12
1 PSU Structure Part Questionnaire Household Address: __________________________________ ___________________ Telephone: _____________ REPUBLIC OF COSTA RICA National Household Survey (ENAHO) July 2016 The confidentiality of the information provided is protected under Section 4 of the National Statistical System Act, Law No. 7839 of 1998. Region: _________________________________ Province: ________________________________ County: _________________________________ District: _________________________________ MG. Is the Household Consumption Expenditure Module applied in this housing unit? Household Questionnaire FOR THE HOUSING UNIT QUESTIONNAIRE ON PAPER FORM CONTROL Yes .... O1 No .... O0 VIV1. How many persons live in this housing unit? VIV3. Have all members of the household lived in this housing unit for over six months? VIV5a. Is any member of the household not previously mentioned currently living elsewhere? VIV6. Does this household have... VIV5b. Will this person (or persons) be absent for a total period of less than six months? VIV2. Do all the persons living in this housing unit share the same budget and collectively prepare meals? Yes ..... O1 No ..... O0 Inquire how many households live in the housing unit Transcribed by:___________________________ Date:_________________________________ FOR EACH HOUSEHOLD Yes ..... O1 No ..... O0 No ..... O0 No ..... O0 No ..... O0 Yes ..... O1 Yes ..... O1 Yes No Yes ..... O1 (skip to VIV5a) How many of them? How many of them? VIV4. Does this person (or persons) have another place to live? How many of them? (Do not include them as member(s) of the household) (Include as member(s) of the household) (Include as member(s) of the household) (Do not include them as member(s) of the household) ...housekeeper(s) staying at the housing unit? ............... O1 O0 ...persons renting a room with or without food included ? ..... O1 O0 Observations: (Include them in the household listing) Interviewed by: ___________________ Supervised by: ___________________ Date: Day Month Year End time: Start time: 16 : :

National Household Survey Questionnaire (ENAHO) July 2016 · 111111111 2 The National Institute for Statistics and Census is the technical governing body of national statistics and

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Page 1: National Household Survey Questionnaire (ENAHO) July 2016 · 111111111 2 The National Institute for Statistics and Census is the technical governing body of national statistics and

1

PSU

StructurePartQuestionnaireHouseholdAddress:__________________________________ ___________________Telephone:_____________

REPUBLIC OF COSTA RICA

National Household Survey(ENAHO)

July 2016TheconfidentialityoftheinformationprovidedisprotectedunderSection4oftheNationalStatisticalSystemAct,LawNo.7839of1998.

Region:_________________________________

Province:________________________________

County:_________________________________

District:_________________________________

MG.IstheHouseholdConsumptionExpenditureModuleapplied

inthishousingunit?

Household Questionnaire

FOR THE HOUSING UNIT QUESTIONNAIRE ON PAPER FORM CONTROL

Yes....O1

No....O0

VIV1. How many persons live in this housing unit?

VIV3. Have all members of the household lived in this housing unit for over six months?

VIV5a. Is any member of the household not previously mentioned currently living elsewhere?

VIV6. Does this household have...

VIV5b. Will this person (or persons) be absent for a total period of less than six months?

VIV2. Do all the persons living in this housing unit share the same budget and collectively prepare meals?

Yes.....O1

No.....O0 Inquire how many households live in the housing unit

Transcribed by:___________________________

Date:_________________________________

FOR EACH HOUSEHOLD

Yes.....O1 No.....O0

No.....O0

No.....O0

No.....O0

Yes.....O1

Yes.....O1

Yes No

Yes.....O1

(skip to VIV5a)

How many of them?

How many of them?

VIV4. Does this person (or persons) have another place to live?

How many of them? (Do not include them as member(s) of the household) (Include as member(s) of the household)

(Include as member(s) of the household)

(Do not include them as member(s) of the household)

...housekeeper(s)stayingatthehousingunit? . . . . . . . . . . . . . . . O1O0

...personsrentingaroomwithorwithoutfoodincluded? . . . . . O1O0

Observations:

(Include them in the household listing)

Interviewed by: ___________________

Supervised by: ___________________

Date:

DayMonthYear

End time:

Start time:

16

:

:

Page 2: National Household Survey Questionnaire (ENAHO) July 2016 · 111111111 2 The National Institute for Statistics and Census is the technical governing body of national statistics and

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TheNationalInstituteforStatisticsandCensusisthetechnicalgoverningbodyofnationalstatisticsandcoordinatoroftheNationalStatisticalSystem(SENinSpanish).SaidcapacitywasvestedundertheNationalStatisticalSystemAct(LawNo.7839ofNovember4,1998),whichwasenactedinconsiderationoftheimportanceofhavingappropriateandupdatedstatisticaldataforestablishingeconomicandsocialpolicies.

