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REPUBLIK INDONESIA BADAN PUSAT STATISTIK

SP2000 PODES

SENSUS PENDUDUK 2000

POTENSI DESAIKELURAHAN "4"

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REPUBLIC OF INDONESIA CENTRAL BUREAU OF STATISTICS

SP2000-PODES

2000 POPULATION CENSUS

POTENTIAL OF VILLAGE/”KELURAHAN” I. IDENTIFICATION June ’99 01.

01

New Identity Changes 01

02

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Province

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Regency/Municipality *)

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District

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Village/Kelurahan/UPT/PMT*)

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Area

Urban Details

-1

Rural

II. WORKERS CHARACTERISTIC Enumerator

01

Name of workers

02

NIP (Employment Identity Number)

03

Date of enumerating/ supervising

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Signature

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Supervisor

*) Cross out inapplicable category ……………………, ………………. 1999 Be Cognizant of Head of Village/Kelurahan/UPT/PMT

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13. Jarak dari kantor desalkelurahan ke kantor kabupatenlkodya yang membawahi: 14. Jarak dari kantor desalkelurahan ke ibukota kabupatenlkodya lain yang terdekat:

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III. VILLAGE/”KELURAHAN” GENERAL CHARACTERISTIC 1. Legal status of the village 1. Definitive (Minister of -1 UPT (Dept. of Transmigration -3 go to Q.6 Internal Affairs) & “PPH”) Preparation (Governor -2 PMST(Dept. of Social) -4 Decree)→ go toQ.3 2. If Q.1 coded “1” , Village/”kelurahan classifcation 2. Self-supporting -1 Self-sufficient -3 Self-developing -2 3. If Q.1 coded “1” or “2”, village/”kelurahan” governmental status 3. Village -1 “Kelurahan” -2→ go toQ.5 4. If Q.3 coded “1” , is there any Village Communication Institution 4. (LMD) Yes -1 No -2 5. LKMD/K category 5. Prepared -0 Category2 -2 Category1 -1 Category3 -3 6. If Q.1 “coded 2,3,or 4”, write down the name of prime village/ location (fill in by supervisor) 6. 6 7. 7. Number of sub-village/ domain …………………… sub-villages 8. a. RT/RW formation Yes -1 b. If “Yes” , consist of 1) Village administrative unit (RK/RW) 2) Neighborhood Association 9. Village /”Kelurahan” geography Shore area Non-shore area -
Valley area Hill area Land area 10. Village/”Kelurahan” topography Flat -1

No

-2 → go toQ.9.

1) 2)

…………..RK/RW ……………RT

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Hill

11. Type of sex of village/”kelurahan” government agencies: Male -1 Female -2 No government agencies a. Secretary of village/ “kelurahan” b. Head of Governmental Affairs c. Head of Development Affairs d. Head of Welfare Affairs e. Head of Financial Affairs f. Head of General Affairs g. Assistant of Married Registration Officer (P3N)

a.

-2

10.

-3 a. b. c. d. e. f. g.

12. Distance from village/ kelurahan office to subordinating sub-regency office: ……………………………………….Km

12.

13. Distance from village/ kelurahan office to subordinating regency/ municipality office: ……………………………..Km

13.

14. Distance from village/ kelurahan office to the nearest regency/ municipality capital ………………………………...Km

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2. Penduduk dan rumahtangga

a. Jumiah penduduk b. Jumlah rumahtangga c. Jumlah rumahtangga pertanian 3 Jumlah keluarga prasejahtera dan sejahtera I

.............. ..orang .............. ..rumahtangga .............. ..rumahtangga .............. ..keIuarga

4. Jumlah pasangan usia subur (PUS) \ 5. Jumlah pesertaIAkseptor KB 3 6. a. Sumber penghasilan sebagian besar penduduk ‘

Industri Perdagangan besarleceran, rumah makan dan akomodasi Lainnya b. Jika R.6.a. berkode "1", maka sebagian besar berusaha dalam sub sektor:

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Pertanian Pertambangan dan penggalian

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Perkebunan Perikanan

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Kehutanan

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Pertanian Iainnya

6

7. Jumlah penduduk yang berhak memiilh dalam pemilu

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a. Laki laki

.............. ..orang

b. Perempuan

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.

