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Household Template 14 -Form Fill

Identification
Q01

Household Number
Q02

Name of the Respondent
Q03

Name of the Household Head
Q04

Village
Q05

Gram Panchayat
Q06

Sub-district/Tehsil
Q07

District
Q08

State
Q09

Investigator
Q10

Supervisor
Q11

Household HeadReligion
Q12

Household HeadCaste
HOUSEHOLD COMPOSITION
A01

Now we would like information on the different persons who usually live in your household.
A02

Relation to respondent woman.
A03

Sex

A04

Age
A05

Marital status?
A06

Main Occupation
A07

Education
HOUSEHOLD SOCIO ECONOMIC STATUS
B01

Do you own the house you live in?
B02

Does your house have any electricity?
B03

Do you have any other kind of electric power? If yes, which type?
B04

What type of fuel does your household mainly use for cooking?
B05

Does your household own any of the following items:

B05_1

Mattress
B05_2

Pressure cooker
B05_3

Chair
B05_4

Cot/ Bed
B05_5

Table
B05_6

Electric fan
B05_7

Radio/Transistor
B05_8

B & W television
B05_9

Colour television
B05_10

Sewing machine
B05_11

Mobile Phone
B05_12

Telephone
B05_13

Internet
B05_14

Computer
B05_15

Refrigerator
B05_16

Air Conditioner / cooler
B05_17

Washing Machine
B05_18

Clock or watch
B05_19

Bicycle
B05_20

Motorcycle/scooter
B05_21

Animal-drawn cart
B05_22

Car/Jeep
B05_23

Water pump
B05_24

Thresher
B05_25

Tractor
B06

Do you ever watch TV?
B07

How often do you watch TV?
B08

Do you ever listen to the radio?
B09

How often do you listen to the radio?
B10

Whether engaged in the activity ?

B10_1

Agriculture labor
B10_2

Non-agriculture labor

B10_3

Skilled labor
B10_4

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

B10_5

NTFP selling
B11

Who in the householdearnedincome over 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

How much did the household earn from [activity] ______ over the past 12 months?

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

In the last 12 months, have any adults (people aged at 15 years or more than 15 years)in your household migrated?
B14

How many adults in your household have migrated because of work? Please tell me how many women and how many men
B15

What was/were the reason(s) for migration?
B16

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?
B17

How often has your household received remittances in the last 12 months?
B18

On average, how much money did your household receive each time you received remittances in the last 12 months?
B19

In the last 12 months, have there been any unexpected incident that has affected your economic situation adversely?
B20

If yes, what has been the event?
LAND OWNERSHIP AND USE OF LAND FOR FARMING
C01

Does any member of your household own, lease in any agricultural land?
C02

Does your household engage in agricultural activities?
C03

What is the total size of the land that your household owns for each of the following categories:

C03A

Owned Land
C03A1

Unit
C03B

Leased in Land
C03B1

Unit
USE OF LAND FOR FARMING
D01

First, please remind me whether you currently produce ______?

D01_1

Wheat
D01_2

Rice
D01_3

Maize
D01_4

Finger Millet
D02

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

D02_1

Wheat
D02_2

Rice
D02_3

Maize
D02_4

Finger Millet
D03

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

D03_1

Wheat
D03_2

Rice
D03_3

Maize
D03_4

Finger Millet
D04

Do you treat the seeds in some way before planting?

D04_1

Wheat
D04_2

Rice
D04_3

Maize
D04_4

Finger Millet
D05

How long before transplantation do you practice weeding?

D05_1

Wheat
D05_2

Rice
D05_3

Maize
D05_4

Finger Millet
D06

Do you use a germination test to check the seeds?

D06_1

Wheat
D06_2

Rice
D06_3

Maize
D06_4

Finger Millet
D07

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

D07_1

Wheat
D07_2

Rice
D07_3

Maize
D07_4

Finger Millet
D08

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

D08_1

Wheat
D08_2

Rice
D08_3

Maize
D08_4

Finger Millet
D09

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

D09_1

Wheat
D09_2

Rice
D09_3

Maize
D09_4

Finger Millet
D10

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

D10_1

Wheat
D10_2

Rice
D10_3

Maize
D10_4

Finger Millet
D11

How many days after planting do you irrigate the crop?

