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Household Template 10 -Form Fill
HOUSEHOLD COMPOSITION
Q01
Name
Q02
Relation to respondent woman.
Mother
Husband
Son or daughter
Son in-law or daughter-in-law
Grand father or grand mother
Grand son or grand daughter
Father or mother
Father-in-law or mother in law
Brother or sister
Brother-in-law or sister in law
Uncle or aunt
Other relatives (including cousins)
Foster/step/adopted children
Not related
Q03
Sex
Male
Female
Q04
Age
Q05
Marital status?
Unmarried
Married
Widowed
Divorced
Separated
Deserted by spouse
Q06
Main Occupation
Farmer (Crops)
Agricultural day labor
Non Agricultural day labor
Service/Salaried worker
Small/cottage industry
Business/Traders
Skilled worker
Other Self-employment
House Work /Housewife
Migrant labor
Jobless
Retired/Old age
Physically challenged
Student
Child (age <5)
Other
Q07
Education
Never attended school
Currently in Aanganwadi/Pre-school Education
Currently in class I
Completed class 1
Completed class 2
Completed class 3
Completed class 4
Completed class 5
Completed class 6
Completed class 7
Completed class 8
Completed class 9
Completed Secondary School
Completed Higher Secondary
Graduate/BA/BSC /Fazil
MA/MSC/Kamil& above
Professional Degree
Hafezia/Kiratia/Nurani madrasa
MATERNAL LITERACYAND CHILD CARE
A01
Do you know how to read and write?
Yes
No
A02
Can you please read the following sentence?
Cannot read at all
Can read some of it
Can read whole sentence
A03
Do you usually do your work for your main occupation at home or outside the home?
Home
Away from home
Both
Don’t work
A04
How much do you contribute to the total household expenses?
Nothing
Some of it
Most of it
All
A05
For this work, how many days a week do you work outside the home?
A06
For this work, when you work outside the home, how many hours do you stay away from home each day?
A07
When you work outside, do you take your youngest child (NAME) with you or do you have someone to take care of him/her?
Always brings with her
Always leaves with Someone else
Both
A08
When you leave home to go to the market or visit people, etc. do you take your youngest child (NAME) with you or do you leave the child with someone else?
Always brings with her
Always leaves with Someone else
Both
A09
For these types of activities, how many times a week do you usually leave the child with someone else to take care of him/her?
A10
For how long each time do you usually leave the child with someone else (baby sitter) at home?
A11
When you leave your youngest child with someone, with whom do you leave him/her with, most often?
Adult (>15 year) family member Within household
Adult(>15 year) family member Outside household
Child (<15 year) family memberWithin household
Child (<15 year) family member Outside household
A12
Do you breastfeed your youngest child?
Yes
No
A13
Did you breastfeed this youngest child in the previous 24 hours?
Yes
No
A14
What else, if anything, was given to this youngest child to eat or drink in the previous 24 hours?
Nothing else
Water
Formula/baby food
Some other liquid
Sem-solid or solid foods
HOUSEHOLD SOCIO ECONOMIC STATUS
B01
In the last 12 months, have any adults (aged 15 years or more) in your household migrated?
Yes
No
B02
How many adults in your household have migrated because of work? Please tell me how many women and how many men
B03
What was/were the reason(s) for migration?
Temporary work/job
Permanent work/job
Entire family relocation
Due to some family member of relative falling ill
Marriage/divorce
Other (specify)
Don’t know
B04
In the last 12 months, has anyone in your household received remittances from a member of the family or other person who is somewhere else in India or abroad?
Yes
No
B05
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
Don’t know
B06
On average, how much money did your household receive each time you received remittances in the last 12 months?
B07
Do you own the house you live in?
Owns house
Rents
Free housing
Other (specify)
B08
Does your house have any electricity?
Yes
No
B09
Do you have any other kind of electric power? If yes, which type?
Generator
Solar
No other type
B10
What type of fuel does your household mainly use for cooking?
Electricity
LPG
Natural gas
Biogas
Kerosene
Charcoal
Wood / straw/leaves
Animal dung
Other (specify)
B11
Did anyone in the household earn income from any of the following sources in the last 12 months?
B11_1
Agriculture labor
Yes
No
B11_2
Non-agriculture labor
Yes
No
B11_3
Skilled labor
Yes
No
B11_4
Small business activities (street vending, shop keeping, handicrafts, sells liquor)
Yes
No
B11_5
NTFP selling
Yes
No
B12
Whetherengaged in the activity ?
B12_1
Agriculture labor
Yes
No
B12_2
Non-agriculture labor
Yes
No
B12_3
Skilled labor
Yes
No
B12_4
Small business activities (street vending, shop keeping, handicrafts, sells liquor)
Yes
No
B12_5
NTFP selling
Yes
No
B13
Who in the householdearnedincome over last 12 months?
B13_1
Agriculture labor
Men
Women
Both Men and Women
Children
All HH Members
No one
B13_2
Non-agriculture labor
Men
Women
Both Men and Women
Children
All HH Members
No one
B13_3
Skilled labor
Men
Women
Both Men and Women
Children
All HH Members
No one
B13_4
Small business activities (street vending, shop keeping, handicrafts, sells liquor)
Men
Women
Both Men and Women
Children
All HH Members
No one
B13_5
NTFP selling
Men
Women
Both Men and Women
Children
All HH Members
No one
B14
How much did the household earn from [activity] ______ over the past 12 months?
B14_1
Agriculture labor
B14_2
Non-agriculture labor
B14_3
Skilled labor
B14_4
Small business activities (street vending, shop keeping, handicrafts, sells liquor)
B14_5
NTFP selling
B15
In the past 12 months, was your household affected by ________?
