country
Stratum
Primary Sampling Unit
Department
Municipality
section
Census Segment
sector
Final sampling unit, sampling point
Urban / rural
Size of place
Questionnaire language
Date
Sex
To begin, in general how satisfied are you with your life? Would you say that yo
In your opinion, what is the most serious problem faced by the country?
How would you describe the country's economic situation? Would you say that it i
Do you think that the country's current economic situation is better than, the s
Do you think that in 12 months the economic situation of the country will be bet
How would you describe your overall economic situation? Would you say that it is
Do you think that your economic situation is better than, the same as, or worse
Do you think that in 12 months your economic situation will be better than, the
A Deputy or Senator
A local public official or local government for example, a mayor, municipal coun
Any ministry or minister, state agency or public agency or institution
Have you attended a town meeting, city council meeting or other meeting in the p
Have you sought assistance from or presented a request to any office, official o
Did they resolve your issue or request?
Would you say that the services the municipality is providing to the people are.
First answer
Second answer
Third answer
How much has the Municipality done to solve this problem?
Have you ever participated in drafting the budget of the municipal government?
In your opinion, the majority of expenditures in this municipality are spent on?
How much confidence do you have that the local/municipal government manages fund
In your opinion, the projects carried out by the municipality benefit or do not
Repairing the roads
Controlling crime
Educating our children
Solving local disputes
Making sure that there are vaccinations for children
Help bring new job opportunities for the people in your community?
Providing land title
Transportation system. Would you say that the service is...
Education system . Would you say that the service is...
Primary  Health Care . Would you say that the service is...
Electricity. Would you say that the service is...
Drinkable water. Would you say that the service is...
Trash disposal. Would you say that the service is...
Now, changing the subject, If you wanted to get a death certificate for someone
If you wanted to get a drivers' license, where would you go to get it?
Thinking now about the days before the January 12th earthquake. What was the sta
Do you have a title to your land?-
And now, speaking of that residence where you lived prior to the earthquake, how
Is your previous residence ...?
What is the name of the municipality in which you were living on the day when th
What is the status of the residence in which you live? This residence is...?
Do you have a title to your land?
Thinking now about the days before the January 12th earthquake, were you living
How much damage did this house suffer from the earthquake?
Why did you move here?
Speaking of that residence where you lived prior to the earthquake, how much dam
How many people were living in this house before the earthquake?
How many persons moved to this home because of the earthquake and are still livi
How many boys?
How many girls?
Male
Female
Are those persons who moved to this house:
What are your family main needs for taking care of the people that moved to this
Second answer- What are your family main needs for taking care of the people tha
Third answer- What are your family main needs for taking care of the people that
How many persons moved to this house because of the earthquake and are still liv
Why did they move here?
First answer- The national government will take some actions to rebuild the coun
Second answer- The national government will take some actions to rebuild the cou
Third answer- The national government will take some actions to rebuild the coun
National Government. How would you evaluate its performance?
Foreign governments.  How would you evaluate their performance?
Local NGOs. How would you evaluate their performance?
Local churches. How would you evaluate their performance?
Neighborhood or community organizations.  How would you evaluate their performan
Foreign NGOs.  How would you evaluate their performance?
Now, changing the subject. In the last 12 months have you tried to help to solve
Meetings of any religious organization? Do you attend them…
Meetings of a parents’ association at school? Do you attend them…
Meetings of a community improvement committee or association? Do you attend them
Meetings of an association of professionals, merchants, manufacturers or farmers
Meetings of a political party or political organization? Do you attend them…
[Women only] Meetings of associations or groups of women or home makers. Do you
On this card there is a ladder with steps numbered 0 to 10. 0 is the lowest step
On which step would you say you stood two years ago, that is to say in 2008?
Now, speaking of the people from around here, would you say that people in this
According to the meaning that the terms "liberals" and "conservatives" have for
In the last 12 months, have you participated in a demonstration or protest march
How many times have you participated in a demonstration or protest march in the
What was the purpose of the demonstration or protest?
Do you believe that when the country is facing very difficult times it is justif
Thinking now about six months before the January 12th earthquake, were you a vic
How many times were a crime victim during the six months prior to the January 12
Thinking of the last crime of which you were a victim in the six months prior to
Have you been a victim of any type of crime since the earthquake?
