Page 1
Questionnaire ID Questionnaire labelS4.1.1 Wages & Salary: In country (current)
S4.1.2 Wages & Salary: Overseas (last 12 months)
S4.1.3 Wages & Salary: In country (last 12 months)
S4.2 Income from Non Subsistence BusinessS4.3.1 Description of Agricultural & Forestry Activities
S4.3.2 Income from Agricultural & Forestry Activities
S4.4.1 Description of Handicraft & Home Processed Food Activities
S4.4.2 Income from Handicraft & Home Processed Food Activities
S4.5.1 Description of Livestock & Aquaculture Activities
S4.5.2 Income from Livestock & Aquaculture Activities
S4.6.1 Description of Fishing, Hunting & Gathering Activities
S4.6.2 Income from Fishing, Hunting & Gathering Activities
S4.7 Property Income, Transfer Income & Other ReceiptsS4.8 Remittances & Other Cash Gifts
COMMENTS
STATE |___|___|
EA No. |___|___| Hhold No. |___|
DATE
|___|___|HAMLET
Dwelling
No.|___|___|___|___|___|
Household Income & Expenditure Survey
IDENTIFICATION
|____|____| << Round Sample Hh Sequence # >> |____|____|____|____|
mm / dd / yy
MODULE 4 - INCOME
BUREAU OF BUDGET AND PLANNING OFFICE OF PLANNING AND STATISTICS
_ _ / _ _ / _ _DATA ENTRY
COMPLETED
_ _ / _ _ / _ _INTERVIEW
COMPLETED
mm / dd / yy
Phone contact (opt.)
NAME (Last name, First name) CODE
H/HOLD HEAD
ENUMERATOR |___|___|
SUPERVISOR |___|___|
In accordance with the Republic of Palau Statistics Act of 2011, all information in this form will be kept strictly confidential
Page 2
) Do any members of this household currently have a wage and salary job?
Include: Jobs within the public service
Jobs in private sector where a wage is received
Ongoing adhoc jobs (baby-sitting, gardening)
Yes Go to 40102 No Go to S4.1.2
S4.1.1 - WAGES & SALARY: In-Country (Current) (15+ yrs) Reference Period
last 12 months40100
Characteristics of the job
Job [HM] Occupation (Activities Undertaken) Industry (Employer)Sector
1 - public
a |___|___| |____|
b |___|___| |____|
2 - private
40101 40102 40103 40104 40105
e |___|___| |____|
f |___|___| |____|
c |___|___| |____|
d |___|___| |____|
$ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
i |___|___| |____|
j |___|___| |____|
g |___|___| |____|
h |___|___| |____|
Income generated in last 12 months
Income (Cash) Income (In-kind)
TOTAL WAGES AND
SALARY INCOME FOR
LAST 12 MONTHSJob
Regular Cash PayOvertime, Bonuses &
CommisionsHousing
Other: Electricity,
Telephone, Transport,
Clothing, Food, etc
USD
j $ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00
i
h
$ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 g $ |__|__|,|__|__|__|.00
$ |__|__|,|__|__|__|.00
USD USD USD USD
40101 40106 40107 40108 40109
b $ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
40110
a $ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
d $ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
c $ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
f $ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
e $ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
$ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
$ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
$ |__|__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|,|__|__|__|.00 $ |__|__|__|,|__|__|__|.00
Page 3
) Has any member of this household done any other wage and salary work in the last 12 months?
Examples include : Wage jobs not held now, but held in last 12 months
Ad-hoc work h'hold members do for a wage not listed already
Yes Go to 40121 No Go to S4.1.3
) Has any member of this household worked overseas in a wage & salary job, any time in the last 12 months?
