CPH FORM 3
AUTHORITY:
Commonwealth Act No. 591, Batas Pambansa Blg. 72,
and Executive Order No. 121 authorize the National
Statistics Office (NSO) to conduct and collect
information for this census.
CONFIDENTIALITY:
Section 4 of the Commonwealth Act No. 591 provides
that all information furnished in this questionnaire shall
be kept STRICTLY CONFIDENTIAL.
Republic of the Philippines 
CIFFO SCITSITATS LANOITAN
NATIONAL STATISTICSEOFFICE
A2
NSCB Approval No. NSO-1003-03
NSCB Approval No. NSO-1003-03
SAMPLE
QUESTIONNAIRE
DLOHESUOH NOMMOC
1102 ,03 eHOUSEHOLD
nuJ :no seripxE
:YTILAITNEDIFNOC
ERIANNOITSEUQ
DATE ACCOMPLISHED
STELKOOB
AUTHORITY:
Commonwealth Act No. 591, Batas Pambansa Blg. 72, and
Executive Order No. 121 authorize the National Statistics
DATE
REVIEWED
Office (NSO) to conduct and collect
information
for this
census.
CONFIDENTIALITY:
(SIGNATURE OVER PRINTED NAME)
______________________________________
ENUMERATOR
VISIT NUOVER
MBER PRINTED NAME)
(SIGNATURE
______________________________________
DATE
DATE
OFACCOMPLISHED
VISIT
MONTH:DATE
______________________________________
TEAM
SUPERVISOR
TIME
BEGAN
(SIGNATURE
OVER PRINTED NAME)
HOUR:MINUTE
______________________________________
TIME ENDED
DATE REVIEWED
HOUR:MINUTE
*
______________________________________
RESULTCAS/ACAS
OF VISIT
(SEE CODES
FOR
RESULTNAME)
OF VISIT)
(SIGNATURE
OVER
PRINTED
NEXT VISIT
______________________________________
DATE REVIEWED
___________________________________________
--------------------------------------
REBMUN AERA NOITAREMUNE
--------------------------------------
REBMUN LAIRES GNIDLIUB
___________________________________________
--------------------------------------
--------------------------------------
REBMUN LAIRES TINU GNISUOH
--------------------------------------
REBMUN LAIRES DLOHESUOH
--------------------------------------
TNEDNOPSER FO REBMUN ENIL
--------------------------------------
--------------------------------------
______________________________________
ROSIVREPUS MAET
)EMAN DETNIRP REVO ERUTANGIS(
HOUSEHOLD MEMBERSHIP
______________________________________
DEWEIVER ETAD
LIST THE _PERSONS
_____________OR
_____HOUSEHOLD
___________________
SACA/SAC
MEMBERS IN)ETHIS
ORDER:
MAN DETNIRP REVO ERUTANGIS(
 Head _____________D_E_W__E_I_V_E_R__E_T_A__D___________
of the head
______
____________________________________
DAEH DLOHESUOH FlO EMSpouse
AN
NATIONAL STATISTICS
OFFICE
LINE
NUMBER
OF RESPONDENT
- - E- M
- -A-N- T- S- R
- -IF- ,-E-M- A- N- -T-S-A-L- - - - - - - - - - - - - - - - CPH
FORM
2
___________children
__________of
___head/spouse
______________
 l  Never-married
ROSIVREPUS OP/OR/OC
2010 CENSUS OF POPULATION
NATIONAL STATISTICS OFFICE from oldest
)EMto
ANthe
DETN
IRP REVO ERUTANGIS(
youngest
___________-_-_-_-_-_-_-_-_-_-_-_-_-_-_- _- _- _- _- _- _- _- _- _- _
SSERDDA
CLUSTER
- _- -_-_-_-_-_-_- - - - - AND NUMBER
HOUSING
AUTHORITY:
l  Ever-married children of head/spouse and
NSCB
Approval
No.
NSO–1003-02
ITISBatas
FO EM
AN RO EMBlg.
AN T
EEand
RTS DNA REBMUN ESUOH
Commonwealth Act No. O
591,
Pambansa
72,
______________________________________
2010 CENSUS OF POPULATION
Executive Order No. 121 authorize the National Statistics
their families fromDEoldest
toTAthe
WEIVER E
D youngest
COMMON
HOUSEHOLD
OfficeOF
(NSO)
to conductHEAD
and collect__________________________________________
information for this
NAME
HOUSEHOLD
Expires on: June 30,AND
2011HOUSING
NSCB Approval No. NSO–1003-02
census.
DROCER WEIVRETNI
LAST NAME, FIRST NAME
l  Other relatives
QUESTIONNAIRE
CONFIDENTIALITY:TISIV FO YRAMMUS
3 TISIV HOUSEHOLD
2 TISIV
1 TISIV
REBMUN TISIV
COMMON
l  Nonrelatives
Section 4 of Commonwealth Act No. 591 provides that all
Expires on: June 30, 2011
GEOGRAPHIC IDENTIFICATION

--------------------------------------
2A
l
2A
information
ADDRESS
furnished
in this questionnaire shall be kept
____________________________________________________________
STRICTLY CONFIDENTIAL.
- - - - - - - - - HOUSE NUMBER AND
EDO
C S’RNAME
OTAR
EM
UNE
STREET
OR
NAME
OF SITIO
QUESTIONNAIRE
BOOKLET
CERTIFICATION
OF
BOOKLETS
- - - - that
- - - -the
- data set forth
EDherein
AM STwere
ISIV FO REBMUN
I hereby certify
personally obtained/reviewed
by me and
in
PROVINCE
__________________________________________
INTERVIEW
RECORD
accordance with the instructions given by the
*
T
I
S
I
V
L
A
N
I
F
F
O
T
L
U
SER
NSO.
