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798 Volume III Annex 3: Questionnaire Part 1. Socio-Economic Data Section 1: Household Roster Section 2: Rations Received and Consumption of Provisions Section 3: Housing Section 4: Education Section 5: Health Section 6: Activities, Entertainment, and Hobbies Section 7: Job Search and Past Employment Part 2. Monthly, Quarterly, and Annual Expenditures Section 8: Expenditures on Nonfood Services and Commodities (past 30 days) Section 9: Expenditures on Nonfood Services and Commodities (past 90 days) Section 10: Expenditures on Nonfood Services and Commodities (past 12 months) Part 3. Daily Expenditures, Income, and Other Section 11: Daily Expenditure on Repetitive Food and Nonfood Commodities Section 12: Jobs during the Previous 12 Months Section 13: Wage Earnings Section 14: Nonwage Earning Activities Section 15: Income from Property and Transfers Section 16: Durable Goods Section 17: Loans, Credits, and Assistance Section 18: Risk Statistical Classifications Used in Coding the Questionnaire The following manuals and classifications were used in coding the questionnaire: The Classification of Individual Consumption According to Purpose (COICOP) was used to code consumption commodities and services. International Standard Industrial Classification of All Economic Activities, third revision (ISIC3) was used in coding economic activities. International Standard Classification of Occupations (ISCO) issued by ILO in 1988 was used in the classification of occupations. Iraq Administrative Units Manual 1. 2. 3. 4.

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Page 1: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

798

Volume III

Annex 3: Questionnaire

Part 1. Socio-Economic DataSection 1: Household RosterSection 2: Rations Received and Consumption of ProvisionsSection 3: HousingSection 4: EducationSection 5: HealthSection 6: Activities, Entertainment, and Hobbies Section 7: Job Search and Past Employment

Part 2. Monthly, Quarterly, and Annual ExpendituresSection 8: Expenditures on Nonfood Services and Commodities (past 30 days)Section 9: Expenditures on Nonfood Services and Commodities (past 90 days) Section 10: Expenditures on Nonfood Services and Commodities (past 12 months)

Part 3. Daily Expenditures, Income, and OtherSection 11: Daily Expenditure on Repetitive Food and Nonfood CommoditiesSection 12: Jobs during the Previous 12 MonthsSection 13: Wage EarningsSection 14: Nonwage Earning ActivitiesSection 15: Income from Property and TransfersSection 16: Durable GoodsSection 17: Loans, Credits, and AssistanceSection 18: Risk

Statistical Classifications Used in Coding the Questionnaire

The following manuals and classifications were used in coding the questionnaire:

The Classification of Individual Consumption According to Purpose (COICOP)

was used to code consumption commodities and services.

International Standard Industrial Classification of All Economic Activities, third

revision (ISIC3) was used in coding economic activities.

International Standard Classification of Occupations (ISCO) issued by ILO in

1988 was used in the classification of occupations.

Iraq Administrative Units Manual

1.

2.

3.

4.

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Annex 3: Survey questionnaire

Part No. 1: Socio-Economic Data

A. FIRST IDENTIFICATION Code

06 Governorate

07 District

08 Area

09 Quarters

10 Alley (Street)

11 Country

12 Village

13 Class Draw circle around appropriate answer

Provinces1 Rural2 Suburban3 Urban / Central

Baghdad Suburban 2 Rural 1

Urban / CentralAl-Rasafah 4 Al-Sader City 3

Al-Karekh 5

14 The number of the building for the survey

C. FIELD STAFF Signature CODE Date

23 INTERVIEWER 24 0-/--/--

25 TEAM LEADER 26 27 0-/--/--

28 DATA ENTRY OPER. 29 30 0-/--/--

31 CENTRAL SUPERVISOR 32 33 0-/--/--

40 Has Household been include in MICS3 Survey? Draw circle around correct answer Yes No

For Researcher: Pls double check against families included in MICS3 Survey

ا�ستيفاء بيانات اال�ستمارة

01 02 03

WAVE (1 - 18) TEAM INT. (1 - 3)

The Ministry of Planning and Development Cooperation

Central Organization for Statistics and Information Technology (COSIT)

The Republic of Iraq For eradication of poverty and enhancing the socio-economic status of the households in Iraq

In cooperation with the Kurdistan Regional Statistical Commission (KRSCO)

Household Socio-Economic Survey in Iraq (IHSES 2007 - 2006)

HOUSEHOLD IDENTIFIER

04 05

CLUSTER HH

B. HOUSEHOLD IDENTIFICATION

15 Household head name

16 Work address

17 Household size

18 HOUSEHOLD SIZE

19 Telephone number

20 Work tel. no.

21Numeral dorm for this household

22 No. of this Questionnaire

D- Visits of Field Researchers RESULT OF THE INTERVIEW

35 First Visit 0-/--/--

36 Second Visit 0-/--/--

37 Third Visit 0-/--/--

38 Fourth Visit 0-/--/--

39 Fifth Visit 0-/--/--

1

2

3

4

5

6

7

8

34

Fully achieved

Partially achieved

No usable Information

Unaccomplished: Household refused interview

Unaccomplished: Household not present

Unaccomplished: House not found

Unaccomplished: Housing unit not occupied

Unaccomplished: Housing unit is seasonal

104Date of BirthWhat is the date of birth of ..[name]..

103Age in Full Years

If less than one year,write (0)

102Gender

Male 1

Name

Write the name the Head of the Household first, followed by the name of the husband / wife then the children as per age (the ones who are unmarried first, then the ones who are married with their families…husband / wife and their children) then the name of the father / mother, then the brother / sister then the other relatives then those who are not related to the Household

101

ID C

OD

E

Female 2

Year MonthDayYear

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section One: Household RosterNumber of ‘collection’

lines in this page

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Section One: Household Roster

Exclusive for Household Members that are 12 years of age or older

107Place of birthIn which province was ..[name] born? And in what environment?Governorate Code

106Was..[name] ..born in thisprovince?

105What is ...[NAME]... relationship to the head of the household?

Ind

ivid

ual

’s C

od

e

109

SPOUSE’S ID

CODE

108

Marital status

What is the marital

status of ..[name]Wife / Husband2

Wasit26Dhouk11Daughter / Son3

Salah-Eddin27Erbil, Kurdistan Region15Yes 1 107 B

Son/Daughter-in-law4

If more then onewife, write thename of the oneliving within theHousehold.If more than onewife within theHousehold, writethe name of thefirst one

Al-Najaf28Al-Sulaimaniya13Grandchild5

Married1Al-Qadisiya31Ninevah12No 2Mother or Father6

110 Never married2Al-Muthanna32Kurkuk14Sister or Brother7

110 Divorced3Thi-Qar33Diala21Other relatives8

110 Separated4Misan34Al-Anbar22Unrelated to the household

9

110 Widow5Basrah35Baghdad23

OtherCountry

90Babil24

Kerbala25

If the husbandor wife were notmembers of thehousehold, Code98

107 B

Environment

1 - Urban

2 - Rural

107 A

Province Code

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

114What is the main reason for theabsence of the …[name].. during the last 12 months away from home?

113How many months has… [name] been absentduring last 12 months from the household?

112Has [name] been absent from home for one month or more during last 12 months

111What is the code of the father of [name]

If the father is deceased (dead) 99

110What is the code of the mother of[name]

If the mother is deceased (dead)Code 99

Ind

ivid

ual

's C

od

e

Education011 yes

Work022 no

Health reasons03 Next Person

Visiting friends or relatives04

Family problems05

Birth06If the father was not a member ofthe Household

Code 98

If the mother was not a member ofthe Household

Code 98

Jail07

Tourism08

Escorting a patient09

Other [name them]10

Months

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section One: Household Roster

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Section Two: Received Supplies Rations & Consumption of Provisions & the like

A Rations received

201 Does the household receive its rations via a "Ration Card"?

1 Yes

2 No Part B

202 How many “Rations Cards” does the household have?

203 How many household members are recorded in the ration card/ cards for this household?

A Household members of 1 year or more in age

B Children under 1 year

of age

C Total

Number Number Number

What is the total cost paid by the HH, including bags and transportation? 204

AValue of

provisionsrations

BValue of

Sacks / bags

CTransport cost

to place of residence

DTotal

1,000dinar dinar 1,000dinar dinar 1,000dinar dinar 1,000dinar dinar

Mat

eria

l Co

de Ask Questions 205 - 221

For Each Material

Material Unit

Wheat flour Kg

Rice Kg

Sugar Kg

Oil or vegetables fat Kg

Chickpeas Kg

White beans Kg

Lentils Kg

Tea Kg

Powder milk Kg

Salt Kg

Soap Kg

Detergents Kg

Baby powder milk Kg

Children nutrients Kg

Kg

Kg

Kg

Kg

Kg

99 Total

Section Two: Received Supplies Rations & Consumption of Provisions & the like

A Rations received

213

Why did

you sell or

traded

in this

material?

212

What was

the value of the

…[ITEM] that

was sold or

traded?

211

To whom did you sell or trade this

…[ITEM]

210

What was

the

quantity

that you

sold

or traded

of the

..[ITEM]..

that was

received?

209

What was

the

quantity

that you

gave

away

(donated)?

208

What price

would you pay

to buy

the ..[ITEM].. of

same quality?

207

How many

months are

covered

by this

quantity?

206

What is

the

quantity of

the …

[ITEM] ..

that you

have

received

the

last time?

205

When wasthe last timethe household received the …[ITEM]from the

agent?

ITE

M C

OD

E

Relative or friend

1

PoorQuality

1Supplyagent

2during last month

1

No needfor it

2Restaurant/workshop

3

Person buying supply rations selling to others

4

during last 3 months

2Need formoney

3Write“zero”if nothingand move on to thenext item

Write “zero”if nothing

more than 3 mon-12mon

3Other4

Other5neverreceived

4

secondMaterial

Code1,000 DindinarCodeQuantityQuantity1,000 DindinarMonthsQuantityCode

01

02

03

04

05

06

07

08

09

10

11

12

13

14

99

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Section Two: Received Supplies Rations & Consumption of Provisions & the like

B. Consumption of ration items and similar during the past 30 days

221How muchof the...[ITEM]... you consumed was produced bythe house--hold?

220How muchof the...[ITEM]...youconsumedwas received as a gift?

219Why was thispurchase of... [ITEM]...made?

218What was thetotal value of...[the...[ITEM?you purchasedthe value of))incomingquantities in (216 + 217)?

217How muchof the ....[ITEM]... youconsumed was purcasedfrom themarket?

216How muchof ITEMconsumedwaspurchasedfrom theration itemssold on themarket?

215How muchof this...[ITEM]...consumedwas received aspart of yourration?

214How much ITEM].. did]..this householdconsumeduring thepast 30days?

ITE

M C

OD

E

Supply rationinsufficient

1

Write “Zero”for None

Write “Zero”for None

Supply ration & othersourcesinsufficient

2

Write “Zero”for None

Write “Zero”for None

Write “Zero”for None

“Write “Zero for None and move onto the nextitem

Wanted better qualitythan rations

3

If the answers were “zero” for both columns, move toquestion 220 other4

QuantityQuantityCode 1,000Din dinarQuantityQuantityQuantityQuantity

01

02

03

04

05

06

07

08

09

10

11

12

13

14

99

Section Three: Housing

Would you say that your housing unit is:311

A) Lack in room number or area of rooms?

1 Yes

2 No

B) Lacks utilities inside the unit (e.g. garden, garage, storage, utilities…) or their areas?

1 Yes

2 No

C) Old or deteriorated building

1 Yes

2 No

B. Acces to water and disposable wastes

How do you dispose your garbage?312

Indicate most used method

1 Taken by the municipality or its contractor

2 Put in special containers

3 Throw outside the residential unit

4 Burn them

5 Submerge with soil

6 Other (mention)

Main sewage disposal method313

1 Public network

2 Septic tank

3 Covered canal

4 Un-covered canal

5 Other (mention)

A. CHARACTERISTICS OF THE DWELLING

301 How many households are there in this dwelling

Number <-----

302 How long have you been staying in this housing unit No. of years <-----

Type of housing unit303

1 House

2 Flat

3 Clay house

4 Bamboo house

5 Other (mention)

Principal material of the walls of the housing unit304

1 Blocks

2 Stone

3 Cement blocks

4 Thermostone

5 Concrete ready made / pre-cast

6 Clay

7 Bamboo

8 Other (mention)

Principal material for the ceiling of the housing unit305

1 Re-enforce concrete

2 Steel girders

3 Wood

4 Other (mention)

Principal material for the flooring of the housing unit306

1 Ceramics

2 Blocks

3 Cement

4 Soil

5 Other (mention)

Principal material for windows307

1 Aluminum

2 Iron

3 Wood

4 Other (mention)

308 What is the total area of the residential unit and the residential grounds that is being occupied by the household?

A- Total Built Area M²

B- Area of the land M²

PARTS OF THE HOUSING UNIT USED BY THE HOUSE--HOLD

Ser

ial

How many rooms [describe types] do you have for

PartsJointly

with otherhouseholds

Specific to the house

hold

310309

No.No.

Bedroom01

Hall02

Living room03

Dining room04

Kitchen05

Bathroom06

Bathroom with utilities07

Separate utilities08

Storage09

Garage with ceiling10

Garden11

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Section Three: Housing

Does the household have raw water to water the garden ?319

1 Yes

2 No

What is the state of the sanitary utilities (bathrooms) and their locations?

320

1 Inside the residential unit and specific for the household

2 Inside the residential unit but shared with other Households

3 Outside the residential unit but specific to the Household

4 Outside the residential unit but shared with other Households

5 There are no sanitary utilities

What is the method used to cool the residential unit?321

1 Air-condition

2 Cooling device

3 Fan

4 Other (mention)

5 There are none 323

What’s the most likely used method for cooling inside the residential unit?

322

1 Central

2 Partially central

3 Non-central

4 Other (mention)

C. ACCESS TO SOURCES OF ENERGY

What are the main sources of electricity?323

1 Public network

2 Shared generators

3 Special generator

4 There is no electricity326

First Second Third

325How many hoursper electricity was provided during those days?

324How many days per week did your household use of ..[SOURCE]..?Source

Ser

ial

If ‘zero’ go to next source

Hours / DayDay / Week

Public network1

Community generator

2

Private generator3

What is the main source of water?314

1 The residential unit is tied to a public water network

2 Public network: public tap

3 Water tank

4 River or canal

5 Open well

6 Lake or pool

7 Water spring

8 Stagnant water

9 Other (mention)

Are there interruptions in the availability of water from public network? 315

1 Stable supply

2 Interruption once or less monthly

3 Interruption once or less weekly

4 Interruption more than once a week

5 Interruption daily

6 Poor running water

7 No public network 318

8 There is a network but it does not work 318

Is the water coming from the public network sufficient?316

1 Yes 318

2 No

How do you deal with water shortages?317

1 Purchase

2 River or canal

3 Public tap

4 Bring water from other areas

5 Usage of water pump

6 Other (mention)

Do you treat the water before usages?318

1 Yes, by boiling

2 Yes, by filtration

3 Yes, by treating it chemically

4 Yes, using water bottles

5 Yes…other

6 No

A- For drinking

B- For cooking

C- For washing

D- For other purposes

What are the problems? (you can mention more than on)333

Draw a circle around the one or more choices

1 Bad situation of the road

2 Traffic jams and condensations

3 Scarcity or distant transport means

4 Hard to reach the transport means

5 Personal security

6 Other (mention)

What type of main road leads to the residential unit?334

1 Paved street

2 Partially paved

3 Paved road, non-paved pavement

4 Road covered with pebbles

5 Soil road

6 Other (mention)

7 There is no land road

How old is this dwelling?330

1 Less than 1 year

2 One year to less than 5 years

3 Five years to less than 10 years

4 Ten years to less than 20 years

5 Twenty years to less than 30 years

6 Thirty years to less than 50 years

7 Fifty years or more

D. OWNERSHIP STATUS AND MONTHLY IMPUTED RENT OF THEHOUSING UNIT

Ownership of residential unit327

1 Owned by the household 329

2 Private sector

3 Public sector

4 Governmental sector

5 Other (mention)

Type of occupancy of the residential unit328

1 Rented

2 Provided by the owner

3 Free in agreement with owner

4 Free without agreement with owner

5 Other (mention)

If you were to reside in a similar dwelling, what would be the estimated rental monthly value?

