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Household Template 8 -Form Fill
HOUSEHOLD IDENTIFICATION
Q01
District name
Q02
District code
Q03
Block name
Q04
Block code
Q05
Village name
Q06
Village Code
Q07
HH No.
Q08
UID
Q09
Are you a SHG member?
Yes
No
Q10
Name of the SHG
Q11
Is SHG federated into VO?
Yes
No
Q12
Is SHG federated into CLF?
Yes
No
Q13
Name of the respondent
Q14
Age of the respondent
Q15
Address
Q16
Important Landmark nearest to the HH
Q17
Phone Number
Q18
What is your role in the SHG?
President
Vice-President
Secretary
Treasurer
Member of SHG
Q19
What is your religion?
Hindu
Muslim
Christian
Sikh
Buddhist/Neo-Buddhist
Jain
Jewish
Parsi/Zoroastrian
No religion
If others (specify)
Q20
What is your caste category?
Scheduled Tribe (ST)
Scheduled Caste (SC)
Other Backward Caste (OBC)
General
If others (specify____)
Q21
What is your marital status?
Married
Unmarried or single
Widowed
Divorced or separated
If others (specify____)
Q22
What is your educational qualification?
Illiterate
No Schooling (But knows to read/ write)
Primary
Secondary
High Secondary
Diploma/ ITI
Graduation
Post Graduation
Signature literate
If other, please specify
Q23
Is the respondent especially abled?
Yes
No
Q24
Which all livelihood activities are you engaged in?
Agriculture/cultivation on own/ leased-in/shared land
Animal husbandry
Fishing
Agriculture labor
Non-agri labor, unskilled (coolie, etc.)
Non-agri labor, skilled (mason, carpenter etc.)
MGNREGS labor
Enterprise/business /shops
Salaried Govt. job
Salaried private job
JEEVikA Cadre
Other’s Specify____________
Q25
In which year SHG was formed?
Q26
When did you joined the SHG as a member?
Survey Information
A01
First Visit
A01_1
Interviewer name
A01_2
Interviewer code
A01_3
Date of the interview
A01_4
Result of the interview
INTERVIEW COMPLETED
VISIT RESCHEDULED
INTERVIEW INCOMPLETE
REFUSED
HOUSEHOLD NOT LOCATED
RESPONDENT IS OUT OF STATION FOR EXTENDED PERIOD
RESPONDENT IS TEMPORARILY AWAY
OTHER (SPECIFY)
A02
Second Visit
A02_1
Interviewer name
A02_2
Interviewer code
A02_3
Date of the interview
A02_4
Result of the interview
INTERVIEW COMPLETED
VISIT RESCHEDULED
INTERVIEW INCOMPLETE
REFUSED
HOUSEHOLD NOT LOCATED
RESPONDENT IS OUT OF STATION FOR EXTENDED PERIOD
RESPONDENT IS TEMPORARILY AWAY
OTHER (SPECIFY)
A03
Third Visit
A03_1
Interviewer name
A03_2
Interviewer code
A03_3
Date of the interview
A03_4
Result of the interview
INTERVIEW COMPLETED
VISIT RESCHEDULED
INTERVIEW INCOMPLETE
REFUSED
HOUSEHOLD NOT LOCATED
RESPONDENT IS OUT OF STATION FOR EXTENDED PERIOD
RESPONDENT IS TEMPORARILY AWAY
OTHER (SPECIFY)
A04
RECORD TIME WHEN YOU START THE INTERVIEW.
HOUSEHOLD CHARACTERISTICS (ALL CATEGORIES)
B01
Does your household own this house or any other house?
Yes
No
B02
LOOK AT THE FLOOR AND CODE THE MAIN MATERIAL OF THE FLOOR
MUD/CLAY/EARTH
SAND
DUNG
RAW WOOD PLANKS
PALM/BAMBOO
BRICK
STONE
PARQUET OR POLISHED WOOD
VINYL OR ASPHALT
CERAMIC TILES
CEMENT
CARPET
POLISHED TONE/MARBLE/GRANITE
OTHER (SPECIFY)
B03
LOOK AT THE EXTERIOR WALLS AND CODE THE MAIN MATERIAL OF THE WALLS
NO WALLS
CANE/PALM/TRUNKS/BAMBOO
MUD
GRASS/REEDS/THATCH
BAMBOO WITH MUD
STONE WITH MUD
PLYWOOD
CARDBOARD
UNBURNT BRICK
RAW WOOD/REUSED WOOD
CEMENT/CONCRETE
STONE WITH LIME/CEMENT
BURNT BRICKS
CEMENT BLOCKS
WOOD PLANKS/SHINGLES
GI/METAL/ASBESTOS SHEETS
OTHER (SPECIFY)
B04
How many rooms in this house are used for sleeping?
B05
Do you have a separate room which is used as a kitchen?
