APIS FORM 1 NSCB Approval No.: NSO-0812-01 Expires: JUNE 30, 2009 Republic of the Philippines NATIONAL STATISTICS OFFICE Manila HOUSEHOLD QUESTIONNAIRE CONFIDENTIALITY: This survey is authorized by Commonwealth Act No. 591. All data obtained cannot be used for taxation, investigation, or law enforcement purposes. Booklet ____ of ____ Booklets A. IDENTIFICATION AND OTHER INFORMATION GEOGRAPHIC IDENTIFICATION CODES RECORD OF INDIVIDUAL VISIT Visit 1 2 3 REGION Time PROVINCE Began MUN/CITY Ended BARANGAY EA . Date SHSN . Result HCN . DESIGN CODES CODE FOR FINAL VISIT Rep licate . Result St ratum . Number of Visits PSU No. Rotation Group . RESULT CODES Number of Households in the Housing Unit . 1 Completed Interview 2 Refusal Name of Respondent: 3 Temporary Away/Not At Home/On Vacation 4 Vacant 5 Housing Unit demolished, destroyed by fire, typhoon, etc. Address: 6 Others, specify 7 Critical area, Flooded area CERTIFICATION I hereby certify that the data gathered in this questionnaire were obtained/reviewed by me personally and in accordance with instructions. Signature Over Printed Name of Interviewer Signature Over Printed Name of Reviewer Date Accomplished Date Reviewed Appendix B-2008 APIS Questionnaire ALL FAMILY MEMBERS B. DEMOGRAPHIC CHARACTERISTICS C. HEALTH STATUS What is Is What What Did ___ FOR L _____'s ______ is is get ill or AGES 5 I relation- male _____'s ____'s injured YEARS N FAMILY MEMBERS ship to or age as marital during OLD & E AS OF DATE OF VISIT the female? of last (civil) the past OVER family birth- status? month? N (Last Name, First Name) head? day? U M Was B _____'s E illness/ R injury Line work- No. related? in LFS ENTER ENT ER CODE CODE (1) (2) (2a) (3) (4) (5) (6) (7) (8) M F Y N Y N 1 2 01 01 12 12 SKIP TO COL. 9 1 2 02 12 12 SKIP TO COL. 9 1 2 03 12 12 SKIP TO COL. 9 1 2 04 12 12 SKIP TO COL. 9 1 2 05 12 12 SKIP TO COL. 9 1 2 06 12 12 SKIP TO COL. 9 1 2 07 12 12 SKIP TO COL. 9 1 2 08 12 12 SKIP TO COL. 9 1 2 09 12 12 SKIP TO COL. 9 1 2 10 12 12 SKIP TO COL. 9 Codes for Column 3 Codes for Column 6 Codes for Columns 11 and 14 (Relationship to Family Head) (Marital Status) (Grade/Year Currently Attending/ Highest Educational Attainment) 01 Head 1 Single 02 Wife/Spouse 2 Married/Living Together 00 No Grade Completed 03 Son/Daughter 3 Widowed 01 Nursery 04 Brother/Sister 4 Divorced/Separated 02 Kinder 05 Son-in-law/Daughter-in-law 5 Unknown 03 Preparatory 06 Grandson/Granddaughter 07 Father/Mother Elementary Secondary 08 Other Relative 11 Grade I 12 Grade II 21 1st Year 13 Grade III 22 2nd Year 14 Grade IV 23 3rd year 15 Grade V 24 4th Year 16 Grade VI/VII 25 Graduate 17 Graduate 2 122 National Statistics Office 2008 Annual Poverty Indicators Survey Appendix B-2008 APIS Questionnaire 3 - 24 YEARS OLD 5 YEARS OLD AND OVER D2. E. ECONOMIC CHARACTERISTICS HIGHEST CLASS SALARIES & WAGES FROM D1. SCHOOLING STATUS JOB/ GRADE OF EMPLOYMENT FROM BUSINESS COMPLETED WORKER JAN. 01-JUNE 30, 2008 Is ____ What Why What is Did ____ What EN-currently grade is EN- the work or kind L CIRCLEattending or year _____ CIRCLE highest have job of I LINEschool? is ____ not LINE educational or business worker Basic Allowances, N NO.curently attend- NO. attainment at anytime is salaries honoraria, E OF attend- ing OF completed from ______? and tips, ALLing? school? ALL by ____? January 01 wages housing, N FAMILY FAMILY to NOTE: clothing, U MEM- MEM-June 30, IF food, etc. M BERS BERS 2008? CODES B 3-24NOTE: 5 3, 4 E YEARS Codes 17, YEARS OR 6 (In cash/ (In cash/ R OLD 25 & 29 OLD SKIP in kind) in kind) are & TO NOT OVER SECTION APPLI- F CABLE ENT ER ENTER ENT ER CODE CODE CODE (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (1) Y N Y N 12 12 01 01 GO TO 01 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 02 02 GO TO 02 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 03 03 GO TO 03 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 04 04 GO TO 04 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 05 05 GO TO 05 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 06 06 GO TO 06 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 07 07 GO TO 07 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 08 08 GO TO 08 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 09 09 GO