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Household Template 9 -Form Fill

Household identification
Q01

State name
Q02

District name

Q03

Block name
Q04

Gram Panchayat Name
Q05

Village name
Q06

Status

Q07

Did this household receive the livestock/ fishery support from the BKBDP (Kosi) project?
Q08

Household number
Q09

GPS Coordinates
Q10

Religion of household head
Q11

Date of interview
Q12

Interview start time
Q13

Household's native language
Q14

Supervisor Name
Q15

Interviewer Name
Q16

How many total members live in this household.
Q17

How many children under 5 years old are in this household?
Q18

How many children between 6-14 years old are in this household?
Q19

How many children between 6-14 have attended school over the past 12 months?
Q20

How many people between 15-65 are in this household?
Q21

How many people above age 65 are in this household?
Q22

Name of the household head.
Q23

Sex
Q24

Age
Q25

Marital Status
Q26

What is the highest level of education "[S1Q01a]" has completed?
Household roster
A01

Member Code
A02

Please tell full names of each household member between 15 and 65 years old, starting from the head.
A03

Sex

A04

The relationship of A01 with the household head?
A05

Age
A06

Marital Status
A07

What is the highest level of education A01 has completed?
Migration intention
B01

Do you intend to migrate as a household in the next 12 months

B02

On a scale from 0-10, how certain are you that you will migrate in the next 12 months?
B03

Member ID
B04

Name
B05

Does [name] have any intentions to migrate in the next 12 months as an individual?
B06

On a scale from 1-10, how certain are you that you will migrate in the next 12 months?
B07

When did your household come to your present location?
B08

Where was your household residing before it moved to the current residence in [year]?
B09

Did you own your previous house?
B10

Has any household member permanently migrated since 2010?
Migration
C01

Member code
C02

Name
C03

Has "C02" gone to stay somewhere else for continuously 6 or more months over the past year?
C04

Has "C02" returned?
C05

Has "C02" gone to stay somewhere else for up to 3 months over the past year?
C06

Since 2010, how many times has [member] gone to stay somewhere else for up to 3 months in a given year?
C07

When did "C02" migrate last ?
C08

Where did "C02" migrate to during the last episode of migration?
C09

If local, use the code below "C02"
C10

If abroad, write country name "C02"
C11

When did "C02" return from migration?
C12

What was "C02" primary activity while migrated?
C13

What was "C02"s occupation during migration?
C14

What were "C02"s reasons for migrating
C15

In which year did the person leave?
C16

Where did this person go?
C17

What was the reason for permanent migration?
Flooding Shock Probability
D01

During the 2008 floods, did the area around your house get flooded?
D02

How deep was the 2008 flood in its worst moments?
D02A

Unit
D03

During the 2008 flooding in this region, how long was your homestead flooded?
D04

In the next 10 years, how deep do you think the worst flood will be in its worst moments? Please indicate using your body or an object and we will measure it using this tape measure. (Ideally, the enumerators would have a tape measure and they could indicate it on the tape measure, e.g., against their body.)
D04A

Unit
D05

Thinking about the 2008 flood, which happened because of the Kusaha embankment breach, how likely do you think it is for such a situation to repeat in the next 5 years? Rate your reponse form 1 to 5, with 1 being very unlikely, while 5 being very likely.
D06

Thinking about the next 25 years, how many times do you think flooding of 30 cm or greater will occur in your area?
D07

Thinking about the next 50 years, how many times do you think flooding of 43 cm or greater will occur in your area?
D08

Does your household presently use or is in possession of (including renting in and out) any land (both cultivated and non-cultivated)?
Land Ownership & Use > Land and Inputs during the last agricultural season
E01

How much land in total do you have (owned, rented, cultivated,non-cultivated, reclaimed, protected)
E01A

Unit
E02

Out of the total land area, how much land do you own?_Quantity
E02A

Unit
E03

Is it exclusively owned by your household or shared with other family members
E04

Have you reclaimed any land within the embankment since 2010?
E05

Is any of the land you cultivate considered "reclaimed land" (land that was once the river bed but now is available for farming)
E06

How much land have you cumulatively reclaimed from the embankment since 2010?_Quantity
E06A