D11_1

Wheat
D11_2

Rice
D11_3

Maize
D11_4

Finger Millet
D12

After planting, when do you practice earthing-up?

D12_1

Wheat
D12_2

Rice
D12_3

Maize
D12_4

Finger Millet
D13

Do you practice hoeing in fields where you grow _____?

D13_1

Wheat
D13_2

Rice
D13_3

Maize
D13_4

Finger Millet
D14

Crop Code
D15

What was the total amount produced in the last year? (KG.)
D16

How much of the harvested____ was sold?(Quantity in kg)
D17

What was the income from the sale of ___?(Indian Rupees)
D18

Have you (yourself) met with any agricultural/livestock/fisheries extension worker (NGO or government) in the past 12 months?
D19

How many times have you met with any agricultural/livestock/fisheries extension worker (NGO or government) in the past 12 months?
D20

Did your household use any ____ during the last year?

D20_1

Improved Farm Tools (e.g., Wheel hoe, weeders, broad coasters)
D20_2

Mechanized tools (e.g., thresher, harvester)
D20_3

Pesticides
D20_4

Herbicides
D20_5

Packaged animal feed
D20_6

Animal drugs/vaccines
D21

Have you or anyone else from your household ever received any training on agriculture, poultry or livestock related work?
D22

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

D22_1

Field crop selection or rotation
D22_2

Improved seeds or crop varieties
D22_3

Pest management
D22_4

Soil improvement
D22_5

Poultry
D22_6

Livestock
D23

Who provided the training?

D23_1

Field crop selection or rotation
D23_2

Improved seeds or crop varieties
D23_3

Pest management
D23_4

Soil improvement
D23_5

Poultry
D23_6

Livestock
D24

When was the last time you received training on______?

D24_1

Field crop selection or rotation
D24_2

Improved seeds or crop varieties
D24_3

Pest management
D24_4

Soil improvement
D24_5

Poultry
D24_6

Livestock
ANIMAL OWNERSHIP AND PRODUCTION AND SALE OF ANIMAL PRODUCTS
E01

During the last 12 months, did anyone in the household own any animals including livestock, poultry, fish, etc?
E02

How many ________ has your household owned in the last 12 months?

E02_1

Cattle/buffalo/oxen/cow/yak
E02_2

Goat
E02_3

Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
E02_4

Sheep
E02_5

Pig
E03

How many ______ does your household currently own?

E03_1

Cattle/buffalo/oxen/cow/yak
E03_2

Goat
E03_3

Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
E03_4

Sheep
E03_5

Pig
E04

Who usually takes/took care of the animals?

E04_1

Cattle/buffalo/oxen/cow/yak
E04_2

Goat
E04_3

Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
E04_4

Sheep
E04_5

Pig
E05

How many ___ did you sell in the last 12 months?

E05_1

Cattle/buffalo/oxen/cow/yak
E05_2

Goat
E05_3

Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
E05_4

Sheep
E05_5

Pig
E06

How much did your household receive for the sale of these ___ in the last 12 months?

E06_1

Cattle/buffalo/oxen/cow/yak
E06_2

Goat
E06_3

Chicken/ Guinea fowl/Pigeons/Duck/ Hen/
E06_4

Sheep
E06_5

Pig
E07

Now we would like some information on your household's production and selling of animal products. Please only consider the previous 12 months.

E08

Did you produce any ___ during the last 12 months?

E08_1

Animal meat/offal
E08_2

Poultry meat/offal
E08_3

Milk (including that produced for milk products)
E08_4

Eggs
E09

Did your household sell any of the ___ produced?

E09_1

Animal meat/offal
E09_2

Poultry meat/offal
E09_3

Milk (including that produced for milk products)
E09_4

Eggs
E10

How much in total did your household receive for the sale of ________?

