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Household Template 33 -Form Fill
HOUSEHOLD STUDY
Q01
Name of the State
Q02
Name of the District
Q03
Name of the Block
Q04
Name of Panchayat
Q05
Name of the Village
Q06
Type of Village
Project
Comparison
Q07
Household structure number
Q08
Name of household head
Q09
Address of Household
Q10
Interviewer Code
Q11
Interviewer Name
Q12
Type of user
User group (with MLINDA connection)
Non-user group (without MLINDA connection)
Q13
Interviewer’s Visits-1
Q13A
Date
Q13B
Result
Completed
Not at home
Postponed
Refused
Partly Completed
No Eligible Person
Eligible Person Incapacitated
Others (specify)
Q14
Interviewer’s Visits-2
Q14A
Date
Q14B
Result
Completed
Not at home
Postponed
Refused
Partly Completed
No Eligible Person
Eligible Person Incapacitated
Others (specify)
Q15
Interviewer’s Visits-3
Q15A
Date
Q15B
Result
Completed
Not at home
Postponed
Refused
Partly Completed
No Eligible Person
Eligible Person Incapacitated
Others (specify)
HOUSEHOLD PROFILE
A01
Name of the respondent
A02
What is the sex of respondent?
Male
Female
Transgender
A03
What is the religion of your household?
Hindu
Muslim
Christian
Sikh
Buddhist/Neo-Buddhist
Jain
Jewish
Parsi/Zoroastrian
Sarna
No Religion
Other (Specify)
A04
Do you belong to a scheduled caste, scheduled tribe, other backward class or general class?
Scheduled Caste (SC)
Scheduled Tribe (St)
Other Backward Caste (OBC)
General
Other (Specify)
A05
How many members are there in your household?
A06
What is the type of your household?
Nuclear
Joint
Others
A07
Does your household own this house or any other house?
Yes
No
A08
How many rooms are there in this house?
A09
Is your household a woman headed household?
Yes
No
A10
What is the level of education of the head of the household?
A11
Does your household have a bank account?
Yes
No
A12
Does your household have a post-office account?
Yes
No
A13
Do you have any owned agricultural land?
Yes
No
A14
Do you have any leased (leased-in) agricultural land?
Yes
No
A15
Do you have any leased (leased-out) agricultural land?
Yes
No
A15A
Please specify, the size of your land
A15A1
unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
A15B
Please specify, the size of your land
A15B1
unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
A15C
Please specify, the size of your land
A15C1
unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
A15D
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)
A15E
What is the main source of lighting in this household?
Lantern
Kerosene Lamp
Candle
Electric
LPG
Solar Energy
Mini Grid
None
Others (Specify)
A16
Does your household possess ration card?
Yes
No
A16A
If yes in A16 which type of ration card (code) do you posses?
Antodaya
BPL
APL
Single card
Others
A16B
Are there any members of your household who are currently residing outside?
Yes
No
A16C
How many members of your households are currently residing outside?
A17A
Name of the Member
A17B
Gender
Male
Female
A17C
Age
A17D
Current Place of Residence
Same state and within the same district
Same state but another district
Outside the state
Another country
Not Known
A17E
Reason of Migration
In search of employment
in search of better employment
business
to take up employment /better employment
transfer of service/ contract
proximity to place of work
studies
natural disaster (drought, flood, tsunami, etc.)
social / political problems (riots, terrorism, political refugee, bad law and order, etc.)
displacement by development project
acquisition of own house/flat
housing problems
health care
post retirement
marriage
migration of parent/earning member of the family
Others (specify)
A17F
Period Since Leaving the Household (in Years)
A17G
In the past one Year, in which months did the migration take place?
Throughout the Year
January
February
March
April
May
June
July
August
September
October
November
December
A18
How many earning members are there in the household?
A20
What is the source of income from following occupations of the household?
A20A
Whether this activity is undertaken by any member of the household?
A20A_1
Agriculture
Yes
No
A20A_2
Agricultural Labour
Yes
No
A20A_3
Non-Agricultural Labour
Yes
No
A20A_4
Livestock
Yes
No
A20A_5
Salaried
Yes
No
A20A_6
Petty Business/Shop
Yes
No
A20A_7
Business/Trader
Yes
No
A20A_8
Skilled Worker
Yes
No
A20A_9
Pension
Yes
No
A20A_10
Remittance
Yes
No
A20A_11
Other (Specify)
Yes
No
A20B
What was the annual income from this activity?