B15_1
Death of income earning HH member
Yes
No
B15_2
Death of other HH member
Yes
No
B15_3
Disease or injury of income-earning HH member
Yes
No
B15_4
Disease or injury of other HH member
Yes
No
B15_5
Loss of employment of any HH member
Yes
No
B15_6
Divorce by husband/wife
Yes
No
B15_7
Loss of crop due to flooding
Yes
No
B15_8
Loss of crop due to otherreasons
Yes
No
B15_9
Disease, injury, loss of cattle
Yes
No
B15_10
Damage to house or any productive assets (theft, fire, river erosion, cyclone etc.)
Yes
No
B15_11
Storage crop damage/theft
Yes
No
B15_12
Business failure
Yes
No
B15_13
Conflict, dispute, legalproblems
Yes
No
B16
In which month did this shock occur for the last time?
B16_1
Death of income earning HH member
B16_2
Death of other HH member
B16_3
Disease or injury of income-earning HH member
B16_4
Disease or injury of other HH member
B16_5
Loss of employment of any HH member
B16_6
Divorce by husband/wife
B16_7
Loss of crop due to flooding
B16_8
Loss of crop due to otherreasons
B16_9
Disease, injury, loss of cattle
B16_10
Damage to house or any productive assets (theft, fire, river erosion, cyclone etc.)
B16_11
Storage crop damage/theft
B16_12
Business failure
B16_13
Conflict, dispute, legalproblems
B17
What was the impact of this shock on the household’s economic situation?
B17_1
Death of income earning HH member
B17_2
Death of other HH member
B17_3
Disease or injury of income-earning HH member
B17_4
Disease or injury of other HH member
B17_5
Loss of employment of any HH member
B17_6
Divorce by husband/wife
B17_7
Loss of crop due to flooding
B17_8
Loss of crop due to otherreasons
B17_9
Disease, injury, loss of cattle
B17_10
Damage to house or any productive assets (theft, fire, river erosion, cyclone etc.)
B17_11
Storage crop damage/theft
B17_12
Business failure
B17_13
Conflict, dispute, legalproblems
B18
I am now going to ask you about household items that are available in your household. For each item, please tell me if the item mentioned is available in your household? If yes, please tell me how many of each item are available?
B18_1
Rickshaw/van
Yes
No
B18_2
Small agricultural tools - (Ex: Saw/Hammer/Hoe/Spade/Axe/ Shovel/Sickle/Harrower/Rake)
Yes
No
B18_3
Fishing net
Yes
No
B18_4
Reaper/Harvester
Yes
No
B18_5
Harrower/weeding machine
Yes
No
B18_6
Machine sprayer (e.g. fertilizer, chemical, pesticide)
Yes
No
B18_7
Wheelbarrow
Yes
No
B18_8
Bullock cart/Horse cart
Yes
No
B18_9
Push cart
Yes
No
B18_10
Tractor
Yes
No
B18_11
Power Tiller/ Small tractor (with steering)
Yes
No
B18_12
Trolley/Trailer
Yes
No
B18_13
Thresher
Yes
No
B18_14
Fodder cutting machine
Yes
No
B18_15
Swing basket
Yes
No
B18_16
Hand tube well/Rower pump
Yes
No
B18_17
Manual wooden thresher/Treadle pump (for irrigation)
Yes
No
B18_18
Low lift pump (LLP) for irrigation (Machine pumping from surface water)
Yes
No
B18_19
Shallow tube well/Diesel motor pump
Yes
No
B18_20
Deep tube well/Electric motor pump
Yes
No
B18_21
Spraying machine for water
Yes
No
B18_22
Carpentry equipment
Yes
No
B18_23
Pottery wheel
Yes
No
B18_24
Blacksmith tools
Yes
No
B18_25
Spinning wheel
Yes
No
B18_26
Manual wooden thresher/Treadle pump (for food processing)
Yes
No
B18_27
Manual flour mill
Yes
No
B18_28
Mattress
Yes
No
B18_29
Pressure Cooker
Yes
No
B18_30
Chair
Yes
No
B18_31
Cot/ Bed
Yes
No
B18_32
Table
Yes
No
B18_33
Electric Fan
Yes
No
B18_34
Radio/ Transister
Yes
No
B18_35
B & W Television
Yes
No
B18_36
Sewing Machine
Yes
No
B18_37
Mobile Telephone
Yes
No
B18_38
Landline Telephone
Yes
No
B18_39
Internet
Yes
No
B18_40
Computer
Yes
No
B18_41
Refrigerator
Yes
No
B18_42
Air Conditioner/ Cooler
Yes
No
B18_43
Washing Machine
Yes
No
B18_44
Watch/ Clock
Yes
No
B18_45
Bicycle
Yes
No
B18_46
MotorCycle/ Scooter
Yes
No
B18_47
Three-wheeler
Yes
No
B18_48
Car
Yes
No
B18_49
AC/ Cooler
Yes
No
B19
If yes then how many?
