REPUBLIC OF INDONESIA CENTRAL BUREAU OF STATISTICS 2006. NATIONAL SOCIO ECONOMIC SURVEY
LISTING OF HOUSEHOLD MEMBERS AND HOUSEHOLD CORE Confidential
IDENTIFICATION 01 Province
02 Regency/Municipality *) 03 Subregency
04 Village/ Kelurahan *) 05 Clasification
Village/Kelurahan
1. Urban 2. Rural
06 a. Enumeration area number b. Segment number
07 Sample code number
08 Serial number of Sample household
II. HOUSEHOLD CHARACTERISTICS 01 The name of household
head
03 Number of children aged 0 - 4 years old
02 Number of household members
04 Number of household members were passed away since 2003 III. ENUMERATING CHARACTERISTICS
01 Name and employment identity number of enumerator
05 Name and employment identity number of supervisor
02 Enumerator’s occupation: 1. Provincial staff 2. Regency staff
3. Subregency staff/KSK 4. Hired worker
06 Supervisor’s occupation 1. Provincial staff 2. ` Regency staff 3. Subregency staff 4. Hired worker
03 Have ever been Susenas Core officer for 3 years
IV. A. HOUSEHOLD MEMBERS CHARACTERISTICS
IV.B. HOUSEHOLD MEMBERS WHO WERE DIED (INCLUDING STILL BORN) DURING PREVIOUS YEAR
01
02
Code of column 3: Code of column 7: Relation to the head of household
V. INDIVIDUAL HEALTH, EDUCATION, MANPOWER, FAMILY PLANNING
V.A. INDIVIDUAL HEALTH AND CHARACTERISTICS
V.B. ONLY FOR CHILDREN AGED 0 – 59 MONTHS
Name: ………..Serial number: ……… Serial number of biological
mother: ……….
(Fill in 00 if biological mother not living in this household)
11. a. Age in month: ………months
(code of the answer, directly filling in the box)
1. Medical doctor 4. Traditional
Birth First
2. Midwife Attendant
3. Other paramedics 5. Relative
6. Others Last
1. Did you have health complaints during the previous month, such as:
13. How many times have immunization? (Filling in 0, if never been in
1. Duration of breast feeding 2. Just breast feeding
3. Breast feeding + food/drink supplement
2. If you have a complain, did it disrupt your work, school, or daily activity?
Yes 1 No 2 →(skip to Q.5.a)
V.C EDUCATIONAL INFORMATION ONLY FOR THOSE AGED 5 YEARS AND ABOVE
3.Duration of disrupted……….days
4. Are still disrupted now? Yes 1 No 2
15. School participation:
5. a. Did you ever have self-treatment in the last month? Yes 1 No 2 →
16. when did you stop schooling?
(Fill in 00, if stopped before 1996
Month:…………Year:…………..
17. Reason for never/not yet attended school or no schooling anymore
1. No Budget 2. Dislike 3. Working
4. Married/housekeeping 5. N
6. Long Distance from school 7. Not needed
8. Invalid
9. Waiting for enrollment 10.Not beginning school yet 11. Not school age yet 7. Frequency of an outpatient treatment:
(filling in the frequency of an outpatient of each facility) a. Hospital
b. Private hospital
c.Doctor practice/polyclinics d. Puskesmas
e. Paramedics
f. Traditional healer
g. traditional attandance h. others
8.Have You ever been treated as an inpatient in the last year. 1. yes 2. no (Q.8)
9.Duration of inpatient (days) a. Hospital
b. Private hospital c. Puskesmas
d. Paramedics
e. Traditional healer f. Others
10. Does available defrayal guarantee / health insurance for having drug road(street / takes care of lodging as in under this?
a. JPK PNS / veteran / retired b. Subsidy / replacement of
expense of olh company c. PK MM / healthy card / JPK
GAKIN / Poor card / card askeskin
d. JPK JAMSOSTEK
e. Private sector Health Insurance
f. Healthy fund g. other JPKM/JPK
19. Level/grade ever or being attended:
0 1 2 3 4 5 6 7 8 (completed)
20. The highest diploma owned
1. Have no primary school diploma 2. Primary school
3. “Ibtidaiyah” (Islamic) 4. “Junior high/ Vocational 5. “Tsanawiyah” (Islamic) 6. Senior High School 7. Aliyah (Islamic)
8. Vocational Senior High school 9. Diploma D1/DII
10.Diploma D.III
11.Diploma IV/Graduate 12.Master/Ph.D
V.D. ACTIVITY OF HOUSEHOLD MEMBERS AGED 10 YEARS AND ABOVE
Q. 26 is asked if Q. 24 = 2 and Q.25 = 2
22. a. Did you do some activity during previous week? Ya tidak
activity used most of the time during previous week?