A20B_1
Agriculture
A20B_2
Agricultural Labour
A20B_3
Non-Agricultural Labour
A20B_4
Livestock
A20B_5
Salaried
A20B_6
Petty Business/Shop
A20B_7
Business/Trader
A20B_8
Skilled Worker
A20B_9
Pension
A20B_10
Remittance
A20B_11
Other (Specify)
A20C
What was the annual expense for this activity?
A20C_1
Agriculture
A20C_2
Agricultural Labour
A20C_3
Non-Agricultural Labour
A20C_4
Livestock
A20C_5
Salaried
A20C_6
Petty Business/Shop
A20C_7
Business/Trader
A20C_8
Skilled Worker
A20C_9
Pension
A20C_10
Remittance
A20C_11
Other (Specify)
A21
Does your household own any of the mentioned assets?
A21_1
Mattress
Yes
No
A21_2
Pressure cooker
Yes
No
A21_3
Chair
Yes
No
A21_4
Cot or bed
Yes
No
A21_5
Table
Yes
No
A21_6
Sewing machine
Yes
No
A21_7
Other type of telephone
Yes
No
A21_8
Watch or clock
Yes
No
A21_9
Bicycle
Yes
No
A21_10
Motorcycle or scooter
Yes
No
A21_11
Animal-drawn cart
Yes
No
A21_12
Car
Yes
No
A21_13
Thresher
Yes
No
A21_14
Tractor
Yes
No
ELECTRICITY SUPPLY & DEMAND
B01
What are the current sources of lighting in your household?
B01A
Primary Source (Select only one)
Grid Electricity
Solar power
Mini Grid
Diesel generator (owned)
Diesel generator (rented)
Kerosene
No lighting
Others (specify)
B01B
Average daily supply of the following (In hours)
B01C
Other Source of Lighting (Multiple Responses)
Grid Electricity
Solar power
Mini Grid
Diesel generator (owned)
Diesel generator (rented)
Kerosene
No lighting
Others (specify)
B01D
Average supply of the following (In hours)
B02
What is the average daily requirement of electricity in your household?
B03
Is your energy demand being currently met?
Yes
No
B04
Where is the light installed at your home?
In the veranda not lighting the kitchen
In the Veranda lighting the kitchen
In the kitchen
In the room used for sleeping
In the bathroom
Others (Please specify)
B05
Does your household also have the following items?
B05_1
Electric fan
Yes
No
B05_2
Radio or transistor
Yes
No
B05_3
Black and white television
Yes
No
B05_4
Colour television
Yes
No
B05_5
Mobile telephone
Yes
No
B05_6
Computer/laptop
Yes
No
B05_7
Refrigerator
Yes
No
B05_8
Water pump
Yes
No
B05_9
Internet
Yes
No
B05_10
Air Conditioner or Cooler
Yes
No
B05_11
Washing Machine
Yes
No
B06
What is the primary source of electricity that you use for operating this appliance?
Govt. Grid
Diesel Generator (Owned)
Diesel Generator (Supplier)
Solar Panel (Owned)
Mini-grid in village
Don’t use electricity
B07
For how many hours is it operated in a day?
B08
Who are the members of the household who use this appliance?
Male members
Female members
Children
B09
Do you face any of the following issues with respect to the primary source of electricity?
B09_1
Light Fluctuation
Never
Yes, Sometimes
Yes, Frequently
Always
B09_2
Low Voltage
Never
Yes, Sometimes
Yes, Frequently
Always
B09_3
Disruption in Supply (Irregular Supply)
Never
Yes, Sometimes
Yes, Frequently
Always
B09_4
Bad or poor supply during Rainy season or during bad weather
Never
Yes, Sometimes
Yes, Frequently
Always
B09_5
Meter Availability (No meter is there, and they want one)
Never
Yes, Sometimes
Yes, Frequently
Always
B09_6
Difficult to contact in case of any problem
Never
Yes, Sometimes
Yes, Frequently
Always
B10
On a scale of 5, how satisfied are you with the following with respect to the primary source
B10_1
Price of Electricity
Highly Satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Highly Dissatisfied
B10_2
Quality of light
Highly Satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Highly Dissatisfied
B10_3
Regularity
Highly Satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Highly Dissatisfied
DECISION MAKING ON ELECTRICITY USAGE
C01
Who usually takes the decision about the purchase of electricity in the household?
Male members of household
Female members of household
Both male and female members
C02
Who normally takes the decision about the purpose for which electricity is to be used?
Male members of household
Female members of household
Both male and female members
C03
Who took the decision of the location of the light to be installed at home?
