User:Bowsertendo666/Vizhutuan census forms

1962, 1967, 1972
1. What is your name? 2. What is your relationship to the head of household? -Head -Wife -Son or daughter -Stepson or stepdaughter -Other relative (print) -Visitor -Boarder -Employee -Other nonrelative (print) 3. Where is your usual residence? -Here -Other residence: State District City or town -None 4. What was your place of residence in 1971? Same residence Other - Print state, district, and city. If born abroad, write name of country. 5. Sex Male or female 6. Date of birth Specify year, month, and day of birth. 7. Martial status Married Widowed Divorced Separated Never married 8. Where were you born? Print state, district, and city. If born abroad, write name of country. 9. Where was your father born? Print state, district, and city. If born abroad, write name of country. 10. Where was your mother born? Print state, district, and city. If born abroad, write name of country. 11. What is your citizenship? Vizhutuan Other citizenship - Print name of country. Stateless 12. What is your race or ethnic origin? Vizhutuan Lenyingan Tambalan Rangitian Buran Nyidushan Fusonchan Pondunyan Nytan Other - ethnic origin 13. What is your mother tongue? 14. Can you speak Sarwabhasa? Very well Well Not well Not at all 15. What is your religious affiliation? Buddhism Nutaderrami Hinduism Islam Traditional religion Not religious Other religion - specify 16. Are you literate? 17. Have you been attending school or college since January 1? 18. What was the highest grade level you attended General: Pre-primary Primary school: 1 2 3 4 5 6 Secondary school: 1 2 3 4 5 6 University: 1 2 3 4 5+ Vocational: Secondary school: 4 5 6 University: 1 2 19. Do you have a disability? If yes, print the disability. 20. What is your current field of education? If currently attending primary or secondary school, write "general" or "vocational" depending on the type of school. If attending or having graduated from a university or vocational program, write the field of the degree. 21-32 are for all people born April 1, 1956 or earlier 21. Have you been employed last week? Employer Employed Family Looking for work Unemployed and not looking for work 22. When was the last time you worked? Last week 1-4 weeks ago 1-12 months ago 1+ years ago Never 23. What is your occupation? Print occupation 24. What industry do you work in? Print industry 25. What is the business of your employer? Federal government State government Local government Employmee of private business 26. Where did you work last week? Specify: City or town District State 27. How many weeks have you been working in the past 12 months? 28. How many hours have you worked in the past 12 months? 29. What is your income from jobs? 30. What is your income from your own business? 31. What is your income from insurance? 32. What is your income from other than earnings and insurance? 33-36 are for married women only 33. How many times have you been married? 34. What was your age at your first marriage 35. How many years have you been married? 36. How many children have you gave birth to?

1977
1. What is your name? 2. What is your relationship to the head of household? []Head []Wife []Son or daughter []Stepson or stepdaughter []Other relative (print) []Visitor []Boarder []Employee []Other nonrelative (print) 3. Where is your usual residence? []Here []Other residence: State District City or town []None 4. What was your place of residence in 1976? []Same residence []Other - Print state, district, and city. If born abroad, write name of country. 5. If you moved to another residence in 1976, why did you move? 6. Sex []Male []Female 7. When were you born? Year, month, day 8. Martial status []Married []Widowed []Divorced []Separated []Never married 9. Where were you born? [] Vizhutua []Abroad - print name of country. 10. Where was your father born? Print state, district, and city. If born abroad, write name of country. 11. Where was your mother born? Print state, district, and city. If born abroad, write name of country. 12. Do any of your parents live in this household? Father: []Yes []No []Deceased Mother: []Yes []No []Deceased 13. What is your citizenship? Vizhutuan Other citizenship - Print name of country. Stateless 14. If you were born in a foreign country, when did you come to live in Vizhutua? Print year. 15. What is your race or ethnic origin? Vizhutuan Lenyingan Tambalan Rangitian Buran Nyidushan Fusonchan Pondunyan Nytan Other - Print ethnic origin 16. What is your mother tongue? 17. Can you speak Sarwabhasa? Very well Well Not well Not at all 18. What is your religious affiliation? Buddhism Nutaderrami Hinduism Islam Traditional religion Not religious Other religion - specify 19. Are you literate (can read and write),? []Yes []No 20. Have you been attending school or college since January 1? 21. What was the highest grade level you attended? General: Pre-primary Primary school: 1 2 3 4 5 6 Secondary school: 1 2 3 4 5 6 University: 1 2 3 4 5+ Vocational: Secondary school: 4 5 6 University: 1 2 22. What is your current field of education? If currently attending primary or secondary school, write "general" or "vocational" depending on the type of school. If attending or having graduated from a university or vocational program, write the field of the degree. 23-38 are for all people born April 1, 1961 or earlier 23. What was your employment status as of last week? []Employer []Employee []Unpaid family worker []Unemployed 24. When was the last time you worked? Last week 1-4 weeks ago 1-12 months ago 1+ years ago Never 25. How long have you been looking for work? []Since last week []Weeks ago []Months ago []Years ago 26. Have you been taking steps to look for work? []Yes []No 27. What is your occupation? Print occupation 28. What industry do you work in? Print industry 29. What is the business of your employer? Federal government State government Local government Employee of private business 30. Where did you work last week? Specify: City or town District State 31. How many weeks have you been working in the past 12 months? 32. How many hours have you worked in the past 12 months? 33. Did you have any other jobs this past week? []Yes []No 34. If you had any other jobs, what other job did you do? 35. What is your income from jobs? 36. What is your income from your own business? 37. What is your income from insurance? 38. What is your income from other than earnings and insurance? 39-43 are for married women only 39. How many times have you been married? 40. What was your age at your first marriage? 41. How many years have you been married? 42. How many children have you gave birth to? 43. What is the status of your children? Print numbers in boxes. Alive: []Male []Female Deceased: []Male []Female 44. Do you have a disability or health issue? If yes, print the disabilities.

