national planning and development agency the world...

Japan International Cooperation Agency

Household interviewed by Distrito Distrito CodeVisit 1

Visit 2 Posto Posto CodeVisit 3

Supervised in the field by Suco Suco CodeVisit 1

Visit 2 Aldeia Aldeia Code

Data entered by

Session 1 Head of the Household HH Serial NumberSession 2

Session 3

Team HH No.Job No.

HOUSEHOLD SURVEY 2001Day Month Year

Task

STRICTLY CONFIDENTIAL

Day Month Year

Day Month Year

National Planning and Development AgencyCensus and Statistics Unit

Asian Development BankThe World Bank United Nations Development Program

POVERTY ASSESSMENT PROJECT

Code

Code

Code

Page No Page No

1 HOUSEHOLD INFORMATION 1 8 EMPLOYMENT 47A: HOUSEHOLD ROSTER 1 A: LABOUR FORCE PARTICIPATION 47B: NEW MEMBERS SINCE THE VIOLENCE IN 1999 4 B: JOB INFORMATION 48C: PERSONS LEAVING HOUSEHOLD AFTER VIOLENCE IN 1999 8 C: INDIVIDUAL TIME USE 57D: INFORMATION ON PARENTS OF HOUSEHOLD MEMBERS 5

9 FARMING AND LIVESTOCK 602 HOUSING 10 A: PLOTS 60

A: DESCRIPTION OF THE DWELLING 10 B: CROPS HARVESTED 64B: HOUSING STATE 11 C: AGRICULTURAL INPUTS 66C: SERVICES 12 D: FORESTRY 67D: OWNERSHIP AND EXPENDITURES 13 E: FARMING EQUIPMENT 68

F: LABOUR & FARM PRODUCE 693 ACCESS TO FACILITIES 14 G: LIVESTOCK 70

H: FISHING AND AQUACULTURE 714 EXPENDITURES/CONSUMPTION 15

A: WEEKLY FOOD CONSUMPTION 15 10 TRANSFERS, BORROWING AND SAVINGS 75B: MONTHLY AND ANNUAL NON-FOOD EXPENDITURE 26 A: TRANSFERS GIVEN & LOANED 75C: DURABLE GOODS 29 B: TRANSFERS RECEIVED 76

C: BORROWING 775 EDUCATION 30 D: AID ASSISTANCE 78

A: GENERAL EDUCATION 30 E: SAVINGS 79B: ATTENDANCE SCHOOL YEARS 1998/99-2001/02 31

11 OTHER INCOME 806 HEALTH 38

A: HEALTH CARE USE 38 12 SOCIAL CAPITAL 81B: CHILDREN HEALTH 43

13 SUBJECTIVE WELLBEING 847 FERTILITY AND MATERNITY HISTORY 45 A: INDIVIDUAL 84

B: HOUSEHOLD 85C: VULNERABILITY 86

TABLE OF CONTENTS

Order of Sections Order of Sections

Please draw a map showing where the household is located. Please show nearby landmarks such as the closest aldeai centre, vehicle passable road, church,elementary school, everyday market or kiosk.

• Own house

Closest aldeia centre

Vehicle passable road

Stream or river

∗ Church

+ Elementary school

∞ Everday market

φ Kiosk

Main area farmed by

the household

Aldeia

Aldeia Code

Head of the Household

HH Serial Number

HOUSEHOLD MAP

LEGEND

1 HOUSEHOLD INFORMATION

A: HOUSEHOLD ROSTER

B: NEW MEMBERS SINCE THE VIOLENCE IN 1999

C:

D: INFORMATION ON PARENTS OF HOUSEHOLD MEMBERS

2 HOUSING

A: DESCRIPTION OF THE DWELLING

B: HOUSING STATE

C: SERVICES

D: OWNERSHIP AND EXPENDITURES

3 ACCESS TO FACILITIES

4 EXPENDITURES/CONSUMPTION

A: WEEKLY FOOD CONSUMPTION

B: MONTHLY AND ANNUAL NON-FOOD EXPENDITURE

C: DURABLE GOODS

9 FARMING AND LIVESTOCK

A: PLOTS

B: CROPS HARVESTED

C: AGRICULTURAL INPUTS

D: FORESTRY

E: FARMING EQUIPMENT

F: LABOUR & FARM PRODUCE

G: LIVESTOCK

H: FISHING AND AQUACULTURE

10 TRANSFERS, BORROWING AND SAVINGS

A: TRANSFERS GIVEN & LOANED

B: TRANSFERS RECEIVED

C: BORROWING

D: AID ASSISTANCE

E: SAVINGS

11 OTHER INCOME

12 SOCIAL CAPITAL

13 SUBJECTIVE WELLBEING

B: HOUSEHOLD

C: VULNERABILITY

FORMULIR PELACAKAN KUESIONER PEWAWANCARA

PERSONS LEAVING HOUSEHOLD AFTER VIOLENCE IN 1999

FORMULIR PELACAKAN KUESIONER PEWAWANCARA

SECTION 7 SECTION 12 SECTION 13

FERTILITAS SUBJEKTIF

PART A PART B PART A PART B PART A PART B PART C PART A

0 - 5 years

6 SAMPAI KURANG DARI 10 YEARS

10 YEARS - < 15 YEARS

15 YEARS OR OLDER

(JIKA PERNAH MENIKAH)

PARTISIPASI TENAGA KERJA

INFORMASI TENAGA KERJA

SECTION 5

DAFTARKAN NAMA-NAMA ORANG DARI ROSTER SESUAI KELOMPOK UMUR PENDIDIKAN

UMUM

MODAL SOSIAL

PENGGUNAAN WAKTU

PERORANGAN

SECTION 8

PENDIDIKAN KESEHATAN TENAGA KERJA

IMUNISASI

SECTION 6

KEHADIRAN DI SEKOLAH

UNTUK TAHUN 1998/99-

PERAWATAN KESEHATAN

SECTION 1: HOUSEHOLD INFORMATION PART A: HOUSEHOLD ROSTER

(2) (3) (4) (5) (6) (7)

HEAD 1WIFE/HUSBAND 2CHILD/ADOPTED/STEP CHILD 3 FARMER 1GRANDCHILD 4 SHARE CROPPER 2NIECE/NEPHEW 5 FARM LABORER 3FATHER/MOTHER 6 NON-FARM LABORER 4SISTER/BROTHER 7 FISHERMAN 5SON/DAUGHTER-IN-LAW 8 TRADER 6BROTHER/SISTER-IN-LAW 9 SKILLED WORKER 7GRANDFATHER/MOTHER 10 CIVIL SERVANT 8FATHER/MOTHER-IN-LAW 11 TEACHER 9OTHER RELATIVE 12 PENSIONER 10SERVANT 13 HOUSEWIFE 11SERVANT'S RELATIVE 14 SCHOOL STUDENT 12

MALE 1 TENANT OR TENANT'S RELATIVE 15 YES 1 UNIVERSITY STUDENT 13FEMALE 2 OTHER (SPECIFY___) 16 NO 2 >>6 OTHER (___) 14

DAY MONTH YEAR YEARS MONTHS

01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

IF < 12 YEARS, WRITE DOWN YEARS AND

MONTHS

IF >= 12 YEARS, WRITE DOWN ONLY

YEARSPROBE FOR BIRTH CERTIFICATE OR ID

CALCULATE PERSON'S AGE, ASK THE RESPONDENT TO CONFIRM IT IN QUESTION 6

SEX Relationship to household head: Can you tell me the date of birth of [NAME]?

WRITE DOWN THE DATE OF BIRTH

How old is [NAME]? What is [NAME]'s main occupation?

IF < 12 YEARS THEN >>11

RESPONDENT: HOUSEHOLD HEAD OR MOST INFORMED MEMBER1

01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(8) (9) (10) (11) (12) (13) (14)

YES 1 THIS DWELLING 0001NO 2 OTHER DWELLING

THIS POSTO 0001 IN THIS POSTO 0003MARRIED 1 OTHER POSTO above OTHER POSTO aboveDIVORCED 2 >>11 WEST TIMOR 9901 WEST TIMOR 9901SEPARATED 3 OTHER IN INDONESIA 9902 RURAL 1 OTHER IN INDONESIA 9902WIDOW OR WIDOWER 4 >>11 YES 1 OTHER (___) 9999 URBAN 2 NOT BORN 8888NEVER MARRIED 5 >>11 NO 2 >>11 1ST 2ND MIXED 3 OTHER (___) 9999

ID CODE ID CODE LANGUAGE CODE ALDEIA NAME CODE ALDEIA NAME CODE

USE SECOND COLUMN IF TWO

WIVES/HUSBANDS.

SEE LANGUAGE CODES ABOVE

SEE POSTO CODES ABOVE SEE POSTO CODES ABOVE

ENG

LISH

Does the husband/wife of [NAME] live in this household now?

COPY THE ID CODE OF THE

WIFE/HUSBAND.

What is [NAME]'s mother tongue?

Does [NAME] speak Tetun, Indonesian, Portuguese,

English?

What is the present marital status of [NAME]?

(15)Where was [NAME] born? This place is... Where did [NAME] live immediately

before the violence in 1999?

TETU

N

IND

ON

ESIA

N

POR

TUG

UES

E


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(20) (21) (22) (23)

THIS POSTO 0001OTHER POSTO above SECURITY 1

YES 1 WEST TIMOR 9901 FOUND OTHER HOUSING 2NO 2 >>19 YES 1 OTHER IN INDONESIA 9902 WORK 3BORN WHILE MOTHER NO 2 OTHER (___) 9999 STUDY 4 YES 1DISPLACED 3 >>18 TOTAL OTHER (___) 5 NO 2

MONTH YEAR MONTH YEAR MONTHS ALDEIA NAME CODE

SEE POSTO CODES ABOVE

HOUSEHOLD MEMBER?

Where has [NAME] been living during most of the time in the past 12 months while he/she has been away from this household?

Why has [NAME] been away from this household?

When did [NAME] leave E. Timor in 1999?

When did [NAME] return to E. Timor?

Has [NAME] been away from this household for more than one month in the last 12 months?

For how many months during the past 12 months has he/she been away from this household?

(19)(16) (17) (18)Was [NAME] displaced outside E. Timor in 1999?

>>23

>>23

SEE INSTRUCTIONS

ABOVE.


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

SECTION 1: HOUSEHOLD INFORMATION PART B: NEW MEMBERS SINCE THE VIOLENCE IN 1999

(1) YES 1NO 2 >> PART C

(2) (3) (4) (5) (6) (7)

SECURITY 1HOUSE INHABITABLE 2WORK 3STUDY 4MARRIED 5WIDOWED 6ORPHANED 7 NOT ALIVE 0004PARENTS CANNOT THIS POSTO 0001 PERMANENTLY 1 THIS POSTO 0001AFFORD TO LOOK OTHER POSTO above OTHER POSTO aboveAFTER CHILD 8 WEST TIMOR 9901 DEPENDING ON 2 WEST TIMOR 9901

YES 1 PARENTS IN W. TIMOR/ OTHER IN INDONESIA 9902 OTHER IN INDONESIA 9902NO 2 OTHER INDONESIA 9 OTHER (___) 9999 OTHER (___) 3 OTHER (___) 9999

OTHER (___) 10MONTH YEAR ALDEIA NAME CODE ALDEIA NAME CODE

>>NEXT PERSON

SEE POSTO CODES ABOVESEE POSTO CODES ABOVE

(EXCLUDE CHILDREN BORN AFTER THE VIOLENCE IN 1999)

Did [NAME] join your household after the violence in 1999?

When did [NAME] join your household?

Why did [NAME] join this household? Where did [NAME] live before joining your household?

How long do you think [NAME] is going to remain a member of your household?

Where do the parents of [NAME] live?

Did any of the present household members join this household since the violence in 1999?

>>NEXT PERSON

HIS/HER JOB/STUDIES

>>NEXT PERSON


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

SECTION 1: HOUSEHOLD INFORMATION PART D: INFORMATION ON PARENTS OF HOUSEHOLD MEMBERS

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

Level Class Level ClassTK 1 TK 1SD 1 - 6 SD 1 - 6SMP 1 - 3 SMP 1 - 3SMA 1 - 3 SMA 1 - 3

YES 1 YES 1 YES 1 ACADEMIA 1 - 3 YES 1 YES 1 YES 1 ACADEMIA 1 - 3NO 2 >>3 NO 2 NO 2 >>6 UNIVERSITAS 1 - 7 NO 2 >>8 NO 2 NO 2 UNIVERSITAS 1 - 7

ID CODE ID CODE >>NEXT PERSON

COPY THE ID CODE FOR THE

FATHER

Is the natural father of [NAME] living in this household?

Is the father of [NAME] still alive?

Did the father of [NAME] attend school?

What was the highest grade he completed?

Is the natural mother of [NAME] living in this household?

COPY THE ID CODE FOR

THE MOTHER

Is the mother of [NAME] still alive?

Did the mother of [NAME] attend school?

What was the highest grade she completed?

>>6>>NEXT PERSON


TETUM 1 Aileu 0101 Hatolia 0703BAEQUENO 2 Laulara 0102 Lete Foho 0704BUNAK 3 Liquidoe 0103 Railaco 0705FATALUCU 4 Remexio 0104 Bazartete 0801GALOLEN 5 Ainaro 0201 Liquica 0802ISNI 6 Hatu Builico 0202 Maubara 0803KAKLUN BIKELI 7 Hato Udo 0203 Iliomar 0901KEMAK 8 Maubisse 0204 Lautem Moro 0902LAKLEI 9 Baguia 0301 Lospalos 0903MACALERO 10 Baucau 0302 Luro 0904MACASAE 11 Fatu Maka 0303 Tutuala 0905MANGILIH 12 Laga 0304 Alas 1001MAMBAE 13 Quelicai 0305 Fatuberliu 1002MIDIKI 14 Vemasse 0306 Same 1003NAUETI 15 Venilale 0307 Turiscai 1004SA ANI 16 Atabae 0401 Barique 1101TETUM TERIK 17 Balibo 0402 Laclo 1102TOKODETE 18 Bobonaro 0403 Laclubar 1103UAIMUA 19 Cailaco 0404 Laleia 1104WAWELOI 20 Lolotoi/Lebos 0405 Manatuto 1105BAHASA INDON 21 Maliana 0406 Soibada 1106PORTUGUESE 22 Fato Lulik 0501 Nitibe 1201INGGRIS 23 Fatumean 0502 Oesilo 1202OTHER (___) 24 Fohorem 0503 Pante Makasar A 1203

Mape/Zumalai 0504 Pante Makasar B 1204Suai Kota 0505 Passabe 1205Tilomar 0506 Lacluta 1301Maukatar 0507 Ossu 1302Atauro 0601 Uatu Carbau 1303Cristo Rei 0602 Uatu Lari 1304Dom Aleixo 0603 Viqueque 1305Metinaro 0604Nein Feto 0605Vera Cruz 0606 West Timor 9901Atsabe 0701 Other in Indonesia 9902Ermera Kota 0702 Other (___) 9999

LANGUAGE CODES POSTO CODES

6

Aileu 1 Liquidoe 35Ainaro 2 Lolotoi/Lebos 36Alas 3 Lospalos 37 LOOK AT THE ANSWER TO QUESTION 19:Atabae 4 Luro 38Atauro 5 Maliana 39Atsabe 6 Manatuto 40Baguia 7 Mape/Zumalai 41Balibo 8 Maubara 42 LOOK AT THE ANSWER TO QUESTION 20: Barique 9 Maubisse 43Baucau 10 Maukatar 44Bazartete 11 Metinaro 45Bobonaro 12 Nein Feto 46Cailaco 13 Nitibe 47Cristo Rei 14 Oesilo 48Dom Aleixo 15 Ossu 49 DECEASED INDIVIDUALS ARE NEVER CLASSIFIED AS HOUSEHOLD MEMBERS. Ermera Kota 16 Pante Makasar A 50Fato Lulik 17 Pante Makasar B 51Fatu Maka 18 Passabe 52Fatuberliu 19 Quelicai 53Fatumean 20 Railaco 54Fohorem 21 Remexio 55Hato Udo 22 Same 56Hatolia 23 Soibada 57Hatu Builico 24 Suai Kota 58Iliomar 25 Tilomar 59Laclo 26 Turiscai 60Laclubar 27 Tutuala 61Lacluta 28 Uatu Carbau 62Laga 29 Uatu Lari 63Laleia 30 Vemasse 64Laulara 31 Venilale 65Lautem Moro 32 Vera Cruz 66Lete Foho 33 Viqueque 67Liquica 34

LODGERS ARE NOT CLASSIFIED AS HOUSEHOLD MEMBERS.

NOTE: SERVANTS WHO LIVE AND TAKE MEALS WITH THE HOUSEHOLD ARE TO BE COUNTED AS HOUSEHOLD MEMBERS, EVEN THOUGH THEY MAY HAVE NO BLOOD RELATION TO THE HOUSEHOLD HEAD

ENTER CODE 1 FOR EACH HOUSEHOLD MEMBER AND CODE 2 FOR ALL OTHER PERSONS. GO ON TO THE NEXT PERSON LISTED.

