SP2020-C1

CONFIDENTIAL
POPULATION CENSUS 2020
REPUBLIC OF INDONESIA set of set
PROCEDURES FOR FILLING IN QUESTIONNAIRE : SAMPLE OF WRITING :
 Use a soft lead 2B pencil to fill in the answers
 If you want to change an answer, erase it
completely
 Do not fold the document and keep it clean 1. Yes 2. No
and dry

BLOCK I. INFORMATION ON PLACE

Copy the answer code in Questions 101, 102, and 103 of List SP2020-DP
101. Province : Regency/Municipality*) : Sub-district : Village/Kelurahan*) :
Current Address
102. Name of Local Neighborhood Unit (SLS) / Non Local Neighborhood Unit (Non-SLS) *) :
103. Code of SLS / Non SLS *) : - Serial Number of Family Number of Building

104. Address :

105. Name of Family Head :

106. Number of Family Members :
107. Family Member Who Can be Connected

a. Name :
b. Cell-phone Number :

BLOCK II. INFORMATION ABOUT THE OFFICER

Enumerator/Data Collector Team Coordinator
(1) (2) (3)

201. Name :
202. Code :
203. Date of Implementation : / / 2 0 2 0 / / 2 0 2 0

BLOCK III. DATA ON PRESENT HOUSING QUARTERS AND RESIDENCE

301. What is the ownership status of the house occupied? 304. Does this house have a latrine / toilet facilities and
1. Self-owned 4. Housing from workplace septic tanks?
2. Contracted/leased 5. Others 1. Yes, with a septic tank
3. Free of rent (living in with other person) 2. Yes, without a septic tank
302. Does it have electricity? 3. No
1. Yes, PLN with more than 900 watts of power
305. What is the biggest part of the floor of this house made of?
2. Yes, PLN with 450 watts or 900 watts of power
3. Yes, PLN without a meter 1. Ceramic tiles/marble/granite 5. Bamboo
4. Yes, non-PLN electricity 2. Tiles / terrazzo 6. Earthen/dirt floors
5. Does not use electricity 3. Cement 7. Others
303. What is the main source of water used by this family? 4. Wood/ boards
1. Bottled water / refill water 5. Springs
2. Plumbing 6. River / lake
3. A pump/deep well pump 7. Rainwater
4. A well 8. Others
*) Cross out unnecessary options Page 1
 Occupation Code

