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Household Template 31 -Form Fill

General Information
Q01

State Name
Q02

District Code
Q03

District Name
Q04

Block Code
Q05

Block Name
Q06

Village Name

Q07

Address/location of the household
Q08

Interviewer Code
Q09

Interviewer name
Q10

Date of Interview
Respondent Information
A01

Full name of the respondent
A02

Name of the household head
A03

How are you related to the household head
A04

Phone Number
A05

Sex of the respondent
A06

Are you a member of any of the following groups?

A06_1

SHG
A06_2

FPO /FPC (Farmer Producer Org./Company)
A06_3

Any other farmer cooperative or company
Socio-economic status of Household
B01

Does your family own this house?
B02

What is the type of your house?
B03

How many rooms are there in your house?
B04

What is the source of drinking water for members in the house?
B05

Is the water available throughout the year
B06

Do you have a toilet in your house?
B07

What is the main source of lighting in your house?
B08

What type of fuel does your HH use for cooking?
B09

Does your HH own the following?

B09_1

Electricity connection
B09_2

Pressure cooker

B09_3

Mixer/grinder

B09_4

Motorcycle/scooter

B09_5

Car/Jeep

B09_6

Tractor

B09_7

Bicycle

B09_8

Animal-drawn cart

B09_9

Chair

B09_10

Table

B09_11

Cot/ Bed

B09_12

Mattress

B09_13

Clock or watch

B09_14

Electric fan

B09_15

Chapakkal

B09_16

Water pump house

B09_17

Pump field

B09_18

Thresher

B09_19

Radio/Transistor

B09_20

Sewing machine

B09_21

Refrigerator

B09_22

B & W television

B09_23

Colour television

B09_24

Telephone

B09_25

Computer

B09_26

Cell Phone (Basic)

B09_27

Cell Phone (Smart)

B09_28

Laser land leveller

B09_29

Rotavator

B09_30

Disc harrow

B09_31

Cultivator

B09_32

Seed drill

B09_33

Power sprayer

B09_34

Combine harvester

B09_35

Others (please specify)
Social and economic empowerment of women
C01

Are you currently a member of any village committees (water committee, forest committee) related to agriculture or farming?
C02

If yes, please specify the type(s) of committees you are a part of. (Select all that apply)
C03

Do you hold any leadership positions in these committees (e.g., president, secretary, treasurer)?
C04

How often do you attend and participate in committee’s meetings?
C05

Do you hold any leadership positions in local government (Panchayati raj institutions, etc.)?
C06

Does your household have any agricultural land? 
C07

How much land do you own/Lease? 
C07A

Do you own land against your name?
C07B

How much land is against your name?
C08

Do you currently engage in sharecropping, where you cultivate land owned by someone else in exchange for a share of the harvest or other agreed-upon arrangements?
C09

Do you own agricultural assets such as machinery, tools, and livestock?
C10

Do you have access to finance?
C11

What are the different financial products you have used?
C12

Do you actively participate in decision making regarding production activities in the household ?
C13

In which production activities do you actively engage in decision-making?
Land and water management practices (Ecological restoration)
D01

How many plots of agricultural land does your household currently own?
D02

Out of the owned plots, how many are currently under cultivation?

D03

Plot

D04

Soil Management
D05

Water Management
D06

Crop Rotation
D07

Pest and Disease Management:
D08

Conservation Measures:
D09

What is the primary source of irrigation for your agricultural activities?
D10

Do you currently practice any water conservation methods on your farm?
D11

What are the various water conservation practices you implement?
Income levels and economic resilience
E01

What is the primary(highest revenue generating) means of livelihood for your household?
E02

Which seasons do you cultivate crops in?

E03

Crop Roster
E04

What crops did you cultivate during last 3 seasons (only include those crops which were sold)?
E05

How much land did you use to cultivate this [CROP]?
E06

What was the total quantity produced (homestead + farm)?

E07

How much produce did you sell to the following?

E08

Can you provide a detailed breakdown of the expenses associated with cultivating [specific crop] in the last agricultural cycle?

E08_1

Buying fertilizer and seeds
E08_2

Ploughing and preparing farm
E08_3

Buying pesticides
E08_4

Cost of irrigation
E08_5

Labor cost
E08_6

Equipment and material cost
E08_7

Others (specify)
E09

What was the total revenue you earned from selling in last season [CROP]?
E10

Have you been trained on climate-smart agriculture practices ?
E11

If yes, when did you receive this training?

E12

Who provided the climate-smart agriculture training?
E13

Can you name at least three climate-smart agriculture practices you learned during the training?
E14

Have you been practicing climate-smart agriculture practices?
E15

If yes, please specify the practices you have implemented in the past 12 months?
Regenerative Agriculture
F01

Have you used high-quality regenerative/organic seeds in last 3 agricultural cycles?
F02

Name the crops for which you have used regenerative/organic seeds?

F03

Have you used organic seed for this crop?
F03A

Where did you procure these seeds from?
F04

Have you used organic fertilizer for this crop?
F05

Where did you procure the fertilizer from?
F06

Have you used organic insecticides/botanicals?
F07

Where did you procure the insecticides/botanicals from?
F08

Have you received trainings on regenerative agriculture practices in last 12 months?
F09

Can you name at least three regenerative agriculture practices you learned during the training?
F10

Who provided the regenerative agriculture training?
F11

Since adopting regenerative agriculture practices (regenerative seeds, fertilizers, botanicals) have you observed changes in yield?
F12

If yes, how has the change in yield resulted?
F13

Since adopting regenerative agriculture practices (regenerative seeds, fertilizers, botanicals) have you observed changes in key indicators such as selling price of the produce?
F14

If yes, how has the change in price resulted?
F15

Since adopting regenerative agriculture practices (regenerative seeds, fertilizers, botanicals) have you observed changes in key indicators such as quality of produce?
F16

If yes, how has the change in quality of produce resulted?