329

1,000 dinar

Section Three: Housing

326What are the used sources of energy for the usages of [activity]..

Activity

seria

l

1 Electricity form public network

2 Electricity from shared generator

3 Electricity from private generator

4 Liquid gas cylinders

5 Kerosene

6 Wood, coal, plant-sources

7 Dung of animals

8 Other (mention)

Source Code

SixthFifthFourthThirdSecondFirst

Cooking1

Lighting2

Heating3

Warming water4

The environmental influences on the residential unit

331Is your householdaffected for this

..[ENVIRONMENTALIMPACT TYPE]…?

Type

Ser

ial

Largely affected1

Little effect2

Very little effect3

No affect at all4

Smoke and gas01

Dust02

Bad odor03

Noise04

Insects, rodents, dogs or other animals05

Garbage near residential unit06

Rain and stagnant water07

Outlets of sanitary systems08

Humidity09

Insufficient ventilation10

Security risks11

Insufficient lighting12

Other (mention)13

Does the household members suffer from transportation problems?

332

1 Yes

2 No 334

E. ENVIRONMENTAL IMPACTS AND ACCESS TO FACILITIES

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Section Three: Housing

F. COMMUNICATIONS

336What is the number of [means of communications] that the household have?

Means of Communications

Ser

ial

Put ‘zero’ if none

If (10) or more, write (9)

No.

Land / phone lines1

Mobile phones2

Internet lines3

Satellite4

Other5

335What’s the distance from your household to the nearest …[FACILITY NAME]…?

Facility

Ser

ial

1 Less than 100 meters

2 From 101 to 300

3 From 301 to 500

4 From 501 to 1,000

5 More than 1 km to 5 km

6 More than 5 km to 10 km

7 More than 10 km

Code

Elementary school01

Mid or high school02

Public hospital03

Private hospital04

Medical center / doctor05

Pharmacy06

Police station07

Post office08

Place of worship09

Youth center10

Bank11

Fire station12

Municipal council13

Public bus waiting station14

Private bus / taxi15

Markets16

Section Three: Housing

G. EXPENSES ON HOUSING

339What is the estimated proportion of use for non household consumption such as production and sale activities carried out within the housing unit?

338What is the length of period for which the pay--ment was made for ..[ITEM]..?

337What was the last payment for this ..[ITEM].. as related to this residential unit?

ITEM DESCRIPTION

Ser

ial

Previous Debts not included

Write zero if the household did pay (for this material) and move on to the next paragraph Write “zero” if there

are noneToFrom

Percentage (%)YearMonthDayYearMonthDay1,000 dinars

The rent of a house rented from the Government, the Public Sector or the Private Sector

1

Water2

Sewerage3

Raw Water4

Electricity from the public network

5

Electricity from shared Generators

6

Land / phone Line7

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Section Four: Education

All Household Members Aged 6 Years or more

401What language can you deal with, and what is your level of proficiency in that language?

ID C

OD

E

C - Third LanguageB -Second LanguageA - Mother Tongue

C4C3C2C1B4B3B2B1A4A3A2A1

Level ofLevel ofLevel ofLanguageLevel ofLevel ofLevel ofLanguageLevel ofLevel ofLevel ofLanguage

speakingwritingreadingcodespeakingwritingreadingcodespeakingwritingreadingcode

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

LanguageCode

Arabic1

Kurdish2

Turkmen3

Syria4

Chaldean5

English6

French7

Persian8

Other Languages9

Skill LevelCode

Cannot1

Weak2

Medium3

Good4

Section Four: Education

All Household Members Aged 6 or More

406What are the highest certifications you have attained?

405Have you ever attended literacy classes?

404Can you readand write

403What is the main reason why you never attended school?

402Have youever attendedschool?

Ind

ivid

ual

’s C

od

e

There is no school01

There are no seats at school02

No certificate, illiterate01yes,1There are no sanitary utilitiesat school

03

No certificate, I only read02currently attending

No

1Transport is very difficult and unsafe

04Yes, at--tended inthe past

1

No certificate, I read and write

03There is no female teacher05

Elementary04There is absolutely no teacher at all06

Intermediate (mid school)05Yes, I wasenrolled inthe past

2I just read2Household cannot afford school expenses

07406

Preparatory06Work for the family08

Vocational07Work for someone else09Yes, I amcurrentlyattending

2

Diploma from an institution08no, never attended

3Disability or disease10

Bachelor degree09I read & write

3Marriage11

Higher diploma10Family not interested12407

Masters degree11[NAME] not interested13

PhD. (doctorate)12There are no documents14No3

Other13For all answers, move to Section Five: 501

Social reasons15

Other16

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Section Four: Education

All Household Members Aged 4 or more

Exclusive for Household Members between 6 - 50 Years of Age

409Look at Question 402 in case the person was currently enrolled in school.

408Is the [name] 50 years or less?

407What is the number of school years and the repeat years that you have spent?

ID C

OD

E

411Is the school or university that you arecurrently enrolled in a public or private one?

410Which level or grade are you enrolled at now (or was enrolled) at school or university?

410

1 Elementary

2 Mid SchoolOtherwise ask the person if she /he had been enrolled in school during the last 12 months

3 Preparatory (or equivalent)

Public in Iraq14 Institute

Private in Iraq25 College

Other in Iraq36 Higher Education

Outside Iraq47 Other

Yes1

Yes1

No2No2

414Move to Section Five: 501

(B)Repeat Years

(A)School Years

Grade / ClassLevel / Stage

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Four: Education

Exclusive for Household Members between 6 - 50 Years of Age

415What is thedistance between the school/university andplace of \residence?

414What is the main reason why you left school or did not enroll in school / university?

413Are you cur--rently enrolled or continuing in school or university?or have youleft(dropped-out)education?

412How oldwere youwhen youenrolled inschool forthe first time?

Ind

ivid

ual

’s C

od

e

Disability or disease10There is no school01

Marriage11No available seats at school02

Family not interested12Unavailability of sanitary utilities03

[Name].. Not interested13Transport is very difficult or unsafe04

Social reasons14There is no female teacher05

There ae no documents15There absolutely no teacher at all06Is attending

415

1

I was expelled / dismissedFrom school

16The household cannot pay the expenses

07

I concluded my education17

Other18Work for the family08

Work for someone else09Dropped out definitely

2

Move to Section Five: 501

Km MeterYears

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Section Four: Education

Exclusive for Household Members between 6 - 50 Years of Age

ID C

OD

E

418How has the household spend (exerted expenditures) during the last 12 months to avail edu--cation for your on ….?

If the responding person was unable but to give you the total sum of amount, write “-2” in the special fields and the total amount in column (9) n

417How much time does it take to reach the school or university?

416What is the main transport means to school or uni--versity

On foot1

Private car2

Public car3

Bicycle4

Residency in same building

5

Other6

9 - 8 - 7 - 6 - 5 - 4 - 3 - 2 -1 -

TotalOtherPrivate lessons

Transport

Booksand

schoolsupplies

ResidencyFoodUniform

or sportsuniform

Tuitionfees

1,000dinar

1,000 dinar

1,000dinar

1,000dinar

1,000dinar

1,000 dinar

1,000dinar

1,000dinar

1,000dinar

Minutes

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Five: Health

All Household Members

Part (A): Disability & Chronic Diseases

506Have you

received any help for the

disability /chronic diseaseduring last 12

months in any ofthe following?

505How manyyearsagodidyou

becomechronicallyill?

504-AWhat is the chronicdisease that you are

suffering from?

504Do yousufferfrom achronic

disease?

503Howmanyyearsagodidyou

becomedisabledl?

502-AHow did you

become disabled ?

502What is the Disabilitythat you are suffering

from?

501Doyou

sufferfromany

disability?

ID C

OD

E

Since birth01

Injury due to Work

02

Diabetes01Disease dueTo work

03

Blindness01

No Chronic/disAble.

00High bloodPressure

02Deafness02

No helpReceived

01Chronic inflammation

03ChemicalStrike orEnriched Uranium

04Dumbness03

Public Hospital

02Cancer04Inability of speech04

Public health Cen.

03Psychological Diseases

05(Oldest

One)Land mines05Inability to walk05

Clinic/priVate hosp

04Nervous system Dis. & Sensory Organs (paralysis)

06Other - Related to civic conflict

06Mobility inability06

GeneralDoctor

05Limping07

Specialist Doctor

06Heart diseases07Because Of wars

07Mental retardations08

Nurse07Respiratory (hardBreathing)

08Yes1Due to a disEase that is notRelated to work

08Multiple disabilities09Yes1

Pharmacy08Digestive system Diseases (stomach,Intestines, …)

09Other

10

Popular Procedures

09No2TrafficAccident

09No2

Clergyman10Disease10506 Other relatedto civic conflict

10504

Outside Iraq11Anemia11

Other12Other12

No. ofYears

ThirdSecondFirstNo. ofYears

ThirdSecondFirstThirdSecondFirst

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Annex 3: Survey questionnaire

Section Five: Health

Part (B): Illness & Injuries

508What sort of illness or injury have you suffered from?

507Have you suffered from any illness or injury in the last 30 days?

ID C

OD

E

InjuriesDiseases

Hepatitis12High sugar level (diabetes)01

1 Torn LigamentsRespiratory system and chest diseases

13Pressure02

2 Head Injuries And Internal Injuries

Women diseases, such as pregnancy and post-natal com--plications

14Heart diseases03

Kidneys04

3 FracturesBlood diseases15Tumors05

Do not list any chronic disease of disability that has beenmentioned before

4 PoisoningInflammation of the thyroid gland

16High level of blood Cholesterol

06

5 BurnsSkin diseases and syphilis disease

17Mental diseases07

6 OtherDiseases leading to impotency18Psychological diseases08

7 510 Not availableDiseases of the sexual and urinary systems

19Nervous system diseases and sensory organs (paralysis)

09

Parasitic and contagious diseases

20 502 / A-504

Other diseases21Digestive system diseases10

There are none22Thyroid gland11Yes1

No2

519

B -Code of the Most Important Injury

A - Code of the Most Important Disease

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Five: Health

All Household MembersPart (B): Illness & Injuries

512Where is this medical service located?

511Where have you received the medical care / remedy?

510Did you receive medical care because of this illness or injury?

509If it were an injury of …What was the main reason for this injury?

ID C

OD

E

Same area1Public hospital01

Same district2Public medical center02

Same province3Clinic / private hospital03Traffic accident1

Other province4General doctor04Yes1Accident due to work2

Specialist doctor05Other accidents3

Medical assistant06No2Family violence4

Nurse07517 Assault outside family5

Pharmacy08Civic disturbances6

Popular medical procedures09Other reasons7

Clergyman10

516 Outside iraq 11

Other12

If more than one, select the most important

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Annex 3: Survey questionnaireSection Five: Health

All Household MembersPart (B): Illness & Injuries

516What is the total that has been spend on the following entries in the last 30 days?518

515How long did it take to reach

the health facility by utilizing

the actualadopted

mean(s )?

514What’s the

main mean ofcommuting

to this healthfacility?

513What is the

distancebetween this

MedicalServices

Location andthe

Residence?

ID C

OD

E

On foot1

Private car

2

Public transport car

36

Total

5

Other

4Lab test,

x-ray, ultrasound, other

3Consultation and Hospital

Fees

2

Medicines

1Accessibility

to medical

services entity

Bicycle4

Other5

1000 Din dinar1000 Din dinar1000 Din dinar1000 Din dinar1000 Din dinar1000 Din dinarMinute KM Meter

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Five: Health

All Family MembersPart (B): Illness & Injuries

519INTERVIEWER: PLEASE LOOK AT PERSON'S AGE, GENDER AND MARITAL STATUS IN THE THE HOUSEHOLD ROSTER AND CLASSIFY THE PERSON AS FOLLOWS:

518How many days were you absent from your normal activities due to illness or injury?

517Why you didn't receive medical care for this illness or injury?

ID C

OD

E

Inability to withstand cost01

The person is a child of less than 5 years of age1

Difficulty in securing means of transport02

Unavailability of a (female) doctor / nurse03

525 Unavailability of a doctor 04

Unavailability of medical means (place)05

The person is a married divorced, separated or widowed woman of 12 – 49 years of age

2

The illness was mild06

Unavailability of the proper services07

Social reasons08

Next questionUnsafe, due to the security status09

Other10

Other3

Go to Section Six: 601

Number of Days

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Annex 3: Survey questionnaire

Section Five: Health

All Women: Married or Divorced or Widowed, aged 12 - 49

Part (C ): Prenatal and postnatal care

Exclusive to recently married or divorced or widowed women

All Women: Married, divorced, widowed, aged 12 - 49

ID C

OD

E

523Have you had any complications during pregnancy or during giving birth which required medical attention?

522Have you had any medical care during the last pregnancy and giving birth?

521When was the last time you gave birth?

520Have you ever given birth to a child?

524Are you currently pregnant?

Yes1Yes1Yes1Yes1

No2No2No2No2

Go to Section Six (601524

YearMonth

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Five: Health

Children of less than 5 yearsPart (D): Breast-Feeding and Inoculations (Vaccinations)

All Children less than 5 years old

ID C

OD

E

If the child has a vaccination card, record the following (otherwise ask the mother): has the child received the following vaccines?

527Is ..[NAME].. in posses--sion of a “Vac--cination Card”?

526Has ..[NAME].. ever been vaccinateds?

525Has ..[NAME]..

received natural breast feedingduring the first

six months?

534Hepatitis

533Measles

532Dosage child got of Triple Vaccine/ DPT Diphtheria, Whooping Cough, Tetanus

531DPT

530The number of dosages / injections taken against Polio

529Polio

528Tuber--culosis (B.C.G.)

Yes1Yes1Yes1Yes1Yes1Yes1Yes1Yes, breast feeding only

1

No2No2No2No2No2No2No2Yes, partial breast feeding

2

533 531 Next Person

No3

# of dosages# of dosages

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Annex 3: Survey questionnaire

Section Six: Activities, Entertainment & Hobbies

For All Household Members Aged 10 and Above

606What isthe totalof hoursyou usetheInternetper week?

605What is the purpose of your using the Internet (as per importance)

604What arethe areas ofusage of theInternet(as perimportance)

603Place ofInternet Usage as perimportance

602Do you use the Internet

601Please indicate if you practice any of these following activities or hobbies and what time intervals do you do that?