Examples include : Seamen
Seasonal Fruit pickers
Military
Yes Go to 40132 No Go to S4.2
S4.1.2 - WAGES & SALARY: In Country (Last 12 Months) (15+ yrs)Reference Period
last 12 months
40120
Don't forget to include persons
that were recorded in S1.6
[HM]
Job 1 Job 2 Job 3
Occupation Salary last 12
months
Occupation Salary last 12
months
Occupation Salary last 12
monthsEg: nurse, teacher,
cook, fisherman
Eg: nurse, teacher,
cook, fisherman
Eg: nurse, teacher,
cook, fishermanUSD USD USD
40121 40122 40123 40124 40125 40126 40127
|__|__|
|__|__| $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00
$ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00
|__|__|
|__|__| $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00
$ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00
|__|__|
|__|__| $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00
$ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00 $ |__|__|,|__|__|__|.00
USD40131 40132 40133 40134 40135 40136
S4.1.3 - WAGES & SALARY: Overseas (Last 12 Months) (15+ yrs) Reference Period
last 12 months
40130
Don't forget to include persons that
were recorded in S1.6
O'seas
Job[HM] Type of work
Country
worked
Weeks worked
o'seas in last
12 months
Amount made in last 12 months
b |___|___| |___|___| $|___|___|___|,|___|___|___|.00
a |___|___| |___|___| $|___|___|___|,|___|___|___|.00
d |___|___| |___|___| $|___|___|___|,|___|___|___|.00
c |___|___| |___|___| $|___|___|___|,|___|___|___|.00
f |___|___| |___|___| $|___|___|___|,|___|___|___|.00
e |___|___| |___|___| $|___|___|___|,|___|___|___|.00
Page 4
)
1) Running a small shop 1) Producing and selling food (S4.4)
2) Running a restaurant 2) Fishing activities (S4.6)
3) Running any trade business 3) Land/Property rental (S4.7 (11 & 12))
- Mechanic 4) Money Lending Activities (S4.7 (14))
- Electrician
- Construction
4) Car rental business
NB1: These businesses should have been identified already in Module 1, S1.2 (10201 = 1 or 4) or (10206 = 1 or 4)
if currently in operation, but other business operations may also have existed in the past
NB2: Only include if the household member was an owner/part-owner of the business, not an employee of the
business
E.g.: Small Store selling food
Restaurant
Car rental business
Provide mechanic service
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
|___|___| |___|___|
Code 40207: Where operate business
1. At home
2. Other location - within Palau
3. Other location - outside Palau
Reference Period
last 12 monthsS4.2 - INCOME / Income as owner of non-subsistence business
obtained by the household (15+ yrs)
Include Exclude
(Tick the appropriate box)
Yes No
40200 During the past 12 months, was anyone in this household the owner/part-owner of any non subsistence
businesses?
Go to S4.3.1Go to 40202
5) Sole proprietorship and partnership (silent partners)
|___|___|
40207
01 |___|___| |___|___| |___|___| |___|___| |___|
[HM] Nocode 40207
40201 40203 40204 40205 40206
Business
Code
Number
HM involved in this business
(start with owner first)
Where do you
operate this
business
from?[HM] No [HM] No [HM] No
07
|___|___|
03 |___|___| |___|___| |___|___| |___|___| |___|
02 |___|___| |___|___| |___|___| |___|___| |___|
|___|
05 |___|___| |___|___| |___|___| |___|___| |___|
04 |___|___| |___|___|
|___|___|
|___|___|
Characteristics of the business
40202
10 |___|___| |___|___| |___|___| |___|___| |___|
|___|
09 |___|___| |___|___| |___|___| |___|___| |___|
08 |___|___| |___|___| |___|___| |___|___|
|___||___|___|
Observations
For how long has the
enterprise been
operating?
Years Months
40208 40209
Description of business
|___|___| |___|___| |___|___| |___|___| |___|
06 |___|___|
4.03
Page 5
1:Entire business
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
|___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___| |___|___| |___|___|___|
01. Salaries to staff 05. Communications 09. Building - Rental 13. All Other02. Goods for resale 06. Fuel 10. Equipment - Rental03. Electricity 07. Raw Materials 11. Registration / Licenses04. Water 08. Repair & Maintenance 12. Equipment
|___|___|___|
|___|___|___|
|___|___|___|
Are these profits
for:
2:Just this hhold's
share
if 2 ► 40216
What share of
the profits is
kept by your
household?
%
40215
|___|___|___|
|___|___|___|
|___|___|___|
|___|___|___|
|___|___|___|
|___|___|___||___|
|___|
|___|
|___|
|___|
40214
|___|
Gross Revenue:
Expenses:
Net Profit:
Gross Revenue Expenses Net Profit
Include both cash and in-
kind money received
Inlcude all expenses listed
below
(code 40217)
Should equal the Gross
Revenue less Expenses
Rough estimate of "Gross Revenue", "Expenses" and "Net Profit"
Bus.
Code #
USD USD
40212 40213
|___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 |___|
40201
How many
workers from
outside the
household
also work in
this business?
40210 40211
USD
40224 40225 4022640218
Rough
estimate of
total
expenditure
|___|
|___|
01 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
02
|___|
03 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
04 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
|___|___|___|
$ |___|___|___|,|___|___|___|.00
05 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
06 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
07 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
08 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
09 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
Breakdown of expenses
Bus.
