Please Wait...

Women Entrepreneurs Template -Form Fill

HOUSEHOLD IDENTIFICATION
Q01

App Version
Q02

State Code
Q03

State name
Q04

District code

Q05

District name

Q06

Block code

Q07

Block name

Q08

Village/CEB code

Q09

Village/CEB name

Q10

Interviewer ID
Q11

Supervisor ID
Q12

Household number
Q13

Unique Reference ID.

Q14

Date of visit
Q15

Result of visit
RESPONDENT INFORMATION
A01

Type of respondent (select all that apply)
A01A

Name of respondent
A02

Is the respondent member of SHG
A02A

Name of the SHG
A02B

Name of the VO
A02C

Name of the CLF
A03

Is the respondent a member of any of the following
A04

Caste category of respondent
A05

Who is the primary income earner in your household (Select the code with respect to the relationship with the respondent)
A06

Who is the head of the household?
HOUSEHOLD INFORMATION
B01

How many members live in this household?
B02

Name of all hh member
B03

Gender
B04

Age (in complete years)
B05

Relationship to head of household
B06

Marital status (Ask only if the age of the member is above 18 years)
B07

Educational qualification
B08

Primary activity status (farm/off-farm/non-farm)
MIGRATION ROSTER
C01

Have you or any member of your household left home to find seasonal/short term work during last two years?
C02

How many members of your household have left home to find seasonal/short term work during the last two years?
C03

Names of the member
C04

Gender
C05

Age (in completed years)
C06

Place of migration
C07

Rural or Urban
C08

When did they leave?
C09

Duration of stay
C10

Relationship with head of the household
C11

Type of work
C12

Do they send remittance?
C13

If yes, how much? (INR)
Income from Livelihood and Other Sources
D01

Does your household cultivate crops/ perform farm based activities that result in income generation on any agricultural land?
D02

What is the ownership type of the agricultural land you utilize for farming?
D03

Which unit do you use to measure the area of your agricultural land?
D04

CONVERSION FACTOR: ONE ACRE EQUALS
D05

What is the total size of your agricultural land?

D06

What is the division of the total land you cultivate on?
D07

Please tell us the type of land that you cultivate on?
D08

Can you tell us the number of crops you grow?
D09

Season
D10

Name of crop
D11

Irrigated?
D12

Area under crop during season
D13

What are the total input costs for the crop?

D13_1

Seeds and saplings
D13_2

Fertilizers and manures
D13_3

Pesticides
D13_4

Irrigation
D13_5

Hiring tractor/Animals
D13_6

fuel for transportation
D13_7

Transportations
D14

How much quantity of crops were produced (in Quintal)
D15

Quantity utilized for self-consumption in Kg (in Quintal)
D16

Quantity sold (in Quintal)
D17

Selling price per unit
D18

Quantity spoiled / rotten
D19

Quantity kept in storage
D20

Total Revenue earned from crop in the last year. (INR)
D21

Is there a value-added product you make from this crop?

D22

If D21=1 (yes), what value added product do you make?
D23

Income earned from the sale of the value added product in a year? (INR)
D24

Total revenue earned by the household from agricultural activities in the last year
D25

Total cost incurred by the household from agricultural activities in the last year
D26

Net income earned by the household from agricultural activities in the last year

OFF-FARM
E01

Do you own any livestock such as cows, buffalo, goats or chickens?
E02

Do you own:
E02A

How many of each do you own:

E02A_1

Milch cows
E02A_2

Milch buffaloes
E02A_3

Draft animals (bullocks etc.)
E02A_4

Goats
E02A_5

Poultry
E02A_6

Pigs
E03

How much money did you make selling milk and milk products
E03A

How much money did you make selling Poultry, eggs, meat etc.
E03B

Have you sold any livestock in the last year?
E03C

Did you sell
E03D

How many [livestock] did you sell and the rate?

E03D1

Number of livestock sold

E03D1_1

Milch cows
E03D1_2

Milch buffaloes
E03D1_3

Draft animals (bullocks etc.)
E03D1_4

Goats
E03D1_5

Poultry
E03D1_6

Pigs
E03D2

Rs charged per livestock

E03D2_1

Milch cows
E03D2_2

Milch buffaloes
E03D2_3

Draft animals (bullocks etc.)
E03D2_4

Goats
E03D2_5

Poultry
E03D2_6

Pigs
E04

Total money earned from selling livestock
E05

Did you buy any livestock in the last year?
E06

If yes, did you buy
E07

How many [livestock] did you buy and the rate?

