1996 PODES96 ques podes se96
SE96-PODES
QUESTIONAIRES
VILLAGE / KELURAHAN POTENSIAL
(PODES)
SE 96
Economic census
CBS Central Bureau of Statistic, Jakarta - Indonesia
1
2
Confidential
Double copy **)
SE96 - PODES
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTIC
1996 ECONOMIC CENSUS
POTENSIAL OF VILLAGE/KELURAHAN
01.
02
03
04
05
01
02
03
04
I. IDENTIFICATION
Province
Regency/Municipality *)
District
Village/Kelurahan/UPT/SPT/PMST*
Area
Urban -1
II. WORKERS CHARACTERISTIC
Details
Enumerator
Name
NIP (Enumerator Identity Number)
Date of supervision
Signature
Rural
-2
Supervisor
*) Cross out inapplicable
**) One copy sends to Province Statistic’s Office, knowing by and another one keep in the Village as a file.
…………………..,1996
Head of Village/Kelurahan,
Name and stamp
3
4
III. VILLAGE/KELURAHAN CHARACTERISTIC
1. Legal status of the village
Definitive
-1
UPT/SPT
-3
go to Q.4
Preparation -2
PMST
-4
2. If Q.1 coded “1” or “2”, the status is
Village
-1
Kelurahan
-2 ® go to Q.4
3. If Q.2 coded “1” , is there any Village Communication Institution
(LMD)
Yes -1
No
-2
4. If Q.1 “not coded 1” , name of identity village/location
____________________________
5. LKMD/K category
Persiapan
-0
Category1
-1
Category2
Category3
(fill in by supervisor)
-2
-3
6. If Q.1 coded “1”, Village/Kelurahan classification
Self-supporting
-1
Self-sufficient
-3
Self-developing
-2
7. This village consist of:
Village administrative unit (RK/RW)
Neighborhood Association
…………..RK/RW
……………RT
8.a.Any changes name of the village after July 1995 (Podes Inti 1995)
or not registered on Podes-SE96 village listing’s at the District area
Yes -1
No
-2 ® go to Q. 9.a
b. If “Yes” , what is the name of old village
Name of village_________________________
(fill in by supervisor)
9.a.Was the village changed land area after July 1995 (Podes Inti 1995)
Yes -1 *)
No
-2
go to Q.10
b. If “Yes”,
(1). “Increased” from area:
a. Enumerator’s area number __________________
b. Province
__________________
c. Regency/municipality
__________________
d. District
__________________
e. Village
__________________
(2). “Decreased” , to area:
a. Enumerator’s area number __________________
b. Province
__________________
c. Regency/municipality
__________________
d. District
__________________
e. Village
__________________
10. Village /Kelurahan geography
Shore area
-1
Non-shore area -à
Valley area
-2
Hill area
-3
Land area
-4
Note: If District……………..
(fill in by supervisor)
(fill in by supervisor)
5
6
III. VILLAGE/KELURAHAN CHARACTERISTIC (CONTINUING)
11. Village/ Kelurahan topography
High land
-1
Low land
-2
12a. Is there any Indonesian Army Force (ABRI) member
(Army, Navy, Air Force and Police) lived in this village
(not include who are living in the barracks)
Yes -1
No
-2 ® go to Q. 13
b. If “Yes” , how many they are __________peoples
13. Environment safety (kamling)
a. Post of kamling
Yes
b. Police station
Yes
c. Post Police
Yes
-1
-3
-5
No
No
No
-2
-4
-6
14a.Source income of majority population
Agriculture
-1
Transportation,
-7
Mining &
-2
storage and
Industry
-3
communication
Electricity,
-4
Finances Institution, -8
gas, and water
real-estate, renting,
Construction
-5
and service company
Wholesaler/,
-6
Community services, -9
retails, restaurant
social, and individual
and accommodation
b. If q.14a. coded “1” main potential of sub-sector:
Food planting
-1
Plantation
-3
Livestock
-2
Fishery
-4
Forestry
-5
IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT
A. Population
1. The population registration has been carried out regularly
Yes -1
No
-2
2. Calculating base on last condition
a. Number of population
b. Number of woman population
c. Number of household
d. Number of household head by woman
…………people
…………people
……………hh
……………hh
3. Number of household has send they’re children/relatives
to university
……………hh
B. Environment, housing and settlement
1. Kind of fuel used for cooking of majority household
Gas/LPG
-1
Firewood
-3
Kerosene
-2
Others (charcoal, husk,
-4
coconut shell, bio-gas)
7
8
IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT (CONTINUED)
2. Trash disposal of majority household
The trash then -1
River
-3
carried away
Other (write)
-4
In the whole -2
……………..
3. Place of latrine of majority household
Private
-1
Public
Shared
-2
not a
-3
-4
4. Gutter condition
Fast
-1
Slowly
-2
-3
-4
Water is stuck
No gutter
5. Pollution environment (during a year ago)
Source
Source of pollution
Type of pollution
Have
-1
From the village -1
Household
-1
Not have
-2
Outside village -2
Factory
-2
(if this column
In & outside
-3
-3
coded 2, Col (3)-(5) Other
Village
-4
should blank)
(1)
(2)
(3)
(4)
a. Water
b. Land
c. Air
d.Voice /vibration
a. Critical land area
____________ ha
b. Could not be planting
____________ ha
c. Not yet planting
____________ ha
d. If Q.6.c. filled in, why not be planting yet?
Not critical yet
-1
No cost/power
-2
Doesn’t have instruction yet
-3
Community doesn’t care
-4
Other
-5
Critical land succeeded planting
____________ ha during last 3 years
Number of houses according to construction
a. Regular
____________ units
b. Irregular
____________ units
Number of houses according to the quality
a. Permanent
____________ units
b. Semi – permanent
____________ units
c. Simple
____________ units
Number of buildings/constructions are
____________ units
having 4 floors or more
a. Is there any river passed this village
Yes
-1
No
-2 ® skip to Q. 13.a
b. If ‘yes’, what for that river used?
(1). Bathing/washing
Yes -1
No
-2
(2). Drink water
Yes -3
No
-4
(3). Basic material of drink water
Yes -5
No
-6
(4). Irrigation
Yes -7
No
-8
(5). Industry/factory
Yes -1
No
-2
(6). Transportation
Yes -3
No
-4
(7). Other
Yes -5
No
-6
Claimed to
Head Village/
“Lurah”
Yes
-1
No
-2
(5)
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10
IV. POPULATION, ENVIRONMENT, HOUSING AND SETTLEMENT (CONTINUED)
12. a. Is there community living along the river?
