1
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
SP2000-PODES
2000 POPULATION CENSUS
POTENTIAL OF VILLAGE/”KELURAHAN”
I. IDENTIFICATION
June ’99
01.
01
New
Identity
Changes
01
02
02
03
03
04
04
05
05
Province
02
Regency/Municipality *)
03
District
04
Village/Kelurahan/UPT/PMT*)
05
Area
Urban
Details
-1
Rural
II. WORKERS CHARACTERISTIC
Enumerator
01
Name of workers
02
NIP (Employment Identity
Number)
03
Date of enumerating/ supervising
04
Signature
-2
Supervisor
*) Cross out inapplicable category
……………………, ………………. 1999
Be Cognizant of
Head of Village/Kelurahan/UPT/PMT
Name and stamp
2
3
III. VILLAGE/”KELURAHAN” GENERAL CHARACTERISTIC
1. Legal status of the village
1.
Definitive (Minister of -1 UPT (Dept. of Transmigration -3
go to Q.6
Internal Affairs)
& “PPH”)
Preparation (Governor -2 PMST(Dept. of Social)
-4
Decree)→ go toQ.3
2. If Q.1 coded “1” , Village/”kelurahan classifcation
2.
Self-supporting
-1 Self-sufficient
-3
Self-developing
-2
3. If Q.1 coded “1” or “2”, village/”kelurahan” governmental status
3.
Village
-1 “Kelurahan”
-2→ go toQ.5
4. If Q.3 coded “1” , is there any Village Communication Institution
4.
(LMD)
Yes -1
No
-2
5. LKMD/K category
5.
Prepared -0
Category2
-2
Category1
-1
Category3
-3
6. If Q.1 “coded 2,3,or 4”, write down the name of prime village/ location
(fill in by supervisor) 6.
6
7.
7. Number of sub-village/ domain
…………………… sub-villages
8. a. RT/RW formation
Yes
-1
b. If “Yes” , consist of
1) Village administrative unit (RK/RW)
2) Neighborhood Association
9. Village /”Kelurahan” geography
Shore area
Non-shore area -
Valley area
Hill area
Land area
10. Village/”Kelurahan” topography
Flat
-1
No
-2 → go toQ.9.
1)
2)
…………..RK/RW
……………RT
9.
-1
-2
-3
-4
Hill
11. Type of sex of village/”kelurahan” government agencies:
Male
-1
Female
-2
No government agencies
a. Secretary of village/ “kelurahan”
b. Head of Governmental Affairs
c. Head of Development Affairs
d. Head of Welfare Affairs
e. Head of Financial Affairs
f. Head of General Affairs
g. Assistant of Married Registration Officer (P3N)
a.
-2
10.
-3
a.
b.
c.
d.
e.
f.
g.
12. Distance from village/ kelurahan office to
subordinating sub-regency office: ……………………………………….Km
12.
13. Distance from village/ kelurahan office to
subordinating regency/ municipality office: ……………………………..Km
13.
14. Distance from village/ kelurahan office to
the nearest regency/ municipality capital ………………………………...Km
14.
4
5
IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT
A. Population
1.
1. Population registration Yes, regularly
-1
Yes, not regularly
-2
No
-3
2. Population and household
2.a.
a. Number of population
…………… people
b. Number of household
…………… household 2.b.
c. Number of agricultural household
…………… household 2.c.
3.
3. Number of pre-welfare family and welfare I family
…………… family
4.
4. Number of fertile age couple (“PUS”)
…………… “PUS”
5.
5. Number of Family Planning member/ acceptor
…………… acceptor
6. a. Income sources of majority population
Agriculture
-1
Mining and excavating
-2
6.a.
Industry
-3
Wholesaler / retailer, restaurants and accommodations
-4
Others
-5
b. If Q.6.a. coded “1” main potential of sub-sector:
6.b.
