ANTIGUA AND BARBUDA Questionnaire and Survey Methodology

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ANTIGUA AND BARBUDA
Survey of Living Conditions and Household Budgets
2005
Questionnaire
and
Survey Methodology
U n itko N ations
Econom ic C om m ission for L atin America and the Caribbean
Subregional H eadquarters for the Caribbean
E C L ñ C
i
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005
2
LIMITED
LC/CAR/L.200
26 June 2009
ORIGINAL: ENGLISH
Questionnaire and Survey Methodology
Antigua and Barbuda
Survey of Living Conditions and Household Budgets 2005
This document has been reproduced without formal editing.
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005____________3
TABLE OF CONTENTS
IN T R O D U C T IO N ............................................................................................................................ 5
CH A PTER 1
SURVEY M E TH O D O LO G Y .........................................................................................................6
CH A PTER 2
COM PONENTS OF THE SURVEY Q U ESTIO N N A IRES.................................................... 8
HOUSEHOLD SCHEDULE.........................................................................................................8
Survey Information sheet........................................................................................................... 8
Section 1 : Housing Characteristics and physical living conditions...................................8
Section 2: Expenditure on accommodation; repair and maintenance o f dwelling
8
Section 3 : Major types o f household expenses.................................................................... 9
Section 4: Furniture, furnishings and household equipment.............................................. 9
Part 1- Furniture, furnishings and household equipm ent...................................................... 9
Part 2 - Repairs and servicing o f household articles.............................................................. 9
Section 5: Agriculture products produced and consumed at home.................................. 10
Section 6: Transportation.......................................................................................................10
Section 7: Regularity o f purchase and main type o f outlet............................................... 10
Section 8: For heads o f household only............................................................................... 10
Section 9: For household members who have moved out o f the household in the past 5
years............................................................................................................................................ 10
Section 10: For children under the age o f 5 years..............................................................11
INDIVIDUAL QUESTIONNAIRE............................................................................................11
Section 1 : Characteristics (for all persons)......................................................................... 11
Section 2: Migration (for all persons)................................................................................. 11
Section 3 : Health (for all persons)........................................................................................ 11
Section 4: Education (for all persons)................................................................................. 12
Section 5: Employment (for persons 15 years and over)...................................................12
Section 6: Marital, union status and fertility (for persons 15 years and over)................12
Section 7 : Crime..................................................................................................................... 13
Section 8: Clothing and footwear consumed during the past 3 m onths.......................... 13
Section 9: Other Expenses.....................................................................................................14
Section 10: Other disbursements............................................................................................14
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005____________4
Section 11 : Income................................................................................................................ 14
ANNEX.............................................................................................................................................16
Survey Questionnaires................................................................................................................ 16
B IB L IO G R A P H Y .........................................................................................................................57
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005
5
INTRODUCTION
This manual documents some of the material related to the Survey of Living
Conditions and Household Budgets (SLC/HBS) conducted in Antigua and Barbuda by the
Kairi Consultants Limited and National Assessment Team between 2005 and 2006.
The SLC/HBS is a sample survey which generates data on households and individuals
in the country. The main objectives o f this survey were (i) to collect information from
households on their expenditure patterns, income and other characteristics and; (ii) to revise
the 'average shopping basket' used in constructing the Consumer Price Index (CPI) for the
country, and the relative weights o f the items in the basket. The survey also provided
valuable data for an assessment o f the impact o f socio-economic policies on the living
conditions o f the resident population in Antigua and Barbuda. Further, data on households
gathered in the survey also provide valuable inputs for the compilation o f the country's
National Accounts statistics relating to the household sector.
This manual was developed by the Economic Commission for Latin America and the
Caribbean (ECLAC) - Subregional Headquarters in the Caribbean as a supplementary
document for the Caribbean Household Surveys Database (CHSD). The main components of
this manual include survey methodology and the questionnaires used for data collection.
The latter are included in the annex at the end o f the document. All information contained
therein was provided by the Statistics Division.
The ECLAC Subregional Headquarters for the Caribbean is pleased to acknowledge
the Antigua and Barbuda Statistics Division for graciously consenting to the use o f their
surveys and metadata under the project Improving Caribbean Household Surveys. Due
recognition must also be given to the Statistics and Economics Projection Division at ECLAC
(Santiago) who provided guidance in the standardization o f the datasets and the creation of
the Caribbean Household Surveys Databank.
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CHAPTER 1: SURVEY METHODOLOGY
The following text outlines the survey methodology used for the National Survey of
Living Conditions and Household Budgets (SLC/HBS) 2005/ 2006 for Antigua and Barbuda.
The full text below was extracted from Chapter 2 o f the Main Report - Living Conditions in
Antigua and Barbuda: Poverty in a Services Economy in Transition (Volume 1) which was
prepared by Kairi Consultants Limited. The Statistics Division o f Antigua and Barbuda
approved the use o f this report by ECLAC under the project - Improving Caribbean
Household Surveys.
The combined Survey o f Living Conditions and Household Budgetary Survey
(SLC/HBS) 2005/2006 was a comprehensive survey which combined a Survey o f Living
Conditions (SLC) with a survey o f household income and expenditure.
This survey had two main objectives: first, it was designed to collect information from
households on their buying habits (expenditures), income and other characteristics. The
survey also allows data users to relate the expenditures and income o f consumers to the
characteristics o f the consumers and their households. This type o f survey may also be used
for the purpose o f revising the list and weighting patterns o f the CPI (Consumer Price Index)
basket, the price o f which is monitored over time to estimate changes in overall prices in the
economy1.
In addition, this survey provided:
■ Valuable data for an assessment o f the impact o f socio-economic policies on the
conditions under which residents live;
■ Inputs for the compilation o f national accounts based on the household sector;
■ Statistics on the distribution o f income and expenditure, which helps to determine the
percentage o f the wealth owned by each income group.
■ Information on the characteristics and expenditure patterns o f the poor, compared to
other groups in the society.
■ Information on household consumption o f various goods and services, including
publicly provided services such as health and education.
The sample for the SLC/HBS 2005/2006 in Antigua and Barbuda was selected from a
sample frame derived from the 2001 census o f population and represents 5.1 percent o f the
population.
For convenience, both in selecting the sample and for field enumeration, a two stage
stratified systematic random sample selection process was used. At the first stage,
Enumeration Districts (EDs) were selected based on a sampling frame constructed from
1 A change in the Consumer Price Index (CPI) is sometimes referred to as “the inflation rate" and is a key macroeconomic indicator. The
“inflation rate" measures the changes in the purchasing power of money and is closely monitored by economic planners, policy makers,
the business community and labour unions.
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005
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Census Enumeration Districts; in the second stage, households were randomly selected from
the EDs with interval and probability proportional to size.
The sample for the SLC/HBS 2005/2006 was large enough to allow the computation of
poverty indicators (that is, the headcount and FGT indicators) by District. The sample for
Barbuda was doubled to ensure that accurate results could be reported for that district given
its small size and its distinctive nature, as a separate island. Breakdowns o f these indicators at
a sub-district level would not result, however, in reliable estimates and do not constitute part
o f the analysis.
The sample frame was divided into eight (8) domains or sub-populations based on
demographic data on the distribution o f the population in the 2001 Population and Housing
Census:
No.
1
2
3
4
5
6
7
8
District
St. John’s City
St. John’s Rural
St. Paul
St. Mary
St. George
St. Peter
St. Philip
Barbuda
Table 1: Domains of Study in the
SLC/HBS 2005/06
The Survey required households to complete a household questionnaire, individual
questionnaires for each member o f the household, and diaries o f expenditure for each adult
member o f the household.
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CHAPTER 2: COMPONENTS OF THE SURVEY
QUESTIONNAIRES
The survey instrument for the SLC/HBS comprised two components:
(i)
the household schedule and;
(ii)
the individual questionnaire.
HOUSEHOLD SCHEDULE
The Household Questionnaire collected information from a sample o f households
drawn from a sample frame derived from the 2001 population census. This questionnaire
was administered to the head o f the household/ adult member o f the household and gathered
information on characteristics o f the household as well as household income and expenditure.
The questionnaire was sectioned out as follows:
Survey Information sheet
The survey information sheet was the first section o f the questionnaire which recorded
information about the household and technical information related to the interview. The
specific items included:
(i)
household identification codes (enumeration number, household number);
(ii)
particulars o f the household (address, telephone number, household size,
household roster);
(iii)
particulars o f the interviewer (name, number) and;
(iv)
information related to the interview (date, length o f interview, duration).
Section 1: Housing Characteristics and physical living conditions
This section captured information on housing conditions and household assets. The
questions in this section related specifically to the aspects o f housing listed below:
2.1:
2.2:
2.3:
2.4:
2.5:
2.6:
2.7:
2.8:
Type o f dwelling unit
Construction material o f outer wall
Main roo fing material
Tenancy o f the dwelling
Main fuel for cooking
Type o f toilet facility
Main water source
Lighting/ Main source o f energy
Section 2: Expenditure on accommodation; repair and maintenance o f dwelling
This section was subdivided into three parts and captured information on the
household’s expenditure on the dwelling. A filter question was used at the start o f the section
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to determine which sections applied for the household. [Filter: In the past 12 months did you
own or rent your dwelling?]
■ Questions in part 1 are related to owner occupied dwellings.
■ Questions in part 2 are targeted at persons who purchased property or constructed in
the survey year.
■ Questions in part 3 are for households who rented a dwelling for all or part o f the
survey year.
This section also contained a series o f questions to assess the expenditure incurred by
the household on building materials and labour for the purpose o f repairing or maintaining
the dwelling.
Section 3: M ajor types o f household expenses
The expenses recorded in this section pertain to major expenses that are incurred on
monthly basis.
The first set o f questions focused on expenses incurred by the household for basic
amenities such as water, electricity, sewage, telephone etc. The questions in the next
sub-section assessed expenses incurred for other services delivered to the household e.g. the
costs associated with employment o f maids, child care outside o f the home, care o f the
disabled/ elderly and cable / internet services etc.
Section 4: Furniture, furnishings and household equipment
Part 1- Furniture, furnishings and household equipment
In this section, the questionnaire captured information on all items purchased or
received as a gift by anyone in the household over the past 12 months. The broad categories
o f furniture and furnishings in that schedule included:
Living or recreation room
Kitchen furniture
Patio and outdoor furniture
Lighting equipment
Carpets
Furnishing material
Towels and table linen
Major laundry appliances
Other major household appliances
Telephone equipment
Miscellaneous equipment
Garden Tools
Dining room furniture
Bedroom furniture
Decorative furnishings
Other furniture
Other floor covering
Beddings
Major kitchen appliances
Major cleaning appliances
Small electronic household appliances
Cutlery, flatware, silverware
Gas powered tools
Small electrical accessories
Part 2 - Repairs and servicing o f household articles
The questions in this subsection were centred on expenses incurred by any member of
the household for the repair and servicing o f pieces o f equipment listed in the schedule.
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Section 5: Agriculture products produced and consumed at home
The questions in this section captured data on home-grown produce for the last
month. This produce included home grown vegetables, ground provisions, meat, poultry, fish
and dairy product consumed by the household. The household reference person had to
estimate the amount in pounds as well as the market value o f the produce even if no monetary
transactions would have taken place.
Section 6: Transportation
Part 1: The initial question in this section assessed ownership o f and access to
vehicles by members o f the household. Respondents needed to declare the type o f vehicle, its
age and purchase price. In addition, for vehicles that had a dual purpose i.e. they were being
used for both private and business purposes, respondents had to record the percentage of
private or household use o f the vehicle along with the percentage o f business use.
Part 2: This subsection captured information on the operation costs associated with
the maintaining the vehicle. Thus for each vehicle, respondents needed to estimate their
expenses for a list o f vehicle-related costs in the questionnaire.
Section 7: Regularity o f purchase and main type o f outlet
The aim o f this section was to gather information on the main store or outlet used by
the household to make purchases o f goods and services. The reference period for this
question was the last 12 months.
Section 8: For heads o f household only
The four questions in this section were all targeted at the head o f the household and
sought to make some connection between the between the present head o f household and the
household in which he/ she grew up. Questions assessed aspects such as:
(i)
the size o f the household in which the respondent grew up;
(ii)
the highest level o f education completed by his/ her mother and father and;
(iii)
the respondents’ perception on whether or not he/ she is better off than his/
her parents.
Section 9: For household members who have moved out o f the household in the p a st 5
years
The questions in this section captured information on migration from the household
over the past 5 years. The key characteristics determined here were the person’s age, sex,
relationship to the head o f the household and the highest grade attained prior to departure.
The specific aspects o f migration that were collected included how long ago the person left,
the reason for leaving and the area to which the person moved. Additionally, information on
the amount o f money sent (remittances) by the migrant as a contribution to the household was
sought here.
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Section 10: For children under the age o f 5 years
This section was designed to capture information on children under the age o f 5 years.
Information sought here included the child’s date o f birth and particulars on the birth
delivery, post-natal care and vaccination characteristics.
INDIVIDUAL QUESTIONNAIRE
The individual questionnaire collected data on all members o f the household listed on
the roster on some thematic areas. Not all items on the questionnaire applied to all members.
Thus, the specific individual (s) to which each section was intended is indicated in brackets.
Section 1: Characteristics (for all persons)
This section captured details on members o f the household listed on the roster. It
sought primarily demographic information on the household members however two items
that measure the use o f ICTs were also included.
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Relationship to the head o f the household
Gender/ sex
Age (at last birthday) and date o f birth
Ethnic/ racial or national group
Religion
Mobile phone and amount spent on phone bills in the past month
Access to the internet
Section 2: Migration (for all persons)
This section captured data on citizenship and migration. Specific items were used to
pinpoint the citizenship o f the respondent as well as the mother’s citizenship and also sought
information on the permanency o f residency o f both mother and respondent in Antigua and
Barbuda.
Section 3: Health (for all persons)
This section captured data on the health o f the population in terms o f their affliction to
chronic illness and other lifestyle diseases. It also examined issues related to health care and
services provided by both private and public health institutions in terms o f the cost and
quality o f the services and satisfaction with the services provided.
3.1 - 3.4:
3.5 - 3.7:
3.8:
3.9 - 3.14:
3.15 -3.17:
3.18 - 3.27:
Severity o f Illness/ injury and nature o f illness/ injury
Lifestyle diseases
Number o f work days lost due to illness
Access and visits to health services/ facilities
Satisfaction with health services
Amount spent on health care/ services
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005
3.28:
12
Health Insurance
Section 4: Education (for all persons)
The questions in this section were targeted primarily at children attending school or
classes. It assessed the education services provided in terms o f quality, access to education
services and other support programmes such as book lending schemes and school feeding
programmes. A few items in this section were targeted to adults over the age o f 15 years.
These questions examined the highest level o f education completed by those respondents as
well as the qualifications attained.
4.1 - 4.8:
Enrolment and Attendance
4.9 - 4.10: Mode and distance travelled to school
4.12 - 4.18: School feeding and text book programmes
For persons not attending school at present
4.19 - 4.22: Reasons for not attending school and particulars about schooling
4.23 - 4.25: Educational Attainment
Section 5: Employment (for persons 15 years and over)
This section tried to determine the employment characteristics o f persons 15 years of
age and older. The questions assessed the respondent’s economic activity status and
categorized them as employed, unemployed or out o f the labour force. The first question in
that section was the filter question for that section [Filter: How many months did he/she work
in the last 12 months?]
5.1b - 5.4:
5.5 - 5.7:
5.8:
5.9:
5.10:
5.11 - 5.12:
Activity status
Employment Status
Occupation
Industry/ Sector o f employment
Category o f worker
Income/ earnings from informal work
5.13 - 5.18: For persons who did not work or do anything to earn an income in the last
week
Section 6: Marital, union status and fertility (for persons 15 years and over)
This section contained questions on marital status, union status, fertility and family
formation. The questions applied exclusively to persons 15 years and over.
6.1:
Union Status
For females 15 - 49 years
6.2 - 6.9:
Fertility, prenatal care, birth and deaths
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Section 7: Crime
This section solicited information from the household on criminal activity and the
impact o f criminal activity on persons in the household.
7.1:
7.2:
7.3 - 7.5:
Whether any member o f the household had been a victim o f crime in the last
12 Months
The nature o f the crime and impact (financial) on the member o f the
household
Whether or not it was reported to the police and level o f satisfaction with
handling
Section 8: Clothing and footwear consumed during the past 3 months
This section required consumption information on articles o f clothing and footwear
for the past 3 months. For the list o f items, respondents were required to supply details of
the quantity purchased and the total cost incurred. Items under this section first had to be
declared as either “purchased” or “homemade”. In the case o f the latter, respondents had to
also record the quantity and estimate the market value o f the item.
The items listed in this section by broad categories were:
Material for men and boy’s garments
Material for women and children garments
Men’s garments - outer wear
Men’s underwear and hosiery
Other articles o f men’s clothing
Boy’s outer wear
Boy’s under garments and hosiery
Boy’s school garments
Other articles o f boys clothing
Women’s outer wear
Women’s underwear
Other women’s clothing and clothing accessories
Girls outer wear
Girl’ underwear and hosiery
Girl’s school garments
Infants (under 1 yea) clothing and clothing accessories
Dry cleaning, laundering and drying o f garments
Repairs and alterations
Men and boy’s shoes (16 years and over)
Women and girls shoes (16 years and over)
Infants and children shoes (up to 16 years )
Shoe repair
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Section 9: Other Expenses
The questions in this section were used to compile information on expenses on a range of
items and services under the following broad categories:
-
Medical expenses
Educational expenses
Entertainment expenses
Transportation by air
Transportation by boat
Personal and other expenses
For all categories respondents had to indicate the amount o f money spent. However,
for some categories additional information on the quantity had to be specified. The reference
period for this section was the last 3 months.
Section 10: Other disbursements
This section gathered information on disbursements made by the spender for non­
consumption items over the last month. The major categories under non-consumption
expenditures related to expenditure incurred on a monthly basis on income taxes, life
insurance premiums, hire purchase instalments, allowances to children, national insurance
payments etc. An additional subsection was included to cover disbursements on other
consumption expenditures. As the categories under this subsection related to investment type
items, the reference period was the last twelve months. The major categories included credit
union shares, bank deposits, treasury bills, stocks etc.
