ED
NUMBER

HOUSEHOLD NO

1 0 0 0 0 0 0 7

INDIVIDUAL QUESTIONNAIRE

INTERVIEWER:
Whenever a dotted line (...) appears in a
question, call the name of the person to whom the information relates, if
it
is not the respondent himself/herself. Else say "You"'/"Your". X the
appropriate box. Please do not write over the
responses:

SECTION 1: CHARACTERISTICS

FOR ALL PERSONS

1.1. Please fill in this person's assigned number from household
roster

1.3. INTERVIEWER: Fill the appropriate oval.
FOR PERSONS NOT
SEEN ASK: Is.........male or female?

1
Male

2
Female

If age is not stated please estimate age if you see
the
person. Otherwise ask the respondent to
estimate the person's
age

1
African Descent/Negro/Black

2
Indigenous People (Amerindian/Carib)

3
East Indian

4
Chinese/Asian

5
Portuguese

6
Syrian/Lebanese

7
White/Caucasian

8
Mixed

10 Don't know/Not Stated

9
Other (please specify.............................)

1.5 To what ethnic, racial or national group do you
think..........belongs?

1.6 What is..........'s
religion/denomination?

1
Anglican

2
Baptist

3
Bahai

4
Brethren

5
Church of God

6
Evangelical

7
Hindu

8
Jehovah Witnesses

9
Methodist

10 Moravian

11 Muslim

12 Pentecostal

13 Presbyterian

14 Rastafarian

15 Roman Catholic

16 Salvation Army

17 Seventh Day Adventist

18 None

19 Not Stated

21 Other (please
specify.............................

20 Wesleyan Holiness

SECTION 2: MIGRATION

FOR ALL PERSONS

1
St. Vincent and the Grenadines

2
Abroad (Another Country)

2.1 Where was.......mother's place of usual residence
when........was

born?

2.2 In which district/parish was .....'s. mother
living?

2.3 In which country was.........mother
living?

(All go to Q2.5)

2.4 In which year did .........last come to live in St. Vincent
and the
Grenadines?

2.5 Is/are ....... living abroad at
present?

1
Yes

2
No

2.6 In which country do(es) ......... now
live?

2.7 How long has/have...... lived there?

FROM MONTH / YEAR

2.8 Why did ........return/come to St. Vincent and the
Grenadines?

1
Regard it as home/Homesick

2
Family is here

3
Deported

4
Retired

5
To start a business

6
The Weather

7
To obtain employment

8
Health Reasons

9
Return from Study

10 Other

11 Not App

2.9 For how long does/do...... intend to
stay?

Months

Years

2.10 Has ...... ever lived abroad in the past ten
years?

1 Yes

2 No (go to 2.12)

1
Yes

2 No (skip to Q1.8)

3 Not Stated

1.7A Do .... have a working mobile phone ?

1.8. Where is Internet access available to .......? X all that
apply

1
Home

2 Work

3 School

4 Internet Cafe

5
Cell Phone

6 Family Friend

7 Other

8
None

1 Drinking Alcohol

2 Smoking of Cigarettes

3 Smoking/Ingestion of banned Substances

4 Sexual abuse

5 Physical abuse

6 Physical abuse of children

7 Abuse of Prescription Drugs

8 Other

9 Don t Know

of another member of
household

2.12 Does any member of ....... household frequently engage in any
of

the following (X all that apply)

(If no, go to Q2.10)

1.7B How much did ..... spend on cellular telephone (pre-paid
and/or

post-paid) in the last month (exclude balances from previous

bills, include monthly package cost and additional cost for
text
messaging, caller ID, call waiting, etc)

.

$

,

(ALL, go to Q2.12)

use 97 for age over 96

Note that for post paid the amount
required is the amount
billed

1.2 What is .....'s relationship to the head of
household?

1
Head

2
Spouse/partner

3
Child

4
Son/daughter-in-law

6
Grandchild

7
Parent/parent-in-law

8
Other relative

9
Non-relative

5
Step son / daughter

1.4 What is.......'s date of birth
(DD/MM/YYYY)?

If not known, ask:
How old was..........on his/her last
birthday?

/

/

2.11 Why did ........return/come to St. Vincent and the
Grenadines?

1 Regard it as home/Homesick

2 Family is here

3 Deported

4 Retired

5 To start a business

6 The Weather

7 To obtain employment

8 Health Reasons

9 Return from Study

10 Other

IMPORTANT!!!

Transfer codes from
front page of
housing
questionnaire

Page 1

(if 11, Not App. Go
to Q2.12)

PARISH

Go to Q2.3

ED
NUMBER

HOUSEHOLD NO

1 0 0 0 0 0 0 7

Draft

SECTION 3: HEALTH

FOR ALL PERSONS

3.1 Did...... have to be

confined to bed

during the past thirty (30)

days due to any illness or injury? For example, cold,
diarrhea,
fever, headache, stomach ache, dizziness, severe pains or
other
illness/injury due to accident?

