Questionnaire SSN 2006 Core
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
2006. NATIONAL SOCIO ECONOMIC SURVEY
LISTING OF HOUSEHOLD MEMBERS AND HOUSEHOLD CORE
Confidential
IDENTIFICATION
01 Province
02 Regency/Municipality *)
03 Subregency
04 Village/ Kelurahan *)
05 Clasification
1. Urban
Village/Kelurahan
2. Rural
06
a. Enumeration area number
b. Segment number
07 Sample code number
08 Serial number of Sample
household
01
02
01
02
03
04
*)
II. HOUSEHOLD CHARACTERISTICS
The name of household
03 Number of children aged 0 head
4 years old
Number of household
04 Number of household members
members
were passed away since 2003
III. ENUMERATING CHARACTERISTICS
Name and employment
05 Name and employment
identity number of
identity number of
enumerator
supervisor
Enumerator’s occupation: 06 Supervisor’s occupation
1. Provincial staff
1.
Provincial staff
2. Regency staff
2.
` Regency staff
3. Subregency staff/KSK
3. Subregency staff
4. Hired worker
4. Hired worker
Have ever been Susenas
07 Date of supervision
Core officer for 3 years
Signature of enumerator
08 Signature of supervisor
Cross out inapplicable category
IV. A. HOUSEHOLD MEMBERS CHARACTERISTICS
Serial
number
(1)
Name of
Household
Members
(write
down who
usually
stay and
eating in
this
household
; adult,
children
or baby)
(2)
Relation Sex:
to the
M 1
head of
F 2
household
(code)
(3)
(4)
Age
(year)
(5)
Marital
Status
(code)
If
k.(6)
coded
2 or
3,
where
is it
recor
ded?
(6)
(7)
Only for
household members
aged 5 years old
How long School
particip
did you
ation
read
(code)
holy
book/
religion
article
in the
last
week?
(hours)
(8)
(9)
01
02
03
04
05
06
07
08
09
10
IV.B. HOUSEHOLD MEMBERS WHO WERE DIED (INCLUDING STILL BORN)
DURING PREVIOUS YEAR
01
02
Code of column 3:
1.
2.
3.
4.
5.
Relation to the head of household
The head of household 6. Parent/In-law
Wife/husband
7. Other relative
Children
8. House maid
Son/daughter in-law
9. Others
Grandchildren
Code of column 6:
Marital Status
1.
2.
3.
4.
Single
Married
Divorced
Widowed
Code of column 7:
1.
2.
3.
4.
KUA(Religion Office)
Civil Registered Office
State Court Office
Others
Code of Column 9:
School Participation
1. In schooling
2. Drop out
V. INDIVIDUAL HEALTH, EDUCATION, MANPOWER, FAMILY
PLANNING
V.A. INDIVIDUAL HEALTH AND
CHARACTERISTICS
Name: ………………..Serial number: ……………
Serial number of biological
mother: …………….
(Fill in 00 if biological mother
not living in this household)
1. Did you have health complaints
during the previous month, such
as:
(read from a to h )
(Fill in code 1 if there an
answer, code 0 if not)
a Fever
b Cough
c Flu/cold
d Asthma/Breath difficulty
l. Paralyze
e. Diarrhea
f. Headache
g. Toothache
h. Others
If all Q.1 = 2, than go to Q.8
V.B. ONLY FOR CHILDREN AGED 0 – 59
MONTHS
11. a. Age in month: …………………months
( go to Q.12 if the content # 00)
b. If R.11.a = 00, age in days:
………..days
12. Who help you during the labor
process?
(code of the answer, directly filling
in the box)
1. Medical doctor
4. Traditional
Birth
First
2. Midwife Attendant
3. Other paramedics
5. Relative
6. Others Last
13. How many times have immunization?
(Filling in 0, if never been in
immunized)
a. BCG
d. Measles/Morbili
b. DPT
e. Hepatitis B
c. Polio
14. a. Have ever been breast feeds?
Yes
1
No
2 → (finished)
b. If yes (Q.14a = 1) filling in
‘days’ if
Q. 11.a = 00 or in ‘month’ if
Q. 11.a #00)
1. Duration of breast feeding
2. Just breast feeding
3. Breast feeding + food/drink
supplement
2. If you have a complain, did it
disrupt your work, school, or
daily activity?
Yes
1
No
2 →(skip to Q.5.a)
V.C EDUCATIONAL INFORMATION
ONLY FOR THOSE AGED 5 YEARS AND ABOVE
3.Duration of disrupted……….days
4. Are still disrupted now?
Yes
1
No
2
15.
