SUSENAS
SSN87-S2
1
RUPUBLIC OF ONDONESIA
CENTRAL BUREAU OF STATISTICS
1987 NATIONAL SOCIO-ECONOMIC SURVEY
CONSUPMTION/HOUSEHOLD EXPENDITURES LISTING
CONFIDENTIAL
I. INDENTIFICATION
01.
Province
02.
Regency/Municipality *)
03.
04.
District
Village
05.
Area
06.
07.
Enumerating Area Number
Census Block Number
08.
SUSENAS Sample Code Number
09.
Sample Household serial number
10.
Number of Household member
11.
Name of Household Head
Serial
Number
(1)
01.
Urban
-1
Rural
-2
02.
03.
04.
05.
06.
07.
08.
09.
10
11
12.
II. HOUSEHOLD LISTING
Source of Income
(2)
Agriculture, Husbandry, Forestry, Hunting, and
Fishery
Mining and Quarrying
Worked Status
Workers/
Have a
employee
business
(3)
1
(4)
2
Manufacture industry
Electricity, water and gas
Building/construction
Large trade, Retail, Restaurant, and Hotel
Transportation, Stored, and Communication
Finance, Insurance, buildings rental business,
Land, and Service Establishment
Community, social and individual Services
Other
Income (pension, gifts, etc)
From all income above, the main income is
…………………………………………….
2
3
Serial
number
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(1)
001
002
003
004
005
006
007
008
009
010
011
012
(2)
A. Cereals
Local rice
High quality rice
Imported rice
Sticky rice
Wet corn with a skin
Dried corn with a skin
Dry-shelled corn
Rice flour
Corn flour (maizena)
Wheat flour
Other ……………….
013
014
015
016
017
018
019
020
021
B. Tuber
Cassava
Sweet potato
Potato
Taro
Dried cassava chip
Cassava flour (Tapioca)
Dried Cassava chip flour
Sago (not made from cassava,
example: Ambon Sago)
Other: ……………….
022
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
4
5
Serial
number
(1)
023
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
C. Fish
024
025
026
027
028
029
030
031
032
033
034
035
1) Fresh fish
Yellow tail fish
Tuna
“Cakalang”
“Tenggiri” fish
“Selar” fish
“Kembung” fish
“Teri” (small fish)
“Bandeng” fish
“Gabus” fish
Tilapia fish
Gold fish
Other
036
037
038
039
2) Fresh shrimp and its types
Shrimp
Squids
Crab
Other
Kg
Kg
Kg
Kg
040
041
3) Preserved fish
Salted “Kembung” fish
“Tenggiri” fish
Ons
Ons
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
6
7
Serial
number
(1)
042
043
044
045
046
047
048
049
050
051
052
053
054
055
056
057
058
059
060
061
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
“Teri” (small fish)
“Selar” fish
“Sepat” fish
“Bandeng” fish
“Gabus” fish
Fish in a can
Other
4) Preserved Shrimp and its types
Shrimp
Squid
Other
(3)
(4)
Ons
Ons
Ons
Ons
Ons
Ons
Ons
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Ons
Ons
Ons
D. Meat
1) Fresh meat
Beef
Buffalo
Horse
Lamb
Ham
Purebred chicken
Free-range chicken
Other poultry meat
Other meat
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
8
9
Serial
number
(1)
062
063
064
065
066
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
2) Preserved meat
Dried meat
Smoke meat
Dried shredded meat
Meat in a can
Other
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Kg
Kg
Kg
Kg
Kg
3) Other
067
068
069
070
071
072
073
074
075
076
077
078
079
080
081
Liver
Innards (other than liver)
Tetelan (bones with a bit of
adhering meat)
Bones
Other
E. Egg and milk
Chicken egg
Duck egg
Quail egg
Other egg
Salted egg
Pure milk
Dairy product
Sweeten condensed milk
Can’s powder milk
Kg
Kg
Kg
Kg
Kg
Kg
pieces
Pieces
Pieces
Pieces
Liter
250 ml
Kg
Kg
10
11
Serial
number
(1)
082
083
084
085
086
087
088
089
090
091
092
093
094
095
096
097
098
099
100
101
102
103
104
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
Baby’s powder milk
Powder milk (in kilogram)
Cheese
Other dairy product
F. Vegetables
Spinach
Swamp cabbage
Cabbage
Mustard white
String bean
Legume (green bean)
Tomato
Carrot
Cucumber