E10_1

Animal meat/offal
E10_2

Poultry meat/offal
E10_3

Milk (including that produced for milk products)
E10_4

Eggs
HOUSEHOLD DIETARY DIVERSITY, COPING STRATEGY AND FOOD SECURITY
F01

How many meals did you eat yesterday during the day and night?
F02

How many meals did the adult members (18+) of your household eat yesterday during the day and night?
F03

How many meals did the children 6 to18 years in this household eat yesterday during the day and night?
F04

Over the last 7 days, how many days did you consume following foods?

F04_1

Maize, maize porridge. Other cereal (rice, sorghum, millet, wheat etc) Roots and Tubers (cassava, potatoes, sweet potatoes)
F04_2

Beans and peas. Groundnuts and cashew nuts
F04_3

Vegetables (including relish and leaves)
F04_4

Fruits
F04_5

Beef, goat, or other red meat and pork, Fish, Poultry and eggs
F04_6

Milk/yogurt/other dairy product
F04_7

Sugar or sugar products
F04_8

Oils/fats/butter
F04A

Over the last 7 days, how many days did the children in this household consume following foods?

F04A_1

Maize, maize porridge. Other cereal (rice, sorghum, millet, wheat etc) Roots and Tubers (cassava, potatoes, sweet potatoes)
F04A_2

Beans and peas. Groundnuts and cashew nuts
F04A_3

Vegetables (including relish and leaves)
F04A_4

Fruits
F04A_5

Beef, goat, or other red meat and pork, Fish, Poultry and eggs
F04A_6

Milk/yogurt/other dairy product
F04A_7

Sugar or sugar products
F04A_8

Oils/fats/butter
F05

Over the last 7 days, how many days did other household members consume following foods?

F05_1

Maize, maize porridge. Other cereal (rice, sorghum, millet, wheat etc) Roots and Tubers (cassava, potatoes, sweet potatoes)
F05_2

Beans and peas. Groundnuts and cashew nuts
F05_3

Vegetables (including relish and leaves)
F05_4

Fruits
F05_5

Beef, goat, or other red meat and pork, Fish, Poultry and eggs
F05_6

Milk/yogurt/other dairy product
F05_7

Sugar or sugar products
F05_8

Oils/fats/butter
F06

What was the main source(s) of the food?

F06_1

Maize, maize porridge. Other cereal (rice, sorghum, millet, wheat etc) Roots and Tubers (cassava, potatoes, sweet potatoes)
F06_2

Beans and peas. Groundnuts and cashew nuts
F06_3

Vegetables (including relish and leaves)
F06_4

Fruits
F06_5

Beef, goat, or other red meat and pork, Fish, Poultry and eggs
F06_6

Milk/yogurt/other dairy product
F06_7

Sugar or sugar products
F06_8

Oils/fats/butter
F07

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?

F07_1

Skip entire days without eating?
F07_2

Limit portion size at mealtimes?
F07_3

Reduce number of meals eaten per day?
F07_4

Borrow food or rely on help from friends or relatives?
F07_5

Rely on less expensive or less preferred foods?
F07_6

Purchase/borrow food on credit?
F07_7

Gather unusual types or amounts of wild food / hunt?
F07_8

Send household members to eat elsewhere?
F07_9

Send household members to beg?
F07_10

You or other female members eat less?
F07_11

Have you sold any household assets to buy food?
F08

Usually, does your household has food available for the whole year?
F09

If no, in a year how many months / days, household lack availability of food?
MATERNAL LITERACYAND CHILD CARE
G01

Do you know how to read and write?
G02

Can you please read the following sentence?
G03

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

G04

How much do you contribute to the total household expenses?
G05

For this work, how many days a week do you work outside the home?
G06

For this work, when you work outside the home, how many hours do you stay away from home each day?
G07

When you work outside, do you take your youngest child (NAME) with you or do you have someone to take care of him/her?
G08

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?

G09

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?

G10

For how long each time do you usually leave the child with someone else (baby sitter) at home?
G11

When you leave your youngest child with someone, with whom do you leave him/her with, most often?
G12

Do you breastfeed your youngest child?
G13

Did you breastfeed this youngest child in the previous 24 hours?
G14

What else, if anything, was given to this youngest child to eat or drink in the previous 24 hours?
WOMEN’S TIME USE
H01

In the previous 24 hours, how many hours did you _____________________?