How many times have you been a crime victim since the earthquake?
Thinking of that the last crime of which you were a victim since the earthquake,
Could you tell me, in what place that last crime occurred?
The last time you were a victim, did you report it to any institution?
To what agency or institution did your report the crime?
Why didn’t you report the crime?
Has any other person living in your household been a victim of any type of crime
In order to catch criminals, do you believe that the authorities should always a
Speaking of the neighborhood where you live and thinking of the possibility of b
Comparing the situation of neighborhood before and after the earthquake, would y
And speaking of the country in general, how much do you think that the level of
If you were a victim of a robbery or assault how much faith do you have that the
To what extent do you think your neighborhood is affected by gangs? Would you sa
To what extent do you think the courts in Haiti guarantee a fair trial?
To what extent do you respect the political institutions of Haiti?
To what extent do you think that citizens’ basic rights are well protected by th
To what extent do you feel proud of living under the political system of Haiti?
To what extent do you think that one should support the political system of Hait
To what extent do you trust the justice system?
To what extent do you trust the Electoral Commission?
To what extent do you trust the Parliament?
To what extent do you trust the national government?
To what extent do you trust the Police (PNH)?
To what extent do you trust the Catholic Church?
To what extent do you trust the Evangelical/Protestant Church?
To what extent do you trust the political parties?
To what extent do you trust the President?
To what extent do you trust the Supreme Court?
To what extent do you trust the local or municipal government?
To what extent do you trust the KASEK?
To what extent are you proud of being Haitian?
To what extent do you trust the mass media?
To what extent do you trust the anti-corruption commission?
To what extent do you trust elections?
To what extent would you say the current government fights poverty?
To what extent would you say the current government promotes and protects democr
To what extent would you say the current government combats government corruptio
To what extent would you say the current government improves citizen safety?
To what extent would you say the current government combats unemployment?
To what extent would you say the current government provides access to justice?
To what extent would you say the current government keeps prices down?
Speaking in general of the current government, how would you rate the job perfor
Speaking in general of the police, would you say that the police are performing
Speaking in general of the MINUSTAH, would you say that the MINUSTAH are perform
Those who govern this country are interested in what people like you think.  How
You feel that you understand the most important political issues of this country
Democracy may have problems, but it is better than any other form of government.
Democracy can exist without political parties. How much do you agree or disagree
The Haitian government, instead of the private sector, should own the most impor
The Haitian government, more than individuals, should be primarily responsible f
The Haitian government, more than the private sector, should be primarily respon
The Haitian government should implement strong policies to reduce income inequal
The Haitian government, more than the private sector should be primarily respons
In general, would you say that you are very satisfied, satisfied, dissatisfied o
In your opinion, is Haiti very democratic, somewhat democratic, not very democra
Of people participating in legal demonstrations. How much do you approve or disa
Of people participating in an organization or group to try to solve community pr
Of people working for campaigns for a political party or candidate. How much do
Of people participating in the blocking of roads to protest. Using the same scal
Of people seizing private property or land to protest. How much do you approve o
Of people taking control over factories, offices and other buildings. How much d
Of people participating in a group working to violently overthrow an elected gov
Of people taking the law into their own hands when the government does not punis
There are people who only say bad things about the Haiti form of government, not
How strongly do you approve or disapprove that such people be allowed to conduct
Still thinking of those who only say bad things about the Haitian form of govern
How strongly do you approve or disapprove of such people appearing on television
And now, changing the topic and thinking of homosexuals, how strongly do you app
How strongly do you approve or disapprove of same-sex couples having the right t
Which of the following statements do you agree with the most:
Do you think that our country needs a government with an iron fist, or that prob
There are people who say that we need a strong leader who does not have to be el
During election times, some people try to convince others to vote for a party or
There are people who work for parties or candidates during electoral campaigns.
Has a police officer asked you for a bribe in the last twelve months?
In the last twelve months, did any government employee ask you for a bribe?
In the last twelve months, to process any kind of document in your municipal gov
Do you work? In your work, have you been asked to pay a bribe in the last twelve
In the last twelve months, have you had any dealings with the courts? Did you ha
Have you used any public health services in the last twelve months? In order to
Have you had a child in school in the last twelve months? Have you had to pay a
Do you think given the way things are, sometimes paying a bribe is justified?