B19_1
Rickshaw/van
B19_2
Small agricultural tools - (Ex: Saw/Hammer/Hoe/Spade/Axe/ Shovel/Sickle/Harrower/Rake)
B19_3
Fishing net
B19_4
Reaper/Harvester
B19_5
Harrower/weeding machine
B19_6
Machine sprayer (e.g. fertilizer, chemical, pesticide)
B19_7
Wheelbarrow
B19_8
Bullock cart/Horse cart
B19_9
Push cart
B19_10
Tractor
B19_11
Power Tiller/ Small tractor (with steering)
B19_12
Trolley/Trailer
B19_13
Thresher
B19_14
Fodder cutting machine
B19_15
Swing basket
B19_16
Hand tube well/Rower pump
B19_17
Manual wooden thresher/Treadle pump (for irrigation)
B19_18
Low lift pump (LLP) for irrigation (Machine pumping from surface water)
B19_19
Shallow tube well/Diesel motor pump
B19_20
Deep tube well/Electric motor pump
B19_21
Spraying machine for water
B19_22
Carpentry equipment
B19_23
Pottery wheel
B19_24
Blacksmith tools
B19_25
Spinning wheel
B19_26
Manual wooden thresher/Treadle pump (for food processing)
B19_27
Manual flour mill
B19_28
Mattress
B19_29
Pressure Cooker
B19_30
Chair
B19_31
Cot/ Bed
B19_32
Table
B19_33
Electric Fan
B19_34
Radio/ Transister
B19_35
B & W Television
B19_36
Sewing Machine
B19_37
Mobile Telephone
B19_38
Landline Telephone
B19_39
Internet
B19_40
Computer
B19_41
Refrigerator
B19_42
Air Conditioner/ Cooler
B19_43
Washing Machine
B19_44
Watch/ Clock
B19_45
Bicycle
B19_46
MotorCycle/ Scooter
B19_47
Three-wheeler
B19_48
Car
B19_49
AC/ Cooler
HOUSEHOLD DIETARY DIVERSITY, COPINGSTRATEGY AND FOOD SECURITY
C01
How many meals did you eat yesterday during the day and night?
C02
How many meals did the adult members (18+) of your household eat yesterday during the day and night?
C03
How many meals did the children 6 to18 years in this household eat yesterday during the day and night?
C04
Over the last 7 days, how many days did you consume following foods?
C04_1
Maize, maize porridge
C04_2
Other cereal (rice, sorghum, millet, wheat etc)
C04_3
Roots and Tubers (cassava, potatoes, sweet potatoes)
C04_4
Sugar or sugar products
C04_5
Beans and peas
C04_6
Groundnuts and cashew nuts
C04_7
Vegetables (including relish and leaves)
C04_8
Fruits
C04_9
Beef, goat, or other red meat and pork
C04_10
Poultry and eggs
C04_11
Fish
C04_12
Oils/fats/butter
C04_13
Milk/yogurt/other dairy product
C05
Over the last 7 days, how many days did other household members consume following foods?
C05_1
Maize, maize porridge
C05_2
Other cereal (rice, sorghum, millet, wheat etc)
C05_3
Roots and Tubers (cassava, potatoes, sweet potatoes)
C05_4
Sugar or sugar products
C05_5
Beans and peas
C05_6
Groundnuts and cashew nuts
C05_7
Vegetables (including relish and leaves)
C05_8
Fruits
C05_9
Beef, goat, or other red meat and pork
C05_10
Poultry and eggs
C05_11
Fish
C05_12
Oils/fats/butter
C05_13
Milk/yogurt/other dairy product
C06
What was the main source(s) of the food?
C06_1
Maize, maize porridge
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_2
Other cereal (rice, sorghum, millet, wheat etc)
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_3
Roots and Tubers (cassava, potatoes, sweet potatoes)
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_4
Sugar or sugar products
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_5
Beans and peas
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_6
Groundnuts and cashew nuts
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_7
Vegetables (including relish and leaves)
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_8
Fruits
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_9
Beef, goat, or other red meat and pork
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_10
Poultry and eggs
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_11
Fish
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_12
Oils/fats/butter
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C06_13
Milk/yogurt/other dairy product
Own production
Casual labour
Borrowed
Gift
Purchases
Food assistance
Barter
Hunting/gathering/catching
PDS
C07
Was yesterday a special day (celebration, feast day, or fasting) where anyone in the HH ate special foods or more or less than usual?
Yes
No
C08
Did the respondent mother eat ________?
C08_1
CEREALS
Yes
No
C08_2
VITAMIN A RICH VEGETABLES AND TUBERS
Yes
No
C08_3
WHITE TUBERS AND ROOTS OR OTHER STARCHY FOODS
Yes
No
C08_4
DARK GREEN LEAFY VEGETABLES
Yes
No
C08_5
OTHER VEGETABLES
Yes
No
C08_6
VITAMIN A RICH FRUITS
Yes
No
C08_7
OTHER FRUITS
Yes
No
C08_8
meats
Yes
No
C08_9
EGGS
Yes
No
C08_10
FISH
Yes
No
C08_11
PULSES
Yes
No
C08_12
MILK AND MILK PRODUCTS
Yes
No
C08_13
OILS AND FATS
Yes
No
C08_14
SWEETS
Yes
No
C08_15
SPICES, CONDIMENTS, BEVERAGES
Yes
No
C09
Did any HH member eat ________?
C09_1
CEREALS
Yes
No
C09_2
VITAMIN A RICH VEGETABLES AND TUBERS
Yes
No
C09_3
WHITE TUBERS AND ROOTS OR OTHER STARCHY FOODS
Yes
No
C09_4
DARK GREEN LEAFY VEGETABLES
Yes
No
C09_5
OTHER VEGETABLES
Yes
No
C09_6
VITAMIN A RICH FRUITS
Yes
No
C09_7
OTHER FRUITS
Yes
No
C09_8
meats
Yes
No
C09_9
EGGS
Yes
No
C09_10
FISH
Yes
No
C09_11
PULSES
Yes
No
C09_12
MILK AND MILK PRODUCTS
Yes
No
C09_13
OILS AND FATS
Yes
No
C09_14
SWEETS
Yes
No
C09_15
SPICES, CONDIMENTS, BEVERAGES
Yes
No
C10
In the past 30 days, how frequently did you resort to using one or more of the following strategies in order to have access to food?
C10_1
Skip entire days without eating?
Never
Seldom
Sometimes
Often
Daily
C10_2
Limit portion size at mealtimes?
Never
Seldom
Sometimes
Often
Daily
C10_3
Reduce number of meals eaten per day?
Never
Seldom
Sometimes
Often
Daily
C10_4
Borrow food or rely on help from friends or relatives?
Never
Seldom
Sometimes
Often
Daily
C10_5
Rely on less expensive or less preferred foods?
