INTERVIEWER ID: ______________________

INTERVIEWER NUMBER: ________________

LAGUNA LAKESHORE ROAD NETWORK (LLRN) PROJECT CENSUS,

IOL AND SES SURVEY QUESTIONNAIRE
Instructions: Please write responses legibly on the space provided. For questions with numbered options,
please circle the number that corresponds to the respondent’s answer. For each question that doesn’t apply
to respondent write “NA” beside the question. For applicable questions without responses, write “NR”. For
other questions, please check the box that corresponds to the respondent’s answer.
Mga Tagubilin. Pakiusap, isulat ng maayos ang mga sagot. Para sa mga tanong na numero ang pagpipilian,
bilugan ang numero na ayon sa sagot. Para sa mga tanong na hindi naaayon sa sumasagot, isulat ang “NA”.
Para sa mga tanong na naaayon sa sumasagot ngunit wala syang sagot, isulat ang “NR”. Para sa ibang tanong
na may kahon, i-check ang box ng naaayon na sagot.

Online Survey Telephone Interview Face-to-face Interview

Online Survey Panayam sa Telepono Harapang Panayam

FS DD Main Line Interchange

Main Structure Tag No: ______________________ Respondent1/PAP2 ID No: _______________

Associated Structure Tag/s (if any):

Non-Structure: Land Only Farm / Fish Pen

To be filled up by encoder:
Title No.: ________________ PIN: _____________ TD No. ______________ Lot ID No._________
Location / Address of Affected Structure / Land / Farm / Fish Pen

Household Number, if any: _________________________

Unit/Bldg. No.: ________ Street: ________________ Village/Subdivision: ______________
Barangay: ___________________ City / Municipality: ______________________________

A. PAP’s PROFILE (Both direct and indirect) Pagkakakilanlan ng PAP (direkta at hindi direktang
maapektuhan)
A1. Name/Pangalang:
________________________,________________________,_______________________,_________
(Family Name/Apelyido) (First Name/Pangalan) (Middle Name/Gitnang Pangalan) (Suffix)
A2. Contact No.: Mobile: _______________________ Landline: ____________________________
A3. SOGIE A4. Age / Edad - ____
1. Male / Lalaki - ___ A5. Birthdate / Kaarawan - ____________
2. Female / Babae - ___ (mm/dd/yyyy)
3. LGBTQI - ___
4. Prefer not to say / Hindi nais sabihin - ___
A6. Civil Status / Katayuang Sibil
1. Single / Dalaga o Binata - _____ 2. Married / Kasal - ____
3. Separated / Hiwalay sa asawa - ____ 4. Widow/er / Byudo/a - ____

1
Respondent refers to a person interviewed who is a representative or family member of the PAP above 18 years
old, and those outside the ROW or secondary impact area
2
PAP means a person residing within the ROW or primary impact area
1
 5. Live-in / May kinakasama - ____

A7. With dependents3? 1. Yes / Oo 2. None / Wala

A8. Ethnicity / Lahi:
1. Tagalog 2. Ilocano 3. Bicolano 4. Cebuano 5. Aklanon 6. Moro
7. IP, specify: ____________ 8. Kapampangan 9. Ilonggo 10. Waray
11. Mixed 12. Others: _________________
A9. Religion / Relihiyon
1. Catholic / Katoliko 2. Protestant / Protestante 3. Born Again 4. Islam
5. INC 6. Others (Specify): _____________________
A10. Type of Project Affected Persons (can be multiple responses)
A10. Mga klase ng indibidwal na apektado ng proyekto (maaring sumagot ng higit sa isa)
1. Household owner / May-ari ng tahanan - ____
2. Institution / Institusyon - ___
3. Business owner (structure) / May-ari ng negosyo (istruktura) - ____
4. Business owner (land) / May-ari ng negosyo (lupa) - ____
5. Landowner (residing) / May-ari ng lupa (naninirahan sa pag-aaring lupa) - ____
6. Landowner (not residing) / May-ari ng lupa (hindi naninirahan sa pag-aaring lupa) - ____
7. Farm / Fish Pen Owner (residing) / May-ari ng bukirin o palaisdaan (naninirahan) - ____
8. Farm / Fish Pen Owner (not residing) / May-ari ng bukirin o palaisdaan (hindi naninirahan) - ____

A11. Based on information provided what assets of the PAPs are affected by this project?
A11. Ayon sa mga impormasyon, ano ang mga pag-aari ng PAPs and maapektuhan ng proyekto?

Assets/Ownership Please check Estimated Extent of Severity Tinatayang Laki ng Epekto

Mga pag-aari the assets
affected
I-check ang
mga
apektadong
pag-aari
Residential House Less than 20% (marginal) 20% and above (severe)
Tirahan na Bahay Kulang sa 20% Sobra sa 20%
Residential Land
Tirahan na Lupa
Commercial
Building
Negosyong
istruktura
Commercial Land
Negosyong Lupa
Electric Poles No. of electric
Poste ng kuryente poles_______
Bilang ng poste
ng kuryente ___
Wire Kable
Gate
Parking area
Paradahan
Fence Bakod
Water meter
Metro ng Tubig

3
Dependents are below 18 years old, above 65 years old, and PWD.
2
 B. RESPONDENT’S PROFILE (Do not fill this out if the PAP is also the respondent; to be filled out for
indirectly affected HH)
B. PAGKAKAKILANLAN NG SASAGOT (Ito ay para lamang sa mga hindi direktang apektado ng
proyekto)
B1. Name / Pangalan:
________________________,________________________,_______________________,_________
(Family Name/Apelyido) (First Name/Pangalan) (Middle Name/Gitnang Pangalan) (Suffix)
B2. If representative, relationship of the respondent to the above PAP. Kung kinatawan ng sasagot,
relasyon ng sasagot sa PAP.
1. Spouse / Asawa 2. Child / Anak 3. Sibling / Kapatid 4. Parent / Magulang
5. Worker/employee / Manggagawa/Tauhan 4. Caretaker / Tagapangalaga
7. Other relatives / Kamag-anak (specify): ________________________________
8. Others (specify): __________________________________________________
B3. Contact No.: Mobile: __________________________ Landline: ______________________________
B4. Ethnicity/Lahi:
__ Tagalog; __ Cebuano; __ Visayan; __ Waray; __ Ilokano; __ Bicolano; __ Aklanon; __ Kapampangan;
__ Moro; __ IP, specify: _________________; Others (specify): ____________________
B5. Sex / Kasarian
1. Male/Lalaki 2. Female/Babae

C. STRUCTURE TYPE AND USE KLASE AT GAMIT NG ISTRUKTURA

C1. Type of Affected Structure Klase ng Apektadong Istruktura
1. Single Detached 2. Duplex 3. Townhouse 4. Rowhouse
5. LRB (2-5 floors) 6. MRB (6-15 floors) 7. HRB (16 floors and up)
8. One level, non-residential building 9. Shanty
10. Other (specify): ________________________________________
11. No Affected Structure [SKIP TO E]

(LRB – Low Rise Building; MRB – Medium Rise Building; HRB – High Rise Building)
C2. Use of Structure Gamit ng Istruktura
1. Residential 2. Commercial 3. Residential/Commercial
4. Residential/Institutional 5. Others (specify): ____________________________
C3. Material of Main Structure Materyal na ginamit sa istruktura
1. Concrete Konkreto/Semento 2. Semi-concrete Halong Konkreto
3. Light Material (wood, bamboo, nipa, palm, etc)
4. Salvaged Material (plastic, tin, cardboard, etc)
5. Mixed Materials Halo-halong materiyales
6. Others (specify): ________________________
C4. Status/Condition of Use Katayuan or kondisyon ng paggamit
1. Occupied Okupado 2. Abandoned/Vacant Abandonado/Bakante [SKIP to E]
3. Under construction Kasalukuyang ginagawa [SKIP to E]
Is there any associated structure? Mayroon bang ibang naka-kabit na istruktura?
1. Yes 2. No [SKIP to D]
C5. Structure Tag No.* C6. Type of Associated C7. Material of C8. Usage
Structure Associated Structure
1.
2.
3.
*Only list down structures with same 1. Fence with gate 1. Concrete 1. Residence
structure owners
2. Fence 2. Semi-conrete 2. Business, specify:
________________________________
3. Shed 3. Light material (word, bamboo, nipa,
palm, etc) 3. Residence cum business
4. Garage

3
 5. Toilet 4. Salvaged material (plastic, tin, 4. Others (specify):
cardboard, etc) ________________________________
6. Storage
5. Mixed materials
7. Water tank
6. Others (specify):
8. Pig pen / animal cage
_________________________________
9. Swimming pool
10. Playground
11. Others (specify):
______________________

D. STRUCTURE OWNERSHIP PAG-AARI SA ISTRUKTURA

D1. Do you own the affected structure? Pag-aari mo ba ang apektadong istruktura?
1. Yes Oo 2. No Hindi [SKIP to D2]

D1.1. If yes, Kung Oo, 1. Only owner Nag-iisang may-ari

2. Co-owner May iba pang may-ari
D1.2. Structure Owner / Co-Owner Details Detalye ng may-ari ng istruktura
Name Pangalan
____________________________,_____________________________,__________________________
(Last) (Apelyido) (First) (Pangalan) (Middle) (Gitnang Pangalan)

Sex Kasarian: 1. Male Lalaki 2. Female Babae

Address Tirahan:
1. Within the Project Area Nasa loob ng project area
2. Other Province with the Philippines Ibang probinsya sa Pilipinas
3. Abroad Ibang bansa
4. Unknown Hindi alam
5. NA (Deceased) Hindi naaayon

Contact No: ______________________________________________

D1.3. Structure Owner / Co-Owner Details (if more than one): Detalye ng may-ari ng istruktura (Kung
higit pa sa isa ang may-ari)
Name Pangalan
____________________________,_____________________________,__________________________
(Last) (Apelyido) (First) (Pangalan) (Middle) (Gitnang Pangalan)

Sex Kasarian: 1. Male Lalaki 2. Female Babae

Address Tirahan:
1. Within the Project Area Nasa loob ng project area
2. Other Province with the Philippines Ibang probinsya sa Pilipinas
3. Abroad Ibang bansa
4. Unknown Hindi alam
5. NA (Deceased) Hindi naaayon