1982
1. What is your name? 2. What is your relationship to the head of household? []Head []Wife []Son or daughter []Stepson or stepdaughter []Other relative (print) []Visitor []Boarder []Employee []Other nonrelative (print) 3. Sex []Male []Female 4. When were you born? Print year, month, and day of burth. 5. Martial status []Married []Widowed []Divorced []Separated []Never married 6. Where is your usual residence? []Here []Other residence: State District City or town []None 7. What was your place of residence in 1976? []Same residence []Other - Print state, district, and city. If born abroad, write name of country. 8. If you moved to another residence in 1976, why did you move? 9. Where were you born? [] Vizhutua []Abroad - print name of country. 10. Where was your father born? Print state, district, and city. If born abroad, write name of country. 11. Where was your mother born? Print state, district, and city. If born abroad, write name of country. 12. Do any of your parents live in this household? Father: []Yes []No []Deceased Mother: []Yes []No []Deceased 13. What is your citizenship? Vizhutuan Other citizenship - Print name of country. Stateless 14. If you were born in a foreign country, what year did you come to live in Vizhutua? 15. If you were born outside your state, what year did you come to live in your state? 16. What is your race or ethnic origin? Vizhutuan Lenyingan Tambalan Rangitian Buran Nyidushan Fusonchan Pondunyan Nytan Other - Print ethnic origin 17. What is your mother tongue? 18. How well are you able to read and write in Sarwabhasa? Very well Well Not well Not at all 19. How well are you able to read and write in your native language? []Yes []No 20. What is your religious affiliation? Buddhism Nutaderrami Hinduism Islam Traditional religion Not religious Other religion - specify 21. Have you been attending school or college since January 1? 22. What was the highest grade level you attended? General: Pre-primary Primary school: 1-6 Secondary school: 1-6 University: 1 2 3 4 5+ Vocational school: 4-6 23. What was the highest grade level you completed? General: Pre-primary Primary school: 1-6 Secondary school: 1-6 University: 1 2 3 4 5+ Vocational school: 4-6 24. What is your current field of education? If currently attending primary or secondary school, write "general" or "vocational" depending on the type of school. If attending or having graduated from a university or vocational program, write the field of the degree. 25-40 are for all people born April 1, 1966 or earlier 25. What was your primary activity last week? []Working []Attending school []Housekeeping []Vacation (but with job) []Other 26. In addition to your primary activity, did you work this past week? []Yes []Yes (unpaid work) []No 27. What was your employment status as of last week? []Self-employed []Employer []Employee []Unpaid family worker []Unemployed 28. When was the last time you worked? []Last week []1-4 weeks ago []1-12 months ago []1+ years ago Never 29. If you are unemployed, how long have you been looking for work? []Since last week []Weeks ago []Months ago []Years ago []Never 30. Have you been taking steps to look for work? []Yes []No 31. How many days have you worked for in the past week? 32. How many hours have you worked in your primary activity in the past week? 33. How many days have you worked in other activities for in the past week? 34. What is your occupation? Print occupation 35. What industry did you work in? Print industry 36. What is the name and business of your employer? []Federal government []State government []Local government []Employee of private business - Print name of company below. 37. Where did you work last week? Specify: City or town District State 38. How many weeks have you been working in the past 12 months? 39. How many hours have you worked in the past 12 months? 40. Did you have any other jobs this past week? []Yes []No 41. If you had any other jobs, what other job did you do? 42. What was your total income last year (1976)? 43. What is your income from jobs? 44. What is your income from your own business? 45. What is your income from insurance? 46. What is your income from other than earnings and insurance? 47-53 are for married women only 47. How many times have you been married? 48. What was your age at your first marriage? 49. How many years have you been married? 50. How many children have you gave birth to? 51. What is the status of your children? Print numbers in boxes. Alive: []Male []Female Deceased: []Male []Female 52. Have you ever used any of the following contraceptives? 53. Where did you get the contraceptive? 54. Do you have a disability during the past week? []Blind []Deaf/mute []Physical []Mental []None 55. Did you feel unwell during the past week? 56. What medical service do you use when you feel unwell?