Never
Seldom
Sometimes
Often
Daily
C10_6
Purchase/borrow food on credit?
Never
Seldom
Sometimes
Often
Daily
C10_7
Gather unusual types or amounts of wild food / hunt?
Never
Seldom
Sometimes
Often
Daily
C10_8
Send household members to eat elsewhere?
Never
Seldom
Sometimes
Often
Daily
C10_9
Send household members to beg?
Never
Seldom
Sometimes
Often
Daily
C10_10
You or other female members eat less?
Never
Seldom
Sometimes
Often
Daily
C10_11
Have you sold any household assets to buy food?
Never
Seldom
Sometimes
Often
Daily
C11
Usually, does your household has food available for the whole year?
Yes
No
C12
If no, in a year how many months / days, household lack availability of food?
SELF HELP GROUPS
D01
Do you currently belong to a self-help group?
Yes
No
D02
For how long have you belonged to the self-help group to which you belong?
D03
Are you an active member of this group, meaning that you participate in meetings, for example?
Yes
No
D04
Which organization started or supports this self-help group?
PRADAN
Other NGO
Government
Don’t know
Other (Specify)
D05
Does you self-help group have savings and credit activities?
Yes
No
D06
Do you personally participate in these savings and credit activities?
Yes
No
D07
Do you take leadership roles in this self-help group?
Yes
No
D08
Are you currently a portfolio-holder?
Yes
No
D09
Do you discuss any of the following in the self-help group?
D09_1
Livelihoods/socio-economic problems in the community
Yes
No
D09_2
Agriculture problems
Yes
No
D09_3
Education problems
Yes
No
D09_4
Health and nutrition problems
Yes
No
D09_5
Gender dynamics
Yes
No
D10
Have you ever been a member of a self-help group?
Yes
No
D11
Were you previously a portfolio holder?
Yes
No
D12
Why do you not belong to a self-help group?
None available in my community
I was never interested
I used to be involved and quit
My husband doesn’t allow me
I don’t have time
Religious/cultural reasons
Don’t know
Other (Specify)
WATER, SANITATION, AND HYGIENE AND HH OBSERVATIONS
E01
For each of the following seasons, what is the main source of drinking water for members of your household?
Piped water into dwelling
Piped water into yard/plt
Public tap/standpipe
Tube well/borehole
Protected spring
Unprotected spring
Surface water (river/canal/lake)
Protected dug well
Unprotected dug well
Rainwater collection
Other (specify)
E02
Do you treat your water in any way to make it safer to drink?
Yes
No
E03
What do you usually do to the water to make it safer to drink?
Boil
Add bleach/chlorine
Strain through a cloth
Use a water filter (ceramic, sand, etc.)
Let it stand/settle
Other (specify)
E04
How long does it take to go to the water source, get water, and come back during the rainy season?
E05
How long does it take to go to the water source, get water, and come back during the dry season?
E06
Who usually goes to this source to fetch the water for your household?
Adult woman
Adult male
Female child (<15yrs)
Male child (<15yrs)
Other (specify)
Anybody from hh
E07
For each season, what is the main source of water used by your household for cooking, bathing, and washing utensils?
Piped water into dwelling
Piped water into yard/plt
Public tap/standpipe
Tube well/borehole
Protected spring
Unprotected spring
Surface water (river/canal/lake)
Protected dug well
Unprotected dug well
Rainwater collection
Other (specify)
E08
What kind of toilet facility do members of your household usually use? Please specify for men, women, and children under 5 years of age.
Flush toilet
Ventilated improved pit biogas latrine
Pit with slab
Pit without slab
Twin pit/composite
Dry toilet
Open field
Other (specify)
E09
Do you share this facility with another household?
Yes
No
E10
The last time the youngest child of the household passed stools, what was done to dispose the stool?
Child used toilet/latrine
Flushed down toilet/latrine
Rinsed into drain/ditch
Buried
Left in the open
Other (specify)
E11
According to you, when should a mother or caretaker of a young child should wash her hands?
After defecation
After cleaning a young child’s bottom
Before cooking/preparing food
Before eating
Before feeding a child
E12
What materials do you use when you wash your hands?
Water
Soap
Ash
Soap/Ash
None
Other (specify)
E13
Did it rain the day of the observation or the day before?
Yes
No
E14
When Was observation done a.m.or p.m.?
E15
What is the mother’s general appearance (observe cleanliness of her hands, hair, clothes, face)?
E15_1
Hands
Clean
Dirty
Dusty
E15_2
Hair
Clean
Dirty
Dusty
E15_3
Clothes
Clean
Dirty
Dusty
E15_4
Face
Clean
Dirty
Dusty
E16
Is the child naked at the time of the visit?
Yes
No
E17
What is the child’s general appearance (observe cleanliness of hands, nails, body and face)
E17_1
Hands
Clean
Dirty
Dusty
E17_2
Hair
Clean
Dirty
Dusty
E17_3
Clothes
Clean
Dirty
Dusty
E17_4
Face
Clean
Dirty
Dusty
E18
Was the child walking, crawling or was carried by the mother or another person during the observation?
Carried
Crawling
Walking
Sitting on the floor
Sitting on a chair or bed
Does not apply (child was sleeping or absent)
E19
Can we observe human feces around the house or in the compound?
Yes
No
E20
Can we observe animal feces (chicken, dogs, cats, etc.) around the house or in the compound?
Yes
No
E21
Is the drinking water container covered?
Yes
No
E22
What is the main material of the floor?
Concrete
Brick/Cement
Tin /CI sheet
Wood
Smoothed mud
Tile
Jute Stick
Bamboo/ Grass/straw
Others (Specify)
E23
What is the main material of the exterior wall?
Concrete
Brick/Cement
Tin /CI sheet
Wood
Smoothed mud
Tile
Jute Stick
Bamboo/ Grass/straw
Others (Specify)
E24
What is the main material of the roof?