Contact No: ______________________________________________

D1.4. How did you obtain the structure? Paano naging sa iyo ang istruktura?
1. Purchase Binili
2. Inherited Minana
3. Gratuitous Act Nakuha na walang kabayaran
4. Self-built Sariling gawa
5. Relocated Inilipat/Pinalipat
6. Others (specify): ______________________________

4
D1.5. Do you rent out the structure? Nirerentahan mo ba ang istruktura?
1. Yes Oo 2. No Hindi [SKIP to D1.8]
D1.6. Number of renters / tenats, if any. Bilang ng mga umuupa, kung mayroon: _____
Name (Last, First, Middle) of renters/tenants Contact No.
Pangalan ng mga umuupa
1.
2.
3.
D1.7. How much is the average rent per month? Magkano ang karaniwang renta kada buwan?
Php ___________
D1.8. Is this structure used for business? Ginagamit ba sa negosyo ang istruktura na ito?
1. Yes Oo 2. No Hindi
D1.9. Do you pay taxes for the structures? Nagbabayad ka ba ng buwis para sa istruktura?
1. Yes Oo 2. No Hindi [SKIP to Section E]

D1.10. If yes, how much is paid in taxes annually? Kung oo, magkano ang buwis na binabayaran
kada taon? Php ___________
For Non Structure owner only (D2 – D3.1) Para sa mga hindi nagmamay-ari ng istruktura (D2 – D3.1)
D2. If not the owner, what type of arrangement do you have with structure owner? Kung hindi
nagmamay-ari ng istruktura, ano ang kasunduan ninyo ng may-ari ng istruktura?
1. Tenant/Renter/Lessee Nangungupahan [ANSWER D2.1 – D3.1]
2. Rent free occupant Walang kabayaran
3. Caretaker Tagapangalaga
4. Sharer May kahati [ANSWER D2.1]
5. Occupant without owner’s permission Nag-ookupa na hindi alam ng may-ari
D2.1. If renter / sharer, how much is your rent/ share per month? Kung nag-rerenta o may kahati,
magkano ang renta o share sa isang buwan? Php _________________

D2.2. What is the size of your rented space? Gaano kalaki o kaliit ang inuupahan mo?
Square meter __________________
D3. What proof do you have to show arrangement with owner? Ano ang katunayan ng inyong
kasunduan ng may-ari na maari mong ipakita?
1. Written contract Kontrata
2. Verbal arrangement Napag-usapan na kasunduan

D3.1. If written contract, what are the terms? Kung may kontrata, ano ang mga kasunduan sa
kontrata?
1. Annual contract Taunang kontrata
2. Others (specify): _________________________________

E. LAND OWNERSHIP PAG-AARI NG LUPA

E1. Do you own the land where this structure/farm/fishpond is built/located? Pag-aari mo ba ang
lupa kung saan nakatayo ang istruktura/bukid/palaisdaan?
1. Yes Oo 2. No Hindi [SKIP to E3]
E1.2. If yes, what is the tenure status of the parcel? Kung oo, ano ang estado ng lote?
1. Fully owned Nag-iisang may-aari 2. Co-owned May iba pang may-ari

5
E1.3. Registered Owner Nakarehistrong may-ari
1. Husband only Asawang lalaki lang
2. Wife only Asawang babae lang
3. Both husband and wife Parehong mag-asawa
4. Female HH Head Babaeng pinuno ng pamilya
5. Male HH Head Lalaking pinuno ng pamilya
6. Female HH member Babaeng miyembro ng pamilya
7. Male HH member Lalaking miyembro ng pamilya
8. Deceased HH member Namayapang miyembro ng pamilya
9. Non-relative Hindi kamag-anak
E2. Do you have a valid/legal document to prove ownership of this land? Mayroon ka bang legal na
dokumento bilang patunay na pag-aari mo ang lupang ito?
1. Yes Oo 2. No Hindi [SKIP to E2.3]
E2.1. If yes, what is your proof of ownership? (Can be multiple responses) Kung oo, ano ang patunay
na pag-aari mo ang lupa? (Maaring sumagot ng higit sa isa)
1. Title (OCT/TCT/CLT/CLOA/CADT/CALT) Titulo
2. Tax Declaration
3. Deed of Sale Kasulatan ng Pagbili ng Lupa
4. Mortgage Sangla o Sanla
5. Contract Kontrata
6. Lease Purchase Agreement Lease Purchase na kasunduan
7. Certificate of Lot Award/Occupancy
8. Others (specify): __________________________________
9. None Wala
E2.2. If title, what is the title number? Kung titulo, ano ang numero? _________________________
E2.3. How did you obtain the land? Paano mo nakuha ang lupa?
1. Purchased Binili
2. Inherited Minana
3. Given Binigay
4. Government Program Programa ng Gobyerno
5. Others (specify): ______________________________________________________
E2.4. Do you pay the real estate tax for the land? Nagbabayad ka ba ng buwis para sa lupa?
1. Yes Oo 2. No Hindi [SKIP to E2.6]

E2.5. If yes, how much per year? Kung oo, magkano kada taon? Php ____________________
E2.6. Do you have tenant/lessees? Mayroon ka bang mangungupahan?
1. Yes Oo 2. No Hindi [SKIP to E2.7]
E2.6.1 If yes, please specify the name of tenant/lessees. Kung mayroon kang mangunugpahan,
ilagay ang kanilang mga pangalan
Name Pangalan (Last, First, Middle) Contact No.
1.
2.
3.
E2.6.2. How much is the rent/share (ask mode of payment, amount of rent) Magkano ang renta o
share (ano ang paraan ng pagbabayad ng renta?) Php _______________ per month

E2.6.3. If not per month, what is frequency of payment of rent? Kung hindi buwanan ang pagbabayad
ng renta, gaano ito kadalas?
1. Monthly Kada buwan
2. Quarterly Kada apat na buwan
3. Bi-annual Dalawang beses sa isang taon
4. Annual Kada taon
5. By contract / tranche Kada Kontrata
6
E2.7. Is this lot currently on loan or used as mortgage to a bank or private entity? Kasalukuyan bang
nasa ilalim ng loan o nakasanla sa bangko o pribadong tao ang lupa?
1. Yes Oo 2. No Hindi
For non landowner only (E3 – E3.1.2) Para sa mga hindi nagmamay-ari ng lupa (E3 – E3.1.2)
E3. If not the landowner, what is your arrangement with the owner? Kung hindi ka nagmamay-ari ng
lupa, ano ang kasunduan ninyo ng may-ari ng lupa?
1. Renting / Leasing Nagrerenta [ANSWER E3.3.1]
2. Occupied with owner’s permission Ginagamit ang lupa na alam ng may-ari
3. Acquired right Nakakuha ng right
4. Occupied without owner’s permission Ginagamit ang lupa na hindi alam ng may-ari
5. Rent-free Libreng naninirahan
6. Tenant Nangungupahan
7. Caretaker Tagapangalaga
8. Other (specify): ___________________________________
E3.1. If renter/lessee, how much is your rent/lease per month? Kung nagrerenta o nangungupahan,
magkano ang bayad sa isang buwan? Php ___________________

E3.2. What is the size of your rented space? Gaano kalaki o kaliit ang inuupahan mo?
Square meter __________________
E3.3. What proof do you have to show arrangement with owner? Ano ang katunayan ng inyong
kasunduan ng may-ari na maari mong ipakita?
3. Written contract Kontrata
4. Verbal arrangement Napag-usapan na kasunduan

E3.3.1. If written contract, what are the terms? Kung may kontrata, ano ang mga kasunduan sa
kontrata?
3. Annual contract Taunang kontrata
Others (specify): _________________________________

F. TYPE AND USE OF AFFECTED LAND URI AT GAMIT NG APEKTADONG LUPA

F1. Type of Land Uri ng Lupa
1. Private Pribado
2. Public Publiko
3. Right of Way (ROW)
4. Ancestral Domain

F1.1. Type of Ownership Uri ng Pag-aari sa Lupa

1. Individual Nag-iisang may-ari
2. Multiple owner May higit sa isang may-ari
3. Corporation Korporasyon
4. Community Ownership (CMP, HOA, Coop) Pag-aari ng isang komunidad
5. Government Pag-aari ng Gobyerno
F2. Current Actual Use of Land (can be multiple responses) Kasalukyang gamit ng Lupa (Maaaring
sumagot ng higit sa isa)
1. Residential [ANSWER Section G]
2. Industrial [ANSWER Section H]
3. Commercial [ANSWER Section H]
4. Institutional [ANSWER Section H]
5. Agricultural [ANSWER Section I]
6. Aquacultural [ANSWER Section I]
7. Vacant / Idle Land [SKIP to J]
8. Others (specify): _______________________________

7
 G. HOUSEHOLD CENSUS SENSUS NG SAMBAHAYAN
G1. HOUSEHOLD INFORMATION IMPORMASYON NG SAMBAHAYAN
G1.1. Composition of Household/Family Members Komposisyon ng sambahayan / Miyembro ng Pamilya
G1.1.1. Number of Household Members Bilang ng Miyembro ng sambahayan ______________

No. G1.1.2. Name Pangalan G1.1.3. Sex G1.1.4. Age G1.1.5. G1.1.6. G1.1.7. Highest G1.1.8. G1.1.9
Kasarian Edad Ethnicity Relationship to Educational If ongoing Occupational Status
Lahi HH Head Attainment education, Katayuan sa trabaho
Relasyon sa Natapos sa location of
Pinuno ng Pag-aaral school?
Pamilya Kung
kasalukuyang
nag-aaral,
lokasyon ng
paaralan?
Last Name First Name Middle Name
1 HH
2 Spouse
3
4
5
6
7
8
9
10
11
12
1.Male 1.Tagalog 1.Head of family 1.Pre-school 1.Within 1.Employed
2.Female 2.Ilocano 2.Spouse 2.Elem. Level neighborhood or 2.Infant/Child
(Grade 1-6) barangay
3.Bicolano 3.Son/daughter 3.Student
3.Elem Graduate 2.Near barangay
4.Cebuano 4.Father/mother 4.PWD
4.High School 3.Other
5.Aklanon 5.Sister/brother 5.Elderly / Retired
Level (Grade 7-12) city/municipality
6.Moro 6.Grandchildren 6.Unemployed
5.High School 4.Overseas
7.IP, specify 7.Grandparents
Graduate 5.Others, please
_____________ 8.Other relative specify
6.Vocational/
8.Kapampangan 9.Non-relative, Technical _______________
9.Ilonggo specify
7.College Level 6.Not applicable
10.Waray _____________
8.College
11.Mixed Graduate
12.Other, specify

8
 _____________ 9.Advanced
College/University
Degree
10.None
11.SPED, specify
level
______________
(If the space is not enough, make a list on a separate paper) Kung hindi sapat ang espasyo para sa mga kasagutan, gumawa ng listahan sa ibang papel.

