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Household Template 44 -Form Fill
Identification Information
Q01
District Name
Q02
District code
Q03
Block Name
Q04
Block Code
Survey Information
A01
Name of the respondent
A02
Designation of the respondent
Chairperson, Zila Parishad
Vice-Chairperson, Zila Parishad
Member of the Panchayat Samiti (Block)
Mukhiya/Sarpanch
DPRO
Others (specify)
A03
Can you tell us your mobile number?
A04A
Can you tell us the status of zilla parishad?
Active
In the process of dissolving
Suspended
A04B
What has been the reason for the suspension of Zila Parishad?
A05
Respondent identification code
A05A
GPS Coordinates
A06
FIRST VISIT
A06_1
Interviewer name
A06_2
Interviewed code
A06_3
Date of the interview
A06_4
Result of the interview
Interview complete
Visit rescheduled
Interview incomplete
Refused
Respondent is out of station for an extended period
Respondent is temporarily away
Other (specify)
A06_5
Record time when you start the interview
A06_6
Record time when you end the interview
A07
SECOND VISIT
A07_1
Interviewer name
A07_2
Interviewed code
A07_3
Date of the interview
A07_4
Result of the interview
Interview complete
Visit rescheduled
Interview incomplete
Refused
Respondent is out of station for an extended period
Respondent is temporarily away
Other (specify)
A07_5
Record time when you start the interview
A07_6
Record time when you end the interview
A08
THIRD VISIT
A08_1
Interviewer name
A08_2
Interviewed code
A08_3
Date of the interview
A08_4
Result of the interview
Interview complete
Visit rescheduled
Interview incomplete
Refused
Respondent is out of station for an extended period
Respondent is temporarily away
Other (specify)
A08_5
Record time when you start the interview
A08_6
Record time when you end the interview
Constitutional and Statutory Obligations
B01
Since how many years/ months have you been working in this department/institution?
B02
Can you tell us the procedure followed for the election of the office bearers, especially the Adhyaksha?
B03
Was it a unanimous decision during the last selection for the position of Adhyaksha?
Yes
No
B04
Please tick all the committees that the Zila Parishad has
General Standing committee
Finance, Audit, and Planning committee
Production Committee
Social Justice Committee
Education Committee
Committee on Public Health, Family Welfare, and Rural Sanitation
Public Works Committee
Others
B05
Name of the committee present and details of the members of the committee
B05_1
Name of the committee
B05_2
Are the following posts filled?
committee
Secretary of the committee
B05_3
Name of the member
B05_4
Gender of the member
Male
Female
B05_5
Caste of the member
SC
ST
OBC
General
Not comfortable in sharing
Others
B05_6
The action was taken by the committee the last year
B05_7
Impact/Changes brought by the action of the sub-committee
B05_8
Has the committee prepared/ released any report in the previous years?
Yes
No
B05_9
Mode of communication to reach the member available in the public domain
Phone Number
Email id
Social media details
All the above
Others
B06
What is the number of meetings at Zila Parishad attended by the Rajya Sabha members last year?
B07
In the last year did any members of parliament pay a visit to the ZP?
Yes
No
B08
In the last two years, has there ever been an instance where a no-confidence motion has been filed against Adhyaksha or Up-Adhyaksha?
Yes
No
B09
Can you tell us about the situation in which the no-confidence motion was filed and the consequences?
B10
In the last two years, have there been instances where the Zila Parishad has been dissolved or has been in the process, and a new Zila Parishad was formed?
Yes
No
B11
Can you tell us the reason why the Zila Parishad was dissolved?
B12
Are there any immediate family members of the office bearers working in the same Zila Parishad?
Yes
No
Roles, Responsibility, and Good Governance
C01
Which of the following facilities does your Zila Parishad have?
A separate building/ office space
Drinking water facility
Toilet facility
24*7 electricity supply
Fans or air-conditioners
Separate toilets for men and women
Conference hall with a capacity of at least 25 members
Use of Computer and electronic media
IT intervention and mode of modern communicating and reporting and digital access
Public library
The method of attendance capture is electronic or fingerprint-based
Waiting areas for the general public
Separate cabins/ rooms for separate departments
Separate cabins/ rooms for all staff members
Special assistance for senior citizens physically challenged people, pregnant women, etc. (like wheelchairs or separate waiting rooms)
Others (specify)
C02
What is the total no. of Zila Parishad meetings (full sessions) conducted last year?
C03
From the total number of meetings conducted last year, how many were emergency meetings, and how many were scheduled?
C04
Have the minutes of the last three meetings been recorded and signed by the president?
Yes
No
C05
Is the attendance of the ZP members marked and tracked through a biometric device?
