1
SUSENAS
Republic of Indonesia
Central Bureau of Statistics
1997 National Socio-Economic Survey
Appendix 3
VSEN97.K
Household Listing
Confidential
01
02
03
04
05
06
07
08
09
10
11
01
02
03
01
02
03
04
I. LOCATION IDENTIFICATION
Province
District/municipality*)
Subdistrict
Village/Village Unit
Area type
Urban 1
Rural
Enumeration area number
Segments group number
Segment number
Sample code number
Sample serial number of household
Village classification
Poor village (IDT)
Non-poor village (Non-IDT)
2
1
2
Filled in by editor
II. HOUSEHOLD CHARACTERISTICS
04
Number of household members attending
school
Number of household members
05
Number of household members who died
during the last year
Number of children aged 0-4 years
06
Was the household victim of any criminal act
during Dec. 1, 1995 – Nov. 30, 1996
Yes
1
No
2
Household head name
III. ENUMERATION PARTICULARS
Name and employment identity number of
05
Name and employment identity number of
enumerator
supervisor
06
Enumerator’s Status:
Supervisor’s status:
Staff KS Province
1. Mantis
Staff KS Province
1. Mantis
Staff KS Regency/municipality 2. Partner
Staff KS Regency/municipality
2. Partner
Date of enumeration
07
Date of supervision
Enumerator’s signature
08
Supervisor’s signature
*) Cross out inapplicable category
2
3
IV.A. HOUSEHOLD LISTING
No
(1)
Name of household
members ((Write
down the name of
everyone. i.e. adults,
children and babies,
who usually eats, and
lives in this h.h).
Relation
to the
head of
h.h.
(Code)
Sex
Male
1
Female 2
(2)
(3)
(4)
Age
(years)
Marital
Status
(Code)
(5)
(6)
Victim of
any crime
during
Dec.1’95 –
Nov.30’96
Yes
1
No
2
(7)
Making a trip during
Sep. 1 – Nov.30’96
Tour
(Code)
Routine
(Code)
Only for h.h.
members
aged 5 yrs
and above
School
participation
(8)
(9)
(10)
01
02
03
04
05
06
07
08
09
10
IV.B. HOUSEHOLD MEMBERS WHO DIED LAST YEAR (INCLUDING STILLBIRTHS)
01
02
Column 3 Code:
Relation to Head of H.H
Head of HH
Wife/husband
Children
Son/daughter in-law
Grandchild
1
2
3
4
5
Parent/in-laws
6
Other relative
7
Servant
8
Others
9
Column 6 Code:
Marital Status
Single
Married
Divorced
Widowed
Column 10 Code:
School Participation
1
2
3
4
Attending school
Not attending school
Column 7 explanation: A criminal victim is the victim of a criminal act. A criminal act is a
person(s) action, intentional or not, successful or failed attempt, which may cause damage, injury
or loss of another person life/body, material goods or honor, punishable by imprisonment or fine.
Column 8 explanation: A tour is completed trip of less than 6 months, not for school, work, or
to get wage and salary from the destination place.
Column 8 code:
to a tourist object
to a tourist object, travel distance > 100 km (r/t)
to a tourist object, travel distance < 100 km (r/t)
but utilizing commercial accommodation
did not make a trip
1
2
3
4
Column 9 explanation: A periodical trip by using vehicle minimal once a week.
Column 9 code:
by public transportation
by own vehicle
did not make a periodical trip
1
2
3
4
1
2
5
V. INDIVIDUAL HEALTH AND EDUCATION
CHARACTERISTICS
Name
Serial No
Serial no. 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: (fill in code 1 if yes, code 0 if no)
a. fever
j. convulsion
b. headache
k. paralysis
c. cough
l. ear discharge
d. chronic cough
m. measles
e. flu/cold
n. jaundice
f. diarrhea
o. domestic accident
g. breathing difficulty
p. accident
h. asthma
q. other accident
i. toothache
(if all 0 code, Skip Q.6)
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?
Yes
1
No
2
6. Did you go for a medical consultation/medical check-up?
Yes
1
No
2
(Code 2 for Q.5 & Q.6, Skip to Q. 8 or Q. 14)
7. Frequency of treatment or check-up?
Treatment / care
OutInConsultation
patient
patient
/ Check-up
(times)
(days)
(times)
(1)
(2)
(3)
(4)
a. public hospital
b. private hospital
c. general practitioner
d. puskesmas
e. subpuskesmas
f. clinic/mch/bp
g. posyandu
h. paramedical
practitioner
i. traditional healer
j. others
k. self treatment
ONLY FOR CHILDREN AGED 0-4 YEARS
8a. Age in month: ___________________month/s
b. Who attended his/her birth:
Doctor
1
Traditional birth attendant 4
Midwife
2
Relative
5
Other paramedical 3 Others
6
9. Has the child been breast fed?
Yes
1
No
2 (Skip to Q 11)
10a. Duration of breast feeding (month)
b. Just breast fed
c. Breast fed plus food/drinks supplement
d. (only for children under 1 year old)
In the last 24 hrs whether the baby was given:
1
♦ Just breast feeding
♦ Breast feeding plus food/drinks supplement 2
3
♦ Just food/drinks supplement
11. Any BCG, DPT, Polio, Measles / Morbili immunization
received?