ID C

OD

E

No, never1

Sometimes2

Email1Home1Less than 2 hours per week3

Pleasure1Chat2Internet Café

2From 2 hours to less than 5 hours per week

4

Talk relatives friends

2Talk to others

3Educational Institute

3From 5 hours to less than 10 hours per week

5

Search site

4Yes1Ten hours or more per week6

Work / Job

3Other5Work4No2FEDCBA

Study Research

4Other5Column 701 (Section Seven)

Artactivities

as hobby

Sportsactivities

Socialnon

politicalactivities

Politicalactivities

Readingother

material

Readingdailynews

papersOther5

Hrs/Week3213214321

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Seven: Job search and past employment

For All Household Members Aged 6 and AbovePart A: Looking for Work

704Why don’t you want work? (or more work)?

703Do you want work or more work of which kind? For example: paid job, new work, or more work?

702Why haven’t your worked during the last seven days, not even for one hour (indicate main reason)?

701How many working hours have you worked during the last seven days?

ID C

OD

E

708 I currently work full time01Next Person

Question401

Too young, low age01

Full-time student 02

I cannot find a job02Social reasons03

708 Satisfied with my status 03706I have a contract and will start work soon

04

708 Housework dedicated female04704Diability / Handicapped05

708 Social ties05704Retired06

708 Too old for work or retired06704House wife07

708 Too young for more work07704I have no desire08

708 Student08I am temporarily away from work due to illness or vacation or other reason (maternity leave …)

09

708 Too ill/unable take more work09

708 Have income no need to work10Due to end of work10

708 Due to the state of security11Yes1I was dismissed11

708 Other12705 I was unable to get a job12

No2Due to security reasons13If one hour or more 703 Other14

Number of Hours

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Annex 3: Survey questionnaire

Section Seven: Job search and past employment

For All Household Members Aged 6 and AbovePart A: Looking for Work

707If there had been job opportunities last week or will be available during the next two weeks, are you ready to start work?

706What have you done for the sake of attaining work?

705When was the last effort or procedure you have taken to search for work (or get more work) of any kind?

ID C

OD

E

1 I asked friends / relatives

2 I applied directly to the work owner's)

3 I registered at the "Employment / Labour Office"

4 I followed up on job opportunities advertisementsLast seven days1

5 I promoted myself by placing and advertisement about my workDuring last month2

6 I tried to find work outside IraqBefore more than a month3

7 I contacted an NGP(non-governmental organization)I never searched 7074

8 I contact local authorities (local governments)

9 Other means

Yes1

No2

Third ProcedureSecond ProcedureFirst Procedure

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Seven: Job search and past employment

For All Household Members Aged 6 and AbovePart B: Previous and Current Employment

710When did you stop doing the last full-time job you had?

709What was your occupation in the last full-time job you had?

708Are you engaged or have you ever been engagedin a full-timewage job?

ID C

OD

E After conclusion of interview with this person, complete data for next person starting with question 401Yes1

No 2

Next Person Question 401 YearMonthProffesion CodeJob Description

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Annex 3: Survey questionnaire

Content

1 Section One: Household Roster

4 Section Two: Received Supplies Rations & Consumption of Provisions & the like

6 Section Three: Housing

11 Section Four: Education

16 Section Five: Health

23 Section Six: Activities, Entertainment & Hobbies

24 Section Seven: Job search and Past Employment

Serial Date Notes Taker Job Title Comments Signature

1 0_ / _ _ / _ _

2 0_ / _ _ / _ _

3 0_ / _ _ / _ _

4 0_ / _ _ / _ _

5 0_ / _ _ / _ _

6 0_ / _ _ / _ _

7 0_ / _ _ / _ _

8 0_ / _ _ / _ _

9 0_ / _ _ / _ _

10 0_ / _ _ / _ _

11 0_ / _ _ / _ _

12 0_ / _ _ / _ _

13 0_ / _ _ / _ _

14 0_ / _ _ / _ _

15 0_ / _ _ / _ _

Notes

Part No. (2): Daily Ledger

A. FIRST IDENTIFICATION Code

06 Governorate

07 District

08 Area

09 Quarters

10 Alley (Street)

11 Country

12 Village

13 Class Draw circle around appropriate answer

Provinces1 Rural2 Suburban3 Urban / Central

Baghdad

Suburban 2 Rural 1

Urban / Central

Al-Rasafah 4 Al-Sader City 3

Al-Karekh 5

14 The Number of the Building for the Survey

C. FIELD STAFF Signature CODE Date

23 INTERVIEWER 24 0-/--/--

25 TEAM LEADER 26 27 0-/--/--

28 DATA ENTRY OPER. 29 30 0-/--/--

31 CENTRAL SUPERVISOR 32 33 0-/--/--

40 Has Household been include in MICS3 Survey? Draw circle around correct answer Yes No

For Researcher: Pls double check against families included in MICS3 Survey

ا�ستيفاء بيانات اال�ستمارة

01 02 03

WAVE (1 - 18) TEAM INT. (1 - 3)

The Ministry of Planning and Development Cooperation

Central Organization for Statistics and Information Technology (COSIT)

The Republic of Iraq For eradication of poverty and enhancing the socio-economic status of the households in Iraq

In cooperation with the Kurdistan Regional Statistical Commission (KRSCO)

Household Socio-Economic Survey in Iraq (IHSES 2007 - 2006)

HOUSEHOLD IDENTIFIER

04 05

CLUSTER HH

B. HOUSEHOLD IDENTIFICATION

15 Household head name

16 Work Address

17 Household Size

18 HOUSEHOLD SIZE

19 Telephone Number

20 Work Tel. No.

21Numeral Form for this household

22 No. of this Questionnaire

1

2

3

4

5

6

7

8

34

Fully Achieved

Partially Achieved

No usable Information

Unaccomplished: Household refused interview

Unaccomplished: Household not present

Unaccomplished: House not found

Unaccomplished: Housing unit not occupied

Unaccomplished: Housing unit is seasonal

D- Visits of Field Researchers RESULT OF THE INTERVIEW

35 First Visit 0-/--/--

36 Second Visits 0-/--/--

37 Third Visit 0-/--/--

38 Fourth Visit 0-/--/--

39 Fifth Visit 0-/--/--

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830

Annex 3: Survey questionnaire

831

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

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at is

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acq

uir

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Ho

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has

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801

Hav

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No

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EX

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ITEM CODE

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Pay

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4115

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4119

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Ren

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g S

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Gas

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gas

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4151

Cyl

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rLi

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com

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4157

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Lite

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4165

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4167

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4181

Lite

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4183

Tota

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4190

Sec

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Fill

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Sta

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_ _

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Wh

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EX

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ITEM CODE

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..Sm

all T

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4247

Sm

all T

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Num

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Man

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4259

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ber

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61

Num

ber

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4273

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85

Num

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Han

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4297

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09

Num

ber

Ala

rm S

yste

ms

4311

Num

ber

Lock

s an

d K

nobs

4323

Num

ber

Oth

er s

mal

l too

ls a

nd a

cces

sorie

s43

29

Tota

l of

this

pag

e43

30

Sec

tio

n E

igh

t: E

xpen

dit

ure

s o

n N

on

-Fo

od

Ser

vice

s an

d C

om

mo

dit

ies

du

rin

g t

he

pas

t 30

day

s

Page 18: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

832

Annex 3: Survey questionnaire

833

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

804

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

803

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

802

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

801

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

30 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T IT

EM

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Co

nsu

mab

le H

ou

seh

old

Go

od

s

Kg.

Soa

p su

pplie

s43

35

Kg.

Com

mer

cial

soa

p43

47

Kg.

Det

erge

nts

supp

lies

4359

Kg.

Com

mer

cial

det

erge

nts

4361

Lite

rLi

quid

dis

hwas

hing

and

cle

anin

g de

terg

ents

4373

Lite

rS

tron

g de

terg

ents

like

Fla

sh43

85

--A

ir F

resh

ener

4397

--G

lass

Cle

anin

g P

rodu

cts

4409

--P

estic

ides

4411

--D

istil

led

Wat

er44

23

--C

lean

ing

Item

s: B

room

s, m

ops…

4435

--C

lean

ing

stan

ds44

47

--K

itche

n to

wel

s44

59

--F

abric

for

mop

s44

61

--P

aper

pro

duct

s: n

apki

ns, b

ags

for

the

vacu

um c

lean

er…

4473

--O

ther

Item

s: m

atch

es, c

andl

es, w

icks

, sta

rch,

pin

s, n

eedl

es,

embr

oide

ry n

eedl

es, t

hist

le, t

hrea

ds, w

indi

ng th

read

s, n

ails

, fir

e ex

tingu

ishe

r pa

rts,

rub

ber

glov

es…

4485

Tota

l of

this

pag

e44

90

Sec

tio

n E

igh

t: E

xpen

dit

ure

s o

n N

on

-Fo

od

Ser

vice

s an

d C

om

mo

dit

ies

du

rin

g t

he

pas

t 30

day

s

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

804

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

803

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

802

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

801

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

30 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T IT

EM

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Do

mes

tic

Ser

vice

s

--M

aid’

s fe

es44

97

--C

ook’

s fe

es45

09

--D

river

’s fe

es45

11

--G

ardn

er’s

fees

4523

--N

anny

/ b

aby

sitte

r fe

es45

35

--G

uard

’s fe

es45

47

Oth

er M

edic

al P

rod

uct

s

--M

edia

l equ

ipm

ent:

ther

mom

eter

, fun

nel,

med

ical

ban

da--

ges,

gau

ze, c

otto

n, …

4561

Pha

rmac

eutic

al P

rodu

cts

--M

edic

ines

for

chro

nic

dise

ases

4585

--M

edic

ines

for

non-

chro

nic

dise

ases

4597

--C

ontr

acep

tives

4609

--O

ther

pha

rmac

eutic

al p

rodu

cts

4613

Fu

el f

or

Per

son

al T

ran

spo

rt

Lite

rF

uel f

rom

the

stat

ion

4647

Lite

rC

omm

erci

al F

uel

4659

Lite

rE

ngin

es o

ils fr

om th

e =

stat

ion

4661

Lite

rC

omm

erci

al e

ngin

es o

ils46

73

--O

ther

: dis

tille

d w

ater

, ant

i-fre

eze…

4685

Tota

l of

this

pag

e46

90

Sec

tio

n E

igh

t: E

xpen

dit

ure

s o

n N

on

-Fo

od

Ser

vice

s an

d C

om

mo

dit

ies

du

rin

g t

he

pas

t 30

day

s

Page 19: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

834

Annex 3: Survey questionnaire

835

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

804

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

803

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

802

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

801

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

30 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T IT

EM

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Rep

air

and

Mai

nte

nan

ce o

f P

erso

nal

Tra

nsp

ort

--F

ixin

g ve

hicl

es: m

echa

nica

l, el

ectr

ical

, pip

ing,

spa

re

part

s, p

unct

ures

..46

97

--W

ashi

ng a

nd lu

bric

atin

g47

09

Co

st o

f P

ub

lic T

ran

spo

rt

--P

asse

nger

s T

rans

port

by

Tra

in47

11

--P

asse

nger

s T

rans

port

by

Pla

ne47

27

--P

asse

nger

s T

rans

port

by

Sea

4735

Oth

er T

ran

spo

rt S

ervi

ces

--P

orte

r fe

es47

59

--Lu

ggag

e sh

ippi

ng o

ffice

s fe

es47

61

--C

omm

issi

ons

for

trav

el a

gent

s47

73

Po

stal

Ser

vice

s

--P

osta

l exp

endi

ture

s: s

tam

ps, p

arce

ls, t

rans

fers

4785

To

tal o

f thi

s pa

ge47

90

Sec

tio

n E

igh

t: E

xpen

dit

ure

s o

n N

on

-Fo

od

Ser

vice

s an

d C

om

mo

dit

ies

du

rin

g t

he

pas

t 30

day

s

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

804

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

803

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

802

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

801

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

30 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T IT

EM

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Ph

on

e an

d F

ax S

ervi

ces

--P

hone

inst

alla

tion

fees

4807

--F

ees

of la

nd li

ne /

phon

e48

15

--P

hone

cal

ls c

harg

es48

23

Num

ber

Mob

ile c

ards

: re

fills

4831

Num

ber

Thu

rayy

ah c

ards

: sa

telli

te s

ervi

ce48

39

--Te

legr

ams,

Fax

and

Tel

ex S

ervi

ces

4847

--D

igita

l ser

vice

s an

d In

tern

et48

55

--C

onne

ctio

n to

the

Inte

rnet

4863

--C

ost o

f tel

ecom

mun

icat

ions

and

wire

less

4871

--R

entin

g ph

ones

and

faxe

s48

79

--O

ther

pho

ne a

nd fa

x se

rvic

es48

87

Cu

ltu

ral S

ervi

ces

--C

ost o

f tic

kets

to c

inem

a, th

eatr

e or

con

cert

s49

05

--E

xpen

ditu

res

on li

brar

ies

and

mus

eum

s49

13

--A

rt s

how

s an

d ex

hibi

tions

4921

--V

isiti

ng h

isto

rical

pla

ces,

pub

lic p

lace

s an

d th

e zo

o49

29

--R

entin

g vi

deo

tape

s or

CD

s / D

VD

s49

37

--P

hoto

grap

hy S

ervi

ces:

film

s an

d de

velo

ping

film

s49

45

--O

ther

cul

tura

l ser

vice

s49

53

Tota

l of

this

pag

e49

60

Sec

tio

n E

igh

t: E

xpen

dit

ure

s o

n N

on

-Fo

od

Ser

vice

s an

d C

om

mo

dit

ies

du

rin

g t

he

pas

t 30

day

s

Page 20: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

836

Annex 3: Survey questionnaire

837

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

804

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

803

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

802

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

801

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

30 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T IT

EM

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Wri

tin

g a

nd

Art

s M

ater

ial

--B

ooks

and

cop

yboo

ks49

79

--P

ens

of a

ll so

rts

4987

--S

harp

ener

s, e

rase

r49

95

--C

arbo

n pa

per

and

tape

s50

03

--S

tapl

es, s

tapl

ers

and

pins

5011

--P

aper

sci

ssor

s50

19

--G

lue

5027

--P

aper

Clip

s50

35

--P

aint

ing

mat

eria

l on

pape

r, ca

nvas

, fab

ric a

nd p

late

s,

boar

ds, w

ax d

yes,

pas

tel,

wat

er c

olou

rs, .

.50

43

--O

ther

: rul

ers,

geo

met

ry to

ols,

cha

lk, p

enci

l hol

der/

sac

…50

51

Nu

rser

y E

xpen

dit

ure

s

--N

urse

ry fe

es50

73

--K

inde

rgar

ten

fees

5077

--N

urse

ry a

nd K

inde

rgar

ten

expe

nses

5081

Per

son

al C

are

--M

en’s

Bar

ber

Cha

rges

5107

--W

omen

’s H

aird

ress

er C

harg

es51

15

--B

ath

Cha

rges

5123

--S

auna

and

mas

sage

5131

--O

ther

per

sona

l car

e51

39

Tota

l of

this

pag

e51

40

Sec

tio

n E

igh

t: E

xpen

dit

ure

s o

n N

on

-Fo

od

Ser

vice

s an

d C

om

mo

dit

ies

du

rin

g t

he

pas

t 30

day

s

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

804

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

803

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

802

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

30

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

801

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

30 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T IT

EM

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Co

llect

ion

of

Was

te a

nd

Gar

bag

e

--C

ost o

f col

lect

ing

garb

age

and

was

te, i

nclu

ding

: ope

ning

of

blo

cked

sew

age

syst

ems

5143

Oth

er S

ervi

ces

Rel

ated

to

th

e P

lace

of

Res

iden

ce

Oth

er s

ervi

ces:

gua

rdin

g, fi

xing

ele

vato

rs51

46

Oth

er E

qu

ipm

ent

and

Pro

du

cts

for

Per

son

al C

are

--N

on-E

lect

rical

s: s

havi

ng to

ols,

sha

ving

bla

des,

sci

ssor

s,

file,

toot

h br

ush

, com

b..