IF THE ANSWER IS 9 MONTHS OR MORE, ONLY THE FOLLOWING ARE HOUSEHOLD MEMBERS:

INFANTS LESS THAN 3 MONTHS OLD NEWLY WED COUPLES AND CLOSE RELATIVES WHO JOINED THE HOUSEHOLD PERMANENTLY A BRIDE WHO HAS JUST JOINED HER HUSBAND'S HOUSEHOLD

IF THE ANSWER TO QUESTION 19 IS "NO" - THAT IS THE PERSON HAS NOT BEEN AWAY FROM THE HOUSEHOLD FOR MORE THAN ONE MONTH IN THE LAST 12 MONTHS - THAT PERSON IS A HOUSEHOLD MEMBER

POSTO CODES QUESTION 23

CLASSIFY EACH PERSON ACCORDING TO THE FOLLOWING CRITERIA:

7

SECTION 1: HOUSEHOLD INFORMATION PART C: PERSONS LEAVING HOUSEHOLD AFTER VIOLENCE IN 1999

(1) YES 1NO 2 >>PART D

(2) (3) (4) (6) (7) (8) (9) (10)

HEAD 1WIFE/HUSBAND 2CHILD/ADOPTED CHILD/STEP CHILD 3GRANDCHILD 4NIECE/NEPHEW 5FATHER/MOTHER 6SISTER/BROTHER 7 SECURITY 1SON/DAUGHTER-IN-LAW 8 HOUSE INHABITABLE 2BROTHER/SISTER-IN-LAW 9 WORK 3GRANDFATHER/MOTHER 10 STUDY 4 THIS POSTO 0001FATHER/MOTHER-IN-LAW 11 DIED IN VIOLENCE 1 MARRIED 5 OTHER POSTO aboveOTHER RELATIVE 12 DIVORCED 6 WEST TIMOR 9901SERVANT 13 DIED, NOT IN VIOLENCE 2 CANNOT AFFORD TO OTHER IN INDONESIA 9902SERVANT'S RELATIVE 14 MALE 1 LOOK AFTER CHILD 7 OTHER (___) 9999 YES 1TENANT OR TENANT'S RELATIVE 15 FEMALE 2 MOVED 3 OTHER (___) 8 NO 2OTHER (___) 16 MONTH YEAR ALDEIA NAME CODE

A

B

C

D

E

F

G

H

I

J

NAMES

SEXWRITE DOWN THE NAMES OF THE

PERSONS WHO LIVED IN THE HOUSEHOLD

BEFORE THE VIOLENCE IN 1999 BUT ARE NO

LONGER HOUSEHOLD MEMBERS TODAY

Relationship to head:

ASK QUESTIONS 3-4 FOR ALL MEMBERS BEFORE GOING TO

QUESTIONS 5-10

(5)When did [NAME] cease to be a member of your household?

SERIAL

How old is/would be [NAME] now?

Where did [NAME] move to after leaving your household?

Why did [NAME] cease to be a member of your household?

>>NEXT PERSON

YEARS

>>NEXT PERSON

Why did [NAME] move away from this household?

Do you think [NAME] has left your household permanently?

Are there any people who were members of your household before the violence in1999 who are not household members today?

>>NEXT PERSON


RESPONDENT: HOUSEHOLD HEAD OR MOST INFORMED RESPONDENT 8

Aileu 0101 Hatolia 0703Laulara 0102 Lete Foho 0704Liquidoe 0103 Railaco 0705Remexio 0104 Bazartete 0801Ainaro 0201 Liquica 0802Hatu Builico 0202 Maubara 0803Hato Udo 0203 Iliomar 0901Maubisse 0204 Lautem Moro 0902Baguia 0301 Lospalos 0903Baucau 0302 Luro 0904Fatu Maka 0303 Tutuala 0905Laga 0304 Alas 1001Quelicai 0305 Fatuberliu 1002Vemasse 0306 Same 1003Venilale 0307 Turiscai 1004Atabae 0401 Barique 1101Balibo 0402 Laclo 1102Bobonaro 0403 Laclubar 1103Cailaco 0404 Laleia 1104Lolotoi/Lebos 0405 Manatuto 1105Maliana 0406 Soibada 1106Fato Lulik 0501 Nitibe 1201Fatumean 0502 Oesilo 1202Fohorem 0503 Pante Makasar A 1203Mape/Zumalai 0504 Pante Makasar B 1204Suai Kota 0505 Passabe 1205Tilomar 0506 Lacluta 1301Maukatar 0507 Ossu 1302Atauro 0601 Uatu Carbau 1303Cristo Rei 0602 Uatu Lari 1304Dom Aleixo 0603 Viqueque 1305Metinaro 0604Nein Feto 0605Vera Cruz 0606 West Timor 9901Atsabe 0701 Other in Indonesia 9902Ermera Kota 0702 Other (___) 9999

POSTO CODES

9

SECTION 2: HOUSING PART A: DESCRIPTION OF THE DWELLING

(1) (5)

BRICK 1 GOOD 1

CONCRETE 2 MEDIOCRE 2

UNBAKED BRICK 3 DAMAGED LITTLE 3WOOD 4 SEVERELY DAMAGED 4BAMBOO 5RATTAN 6TIN 7 (6)MUD 8OTHER (___) 9

DO NOT COUNT BATHROOMS, KITCHENS, BALCONIES, AND CORRIDORS(2)

NUMBER OF ROOMSCONCRETE 1WOOD 2 (7)METAL SHEETS/ZINC 3TILE 4SUGAR PALM FIBRE 5 WRITE ZERO IF ROOMS ARE NOT USED FOR BUSINESS OR TRADELEAVES 6

OTHER (___) 7 NUMBER OF ROOMS(3)

(8)

MARBLE/CERAMIC 1FLOOR TILE/CEMENT 2CONCRETE/BRICK 3

WOOD 4 SQUARE METERSBAMBOO 5EARTH/CLAY 6 (9)OTHER (___) 7 YEARS MONTHS

(4)WHAT TYPE OF DWELLING IS IT?

BAMBOO HOUSE 1 (10)SEMI-PERMANENT 2 ASK FOR ESTIMATE IF RESPONDENT UNSURE OF EXACT YEARTRADITIONAL HOUSE 3 SMALL HOUSE IN COMPOUND OF MAIN HOUSE 4 YEAR BUILT

PERMANENT HOUSE 5

EMERGENCY/TENT 6

OTHER (____) 7

In approximately what year was this dwelling built?

WHAT IS THE PRIMARY MATERIAL OF THE FLOOR? What is the floor area of your dwelling?

How long has your household been living in this dwelling?

IF MORE THAN THREE YEARS, DO NOT REQUIRE MONTHS

How many rooms do the members of your household occupy, including bedrooms, living rooms and rooms used for household enterprises?

WHAT IS THE MAJOR MATERIAL OF THE ROOF?

How many, if any, of these rooms are used primarily for household enterprise or trade?

Now, I would like to ask you some questions about your housing conditions. I mean by housing all the rooms and all separate buildings used by your household members to live in.BEFORE ASKING QUESTION 5, OBSERVE THE DWELLING AND NOTE RESPONSES TO QUESTION 1 TO QUESTION 5.

WHAT IS THE MAJOR CONSTRUCTION MATERIAL OF THE EXTERNAL WALLS? WHAT IS THE CONDITION OF THE DWELLING UNIT?

RESPONDENT: MOST INFORMED HOUSEHOLD MEMBER 10

SECTION 2: HOUSING PART B: HOUSING STATE

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

FAMILY/FRIENDS 1LIVING 1 COMPLETELY 1 COMMUNITY 2 LABOR 1

YES 1 LIVESTOCK 2 PARTIALLY 2 YES 1 CHURCH 3 BUILDINGNO 2 STORAGE 3 COMPLETELY 1 NOT AT ALL 3 NO 2 NGO 4 MATERIAL 2

MIXED 4 PARTIALLY 2 OTHER (___) 5 MONEY 3BUILDING RUPIAH RUPIAH

1

2

3

4

5

6

7

8

9

>>NEXT BDG

DO NOT INCLUDE THE VALUE OF WORK SUPPLIED BY THE

HOUSEHOLD

>>NEXT BDG

How much did you spend from your own resources in kind or cash in the past 12 months to rehabilitate [BUILDING]?

>>10

Now, I would like to ask you some questions about the structures that your household occupies for living and other household activities. I mean by structures all the rooms and all separate buildings used by your household members for living or for storage of agricultural products or livestock or to operate a business. Please include any structure in this housing compound that you used before the violence in 1999, even if you are not using it now.

BUILDING CODE

Was the [BUILDING] damaged in the violence of 1999?

What was the [BUILDING] used for?

Was the [BUILDING] completely damaged or partially damaged?

Have you rehabilitated the [BUILDING]?

Did you receive any assistance to rehabilitate the [BUILDING]?

Who provided assistance? What kind of assistance did you receive?

How much did you receive in assistance in kind or cash in the past 12 months to rehabilitate [BUILDING]?


SECTION 2: HOUSING PART C: SERVICES

(1) (6) How do you treat your drinking water? (11) BOIL IT 1

BOTTLED WATER 1 >>3 FILTER IT 2TAP WATER 2 >>3 ADD CHEMICALS 3 PRIVATE 1PUMP 3 BOIL AND FILTER IT 4 SHARED 2PROTECTED WELL 4 OTHER (___) 5 PUBLIC 3UNPROTECTED WELL 5 (7) OTHER (______) 4PROTECTED SPRING 6UNPROTECTED SPRING 7 (12) What is the final disposal of sewage?RIVER, STREAM, LAKE, POND 8 >>3 PRIVATE CONNECTION TO PIPELINE 1RAINWATER 9 >>3 PRIVATE WELL 2 SEPTIC TANK 1OTHER 10 >>3 PUBLIC TAPS/STANDPIPE 3 POND/FIELD 2

PUBLIC WELL 4 RIVER/LAKE/OCEAN 3(2) What is the nearest distance to the septic tank? SPRING 5 HOLE 4

< 6m 1 RIVER, STREAM, LAKE, POND 6 SHORE/OPEN FIELD 56-10 m 2 RAINWATER 7 OTHERS 611-15 m 3 OTHER (___) 8 (13)>=16 m 4

DON'T KNOW 5 (8) ELECTRICITY 1(3) PRIVATED GENERATED ELECTRICITY 2 >>15

INDOOR BATH/SHOWER 1 PETROMAX (KER PRESSURE LANTERN) 3 >>15PRIVATE 1 >>5 OUTDOOR BATH/SHOWER 2 LAMP 4 >>15SHARED 2 RIVER, POND, ETC 3 >>10 CANDLES OR BATTERY FLASHLIGHTS 5 >>15PUBLIC 3 OTHER (___) 4 >>10 OTHER (____) 6 >>15NONE 4 (14)

(9) Is this bath/shower used only by your household?(4) YES 1

NO 2 NUMBER OF HOURS PER DAYONE-WAY DISTANCE

METERS (10) What type of toilet is used by your household? (15) What fuel do you use most often for cooking?

How long does it take you to reach the water source? FLUSH TOILET 1 GAS/LPG 1ONE-WAY TIME TRADITIONAL LATRINE 2 ELECTRICITY 2

MINUTES BOWL/BUCKET 3 >>12 WOOD 3(5) OTHER (___) 4 >>12 COAL 4

NO TOILET 5 >>13 KEROSENE 5YES 1 PEAT, MANURE 6NO 2 >>7 OTHER (____) 7

What is the main source of water for drinking for your household?

What is the main source of light in your dwellling?

Where do members of your household bathe?

Is the drinking water facility private, shared or public?

Is this toilet used by your household private, shared or public?

What is the main source of water for bathing and washing for your household?

How many hours on average was electricity available in your dwelling during the past 3 months?

What is the distance to the drinking water source?

Does your household treat your drinking water in any way?


SECTION 2: HOUSING PART D: OWNERSHIP AND EXPENDITURES

(1) (5) What is the ownership status of this dwelling? (7)

LEASE/RENT 1YES 1 OFFICIAL HOUSE 2 >>7NO 2 >>5 RENT FREE 3 >>7

OTHERS 4 >>7 RUPIAH(2)

(6) (8)YES 1

RELATIVE 1 NO 2 >>10PRIVATE EMPLOYER 2STATE 3 (9)PRIVATE PERSON 4

(3) OTHER (___) 5 GASOLINE 1KEROSENE 2DIESEL 3

YES 1NO 2 (10) (12)

(4)

RUPIAHFirewood 02

RUPIAH UNIT AMOUNT

How much does your household pay in cash, goods, or services to rent this dwelling for one month? IF NO RENT IS PAID, PLEASE ASK FOR ESTIMATE OF AMOUNT YOU WOULD HAVE TO PAY

Does your household own a generator?

What fuel do you use for the generator?

(13)

How much did your household pay in the past 12 months for [SERVICE]?

What is the amount of [SERVICE] you used in the past month?

UNIT

(11)

What is the amount of [SERVICE] you used in the past 12 months?

Others (flashlight, batteries, matches, lamp, etc.)

Maintenance costs of the house

Fuel for generator (besides kerosene)

lubricant Oil for the Generator

Maintenance & repair of the generator

Other fuel

Electricity

Telephone

Water

Liquid Propane gas

CODE RUPIAH

How much did your household pay in the past month for [SERVICE]?

AMOUNT01

Estimate, please, the amount of money you could receive as rent if you let this dwelling to another person for one month?

Does a person from another household dispute the ownership of this dwelling by a member of your household?

SERVICEKerosene

Since when is this dwelling owned by a member of your household?

YEAR

From whom do you rent/lease this dwelling?

Is this dwelling owned by a member of your household?

12

03

04

05

06

07

08

11

09

10

>>8>>8


SECTION 3: ACCESS

(1) What is the name of the aldeia centre your household normally goes to? (6) Is this road accessible to vehicles even during the rainy season?

Aldeia YES 1

NO 2

(7)

(2)

TIMES

YES 1

NO 2(8) Do you have to rely on this vehicle passable road to reach a

(3)

YES 1KM NO 2

(4)

(9)ONE WAY TRIP ONLY HOURS MINUTES

1

TO BUY ITEMS 2

TO SELL AGRICULTURAL PRODUCE 3 Second most important TO GO TO SCHOOL 4

TO GET HEALTH CARE 5

(5) OTHER ( __ ) 6

HOURS MINUTES

In this section I will ask you about your travel to the aldeia centre that your household normally goes to or travels through in order to use facilities and the type of road you use. This aldeia centre may not necessarily be the centre of this aldeia.

In the past month, how many times have you travelled on this road (by walking, by motorcycle, by minibus etc)?

How long does it take you to walk to the nearest vehicle passable road from your house?

How far is it from your house to the aldeia centre your household normally goes to?

How long does it take to travel by walking from here to this aldeia centre?

Aldeia Code

INTERVIEWER: IS THE CLOSEST ALDEIA CENTER FOR THE HOUSEHOLD THE ALDEIA IN WHICH THE HOUSEHOLD LIVES

Hospital

Community health center

School

Market to buy and sell goods

Third most important

What are the three main reasons why your household normally uses this road?

TO VISIT FRIENDS OR RELATIVES Most important


SECTION 4: CONSUMPTION/EXPENDITURES PART A: WEEKLY FOOD CONSUMPTION

(1) (3) (5) (7)

ITEM NO YES CODE AMOUNT UNIT RUPIAH AMOUNT UNIT RUPIAH AMOUNT UNIT RUPIAH

Cereals

Local rice 1001 Kg. , ,000 Kg. , ,000 Kg. , ,000

Unhusked rice 1002 Kg. , ,000 Kg. , ,000 Kg. , ,000

Imported rice 1003 Kg. , ,000 Kg. , ,000 Kg. , ,000

Corn 1004 Kg. , ,000 Kg. , ,000 Kg. , ,000

Wheat flour 1005 Kg. , ,000 Kg. , ,000 Kg. , ,000

Corn Flour 1006 Kg. , ,000 Kg. , ,000 Kg. , ,000

Other cereals 1007 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Cereals) 1000 , ,000 , ,000 , ,000

Tubers

Cassava 1011 Kg. , ,000 Kg. , ,000 Kg. , ,000

Sweet potatoes 1012 Kg. , ,000 Kg. , ,000 Kg. , ,000

Sago (ambon sago) 1013 Kg. , ,000 Kg. , ,000 Kg. , ,000

Taro 1014 Kg. , ,000 Kg. , ,000 Kg. , ,000

Potatoes 1015 Kg. , ,000 Kg. , ,000 Kg. , ,000

Other tubers 1016 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Tubers) 1010 , ,000 , ,000 , ,000

Fish

Tuna 1021 Kg. , ,000 Kg. , ,000 Kg. , ,000

V. small sea fish (Sardines, teri, etc.) 1022 Kg. , ,000 Kg. , ,000 Kg. , ,000

Other fresih fish 1023 Kg. , ,000 Kg. , ,000 Kg. , ,000

Salted fish 1024 Kg. , ,000 Kg. , ,000 Kg. , ,000

Canned fish 1025 100 gms , ,000 100 gms , ,000 100 gms , ,000

Squid 1026 Kg. , ,000 Kg. , ,000 Kg. , ,000

Fresh shrimp 1027 Kg. , ,000 Kg. , ,000 Kg. , ,000

Dried shrimp 1028 100 gms , ,000 100 gms , ,000 100 gms , ,000

Other seafood 1029 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Fish) 1020 , ,000 , ,000 , ,000

Meat

Beef 1031 Kg. , ,000 Kg. , ,000 Kg. , ,000

What is the value of the [FOOD] received?

ASK QUESTION 1 FOR ALL ITEMS FIRST, PUTTING A CROSS [X] IN THE APPROPRIATE BOX. THEN ASK Q 2-7 FOR ALL ITEMS THAT WERE

CONSUMED

(4) (6)I want to ask about all food consumed by your household, regardless of which person ate it. Has your household consumed [FOOD] during the past 7 days? Please exclude from your answer any [FOOD] purchased for processing or resale.

Of the [FOOD] consumed by your household during the last 7 days, how much was purchased? IF "0" >> 4

How much did you spend for the [FOOD] purchased?

Of the [FOOD] consumed during the last 7 days, how much was grown by your household or home-produced? IF "0" >> 6

What is the value of the [FOOD] grown or home-produced?

