QUESTIONNAIRE OF

POPULATION AND HOUSING CENSUS 2011

From 1 till 21 October 2011, 12.000 enumerators throughout will be knocking on your doors in order to carry out the Population and Housing Census. The Census is a complete count of all people, households and dwellings in Albania. The data to be collected by this questionnaire will provide valuable statistical information on the demographic and socio-economic reality of the country which will help in the planning of the needs and resources available for public services such as education, healthcare, transportation, housing, employment, etc.

CONFIDENTIALITY

In accordance with the Law No. 9180, date 5.2.2004, article 15, “On Confidentiality”, the information collected will be used only for statistical purposes. These data are confidential and are also subject to the Law 9887 dated 10.03.2008 “On the protection of personal data”, article 9, and will be held, processed and stored securely throughout the census processes. The collection, controlling, processing and analysis of the results will be in compliance with the Law on Statistics and the Law on the Population and Housing Census.

Population and Housing Census is the biggest statistical investment of a country. Your contribution to this process is crucial, so actively participate , and thus completing our own future Do NotThank you for your collaborationCopy

Ph.D Ines NURJA

DIRECTOR GENERAL

Institute of Statistics Bul.”Zhan D’ark”, Nr. 3, , ALBANIA, Tel: +355 (4) 222411 / 2233356 / 2233357 / Fax: + 355 (4) 2228300 www.instat.gov.al

1 IDENTIFICATION PAGE

District Mun./Comm. EA code Building Dwelling HH code code code code code

Questionnaire of used

Town/Village

Name of Street/Quarter

Building no. Entrance no. Apartment no.

Supervisor Completed by the enumerator: code

Name Checked by the supervisor: Surname In compliance with article 4 of the Law No. 8669, date 26.10.2000 amended, all the questions in this Day questionnaire are mandatory except questions 39 Calendar day of questionnaire completion and 40 D D Questionnaire is completed:

DISTRICT CODES 1 Fully

01 19 Lezhë 2 Partially 02 Bulqizë 20 3 No contact 03 Delvinë 21 Lushnje 4 Refused 04 22 Malësi e Madhe 05 Dibër 23 Mallakastër Checked by the controller: 06 Durrës Do24 Not Copy

07 25 Mirditë Total number of household members: 08 26 09 Gramsh 27 Përmet Controller code 10 Gjirokastër 28 11 29 Pukë 12 Kavajë 30 Sarandë Name 13 Kolonjë 31 14 Korçë 32 Shkodër Surname 15 Krujë 33 Tepelenë 16 Kuçovë 34 Tiranë Day Month 17 Kukës 35 Tropojë Day and month of questionnaire check D D M M 18 36 Vlorë

2 BUILDING QUESTIONNAIRE 4 What type of toilet is in use? 1 What is the type of building? 1 Flush toilet inside the dwelling 1 Detached house 2 Flush toilet outside the dwelling, but inside the building 2 Semi-detached house Row (or terraced) house (with at least three linked 3 Flush toilet available outside the building 3 dwellings, each with separate entrance) 4 Toilet of other type 4 Apartment building (flat) 5 No toilet available 5 Collective living quarters Building designed for 6 GO TO DWELLING 5 Does this dwelling have a fixed bath or shower? non-residential purposes QUESTIONNAIRE 7 Other residential housing unit 1 YES

1 Shetler 2 NO

2 Tent What is the total number of rooms used for living 6 3