001. Accountant 053. Machinist 098. Writer 127. Bank Teller

002. Regional Representative Council 054. Mechanic 099. Event Organizer (Event Organizer/ 128. Washer Woman/Man
(DPD) Member 055. Minister EO) 129. Cleaning Worker
003. Provincial/Regency/City House of 056. Captain 100. Radio Broadcaster 130. Administrative Staff
Representatives Member (DPRD) 057. Fisherman 101. Television Broadcaster 131. Indonesian National Army
004. Member of the Indonesian 058. Notary Public 102. Fortune Teller Member
Parliament 059. Machine Operator 103. Fashion Designer 132. Construction Worker
005. Pharmacist 060. Court Clerk 104. Village Official 133. Painter
006. Architect 061. Traditional midwife (Paraji) 105. Nurse 134. Barber
007. Pharmacist Assistant 062. Psychic 106. Fish Farmer 135. Photocopier
008. Attaché 063. Priest 107. Farmer / Planter 136. Dentist
009. Athlete/Sportsman 064. Trader 108. Breeder 137. Glass Fitter
010. Ship Crew 065. Street Food Pedlar/Hawker 109. Pilot 138. Carpenter
011. Monk/Brother/Nun 066. Non-food Pedlar/Hawker 110. Specific Functional Civil Servant 139. Locksmith
012. Midwife 067. Online Merchant 111. General Functional Civil Servant 140. Welder / Blacksmith
013. Broker / Stockbroker 068. Garment industry / Tailoring 112. Structural Civil Servant 141. Electrician
014. Regent Workers 113. Police 142. Massage Therapist/ Masseur or
015. Goods Transportation worker 069. Printing Worker 114. Airhost/airhostess Masseuse
016. Construction Worker 070. Sports Coach / Instructor 115. President 143. Plumber
017. Industrial Worker 071. Restaurant / Food Stall 116. Programmer 144. Screen Printing Worker
018. Fisheries Worker Waiter 117. Psychiatrist 145. Shoe Repairman
019. Mining Worker 072. Shop Assistant 118. Psychologist 146. Tire repairman
020. Agriculture / Forestry Worker 073. Household Helper / Assistant 119. Public Relations officer 147. Carpenter
021. Animal Husbandry Worker 074. Food Maker 120. Receptionist 148. Ustadz / Mubaligh (Islamic
022. Head of Sub-District 075. Beverage Maker 121. Secretary Religious Teacher)
023. Chef 076. Cigarette / Cigar / Rolled 122. Artist 149. Deputy Regent
024. Chief Executive Officer (CEO) Tobacco Maker 123. Driver 150. Deputy Governor
025. Customer Service 077. Shoes and bags Maker 124. Supervisor / Overseer 151. Vice President
026. Dentist 078. Debt Collector 125. Islamic Traditional Doctor (Tabib) 152. Deputy Mayor
027. Veterinarian 079. Spiritual Advisor 126. Technician 153. Mayor
028. Specialist Doctor 080. Clothing Designer 154. Reporters
029. General Practitioner 081. Hairdresser 155. Others
030. Lecturer 082. Makeup Artist
031. Ambassador 083. Pastor
032. Photographer 084. Researcher
033. Governor 085. Translator
034. Teacher 086. Lawyer
035. Judge 087. Baby Sitter
036. Chief Justice 088. Online Motorcycle Taxi Driver
037. Imam in a Mosque 089. Motorcycle Taxi Driver
038. Prosecutor 090. Stoneworker
039. Attorney General 091. Craftsman of Wood, Bamboo
040. Drafting Technician/ Drafter and Matting
041. Cook 092. Leather and Textile
042. Cameraman Craftsman
043. Ship Captain 093. Metal Craftsman
044. Cashier 094. Jewellery Craftsman
045. Village Head (Kepala Desa) 095. Pottery / Ceramics Worker
046. Indigenous Chief 096. Security Guard / Security
047. Chair of Organization 097. Tailor
048. Consultant
049. Courier
050. Head of Kelurahan (urban village)
051. Agent
052. Manager

Page 2
Province Regency/City Sub-district Village/Kel Code of SLS/ Non SLS Family Serial Number Family Number Serial Number Building Number Put check mark (P ) if the status
column on SP2020-DP is coded 1 or 3
- Complete d th e Online
Pop ulation Census

BLOCK IV. POPULATION DATA

401. Full Name according to Family Card / Identity Card 411. Relationship status with the head of the family
01. Head of Family 07. Parent
02. Husband 08. Parent-in-law
03. Wife 09. Other family member
402. Sex
04. Child 10. Household Helper
1. Male 2. Female
05. Daughter-in-law/Sister-in-law 11. Other
403.a. Population Identity Number (NIK)
06. Grandchild
412.a. Duration of stay at the current address (Local
If you have filled in the Population Identification Number, go to question 404 Neighborhood Unit)
b. If you have not filled in the NIK, please state the reason: Is the duration of stay more than or equal to one year?
1. Document lost / damaged 1. Yes, duration of stay in years Year
2. Do not have/ do not yet have a Family Card / Identity Card (Duration of stay is rounded down)

3. Family Card or Identity Card in other places Continue to question 413

404. Does your current residence address (Local Neighborhood 2. No, duration of stay in months Month
Unit) match the address written on the Family Card? (Duration of stay is rounded down)