1
Yes

2
No

3.2 What type of illness/injury was this?

list only the major illness/injury as clearly as
possible

3.3 During the past 30 days, did ...... suffer from cold, diarrhea,
fever,

headache, stomach ache, dizziness, severe pains or other

illness/injury due to accident?

1
Yes

2
No

3.4 What type of illness/injury was this?

list only the major illness/injury as clearly as
possible

3.5 Does .... suffer from any of the following diseases, Diabetes,
High

Blood Pressure, Heart Condition, Cancer, HIV,
asthma?

1
Yes

2
No

3.6 If yes, which of these?

1
Diabetes

2
High Blood Pressure

3
Heart Condition

4
Cancer

5
HIV/AIDS

6
Asthma

7
Other

If yes to either Q3.1 or Q3.3 and No to
Q3.5 go to
Q3.7

3.7 Did .......'s illness/injury begin within or before the last
thirty (30)

days?

1
Within

2
Before

3.8 For how many days during the past thirty (30) days was\were
.....

unable to carry on his/her usual activities because of
illness/injury?

Days

3.9 Did ...... visit a doctor, nurse, pharmacist, healer, spiritual
healer,

midwife or other health practitioner during the past thirty (30)
days
due to illness/injury?

1
Yes (Go to Q 3.11)

2
No

3.10 If no, why not?

1
No Need

2
Too expensive

3
Too far

4
Un treatable

5
Other

After Q 3.10 go to Q3.23

3.11 How many visits did ...... make in the past thirty (30) days
to

health practitioners?

Visits

3.12 Where was ..... first visit made?

1
Public Hospital

2
Private Hospital

3
Health Center

4
Private doctor/ dentist abroad

6 Private Doctor/Dentist

7 Traditional Healer

8 Hospital Abroad

9 Pharmacy / Chemist

10 Other

3.13 Why did ...... go there first?

SECTION 3: HEALTH con't

FOR ALL PERSONS

3.14 Who attended to ......... first visit?

1
Nurse, health care worker

2 Pharmacist

3 Healer

4
Doctor

5 Midwife

6 Other

3.15 How long did ........ have to wait at this place before being
attended

to?

Minutes

3.16 How satisfied were/was ....... with the attention/treatment
received?

1
Very satisfied, Go to Q3.18

2
Satisfied, Go to Q3.18

3
Dissatisfied

4
Very dissatisfied

3.17 Why were/was............ not
satisfied?

3.18 How much did ......... have to pay at public health facilities
for all

visits made during the past thirty (30) days? Do not include
the
cost of drugs or any cost paid by your insurance.

EC

$

,

3.19 How much did ......... have to pay at private/public health
facilities

for all visits made during the past thirty (30) days? Do
not
include the cost of drugs or any cost paid by your
insurance.

EC

$

,

3.20 Did ...... spend the night in a public/private hospital or
any

other

public establishment during the past thirty (30)
days?

1
Yes

2
No

3.21 How many nights during the past thirty (30) days did ......
spend in

the public/private hospital?

Nights

3.22 How much did ...... have to pay or have paid altogether for
his/her

stay in a public/Private hospital during the past (30) days? Do
not
include the cost of drugs or any cost paid by your
insurance.

EC

$

,

3.23 Did ...... buy medicines during the past thirty (30)
days?

1
Yes

2
No

3.26 Did ...... obtain medicines at a public
facility?

1 Yes

2 No

3.24 Did ...... obtain medicines at a private facility or
pharmacy?

1 Yes

2 No

3.25 How much would ....... have spent if he/she were to
purchase

the medicines obtained from a public facility at a private
facility?

EC

$

,

3.27 How much has ....... spent for medicines at private/public
sources

in the past (30) days?

,

3.28 Is ...... covered by Private Health Insurance, Employee
Medical

Plan?

1 Yes

2 No

If no to Q3.23

If no to Q3.28

1
Drugs not available

2
Drugs not affordable

3
Attitude of Staff

4
Long waiting time

5
Equipment not available or operational

6
No Doctor/Trained

7
To many revisits

staff available

If No, go to Q3.3

If No, go to Q3.5

How many of these were
days of work without
pay?

Days

1.

2.

if No to Q3.1, Q3.3 and Q3.5 go to Q3.28
Otherwise, answer
Q3.6 and Continue

$

,

Private (in EC Dollars)

Public (in EC Dollars)

Page 2

If yes, go to Q3.26

1 0 0 0 0 0 0 7

Draft

FOR ALL PERSONS

SECTION 4: EDUCATION

4.2 Is ..... attending school/classes?

1
Yes

2
No If no to Q4.19

4.3 Is it?

1
Full-time

2
Part-time

3
Not Stated

4.4 What is the current grade ...... are/is attending at
present?

4.5 Does ........ attend private
school/classes?

1
Yes

2
No

4.6a Does ...... live at home while attending
school/classes?

1
Yes

2
No

4.7 During the last five days of school how many days did ......
actually

go to school/classes?

