135
SUSENAS
Attachment 7
VSEN93.K.
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
1993 NATIONAL SOCIO ECONOMIC SURVEY
CORE HOUSEHOLD AND HOUSEHOLD MEMBERS CHARACTERISTICS
01
02
03
04
05
06
07
08
09
01
02
03
01
02
03
CONFIDENTIAL
I. LOCATION IDENTIFICATION
Province
District/ Municipality *)
Sub-District
Village /Village Unit*)
Area
Urban – 1
Rural - 2
Enumeration Area Number
Segment Group Number
Packet Number
Susenas Sample Code Number
II. HOUSEHOLD PARTICULARS
Name of Household Head
04
Number of Household Members who are in
school
Number of Household Members
05
Number of Household Members who
passed away
Number of Children aged 0-4 year
06
Has this household ever experienced a
criminal act during previous year:
Yes
1
No
2
III. ENUMERATION PARTICULARS
Name and
04
Name and
NIP Enumerator
NIP of Supervisor
Date of Enumeration
05
Date of Supervision
Signature
06
Signature
*) Cross out inapplicable category
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137
IV. HOUSEHOLD CHARACTERISTICS
No
Name of Household
Members
(write down who
usually stay and eat
in this household;
adult, children, or
baby)
Relation to
the Head of
Household
Gender :
M
1
F
2
Age
(Year)
Marital
Status
(Code)
Traveled in
the past 3
months
(Code)
Was a victim
of a criminal
act in the
past year
(Code)
School Status
(Code)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
HOUSEHOLD MEMBERS WHO PASSED AWAY IN THE PAST YEAR
Codes for column (3)
Codes for column (6)
Relation to the head of household
Marital Status
Head of household 1 Parent/In-law
6
Single
1
Wife/husband
2 Other relative
7
Married
2
Children
3 House maid
8
Divorced
Son/daughter in-law 4 Other
9
Widowed
Grandchildren
5
Codes for column (9)
School Participation
Still attending schooling
1
Not attending school
2
3
4
To trvale is to have traveled (non-routine travel) to a destination having natural or man-made attraction,
disregarding distance or purpose
Codes for column (7):
Yes
1
No
2
A crime victim is the victim of criminal act due to another person(s) actions, whether intentional or not,
successful or failed attempt, which may cause damage or loss to the victim’s life, body, material goods,
etc, punishable by imprisonment or fine.
Code column (8):
- Homicide
- Assault
- Battery
- Kidnapping/abduction
Yes
1
No
2
Type of criminal act:
- Burglary
- Embezzlement
- Theft
- Fraud
- Arson
- Rape
- Destruction
- Adultery
- Robbery
- Insult
- Narcotics
- Gambling
- Others
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139
V. INDIVIDUAL HEALTH AND EDUCATION
CHARACTERISTICS
Name: ………………..Serial number: ……………
Serial number of biological mother: …………….
(Fill in 00 if biological mother not living 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
Others
9
Diarrhea and
5
No complaint
0
(skip to Q. 6)
Vomiting
2. If any, did it disrupt your work, school, or daily
activity
Yes
1
No
2 (skip to Q.5)
3. If ‘Yes’ in Q.2 , how long?………days
4. Are you still disrupted now?
Yes
1
No
2
5. Did you take medication?
1 (skip to Q 7)
Yes
No
2
6. Did you go for consultation/medical check up?
(Q.1 = 0 and Q 6 = 2, than Q 7 no need to be
asked)
Yes
1 (skip to 7 col. 4)
No
2
7. Frequency of treatment or check up:
Treatment/care
(1)
Out
In
Consul
Patient Patient tation/
(times) (days) check-up
(2)
(3)
a. Public hospital
b. Private hospital
c. Doctor ‘s practice
d. Puskesmas
e. Clinic/KIA/BP
f. Paramedic’s
practice
g. Traditional healer
h. Others
i. Self treated
(4)
ONLY FOR CHILDREN AGED 0 – 4 YEARS
8. Who attended his/her birth?
Doctor
1 Traditional birth 4
Midwife
2 Attendants
Other paramedic
3 Relative
5
Others
6
9. Was/is the child breast fed?
Yes
1
No
2
10.Duration of breast feeding (month):
a. Breast feeding only
b. Breast feeding plus food/drinks supplement
11.Has the child been immunized?