VISIT 1
VISIT 2
PROVINCE
CITY/MUNICIPALITY
__________________________________________
BARANGAY
______________________________________
- - - - - ENUMERATOR
- - - - SREBMEM DLOHESUOH FO REBMUN
(SIGNATURE OVER
PRINTED NAME)
CITY/MUNICIPALITY
__________________________________________
TISIV FO ETAD
YAD:HTNOM
GEOGRAPHIC IDENTIFICATION
BOOKLET
OF
NAGEB EMIT
BOOKLETS ETUNIM:RUOH
SUMMARY OF VISIT
VISIT 3
__________________________________________
* TISIV FO TLUSER
TLUSER ROF SEDOC EES(
)TISIV FO
__________________________________________
NUMBER OF VISITS MADE
----------
- - - - - - RESULT
- - - - - - OF
- - -FINAL
- - - - VISIT
- - - - *- - - - - - - - - - - -- ------- - - - - -
ENUMERATION
BUILDING SERIAL NUMBER
- - - - - - - - - - - - - - - - -R-O- T- A- C
- I-D
- N- I- Q
- -A-S- - - - - - -AREA
- - NUMBER
______________________________________
TISIV TXEN
SUPERVISOR
snoitcTEAM
urtsnI Q
AS tuohtiw dlohesuoh elpma snoN 1
(SIGNATURE
snoitcurtOVER
snI QAPRINTED
S htiw dlohNAME)
esuoh elpma snoN 2
HOUSING UNIT SERIAL NUMBER
- - - - - - - - - - - - - - - - - - - - - - -BUILDING
- - - - - - - - SERIAL
- - - - - - NUMBER
snoitcurtsnI QAS htiw dlohesuoh elpmaS 3
- - - - - - NUMBER
- - - - - - -OF
- - HOUSEHOLD
- - - - - - - - - -MEMBERS
- - - - - - - - - -- ----- -- - - - - -
______________________________________
TISIV FO TLUSER ROF SEDOC *
DATE REVIEWED
NUMBER
HOUSEHOLD SERIAL NUMBER denopts-o-P- -4- - - - - - - - - - - - - - - - -d-e-teHOUSING
-lp-m- o-C- -1- - UNIT
- - - - -SERIAL
--
--------------------------------------
ETAD
YAD:HTNOM
/yawa yliraropmet si dlohesuoH 5
detelpmoc yltraP 2
______________________________________
dnuora tnednopsCAS/ACAS
er-o-n- - - - - - - - - - - - - - - - - - - - -HOUSEHOLD
SERIAL NUMBER
LINE NUMBER OF RESPONDENT
de-s-u-fe-R- -3- - - - - - - - -
LINE NUMBER OF RESPONDENT
__________________________________________
PIHSRELAST
BMENAME,
M DLOFIRST
HESU
OH
______________________________________
NAME
DATE :REVIEWED
REDRO SIHT NI SREBMEM DLOHESUOH RO SNOSREP EHT TSIL
VISIT 2
----------
NUMBER OF FEMALES
- - - - - - - -E- T- UNIM:RUOH
EMIT
--------------------------------------
A2
(SIGNATURE
YFICEPS ,srOVER
ehtO 6PRINTED NAME)
_________________________
NUMBER OF MALES
OF
VISIT

* CODES FOR RESULT
E
C
I
F
F
O
S
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CITSITATS LANOITAN
NOITINIFED DLOHESUOH
1 Completed
4 Postponed
a ro enola gnivil nosrep a fo gnitsisnocNtiO
nuIT
laiA
coL
sU
aP
siO
dlP
ohF
esO
uoS
hU
A SNEC
NAME OF HOUSEHOLDdaHEAD
__________________________________________
eH
• a evah dna
2 tPartly
inu gcompleted
nisuoh emas eht ni peels5 o
hw snostemporarily
rep fo puaway/
org
Household
LAST
NAME,
FIRST NAME
GNISUnO
H DNA
0S-300•1–OS.N
pupsA
__________________________________________
daeh eht fo esu2
op
______________________________________
do.oofN
fo lnaovio
tprm
noBcC
dS
naNnoitaraperp eht nino
tnrespondent
emegnarraaround
ommoc
3 Refused
CO/RO/PO
STREET
tsHOUSE
egSUPERVISOR
nuoyNUMBER
e ht ot tseAND
dlo m
orf esuNAME
ops/daOR
eh NAME
fo nerdOF
lihcSITIO
deirram-reveN
•
PRINTED
ts(SIGNATURE
egnu oy eht ot tOVER
sedlo m
orf seilimaNAME)
f rieht dna esuops/dae h fo nerdlihc deirram-revE
ADDRESS
sevitaler rehtO
INTERVIEW RECORD
sevitalernoN
______________________________________
DATE
VISIT
3 REVIEWED
SUMMARY OF VISIT
VISIT NUMBER
ENUMERATOR’S
CODE
VISIT 1
VISIT 2
---------
0102
DLOHESUOH NOMMOC
ERIANNOITSEUQ
• 1102 ,03 enuJ :no seripxE
6 Others, SPECIFY _________
__________________________________________
•
HOUSE NUMBER AND STREET NAME OR NAME OF SITIO
•
NOITACIFITNEDI CIHPARGOEG
INTERVIEW RECORD
DATE OF VISIT
MONTH:DAY
DEDNE EMIT
ETUNIM:RUOH
__________________________________________
ENUMERATOR'S CODE
----------
--------SELAM FO REBMUN
______________________________________
ENUMERATION AREA NUMBER
- - - - - - - - - - - - - - - - - - - - - - -BARANGAY
--------------DATE ACCOMPLISHED
--------SELAMEF FO REBMUN
ADDRESS
VISIT 1
A household
of a
_______is
___a
___social
________ _unit
______consisting
__ ________
ROTAREMUNE
person
living
alone
or
a
group
of
persons
who
)EMAN DETNIRP REVO ERUTANGIS(
YTILAPICINUM/YTIC
sleep in the same housing unit and have a
_________________in
____the
______preparation
___________
common
arrangement
and
YAGNARAB
DEHSILPMOCCA ETAD
consumption of food.