Section 11: Income
This section required information on income. For this, the section was subdivided
into two sub-sections. The first related to income from employment and the second sought
information on income from other sources.
Part 1 : Income from employment
Respondents were required to state gross income for the last pay period, before
income tax or other deductions from both the main job and a secondary job if it applied.
Additional questions in this section also attempted to determine how regularly that income
was received.
Part 2: Other Income sources
Respondents were required to state the amount o f income received from other income
sources such as:
Remittances from abroad
Rental for house, land or other property
Other entrepreneurial income e.g. self employment
Dividends on local and foreign investments
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005
Interest on local and foreign bank deposits
Government retirement pension
Pension from other employer outside o f Antigua and Barbuda
Pension from foreign employer
Social security (excluding retirement pension)
Insurance annuities
Public assistance
Child support
Allowances - alimony, financial aid, scholarships
Interest from stocks, shares, treasury bills and other investments
All other income
15
Antigua and B arbuda —Survey o f Living C onditions and H ousehold Budget 2005____________ 16
ANNEX
SURVEY QUESTIONNAIRES
EI
9226
5
ANTIG UA AND BARBUDA
SURVEY OF LIVING CONDITIONS AND
HOUSEHOLD BUDGETS 2005
H ousehold S chedule
▼
For optimum accuracy, please print carefully
and avoid contact with the edges of the box.
The following will serve as an example:
ABC
DEF
GHI
IMPORTANT!!! Place an X in the
box fo r m ultiple choice options
Subsample No
O »
J K L M N O P Q R S T U V W X Y Z
BUILDING NO
ja
USE ONLY 2B PENCIL
IM P O R T A N T !!!
Replicate letter
Transfer these codes to
-
_____
in dividu al questionnaire
[>
R em em b er to p u t the lookup fo r each ED and
H ousehold on a ll o f the questionnaires so you
do n o t have this problem linking the
household, person an d diary questionnaires
Address of Household:
Telephone number
Interviewer No
INTERVIEWER'S NAME^_
SUPERVISOR'S NAME:__
Household (HH) size
EDITOR/CODER'S NAME:
Confidential
LIS TIN G OF H O U S E H O L D M E M B E R S
S u rnam e
F irst Nam e
S urnam e
01
□
02
□
First Nam e
11
□
12
□
v>
03
13
! □
3
C
04
.52 □
14
.52 ,
c D
15
<u
0
05
! □
06
! □
Ç
X
07
ZD
S
16
!□
<D
17
Q.
«2
08
□
18
□
09
□
19
□
10
□
20
□
Confidential
INTERVIEW ER RESULTS
Interview Calls
1
Date (DD/MM/YY)
/
/
Time Started
0
Duration
*Results
5
2
3
4
*RESULTS CODES: 1 = Completed
2 = Partially Completed
3 = Refused
4 = No Suitable respondent at home 5 = No Contact
6=
Vacant
Statistics Division, 1st Floor, A C T Building, Church and M arket Streets, St. John's, A n tigua and Barbuda, Tel No: 1 268 462 4775
Confidential
Confidential
P age 1 o f 20
EH
SECTION 1 - HOUSING
19226
H2.
Page 2 o f 20
H3.8 In which year was this dwelling built?
H2.1 What type of dwelling does this household occupy?
□ 1 Before 1970
□ 7 2002
□ 1 Undivided private house
□
5
Double house/Duplex
□ 2 1970 - 1979
□
□ 2 Part of a private house
□ 3 Flat, apartment, condominium
□
6
Combined business & dwelling
□ 3 1980 - 1989
□ 9 2004
□ 4 1990 - 1995
□ 10 2005
□ 5 1996 - 2000
□ 11 Don't Know
□ 7 Barracks
□ 4 Townhouse
□ 8 Other
H2.2 What is the construction material of the outer walls?
□ 1 Wood/Timber
□ 5 Brick/Blocks
□ 2 Concrete/Concrete Blocks
□ 3 Wood & Concrete
□ 4 Stone
□
8
2003
6 2001
H3.9 How many rooms does your dwelling unit contain?
(Do not count bathrooms, porches, kitchens, laundry rooms etc.)
Number of Rooms
□
6
Plywood
^
8
Other/Don't Know
□ 7 Makeshift (Specify...................................... )
H2.3 What is the material used for roofing?
□ 1 Sheet metal (galvanize, galvalume)
H3.10 How many are used
□
5
Tile
□ 2 Shingle (asphalt)
□
6
Concrete
□ 3 Shingle (wood)
□ 7 Makeshift/thatched
□ 4 Shingle (other)
O 9 Don't know
□
8
1.
Other (Specify............................................ )
2
.
Solely as bedrooms?
3. Rented or
sub-letted?
Used for business?
4. Vacant?
H2.4 Does the household own the land beneath the dwelling?
□ 1 Owned with title
□ 4
□ 2 Family Owned
□ 5Squatting
Leases the land
□ 3 Rents the land
□
6 Not
H3.11 How do you compare the overall economic situation of the
household with one year ago?
□ 1 Much worse now
□ 4 A Little better now
Owned
H3.
H3.1 Does this household own,rent or lease this dwelling?
□ 1 Owned (with mortgage)
□
5
□ 2 Owned (Without mortgage)
□
6
Rentfree
7
Squatted
□ 3 Rented-Furnished
□ 4 Rented-Unfurnished
□
8
n
□ 2 A Little worse now
D 5 Much better now
□ 3 Same
□
6
Don't know
H3.12 On a scale of 1 to 5, where 1 is poor and 5 is rich how would
you rate your household?
Leased
□ 1
□2
□3
□ 4
□ 5
H4.
H4 . 1 Indicate how m any of each of the following items is owned
by all household members? (W rite "0" where there is none)
Number
Other (please specify.........................)
H3.2 What type of fuel does this household use most for cooking?
D
□
2
Coal
Wood
n
3
Gas/LPG/Cooking gas
1
1.
□ 4 Kerosene
□ 5 Electricity
Q
6
Other (please specify....................... )
2
Telephone - Land Line
. Telephone - Cellular
H3.3 What type of toilet facilities does this household have?
3. Television
□ 1 W.C. (flush toilet) linked to sewer
□ 2 W.C. (flush toilet) linked to Septic tank/Soak-away
□ 3 Pit-latrine
4. Video/VCR
□ 4 Ventilated Pit-latrine
□ 5 Other (please specify............................................ )
□
6
None
H3.4 Does your household share any of the following facilities with
another household?
□ 1 Kitchen
□ 4 Any combination of 1, 2 or 3
□ 2 Toilet / Bathroom
□ 5 None
□ 3 Water
□
Other (please specify......................)
6
5. DVD Player
6
. Electric/Gas Stove
7. Electric Iron
8
. Refrigerator/Freezer
H3.5 What is the MAIN source of your water supply?
□ 1 Public, piped into dwelling
□
□ 2 Public, piped into yard
□ 5 Private, piped into dwelling
□ 3 Public standpipe
□
4
6
Public well/tank or truck
Private catchment not piped
10. Washing Machine
□ 7 Private catchment piped
□
8
Other (please specify.....
.. )
If response is 1 o r 2 to H 3 .5 continue, otherw ise skip to H 3.7
H3.6 In the past twelve months, how many days on average per week do
you have water in your pipe?
□
Days
1
Gas
□
2
Kerosene
11. Motor Vehicle
12. Computer (laptop, desktop)
13. Sewing Machine
e n te r 8 fo r "D o n t K n o w " a n d 9 fo r "Not S tated"
H3.7 What type of lighting does this household use most?
O
9. Radio/Stereo/CD Player
□ 3 Electricity - Public
14. Water Tank
□ 4 Electricity - Private Generator
□
5
Other (please specify...............
□
6
None
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
15.
Cisterns
16.
Weed Eater/Lawn Mower|_
□
P age 2 o f 20
■ EH
SECTION 2 - EXPENDITURE ON ACCOMMODATION
|
INTERVIEWER: F o r each o f the fo llo w in g q u e stio n s w here an an sw e r is not ap plicable leave blank. If an
an sw e r is applicable bu t un know n p u t 9's fo llo w e d b y 8 in the last p o sitio n . F o r en tries n o t stated make
an e ffo rt to ob tain an answer. If th is is n o t p o ssib le p u t 9's in the boxes provided. A ll en tries are annual
un le ss oth erw ise stated and sh o u ld be rounded to the nearest $
FILTER: In the past twelve months did you own or rent your dwelling?
□ 1 Own (Continue)
□ 2 Both (Continue)
□ 3 Rent (Go to PART 3)
19226
PART 1 - O W N E R O C C U P IE D A C C O M M O D A TIO N
CODE
1 House taxes----------------------------------------
0423103
Other property taxes, eg. Land Tax
2
0423102
1.2
What is the annual rent or lease for the land on which the house is built?
0411201
1.3
How much Insurance premium is paid on this dwelling annually ?
1252101
1.4 Is any part of this dwelling rented?-------------------1.5
A m o un t ($)
How much is paid annually for the following:
1.1
□ 1 Yes
f No, go to 1.6
□ 2 No
What amount do you receive monthly for rental/sub-letting: for any or all of the
following purposes:
1
Furnished/Partly furnished (household accommodation)
1800501
2
Unfurnished (household accommodation)
1800502
______________________________________________________
1800503
1.6 How much rent would you charge m onthly if you were to rent this accommodation
0421101
1.7 What is the estimated market value of the dwelling unit currently occupied by
this household?___________________________________________________
1900104
3 Business
1.8 Do you make mortgage payments for this dwelling?______ ^ 1 Yes
^ 2 No
f No, go to 2.1
Check H 3 .1 then an s w e r this question
1.9 What is the monthly mortgage payments for this dwelling.?___________________
PART 2
1900105
A m o un t ($)
P R O P E R TY B O U G H T/C O N S T R U C T E D IN S U R V E Y Y EA R
Yes, Continue
If no, go to Q3.1
2.1 Did you purchase/construct this dwelling unit during the past 12 months?
□ 1 Yes
□ 2 No
2.2 If purchased, was the dwelling unit bought new or was it previously occupied?
□ 1 New
□ 2 Used
Please state the following:
2.3 Purchase price or construction cost_________________________________
1900101
2.4 Duration of mortgage
1900102
2 .5
Amount of mortgage
After Q2.5 go to Q3.1
Years
1900103
PART 3 - R EN TED A C C O M M O D A TIO N
IN T E R V IE W E R : If th e fa m ily o c c u p ie d a re n te d d w e llin g fo r a ll o r p a rt o f th e s u r v e y y e a r, c o m p le te th is s e c tio n
A s k question if household has been renting fo r all o r p a rt of the last tw elve m onths
3.1
State amount paid for monthly rent________________________________
3.2
Is any part of this dwelling unit sub-letted?
3.3
State monthly receipts from sub-letting or renting
3.4
0411100
□ 1 Yes
Furnished/Partly furnished
1800801
Unfurnished_________________________
1800802
Business
1800803
If rent includes meals, estimate approximately the monthly value of meals
O 2 No
if No, go to 4.1
1800901
P age 3 o f 20
SEC TIO N 2 - R EP A IR A ND M A IN TEN A N C E OF D W ELLIN G
19226
4 .1
D u r in g t h e p a s t 1 2 m o n t h s h a v e y o u in c u r r e d a n y e x p e n d i t u r e o n a n y o f th e f o l l o w i n g it e m s f o r
t h e p u r p o s e o f r e p a ir in g a n d m a in t a in in g t h e a c c o m m o d a t i o n o c c u p ie d b y y o u r h o u s e h o ld .
N o te :
E x c lu d e a n y e x p e n d i t u r e s o n m a jo r a d d i t i o n s a n d im p r o v e m e n t s w h ic h a d d t o t h e v a l u e o f th e
p r o p e r t y , e . g . b u il t a n e w w a ll, b u ilt a r e t a in in g w a ll, e t c . A ls o , e x c lu d e e x p e n d i t u r e o n d a m a g e s
c a u s e d b y e x t r a o r d i n a r y e v e n t s , e . g . h u r r ic a n e , fir e , e tc .
N o t applicable
Leave B lan k
N o t Know n
9's ending in 8
A m o u n t too large 9's ending in 7
N o t Stated
Try harder, if n o t use a ll 9's
E v e n if r e n t e d , p r o b e f o r r e p a ir a n d m a in t e n a n c e e x p e n s e s .
□ 1 Yes (Complete Q 4.1)
□ 2 No (Go to Q 4.2)
R EP A IR A ND M A IN TEN A N C E
Y/N
M aterials (excluding labor)
□ Yes
1. P ainting e.g. paints, varn is h e s , bru s h e s and scra pers
□ No
2. M a s o n ry e.g. C em e nt, sand and lim e
0431401
□ Yes
□ No
6
0431301
□ Yes
□ No
5 . E le c tric a l e .g . sw itches, w ires, fu s e bo xes
0431201
□ Yes
□ No
4 . P lum bing e .g . pipes, taps, jo in ts e tc .
0431101
□ Yes
□ No
3. C a rp e n try e.g. W o o d e n planks, plyw ood etc.
CODE
0431501
□ Yes
. O th e r m a terials
0431801
□ No
L abo r excluding m aterials costs
□ Yes
7 . P ainting, ou tsid e and inside (in c lu d in g roof)
□ No
8
. P lastering and M asonry, e .g . repairin g w alls, flo o rin g etc.
0432101
□ Yes
0432102
10. P lum bing, e .g . replaced w a te r pu m p etc.
□ Yes
0432103
0432104
. E lectrical, re placed w irin g etc.
□ Yes
0432105
□ Yes
. A ll o th e r service s
0432199
□ Yes
In the past twelve months, did the physical structure of your
dwelling suffer any damage caused by extra-ordinary events (e.g.
hurricane, flooding, landslide, fire, earthquake etc.?
□ 1 Yes
4.5
J
J
□ 3 Windows or Doors
□ 4 Floors □ 5 Other
4.4 How much have you paid to repair these damages?
■
$
1
J
How were these repairs funded and at
(Fill in all that apply)?
□ 1 Out of Pocket
$
□ 2 Insurance Claim
$
□ 2 No (if no, go to 5.1)
□ 2 Walls
1
J
4.3 Can you tell me the nature of the damage? (select all that apply)
□ 1 Roof
1
J
J
□ No
4.2
1
1
1
1
1
J
□ No
13. T O T A L E X P E N D IT U R E
J
J
□ No
12
1
J
□ No
11
J
J
□ No
□ Yes
u□□ □□□
u□□ □□□
u□□ □□□
u□□ □□□
u□□ □□□
u□□ □□□
u□□ □□□
u□□ □□□
u□□ □□□
□□□ □□□
□□□ □□□
□□□ □□□
□□□ □□□
1
J
□ No
9 . C a rp e n try e .g . repairin g o f doors, w indo w s, ro ofs and
c eiling s e tc .
$ AM O U N r
□ 3 Relatives and friends $
□ 4 Government Support $
□ 5 Other
$
P age 4 o f 20
1
S EC TIO N 3 - M A JO R T YP E S OF H O U S E H O L D E X P E N S E S
19226
N o t applicable
Leave Blank
N o t Know n
9's end ing in 8
A m ou nt too large 9's ending in 7
N o t Stated
Try harder, i f n o t use a ll 9 's
A S K T H E H O U S E H O L D R E F E R E N C E P E R S O N I N I T I A L L Y A N D O T H E R M E M B E R S IF N E C E S S A R Y
PLEASE WRITE CLEARLY AND LEGIBLY
A m o un t ($)
H O W M U C H W A S S P E N T O N T H E S E R V IC E S L IS T E D B E L O W
5.1
How much did you spend during the last 3 months on gas for cooking? e.g. propane, butane cylinders
0452101
5.2
How much were you billed for water in the last last month (exclude balances from previous bills from
APUA)
0441101
5.3
How much were you billed for sewerage in the last month (exclude balances from previous bills)
0443000
5.4
How much were you billed for electricity in the last month (exclude balances from previous bills)
0451101
5.5
How much were you billed for fixed line telephone in the last month
(exclude balances from previous bills, including phone cards, caller ID, call waiting, etc)
0830201
How much was paid by you in the last twelve months for other related household expenses n.e.s
(Specify) e.g. Emptying of septic tank________________________________________________
0562601
5.6
HOW MUCH W AS SPENT
M O N T H LY O N T H E S E R V I C E S L I S T E D
CODE
5.7
Employed staff including maids, butlers, drivers, gardeners, etc
0562100
5.8
Persons engaged temporarily for baby-sitting, housework, etc.
0562200
5.9
Child care outside of the home e.g. day nurseries and other child
minding services----------------------------------------------------------------
1240201
5.10
Care of elderly relatives inside the home
1240102
5.11
Care of elderly relatives outside the home
1240103
5.12
Care of the disabled
1240104
5.13
Care of Domestic Animals (Pets)
0935000
5.14
Gardening/lawn care services
0562203
5.15
Cablevision Service, Karib Cable and CTV (Include installation cost if installation occurred_
in the last month only)
0830103
5.16
Internet Services_________________________________________________________
0830401
HOW MUCH W AS SPENT
5.17
□
□
□
□
□
□
□
A m o un t ($)
A N N U A LL Y O N T H E S E R V I C E S L I S T E D
Amount spent last twelve months on other household services, moving, laundry, pest control etc
A m o un t ($)
4532199
P age 5 o f 20
SEC TIO N 4 - FU R N ITU R E, F U R N IS H IN G S A N D H O U S E H O L D E Q U IP M E N T
19226
A S K THE H O U S E H O L D R E F E R E N C E P ER SO N IN IT IA L L Y A N D O T H E R M E M B E R S IF N E C E S S A R Y
C om p lete the s c h e d u le be lo w fo r all item s p u rchase d o r re ceived as a gift by an yone in the ho useho ld in the past 12 m onths.
Note:
I)
If a n y item w a s b o u g h t on an in s ta llm e n t plan, you sho uld e n te r the cash price o f the item and not the m o nthly
repaym ent. If the cash price is n o t a va ila b le o r ca n n o t be re called then use the "re g u la r price". H ow ever, if the
re s p o n d e n t is not ab le to recall e ith e r the "cash price" o r the "re g u la r price" then use the total hire purchase
price.
