RESPONDENTS’ FEEDBACK SURVEY
IDENTIFICATION AND OTHER INFORMATION
San Fernando City
Name of Respondent
Name of Household Head
A. DEMOGRAPHIC AND ECONOMIC CHARACTERISTICS
A1. Respondent’s Characteristics:
A1a. What is your relationship to the household head?
01 – Head
02 – Wife/Spouse
03 – Son/daughter
04 – Brother/sister
05 – Son/Daugther-in-law
06 – Grandson/granddaughter
07 – Father/mother
08 – Other relative
09 – Boarder
10 – Domestic helper
11 – Non-relative
A1b. How old are you as of your last birthday?
A1c. What is your sex?
A1d. What is your marital/civil status?
1 – Single
2 – Married
3 – Widowed
4 – Divorced/Separated
5 – Common-law/Live-in
6 - Unknown
A1e. What is your highest educational attainment?
A1f. Did you do any work at least one hour/have a job or business during the past three months? If No (Go to Section A2)
A1g. What was your primary occupation during the past three months?
A1h. In what kind of industry did you work during the past three months?
A2. Household Characteristics:
A2a. How many members are there in your household excluding those who are working as OCW/OFW?
A2b. How many members are below 5 years old?
A2b. How many members are below 5 to 14 years old?
A2b. How many members are below 15 to 59 years old?
A2b. How many members are below 60 to 65 years old?
A2b. How many members are below 65 years old and over?
A2c. How many household members including the head and his/her spouse were employed for pay or profit during the past three months?
A2d. How many Overseas Filipino Workers are there in this household at this time of visit?
A2e. What is the average gross monthly income of your household (including the OFW’s remittances)?
01 – less than P5,000
02 – P5,000-P9,999
03 – P10,000-P19,999
04 – P20,000-P29,999
05 – P30,000-P39,999
06 – P40,000-P49,999
07 – P50,000-P74,999
08 – P75,000-P99,999
09 – P100,000-P149,999
11 – P200,000 and over
B. AWARENESS OF HOUSEHOLDS TO THE PHILIPPINE STATISTICS AUTHORITY
B1. Are you aware of the presence of the Philippine Statistics Authority?
B2. What is/are the source of your information regarding the PSA?
a. Local newspapers
d. Online new sites
e. PSA website
f. Online social network
g. Friend and relative
h. Local government official
i. Survey conducted by the agency
j. Data Dissemination/information drive
k. Others, please specify _______________________
B2. What is/are the source of your information regarding the PSA? K. Others, please specify _______________________
C. RESPONDENT’S FEEDBACK AND OTHER RELEVANT INFORMATION
C1. Please rate your willingness to be a respondent to our survey undertakings?
C2. What would you expect to receive in return from PSA after you provided information through our survey undertakings? (If code 2 go to C3, else go to C4.)
1 – Nothing
2 – Incentive/Token
3 – Others, please specify _____________________
C2. What would you expect to receive in return from PSA after you provided information through our survey undertakings? 3 – Others, please specify _____________________
C3. If possible, what type of incentive/s would you want PSA to provide?
b. Bag of Grocery
e. Paper fan
f. Caps/Sun visor what possible incentive they would want PSA to provide
h. Free services
i. Assistance in availing services
j. Others, please specify _______________________
C3. If possible, what type of incentive/s would you want PSA to provide? J. Others, please specify ______________________
C4. Do you or any member of the household have access to the internet?
C5. What is your preferred mode of providing us your information?
a. Paper and pencil – Personal Interview
b. Computer aided – Personal Interview
c. Paper and pencil – Self-administered
d. Online through the agency’s website – Self-administered
e. Through short messaging service
f. Through social media account
g. Through electronic mail
h. Through telephone/cellphone call
i. Others, please specify _______________________
C5. What is your preferred mode of providing us your information? I. Others, please specify _______________________
C6. On your own personal view, please rate the level of importance of the information you have provided us?
Not at all important
C7. What is the most convenient time for you to be interviewed?
C7. What is the most convenient day for you to be interviewed?
C8. Did you experience difficulty in any aspect of the administration of our survey undertakings?
a. Questionnaire to lengthy
b. Answers required are too personal
c. Hard time in recalling answers
d. Others, please specify _________________________
C8. Did you experience difficulty in any aspect of the administration of our survey undertakings? D. Others, please specify _________________________
D. FIELD INTERVIEWER EVALUATION
D1. Please honestly answer the following questions with regard to the field interview.
a. The field interviewer wore appropriate attire with identification card.
b. The field interviewer properly introduced himself/herself and the objective of
c. The field interviewer was courteous, friendly and approachable in
administering the interview.
d. The field interviewer answered queries of the respondents regarding the survey.
E. REMARKS AND OTHER SUGGESTIONS
E1. Any other suggestions/recommendations to further improve the conduct of our survey undertakings?
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