ECNIVORP
__________________________________________
HOUSEHOLD SERIAL NUMBER
______________________________________
DATE REVIEWED
VISIT NUMBER
BOOKLETS
CITY/MUNICIPALITY
BUILDING SERIAL NUMBER
______________________________________
MONTH:DATE
CO/RO/PO SUPERVISOR
(SIGNATURE OVER PRINTED NAME)
TIME
HOUR:MINUTE
OF
_______________________________________________________
______________________________
NAME OF HOUSEHOLD HEAD
DATE
TELKOOB
PROVINCE
HOUSING UNIT SERIAL NUMBER
CAS/ACAS
(SIGNATURE OVER PRINTED NAME)
FO
BOOKLET
ENUMERATION AREA
DATE REVIEWED
I hereby certify that the data set forth herein were
personally obtained/reviewedDATE
by REVIEWED
me and in
accordance with the instructions given by the
NSO.
NOITACIFITREC
EFehINt tIaThItOyNfitrec ybereh I
erew nHieOreUhShEtrH
ofOteLsDatD
ad
ni dna em yb deweiver/deniatbo yllanosrep
eht yb nevig snoitcurtsni eht htiw ecnadrocca
.OSN
__________________________________________
BARANGAY
TEAM SUPERVISOR
(SIGNATURE OVER PRINTED NAME)
CERTIFICATION
.LAITNEDIFNOC YLTCIRTS
NOITACIFITNEDI CIHPARGOEG
I hereby certify that the data set forth herein were
personally obtained/reviewed by me and in accordance
with the instructions given by the NSO.
Section 4 of Commonwealth Act No. 591 provides that all
information furnished in this questionnaire
shall be kept
CO/RO/PO SUPERVISOR
STRICTLY CONFIDENTIAL.
lla taht sedivorp 195 .oN tcA htlaewnommoC fo 4 noitceS
Expires on:
tpek June
eb llahs30,
erian2011
noitseuq siht ni dehsinruf noitamrofni
GEOGRAPHIC IDENTIFICATION
ENUMERATOR
(SIGNATURE OVER PRINTED NAME)
:YTIROHTUA
dna ,27 .glB asnabmaP sataB ,195 .oN tcA htlaewnommoC
NOITALUPOP FO SUSNEC 0102
scitsitatS lanoitaN eht ezirohtua 121 .oN redrO evitucexE
2010 CENSUS OF POPULATION
ANDGHOUSING
siht rJune
of noitam30,
rofni 2011
tcelloc dna tcudnoc ot )OSN( eciffO
Expires
on:
NISUOH DNA
20-3001–OSN .oN lavorppA BCSN
.susnec
CERTIFICATION
CPH FORM 2
3A
3A
2 MROF HPC
VISIT 3 STELKOOB
FO
SUMMARY
TELKOOOF
B VISIT
3B
L
I
N
E
N
U
M
B
E
R
POPULATION CENSUS QUESTIONS
Relationship
to Head
Sex
Who is the head
of this household?
Who are the persons
usually residing here
as of May 1, 2010?
What is ______’s
relationship
to the head
of the household?
Is _______
male
or female?
was ______ born?
1 Male
2 Female
MM Month
YYYY Year
WRITE
THE ANSWER
ON THE SPACE
PROVIDED.
Date of Birth
LIST THE PERSONS
OR HOUSEHOLD MEMBERS
IN THE ORDER SPECIFIED
ON PAGE 3A.
SEE CODES
AT THE BOTTOM.
WRITE X
IN THE
BOX.
P1
P2
P3
In what month
and year
P4
1
1
____________________________
LAST NAME
____________________________
FIRST NAME
For All 5 Years Old and Over
For All Persons
Name
Was _____’s
birth
registered
with the Civil
Registry
Office?
1 Yes
2 No
3 Don’t
know
Marital Status
Religious
Affiliation
Is ______ single, married,
widowed, divorced/ separated,
or in a common-law/live-in
arrangement?
What is
_____’s
religious
affiliation?
1
2
3
4
5
6
Single
Married
Widowed
Divorced/Separated
Common-law/Live-in
Unknown
WRITE THE AGE
IN THE BOXES.
WRITE X
IN THE BOX.
WRITE X IN THE BOX
CORRESPONDING TO ANSWER.
FOR PERSONS 0 TO 9 YEARS OLD,
WRITE X IN THE BOX FOR SINGLE.
P5
P6
P7
1
4
2
2
5
3
3
6
1
1
4
2
2
5
3
3
6
1
1
4
2
2
5
3
3
6
1
1
4
2
2
5
3
3
6
1
1
4
2
2
5
3
3
6
1
1
4
2
2
5
1
MM
2
__________________
SPECIFY
Age
What is _____’s
age as of his/her
last birthday?
Birth
Registration
YYYY
WRITE
THE ANSWER
ON THE
SPACE
PROVIDED.
Citizenship
Is _____
a citizen
of the
Philippines?
What country/
other country
is _____
a citizen of?
1 Yes, (Filipino
citizen)
2 Yes, (Filipino
with dual
citizenship)
3 No
WRITE
THE ANSWER
ON THE SPACE
PROVIDED.