E07A

Number of livestock bought

E07A_1

Milch cows
E07A_2

Milch buffaloes
E07A_3

Draft animals (bullocks etc.)
E07A_4

Goats
E07A_5

Poultry
E07A_6

Pigs
E07B

Rs charged per livestock

E07B_1

Milch cows
E07B_2

Milch buffaloes
E07B_3

Draft animals (bullocks etc.)
E07B_4

Goats
E07B_5

Poultry
E07B_6

Pigs
E08

Total money spent on buying livestock
E09

Money spent on feed and fodder in the last year

E09A

Value of purchased feed & fodder
E09B

Value of home produced/collected feed & fodder.
E10

How much was the cost of the following last year:

E10A

Veterinary services
E10B

Hired labour for grazing/care
E10C

Other costs (ropes, transport etc.)
E11

Infrastructure for livestock rearing

E11_1

Do you have a designated are or shelter for housing your animals?
E11_2

What type of shelter do you provide for your animals?
E11_3

Do you have feeding troughs or bins for your animals?
E11_4

Do you have a separate area for feeding you animals?
E11_5

Do you provide proper fencing or enclosure to protect your animals from predators?
E11_6

Do you visit a veterinarian when your animals are ill?
E12

Challenges in using infrastructure

E12_1

What are the main challenges you face regarding animal shelter and infrastructure?
E12_2

How do you manage extreme weather conditions (e.g., heatwaves, cold, rain) for your animals?
E12_3

What difficulties do you encounter in providing clean water to your animals?
E12_4

Do you face any difficulty seeking healthcare (medicine, vaccination etc.) for your livestock?
E12_5

What difficulties do you face seeking healthcare for your livestock?
E13

Total revenue earned by the household from the sale of animals and animal products in the last year
E14

Total cost incurred by the household from livestock rearing in the last year
E15

Net income of the household from livestock rearing in the last year
E16

How many members of your household participate in animal rearing?
E16A

Household members who participated in taking care of the animals
E16B

How often did [PERSON] help take care of animals?
E16C

What is your relationship with the primary person responsible for taking care of animals in the household?
NON-FARM
F01

Does anybody in the household own non-farm business?
F01A

If yes, how many businesses do they own?
F02

Description of activity

F02A

Industry
F02B

Occupation

F03

Is this business in partnership?
F03A

What was the gross receipt from this business over the last 12 months
F03B

If the respondent claims a gross loss for the business in E10A, note total loss here:
F04

How much did it cost to operate this business (in last 12 months)

F04_1

Rent

F04_2

Electricity, water, transport
F04_3

Labour

F04_4

Material and inputs
F04_5

Business loan installment, interest etc.?
F04_6

Taxes
F04_7

Total
F05

Net amount earned by household from the enterprise in the last year
F06

Who is the primary decision maker for the business?
F07

Did you make any major investment for your business last year?
F08

If yes, how much was it?
F09

Does any family member, other than you, work in the business?
F10

Name
F11

Relationship with respondent:
F12

How many days did [PERSON] work last year?
F13

How many hours a day did [PERSON] usually work?
OTHERS (Wage and salary work)
G01

Name
G02

Relationship with respondent:
G03

Industry code
G04

Occupation code
G05

Duration of work (in days)
G06

Wage received.
G07

Frequency of payment
G08

Is [NAME] a casual or a permanent worker?
G09

Nature of job/work?
G10

Total revenue earned by the household from its enterprise(s) and wage and salary work in the last year
G11

Total cost incurred by the household from its enterprise(s) and wage and salary work in the last year
G12

Net income earned by the household from its enterprise(s) and wage and salary work in the last year
HOUSEHOLD EXPENDITURE AND CONSUMPTION
H01

Over the last 7 days, how many days did you consume following foods?