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8. Jumlah calon pemilih

a. Laki laki b. Perempuan 9. Jumlah pemilih

.............. ..orang .............. ..orang

a. Laki laki

.............. ..orang

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b. Perempuan . 10. Jumlah kartu suara yang rusak seteiah pencoblosan

. 1

1 A

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B. LINGKUNGAN HIDUP, PERUMAHAN DAN PERMUKIMAN

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Non Iistrik 3. Bahan bakar yang digunakan sebagian besar rumahtangga untuk memasak Gas kotaILPG

1

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2

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kemudian diangkut 1 Lainnya (tuliskan) Dalam lubangldibakar 2 ............................. .. ‘ 5. Tempat buang air besar sebagian besar rumahtangga Jamban sendiri 1 Jamban umum Jamban bersama 2 Bukan jamban

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IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT A. Population 1. 1. Population registration Yes, regularly -1 Yes, not regularly -2 No -3 2. Population and household 2.a. a. Number of population …………… people b. Number of household …………… household 2.b. c. Number of agricultural household …………… household 2.c. 3. 3. Number of pre-welfare family and welfare I family …………… family 4. 4. Number of fertile age couple (“PUS”) …………… “PUS” 5. 5. Number of Family Planning member/ acceptor …………… acceptor 6. a. Income sources of majority population Agriculture -1 Mining and excavating -2 6.a. Industry -3 Wholesaler / retailer, restaurants and accommodations -4 Others -5 b. If Q.6.a. coded “1” main potential of sub-sector: 6.b. Food planting -1 Plantation -4 Livestock -2 Fishery -5 Forestry -3 Other planting -6 7. Number of population who have rights to vote in general elections 7.a. a. Male ……………. People 7.b. b. Female …………….. people 8. Number of future voter 8.a. a. Male ……………. People 8.b. b. Female …………….. people 9. Number of voter 9.a. a. Male ……………. People 9.b. b. Female …………….. people 10. 10. Number of broken voting card after the elections ……………… cards B. Environment, housing and settlement 1. Number of electricity household subscriber 1.a. a. “State-owned” electricity 1.b. b. Non “state-owned” electricity 2. a. Village/ kelurahan main road lightening 2.a. Yes, there is -1 No, there isn’t -2 →go to Q.3 b. If “Yes”, types: “State-owned” electricity -1 Non “state-owned” electricity - 2 2.b. No electricity -3 3. Kind of fuel used for cooking of majority household 3. Gas/LPG -1 Firewood -3 Kerosene -2 Others (charcoal, husk, -4 coconut shell, bio-gas) 4. Trash disposal of majority household The trash then -1 River carried away Other (write) Buried in the hole -2 …………….. 5. Place of latrine of majority household Private toilet -1 Public toilet Shared toilet -2 Not toilet

-3 -4

4.

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5.

6

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IV. POPULATION, ENVIRONMENT, HOUSING AND SETTLEMENT (ADVANCED) Major condition of liquid waste/ dirty water reservoir Fast -1 Water is stuck -3 Slowly -2 No gutter -4 Number of flat building a. Number of physical building (tower) ……………… units b. Number of census building …………….. . units Number of house categories by quality a. Permanent ……………… units b. Not permanent ……………. . units a. Community living along the river? Yes -1 No -2 go to Q. 10.a There is no river -3 b. If ‘Yes” (1) Number of household …………….. hh (2) Number of house’s building …………….. units a. Community living under high voltage of electric’s network Yes -1 No -2 go to Q. 11.a There is no river -3 b. If “yes” (1) Number of household …………….. hh (2) Number of house’s building …………….. units a. Poor settlement Yes -1 No -2 → go to Q. 12.a b. If “Yes” , (1) Location ……………. Location (2) Land area ……………. Ha (3) Number of household ……………. Household (4) Number of household member ……………. People a. Within the last 2 years, is there any new house built by developer? Yes -1 No -2 → Skip to Q. 13.a b. If “Yes”, (1) Total number ………….. units (2) Number of simplest type house’s (RSS) ………….. units (3) Number of simple type house’s (RS) ………….. units (4) Number of ‘middle’ type house’s ………….. units (5) Number of luxurious type house’s ………….. units a. Is there any processing/ manufacturing industry in this village? Yes -1 No -2 → Skip to Q. 14 b. If “Yes”, type of industry? (1) Leather tanning ………….. units (2) Food processing ………….. units (3) Brick/ thick tile/ lime burning …………. units (4) Batik .………… units (5) Other industry ………….. units c. If “there is”, type of waste produced: (1) Solid Yes -1 No -2 (2) Liquid Yes -3 No -4 (3) Gas Yes -5 No -6 (4) Voices Yes -7 No -8