Ethnicity
Disability
Functional Difficulty
What is _____’s
ethnicity by blood?
Is he/she
a/an _____?
Does ______
have any
physical
or mental
disability?
Does _____ have any difficulty/problem in…?
MENTION THE
PREDOMINANT/
COMMON IP OR
NON-IP GROUPS
IN THE AREA.
WRITE THE ANSWER
ON THE SPACE
PROVIDED.
1 Yes
2 No
SEE
CODEBOOK.
WRITE X
IN THE BOX.
IF CODE “1”,
SKIP TO P11.
SEE CODEBOOK.
SEE CODEBOOK.
WRITE X
IN THE BOX.
P8
P9
P10
P11
P12
WRITE X IN THE BOX
CORRESPONDING TO THE ANSWER
FOR EACH DIFFICULTY/PROBLEM.
P13
No
1
2
3
Seeing, even when wearing eyeglasses
Hearing, even when using a hearing aid
Walking or climbing steps
Remembering or concentrating
Self-caring (bathing or dressing)
Communicating using his/her usual
language
Yes
1
________________
SPECIFY
a
b
c
d
e
f
2
_________________
SPECIFY
____________________
SPECIFY
2
____________________________
LAST NAME
____________________________
FIRST NAME
MM
2
__________________
SPECIFY
YYYY
1
2
________________
SPECIFY
3
_________________
SPECIFY
3
____________________________
LAST NAME
____________________________
FIRST NAME
MM
2
__________________
SPECIFY
YYYY
2
________________
SPECIFY
3
_________________
SPECIFY
4
____________________________
LAST NAME
____________________________
FIRST NAME
MM
2
__________________
SPECIFY
YYYY
________________
SPECIFY
3
c
f
1
5
____________________________
FIRST NAME
MM
2
__________________
SPECIFY
YYYY
________________
SPECIFY
3
2
b
e
c
f
Yes
1
6
____________________________
LAST NAME
____________________________
FIRST NAME
MM
__________________
SPECIFY
____________________________
LAST NAME
____________________________
FIRST NAME
3
3
6
1
1
4
2
2
5
3
3
6
1
1
4
2
2
5
3
3
6
YYYY
1
7
2
2
MM
2
__________________
_
SPECIFY
YYYY
________________
SPECIFY
3
2
_________________
SPECIFY
____________________
SPECIFY
Yes
1
2
________________
SPECIFY
3
_________________
SPECIFY
8
____________________________
LAST NAME
____________________________
FIRST NAME
MM
2
__________________
SPECIFY
YYYY
________________
SPECIFY
HOUSEHOLD SIZE
1. Are there any other persons such as small children, infants, and/or overseas workers
who were not yet listed?
1 Yes, ADD IN THE LIST.
2 No
3
f
Yes
d
b
e
c
f
Yes
1 Yes, USE ADDITIONAL BOOKLET.
2 No
No
a
d
b
e
c
f
Yes
No
2
b
e
c
f
____________________
SPECIFY
Yes
No
No
a
d
b
e
c
f
CODES FOR P2 (RELATIONSHIP TO HOUSEHOLD HEAD)
2. IF THERE ARE MORE THAN 8 MEMBERS IN THIS HOUSEHOLD, WRITE X
IN THE BOX FOR YES. OTHERWISE, WRITE X IN THE BOX FOR NO.
No
a
d
2
_________________
SPECIFY
c
a
1
2
e
No
____________________
SPECIFY
1
b
1
Yes
1
d
No
1
No
a
No
____________________
SPECIFY
1
Yes
No
2
_________________
SPECIFY
No
d
1
2
Yes
a
Yes
____________________________
LAST NAME
No
1
____________________
SPECIFY
1
No
e
2
_________________
SPECIFY
Yes
b
1
2
f
2
____________________
SPECIFY
1
c
d
Yes
1
e
a
____________________
SPECIFY
1
b
1
Yes
1
No
d
No
Yes
1
Yes
a
01 Head
23 Son-in-law
41 Brother
57 Other relative
02 Spouse
24 Daughter-in-law
42 Sister
58 Nonrelative
03 Son
31 Grandson
43 Uncle
65 Boarder
04 Daughter
32 Granddaughter
44 Aunt
66 Domestic helper
21 Stepson
33 Father
55 Nephew
22 Stepdaughter
34 Mother
56 Niece
P14
PROV
P15
P16
P17
CITY/MUN
PROV
1
1
L
L
II
N
N
L
E
E
I
N
N
N
E
U
U
M
M
N
B
B
U
E2
E
M
R
B
E
R
PROV
3
CITY/MUN
PROV
P14
P15
CITY/MUN
4
3
3
3
45
4
4
P16
1
11
1
______________________________
______________________________2
______________________________
2
PROVINCE
PROVINCE
PROVINCE
______________________________
______________________________2
______________________________
PROVINCE CITY/MUNICIPALITY
______________________________
CITY/MUNICIPALITY
CITY/MUNICIPALITY
______________________________
CITY/MUN
PROV
CITY/MUNICIPALITY
2
2
1
1
1
CITY/MUN
PROV ______________________________
______________________________
2
______________________________
PROVINCE
2
PROVINCE
PROVINCE
______________________________
______________________________21
______________________________
PROVINCE CITY/MUNICIPALITY
CITY/MUNICIPALITY
CITY/MUNICIPALITY
CITY/MUN
PROV
CITY/MUN
PROV
______________________________
CITY/MUN
PROV
CITY/MUNICIPALITY
______________________________
CITY/MUN
PROV
PROVINCE
1
21
3
1
______________________________
______________________________2
______________________________
______________________________
PROVINCE
PROVINCE
2
CITY/MUNICIPALITY
PROVINCE
______________________________
______________________________
2
______________________________
CITY/MUNICIPALITY
CITY/MUNICIPALITY
PROVINCE
CITY/MUN
PROV
CITY/MUNICIPALITY
CITY/MUN
PROV
CITY/MUN
PROV
______________________________
CITY/MUN
PROV
CITY/MUNICIPALITY
1
1
CITY/MUN
PROV
1
4
1
______________________________
______________________________2
______________________________
PROVINCE
PROVINCE
22
______________________________
PROVINCE
PROVINCE
______________________________
______________________________
2
CITY/MUNICIPALITY
PROVINCE CITY/MUNICIPALITY
______________________________
CITY/MUNICIPALITY
CITY/MUN
PROV
PROV
PROV
5
5
6
6
6
6
7
7
7
7
CITY/MUN
CITY/MUN
1
5
11
______________________________
______________________________2
PROVINCE
PROVINCE
______________________________
2
