1
Attachment 3
SUSENAS
VSEN98.K
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
1998. NATIONAL SOCIO ECONOMIC SURVEY
LISTING OF HOUSEHOLD CORE AND HOUSEHOLD MEMBERS
Confidential
1
2
3
4
5
6
7
8
9
10
11.
01
02.
03
I. LOCATION IDENTIFICATION
Province
District/Municipality *)
Sub-district
Village/ Village Unit *)
Area
Urban 1
Rural
Enumeration area number
Segment group number
Segment number
Sample code number
Serial number of Sample household
Village classification
Least developed village
Developed village
2
1
2
Fill in by
CBS
II. HOUSEHOLD CHARACTERISTICS
04
Number of household memberS who are still in
school
Number of household members
05
Number of household members who had passed
away
Name of household head
Number of children aged 0 - 4 years old
06
Does this household have a Holy Book?
III. ENUMERATION PARTICULARS
Name and NIP/NMS of enumerator
05
Name and NIP/NMS of supervisor
Position of enumerator:
06
Position of supervisor
Staff of KS Province 1 Mantis
3
Staff of KS Province 1 Mantis
Staff of KS District
2 Partner
4
Staff of KS District
2 Partner
03
Date of enumeration
07
Date of supervision
04
Signature of enumerator
08
Signature of supervisor
*) Cross out inapplicable category
01
02
3
4
2
3
Serial
number
(1)
01
02
03
04
05
06
07
08
09
10
Name of
Household
Members
(write
down those
who
usually stay
and eat in
this
household;
adult,
children, or
baby)
(2)
IV. A. HOUSEHOLD MEMBERS CHARACTERISTICS
Relation
Gender:
Age
Marital If k.(6)
to the
M
1
(year) Status
coded 2 or
head of
F
2
(code) 3, where
household
is it
recorded?
(3)
(4)
(5)
(6)
Only for household
members aged 5
years old
School
For how
attendanc
long did
you read e
holy
book/
religion
article in
the last
week?
(7)
(8)
(9)
IV.B. HOUSEHOLD MEMBERS WHO DIED (INCLUDING STILLBORN)
DURING PREVIOUS YEAR
01
02
Codes for column 3:
Relation to the head of household
The head of household 1
Parent/In-law
Wife/husband
2
Other relative
Children
3
Servant
Son/daughter in-law
4
Others
Grandchildren
5
Codes for column 6:
Marital Status
Single
Married
Divorced
Widowed
1
2
3
4
Codes for column 7:
6
7
8
9
KUA (Religion Office)
Civil Registered Office
State Court Office
Others
1
2
3
4
Codes for Column 9:
School Participation
In school
No longer in school
1
2
4
5
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, such as:
(read from a to p )
a Fever
i. Liver/jaundice
b Cough
j. Headache
c Flu/cold
k. Convulsion
d Asthma
l. Paralysis
e Breathing difficulty m. Senility
f. Diarrhea
n. Accident
g. Measles
o. Toothache
h. Ears discharge
p. Others
If all coded 0, than go to Q.7.a. or Q. 14
2. If any of them, did it disrupt your work, school,
or daily activity?
Yes
1
No
2 →(skip to Q.5.a)
3. Duration of disruptin ……………….days
4. Are you still disrupted now?
Yes
1
No
2
5. a. Did you ever have self-treatment in the last
month? Yes 1
No 2 → (skip to Q.6.A)
b. Duration of self-treatment …….. days
c. Type of medicine used:
Modern medicine
1 Others
4
Traditional medicine 2
d. If used modern medicine, where was it
purchased?
Pharmacy
1 Vendor
8
Drug store
2 Remote vendor
16
Village Medicine 4 Other
32
Post
6.a. Were you an outpatient in the last month?
Yes
1
No
2 → (skip to Q.7.a or Q14)
6.b. Frequency of an outpatient treatment:
(filling in the frequency of an outpatient of each
services)
01. Hospital
06. Polyclinic
02. Private hospital
07. Paramedics
03. Doctor practice
practice
04. Puskesmas
08. Traditional healer
05. Supporting
09. “Polindes”
Puskesmas
(Village Maternity
Post)
10. “Posyandu” (Integrated Service Post)
c. Where did you go for an outpatient at first
time?