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IV. POPULATION, ENVIRONMENT, HOUSING, AND SETTLEMENT (ADVANCED) 14. Environmental disturbance during a previous year If column (2) coded “1”, Is there any report to Yes -1 Type of disturbance Head of village/ Lurah No -2 Yes -1 No -2 (1) (2) (3) a. a. a. Water pollution b. b. b. Land pollution (decreasing of land fertility) c. c. c. Air pollution d. d. d. Decreasing of green opened area e. e. e. Decreasing of population and variety of plants f. f. f. Decreasing of population and species of animals g. g. g. Voices pollution 15.a. 15. a. Natural disaster during 3 previous year ……………. times b. If disaster happened, its type b.1 1. Earthquake Yes -1 No -2 b.2 2. Mount Explosion Yes -3 No -4 b.3 3. Dried Yes -5 No -6 b.4 4. Forest and settlement area fire Yes -7 No -8 b.5 5. Flood Yes -9 No -10 b.6 6. Smoke/ smog Yes -11 No -12 b.7 7. Landslide Yes -13 No -14 b.8 8. Coast abrasion Yes -15 No -16 b.9 9. Wave tide/ tsunami Yes -17 No -18 b.10 10. Other (……………… ) Yes -19 No -20 16. 16. Is there critical area Yes -1 No -2 17.a 17. a. Is there a river which cross over this village/ kelurahan Yes -1 No -2→go to Q. 18 b. If “yes”, water from the river is used for b.(1) (1) Bathing/ washing Yes -1 No -2 b.(2) (2) Drinking Yes -3 No -4 b.(3) (3) Raw material of drinking water Yes -5 No -6 b.(4) (4) Irrigation Yes -7 No -8 b.(5) (5) Input for industry/ fabric Yes -9 No -10 b.(6) (6) Transportation Yes -11 No -12 b.(7) (7) Other (write it down) Yes -13 No -14 …………………… 18. 18. Location of this village/ kelurahan relatively to forest area Inside -1 Border -2 Outside -3 19. Number of excavating location type C according to excavating types a. a. Stone/ corral ………………………. locations b. b. Sand ……………………… locations c. c. Lime ……………………… locations d. d. Sulfur ……………………… locations e. e. Kaolin ……………………… locations f. f. Quartz sand ……………………… locations g. g. Clay ……………………… locations h. Other (write down) h. ………………………. ……………………... locations

10

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g. Menjahitltata busana h. Pertanian

Ada Ada

1

Komputer

Ada

j. Pertukanganlrnebel

Ada

k. Kerajinan rumahtangga I. Kecantikanlkeluwesan

Ada Ada

1 3 5 7 1 3 5 1 1 3 5 7

2 4 6 a 2 4 Ja a 2 4

Tidak Tidak 'i"|dak Tidak Tidak Tidak Tidak Tidak '|"|dak Tidak Tidak 1"|dak

a r_ b Y ri J...........

. . i 1 (\ 1. L _...__i

11

3. Jumlah anak yang menenma bantuan pendidikan melaluiz a. Gerakan Nasional Orang Tua Asuh (GNOTA) ................... .. b. Program Jaring Pengaman Sosial (JPS) ................... ..

1‘ 4. Jumlah rumahtangga yang menyekolahkan anaklfamili ke Peruruan Tinggi

................... ..

e. f.

1*"? g. ..__.l @

h.

DJ

__, 1 .

6.

k

1

a

4

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i

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c cl.

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3.a. 3.b.

rumahtangga

CID 4

5 “ Kecenderungan jurniah anak sekolah yang putus sekoiah setahun terakhii".

( I

a. Sekoiah Dasar (SD) Meningkat tajam Meningkat

‘

b. Sekolah Lanjutan Tingkat Pertama (SLTP) Meningkat tajam Meningkat

1 2 1 2

Tidak berubah Berkurang

3 4

Tidak berubah Berkurang

3 4

.

I3 5.a.

I

U 51>.

11

V. EDUCATION 1. Number of school by education level Number of school Education level

Stateowned

(1) (2) Kindergarten a. Primary school b. Junior High School c. Vocational school d. Academy/ University e. School for disable students f. Islamic boarding school “Madrasah Diniyah” (Islamic school for basic level) i. Seminary/ theological school/ monastery 2. Skilled educational institution in this village a. Motor/ automobile technician b. Electronics technician c. Typing/ stenography d. Language e. Accounting/ book keeping f. Cooking g. Sewing/ tailoring h. Planting (agriculture) i. Computer j. Carpentry/ furniture skilled k. Household craft l. Beauty/ modelling

Private (3) a. b. c. d. e. f. g. h.

a. b. c. d. e. f. g. h.