PROVINCE
______________________________
______________________________
______________________________
2
CITY/MUNICIPALITY
PROVINCE CITY/MUNICIPALITY
______________________________
2
CITY/MUNICIPALITY
CITY/MUN
PROV
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31rdstst Year
Year
810
810 1thst Year
nd Year
840
810
Year
Year
820 4122nd
820
th Year
rd
850
rd Year
830 5323nd
Year
830
Year
820
th Year
860
840 644thrdth Year
Year
840
830
3 Year
Year
Year
850 55thth Year
850
thth
840
Year
860 646th Year
Year
860
850 5th Year
860 6th Year
PROV
PROV
PROV
CITY/MUN
PROV
P23
CITY/MUN
CITY/MUN
P24
P25
P26
CITY/MUN
______________________________
______________________________
______________________________
PROVINCE
PROVINCE
PROVINCE
______________________
______________________
______________________
______________________
______________________________
_______________
_______________
______________________
______________________
______________________________
______________________________
_______________
______________________________
______________________________
PROVINCE
SPECIFY
SPECIFY SPECIFY
SPECIFYSPECIFY
SPECIFY
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
CITY/MUNICIPALITY
CITY/MUNICIPALITY
PROVINCE
______________________ ______________________ _______________ ______________________________
CITY/MUN
PROV
CITY/MUN
PROV
CITY/MUN
PROV
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
______________________ ______________________ _______________ ______________________________
1
SPECIFY
SPECIFY
SPECIFY
CITY/MUN
PROV
CITY/MUNICIPALITY
______________________________
______________________________
CITY/MUNPROVINCE
PROV
______________________________
PROVINCE
PROVINCE
______________________
______________________
______________________
______________________
______________________________
_______________
______________________________
______________________________
______________________ ______________________ _______________
_______________
______________________________
PROVINCE
SPECIFY
SPECIFY
SPECIFY SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
CITY/MUNICIPALITY
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
______________________ ______________________ _______________ ______________________________
CITY/MUN
PROV
CITY/MUN
PROV
SPECIFY
SPECIFY
SPECIFY
CITY/MUN
PROV
CITY/MUNICIPALITY
______________________________
1
PROVINCE
CITY/MUN
PROV
2
______________________ ______________________ _______________ ______________________________
______________________________
______________________________
2
______________________________
PROVINCE
PROVINCE
SPECIFY
SPECIFY
SPECIFY
PROVINCE
CITY/MUNICIPALITY
______________________
______________________
______________________
______________________
______________________________
_______________
_______________
______________________________
______________________________
______________________
______________________
SPECIFY
SPECIFY
SPECIFY
PROVINCE CITY/MUNICIPALITY
SPECIFY
SPECIFY
SPECIFY
_______________
______________________________
CITY/MUNICIPALITY
PROV CITY/MUN
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
______________________ ______________________ _______________ ______________________________
CITY/MUN
PROV
CITY/MUN
PROV
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
CITY/MUN
PROV
1
CITY/MUN
PROV
______________________________
______________________________
______________________________
PROVINCE
PROVINCE
______________________________
PROVINCE
PROVINCE
______________________
______________________
______________________
______________________
______________________________
_______________
_______________
______________________________
______________________________
SPECIFY
SPECIFY
SPECIFY
SPECIFY
SPECIFY
SPECIFY
PROVINCE CITY/MUNICIPALITY
______________________
______________________
______________________
______________________
_______________
CITY/MUNICIPALITY
_______________
______________________________
SPECIFY
SPECIFY
SPECIFY
SPECIFY
SPECIFY
SPECIFY
______________________ ______________________ _______________ ______________________________
CITY/MUNICIPALITY
CITY/MUNICIPALITY
CITY/MUN
PROV
CITY/MUN
PROV
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
CITY/MUN
PROV
1
2
PROV
PROV
1
1
______________________________
______________________________2
2
PROVINCE
PROVINCE
______________________________
2
PROVINCE
______________________________
______________________________2
CITY/MUNICIPALITY
CITY/MUNICIPALITY
Post secondary**
000 No grade
completed
240 Grade 4 240 Grade 4
High school High school
Post secondary**
000 No grade completed
C
OD
DE
ES
S FF310
MP
LE
E
010 Preschool010 Preschool 250 Grade 5 250 Grade 5
310 C
1stO
1PstL
Year
OOORRR PPP1111666st Year
(((HHHIIIGGGHHHEEESSSTTT 410
GGGRRRAAADDD1stEEE///Year
YYYEEEAAARRR 410
CCCOOOM
TTTEEEDDD)))
C
OYear
DE
SF
MP
LE
nd
nd
nd
420
2 Year 420 2nd Year
320
2 Year 320 2 Year
260
Grade
64 260 Grade 6
Post
secondary**
000
No
grade
completed
240
Grade
High
school
Post
secondary**
000
No
grade
completed
240
Grade
4
High
school
rd
rd
rd
rd
Elementary
Elementary
Post
000 No
grade completed
240
Grade
High
