1 Attachment 3 SUSENAS VSEN98.K

REPUBLIC OF CENTRAL BUREAU OF STATISTICS

1998. NATIONAL SOCIO ECONOMIC SURVEY

LISTING OF HOUSEHOLD CORE AND HOUSEHOLD MEMBERS Confidential I. LOCATION IDENTIFICATION 1 Province 2 District/Municipality *) 3 Sub-district 4 Village/ Village Unit *) 5 Area Urban 1 Rural 2 6 Enumeration area number 7 Segment group number 8 Segment number 9 Sample code number 10 Serial number of Sample household 11. Village classification Least developed village 1 Fill in by Developed village 2 CBS

II. HOUSEHOLD CHARACTERISTICS 01 Name of household head 04 Number of household memberS who are still in school 02. Number of household members 05 Number of household members who had passed away 03 Number of children aged 0 - 4 years old 06 Does this household have a Holy Book?

III. ENUMERATION PARTICULARS 01 Name and NIP/NMS of enumerator 05 Name and NIP/NMS of supervisor 02 Position of enumerator: 06 Position of supervisor Staff of KS Province 1 Mantis 3 Staff of KS Province 1 Mantis 3 Staff of KS District 2 Partner 4 Staff of KS District 2 Partner 4 03 Date of enumeration 07 Date of supervision 04 Signature of enumerator 08 Signature of supervisor *) Cross out inapplicable category

2 3 IV. A. HOUSEHOLD MEMBERS CHARACTERISTICS Serial Name of Relation Gender: Age Marital If k.(6) Only for household number Household to the M1(year) Status coded 2 or members aged 5 Members head of F2 (code) 3, where years old (write household is it For how School down those recorded? long did attendanc who you read e usually stay holy and eat in book/ this religion household; article in adult, the last children, or week? baby) (1) (2) (3) (4) (5) (6) (7) (8) (9) 01 02 03 04 05 06 07 08 09 10 IV.B. HOUSEHOLD MEMBERS WHO DIED (INCLUDING STILLBORN) DURING PREVIOUS YEAR 01 02

Codes for column 3: Codes for column 7: Relation to the head of household The head of household 1 Parent/In-law 6 KUA (Religion Office) 1 Wife/husband 2 Other relative 7 Civil Registered Office 2 Children 3 Servant 8 State Court Office 3 Son/daughter in-law 4 Others 9 Others 4 Grandchildren 5

