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Village Level Template -Form Fill

IDENTIFICATION PARTICULARS
Q01

Do you agree to participate in the survey?
Q02

Interviewer Name

Q03

Interviewer NFID
Q04

Supervisor Name

Q05

Supervisor NFID
Q06

State name

Q07

state code
Q08

District name
Q09

district code
Q10

Block name
Q11

block code
Q12

Gram panchayat name
Q13

gram panchayat code
Q14

Sample village name
Q15

Sample village code
Q16

Type of District – aspirational or developed?
Q17

Date of visit
Q18

Time of visit
Q19

GPS Coordinates for the Location:

Q20

No. of respondents
RESPONDENT & INSTITUTION PARTICULARS
A01

Respondent 1

A01_1

Name of respondent
A01_2

Please mention your designation
A01_3

Contact telephone number
A01_4

Age (in completed years)
A01_5

Sex of respondent
A02

Respondent 2

A02_1

Name of respondent
A02_2

Please mention your designation
A02_3

Contact telephone number
A02_4

Age (in completed years)
A02_5

Sex of respondent
A03

Respondent 3

A03_1

Name of respondent
A03_2

Please mention your designation
A03_3

Contact telephone number
A03_4

Age (in completed years)
A03_5

Sex of respondent
Can you please provide some details about your Village?
B01

Total Population
B02

Total Households
B03

Is there an all-weather motorable road leading to the village?
B03A

Distance from Motorable Road (km)
B04

What proportion of the roads in the village are brick-paved or cemented?

B05

Distance from River Ferry (km)
B06

Distance from 11 kV line (km)
B07

Distance from permanent market (km)
B08

No. of Primary school
B09

No. of Middle school
B10

No. of High school
B11

No. of households having piped water supply
B12

PDS/Ration Shop
B13

How many households are involved in the following occupations?

B13_1

Agriculture and allied activities
B13_2

Small scale/cottage industries
B13_3

Salaried employment
Agriculture Details
C01

Can you show me the village map?

C02

No. of small, medium and large farmers
C03

No. of farmers who practice subsistence agriculture
C04

No. of farmers who undertake irrigation
C05

No. of farmers using solar pumps for irrigation
Can you please provide details about the status of electrification in your village?
D01

Is the village 100% electrified?
D01A

In which year was the village electrified?
D02

Does your village receive electricity from the main grid (state electricity supply board), from a solar mini grid or solar plant, or grid based on Rooftop Solar grid?
D02A

What is the primary source of power for the village?
D03

Nearest Grid Substation, and Distance from the village (km)
D04A

Are the main grid connections metred?
D04B

What is the frequency of billing?

D04C

How are collections done for electricity bills in the village?

D04D

Do villagers have overdue bills for main grid electricity supply?
D04E

Is electricity supply disconnected due to non-payment of bills?

D04F

After how many months of non-payment is the supply disconnected?
D04G

Are institutions (school, AWC, Panchayat Bhawan, Sub-Centre, etc) provided with free or paid connections?
D04H

What is the tariff structure for institutional connections?
D04I

In case of separate tariff structure for institutions, please provide the following details

D04I_1

One-time connection cost
D04I_2

Fixed cost component
D04I_3

Per unit charge
D04J

What is the electricity tariff in neighbouring villages or other parts of the state?
D05

Can you tell us the number of connections in each category?

D05_1

Domestic
D05_2

Commercial
D05_3

Industrial
D05_4

Community/institutional

D05_5

How many households in the village do not have electricity connections?
D05_6

How many institutions do not have electricity connections?
D05_7

How many commercial establishments do not have electricity connections?
D06

As per your view, do the households face any challenge with the current grid supply?
D07

If the households in your village face any challenge with the grid electricity supply, what are the reasons there of?
D07A

On an average, how many hours of electricity is provided in a day?
D07B

How frequently do power outages/disruptions happen?
D07C

Is there a particular time in a day when power outages/disruptions are more frequent?
D07D

Has there been any improvement in the quality of supply of electricity (no. of hours of supply, voltage stability, etc.) in the last five years?
D08

Is there any demand for mini grid/solar plant electricity supply in your village?
D08A

Are there any local mini grid/solar plant projects?
D09

Number of mini grids/solar plants and Capacity in kW

D09_1

No. of mini grids/solar plants
D09_2

Grid capacity (in kW)
D09_3

Inverter capacity (in kW)
D10

Average no. of HHs supplied mini grids/solar plants
D11

Average hours of service per day
D12

Total average Expenditure per month per household
D12_1

Are the mini grid/solar plant connections metred?
D12_2

What is the frequency of billing?