Code #
40201
Major Expense 1 Major Expense 2 Major Expense 3 Major Expense 4
40217 40219 40220 40221 40222
% %
All otherDid this
business
report
expenses in
40212
above?
Yes=1 No=2
if 2 ► S.4.3.1
Rough
estimate of
total
expenditure
Important Definitions
09 |___|
10 |___|
"Raw" sales income; the amount customers actually pay the company when they make their purchases.
Covers all expenses incurred by the business
Equates to the money taken home by the business owners (Gross Revenue - Expenses)
|___|
06 |___|
07 |___|
08 |___|
01 |___|
02 |___|
10 |___|___| $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00 $ |___|___|___|,|___|___|___|.00
Code 40217: Expense Codes
03 |___|
04 |___|
05
code
40217
Expense
Code
Expense
Code
Expense
Code
Expense
Code
Expense
Code
% %
Rough
estimate of
total
expenditure
Rough
estimate of
total
expenditure
Rough
estimate of
total
expenditure
code
40217
40216
%
code
40217
code
40217
code
40217
40223
4.04
Page 6
) During the past 3 months, did this household produce any agriculture / forestry items?
(e.g., eggplant, cabbage, taro, banana, breadfruit, yam, mango, betelnut, firewood, etc.)
Include Fruit Trees in the yard if fruits are often harvested from these trees
HM aged 15 and above involved in this activity (start with owner first)
1. Custom ownership
2. Own land (freehold)
3. Rent (lease)
Total Amount
|____|
|____||_____|1 = Yes
2 = No
Apart from the hh members, have you paid anyone to work in this
activity during the past 3 months?
[HM] No |____|____|
[HM] No
[HM] No
[HM] No |____|____|
[HM] No |____|____|
[HM] No |____|____|
|____|____|
Go to S4.4.1
|____|____|
|____|____|
Include activities for own
consumption also.
ObsCharacteristics of the agricultural & forestry activities
40301 40349
|____|
|____|
|____||____|____|
|____|
[HM] No[HM] No |____|____|
[HM] No |____|____|
Observations
|____|
Expenditure on agricultural and forestry activitiesOver the past 3 months, did you spend money on the following items?
Obs
|____|
40306
40308
|____|
1 = Yes
2 = No|_____| |____|
|_____| |____|
USD
USD
1=Yes / 2 = No
1. Transport
2. Labor
3. Purchase of equipment
4. Rental of equipment (coconut grinder/tractor...)
5. Other (seeds, fertilizer, tools...)
|___|
|____|
1 = Yes
2 = No
|____|
|____|
Did you use any land under "freehold" or "lease" in the last 3 months?|_____|
Did you use the microcredit to develop your agricultural activities?
Did you participate in any "producer organization" (cooperative)?
USD $ |____|____|,|____|____|____|.00
|____|
|_____| |____|How many visits of an agriculture extension agent did you receive during the last 3
months?
1 = Yes
2 = No
|___|
|___|
|___|
|___|
Reference Period
last 3 monthsS4.3.1 - Description of the agriculture & forestry activities
40300
NoGo to 40301
(Tick the appropriate box)
Yes
USD
USD
$ |____|____|,|____|____|____|.00
$ |____|____|,|____|____|____|.00
$ |____|____|,|____|____|____|.00
$ |____|____|,|____|____|____|.00
$ |____|____|,|____|____|____|.00
40304
40307
USD
40303|_____| |____|
40302
During the past 3 months, what was the main arrangement
under which you worked on agricultural land?
40305
[HM] No
4.05
Page 7
Total amount →
26 Ornamental plants |____| |____| $ |____|,|____|____|____|.00 |___|
$ |____|____|,|____|____|____|.00 Total amount →
$ |____|,|____|____|____|.00 |___|
Pumpkin |____|
$ |____|,|____|____|____|.00 |___|
Nappa, kangkum |____| |____| $ |____|,|____|____|____|.00 |___|
Eggplant
|____| |____| $ |____|,|____|____|____|.00 |___|
22 Imekurs (oterbekii) |____| |____| $ |____|,|____|____|____|.00
If you sold some of them during the past 3 months, how much money did you earn from these sales over the three
month period (40355)
Last 3 months
Did you harvest?
1 = Yes / 2 = No
Did you sell ?
