1. Household members
1.1. How many members are there in your household?
(Enter the number of members in your household who are presently living together under the same roof or on the same lot.)
__ __ persons
1.2. For each member of your family, enter their personal relationship to you, their sex, age, student or worker status, living with you or separately, and marital status.
(Please include here your husband and any children living separately from you due to work, schooling, living with their spouse or in-laws, or being hospitalized.)
Personal relationship to you |
Personal relationship to you |
Sex |
Age |
Student or worker status |
Living together or separately |
Marital status |
|
---|---|---|---|---|---|---|---|
ME |
1. male
2. female
|
1. Together
2. Separately
|
1. Single
2. Married
|
||||
1. male
2. female
|
1. Together
2. Separately
|
1. Single
2. Married
|
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⋮ |
⋮ |
⋮ |
⋮ |
⋮ |
⋮ |
⋮ |
|
1. male
2. female
|
1. Together
2. Separately
|
1. Single
2. Married
|
00 Me
01 My first child
02 My second child
03 My third child
04 My forth child
05 Fifth or later child subsequent
06 My parent
|
07 My grandparent
08 My brother or sister
09 My child’s spouse
10 My grand child
11 Other relative
12 Other
|
Todo
The following code table is not included in the questionnaire.
1. Preschooler
2. Student in grades 1 to 3 of primary school
3. Student in grades 4 to 6 of primary school
4. Junior-high school student
5. Senior-high school student
|
6. University or college student
7. Vocational school student
8. Worker
9. Unemployed
10. Other
|