LISTING I.2: HOUSEHOLD LISTING
Confidential
I. LOCATON IDENTIFICATION
1. Province:
2. District/Municipality:
Rural area -2
II. ENUMERATION PARTICULARS
1. Name of enumerator:
2. Date of enumeration:
3. Signature of enumerator:
Statement from Supervisor that this list
has been verified/examined:
3. Sub-district:
4. Village:
4. Name of Supervisor:
5. Date of Supervision:
5. Selected enumeration area number:
6. Signature of supervisor:
6. Selected Census block number:
IV. N O T E
III. SUMMARY
1. Number of Households:
a. Cultivating farm land
b. Not cultivating farm land
2. Number of husbandry households:
3. Sample interval:
a. Susenas: …….. b. Livestock:………..
4. Number of selected household
a. Susenas: …….. b. Livestock:………..
5. Number of ‘ubinan’ (plots/parcels)
a. Rice padi:……. e. Sweet potato: …
b. unirrigated
f. Peanut: ……….
rice field: …… g. Soybean: ……
c. Corn:………… h. Total: ……….
d. Cassava:……..
V. HOUSEHOLD LISTING
Serial
number
of
construc
tion
Type of
construction:
Dwelling
-1
Non dwelling -2
Both
-3
Serial
number
of
house
hold
Name
of
House
hold
head
Number
of house
hold
mem
bers *)
(1)
(2)
(3)
(4)
(5)
*) Including Household head
Number of livestock
Dairy
cow
Cattl
e
Buffalo
Horse
Goat
Sheep
Pig
Selection of sample
husbandry/livestock
household
Big
Small
livestock livestock
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
V. HOUSEHOLD LISTING
Do you
cultivated
agricultural land?
Yes
No
If “yes”
amount of
land
cultivated
Serial
numbe
r of
land
Rice
field
-1
Dry
land
-2
Number
of plots
in each
section
of land
Rice plant/ palawija
(secondary crops) which
will be harvested between
January – April, 1980
Number Estima
Type
of plots ted
of
month
which
plant
of
(elabor will be
harvest
harvest
ate)
Selection of plot
Rice
field
Dry
rice
field
Corn
Cassava
Sweet
potato
Peanut
1. Mark O at column (3) for selected SUSENAS households
2. Mark  at column (3) for selected livestock households
3. Copy the serial number of household, name of household head, etc which
‘ubinan’ selected to I.3 LIST, Block II
Soybean
LISTING II: DEMOGRAPHY, LABOUR FORCE, AND CHILDREN’S HEALTH
Urban area -1
Rural area -2
Confidential
I. LOCATION IDENTIFICATION
1. Province
2. District/Municipality
3. Sub-district
4. Village
5. Selected Enumeration Area Number
6. Selected Census Block Number
7. Sample Code Number
8. Building/construction Serial Number
9. Selected Household Serial Number
10. Name of Household Head
11. Number of Household members
12. Number of Household members aged 10 years and older
II. ENUMERATION PARTICULARS
1. Name of Enumerator
2. Date of Enumeration
3. Signature of Enumerator
Statement of Supervisor that this list has been checked/examined
4. Name of Supervisor
5. Date of Supervision
6. Sign of Supervisor
III. N O T E
Serial
number
(1)
01
02
03
04
05
06
07
08
09
10
11
12
Name of
Household
members
(2)
Relation to the Head
of household:
Head of hh
-1
Wife
-2
Children
-3
Son/daughter
-4
in-law
Grandchild
-5
Parent
-6
Parent in-law
-7
Relative
-8
Others
-9
Servant
-0
(3)
Gender:
Male
-1
Female -2
(4)
IV. HOUSEHOLD MEMBERS LISTING
Age
For aged 10 years and older
(in years) Education completed:
Looking for If column
Primary activity
work?
(7) not
No schooling
-1
during previous
Yes
-1
coded 1 and
Not/not yet
-2
week:
-2
Working
-1 No
2, during
completed
Temporarily -2
previous
primary school
not working
week did
Primary school
-3
Attending school3
you work at
Junior high
-4
Taking care of
least 1 hour
School
household
-4
per day?
Vocational Jr.
-5
Yes
-1
Retired,
-5
high school
No
-2
Disabled
Senior high
-6
Others
-6
School
Vocational
-7
senior high
school
Academy
-8
Univ.
-9
(5)
(6)
(7)
(8)
(9)
If column (7)
coded……….
Field of work
(Write down……
(10)
Code
(11)
IV. HOUSEHOLD MEMBERS LISTING (CONTINUED)
For aged 10 years and above
Type of work
(Write down
clearly, what your
daily tasks at your
main job)
(12)
Code
(13)
Work status:
Worker/
-1
Employee
Self-2
Employed
without workers
Self
-3
Employed
with
workers
Family
-4
worker without
pay
(14)
Number of
hours
worked
during the
previous
week
(15)
Salary/wage received during
previous month from all
jobs (Rp)
Do you
have any
additional
jobs?
Yes
-1
No
-2
If “yes”
total work
hours at
additional
job?
Did you
work as a
worker/
employee
during the
previous
month
Yes
-1
No
-2
If “yes” what kind of
work did you have to
do as a worker/
employee?
(Write down clearly,
and if it is the same as
column (12), just
write “SAME”
Cash/
money
In kind
(16)
(17)
(18)
(19)
(20)
(21)
Total
(22)
V. HEALTH CONDITION OF CHILD AGED UNDER 10 YEARS OLD
Serial
numb
er of
house
hold
memb
ers as
per
col.
(1)
on
block
IV
Name
Age
(year)
Moth
er’s
serial
num
ber if
she
lives
in this
house
hold
What
is the
condit
ion of
the
child
During
previo
us
week,
did the
child
work
at least
1 hour
per
day?