9
G1. HOUSEHOLD INFORMATION IMPORMASYON NG SAMBAHAYAN (Continuation… Please list all household members in the same order in the following table)
(Ilista ang pangalan ng miyembro ng pamilya ayon sa pagkakasunud-sunod sa naunang table)

No. Name Pangalan G1.3.1. G1.3.2. Income G1.3.3. G1.3.4. G1.3.5. G1.3.6. G1.3.7. G1.3.8.
(For working HH members only) Main source of (Php/month) Location Periodicity of If land-based, what If wage-based, If wage- If enterprise-
income Kita kada income type? what is the based what based, what
(Para sa mga nagtatrabahong Lokasyon
Pangunahing buwan payment status of type? type of
miyembro ng pamilya lamang) Uri ng
pinagkakakitaan Dalas ng kita pinagkakakitan employment? (please enterprise? Uri
kung nasa Kung specify) ng enterprise
kalupaan swelduhan, ano Uri ng
ang estado ng trabaho
trabaho?
Last First Middle
Name Name Name
1 HH
2 Spouse
3
4
5
6
7
8
G1.3.9. Combined primary family income Php
Pinagsamang kita ng pamilya __________
* Others: Wage-Based 1- Land–Based, 1. Own 1. Daily 1. Crop Production 1.Permanent/Regular 1. Office Work 1.Sari-sari Store
10. Production/Factory Workers, 11. Aviation, 12. 2- Wage-Based, residence 2. Weekly 2. Fish Production 2.Contractual/Project 2.Public Official 2.Peddling
Arts, 13. Business (worker receiving salary), 14. 2. Outside 3.Food processing/
3- Enterprise- Based, 3. Monthly 3. Livestock/poultry Based 3.Sales/Vendor
Law Enforcement, 15. Media, residence but preparation
4- Remittance- 4.Bi-Monthly production 3.Temporary/ Casual 4.Driver 4.Hair/Nails/Beauty
16. Medical, 17. Service Industry, 18. Teaching, 19. Based/Pension within PROW 5.Pakyaw or 4. Mix 4. Seasonal/ 5. House help Salon
Technology, 3. Within Piecemeal 5.Others please specify
/Donation Intermittent 6. Construction 5.Transport (e.g.
20. Animal Career, 21. Military Service, 22. Clergy neighborhood or
5- Others, specify 6.Commission Worker tricycle, grab, PUV
Profession, barangay 5.Others, please specify
7.Irregular, Please operator)
23. Sea-based Careers, 24. OFW, 25. Engineering 4. Near 7. Industry
specify 6.Small Scale
Professionals barangay Worker Industry (tailoring,
26. Others, specify: 5. Other city 8. Farm work crafts making)
/municipality 9. Fishing 7.House/Room
** Others: Enterprise-Based 6. Overseas Rental
13. Used Clothing (ukay-ukay), 14. Small Town Lotto activity
7. No definite 8.Construction
(STL), 9.Vulcanizing Shop
area
15. Computer Shop/Pisonet, 16. Shoe-Making, 17. *Others, please 10.Farming
8. Others,
Buy and Sell, see choices 11.Fishing
please specify
18. Online Selling, 19. Tattoo/Laundry/Repair Shop, (left) 12.Junk shop/
20. Beauty, Cosmetic and Personal Care Dealer, 21. scavenging
For Enterprise
Billiards,
based and land ** Others, please see
22. Printing and Reproduction (tarpaulin, Xerox), 23. based, if located
Piggery/poultry choices
within own
24. Others, specify: residence or
PROW,
interview using

10
 BS/AF Form

G1. HOUSEHOLD INFORMATION IMPORMASYON NG SAMBAHAYAN (Continuation… Please list all household members in the same order in the following table)
(Ilista ang pangalan ng miyembro ng pamilya ayon sa pagkakasunud-sunod sa naunang table)

No. Name Pangalan G1.4.1. G1.4.2. Income G1.4.3. G1.4.4. G1.4.5. G1.4.6. G1.4.7. G1.4.8.
(For working HH members only) Secondary source (Php/month) Location Periodicity of If land-based, If wage-based, If wage- If enterprise-
of income Iba pang Kita kada income what type? what is the based based, what
(Para sa mga nagtatrabahong Lokasyon
pinagkakakitaan buwan payment status of what type of
miyembro ng pamilya lamang) Uri ng
Dalas ng kita pinagkakakitan employment? type? enterprise?
kung nasa Kung (please Uri ng
kalupaan swelduhan, ano specify) enterprise
ang estado ng Uri ng
trabaho? trabaho
Last First Middle
Name Name Name
1 HH
2 Spouse
3
4
5
6
7
8
G1.3.9. Combined primary family income Php G1.4.10 No. of members contributing G1.4.11. Total Combined HH Monthly Income
Pinagsamang kita ng pamilya __________ Bilang ng miyembro ng pamilya na nagbibigay ng kita Kabuuan ng kita ng buong pamilya sa isang
________ buwan Php ________
(Sum of Pinagsama-sama G1.3.9 & G1.4.9)
* Others: Wage-Based 1- Land–Based, 1. Own residence 1. Daily 1. Crop Production 1.Permanent/Regular 1. Office Work 1.Sari-sari Store
10. Production/Factory Workers, 11. Aviation, 12. 2-Wage-Based, 2. Outside residence 2. Weekly 2. Fish Production 2.Contractual/Project 2.Public 2.Peddling
Arts, 13. Business (worker receiving salary), 14. 3-Enterprise- Based, but within PROW 3.Food processing/
3. Monthly 3. Livestock/poultry Based Official
Law Enforcement, 15. Media, 4-Remittance- preparation
3. Within 4.Bi-Monthly production 3.Temporary/ Casual 3.Sales/Vendor
16. Medical, 17. Service Industry, 18. Teaching, 19. Based/Pension 4.Hair/Nails/Beauty
neighborhood or 5.Pakyaw or 4. Mix 4.Driver
4. Seasonal/ Salon
Technology, 5-Donation barangay Piecemeal 5.Others please specify
20. Animal Career, 21. Military Service, 22. Clergy Intermittent 5. House help 5.Transport (e.g.
6- Others, specify 4. Near 6.Commission tricycle, grab, PUV
Profession, barangay 5.Others, please specify 6. Construction
7.Irregular, Please operator)
23. Sea-based Careers, 24. OFW, 25. Engineering 5. Other city Worker
specify 6.Small Scale
Professionals /municipality 7. Industry Industry (tailoring,
26. Others, specify: 6. Overseas Worker crafts making)
7. No definite area 8. Farm work 7.House/Room
** Others: Enterprise-Based Rental
8. Others, please 9. Fishing
13. Used Clothing (ukay-ukay), 14. Small Town Lotto 8.Construction
specify activity
(STL), 9.Vulcanizing Shop
15. Computer Shop/Pisonet, 16. Shoe-Making, 17. 10.Farming
For Enterprise based
Buy and Sell, *Others, 11.Fishing
and land based, if
18. Online Selling, 19. Tattoo/Laundry/Repair Shop, please 12.Junk shop/
located within own
20. Beauty, Cosmetic and Personal Care Dealer, 21. scavenging

11
 Billiards, residence or PROW, see choices
22. Printing and Reproduction (tarpaulin, Xerox), 23. interview using BS/AF (left) ** Others, please
Piggery/poultry Form see choices
24. Others, specify:

G1. HOUSEHOLD INFORMATION IMPORMASYON NG SAMBAHAYAN (Continuation… Please list all household members in the same order in the following table)
(Ilista ang pangalan ng miyembro ng pamilya ayon sa pagkakasunud-sunod sa naunang table)

No. Name Pangalan G1.5.1. G1.5.2. Preferred skills G1.5.3. G1.5.4. G1.5.5.
Current Skills training for other skills Membership in Vulnerability Who takes care of
Kasalukiyang interested to learn Organization Kahinaan vulnerable HH member?
kakayahan Nais na matutunang Organisasyong Sino ang nangangalaga sa
kasanayan kinabibilangan vulnerable na miyembro
ng pamilya?
Last Name First Name Middle Name
1 HH
2 Spouse
3
4
5
6
7
8
1.Carpentry, 1.Carpentry, 1.Homeowners Association 1.Baby/Toddler 1.Other family / household member or
2.Driving, 2.Driving, 2.Cooperative 2.Pregnant relatives living independently
3. Mechanic, 3. Mechanic, 3. Women’s Group 3.Elderly 2.Day Care Center
4.Practical Electricity, 4.Practical Electricity, 4.Savings Group 4.Mental Disorder 3.Leaving the children / vulnerable in
the care of neighbors
5.Welding, 5.Welding, 5.Religious Organization 5.Needs assistance
walking/ cannot walk 4.Leaving the children / vulnerable
6.Industrial Painting, 6.Industrial Painting, 6. Senior Citizen unattended
7.Computer Technician 7.Computer Technician 7.4Ps 6.Seriously ill
5.Other facilities, please specify
8.Dressmaking/ Tailoring 8.Dressmaking/ Tailoring 8.Others, please specify 7.Blind ______________________________
9.Food Processing 9.Food Processing ______________________ 8.Mute / Deaf 6. None
10.Handicrafts Making 10.Handicrafts Making 9.None 9.Others, please specify 7. Not applicable
11.Hair Dressing/ 11.Hair Dressing/ ____________________
Cosmetology Cosmetology 10.None
12.Cooking 12.Cooking
13.Others, please specify 13.Others, please specify
____________________ __________________________
14.None 14.None

12
G2. BASIC HOUSEHOLD INFORMATION PANGUNAHING IMPORMASYON NG SAMBAHAYAN
Applicable only to PAPs losing their residence (place of living) due to the project
Naaayon lamang sa mga residenteng nabibilang sa PAPs na mawawalan ng kabuhayan dahil sa proyekto

G2.1. Affected Household? Maapektuhan ba ang sambahayan?