Days (If 5 days go to Q4.9)

4.8 Why did ........ not go to school during all of the last five
school

days?

1
Illness

2
Financial Problems

3
Transportation Problems
4 Working

5
Home duties

6
Not worth going

7
School closed/holidays

8
Truant/Delinquent (no reason)

9
Pregnant/young mother

10 Baby sitting

11
Apprenticeship

12
Fear of Gangs

14 Menstrual Problems

15
Other (Specify

4.9 How far away is ...... school from here (in minutes based
on
his/her usual/normal means of getting there)?

4.19 For persons under sixteen (16) years of age, why is ........
not

attending?

FOR ALL PERSONS NOT ATTENDING SCHOOL AT
PRESENT

1 Too young
2 Financial Problems
3 Transportation Problems
4
Working
5 Illness
6 Physically/mentally challenged
7 No school
available
8 No space in school

9 Pregnant/young mother
10 Baby sitting
11 Apprenticeship
12
Not worth going to school
13 Expelled
14 Suspended
15 Other
(Specify

16 Not applicable (if person > 15 years)

4.20 Has........ ever attended school?

1 Yes

2 No

4.21 What age did ...... start formal
education?

4.22 What age did ...... leave formal
education?

4.23 What is the highest grade ......
completed?

4.1 Can ...... read and write?

1
Yes

2
No

4.10 How does ...... normally get to
school?

1
Walking

2
Cycling

3
Taxi

4 Bus/Mini Bus

5 Private transport

6 Other (Specify)

4.11 Is there a school feeding programme at.............'s
school?

1
Yes

2 No

4.12 Do you pay for the school meal
service?

1
Yes

2 No

4.13 Does.......receive meals or snack from this
service?

1
Yes

2 No

4.14 Does.......have all textbooks required for his/her use at
school?

1
Yes, has books for exclusive use

2
Yes, but shares with other family members

3
Has only some books

4
Has none

4.15 Were any of..........'s books provided by the school at no
cost?

1
Yes

2
No

4.16 Were some of these books acquired by.........in any of the
following

ways? (Select all that apply)

1
Borrowed for use during year

2
Received from relatives or friends

3
Purchased New

4
Purchased second hand

5
Bought some/got some on loan or free

6
Received from NGO

7
Government Book Loan

8
Other

INTERVIEWER: for those answering 1 in Q. 4.14 go to
Q.4.18

4.17 What are the reasons for.......not having required
textbooks?

1
Books not available

2
Could not afford

3
Books available in school library

4
Books were lost or destroyed

5
To be purchased

6
Other (Specify)

4.18 Has.......or.......'s parents ever made use of a book loan
facility?

1
Yes

2
No

All go to Q. 4.25

Minutes

(if no, go to Q4.14)

(if none, go to Q4.17)

4.6b Are/is ....... enrolled in a distant education
programme?

1
Yes

2
No

(If yes, go to Q4.21)

For Part time and distant education persons, you should proceed
to Q4.21

(If no, go to Q4.24)

00
none

10 G1/Std 1 20 form1

30 CFBC-A

01
Nursery

11 G2/Std 2 21 form2

31 CFBC-TECH

02
Pre-school

12 G3/Std 3 22 form3

32 CFBC-level I

03
Kindergarten

13 G4/Std 4 23 form4

33 University-UWI

04
Special Education 14 G5/Std 5 24 form5

34 University-Other

05
Don't know

15 G6/Std 7 25 form6 35 Other

26 'A' Level

00 none

10 G1/Std 1 20 form1

30 CFBC-A

01 Nursery

11 G2/Std 2 21 form2

31 CFBC-TECH

02 Pre-school

12 G3/Std 3 22 form3

32 CFBC-level I

03 Kindergarten

13 G4/Std 4 23 form4

33 University-UWI

04 Special Education 14 G5/Std 5 24 form5

34 University-Other

05 Don't know

15 G6/Std 7 25 form6 35 Other

26 'A' Level

Page 3

1 0 0 0 0 0 0 7

Draft

FOR PERSONS 15 YEARS AND OVER

SECTION 5: EMPLOYMENT

5.9 What is the main activity at the place of ....... 's main job?
Is it

Tourism Related?

1 Agriculture/fishing - Other
3 Manufacturing -
Other

6
Const - Tourism Related

7 Wholesale and Retail - Other
9 Hotel and Restaurant
10
Transportation - Other
12 Services - Other
14 Admin/social
security

15 Admin - Tourism related

18 Other

11 Transp - Tourism Related

8
W&R - Tourism Related

5
Construction - Other

13 Services - Tourism related

4
Manu - Tourism Related

2
Agric/fish - Tourism Related

19 Other - Tourism related

16 Educ/social work

17 educ/social - tourism related

5.11 If worked for self without paid help or did any informal
work,

please provide the following information for the last twelve
months?

1. Location

2. Average value of sales/service

3. Product/service provided

4. Total Capital Invested

1
Fixed

2
Moved from place to place

EC

$

,

EC

$

,

5.12 What has been the major problem preventing you from earning
a

higher income in the past twelve months?

