REPUBLIC OF LIBERIA
MINISTRY OF PLANNING AND ECONOMIC AFFAIRS
NAME OF HOUSEHOLD HEAD_____
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
NO COMPETENT RESPONDENT AT HOME 2
DWELLING VACANT 5
ADDRESS NOT A DWELLING 6
HOUSEHOLD NOT FOUND OR NONEXISTENT 7
OTHER (SPECIFY) 8
OFFICE EDITED BY:
I would like some information about the people who usually live in your household or are staying with you now.
1) LINE NUMBER
7) Does this child's mother usually live in this household?
8) What kind of work does this person do?
1. Is there anybody else, such as babies or servants or lodgers, that I have not listed?
2. Do you have any visitors staying with you that I did not list?