SAK0809 DSRT Versi English

THE NATIONAL LABOR FORCE SURVEY 2009

LIST OF SAMPLE HOUSEHOLD

[AUGUST 2009]

CONFIDENTIAL

I. LOCATION IDENTIFICATION

1. PROVINCE

2. REGENCY/MUNICIPALITY *)

3. SUB-REGENCY

4.

VILLAGE/POLITICAL DISTRICT ADMINISTERED BY LURAH *)

5. VILLAGE CATEGORY URBAN - 1 RURAL - 2

6.

A. CENCUS BLOCK CODE

B. SUB-CENCUS BLOCK CODE

7. SERIAL NUMBER OF SAMPLED SAKERNAS

II. INFORMATION OF SAMPLE SELECTION

1. NAME AND CODE OF TEAM COORDINATOR

2. DATE OF COPIED SAMPLE _{DATE: MONTH:}

3. SIGNATURE OF SAMPLING WORKER

*) Please crossed it out the inapplicable one

SAK09 - DSRT Two sets for BPS Regency and BPS

Province

*) _{Coret yang tidak perlu}

III. SAMPLED HOUSEHOLD

(Copied from Block III List of SAK09-UD or SAK09-L)

Serial

Name of Household Head

Number of

Household

Members

Address and Set Area of Environment

(Name of Street/Gangway, RT, RW, Orchard)

(1) (2) (3) (4) (5) (6) (7) (8)

IV. NOTE OF SAMPLE SELECTION

Number of household (copied from Q.8 Block I List of SAK09-UD or SAK09-L) = ...