USD
If you sold your production or a part of it how much
did you earn? obsAgriculture or Forestry Item
|____| $ |____|,|____|____|____|.00 |___|
Pepper (Chilli & Bell)
40355 40399
Vegetables
Sweet Potato Leaf |____| |____| $ |____|,|____|____|____|.00 |___|
Cucumber |____| |____| $ |____|,|____|____|____|.00 |___|
|____| |____| $ |____|,|____|____|____|.00 |___|
|____| |____| $ |____|,|____|____|____|.00 |___|
|____| |____| $ |____|,|____|____|____|.00
Other(obs)
$ |____|,|____|____|____|.00 |___|
Banana |____| |____| $ |____|,|____|____|____|.00 |___|
$ |____|,|____|____|____|.00
|___|
$ |____|,|____|____|____|.00
Lime/lemon |____| |____| $ |____|,|____|____|____|.00 |___|
Papaya |____| |____| $ |____|,|____|____|____|.00 |___|
|___|
$ |____|,|____|____|____|.00 |___|
Breadfruit |____| |____| $ |____|,|____|____|____|.00 |___|
Titiml |____| |____| $ |____|,|____|____|____|.00 |___|
40351
01
02
03
04
05
Other(obs) |____| |____|
|____|16 |____|
40352 40353 40354
Beans |____| |____|
|____| |____|
08
09
18
17
Coconut-green and old
Fruits
Mango
11 Taro (all types)
12 Tapioca
13 Sweet potato
23
15
06 |____| |____| $ |____|,|____|____|____|.00 |___|
Rootcrops
10 Yam |____| |____| $ |____|,|____|____|____|.00 |___|
|____| |____| $ |____|,|____|____|____|.00 |___|
|____| |____| $ |____|,|____|____|____|.00 |___|
Green Onion
07
|____| |____|
27 Other (sugar cane, hibiscus park, etc) |____| |____| $ |____|,|____|____|____|.00 |___|
|___|
14 Other (obs) |____| |____| $ |____|,|____|____|____|.00 |___|
Other crops
24 Pandanus |____| |____| |___|
19
20
21
S4.3.2 - INCOME / Agricultural and Forestry activities Reference Period
last 3 months
30 Leaves (thatch roof) |____| |____| $ |____|,|____|____|____|.00 |___|
For all this list of vegetables, rootcrops, fruits, other crops and forestry produce, specify if you harvested and sold them
during the past 3 months (40353 & 40354)
Forestry products
28 Wood (lumber & construction) |____| |____| $ |____|,|____|____|____|.00 |___|
29 Firewood |____| |____| $ |____|,|____|____|____|.00 |___|
25 Betelnut/pepper leaves
4.06
Page 8
HM aged 15 and above involved in this activity (start with owner first)
[HM] No [HM] No
[HM] No [HM] No
[HM] No [HM] No
[HM] No [HM] No
[HM] No [HM] No
1. Ingredients for making food
2. Materials for making handicrafts
3. Transport
4. Labor
5. Other
|____|____|
|____|____|
|____|____|
|___|
|___|
Reference Period
last 3 months
S4.4.1 - Description of handicrafts and home processed
food activities
$ |____|,|____|____|____|.00
$ |____|,|____|____|____|.00
|____|
|____|____| |____|
40449
Characteristics of the handicraft and home processed food activities
|____|____| |____|
Obs
Expenditure on handicraft and home processed food activities
40402 Apart from the hh members, have you paid anyone to work with you
in your handicraft and home processed food activities?
During the past 3 months, did any member of this household prepare and/or sell any handicraft or home processed
foods?
40400
|____|____| |____|
40401
|____|____| |____|
|____|____|
(Tick the appropriate box)
Yes NoGo to 40401 Go to S4.5.1
|____|____|
|____|____|
1 = Yes
2 = No |____| |____|
Observations
|____|
|____|USD
USD
$|____|,|____|____|____|.00
$ |____|____|,|____|____|____|.00
$ |____|,|____|____|____|.00USD|___|
|___|
40403
Total Amount |____|
|____|
|____|
Over the past 3 months, did you spend money on the following items?
|____|
$ |____|,|____|____|____|.00
USD
USD
USD
1=Yes / 2 = No
|___|
4.07
Page 9
Lei 21 |____| |____| $ |___|,|___|___|___|.00 |___|
12 Coconut Oil - Hair & Body |____| |____| $ |___|,|___|___|___|.00 |___|
$ |___|,|___|___|___|.00 |___|
|___|
Fans |____| |____| $ |___|,|___|___|___|.00 |___|
|____| |____| $ |___|,|___|___|___|.00 |___|
If you sold your production or a
part of it how much did you earn?
