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Sarpanch Survey -Form Fill
Screening
Q01
What is your name?
Q02
Mobile number of the Respondent
Q03
Election Year
Q04
Other Election Year
Q05
Were you officially elected Sarpanch in election year, meaning your name appeared on the ballot?
Yes
No
Q06
Was someone else from your household officially elected Sarpanch in election year, meaning their name appeared on the ballot?
Yes
No
Q07
What is their name?
Background
A01
Did you perform the roles and responsibilities of Sarpanch?
Yes
No
A02
In which Gram Panchayat did you or someone from your household serve as Sarpanch?
A03
In which block is GramPanchayat?
A04
Was the Sarpanch seat reserved for women in election year?
Yes
No
A05
Was the Sarpanch seat reserved for SC, ST, or OBC in election year?
No
SC
ST
OBC
A06
How competitive/close was the election year Sarpanch election?
Not very competitive
Somewhat competitive
Very competitive
A07
Was the Sarpanch seat reserved for women in other election year?
Yes
No
A08
Was the Sarpanch seat reserved for SC, ST, or OBC in other election year?
No
SC
ST
OBC
Respondent Particulars
B01
What is your gender?
Male
Female
Other
B02
What is your relationship to the head of household?
HOH
Spouse
Child
Child-in-law (Daughter/Son-in-law)
Grandchild
Parent
Sibling
Parent-in-law
Niece/nephew
Sibling-in-law
Other (specify)
B03
What is your age?
B04
What was your marital status in $ELECTIONYEAR?
Never married
Currently married
Widowed
Separated
Divorced
B05
What was your primary occupation/principal activity in $ELECTIONYEAR?
Farmer with more than 10 hectares of land
Farmer with more 2- 10 hectares of land
Farmer with less than 2 hectares of land
Tenant farmer
Permanent salaried employee (manager/officer grade)
Permanent salaried employee (non-managerial/non-officer grade)
Salaried employee in a part-time/non-permanent private job
Self-employed professional running any vocational trade (e.g. carpenter, plumber, self-employed driver, electrician, etc.)
Self-employed professional providing consulting services (e.g. doctor, lawyer, chartered accountant, real estate agent, etc. running their own consulting business)
Business/shop owner with paid employees
Business/shop owner without paid employees
Daily wage labourer
Domestic help
Home-based artisan/piecemeal job worker
Homemaker/housewife
Political worker
Retired or too old to work or with disability
Student
Others (Specify)
B06
What was the highest level of education you had completed $ELECTIONYEAR?
0-12
13-Graduate or higher
14-Other (specify)
B07
What is your religion?
Hinduism
Islam
Christianity
Sikhism
Jainism
Buddhism
Zoroastrianism
Other (specify)
B08
What is your caste category?
SC
ST
OBC
GC
B09
What is your jati/tribe?
B10
For how many years have you lived in this Gram Panchayat?
B11
Did you run for office in the $OTHERELECTIONYEAR local elections?
Yes
No
B12
Which position did you contest?
Sarpanch
Up Sarpanch
(Ward member)
Other (specify)
B13
Did you win?
Yes
No
Sarpanch Particulars
C01
What is $Q4NAME's gender?
Male
Female
Other
C02
What is $Q4NAME's relationship to the head of household?
HOH
Spouse
Child
Child-in-law (Daughter/Son-in-law)
Grandchild
Parent
Sibling
Parent-in-law
Niece/nephew
Sibling-in-law
Other (specify)
C03
What is $Q4NAME's age?
C04
What was $Q4NAME's marital status in $ELECTIONYEAR?
Never married
Currently married
Widowed
Separated
Divorced
C05
What was $Q4NAME's primary occupation/principal activity in $ELECTIONYEAR?
Farmer with more than 10 hectares of land
Farmer with more 2- 10 hectares of land
Farmer with less than 2 hectares of land
Tenant farmer
Permanent salaried employee (manager/officer grade)
Permanent salaried employee (non-managerial/non-officer grade)
Salaried employee in a part-time/non-permanent private job
Self-employed professional running any vocational trade (e.g. carpenter, plumber, self-employed driver, electrician, etc.)