Yes
-1
No
-2
Has the child
ever been
vaccinated?
Has the child ever gotten
other immunization?
Yes
-1
No
-2
Yes
-1
No
-2
(code)
(code)
(1)
(2)
(3)
(4)
(5)
If
‘yes’,
where
?
(6)
(7)
(8)
(9)
If ‘yes’
What
kind
of
injecti
on?
Where
?
(code)
(code)
(10)
(11)
Had the child been ill during the
previous year?
Yes
-1
No
-2
If ‘yes’
What
kind
of
illness
?
Did
he/she
go for
medic
al
treatm
ent?
If
‘yes’
where
did
he/she
go for
medic
al
treatm
ent?
Was the child
breast fed as a
baby?
Yes
-1
No
-2
If
‘yes’,
for
how
many
months
?
For children under 12 years old
What kind of other food was usually
given to that child at
0-3
3–6
6 – 12
12-23
months
months
months months
(code)
(12
)
(13)
(14)
(code)
(15)
(16)
(17)
(18)
(19)
(20)
(21)
CODE LIST:
Column (5)
Blind
Mute/deaf
Disabled
Mentally disabled
Normal
-1
-2
-3
-4
-5
Column (8) and (11)
Puskesmas/supporting
Puskesmas (BP/BKIA)
Hospital
Village meeting hall,
Neighborhood, school
Others
-1
-2
-3
-4
Column (10)
BCG
-1
DPT
-2
Chotypa
-3
TCD
-4
Other
-5
TT
-9
Column (13)
Fever
Diarrhea/vomitting
Skin/swollen skin
Ears disease
Eyes disease
Injury, accident
Goiter disease
Others
-1
-2
-3
-4
-5
-6
-7
-8
Column (15)
Puskesmas/supporting
Puskesmas (BP/BKIA)
Hospital
Doctor’s private practice
Midwife or other paramedics
who has a practice
Traditional healer
Own treatment
-1
-2
-3
-4
-5
-6
Column (18) to (21)
“Tim rice” (rice and
vegetables)
Cow’s milk, baby
formula
Fruits
Biscuit
Rice/porridge made
from rice, corn flour
Mung bean porridge
oat porridge
Meat, chicken liver,
Fish, egg
Vegetables
Others
-a
-b
-c
-d
-e
-f
-g
-h
LISTING III: HOUSEHOLD EXPENDITURE AND CONSUMPTION CHARACTERISTICS
Urban area -1
Rural area
-2
Confidential
I. LOCATION IDENTIFICATION
1. Province
2. District/Municipality
3. Sub-district
4. Village
5. Selected Enumeration Area number
6. Selected Census Block number
7. Sample Code Number
8. Building Serial number
9. Selected Household serial number
10. Name of Household head
11. Number of Household members
II. ENUMERATION PARTICULARS
1. Name of enumerator
2. Date of enumeration
3. Signature of enumerator
Statement from Supervisor that this list has been checked/examined
4. Name of supervisor
6. Signature of supervisor
III. N O T E
LISTING III: Page 2
Seri
al
Num
ber
(1)
0010
0020
0030
0040
0050
0060
0070
0080
0090
0100
0110
0120
…
Detail
(2)
a. Cereal and its
products
Rice, free market
Rice, own production
Glutinous rice
Rice products
Wet corn with skin
Dry corn with skin
Dry shelled corn
Corn flour
Wheat flour
…………………
Sub-total a
b. Tuber and its
products
Cassava
Loca Stan
dard
l
Unit Unit
(3)
(4)
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Conver
sion
local
unit to
standar
d unit
(5)
Price
of
local
unit
Rp
Quant
ity in
local
unit
Quant
ity in
stand
ard
unit
(6)
(7)
(8)
Va
lue
in
Ru
pi
ah
(9)
Seri
al
num
ber
Detail
(1)
(2)
0140 Cassava flour
(Tapioca, etc)
0150 Sweet potato
0160 Potato
0170 Taro
0180 Sago (not from cassava,
eg Ambon sago)
0190 ……………………
0200 Sub-total b
c. Fish and its product
0210 Fresh sea water fish
0220 Fresh water fish
0230 Salted fish and Dried fish
0240 Canned fish
0250 Shrimp, crab, squid, etc
0260 ……………………..
0270
Local
Unit
Stand
ard
Unit
(3)
Kg
(4)
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Convers
ion from
local
unit to
standard
unit
(5)
Price
of
local
unit
Rp
Quant
ity in
local
unit
Quant
ity in
standa
rd
unit
(6)
(7)
(8)
Va
lue
in
Ru
pi
ah
(9)
Seri
al
Num
ber
Detail
(1)
(2)
Loca Stan
l
dard
Unit Unit
(3)
(4)
Conver
sion
local
unit to
standar
d unit
(5)
Price
of
local
unit
Rp
Quant
ity in
local
unit
LISTING III: Page 3
Quant Va Seri
lue al
ity in
in
num
stand
Rp. ber
ard
unit
(6)
(7)
(8)
(9)
(1)
d. Meat
1. Beef
2. Other
1. meat
Buffalo
2. Other
1. lamb
Goat
2. Other
1. ham
Pig
2. Other
Preserved meat
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Kg
0330
0340
0350
0360
Other meat
Chicken meat
Other poultry meat
Sub-total d
e. Egg, dairy products
Kg
Unit
Unit
0371
0372
0381
0382
0390
Egg
Unit
Unit
Liter
Liter
Kg
0401
0402
0410
1. Chicken
2. Other
1. Pure
Milk
2. Factory
Condensed Milk
(Indomilk, Bendera, etc)
Powdered 1. Baby
Milk
2. Other
Milk product
(2)
Local
Unit
Stand
ard
Unit
Convers
ion local
unit to
standard
unit
Price
of
local
unit
Rp
Quant
ity in
local
unit
Quant
ity in
standa
rd
unit
Va
lue
in
Rp
(3)
(4)
(5)
(6)
(7)
(8)
(9)
f. Vegetables
0281
0282
0291
0292
0301
0302
0311
0312
0320
Cow
Detail
Kg
Kg
kg
0430 Spinach
Kg
0440 Water spinach
Kg
0451 Mustard green
Kg
0471 Peas
Kg
0490
0500
0520
0530
0540
0550
0560
0580
Kg
Kg
Kg
Kg
Kg
Kg
Kg
Ounce
Green beans
Tomato
Carrot
Cucumber
Cassava leaf
Eggplant
Soya bean sprouts
Shallot
0590 Garlic
0600 Red chili
0610 Small chili
……………………
…………………..