Of the [FOOD] consumed in the last 7 days, how much did your household receive in-kind, as a gift, payment for work, or food aid? If "0" >> NEXT ROW

(2)PURCHASED HOME-PRODUCED AID OR IN-KIND



(1) (3) (5) (7)




CONSUMED








Buffalo meat 1032 Kg. , ,000 Kg. , ,000 Kg. , ,000

Goat 1033 Kg. , ,000 Kg. , ,000 Kg. , ,000

Pork 1034 Kg. , ,000 Kg. , ,000 Kg. , ,000

Chicken 1035 Kg. , ,000 Kg. , ,000 Kg. , ,000

Canned meat 1036 Kg. , ,000 Kg. , ,000 Kg. , ,000

Meat scraps and bones 1037 Kg. , ,000 Kg. , ,000 Kg. , ,000

Other meat 1038 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Meat) 1030 , ,000 , ,000 , ,000

Eggs and milk products

Chicken eggs 1041 Each , ,000 Each , ,000 Each , ,000

Other eggs 1042 Each , ,000 Each , ,000 Each , ,000

Fresh milk 1043 Litre , ,000 Litre , ,000 Litre , ,000

Canned sweet milk 1044 390 gms , ,000 390 gms , ,000 390 gms , ,000

Powdered milk 1045 Kg. , ,000 Kg. , ,000 Kg. , ,000

Baby milk 1046 400 gms , ,000 400 gms , ,000 400 gms , ,000

Other eggs/milk and dairy 1047 100 gms , ,000 100 gms , ,000 100 gms , ,000

TOTAL (Eggs and milk products) 1040 , ,000 , ,000 , ,000

Vegetables

Spinach 1051 Kg. , ,000 Kg. , ,000 Kg. , ,000

Kangkung 1052 Kg. , ,000 Kg. , ,000 Kg. , ,000

Cabbage 1053 Kg. , ,000 Kg. , ,000 Kg. , ,000

Light mustard green 1054 Kg. , ,000 Kg. , ,000 Kg. , ,000

Dark mustard green 1055 Kg. , ,000 Kg. , ,000 Kg. , ,000

String bean 1056 Kg. , ,000 Kg. , ,000 Kg. , ,000

Tomato 1057 100 gms , ,000 100 gms , ,000 100 gms , ,000

Carrot 1058 Kg. , ,000 Kg. , ,000 Kg. , ,000

Cucumber 1059 Kg. , ,000 Kg. , ,000 Kg. , ,000

Cassava leaves 1061 Kg. , ,000 Kg. , ,000 Kg. , ,000

Eggplant 1062 Kg. , ,000 Kg. , ,000 Kg. , ,000

Squash 1063 Kg. , ,000 Kg. , ,000 Kg. , ,000



(1) (3) (5) (7)




CONSUMED








Papaya, young 1064 Kg. , ,000 Kg. , ,000 Kg. , ,000

Papaya flowers 1065 Kg. , ,000 Kg. , ,000 Kg. , ,000

Lettuce 1066 Kg. , ,000 Kg. , ,000 Kg. , ,000

Pumpkin 1067 Kg. , ,000 Kg. , ,000 Kg. , ,000

Pumpkin leaves 1068 Kg. , ,000 Kg. , ,000 Kg. , ,000

Kabura 1069 Kg. , ,000 Kg. , ,000 Kg. , ,000

A Timor veg 1071 Kg. , ,000 Kg. , ,000 Kg. , ,000

Tips of banana plants 1072 Kg. , ,000 Kg. , ,000 Kg. , ,000

Green bitter melon 1073 Kg. , ,000 Kg. , ,000 Kg. , ,000

Onion (big) 1074 Kg. , ,000 Kg. , ,000 Kg. , ,000

Garlic 1075 Kg. , ,000 Kg. , ,000 Kg. , ,000

Red pepper/chili 1076 Kg. , ,000 Kg. , ,000 Kg. , ,000

Sukun 1077 Kg. , ,000 Kg. , ,000 Kg. , ,000

Other vegetables 1078 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Vegetables) 1050 , ,000 , ,000 , ,000

Legumes/nuts

Soya bean 1081 Kg. , ,000 Kg. , ,000 Kg. , ,000

Mung bean 1082 Kg. , ,000 Kg. , ,000 Kg. , ,000

Cashews 1083 100 gms , ,000 100 gms , ,000 100 gms , ,000

Peanuts 1084 Kg. , ,000 Kg. , ,000 Kg. , ,000

Kidney bean 1085 Kg. , ,000 Kg. , ,000 Kg. , ,000

Tofu & Tempe 1086 Kg. , ,000 Kg. , ,000 Kg. , ,000

Other legumes/nuts 1087 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Legumes/nuts) 1080 , ,000 , ,000 , ,000

Fruit

Orange/tangerines 1091 Kg. , ,000 Kg. , ,000 Kg. , ,000

Mango 1092 Kg. , ,000 Kg. , ,000 Kg. , ,000

Apples 1093 Kg. , ,000 Kg. , ,000 Kg. , ,000

Avocado 1094 Kg. , ,000 Kg. , ,000 Kg. , ,000

Pineapple 1095 Kg. , ,000 Kg. , ,000 Kg. , ,000



(1) (3) (5) (7)




CONSUMED








Banana 1096 Kg. , ,000 Kg. , ,000 Kg. , ,000

Papaya 1097 Kg. , ,000 Kg. , ,000 Kg. , ,000

Jambu air 1098 Kg. , ,000 Kg. , ,000 Kg. , ,000

Goiabas 1099 Kg. , ,000 Kg. , ,000 Kg. , ,000

Watermelon 1101 Kg. , ,000 Kg. , ,000 Kg. , ,000

Soursop 1102 Kg. , ,000 Kg. , ,000 Kg. , ,000

Jackfruit 1103 Kg. , ,000 Kg. , ,000 Kg. , ,000

Markisa 1104 Kg. , ,000 Kg. , ,000 Kg. , ,000

Canned fruit 1105 Kg. , ,000 Kg. , ,000 Kg. , ,000

Coconuts 1106 Kg. , ,000 Kg. , ,000 Kg. , ,000

Other fruit 1107 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Fruit) 1090 , ,000 , ,000 , ,000

Oil & fat

Coconut oil 1111 Litre , ,000 Litre , ,000 Litre , ,000

Pork oil 1112 Litre , ,000 Litre , ,000 Litre , ,000

Other cooking oil 1113 Litre , ,000 Litre , ,000 Litre , ,000

Dry coconut 1114 Kg. , ,000 Kg. , ,000 Kg. , ,000

Butter and margarine 1115 100 gms , ,000 100 gms , ,000 100 gms , ,000

Other oil and fat 1116 Litre , ,000 Litre , ,000 Litre , ,000

TOTAL (Oil & fat) 1110 , ,000 , ,000 , ,000

Beverages/drinks

Sugar 1121 100 gms , ,000 100 gms , ,000 100 gms , ,000

Palm sugar 1122 100 gms , ,000 100 gms , ,000 100 gms , ,000

Tea 1123 100 gms , ,000 100 gms , ,000 100 gms , ,000

Coffee 1124 100 gms , ,000 100 gms , ,000 100 gms , ,000

Cocoa/Chocolate powder 1125 100 gms , ,000 100 gms , ,000 100 gms , ,000

Soda drinks (Sprite, Coca Cola) 1126 Litre , ,000 Litre , ,000 Litre , ,000

Other beverages 1127 Litre , ,000 Litre , ,000 Litre , ,000

TOTAL (Beverages/drinks) 1120 , ,000 , ,000 , ,000

Ingredients



(1) (3) (5) (7)




CONSUMED








Salt 1131 100 gms , ,000 100 gms , ,000 100 gms , ,000

Honey 1132 Kg. , ,000 Kg. , ,000 Kg. , ,000

Candle nut 1133 100 gms , ,000 100 gms , ,000 100 gms , ,000

Paprika 1134 100 gms , ,000 100 gms , ,000 100 gms , ,000

Soy sauce sweet/sour 1135 140 ml , ,000 140 ml , ,000 140 ml , ,000

MSG 1136 Gram , ,000 Gram , ,000 Gram , ,000

Other ingredients (spices) 1137 Kg. , ,000 Kg. , ,000 Kg. , ,000

TOTAL (Ingredients) 1130 , ,000 , ,000 , ,000

Miscellaneous foods

Instant noodles 1141 80 gms , ,000 80 gms , ,000 80 gms , ,000

Macronie 1142 100 gms , ,000 100 gms , ,000 100 gms , ,000

White bread 1143 Small piece , ,000 Small piece , ,000 Small piece , ,000

Sweet bread 1144 Each , ,000 Each , ,000 Each , ,000

Biscuits 1145 100 gms , ,000 100 gms , ,000 100 gms , ,000

Sweets/cakes 1146 Each , ,000 Each , ,000 Each , ,000

Snacks 1147 portion , ,000 portion , ,000 portion , ,000

Other food 1148 , ,000 , ,000 , ,000

Prepared food and drink 1149 , ,000 , ,000 , ,000

TOTAL (Miscellaneous foods) 1140 , ,000 , ,000 , ,000

Alcoholic drinks

Beer 1151 620 ml , ,000 620 ml , ,000 620 ml , ,000

Wine 1152 620 ml , ,000 620 ml , ,000 620 ml , ,000

Tua mutin 1153 Litre , ,000 Litre , ,000 Litre , ,000

Tua sabu 1154 Litre , ,000 Litre , ,000 Litre , ,000

Other alcoholic beverages 1155 Litre , ,000 Litre , ,000 Litre , ,000

TOTAL (Alcoholic drinks) 1150 , ,000 , ,000 , ,000

Tobacco & betel

Clove cigarette, filter 1161 Each , ,000 Each , ,000 Each , ,000

Clove cigarette, non filter 1162 Each , ,000 Each , ,000 Each , ,000

Tobacco cigarette, filter 1163 Each , ,000 Each , ,000 Each , ,000



(1) (3) (5) (7)




CONSUMED








Tobacco cigarette, non filter 1164 Each , ,000 Each , ,000 Each , ,000

Tobacco 1165 100 gms , ,000 100 gms , ,000 100 gms , ,000

Betel fruit 1166 Stick , ,000 Stick , ,000 Stick , ,000

Betel nuts 1167 100 gms , ,000 100 gms , ,000 100 gms , ,000

Betel leaves 1168 Grams , ,000 Grams , ,000 Grams , ,000

Areca nut 1169 Stick , ,000 Stick , ,000 Stick , ,000

TOTAL (Tobacco & betel) 1160 , ,000 , ,000 , ,000


BAHASA INDONESIA TETUMPadi-Padian Hare

Beras lokal Fos rae 1001

Gabah Hare 1002

Beras impor Fos import 1003

Jagung Batar 1004

Tepung terigu/gandum Terigu 1005

Tepung jagung (maizena) Batar ut (maizena) 1006

Jenis padi-padian Hare seluk tan 1007

TOTAL (padi-padian) TOTAL (Hare) 1000

Umbi-umbian Aihan

Singkong/ketela pohon Aifarina 1011

Ketela rambat/ubi jalar Fehuk midar 1012

Sagu(bukan dari ketela pohon) Akar 1013

Talas/keladi Talas 1014

Kentang Fehuk ropa 1015

Umbi-umbian jenis lainnya Aihan seluk 1016

TOTAL (Umbi-umbian) TOTAL (Aihan) 1010

Ikan Ikan

Tuna (Ikan Tongkol/Cakalang) Ikan Tongkol/Cakalang 1021

Ikan laut ukuran kecil (sardin, teri, dll) Ikan Kiic tasi nian (Sardina, ikan lotuk) 1022

Jenis ikan segar lainnya Ikan fresco seluk 1023

Ikan Asin/Ikan diawetkan Ikan maran 1024

Ikan kaleng (sarden, dll) Ikan lata 1025

Cumi-cumi/sotong/gurita Kurita/Suntu 1026

Udang segar Boek 1027

Udang kering (ebi) Boek maran 1028

Jenis makanan laut lainnya Haán tasi seluk tan 1029

TOTAL (Ikan) TOTAL (Ikan) 1020

Daging Naán

Daging sapi Na'an carau vaca 1031

Daging kerbau Na'an carau timur 1032

Daging Kambing Naan bibi 1033

Daging Babi Naan fahi 1034

Daging Ayam Naan manu 1035

21

BAHASA INDONESIA TETUMDaging kaleng Naan lata 1036

Daging tetelan, tulang Na'an rahun, ruin 1037

Jenis daging lainnya Naan seluk tan 1038

TOTAL (Daging) TOTAL (Naán) 1030

Telur dan Produk Susu Mantulun ho produk susuben

Telur Ayam Manu tolun 1041

Jenis telur yang lainnya Manu tolun seluk 1042

Susu segar Susu ben karau 1043

Susu kental manis Susu ben lata 1044

Susu bubuk Susu ben rahun 1045

Susu bubuk bayi Susuben bebe nian 1046

Jenis telur, susu lainnya (termasuk keju, yoghurt) Manu tolun, susuben seluk tan (keju) 1047

TOTAL (Telur dan Produk Susu) TOTAL (Mantulun ho produk susuben) 1040

Sayur-sayuran Modo Tahan

Bayam Bayan 1051

Kangkung Kanko 1052

Kubis/Kol Repolyu/Kovi 1053

Sawi putih Mostarda mutin 1054

Sawi hijau Mostarda metan 1055

Buncis Koto nurak 1056

Tomat Tomate 1057

Wortel / Cenoura Cenora 1058

Ketimun/mentimum Pipinu 1059

Daun ketela pohon Aifarina tahan 1061

Terong Brinjela 1062

Labu Lakeru 1063

Pepaya muda Aidila okir 1064

Daun Pepaya Aidila tahan 1065

Daun Selada / Alfase Salada/Alfase 1066

Labu Siam Lakeru mutin 1067

Daun Labu Lakeru dikin 1068

Kabura Kaibura 1069

Salada air / Angriaun Anggriaung 1071

Pucuk pohon pisang (jantung pisang) Hudi dubun 1072

22

BAHASA INDONESIA TETUMPare Baria 1073

Bawang merah lis mean 1074

Bawang putih lis mutin/asu 1075

Cabe merah / Pimentao Aimanas boot 1076

Sukun Kulu Baucau 1077

Sayuran jenis lainnya Modo seluktan 1078

TOTAL (Sayur-sayuran) TOTAL (Modo Tahan) 1050

Polong-polongan/Kacang-kacangan Koto/Fore

Kacang kedelai Forkeli 1081

Kacang hijau Formunggu 1082

Kacang mede (Kaizu) Kaijus 1083

Kacang tanah Forai 1084

Kacang merah Koto 1085

Tahu & tempe Tahu & tempe 1086

Jenis kacang-kacangan lainnya Foretalin (fore seluk tan) 1087

TOTAL (Polong-polongan/Kacang-kacangan) TOTAL (Koto/Fore) 1080

Buah-buahan Aifuan

Jeruk Sabraka/tanjerina 1091

Mangga Has 1092

Apel Masan 1093

Alpokat Avokat 1094

Nanas Ainanas 1095

Pisang Hudi 1096

Pepaya Aidila 1097

Jambu air Jambucao 1098

Goiabas Goiabas 1099

Semangka Pateka 1101

Sirsak / ayata Ayata 1102

Nangka Kulu jaka 1103

Markisa Markuizas 1104

Buah dalam kaleng Aifuan lata 1105

Kelapa Nu 1106

Jenis buah lainnya Aifuan seluktan 1107

TOTAL (Buah-buahan) TOTAL (Aifuan) 1090

23

BAHASA INDONESIA TETUMMinyak dan Lemak Mina

Minyak Kelapa Mina nu 1111

Minyak fahi Mina fahi 1112

Minyak goreng lainnya Mina tein seluk tan 1113

Kelapa kering Nu maran 1114

Mentega dan Margarin Mantega & Blue band 1115

Jenis minyak lainnya Mina seluk tan 1116

TOTAL (Minyak dan Lemak) TOTAL (Mina) 1110

Minuman Hemo

Gula pasir Masi midar 1121

Gula merah Jarga 1122

Teh Cha 1123

Kopi Café 1124

Coklat Coklat/kakau 1125

Minuman bersoda (Sprite, Coca Cola) Sprite, Coca cola 1126

Jenis minuman lainnya Hemo seluk tan 1127

TOTAL (Minuman) TOTAL (Hemo) 1120

Bumbu-bumbuan Temperus

Garam Masin 1131

Madu Banibeen 1132

Kemiri Kami 1133

Paprika/cabe kecil Aimanas kiik 1134

Kecap manis/asin Sutati midar/masin 1135

Penyedap masakan/vetsin Metsin 1136

Bumbu dapur lainnya (rempah-rempah) Temperus dapur seluk 1137

TOTAL (Bumbu-bumbuan) TOTAL (Temperus) 1130

Macam-macam makanan lainnya Han Oi 'oin

Mie Instant Supermi 1141

Macaroni/mei kering Macarao 1142

Roti tawar Pao feito 1143

Roti manis/roti lainnya Pao midar/pao seluk 1144

Biskuit 1145

Kue Dosi 1146

Makanan ringan Merenda 1147

24

BAHASA INDONESIA TETUMMakanan lainnya Haán seluk 1148

Makanan dan minuman yang didapat dari luar rumah (restoran, tetangga dll) Haán hemo hetan husi liur (restaurante, urinho, etc.) 1149

TOTAL (Macam-macam makanan lainnya) TOTAL (Han Oi 'oin) 1140

Minuman beralkohol Tua ho alkohol

Bir Cerveja 1151

Anggur Anggur 1152

Tua mutin Tua mutin 1153

Tua sabu Tua sabu 1154

Minuman beralkohol lainnya Tua alkhol seluk tan 1155

TOTAL (Minuman beralkohol) TOTAL (Tua ho alkohol) 1150

Tembakau dan Sirih Tabaco & buah, malus

Rokok kretek filter Cigaro kretek o filter 1161

Rokok kretek tanpa filter Cigaro kretek laos o filter 1162

Rokok putih filter Cigaro mutin o filter 1163

Rokok putih tanpa filter Cigaro mutin laos o filter 1164

Tembakau Tabaco 1165

Buah sirih Malus fuan 1166

Kapur sirih Ahu 1167

Daun sirih Malus tan 1168

Buah pinang Buah 1169

TOTAL (Tembakau dan sirih) TOTAL (Tabaco & buah, malus) 1160

25

SECTION 4: CONSUMPTION/EXPENDITURE PART B: MONTHLY AND ANNUAL NON-FOOD EXPENDITURE

LAST 12 MONTHS(1) (2) (3) (4)

YES 1

ITEM NO YES CODE NO 2 >>4 RUPIAH RUPIAH

GOODS AND SERVICES

Personal care items (soap, shampoo, toothpaste, etc.) 3001 , ,000 , ,000

Cosmetics 3002 , ,000 , ,000

Personal services (haircuts, shaving, manicures, etc.) 3003 , ,000 , ,000

House cleaning supplies and toilet supplies 3004 , ,000 , ,000

Public hospital/community health center/clinic 3005 , ,000 , ,000

Church or private hospital/community health center/clinic 3006 , ,000 , ,000

Mobile clinic 3007 , ,000 , ,000

Midwife/private nurses 3008 , ,000 , ,000

Traditional healers and traditional birthing assistants 3009 , ,000 , ,000

Medicines purchased to treat self 3011 , ,000 , ,000

Other health expenditures (contraception, vitamins, etc.) 3012 , ,000 , ,000

School fees: enrollment, SPP, BP3/POMG 3013 , ,000 , ,000

Textbooks/photo copy of textbooks, stationaries (calculator, compass, etc.) 3014 , ,000 , ,000

Special sources and other school fees 3015 , ,000 , ,000

Newspapers, magazines, books and stationery (exclude school needs) 3016 , ,000 , ,000

Postage, telegram, public telephone, and post materials 3017 , ,000 , ,000

Maintenance and repair of motor vehicle 3018 , ,000 , ,000

Costs of transportation (bus, airline, taxi, parking fee, etc) 3019 , ,000 , ,000

Entertainment (hotel, motel, cinema, sport, and other recreation fees) 3021 , ,000 , ,000

Payments to a servant who lives in HH 3022 , ,000 , ,000

Payments to a servant/driver who does not live in HH 3023 , ,000 , ,000

Other services (ID card, drivers license, birth certificate, photocopy) 3024 , ,000 , ,000

GOODS AND SERVICES TOTAL 3000 , ,000 , ,000

Has your household bought, spent money on or received gifts of any [ITEM] during the past 12 months?

