Palestinian Family Survey 2010 Final Report - Palestinian Central ...

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PCBS: Palestinian Family Survey, 2010Appendix H. Questionnaireshousehold questionnaireState of Palestine PFS 2010Palestinian AuthorityPalestinian Central Bureau of StatisticsPalestinian Family Survey, 2010Household questionnaire• All information in this questionnaire is for purely statistical purposes only.• It is considered confidential in accordance with the Public Statistics Law of 2000.HH1Cluster number:HH2PHH1 Questionnaire’s serial number in sample HH7PHH3Building’s address: __________________HH8PHH13PHH4 Locality: ________Household number:Governorate:Name of head of household: _______________Building No.Interviewer: ask the member who will answer the questions : May I start now? 1. yes 2. noAfter all questionnaires for the household have been completed, fill in the following information:HH9: Result of household interview:01 Completed02 Not at home03 Refused04 Household not found05 Partially completed07 Household travelled08 Household destroyed09 Information not available96 Other / specify ………………………………..HH10. Respondent to household questionnaire:Name: ______________ Line Number:HH11. Total number of household members:HH12. Number of eligible women:HH14. Number of children under age 5:HH13. Number of women’s questionnaires completed:HH15. Number of under-5 questionnaires completed:207
PCBS: Palestinian Family Survey, 2010PHH6. Number of persons 5-24 years: PHH7. Number of children 5-14 years :PHH8. Number of persons 60 years and older interviewedHH5PHH5Visits’ scheduleTotal number of visitsHH3 - Interviewer’s No:Interviewer’s name:HH16- Editor’s No:Editor’s name:PHH11- Encoder’s No:Encoder’s name:1 st visit2 nd visit3 rd visitPHH9. Number of youth 15-29 years:Day Month Start hour End hourHH4 - Supervisor’s No:Supervisor’s name:HH17 - Data entry clerk’s No:Data entry clerk’s name:PHH12 - Date of data entry ……………..: :: :: :Interviewer: Please check the box with X if an additional questionnaire has been used.208
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