Codes for column 6: Codes for Column 9: Marital Status School Participation

Single 1 In school 1 Married 2 No longer in school 2 Divorced 3 Widowed 4

4 5 V. INDIVIDUAL HEALTH AND EDUCATION ONLY FOR CHILDREN AGED 0 – 59 MONTHS CHARACTERISTICS Name: ………………..Serial number: …………… 7. a. Age in month: …………………months Serial number of biological mother: ……………. ( go to Q.8 if the content # 00) (Fill in 00 if biological mother not living in this b. If Q. 7.a = 00, age in days: ………..days household) 8. Who helped you during the labor process? 1. Did you have health complaints during the (Codes for the answer, directly filling in the box) previous month, such as: 1. Medical doctor 4. Traditional Birth (read from a to p ) 2. Midwife Attendant 3. Other paramedics 5. Relative First a Fever i. Liver/jaundice 6. Others Last b Cough j. Headache c Flu/cold k. Convulsion 9. How many times the children have immunization? d Asthma l. Paralysis (Filling in 0, if never been in immunized) e Breathing difficulty m. Senility a. BCG c. Polio f. Diarrhea n. Accident b. DPT d. Measles/Morbili g. Measles o. Toothache 10. Do you have KMS/Immunization Card? h. Ears discharge p. Others Yes, have at home 1 Yes, have in 2 go to If all coded 0, than go to Q.7.a. or Q. 14 another Place Q. 12 Doesn’t have 3 2. If any of them, did it disrupt your work, school, 11. Copy the frequency of immunization based on or daily activity? KMS/Immunization data Yes 1 No 2 →(skip to Q.5.a) a. BCG c. Polio b. DPT d. Measles/Morbili 3. Duration of disruptin ……………….days 4. Are you still disrupted now? 12. Have ever been breast fed? Yes 1 No 2 Yes 1 No 2 → (finished) 5. a. Did you ever have self-treatment in the last 13. (Please filling in ‘days’ if Q. 7.a = 00 or in ‘month’ if Q.7.a #00) month? Yes 1 No 2 → (skip to Q.6.A) a. Duration of breast feeding b. Duration of self-treatment …….. days b. Just breast feeding c. Type of medicine used: c. Breast feeding + food/drink supplement d. (Specific for children under 12 month) Modern medicine 1 Others 4 Within 24 the last hours, the child given: Traditional medicine 2 - Just breast feeding 1 d. If used modern medicine, where was it - Breast feeding + food/drink supplement 2 purchased? - No breast feeding (only food and drinks) 3 Pharmacy 1 Vendor 8 Drug store 2 Remote vendor 16 ONLY FOR CHILDREN AGED 5 YEARS AND ABOVE Village Medicine 4 Other 32 Post 14.School participation: 6.a. Were you an outpatient in the last month? No school 1 →(skip to Q.18) Yes 1 No 2 → (skip to Q.7.a or Q14) In school 2 6.b. Frequency of an outpatient treatment: No longer in school 3 (filling in the frequency of an outpatient of each 15.a. Highest level and type of education ever or being services) attended: 01. Hospital 06. Polyclinic Primary school 01 “Aliyah” (islamic) 08 02. Private hospital 07. Paramedics “Ibtidaiyah” (Islamic) 02 Vocational senior 09 03. Doctor practice practice “A” packet group 03 High school 04. Puskesmas 08. Traditional healer Junior high/ Vocational 04 Diploma I/II 10 05. Supporting 09. “Polindes” “Tsanawiyah” (Islamic) 05 Diploma III/bach. 11 Puskesmas (Village Maternity “B” packet group 06 Diploma IV/ 12 Post) Senior High school 07 Under graduate 10. “Posyandu” (Inte- Master 13 grated Service Post) PhD 14 b. Educational organizer: c. Where did you go for an outpatient at first Government 1 Foreign 3 time? Private 2 (Filling in the Codes for services which 16. Highest level/grade ever or being attended” appropriated with Q. 6.b) 1 2 3 4 5 6 7 8 (finished)

6 7 17.Highest level completed: 27. What was the wage/net salary received in a month Not completed 1 Vocational Sr. school 5 from main work? Primary school Diploma I/II 6 Wage/salary: Rp………………….. Primary school 2 Diploma III/bachelor 7 Wage/salary (in-kind) Rp …………… Junior high school/ 3 Diploma IV/graduate 8 28. Have you aver worked before? Vocational Jr.school Master/PhD 9 Yes 1 No 2 Senior high school 5 29. Were you looking for a job? 18.Can you speak Indonesian? Yes 1 No 2 Yes 1 No 2 30. Did you listen to the radio during previous week 19.Can you write and read? Yes 1 No 2 Latin 1 Can not 3 31. Did you watch TV during the previous week? Other alphabets 2 Yes 1 No 2 VI. ACTIVITY OF HOUSEHOLD MEMBER AGED 10 32. Did you read newspaper/magazine during previous YEARS AND ABOVE week? Yes 1 No 2 20.a. Did you do some activity during previous week? VII. FERTILITY AND FAMILY PLANNING Yes 1 No 0 EVER MARRIED WOMEN AGED ≥ 10 YEAR a.1. Work for living/helped to work for living (Block IV.A. Column 4=2, Column 6=2, 3,4) a.2. Attending school 33. Age at first marriage……………….years a.3. Looked after HH a.4. Looking for a job 34. The longest marriage period: ………….years a.5. Others 35. Number of biological child M F M+F b. From Q. 20.a. activity of 1 to 5 that are coded 1, which activity used most of the time during a. Born alive previous week? b. Still alive 1 (skip to Q.23) 2 3 4 5 b.1. In this household 21.Did you work for living at least 1 hour during b.2. Outside of this h.h previous week? c. Have died (If Q.20.a.1. = 1, circle code 1) Yes 1 (skip to Q.23) No 2 WOMEN AGED 10-49 YEARS AND MARRIED “Should ask directly to the respondent” 22. Did you have permanent job, but temporarily not for working during previous week? Yes 1 No 2 1 (skip to Q.28) 36. Did you ever use contraceptive? 23.a. Total work days: …………. days Yes 1 No 2 → Finished b. Number of hours worked daily in the previous week Mon. Tue Wen. Thu Fri Sat Sun Total …. …. …. …. …. … …. …… 37. Do you currently use contraceptive? Yes 1 No 2 → Finished 24. Type of work/position at main activity during previous week (write down completely) ………………………………….. 38. Type of contraceptive currently used: 25.Business field of work place/office/company during Tubectomy previous week (write down completely) Vasectomy ……………………………………… IUD 26.Status of main work during previous week: Injected contraceptive Self-employed 1 Implant Self-employed assisted by workers/ 2 Pill Temporary workers/unpaid workers Condom Self-employed assisted by workers/ 3 Other modern method Permanent workers Traditional method Worker/employee/paid worker 4 Unpaid worker 5