Unit
E07

How much of reclaimed land do you currently cultivate?_Quantity
E07A

Unit
E08

Was this land cultivated before 2010?
E09

Out of the total land area, how much land are you renting in?_Quantity
E09A

Unit
E10

If renting in, how much do you pay in Cash (Rupees) for the use of the land?
E11

If renting in, how much do you pay in-kind (Rupees) for the use of the land?
E12

If renting in, how much Harvest Share (in percentage) do you pay for the use of land?
E13

Indicate the number of months this payment covers_Months
E14

How much of your land was rented out? _Quantity
E14A

Unit
E15

If renting out, how much do you receive in Cash (Rupees) or in- kind (Rupees) for the use of the land?
E16

If renting out, how much Harvest Share (in percentage) do you receive for the use of land?
E17

How many months did the rent cover?_Months
E18

Have you or any household members migrated to the spurs for agricultural purposes?
E19

Has this migration led to a change in the amount of agricultural land being used in protected/reclaimed areas?
E20

Amount Increase_Quantity
E20A

Unit
E21

Since the start of the spur construction, has the amount of area under cultivation increased for your household?
E22

Amount Increase_Unit
E23

Quantity
E24

Did you use any of the following agricultural inputs in the last growing season?
Land Ownership & Use > Agricultural inputs
F01

Item
F02

Did you use.
F02A

Unit

F03

Quantity

F04

Expenditure (Rs)
Land Ownership & Use > Irrigation
G01

How much of your land is irrigated for the current Rabi season?
G01A

Unit
G02

Quantity
G03

Do you practice the following irrigation techniques?

G03_1

Drip irrigation
G03_2

Canal irrigation
G03_3

Rain-fed irrigration
G03_4

Rahat system
G03_5

Tube well
G03_6

Sprinkler System
G03_7

Check dams/pond for water storage
G03_8

Manual watering
G03_9

Surface/flood/furrow irrigation
G03_10

Sub-irrigation (seepage)
G04

Do you own the following irrigation equipment?

G04_1

Drip irrigation line or tapes
G04_2

Sprinkler system
G04_3

water pump
G04_4

pipe and hoses
G04_5

filtration system
G04_6

moisture sensor
G04_7

flow meter
G04_8

power generator
Farming - Production
H01

Did your household engage in agricultural activities during the most recent Rabi or Kharif seasons?
H02

Can you recall and tell me if your family indulged in farming 10 years ago?
H03

What was the main crop you cultivated 10 years ago?
H04

How many types of crops did you plant in a year 10 years ago (up to 10 types)?
H05

How many types of crops did you grow in the last Kharif season?
H06

Crop Name
H07

Total area of land dedicated to this crop in the last Kharif season_Quantity
H07A

Unit
H08

Please specify the month and year in which you began planting in the last Kharif season
H09

Have you harvested in the last Kharif season?
H10

Please specify the month and year in which you began harvesting in the last Kharif season
H11

Total production from the harvest in the last Kharif season
H12

Total post-harvest loss since the last Kharif season
H13

Total amount in storage since the last Kharif season
H14

How much of the harvest was paid in kind?
H14A

Unit
H15

How much of the harvest was donated/given to family members?
H15A

Unit

H16

Home consumption since the last Kharif season_KG
H17

Total value of sales
H18

Can you recall and tell me if your family indulged in farming 10 years ago?
H19

What was the main crop you cultivated 10 years ago?
H20

How many types of crops did you plant in a year 10 years ago?
H21

How many types of crops did you grow in the last Rabi season?
H22

Crop Name
H23

Total area of land dedicated to this crop in the current Rabi season
H23A

Unit

H24

Please specify the month and year in which you began planting in the current Rabi season
H25

Have you harvested "[CALS3CQ0R]" in the current Rabi season?
H26

Please specify the month and year in which you began harvesting in the current Rabi season
H27

Total production from the harvest in the current Rabi season
H28

Total post-harvest loss since the current Rabi season
H29

Total amount in storage since the current Rabi season
H30

How much of the harvest was paid in kind?
H30A

Unit
H31

How much of the harvest was donated/given to family members?
H31A

Unit
H32

Home consumption since the current Rabi season
H33

Total value of sales

H34

Do you select different crops depending on your exposure to flood risk?
H35

How do you receive payments for your crops
H36

Is your Aadhar card linked to a mobile number for receiving government support?
Climate Past
I01

Weather event
I02

Have you ever experienced during the past 5 years (between 2019-2024)
I03

During the past 5 years (between 2019 and 2024), how frequently did you experience the following [CLIMATE/WEATHER EVENT] in this community?
I04

During the past 5 years (between 2019 and 2024), how frequently did you experience the following [CLIMATE/WEATHER EVENT] in this community?
I05

When did you experience the most recent in the past 5 years?
I06

When the most recent occurred, did any of the following happen?