Cassava leaves
Egg plant
Bean sprouts
Siam Gourd
Radish
Vegetable soup
“asam” soup (‘sour’ soup)
Young Jack fruit
Young papaya
(3)
(4)
Kg
Kg
Ons
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Kg
Kg
Kg
Kg
Kg
Kg
Ons
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Packet
Packet
Kg
Kg
12
13
Serial
number
(1)
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
Mushrooms
Petai
Jengkol
Shallots
Garlic
Red peppers
Green peppers
Cabe rawit
Canned vegetables
Other Vegegables
G. Beans & Nuts (Sub-total)
Ground nuts
Soy beans
Green beans
Red beans
Polong nuts
Tunggak nuts
Cashews
Other beans/nuts
Tofu
Tempe
Tauco
Oncom
(3)
(4)
Ons
Kg
Kg
Ons
Ons
Ons
Ons
Ons
Kg
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Kg
Kg
Kg
Kg
Kg
Kg
Ons
Kg
Kg
Kg
Kg
Kg
14
15
Serial
number
(1)
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
Detail
(2)
Saridele”
Other
H. Fruits
Orange
Mango
Apple
Avocado
“Rambutan”
Lanzon
Durian
Snake fruit
Pineapple
Banana
King “Raja” banana
Other banana
Papaya
Rose-apple
Sapodilla
Star fruit
“Kedondong”
Watermelon
Jack fruit
Tomato
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
16
17
Serial
number
(1)
151
152
Detail
(2)
Canned fruit
Other
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Kg
153
154
155
156
157
158
159
I. Oil and fat
Coconut oil
Corn oil
Other cooking oil
Coconut
Margarine
Other
Liter
Liter
Liter
Pieces
Ons
160
161
162
163
164
165
166
167
J. Beverages materials
Granulated sugar
Tea
Powder coffee
Coffee bean
Powder chocolate
Syrup
Other
Ons
Ons
Ons
Ons
Ons
620ml
168
169
170
K. Spices
Salt
Macadamia nut
Ons
Ons
18
19
Serial
number
(1)
171
172
173
174
175
176
177
178
179
180
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
Coriander
Pepper
Tamarind
Nutmeg
Clove
Fish paste
Soy sauce
Palm sugar
Monosodium glutamate
Other cooking spices
181
182
183
184
185
186
187
L. Other consumption
Crackers
Crisp chip
Noodle
Wheat & rice noodle
Macaroni
Other
188
189
190
191
M. Prepared foods and drinks
Bread
Other bread
Dry cake
(3)
(4)
Ons
Ons
Ons
Ons
Ons
Ons
10 ml
Ons
Ons
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
Ons
Ons
Kg
Kg
Kg
Ons
Ons
20
21
Serial
number
(1)
192
193
194
195
196
197
198
199
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
Wet cake
Mungbean porridge
“Gado-gado” (vegetables mixed
with peanut butter)
Plate of rice and side dish
Meat ball & noodle
Syrup ice
“Mambo” ice
Other ice
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
CO2 Soft drink
200
201
In a bottle
In a can
250 ml
330 ml
Non CO2 Soft drink
202
203
204
205
206
In a bottle
In a can
Other packaging
Other beverages
Other
200 ml
330 ml
200 ml
22
23
Serial
number
(1)
207
Detail
III. 1. CONSUMPTION OF FOODS, BEVERAGES, AND TOBACCO DURING A WEEK
Type/ Standard
Purchasing
Own production
Dividend,
quality
unit
(cash/credit)
distribution, etc
Quantity Value Quantity Value Quantity Value
(0,00)
(Rp)
(0,00)
(Rp)
(0,00)
(Rp)
(2)
N. Alcohol beverages
(3)
(4)
208
Bier
620 ml
209
Wine
620 ml
210
Other alcohol drinks
211
(5)
(6)
(7)
(8)
(9)
(10)
Total consumption
Quantity
(5)+(7)+(9)
(0,00)
(11)
Value
(6)+(8)+(10)
(Rp)
(12)
O. Tobacco and betel
212
Filtered cove cigarette
10 pieces
213
Unfiltered clove cigarette
10 pieces
214
Menthol cigarette
20 pieces
215
Cigar
pieces
216
Tobacco
Ons
217
Betel/areca nut
218
Other
24
25
Serial
number
(1)
219
220
221
222
223
224
225
226
227
228
229
230
231
III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO
Detail
Value in Rupiah
12 months ago
Month ago
(2)
(3)
(4)
A. Housing, Fuel, Electricity, and Water
This house is: Own property/free of rent
-1
Rent purchased
-4
Lease
-2
Official house
-5
Rents
-3
Other
-6
If own property, estimation monthly renting: Rp. ………………….