Ounce
Ounce
Ounce
Kg
Kg
LISTING III: Page 4
Seri
al
Num
ber
(1)
0640
0650
0660
0670
0680
0690
0700
0710
0720
0730
0740
0750
0760
0770
Detail
(2)
g. Pulses
Peanut
Mungbean
Kidney beans
Soybean
Lima bean
Tofu
Tempe/fermented
soybean cake
Fermented soybean
paste
Oncom/soya bean
sediment cake
……………….
Sub-total g
h. Fruits
Orange
Mango
Apple
Loca Stan
dard
l
Unit Unit
(3)
(4)
Conver
sion
from
local
unit to
standar
d unit
(5)
Detail
Price
of
local
unit
Rp
Quant
ity in
local
unit
Quant
ity in
stand
ard
unit
Va
lue
in
Rp
Seri
al
num
ber
(6)
(7)
(8)
(9)
(1)
(2)
0790 “Rambutan”
Local
Unit
Stand
ard
Unit
Convers
ion from
local
unit to
standard
unit
Price
of
local
unit
Rp
Quant
ity in
local
unit
Quant
ity in
standa
rd
unit
Va
lue
in
Rp.
(3)
(4)
Kg
(5)
(6)
(7)
(8)
(9)
Kg
Kg
Kg
Kg
Kg
Kg
Kg
0800 Lanzon
Durian
0810 Snake fruit
0820 Pineapple (with the stem)
0830 Banana
0840 Papaya
Kg
Kg
Kg
Kg
Kg
0850 Roseapple (jambu air)
Kg
Kg
0860 Guava
Kg
Kg
Kg
0870 “Sawo”
0880 Star fruit
0890 “Kedondong”
Kg
Kg
Kg
0900 Water melon
0910 ……………………….
Kg
Kg
Kg
Kg
0930 Sub-total h
Kg
LISTING III: Page 5
Detail
Seri
al
Num
ber
(1)
0960
0970
(2)
i. other consumables
Salt
Pepper, nutmeg, clove,
caraway seed, cinnamon
Fish paste, shrimp paste
Soybean sauce
0980
Coconut
0990
1000
1010
Coconut oil
Butter
Candle nut, ginger
galangale, turmeric
Brown sugar
Granulated sugar
Tea
Coffee
Cocoa powder
Shrimp/fish crackers
Noodle
Rice noodle
Monosodium glutamate
………………………
Sub-total i
0940
0950
1020
1030
1040
1050
1060
1070
1081
1082
1090
1110
Loca Stan
dard
l
Unit Unit
(3)
(4)
Conver
sion
from
local
unit to
standar
d unit
(5)
Price
of
local
unit
Rp
Quant
ity in
local
unit
Quant
ity in
stand
ard
unit
Va
lue
in
Ru
pi
ah
Seri
al
num
ber
Detail
(6)
(7)
(8)
(9)
(1)
(2)
j. Prepared foods
Syrup
Coca cola, soda pop,
Fanta
Bread, biscuit
Prepared foods and drinks
Ounce
1120
1130
Ounce
Bottle
(350cc
Unit
1140
1150
Liter
Ounce
Ounce
Ounce
Ounce
Ounce
Ounce
Ounce
Ounce
Ounce
Ounce
Loca
l
Unit
Standar
d Unit
Convers
ion from
local
unit to
standard
unit
Price
of
local
unit
Rp
Quant
ity in
local
unit
Quant
ity in
standa
rd
unit
Va
lue
in
Ru
pi
ah
(3)
(4)
Bottle
700 cc
Bottle
350cc
(5)
(6)
(7)
(8)
(9)
1160 Prepared foods and drinks,
home/cottage industry
1170 Sub-total j
k. Alcoholic beverages
1190 Beer
1190 …………………….
1200 Sub-total k
l. Tobacco, betel
1210 White tobacco cigarettes
1220 Clove cigarettes
1240 Tobacco
1250 Betel, areca nut, etc
……………………..
……………………
1270 Sub-total l
Bottle
700 cc
Botlle
Pack
20 pcs
Pack
20 pcs
Ounce
LISTING III: Page 6
V. EXPENDITURE FOR HOUSING, ELECTRICITY, WATER
DURINGTHE PREVIOUS MONTH
Serial
number
(1)
1280
1290
1300
1330
1340
1351
1352
1360
1370
1380
1390
1400
1410
1420
Serial
number
(1)
1430
1441
1460
1471
1472
Serial
Detail
Value (Rp)
number
(1)
(2)
(3)
Detail
Quantity Value (Rp)
1480
School expenses (school fee, donation,
Stationary, books during previous year)
(2)
(3)
(4)
1491
Course costs, newspaper, magazines, book and
Is this house your own property/rent free?
stationary (outside of school needs) incl. rent for
Yes
-1
No
-2
textbooks and reading books.