10 Locally produced alcohol |____| |____| $ |___|,|___|___|___|.00 |___|
S4.4.2 - INCOME / Home Processed Food, Handicrafts and Other
Products
Home Processed Food
Home Processed Non-Food
|____| |____| $ |___|,|___|___|___|.00 |___|
08
09 Local Medicine (noni, btaches, etc.)
Other (obs) |____| |____| $ |___|,|___|___|___|.00 |___|
Reference Period
last 3 months
1 = Yes / 2 = No
Dried/Salted Fish |____| |____| $ |___|,|___|___|___|.00 |___|
Pickled/Prepared Seafood |____| |____| $ |___|,|___|___|___|.00 |___|
For this list of handicrafts and home processed foods, specify if you produced and sold them during the past 3 months
If you sold some of them during the past 3 months, specify how much money did you earn from these sales over the
period
40452 40453 40454 40455 40499
Last 3 months
Did you
produce?Did you sell ?
obs
USD
Takeout food/sandwich (incl soup) |____| |____| $ |___|,|___|___|___|.00 |___|
|____| |____| $ |___|,|___|___|___|.00 |___|Other local recipes (chocho, karinto, tama, eliud, etc.)
$ |___|,|___|___|___|.00Pastries (cakes, turnover, pies) |____| |____| |___|
|____| |____| $ |___|,|___|___|___|.00 |___|
|____| |____| $ |___|,|___|___|___|.00 |___|
Local vinegar (from lemon, coconut)
Coconut Oil - Cooking
Painting/Drawing |____| |____| $ |___|,|___|___|___|.00 |___|
|____|
|____| |____| $ |___|,|___|___|___|.00 |___|Lime
07
11
Total amount → $ |___|,|___|___|___|.00
40451
01
02
03
04
05
06
Local jeweleries (e.g., necklace, earing, hair accessories) |____| |____| $ |___|,|___|___|___|.00
|____| |____| $ |___|,|___|___|___|.00
|____| |____| $ |___|,|___|___|___|.00
Other (obs) |____| |____|
26
18
19
20
22
23
25 |___|
Other (obs) |____| |____| $ |___|,|___|___|___|.00 |___|
Grass skirt |____| |____| $ |___|,|___|___|___|.00 |___|
Clothing/Patchwork (e.g., mumu, skirt, lavalava, quilt)
Taro pounder, coconut grater, etc |____| |____| $ |___|,|___|___|___|.00 |___|
24 Coral based ornaments and jewelry |____| |____| $ |___|,|___|___|___|.00 |___|
13
14
15
16
17
Handicrafts
Mats
Wood carving/wall/ceiling hangings
Brooms
Baskets
|____| $ |___|,|___|___|___|.00 |___|
|____| |____| $ |___|,|___|___|___|.00 |___|
|___|
4.08
Page 10
) During the past 12 months, did any member of this household raise any livestock or produce any aquaculture?
HM aged 15 and above involved in this activity (start with owner first)
Do you have? 1. Pigs2. Chickens
3. Ducks
4. Others
5. Clam
6. Crab
7. Milkfish8. Other
1. Feed
2. Fencing and enclosure
3. Transport of animals
4. Purchase of animals
5. Labor
6. Veterinary
7. Other
[HM] No |_____I_____|
[HM] No |_____I_____|
[HM] No |_____I_____|
[HM] No |_____I_____|
[HM] No |_____I_____|
|___|
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
USD
USD
USD
USD
USD
USD
USD
USD
|___|
|___|
|___|
|___|
40501
40502
S4.5.1 - Description of the livestock and aquaculture activitiesReference Period
last 12 months
40500
Go to 40501 Go to S4.6.1
(Tick the appropriate box)
$ |___|,|___|___|___|.00
2 = No
How many?
↓
1 = Yes
2 = No
1 = Yes
2 = No
Livestock
Aquaculture
|____|
|____|
n/a
n/a
|_____I_____|
1=Yes / 2 = No
|____|
[HM] No |_____I_____| |____|
[HM] No |_____I_____|
|_____I_____|
1 = Yes
40503
Yes No
|____|
|____|
|____|
|____|
|____| n/a |____|
Apart from the hh members, have you paid anyone to work with you in
your aquaculture activities?|____|
|____|
[HM] No
|____|
|_____I_____|
Characteristics of the livestock and aquaculture activities
[HM] No |_____I_____| |____|
40549
Obs
|____|
[HM] No |_____I_____|
40505
Apart from the hh members, have you paid anyone to work with you in
your livestock activities?|____| |____|
|____| n/a |____|
Expenditure on livestock and aquaculture activitiesObs
|____|
|____|
|____|
|____| |_____I_____|
|____|
|____|
|____| |_____I_____|
40504
Over the past 12 months, did you spend money on the following items?