Yes
No
B06
What type of fuel does your household mainly use for cooking?
ELECTRICITY
LPG/NATURAL GAS
BIOGAS
KEROSENE
COAL/LIGNITE
CHARCOAL
WOOD
STRAW/SHRUBS/GRASS
AGRICULTURAL CROP WASTE
DUNG CAKES
OTHER (SPECIFY)
B07
What is the main source of lighting in this household?
LANTERN
KEROSENE LAMP
CANDLE
ELECTRIC
LPG/BATTERY
SOLAR ENERGY
NONE
OTHERS (SPECIFY)
B08
What is the main source of drinking water for members of your household?
PIPED INTO DWELLING
PIPED TO YARD/PLOT
PUBLIC TAP/STANDPIPE
TUBE WELL/BOREHOLE
PROTECTED WELL
UNPROTECTED WELL
PROTECTED SPRING
UNPROTECTED SPRING
RAINWATER
TANKER TRUCK
CART WITH SMALL TANK
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL)
BOTTLED WATER
GOVERNMENT HAND PUMP
HAND PUMP AT HOME
NEIGHBOUR’S HAND PUMP
OTHER (SPECIFY)
B09
Is the main source of drinking water within the premises of the household?
Yes
No
B10
Does your household have a toilet?
Yes
No
B11
What kind of toilet facilities does your household have?
FLUSH TO PIPED SEWER SYSTEM
FLUSH TO SEPTIC TANK
FLUSH TO PIT LATRINE
FLUSH TO SOMEWHERE ELSE
FLUSH, DON'T KNOW WHERE
VENTILATED IMPROVED PIT (VIP)/BIOGAS LATRINE
PIT LATRINE WITH SLAB
PIT LATRINE WITHOUT SLAB/ OPEN PIT
TWIN PIT/COMPOSTING TOILET
DRY TOILET
OTHER (SPECIFY)
B12
What kind of toilet facility do members of your household usually use?
FLUSH TO PIPED SEWER SYSTEM
FLUSH TO SEPTIC TANK
FLUSH TO PIT LATRINE
FLUSH TO SOMEWHERE ELSE
FLUSH, DON'T KNOW WHERE
VENTILATED IMPROVED PIT (VIP)/BIOGAS LATRINE
PIT LATRINE WITH SLAB
PIT LATRINE WITHOUT SLAB/ OPEN PIT
TWIN PIT/COMPOSTING TOILET
DRY TOILET
NO FACILITY/USES OPEN SPACE OR FIELD
OTHER (SPECIFY)
B13
Does your household have
B13_1
Electricity
Yes
No
B13_2
A mattress
Yes
No
B13_3
A pressure cooker
Yes
No
B13_4
A chair
Yes
No
B13_5
A cot or bed
Yes
No
B13_6
A table
Yes
No
B13_7
An electric fan
Yes
No
B13_8
A radio or transistor
Yes
No
B13_9
A black and white television
Yes
No
B13_10
A color television
Yes
No
B13_11
A sewing machine
Yes
No
B13_12
A mobile telephone
Yes
No
B13_13
Any other type of telephone
Yes
No
B13_14
A computer/laptop
Yes
No
B13_15
A refrigerator
Yes
No
B13_16
A watch or clock
Yes
No
B13_17
A bicycle
Yes
No
B13_18
A motorcycle or scooter
Yes
No
B13_19
An animal-drawn cart
Yes
No
B13_20
A car
Yes
No
B13_21
A water pump
Yes
No
B13_22
A thresher
Yes
No
B13_23
A tractor
Yes
No
B13_24
Internet
Yes
No
B13_25
Air Conditioner or Cooler
Yes
No
B13_26
Washing Machine
Yes
No
ACCESS TO AND KNOWLEDGE OF GOVERNMENT SCHEMES
C01
Have you ever heard about _?
C01_1
Pradhan Mantri Awas Yojna (IAY)
Yes
No
C01_2
Swachh Bharat Abhiyan (SBA)
Yes
No
C01_3
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
Yes
No
C01_4
Pradhan Mantri Jeevan Jyoti Beema Yojana (Life Insuarance)
Yes
No
C01_5
Janani Shishu Suraksh Karykaram (JSSK)
Yes
No
C01_6
National Social Assistance Programme (NSAP)- Pension, death compensation & Maternity Benefits
Yes
No
C01_7
Satat Jeevikoparjan Yojna
Yes
No
C01_8
Food, Nutrition, Health and WASH (FNHW) Intervention
Yes
No
C01_9
Atal Pension Yojana
Yes
No
C01_10
Pension for the disabled
Yes
No
C02
Is your household / anyone in your household eligible for this scheme?