1987
1. What is your name? 2. What is your relationship to the head of household? []Head []Husband/wife []Biological son or daughter []Adopted son or daughter []Stepson or stepdaughter []Other relative (print) []Visitor []Boarder []Employee []Other nonrelative (print) 3. Sex []Male []Female 4. When were you born? Print year, month, and day of burth. 5. Martial status []Married []Widowed []Divorced []Separated []Never married 6. Where is your usual residence? []Here []Other residence: State District City or town []None 7. What was your place of residence in 1986? []Same residence []Different residence - Print state, district, and city. If born abroad, write name of country. 8. If you moved to another residence in 1986, why did you move? 9. Where were you born? [] Vizhutua []Abroad - print name of country. 10. Where was your father born? Print state, district, and city. If born abroad, write name of country. 11. Where was your mother born? Print state, district, and city. If born abroad, write name of country. 12. Do any of your parents live in this household? Father: []Yes []No []Deceased Mother: []Yes []No []Deceased 13. What is your citizenship? Vizhutuan Other citizenship - Print name of country. Stateless 14. If you were born in a foreign country, what year did you come to live in Vizhutua? 15. If you were born outside your state, what year did you come to live in your state? 16. If you were born outside your state or country, why did you come to live in your state? 17. What is your race or ethnic origin? Vizhutuan Lenyingan Tambalan Rangitian Buran Nyidushan Fusonchan Pondunyan Nytan Other - Print ethnic origin 18. What is your mother tongue? 19. How well are you able to read and write in Sarwabhasa? Very well Well Not well Not at all 20. How well are you able to read and write in your native language? []Yes []No 21. What is your religious affiliation? Buddhism Nutaderrami Hinduism Islam Traditional religion Not religious Other religion - specify 22. Have you been attending school or college since January 1? 23. What was the highest grade level you attended? General: Pre-primary Primary school: 1-6 Secondary school: 1-6 University: 1 2 3 4 5+ Vocational school: 4-6 24. What was the highest grade level you completed? General: Pre-primary Primary school: 1-6 Secondary school: 1-6 University: 1 2 3 4 5+ Vocational school: 4-6 25. What is your current field of education? If currently attending primary or secondary school, write "general" or "vocational" depending on the type of school. If attending or having graduated from a university or vocational program, write the field of the degree. 26. What school did you go to this school year? 27-42 are for all people born April 1, 1971 or earlier 27. What was your primary activity last week? []Working []Attending school []Housekeeping []Vacation (but with job) []Other 28. In addition to your primary activity, did you work this past week? []Yes []Yes (unpaid work) []No 29. What was your employment status as of last week? []Self-employed []Employer []Employee []Unpaid family worker []Unemployed 30. When was the last time you worked (in months?) Write "Never" if you did not work at all. 31. If you are unemployed, why are you not working? 32. If you are unemployed, how long have you been looking for work? []Since last week []Weeks ago []Months ago []Years ago []Never 33. How have you been taking steps to look for work? []Yes []No 34. If you were looking for work, was the work full-time or part-time? 35. How many days have you worked for in the past week? 36. How many hours have you worked in your primary activity in the past week? 37. How many days have you worked in other activities for in the past week? 38. What is your occupation? Print occupation 39. What industry did you work in? Print industry 40. What is the name and business of your employer? []Federal government []State government []Local government []Employee of private business - Print name of company below. 41. Where did you work last week? Specify: City or town District State 42. How many weeks have you been working in the past 12 months? 43. How many hours have you worked in the past 12 months? 44. Did you have any other jobs this past week? []Yes []No 45. If you had any other jobs, what other job did you do? 46. What was your total income last year (1986)? 47. What is your income from jobs? 48. What is your income from your own business? 49. What is your income from insurance? 50. What is your income from other than earnings and insurance? 51-57 are for married women only 51. How many times have you been married? 52. What was your age at your first marriage? 53. How many years have you been married? 54. How many children have you gave birth to? 55. What is the status of your children? Print numbers in boxes. Alive and living inside your household: []Male []Female Alive but living outside your household: Deceased: []Male []Female Total: []Male []Female 56. Have you ever used any of the following contraceptives? 57. Where did you get the contraceptive? 58. Do you have a handicap during the past week? []Blind []Deaf/mute []Physical []Mental []None 59. Did you feel unwell during the past week? 60. What medical service did you use when you felt unwell this past week?