If ‘Yes’, estimate monthly rent?
If ‘No’, monthly rent:
1520
Transportation costs (inc. gasoline, maintenance)
Expenses for house maintenance (painting, etc)
1530
Cinema, theatre, sport and other recreations
during the previous year Rp…………………
1540
Servant
Electricity: 1. Meter…………………Kwh
1550
Others (stamps, telegram, camphor, mosquito
2. Subscription:……………watt
repellent, etc)
Gas: ………….m3
1560
Total
Elpiji (Liquid Propane Gas): ……………..kg
VII. EXPENDITURE FOR CLOTHING, HEAD GEAR, FOOTWEAR
DURING PREVIOUS MONTH
Kerosene:……………….liter
Gasoline, lubricant, repair and maintenance of
Serial
Detail
Value (Rp)
generator
number
Charcoal:…………..kg
(1)
(2)
(3)
Firewood
1571
Ready to wear cloth (shirt, T-shirt, jacket, gown,
Sarong, skirt, under wear, etc) during previous
Water
year
Other (battery, dry cell battery, matches, candle,
lamp)
1601
Clothing fabrics (famatex, wool, tetoron, popline, paris, caterina, etc) previous year..Rp….
Total
VI. EXPENDITURE FOR GOODS & SERVICES
1630
Costs for tailoring & repair of clothes previous
DURING THE PREVIOUS MONTH
year Rp…………..
Detail
Value Rp) 1641
Footwear (shoes, sandal, socks, etc) for previous
year
Rp…………………
(2)
(3)
1670
Head gear (hat, rimless cap) for previous year.
Rp…………….
Bathing soap, toothpaste, tooth brush, shampoo
Cosmetics, skin, face, hair treatments
1690
Washing soap/powder soap (‘Cap tangan’, B 29,
'Rinso’, ‘Dino’, etc)
Rp………………
OTC medication (Bodrex, Rheumason, Kayu Putih oil,
mercurochrome)
1710
Others (thread, laundry, towel, belt, shoe polish,
etc) of previous year
Rp…………..
Medical treatment and medication costs (incl. medication)
1. Doctor, nurses and other paramedics, during previous year:
1730
Total
Rp……………..
2. Traditional healers during previous year:Rp………………….
VIII. EXPENDITURE FOR DURABLE GOODS, TAXES, FESTIVITIES AND
CEREMONIES DURING PREVIOUS MONTH
Serial
number
1730
Detail
a. Durable goods
Furniture and household equipment (table, chair, cupboard,
Mattress, blanket, iron, broom, scissors, knife) during
previous year
Rp………………….
Kitchen utensils and eating utensils (stove, pan, plate, glass,
spoon, set of stacked containers, washbasin, and other breakable
utensils Rp………………….
Repairing of household furniture, utensils and equipment during
previous year
Rp………………….
Wristwatch, clock, camera, umbrella, bag, toys and similiar,
during previous year
Rp…………………..
Gold, diamond, pearl, etc, during previous year Rp………..
Entertainment & sport equipment’s (TV, radio, cassette player,
guitar, chess, racket, ball, etc) during previous year Rp……..
Vehicle (bicycle, motor cycle, car) previous year Rp……..
Other durable goods (wall decoration, aquarium, etc) during
previous year Rp……………………
Total a
b. Tax & insurance premiums
(‘Ipeda/Ireda’, radio, TV, vehicle taxes, donation, fireinsurance premium, etc) previous year
Rp………….
b. Festivities and ceremonial needs
(Marriage, circumcisions, religious festival, traditional
ceremony & burial) previous year
Rp………….
Value
(Rp)
IX. SUMMARY OF HOUSEHOLD EXPENDITURES
(In Rupiah)
Serial
number
(1)
1990
01
Expenditure
category
(2)
Cereals
(IV a)
02
03
Tuber
Fish
(IV b)
(IV c)
04
05
06
07
08
09
Meat
(IV d)
Egg, milk (IV e)
Vegetables (IV f)
Pulses
(IV g)
Fruit
(IV h)
Other
(IV I)
Consumption
Within
a week
(3)
Serial Expenditure
number category
(1)
(2)
14
Sub-total (11 to
12) X 30/7
15
16
10
11
12
13
Prepared food
(IV j)
Alcoholic
beverages (IV k)
Tobacco, betel
(IV l)
Sub-total (11 to
12)
17
Housing, fuel
(V)
Goods & service
(VI)
Clothing, foot
wear, head gear
(VII)
18
Durable goods
(VIII a)
19
Taxes and
Insurance (VIIIb)
20
Festivities & cere
monies (VIIIc)
Monthly expen
ditures (14 to20)
21
22
Monthly income
(from Listing IV,
Block XVI,
detail 16
Within a
month
(3)
LISTING IV: CHARACTERISTICS OF HOUSEHOLD BUSINESS/ACTIVITY, INCOME AND REVENUE
Urban
Rural
Confidential
I. LOCATION IDENTIFICATION
1. Province
2. District/Municipality
3. Sub-district
4. Village
5. Selected Enumeration area number
6. Selected Census Block number
7. Sample Code Number
8. Serial number of building
9. Selected household serial number
10. Name of household head
11. Number of household members
II. ENUMERATION PARTICULARS
1. Name of enumerator
2. Date of enumeration
3. Signature of enumerator
Statement that this list has been
verified/examined:
4. Name of supervisor
5. Date of supervision
6. Signature of Supervisor
III. ENUMERATION CHARACTERISTICS
1. Source of household business income
Business
Last month Last year
Type of business/activity
Private -1
Yes
-1
Yes
-1
Partnership
No
-2
No
-2
-2
(1)
a. Agriculture
b. Husbandry
c. Fishery, Forestry, Hunting
d. Manufacturing/handicraft
e. Transportation
f. Services
g. Trade
h. Other (quarrying & construction)
2. In addition to the income from household
activity above, do you have any other income
and revenue sources?
