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Household Template 10 -Form Fill

HOUSEHOLD COMPOSITION
Q01

Name

Q02

Relation to respondent woman.

Q03

Sex

Q04

Age

Q05

Marital status?

Q06

Main Occupation

Q07

Education

MATERNAL LITERACYAND CHILD CARE
A01

Do you know how to read and write?

A02

Can you please read the following sentence?

A03

Do you usually do your work for your main occupation at home or outside the home?

A04

How much do you contribute to the total household expenses?

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?

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?

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?

A12

Do you breastfeed your youngest child?

A13

Did you breastfeed this youngest child in the previous 24 hours?

A14

What else, if anything, was given to this youngest child to eat or drink in the previous 24 hours?

HOUSEHOLD SOCIO ECONOMIC STATUS
B01

In the last 12 months, have any adults (aged 15 years or more) in your household migrated?

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?

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?

B05

How often has your household received remittances in the last 12 months?

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?

B08

Does your house have any electricity?

B09

Do you have any other kind of electric power? If yes, which type?

B10

What type of fuel does your household mainly use for cooking?

B11

Did anyone in the household earn income from any of the following sources in the last 12 months?

B11_1

Agriculture labor

B11_2

Non-agriculture labor

B11_3

Skilled labor

B11_4

Small business activities (street vending, shop keeping, handicrafts, sells liquor)

B11_5

NTFP selling

B12

Whetherengaged in the activity ?

B12_1

Agriculture labor

B12_2

Non-agriculture labor

B12_3

Skilled labor

B12_4

Small business activities (street vending, shop keeping, handicrafts, sells liquor)

B12_5

NTFP selling

B13

Who in the householdearnedincome over last 12 months?

B13_1

Agriculture labor

B13_2

Non-agriculture labor

B13_3

Skilled labor

B13_4

Small business activities (street vending, shop keeping, handicrafts, sells liquor)

B13_5

NTFP selling

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

B15_2

Death of other HH member

B15_3

Disease or injury of income-earning HH member

B15_4

Disease or injury of other HH member

B15_5

Loss of employment of any HH member

B15_6

Divorce by husband/wife

B15_7

Loss of crop due to flooding

B15_8

Loss of crop due to otherreasons

B15_9

Disease, injury, loss of cattle

B15_10

Damage to house or any productive assets (theft, fire, river erosion, cyclone etc.)

B15_11

Storage crop damage/theft

B15_12

Business failure

B15_13

Conflict, dispute, legalproblems

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

B18_2

Small agricultural tools - (Ex: Saw/Hammer/Hoe/Spade/Axe/ Shovel/Sickle/Harrower/Rake)

B18_3

Fishing net

B18_4

Reaper/Harvester

B18_5

Harrower/weeding machine

B18_6

Machine sprayer (e.g. fertilizer, chemical, pesticide)

B18_7

Wheelbarrow

B18_8

Bullock cart/Horse cart

B18_9

Push cart

B18_10

Tractor

B18_11

Power Tiller/ Small tractor (with steering)

B18_12

Trolley/Trailer

B18_13

Thresher

B18_14

Fodder cutting machine

B18_15

Swing basket

B18_16

Hand tube well/Rower pump

B18_17

Manual wooden thresher/Treadle pump (for irrigation)

B18_18

Low lift pump (LLP) for irrigation (Machine pumping from surface water)

B18_19

Shallow tube well/Diesel motor pump

B18_20

Deep tube well/Electric motor pump

B18_21

Spraying machine for water

B18_22

Carpentry equipment

B18_23

Pottery wheel

B18_24

Blacksmith tools

B18_25

Spinning wheel

B18_26

Manual wooden thresher/Treadle pump (for food processing)

B18_27

Manual flour mill

B18_28

Mattress

B18_29

Pressure Cooker

B18_30

Chair

B18_31

Cot/ Bed

B18_32

Table

B18_33

Electric Fan

B18_34

Radio/ Transister

B18_35

B & W Television

B18_36

Sewing Machine

B18_37

Mobile Telephone

B18_38

Landline Telephone

B18_39

Internet

B18_40

Computer

B18_41

Refrigerator

B18_42

Air Conditioner/ Cooler

B18_43

Washing Machine

B18_44

Watch/ Clock

B18_45

Bicycle

B18_46

MotorCycle/ Scooter

B18_47

Three-wheeler

B18_48

Car

B18_49

AC/ Cooler

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

C06_2

Other cereal (rice, sorghum, millet, wheat etc)

C06_3

Roots and Tubers (cassava, potatoes, sweet potatoes)

C06_4

Sugar or sugar products

C06_5

Beans and peas

C06_6

Groundnuts and cashew nuts

C06_7

Vegetables (including relish and leaves)

C06_8

Fruits

C06_9

Beef, goat, or other red meat and pork

C06_10

Poultry and eggs

C06_11

Fish

C06_12

Oils/fats/butter

C06_13

Milk/yogurt/other dairy product

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?

