No. QUESTIONS -English QUESTIONS -Bahasa Indonesia PROMPT / OPTIONS -Englsih PROMPT / OPTIONS -Bahasa Indonesia NOTES
## SURVEYOR IDENTITY
1 form number bnetuk
2 surveyor ID surveyor ID
3 surveyor 2 ID surveyor 2 ID
4 camera ID ID kamera
5 GPS ID ID GPS
6 village, subdistrict/district
7 interview date (mm/dd/yyyy)
8 duration (hh:mm)
9 notes
## RESPONDENT IDENTITY
10 name of respondent nama (first, middle, last name)
11 available ID national ID (only one; in order of preference)
* postal ID
* voter’s ID
* driver’s license
* birth certificate
* marriage certificate
* others, specify
12 photo ID (file ID) Note 2: Respondent must be a member of the household. Details must be recorded in the Table on pages 4
* incl. camera no /* This is another point that could be programatically tied together */
* incl. photo number /* To keep track of the relationship of images to specific response questions, such a identifying a person, we could integrate a "capture" feature within specific sections for data collection. */
13 sex jenis kelamin male ** Must be recorded. Give an approximation if the actual date is unknown. **
* female
14 age umur (note years of age; estimate if unknown) ** Must be recorded. Give an approximation if the actual date is unknown. **
15 date of birth (mm/dd/yy) ** Must be recorded. Give an approximation if the actual date is unknown. **
16 father’s name (first, middle, last name)
17 mother’s name (first, middle, last name)
18 civil status belum menikah
* single
* married
* widowed
19 birthplace
20 inhabitant of this village since year… migrant from ...
21 residency status
* resident
* normally resident (absent)
* temporary resident
* non-resident (outside project-affected villages)