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SUSENAS

attachment 3 VSEN92.K
REPUBLIC OF INDONESIA CENTRAL BUREAU OF STATISTICS

1992 NATIONAL SOCIO-ECONOMIC SURVEY CORE HOUSEHOLD AND MEMBER CHARACTERISTICS

Confidential 01 02 03 04 05 06 07 08 09 10 I. LOCATIONS IDENTIFICATION Province District/Municipality *) Sub-District Village/Village Unit*) Area Enumeration Area Number Urban Segment group number Package number Sample code number Sample household serial number II. HOUSEHOLD LISTING 01 02 Name of household head Number of household members 03 04 Number of children aged 0-4 years Number of household's members who are attending school

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Rural

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III. ENUMERATION PARTICULARS 01 Enumerator's name and NIP 02 Enumeration date 03 Signature *) cross out in applicable category 04 05 06 Supervisor's name and NIP Date of supervision Signature

Interview start time: IV. HOUSEHOLD MEMBERS LISTING No

Name of household members (write down the name of everyone i.e. adults, children and babies, who usually eat and live in this household Relation to the head of household Gender: Male Female -1 -2 Age (year) Marital Status (code) Travel ed in the past 3 months (code) Victim of crime event this past year (code)

(1) 01 02 03 04 05 06 07 08 09 10 01 02

(2)

(3)

(4)

(5)

(6)

(7)

(8)

HOUSEHOLD MEMBERS WHO DIED LAST YEAR

Head of HH Wife/husband Children

Codes for column (3): Relation to head of household -1 Son/daughter in-law -4 Other relative -2 Grandchild -5 Servant -3 Parent/In-laws -6 Other

-7 -8 -9

Codes for column (6): Marital status Single -1 Divorced -3 Married -2 Widowed -4

To make a tourism-related trip is to travel (non routine travel) to a destination that has natural or man-made attractions . -1 No -2 Codes for Column (7): Yes A victim of crime is a victim of an act caused by other persons, whether these acts were done on purpose or not, whether the act was successful or an attempt. These acts can result in the victims death or cause bodily injuries, material loss, etc and those act can be punished with imprisonment or a No -2 (the left side box, row 01 prepared for household as a victim) Codes for column (8): Yes -1 Categorized of criminal act: - Homicide - Burglary - Embezzlement - Insult - Assault - Theft - Fraud - Narcotics - Battery - Arson - Rape - Gambling - Kidnapping/abduction - Destruction - Adultery - Others - Robbery

V. INDIVIDUAL HEALTH AND EDUCATION CHARACTERISTICS

Name: Serial number: Serial number of biological mother:.. (Fill in 00 if the biological mother does not live in this household) 1. Did you have health complaints during the previous month, because of: Fever -1 Toothache -6 Cough -2 Convulsions -7 Flu/cold -3 Accident -8 Diarrhea -4 Other -9 Vomit/diarrhea -5 Nothing -0 Go to Q. 5 2 If any, did it disrupt your work, school, or daily activity? Yes -1 No -2 (go to Q. 4) 3. If "yes" at Q.2, how long?: days 4. Are you still feeling sick? Yes -1 No -2 5. How many times/days have you been treated? Treatment Out-patient in-patient (times) (days) a. Govt. hospital b. Private hospital c. Doctors Practice d. Puskesmas e. Clinic/MCH/BP f. Health workers practice g. Traditional healer h. Others i. Self treated ONLY FOR CHILDREN AGED 0-4 YEARS 6. Who attended his/her birth? Doctor 1 Traditional birth 4 Midwife 2 attendant Other paramedic 3 Relative 5 Others 6 7. Has the child been breast fed? Yes -1 No -2 (go to Q. 9) 8. How long (month) was/has been breast fed: a. Without food/drink supplement b. With food/drink supplement

9. Has the child ever been immunized? Yes, with card Yes, without card No, with card No, no card 10 If "yes" on Quest. 9, type of immunization BCG 1 Polio 4 DPT 2 Measles/morbili 8 11 If immunized with DPT or Polio, how many times? DPT: .times Polio: .times ONLY FOR AGED 5 YEARS AND OLDER 12 Education status: No schooling 1 ! go to Q. 16 Attending school 2 No longer in school 3 13a) Highest education ever or being attended: Primary school 1 Diploma I/II 6 Junior school 2 Academy/ 7 Vocational Junior 3 Diploma III School University/ 8 Senior high school 4 Diploma IV Vocational high 5 School b) Educational institute: Government: Secular 1 Religious Private Secular 3 Religious

2 4

14 Highest grade ever or being attended: 1 2 3 4 5 6 7 8(completed) 15 Highest education completed: Not/not yet completed Vocational senior Primary school 1 high school Primary school 2 Diploma I/II Junior school 3 Academy/Diploma Vocational junior 4 III School University/Diploma Senior high school 5 IV 16 Can speak Indonesian? Yes 1 No 17 Can read and write? Latin -1 Other alphabets -2 -2