430
31stst Year
Year 330 3 Year
Year 430 3 Year
330
31stst Year
270
410 secondary**
010
Preschool
250 Grade
Grade 7545 270 Grade 7
310 school
410
1st Year
010
Preschool
250
Grade
310
1thst Year
210
1 210 Grade 1
nd Year 340 4th Year
nd
340
280
graduate
Elementary graduate
410
Year
Year
010 Grade
Preschool
250
Grade
310
Year
Year
420 122nd
320 4122nd
260 Elementary
Grade 656 280
Year
Year
420
320
260
Grade
220
Grade 2 220 Grade 2
rd
rd
Elementary
350
school
350graduate
High school graduate
rd Year
rd Year
430 233nd
330 High
3nd
270 Grade
Grade 767
Elementary
430
Year
Year
330
3
270
Year
Year
420
320
2
260
Grade
230
210 Grade
Grade 311 230 Grade 3
210
Grade
Year
340 44thrdth Year
280 Elementary graduate
graduate
340
280
Elementary
430 3rd Year
330
3HighYear
270 Elementary
Grade 7
220 Grade
Grade 22
220
350 High
school graduate
350
th school graduate
210
Grade
1
230
Grade
3
340 4 Year
280 Elementary graduate
230 Grade 3
220 Grade 2
230 Grade 3
1
P20
CITY/MUN
CITY/MUN
______________________________
______________________________
PROVINCE
PROVINCE
______________________________
PROVINCE
______________________
______________________
______________________
______________________
_______________
_______________
______________________________
______________________________
______________________________
SPECIFY
SPECIFY SPECIFY
SPECIFYSPECIFY
SPECIFY
PROVINCE CITY/MUNICIPALITY
CITY/MUNICIPALITY
______________________ ______________________ _______________ ______________________________
______________________________
SPECIFY
SPECIFY
SPECIFY
PROVINCE
______________________ ______________________ _______________ ______________________________
CITY/MUNICIPALITY
CITY/MUN
PROV
CITY/MUN
PROV
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
______________________
______________________ _______________ ______________________________
CITY/MUN
PROV
1
CITY/MUN
PROV
SPECIFY
SPECIFY
SPECIFY
2
CITY/MUNICIPALITY
______________________________
______________________________
PROVINCE
CITY/MUNPROVINCE
PROV
______________________________
______________________
______________________
______________________
______________________
_______________
_______________
PROVINCE
______________________________
______________________________
______________________________
SPECIFY
SPECIFY SPECIFY
SPECIFYSPECIFY
SPECIFY
PROVINCE CITY/MUNICIPALITY
CITY/MUNICIPALITY
______________________ ______________________ _______________ ______________________________
______________________
______________________
SPECIFY
SPECIFY
SPECIFY
_______________
______________________________
CITY/MUN
PROV
CITY/MUN
PROV
CITY/MUNICIPALITY
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
1
CITY/MUN
PROV
______________________________
CITY/MUN
PROV
PROVINCE
2
______________________________
______________________________
2
______________________
______________________ _______________ ______________________________
PROVINCE
PROVINCE
SPECIFY
SPECIFY
SPECIFY
______________________________
CITY/MUNICIPALITY
______________________
______________________
______________________
______________________
_______________
_______________
______________________________
______________________________
______________________________
PROVINCE
SPECIFY
SPECIFY SPECIFY
SPECIFYSPECIFY
SPECIFY
PROVINCE CITY/MUNICIPALITY
CITY/MUNICIPALITY
______________________ ______________________ _______________ ______________________________
CITY/MUN
PROV
______________________
______________________
_______________
______________________________
CITY/MUN
PROV
SPECIFY
SPECIFY
SPECIFY
CITY/MUN
PROV
CITY/MUNICIPALITY
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
1
CITY/MUN
PROV
CITY/MUN
PROV
______________________________
______________________________
______________________________
PROVINCE
PROVINCE
2
PROVINCE
______________________________
______________________
______________________
______________________
______________________
_______________
_______________
______________________________
______________________________
______________________________
PROVINCE
SPECIFY
SPECIFY SPECIFY
SPECIFYSPECIFY
SPECIFY
PROVINCE CITY/MUNICIPALITY
CITY/MUNICIPALITY
______________________ ______________________ _______________ ______________________________
______________________ ______________________ _______________ ______________________________
______________________
______________________
SPECIFY
SPECIFY
SPECIFY
_______________
CODES FOR P2C2O(DCELSASFS
OROFP2W2O(CRLKAESRS) OF WORKER)
______________________________
SPECIFY
SPECIFY
SPECIFY
CITY/MUNICIPALITY
CITY/MUNICIPALITY
SPECIFY
SPECIFY
SPECIFY
College**
810 1st Year
820 2nd Year
830 3rd Year
840 4th Year
850 5th Year
860 6th Year
1
2
31
900 Post
Post baccalaureate
1
900
900IF GRADUATE
Post baccalaureate
baccalaureate
**
IN GRADUATE
POST
** IF
IN POST 412
2
COLLEGE, OR COLLEGE,
SECONDARY OR
SECONDARY
523
3
SPECIFY COURSE.
SPECIFY COURSE.
64
** IF
IF GRADUATE
GRADUATE IN
IN POST
POST
43
**
75
OR
COLLEGE,
SECONDARY
SECONDARY OR COLLEGE,
54
**SPECIFY
IF GRADUATE
IN POST
SPECIFY
COURSE.
COURSE.
66
SECONDARY OR COLLEGE,
757
900 Post baccalaureate
900 Post baccalaureate
SPECIFY COURSE.