3.

4.

5.

If there is no school Distance to the Time to spend to nearest school go to the nearest (Km) school (hours) (4) (5) Minutes a. Hours b. b. c. c. d. d.

i.

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

-1 -3 -5 -7 -1 -3 -5 -7 -1 -3 -5 -7

No No No No No No No No No No No No

a. b. c. d. d. f. g. h. i. j. k. l.

-2 -4 -6 -8 -2 -4 -6 -8 -2 -4 -6 -8

Number of children who receive educational aid from: a. National Movement for Foster Parents (GNOTA) b. Social Safety Net Program (JPS)

……… children ……… children

3.a. 3.b.

Number of household who able to finance their children/ family to university

……….. household

4.

Schooling drop out trend in this one last year: a. Primary School Increasing sharply -1 Increasing -2 b. Junior High School Increasing sharply -1 Increasing -2

Not changing Decreasing

-3 -4

5.a.

Not changing Decreasing

-3 -4

5.b.

12

7

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..................... .. ..................... .. ..................... .. ..................... .. ..................... .. ..................... ..

bangunan bangunan bangunan bangunan bangunan bangunan

a. b. c. d.

r.

‘

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.

*

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T Keberadaan A Jika Koiom (2) = “ 1", aklivitasnya: Ada 1 ; Meningkat 1 Tetap 2 Tidak 2 j MenuLu[1* 3 N” W i j Q) (3)

a. Kegiatan institusi Sosial 1. Gugus depan pramuka Panti asuhan Panti wredafjompo . Panti cacatlYPAC . Majelis ta'lim/kel. pengajianlkel. kebaktian 0: 1 : _wg~.> Karang taruna 7. PKK b. Kegiatan kemasyarakatan 1. Arisan 2. Gotong royong 3. Pengumpulan Zakat lnfak & Sodakhoh (ZIS)

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a. b. c. d. e. f.

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2

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Ada

3

Tidak

4

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6

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u ¢

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Ada

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b.(2)

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5.a. 5.b.

13

VI. SOCIO-CULTURE 1. Number of Places of worship a. Mosque : b. Prayer-house (=small mosque) : c. Church/Chapel Protestant : d. Church/Chapel Catholic : e. Pura (place of worship of Hinduism) : f. Vihara (place of worship of Buddhist) : 2. Social activity institution Yes (1) a. Social activity institution 1. Boy Scouts 2. Orphanage 3. Elderly House 4. Handicap rehabilitation 5. Majlis Ta’lim/ reciting Koran activity/religion lecturing (Christ.) 6. Youth Club 7. Family Welfare Management (Program at village level to educate Woman on various aspects of family welfare) b. Social activity 1. Regular social gathering 2. Community sef-help 3. Collecting money, rice, or other things from rich people to poor people (tithe in Islamic community) 3. Sports

a. b. c. d. e. f. g. h. 1. 2. 3.

Type of sports (1) Soccer Volley ball Badminton Basket ball Tennis Swimming Ping pong Pencak silat

Availability -1 No (2)

units units units units units units If Column (2)=”1”, its activity: Increasing -1 Constant -2 -2 Decreasing -3 (3)

1. 2. 3. 4. 5.

1. 2. 3. 4. 5.

6. 7.

6. 7.

1. 2 3.

1. 2. 3.

Hall/ gymnasium (2) -1 No-2 -3 No-4 -5 No-6 -7 No-8 -1 No-2 -3 No-4

Group of activity (3) Yes a. Yes -1 No-2 Yes b. Yes -3 No-4 Yes c. Yes -5 No-6 Yes d. Yes -7 No-8 Yes e. Yes -1 No-2 Yes f. Yes -3 No-4 Yes -5 No-6 Yes -7 No-8 VII. RECREATION AND ENTERTAINMENT 1. Open hall/ town square/ park? Yes -1 No -2 2. Amusement park/ recreation place Yes -1 No -2 3.a. a. Movie Theater /Cinema Yes -1 → go to Q.4 No -2 b. If “have not”, (1) The nearest distance from the village office’s …………. Km (2) Time to spend ………… hour

4. a. Video/ VCD/ DVD/ LD rental places Yes -1 No b. If “No”, the nearest distance to the rental place ……………..km 5. a. Billiards house Yes -1 No b. If “No”, the nearest distance to the billiards house ...………..km

a. b. c. d. e. f. g. h.

b.(1). b.(2). -2 -2

4.a. 4.b. 5.a. 5.b.