Food planting
-1
Plantation
-4
Livestock
-2
Fishery
-5
Forestry
-3
Other planting -6
7. Number of population who have rights to vote in general elections
7.a.
a. Male
……………. People
7.b.
b. Female
…………….. people
8. Number of future voter
8.a.
a. Male
……………. People
8.b.
b. Female
…………….. people
9. Number of voter
9.a.
a. Male
……………. People
9.b.
b. Female
…………….. people
10.
10. Number of broken voting card after the elections
……………… cards
B. Environment, housing and settlement
1. Number of electricity household subscriber
1.a.
a. “State-owned” electricity
1.b.
b. Non “state-owned” electricity
2. a. Village/ kelurahan main road lightening
2.a.
Yes, there is
-1
No, there isn’t
-2 →go to Q.3
b. If “Yes”, types: “State-owned” electricity
-1
Non “state-owned” electricity
- 2 2.b.
No electricity
-3
3. Kind of fuel used for cooking of majority household
3.
Gas/LPG
-1
Firewood
-3
Kerosene
-2
Others (charcoal, husk,
-4
coconut shell, bio-gas)
4. Trash disposal of majority household
The trash then
-1
River
carried away
Other (write)
Buried in the hole
-2
……………..
5. Place of latrine of majority household
Private toilet -1
Public toilet
Shared toilet -2
Not toilet
-3
-4
4.
-3
-4
5.
6
7
6.
7.
8.
9.
10.
11.
12.
13.
IV. POPULATION, ENVIRONMENT, HOUSING AND SETTLEMENT (ADVANCED)
Major condition of liquid waste/ dirty water reservoir
Fast
-1
Water is stuck
-3
Slowly
-2
No gutter
-4
Number of flat building
a. Number of physical building (tower)
……………… units
b. Number of census building
…………….. . units
Number of house categories by quality
a. Permanent
……………… units
b. Not permanent
……………. . units
a. Community living along the river?
Yes
-1
No
-2 go to Q. 10.a
There is no river
-3
b. If ‘Yes”
(1) Number of household
…………….. hh
(2) Number of house’s building
…………….. units
a. Community living under high voltage of electric’s network
Yes
-1
No
-2 go to Q. 11.a
There is no river
-3
b. If “yes”
(1) Number of household
…………….. hh
(2) Number of house’s building
…………….. units
a. Poor settlement
Yes
-1
No
-2 → go to Q. 12.a
b. If “Yes” ,
(1) Location
……………. Location
(2) Land area
……………. Ha
(3) Number of household
……………. Household
(4) Number of household member
……………. People
a. Within the last 2 years, is there any new house built by developer?
Yes
-1
No
-2 → Skip to Q. 13.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
a. Is there any processing/ manufacturing industry in this village?
Yes
-1
No
-2 → Skip to Q. 14
b. If “Yes”, type of industry?
(1) Leather tanning
………….. units
(2) Food processing
………….. units
(3) Brick/ thick tile/ lime burning
…………. units
(4) Batik
.………… units
(5) Other industry
………….. units
c. If “there is”, type of waste produced:
(1) Solid
Yes
-1
No
-2
(2) Liquid Yes
-3
No
-4
(3) Gas
Yes
-5
No
-6
(4) Voices Yes
-7
No
-8
8
9
IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT (ADVANCED)
14. Environmental disturbance during a previous year
If column (2) coded “1”,
Is there any report to
Yes
-1
Type of disturbance
Head of village/ Lurah
No
-2
Yes
-1
No
-2
(1)
(2)
(3)
a.
a.
a. Water pollution
b.
b.
b. Land pollution (decreasing of
land fertility)
c.
c.
c. Air pollution
d.
d.
d. Decreasing of green opened
area
e.
e.
e. Decreasing of population and
variety of plants
f.
f.
f. Decreasing of population and
species of animals
g.
g.
g. Voices pollution
15.a.
