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Household Template 23 -Form Fill

HOUSEHOLD IDENTIFICATION
Q01

Village

Q02

District

Q03

Block

Q04

State

Q05

Project/Comparison area

Q06

Gram Panchayat name

Q07

Household No.

Q08

Unique Reference ID

Q09

Landmark

Q10

Mobile no.

Q11

Name of the household head

Q12

Name of the Respondent

Q13

Gender of the Respondent

Q14

Does your household belong to APL or BPL category? (check ration card if available)

Q15

Religion

Q16

Social classification (caste)

Q17

Investigator Name

Q18

Date

Q19

Interview Start Time

Q20

Interview End Time

Q21

Interview Result

HOUSEHOLD INFORMATION AND OCCUPATION PROFILE
A01

Please tell me the names of all the people who live and take meals in this house.

A02

Sex

A03

What is the relationship of this person with the head?

A04

What is the age of this person (in completed years)?

A05

How many years of education has this per son completed?

A06

Primary Activity Status of the person

A07

Was the person involved in this activity prior to May 2020?

A08

Household income between May 2019 and May 2020

LIVESTOCK OWNERSHIP, PRODUCTION, MAINTENANCE AND SALE
B01

Did you or anyone else from your household receive any training/information on livestock management before May 2020? (like goat, sheep, poultry, etc.)

B01A

For what all livestock have you received training/ information ? (MULTIPLE RESP0NSE)

B02

Do you recall receiving training/information on the following livestock management practices before may 2020?

B02_1

Feeding quantity and periodicity

B02_2

Construction of goat/poultry shed/cattle shed, or any other structure for keeping the livestock

B02_3

Hygiene and sanitation of shed for better livestock management

B02_4

Identification of major diseases in livestock

B02_5

Vaccination for protecting against diseases

B02_6

Selection of quality breed suitable for local condition

B02_7

Deworming

B02_8

Castration

B02_9

Artificial Insemination

B02_10

Clean milk production

B03

Did you adopt this practice?

B03_1

Feeding quantity and periodicity

B03_2

Construction of goat/poultry shed/cattle shed, or any other structure for keeping the livestock

B03_3

Hygiene and sanitation of shed for better livestock management

B03_4

Identification of major diseases in livestock

B03_5

Vaccination for protecting against diseases

B03_6

Selection of quality breed suitable for local condition

B03_7

Deworming

B03_8

Castration

B03_9

Artificial Insemination

B03_10

Clean milk production

B04

Why did you not adopt this practice?

B04_1

Feeding quantity and periodicity

B04_2

Construction of goat/poultry shed/cattle shed, or any other structure for keeping the livestock

B04_3

Hygiene and sanitation of shed for better livestock management

B04_4

Identification of major diseases in livestock

B04_5

Vaccination for protecting against diseases

B04_6

Selection of quality breed suitable for local condition

B04_7

Deworming

B04_8

Castration

B04_9

Artificial Insemination

B04_10

Clean milk production

B05

Who provided you these trainings/information?

B06

Has adoption of these practices benefitted you?

B07

In what ways have you benefitted?

B08

Has adoption of these practices led to increase in income from sale of livestock and livestock products?

B09

Did you own [livestock name] in May 2020?

B09_1

Cow

B09_2

Bullock

B09_3

Buffalo

B09_4

Chicken

B09_5

Duck

B09_6

Goat

B09_7

Sheep

B10

How many [livestock] did you own in May 2020?

B10_1

Cow

B10_2

Bullock

B10_3

Buffalo

B10_4

Chicken

B10_5

Duck

B10_6

Goat

B10_7

Sheep

B11

How many [livestock] did you buy between May 2019 - May 2020?

B11_1

Cow

B11_2

Bullock

B11_3

Buffalo

B11_4

Chicken

B11_5

Duck

B11_6

Goat

B11_7

Sheep

B12

How much money did you spend to buy [livestock]? (Rs.)

B12_1

Cow

B12_2

Bullock

B12_3

Buffalo

B12_4

Chicken

B12_5

Duck

B12_6

Goat

B12_7

Sheep

B13

How many [livestock] did you sell between May 2019 - May 2020?

