Professional Documents
Culture Documents
CPH FORM 3 - Sample Household Questionnaire
CPH FORM 3 - Sample Household Questionnaire
Dear Sir/Madam:
The Philippine Statistics Authority (PSA) is conducting the 2020 Census of Population and Housing (2020 CPH)
to gather data on the demographic, socioeconomic, and housing characteristics of all persons, households, and institutional living
quarters (ILQ) in all barangays nationwide. These data will be used by government planners, policy makers, and administrators
in formulating their social and economic development plans, policies, and programs.
The conduct of the 2020 CPH is in accordance with Republic Act (RA) No. 10625 (Philippine Statistical Act of 2013), which authorizes the PSA
to prepare and conduct periodic censuses on population, housing, and other sectors of economy. Batas Pambansa Blg. 72
and Executive Order No. 352 also stipulate the conduct of a census of population and housing every ten (10) years.
Section 25 of RA 10625, states that all respondents whether natural or legal persons are obliged to provide TRUTHFUL AND
COMPLETE ANSWERS to the 2020 CPH. Hence, we are requesting you to please answer all the questions that will be asked by our
census interviewer. Rest assured that the data that you will furnish in this census shall be considered PRIVILEGED COMMUNICATION
and as such shall be inadmissible as evidence in any proceeding. Provisions on CONFIDENTIALITY OF INFORMATION are
stipulated in Section 26 of RA 10625 and Section 4 of Commonwealth Act No. 591.
Moreover, please be informed that Section 4(e) of RA 10173 (Data Privacy Act of 2012) states that data privacy does not apply to
“information necessary in order to carry out the functions of public authority which includes the processing of personal data for the
performance by the independent agencies of their constitutionally and statutorily mandated functions.”
We appreciate your utmost cooperation and support for the success of the 2020 CPH.
Thank you very much.
CITY/MUNICIPALITY
ENUMERATOR
SIGNATURE OVER PRINTED NAME
CAS/ACAS
SIGNATURE OVER PRINTED NAME HOUSEHOLD SERIAL NUMBER
NAME OF THE
CO/RSSO/PSO SUPERVISOR HOUSEHOLD HEAD
SIGNATURE OVER PRINTED NAME LAST NAME FIRST NAME
ADDRESS
DATE REVIEWED
(mm/dd) HOUSE/BUILDING NUMBER AND STREET OR SITIO/PUROK NAME
INTERVIEW RECORD
VISIT NUMBER 1 2 3 SUMMARY OF VISIT
DATE
MONTH/DAY (mm/dd) (mm/dd) (mm/dd) NUMBER OF VISIT/S MADE
TIME BEGAN
HOUR:MINUTE AM/PM AM/PM AM/PM
RESULT OF FINAL VISIT *
TIME ENDED
HOUR:MINUTE AM/PM AM/PM AM/PM
NUMBER OF HOUSEHOLD MEMBERS
RESULT
OF VISIT
CODES FOR THE RESULT OF VISIT NUMBER OF MALES
1 COMPLETED * 4 REFUSED
2 NOT YET COMPLETED 5 OTHERS,SPECIFY * NUMBER OF FEMALES
(FOR CALLBACK)
3 ENTIRE HOUSEHOLD
IS ABSENT/AWAY DURING ENUMERATOR’S CODE
THE ENUMERATION PERIOD *
MM
1 LAST NAME SPECIFY
MM
2 LAST NAME SPECIFY
MM
3 LAST NAME SPECIFY
MM
4 LAST NAME SPECIFY
MM
5 LAST NAME SPECIFY
MM
6 LAST NAME SPECIFY
FOR ALL PERSONS FOR ALL PERSONS 5 YEARS OLD AND OVER
Religious
L Citizenship Ethnicity Functional Difficulty
Affiliation
I
N
P9 P10 P11 P12 P13
E
What is Is ____ What What is ____’s The following questions ask about difficulties a person may have
N ____’s a citizen country/ ethnicity doing certain activities because of a HEALTH PROBLEM.