D12_3

How are collections done for electricity bills in the village?
D12_4

Do villagers have overdue bills for mini grid/solar plant electricity supply?
D12_5

Is electricity supply disconnected due to non-payment of bills?

D12_6

After how many months of non-payment is the supply disconnected?
D12_7

Are institutions (school, AWC, Panchayat Bhawan, Sub-Centre, etc) provided with free or paid connections?
D12_8

What is the tariff structure for institutional connections?
D12_9

In case of separate tariff structure for institutions, please provide the following details

D12_9A

One-time connection cost
D12_9B

Fixed cost component
D12_9C

Per unit charge
D12_9D

Pre-paid recharge amount
D13

On a scale of 1-5 (1=Extremely dissatisfied and 5=Extremely satisfied), how satisfied are households with the current mini grid/solar plant supply?
D14

If the households in your village face any challenge with the mini grid/solar plant electricity supply, what are the reasons there of?
D15

Between grid electricity supply and mini grid/solar plant supply, as per you, which one is better from consumer point of view?
D16

If grid electricity supply is better from consumer point of view, what is the reason there of?
D17

If mini grid/solar plant supply is better from consumer point of view, what is the reason there of?
D18

If a new community-based nano/micro/mini/community level bio-mass gasifier plant is built in the village/cluster of villages, designed for the aspirational service level (24X7 supply), it may hypothetically cost 8 lakh rupees. Would your village be willing to contribute to some part of the capital cost? How much could be the level of contribution that your village and the villagers would be willing to share?
D19

Would the contribution be in cash, kind, or with labour contribution – or a mix of these?
Commercial and institutional establishments
E01

Which of these commercial establishments and institutions are present in your village? Please select all that apply.

How many Irrigation pump sets are working in your village?
F01

Electric
F02

Diesel (fixed/movable)
F03

Kerosene (fixed/movable)
F04

Solar
Industrial Establishments
G01

Which of these industrial establishments are present in your village? Please select all that apply.
Knowledge, Attitude and Practices (KAP) Assessment
H01

Please tell me whether you agree or disagree with each of the statements.

H01_1

With electricity availability, children are able to study after sunset for longer hours.

H01_2

People work longer hours in the house with electricity availability.

H01_3

Women spend more hours on cooking.

H01_4

People are taking up skilling activities which are facilitated by electricity availability.
H01_5

People are taking up household enterprises which are facilitated by electricity availability.
H01_6

People are taking up commercial enterprises which are facilitated by electricity availability.
H01_7

Commercial establishments are able to mechanize rapidly due to stable and reliable electricity supply
H01_8

Households own a greater number of electronic gadgets.
H01_9

More villagers are undertaking digital/online payments as a result of using smart phones.
H01_10

It is easier to move about after dark.

H01_11

There has been an increase in insects in the house due to lighting.

H01_12

Fear from getting bitten by snakes has decreased.
H01_13

Incidences of molestation and other harassment has increased.
H01_14

There has been decrease of thieving activities.
H02

Please tell me whether you agree or disagree with each of the statements.

H02_1

There are streetlights in some parts of our village.
H02_2

Wild animals like elephants have stopped entering the village.
H02_3

Irrigation has become more affordable due to the use of solar water pumps.

H02_4

Mechanization of agriculture has improved crop diversity.
H02_5

Most of the public institutions in our village (like - Panchayat Bhawan, Schools, Anganwadi, Health Sub-Centre) have electricity connection.
H02_6

There are people in our village (Panchayat, FPO, community-based organizations) who take up responsibility for meter reading.

H02_7

There are people in our village (Panchayat, FPO, community-based organizations) who help with the collection of electricity payments.
H02_8

There are households in the village who have illegal electricity connections.
H02_9

Using solar energy is good for the environment as it reduces pollution.
H02_10

Solar energy is affordable and accessible to people in the village.