C02_1
Pradhan Mantri Awas Yojna (IAY)
Yes
No
C02_2
Swachh Bharat Abhiyan (SBA)
Yes
No
C02_3
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
Yes
No
C02_4
Pradhan Mantri Jeevan Jyoti Beema Yojana (Life Insuarance)
Yes
No
C02_5
Janani Shishu Suraksh Karykaram (JSSK)
Yes
No
C02_6
National Social Assistance Programme (NSAP)- Pension, death compensation & Maternity Benefits
Yes
No
C02_7
Satat Jeevikoparjan Yojna
Yes
No
C02_8
Food, Nutrition, Health and WASH (FNHW) Intervention
Yes
No
C02_9
Atal Pension Yojana
Yes
No
C02_10
Pension for the disabled
Yes
No
C03
Has anyone in your household ever availed this scheme?
C03_1
Pradhan Mantri Awas Yojna (IAY)
Yes
No
C03_2
Swachh Bharat Abhiyan (SBA)
Yes
No
C03_3
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
Yes
No
C03_4
Pradhan Mantri Jeevan Jyoti Beema Yojana (Life Insuarance)
Yes
No
C03_5
Janani Shishu Suraksh Karykaram (JSSK)
Yes
No
C03_6
National Social Assistance Programme (NSAP)- Pension, death compensation & Maternity Benefits
Yes
No
C03_7
Satat Jeevikoparjan Yojna
Yes
No
C03_8
Food, Nutrition, Health and WASH (FNHW) Intervention
Yes
No
C03_9
Atal Pension Yojana
Yes
No
C03_10
Pension for the disabled
Yes
No
C04
When was the last time someone in your household used this scheme?
C04_1
Pradhan Mantri Awas Yojna (IAY)
C04_2
Swachh Bharat Abhiyan (SBA)
C04_3
Pradhanmantri Surakha Beema Yojana (accidental death insurance)
C04_4
Pradhan Mantri Jeevan Jyoti Beema Yojana (Life Insuarance)
C04_5
Janani Shishu Suraksh Karykaram (JSSK)
C04_6
National Social Assistance Programme (NSAP)- Pension, death compensation & Maternity Benefits
C04_7
Satat Jeevikoparjan Yojna
C04_8
Food, Nutrition, Health and WASH (FNHW) Intervention
C04_9
Atal Pension Yojana
C04_10
Pension for the disabled
C05
Have you ever heard about Mahatma Gandhi rural Employment Guarantee Act (MGNREGA)?
Yes
No
C06
Does anyone in your household have a MGNREGA job card? If yes, please show me.
Yes
No
C07
For total number of days worked by household members, how many days were worked by men and how many days were worked by women?
C08
Have you ever heard of Public Distribution System?
Yes
No
C09
Have you ever heard of Antyodaya Anna Yojana?
Yes
No
C10
Does your household have a ration card?
Yes
No
C11
Is your name included in the ration card?
Yes
No
C12
Which card do you have?
ANTODAYA ANNA YOJANA
ANNAPURNA
BPL
APL
OTHER
DO NOT KNOW
C13
In the past 30 days, did you buy anything from a ration shop?
Yes
No
C14
Which items did you buy from the ration shop in the last 30 days and in what quantity?
C15
Whether Purchased
C15_1
Rice
Yes
No
C15_2
Wheat
Yes
No
C15_3
Sugar
Yes
No
C15_4
Salt
Yes
No
C15_5
Kerosene
Yes
No
C15_6
Clothes
Yes
No
C16
Quantity Purchased
C16_1
Rice
C16_2
Wheat
C16_3
Sugar
C16_4
Salt
C16_5
Kerosene
C16_6
Clothes
C17
Have you ever heard of the ICDS scheme / Anganwadi centre?
Yes
No
C18
At present is there any ____ in your household?
C18_1
Pregnant Woman
Yes
No
C18_2
Lactating Woman
Yes
No
C18_3
Child aged 6-35 months
Yes
No
C18_4
Child aged 3-6 years
Yes
No
C19
Did the member receive supplementary nutrition / hot cooked food from the AWC in the last 12 months?
C19_1
Pregnant Woman
Yes
No
C19_2
Lactating Woman
Yes
No
C19_3
Child aged 6-35 months
Yes
No
C19_4
Child aged 3-6 years
Yes
No
C20
How many times did the member receive food from the AWC in the last month?
C20_1
Pregnant Woman
C20_2
Lactating Woman
C20_3
Child aged 6-35 months
C20_4
Child aged 3-6 years
C21
Have you ever heard about the Janani suraksha Yojana Scheme?
Yes
No
C22
Do you know how much money the beneficiary is supposed to get under the JSY scheme?
C23
Does the household avail the following?
C23_1
SAVINGS
Yes
No
C23_2
CREDIT
Yes
No
C23_3
INSURANCE
Yes
No
C23_4
REMITTANCE
Yes
No
C23_5
PENSION
Yes
No
C24
Where does the household save?
