1
CENTRAL BUREAU OF STATISTICS
SUSENAS
NATIONAL SOCIO ECONOMIC SURVE
SUSENAS 79 – II
LISTING II: FERTILITY, WORK FORCE AND
FOODS CONSUMPTION LIST
CONFIDENTIAL
IDENTIFICATION
1. Province
2. Regency/Municipality
3. District
4. Village
5. Enumerating Area Number
6. Sample Code Number
7. Building Serial Number
8. Household Serial Number
9. Number of Household members
10. Number of Household member aged 10 years old and above
5
7
9
11
14
16
URBAN -1
RURAL -2
CONDUCTED MONTH:
II. ENUMERATING CHARACTERISTICS
1. Name of Enumerator
:
2. Date of Enumeration
:
3. Signature of Enumerator
:
4. Name of Supervisor
:
5. Date of Supervising
:
6. Date of Checking
:
7. Signature if Supervisor
:
III. NOTE
2
3
Ser
ial
nu
mb
er
Name
of h.h
memb
er
Relation to
household
head’s:
Head of hh 1
Wife
-2
Children –3
Son/daughter
in-law -4
Grand
children -5
Parents -6
Parents
in-law -7
Relative -8
Other
-9
Housemaid 0
Sex:
Male
-1
Femal
e -2
Year
and
month
of birth
(in
Christia
n
calenda
r)
Age
(in
year
)
(1)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
(2)
(3)
(4)
(5)
(6)
III. FERTILITY AND HOUSEHOLD MEMBERS LISTING
FOR AGED 10 YEARS OLD AND ABOVE
Dwelling
If she
of mother:
lived in
If column (9), not
For ever married woman
Education
Status of
Living in
this
coded 1, school and
completed:
marriage:
this
househ
If this not Aged at
last grade ever/ being
Not School -1
Single
-1 Is this
household
old fill
present
first
first
attended:
Not
completed
Married
-2
in serial
married
marriage, married
Primary
School
Widowed
-3
School
Grade
1
number
(in year)
-2
Divorced -4 is the last what
Code 3 to
Living
of the
marriage
marriage
Primary
School
8
like
outside of
mother
which is
do you
-3
column
this
first
have?
Junior
High
(9)
household
married?
School
-4
-2
Yes -1
Vocational Junior
Passed
No -2
High
School
-5
away
Senior High
3
School
-6
Don’t know
Vocational
Senior
-4
High
–7
Acad/univ.
-9
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
4
5
Serial
Number
(same
as
column
1)
(16)
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
Name
of
woman
who
ever
married
(taken
from
column
2)
Number
of
children
born
alive
Childr
en
who
are
living
here
(17)
(18)
(19)
III. FERTILITY AND HOUSEHOLD MEMBERS LISTING (CONTINUED)
PARTICULARLY FOR EVER MARRIED WOMAN
For married status woman
Childr Deceas
If column
en
ed
(18) the
Have you
If ‘Yes’, type of Do you
If “yes” what
who
children content is
ever heard
contraceptives
currently
contraceptive do
are not
not 0,
about birth have been
use
you used?
living
month and
spacing
known:
contracept Pill
-1
here
year of the
Yes
-1 Pill
-1 ive?
IUD
-2
last baby
No
-2 IUD
-2
Condom
-3
born (in
Condom
-3 Yes -1
Coitus
Christian
Coitus
No
-2
interruptus -4
calendar)
interruptus -4
Tubectomy -5
Tubectomy -5
Calendar system
Calendar system
-6
-6
Not making love
Not making love
-7
-7
Vasectomy -8
Vasectomy -8
Herbs, massages
Herbs,
-9
massages
-9
(20)
(21
(22)
(23)
(24)
(25)
(26)
Place of obtained
contraceptive of
advice about birth
spacing:
FP Clinic
-1
Hospital
-2
FP Field Worker
-3
Pharmacy
-4
Private doctor -5
FP Field
Assistant
-6
Other
-7
How long
the time
spent to that
place from
your house?:
< 1 hour -1
1-2 hours -2
2-3 hours -3
3 and more
-4
hours
(27)
(28)
6
7
V. SOURCE OF HOUSEHOLD INCOME
What is the household income?