II)
If a n y tra de-in a llo w a n c e w as given, the p u rch a se price re p re se n ts the a m o u n t paid plus the va lu e o f
a n y tra d e -in (the full p u rchase price o f the new item be fo re de d u ctin g tra de-in value).
III) Y ou sho uld re cord all pu rc h a s e s including tho se b o ught abroad , throug h m ail o rd e r cata logue s, ove r
the Interne t and purchase d in A ntigu a and B arb uda
IV) Include all ho m e m a de fu rn itu re an d e q u ip m e n t an d indica te this by placing an X
in
the c h e c k box
"H om eM a de" n e xt to the de s c rip tio n o f the item u n d e r the colum n "H A V E B O U G H T ".
PART 1 - During the past 12 m onths have you, o r anyone in y o u r household purchased o r received
_________ gifts, fo r th e ir own use o r use by any m em bers o f the household, any o f the fo llo w ing ?
PU R C H A S E D (h o m em ad e)
FURNITURE AND FURNISHINGS
CODE
H A VE
BOUGHT
QTY
BOUGHT
TO TA L C O S T($)
G IFTS
QTY
Received
TO TA L C O S T($)
□ Yes
L iv in g o r re c re a tio n ro o m
3 / 5 / 7 piece suites
0511101
W a ll un it /
0511103
□ HomeMade
□ Yes
D is p la y ca b in e t
cou ch o r sofa
C offe e /side
ta b le /c e n tre table
T V / S te re o stand
/e n te rta in m e n t cen ter
□ Yes
0511104
□ HomeMade
□ Yes
0511107
□ HomeMade
□ Yes
0511108
□ HomeMade
□ Yes
P laypens
0511111
B ook c a s e / bo ok s h e lf
0511112
O th e r living room fu rniture
not sp e cifie d by type
0511199
D ining room fu rn itu re
5 piece Dinette / Dining Suites
0511203
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
C hina cab in ets
/H u tch back
0511204
Individual tab les
0511207
Individual cha irs
0511208
O th e r dinin g room fu rn itu re
n o t spe cifie d b y type
0511299
K itc h e n fu r n itu r e
Table
0511301
C h airs/S tools
0511302
T rolleys
□ HomeMade
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
0511303
C a b in e ts/ C upb oards
(n ot built in)
0511304
O th er kitche n fu rn itu re
not sp e cifie d by type
0511399
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
[~l HomeMade
□ Yes
□ HomeMade
P age 6 o f 20
■
S EC TIO N 4 - FU R N ITU R E, F U R N IS H IN G S AND H O U S E H O L D E Q U IP M E N T
fl-T
1
19226
■
J
PART 1 - During the past 12 months have you, or anyone in your household purchased or received gifts, for
their own use or use by any members of the household, any of the following?
P U R C H A S E D (h o m em ad e)
FURNITURE AND FURNISHINGS
B e d ro o m fu r n itu r e
B edroom S uites
CODE
H A VE
BOUGHT
□ Yes
0511401
□ HomeMade
□ Yes
D ouble b e d /b u n k bed
K ing/Q u een size bed
S ingle bed
M a ttress
C h e s t o f D raw ers
0 5 1 1 4 0 2 □ HomeMade
□ Yes
0511403
0511404
□ HomeMade
□ Yes
□ HomeMade
□ Yes
0 5 1 1 4 0 6 □ HomeMade
□ Yes
0511408
□ HomeMade
□ Yes
W a rd ro b e
0511409
□ HomeMade
□ Yes
C ots, cribs
0 5 1 1 4 1 0 □ HomeMade
□ Yes
C o m b inatio n w a rd ro b e
0 5 1 1 4 1 2 □ HomeMade
□ Yes
D ressing table
0511407
□ HomeMade
O th e r be droom fu rn itu re
not s pe cifie d b y type
□ Yes
0 5 1 1 4 9 9 □ HomeMade
P a tio a n d o u td o o r fu r n itu r e
T a b le and c h a ir
0511501
Lo unge c h a ir
□ Yes
□ HomeMade
□ Yes
0 5 1 1 5 0 5 □ HomeMade
O th e r o u td o o r fu rn itu re not
sp e cifie d by type
0 5 1 1 5 9 9 □ HomeMade
D e c o ra tiv e fu r n is h in g s
P icture s and paintings
□ Yes
0 5 1 1 6 0 1 □ HomeMade
□ Yes
D ecorative clocks
□ Yes
0 5 1 1 6 0 5 □ HomeMade
F lo ra l A rra n g e m e n ts
□ Yes
0 5 1 1 6 0 2 □ HomeMade
O rn am e nts, V a s e s
□ Yes
0 5 1 1 6 0 3 □ HomeMade
O th e r d e c o ra tiv e fu rn itu re
not s pe cifie d by type
L ig h tin g e q u ip m e n t
S tand ard La m ps/w all lam ps
□ Yes
0 5 1 1 6 9 9 □ HomeMade
QTY
BOUGHT
T O T A L C O S T ($ )
G IFTS
QTY
Received
T O T A L C O S T ($ )
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
□ Yes
0 5 1 1 7 0 5 □ HomeMade
□ Yes
K e ro s e n e La m p
O th er lighting e q u ip m e n t
not spe cifie d by type
O th e r fu r n itu r e
C o m p u te r de sks
Iro n in g boards
0511701
□ HomeMade
□ Yes
0511799
□ HomeMade
□ Yes
0511801
□ HomeMade
□ Yes
0 5 1 1 8 0 3 □ HomeMade
□ Yes
S trollers
O th e r fu rn itu re not
sp e cifie d by type
0 5 1 1 8 0 5 □ HomeMade
0511899
□ Yes
□ HomeMade
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
J
J
J
J
P age 7 o f 20
EH
19226
SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT
PART 1 - During the past 12 months have you, or anyone in your household purchased or received gifts, for
their own use or use by any members of the household, any of the following?
P U R C H A S E D (hom em ade)
FURNITURE AND FURNISHINGS
C a rp e ts
F itted carpets
CODE
H A VE
BOUGHT
□ Yes
0 5 1 2 1 0 1 □ HomeMade
□ Yes
N on fitte d ca rp e ts /ru g s
O th e r flo o r c o v e rin g
Linoleum
0 5 1 2 1 0 2 □ HomeMade
□ Yes
0 5 1 2 2 0 1 □ HomeMade
□ Yes
C e ra m ic tiles
0 5 1 2 2 0 2 □ HomeMade
□ Yes
V inyl tiles
0 5 1 2 2 0 3 □ HomeMade
□ Yes
W o o d e n flo o r cove ring
0 5 1 2 2 0 4 □ HomeMade
□ Yes
O th e r flo o r co ve rin g not
sp e cifie d b y type
0 5 1 2 2 9 9 □ HomeMade
F u rnishin g Material
Furnishing Fabrics/ cushion
fabrics
□ Yes
0 5 2 0 1 0 1 □ HomeMade
C urtain m aterial
(o v e r lace)
0520102
D rape m aterial
□ Yes
0 5 2 0 1 0 4 □ HomeMade
O th e r furn is h in g m a terial
not s pe cifie d b y type
□ Yes
0 5 2 0 1 9 9 □ HomeMade
Ready made article s
Curtains- panels, kitchen sets
(not plastic)
□ Yes
0 5 2 0 2 0 1 □ HomeMade
D rapes
0520202
O th e r re ady m a de articles
not s pe cifie d b y type
0520299
B e d d in g s
S h e e ts and pillow cases
□ Yes
0 5 2 0 3 0 2 □ HomeMade
pillow s
0520303
cu sh io n s
0520307
T ra velling ba gs
0520306
O th e r re ady m a de be dding s
not s pe cifie d b y type
0520399
T o w e ls a n d T a b le L in e n
T o w els-B ath
□ Yes
0 5 2 0 4 0 1 □ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
K itchen tow e ls
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
0520403
□ HomeMade
□ Yes
T a b le cloths, T a b le na pkins
B a th ro o m m ats
D oor m ats
O th er to w e ls an d tab le linen
not s pe cifie d b y type
O th e r h o u s e h o ld te x tile s
S h o p p in g bags
0 5 2 0 4 0 4 □ HomeMade
□ Yes
0520405
0520406
□ HomeMade
□ Yes
□ HomeMade
□ Yes
0520499
0520501
□ HomeMade
□ Yes
□ HomeMade
QTY
BOUGHT
T O T A L C O S T ($ )
G IFTS
QTY
Received
T O T A L C O S T ($ )
□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
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□□ □□ □□□□□□□ □□□
□□ □□ □□□□□□□ □□□
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
P age 8 o f 20
EH
19226
SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT
PART 1 - During the past 12 months have you, or anyone in your household purchased or received gifts, for
their own use or use by any members of the household, any of the following?
P U R C H A S E D (h o m em ad e)
FURNITURE AND FURNISHINGS
CODE
H A VE
BOUGHT
O th er h o useho ld textile s not
sp e cifie d by type
□ Yes
0 5 2 0 5 9 9 □ HomeMade
M a jo r k itc h e n a p p lia n c e s
C ookin g sto ve (g as/electric)
QTY
BOUGHT
TO TA L C O S T($)
G IFTS
QTY
Received
TO TAL C O S T($)
j
j
0 5 3 1 1 0 1 □ HomeMade
j
j
M icro w ave O vens
□ Yes
0 5 3 1 1 0 2 □ HomeMade
j
j
R e frig e ra to r and F re e z e r
□ Yes
0 5 3 1 1 0 3 □ HomeMade
j
j
H om e d e e p fre e z e r
□ Yes
0 5 3 1 1 0 5 □ HomeMade
j
j
Other major kitchen appliances
not specified by type
□ Yes
0 5 3 1 1 9 9 □ HomeMade
j
j
M a jo r la u n d ry a p p lia n c e s
C lothe s w a s h e r fu lly
a u to m a tic
0531201
j
j
C lothe s w a s h e r
se m i- a u to m a tic
0531202
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
C lothe s d ry e r (e le ctric)
Other major laundry appliances
not specified by type
M a jo r c le a n in g a p p lia n c e s
V a c u u m cle a n e r
Other major cleaning appliances
not specified by type
□ Yes
□ Yes
0531205
0531299
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
0 5 3 1 3 0 1 □ HomeMade
□ Yes
0 5 3 1 3 9 9 □ HomeMade
□ Yes
M ajor a ir and w a te r appliances
0 5 3 1 4 0 1 □ HomeMade
Air conditioning unit
□ Yes
W a te r he a te r(s o la r/e le c tric )
Other major air and water
appliances not specified by type
O ther m a jo r ho useho ld
appliances
Sewing machines
0 5 3 1 4 0 4 □ HomeMade
□ Yes
0 5 3 1 4 9 9 □ HomeMade
□ Yes
0 5 3 1 5 0 1 □ HomeMade
□ Yes
C om p uters
0 9 1 3 1 0 1 □ HomeMade
□ Yes
F a x m a chines
0531503
Other major household
appliances not specified by type
0531599
S m all e le c tro n ic h o useho ld
appliances
Mixer
0 5 3 2 0 0 1 □ HomeMade
j
j
T o a s te r
□ Yes
0 5 3 2 0 0 2 □ HomeMade
j
j
S a n d w ic h m a k e r
□ Yes
0 5 3 2 0 0 4 □ HomeMade
j
j
B le n d e r
□ Yes
0 5 3 2 0 0 5 □ HomeMade
j
j
E lectric fan
□ Yes
0 5 3 2 0 0 7 □ HomeMade
j
j
E lectric Iron
0532008
j
j
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ Yes
□ HomeMade
P age 9 o f 20
[SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT
19226
PART 1 - During the past 12 months have you, or anyone in your household purchased or received gifts, for
their own use or use by any members of the household, any of the following?
P U R C H A S E D (h o m em ad e)
FURNITURE AND FURNISHINGS
E lectric kettle
F o od p rocessors
Small electronic household
appliances not specified by
type
T e le p h o n e e q u ip m e n t
T e lepho nes
Cell ph ones
R e c re a tio n a n d c u ltu re
T e levision sets
CODE
0532009
H A VE
BOUGHT
□ Yes
□ HomeMade
0532014
□ Yes
□ HomeMade
□ Yes
0532099
□ HomeMade
□ Yes
0820102
□ HomeMade
□ Yes
0820101
□ HomeMade
□ Yes
0911101
□ HomeMade
□ Yes
P ersonal S te re o s
0911304
□ HomeMade
□ Yes
R adio s
C D players
0911201
□ Yes
0911303
China, Glass, Ceramic and
Crystals Plates, teacups,
saucers, mugs, bowls
0540101
G lasses, Jug, -(G lass,
c e ra m ic )
0540102
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
Pottery, O ven ware-(glass,
ceramic)
0540103
Cutlery, Flatw are,Silverw are
Forks, Knives, Spoons
0540201
Cooking Utensils-Knives,
Serving spoons, Openers,
Scissors, graters
Non - e le c tric kitchen
e q uipm e nt Pressure cookers
Saucepans, Stew pots,
□ HomeMade
□ HomeMade
□ Yes
□ HomeMade
□ Yes
0540202
□ HomeMade
□ Yes
0540301
□ HomeMade
□ Yes
S terilizers/F ilters
0540303
F e e d in g bo ttles,
T h e rm o s fla sks, B ottles
0540305
Ice boxes, coo le rs
□ Yes
Pails, B asins, Potty,
T u b s , Bath T u bs
0540403
G a s P o w e re d to o l
La w n M ow er
□ HomeMade
□ Yes
0540401
O th e r m is c e lla n e o u s e q u ip ­
m e n t not sp e cifie d by type
□ HomeMade
□ Yes
0540306
M iscellaneous E quipm ent
Laundry baskets, W aste bins
M o ps, bro o m s,
brushes
□ HomeMade
□ HomeMade
□ Yes
□ HomeMade
□ Yes
0540404
□ HomeMade
□ Yes
0540499
□ HomeMade
□ Yes
0551202
□ HomeMade
□ Yes
W e e d Eaters
O th er gas po w e red tools
0551203
□ HomeMade
□ Yes
0551299
□ HomeMade
QTY
BOUGHT
T O T A L C O S T ($ )
G IFTS
QTY
R eceived
T O T A L C O S T ($ )
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
□□ □□ □□□□□□□ □□
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
P age 10 o f 20
EH
19226
SECTION 4 - FURNITURE, FURNISHINGS AND HOUSEHOLD EQUIPMENT
PART 1 - During the past 12 months have you, or anyone in your household purchased or received gifts, for
their own use or use by any members of the household, any of the following?
P U R C H A S E D (hom em ade)
T
H A VE
BOUGHT
CODE
FURNITURE AND FURNISHINGS
□ Yes
G a rd e n T o o ls
S pades, sho vels, rakes
0552202
□ HomeMade
□ Yes
W h e e lb a rro w s
0552201
La dders and step s
0552301
Sm all E lectrical A ccessorie s
Transformers
0552501
Electric bulbs,
Fluorescent lighting tubes
0552502
Flash -lights,
To rche s,
0552503
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
□ Yes
□ HomeMade
QTY
BOUGHT
G IFTS
QTY
Received
T O T A L C O S T ($ )
T O T A L C O S T ($ )
□□ □□ □□□ □□ □□ □□
□□ □□ □□□ □□ □□ □□
□□ □□ □□□ □□ □□ □□
□□ □□ □□□ □□ □□ □□
□□ □□ □□□ □□ □□ □□
nn nn nnn □nnn nnn
j
j
j
j
j
j
j
j
j
j
j
j
ii
i
i
S EC TIO N 4 - R EPA IR S AND S E R V IC IN G OF H O U S E H O L D A R TIC LE S
PART 2 - D uring the past tw elve m onths have you o r any o th e r m em b er o f y o u r household incurred
any exp enses fo r the
repair and servicing o f any o f the
REPAIRS TO APPLIANCES AND EQUIPMENT
R e p a ir o f fu r n itu r e , fu r n is h e s a n d flo o r c o v e rin g s
R e p a ir o f fu rn itu re
fo llo w ing pieces o f eq uip m en t?
1
□ 1 Yes
0512301
J
□ 2 No
1
□ 1 Yes
R e p a ir o f flo o r c ove ring (c o s t o f la b o u r plus m a te ria l)
□ 2 No
0512303
J
1
□ 1 Yes
R e p a irs to m a jo r kitche n a p pliance s
□ 2 No
R e p a irs to m a jo r laun dry a p p lia n c e s e.g
w a s h in g m a chine
0533001
0533002
□ 2 No
0533003
□ 2 No
0533004
J
□ 1 Yes
R e p a irs to sm a ll e le c tric ap p lia n ce s e.g blen der
□ 2 No
0533005
J
□ 1 Yes
R e p a ir o f te le p h o n e and te le fa x e q u ip m e n t
□ 2 No
0820201
J
□ 1 Yes
R e p a irs to au dio -visua l e q u ip m e n t (eg tele visio n se t)
□ 2 No
J
0915101
□ 1 Yes
R e p a irs to ph o to g ra p h ic e q u ip m e n t e.g c a m e ra s
□ 2 No
R e p a irs to info rm atio n processing
e q u ip m e n t (e .g . co m p u te rs )
J
0915102
1
□ 1 Yes
0915103
J
□ 2 No
□ 1 Yes
O th e r re pairs and servicin g
□ 2 No
1
J
□ 1 Yes
R e p a irs to o th e r m a jo r ap p lia n ce s
1
J
1
□ 1 Yes
R e p a irs to m a jo r clean ing a p p lia n c e s e.g
va cu u m c le a n e r
J
1
□ 1 Yes
□ 2 No
u□□□□
□□□□□
□□□□□
□□□□□
□□□
□□□
□□□
□□□
□□□
□□□□□
□□□
□□□
A M O U N T ($)
S P E N T L A S T Y EA R
CODE
0534101
J
1
1
P age 11 o f 20
SECTION 5 - AGRICULTURE PRODUCTS PRODUCED AND CONSUMED AT HOME
19226
IN T E R V IE W E R :
A d v is e the househo ld re fe re n ce pe rson th a t w h a t is needed in this sectio n is an estim a te o f the qu antity
in po unds (lbs), un le ss oth e rw ise sp e cifie d and the v a lu e o f ho m e grow n p roduce co n su m e d b y his/h er
ho useho ld LA S T M O N T H . N o te : C o co n u t trees, fru it trees, tom atoe s, lettuce, sw e e t p e p p e r e tc grow n
in th e ba ckyard garden should be recorde d here as ho m e grow n pro d u ce if co n su m e d in the pa st m onth.
