1

2

SUSENAS VSEN96.MREPUBLIC OF INDONESIA

CENTRAL BUREAU OF STATISTICS1996 NATIONAL SOCIO-ECONOMIC SURVEY

CONSUMPTION / HOUSEHOLD EXPENDITURES INFORMATION

CONFINDENTIALI. LOCATION IDENTIFICATION II. ENUMERATION PARTICULARS

01 Province 01 Name and employment identitynumber of enumerator

02 District/Municipality*)03 Sub-District04 Village / village unit *)05 Area type Urban -1

Rural -2

02 Enumerator ‘s Status Province KS staff 1District/municipality 2KS staffMantis 3Partner 4

06 Enumeration area number 03 Date of enumeration07 Segments group number 04 Enumerator’s signature08 Segment number09 Sample code number

05 Name and employment identitynumber of supervisor

10 Sample serial number of household11 Village classification Tertinggal

tdk tertinggalFilled in byeditorFilled in byeditor

06 Supervisor’s Status Province KS staff 1District/municipality 2KS staffMantis 3

12 Household head name13 Number of household members

07 Date of supervision

14 Address (name of road /alley, home number, RT/RW)

08 Supervisor’s signature

3

4

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTION DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

001 A. Cereals002 Local rice Kg003 High quality rice’s Kg004 Imported rice Kg005 Glutinous rice Kg006 Wet corn with skin Kg007 Dry corn with skin Kg008 Dry-shelled corn Kg009 Rice flour Kg010 Corn flour (maizena) Kg011 Wheat flour Kg012 Other ………………. Kg

013 B. Tuber Kg014 Cassava Kg015 Sweet potato Kg016 Potato Kg017 Taro Kg018 Dried cassava Kg

5

6

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

019 Cassava flour (Tapioca) Kg020 Dried-cassava flour Kg021 Sago (not made from cassava,

example: Ambon Sago)Kg

022 Other: ………………. Kg

023 C. Fish1] Fresh fish

024 Yellow tail fish Kg025 Tuna Kg026 “Tenggiri” /Spanish mackerel Kg027 “Selar” /mackerel Kg028 “Kembung” fish029 “Teri” Kg030 “Bandeng” milkfish Kg031 “Gabus” fish Kg032 Tilapia fish Kg033 Gold fish Kg

7

8

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

034 “Lele” fish (catfish)035 “Kakap” fish Kg036 Other ………………. Kg

2] Shrimp and other fresh animal’swater

Kg

037 Shrimp/Dried shrimps Kg038 Squid Kg039 Crab Kg040 Shell/snail Kg041 Other ………………. Kg

3] Preserved fish Kg042 “Kembung” fish Ounce043 “Tenggiri” fish Ounce044 Tuna fish Ounce045 “Teri” Ounce046 “Selar” fish Ounce047 “Sepat” fish Ounce

9

10

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

048 “Bandeng” fish Ounce049 “Gabus” fish Ounce050 Canned fish Ounce051 Other ………………. Ounce

4] Shrimp and other preserved wateranimals

052 Shrimp (Dried shrimp) Ounce053 Squid Ounce054 Other ………………. Ounce055 D. Meat

1] Fresh meat056 Beef Kg057 Buffalo Kg058 Goat Kg059 Pork Kg060 Purebred chicken Kg061 Free range chicken Kg

11

12

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

062 Other poultry meats …………..063 Other meats ……………….. Kg

2] Preserved meats Kg064 Dried meat Kg065 Dried shredded meat Ounce066 Meat in a can Kg067 Other ………………. Kg

3] Other Kg068 Liver Kg069 ‘Innards’ (other than liver) Kg070 “Tetelan” (bones with a bit of

adhering meat)Kg

071 Bones Kg072 Other ……………….

Kg073 E. Egg and milk Kg074 Egg of purebred chicken Kg

13

14

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

075 Egg of free range chicken Pieces076 Duck egg Pieces077 Quail egg Pieces078 Other eggs Pieces079 Salted egg Pieces080 Pure milk Liter081 Factiry-processed liquid milk 250ml *)082 Sweetened condensed milk 397gr **)083 Powder milk Kg084 Baby powder milk 400gr ***)085 Cheese Ounce086 Other dairy product: ……………. Ounce087 F. Vegetables088 Spinach Kg089 Water Spinach Kg090 Cabbage Kg*) box