5153

--P

erso

nal H

ygie

ne: m

edic

ated

soa

p, s

havi

ng c

ream

, too

th

past

e..

5161

--B

eaut

y P

rodu

cts/

Mak

e-U

p: li

pstic

k, n

ail p

olis

h, a

tom

izer

, bo

dy s

pray

, per

fum

es..

5169

--O

ther

pro

duct

s: to

ilet p

aper

, tis

sues

, pam

pers

..51

77

Tota

l of

this

pag

e51

80

No.

of l

ines

fille

d fo

r S

ectio

n E

ight

Sec

tio

n E

igh

t: E

xpen

dit

ure

s o

n N

on

-Fo

od

Ser

vice

s an

d C

om

mo

dit

ies

du

rin

g t

he

pas

t 30

day

s

Page 21: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

838

Annex 3: Survey questionnaire

839

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Clo

thin

g

Met

erW

oole

n m

en fa

bric

5511

Met

erW

oole

n w

omen

fabr

ics

5523

Met

erW

oole

n ki

ds fa

bric

5535

Met

erC

otto

n m

en fa

bric

s55

47

Met

erC

otto

n w

omen

fabr

ics

5559

Met

erC

otto

n ki

ds fa

bric

s55

61

Met

erS

ilk m

en fa

bric

s55

73

Met

erS

ilk w

omen

fabr

ics

5585

Met

erS

ilk k

ids

fabr

ics

5597

Met

erS

ynth

etic

men

fabr

ics

5609

Met

erS

ynth

etic

wom

en fa

bric

5611

Met

erS

ynth

etic

kid

s fa

bric

s56

23

ــTa

ilorin

g fe

es fo

r m

en56

35

ــD

ress

mak

ing

fees

for

wom

en56

47

ــD

ress

mak

ing

fees

for

kids

5659

ــO

ther

clo

thin

g ite

ms

5663

Tota

l of

this

pag

e56

70

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Clo

thes

Rea

dy

mad

e m

en’s

clo

thin

g

Num

ber

Coa

ts56

73

Num

ber

Kni

tted

5685

Num

ber

Pan

ts56

97

Num

ber

Qam

asel

/ ve

st57

09

Num

ber

Shi

rts

5711

Num

ber

Und

erw

ear

5723

Num

ber

Who

le s

uits

5735

Num

ber

Long

dre

ss57

47

Num

ber

Woo

len

cloa

k57

59

Num

ber

P.J.

s57

61

Num

ber

Hea

d dr

ess

- tr

aditi

onal

wea

r57

73

Num

ber

The

rop

e-lik

e ci

rcle

ato

p he

ad d

ress

5785

Num

ber

A s

ort o

f hea

d dr

ess

“ara

qjee

n57

97

Pai

rS

ocks

5809

Num

ber

Spo

rts

wea

r58

11

Num

ber

Blo

use

5823

Num

ber

T-sh

irt58

35

--R

eady

mad

e m

en’s

wea

r58

47

Tota

l of

this

pag

e58

50

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Page 22: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

840

Annex 3: Survey questionnaire

841

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Rea

dy

mad

e w

om

en’s

wea

r

Num

ber

Coa

ts58

59

Num

ber

Jack

ets

5861

Num

ber

Pan

ts58

73

Num

ber

Qam

asel

/ ve

st58

85

Num

ber

Shi

rts

5897

Num

ber

Und

erw

ear

5909

Num

ber

Sui

ts59

11

Num

ber

Flo

win

g lig

ht c

loak

/ su

mm

er59

23

Num

ber

Clo

ak

5935

Num

ber

Paj

amas

5947

Num

ber

Ski

rts

5959

Num

ber

Jurg

hod

5961

Num

ber

Wra

p59

73

Num

ber

Sca

rf59

85

Pai

rS

ocks

5997

Num

ber

Spo

rts

wea

r60

09

Num

ber

Blo

use

6011

Num

ber

T-sh

irt60

17

Num

ber

Oth

er r

eady

mad

e w

omen

’s g

arm

ents

6023

Tota

l of t

his

page

6030

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Kid

s W

ear

Num

ber

Coa

ts60

35

Num

ber

Jack

ets

6047

Num

ber

Pan

ts60

59

Num

ber

Qam

asel

/ ve

st60

61

Num

ber

Shi

rts

6073

Num

ber

Und

erw

ear

6085

Num

ber

Sui

ts60

97

Num

ber

Ligh

t sum

mer

clo

cks

6109

Num

ber

Spo

rts

wea

r61

11

Num

ber

Paj

amas

6123

Num

ber

Ski

rts

6135

Num

ber

Blo

use

6147

Pai

rS

ocks

6159

--O

ther

kid

s w

ear

6161

Tota

l of

this

pag

e61

70

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Page 23: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

842

Annex 3: Survey questionnaire

843

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Oth

ers

So

rts

of

Wea

r an

d A

cces

sori

es

Num

ber

Nec

k-tie

6173

Num

ber

Han

dker

chie

fs61

85

Pai

rG

love

s of

all

sort

s61

97

Num

ber

Bel

ts62

09

Num

ber

Pan

ts h

olde

rs62

11

Num

ber

Hat

s62

23

--T

hrea

ds fo

r se

win

g an

d kn

ittin

g62

35

--Z

ippe

rs62

47

--B

utto

ns62

59

--O

ther

6261

Dry

Cle

an, M

end

ing

an

d R

enti

ng

--C

loth

es r

epai

r fe

es62

73

--C

loth

es k

nitti

ng fe

es62

85

--C

loth

es ir

onin

g62

97

--C

loth

es w

ashi

ng63

09

--C

loth

es d

ying

6311

--C

loth

es d

arni

ng63

23

--C

loth

es r

entin

g63

35

--O

ther

fees

: dry

cle

an, fi

xing

, ren

ting…

6339

Tota

l of

this

pag

e63

40

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Sh

oes

Men

’s S

ho

es

Pai

rLe

athe

r sh

oes

6347

Pai

rN

on-le

athe

r sh

oes

6359

Pai

rS

lippe

rs63

61

Pai

rS

port

s sh

oes

6373

Pai

rO

ther

: clo

gs, …

6385

Wo

men

’s S

ho

es

Pai

rLe

athe

r sh

oes

6397

Pai

rN

on-le

athe

r sh

oes

6409

Pai

rS

lippe

rs64

11

Pai

rS

port

s sh

oes

6423

Pai

rO

ther

: clo

gs, …

6435

Kid

s S

ho

es

Pai

rLe

athe

r sh

oes

6447

Pai

rN

on-le

athe

r sh

oes

6459

Pai

rS

lippe

rs64

61

Pai

rS

port

s sh

oes

6473

Pai

rO

ther

: clo

gs, …

6485

Tota

l of

this

pag

e64

90

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Page 24: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

844

Annex 3: Survey questionnaire

845

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Fab

rics

, L

inen

, Tap

estr

y

Num

ber

Mat

tres

ses

and

bed

shee

ts64

97

Num

ber

Bla

nket

s65

09

Num

ber

Rea

dy m

ade

pillo

ws

6511

Num

ber

Ben

ch a

nd q

uilt

6523

Num

ber

Tow

els

6535

Num

ber

Tabl

e lin

en ,

or c

over

s65

47

Num

ber

Tabl

e m

ats

/ nap

kins

6559

Kg.

Woo

l65

61

Kg.

Cot

ton

6573

Kg.

Fea

ther

6585

Met

erS

pong

e65

97

--F

ees

for

prep

arin

g m

attr

ess

6609

Met

erF

abric

s fo

r fu

rnitu

re66

11

--U

phol

ster

y fe

es66

23

--M

endi

ng fe

es66

35

--F

abric

s an

d ot

her

furn

ishi

ngs

6639

Ho

me

Ser

vice

s

--C

lean

ing

carp

ets

and

wal

l-to-

wal

l car

pets

6647

--C

lean

ing

linen

and

furn

iture

with

ste

am66

59

--R

entin

g fu

rnitu

re, f

urni

shin

gs, c

arpe

ts a

nd h

ome

equi

pmen

t66

61

--O

ther

ser

vice

s66

67

Tota

l of

this

pag

e66

70

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Med

ical

Ser

vice

s

--G

ener

al D

octo

r66

73

--P

rivat

e D

octo

r66

81

--D

enta

l Car

e S

peci

alis

t : in

bra

ces

6689

Den

tal C

are

--D

entis

t67

09

--F

alse

teet

h m

ount

ing

6711

--R

epai

r an

d m

aint

enan

ce67

23

--O

ther

den

tal s

ervi

ces

6727

Su

pp

ort

ive

Med

ical

Ser

vice

s

--A

naly

sis

fees

6735

--X

-ray

fees

6747

--N

urse

fees

6759

--M

id-w

ife fe

es :

to a

ssis

t in

givi

ng b

irth

6761

--N

atur

al th

erap

y67

73

--R

entin

g tr

eatm

ent e

quip

men

t67

85

--N

atur

al h

erbs

6797

--C

ardi

olog

y68

09

--S

onar

6811

--U

ltra

soun

d68

23

--O

ther

med

ical

ser

vice

s: p

last

erin

g, in

ject

ions

…68

35

--F

irst a

id s

ervi

ces

6847

--R

entin

g of

ther

apeu

tic e

quip

men

t68

59

Tota

l of

this

pag

e68

60

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Page 25: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

846

Annex 3: Survey questionnaire

847

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Oth

er T

reat

men

t S

ervi

ces

--K

idne

ys w

ash

6861

--C

hem

o th

erap

y68

73

--O

ther

trea

tmen

t ser

vice

s68

77

Ho

spit

al S

ervi

ces

--P

ublic

hos

pita

l68

85

--P

rivat

e ho

spita

l68

97

--P

opul

ar c

linic

6909

--H

ealth

cen

ter

6911

--C

ost o

f tre

atm

ent o

utsi

de Ir

aq69

23

--O

ther

hos

pita

l ser

vice

s69

27

Rec

ord

s K

eep

ing

Met

ho

do

log

ies

--V

ideo

s69

35

--Ta

pes

and

disk

s69

47

--P

C C

ompa

ct D

isks

: CD

s69

59

--R

egul

ar b

lack

and

whi

te o

r co

lour

ed fi

lms

6961

--O

ther

tapi

ng o

r re

cord

ing

mea

ns69

67

Gar

den

s P

lan

ts a

nd

Flo

wer

s

--N

atur

al p

lant

s69

73

--A

rtifi

cial

pla

nts

6985

--O

ther

: fer

tiliz

er…

6997

Tota

l of

this

pag

e70

00

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

904

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

903

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

902

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

90

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

901

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

90 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

N

EX

T M

ater

ial

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

En

tert

ain

men

t an

d S

po

rtiv

e S

ervi

ces

--V

alue

of t

icke

ts to

the

fun

fair

7009

--V

alue

of t

icke

ts to

the

spor

ts m

atch

es70

11

--S

ubsc

riptio

n fe

es in

soc

ial,

cultu

ral a

nd s

port

ive

club

s,

incl

udin

g m

embe

rshi

p / i

nitia

tion

fees

, don

atio

ns, …

7023

--E

xpen

ses

at th

e sp

orts

cen

ter

7035

--R

entin

g eq

uipm

ent f

or e

nter

tain

men

t and

spo

rts

7047

--T

rain

ing

prog

ram

s: s

wim

min

g le

sson

s, m

usic

…70

59

--To

uris

m g

uida

nce

serv

ices

7061

--O

ther

spo

rtiv

e or

ent

erta

inm

ent s

ervi

ces

7065

Res

iden

cy S

ervi

ces

insi

de

Iraq

--H

otel

s70

73

--R

esor

ts a

nd to

uris

m o

utle

ts70

85

--In

tern

al s

ectio

ns70

97

--O

ther

acc

omm

odat

ions

insi

de Ir

aq71

03

Res

iden

cy S

ervi

ces

Ou

tsid

e Ir

aq

--E

xpen

ses

of li

ving

abr

oad,

out

side

Iraq

7125

Tota

l of

this

pag

e71

30

No.

of l

ines

for

Sec

tion

Nin

e

Sec

tio

n N

ine:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

90 d

ays

Page 26: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

848

Annex 3: Survey questionnaire

849

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Mat

eria

l fo

r m

ain

tain

ing

th

e h

ou

se a

nd

rep

air

it--

Rep

air,

repa

ir &

mai

ntai

ning

hou

se75

11--

Inte

rior

desi

gn w

orks

/dec

orat

ion

7523

--H

ouse

pai

nt75

35S

ervi

ces

for

repa

ir &

mai

ntai

ning

hou

se--

Ser

vice

s w

orks

to m

aint

ain

hous

e75

49F

urni

ture

& e

quip

men

t--

Bed

room

7573

--S

alon

/ Li

ving

Roo

m75

85N

umbe

rD

inin

g ta

ble

and

chai

rs75

97N

umbe

rD

inin

g C

ount

er -

Buf

fet

7609

--Li

ving

roo

m76

11N

umbe

rB

eds,

all

sort

s76

23N

umbe

rC

hairs

7635

Num

ber

Tabl

e76

47N

umbe

rC

lose

t76

59N

umbe

rLi

brar

y76

61N

umbe

rK

itche

n co

unte

rs76

73N

umbe

rTa

ble

Lam

p76

85N

umbe

rP

aint

ings

7697

Num

ber

Sta

tues

& a

rtifa

cts

7709

Num

ber

Cur

tain

s of

all

sort

s77

11N

umbe

rC

hand

elie

rs77

23N

umbe

rM

irror

s77

35N

umbe

rV

ases

7747

--O

ther

...F

urni

ture

or

equi

pmen

t 77

59To

tal o

f th

is p

age

7760

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Car

pet

s an

d fl

oo

r co

vers

M.S

q.C

arpe

ts77

61

M.S

q.W

all-t

o-w

all

7773

M.S

q.S

traw

str

etch

es77

85

M.S

q.R

ugs

7797

--R

epai

r fe

es78

03

--O

ther

(ca

rpet

s, fl

oor

cove

rs…

)78

07

Fri

dg

es a

nd

fre

ezer

s

Num

ber

Frid

ge78

11

Num

ber

Fre

ezer

7823

Num

ber

Wat

er c

oole

r78

35

--O

ther

(F

ridge

s, c

oolin

g de

vice

s…)

7839

Was

her

, dry

ers

and

iro

nin

g

Num

ber

Ele

ctric

clo

thes

was

her

7847

Num

ber

Ele

ctric

clo

thes

dry

er78

59

Num

ber

Ele

ctric

dis

h w

ater

7861

Num

ber

Ele

ctric

iron

7873

--O

ther

(w

ashe

rs, d

ryer

s, ir

onin

g …

)78

77

Tota

l of

this

pag

e78

80

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Page 27: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

