Surveypoint

Q01

District

Q02

Block

Q03

Village/Urban Ward/Cluster

Q04

Village/Urban Ward/Cluster Code

Q05

Houselister/Interviewer

Q06

Date

Q07

S. No.

Q08

Str. Type

Residential

Non-residential

Q09

Str. No.

Q10

HH No.

Q11

Result Code

Complete

Refused

HH Migrated

HH temporarily away

Q12

Caste Code

Brahmin

Rajput/Thakur

Bhumihar

Kayasth/ Srivastava/Lala

Dalit

Chamar

Dusadh/Paswan

Musahar

Pasi

Dhobi

Baghela

Jaat

Saini

Rajwar

Yadav

Vaishya/Bania

Kurmi

Shah

Muslim

Gujjar

Other Caste Or Tribe (Specify)

Q13

Household Head Name

Q14

Is there a woman between 15-49 years in your house who is married?

yes

no

Q15

If yes, how many?

Q16

Names, age, relation with HH head, will she stay here for next 2 weeks

Q17

Household Listing Template 6 -Form Fill