1. Yes 2. No b. If the duration of stay at the current address is less than

1 year, do you intend to stay?
405.a. Place of Birth (Code filled in by Team Coordinator)
Born in Indonesia : 1. Yes 2. No
Province : 413. Diploma acquired / highest education completed
Regency/City *) : 01. No schooling / not yet in school 06. Diploma I/II
Born Abroad : (Code filled in by Team Coordinator) 02. Not yet completed elementary 07. Academy /
school / equivalent Diploma III
Country :
03. Graduated from elementary 08. Diploma IV /
b. Is your date of birth the same as that in the Family school / equivalent Bachelor s Degree
Card / Identity Card? 04. SLTP / equivalent 09. Master s Degree
1. Yes 2. No/No Family Card/Identity Card
05. SLTA / equivalent 10. Doctoral Degree
c. Date/Month/Year of Birth Age (Years)
/ / BLOCK V. RESIDENT AGED 5 YEARS OR MORE
406.a. Do you have a birth certificate from the civil registry office? 501. Can you speak Indonesian?
1. Yes Continue to question 407
1. Yes 2. No
2. Don t have one
3. Don t know Continue to question 407 502.a. Your daily activity
1. Yes 2. No
b. The main reason for not having a birth certificate i. Work?
1. Can not afford it 3. Don't know the benefits
of having a certificate ii. Taking care of the household?
2. The office is difficult to access /
too far 4. Others iii. Attending School / College/ University?
407. Nationality iv. Other? (If Yes, please specify)
Continue to
1. Indonesian Citizen 2. Foreign Citizen question 409
408. Ethnic Group Code filled by Team Coordinator
b. Are you retired?
(receive severance pay / pension funds)

409. Religion/Belief 1. Yes 2. No

1. Islam 5. Buddhist If not working (question 502.a.i mark in code 2), then move on to the next
family member
2. Christian 6. Confucian
3. Catholic 7. Other Faiths
503. Work
4. Hindu 8. Others (specify) (Fill in as complete as possible) (Code filled in by Team Coordinator)

410.a. Marital Status

1. Not married Continue to 3. Divorced
question 411
2. Married 4. Widow/widower
b. If the marital status is "married" or "divorced" or "widow/ 504. Job status
widower", write down the deed number / marriage
certificate number/divorce or death certificate number of 1. Self-employed / assisted by 3. Paid Worker / Employee
deceased husband / wife? unpaid workers
2. Entrepreneur assisted by paid 4. Unpaid workers / Family
workers Workers
*) Cross out the unnecessary option Page 3
 Family Number Serial Number Put check mark (P ) if the status
column on SP2020-DP is coded 1 or 3
Completed the Online
Population Census

BLOCK IV. POPULATION DATA

401. Full Name according to Family Card / Identity Card 411. Relationship status with the head of the family
01. Head of Family 07. Parent
02. Husband 08. Parent-in-law
03. Wife 09. Other family member
402. Sex
04. Child 10. Household Helper
1. Male 2. Female
05. Daughter-in-law/Sister-in-law 11. Other
403.a. Population Identity Number (NIK)
06. Grandchild
412.a. Duration of stay at the current address (Local
If you have filled in the Population Identification Number, go to question 404 Neighborhood Unit)
b. If you have not filled in the NIK, please state the reason: Is the duration of stay more than or equal to one year?
1. Document lost / damaged 1. Yes, duration of stay in years Year
2. Do not have/ do not yet have a Family Card / Identity Card (Duration of stay is rounded down)

3. Family Card or Identity Card in other places Continue to question 413

404. Does your current residence address (Local Neighborhood 2. No, duration of stay in months Month
Unit) match the address written on the Family Card? (Duration of stay is rounded down)

1. Yes 2. No b. If the duration of stay at the current address is less than

1 year, do you intend to stay?
405.a. Place of Birth (Code filled in by Team Coordinator)
Born in Indonesia : 1. Yes 2. No
Province : 413. Diploma acquired / highest education completed
Regency/City *) : 01. No schooling / not yet in school 06. Diploma I/II
Born Abroad : (Code filled in by Team Coordinator) 02. Not yet completed elementary 07. Academy /
school / equivalent Diploma III
Country :
03. Graduated from elementary 08. Diploma IV /
b. Is your date of birth the same as that in the Family school / equivalent Bachelor s Degree
Card / Identity Card? 04. SLTP / equivalent 09. Master s Degree
1. Yes 2. No/No Family Card/Identity Card
05. SLTA / equivalent 10. Doctoral Degree
c. Date/Month/Year of Birth Age (Years)
/ / BLOCK V. RESIDENT AGED 5 YEARS OR MORE
406.a. Do you have a birth certificate from the civil registry office? 501. Can you speak Indonesian?
1. Yes Continue to question 407
1. Yes 2. No
2. Don t have one
3. Don t know Continue to question 407 502.a. Your daily activity
1. Yes 2. No
b. The main reason for not having a birth certificate i. Work?
1. Can not afford it 3. Don't know the benefits
of having a certificate ii. Taking care of the household?
2. The office is difficult to access /
too far 4. Others iii. Attending School / College/ University?
407. Nationality iv. Other? (If Yes, please specify)
Continue to
1. Indonesian Citizen 2. Foreign Citizen question 409
408. Ethnic Group Code filled by Team Coordinator
b. Are you retired?
(receive severance pay / pension funds)