850

Annex 3: Survey questionnaire

851

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Co

oki

ng

Num

ber

Gas

coo

ker

7885

Num

ber

Ele

ctric

coo

ker

7897

Num

ber

Fue

l coo

ker

7909

Num

ber

Ele

ctric

ove

n79

11

Num

ber

Ele

ctric

gril

l79

23

Num

ber

Gas

gril

l79

35

Num

ber

Old

fash

ione

d oi

l / fu

el li

ke la

nter

n79

47

Num

ber

Gas

Lan

tern

7959

--O

ther

79

63

Hea

ters

and

Air-

cond

ition

s

Num

ber

Ele

ctric

hea

ter

7973

Num

ber

Gas

hea

ter

7985

Num

ber

Fue

l hea

ter

7997

Num

ber

Air-

cond

ition

or

spl

it un

it80

09

Num

ber

Coo

ling

devi

ce80

11

Num

ber

Ele

ctric

fan

8023

Num

ber

Ele

ctric

hea

ter

8035

Num

ber

Gas

hea

ter

8047

Num

ber

Fue

l hea

ter

8059

--O

ther

(he

ater

s, c

ondi

tions

…)

8061

Tota

l of

this

pag

e80

70

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Cle

anin

g e

qu

ipm

ent

Num

ber

Ele

ctric

vac

uum

cle

aner

8073

Num

ber

Ele

ctric

vac

uum

cle

aner

for

carp

ets

and

wal

l to

wal

l80

85--

Oth

er c

lean

ing

equi

pmen

t80

89M

ain

ho

use

ho

ld e

qu

ipm

ent

Num

ber

Spe

cial

gen

erat

or80

97N

umbe

rE

lect

ric s

ewin

g m

achi

ne81

09N

umbe

rN

on-e

lect

ric s

ewin

g m

achi

ne81

11N

umbe

rE

lect

ric k

nitti

ng m

achi

ne81

23N

umbe

rN

on-e

lect

ric k

nitti

ng m

achi

ne81

35N

umbe

rE

lect

ric e

mbr

oide

ry m

achi

ne81

47N

umbe

rN

on-e

lect

ric e

mbr

oide

ry m

achi

ne81

59N

umbe

rW

ater

filte

r de

vice

8161

Num

ber

Hom

e S

afe

8173

--O

ther

mai

n ho

useh

old

equi

pmen

t81

85S

mal

l ho

use

ho

ld e

qu

ipm

ent

Num

ber

Ele

ctric

grin

der

8197

Num

ber

Ele

ctric

Jui

cer

(Squ

eeze

r)82

09N

umbe

rB

lend

ers

8211

Num

ber

Fry

ing

devi

ces

/ pot

s82

23N

umbe

rM

eat g

rills

8235

Num

ber

Ele

ctric

Kitc

hen

Set

8247

Num

ber

Ele

ctric

Mea

t Mac

hine

(di

cing

)82

59N

umbe

rno

n-el

ectr

ic m

eat m

achi

ne82

61N

umbe

rN

on-e

lect

ric g

rinde

r82

73--

Oth

er ..

.toas

ter

8285

Tota

l of t

his

page

8290

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Page 28: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

852

Annex 3: Survey questionnaire

853

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Rep

air

an

d R

enti

ng

Ele

ctri

c D

evic

es

--R

+A

137e

pair

hou

seho

ld d

evic

es82

97

--R

entin

g ho

useh

old

devi

ces

8309

--S

pare

par

ts o

f ele

ctric

equ

ipm

ent

8311

Gla

ssw

are,

tab

lew

are

and

ho

use

ute

nsi

ls

-- G

lass

kitc

hen

ute

nsils

8323

--N

on-g

lass

kitc

hen

uten

sils

8329

--F

ix, m

aint

ain,

ren

t, ki

tche

n ut

ensi

ls83

37

Ho

use

& G

ard

en e

qu

ipm

ent

& t

oo

ls

Num

ber

Loan

mow

er83

51

--O

ther

hou

se &

gar

den

equi

pmen

t83

57

Med

icin

al e

qu

ipm

ent

and

mat

eria

l

--E

ye-g

lass

es, c

onta

ct le

nses

8369

--H

earin

g ai

d83

73

Num

ber

Pre

ssur

e m

easu

ring

devi

ce83

85

Num

ber

Whe

el c

hair

8397

Num

ber

Cru

tche

s84

09

Num

ber

Nec

k pi

ece

8411

Num

ber

Sug

ar m

easu

ring

devi

ce84

23

Num

ber

Val

ue o

f art

ifici

al te

eth

set

8435

Num

ber

Art

ifici

al li

mps

8447

Num

ber

Med

icin

al B

anda

ges

8459

--R

epai

r a

nd M

aint

enan

ce84

73

--O

ther

(m

edic

inal

trea

tmen

t equ

ipm

ent…

.)84

77

Tota

l of

this

pag

e84

80

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Tran

spo

rt

Pu

rch

ase

of

Tran

spo

rtat

ion

Mea

ns

Num

ber

Car

s85

19

Num

ber

Pur

chas

e of

car

avan

s85

23

Num

ber

Pur

chas

e of

boa

ts85

35

Num

ber

Ste

am b

ikes

8547

Num

ber

Bic

ycle

s85

59

Num

ber

Car

riage

s pu

lled

by a

nim

als

8561

Num

ber

Ani

mal

s ne

eded

to p

ull c

arria

ges

8573

--O

ther

...tr

ansp

ort m

eans

pur

chas

e85

79

Sp

are

Par

ts &

Nee

ded

Eq

uip

men

t fo

r P

erso

nal

Tra

nsp

ort

Num

ber

Tire

s85

85

Num

ber

Liqu

id b

atte

ries

8597

--O

ther

spa

re it

ems

8609

--C

ar a

cces

sorie

s ...

seat

s, o

ther

par

ts86

11

Ser

vice

s R

elat

ed f

or

Eq

uip

men

t fo

r P

erso

nal

Tra

nsp

ort

--A

nnua

l car

lice

nse

8623

--D

river

s’ li

cens

e86

35

--C

ar r

egis

trat

ion

fees

8647

--C

ar p

ark

fees

8659

--C

ar in

sura

nce

fees

8661

--O

ther

exp

ense

s , …

driv

ing

less

ons,

ren

t a c

ar86

73

Tota

l of

this

pag

e86

80

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Page 29: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

854

Annex 3: Survey questionnaire

855

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Tele

ph

on

e an

d F

ax e

qu

ipm

ent

Num

ber

Pho

ne /

Land

line

8685

Num

ber

Mob

ile86

93

Num

ber

Wire

less

pho

ne87

01

Num

ber

Thu

rayy

ah (

Sat

ellit

e C

onne

ctio

n)87

09

Num

ber

Fax

8717

Num

ber

Pho

ne s

peak

ers

8725

--re

pair

and

Mai

nten

ance

8733

--O

ther

….p

hone

and

fax

equi

p87

41

Mu

ltim

edia

an

d In

form

atio

n S

yste

ms

Num

ber

TV

set

less

than

26

inch

8759

Num

ber

TV

set

of 2

6 in

ch o

r m

ore

8767

Num

ber

Rec

orde

r87

75

Num

ber

Vid

eo87

83

Num

ber

Rad

io87

91

Num

ber

Rad

io /

Rec

orde

r87

99

Num

ber

Spe

aker

s88

07

Num

ber

Ant

enna

s fo

r T

V88

15

Num

ber

TV

/Vid

eo G

ames

(A

tari

..etc

8823

Num

ber

Sat

ellit

e eq

uipm

ent

8831

--A

udio

-vis

ual /

mul

timed

ia a

nd o

ther

dig

ital /

info

rmat

ion

syst

ems

8839

Tota

l of

this

pag

e88

40

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Ph

oto

gra

ph

y, C

inem

atic

Ph

oto

gra

ph

y an

d O

ther

Vis

ual

Aid

s / C

amer

as

Num

ber

Pho

togr

aphi

c ca

mer

a88

59

Num

ber

vide

o ca

mer

a88

61

Num

ber

Oth

er e

quip

men

t and

inst

rum

ents

(en

larg

emen

t and

dea

ling

with

pho

tos…

)88

73

Dat

a P

roce

ssin

g D

evic

es

Num

ber

Per

sona

l Com

pute

r P

C88

85

Num

ber

Prin

ters

and

Sof

twar

e88

97

Num

ber

Cal

cula

tors

8909

Num

ber

Type

writ

ers

8911

--O

ther

Info

rmat

ion

or d

ata

proc

essi

ng d

evic

es89

15

Rep

air

an

d M

ain

ten

ance

--re

pair

and

mai

ntai

ning

aud

io-v

isua

l equ

ipm

ent,

phot

ogra

phy

or in

form

atio

n pr

oces

sing

8923

Lo

ng

-lif

e co

mm

od

itie

s fo

r en

tert

ain

men

t &

cu

ltu

re

--C

ampi

ng te

nts

8935

--P

urch

ase

of b

oats

8947

--H

orse

, don

key,

…89

59

--C

art p

ulle

d by

hor

ses

8961

--O

ther

..re

igns

, sad

dles

, vet

s, n

utrit

ion

8973

Lo

ng

-lif

e m

usi

cal i

nst

rum

ents

fo

r en

tert

ain

men

t in

sid

e re

sid

ence

--M

usic

al in

stru

men

ts: p

iano

, gui

tar,

viol

in, d

rum

s …

8985

--Ta

bles

(B

illia

rds/

pool

, tab

le te

nnis

…89

97

--R

epai

r a

nd M

aint

enan

ce90

09

Tota

l of

this

pag

e90

10

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Page 30: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

856

Annex 3: Survey questionnaire

857

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Gam

es a

nd

Ho

bb

ies

--C

ards

, che

ss &

bac

kgam

mon

9011

--A

ll so

rt o

f gam

es (

Go-

kart

s, e

lect

roni

c ca

rs …

9023

--S

tam

ps c

olle

ctio

n: c

urre

nt a

nd o

ld s

tam

ps, c

ance

led

stam

ps, a

lbum

s…90

35

--V

ideo

gam

es90

47

--O

ther

(co

in c

olle

ctio

n, g

arde

ning

, pet

s…)

9059

Sp

ort

s eq

uip

men

t, c

amp

ing

, en

tert

ain

men

t o

uts

ide

the

ho

use

--R

acke

ts90

61

--F

ootb

all,

socc

er, t

enni

s,..

9073

--B

ody

build

ing

and

liftin

g w

eigh

ts90

85

--fis

hing

and

fish

ing

rods

9097

--O

ther

(po

sses

sion

of g

uns

for

hunt

ing,

hob

by o

r se

lf de

fens

e, c

ampi

ng, …

9109

--re

pair

and

Mai

nten

ance

9111

Pet

s / T

ame

An

imal

s

--P

urch

ase

of p

ets

9123

--P

ets

need

s 91

35

--O

ther

mat

eria

l91

37

Vet

erin

ary

Ser

vice

s

--V

et91

47

--S

peci

al m

edic

ine

for

anim

als

9159

--O

ther

Vet

Ser

vice

s91

63

Tota

l of

this

pag

e91

70

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Bo

oks

--C

ultu

ral b

ook:

dic

tiona

ry, A

tlas

wor

ld m

aps,

enc

yclo

pedi

a,

book

s co

verin

g91

71

--A

ssig

ned

scho

ol b

ooks

9179

--E

xter

nal s

choo

l boo

ks91

87

Pu

blis

hed

Var

ieti

es

--C

atal

ogue

s, a

dver

tisem

ent,

card

s,91

97

--P

oste

rs, p

ostc

ards

, let

ters

,…92

09

--M

aps

and

Glo

be m

odel

s92

11

--O

ther

pub

licat

ions

9215

Tou

rist

Tri

ps

--F

ees

for

join

ing

scho

ol tr

ips

9223

--To

urs

insi

de Ir

aq, a

ccom

mod

atio

n, e

xpen

ses.

.92

29

--P

ilgrim

age

and

Om

ra tr

ips

9237

--O

ther

trip

s ou

tsid

e Ir

aq92

45

Ed

uca

tio

n

Ele

men

tary

, Pre

par

ato

ry &

Sec

on

dar

y

--E

xpen

ditu

res

and

Prim

ary

Sch

ool F

ees

9261

--P

rivat

e tu

torin

g fo

r pr

imar

y st

ages

9273

--E

xpen

ditu

res

and

mid

Sch

ool F

ees

9285

--P

rivat

e tu

torin

g fo

r m

id s

choo

l92

97

--E

xpen

ditu

res

and

Pre

para

tory

sch

ools

fees

9309

--P

rivat

e tu

torin

g fo

r pr

epar

ator

y sc

hool

9311

--O

ther

exp

ense

s

9315

Tota

l of

this

pag

e93

20

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Page 31: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

858

Annex 3: Survey questionnaire

859

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Un

iver

sity

an

d H

igh

er E

du

cati

on

--E

xpen

ditu

res

and

fees

for

univ

ersi

ty93

21

--E

xpen

ditu

res

for

Dip

lom

a st

udie

s, M

aste

rs o

r P

h.D

.93

29

--E

xpen

ditu

res

of p

rivat

e le

sson

s93

37

--O

ther

exp

ense

s93

45

Trai

nin

g

--V

ocat

iona

l and

Dev

elop

men

tal T

rain

ing

9357

--La

ngua

ges

prog

ram

s93

63

--C

ompu

ter

prog

ram

s93

75

--O

ther

voc

atio

nal a

nd d

evel

opm

enta

l pro

gram

s93

87

Per

son

al C

are

Ele

ctri

c E

qu

ipm

ent

--E

lect

ric E

quip

men

t (B

low

-dry

ers,

sha

ver,…

9399

--R

epai

r an

d m

aint

enan

ce94

01

--O

ther

per

sona

l car

e eq

uipm

ent

9405

Jew

elry

, Lar

ge

and

Han

d W

atch

es

--G

old

and

Dia

mon

ds to

wea

r94

13

--W

all C

lock

s94

21

--H

and

Wat

ches

, (fo

r m

en &

wom

en)

9429

--M

aint

aini

ng a

nd r

epai

r je

wel

ry &

wat

ches

9437

--O

ther

, gra

ndfa

ther

’s c

lock

, jew

elry

…94

45

Tota

l of

this

pag

e94

50

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Per

son

al L

ug

gag

e

--W

omen

’s c

arry

-on

9457

--M

en’s

bag

s an

d w

alle

ts94

63

--S

choo

l bag

s94

75

--T

rave

ling

Lugg

age

9487

--S

peci

al fo

r ch

ildre

n, p

ram

s …

9499

--V

ario

us p

erso

nal c

arry

-ons

9501

--S

un g

lass

es, m

en &

wom

en95

13

--Li

ghte

rs95

25

--U

mbr

ella

s95

37

--K

ey c

hain

s95

49

--C

anes

9551

--N

on-G

olde

n ac

cess

orie

s95

63

--R

epai

r an

d m

aint

ain

pers

onal

lugg

age

9575

--O

ther

per

sona

l lug

gage

9579

Tota

l of

this

pag

e95

80

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Page 32: Annex 3: Questionnaire - World Banksiteresources.worldbank.org/INTIRAQ/Resources/ihses_annexes-3.pdf · Annex 3: Questionnaire Part 1. Socio-Economic Data ... Annex 3: Survey questionnaire

Volume III

860

Annex 3: Survey questionnaire

861

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

er

ho

use

ho

lds

2

Gif

ts a

nd

do

nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

Pay

men

t fo

r w

ork

4

Fro

m s

elf-

pro

du

ctio

n5

Oth

er, t

o b

e m

enti

on

ed a

fter

an

swer

co

de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Exp

end

itu

res

on

oth

er s

ervi

ces

--Le

gal s

ervi

ces

fees

9587

--M

embe

rshi

ps a

nd s

ubsc

riptio

ns fe

es95

99

--E

xpen

ditu

res

of w

eddi

ngs

and

occa

sion

s96

01

--E

xpen

ditu

res

of fu

nera

ls96

13

--E

xpen

ditu

res

on a

dver

tisin

g96

25

--E

xpen

ditu

res

of d

ocum

ents

ext

ract

ions

: mar

riage

cer

tific-

cate

s, c

ivic

doc

umen

ts, d

eath

cer

tifica

tes.