B13_1

Cow

B13_2

Bullock

B13_3

Buffalo

B13_4

Chicken

B13_5

Duck

B13_6

Goat

B13_7

Sheep

B14

How much money did you get by selling [livestock]? (Rs.)

B14_1

Cow

B14_2

Bullock

B14_3

Buffalo

B14_4

Chicken

B14_5

Duck

B14_6

Goat

B14_7

Sheep

B15

Have you produced [livestock product name] in the last 30 days?

B15_1

Goat Milk (Litres)

B15_2

Goat Milk products (e.g. khoya.) (in kg)

B15_3

Other cattle milk (in Liter)

B15_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B15_5

Meat (in Kg)

B15_6

Egg (number)

B15_7

Wool (Kg)

B15_8

Farmyard manure (FYM) (Kg)

B15_9

Dung cake (Kg)

B16

How much quantity of [livestock product] did you produce in the last 30 days?

B16_1

Goat Milk (Litres)

B16_2

Goat Milk products (e.g. khoya.) (in kg)

B16_3

Other cattle milk (in Liter)

B16_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B16_5

Meat (in Kg)

B16_6

Egg (number)

B16_7

Wool (Kg)

B16_8

Farmyard manure (FYM) (Kg)

B16_9

Dung cake (Kg)

B17

Did you sell any [livestock product] in the last 30 days?

B17_1

Goat Milk (Litres)

B17_2

Goat Milk products (e.g. khoya.) (in kg)

B17_3

Other cattle milk (in Liter)

B17_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B17_5

Meat (in Kg)

B17_6

Egg (number)

B17_7

Wool (Kg)

B17_8

Farmyard manure (FYM) (Kg)

B17_9

Dung cake (Kg)

B18

How much quantity of the [livestock product] did you sell in the last 30 days?

B18_1

Goat Milk (Litres)

B18_2

Goat Milk products (e.g. khoya.) (in kg)

B18_3

Other cattle milk (in Liter)

B18_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B18_5

Meat (in Kg)

B18_6

Egg (number)

B18_7

Wool (Kg)

B18_8

Farmyard manure (FYM) (Kg)

B18_9

Dung cake (Kg)

B19

Market price at which [livestock product] was sold?

B19_1

Goat Milk (Litres)

B19_2

Goat Milk products (e.g. khoya.) (in kg)

B19_3

Other cattle milk (in Liter)

B19_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B19_5

Meat (in Kg)

B19_6

Egg (number)

B19_7

Wool (Kg)

B19_8

Farmyard manure (FYM) (Kg)

B19_9

Dung cake (Kg)

B20

Total income from sale of [livestock product] in the last 30 days??

B20_1

Goat Milk (Litres)

B20_2

Goat Milk products (e.g. khoya.) (in kg)

B20_3

Other cattle milk (in Liter)

B20_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B20_5

Meat (in Kg)

B20_6

Egg (number)

B20_7

Wool (Kg)

B20_8

Farmyard manure (FYM) (Kg)

B20_9

Dung cake (Kg)

B21

Have you produced [livestock product name] between May 2019-May 2020?

B21_1

Goat Milk (Litres)

B21_2

Goat Milk products (e.g. khoya.) (in kg)

B21_3

Other cattle milk (in Liter)

B21_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B21_5

Meat (in Kg)

B21_6

Egg (number)

B21_7

Wool (Kg)

B21_8

Farmyard manure (FYM) (Kg)

B21_9

Dung cake (Kg)

B22

How much quantity of [livestock product] did you produce between May 2019 - May 2020?

B22_1

Goat Milk (Litres)

B22_2

Goat Milk products (e.g. khoya.) (in kg)

B22_3

Other cattle milk (in Liter)

B22_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B22_5

Meat (in Kg)

B22_6

Egg (number)

B22_7

Wool (Kg)

B22_8

Farmyard manure (FYM) (Kg)

B22_9

Dung cake (Kg)

B23

Did you sell any [livestock product] between May 2019 - May 2020?

B23_1

Goat Milk (Litres)

B23_2

Goat Milk products (e.g. khoya.) (in kg)

B23_3

Other cattle milk (in Liter)

B23_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B23_5

Meat (in Kg)

B23_6

Egg (number)

B23_7

Wool (Kg)

B23_8

Farmyard manure (FYM) (Kg)

B23_9

Dung cake (Kg)

B24

How much quantity of the [livestock product] did you sell between May 2019 and May 2020?

