1 QUESTIONNAIRE Census data regarding a resident and his dwelling shall be confidential and may only be used to obtain aggregated data. Republic of Lithuania, Law on the Population and Housing Census 2001, Article 7 Example of marking Municipality code Census districts No. Supervisors area No. Enumerations area No. Address municipality town/city seniûnija (local administration unit) rural settlement street flat No. house No. land plot No. for those usually residing at their cottage Indicate the name of the owner the name of the land plot partnership in villages, if street names and numbers of houses are not indicated of cottage or dwelling in the territory of a land plot partnership, if used as the place of usual residence name surname homeless person male female 1 Main questionnaire No. number temporarily present persons 11 number of persons in the dwelling answered by usual resident 2 Type of institution welfare institution care homes, lodging houses, etc. Data on building 3. Construction materials of the outer walls 1. Period of construction before 1919 1971 - 1980 brick, stone, block religious institution 1919 - 1945 1981 - 1990 large-block military institution 1946 - 1960 1991 - 2001 monolith educational institution 1961 - 1970 monastery, seminary, etc. barracks, etc. boarding school, etc. other prison, etc. For persons staying in the institution do not fill data on building, dwelling and household Þ health care institution wood various materials 2. Type of building dwelling in residential building other dwelling in non-residential building Data on dwelling 7. Number of rooms 10. Type of heating central heating individual house available from a central heating centre 8. Kicthen separate apartment (flat) 9. Conveniences hostel piped water yes no gas heating hotel etc. sewerage yes no solid fuel other living quarters hot water yes no liquid fuel bath/shower yes no stove, fire-place private flush toilet yes no other private electricity yes no no heating at all state, municipality gas or electric cooker yes no other kicthen-range (oven) yes no occupied telephone yes no reserved for seasonal or secondary use 5. Type of ownership natural person legal person 6. Useful floor space yes no central heating part of the house available from a local source electric heating m2 11. Use of dwelling vacant 2 Main questionnaire No. 2 4. Type of housing 3 List of residents of the dwelling continued main questionnaire No. Name, surname 1 by households Persons No. of order Relationship to the husband/ Persons House- reference wife/, hold No. of father person in cohabi- mother No. order household* tant 2 3 4 6 5 7 Tem- Tempoporarily rarily abpresent sent 8 9 No. of questionnaire Data on person 10 ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... ....................................................... * codes 5 - father/mother 6 - father-in-law/mother-in-law 7 - brother/sister 8 - son-in-law/daughter-in-law 4 - son/daughter of reference person, or of his/her spouse/ partner 3 Main questionnaire No. 9 - grandparent 10 - grandchild 11 - other relative 12 - non relative 3 1 - reference person 2 - husband/wife 3 - cohabitant Duration and cause of temporary departure/arrival of persons continued main questionnaire No. 4 Cause of temporary arrival or Temporarily Duration absent/present temporary departure persons No. of up to one number of conscriporder No. from the other tion month months studies work list of residents Indicate the country Abroad Data on household Household No. Household No. 12. Do you have own private dwelling? yes yes no 13. Do you rent the dwelling for yourself? yes 13. Do you rent the dwelling for yourself? yes all dwelling yes all dwelling part of the dwelling part of the dwelling no 14. Do you have a land plot? yes hectare are Þ hectare are no rented land Þ yes are hectare Þ are hectare no 15. Do you have a car(s)? yes land owned Þ Þ Þ rented land Þ Þ number of cars, private or provided by the employer for household use yes land owned Þ rented land Þ hectare are hectare are no 15. Do you have a car(s)? no part of the dwelling 14. Do you have a land plot? 14. Do you have a land plot? Þ land owned all dwelling no Þ no more than one one no 13. Do you rent the dwelling for yourself? Þ more than one one no no yes more than one one yes 12. Do you have private dwelling? Þ 15. Do you have car(s)? number of cars, private or provided by the employer for household use 4 Main questionnaire No. yes Þ no number of cars, private or provided by the employer household use 4 12. Do you have own private dwelling? Household No. Data on person 5 No. of main questionnaire Persons No. of order 22. Citizenship Lithuanian answered himself/herself other without citizenship Þ 16. Name name 23. Nationality surname male Russian Polish Byelorussian other female Þ 17. Sex Lithuanian 18. Personal identification code not indicated 19. Date of birth 24. Mother tongue month year age, in years day 20. Place of birth Lithuania urban area rural area abroad Lithuanian Russian Polish Byelorussian Þ Þ other indicate the country 25. What other languages do you know, i.e. are able to speak and/or write? 21. Have you lived in this place one year prior to the census? no Þ Þ 22 question Lithuanian Russian Polish arrived from English French German rural area other Þ urban area Þ abroad indicate the country no command of other languages 1 Questionnaire No. 5 yes Data on person 6 26. Marital status to be asked of person 15 years of age and over single (never married) 29. Educational attainment to be asked of person 10 years of age and over; to mark the highest level of education higher married yes no college - type school re-married 32. Do you belong to any religious community? not indicated, cannot answer technicum divorced professional secondary widowed secondary years of the 1 marriage st 27. Have you delivered a child? to be asked of woman 15 years of age and over yes 33. Whitch religion confession would you attach yourself to? professional basic Roman Catholic basic Ortodox Believer primary Old Believer not finished primary Evangelic Lutheran literate (no schooling) Year of your first child delivery Evangelic Reformer illiterate Number of live born children Moslem 30. Do you attend school at present? no 28. Is a group of disablement established? to be asked of person 5 years of age and over Judaist Greek Catcholic Þ which one yes Þ 31 question Karaite no Þ 29 question no Þ 32 question other Þ yes Cause of disability 31. Type of current educational institution illness or trauma higher work-related college - type school Kind of disability mobility internal organs hearing mental sight/vision (eyes) other vocational general education not any 2 Questionnaire No. 6 congenital 7 Data on person 34. Sources of your income in the last 12 months indicate no more than 3 sources according to size of sources; mark only in numbers 1 2 3 salary or wage income from business income from farming 35 - 45 questions to be asked of person 15 years of age and over about work in the last week before census (March 26 - April 1) 35. Are you employed? 38 - 45 questions to be asked of employed, 38 - 44 questions - in the main workplace 38. Which of the following employed are you? employee yes Þ 38 question employer no Þ 36 question own - account worker 36. Are you unemployed? Þ yes Have you registered at labour exange office? family worker member of producers cooperative yes conscript pension no other Finish interview for unemployed benefit no Þ 37 question Þ income from property or investments 39. Location of your workplace town, village, individual farm 37. Which of the following unemployed are you? in the same place as usual residence pupil, student not in the same place where person lives supported by family and/or other persons pensioner, retired abroad other housewife (homemaker) Þ state supported indicate the country other 3 Questionnaire No. 7 grant Data on person 8 40. Place of work at home, at household farm a fixed place of work outside the home no fixed place of work 41. Workplace subsidiary Name Address municipality town/city rural settlement street flat No. if workplace is registered in the flat house No. 42. Describe the main economic activity of the workplace (business) 43. What is your occupation, work perfomed or position? 44. Give a short description of your job yes 4 Questionnaire No. no 8 45. Do you work at another workplace? 9 The address of usual residence of temporarily present person main qustionnaire No. Name Surname Persons order No. municipality town/city seniûnija (local administration unit) rural settlement street house No. for those usually residing at their cottage flat No. land plot No. the name of the land plot partnership Indicate the name of the owner in villages, if street names and numbers of houses are not indicated of cottage or dwelling in the territory of a land plot partnership, if used as the place of usual residence name surname 9 Addtitional questionnaire No.
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