1. Yes Oo 2. No Hindi [SKIP to G3]
G2.2. Type of Residence Uri ng Tirahan
1. Primary Residence Pangunahing Tirahan
If primary, do you have a secondary residence?
Kung pangunahing tirahan, mayroon ka bang pangalawang tirahan?
____ Yes Oo ____ No Hindi
2. Secondary Residence Pangalawang Tirahan
If secondary, where is your primary residence located?
Kung may pangalawang tirahan, saan ang pangunahing tirahan?
Specify: ______________________________________________________________________
G2.3. Length of stay on current location Tagal ng paninirahan sa kasalukyang lokasyon
1. 0-6 months / buwan
2. 7-11 months / buwan
3. 1-2 years / taon
4. 3-5 years / taon
5. 6-10 years / taon
6. 11-15 years / taon
7. 16-20 years / taon
8. More than 20 years / mahigit 20 taon
9. Since birth / mula nang ipinanganak [SKIP to G2.5]
G2.4. Place prior to current location Unang tirahan bago ang kasalukuyang lokasyon
1. Same barangay Parehong barangay
2. In city / Municipality Sa parehong bayan
3. Metro Manila (Syudad: __________________________)
4. Other City/Municipality Ibang Bayan (Specify): ________________________________
5. Other province Ibang Probinsya (Specify): ___________________________________
G2.5. Primary reason for establishing residence on current location (Single response only)
Pangunahing rason kung bakit nanirahan sa kasalukuyang lokasyon (Isang sagot lamang)
1. Proximity to livelihood Lapit sa pangkabuhayan
2. Rent free / affordable rental fee Libreng paninirahan / Murang bayad sa renta
3. Family ties Malapit sa pamilya
4. Near school Malapit sa paaralan
5. Got married Nakapag-asawa
6. Other (specify): ________________________________________________________
G2.6. Financial Institution Membership (Can be multiple responses)
Kinabibilangan na Institusyong Pang-pinansyal (Maaaring sumagot ng higit sa isa)
1. Pag-ibig Fund HDMF
2. GSIS
3. SSS
4. Cooperative Kooperatiba (specify name): ____________________________________________
5. PhilHealth
6. Micro-Finance
7. 4Ps
8. Others (specify): ________________________________________________________________

(HDMF – Home Development Mutual Fund; GSIS – Government Service Insurance System; SSS – Social Security System; 4Ps –
Pantawid Pamilyang Pilipino Program)

13
G3. MONTHLY EXPENDITURE OF HOUSEHOLD BUWANANG GASTOS NG SAMBAHAYAN (PHP)
G3.1. Expense items Mga bagay na G3.2. Estimated Cost G3.3. Remarks
ginagastusan Tinatayang gastos kada
Buwan (Php/Month)
1. Rent (land) Renta sa lupa - E3.1
2.Rent (house/room) Renta sa bahay o
kwarto - D2.1
3. Housing amortization (rent to own)
Bayad sa pansariling bahay
4. Car/motorcycle amortization Bayad
sa pansariling sasakyan
5. Savings Ipon If in bank, under whose name?
Kung nasa bangko, kanina
nakapangalan ito?
__________________________
Sex Kasarian:
1. Male Lalaki
2. Female Babae
3. Both Pareho
6.Tax (Land/Structure) Buwis sa
istruktura o lupa - D1.10, E2.4,
7.Food /Groceries Pagkain na bilihin
8.Non-Food Items/ Groceries Di
pagkain na bilihin
9. Light (Electricity) Kuryente
10. Water Tubig
11. Education Edukasyon
12. Communication (landline/mobile
phone) Komunikasyon/telepono
13. Internet Connection Koneksyon sa
internet
14. Cable Connection Koneksyon sa
Kable
15.Transportation (Fare/Gas)
Transportasyon
16. Recreation (Travel, Eat Out, etc.)
Libangan
17.Health (Check-up, Maintenance
Medicine) Kalusugan
18. Cooking (LPG, Gas, Charcoal)
Pagluluto
19. Loan Payment/Amortization
(Appliances, Furniture, Personal/Bank
Debt, etc.) Pambayad sa utang
20. Financial Support Pinansyal na
suporta
21. Salary (House help, Driver,
Employee, etc) Sweldo sa mga tauhan

14
22.Others (Specify) Iba pa
TOTAL KABUUAN (PHP)

G4. HOUSEHOLD GOODS/ASSETS OWNED MGA PAG-AARING MAY HALAGA NG SAMBAHAYAN

G4.1. Item G4.2 Quantity Bilang G4.3. Sex of G4.4.
Mga bagay G4.2.1 No. of G4.2.2. No of G4.2.3.
Owners Estimated
Functioning non- Total No. Kasarian ng Total Value
Bilang ng functioning Kabuuang may-ari Tinatayang
gumagana Bilang ng mga bilang (1.Male Lalaki; Kabuuang
hindi 2.Female Babae;
gumagana
Halaga (PhP)
3.Both Pareho)

1.House Bahay (Yes in D1)

2. Car Sasakyan
3.Tricycle
4.Motorcycle/E-bike
5. Landline telephone
Telepono
6. Cell phone
7. Computer
8. TV set/Videoke
9. VCD/DVD
10. Stereo Component
11.Refrigerator/Freezer
12.Washing machine/ Dryer
13.Oven/Range
14.Microwave
15. Bed Kama
16.Sala Set
17.Dining Set
18. Electric Fan
19. Aircon
20. Others, specify

G5. DECISION MAKING: HOUSEHOLD FINANCE PAGGAWA NG DESISYON SA PINANSYAL NG

SAMBAHAYAN
G5. In your family/household, who decides for the following? (Single response only) Sa inyong
pamilya o sambahayan, sino ang nagdedesisyon sa mga sumusunod? (Isang sagot lamang)
G5.1 Whether to let children continue school, or send to higher education Kung nararapat bang
ipagpatuloy ng mga anak ang pag-aaral sa mas mataas na paaralan
1. Husband only Asawang lalaki lamang
2. Wife only Asawang babae lamang
3. Both husband & wife Parehong mag-asawa
4. Household Head Pinuno ng pamilya
5. Others (Specify) Iba pa
6. Not Applicable: no student in the household Hindi naaayon: walang mag-aaral sa pamilya
G5.2 How income of household/family member is managed for household expenses? Paano
naisasaayos ang kita ng buong pamilya para sa gastos ng pamilya?

15
 1. Both husband and wife pool their income together for household expenses.
Parehong mag-asawa ang nagtutulong para kumita para sa gastos ng buong pamilya
2. Husband collects income from wife and other members for household expenses.
Kinokolekta ng asawang lalaki ang kita ng asawang babae at iba pang miyembro ng pamilya para
sa gastos ng pamilya
3. Husband gives his income to wife and wife manages the fund for household expenses.
Binibigay ng asawang lalaki ang kanyang kita sa asawang babae para isaayos ang kita na naaayon
sa gastos ng pamilya
4. Other female household member collects income from income earning members and manages
fund.
Ang ibang babaeng miyembro ng pamilya ay kinokolekta ang kita ng iba pang miyembro ng pamilya
para isaayos ito ng naaayon sa gastos ng pamilya
5. Other male household member collects income from income earning members and manages fund.
Ang ibang lalaking miyembro ng pamilya ay kinokolekta ang kita ng iba pang miyembro ng pamilya
para isaayos ito ng naaayon sa gastos ng pamilya
6. Household Head Pinuno ng Pamilya
7. Others Iba pa: ______________________________________________________

G6. RESPONSIBILITY IN DOMESTIC CHORES MGA RESPONSIBILIDAD SA GAWAING BAHAY

G6. In your family/household, who does the following? Sa inyong pamilya o sambahayan, sino ang
gumagawa ng mga sumusunod?
G6.1. Supervising and giving discipline to child(ren) (Single response only)
Pagtingin at pagdidisiplina sa mga bata o anak (Isang sagot lamang)
1. Husband only Asawang lalaki lamang
2. Wife only Asawang babae lamang
3. Both husband and wife Parehong mag-asawa
4. Female HH Head Babaeng pinuno ng pamilya
5. Male HH Head Lalaking pinuno ng pamilya
6. Female HH member Babaeng miyembro ng pamilya
7. Male HH member Lalaking miyembro ng pamilya
8. Others Iba pa (specify): _________________________________________
9. Not applicable: no children in the household Hindi naaayon: walang anak sa sambahayan
G6.2. Taking care of vulnerable member of the household/family (single response only)
Tagapangalaga sa mahinang miyembre ng pamilya (Isang sagot lamang)
1. Husband only Asawang lalaki lamang
2. Wife only Asawang babae lamang
3. Both husband and wife Parehong mag-asawa
4. Female HH Head Babaeng pinuno ng pamilya
5. Male HH Head Lalaking pinuno ng pamilya
6. Female HH member Babaeng miyembro ng pamilya
7. Male HH member Lalaking miyembro ng pamilya
8. Others Iba pa (specify): _________________________________________
9. Not applicable: no children in the household Hindi naaayon: walang anak sa sambahayan
G6.3. Doing household chores – cleaning and tidying the house and improvement, preparing meals,
disposal of garbage, etc. (single response only)
1. Husband only Asawang lalaki lamang
2. Wife only Asawang babae lamang
3. Both husband and wife Parehong mag-asawa
4. Female HH Head Babaeng pinuno ng pamilya
5. Male HH Head Lalaking pinuno ng pamilya
6. Female HH member Babaeng miyembro ng pamilya
7. Male HH member Lalaking miyembro ng pamilya
8. All HH members Lahat ng miyembro ng pamilya
9. Others Iba pa (specify): _________________________________________

