Field form

Let's record the family's situation completely.

Fill in all questions according to the actual conditions. This data helps in mapping the socio-economic status of residents more accurately.

Data and photos are stored for the data collection manager.

Survey completeness0%

Answer all questions to submit.

Identity

Family and regional data

Surveyor name Surveyor role Name of the head of the family Head of family NIK Family Card Number Phone number Full address Village / sub-district District

Family composition

Family members living in the same house

Number of family members Number of children still in school

Are there any elderly family members?

YesNone

Are there any family members with disabilities?

YesNone

Highest education of the head of the family Health insurance access

Living conditions

Housing, basic services, and assistance

Home ownership status Dominant floor type Electric power Drinking water source Toilet facility Cooking fuel Social assistance received

Family economy

Income, assets, expenses, and occupation

Main occupation of the head of the family Average monthly income (IDR) Estimated value of assets owned (Rp) Average monthly expenses (IDR) Total current installments / debts (Rp) Additional notes

Documentation

Survey supporting photos

Upload a photo of the house condition and one photo of a supporting document. Ensure the photos are clear and not blurry.

＋Photo of house conditionJPG, PNG, maximum 8 MB ＋Supporting document photoJPG, PNG, maximum 8 MB

All questions and photos are mandatory.

Already recorded

Names of surveyed residents

No names recorded yet.

Resident Condition Survey

Citizen Condition Survey

Let's record the family's situation completely.

Family and regional data

Family members living in the same house

Housing, basic services, and assistance

Income, assets, expenses, and occupation

Survey supporting photos

Names of surveyed residents

Socio-economic recapitulation of residents

Socio-economic status distribution

Survey results and internal classification

Let's record the family's situation completely.

Family and regional data

Family members living in the same house

Housing, basic services, and assistance

Income, assets, expenses, and occupation

Survey supporting photos

Names of surveyed residents

Log in to owner recap

Socio-economic recapitulation of residents

Socio-economic status distribution

Survey results and internal classification