Questionnaire Text

Questionnaire form view entire document:  text  image
I. Identification
Q.1. Province ____
Q.2. Regency/municipality _____
Q.3. District ____
Q.4. Village ____
Q.5. Area ____

1 Urban
2 Rural

Q.6. Enumeration area number ____
Q.7. Census block number ____
Q.8. Sample code number ____
Q.9. Sample serial number (RBS) ____
Q.10. Selected household serial number (RBS) ____

Questionnaire instructions view entire document:  text  image

a. Block I: Geographic identification

Points 1- 4: Write the name of the province, regency/municipality, sub-district and village. Provincial and regency/municipality codes should be written in the boxes provided.

Point 5: Urban/rural classification

Points 6-8: The enumeration area, census block number and sample code number are copied from Form L I, Block I, point 6-8.

Point 9: Sample serial number