CPH FORM 3 3A

2 MROF HPC 3A
A2 Republic of the Philippines 
AUTHORITY:
Commonwealth Act No. 591, Batas Pambansa Blg. 72, NATIONAL STATISTICSEOFFICE CIFFO SCITSITATS LANOITAN
and Executive Order No. 121 authorize the National NSCB Approval No. NSO-1003-03 :YTIROHTUA
NOITALUPOP FO SUSNEC 0102 dna ,27 .glB asnabmaP sataB ,195 .oN tcA htlaewnommoC
Statistics Office (NSO) to conduct and collect
information for this census.
2010 CENSUS OF POPULATION ANDGHOUSING
NISUOH DNA Expires on:
siht rJune
of noitam30,
rofni 2011
scitsitatS lanoitaN eht ezirohtua 121 .oN redrO evitucexE
tcelloc dna tcudnoc ot )OSN( eciffO
20-3001–OSN .oN lavorppA BCSN
NSCB Approval No. NSO-1003-03
.susnec
CONFIDENTIALITY:
Section 4 of the Commonwealth Act No. 591 provides
SAMPLE
1102 ,03 eHOUSEHOLD QUESTIONNAIRE
DLOHESUOH NOMMOC :YTILAITNEDIFNOC

that all information furnished in this questionnaire shall

nuJ :no seripxE
Expires on:
tpek June
eb llahs30,
erian2011
lla taht sedivorp 195 .oN tcA htlaewnommoC fo 4 noitceS
noitseuq siht ni dehsinruf noitamrofni

be kept STRICTLY CONFIDENTIAL.

ERIANNOITSEUQ .LAITNEDIFNOC YLTCIRTS

NOITACIFITNEDI CIHPARGOEG NOITACIFITREC

CERTIFICATION GEOGRAPHIC IDENTIFICATION erew nHieOreUhShEtrH
ofOteLsDatD
adEFehINt tIaThItOyNfitrec ybereh I
STELKOOB FO TELKOOB ni dna em yb deweiver/deniatbo yllanosrep
I hereby certify that the data set forth herein were eht yb nevig snoitcurtsni eht htiw ecnadrocca
personally obtained/reviewed by me and in accordance BOOKLET OF BOOKLETS .OSN
with the instructions given by the NSO.
A household _______is
___a
___social
________ _unit
______consisting of a
__________________________________________ ECNIVORP
__ ________

_______________________________________________________
______________________________
person
YTILAPICINUM/YTIC
living alone or a group
ROTAREMUNE
of
)EMAN DETNIRP REVO ERUTANGIS( persons who
PROVINCE
ENUMERATOR sleep in the same housing unit and have a
(SIGNATURE OVER PRINTED NAME)
__________________________________________ common
YAGNARAB arrangement
_________________in____the
______preparation
___________ and
CITY/MUNICIPALITY ___________________________________________
consumption of food.
DEHSILPMOCCA ETAD

DATE ACCOMPLISHED -------------------------------------- REBMUN AERA NOITAREMUNE ______________________________________

BARANGAY ___________________________________________
ROSIVREPUS MAET
)EMAN DETNIRP REVO ERUTANGIS(
-------------------------------------- REBMUN LAIRES GNIDLIUB
ENUMERATION AREA -------------------------------------- HOUSEHOLD MEMBERSHIP
TEAM SUPERVISOR ______________________________________
(SIGNATURE OVER PRINTED NAME) -------------------------------------- REBMUN LAIRES TINU GNISUOH DEWEIVER ETAD
BUILDING SERIAL NUMBER --------------------------------------
LIST THE _PERSONS
_____________OR
_____HOUSEHOLD
___________________
-------------------------------------- REBMUN LAIRES DLOHESUOH
DATE REVIEWED HOUSING UNIT SERIAL NUMBER -------------------------------------- MEMBERS IN)ETHIS ORDER:
SACA/SAC
MAN DETNIRP REVO ERUTANGIS(