Source of income
(1)
a. Wage/salary received as a
worker
b. Pension
Last month
Yes
-1
No
-2
(2)
c. Rental (land, building, goods,
etc)
d. Interest received
e. Others
4. If ‘Never” received credit, do you need credit?
5. If “yes”, what is the amount needed?
6. From the answers to question 1 and 2, please specify
the main source of income
(2)
(3)
(4)
-1
-2
If code “2” at
column (4)
% ownership of
capital
(5)
3. If code “1” on column (2) or (3)
in question 1 above, have you ever
received credit (loan) from other party?
Yes
-1
No
-2
Last year
Type of
Amou Monthly
Yes
-1
Credit source
nt
Interest
No
-2
(Rp)
(Rp)
(3)
(1)
(2)
(3)
a. Permanent Capital
loan
b. Small Investment
loan
c. Loan for small
middlemen
d. Bank, State Pawn
e. Other (cooperative,
Individual, etc)
: Yes
-1
No
-2
: Rp……………………..
: …………………………………
: ………………………………….
LISTING IV: Page 2
IV. OWNERSHIP/CONTROL OF AGRICULTURE LAND (TO BE ASKED TO ALL SELECTED HOUSEHOLDS)
A. LAND UNDER POSSESSION/CONTROL
Yes
-1
No,
-2
1. Is there any land that is under the possession of the head/members of household?
2. If “yes” how big is that land?
Number of sections: Rice field ……………….. Dry land: ……………………….
Type of land possession
Rice field surface area (0.00 Ha)
Dry land area (0,00 Ha)
Not irrigated Amount of
Yard land
Farming land Other dry
Irrigated rice field
Rice fields
land
All year
Not 1 full year rice field
a. Owned Land
b. Adat land
c. “Bengkok’ land
d. Other land in control
e. Total area (a+b+c+d)
Amount of
dry land
Amount of
dry + rice
field land
B. LAND THAT IS OWNED BY HOUSEHOLD BUT THAT IS CULTIVATED BY OTHERS
Yes
-1
1. Are all the lands that is registered above cultivated by the household itself?
2. If not, what control status of the land?
Rice field
Dry land
Amount
Status land that is owned/
Irrigated
Without Amount Yard land Agricultu Other Amount of dry
controlled by household but
irrigation of rice
re land
dry
of dry land and
All year Not 1
cultivated by others
rice field
field
land
land
round
full year
(1)
a. Rented:
Land area (0,00 Ha)
Rent:
- If in cash (Rp/season)
- If % of production
b. Sharecropping:
Land area (0,00 Ha)
Owner’s “Saprodi” part (%)
Owner’s production part (%
c. ………………………….
Land area (0,00 Ha)
Exchange value (Rp)
d. Total land area
(a + b + c) (0,00 Ha)
(2)
(3)
(4)
Saprodi: Sarana Produksi Padi/Rice production tools/needs
(5)
(6)
(7)
(8)
(9)
(10)
No
-2
Who is working on the land?
Farmer Non
Company/
farmer plantation
(11)
(12)
(13)
Other
(14)
LISTING IV: Page 3
C. LAND THAT IS CULTIVATED BY HOUSEHOLD BUT NOT OWNED/CONTROLLED BY THEM
1. Is the head of the household or any household members working on agricultural land which is owned by others?
2. If yes, what is the status of the land, type of the land and where does the land come from?
Rice field
Dry land
Status of the cultivated land With irrigation
Without Rice field Yard land Farming Other Dry
that is now owned by the
land
irrigation area
land
dry
All year Not one
household
land area
full year
Yes
-1
No
-2
Rice
Origin of the land
field/dry Farmer Non
Company/
field area owner
Farmer plantation
owner
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
a. Leased:
Land area (0,00 Ha)
Lease:
If in cash (Rp/season)
If % of production
b. Sharecropping
Land area (0,00 Ha)
Cultivator’s Saprodi (%)
Cultivator’s production part
(%)
c. …………………………..
Land area (0,00 Ha)
Exchange value (Rp)
d. Total area (a+b+c) 0,00 Ha)
D. Total cultivated land area
(A.2a.B2d+C.2d)
V. AGRICULTURE ACTIVITIES (TO BE ASKED ONLY TO HOUSEHOLDS CULTIVATING AGRICULTURAL LAND)
(13)
Other
(14)
A. PLANTS HARVESTED DURING PREVIOUS YEAR
Type of plant
a. Rice plants
Irrigated Rice field
Unirrigated rice field
b. Secondary crops
Code
(CBS)
Number
of
harvest
seasons
Harvest Type of plant
area
(0,00 Ha)
Code
(CBS)
Number
of
harvest
season
Harvest Type of plant
area
(0,00 Ha)
c. Vegetables
e. Commercial plant
d. Fruits
f. Other plants
01
02
Code
(CBS)
Number
of
harvest
seasons
Harvest
area
(0,00 Ha)
LISTING IV: Page 4
B. HARVEST INFORMATION ( for those who had harvested during previous year)
Number 1 to 3 for all type of plants
1. Who harvested?
Rice field Gogo rice ……….
Type of plants
………
……….
……….
……….
a. Harvested by the household themselves
b. Tebas: pre-sold Harvest area (0,00Ha)
harvest yield
Value of tebas(Rp)
c. Ijon , pre-sold Harvest area (0,00Ha)
rice before
Value of ijon(Rp)
harvest
Total area (0,00 Ha)
If cash (Rp)
If by production/bawon share
2. If harvested by yourselves
a. What was the wage for harvest
per person/day?