409. Religion/Belief 1. Yes 2. No

1. Islam 5. Buddhist If not working (question 502.a.i mark in code 2), then move on to the next
family member
2. Christian 6. Confucian
3. Catholic 7. Other Faiths
503. Work
4. Hindu 8. Others (specify) (Fill in as complete as possible) (Code filled in by Team Coordinator)

410.a. Marital Status

1. Not married Continue to 3. Divorced
question 411
2. Married 4. Widow/widower
b. If the marital status is "married" or "divorced" or "widow/ 504. Job status
widower", write down the deed number / marriage
certificate number/divorce or death certificate number of 1. Self-employed / assisted by 3. Paid Worker / Employee
deceased husband / wife? unpaid workers
2. Entrepreneur assisted by paid 4. Unpaid workers / Family
workers Workers
*) Cross out the unnecessary option Page 4
Province Regency/City Sub-district Village/Kel Code of SLS/ Non SLS Family Serial Number Family Number Serial Number Building Number Put check mark (P ) if the status
column on SP2020-DP is coded 1 or 3
- Complete d th e Online
Pop ulation Census

BLOCK IV. POPULATION DATA

401. Full Name according to Family Card / Identity Card 411. Relationship status with the head of the family
01. Head of Family 07. Parent
02. Husband 08. Parent-in-law
03. Wife 09. Other family member
402. Sex
04. Child 10. Household Helper
1. Male 2. Female
05. Daughter-in-law/Sister-in-law 11. Other
403.a. Population Identity Number (NIK)
06. Grandchild
412.a. Duration of stay at the current address (Local
If you have filled in the Population Identification Number, go to question 404 Neighborhood Unit)
b. If you have not filled in the NIK, please state the reason: Is the duration of stay more than or equal to one year?
1. Document lost / damaged 1. Yes, duration of stay in years Year
2. Do not have/ do not yet have a Family Card / Identity Card (Duration of stay is rounded down)

3. Family Card or Identity Card in other places Continue to question 413

404. Does your current residence address (Local Neighborhood 2. No, duration of stay in months Month
Unit) match the address written on the Family Card? (Duration of stay is rounded down)

1. Yes 2. No b. If the duration of stay at the current address is less than

1 year, do you intend to stay?
405.a. Place of Birth (Code filled in by Team Coordinator)
Born in Indonesia : 1. Yes 2. No
Province : 413. Diploma acquired / highest education completed
Regency/City *) : 01. No schooling / not yet in school 06. Diploma I/II
Born Abroad : (Code filled in by Team Coordinator) 02. Not yet completed elementary 07. Academy /
school / equivalent Diploma III
Country :
03. Graduated from elementary 08. Diploma IV /
b. Is your date of birth the same as that in the Family school / equivalent Bachelor s Degree
Card / Identity Card? 04. SLTP / equivalent 09. Master s Degree
1. Yes 2. No/No Family Card/Identity Card
05. SLTA / equivalent 10. Doctoral Degree
c. Date/Month/Year of Birth Age (Years)
/ / BLOCK V. RESIDENT AGED 5 YEARS OR MORE
406.a. Do you have a birth certificate from the civil registry office? 501. Can you speak Indonesian?
1. Yes Continue to question 407
1. Yes 2. No
2. Don t have one
3. Don t know Continue to question 407 502.a. Your daily activity
1. Yes 2. No
b. The main reason for not having a birth certificate i. Work?
1. Can not afford it 3. Don't know the benefits
of having a certificate ii. Taking care of the household?
2. The office is difficult to access /
too far 4. Others iii. Attending School / College/ University?
407. Nationality iv. Other? (If Yes, please specify)
Continue to
1. Indonesian Citizen 2. Foreign Citizen question 409
408. Ethnic Group Code filled by Team Coordinator
b. Are you retired?
(receive severance pay / pension funds)