(Filling in the Codes for services which
appropriated with Q. 6.b)
ONLY FOR CHILDREN AGED 0 – 59 MONTHS
7. a. Age in month: …………………months
( go to Q.8 if the content # 00)
b. If Q. 7.a = 00, age in days: ………..days
8. Who helped you during the labor process?
(Codes for the answer, directly filling in the box)
1. Medical doctor
4. Traditional Birth
2. Midwife
Attendant
3. Other paramedics
5. Relative First
6. Others
Last
9. How many times the children have immunization?
(Filling in 0, if never been in immunized)
a. BCG
c. Polio
b. DPT
d. Measles/Morbili
10. Do you have KMS/Immunization Card?
Yes, have at home
1
Yes, have in
2 go to
another Place
Q. 12
Doesn’t have
3
11. Copy the frequency of immunization based on
KMS/Immunization data
a. BCG
c. Polio
b. DPT
d. Measles/Morbili
12. Have ever been breast fed?
Yes
1
No 2 → (finished)
13. (Please filling in ‘days’ if Q. 7.a = 00 or in ‘month’ if Q.7.a #00)
a. Duration of breast feeding
b. Just breast feeding
c. Breast feeding + food/drink supplement
d. (Specific for children under 12 month)
Within 24 the last hours, the child given:
- Just breast feeding
1
- Breast feeding + food/drink supplement
2
- No breast feeding (only food and drinks)
3
ONLY FOR CHILDREN AGED 5 YEARS AND ABOVE
14.School participation:
No school
1 →(skip to Q.18)
In school
2
No longer in school
3
15.a. Highest level and type of education ever or being
attended:
Primary school
01 “Aliyah” (islamic)
“Ibtidaiyah” (Islamic)
02 Vocational senior
“A” packet group
03 High school
Junior high/ Vocational 04 Diploma I/II
“Tsanawiyah” (Islamic) 05 Diploma III/bach.
“B” packet group
06 Diploma IV/
Senior High school
07 Under graduate
Master
PhD
b. Educational organizer:
Government
1
Foreign
3
Private
2
16. Highest level/grade ever or being attended”
1 2 3
4 5 6 7 8 (finished)
08
09
10
11
12
13
14
6
7
17.Highest level completed:
Not completed
1
Primary school
Primary school
2
Junior high school/
3
Vocational Jr.school
Senior high school
5
Vocational Sr. school
Diploma I/II
Diploma III/bachelor
Diploma IV/graduate
Master/PhD
5
6
7
8
9
18.Can you speak Indonesian?
Yes
1
No
2
19.Can you write and read?
Latin
1
Can not
3
Other alphabets 2
VI. ACTIVITY OF HOUSEHOLD MEMBER AGED 10
YEARS AND ABOVE
20.a. Did you do some activity during previous week?
Yes
1
No
0
a.1. Work for living/helped to work for living
a.2. Attending school
a.3. Looked after HH
a.4. Looking for a job
a.5. Others
b. From Q. 20.a. activity of 1 to 5 that are coded 1,
which activity used most of the time during
previous week?
1 (skip to Q.23) 2 3 4 5
21.Did you work for living at least 1 hour during
previous week?
(If Q.20.a.1. = 1, circle code 1)
Yes
1 (skip to Q.23)
No
2
22. Did you have permanent job, but temporarily not for
working during previous week?
Yes
1
No
2 1 (skip to Q.28)
23.a. Total work days: …………. days
b. Number of hours worked daily in the previous week
Mon. Tue Wen. Thu Fri Sat Sun Total
….
…. ….
…. …. … …. ……
24. Type of work/position at main activity during
previous week (write down completely)
…………………………………..
25.Business field of work place/office/company during
previous week (write down completely)
………………………………………
26.Status of main work during previous week:
Self-employed
1
Self-employed assisted by workers/
2
Temporary workers/unpaid workers
Self-employed assisted by workers/
3
Permanent workers
Worker/employee/paid worker
4
Unpaid worker
5
27. What was the wage/net salary received in a month
from main work?
Wage/salary: Rp…………………..
Wage/salary (in-kind) Rp ……………
28. Have you aver worked before?
Yes
1
No
2
29. Were you looking for a job?
Yes
1
No
2
30. Did you listen to the radio during previous week
Yes
1
No
2
31. Did you watch TV during the previous week?
Yes
1
No
2
32. Did you read newspaper/magazine during previous
week? Yes
1
No
2
VII. FERTILITY AND FAMILY PLANNING
EVER MARRIED WOMEN AGED ≥ 10 YEAR
(Block IV.A. Column 4=2, Column 6=2, 3,4)
33. Age at first marriage……………….years
34. The longest marriage period: ………….years
35. Number of biological child
M F
M+F
a. Born alive
b. Still alive
b.1. In this household
b.2. Outside of this h.h
c. Have died
WOMEN AGED 10-49 YEARS AND MARRIED
“Should ask directly to the respondent”