Free market
-1 Cooperative/
-2
b. Where is the harvest to be
-3 BUUD/KUD
-4
marketed? (Specify market by priority) Middleman/
Trader
Few hours after harvested
-1
c. When is the main harvest to be
When need cash
-2
marketed?
When the price very good
-3
d. Did the harvest workers have any
ties with other activities pertaining Yes
-1
No
-2
to that harvest?
3. If harvest was pre-sold:
The cost of harvest too expensive
-1
a. What is the reason to pre-sell?
Practical
-2
Need cash
-3
b. Did the farmer join the harvest? Yes
-1
No
-2
c. If 3b “yes” , what was the wage If in cash (Rp)
per person/day?
If with production/’bawon’ (share)
Cut down with a sickle -1 with ‘ani-ani’ -2
4. Specifically for rice field harvest:
-3
a. If harvested by yourself, how did Other
you do that?
b. If it was pre-sold, how did you
Cut down with a sickle -1 with ‘ani-ani’ -2
harvest?
Other
-3
c. If harvested by yourself, in what Rice -1 unhulled paddy -2
paddy -3
form was the production sold and at
Price of rice/unhulled paddy/paddy* per
what price?
‘kwintal’
* cross out inapplicable category
C. ADDITIONAL INFORMATION:
1. For agriculture activities, do you used external fund
sources?
Yes
-1
No
-2
If “yes” , where did the fund come from?
‘BIMAS’ project
Cooperative/BUUD/
KUD
d. If selling in the form of rice, how Pounded -1, own mill -2, gave to mill -3
was the rice produced
Cost of milling (Rp/’kwintal’)
“Ijon” = sell rice long before the harvest;
“Ani—ani” = small palm-held reaping knife for cutting rice stalks;
“bawon” = share of rice harvest received for oneself service during harvesting
-1
-2
1 Kwintal = 100 kg;
Middleman/trader -3
Other
-4
LISTING IV: Page 5
D. HARVEST AREA, PRODUCTION AND EXPENSES
Type of plants
DETAIL
(2)
(1)
1. Harvest season:
“Rendengan”
-1 Other -3
“Gadu”
-2
2. Control of land/land status:
Possession
-1 sharecroping -3
Rented
-2 Other
-4
3. Type of seed
VUTWI (PB/IR 26, 28, 30, Asahan
Brantas, Serayu, Citarum)
-1
VUTWII (PB/IR 32, 36, 38)
-2
VUB (C4, Pelita, PB5, 6, etc)
-3
Unggul Nasional
-4
Local
-5
Non Paddy
-6
4. Intensification that is followed
Specific
Public
Intensification
Intensification
Original ‘Bimas’-1 Orig. ‘Bimas’ -5
New ‘Bimas’
-2 New ‘Bimas’ -6
Original ‘Inmas’ -3 Orig. ‘Bimas’ -7
New ‘Inmas’
-4 New ‘Bimas’ -8
’Polowijo’ intensification
Non Intensification
5. Harvest area (0,00 Ha)
(Number of trees for annual plants)
6. Harvest situation
Good -1 Normal -2 Unsatisfactory-3
7a. Ever have been attacked (pests)?
Yes
-1
No
-2
b. If ‘yes’ elaborate type of attack:
8. Type of production
Kg
9. Production (including that for land
rent, share cropping, ‘bawon, etc)
Rp
Type of plants
(3)
(Continued of expenses)
(1)
11. Amount/value of chemicals
a. Insecticide ……………..
b. Others………………….
12. Amount/value of fertilizer
a. Factory/Chemical fertilizer
b. Manure
c. Other fertilizer
(2)
Kg
(3)
Rp
Kg
Rp
13. Tractor/animal
14. Irrigation expenses:
a,. Donation for irrigation
b. Repair/maintenance of
waterways
15. Workers/worker’s wage
a. To hoe
b. To plow (without animal/tools)
c. To plant
d. Clear away
e. Harvest
f. Others
16. Other expenses:
a. Tax (for agriculture)
b. Repairs/maintenance of
tools
c. Transportation expenses
d. Others expenses
Kg
Rp
Expenses:
