CPH FORM 5 5A

Republic of the Philippines

Approval Number : PSA-1962-05
Expiry Date : 31 December 2020 Philippine Statistics Authority
OBLIGATION TO PROVIDE INFORMATION:
Section 25 of Republic Act 10625 (Obligation
to Provide Information) stipulates that all
respondents whether natural or legal persons
are required to provide truthful and complete
information to all statistical inquiries or surveys
conducted by the Philippine Statistics Authority
(PSA).
CONFIDENTIALITY:
The PSA adheres and commits to the
confidentiality of information as stipulated in
Section 26 of RA 10625 (Confidentiality of
Information) and Section 8 of RA 10173
(Confidentiality). All data obtained herein shall
be held strictly confidential, and will not
be used for taxation, investigation or law
enforcement purposes.
BARANGAY SCHEDULE
Dear Sir/Madam:
The Philippine Statistics Authority (PSA) is conducting the 2020 Census of Population and Housing (2020 CPH)
to gather data on the demographic, socioeconomic, and housing characteristics of all persons, households, and institutional living
quarters (ILQ) in all barangays nationwide. These data will be used by government planners, policy makers, and administrators
in formulating their social and economic development plans, policies, and programs.
The conduct of the 2020 CPH is in accordance with Republic Act (RA) No. 10625 (Philippine Statistical Act of 2013), which authorizes
the PSA to prepare and conduct periodic censuses on population, housing, and other sectors of economy. Batas Pambansa Blg. 72
and Executive Order No. 352 also stipulate the conduct of a census of population and housing every ten (10) years.
Section 25 of RA 10625, states that all respondents whether natural or legal persons are obliged to provide TRUTHFUL AND
COMPLETE ANSWERS to the 2020 CPH. Hence, we are requesting you to please answer all the questions that will be asked by our
census interviewer. Rest assured that the data that you will furnish in this census will be considered PRIVILEGED COMMUNICATION
and as such shall be inadmissible as evidence in any proceeding. Provisions on CONFIDENTIALITY OF INFORMATION are
stipulated in Section 26 of RA 10625 and Section 4 of Commonwealth Act No. 591.
Moreover, please be informed that Section 4(e) of RA 10173 (Data Privacy Act of 2012) states that data privacy does not apply to
“information necessary in order to carry out the functions of public authority which includes the processing of personal data for the
performance by the independent agencies of their constitutionally and statutorily mandated functions.”
We appreciate your utmost cooperation and support for the success of the 2020 CPH.
Thank you very much.

CLAIRE DENNIS S. MAPA, Ph.D.

Undersecretary
National Statistician and Civil Registrar General

GEOGRAPHIC IDENTIFICATION

PROVINCE

CITY/MUNICIPALITY

BARANGAY

NAME OF RESPONDENT
LAST NAME FIRST NAME
DESIGNATION/POSITION
IN THE BARANGAY
ADDRESS OF THE
BARANGAY HALL
NUMBER & STREET OR SITIO NAME

INTERVIEW RECORD
DATE OF VISIT TIME BEGAN TIME ENDED
MONTH/DAY (mm/dd) HOUR:MINUTE AM/PM HOUR:MINUTE AM/PM

CERTIFICATION
I hereby certify that the data set forth herein were personally obtained/reviewed by me and in accordance with the instructions given by the PSA.

CAS/ACAS HEAD CAS CO/RSSO/PSO SUPERVISOR

SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME

DATE SIGNED DATE SIGNED DATE SIGNED

(mm/dd) (mm/dd) (mm/dd)

REMARKS
5B GENERAL INSTRUCTION: WRITE THE NUMBER OR CODE CORRESPONDING TO THE ANSWER IN THE BOX.

Part I –Part
Barangay
I – Barangay
Facilities/Characteristics
Facilities/Characteristics CODE

Q1 Is your barangay a …

Q1a. former poblacion or central district of the city/municipality? 1 − YES 2 − NO

Q1b. poblacion/central district or part of the poblacion/central district? 1 − YES 2 − NO

Q2 Does your barangay have a street pattern, that is, a network 1 − YES 2 − NO
of at least three (3) streets or roads?
Q3 1 − YES 2 − NO, GO TO Q4a
Is this barangay accessible to the national highway?

IF YES, what is the distance in kilometers between the nearest point 1 − two (2) kms. or less 2 − more than two (2) kms.
of this barangay and the national highway using the access road?
Q4 In the barangay, is there a/an ...

Q4a. town/city hall or provincial capitol? 1 − YES, GO TO Q4b 2 − NO

IF NO, what is the distance of the nearest town/city hall or provincial capitol 1 − two (2) kms. or less 2 − more than two (2) kms.
from the barangay hall?