.96

37

--G

uida

nce

fees

9649

--La

wye

rs fe

es96

51

--E

xpen

ditu

res

for

phot

ocop

ying

or

extr

actin

g do

cum

ents

, pa

sspo

rts,

sch

ool c

ertifi

cate

s..

9663

--S

pend

ing

of p

hoto

copy

ing

scho

ol c

urric

ula

9675

--Lo

ans

expe

nses

from

ban

ks96

87

--H

ealth

insu

ranc

e fe

es96

91

--A

ccid

ent I

nsur

ance

Pol

icie

s96

95

--Li

fe in

sura

nce

polic

ies

9699

--In

stal

lmen

ts o

f hea

lth, a

ccid

ents

or

othe

r in

sura

nce

9703

--O

wne

rshi

p tr

ansf

er fe

es97

07

--B

ank

fees

and

com

mis

sion

s 97

11

--F

ees

for

leav

ing

bord

ers

9715

--C

ourt

fees

9719

--O

ther

: sp

endi

ng o

n se

rvic

es97

23

Tota

l of

this

pag

e97

30

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

Fill

ed u

p li

nes

fo

r th

is p

age

Sta

rt D

ate

_ _

/ _ _

/ _

0 E

nd

Dat

e _

_ / _

_ /

_ 0

1004

Wh

at is

th

e m

ain

so

urc

e fo

r al

l th

e ..[

ITE

M].

. in

acq

uir

ed?

1003

Ho

w m

uch

has

yo

ur

ho

use

ho

ld

spen

t o

r w

hat

is

the

esti

mat

ion

fo

r al

l qu

anti

ties

of

..[IT

EM

].. b

ou

gh

t o

r re

ceiv

ed d

uri

ng

th

e 12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1002

Wh

at is

th

e Q

uan

tity

of

the.

.[IT

EM

]..

bo

ug

ht

or

acu

iere

d b

y yo

ur

ho

use

ho

ld

du

rin

g t

he

12

day

s p

rece

din

g

the

firs

t d

ay o

f in

terv

iew

?

1001

Hav

e yo

u o

r an

y m

emb

er o

f yo

ur

ho

use

ho

ld b

ou

gh

t o

r re

ceiv

ed w

ith

ou

t p

ayin

g

cash

fo

r an

y [.

.[IT

EM

]..]

du

rin

g t

he

12 d

ays

pre

ced

ing

th

e fi

rst

day

of

inte

rvie

w?

1

Y

es 2

No

NE

XT

Mat

eria

l

ITEM CODE

Cas

h s

pen

din

g1

Gif

ts a

nd

do

nat

ion

s fr

om

oth

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ho

use

ho

lds

2

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ts a

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nat

ion

s fr

om

ou

tsid

e h

ou

seh

old

sec

tor

3

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men

t fo

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4

Fro

m s

elf-

pro

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n5

Oth

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o b

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enti

on

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fter

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swer

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de

6

Din

1000

Din

ar

Qu

anti

tyU

nit

Item

Des

crip

tio

n

Cap

ital E

xpen

ses

of th

e H

ouse

hold

--P

urch

ase

new

res

iden

ce97

37

--B

uild

ing

or a

ddin

g ex

tens

ions

9749

--B

uyin

g a

resi

dent

ial l

and

9751

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stal

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ts fo

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usin

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63

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ees

for

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stem

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tilin

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75

--B

uyin

g G

old

Pla

tes,

or

jew

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or

antiq

ues

arts

9787

--P

urch

ase

of fo

reig

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9799

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uyin

g sh

ares

and

bon

ds98

01

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ther

cap

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xpen

ditu

res

of th

e H

ouse

hold

9813

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er T

rans

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s

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end

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and

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tions

9825

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Kin

d G

ifts

9837

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ash

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9849

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onat

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, mon

ey to

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poor

, Zak

at..

9851

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ce p

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ents

and

legi

slat

ive

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paym

ents

9863

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raffi

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es a

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s98

75

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ther

con

vers

ions

insi

de Ir

aq98

87

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ther

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vers

ions

out

side

Iraq

9899

--R

elig

ious

Pay

men

ts &

Vow

s99

01

--T

ribal

Fun

ds99

13

--T

ribal

Gro

ups

Mem

bers

hips

9925

--O

ther

tran

sfer

able

pay

men

ts99

29

Tota

l of

this

pag

e99

30

No.

of fi

lled

lines

for

Sec

tion

10

Sec

tio

n T

en:

Exp

end

itu

res

on

No

n-F

oo

d S

ervi

ces

and

Co

mm

od

itie

s d

uri

ng

th

e p

ast

12 d

ays

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Content

Section 8: Expenditures on Non-Food Services and Commodities during the past 30 days

Section Nine: Expenditures on Non-Food Services and Commodities during the past 90 days

Section Ten: Expenditures on Non-Food Services and Commodities during the past 12 months

Serial Date Name of Notes Taker Job Title Comments Signature

1 0_ / _ _ / _ _

2 0_ / _ _ / _ _

3 0_ / _ _ / _ _

4 0_ / _ _ / _ _

5 0_ / _ _ / _ _

6 0_ / _ _ / _ _

7 0_ / _ _ / _ _

8 0_ / _ _ / _ _

9 0_ / _ _ / _ _

10 0_ / _ _ / _ _

11 0_ / _ _ / _ _

12 0_ / _ _ / _ _

13 0_ / _ _ / _ _

14 0_ / _ _ / _ _

15 0_ / _ _ / _ _

NotesPart No. (3): Daily Ledger

A. FIRST IDENTIFICATION Code

06 Governorate

07 District

08 Area

09 Quarters

10 Alley (Street)

11 Country

12 Village

13 Class Draw circle around appropriate answer

Provinces1 Rural2 Suburban3 Urban / Central

Baghdad

Suburban 2 Rural 1

Urban / Central

Al-Rasafah 4 Al-Sader City 3

Al-Karekh 5

14 The Number of the Building for the Survey

C. FIELD STAFF Signature CODE Date

23 INTERVIEWER 24 0-/--/--

25 TEAM LEADER 26 27 0-/--/--

28 DATA ENTRY OPER. 29 30 0-/--/--

31 CENTRAL SUPERVISOR 32 33 0-/--/--

40 Has Household been include in MICS3 Survey? Draw circle around correct answer Yes No

For Researcher: Pls double check against families included in MICS3 Survey

ا�ستيفاء بيانات اال�ستمارة

01 02 03

WAVE (1 - 18) TEAM INT. (1 - 3)

The Ministry of Planning and Development Cooperation

Central Organization for Statistics and Information Technology (COSIT)

The Republic of Iraq For eradication of poverty and enhancing the socio-economic status of the households in Iraq

In cooperation with the Kurdistan Regional Statistical Commission (KRSCO)

Household Socio-Economic Survey in Iraq (IHSES 2007 - 2006)

HOUSEHOLD IDENTIFIER

04 05

CLUSTER HH

B. HOUSEHOLD IDENTIFICATION

15 Household head name

16 Work Address

17 Household Size

18 HOUSEHOLD SIZE

19 Telephone Number

20 Work Tel. No.

21Numeral form for this household

22 No. of this questionnaire

D- Visits of Field Researchers RESULT OF THE INTERVIEW

35 First Visit 0-/--/--

36 Second Visits 0-/--/--

37 Third Visit 0-/--/--

38 Fourth Visit 0-/--/--

39 Fifth Visit 0-/--/--

1

2

3

4

5

6

7

8

34

Fully Achieved

Partially Achieved

No usable Information

Unaccomplished: Household refused interview

Unaccomplished: Household not present

Unaccomplished: House not found

Unaccomplished: Housing unit not occupied

Unaccomplished: Housing unit is seasonal

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Household Roster (Abbreviated Content)

103102

101

The one conducting the interview: copy the name and gender and age of all household members from the First Section: (Household Roster on Section No. (1): Socio-Economic Data)

ID C

OD

E

Age in YearsGenderNames

1Male

2Female

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869

Day

# 2

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Volume III

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871

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Annex 3: Survey questionnaire

883

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mm

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nit

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1102

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.

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pen

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2

Do

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Un

it o

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re

3

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nat

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om

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tsid

e

h

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s C

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m1

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er2

4

Pay

men

t fo

r w

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er3

5

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f P

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it o

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to b

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od

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uan

tity

Un

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ho

us.

Din

ar

.

Din

nar

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

T

ota

l --

- >40S

ecti

on

Ele

ven

: D

aily

Exp

end

itu

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e F

oo

d a

nd

No

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ies

Col

lect

ed L

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Ove

r D

ay #

9

Day

# 9

Nu

mb

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f L

ines

Co

llect

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Th

is P

age

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cher

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mm

ents

1104

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2

Do

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gra

m1

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er2

4

Pay

men

t fo

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mb

er3

5

Sel

f P

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uct

ion

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od

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Un

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Din

ar

.

Din

nar

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

19

T

ota

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on

Ele

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Exp

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dit

ies

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Day

# 1

0

Nu

mb

er o

f L

ines

Co

llect

ed f

or

Th

is P

age

To

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pen

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2

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Un

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Din

ar

.

Din

nar

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

T

ota

l --

- >40S

ecti

on

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ven

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Exp

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Col

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ay #

10

A- Jobs of the household members For All Household Members Aged 6 or more

1203Please describe all work performed by allmembers of the household, for the last 12months, whether paid or not

1202What is the type of work in terms of wages?

Put x in the appropriate square

1201Please describe all work performed by all members of the household, for the last 12 months, whether paid or not

Comments of the Researcher

Job

Ser

ial N

um

ber

ID C

OD

E

1- Look for the self-employment activities, such as sewing, embroidery, fabrics, weing, ladies hairdressing, handicrafts, etc...

2- Look for work professions at the family farm and rearing of live stocks

010203040506070809101112

B- Non wage jobA- Wage job

Occupation

Code

Jan

uar

y

Feb

ruar

y

Mar

ch

Ap

ril

May

Jun

e

July

Au

gu

st

Sep

tem

ber

Oct

ob

er

No

vem

ber

Dec

emb

erB- 2B - 1

Other thanAgriculture

In Agriculture or other than Agriculture all the same

Occupation Code

InAgriculture

or otherDescription of the Occupation

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

1

2

3

4

Note: Question in Column 1202* Column (A) Paid Job will be denoted in Section 13* Column (B) Non-Paid Agricultural Job B – 1 will be denoted in Section 14 Part (A)* Column (B) Non-Paid Non-Agricultural Job B – 2 will be denoted in Section 14 Part (B)

Section Twelve: Jobs during the last 12 Months

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For All Household Members Aged 6 or more B- Family bussiness and self employment

1206 Put the Codes of the Household Members Who are Participating in this business.

1205Describe all the household businesses otherthan the mentioned agricultural ones viamembers of the household, such as: grocery,trade, selling newspaper on the side of theroad, taxi, etc...

Inte

rnal

Pro

ject

Co

de

(*)

Individual Code

UNPAID FAMILY WORKERSOne inCharge

ActivityCode

Description of the activity

Fifth Fourth Third Second First

A

B

C

D

E

F

* This will be indicated or referred to in Section Fourteen, Part (B)

1204How many hours have you worked in the last 7 day

7 6 5 4 3 2 1

Sat

urd

ay

Fri

day

Th

urs

day

Wed

nes

day

Tues

day

Mo

nd

ay

Su

nd

ay

Section Twelve: Jobs during the last 12 Months

1305How many individuals are working in the project, organization or institution that you are working at?

1304Is this ..[JOB].. included in retirement systems and social security?

1303What is the economical sector of the entity you are working this ..[JOB]..?

1302Economical ActivityDescribe in details the economical activity that the entity practices, where the individual is working

1301Copy the Individual ID CODE and the Job Serial Number from Section Twelve ONLY WAGE JOBS

LIN

E N

UM

BE

R

Governmental sector01

Public sector02

Private sector03

Cooperative sector04

Less than 5 employees

1Mixed sectors05

Local non-gov. organizations

065 - 10 employees

2International nongov. organization

0711 - 50 employees

3Yes1

No2Private household08

more than 50 employees

4Foreign sector09Job

Serial Number

ID CODE Other10Activity Code

Activity Description

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Thirteen: Wage Earnings

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Section Thirteen: Wage Earnings

1308What is your evaluation to the degree of danger at work

1307Is your health adversely effected by the following at the working environment of this ..[JOB]..?

1306What kind of air-conditioning is available to you at this ..[JOB]..?

LIN

E N

UM

BE

R

I

Other

H

Fatigue

G

Insects

F

Lighting

E

Noise

D

Humidity

C

Heat

B

Chemicals and

Radiation

A

Soil and Gases

Central air-conditioning

1 Very Dangerous

1

Dangerous2Non-central cooling and heating

2 Relatively Dangerous

3

Not Dangerous

4Has ceiling but no heating or cooling0

3

Partially subjected to weather conditions

4

1 Yes 1 Yes 1 Yes 1 Yes 1 Yes 1 Yes 1 Yes1 Yes1 YesTotally subjected to weather conditions

5 2 No 2 No 2 No 2 No 2 No 2 No 2 No2 No2 No

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Thirteen: Wage Earnings

1316What is the number of days of yearly vacations for this job?

1315What is the numberof daysof holidays for this job?

1314What are the weekly hours you work at this job?

1313How much time do you need to arrive to your place of work?

1312What is the main transportaion means to get you to your place of work?

1311What is the distance between your home and work place?

1310How do you describe your work’s continuity? (how long it will last)

1309How youcompare working hours in this ..[JOB].. with normal hours

LIN

E N

UM

BE

R

Continuous: 30 hours a week or more

1On foot1

Private car2Totally within

1Public car3

Bicycle4

Continuous: 30 hrs./wk or less

2Partially within

2 Resident in same building

5

Employer provides transport

6Totally outside

3Seasonal3

Other7Unorganized4

Other5

DaysDaysHoursMinutesKm M

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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1320 Does this work provide any?of the following privillages

1319 What is the unit on which wages are set?in this job

1318 What is the main means you used to get this?job

1317 Since when have you worked?for this employer

LIN

E N

UM

BE

R

I called a governmental employment center01

I called private employment centers02

I called employers personally, or via phone03

Daily1I filled in applications04

Weekly2I asked relatives / friends to search for me05

Bi-weekly3 I did some arrangements for activities fornew works or more

06

C

PaidVacation

B

Retirement

A

Inclusionin Health Care

Monthly4I asked humanitarian organizations07

Per piece5I contacted governmental institutions08

Other6I called multi-national forces09

I followed up on job opportunities ads10

I promoted my work via an advertisement11

Yes1Yes1Yes1Other12

No2No2No2

YearMonth

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

Section Thirteen: Wage Earnings Section Thirteen: Wage Earnings

1324What was the total amount that you have received during the last 12 months for over-time, or as a donation / grant, or reward, or privileges or other benefits? (including in-kind payments) with the exception of your salary or wages?