EXCLUDE ANY [ITEM] PURCHASED FOR PROCESSING OR RESALE AS BUSINESS

ASK QUESTION 1 FOR ALL ITEMS FIRST, PUTTING A CROSS [X] IN THE APPROPRIATE BOX. THEN ASK Q 2-4 FOR ALL ITEMS THAT WERE CONSUMED

Did you buy or receive any [ITEM] for free (as a gift, or as payment for work) during the past 30 days?

How much did your household spend on [ITEM] in the past 30 days? ADD THE VALUE OF ANY [ITEM] RECEIVED FOR FREE

How much did your household spend on [ITEM] in the past 12 months? ADD THE VALUE OF ANY [ITEM] RECEIVED FOR FREE

LAST 30 DAYS



LAST 12 MONTHS(1) (2) (3) (4)

YES 1








LAST 30 DAYS

CLOTHING, FOOTWEAR AND HEADGEAR

Ready made men's wear 3031 , ,000 , ,000

Ready made women's wear 3032 , ,000 , ,000

Ready made children's clothing 3033 , ,000 , ,000

Materials/fabrics for men, women and children 3034 , ,000 , ,000

Tailoring and repair costs, thread and sewing needs 3035 , ,000 , ,000

Footwear for men 3036 , ,000 , ,000

Footwear for women 3037 , ,000 , ,000

Footwear for children 3038 , ,000 , ,000

Headgear 3039 , ,000 , ,000

Clothing cleaning supplies (soap, washing powder, bleach, etc.) 3041 , ,000 , ,000

Other clothing and supplies (shoepolish, belts, etc) 3042 , ,000 , ,000

CLOTHING, FOOTWEAR AND HEADGEAR TOTAL 3030 , ,000 , ,000

DURABLE GOODS

Furniture (bed, table, chair, wardrobe, etc) 3051 , ,000 , ,000

Household equipment (sewing machine, refrigerator etc) 3052 , ,000 , ,000

Household linens (sheets, blankets, towels) and items (mattress, curtains, carpet) 3053 , ,000 , ,000

Household tools (iron, broom, scissors, knife, machete, saw, etc.) 3054 , ,000 , ,000

Kitchen tools and eating utensils(pots, cooking pots, wok, spoon, plates, etc.) 3055 , ,000 , ,000

Small electrical items ( watch, clock, camera, video camera etc.) 3056 , ,000 , ,000

Jewellery and its repair 3057 , ,000 , ,000

Children's toys and repair 3058 , ,000 , ,000

TV, Video, cassette, computer, etc and its repair 3059 , ,000 , ,000

Sports and hobby equipment and repair 3061 , ,000 , ,000

Vehicle repair and maintenance (do not include gasoline) 3062 , ,000 , ,000

Pets and plants including maintenace 3063 , ,000 , ,000

Other durable goods (cradle, baby carriage, electricity installation etc) 3064 , ,000 , ,000

DURABLE GOODS TOTAL 3050 , ,000 , ,000



LAST 12 MONTHS(1) (2) (3) (4)

YES 1








LAST 30 DAYS

TAXES AND INSURANCE

Income tax 3071 , ,000 , ,000

Building and land tax 3072 , ,000 , ,000

Other taxes (vehicle, motor, community, garbage, radio and TV etc) 3073 , ,000 , ,000

TAXES AND INSURANCE TOTAL 3070 , ,000 , ,000

FESTIVITIES AND CEREMONIES

Marriages, births, and other ceremonies 3081 , ,000 , ,000

Dowry or bride price 3082 , ,000 , ,000

Religious festivals 3083 , ,000 , ,000

Funeral expenses 3084 , ,000 , ,000

FESTIVITIES AND CEREMONIES TOTAL 3080 , ,000 , ,000

OTHER EXPENSES

Donations to the Church/ religious donations 3091 , ,000 , ,000

Other charity/donations/gifts 3092 , ,000 , ,000

Gambling losses 3093 , ,000 , ,000

Cash losses 3094 , ,000 , ,000

Deposits to savings accounts 3095 , ,000 , ,000

Legal or notary services 3096 , ,000 , ,000

OTHER EXPENSES TOTAL 3090 , ,000 , ,000


SECTION 4: CONSUMPTION/EXPENDITURE PART C: DURABLE GOODS

(1) (2) (3) (4)

US Dollar 1

Rupiah 2 >>5

(5) (6)

ITEM CODE NUMBER RUPIAH

Stoves 4001 , ,000 US Dollar 1

Refrigerators 4002 , ,000 Rupiah 2 >>7

Washing Machines 4003 , ,000

Sewing/knitting machines 4004 , ,000 (7) (8)

Clothes cupboard(lemari pakaian) 4005 , ,000

Buffet 4006 , ,000

Fans 4007 , ,000 US Dollar 1

Televisions 4008 , ,000 Rupiah 2 >>BAB 5

Video players 4009 , ,000

Tape players/CD players 4011 , ,000

Cameras, video cameras 4012 , ,000

Personal computer 4013 , ,000

Radios 4014 , ,000

Bicycles 4015 , ,000

Motorcycles/scooters 4016 , ,000

Car or truck 4017 , ,000

Motor Boat 4018 , ,000

Boat without a motor 4019 , ,000

Generator 4021 , ,000

Water Dispenser 4022 , ,000

Electric Rice Cooker 4023 , ,000

Mosquito nets 4024

TOTAL 4000 , ,000

What exchange rate did you use to convert the US Dollar transactions to Rupiah for the expendiures in the past 7 days?

1 US Dollar = RUPIAH

What exchange rate did you use to convert the US Dollar transactions to Rupiah for the expendiures for the past 30 days?

How many [ITEM] does your household own? If you were to sell these [ITEMS] today, how much would you receive?

For your transactions in the past 7 days, what was the main currency you used?

For your transactions in the past 30 days, what was the main currency you used?


For your transactions in the past 12 months, what was the main currency you used?


What exchange rate did you use to convert the US Dollar transactions to Rupiah for the expendiures for the past 12 months?


SECTION 5: EDUCATION PART A: GENERAL EDUCATION

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

Level ClassPUBLIC 1 TK 1

YES, WITHOUT YES, WITHOUT PRIVATE SD 1 - 6DIFFICULTY 1 DIFFICULTY 1 SECULAR 2 SMP 1 - 3YES, BUT WITH YES, BUT WITH PRIVATE SMA 1 - 3 YES 1

YES 1 >>3 DIFFICULTY 2 DIFFICULTY 2 YES 1 >>7 RELIGIOUS 3 ACADEMIA 1 - 3NO 2 NO 3 NO 3 NO 2 OTHER (___) 4 UNIVERSITAS 1 - 7 NO 2

ID CODE REASON REASON

01

02

03

04

05

06

07

08

09

10

11

12

Why have you/[NAME] stopped attending school?

INCLUDE TECHNICAL, PROFESSIONAL, OR

UNIVERSITY EDUCATION

SEE REASON CODES ABOVE


Have you/[NAME] attended school anytime between Sept. 1998 and now?

ID CODE

IS THIS PERSON ANSWERING FOR HIMSELF/ HERSELF?

COPY THE ID CODE OF RESPONDENT FROM ROSTER

Can you /[NAME] write a letter?

Can you /[NAME] read a letter?

Have you/[NAME] ever attended school?

Why have you/[NAME] never attended school?

What type of school have you/[NAME] attended last?

What is the highest grade you/[NAME] have completed in school?

>>PART B

>>NEXT PERSON

>>NEXT PERSON

RESPONDENT: ALL HOUSEHOLD MEMBERS 5 YEARS AND OLDER 30

SECTION 5: EDUCATION PART B: ATTENDANCE SCHOOL YEARS 1998/99-2001/2002

(1) (2) (3) (4) (5) (6) (7) (8)

Level Class Level ClassTK 1 TK 1SD 1 - 6 SD 1 - 6SMP 1 - 3 SMP 1 - 3SMA 1 - 3 SMA 1 - 3

YES 1 ACADEMIA 1 - 3 YES 1 ACADEMIA 1 - 3 YES 1 >>10NO 2 >>3 UNIVERSITAS 1 - 7 NO 2 >>7 UNIVERSITAS 1 - 7 NO 2

REASON MONTHS REASON

01

02

03

04

05

06

07

08

09

10

11

12




Did you/[NAME] attend school in academic year 1998/1999?

What grade did you/ [NAME] attend in academic year 1998/1999?

Why did you/[NAME] not attend school in academic year

1998/1999?


How many months did you/ [NAME] attend

school in academic year

1999/2000?

What grade did you/[NAME] attend in academic year 1999/2000?

Why did you/[NAME] not attend school in academic year 1999/2000?







ID CODE

>>4

>>8

RESPONDENT: ALL HOUSEHOLD MEMBERS ATTENDING SCHOOL ANYTIME SINCE SEPTEMBER 1998 31

01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(9) (10) (11) (12) (13) (14) (15)

Level ClassPUBLIC 1 TK 1PRIVATE SD 1 - 6SECULAR 2 SMP 1 - 3PRIVATE SMA 1 - 3RELIGIOUS 3 ACADEMIA 1 - 3 YES 1OTHER (___) 4 UNIVERSITAS 1 - 7 NO 2

REASON NAME ALDEIA SUCO DAYS REASON



Why did you/[NAME] not attend school in academic year 2000/2001?

What is the name of the school you attended in academic year 2000/2001? What type of school did you/[NAME] attend in the academic year 2000/2001?

What grade did you/[NAME] attend in academic year 2000/2001?

Did you/[NAME] complete/ graduate from the grade in academic year 2000/2001?

How many days were you/ [NAME] absent from school in the last three months of the 2000/2001 academic year??

Why were you/[NAME] absent from school on

those days?

IF 0 DAYS >>16

>>29


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(16) (17) (18)

A B C D E F G H I

YES 1NO 2 >>19

RUPIAH RUPIAH RUPIAH RUPIAH RUPIAH RUPIAH RUPIAH RUPIAH RUPIAH RUPIAH

Did any people who are not members of your/[NAME]'s household, such as relatives orfriends, pay any of your/[NAME]'s educational expenses in academic year 2000/2001?

How much money did this person (these people) pay for your/[NAME]'s educational expensesin academic year 2000/2001?

Tuition and other required fees?

Parents association fees?

Uniforms and other clothing?

TotalTextbooks?

How much has your/[NAME]'s household spent on your/[NAME]'s education in academic year 2000/2001?

INCLUDE MONETARY VALUE OF IN-KIND PAYMENTS

AFTER ASKING THE INDIVIDUAL AMOUNTS, CALCULATE TOTAL AND ASK "So, altogether you have spent _____ rupiahs on your/[NAME'S] education in the last year. Is that right?" PROBE AND RECONCILE.

Other expenses (optional fees, etc.)?

Meals, transportation and/or lodging?

Fees for tutoring or extra classes

Other educational materials (pens, exercise books, etc.)?


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(19) (20) (21) (22) (24) (25) (26)

CAN TAKE HOME 1PROVIDED BY THE SCHOOL,CANNOT TAKE HOME 2NEWLY PURCHASED FROMTHE SCHOOL 3 ALL THE TIME 1NEWLY PURCHASED FROM ALMOST ALL THE TIME 2

WALK 1 PRIVATE MARKET 4 THREE-QUARTERS 3BICYCLE 2 YES, COMPLETE 1 GIFT 5 ABOUT HALF THE TIME 4CAR 3 NO, ONLY SOME 2 PASSED DOWN FROM OLDER QUARTER TO HALF 5BUS 4 NO, NONE 3 SHARED 1 BROTHER/SISTER/FAMILY 6 ONE FOURTH 6ANIMAL 5 EXCLUSIVE PURCHASED USED 7 YES 1 YES 1 LESS THAN ONE-FOURTH 7OTHER (___) 6 USE 2 OTHER (___) 8 NO 2 NO 2 BARELY THERE 8

HOURS MINUTES FIRST SECOND THIRD

How do you/[NAME] go to school?

How long does it take you/[NAME] to travel to your school?

LIST MAIN MODE OF TRANSPORT

>>24

Do you/ [NAME] have a chair/desk to sit in at school in the academic year 2000/2001?

In the academic year 2000/2001, were your/[NAME'S] teachers in school to teach …

Do you/ [NAME] have breakfast before going to school?ONE WAY TRAVEL

TIME

(23)Do you/[NAME] have a complete set of textbooks for your/[NAME]'s use in academic year 2000/2001?

Do you/[NAME] share these textbooks with other students or are they for your/[NAME]'s exclusive use?

How did you/[NAME] obtain the textbooks for 2000/2001?

ALLOW UP TO 3 RESPONSES

PROVIDED BY THE SCHOOL,


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

PART B: ATTENDANCE SCHOOL YEARS 1998/99-2001/2002

(27) (28) (29) (30) (31) (32)

Level ClassPUBLIC 1 TK 1

TETUN 1 PRIVATE SD 1 - 6BAHASSA 2 SECULAR 2 SMP 1 - 3PORTUGUESE 3 PLAN TO 1 >>31 PRIVATE SMA 1 - 3OTHER (___) ABOVE ATTENDING 2 >>31 RELIGIOUS 3 ACADEMIA 1 - 3

NO 3 OTHER (___) 4 UNIVERSITAS 1 - 7HOURS REASON


Do you/does [NAME] attend/ plan to attend school in the academic year 2001/ 2002?

Why are you/[NAME] not

attending/not planning to attend school in academic year 2001/2002?

What type of school do you/ does [NAME] attend/plan to attend in the academic year 2001/2002?

What grade do you/does [NAME] attend/plan to attend in academic year 2001/2002?

What was the main language of instruction in your/[NAME'S] school?

How many hours of homework did you/ [NAME] do in a typical week in the academic year 2000/2001?

IF "OTHER", USE LANGUAGE CODES

ABOVE>> NEXT PERSON


BELOW SCHOOL AGE 1COMPLETED STUDIES 2TOO OLD 3TOO EXPENSIVE 4NO INTEREST 5AGRICULTURAL WORK 6WORK AT HOUSE/HOME 7OTHER WORK 8SCHOOL TOO FAR 9NO TEACHER 10NO SUPPLIES 11SCHOOL NOT FUNCTIONAL 12ILLNESS 13FAMILY ILLNESS/DEATH 14DISPLACED 15SAFETY 16HARASSMENT 17LANGUAGE 18GOT MARRIED 19OTHER (_______) 20

REASONS FOR NOT ATTENDING SCHOOL

36

TETUM 1

BAEQUENO 2 BELOW SCHOOL AGE 1

BUNAK 3 COMPLETED STUDIES 2

FATALUCU 4 TOO OLD 3

GALOLEN 5 TOO EXPENSIVE 4

ISNI 6 NO INTEREST 5

KAKLUN BIKELI 7 AGRICULTURAL WORK 6

KEMAK 8 WORK AT HOUSE/HOME 7

LAKLEI 9 OTHER WORK 8

MACALERO 10 SCHOOL TOO FAR 9

MACASAE 11 NO TEACHER 10

MANGILIH 12 NO SUPPLIES 11

MAMBAE 13 SCHOOL NOT FUNCTIONAL 12

MIDIKI 14 ILLNESS 13

NAUETI 15 FAMILY ILLNESS/DEATH 14

SA ANI 16 DISPLACED 15

TETUM TERIK 17 SAFETY 16

TOKODETE 18 HARASSMENT 17

UAIMUA 19 LANGUAGE 18

WAWELOI 20 GOT MARRIED 19

BAHASA INDONESIA 21 OTHER (_______) 20

PORTUGUESE 22

INGGRIS 23

OTHER (___) 24

LANGUAGE CODES REASONS FOR NOT ATTENDING SCHOOL

37

SECTION 6: HEALTH PART A: HEALTH CARE USE

(2)

STOMACH DISORDER 1COUGH 2COLD 3BACK PAIN 4ASTHMA 5STOMACH ACHE 6HEADACHES 7TOOTHACHES 8EAR PAIN 9DIARRHOEA 10

VERY GOOD 1 MUCH BETTER NOW 1 SKIN PROBLEM 11GOOD 2 SOMEWHAT BETTER NOW 2 ACCIDENTS 12AVERAGE 3 ABOUT THE SAME 3 13BAD 4 SOMEWHAT WORSE 4 JOINT/MUSCLE PAIN 14

YES 1 >>3 VERY BAD 5 MUCH WORSE 5 YES 1 YES 1 15 YES 1 YES 1NO 2 NO 2 NO 2 >>14 16 NO 2 >>11 NO 2

ID CODE 1ST

01

02

03

04

05

06

07

08

09

10

11

12

OTHER (___)

(10)What health complaints did you/[NAME] have?