SHG
GOVERNMENT BANK
COOPERATIVE BANK
PRIVATE BANK
POST OFFICE
FRIENDS / RELATIVES
AT HOME
OTHERS (Specify)
C25
From what sources does the household avail credit?
SHG
GOVERNMENT BANK
COOPERATIVE BANK
PRIVATE BANK
FRIENDS / RELATIVES
KISAN CREDIT CARD
MONEY LENDERS
OTHERS (Specify)
C26
What type of insurance does the household have?
LIFE INSURANCE
ASSET INSURANCE
LIVESTOCK INSURANCE
CROP INSURANCE
HEALTH INSURANCE
ACCIDENT INSURANCE
OTHER (SPECIFY)
C27
Does anyone in your household have a bank account opened under the Pradhan Mantri Jan Dhan Yojana?
Yes
No
C28
Has the account been operated in the last 3 months?
Yes
No
C29
Does any member of your household avail retirement pension?
Yes
No
C30
What are the pensions that the household members receive?
CENTRAL GOVERNMENT PENSION
STATE GOVERNEMENT PENSION
PRIVATE COMPANY PENSION
CONTRIBUTARY PENSION FROM BANK (NATIONALIZED OR PRIVATE)
OTHER
C31
Have you ever heard of the old Age Pension Scheme?
Yes
No
C32
How many members availed the Old Age Pension Scheme in the last 1 year?
C33
Have you ever heard of the widow pension scheme?
Yes
No
C34
How many members have availed the Widow Pension Scheme in the last 1 year?
C35
Have you ever heard about Rashtriya Swasth Bima Yojana (RSBY)?
Yes
No
C36
Does your Household have a RSBY smart card?
Yes
No
C37
Was the smart card updated in the last one year?
Yes
No
C38
Did anyone in your household use the smart card in last one year?
Yes
No
INCOME
D01
Whether earned from this activity?
D01_1
In last 12 months has anyone in your household engaged in agriculture labour
Yes
No
D01_2
In last 12 months has anyone in your household engaged in non-agricultural labour like construction of roads, carrying bricks, digging wells etc.
Yes
No
D01_3
In last 12 months has anyone in your household engaged in skilled labour
Yes
No
D01_4
In last 12 months has anyone in your household engaged in Small business activities (street vending, shop keeping, handicrafts, sells liquor)
Yes
No
D01_5
In last 12 months has anyone in your household engaged in NTFP selling
Yes
No
D01_6
In last 12 months has anyone in your household earned from salaried job?
Yes
No
D02
Who in the household earned income over last 12 months?
D02_1
In last 12 months has anyone in your household engaged in agriculture labour
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
D02_2
In last 12 months has anyone in your household engaged in non-agricultural labour like construction of roads, carrying bricks, digging wells etc.
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
D02_3
In last 12 months has anyone in your household engaged in skilled labour
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
D02_4
In last 12 months has anyone in your household engaged in Small business activities (street vending, shop keeping, handicrafts, sells liquor)
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
D02_5
In last 12 months has anyone in your household engaged in NTFP selling
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
D02_6
In last 12 months has anyone in your household earned from salaried job?
MEN
WOMEN
BOTH MEN & WOMEN
CHILDREN
ALL HH MEMBERS
D03
How much did the household earn from [activity] ______ over the past 12 months?
D03_1
In last 12 months has anyone in your household engaged in agriculture labour
D03_2
In last 12 months has anyone in your household engaged in non-agricultural labour like construction of roads, carrying bricks, digging wells etc.
D03_3
In last 12 months has anyone in your household engaged in skilled labour
D03_4
In last 12 months has anyone in your household engaged in Small business activities (street vending, shop keeping, handicrafts, sells liquor)
D03_5
In last 12 months has anyone in your household engaged in NTFP selling
D03_6
In last 12 months has anyone in your household earned from salaried job?
D04
In the last 12 months, has any member of the household or other relatives have sent you any money from outside?
Yes
No
D05
How often has your household received remittances in the last 12 months?
EACH MONTH
MANY TIMES / YEAR
TWICE A YEAR
ONCE A YEAR
LESS THAN ONCE A YEAR
DO NOT KNOW
D06
How much money did your household receive as remittances in the last 12 months?
D07
During the last 12 months, did anyone in the household own any animals including livestock, poultry, fish, etc.?
Yes
No
D08
How many _______ did you sell in the last 12 months?
D08_1
Buffalo
D08_2
Oxen
D08_3
Cow
D08_4
Goat
D08_5
Sheep
D08_6
Duck
D08_7
Poultry
D08_8
Pig
D08_9
Fish
D09
How much did your household receive for the sale of these _________ in the last 12 months?
