Self-Administered Questionnaire For Common Household: Philippine Statistics Authority
Self-Administered Questionnaire For Common Household: Philippine Statistics Authority
SELF-ADMINISTERED QUESTIONNAIRE
FOR COMMON HOUSEHOLD
Dear Sir/Madam:
The Philippine Statistics Authority (PSA) is currently conducting the 2020 Census of Population
and Housing (CPH) to gather data on the basic characteristics of the population and housing units throughout
the country. Your cooperation in this census is of utmost importance to us. Rest assured that all information
collected in this undertaking will be held STRICTLY CONFIDENTIAL and will not be used for taxation,
investigation or law enforcement purposes, as stipulated in Section 26 of Republic Act No. 10625.
The information that will be published by the PSA based on the census will be in the form of statistical tables
or summaries in which no reference to an individual or household shall appear.
This CPH Form 7A is a Self-Administered Questionnaire that contains the census questions and
instructions.
If you have any questions/concerns or if you need additional questionnaires, please contact the
Census Enumerator/Team Supervisor whose contact details are indicated below.
For further information about this census and for inquiries on how to accomplish this form, you may
also contact our PSA Provincial Statistical Office, the contact details of which are also found below.
Thank you very much for your cooperation and support for the success of the 2020 CPH.
Name :
Designation :
Address :
Contact Number :
Address :
Contact Number :
Email :
7A-2 CPH Form 7A - SELF-ADMINISTERED QUESTIONNAIRE FOR COMMON HOUSEHOLD (CPH FORM 2)
General Information
What is CPH?
Census of Population and Housing (CPH) is the complete
process of collecting, compiling, evaluating, analyzing, publishing, and
disseminating data about the population and housing units in the
country. It entails the listing and recording of the characteristics of
each individual and each living quarter as of a specified time and
within a specified territory. Other information gathered in the CPH are
selected household and barangay characteristics.
Section 25 of Republic Act 10625 (Obligation to Provide Information) stipulates that all respondents whether
natural or legal persons are required to provide truthful and complete information to all statistical inquiries or
surveys conducted by the Philippine Statistics Authority (PSA).
The PSA adheres and commits to the confidentiality of information as stipulated in Section 26 of RA 10625
(Confidentiality of Information) and Section 8 of RA 10173 (Confidentiality). All data obtained herein shall be
held strictly confidential, and will not be used for taxation, investigation or law enforcement purposes.
Moreover, please be informed that Section 4(e) of RA 10173 (Data Privacy Act of 2012) states that data
privacy does not apply to “information necessary in order to carry out the functions of public authority which
includes the processing of personal data for the performance by the independent agencies of their
constitutionally and statutorily mandated functions.”
CITY/MUNICIPALITY
ENUMERATOR
SIGNATURE OVER PRINTED NAME
ENUMERATION AREA
TEAM SUPERVISOR
SIGNATURE OVER PRINTED NAME
BUILDING SERIAL NUMBER
DATE REVIEWED
(mm/dd)
HOUSING UNIT SERIAL NUMBER
CAS/ACAS
SIGNATURE OVER PRINTED NAME HOUSEHOLD SERIAL NUMBER
NAME OF THE
CO/RSSO/PSO SUPERVISOR HOUSEHOLD HEAD
SIGNATURE OVER PRINTED NAME LAST NAME FIRST NAME
ADDRESS
DATE REVIEWED
(mm/dd) HOUSE/BUILDING NUMBER AND STREET OR SITIO/PUROK NAME
INTERVIEW RECORD
DATE
MONTH/DAY (mm/dd) (mm/dd) (mm/dd) NUMBER OF VISIT/S MADE
TIME BEGAN
HOUR:MINUTE AM/PM AM/PM AM/PM
RESULT OF FINAL VISIT *
TIME ENDED
HOUR:MINUTE AM/PM AM/PM AM/PM
RESULT
NUMBER OF HOUSEHOLD MEMBERS
OF VISIT
NUMBER OF MALES
CODES FOR THE RESULT OF VISIT
APPOINTMENT FOR NEXT VISIT 1 PAPER AND PENCIL PERSONAL INTERVIEW (PAPI)
2 SELF-ADMINISTERED QUESTIONNAIRE (SAQ)
VISIT NUMBER 1 2 3
3 COMPUTER-ASSISTED PERSONAL INTERVIEW (CAPI)
DATE
MONTH/DAY (mm/dd) (mm/dd) (mm/dd)
TIME
HOUR:MINUTE AM/PM AM/PM AM/PM
7A-4 POPULATION CENSUS QUESTIONS
Relationship
to the
L Name Household Sex Date of Birth Age Birth Registration Marital Status
I (SEE PAGE 7A-9.) Head
N
E P1 P2 P3 P4 P5 P6 P7 P8
Who is the head of this What Is ____ In what What Was Has ____ Is ____
N household? Who are is ____’s male month is ____’s ____’s ever had single, married,
U the persons usually relationship or and year age birth a copy common law/
M residing here to the head female? was ____ as of registered of his/her live-in, widowed,
B as of May 1, 2020? of this born? his/her with the birth or divorced/
E household? last Local certificate? separated/annulled?