FOR ALL PERSONS WHO DID NOT WORK OR DO
ANYTHING TO EARN AN
INCOME LAST WEEK

5.13 When last did ...... work?

1 Never Worked (Go to Q 5.15)
2 Less than one month
3 1 > 3
months

4
3 > 6 months

5
6 > 12 months

6
1 year and more

5.14 What was the main reason why ...... left last
job?

1 New Job

2 Fired

3 Illness/Injury

4 Retired

5 To return to school

6 Retrenched/laid off

7 Did not want to work

8 No more work available

9 Wages too low

10 Seasonal job

11 Home Duties

12 Sexual Harassment

14 Other (Specify)

13 Pregnancy

5.15 Did ...... look for work or do anything to earn income last
week?

1 Yes

2 No

5.16 Why did ...... not seek work or do anything to earn income
last

week?

1 At school

2 Housekeeping

3 Retired

4 Disabled

5 Temporary illness

6 Did not want work

7 Awaiting results or applications

8 Knew of no vacancy

9 Discouraged

10 Caring for someone

11 Pregnancy

12 Other (specify)

4.24 What is the highest examination ever
passed?

1
None

2
School leaving Certificate

3
CXC Basic

4
GCE "O"/CXC Gen Prof (1 or 2 subjects) Grade I, II, III

5
GCE "O"/CXC Gen Prof (3 or 4 subjects) Grade I, II, III

6
GCE "O"/CXC Gen Prof (5 and over subjects) Grade I, II, III

7
GCE "A"/CAPE/HSC 1 or 2

8
GCE "A"/CAPE/HSC 3 and over

9
Diploma or Equivalent Certificate

10
Associate Degree

11
Undergraduate Degree

12 Postgraduate Degree
13 Professional Qualifications -
Computer

14 Professional Qualifications - Accounting
15 Professional
Qualifications - Other

17 Standard Seven - School Leaving Certificate

16
Other

4.25 Did ...... have any vocational or technical
training?

1
Vocational

2
Technical

3
Both

4
None

FOR PERSONS 15 YEARS AND OVER

SECTION 5: EMPLOYMENT

5.1c Did ...... do any type of work in the last 7
days?

1
Yes

2
No

(If Yes go to Q5.5)

5.2 Was ...... absent from work in the last 7
days?

1
Yes

2
No

(If Yes go to Q5.5)

5.3 Has ..... been looking for work and ready for work in the
last

month?

1
Yes

2
No

5.4 What was the main reason ...... was not working in the last 7
days?

1
No work available

2
Seasonal inactivity

3
Student

4
Household/family duties

5
Retired

6
Infirmity/Disabled

7
Did not want to work

8
Maternity Leave

9 Other

5.5 How many years have .... been in this
job?

(All go to Q5.13)

Years

5.6 How many hours did/does ..... normally work in a
week?

5.7 What is the reason for working less than 35
hours?

1
Own illness/injury

2
Holiday/vacation

3
Personal/family responsibilities

4
In school/training

5
Strike/lock out

6 Job ended in reference week

7 Firm not getting enough work

8 Could not find more work

9 Part Time Work

10 Pregnancy

11 Other

5.8 What is your occupation, that is what activities do you do in
your
work?

e.g. sales manager or sales clerk, mason
etc

5.1b How many months did you/he/she work in the past 12
months?

0

1

2

3

4

5

6

7

8

9

10

11

12

(if greater than 35 hours, go to
Q5.8)

If under 15, go to Section 7

(If yes, go to Q5.13)

(If yes, go to Q5.17)

For all persons who are employed go to
Q6.1

1
Paid Employee - Government

2
Paid Employee - Statutory

3
Paid Employee - private

4
Self employed without employees

5 Self employed with employees
6 Unpaid family
worker

7
Other

(If 1,2 or 3 go to Q5.12)

5.10 What is..... status in the main job?

00 for
under 6
mths

(All, go to Q5.18)

Page 4

5.1a Did you work at all in the past twelve
months??

(If No, go to Q5.3)

1
Yes

2
No

1 0 0 0 0 0 0 7

Draft

5.17 What kind of work are you looking for?

INTERVIEWER: What is required is a description of the work
you
are looking for e.g. sales manager or sales clerk, mason
etc

5.18 What would have prevented ...... from doing a job if one
were

available during the last three weeks?