Yes
-1
No
-2 ® Skip to Q. 13.a
b. If ‘Yes”
(1) Number of household
…………….. h.h
(2) Number of house’s building
…………….. Units
13. a. Is there community living under high voltage of electric’s network
Yes
-1
No
-2 ® Skip to Q. 14.a
b. If “yes”
(1) Number of household
…………….. h.h
(2) Number of house’s building
…………….. units
14. a. Is there any poor settlement’s in this village/kelurahan?
Yes
-1
No
-2 ® Skip to Q. 15.a
b. If “Yes” ,
(1) Land area
……………. Ha
(2) Number of household member
……………. Peoples
(3) Number of household
……………. H.h
15. a. Within the last 2 years, is there any new house built by community?
Yes
-1
No
-2 ® Skip to Q. 16.a
b. If “Yes”, number of new house built ……….units
16. a. Within the last 2 years, is there any new house built by Developer?
Yes
-1
No
-2 ® Skip to Q. 17.a
b. If “Yes”,
(1) Total number
………….. units
(2) Number of simplest type house’s (RSS)
………….. units
(3) Number of simple type house’s (RS)
………….. units
(4) Number of ‘middle’ type house’s
………….. units
(5) Number of luxurious type house’s
………….. units
17. a. Is there any processing/macnufacture ‘s industry in this village?
Yes
-1
No
-2 ® Skip to Q. 20.a
b. Number of industry?
………….. units
18. a. If Q.17.a. coded “1”, type of wasted produce:
(1) Solid
Yes
-1 No
-2If Q.18.a.(1) and Q 18.a.(2) filled in
(2) Liquid Yes
-3 No
-4
“No”, skip to Q. 19
(3) Gas
Yes
-5 No
-6
(4) Voices Yes
-7 No
-8
b. If Q.18.a. (1) or R 18.a. (2) filled in “Yes”, how was industrial’s waste
processed?
(1) Recycling
Yes
-1 No -2
(2) Processed by Waste Process Unit (UPL)
Yes
-3 No -4
than discarded
(3) Discarded directly to the river
Yes
-5 No -6
(4) Piled at around industrial location
Yes
-7 No -8
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IV. POPULATION, ENVIRONMENT, HOUSING AND SETTLEMENT (CONTINUED)
19.a. Is there any materials (material of construction) industry?
Yes
-1
No
-2 ® skip to Q. 20.a.
b. If “yes”, number of industry
……………. Units
20.a. Is there any household’s trash transporter service in this village?
Yes
-1
No
-2 ® skip to block V
b. If “yes”, how many times taken away from the house every month?
……… times
V. EDUCATION
1. Number of school according to level of education and building ownership
School
If there is no school available
Time spent to
Distance to
the closest
the closest
Government
Private
Level of education Having a Not having Having a Not having school
school
building
a building
building
a building
(1)
(2)
(3)
(4)
(5)
(6)
(7)
a. Kindergarten
b. Primary School
c. Junior High
d. High School
e. Academy/
University
2. Skill education
a. Motorcycle/car Mechanic
Have
-1
Have not
-2
b. Electronic Mechanic
Have
-3
Have not
-4
c. Typing/Shorthand
Have
-5
Have not
-6
d. Language
Have
-7
Have not
-8
e. Accountancy
Have
-1
Have not
-2
f. Cooking
Have
-3
Have not
-4
g. Sewing
Have
-5
Have not
-6
h. Farming
Have
-7
Have not
-8
i. Computer
Have
-1
Have not
-2
j. Trade / carpentry
Have
-3
Have not
-4
k. Handicraft
Have
-5
Have not
-6
l. Beauty
Have
-7
Have not
-8
m. Other
Have
-1
Have not
-2
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VI. SOCIO-CULTURE
A. Number of Places of worship
1. Mosque
:
units
2. Prayer-house (=small mosque)
:
units
3. Church/Chapel
:
units
4. Pura (place of worship of Hinduism) :
units
5. Vihara (place of worship of Buddhist) :
units
B. Social activity
1. Boy Scouts
Have
-1
Have not -2
2. Orphanage
Have
-3
Have not -4
3. Elderly House
Have
-5
Have not -6
4. Handicap rehabilitation
Have
-7
Have not -8
5. Youth Club
Have
-1
Have not -2
6. Family Welfare Management
Have
-3
Have not -4
(Program at village level to educate Woman on various aspects of family
welfare)
VII. RECREATION AND ENTERTAINMENT
1. a. Movie Theater /Cinema
Have
-1 ® Skip to Q.2
Not have
-2
b. If “not have”,
(1) Closest distance from the village office’s …………. km
(2) Time to spent
………… hour
2. Recreation place
a. Managed (charges)
b. Unmanaged
3. Zoo
4. Historical places
5. Museum
6. Commercial Pool places
7. Commercial fishing places
8. Game Arcade
9. Night Club/Discotheque/Karaoke
10. Massage/Fitness/Sauna Center
11. Natural bathing pool
12. Rental Meeting Hall
13. Prostitution localization
14. Other (please write down)
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
-1
-3
-5
-7
-1
-3
-5
-7
-1
-3
-5
-7
-1
-3
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
-2
-4
-6
-8
-2
-4
-6
-8
-2
-4
-6
-8
-2
-4
15
16
VIII. HEALTH
Total
Health Facility
(1)
(2)
a. Hospital
b. Maternity Hospital
c. Maternity house
d. Polyclinic
e. Puskesmas (Integrated Health Center)
f. Supported Puskesmas (small Puskesmas)
g. Medicinal treatment center
h. Doctor practice place’s
i. Polindes (Village Maternity Post)
j. Pharmacy
k. Drug Store
Number of Health Workers who live in this village:
a. Doctor
1. Male
…………… person
2. Female …………… person
b. Paramedics (exclude Midwife)
1. Male
…………… person
2. Female …………… person
c. Midwife
…………… person
d. Midwife at the village
…………… person
(as localization of Government Order)
e. Traditional Birth Attendance 1. Skilled ………… person
2. Unskilled ……….. person
Illness Epidemic during a year ago
a. Diarrhea and vomiting
……….. times
b. Denging fever
……….. times
c. Other (please write down) ………..
……….. times
a. Source of water for drinking/cooking:
PAM/PDAM/SAM
-1
Spring
(Municipal Water Corp.)/
River/lake
mineral water
Rain water
Electric Pump/hand pump -2
Other
Artesian Well
-3
(write down)
Well
-4
b. Source of water for bathing/washing:
PAM/PDAM/SAM
-1
Spring
(Municipal Water Corp.)/
River/lake
mineral water
Rain water
Electric Pump/hand pump -2
Other
Artesian Well
-3
(write down)
Well
-4
If Q.1a. col. (2)=0, distance to
the closest hospital
(Km)
(3)
-5
-6
-7
-8
-5
-6
-7
-8
17
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IX. TRANSPORTATION
A. TRANSPORT
1. Road facility inter village
a. Traffic inter village majority through:
Land -1 Sea/river
-2 ® to Q.2
Air
-3 ® to Q.2
b. If the traffic majority through land (Q.1.a. coded “1”)
(1). Type of widest road
Asphalt/Concrete/cone block
-1
Soil
-3
Hardened (stone, pebble, etc)
-2
Other
-4
……………….