16
G7. LIVING CONDITION KONDISYON NG PAMUMUHAY
G7. Access to Utilities Access sa mga Utilities
G7.1. Primary access to electricity (single response only) Pangunahing access sa kuryente (isang
sagot lamang)
1. Owned electric meter for power connection May sariling metro ng kuryente para sa koneksyon
2. Shared connection May ka-share sa koneksyon sa kuryente
3. Illegal connection May illegal na koneksyon sa kuryente
4. No connection Walang koneksyon ng kuryente (gas/kerosene, rechargeable battery, LPG, oul)
5. Others Iba pa (specify): ____________________________________

G7.2. Primary Access to Water (single response only) Pangunahing access sa tubig (isang sagot
lamang)
1. Piped/metered connection May metro ang koneksyon
2. Shared with neighbor (community faucet) May ka-share na kapitbahay (Para sa buong komunidad)
3. Deep well Malalim na Balon
4. Shallow well Mababaw ng Balon
5. Buy from water vendors Bumibili sa mga nagtitinda ng tubig
6. Others Iba pa (specify): ____________________________________
G7.3. Primary Access to Sanitation (single response only) Pangunahing access sa kalinisan (isang
sagot lamang)
1. Owned water sealed toilets (inside house) May sariling saradong palikuran sa loob ng bahay
2. Open pit Bukas na hukay pampalikuran
3. Communal / barangay toilet Palikuran ng barangay o komunidad
4. No toilet Walang palikuran
5. Others Iba pa (specify): ___________________________________

G7.4. Main Fuel Used for Cooking (single response only) Pangunahing uri ng panggatong sa pagluluto
(isang sagot lamang)
1. Gas (LPG)
2. Kerosene
3. Charcoal Uling
4. Wood Kahoy
5. Electricity Kuryente
6. None Wala
7. Other Iba pa (specify): ___________________________________
G8. Access to Transportation Access sa transportasyon
3. Common mode of transportation (tabular form) Karaniwang uri ng transportation
- Women and men vulnerable groups Babae at lalaking nabibilang sa vulnerable na
grupo
- School children Mga mag-aaral
- PWD Mga may kapansanan
4. Accessibility – distance from home to transport terminals
Accessibility – layo o lapit mula sa bahay papunta sa terminal ng mga sasakyan
5. Length of travel from current residence to schools, church, workplace, market, health centers,
recreation facilities, etc.
Haba ng byahe mula sa kasalukuyang tirahan patungo sa paaralan, simbahan, trabaho o opisina,
pamilihan, health centers, recreation facilities, at iba pa.

G9. HEALTH CONDITIONS (can be multiple responses) KONDISYONG PANGKALUSUGAN (maaaring

sumagot ng higit sa isa)
G9.1 Morbidity: Health problems experienced in your household/family for the past one year
Karamdaman: Mga karamdaman na naranasan sa iyong pamilya sa nakaraang isang taon
1. HIV/AIDS
2. Malaria
3. Dengue
4. Typhoid fever
5. Diarrhea
17
 6. Skin diseases
7. Pneumonia/Tuberculosis
8. Flu
9. Cancer
10. Heart problems
11. Hypertension
12. Diabetes
13. None
14. Liver Failure
15. Others Iba pa (specify): ______________________________
G9.2 Mortality: Observed causes of death in your community
Pagkamatay: Karaniwang dahilan ng pagkamatay ng mga tao sa inyong komunidad
1. HIV/AIDS
2. Malaria
3. Dengue
4. Typhoid fever
5. Diarrhea
6. Skin diseases
7. Pneumonia/Tuberculosis
8. Flu
9. Cancer
10. Heart problems
11. Hypertension
12. Diabetes
13. None
14. Liver Failure
15. Others Iba pa (specify): ______________________________

G10. COMMUNITY ISSUES (can be multiple responses) MGA ISYU SA KOMUNIDAD (maaaring sumagot
ng higit sa isa)
G10.1. What do you think are the persistent problems in your community? Ano sa tingin mo ang
mga kasalukuyan ang patuloy na problema sa inyong komunidad?
1. Health Kalusugan
2. Water / Sanitation Kalinisan
3. Flooding Pagbaha
4. Safety / Security Kaligtasan
5. Illegal drugs Iligal na droga
6. Job/Employment Trabaho
7. Garbage collection Pagkolekta ng basura
8. Others Iba pa (specify): __________________________________________________
9. None Wala

G11. PREVIOUS EXPERIENCE IN RELOCATION KARANASAN SA RELOKASYON

G11.1. Have you ever been displaced due to a relocation, demolition or government infrastructure
project? Nakaranas ka na ba na malipat ng lokasyon dahil sa relokasyon, demolisyon o iba pang
proyektong imprastraktura ng gobyerno?
1. Yes Oo 2. No Hindi

G11.2. Have you availed of a government housing program before? Kumuha o sumali ka na ba sa
programang pabahay ng gobyerno noon?
1. Yes Oo 2. No Hindi [SKIP to G10.5]

G11.3. What kind of housing project was it? Anong uri ng programang pabahay ito?
1. NHA relocation site
2. SHFC CMP
3. Pag-IBIG Housing

18
 4. LGU Housing Pabahay ng Munisipyo o Syudad
5. DSWD
6. Other government agency initiative Iba pang programa ng gobyerno
7. Others Iba pa (specify): ______________________________________________

(NHA – National Housing Authority; SHFC CMP – Socialized Housing Finance Corporation, Community Mortgage Program; Pag-IBIG
– Pagtutulungan sa Kinabukasan: Ikaw, Bangko, Industriya, Gobyerno; LGU – Local Government Unit; DSWD – Department of Social
Welfare and Development)

G11.4. What did you do in your housing unit? Ano ang ginawa mo sa iyong bahay?
1. Kept/Maintained Pinanatili ang kaayusan
2. Transferred to children/relatives Ibinigay sa anak o kamag-anak
3. Abandoned Pinabayaan
4. Rented out Pina-upahan
5. Sold / Mortgaged Binenta o isinanla
6. Others Iba pa (specify): ______________________________________________
G11.5. Did you avail of Balik Probinsya Program? Kasama o kasali ka ba sa mga nag Balik Probinsya
Program?
1. Yes Oo 2. No Hindi
G11.6. If previously relocated and have gone back to the area, what made you come back? (Multiple
responses) Kung dati nang na-relocate at bumalik lamang sa lugar, bakit ka bumalik? (maaaring
sumagot ng higit sa isa)
1. No work / livelihood opportunities Walang trabaho o iba pang pangkabuhayan
2. No access to public transportation Walang access sa pampublikong transportasyon
3. No access to / provision of utilities Walang access sa mga utilities (tubig / kuryente)
4. No available healthcare facilities Walang pasilidad na pangkalusugan
5. No near educational facilities Walang malapit na paaralan
6. Others Iba pa (specify): _____________________________________________

G11.7. If you are to be relocated, where do you prefer to live? (single response only) Kung ikaw ay
irerelocate, saan mo nais tumira? (isang sagot lamang)
1. Same barangay Parehong barangay
2. Within the same city/municipality Sa parehong Bayan
3. City/Municipality within same province Sa parehong Probinsya
4. Withing Metro Manila Sa Metro Manila
5. City / Municipality in other province/region Sa ibang probinsya o rehiyon
G11.8. Do you own land in your province or anywhere in the country? Nagmamay-ari ka ba ng lupain
sa inyong probinsya o sa ibang lugar sa Pilipinas?
1. Yes Oo 2. No Hindi

G11.9. If yes, where? Kung oo, saan? (specify): ________________________________________

G11.10. Will you agree to be relocated in high density housing? Papayag ka bang malipat sa
maraming naninirahan na pabahay?
1. Yes Oo 2. No Hindi
G11.11. How much are you willing to pay for a housing unit per month (Php)? Magkano ang bukal
sa iyong kalooban na buwanang bayad sa isang pabahay (Php)?
1. Above Php 5,000 Higit pa sa Php 5,000
2. Php 5,000
3. Php 4,000
4. Php 3,000
5. Php 2,000
6. Php 1,500
7. Php 1,000
8. Below Php,1000 Mababa sa Php 1,000
9. Php 500
10. Below Php 500 Mababa sa Php 500

19
 H. CENSUS OF BUSINESS/INSTITUTION SENSUS NG NEGOSYO/INSTITUSYON
Applicable for PAPs with non-dwelling structure inside the project area
Naaayon lamang sa mga PAPs na walang istruktura sa loob ng project area

H1. PROFILE OF BUSINESS/INSTITUTION DETALYE NG NEGSYO O INSTITUSYON

H1. Do you own/operate a business/institution in the affected area? Mayroon ka bang pag-aari na
negosyo o institusyon sa apektadong lugar ng proyekto?
1. Yes Oo 2. No Hindi [SKIP to I]
H1.1. Business / institution Name Pangalan ng Negosyo o Institusyon:
___________________________________________________________________________________
H1.2. Type of Business / Institution Uri ng Negosyo o Institusyon
1.Trading/Retailing Kalakalan o 2.Manufacturing 4.Personal services (barber shop,
tingi-tingi na negosyo 3.Restaurant/fastfood/ eatery laundry shop, pump service, etc)
(General Merchandise, Paint 5.Transport
shop/hardware, fruit/food stand)
6.Home / small-scale industry
7.Service contracting [ANSWER 8.House/Room rental 10.Barangay/Office / Organization
H1.5] 9. Commercial space / unit rental 11.Bank / Church / School /
hospital
12. Resort
13.Machining and fabrication 14.Printing, repro, art sign 17.Aquaculture
15.Cockpit ring 18.Poultry/Livestock Raising
16. Farming 19. Warehouse
20. Others Iba pa (specify):