H01_1

Engage in agricultural labor including any paid or unpaid agricultural related tasks at home or working for others?
H01_2

Engage in non-agricultural labor including self-employment or working for others?
H01_3

Spend caring for children or the elderly?
H01_4

Spend on domestic work including cooking, cleaning, shopping, fetching water, etc.?
H01_5

Spend on leisure, social, and religious activities?
H01_6

Spend resting or sleeping?
H02

Was the amount of sleep you got last night less than average, average, or more than average?
H03

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

H04

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 DECISION-MAKING, AUTONOMY IN PRODUCTIVE DECISIONS&INCOME CONTROL
I01

Did you (singular) participate in _____ in the past 12 months?

I01_1

Food crop farming: crops that are grown primarily for household food consumption
I01_2

Cash crop farming: crops that are grown primarily for sale in the market
I01_3

Livestock raising
I01_4

Poultry (e.g. chicken, duck, pigeon)
I01_5

Fishing or fishpond culture
I01_6

Non-farm economic activities: small business, self-employment, buy-and-sell
I01_7

Wage and salary employment: in-kind or monetary work(both agriculture and non-ag work)
I02

How much input did you have in making decisions about _____?

I02_1

Food crop farming: crops that are grown primarily for household food consumption
I02_2

Cash crop farming: crops that are grown primarily for sale in the market
I02_3

Livestock raising
I02_4

Poultry (e.g. chicken, duck, pigeon)
I02_5

Fishing or fishpond culture
I02_6

Non-farm economic activities: small business, self-employment, buy-and-sell
I02_7

Wage and salary employment: in-kind or monetary work(both agriculture and non-ag work)
I03

How much input did you have in decisions on the use of income generated from _____?

I03_1

Food crop farming: crops that are grown primarily for household food consumption
I03_2

Cash crop farming: crops that are grown primarily for sale in the market
I03_3

Livestock raising
I03_4

Poultry (e.g. chicken, duck, pigeon)
I03_5

Fishing or fishpond culture
I03_6

Non-farm economic activities: small business, self-employment, buy-and-sell
I03_7

Wage and salary employment: in-kind or monetary work(both agriculture and non-ag work)
I04

Who normally takes the decision regarding _____?

I04_1

Girl Children are send to school
I04_2

Male children are send to school
I04_3

Marriage of the girl children
I04_4

Marriage of the male children
I04_5

Expenditure on women’s health
I04_6

Expenditure on health of male household members
I04_7

Decision to take loan for household consumption & production needs

I04_8

Who has control over expenditure of the loan amount?

I04_9

Who is responsible for repayment of the loan?
I04_10

Adoption of HYV
I04_11

Use of fertilizer
I04_12

Use of Plant protection Measures

I04_13

Purchase of farm machinery
I04_14

Purchase and sale of animals
I04_15

Changing of crops
I04_16

Decision to take loans of bigger amounts
I04_17

Marketing of produce

I04_18

Investment of added profit

I04_19

Purchase of articles for household common use

I04_20

Whether to use any of the contraceptive methods

I04_21

Number of children you should have
I05

Now I am going to rad out some statements. Please think about the activity and answer the following questions keeping them in mind. Please tell me if they are true or not. Please remember that there are no right or wrong answers.

I05_1

My actions in agricultural production are partly because I will get in trouble with someone if I act differently.
I05_2

Regarding agricultural production I do what I do so others don’t think poorly of me.
I05_3

Regarding agricultural production I do what I do because I personally think it is the right thing to do.
I05_4

My actions in which inputs to buy are partly because I will get in trouble with someone if I act differently.
I05_5

Regarding which inputs to buy I do what I do so others don’t think poorly of me.
I05_6

Regarding which inputs to buy I do what I do because I personally think it is the right thing to do.
I05_7

My actions in which type of crops to grow are partly because I will get in trouble with someone if I act differently.
I05_8