If the house is lease:
a. Lease agreement
: Rp. …………….
b. Value of lease
: Rp. …………….
c. Average value of lease in a month:
Rp. …………….
If this house rented, value of monthly renting: Rp. …………….
If the status of dwelling is rent purchased, official, and other,
average value of monthly renting: Rp. …………….
Maintenance costs (plastering/painting the wall, painting, replace the leakage roof,
broken glasses, hinge, etc
Electricity:
Quantity:
a. 12 months ago: ……………….. kwh/watt *)
Fill in by
b. a month ago: ……………….. kwh/watt *)
CBS
Value:
Natural Gas:
Quantity:
a. 12 months ago: ……………….. m3
b. a month ago: ……………….. m3
Value:
LPG:
Quantity:
a. 12 months ago: ……………….. kg
b. a month ago: ……………….. kg
Value:
26
27
III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO
Detail
Value in Rupiah
12 months ago
Month ago
(2)
(3)
(4)
Serial
number
(1)
232
233
234
235
236
237
238
239
240
241
242
243
244
Kerosene:
Quantity:
Value:
Generator:
a. Gasoline
Quantity:
Value:
a. Solar fuel
Quantity:
Value:
c. Kerosene
Quantity:
Value:
d. Lubricant oil
Quantity:
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
Value:
e. Maintenance and repair
Charcoal:
Quantity:
a. 12 months ago: ……………….. kg
b. a month ago: ……………….. kg
Value:
28
29
Serial
number
(1)
245
246
247
248
III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO
Detail
Value in Rupiah
12 months ago
Month ago
(2)
(3)
(4)
Firewood
Water
Other (Flashlight, storage battery, matches, mosquito repellent, etc)
b. Goods and Services
249
250
251
Bathing soap, toothpaste, and shampoo
Beauty’s stuffs (perfume, pomade, deodorant, powder, etc)
Treatments of skin, face, nails, hair (cutting, curl, etc)
252
253
254
255
256
257
258
259
260
Health
a. Doctor’s cost
b. Treatment’s cost
c. Midwife’s cost
d. Paramedic’s cost
e. Contraceptive’s cost
f. Traditional healer’s cost
g. Medicine with doctor’s prescription
h. Medicine without doctor’s prescription
i. Other
261
262
263
264
265
266
Cost of school/course
a.School Development Contribution (Enrollment fee)
b. School fee and contribution for BP3/POMG
c. Other school contribution
d. Text book
e. Stationary (including photo copy)
f. Course’s fee
30
31
Serial
number
(1)
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO
Detail
Value in Rupiah
12 months ago
Month ago
(2)
(3)
(4)
Newspaper, magazine, books, and stationers (exclude school and course needs)
including rents of magazine/literatures
Post, telegram, telephone, and post materials
Motor Vehicle
a. Gasoline:
Quantity:
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
Value:
b. Solar fuel
Quantity:
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
Value:
c. Lubricant oil
Quantity:
a. 12 months ago: ……………….. liter
b. a month ago: ……………….. liter
Value:
d. Maintenance and repair of vehicle
Transportation cost (bus, train, airplane, ship, “becak”, parking fee, etc)
Cinema, play, sport, and other recreation, (exclude transportation and goods for
recreation)
Housemaid and driver (salary or wage only)
Other (toothbrush, camphor, photo copy, etc)
B. Clothes, Footwear, and head gear
Ready made man’s wear (Blazer, long-sleeved shirt, Jacket, sarong, pants, T-shirt,
underwear, etc
32
33
Serial
number
(1)
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO
Detail
Value in Rupiah
12 months ago
Month ago
(2)
(3)
(4)
Ready made woman’s wear (Gown, long fabric, blouse, nightgown, sweater, skirt,
sarong, shawl, “angkin” (cloth waisband), underwear, etc)
Ready made children’s wear (clothes, pants, sweater, T-shirts, under wear, etc)
Fabrics for men’s clothes (wool, polyester, cotton, silk, etc)
Fabric for woman’s clothes