W h a t is the v a lu e o f ho m e grow n ve g e ta b le s, ground provisions, m eat, poultry, fish o r d a iry products
co n s u m e d b y y o u r househo ld d u ring the la st m o nth?
□ 1 Yes Continue
5 .1
HOME GROW N PRODUCE
Orange (Number)
Grapefruit (Number)
Limes (Number)
Other Citrus (Number)
Ripe bananas (lbs.)
Mangoes (any variety) Number
□ 2 No Go to Section
CODE
6
0116101
□ 1 Yes
0116102
□ 1 Yes
0116124
0116104
0116105
□ 1 Yes
0116117
□ 1 Yes
Other fresh fruits (pawpaw, plums, cherries,
sour sop, golden apples, etc (lbs.)
0116199
□ 1 Yes
Green bananas (lbs.)
0116128
□ 1 Yes
0116129
□ 1 Yes
0116126
□ 1 Yes
Avocadoes (Number)
0116125
□ 1 Yes
Dry coconuts (Number)
0116401
□ 1 Yes
0116132
□ 1 Yes
0117101
□ 1 Yes
Pumpkins (lbs)
0117102
□ 1 Yes
Sweet pepper, seasoning pepper (lbs.)
0117131
□ 1 Yes
0117103
□ 1 Yes
Carrots (lbs.)
0117105
□ 1 Yes
Spinach (lbs.)
0117132
□ 1 Yes
Plantains/Bugerment (lbs.)
Breadfruit (Number)
□□□
Uuu
Uuu
uuu
□ 1 Yes
□ 1 Yes
E s tim a te A m o u n t ($ )
C o n s u m e d L a s t M o n th
□ □□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□
□ □□□
□ □□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□
□ □□□
□ □□□
□ □□□
n nnn
n nnn
□ □□□
□ □□□
j
□ 1 Yes
0116110
Watermelons (lbs.)
Q U A N T IT Y
(Y /N )
j
i
j
i
j
i
j
i
j
□□□
j
i
j
nnn
nnn
nnn
□□□
j
j
j
j
---------------------------1
Jelly coconuts (Number)
Tomatoes (lbs.)
Cabbage (Green) (lbs. )
j
i
nnn
nnn
□□□
nnn
nnn
□□□
□□□
j
j
j
j
j
j
j
P age 12 o f 20
i
S E C T IO N 5 - A G R IC U L T U R E P R O D U C T S P R O D U C E D A N D C O N S U M E D A T H O M E
19226
What is the value of home grown vegetables, ground provisions, meat, poultry, fish or dairy products
consumed by your household during the last month?
5.1 HOM E G R O W N PRO DU CE
CODE
(Y/N)
0117106
□ 1 Yes
0117122
□ 1 Yes
0117199
□ 1 Yes
0117115
□ 1 Yes
0117117
□ 1 Yes
0119223
□ 1 Yes
Yams - white (lbs.)
0117503
□ 1 Yes
Yams - yellow (lbs.)
0117501
□ 1 Yes
Lettuce, water cress (Head / bundles)
Celery, parsley (bundle)
Other Fresh vegetables (lbs.)
Green pigeon peas (lbs.)
String Beans (lbs.)
Spices, cinnamon, nutmeg, ginger (lbs.)
Yams - Banja (lbs)
0117504
□ 1 Yes
Eddoes (lbs.)
0117508
□ 1 Yes
Dasheen (lbs.)
Sweet potatoes (lbs.)
Eggplant (lbs.)
Nuts (cashews, peanuts etc.) (lbs.)
Other ground provisions (lbs.)
0117505
0117506
0117509*
0116130
0117699
Q U A N T IT Y
E s tim a te A m o u n t ($)
C o n s u m e d L a s t M o n th
nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
nnn
nnn
nnn
nnn
nnn
□□□
□□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
1
J
□ 1 Yes
□ 1 Yes
□ 1 Yes
□ 1 Yes
□ 1 Yes
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
Hom e P roduced M eat and P oultry
Beef
Pork
Mutton/Goat
Rabbit
Other Meats
0112107
0112207
0112303
0112402
0112499
□ 1 Yes
□ 1 Yes
□ 1 Yes
□ 1 Yes
□ 1 Yes
Chicken
0112701
□ 1 Yes
Other Poultry
0112999
□ 1 Yes
i
J
1
J
1
J
1
J
1
J
1
J
J
1
P age 13 o f 20
EH
19226
5 .1
SECTION 5 - AGRICULTURE PRODUCTS PRODUCED AND CONSUMED AT HOME
What is the value of home grown vegetables, ground provisions, meat, poultry, fish or dairy products
________________ consumed by your household during the last month?_________________________________________
CODE
HOME GROW N PRODUCE
E s tim a te A m o u n t ($ )
C o n s u m e d L a s t M o n th
Q U A N T IT Y
(Y /N )
Home Produced D airy P rod ucts and Fish:
Milk (quarts)
0114101
□ 1 Yes
Eggs (doz)
0114501
□ 1 Yes
Fish caught (lbs.)
0113199
□ 1 Yes
Collie/Talapia (lbs.)
0113113
□ 1 Yes
Shrimps /Crayfish (lbs.)
0113115
□ 1 Yes
Crabs (Number)
0113117
□ 1 Yes
Uuu
□□□
□□□
□□□
Uuu
□□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
J
J
J
J
J
J
S EC TIO N 6 - TR A N S P O R TA TIO N
Note: 1 . L is t o n a s e p a r a t e lin e e a c h m o t o r v e h ic le , m o t o r c y c le , b ic y c le e t c . a n d a n y o t h e r v e h ic le
o w n e d a n d o p e r a t e d in t h e p a s t 3 m o n t h s
2 . W h e n t r a d e - in s o c c u r t h e p u r c h a s e p r ic e r e p r e s e n t s c a s h p lu s a m o u n t c r e d it e d t o w a r d s
t r a d e d v e h ic le ,
always clarify this
PART 1 - Do you o r any m em b er o f this household ow n o r had ow ned and o perated any
veh icle during the past 3 m onths?
□ 1 Yes Continue
□ 2 No Go to Section 7
AGE
TYPE
NO
01
□ Car
□ Motorcycle
□ Van
□ Truck
□ Jeep/SUV □ Other
P U R C H A S E PRICE
(in years fro m date
o f m anufacture)
1
% P R IV A T E
98 = 10 0%
% B U S IN E S S
98 =100%
□ □□ □
□
□ □□ □
□
□ □□ □
□
□ □□ □
□
□ □□ □
□
J
Vehicle no
□ Car
02 □ Van
□ Motorcycle
□ Truck
□ Jeep/SUV □ Other
J
Vehicle no
□ Car
03 □ Van
□ Motorcycle
□ Truck
□ Jeep/SUV □ Other
J
Vehicle no
□ Car
04 □ Van
□ Motorcycle
□ Truck
□ Jeep/SUV □ Other
J
Vehicle no
□ Car
05 □ Van
□ Motorcycle
□ Truck
□ Jeep/SUV □ Other
J
1
Vehicle no
P age 14 o f 2 0
1
EE
19226
S EC TIO N 6 - TR A N S P O R TA TIO N
P A R T 2 - VEHICLE MAINTENANCE AND REPAIR EXPENDITURE DURING THE PAST 3 MONTH PERIOD
IN T E R V IE W E R : if v e h ic le is used e n tire ly fo r bu sin e ss do no t includ e its e xp e n se s in the list w hich
follow s. F o r ea ch v e h ic le list the p a rticu la r exp ense, then sum it up in the a m o u n t field provided.
R e m e m b e r the v e h ic le n u m b e r re fe rre d to is the n u m b e r a ssign ed to the ve h icle fro m th e previous page.
M a in te n a n c e e x p e n d itu re
d u rin g th e p a s t th re e
m o n th s
P a rts
Tyres
V e h ic le 01
V e h ic le 02
V e h ic le 03
V e h ic le 04
N o:
N o:
No:
No:
CODE
$ Am oun
J
0721101
1
1
Oil Filters/Spark plugs
0721103
I
I
1
□□ □□□
1
□□ □□□
1
□□ □□□
J□□ □□□
I□□ □□□
I□□ □□□
I□□ □□□
□ □□□
1
□ □□□
1
□ □□□
1
□□ □□□
1
□□ □□□
1
I
I
1
□□ □□□
1
□□ □□□
□□□ □□□
□□□ □□□
□
u
J
1
Batteries
0721104
J
1
Brakes
Other parts
0721109
0721199
O p e r a tio n C o s ts
Gasoline
0722101
Diesel
0722102
Oil
0722201
License
0724404
Insurance (vehicle)
1254100
Driving permits
0724303
J
J
J
J
1
J
1
J
1
J
1
J
1
Parking fines /Tickets
0724701
J
1
Other operating cost
Repairs and Servicing (including
parts and labour) General servicing,
Tune-ups, electrical/motor repairs
0723199
J
1
0723110
J
1
Body work (straighten, paint)
0723108
J
1
Upholstery
0723114
Front end alignment and wheel
balancing
0723104
Exhaust system repairs
0723105
Brake adjustments, repairs
and service
0723103
Air Condition
0723115
Car Wash, polish etc.
0723101
J
1
J
1
J
J
J
J
1
Other (Specify)
0723199
1
J
P age 15 o f 20
EH
19226
SECTION 7 - REGULARITY OF PURCHASE AND MAIN TYPE OF OUTLET
Which was the main storefoutiet used in the last twelve months by your household for
purchasing the following items?______________________
CODE
REGULARITY
OF PURCHASE
NAME OF OUTLET
FREQ
(1 )
(2 )
1. Beef Pork/Muttor 0112401
- Fresh / Frozen
2. Fish - Fresh
/ Frozen
01 1319 9
3. Chicken - Fresh
/ Frozen
01 1289 9
4. Vegetables
01 1710 0
5. Ground
Provisions
01 1750 0
6
. Bread and
Cakes
0 1 1 1 1 0 0
0119501
. Household
Supplies
0 5 6100 0
9. Clothing
Material
03 1100 0
10. Clothing Women
03 1230 0
11. Clothing - Men
03 1210 0
12. Clothing Children
0313601
13. Furniture
05 1100 0
14. Footwear
03 2100 0
(3)
(4)
(5)
Outlet
Code
(See
below)
LOCATION OF OUTLET
(Community, Street, Parish)
(6 )
(7)
□
□
□
□
□
□
□
□
□
□
□
□
□
□
REGULARITY OF PURCHASE CODES
TYPE OF OUTLET - CODES
1. DAILY
2. WEEKLY
3. FORTNIGHTLY
4. MONTHLY
5. SEMI-ANNUALLY
6 . ANNUALLY
9. OTHER
19. SHOE STORE
20. VENDORS MALL
01. SUPERMARKET
10. MEAT MARKET
21. VARIETY STORE
02. MINI-MART
11. BAKERY
22. PHARMACY
03. GROCERY SHOP
12. RESTAURANT
23. HOSPITAL
04. WHOLESALE OUTLET
13. HARDWARE STORE
24. CLINIC (HEALTH CENTRE)
05. HERITAGE VEGETABLE MARKET
14. FURNITURE AND APPLIANCES STORE
06. CENTRAL MARKET CORP
15. DEPARTMENTAL STORE
25. PRIVATE DOCTOR
07. WAYSIDE MARKET
16. CLOTHING STORE
26. ABROAD -USA
08. FISH MARKET
17. VENDORS
27. ABROAD -OTHER
18. TEXTILE STORE
28. OTHER
P age 16 o f 20
EH
SECTION 7 - REGULARITY OF PURCHASE AND MAIN TYPE OF OUTLET
Which was the main store/outlet used in the last twelve months by your household for
19226
ITEM
CODE
(2 )
(1 )
15. Appliances
0 5 3100 0
16. Medical
Expenses
-prescriptions/Cou
nter Medication
061110 0
17. M e d ic a l E x p e n s e s
062110 0
- Consultation
18. M e d ic a l E x p e n s e s
- Procedure
0630000
19. Breakfast
(responsible
adult)
20. Lunch
(responsible
adult)
21. Dinner
(responsible
adult)
1 1 11101
1 111201
1111301
REGULARITY
OF PURCHASE
CODE
FREQ
(3)
(4)
Outlet
Code
(See
below)
NAME OF OUTLET
(5)
LOCATION OF OUTLET
(Community, Street, Parish)
(7)
(6 )
□
□
□
□
□
□
□
REGULARITY OF PURCHASE CODES
TYPE OF OUTLET - CODES
1. DAILY
2. WEEKLY
3. FORTNIGHTLY
4. MONTHLY
5. SEMI-ANNUALLY
. ANNUALLY
9. OTHER
6
01.
02.
03.
04.
05.
06.
07.
08.
19. SHOE STORE
20. VENDORS MALL
SUPERMARKET
10. MEAT MARKET
21. VARIETY STORE
MINI-MART
11. BAKERY
22. PHARMACY
GROCERY SHOP
12. RESTAURANT
23. HOSPITAL
WHOLESALE OUTLET
13. HARDWARE STORE
24. CLINIC (HEALTH CENTRE)
HERITAGE VEGETABLE MARKET
14. FURNITURE AND APPLIANCES STORE
CENTRAL MARKET CORP
15. DEPARTMENTAL STORE
25. PRIVATE DOCTOR
WAYSIDE MARKET
16. CLOTHING STORE
26. ABROAD -USA
FISH MARKET
17. VENDORS
27. ABROAD -OTHER
18. TEXTILE STORE
28. OTHER
SEC TIO N 8 FO R HEADS OF H O U SE H O LD O N LY
8.1
What was the size of the household in which you grew up?
8 .2
What is the highest grade completed by ... father?
00
01
02
03
04
98
N one
NurseryP re-sch o o l
K in d erg arte n
Special E d u c a tio n
D o n 't K n o w
00
01
02
03
04
98
None
N u rse ry
P re-sch o o l
K in d erg arte n
Special E d u c a tio n
D o n 't K n o w
8.3
8.4
11
12
13
14
15
16
20
G ra d e 1
G ra d e 2
G 3 / S td 1
G 4 / S td 2
G 5 / S td 3
G 6 / S td 4
G 7 / S td 5
21
22
25
26
27
28
29
30
G 8 /S td 6
31 A S C - A 'L evel
39 H o te l T ra d es S chool
G 9 /S td 7
32 A SC - T e c h /V o c
40 V o c a tio n a l/T e c h In s t
41 O th e r
F rm 1 /S P 1
33 A SC - B usiness
F rm 2 /S P 2
34 A SC - Yr1 o r Y r2 U W I
F rm 3 /S P 3
35 A SC - O th e r
F rm 4 / G 1 0
36 U niversity - U W I C am pus
F rm 5 /G 1 1
37 U niversity - O th e r
F rm 6 / A Level
38 A B B IT
What is the highest grade completed b y
11
12
13
14
15
16
20
G ra d e 1
G ra d e 2
G 3 /S td 1
G 4 /S td 2
G 5 /S td 3
G 6 /S td 4
G 7 /S td 5
21
22
25
26
27
28
29
30
G 8 / S td 6
G 9 /S td 7
F rm 1 /S P 1
F rm 2 /S P 2
F rm 3 /S P 3
F rm 4 /G 1 0
F rm 5 /G 1 1
F rm 6 / A Level
mother?
31 A SC - A 'L evel
39 H o te l T ra d es S chool
32 A SC - T e c h /V o c
40 V o c a tio n a l/T e c h In s t
33 A SC - B usiness
41 O th e r
34 A SC - Yr1 o r Y r2 U W I
35 A S C - O th e r
36 U niversity - U W I C am pus
37 U niversity - O th e r
38 A B B IT
Do(es) ... perceive yourself/himself/herself as being better off than........ parents?
□ 1 Yes
□ 2 No
□ 3 Somewhat
□ 4 Don't Know
P age 17 o f 20
EZE
S EC TIO N 9 - TO BE C O M P L E T E D FO R H O U S E H O L D M E M B E R S
W H O HAVE M O VED O U T OF THE H O U S E H O L D IN
THE PAST FIVE YEA R S
19226
FILL IN FOR EACH MEMBER WHO LEFT THE HOUSEHOLD
2
Sex
3
Age
Male
1 Years
Female.. 2
4
5
What is...................
What was the grade
Relationship to Head level attained by.......
prior to departure?