1.
2.
3.
School participation:
No school
→(skip to Q.17)
In schooling→(skip to Q.18)
No School anymore
5. a. Did you ever have selftreatment in the last month?
Yes
1
No
2 →
(skip to Q.6)
b. Type of medicine used:
1. Traditional medicine
2. Modern medicine
3. Others
6. Were you an outpatient in the
last month?
Yes
1
No
2 → R.10
7. Frequency of an outpatient
treatment:
(filling in the frequency of an
outpatient of each facility)
a. Hospital
b. Private hospital
c.Doctor practice/polyclinics
d. Puskesmas
e. Paramedics
f. Traditional healer
g. traditional attandance
h. others
8.Have You ever been treated as an
inpatient in the last year.
1. yes
2. no (Q.8)
9.Duration of inpatient (days)
a. Hospital
b. Private hospital
c. Puskesmas
d. Paramedics
e. Traditional healer
f. Others
16. when did you stop schooling?
(Fill in 00, if stopped before 1996
Month:…………Year:…………..
17. Reason for never/not yet attended
school or no schooling anymore
1. No Budget
2. Dislike
3. Working
4. Married/housekeeping
5. N
6. Long Distance from school
7. Not needed
8. Invalid
9. Waiting for enrollment
10. Not beginning school yet
11. Not school age yet
12. Others
If Q.15 = 1 go to Q.21
18. The highest level and type of
education ever or being attended:
01. Primary school
02. “Ibtidaiyah” (Islamic)
03. “Junior high/ Vocational
04. “Tsanawiyah” (Islamic)
05. Senior High School
06. Aliyah (Islamic)
07. Vocational Senior High school
08. Diploma D1/DII
09. Diploma D.III
10. Diploma IV/Strata S1
11. S2/S3
10. Does available defrayal
guarantee / health insurance for
having drug road(street / takes
care of lodging as in under this?
a.
b.
c.
d.
e.
f.
g.
19. Level/grade ever or being
attended:
0
1
2
3
4
5
6
7
(completed)
8
JPK PNS / veteran / retired
Subsidy / replacement of
expense of olh company
PK MM / healthy card / JPK
GAKIN / Poor card / card
askeskin
JPK JAMSOSTEK
Private sector Health
Insurance
Healthy fund
other JPKM/JPK
20. The highest diploma owned
1. Have no primary school diploma
2. Primary school
3. “Ibtidaiyah” (Islamic)
4. “Junior high/ Vocational
5. “Tsanawiyah” (Islamic)
6. Senior High School
7. Aliyah (Islamic)
8. Vocational Senior High school
9. Diploma D1/DII
10.Diploma D.III
11.Diploma IV/Graduate
12.Master/Ph.D
21. Can you write and read?
1. Latin
3. Can not
2. Other alphabets
V.D. ACTIVITY OF HOUSEHOLD MEMBERS
AGED 10 YEARS AND ABOVE
22. a. Did you do some activity
during previous week?
Ya
tidak
1. Working
1
2
2. Attending school 1
2
3. House keeper
1
2
4. Others
1
2
b. From Q. 22.a. activity of 1 to
4 that are coded 1, which
activity used most of the time
during previous week?
1
2
3
4
(if Q.22.a.1=1,lanjutkan ke Q.24
Q. 26 is asked if Q. 24 = 2 and
Q.25 = 2
27. a. Total days of work: ………….
days
b. Number of hours of total
daily worked in the previous
week
Mon. Tue
Wen.
Thu
Fri
Sat
Sun
Total
….
….
….
….
….
…
….
……
28. Business field/work
place/office/company of main
work during previous week (write
down completely)
……………………………………… Coded by editor
23. Do you have permanent job, but
were temporary not working
during previous week?
1 yes
2
no
29. Type of work/position of main
work during previous week (write
down completely)
Coded
…………………………………..
by
editor
24. Are you looking for a job ?
1. yes
2. No
30. Status / position in main work
during one week last
25. Are you drawing up a business
during previous week ?
1. yes
2. No
26. Main reason doesn’t look for a
job/drawing up bussines :
1. feels not possibly gets work
2. has had work, but has not
engaged in
3. School or manages household
4. Has had job/bussines
5. feels have been enough
6. Unable to do work ( getting
old, handicap)
7. others (write) …….