Fabric for children’s clothes
Sewing cost and fixed the clothes
Footwear for man (shoes, sandal, sock, etc)
Footwear for woman
Footwear for children
Head gear for man, woman and children (hat, ‘kopiah” =rimless cap, veil, etc)
Thread, and other stuffs of sewing needs
Laundry-soap (in bar form)
Powder soap and cream soap
Others (towel, belt, shoe polish, tie, tailor-fee, etc)
D. Durable goods
Household furniture (table, chair, bed, wardrobe, sewing machine, refrigerator, fan)
Supporting of household furniture (mattress, pillow, table cloth, bed sheet, pillow
sheet, blanket, curtain, rug, etc.)
Instruments of household (iron, broom, scissors, electric tools, knife, machete, saw,
etc)
Cooking & eaten utensils (rack of plate, stove, cooking pot, pan, pail, wok, spoon,
thermos bottle, plate, glass, and other utensils made of glass, ceramic, and plastic, etc)
34
35
Serial
number
(1)
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
III. 2. EXPENDITURES OF NON FOODS DURING 12 MONTHS/1 MONTH AGO
Detail
Value in Rupiah
12 months ago
Month ago
(2)
(3)
(4)
Repairs of furniture, supporting and instrument of household
Watch, clock, camera, glasses and its repairs
Umbrella, bag, luggage, and its repairs
Expensive jewelers (gold, diamond, pearls, etc) and its repairs
Children’s toy, cheap jewelry and its repairs
Entertainment instruments (T.V, video, radio cassette, guitar, piano, etc) and its repairs
Sports equipment (chess, racket, ball, net, etc) and its repairs
Vehicle (bicycle, motor cycle, car) and its repairs
Other durable goods (wall hanging decoration, aquarium, electric installation,
telephone, pipe and its repairs)
E. Tax and Insurance
Building and Land tax (PBB)
Radio and TV tax, and it’s type
Tax of motor and non-motor vehicle
Other levied (contribution, etc)
Health and accident insurance
F. Festivities and ceremonies
Marriage
Circumcision, birthday
Celebrating of religious ritual (“Idul Fitri”, :Idul Adha”, Christmas,/New Year,
“Waisak”, “Galungan”, etc)
Other traditional ceremonies (“selamatan”, offering, etc)
Funeral
36
37
Serial
number
(1)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
III. 3. SUMMARY OF HOUSEHOLD EXPENDITURE
Type of expenditure
During a week
(Rp)
(2)
(3)
During 12 months
(Rp)
(4)
During a month
(Rp)
(5)
Cereals (III.1 A)
Tuber (III.1 B)
Fish (III.1 C)
Meat (III.1 D)
Egg and milk (III.1 E)
Vegetables (III.1 F)
Pulses (III.1 G)
Fruits (III.1 H)
Oil & Fat (III.1 I)
Beverages material (III.1 J)
Spices (III.1 K)
Other consumption (III.1 L)
Prepared food and drink (III.1 M)
Alcohol drink (III.1 N)
Tobacco and betel leaves (III.1 O)
Sub total (1 to 15)
Sub total (16) x 30
7
Expenses for housing, fuel, electricity, and water (III.2 A)
Expenses for goods and services (III.2 B)
Expenses for clothes, footwear, and head gear (III.2 C)
Expenses for durable goods (III.2 D)
Tax and insurance (III.2 E)
Expenses for festivities and ceremonies (III.2 F)
Total expenses (17 to 23)
38
39
IV. MONTHLY HOUSEHOLD INCOME/REVENUE
A. Income of salary/wage in form of money or in-kind/services which received during previous month (Rp)
Serial
number
Name of Household member
(1)
(2)
Salary/Wage
Main work
Additional work
(3)
(4)
B. Income from agriculture business during previous year (Rp)
Own
Type of business
(1)
1. Agriculture (1a + 1b)
a. Food plants
1) Cereals
2) Tuber
3) Pulses
4) Vegetables
5) Fruits
Overtime, honorarium,
etc
(5)
In-kind of
salary/wage
(6)
Total column
(3) to (6)
(7)
Production
To sell
consumpti
on
Given to
other
party
Production
left over
Total
Col. (3) to (6)
Production
cost
Income
Col. (7) – (8)
Average of
monthly
income col.