I06_1

Damage to/loss of crop harvest.
I06_2

Damage to/loss of livestock.
I06_3

Damage to/loss of food stock.
I06_4

Damage to/collapse of main dwelling/farm buildings/business facilities
I06_5

Damage to/breakage of machinery/production equipment.
I06_6

Interruption/breakage of roads normally used by the household (to travel to work or to markets for sale of outputs/purchase of inputs, etc.).
I06_7

Displacement from homestead.
I07

In the most recent , did you receive early warnings?
I08

How did you receive the warning?
I09

What did you do about the early warning?
I10

During the most recent , how severe was the damage to your livestock?
I11

During the most recent , how severe was the damage to your crop harvest?
I12

During the most recent , how severe was the damage to your food stock?
I13

Were any household members killed or injured due to the most recent ?
I14

Overall, how many household members were killed due to ?
I15

Overall, how many household members were injured due to ?
I16

How long did the most recent last?
I17

During the most recent , How high did the water rise in your dwelling?
I17A

Unit
Climate Expectations
J01

Weather event
J02

Thinking of the worst [WEATHER EVENT] in the past 10 years. In the next 10 years, how many times do you expect that you will experience an like that?
J03

On a scale from 1 to 10 with 1 being impossible and 10 being absolutely certain, what is your subjective expectation of to happen at least once in the next 10 years?
J04

What actions have you taken (or are you planning to take) to adapt to ?
Intervention
K01

How close is your nearest agricultural field to the nearest embankment?
K01A

Unit
K02

Has an embankment spur in your village been improved or strengthened by the government since 2015?
K03

In your opinion, on a scale of 1 to 10 where 1 is not effective at all and 10 is very effective, how effective are the embankments in protecting your village from bad floods, like the flood from 2008?
K04

Hypothetically, would you be willing to contribute any money towards strengthening embankments by elevating spurs with additional materials in your village?
K05

How much would you be willing to contribute this year?
K06

Have you reported any concerns about embankment to the local community/community leaders
K07

Parameter
K08

Which type of transportation do you take to cummute to ?
K09

How satisfied are you with the quality of the road going to ?
K10

What are the reasons for dissatisfaction ?
K11

How do you transport your produce to the market?
K12

Last time you went to the nearest market, how much time does it take for you to travel to the nearest market?
K13

How much time does it take for you to travel to work?
K14

Which type of transportation do you take?
K15

How frequently do you travel outside your village via the roads that go in different directions and different destinations?
K16

Has a road or bridge close to you been repaired or rebuilt by the government since 2015?
K17

Do the new roads save you any time in transportation between places as compared to before it was made?
K18

If yes, how much time do you save to block HQ?
K19

If yes, how much time do you save to district HQ?
K20

Do you see any changes in the no. of facilities available to you or accessible by you after the construction of these roads?
K21

If yes, what type of facilities? (multiple response)
K22

Do you remember using boats to go across the Kosi river?
K23

When did you stop using boats to commute across the river?
K24

If uses till date, for what purpose?
K25

Why have you stopped using the boats?
Business or Labor Income
L01

Member Code
L02

Name
L03

Type of work

L04

Reasons for not working over the past 12 months?
L05

Category of work ?
L06

Subcategory

Salaried or wage earner
M01

Name
M02

On average, how many hours did you work per day for this ?
M03

On average, how many days did you work in a week ?
M04

How many weeks did you work last year ?
M05

Frequency of salary/ wage ?
M06

How much were you paid for this job per day/week/month ?
M07

Did you sign a contract for this employment
M08

How many types of unique business run in this household.
Self-employed or running a business
N01