10. Amount/seed value being used
a. From buyers
b. From own product
Rendengan : planted in rainy season Padi gadu : wet field rice
17. Total expenses (Rp)
18. Expenses production (Rp)
19. Supplementary production (Rp)
20. Damage/lost (Rp)
21. Income (Rp.)
Number of
unpaid
worker x
day
Number of paid worker
Number
Wage paid
of worker x (Rp)
day
Total wage of workers
Number of
unpaid
worker x
day
Number of paid worker
Number
Wage paid
of worker x (Rp)
day
Total wage of workers
LISTING IV: Page 6
VI. HUSBANDRY ACTIVITIES
A. Livestock
A1. Production and livestock utilization during the previous year
Detail *)
(1)
Type of livestock
Type of livestock
Quantity Value (Rp) Quantity
Value (Rp)
(unit)
(unit)
(2)
(3)
(4)
(5)
1. Quantity at time of enumeration
2. Quantity previous year
3. Births/additions
4. Purchased
5. Received from others
6. Lost/died/damaged
7. Sold/exchanged with goods or service
8. Consumed/killed
9. Given to others
10. RECEIVED (7 + 8 + 9)
A3. Number of workers: a) Family workers
b) Permanent paid workers
………. people
……………….. people
B. Poultry
B1. Production and poultry utilization during previous month
Type of poultry
Type of poultry
Detail *)
Quantity
Value
Quantity
Value
(unit)
(Rp)
(unit)
(Rp)
(1)
(2)
(3)
(4)
(5)
1. Quantity at time of enumeration
2. Quantity previous year
3. Births/additions
4. Purchased
5. Received from others
6. Lost/died/damaged
7. Sold/exchanged with goods or service
8. Consumed/killed
9. Given to others
10. RECEIVED (7 + 8 + 9)
B3. Number of workers: a) Family workers
………. people
Side production
(milk, skin,
fertilizer) (Rp)
(6)
A2. Livestock breeding expenses during previous month (Rp)
1. Wage/salaries paid
2. Animal feed
3. Medications
4. Electricity, gas, lubricant oil, etc
5. Maintenance of facilities
6. Transportation costs
7. Others (tax, rental space, etc)
8. TOTAL EXPENSES (1 to 7)
9. Monthly revenue:
1/12 (detail 10 part A1 col. (3) + (5) + (6)
10. INCOME (9 – 8)
B2. Poultry breeding expenses of during previous month (Rp)
Side production (egg 1. Wage/salaries paid
feather, etc)
2. Poultry feed
(6)
3. Medication
4. Electricity, fuel, lubricant oil, etc
5. Maintenance of facility
6. Transportation expenses
7. Others (tax, rental space, etc)
8. TOTAL EXPENSES (1 to 7)
9. Monthly revenue:
1/12 (detail 10 part B1 col. (3) - (5) - (6)
b) Permanent paid workers
……………….. people
10. INCOME (9 – 8)
LISTING IV: Page 7
VII. FISHERY, FORESTRY AND HUNTING ACTIVITIES
FISHERY
FORESTRY
HUNTING
Value (Rp)
(2)
Value (Rp)
(3)
Value (Rp)
(4)
DETAIL
(1)
A. Production and utilization during previous month
1. Production obtained
2. Lost/ damage
3. Sold
4. Exchanged with goods/services
5. Household consumption
6. Business consumption
7. Paid in lieu of rent/ production sharing
8. Given to others, etc
9. RECEIVED (3 + 4 + 5 + 6 + 7 + 8)
B. Expenses during previous month
10. Fish feed
11. Fish food
12. Wage/salaries
13. Maintenance of facilities
14. Fuel, lubricant, etc
15. Transportation costs
16. Others (tax/ space rental, etc)
17. TOTAL EXPENSES (10 to 16)
18. INCOME (9 – 17)
C. Number of worker according to type:
19. Unpaid family workers
20. Paid permanent workers
…………… people
…………… people
…………… people
…………… people
…………… people
…………… people
TOTAL (2)+ (3) +(4)
(Rp)
(5)
LISTING IV: Page 8
VIII. Manufacturing/Handicraft Activities
A. Type of manufacturing/handicraft:……………….
A2. Expenses during previous month (Rp)
A1. Production (main, side) and utilization during previous month
Detail
(1)
1. Stock time of enumeration
2. Stock previous year
3. Production
4. Lost/damaged
5. Services produced
6. Sold
7. Exchanged goods or service
8. Household consumption
9. Business consumption
10. Given to others
11. RECEIVED (5 to 10)
A3. Number of workers: a) Family workers
………. people
Type of goods/
Services…….
Value (Rp)
Type of goods/
Services…….
Value (Rp)
Type of goods/
Services…….
Value (Rp)
Type of goods/
Services…….
Value (Rp)
(2)
(3)
(4)
(5)
1. Wage/salaries
2a. Raw material purchased
b. Raw material, own production
3. Electricity, fuel, lubricant oil, etc
4. Routine repairs and maintenance
5. Payment for services
6. Transportation costs
7. Others (tax, rental space, interest, packaging
etc)
8. TOTAL EXPENSES (1 to 7)
b) Permanent paid workers
……………….. people
B. Type of manufacturing/handicraft
B1. Production (main, side) and utility during previous month
9. INCOME = detail 11 part A1 col. (2+ 3 + 4
+ 5) – detail 8 part A2
B2. Expenses during previous month (Rp)
1. Wage/salaries
Detail
2a. Raw material purchased
(1)
1. Stock time of enumeration
2. Stock previous year
3. Production
4. Lost/damaged
5. Services produced
6. Sold
7. Exchanged goods or service
8. Household consumption
9. Business consumption
10. Given to others
11. INCOME (5 to 10)
B3. Number of workers: a) Family workers
………. People
(2)
(3)
(4)
(5)
2 b. Raw material, own production
3. Electricity, fuel, lubricant oil, etc
4. Routine repairs and maintenance
5. Payment for services
6. Transportation costs
b) Permanent paid workers
……………….. People
7. Others (tax, rental space, interest, packaging
etc)
8. TOTAL EXPENSES (1 to 7)
9. INCOME = detail 11 part B1 col. (2+ 3 + 4
+ 5) – detail 8 part B2
LISTING IV: Page 9
IX. TRANSPORTATION
DETAIL
(1)
A. Production.
1. Service produced
B. Expenses
2. Additional production materials
3. Wage/salaries
SERVICES PRODUCED AND EXPENSES DURING
PREVIOUS MONTH
Type of vehicle
Type of vehicle
Type of vehicle
……….
……….
……….
Value (Rp)
Value (Rp)
Value (Rp)
(2)
(3)
(4)
X. SERVICES SECTOR
SERVICES PRODUCED AND EXPENSES DURING
PREVIOUS MONTH
Type of service
Type of service
Type of service
……….
……….
……….