Spouse/partner....... 1 0 0 N o n e
01 N u r s e r y
Child....................... 2 0 2 P r e - s c h o o l
Son/daughter in law.3 0 3 K in d e r g a r t e n /S ta g e 1
grand-child.............. 4 11 G r a d e 1
parent/parent-in-law. 5 1 2 G r a d e 2
grand parent........... 6 1 3 G r a d e 3
14 G ra d e 4
other relative........... 7 1 5 G r a d e 5
brother /sister......... 8 1 6 G r a d e 6
non-relative............ 9 21 G ra d e 7 / F r 1 1/S P 1
22
23
24
25
26
G ra d e
G ra d e
G ra d e
G ra d e
G ra d e
8 / F n 1 2 /S P 2
9 / F r i 3 /S P 3
1 0 /F ri 4
1 1 /F r 5
1 2 /F r 6
6
How long
ago did...
move
away
(in years)
Less than
6 months
0
months
to 1 year
6
9
Does this former
household member
send any
contributions to this
more income..... 1 Another part of the household?
work.................. 2 country............... 1
study................. 3 St. Martin........... 2 Provide an annual
marriage............ 4 Other CARICOM.3 estimate of amount
medical.............. 5 UK..................... 4 sent in $EC dollars in
other family
USA................... 5 the last year. Provide
reason............... 6 Canada.............. 6 a monetary value for
other.................. 7 BVI..................... 7 in-kind contributions
don't know......... 8 Rest of World..... 8 sent
don't know.......... 9
8
7
Most important
Area former
reason for leaving household
the household
member moved to
31 T e r tia r y
3 2 U n iv e rs ity
41 V o c a tio n a l/T e c h n ic a l
□ 1M
01
□
1
□ 4
□ 7
□
2
□ 5
□
8
□ 2F
□ 1M
02
03
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
04
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
05
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
06
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
07
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
08
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
09
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
□ 1M
10
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
8
□ 2F
□ 1M
□ 3
□
□
1
□ 4
□ 7
□
2
□ 5
□
6
□ 2F
□ 3
□
6
8
□
□
□
□
□
□
□
□
□
□
□
□
1
□
2
In E C D ollars
□ 4
□ 7 □
1
□ 4
ru
□ 5
□
2
□ 5
□
□
□ 9
8
□
8
□ 3
□
□
1
□ 4
□ 7 □
1
□ 4
ru
□
2
□ 5
□
2
□ 5
□
□
□ 9
□ 3
6
8
□
□ 3
□
□
1
□ 4
□ 7 □
1
□
2
□ 5
□
□
2
□ 3
6
8
□ 3
□
□
1
□ 4
□ 7 □
1
□
2
□ 5
□
□
2
□ 3
6
8
□ 3
□
□
1
□ 4
□ 7 □
1
□
2
□ 5
□
□
2
□ 3
6
8
□ 3
□
□
1
□ 4
□ 7 □
1
□
2
□ 5
□
2
□ 3
6
8
□
□ 3
□
□
1
□ 4
□ 7 □
1
□
2
□ 5
□
2
□ 3
6
8
□
□ 3
□
□
1
□ 4
□ 7 □
1
□
2
□ 5
□
2
□ 3
6
8
□
□ 3
□
□
1
□ 4
□ 7 □
1
□
2
□ 5
□
2
□ 3
6
8
□
6
6
In E C D ollars
8
In E C D ollars
□ 4
ru
□ 5
□
□
□ 9
6
□ 4
8
In E C D ollars
ru
□ 5
□
□
□ 9
6
□ 4
8
In E C D ollars
ru
□ 5
□
□
□ 9
6
□ 4
8
In E C D ollars
ru
□ 5
□
□
□ 9
6
□ 4
8
In E C D ollars
ru
□ 5
□
□
□ 9
6
□ 4
8
In E C D ollars
ru
□ 5
□
□
□ 9
6
□ 4
8
In E C D ollars
ru
□ 5
□
□
□ 9
8
□ 3
□
□
1
□ 4
□ 7 □
1
□ 4
□
2
□ 5
□
□
2
□ 5
□
□
□ 9
□ 3
6
8
6
In E C D ollars
ru
8
□ 3
□
□
1
□ 4
□ 7 □
1
□ 4
□
2
□ 5
□
□
2
□ 5
□
□
□ 9
□ 3
□
□ 3
6
6
8
□ 3
6
6
In E C D ollars
ru
8
P age 18 o f 20
EH
1A.
19226
Individual Number
1B.
Mother's Number
SECTION 10 - FOR CHILDREN UNDER THE AGE OF FIVE YEARS
Child No. 1
Child No. 2
Hospital □ 1
clinic/centre □ 2
At home
Other 9 4
Hospital
clinic/centre
At home
Other
Child No. 3
Child No. 4
Child 5
2. Date of Birth (dd/mm/yy)
Age
(in months)
3. Where was child delivered?
4. Who delivered the child?
5. In the past two weeks, has ..... had running
belly (diarrhea) i.e. three or more loose stools
per day?
6
. During this last episode of diarrhea, did ....
drink:(prompt and insert X for all items
mentioned)
1. Breast Milk
Hospital
clinic/centre
At home
Other
Hospital
clinic/centre
At home
Other
□ 1
□ 2
□ 3
□ 4
r 1
r 2
r 3
c 4
Doctor Q 1
Doctor Q 1
Doctor m
Doctor Q 1
Nurse, midwife Q 2 Nurse, midwife Q 2 Nurse, midwife Q 2 Nurse, midwife Q 2
Other/self
Q 3
Other/self Q 3
Other/selfQ
3
Other/selfQ 3
□ 1
□ 2
□ 3
□ 1 Yes
□ 1
□ 2
□ 3
□ 4
□ 1 Yes
□ 2 No (Go to Q8 ) □ 2 No (Go to Q8 )
□ 1
□ 2
□ 3
□ 4
□ 1 Yes
□ 1 Yes
□ 1 Yes
□ 2 No (Go to Q8 )
□ 2 No (Go to Q8 )
□ 2 No
□
1
□
1
□
1
□
1
□
1
2. Cereal-based gruel or gruel made from
roots or soup
□
2
□
2
□
2
□
2
□
2
3. Other locally-defined acceptable home fluids
□ 3
□ 3
□ 3
□ 3
□ 3
4. ORS (oral rehydration solution) packet solution
□ 4
□ 4
□ 4
□ 4
□ 4
5. Water with feeding during some part of the day
□ 5
□ 5
□ 5
□ 5
□ 5
□
□
□
□
□
6
. Water alone
7. Other milk or infant formula
8
. Defined "unacceptable" fluids
9. Don't know
6
6
6
6
6
□ 7
□ 7
□ 7
□ 7
□ 7
□
□
□
□
□
8
8
8
□ 9
□ 9
□ 9
8
□ 9
8
□ 9
7. D uring
's diarrhea, did he/she drink much
less, about the same, or more than usual?
8
1.
Much less or more
□
1
□
1
□
1
□
1
□
1
2.
About the same (or somewhat less)
□
2
□
2
□
2
□
2
□
2
3.
More
□ 3
□ 3
□ 3
□ 3
□ 3
4.
Don't know
□ 4
□ 4
□ 4
□ 4
□ 4
□
1
□
1
□
1
□
1
□
1
□
2
□
2
□
2
□
2
□
2
□
1
□
1
□
1
□
1
□
1
□
2
□
2
□
2
□
2
□
2
□
□
1
□
□
2
□
□
1
2
□
□
1
2
2
□
□
2
. Has
1.
2.
ever been breast fed?
Yes
No
9. Is he/she still being breast fed?
1. Yes
2.
No
10. Since this time yesterday, did he/she receive
any of the following? (Prompt and insert X
code for all
1. Vitamins, mineral supplements or medicine
2. Plain water.......................................................
3. Sweetened, flavoured water or fruit juice or tea
or infusion
4. Oral re-hydration solution (ORS)
5. Tinned, powdered or fresh milk or infant formula
6
. Solid or semi-solid (mushy) food.......................
7. Other...............................................................
8
. Received ONLY breastmilk..............................
9. Don't know.......................................................
□ 3
1
1
□ 3
□ 3
□ 3
□ 3
□ 4
□ 5
□ 4
□ 5
□ 4
□ 5
□ 4
□ 5
□ 4
□ 5
□
□
□
□
□
6
6
6
6
6
□ 7
□ 7
□ 7
□ 7
□ 7
□
□
□
□
□
8
8
8
8
8
□ 9
□ 9
□ 9
□ 9
□ 9
1. Polio............................................
□
1
□
1
□
1
□
1
□
1
2. Diphtheria....................................
□
2
□
2
□
2
□
2
□
2
3.
BCG.........................................
□ 3
□ 3
□ 3
□ 3
□ 3
HIB...........................................
□ 4
□ 4
□ 4
□ 4
□ 4
□ 5
□ 5
□ 5
□ 5
□ 5
Hepatitis-B................................
□
□
□
□
□
MMR1..
□ 7
11. W as
4.
5.
6
.
7..
immunized against
Measles....................................
6
6
□ 7
6
□ 7
6
□ 7
P age 19 o f 2 0
6
□ 7
19226
COMMENTS
We have recieved from the enum erator o f o ur household the sum o f (Num ber o f
Spenders b y $15) as a result o f o ur full participation in the Antigua and Barbuda
Survey o f Living Conditions and Household Budgets. We have supplied the
enum erator with all the information required.
Spender(s)/Representative o f Household
Householder on a scale of one (1) to ten (10), where 1 is very poor and 10 is Excellent, how would you rate your enumerator?
□ 1
D2
□ 3
□ 4
□ 5
□
6
□ 7
□
8
[]9
□ 10
P age 20 o f 20
n
INDIVIDUAL QUESTIONNAIRE
n
10281
IM P O R T A N T !!!
Transfer codes from ___________
fro nt pag e o f housing
questionnaire
t>
IN T E R V IE W E R :
W h e n e v e r a do tted line (...) a p pears in a qu estion, call the na m e o f the pe rson to w h o m the in fo rm a tio n relates, if it
is n o t th e re s p o n d e n t him se lf/h e rse lf. Else s a y "Y ou"T 'Y our". X the a p p ro p ria te box. P lease do not w rite o v e r the
re s p o n s e s :
S E C T IO N 1: C H A R A C T E R IS T IC S
FO R A L L P E R S O N S
1.1. Please fill in this person's assigned number from household roster
2.1 Where was
born?
□
1.2 W h a t i s
’s re la tio n sh ip to th e h e a d o f h o usehold?
□
1 H ead
□
5 G ra n d c h ild
□
2 S p o u s e / p a rtn e r
□
6 P a re n t/p a re n t-in -la w
□
3 C h ild
□
7 O th e r re lative
□
4 S o n /d a u g h te r-in -la w
□
8 N o n -re la tiv e
1.3. INTERVIEWER: Fill the appropriate oval.
FOR PERSONS NOT SEEN ASK: Is
male or
mother's place of usual residence when
1 A n tig u a a n d B a rb u d a
1 M a le
1.4
□
□
was
2 A b ro a d (A n o th e r C o u n try ) G o to Q 2 .3
2.2 In which district/parish was .... 's. mother living?
(A ll g o to Q2.5)
2.3 In which country was
mother living?
female?
2.4 In which year did
□
FO R A L L P E R S O N S
S E C T IO N 2: M IG R A T IO N
last come to live in Antigua and Barbuda?
2 F e m a le
What is
's date of birth?
/
2.5 Is/are ....... living abroad at present?
If n ot kn ow n , as k :
H o w o ld w a s
□
1 Yes
□
2 No
(If no, g o to Q2.10)
o n h is/h e r la s t b irth d a y ?
I f age is n o t stated please estim ate age i f you s
the perso n. O therw ise ask the respondent to
estim ate the perso n's age
2.6 In which country does
now live?
use 97 for age over 96
1.5 To what ethnic, racial or national group do you think
belongs?
□
1 A fric a n D e s c e n t/N e g ro / B la c k
□
6 S y ria n /L e b a n e s e
□
2 In d ig e n o u s P e o p le (A m e rin d ia n /C a rib )
□
7 W h ite / C a u c a s ia n
□
3 E a s t Indian
□
8 M ix e d
□
4 C h in e s e / A s ia n
□
10 D o n 't k n o w /N o t S ta te d
□
5 P o rtu g u e s e
Q
2.7 How long has/have
FR O M M O N T H / Y E A R
/
9 O th e r (p le a s e s p e c ify ................................. )
2.8 Why did
1.6 What is
's religion/denomination?
□
1 A n g lic a n
□
11 M u slim
□
2 B a p tis t
□
12 P e n te c o s ta l
□
3 Bahai
□
13 P re s b y te ria n
□
4 B re th re n
□
14 R a s ta fa ria n
□
5 C h u rc h o f G o d
□
15 R o m a n C a th o lic
□
6 E v a n g e lic a l
□
16 S a lv a t io n A rm y
□
7 H in d u
□
17 S e v e n th D a y A d v e n tis t
□
8 J e h o v a h W itn e s s e s
□
18 N o n e
□
9 M e th o d is t
□
19 N o t S ta te d
□
10 M o ra v ia n
□
2 0 O th e r (p le a s e sp e cify ....
1.7A Do
.
O
□
2 N o (sk ip to Q 1 .8 )
□
□
1 H om e
□
5 C e ll P h o n e d
□
□
8 N one
2 W ork
□
3 S chool
6 F a m ily F r ie n d
□
□ 5 T o sta rt a b u s in e s s
□
2 F a m ily is h ere
□
6 T h e W e a th e r
□
3 D e p o rte d
□
7 T o o b ta in e m p lo y m e n t
□
4 R e tire d
□
8 H e a lth R e a s o n s
□
9 O th e r
intend to stay?
Y ears
□
1 Yes
0 2
2.11 Why did
3 N o t S ta ted
Note that fo r p o s t p a id the am ount
required is the am ount billed
1.8. Where is Internet access available t o
1 R e g a rd it a s h o m e /H o m e s ic k
M o nths (ALL, g o to Q2.12)
2.10 Has ..... ever lived abroad in the past ten years?
1.7B How much did .... spend on cellular telephone (pre-paid and/or
post-paid) in the last month (exclude balances from previous
bills, include monthly package cost and additional cost for text
messaging, caller ID, call waiting, etc)
$
return/come to Antigua and Barbuda?
□
2.9 For how long does/do
have a working mobile phone ?
1 Y es
lived there?
? X all that apply
□
7 O th e r
4 Internet C a fe
N o (go to 2.12 )
return/come to Antigua and Barbuda?
□
1 R e g a rd it
a s h o m e /H o m e s ic k
□
5 T o s ta rt a b u s in e s s
□
2 F a m ily is h e re
□
6 T h e W e a th e r
□
3 D e p o rte d
□
7 T o o b ta in e m p lo y m e n t
□
4 R e tire d
□
8 H e a lth R e a s o n s
□
9 O th e r
2.12 Does any member of ....... household frequently engage in any of
the following (X all that apply)
□
1 D rin k in g A lc o h o l
□
4 S ex u al ab u se
□
2 S m o k in g o f C ig a re tte s
□
5 P h y s ic a l a b u s e
□
□
3 S m o k in g /In g e s tio n o f b a n n e d S u b s t a n c e s o f a n o th e r m e m b e r ° f
h o u s e h o ld
7 O th e r
□ 6 P h y s ic a l a b u s e o f c h ild re n
□
8 N o n e o f th e a b o v e
□
9 Don t K now
P age 1 o f 20
n
Page 2 of 20
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10281
FO R A L L P E R S O N S
S E C T IO N 3: H E A L T H
3.1 Did
have to be c o n fin e d to b e d during the past thirty (30)
days due to any illness or injury? For example, cold, diarrhea,
fever, headache, stomach ache, dizziness, severe pains or other
illness/injury due to accident?
□ 1 Yes
□ 2 N o If No, go to Q3.3
3.2 What type of illness/injury was this?
3.15 How long did ....... have to wait at this place before being attended
to?
M inu tes
3.16 How satisfied were/was ....... with the attention/treatment received?
list o nly the m ajo r illness/injury as clearly as possible
3.3 During the past 30 days, did ..... suffer from cold, diarrhea, fever,
headache, stomach ache, dizziness, severe pains or other
illness/injury due to accident?
□
1 Yes
□
□
1 V e r y s a tis fie d , G o to Q 3 .1 8
□
3 D is s a tis fie d
□
2 S a tis fie d , G o to Q 3 .1 8
□
4 V e r y d is s a tis fie d
3.17 Why were/was........... not satisfied?
□
1 D ru g s n ot a v a ila b le
□
3 A ttitu d e o f S ta ff
□
2 D ru g s n ot a ffo rd a b le
□
4 L o n g w a itin g tim e
□
5 E q u ip m e n t n ot a v a ila b le o r o p e ra tio n a l
3.4 What type of illness/injury was this?
$
3.5 Does
suffer from any of the following diseases, Diabetes, High
Blood Pressure, Heart Condition, Cancer, HIV?
1 Yes
□
I f yes to e ith e r Q 3 .1 o r Q3.3 an d N o to
Q 3.5 g o to Q 3.7
i f N o to Q3.1, Q 3.3 an d Q 3.5 g o to Q3.28
Otherwise, an s w er Q 3.6 an d C ontinue
2 No
3.6 If yes, which of these?
□
1 D ia b e te s
□
2 H ig h B lo o d P r e s s u r e □
□
4 Cancer
□
5 H IV /A ID S □
3.7 Did
days?
□
□
How many of these were 2.
days of work without pay?
(G o to Q 3 .1 1 )
□
EC
3.20 Did ..... spend the night in a public/private hospital or any
other
public establishment during the past thirty (30) days?
□
1 Yes
[ ] 2 No
I f no to Q3.23
3.21 How many nights during the past thirty (30) days did ..... spend in
the public/private hospital?
Days
3.9 Did ..... visit a doctor, nurse, pharmacist, healer, spiritual healer,
midwife or other health practitioner during the past thirty (30) days
due to illness/injury?
1 Yes
EC
$
3.8 For how many days during the past thirty (30) days was/were ....
unable to carry on his/her usual activities because of illness/injury?
□
7 T o m a n y re v is its
3 H e a rt C o n d itio n
2 B e fo re
D ays
□
3.19 How much did ........ have to pay at private/public health facilities
for all visits made during the past thirty (30) days? Do not
include the cost of drugs or any cost paid by your insurance.
6 O th e r
's illness/injury begin within or before the last thirty (30)
1 W ith in
6 N o D o cto r/T ra in e d
3.18 How much did ........ have to pay at public health facilities for all
visits made during the past thirty (30) days? Do not include the
cost of drugs or any cost paid by your insurance.
list o nly the m a jo r illness/injury as clearly as possible
□
□
s ta ff ava ila ble
If No, go to Q3.5
2 No
FO R A L L P E R S O N S
S E C T IO N 3: H E A L T H c o n 't
N ights
3.22 How much did ..... have to pay or have paid altogether for his/her
stay in a public/Private hospital during the past (30) days? Do not
include the cost of drugs or any cost paid by your insurance.
2 No
$
EC
3.10 If no, why not?
□
1 No N eed
□
2 T o o e x p e n s iv e
□
4 U n tre a ta b le
□
5 O th e r
□
3 T o o fa r
3.23 Did ..... buy medicines during the past thirty (30) days?
□
A fte r Q 3.10 go to Q3.28
1 Yes
□
2 No
If no to Q3.28
3.24 Did ..... obtain medicines at a public facility?
3.11 How many visits did ..... make in the past thirty (30) days to
health practitioners?
