Questionnaire Text

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Section A: Geographic Location of the Dwelling
____ _ _ 1. Province
____ _ _ 2. District
____ _ _ 3. Administrative Post
[] 4. Urban area
5. Locality/Town/Village _ _
Name ____
6. Neighborhood ____ _ _
7. Enumeration Area No. _ _ _
8. Communal Unit _ _
Name ____
9. Block No. _ _ _

12. House No. _ _ _
13. No. of households in this dwelling _
14. No. of this household _
[] 4. Rural area
5. Locality ____ _ _
7. Enumeration Area No. _ _ _
10. Name of Village/ Settlement ____ _ _
11. Name of Zone/ Neighborhood ____ _ _
12. House No. _ _ _
13. No. of households in this dwelling _
14. No. of this household _
Enumerator: Write the home address that can be used by the National Institute of Statistics (INE) to locate and identify the household.

15.Home address:
Street: _______
No.: ____
Floor: ____
Apt: ____
Description: ________