This law further sets out the obligation to provide any necessary data to produce national statistics and theconfidentialitythereof:

Section4:“...Anydatacollectedinaccordancewiththislawshallbedeemedstrictlyconfidential...Datafromprivatenaturalorlegalpersonsshallnotbedisclosedorpublishedindividually,butratheraspartofoverallfigures,exceptasotherwiseauthorized–inadvance–bythepartywhodisclosedtheinformation.Tothatextent,figurespertainingtothreeormorenaturalorlegalpersonsshallbeconsideredoverallfigures.Moreover,suchinformationshallnotbedisclosedforanytaxpurposesorotherwise...”

Section5:“SENmayrequestinformationfromallnaturalandlegalpersonsbasedinCostaRicathatrelatestotheiractivity...”

OBLIGATION AND CONFIDENTIALITY OF THE INFORMATION

V2a. Is this housing unit...

....ownedbythehouseholdandhasitbeenpaidinfull?.O1

...ownedbythehouseholdandbeingpaidininstallments?. . . . . . O2

...rented?. . . . . . . . . . . . . . O3

...locatedinasquattersettlement?O4

...other(assigned,lent)? . O5

Monthly payment

V4. What is the predominant roof material?

Zincormetalsheets. . . . . . . . . . . . . . . O1

Fibercement . . . . . . . . . . . . . . . . . . . . . O2

Mezzanine. . . . . . . . . . . . . . . . . . . . . . . . O3

Naturalfibers(bamboo,cane,palm).... O4

Other____________________ O5

(specify)

Wastematerial . . . . . . . . . . . . . . . . . . . O0

V1. Type of housing unit

Condominiumhouseorgatedcommunity. . . . . . . . . . . . . . . . . O1

Independenthouse................ O2

Roworadjacenthouses . . . . . . . . . . . O3

Inabuilding(verticalcondominiumor apartment). . . . . . . . . . . . . . . . . . . . . . . O4

Multi-unitdwelling. . . . . . . . . . . . . . . . . O5

Slum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . O6

Other_____________________O7 (specify)

Only use codes 1, 2 and 5 for question V2a

V2b. If monthly rent had to be paid for this housing unit, how much would you pay?

}

V3. What is the predominant exterior wall material?

Blockorbricks . . . . . . . . . . . . . . . . . . . . O1

Plinth(wooden,zincorfibercement) . . . . O2

Wood . . . . . . . . . . . . . . . . . . . . . . . . . . . .O3

Prefabricated . . . . . . . . . . . . . . . . . . . . . O4

Zinc. . . . . . . . . . . . . . . . . . . . . . . . . . . . .O5

Fibercement(Fibrolit, Ricalit)... . . . . . . . O6

Naturalfibers(bamboo,cane,palm)....O7

Other____________________O8

(specify)

Wastematerial . . . . . . . . . . . . . . . . . . . O0

HOUSING AND SERVICES

V5. Does this housing unit have a ceiling?

Yes . . . . . . .O1No.......O0

V7. What is the condition of the... BADFAIRGOOD

...externalmaterial?.........O1 O2 O3

...roof?............O1 O2 O3

...floor?.............O1 O2 O3

V8. How many bedrooms does the housing unit have?

Numberofbedrooms

V6a. Is the housing unit built on stilts?

Yes....O1No.......O0

V6. What is the predominant floor material?

Tiles,ceramic,terrazzo.......O1

Cement(polishedornot).......O2

Wood.......................O3

Naturalfibers(bamboo,cane,palm)..O4

Other_________________O5

(specify)

Nofloor(groundfloor)..........O0

(Includes coffered ceiling)

V9. Not including toilets, laundry room, hallways, garage, how many rooms (total) does this housing unit have (including number of bedrooms)?

Numberofrooms . . . . .

V10. Approximately, what is the grass floor area in square meters of this housing unit?

Under30m2 . ..................O1

Between30and40m2. . . . . . . . . . . O2

Between41and60m2. . . . . . . . . . . O3

Between61and100m2. . . . . . . . . . . O4

Between101and150m2 . . . . . . . . . O5

Between151and200m2 . . . . . . . . . O6

Morethan200m2. . . . . . . . . . . . . . . . O7

V11. Does this housing unit’s water supply come from...