Are your/[NAMEs] primary daily activities disrupted now due to poor health?

During the past 30 days, how many days of your/ [NAMEs] primary daily activities were missed due to poor health?

MALARIA

FEVER/DENGUE FEVER

ID CODE

(1) (3) (4) (5) (6) (7) (8) (9)Is [NAME] answering for himself/ herself?

WRITE ID CODE OF

THE RESPONDENT FROM

THE ROSTER

How would you/[NAME] evaluate your/[NAMEs] health?

Compared with your/[NAME's] health one year ago, would you/[NAME] say that your/[NAMEs] health is:

Did you/ [NAME] sleep under a mosquito net last night?

Did you/ NAME have any health complaints in the past 30 days? For example, a cold/ cough, diarrhoea, back pain, fever, stomach ache, headache etc.

Did your/ [NAMEs] health complaints disrupt work, school or daily activities?

DAYS2ND

RESPONDENT: ALL HOUSEHOLD MEMBERS /PARENTS OR GUARDIANS FOR CHILDREN UNDER 10 YEARS 38

01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(14) (15)

123 IMMUNIZATION 14 MEDICAL CHECK-UP 2

NOT SERIOUS ENOUGH 1 CONSULTATION 3HEALTH FACILTY TOO FAR 2 5 MEDICATIONS 4NO TRANSPORT 3 6 PUBLIC HOSPITAL 1 INJECTIONS 5HEALTH CARE TOO EXPENSIVE 4 7 COMMUNITY HEATH CENTER 2 TREATMENT FOR INJURY 6TRANSPORT TOO EXPENSIVE 5 PUBLIC HEALTH POST 3 TREATMENT FOR ILLNESS 7HEALTH WORKERS UNFRIENDLY 6 8 MOBILE CLINIC 4 PRENATAL CARE 8HEALTH WORKERS NOT PRESENT 7 PRIVATE HOSPITAL/ DELIVERY OF BABY 9

YES 1 >>13 HEALTH CARE NOT GOOD QUALITY 8 9 HEALTH CLINIC 5 POST NATAL CARE 10NO 2 OTHER (___) 9 10 CHURCH CLINIC 6 OTHER (_________) 11

FIRST NUMBER

(13) (16)(11) (12)Why did you/[NAME] not get any treatment at a health facility or health provider for your health problems?

In the past 30 days did you/[NAME] seek treatment at a health facility or health provider for your health problems?

PRACTIONER/TBA

What kind of health care facility or health care provider did you/[NAME] visit in the past 30 days?

OTHER (___)

What kind of health care facility did you/[NAME] visit most recently in the past 30 days?

What was the purpose of your/[NAMEs] visit?

PUBLIC HOSPITALCOMMUNITY HEALTH CENTER

How many times did you/[NAME] visit a health care facility in the past 30 days to obtain outpatient care? Do not include visits to private nurses, doctors, trained midwives.

PUBLIC HEALTH POSTMOBILE CLINIC

CHURCH CLINIC

PRIVATE HOSPITAL/HEALTH CLINIC

PRIVATE DOCTOR

TRADITIONAL HEALTH

PRIVATE NURSE/PARAMEDIC/MIDWIFE

IF NONE, WRITE 0 AND >>21

SECOND

>>14


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(18) (25)

IMMUNIZATION 1MEDICAL CHECK-UP 2CONSULTATION 3MEDICATIONS 4INJECTIONS 5

WALK 1 TREATMENT FOR INJURY 6BICYCLE 2 TREATMENT FOR ILLNESS 7CAR 3 PRIVATE DOCTOR 1 PRENATAL CARE 8BUS 4 PRIVATE NURSE 2 DELIVERY OF BABY 9ANIMAL 5 MIDWIFE 3 POST NATAL CARE 10OTHER (___) 6 OTHER (___) 4 OTHER (_________) 11

RUPIAH HOURS MIN RUPIAH

How much time did you/[NAME] spend traveling to this health care facility?

What kind of health care provider did you/[NAME] visit most recently in the past 30 days?

(20)(17) (19) (21) (22) (23) (24)How much did you/[NAME] pay, either in money or in kind, in transport costs for these visits to the health care facility in the past 30 days? Please include the transportation costs of anyone who accompanied you.

How much did you/[NAME] pay in total, either in money or in kind, for all costs associated with these visits to the health care facility in the past 30 days? Include any medicines prescribed during this visit even if purchased elsewhere. Please exclude transportation costs.

How did you/[NAME] go to this health care facility?

ONE WAY TIME


How much did you/[NAME] pay, either in money or in kind, in transport costs to visit the health provider in the past 30 days? Please include the transportation costs of anyone who accompanied you.

How many times did you/[NAME] visit a private doctor or nurse, paramedic or trained midwife in the past 30 days to obtain health care?


RUPIAH

How much did you/[NAME] pay, either in money or in kind, for all costs associated with these visits to the health provider in the past 30 days? Include any medicines prescribed during this visit even if purchased elsewhere. Please exclude transportation costs.

TIMES RUPIAH


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(29) (33)

IMMUNIZATION 1MEDICAL CHECK-UP 2CONSULTATION 3MEDICATIONS 4INJECTIONS 5TREATMENT FOR INJURY 6 PHARMACY 1TREATMENT FOR ILLNESS 7 ANTIBIOTICS 1 DRUG STORE 2PRENATAL CARE 8 ANTI-MALARIA 2 VILLAGE MEDICINE MAN 3DELIVERY OF BABY 9 OTHER MODERN 3 VENDOR/KIOSK OWNER 4POST NATAL CARE 10 YES 1 TRADITIONAL 4 AMBULANT VENDOR 5OTHER (_________) 11 NO 2 >>34 OTHERS (____) 5 OTHER 6

RUPIAH RUPIAH

How much did you/[NAME] pay, either in money or in kind, in transport costs to visit the traditional health practioner in the past 30 days? Please include the transportation costs of anyone who accompanied you.

What type of medicine did you/ [NAME] purchase?

Where did you/[NAME] purchase medicine?

How much in total did you/[NAME] spend in the past 30 days for medicines?

(31) (32)(26) (27) (28) (30)How much did you/[NAME] pay, either in money or in kind, for all costs associated with these visits to the traditional health practioner in the past 30 days? Include any medicines prescribed during these visits, even if purchased elsewhere. Please exclude transportation costs

How many times did you/[NAME] visit a traditional health practioner or traditional birth attendant in the past 30 days to obtain health care?



Did you/[NAME] purchase any medicines in the past 30 days on your own without a prescripton to treat your health problems or general health?

TIMES RUPIAH


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(35) (37) (38) (39)

WALK 1BICYCLE 2

PUBLIC 1 CAR 3YES 1 PRIVATE 2 BUS 4NO 2 CHURCH 3 ANIMAL 5

>>NEXT PERSON OTHER 4 OTHERS (____) 6NUMBER DAYS RUPIAH RUPIAH HOURS MIN

How much did you/[NAME] pay, either in money or in kind, for all costs associated with this stay in a hospital? Include any medicines prescribed during this stay, even if purchased elsewhere. Please exclude transportation costs.

How many times were you/[NAME] hospitalized in the past 12 months?

How much did you/[NAME] pay, either in money or in kind, in transport costs? Please include transport costs of anyone who accompanied you.

How much time did you/[NAME] spend traveling to this health care facility?

How did you/[NAME] go to this health care facility?

ONE WAY TIME

(40) (41)

CONTINUE TO ASK THE HEALTH QUESTIONS FOR ALL THE HOUSEHOLD MEMBERS. WHEN YOU HAVE FINISHED ALL THE MEMBERS, GO TO THE NEXT

PAGE AND ASK THE CHILDREN'S HEALTH QUESTIONS FOR ALL

CHILDREN UNDER 5 YEARS OF AGE.

During the past 12 months, have you/[NAME] been hospitalized -that is, stayed one or more nights in a hospital/clinic?

(34) (36)Let's talk about the most recent time you/[NAME] were hospitalized. In what type of hospital/clinic did you stay?

How many days did you/[NAME] spend in the hospital?


SECTION 6: HEALTH PART B: IMMUNIZATION

(1) (2) (3) (4)

YES, SEEN 1 YES, NOTAVAILABLE 2 >>3 YES 1NO 3 >>3 NO 2 >>6

TIMES

01

02

03

04

05

06

07

08

09

10

11

12

YEAR

MO

NTH

YEAR

YEAR

DPT2

MO

NTH

POLIO 3 DPT1

Do you have a card which shows which vaccinations [NAME] has received?

FROM THE CARD, RECORD THE

NUMBER OF TIMES VITAMIN A WAS GIVEN

Do you remember when [NAME] received which type of vaccination?

COPY THE VACCINATION DATE FOR EACH VACCINE FROM THE CARD

MEASLESMOST

RECENT VITAMIN A

DPT3POLIO 1 POLIO 2

YEAR

MO

NTH

MO

NTH

YEAR

MO

NTH

YEAR

BCG POLIO 0

MO

NTH

YEAR

MO

NTH

ID CODE

MO

NTH

YEAR

MO

NTH

YEAR

MO

NTH

YEAR

>>4

RESPONDENT: CHILDREN FIVE YEARS AND UNDER - PARENT GUARDIAN TO RESPOND 43

01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

SECTION 6: HEALTH PART B: IMMUNIZATION

(5) (6) (7) (8) (9) (10) (11) (12)

YES 1 YES 1 JUST AFTER YES 1 YES 1YES 1 NO 2 NO 2 >>10 BIRTH 1 NO 2 >>12 NO 2NO 2 DON’T KNOW 3 DON’T KNOW 3 >>10 LATER 2 DON’T KNOW 3 >>12 DON’T KNOW 3

TIMES TIMES

How many times was the polio vaccine given?

Has [NAME] been given an injection against measles?

IF YES, PROBE AND PUT YEAR/MONTH IN Q.4

Has [NAME] received a BCG vaccination against tuberculosis, that is an injection in the upper arm that left a scar?

Has [NAME] received a polio vaccine, that is pink or white drops in the mouth?

Has [NAME] been given a DPT vaccination, that is an injection usually given in the thigh or buttocks at the same time as polio drops?

Has [NAME] received any vaccinations that are not recorded on this card, including vaccinations received in a national immunization campaign?

How many times did [NAME] get this shot?

When was the first polio vaccine received, just after birth or later?

>>NEXT CHILD

>>NEXT CHILD

RESPONDENT: CHILDREN FIVE YEARS AND UNDER - PARENT GUARDIAN TO RESPOND 44

SECTION 7: FERTILITY

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

HOURS 1 1YES 1 >>3 YES 1 YES 1 YES 1 DAYS 2 2

NO 2 NO 2 >>15 NO 2 >>15 NO 2 >>10 MONTHS 3 3

ID CODE BOYS GIRLS TOTAL BOYS GIRLS TOTAL ID CODE AGE YEARS 4

01

02

03

04

05

06

07

08

09

10

11

12

1-2 HOURS

MORE THAN 2 HOUR

YEARS

WRITE ID CODE OF PERSON

ACTUALLY INTERVIEW

ED.

ENTER THE TOTAL ENTER THE TOTAL

Have you ever given birth to a child?

INCLUDE LIVE BIRTHS ONLY

IS THIS PERSON ANSWERING FOR HERSELF?

At what age were you first married?

How many boys have you given birth to? How many girls?

How many boys are still alive? And how many girls?

How soon after you gave birth did you start to breastfeed this child?

LESS THAN 1 HOUR AFTER BIRTH

ID C

OD

E

Have you given birth after August 1998?

Now I would like to ask you about your last child born. Is this child alive?

At what age did this child die?

ENTER THE ID CODE FROM THE ROSTER FOR THE LAST CHILD BORN

>> 11

RESPONDENT: EVER MARRIED WOMEN AGED 10-49 YEARS 45

01

02

03

04

05

06

07

08

09

10

11

12

ID C

OD

E

SECTION 7: FERTILITY

(12) (13) (14) (15) (16) (17) (18) (19)

ABSTINENCE 1

CALENDAR 2

WITHDRAWAL 3

1 HERBS/POTIONS 4

CURRENTLY PREGNANT 2 INJECTION 5

WANTED CHILDREN 3 CONDOM 6

SIDE EFFECTS 4 MALE STERILIZATION 7

EXPENSE 5 FEMALE STERILIZATION 8

NOT AVAILABLE 6 DIAPHRAGM 9

INEFFECTIVE 7 PILL 10

RELIGIOUS REASONS 8 IUD 11

HOURS 1 HOURS 1 HOURS 1 YES 1 NOT COMFORTABLE 9 SPERMICIDE 12 YES 1

DAYS 2 DAYS 2 DAYS 2 NO 2 YES 1 >>18 HUSBAND DISAGREES 10 NORPLANT/IMPLANT 13 NO 2

MONTHS 3 MONTHS 3 MONTHS 3 NO 2 OTHER (___) 11 OTHER MODERN 14

AGE YEARS 4 AGE YEARS 4 AGE YEARS 4 OTHER TRADITIONAL 15

Have you ever used a contraception method to avoid pregnancy or to space births?

>> NEXT WOMAN

At what age of the child did you stop breastfeeding this child?

WRITE "99" IF THE RESPONDENT IS STILL BREASTFEEDING THIS

CHILD

At what age did you first give any other food to this child (tajin, burbur, etc.)?

At what age did you first give any drink to this child (water, sugar water, honey, baby milk powder, formula, etc.)?

Some couples use contraception methods to avoid pregnancy or to space births. Are you currently using a method of contraception? (For example, the pill, condoms, withdrawal, calendar, abstinence.)

Why are you not using contraception methods?

What contraceptive method are you and your partner using at present?

HYSTERECTOMY/ MENOPAUSE

>> NEXT WOMAN

Are you currently married?

>>19>>19>> NEXT WOMAN

RESPONDENT: EVER MARRIED WOMEN AGED 10-49 YEARS 46

SECTION 8: EMPLOYMENT PART A: LABOUR FORCE PARTICIPATION

(1) (2) (3) (4) (5) (6) (7) (8) (9)

YES 1 >>3 YES 1 >>5 YES 1 YES 1 >>7 YES 1 YES 1 >>9 YES 1 ANY YES 1 NO 2 NO 2 NO 2 NO 2 NO 2 NO 2 NO 2 NO 2 >>11

ID CODE

01

02

03

04

05

06

07

08

09

10

11

12

At any time in the past 12 months, have you worked for anyone who is not a member of your household?

During the past 7 days, have you worked on a farm owned or rented by a member of your household or cared for livestock belonging to your household, or engaged in fishing or forestry activities of your household?

In the past 12 months have you worked on a farm owned or rented by a member of your household or cared for livestock belonging to your household, or engaged in fishing or forestry activities of your household?

During the past 7 days, have you worked on your own account or in a business belonging to you or someone in your household?

ID CODE

IS THIS PERSON ANSWERING FOR HIMSELF/ HERSELF?

COPY THE ID CODE OF RESPONDENT FROM ROSTER

During the last 7 days, have you worked for someone who is not a member of your household, for example an enterprise, a company, the goverment or any other individual?

During the past 12 months, have you worked on your own account or in a business belonging to you or someone in your household?

CHECK ANSWERS TO Q. 3, 5 AND 7. (WORKED IN LAST 7

DAYS)

RESPONDENT: ALL HOUSEHOLD MEMBERS 10 YEARS AND OLDER47

01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

SECTION 8: EMPLOYMENT PART A: LABOUR FORCE PARTICIPATION

(10) (11) (12) (13) (14)

STUDENT 1HOUSEWIFE/CHILDCARE 2TOO OLD/

SICK 1 RETIRED 3MATERNITY 2 HANDICAPPED 4HOUSEHOLD WAITING FOR REPLYMEMBER ILL 3 FROM EMPLOYER 5VACATION 4 WAITING FOR RECALLON LEAVE 5 BY EMPLOYER 6STRIKE 6 WAITING FOR BUSY

YES 1 SUSPENSION BY EMPLOYER 7 YES 1 >>15 SEASON 7MON TUE WED THU FRI SAT SUN TOT NO 2 >>13 OTHER (___) 8 NO 2 OTHER (___) 8

HOURS

How many hours did you work on each day in the previous week for all jobs? Do you have a permanent job even though you did not work in the last 7 days?

What is the main reason that you did not work in the last 7 days?

Have you looked for work in the last 7 days?

What is the main reason you did not look for a job in the last 7 days?

>>15

>>15


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

SECTION 8: EMPLOYMENT PART B: JOB INFORMATION

(1) (2) (3) (4) (5)

ANY YES 1YES 1

ALL NO 2 NO 2>> PART C POSTO HOURS

DESCRIPTION CODE DESCRIPTION CODE CODE PER WEEK

>>PART B

(15)

>>PART C

I would like to ask you some questions about the work you did in the last 3 months, whether work on your own account, on a farm, in a household business enterprise, or for someone else. In case you dstart with the job that you consider as your main job, and then talk about your secondary job.

CHECK ANSWERS TO QUESTIONS 4, 6, 8 AND 9

Have you had a job in the past 3 months?

Let's talk about your primary work. What did you do?

Offi

ce C

ode

What secto/industry is your primary job connected with?

OCCUPATION SECTOR

Offi

ce C

ode

Where did you work? For how many hours in the last 7 days did you do this work?