(2)
Is the road can be pass through 4 wheels or more vehicle all the years?
Yes
-1
No
-2
2. Type of public transportation used by community to the district’s capital/closest city
Code
Type of transportation
01
Bicycle “Ojek” (bicycle used for
Have -1 Not have -2
public transport passenger)
02
“Becak” (Pedicab, with tricycle)
Have -3 Not have -4
03
Wagon/”Pedati” (horse-drawn cart)
Have -5 Not have -6
04
“Delman/Dokar/Bendi” (two-wheeled buggy/ Have -7 Not have -8
horse-drawn buggy/two-wheeled carriage)
05
Motor cycle “Ojek”
Have -1 Not have -2
06
3 wheeled motor vehicle
Have -3 Not have -4
07
4 wheeled motor vehicle
Have -5 Not have -6
08
Rowboat
Have -7 Not have -8
09
Motor boat
Have -1 Not have -2
10
Motor ship
Have -3 Not have -4
11
Other
Have -5 Not have -6
3. From these transportation facility above (detail 2), the main transport :
………………………………(put the selected code of detail 2 into the box)
4. a.
b.
c.
d.
e.
Public motor transport station/terminal
Rail-way station
Seaport
River pier
Airport
Have
Have
Have
Have
Have
5. Easeness of majority population to reach some closest facilities:
Facility
Easy to reach
a. Hospital
Very easy -1 Easy
difficult -4
b. Puskesmas/other health facility
Very easy -1 Easy
difficult -4
c. Market with permanently building
Very easy -1 Easy
difficult -4
d. Shopping complex
Very easy -1 Easy
difficult -4
-1
-3
-5
-7
-1
Not have
Not have
Not have
Not have
Not have
-2
-4
-6
-8
-2
-2 Difficult -3 Very
-2 Difficult -3 Very
-2 Difficult -3 Very
-2 Difficult -3 Very
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20
IX. TRANSPORTATION (CONTINUED)
B. COMMUNICATION
1. Household who has a telephone
2. Communication radio
3. a. Post Office/Post Office assistant/ Post House
Have
-1 ® to Q. 4
Not have
b. If “Not have”, the closest distance to the Post Office
4. Mobile Post
5. Public Television
6. Household who has the television
7. Household who has the satellite antenna
8. Household who has Radio
9. Newspaper/magazine customers
10. Public Message Board
…………. H.h
…………. Unit
-2
Have
Have
-1
-3
Have
Have
-1
-3
…………. Km
Not have -2
Not have -4
…………. H.h
…………. H.h
………… h.h
Not have -2
Not have -4
X. LAND USED
A. Village’s land area (R.B + R.C)
…………….. ha
B. Rice field area (R.1 + R.2)
………….…. ha
1. Rice fields area used for farming (R.a + R.b + R.c + R.d)
a. Technical Irrigation
b. Non-technical irrigation
c. “Tadah hujan” Dependent on rain water for irrigation
d. The rise and fall of the tides, polder, lowlands, and swamp
which planted of rice
2. Rice fields area are not used for farming temporarily:
C. Non rice field land area (R.1 +R.2 + R.3 )
1. Non rice field land area used for farming
(R.a +R.b + R.c + R.d)
a. Unirrigated agricultural field/”huma” (field for dry rice
cultivation)/”tegal” (cultivation without irrigation)/
plantation/pond / “tambak” (earthen dam)
b. Plantation
c. Peoples forest
d. Other
……………. ha
…………… ha
…………… ha
…………… ha
…………….ha
…………… ha
…………… ha
…………… ha
………….. ha
…………..
…………..
…………..
…………..
ha
ha
ha
ha
2. Non rice field land area which not used for farming (R.a +R.b + R.c)
a. Land for housing and settlement
………….. ha
b. Land for other building (industry, office complex,
………….. ha
shopping complex)
c. Other (excluded State Forest)
………….. ha
3. Unused non rice field land area temporarily
………….. ha
21
22
XI. ECONOMIC
A. PRODUCTION FACILITY AND MARKETING
1. a. Shopping complex category
Have
-1 ® to Q.2
b. If “Not have”,
(1). The distance
(2). Time to spend
2. a. Market with permanent building/semi-permanent
b. If not have
(1). The distance
(2). Time to spend
3. Market without permanent building
4. Supermarket/department store
5. Veterinary market
6. Slaughterhouse
7. Fish dropping point
8. Fish Auction place
9. Electric/electronic tools shop
10. Agriculture production facility kiosk
Own by KUD (Village Cooperative Unit)
Own by non-KUD
11. Industrial Area
12. Industrial Central (please write down)
……………………
13. Small industrial area
14. Small industrial village (please write down)
…………………
15. Place of excavated material marketing
16. Fuel Station
17. Agent/seller of LPG
18. a. Restaurant
b. How many of them has a permission certificate from
“Diparda” (
19. Food/drinks stall
B. BUSINESS AND RENTAL SERVICES
1. Party facility equipment rental
2. Vide cassette/laser Disc rental
3. Car/motor vehicle rental
4. Photo copy business
5. Repairs of non-motor vehicle
6. Repairs of motor vehicle (car, motorcycle)
7. Repairs of electronic and electric tools
8. Beauty salon
9. Studio photo
10. Laundry
Not have
-2
……………. Km
……………. Hours
……………. Units
……………. Km
……………. Hours
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
23
24
XI. ECONOMIC (CONTINUED)
Man power distributor
……………. Units
Hotel/Motel/hostel/inn
……………. Units
Travel Bureau / Agent
……………. Units
Computer service rental
……………. Units
a. Joint Business Group
……………. Units
Have
-1
Not have
-2 ® to C
……………. Units
b. If “have”,
(1) Number of group
…………… Group
(2) Number of member of each group
…………… Group
FINANCE INSTITUTION
Number of Banks (public bank)
a. Bank’s Offices
(Central Office, branch office)
…..………. Units
b. Cash Office
…..………. Units
c. “BRI” (Indonesia Peoples Banks) unit office and
…..………. Units
BRI Village Service Post
Number of “Bank Perkreditan Rakyat”/BPR (Peoples Credit Bank)
a. BPR non “Badan Kredit Desa” (Village Credit Institution)
(New BPR, P.T. Bank Pasar/P.T. Bank Desa, Bank Karya Produksi
Desa, BPR ex LDKP)
(1). Central Office and branch
…..………. Units
(2). Cash Office
…..………. Units
b. BPR “Badan Kredit Desa”
(1). “Bank Desa”
…..………. Units
(2). “Lumbung Desa”
…..………. Units
c. Lembaga Dana Kredit Pedesaan/LDKP (Village Credit Fund Institution)
Number of Pawn office
…..………. Units
Number of Insurance company
…..………. Units
Number of Cooperative
…..………. Units
a. Village Cooperative Unit (KUD)
…..………. Units
b. Craft industry & Small Industry Cooperative (Kopinkra)
…..………. Units
c. Lending and saving cooperative
…..………. Units
d. Other non-KUD cooperative
…..………. Units
Other Financial Institution
a. Other Credit office
…..………. Units
b. Other Financial Institution Offices
…..………. Units
Credit facility received by community during a year ago
a. KUK (Small Business Credits)
Have
-1
Not have -2
b. KPR (Housing Credit)
Have
-3
Not have -4
c. TRI (Intensification sugar cane
Have
-5
Not have -6
plantation Credit)
d. Other farmer business credits
Have
-7
Not have -8
e. Other credits
Have
-1
Not have -2
If Q.5. has content and one of Q.7 content is “Have”, is they’re of the credit distributed
through this village cooperative?