Yes; with card
1
Yes, no card
2
No, with card
3 ----- STOP
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 and or Polio, how many times?
DPT:________ times
Polio: __________ times
ONLY FOR THOSE AGED 5 YEARS AND ABOVE
14. School participation:
No school
In school*)
No longer in school
1 (skip to Q. 18)
2
3
15a. Highest school ever or being attended:
Primary school
Junior high school
High school
Vocational high school
Diploma I/II
Diploma III
Diploma IV/University
b. Educational organizer/institution:
Government
1
Foreign
Private
2
16. Highest grade ever or being attended
1 2 3 4 5 6 7 8 (completed)
1
2
3
4
5
6
7
3
6
7
V. CONTINUED
17. Highest level of education completed
Not yet completed primary school
Primary school
Junior high school
High school
Vocational high school
Diploma I/II
Diploma III/Academy
Diploma IV/University
1
2
VI. CONTINUED
27. If Q. 26 = 1, 2 or 3 code, distance to work place
__________ km
3
4
5
6
7
8
18. Can you speak Indonesian?
Yes
1
No
2
19. Can you read and write?
Latin
1
Can not
3
Other alphabets
2
VI. ACTIVITY OF HOUSEHOLD MEMBERS AGED
10 YEARS AND OLDER
20. Primary activity during the previous week:
Work
1 (Skip to Q.23) Looked after HH
3
Attending school 2
Others
4
21. If Q.20 # 1 code, did you work at least 1 hour during the
previous week?
Yes
1 (Skip to Q. 23)
No
2
22. If Q.20 = 2 code, do you have a permanent job but were
temporarily not working during previous week?
Yes
1
No
2 (Skip to Q. 28)
23a. Total days worked: _____ days
b. Number of hours worked daily in the previous week
1
2
3
4
5
6
7
Total
…
…
…
…
…
….
…
hours
24. Type of primary work during previous week (describe
clearly and accurately) [coded by editor]
25. Field of primary work during the previous week:
Agriculture
1
Mining & quarrying
2
Industry
3
Electricity, gas, & water
4
Construction
5
Trade
6
Transport & communication
7
Financing
8
Services
9
Others
0
36. Employment status during the previous week:
Self employed without help
1
Self employed assisted by family members/
Temporary worker
2
Employer with permanent workers
3
Government employee
4
State-owned corporation employee
5
Private employee
6
Family worker
7
28. Are you looking for work since the previous week?
Yes
1
No
29. Did you listen to the radio during the previous week
Yes
1
No
30. Did you watch TV during the previous week?
Yes
1
No
2
2
2
31. Did you read newspaper/magazine during the previous
week? Yes
1
No
2
VII. FERTILITY AND FAMILY PLANNING
Women Ever Married Aged 10 Years and Above
(Block IV, Column 4=2, Column 6=2,3,4)
32. Age first married
_________ years
33. Number of childbirths
Male
Female M+F
a. Born alive
b. Still alive
b1. Live in this HH
b2. Live outside this HH
c. Died
WOMEN AGED 10-49 YEARS AND MARRIED
(Block IV, Column 4=2, Column 5=10-49, Column 6=2)
Must Obtain data directly from the subject
34. Did you ever use contraception?
Yes
1
No
35. Do you currently use a contraceptive?
Yes
1
No
36. Type of contraceptive currently using:
Tubectomy
Vasectomy
IUD
Injectable
4
Implant
5
Oral Pill
Condom
Others
Traditional method
9
2 (STOP)
2 (STOP)
1
2
3
6
7
8
8
9
VIII. HOUSING, HOUSING FACILITY
AND SETTLEMENT
1.
IX. AVERAGE MONTHLY HOUSEHOLD
EXPENDITURE AND MAIN SOURCE OF
INCOME
Rp
A. Food Expenditure During
Floor area: ____________ m2
the Previous Week
2. Type of wall:
Brick
1
Wood
2
3. Type of roof:
Concrete
1
Wood
2
Corrugated zinc 3
Asbestos
4
4. Type of floor:
Marble/ceramic 1
Floor tile/
2
Concrete brick 3
1.
Bamboo
Others
3
4
Sugar palm fiber 5
Leaves
6
Others
7
Wood
Bamboo
Earth
Others
2.
Tuber (cassava, sweet potato, potato,
dried cassava chip, taro, sago, etc)
3.
Fish (fresh fish, salted and dried fish,
shrimp, etc.)
4.
Meat (beef, buffalo, goat, pork, broiler,
innards including liver, liver, spleen,
dried beef, etc)
5.