U religious of the other by descent/
M affiliation? Philippines? country blood relation/ Does ____ have any difficulty/problem in…?
B is ____ consanguinity?
E 1 YES, Filipino a citizen of? a b c d e f
R citizen Is he/she Seeing, Hearing, Walking Remembering Self-caring Communicating
2 YES, Filipino a/an ____? even if even or or (such as using his/her
with dual wearing if using climbing concentrating washing usual
citizenship glasses hearing steps all over (customary)
3 NO aid or dressing) language
MENTION THE
PREDOMINANT/
COMMON
INDIGENOUS
PEOPLES (IP) MENTION THESE CATEGORIES:
IF CODE “1”, OR NON-IP
GO TO GROUPS
ITEM P12. 1 – NO, 2 – YES, some 3 – YES, a lot 4 – Cannot
IN THE AREA.
no difficulty difficulty of difficulty do it at all
a b c d e f
REMARKS
3D POPULATION CENSUS QUESTIONS
GENERAL INSTRUCTIONS: 1. WRITE THE ANSWER/DETAILED DESCRIPTION ON THE LINES PROVIDED.
2. WRITE THE NUMBER OR CODE CORRESPONDING TO THE ANSWER IN THE BOX/ES.
3. REFER TO THE CODE BOOK FOR THE CODES IN ITEMS P14, P15, AND P19.
FOR ALL
FOR ALL PERSONS PERSONS
L FOR ALL PERSONS 5 YEARS OLD AND OVER
5 TO 24 YEARS OLD 15 YEARS OLD
I AND OVER
N
E Residence of Mother Residence
Highest Grade/ School Overseas
at the Time of Birth Five (5) Literacy Place of School
N of the Household Member
Year Completed Attendance Worker
Years Ago
U P14 P15 P16 P17 P18 P19 P20
M
B In what province In what province Can What is the highest Did ____ In what province Is ____
E and city/municipality and city/ ____ grade/year attend school and city/ an overseas
R did ____'s mother reside municipality read completed at anytime municipality worker?
at the time did ____ reside and write by____ ? from did ____ attend
of ____'s birth? on May 1, 2015? a simple June 2019 school? 1 Yes
2 No
message to May 2020?
in any
language
or 1 Yes
dialect? 2 No
REFER TO THE CODES
1 Yes AT THE BOTTOM
2 No OF THIS PAGE, EXCEPT
FOR THE CODES IF NO,
FOR SPECIFIC GO TO
COURSES. ITEM P20.
1
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY CITY/MUNICIPALITY
2
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY CITY/MUNICIPALITY
3
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY CITY/MUNICIPALITY
4
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY CITY/MUNICIPALITY
5
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY CITY/MUNICIPALITY
6
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY CITY/MUNICIPALITY
L FOR ALL PERSONS 15 YEARS OLD AND OVER FOR ALL FEMALE PERSONS 15 TO 49 YEARS OLD
I
N
E
Class
Usual Activity/ Kind of Business
of Place of Work Fertility Indicators
N Occupation or Industry
Worker
U
M P21 P22 P23 P24 P25 P26 P27 P28
B During the past In what kind What In what province How many From among From among What
E 12 months, of business kind and city/ children have the children the children was ____’s
R what was ____’s or industry of worker municipality been born who have who have been age at first
usual activity/ did ____work is ____? did ____ work
occupation? during the past during the past alive been born born alive marriage?
12 months? 12 months? to ____? alive to to ____,
IF THE ANSWER
MENTION
____, how how many
IN ITEM P21
IS STUDENT, THE many are were born
CATE-
HOUSEKEEPER,
GORIES still living? alive from
DEPENDENT
OR ENGAGED AT THE May 1, 2019 IF THE ANSWER
IN OTHER NON- BOTTOM. IN ITEM P8
GAINFUL ACTIVITY,
to April 30, (MARITAL STATUS)
IF NONE,
GO TO ITEM P25. WRITE “00” 2020? IS CODE “1”
(SINGLE),
LEAVE LEAVE AND GO TO LEAVE
THE BOXES BLANK. THE BOXES BLANK. ITEM P28. ITEM P28 BLANK.