...internalpiping?................O1

...externalpiping,however, withinthelotorbuilding? . . . . . . . . O2

...pipingoutsidethelotorbuilding? O3

Nosupplythroughpipes. . . . . . . . . . O0

V12. Does the water that you consume come from...

...AnA y Aaqueduct?...............O1

...aruralaqueduct? . . . . . . . . . . . . . . . O2

...amunicipalaqueduct? . . . . . . . . . . . O3

...acompanyorcooperative?. . . . . . . O4

...awaterwell? . . . . . . . . . . . . . . . . . . . O5

...ariver,creekorwaterspring? . . . . O6

...rainwaterorother?O7(specify)

2016

Page 3: National Household Survey Questionnaire (ENAHO) July 2016 · 111111111 2 The National Institute for Statistics and Census is the technical governing body of national statistics and

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V22. Has a housing bond been applied for?

No. . . . . O0(skip to V22b)

Yes . . . . O1

a. Why has the allowance not been received?

Understudyorpending....O1

Rejected.................O2

OtherO3

V22b. Has it not been requested because....

…itisnotneededordoesnotqualify?. . . . . . . . . . . . . . . . . . . . . . . .O1

…he/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit?. . . . . . . . . . . . . . . . . .O2

...theproceduresarecomplicated? . .O3

…he/shehasnopapers(noresidency)?. . . . . . . . . . . . . . . . . .O4

…theprogramisnotavailablewherehe/shelives?. . . . . . . . . . . . . .O5

OtherO6

(skip to Section R)

V21. Has this household received a housing bond?

Yes. . . O1

b. In what year?

a. Of what kind?

Purchaseofexistinghousingunit.....................O1

Lotpurchaseandconstruction..............O2

Lotpurchase.............O3

Housingunitconstructioninownproperty...........O4

Expansionorcompletion....O5

Nohousingbondhasbeenreceived . . . . . . . . . . . . . . . . . . . . . . . . O0

V14a. Does this housing unit have a bathroom?

Yes.....O1Howmany?

No.....O0

V15. Is this housing unit’s electric light...

...suppliedbyICE? . . . . . . . . . . . . . . . . O1

...suppliedbyCNFL? . . . . . . . . . . . . . . O2

...suppliedbyESPH/JASEC?. . . . . . . . O3

...suppliedbyacooperative?. . . . . . . O4

...suppliedbyaprivateplant?. . . . . . O5...suppliedbyadifferentsource? O6

Noelectriclight. . . . . . . . . . . . . . . . . . O0

V19. Does this housing unit have internet?

Yes.....O1No.....O0

V19b. Is the type of connection used to access the internet...

...bylandline(KOLBI-HOGAR)? . . . . . . . . O1

...bycable?. . . . . . . . . . . . . . . . . . . . . . . .O2

...bymobiledevices? . . . . . . . . . . . . . . . .O3

...Othertypeofconnection?O4

skip to V21

V17a. Is garbage primarily disposed of...

...byagarbagetruck?. . . . . . . . . . O1

...bythrowingitinaholeorburyingit?. . . . . . . . . . . . . . . . . . O2

...byburningit? . . . . . . . . . . . . . . . O3

...bythrowingitinanemptylot? O4

...bythrowingitinariver,creekorocean?. . . . . . . . . . . . . . . . . . . . . . O5

...other?O6(specify)

V16. What is the main source of power used for cooking?

Electricpower . . . . . . . . . . . . . . . . . O1 Gas . . . . . . . . . . . . . . . . . . . . . . . . . . O2 Firewoodorcharcoal . . . . . . . . . . . O3 OtherO4

(specify)

None(doesnotcook). . . . . . . . . . . O0

V17b. Is garbage separated into... Yes No

...organicwaste(foodleftovers,peels,bones)? . . . . . . . . . . . O1 O2

...plastic? . . . . . . . . . . . . . . . . . O3 O4

...glass? . . ...............O5 O6

...aluminum?. . . . . . . . . . . . . . O7 O8

...paperorcardboard?. . . . . . O1O2

...other?O3 O4

(specify)

V13a. Does this housing unit have a toilet...

...connectedtoasewer? . . . . . . . . . . . . . O1

...connectedtoaseptictank?.......... O2

...connectedtoaseptictankwithwatertreatment(biologicalpit)? . . . . O3

...pit,outhouseorlatrine?. . . . . . . . . . . . . . . . . . . . . . . .O4

...connectedtoothertypeofsystem?O5

Hasnotoilet . . . . . . . . . . . O0

V13b. Is the toilet...

...exclusivetothishousingunit? . O1

...sharedamongthisandotherhousingunits? . . . . . . .........O2

V14b. Is the use of the bathroom...