409. Religion/Belief 1. Yes 2. No

1. Islam 5. Buddhist If not working (question 502.a.i mark in code 2), then move on to the next
family member
2. Christian 6. Confucian
3. Catholic 7. Other Faiths
503. Work
4. Hindu 8. Others (specify) (Fill in as complete as possible) (Code filled in by Team Coordinator)

410.a. Marital Status

1. Not married Continue to 3. Divorced
question 411
2. Married 4. Widow/widower
b. If the marital status is "married" or "divorced" or "widow/ 504. Job status
widower", write down the deed number / marriage
certificate number/divorce or death certificate number of 1. Self-employed / assisted by 3. Paid Worker / Employee
deceased husband / wife? unpaid workers
2. Entrepreneur assisted by paid 4. Unpaid workers / Family
workers Workers
*) Cross out the unnecessary option Page 5
 Family Number Serial Number Put check mark (P ) if the status
column on SP2020-DP is coded 1 or 3
Completed the Online
Population Census

BLOCK IV. POPULATION DATA

401. Full Name according to Family Card / Identity Card 411. Relationship status with the head of the family
01. Head of Family 07. Parent
02. Husband 08. Parent-in-law
03. Wife 09. Other family member
402. Sex
04. Child 10. Household Helper
1. Male 2. Female
05. Daughter-in-law/Sister-in-law 11. Other
403.a. Population Identity Number (NIK)
06. Grandchild
412.a. Duration of stay at the current address (Local
If you have filled in the Population Identification Number, go to question 404 Neighborhood Unit)
b. If you have not filled in the NIK, please state the reason: Is the duration of stay more than or equal to one year?
1. Document lost / damaged 1. Yes, duration of stay in years Year
2. Do not have/ do not yet have a Family Card / Identity Card (Duration of stay is rounded down)

3. Family Card or Identity Card in other places Continue to question 413

404. Does your current residence address (Local Neighborhood 2. No, duration of stay in months Month
Unit) match the address written on the Family Card? (Duration of stay is rounded down)

1. Yes 2. No b. If the duration of stay at the current address is less than

1 year, do you intend to stay?
405.a. Place of Birth (Code filled in by Team Coordinator)
Born in Indonesia : 1. Yes 2. No
Province : 413. Diploma acquired / highest education completed
Regency/City *) : 01. No schooling / not yet in school 06. Diploma I/II
Born Abroad : (Code filled in by Team Coordinator) 02. Not yet completed elementary 07. Academy /
school / equivalent Diploma III
Country :
03. Graduated from elementary 08. Diploma IV /
b. Is your date of birth the same as that in the Family school / equivalent Bachelor s Degree
Card / Identity Card? 04. SLTP / equivalent 09. Master s Degree
1. Yes 2. No/No Family Card/Identity Card
05. SLTA / equivalent 10. Doctoral Degree
c. Date/Month/Year of Birth Age (Years)
/ / BLOCK V. RESIDENT AGED 5 YEARS OR MORE
406.a. Do you have a birth certificate from the civil registry office? 501. Can you speak Indonesian?
1. Yes Continue to question 407
1. Yes 2. No
2. Don t have one
3. Don t know Continue to question 407 502.a. Your daily activity
1. Yes 2. No
b. The main reason for not having a birth certificate i. Work?
1. Can not afford it 3. Don't know the benefits
of having a certificate ii. Taking care of the household?
2. The office is difficult to access /
too far 4. Others iii. Attending School / College/ University?
407. Nationality iv. Other? (If Yes, please specify)
Continue to
1. Indonesian Citizen 2. Foreign Citizen question 409
408. Ethnic Group Code filled by Team Coordinator
b. Are you retired?
(receive severance pay / pension funds)