Taking into account your own experience or what you have heard, corruption among
In general, would you say the fight against corruption in Haiti has been very su
Over the last 12 months that is from June 2009 until today have you or any house
Referring to the last time you or you or any household member needed medical att
Where did you receive medical service?
How difficulty or easy was it to get to the health care facilities?  Was it...?
How satisfied were you with the service at the health care facilities?
What is the main reason that you were not satisfied with the service at the heal
Do you have an ID card
Are you registered to vote?
Did you vote in the last presidential elections of 2006?
If you did not vote, why did you not vote in the last presidential elections?
Who did you vote for in the last presidential elections of 2006?
Do you currently identify with a political party?
Which political party do you identify with?
If you had to vote today, who would you vote for in the next presidential electi
In general, do you think elections in Haiti are fair and the candidate with the
How much interest do you have in politics: a lot, some, little or none?
Could you tell me, what is your main source of information about the country’s s
Do you listen to community radio?
Besides music, which program run by the community radio do you prefer the most?
Have officials or organizations given your community any advice on how to prepar
Have you personally made any preparations or plans if there is a hurricane or ot
During the past three months, was there any day when you or any other adult in y
Did you receive any food fee from the government in the last four weeks?
Did you receive any food fee  an international organization in the last four wee
How many years of schooling have you completed?
How many children between 6 and 17 years old live in this house?
How many of the children between 6 and 17 years old currently study or go to sch
First answer- Why are some of your children between 6 and 17 years old not in sc
Second answer- Why are some of your children between 6 and 17 years old not in s
Third answer- Why are some of your children between 6 and 17 years old not in sc
Now, let’s talk only about your child between 6 and 17 years old who is next goi
What grade is he/she in now?
Does that child attend a private or public school?
Is this private school run by:
How would you evaluate the condition of the school building and its facilities a
How would you rate or evaluate the quality of education to be at your child's sc
What level of education do you hope that this child will eventually achieve?
How important is educational achievement for your child's future?
How old are you?
Within five years, do you see yourself playing some role in the country’s politi
What issues or problems frequently worry you?
In your opinion, generally speaking, is the country moving in the right directio
What is your religion, if any?
How often do you attend religious services?
Could you please tell me how important is religion in your life?
Into which of the following income ranges does the total monthly income of this
Do you or someone else living in your household receive remittances, that is, ec
To what extent does the income of this household depend on remittances from abro
In the last twelve months, has the amount of money that you receive from abroad
Do you have close relatives who used to live in this household and are now livin
How often do you communicate with them?
Do you have any intention of going to live or work in another country in the nex
The salary that you receive and  total household income :
Over the past two years, has the income of your household:
What is your marital status?
Do you have children? How many children do you have?
How many children live with you at the present time?
Do you consider yourself black, mulatto or white?
What is your mother tongue, that is the language you spoke first at home when yo
Do you speak any other languages?
In what language do you think children should be taught at schools?
Talking about other things, how often do you use the internet?
About how often do you pay attention to the news, whether on TV, the radio, news
What is the name of the current president of the United States?
How many departments does Haiti have?
How long is the presidential term of office in Haiti?
Television
Refrigerator
Landline telephone (not cellular)
Cellular telephone
Vehicle/car How many?
Washing machine
Microwave oven
Motorcycle
Indoor bathroom
Computer
Flat panel TV
Internet
Where does the water used in this house come from?
How often does this household receive water?
Is this house/apartment connected to the public electric power supply?
Approximately how many hours per day have you been supplied with electricity wit
What type of fuel/energy does this household mainly use for cooking?
How do you mainly spend your time? Are you currently…
What is your main occupation or type of work?
In this job are you:
How many hours do you normally work per day in your primary job?
Would you like to work more, less or the same number of hours?
How many people altogether work in the same organization where you do your work?
Do you have health insurance through your employer?
Your contract is :
To what extent are you satisfied with the job that you have? Would you say that
How many months have you been without a job during the past twelve months?
At beginning of this year right before the earthquake,   how did you mainly spe
During your childhood, where did you live mainly? In  a section communale? In  a
How long have you been living  in this municipality?
Do you have any intention of going to live or work in another municipality in th
Duration of interview
Interviewer ID number:
Note your own sex:
Weight variable