B24_1

Goat Milk (Litres)

B24_2

Goat Milk products (e.g. khoya.) (in kg)

B24_3

Other cattle milk (in Liter)

B24_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B24_5

Meat (in Kg)

B24_6

Egg (number)

B24_7

Wool (Kg)

B24_8

Farmyard manure (FYM) (Kg)

B24_9

Dung cake (Kg)

B25

Market price at which the [livestock product] was sold?

B25_1

Goat Milk (Litres)

B25_2

Goat Milk products (e.g. khoya.) (in kg)

B25_3

Other cattle milk (in Liter)

B25_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B25_5

Meat (in Kg)

B25_6

Egg (number)

B25_7

Wool (Kg)

B25_8

Farmyard manure (FYM) (Kg)

B25_9

Dung cake (Kg)

B26

Total income from sale of [livestock product]

B26_1

Goat Milk (Litres)

B26_2

Goat Milk products (e.g. khoya.) (in kg)

B26_3

Other cattle milk (in Liter)

B26_4

Other cattle milk products (Including ghee, curd, buttermilk etc.) (in Liter)

B26_5

Meat (in Kg)

B26_6

Egg (number)

B26_7

Wool (Kg)

B26_8

Farmyard manure (FYM) (Kg)

B26_9

Dung cake (Kg)

B27

Where do you sell these livestock products?

B28

Where did you sell these livestock products before May 2020?

B29

Did you own [livestock name] in the last 30 days?

B29_1

Cow

B29_2

Bullock

B29_3

Buffalo

B29_4

Chicken

B29_5

Duck

B29_6

Goat

B29_7

Sheep

B30

How much did you spend on feed and fodder in the last 30 days?

B30_1

Cow

B30_2

Bullock

B30_3

Buffalo

B30_4

Chicken

B30_5

Duck

B30_6

Goat

B30_7

Sheep

B31

How much was the cost of Veterinary services in the last 30 days?

B31_1

Cow

B31_2

Bullock

B31_3

Buffalo

B31_4

Chicken

B31_5

Duck

B31_6

Goat

B31_7

Sheep

B32

How much was the cost of Hired labor (if any) in the last 30 days?

B32_1

Cow

B32_2

Bullock

B32_3

Buffalo

B32_4

Chicken

B32_5

Duck

B32_6

Goat

B32_7

Sheep

B33

Other costs in the last 30 days? (transportation, ropes, chains etc.)

B33_1

Cow

B33_2

Bullock

B33_3

Buffalo

B33_4

Chicken

B33_5

Duck

B33_6

Goat

B33_7

Sheep

B34

Total expense

B34_1

Cow

B34_2

Bullock

B34_3

Buffalo

B34_4

Chicken

B34_5

Duck

B34_6

Goat

B34_7

Sheep

B35

Livestock

B35_1

Cow

B35_2

Bullock

B35_3

Buffalo

B35_4

Chicken

B35_5

Duck

B35_6

Goat

B35_7

Sheep

B36

How much did you spend on feed and fodder between May 2019 - May 2020?

B36_1

Cow

B36_2

Bullock

B36_3

Buffalo

B36_4

Chicken

B36_5

Duck

B36_6

Goat

B36_7

Sheep

B37

How much was the cost of Veterinary services May 2019 - May 2020?

B37_1

Cow

B37_2

Bullock

B37_3

Buffalo

B37_4

Chicken

B37_5

Duck

B37_6

Goat

B37_7

Sheep

B38

How much was the cost of Hired labor (if any) between May 2019 - May 2020?

B38_1

Cow

B38_2

Bullock

B38_3

Buffalo

B38_4

Chicken

B38_5

Duck

B38_6

Goat

B38_7

Sheep

B39

Other costs (transportation, ropes, chains etc.)

B39_1

Cow

B39_2

Bullock

B39_3

Buffalo

B39_4

Chicken

B39_5

Duck

B39_6

Goat

B39_7

Sheep

B40

Total expense

B40_1

Cow

B40_2

Bullock

B40_3

Buffalo

B40_4

Chicken

B40_5

Duck

B40_6

Goat

B40_7

Sheep

B41

From where do you get the veterinary services for your livestock?