PROVINCE
1
SPECIFY SPECIFY SPECIFY CITY/MUNICIPALITY
PROVINCE
2
SPECIFY SPECIFY SPECIFY CITY/MUNICIPALITY
PROVINCE
3
SPECIFY SPECIFY SPECIFY CITY/MUNICIPALITY
PROVINCE
4
SPECIFY SPECIFY SPECIFY CITY/MUNICIPALITY
PROVINCE
5
SPECIFY SPECIFY SPECIFY CITY/MUNICIPALITY
PROVINCE
6
SPECIFY SPECIFY SPECIFY CITY/MUNICIPALITY
ITEMS B1 TO B4 AND B7 ARE TO BE ANSWERED THROUGH OBSERVATION. IF DOUBTFUL, ASK THE RESPONDENT. CODE
B1 Type of building
1 Single house 6 Commercial/industrial/agricultural (e.g. office, factory, barn)
2 Duplex 7 Institutional living quarter (e.g. hotel, hospital, convent, jail)
3 Apartment/accessoria/rowhouse 8 Other types of building (e.g. bus/trailer, boat, tent),
4 Condominium/condotel SPECIFY ________________________GO TO ITEM H5.
5 Other multi-unit residential 9 None (e.g. homeless, cart), END INTERVIEW.
01 Concrete/brick/stone 06 Asbestos
02 Wood 07 Glass
03 Half concrete/brick/stone and half wood 08 Makeshift/salvaged/improvised materials
04 Galvanized iron/aluminum 09 Others, SPECIFY _______________________________
05 Bamboo/sawali/cogon/nipa 10 None
CODE
H3 Source of financing of the housing unit
Did this household avail of the following sources of financing in the construction/purchase of this housing unit?
WRITE CODE “1” IF THE ANSWER IS “YES”; OTHERWISE, WRITE CODE “2” IF THE ANSWER IS “NO”.
THEN GO TO ITEM H5.
a) Own resources/interest-free loans from relatives/friends
b) Government assistance, PAG-IBIG, GSIS, SSS, LBP, and others
c) Private bank/foundation/cooperative
d) Employer assistance
e) Private persons
f) Others, SPECIFY _________________________________________________________________________
b) Agricultural land/s
CODE
H12 Presence of operator in crop farming, livestock and/or poultry raising, aquaculture, fishing,
and other farm/activity
In 2019, is there any member of this household who operated a/an…?
a) Crop farm
b) Livestock and/or poultry farm
c) Aquafarm
d) Fishing activity
e) Other farm/activity, SPECIFY _______________________________________________________________
a) Refrigerator/freezer
b) Stove with oven/gas range
c) Microwave oven
d) Washing machine
e) Air conditioner
f) Electric fan and other cooling equipment
ICT devices
g) Radio/radio cassette (AM, FM, and transistor)
h) Television
i) CD/DVD/VCD player
j) Audio component/stereo set/karaoke/videoke
k) Landline/wireless telephone
l) Mobile phone
m) Tablet
n) Personal computer (desktop, laptop, notebook, netbook, and others)
Vehicles
o) Car/van/jeep/truck
p) Motorcycle/motor scooter/tricycle
q) Bicycle/pedicab
r) Motorized boat/banca
s) Nonmotorized boat/banca
a) Fixed (wired) narrowband/broadband network [e.g. via Digital Subscriber Line (DSL), cable modem,
high speed leased line, fiber-to-the-home/building, powerline, and other fixed (wired) broadband]
b) Fixed (wireless) broadband network [e.g. via WiMAX and fixed Code Division Multiple Access (CDMA)]
c) Satellite broadband network
d) Mobile broadband network [e.g. via handset, card (e.g. integrated Subscriber
Identity Module or SIM card) or USB modem]