|____|
|___|
|___|
$ |___|,|___|___|___|.00
Observations
|____|
Total Amount |____|
|____|
|____|
|____|
|____|
$ |___|,|___|___|___|.00
4.09
Page 11
If you sold some of them during the past 12 months, specify how much money did you earn from these sales over the
period (40509)
S4.5.2 - INCOME / Livestock & Aquaculture activitiesReference Period
last 12 months
For all this list of livestock and aquaculture, specify if you had sold (40508) them during the past 12 months
40599
Did you sell? If you sold livestock or aquaculture how
much did you sell it for? obs
USD
40508 40509
1 = Yes
2 = No
3
4
5
Aquaculture
Clam
Duck
Others
|____|
|___|
|___|
|___||____| $ |__|,|__|__|__|.00
|____| $ |__|,|__|__|__|.00
$ |__|,|__|__|__|.00
Observations
|____| $ |__|,|__|__|__|.00 |___|
8 |____| $ |__|,|__|__|__|.00 |___|
Crab
Others
6
7 Milkfish |____| $ |__|,|__|__|__|.00 |___|
40507
Livestock
Pig
Chicken
40506
1
2
$ |__|,|__|__|__|.00 |___|
|____|
$ |__|,|__|__|__|.00 |___||____|
$ |__|,|__|__|__|.00
4.10
Page 12
) During the past 3 months, did any member of this household conduct any fishing, gathering or hunting activities?
HM aged 15 and over involved in this activity (start with owner first)
What type of methods were carried out by members of this household for each activity?
Fishing Other Sea Gathering
a. Trolling i. Spear/Harpoon
b. Bottom Fishing (include drop stone) j. Trap 1=Yes
c. Casting (handline/pole) k. Line 2=No
d. Spear/Harpoon 1=Yes l. Other
e. Net fishing 2=No Hunting
f. Trap m. Shooting
g. Poison/Dynamite n. Trap
h. Other o. Other
Fishing Other Sea Gathering
a. Open Ocean h. Mangrove
b. FAD fishing (include buoy) i. Reef
c. Outer Reef j. Beach
d. Coastal Reef k. Coastal Sea
e. Submerged Reef l. Other
f. Lagoon Hunting
g. Other m. Forest 1=Yes
n. Other 2=No
How many times on average do members of this household fish in a typical month
On average, how many hours do members of the household fish per trip?
a. Motorized boat c. Walk/Drive
b. Non-motorized boat d. Swim
1. Fuel & oil2. Maintenance and repair (boat)3. Purchase of fishing equipment4. Transport of catch5. Labor6. Ice7. Other (eg, bait)
|____|
|____| |____|
|____| |____|
[HM] No |____|____|
[HM] No |____|____|
1=Yes
2=No
1=Yes / 2 = No
|____|
|____|
|____|
|____|
|____|
|____|
|____|
|____|
|____|
|____|
|____|
|____|
|____|
USDUSD
USD
USD
USDUSDUSDUSD
|___||___||___||___||___||___||___|
|____|
|____|
|____|
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
$ |___|,|___|___|___|.00
|____|
|____|
|____|
|____|
|____|
1=Yes
2=No
|____|
|____|
|____|
1=Yes
2=No
|____|
|____|
[HM] No
[HM] No
Expenditure on fishing, gathering and hunting activitiesOver the past 3 months, did you spend money on the following items?
|____|____|
|____|____|
1 = Yes|____|
40603
40605
40606
40604 In which location do members of your household fish, gather and hunt?
40607 Main fishing mean or mode of transport to fishing site?
40608
40602 Apart from the hh members, have you paid anyone to work with you in
your fishing, gathering and hunting activities? 2 = No
|____|
[HM] No |____|____|
[HM] No |____|____|
|____|
(Tick the appropriate box)
Yes No Go to S4.7
Obs
Go to 40601
40649
[HM] No |____|____|
40600
S4.6.1 - Description of the Fishing/Gathering/Hunting activitiesReference Period
last 3 months
|____|
|____|
|____|
|____|
|____|____| trips |____|
|____|____| hrs |____|
|____|
Obs
|____|
|____|
|____|
|____|
[HM] No
40601
Characteristics of the fishing, gathering and hunting activities
[HM] No |____|____|
|____|
|____|
Total Amount |____|
|____|
[HM] No |____|____| |____|
|____|____| |____|
|____|
|____|
|____|
|____|
|____|
|____|
|____|
$ |___|,|___|___|___|.00
|____|
|____|
|____|
|____|
4.11
Page 13
Other large pelagic (eg, rainbow runner)
Coastal Pelagic (Trevally, Barracuda, etc)
Reef fish (Parrot fish, snapper, moonfish, etc)
Grouper
Other coastal fish
Lobster
Mangrove Crab
Crab (land crab, coconut crab, etc.)