Q4b. church, chapel or mosque where religious service is held at least 1 − YES, GO TO Q4c 2 − NO
once a month?
IF NO, what is the distance of the nearest church, chapel or mosque (where 1 − two (2) kms. or less 2 − more than two (2) kms.
religious service is held at least once a month) from the barangay hall?

Q4c. public plaza or park for recreation? 1 − YES, GO TO Q4d 2 − NO

IF NO, what is the distance of the nearest public plaza or park for recreation 1 − two (2) kms. or less 2 − more than two (2) kms.
from the barangay hall?

Q4d. cemetery? 1 − YES, GO TO Q4e 2 − NO

IF NO, what is the distance of the nearest cemetery from the barangay hall? 1 − two (2) kms. or less 2 − more than two (2) kms.

Q4e. market place or building where trading activities are carried out 1 − YES, GO TO Q4f 2 − NO
at least once a week?
IF NO, what is the distance of the nearest market place or building (where 1 − two (2) kms. or less 2 − more than two (2) kms.
trading activities are carried out at least once a week) from the barangay hall?

Q4f. elementary school? 1 − YES, GO TO Q4g 2 − NO

IF NO, what is the distance of the nearest elementary school 1 − two (2) kms. or less 2 − more than two (2) kms.
from the barangay hall?

Q4g. high school? 1 − YES, GO TO Q4h 2 − NO

IF NO, what is the distance of the nearest high school 1 − two (2) kms. or less 2 − more than two (2) kms.
from the barangay hall?

Q4h. college/university? 1 − YES, GO TO Q4i 2 − NO

IF NO, what is the distance of the nearest college/university 1 − two (2) kms. or less 2 − more than two (2) kms.
from the barangay hall?

Q4i. library? 1 − YES, GO TO Q4j 2 − NO

IF NO, what is the distance of the nearest library from the barangay hall? 1 − two (2) kms. or less 2 − more than two (2) kms.

Q4j. hospital? 1 − YES, GO TO Q4k 2 − NO

IF NO, what is the distance of the nearest hospital from the barangay hall? 1 − two (2) kms. or less 2 − more than two (2) kms.

Q4k. puericulture center, barangay health center/station or clinic? 1 − YES, GO TO Q4l 2 − NO

IF NO, what is the distance of the nearest puericulture center, barangay 1 − two (2) kms. or less 2 − more than two (2) kms.
health center/station or clinic from the barangay hall?

Q4l. fire station or public fire protection service? 1 − YES, GO TO Q4m 2 − NO

IF NO, what is the distance of the nearest fire station or public fire protection 1 − two (2) kms. or less 2 − more than two (2) kms.
service from the barangay hall?

Q4m. seaport in operation? 1 − YES, GO TO Q4n 2 − NO

IF NO, what is the distance of the nearest seaport in operation 1 − two (2) kms. or less 2 − more than two (2) kms.
from the barangay hall?

Q4n. community waterworks system? 1 − YES, GO TO Q4o 2 − NO

IF NO, what is the distance of the nearest place with community waterworks 1 − two (2) kms. or less 2 − more than two (2) kms.
system from the barangay hall?

Q4o. post office or postal service? 1 − YES, GO TO Q4p 2 − NO

IF NO, what is the distance of the nearest post office or postal service
1 − two (2) kms. or less 2 − more than two (2) kms.
from the barangay hall?

Q4p. landline telephone system or calling station? 1 − YES, GO TO Q4q 2 − NO

IF NO, what is the distance of the nearest place with a landline telephone 1 − two (2) kms. or less 2 − more than two (2) kms.
system or calling station from the barangay hall?

Q4q. cellular phone signal? 1 − YES 2 − NO

Q4r. public street sweeper? 1 − YES 2 − NO

 GENERAL INSTRUCTION: WRITE THE NUMBER OR CODE CORRESPONDING TO THE ANSWER IN THE BOX/ES. 5C
PART II − Number of Establishments in the Barangay by Type and Employment Size
In the barangay, is there a/an … CODE CODE / NUMBER

Q5 wholesale and/or retail trade establishment such Q5a. Does this barangay have wholesale
as a wholesale and/or retail store, department and/or retail trade establishments 1 - YES
store, supermarket, hyper-market, grocery, convenience with 100 employees or more? 2 - NO
store, bazaar, ukay-ukay, meat shop, hardware
store, drugstore, bookstore, gasoline station, LPG Q5b. Does this barangay have wholesale
dealer, motor vehicles and auto supplies dealer, and/or retail trade establishments 1 - YES
animal feeds dealer, pet shop or sari-sari store with 10 to 99 employees? 2 - NO
GO TO Q6
with at least one paid employee?
Q5c. How many wholesale and/or retail trade
establishments with 10 to 99 employees are there
1 − YES, GO TO Q5a
in this barangay?
2 − NO, GO TO Q6 WRITE THE NUMBER IN THE BOXES.
Q6 recreational establishment such as a gym, fitness Q6a. Does this barangay have recreational
center, badminton court, billiard hall, bowling lane, establishments with 100 employees 1 - YES
golf course, racetrack, lottery or betting station, or more? 2 - NO
cockpit arena, beach resort, swimming resort,
recreational camp, and others? Q6b. Does this barangay have recreational
establishments with 10 to 99 employees? 1 - YES
2 - NO
GO TO Q7