(Put sign √ to small boxes)
Source of
income
(1)
1. Agriculture
Worker
s
Businessma
n
(2)
(3)
↓
continue
Workers
and
Businessma
n
(4)
↓
Code 1 to 8:
Worker
–1
Businessman
-2
Workers and
Businessman
-3
(5)
18
Type of
business
(1)
1. Seasonal
Plants
…………
…
…………
…
VI. AGRICULTURAL BUSINESS HAVE BEEN DONE DURING 6 MONTHS AGO
Production
Harvest
Number of
Production
Productions
area
trees
value
cost *)
Total
Unit
(0,000 ha)
RP
(2)
(3)
(4)
(5)
(6)
(7)
Income
(Rp)
(6) – (7)
Card
column
(8)
(9)
Hundred
to VI
2. Industry
3. trade
4.
Transportation
5. Services
19
20
21
6. Other
business
7. Government
8. Revenue
income
(Pension,
gifts, etc)
23
9. From the source of income of column (1) above,
main source of income is:
………………………………………………..
10.
As a businessman on column (1) above,
main source of income is :
………………………………………………..
22
24
25
26
27
2. Yearly
Plants
…………
…
hundred
…………
…
3.
Husbandry
Egg
Milk
Livestoc
Hundred
k
Total
4. Fishery
Hundred
5. Hunting/
Forestry
Hundred
6. Land area:
FILL IN HA, 3 DIGIT AFTER COMA
a. Private
: ………………………………Ha
(0,000 ha)
b. Private but deliver to other party such as to rent, sharecropping, etc
: ……………………………… Ha
(0,000 ha)
c. Obtained from other party, sharecropping, etc
: ……………………………… Ha
(0,000 ha)
d. Land area possessed
: ……………………………… Ha
(0,000 ha)
*) Production cost means all costs paid since beginning until production, such as seed, fertilizer, renting animal, worker’s wage, etc.
Purchasing large equipment or capital goods such as, mattock etc is not includes production cost.
8
9
VII. LISTING OF WORK FORCE OF HOUSEHOLD MEMBER AGED 10 YEARS OLD AND ABOVE
Name of household member
1
Household member serial number
18
VII. A. ACTIVITY DURING PREVIOUS WEEK
•
Can you tell us, the activity have been done during previous week, start from yesterday…….., day before
yesterday…….., 3 days ago etc.
•
If you work, how long (hours) a day?
•
Put sign check (√) on the small boxes as appropriated
Working
Have
Looking
School
Housekeeper
Others
Activity
(at least 1
permanent
for work
(Pension,
hour a day)
work, but
handicap, etc.)
Day
temporary not
working
(1)
Yesterday,
…………
Day before
yesterday,
………..
3 days ago,
…………..
4 days ago,
…………..
5 days ago,
…………..
6 days ago,
…………..
7 days ago,
…………..
Total
Card Column
(2)
(3)
(4)
(5)
(6)
VII. B. Particularly for ‘School, Housekeeper/ other’
1. Have ever looking for work during 3 months ago?
1. Yes
2. No
2. Reason why not looking for work:
(7)
1.
2.
3.
4.
5.
…….hours
…….hours
…….hours
Housekeeper
School
Health
Pension, too old, handicap
Don’t want to work
…….hours
…….hours
…….hours
3. If a suitable work for you, will you take the work?
…….hours
1. Yes
2. No
………hours
VII C
VII D
VII B (Only asked if column 2,3,and 4
Blank)
10
11
VII. C. WORKING/HAVE A JOB
1. Where is your work, describe your field working in the
company/office of your work
……………………………………… field working:
……………………
2. Type/position of your work: ………………………….
3. Work status:
1. Worker
3. Businessman with workers
2. Businessman without workers 4. Family worker without paid
4. How many hours you have been done of your work during previous
week?