1992
1-21: Personal Questions 1. What is your name? 2. What is your relationship to Person 1? []Husband/wife []Biological son or daughter []Adopted son or daughter []Stepson or stepdaughter []Other relative (print) []Visitor []Boarder []Employee []Other nonrelative (print) 3. Sex []Male []Female 4. When were you born? Print year, month, and day of burth. 5. Martial status []Married []Widowed []Divorced []Separated []Never married 6. Where is your usual residence? []Here []Other residence: State District City or town []None 7. What was your place of residence in 1991? []Same residence []Different residence - Print state, district, and city. If born abroad, write name of country. 8. If you moved to another residence in 1976, why did you move? 9. Where were you born? [] Vizhutua []Abroad - print name of country. 10. Where was your father born? Print state, district, and city. If born abroad, write name of country. 11. Where was your mother born? Print state, district, and city. If born abroad, write name of country. 12. Do any of your parents live in this household? Father: []Yes []No []Deceased Mother: []Yes []No []Deceased 13. What is your citizenship? Vizhutuan Other citizenship - Print name of country. Stateless 14. If you were born in a foreign country, what year did you come to live in Vizhutua? 15. If you were born outside your state, what year did you come to live in your state? 16. If you were born outside your state or country, why did you come to live in your state? 17. What is your race or ethnic origin? Vizhutuan Lenyingan Tambalan Rangitian Buran Nyidushan Fusonchan Pondunyan Nytan Other - Print ethnic origin 18. What is your mother tongue? 19. How well are you able to read and write in Sarwabhasa? Very well Well Not well Not at all 20. How well are you able to read and write in your native language? []Yes []No 21. What is your religious affiliation? Buddhism Nutaderrami Hinduism Islam Traditional religion Not religious Other religion - specify 22-28: Educational Questions 22. Have you been attending school or college since January 1? 23. What was the highest grade level you attended? General: Pre-primary Primary school: 1-6 Secondary school: 1-6 University: 1 2 3 4 5+ Vocational school: 4-6 24. What was the highest grade level you completed? General: Pre-primary Primary school: 1-6 Secondary school: 1-6 University: 1 2 3 4 5+ Vocational school: 4-6 25. What is your current field of education? If currently attending primary or secondary school, write "general" or "vocational" depending on the type of school. If attending or having graduated from a university or vocational program, write the field of the degree. 26. What school did you go to this school year? 27. Is it a public, private, or religious school? 28. How did you go to school last week? 29-45 are to be answered by all persons born April 1, 1976 or earlier 29. What was your primary activity last week? []Working []Attending school []Housekeeping []Vacation (but with job) []Other 30. In addition to your primary activity, did you work this past week? []Yes []Yes (unpaid work) []No 31. What was your employment status as of last week? []Self-employed []Employer []Employee []Unpaid family worker []Unemployed 32. When was the last time you worked (in months?) Write "Never" if you did not work at all. 33. If you are unemployed, why are you not working? 34. If you are unemployed, how long have you been looking for work? []Since last week []Weeks ago []Months ago []Years ago []Never 35. How have you been taking steps to look for work? []Yes []No 36. If you were looking for work, was the work full-time or part-time? 37. How many days have you worked for in the past week? 38. How many hours have you worked in your primary activity in the past week? 39. How many days have you worked in other activities for in the past week? 40. How do you go to work? 41. What is your occupation? Print occupation 42. What industry did you work in? Print industry 43. What is the name and business of your employer? []Federal government []State government []Local government []Employee of private business - Print name of company below. 44. Where did you work last week? Specify: City or town District State 45. How many weeks have you been working in the past 12 months? 46. How many hours have you worked in the past 12 months? 47. Did you have any other jobs this past week? []Yes []No 48. If you had any other jobs, what other job did you do? 49a. What is your income from jobs? 49b. What is your income from your own business? 49c. What is your income from insurance? 49d. What is your income from other than earnings and insurance? 49e. What is your total income? 50-57 are to be answered by married women only. 50. How many times have you been married? 51. What was your age at your first marriage? 52. How many years have you been married? 53. How many children have you gave birth to? 54. What is the status of your children? Print numbers in boxes. Alive and living inside your household: []Male []Female Alive but living outside your household: Deceased: []Male []Female Total: []Male []Female 55. How many children have you gave birth to in the past year (1991)? 56. Have you ever used any of the following contraceptives? 57. Where did you get the contraceptive? 58-60: Health Questions 58. Do you have a handicap during the past week? []Blind []Deaf/mute []Physical []Mental []None 59. Did you feel unwell during the past week? 60. What medical service did you use when you felt unwell this past week?