1. on feet
2. Tries assisted [by] erratic
labour / labour is not paid
3. Tries assisted [by] permanent
labour / labour is paid [by]
(Blok V.E)
4. Labour / employee / officer –
Q.31
5. free lancer in agriculture
6. free lancer in non agriculture
7. worker is not paid
(Blok V.E)
JUST FOR HOUSEHOLD MEMBER IS
WORKING Q.22.a.1 = 1 atau Q.23 = 1
31. How much the wage/net salary
received in a month of main
work?
Rp…………………..
V E.FERTILITY AND FAMILY PLANNING
EVER MARRIED WOMEN AGED ≥ 10
YEAR
MARRIED WOMAN, DIVORCE DEATH,
DIVORCE LIFE
(Block IV.A. Column 4=2, Column
6=2, 3,4)
32. Age first married ……………….year
33. The longest period in marriage:
………….years
34. Number of biological child
which gave a birth
M F
M+F
a. Born alive
b. Still
alive
a. Died
35. Using
1.
2.
3.
a contraceptive:
be using
didn't apply again
have never applied
36. Type of contraceptive currently
usimg:
1. Tubectomy 6. Pill
2. Vasectomy 7. Condom
3. IUD
8. Intravag/Tissue
for woman
4. Injectable 9. Traditional
method
5. Implant
VI. HOUSING
1.Status of house:
1. Own property 5. Official
2. Lease
6. house
3. Rentproperty
of others
4. Free Rent
7. Others
2. Type of roof:
1. Concrete
2. Corrugated tile
3. Shingle roof
4. Iron sheeting
5. Asbestos
6. Sugar palm fiber
7. others
3. Type of wall:
1. Brick
3. Bamboo
2. Wood
4. Others
4.
Type of floor:
1. not soil
2. Soil
5. Floor area: …………………….m2
6.
a. Source of drinking water:
1. Bottled water
2. Tap water
3. Pump
4. Protected well
5. Unprotected wel
6. Protected spring
7. Unprotected spring
8. River
9. Rain water
10. Others
b. If Q.6.a. =3 to 7
(pump/well/spring) nearest
distance to the septic tank:
1. 10 m
3. don’t know
VII. AVERAGE MONTHLY HOUSEHOLD
EXPENDITURE AND MIAN OF SOURCE
A. Food expenditure
Rp
during previous week
(1)
(2)
1. Cereals
a. rice
b. others (corn,
wheat flour, rice
flour, corn flour,
etc)
2.Tuber (cassava, sweet
potato, potato, dried
cassava chip, taro,
sago, etc)
3. Fish/shrimp/shell,etc
a. fresh fish
b. salted/preserved)
4.Meat (beef/ buffalo/
lamb/mutton/ham/
chicken, entrails,
liver, spleen,
shredded dried meat,
dried meat, etc)
5.Egg and milk a.chicken
egg/duck
egg/quail
egg
b. fresh milk,
sweetened condensed
milk, powdered milk,
etc)
6.Vegetables (spinach,
swamp cabbage,
cucumber, carrot,
string bean, green
bean, union, chili,
tomato, etc)
7.
Drinking water facility:
1. Private
3. Public
2. Shared
4. None
8.
How to obtain the drinking
water:
1. Purchased 2. Does not purchase
9.a. Toilet facility:
1. Private 3. Public
2. Shared
4. Others
b. Type of toilet:
1. Squatter 3. Drylatrine
2. Throne
4. Others
c. Final disposal:
1. Septic tank
2. Pond/field rice
3. River/lake/
4. Hole
5. Shore/open field/Ocean
6. Others
10.
1.
2.
3.
4.
Source of light:
PLN electricity
Electricity non PLN
Pump lantern
Oil lamp
5. Others
11. Expenditure of fuel/energy for
cooking and source of light in
household previously month
a. PLN electric
Rp …….
b. kerosene
Rp…
c. fire wood
7.Pulses
(peanut/mungbean/
soybean/ kidney
bean/lima bean/cashew
nut, tofu, fermented
soybean cake,
fermented soybean
sauce, peanut expeller
cake, etc)
8.Fruits (orange, mango,
apple, durian,
‘rambutan’, snake
fruit, lanzon,
pineapple, water
melon, banana, papaya,
etc)
9.Oil and fat (coconut
oil/frying oil,
coconut, butter, etc)
10.Beverage flavor
(granulated sugar,
palm sugar, tea,
coffee, cocoa, syrup,
etc)
11.Spices (salt, candle
nut, coriander,
pepper, fish paste,
soybean sauce,
monosodium glutamate,
etc)
12. Other consumption,
a.noodle, wheat & rice
noodle, macaroni, etc)
b.crisp, crisp chip
13. Prepared food and
beverages
a. Prepared food
(bread, biscuits, wet
cake, porridge, meat
ball
b. Non Alcohol
beverages ( syrup ice,
soda pop, salad, plate
of rice and side dish,
etc)
c. Alcoholic beverages
(beer, wine, and other
alcoholic drink)
14. Tobacco and betel
a. Cigarette(clove
cigarette, menthol
cigarettes, cigar, b.