(9) : 12
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
b. Non-food plants
Plantation
Other than plantation
2. Husbandry (2a + 2b)
a. Livestock
b. Other (milk, fertilizer)
40
41
IV. MONTHLY HOUSEHOLD INCOME/REVENUE
B. Continued
Type of business
Production
To sell
Own
consumpti
on
Given to
other
party
Production
left over
Total
Col. (3) to (6)
Production
cost
Income
Col. (7) – (8)
Average of
monthly
income col.
(9) : 12
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(1)
3. Poultry husbandry (3a + 3b)
a. Fowl
b. Other (egg, hair, etc)
4. Variety of livestock (rabbit,
quail, etc)
5. Fishery
6. Forestry/Hunting
Total (B1 to B6)
C. Income of non agriculture business during 3 months ago (Rp)
Number of
Pro
Own
Type of business
business
month
(1)
1. Industry/handicraft
2. Trade
3. Transportation
4. Other (construction,
quarrying, etc)
(2)
duc
tion
To sell
consumpti
on
Given to
other
party
Production
left over
Total
Col. (4) to (6)
Production
cost
Income
Col. (7) – (8)
Average of
monthly
income col.
(10) : 12
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Total (C1 to C5)
42
43
IV. MONTHLY HOUSEHOLD INCOME/REVENUE
D. Other income (besides salary/wage and business) during previous month
Type of income
Rp
1. Interest
2. Land leased
3. Lease/contract (building, party equipment’s, etc)
4. Dividend
5. pension
6. Income from ‘gift’ (official boundary, scholarship, etc)
7. Other income from:
a. Agriculture sector which not a business field
b. Other sector which not a business field
8. Claimed of Life insurance
9. Estimation of monthly house renting
10. Other
Total (D1 to D10)
E. Payment and revenue of transfer during previous month
Revenue
Rp
(1)
1. Receive money transferred
2. Will
3. Receive donation, gift, grant, and aid
Total
Expenses
(2)
(3)
Rp
(4)
1. Sending money
2. Give donation, gift, grant, aid
Total
44
45
IV. MONTHLY HOUSEHOLD INCOME/REVENUE
F. Other Income and expenses during previous month
Income
Rp
Expenses
(1)
(2)
(3)
1. Selling of bonds/gold/jewelry
1. Purchase bonds
2. Selling of immovable goods (building, land)
2. Purchase immovable goods includes large repaired
building/pamatangan tanah
3. Selling of second hand goods
4. Saving withdrawal
3. To pay insurance premium
5. Other insurance claimed
4. Saving
6. Lend/received credit
5. To lend/paid credit
7. Pawn the goods
6. Execution pawn goods
8. Receive ‘arisan’
7. Pay ‘arisan’
9. Other
8. Other
Total
Total
G. Household expenses and revenue during previous month
Expenses
(1)
1. Expenses of household consumption block III.3
detail 24 column (5)
2. Transfer payment
Total column (4) block IV. E
3. Other expenses
total column (4) block IV F
Total
Rp
(2)
Revenue
(3)
1. Income of salary/wage
Total column (7) block IV. A
2. Income of agriculture business
Total column (10) block IV. B
3. Income from non agriculture business
Total column (11) block IV. C
4. Other income
Total column (2) block IV D
5. Receive transfer
Total column (2) block IV E
6. Other revenue
Total column (2) block IV F
Total
Note: Number purchase of second hand goods: a. During previous month = Rp. ……….
b. During previous year = Rp ………….
Rp
(4)
Rp
(4)
46