R ORDER OF LISTING: 1 Male Month (MM) birthday? Civil
2 Female Year (YYYY) 1 Single
• Head Registry 1 Yes
2 Married
• Spouse of the head Office? 2 No
3 Don’t 3 Common-law/Live-in
• Never-married children 4 Widowed
of the head/spouse, from WRITE know
THE AGE 1 Yes 5 Divorced/Separated/
the oldest to the youngest
IN COMPLETED 2 No Annulled
• Ever-married children WRITE 3 Don’t 6 Unknown
YEARS IN THE
of the head/spouse and THE ANSWER
their families, from the WRITE BOXES. know
ON THE LINE.
oldest to the youngest THE ANSWERS IF LESS THAN
• Other relatives of the head SEE CODES WRITE IN THE BOXES ONE YEAR WRITE WRITE
• Nonrelatives of the head AT THE THE CODE CORRESPONDING OLD, WRITE THE CODE THE CODE WRITE
BOTTOM NUMBER TO THE MONTH “000” IN THE NUMBER NUMBER THE CODE NUMBER
OF THIS PAGE. IN THE BOX. AND YEAR. BOXES. IN THE BOX. IN THE BOX. IN THE BOX.
MM
1 LAST NAME SPECIFY
MM
2 LAST NAME SPECIFY
MM
3 LAST NAME SPECIFY
MM
4 LAST NAME SPECIFY
MM
5 LAST NAME SPECIFY
MM
6 LAST NAME SPECIFY
FOR ALL PERSONS FOR ALL PERSONS 5 YEARS OLD AND OVER
Religious
L Citizenship Ethnicity Functional Difficulty
Affiliation
I (SEE PAGE 7A-9.) (SEE PAGES 7A-9 AND 7A-10.)
N
P9 P10 P11 P12 P13
E
What Is ____ What What is ____’s The following questions ask about difficulties a person may have
N is ____’s a citizen country/ ethnicity doing certain activities because of a HEALTH PROBLEM.
U religious of the other by descent/
M affiliation? Philippines? country blood relation/ Does ____ have any difficulty/problem in…?
B is ____ consanguinity?
E 1 YES, Filipino a citizen of? Is he/she a b c d e f
R citizen a/an ____? Seeing, Hearing, Walking Remembering Self-care Communicating
2 YES, Filipino even if even or or (such as using his/her
with dual wearing if using climbing concentrating washing usual
citizenship glasses hearing steps all over (customary)
3 NO aid or dressing) language
WRITE
THE CODE CHOOSE AMONG THESE CATEGORIES*
WRITE NUMBER WRITE WRITE
THE ANSWER IN THE BOX. THE ANSWER THE ANSWER 1 – NO, 2 – YES, some 3 – YES, a lot 4 – Cannot
ON THE LINE. ON THE LINE. ON THE LINE. no difficulty difficulty of difficulty do it at all
IF CODE “1”,
LEAVE THE GO TO LEAVE THE LEAVE THE
BOXES BLANK. ITEM P12. BOXES BLANK. BOXES BLANK. WRITE THE CODE NUMBER IN THE BOX
a b c d e f
REMARKS
*Response Categories
L
I Residence of Mother Highest Grade/
Residence
N at the Time of Birth Literacy Year Completed Overseas Worker
Five (5) Years Ago
E of the Household Member (SEE PAGE 7A-10.)