Yes
No
C06
If not, can you tell us about the guidelines and how the members' attendance is marked and tracked?
C07
Has the Zila Parishad provided any training to its members?
Yes
No
C07A
Topics covered in training (List out)
C07B
Who conducted this training?
Government
NGO
External Agency
State Panchayat Resource Centre (SPRC)
Others (please specify)
C07C
How many days of training have been conducted?
C08
Does the ZP have guidelines listed down for the procurement of goods?
Yes
No
C09
Can you tell us about the guidelines for the procurement of goods?
C10
Does the Zila Parishad have a grievance redressal mechanism?
Yes
No
C11
Please explain the grievance redressal mechanism that is followed.
C12
Has the ZP utilized technology to improve the processes followed and governance?
Yes
No
C13
If yes. Can you tell us how technology was used to improve processes and governance?
C14
Is there a mechanism for disaster management planning and control available in ZP?
Yes
No
C15
What steps has the ZP done in managing any disaster that may have happened in the last 2 years?
Assessment of Human resources and Core Zila Parishad Functionaries
D01
Who among the listed staff is externally hired?
Safai Karamchari
Security Personnel
Peons
Drivers
None of the above posts
D02
Are you aware of the 15th Finance Commission?
Yes
No
D03
If yes, has there been any meeting conducted or not in this regard? (Feb 2022 onwards)
Yes
No
D04
In the last two years, have there been any issues raised/discussed regarding the unavailability of Doctors, Specialists, Nurses, and Community Health Officers?
Yes
No
D05
How many issues have been raised/discussed regarding the unavailability of Doctors, Specialists, Nurses, and CHOs?
D06
Were the issues that were raised/discussed resolved?
Yes
No
D07
If yes, can you tell us the solution that was brought about for the issues and in how much time?
D08
If not, why was the issue not resolved?
D09
In the last two years, have there been any issues raised/discussed regarding the unavailability of ANMs, ASHA Workers, and Anganwadi Workers?
Yes
No
D09A
Does your Zila Parishad have the following position?
D09A_1
Adhyaksha
Yes
No
D09A_2
Up-Adhyaksha
Yes
No
D09A_3
Pradhan of Panchayat Samitis
Yes
No
D09A_4
CEO
Yes
No
D09A_5
Any Other (specify)
Yes
No
D09B
Is this position currently filled or vacant?
D09B_1
Adhyaksha
Filled
Vacant
Don't know
D09B_2
Up-Adhyaksha
Filled
Vacant
Don't know
D09B_3
Pradhan of Panchayat Samitis
Filled
Vacant
Don't know
D09B_4
CEO
Filled
Vacant
Don't know
D09B_5
Any Other (specify)
Filled
Vacant
Don't know
D09C
Why is this position vacant?
D09C_1
Adhyaksha
Hiring under process
Lack of budget
Not required/ substitute available
Others (specify)
D09C_2
Up-Adhyaksha
Hiring under process
Lack of budget
Not required/ substitute available
Others (specify)
D09C_3
Pradhan of Panchayat Samitis
Hiring under process
Lack of budget
Not required/ substitute available
Others (specify)
D09C_4
CEO
Hiring under process
Lack of budget
Not required/ substitute available
Others (specify)
D09C_5
Any Other (specify)
Hiring under process
Lack of budget
Not required/ substitute available
Others (specify)
D09D
The number of people who have been hired for this position
D09D_1
Adhyaksha
D09D_2
Up-Adhyaksha
D09D_3
Pradhan of Panchayat Samitis
D09D_4
CEO
D09D_5
Any Other (specify)
D09E
What is the gender of the member?
D09E_1
Adhyaksha
Male
Female
Other
Don't know
D09E_2
Up-Adhyaksha
Male
Female
Other
Don't know
D09E_3
Pradhan of Panchayat Samitis
Male
Female
Other
Don't know
D09E_4
CEO
Male
Female
Other
Don't know
D09E_5
Any Other (specify)
Male
Female
Other
Don't know
D09F
What is the caste category of the members?
D09F_1
Adhyaksha
SC
ST
OBC
General
Not comfortable answering
Others
D09F_2
Up-Adhyaksha
SC
ST
OBC
General
Not comfortable answering
Others
D09F_3
Pradhan of Panchayat Samitis
SC
ST
OBC
General
Not comfortable answering
Others
D09F_4
CEO
SC
ST
OBC
General
Not comfortable answering
Others
D09F_5
Any Other (specify)
SC
ST
OBC
General
Not comfortable answering
Others
D09G
Has there ever been a police complaint/FIR filed against the member?