C08

Did the respondent mother eat ________?

C08_1

CEREALS

C08_2

VITAMIN A RICH VEGETABLES AND TUBERS

C08_3

WHITE TUBERS AND ROOTS OR OTHER STARCHY FOODS

C08_4

DARK GREEN LEAFY VEGETABLES

C08_5

OTHER VEGETABLES

C08_6

VITAMIN A RICH FRUITS

C08_7

OTHER FRUITS

C08_8

meats

C08_9

EGGS

C08_10

FISH

C08_11

PULSES

C08_12

MILK AND MILK PRODUCTS

C08_13

OILS AND FATS

C08_14

SWEETS

C08_15

SPICES, CONDIMENTS, BEVERAGES

C09

Did any HH member eat ________?

C09_1

CEREALS

C09_2

VITAMIN A RICH VEGETABLES AND TUBERS

C09_3

WHITE TUBERS AND ROOTS OR OTHER STARCHY FOODS

C09_4

DARK GREEN LEAFY VEGETABLES

C09_5

OTHER VEGETABLES

C09_6

VITAMIN A RICH FRUITS

C09_7

OTHER FRUITS

C09_8

meats

C09_9

EGGS

C09_10

FISH

C09_11

PULSES

C09_12

MILK AND MILK PRODUCTS

C09_13

OILS AND FATS

C09_14

SWEETS

C09_15

SPICES, CONDIMENTS, BEVERAGES

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?

C10_2

Limit portion size at mealtimes?

C10_3

Reduce number of meals eaten per day?

C10_4

Borrow food or rely on help from friends or relatives?

C10_5

Rely on less expensive or less preferred foods?

C10_6

Purchase/borrow food on credit?

C10_7

Gather unusual types or amounts of wild food / hunt?

C10_8

Send household members to eat elsewhere?

C10_9

Send household members to beg?

C10_10

You or other female members eat less?

C10_11

Have you sold any household assets to buy food?

C11

Usually, does your household has food available for the whole year?

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?

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?

D04

Which organization started or supports this self-help group?

D05

Does you self-help group have savings and credit activities?

D06

Do you personally participate in these savings and credit activities?

D07

Do you take leadership roles in this self-help group?

D08

Are you currently a portfolio-holder?

D09

Do you discuss any of the following in the self-help group?

D09_1

Livelihoods/socio-economic problems in the community

D09_2

Agriculture problems

D09_3

Education problems

D09_4

Health and nutrition problems

D09_5

Gender dynamics

D10

Have you ever been a member of a self-help group?

D11

Were you previously a portfolio holder?

D12

Why do you not belong to a self-help group?

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?

E02

Do you treat your water in any way to make it safer to drink?

E03

What do you usually do to the water to make it safer to drink?

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?

E07

For each season, what is the main source of water used by your household for cooking, bathing, and washing utensils?

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.

E09

Do you share this facility with another household?

E10

The last time the youngest child of the household passed stools, what was done to dispose the stool?

E11

According to you, when should a mother or caretaker of a young child should wash her hands?

E12

What materials do you use when you wash your hands?

E13

Did it rain the day of the observation or the day before?

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

E15_2

Hair

E15_3

Clothes

E15_4

Face

E16

Is the child naked at the time of the visit?

E17

What is the child’s general appearance (observe cleanliness of hands, nails, body and face)

E17_1

Hands

E17_2

Hair

E17_3

Clothes

E17_4

Face

E18

Was the child walking, crawling or was carried by the mother or another person during the observation?

E19

Can we observe human feces around the house or in the compound?

E20

Can we observe animal feces (chicken, dogs, cats, etc.) around the house or in the compound?

E21

Is the drinking water container covered?

E22

What is the main material of the floor?

E23

What is the main material of the exterior wall?

E24

What is the main material of the roof?

MARKET AND INFORMATION ACCESS
F01

Which types of markets does your family purchase foods from?

F02

Who purchases most of the foods consumed by the family?

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?

F05

Who buys these special foods for children?

F06

Do you ever watch TV?

F07

How often do you watch TV?

F08

Do you ever listen to the radio?

F09

How often do you listen to the radio?

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?

G03

Was the amount of time spent working less than average, average, or 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?

WOMEN’S ACCESS TO CAPITAL AND CREDIT
I01

Does anyone in your household currently have any _____?