b.others (tobacco,
betel, areca nut, etc)
15. Total food (Q. 1 to
– 15):
VII. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME
12 Months Ago
B. NON FOOD EXPENDITURE DURING THE LAST 12
Previous
(Rp)
MONTHS/PREVIOUS MONTH
Month
(Rp)
(1)
(2)
(3)
16. Housing and household facility
a. Rents, Value of imputed rent
b. House maintenance and simple reparation
c. electricity bill,water, gas, kerosene,
wood etc
d. bills of telephone, handphone
voucer,telecommunication centre,postal
etc
17. Miscellaneous goods and services
a. Toilet soap, cosmetic article,
b. Health expenses (hospital, Puskesmas,
medical doctor, traditional healer,
medicines, etc)
c. Education expenses (entry/registration
fee, tuition, scouts, handicraft, etc)
d. Transportation
e. Other services (salary of driver, maid
hotel etc)
18. Clothing, footwear, head gear (material
clothes, ready-made clothes, shoes, hat,
detergent, etc)
19. Durable goods (household appliances,
tools, kitchen ware, amusement tools,
sports equipment, expensive jewelry/
imitation jewelry, vehicle, umbrella,
watch, camera, telephone installment
expenses, electricity installment
expenses, etc)
20. Taxes and insurance
a. Taxes (building and land tax, vehicle
tax etc)
b. Retribution
c. Health Insurance
d. Others (other insurance,fine, income tax,
etc)
21. Festivities and ceremonies (wedding,
circumcision, birthday, religious
festival, traditional ceremony, etc)
22.Total non food(Question 17 to 24)
23. Average of monthly food expenditure (Q.
16 x 30 )
7
24. Average of monthly non food expenditure
(Q 25 Column 3)
12
25. Average of monthly household
expenditure (Q 26 + Q.27)
Filled in
Editor
26. Main income in the households (choose
from household member with the biggest
income)
a. Main Industry ..........
(write completely)
b. Employment status:
0. Income receiver
1. Employee/labor
2. Enterpreneur
VIII. DESCRIPTION OF OTHERS SOCIAL
ECNOMICS
1. a. Is this household receiver
BLT/SLT?
1. yes
2. No
b. When first time takes BLT/SLT ?
…….. month
year……..
2. a. Are there member of household
getting free health service during 6
last month?
1. yes
2. No
b. If yes ( Q.2.a = 1), card applied.
1. askeskin
3. health card
2. KKB
4. others.
3. a. Does household have ever bought
cheap rice / raskin during 6 last
month?
1. yes
2. No
b. If yes ( Q.3.a = 1), how many
cheap rice kg bought?
………. Kg
c. How much rupiah per kg paid by
household to buy last cheap rice?
Rp……………..
4. a.
Are there member of
household
receiving
credit
effort for in one year last?
1. yes
2. No
Line of credit received :
1. District development
program
2. Program P2kp
3. Other government program
4. Bank program
5. Co-Operation Program /
institution
6. private
7. other
5.a. Are There member/former
of household which is working
as TKI
1. yes
2. No
3. Not know
If yes ( Q.5.a = 1), writes
down number of member of
household and former
according to the work type.
Jumlah
Type of job sedang
pernah
1. nurse
2. servent/
Baby sitter
3. Driver
4. builder
5. plantation labour
6. factory labour
IX. COMMUNICATIONS TECHNOLOGY &
INFORMATION
1. Is in this household there are
telephone?
1. yes
2. No
4. a. Does this household
apply computer to access to
internet during one month
last ?
1. yes
2. No
b. If yes, number of
member of households using
the facility ....... people.
5. Using outdoor internet
2. a. Are there member of household
having cellular telephone ( HP)?
1. yes
2. No
location
of
usage.
b. If yes, number of cellular
telephone owned in this household.
………………. number
a. booth
telecomu
nication
b.
office
c.
others
Are there
member of
household
using
outdoors
internet
a month
last?
1. yes
2. no
If yes,
number of
member of
using
household
s.