H01_1

Cereals like rice, wheat , bajra, maize, millet etc 
H01_2

Dals (pulses, arhar, toor, lobia, channa etc) 
H01_3

Vegetables (including leafy vegetables) 
H01_4

Fruits
H01_5

Chicken and eggs  
H01_6

Fish 
H01_7

Goat, pork and meat 
H01_8

Milk/yogurt/other dairy product 
OWNERSHIP OF HH ASSETS
I01

Does your household have

I01_1

Electricity
I01_2

A mattress
I01_3

A pressure cooker
I01_4

A chair
I01_5

A cot or bed
I01_6

A table

I01_7

An electric fan
I01_8

A radio or transistor
I01_9

A color television
I01_10

A sewing machine
I01_11

A mobile telephone
I01_12

Any other type of telephone
I01_13

A computer/laptop
I01_14

A refrigerator
I01_15

A watch or clock
I01_16

A bicycle
I01_17

A motorcycle or scooter
I01_18

A car
I01_19

Internet
I01_20

Air Conditioner or Cooler
I01_21

Washing Machine
I02

Does your household have:

I02_1

An animal-drawn cart
I02_2

A water pump
I02_3

A thresher
I02_4

A tractor
I02_5

Internet for productive purposes
I02_6

Plows, harrows, and other farming equipment
I02_7

Sprinkler
I02_8

Drip pipeline
I02_9

Bore Well
I02_10

Farm hand tools
I02_11

Combine
I02_12

Animal stable
I02_13

Cultivator
I02_14

Tiller
I02_15

Seed drill
I02_16

Fishing equipment (nets, boats)
I02_17

Beehives
I02_18

Crop storage facilities

I02_19

Greenhouses
I02_20

Milking machines
I02_21

Grinding mills
I02_22

Sewing machines
I02_23

Weaving looms
I02_24

Oil press
I02_25

Fruit processing equipment
I02_26

Dairy equipment (churns, pasteurizers)
I02_27

Bakery equipment (ovens, mixers)
I02_28

Honey processing equipment
I02_29

Livestock shelters or barns
I02_30

Cold storage facilities
I02_31

Farm fencing
I02_32

Rainwater harvesting systems
I02_33

Livestock feed mills
I02_34

Agricultural or artisanal tools (e.g., pottery wheels, looms)
I02_35

Grinders for grain or spices
I02_36

Boilers for food processing
I02_37

Irrigation pumps and pipes
I02_38

Veterinary equipment (if applicable)
I02_39

Livestock feed and forage stocks
I02_40

Weighing scales
I02_41

Soil testing kit
I02_42

Pesticide or fertilizer application equipment
I02_43

Livestock vaccination equipment
I03

Who takes decisions concerning the usage of this asset

I03_1

An animal-drawn cart
I03_2

A water pump
I03_3

A thresher
I03_4

A tractor
I03_5

Internet for productive purposes
I03_6

Plows, harrows, and other farming equipment
I03_7

Sprinkler
I03_8

Drip pipeline
I03_9

Bore Well
I03_10

Farm hand tools
I03_11

Combine
I03_12

Animal stable
I03_13

Cultivator
I03_14

Tiller
I03_15

Seed drill
I03_16

Fishing equipment (nets, boats)
I03_17

Beehives
I03_18

Crop storage facilities

I03_19

Greenhouses
I03_20

Milking machines
I03_21

Grinding mills
I03_22

Sewing machines
I03_23

Weaving looms
I03_24

Oil press
I03_25

Fruit processing equipment
I03_26

Dairy equipment (churns, pasteurizers)
I03_27

Bakery equipment (ovens, mixers)
I03_28

Honey processing equipment
I03_29

Livestock shelters or barns
I03_30

Cold storage facilities
I03_31

Farm fencing
I03_32

Rainwater harvesting systems
I03_33

Livestock feed mills
I03_34

Agricultural or artisanal tools (e.g., pottery wheels, looms)
I03_35

Grinders for grain or spices
I03_36

Boilers for food processing
I03_37

Irrigation pumps and pipes
I03_38

Veterinary equipment (if applicable)
I03_39

Livestock feed and forage stocks
I03_40

Weighing scales
I03_41

Soil testing kit
I03_42

Pesticide or fertilizer application equipment
I03_43

Livestock vaccination equipment
I04

In the last three years, did you household avail any loan

I05

Have you availed loans from sources mentioned below

I05_1

Bank/ Govt. Program/ Other Credit Program?
I05_2

Micro finance/ Community group/ NGO/ Self- help group?
I05_3

A money lender?
I05_4

Employer?
I05_5

Friends/ Relatives?
I06

Who took the decision regarding availing this loan
I07

how many loans have you taken in the past three years?
I08

Ask for the largest loan amount received:
I09

How many years ago did you obtain this loan?
I10

How much did you borrow?
I11

For what purpose was the loan taken?
I12

From where did you obtain this loan?
I13

What was the interest rate on the loan?
I14

Has the loan been paid off yet?
I15

Have you inherited any loans from your father or other relatives that is still pending?
I16

In the last three years, have you sold

I16A