I01_1

Agricultural land

I01_2

Other land not used for agriculture

I01_3

Large livestock (e.g. oxen, cattle, buffalo, horse)

I01_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)

I01_5

Fish pond or fishing equipment

I01_6

Farm equipment (non-mechanized)

I01_7

Farm equipment (mechanized e.g. tractor)

I01_8

Ornaments and jewellery

I02

Who would you say owns most of the _____?

I02_1

Agricultural land

I02_2

Other land not used for agriculture

I02_3

Large livestock (e.g. oxen, cattle, buffalo, horse)

I02_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)

I02_5

Fish pond or fishing equipment

I02_6

Farm equipment (non-mechanized)

I02_7

Farm equipment (mechanized e.g. tractor)

I02_8

Ornaments and jewellery

I03

Do you own any of the ____?

I03_1

Agricultural land

I03_2

Other land not used for agriculture

I03_3

Large livestock (e.g. oxen, cattle, buffalo, horse)

I03_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)

I03_5

Fish pond or fishing equipment

I03_6

Farm equipment (non-mechanized)

I03_7

Farm equipment (mechanized e.g. tractor)

I03_8

Ornaments and jewellery

I04

Who can decide whether to sell _____ most of the time?

I04_1

Agricultural land

I04_2

Other land not used for agriculture

I04_3

Large livestock (e.g. oxen, cattle, buffalo, horse)

I04_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)

I04_5

Fish pond or fishing equipment

I04_6

Farm equipment (non-mechanized)

I04_7

Farm equipment (mechanized e.g. tractor)

I04_8

Ornaments and jewellery

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)

I05_2

Informal lender

I05_3

Formal lender (direct credit from bank/financial institution)

I05_4

Friends or relatives

I05_5

Savings and Credit cooperatives/groups

I05_6

Women's groups

I06

Who made the decision to borrow from _____?

I06_1

Non-governmental organization (NGO)

I06_2

Informal lender

I06_3

Formal lender (direct credit from bank/financial institution)

I06_4

Friends or relatives

I06_5

Savings and Credit cooperatives/groups

I06_6

Women's groups

I07

Who makes the decision about what to do with the money/item borrowed from _____?

I07_1

Non-governmental organization (NGO)

I07_2

Informal lender

I07_3

Formal lender (direct credit from bank/financial institution)

I07_4

Friends or relatives

I07_5

Savings and Credit cooperatives/groups

I07_6

Women's groups

I08

Has such a situation ever occurredwhere you wanted to take loan but you couldn’t take?

I08_1

Non-governmental organization (NGO)

I08_2

Informal lender

I08_3

Formal lender (direct credit from bank/financial institution)

I08_4

Friends or relatives

I08_5

Savings and Credit cooperatives/groups

I08_6

Women's groups

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?

J02

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

J03

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

J04

Is there a ____ in your community?

J04_1

Agricultural/livestock/fisheries producer group (including marketing groups)

J04_2

Water users’ group

J04_3

Land/forest users’ groups

J04_4

Credit or microfinance group

J04_5

Mutual help or insurance group (including burial societies) (not-self-help group)

J04_6

Trade and business association

J04_7

Civic group (improving community) or charitable group (helping others)

J04_8

Religious group

J04_9

Mother’s group

J04_10

Other women’s group (only if it does not fit into one of the other categories)

J05

Are you a member/active member of any ______?

J05_1

Agricultural/livestock/fisheries producer group (including marketing groups)

J05_2

Water users’ group

J05_3

Land/forest users’ groups

J05_4

Credit or microfinance group

J05_5

Mutual help or insurance group (including burial societies) (not-self-help group)

J05_6

Trade and business association

J05_7

Civic group (improving community) or charitable group (helping others)

J05_8

Religious group

J05_9

Mother’s group

J05_10

Other women’s group (only if it does not fit into one of the other categories)

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?

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.

K07_2

If the woman works outside home, her husband or partner should help her with the daily housework.

K07_3

A husband should not let his wife work outside home, even if she would like to do it.

K07_4

A woman has the right to express her opinion if she does not agree with what the husband or partner says.

K07_5

A woman must accept that her husband or partner beats her in order to keep the family together.

K07_6

It is better to send a son to school than a daughter.

K08

Do you have your own money that you can use for what you want to use it?

K09

How often do you see or talk to somebody from your own family other than the one who live in the same house?

K10

Do you need to ask your husband’s or another family member’s permission in order to travel

K10_1

To the market?

K10_2

To a friend or family member’s house less than one hour away?

K10_3

To the temple, church or mosque?

K10_4

To a public village meeting?

K10_5

To a meeting of any association of which you are a member including a self-help group?