□
1 Yes
□
2 No
3.25 Did ..... obtain medicines at a private facility or pharmacy?
□
V isits
1 Yes
□
2 No
3.26 How much would ...... have spent if he/she were to purchase
the medicines obtained from a public facility at a private facility?
Where was .... first visit made?
□
1 P u b lic H o sp ita l
□
6 P riv a te D o c to r/D e n tist
□
2 P riv a te H o sp ita l
□
7 T ra d itio n a l H e a le r
□
3 C o m m u n ity H e a lth C lin ic
□
8 O u t o f s ta te h o sp ita l
□
4 P o ly c lin ic
□
9 P h a rm a c y / C h e m is t
□
5 F a m ily P la n n in g C lin ic
□
10 O th e r
$
EC
3.27 How much h a s
spent for medicines at private/public sources
in the past (30) days?
P riv a te (in E C D o lla rs )
Why did ..... go there first?
P u b lic (in E C D o lla rs )
$
3.14 Who attended to ........ first visit?
□
1 N u rs e , h e a lth c a re w o rk e r
□
4 D o c to r
□
5 M id w ife
□
□
2 P h a r m a c is t
□
3 H e a le r
3.28 Is ..... covered by Private Health Insurance, Employee Medical
Plan, S.S. or Social Welfare?
□
1 Yes
□
2 No
6 O th e r
P age 2 o f 20
n
Page 3 of 20
n
10281
S E C T IO N 4: E D U C A T IO N
FO R A L L PERSONS
4.1 Can ..... read and write?
4.2 I s
□
attending school/classes? □
1 Yes
□
1 Yes
□
4.14 Does
have all textbooks required for his/her use at school?
□
1 Y e s , h a s b o o k s fo r e x c lu s iv e u se
□
2 Y e s , but s h a r e s w ith o th e r fa m ily m e m b e rs
□
3 H a s o n ly s o m e b o o k s
□
4 H a s none
2 No
2 No
I f no to Q 4.19
Classes includes Distant Education, fo r d istant education g o to 4.6b
4.3 Is it?
□
1 F u ll-tim e
□
2 P a rt-tim e
□
(if none, g o to Q4.17)
3 N o t S ta te d
4.15 Were any of
4.4 What is the current grade
00
01
02
03
04
98
N one
N u rse ry
P re-sch o o l
K in d erg arte n
Special E d u c a tio n
D o n 't K n o w
11
12
13
14
15
16
20
G ra d e 1
G ra d e 2
G 3 /S td 1
G 4 /S td 2
G 5 /S td 3
G 6 /S td 4
G 7 /S td 5
21
22
25
26
27
28
29
30
4.5 Does ....... attend private
□
1 Yes
□
2 No
are/is attending at present?
□
G 8 / S td 6
G 9 /S td 7
F rm 1 /S P 1
F rm 2 /S P 2
F rm 3 /S P 3
F rm 4 / G 1 0
F rm 5 /G 1 1
F rm 6 / A Level
31 A SC - A 'Level
32 A SC - T e c h /V o c
33 A SC - B usiness
34 A SC - Yr1 o r Y r2 U W I
35 A SC - O th e r
36 U niversity - U W I C am pus
37 U niversity - O th e r
38 A B B IT
39 H o te l T ra d es S chool
school/classes ?
40 V o c a tio n a l/T e c h In s t
41 O th e r
4.6a Does ...... live at home while attending school/classes?
□
1 Yes
□
1 Yes
's books provided by the school at no cost?
□
2 No
4.16 Were some of these books acquired by
ways? (Select all that apply)
□
1 B o rro w e d fo r u s e d u rin g y e a r
□
2 R e c e iv e d fro m re la tiv e s o r frie n d s
□
3 P u rc h a s e d N e w
□
5 R e c e iv e d fro m N G O
□
4 P u rch a s e d s e co n d hand
□
7 G overnm e n t B o o k S ch e m e
6 B o u g h t som e/
9ot
lo a n or fre e
INTERVIEWER: for those answering 1 in Q. 4.14 go to Q.4.18
4.17 What are the reasons for
1 Yes
□
2 No
4.6b Are/is ...... enrolled in a distant education programme?
□
in any of the following
□
2 No
(If yes, go to Q4.20)
not having required textbooks?
□
1 B o o k s n ot a v a ila b le
□
4 B o o k s w e re lo s t o r d e s tro y e d
□
2 C o u ld n ot affo rd
□
5 T o be p u rc h a s e d
□
3 B o o k s a v a ila b le in s c h o o l lib ra ry
F o r Part tim e and distant education persons, you sho u ld proceed to Q4.20
4.7 During the last five days of school how many days did
go to school/classes?
□
(If 5 days go to Q4.9)
D ays
4.8
4.9
4.18
6 O th e r (S p e cify )
or
1 Yes
's parents ever made use of a book loan facility?
□
2 No
not go to school during all of the last five school
□
1 Illn ess
□
6 N o t w o rth g o in g
□
2 F in a n c ia l P ro b le m s
□
7 S c h o o l c lo s e d /h o lid a y s
□
3 T ra n s p o rta tio n P ro b le m s
□
8 T ru a n t/D e lin q u e n t (no re a so n )
□
4 W o rk in g
□
9 P re g n a n t/y o u n g m o th e r
□
5 H o m e d u tie s
□
10 B a b y sittin g
□
11 A p p re n tic e s h ip
□
14 M e n s tru a l P ro b le m s
□
12 F e a r o f G a n g s
□
15 O th e r (S p e c ify
All go to Q. 4.25
FOR ALL PERSONS NOT ATTENDING SCHOOL AT PRESENT
4.19
How far away is school from here (in minutes based on
his/her usual/normal means of getting there)?
M inu tes
How does .. normally get to school?
4.10
Has
□
Why did
days?
D
actually
□
1 W a lk in g
□
4 B u s / M in i B u s
□
2 C y c lin g
□
5 P riv a te tra n sp o rt
□
3 Taxi
□
6 O th e r (S p e cify )
For persons under sixteen (16) years of age, why i s
attending?
not
□
1 Too young
□
9 P re g n a n t/y o u n g m o th e r
□
2 F in a n c ia l P ro b le m s
□
10 B a b y sittin g
□
3 T ra n s p o rta tio n P ro b le m s
□
11 A p p re n tic e s h ip
□
4 W o rk in g
□
12 N o t w o rth g o in g to s c h o o l
□
5 Illn e s s
□
13 E x p e lle d
□
6 P h y s ic a lly / m e n ta lly c h a lle n g e d
□
14 S u s p e n d e d
□
7 N o s c h o o l a v a ila b le
□
15 O th e r ( S p e c ify
□
8 N o s p a c e in s c h o o l
□
16 N o t a p p lic a b le (if p e rs o n > 15 y e a rs )”
4.20
Has
□
1 Yes
ever attended school?
□
2 No
(If no, go to Q4.24)
4.21 What age did ..... start?
4.11 Is there a school feeding programme at............ 's sch
□
1 Yes
□
2 No
(if no, g o to Q4.14)
4.22 What age did ..... leave?
4.12 Do you pay for the school meal service?
□
1 Yes
4.13 Does
□
1 Yes
□
2 No
receive meals or snack from this service?
□
2 No
4.23 What is the highest grade ..... completed?
00
01
02
03
04
98
N one
N u rse ry
P re-sch o o l
K in d erg arte n
Special E d u c a tio n
D o n 't K n o w
11 G ra d e 1
12 G ra d e 2
13 G 3 / S td 1
14 G 4 / S td 2
15 G 5 / S td 3
16 G 6 / S td 4
20 G 7 / S td 5
21 G 8 /S td 6
22 G 9 /S td 7
25 F rm 1 /S P 1
26 F rm 2 /S P 2
27 F rm 3 /S P 3
28 F rm 4 / G 1 0
29 F rm 5 /G 1 1
30 F rm 6 / A Level
31 A SC - A 'L evel
32 A S C - T e c h /V o c
33 A SC - B usiness
34 A SC - Yr1 o r Y r2 U W I
35 A SC - O th e r
36 U niversity - U W I C am pus
37 U niversity - O th e r
38 A B B IT
39 H o te l T ra d es School
40 V o c a tio n a l/T e c h In s t
41 O th e r
P age 3 o f 20
■
t ü
3
P age
4 of 20
10281
S E C T IO N 5: E M P L O Y M E N T
4.24 What is the highest examination ever passed?
5.9
□
1 None
□
2 S c h o o l le a v in g C e rtific a te
□
3 C X C B a s ic
□
4 G C E "O 7LC C /C X C
G e n P r o f (1 o r 2 s u b je c ts ) G ra d e
□
5 G C E "O "/L C C /C X C
G e n P r o f (3 o r 4 s u b je c ts ) G ra d e
□
6 G C E "O "/L C C /C X C
G e n P r o f (5 a n d o v e r s u b je c ts ) G ra d e I, II, III
□
for per so n s
What is the main activity at the place of
Tourism Related?
15 y e a r s a n d o v e r
's main job? Is it
□
1 A g ric u ltu re /fish in g - O th e r
□
2 A g ric /fis h - T o u ris m R e la te d
□
3 M a n u fa c tu rin g - O th e r
□
4 M a n u - T o u ris m R e la te d
I, II, III
□
5 C o n s tru c tio n - O th e r
□
6 C o n s t - T o u ris m R e la te d
I, II, III
□
7 W h o le s a le a n d R e ta il - O th e r
□
8 W & R - T o u ris m R e la te d
□
9 H o te l a n d R e s ta u ra n t
□
10 T ra n s p o rta tio n - O th e r
□
11 T ra n s p - T o u ris m R e la te d
7 G C E "A "/C A P E /H S C 1 or 2
□
12 S e r v ic e s - O th e r
□
13 S e r v ic e s - T o u ris m re late d
□
8 G C E "A "/C A P E /H S C 3 and over
□
14 A d m in /s o c ia l s e c / G o v / M e d ic a l
□
15 A d m in etc. - T o u ris m re late d
□
9 D ip lo m a o r E q u iv a le n t C e rtific a te
□
16 E d u c / s o c ia l w o rk
□
17 e d u c /s o c ia l - to u ris m re late d
□
18 O th e r
19 O th e r - T o u ris m re late d
□
□
10 A s s o c ia t e D e g re e
□
11 U n d e rg ra d u a te D e g re e
□
12 P o s tg ra d u a te D e g re e
□
1 P a id
E m p lo y e e - G o v e r n m e n t
□
□
13 P ro fe s s io n a l Q u a lific a tio n s - C o m p u te r
□
2 P a id
E m p lo y e e - S ta tu to ry
□
□
14 P r o fe s s io n a l Q u a lific a tio n s - A c c o u n tin g
□
3 P a id
E m p lo y e e - p rivate
□
15 P ro fe s s io n a l Q u a lific a tio n s - O th e r
□
4 S e lf e m p lo y e d w ith o u t e m p lo y e e s
□
16 O th e r
4.25 Did
5.10 What is. status in the main job?
1 V o c a tio n a l
□
3 B oth
□
2 T e c h n ic a l
□
4 None
If u n d e r 15, g o to S ection
S E C T IO N 5: E M P L O Y M E N T
6 U n p a id fa m ily w o rk e r
7 O th e r
□
(If 1,2 or 3 go to Q5.12)
5.11 If worked for self without paid help or did any informal work,
please provide the following information for the last twelve months?
have any vocational or technical training?
□
5 S e lf e m p lo y e d w ith e m p lo y e e s
7
f o r p e rs o n s 15 y e a r s a n d o v e r
1. Location
n 1
F ix e d
□
2 M o v e d from p la c e to p la c e
2. A ve ra g e v a lu e o f s a le s/se rvice $
EC
5.1a H ow m an y m o n th s d id yo u /h e/sh e w o rk in th e p a s t 12 m o n th s?
0
1
2
3
4
5
6
7
8
9
10
11
□ □ □ □ □ □ □ □ □ □ □
12
□ □
3. P rod uct/service pro vid e d ________
If response is 0, skip to Q5.13
5.1b D id
do any type of work in the last 7 days?
4.
□
1 Yes
2 No
□
5.12
5.2 Was ..... absent from work in the last 7 days?
□
1 Yes
□
2 No
$
T o ta l C apital Invested
EC
(If Yes go to Q5.5)
What has been the major problem preventing you from earning a
higher income in the past twelve months?
(If Yes go to Q5.5)
F o r a ll p erso ns w ho are em ployed go to Q 6 .1
5.3 H as
been looking for work and ready for work in the last 2
months?
□
1 Yes
2 No
n
FO R A L L P E R S O N S W H O DID N O T W O R K O R DO
A N Y T H IN G T O EAR N A N IN C O M E LA S T W E E K
(If yes, go to Q5.13)
5.4 What was the main reason
was not working in the last 7 days?
5.13
When last d id
work?
6 m o n th s
□
1 N o w o rk a v a ila b le
□
6 In firm ity /D isa b le d
□
□
4 3 >
□
2 S e a s o n a l in a ctiv ity
□
7 D id n ot w a n t to w o rk
□
2 L e s s th a n o n e m onth
□
5
□
3 1 > 3 m o n th s
□
6 1 y e a r a n d m ore
□
3 S tu d e n t
□
8 M a te rn ity L e a v e
□
4 H o u s e h o ld /fa m ily d u tie s
□
9 O t h e r ____________________________
□
5 R e tire d
5.14
(Aligo to Q5.13)
5.5 How many years have
been in this job?
5.6 How many hours did/does
Y e a rs
0 fo r
under 6
mths
normally work in a week?
(if greater than 35 hours, go to Q5.8)
5.7 What is the reason for working less than 35 hours?
□
1 O w n illn e s s/in ju ry
□
6 J o b e n d e d in re fe re n c e w e e k
□
2 H o lid a y /v a c a tio n
□
7 F irm n ot g e tting e n o u g h w o rk
□
3 P e rs o n a l/fa m ily re s p o n s ib ilitie s
□
8 C o u ld n ot fin d m o re w o rk
□
4 In s ch o o l/tra in in g
□
9 P a rt T im e W o r k
□
5 S trik e / lo c k ou t
□
10 P re g n a n c y
□
11 O th e r
5.8 What is your occupation, that is what activities do you do in your
work? e.g. sales manager or sales clerk, mason etc
1 N e v e r W o r k e d (G o to Q 5.15)
What was the main reason w h y
6 > 12 m o n th s
left last job?
□
1 N ew Jo b
□
7 D id n ot w a n t to w o rk
□
2 F ire d
□
8 N o m o re w o rk a v a ila b le
□
3 Illn ess/In ju ry
□
9 W a g e s to o low
□
4 R e tire d
□
10 S e a s o n a l job
□
5 T o retu rn to s c h o o l
□
11 H o m e D u tie s
□
6 R e tre n c h e d / la id off
□
12 S e x u a l H a ra s s m e n t
□
14 O th e r (S p e cify )
□
13 P re g n a n c y
5.15 D id
□
look for work or do anything to earn income last month?
1 Yes
□
2 No
(If yes, go to Q5.17)
5.16 Why d id ...... not seek work or do anything to earn income last
week?
□
1 A t school
□
7 A w a itin g re s u lts o r a p p lic a tio n s
□
2 H o u s e k e e p in g
□
8 K n ew o f no v aca n cy
□
3 R e tire d
□
9 D is c o u ra g e d
□
4 D is a b le d
□
10 C a rin g fo r s o m e o n e
□
5 T e m p o ra ry illn e s s
□
11 P re g n a n c y
□
6 D id n ot w a n t w o rk
□
12 O th e r (sp e cify)
(All, g o to Q5.18)
P age 4 o f 20
■
[n a
10281
5.17 What kind of work are you looking for?
INTERVIEWER: What is required is a description of the work you
are looking for e.g. sales manager or sales clerk, mason etc
SECTION 7 CRIME
7.1 In the last 12 months have you/he/she............ been a victim of
crime?
I" ! 1 Y e s
□
5.18 What would have prevented
from doing a job if one were
available during the last three weeks?
□
1 A t sch ool
□
7 H a v e to s ta y h o m e w ith c h ild re n
□
2 H o u s e k e e p in g
□
8 P re g n a n c y
□
3 R e tire d
□
10 C a rin g fo r s o m e o n e
□
4 D is a b le d
□
11 O th e r (sp e cify)
□
5 T e m p o ra ry illn e s s
□
12 D o n 't K N o w
□
6 D id n o t w a n t w o rk
□
13 N o th in g
SECTION 6 : MARITAL, UNION STATUS AND FERTILITY FOR PERSONS
15 YEARS AND OVER
l~ l 3 N o t S tated
7.2 A. Describe the nature of the main crime (inclusive of
domestic violence)?
7.2 b What did the crime cost you:
Days without pay:
6.1 What is your/....'s present union status?
□
1 L e g a lly m a rrie d
□
2 C o m m o n L a w un io n
□
3 V is itin g p a rtn e r
□
4 M a rrie d but n ot in un io n
□
5 L e g a lly s e p a ra te d a n d n ot in a u n io n
□
6 W id o w e d a n d n ot in un io n
If No, go to Section 8 for all spenders
Otherwise end the interview
2 No
Other economic loss::
□
7 D iv o rc e d a n d n ot in un io n
□
8 N o t in a u n io n (S in g le )
□
9 D o n ^ k n o w /N o t s ta te d
D ays
$
7.3 Was the crime reported to the police?
Go to Q 7.5
□
1 Yes
□
2 No
□
3 N o t S ta te d
A ll m ales go to Q 7.1
7.4 Why was the crime not reported to the police?
FO R F E M A L E S 15 T O 4 9 Y E A R S
□
1 N o c o n fid e n c e in th e a d m in is tra tio n o f ju s tic e
6.2 Is/Are ..... currently pregnant?
□
2 A fra id o f th e p e rp e tra to r
□
3 P e rp e tra to r h o u s e h o ld m e m b e r/re la tiv e
□
4 N o t s e rio u s e n o u g h
□
5 O th e r ( S p e c ify ) ...........
□
1 Yes
6.3 Is/Are
□
1 Yes
□
(If no, g o to Q6.4)
2 No
attending a public health clinic?
□
Spenders skip to Section 8
For all others end interview
2 No
7.5 How satisfied was/were
police?