Yes; with card
1
Yes, no card
2
No, with card
3
Finished
No, no card
4
12.If “yes” in Q.11, kind of immunization:
BCG
1
Polio
4
DPT
2
Measles/morbili
8
13.If immunized with DPT or Polio, how many
times? DPT:
times
Polio
times
ONLY FOR THOSE AGED 5 YEARS AND
OLDER
14.School attendance:
No schooling
1 (skip to Q.18)
In school
2
No longer in school 3
15.a) Highest school ever or being attended:
Primary school
1
Diploma I/II
6
Junior high school 2
Academy/Dipl. III
7
Vocational Jr school 3
University/ Dipl. IV 8
Senior high school 4
Vocational senior
5
b). Educational institute:
Government:
Private:
Secular
Secular
Religion
Religion
16. The highest class/grade ever of being attended
1 2 3 4 5 6 7 8 (completed)
17. Highest level of education completed:
Not/Not yet completed 1 Vocational senior
6
Primary school
high school
Primary school
2
Diploma I/II
7
Junior high school 3
Academy/Dipl.III
8
Vocational Jr school 4
University/Dipl.IV
9
Senior high school 5
18. Can speak Indonesian? Yes 1 No 2
19. Can read and write?
Latin
1
Can not
3
Other alphabets2
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141
VI. ACTIVITY OF HOUSEHOLD MEMBERS
AGED 10 YEARS AND ABOVE
20 Primary activity during previous week
Worked
1 (skip to Q.23)
Attended school
2
Took care of household 3
Others
4
21.If Q. 20 not coded 1, worked at least 1 hour
during previous week: Yes 1 (to Q.23) No 2
22.If Q.21 coded 2, have a job but temporarily not
working during previous week:
Yes 1 (skip to Q.24)
No 2 (skip to Q.27)
23 Number of hours worked daily in the previous
week
Days…
1
2
3 4 5 6 7 Total
… …. …. … … . .. … …….hours
24.Type of primary work during previous week
(specify) ……………………….
25.Field of main activity (work) during previous
week:
Agriculture
1 Trade
6
Mining & quarrying 2 Transportation 7
Industry
3 and communication
Electricity, Gas,
4 Financing
8
Water
Services
9
Constructions
5 Other
0
26.Status of main work during previous week:
Self employed without assistance
1
Self employed assisted by family
2
members/temporary workers
Employer with permanent workers
3
Government employee
4
Private employee
5
Family worker
6
27.Did you look for a job?
Yes
1
No
2
VI. CONTINUED
28.Did you listen to the radio during the previous
week
Yes
1
No
2
29.Did you watch TV during the previous week?
Yes
1
No
2
30.Did you read newspaper/magazine during
previous week?
Yes
1
No
2
VII. FERTILITY AND FAMILY PLANNING
WOMEN EVER MARRIED
(Block IV Col. (4) = 2, Col. (6) = 2, 3, 4)
31.Age at first marriage? ………. Year
32.Number of child births:
M
F
M+F
a. Born alive
b. Still alive
b.1. Live in this H.H
b.2. Live outside this
H.H
Total
c. Have died
WOMEN AGED < 50 YEARS AND MARRIED
(Block IV Col. (4)=2. Col. (5) < 50, Col. (6)=2)
=should obtain data directly from respondent)
33.Did you ever use contraceptives?
Yes
1
No
2 (skip to B. VIII)
34.Do you currently use a contraceptive?