Other crustacean (e.g., shrimp)
Octopus
Squid
Shellfish (Clams, Oysters, etc)
Sea cucumber
Turtle
Other Seafood
Land Activities (e.g.,Hunting)
Wild Birds (chicken, others)
Wild Pig
Fruit Bat
Others27 |____| |____| $|____|,|____|____|____|.00c |___|
S4.6.2 - INCOME - Fishing/Gathering/Hunting activitiesReference Period
last 3 months
For all this list of fish, other seafood and species hunted, specify if you had collected and sold them during the past 3
months (40611 & 40612)
If you sold some of them during the past 3 months, specify how much money did you earn from these sales over the
period (40613)
|____|
22 |____|
|____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
Small coastal (rabbit fish, rudder fish, mullets, etc)
|____| $|____|,|____|____|____|.00c |___|
|____| |____|
21
20
19
18
17 |____| $|____|,|____|____|____|.00c
Other Sea Gathering Activities
|____| $|____|,|____|____|____|.00c |___|
|____|
|____| |____| $|____|,|____|____|____|.00c |___|
$|____|,|____|____|____|.00c
|___|
|____|
|___|
26 |____| |____| $|____|,|____|____|____|.00c |___|
9
8
6 |____| |____| $|____|,|____|____|____|.00c |___|
Sharks (all species)
16 |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
10
11
13
14
15
12
obsDid you
catch?
Did you
sell?
1 = Yes / 2 = No
2
3
4
5
7
Tuna (yellow fin and bigeye) |____| |____| $|____|,|____|____|____|.00c
Mahi Mahi
Bill fish (Marlin, Sail Fish, etc)
|___|
|____| |____|
USD
If you sold your catches or a
part of it how much did you
earn?
Tuna (skipjack) |____| |____| $|____|,|____|____|____|.00c |___|
40610 40611 40612 40613 40699
Fishing Activites
40609
1
Fish/Hunting/Gathering Activities
last 3 months
|___|
Tuna (other) |____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
Wahoo |____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c
$|____|,|____|____|____|.00c |___|
|____|
23
25
24 |____| |____| $|____|,|____|____|____|.00c |___|
|____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
|____| |____| $|____|,|____|____|____|.00c |___|
4.12
Page 14
Home rental
Land Lease
Dividends
Other (eg, Royalties)
SS benefits - PALAU
SS benefits - US (non-Military)
Pension - PALAU
Pension - US (non-Military)
Military retirement/pension
Military dependent benefits
Child Support/Alimony
Other transfer income
Sale of Motor Vehicle
Sale of Other Assets
Inheritance
Other casual income
|___|___|
|___|___|
|___|___|
11
n/a
USD USD
|___| n/a $|__|__|,|__|__|__|.00
$|__|__|,|__|__|__|.00
|___|
n/a
|___|
40701
n/a
40706
n/a
$ |__|,|__|__|__|.00 n/a
$|__|__|,|__|__|__|.00
Interest (finance institutions)
14
15
16
|__|
|__|
|__||___|
|___|
|___|
|___|
n/a
n/a
|___|___|
|__||___|
n/a
n/a
S4.7 - INCOME / Property income, transfer income and other
casual receipts
Reference Period
last 12 months
1=Yes
2=No
obs
1=within Palau
2=outside
Palau
►If yes ask (40704 and 40705) or (40706)
Where was
this money
received?
40707
If any hh member received one of these sources of income during the last 12 months, specify the last amount received
in 40704 and the number of times this payment was received in last 12 months (40705) or the total amount received
during the last 12 months (40706)
40705
Amount of
times
payment
received in
the last 12
months
Amount of the last
payment received in
the last 12 months
Total amount received
during the past 12
months
Property / Transfer / other
casual
income
Incom
e
Code
Last amount received Total last 12 months
Do not leave it
blank
List all sources of property, transfer and other casual income from list 40702 and for each source of income complete
40703 with YES (1) if it was received by any hh member during the last 12 months and NO(2) if it was not.