H1.3. Should be Location of Business Lokasyon ng Negosyo

a) ____ Public Market Pampublikong Pamilihan
b) ____ Talipapa in the barangay
c) ____ Others Iba pa (specify): ______________________________________________________
H1.4. Type of Business/Institution Ownership Uri ng Pag-aari ng Negosyo o Institusyon
1. Single proprietorship Solong Pagmamay-ari
2. Partnership May kasama na nagmamay-ari
3. Corporation Korporasyon
4. Cooperative Kooperatiba
5. Association Asosyasyon
6. Government (non-corp) Gobyerno
7. Government Owned and Controlled Corporation (GOCC) Korporasyon na Pag-aari ang Kontrolado
ng Gobyerno
8. Others Iba pa (specify):
_______________________________________________________________
H1.5. How much is your capital / business asset? Magkano ang iyong capital sa negosyo?
1. < 3M Hindi hihigit sa 3 Milyon
2. > 3M, < 15M Nasa loob ng 3-15 Milyon
3. >15M, <100M Nasa loob ng 15-100 Milyon
4. Not applicable Hindi naaayon [SKIP to H2]
H1.6 Type of Service Uri ng Serbisyo
1. Information Technology Impormasyon at Teknolohiya
2. Education / Training Services Edukasyon
3. Consulting
4. Transportation Services Serbisyong Transportasyon
5. Events
6. Media

20
 7. Financial Services Serbisyong Pinansyal
8. Medicine Medisina
9. Professional Services Serbisyong Propesyonal
10. Wellness Pangkalusugan
11. Production/manufacturing Produksyon
12. Others Iba pa

H1.7. Length of Business / Institution in Operation Tagal ng Negosyo o Institusyon na nago-operate:

__________ No. of Years Bilang ng Taon

H1.8. Start of Operation Nagsimula ng operasyon: _________ (specify year)

H1.9. Business License/Registration/Permit (Multiple Response) Lisensya/Rehistro/Permiso ng
Negosyo (maaring sumagot ng higit sa isa)
1. Registered with DTI Rehistrado sa DTI
2. Registered with SEC Rehistrado sa SEC
3. Registered with BIR Rehistrado sa BIR
4. Barangay Business Permit Permiso mula sa Barangay
5. Mayor’s Permit/LGU Permit Permiso mula sa Mayor o sa LGU
6. Not registered in any Walang kahit na anong rehistro/lisensya/permiso
H1.10. Monthly Business Income Buwanang Kita ng Negosyo
H1.10.1. Average Gross Monthly Income
Karaniwang Kabuuang Kita kada buwan: Php _________

H1.9.2. Average Net Monthly Income

Karaniwang Netong Kita kada buwan: Php ____________

H2. EMPLOYEE INFORMATION IMPORMASYON NG EMPLEYADO

H2.1. Who help you in your business operation/production? Sino ang tumutulong sa iyong
operasyon o produksyon ng negosyo?
1. Family members Miyembro ng Pamilya
2. Relatives Kamag-anak
3. Non-relatives Hindi kamag-anak
4. Mix of 1,2, & 3 Pinagsama-samang 1,2, & 3
5. None Wala [SKIP to I]
H2.2 Do you have paid employee? Mayroon ka bang binabayaran na empleyado?
1. Yes Oo 2. No Hindi [SKIP to I]
H2.3. How many employees do you have? Ilang empleyado mayroon ka?
1. 1-9 2. 10-99 3. 100-199 4. 200 and up 200 pataas
H2.3.1. Total number of employees H2.3.2.No of Employees H2.3.3 Average *H2.3.4. Skills
by Sex
(fill out what’s applicable) Monthly Salary Kakayahan
Bilang ng empleyado
Kabuuang bilang ng empleyado ayon sa kasarian Karaniwang
(sagutan kung alin ang naaayon) Buwanang Sahod
ML FB
Management / Executive level
-PWD
-LGBTQ
-Other vulnerable groups, specify
_______________________________
Technical staff/skilled workers - same
*1.Construction related 2.Food preparation/technology 3.Hotel/Restaurant related 4.Automotive related 5.Electronic/Electrical Related
6.Computer related 7.Health related 8.Clerical related 9.Sales related 10.Personal Services related 11.Design/arts related
12.Dressmaking related 13.Agriculture related 14.Aquaculture related 15.Business/Finance related

21
 I. CENSUS OF AGRICULTURE AND FISHERIES SENSUS NG AGRIKULTURA AT PANGINGISDA
Applicable for PAP with farm/fish pen inside the project area. Naaayon para sa mga PAPs na nagmamay-ari
ng bukid/palaisdaan sa loob ng project area

I1. CROPS AND TREES MGA PANANIM AT MGA PUNO

I1. Do you or any member of your family own/harvest crops/trees in the affected area? Ikaw ba o
kahit sinong miyembro ng iyong pamilya ay nangongolekta o may pag-aari na mga pananim o mga
puno sa loob ng apektadong lugar ng proyekto?
1. Yes Oo 2. No Hindi [SKIP to I2.1]

If yes, who in the family and gender. Kung oo, sino sa pamilya mo at ano ang kasarian.
____ Female Babae ____ Male Lalaki

Additional information on who (family member) cultivates what:

Karagdagang impormasyon sa kung sino (miyembro ng pamilya) ang nangangalaga ng ano:
____________________________________________________________________________________
____________________________________________________________________________________
I1.2. Affected Trees Mga maaapektuhang puno
TYPE OF AGE QTY ANNUAL TYPE OF CROP AREA ANNUAL
TREE EDAD BILANG HARVEST URI NG LAWAK HARVEST
URI NG TAUNANG PANANIM (SQ M.) TAUNANG
PUNO KOLEKSYON KOLEKSYO
(PHP) N (PHP)

Timber Rice
Fruit Bearing Corn
Palms Root crops
Ornamentals Orchid/Flower
Others, Vegetable
specify (Annual)
___________
Vegetable
(Perennial)
Fruit (Annual)
Other Annual
Crops
Other Perennial
Crops
I1.3 Total I1.4 Total
Kabuuan Kabuuan
I1.5 What is the planting pattern of the crops (for annual crops only)? Ano ang pattern ng pagtatanim
(para sa mga taunang pananim lamang)?
1. Mono-cropping
2. Inter cropping
3. Mixed cropping
Agricultural technology being used for vegetables, fruits, and ornamental plants Pang-agrikulturang
teknolohiya na ginagamit para sa mga gulay, prutas, at palamuting halaman
a. Chemical/inorganic inputs - __________
b. Organic/natural farming - ____________
c. Mixed - __________________________
d. Others, specify - ___________________

22
 I1.6. What is the planting pattern of the crops (for perennial crops/trees only)?
Ano ang pattern ng paghahalaman sa mga perennial na pananim o puno?
1. Compact Sama-sama
2. Scattered Kalat
I1.7. What is the scale of crop production? Ano ang scale ng produksyon ng mga pananim?
1. Subsistence farming
2. 2. Small to medium scale farming
3. Plantation [ANSWER Section H]
I1.8. How are the crops utilized? Saan ginagamit ang mga pananim?
1. For family consumption only Para sa pam-pamilyang pagkonsumo
2. For profit Pinagkakakitaan
3. Both Pareho
I1.9 How are the forest trees, fruit bearing trees, palms and ornamentals utilized? Saan ginagamit
ang mga puno sa gubat, puno na namumunga ng prutas, palms, and palamuting halaman?
1. For family consumption only Para sa pam-pamilyang pagkonsumo
2. For profit Pinagkakakitaan
3. Both Pareho
I1.7. Primary product/goods produced:

I.8. What is the primary source of water/irrigation for the crops/trees? Ano ang pangunahing
pinagmumulan ng tubig o irigasyon para sa mga pananim at mga puno?
1. National irrigation system
2. Communal irrigation system
3. Tube well
4. Dug well
5. Surface /ram pump
6. Small farm reservoir (SFR)
7. Shallow well impounding (SWIP)
8. Small Diversion Dam (SDD)
9. Level 34

I2. ANIMAL RAISING/PRODUCTION PANGANGALAGA NG MGA HAYOP

I2.1. Do you or any member of your family graze/raise animals in the affected area? Ikaw ba o kahit
na sinong miyembro ng iyong pamilya ay nangangalaga ng mga hayop sa loob ng apektadong lugar
ng proyekto?
1. Yes Oo 2. No Hindi [SKIP to I3.1]

If yes, which family member (sex)? Kung oo, sino sa miyembro ng inyong pamilya at ano ang
kasarian? ______________________________________________________________________
I2.2. If yes, which of the following activities are you engaged, at what scale, and type of technology?
(suggest to present this in tabular form – Type of Activities; Scale of Production/ # of heads; Type
of Technology (can be commercial technology vs. organic/natural technology)
Kung oo, ano sa mga sumusunod na aktibidad ang ginagawa mo, gaano kalawak at anong uri ng
teknolohiya? (iminumungkahi na gawin ito sa tabular na format – Uri ng aktibidad; Lawak ng
produksyon/bilang; Uri ng teknolohiya (maaaring teknolohiyang komersyan laban sa natural na
teknolohiya)
1. Livestock raising Pangangalaga ng malalaking hayop
2. Poultry production Pangangalaga ng mga manok
3. Animal breeding Pagpapalahi ng mga hayop
4. Raising of animal for racing/cockfighting Pag-aalaga ng mga hayop pang-laban
5. Herding of cattle Pagpapastol ng baka
6. Vermiculture Pag-aalaga ng mga uod
7. Sericulture / silk / cocoon production Produksyon ng silk/cocoon

4
Piped water supply with a private water point
23
 8. Bee culture/honey production Pangangalaga ng mga bubuyog / Produksyon ng honey
9. Others Iba pa
I2.3 Scale of production – delete this
1. Subsistence 2. Small to medium scale 3. Commercial scale [ANSWER Section H]
I2.4 What is the purpose/use of livestock/animal raising? Ano ang dahilan o saan ginagamit ang mga
alagang hayop?
1. Raising animals/livestock for food Pagkain
2. Raising animals/livestock for profit Pinagkakakitaan
3. Both Pareho
I2.5.
Livestock/other No. of Heads Annual Income Poultry Mga Types Uri No. of Birds Annual Income
animals Bilang Taunang Kita Alagang Manok Bilang ng mga Taunang Kita
Mga alagang ibon
Hayop
Cattle (cow) Chicken Native
Carabao Broiler
Swine (Pig) Layer
Goat Breeder
Sheep Game Fowl
Horse Duck Broiler
Race Horse Layer
Breeder dogs Breeder
Other livestock/animals, specify below Quail Broiler
1. Layer
2. Breeder
3. Other Poultry, specify below
4. 1.
5. 2.
6. 3.
7. 4.