1
At school

2
Housekeeping

3
Retired

4
Disabled

5
Temporary illness

6
Did not want work

7
Have to stay home with children

8
Pregnancy

10 Caring for someone

11 Other (specify)

12 Don't KNow

13 Nothing

SECTION 6: MARITAL STATUS, UNION STATUS AND
FERTILITY

FOR PERSONS 15 YEARS AND OVER

6.2 Is/Are ...... currently pregnant?

FOR FEMALES 15 TO 49 YEARS

1
Yes

2
No

6.3 Is/Are ...... attending/visiting a public health clinic/private
doctor?

1
Yes

2 No

6.4 How many live births has ....... ever
had?

(if Zero, enter 00 and skip to Q7.1)

6.5 How many died?

Before first birthday

After first birthday

6.6 How old were you/was she when you/she had the first live
born
child?

6.7 How many live births did you/she have in the last 12
months?

1 None
2 One
3 Two separate births

4
Twins

5
Three or more

(If no, go to Q6.4)

(If no, go to Q7.1)

6.8 Of these, have any of the babies died?

1
Yes

2
No

6.9 How many have died?

Within the first 30 days of life

After 30 days but before one year

SECTION 7 CRIME

1
Yes

2
No

3
Not Stated

7.2 A. Describe the nature of the main crime (inclusive
of
domestic violence)?

7.3 Was the crime reported to the police?

1
Yes

2
No

3
Not Stated

7.4 Why was the crime not reported to the
police?

1
No confidence in the administration of justice

2 Afraid of the perpetrator

3 Perpetrator household member/relative

4 Not serious enough

5 Other
(Specify).................................................

7.1 In the last 12 months have you/he/she.............been a
victim of
crime?

7.5 How satisfied was/were ........ with the handling of the matter
by the

police?

1 Very satisfied

2 Satisfied

3 Dissatisfied

4 Very dissatisfied

Go to Q 7.5

(If no, go to Q7.1)

If No, go to Section 8 for all spenders
Otherwise end the
interview

End of Interview for all non-
spenders

Spenders skip to Section 8
For all others end
interview

7.2 b What did the crime cost you:

Days without pay:

Other economic loss:

Days

$

,

Not applicable Leave Blank
Not Known 9's ending in
8
Amount too large 9's ending in 7
Not Stated Try harder, if not use all
9's

Page 5

6.2 Is/Are ...... currently pregnant?

1
Yes

2
No

3
Not Stated

4
Not Applicable (for Males)

1
Legally married

2
Common Law union

3
Visiting partner

4
Married but not in union

5
Legally separated and not in a union

6
Widowed and not in union

7
Divorced and not in union

8 Not in a union
9 Don't know/Not stated

6.1 What is your/....'s present union
status?

All males go to Q7.1

6.2bAre you currently practicing a form of birth
control?

1
Yes

2
No

6.2c If yes, what form(s)?

1
Pill
2 IUD
3 Abstinence
4 Injectable

5
Diaphragm foam/jelly

6
Male Condoms

7 Female Condoms
8 Female sterilization
9 Male
sterilization
10 Norplant
11 Rhythm
12 Withdrawal

13 Other Traditional

14 Other

if yes, skip to Q6.3

1 0 0 0 0 0 0 7

Draft

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

HAVE

BOUGHT

QTY

BOUGHT

QTY

recieved

GIFTS

DESCRIPTION

TOTAL COST($)

TOTAL COST($)

CODE

Tailoring for Suit

Material for men
and boy's garments
Suiting
Material

0311101

Tweed

0311102

Khaki

0311103

Material for school
Trousers

0311104

0311105

Tailoring for Trousers

0311106

Material for women
and children garments
Crepe back
Satin

0311201

Satin

0311202

Chiffon

0311203

Linen

0311204

Madras

0311205

Poplin

0311206

Flowered

0311207

Cotton

0311208

Silk

0311209

Polyester

0311310

Material for school
overall

0311311

Material for school
shirts

0311312

Suiting material

0311313

Over

0311314

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

PURCHASED (homemade)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Page 6

1 0 0 0 0 0 0 7

Draft

HAVE

BOUGHT

QTY

BOUGHT

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

CODE

Seamstress fees for suit

0311315

Seamstress
fees for uniform

0311316

Seamstress fees for
formal wear

0311317

Men's Garments -Outer wear
Complete Suits - 2
piece

0312101

Jackets

0312102

Sweaters

0312103

Waistcoats/pullovers

0312104

Long Trousers/ pants
for dress and office

0312105

Long Trousers/
pants casual wear

0312106

Long Jeans pants

0312107

Short pants
(casual)

0312108

Short pants (Jeans)

0312109

Short pants(house
wear)

0312110

Shirts - long
sleeves (dress)

0312111

Shirts (casual,
working)

0312112

Jerseys (dress,
working)

0312113

Sports wear /vests

0312114

Polo Shirts

0312115

T- Shirts

0312116

Track suits
/Jogging suits

0312117

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

PURCHASED (homemade)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Page 7

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

CODE

HAVE

BOUGHT

QTY

BOUGHT

Pyjamas

Bath robes /housecoats

0312119

Costumes

0312120

Overcoat/ raincoat

0312121

Work overalls

0312122

Men's outerwear not
specified by type

0312199

Men's underwear
and Hosiery
Vests

0312124

Boxer shorts

0312125

Underwear
/underpants

0312126

Socks

0312127

All other men's outer
wear

0312199

Other articles of Men's
clothing
Ties &
Scarves

0313101

Hats and caps

0313102

Belts

0313103

Beachwear

0313104

Braces

0313105

Handkerchiefs

0313106

Sewing thread, buttons,
zips, buckles

0313107

Helmets

0313008

Other men's clothing

0313199

0312118

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

PURCHASED (homemade)