15. a. Natural disaster during 3 previous year
……………. times
b. If disaster happened, its type
b.1
1. Earthquake
Yes
-1
No
-2
b.2
2. Mount Explosion
Yes
-3
No
-4
b.3
3. Dried
Yes
-5
No
-6
b.4
4. Forest and settlement area
fire
Yes
-7
No
-8
b.5
5. Flood
Yes
-9
No
-10
b.6
6. Smoke/ smog
Yes
-11
No
-12
b.7
7. Landslide
Yes
-13
No
-14
b.8
8. Coast abrasion
Yes
-15
No
-16
b.9
9. Wave tide/ tsunami
Yes
-17
No
-18
b.10
10. Other (……………… )
Yes
-19
No
-20
16.
16. Is there critical area
Yes
-1
No
-2
17.a
17. a. Is there a river which cross over
this village/ kelurahan
Yes
-1
No -2→go to Q. 18
b. If “yes”, water from the river is
used for
b.(1)
(1) Bathing/ washing
Yes
-1
No
-2
b.(2)
(2) Drinking
Yes
-3
No
-4
b.(3)
(3) Raw material of drinking water Yes
-5
No
-6
b.(4)
(4) Irrigation
Yes
-7
No
-8
b.(5)
(5) Input for industry/ fabric
Yes
-9
No
-10
b.(6)
(6) Transportation
Yes
-11
No
-12
b.(7)
(7) Other (write it down)
Yes
-13
No
-14
……………………
18.
18. Location of this village/ kelurahan relatively to forest area
Inside
-1
Border
-2
Outside
-3
19. Number of excavating location type C according to excavating types
a.
a. Stone/ corral
………………………. locations
b.
b. Sand
……………………… locations
c.
c. Lime
……………………… locations
d.
d. Sulfur
……………………… locations
e.
e. Kaolin
……………………… locations
f.
f. Quartz sand
……………………… locations
g.
g. Clay
……………………… locations
h. Other (write down)
h.
……………………….
……………………... locations
10
11
V. EDUCATION
1. Number of school by education level
Number of school
Education level
Stateowned
(1)
(2)
Kindergarten
a.
Primary school
b.
Junior High School
c.
Vocational school
d.
Academy/ University
e.
School for disable students
f.
Islamic boarding school
“Madrasah Diniyah” (Islamic
school for basic level)
i. Seminary/ theological school/
monastery
2. Skilled educational institution in this village
a. Motor/ automobile technician
b. Electronics technician
c. Typing/ stenography
d. Language
e. Accounting/ book keeping
f. Cooking
g. Sewing/ tailoring
h. Planting (agriculture)
i. Computer
j. Carpentry/ furniture skilled
k. Household craft
l. Beauty/ modelling
Private
(3)
a.
b.
c.
d.
e.
f.
g.
h.
a.
b.
c.
d.
e.
f.
g.
h.
3.
4.
5.
If there is no school
Distance to the
Time to spend to
nearest school
go to the nearest
(Km)
school (hours)
(4)
(5)
Minutes
a. Hours
b.
b.
c.
c.
d.
d.
i.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
-1
-3
-5
-7
-1
-3
-5
-7
-1
-3
-5
-7
No
No
No
No
No
No
No
No
No
No
No
No
a.
b.
c.
d.
d.
f.
g.
h.
i.
j.
k.
l.
-2
-4
-6
-8
-2
-4
-6
-8
-2
-4
-6
-8
Number of children who receive educational aid from:
a. National Movement for Foster Parents (GNOTA)
b. Social Safety Net Program (JPS)
……… children
……… children
3.a.
3.b.
Number of household who able to finance their children/
family to university
……….. household
4.
Schooling drop out trend in this one last year:
a. Primary School
Increasing sharply
-1
Increasing
-2
b. Junior High School
Increasing sharply
-1
Increasing
-2
Not changing
Decreasing
-3
-4
5.a.
Not changing
Decreasing
-3
-4
5.b.
12
13
VI. SOCIO-CULTURE
1. Number of Places of worship
a. Mosque
:
b. Prayer-house (=small mosque)
:
c. Church/Chapel Protestant
:
d. Church/Chapel Catholic
:
e. Pura (place of worship of Hinduism)
:
f. Vihara (place of worship of Buddhist) :
2. Social activity institution
Yes
(1)
a. Social activity institution
1. Boy Scouts
2. Orphanage
3. Elderly House
4. Handicap rehabilitation
5. Majlis Ta’lim/ reciting Koran
activity/religion lecturing (Christ.)