D09_1
Buffalo
D09_2
Oxen
D09_3
Cow
D09_4
Goat
D09_5
Sheep
D09_6
Duck
D09_7
Poultry
D09_8
Pig
D09_9
Fish
D10
Did you produce any ___ during the last 12 months?
D10_1
Animal/Fish meat/offal
Yes
No
D10_2
Poultry meat/offal
Yes
No
D10_3
Milk (including that produced for milk products)
Yes
No
D10_4
Eggs
Yes
No
D11
Did your household sell any of the ___ produced?
D11_1
Animal/Fish meat/offal
Yes
No
D11_2
Poultry meat/offal
Yes
No
D11_3
Milk (including that produced for milk products)
Yes
No
D11_4
Eggs
Yes
No
D12
How much in total did your household receive for the sale of ________?
D12_1
Animal/Fish meat/offal
D12_2
Poultry meat/offal
D12_3
Milk (including that produced for milk products)
D12_4
Eggs
D13
Crop Code
RICE
WHEAT
MAIZE
SORGHUM
MILLETS
BUCKWHEAT
BARLEY
GROUNDNUT
SOYBEANS
LENT
PEAS
CHICKPEAS
BEANS
SUGARCANE
COTTON
SUNFLOWER
TOBACCO
TEA
OIL SEEDS
SWEET POTATOES
POTATOES
CARROTS
CUCUMBER
CHILI
EGGPLANT
GREEN LEAFY VEGETABLES
OKRA / LADY FINGER
ONION
CAPSICUM
CABBAGE
CAULIFLOWER
BOTTLE GOURD
SPONGE GOURD
BITTER GOURD
GREEN BEANS
GARLIC
GINGER
PUMPKIN / ZUCHIMI
TOMATO
AVOCADO
GUAVA
MANGO
LEMON / LIME
ORANGE / TANGERINE
PAPAYA
MELON
LYCHEE
APPLE
BERRIES
BANANAS
SARSON
URAT DAL
MUSSOR DAL
ARHAR DAL
CHANA
OTHER (SPECIFY)
D14
What is the total quantity produced?
D15
How much of the harvested____
D16
What was the income from the sale of ___?
D17
Does your household receive any farm produce from the land that you lease out?
Yes
No
D18
Crop Code
RICE
WHEAT
MAIZE
SORGHUM
MILLETS
BUCKWHEAT
BARLEY
GROUNDNUT
SOYBEANS
LENT
PEAS
CHICKPEAS
BEANS
SUGARCANE
COTTON
SUNFLOWER
TOBACCO
TEA
OIL SEEDS
SWEET POTATOES
POTATOES
CARROTS
CUCUMBER
CHILI
EGGPLANT
GREEN LEAFY VEGETABLES
OKRA / LADY FINGER
ONION
CAPSICUM
CABBAGE
CAULIFLOWER
BOTTLE GOURD
SPONGE GOURD
BITTER GOURD
GREEN BEANS
GARLIC
GINGER
PUMPKIN / ZUCHIMI
TOMATO
AVOCADO
GUAVA
MANGO
LEMON / LIME
ORANGE / TANGERINE
PAPAYA
MELON
LYCHEE
APPLE
BERRIES
BANANAS
SARSON
URAT DAL
MUSSOR DAL
ARHAR DAL
CHANA
OTHER (SPECIFY)
D19
What is the total quantity received?
D20
How much of the received ____
D21
What was the income from the sale of ___?
FOOD SECURITY
E01
How many meals did you eat yesterday during the day and night?
E02
How many meals did the adult members (18+) of your household eat yesterday during the day and night?
E03
How many meals did the children 6 to18 years in this household eat yesterday during the day and night?
E04
Over the last 7 days, how many days were the following food groups consumed by
E05
YOU AND OTHER FEMALE MEMBERS OF THE HH
E05_1
Rice, Wheat, Maize, maize porridge, Other cereal (sorghum, millet, etc), Roots and Tubers (cassava, potatoes, sweet potatoes)
E05_2
Beans and peas, pulses groundnuts and cashew nuts`
E05_3
Vegetables (including leaves)
E05_4
Fruits
E05_5
Egg, meat, fish etc.
E05_6
Milk/yogurt/other dairy product
E05_7
Sugar or sugar products, honey
E05_8
Oils/fats/butter
E06
CHILDREN AGE 6-18 YRS.
E06_1
Rice, Wheat, Maize, maize porridge, Other cereal (sorghum, millet, etc), Roots and Tubers (cassava, potatoes, sweet potatoes)
E06_2
Beans and peas, pulses groundnuts and cashew nuts`
E06_3
Vegetables (including leaves)
E06_4
Fruits
E06_5
Egg, meat, fish etc.