Write ‘zero’ if nothing

1323What is the average of the amount you normal get after tax deduction or any other retirement deductions for the time duration that was specified in 1322?

Write ‘zero’ if nothing

One Thousand Dinars / Unit

1322What is the time interval that is covered by this last amount?Unit

1 Day2 Week3 Fortnight4 Month

1321What was the last salary or wages you have received after tax or retirement deductions?

Write ‘zero’ if nothing

B ABABABA

In KindCashIn KindCashUnitNo.of UnitsIn KindCash

1000 Dinar1000 Dinar1000 Dinar1000 Dinar1000 Dinar1000 Dinar

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

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Part (A): Agriculture, rearing of live stock, fishing and forestry activities

A - 1 :Land

Record the total area of the land of all agricultural areas whether owned or run by the household

Has the household or one of its members had any agricultural land during the last 12 months?

Donum Evlec 1 Yes 2 No 1409

What was the actual cultivated area out of the agricultural areas that is owned or run by the household?

Who in the household owns or operate this land?

ID CODE

Donum Evlec 4321

A - 2: Plant Production

Section Fourteen: Non wage earning activities

1408What is the total amount received from sales of the ..[CROP].. during the last 12 months?

1407What is the quantity of ..[CROP].during the last 12 months, .that you have dealt with in any of the following ways?

1406

What was the

quantity that

was produced of

...[CROP]...

during the last 12

months by your

household? And

what is its

estimated value?

1405

Has the house--

hold or any of its

members

produced any

..[CROP].. in the

last 12 months?

1 Yes

2 No Next Typ

e o

f C

rop

IOther?

HI gave as in kind wages

GI gave to the owner as in kind pay--ment

FI used it as stor--age for the future

EBy us--ing it as seeds

DBy using it as fod--der for animals, last 12 months?

C By giving it as a donation in the last 12 months?

B By con--suming it by the house--hold during the last 12 months

A By selling it in the last 12 months?

Value at

1000 Dinars

Qty

Kg

Qty

Kg

Qty

Kg

Qty

Kg

Qty

Kg

Qty

Kg

Qty

Kg

Qty

Kg

Qty

Kg

Value at

1000 Dinars

Qty

KgCode

Crop

Description

Seeds1

Fruits2

Vegetables3

Dates4

Tobaco5

Other (list)6

Total7

A - 3 Livestock

1409 Does the household or any of its members have any activities with live stock / animal production

1 Yes

2 No

1410 How many animals does the household currently have?

Goats & Sheep Donkeys & Mules Bee-hives Cows Horses Other Water Baffalo Poultry

1411 How much has your household received from sales of animals in the last 12 months?

1412 How much has your household received from sales of animals products, such

as: (meat, honey, eggs, butter, dairy products, …etc) in the last 12 months?

1413 What is the value of what your household has consumed of animal products

(such as:meat, honey, eggs, butter, dairly products, …etc) in the last 12 months?

1413 -A What is the value of the products you gave to the owner as in kind payment?

1000 Dinars

1000 Dinars

Write 'zero' in case of no sales

1000 Dinars

Write 'zero' in case of no sales

1000 Dinars

Write 'zero' if nothing

Part (A): Agriculture, rearing of live stock, fishing and forestry activitiesA - 4: Livestock

1414 How much did you spend on the following during the past 12 months?

If the answer to question 1401 or 1409 is yes, go ahead to question 1414, otherwise, go to question 1415

1000 Dinars1000الفقرة DinarsClause of paragraph

Other, what is related to animal production13Fertilizers, pesticides01

Labour wages (cash and in kind)14seeds02

Interests and expenditures over agricultural loans15Seedlings (or sprouts)03

Outcome of the land16Sacs, plastic sheets, field tools, storage facilities, maintenance and fixing

04

Cash share of the owner from crops sales17Fuel to dry crops or for transport means or irrigation, etc…05

cash share of the owner from plants and animal pro--ductions sales

18Rental of catterpillar machinery (inclusive cost of fuel), rental of irrigation equipment …etc

06

Tax19Transport07

purchase of equipment and agricultural machinery20Irrigation (do not list fuel)08

Miscellanouse purchases, transportation means21Other , related to plant production09

improving the land22Fodder10

Purchase of productive animals23Veterinary11

Bard building, digging of canals and wells, building of warehouses

24Water and electricity12

<---Total25

What is the value and quantity of fish or other aqatic aninals which has been

ASold during last 12 months

BYou consumed at home during the last 12 months?

CGiven as gift or in kind donation during the last 12 months?

Value Amount Value Amount Value Amount

Kg. 1000 Diners Kg. 1000 Diners Kg. 1000 Diners

1417 How much did you spend (in total) during the past 12 months, to implement fishing and fisheries activities?

HIRED LABOR A. C. OTHER EXPENSES BOAT PURCHASE

1000 Diners 1000 Diners 1000 Diners

A - 6 Forestry and Woods Activities

A - 1417 Have you or any household member done any forestry or woods activities, last 12 months?

B - 1417 How much did your household receive from your sales?

C - 1417 How much did the household consume of products you gathered?

D - 1417 How much did you spend to get those products?

Write 'zero' for no sale1000 Diners

A - 5 Hunting Activities and Fisheries

1415 Have you or any household member hunted or breaded fish (or other aquatic animals), or prawns or crabls or oysters…etc in the last 12 months?

A - 1417 1 Yes

2 No

1 Yes

Bart B 2 No

Section Fourteen: Non wage earning activities

Fodder, veterenary material, rental escort, cooling, fixing and maintaining fishing nets, fuel for boat, fix and maintain boat, rent boat (cash), services (technical assistance)…

Write 'zero' for no sale1000 Diners

Write 'zero' for no sale1000 Diners

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Section Fourteen: Income, Cost of Production of Non-Paid Work Activities

Part (B): Non-paid work activities in all areas save agriculture

Do not list agriculture, fishing and forestry that had been recorded in Section

Fourteen, Part (A)

(*) Take project code from Section Twelve, Column 1205

B-1: PRODUCTION COST DURING THE PAST 12 MONTHS

NO MaterialProject A

(*)1000 Dinar

Project B(*)

1000 Dinar

Project C(*)

1000 Dinar

Project D(*)

1000 Dinar

Project E(*)

1000 Dinar

Project F(*)

1000 Dinar

1418 Raw Material

1419 Commodities bought with intention of sales

1420 Water and Electricity

1421 Cables, Post, Phone

1422 Fuel & Oil (for other than transport)

1423 Packaging Material

1424 Renting of Machinery / Equipment

1425 Repair and Maintain Machinery

1426 Rental of Utilities

1427 Cost of Transport, inclusive fuel & oil

1428 Repair and Maintain Utility Areas

1429 Other Expenditures

1430 Paid interest on work loans

1431 Cash payments to workers

1432 In-kind payments to workers

1433 Direct Tax

1434 Indirect Tax

1435 Total

B-2: PRODUCTION REVENUE DURING THE PAST 12 MONTHS

1436 Net profit from industrial work

1437 Depretiation value for produced goods

1438 Net profit from commercial work

1439 Net profit from building and construction

1440Net profit from communications and transp-port

1441 Net profit from services activities

1442 Total

B-3: WORK CONDITIONS

NOAsk these questions to the one in charge of the Family Bussines / Self Employmet Job

Project A

Project B

Project C

Project D

Project E

Project F

1443

What kind of airconditioning is available at place of work?

1 Central airconditioning

2 Non-Central heating and cooling

3 Has roof, but no heating or cooling

4 Partially open, subjected to weather conditions

5 Totally subjected to weather conditions

Section Fourteen: Income, Cost of Production of Non-Paid Work Activities

Part (B): Non-paid work activities in all areas save agriculture

B-3: WORK CONDITIONS

NOAsk these questions to the one in

charge of the Family Bussines / Self Employmet Job

Project A

Project B

ProjectC

Project D

Project E

Project F

1444

Is your health adversly affected by some of the following surrounding environment?

A Soil & Gases

B Chemicals & Radiation

1 Yas C Heat

2 No D Humidity

E Noise

F Lighting

G Insects

H Fatique

I Other

1445

What is your estimation to the degree of danger for this work?

1 Very dangerous

2 Dangerous

3 Relatively dangerous

4 Not dangerous

1446

How do you compare the working hours of the project with normal working hours?

1 It is within

2 It is partially within

3 It is totally outside

How do you describe sustainability / continouty of the work at the project?

1447

1 Permanent at 30 hrs. / week & more

2 Permanent at less than 30 hrs./week

3 Seasonal

4 Un-regular

5 Other

1448 What is the distance between work and

residence?

Km M Km M Km M Km M Km M Km M

What is the main means of transport to work?

1449

1 On foot

2 Private Car

3 Public Car

4 Bicycle

5 Residing in same building as work

6 Other (mention)

1450 What is the distance between work and

residence?

Minutes Minutes Minutes Minutes Minutes Minutes14

51 How many hours per week do you work at this project?

No.of Hours No.of Hours No.of Hours No.of Hours No.of Hours No.of Hours

1452 What are the yearly days of holiday for this

work at the project?

No.of Days No.of Days No.of Days No.of Days No.of Days No.of Days

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1502Who of the household members got income from ...[SOURCE]... and what was the total he/she received, last 12 months?

1501Has any of the household membersreceived income from ...[SOURCE]..., last 12 months?

1 Yes

2 No NEXT LINE

SO

UR

CE

NU

MB

ER

CAll Other Household Members

Write code of member of

highest income

BSecond Household

Member

AFirst Household

Member

ID CODE

1000 DinarID

CODE1000 Dinar

ID CODE

1000 DinarCodeSource of Income

Income from Ownership

From renting agricultural land1501

Income from agricultural land cooperative system

1502

Rental of vacant land 1503

Rent of residential buildings1504

Rent of non-residential buildings1505

Rent of machinery or equipment1506

Rent of means of transport1507

Other rentals1508

Shares profit1509

Profits from cooperative companies

1510

Interests on bonds & Trusts1511

Property Rights and Publications1512

Income from Selling an Owned Possession

Sales of agricultural land1513

Sales of non-agricultural land1514

Sales of Buildings1515

Sales of Machinery & Equipment1516

Sales of gold and jewelry1517

Sales of shares and bonds1518

Sales of foreign currency1519

Sales of long-life goods1520

Sales of other possessions1521

.... > total [1501 - 15211554

Section Fifteen: Income, Cost of Production of Non-Paid Work Activities

1502Who of the household members got income from ...[SOURCE]... and what was the total he/she received, last 12 months?

1501Has any of the household membersreceived income from ...[SOURCE]..., last 12 months?

1 Yes

2 No NEXT LINE

SO

UR

CE

NU

MB

ER

CAll Other Household Members

Write code of member of

highest income

BSecond Household

Member

AFirst Household

Member

ID CODE

1000 DinarID

CODE1000 Dinar

ID CODE

1000 DinarCodeSource of Income

Income from Ownership

Civil retirement1522

Military retirement1523

Inherited retirement1524

Social security retirement1525

Disability retirement1526

Special Funds retirement1527

Salary from Family Welfare Fund1528

Salaries of disabled1529

Maternity salaries1530

Social Protection Network Donations1531

Unemployment compensation1532

Emergency payments1533

Vocational Training Allocations1534

Educational Scholarships1535

Gifts, Donations and Compensations

From other families in Iraq1536

Other families outside Iraq1537

From Government1538

From other sources in Iraq1539

Other sources outside Iraq1540

In Kind Assistance

From other families in Iraq1541

Other families outside Iraq1542

From Government1543

From other sources in Iraq1544

Other sources outside Iraq1545

Other Transferable Income

Insurance compensations1546

Legal payments1547

Zakat Funds Support1548

Source of inheritance1549

Marriage endowment1550

Lottery winnings1551

Consumable loans1552

Other Transferable Income, e.g. selling of supplies shares …

1553

...> Total 1522 - 15531555

Section Fifteen: Income, Cost of Production of Non-Paid Work Activities

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Section Seventeen: Loans, credits and assistance

1 Did not receive any help

2 Governmental Sources

3 Private Sector Establishments

4 Foreign Organizations

5 Relatives inside Iraq

6 Relatives outside Iraq

7 Other than relatives inside Iraq

8 Other sources

Does the household have outstanding debts or loans or advances to the benefit of other households or establishments?1701

1 Yes

2 No 1705

01 Relatives inside Iraq

02 Relatives residing abroad

03 Friends / neighbors

04 Loan-givers / loan sharking

05 Merchant

06 House Owner

07 Employer

08 Governmental Entity or Bank

09 Civic Bank

10 Non-Governmental Organization

11 Other

12 I never got the loan 1705

1 Household consumable needs

2 Emergency: sickness, fire, flood, theft, injury

3 Ceremonial: wedding, funeral, …

4 House maintenance

5 Buy land

6 Build House

7 Buy House

8 Buy long-life consumable commodity

9 Pay back existing loans

10 Other

From which party did you get the loan(s), last 12 months (Write codes of 3 entities and as per their importance)1702

What is the main purpose of borrowing money, last 12 months (write 3 reasons’ codes, and as per importance)1703

1 None

2 Some ..... Less than 50%

3 Most ..... Less than 50%

4 All

What are the percentages of the loan values and accumulated advances with interests, last 12 months?1704

If the household received assistance (cash or other than cash), last 12 months, who is the donating entity? Write codes of entities, up to 3 most important

1705

First

Third

Second

First

Third

Second

First

Third

Second

Section Sixteen: Durable Goods

1604How much have you paid for this ..[DURABLE GOOD]..? If more than one, mention the last one

1603When did you aquire this ..[DURABLE GOOD]..? If more than one, memtion the last one aquired

1602What is the total number of …DURABLE GOOD]... owned by household or member of household?

1601Does the household or any of its memberpossess any of the following?

LIN

E N

UM

BE

R

1 Yes

2 No

NEXT DURABLE GOOD If it has been given to you free of charge, ask about its estimated value

DinarYearNumberDescription of Durable Good

Private car01

Taxi (if it’s also being used by household02

Small/ medium sized bus03

Bicycle04

Steam Bike05

Gas or electric cooker06

Fuel-run cooker07

Electric Blender08

Fridge09

Electric Washing Machine10

Iron11

Electric Water Heater12

Gas Water Heater13

Solar Water Heater14

Fuel-run Water Heater15

Cooling fan / device16

Water cooler17

Freezer18

Diswasher19

Electric Vacum Cleaner20

Radio / Recorder21

Coloured T.V22

Black and white T.V23

Video / recorder24

CD-Player / DVD25

Sewing machine26

Electric generator27

Electric fan28

Aircondition29

Personal Computer PC30

Play Station /Games31

Fuel-operated heater32

Gas heater33

Electric heater34

Sattelite35

Other36

Total37

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1802To compensate or avoid lowering or loosing income due to one or more of the aforementioned problems in the previous question, during last 12 months. Has the household done the following procedure [Name the procedure]

Ser

ial

Code: 1 Yes

2 NoType of Action, Procedure

Reducing quantity and quality of food1

Reducing expenditures2

Spending savings or investments3

I got loans from friends or relatives4

Got loan from employers, shark-loaners, merchants, Non-Governmental Organizations

5

Buying food against credit from merchants6

I got help from others in the community7

Selling: furniture, equipment, jewelry, doors, windows…8

Selling income generating equipment9

Renting land to others10

Placing a mortgage on house or land11

Selling livestock: females that can produce12

Selling house of land13

Selling supplies shares14

Got food & other items from rescue missions and programs from Government, NGOs and international agencies

15

One of the household members immigrated abroad to look for work16

One of the household members joined the armed forces or internal security forces17

I had to go for children’s labour or increase their hours of work18

I sent my sons to work under unjust contractual conditions19

I got the daughters to get married at a young age20

I started to beg21

I moved to another area22

Other (mention)23

I did no do anything24

Section Eighteen: Risks

1801Has any of the household members been adversity affected by [name problem], last 12 months?