Land to pay off expenses or pay off loans?
I16B

Jewelry to pay off expenses or pay off loans?
I17

How much in total does your household currently owe to others?
I18

Has your household given a loan to others?
I18A

How much of the loans that you have given to others is still to be returned?
I19

Who in the household took decision about availing the loan?
I20

Who in the household took decision about availing the loan?
I21

Who in the household takes decision about repaying the loan?
SAVINGS
J01

Are you personally currently saving money?
J01A

How long ago did you start saving?
J01B

How much have you personally saved in cash?
J01C

During the last 12 months, where did you deposit your savings usually?
J01D

Who is majorly responsible for/manages the savings?
MARKET LINKAGES
K01

Where do you typically sell your agricultural output?
K02

How do you source agricultural inputs for your farming activities?
K03

How do you perceive the ease of accessing markets for your agricultural products in terms of:

K03A

Is the cost of transporting your products to the market affordable for you?
K03B

Does the time it takes to reach the market impact your ability to sell your products effectively?
K03C

How satisfied are you with the quality of market facilities and storage options available?
K04

Are there any specific challenges you face in the transportation of your agricultural produce to markets?
K05

If yes, please specify the main challenges you face in transporting your agricultural produce to markets.
K06

How do you perceive the ease of accessing markets for your agricultural products in terms of:

K06A

Are the required agricultural inputs readily available in your area?
K06B

Are the prices of agricultural inputs reasonable and affordable for you?
K06C

Are you satisfied with the time it takes you to procure basic inputs like seeds, fertilizers etc.?
K06D

How satisfied are you with the quality of agricultural inputs available to you?
K07

Do you face any challenges in procuring agricultural inputs?
K08

If yes, please specify the main challenges you face in procuring agricultural inputs.
SKILLS AND CAPACITY
L01

Are you part of any collective which helps you to grow your business?
L02

Have you received any training from cadres on this topic so far?
L02A

Have you received any of the following trainings:
L03A

Have you received any training from the cadres?
L03B

How did the training help you access the services mentioned in the training module (eg: inputs, linkages, credit etc.)
L04

Were you provided any IEC training material?
L05

Were the topics covered relevant to your needs?
L06

Trainer Effectiveness

L06_1

How knowledgeable was the trainer on the subject matter?
L06_2

Was the trainer good at communicating information?
L06_3

Did the trainer clarify your doubts?
L07

Training Delivery

L07A

Was the training pace appropriate?
L07B

Were practical examples and exercises provided?
L08

Were the training facilities (venue, equipment etc.) satisfactory?
L09

Post-training knowledge

L09A

Do you feel that you have gained valuable knowledge and skills from this training?
L09B

Are you confident in applying what you’ve learned in your work or daily?
L10

Training Impact

L10A

Have you been able to apply these trainings in real life?
L10B

Have you seen positive results or improvements as a result of these trainings?
L11

Are you aware of the work of FIAS
L12

What are the services you receive from the FIA
L13

Convergence

L13_1

Has the cadre of FIAs supported you to file application for a government scheme
L13_2

Who assisted you in filing application for the government support
L13_3

Have you received any benefits from government programs?
L13_4

What are the benefits you received from government schemes
L13_5

What are the major challenges you face in accessing benefits from government schemes?
DIGITAL AND FINANCIAL LITERACY
M01

Do you have an active bank account?
M02

When was the last time you visited the bank?
M03

Are you aware of digital banking services such as mobile banking or internet banking?
M04

If yes, do you use digital banking services?
M06

Do you have access to a smartphone or a feature phone with internet connectivity?
M07

If you use digital banking, what are the main challenges or concerns you face?
Access to productive capital
N01

Does the HH own the asset?

