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End Users Template 2 -Form Fill
General Information
Q01
State Name
Q02
District Code
Q03
District Name
Q04
Branch Code
Q05
Branch Name
Q06
Village Name
Q07
Interviewer name
Q08
Date of Interview
Q09
Enterprise name
Respondent Information
A01
Full name of the respondent
A02
Phone Number
A03
Sex of the respondent
Female
Male
Others
SME/FPO information and Availing capital services
B01
What services have you availed from the _________?
Inputs (Farm and Non-Farm)
Processing & Value addition
Trading & Market linkage
Warehousing
Marketing
Leasing farm equipment
Farm/Non-farm advisory
Access to loan
None
Others (please specify)
B02
How did you learn about _________?
Through online channels (website, social media)
Through local community events or workshops
Through word of mouth (friends, family, neighbors)
The lending enterprise approached us/ through a local representative or agent
Other (please specify)
B03
Why do you not receive/use the services of the _____?
Better terms outside the FPO
It only favors the board members
Discriminatory policy
Do not attend meetings
Do not require the services
Others (please specify)
B04
Do you actively participate in the activities of the SME/FPO?
Yes
No
B05
Have you ever receive a loan from a bank or a financial institution before _______?
Yes
No
B06
Have you applied for any loan in FY22 and FY23 from ____?
Yes
No
B07A
How many loans did you apply for in FY22 and FY23?
One
Two
Three
More than 3
B07A1
Name of lending enterprise____
B07B
When did you apply for it?
B07C
What was the purpose of the loan?
For business operations (non-agri based)
For buying agri inputs (seeds, fodder, etc.)
For setting up infrastructure
For setting up renewable energy infrastructure (solar pumps, etc.)
For agri-based transportation
For agri-based market linkages
For technology and innovation
For agri labor
For marketing and promotion of agri products
For personal consumption & household expenditure
Have not utilized yet
Other (please specify)
B07D
Did you face any challenges in the loan application process?
Lengthy application forms
Document submission requirements
Understanding terms and conditions
Language barriers
Difficulty in negotiating interest rates and terms
Difficulty in travelling due to distance
Difficulty in finding time
No challenge faced
Other (please specify)
B07E
Did it get approved?
Yes
No
B07F
What was the reason for rejection of loan?
Insufficient credit history
Bad credit score
Inadequate income to debt ratio
Incomplete or inaccurate documentation
Unstable employment history
Lack of collateral
Loan amount too high
Not meeting eligibility criteria
Outstanding debts or existing loans
Failure to provide a co-signer or guarantor
Other (please specify)
Don’t know
B07G
Did you receive the full loan amount you demanded?
Yes
No
Farm Practices
C01
What are the kinds of land you use for cultivation?
C01_1
Total owned land (for cultivation)
Yes
No
C01_2
Leased-in/rented land (for cultivation)
Yes
No
C01_3
Leased-out land (for cultivation)
Yes
No
C01_4
Sharecropped land (for cultivation)
Yes
No
C01_5
Total land under irrigation
Yes
No
C01A
Land size
C01A_1
Total owned land (for cultivation)
C01A_1A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Killa
Ghuntha
C01A_2
Leased-in/rented land (for cultivation)
C01A_2A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Killa
Ghuntha
C01A_3
Leased-out land (for cultivation)
C01A_3A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Killa
Ghuntha
C01A_4
Sharecropped land (for cultivation)
C01A_4A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Killa
Ghuntha
C01A_5
Total land under irrigation
C01A_5A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Killa
Ghuntha
C02
What is the size of your total cultivated land?
C03
What kind of farming activities are you engaged in?
Cultivation
Fish farming
Livestock rearing
Forest produce
Agri-labour on land owned by others
Processing of agri-produce
Others (please specify)
C04
Which seasons do you grow crops in?
Kharif season/Barsa (June to October)
Rabi season (October to March)
Summer season/Zaid/ Garma (March to June)
C05A
How many crops did you grow during this season?
One
Two
Three
More than 3
C05
What major crop did you grow during this season?