B42

From where did you get the veterinary services before May 2020?

B43

From where do you buy the feed and fodder?

B44

From where did you buy the feed and fodder before May 2020?

INVESTMENT FOR UPSCALING LIVELIHOOD ACTIVITIES
C01

Had you or your household member taken any loan before May 2020?

C01A

When was the loan taken?

C02

What was the amount borrowed?

C03

Credit agency from which the loan was taken?

C04

Rate of interest at which the loan was given?

C05

Purpose of loan?

C06

Type of security

C07

Have you repaid the loan?

C08

Because of some reasons have you not been able to pay installments for this loan on time?

C09A

Why did you face difficulty in repaying the loan?

C09B

What is your most preferred source for availing credit currently?

C10

Did your HH make any investment in livestock between May 2019 and May 2020?

C11

What was the source of this investment?

ASSET OWNERSHIP AND STANDARD OF LIVING
D01

Is this house owned by you, a rented accommodation or has been given to you by the government?

D01A

Current

D01B

Before May 2020

D02

Do own any land?

D02A

Current

D02B

Before May 2020

D03

Do you or any one in your household have a personal Bank Account?

D03A

Current

D03B

Before May 2020

D04

Look at the floor and code the main material of the floor.

D04A

Current

D04B

Before May 2020

D05

Look at the roof and code the main material of the roof.

D05A

Current

D05B

Before May 2020

D06

Look at the exterior walls and code the main material of the walls.

D06A

Current

D06B

Before May 2020

D07

How many rooms are there in this house?

D07A

Current

D07B

Before May 2020

D08

Do you have a separate room for cooking?

D08A

Current

D08B

Before May 2020

D09

Do you have a window in your house?

D09A

Current

D09B

Before May 2020

D10

What type of window(s)?

D10A

Current

D10B

Before May 2020

D11

What type of toilet facility do you have?

D11A

Current

D11B

Before May 2020

D12

What is the main source of lighting?

D12A

Current

D12B

Before May 2020

D13

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

D13A

Current

D13B

Before May 2020

D14

Does your household own any of the following items?

D14_1

Electricity

D14_2

Mattress

D14_3

Pressure cooker

D14_4

Chair

D14_5

Cot/ Bed

D14_6

Table

D14_7

Electric fan

D14_8

Radio/Transistor

D14_9

Sewing machine

D14_10

Clock or watch

D14_11

Bicycle

D14_12

Almirah

D14_13

Black & White television

D14_14

Colour television

D14_15

Mobile Phone

D14_16

Landline Phone

D14_17

Refrigerator

D14_18

Air conditioner / Cooler

D14_19

Washing Machine

D14_20

Internet

D14_21

Computer

D14_22

Motorcycle/scooter

D14_23

Car/Jeep

D14_24

Water pump

D14_25

Thresher

D14_26

Tractor

D14_27

Animal drawn cart

D14_28

Tiller/ Cultivator

D14_29

Power sprayer

D15

What is the main source of drinking water for members of your household?

D15A

Current

D15B

Before May 2020

WOMEN EMPOWERMENT SECTION
E01

Who had the most say in decision-making regarding the following issues before May 2020?

F01_1

What food items to purchase?

F01_2

How many children to have?

F01_3

What to do if you fall sick?

F01_4

How much money to spend on a social function such as marriage?

F01_5

What to do if a child falls sick?

F01_6

Whom your children should marry?

F01_7

Children’s education: whether all children should be sent to school?

F01_8

Nutrition of children: How many meals to have, when to eat and what to eat?

F02

How much input did you have before May 2020 in making decisions about [ACTIVITY]?

F02_1

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

F02_2

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

F02_3

Livestock raising

F02_4

Non-farm economic activities: This would include things like running a small business, self-employment, buy-and-sell

F02_5

Wage and salary employment: This could be work that is paid for in cash or in-kind, including both agriculture and other wage work

F02_6

Major household expenditures (such as buying movable and immovable assets, like jewelry, land, house, etc.)

F02_7

Minor household expenditures (such as food for daily consumption, consumer durables or other household needs)

F02_8

Borrowing from SHGs

F02_9

Borrowing from MFIs/Banks

F02_10

Borrowing from informal credit sources

F02_11

Use of savings in the family

F02_12

Use of income earned by you/husband in family