15

16

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

091 Chinese cabbage (“petsai”) Kg092 Mustard greens Kg093 Green bean Kg094 Long beans Kg095 Tomato Ounce096 Carrot Kg097 Cucumber Kg098 Leaves of cassava Kg099 Eggplant Kg100 Soya bean sprouts Kg101 Squash Kg102 Baby corn Ounce103 Vegetables soup/stir-fried

vegetablesPackage

104 “Sayur asam” (sour soup) Package105 Young jack fruit Kg106 Unripe papaya Kg107 Mushroom Ounce

17

18

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

108 “Petai” (beans with pungent odor) Kg109 “Jengkol” (Phithecolobium) Kg110 Shallot Ounce111 Garlic Ounce112 Red pepper Ounce113 Green pepper Ounce114 Small chili Ounce115 Vegetables in a can Kg116 Other …………….. Kg117 G. Pulses118 Peanut with skin Kg119 Peanut without skin Kg120 Soy bean Kg121 Mung bean Kg122 Cashew nut Ounce123 Other peanuts Kg

(………………..)

19

20

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

124 Tofu Kg125 Tempe Kg126 Fermented soy bean sauce Ounce127 Oncom Ounce128 Other …………………. Ounce

129 H. Fruits130 Orange Kg131 Mango Kg132 Apple Kg133 Avocado Kg134 “Rambutan” Kg135 Lanzon Kg136 Durian Kg137 Snake fruit Kg138 Pineapple Kg139 Banana Kg

21

22

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

140 King “Raja” banana Kg141 Other banana Kg

…………………… Kg142 Papaya Kg143 “Jambu” (rose-apple) Kg144 “Sawo” (Sapodilla)145 Star fruits146 “Kedondong” Kg147 Watermelon Kg148 Melon Kg149 Jack fruit Kg150 Tomato Kg151 Fruits in a can Kg152 Other ……………….. Kg153 I. Oil and fat Kg154 Coconut oil Liter155 Corn oil Liter

23

24

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

156 Other cooking oil: Liter157 Coconut pieces158 Margarine Ounce159 Other

……………………..160 J. Beverages ingredients161 Granulated sugar Ounce162 Palm sugar Ounce163 Tea Ounce164 Powdered coffee Ounce165 Coffee bean Ounce166 Cocoa powder Ounce167 Syrup (fruit syrup concentrate for

drink)620ml

168 Other ……………….169 K. Spices170 Salt Ounce171 Candlenut Ounce

25

26

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

172 Coriander/caraway seed Ounce173 Pepper Ounce174 Tamarind Ounce175 Nutmeg Ounce176 Clove Ounce177 Fish paste Ounce178 Soy sauce 10 ml179 Monosodium glutamate Gram180 “Sambal” (chili sauce) /tomato

sauce140 ml

181 Prepared spices Ounce182 Other spices

…………………….183 L. Other consumption184 Fish/shrimp crakcers Ounce185 Emping chip Ounce186 Wet noodle Kg187 Instant noodle 80 gr

27

28

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

188 Rrice noodle Ounce189 Macaroni/ dried noodle Ounce190 Jelly Pack (7 gr)*)191 Baby porridge (packaged) 150 gr192 Other

………………………..193 M. Prepared foods & drinks194 Bread Small pack195 Sweet bread/other bread Piece196 Cookies/Biscuit/’semprong’ Ounce197 Cake Piece198 Fried food Piece199 Mungbean porridge Bowl200 Gado-gado/’ketoprak/’pecel’ Plate201 Rice and side dishes (nasi rames) Plate202 Fried rice Plate203 Rice Plate*) Small pack

29

30

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

204 “Lontong” (ice steamed in a bananaleaf)/ Ketupat sayur (rice cake withvegetables)

Bowl

205 “Soto”/curry/ soup/”rawon”/mince Bowl206 “Sate”/”Tongseng” (goat stir-fry) Plate207 Meat ball noodle/boiled

noodle/fried noodleBowl

208 Instant noodle Bowl209 Snack for kids/fish or shrimp

crackers/chipsOunce

210 Fish (fried, baked, etc) Piece211 Chicken/meat (fried, baked, etc) Piece212 Ice cream Small bowl213 Other ice …………… Glass214 Other prepared food ……………..215 Soft drink with CO2 (soda) 200 ml *)

Beverages without CO2:

216 Packaging water 500 ml **)217 Packaging tea 200 ml ***) *) Small Glass Bottle **) Small Plastic Bottle***) “Tea bottle” packaging

31

32

III. 1. FOOD, DRINK, AND TOBACCO CONSUMPTIONS DURING PREVIOUS WEEKPurchase

(cash/owed)Private production,

given, etc.Total of consumption’s

NO Details Standard unit Total

(0,00)

Value

(Rp)

Total

(0,00)

Value

(Rp)

Total(4) + (6)(0,00)

Value(5) + (7)

(Rp)(1) (2) (3) (4) (5) (6) (7) (8) (9)

218 Packaged fruit juice 200 ml*219 Health drink/energy drinks Bottle **

(100 ml)220 Other drinks (coffee, milk coffee,

tea, chocolate milk)Glass

221 N. Alcoholic drinks222 Beer 620 ml223 Wine 620 ml224 Other alcoholic drinks ………. 620 ml

………………..225 O. Tobacco and betel226 Filtered clove cigarette 10 pieces227 Unfiltered clove cigarette 10 pieces228 White tobacco cigarette 10 pieces229 Tobacco Ounce230 Betel leaves/areca nut231 Other …………………..• * Boxed packaging• ** Small bottle

33

34

III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)232

233

A. Housing and Household facility

The house of living is:Owned property/free of rent 1 Installment payment 4Lease 2 Official house 5Rent 3 Other 6

234 If the house is own property/free of rent, estimated monthly rent: Rp. ………………….

235 If the house is leased:

a. Lease agreement: ……………….yearb. Lease value: Rp. …………………..c. Average monthly lease value: Rp. …………

236 If the house is rented, monthly rent value: Rp. ………….

237 If the status of dwelling is installment, official and others, average monthly rent value:Rp. ……………

238 Maintenance costs (paint, plastering, painting the wall, replacing roof tiles, broken glass, hinge, etc, includingwages for workers)

239

240

Electricity:

Used electricity (quantity): a. A month ago: …….………..kwh/watt *) Fill in byb. 12 months ago: …………….kwh/watt *) CBS

Value:241 Telephone :

35

36

III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)242

243

Water (“PAM” = Municipal Water Corporation / from water vendor/ purchased)

Quantity: a. A month ago: ……………………m3b. 12 months ago: ………………….m3

Value:244

245

LPG (Liquid Propane Gas)

Quantity: a. A month ago: ……………………kgb. 12 months ago: ………………….kg

Value246

247

City Gas

Quantity: a. A month ago: ……………………m3b. 12 months ago: ………………….m3

Value:248

249

Kerosene

Quantity: a. A month ago: ……………………m3b. 12 months ago: ………………….m3

Value250

251

Generator

a. Type and number of fuel used:

Gasoline 1 Kerosene 3 A month ago: ……………..literDiesel 2 12 months ago: ……………liter

Value

37

38

III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)252

253

254

b. Lubricants:

Quantity: a. A month ago: ……………………literb. 12 months ago: ………………….liter

Value:

c. Maintenance and repair255

256

Charcoal

Quantity: a. A month ago: ……………………kgb. 12 months ago: ………………….kg

Value257 Firewood and other fuel

258 Others (flashlight, storage battery, matches, mosquito repellent, lamp, air freshener, Liquid floor cleaner, etc)

259

260

Goods and Services

Bath soap, toothpaste, toothbrush, and shampoo

261 Cosmetics (perfume, pomade, deodorant, powder, lipstick, comb, etc), and sanitary napkin

262 Treatments for skin, face, nails, hair (cut, curl, cream bath, etc)

39

40

III. 2. EXPENDITURE OF NON FOOD GOODS DURING A MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)

263264265266267268269270271272273

Health

a. Government’s hospitalb. Private’s hospitalc. Doctor’s practiced. Puskesmas (Integrated Health Center)e. Supporting Puskesmasf. Clinic/”Mother and Child’s Clinic”/ BP (infirmary)g. Posyandu (Integrated Health Services Post)/Caderh. Midwife/paramedic/practicing nursesi. Traditional healer/Shinshe (Chinese traditional healer)j. Purchased medication with doctor’s prescriptionk. Own treatment/purchased medicine without doctor’s prescription/purchased medicinal herbs

274275276277

Other health:

a. Pregnancy examination costb. Delivery costc. Immunization cost for children under 5 yearsd. Check-up and contraceptive costs