TO 09 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER 12 12 10 10 GO TO 10 SKIP SKIP TO NEXT FAMILY TO COL. 12 COL. 13 MEMBER Codes for Columns 11 and 14 Codes for Column 12 Codes for Column 16 (Grade/Year Currently Attending/ (Reasons for not attending school) (Class of Worker) Highest Educational Attainment) 01 Schools are v ery far 0 Worked for private Post Secondary Post Graduate 02 No schools within the bgy . household 03 No regular transportation 1 Worked for private 26 1st Year 36 With some units 04 High cost of education establishment 27 2nd Year earned or enrolled 05 Illness/disability 2 Worked for government/ 28 3rd Year in graduate school 06 Housekeeping government corporation 29 Graduate 07 Marriage 3 Self-employ ed w/o any 08 Employ ment/looking for work employee College Graduate, specify 09 Lack of personal interest 4 Employer in own family 31 1st Year PhD/Master's 10 Cannot cope with school work operated farm or business 32 2nd Year Degree 11 Finished schooling 5 Worked with pay on 33 3rd Year 12 Problem with school record own-family operated 34 4th Year 13 Problem with birth certificate farm or business College graduate, 14 Too young to go to school 6 Worked without pay in specify course 15 Others, specify _______ own family operated farm or business 3 National Statistics Office 2008 Annual Poverty Indicators Survey 123 Appendix B-2008 APIS Questionnaire F. HOUSING At the time of visit - F1. In what type of building/house does the family reside? 1 Single house 4 Commercial/industrial/ 2 Duplex agricultural building/house 3 Apartment/Accessoria 5 Other housing units (e.g. cave, condominium/townhouse boat) Specify ____________ F2. What type of construction materials is the roof made of? 1 Strong materials (galvanized iron, aluminum, tile, concrete, brick, stone, asbestos) 2 Light materials (cogon, nipa, anahaw) 3 Salvaged/makeshift materials 4 Mixed but predominantly strong materials 5 Mixed but predominantly light materials 6 Mixed but predominantly salvaged materials 7 Not Applicable F3. What type of construction materials is the outer wall made of? 1 Strong materials (galvanized iron, aluminum, tile, concrete, brick, stone, wood, plywood, asbestos) 2 Light materials (cogon, nipa, anahaw) 3 Salvaged/makeshift materials 4 Mixed but predominantly strong materials 5 Mixed but predominantly light materials 6 Mixed but predominantly salvaged materials 7 Not Applicable F4a. What is the tenure status of the housing unit and lot occupied by your family? 1 Own house and lot or owner-like possession of house and lot How much is the imputed rent per month? . P x 6 = 2 Rent house/room including lot How much is the rent per month? . Px6= 3 Own house, rent lot How much is the rent of the lot per month? . P x 6 = How much is the imputed rent of the house per month? . Px6= 4 Own house, rent-free lot with consent of owner How much is the imputed rent of the lot per month? . P x 6 = how much is the imputed rent of the house per month? . Px6= 5 Own-house, rent-free lot, without consent of owner How much is the imputed rent per month? . Px6= 6 Rent-free house and lot with consent of owner How much is the imputed rent per month? . Px6= 7 Rent-free house and lot without consent of owner How much is the imputed rent per month? . P x 6 = F4b. What is the floor area of the housing unit? . SQ. M. F4c. Do you own any other housing unit elsewhere which you also use as residence? 1 Yes, how much is the imputed rent per month? . P x 6 = 2No F4d. Did you or any member of your family acquire any house and/or lot thru the assistance of the government housing or financing program? 1YES 2NO, GO TO F4g F4e. How many house(s) and/or lot(s) have you or any member of your family acquired thru government housing or financing program? F4f. When did you or any member of your family acquire this/these house(s) and/or lot(s) A 2008 D 2005 G 1999-2000 J Don't Know B 2007 E 2004 H 1992-1998 C 2006 F 2001-2003 I 1991 or earlier F4g. Do you own any land which you use for agricultural purposes? 1YES 2NO, GO TO F5 F4h. Did you acquire this agricultural land under the CARP land-distribution program? 1 YES 2 NO 4 124 National Statistics Office 2008 Annual Poverty Indicators Survey Appendix B-2008 APIS Questionnaire F.