RESPONDENTS’ FEEDBACK SURVEY
IDENTIFICATION AND OTHER INFORMATION
GEOGRAPHIC IDENTIFICATION
Province *
Municipality/City *
Barangay *
Your answer
Name of Respondent *
Your answer
Name of Household Head *
Your answer
Address *
Your answer
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? *
Your answer
A1c. What is your sex? *
Required
A1d. What is your marital/civil status? *
Required
A1e. What is your highest educational attainment? *
Your answer
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?
Your answer
A1h. In what kind of industry did you work during the past three months?
Your answer
A2. Household Characteristics:
A2a. How many members are there in your household excluding those who are working as OCW/OFW? *
Your answer
A2b. How many members are below 5 years old? *
Your answer
A2b. How many members are below 5 to 14 years old? *
Your answer
A2b. How many members are below 15 to 59 years old? *
Your answer
A2b. How many members are below 60 to 65 years old? *
Your answer
A2b. How many members are below 65 years old and over? *
Your answer
A2c. How many household members including the head and his/her spouse were employed for pay or profit during the past three months? *
Your answer
A2d. How many Overseas Filipino Workers are there in this household at this time of visit? *
Your answer
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 _______________________
Your answer
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 _____________________
Your answer
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 ______________________
Your answer
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 _______________________
Your answer
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 _________________________
Your answer
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?
Your answer
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