1 2 3 4 (if Q.22.a.1=1,lanjutkan ke Q.24
27. a. Total days of work: …………. days
b. Number of hours of total daily worked in the previous week
Mon. Tue Wen. Thu Fri Sat Sun Total
…. …. …. …. …. … …. ……
28. Business field/work place/office/company of main work during previous week (write down completely)
……… Coded by editor 29. Type of work/position of main
work during previous week (write down completely) Coded ……….. by editor
23.Do you have permanent job, but were temporary not working during previous week? 1 yes 2 no
24. Are you looking for a job ? 1. yes 2. No
25. Are you drawing up a business during previous week ?
1. yes 2. No
30. Status / position in main work during one week last
1. on feet
2. Tries assisted [by] erratic labour / labour is not paid 3. Tries assisted [by] permanent
labour / labour is paid [by] (Blok V.E)
4. Labour / employee / officer – Q.31
5. free lancer in agriculture 6. free lancer in non -
agriculture
7. worker is not paid (Blok V.E)
26. Main reason doesn’t look for a job/drawing up bussines :
1. feels not possibly gets work 2. has had work, but has not
engaged in
3. School or manages household 4. Has had job/bussines
5. feels have been enough 6. Unable to do work ( getting
old, handicap) 7. others (write) …….
JUST FOR HOUSEHOLD MEMBER IS
WORKING Q.22.a.1 = 1 atau Q.23 = 1
31. How much the wage/net salary received in a month of main work?
V E.FERTILITY AND FAMILY PLANNING EVER MARRIED WOMEN AGED ≥ 10 YEAR
MARRIED WOMAN, DIVORCE DEATH, DIVORCE LIFE
(Block IV.A. Column 4=2, Column 6=2, 3,4)
32. Age first married ……….year
33. The longest period in marriage: ………….years
34. Number of biological child which gave a birth
M F M+F
a. Born alive b. Still alive
a. Died
35. Using a contraceptive: 1. be using
2. didn't apply again 3. have never applied
36. Type of contraceptive currently usimg:
1. Tubectomy 6. Pill 2. Vasectomy 7. Condom
3. IUD 8. Intravag/Tissue for woman
4. Injectable 9. Traditional method
VI. HOUSING VII. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MIAN OF SOURCE 1.Status of house:
1. Own property 5. Official 2. Lease 6. house 3. Rentproperty
of others
4. Free Rent 7. Others
A. Food expenditure during previous week
Rp
(1) (2) 1. Cereals
a. rice
b. others (corn, wheat flour, rice flour, corn flour, etc)
2. Type of roof: 1. Concrete
2. Corrugated tile 3. Shingle roof 4. Iron sheeting 5. Asbestos
6. Sugar palm fiber 7. others
2.Tuber (cassava, sweet potato, potato, dried cassava chip, taro, sago, etc)
b. salted/preserved) 4.Meat (beef/ buffalo/
lamb/mutton/ham/ chicken, entrails, liver, spleen,
shredded dried meat, dried meat, etc) 4. Type of floor:
1.not soil 2. Soil
5. Floor area: ……….m2 5.Egg and milk a.chicken egg/duck egg/quail egg
b. fresh milk, sweetened condensed milk, powdered milk, etc)
6. a. Source of drinking water: 1. Bottled water
2. Tap water 3. Pump
7. Drinking water facility: 1. Private 3. Public 2. Shared 4. None
8. How to obtain the drinking water:
1. Purchased 2. Does not purchase 9.a. Toilet facility:
1. Private 3. Public nut, tofu, fermented soybean cake,
fermented soybean
sauce, peanut expeller cake, 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)
10. Source of light: 1. PLN electricity 2. Electricity non PLN 3. Pump lantern
4. Oil lamp 5. Others
11.Spices (salt, candle nut, coriander,
pepper, fish paste, soybean sauce,
monosodium glutamate, etc)
11. Expenditure of fuel/energy for cooking and source of light in household previously month a. PLN electric Rp ……. b. kerosene Rp… c. fire wood
13. Prepared food and beverages
a. Prepared food (bread, biscuits, wet cake, porridge, meat ball
b. Non Alcohol
beverages ( syrup ice, soda pop, salad, plate of rice and side dish, etc)