14

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Jumlah Sarana yan ada

Sarana Kesehatan

A

..

_ ____ (1.). .

_

. Rumah sakit Rumah sakit bersalin . Rumah bersalin . Poliklinik . Puskesmas Puskesmas pembantu . Balai pengobatan . Tempat praktek dokter Tempat praktek bidan ‘ ' :'Q " mQop'n> Posyandu k. Polindes (Pondok Bersalin Desa) I.

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Tidak berubah 3 ___Menurun i 4* a ' e. G balita

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15

VII. RECREATION AND ENTERTAINMENT (ADVANCED) 6. a. Pub/ discotheque/ karaoke Yes -1 No -2 b. If “No”, the nearest distance to pub/ discotheque/ karaoke ……………..km 7. Rental meeting hall Yes -1 No -2 VIII. HEALTH, NUTRIENT AND FAMILY PLANING 1. Number of health facility in this village/ kelurahan Number of If not available or col. (2)=”0” Health Facility facility Distance from Degree of the which is village/ accessibility available kelurahan to Very easy -1 health facility Easy -2 Difficult -3 Very difficult -4 (1) (2) (3) (4) a. a. a. a. Hospital b. b. b. b. Maternity Hospital c. c. c. c. Maternity house d. d. d. d. Polyclinic e. e. e. e. Puskesmas (Integrated Health Center) f. f. f. f. Supported Puskesmas (small Puskesmas) g. g. g. g. Medicinal treatment center h. h. h. h. Doctor practice place i. i. i. i. Midwives practice place j. j. j. j. Posyandu (Integrated post services) k. k. k. k. Polindes (Village Maternity Post) l. l. l. l. Pharmacy m. m. m. m. POD (Village medicine post) n. n. n. n. Drug Store 2. Number of Health Workers who live in this village: 2.a. a. 1. Male doctor Yes -1 No -2 2. Female Yes -3 No -4 2.b. b. 1. Male dentist Yes -1 No -2 2. Female dentist Yes -3 No -4 2.c. c. 1. Male paramedics Yes -1 No -2 2. Female paramedics (exclude Midwife) Yes -3 No -4 2.d. d. Midwife Yes -1 No -2 2.e. e. Midwife at the village Yes -1 No -2 (as localization of Government Order) 2.f. f. 1. Skilled traditional birth attendance Yes -1 No -2 2. Unskilled traditional birth attendance Yes -3 No -4 2.g. g. Traditional healer for broken bone Yes -1 No -2 2.h. h. Massager Yes -1 No -2 2.i. i. Supported Worker for Village Yes -1 No -2 Family Planing (PPKBD) 4. Trends of people health condition during a previous year Increasing sharply -1 Not change -2 Decreasing sharply -3 Increasing -4 Decreasing -5 a. Ill sufferer e. Baby nutrient b. Ability to cure the ill f. Family Planning member/ acceptor c. Availability of medicine g. Availability of contraception tools d. Health services h. Family Planning services

16

9

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; 6. Jumlah keluarga yang menerima kartu sehat (JPS)

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8. a. Keperluan air untuk minumlmemasak pada umumnya bersurnber dari PAMlair Mineral Mata air Sungaildanau i Pompa listrikltangan Sumur artesis Air hujan Sumur/perigi J> wrb ' > Lainnya (embung, waduk) Tuliskan: ................. .. b. Apakah ada penduduk desa ini adayang membeli air untuk minum Ada 1 Tidak c. Keperluan air untuk mandi/cuci pada umumnya bersumber dari PAM 1 Mata air Pompa listnkltangan 2 Sungaildanau

A

a

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b

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1 2

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Lainnya (embung, waduk) Tuliskan: ...................... .. 1 9. Kriteria yang digunakan untuk menentukan keluarga miskin berasal dari .

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Jenis jalan antar desalkelurahan a. Sebagian besar Ialu iintas antar desalkelurahan melalui

Dara!

1

Air

2

>ke R.2

Udara

3

>ke R.2

A G13

b. Jika sebagian besar melalui darat (R.1.a berkode "1")

(1 ).