I3. AQUACULTURE PRODUCTION PRODUKSYON NA PANG-AQUACULTURE

I3.1. Is there any member of this household who is engaged in/manage the fish
culture, seaweeds or other aquatic plants and animals in a fishpond, fish cage or
other types of aquafarms in the affected area?
Mayroon bang miyembro ng inyong pamilya ang nangangalaga ng mga isda,
seaweeds or iba pang uri ng halaman o hayop sa tubig sa isang palaisdaan, fish cage,
o iba pang uri ng aquafarms sa loob ng apektadong lugar ng proyekto?
1. Yes Oo 2. No Hindi [SKIP to I3.6]

If yes, who (family member). Kung oo, sino sa miyembro ng pamilya at ano ang
kasarian.
___ - Female Babae ____ - Male Lalaki
_______________________________________________________________________
I3.2. Fish pen/pond information (underline whether it is a fishpond or a fishpen. If
fishpond, go to I3.2.2. If fishpen, specify whether it is baklad or other type/s
Impormasyon ng fish pen/pond (Guhitan sa ilalim kung fishpond o fishpen. Kung
fishpond, magtungo sa I3.2.2. Kung fishpen, isulat kung baklad o iba pang uri.

24
 I3.2.1 Fresh I3.2.2. Type I3.2.3. Size of fish I3.2.4. Number of I3.2.5 I3.2.6. Estimated cost of
water/ of fishcage cage/pen cages/pens Annual fish cage
aquamarine Uri ng Laki ng fish cage/pen Bilang ng cages/pens Harvest Tinatayang halaga ng
products fishcage Taunang fish cage
Mga Koleksyon
produktong Baklad Length Width No. of No. of (Php) Before Now
nagmula sa Other type Haba Lapad cages Poles Noon Ngayon
fresh water (sq.m.) Bilang ng Bilang ng
cages poles
Tilapia
Milk fish /
Bangus
Crustaceans
(shrimps,
crab)
Seaweed
Water Lily
Other
__________
I3.3. Total

I3.4. What is the scale of fish pen/pond operation? Ano ang lawak ng operasyon ng fish pen/pond?
1. Subsistence
2. Small to medium scale
3. Commercial Scale [ANSWER Section H]
I3.5. How is the fish pen/pond utilized? Paano o saan ginagamit ng fish pen/pond?
1. For family consumption only Para sa konsumo ng pamilya
2. For profit Pinagkakakitaan
3. Both Pareho
I3.6. Do you catch fish in the affected area? Nakakahuli ka ba ng isda sa mga apektadong lugar ng proyekto?
1. Yes Oo 2. No Hindi [SKIP to Section I4.1]
I3.7. Scale of fishing operation Lawak ng operasyon ng pangingisda
1. Artisanal fishing
2. Municipal fishing
3. Commercial fishing [ANSWER Section H]
I3.8. How is the fish pen/pond utilized? Paano o saan ginagamit ang fish pen/pond?
1. For family consumption only Para sa konsumo ng pamilya
2. For profit Pinagkakakitaan
3. Both Pareho
I3.9. Monthly income Buwanang kita: _________________________________________________________

14.TREES AND PERENNIALS (In case there are many trees that will be affected) MGA PUNO (kung may
mga pagkakataon na marami pang mga puno ang maapektuhan)
Tree Species Total Area Area Affected Total Number of Age in years Diamater at Remarks
Lahi ng Puno Planted Lugar na remaining trees Edad Base Height
Kabuuang apektado area Bilang ng Sukat ng
lugar na may (sq.m.) Kabuuang puno lapad
tanim (sq.m.) matitirang
lugar (sq.m.)
14.1Timber
Species

25
14.2. Fruit Total Area Area Affected Total Number of Age in years Diamater at Remarks
Trees and Planted Lugar na remaining trees Edad Base Height
Perennial Kabuuang apektado area Bilang ng Sukat ng
lugar na may (sq.m.) Kabuuang puno lapad
tanim (sq.m.) matitirang
lugar (sq.m.)

15.CROPS Total Area Area Affected Total Vegetative Yield (last Remarks
Planted Lugar na remaining Stage three years)
Kabuuang apektado area
lugar na may (sq.m.) Kabuuang
tanim (sq.m.) matitirang
lugar (sq.m.)

I4.1. Did you answer YES in anyone (I1, I2, I3) above? Sumagot ka ba ng OO sa kahit isa (I1, I2, I3) sa itaas?
1. Yes Oo 2. No Hindi [SKIP to J]
I4.2. Did you register your land/water-based activity? Naka-rehistro ba ang iyong mga aktibidad sa lupa o sa
tubig?
1. Yes Oo 2. No Hindi
I4.3. Do you have paid agriculture / aquaculture workers? Mayroon ka bang mga binabayaran na manggagawa
sa agrikultura o sa aquaculture?
1. Yes Oo 2. No Hindi [SKIP to I4.5]
I4.4. How many paid agriculture / aquaculture / fishery workers to you employ? Ilan ang bilang ng mga
binabayaran mong manggagawa sa agrikultura / aquacultute/fishery?
1. 1-9 2. 10-99 3. 100-199 4. 200 and up Pataas
I4.5. Do you own the operation of the agriculture/aquaculture? Ikaw ba ang nagmamay-ari ng operasyon ng
agrikultura/aquaculture?
1. No Hindi
2. Solely owned Solong may-ari
3. Co-owned May kasamang may-ari
4. Group owned May group ng mga may-ari
5. Owned by someone else May iba pang mang-ari
I4.6. Do you own the affected land/body of water? Ikaw ba ang nagmamay-ari ng apektadong lugar sa
lupa/tubig?

26
 1. Yes Oo [SKIP to J] 2. No Hindi
I4.7. If not, what is your arrangement with the landowner or lake/marine administrator? Kung hindi, ano ang
kasunduan mo sa may-ari ng lupa o sa nangangasiwa ng lawa o tubig?
1. Tenant Nangungupahan
2. Sharecropper Nakikihati sa pananim [SKIP to I4.9]
3. Lessee Pangmatagalang pag-upa
4. Occupied without permission Hindi alam ng may-ari na inokupa ang lugar
5. Occupied with permission Alam ng may-ari na inokupa ang lugar
6. Mortgage / Pawned Nakasanla ang lugar
7. Others Iba pa (specify): ___________________________________________________________
I4.8. If tenant/lessee, how much do you pay the landowner per year? Kung nangungupahan, magkano ang
binabayaran sa may-ari ng lupa kada taon? PhP ___________________________________________
I4.9. What is the size of the rented/leased/used area? Ano ang sukat ng nirerentahan na lugar?
_________________sq.m.
I4.10. If sharecropper, what is your sharing arrangement with the owner? Kung nakikihati sa pananim, ano
ang kasunduan ninyo ng may-ari?
_____ % Owner _____ % sharecropper

J. FLOODING DISASTER AWARENESS AND EXPERIENCE, IMPACTS AND DAMAGES

KAALAMAN AT KARANASAN SA PAGBAHA, MGA EPEKTO AT PINSALA
J-1 FLOODING Awareness and Experience Mga Kaalaman at Karanasan sa Pagbaha
1 How is your property threatened by floods from the neaby lake/bay in the past 12 months?
Ano ang mga nagging masamang epekto ng pagbaha mula sa lawa sa iyong pag-aari sa nakaraang
12 na buwan?
1. Inundation Pagbaha
2. Landslide Malakihang pagguho ng lupa
3. Soil erosion Maliliit na pagguho ng lupa
4. Others, specify _____________________________________________________
2 When do you experience flooding in you property? Tuwing kailan mo nararanasan ang pagbaha sa
iyong lugar?
1. Every time it rains Tuwing umuulan
2. Only during heavy rains Tuwing malakas lamang ang ulan
3. During high tide Tuwing mataas ang lebel ng tubig sa lawa
4. During rain and high tide Tuwing umuulan at mataas ang lebel ng tubig sa lawa
5. No flooding Walang nararanasang pagbaha
J-2 If flooding is experienced Kung nararanasan ang pagbaha:
1 How often does flooding occur? Gaano mo kadalas maranasan ang pagbaha sa iyong lugar?
1. Once every 5-10 years Isa sa kada 5-10 taon
2. Once every 2-5 years Isa sa kada 2-5 taon
3. Once every 1-2 years Isa sa kada 1-2 taon
4. 2 to 5 times a year 2 hanggang 5 beses sa isang taon
5. 6 to 10 times a year 6 hanggang 10 beses sa isang taon
6. More that 10 times a year Mahigit sa 10 beses sa isang taon
2 What was the deepest flood you ever experienced? Ano ang pinakamalalim na baha ang naranasan
mo sa iyong lugar?
1. Ankle deep Hanggang bukong-bukong
2. Knee deep Hanggang tuhod
3. Waist deep Hanggang baywang
4. 1 meter Isang metro
5. >1 meter to 2 meters Isa hanggang dalawang metro
6. More than 2 meters Mahigit sa dalawang metro

3 When / what year? Kailan o anong taon ito? _________________

4 How long did it take for the flood to subside? Gaano katagal bago humupa ang baha?
1. Less than 1 day Wala pang isang araw

27
 2. 1 day Isang araw
3. 2-3 days 2 hanggang 3 araw
4. 4-7 days 4 hanggang 7 araw
5. More than 1 week Mahigit isang linggo
5 In your opinion, why does flooding happen in your community? Sa iyong palagay, bakit nagkakaroon
ng pagbaha sa inyong komunidad?
_____________________________________________________________________________
What were the impacts and damages on your property and over-all living condition? Ano ang mga
epekto at pinsala ng pagbaha sa iyong pag-aari at sa pangkalahatang kondisyon ng inyong
pamumuhay?
_____________________________________________________________________________