278 Health treatment (vitamin, herbs, massage, fitness, etc)

279280281282283284

School & courses expenses

a. Donation for school development (school enrollment fee)b. School tuition (SPP) and BP3/POMG contributionc. Other school contributions (vocational skills, additional lesson, exams, etc.)d. Textbooks/photocopy of textbookse. Stationeries (calculator, compass, etc)f. Course fee

41

42

III. 2. EXPENDITURE FOR NON-FOOD CATEGORY LAST MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)285 Newspapers, magazines, books, and stationery (excluding school and course needs) including rent of

magazines/literatures

286 Post, Telegram, public phone, and postal materials, including pager fee

287

288

289

290

291

292

Motor vehicle fuels used for household needs (not for business/work)

a. GasolineQuantity: (1) A month ago: ………………………….liter

(2) 12 months ago: ………………………..liter Value:

b. Solar fuelQuantity: (1) A month ago: ………………………….liter

(2) 12 months ago: ………………………..liter Value:

c. Lubricant oilQuantity: (1) A month ago: ………………………….liter

(2) 12 months ago: ………………………..liter Value:

293 Maintenance and repairs of motor vehicle

294 Costs of transportation (bus, train, airline, ship, ‘becak’, parking fee, toll fee, etc)

295 Hotel, motel, cinema, theatre, sport, decoder, and other recreations, (excluding transportation cost and purchaseof goods for recreation)

296 Servant and driver (wages or salary)

297 Other goods (tissue, camphor, banana leaves, coconut leaves, ‘sate’ stick, etc)

298 Other services (Identity card, Driver license, birth certificate, photo copy,

43

44

III. 2. EXPENDITURE FOR NON FOOD CATEGORY LAST MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)299

300

C. Clothes, Footwear, and Head gear

Ready made men’s wear (Blazer, long-sleeved shirt, Jacket, sarong, pants, T-shirt, underwear, etc)301 Ready made women’s wear (Gown, long fabric, blouse, nightgown, sweater, skirt, sarong, shawl, cloth girdle,

underwear, etc)302 Ready made children’s wear (clothes, pants, sweater, shirts, under wear, baby napkin, etc)

303 Materials/fabrics for men, women, and children (wool, polyester, cotton, silk, etc)

304 Cost for tailoring, clothes repair, thread and other sewing needs

305 Footwear for men (shoes, sandal, sock, etc)

306 Footwear for women

307 Footwear for children

308 Head gear for man, woman and children (hat, ‘kopiah” =rimless cap, veil, etc)

309 Laundry-soap (in bar form)

310 Powder soap and cream soap

311 Others (towel, belt, shoe polish, tie, laundry, etc)

45

46

III. 2. EXPENDITURE FOR NON FOOD CATEGORY LAST MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)312

313

D. Durable goods

Furniture ( table, chair, bed, wardrobe, cabinet, shelving, mirror, food cabinet, baby bed, etc)314 Household equipment (sewing machine, refrigerator, fan, washing machine, air conditionner, etc)

315 Household furnishings (mattress, pillow, table cloth, bed sheet, mirror, pillow sheet, blanket, plaited mat,curtain, carpet, etc)

316 Household utensils (Iron, broom, scissors, knife, machete, saw, vacuum cleaner, etc)

317 Kitchen/eating utensils (plate rack, stove, cooking pan, pan, pail, wok, spoon, thermos bottle, plate, glass, andother utensils made of glass, ceramic, melamine, and plastic; mixer, blender, microwave, oven, etc)

318 Decorative goods (wall decoration, aquarium, decoration goods made of ceramic, porcelain, onyx, marble,wood, etc)

319 Repaired of household furniture, furnishings and equipment

320 Watch, clock, camera, glasses, and their repair

321 Umbrella, bag, luggage, and their repair

322 Expensive jewelers (gold, diamond, pearl, etc) and their repair

323 Children’s toy and their repair

324 Television, video, radio, cassette, radio cassette, guitar, piano/organ, computer, and their repair

325 Sport utensils (chess, racket, ball, net, bet, stick, etc) and their repair

326 Vehicle (bicycle, motor cycle, car, etc) and their repair

327 Pets and plants including maintenance

328 Other durable goods (cradle, baby carriage, electricity installation, telephone, plumbing, pager, and their repair

47

48

III. 2. EXPENDITURE FOR NON FOOD CATEGORY PAST MONTH AND 12 MONTHS AGOValue in RupiahNO DETAIL

A month ago 12 month ago(1) (2) (3) (4)329

330

Taxes and insurance:

Building and Land tax (PBB)331 Radio & TV tax, and its type

332 Vehicle (motor and non motor) tax

333 Other taxes/levies (household contribution, garbage, security, cemetery, etc)

334 Accident & loss insurance

335

336

F. Festivities and ceremonies

Weeding (rentals for facilities and services, function hall rental, etc)337 Circumcision, birthday

338 Religious holidays (“Idul Fitri” = holiday celebrating the end of fasting period, “Idul Adha”, Christmas, NewYear, “Waisak “= Budhist New Year, “Galungan” = Hindu Holy Day, expenses for going to Mecca for Haj

339 Other Traditional ceremonies (“selametan’, party, “sajen” = offerings, etc)

340 Funeral

49

50

III. 3. AVERAGE MONTHLY HOUSEHOLD EXPENSES ( IN RUPIAH)NO Type of expenses During a week Average in a

monthDuring 12

months(1) (2) (3) (4) (5)01 Cereals (III.1 A)02 Tuber (III. 1 B)

03 Fish (III. 1 C)04 Meat (III. 1 D)05 Egg and Milk (III. 1 E)

06 Vegetables (III. 1 F)07 Pulses (III. 1 G)

08 Fruits (III. 1 H)09 Oil and Fat (III. 1 I)10 Drinks (III. 1 J)

11 Spices (III. 1 K)12 Other consumables (III. 1 L)13 Prepared foods and drinks (III. 1 M)14 Alcoholic drink (III. 1 N)15 Tobacco and betel (III. 1 O)

16 Sub Total (1 to 15)

17 Sub total (16) x 30 7

18 Housing and Household facility (III. 2 A)

19 Goods and Services (III. 2 B)20 Clothes, Footwear, and Headgear (III. 2 C)21 Durable goods (III. 2 D)

22 Tax and Insurance (III. 2 E)23 Festivities and ceremonies (III. 2 F)

24 Average monthly expenses(17 to 23)

51

52

IV. INCOME, REVENUE AND EXPENSES FOR NON FOOD CATEGORY DURING THE PAST 12 MONTHS(IN RUPIAH)

1. Wages/salary received in cash and in kind2. Income from agriculture business/activities

a. Food and non-food crops

b. Other farming activities(livestock, poultry, miscellaneous livestock, fishery, forestry)3. Income from non agriculture business/activities4. Income outside of wage/salary and business

a. Estimated house rent

b. Other (pension, duty-binding scholarship/ scholarship, claimed life insurance, dividend, land lease, others)5. Expenses and money transfers received

Expenses: Revenue: (transferred money, give donation, gift, bequest, and aid) (received money transfers, inheritance, donation, gift, aid)

6. Other expenses and revenue

Expenses: Revenue:a. Purchased stock/bonds/gold/jewelry, immovable goods a. Sold of bond/gold/jewelry/immovable goods, second-

including building renovation hand goods

b. Others (saving, paid of insurance, loans/paid back loans, b. Others (withdrew savings, claimed other insurance,down payment, paid “arisan” = social gathering received “arisan”, received loans, panwed goods, etcwhose member contribute to and take turns sum of money,etc)

7. Income/revenue of household(Total of income/revenue, details 1 to 6 – total expenses, details 5 to 6)

8. Average income/revenue of household in a month (details 7 : 12)

53

54

V. HOUSEHOLD MEMBERS RICE CONSUMPTION FREQUENCYAND NUMBER OF CLOTHES

VI. LIVESTOCK AND POULTRY LISTING

Frequency of riceeaten previous week

Number of clothes owned attime of enumeration

1. Do you have livestock/poultry at time of enumeration?Yes 1 No 2 → finished

No Name Preparedat home

Preparedfood

Tops Skirt/shorts/pants

Dress

(1) (2) (3) (4) (5) (6) (7)

2. If “yes” , number of livestock/poultry raised:

Type of livestock/poultry male female Total (1) (2) (3) (4)

0102 01. Dairy cow03 02. Cow04 03. Buffalo05 04. Horse06 05. Goat07 06. Sheep08 07. Pig09 08. Free range chicken10 09. Layer chicken11 10. Broiler chicken12 11. Ducks

55

56

VII. NOTE