8. Did ....... purchase or recieve as gifts any of the following
items in the past 3 months?

Page 8

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

QTY

BOUGHT

HAVE

BOUGHT

CODE

Boy's outer wear
Complete Suits -2/3
piece

0312201

Jackets

0312202

Sweaters

0312203

Waistcoats / pullovers

0312204

Long Trousers /pants
(dress)

0312205

Long trousers / pants
(casual wear)

0312206

Long Jeans pants

0312207

Short pants (casual)

0312208

Short pants (Jeans)

0312209

Short pants
(house wear)

0312210

Shirts -dress(Long
sleeves)

0312211

Shirts (casual)

0312212

Jerseys (dress)

0312213

Sports wear/ vests

0312214

Polo Shirts

0312215

T- Shirts

0312216

Track suits/
Jogging suits

0312217

Pyjamas

0312218

Bath robes
/housecoats

0312219

Costumes

0312220

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

PURCHASED (homemade)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Page 9

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

QTY

BOUGHT

HAVE

BOUGHT

CODE

Overcoat/ raincoat

0312221

Boy's outer wear not
specified by type

0312299

Boy's underwear
and Hosiery
Vests

0312224

Boxer shorts

0312225

Underwear / underpants

0312226

Socks

0312227

All other boy's outer wear

0312299

Boy's school garments
Long Pants
(school)

0312228

Short Pants (school)

0312229

Shirt (school)

0312230

Sports uniform

0312231

Other articles of
Boy's clothing
Ties &
Scarves

0313201

Hats and caps

0313202

Belts

0313203

Beachwear

0313204

Other boy's clothing

0313299

Women's outer wear Skirt
Suits (2 or 3
piece)

0312301

Pants suits

0312302

Dresses
(evening formal)

0312303

Dresses (office)

0312304

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

PURCHASED (homemade)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Page 10

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

QTY

BOUGHT

HAVE

BOUGHT

CODE

0312305

0312306

0312307

0312308

0312309

0312310

0312311

0312312

0312313

0312314

0312315

0312316

0312317

0312318

0312319

0312320

0312321

0312322

0312323

Dresses (casual)

Shirts /blouses (formal)

Shirts / blouses (casual)

Skirts (long)

Skirts (short)

Slacks / trousers

Jeans (Long)

Jeans (short)

T-
shirts

Jerseys
with sleeves

Jerseys without sleeves

Polo -shirts

Track suits / Jogging
suits

Sports clothes
(netball)

Sweaters / Jumpers

House clothes

Sleep

Robes/ Housecoats

Raincoats / overcoats

0312324

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

PURCHASED (homemade)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Overalls

Page 11

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

QTY

BOUGHT

HAVE

BOUGHT

CODE

0312399

0312325

0312326

0312327

0312328

0312329

0312330

0312331

0312332

0313301

0313302

0313303

0313304

0313305

0313306

0313307

0313308

Girls Outer wear
Dresses (formal/
evening)

All other women's
outer wear

Women's Underwear

Slips- half or full

Bras

Vests

Panties

Tights / Panty hose

Girdles

Socks

Stockings

Other Women's Clothing and
Clothing
Accessories
Hats

Bags

Purses

Watches

Necklaces and earrings
(Gold, silver,
precious
stones)

Necklaces and
earrings (cosmetics)

0312401

Shirts/ blouses (casual)

0312402

T- shirts

0312403

Scarves / belts

Bathing suits /
Beachwear

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

PURCHASED (homemade)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Page 12

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

QTY

BOUGHT

HAVE

BOUGHT

CODE

Skirts (casual)

0312404

Slacks / trousers

0312405

Jeans pants (long/short)

0312406

Jeans skirts

0312407

Pants suits (casual)

0312408

Jerseys

0312409

House clothes

0312410

Sleep wear /
pajamas

0312411

Raincoats

0312412

Other girls outer wear not
specified by type

0312499

Girl's underwear
and hosiery
Bras

0312424

Panties

0312425

Vests

0312426

Tights

0312427

Socks/ stockings

0312428

Girl's school garments
School Overall

0312430

School blouses/ shirts

0412431

School Skirts

0412432

Sports uniform

0412433

Other girl's clothing
Hats

0313401

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

PURCHASED (homemade)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Page 13

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

QTY

BOUGHT

HAVE

BOUGHT

CODE

Bathing suits

0312402

0313501

Play suits

0313502

Baby shirts /vests

0313503

Diapers

0313504

Socks/ booties

0313505

Hats /bonnets

0313506

Other infant clothing
not specified by type

0313599

Dry- cleaning, laundering and
dying of garments
Men and
boy's clothing

0314101

Women, girls and
infants clothing

0314102

Repairs and alterations
Men and boys
clothing

0314201

Women and
girls clothing

0314202

Infants clothing

0314203

Hire of garments
Men and boys garments
(Jackets,
suits)