Concrete
Brick/Cement
Tin /CI sheet
Wood
Smoothed mud
Tile
Jute Stick
Bamboo/ Grass/straw
Others (Specify)
MARKET AND INFORMATION ACCESS
F01
Which types of markets does your family purchase foods from?
Neighborhood shop
Retail market in village
Wholesale market in village
Market in other village
Other (specify)
Don’t know
F02
Who purchases most of the foods consumed by the family?
Husband/partner
Self
Both
Someone else
Don’t know
F03
How far is the nearest market/shop where you can buy some basic food items for your household?
F04
Are there any special foods that someone in your household buys for children?
Yes
No
F05
Who buys these special foods for children?
Husband/partner
Self
Both
Someone else
Don’t know
F06
Do you ever watch TV?
Yes
No
F07
How often do you watch TV?
Daily (7 days a week)
2 to 6 days a week
Once a week
Once every two weeks
Once a month
Rarely
F08
Do you ever listen to the radio?
Yes
No
F09
How often do you listen to the radio?
Daily (7 days a week)
2 to 6 days a week
Once a week
Once every two weeks
Once a month
Rarely
WOMEN’S TIME USE
G01
In the previous 24 hours, how many hours did you _____________________?
G01_1
Engage in agricultural labor including any paid or unpaid agricultural related tasks at home or working for others?
G01_2
Engage in non-agricultural labor including self-employment or working for others?
G01_3
Spend caring for children or the elderly?
G01_4
Spend on domestic work including cooking, cleaning, shopping, fetching water, etc.?
G01_5
Spend on leisure, social, and religious activities?
G01_6
Spend resting or sleeping?
G02
Was the amount of sleep you got last night less than average, average, or more than average?
Less than average
Average
More than average
G03
Was the amount of time spent working less than average, average, or more than average?
Less than average
Average
More than average
G04
How satisfied are you with your available time for leisure activities like visiting neighbors, watching T.V., listening to the radio, seeing movies or participating in sports?
Very satisfied
Somewhat satisfied
Neither satisfied nor unsatisfied
To some extent unsatisfied
Very unsatisfied
Other (Specify
WOMEN’S ACCESS TO CAPITAL AND CREDIT
I01
Does anyone in your household currently have any _____?
I01_1
Agricultural land
Yes
No
I01_2
Other land not used for agriculture
Yes
No
I01_3
Large livestock (e.g. oxen, cattle, buffalo, horse)
Yes
No
I01_4
Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
Yes
No
I01_5
Fish pond or fishing equipment
Yes
No
I01_6
Farm equipment (non-mechanized)
Yes
No
I01_7
Farm equipment (mechanized e.g. tractor)
Yes
No
I01_8
Ornaments and jewellery
Yes
No
I02
Who would you say owns most of the _____?
I02_1
Agricultural land
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I02_2
Other land not used for agriculture
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I02_3
Large livestock (e.g. oxen, cattle, buffalo, horse)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I02_4
Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I02_5
Fish pond or fishing equipment
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I02_6
Farm equipment (non-mechanized)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I02_7
Farm equipment (mechanized e.g. tractor)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I02_8
Ornaments and jewellery
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I03
Do you own any of the ____?
I03_1
Agricultural land
Yes
No
I03_2
Other land not used for agriculture
Yes
No
I03_3
Large livestock (e.g. oxen, cattle, buffalo, horse)
Yes
No
I03_4
Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
Yes
No
I03_5
Fish pond or fishing equipment
Yes
No
I03_6
Farm equipment (non-mechanized)
Yes
No
I03_7
Farm equipment (mechanized e.g. tractor)
Yes
No
I03_8
Ornaments and jewellery
Yes
No
I04
Who can decide whether to sell _____ most of the time?
I04_1
Agricultural land
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I04_2
Other land not used for agriculture
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I04_3
Large livestock (e.g. oxen, cattle, buffalo, horse)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I04_4
Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I04_5
Fish pond or fishing equipment
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I04_6
Farm equipment (non-mechanized)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I04_7
Farm equipment (mechanized e.g. tractor)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I04_8
Ornaments and jewellery
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member
Spouse and other hh member
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I05
Has anyone in your household taken any loans or borrowed cash/in-kind from _____ in the past 12 months?
I05_1
Non-governmental organization (NGO)
Yes, cash
Yes, in-kind
Yes, cash and in-kind
No
Don’t know
I05_2
Informal lender
Yes, cash
Yes, in-kind
Yes, cash and in-kind
No
Don’t know
I05_3
Formal lender (direct credit from bank/financial institution)
Yes, cash
Yes, in-kind
Yes, cash and in-kind
No
Don’t know
I05_4
Friends or relatives
Yes, cash
Yes, in-kind
Yes, cash and in-kind
No
Don’t know
I05_5
Savings and Credit cooperatives/groups
Yes, cash
Yes, in-kind
Yes, cash and in-kind
No
Don’t know
I05_6
Women's groups
Yes, cash
Yes, in-kind
Yes, cash and in-kind
No
Don’t know
I06
Who made the decision to borrow from _____?
I06_1
Non-governmental organization (NGO)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I06_2
Informal lender
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I06_3
Formal lender (direct credit from bank/financial institution)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I06_4
Friends or relatives
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I06_5
Savings and Credit cooperatives/groups
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I06_6
Women's groups
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I07
Who makes the decision about what to do with the money/item borrowed from _____?
I07_1
Non-governmental organization (NGO)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I07_2
Informal lender
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I07_3
Formal lender (direct credit from bank/financial institution)
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I07_4
Friends or relatives
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I07_5
Savings and Credit cooperatives/groups
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I07_6
Women's groups
Self
Spouse
Self and spouse
Other male hh member
Other female hh member
Self and other hh member(s)
Spouse and other hh member(s)
Self, spouse and other hh member(s)
Someone (or group) outside the hh
Self and other outside non hh people
Spouse and other non hh people
Self, spouse and other outside People
I08
Has such a situation ever occurredwhere you wanted to take loan but you couldn’t take?