Regarding which types of crops to grow I do what I do so others don’t think poorly of me.
I05_9

Regarding which types of crops to grow I do what I do because I personally think it is the right thing to do.
I05_10

My actions in when to take or who should take the crop to market are partly because I will get in trouble with someone if I act differently.
I05_11

Regarding when to take or who should take the crop to marketI do what I do so others don’t think poorly of me.
I05_12

Regarding when to take or who should take the crop to marketI do what I do because I personally think it is the right thing to do.
I05_13

My actions in livestock productionare partly because I will get in trouble with someone if I act differently.
I05_14

Regarding livestock production I do what I do so others don’t think poorly of me.
I05_15

Regarding livestock productionI do what I do because I personally think it is the right thing to do.
WOMEN’S ACCESS TO CAPITAL AND CREDIT
J01

Does anyone in your household currently have any _____?

J01_1

Agricultural land
J01_2

Other land not used for agriculture
J01_3

Large livestock (e.g. oxen, cattle, buffalo, horse)
J01_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
J01_5

Fish pond or fishing equipment
J01_6

Farm equipment (non-mechanized)
J01_7

Farm equipment (mechanized e.g. tractor)
J01_8

Ornaments and jewellery
J02

Who would you say owns most of the _____?

J02_1

Agricultural land
J02_2

Other land not used for agriculture
J02_3

Large livestock (e.g. oxen, cattle, buffalo, horse)
J02_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
J02_5

Fish pond or fishing equipment
J02_6

Farm equipment (non-mechanized)
J02_7

Farm equipment (mechanized e.g. tractor)
J02_8

Ornaments and jewellery
J03

Do you own any of the ____?

J03_1

Agricultural land
J03_2

Other land not used for agriculture
J03_3

Large livestock (e.g. oxen, cattle, buffalo, horse)
J03_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
J03_5

Fish pond or fishing equipment
J03_6

Farm equipment (non-mechanized)
J03_7

Farm equipment (mechanized e.g. tractor)
J03_8

Ornaments and jewellery
J04

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

J04_1

Agricultural land
J04_2

Other land not used for agriculture
J04_3

Large livestock (e.g. oxen, cattle, buffalo, horse)
J04_4

Small livestock (goats, pigs, sheep, chickens, ducks, pigeons)
J04_5

Fish pond or fishing equipment
J04_6

Farm equipment (non-mechanized)
J04_7

Farm equipment (mechanized e.g. tractor)
J04_8

Ornaments and jewellery
J05

Has anyone in your household taken any loans or borrowed cash/in-kind from _____ in the past 12 months?

J05_1

Non-governmental organization (NGO)
J05_2

Informal lender
J05_3

Formal lender (direct credit from bank/financial institution)
J05_4

Friends or relatives
J05_5

Savings and Credit cooperatives/groups
J05_6

Women's groups
J06

Who made the decision to borrow from _____?

J06_1

Non-governmental organization (NGO)
J06_2

Informal lender
J06_3

Formal lender (direct credit from bank/financial institution)
J06_4

Friends or relatives
J06_5

Savings and Credit cooperatives/groups
J06_6

Women's groups
J07

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

J07_1

Non-governmental organization (NGO)
J07_2

Informal lender
J07_3

Formal lender (direct credit from bank/financial institution)
J07_4

Friends or relatives
J07_5

Savings and Credit cooperatives/groups
J07_6

Women's groups
J08

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

J08_1

Non-governmental organization (NGO)
J08_2

Informal lender
J08_3

Formal lender (direct credit from bank/financial institution)
J08_4

Friends or relatives
J08_5

Savings and Credit cooperatives/groups
J08_6

Women's groups
WOMEN’S GROUP MEMBERSHIP AND LEADERSHIP
K01

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?
K02

Do you feel comfortable speaking up in public to ensure proper payment of wages for public works or other similar programs?
K03

Do you feel comfortable speaking up in public to protest the misbehavior of authorities or elected officials?
K04

Is there a ____ in your community?