-------------------------------------- TNEDNOPSER FO REBMUN ENIL

CPH FORM 2 HOUSEHOLD SERIAL NUMBER

-------------------------------------- l  Head _____________D_E_W__E_I_V_E_R__E_T_A__D___________
CAS/ACAS
(SIGNATURE OVER PRINTED NAME) NATIONAL STATISTICS ______ ____________________________________
OFFICE
2A DAEH DLOHESUOH FlO EMSpouse
AN of the head
LINE NUMBER OF RESPONDENT - - E- M
- -A-N- T- S- R
- -IF- ,-E-M- A- N- -T-S-A-L- - - - - - - - - - - - - - - - -
AUTHORITY:
CPH FORM 2  l  Never-married
___________children
__________of ___head/spouse
______________
2A
ROSIVREPUS OP/OR/OC
Commonwealth Act No. 591, Batas Pambansa Blg. 72, and
Executive Order No. 121 authorize the National Statistics
2010 CENSUS OF POPULATION NATIONAL STATISTICS OFFICE from oldest )EMto
ANthe
DETNyoungest
IRP REVO ERUTANGIS(
DATE REVIEWED CLUSTER
Office (NSO) to conduct and collect
census.
information for this AND NUMBER
AUTHORITY:HOUSING ___________-_-_-_-_-_-_-_-_-_-_-_-_-_-_- _- _- _- _- _- _- _- _- _- _
NSCB Approval
- _- -_-_-_-_-_-_- - - - - -
No. NSO–1003-02
SSERDDA
l  Ever-married children of head/spouse and
Commonwealth Act No. O ITISBatas
FO EM AN RO EMBlg. AN T EEandRTS DNA REBMUN ESUOH
591, Pambansa 72,
2010 CENSUS OF POPULATION ______________________________________
CONFIDENTIALITY:
COMMON Executive Order No. 121 authorize the National Statistics
NAME
OfficeOF HOUSEHOLD
HOUSEHOLD
to conductHEAD
and collect__________________________________________
their families fromDEoldest
WEIVER E toTAtheD youngest
Section 4 of Commonwealth Act No. 591 provides that all (NSO) information for this Expires on: June 30,AND 2011HOUSING NSCB Approval No. NSO–1003-02
DROCER WEIVRETNI l  Other relatives
census. LAST NAME, FIRST NAME
CO/RO/PO SUPERVISOR
information furnished in this questionnaire shall be kept
QUESTIONNAIRE
STRICTLY CONFIDENTIAL.
(SIGNATURE OVER PRINTED NAME)
CERTIFICATION
CONFIDENTIALITY:TISIV FO YRAMMUS
Section 4 of Commonwealth Act No. 591 provides that all
GEOGRAPHIC IDENTIFICATION
COMMON 3 TISIV HOUSEHOLD
l  Nonrelatives
2 TISIV 1 TISIV
Expires on: June 30, 2011
REBMUN TISIV

ADDRESS
information ____________________________________________________________
furnished in this questionnaire shall be kept
I hereby certify that the data set forth herein were STRICTLY CONFIDENTIAL.
- - - - - - - - - HOUSE NUMBER AND EDO STREET
C S’RNAME
OTAR OR
EMNAME
UNEOF SITIOQUESTIONNAIRE TISIV FO ETAD
YAD:HTNOM
personally obtained/reviewedDATE by REVIEWED
me and in BOOKLET
CERTIFICATION OF BOOKLETS GEOGRAPHIC IDENTIFICATION
accordance with the instructions given by the
NSO. - - - - that
I hereby certify - - - -the
- data set forth
EDherein
AM STwere ISIV FO REBMUN NAGEB EMIT
PROVINCE personally obtained/reviewed by me and INTERVIEW
in RECORD