ALDEIA NAME

SEE OCCUPATION CODES ABOVE

SEE SECTOR/INDUSTRY

CODES ABOVE



01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(6) (7) (8) (9) (10) (11) (12)Now I would like to ask you about your work as

1FARM WITH SHARE CROPPING 2OTHER FARM 3YOUR HOME 4OTHER HOME 5 Employer (self-employed with paid workers) 1 >>21VEHICLE 6 Self-employed 2 >>21FROM DOOR TO DOOR 7IN THE STREET 3 >>21 A private company,NO FIXED PLACE 8 enterprise or cooperative? 1IN THE STREET 4 >>23 A rural public works program? 2FIXED PLACE 9 The government,

WEEKS OFFICE/FACTORY 10 5 >>17 public sector or army? 3DAYS PER LAST HOURS FISHERMAN 11 A state-owned enterprise? 4

PER WEEK 3 MONTHS PER WEEK OTHER 12 6 A private individual? 5 NUMBER

How many people altogether work at the place where you do this work?

u did more than one job, please

For how many days in the last 7 days did you do this work?

For how many weeks in the last 3 months did you do this work?

During these weeks, how many hours per week did you usually do this work?

In this work were you… Is your employer for this work…

Paid worker in a household farm or non-farm business enterprise

FARM OWNED OR OPERATED BY A HOUSEHOLD MEMBER READ ALL RESPONSES!

READ ALL RESPONSES!

Self -employed assisted by unpaid family workers

Unpaid family worker in a household farm or non-farm business enterprise

Employee/Paid worker of someone who is not a member of the household


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(13) (14) (15) (16) (17) (18) (19)

1 HOUR 1

YES 1 >>17 LABOR EXCHANGE 2 DAY 2 YES 1DAY 1 NO 2 PAYING OF DEBT 3 WEEK 3 NO 2 >>23

NUMBER WEEK 2 HOURS MINUTES OTHER (___) 4 RUPIAH MONTH 4 HOURS

How often do you travel from home to work (for example, twice a day or once a week)?

How long does it take you to get to work from home?

Do you receive wages, salary or other payments either in cash or in other forms from this employer for this work?

What is the main reason you receive no payment for this work?

How much was your last cash payment? How many hours did you work (or will you work) for the pay you just reported? Please include any hours of paid vacation or sick leave.

Do you receive any payment for this work in any other form?

ONE WAY TRAVEL TIME IF RESPONDENT HAS NOT YET BEEN PAID, ASK:

What payment do you expect? What period of time did this payment cover?

APPRENTICESHIP OR UNPAID TRAINEESHIP

>>23


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(20) (21) (22) (23)

HOUR 1 NET PROFIT 1 NET PROFIT 1DAY 2 GROSS PROFIT 2 GROSS PROFIT 2 YES 1WEEK 3 NO INCOME 3 NO INCOME 3 NO 2

RUPIAH MONTH 4 RUPIAH BUSINESS LOSS 4 RUPIAH BUSINESS LOSS 4 >> PART 8C

What is the value of those payments? Over what time interval?

What was your net profit (after taking out cost) from the job in the past 30 days? IF NET PROFITS ARE UNKNOWN, REPORT GROSS INCOME

What was your net profit (after taking out cost) from the job in the past 12 months? IF NET PROFITS ARE UNKNOWN, REPORT GROSS INCOME

In addition to the work you have already described, did you do any other work during the past 3 months? If you have several other jobs, talk about the one you consider the most important.>>23


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(24) (25) (26) (27) (28) (29)

WEEKSPOSTO HOURS DAYS PER LAST

DESCRIPTION CODE DESCRIPTION CODE CODE PER WEEK PER WEEK 3 MONTHS

Let's talk about your secondary work. What did you do?

Offi

ce C

ode

What sector/industry is your secondary job connected with?

Offi

ce C

ode

Where did you work? For how many hours in the last 7 days did you do this work?

For how many days in the last 7 days did you do this work?

For how many weeks in the last 3 months did you do this work?

OCCUPATION SECTORALDEIA NAME

SEE OCCUPATION CODES ABOVE

SEE SECTOR/INDUSTRY

CODES ABOVE



01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(30) (31) (32) (33) (34)

1OTHER FARM 2YOUR HOME 3OTHER HOME 4 Employer (self-employed with paid workers) 1 >> 40VEHICLE 5 Self-employed 2 >> 40FROM DOOR TO DOOR 6IN THE STREET, 3 >> 40 A private company,NO FIXED PLACE 7 enterprise or cooperative? 1IN THE STREET, 4 >> PART C A rural public works program? 2FIXED PLACE 8 The government,OFFICE/FACTORY 9 5 >> 36 public sector or army? 3 YES 1 >>36

HOURS FISHERMAN 10 A state-owned enterprise? 4 NO 2PER WEEK OTHER 11 6 A private individual? 5

During these weeks, how many hours per week did you usually do this work?

Now I would like to ask you about your work as [READ OUT OCCUPATION FROM QUESTION 2]. Where did you carry out most of this work?

In this work were you… Is your employer for this work…

Paid worker in a household farm or non-farm business enterprise

Do you receive wages, salary or other payments either in cash or in other forms from this employer for this work?

FARM OWNED OR OPERATED BY A HOUSEHOLD MEMBER

READ ALL RESPONSES!READ ALL RESPONSES!

Self -employed assisted by unpaid family workers

Unpaid family worker in a household farm or non-farm business enterprise

Employee/Paid worker of someone who is not a member of the household


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE


(35) (36) (37) (38) (39) (40)

1 HOUR 1 HOUR 1 NET PROFIT 1LABOR EXCHANGE 2 DAY 2 YA 1 DAY 2 GROSS PROFIT 2PAYING OF DEBT 3 WEEK 3 TIDAK 2 >> PART 8C WEEK 3 NO INCOME 3

OTHER (___) 4 RUPIAH MONTH 4 HOURS RUPIAH MONTH 4 RUPIAH BUSINESS LOSS 4

What is the main reason you receive no payment for this work?

How much was your last cash payment? How many hours did you work (or will you work) for the pay you just reported? Please include any hours of paid vacation or sick leave.

Do you receive any payment for this work in any other form?

What is the value of those payments? Over what time interval?

What was your net profit (after taking out cost) from the job in the past 30 days? IF NET PROFITS ARE UNKNOWN, REPORT GROSS INCOME

IF RESPONDENT HAS NOT YET BEEN PAID, ASK:

What payment do you expect? What period of time did this payment cover?

APPRENTICESHIP OR UNPAID TRAINEESHIP

>>PART C>>PART C


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

(41)

NET PROFIT 1GROSS PROFIT 2NO INCOME 3

RUPIAH BUSINESS LOSS 4

What was your net profit (after taking out cost) from the job in the past 12 months? IF NET PROFITS ARE UNKNOWN, REPORT GROSS INCOME


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

SECTION 8: EMPLOYMENT PART C: INDIVIDUAL TIME USE

(1) (2) (3) (4) (5) (6) (7) (8)

YES 1YES 1 YES 1 YES 1 NO 2NO 2 >>3 NO 2 >>5 NO 2 >>7

HOURS HOURS HOURSHOURS

During the past 7 days, how many hours did you do this kind of work?

During the past 7 days, have you at times been the main person caring for or watching over one or more young children?

>>NEXT PERSON

Sekarang saya ingin bertanya mengenai beberapa kegiatan kerumah-tanggaan yang anda lakukan seminggu terakhir ini, termasuk mencari air atau kayu bakar. Kegiatan-kegiatan ini tidak dimaksudkan untuk memperoleh suatu nilai pendapatan.

During the past 7 days, have you fetched any water?



During the past 7 days, have you done any work around the house, such as cooking, cleaning, washing clothes, or performing maintenance work on your home?

During the past 7 days, have you fetched any wood?

During the past 7 days, for how many hours were you the main person caring for or watching over one or more young children?

DO NOT COUNT TIME WHEN CHILDREN ARE

SLEEPING


OCCUPATION CODESAileu 0101 Hatolia 0703

Professional and technical expert 1 Laulara 0102 Lete Foho 0704

Managerial, administrative and decision making staff 2 Liquidoe 0103 Railaco 0705

Clerical 3 Remexio 0104 Bazartete 0801

Sales workers 4 Ainaro 0201 Liquica 0802

Services workers 5 Hatu Builico 0202 Maubara 0803

Workers in agriculture and husbandry (farmers) 6 Hato Udo 0203 Iliomar 0901

Worker in forestry 7 Maubisse 0204 Lautem Moro 0902

Worker in fishing 8 Baguia 0301 Lospalos 0903

Working in hunting 9 Baucau 0302 Luro 0904

Production workers 10 Fatu Maka 0303 Tutuala 0905

Transportation operations workers 11 Laga 0304 Alas 1001

Unskilled workers (including agricultural laborers) 12 Quelicai 0305 Fatuberliu 1002

Others 13 Vemasse 0306 Same 1003

Venilale 0307 Turiscai 1004SECTOR CODES Atabae 0401 Barique 1101

Balibo 0402 Laclo 1102

Agriculture, livestock 1 Bobonaro 0403 Laclubar 1103

Forestry 2 Cailaco 0404 Laleia 1104

Fishing 3 Lolotoi/Lebos 0405 Manatuto 1105

Hunting 4 Maliana 0406 Soibada 1106

Mining and quarrying 5 Fato Lulik 0501 Nitibe 1201

Manufacture or Processing Industry 6 Fatumean 0502 Oesilo 1202

Electricity, gas, water 7 Fohorem 0503 Pante Makasar A 1203

Construction 8 Mape/Zumalai 0504 Pante Makasar B 1204

Wholesale trade, retail, restaurants and hotels 9 Suai Kota 0505 Passabe 1205

Transportation, storage and communications 10 Tilomar 0506 Lacluta 1301

Finance, insurance, real estate and business services 11 Maukatar 0507 Ossu 1302

Public Administration/Military 12 Atauro 0601 Uatu Carbau 1303

Health 13 Cristo Rei 0602 Uatu Lari 1304

Education 14 Dom Aleixo 0603 Viqueque 1305

Other community, social and personal services activities 15 Metinaro 0604

Other 16 Nein Feto 0605 West Timor 9901

Vera Cruz 0606 Other in Indonesia 9902

Atsabe 0701 Other (___) 9999

Ermera Kota 0702

POSTO CODES

58

OCCUPATION CODES

Professional and technical expert 1

Managerial, administrative and decision making staff 2

Clerical 3

Sales workers 4

Services workers 5

Workers in agriculture and husbandry (farmers) 6

Worker in forestry 7

Worker in fishing 8

Working in hunting 9

Production workers 10

Transportation operations workers 11

Unskilled workers (including agricultural laborers) 12

Others 13

SECTOR CODES

Agriculture, livestock 1

Forestry 2

Fishing 3

Hunting 4

Mining and quarrying 5

Manufacture or Processing Industry 6

Electricity, gas, water 7

Construction 8

Wholesale trade, retail, restaurants and hotels 9

Transportation, storage and communications 10

Finance, insurance, real estate and business services 11

Public Administration/Military 12

Health 13

Education 14

Other community, social and personal services activities 15

Other 16

59

SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART A: PLOTS

YES 1

NO 2

>> PART D (Forestry)

(2) (5) (6) (7)

ANNUAL CROPS OR FALLOW 1

TREE CROP LAND 2 CROP ROTATION 1

FOREST 3 >>8 LACK OF INPUTS 2

1 PASTURE 4 >>8 LACK OF MANPOWER 3

2 PLANTATION 5 NONE 1 LACK OF EQUIPMENT 4

BUSH/UNDERBRUSH 6 1-25% 2 LACK OF ANIMAL POWER 5

3 GRASSLAND 7 25-50% 3 NO WATER SOURCE 6

SWAMP 8 50-75% 4 NO ROAD 7

4 GARDEN/GARDEN PLOT 9 ENTIRE 5 PROBLEMS WITH SOIL 8

WATER SURFACE 10 >>8 OTHER RISKS 9

HOUSE/BUILDING 11

NAME OF PLOT CODE AMOUNT OTHER (___) 12 CODE

1

2

3

4

5

6

7

8

9

CODE

>>8

(4)

Did you plant crops on the entire plot or only a part of it? If part, indicate approximately how much was cropped.

BACA SEMUA PILIHAN PADA DAFTAR DI BAWAH INI

AREA UNITS:

Why did you not crop the entire plot?

PLOT ID

ARES

(10m x 10m)

HECTARES

(100m x 100m)

Please tell me about each plot of land that a member of your household cultivated, or any plot of arable land a member of your household controlled, even though it does not belong to your household. Include also garden plots. Please describe or give me the name of each plot.

WRITE DOWN THE NAME OF THE HOUSEHOLD MEMBER AND

THE PERSON'S ID CODE. ASK THIS PERSON QUESTIONS 4-21.

AREA CODENAME

(1) During the last year (from (MONTH, YEAR to MONTH, YEAR) has any member of your household cultivated crops, or has any member of your household owned or controlled any arable land?

What kind of land is this?

(3)

Who in this household makes the decisions about this plot of land?

What is the area of this plot?

FARM PLOTS

OTHER (___)

SQ. METRES

RESPONDENT: HOUSEHOLD HEAD OR MOST INFORMED HOUSEHOLD MEMBER 60

1

2

3

4

5

6

7

8

9

PLOT ID


(8) (9) (10) (11) (12) (13) (14) (15)

OWNER 1 INHERITED 1 1

PART OWNER 2 OPENED 2 DEED 1

RENTED FROM SOMEONE 3 >>13 PURCHASED 3 SALES RECEIPT 2 2

RENTED TO SOMEONE 4 USE RIGHT GIVEN CUSTOMARY FLAT 1

PUBLIC LAND 5 >>13 BY LOCAL LEADER 4 RIGHT 3 SLIGHT SLOPE 2 3

PRIVATE LAND 6 OCCUPIED 5 OTHER (___) 4 YES 1 MODERATE SLOPE 3 NO 4

OTHER (___) 7 OTHER (___) 6 NONE 5 NO 2 STEEP SLOPE 4

YEARS RUPIAH

, ,000

, ,000

, ,000

, ,000

, ,000

, ,000

, ,000

, ,000

, ,000

What legal title or ownership rights do you have for this plot of land?

How many years has your household farmed/cultivated or had a right to this [PLOT]?

IF LESS THAN 1 YEAR PUT "0"

Does another household dispute the ownership if this [PLOT] by your household? YES, SIMPLE

IRRIGATION

YES, SEMI-TECHNICAL IRRIGATION

How did your household acquire this [PLOT]?

>>19

In general, what is the slope of this[PLOT]?

YES, TECHNICAL IRRIGATION

Is this [PLOT] irrigated?If you were to sell this [PLOT] of land today, how much could you sell it for?

What is the tenure status of this [PLOT]?


1

2

3

4

5

6

7

8

9

PLOT ID


(16) (17) (18) (19) (21) (22)

TUBEWELL 1 BY HAND 1

DITCH/CANAL 2

POND/TANK 3 SELF-MANAGED 1 2

RIVER 4 FARMER COMMUNITY 2

SPRING 5 AGENCY MANAGED 3

SEASONAL 1 MIXED 6 COMMUNITY MANAGED 4 3

YEAR-ROUND 2 OTHER (___) 7 OTHER (___) 5 TRACTOR 4 YES 1

NO 2

KM 1ST 2ND 3RD 4TH 5TH

How do you cultivate your field?

(20)

What were the main crops grown on this [PLOT] during the last year, during both dry and wet seasons?

Did your household harvest any coffee in the past 12 months?

USE THE CROP CODES ABOVE

LIST UP TO FIVE CROPS, PUTTING THEM IN ORDER OF IMPORTANCE

Is the irrigation seasonal or year-round?

What is the mode of irrigation on the [PLOT]?

Who manages the irrgation system that is used on the [PLOT]?

How far is this [PLOT] from the road?

TRAMPLING WITH RENTED ANIMALS (RENCAH)

TRAMPLING WITH OWN ANIMALS


"Gogo" rice 1Rice 2Maize 3Cassava 4Coffee (cherries) 5Coffee (dry beans) 6Kidney bean 7Sweet potato 8Potato 9Taro 10Squash 11Mung bean 12Soy bean 13Coconut 14Peanuts 15Vegetables 16Bananas 17Other fruit 18

CROP CODES

63

SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART B: CROPS HARVESTED

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

SALES AT MARKET 1

TRADER 2

RELATIVE 3

FRIEND/NEIGHBOUR 4

METRE 1 INDIVDUAL 5

ARES 2 COOPERATIVE 6

(10m x 10m) ONCE A YEAR 1 GOVERNMENT 7

HECTARES 3 TWICE A YEAR 2 WHOLESALER 8

(100m x 100m) THREE TIMES A YEAR 3 RETAILER 9

OTHER (____) 4 MORE THAN THREE 4 NGO 10

OTHER (____) 11

CROP UNIT UNIT

NAME CODE % CODE 1ST % % % %

01"Gogo" rice , ,000

02Rice , ,000

03Maize , ,000

04Cassava , ,000

05Coffee (Cherries) , ,000

06Coffee (Dry beans) , ,000

07Kidney bean , ,000

08Sweet potatoe , ,000

09Potatoe , ,000

10 Taro (Talas/Kontas) , ,000

11Squash , ,000

12Mung bean , ,000

13Soy bean , ,000

14Coconut , ,000

15Peanuts , ,000

16Vegetables , ,000

17Bananas , ,000

18Other fruit , ,000

UNIT CODE: Kg. - 1 Kaleng (11 Litres) - 2 Kaleng Susu (390 g) - 3 Buah - 4 Karung (50Kg) - 5 Karung (100Kg) - 6

What was the total yield of [CROP] in the last year, since [MONTH] [YEAR]?

AMOUNT2ND

What percentage of the [CROP] harvested did you barter in exchange for other goods?

After it was harvested, what percentage of [CROP] was lost to insects, rodents, rotting or some other problem?

What percentage of the [CROP] harvested during the last year was given to paylaborers or make other payments?

What percentage of the [CROP] harvested during the last year has already been or will be consumed by your household?

To whom did you sell this [....]?What percentage of the [CROP] you harvested during the last year was sold?

What price did you get for the [CROP] you sold?

IF MORE THAN ONE PRICE, GET THE AVERAGE PRICE

RUPIAH

KOD

E TA

NAM

AN

What is the area of the plot you grow this [CROP] on?

How many times per year do you harvest this [CROP]?