36. Did you ever use contraceptive?
Yes
1
No
2 → Finished
37. Do you currently use contraceptive?
Yes
1
No
2 → Finished
38. Type of contraceptive currently used:
Tubectomy
Vasectomy
IUD
Injected contraceptive
Implant
Pill
Condom
Other modern method
Traditional method
8
9
VIII. HOUSING AND SETTLEMENT
1. Type of roof:
Concrete
Corrugated tile
Shingle roof
Iron sheeting
1
2
3
4
Asbestos
Sugar palm fiber
Leaves
Others
2. Type of wall:
Brick
1
Bamboo
Wood
2
Others
3. Type of floor:
Marble/ceramic
1
Wood
Floor tile
2
Bamboo
Cement plaster/
3
Earth
Bricks
Others
4. Floor area: …………………….m2
5
6
7
8
3
4
4
5
6
7
5. a. Source of drinking water:
Bottled water
1
Protected spring
6
Tap water
2
Unprotected spring 7
Pump
3
River
8
Protected well 4
Rain water
9
Unprotected well 5
Others
0
b. If Q.5.a. =3 to 7 (pump/well/spring) nearest
distance to the septic tank:
<6m
1
≥ 16 m
4
6 – 10 m
2
Don’t know
5
11 – 15 m
3
6. How to obtain the drinking water:
Purchased
1
Does not purchase
2
7. Drinking water facility:
Private
1
Shared
2
8. a. Toilet facility:
Private
1
Shared
2
b. Type of toilet:
Squatter
1
Throne
2
c. Final disposal:
Septic tank
1
Pond/field rice 2
River/lake/
3
Ocean
9. Source of light:
PLN electricity
1
Electricity non PLN 2
Pump lantern
3
Public
None
3
4
Public
Others
3
4
Dry latrine
Others
3
4
Hole
Shore/open field/
Others
4
5
6
Oil lamp
Others
4
5
IX. AVERAGE MONTHLY HOUSEHOLD
EXPENDITURE AND MAIN OF SOURCE
A. Food expenditure during 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/ lamb/goat/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,
tempe, 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 flavor (granulated sugar, palm
sugar, tea, coffee, cocoa, syrup, etc)
11.Spices (salt, macadamia nut, coriander,
pepper, fish paste, soybean sauce,
monosodium glutamate, etc)
12.Other consumption (crisp, crisp chip,
noodle, wheat & rice noodle, macaroni,
etc)
13.Prepared food and beverages (bread,
biscuits, wet cake, porridge, meat ball,
syrup ice, soda pop, gado gado, rice and
side dish, etc)
14.Alcoholic beverages (beer, wine, and
other alcoholic drink)
15.Tobacco and betel (clove cigarette,
cigarettes, 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 12 MONTHS
Previous Month 12 Months Ago
AGO/PREVIOUS MONTH
(Rp)
(Rp)
(1)
(2)
(3)
17. Housing and household facility
(rents, estimated rent value, electricity bill, telephone, gas,
kerosene, water, wood, etc)
18.Miscellaneous goods and services (toilet soap, cosmetic
article, transportation, reading material, ID & driver’s license,
recreation, telephone card, postal, etc)
19.Education expenses (enrollment/registration fee, tuition,
scouts, handicraft, etc)
20.Health expenses (hospital, Puskesmas, medical doctor,
traditional healer, medicines, etc)
21.Clothing, footwear, head gear (fabric, ready-made clothes,
shoes, hat, detergent, etc)
22.Durable goods (household furniture, equipment, kitchen ware,
recreational tools, sports equipment, expensive jewelry/
imitation jewelry, vehicle, umbrella, watch, camera, telephone
installment cost, electricity installment cost, 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 (Question 17 to 24)
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 + Q.27)
29.Main source of household income (write down completely:
……………………………..
Filled in Editor
12
13
X. HOUSEHOLD PARTICIPATION IN POVERTY ALLEVIATION PROGRAM DURING 1996-1997
1. Has the head/member of household ever received credit/aid to increase the income during 1996-1997?
Yes
1
No
2 (skip to Block XI)
2. If Q.1 = 1, aid received:
Name of
How many
Specific for the last one
Program
times
Type of aid
Type of
Credit payment
When did you Amount of
received aid
(code)
activity
(Code)
fund
get it
in the last 2
conducted
received
(month,
year)
years?
(code)
(in thousand
rupiah)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
1
code
2
3
4
Codes for column (1):
IDT (01); UPPKS (02); Takesra/Kukesra (03); P4K (04); Prokesos/Kube (05); UP2K (06); KUB (07); KUT
(08); KCK (09); KKPA (10); PKM (11); PHBK (12); KUKDAS (13); KUPEDES (14); UED-SP (15)
Codes for column (5):
Bequest
1
Credit
2
Roll-over
3
Don’t know
4
Type of livestock
(1)
(01) Milking a cow
(02) Cattle
(03) Buffalo
(04) Horse
(05) Goat
(06) Sheep
(07) Pig
(08) Free-range chicken
(09) Layer Chicken
(10) Broiler Chicken
(11) Ducks
Codes for column (6):
Food crops agriculture
Fishery
Husbandry
Other agriculture
Small industry/household
1
2
3
4
5
Trade
Service
Others
Not yet
6
7
8
9
XI. LIVESTOCK/POULTRY BREEDING LISTING
Raising livestock/poultry
January 1, 1998
Yes
1
No
2
1997
January 1, 1998 Male
Female
(2)
(3)
(4)
(5)
Codes for column (7):
Paid
1
Doesn’t have a job
2
Can not pay/postpone 3
payment
During January 1, to
December, 31, 1997
Born
Death
(6)
(7)
14
15
XII. N O T E S
16