Male members of household
Female members of household
Both male and female members
C04
Who normally takes the decision of the usage of shared electrical devices?
Male members of household
Female members of household
Both male and female members
BENEFITS OF ELECTRICITY ON EDUCATION
D01A
Are there any children in the household?
Yes
No
D01B
Total Number of Children in your Household?
D01C
How many of them are above five years?
D02
How many of these children in your household go to school?
D03
Do children in your household study after dark?
Yes
No
D04
For how many hours, do the children study after dark?
D05
What are the main reasons for not being able to study after dark?
Light flickers
Light is not consistent in supply
Light does not cover a larger area hence less no. of children can study
Children complain of eye irritation
No/limited facility of evening classes
Others (specify)
BENEFITS OF ELECTRICITY ON HEALTH & SAFETY
E01
Has anyone in your household suffered from injuries in the dark due to unavailability of electricity?
yes
no
never happened
E02
Has there been any incidence of fire due to explosion of kerosene lanterns due to unavailability of electricity?
yes
no
never happened
E03
Has there been any incidence of eye problems due to the fuel used for electricity?
yes
no
never happened
E04
Has there been any incidence of coughing due to the fuel used for electricity?
yes
no
never happened
HOUSEHOLD FOOD EXPENDITURE DURING LAST MONTH (30 DAYS)
F01
Please tell me how much of these items have been consumed by the household in the past 30 days?
F01A
Whether consumed?
F01A_1
Rice (KG)
Yes
No
F01A_2
Wheat and Wheat flour (KG)
Yes
No
F01A_3
Sugar, Jaggery (Gur) & other sweeteners (Includes candy, misri, honey) (KG)
Yes
No
F01A_4
Pulses and pulse products (includes soyabean, grams) (kg)
Yes
No
F01A_5
Other cereals like Maize, Jowar, Bajra and their products (kg)
Yes
No
F01A_6
Milk & Milk Products like Ghee, butter, ice-cream, curd (dahi), paneer, etc. (KG)
Yes
No
F01A_7
Vegetables (Including ginger, garlic) (KG)
Yes
No
F01A_8
Meat/fish/chicken/egg (kg)
Yes
No
F01A_9
Edible oil & Vanaspati (LITER)
Yes
No
F01A_10
Salt & Spices (include dry chillies, curry powder, oilseeds etc.)
Yes
No
F01A_11
Other food items like tea, coffee, processed foods such as biscuits, cake, pickles, sauce, etc.
Yes
No
F01A_12
Fruits & nuts (includes mango, banana, coconut, dates, kishmish, monacco, other dry fruits etc.)
Yes
No
F01A_13
Paan, Tobacco, Alcohol etc
Yes
No
F01B
How much (kgs)?
F01B_1
Rice (KG)
F01B_2
Wheat and Wheat flour (KG)
F01B_3
Sugar, Jaggery (Gur) & other sweeteners (Includes candy, misri, honey) (KG)
F01B_4
Pulses and pulse products (includes soyabean, grams) (kg)
F01B_5
Other cereals like Maize, Jowar, Bajra and their products (kg)
F01B_6
Milk & Milk Products like Ghee, butter, ice-cream, curd (dahi), paneer, etc. (KG)
F01B_7
Vegetables (Including ginger, garlic) (KG)
F01B_8
Meat/fish/chicken/egg (kg)
F01B_9
Edible oil & Vanaspati (LITER)
F01B_10
Salt & Spices (include dry chillies, curry powder, oilseeds etc.)
F01B_11
Other food items like tea, coffee, processed foods such as biscuits, cake, pickles, sauce, etc.
F01B_12
Fruits & nuts (includes mango, banana, coconut, dates, kishmish, monacco, other dry fruits etc.)
F01B_13
Paan, Tobacco, Alcohol etc
F01C
Was this home grown
F01C_1
Rice (KG)
Yes
No
F01C_2
Wheat and Wheat flour (KG)
Yes
No
F01C_3
Sugar, Jaggery (Gur) & other sweeteners (Includes candy, misri, honey) (KG)
Yes
No
F01C_4
Pulses and pulse products (includes soyabean, grams) (kg)
Yes
No
F01C_5
Other cereals like Maize, Jowar, Bajra and their products (kg)
Yes
No
F01C_6
Milk & Milk Products like Ghee, butter, ice-cream, curd (dahi), paneer, etc. (KG)
Yes
No
F01C_7
Vegetables (Including ginger, garlic) (KG)
Yes
No
F01C_8
Meat/fish/chicken/egg (kg)
Yes
No
F01C_9
Edible oil & Vanaspati (LITER)
Yes
No
F01C_10
Salt & Spices (include dry chillies, curry powder, oilseeds etc.)
