Literal question
IDENTIFICATION
NAME AND CODE OF REGION* ______________
NAME OF VILLAGE/TOWN/CITY ________________
URBAN/RURAL (URBAN = 1, RURAL = 2) ______________
LARGE CITY/SMALL CITY/TOWN/RURAL _______________
(LARGE CITY=1, SMALL CITY=2, TOWN=3, RURAL=4) HOUSEHOLD NUMBER _____
NAME OF HOUSEHOLD HEAD _____________
IS HOUSEHOLD SELECTED FOR MAN'S SURVEY? (YES = 1, NO = 2) ________