K04_1

Agricultural/livestock/fisheries producer group (including marketing groups)
K04_2

Water users’ group
K04_3

Land/forest users’ groups
K04_4

Credit or microfinance group
K04_5

Mutual help or insurance group (including burial societies) (not-self-help group)
K04_6

Trade and business association
K04_7

Civic group (improving community) or charitable group (helping others)
K04_8

Religious group
K04_9

Mother’s group
K04_10

Other women’s group (only if it does not fit into one of the other categories)
K05

Are you a member/active member of any ______?

K05_1

Agricultural/livestock/fisheries producer group (including marketing groups)
K05_2

Water users’ group
K05_3

Land/forest users’ groups
K05_4

Credit or microfinance group
K05_5

Mutual help or insurance group (including burial societies) (not-self-help group)
K05_6

Trade and business association
K05_7

Civic group (improving community) or charitable group (helping others)
K05_8

Religious group
K05_9

Mother’s group
K05_10

Other women’s group (only if it does not fit into one of the other categories)
K06

Why are you not a member of ________?

K06_1

Agricultural/livestock/fisheries producer group (including marketing groups)
K06_2

Water users’ group
K06_3

Land/forest users’ groups
K06_4

Credit or microfinance group
K06_5

Mutual help or insurance group (including burial societies) (not-self-help group)
K06_6

Trade and business association
K06_7

Civic group (improving community) or charitable group (helping others)
K06_8

Religious group
K06_9

Mother’s group
K06_10

Other women’s group (only if it does not fit into one of the other categories)
SELF HELP GROUPS
L01

Do you currently belong to a self-help group?
L02

For how long have you belonged to the self-help group to which you belong?
L03

Are you an active member of this group, meaning that you participate in meetings, for example?
L04

Which organization started or supports this self-help group?
L05

Does you self-help group have savings

L06

Do you personally participate in these savings and credit activities?
L07

Do you take leadership roles in this self-help group?
L08

Are you currently a portfolio-holder?
L09

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

L09_1

Livelihoods/socio-economic problems in the community
L09_2

Agriculture problems
L09_3

Education problems
L09_4

Health and nutrition problems
L09_5

Gender dynamics
L10

Have you ever been a member of a self-help group?
L11

Were you previously a portfolio holder?
L12

Why do you not belong to a self-help group?
WOMAN’S STATUS
M01

Do you currently live with your partner or husband?
M02

At what age did you get married?
M03

At what age did you first get pregnant?
M04

How many times have you been pregnant?
M05

At what age did you first give birth?
M06

How many times have you given birth?
M07

Please tell me if you agree or not with each of the following declarations.There are people who say

M07_1

In a household, the man should take the important decisions.
M07_2

If the woman works outside home, her husband or partner should help her with the daily housework.
M07_3

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

M07_4

A woman has the right to express her opinion if she does not agree with what the husband or partner says.
M07_5

A woman must accept that her husband or partner beats her in order to keep the family together.
M07_6

It is better to send a son to school than a daughter.
M08

Do you have your own money that you can use for what you want to use it?
M09

How often do you see or talk to somebody from your own family other than the one who live in the same house?
M10

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

M10_1

To the market?
M10_2

To a friend or family member’s house less than one hour away?
M10_3

To the temple, church or mosque?
M10_4

To a public village meeting?
M10_5

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

M10_6

Outside your village?

M10_7

To see a health care provider?
ACCESS TO AND KNOWLEDGE OF GOVERNMENT SCHEMES
N01

Have you ever heard about_______?

N01_1

Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
N01_2

Indira AwasYojna
N01_3

AntyodyaYojna
N01_4

Swajaldhara
N01_5

TSC / Nirmal Bharat Abhiyan
N01_6

ICDS / Anganwadi
N01_7

JananiSurakshaYojana (JSY)
N01_8

JananiShishuSurakshKarykaram (JSSK)
N02

Is anyone in your household eligible for this scheme?

N02_1

Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
N02_2

Indira AwasYojna
N02_3

AntyodyaYojna
N02_4

Swajaldhara
N02_5

TSC / Nirmal Bharat Abhiyan
N02_6

ICDS / Anganwadi
N02_7

JananiSurakshaYojana (JSY)
N02_8

JananiShishuSurakshKarykaram (JSSK)
N03

Has anyone in your household ever used this scheme?

