RESPONDENTS’ FEEDBACK SURVEY
IDENTIFICATION AND OTHER INFORMATION
GEOGRAPHIC IDENTIFICATION
Province *
Municipality/City *
Barangay *
Name of Respondent *
Name of Household Head *
Address *
A. DEMOGRAPHIC AND ECONOMIC CHARACTERISTICS
A1. Respondent’s Characteristics:
A1a. What is your relationship to the household head? *
A1b. How old are you as of your last birthday? *
A1c. What is your sex? *
Required
A1d. What is your marital/civil status? *
Required
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) *
Required
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)? *
B. AWARENESS OF HOUSEHOLDS TO THE PHILIPPINE STATISTICS AUTHORITY
B1. Are you aware of the presence of the Philippine Statistics Authority? *
Required
B2. What is/are the source of your information regarding the PSA? *
Required
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? *
Very Unwilling
Very Willing
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.) *
Required
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?
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? *
Required
C5. What is your preferred mode of providing us your information? *
Required
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
Very Important
C7. What is the most convenient time for you to be interviewed? *
Time
:
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? *
Required
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. *
Required
E. REMARKS AND OTHER SUGGESTIONS
E1. Any other suggestions/recommendations to further improve the conduct of our survey undertakings?
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