Value (Rp)
Value (Rp)
Value (Rp)
(1)
(2)
(3)
4. Maintenance of facilities
5. Electricity, fuel (gasoline, solar,
kerosene, etc), lubricant
6. Transportation costs (example:
transportation fee for production
equipment)
7. Animal feed (particularly for ‘delman
/sado’, wagon, etc)
8. Others (tax, renting space, etc)
9. TOTAL EXPENSES (2 to 8)
10. INCOME (1 – 9)
C. Number of workers according to:
11. Unpaid family workers
12. Permanent paid workers
…………people
…………people
…………people
…………people
…………people
…………people
…………people
…………people
LISTING IV: Page 10
XI. TRADING
PURCHASE, SALE, COMMISSION OF CONSIGNED GOODS AND EXPENSES
DURING PREVIOUS MONTH AS WELL AS NUMBER OF WORKERS
Detail
Type of trade Type of trade Type of trade
Value (Rp)
Value (Rp)
Value (Rp)
(1)
(2)
(3)
(4)
A. Purchase and utilization
1. Sold (incl. consigned to other)
2. Commission
3. Household consumption
4. Using for ……….activity
5. Given to others
6. TOTAL (1 to 5)
7. Purchased from detail 6
8. REVENUE (6 – 7)
B. Expenditure
9. Wage/salaries
4. Maintenance of facility
5. Electricity, fuel (gasoline,
kerosene, firewood, charcoal,
lubricant, etc)
6. Transportation costs
10. Electricity, fuel (gasoline,
kerosene, firewood, charcoal,
lubricant, etc)
11. Transportation costs
12. Other (tax, renting space,
interest, packaging, etc)
13. Total Expenditure (9 to 12)
14. INCOME (8 – 13)
C. Number of workers according to:
15. Unpaid family workers
16. Permanent paid workers
XII. OTHER ACTIVITIES (quarrying, construction, etc)
SERVICES PRODUCED AND EXPENSES DURING PREVIOUS
MONTH AS WELL AS NUMBER OF WORKERS
Detail
Type of activity Type of activity
Value (Rp)
Value (Rp)
(1)
(2)
(3)
A. Production
1. Services produced
B. Expenditure
2. Additional production
material
3. Wage/salaries
7. Others ( tax, renting space,
interest, packaging, etc)
8.TOTAL EXPENSES
(2 to 7)
9. INCOME ( 1 – 8)
……people
……people
……people
……people
……people
……people
C. Number of workers:
10. Unpaid family workers
11. Paid permanent workers
……..people
……..people
……..people
……..people
LISTING IV: Page 11
XIII. OTHER HOUSEHOLD INCOME DURING PREVIOUS MONTH
XIV. REVENUE AND PAYMENT (TRANSFER) DURING PREVIOUS MONTH
Other sources of income
Rp.
REVENUE
(In come)
Rp.
PAYMENT
(Out come)
Rp
(1)
(2)
(1)
(2)
(3)
(4)
1. Pension
2. Rent (e.g.: income from renting land/house)
3. Interest
4. Others ( profits from legal establishments PT. CV.
FIRMA, etc, estimated rent for own house, duty-binding
scholarships, income from agriculture activities that are
not the household’s activities)
5. TOTAL (1 to 4)
1. Receiving money
transfer
1. Money transfer
2. Receiving donation
and gift (cash and inkind)
2. Giving donation
and gift (cash and
in kind)
3. TOTAL (1 + 2)
3. TOTAL (1 + 2)
XV. FINANCIAL ASSETS DURING PREVIOUS MONTH
INCOMING CASH
Rp.
OUT GOING CASH
Rp
(1)
(2)
(3)
(4)
1. Savings withdrawal from Bank, Post Office, Cooperative
1. Saving to the Bank, Post Office, Cooperative
2. Sale of bonds and Stocks
2. Purchase of bonds, stocks
3. Sale of non-movable goods (such as land, building)
3. Purchase non movable goods (such as land, building0
4. From pawned goods
4. Insurance
5. Loan (credit)
5. Lend money
6. Loan repaid by others
6. Repaying loan
7. Others (sale of second-hand goods, etc)
7. Others
8. TOTAL ( 1 to 7)
8. TOTAL (1 to 7)
LISTING IV: Page 12
XVI. SUMMARY OF HOUSEHOLD INCOME AND REVENUE DURING PREVIOUS MONTH
A. INCOME
01. Agriculture
(list IV, Block VD, detail 21, column 2+3):12
Rp
02. Husbandry
(list IV, Block VI, part A2, detail 10)
Rp
03. Poultry
(list IV, Block VI, part B2, detail 10)
Rp
04. Fishery, Forestry, Hunting
(list IV, Block VII, detail 18, column 5)
Rp
05. Manufacturing/Handicraft
(list IV, Block VIII, detail 9, part A2+detail 9, part
B2
Rp
06. Transportation
(list IV, Block IX, detail 9, column 2 + 3 + 4)
Rp
07. Service
(list IV, Block X, detail 10, column 1 + 2 + 3)
Rp
08. Trade
(list IV, Block XI, detail 14, column 2 + 3)
Rp
09. Other business (quarrying, construction)
(list IV, Block XII, detail 9, column 2 + 3 + 4)
Rp
10. Wage/.salary
(list II, Block IV, total content of column 22)
Rp
11. Pension, renting, Interest, etc
B. REVENUE
(list IV, Block XIII, detail 5, column 2)
Rp
12. Received gifts/ transfers
(list IV, Block XIV, detail 3, column 2)
Rp
13. Sent gifts/transfers
(list IV, Block XIV, detail 3, column 4)
Rp
14. Incoming money
(list IV, Block XV, detail 8, column 2)
Rp
15. Outgoing money
(list IV, Block XV, detail 8, column 4)
Rp
16. TOTAL INCOME/REVENUE:
Detail (1 to 12) – detail (13) + detail (14) – detail (15)
Rp
XVII. N O T E