P14 P15 P16 P17 P20
N
U
In what province In what province Can ____ read What is the highest Is ____
and city/municipality and city/municipality and write grade/year completed an overseas
M
did ____'s mother did ____ reside a simple message by ____ ? worker?
B
reside at the time on May 1, 2015? in any language
E
of ____'s birth? or dialect? 1 Yes
R 2 No
1 Yes
2 No
PROVINCE PROVINCE
1
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY
PROVINCE PROVINCE
2
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY
PROVINCE PROVINCE
3
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY
PROVINCE PROVINCE
4
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY
PROVINCE PROVINCE
5
CITY/MUNICIPALITY CITY/MUNICIPALITY SPECIFY
PROVINCE PROVINCE
B1 Type of building
01 Concrete/brick/stone 06 Asbestos
02 Wood 07 Glass
03 Half concrete/brick/stone and half wood 08 Makeshift/salvaged/improvised materials
04 Galvanized iron/aluminum 09 Others, SPECIFY _______________________________
05 Bamboo/sawali/cogon/nipa 10 None
1 Concrete
5 Earth/sand/mud
2 Wood
6 Makeshift/salvaged/improvised materials
3 Coconut lumber
7 Others, SPECIFY _______________________________
4 Bamboo
b) Agricultural land/s
H12 Presence of operator in crop farming, livestock and poultry raising, aquaculture, fishing,
and other farm/activity (SEE PAGE 7A-10.)
a) Crop farm
c) Aquafarm
d) Fishing activity
WRITE THE ANSWERS ON THE LINE. IF FOREIGN COUNTRY, WRITE THE NAME OF THE COUNTRY
ON THE LINE FOR THE PROVINCE. LEAVE THE BOXES BLANK.
PROV CITY/MUN
____________________________________________ ____________________________________________
PROVINCE CITY/MUNICIPALITY
REMARKS
PLEASE READ THE CONCEPTS AND DEFINITIONS CAREFULLY 7A-9
TO GUIDE YOU IN FILLING OUT THE CENSUS QUESTIONNAIRE
Household refers a social unit consisting of a person living alone or a group of persons who sleep
in the same housing unit and have a common arrangement in the preparation and consumption of food.
In most cases, a household consists of persons who are related by kinship ties, such as parents
and their children. In some instances, several generations of familial ties are represented in one
household while, still in others, even more distant relatives are included as members of the household.
Some household members may have no relationship to the head of the household, such as
a household helper, boarder, and nonrelative. They are considered members of the household,
provided that they sleep in the same housing unit and have a common arrangement for the preparation
and consumption of food with the household and that they do not go home to their respective family
at least once a week.
Ethnicity refers to the primary sense of belonging to an ethnic group based on descent/blood relation/
consanguinity. Ethnic group is consanguineous in nature, meaning, the ties are reckoned by blood and
traced through the family tree. Thus, ethnicity refers to the household member’s identity by descent/
blood/consanguinity and not by mere choice nor by adoption or confirmation by any ethnic group.
Ethnicity includes indigenous peoples, non-indigenous ethnic groups, and foreign descent. Examples of
indigenous peoples are Akeanon, Manobo, Subanen/Subanon, Ibanag, and Kankanaey while
non-indigenous ethnic groups includes Tagalog, Bisaya/Binisaya, Cebuano, Ilocano, and Ilonggo,
among others. American, Chinese, Japanese, Indian, and Koreans are some of the examples of foreign
descent.
Seeing refers to an individual using his/her eyes and vision capacity in order to perceive or observe
what is happening around him/her.
• seeing things close up or far away, and
• seeing out of one eye or only seeing directly in front but not to the sides.
Hearing refers to an individual using his/her ears and auditory (or hearing) capacity in order to know
what is being said to him/her or the sounds of activity, including danger that is happening around
him/her.