…….person
CENTRAL BUREAU OF STATISTICS
2006. NATIONAL SOCIO ECONOMIC SURVEY
LISTING OF HOUSEHOLD MEMBERS AND HOUSEHOLD CORE
Confidential
IDENTIFICATION
01 Province
02 Regency/Municipality *)
03 Subregency
04 Village/ Kelurahan *)
05 Clasification
1. Urban
Village/Kelurahan
2. Rural
06
a. Enumeration area number
b. Segment number
07 Sample code number
08 Serial number of Sample
household
01
02
01
02
03
04
*)
II. HOUSEHOLD CHARACTERISTICS
The name of household
03 Number of children aged 0 head
4 years old
Number of household
04 Number of household members
members
were passed away since 2003
III. ENUMERATING CHARACTERISTICS
Name and employment
05 Name and employment
identity number of
identity number of
enumerator
supervisor
Enumerator’s occupation: 06 Supervisor’s occupation
1. Provincial staff
1.
Provincial staff
2. Regency staff
2.
` Regency staff
3. Subregency staff/KSK
3. Subregency staff
4. Hired worker
4. Hired worker
Have ever been Susenas
07 Date of supervision
Core officer for 3 years
Signature of enumerator
08 Signature of supervisor
Cross out inapplicable category
IV. A. HOUSEHOLD MEMBERS CHARACTERISTICS
Serial
number
(1)
Name of
Household
Members
(write
down who
usually
stay and
eating in
this
household
; adult,
children
or baby)
(2)
Relation Sex:
to the
M 1
head of
F 2
household
(code)
(3)
(4)
Age
(year)
(5)
Marital
Status
(code)
If
k.(6)
coded
2 or
3,
where
is it
recor
ded?
(6)
(7)
Only for
household members
aged 5 years old
How long School
particip
did you
ation
read
(code)
holy
book/
religion
article
in the
last
week?
(hours)
(8)
(9)
01
02
03
04
05
06
07
08
09
10
IV.B. HOUSEHOLD MEMBERS WHO WERE DIED (INCLUDING STILL BORN)
DURING PREVIOUS YEAR
01
02
Code of column 3:
1.
2.
3.
4.
5.
Relation to the head of household
The head of household 6. Parent/In-law
Wife/husband
7. Other relative
Children
8. House maid
Son/daughter in-law
9. Others
Grandchildren
Code of column 6:
Marital Status
1.
2.
3.
4.
Single
Married
Divorced
Widowed
Code of column 7:
1.
2.
3.
4.
KUA(Religion Office)
Civil Registered Office
State Court Office
Others
Code of Column 9:
School Participation
1. In schooling
2. Drop out
V. INDIVIDUAL HEALTH, EDUCATION, MANPOWER, FAMILY
PLANNING
V.A. INDIVIDUAL HEALTH AND
CHARACTERISTICS
Name: ………………..Serial number: ……………
Serial number of biological
mother: …………….
(Fill in 00 if biological mother
not living in this household)
1. Did you have health complaints
during the previous month, such
as:
(read from a to h )
(Fill in code 1 if there an
answer, code 0 if not)
a Fever
b Cough
c Flu/cold
d Asthma/Breath difficulty
l. Paralyze
e. Diarrhea
f. Headache
g. Toothache
h. Others
If all Q.1 = 2, than go to Q.8
V.B. ONLY FOR CHILDREN AGED 0 – 59
MONTHS
11. a. Age in month: …………………months
( go to Q.12 if the content # 00)
b. If R.11.a = 00, age in days:
………..days
12. Who help you during the labor
process?
(code of the answer, directly filling
in the box)
1. Medical doctor
4. Traditional
Birth
First
2. Midwife Attendant
3. Other paramedics
5. Relative
6. Others Last
13. How many times have immunization?
(Filling in 0, if never been in
immunized)
a. BCG
d. Measles/Morbili
b. DPT
e. Hepatitis B
c. Polio
14. a. Have ever been breast feeds?
Yes
1
No
2 → (finished)
b. If yes (Q.14a = 1) filling in
‘days’ if
Q. 11.a = 00 or in ‘month’ if
Q. 11.a #00)
1. Duration of breast feeding
2. Just breast feeding
3. Breast feeding + food/drink
supplement
2. If you have a complain, did it
disrupt your work, school, or
daily activity?
Yes
1
No
2 →(skip to Q.5.a)
V.C EDUCATIONAL INFORMATION
ONLY FOR THOSE AGED 5 YEARS AND ABOVE
3.Duration of disrupted……….days
4. Are still disrupted now?
Yes
1
No
2
15.
