VILLAGE DATA FORM | Questionnaire for the Village Head I. GENERAL INFORMATION Q 1 Survey ID: VH KABUPATEN NAME Household Number KECAMATAN NAME KEC NUM VILLAGE NAME VIL NUM Survey CODE # Q 2 Date/Time of Interview: A. (DD/MM/YY) B. Interview Start Time C. Interview End Time |__|__|/|__|__|/|__|__| (24 hr clock) |__|__| : |__|__| (24 hr clock) |__|__| : |__|__| Q 3 Enumerator Name and ID: FIRST NAME LAST NAME ENUMERATOR ID II. DEMOGRAPHICS Q 4 Q 5 Q 6 Q 7 Q 8 Q 10 [Work Situation] Q 11 Q 9 [Education] [Sex] [Age] [Marital] [Ethnicity] [Literacy] [Primary Activities] Which option best describes Ethnic Group Highest Completed […]’s employment situation If 1,3 or 4 to Q 10: Marital [Use Code L] 1 Full time employment What is […]’s primary 0 None Status 1 Acehnese 2 Working in household employment? 1 Primary school 2 Gayo housewife Can […] read or Madrasah Ibtidahiyah (MI) Sex 1 Married / 3 Tamiang 3 Consistent part-time/ If 5: What type of Year of and write? 2 Junior high/ Vocational or Living 4 Alas Contract work employment did […] birth? 5 Aneuk Jame Madrasah Tsanamiyah (MT) 4 Some part-time/ seek? 0 Female together 3 Senior High School or 6 Simeulue 0 No Contract work 1 Male Yyyy 2 Div/Sep Madrasah Aliyah (MA) or 7 Kluet 1 Yes 5 No job but seeking If 6: What was […]’s 3 Widowed 8 Singkil Vocational High School Work primary employment? 4 Never Mar 9 Padang 4 Diploma I/II 6 No job and not 5 Diploma III/Bachelor 10 Batak seeking work [Code M [6-30]] 11 Javanese 6 Diploma IV/S1/Graduate 7 Retired 7 Master/ Ph.D 99 Others 8 Student 9 5 or younger __ __ __ 0 1 __ ____ ____ 0 1 ____ ____ ____ No Yes Other Code Q 12 [Born Here] Were you the village head born in this village? 0 1 Q 13 [Came Here] If no, when did you first arrive here to live? (yyyy) ___ ___ ___ ___ Q 14 [Came From] If no, where were you born? [Use Code R] ____ __ __ / __ __ __ __ Q 15 Since when have you held the position of […] in this village? M M Y Y Y Y Elected Appointed Other Code Q 16 How did you first become the […]? 1 2 _____________ SURVEY CODE NUMBER _____________ 1 III. HOUSEHOLD WEALTH In Q 17 [ASSETS] In Sept. In Sept. Q 18 [WATER] What is your main source How many of the following things do you or a Now In 1998 2005 Now 1998 2005 of drinking water? [MARK ONE] (After (After member of your household possess? MoU) MoU) A STOVE ___ ___ ___ WATER IN CONTAINER A A A B RADIO/TAPE RECORDER / VIDEO ___ ___ ___ TAP WATER B B B C TELEVISION ___ ___ ___ PUMP C C C D PARABOLA ANTENNA ___ ___ ___ PROTECTED WELL D D D E ORNAMENTAL SIDEBOARD/BUFFET ___ ___ ___ UNPROTECTED WELL E E E F REFRIGERATOR ___ ___ ___ PROTECTED SPRING F F F G BICYCLE / ROW BOAT ___ ___ ___ UNPROTECTED SPRING G G G HQ 17 MOTORCYCLE/PORTABLE ENGINE ___ ___ ___ RIVER H H H I CAR/ MOTORISED BOAT ___ ___ ___ RAINWATER I I I J TELEPHONE / CELLULAR PHONE ___ ___ ___ OTHER 50 50 50 K CHICKEN / FOWL ___ ___ ___ ___ ___ ___ In Sept. Q 19 [WALLS] What is the material used L GOATS / SHEEP In 1998 2005 Now most in your house wall? [MARK ONE] (After MoU) M WATER BUFFALO, COWS OR HORSES ___ ___ ___ CONCRETE A A A N STORE / KIOSK ___ ___ ___ TIMBER B B B O LARGE AGRICULTURAL MACHINERY ___ ___ ___ BAMBOO (Bambu / Papan) C C C P NON-AGRICULTURAL MACHINERY ___ ___ ___ OTHER 50 50 50 Q NUMBER OF ROOMS IN HOUSE/USED BY HOUSEHOLD In Q 20 How many m2 of land is being farmed by this In Sept. Now household? 1998 2005 (After MoU) ___ ___ ___ Q 21 During the rainy season how many hours or minutes walk does it take you to go to the nearest … A. Food market ____ Hrs ___ Mins B. Public transportation ____ Hrs ___ Mins C. Primary school ____ Hrs ___ Mins D. Secondary school ____ Hrs ___ Mins In Sept. Q 22 What is this household’s most E. Health clinic or hospital ____ Hrs ___ Mins In 1998 2005 (After Now important source of income? [Code M] MoU) F. Police Post or Police Station ____ Hrs ___ Mins ___ ___ ___ Among the poorest third Among the middle third Among the richest third (Relatively Poor) (Average) (Relatively Rich) Q 23 In your opinion, relative to others in your 0 1 2 village, how poor is your household? Q 24 In your opinion, relative to others in your 0 1 2 village, how poor was your household in 1998? Q 25 Typically, how many times does this household eat a cooked a meal in a day? ____ Q 26 What percentage of your total income in the past month comes from your position as Head of Village/kelurahan └─┴─┴─┘percent SURVEY CODE NUMBER _____________ 2 IV. VILLAGE POPULATION AND SOCIAL COHESION Q 27 What is the total population of this village? Q 28 What is the total number of households in this village? └─┴─┘.