6 7 8 9

Can not

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VI. ACTIVITY OF HOUSEHOLS MEMBERS VI. CONTINUED AGED 10 YEARS AND OLDER
18 Primary activity during previous week: Worked -1 (skip to Q.21) Took care of -3 Attended -2 household school Others -4 19 If Q 18 not coded 1, did you work at least 1 hour during the previous week? Yes -1 (skip to Q. 20) No -2 20 If Q 19 coded 2, do you have a permanent job but were temporarily not working during previous week: Yes -1 (skip to Q. 22) No -2 (skip to Q25) 21 Total number of hours worked daily in the previous week 1 2 3 4 5 6 7 Total .. hours 22 Type of primary work during previous week (specify) .. 23 Field of primary work during previous week: Agriculture -1 Trade Mining & quarrying -2 Transportation & Industry -3 communication Electricity, Gas and -4 Finance Water Service Construction -5 Other 24 Status of primary work during previous week: Self-employed with no assistance -1 Self-employed assisted by household -2 member/temporary workers Employer with permanent workers -3 Government employee/worker -4 Private employee/worker -5 Family worker -6 25 Looking for work? Yes -1 No 26 Did you listen to the radio during previous week? Yes -1 No -2 27 Did you watch TV during previous week? Yes -1 No -2 28 Did you read newspaper/magazine during previous week? Yes -1 No -2

VII. FERTILITY AND FAMILY PLANNING

EVER MARRIED WOMEN {Block IV col. (4)=2, col. (6)= 2,3,4} 29 Age at first marriage: year 30 Number of children born alive . 31 Number of children who have died: . 32 Number of living children . WOMEN AGED <50 YEARS AND MARRIED {Block IV Col. (4)=2, Col. (5), Col. (6)=2} = should be asked directly to the respondent = 33 Have you ever-used contraceptives? Yes -1 No -2 (to B VIII) 34 Do you currently use a contraceptive? Yes -1 No -2 !(go to B VIII) 35 Type of contraceptive currently used: Tubectomy -1 Condom Vasectomy -2 Implant IUD -3 Other Injection -4 traditional method Pill -5 -6 -7 -8 -9

-6 -7 -8 -9 -0

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VIII. HOUSING, HOUSING FACILITY AND ENVIRONMENT

1. Floor area: ..m2 2. Type of wall (majority): Brick -1 Bamboo Wood -2 Other 3. Type of roof (majority): Concrete -1 Sugar palm Wood -2 fiber Zing/Asbestos -3 Leaves Corrugated tile -4 Other 4. Type of floor (majority): Marble/ceramic -1 Wood Floor tile -2 Bamboo Cement/red brick -3 Earth Others 5. Source of lighting: PLN electricity -1 Non-PLN electricity -2 Pump lantern -3 oil lamps other

IX. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME

A. Food expenditure during previous week (1) Rp (2)
1. Cereals (rice, corn, flour, rice flour, corn flour, etc) 2. Tuber (Cassava, sweet potato, potato, dried cassava, taro, sago, etc) 3. Fish (fresh fish, preserved fish/ salted fish, shrimp, etc) 4. Meat (beef/buffalo/goat/mutton/pork/chicken, innards, liver, spleen, dried shredded beef, dried beef, 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, fermented soybean sauce, oncom, etc) 8. Fruits (orange, mango, apple, durian, 'rambutan', snake fruit, lanzon, pineapple, watermelon, banana, papaya, etc) 9. Oil and fat (coconut oil/cooking oil, coconut, butter, etc) 10 Beverages material (granulated sugar, tea, coffee, cocoa, syrup, etc) 11 Spices (salt, candlenut, coriander, pepper, fish/shrimp paste, soybean sauce, palm sugar, monosodium glutamate, etc) 12 Other consumables (shrimp/fish crackers, emping chips, noodle, rice noodle, macaroni, etc) 13 Prepared food & drink (bread, biscuit, cakes, porridge, meatball noodle soup, ice syrup, soda pop, gado-gado, rice and side dishes) 14 Alcoholic beverages (beer, wine, and other alcoholic beverages) 15 Tobacco and betel (clove cigarette, white tobacco cigarette, cigar, tobacco, betel, areca nut, etc) 16 Total food (Q 1 to 15):

-3 -4 -5 -6 -7 -4 -5 -6 -7 -4 -5

6. Drinking water facility: Private -1 Shared -2 Public -3 7. Source drinking water: Pipe -1 Pump -2 Protected well -3 Unprotected well -4 Protected spring -5

Purchased Other

-4 -5

Unprotected spring River Rain water Other

-6 -7 -8 -9

8. If Q. 7= 2 to 6 (pump/well/spring), closest distance to the septic tank 16 m <6m -1 -4 6 - 10 m -2 Don't know -5 11 - 15 m -3 9. Toilet facility: Private, with septic tank Shared, with septic tank Private, without septic tank Shared, without septic tank Public toilet -5 Pond -6 Hole River -7 Other -1 -2 -3 -4 -8 -9

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IX. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME B. Non food expenditure during the previous month/previous Previous month The 12 months year (Rp) ago (Rp) (1) (2) (3) 17.Housing, fuel, light, and water (rent, value of imputed rent, electricity, kerosene, water, wood, etc) 18.Miscellaneous goods and services (toilet soap, cosmetic goods, transportation, reading material, recreation, etc) 19.Education cost (enrollment/registration fee, tuition/ extracurricular fee, Scouts, handicraft, etc) 20.Health cost (hospital, Puskesmas, medical doctor, traditional healer, medication, etc) 21.Clothing, footwear, and headgear (fabric, ready-made clothes, shoes, hat, laundry soap, etc) 22.Durable goods (furniture, household equipment, kitchen utensils, recreational utensils, 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 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 + 27) 29.Main source of household income: Fill in by CBS . Time finished interview

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