8 9 VIII. HOUSING AND SETTLEMENT IX. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN OF SOURCE 1. Type of roof: A. Food expenditure during previous week Rp Concrete 1 Asbestos 5 (1) (2) Corrugated tile 2 Sugar palm fiber 6 1. Cereals (rice, corn, wheat flour, rice Shingle roof 3 Leaves 7 flour, corn flour, etc) Iron sheeting 4 Others 8 2. Tuber (, sweet potato, potato, dried cassava, taro, , etc) 2. Type of wall: 3. Fish (fresh fish, salted/preserved fish, Brick 1 Bamboo 3 shrimp, etc) Wood 2 Others 4 4. Meat (beef/ buffalo/ lamb/goat/pork/ 3. Type of floor: chicken, innards, liver, spleen, shredded Marble/ceramic 1 Wood 4 dried meat, dried meat, etc) Floor tile 2 Bamboo 5 5. Egg and milk (chicken egg/duck Cement plaster/ 3 Earth 6 egg/quail egg, fresh milk, sweetened Bricks Others 7 condensed milk, powdered milk, etc) 4. Floor area: …………………….m2 6. Vegetables (spinach, water spinach, cucumber, carrot, string bean, green bean, , chili, tomato, etc) 5. a. Source of drinking water: 7. Pulses (/mung bean/ / Bottled water 1 Protected spring 6 kidney bean/lima bean/cashew nut, , Tap water 2 Unprotected spring 7 tempe, oncom, etc) Pump 3 River 8 8. Fruits (orange, mango, apple, , Protected well 4 Rain water 9 ‘rambutan’, snake fruit, lanzon, Unprotected well 5 Others 0 pineapple, water melon, banana, b. If Q.5.a. =3 to 7 (pump/well/spring) nearest papaya, etc) distance to the septic tank: 9. Oil and fat ( oil/frying oil, < 6 m 1 ≥ 16 m 4 coconut, butter, etc) 6 – 10 m 2 Don’t know 5 10.Beverage flavor (granulated sugar, palm 11 – 15 m 3 sugar, tea, coffee, cocoa, syrup, etc) 6. How to obtain the drinking water: 11.Spices (salt, macadamia nut, , Purchased 1 Does not purchase 2 pepper, , soybean sauce, monosodium glutamate, etc) 7. Drinking water facility: 12.Other consumption (crisp, crisp chip, Private 1 Public 3 noodle, wheat & rice noodle, macaroni, Shared 2 None 4 etc) 8. a. Toilet facility: 13.Prepared food and beverages (bread, Private 1 Public 3 biscuits, wet cake, porridge, meat ball, Shared 2 Others 4 syrup ice, soda pop, gado gado, rice and b. Type of toilet: side dish, etc) Squatter 1 Dry latrine 3 14.Alcoholic beverages (beer, wine, and Throne 2 Others 4 other alcoholic drink) c. Final disposal: 15.Tobacco and betel ( cigarette, Septic tank 1 Hole 4 cigarettes, cigar, tobacco, betel, areca Pond/field rice 2 Shore/open field/ 5 nut, etc) River/lake/ 3 Others 6 Ocean 9. Source of light: 16.Total food (Q. 1 to – 15): PLN electricity 1 Oil lamp 4 Electricity non PLN 2 Others 5 Pump lantern 3