0314301

Women and girls
garments (Wedding out
fits, evening
gowns)

0314302

0321101

Shoes - casual

0321103

Sandals

0321104

Sneakers /sports
shoes/ gym shoes

0321105

Infants (under 1 year) Clothing
and clothing
accessories
Dresses/ Suits

Men and Boy's shoes
(16yrs. and over)
Shoes -
dress (man-made)

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

PURCHASED (homemade)

Shoes - dress (Leather)

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

0321102

Page 14

QTY

recieved

1 0 0 0 0 0 0 7

Draft

GIFTS

DESCRIPTION

SECTION 8: CLOTHING AND FOOT-WEAR CONSUMED DURING PAST 3
MONTHS

TOTAL COST($)

TOTAL COST($)

QTY

BOUGHT

HAVE

BOUGHT

CODE

0321107

Slippers -house

0321108

Women and girls (16 years
and over)
Shoes -dress (man -
made)

0321201

Shoes -casual

Sandals

0321204

Sneakers/ sports shoes
/gym shoes

0321205

Boots

0321206

Slippers- fashion

0321203

0321207

Slippers- house

0321208

Infants and children (up to 16
years)
Shoes
-school

0321301

Shoes -dress

0321302

Sandals

0321303

Sneakers /
Sports shoes

0321304

Shoes -fashion

0321305

Slippers -house

0321306

Shoe Repair
Men and boys shoe
repair

0322101

Women and girls shoe
repair

0322201

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

Yes

Home

,

,

PURCHASED (homemade)

Shoes -dress (Leather)

Boots -work

0321106

8. Did ....... purchase or receive as gifts any of the following
items in the past 3 months?

Boots-casual

0321202

Page 15

QTY

recieved

1 0 0 0 0 0 0 7

Draft

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

SECTION 9 - OTHER EXPENSES

Expenditure During Last 3 Months

Doctors Fees (Number of visits)

Dentist Fees (Number of visits)

Child Delivery Fees

Optician Fees

Private hospital care (number of nights)

Lab Tests and X-rays (number of lab test)

Other Drugs and Prescriptions, Medical

li

Spectacles, hearing aids, dentures, etc

Health and Accident Insurance

Other Medical Expenses

Tuition - Correspondence Courses (all levels)

Boarding and lodging

School and technical books

Drugs for Hypertension

Drugs for Cancer

Drugs for Diabetes

Drugs for Cold/Flu

Lessons for Children Primary/Secondary

Tuition - Tertiary, University and Other

MEDICAL EXPENSES

EDUCATIONAL EXPENSES

(Always indicate value, Include Quantity where
requested)

CODE

(Y/N)

QUANTITY

NO.

AMOUNT ($)

SPENT 3 MONTHS

0621101

0622101

0621106

0621104

0623101

0611102

0611103

0611104

0611112

0611199

0613101

0623199

0630108

1253001

1040202

1050101

1040101

1120101

0951101

Tuition - Primary, Secondary School

1040101

Exam fees

1040203

Tuition - For pre-school/Day Care

Lessons/Night Classes for Adults

9. Did ....... spend money on any of the following in the past 3
months?

1010101

1050102

Page 16

1 0 0 0 0 0 0 7

Draft

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

AMOUNT ($)

SPENT 3 MONTHS

Expenditure During Last 3 Months

(Y/N)

Dues, subscriptions and memberships

Participant sports

Spectator sports, football, cricket

Concerts, plays, fetes and other admissions

Cinemas/video/DVD rentals/video clubs

Carnival

Lottery games

Newspapers

Other Entertainment, Hobby

Specify.........................................................

Toys for Children

TRANSPORTATION BY AIR
(for Quantity indicate number of
visits)

Inter-Island Travel
Caribbean - Grenadines

Caribbean - Trinidad and Tobago

Caribbean - Other

USA - New York, Miami, etc..

England - London, etc

Other Foreign Travel by Air

ENTERTAINMENT EXPENSES

SECTION 9 - OTHER EXPENSES

(Always indicate value, Include Quantity where
requested)

CODE

QUANTITY

NO.

0733101

0733102

0733103

0733104

0733105

0733106

0942105

0914101

0942101

0941102

Night clubs, dances, parties

0942104

1270104

Books,magazines
(non-technical and not for
school)

0952101

0931100

0952102

0942105

0942198

0942199

Other

1050101

EDUCATIONAL EXPENSES (Cont'd)

School Transportation fees

School Meals

0119423

0737101

Computer software and accessories

0913105

9. Did ....... spend money on any of the following in the past 3
months?

Page 17

1 0 0 0 0 0 0 7

Draft

AMOUNT ($)

SPENT 3 MONTHS

Expenditure During Last 3 Months

(Y/N)

Local accommodation expenses

Funerals

Legal and accounting expenses
(non-business)

Weddings

Bus Transportation

Taxi Transportation

Beauty Salon (manicures, pedicures, facials etc..)