Have
-1
Not have
-2
25
26
XI. ECONOMIC (CONTINUED)
D. ESTABLISHMENT/BUSINESS BY ECONOMIC SECTOR
1. Number of agriculture establishment of law
…………… Units
2. Number of excavation location of C category according to the excavated
a. Stone, coral
……….. location
b. Sand
……….. location
c. Lime
……….. location
d. Sulfur
……….. location
e. Kaolin
……….. location
f. “Kwarsa” sand
……….. location
g. Clayey
……….. location
h. Other (please write down) ……………………
……….. location
3. Industry (large, small, medium/household handicraft)
……….. unit
4. Industry business with < 20 persons man power
……….. unit
5. Electric’s establishment/business non – PLN(State Electricity
……….. unit
Enterprise)
6. Construction establishment’s of law
……….. unit
7. Few units of housing and settlements developed by
……….. unit
Developer
8. Trade establishment of law
……….. unit
9. Transportation, Warehousing, and Communication
a. Transportation company
(1). Motor transportation company
……….. unit
(2). Non motor transportation company
……….. unit
b. Warehousing company
……….. unit
c. Public Warehousing
……….. unit
d. Communication
(1). Public telephone (using coin)
……….. unit
(2). Public telephone (using card)
……….. unit
(3). “Wartel” (telephone stall)
……….. unit
(4). “Warpostel” (telephone and post stall)
……….. unit
(5). “Warpaspostel” (
……….. unit
E. OTHERS
1. Household according by economic sector (based on main job of household head)
a. Agriculture/farming
………. h.h
b. Mining and Exploration
……….. h.h
c. Industry/handicraft
……….. h.h
d. Electricity, Gas, and Water
……….. h.h
e. Construction
……….. h.h
f. Trade
……….. h.h
g. Transportation
……….. h.h
h. Financial institution
……….. h.h
i. Other
……….. h.h
2. Number of household which the member of household worked
in agriculture sector
……….. h.h
3. Number of electric’s customer household
……….. h.h
a. PLN
……….. h.h
b. Non PLN
……….. h.h
27
28
XI. ECONOMIC (CONTINUED)
a. Main road village lighting
Have
-1
Not have
-2 ® to Q.5.
b. If “have”, type: PLN electricity (formally by Government)
Other electricity
Non-electricity
Number of household has motor vehicle with 4 wheels or more drive
(including for business)
Number of household has motor vehicle with 2 wheels or 3 wheels
or motor boat (including for business
Community socio-economic situation in general
Wealthiest
-1
Poor
-4
Wealthy
-2
Poorest
-5
Rich
-3
a. Do the village conducted family welfare registration
Done
-1
Not yet
-2 ® skip to Block XII
b. If “done”, how many family according to type of welfare:
(1) Pre-prosperous family
…………. family
(2) Prosperous Family stage I
…………. family
(3) Prosperous Family stage II
…………. family
(4) Prosperous Family stage III
…………. family
(5) Prosperous Family stage III +
…………. Family
XII. 1995/1996 VILLAGE FINANCIAL
1. Realization of village expenses and income (000 Rp)
a. Income
(1). Left over (plus) of 1994/1995 budgets
(2). a. Village ‘original’ income
b. Community self-supporting (money, goods,
and in kind)
(3). Funding from Central level
(4). Funding from province level
(5). Funding from Regency level
(6). Other revenues/income
b. Routine expenses
(1). Left over (mines) 1994/1995 budgets
(2). Employee expenses
(3). Goods expenses
(4). Maintenance expenses
(5). Travelling expenses
(6). Other routine expenses
(7). Miscellaneous expenses
c. Development expenses
(1). Village infra structure facility
(2). Production facility
(3). Transportation facility
(4). Marketing facility
(5). Social facility
(6). Other development expenses
Balanced [a – (b + c)]
-1
-2
-3
……..… h.h
……….. h.h
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
29
30
XII. 1995/1996 VILLAGE FINANCIAL (CONTINUED)
2. Have you ever received Integrated Area Development Fund (PKT) or Integrated
Area Development (P2WT)
Yes
-1
No
-2
3. Percentage of PBB (land and building taxes) income realization during 1994/1995
budgets of targeted
………………. %
4. a. Have this village ever received IDT (Hard to reach Village
Yes
-1
No
-2 ® to Block XIII
b. If “Yes” budgets year:
(1). 1994/1995
Yes
-1
No
-2
(2). 1995/1996
Yes
-3
No
-4
(3). 1996/1997
Yes
-5
No
-6
5. a. If Q.4.a coded “1”,
(1). Number of community group (“pokmas”) in this village
……… group
(2). Number of community group which has received IDT fund ……… group
(3). Number of family which has received IDT fund
……… group
b. Number of supporting of community group which has received ……… group
IDT fund
XIII. HEAD OF VILLAGE CHARACTERISTIC
1. Age
………… years old
2.
2.
Sex
Male
-1
-2
The highest education ever completed:
No schooling
Not completed
Primary School
Primary School
Junior High School
4.
Female
-1
-2
High School
Academy
University
-5
-6
-7
-3
-4
Duration of occupy (since got promotion till to enumeration carry out ……. year
XIV. NOTE
31
32
Province
Regency/Municipality
District
Village
Estimation scale
1
XV. SKETCH OF CHANGED AREA
: ……………………………
: ……………………………
: ……………………………
: ……………………………
: …………………………….