10 11 IX. AVERAGE MONTHLY HOUSEHOLD EXPENDITURE AND MAIN SOURCE OF INCOME B. NON FOOD EXPENDITURE DURING 12 MONTHS Previous Month 12 Months Ago AGO/PREVIOUS MONTH (Rp) (Rp) (1) (2) (3) 17. Housing and household facility (rents, estimated rent value, electricity bill, telephone, gas, kerosene, water, wood, etc) 18.Miscellaneous goods and services (toilet soap, cosmetic article, transportation, reading material, ID & driver’s license, recreation, telephone card, postal, etc) 19.Education expenses (enrollment/registration fee, tuition, scouts, handicraft, etc) 20.Health expenses (hospital, Puskesmas, medical doctor, traditional healer, medicines, etc) 21.Clothing, footwear, head gear (fabric, ready-made clothes, shoes, hat, detergent, etc) 22.Durable goods (household furniture, equipment, kitchen ware, recreational tools, sports equipment, expensive jewelry/ imitation jewelry, vehicle, umbrella, watch, camera, telephone installment cost, electricity installment cost, etc) 23.Taxes and insurance (building and land tax, TV/radio tax, vehicle tax, accident/health insurance 24.Festivities and ceremonies (wedding, circumcision, birthday, religious festival, traditional ceremony, etc)

25.Total non food (Question 17 to 24)

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 + Q.27)

29.Main source of household income (write down completely: Filled in Editor ……………………………..

12 13 X. HOUSEHOLD PARTICIPATION IN POVERTY ALLEVIATION PROGRAM DURING 1996-1997 1. Has the head/member of household ever received credit/aid to increase the income during 1996-1997? Yes 1 No 2 (skip to Block XI) 2. If Q.1 = 1, aid received: Name of How many Specific for the last one Program times received aid When did you Amount of Type of aid Type of Credit payment in the last 2 get it fund (code) activity (Code) years? (month, year) received conducted (in thousand (code) rupiah) (1) (2) (3) (4) (5) (6) (7) 1 code 2 3 4 Codes for column (1): IDT (01); UPPKS (02); Takesra/Kukesra (03); P4K (04); Prokesos/Kube (05); UP2K (06); KUB (07); KUT (08); KCK (09); KKPA (10); PKM (11); PHBK (12); KUKDAS (13); KUPEDES (14); UED-SP (15)

Codes for column (5): Codes for column (6): Codes for column (7): Bequest 1 Food crops agriculture 1 Trade 6 Paid 1 Credit 2 Fishery 2 Service 7 Doesn’t have a job 2 Roll-over 3 Husbandry 3 Others 8 Can not pay/postpone 3 Don’t know 4 Other agriculture 4 Not yet 9 payment Small industry/household 5

XI. LIVESTOCK/POULTRY BREEDING LISTING Type of livestock Raising livestock/poultry January 1, 1998 During January 1, to Yes 1 No 2 December, 31, 1997 1997 January 1, 1998 Male Female Born Death (1) (2) (3) (4) (5) (6) (7) (01) Milking a cow (02) Cattle (03) Buffalo (04) Horse (05) Goat (06) Sheep (07) Pig (08) Free-range chicken (09) Layer Chicken (10) Broiler Chicken (11) Ducks

14 15 XII. N O T E S

16