SSRCS Form 5

Revised May 2019

Republic of the Philippines
Philippine Statistics Authority
Batanes
List of Revised and New Data Items

INSTRUCTION: Kindly provide all the details on the new data items and revisions made in the survey
questionnaire/s. For not applicable sections of the form, please indicate n/a. Attach separate sheets if
necessary.
1. Title of Statistical Survey 2. Reference Period

3. Proponent Division/Service

4. Revised Data Items

4.1. Data Item No. 4.2. Proposed Revision 4.3. Reason for Revision
1. Previous:

2. Revision:

1. Previous:

2. Revision:

5. New Data Items

5.1. Data Item No. 5.2. New Question/Data Item 5.3. Reason for Adding the
Data Item

6. Other Revisions
6.1. Data Item No. 6.2. Proposed Revision 6.3. Reason for Revision

PSA Complex, East Avenue, Diliman, Quezon City, Philippines 1101

Telephone: (632) 938-5267
www.psa.gov.ph
Prepared by Recommended by
Signature: Signature:

Name of Division Chief: Name of Assistant National Statistician:

Date: Date:
Endorsed by

Interagency Committee (IAC) on ________________________________:

Name/Signature of IAC Chair:

Designation:

Affiliation:

Date:

ACTIONS BY THE PSA EXECUTIVE COMMITTEE

Please check the box to approve/not approve the list of revised and new data items as well as the
revisions to the survey

Approved Not Approved

(Please attach a separate sheet for the reason for disapproving the proposed revisions/new data items)

(Signature) (Signature)
JOSIE B. PEREZ DANIEL A. ARIASO, SR., CESO II
Assistant Secretary Assistant Secretary
Officer-In-Charge Deputy National Statistician
Civil Registration and Central Support Office
Date:_______________________ Date:_______________________

(Signature) (Signature)
ROSALINDA P. BAUTISTA ATTY. LOURDINES C. DELA CRUZ
(Director II) (Director III)
Officer-in-Charge Interim Deputy National Statistician
Sectoral Statistics Office Philippine Indentification System (PhilSys) –
Registry Office
Date:_______________________ Date:_______________________

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NOTES:
1. Fill out the form and route for the approval of the PSA Executive Committee.
2. The approved form should be attached as part of the SSRCS documentary requirements for PSA
censuses and surveys. If some items in the form are not approved by the PSA Executive Committee,
the proponent division and service should address their concerns and seek their approval for the
revisions made through the form before routing the census/survey documents for review of the
Standards Service.
3. Censuses/surveys with no revisions need not submit the form. However, if the Standards Service finds
that there were revisions made in the questionnaire but there was no SSRCS Form 5 submitted, the
proponent division and service will be requested to submit the needed form. The review process under
the SSRCS will not proceed without this important documentary requirement.

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