K10_6

Outside your village?

K10_7

To see a health care provider?

ACCESS TO AND KNOWLEDGE OF GOVERNMENT SCHEMES
L01

Does anyone in your household have a MGNREGA job card? If yes, please show me

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?

L05

Do you have a ration card?

L06

Which card do you have?

L07

In the past 30 days, did you buy anything from a fair price shop?

L08

Which items did you buy from the fair price shop in the last 30 days?

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?

L11

Did you or any member of your household ever receive any food from Anganwadicentre?

L12

Who received food from an Anganwadi centre

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?

L14

Who provided information about these schemes?

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

L16_2

Indira AwasYojna

L16_3

AntyodyaYojna

L16_4

Swajaldhara

L16_5

TSC / Nirmal Bharat Abhiyan

L16_6

ICDS / Anganwadi

L16_7

JananiSurakshaYojana (JSY)

L16_8

JananiShishuSurakshKarykaram (JSSK)

L17

Isanyone in yourhouseholdeligible for thisscheme?

L17_1

Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act

L17_2

Indira AwasYojna

L17_3

AntyodyaYojna

L17_4

Swajaldhara

L17_5

TSC / Nirmal Bharat Abhiyan

L17_6

ICDS / Anganwadi

L17_7

JananiSurakshaYojana (JSY)

L17_8

JananiShishuSurakshKarykaram (JSSK)

L18

Hasanyone in yourhouseholdeverusedthisscheme?

L18_1

Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act

L18_2

Indira AwasYojna

L18_3

AntyodyaYojna

L18_4

Swajaldhara

L18_5

TSC / Nirmal Bharat Abhiyan

L18_6

ICDS / Anganwadi

L18_7

JananiSurakshaYojana (JSY)

L18_8

JananiShishuSurakshKarykaram (JSSK)

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?

M02

Do you have voter identification card?

M03

Did you vote in the last election?

M04

Why did you vote?

M05

In your house who decides to vote?

M06

Why did not you vote?

M07

Have you ever participated in gram sabha meeting?

M08

Did you attend last gram sabha meeting?

M09

What was the reason to attend Gram sabha meeting?

M10

What was the reason for not attending gram sabha meeting?

M11

Have you ever raised any concern or given your opinion in any gram sabha meeting?

M12

Has ever your a concern or suggestion resulted in resolution being adopted at gram sabha?

M13

Does gram Panchayat take action to address a complaint or suggestion raised collectively by women/SHGs?

LAND OWNERSHIP AND USE OF LAND FOR FARMING
N01

Does any member of your household own, rent, or use land?

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

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

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?

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

O10_2

Mechanized tools (e.g., thresher, harvester)

O10_3

Plough

O10_4

Pesticides

O10_5

Herbicides

O10_6

Packaged animal feed

O10_7

Animal drugs/vaccines

O11

Have you or anyone else from your household ever received any training on agriculture, poultry or livestock related work?

O12

Did you or anyone else from your household ever receive training on_________?

O12_1

Field crop selection or rotation

O12_2

Improved seeds or crop varieties

O12_3

Pest management

O12_4

Soil improvement

O12_5

Poultry

O12_6

Livestock

O13

Who provided the training?

O13_1

Field crop selection or rotation

O13_2

Improved seeds or crop varieties

O13_3

Pest management

O13_4

Soil improvement

O13_5

Poultry

O13_6

Livestock

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 ______?

O16

What type of seed was primarily used for production of ____?

O17

When was the last time you purchased new seeds for this crop?

O18

Do you treat the seeds in some way before planting?

O19

How long before transplantation do you practice weeding?

O20

Do you use a germination test to check the seeds?

O21

Was any fertilizer used on the land during production of _______?

O22

In addition to the basic fertilizer, what do you apply to neutralize the acidity in the soil?

O23

For this crop, are you using line planting/transplanting or do you broadcast the crop in the main field or both?

O24

At what stage of the cropping practices do you usually apply urea?

O25

How many days after planting do you irrigate the crop?

O26

After planting, when do you practice earthing-up?

O27

Do you practice hoeing in fields where you grow _____?

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?

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

P07_2

Poultry meat/offal

P07_3

Milk (including that produced for milk products)

P07_4

Eggs

P08

Did you produce any ___ during the last 12 months?

P08_1

Animal meat/offal

P08_2

Poultry meat/offal

P08_3

Milk (including that produced for milk products)

P08_4

Eggs

P09

Did your household sell any of the ___ produced?

P09_1

Animal meat/offal

P09_2

Poultry meat/offal

P09_3

Milk (including that produced for milk products)

P09_4

Eggs

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