D09G_1
Adhyaksha
Yes
No
D09G_2
Up-Adhyaksha
Yes
No
D09G_3
Pradhan of Panchayat Samitis
Yes
No
D09G_4
CEO
Yes
No
D09G_5
Any Other (specify)
Yes
No
D10
Apart from the positions mentioned above are there any other positions that are currently vacant?
Yes
No
D11
If yes, can you tell us the positions that are currently vacant?
D12
Can you tell us know if the ZP follows any processes to expedite the process of filling the vacancies?
D13
What are the processes followed by the ZP to expedite the process?
Reporting, Record-keeping, Grants, and Expenditure
E01
Does your office have the following documents for the following years?
E01A
2018-19
E01A_1
Annual budget document
Yes
No
E01A_2
Annual Administrative report
Yes
No
E01A_3
Audit report
Yes
No
E01A_4
Monitoring reports from all the Gram Panchayat
Yes
No
E01B
2019-20
E01B_1
Annual budget document
Yes
No
E01B_2
Annual Administrative report
Yes
No
E01B_3
Audit report
Yes
No
E01B_4
Monitoring reports from all the Gram Panchayat
Yes
No
E01C
2020-21
E01C_1
Annual budget document
Yes
No
E01C_2
Annual Administrative report
Yes
No
E01C_3
Audit report
Yes
No
E01C_4
Monitoring reports from all the Gram Panchayat
Yes
No
E02
Is the annual Budget and planning report collected from each Panchayat Samiti, appraised, and approved?
Yes
No
E03
If yes, can you tell us the mechanism followed for monitoring, submitting, and approving budget plans?
E04
What are the books of records available in this Zila Parishad?
E04A
Availability of physical record
E04A_1
Asset Register
Yes
No
E04A_2
Cashier Cash Book
Yes
No
E04A_3
Daily Collection Register
Yes
No
E04A_4
Grant Register
Yes
No
E04A_5
Stock Register
Yes
No
E04A_6
Advance ledger
Yes
No
E04B
Availability of digital record
E04B_1
Asset Register
Yes
No
E04B_2
Cashier Cash Book
Yes
No
E04B_3
Daily Collection Register
Yes
No
E04B_4
Grant Register
Yes
No
E04B_5
Stock Register
Yes
No
E04B_6
Advance ledger
Yes
No
E04C
Last date of update of Physical record
E04C_1
Asset Register
E04C_2
Cashier Cash Book
E04C_3
Daily Collection Register
E04C_4
Grant Register
E04C_5
Stock Register
E04C_6
Advance ledger
E04D
Is the register maintained in the govt prescribed format?
E04D_1
Asset Register
Yes
No
E04D_2
Cashier Cash Book
Yes
No
E04D_3
Daily Collection Register
Yes
No
E04D_4
Grant Register
Yes
No
E04D_5
Stock Register
Yes
No
E04D_6
Advance ledger
Yes
No
E05
Has this Zila Parishad tried to digitize the records?
Yes
No
Budget, Income, Grants, and Expenditure of the Zila Parishad
F01
Are the budget estimates based on the average of the last year's actual income and expenses? (in INR)
F01A
2018-19
F01A_1
Total revenue
F01A_2
Total expenditure
F01A_3
Net profit/loss
F01A_4
Total fixed assets
F01A_5
Total grants
F01A_6
Total Grants surrendered
F01B
2019-20
F01B_1
Total revenue
F01B_2
Total expenditure
F01B_3
Net profit/loss
F01B_4
Total fixed assets
F01B_5
Total grants
F01B_6
Total Grants surrendered
F01C
2020-21
F01C_1
Total revenue
F01C_2
Total expenditure
F01C_3
Net profit/loss
F01C_4
Total fixed assets
F01C_5
Total grants
F01C_6
Total Grants surrendered
F02
Has the ZP undertaken any revenue generation activities in the last three years?
Yes
No
F03
If yes, what are the initiatives/activities that have been taken by the ZP in the last 3 years?
F04
Does this Zila Parishad have an SOP in place for conducting business transactions?
Yes
No
F05
Can you tell us the process followed in the disbursement of the funds/grants?
F06
What percentage of funds and expenditure is paid online and in cash?
Online Method
Cash Transactions
Development Activities by Zila Parishad
G01
What is the total allocated budget and expenditure for the following activities?
G01_1
Agricultural related activities
G01_2
Land improvement activities
G01_3
Promotion of cultivation of fruits, vegetables, and other cash crops
G01_4
Fishery Development
G01_5
Market the product of small-scale industries, khadi, handloom, and village cottage industries and promote the Artisans
G01_6
Promoting educational activities
G02
What were the top major/innovative activities undertaken by ZP in the last 3 years?