__________________________________________ BOOKLET OF BOOKLETS ETUNIM:RUOH
______________________________________ accordance with the instructions given by the
ENUMERATOR NSO. - - - - - - - - - * T IS IV L A N IF F O T LU SER
SUMMARY OF VISIT
VISIT NUOVER
(SIGNATURE MBER PRINTED NAME) VISIT 1
CITY/MUNICIPALITY VISIT 2 PROVINCE
__________________________________________ VISIT 3 __________________________________________ DEDNE EMIT
______________________________________ ETUNIM:RUOH
- - - - - ENUMERATOR
- - - - SREBMEM DLOHESUOH FO REBMUN
______________________________________ (SIGNATURE OVER PRINTED NAME) CITY/MUNICIPALITY __________________________________________
BARANGAY __________________________________________ ENUMERATOR'S CODE ----------
DATE
DATEOFACCOMPLISHED
VISIT * TISIV FO TLUSER
MONTH:DATE --------- SELAM FO REBMUN TLUSER ROF SEDOC EES(
______________________________________ )TISIV FO
ENUMERATION AREA NUMBER - - - - - - - - - - - - - - - - - - - - - - -BARANGAY
--------------- NUMBER OF VISITS MADE ----------
__________________________________________
______________________________________ DATE ACCOMPLISHED
TIME BEGAN
TEAM SUPERVISOR --------- SELAMEF FO REBMUN
- - - - *- - - - - - - - - - - -- ------- - - - - -
(SIGNATURE OVER PRINTED NAME)
HOUR:MINUTE BUILDING SERIAL NUMBER - - - - - - - - - - - - - - - - -R-O- T- A- C
______________________________________
ENUMERATION
- I-D - -A-S- - - - - - -AREA
- N- I- Q - - NUMBER - - - - - - RESULT
- - - - - - OF
- - -FINAL
- - - - VISIT
TISIV TXEN
snoitcTEAM SUPERVISOR
urtsnI Q AS tuohtiw dlohesuoh elpma snoN 1
TIME ENDED
______________________________________ (SIGNATURE
snoitcurtOVER
snI QAPRINTED
S htiw dlohNAME)
DATE REVIEWED
esuoh elpma snoN 2
- - - - - - - - - - - - - - - - - - - - - - -BUILDING
- - - - - - - - SERIAL
- - - - - - NUMBER - - - - - - NUMBER
- - - - - - -OF
- - HOUSEHOLD
- - - - - - - - - -MEMBERS
- - - - - - - - - -- ----- -- - - - - - ETAD
HOUR:MINUTE HOUSING UNIT SERIAL NUMBER
snoitcurtsnI QAS htiw dlohesuoh elpmaS 3
-
YAD:HTNOM
TISIV FO TLUSER ROF SEDOC *
______________________________________ NUMBER OF MALES ----------
*
______________________________________ DATE REVIEWED
RESULTCAS/ACAS
OF VISIT HOUSEHOLD SERIAL NUMBER denopts-o-P- -4- - - - - - - - - - - - - - - - -d-e-teHOUSING
-lp-m- o-C- -1- - UNIT
- - - - -SERIAL
-- NUMBER -------------------------------------- EMIT
(SEE CODES
(SIGNATURE OVERFOR RESULTNAME)
PRINTED OF VISIT) NUMBER OF FEMALES - - - - - - - -E- T- UNIM:RUOH
/yawa yliraropmet si dlohesuoH 5 detelpmoc yltraP 2
______________________________________
er-o-n- - - - - - - - - - - - - - - - - - - - -HOUSEHOLD
dnuora tnednopsCAS/ACAS
LINE NUMBER OF RESPONDENT SERIAL NUMBER --------------------------------------
de-s-u-fe-R- -3- - - - - - - - -
NEXT VISIT OF
VISIT