21
40703 40704
Did any [HM]
receive during
the last 12
months ?
Interest (money lending)
40702
n/a
Property Income
$|__|__|,|__|__|__|.00
|___| $ |__|,|__|__|__|.00
|___|
|___|
|__|$ |__|,|__|__|__|.00 |___|
40799
12
13
n/a
n/a
|___|___|
|___| |__|
|__|
|__|
|__|
n/a
n/a
Transfer Income
|___|
n/a
|___|
|___|
|___|
|___|
|___||___|___|
|___|___|
|___|___|
|__|
|__|
|__|
23
|___| $ |__|,|__|__|__|.0022
|___|
|___|
$ |__|,|__|__|__|.00
$ |__|,|__|__|__|.00
24
25
26 $ |__|,|__|__|__|.00
|___| $ |__|,|__|__|__|.00
|___|
n/a
|___| n/a
$ |__|,|__|__|__|.00
$|__|__|,|__|__|__|.00
$|__|__|,|__|__|__|.00
|___| n/a
Other Casual Receipts
34
31
32
|__|
|__|27 |___||___|___||___|
|___|
|___|
|___|
|___|
|___|
Observations
|___| n/a $|__|,|__|__|__|__|.0028
|__|
|__|33
|__|
|___| n/a $|__|__|,|__|__|__|.00
|___| n/a
|__|
$|__|__|,|__|__|__|.00
n/a
n/a
n/a
n/a
n/a
4.13
Page 15
)
code 40804: relationship code 40805: Place of residence code 40806: remittances code code 40809: purpose
1. Spouse 1. Palau 1. Money transfer in a 1. Church gift
2. Son/daughter (incl. adopt) 2. Guam bank account 2. Traditional ceremony
3. Son/daughter-in-law 3. CNMI 2. Money tranfer WU / 3. Funeral
4. Parent 4. FSM/RMI Money Gram 4, Wedding/Birthday
5. Spouse’s parent 5. Other Pacific 3. Cash received via 5. Living Support
6. Uncle/Auntie 6. USA (incl. Hawaii) friends/relatives 6. Other (obs)
7. Nephew/niece 7. Philippines 4. Cash by mail
8. Cousin 8. Bangladesh 5. Other (obs)
9. Other relative 9. Other Asia
10. Other non relative 10. Other
Yes No
|____|
|____|
|____|
|____|
|____| |____|
|____|
|____| |____||____|
|____|
|____|
|____|
|____| |____|
S4.8 - Remittances & Other Cash GiftsReference Period
last 12 months
Person 1
Person 2
etc
Simply list as:
Is
he/she
a US
military
person?
R'ship to
hhold
head?
Go to 40802 (End of Module 4)
How much did you
receive from the
sender in total the
last 12 months?
Place
they
reside?
Sender Information Remittance Information
Remit
Code
40800 Did any member of this household receive any money from a member of another household in the last 12
months?
obs
(Exclude money earned from HH members overseas (e.g., seafarer), recorded as a wage and salary in S4.1.3)
2.Ad-hoc
if 1 ► 40808
if 2 ► 40809
code
40806code 40809
40801
01
40803 40806 40807 40808 40809
|___|___||____| |____||____|
40899
|____| |____| $ |__|__|,|__|__|__|.00
40802 40804 40805 40810
|___|
|___|
|___|
|___|
|___|
|___|
|___|
|___|___|
|___|___|
|___|___|
|___|___|
|___|___|
|___|___|
|____|
|____|
|____|
|____|
|____|
|____|
$ |__|__|,|__|__|__|.00
$ |__|__|,|__|__|__|.00
$ |__|__|,|__|__|__|.00
05
06
code 40804code
40805 USD2 = No
Line #
|____| |____|
|____|
|____|
|____|
1 = Yes
|____| |____| $ |__|__|,|__|__|__|.00
|____| |____| $ |__|__|,|__|__|__|.00
02
03
04
Observations
|____| |____| $ |__|__|,|__|__|__|.00
|____|
|____| |____| $ |__|__|,|__|__|__|.00 07
08 |___||___|___|
$ |__|__|__|,|__|__|__|.00
|____|
Total amount ►
|____| |____||____|
Purpose of
remittance
1.Regular
(once a yr or
more)
or
How often
in a year do
you usually
receive this
amount?
|____|
|____|
|____|
|____|
4.14