6.4 How many live births has ...... ever had?
(if Zero, enter 00 and skip to Q7.1)
□
1 V e r y s a tis fie d
□
3 D is s a tis fie d
2 S a tis fie d
□
4 V e r y d is s a tis fie d
6.5 How many died?
□
B e fo re first b irth d a y
with the handling of the matter by the
End o f Interview for all non- spenders
A fte r first b irth d a y
How old were you/was she when you/she had the first live born
child?
6.6
6.7 How many live births didyou/she have in the last
6.8
(If no, g o to Q 7.1)
□
1 None
□
2 One
□
3 T w o s e p a ra te births
12
months?
□
4 T w in s
□
5 T h re e o r m ore
Of these, have any of the babies died?
□
1 Yes
□
2 No
(If no, g o to Q7.1)
6.9 How many have died?
W ith in th e firs t 3 0 d a y s o f life_________________________________
A fte r 3 0 d a y s but b e fo re o n e y e a r
N o t applicable
Leave Blank
N o t Know n
9's ending in 8
A m o u n t too large 9's ending in 7
N o t Stated
Try harder, if n o t use all 9's
P age 5 o f 20
[s e c t io n 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id
p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
I
D E S C R IP T IO N
M a te ria l fo r m e n
a n d b o y 's g a rm e n ts
S uiting M aterial
T w eed
K haki
CODE
0 3 1110 5
C hiffo n
Linen
M adras
Poplin
Flo w e red
C otton
Silk
P olyester
0311201
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
Q
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
LI
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
03 1120 2
0 3 1120 3
0 3 1120 4
0 3 1120 5
0 3 1120 6
0 3 1120 7
0 3 1120 8
0 3 1120 9
03 1131 0
0311311
M a terial fo r scho ol
shirts
03 1131 2
O v e r lace
□
0 3 1110 6
M aterial fo r school
overall
S uiting m aterial
Yes
0 3 1110 3
T a ilo rin g fo r S u it
S atin
□
031110 2
0 3 1110 4
M a te ria l fo r w o m e n
a n d c h ild r e n g a rm e n ts
C re p e back S atin
b o u g h t boQjGHT
0 3 1 1 1 0 1
M aterial fo r school
T ro u s e rs
T a ilo rin g fo r T ro u s e rs
I P U R C H A S E D (h o m em ad e) I
0 3 1131 3
0 3 1131 4
TO TA L C O S T($)
G IFTS
BOQ jGHT
TO TAL C O S T($)
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
P age 6 o f 20
ms
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
10281
8
. D id
p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
P U R C H A S E D (hom em ade)
D E S C R IP T IO N
CODE
HAVE
QTY
BOUGHT BOUGHT
□ Yes
S e a m s tre s s fee s fo r su it
03 1131 5
□ Home
S e a m s tre ss
fe e s fo r u n iform
□ Yes
0 3 1131 6
□ Home
S e a m s tre ss fe e s for
fo rm a l w e a r
□ Yes
0 3 1131 7
□ Home
M e n 's G a rm e n ts -O u te r w e a r
C om p le te S uits - 2 piece
□ Yes
0312101
□ Home
□ Yes
Jacke ts
031210 2
□ Home
□ Yes
S w eate rs
0 3 1210 3
□ Home
□ Yes
W aistco a ts/p u llo ve rs
0 3 1210 4
□ Home
Long T ro u s e rs / pants
fo r d re s s a n d o ffic e
Long T ro u s e rs /
p a nts casu al w e a r
□ Yes
0 3 1210 5
□ Yes
0 3 1210 6
□ Yes
□ Home
□ Yes
0 3 1210 8
S h o rt pants (J e a n s )
0 3 1210 9
□ Home
□ Yes
□ Home
S h o rt pa n ts(h o u se
w ear)
□ Yes
0 3 1211 0
S hirts (ca sual,
w o rk in g )
J e rse ys (d re s s ,
w o rk in g )
S ports w e a r /vests
P olo S hirts
T - S hirts
T ra c k suits
/J o g g in g suits
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
nn nn nnnnn □□□□□
nnnn nnnnn□□□□□
□□□□□
□□□□□
□□□□□
nnnn nnnnn nn nn□
nn nn nnn nn nn nn□
□□□□□
□□□□□
□□□□□
□□□□□
□□ □□ □□□□□
□□ □□ □□□□□
i
j
j
j
j
i
j
j
j
j
i
j
j
j
j
j
j
____________
j
____________
j
i
j
j
j
j
j
j
____________
j
□ Home
S hirts - long
s leeve s (dress)
T O T A L C O S T ($ )
j
0 3 1210 7
S h o rt pants
(ca sual)
T O T A L C O S T ($ )
j
□ Home
□ Home
Long Jea ns pants
G IFTS
QTY
BOUGHT
Q
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
0312111
031211 2
0 3 1211 3
0 3 1211 4
0 3 1211 5
0 3 1211 6
0 3 1211 7
j
________
j
j
j
j
i
j
j
j
j
i
j
j
j
j
j
1
1
j
i
i
i
P age 7 o f 20
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id
p u r c h a s e o r r e c ie v e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
PU R C H A S E D (h o m em ad e)
D E S C R IP T IO N
CODE
HAVE
QTY
BOUGHT BOUGHT
0 3 1211 8
□ Home
□ Yes
B a th robes /h o u s e c o a ts
031211 9
□ Home
O Yes
C ostu m es
0 3 1212 0
□ Home
□ Yes
O v e rc o a t/ ra in c o a t
0312121
□ Home
□ Yes
W o rk ove ralls
0312122
□ Home
O Yes
M e n's o u te rw e a r not
sp e cifie d b y type
M e n 's u n d e rw e a r
a n d H o s ie ry
V ests
03 1219 9
□ Home
□ Yes
0 3 1212 4
□ Home
0 3 1212 5
0 3 1212 6
□ Home
0 3 1212 7
□ Home
O Yes
All o th e r m e n 's ou ter
wear
O th e r a r tic le s o f M e n 's
c lo th in g
T ie s & S carve s
031219 9
□ Home
□ Yes
0313101
□ Home
031310 2
0 3 1310 3
□ Home
03 1310 4
□ Home
O Yes
B race s
03 1310 5
□ Home
Q Yes
H a n d k e rc h ie fs
03 1310 6
□ Home
□ Yes
S ew ing th re a d , b u tto n s ,
zips, bu ckle s
0 3 1310 7
H e lm e ts
0 3 1300 8
□ Home
O Yes
□ Home
O th e r m e n's clothing
□
Yes
□
H om e
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
____________
□ Yes
B e a ch w e a r
?
?
□ Home
L I Yes
B elts
?
____________
LJ Yes
H a ts and caps
?
____________
□ Yes
S ocks
□□ □□
□□ □□
□□ □□
□□ □□
□□ □□
□□ □□
□□ □□
n nn nnnnnnn nn□
n nn nnn nn □□□□□
□□ □□
□□ □□
□□ □□
n nn nnnnnnn nn□
n nn nnn nn □□□□□
□□ □□
□□ □□
□□ □□
□□ □□
nn □□□□ □□□□ □□
n1□□□□ i□□i□□ □□i
i
?
?
□ Home
□ Yes
U n d e rw e a r
/u n d e rp a n ts
T O T A L C O S T ($ )
____________
□ Yes
B o x e r shorts
QTY
BOUGHT
T O T A L C O S T ($ )
i
O Yes
P yjam as
G IFTS
0 3 1319 9
1
?
?
?
?
?
?
?
?
?
?
?
?
?
?
P age 8 o f 20
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id
p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
I
D E S C R IP T IO N
B o y 's o u te r w e a r
C o m p le te S uits -2 /3 piece
J a c k e ts
S w eate rs
W a is tc o a ts / pullovers
L o ng T ro u s e rs /p a n ts
(dress)
L o ng tro u s e rs / pants
(casual w ear)
L o ng J e a n s pants
S h o rt pants (casual)
S h o rt pants (Jeans)
S h o rt pants
(h ouse w ear)
S hirts -d re s s (L o n g
sleeve s)
S hirts (ca sual)
J e rs e y s (dress)
S ports w e a r/ vests
P olo S hirts
T - S hirts
T ra c k su its/
Jo g g in g suits
P yjam as
B ath robes
/h o u s e c o a ts
C o s tu m e s
I
CODE
I P U R C H A S E D (h o m em ad e) I
BOHU
AVGE
HT boujcsHT
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
0312201
03 1220 2
0 3 1220 3
0 3 1220 4
0 3 1220 5
0 3 1220 6
0 3 1220 7
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
0 3 1220 8
0 3 1220 9
0 3 1221 0
0312211
03 1221 2
0 3 1221 3
0 3 1221 4
0 3 1221 5
0 3 1221 6
0 3 1221 7
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
0 3 1221 8
0 3 1221 9
0 3 1222 0
TO TAL C O S T($)
G IFTS
b OUGHT
TO TA L C O S T($)
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
P age 9 o f 20
I
m3
10281
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id ........ p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
P U R C H A S E D (hom em ade)
D E S C R IP T IO N
CODE
HAVE
QTY
BOUGHT BOUGHT
□ Yes
O v e rc o a t/ ra in coat
0312221
□ Home
B o y 's o u te r w e a r not
sp e cifie d by type
O Yes
0 3 1229 9
□ Home
B o y 's u n d e rw e a r
a n d H o s ie ry
V e s ts
0 3 1222 4
B o x e r sho rts
0 3 1222 5
□ Yes
□ Home
O Yes
□ Home
□ Yes
U n de rw ea r / un derp ants
0 3 1222 6
□ Home
□ Yes
S ocks
0 3 1222 7
□ Home
□ Yes
All o th e r boy's o u te r w e a r
0 3 1229 9
□ Home
□ Yes
B o y 's s c h o o l g a rm e n ts
Lo ng P ants (school)
03 1222 8
S h o rt P ants (sch ool)
0 3 1222 9
□ Home
O Yes
□ Yes
S h irt (sch ool)
0 3 1223 0
S ports uniform
0312231
O th e r a r tic le s o f
B o y 's c lo th in g
T ie s & S carve s
0313201
H a ts and caps
03 1320 2
O th e r boy's clothing
W o m e n 's o u te r w e a r S k irt
S uits (2 o r 3 piece)
P ants suits
D re s s e s
(evening form al)
D re s s e s (o ffice)
T O T A L C O S T ($ )
□□□□□
□□□□□
□□□□□
□□□□□
nn nnn
□□□□□
nn nnn
□□□□□
uu uu uuuuu □□□□□
uu uu uuuuu □□□□□
uu uu uuuuu □□□□□
□□□□□
uu uu uuuuu □□□□□
nn nnn
□□□□□
nn nnn
□□□□□
□□□□□
□□ □ □□□□□□□□
M □ □□□□□□□□
i
J
j
J
j
J
j
J
j
J
j
J
j
J
j
J
j
J
j
---------------------1
j
---------------------1
J
□ Yes
□ Home
□ Yes
Beachw ear
T O T A L C O S T ($ )
J
O Yes
B elts
G IFTS
QTY
BOUGHT
□
Yes
□
H om e
□
Yes
□
H om e
O
Yes
□
H om e
□
Yes
□
H om e
O
Yes
□
H om e
□
Yes
□
H om e
0 3 1320 3
0 3 1320 4
0 3 1329 9
0312301
03 1230 2
0 3 1230 3
O
Yes
□
H om e
0 3 1230 4
j
---------------------1
J
j
J
j
---------------------1
J
j
J
j
J
j
J
j
J
j
J
j
1
1
J
i
j
1
1i
i
P age 10 o f 20
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id ........ p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g i t e m s in t h e p a s t 3 m o n t h s ?
P U R C H A S E D (h o m em ad e)
D E S C R IP T IO N
CODE
HAVE
QTY
BOUGHT BOUGHT
□ Yes
D resse s (ca sual)
0 3 1230 5
□ Home
□ Yes
S hirts /b lo u s e s (form al)
0 3 1230 6
□ Home
D Yes
S hirts / blou ses (casual)
03 1230 7
□ Home
□ Yes
S k irts (long)
03 1230 8
□ Home
D Yes
S k irts (short)
03 1230 9
□ Home
□ Yes
S la cks / tro users
03 1231 0
□ Home
□ Yes
Je a n s (Long)
0312311
□ Home
□ Yes
Je a n s (short)
031231 2
□ Yes
0 3 1231 3
□ Home
□ Yes
Jerseys
w ith sleeve s
03 1231 4
□ Home
D Yes
Jerseys w ith o u t sleeve s
0 3 1231 5
□ Home
□ Yes
Polo -s h irts
03 1231 6
O ve ra lls
0 3 1231 7
□ Home
L I Yes
□ Home
□ Yes
T ra c k suits / Jog ging
suits
03 1231 8
S ports clothes
(netball)
03 1231 9
S w eate rs / J u m pers
03 1232 0
□ Home
□ Yes
□ Home
D Yes
□ Home
□ Yes
H o u s e clothes
0312321
□ Home
D Yes
S leep w ear
031232 2
□ Home
□ Yes
R o b e s / H o u s e c o a ts
03 1232 3
□ Home
□ Yes
R a in c o a ts / ove rcoats
QTY
BOUGHT
TO TAL C O S T($)
TO TAL C O S T($)
□□ □□
□□ □□
□□ □□
□□ □□
□□ □□
□□ □□
□□ □□
nn nn nnn nn □□□□□
nn nn nnn nn □□□□□
□□ □□
nnnn nnnnnnn nn□
□□ □□
nn nn nnn nn □□□□□
nn nn nnn nn nn nn□
□□ □□
□□ □□
□□ □□
□□ □□
□ □□□□ □□□□ □□
□□□□□□□□□□□□□□
i
i
j
j
j
j
j
j
j
j
j
j
j
j
j
j
1
1
____________
j
□ Home
T - shirts
G IFTS
0 3 1232 4
□ Home
j
____________
j
j
j
j
____________
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
i
i
j
__________
j
_____________ _________
____________
j
i
j
i
i
i
P age 11 o f 20
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id
p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
P U R C H A S E D (h o m em ad e)
D E S C R IP T IO N
CODE
HAVE
QTY
BOUGHT BOUGHT
□
A ll o th e r w o m e n 's
o u te r w e a r
Yes
0 3 1239 9
W o m e n 's U n d e rw e a r
□
H om e
□
Yes
□
H om e
□
Y es
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
0 3 1232 5
S lip s - h a lf o r full
B ras
V ests
P anties
T ig h ts / P anty hose
G ird le s
S ocks
S to ckin g s
0 3 1232 6
0 3 1232 7
0 3 1232 8
0 3 1232 9
0 3 1233 0
0312331
03 1233 2
O th e r W o m e n 's C lo th in g a n d
C lo th in g A c c e s s o r ie s
H ats
0313301
Bathing s uits /
B e a ch w e a r
03 1330 2
S c a rv e s / belts
0 3 1330 3
Bags
P urses
W a tc h e s
0 3 1330 4
0 3 1330 5
0 3 1330 6
N e c k la c e s and earring s
(G old, silver, precious
s to n e s )
0 3 1330 7
N e c k la c e s and
e a rrin g s (c o s m e tic s )
0 3 1330 8
G irls O u te r w e a r
D resse s (fo rm a l/ e v e n in g )
0312401
S h irts / blou ses (casual)
03 1240 2
T - shirts
G IFTS
QTY
BOUGHT
TO TA L C O S T($)
TO TAL C O S T($)
□ □□
□ □□
□ □
□ □□
□ □□
□ □□
□ □□
□ □□
□ □□
□ □□
□ □
□ □□
□ □□
□ □□
□ □□
□ □
□ □□
□ □□
□□□ □□□□□ □ □
□□□□ □□□ □□□□ □□□
1
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
0 3 1240 3
______
J
________ ______
________
J
1
J
11
1
1
P age 12 o f 20
S E C T IO N
8
: C L O T H IN G A N D F O O T -W E A R C O N S U M E D D U R IN G P A S T 3 M O N T H S
10281
_______________8 .D i d .......... p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
P U R C H A S E D (h o m em ad e)
D E S C R IP T IO N
CODE
HAVE
QTY
BOUGHT BOUGHT
0 3 1240 4
03 1240 5
□ Home
O Yes
0 3 1240 6
□ Home
03 1240 7
□ Home
□ Yes
P ants suits (casual)
03 1240 8
□ Home
O Yes
Jerseys
0 3 1240 9
□ Home
03 1241 0
R a in c o a ts
031241 2
□ Home
Q Yes
□ Home
□ Yes
O th e r girls ou ter w e a r not
s p e c ifie d by type
G ir l's u n d e rw e a r
a n d h o s ie ry
B ras
03 1249 9
□ Home
O Yes
0 3 1242 4
□ Home
03 1242 5
□ Home
O Yes
V e s ts
0 3 1242 6
□ Home
□ Yes
T ig h ts
03 1242 7
□ Home
03 1242 8
□ Home
O Yes
G ir l's s c h o o l g a rm e n ts
S choo l O verall
0 3 1243 0
□ Home
0412431
□ Home
□ Yes
S choo l S kirts
041243 2
□ Home
O Yes
S ports uniform
0 4 1243 3
□ Home
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
1
□ Yes
O th e r g ir l's c lo th in g
Hats
j
i
□ Yes
S choo l b lo u s e s / shirts
j
i
□ Yes
S o c k s / s tockin gs
j
i
□ Yes
Panties
j
________
□ Yes
0312411
j
j
□ Home
S leep w e a r /
p a ja m as
j
i
□ Yes
H o u s e cloth es
j
i
□ Yes
J ea ns skirts
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
nn nn nnnnn nn nn□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□□□□
□□ □□ □□□□□
□□ □□ □□□□□
i
□ Yes
J ea ns pants (lon g/sho rt)
T O T A L C O S T ($ )
j
□ Home
S la cks / tro users
QTY
BOUGHT
T O T A L C O S T ($ )
i
□ Yes
S k irts (ca sual)
G IFTS
0313401
j
□ Home
1
1
j
i
i
i
P age 13 o f 20
|
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id
p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
I P U R C H A S E D (h o m em ad e) I
D E S C R IP T IO N
B a t h in g s u it s
CODE
BOUGHT
BOUGHT
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
0313501
D r e s s e s / S u it s
P la y s u it s
Q TY
0312402
I n fa n t s ( u n d e r 1 y e a r ) C lo t h in g
a n d c lo t h in g a c c e s s o r ie s
HAVE
0313502
T O T A L
G IFTS
QTY
C O S T ($ )
T O T A L
BOUGHT
C O S T ($ )
□ □□
□ □□
□ □□
nn nn nnn nn□□□□□
□ □□
□ □□
□ □□
□ □□
□ □□
nn nn nnn nn□n nn□
nnnn nnn nn□□□□□
nnnn nnnnn□□□□□
□ □□
□ □□
nn nn nnnnn□n nn□
nn nn nnn nn□□□□□
□ □□
□ □□
□□□ □□□□□ □ □
nn □n nn□□nnn nn□
i
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
j
-------------------B a b y s h ir t s / v e s t s
D ia p e r s
S o c k s / b o o t ie s
H a ts /b o n n e ts
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
0313503
0313504
0313505
0313506
O t h e r in f a n t c lo t h in g
n o t s p e c ifie d b y ty p e
0313599
D r y - c le a n in g , la u n d e r in g a n d
d y in g o f g a r m e n t s
0314101
M e n a n d b o y 's c lo t h in g
-------------------□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
( J a c k e t s , s u it s )
□
H om e
W o m e n a n d g ir ls
□
Yes
□
H om e
W o m e n , g ir ls a n d
i n f a n t s c lo t h in g
0314102
_________________
R e p a ir s a n d a lt e r a t io n s
M e n a n d b o y s c lo t h in g
0314201
j
j
_________________
W om en and
g ir ls c lo t h in g
I n f a n t s c lo t h in g
0314202
0314203
H ir e o f g a r m e n t s
M e n a n d b o ys g a rm e n ts
0314301
j
j
j
j
j
j
_________________
g a r m e n t s ( W e d d in g o u t
0314302
f it s , e v e n i n g g o w n s )
j
j
-------------------M e n a n d B o y 's s h o e s
(1 6 y rs. a n d o v e r)
S h o e s - casu al
S a n d a ls
S n e a k e rs /spo rts
s h o e s / gym sho es
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
0321101
S h o e s - d re s s (m a n -m a d e )
S h o e s - d re s s (L e a th e r)
□
0321102
0321103
-------------------------
j
j
j
j
j
j
j
0321104
0 3 2110 5
______
j
________ ______ _______
j
i
j
i
i
i
P age 14 o f 20
SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3 MONTHS
8
. D id
p u r c h a s e o r r e c e iv e a s g i f t s a n y o f t h e f o l l o w i n g it e m s in t h e p a s t 3 m o n t h s ?