______________________________________
DATE REVIEWED
(SIGNATURE
YFICEPS ,srOVER
ehtO 6PRINTED NAME)
_________________________
A2 * CODES FOR RESULT
NAME OF HOUSEHOLD HEAD LINE NUMBER OF RESPONDENT
__________________________________________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CITSITATS LANOITAN
E C I F F O S
DATE PIHSRELAST
BMENAME,
M DLOFIRST
HESU
______________________________________ OH
NAME NOITINIFED DLOHESUOH
MONTH:DATE
______________________________________ DATE :REVIEWED 1 Completed 4 Postponed
CO/RO/PO SUPERVISOR REDRO SIHT NI SREBMEM DLOHESUOH RO SNOSREP EHT TSIL a ro enola gnivil nosrep a fo gnitsisnocNtiO nuITlaiA
coLsUaP siO
dlP
ohFesOuoShUA SNEC 0102
NAME OF HOUSEHOLDdaHEAD __________________________________________
2 tPartly
(SIGNATURE OVER PRINTED NAME) eH • a evah dna inu gcompleted
nisuoh emas eht ni peels5 o Household
hw snostemporarily
rep fo puaway/
org
TIME ADDRESS __________________________________________
______________________________________ daeh eht fo esu2 0S-300•1–OS.N
op do.oofN
fo lnaovio
LAST
tprm
NAME,
pupsA
noBcC
dS
FIRST NAME
naNnoitaraperp eht nino
GNISUnO
tnrespondent
emegnarraaround
H DNA
ommoc
HOUR:MINUTE CO/RO/POegSUPERVISOR
tsHOUSE
nuoyNUMBER
e ht ot tseAND STREET
dlo morf esuNAME
ops/daOR
eh NAME
fo nerdOF
lihcSITIO
deirram-reveN • 3 Refused
______________________________________
DATE REVIEWED ts(SIGNATURE
egnu oy eht ot tOVER PRINTED
sedlo morf seilimaNAME)
f rieht dna esuops/dae h fo nerdlihc deirram-revE
ADDRESS
• 1102 ,03 enuJ :no seripxE DLOHESUOH NOMMOC
6 Others, SPECIFY _________
__________________________________________
sevitaler rehtO
INTERVIEW RECORD
______________________________________ sevitalernoN
•
•
HOUSE NUMBER AND STREET NAME OR NAME OF SITIO ERIANNOITSEUQ
VISIT NUMBER VISIT 1 VISIT 2 VISIT 3 REVIEWED
DATE SUMMARY OF VISIT NOITACIFITNEDI CIHPARGOEG
INTERVIEW RECORD
DATE OF VISIT
VISIT NUMBER ENUMERATOR’S
VISIT 1 CODE VISIT 2 --------- VISIT 3 STELKOOB FO SUMMARY
TELKOOOF
B VISIT
MONTH:DAY
3B POPULATION CENSUS QUESTIONS
For All Persons For All 5 Years Old and Over
Name Relationship Birth Religious
Sex Date of Birth Age Marital Status Citizenship Ethnicity Disability Functional Difficulty
to Head Registration Affiliation
Who is the head What is ______’s Is _______ In what month What is _____’s Was _____’s Is ______ single, married, What is Is _____ What country/ What is _____’s Does ______ Does _____ have any difficulty/problem in…?
of this household? relationship male and year age as of his/her birth widowed, divorced/ separated, _____’s a citizen other country ethnicity by blood? have any
L of the Is he/she
Who are the persons to the head or female? was ______ born? last birthday? registered or in a common-law/live-in religious is _____ physical a Seeing, even when wearing eyeglasses
I Philippines? a/an _____?
usually residing here of the household? with the Civil arrangement? affiliation? a citizen of? or mental b Hearing, even when using a hearing aid
N as of May 1, 2010? Registry disability? c Walking or climbing steps
E 1 Single 1 Yes, (Filipino MENTION THE
1 Male MM Month Office? d Remembering or concentrating
2 Married citizen) PREDOMINANT/
2 Female YYYY Year 1 Yes e Self-caring (bathing or dressing)
N 3 Widowed WRITE 2 Yes, (Filipino COMMON IP OR
1 Yes WRITE 2 No f Communicating using his/her usual
U WRITE 4 Divorced/Separated THE ANSWER with dual NON-IP GROUPS
2 No THE ANSWER language
THE ANSWER 5 Common-law/Live-in ON THE citizenship) IN THE AREA.
M 3 Don’t ON THE SPACE
ON THE SPACE 6 Unknown SPACE 3 No
B know PROVIDED. WRITE THE ANSWER
LIST THE PERSONS PROVIDED. WRITE X IN THE BOX PROVIDED. WRITE X ON THE SPACE
E
R OR HOUSEHOLD MEMBERS WRITE X CORRESPONDING TO ANSWER. IN THE BOX. PROVIDED. WRITE X IN THE BOX
IN THE ORDER SPECIFIED SEE CODES IN THE WRITE THE AGE WRITE X FOR PERSONS 0 TO 9 YEARS OLD, SEE IF CODE “1”, WRITE X CORRESPONDING TO THE ANSWER
ON PAGE 3A. AT THE BOTTOM. BOX. IN THE BOXES. IN THE BOX. WRITE X IN THE BOX FOR SINGLE. CODEBOOK. SKIP TO P11. SEE CODEBOOK. SEE CODEBOOK. IN THE BOX. FOR EACH DIFFICULTY/PROBLEM.