Jenis permukaan jalan yang terluas AspallBeton/con block Diperkeras (kerikiI,batu, dsb)

1 2

Tanah

3

i

*

|:]1b.(1)

2

;

1b.(2)

Lainnya (tuliskan)

4

1 1

2

(2). Apakah dapat dilaiui kendaraan bermotor

roda 4 atau Iebih sepanjang tahun Ya c. Jalan eks angkutan log (kayu gelondongan) Ada

Tidak Tidak

1.c

17

VIII. HEALTH, NUTRIENT AND FAMILY PLANING (ADVANCED) 4. Are there bloating due to starvation/ HO/ lack of nutrient/ marasmus cases in this village 4.a. a. Balita (Children under five) Many -1 Some -2 None -3 4.b. b. Exclude balita Many -1 Some -2 None -3 5. 5. Number of family who received identification paper for poor family …………………. head of household 6. 6. Number of family who received healthy card (Social safety Net) ………………… head of household 7. Illness Epidemic during a year ago

Yes -1 No -2 (2) a. b. c. d. e. f.

Number of death people who die because of the epidemic (3) a. b. c. d. e. f. 8.a.

(1) a. Diarrhea and vomiting b. Dengue fever c. Infection on respiratory system d. Measles e. Malaria f. Other 8. a. Source of water for drinking/cooking: PAM/ mineral water -1 Spring -5 Electric Pump/hand pump -2 River/lake -6 Artesian Well -3 Rain water -7 Well -4 Other -8 (write down): ……………. b. Are there some people in this village buying water for drinking Yes -1

8.b. No

c. Source of water for bathing/washing: PAM/ mineral water -1 Spring -5 Electric Pump/hand pump -2 River/lake -6 Artesian Well -3 Rain water -7 Well -4 Other -8 (write down): ……………. 9. Institution which give criteria to determine poor family BKKBN (Pre welfare/ welfare I) -1 Head of village/ kelurahan Modified BKKBN -2 Regency/ municipality/ sub regency agency IX. TRANSPORTATION A. TRANSPORT

-2 8.c.

9. -3 -4

1. Inter village road type a. Traffic inter village majority through: Land -1 Sea/river -2 →go to Q.2 Air -3 → go to Q.2 b. If the traffic majority through land (Q.1.a. coded “1”) (1). Type of widest road Asphalt/Concrete/cone block -1 Soil -3 Hardened (stone, pebble, etc) -2 Other -4 ………………. (2) Is the road can be pass through 4 wheel motorize vehicle all the years? Yes -1 No -2 c. Ex-logging transport road (log) Yes, there is -1 No -2

1.a.

1.b.(1).

1.b.(2) 1.c.

18

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Jenis angkutan umum yang digunakan oleh penduduk ke ibukota kecamatanlkota berdekat

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§ 1

02 03 04 05 06 07 D8 09 10 11

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4. a. Jembatan sungai yang dapat dilalui

[:|4.a

kendaraan roda 4 di dewkelurahan ini

b. Jika"ada"1:arbuat dari:

Besilboton

Kayulbambu 5. Prasarana angkutan umum di desa ini

Ada

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Tidak

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7. Banyaknya rumahtangga yang memiliki kendaraan bermotor roda empat atau lebih (termasuk untuk usaha)

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8. Banyaknya rumahtangga yang memiliki kondaraan

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..... ..... .. rt

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KOMUNIKASI 1. Rumahtangga yang mempunyai telepon

Ulll

2. Rumahtangga yang mempunyai radio komunikasi

.

|

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Q

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Ada

1 >ke R.4

4. Pos keliling

Ada

5. Telavisi umum

Ada

¢ o

1 3

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Ada Ada Ada Ada Ada

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IX. TRANSPORTATION (ADVANCED) 2. Type of public transportation used by community to the district’s capital/closest city Type of transportation Code 01 Bicycle “Ojek” (bicycle used for Have -1 Not have -2 public transport passenger) 02 “Becak” (Pedicab, with tricycle) Have -3 Not have -4 03 Wagon/”Pedati” (horse-drawn cart) Have -5 Not have -6 04 “Delman/Dokar/Bendi” (two-wheeled buggy/ Have -7 Not have -8 horse-drawn buggy/two-wheeled carriage) 05 Motor cycle “Ojek” Have -1 Not have -2 06 3 wheeled motor vehicle Have -3 Not have -4 07 4 wheeled motor vehicle Have -5 Not have -6 08 Rowboat Have -7 Not have -8 09 Motor boat Have -1 Not have -2 10 Motor ship Have -3 Not have -4 11 Other Have -5 Not have -6

01. 02. 03. 04. 05. 06. 07. 08. 09 10. 11.