CITY/MUNICIPALITY
Worked for private
household
(domestic
services)
– PHHservices) – PHH
1 Worked
for private
household
(domestic
CO
O
WO
OR
RK
KE
ER
R)))
Worked for private
business/enterprise/farm
2 Worked
for privateC
business/enterprise/farm
DDDEEESSS FFFOOO-RRRPVT
PPP222222 (((CCCLLLAAASSSSSS-OOOPVT
FFF W
CO
WO
RK
ER
Worked
corporation
3 Worked
for government/government
corporation – GOV
Worked for
for government/government
private
household
(domestic
services)– ––GOV
PHH
Worked
for
private
household
(domestic
services)
PHH
Worked
for
private
household
(domestic
services)
–
PHH
Self-employed
any paidwithout
employee
SELF
4 without
Self-employed
any –paid
employee – SELF
Worked for
for private
private
business/enterprise/farm
PVT
Worked
business/enterprise/farm
-- PVT
Employer
farm
or business
– EMP
5ownEmployer
in own farm
or business
EMP
Worked
business/enterprise/farm
- PVT–– –GOV
Worked for
forinprivate
government/government
corporation
GOV
Worked
for
government/government
corporation
Worked
with6pay
in ownany
family-operated
farm
or businessfarm
– PAID
Worked
with
payemployee
in own family-operated
or business – PAID
Self-employed
without
paid
SELF
Self-employed
without
any paid
employee
–– SELF
Worked
for
government/government
corporation
–
GOV
Worked
pay
in or
own
family-operated
farm or businessfarm
- UNPAID
without
pay–inEMP
own family-operated
or business - UNPAID
Employerwithout
in 7own
ownWorked
farm
business
Employer
in
farm
or
business
–
EMP
Self-employed
without
any
paid employeefarm
– SELF
Worked with
with pay
pay in
in own
own family-operated
family-operated farm
or business
business –– PAID
PAID
Worked
or
Employer
in ownpay
farminin orown
business
– EMP farm
Worked without
without
pay
own
family-operated
farm or
or business
business -- UNPAID
UNPAID
Worked
family-operated
6 Worked with pay in own family-operated farm or business – PAID
7 Worked without pay in own family-operated farm or business - UNPAID
P27
3D
HOUSEHOLD/HOUSING CENSUS QUESTIONS
B1 TO B4 ARE TO BE ANSWERED BY MERE OBSERVATIONS. IF DOUBTFUL, ASK THE RESPONDENT.
B1 Type of building/house
WRITE X IN THE BOX.
1 Single house
2 Duplex
3 Multi-unit residential
(three units or more)
B2 Construction materials of the roof
WRITE X IN THE BOX.
4 Commercial/industrial/
agricultural
(office, factory, and others)
5 Institutional living quarter
(hotel, hospital, and others)
6 Other housing units
(boat, cave, and others)
B3 Construction materials of the outer walls
WRITE X IN THE BOX.
01 Concrete/brick/stone
06 Asbestos
02 Wood
07 Glass
03 Half concrete/brick/
stone and half wood
04 Galvanized iron/
aluminum
08 Makeshift/salvaged/
improvised materials
09 Others, SPECIFY
______________________
05 Bamboo/sawali/
cogon/nipa
H4 Tenure status of the housing unit
Do you own or amortize this housing unit occupied by your
household or do you rent it, do you occupy it rent-free with
consent of owner, or rent-free without consent of owner?
WRITE X IN THE BOX.
10 No walls
1 Galvanized iron/aluminum
5 Cogon/nipa/anahaw
2 Tile concrete/clay tile
6 Asbestos
3 Half galvanized iron
and half concrete
7 Makeshift/salvaged/
improvised materials
4 Wood
8 Others, SPECIFY
___________________
B4 State of repair of the building/house
WRITE X IN THE BOX.
1 Needs no repair/
needs minor repair
5 Under construction
2 Needs major repair
6 Unfinished construction
3 Dilapidated/condemned
7 Not applicable
1 Inherited, SKIP TO H8
2 Gift, SKIP TO H8
2 Rented, SKIP TO H7
3 Rent-free with consent of owner, SKIP TO H8
4 Rent-free without consent of owner, SKIP TO H8
3 Company benefit, SKIP TO H8
4 Purchased
5 Others, SPECIFY ________________________
H6 Source of financing of the housing unit
Did you avail of the following sources of financing
in the construction/purchase of this housing unit?
WRITE X IN THE BOX. THEN SKIP TO H8.
YES NO
a Own resources/interest–free loans from
relatives/friends
b Governrnent assistance, PAG-IBIG, GSIS, SSS,
DBP, and others
c Private banks/foundations/cooperatives
4 Under renovation/
d Employer assistance
being repaired
H7 Monthly rental of the housing unit
How much is the monthly rental of this housing unit?
WRITE X IN THE BOX.
1 [PhP500 or less]
6 [PhP4,001- 6,000]
2 [PhP501- 1,000]
7 [PhP6,001 - 7,500]
3 [PhP1,001 - 1,500]
8 [PhP7,501 - 10,000]
4 [PhP1,501 - 2,000]
9 [PhP10,001 and over]
5 [PhP2,001 - 4,000]
e Private persons
f Others, SPECIFY _______________________
B5 IS TO BE ASKED FROM ANY HOUSEHOLD IN THE BUILDING.
D1 IS TO BE ASKED FROM ANY HOUSEHOLD IN THE HOUSING
UNIT.
B5 Year building/house was built
When was this building/house built? WRITE X IN THE BOX.
D1 Floor area of the housing unit
What is the estimated floor area of this housing unit?
WRITE X IN THE BOX.