é
U
33
QUESTIONAIRES
VILLAGE / KELURAHAN POTENSIAL
(PODES)
SE 96
Economic census
CBS Central Bureau of Statistic, Jakarta - Indonesia
1
2
Confidential
Double copy **)
SE96 - PODES
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTIC
1996 ECONOMIC CENSUS
POTENSIAL OF VILLAGE/KELURAHAN
01.
02
03
04
05
01
02
03
04
I. IDENTIFICATION
Province
Regency/Municipality *)
District
Village/Kelurahan/UPT/SPT/PMST*
Area
Urban -1
II. WORKERS CHARACTERISTIC
Details
Enumerator
Name
NIP (Enumerator Identity Number)
Date of supervision
Signature
Rural
-2
Supervisor
*) Cross out inapplicable
**) One copy sends to Province Statistic’s Office, knowing by and another one keep in the Village as a file.
…………………..,1996
Head of Village/Kelurahan,
Name and stamp
3
4
III. VILLAGE/KELURAHAN CHARACTERISTIC
1. Legal status of the village
Definitive
-1
UPT/SPT
-3
go to Q.4
Preparation -2
PMST
-4
2. If Q.1 coded “1” or “2”, the status is
Village
-1
Kelurahan
-2 ® go to Q.4
3. If Q.2 coded “1” , is there any Village Communication Institution
(LMD)
Yes -1
No
-2
4. If Q.1 “not coded 1” , name of identity village/location
____________________________
5. LKMD/K category
Persiapan
-0
Category1
-1
Category2
Category3
(fill in by supervisor)
-2
-3
6. If Q.1 coded “1”, Village/Kelurahan classification
Self-supporting
-1
Self-sufficient
-3
Self-developing
-2
7. This village consist of:
Village administrative unit (RK/RW)
Neighborhood Association
…………..RK/RW
……………RT
8.a.Any changes name of the village after July 1995 (Podes Inti 1995)
or not registered on Podes-SE96 village listing’s at the District area
Yes -1
No
-2 ® go to Q. 9.a
b. If “Yes” , what is the name of old village
Name of village_________________________
(fill in by supervisor)
9.a.Was the village changed land area after July 1995 (Podes Inti 1995)
Yes -1 *)
No
-2
go to Q.10
b. If “Yes”,
(1). “Increased” from area:
a. Enumerator’s area number __________________
b. Province
__________________
c. Regency/municipality
__________________
d. District
__________________
e. Village
__________________
(2). “Decreased” , to area:
a. Enumerator’s area number __________________
b. Province
__________________
c. Regency/municipality
__________________
d. District
__________________
e. Village
__________________
10. Village /Kelurahan geography
Shore area
-1
Non-shore area -à
Valley area
-2
Hill area
-3
Land area
-4
Note: If District……………..
(fill in by supervisor)
(fill in by supervisor)
5
6
III. VILLAGE/KELURAHAN CHARACTERISTIC (CONTINUING)
11. Village/ Kelurahan topography
High land
-1
Low land
-2
12a. Is there any Indonesian Army Force (ABRI) member
(Army, Navy, Air Force and Police) lived in this village
(not include who are living in the barracks)
Yes -1
No
-2 ® go to Q. 13
b. If “Yes” , how many they are __________peoples
13. Environment safety (kamling)
a. Post of kamling
Yes
b. Police station
Yes
c. Post Police
Yes
-1
-3
-5
No
No
No
-2
-4
-6
14a.Source income of majority population
Agriculture
-1
Transportation,
-7
Mining &
-2
storage and
Industry
-3
communication
Electricity,
-4
Finances Institution, -8
gas, and water
real-estate, renting,
Construction
-5
and service company
Wholesaler/,
-6
Community services, -9
retails, restaurant
social, and individual
and accommodation
b. If q.14a. coded “1” main potential of sub-sector:
Food planting
-1
Plantation
-3
Livestock
-2
Fishery
-4
Forestry
-5
IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT
A. Population
1. The population registration has been carried out regularly
Yes -1
No
-2
2. Calculating base on last condition
a. Number of population
b. Number of woman population
c. Number of household
d. Number of household head by woman
…………people
…………people
……………hh
……………hh
3. Number of household has send they’re children/relatives
to university
……………hh
B. Environment, housing and settlement
1. Kind of fuel used for cooking of majority household
Gas/LPG
-1
Firewood
-3
Kerosene
-2
Others (charcoal, husk,
-4
coconut shell, bio-gas)
7
8
IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT (CONTINUED)
2. Trash disposal of majority household
The trash then -1
River
-3
carried away
Other (write)
-4
In the whole -2
……………..
3. Place of latrine of majority household
Private
-1
Public
Shared
-2
not a
-3
-4
4. Gutter condition
Fast
-1
Slowly
-2
-3
-4
Water is stuck
No gutter
5. Pollution environment (during a year ago)
Source
Source of pollution
Type of pollution
Have
-1
From the village -1
Household
-1
Not have
-2
Outside village -2
Factory
-2
(if this column
In & outside
-3
-3
coded 2, Col (3)-(5) Other
Village
-4
should blank)
(1)
(2)
(3)
(4)
a. Water
b. Land
c. Air
d.Voice /vibration
a. Critical land area
____________ ha
b. Could not be planting
____________ ha
c. Not yet planting
____________ ha
d. If Q.6.c. filled in, why not be planting yet?
Not critical yet
-1
No cost/power
-2
Doesn’t have instruction yet
-3
Community doesn’t care
-4
Other
-5
Critical land succeeded planting
____________ ha during last 3 years
Number of houses according to construction
a. Regular
____________ units
b. Irregular
____________ units
Number of houses according to the quality
a. Permanent
____________ units
b. Semi – permanent
____________ units
c. Simple
____________ units
Number of buildings/constructions are
____________ units
having 4 floors or more
a. Is there any river passed this village
Yes
-1
No
-2 ® skip to Q. 13.a
b. If ‘yes’, what for that river used?
(1). Bathing/washing
Yes -1
No
-2
(2). Drink water
Yes -3
No
-4
(3). Basic material of drink water
Yes -5
No
-6
(4). Irrigation
Yes -7
No
-8
(5). Industry/factory
Yes -1
No
-2
(6). Transportation
Yes -3
No
-4
(7). Other
Yes -5
No
-6
Claimed to
Head Village/
“Lurah”
Yes
-1
No
-2
(5)
9
10
IV. POPULATION, ENVIRONMENT, HOUSING AND SETTLEMENT (CONTINUED)
12. a. Is there community living along the river?