3. From these public transportation above (detail 2), the main transport : ………………………………(put the selected code of detail 2 into the box)

3.

4. a. River bridge which can be passed trough Have -1 Not have -2→go to Q.5 by 4-wheel vehicle in this village/ kelurahan b. If “have” made by Steel/ concrete -1 Steel/ concrete and wood/ bamboo -3 Wood/ bamboo -2 5. a. Public motor transport station/terminal Have -1 Not have -2 b. Seaport Have -3 Not have -4 c. Airport Have -5 Not have -6

4.a.

6. Travel agent/ transport ticketing place 7. Number of household who has 4-wheel or more vehicle (including vehicle for business utility) 8. Number of household who has 2 or 3 -wheel vehicle or motor boat (including vehicle for business utility)

6. 7.

Have

-1

Not have

-2

4.b.

5.a. 5.b. 5.c.

………………….. household 8. ………………….. household

B. COMMUNICATION 1. Number of household who has telephone ………………… household 2. Number of house hold who has communication radio ………………… household 3. a. Post office/ supporting post office/ post house Have→go to Q.4 -1 Not have -2 b. If “not have”, distance to the nearest post ………………… km 4. Mobile Post Have -1 Not have -2 5. Public Television Have -3 Not have -4 6. Household who has the television ………………… household 7. Household who has the satellite antenna ………………… household 8. Newspaper/magazine customers Have -1 Not have -2 9. Coin public phone Have -3 Not have -4 10. Card public phone Have -5 Not have -6 11. Phone stall (Wartel) Have -7 Not have -8 12. Phone and post stall (Warpostel/ Warparpostel) Have -9 Not have -10

1. 2. 3.a. 3.b. 4. 5. 6. 7. 8. 9. 10 11. 12.

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X. LAND AND UTILIZATION A. Village’s land area (R.B + R.C)

…………….. ha

A

B. Rice field area (R.1 + R.2)

………….…. ha

B

1. Rice fields area used technical Irrigation 2. Rice fields are used non-technical irrigation 3. Rice fields area are not used for farming temporarily

……………. ha …………… ha …………… ha

1. 2. 3.

C. Non rice field land area (R.1+R.2+R.3+R.4+R.5+R.6+R.7) 1. Unirrigated agricultural field/”huma” (field for dry rice cultivation)/”tegal” (cultivation without irrigation)/ plantation/pond / “tambak” (earthen dam) 2. State crops/ plantation 3. Peoples forest 4. House and settlement 5. Land for other utilization 6. Other (Not including government forest) 7. Unused non rice field land area temporarily temporarily

…………… ha

C.

………….. ha

1.

………….. ………….. ………….. ………….. ………….. ……….…. ….……….

2. 3. 4. 5. 6. 7.

ha ha ha ha ha ha ha

D. Parts of village/ kelurahan’ s land which are 1. Village land (Bengkok, titisara, etc.) …………… ha 2. Village cash land …………… ha 3. Private owner land …………… ha 4. Grant land (in Islamic way) ……………. ha 5. Unutilized land ……………. ha 6. Cemetery (Public graveyard) …………… ha XI. ECONOMICS A. PRODUCTION FACILITY, MARKETING AND RENTING 1. a. Shopping complex category Have -1 → to Q.2 Not have -2 b. If “Not have”, (1). The distance ……………. Km (2). Time to spend … Hours….. minutes 2. a. Market with permanent building/semi-permanent b. If not have (1). The distance (2). Time to spend

1. 2. 3. 4. 5. 6.

a. b.(1). b.(2).

……………. Units

a.

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b.(1). b.(2).

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3. Pasar tanpe bangunan pemwanen

Ada

1

Tidak

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4. Supennarketlpasar swalayanltoserba