Yes
No
F01C_11
Other food items like tea, coffee, processed foods such as biscuits, cake, pickles, sauce, etc.
Yes
No
F01C_12
Fruits & nuts (includes mango, banana, coconut, dates, kishmish, monacco, other dry fruits etc.)
Yes
No
F01C_13
Paan, Tobacco, Alcohol etc
Yes
No
F01D
How much did you pay for the food item consumed in past 30 days?
F01D_1
Rice (KG)
F01D_2
Wheat and Wheat flour (KG)
F01D_3
Sugar, Jaggery (Gur) & other sweeteners (Includes candy, misri, honey) (KG)
F01D_4
Pulses and pulse products (includes soyabean, grams) (kg)
F01D_5
Other cereals like Maize, Jowar, Bajra and their products (kg)
F01D_6
Milk & Milk Products like Ghee, butter, ice-cream, curd (dahi), paneer, etc. (KG)
F01D_7
Vegetables (Including ginger, garlic) (KG)
F01D_8
Meat/fish/chicken/egg (kg)
F01D_9
Edible oil & Vanaspati (LITER)
F01D_10
Salt & Spices (include dry chillies, curry powder, oilseeds etc.)
F01D_11
Other food items like tea, coffee, processed foods such as biscuits, cake, pickles, sauce, etc.
F01D_12
Fruits & nuts (includes mango, banana, coconut, dates, kishmish, monacco, other dry fruits etc.)
F01D_13
Paan, Tobacco, Alcohol etc
F01E
How much would have cost you to purchase the food item consumed in past 30 days?
F01E_1
Rice (KG)
F01E_2
Wheat and Wheat flour (KG)
F01E_3
Sugar, Jaggery (Gur) & other sweeteners (Includes candy, misri, honey) (KG)
F01E_4
Pulses and pulse products (includes soyabean, grams) (kg)
F01E_5
Other cereals like Maize, Jowar, Bajra and their products (kg)
F01E_6
Milk & Milk Products like Ghee, butter, ice-cream, curd (dahi), paneer, etc. (KG)
F01E_7
Vegetables (Including ginger, garlic) (KG)
F01E_8
Meat/fish/chicken/egg (kg)
F01E_9
Edible oil & Vanaspati (LITER)
F01E_10
Salt & Spices (include dry chillies, curry powder, oilseeds etc.)
F01E_11
Other food items like tea, coffee, processed foods such as biscuits, cake, pickles, sauce, etc.
F01E_12
Fruits & nuts (includes mango, banana, coconut, dates, kishmish, monacco, other dry fruits etc.)
F01E_13
Paan, Tobacco, Alcohol etc
HOUSEHOLD NON-FOOD EXPENDITURE
G01
On average, in a month, how much your household spend on
G01_1
Rent / Housing
G01_2
Healthcare
G01_3
Basic Education (Expense on books, clothes, coaching)
G01_4
Toilet Articles (Includes toothpaste, hair oil, shaving blades etc.)
G01_5
Household Items (Includes bulb, tube light, glassware, soaps, bucket etc.)
G01_6
Entertainment (includes cinema, sports, picnic, club fees etc.), cable, internet
G01_7
Telephone and mobile charges
G01_8
On travelling (like railway, Bus, auto-rickshaw fare
G01_9
Clothing and footwear
G01_10
Gift to relatives, ceremony, social functions
HOUSEHOLD EXPENDITURE ON ENERGY (FUEL, LIGHT & HOUSEHOLD APPLIANCES) DURING THE LAST MONTH (30 DAYS)
H01
Please tell me how much was spent on these items by the household in the past 30 days?
H01_1
Firewood (kg)
H01_2
Grid electricity (unit)
H01_3
dung cake
H01_4
Kerosene
H01_5
LPG
H01_6
Coal
H01_7
petrol (litre)
H01_8
diesel (litre)
H01_9
Solar home lighting system
H01_10
Mini grid
HOUSEHOLD ASSETS AND SAVINGS INFORMATION DURING LAST YEAR
I01
Did you buy the following asset in the last one year?
I01_1
Land or house or other property
Yes
No
I01_2
Livestock
Yes
No
I01_3
Jewellery
Yes
No
I01_4
Vehicle like scooter, tractor etc.
Yes
No
I01_5
Electrical Appliances
Yes
No
I01_6
Solar Panel
Yes
No
I01_7
Any other large asset?