P1 P2 P3 P4 P5 P6 P7 P8 P9 P10 P11 P12 P13

Yes No Yes No
1 4 1
1 1 1 a d
____________________________
LAST NAME MM 2 5
1 2 2 b e
2 2

____________________________ __________________ ________________ _________________ ____________________

3 3 6 3
SPECIFY c f
FIRST NAME SPECIFY YYYY SPECIFY SPECIFY

Yes No Yes No
1
1 1 1 4 1 a d

____________________________
MM
2 LAST NAME 2 2 5 2 e
2 2 b

__________________ ________________ _________________ ____________________

____________________________ 3 3 6 3
SPECIFY SPECIFY SPECIFY SPECIFY c f
FIRST NAME YYYY

Yes No Yes No
1 4 1
1 1 1 a d

____________________________
3 LAST NAME MM 2 2 5
2 b e
2 2

__________________ ________________ _________________ ____________________

____________________________ 3 3 6 3
SPECIFY SPECIFY c f
FIRST NAME SPECIFY YYYY SPECIFY

Yes No Yes No
1
1 1 1 4 1 a d

____________________________
MM
4 LAST NAME 2 2 5 2 b e
2 2

__________________ ________________ _________________ ____________________

____________________________ 3 3 6 3 f
SPECIFY SPECIFY c
FIRST NAME SPECIFY YYYY SPECIFY

Yes No Yes No
1
1 1 1 4 1 a d

____________________________
5 LAST NAME MM 2 2 5 b e
2
2 2

__________________ 3 ________________ _________________ ____________________

____________________________ 3 6 3 c f
FIRST NAME SPECIFY SPECIFY SPECIFY SPECIFY
YYYY
Yes No Yes No

1 4 1
1 1 a d
1

____________________________
6 LAST NAME MM 2 2 5 b e
2
2 2

3 3 6 ________________ _________________ ____________________

____________________________ __________________ 3 c f
FIRST NAME SPECIFY SPECIFY SPECIFY SPECIFY
YYYY

Yes No Yes No
1
1 1 1 4 1 a d

____________________________ MM
7 2 2 5 2
LAST NAME 2 b e
2

__________________ ________________ _________________ ____________________

_ 3 3 6 3
____________________________ SPECIFY SPECIFY SPECIFY c f
SPECIFY YYYY
FIRST NAME
Yes No Yes No
1
1 1 1 4 1 a d

____________________________
MM
8 LAST NAME 2 2 5 2 b e
2 2

__________________ ________________ _________________ ____________________

____________________________ 3 3 6 3 c f
SPECIFY SPECIFY SPECIFY SPECIFY
FIRST NAME YYYY

HOUSEHOLD SIZE CODES FOR P2 (RELATIONSHIP TO HOUSEHOLD HEAD)