Yes
-1
No
-2 ® Skip to Q. 13.a
b. If ‘Yes”
(1) Number of household
…………….. h.h
(2) Number of house’s building
…………….. Units
13. a. Is there community living under high voltage of electric’s network
Yes
-1
No
-2 ® Skip to Q. 14.a
b. If “yes”
(1) Number of household
…………….. h.h
(2) Number of house’s building
…………….. units
14. a. Is there any poor settlement’s in this village/kelurahan?
Yes
-1
No
-2 ® Skip to Q. 15.a
b. If “Yes” ,
(1) Land area
……………. Ha
(2) Number of household member
……………. Peoples
(3) Number of household
……………. H.h
15. a. Within the last 2 years, is there any new house built by community?
Yes
-1
No
-2 ® Skip to Q. 16.a
b. If “Yes”, number of new house built ……….units
16. a. Within the last 2 years, is there any new house built by Developer?
Yes
-1
No
-2 ® Skip to Q. 17.a
b. If “Yes”,
(1) Total number
………….. units
(2) Number of simplest type house’s (RSS)
………….. units
(3) Number of simple type house’s (RS)
………….. units
(4) Number of ‘middle’ type house’s
………….. units
(5) Number of luxurious type house’s
………….. units
17. a. Is there any processing/macnufacture ‘s industry in this village?
Yes
-1
No
-2 ® Skip to Q. 20.a
b. Number of industry?
………….. units
18. a. If Q.17.a. coded “1”, type of wasted produce:
(1) Solid
Yes
-1 No
-2If Q.18.a.(1) and Q 18.a.(2) filled in
(2) Liquid Yes
-3 No
-4
“No”, skip to Q. 19
(3) Gas
Yes
-5 No
-6
(4) Voices Yes
-7 No
-8
b. If Q.18.a. (1) or R 18.a. (2) filled in “Yes”, how was industrial’s waste
processed?
(1) Recycling
Yes
-1 No -2
(2) Processed by Waste Process Unit (UPL)
Yes
-3 No -4
than discarded
(3) Discarded directly to the river
Yes
-5 No -6
(4) Piled at around industrial location
Yes
-7 No -8
11
12
IV. POPULATION, ENVIRONMENT, HOUSING AND SETTLEMENT (CONTINUED)
19.a. Is there any materials (material of construction) industry?
Yes
-1
No
-2 ® skip to Q. 20.a.
b. If “yes”, number of industry
……………. Units
20.a. Is there any household’s trash transporter service in this village?
Yes
-1
No
-2 ® skip to block V
b. If “yes”, how many times taken away from the house every month?
……… times
V. EDUCATION
1. Number of school according to level of education and building ownership
School
If there is no school available
Time spent to
Distance to
the closest
the closest
Government
Private
Level of education Having a Not having Having a Not having school
school
building
a building
building
a building
(1)
(2)
(3)
(4)
(5)
(6)
(7)
a. Kindergarten
b. Primary School
c. Junior High
d. High School
e. Academy/
University
2. Skill education
a. Motorcycle/car Mechanic
Have
-1
Have not
-2
b. Electronic Mechanic
Have
-3
Have not
-4
c. Typing/Shorthand
Have
-5
Have not
-6
d. Language
Have
-7
Have not
-8
e. Accountancy
Have
-1
Have not
-2
f. Cooking
Have
-3
Have not
-4
g. Sewing
Have
-5
Have not
-6
h. Farming
Have
-7
Have not
-8
i. Computer
Have
-1
Have not
-2
j. Trade / carpentry
Have
-3
Have not
-4
k. Handicraft
Have
-5
Have not
-6
l. Beauty
Have
-7
Have not
-8
m. Other
Have
-1
Have not
-2
13
14
VI. SOCIO-CULTURE
A. Number of Places of worship
1. Mosque
:
units
2. Prayer-house (=small mosque)
:
units
3. Church/Chapel
:
units
4. Pura (place of worship of Hinduism) :
units
5. Vihara (place of worship of Buddhist) :
units
B. Social activity
1. Boy Scouts
Have
-1
Have not -2
2. Orphanage
Have
-3
Have not -4
3. Elderly House
Have
-5
Have not -6
4. Handicap rehabilitation
Have
-7
Have not -8
5. Youth Club
Have
-1
Have not -2
6. Family Welfare Management
Have
-3
Have not -4
(Program at village level to educate Woman on various aspects of family
welfare)
VII. RECREATION AND ENTERTAINMENT
1. a. Movie Theater /Cinema
Have
-1 ® Skip to Q.2
Not have
-2
b. If “not have”,
(1) Closest distance from the village office’s …………. km
(2) Time to spent
………… hour
2. Recreation place
a. Managed (charges)
b. Unmanaged
3. Zoo
4. Historical places
5. Museum
6. Commercial Pool places
7. Commercial fishing places
8. Game Arcade
9. Night Club/Discotheque/Karaoke
10. Massage/Fitness/Sauna Center
11. Natural bathing pool
12. Rental Meeting Hall
13. Prostitution localization
14. Other (please write down)
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
Have
-1
-3
-5
-7
-1
-3
-5
-7
-1
-3
-5
-7
-1
-3
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
Have not
-2
-4
-6
-8
-2
-4
-6
-8
-2
-4
-6
-8
-2
-4
15
16
VIII. HEALTH
Total
Health Facility
(1)
(2)
a. Hospital
b. Maternity Hospital
c. Maternity house
d. Polyclinic
e. Puskesmas (Integrated Health Center)
f. Supported Puskesmas (small Puskesmas)
g. Medicinal treatment center
h. Doctor practice place’s
i. Polindes (Village Maternity Post)
j. Pharmacy
k. Drug Store
Number of Health Workers who live in this village:
a. Doctor
1. Male
…………… person
2. Female …………… person
b. Paramedics (exclude Midwife)
1. Male
…………… person
2. Female …………… person
c. Midwife
…………… person
d. Midwife at the village
…………… person
(as localization of Government Order)
e. Traditional Birth Attendance 1. Skilled ………… person
2. Unskilled ……….. person
Illness Epidemic during a year ago
a. Diarrhea and vomiting
……….. times
b. Denging fever
……….. times
c. Other (please write down) ………..
……….. times
a. Source of water for drinking/cooking:
PAM/PDAM/SAM
-1
Spring
(Municipal Water Corp.)/
River/lake
mineral water
Rain water
Electric Pump/hand pump -2
Other
Artesian Well
-3
(write down)
Well
-4
b. Source of water for bathing/washing:
PAM/PDAM/SAM
-1
Spring
(Municipal Water Corp.)/
River/lake
mineral water
Rain water
Electric Pump/hand pump -2
Other
Artesian Well
-3
(write down)
Well
-4
If Q.1a. col. (2)=0, distance to
the closest hospital
(Km)
(3)
-5
-6
-7
-8
-5
-6
-7
-8
17
18
IX. TRANSPORTATION
A. TRANSPORT
1. Road facility inter village
a. Traffic inter village majority through:
Land -1 Sea/river
-2 ® to Q.2
Air
-3 ® to Q.2
b. If the traffic majority through land (Q.1.a. coded “1”)
(1). Type of widest road
Asphalt/Concrete/cone block
-1
Soil
-3
Hardened (stone, pebble, etc)
-2
Other
-4
……………….