N01_1

Agricultural Land – cultivable land
N01_2

Agricultural Land – non-cultivable land
N01_3

Land / property
N01_4

Gold
N01_5

Fixed deposits
N01_6

Recurring deposit
N01_7

Savings account

N01_8

Current account
N01_9

Flat/ Apartment/ House (other than own house)
N01_10

Mutual Fund/Unit Trust/Share Market/Bonds
N01_11

Chit fund, self-help group or credit society account
N01_12

Post Office Account (RD, Kisan vikas patra, etc.)
N01_13

Pension Fund/LIC/Other savings schemes
N01A

Who has the ownership of the asset?

N01A_1

Agricultural Land – cultivable land
N01A_2

Agricultural Land – non-cultivable land
N01A_3

Land / property
N01A_4

Gold
N01A_5

Fixed deposits
N01A_6

Recurring deposit
N01A_7

Savings account

N01A_8

Current account
N01A_9

Flat/ Apartment/ House (other than own house)
N01A_10

Mutual Fund/Unit Trust/Share Market/Bonds
N01A_11

Chit fund, self-help group or credit society account
N01A_12

Post Office Account (RD, Kisan vikas patra, etc.)
N01A_13

Pension Fund/LIC/Other savings schemes
Decision making
O01

Who takes decision on planting which crop?
O01_1

Do you own any land which is cultivated?
O01_2

Who takes decision on choosing the market for selling the produce?
O01_3

Who handles the major expenses of household?
O01_4

Who takes decision on utilizing savings of HH?
O01_5

Who takes decision on utilizing income of HH?
O01_6

Who takes decision on education of children?
O01_7

Who took the decision for starting of enterprise?
O01_8

Who takes decision on operations of enterprise?
O01_9

Who takes decision on livestock rearing practices?
O02A

How often do you visit these places and attend the following meetings?

O02A_1

Village market/ Hatt/ Block market
O02A_2

District market
O02A_3

Gram sabha meeting
O02A_4

Group/CBO meeting
O02A_5

External training
O02A_6

Hospitals
O02A_7

Medical camp
O02A_8

Temple/church/mosque etc
O02A_9

Community meeting/ gathering
O02A_10

Outside village
O02B

Do you take permission from your husband / partner to visit these places?

O02B_1

Village market/ Hatt/ Block market
O02B_2

District market
O02B_3

Gram sabha meeting
O02B_4

Group/CBO meeting
O02B_5

External training
O02B_6

Hospitals
O02B_7

Medical camp
O02B_8

Temple/church/mosque etc
O02B_9

Community meeting/ gathering
O02B_10

Outside village
O02C

Under what circumstances they might allow you to go?

O02C_1

Village market/ Hatt/ Block market
O02C_2

District market
O02C_3

Gram sabha meeting
O02C_4

Group/CBO meeting
O02C_5

External training
O02C_6

Hospitals
O02C_7

Medical camp
O02C_8

Temple/church/mosque etc
O02C_9

Community meeting/ gathering
O02C_10

Outside village
O02D

Do these objections prevent you from going alone?

O02D_1

Village market/ Hatt/ Block market
O02D_2

District market
O02D_3

Gram sabha meeting
O02D_4

Group/CBO meeting
O02D_5

External training
O02D_6

Hospitals
O02D_7

Medical camp
O02D_8

Temple/church/mosque etc
O02D_9

Community meeting/ gathering
O02D_10

Outside village
O03A

Who does the following activities?

O03A_1

Cooking
O03A_2

Taking care of children
O03A_3

Cleaning house
O03A_4

Cleaning kitchen
O03A_5

Buying ration/ vegetables
O03A_6

Other HH chores
O03A_7

Sowing seeds
O03A_8

Harvesting produce
O03A_9

Feeding livestock
O03A_10

Handling enterprise operations
O03A_11

Handling customers
O03A_12

Handling records
O03B

How many hours do you put in on average for these activities?