1.
2.
3.
School participation:
No school
→(skip to Q.17)
In schooling→(skip to Q.18)
No School anymore
5. a. Did you ever have selftreatment in the last month?
Yes
1
No
2 →
(skip to Q.6)
b. Type of medicine used:
1. Traditional medicine
2. Modern medicine
3. Others
6. Were you an outpatient in the
last month?
Yes
1
No
2 → R.10
7. Frequency of an outpatient
treatment:
(filling in the frequency of an
outpatient of each facility)
a. Hospital
b. Private hospital
c.Doctor practice/polyclinics
d. Puskesmas
e. Paramedics
f. Traditional healer
g. traditional attandance
h. others
8.Have You ever been treated as an
inpatient in the last year.
1. yes
2. no (Q.8)
9.Duration of inpatient (days)
a. Hospital
b. Private hospital
c. Puskesmas
d. Paramedics
e. Traditional healer
f. Others
16. when did you stop schooling?
(Fill in 00, if stopped before 1996
Month:…………Year:…………..
17. Reason for never/not yet attended
school or no schooling anymore
1. No Budget
2. Dislike
3. Working
4. Married/housekeeping
5. N
6. Long Distance from school
7. Not needed
8. Invalid
9. Waiting for enrollment
10. Not beginning school yet
11. Not school age yet
12. Others
If Q.15 = 1 go to Q.21
18. The highest level and type of
education ever or being attended:
01. Primary school
02. “Ibtidaiyah” (Islamic)
03. “Junior high/ Vocational
04. “Tsanawiyah” (Islamic)
05. Senior High School
06. Aliyah (Islamic)
07. Vocational Senior High school
08. Diploma D1/DII
09. Diploma D.III
10. Diploma IV/Strata S1
11. S2/S3
10. Does available defrayal
guarantee / health insurance for
having drug road(street / takes
care of lodging as in under this?
a.
b.
c.
d.
e.
f.
g.
19. Level/grade ever or being
attended:
0
1
2
3
4
5
6
7
(completed)
8
JPK PNS / veteran / retired
Subsidy / replacement of
expense of olh company
PK MM / healthy card / JPK
GAKIN / Poor card / card
askeskin
JPK JAMSOSTEK
Private sector Health
Insurance
Healthy fund
other JPKM/JPK
20. The highest diploma owned
1. Have no primary school diploma
2. Primary school
3. “Ibtidaiyah” (Islamic)
4. “Junior high/ Vocational
5. “Tsanawiyah” (Islamic)
6. Senior High School
7. Aliyah (Islamic)
8. Vocational Senior High school
9. Diploma D1/DII
10.Diploma D.III
11.Diploma IV/Graduate
12.Master/Ph.D
21. Can you write and read?
1. Latin
3. Can not
2. Other alphabets
V.D. ACTIVITY OF HOUSEHOLD MEMBERS
AGED 10 YEARS AND ABOVE
22. a. Did you do some activity
during previous week?
Ya
tidak
1. Working
1
2
2. Attending school 1
2
3. House keeper
1
2
4. Others
1
2
b. From Q. 22.a. activity of 1 to
4 that are coded 1, which
activity used most of the time
during previous week?
1
2
3
4
(if Q.22.a.1=1,lanjutkan ke Q.24
Q. 26 is asked if Q. 24 = 2 and
Q.25 = 2
27. a. Total days of work: ………….
days
b. Number of hours of total
daily worked in the previous
week
Mon. Tue
Wen.
Thu
Fri
Sat
Sun
Total
….
….
….
….
….
…
….
……
28. Business field/work
place/office/company of main
work during previous week (write
down completely)
……………………………………… Coded by editor
23. Do you have permanent job, but
were temporary not working
during previous week?
1 yes
2
no
29. Type of work/position of main
work during previous week (write
down completely)
Coded
…………………………………..
by
editor
24. Are you looking for a job ?
1. yes
2. No
30. Status / position in main work
during one week last
25. Are you drawing up a business
during previous week ?
1. yes
2. No
26. Main reason doesn’t look for a
job/drawing up bussines :
1. feels not possibly gets work
2. has had work, but has not
engaged in
3. School or manages household
4. Has had job/bussines
5. feels have been enough
6. Unable to do work ( getting
old, handicap)
7. others (write) …….
