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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

A03

Can you tell us your mobile number?

A04A

Can you tell us the status of zilla parishad?

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

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

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

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?

B04

Please tick all the committees that the Zila Parishad has

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?

B05_3

Name of the member

B05_4

Gender of the member

B05_5

Caste of the member

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?

B05_9

Mode of communication to reach the member available in the public domain

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?

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?

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?

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?

Roles, Responsibility, and Good Governance
C01

Which of the following facilities does your Zila Parishad have?

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?

C05

Is the attendance of the ZP members marked and tracked through a biometric device?

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?

C07A

Topics covered in training (List out)

C07B

Who conducted this training?

C07C

How many days of training have been conducted?

C08

Does the ZP have guidelines listed down for the procurement of goods?

C09

Can you tell us about the guidelines for the procurement of goods?

C10

Does the Zila Parishad have a grievance redressal mechanism?

C11

Please explain the grievance redressal mechanism that is followed.

C12

Has the ZP utilized technology to improve the processes followed and governance?

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?

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?

D02

Are you aware of the 15th Finance Commission?

D03

If yes, has there been any meeting conducted or not in this regard? (Feb 2022 onwards)

D04

In the last two years, have there been any issues raised/discussed regarding the unavailability of Doctors, Specialists, Nurses, and Community Health Officers?

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?

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?

D09A

Does your Zila Parishad have the following position?

D09A_1

Adhyaksha

D09A_2

Up-Adhyaksha

D09A_3

Pradhan of Panchayat Samitis

D09A_4

CEO

D09A_5

Any Other (specify)

D09B

Is this position currently filled or vacant?

D09B_1

Adhyaksha

D09B_2

Up-Adhyaksha

D09B_3

Pradhan of Panchayat Samitis

D09B_4

CEO

D09B_5

Any Other (specify)

D09C

Why is this position vacant?

D09C_1

Adhyaksha

D09C_2

Up-Adhyaksha

D09C_3

Pradhan of Panchayat Samitis

D09C_4

CEO

D09C_5

Any Other (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

D09E_2

Up-Adhyaksha

D09E_3

Pradhan of Panchayat Samitis

D09E_4

CEO

D09E_5

Any Other (specify)

D09F

What is the caste category of the members?

D09F_1

Adhyaksha

D09F_2

Up-Adhyaksha

D09F_3

Pradhan of Panchayat Samitis

D09F_4

CEO

D09F_5

Any Other (specify)

D09G

Has there ever been a police complaint/FIR filed against the member?

D09G_1

Adhyaksha

D09G_2

Up-Adhyaksha

D09G_3

Pradhan of Panchayat Samitis

D09G_4

CEO

D09G_5

Any Other (specify)

D10

Apart from the positions mentioned above are there any other positions that are currently vacant?

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

E01A_2

Annual Administrative report

E01A_3

Audit report

E01A_4

Monitoring reports from all the Gram Panchayat

E01B

2019-20

E01B_1

Annual budget document

E01B_2

Annual Administrative report

E01B_3

Audit report

E01B_4

Monitoring reports from all the Gram Panchayat

E01C

2020-21

E01C_1

Annual budget document

E01C_2

Annual Administrative report

E01C_3

Audit report

E01C_4

Monitoring reports from all the Gram Panchayat

E02

Is the annual Budget and planning report collected from each Panchayat Samiti, appraised, and approved?

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

E04A_2

Cashier Cash Book

E04A_3

Daily Collection Register

E04A_4

Grant Register

E04A_5

Stock Register

E04A_6

Advance ledger

E04B

Availability of digital record

E04B_1

Asset Register

E04B_2

Cashier Cash Book

E04B_3

Daily Collection Register

E04B_4

Grant Register

E04B_5

Stock Register

E04B_6

Advance ledger

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

E04D_2

Cashier Cash Book

E04D_3

Daily Collection Register

E04D_4

Grant Register

E04D_5

Stock Register

E04D_6

Advance ledger

E05

Has this Zila Parishad tried to digitize the records?

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?

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?

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?

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?

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?

G25

Are the records of the health facilities being digitally printed?

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?

G28

What is the frequency of attending meetings with the district health society?

G29

Has the ZP provided any training to the health care workers in the last year?

G30

What is the training provided to the health care workers?

G31

Do the ZP officials undertake supervision visits to the various health centers?

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?

G34

Has the ZP conducted social audits of the healthcare programs?