...exclusivetothishousingunit? . O1

...sharedamongthisandotherhousingunits? . . . . . . ........O2

skip to V14a

skip to V15

(specify)

(specify)

V19c. Do you have a wireless router?

Yes. . O1

V19a. Whatcompanyprovidestheinternetservice?_____________________

No. . . O0

HOUSING AND SERVICES 2016

(specify)

(specify)

For each household (Housing bond)

Comments:

WhoistheTVserviceprovider?________________________

How many?V18.Do persons in this housing unit have...

Yes No

...mobilephone?...........O1 O2

...alandline?. . . . . . . . . . . . . . .O3 O4

...arefrigerator? . . . . . . . . . . .O5 O6...waterheatingsystemfortheentirehouse?......O7O8

...waterstoragetank? . . . . . . .O1 O2

...alaptop? . . . . . . . . . . . . . . . .O3 O4

...adesktopcomputer? . . . . . .O5 O6

...atablet?. . . . . . . . . . . . . . . . .O1 O2

...afaxmachine(computer-independent)? . .O7 O8

...radioorstereosystem? . . .O1 O2

...avehicle(notprovidedbyemployer)?. . . . . . . . . . . .O3 O4

...amotorcycle(notprovidedbyemployer)?. . . . . . . . . . . .O5 O6

...aplasma,LCDorLEDtelevision? . . . . . . . . . . .O7 O8

...aconventionaltelevision?. .O1 O2

...cabletelevision? . . . . . . . . . .O3 O4

...satellitetelevision? . . . . . . . .O5 O6

...othertypeofsubscriptiontelevisionservice? . . . . . . . .O7 O8

(specify)

(specify)

(specify)

(skip to section

R)

(skip to section

R)

Page 4: National Household Survey Questionnaire (ENAHO) July 2016 · 111111111 2 The National Institute for Statistics and Census is the technical governing body of national statistics and

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10

Name(s) (R1a) (R1b) (R1c)

R. RESIDENCY STATUS OF HOUSEHOLD N°.

02

04

Line

N°.

Circle the line number of the infor-mant.

What is the name of the person considered to be the head of the household?(Write his/her name in line 01)

Then write the name of the other family members including their kinship and age.

Do you have any other perma-nent place to live?

Yes...1

Write code and trace a

line from

question A3 to

question A 23

No...0

03

01

05

06

07

08

09

Has (name) been liv-ing here for over 6 months?

Yes...1

Write code

continue with the

next person

No...0

Do you plan to continue living here?

Yes...1

Write code

continue with the

next person

No...0

(Write thecode)

(Write thecode)

(Write thecode)

(Write code and continue with the

next person)

Usualresident

Usualresident

Usualresident

Non-usualresident

(Panel line)

(Line)

LAST

YEA

R

LINE

2016

Interviewer:

R4a. Did the informer indicate the head of

the household is shared?

Yes.........O1

No........O0

R4b Line No. of the other head of household

Kinship Relationship

What is the kinship relationship between (name) and the head of household?

Headofhousehold. . . . . . . . . . . 01

Spouseorsignificantother.. . . . . . . . . . . 02

Sonordaughter . . . . . . . . . . . . 03

Stepsonorstepdaughter . . . . 04

Son-in-lawordaughter-in-law . . . . . . . . . . . . 05

Grandsonorgranddaughter . . 06

Father,mother. . . . . . . . . . . . . . 07

Father-in-lawormother-in-law. . . . . . . . . . . . . . 08

Brotherorsister. . . . . . . . . . . . 09

Brother-in-lawordaughter-in-law . . . . . . . . . . . . 10

Otherrelative . . . . . . . . . . . . . . 11

Othernon-relative . . . . . . . . . . 12

Personproviding

housekeepingservicesortheirrelative. . . . . . . . . . . . . 13

Lodgerortheirrelative(tenant). . . . . . . . . . . . . . . . . . . . 14

(Write the code)

(A3)

Page 5: National Household Survey Questionnaire (ENAHO) July 2016 · 111111111 2 The National Institute for Statistics and Census is the technical governing body of national statistics and

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Sex

Male or female?

Male.....1

Female...2

(Write thecode)

10

Maritalstatus

Is (name)...

livinginacommon-lawmarriage. . . . .1

Married . . . . . .2

Divorced . . . . .3

Separated. . . .4

Widowed. . . . .5

Single. . . . . . 6

Under10yearsofage . . . . . . 0

(Write the code)

(A4) (A5) (A7a) (A7b)

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS

02

04

Place of birth

When (name) was born, where did his/her mother lived?