c. Alcoholic beverages (beer, wine, and other alcoholic drink)
14. Tobacco and betel a. Cigarette(clove cigarette, menthol cigarettes, cigar, b. b.others (tobacco, betel, areca nut, etc) 15. Total food (Q. 1 to
VII. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME B. NON FOOD EXPENDITURE DURING THE LAST 12
MONTHS/PREVIOUS MONTH
Previous Month
(Rp)
12 Months Ago (Rp)
(1) (2) (3)
16. Housing and household facility a. Rents, Value of imputed rent
b. House maintenance and simple reparation c. electricity bill,water, gas, kerosene,
wood etc
d. bills of telephone, handphone
voucer,telecommunication centre,postal etc
17. Miscellaneous goods and services a. Toilet soap, cosmetic article,
b. Health expenses (hospital, Puskesmas, medical doctor, traditional healer, medicines, etc)
c. Education expenses (entry/registration fee, tuition, scouts, handicraft, etc) d. Transportation
e. Other services (salary of driver, maid hotel etc)
18. Clothing, footwear, head gear (material clothes, ready-made clothes, shoes, hat, detergent, etc)
19. Durable goods (household appliances, tools, kitchen ware, amusement tools, sports equipment, expensive jewelry/ imitation jewelry, vehicle, umbrella, watch, camera, telephone installment expenses, electricity installment expenses, etc)
20. Taxes and insurance
a. Taxes (building and land tax, vehicle tax etc)
b. Retribution
c. Health Insurance
d. Others (other insurance,fine, income tax, etc)
21. Festivities and ceremonies (wedding, circumcision, birthday, religious
festival, traditional ceremony, etc) 22.Total non food(Question 17 to 24)
7
24. Average of monthly non food expenditure (Q 25 Column 3)
12
25. Average of monthly household expenditure (Q 26 + Q.27)
Filled in
Editor 26. Main income in the households (choose
from household member with the biggest income)
a. Main Industry ... (write completely)
VIII. DESCRIPTION OF OTHERS SOCIAL ECNOMICS
1. a. Is this household receiver BLT/SLT?
1. yes 2. No
b. When first time takes BLT/SLT ? …….. month year……..
4. a. Are there member of household receiving credit effort for in one year last? 1. yes 2. No
Line of credit received : 1. District development
program
2. Program P2kp
3. Other government program 4. Bank program
5. Co-Operation Program / institution
6. private 7. other 2. a. Are there member of household
getting free health service during 6 last month?
1. yes 2. No
b. If yes ( Q.2.a = 1), card applied. 1. askeskin 3. health card 2. KKB 4. others.
5.a. Are There member/former of household which is working as TKI
1. yes 2. No 3. Not know
If yes ( Q.5.a = 1), writes down number of member of household and former
according to the work type. Jumlah Type of job sedang pernah 1. nurse
2. servent/ Baby sitter 3. Driver 4. builder
5. plantation labour 6. factory labour 3. a. Does household have ever bought
cheap rice / raskin during 6 last month?
1. yes 2. No
b. If yes ( Q.3.a = 1), how many cheap rice kg bought?
………. Kg
c. How much rupiah per kg paid by household to buy last cheap rice? Rp………..
IX. COMMUNICATIONS TECHNOLOGY & INFORMATION
1. Is in this household there are telephone?
1. yes 2. No
4. a. Does this household apply computer to access to internet during one month last ?
1. yes 2. No b. If yes, number of member of households using the facility ... people. 5. Using outdoor internet
2. a. Are there member of household having cellular telephone ( HP)? 1. yes 2. No b. If yes, number of cellular telephone owned in this household. ………. number
location of
usage.
Are there member of household using outdoors internet a month last? 1. yes 2. no
If yes, number of member of using household s.
…….person
a. booth
telecomu nication b.