SAK0809 DSRT Versi English

SAK09 - DSRT
Two sets for BPS
Regency and BPS
Province

THE NATIONAL LABOR FORCE SURVEY 2009
LIST OF SAMPLE HOUSEHOLD
[AUGUST 2009]
0

CONFIDENTIAL

I. LOCATION IDENTIFICATION
1.

PROVINCE

2.

REGENCY/MUNICIPALITY *)

3.

SUB-REGENCY
VILLAGE/POLITICAL DISTRICT ADMINISTERED BY

4.
LURAH *)
5.

URBAN - 1

VILLAGE CATEGORY

RURAL

A. CENCUS BLOCK CODE
6.
B. SUB-CENCUS BLOCK CODE
7.

SERIAL NUMBER OF SAMPLED SAKERNAS

II. INFORMATION OF SAMPLE SELECTION
1.

NAME AND CODE OF TEAM COORDINATOR

2.

DATE OF COPIED SAMPLE

3.

SIGNATURE OF SAMPLING WORKER

*) Please crossed it out the inapplicable one

DATE:

MONTH:

-2

8

0

9

*)

Coret yang tidak perlu

III. SAMPLED HOUSEHOLD
(Copied from Block III List of SAK09-UD or SAK09-L)

Serial
Number
Number

Segment

of

Number

Number

Number of
Number

of Physical

Name of Household Head

of Cencus

Household

Address and Set Area of Environment

Members

(Name of Street/Gangway, RT, RW, Orchard)

(7)

(8)

of Sampled
Building

Building
Household

Sampled
Household
(1)

(2)

(3)

(4)

(5)

(6)

1
2
3
4
5
6
7
8
9
10
11

12
13
14
15
16
17
18
19
20

IV. NOTE OF SAMPLE SELECTION
Number of household (copied from Q.8 Block I List of SAK09-UD or SAK09-L) = ............................................

22