1. Are there any other persons such as small children, infants, and/or overseas workers 2. IF THERE ARE MORE THAN 8 MEMBERS IN THIS HOUSEHOLD, WRITE X 01 Head 23 Son-in-law 41 Brother 57 Other relative
who were not yet listed? IN THE BOX FOR YES. OTHERWISE, WRITE X IN THE BOX FOR NO. 02 Spouse 24 Daughter-in-law 42 Sister 58 Nonrelative
03 Son 31 Grandson 43 Uncle 65 Boarder
1 Yes, ADD IN THE LIST. 2 No 1 Yes, USE ADDITIONAL BOOKLET. 2 No
04 Daughter 32 Granddaughter 44 Aunt 66 Domestic helper
21 Stepson 33 Father 55 Nephew
22 Stepdaughter 34 Mother 56 Niece
 P14 P15 P16 P17 P18 P19 P20 P21 P22 P23 P24 P25 P26 P27
PROV CITY/MUN PROV CITY/MUN PROV CITY/MUN

P1OPULATION CENSUS QUESTIONS 3C

1 1 POPULATIONPCOEPNUSLUASTIQ
OUNECSETNIOSNUSS QUESTIONS 3C 3C
For All 10 Years
For All 5 Years Old and Over For All 5 to 24 Years Old For All 10 Over
Years
For All 10 Years For All 15 Years Old and Over For All Females 15 to 49 Years Old
For All 5 YearsFOolrdAalnl 5d YOevaerrs Old and Over For All 5 to 24 Y Foear rAsllO5ldto 24 Years Old Old and P OPUOld
LATand
IONOver
CENSUS QUESTIONS For All 15 YearFsoOr lA
dlal n15d YOevaerrs Old and Over For All FemalesFo1r5Atoll 4F9em Yeaalers 1O5ldto 49 Yea3rC s Old
Old and Over
1 Highest Grade/ School Kind of Business Class
Residence 5 Years Ago Literacy Highest Grade/ Highest Grade/ Place ofOSchool
SchoolFor All ______________________________
5 School
For All 10 Years
Overseas Worker Usual Occupation Kind of FBusiness
or All 1Kind
5 Yeof OldofaClass
arsBusiness ______________________________
Class Place of W ork For All FeFFm ertility Indicators ears Old
______________________________
Residence 5 Years For Al5l 5Years
Ago
Residence YearsAgo Old and OverLiteracy
Literacy Year Completed Attendance to 24Place
Yearsof ld Place of School
School Overseas 2 OverseasUsual
Old andWorker
Over WorkerOccupationUsual Occupation or Industry nd Over
Worker Place of W ork Place of W ork eratilleitsy 1In5dticoa4to9FrsY
ertility Indicators
2 Attendance2
Year CompletedYear Completed Attendance or Industry of Worker
or Industry of Worker PROVINCE
PROVINCE PROVINCE
In what city/municipality Can _____ Highest
What is theGrade/
highest Did School
______ In what city/municipality Is ______ During the past 12 In Kindkind
what of Business
of business Class
What kind In what city/municipality How many How How many What is ____’s
Residence
In 5 Years Agocity/municipality
what city/municipality Literacy
Can _____ What Place of School Overseas Worker Is______________________
Usual Occupation Placity/municipality
ce of WInorkwhat city/municipality Fertility IndHow icHow
atormany
s
L
L
In what
did ______ reside read and
Can YearisCompleted
_____ the highest
_______________________
grade/year completed
Did
What is the highest ______
Attendance
attend school
DidIn______
what
did _____
city/municipality
_____ attend
attend school?
school?
Is ______
In what city/municipality
an overseas
During
______ the past During
months, what was
12 Inpast
the what12
orkind of business
______________________
or industry
What
In what kind of business
did ______ _______________
Industry of kind
of Worker
worker
In what
What kind
______________________________
did _____ work during
during
How many
children
How How
many
many children
Whatmany
How is ____’s What is ____’s
age at first
didL______ reside
______________________________
did ______ resideread and grade/year
read and completed attend school attend
grade/year completed ______________________________
did school an overseas an overseas
did _____ attend school? months, what was or industry
months, what was did ______ of worker
or industry did ______ of did _____ work did
worker children
_____ work during many
children children
many age at first
children age at first
II on
on IMay
May 1,
1, 2005?
2005?
In CITY/MUNICIPALITY on
what city/municipality May 1, write
write
2005?Can
a
a simple
simple
_____ write a by
bySPECIFY
simple _____?
_____?
What is the highest by _____?at
at
Did
anytime
anytime
______ at anytime
In CITY/MUNICIPALITY
what city/municipality
worker?
worker?
Is ______ worker? SPECIFYusual
________’s
________’s usual
During the past 12________’s work
work
usual SPECIFY
during
during
In what12kind
the
the past
past
work
of business during is
the _____?
SPECIFY
is _____?
past
What kind is _____?the past 12 months?
CITY/MUNICIPALITY
the past 12 months?
the past
In what city/municipality 12 have
have
months?
How
been
been
many
are
are
have How
still
still
been were
were
are
How
born
born
still
many
alive
alive were marriage?
marriage?
What isalive
born ____’s marriage?
N
N message from June 0000 Same attend
