2016 2161 ques VIMK16 L

BADAN PUSAT STATISTIK

PENDAFTARAN PERUSAHAAN/USAHA

SURVEI INDUSTRI MIKRO DAN KECIL
2016
RAHASIA

VIMK 16 -L1
BLOK I. KETERANGAN TEMPAT

101. PROVINSI

104. DESA/KELURAHAN *)

102. KABUPATEN/KOTA *)

105. NOMOR BLOK SENSUS (NBS)

103. KECAMATAN


106. NOMOR KODE SAMPEL (NKS)

*) Coret yang tidak sesuai

BLOK II. RINGKASAN
KODE KBLI-2 DIGIT

URAIAN
(1)

Jumlah

10

11

12

13


14

15

16

17

18

19

20

21

22

23


24

25

26

27

28

29

30

31

32

33


(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)


(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)

(20)

(21)


(22)

(23)

(24)

(25)

201. JUMLAH RUMAH TANGGA ( Blok III Kolom (6) nomor urut terakhir pada halaman terakhir )
202.a. POPULASI INDUSTRI MIKRO
(B.III R.c hal. terakhir Kol. 19 s.d 42)
202.b. SAMPEL INDUSTRI MIKRO
(B.IV Kol. 1 s.d 24 R. mhi)
203.

POPULASI INDUSTRI KECIL

(26)

Halaman ……... dari ….….. halaman


No. Urut

Penggunaan
Bangun
-an

Jika Kol. (4)
kode 2, Apakah
untuk usaha IMK
dan aktif
berproduksi
selama
triwulan I 2016 *)

(Kode)

Ya

Bangunan

S
e
g
m
e
n

F
i
s
i
k

S
e
n
s
u
s


(2)

(3)

Keterangan:

(4)

Nama
Kepala Rumah Tangga
(KRT)

-0
(5)

Ya
Tidak

No.
(6)


(7)

a.

Jumlah halaman ini

b.

Jumlah kumulatif halaman sebelumnya

c.

Jumlah kumulatif halaman ini

Kode Kol. (4)

Selama
triwulan I
2016*),

adakah ART
berusaha di
sektor IMK?

Tempat tinggal
Bukan tempat tinggal
Campuran

-1
-2
-3

-1

Selama
triwulan I 2016*)
adakah pihak lain
yang berusaha
disektor IMK di
Tempat
bangunan ini?
usaha
(Kode)
Ya
-1

-0
Kol. (11)
(8)

USAHA/RUMAH TANGGA

Jika Kol. (5) kode 1; Kol. (10)

kode 1 atau 2 ; Kol. (11) kode 1

(9)

(10)

Nama Perusahaan/Usaha
atau
Pengusaha/Pemilik

Tidak - 0

No.

(11)

(12)

*) Khusus usaha musiman yang aktif berproduksi selama
periode Triwulan II 2015 s.d Triwulan I 2016

Kode Kol. (10)

(13)

Kegiatan Utama
(Tuliskan sejelas-jelasnya)

Alamat Lengkap
(Jalan, No., RT/RW)

(15)

(14)

Di bangunan sensus ini
Bukan di bangunan sensus/keliling
Di bangunan sensus lain

-1
-2
-3

Jika Kolom (17) bertanda cek (√)

Isikan tanda
cek (√)
sesuai jumlah
tenaga kerja
termasuk pemilik
pada bulan
terakhir
berproduksi
Triwulan I 2016

Jika Kol. (8) kode 1

Nama ART

-1
Kol. (12)

Tidak
(1)

Jika Kol. (4) kode 1 atau 3

BLOK III : PENDAFTARAN

Isikan tanda cek (√) sesuai kode 2-digit KBLI

Kode
2-digit
KBLI

1-4

5 - 19

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

(16)

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)

(26)

(27)

(28)

(29)

(30)

(31)

(32)

(33)

(34)

(35)

(36)

(37)

(38)

(39)

(40)

(41)

(42)

BLOK IV: KETERANGAN

PENARIKAN SAMPEL UTAMA

KBLI 2 digit

KBLI 2 digit

10

11

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19

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29

30

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33

(1)

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(13)

(14)

(15)

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(18)

(19)

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(21)

(22)

(23)

(24)

Mhi = ………

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Ihi

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Mhi : jumlah industri mikro menurut KBLI, diambil dari isian Blok III Rincian C Kolom 19-42
mhi : target sampel industri mikro menurut KBLI dalam satu blok sensus (perhitungan dilakukan BPS kabupaten/kota)
Ihi : interval sampel

Mhi : jumlah industri mikro menurut KBLI, diambil dari isian Blok III Rincian C Kolom 19 - 42
mhi : target sampel industri mikro menurut KBLI dalam satu blok sensus (perhitungan dilakukan BPS kabupaten/kota)
Ihi : interval sampel

BLOK V . C A T A T A N
Apabila ada hal-hal yang memerlukan keterangan lebih lanjut, tuliskan pada blok ini. Selain informasi dari responden, pencacah, dan pemeriksa juga
bisa menambahkan catatan untuk memperjelas masalah yang berkaitan dengan daftar isian.

BLOK VI. KETERANGAN PETUGAS

URAIAN
Nama petugas
Tanggal

Tanda tangan

PENCACAH

PENGAWAS