………………. Hours
5. Your previous week worked is the same work with the last 3 months
work?
1. Yes
2. No
6. How much you’re net income of your last month work? (exclude the
harvest in block VI column 8)
In money
Rp …………………
In kind
Rp …………………
Total
Rp. ………………..
7. Besides of your permanent work, do you have another work?
1. Yes
2. No→ go to Q. 10
8. How many hours you do all the work during previous week?
……………………………hours
9. How much your net income of all other work during the last month?
In money
Rp …………………
In kind
Rp …………………
Total
Rp. ………………..
10.
Are you willing and have time to take another work?
CARD
COLUMN
VII. D. LOOKING FOR WORK
CARD
COLUMN
1. How long that you’ve been looking for work?
…………….. month
2. Are you looking the work for full time or part time?
1. Full time
2. Part time
3. Source of income to fulfil your daily needs:
1. Working
2. Working sometimes
hundreds
hundreds
3. From family/friend
4. Other
4. Have you ever worked before?
1. Yes
2. No
VII. E. OTHER REVENUE DURING PREVIOUS MONTH
1. Renting land, house, interest
Rp. ………………………
2. Other, in kind formed (gifts, own production)
Rp. ………………………
Total
Rp. ………………………
Hundreds
VII. F. OTHER INCOME AND EXPENSES DURING PREVIOUS MONTH
Income
Expenses
Income
Total
Expenditure
Total
(1)
(2)
(3)
(4)
1. Pension
…………..
1. Sending money
……….
2. Money transferred
…………..
2. Saving
.
3. Took a saving
…………..
3. Other (paying loan,
……….
hundreds
4. Other (to lend, ‘arisan’,
…………..
‘arisan’ contribution,
.
etc)
pension, etc)
……….
.
Total
…………
Total
……….
…
.
12
13
Seria
l
number
(1)
0010
0020
0030
0040
0050
0060
0070
0080
0090
0100
0110
0120
0130
0140
0150
0160
VIII. HOUSEHOLD EXPENDITURE/CONSUMPTION LISTING
VIII. A. NUMBER OF HOUSEHOLD EXPENDITURE DURING PREVIOUS MONTH: Rp. ………………..
III. B. USED OF FOODS, DRINKS, TOBACCO AND KEROSENE DURING PREVIOUS WEEK AND FINISHED ON : ……………………
Detail
Local
Stan
Local
Price
Quan- Quan- Value
Serial
Detail
Local
Stan
Local
Price
Unit
dard
unit
per
tity in
tity in
in Rp. numUnit
dard
unit
per
Unit
converlocal
local
stanber
Unit
converlocal
ted to
unit
unit
dard
ted to
unit
standard
Rp.
unit
standard
Rp.
unit
unit
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(1)
(2)
(3)
(4)
(5)
(6)
0170
Taro, etc
Kg
a. Cereals and its products
0180
Sago (not made of sweet
Kg
Rice of free
Kg
potato, for example
market/distribution
Ambon sago, etc)
Own production rice
Kg
Sticky rice
Kg
0190
Other (…………..)
Kg
Rice products
Kg
0200
Sub-total b.
Kg
c. Fish and its products
Kg
Wet corn with a skin
Kg
Dry corn with a skin
Kg
0210
Fresh sea water fish
Dry-shelled corn
Kg
0220
Fresh water fish
Kg
Corn flour
Kg
Wheat flour
Kg
Other (…………………….)
Kg
0230
Salted fish and dried
Kg
fish
Sub-total a
b. Tuber and its products
0340
Fish in a can
Kg
Cassava
Dried cassava chip
Flour of cassava (such as
tapioca)
Sweet potato
Potato
Kg
Kg
Kg
0250
Shrimps, crabs, squid,
etc
Kg
Kg
Kg
0260
0270
Other (…………..)
Sub-total c.
Kg
Quantity in
local
unit
Quantity in
standa
rd
unit
Value
in Rp.