E06_6
Milk/yogurt/other dairy product
E06_7
Sugar or sugar products, honey
E06_8
Oils/fats/butter
E07
OTHER MALE MEMBERS
E07_1
Rice, Wheat, Maize, maize porridge, Other cereal (sorghum, millet, etc), Roots and Tubers (cassava, potatoes, sweet potatoes)
E07_2
Beans and peas, pulses groundnuts and cashew nuts`
E07_3
Vegetables (including leaves)
E07_4
Fruits
E07_5
Egg, meat, fish etc.
E07_6
Milk/yogurt/other dairy product
E07_7
Sugar or sugar products, honey
E07_8
Oils/fats/butter
E08
What was the main source(s) of the food?
E08_1
Rice, Wheat, Maize, maize porridge, Other cereal (sorghum, millet, etc), Roots and Tubers (cassava, potatoes, sweet potatoes)
E08_2
Beans and peas, pulses groundnuts and cashew nuts`
E08_3
Vegetables (including leaves)
E08_4
Fruits
E08_5
Egg, meat, fish etc.
E08_6
Milk/yogurt/other dairy product
E08_7
Sugar or sugar products, honey
E08_8
Oils/fats/butter
COPING STRATEGY
F01
Usually, does your household has sufficient food available for the whole year?
Yes
No
F02
If no, in a year how many months / days, the household has insufficient food?
F03
In a year, how frequently do you have to do ________ because of insufficient food in the household
F03_1
Skip entire days without eating?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_2
Limit portion size at mealtimes?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_3
Reduce number of meals eaten per day?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_4
Borrow food or rely on help from friends or relatives?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_5
Rely on less expensive or less preferred foods?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_6
Purchase/borrow food on credit?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_7
Gather unusual types or amounts of wild food / hunt?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_8
Send household members to eat elsewhere?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_9
Send household members to beg?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F03_10
You or other female members eat less?
NEVER
SELDOM
SOMETIMES
OFTEN
DAILY
F04
Have you sold any household assets to buy food?
Yes
No
Access to loan and Income of Household
G01
Have you taken any loan before micro credit plan?
Yes
No
G02
Does your microcredit plan get approved?
Yes
No
G03
What was the loan amount you received?
G04
For what purpose was the loan amount granted?
Agriculture Purpose
Educational Purpose
Consumption Purpose
Income Generation purpose
If other (Specify__)
G05
For what purpose have you used that loan amount?
Agriculture Purpose
Educational Purpose
Consumption Purpose
Income Generation purpose
If other (Specify__)
G06
What is the repayment status of the loan availed?
Fully repaid
Partially repaid
Repayment going on time
Not repaid at all/ Not started the repayment process
G07
What is the frequency of your participation in Micro Investment Planning?
Weekly
Fortnightly
Monthly
Quarterly
Half yearly
Annually
G08
What was the mode of loan fund transfer?
Cash
Bank account transfer
If other (Specify__)
G09
What were the sources of accessing the loan/ credit?
From your SHG
Through Bank
Traditional money lender
Relatives/ family members
MFIS
If other (Specify__)
G10
What was your monthly Household income before joining SHG?
G11
What were the livelihood activities were your household engaged in before joining the SHG?
Agriculture/cultivation on own/ leased-in/shared land
Animal husbandry
Fishing
Agriculture labor
Non-agri labor, unskilled (coolie, etc.)
Non-agri labor, skilled (mason, carpenter etc.)
MGNREGS labor
Enterprise/business /shops
Salaried Govt. job
Salaried private job
JEEVikA Cadre
Other’s Specify
G12
What is your current monthly Household income after joining SHG?
G13
What were the livelihood activities were your household engaged in before joining the SHG?
Agriculture/cultivation on own/ leased-in/shared land
Animal husbandry
Fishing
Agriculture labor
Non-agri labor, unskilled (coolie, etc.)
Non-agri labor, skilled (mason, carpenter etc.)
MGNREGS labor
Enterprise/business /shops
Salaried Govt. job
Salaried private job
JEEVikA Cadre
Other’s Specify
G14
How much amount of loan have you accessed through RF?
G15
How much amount of loan have you received through ICF?
Opinion on Women’s Role in Economic development
H01
Who has the most say in decision-making regarding the following issues.
Respondent
Husband
Senior Male
Senior Female
No children
Not Applicable
Others
H01A
Has there been any change in your contribution towards decision making on this household issue after you joined SHG?
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
H02
What food items to purchase?
H03
How many children to have?
H04
What to do if you fall sick?
H05
How much money to spend on a social function such as marriage?
H06
What to do if a child falls sick?
H07
Whom should your children marry?
H08
Children’s education: whether all children should be sent to school?
H09
Nutrition of children: How many meals to have when to eat and what to eat?
ROLE IN HOUSEHOLD DECISION-MAKING AROUND PRODUCTION, CREDIT, AND INCOME GENERATION
I01
How much input did you have in making decisions about [ACTIVITY]?