• hearing in a noisy or a quiet environment,
• distinguishing sounds from different sources, and
• hearing in one ear or both ears.
Walking or climbing steps refers to the use of lower limbs (legs) in such a way as to propel oneself
over the ground to get from point A to point B. The capacity to walk should be without assistance of any
device (wheelchair, crutch, walker, and others) or human. If such assistance is needed, the person has
difficulty walking.
• walking short (about 100 yards/meters) or long distances (about 500 yards/meters),
• walking any distance without stopping to rest is included, and
• walking up or down steps.
Remembering refers to the use of memory to recall incidents or events. It means the individual can
bring to mind or think again about something that has taken place in the past (either the recent past or
further back). With younger people, remembering is often associated with storing facts learned in school
and being able to retrieve them when needed.
• problems remembering what someone just said, or
• becoming confused or frightened about most things.
Concentrating refers to the use of mental ability to accomplish some tasks such as reading, calculating
numbers or learning something. It is associated with focusing on the task at hand in order to complete
the task.
• finding one’s way around,
• being unable to concentrate on an activity, or
• forgetting one’s whereabouts or the date.
7A-10 PLEASE READ THE CONCEPTS AND DEFINITIONS CAREFULLY
TO GUIDE YOU IN FILLING OUT THE CENSUS QUESTIONNAIRE
Washing all over refers to the process of cleaning one’s entire body (usually with soap and water) in
the usual manner for the culture.
• cleaning hair and feet, or
• gathering any necessary items for bathing such as soap or shampoo, a wash cloth or water.
Dressing refers to all aspects of putting clothing or garments on the upper and lower body including
the feet, if culturally appropriate.
• acts of gathering clothing from storage areas (closet, dresser), or
• securing buttons, tying knots, zipping, and others.
Communicating refers to an individual’s exchanging information or ideas with other people through the
use of language. They may use their voices for their exchange or make signs or write the
information that they want to exchange.
• use of the voice for the exchange or using signs (including sign language) or writing the information to
be conveyed.
• problems making oneself understood, or problems understanding other people when they speak or
try to communicate in other ways.
Highest grade/year completed refers to the highest grade or year completed in school, college
or university as of May 1, 2020. This may be any one of the specific grades or years in elementary,
high school, and college. It may also be inclusive/special needs education program, continuing/
second-chance education program, postsecondary, short-cycle tertiary education program, college, and
post baccalaureate courses.
An agricultural operator is a person who takes the technical and administrative responsibility of
managing the day-to-day agricultural, aquafarm or fishing operation. He/she is responsible for making
major decisions, including the management and supervision of his/her hired labor. An operator may be
a farm owner or a hired manager.
• Crop farm - any member in the household who operated a crop farm or was a hired manager of
llllllllllllllllllllllllllllfarm/establishment involved in growing or crops.
• Livestock and/or poultry farm - any member in the household who operated a livestock and/or
llllllllllllllllllllllllllllpoultry farm or was a hired manager of farm/establishment involved in livestock and/or
llllllllllllllllllllllllllllpoultry raising.
• Aquafarm - any member in the household who operated a fishpond, fish cage, fish pen, fish tank,
lllllllllllllllllllllllllllseaweed farm or other aquafarm or was a hired manager of another household’s
lllllllllllllllllllllllllllaquafarm or an aquacultural establishment.
• Fishing ll - llany member in the household who operated a fishing activity such as catching/gathering
llllllllllllllllllllllllllfish,crab, shrimp, mussel, and other aquatic plants/animals or was a hired manager of
llllllllllllllllllllllllllanother household’s fishing operation or a fishing establishment.
• Other farm/activity, SPECIFY _____________ - any member in the household who was an operator
lllllllllllllllllllllllllllfor raising of breeder dogs and race horses for sale and for other agricultural activities
lllllllllllllllllllllllllllsuch as contract growing of trees, growing of orchids for sale, gardening of ornamental
llllllllllllllllllllllllllland flowering plants for sale, culturing of bee, earthworm, silkworm, and others.