J.PROJECT AWARENESS KAALAMAN TUNGKOL SA PROYEKTO

J1. Have you heard about the LLRN Project? Narinig mo na ba ang proyektong LLRN?
1. Yes 2. No
Explain about the project: The LLRN Phase 2 is a high standard highway that the DPWH will build along the
western side of the Laguna Lake. The project will substantially ease travel time from in the priority
municipalities in the provinces of Rizal and Laguna. It is an approximately 80-kilometer road network that
will start from Taytay in Rizal to Bay, Laguna with interchanges and connecting roads towards the Manila
South Road.
Paliwanag tungkol sa proyekto: Ang LLRN Phase ay isang highway na ginamitan ng mataas na pamantasan
na itatayo ng DPWH sa kahabaan ng kanlurang bahagi ng Lawa ng Laguna. Layunin ng proyektong ito na
mapabilis ang pagbyahe sa Probinsya ng Rizal ang Laguna. Tinatayang aabot sa 80 kilometrong kalsada
ang magmumula sa Binangonan sa Rizal hanggang Bay sa Laguna na konektado rin sa Manila South Road.
J2. What benefits do you think can be derived from this project? (can be multiple responses) Sa iyong
palagay, ano ang mga maaring maging magandang benepisyo sa pagtatayo ng proyektong ito?
(maaaring sumagot ng higit sa isa)
1. will reduce the traffic jam mababawasan ang traffic
2. will improve comfort and convenience to passengers and car owners mas maayos at
comportableng byahe para sa mga pasahero at may sariling sasakyan
3. project will improve access to social amenities and facilities such as schools, hotels,
recreational facilities, and hospitals mas maayos na access sa mga social amenities tulad
ng paaralan, hotels, ospital
4. will improve access to working place/office mas mabilis na access sa trabaho o opisina
5. value of commercial and residential properties will increase mas mataas na value ng mga
residensyal at komersyal na establisyimento
6. will open up opportunities for work and business mas maraming oportunidad tulad ng
trabaho at negosyo
7. others iba pa (Specify) ____________________________________________________
J3. What are your overall issues and concerns about the project? (Can be multiple responses) Ano
ang iyong mga isyu o hinaing patungkol sa proyekto? (maaring sumagot ng higit sa isa)
1. My house will be demolished/We will be relocated to another area.
Made-demolish ang aking bahay/mare-relocate kami sa ibang lugar
2. My fish cage/pen will be affected.
Maaapektuhan ang aking fish cage/pen
3. My fishing and/or farming activity will be stopped
Matitigil ang aking pangingisda at pagbubukid
4. Fishing environment in the area will be disturbed because of bridge construction activities
Magugulo ang tahanan ng mga isda dahil sa mga tulay na itatayo
5. Number of fish species will significantly decrease
Mababawasan ang mga lahi ng isda
6. Farming areas will be significantly decreased
Mababawasan ang mga lugar na pwedeng sakahan
7. My business will be affected.
Maaapektuhan ang aking negosyo
8. I will lose income
Mawawalan ako ng pinagkakakitaan

28
 9. I will lose access to the lake
Mawawalan ako ng access sa lawa
10. Increased noise and vibration
Magliliha ito ng ingay sa paligid
11. Risk of flooding
Magkakaroon ng banta ng pagbaha
12. Value of commercial and residential properties will decrease.
Bababa ang value ng mga komersyal at residensyal na pag-aari
13. I will lose access to complete and free basic services like (please check; can be multiple):
Mawawalang ako ng access sa mga libreng serbisyo (i-check ang sagot; maaaring
sumagot ng higit sa isa)
a) education edukasyon - __; b) health kalusugan - ___; c) housing subsidy pabahay- ___
14. I will lose my social network (proximity to family and friends) if my family will be relocated
Mawawalan ako ng koneksyon sa kaibigan at pamilya kung sila ay mare-relocate
15. Others Iba pa (Specify) ____________________________________________________
J4. What are your recommendations to addess your issues and concerns? Ano ang iyong maaring
abiso upang masolusyonan ang iyong mga isyu?
1. Provision of adequate compensation Pagbibigay ng sapat na kabayaran
2. Financial assistance Tulong pinansyal
3. Livelihood restoration Pangkabuhayan
4. Relocation house/structure with complete amenities and access to basice services like water,
electricity, schools, hospitals/clinics, church, etc
Ang paglilipatan na lugar o bahay ay dapat may kumpletong amenities at access sa mga
pangunahing seribisyo tulad ng tubig, kuryente, paaralan, ospital, simbahan, at iba pa
5. Will go back to the province provided I get compensated for my losses
Babalik sa probinsya ngunit kinakailangan na may sapat na kabayaran ang mawawalang pag-aari
6. Others Iba pa, please specify ______________________________________________

K.LIVELIHOOD REHABILITATION MEASURES (may include more than one response) MGA PANUKALA
SA REHABILITASYON NG PANGKABUHAYAN (maaring sumagot ng higit sa isa)
K1. In case you lose your job/close enterprise or business due to the implementation of the project,
what type of livelihood assistance would you need? Kung sakali na mawalan ka ng hanapbuhay o
pagkakakitaan dahil sa proyekto, ano ang uri ng pangkabuhayan ang nais mo?
1. Job/employment within the current sector Trabaho na naaayon sa kinabibilangang sektor
2. Any job/employment Kahit anong trabaho
3. Financial assistance in finding new employment Tulong pinansyal para makahanap ng bagong trabaho
4. Financial assistance (grant or soft loan) and/or starter kits (goods) to revive livelihood (farming or fishing,
or micro enterprise) activity Tulong pinansyal (utang) o panimula na pangkabuhayan
5.Replacement land/business structure Kapalit na lupa o negosyo
6.Vocational/Skills Training Panibagong kasanayan
7. Others Iba pa (Specify): _____________________________________________________________
K2. Where is your preferred location for employment or new business? Saan ang nais mong lugar
ng trabaho o bagong negosyo?
1. Current barangay Sa kasalukuyang barangay
2. Any barangay within current city Kahit saang barangay sa kasalukuyang bayan
3. Any city within same province Kahit saang bayan sa kasalukuyang probinsya
4. Near relocation site Malapit sa paglilipatan na lugar
5. Other province Ibang probinsya
6. Abroad/Outside the country Sa ibang bansa
K3. What kind of livelihood activity would you like to start or revive and estimated funding needs?
(Can be multiple responses) Ano ang uri ng pangkabuhayan ang nais mong simulan o gawin mula at
magkano ang tinatayang kailangan pera? (maaaring sumagot ng higit sa isa)
___ - rice farming; _______ Ph
___- corn farming; _______ Ph

29
___ - root crops; ________ Ph
___- vegetables; ________ Ph
___- fishing, please specify - ________; _________ Ph
___-micro-enterprise, specify type - __________; _________ Ph
K4. What is/are your current skills/expertise? Ano ang kasalukuyang kakayahan o expertise mo?
1. Construction related
2. Food Preparation/Technology
3. Hotel/Restaurant related
4. Automotive related
5. Electronic/Electrical related
6. Computer related
7. Health related
8. Clerical related
9. Sales related
10. Personal Services related
11. Design/Arts related
12. Dressmaking related
13. Agriculture related
14. Aquaculture Related
15. Business/Finance related
K5. What is/are your preferred vocational/skills training? Or What other skills would you be
interested to learn? Ano ang nais mong dagdag kaalaman o ano ang ibang skills ang nais mong
matutunan?
1. Construction related
2. Food Preparation/Technology
3. Hotel/Restaurant related
4. Automotive related
5. Electronic/Electrical related
6. Computer related
7. Health related
8. Clerical related
9. Sales related
10. Personal Services related
11. Design/Arts related
12. Dressmaking related
13. Agriculture related
14. Aquaculture Related
15. Business/Finance related
K6. Are these skills needed in your municipality and neighboring municipalities? Kinakailangan ba
sa inyong bayan o kalapit bayan ang ganitong uri ng kakayahan o skills?
Yes- ___; No- __

If Yes, would you know who or which institutions will need these skills?
Kung oo, alam mo ba kung anong institusyon ang nangangailangan ng ganitong skills?
a) LGU -___; b) schools- ___; c) hospitals- ___;
d) private subdivision owners -___; e) offices - ___;
f) others (specify) - ____.
K7. Who among the family or HH members have existing skills and what are these? Please
enumerate. Sino sa miyembro ng pamilya ang may skills at ano ang mga ito?
30
 a)
b)
c)
Others _________________________________________________________________
K8. Are they interested to learn other skills? Interesado ba silang matuto ng iba pang skills?
__ Yes ___ No

If yes, what are these? Please anumerate. Kung oo, ano ang mga ito?
a)
b)
c)
Others, specify ____________________________________________________________________

DATA PRIVACY CONSENT PAHINTULOT SA PRIBADONG DATA

I understand that the information above is collected for the purpose of the Laguna Lakeshore Road Network
(LLRN) Project Phase 2 Feasibility Study and I express my consent for the DPWH-RMC II, and its consultants
/ subcontractor to collect, record, organize, store, retrieve, consult, use, consolidate, block, erase or destroy
my personal data as part of my information. I also agree that my personal data and all privileged information
herein shall be processed only in accordance with the provisions set forth in Chapter 3 of Republic Act No.
10173 of the Philippines, Data Privacy Act of 2012 and its corresponding Implementing Rules and Regulations,
provided further that all information herein shall be protected and shall not be used for other purposes aside
from the above project without my knowledge and consent.
Nuunawaan ko na ang impormasyong nasa itaas ay kinokolekta para sa Laguna Lakeshore Road Network
(LLRN) Project Phase 2 Feasibility Study at sumasang-ayon ako para sa DPWH-RMC II, at sa mga consultants
/ subcontractor nito na mag-kolekta, magtala, mag-organisa, mag-imbak, kumuha, kumonsulta, gumamit,
magkonsolida, mag-block, magbura o magwasak ng aking personal na datos bilang bahagi ng aking
impormasyon. Sumasang-ayon din ako na ang aking personal na datos at lahat ng impormasyon dito ay
ipoproseso lamang alinsunod sa mga probisyon na itinakda sa Chapter 3 ng Republic Act No. 10173 ng
Pilipinas, Data Privacy Act of 2012 at ang kaukulang Implementing Rules and Regulations nito, na may
karagdagang probisyon na ang lahat ng impormasyon dito ay protektado at hindi gagamitin para sa ibang
layunin maliban sa nabanggit na proyekto nang wala sa aking kaalaman at pagsang-ayon.
Name Pangalan Signature Pirma Date Petsa
Respondent
Taga-sagot
Interviewer
Taga-tanong
Field Supervisor
QC Editor
Encoder

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