I01_1
Food crop farming: These are crops that are grown primarily for household food consumption
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_2
Cash crop farming: These are crops that are grown primarily for sale in the market
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_3
Livestock raising
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_4
Non-farm economic activities: This would include things like running a small business, self-employment, buy-and-sell
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_5
Wage and salary employment: This could be work that is paid for in cash or in-kind, including both agriculture and other wage work
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_6
Fishing or fishpond culture
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_7
Major household expenditures (such as buying movable and immovable assets, like jewellery, land, house, etc.)
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_8
Minor household expenditures (such as food for daily consumption, consumer durables or other household needs)
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_9
Borrowing from SHGs
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_10
Borrowing from MFIs/Banks
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_11
Borrowing from informal credit sources
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_12
Use of savings in the household
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I01_13
Use of income earned by you/husband in the household
No input or input in few decisions
Input into some decisions
Input into most or all decisions
No decision made
I02
Has there been any change in the inputs provided by you for this activity after you joined SHG?
I02_1
Food crop farming: These are crops that are grown primarily for household food consumption
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_2
Cash crop farming: These are crops that are grown primarily for sale in the market
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_3
Livestock raising
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_4
Non-farm economic activities: This would include things like running a small business, self-employment, buy-and-sell
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_5
Wage and salary employment: This could be work that is paid for in cash or in-kind, including both agriculture and other wage work
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_6
Fishing or fishpond culture
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_7
Major household expenditures (such as buying movable and immovable assets, like jewellery, land, house, etc.)
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_8
Minor household expenditures (such as food for daily consumption, consumer durables or other household needs)
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_9
Borrowing from SHGs
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_10
Borrowing from MFIs/Banks
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_11
Borrowing from informal credit sources
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_12
Use of savings in the household
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
I02_13
Use of income earned by you/husband in the household
Yes, my participation has increased significantly
Yes, my participation has increased moderately
No change/Decrease
FREEDOM OF MOBILITY
J01
Now, I would like to ask you about going to the following places, and please tell us whether you have to ASK PERMISSION of your husband or a senior household member to go
J01_1
To the local health centre?
Yes, inform my husband
Yes, Inform my mother-in-law
Yes, inform any senior household member
No need to inform
J01_2
To the home of relatives or friends in the village neighbourhood?
Yes, inform my husband
Yes, Inform my mother-in-law
Yes, inform any senior household member
No need to inform
J01_3
To the grocery shop?
Yes, inform my husband
Yes, Inform my mother-in-law
Yes, inform any senior household member
No need to inform
J01_4
To short distance by train or bus?
Yes, inform my husband
Yes, Inform my mother-in-law
Yes, inform any senior household member
No need to inform
J01_5
Market?
Yes, inform my husband
Yes, Inform my mother-in-law
Yes, inform any senior household member
No need to inform
J01_6
To natal home from in-law’s place?
Yes, inform my husband
Yes, Inform my mother-in-law
Yes, inform any senior household member
No need to inform
J01_7
Attending SHG meetings?
Yes, inform my husband
Yes, Inform my mother-in-law
Yes, inform any senior household member
No need to inform
J02
Can you go unaccompanied to the following locations?
J02_1
To the local health centre?
Yes
No
J02_2
To the home of relatives or friends in the village neighbourhood?
Yes
No
J02_3
To the grocery shop?
Yes
No
J02_4
To short distance by train or bus?
Yes
No
J02_5
Market?
Yes
No
J02_6
To natal home from in-law’s place?
Yes
No
J02_7
Attending SHG meetings?
Yes
No
J03
In the last five years, has there been any change in your freedom of mobility?
Yes, there has been a moderate improvement
No change/Decreased
Yes, there has been a moderate improvement
J04
What has led to this change?
Due to active participation in SHG and community-l level institutions
Exposure to various project led activities including training, market etc
Feeling of safe space due to the presence of SHGs in the village
Others (please specify)
J05
How much do you agree or disagree with the following statements?
J05_1
I can count on fellow SHG members if I need to borrow money
Agree
Neither agree nor disagree
Disagree
J05_2
I can count on fellow SHG members to talk about my problems
Agree
Neither agree nor disagree
Disagree
J05_3
SHG members worry about themselves only
Agree
Neither agree nor disagree
Disagree
J05_4
I can count on fellow SHG members to help me address the problems I am unable to solve on my own (E.g. Violence)
Agree
Neither agree nor disagree
Disagree
POLITICAL PARTICIPATION
K01
Have you ever raised voice for any concern or issue in the community?
Yes
No
K02
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
K03
Did you vote in the last election?
Yes
No
K04
Why did you vote?
My husband had asked me to do so
It is my right
Political party requested to cast a vote.
Political party distributed incentives to cast a vote
I believe in the manifesto the party presented
Others specify
K05
Why did you not vote?