(7)
(8)
(9)
14
15
Seria
l
number
Detail
(1)
(2)
d. Meat
0281
1. meat
beef
0282
2. other
0291
1. meat
buffalo
0292
2. other
0301
1. meat
Lamb
0302
0311
2. other
1. meat
VIII. HOUSEHOLD EXPENDITURE/CONSUMPTION LISTING
VIII. A. NUMBER OF HOUSEHOLD EXPENDITURE DURING PREVIOUS MONTH: Rp. ………………..
III. B. USED OF FOODS, DRINKS, TOBACCO AND KEROSENE DURING PREVIOUS WEEK AND FINISHED ON : ……………………
Local
Stan
Local
Price
Quan
Quan
Value
Serial
Detail
Local
Stan
Local
Price
Unit
dard
unit
per
tity in
tity in
in Rp. numUnit
dard
unit
per
Unit
conver
local
local
stan
ber
Unit
conver
local
ted to
unit
unit
dard
ted to
unit
standar
Rp.
unit
standard
Rp.
d unit
unit
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(1)
(2)
(3)
(4)
(5)
(6)
f. Vegetables
Kg
0430
Spinach
Kg
0440
Swamp cabbage
Kg
0450
Cabbage
Kg
0460
“Petsai” (mustard)
0470
String beans
0480
Peas
0490
Legume
0500
Tomato
0510
Radish
0520
Carrot
0530
Cucumber
0540
Cassava leaves
Quan
tity in
local
unit
Quan
tity in
stan
dard
unit
Value
in Rp.
(7)
(8)
(9)
Ham
0312
0320
0330
0340
0350
0360
0140
0371
0372
2. other
Preserved meat
Other meat
Chicken meat
Kg
Kg
Unit
Other poultry meat
Sub-total d.
e. Egg, milk and dairy
products
1. Chicken
Egg
2. Other
Unit
0381
1. pure milk
Pieces
0550
Egg plant
Liter
Kg
0560
0570
0580
0590
0600
Bean sprout
Gourd
Shallot
Garlic
Red chili
Kg
0610
Small chili
Kg
Kg
0620
Other (…………….)
0630
Sub-total f.
Pieces
Liter
Milk liquid
0382
0390
0401
0402
0410
0420
2. factory milk
Sweeten condensed milk
(‘indomilk’ ‘cap bendera’)
1. milk for baby
Powder milk
2. regular milk
Dairy products (cheese, etc)
Sub-total e.
16
17
Serial
number
(1)
0640
0650
0660
0670
0680
0690
0700
0710
0720
0730
0740
0750
0760
0770
0780
VIII. HOUSEHOLD EXPENDITURE/CONSUMPTION LISTING
VIII. A. NUMBER OF HOUSEHOLD EXPENDITURE DURING PREVIOUS MONTH: Rp. ………………..
III. B. USED OF FOODS, DRINKS, TOBACCO AND KEROSENE DURING PREVIOUS WEEK AND FINISHED ON : ……………………
Detail
Local
Stand
Local
Price
Quan
Quan
Value
Serial
Detail
Local
Stan
Local
Price
Unit
ard
unit
per
tity in
tity in
in Rp. numUnit
dard
unit
per
Unit
conver
local
local
stan
ber
Unit
conver
local
ted to
unit
unit
dard
ted to
unit
standard
Rp.
unit
standard
Rp.
unit
unit
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(1)
(2)
(3)
(4)
(5)
(6)
g. Pulses
0790
“Rambutan” (with a
stem)
Peanut
Kg
Mung bean
Kg
0800
Lanzon
Kidney bean
Kg
0810
Durian
Soybean
Kg
0820
Snake fruit
Lima bean
Kg
0830
Pinapple with stem
Tofu
0840
Banana
Fermented soybean cake
Kg
0850
Papaya
Fermented soybean sauce
Kg
0860
Rose-apple
Ounce
“Oncom” Fermented
0870
Guava
peanut expeller cake
Other (……………)
Kg
0880
Sapodilla
Sub-total g.