AMOUNTYES NO

ASK QUESTION 1 FOR EACH CROP BEFORE ASKING

QUESTIONS 2-16

Did you harvest any [CROP] during the last year, since [MONTH] [YEAR]?

AREA UNIT

AREA UNIT:

JIKA 0 >> 7IF 0 >> 8


01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

KOD

E TA

NAM

AN

SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART B: CROPS HARVESTED

(12) (13) (14) (15) (16)

PLANT DISEASE 1

INSECTS 2

BIRDS 3 WORMS/FLEAS 1

1 MICE/RODENTS 4 1 MICE/RODENTS 2

2 OTHER ANIMALS 5 2 FUNGI 3

3 OTHER (___) 6 3 OTHER (___) 4

1ST 1ST

KODE SATUAN: Kg. - 1 Kaleng (11 Liter) - 2 Kaleng Susu (390 g) - 3 Buah - 4 Karung (50Kg) - 5 Karung (100Kg) - 6

NONO

While the [CROP] was in storage, did you have any loss of the crop due to pests or plant diseases?

What pests caused the loss while the crop was in storage?

YES, MAJOR LOSS

YES, MINOR LOSS

>>NEXT CROP

2NDAMOUNT

What pests caused the loss while the crop was growing?

2ND

YES, MINOR LOSS

While [CROP] was still growing in the field, did you have any loss of the crop due to pests or plant diseases?

>> 15

How much [CROP] did your household buy in the last 12 months? ONLY ASK FOR RICE, CORN AND CASSAVA

IF NONE, PUT "0" YES, MAJOR LOSS

UNIT CODE


SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART C: AGRICULTURAL INPUTS

(1) YES 1 >>4

NO 2

1

2

(2) YES 1 >>4 3

NO 2 4

5

6

7

(5) (6) (7) (9) (10) (11) (12)

PRIVATE INDIVIDUAL 1

1 PRIVATE FIRM 2

2 COOPERATIVE 3

DO NOT LIKE TO USE 1 3 GOVERNMENT 4

DO NOT REQUIRE 2 4 NGO 5DO NOT KNOW HOW TO USE 3 5 FRIEND/RELATIVE 6

NOT AVAILABLE 4 Kg. 1 6 Kg. 1 LANDLORD 7 Kg. 1

YES 1 >>6 TOO EXPENSIVE 5 Litre 2 Litre 2 OTHER (___) 8 Litre 2

NO 2 TOO FAR TO CARRY 6 1ST

INPUT OTHER 7 AMOUNT UNIT RUPIAH AMOUNT UNIT SOURCE AMOUNT UNIT 1ST 2ND 3RD

6001 Manure , ,000

6002 Fertiliser , ,000

6003 Pesticide , ,000

6004 Herbicide , ,000

6005 Rice Seeds , ,000

6006 Maize Seeds , ,000

6007 Bean Seeds , ,000

In the past year have you used manure, fertiliser or pesticides or herbicides on your crops?

(3)

Why did you not use fertiliser, pesticides or herbicides on your crops?

RECORD THE RESPONSES IN ORDER OF IMPORTANCE

SUMBER SUMBER 2ND CROP CODE

How much of [INPUT] did you receive for free?

From whom did you receive this [INPUT] during the past year?

How much [INPUT] did you produce yourself during the past year?

Which crops did you use the [INPUT] for?

ORANG LAIN

(4)

INPUT CODE

Why did you not use [INPUT]? Did you use any [INPUT] for your crops in the last year?

SOURCEPERTAMA KEDUA

OTHER (___)

In the past year have you purchased or been given for free any maize, rice or bean seeds?

DO NOT KNOW HOW TO USE

NOT AVAILABLE

TOO EXPENSIVE

TOO FAR TO CARRY

LSM

LAIN [SEBUTKAN ___]

DO NOT LIKE TO USE

DO NOT REQUIRE

How much [INPUT] did you purchase during the past year?

Where did you purchase this [INPUT] during the past year?

(8)

How much did you spend in total to purchase

[INPUT] during the past year?

PERUSAHAAN SWASTA

KOPERASI

PEMERINTAH

>>NEXT INPUT

IF '0' >> 9 IF '0' >> 11

>> PART D

RESPONDENT : HOUSEHOLD HEAD OR MOST INFORMED HOUSEHOLD MEMBER 66

SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART D: FORESTRY

(8) YES 1(1) (5) NO 2

>>PART EYA TDK

YES 1 (9) (10)NO 2 >>3

(2)

12 (6)3

(3) YES 1NO 2 >>8

PRODUCT AMOUNT UNIT RUPIAHYES 1 (7)

NO 2 >>5 8001 Timber wood Cubic metres , ,000

8002 Fuel wood Bunch ( .04 cu. m) , ,000

(4) 8003 Sandal wood Kg , ,000

8004 Honey Litres , ,000

AMOUNT 8005 Rattan Pieces , ,000

8006 Bamboo Pieces(1.85 m.) , ,000

8007 Candle nut (kemiri) Kg , ,000

TREES 8008 Other (___) , ,000

Approximately how many trees has your household planted in the last three years, since[MONTH], 1998?

Approximately how many species of plants does your household gather?

CODE

Does your household plant trees to supply wood for cooking?

GATHER FROM FOREST AREASBUY FROM A STOREBUY FROM A WOOD SALESMAN

Other large animals

Does anyone in your household gather plants for medicinal purposes?

FishBirds

How much did you receive from the sale of [PRODUCT] in the past year?

Did your household produce any forest products such as wood, honey, or candlenut in the past year?Does your household use wood for cooking? Does your household hunt/catch [...]?

PigsDeer In the past year, how much did your

household produce of [PRODUCT]?

Where do you mainly get the wood you use for cooking? Small animals

IF "0" >> NEXT PRODUCT


SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART E: FARMING EQUIPMENT

YES 1NO 2 >>PART F

IMPLEMENTS

7001 Hoes PERALATAN PERTANIAN7002 Axes (3) (4) (5) (6)7003 Shovels

7004 Picks

7005 Big knife

7006 Sickle/Reaping hook

7007 Hand thresher

7008 Rice miller

7009 Crop drying area

7011 Tarp/Canvas

7012 Basket YES 17013 Small cart pushed by person NO 2

YES 1NO 2 RUPIAH/DAY

7021 , ,000

7022 , ,000

7023 , ,000

7024 , ,000

7025 , ,000

7026 , ,000

7027 , ,000

7028 , ,000

7029 , ,000

7031 , ,000

7032 , ,000

7033 , ,000

Mechanical water pump

Motorized thresher

Ox cart

Rice winnower

Rice/Corn mill

Motorized insecticide pump

Hand insecticide pump

Manual coffee grinder

Motorized coffee grinder

How much did you spend per day to rent the [EQUIPMENT]?

DAYS

During the last year has any member of your household owned a [EQUIPMENT]?

During the last year, has any member of your household rented a [EQUIPMENT]?

EQUIPMENTEQUIPMENT

IMP CODE

Animal pulled plow

Machine pulled plow or harrower

(1) (2)

Tractor

How many [IMPLEMENTS] does your household own today?

AMOUNT

How many days in total did you

rent [EQUIPMENT] during the past

year?

Did your household own or rent any farm equipment such as tractors, plows, threshers, pumps or oxcarts in the last year?

EQUIP CODE

>>NEXT

IF "0" >>NEXT IMPLEMENT


SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART F: LABOUR & FARM PRODUCE

FARM LABOUR FARM PRODUCE(1) (7)

YES 1 YES 1

NO 2 >>6 NO 2

>> PART G

(2) (5) (8) (9)

1

2

TYPE OF DAILY WAGE

LABOURER CODE NUMBER 3 RUPIAH ITEM NO YES CODE RUPIAH

Male adult 1 , ,000 Eggs 6001 , ,000

Female adult 2 , ,000 Meat 6002 , ,000

Child [< 15 YRS] 3 , ,000 Animal hides 6003 , ,000

Bananas 6004 , ,000

(6) Other fruit 6005 , ,000

Other (___) 6006 , ,000

RUPIAH

Transportation for marketing crops , ,000

Irrigation , ,000

DAYS

In the last 12 months, how much did you spend for:

PAID IN BOTH

How much did you receive from the sale of [PRODUCT] in the past year?

What is the wage for one day for [TYPE] labour on the farm?

INCLUDE THE VALUE OF IN KIND PAYMENTS

During the past 12 months, has your household sold [PRODUCE] for cash?

ASK QUESTION 8 FOR ALL ITEMS FIRST, PUTTING A CROSS [X] IN THE APPROPRIATE

BOX. THEN ASK Q. 9 FOR ALL ITEMS THAT WERE SOLD FOR CASH BY THE HOUSEHOLD

How many [TYPE] labourers did your household hire for farm work in the last year?

ASK FOR ALL TYPES BEFORE ASKING Q 3-5

Did your household sell any farm products for cash in the past year?

Did your household hire any farm labourers in the past year?

How many days in total (including exchange days) did you hire [TYPE] labourers during the past year?

(3) (4)

PAID IN CASH

PAID IN KIND

Did you pay [TYPE] in cash, in kind or both?


SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART G: LIVESTOCK SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES

(1) YES 1NO 2 >> PART H

(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

YES 1NO 2

ANIMAL NUMBER NUMBER RUPIAH NUMBER RUPIAH NUMBER RUPIAH NUMBER NUMBER NUMBER NUMBER NUMBER

8001 Buffalo , ,000 , ,000 , ,000

8002 Bali cow , ,000 , ,000 , ,000

8003 Cow , ,000 , ,000 , ,000

8004 Horse , ,000 , ,000 , ,000

8005 Pig , ,000 , ,000 , ,000

8006 Goat , ,000 , ,000 , ,000

8007 Sheep , ,000 , ,000 , ,000

8008 Chicken , ,000 , ,000

8009 Duck , ,000 , ,000

8011 Other (___) , ,000 , ,000 , ,000

How many adult [ANIMALS] are owned by your household today?

How many young [ANIMALS] are owned by your household today?

If you sold one of those young [ANIMALS] today, how much money could you get for it?

Did any member of your household raise or own livestock, poultry or any other domesticated animal before the violence in 1999, or in the last year, since [MONTH], [YEAR]?

How many [ANIMALS] were owned by your household before the violence in 1999?

>>NEXT ANIMAL

ANI

MAL CODE

Either before the violence in 1999, or during the last year, has any member of your household raised any [ANIMALS]?

If you sold one of those adult [ANIMALS] today, how much money could you get for it?

FIRST ASK QUESTION 2 FOR ALL ANIMALS, THEN ASK QUESTIONS 3-15 FOR EACH ANIMAL BEFORE

GOING TO THE NEXT ONE.INCLUDE VALUE OF IN

KIND PAYMENTS

How much did your household receive for the sale of all these [ANIMALS] during the last year?

How many of your [ANIMALS] died or were lost to disease during the last year?

How many of your [ANIMALS] did you sell during the last year?

How many of your [ANIMALS] are vaccinated?

How many of your [ANIMALS] were stolen during the last year?

How many [ANIMALS] did your household purchase during the last year?

How many of your [ANIMALS] did your household eat during the last year?

IF "0" >>10


SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES PART H: FISHING AND AQUACULTURE

(1) YES 1

NO

(2) YES 1

BOATS: NO 2 >>12

(3) (4) (5) (6) (7) (8) (9) (11)

OWNED 1 1

CANOE (BASIC) 1 SHARED OWNED 2 2

CANOE (PLANKS) 2 LEASED 3 >>6 3

WOODEN BOAT 3 GOVERNMENT OWNED 4 >>6 4

OTHER (___) 4 OTHER (___) 5 >>6 YEARS METRES METRES YEARS NUMBER 5 RUPIAH

01 , ,000

02 , ,000

03 , ,000

Has any member of your household raised fish or been engaged in fishing in the past twelve months?

Do you use a boat for fishing?

PADDLE/SAIL

LONG TAIL

OUTBOARD MOTOR

INBOARD DIESEL

If you were to sell this boat today, how much would you get for it?

What is the ownership of the boat?

2 >>24

(10)

What type of boat do you use for fishing?

How long have you owned the boat?

What is the length of the boat?

What is the width of the boat?

How old is the hull?

How many members are there in the crew?

What is the source of power for the boat?

OTHER (___)


01

02

03


FISHING:

(12) (13) (15) (16) (17) (18)

HAND CATCH 1

SPEAR 2

HAND LINE 3

GILL NET 4

CAST NET 5

FISH/CRAB POT 6 YES 1

TRAP 7 NO 2

BEACH SEINE 81ST HOURS MINUTES DAYS RUPIAH RUPIAH %

, ,000 , ,000

, ,000 , ,000

, ,000 , ,000

(14)

ONE-WAY TIME ON AVERAGE

Are there times and places you cannot fish because traditional rules prohibit it?

What percent of your fish catch do you sell?

How many days in the last 12 months did you boat go fishing?

How much money did you and your crew earn in the last 12 months from fishing?

2ND

Of this amount, how much did you keep?

What type of fishing gear do you use? LIST RESPONSES IN ORDER OF IMPORTANCE

How long does it take to reach the fishing ground you usually go to?

IF "0">> 23


01

02

03


(20) (23)

SELL AT MARKET 1

TRADER 2

RELATIVE 3 1

FRIEND/NEIGHBOR 4 ON FOOT 2

OTHER INDIVIDUAL 5 ANIMAL 3

RESTAURANT 6 BIKE 4

HOTEL 7 MOTORCYCLE 5

WHOLESALER 8 BUS 6

RETAILER 9 CAR/TAXI 7

2 KG - KEATAS KG 0,5 - 2 KG 0 - 0,5 2 KG - KEATAS KG 0,5 - 2 KG 0 - 0,5 OTHER (___) 10 OTHER (___) 8 %

, ,000 , ,000 , ,000

, ,000 , ,000 , ,000

, ,000 , ,000 , ,000

(21)

What percentage of your catch is large, medium and small fish?

PERSEN (%)

Who do you sell the fish to?What is the average price of each fish category you sell?

(22)(19)

What percent of your fish catch do members of your household consume?

How do you transport the fish for selling?

SOLD IMMEDIATELY AT THE PORT

RUPIAH/KG


01

02

03

SECTION 9: FARMING, LIVESTOCK, FORESTRY AND FISHERIES

AQUACULTURE:

(24) (25)

YES 1

NO 2

SQUARE METRES SPECIES KG/YEAR

1ST

2ND

3RD

(26)

What is the area of the pond?

What species did you grow in the pond in the last 12 months? List up to three species and the production in KG.

Do you have a pond in which you raise shrimp or fish?

>>NEXT SECTION


SECTION 10: TRANSFERS, BORROWING AND SAVINGS PART A: TRANSFERS GIVEN AND LOANS

(1) 1

2

(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14)

SPOUSE 1 CHILD SUPPORT 1CHILD 2 EDUCATIONALGRANDCHILD 3 EXPENSES 2NIECE OR NEPHEW 4 MEDICALPARENT 5 EXPENSES 3SISTER/BROTHER 6 SEE HOUSE REPAIR 4SON/DAUGHTER- 7 LOCATION WEDDING 5IN-LAW CODES FUNERAL 6BROTHER/SISTER- 8 ABOVE INVESTMENT ININ-LAW HOUSEHOLDGRAND FATHER/ 9 ENTERPRISE 7GRAND MOTHER PURCHASE OF A

YES 1 YES 1 FATHER/MOTHER- 10 MALE 1 YES 1 YES 1 DURABLE GOOD 8NO 2 >>5 NO 2 >>7 IN-LAW FEMALE 2 NO 2 NO 2 >>14 OTHER (___) 9

NAME ID CODE OTHER RELATIVE 11 CODE RUPIAH RUPIAH TIMES

1

2

3

4

5

6

7

8

9

How many times per year does [NAME] receive this assistance?

LIST ALL NAMES

BEFORE MOVING ON

TO QUESTIONS 3-

14

COPY ID CODE OF PERSON

FROM ROSTER

How much money have members of this household given/loaned to [NAME] in the past 12 months?

What is the approximate value in cash of the assistance given in food or other goods in the past 12 months?

Is the assistance given/ loaned for a specific reason?

Is [NAME] related to the household head?

Where does [NAME] live?NAME IS ...… OF

HOUSEHOLD HEAD

What is the main reason for this assistance?

ID CODE

What are the names of the persons this household provided assistance or loans to during the past 12 months?

Did a specific household member provide this assistance/ loan to [NAME]?

Which household member provides this assistance to [NAME]?

How is [NAME] related to the household head?

Is [NAME] male or female?

Must [NAME] repay this assistance given by your household?

>> PART B

During the past 12 months has your household or any of its members provided assistance or lent any money or goods to persons who are not member of your household? For example to relatives living elsewhere, child support or alimony, or friends and neighbors.

YES

NO

RESPONDENT: MOST KNOWLEDGEABLE HOUSEHOLD MEMBER 75

SECTION 10: TRANSFERS, BORROWING AND SAVINGS PART B: TRANSFERS RECEIVED

(1) YES 1

NO 2

(2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)

SPOUSE 1CHILD 2 CHILD SUPPORT 1GRANDCHILD 3 EDUCATIONALNIECE OR NEPHEW 4 EXPENSES 2PARENT 5 MEDICALSISTER/BROTHER 6 EXPENSES 3SON/DAUGHTER- 7 SEE HOUSE REPAIR 4IN-LAW LOCATION WEDDING 5BROTHER/SISTER- 8 CODES FUNERAL 6IN-LAW ABOVE INVESTMENT INGRAND FATHER/ 9 HOUSEHOLDGRAND MOTHER ENTERPRISE 7FATHER/MOTHER- 10 PURCHASE OF A

YES 1 YES 1 IN-LAW MALE 1 YES 1 DURABLE GOOD 8NO 2 >>5 NO 2 >>7 OTHER RELATIVE 11 FEMALE 2 NO 2 >>13 OTHER (___) 9

NAME ID CODE RUPIAH RUPIAH TIMES

1

2

3

4

5

6

7

8

9

How many times per year does [NAME] send this assistance?