Ada

3

Tidak

5. Restoranlrumah makanlkedai makan minum

Ada

5

Tidak

6. Pasar hewan

Ada

7

Tidak

7. Rumah potong hewan (RPH)

Ada

8. Pangkalan pendaratan ikan (PPI)

Ada

3

Tidak

2 4 e s 2 4

9. Tempat pelelangan ikan (TPI)

Ada

5

Tidak

6

Ada

7

Tidak

a 2

A 10. Hotellpenginapan A

11. Pefs§waan alat aiat untuk keperluan pasta dan sejemsnya

Tidak

Ada

Tidak

1!‘

3 4 5 6

1

7 B 9 10 11

12. lndustri kacillkerajinan rakyat a. Kerajinan dari kulit

Ada

b. Kerajinan dari kayulbambulrotan

Ada

c. Kerajinan dari logam

Ada

d. Kerajinan dari logam mulia

Ada

1 3 5 7

Tidak

1 3

Tndak

Tidak Tidak

Tudak

2 4 s a

E II 1U E

12.a

2 4

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1

12.b 12.0 12.d

‘B. LEMBAGA KEUANGAN 1%

1. Bank Umum

Ada

2. Bank Perkreditan Rakyat

Ada

Tidak

2

3. Keberadaan koperasi: . Koperasi Unit Desa (KUD) Koperasi lndustri Kecil dan Kerajinan Rakyat (Kopinkra) . Koperasi Simpan Pinjam . Koperasi Pondok Pesantren . Koperasi Tahu Tempe Koperasi Non KUD iainnya C.

§§§

Ada Ada Ada

c’nl |mc'o '

Tidak Tidak Tidak Tidak Tidak Tidak

3.a. 3.b. 3.0. 3.d. 3.e. 3~.f.

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DAMPAK KRISIS EKONOMI

1. Keadaan ekonomi penduduk seoara umum Sangat kaya 1 Kaya 2 Cukup 3

. 1:]

Miskin Sangat miskin

1

2. Unit usaha yang ada di desa yang bangkrutlgulung tikar

_

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Ya

1

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2

Q

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Ya

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Tidak

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23

XI. ECONOMICS (ADVANCED) 3. Market without permanent building Have -1 4. Supermarket/department store Have -3 5. Restaurant/ food market/ food-drinking stall Have -5 6. Veterinary market Have -7 7. Slaughterhouse (RPH) Have -1 8. Fish dropping point (PPI) Have -3 9. Fish Auction place (TPI) Have -5 10. Hotel/ motel Have -7 11. Party appliances rental Have -1 12. Small industry/ people’s craft a. Crafts made from leather Have -1 b. Crafts made from wood/ bamboo/ rattan Have -3 c. Crafts made from metal Have -5 d. Crafts made from gold Have -7

Not have Not have Not have Not have Not have Not have Not have Not have Not have

-2 -4 -6 -8 -2 -4 -6 -8 -2

3. 4. 5. 6. 7. 8. 9. 10 11.

Not have Not have Not have Not have

-2 -4 -6 -8

12.a. 12.b. 12.c. 12.d.

B. FINANCIAL INSTITUTION 1. Public banks 2. Peoples Credit Banks 3. Cooperative types a. Village Cooperative Unit (KUD) b. Craft industry & Small Industry Cooperative (Kopinkra) c. Lending and saving cooperative d. Pondok Pesantren cooperative e. Tofu and tempe cooperative f. Other non Village Cooperative Unit

Have Have

-1 -3

Not have Not have

-2 -4

1. 2.

Have Have

-1 -3

Not have Not have

-2 -4

3.a. 3.b.

Have Have Have Have

-5 -7 -1 -3

Not have Not have Not have Not have

-6 -8 -2 -4

3.c. 3.d. 3.e. 3.f.

C. ECONOMIC CRISIS IMPACT 1. People economics conditions in general Very rich -1 Rich -2 Sufficient -3 2. Bankruptcy business unit in this village a. Handicraft business b. Livestock/ poultry business

1. Poor Very poor

Yes Yes

-4 -5

-1 -1

No No

-2 -2

2.a. 2.b.

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5.

Impact of monetary and economic crisis Tackling Program a. Impact of monetary and economic crisis Tackling Program b. PMT under 2 age c. PMT pregnant mother d. Labor intensive program in Social Safety Net during a previous year: 1. Cleaning the gutter 2. Reforestation 3. Making the road/ bridge 4. Others (……………)

-2 -4

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5.a. 5.b. 5.c. d.1. d.2. d.3. d.4.

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Type of criminal action

a. b. c. d. e. f. g. h. i.

(1) Stealing Robbery Plundering Killing Mistreatment Juvenile Delinquency Incineration Suicide Other (write down):…………….. ………………

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-1 -2

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3. Safety surrounding facility

a. b. c. 1. 2.

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2.e. If “not have” Accessibility : The nearest Very easy -1 distance Easy -2 Difficult -3 (km) Very difficult -4 (3) (4) a. a.

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b. c. 1. 2.

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The highest education ever completed: No schooling Not completed Primary School Primary School Junior High School

4.

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High School Academy University

-5 -6 -7

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Duration of occupy (since got promotion till to enumeration carry out) XIV. NOTE

……. year

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