Paddy
Jowar
Bajra
Maize
Ragi
Wheat
Barley
Small millets
Other cereals
Gram
Tur (arhar)
Urad
Moong
Masur
Horsegram
Beans (pulses)
Peas (pulses)
Other pulses
Sugarcane
Other sugar crops
Pepper (black)
Chillies
Ginger
Turmeric
Garlic
Coriander
Cumin seed
Nutmeg
Fenugreek
Other condi. & spices
Nutmeg
Fenugreek
Other condi. & spices
Potato
Elephant foot yam
Colocasia/arum
Other tuber crop
Onion
Carrot
Radish
Beetroot
Turnip (shalgam)
Tomato
Spinach
Amaranths (chaulai)
Cabbage
Other leafy vegetable
Brinjal
Peas (vegetable) (green)
Lady’s finger (bhindi)
Cauliflower
Cucumber
Bottle gourd (lauki)
Pumpkin
Bitter gourd
Other gourds
Vench (guar)
Beans (green)
Drumstick
Capsicum
Green chillies
Cowpea
Other vegetables
Groundnut
Castorseed
Sesamum (til)
Rapeseed & mustard (toria/ taramira)
Linseed
Coconut
Sunflower
Safflower
Soyabean
Oil palm
Other oilseeds
Cotton
Jute
Sunhemp
Other fibres
Indigo
Other dyes & tan. Materials
Tea
Other plantation crops
Other flowers
Other aromatic plant
Other non-food crops
Mangoes
Lemon / acid lime
Other citreous fruits
Banana
Table grapes
Wine grapes (black)
Pear
Peaches
Papaya
Guava
Cashewnuts
Jackfruit
Lichi
Pineapple
Watermelon
Musk melon
Ber
Bel
Mulberry (sahatoot)
Other fruits
Other perennial crops
C06
How much land did you use to cultivate this [CROP]?
C07
What was the total quantity produced?
C08
How much [CROP] did you lose?
C09
How much of the total quantity produced did you give/sell to?
C09_1
Give as payment (landlords, laborers)
C09_2
Keep for self-consumption (kept for self, given to relatives/friends, storage, etc.)
C09_3
Sell
C10
How much produce did you sell to the following?
C10_1
Local market in the village
C10_2
Retail market outside village
C10_3
APMC/Mandi
C10_4
Middlemen/Trader
C10_5
FPC/ enterprise/ collective
C10_6
Direct purchase from field by private trader
C11
What was the rate you got for selling [CROP] to the following? (in rupees per kg/quintal/ton)
C11_1
Local market in the village
C11_2
Retail market outside village
C11_3
APMC/Mandi
C11_4
Middlemen/Trader
C11_5
FPC/ enterprise/ collective
C11_6
Direct purchase from field by private trader
C12
What was the total revenue you earned from selling [CROP]?
C13
What were the input costs for [CROP]? (in rupees)?
C13_1
Purchase of seed/saplings
C13_2
Fertilizers & Manure
C13_3
Pesticides & Herbicides
C13_4
Purchase of water for irrigation
C13_5
Hired labour/tractors or equipment/animals
C13_6
Diesel, electricity, fuel
C13_7
Transportation cost
C13_8
Post-production
Livestock Roster
D01
Does your household own and rear _____?
D01_1
Poultry
Yes
No
D01_2
Goatery
Yes
No
D01_3
Piggery
Yes
No
D01_4
Cow/Buffalo
Yes
No
D01_5
Fishery
Yes
No
D02
How many _____ do you have currently?
D02_1
Poultry
D02_2
Goatery
D02_3
Piggery
D02_4
Cow/Buffalo
D02_5
Fishery
D03
How many did you sell in the past one year?
D03_1
Poultry
D03_2
Goatery
D03_3
Piggery
D03_4
Cow/Buffalo
D03_5
Fishery
D04
What was the average rate you got for selling? (Rupees per number/kg/quintal/ton)
D04_1
Poultry
D04_2
Goatery
D04_3
Piggery
D04_4
Cow/Buffalo
D04_5
Fishery
D05
Where did you sell?
D05_1
Poultry
Local market in the village
Retail market outside village
Wholesale market
Middlemen/Trader
Farmer Producer Company/ other collective
Direct purchase of produce from field by private trader
APMC Mandi
Others (specify)
D05_2
Goatery
Local market in the village
Retail market outside village
Wholesale market
Middlemen/Trader
Farmer Producer Company/ other collective
Direct purchase of produce from field by private trader
APMC Mandi
Others (specify)
D05_3
Piggery
Local market in the village
Retail market outside village
Wholesale market
Middlemen/Trader
Farmer Producer Company/ other collective
Direct purchase of produce from field by private trader
APMC Mandi
Others (specify)
D05_4
Cow/Buffalo
Local market in the village
Retail market outside village
Wholesale market
Middlemen/Trader
Farmer Producer Company/ other collective
Direct purchase of produce from field by private trader
APMC Mandi
Others (specify)
D05_5
Fishery
Local market in the village
Retail market outside village
Wholesale market
Middlemen/Trader
Farmer Producer Company/ other collective
Direct purchase of produce from field by private trader
APMC Mandi
Others (specify)
D06
What was the total income you earned from selling the livestock/selling its produce (eggs, milk, renting out bulls, etc)?
D06_1
Poultry
D06_2
Goatery
D06_3
Piggery
D06_4
Cow/Buffalo
D06_5
Fishery
D07
What were the input costs for [LIVESTOCK]? (in rupees)
D07_1
Money spent on buying [LIVESTOCK]
D07_2
Money spent on feed and fodder
D07_3
Veterinary services
D07_4
Hired labour for grazing/care
D07_5
Other costs (ropes, transport, etc.)