└─┴─┴─┘Persons └─┘.└─┴─┴─┘ HH Q 29 What was the total population of this village in (Aug) 1998? Q 30 What was the total number of households in this village in (Aug) 1998? └─┴─┘.└─┴─┴─┘Persons └─┘.└─┴─┴─┘ HH Q 31 Are there members of the […] Q 32 If yes to Q 31: Out of all the people in this Other ethnic group living in the village? village, approximately what proportion belongs to Code: No Yes this ethnic group? Acehnese 0 1 __ __ __ ___ Gayo (Aceh Tengah and Bener Meriah) 0 1 __ __ __ ___ Tamiang 0 1 __ __ __ ___ Alas (Southeast Aceh/ Aceh Tenggara) 0 1 __ __ __ ___ Aneuk Jame (South Aceh, mixed Padang and Acehnese) 0 1 __ __ __ ___ Simeulue 0 1 __ __ __ ___ Kluet (South Aceh) 0 1 __ __ __ ___ Singkil (Aceh Singkil) 0 1 __ __ __ ___ Padang 0 1 __ __ __ ___ Batak (Aceh Tenggara and Subulussalam) 0 1 __ __ __ ___ Javanese 0 1 __ __ __ ___ Others [Code L] 0 1 __ __ __ ___ Total: 100 CONFLICT VICTIMS/IDP’S Q 33 In your village, since 1998, Q 34 In your village, how Q 35 In your village, how Q 36 Are there any conflict- Q 37 If yes: How many how many households have fled many conflict-affected many conflict-affected affected IDPs from other conflict-related IDP the village (for at least three households have fled and households have fled and villages who came to households came to this months) due to conflict? have not yet returned? have returned? this village and are here still? village and are here still? └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ 0 No 1 Yes └─┴─┴─┘ GAM/PRISONERS/MILITIA MEMBERS Q 38 How many GAM- Q 39 How Q 40 How many former Q 41 How many former Q 42 How many former Q 43 How many TNA were living in the many ex-TNA prisoners were living in prisoners now live in militia/PETA members were former militia/PETA village in August 2005 now live in your your village in August your village? living in your village BEFORE members now live in (just before the signing village? 2005 (just before the the signing of the MoU? your village? of the MoU (August signing of the MoU)? 2005)? └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ └─┴─┴─┘ Over the last 6 months… Never Once A few Often If 1, 2 or 3: who are times they? [Use Code H] Q 44 How often have some people in this village been prevented from using social services (accessing health or educational services, participating in associations etc.) by 0 1 2 3 _____ other people in this village? Q 45 How often have some people in this village been prevented from engaging in 0 1 2 3 _____ economic activities (accessing land, using markets etc.) by other people in this village? Q 46 [Accept Others] I would now like to ask you some questions about your feelings toward different categories of people. Ex-combatants New Migrants IDPs Conflict Returnees Should […] be fully welcomed in this village? 0 1 0 1 0 1 0 1 Should […] be allowed membership in community associations? 0 1 0 1 0 1 0 1 Should […] be allowed to be among the leaders of the village? 0 1 0 1 0 1 0 1 Could […] be among your close friends? 0 1 0 1 0 1 0 1 Would you welcome […] into your family through marriage? 0 1 0 1 0 1 0 1 No Yes Other Code Q 47 Has there been a peusijeuk or other ceremony held in your village for former political prisoners or former GAM-TNA 0 1 combatants that have returned to the community since the signing of the MOU? SURVEY CODE NUMBER _____________ 3 V. VILLAGE WELFARE Q 48 In your estimation, how many households in the village are classified as poor (prasejahtera or sejahtera I) ? └─┘.└─┴─┴─┘ HH Q 49 When was the last completed transaction in which Other Q 50 Based on the last transaction in this village, what Land types […] was bought/sold in this village? Code approximately was the selling price for […]? [Record in Rp/ (mm/yyyy) m2] [1 hectare = 10,000 m2] 1 Rain-fed rice field ___ __ __/__ __ __ __ 1.