O03B_1

Cooking
O03B_2

Taking care of children
O03B_3

Cleaning house
O03B_4

Cleaning kitchen
O03B_5

Buying ration/ vegetables
O03B_6

Other HH chores
O03B_7

Sowing seeds
O03B_8

Harvesting produce
O03B_9

Feeding livestock
O03B_10

Handling enterprise operations
O03B_11

Handling customers
O03B_12

Handling records
O03C

Do you receive any help from other HH members?

O03C_1

Cooking
O03C_2

Taking care of children
O03C_3

Cleaning house
O03C_4

Cleaning kitchen
O03C_5

Buying ration/ vegetables
O03C_6

Other HH chores
O03C_7

Sowing seeds
O03C_8

Harvesting produce
O03C_9

Feeding livestock
O03C_10

Handling enterprise operations
O03C_11

Handling customers
O03C_12

Handling records
O03D

What is the extent of the help received?

O03D_1

Cooking
O03D_2

Taking care of children
O03D_3

Cleaning house
O03D_4

Cleaning kitchen
O03D_5

Buying ration/ vegetables
O03D_6

Other HH chores
O03D_7

Sowing seeds
O03D_8

Harvesting produce
O03D_9

Feeding livestock
O03D_10

Handling enterprise operations
O03D_11

Handling customers
O03D_12

Handling records
O04A

Do you respect the member?

O04A_1

Husband
O04A_2

Wife
O04A_3

Father
O04A_4

Mother
O04A_5

Sister
O04A_6

Father-in law
O04A_7

Mother-in law
O04A_8

Sister-in-law
O04A_9

Brother-in-law
O04A_10

Other relationship
O04B

Does the member respect you?

O04B_1

Husband
O04B_2

Wife
O04B_3

Father
O04B_4

Mother
O04B_5

Sister
O04B_6

Father-in law
O04B_7

Mother-in law
O04B_8

Sister-in-law
O04B_9

Brother-in-law
O04B_10

Other relationship
O04C

Do you trust the member to do things that are best in your interest?

O04C_1

Husband
O04C_2

Wife
O04C_3

Father
O04C_4

Mother
O04C_5

Sister
O04C_6

Father-in law
O04C_7

Mother-in law
O04C_8

Sister-in-law
O04C_9

Brother-in-law
O04C_10

Other relationship
O04D

Are you comfortable in communicating with the person if you disagree with him/her?

O04D_1

Husband
O04D_2

Wife
O04D_3

Father
O04D_4

Mother
O04D_5

Sister
O04D_6

Father-in law
O04D_7

Mother-in law
O04D_8

Sister-in-law
O04D_9

Brother-in-law
O04D_10

Other relationship
O05

In your opinion is a husband justified in hitting or beating his wife in the following situation?

O05_1

If she goes out without telling him?
O05_2

If she neglects the children?
O05_3

If she argues with him?
O05_4

If she refuses to have physical intimacy??
O05_5

If she burns the food?
O06

How much do you agree or disagree with the following statements?

O06_1

I can count on fellow SHG members if I need to borrow money

O06_2

I can count on fellow SHG members to talk about my problem

O06_3

SHG members worry about themselves only
O06_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)

O07_1

Have you ever participated in Gram Sabha meetings?

O07_2

What was the reason for attending a Gram Sabha meeting?
O07_3

What was the reason for not attending the Gram Sabha meeting?
CONFIDENCE AND PUBLIC SPEAKING
P01

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?
P02

Do you feel comfortable speaking up in public to ensure proper payment of wages for public works or other similar programs?
P03

Do you feel comfortable speaking up in public to protest the misbehaviour of authorities or elected officials?
P04

How confident do you feel speaking your opinion in any training or SHG meeting?
P05

How confident do you feel when you have to talk to a bank officer/ manager/ teacher/ AWW?

P06

How confident do you feel when you have to talk to Sarpanch/Pradhan?
P07

How confident are you in speaking at a GP/GS meeting
P08

When was the last time you spoke at GP/GS meeting?
P09

What are the challenges you face while speaking at GP/GS?
P10

Do you currently hold any leadership positions at the SHG or PG related institutions?
P11

What is the title of the position held?
P12

In which organisation do you hold this position?