FINANCIAL RESILIENCE
E01
Between Rabi 2022 and Kharif 2023, how much income did your household generate through the following activities?
E01_1
Wage or salaried work (agricultural: livestock rearing, intercultural activities, sowing, etc.)
E01_2
Wage or salaried work (non-agricultural: teacher, construction worker, handy person, etc.)
E01_3
Business (selling non-farm produce, selling farm inputs, running a shop, non-timber forest produce, et)
E01_4
Remittances (pension, rental income)
E02
Could you give us an estimate of the total current savings available with your household in cash?
E03
Weather related shocks such as drought, excessive rain or heat, etc. do not have a significant bearing on my household’s financial stability
Strongly disagree
Somewhat Disagree
Neutral
Somewhat agree
Strongly agree
E04
If members of my household were to lose their income generating activities, my household would be able to remain stable
Strongly disagree
Somewhat Disagree
Neutral
Somewhat agree
Strongly agree
E05
If the market rate for my crop or animal produce is substantially lower than anticipated, my household would be able to maintain financial stability
Strongly disagree
Somewhat Disagree
Neutral
Somewhat agree
Strongly agree
E06
We are trying to understand factors which contribute to your household’s resilience. Can you please tell us if your household receives, has received, or can receive entitlements under the following?
E06_1
Social assistance plans (widow pension, old age pension, disability pension, etc.)
receiving / have received
not receiving
don’t know
E06_2
Pradhan Mantri Suraksha Bima Yojana
enrolled
not enrolled
don’t know
E06_3
Pradhan Mantri Jeevan Jyoti Bima Yojana
enrolled
not enrolled
don’t know
E06_4
PM Jan Arogya Yojana
enrolled
not enrolled
don’t know
E06_5
PM Awas Yojana
receiving / have received
not receiving
don’t know
E07
Lastly, we want to similarly understand how your social and peer networks may help your household deal with unexpected calamities (e.g., floods, drought etc). Can you tell us different actors your household can rely on in times of need?
neighbours / friends
village elders
extended family
landlord
input shops
creditor
No one
others(specify)
E08
For the selected groups, what kind of support can you expect?
cash (borrowing)
cash (non-borrowing)
kind (food, produce, etc.)
domestic help (care taking, etc.)
employment or wage work
transportation
shelter
others (specify)
Renewable Energy Information
F01
Do you use any product in your farming/profession that uses solar, wind, or biofuel or any form of renewable energy for agriculture?
Yes
No
F02
How did you come to know about renewable energy resources?
Enterprise
Govt. Schemes
Extension Workers
Online sources (WhatsApp, YouTube)
Farmer Groups/ Cooperatives
Friends/Relatives/Neighbors
NGOs
Others (please specify)
F03
For what purpose do you use renewable energy?
Agricultural machinery and equipment operation
Crop irrigation and watering
Food storage
Food processing and canning
Dairy processing
Composting and waste management
Farmyard lighting
Soil testing and analysis
Seed drying and storage
Crop sorting and packaging
Aquaponics or hydroponics
Pest monitoring and control
Livestock cooling and heating
Others (please specify)
F04
Since when you have been using renewable energy?
Less than a year
1-3 years
3-5 years
More than 5 years
Don’t Know
F05
According to you what are the perceived benefits of using renewable energy?
Cost savings
Continuous supply of power
Easy management
Reduces pollution/ better for the environment
Self-reliance
Increased profitability
No benefits
Others (please specify)
Don’t Know
F06
What kind of support did you receive from the _____ while adopting renewable energy?
Govt. Subsidy
Discounts from the enterprise
Bank Loans
Technical/Advisory Support
Access to RE infrastructure
None/ No support received
Others (please specify)
Don’t Know
Climate Smart Agriculture
G01
Did you receive training on CSA in the past one year?
Yes
No
G02
Do you have access to irrigation?
Yes
No
G03
What is the primary method you use for irrigation on your farm?
Traditional Flooding
Drip Irrigation
Sprinkler Irrigation
Canal Irrigation
Rainfed Agriculture
Lift Irrigation
Others (please specify)
G04
What kind of pesticides do you use on your farm?
Chemical pesticides
Organic pesticides
Encouragement of natural predators
Don’t use any pesticide
Other (please specify)
Don’t know
G05
What kind of fertilizers do you use on your soil?
Chemical fertilizers
Organic fertilizers (animal manure, green manure)
Don’t use any fertilizer
Other (please specify)
Don’t know
G06
Have you practiced crop rotation in the last one year?
Yes, always
Yes, sometimes
No, rarely
No, never
G07
Have you tested soil health in the last one year?