409. Religion/Belief 1. Yes 2. No

1. Islam 5. Buddhist If not working (question 502.a.i mark in code 2), then move on to the next
family member
2. Christian 6. Confucian
3. Catholic 7. Other Faiths
503. Work
4. Hindu 8. Others (specify) (Fill in as complete as possible) (Code filled in by Team Coordinator)

410.a. Marital Status

1. Not married Continue to 3. Divorced
question 411
2. Married 4. Widow/widower
b. If the marital status is "married" or "divorced" or "widow/ 504. Job status
widower", write down the deed number / marriage
certificate number/divorce or death certificate number of 1. Self-employed / assisted by 3. Paid Worker / Employee
deceased husband / wife? unpaid workers
2. Entrepreneur assisted by paid 4. Unpaid workers / Family
workers Workers
*) Cross out the unnecessary option Page 6
Province Regency/City Sub-district Village/Kel Code of SLS/ Non SLS Family Serial Number Family Number Serial Number Building Number Put check mark (P ) if the status
column on SP2020-DP is coded 1 or 3
- Complete d th e Online
Pop ulation Census

BLOCK IV. POPULATION DATA

401. Full Name according to Family Card / Identity Card 411. Relationship status with the head of the family
01. Head of Family 07. Parent
02. Husband 08. Parent-in-law
03. Wife 09. Other family member
402. Sex
04. Child 10. Household Helper
1. Male 2. Female
05. Daughter-in-law/Sister-in-law 11. Other
403.a. Population Identity Number (NIK)
06. Grandchild
412.a. Duration of stay at the current address (Local
If you have filled in the Population Identification Number, go to question 404 Neighborhood Unit)
b. If you have not filled in the NIK, please state the reason: Is the duration of stay more than or equal to one year?
1. Document lost / damaged 1. Yes, duration of stay in years Year
2. Do not have/ do not yet have a Family Card / Identity Card (Duration of stay is rounded down)

3. Family Card or Identity Card in other places Continue to question 413

404. Does your current residence address (Local Neighborhood 2. No, duration of stay in months Month
Unit) match the address written on the Family Card? (Duration of stay is rounded down)

1. Yes 2. No b. If the duration of stay at the current address is less than

1 year, do you intend to stay?
405.a. Place of Birth (Code filled in by Team Coordinator)
Born in Indonesia : 1. Yes 2. No
Province : 413. Diploma acquired / highest education completed
Regency/City *) : 01. No schooling / not yet in school 06. Diploma I/II
Born Abroad : (Code filled in by Team Coordinator) 02. Not yet completed elementary 07. Academy /
school / equivalent Diploma III
Country :
03. Graduated from elementary 08. Diploma IV /
b. Is your date of birth the same as that in the Family school / equivalent Bachelor s Degree
Card / Identity Card? 04. SLTP / equivalent 09. Master s Degree
1. Yes 2. No/No Family Card/Identity Card
05. SLTA / equivalent 10. Doctoral Degree
c. Date/Month/Year of Birth Age (Years)
/ / BLOCK V. RESIDENT AGED 5 YEARS OR MORE
406.a. Do you have a birth certificate from the civil registry office? 501. Can you speak Indonesian?
1. Yes Continue to question 407
1. Yes 2. No
2. Don t have one
3. Don t know Continue to question 407 502.a. Your daily activity
1. Yes 2. No
b. The main reason for not having a birth certificate i. Work?
1. Can not afford it 3. Don't know the benefits
of having a certificate ii. Taking care of the household?
2. The office is difficult to access /
too far 4. Others iii. Attending School / College/ University?
407. Nationality iv. Other? (If Yes, please specify)
Continue to
1. Indonesian Citizen 2. Foreign Citizen question 409
408. Ethnic Group Code filled by Team Coordinator
b. Are you retired?
(receive severance pay / pension funds)

409. Religion/Belief 1. Yes 2. No

1. Islam 5. Buddhist If not working (question 502.a.i mark in code 2), then move on to the next
family member
2. Christian 6. Confucian
3. Catholic 7. Other Faiths
503. Work
4. Hindu 8. Others (specify) (Fill in as complete as possible) (Code filled in by Team Coordinator)