I08_1
Non-governmental organization (NGO)
Yes
No
I08_2
Informal lender
Yes
No
I08_3
Formal lender (direct credit from bank/financial institution)
Yes
No
I08_4
Friends or relatives
Yes
No
I08_5
Savings and Credit cooperatives/groups
Yes
No
I08_6
Women's groups
Yes
No
WOMEN’S GROUP MEMBERSHIP AND LEADERSHIP
J01
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 comfortable
Yes, very comfortable
J02
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 comfortable
Yes, very comfortable
J03
Do you feel comfortable speaking up in public to protest the misbehavior 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 comfortable
Yes, very comfortable
J04
Is there a ____ in your community?
J04_1
Agricultural/livestock/fisheries producer group (including marketing groups)
Yes
No
J04_2
Water users’ group
Yes
No
J04_3
Land/forest users’ groups
Yes
No
J04_4
Credit or microfinance group
Yes
No
J04_5
Mutual help or insurance group (including burial societies) (not-self-help group)
Yes
No
J04_6
Trade and business association
Yes
No
J04_7
Civic group (improving community) or charitable group (helping others)
Yes
No
J04_8
Religious group
Yes
No
J04_9
Mother’s group
Yes
No
J04_10
Other women’s group (only if it does not fit into one of the other categories)
Yes
No
J05
Are you a member/active member of any ______?
J05_1
Agricultural/livestock/fisheries producer group (including marketing groups)
Yes member
Yes active member
J05_2
Water users’ group
Yes member
Yes active member
J05_3
Land/forest users’ groups
Yes member
Yes active member
J05_4
Credit or microfinance group
Yes member
Yes active member
J05_5
Mutual help or insurance group (including burial societies) (not-self-help group)
Yes member
Yes active member
J05_6
Trade and business association
Yes member
Yes active member
J05_7
Civic group (improving community) or charitable group (helping others)
Yes member
Yes active member
J05_8
Religious group
Yes member
Yes active member
J05_9
Mother’s group
Yes member
Yes active member
J05_10
Other women’s group (only if it does not fit into one of the other categories)
Yes member
Yes active member
J06
Why are you not a member of ________?
J06_1
Agricultural/livestock/fisheries producer group (including marketing groups)
J06_2
Water users’ group
J06_3
Land/forest users’ groups
J06_4
Credit or microfinance group
J06_5
Mutual help or insurance group (including burial societies) (not-self-help group)
J06_6
Trade and business association
J06_7
Civic group (improving community) or charitable group (helping others)
J06_8
Religious group
J06_9
Mother’s group
J06_10
Other women’s group (only if it does not fit into one of the other categories)
WOMAN’S STATUS
K01
Do you currently live with your partner or husband?
Yes
No
K02
At what age did you get married?
K03
At what age did you first get pregnant?
K04
How many times have you been pregnant?
K05
At what age did you first give birth?
K06
How many times have you given birth?
K07
Please tell me if you agree or not with each of the following declarations.There are people who say
K07_1
In a household, the man should take the important decisions.
Yes, agree
No, don’t agree
Don’t know
K07_2
If the woman works outside home, her husband or partner should help her with the daily housework.
Yes, agree
No, don’t agree
Don’t know
K07_3
A husband should not let his wife work outside home, even if she would like to do it.
Yes, agree
No, don’t agree
Don’t know
K07_4
A woman has the right to express her opinion if she does not agree with what the husband or partner says.
Yes, agree
No, don’t agree
Don’t know
K07_5
A woman must accept that her husband or partner beats her in order to keep the family together.
Yes, agree
No, don’t agree
Don’t know
K07_6
It is better to send a son to school than a daughter.
Yes, agree
No, don’t agree
Don’t know
K08
Do you have your own money that you can use for what you want to use it?
Yes
No
K09
How often do you see or talk to somebody from your own family other than the one who live in the same house?
Several times per week
About once per week
Several times per month
Less than once per month but more than once a year
About once per year or less
Never
K10
Do you need to ask your husband’s or another family member’s permission in order to travel
K10_1
To the market?
Yes, always
Yes, sometimes
No, never
K10_2
To a friend or family member’s house less than one hour away?
Yes, always
Yes, sometimes
No, never
K10_3
To the temple, church or mosque?
Yes, always
Yes, sometimes
No, never
K10_4
To a public village meeting?
Yes, always
Yes, sometimes
No, never
K10_5
To a meeting of any association of which you are a member including a self-help group?
Yes, always
Yes, sometimes
No, never
K10_6
Outside your village?
Yes, always
Yes, sometimes
No, never
K10_7
To see a health care provider?
Yes, always
Yes, sometimes
No, never
ACCESS TO AND KNOWLEDGE OF GOVERNMENT SCHEMES
L01
Does anyone in your household have a MGNREGA job card? If yes, please show me
Yes
No
L02
In the past year, how many days did members of your household work for MGNAREG?
L03
For this total number of days worked by household members, how many days were worked by men and how many days were worked by women?
L04
Do you feel that MNREGA gives you employment security?
Yes
No
L05
Do you have a ration card?
Yes
No
L06
Which card do you have?
Antyodhya Anna Yojna
BPL
Other (Specify)
Don’t know
L07
In the past 30 days, did you buy anything from a fair price shop?
Yes
No
L08
Which items did you buy from the fair price shop in the last 30 days?
Rice
Wheat
Sugar
Kerosene
Other staple cereals
Don’t know
Other (specify)
L09
For each item bought at the fair price shop in the last 30 days, how much _____________ did you receive?