Inthiscounty.........0

(Write 0 in the code box)

Inanothercounty......1

(Write 1 in the code box, the name of the county and the

province in the adjacent space)

Inanothercountry.....2

(Write 2 in the code box and the name of the country in the

adjacent space)

Place of residence two years ago

Where did (name) reside on July 2014?

Inthiscounty.........0

(Write 0 in the code box)

Inanothercounty......1

(Write 1 in the code box, the name of the county and the

province in the adjacent space)

Inanothercountry.....2

(Write 2 in the code box and the name of the country in the

adjacent space)

03

01

05

06

07

08

09

Age

What is the age of (name) in completed years?

Ifunder1yearold....00

Age,under12yearsold....98

Age,over12yearsold...99

(Write the number

of completed years)

Line N°

INTE

RVIE W

GUIDE

Name of the other county and province, or country

Name of the other county and province, or countryCo

de

Code

(Write) (Write)

2016

(A7c) (A7d) (A6)

Page 6: National Household Survey Questionnaire (ENAHO) July 2016 · 111111111 2 The National Institute for Statistics and Census is the technical governing body of national statistics and

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a. During this year has any member of the household received aid from IMAS such as...

...Avancemos program? 1

...monetaryaid?. . . . . . . 2

...ChildCareNetwork(CECUDIorCommunityHome)? . . . 3

...otheraids? . . . . . . . . . 4

Noaidhasbeenreceived. . . . . . . . . . . . 0

(Applies only for codes 1 and 2)

b. What is the amount received or currently being received?

(Write the amount in colones)

c. How often is it received?

d. Has assistance from IMAS been requested?

No . . . . . . . . . 0

Yes. . . . . . . . . 1

e. Why has assistance not been received?

Understudyorpending. . . 1

Rejected . . . . . 2

Other3

(skip to A10a)

(write code)

f. Has assistance not beenrequested because...

...itisnotneededordoesnotqualify? . . . 1

...He/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit?. . . . . . . . 2

...Theproceduresarecomplicated?.3

...He/shehasnopapers(noresidency)?..4

...Theprogramisnotavailableintheareawherehe/shelives? . . . . . . 5

Other6

(write code)

c. During this year has the National Rehabilitation Council provided you with any service or monetary aid?

Yes. . . . . . . . . . . 1

No . . . . . . . . . . . 0

d. Has assistance been requested?

No . . . . . . . . . . . 0(skip to A8f)

Yes. . . . . . . . . . . 1

e. Why has assistance not been received?

Understudyorpending. . . . . 1

Rejected . . . . . . . 2

Other3

(skip to A9a)

(write code)

IMASDisability (permanent)

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS

10

02

04

03

01

05

06

07

08

09

2016

(A8a) (A8b) (A8c) (A8d) (A8e) (A8f) (A9a) (A9d)(A9b) (A9e)(A9c) (A9f)

Line N°

INTERVIE

W

GUIDE

Does (name) have any limitation that permanently hinders or impairs him/her to...

...seeevenwhenwearinglensesoreyeglasses? . . .1

...hear?. . . . . . . . .2

...talk? . . . . . . . . . . 3

...walkorclimbstairs? . . . . . . . . 4

...usehis/herarmsandhands?. . . . . . . . 5

...ofintellectualnature?(Retardation,DownSyndrome,other) . . . . . . . . .6

...mentalillness?(bipolar,schizophrenia,other) . . . . . . . . . 7

None. . . . . . . . . . . . 0

(Write a code in each box, you can

write a maximum of 2 limitations.

All the boxes must have a valid code from

0 to 7)

Disabled person Persons not receiving aid from IMASPersons with any

disability that have NOT applied for assistance

f. Has assistance not been requested because...

...itisnotneededordoesnotqualify? . . . . . . 1

…He/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit? . . 2

...Theproceduresarecomplicated? . . 3

...He/shehasnopapers(noresidency)? . . . 4...theprogramisnotavailableneartheareawherehe/shelives? . . . . . . . . . 5

Other6

(write code)

(skip to A9a)

(specify)

(specify)

(specify)

(specify)

(Write the corresponding code, amount and period)

a. Receives

b. Amount

c. Period

(skip to A10)

(skip to A9f)

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a. During this year has (name) received care from any day-care center or adult care network?

Yes. . . . . . . . . . . 1 (skip to A11)

No. . . . . . . . . . . 0

b. Has any care been requested?