Ser

ial

Code: 1 Yes

2 No Problem Type

Loss of job by any household member1

Lowering of wages of any of the household members2

Bankruptcy of commercial family business3

Sever sickness or accident to any household member4

Death of working household member5

Death of another household members6

Theft7

Violence due to the usual circumstances of Iraq8

Kidnapping, threading to kill, pertaining to usual circumstances in Iraq9

Other types of violence10

Another huge problem11

If all answer were NO, conclude the interview

Content

Section Eleven: Daily Repetitive Expenditures on Food Goods and Non-Food (Edible) Goods

Section Twelve: Work in the last 12 Months

Section Thirteen: Generating Income

Section Fourteen: Income and Cost of Production for Non-Paid Work Activities

Section Fifteen: Income from Ownership and Transferable

Section Sixteen: List of Long-Life Commodities

Section Seventeen: Loans, Advances, Assistance

Section Eighteen: Risks

Serial DateName of Person

Taking NotesJob Title Comments Signature

1 0_ / _ _ / _ _

2 0_ / _ _ / _ _

3 0_ / _ _ / _ _

4 0_ / _ _ / _ _

5 0_ / _ _ / _ _

6 0_ / _ _ / _ _

7 0_ / _ _ / _ _

8 0_ / _ _ / _ _

9 0_ / _ _ / _ _

10 0_ / _ _ / _ _

11 0_ / _ _ / _ _

12 0_ / _ _ / _ _

13 0_ / _ _ / _ _

14 0_ / _ _ / _ _

15 0_ / _ _ / _ _

Notes

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Part No. (4): Daily Ledger

A. FIRST IDENTIFICATION Code

06 Governorate

07 District

08 Area

09 Quarters

10 Alley (Street)

11 Country

12 Village

13 Class Draw circle around appropriate answer

Provinces1 Rural2 Suburban3 Urban / Central

Baghdad

Suburban 2 Rural 1

Urban / Central

Al-Rasafah 4 Al-Sader City 3

Al-Karekh 5

14 The Number of the Building for the Survey

C. FIELD STAFF Signature CODE Date

23 INTERVIEWER 24 0-/--/--

25 TEAM LEADER 26 27 0-/--/--

28 DATA ENTRY OPER. 29 30 0-/--/--

31 CENTRAL SUPERVISOR 32 33 0-/--/--

40 Has Household been include in MICS3 Survey? Draw circle around correct answer Yes No

For Researcher: Pls double check against families included in MICS3 Survey

ا�ستيفاء بيانات اال�ستمارة

01 02 03

WAVE (1 - 18) TEAM INT. (1 - 3)

The Ministry of Planning and Development Cooperation

Central Organization for Statistics and Information Technology (COSIT)

The Republic of Iraq For eradication of poverty and enhancing the socio-economic status of the households in Iraq

In cooperation with the Kurdistan Regional Statistical Commission (KRSCO)

Household Socio-Economic Survey in Iraq (IHSES 2007 - 2006)

HOUSEHOLD IDENTIFIER

04 05

CLUSTER HH

B. HOUSEHOLD IDENTIFICATION

15 Household head name

16 Work Address

17 Household Size

18 HOUSEHOLD SIZE

19 Telephone number

20 Work tel. no.

21Numeral Form for this household

22 No. of this Questionnaire

D- Visits of Field Researchers RESULT OF THE INTERVIEW

35 First Visit 0-/--/--

36 Second Visits 0-/--/--

37 Third Visit 0-/--/--

38 Fourth Visit 0-/--/--

39 Fifth Visit 0-/--/--

1

2

3

4

5

6

7

8

34

Fully Achieved

Partially Achieved

No usable Information

Unaccomplished: Household refused interview

Unaccomplished: Household not present

Unaccomplished: House not found

Unaccomplished: Housing unit not occupied

Unaccomplished: Housing unit is seasonal

Description Unit of Measure Code

Bread and grains

Rice

Supplies Rice Kg 1011

Imported commercial rice Kg 1023

Local commercial rice Kg 1035

Rice flour Kg 1047

Other -- 1059

Seeds and its products

Wheat germ Kg 1061

Dark wheat germ supplies Kg 1073

Dark wheat germ commercial Kg 1085

White Wheat supplies Kg 1097

White commercial wheat Kg 1109

Barley Kg 1111

Barley flour Kg 1123

Yellow corn Kg 1135

Seeds and other products -- 1147

Products made from seeds

Burgul Kg 1159

Kind of seeds (Habbiyah) Kg 1161

Semolina Kg 1173

Noodles & Macaroni Kg 1185

Starch Kg 1191

Corn flakes Kg 1197

Infants Food Supplies Kg 1203

Infants Food Commercial Kg 1209

Yellow Corn Chips / Flakes Kg 1211

Sweet Corn Kg 1223

Other -- 1235

Bread and Products of Bakeries

All sorts of bread Kg 1247

Small loafs Kg 1259

Kahi Kg 1261

Klijeh Kg 1273

Cakes Kg 1285

Biscuits Kg 1297

Dried Sweet Cookies Kg 1309

Ready-made Pizza Kg 1311

Other Bakery Items Kg 1323

Fees for grinding and for ovens -- 1335

Meats

Fresh or frozen meat

Fresh Beef Kg 1347

Frozen Beef Kg 1359

Fresh Veal Kg 1361

List of Food Items, to use their codes in the daily ledger

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Description Unit of Measure Code

Ready Cream Kg 1749

Fresh Cream Kg 1753

Other -- 1757

Eggs

Chicken Eggs No. 1761

Other kinds of eggs No. 1765

Oils

Oils and Gee

Vegetable fat supplies Kg 1873

Vegetable fat commercial Kg 1885

Animal fat Kg 1897

Vegetable oil supplies Liter 1909

Vegetable oil commercial Liter 1911

Olive oil Liter 1923

Rashi Kg 1935

Markin Kg 1947

Other fats and oils -- 1959

Fruits

Fresh fruits

Oranges Kg 1961

Sour Lime Kg 1973

Sweet Lime Kg 1985

Lankli Kg 1997

Mandarin Kg 2009

Grapefruit Kg 2011

Tangerine Kg 2023

Other citrus fruits Kg 2035

Pomalete Kg 2047

Plums Kg 2059

Pears Kg 2061

Aski-Dunya (orange tropical ) Kg 2073

Fresh Olives Kg 2085

Apricots Kg 2097

Alo-Palo Kg 2109

Za’rour -- 2111

Apples Kg 2123

Sweet Melon Kg 2135

Water Mellon Kg 2147

Pomegrade Kg 2159

Grapes Kg 2161

Bananas Kg 2173

Fat Pears Kg 2185

Figs Kg 2197

Kaka Kg 2209

Kiwi Kg 2211

Takki Kg 2223

Pineapples Kg 2235

Description Unit of Measure Code

Frozen Veal Kg 1373

Frozen Chicken Kg 1397

Alive Chicken Kg 1409

Goat Meat Kg 1411

Water Buffalo Meat Kg 1423

Red imported meats Kg 1429

Camel Meat Kg 1435

Pork Kg 1447

Other Animal’s Meat: Rabbit, etc Kg 1459

Internal parts Kg 1461

Intestines Kg 1473

Brain Kg 1485

Tongue Kg 1497

Kidneys Kg 1509

Goat Eggs Kg 1511

Lard Kg 1523

Chicken Liver, kidney, hearts Kg 1535

Chicken wings and necks Kg 1547

Other parts of chicken Kg 1559

Other Fresh Meat Kg 1561

Dried Meet (Bastermah) Kg 1573

Canned Meat including Hot Dogs Kg 1585

Cost of dicing meat -- 1597

Cost for grilling meat -- 1609

Cost for slaughtering -- 1611

Other Fresh or Frozen Meat -- 1623

Fish

Fish and Sea Food

Fresh river fish Kg 1635

Fresh sea fish Kg 1647

Frozen fish Kg 1659

Dried fish Kg 1661

Canned fish Kg 1673

Prawns Kg 1685

Other types of fish -- 1697

Milk

Milk and its derivatives

Fresh milk Liter 1709

Powder milk supplies Kg 1713

Powder milk commercial Kg 1717

Condensed milk Kg 1721

Children’s / infants milk Kg 1725

Yogurt Kg 1729

Sweet cheese Kg 1733

Imported cheese Kg 1737

Popular milk drink (Quaimar) Kg 1741

Butter Kg 1745

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Description Unit of Measure Code

Carrots Kg 2697

Radish Kg 2709

Lettuce Kg 2711

Sileq (like spinach) Kg 2723

Cucumber Kg 2735

Canned, Dried and Frozen Vegetables Kg 2747

Kima (grows from thunder Kg 2761

Mushrooms Kg 2773

Other: Salary .. -- 2785

Preserved or canned vegetables

Tomato paste Kg 2797

Canned Brown Beans Kg 2809

Cooked and Canned Vegetables Kg 2811

Other canned vegetables Kg 2823

Preserved or canned vegetables -- 2835

Legumes

Dry beans supplies Kg 2847

Dry beans commercial Kg 2859

Dry Baqlah Kg 2861

Chick Pea supplies Kg 2873

Chick Pea commercial Kg 2885

Tahiniyyah for Humous Kg 2897

Lentils supplies Kg 2909

Lentils commercial Kg 2911

Dry Lobia (like green beans) Kg 2923

Mash Kg 2935

Sesame seeds Kg 2947

Hartman Kg 2959

Other legumes -- 2965

Products of vegetables

Gips Kg 2973

Other products Kg 2985

Sugar

Sugar and its products

Sugar supplies Kg 2997

Sugar Commercial Kg 3009

Mixed deserts Kg 3011

Nestle Kg 3023

Jam Kg 3035

Honey Kg 3047

Dates Honey Kg 3059

Factory Syrup -- 3061

Alek -- 3073

Coloured water ice-cream Kg 3085

Ice -- 3097

Other sugar products -- 3109

Unclassified food items

Unclassified food products

Description Unit of Measure Code

Cherries Kg 2247

Strawberries Kg 2259

Fresh Dates Kg 2267

Other (Citrus - Safargal…) Kg 2273

Canned and Dried Fruits

Canned fruits Kg 2285

Canned olives Kg 2297

Apricots Kg 2309

Dry Figs Kg 2311

Tarshanah Kg 2323

Qisi and Alloujah Kg 2335

Dried Dates Kg 2359

Canned Dates Kg 2361

Almonds Kg 2373

Walnut Kg 2385

Coconut No. 2397

Ground Coconut Kg 2409

Chestnuts and Oak Kg 2411

Seeds of water melon Kg 2423

seed of trees Kg 2435

Pistachios Kg 2447

Hazel nuts Kg 2459

Peanuts Kg 2461

Other : raising, dried apricot rolls -- 2467

Vegetables

Fresh, Frozen and Canned Vegetables

Tomato Kg 2485

Okra Kg 2497

Egg Plant Kg 2509

Qare’ (like Zucchini but stouter) Kg 2511

Lobya, like green beans but thinner Kg 2523

Green Baqleh (for salad) Kg 2535

Green Peas Kg 2547

Green Beans Kg 2559

Cauliflower Kg 2561

Lahhanah Kg 2573

Potatoes Kg 2585

Dry Onions Kg 2597

Green Onions / spring onion Kg 2609

Dry Garlic Kg 2611

Green Garlic Kg 2623

Spinach Kg 2635

Perbin Kg 2647

Shalgham Kg 2659

Beet Root Kg 2661

Kalm Kg 2673

Green pepper / belly pebber Kg 2685

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Description Unit of Measure Code

Drugs

Cocaine -- 3523

Newspapers and Periodicals

Newspapers and Journals -- 3535

Magazines and Periodicals -- 3547

Restaurants and Coffee Shops

Restaurants and Coffee Shops and the like

Snacks & Sandwiches -- 3559

Kebab, Indian Tikka and Intestines -- 3561

Grilled chicken -- 3573

Fried and grilled fish -- 3585

Appetizers -- 3597

Various Meals -- 3609

Non-alcoholic beverages, coffee, tea, carbonated, juices -- 3611

Alcoholic Beverages, Whiskey, Brandy, wine… -- 3623

Hubble-Bubble -- 3635

Restaurants, Cafés and the like -- 3639

Fuel for Private Generators

Regular fuel from station Liter 4001

Super fuel from station Liter 4005

Commercial fuel Liter 4009

Fuel for Private Transport

Regular fuel from station Liter 4031

Super fuel from station Liter 4035

Commercial fuel Liter 4039

Fees for Public Transport

Passengers by land -- 4741

Passengers by sea -- 4749

Description Unit of Measure Code

Salt supplies Kg 3111

Salt commercial Kg 3123

Vinegar Liter 3135

Cardamom Kg 3147

Lumi small dried lime for cooking Kg 3153

Turshi Kg 3159

Processed olives Kg 3161

Mayonnaise -- 3173

Spices -- 3185

Darsin -- 3197

Black Pepper -- 3209

Baking Powder -- 3211

Yeast -- 3223

Kajub -- 3235

Mustard -- 3247

Sauces and Flavors -- 3259

Products of unclassified foods -- 3261

Non-alcoholic beverages

Coffee, Tea and Cocoa

Tea, from supplies Kg 3285

Tea, bought commercially Kg 3297

Coffee and Nescafe Kg 3309

Cocoa Kg 3311

Other tea, coffee and cocoa -- 3315

Gaseous/ Carbonated Drinks, Fruits & Vegetables Juices

Carbonated drinks Liter 3335

Mineral water Liter 3347

Soda Liter 3359

Fruits Juices Liter 3361

Kinds of syrups Liter 3373

Other Carbonated Drinks, Fruits & Vegetables Juices -- 3385

Alcoholic Drinks, Tobacco and Drugs

Alcoholic Beverages

Whiskey Liter 3397

Wine Liter 3409

Araq Liter 3411

Brandy Liter 3423

Beer Liter 3435

Other alcoholic drinks -- 3447

Tobacco

Cigarettes No 3459

Tobacco Kg 3461

Tumbak Kg 3473

Cigars No 3485

Hubble-Bubble Kg 3497

Sniffs Kg 3509

Other Tobacco -- 3511

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917

Day

# 4

Nu

mb

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f F

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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19

Tota

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Tota

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919

Day

# 5

Nu

mb

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f F

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es f

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this

Pag

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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19

Tota

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Tota

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_ _

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921

Day

# 6

Nu

mb

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f F

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this

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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19

Tota

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

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e _

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_ _

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Volume III

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Annex 3: Survey questionnaire

923

Day

# 7

Nu

mb

er o

f F

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es f

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this

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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19

Tota

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

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_ _

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Volume III

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Annex 3: Survey questionnaire

925

Day

# 8

Nu

mb

er o

f F

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es f

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this

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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19

Tota

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

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_ _

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Volume III

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Annex 3: Survey questionnaire

927

Day

# 9

Nu

mb

er o

f F

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es f

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e:

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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

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_ _

/ _ _

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Annex 3: Survey questionnaire

929

Day

# 1

0

Nu

mb

er o

f F

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Lin

es f

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this

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01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19

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21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

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