410.a. Marital Status

1. Not married Continue to 3. Divorced
question 411
2. Married 4. Widow/widower
b. If the marital status is "married" or "divorced" or "widow/ 504. Job status
widower", write down the deed number / marriage
certificate number/divorce or death certificate number of 1. Self-employed / assisted by 3. Paid Worker / Employee
deceased husband / wife? unpaid workers
2. Entrepreneur assisted by paid 4. Unpaid workers / Family
workers Workers
*) Cross out the unnecessary option Page 7
 Family Number Serial Number Put check mark (P ) if the status
column on SP2020-DP is coded 1 or 3
Completed the Online
Population Census

BLOCK IV. POPULATION DATA

401. Full Name according to Family Card / Identity Card 411. Relationship status with the head of the family
01. Head of Family 07. Parent
02. Husband 08. Parent-in-law
03. Wife 09. Other family member
402. Sex
04. Child 10. Household Helper
1. Male 2. Female
05. Daughter-in-law/Sister-in-law 11. Other
403.a. Population Identity Number (NIK)
06. Grandchild
412.a. Duration of stay at the current address (Local
If you have filled in the Population Identification Number, go to question 404 Neighborhood Unit)
b. If you have not filled in the NIK, please state the reason: Is the duration of stay more than or equal to one year?
1. Document lost / damaged 1. Yes, duration of stay in years Year
2. Do not have/ do not yet have a Family Card / Identity Card (Duration of stay is rounded down)

3. Family Card or Identity Card in other places Continue to question 413

404. Does your current residence address (Local Neighborhood 2. No, duration of stay in months Month
Unit) match the address written on the Family Card? (Duration of stay is rounded down)

1. Yes 2. No b. If the duration of stay at the current address is less than

1 year, do you intend to stay?
405.a. Place of Birth (Code filled in by Team Coordinator)
Born in Indonesia : 1. Yes 2. No
Province : 413. Diploma acquired / highest education completed
Regency/City *) : 01. No schooling / not yet in school 06. Diploma I/II
Born Abroad : (Code filled in by Team Coordinator) 02. Not yet completed elementary 07. Academy /
school / equivalent Diploma III
Country :
03. Graduated from elementary 08. Diploma IV /
b. Is your date of birth the same as that in the Family school / equivalent Bachelor s Degree
Card / Identity Card? 04. SLTP / equivalent 09. Master s Degree
1. Yes 2. No/No Family Card/Identity Card
05. SLTA / equivalent 10. Doctoral Degree
c. Date/Month/Year of Birth Age (Years)
/ / BLOCK V. RESIDENT AGED 5 YEARS OR MORE
406.a. Do you have a birth certificate from the civil registry office? 501. Can you speak Indonesian?
1. Yes Continue to question 407
1. Yes 2. No
2. Don t have one
3. Don t know Continue to question 407 502.a. Your daily activity
1. Yes 2. No
b. The main reason for not having a birth certificate i. Work?
1. Can not afford it 3. Don't know the benefits
of having a certificate ii. Taking care of the household?
2. The office is difficult to access /
too far 4. Others iii. Attending School / College/ University?
407. Nationality iv. Other? (If Yes, please specify)
Continue to
1. Indonesian Citizen 2. Foreign Citizen question 409
408. Ethnic Group Code filled by Team Coordinator
b. Are you retired?
(receive severance pay / pension funds)

409. Religion/Belief 1. Yes 2. No

1. Islam 5. Buddhist If not working (question 502.a.i mark in code 2), then move on to the next
family member
2. Christian 6. Confucian
3. Catholic 7. Other Faiths
503. Work
4. Hindu 8. Others (specify) (Fill in as complete as possible) (Code filled in by Team Coordinator)

410.a. Marital Status

1. Not married Continue to 3. Divorced
question 411
2. Married 4. Widow/widower
b. If the marital status is "married" or "divorced" or "widow/ 504. Job status
widower", write down the deed number / marriage
certificate number/divorce or death certificate number of 1. Self-employed / assisted by 3. Paid Worker / Employee
deceased husband / wife? unpaid workers
2. Entrepreneur assisted by paid 4. Unpaid workers / Family
workers Workers
*) Cross out the unnecessary option Page 8