(2)
Is the road can be pass through 4 wheels or more vehicle all the years?
Yes
-1
No
-2
2. Type of public transportation used by community to the district’s capital/closest city
Code
Type of transportation
01
Bicycle “Ojek” (bicycle used for
Have -1 Not have -2
public transport passenger)
02
“Becak” (Pedicab, with tricycle)
Have -3 Not have -4
03
Wagon/”Pedati” (horse-drawn cart)
Have -5 Not have -6
04
“Delman/Dokar/Bendi” (two-wheeled buggy/ Have -7 Not have -8
horse-drawn buggy/two-wheeled carriage)
05
Motor cycle “Ojek”
Have -1 Not have -2
06
3 wheeled motor vehicle
Have -3 Not have -4
07
4 wheeled motor vehicle
Have -5 Not have -6
08
Rowboat
Have -7 Not have -8
09
Motor boat
Have -1 Not have -2
10
Motor ship
Have -3 Not have -4
11
Other
Have -5 Not have -6
3. From these transportation facility above (detail 2), the main transport :
………………………………(put the selected code of detail 2 into the box)
4. a.
b.
c.
d.
e.
Public motor transport station/terminal
Rail-way station
Seaport
River pier
Airport
Have
Have
Have
Have
Have
5. Easeness of majority population to reach some closest facilities:
Facility
Easy to reach
a. Hospital
Very easy -1 Easy
difficult -4
b. Puskesmas/other health facility
Very easy -1 Easy
difficult -4
c. Market with permanently building
Very easy -1 Easy
difficult -4
d. Shopping complex
Very easy -1 Easy
difficult -4
-1
-3
-5
-7
-1
Not have
Not have
Not have
Not have
Not have
-2
-4
-6
-8
-2
-2 Difficult -3 Very
-2 Difficult -3 Very
-2 Difficult -3 Very
-2 Difficult -3 Very
19
20
IX. TRANSPORTATION (CONTINUED)
B. COMMUNICATION
1. Household who has a telephone
2. Communication radio
3. a. Post Office/Post Office assistant/ Post House
Have
-1 ® to Q. 4
Not have
b. If “Not have”, the closest distance to the Post Office
4. Mobile Post
5. Public Television
6. Household who has the television
7. Household who has the satellite antenna
8. Household who has Radio
9. Newspaper/magazine customers
10. Public Message Board
…………. H.h
…………. Unit
-2
Have
Have
-1
-3
Have
Have
-1
-3
…………. Km
Not have -2
Not have -4
…………. H.h
…………. H.h
………… h.h
Not have -2
Not have -4
X. LAND USED
A. Village’s land area (R.B + R.C)
…………….. ha
B. Rice field area (R.1 + R.2)
………….…. ha
1. Rice fields area used for farming (R.a + R.b + R.c + R.d)
a. Technical Irrigation
b. Non-technical irrigation
c. “Tadah hujan” Dependent on rain water for irrigation
d. The rise and fall of the tides, polder, lowlands, and swamp
which planted of rice
2. Rice fields area are not used for farming temporarily:
C. Non rice field land area (R.1 +R.2 + R.3 )
1. Non rice field land area used for farming
(R.a +R.b + R.c + R.d)
a. Unirrigated agricultural field/”huma” (field for dry rice
cultivation)/”tegal” (cultivation without irrigation)/
plantation/pond / “tambak” (earthen dam)
b. Plantation
c. Peoples forest
d. Other
……………. ha
…………… ha
…………… ha
…………… ha
…………….ha
…………… ha
…………… ha
…………… ha
………….. ha
…………..
…………..
…………..
…………..
ha
ha
ha
ha
2. Non rice field land area which not used for farming (R.a +R.b + R.c)
a. Land for housing and settlement
………….. ha
b. Land for other building (industry, office complex,
………….. ha
shopping complex)
c. Other (excluded State Forest)
………….. ha
3. Unused non rice field land area temporarily
………….. ha
21
22
XI. ECONOMIC
A. PRODUCTION FACILITY AND MARKETING
1. a. Shopping complex category
Have
-1 ® to Q.2
b. If “Not have”,
(1). The distance
(2). Time to spend
2. a. Market with permanent building/semi-permanent
b. If not have
(1). The distance
(2). Time to spend
3. Market without permanent building
4. Supermarket/department store
5. Veterinary market
6. Slaughterhouse
7. Fish dropping point
8. Fish Auction place
9. Electric/electronic tools shop
10. Agriculture production facility kiosk
Own by KUD (Village Cooperative Unit)
Own by non-KUD
11. Industrial Area
12. Industrial Central (please write down)
……………………
13. Small industrial area
14. Small industrial village (please write down)
…………………
15. Place of excavated material marketing
16. Fuel Station
17. Agent/seller of LPG
18. a. Restaurant
b. How many of them has a permission certificate from
“Diparda” (
19. Food/drinks stall
B. BUSINESS AND RENTAL SERVICES
1. Party facility equipment rental
2. Vide cassette/laser Disc rental
3. Car/motor vehicle rental
4. Photo copy business
5. Repairs of non-motor vehicle
6. Repairs of motor vehicle (car, motorcycle)
7. Repairs of electronic and electric tools
8. Beauty salon
9. Studio photo
10. Laundry
Not have
-2
……………. Km
……………. Hours
……………. Units
……………. Km
……………. Hours
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
……………. Units
23
24
XI. ECONOMIC (CONTINUED)
Man power distributor
……………. Units
Hotel/Motel/hostel/inn
……………. Units
Travel Bureau / Agent
……………. Units
Computer service rental
……………. Units
a. Joint Business Group
……………. Units
Have
-1
Not have
-2 ® to C
……………. Units
b. If “have”,
(1) Number of group
…………… Group
(2) Number of member of each group
…………… Group
FINANCE INSTITUTION
Number of Banks (public bank)
a. Bank’s Offices
(Central Office, branch office)
…..………. Units
b. Cash Office
…..………. Units
c. “BRI” (Indonesia Peoples Banks) unit office and
…..………. Units
BRI Village Service Post
Number of “Bank Perkreditan Rakyat”/BPR (Peoples Credit Bank)
a. BPR non “Badan Kredit Desa” (Village Credit Institution)
(New BPR, P.T. Bank Pasar/P.T. Bank Desa, Bank Karya Produksi
Desa, BPR ex LDKP)
(1). Central Office and branch
…..………. Units
(2). Cash Office
…..………. Units
b. BPR “Badan Kredit Desa”
(1). “Bank Desa”
…..………. Units
(2). “Lumbung Desa”
…..………. Units
c. Lembaga Dana Kredit Pedesaan/LDKP (Village Credit Fund Institution)
Number of Pawn office
…..………. Units
Number of Insurance company
…..………. Units
Number of Cooperative
…..………. Units
a. Village Cooperative Unit (KUD)
…..………. Units
b. Craft industry & Small Industry Cooperative (Kopinkra)
…..………. Units
c. Lending and saving cooperative
…..………. Units
d. Other non-KUD cooperative
…..………. Units
Other Financial Institution
a. Other Credit office
…..………. Units
b. Other Financial Institution Offices
…..………. Units
Credit facility received by community during a year ago
a. KUK (Small Business Credits)
Have
-1
Not have -2
b. KPR (Housing Credit)
Have
-3
Not have -4
c. TRI (Intensification sugar cane
Have
-5
Not have -6
plantation Credit)
d. Other farmer business credits
Have
-7
Not have -8
e. Other credits
Have
-1
Not have -2
If Q.5. has content and one of Q.7 content is “Have”, is they’re of the credit distributed
through this village cooperative?
