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Household Listing Template 2 -Form Fill
INFORMATION
Q01
State Code
Q02
District Code
Q03
Sub-District Code
Q04
PSU Name
Q04A
PSU Code
Q05
Structure . No
Q06
HH No.
Q07
Name of HH Head
Q08
HH Member’s available for interview ?
Yes
No
Q09
Religion
HINDU
MUSLIM
CHRISTIAN
JAIN
BUDDHIST
SIKH
NO RELIGION
Q10
Caste
SCHEDULE CASTE
SCHEDULE TRIBE
OBC
GENERAL
Q11
No. Of women with children under 2 years of age
Q12
Name of the Caste / Surname
Q13
Name of the Mother
Q14
Will you / She stay here for the next 15 days
Yes
No
Q15
No. Of children under 2 years of age
Q16
Name of the child
Q17
DOB of child
Q18
Age of the child
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