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SUSENAS
attachment 3
VSEN92.K
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
1992 NATIONAL SOCIO-ECONOMIC SURVEY
CORE HOUSEHOLD AND MEMBER CHARACTERISTICS
Confidential
01
02
03
04
05
06
07
08
09
10
I. LOCATIONS IDENTIFICATION
Province
District/Municipality *)
Sub-District
Village/Village Unit*)
Area
Enumeration Area Number
Urban
Segment group number
Package number
Sample code number
Sample household serial number
-1
Rural
-2
II. HOUSEHOLD LISTING
01
02
Name of household head
Number of household members
03
04
Number of children aged 0-4 years
Number of household's members who
are attending school
III. ENUMERATION PARTICULARS
01
Enumerator's name and NIP
02
Enumeration date
03
Signature
*) cross out in applicable category
04
05
06
Supervisor's name and NIP
Date of supervision
Signature
2
3
Interview start time:
IV. HOUSEHOLD MEMBERS LISTING
No
Name of household
members (write down the
name of everyone i.e.
adults, children and babies,
who usually eat and live in
this household
(1)
01
02
03
04
05
06
07
08
09
10
(2)
Relation to
the head of
household
(3)
Gender:
Male
Female
-1
-2
(4)
Age
(year)
Marital
Status
(code)
Travel
ed in
the
past 3
months
(code)
Victim of
crime
event this
past year
(code)
(5)
(6)
(7)
(8)
HOUSEHOLD MEMBERS WHO DIED LAST YEAR
01
02
Head of HH
Wife/husband
Children
Codes for column (3):
Relation to head of household
-1 Son/daughter in-law -4 Other relative
-2 Grandchild
-5 Servant
-3 Parent/In-laws
-6 Other
-7
-8
-9
Codes for column (6):
Marital status
Single
-1 Divorced -3
Married -2 Widowed -4
To make a tourism-related trip is to travel (non routine travel) to a destination that has natural or man-made
attractions .
-1
No
-2
Codes for Column (7): Yes
A victim of crime is a victim of an act caused by other persons, whether these acts were done on purpose or
not, whether the act was successful or an attempt. These acts can result in the victim’s death or cause bodily
injuries, material loss, etc and those act can be punished with imprisonment or a
No -2 (the left side box, row 01 prepared for household as a victim)
Codes for column (8): Yes -1
Categorized of criminal act:
- Homicide
- Burglary
- Embezzlement
- Insult
- Assault
- Theft
- Fraud
- Narcotics
- Battery
- Arson
- Rape
- Gambling
- Kidnapping/abduction
- Destruction
- Adultery
- Others
- Robbery
4
5
V. INDIVIDUAL HEALTH AND
EDUCATION CHARACTERISTICS
Name:
Serial number:
Serial number of biological mother:………………..
(Fill in 00 if the biological mother does not live in
this household)
1. Did you have health complaints during the
previous month, because of:
Fever
-1 Toothache
-6
Cough
-2 Convulsions
-7
Flu/cold
-3 Accident
-8
Diarrhea
-4 Other
-9
Vomit/diarrhea -5 Nothing
-0
Go to Q. 5
2 If any, did it disrupt your work, school, or daily
activity?
Yes -1
No
-2 (go to Q. 4)
3. If "yes" at Q.2, how long?: ……………days
4. Are you still feeling sick?
Yes -1
No
-2
5. How many times/days have you been treated?
Treatment
Out-patient in-patient
(times)
(days)
a. Govt. hospital
b. Private hospital
c. Doctor’s Practice
d. Puskesmas
e. Clinic/MCH/BP
f. Health worker’s
practice
g. Traditional healer
h. Others
i. Self treated
ONLY FOR CHILDREN AGED 0-4 YEARS
6. Who attended his/her birth?
Doctor
1 Traditional birth
4
Midwife
2 attendant
Other paramedic
3 Relative
5
Others
6
7. Has the child been breast fed?
Yes
-1
No
-2 (go to Q. 9)
8. How long (month) was/has been breast fed:
a. Without food/drink supplement
b. With food/drink supplement
9. Has the child ever been immunized?
Yes, with card
Yes, without card
No, with card
No, no card
10 If "yes" on Quest. 9, type of immunization
BCG
1 Polio
4
DPT
2 Measles/morbili
8
11 If immunized with DPT or Polio, how many
times?