Yes
No
G08
Have you been provided with a Soil Health Card for your farm?
Yes
No
G09
Do you follow the recommended ratio of Nitrogen (N), Phosphorus (P), and Potassium (K) in your fertilization practices?
Yes, always
Yes, sometimes
No, rarely
No, never
G10
Do you produce renewable energy on your agricultural land?
Yes, through solar panels
Yes, through wind turbines
Yes, through biofuel production
No, not producing renewable energy
Other (please specify)
Don’t know
G11
How do you typically access agricultural advisory services?
Through government extension services
Private advisory services
Farmer cooperatives
Other (please specify)
Don’t know
G12
How do you stay informed about local weather conditions?
Radio/TV broadcasts
Mobile applications
Weather stations
I don’t stay informed
Other (please specify)
G13
What is your primary tillage method?
Conventional tillage (harrowing, plowing, disking)
Conservation tillage (minimum tillage, strip tillage, bare minimum done to prevent soil erosion)
No-till farming
Others (please specify)
Don’t Know
G14
Do you use digital sensors or technology for monitoring crop conditions?
Yes
No
Women Empowerment
H01
Are you involved in farming related activities?
Yes
No
H02
What are the different farming related activities you are involved in?
Buying inputs (seeds, fertilizers, machinery)
Land preparation (nursery prep, plowing, tilling, leveling)
Crop cultivation and harvesting (sowing, watering, weeding, harvesting)
Livestock rearing (feeding animals, milking, grazing)
Livestock slaughtering
Sorting, cleaning or packaging crops
Transporting crops
Selling crops to agents and distributors
Selling crops by self at market
Promotion of crops
Food and Textile processing
Others (please specify)
H03
How involved are you in making decisions about [ACTIVITY CODE]?
H03_1
Food crop farming: These are crops that are grown primarily for household food consumption
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_2
Cash crop farming: These are crops that are grown primarily for sale in the market
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_3
Livestock rearing
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_4
Non-farm economic activities: This would include things like running a small business, self-employment, buy-and-sell
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_5
Wage and salary employment: This could be own work that is paid for in cash or in-kind, including both agriculture and other wage work
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_6
Fishing or fishpond culture
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_7
Major household expenditures (such as buying movable and immovable assets, like jewellery, land, house, education, etc.)
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_8
Minor household expenditures (such as food for daily consumption, consumer durables or other household needs)
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_9
Borrowing from SHGs
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_10
Borrowing from MFIs/Banks
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_11
Borrowing from informal credit sources
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_12
Use of savings in the household
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H03_13
Use of income earned by you/husband in the household
Highly involved
Moderately involved
Minimally involved
Not involved
Not applicable
H04
Do women in your household have legal ownership or land rights to agricultural land?
Yes
No
H05
Are there any specific challenges or barriers that women in your household face in exercising control over finance related decisions and resource management in agriculture?
Limited access to credit or loans for agricultural purposes.
Unequal distribution of income generated from agricultural activities.
Limited ownership or land rights for women.
Lack of financial literacy or training opportunities for women.
Cultural or traditional norms impacting women's control over finances.
Limited access to markets for selling agricultural produce.
Insufficient representation or participation in agricultural cooperatives or associations due to limited access to information, exposure and networking
Other (please specify)
H06
Do you have to ASK PERMISSION of your husband or a senior household member to go outside of your house?
Yes, ask my husband
Yes, ask my mother-in-law
Yes, ask any senior household member
No need to ask
H07
Since moving into your current household (or in last 5 years), has there been any change in your freedom of mobility?
Yes, there has been a substantial improvement
Yes, there has been a moderate improvement
No change/Decreased
H08
What has led to this change?
Due to financial independence
Change in household composition
Change in my attitude
Change in my spouse's attitude
Change in attitude of other family members
Change in social norms,
Others (please specify)
H09
Are you a member of any agricultural or women's cooperative or group?
Yes
No
H10
How often do you attend your group meetings?
Yes, regularly
Yes, occasionally
Very rarely
Never attended
H11
Have you ever raised voice for any concern or issue in the community?
Yes
No
H12
Have you ever participated in any mass events like rallies, campaigns, vigils, etc. for social change or to demand something (for ex. Against alcoholism)?
Yes
No
H13
If yes, for what?
Demand for MNREGA
Demand for PDS/ration card
Demand for opening bank account
On-time delivery of services meant for poor from the government
Supply of safe drinking water
Supply of sufficient water for household purposes
Supply of sanitation services e.g. latrine facilities/construction of toilets
Preparation of village development plans
Demand for better school facilities
Demand for better anganwadi facilities
Addressing liquor consumption issues in village
Other (specify)
H14
Have you ever participated in a Gram Sabha meeting?
Yes
No
H15
Have you ever raised any concern or given your opinion in any Gram Sabha meeting?
Yes
No
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