Business Name
N02

How many members of your HH are involved in this business

N03

Number of employees (excluding household members)
N04

On average, how many hours did you work per day for this

N05

On average, how many days did you work in a week
N06

Months operated last year
N07

Annual work revenue in the last year
N08

Annual work expenditure in the last year
N09

How many years has this enterprise been running
N10

If your village were to experience a flooding of 43 cm depth (APPROXIMATELY UPTO THE LEVEL OF YOUR KNEES), what would be the total revenue of this business during the 30 days after the start of the flood
N11

Is the enterprise/ activity registered by the govt. or local govt.
Household Expenditure
O01

Member Name
O02

Expenditures on food and beverages over the past 7 days

O02_1

Fruits
O02_2

Vegetables
O02_3

Dairy Products
O02_4

Meats and Poultry
O02_5

Grains and cereals
O02_6

Pulses and Legumes
O02_7

Seafood
O02_8

Spices and condiments
O02_9

Liquid Beverages (Beer, bottled water, beverage came in liquid form)
O02_10

Dry beverages (tea, coffee bean, powdered drink)
O02_11

Snacks and savories
O02_12

Sweets and desserts
O02_13

Oils and Fats
O02_14

Pickles and preserves
O02_15

Nuts and seeds
O02A

Frequency

O02A_1

Fruits
O02A_2

Vegetables
O02A_3

Dairy Products
O02A_4

Meats and Poultry
O02A_5

Grains and cereals
O02A_6

Pulses and Legumes
O02A_7

Seafood
O02A_8

Spices and condiments
O02A_9

Liquid Beverages (Beer, bottled water, beverage came in liquid form)
O02A_10

Dry beverages (tea, coffee bean, powdered drink)
O02A_11

Snacks and savories
O02A_12

Sweets and desserts
O02A_13

Oils and Fats
O02A_14

Pickles and preserves
O02A_15

Nuts and seeds
O03

Purchase or exchange- Quantity
O03A

Purchase or exchange- Unit

O04

Purchase or exchange- Total Value

O05

Received from home produce, gift, subsidies, donations
O05A

Received from home produce, gift, subsidies, donations- Unit

O06

Received from home produce, gift, subsidies, donations- Value

O07

Source
O08

Non-food Expenditure over the past 365 days [Rupees]

O08_1

Rent or mortgage
O08_2

Construction materials
O08_3

Home repair
O08_4

Vehicle cost (Fuel, maintenance, etc)
O08_5

Festive/ceremonial spending
O08_6

Charitable Givings
O08_7

Education Expenditure
O08_8

Medical Expenditures
O08_9

Energy (fuel, wood, coal, kerosene, etc)
O08_10

Transportation
Assets
P01

Please tell which of the following durables your household has?

P01_1

Automobile(s)
P01_2

Motorbike(s)
P01_3

Bicycle(s)
P01_4

e-rickshaw
P01_5

rickshaw
P01_6

Pumping machine(s)
P01_7

Electricity generator(s)
P01_8

Landline telephone(s)
P01_9

Mobile telephone(s)
P01_10

Sewing machine(s)
P01_11

Color TV(s)
P01_12

Music rack of various kinds
P01_13

Radio/radio-cassette player(s)
P01_14

Disk player(s)
P01_15

Computer(s)
P01_16

Camera(s), video recorder(s)
P01_17

Refrigerator(s)
P01_18

Air conditioner
P01_19

Washing machine(s), (clothes-) drying machine(s)
P01_20

Electric fan(s)
P01_21

(Bath) water heater(s)
P01_22

Bed(s)
P01_23

Desk(s), chair(s), long bench(es), dressing table(s)
P01_24

Vacuum cleaner(s), dehumidifier(s), water filter(s)
P01_25

Microwave oven(s), baking oven(s)
P01_26

Juice extractor(s), citrus juicer(s)
P01_27

Solar Panel
P01_28

Solar heater
P01_29

Mix grinder
P01_30

Water Pump
P01_31

Chulha
P01_32

Charpoy
P01_33

Plough
P01_34

Tractor
P01_35

Thresher
P01_36

Non-agricultural Land
Farming- Livestock
R01

Was any Farmer Interest Group (FIG) formed in your village?
R02

Did the FIG seek interest from you for any kind of livestock rearing?
R03

If yes, you registered your interest in which of the following?
R04

Have you or someone in your household been supported by the government to build your livestock or fishery assets in the form of financial support or training?
R05

If yes, what benefit or support did you receive?