Yes
1
No
2 (skip to B.VIII)
35.Type of contraceptive currently used:
Tubectomy
1
Condom
Vasectomy
2
Implant
IUD
3
Others
Injectable
4
Traditional
Pill
5
method
6
7
8
9
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VIII. HOUSING, HOUSING FACILITY AND
SETTLEMENT
1. Floor area: ……….m2
2. Type of wall:
Brick
1
Bamboo
Wood
2
Others
3. Type of roof:
Concrete
1
Sugar palm fiber
Wood
2
Leaves
Corrugated zinc/ 3
Others
Asbestos
Roof tile
4
3
4
5
6
7
4. Type of floor:
Marble/ceramic 1
Wood
4
Floor tile
2
Bamboo
5
Cement/concrete 3
Earth
6
brick
Others
7
5. Source of light:
PLN electricity
1 Oil lamp
4
Non PLN electricity 2 Others
5
Pump lantern
3
6. Drinking water facility:
Private
1
Purchased
4
Shared
2
Others
5
Public
3
7. Source of drinking water:
Pipe
1
Unprotected spring 6
Pump
2
River
7
Protected well
3
Rain water
8
Unprotected well 4
Others
9
Protected Spring 5
8. If Q. 7=2 to 6 (pump/well/spring), distance to
nearest septic tank:
<6m
1
4
≥ 16 m
6 10 m
2
Don’t know
5
11 – 15 m
3
9. Toilet facility:
Private toilet, with septic tank
Shared toilet, with septic tank
Private toilet, without septic tank
Shared toilet, without septic tank
Public toilet
Pond
River
Hole
Others
1
2
3
4
5
6
7
8
9
IX. AVERAGE MONTHLY HOUSEHOLD
EXPENDITURE AND MAIN SOURCE OF
INCOME
A. Food expenditure during the previous week Rp
(1)
(2)
1. Cereals (rice, corn, wheat flour, rice flour,
corn flour, etc)
2. Tuber (cassava, sweet potato, potato, dried
cassava, taro, sago, etc)
3. Fish (fresh fish, salted/preserved fish/
shrimp, etc)
4. Meat (beef/ buffalo/goat/mutton/pork/
chicken, innards, liver, spleen, shredded
dried meat, dried meat, etc)
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)
7. Pulses (peanut/mung bean/soybean/kidney
bean/lima bean/cashew nut, tofu, ftempe,
oncom, etc)
8. Fruits (orange, mango, apple, durian,
‘rambutan’, snake fruit, lanzon, pineapple,
water melon, banana, papaya, etc)
9. Oil and fat (coconut oil/frying oil, coconut,
butter, etc)
10.Beverage ingredients (granulated sugar,
tea, coffee, cocoa, syrup, etc)
11.Spices (salt, candlenut, coriander, pepper,
fish paste, soybean sauce, palm sugar,
monosodium glutamate, etc)
12.Other consumption (shrimp cracker,
emping chip, noodle, rice noodle,
macaroni, etc)
13.Prepared food and beverages (bread,
biscuits, cake, porridge, meatball and
noodle coup, syrup ice, soda pop, gado
gado, rice and side dish, etc)
14.Alcoholic beverages (beer, wine, and other
alcoholic drinks)
15.Tobacco and betel (clove cigarette, white
tobacco cigarettes, cigar, tobacco, betel,
areca nut, etc)
16.Total food (Q. 1 to – 15):
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145
IX. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME
B. NON FOOD EXPENDITURE DURING THE LAST 12
Previous Month
12 Months Ago
MONTHS/PREVIOUS MONTH
(Rp)
(Rp)
(1)
(2)
(3)
17. Housing, fuel, light, and water (rent, value of estimated rent,
electricity, kerosene, water, wood, etc)
18.Miscellaneous goods and services (toilet soap, cosmetics,
transportation, reading material, recreation, etc)
19.Education expenses (enrollement/registration fee, tuition,
scouts, handicraft, etc)
20.Health expenses (hospital, Puskesmas, medical doctor,
traditional healer, medicines, etc)
21.Clothing, footwear, head gear (fabircs, ready-made clothes,
shoes, hat, detergent, etc)
22.Durable goods (household appliances, equipment, kitchen
ware, recreational tools, sports equipment, jewelry/imitation
jewelry, vehicle, umbrella, watch, camera, etc)
23.Taxes and insurance (building and land tax, TV/radio 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) : (2)
28.Average monthly household expenditure (Q 26 + 27)
29.Main source of household income:
……………………………..
Filled in by Editor
146
147
X. N O T E
148