DPT: ………….times
Polio: ………….times
ONLY FOR AGED 5 YEARS AND OLDER
12 Education status:
No schooling
1 ! go to Q. 16
Attending school
2
No longer in school
3
13a) Highest education ever or being attended:
Primary school
1 Diploma I/II
6
Junior school
2 Academy/
7
Vocational Junior 3 Diploma III
School
University/
8
Senior high school 4 Diploma IV
Vocational high
5
School
b) Educational institute:
Government: Secular 1
Religious
Private
Secular 3
Religious
2
4
14 Highest grade ever or being attended:
1 2 3 4 5 6 7 8(completed)
15 Highest education completed:
Not/not yet completed Vocational senior
Primary school
1 high school
Primary school
2 Diploma I/II
Junior school
3 Academy/Diploma
Vocational junior 4 III
School
University/Diploma
Senior high school 5 IV
16 Can speak Indonesian?
Yes
1
No
17 Can read and write?
Latin
-1
Other alphabets -2
6
7
8
9
-2
Can not
-3
6
7
VI. ACTIVITY OF HOUSEHOLS MEMBERS VI. CONTINUED
AGED 10 YEARS AND OLDER
18 Primary activity during previous week:
Worked
-1 (skip to Q.21) Took care of -3
Attended -2
household
school
Others
-4
19 If Q 18 not coded 1, did you work at least 1 hour
during the previous week?
Yes -1 (skip to Q. 20)
No
-2
20 If Q 19 coded 2, do you have a permanent job
but were temporarily not working during
previous week:
Yes -1 (skip to Q. 22) No -2 (skip to Q25)
21 Total number of hours worked daily in the
previous week
1 2 3 4 5 6 7 Total
… … … … … … … .. hours
22 Type of primary work during previous week
(specify) …………………………………..
23 Field of primary work during previous week:
Agriculture
-1 Trade
Mining & quarrying -2 Transportation &
Industry
-3 communication
Electricity, Gas and -4 Finance
Water
Service
Construction
-5 Other
24 Status of primary work during previous week:
Self-employed with no assistance
-1
Self-employed assisted by household
-2
member/temporary workers
Employer with permanent workers
-3
Government employee/worker
-4
Private employee/worker
-5
Family worker
-6
25 Looking for work?
Yes
-1
No
-6
-7
-8
-9
-0
26 Did you listen to the radio during previous
week?
Yes
-1
No
-2
27 Did you watch TV during previous week?
Yes
-1
No
-2
28 Did you read newspaper/magazine during
previous week?
Yes
-1
No
-2
VII. FERTILITY AND FAMILY PLANNING
EVER MARRIED WOMEN
{Block IV col. (4)=2, col. (6)= 2,3,4}
29 Age at first marriage:
…………………… year
30 Number of children born alive
………………….
31 Number of children who have died:
………………….
32 Number of living children
…………………….
WOMEN AGED <50 YEARS AND MARRIED
{Block IV Col. (4)=2, Col. (5), Col. (6)=2}
= should be asked directly to the respondent =
33 Have you ever-used contraceptives?
Yes
-1
No
-2 (to B VIII)