6. Youth Club
7. Family Welfare Management
(Program at village level to educate
Woman on various aspects of family
welfare)
b. Social activity
1. Regular social gathering
2. Community sef-help
3. Collecting money, rice, or other
things from rich people to poor
people (tithe in Islamic community)
3. Sports
a.
b.
c.
d.
e.
f.
g.
h.
1.
2.
3.
Type of sports
(1)
Soccer
Volley ball
Badminton
Basket ball
Tennis
Swimming
Ping pong
Pencak silat
Availability
-1 No
(2)
units
units
units
units
units
units
If Column (2)=”1”, its activity:
Increasing
-1 Constant -2
-2
Decreasing
-3
(3)
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
7.
6.
7.
1.
2
3.
1.
2.
3.
Hall/ gymnasium
(2)
-1
No-2
-3
No-4
-5
No-6
-7
No-8
-1
No-2
-3
No-4
Group of activity
(3)
Yes
a. Yes
-1
No-2
Yes
b. Yes
-3
No-4
Yes
c. Yes
-5
No-6
Yes
d. Yes
-7
No-8
Yes
e. Yes
-1
No-2
Yes
f.
Yes
-3
No-4
Yes
-5
No-6
Yes
-7
No-8
VII. RECREATION AND ENTERTAINMENT
1.
Open hall/ town square/ park?
Yes
-1
No
-2
2.
Amusement park/ recreation place Yes
-1
No
-2
3.a.
a. Movie Theater /Cinema
Yes
-1 → go to Q.4 No
-2
b. If “have not”,
(1) The nearest distance from the village office’s …………. Km
(2) Time to spend
………… hour
4. a. Video/ VCD/ DVD/ LD rental places
Yes
-1
No
b. If “No”, the nearest distance to the rental place ……………..km
5. a. Billiards house
Yes
-1
No
b. If “No”, the nearest distance to the billiards house ...………..km
a.
b.
c.
d.
e.
f.
g.
h.
b.(1).
b.(2).
-2
-2
4.a.
4.b.
5.a.
5.b.
14
15
VII. RECREATION AND ENTERTAINMENT (ADVANCED)
6. a. Pub/ discotheque/ karaoke
Yes
-1
No
-2
b. If “No”, the nearest distance to pub/ discotheque/ karaoke ……………..km
7. Rental meeting hall
Yes
-1
No
-2
VIII. HEALTH, NUTRIENT AND FAMILY PLANING
1. Number of health facility in this village/ kelurahan
Number of
If not available or col. (2)=”0”
Health Facility
facility
Distance from
Degree of the
which is
village/
accessibility
available
kelurahan to
Very easy
-1
health facility
Easy
-2
Difficult
-3
Very difficult -4
(1)
(2)
(3)
(4)
a.
a.
a.
a. Hospital
b.
b.
b.
b. Maternity Hospital
c.
c.
c.
c. Maternity house
d.
d.
d.
d. Polyclinic
e.
e.
e.
e. Puskesmas (Integrated Health Center)
f.
f.
f.
f. Supported Puskesmas (small Puskesmas)
g.
g.
g.
g. Medicinal treatment center
h.
h.
h.
h. Doctor practice place
i.
i.
i.
i. Midwives practice place
j.
j.
j.
j. Posyandu (Integrated post services)
k.
k.
k.
k. Polindes (Village Maternity Post)
l.
l.
l.
l. Pharmacy
m.
m.
m.
m. POD (Village medicine post)
n.
n.
n.
n. Drug Store
2. Number of Health Workers who live in this village:
2.a.
a. 1. Male doctor
Yes
-1
No
-2
2. Female
Yes
-3
No
-4
2.b.
b. 1. Male dentist
Yes
-1
No
-2
2. Female dentist
Yes
-3
No
-4
2.c.
c. 1. Male paramedics
Yes
-1
No
-2
2. Female paramedics (exclude Midwife) Yes
-3
No
-4
2.d.