Have
-1
Not have
-2
25
26
XI. ECONOMIC (CONTINUED)
D. ESTABLISHMENT/BUSINESS BY ECONOMIC SECTOR
1. Number of agriculture establishment of law
…………… Units
2. Number of excavation location of C category according to the excavated
a. Stone, coral
……….. location
b. Sand
……….. location
c. Lime
……….. location
d. Sulfur
……….. location
e. Kaolin
……….. location
f. “Kwarsa” sand
……….. location
g. Clayey
……….. location
h. Other (please write down) ……………………
……….. location
3. Industry (large, small, medium/household handicraft)
……….. unit
4. Industry business with < 20 persons man power
……….. unit
5. Electric’s establishment/business non – PLN(State Electricity
……….. unit
Enterprise)
6. Construction establishment’s of law
……….. unit
7. Few units of housing and settlements developed by
……….. unit
Developer
8. Trade establishment of law
……….. unit
9. Transportation, Warehousing, and Communication
a. Transportation company
(1). Motor transportation company
……….. unit
(2). Non motor transportation company
……….. unit
b. Warehousing company
……….. unit
c. Public Warehousing
……….. unit
d. Communication
(1). Public telephone (using coin)
……….. unit
(2). Public telephone (using card)
……….. unit
(3). “Wartel” (telephone stall)
……….. unit
(4). “Warpostel” (telephone and post stall)
……….. unit
(5). “Warpaspostel” (
……….. unit
E. OTHERS
1. Household according by economic sector (based on main job of household head)
a. Agriculture/farming
………. h.h
b. Mining and Exploration
……….. h.h
c. Industry/handicraft
……….. h.h
d. Electricity, Gas, and Water
……….. h.h
e. Construction
……….. h.h
f. Trade
……….. h.h
g. Transportation
……….. h.h
h. Financial institution
……….. h.h
i. Other
……….. h.h
2. Number of household which the member of household worked
in agriculture sector
……….. h.h
3. Number of electric’s customer household
……….. h.h
a. PLN
……….. h.h
b. Non PLN
……….. h.h
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28
XI. ECONOMIC (CONTINUED)
a. Main road village lighting
Have
-1
Not have
-2 ® to Q.5.
b. If “have”, type: PLN electricity (formally by Government)
Other electricity
Non-electricity
Number of household has motor vehicle with 4 wheels or more drive
(including for business)
Number of household has motor vehicle with 2 wheels or 3 wheels
or motor boat (including for business
Community socio-economic situation in general
Wealthiest
-1
Poor
-4
Wealthy
-2
Poorest
-5
Rich
-3
a. Do the village conducted family welfare registration
Done
-1
Not yet
-2 ® skip to Block XII
b. If “done”, how many family according to type of welfare:
(1) Pre-prosperous family
…………. family
(2) Prosperous Family stage I
…………. family
(3) Prosperous Family stage II
…………. family
(4) Prosperous Family stage III
…………. family
(5) Prosperous Family stage III +
…………. Family
XII. 1995/1996 VILLAGE FINANCIAL
1. Realization of village expenses and income (000 Rp)
a. Income
(1). Left over (plus) of 1994/1995 budgets
(2). a. Village ‘original’ income
b. Community self-supporting (money, goods,
and in kind)
(3). Funding from Central level
(4). Funding from province level
(5). Funding from Regency level
(6). Other revenues/income
b. Routine expenses
(1). Left over (mines) 1994/1995 budgets
(2). Employee expenses
(3). Goods expenses
(4). Maintenance expenses
(5). Travelling expenses
(6). Other routine expenses
(7). Miscellaneous expenses
c. Development expenses
(1). Village infra structure facility
(2). Production facility
(3). Transportation facility
(4). Marketing facility
(5). Social facility
(6). Other development expenses
Balanced [a – (b + c)]
-1
-2
-3
……..… h.h
……….. h.h
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
Rp…………….
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30
XII. 1995/1996 VILLAGE FINANCIAL (CONTINUED)
2. Have you ever received Integrated Area Development Fund (PKT) or Integrated
Area Development (P2WT)
Yes
-1
No
-2
3. Percentage of PBB (land and building taxes) income realization during 1994/1995
budgets of targeted
………………. %
4. a. Have this village ever received IDT (Hard to reach Village
Yes
-1
No
-2 ® to Block XIII
b. If “Yes” budgets year:
(1). 1994/1995
Yes
-1
No
-2
(2). 1995/1996
Yes
-3
No
-4
(3). 1996/1997
Yes
-5
No
-6
5. a. If Q.4.a coded “1”,
(1). Number of community group (“pokmas”) in this village
……… group
(2). Number of community group which has received IDT fund ……… group
(3). Number of family which has received IDT fund
……… group
b. Number of supporting of community group which has received ……… group
IDT fund
XIII. HEAD OF VILLAGE CHARACTERISTIC
1. Age
………… years old
2.
2.
Sex
Male
-1
-2
The highest education ever completed:
No schooling
Not completed
Primary School
Primary School
Junior High School
4.
Female
-1
-2
High School
Academy
University
-5
-6
-7
-3
-4
Duration of occupy (since got promotion till to enumeration carry out ……. year
XIV. NOTE
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32
Province
Regency/Municipality
District
Village
Estimation scale
1
XV. SKETCH OF CHANGED AREA
: ……………………………
: ……………………………
: ……………………………
: ……………………………
: …………………………….
é
U
33