CBMS FORM 1 Republic of the Philippines

Approval Number: PSA-2225-05 Philippine Statistics Authority

Expiry Date: 30 April 2023

2022 COMMUNITY-BASED MONITORING SYSTEM

LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS
Dear Sir/Madam:

The Philippine Statistics Authority (PSA) is collecting information from every household in the country using the Community-Based Monitoring System or CBMS. The CBMS aims to gather information about your household on different dimensions of living conditions
such as health, nutrition, water, sanitation, shelter, education, income, employment, security, participation, and disaster-preparedness. The data collected will be used by your city/municipality and national government agencies to craft evidenced-based policies and
programs for the development of the community.

The PSA highly encourages your participation and cooperation in the CBMS since data collected will be used as basis in targeting beneficiaries of social and economic development programs of the government, among its other goals. However, participation in CBMS
is purely voluntary. It is assured that the data you will provide shall be utilized in the betterment of the community. In addition, there is no right or wrong answer in accomplishing this questionnaire, but we encourage you to provide truthful and complete answers.

Please be informed that all information shared are strictly confidential pursuant to Section 10 (Confidentiality of Information) of Republic Act (RA) No. 11315 or the CBMS Act and Section 8 (Confidentiality) of RA No. 10173 or the Data Privacy Act of 2012 and will not
be used against you or any of your household member for taxation, investigation, or law enforcement purposes.

If you have inquiries, you may contact PSA at (02) 8376-1909. You may also send us a message through the following e-mail addresses: cbms@psa.gov.ph and psacbms@gmail.com.

Thank you very much.

CLAIRE DENNIS S. MAPA, Ph.D.

Undersecretary
National Statistician and Civil Registrar General
GEOGRAPHIC IDENTIFICATION

BOOKLET OF BOOKLETS

PROVINCE BARANGAY

CITY/MUNICIPALITY ENUMERATION AREA NUMBER …………………………………………………………………………

CERTIFICATION
Special Household Serial Number Homeless Serial Number
HSN = 7777 Non Usual Resident (NUR) BSN = 6000 Series
HSN = 8888 Foreign ambassadors, minister, consul or other HUSN = 6000 Series
EN CODE TS CODE diplomatic representatives
HSN = 8889 Vacation / Rest House (VRH) BSN and HUSN, starts at 6001
HSN = 9999 Vacant Building/Housing Unit (VBLDG/VHU)
ENUMERATOR TEAM SUPERVISOR
SIGNATURE OVER PRINTED NAME / DATE ACCOMPLISHED SIGNATURE OVER PRINTED NAME / DATE REVIEWED Newly Tagged Building Serial Number
BSN = 4000 Series, starts at 4001

CAS CODE Temporary Relocation Serial Number

BSN = 5555
HUSN = 5555
CBMS AREA SUPERVISOR
SIGNATURE OVER PRINTED NAME / DATE REVIEWED
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1A
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)
e.g., For callback on 07/16
1

10

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1B
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

11

12

13

14

15

16

17

18

19

20

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
TOTAL VACANT
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1C
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

21

22

23

24

25

26

27

28

29

30

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
TOTAL VACANT
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1D
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

31

32

33

34

35

36

37

38

39

40

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1E
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

41

42

43

44

45

46

47

48

49

50

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1F
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

51

52

53

54

55

56

57

58

59

60

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1G
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

61

62

63

64

65

66

67

68

69

70

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1H
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

71

72

73

74

75

76

77

78

79

80

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1I
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

81

82

83

84

85

86

87

88

89

90

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1J
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

91

92

93

94

95

96

97

98

99

100

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1K
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

101

102

103

104

105

106

107

108

109

110

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1L
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

111

112

113

114

115

116

117

118

119

120

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1M
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

121

122

123

124

125

126

127

128

129

130

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1O
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

131

132

133

134

135

136

137

138

139

140

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1P
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

141

142

143

144

145

146

147

148

149

150

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1Q
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

151

152

153

154

155

156

157

158

159

160

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1R
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

161

162

163

164

165

166

167

168

169

170

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1S
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

