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Attachment 1
SUSENAS
VSEN91.L
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
1991 NATIONAL SOCIO-ECONOMIC SURVEY
HOUSEHOLD LISTING
Confidential
I. LOCATION IDENTIFICATION
1. Province
2. District/Municipality *)
3. Sub-District
4. Village/Village Unit*)
5. Area
Urban
1
Rural
2
6. Enumeration area number
7. Segment group number
8. Susenas sample code number
II. SUMMARY
1. Household (last serial number from column 3 Block IV)
Total
Sample
2. Susenas household:
a. Household with victims of crime (number of ! signs on col. 5 block IV)
b. Household of non criminal victim(number of ! signs on col. 6 block IV)
3. Members of household who has tour (number of ! signs on col. 7 block IV)
4. Agriculture household (number of ! signs on column 8 block IV)
a. Fishery household (number of ! signs on column 9 block IV)
b. Household of non fishery:
i. Rice and corps planted (number of ! signs on column 10 block IV)
ii. Vegetables and fruits (number of ! signs on column 11 block IV)
iii. Plantation (number of ! signs on column 12 block IV)
iv. Husbandry and poultry (number of ! signs on column 13 block IV)
v. Other farming (number of ! signs on column 14 block IV)
III. ENUMERATION PARTICLUARS
1. Name and NIP of enumerator
4. Name/NIP of supervisor
2. Date of enumeration
5. Date of supervision
3. Signature of enumerator
6. Signature of supervisor
*) cross out in applicable category
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3
Susenas
physical
building
serial
number
SP90
census
building
number
House
hold
serial
number
House
hold
head
name
During previous
year, has this
household/hous
ehold member
been a victim of
crime??
Yes
(1)
(2)
(3)
(4)
(5)
No
(6)
IV. HOUSEHOLD LISTING
Did you
During the
engage in
past 3
agricultural
months,
Did you
activities
were there
engage in
last year?
any
fishery
!
Yes
household
activities?
No
members
Yes !
who
No traveled?
(not routine
travel)
Yes !
No
(7)
(8)
(9)
If "Yes"
If did not engage in fishery activities, put a ! sign
under the primary agriculture activity.
Rice or
second
ary
crops
Vegeta
bles or
fruits
Planta
tion
Livestock
or poultry
Other
argicultu
re
(10)
(11)
(12)
(13)
(14)
A. Total this page
B. Cumulative total from previous
pages
C. Cumulative total with this page
(A+B)
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