01 [2010]
07 [1991 - 2000]
02 [2009]
08 [1981 - 1990]
01 [Less than 5 sq.m./
less than 54 sq.ft.]
07 [70 - 89 sq.m./
749 - 963 sq.ft.]
03 [2008]
09 [1971 - 1980]
02 [5 - 9 sq.m./
54 - 107 sq.ft.]
08 [90 - 119 sq.m./
964 - 1286 sq.ft.]
04 [2007]
10 [1970 or earlier]
03 [10 -19 sq.m./
108 - 209 sq.ft.]
09 [120 - 149 sq.m./
1287 - 1609 sq.ft.]
05 [2006]
11 [Not applicable]
04 [20 - 29 sq.m./
210 - 317 sq.ft.]
10 [150 - 199 sq.m./
1610 - 2147 sq.ft.]
06 [2001- 2005]
12 [Don’t know]
05 [30 - 49 sq.m./
318 - 532 sq.ft.]
11 [200 sq.m. and over/
2148 sq.ft. and over]
12 Not applicable
06 [50 - 69 sq.m./
533 - 748 sq.ft.]
H1 TO H11 ARE TO BE ANSWERED BY ALL HOUSEHOLDS.
H1 Fuel for lighting
What type of fuel does this household use for lighting?
WRITE X IN THE BOX.
1 Electricity
2 Kerosene (gaas)
3 Liquefied petroleum
gas (LPG)
4 Oil (vegetable, animal,
and others)
5 Others, SPECIFY
_______________________
0 None
H2 Fuel for cooking
What kind of fuel does this household use most of the time
for cooking? WRITE X IN THE BOX.
1 Electricity
5 Wood
2 Kerosene (gaas)
6 Others, SPECIFY,
____________________
0 None
3 Liquefied petroleum gas
(LPG)
4 Charcoal
H3 Source of water supply for drinking, cooking, and laundry/bathing
What is the household’s main source of water supply for drinking, cooking, and laundry/bathing?
WRITE X IN THE BOX.
Drinking Cooking Laundry/Bathing
Drinking Cooking Laundry/Bathing
01 Own use, faucet community
water system
02 Shared, faucet community
water system
03 Own use, tubed/piped deep well
(at least 100ft/30m deep)
04 Shared, tubed/piped deep well
10 Peddler
05 Tubed/piped shallow well
11 Bottled water
06 Dug well
REMARKS:
1 Owned/being amortized
H5 Acquisition of the housing unit
How did you acquire this housing unit?
WRITE X IN THE BOX.
07 Protected spring
08 Unprotected spring
09 Lake, river, rain, and others
12 Others, SPECIFY _______________
H8 Tenure status of the lot
Do you own or amortize this lot occupied by your
household or do you rent it, do you occupy it rent-free with
consent of owner, or rent-free without consent of owner?
WRITE X IN THE BOX.
1 Owned/being amortized
2 Rented
3 Rent-free with consent of owner
4 Rent-free without consent of owner
5 Not applicable
H9 Usual manner of garbage disposal
How does your household usually dispose of your kitchen garbage
such as leftover food, peeling of fruits and vegetables, fish and
chicken entrails, and others?
WRITE X IN THE BOX.
1 Picked up by garbage truck
5 Burying
2 Dumping in individual pit
(not burned)
3 Burning
6 Feeding to animals
7 Others, SPECIFY
___________________
4 Composting
H10 Kind of toilet facility
What type of toilet facility does this household use? WRITE X IN THE BOX.
3 Water-sealed, other
depository, used
exclusively
by household
4 Water-sealed, other
depository, shared with
other households
1 Water-sealed, sewer
septic tank used
exclusively
by household
2 Water-sealed, sewer
septic tank, shared with
other households
H11 Land ownership
Does any member of this household own the following?
WRITE X IN THE BOX.
YES NO
5 Closed pit
7 Others (pail system,
and others)
6 Open pit
0 None
H12 TO H15 HOUSEHOLD CENSUS QUESTIONS
H12 Language/dialect generally spoken at home
What is the language/dialect generally spoken at home
by members of this household?
a Other residential land/s
SPECIFY ANSWER
ON THE SPACE PROVIDED.
b Agricultural land/s
SEE CODEBOOK.
c Agricultural land/s acquired through CARP,
Agrarian Reform Beneficiary
_____________________________
SPECIFY
d Other land/s
H13 Residence five years from now
In what city/municipality does this household intend
to reside on May 1, 2015?
PROV
CITY/MUN
0000 Same city/municipality
8887 Foreign country
9999 Unknown
_____________________________
IF SAME CITY/
PROVINCE
MUNICIPALITY,
_____________________________
WRITE “SAME”
CITY/MUNICIPALITY
ON THE SPACE PROVIDED.
IF ANOTHER CITY/MUNICIPALITY,
SPECIFY CITY/MUNICIPALITY
AND PROVINCE.
SEE CODEBOOK.
H15 Internet access
Does this household have access to internet?
WRITE X IN THE BOX.
YES NO
YES NO
a From home
b From elsewhere
H14 Presence of household conveniences/devices
Does this household have the following household
conveniences/devices in working condition? WRITE X
IN THE BOX CORRESPONDING TO THE ANSWER
FOR EACH HOUSEHOLD CONVENIENCE/DEVICE.
YES NO
a Radio/
radio cassette
b Television set
c CD/DVD/VCD
player
d Component/
stereo set
e Landline/wireless
telephone
f Cellular phone
g Personal computer
(desktop, laptop,
notebook, netbook,
and others)
YES NO
h Refrigerator/
freezer
i Cooking range
j Washing machine
k Car/jeep/van
l Motorcycle/
tricycle
m Motorized boat/
banca