LIST ALL NAMES

BEFORE ASKING

QUESTIONS 3 - 13

COPY ID CODE OF PERSON

FROM ROSTER

How much money have members of the household received from [NAME] in the past 12 months?

What is the approximate value in cash of the assistance given in food or other goods in the past 12 months?

Is the assistance sent by [NAME] provided for a specific reason?

What is the main reason why [NAME] sent this assistance?

Is [NAME] male or female?

Where does ..[NAME] live?

HOUSEHOLD HEAD IS ....

During the past 12 months has your household or any of its members received any money or goods that did not have to be repaid from persons who are not members of your household? For example from relatives living elsewhere, child support or alimony, friends, neighbors? Do not include any organizations, like NGOs, church, etc. DO NOT INCLUDE MONEY OR GOODS THAT HAVE TO BE REPAID.

>>PART C

ID CODE

What are the names of the persons who gave assistance to this household during the past 12 months?

Is this assistance from [NAME] given to a specific member of this household?

Which household member does [NAME] send this assistance for?

Is [NAME] related to the household head?

How is [NAME] related to the household head?

IS .... OF [NAME]


SECTION 10: TRANSFERS, BORROWING AND SAVINGS PART C: BORROWING #

(1) (5) (8)RELATIVE 1 FRIEND 2 PRIVATE MONEY LENDER 3CREDIT UNION 4

YES 1 BNU 5 YES 1NO 2 CEP 6 NO 2

NGO 7OTHER SOURCE 8 (9) What is the rate of interest you pay/paid?

(2) PER CENT

(6) ANNUAL 1AGRICULTURAL INPUTS 1 MONTHLY 2LAND FOR FARMING 2 WEEKLY 3NON-AGRICULTURAL BUSINESS 3 DAILY 4LAND FOR A HOUSE 4 DON’T KNOW 5

(3) HOUSE- BUY OR REPAIR 5 (10)HOUSEHOLD DURABLES 6OTHER CONSUMPTION 7 DAYS 1FAMILY CELEBRATION (EG WEDDING) 8 MONTHS 2OTHER 9 YEARS 3

TIME PERIOD

(7)

(4) LAND 1BUILDING, OTHER PROPERTY 2 (11)HOUSEHOLD DURABLE 3VEHICLE 4LIVESTOCK 5

RUPIAH PERSONAL GUARENTEE 6 RUPIAHCO-GUARANTOR 7OTHER SOURCE 8NO SECURITY/COLLATERAL 9

What kind of collateral did you provide to obtain this loan?

What is the total amount of money or goods that you expect to pay/paid back over the entire loan period?

In the last 12 months, how many times did you borrow or obtain funds that you had to (have to) repay from a family member, friend or other individual, or an institution?

INCLUDE FEES AND COSTS OF LOAN PROCESSING

What was the main reason for obtaining this loan? >>PART D>>PART D>>PART D>>PART D

From the date you received the loan, how much time do you have/did you have to repay the money or goods?

NUMBER OF DAYS, MONTHS OR YEARS

I would now like to ask you about whether any member of your household has borrowed any money or goods or obtained funds that you must repay from family, friends or institutions.

In the last 12 months, has your household borrowed or obtained funds that you had to (have to) repay from a family member, friend or other individual, or an institution? (Include all loans made this year, even if already repaid)?

Do you/did you pay pay interest on this loan, in other words, is/was the total amount of money you pay/paid back more than you received or borrowed originally?

INCLUDE FEES AND COSTS OF LOAN PROCESSING

Where precisely did you obtain this most recent loan?

>>PART D >>PART D

What was the total amount borrowed from family members, friends or other individuals, or an institution in the last 12 months?

NUMBER

How much was the last loan you borrowed?

RUPIAH


SECTION 10: TRANSFERS, BORROWING AND SAVINGS PART D: AID ASSISTANCE

(1) YES 1NO 2 >>PART E

(2) (3) (4) (5)

YES 1NO 2

ASSISTANCE MONTH YEAR NAME UNIT

1 Credit/cash

2 Vaccination for cattle / buffaloes vaccinations

3 Cttle cattle

4 Pigs pigs

5 Chickens chickens

6 Seeds kg

7 Fertilizer kg

8 Fruit tree trees

9 Agricultural tools tools

10 Non-agricultural tools tools

11 Fishing nets nets

12 Mosquito net nets

13 Mosquito net repair kits repair kits

14 Contraception (eg condoms, injections, pills)

15 Shelter/Housing repair kits kits

16 Building materials

17 Rice kg

18 Corn kg

19 Other food (please specify) kg

20 Other (please specify) number

21 Other (please specify) number

Who provided you with [ASSISTANCE] the last time?

In the past 12 months, have you or any members of your household received any assistance in the form of goods or cash from NGOs, the church or other organizations?

(6)

CODE

ASK QUESTION 2 FOR ALL [ASSISTANCE], THEN ASK QUESTIONS 3-6

Did you receive any [ASSISTANCE] in the past 12 months?

When did you receive

[ASSISTANCE] the last time?

What was the amount of [ASSISTANCE] from all organizations that you received in total in the past 12 months?

What was the value of [ASSISTANCE] from all organizations that you received in total in the past 12 months?

>> NEXT ROW AMOUNT RUPIAH

OFFICE CODE


SECTION 10: TRANSFERS, BORROWING AND SAVINGS PART E: SAVINGS

(1)

YES 1NO 2 >>SECTION 11

2 3

YES 1NO 2

Amount Unit

1 Cash (Rupiah)

2 Cash (Foreigh currency)

3 Deposits with Indonesian institutions (BDN, BI, BRI, or BTN)

4 Deposits with other banks and institutions (Specify_____)

5 Gold, silver or other precious metals

6 Jewellery

7 Other (______________________________________)

Does any member of your household have any savings, in cash, accounts in banks, gold or other precious metals, jewellery or other? If you/any household member had savings in bank account in Indonesia before the violence in 1999, answer YES.

>>NEXT SAVING

Type of savings

Do you or any members of your

household have any of the following types

of savings?

How much is the current value of such assets?


SECTION 11: OTHER INCOME

(1) YES 1NO 2 >>SECTION 12

(3)

YES 1NO 2 >>NEXT SOURCE

SOURCE RUPIAH

1 Pensions

2 Rent or lease of land or buildings

3 Interest on invested money or loans

4 Bride price paid to the household

5 Inheritance

6 Sale of vehicles or other durable goods

7 Sale of gold, silver, jewellery

8 Other income (specify_____)



How much did your household receive in the last 12 months from [SOURCE] including the value of any payment in the form of goods?

(2)In the last 12 months, did your household, or any of its members, receive any payments, in cash or in any other form, from the following sources?

In the past 12 months, have you or any members of your household received any income such as pensions, rents, inheritance, bride price, revenue from selling a vehicle or other goods, revenue from selling gold or jewellery, or any other income?

CODE


SECTION 12: SOCIAL CAPITAL

(1) (2) (3) (7) (8) (9) (10) (11)

1

1 1 22 23 3 3

WEEK 1 4MONTH 2 4 4 5QUARTE 3 5 5 6

YES 1 YEAR 4 6 6YES 1 >>3 NO 2 >>NEXT YES 1 7 7 7NO 2 PERSON NO 2 >>7 8 8 8

ID CODE TYPE CODE RUPIAH TIMES TIMES 1ST 1ST 1ST

01

02

03

04

05

06

07

08

09

10

11

12

What problems did the group encounter in its activities during the last 3 months?

TIME

MEMBERS NOTMOTIVATED

NO PROBLEM

TOO FEW MEMBERSINPUT PURCHASE

MARKETING

SEE GROUP CODES ABOVE

Did you/[NAME] pay a membership fee over the last 12 months to participate in the group? Include in-kind payments.

How much did you/[NAME] pay? Evaluate in-kind payments at local market prices.

INPUT PURCHASE

PHYSICAL


PRODUCTION

MARKETING

Let's talk about the main or principal user or community group you/[NAME] participated in. What type of group was it?

INFRASTRUCTURELACK OF RULESLACK OF INFLUENCE

NO LEADERSHIPLACK OF FUNDS

(4) (5) (6)

I would like to ask you some questions about any user or community groups you participated in during the last 12 months. In case you participated in more than one local group, please start with the the most important group, and then talk about your second most important group.

Is [NAME] answering for himself/ herself?

COPY THE ID CODE OF RESPON-DENT FROM ROSTER

Over the past 12 months, did you/[NAME] participate in any user or community group?

PRODUCTION

CREDIT CREDIT

How many group meetings took place in the last 3 months?

How many times did you/[NAME] attend these meetings in the last 3 months?

What were the main actitivities of the group during the last 3 months?

What benefits did you gain from the actitivities of the group during the last 3 months?


ID CODE

INFORMATION INFORMATION


OTHER (___) OTHER (___)

PHYSICALINFRASTRUCTURE

SOCIAL GATHERING SOCIAL GATHERINGOTHER (___)IN COMMUNITY

PERIOD 2RD 2RD 2ND


01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

SECTION 12: SOCIAL CAPITAL

(12) (16) (17) (18) (19) (20)

1

1 1 22 23 3 3

WEEK 1 4MONTH 2 4 4 5QUARTER 3 5 5 6

YES 1 YEAR 4 6 6NO 2 >>NEXT YES 1 7 7 7

PERSON NO 2 >>16 8 8 8TYPE CODE RUPIAH TIMES TIMES 1ST 1ST 1ST

NO LEADERSHIPLACK OF FUNDS

OTHER (___)

INFRASTRUCTURE INFRASTRUCTURE

(13) (14) (15)How much did you/[NAME] pay? Evaluate in-kind payments at local market prices.

Let's talk about the other user or community group you/[NAME] participated in. What type of group was it?

Did you/[NAME] pay a membership fee over the last 12 months to participate in the group? Include in-kind payments.

INPUT PURCHASE INPUT PURCHASE

PHYSICAL PHYSICAL

TOO FEW MEMBERS

What problems did the group encounter in its activities during the last 3 months?




How many group meetings took place in the last 3 months?

How many times did you/[NAME] attend these meetings in the last 3 months?

What were the main actitivities of the group during the last 3 months?

What benefits did you gain from the actitivities of the group during the last 3 months?

IN COMMUNITY

Over the past 12 months, did you/[NAME] participate in any other user or community group?

MEMBERS NOTPRODUCTION PRODUCTION MOTIVATED

NO PROBLEM

CREDIT CREDIT

LACK OF RULESINFORMATION INFORMATION LACK OF INFLUENCEMARKETING MARKETING

TIME OTHER (___)OTHER (___)SEE GROUP

CODES ABOVE SOCIAL GATHERING SOCIAL GATHERING

2NDPERIOD 2RD 2RD


FARMERS 1WATER 2AGRO-FORESTRY 3FISHERY 4HEALTH 5CREDIT 6WOMEN 7CEP KONSIL 8MUDIKA 9PEMUDA & OLAHRAGA 10

OTHER (___) 11

COMMUNITY GROUP CODES

83

SECTION 13: SUBJECTIVE WELLBEING PART A: INDIVIDUAL

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)

EDUCATION 1EMPLOYMENT 2HEALTH CARE 3HOUSING 4ACCESS TO LAND 5 VERY SATISFIED 1

LIVED MUCH DEMAND FOR PRODUCTS 6 RATHER SATISFIED 2BETTER 1 INFRASTRUCTURE 7 NEITHER SATISFIEDLIVED THE SAME, SAFETY 8 NOR UNSATISIFIED 3LIKE NOW 2 POLITICAL PARTICIPATION 9 MORE 1 SOMEWHATLIVED MUCH STATUS IN COMMUNITY 10 AS MUCH 2 UNSATISFIED 4WORSE 3 OTHER (___) 11 LESS 3 VERY UNSATISFIED 5

1ST 1ST 1ST 1ST STEP STEP STEP STEP

01

02

03

04

05

06

07

08

09

10

11

12

2ND2ND2ND2ND

ID CODE

How did you live two years ago, before the violence in 1999, when compared to how you live today?

What has improved since the violence in 1999?

What has worsened since the violence in 1999?

What is most important for improving your living standards?

What is most important for improving living standards in East Timor?

Do you think there is more or less corruption compared to before the violence in 1999?

And now, please, imagine a 9-step ladder where on the bottom, the first step, stand the poorest people, and on the highest step, stand the rich. On which step are you today?

ALLOW UP TO TWO RESPONSES:

On which step were you two years ago, before before the violence in 1999?

And now, please, imagine a 9-step ladder where on the bottom, the first step, stand people who are completely without rights, and on the highest step, stand those who have a lot of power. On which step are you today?

On which step were you two years ago, before before the violence in 1999?

Are you satisfied with your life in general at the present time?


SECTION 13: SUBJECTIVE WELLBEING PART B: HOUSEHOLD

(1) (6)

LESS THAN ADEQUATE 1 LESS THAN ADEQUATE 1JUST ADEQUATE 2 JUST ADEQUATE 2MORE THAN ADEQUATE 3 MORE THAN ADEQUATE 3

(2)

(7)LESS THAN ADEQUATE 1JUST ADEQUATE 2MORE THAN ADEQUATE 3

(3)

(8)LESS THAN ADEQUATE 1JUST ADEQUATE 2MORE THAN ADEQUATE 3

(4)

LESS THAN ADEQUATE 1JUST ADEQUATE 2MORE THAN ADEQUATE 3 (9)

(5) CATHOLIC 1OTHER CHRISTIAN 2MOSLEM 3HINDU 4

LESS THAN ADEQUATE 1 OTHER (___) 5JUST ADEQUATE 2 NONE 6MORE THAN ADEQUATE 3NO CHILDREN 4

Concerning your household's health care situation over the past one month, which of the following is true?

RUPIAH

Concerning your household's food consumption over the past one month, which of the following is true?

Concerning your household's total income situation over the past one month, which of the following is true?

Concerning your household's housing situation over the past one month, which of the following is true?

In your opinion, how much would your household need each month so that you can think of yourself as "not poor". Please approximate in cash the value of food and other goods you would need.

Concerning your children's education situation over the past one month, which of the following is true?

RUPIAH

What do you think, what amount of food and other goods did your household's have in the last month? Please approximate in cash the value of food and other goods.

What is the religion of this household?

Concerning your household's clothing situation over the past one month, which of the following is true?

PRINCIPAL RESPONDENT 85

SECTION 13: SUBJECTIVE WELLBEING PART C: VULNERABILITY

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

HIGH 1AVERAGE 2LOW 3

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

(13)

MONTHS

(14)

1ST ID CODE 2ND ID CODE 3RD ID CODE

(15)

1ST REASON 2ND REASON 3RD REASON1234567

ATE LESS FOODSWITCHED FROM RICE TO CORN OR OTHER FOODATE LESS MEAT/VEGETABLES

Which household members are affected the most by this shortage of food?

WRITE THE ID CODES IN ORDER OF IMPORTANCE, LISTING THE MOST AFFECTED FIRST. IF EVERONE AFFECTED THE SAME PUT "0"

ASK ONLY IF THE ANSWER TO QUESTIONS 1-12 INCLUDES A "3" FOR ANY OF THE MONTHS.

What actions did your household take to deal with not having enough food to eat. List up to three reasons, starting with the most important reason.

In the past twelve months, please tell me for each month, whether your family's consumption of food was high, average or low, where low indicates that your family did not have enough food to eat.

For how many months, in the past 12 months, did your household not have enough rice or maize to eat?

ASK ONLY IF THE ANSWER TO QUESTIONS 1-12 INCLUDES A "3" FOR ANY OF THE MONTHS.

BORROWED MONEY FROM FRIENDS/RELATIVESSOLD LIVESTOCK OR OTHER ASSETS TO PURCHASE FOODGOT FOOD AID FROM NGOS/OTHERSOTHER (___)

PRINCIPALRESPONDENT 86

1 2 3 4 5 6 7 8 9LOWEST STEP HIGHEST STEP

9 - STEP LADDER

87

(1)

AGEAG

01

02

03

04

05

06

07

08

09

10

11

12

ID CODE

NAME

NAME OF HOUSEHOLD MEMBERS

88

SECTION 1: HOUSEHOLD INFORMATION

1-3

*

*

*

*

4-22

WRITE DOWN THE NAME, SEX AND RELATIONSHIP TO THE HEAD OF HOUSEHOLD.

PERSON INTERVIEWED: PREFERABLY THE HEAD OF THE HOUSEHOLD. IF HE/SHE IS NOT AVAILABLE, FIND A “PRINCIPAL RESPONDENT” TO ANSWER THE QUESTIONS IN HIS/HER PLACE. THE PERSON SELECTED MUST BE A MEMBER OF THE HOUSEHOLD WHO IS ABLE TO GIVE INFORMATION ON THE OTHER HOUSEHOLD MEMBERS.

I would like to make a complete list of all the people who normally live and eat their meals together in this dwelling.

First, I would like to have the names of all the members of your immediate family, who normally live and eat their meals together in this dwelling. Start with the head of the household, wife/husband of household head, his/her children in order of age.

ALWAYS WRITE DOWN THE HEAD OF THE HOUSEHOLD FIRST, FOLLOWED BY HIS/HER SPOUSE AND THEIR CHILDREN IN ORDER OF AGE.

WRITE DOWN THE NAME IN CAPITAL LETTERS, SEX AND RELATIONSHIP TO THE HEAD OF HOUSEHOLD FOR EACH PERSON.

Please give me the names of any other persons related to the head of the household or to his/her wife/husband, together with their families, who normally live and eat their meals here.


Please give me the names of any other persons not related to the head of household or to his/her wife/husband but who normally live and eat their meals here. For instance, tenants, lodgers, servants or other persons who are not relatives.

Are there any other persons not now present but who normally live and eat their meals here? For example, any person studying somewhere else or who is on vacation or who is visiting other people?


FOR EACH PERSON LISTED IN QUESTION 1, ASK THE QUESTIONS 4-23. COMPLETE THE ENTIRE LINE BEFORE GOING ON TO THE NEXT PERSON LISTED.

Now I would like to have some information about each of the persons you mentioned.

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