Questionnaire Text

Questionnaire form view entire document:  text  image

[Questions A17a and A17b were asked of persons not living in the same district five years ago]

A17a. In which village, sub-district, and district were you living in five years ago?

If "No" (A17 = code T).

Write in the name of the village: ____

Was this village part of a city, a town, or a rural area?

[] B City
[] K Town
[] P Rural area

Write in the name of the sub-district: ____

Write in the name of the district: ____

Kabupaten or koyamadya? Cross incorrect answer.

Kab. / Kod.

Coded by central office: _ _ _

Questionnaire instructions view entire document:  text  image

Columns (6) through (12)
If the answer for column (5) is "Y", then 5 years ago the person lived in this regency / municipality and the questions for column (6) through (12) do not need to be asked; go directly to page 5 (in the original text the page number mentioned here is 4, but that is incorrect).
If answer for column (5) is T, 5 years ago this person lived in a different regency/municipality so ask where he lived 5 years ago beginning with question Al7a and put the answers in columns (6) through (12).

Column (9) Regency/municipality
Ask the name of the regency/municipality where the person lived 5 years ago.

Column (10)
Do not forget to ask if the place he lived 5 years ago (in column 9) was a regency or a municipality, and strike out whichever is not applicable.