Driving Lessons

Other personal services

PERSONAL AND OTHER EXPENSES

Laundry/Dry cleaners

Photo studios

SECTION 9 - OTHER EXPENSES

CODE

0732400

0732100

1270103

1270101

1270102

1120104

Barbershop

Hairdresser

1211201

1211101

1211102

0562205

0942106

0724301

TRANSPORTATION BY BOAT
(for Quantity indicate number of
trips)

Other, B'dos, St Lucia, Trinidad and Tobago

0734101

0734102

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

QUANTITY

NO.

Other travelling expenses

9. Did ....... spend money on any of the following in the past 3
months?

1211300

0738102

Page 18

Inter-Island Travel
Caribbean - Grenadines

1 0 0 0 0 0 0 7

Draft

SECTION 10 - OTHER DISBURSEMENTS

AMOUNT ($)

Expenditure During Last Month

Gifts (Cash and financial)

Hire-purchase installments

Credit Card Payments

Interest on consumer loans

Annuities

Life insurance premium

Other taxes, duties, fees and other compulsory charges
e.g.
Customs duties, departure tax, stamp duty etc.

Allowances to children

Remittance sent to persons abroad

Loans given out

Other Non Consumption Expenditure

NON-CONSUMPTION EXPENDITURES

Alimony/Child maintenance

Donations and charities

Subscriptions and contributions to trade unions
and other
organizations

Partnerhand

Credit Union Shares

Bank Deposits

Treasury Bills / Government Bonds

Stocks and shares in local companies

Stocks and shares in foreign companies

Investment in real estate (Land)

Other Disbursements

DISBURSEMENTS OTHER THAN CONSUMPTION EXPENDITURES LAST TWELVE
MONTHS

CODE

Income Taxes

2010001

2010002

1251001

2020001

2020002

2020003

2020004

2030001

2040001

2040002

2030002

2040003

2050001

2060001

2060099

2110001

2110002

2110003

2120001

2120002

2120003

2130001

2130099

(Y/N)

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

,

Yes

No

Social Security Payments/Social Services
Levy

Some of the more common expenditures are in
bold

10. Did ....... spend money on any of the following last
month?

1255102

Page 19

1 0 0 0 0 0 0 7

Draft

1B. How much did you receive in wages and salary LAST PAY
PERIOD

FROM MAIN JOB (GROSS PAY) . Include Overtime, tips and
bonuses,
income taxes and Social Security

5.

Money sent by relatives and friends overseas - Remittances from
abroad

10. Government retirement pension

11. Pension from other former local employer

15. Public assistance

13. Social Security (NIS), excluding old age/retirement
pension

,

2.

Do
you get this amount regularly?

1
Yes

2
No

6.

Rental income received by you for house, land and other
property

,

8.

Dividends on local and foreign investments (e.g Credit union
dividends)

,

7.

Other entrepreneurial income, example from self
employment

4.

Do you get this amount regularly?

3.
How much did you receive in wages and salary LAST PAY
PERIOD

FROM OTHER JOB (GROSS PAY). Include Overtime, tips and
bonuses,
income taxes and Social Security

,

,

1
Yes

2
No

12. Pension from former foreign employer

9.

Interest on local and foreign bank deposits, bonds

16. Child support

17. Allowances - alimony

14. Insurance Annuities

21. All Other Income, nes

,

,

,

,

,

,

,

,

,

,

,

INCOME SOURCES - OTHER, RECEIVED ANNUALLY

,

18. Allowances -

financial aid

19. Allowances - scholarships

,

,

2231001

2231002

2331001

2341001

2231003

2351001

2361001

2371001

2371002

2371003

2371004

2381001

2381002

2381003

2391003

2391002

2391003

20. Interest from stocks, shares, Treasury bills and other
investments

2361002

2391099

INCOME SOURCES - EMPLOYMENT

CODE

PERIOD

AMOUNT ($)

1A. What was...'s gross pay/income during the last pay period,
from

MAIN job, that is, before income tax or other
deductions?
(PRESENT FLASH CARD)

Income Group

1
Yes

2
No

1
Yes

2
No

1
Yes

2
No

1
Yes

2
No

1
Yes

2
No

1
Yes

2
No

1
Yes

2
No

1
Yes

2
No

1 Yes

2 No

1 Yes

2 No

1 Yes

2 No

1 Yes

2 No

1 Yes

2 No

1
Yes

2
No

1
Yes

2
No

1
Yes

2
No

1 Yes

2 No

Not applicable Leave Blank
Not Known 9's ending in
8
Amount too large 9's ending in 7
Not Stated Try harder, if not use all
9's

11. Did ....... receive money from any of the following
sources?

Page 20

SECTION 11 - INCOME FOR EMPLOYED PERSONS

CODE PERIOD

1
Daily

6

Semi-Annually

2
Weekly

7

Annually

3 Fortnightly
4 Monthly
5 Quarterly

1 0 0 0 0 0 0 7

Draft