I P U R C H A S E D (h o m em ad e) I
D E S C R IP T IO N
B oots -w o rk
B oots-casua l
S lip p e rs -h o u s e
CODE
032120 2
B oots
03 2120 6
S hoe s -d re s s
S and als
Y es
□
H om e
□
Yes
□
H om e
□
Y es
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
D
Yes
□
H om e
D
Yes
□
H om e
D
Y es
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
□
Yes
□
H om e
D
Yes
□
H om e
D
Yes
□
H om e
□
Yes
03 2120 7
03 2120 8
0321301
032130 2
0 3 2130 3
S n e a k e rs /
S ports sho es
03 2130 4
S h o e s -fa shion
03 2130 5
S lip p e rs -h o u s e
D
0 3 2120 4
03 2120 5
In fa n ts a n d c h ild r e n (u p to 16
y e a rs )
S hoe s -sch ool
H om e
03 2120 3
S n e a k e rs / s p o rts sho es
/gym sho es
S lip p e rs - house
□
03 2110 8
S hoe s -d re s s (Leath er)
S lip p e rs - fashion
Yes
0 3 2110 7
0321201
S and als
D
03 2110 6
W o m e n a n d g ir ls (16 y e a rs
a n d o v e r)
S hoe s -d re s s (m an - m ade)
S h o e s -ca sual
HAVE
QTY
BOUGHT BOUGHT
03 2130 6
0322101
W o m e n and g irls sho e
re pair
0322201
QTY
BOUGHT
TO TAL C O S T($)
TO TAL C O S T($)
□□ □ □
□ □
□□ □ □
□□ □ □
□□ □ □
□□ □ □
□□ □ □
□□ □ □
□ □
□□ □ □
□□ □ □
□□ □ □
□□ □ □
□□ □ □
□ □
□ □
uu uu uuuuu□□ □□□
□□□□ □□□□□□□ □□□
□□ □ □□□□□□□ □ □
1
J
J
J
J
J
J
J
J
J
J
1
1
J
J
J
J
J
J
J
J
J
J
J
J
J
J
1
1
J
J
J
J
J
J
J
J
J
I""! H o m e
S h o e R e p a ir
M en and boys sho e
re pair
G IFTS
□
Yes
□
H om e
□
Yes
□
H om e
-----------------
J
--------------------- 1----------------
-------------------- 1
J
-----------------
J
--------------------- 11---------------- 1
J
1
-------------------- 1
J
1
11
1
P age 15 o f 20
[33
SECTION 9 - OTHER EXPENSES
(Always indicate value, Include Quantity where requested)
10281
9. D i d
spend m oney on any o f the fo llo w ing in the past 3 m onths?
E x p e n d it u r e D u r in g L a s t 3 M o n t h s
C O D E
M
E D I C A L
E X P E N S E S
D o c to rs F e e s
(N u m b e r o f v isits)
D e n tis t F e e s
(N u m b e r o f v isits)
0621101
(Y /N )
□
Yes
0622101
□
Yes
C h ild B e a rin g F e e s
0621106
□
Yes
O p tic ia n
0621104
□
Yes
Fees
P riv a te h o s p ita l c a r e (n u m b e r o f n ig h ts)
0630108
L a b T e s ts a n d X - r a y s (n u m b e r o f la b te st)
0623101
□
Yes
D ru g s f o r H y p e rte n s io n
0611102
□
Yes
D ru g s f o r C a n c e r
0611103
□
Yes
D ru g s f o r D ia b e te s
0611104
□
Yes
D ru g s f o r C o ld / F lu
0611112
□
Yes
O th e r D ru g s a n d P r e s c rip tio n s , M e d ic a l s u p p lie s
0611199
□
Yes
S p e c ta c le s , h e a rin g a id s , d e n tu re s , e tc
H e a lth a n d A c c id e n t In s u ra n ce
O th e r M e d ic a l E x p e n s e s
E D U C A T I O N A L
□
Yes
Yes
1253001
□
Yes
0623199
□
Yes
A M O U N T ($ )
NO.
S P E N T 3 M O N TH S
:: □ □□□
Uu □ □□□
uu □ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
J
1
J
1
J
1
J
1
J
1
J
E X P E N S E S
T u itio n - F o r p re -s c h o o l/D a y C a re
T u itio n - C o r r e s p o n d e n c e C o u r s e s (all le v e ls )
L e s s o n s fo r C h ild re n P rim a r y / S e c o n d a ry
L e s s o n s / N ig h t C la s s e s f o r A d u lts
T u itio n - P rim a ry , S e c o n d a r y S c h o o l
T u itio n - T e rtia ry , U n iv e rs ity a n d O th e r
B o a rd in g a n d lo d g in g
S c h o o l a n d te c h n ic a l b o o k s
E x a m fe e s
0613101
□
Q U A N T IT Y
1010101
□
Yes
1040202
□
Yes
1050101
□
Yes
1050102
1040101
□
Yes
□
Yes
□
Yes
□
Yes
1040101
1120101
0951101
□
Yes
□
Yes
1040203
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □□□
□ □
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
1
J
P age 16 o f 20
1
[33
SECTION 9 - OTHER EXPENSES
(Always indicate value, Include Quantity where requested)
10281
9. D i d
spend m oney on any o f the fo llo w ing in the past 3 m onths?
E x p e n d itu re D u rin g L a s t 3 M o n th s
EDUCATIONAL EXPENSES (Cont'd)
C o m p u t e r s o ftw a re a n d a c c e s s o r ie s
S c h o o l T ra n s p o rta tio n f e e s
S c h o o l M e a ls
O th e r
09 1310 5
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
A M O U N T ($)
SPENT 3 MONTHS
□
0737101
011942 3
1050101
E N T E R T A IN M E N T E X P E N S E S
C a rn iv a l
094210 5
C in e m a s / v id e o / D V D re n ta ls /v id e o c lu b s
0914101
C o n c e rts , p la y s , fe te s a n d o th e r a d m is s io n s
QUANTITY
NO.
CODE
0942101
S p e c ta to r s p o rts , fo o tb a ll, c ric k e t
0941102
N ig h t c lu b s , d a n c e s , p a rtie s
0 9 4210 4
P a rtic ip a n t s p o rts
0 9 4219 8
D u e s , s u b s c rip tio n s a n d m e m b e rs h ip s
09 4210 5
L o tte ry g a m e s
1270104
N e w s p a p e rs
0952101
T o y s fo r C h ild re n
093110 0
B o o k s ,m a g a z in e s
(n o n -te c h n ic a l a n d n ot f o r s c h o o l)
095210 2
O th e r E n te rta in m e n t, H o b b y
□
094219 9
S p e c if y ........................................
T R A N S P O R TA TIO N BY A IR
(fo r Q u a n tity indicate n u m b er o f visits)
C a rib b e a n - S t M a rtin /S t. M a a rte n
0733101
C a rib b e a n - P u e rto R ic o
073310 2
C a rib b e a n - O th e r
0 7 3310 3
U S A - N e w Y o rk , M ia m i, etc..
0 7 3310 4
E n g la n d - L o n d o n , e tc
0 7 3310 5
O th e r F o re ig n T ra v e l by A ir
0 7 3310 6
□
□
□
P age 17 o f 20
■
■
SEC TIO N 9 - O T H E R E X P E N S E S
9.
D id
spend m oney on any o f th e fo llo w ing in the past 3 m onths?
E x p e n d itu re D u rin g L a s t 3 M o n th s
CODE
(Y/N)
Q U A N T IT Y
NO.
A M O U N T ($)
SPENT 3 MONTHS
T R A N S P O R TA TIO N BY BOAT
(fo r Q u an tity indicate n u m b er o f trips)
B a rb u d a
0734101
O th e r
073410 2
P E R S O N A L A N D
O T H E R
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
B u s T ra n s p o rta tio n
W e d d in g s
L e g a l a n d a c c o u n tin g e x p e n s e s
(n o n -b u s in e s s )
F u n e ra ls
L o c a l a c c o m m o d a tio n e x p e n s e s
□
Yes
0 7 3240 0
073210 0
1270103
1270101
1270102
1120104
B a rb e rs h o p
1 2 1 1 2 01
H a ir d r e s s e r
1 2 1 1 1 01
B e a u ty S a lo n (m a n ic u re s , p e d ic u re s , f a c ia ls e tc..)
P h o to s tu d io s
1 2 1 1 1 0 2
0 5 6220 5
0 9 4210 6
D riv in g L e s s o n s
0724301
□
Yes
O th e r p e rs o n a l s e r v ic e s
1211300
□
Yes
□
Yes
O th e r tra v e llin g e x p e n s e s
J
J
E X P E N S E S
T a x i T ra n s p o rta tio n
L a u n d ry /D ry c le a n e r s
nn n nn
□□ □□□□
073810 2
u □□□
u □□□
u □□□
u □□□
u □□
u □□
u □□□
j □□□
j □□□
u □□□
□□□
□□□
u □□□
□□□
i
J
i
J
J
i
i
J
J
i
i
J
J
J
J
J
J
i
i
i
i
i
i
J
J
J
P age 18 o f 20
i
i
■ HQ
10281
SEC TIO N 10 - O T H E R D IS B U R S E M E N T S
10.
D id
E x p e n d itu re D u rin g L a s t M o n th
spend m oney on any o f the fo llo w ing last m onth?
CODE
(Y /N )
Some of the more common expenditures are in bold
□
N O N - C O N S U M P T IO N E X P E N D IT U R E S
Income Taxes
□
2 0 1 0 0 0 2
Life insurance premium
1251001
Interest on consumerloans
C re d it C a r d P a y m e n ts
Hire-purchase installments
G ifts ( C a s h a n d fin a n c ia l)
A llow ances to children
A lim o n y / C h ild m a in te n a n c e
R e m itta n c e s e n t to p e rs o n s a b ro a d
D o n a tio n s a n d c h a ritie s
S u b s c r ip tio n s a n d c o n trib u tio n s to tra d e u n io n s
a n d o th e r o rg a n iz a tio n s
L o a n s g iv e n ou t
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
J
J
2 0 2 0 0 0 2
J
202000 4
J
2030001
J
J
2040002
J
2030002
J
204000 3
2060001
□□□□□□
□□□□□□
□□□□□□
□□□□□□
□□□□□□
□□□□□□
J
2020003
2050001
1
J
2 0 2 0 00 1
2040001
nnn □□□
J
2 0 1 0 0 0 1
O th e r ta x e s , d u tie s , f e e s a n d o th e r c o m p u ls o r y c h a rg e s
e .g. C u s t o m s d u tie s , d e p a rtu re tax, s ta m p d u ty etc.
A n n u itie s
Yes
A M O U N T ($)
J
□□□□□□
□□□□□□
□□□□□□
□□□□□□
J
J
National Insurance payments
O th e r N o n C o n s u m p tio n E x p e n d itu re
1255102
J
20 6009 9
J
D IS B U R S E M E N T S O T H E R T H A N C O N S U M P T IO N E X P E N D IT U R E S L A S T T W E L V E M O N T H S
S o u S o u , box
C redit U nion Shares
B ank Deposits
T re a s u r y B ills / G o v e r n m e n t B o n d s
S to c k s a n d s h a r e s in lo c a l c o m p a n ie s
S to c k s a n d s h a re s in fo re ig n c o m p a n ie s
Investm ent in real estate (Land)
O th e r D is b u rs e m e n ts
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
□
Yes
2 1 1 0 0 0 1
J
2 1 1 0 0 0 2
211000 3
J
J
2 1 2 0 0 0 1
eee ccE
eee ccE
eee ccE
eee ccE
eee EEE
J
2 1 2 0 0 0 2
J
212000 3
J
2130001
213009 9
rr E
J
J
P age 19 o f 20
1
i
ma
SECTION 11 - INCOME
CODE
10281
Not applicable
Not Known
Amount too large
Not Stated
11. Did
Leave Blank
9's ending in 8
9's ending in 7
Try harder, if not use all 9's
2
3
4
5
receive m oney from any o f the fo llo w ing so urces?
IN C O M E S O U R C E S - E M P L O Y M E N T
1A.
What was...'s gross pay/income during the last pay period, that is
before income tax or other deductions? (PRESENT FLASH CARD)
1B .
How much did you receive in wages and salary LAST PAY PERIOD
FROM MAIN JOB (GROSS PAY) . In clu d e O v e rtim e , tip s a n d b o n u s e s ,
In co m e ta x, m e d ic a l b e n e fit a n d S S
2.
D o y o u g e t th is a m o u n t re g u la rly ?
3.
How much did you receive in wages and salary LAST PAY PERIOD
FROM OTHER JOB (GROSS PAY). In clu d e O v e rtim e , tip s a n d b o n u s e s ,
S e m i- A n n u a lly
A n n u a lly
6
CODE
PERIOD
In co m e G ro u p
AMOUNT ($)
>
□
i
□□ □□□
2231001
j
□
1 Yes
□
2 No
□□ □□□
C
2231002
In co m e ta x, m e d ic a l b e n e fit a n d S S
4.
PER IO D
D aily
W e e k ly
F o rtnig htly
M o nthly
1
j
□
1 Yes
□
2 No
2331001
□
1 Yes
□
2 No
Do you get this amount regularly?
IN C O M E S O U R C E S - O T H E R , R E C E IV E D A N N U A L L Y
5.
M o n e y s e n t b y re la tiv e s a n d frie n d s o v e r s e a s - R e m itta n c e s from a b ro a d
6.
R e n ta l in c o m e re c e iv e d by y o u fo r h o u s e , la n d a n d o th e r p ro p e rty
2341001
□
1 Yes
□
2 No
7.
O th e r e n tre p re n e u ria l in c o m e , e x a m p le from s e lf e m p lo y m e n t
223100 3
□
1 Yes
□
2 No
8.
D iv id e n d s on lo c a l a n d fo re ig n in v e s tm e n ts (e.g C re d it u n io n d iv id e n d s )
2351001
□
1 Yes
□
2 No
9.
In te re st on lo c a l a n d fo re ig n b a n k d e p o s its , b o n d s
2361001
□
1 Yes
□
2 No
2371001
□
1 Yes
□
2 No
□
1 Yes
□
2 No
10 . G o v e r n m e n t re tire m e n t p e n sio n
j
j
j
j
j
j
11.
P e n s io n fro m o th e r fo rm e r A n tig u a a n d B a rb u d a e m p lo y e r
2371002
12.
P e n s io n from fo rm e r fo re ig n e m p lo y e r
237100 3
□
1 Yes
□
2 No
237100 4
□
1 Yes
□
2 No
j
2381001
□
1 Yes
□
2 No
j
2381002
□
1 Yes
□
2 No
2381003
□
1 Yes
□
2 No
2391003
□
1 Yes
□
2 No
2391002
□
1 Yes
□
2 No
□
1 Yes
□
2 No
2361002
□
1 Yes
□
2 No
239109 9
□
13. S o c ia l S e c u r it y (S S ), e x c lu d in g o ld a g e /re tire m e n t p e n s io n
14.
In s u ra n c e A n n u itie s
15. P u b lic a s s is t a n c e
16. C h ild s u p p o rt
17. A llo w a n c e s - a lim o n y
18. A llo w a n c e s -
fina ncial aid
19. A llo w a n c e s - s c h o la rs h ip s
2 0. In tere st fro m s to c k s , s h a re s , T re a s u ry b ills a n d o th e r in v e s tm e n ts
2 1. A ll O th e r In co m e , n e s
239100 3
j
j
j
j
j
j
□□ □□□
□
3 3
j
j
1 Yes
□
2 No
j
P age 20 o f 20
1