No. . . . . . . . . . . .0 (skip to A25d)

Yes. . . . . . . . . . . .1

c. Why has it not been received? Understudyorpending. . . . . . . . . . . . 1

Rejected . . . . . . . . . . . . . . 2

Other3

(skip to A11)

(Write the code)

(A10d) (A25a)(A10e) (A25b) (A25c)(A10f)(A10)

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS

10

02

04

03

01

05

06

07

08

09

2016

CEN - CINAI Senior Citizens (65 years old and older)

(A25d)

During this year has any member of the household received services from the CEN-CINAI such as...

...whole-daycareatthechildren’s

center? ........ 1

...servedmeals?........ 2 ...food

package?...... 3

...milk? . . . . . . . . . . 4

Hasnoaidbeenreceived?........0

(Write the code)

d. Have you requested any service from CEN - CINAI?No. . . . . . . . . . . . . . .0

Yes. . . . . . . . . . . . . . .1

e. Why has it not been received?

Understudyorpending. . . . . . . 1

Rejected . . . . . . . . . 2

Other3

(skip to A11)

(Write the code)

f. Has assistance not been requested because...

...itisnotneededordoesnotqualify? . . . . . . . 1

...He/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit?. . . . 2

...Theproceduresarecomplicated?...3

...He/shehasnopapers(noresidency)?....4

...Theprogramisnotavailableintheareawherehe/shelives? . . . . . . . . . . 5

Other6

(Write the code)

d. Has assistance not been requested because...

...itisnotneededordoesnotqualify? . . . . . . . 1

...He/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit?. . . . 2

...Theproceduresarecomplicated?..3

...He/shehasnopapers(noresidency)?....4

...Theprogramisnotavailableintheareawherehe/shelives? . . . . . . . . . . 5

Other6

(Write the code)

(Write a code in each box, you can

write a maximum of 3 services.

All the boxes must have a valid code

from 0 to 4)

(specify)

(specify)

(specify)

(specify)

Line N°

INTERVIE

W

GUIDE

a b c

(skip to A10f)

Persons aged 7 or younger who do not receive any services from the CEN-CINAI

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8

(A11) (A11a) (A12a)(A11b) (A12b) (A12c)(A11c)

10

02

04

03

01

05

06

07

08

09

Insurance Status

What type of Social Security does (name) have?

SalariedEmployee. . . . . . . . . 01

Throughinstitutionalagreements,(Associations,tradeunionscooperatives,etc.). . . . . . . . . 02

Voluntary. . . . . . . . . . . . . . . . . 13

Independentworker. . . . . . . . 14

State-provided(coveringthefamilymemberinsuredbythestate). . . . . . . 04

Relativeofinsuredpersonpayingdirectcontributions(salariedemployee,throughinstitutionalagreement,voluntary) . . . . . . . . . . . . . . . . 05

Retireereceivingnon-contrib-utorystatepensionspecialinsurance(basicamount). . . 06

Retireereceivingnon-contrib-utorystatepensionspecialinsurance(graceorwar) . . . . 07

RetireereceivingIVM(Disability,OldAgeandDeathPensions)oftheCCSS(CostaRicanSocialSecurityAdministration) . . . . 08

RetireeundertheTeacher’s,JudicialBranchandMinistryofFinancepensionschemes,orother...................09

Relativeofretiree . . . . . . . . . 10

Otherformsofinsurance(student,refugeeandother).11

Privateorforeigninsurance..12

Uninsured . . . . . . . . . . . . . . . . 00 (Write the code)

Non-contributory pensionPensionState-provided insurance

(A12)

a. Has State-provided insurance been applied for?

No. . . . . . . . . . . 0

Yes. . . . . . . . . . 1

b. Why has it not been received?

Understudyorpending. . . . 1

Rejected . . . . . 2

Other3

(skip to A12)

(Write the code)

a. Has the Non-Contributory Regime (RNC) pension been requested?

No. . . . . . . . . . . 0(skip to A12c)

Yes. . . . . . . . . . 1

b. Why has it not been received?

Understudyorpending. . . . 1

Rejected . . . . . 2

Other3

(skip to A13)

(Write the code)

C. Has insurance not been requested because...

...itisnotneededordoesnotqualify? . . . . . 1

...He/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit?. . 2

...Theproceduresarecomplicated?.3

...He/shehasnopapers(noresidency)?..4

...Theprogramisnotavailableintheareawherehe/shelives? . . . . . . . . 5

Other6

(Write the code)

c. Has insurance not been requested because...