1. on feet
2. Tries assisted [by] erratic
labour / labour is not paid
3. Tries assisted [by] permanent
labour / labour is paid [by]
(Blok V.E)
4. Labour / employee / officer –
Q.31
5. free lancer in agriculture
6. free lancer in non agriculture
7. worker is not paid
(Blok V.E)
JUST FOR HOUSEHOLD MEMBER IS
WORKING Q.22.a.1 = 1 atau Q.23 = 1
31. How much the wage/net salary
received in a month of main
work?
Rp…………………..
V E.FERTILITY AND FAMILY PLANNING
EVER MARRIED WOMEN AGED ≥ 10
YEAR
MARRIED WOMAN, DIVORCE DEATH,
DIVORCE LIFE
(Block IV.A. Column 4=2, Column
6=2, 3,4)
32. Age first married ……………….year
33. The longest period in marriage:
………….years
34. Number of biological child
which gave a birth
M F
M+F
a. Born alive
b. Still
alive
a. Died
35. Using
1.
2.
3.
a contraceptive:
be using
didn't apply again
have never applied
36. Type of contraceptive currently
usimg:
1. Tubectomy 6. Pill
2. Vasectomy 7. Condom
3. IUD
8. Intravag/Tissue
for woman
4. Injectable 9. Traditional
method
5. Implant
VI. HOUSING
1.Status of house:
1. Own property 5. Official
2. Lease
6. house
3. Rentproperty
of others
4. Free Rent
7. Others
2. Type of roof:
1. Concrete
2. Corrugated tile
3. Shingle roof
4. Iron sheeting
5. Asbestos
6. Sugar palm fiber
7. others
3. Type of wall:
1. Brick
3. Bamboo
2. Wood
4. Others
4.
Type of floor:
1. not soil
2. Soil
5. Floor area: …………………….m2
6.
a. Source of drinking water:
1. Bottled water
2. Tap water
3. Pump
4. Protected well
5. Unprotected wel
6. Protected spring
7. Unprotected spring
8. River
9. Rain water
10. Others
b. If Q.6.a. =3 to 7
(pump/well/spring) nearest
distance to the septic tank:
1. 10 m
3. don’t know
VII. AVERAGE MONTHLY HOUSEHOLD
EXPENDITURE AND MIAN OF SOURCE
A. Food expenditure
Rp
during previous week
(1)
(2)
1. Cereals
a. rice
b. others (corn,
wheat flour, rice
flour, corn flour,
etc)
2.Tuber (cassava, sweet
potato, potato, dried
cassava chip, taro,
sago, etc)
3. Fish/shrimp/shell,etc
a. fresh fish
b. salted/preserved)
4.Meat (beef/ buffalo/
lamb/mutton/ham/
chicken, entrails,
liver, spleen,
shredded dried meat,
dried meat, etc)
5.Egg and milk a.chicken
egg/duck
egg/quail
egg
b. fresh milk,
sweetened condensed
milk, powdered milk,
etc)
6.Vegetables (spinach,
swamp cabbage,
cucumber, carrot,
string bean, green
bean, union, chili,
tomato, etc)
7.
Drinking water facility:
1. Private
3. Public
2. Shared
4. None
8.
How to obtain the drinking
water:
1. Purchased 2. Does not purchase
9.a. Toilet facility:
1. Private 3. Public
2. Shared
4. Others
b. Type of toilet:
1. Squatter 3. Drylatrine
2. Throne
4. Others
c. Final disposal:
1. Septic tank
2. Pond/field rice
3. River/lake/
4. Hole
5. Shore/open field/Ocean
6. Others
10.
1.
2.
3.
4.
Source of light:
PLN electricity
Electricity non PLN
Pump lantern
Oil lamp
5. Others
11. Expenditure of fuel/energy for
cooking and source of light in
household previously month
a. PLN electric
Rp …….
b. kerosene
Rp…
c. fire wood
7.Pulses
(peanut/mungbean/
soybean/ kidney
bean/lima bean/cashew
nut, tofu, fermented
soybean cake,
fermented soybean
sauce, peanut expeller
cake, etc)
8.Fruits (orange, mango,
apple, durian,
‘rambutan’, snake
fruit, lanzon,
pineapple, water
melon, banana, papaya,
etc)
9.Oil and fat (coconut
oil/frying oil,
coconut, butter, etc)
10.Beverage flavor
(granulated sugar,
palm sugar, tea,
coffee, cocoa, syrup,
etc)
11.Spices (salt, candle
nut, coriander,
pepper, fish paste,
soybean sauce,
monosodium glutamate,
etc)
12. Other consumption,
a.noodle, wheat & rice
noodle, macaroni, etc)
b.crisp, crisp chip
13. Prepared food and
beverages
a. Prepared food
(bread, biscuits, wet
cake, porridge, meat
ball
b. Non Alcohol
beverages ( syrup ice,
soda pop, salad, plate
of rice and side dish,
etc)
c. Alcoholic beverages
(beer, wine, and other
alcoholic drink)
14. Tobacco and betel
a. Cigarette(clove
cigarette, menthol
cigarettes, cigar, b.