Q6c. How many recreational establishments

with 10 to 99 employees are there
1 − YES, GO TO Q6a
in this barangay?
2 − NO, GO TO Q7 WRITE THE NUMBER IN THE BOXES.
Q7 manufacturing establishment such as a slaughter Q7a. Does this barangay have manufacturing
house, fish dryer, ice cream maker, grains miller, establishments with 100 employees 1 - YES
sugar refinery/miller, bakery, ice plant, wine maker, or more? 2 - NO
water refilling station, garments factory, tailor or
dress shop, shoe factory, handicrafts maker, furni- Q7b. Does this barangay have manufacturing
ture maker, firecracker factory, cement plant, boat establishments with 10 to 99 employees? 1 - YES
shop, and others? 2 - NO
GO TO Q8
Q7c. How many manufacturing establishments
with 10 to 99 employees are there
1 − YES, GO TO Q7a
in this barangay?
2 − NO, GO TO Q8 WRITE THE NUMBER IN THE BOXES.
Q8 accommodation and food service establishment Q8a. Does this barangay have accommodation
such as a hotel, motel, suite/apartment hotel, and food service establishments 1 - YES
condotel, inn, guest house, hostel, pension house, with 100 employees or more? 2 - NO
dormitory, boarding house, restaurant, cafeteria or
refreshment parlor, café or coffee shop, canteen, Q8b. Does this barangay have accommodation
burger stand, caterer, night club, bar, videoke club, and food service establishments 1 - YES
and others? with 10 to 99 employees? 2 - NO
GO TO Q9

Q8c. How many accommodation and food service

establishments with 10 to 99 employees are there
1 − YES, GO TO Q8a
in this barangay?
2 − NO, GO TO Q9 WRITE THE NUMBER IN THE BOXES.
Q9 financial establishment such as a bank, financing/ Q9a. Does this barangay have financial
investment/insurance company, credit/lending firm, establishments with 100 employees 1 - YES
pawnshop, credit cooperative, and others? or more? 2 - NO

Q9b. Does this barangay have financial establishments

with 10 to 99 employees? 1 - YES
2 - NO
GO TO Q10

Q9c. How many financial establishments

with 10 to 99 employees are there
1 − YES, GO TO Q9a
in this barangay?
2 − NO, GO TO Q10 WRITE THE NUMBER IN THE BOXES.
Q10 establishment offering repair services such as an Q10a. Does this barangay have repair service
auto repair shop, vulcanizing shop, computer establishments with 100 employees 1 - YES
repair shop, watch repair shop, and other repair or more? 2 - NO
shops for consumer electronics, household
appliances, and other personal and household Q10b. Does this barangay have repair service
goods? establishments with 10 to 99 employees? 1 - YES
2 - NO
GO TO Q11

Q10c. How many repair service establishments

with 10 to 99 employees are there
1 − YES, GO TO Q10a
in this barangay?
2 − NO, GO TO Q11 WRITE THE NUMBER IN THE BOXES.
Q11 establishment offering personal services such as a Q11a. Does this barangay have personal service
health spa, beauty parlor, barber shop, massage establishments with 100 employees 1 - YES
parlor, laundry shop, funeral parlor, and others? or more? 2 - NO

Q11b. Does this barangay have personal service

establishments with 10 to 99 employees? 1 - YES
2 - NO
GO TO Q12

Q11c. How many personal service establishments

1 − YES, GO TO Q11a
2 − NO, GO TO Q12
Q12 other establishment such as an internet shop,
computer game station, medical clinic, law office,
taxi operator, vehicle rental firm, cargo handler,
freight forwarder, courier, private postal service
firm, video rental, photocopier, waste collector,
establishment engaged in electrical and plumbing
works, and other establishments not included
in Items Q5 to Q11?
1 − YES, GO TO Q12a
2 − NO, GO TO Q13
with 10 to 99 employees are there
in this barangay?
WRITE THE NUMBER IN THE BOXES.
Q12a. Does this barangay have other establishments
such as ___________ (MENTION EXAMPLES 1 - YES
IN Q12) with 100 employees or more? 2 - NO
Q12b. Does this barangay have other establishments
such as ___________ (MENTION EXAMPLES 1 - YES
IN Q12) with 10 to 99 employees? 2 - NO
GO TO Q13
Q12c. How many other establishments
with 10 to 99 employees are there
in this barangay?
WRITE THE NUMBER IN THE BOXES.
5D GENERAL INSTRUCTIONS:
1 WRITE THE NUMBER OR CODE CORRESPONDING TO THE ANSWER IN THE BOX/ES.
2 ASK FOR THE BEST ESTIMATE OF THE NUMBER OF HOUSEHOLDS AND WRITE THE NUMBER INSIDE THE BOXES.
3 WRITE THE SPECIFIC ANSWER/S ON THE LINE PROVIDED.
PART III − Presence and Number of Informal Settlers CODE / NUMBER

In this barangay, are there households who reside...

