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SUSENAS VSEN98.PMKS

REPUBLIC OF INDONESIACENTRAL BUREAU OF STATISTICS

LISTING OF MAIN HOUSEHOLD AND HOUSEHOLD MEMBER(

Confidential

I. LOCATION IDENTIFICATION01 Province02 District/Municipality *)03 Sub-District04 Village/Village Unit*)05 Area Urban 1 Rural 206 Enumeration area number07 Segment group number08 Segment number09 Sample code number10 Sample household serial number11 Village classification Least developed village 1 Fill in at

Developed village 2 CBS

II. SUMMARY01 Name of household head 06. Is the household have reserved fund to buy basic

food for the next week?Yes 1 No 2

02 Number of household members 07. Have you ever got the aid/service specific fordisability?Yes 1 No 2

03 Number of children aged 0 – 4 years old04 Number of household members who has a

disability05 Number of household members aged ≥ 21

years old and single

08. a. If Q.7 = 1, source of aid/service: Government 1 Private 2

b. Type of aid/service:Giving capital aid 1Skill training 2Counseling 4Tools aid 8Work chances 16

III. ENUMERATION PARTICULARS01 Name and NIP/NMS of enumerator 03 Date of enumeration02 Position of enumerator:

Staff of KS province 1 Mantis 3Staff of KS regency 2 Partner 4

04 Signature of enumerator

*) Cross out inapplicable category

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IV. HOUSEHOLD LISTINGTake the contents from List of VSEN98.K,Block IV

ONLY FOR HOUSEHOLD MEMBERS AGED < 5 YEARS OLD

Serialno.(Col.1)

Nameofhouseholdmember(Col.2)

Age(Col.5)

MaritalStatus(Col. 6)

Is yourbiologi-calmotherstillalive?Yes 1No 2

↵Block V

Is themotherlive in thishousehold(checkVSEN98.K BlockV, serialnumber ofbiologicalmother)Yes 1No 2 ↵Block V

Is themotherworking?Yes 1No 2

↵Col. (9)

IfCol.7=1Place ofwork(code)

IfCol.7=1, doesthemotheroftenleavethechildrenalone?Yes 1No 2

IfCol.8=1or Col.9=1 Howmanytimeswere thechildrenalone thepreviousweek(days)

Averagetimechildrenalone(hours)

To whom(usually)thechildrenentrusted?(code)

Ifcol.8=2orcol.9=2,averagetimechildrenalone(hours)

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)

Code of column (8):

- Inside the house 1- Outside the house 2

☛ If the answer is coded 1, skip the questionto Column 10.

☛ If the answer is coded 2, skip the questionto column 13

Code of column (12):

- Father 1- Relative 2- Neighbor 3- Baby sitter 4- Servant 5- Day care center 6

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V. INDIVIDUAL LISTINGName: Serial number: Name: Serial number:1. Do you have a disability?

Yes 1 No 2 →skip to Q. 4 or finished forHousehold member of 22-59Years old

1. Are you a disabled?Yes 1 No 2 →skip to Q. 4 or finished for

Household member of 22-59Years old

2. If “yes” type of disability:Blind 1 Unemployed 8Deft 2Mute 4

2. If “yes” type of disability:Blind 1 Unemployed 8Deft 2Mute 4

3. Cause of disability:Since birth 1Accident/natural disaster 2Illness 4

3. Cause of disability:Since birth 1Accident/natural disaster 2Illness 4

ONLY FOR HOUSEHOLD MEMBERS AGED 0-21YEARS OLD, SINGLE, 60 YEARS AND ABOVE

ONLY FOR HOUSEHOLD MEMBERS AGED 0-21YEARS OLD, SINGLE, 60 YEARS AND ABOVE

4. How many pairs of clothes do you have? ……pairs 4. How many pairs of clothes do you have? ……pairs5. Frequency eating basic food in a week:………times 5. Frequency eating basic food in a week:………times6. Frequency eating vegetables and fruits I a week:

……….times6. Frequency eating vegetables and fruits I a week:

……….times7. Frequency eating side dish in a week: ………time 7. Frequency eating side dish in a week: ………timeONLY FOR HOUSEHOLD MEMBERS AGED 60YEARS AND ABOVE

ONLY FOR HOUSEHOLD MEMBERS AGED 60YEARS AND ABOVE

8. Are you a member of Community Social OrganizationYes 1 No 2 (finished)

8. Are you a member of Community Social OrganizationYes 1 No 2 (finished)

9. If Q.8=1, type of activity:Reading Quran 1 Burial 4 Others 16“Arisan” 2 Sport 8

9. If Q.8=1, type of activity:Reading Quran 1 Burial 4 Others 16“Arisan” 2 Sport 8

FOR HOUSEHOLD MEMBERS AGED ≥ 21 YEARSOLD AND SINGLE

FOR HOUSEHOLD MEMBERS AGED ≥ 21 YEARSOLD AND SINGLE

10. Is your biological father still alive? Yes 1 No 2

10. Is your biological father still alive? Yes 1 No 2

11. Average of a day of household doing activity togetherwith the parent (in hour)a. Watching TV ……….. hoursb. Eating together ……….. hoursc. Talking ……….. hours

11. Average of a day of household doing activity togetherwith the parent (in hour)d. Watching TV ……….. hourse. Eating together ……….. hoursf. Talking ……….. hours