 Other
[] 4 No toilet

57. At present, is your household using any of the following appliances?

Television?
[] 1 Yes
[] 2 No
Radio/radio cassette player?
[] 1 Yes
[] 2 No
Telephone?
[] 1 Yes
[] 2 No
Computer?
[] 1 Yes
[] 2 No
Washing machine?
[] 1 Yes
[] 2 No
Refrigerator?
[] 1 Yes
[] 2 No
Air conditioner?
[] 1 Yes
[] 2 No
Motorcycle or motorbike?
[] 1 Yes
[] 2 No