0890
Star fruit
h. Fruits
0900
“Kedondong”
Orange
Mango
Apple
Avocado
Kg
Kg
Kg
KG
0910
0920
0930
Quan
tity in
local
unit
Quan
tity in
stan
dard
unit
Value
in Rp.
(7)
(8)
(9)
Watermelon
Other (……………..)
Sub-total h.
18
19
Serial
number
(1)
0940
0950
0960
0970
0980
0990
1000
1010
1020
1030
1040
1050
1060
1070
1080
1090
1100
1110
VIII. HOUSEHOLD EXPENDITURE/CONSUMPTION LISTING
VIII. A. NUMBER OF HOUSEHOLD EXPENDITURE DURING PREVIOUS MONTH: Rp. ………………..
III. B. USED OF FOODS, DRINKS, TOBACCO AND KEROSENE DURING PREVIOUS WEEK AND FINISHED ON : ……………………
Detail
Local
Stan
Local
Price
Quan
Quan
Value
Serial
Detail
Local
Stan
Local
Unit
dard
unit
per
tity in
tity in
in Rp. numUnit
dard
unit
Unit
conver
local
local
stan
ber
Unit
conver
ted to
unit
unit
dard
ted to
standard
Rp.
unit
standard
unit
unit
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(1)
(2)
(3)
(4)
(5)
i. Other consumption
j. Prepared food
Bottle
Ounce
Salt
1120
Syrup
700cc
Ounce
1130
Soda pop, coca cola,
Bottle
Pepper
Ounce
Fanta, etc
350cc
Fish paste/shrimp paste
Bottle
Soy sauce
1140
Bread, biscuit, etc
350cc
1150
Prepared food and drink
which eaten at home
Coconut
Unit
Cooking oil
Liter
1160
Prepared food and drink
Ounce
which eaten outside
Butter
home
Ounce
Fat oil
Ounce
Sugar brown
1170
Sub-total j.
Ounce
Granulated sugar
k. Alcohol beverages
Ounce
Bottle
Tea
1180
Bier
700cc
Ounce
Coffee
Ounce
Powder chocolate
1190
Other (……………..)
Bottle
700cc
Ounce
Crisp (crisp chip, shrimp
1200
Sub-total k.
crackers, etc)
l. Tobacco, betel
Noodle, wheat & rice
noodle
Ounce
Monosodium glutamate
(“sasa”, “miwon”, etc)
Other (…………….)
Sub-total i.
Ounce
Ounce
1210
1220
Menthol Cigarettes
Clove cigarettes
1230
Cigar
1240
1250
1260
1270
1280
Tobacco
Betel leaves/areca nut
Other (……………….)
Sub-total l.
Kerosene
Price
per
local
unit
Rp.
Quan
tity in
local
unit
Quan
tity in
stan
dard
unit
Value
in Rp.
(6)
(7)
(8)
(9)
Pack
20 bars
Pack
10 bars
Pack
10 bars
Ounce
liter
20
21
Serial
number
(1)
1.
2.
3.
4.
5.
6.
7.
Type of expenses
(2)
Cereals and its products
Tuber and its products
Fish and other fish products
Meat
Egg, milk and dairy products
Vegetables
Pulses and its products
8.
Fruits
VIII. C. SUMMARY OF HOUSEHOLD EXPENSES
During a week
Serial
Type of expenses
Rp.
number
(3)
(1)
(2)
(Block VIII B a)
9.
Other consumption
(Block VIII B i)
(Block VIII B b)
10.
Prepared food
(Block VIII B j)
(Block VIII B c)
11.
Alcohol beverages
(Block VIII B k)
(Block VIII B d)
12.
Betel tobacco
(Block VIII B l)
(Block VIII B e)
13.
Total (1 to 12)
(Block VIII B f)
14.
Total expenses for food (1 to 12) x 30/7
(Block VIII B g)
15.
Kerosene
(Block VIII B detail
1280)
(Block VIII B h)
16.
Total monthly expenses
(Block VIII A)
During a week
Rp.
(3)
22