b.others (tobacco,
betel, areca nut, etc)
15. Total food (Q. 1 to
– 15):
VII. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME
12 Months Ago
B. NON FOOD EXPENDITURE DURING THE LAST 12
Previous
(Rp)
MONTHS/PREVIOUS MONTH
Month
(Rp)
(1)
(2)
(3)
16. Housing and household facility
a. Rents, Value of imputed rent
b. House maintenance and simple reparation
c. electricity bill,water, gas, kerosene,
wood etc
d. bills of telephone, handphone
voucer,telecommunication centre,postal
etc
17. Miscellaneous goods and services
a. Toilet soap, cosmetic article,
b. Health expenses (hospital, Puskesmas,
medical doctor, traditional healer,
medicines, etc)
c. Education expenses (entry/registration
fee, tuition, scouts, handicraft, etc)
d. Transportation
e. Other services (salary of driver, maid
hotel etc)
18. Clothing, footwear, head gear (material
clothes, ready-made clothes, shoes, hat,
detergent, etc)
19. Durable goods (household appliances,
tools, kitchen ware, amusement tools,
sports equipment, expensive jewelry/
imitation jewelry, vehicle, umbrella,
watch, camera, telephone installment
expenses, electricity installment
expenses, etc)
20. Taxes and insurance
a. Taxes (building and land tax, vehicle
tax etc)
b. Retribution
c. Health Insurance
d. Others (other insurance,fine, income tax,
etc)
21. Festivities and ceremonies (wedding,
circumcision, birthday, religious
festival, traditional ceremony, etc)
22.Total non food(Question 17 to 24)
23. Average of monthly food expenditure (Q.
16 x 30 )
7
24. Average of monthly non food expenditure
(Q 25 Column 3)
12
25. Average of monthly household
expenditure (Q 26 + Q.27)
Filled in
Editor
26. Main income in the households (choose
from household member with the biggest
income)
a. Main Industry ..........
(write completely)
b. Employment status:
0. Income receiver
1. Employee/labor
2. Enterpreneur
VIII. DESCRIPTION OF OTHERS SOCIAL
ECNOMICS
1. a. Is this household receiver
BLT/SLT?
1. yes
2. No
b. When first time takes BLT/SLT ?
…….. month
year……..
2. a. Are there member of household
getting free health service during 6
last month?
1. yes
2. No
b. If yes ( Q.2.a = 1), card applied.
1. askeskin
3. health card
2. KKB
4. others.
3. a. Does household have ever bought
cheap rice / raskin during 6 last
month?
1. yes
2. No
b. If yes ( Q.3.a = 1), how many
cheap rice kg bought?
………. Kg
c. How much rupiah per kg paid by
household to buy last cheap rice?
Rp……………..
4. a.
Are there member of
household
receiving
credit
effort for in one year last?
1. yes
2. No
Line of credit received :
1. District development
program
2. Program P2kp
3. Other government program
4. Bank program
5. Co-Operation Program /
institution
6. private
7. other
5.a. Are There member/former
of household which is working
as TKI
1. yes
2. No
3. Not know
If yes ( Q.5.a = 1), writes
down number of member of
household and former
according to the work type.
Jumlah
Type of job sedang
pernah
1. nurse
2. servent/
Baby sitter
3. Driver
4. builder
5. plantation labour
6. factory labour
IX. COMMUNICATIONS TECHNOLOGY &
INFORMATION
1. Is in this household there are
telephone?
1. yes
2. No
4. a. Does this household
apply computer to access to
internet during one month
last ?
1. yes
2. No
b. If yes, number of
member of households using
the facility ....... people.
5. Using outdoor internet
2. a. Are there member of household
having cellular telephone ( HP)?
1. yes
2. No
location
of
usage.
b. If yes, number of cellular
telephone owned in this household.
………………. number
a. booth
telecomu
nication
b.
office
c.
others
Are there
member of
household
using
outdoors
internet
a month
last?
1. yes
2. no
If yes,
number of
member of
using
household
s.
…….person