N03_1

Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
N03_2

Indira AwasYojna
N03_3

AntyodyaYojna
N03_4

Swajaldhara
N03_5

TSC / Nirmal Bharat Abhiyan
N03_6

ICDS / Anganwadi
N03_7

JananiSurakshaYojana (JSY)
N03_8

JananiShishuSurakshKarykaram (JSSK)
N04

When was the last time someone in your household used this scheme?

N04_1

Mahatma Ghandi National Rural Employment Guarantee (MGNAREG) Act
N04_2

Indira AwasYojna
N04_3

AntyodyaYojna
N04_4

Swajaldhara
N04_5

TSC / Nirmal Bharat Abhiyan
N04_6

ICDS / Anganwadi
N04_7

JananiSurakshaYojana (JSY)
N04_8

JananiShishuSurakshKarykaram (JSSK)
N05

Does anyone in your household have a MGNREGA job card? If yes, please show me.
N06

In the past year, how many days did members of your household work for MGNAREG?

N07

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?
N08

Do you feel that MNREGA gives you employment security?
N09

Do you have a ration card?
N10

Which card do you have?
N11

In the past 30 days, did you buy anything from a fair price shop?
N12

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

N12_1

Rice
N12_2

Wheat
N12_3

Sugar
N12_4

Kerosene
N12_5

Other staple cereals
N12A

Quantity

N12A_1

Rice
N12A_2

Wheat
N12A_3

Sugar
N12A_4

Kerosene
N12A_5

Other staple cereals
N13

Do you feel that fair price shops help your household be food secure?
N14

Did you or any member of your household ever receive any food from Anganwadicentre?
N15

Who received food from an Anganwadicentre
N16

How much money are you supposed to get under the JSY scheme?

POLITICAL PARTICIPATION
O01

Have you ever raised voice for any concern or issue in the community?

O02

Do you have voter identification card?
O03

Did you vote in the last election?
O04

Why did you vote?
O05

In your house who decides to vote?
O06

Why did not you vote?
O07

Have you ever participated in gram sabha meeting?

O08

Did you attend last gram sabha meeting?
O09

What was the reason to attend Gram sabha meeting?
O10

What was the reason for not attending gram sabha meeting?
O11

Have you ever raised any concern or given your opinion in any gram sabha meeting?
O12

Has ever your a concern or suggestion resulted in resolution being adopted at gram sabha?
O13

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

WATER, SANITATION, AND HYGIENE AND HH OBSERVATIONS
P01

For each of the following seasons, what is the main source of drinking water for members of your household?
P02

Do you treat your water in any way to make it safer to drink?
P03

What do you usually do to the water to make it safer to drink?
P04

How long does it take to go to the water source, get water, and come back during the rainy season?
P05

How long does it take to go to the water source, get water, and come back during the dry season?

P06

Who usually goes to this source to fetch the water for your household?
P07

For each season, what is the main source of water used by your household for cooking, bathing, and washing utensils?
P08

What kind of toilet facility do members of your household usually use? Please specify for men, women, and children under 5 years of age.
P09

Do you share this facility with another household?
P10

The last time the youngest child of the household passed stools, what was done to dispose the stool?
P11

According to you, when should a mother or caretaker of a young child should wash her hands?
P12

What materials do you use when you wash your hands?
P13

Did it rain the day of the observation or the day before?
P14

When Was observation done?
P15

What is the mother’s general appearance (observe cleanliness of her hands, hair, clothes, face)?
P16

Is the child naked at the time of the visit?
P17

What is the child’s general appearance (observe cleanliness of hands, nails, body and face)
P18

Was the child walking, crawling or was carried by the mother or another person during the observation?
P19

Can we observe human feces around the house or in the compound?
P20

Can we observe animal feces (chicken, dogs, cats, etc.) around the house or in the compound?
P21

Is the drinking water container covered?

P22

What is the main material of the floor?
P23

What is the main material of the exterior wall?
P24

What is the main material of the roof?