d. Midwife
Yes
-1
No
-2
2.e.
e. Midwife at the village
Yes
-1
No
-2
(as localization of Government Order)
2.f.
f. 1. Skilled traditional birth attendance Yes
-1
No
-2
2. Unskilled traditional birth attendance Yes
-3
No
-4
2.g.
g. Traditional healer for broken bone
Yes
-1
No
-2
2.h.
h. Massager
Yes
-1
No
-2
2.i.
i. Supported Worker for Village
Yes
-1
No
-2
Family Planing (PPKBD)
4. Trends of people health condition during a previous year
Increasing sharply -1
Not change -2
Decreasing sharply
-3
Increasing
-4
Decreasing -5
a. Ill sufferer
e. Baby nutrient
b. Ability to cure the ill
f. Family Planning member/ acceptor
c. Availability of medicine
g. Availability of contraception tools
d. Health services
h. Family Planning services
16
17
VIII. HEALTH, NUTRIENT AND FAMILY PLANING (ADVANCED)
4. Are there bloating due to starvation/ HO/ lack of nutrient/
marasmus cases in this village
4.a.
a. Balita (Children under five)
Many -1 Some -2
None
-3
4.b.
b. Exclude balita
Many -1 Some -2
None
-3
5.
5. Number of family who received identification paper for poor family
…………………. head of household
6.
6. Number of family who received healthy card (Social safety Net)
………………… head of household
7. Illness Epidemic during a year ago
Yes
-1
No
-2
(2)
a.
b.
c.
d.
e.
f.
Number of death people who die because of
the epidemic
(3)
a.
b.
c.
d.
e.
f.
8.a.
(1)
a. Diarrhea and vomiting
b. Dengue fever
c. Infection on respiratory system
d. Measles
e. Malaria
f. Other
8. a. Source of water for drinking/cooking:
PAM/ mineral water
-1
Spring
-5
Electric Pump/hand pump -2
River/lake
-6
Artesian Well
-3
Rain water
-7
Well
-4
Other
-8
(write down): …………….
b. Are there some people in this village buying
water for drinking
Yes
-1
8.b.
No
c. Source of water for bathing/washing:
PAM/ mineral water
-1
Spring
-5
Electric Pump/hand pump -2
River/lake
-6
Artesian Well
-3
Rain water
-7
Well
-4
Other
-8
(write down): …………….
9. Institution which give criteria to determine poor family
BKKBN (Pre welfare/ welfare I)
-1
Head of village/ kelurahan
Modified BKKBN
-2
Regency/ municipality/ sub
regency agency
IX. TRANSPORTATION
A. TRANSPORT
-2
8.c.
9.
-3
-4
1. Inter village road type
a. Traffic inter village majority through:
Land -1 Sea/river
-2 →go to Q.2
Air
-3 → go 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 wheel motorize vehicle all the years?
Yes
-1
No
-2
c. Ex-logging transport road (log)
Yes, there is
-1
No
-2
1.a.
1.b.(1).
1.b.(2)
1.c.
18
19
IX. TRANSPORTATION (ADVANCED)
2. Type of public transportation used by community to the district’s capital/closest city
Type of transportation
Code
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
01.
02.
03.
04.
05.
06.
07.
08.
09
10.
11.
3. From these public transportation above (detail 2), the main transport :
………………………………(put the selected code of detail 2 into the box)
3.
4. a. River bridge which can be passed trough
Have -1 Not have -2→go to Q.5
by 4-wheel vehicle in this village/ kelurahan
b. If “have” made by
Steel/ concrete
-1
Steel/ concrete and wood/ bamboo
-3
Wood/ bamboo
-2
5. a. Public motor transport station/terminal
Have -1 Not have -2
b. Seaport
Have -3 Not have -4
c. Airport
Have -5 Not have -6
4.a.
6. Travel agent/ transport ticketing place
7. Number of household who has 4-wheel
or more vehicle (including vehicle for
business utility)
8. Number of household who has 2 or 3 -wheel
vehicle or motor boat (including vehicle for
business utility)
6.