Self-employed professional providing consulting services (e.g. doctor, lawyer, chartered accountant, real estate agent, etc. running their own consulting business)
Business/shop owner with paid employees
Business/shop owner without paid employees
Daily wage labourer
Domestic help
Home-based artisan/piecemeal job worker
Homemaker/housewife
Political worker
Retired or too old to work or with disability
Student
Others (Specify)
C06
What was the highest level of education $Q4NAME's had completed in $ELECTIONYEAR?
0-12
13-Graduate or higher
14-Other (specify)
C07
What is $Q4NAME's religion?
Hinduism
Islam
Christianity
Sikhism
Jainism
Buddhism
Zoroastrianism
Other (specify)
C08
What is $Q4NAME's caste category?
SC
ST
OBC
GC
C09
What is $Q4NAME's jati/tribe?
C10
For how many years has $Q4NAME lived in this Gram Panchayat?
C11
Did $Q4NAME run for office in the $OTHERELECTIONYEAR local elections?
Yes
No
C12
Which position did they contest?
Sarpanch
Up Sarpanch
(Ward member)
Other (specify)
C13
Did they win?
Yes
No
Attitudes and Background
D01
Has anyone else from your family ever been Sarpanch?
Yes
No
D02
Has anyone else from your family ever held any other elected post? Which post?
None
Sarpanch
Up Sarpanch
(Ward member)
Other (specify)
D03
In your opinion, how important is it that elected officials have high levels of education?
Not at all important
Somewhat important
Very important
D04
In your opinion, how important is it that elected officials represent the diversity of the populations they serve?
Not at all important
Somewhat important
Very important
D05
Some people believe that reservations ensure that all people are represented in local government. Others believe that reservations stop the most qualified candidates from being represented. What about you, what do you think?
Reservations ensure representation
Reservations inhibit quality
Neither
Other
Refuse to say
D06
In this Gram Panchayat, how much conflict would you say there is among the communities / jatis that live here?
Not much conflict
Some conflict
A lot of conflict
Attitudes and Background of household
E01
What is the predominant material of wall of dwelling room?
Grass/thatch/bamboo
Plastic/polythene
Mud/unburnt brick
Wood
Stone not packed with mortar
Stone packed with mortar
G.I./metal/asbestos sheets
Burnt brick
Concrete
Any other
E02
What is the predominant material of roof of dwelling room?
Grass/thatch/bamboo/wood/mud
Plastic/polythene
Handmade tiles
Machine made tiles
Burnt brick
Stone
Slate
G.I./metal/asbestos sheets
Concrete
Any other
E03
What is the ownership status of your house?
Owned
Rented
Any other
E04
Ho wmany dwelling rooms are exclusively in possession of this household?
E05
Does any household member have a salaried job?
Yes
No
E06
Is this job in the government, public sector, or private sector?
Government
Public sector
Private sector
E07
Does any household member pay income or professional tax?
Yes
No
E08
Does any household member own/operate an enterprise which is registered with the government?
Yes
No
E09
What is the monthly income of the highest earning household member?
E10
What is the main source of household income?
Farmer with more than 10 hectares of land
Farmer with more 2- 10 hectares of land
Farmer with less than 2 hectares of land
Tenant farmer
Permanent salaried employee (manager/officer grade)
Permanent salaried employee (non-managerial/non-officer grade)
Salaried employee in a part-time/non-permanent private job
Self-employed professional running any vocational trade (e.g. carpenter, plumber, self-employed driver, electrician, etc.)
Self-employed professional providing consulting services (e.g. doctor, lawyer, chartered accountant, real estate agent, etc. running their own consulting business)
Business/shop owner with paid employees
Business/shop owner without paid employees
Daily wage labourer
Domestic help
Home-based artisan/piecemeal job worker
Homemaker/housewife
Political worker
Retired or too old to work or with disability
Student
Others (Specify)
E11
Does the household own any of the following assets?
Refrigerator
Landline telephone
Mobile phone
Motorized two/three/four wheelers or motorized fishing boat requiring registration
Land
Mechanized three/four wheeler
agricultural equipment
Irrigation equipment
E12
How many acres of un-irrigated land does your household own?
E13
House many acres of irrigated land does your household own?
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