Do not feel this to be necessary
Stopped from going by husband/household members
Fearful
Not aware of the process
Others specify
Don’t know
K06
Have you ever participated in Gram Sabha meetings?
Yes
No
K07
What was the reason for attending a Gram Sabha meeting?
I was given an incentive to attend the meeting
To keep myself updated with the political happening
It is my right to share my views and concern
Issue to be discussed was of interest to me
Issue to be discussed was of interest to my SHG/federation
Other, Specify
K08
What was the reason for not attending the Gram Sabha meeting?
I did not get information about the meeting
Date or time was not convenient.
Gram Sabha is not of interest to me
Issue to be discussed in the meeting was not of interest to me
Other (specify)
K09
Do you feel comfortable speaking up in public to help decide on infrastructure (like small wells, roads, water supplies) to be built in your community?
No, not at all comfortable
Yes, but with a great deal of difficulty
Yes, but with a little difficulty
Yes, mostly
Yes, very comfortable
Not applicable
K10
Do you feel comfortable speaking up in public to ensure proper payment of wages for public works or other similar programs?
No, not at all comfortable
Yes, but with a great deal of difficulty
Yes, but with a little difficulty
Yes, mostly
Yes, very comfortable
Not applicable
K11
Do you feel comfortable speaking up in public to protest the misbehaviour of authorities or elected officials?
No, not at all comfortable
Yes, but with a great deal of difficulty
Yes, but with a little difficulty
Yes, mostly
Yes, very comfortable
Not applicable
K12
How confident do you feel speaking your opinion in any training or SHG meeting?
No, not at all comfortable
Yes, but with a great deal of difficulty
Yes, but with a little difficulty
Yes, mostly
Yes, very comfortable
Not applicable
K13
How confident do you feel when you have to talk to a bank officer/ manager/ teacher/ AWW?
No, not at all comfortable
Yes, but with a great deal of difficulty
Yes, but with a little difficulty
Yes, mostly
Yes, very comfortable
Not applicable
K14
How confident do you feel when you have to talk to Sarpanch/Pradhan?
No, not at all comfortable
Yes, but with a great deal of difficulty
Yes, but with a little difficulty
Yes, mostly
Yes, very comfortable
Not applicable
Response to COVID-19
L01
Have you received any information/directives during COVID-19?
Yes
No
L02
Who has provided the information/directives ?
SHG
VO
CLF
ASHA
AWW
Gram Pradhan/sarpanch
Other(specify)
L03
What are the directives/infromation your CLF has received?
Suspend all meetings until the next notice
Information on symptoms of CORONA (COVID-19)
Information on preventive measures for CORONA (COVID-19)
Instructions on how to carry out the financial activities during the lockdown
Others (specify)
L04
What are the initiatives that your SHG took to fight against CORONA (COVID-19)?
Provide information on symptoms and prevention from CORONA (COVID-19) to the VO and SHG members through mobile messaging
SHG members helped ASHA/ ANM/ AWW in distribution of face masks and sanitizers
Others (specify)
No initiative taken
L05
What are the preventive measures SHG members adopted while helping with the COVID-19 situation at the community level?
Wash hands frequently
Wash hands frequently with soap
Clean hands with sanitizer
Cover nose and mouth with handkerchief/ tissue/elbow while coughing or sneezing
Don't touch eyes, nose, or mouth
Don't be in close physical contact with anyone
Avoid crowded places
Be at least 1 meter away from everyone
Don't spit in public
Wear a mask if sick
Avoid physical contact with infected individuals
Avoid touching common surfaces, items or sharing plates/utensils
Avoid touching what sick persons have touched such as surfaces, items, plates/utensils
Keep cleaning common surfaces
Don't shake hands with others
Others (specify)
Don't Know
L06
Does meeting of SHGs postponed/ delayed due to COVID lockdown?
Yes
No
L07
Have you faced any issue in access to funds during COVID-19?
Yes
No
L08
Was there any issue faced in communication with the BRLPS team due to COVID-19 lockdown?
Yes
No
L09
Was there any issue faced in communication with the VO/ CLF members due to COVID lockdown?
Yes
No
L10
Have you faced any issue in accessing basic amenities during lockdown?
Yes
No
L11
Were you involved in any economic activity during COVID-19 ?
Yes
No
L12
What kind of economic activities have you taken up during COVID-19 lockdown with support of JEEViKA?
L13
What were the social interventions/ initiatives taken up by the SHG/ VO/ CLF during COVID-19 with support of JEEViKA?
L14
How has your life changed after becoming part of JEEViKA ?
L15
What were your aspirations that JEEViKA has helped to achieve?
L16
What are the challenges you are facing even after becoming part of the SHG?
L17
What actions can be taken to tackle the challenges that you are facing?
L18
What is your plan for the next 5 years to grow with JEEViKA?
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