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SUSENAS
VSEN99.L
REPUBLIC OF INDONESIA
CENTRAL BUREAU OF STATISTICS
1999. NATIONAL SOCIO ECONOMIC SURVEY
LISTING OF BUILDING AND HOUSEHOLD
Confidential
I. LOCATION IDENTIFICATION
1
2
3
4
5
6
7
8
9
1
2
3
4
Province
District/Municipality *)
Sub-district
Village/Village Unit*)
Area
Enumeration area number
Segments group number
Segment number
Sample code number
1. Urban
2. Rural
II. SUMMARY
Number of census buildings
Number of households receiving health care since
(Column 5 Block IV)
September 1998
a. Occupied housing
5
(Column 10 Row C, last pages Block IV)
(Total code 1)
6. Number of households by monthly household
b. Empty housing
expenditure category (Column 11 to Column ..Row
(Total code 2)
C, last pages Block IV)
c. Non-residential
Expenditure category
Number of households
(Total code 3)
(thousand
rupiah)
Number of households
(Column 6 Last Row, the last page of
a…….
Block IV)
b. ……….
Number of household members
(Column 8 Row C, the last page of Block
c. ………….
IV)
d. Total
Number of households receiving
scholarships for the year 1998/1999
7. Sample selection information
(Column 9 Row C, the last page of Block
I=………………R1=…………….
IV)
III. ENUMERATION PARTICULARS
Name & NIP of enumerator
5
Name and NIP of supervisor
6
Supervisor’s occupation:
Enumerator’s occupation:
1. Provincial staff
3. Sub-district staff
1. Provincial staff
3. Sub-district staff
2. District staff
4. Partner
2. District staff
4. Partner
3
Date of enumeration
7
Date of supervision
4
Signature of enumerator
8
Signature of supervisor
*) Cross out inapplicable category
1
2
2
3
Segment
number
(1)
Local
Community
Unit (RT,
RW, Village,
Street Name)
(2)
Physical
building
serial
number
Census
building
serial
number
Utilization of
census
building
(code)
House
hold
serial
number
Name
of head
of
house
hold
Number
of house
hold
members
Does a
member of
the
household
receive a
scholarship
1)
Yes
!
No
-
Has this
household
received a
health
card?
2)
Yes
!
No
-
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Monthly household
expenditure category
(in thousand rupiah)
Filling in with check
mark (!)
3)
…….
…….
…….
(11)
(12)
(13)
A. Number of this page
B. Cumulative total number of previous
page
C. Cumulative number of this page
(A+B)
Codes for column (5):
1. Occupied residential census building
2. Empty residential census building
3. Non-residential census building
Codes for column:
1) Received from government for study year 1998/1999
2) Received from head of village/Puskesmas/Midwife in the village since Sep 1998
3) Write down the expenditure category on the empty block on column 11 to 13
which is appropriate with each province.
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