34 Do you currently use a contraceptive?
Yes -1
No
-2 !(go to B VIII)
35 Type of contraceptive currently used:
Tubectomy
-1
Condom
Vasectomy
-2
Implant
IUD
-3
Other
Injection
-4
traditional method
Pill
-5
-6
-7
-8
-9
-2
8
9
VIII. HOUSING, HOUSING FACILITY AND
ENVIRONMENT
1. Floor area: ……………………..m2
2. Type of wall (majority):
Brick
-1
Bamboo
Wood
-2
Other
3. Type of roof (majority):
Concrete
-1
Sugar palm
Wood
-2
fiber
Zing/Asbestos
-3
Leaves
Corrugated tile
-4
Other
4. Type of floor (majority):
Marble/ceramic
-1
Wood
Floor tile
-2
Bamboo
Cement/red brick
-3
Earth
Others
5. Source of lighting:
PLN electricity
-1
Non-PLN electricity -2
Pump lantern
-3
6. Drinking water facility:
Private
-1
Shared
-2
Public
-3
7. Source drinking water:
Pipe
-1
Pump
-2
Protected well
-3
Unprotected well
-4
Protected spring
-5
IX. AVERAGE MONTHLY HOUSEHOLD
EXPENDITURE AND MAIN SOURCE OF
INCOME
A. Food expenditure during previous week
(1)
-3
-4
-5
-6
-7
-4
-5
-6
-7
1. Cereals (rice, corn, flour, rice flour, corn flour,
etc)
2. Tuber (Cassava, sweet potato, potato, dried
cassava, taro, sago, etc)
3. Fish (fresh fish, preserved fish/ salted fish,
shrimp, etc)
4. Meat (beef/buffalo/goat/mutton/pork/chicken,
innards, liver, spleen, dried shredded beef,
dried beef, etc)
-4
-5
5. Egg and milk (chicken egg/duck egg/quail
egg, fresh milk, sweetened condensed milk,
powdered milk, etc)
6. Vegetables (spinach, water spinach,
cucumber, carrot, string bean, green bean,
onion, chili, tomato, etc)
Purchased
Other
-4
-5
7. Pulses (peanut/mung bean/ soybean/ kidney
bean/lima bean/cashew nut, tofu, tempe,
fermented soybean sauce, oncom, etc)
8. Fruits (orange, mango, apple, durian,
'rambutan', snake fruit, lanzon, pineapple,
watermelon, banana, papaya, etc)
Unprotected
spring
River
Rain water
Other
-6
9. Oil and fat (coconut oil/cooking oil, coconut,
butter, etc)
oil lamps
other
-7
-8
-9
8. If Q. 7= 2 to 6 (pump/well/spring), closest
distance to the septic tank
≥16 m
<6m
-1
-4
6 - 10 m
-2
Don't know
-5
11 - 15 m
-3
9. Toilet facility:
Private, with septic tank
Shared, with septic tank
Private, without septic tank
Shared, without septic tank
Public toilet -5
Pond
-6
Hole
River
-7
Other
-1
-2
-3
-4
-8
-9
Rp
(2)
10 Beverages material (granulated sugar, tea,
coffee, cocoa, syrup, etc)
11 Spices (salt, candlenut, coriander, pepper,
fish/shrimp paste, soybean sauce, palm sugar,
monosodium glutamate, etc)
12 Other consumables (shrimp/fish crackers,
emping chips, noodle, rice noodle, macaroni,
etc)
13 Prepared food & drink (bread, biscuit, cakes,
porridge, meatball noodle soup, ice syrup,
soda pop, gado-gado, rice and side dishes)
14 Alcoholic beverages (beer, wine, and other
alcoholic beverages)
15 Tobacco and betel (clove cigarette, white
tobacco cigarette, cigar, tobacco, betel, areca
nut, etc)
16 Total food (Q 1 to 15):
10
11
IX. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME
B. Non food expenditure during the previous month/previous
Previous month
The 12 months
year
(Rp)
ago
(Rp)
(1)
(2)
(3)
17.Housing, fuel, light, and water (rent, value of imputed rent,
electricity, kerosene, water, wood, etc)
18.Miscellaneous goods and services (toilet soap, cosmetic
goods, transportation, reading material, recreation, etc)
19.Education cost (enrollment/registration fee, tuition/
extracurricular fee, Scouts, handicraft, etc)
20.Health cost (hospital, Puskesmas, medical doctor,
traditional healer, medication, etc)
21.Clothing, footwear, and headgear (fabric, ready-made
clothes, shoes, hat, laundry soap, etc)
22.Durable goods (furniture, household equipment, kitchen
utensils, recreational utensils, sporting goods, jewelry/
imitation jewelry, vehicle, umbrella, watch, camera, etc)
23.Taxes and insurance (building and land tax, radio & TV tax,
vehicle tax, accident/health insurance)
24.Festivities and ceremonies (wedding, circumcision,
birthday, religious festival, traditional ceremony, etc)
25.Total non food
26.Average monthly food expenditure (Q 16 x 30 )
7
27.Average monthly non food expenditure
(Q. 25 Column (3) : 12)
28.Average monthly household expenditure (Q 26 + 27)
29.Main source of household income:
Fill in by CBS
…………………………………….
Time finished interview
12