L09_1
Rice
L09_2
Wheat
L09_3
Sugar
L09_4
Kerosene
L09_5
Other staple cereals
L10
Do you feel that fair price shops help your household be food secure?
Yes
No
L11
Did you or any member of your household ever receive any food from Anganwadicentre?
Yes
No
L12
Who received food from an Anganwadi centre
Pregnant woman in the household
Lactating woman in the household
Child less than 6 months of age
Child 6 to 24 months of age
Child 2 to 5 years of age
Other (specify)
L13
Have you heard about any schemes that provided incentives for mothers to give birth in a facility, such as JananiSurakshaYojana (JSY), Janani-ShishuSurakshaKaryakram (JSSK) and Mamata scheme?
Yes, JSY
Yes, JSSK
Yes, Mamata
No, none
Other (specify)
L14
Who provided information about these schemes?
Government doctor
Private doctor
Staff nurse
ANM
AHW
ASHA
PRADAN
Other NGO
Family member
Neighbors/friends
Shopkeeper
Other (specify)
L15
How much money are you supposed to get under the JSY scheme?
L16
Haveyoueverheard about_______?
L16_1
Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L16_2
Indira AwasYojna
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L16_3
AntyodyaYojna
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L16_4
Swajaldhara
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L16_5
TSC / Nirmal Bharat Abhiyan
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L16_6
ICDS / Anganwadi
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L16_7
JananiSurakshaYojana (JSY)
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L16_8
JananiShishuSurakshKarykaram (JSSK)
Family member
Friends/neighbors
Media (TV, radio, newspaper, etc.)
Government officials
PRADAN
Other NGO
Members of my SHG
Other
L17
Isanyone in yourhouseholdeligible for thisscheme?
L17_1
Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
Yes
No
L17_2
Indira AwasYojna
Yes
No
L17_3
AntyodyaYojna
Yes
No
L17_4
Swajaldhara
Yes
No
L17_5
TSC / Nirmal Bharat Abhiyan
Yes
No
L17_6
ICDS / Anganwadi
Yes
No
L17_7
JananiSurakshaYojana (JSY)
Yes
No
L17_8
JananiShishuSurakshKarykaram (JSSK)
Yes
No
L18
Hasanyone in yourhouseholdeverusedthisscheme?
L18_1
Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
Yes
No
L18_2
Indira AwasYojna
Yes
No
L18_3
AntyodyaYojna
Yes
No
L18_4
Swajaldhara
Yes
No
L18_5
TSC / Nirmal Bharat Abhiyan
Yes
No
L18_6
ICDS / Anganwadi
Yes
No
L18_7
JananiSurakshaYojana (JSY)
Yes
No
L18_8
JananiShishuSurakshKarykaram (JSSK)
Yes
No
L19
Whenwas the last time someone in yourhouseholdusedthisscheme?
L19_1
Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
L19_2
Indira AwasYojna
L19_3
AntyodyaYojna
L19_4
Swajaldhara
L19_5
TSC / Nirmal Bharat Abhiyan
L19_6
ICDS / Anganwadi
L19_7
JananiSurakshaYojana (JSY)
L19_8
JananiShishuSurakshKarykaram (JSSK)
POLITICAL PARTICIPATION
M01
Have you ever raised voice for any concern or issue in the community?
Yes
No
M02
Do you have voter identification card?
Yes
No
M03
Did you vote in the last election?
Yes
No
M04
Why did you vote?
My husband had asked me to do so
It is my right
Political party requested to cast vote
Political party distributed incentives to cast vote
I believe in the manifesto the party presented
Others specify
M05
In your house who decides to vote?
Self
Husband
Elder family member
Village level influential
Others specify
DK/CS
M06
Why did not you vote?
Do not feel this to be necessary
Stopped from going by husband/family members
Fearful
Not aware of the process
Others specify
DK/CS
M07
Have you ever participated in gram sabha meeting?
Yes
No
M08
Did you attend last gram sabha meeting?
Yes
No
M09
What was the reason to attend Gram sabha meeting?
I was given 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
Other, Specify
M10
What was the reason for not attending 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)
M11
Have you ever raised any concern or given your opinion in any gram sabha meeting?
Yes
No
M12
Has ever your a concern or suggestion resulted in resolution being adopted at gram sabha?
Yes
No
M13
Does gram Panchayat take action to address a complaint or suggestion raised collectively by women/SHGs?
Yes, always
Yes, sometimes
No, never
LAND OWNERSHIP AND USE OF LAND FOR FARMING
N01
Does any member of your household own, rent, or use land?
Yes
No
N02
What is the total size of the land that your household owns for each of the following categories:
N02_1
Dwelling and homestead
N02_2
Farm and cultivated land
N02_3
Wasteland
N02_4
Water bodies
FARMING PRACTICES AND INPUTS
O01
Crop Code
Rice
Wheat
Maize
Sorghum
Finger millet
Buckwheat
Barley
O02
How many months in the last 12 months could you consume the produced _______?
O03
How much of the harvested____ was sold?(Quantity in kg)
O04
What was the income from the sale of ___?(Indian Rupees)
O05
Crop Code
Groundnut
Soybeans
Lent
Peas
Chickpeas
Beans
Sugarcane
Cotton
Sunflower
Tobacco
Tea
Oil seeds
Sweet potatoes
Potatoes
Carrots
Cucumber
Chili
Eggplant
Green leaves
Okra/Lady Finger
Onion
Capsicum/Bell pepper
Cabbage
Cauliflower
Bottle gourd
Sponge gourd
Bitter gourd
Green Beans
Garlic
Ginger
Pumpkin/Zuchini
Tomato
Avocado
Guava
Mango
Lemon/Lime
Orange/Tangerine
Papaya
Melon
Lychee
Apple
Berries
Bananas
O06
How much of the harvested ____ was sold?Quantity in kg
O07
What was the income from the sale of ___?