G02_1
Agricultural related activities
G02_2
Land improvement activities
G02_3
Promotion of cultivation of fruits, vegetables, and other cash crops
G02_4
Fishery Development
G02_5
Market the product of small-scale industries, khadi, handloom, and village cottage industries and promote the Artisans
G02_6
Promoting educational activities
G02_7
Poverty Alleviation Activities
G03
How much training in agriculture has been conducted under this Zila Parishad in the last three years?
G03_1
2018-19
G03_2
2019-20
G03_3
2020-21
G04
How many have storage facilities like cold storage and godown been established under this Zila Parishad in the last three years?
G04_1
2018-19
G04_2
2019-20
G04_3
2020-21
G05
How many irrigation projects have been started under this Zila Parishad in the last three years?
G05_1
2018-19
G05_2
2019-20
G05_3
2020-21
G06
Are you aware of any illegal soil mining happening in your district?
Yes
No
G07
How many villages are there under this Zila Parishad?
G08
How many villages have been fully electrified under this Zila Parishad?
G09
What are the plans for increasing the coverage of electrification villages under this Zila Parishad?
G10
How many veterinary hospitals or dispensaries have been constructed/renovated/developed by this Zila Parishad in the last 3 years?
G10_1
2018-19
G10_2
2019-20
G10_3
2020-21
G11
How many mobile diagnostics & clinics have been constructed/renovated/developed by this Zila Parishad in the last 3 years?
G11_1
2018-19
G11_2
2019-20
G11_3
2020-21
G12
How many farms (breeding farms for cows, pigs, and poultry farms) have been constructed /developed by this Zila Parishad in the last 3 years?
G12_1
2018-19
G12_2
2019-20
G12_3
2020-21
G13
How many have cold storage facilities been constructed/renovated/developed by this Zila Parishad in the last 3 years?
G13_1
2018-19
G13_2
2019-20
G13_3
2020-21
G14
How many times has the ZP collaborated with the District health society for responding to any health crisis?
G14_1
2018-19
G14_2
2019-20
G14_3
2020-21
G15
What is the distance of the roads in KM that were newly constructed or renovated by this Zila Parishad in the last 3 years?
G15_1
2018-19
G15_2
2019-20
G15_3
2020-21
G16
How many skill trainings were conducted to promote the small-scale industries by this Zila Parishad in the last 3 years?
G16_1
2018-19
G16_2
2019-20
G16_3
2020-21
G17
How many hospital (Sub-Center, HWC, or APHC) buildings have been constructed or renovated by this Zila Parishad in the last 3 years?
G17_1
2018-19
G17_2
2019-20
G17_3
2020-21
G18
How many medical camps have been set up by this Zila Parishad in the last 3 years?
G18_1
2018-19
G18_2
2019-20
G18_3
2020-21
G19
What are the different community health-related activities undertaken by the Zila Parishad in the last 3 years?
G20
How many student hostels have been constructed or renovated by this Zila Parishad in the last 3 years?
G20_1
2018-19
G20_2
2019-20
G20_3
2020-21
G21
How many scholarships have been distributed to the SC/ST category students by this Zila Parishad in the last 3 years?
G21_1
2018-19
G21_2
2019-20
G21_3
2020-21
G22
How many scholarships have been distributed to the students from other caste categories by this Zila Parishad in the last 3 years?
G22_1
2018-19
G22_2
2019-20
G22_3
2020-21
G23
What have been initiatives taken by the ZP against child marriage, dowry harassment, or any other social issue present in the district?
G24
Do the health facilities have a functional ambulance or other emergency vehicles for clients stationed at or operating from this facility?
Yes
No
G25
Are the records of the health facilities being digitally printed?
Yes
No
G26
Please tell us the number of CHC and PHC which have been provided the following facilities?
G26A
Number of CHC
G26A_1
Clean drinking water
G26A_2
Toilets/sanitation facilities
G26A_3
Solar power intervention
G26B
Number of PHC
G26B_1
Clean drinking water
G26B_2
Toilets/sanitation facilities
G26B_3
Solar power intervention
G27
At any given time in the day, can anybody avail of medical facilities/ services at PHC/ CHC?
Yes
No
G28
What is the frequency of attending meetings with the district health society?
Daily
Weekly
Fortnightly
Others
G29
Has the ZP provided any training to the health care workers in the last year?
Yes
No
G30
What is the training provided to the health care workers?
G31
Do the ZP officials undertake supervision visits to the various health centers?
Yes
No
G32
Are there any other ways the ZP officials have helped improve the efficiency of the health care systems?
G33
Is there any grievance redressal mechanism available in ZP for healthcare users?
Yes
No
G34
Has the ZP conducted social audits of the healthcare programs?
Yes
No
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