Questionnaire Text

Questionnaire form view entire document: text image

Identification

____ Province
____ Canton
____ District
____ Agricultural Region number
____ Zone number
____ Section number
____ Segment number

[] Urban
[] Rural

____ Census household number (visit order)
____ Institution (name)
____ Neighborhood or hamlet (caserío)
____ Avenues (numbers)
____ Streets (names)
____ Highway, route, etc.

Questionnaire instructions view entire document: text image

Institution: Written here is the name of the hotel, jail, hospital, clinic, boarding house etc., in which a Non Family Group resides. If the institution does not have a name, write down for example: Boarding House of Juan Pérez, Jail of Liberia, Clinic of Dr. Pedro Camacho, etc.