Q13 along estero/creek/waterway? 1 − YES 2 − NO, GO TO Q14

IF YES, how many households reside along estero/creek/waterway?

Q14 along riverbank/shoreline? 1 − YES 2 − NO, GO TO Q15

IF YES, how many households reside along riverbank/shoreline?

Q15 along railroad? 1 − YES 2 − NO, GO TO Q16

IF YES, how many households reside along railroad?

Q16 in garbage dumpsite? 1 − YES 2 − NO, GO TO Q17

IF YES, how many households reside in garbage dumpsite?

Q17 under the bridge? 1 − YES 2 − NO, GO TO Q18

IF YES, how many households reside under the bridge?

Q18 along sidewalk or easement of roads and highways? 1 − YES 2 − NO, GO TO Q19

IF YES, how many households reside along sidewalk or easement of roads

and highways?
Q19 in other danger areas such as cliff, cemetery, and others? 1 − YES 2 − NO, GO TO Q20
IF YES, SPECIFY_______________________________
IF YES, how many households reside in other danger areas such as cliff,
cemetery, and others?
Q20 in government land without legally recognizable claim to the land? 1 − YES 2 − NO, GO TO Q21

IF YES, how many households reside in government land without legally

recognizable claim to the land?
Q21 in private land which they do not own? 1 − YES 2 − NO, GO TO Q22

IF YES, how many households reside in private land which they do not own?

PART IV – Presence of Relocation Area and Number of Households in the Relocation Area CODE / NUMBER

In this barangay, is there a...

Q22 temporary relocation area? 1 − YES 2 − NO, GO TO Q23

IF YES, how many households reside in the temporary relocation area?

Q23 permanent relocation/resettlement area? 1 − YES 2 − NO, GO TO Q24

IF YES, how many households reside in permanent relocation/resettlement area?

PART V – Occurrence and Number of In-Movers to the Barangay by Barangay/s of Origin CODE / NUMBER
In this barangay, was there a large or significant number of households who moved in or transferred
to this barangay in the last five (5) years due to the following reasons...
Q24 typhoon? 1 − YES 2 − NO, GO TO Q25

IF YES, how many households moved or transferred to this barangay

due to typhoon? SPECIFY BARANGAY/S OF ORIGIN ___________________________________________________
Q25 other natural calamity/disaster? IFYES, SPECIFY_______________________ 1 − YES 2 − NO, GO TO Q26

IF YES, how many households moved or transferred to this barangay

due to other natural calamity/disaster? SPECIFY BARANGAY/S OF ORIGIN __________________________________
Q26 peace and order problem? 1 − YES 2 − NO, GO TO Q27

IF YES, how many households moved or transferred to this barangay

due to peace and order problem? SPECIFY BARANGAY/S OF ORIGIN _____________________________________
Q27 other reasons? IF YES, SPECIFY___________________________________ 1 − YES 2 − NO, GO TO Q28

IF YES, how many households moved or transferred to this barangay

due to other reasons? SPECIFY BARANGAY/S OF ORIGIN ______________________________________________
PART VI – Occurrence and Number of Out-Movers from the Barangay by Barangay/s of Destination CODE / NUMBER

In this barangay, was there a large or significant number of households who moved out or transferred
from this barangay in the last five (5) years due to the following reasons...
Q28 typhoon? 1 − YES 2 − NO, GO TO Q29

IF YES, how many households moved or transferred from this barangay

due to typhoon? SPECIFY BARANGAY/S OF DESTINATION _____________________________________________
Q29 other natural calamity/disaster? IF YES, SPECIFY______________________ 1 − YES 2 − NO, GO TO Q30

IF YES, how many households moved or transferred from this barangay

due to other natural calamity/disaster? SPECIFY BARANGAY/S OF DESTINATION ____________________________
Q30 peace and order problem? 1 − YES 2 − NO, GO TO Q31

IF YES, how many households moved or transferred from this barangay

due to peace and order problem? SPECIFY BARANGAY/S OF DESTINATION _______________________________
Q31 other reasons? IF YES, SPECIFY___________________________________ 1 − YES 2 − NO, END INTERVIEW

IF YES, how many households moved or transferred from this barangay

due to other reasons? SPECIFY BARANGAY/S OF DESTINATION ________________________________________