O08
Have you (yourself) met with any agricultural/livestock/fisheries extension worker (NGO or government) in the past 12 months?
Yes
No
O09
How many times have you met with any agricultural/livestock/fisheries extension worker (NGO or government) in the past 12 months?
O10
Did your household use any ____ during the last year?
O10_1
Hand tools
Yes
No
O10_2
Mechanized tools (e.g., thresher, harvester)
Yes
No
O10_3
Plough
Yes
No
O10_4
Pesticides
Yes
No
O10_5
Herbicides
Yes
No
O10_6
Packaged animal feed
Yes
No
O10_7
Animal drugs/vaccines
Yes
No
O11
Have you or anyone else from your household ever received any training on agriculture, poultry or livestock related work?
Yes
No
O12
Did you or anyone else from your household ever receive training on_________?
O12_1
Field crop selection or rotation
Yes
No
O12_2
Improved seeds or crop varieties
Yes
No
O12_3
Pest management
Yes
No
O12_4
Soil improvement
Yes
No
O12_5
Poultry
Yes
No
O12_6
Livestock
Yes
No
O13
Who provided the training?
O13_1
Field crop selection or rotation
Government
NGO
AAMA/HKI/HFP/VMF trainer
Religious groups
Business groups
Community organizations
Family members/friends
Other (Specify)
O13_2
Improved seeds or crop varieties
Government
NGO
AAMA/HKI/HFP/VMF trainer
Religious groups
Business groups
Community organizations
Family members/friends
Other (Specify)
O13_3
Pest management
Government
NGO
AAMA/HKI/HFP/VMF trainer
Religious groups
Business groups
Community organizations
Family members/friends
Other (Specify)
O13_4
Soil improvement
Government
NGO
AAMA/HKI/HFP/VMF trainer
Religious groups
Business groups
Community organizations
Family members/friends
Other (Specify)
O13_5
Poultry
Government
NGO
AAMA/HKI/HFP/VMF trainer
Religious groups
Business groups
Community organizations
Family members/friends
Other (Specify)
O13_6
Livestock
Government
NGO
AAMA/HKI/HFP/VMF trainer
Religious groups
Business groups
Community organizations
Family members/friends
Other (Specify)
O14
When was the last time you received training on______?
O14_1
Field crop selection or rotation
O14_2
Improved seeds or crop varieties
O14_3
Pest management
O14_4
Soil improvement
O14_5
Poultry
O14_6
Livestock
O15
First, please remind me whether you currently produce ______?
Yes
No
O16
What type of seed was primarily used for production of ____?
Improved
Local
Don’t know
O17
When was the last time you purchased new seeds for this crop?
O18
Do you treat the seeds in some way before planting?
Yes
No
O19
How long before transplantation do you practice weeding?
O20
Do you use a germination test to check the seeds?
Yes
No
O21
Was any fertilizer used on the land during production of _______?
Organic
K (Potash)
P(Phosphate)
N (Nitrogen/ Urea)
Composite (DAP, NPK, etc.)
Other
None
O22
In addition to the basic fertilizer, what do you apply to neutralize the acidity in the soil?
Lime
Dolomite
Other
Nothing
O23
For this crop, are you using line planting/transplanting or do you broadcast the crop in the main field or both?
Line planting/ transplanting
Broadcast crop
Both
Don’t know
O24
At what stage of the cropping practices do you usually apply urea?
Never
All the time
After irrigation
Before irrigation
After weeding
Flowering stage
O25
How many days after planting do you irrigate the crop?
O26
After planting, when do you practice earthing-up?
Immediately
Within 7 days
Within 30 days
After 1month
Any time
Never
O27
Do you practice hoeing in fields where you grow _____?
Yes
No
ANIMAL OWNERSHIP AND PRODUCTION AND SALE OF ANIMAL PRODUCTS
P01
During the last 12 months, did anyone in the household own any animals including livestock, poultry, fish, etc?
Yes
No
P02
How many ________ has your household owned in the last 12 months?
P02_1
Cattle/buffalo/oxen/cow/yak
P02_2
Goat
P02_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
P02_4
Sheep
P02_5
Pig
P03
How many ______ does your household currently own?
P03_1
Cattle/buffalo/oxen/cow/yak
P03_2
Goat
P03_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
P03_4
Sheep
P03_5
Pig
P04
Who usually takes/took care of the animals?
P04_1
Cattle/buffalo/oxen/cow/yak
P04_2
Goat
P04_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
P04_4
Sheep
P04_5
Pig
P05
How many ___ did you sell in the last 12 months?
P05_1
Cattle/buffalo/oxen/cow/yak
P05_2
Goat
P05_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
P05_4
Sheep
P05_5
Pig
P06
How much did your household receive for the sale of these ___ in the last 12 months?
P06_1
Cattle/buffalo/oxen/cow/yak
P06_2
Goat
P06_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
P06_4
Sheep
P06_5
Pig
P07
Did you produce any ___ during the last 12 months?
P07_1
Animal meat/offal
Yes
No
P07_2
Poultry meat/offal
Yes
No
P07_3
Milk (including that produced for milk products)
Yes
No
P07_4
Eggs
Yes
No
P08
Did you produce any ___ during the last 12 months?
P08_1
Animal meat/offal
Yes
No
P08_2
Poultry meat/offal
Yes
No
P08_3
Milk (including that produced for milk products)
Yes
No
P08_4
Eggs
Yes
No
P09
Did your household sell any of the ___ produced?
P09_1
Animal meat/offal
Yes
No
P09_2
Poultry meat/offal
Yes
No
P09_3
Milk (including that produced for milk products)
Yes
No
P09_4
Eggs
Yes
No
P10
How much in total did your household receive for the sale of ________?
P10_1
Animal meat/offal
P10_2
Poultry meat/offal
P10_3
Milk (including that produced for milk products)
P10_4
Eggs
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