7.
Have
-1
Not have
-2
4.b.
5.a.
5.b.
5.c.
………………….. household
8.
………………….. household
B. COMMUNICATION
1. Number of household who has telephone
………………… household
2. Number of house hold who has communication radio
………………… household
3. a. Post office/ supporting post office/ post house
Have→go to Q.4 -1 Not have -2
b. If “not have”, distance to the nearest post
………………… km
4. Mobile Post
Have -1 Not have -2
5. Public Television
Have -3 Not have -4
6. Household who has the television
………………… household
7. Household who has the satellite antenna
………………… household
8. Newspaper/magazine customers
Have -1 Not have -2
9. Coin public phone
Have -3 Not have -4
10. Card public phone
Have -5 Not have -6
11. Phone stall (Wartel)
Have -7 Not have -8
12. Phone and post stall (Warpostel/ Warparpostel)
Have -9
Not have -10
1.
2.
3.a.
3.b.
4.
5.
6.
7.
8.
9.
10
11.
12.
20
21
X. LAND AND UTILIZATION
A. Village’s land area (R.B + R.C)
…………….. ha
A
B. Rice field area (R.1 + R.2)
………….…. ha
B
1. Rice fields area used technical Irrigation
2. Rice fields are used non-technical irrigation
3. Rice fields area are not used for farming temporarily
……………. ha
…………… ha
…………… ha
1.
2.
3.
C. Non rice field land area
(R.1+R.2+R.3+R.4+R.5+R.6+R.7)
1. Unirrigated agricultural field/”huma” (field for dry rice
cultivation)/”tegal” (cultivation without irrigation)/
plantation/pond / “tambak” (earthen dam)
2. State crops/ plantation
3. Peoples forest
4. House and settlement
5. Land for other utilization
6. Other (Not including government forest)
7. Unused non rice field land area temporarily temporarily
…………… ha
C.
………….. ha
1.
…………..
…………..
…………..
…………..
…………..
……….….
….……….
2.
3.
4.
5.
6.
7.
ha
ha
ha
ha
ha
ha
ha
D. Parts of village/ kelurahan’ s land which are
1. Village land (Bengkok, titisara, etc.)
…………… ha
2. Village cash land
…………… ha
3. Private owner land
…………… ha
4. Grant land (in Islamic way)
……………. ha
5. Unutilized land
……………. ha
6. Cemetery (Public graveyard)
…………… ha
XI. ECONOMICS
A. PRODUCTION FACILITY, MARKETING AND RENTING
1. a. Shopping complex category
Have
-1 → to Q.2
Not have
-2
b. If “Not have”,
(1). The distance
……………. Km
(2). Time to spend
… Hours….. minutes
2. a. Market with permanent building/semi-permanent
b. If not have
(1). The distance
(2). Time to spend
1.
2.
3.
4.
5.
6.
a.
b.(1).
b.(2).
……………. Units
a.
……………. Km
…Hours…… minutes
b.(1).
b.(2).
22
23
XI. ECONOMICS (ADVANCED)
3. Market without permanent building
Have
-1
4. Supermarket/department store
Have
-3
5. Restaurant/ food market/ food-drinking stall
Have
-5
6. Veterinary market
Have
-7
7. Slaughterhouse (RPH)
Have
-1
8. Fish dropping point (PPI)
Have
-3
9. Fish Auction place (TPI)
Have
-5
10. Hotel/ motel
Have
-7
11. Party appliances rental
Have
-1
12. Small industry/ people’s craft
a. Crafts made from leather
Have
-1
b. Crafts made from wood/ bamboo/ rattan
Have
-3
c. Crafts made from metal
Have
-5
d. Crafts made from gold
Have
-7
Not have
Not have
Not have
Not have
Not have
Not have
Not have
Not have
Not have
-2
-4
-6
-8
-2
-4
-6
-8
-2
3.
4.
5.
6.
7.
8.
9.
10
11.
Not have
Not have
Not have
Not have
-2
-4
-6
-8
12.a.