...itisnotneededordoesnotqualify?. . . . . 1

...He/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit?. 2

...Theproceduresarecomplicated?.3

...He/shehasnopapers(noresidency)?..4

...Theprogramisnotavailableintheareawherehe/shelives? . . . . . . . 5

Other6

(Write the code)

(specify)

(specify)

(specify)

(specify)

(skip to A11c)

Write code 0 in box A11 for persons with no insurance of any type

Compulsory Basic Regime

Codes 01, 02, 13 and 14 only for question A11

Persons aged 65 years old or older with codes 0, 4, 5 or 10

for question A11

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS

To what regime does (name) pay contributions?

IVMregimeoftheCCSS. . . . . . . . . . .1

Otherregime(Teacher’s,JudicialBranch,MinistryofFinancepensionschemes,

etc.) . . . . . . . . . . .2

None. . . . . . . . . . .0

(Write the code)

2016

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9

(A13) (A14) (A15a) (A15b) (A16a) (A16b) (A17)

Regular Education

What is the last grade or year completed? Level Year

None . . . . . . . 0 0

Preparatory.0 1

SpecialEducation...0 2

Primaryschool1 X

HighSchool...2 X(Ifinformanthasahighschooldiploma,write26)

TechnicalHighSchool . . . . . . 3 X(Ifinformanthasahighschooldiploma,write37)

Technicalhighereducation . . .4 X

Universityeducation.....5 X

Specialty.....7 X

Master’sdegree,Doctorate....8 X

X: Last year of education completed Which one?

Degree codeLevel Name of program or specialty?

Does (name) attend...

...nurseryschool,interactiveschool,earlychildhoodeducationcenter?......01

...transitioncycleorpreparatory?.02

...primaryschool?......03

...highschool?..04

...technicalhighereducation?. . . 05

...universityeducation?...06

...specialeducation?...07

...openeducationininstitutestotakeMEP(MinistryofPublicEducation)tests?.......08

...non-regulareducation?09

Doesnotreceiveeducation....00 (Write code)

Level 3, 4, 5, 7 and 8 only for question A14

a. What is the name of the program or specialty he/she studied or is currently studying?

(If he/she holds more than one specialty, write the higher ranked or the one that shows more years completed)

b. Has he/she been awarded any degree in that program or specialty?

(If he/she holds more than one specialty, write the higher ranked or the one that shows more years completed)

Yes . . . . . .Whichone?

Technician,non-universityexpert. ......................1

Teachingdegreetechnical degree,orassociate’sdegreefrom university . . . . . . . . . . . . . . . . . .2

Bachelor’s . . . . . . . . . . . . . . . . . . . . .3

Licentiate’s . . . . . . . . . . . . . . . . . . . .4

Specialization. . . . . . . . . . . . . . . . . .5

Master’s,Doctorate . . . . . . . . . . . . .6

Holdsnodegree................0

a. Is (or was) the education center that he/she attends (or attended)...

...public?. . . . . . . 1

...semi-publicorsemi-official?. 2...private?. . . . . .3

...foreign? . . . . . .4

b. If he/she attends (or attended) a public university, ask: which?

UCR . . . . . . . . . . .1

UNA. . . . . . . . . . .2TEC . ...........3

UNED . . . . . . . . . .4

UTN . . . . . . . . . . .5

(Write code)

What is the main reason why (name) does not attend preparatory, primary school, secondary school, or university?

Needstowork. . . . . . . . . . . . . . 01

Preferstowork............. 02

Hastotakecareofchildren,eldersorotherpersons. . . . . . 03

Hastoassistindomesticchores.......... 04

Isunabletopayforhis/herstudies. . . . . . . . . . . . . . . . . . . . 05

Problemswithaccesstotheeducationsystem. . . . . . . 06

Hasdifficultystudying.......07

Notinterestedinformallearning............08

Pregnancyormarriage.....09

Illnessordisability.........10

Notoldenough . . . . . . . . . . . . .11

HasnotpassedMEPtests/admissiontests............12

Other 13

Persons aged between 5 and 24 years old with codes 0, 8, and 9 for question A13

(Write)

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS

10

02

03

01

05

06

07

08

09

(Write)

(specify)

2016

(Write code)(specify)

04

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During this year, has any member of the household received or attended…

...regularlytothestudentcafeteria? . . . . 1

…freetransportationfromMEP? . . . . . . .2

...freetextbooksfromMEP?. . . . . . . . 3

Noincentivehasbeenreceived . . . .0

Why has food not been received from the student cafeteria?