R06

Did you receive support
R07

Qty (number/ Rs)
R08

When did you receive this assistance? (specify the year)
R09

Frequency
R10

Are you or any member of your family a member of any farmer association or cooperative?
R11

Does any member of your household own any livestock at the present time?
R12

Do you own goats?
R13

Since when are you involved in goat rearing?
R14

How many goats did you own in the year 2023?
R15

Which breed of goats did you own?
R16

How many goats did you sell in that year?
R17

Where did you sell?
R18

How much revenue in total did you make from goat sales last year?
R19

How many goats did you consume?
R20

Do you own cattle?
R21

Since when are you involved in cattle rearing?
R22

How many cattle did you own in the year 2023?
R23

How much do they worth in total today?
R24

Which breeds of cattle did you have?
R25

How much revenue did you make from selling cattle during the past year?
R26

Where did you sell your cattle?
R27

How many litres of milk on an average did all the cattle produce per month?
R28

How much revenue did you make from selling milk on an average per month?
R29

Where did you sell the milk?
R30

How much of the milk produced per month was used for self- consumption? (in liter)
R31

How much of the total milk produced per month was converted to milk-based products (such as curd, paneer etc.) and sold?
R32

To whom did you sell the milk-based products?
R33

On an average, how much did you earn from the sale of milk- based products per month (in INR)?
R34

Do you engage in fish farming?
R35

Since when are you involved in fish farming?
R36

Where are you doing fish farming?
R37

What model do you engage with?
R38

Where did you source it from?
R39

What type of fishes did you farm?
R40

How much of fish did you purchase for farming in 2023?
R41

How much did you spend to acquire all the seedling/fingerling fro the fish in 2023?
R42

How much of the harvested fish did you sell in 2023? (in INR)
R43

Where did you sell the harvested fish?
R44

Do you engage in poultry farming?
R45

Since when are you involved in poultry farming?
R46

Where are you doing poultry farming?
R47

What model do you engage with?
R48

Where did you source it from?
R49

What breed of birds do you have?
R50

How much in total did you pay for the birds for farming in 2023?
R51

How many birds did you sell in 2023? (INR)
R52

Where did you sell the birds?
R53

What was the average selling price per bird?
R54

What was your average monthly expenditure (in INR)?
R55

Livestock
R56

Over the past 12 months, what is the associated

R56_1

Quantity
R56_2

Cost of feed used
R56_3

Actual Revenue (Rs) (Sales of animal, products, etc)
R56_4

Actual Revenue (Rs) (Sales of animal, products, etc)
Finances
S01

Does your household have a bank account?
S02

In the past 12 months, have you saved money in any means? Ways of savings may include banks, cash at home, friends and family, other associations, or an (informal savings association).
S03

How much money have you saved in the last 30 days?
S04

In the past 12 months, have you borrowed money or taken any loans?
S05

Borrowing Source
S06

Have you ever borrowed or are borrowing from this source?

S07

Amount
S08

Repayment duration
S09

In the past 12 months, have you lent money or given any loans?
S10

Recipient of lending
S11

Is this Recipient of lending
S12

Amount
S13

Repayment duration

Housing
T01

Please give us some information on your household's accommodation.
T02

In how many dwellings does your household actually live?
T03

Total residential area?
T03A

Unit
T04

Do you have a toilet facility in your house?
T05

In which year did your household begin living in this housing accommodation?
T06

Who owns the main housing accommodation that your household lives in?
T07

Does your household pay rent? (in cash or kind)
T08

How much have you spent on rents over the past 12 months? (both in cash and values of kind)
T09

How would you rate the overall condition of the house?
T10

What is the main material of the roof of the house where your household lives now?
T11

What is the main material of the walls or surroundings of the house where the household lives now?
T12

How would you rate the overall sanitation and cleanliness of the house?
T13

Which type is this housing accommodation?
Mental Health
U01

Name
U02

Think of a ladder, with the best possible life for them being a 10 and the worst possible life being a 0. Please rate your current life