12.b.
12.c.
12.d.
B. FINANCIAL INSTITUTION
1. Public banks
2. Peoples Credit Banks
3. Cooperative types
a. Village Cooperative Unit (KUD)
b. Craft industry & Small Industry
Cooperative (Kopinkra)
c. Lending and saving cooperative
d. Pondok Pesantren cooperative
e. Tofu and tempe cooperative
f. Other non Village Cooperative Unit
Have
Have
-1
-3
Not have
Not have
-2
-4
1.
2.
Have
Have
-1
-3
Not have
Not have
-2
-4
3.a.
3.b.
Have
Have
Have
Have
-5
-7
-1
-3
Not have
Not have
Not have
Not have
-6
-8
-2
-4
3.c.
3.d.
3.e.
3.f.
C. ECONOMIC CRISIS IMPACT
1. People economics conditions in general
Very rich
-1
Rich
-2
Sufficient
-3
2. Bankruptcy business unit in this village
a. Handicraft business
b. Livestock/ poultry business
1.
Poor
Very poor
Yes
Yes
-4
-5
-1
-1
No
No
-2
-2
2.a.
2.b.
24
25
XI. ECONOMICS (ADVANCED)
3. Agricultural production
a. Rice
Available excessively -1
Adequate
-2
Lack
-3 3.a.
b. Maize
Available excessively -1
Adequate
-2
Lack
-3 3.b.
c. Cassava/ sweet Available excessively -1
Adequate
-2
Lack
-3 3.c.
potato
4. Availability of nine prime food (sembako) in the market/ stall
Code: Always available
-1
Not available, often
Sometimes not available
-3
Not available
a.
b.
c.
Rice
Sugar
Cooking oil
d. Kerosene
e. Milk
f. Egg
5.
Impact of monetary and economic crisis Tackling Program
a. Impact of monetary and economic crisis Tackling Program
b. PMT under 2 age
c. PMT pregnant mother
d. Labor intensive program in Social Safety Net during a previous year:
1. Cleaning the gutter
2. Reforestation
3. Making the road/ bridge
4. Others (……………)
-2
-4
g. Meat
h. Maize
i. Iodized salt
5.a.
5.b.
5.c.
d.1.
d.2.
d.3.
d.4.
XII. SECURITY
1. Type of criminal action happened in one last year
Type of criminal action
a.
b.
c.
d.
e.
f.
g.
h.
i.
(1)
Stealing
Robbery
Plundering
Killing
Mistreatment
Juvenile Delinquency
Incineration
Suicide
Other (write down):……………..
………………
Is there any case
Yes
No
(2)
a.
b.
c.
d.
e.
f.
g.
h.
i.
-1
-2
Criminal action trend in
one last year comparing
with a year ago
Decreasing
-1
Not change
-2
Increasing
-3
(3)
a.
b.
c.
d.
e.
f.
g.
h.
26
27
2.
XII. SECURITY (ADVANCED)
Self-defense action done by community
a. Build surrounding safety post
b. Form surrounding safety guard group
c. Add “hansip” member
d. Check every unrecognized people
Who wants to enter this area
e. Others
3. Safety surrounding facility
a.
b.
c.
1.
2.
3.
-1→ to B.3
-2
2.e.
If “not have”
Accessibility :
The nearest
Very easy
-1
distance
Easy
-2
Difficult
-3
(km)
Very difficult -4
(3)
(4)
a.
a.
(1)
(2)
Safety surrounding post
a.
(hansip)
Police post
b.
b.
Police sector
c.
c.
XIII. HEAD OF VILLAGE CHARACTERISTIC
Age
………… years old
Sex
Male
b.
c.
1.
2.
-1
Female
-2
3.
The highest education ever completed:
No schooling
Not completed
Primary School
Primary School
Junior High School
4.
Have
Not have
2.a.
2.b.
2.c.
2.d.
-1
-2
High School
Academy
University
-5
-6
-7
-3
-4
Duration of occupy
(since got promotion till to enumeration carry out)
XIV. NOTE
……. year
4.
28