Itdoesnotexistintheeducationcenter . . . . . . . . . . 1

Itdoesexist,how-everhe/shedoesnotqualify . . . . . . . . . . 2

Itdoesexist,how-everhe/shedoesnotisunabletopayforthefee . . . . . . . . . . . . . 3

Itdoesexist,how-everhe/shedoesnotdoesnotneedtheservice . . . . . . . . . 4

Doesnotlikethe

place . . . . . . . . . . 5

Other6

a. Do any of the persons currently studying receive a monetary scholarship from...

...FONABE? . . . . . . . . . . . . . . . . . . 1

...INA?. . . . . . . . . . . . . . . . . . . . . . . 2

...Municipality?. . . . . . . . . . . . . . . 3

...Publicuniversity?. . . . . . . . . . . 4

...Privateuniversity?..........5

...Privatecompany?. . . . . . . . . . . 6

...Empleateprogram?. . . . . . . . . 7

Other8

Doesnotreceiveanyscholarship. . . . . . . . . . . . . . . . . . 0

(Only for codes 1 to 8)

b. What is the amount received or cur-

rently being received?

(Write the amount in colones)

c. How often is it received?

(Write code) (Write code)

(specify)

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS 2016

(A19a)(A18)

a. Receives

(A19b) (A19d) (A19e) (A19f)(A18d)

b. Amount

(A19c)

c. Period

(Write the corresponding code, amount and period)

(Write a code in each box.

All the boxes must have a valid code from

0 to 3)

Line N°

INTERVIE

W

GUIDE

a b c

(specify)

d. Has a FONABE scholarship been requested?

No. . . . . . . . . . . . 0

(skip to A19f)

Yes. . . . . . . . . . . 1

e. Why has assistance not been received?

Understudyorpending. . . . . 1

Rejected . . . . . . 2

Other3

(skip to A20)

(Write the code)

f. Has assistance not been requested because...

...itisnotneededordoesnotqualify?. . . . . 1

...He/shehasnoknowledgeoftheprogramordoesnotknowhowtoapplyforit?. 2

...Theproceduresarecomplicated?.3

...He/shehasnopapers(noresidency)?..4

...He/shereceivesaidfromthe Avancemosprogram? . . . 5

Other6

(Write the code)

(specify)

(specify)

Education Incentives

ScholarshipsOnly if he/she attends a public education center

Students not receiving a scholarship

10

02

04

03

01

05

06

07

08

09

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11

a. In addition to regular education, has (name) studied any other course or received any other training for which he/she was awarded a degree or certificate?

Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

b. What is the name of the course?

(In case of multiple courses, please write the most relevant and that for which a certificate or degree was awarded. E.g. computer science, auto mechanics, etc.)

Nonewerereceived . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 (skip to A24)

Non-regular education

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS

10

02

04

03

01

05

06

07

08

09

Which institution provided the course?

INA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .01

Privateinstitute(Jiménez,Bostonetc.). . . . . . . . . . . . . . . . . . . . . . . . . . .02

Communitycollege(CUNA,CUC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03

Publicuniversity...............................04

Privateuniversity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .05

Publicinstitution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 06

Privatecompany..............................07Foreign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .08

Other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .09

(Write the code)

2016

For persons aged 10 years old or older

(A20b)(A20a) (A21)

Name of course or training Code

(Write)

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1212

SECTION A. SOCIODEMOGRAPHIC CHARACTERISTICS

During the past three months, has (name)used...

...amobilephone? . . . . . . . . . . . . 1

...alaptop?. . . . . . . . . . . . . . . . . . . . 2

...atablet?. . . . . . . . . . . . . . . . . . . . 3

...adesktopcomputer? . . . . . . . . . 4

...theinternet? . . . . . . . . . . . . . . . .5

...Noneoftheabove. . . . . . . . . . . .0

Who is the breadwinner of the household? (Please remember that the support must be

indispensable)

Entercode1inthecorrespondinglineorlines.

Aninstitutionorapersonnotlivinginthehouseholdbutbasedinthecountry. . . . . . . . . . 7

Apersonnotlivinginthehouseholdbutlivingabroad. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

(If code 7 or 8 applies, enter the same solely in line 01)

LanguagesUse of technology Breadwinner

Persons aged 5 years old or older Persons aged 10 years old or older

10

02

03

01

05

06

07

08

09

(A23)

2016

a. Does (name) fluidly speak, read and write any other language different than his/her native language...

b. What language...

...English?. . . . . . . . . . 1

...French? . . . . . . . . . . 2

...Spanish? . . . . . . . . . 3

Otherlanguage?

4

(Write)

(specify)

Yes...1No...0 (skip to A23)

Speaks... Language

(A22b)(A22a)(A24)

(Enter code(s)) (Write code)

04