City/Municipality activity/occupation? months? born alive living? to ______ from
E
L didN______ reside message
read and
in any
any
message
WRITE THEcompleted
grade/year ANSWER
from June
attend from
school 0000
2009 did June
Same
_____ City/Municipality
0000 Same City/Municipality
school? an1overseas
Yes
activity/occupation?
months, what was 12 months?
activity/occupation?
or industry did ______ 12 months?
MENTION
of worker
MENTION THEMENTIONdid
THE _____ work during
THE
born alive
tochildren
_____?
living?
bornmanyalive to living?
______ from to ______
Maychildren
1, 2009
2009 to to IFage atfrom
ANSWER first
EI EMayCity/Municipality
Same
0000 PROV 1,CITY/MUN in WRITE
in any byTHE ANSWER
WRITE THE ANSWER 2009 8887 Foreign country
2009Foreign country 1 Yes 1 Yes 0000theSame City/Municipality to _____? toare
_____? May 1, alive MayIF1, ANSWER
2009 to IF ANSWER
0000 on
Same City/Municipality
0000 write
2005?Same City/Municipality a simple
language ON THE
THE_____?
SPACEON THE SPACE attoanytime
March 8887 PROV CITY/MUN
8887 Foreign countryworker?
2 NoNo ________’s
WRITE
WRITE usual
DETAILED
DETAILED
WRITE work during the past
DETAILED CATEGORIES
is _____? CATEGORIES
CATEGORIES 0000 PROV CITY/MUN
pastCity/Municipality
Same 120000
months? have
Same City/Municipalitybeen still were born2010?
April 30,
30, marriage?
IN 2010?
P7 IS IS
N Foreign country
8887 Foreign country language
message ON
language SPACE to
from March
June to March 2 2 No
activity/occupation?
DESCRIPTIONDESCRIPTION 12 months? AT THE
THE BOTTOM.
BOTTOM. 8887 Foreign country
8887 Foreign countryborn alive
Foreign country living? April
to ______ from 2010? April IN
30, P7 IN P7 IS
N 8887 8887 Foreign countryor dialect?
or indialect? or PROVIDED. PROVIDED.
PROVIDED.
dialect? 2010?
2010? 0000
2010?
IF SAME
IF SAME
Same CITY/ IF SAME CITY/
City/Municipality
CITY/ DESCRIPTION AT
MENTION THE AT THE8887
BOTTOM. SINGLE,
SINGLE, SINGLE,
N
E N any WRITE THE ANSWER 2009 1 Yes 1 ON THE SPACE to _____? May 1, 2009 to IF ANSWER
U 0000 Same City/Municipality 8887MUNICIPALITY,
Foreign country
MUNICIPALITY, WRITE
WRITE
MUNICIPALITY, WRITE ON THE SPACE ON THE SPACE CATEGORIES 0000 Same City/Municipality GO TO NEXT
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farmin orown family-operated
without
businesspay–inEMP farm or businessfarm
own family-operated - UNPAID
or business - UNPAID
Elementary
Grade 22
220 Grade 270 Elementary
280
Grade 7 340
330 3HighYear 430 3rd Year 840
830 3 Year Year **SPECIFY
IF GRADUATE
SPECIFY COURSE. IN POST 54 Employer in
Self-employed farm
without or
any business – EMP
paid employeefarm – SELF
220 350 High school graduate 850 55thth Year
Year COURSE. 66 Worked with
Worked with paypay in
in own
own family-operated
family-operated farm or business
or business –– PAID PAID
210 Grade 1 350 th school graduate 850
SECONDARY OR COLLEGE, Employer in ownpay farminin orownbusiness – EMP farm
757
thth
230 Grade
230 Grade 3 3 280 Elementary graduate 340 4 Year 860 646th Year
840
860 Year
Year Worked without
Worked without pay own family-operated
family-operated farm or or business
business -- UNPAID UNPAID
220 Grade 2 SPECIFY COURSE. 6 Worked with pay in own family-operated farm or business – PAID
350 High school graduate 850 5th Year
230 Grade 3 860 6th Year 7 Worked without pay in own family-operated farm or business - UNPAID
3D
B1 TO B4 ARE TO BE ANSWERED BY MERE OBSERVATIONS. IF DOUBTFUL, ASK THE RESPONDENT.
B1 Type of building/house
WRITE X IN THE BOX.
1 Single house
2 Duplex
3 Multi-unit residential
(three units or more)
HOUSEHOLD/HOUSING CENSUS QUESTIONS
H4 Tenure status of the housing unit H5 Acquisition of the housing unit
Do you own or amortize this housing unit occupied by your How did you acquire this housing unit?
B2 Construction materials of the roof household or do you rent it, do you occupy it rent-free with WRITE X IN THE BOX.
WRITE X IN THE BOX. consent of owner, or rent-free without consent of owner?
WRITE X IN THE BOX.
4 Commercial/industrial/ 1 Galvanized iron/aluminum 5 Cogon/nipa/anahaw 1 Inherited, SKIP TO H8
agricultural 1 Owned/being amortized
(office, factory, and others) 2 Tile concrete/clay tile 6 Asbestos 2 Gift, SKIP TO H8
2 Rented, SKIP TO H7
5 Institutional living quarter 3 Half galvanized iron 7 Makeshift/salvaged/
3 Company benefit, SKIP TO H8
(hotel, hospital, and others) and half concrete improvised materials 3 Rent-free with consent of owner, SKIP TO H8
6 Other housing units
4 Purchased
(boat, cave, and others) 4 Wood 8 Others, SPECIFY 4 Rent-free without consent of owner, SKIP TO H8
___________________ 5 Others, SPECIFY ________________________