Egg and milk (chicken egg, duck egg,
quail egg, fresh milk, canned milk,
powder milk, etc)
6.
Vegetables (spinach, water spinach,
cucumber, carrot, string bean, green
bean, union, chili, tomato, etc)
Pulses (peanut, mungbean, soybean,
kidney bean, lima bean, cashew nut,
tofu, tempe, etc)
Fruit (orange, mango, apple, durian,
rambutan, snake fruit, lanzon, pine
apple, watermelon, banana, etc)
Oil and fat (coconut/frying oil, coconut,
butter, etc)
4
5
6
7
5. Source of light
PLN electricity
1 Torch
5
Electricity non PLN 2 Others
6
Pump lantern
3
6a. Source of drinking water:
Pipe
1
Protected spring
Pump
2
Unprotected spring
Protected well 3
River
Unprotected well 4
Rain water
Others
5
6
7
8
9
7.
8.
If Q.6.a.=2-6 (pump/well/spring), nearest
distance to septic tank:
< 6m
1
> 16 m
6-10 m
2
don’t know
11-15 m
3
7. How to get drinking water
Bought
1
didn’t buy
2
8. Drinking water facility
Private
1
Public
3
Shared
2
Others
4
9a. Toilet facility
Private
1
Public
3
Shared
2
Others
4
b.
9b. Type of toilet disposal
Squatter
1
Dry latrine
Throne
2
Others
9c. Final disposal
Septic tank
1
Pond/field rice 2
River/lake/
Ocean
3
Hole
3
4
4
Shore/open field 5
Others
6
4
5
(1)
Cereals (rice, corn, wheat flour, rice
flour, corn meal, etc)
9.
(2)
10. Beverage ingredients (cane sugar, tea,
coffee, cocoa, syrup, etc)
11. Spice (salt, candle nut, coriander,
pepper, fish paste, soy sauce, brown
sugar, monosodium glutamate)
12. Miscellaneous food (shrimp/fish
crackers, emping chips, rice noodle,
macaroni)
13. Prepared food (bread, biscuit, cakes,
porridge, meatball and noodle soup,
syrup, soda pop, gado- gado, rice and
side dish)
14. Alcoholic beverages (beer, wine, and
other alcoholic drinks
15. Tobacco and betel (clove cigarette,
cigarette, cigars, tobacco betel, areca
nut, etc)
16. Total food (Q. 1 – 15)
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IX. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME
B. Non-food expenditure 12 months ago/previous month
Previous month The Last 12 months
(rupiah)
(rupiah)
1
2
3
17. Housing, fuel, light, and water (rent, estimated rent, electricity,
kerosene, water, firewood, etc)
18. Miscellaneous goods and services (toilet soap, cosmetic article,
transportation, reading material, recreation, driver’s license/social
security card, etc)
19. Education cost (enrollment/registration fee, tuition, scout,
handicraft, etc)
20. Health cost (hospital, health center, medical doctor, traditional
healer, medicines, etc)
21. Clothing, footwear, headgear (fabrics, ready-made clothes shoes,
hat, laundry soap, etc)
22. Durable goods (furniture, household equipment, kitchen utensils,
amusement tools, 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 (Q. 17 – Q. 24)
26. Average monthly food expenditure (Q. 16 x 30)
7
27. Average monthly expenditure non-food expenditure
(Q. 25 Column 3 : 12)
28. Average monthly household expenditure (Q. 26 + Q. 27)
29. Main source of household income:
Filled in by editor
__________________________
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13
X. HOUSEHOLD PARTICIPATION IN IDT (POVERTY ALLEVIATION PROGRAM)
3. Amount of fund and source
Has head/member of household ever been a
member of community group (Pokmas) in IDT
Year
Amount of fund
Source
Program?
(Rp)
(Code)
Yes
1
No
2 (Skip to Block XI) 1994
2. Have you ever received IDT fund?
1995
Yes
1
No
2 (Skip to Block XI)
1996
1.
Source: Direct fund
Rotate fund
Don’t know
1
2
4
XI. LIVESTOCK / POULTRY
1. Did you have livestock/poultry during period January 1 – December 31, 1996?
Yes, still have it
1 (Skip to Q. 2a, column 2-6 and or Q. 2.b)
Yes, Not anymore
2 (skip to Q. 2a, column 5-6)
No
3 (STOP)
2a. Number of livestock:
Type of livestock
(1)
(01)
(02)
(03)
(04)
(05)
(06)
(07)
Male
(2)
January 1, 1997
Female
Total
(3)
(4)
During Jan.1 – Dec. 31, 1996
Born
Death
(5)
(6)
Dairy cow
Cow
Buffalo
Horse
Goat
Sheep
Pig
2b. Number of poultry in January 1, 1997
(01) Free range chicken
(02) Layer chicken
(03) Broiler chicken
(04) Ducks
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