Yes
No
I02
How much money did you spend on purchasing this asset in the last one year?
I02_1
Land or house or other property
I02_2
Livestock
I02_3
Jewellery
I02_4
Vehicle like scooter, tractor etc.
I02_5
Electrical Appliances
I02_6
Solar Panel
I02_7
Any other large asset?
I03
How much money did your household save in the last year?
I03_1
SHG Loan
I03_2
Cooperative
I03_3
Bank
I03_4
Post-office
I03_5
Friends/Relative
I03_6
MFI
I03_7
Home
I03_8
Others (specify)
WOMEN’S TIME USE
J01
How many women are there in the household in the age range of 15years or above?
J02
In a regular day of 24 hours, how many hours do you spend in the below mentioned activities?
J02_1
Engage in agricultural activities at home?
J02_2
Engage in agricultural labor working for others?
J02_3
Engage in non-agricultural income generating activities?
J02_4
Study time at home or school?
J02_5
Spend on domestic work including cooking, cleaning, shopping, fetching water, etc.?
J02_6
Spend on leisure, social, and religious activities like radio listening, television viewing, doing prayers, talking, communication, travelling?
J02_7
Capacity building and training etc.
MEN’S TIME USE
K01
How many men are there in the household in the age range of 15 years or above?
K02
In a regular day of 24 hours, how many hours do you spend in the below mentioned activities?
K02_1
Engage in agricultural activities at home?
K02_2
Engage in agricultural labour working for others?
K02_3
Engage in non-agricultural income generating activities?
K02_4
Study time at home or school?
K02_5
Spend on domestic work including cooking, cleaning, shopping, fetching water, etc.?
K02_6
Spend on leisure, social, and religious activities like radio listening, television viewing, doing prayers, talking, communication, travelling?
K02_7
Capacity building and training etc.
CHILD TIME USE
L01
How many children are there in the household in the age range of 10 to 15 years?
L02
In a regular day of 24 hours, how many hours do you spend in the below mentioned activities?
L02_1
Spend in school?
L02_2
Spend in studying at home?
L02_3
Spend in playing, leisure and social activities like radio listening, television viewing, talking, and travelling?
L02_4
Spend on domestic work including cooking, cleaning, shopping, fetching water, etc.?
L02_5
Engage in income generating activities?
AGRICULTRE TOTAL PRODUCTION AND SALES IN LAST ONE YEAR
M01
What crops did you grow in the last one year?
Rice
Wheat
Maize
Pulses
Finger millet
Radish
Barley
Groundnut
Soybeans
Peas
Bananas
Beans
Sugarcane
Cotton
Sunflower
Tobacco
Jute
Oil seeds
Sweet potatoes
Potatoes
Carrots
Cucumber
Chilli
Brinjal
Okra/Lady Finger
Litchi
Onion
Cabbage
Cauliflower
Garlic
Ginger
Tomato
Guava
Mango
Lemon/Lime
peppermint
watermelon
Tulsi
pumpkin
turmeric
others
M02
Total expense on crop production
M03
Total Crop production
M04
Out of total crop production, how much is sold
M05
How much was sold outside the village?
M06
Unsold
M07
Was this crop irrigated?
Yes
No
M08
Was irrigation pump used for irrigation?
Yes
No
M09
What is primary source of energy to operate this pump?
Govt. Grid
Diesel Generator (Owned)
Diesel Generator (Supplier)
Solar Panel (Owned)
Mini-grid in village
Don’t use electricity
Others (specify)
NON-USERS OF MLINDA (To be asked with households which are not connected to MLINDA grid electricity
N01
Are you aware of MLINDA connections available in your village?
Yes
No
N02
Did you ever avail an MLINDA connection?
Yes
No
N03
What package did you avail?
1 LED bulb+ 1 Mobile charging point
2 LED bulb+ 1 Mobile charging point
Fixed package for operating appliance
Metered connection
Other (Specify)
N04
Why did you discontinue with the connection?
Proved to be too costly
Supply hours were less
Supply hours did not meet requirements
Voltage fluctuations in supply
Irregular supply
Difficult to report problems
Poor response to filed complaints
Other (Specify)
N05
What are the reasons for not opting the connection under MLINDA?
Don’t feel the need of electricity
Already have a grid connection
Registration fees for MLINDA is too much MLINDA
Monthly rent is high
Have not been able to get in touch with the person responsible for providing the connection
Others (Specify)
N06
Would you like to have a connection under MLINDA?
Yes
No
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