B3 Construction materials of the outer walls H6 Source of financing of the housing unit H7 Monthly rental of the housing unit
B4 State of repair of the building/house Did you avail of the following sources of financing How much is the monthly rental of this housing unit?
WRITE X IN THE BOX.
WRITE X IN THE BOX. in the construction/purchase of this housing unit? WRITE X IN THE BOX.
WRITE X IN THE BOX. THEN SKIP TO H8.
01 Concrete/brick/stone 06 Asbestos
1 Needs no repair/ 5 Under construction YES NO 1 [PhP500 or less] 6 [PhP4,001- 6,000]

02 Wood 07 Glass needs minor repair a Own resources/interest–free loans from

relatives/friends 2 [PhP501- 1,000] 7 [PhP6,001 - 7,500]
03 Half concrete/brick/ 08 Makeshift/salvaged/ 2 Needs major repair 6 Unfinished construction b Governrnent assistance, PAG-IBIG, GSIS, SSS,
stone and half wood improvised materials DBP, and others 3 [PhP1,001 - 1,500] 8 [PhP7,501 - 10,000]
04 Galvanized iron/ 09 Others, SPECIFY 3 Dilapidated/condemned 7 Not applicable c Private banks/foundations/cooperatives
aluminum ______________________ 4 Under renovation/ 4 [PhP1,501 - 2,000] 9 [PhP10,001 and over]
d Employer assistance
05 Bamboo/sawali/ 10 No walls being repaired e Private persons 5 [PhP2,001 - 4,000]
cogon/nipa
f Others, SPECIFY _______________________
B5 IS TO BE ASKED FROM ANY HOUSEHOLD IN THE BUILDING. D1 IS TO BE ASKED FROM ANY HOUSEHOLD IN THE HOUSING H8 Tenure status of the lot H9 Usual manner of garbage disposal
UNIT. Do you own or amortize this lot occupied by your How does your household usually dispose of your kitchen garbage
household or do you rent it, do you occupy it rent-free with such as leftover food, peeling of fruits and vegetables, fish and
B5 Year building/house was built D1 Floor area of the housing unit consent of owner, or rent-free without consent of owner? chicken entrails, and others?
When was this building/house built? WRITE X IN THE BOX. What is the estimated floor area of this housing unit? WRITE X IN THE BOX. WRITE X IN THE BOX.
WRITE X IN THE BOX.
01 [2010] 07 [1991 - 2000] 1 Owned/being amortized 1 Picked up by garbage truck 5 Burying
01 [Less than 5 sq.m./ 07 [70 - 89 sq.m./
less than 54 sq.ft.] 749 - 963 sq.ft.] 2 Rented
02 [2009] 08 [1981 - 1990] 2 Dumping in individual pit 6 Feeding to animals
02 [5 - 9 sq.m./ 08 [90 - 119 sq.m./ 3 Rent-free with consent of owner (not burned)
03 [2008] 09 [1971 - 1980] 54 - 107 sq.ft.] 964 - 1286 sq.ft.] 4 Rent-free without consent of owner 3 Burning 7 Others, SPECIFY
___________________
03 [10 -19 sq.m./ 09 [120 - 149 sq.m./ 5 Not applicable
4 Composting
04 [2007] 10 [1970 or earlier] 108 - 209 sq.ft.] 1287 - 1609 sq.ft.]
H10 Kind of toilet facility
04 [20 - 29 sq.m./ 10 [150 - 199 sq.m./
05 [2006] 11 [Not applicable] What type of toilet facility does this household use? WRITE X IN THE BOX.
210 - 317 sq.ft.] 1610 - 2147 sq.ft.]
1 Water-sealed, sewer 3 Water-sealed, other 5 Closed pit 7 Others (pail system,
06 [2001- 2005] 12 [Don’t know] 05 [30 - 49 sq.m./ 11 [200 sq.m. and over/
septic tank used depository, used and others)
318 - 532 sq.ft.] 2148 sq.ft. and over] exclusively exclusively
06 [50 - 69 sq.m./ 12 Not applicable by household by household
2 Water-sealed, sewer 4 Water-sealed, other 6 Open pit 0 None
533 - 748 sq.ft.] septic tank, shared with depository, shared with
other households other households
H1 TO H11 ARE TO BE ANSWERED BY ALL HOUSEHOLDS. H11 Land ownership H12 TO H15 HOUSEHOLD CENSUS QUESTIONS
H1 Fuel for lighting H2 Fuel for cooking Does any member of this household own the following?
H12 Language/dialect generally spoken at home
What type of fuel does this household use for lighting? What kind of fuel does this household use most of the time WRITE X IN THE BOX.
What is the language/dialect generally spoken at home
WRITE X IN THE BOX. for cooking? WRITE X IN THE BOX.
by members of this household?
YES NO
1 Electricity 4 Oil (vegetable, animal, 1 Electricity 5 Wood SPECIFY ANSWER
a Other residential land/s ON THE SPACE PROVIDED.
and others)
2 Kerosene (gaas) 5 Others, SPECIFY 2 Kerosene (gaas) 6 Others, SPECIFY,
b Agricultural land/s SEE CODEBOOK.
_______________________ ____________________
3 Liquefied petroleum 0 None 3 Liquefied petroleum gas 0 None c Agricultural land/s acquired through CARP,
_____________________________
gas (LPG) (LPG) Agrarian Reform Beneficiary SPECIFY
4 Charcoal
d Other land/s
H3 Source of water supply for drinking, cooking, and laundry/bathing H13 Residence five years from now H14 Presence of household conveniences/devices
What is the household’s main source of water supply for drinking, cooking, and laundry/bathing? In what city/municipality does this household intend
Does this household have the following household
WRITE X IN THE BOX. to reside on May 1, 2015? conveniences/devices in working condition? WRITE X
PROV CITY/MUN
Drinking Cooking Laundry/Bathing Drinking Cooking Laundry/Bathing IN THE BOX CORRESPONDING TO THE ANSWER
0000 Same city/municipality FOR EACH HOUSEHOLD CONVENIENCE/DEVICE.
01 Own use, faucet community 07 Protected spring 8887 Foreign country
water system 9999 Unknown YES NO YES NO
_____________________________
02 Shared, faucet community 08 Unprotected spring IF SAME CITY/ PROVINCE
a Radio/ h Refrigerator/
water system MUNICIPALITY, radio cassette freezer
_____________________________
03 Own use, tubed/piped deep well 09 Lake, river, rain, and others WRITE “SAME” CITY/MUNICIPALITY
b Television set i Cooking range
(at least 100ft/30m deep) ON THE SPACE PROVIDED.
04 Shared, tubed/piped deep well 10 Peddler IF ANOTHER CITY/MUNICIPALITY, c CD/DVD/VCD j Washing machine
SPECIFY CITY/MUNICIPALITY player
AND PROVINCE.
05 Tubed/piped shallow well 11 Bottled water d Component/ k Car/jeep/van
SEE CODEBOOK. stereo set
06 Dug well 12 Others, SPECIFY _______________ e Landline/wireless l Motorcycle/
telephone tricycle
H15 Internet access f Cellular phone m Motorized boat/
REMARKS:
Does this household have access to internet? banca
WRITE X IN THE BOX. g Personal computer
YES NO YES NO (desktop, laptop,
notebook, netbook,
a From home b From elsewhere and others)