171

172

173

174

175

176

177

178

179

180

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1T
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

181

182

183

184

185

186

187

188

189

190

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1U
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

191

192

193

194

195

196

197

198

199

200

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1V
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

201

202

203

204

205

206

207

208

209

210

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1W
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

211

212

213

214

215

216

217

218

219

220

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1X
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

221

222

223

224

225

226

227

228

229

230

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1Y
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

231

232

233

234

235

236

237

238

239

240

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1Z
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

241

242

243

244

245

246

247

248

249

250

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AA
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

251

252

253

254

255

256

257

258

259

260

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AB
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

261

262

263

264

265

266

267

268

269

270

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AC
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

271

272

273

274

275

276

277

278

279

280

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AD
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

281

282

283

284

285

286

287

288

289

290

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AE
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

291

292

293

294

295

296

297

298

299

300

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AF
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

301

302

303

304

305

306

307

308

309

310

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AG
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

311

312

313

314

315

316

317

318

319

320

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AH
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

321

322

323

324

325

326

327

328

329

330

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AI
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

331

332

333

334

335

336

337

338

339

340

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AJ
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

341

342

343

344

345

346

347

348

349

350

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AK
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

351

352

353

354

355

356

357

358

359

360

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AL
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

361

362

363

364

365

366

367

368

369

370

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AM
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

371

372

373

374

375

376

377

378

379

380

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AN
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

381

382

383

384

385

386

387

388

389

390

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AO
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

391

392

393

394

395

396

397

398

399

400

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AP
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

401

402

403

404

405

406

407

408

409

410

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AQ
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

411

412

413

414

415

416

417

418

419

420

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AR
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

421

422

423

424

425

426

427

428

429

430

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AS
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

431

432

433

434

435

436

437

438

439

440

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AT
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

441

442

443

444

445

446

447

448

449

450

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AU
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

451

452

453

454

455

456

457

458

459

460

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AV
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

461

462

463

464

465

466

467

468

469

470

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AW
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (15) (16) (17)

471

472

473

474

475

476

477

478

479

480

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR
 LISTING RECORD OF BUILDINGS, HOUSING UNITS AND HOUSEHOLDS 1AX
NAME OF HOUSEHOLD HEAD SITIO/PUROK HOUSEHOLD MEMBER GEOTAGGED TIME TIME RESULT NAME OF RESPONDENT SIGNED THE REMARKS

SERIAL NUMBER (BSN)

HOUSING UNIT SERIAL

HOUSEHOLD SERIAL
(LAST NAME, FIRST NAME, MIDDLE NAME) (IF AVAILABLE) COUNT START END OF VISIT (LAST NAME, FIRST CONSENT (OTHER INFORMATION SUCH AS
(NAME) NAME, MIDDLE NAME) WAIVER CALLBACK/APPOINTMENT FOR NEXT VISIT,

DATE UPLOADED
NUMBER (HUSN)

NUMBER (HSN)
ADDRESS FORM? ETC.)
DATE OF VISIT
LINE NUMBER

BUILDING (ENTER HOUSE/BUILDING NUMBER AND 1 YES

STREET, ALSO INCLUDES UNIT NUMBER IF 2 NO HH:MM HH:MM (SEE 1 YES

FEMALE
MM/DD

MM/DD
TOTAL
AVAILABLE) CODES 2 NO

MALE
BELOW)
(01) (02) (03) (04) (05) (06) (07) (08) (09) (10) (11) (12) (13) (14) (148) (16) (17)

481

482

483

484

485

486

487

488

489

490

BSN HUSN HSN COUNT MALE FEMALE CODES FOR (13) RESULT OF VISIT
TOTAL TOTAL 1 COMPLETED 6 EXCLUDED IN THE INTERVIEW
2 REFUSED 7 VRH
3 TERMINATED INTERVIEW 8 CALLBACK (WITH APPOINTMENT DATE)
TOTAL VACANT 4 VHU/VBLDG 9 CALLBACK (NOT YET COMPLETED)
5 NUR