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Women Template -Form Fill

Demographics and HH size
Q01

How old are you?

Q02

What is your marital status?

Q03

How many years of formal education do you have?

Q04

Can you read Hindi comfortably?

Q05

Can your husband read and write Hindi?

Q06

How many years of education does your husband have?

Q07

What is your religion?

Q08

Do you belong to a scheduled caste, a scheduled tribe, other backward caste, economically backward class or none of these?

Q09

Besides yourself, how many people live here?

Q10

Line number

Q11

Name of the Person

Q12

Gender

Q13

Age

Q14

Relationship with HH head

Q15

Marital Status

Q16

Any physical disability

General Income Sources of the HH
A01

In the past 12 months (January 2022-Dec 2022), who among the following contributed to household income?

A02

In the past 12 months (January 2022-Dec 2022), How many months was your husband employed/earning wages/Other income, it can be either partially for the year or for the full year?

A03

What work did your husband do?

A04

What was your husband’s approximate monthly income (monies coming from any and all sources) during the last year (January 2022 to Dec 2022)?

A05

In the past 12 months (January 2022-Dec 2022), How many months were you employed/earning wages/Other income, it can be either partially for the year or for the full year?

A06

What work did you do?

A07

What was your approximate monthly income (monies coming from any and all sources) during the last year (January 2022 to Dec 2022)?

A08

In the past 12 months (January 2022-Dec 2022), How many months were other household member employed/earning wages/Other income, it can be either partially for the year or for the full year?

A09

What work did they do?

A10

What was their approximate monthly income (monies coming from any and all sources) during the last year (January 2022 to Dec 2022)?

General awareness and Job card status
B01

Do you know or have heard about MGNREGA/ Job card scheme of the Government?

B01A

What have you heard?

B02

Do you have a MGNREGA job card?

B02A

Who keeps the job card?

B03

Last 4 digit of Job card ID

B04

Worked under MGNREGA during Jan 2022 to Dec 2022

B05

Total days of employment (During January 2022-Dec 2022)

B06

Total Money Received from MGNREGA

B07

Does anyone else in your family have a MGNREGA job card?

B08

Name

B09

Gender

B10

Age

B11

Worked under MGNREGA during Jan 2022 to Dec 2022

B12

Total Days of employment under MGNREGA during Jan 2022 to Dec 2022

B13

Did anyone help you in getting the Job Card?

Gram Rojgar Diwas
C01

Have you heard anything about Gram Rojgar Diwas in reference to MGNREGA employment?

C02

What is the objective of Gram Rojgar Diwas?

C03

Did any Gram Rozgar Diwas happen in your Panchayat in the past 6 months?

C03A

How many?

C04

Did you attend any Gram Rogjar Diwas in past 6 months, how many?

C05

Why did not attend Gram Rozgar Diwas?

C06

Did you get any benefit by attending the Gram Rozgar Diwas? What?

VPRP-GPDP Integration
D01

Are you aware of individual assets for vulnerable families that can be built under MGNREGA?

D02

What type of individual assets can be built under MGNREGA?

D03

Did you/any other household member apply and received/built any individual assets under MGNREGA in the past year?

D04

What type of individual assets did you receive/Apply?

D05

Was the asset applied on your name?

D06

Did you ever use the asset to generate any income?

D07

Who was the custodian of income generated from the above asset?

D08

Are you aware of any Common Infrastructure assets for NRLM Compliant Self-Help Groups that can be built under MGNREGA?

D09

Did your SHG/VO apply and got approved/built for any Common Infrastructure assets under MGNREGA in the past year?

D10

What type of Common infrastructure assets did your SHG/VO receive?

D11

Did you ever use the common asset to generate any income?

D12

Who was the custodian of any personal income generated from the above common asset?

D13

Have you heard of a process called VPRP-GPDP, under which the demand for assets such as discussed above can be consolidated by the SHG/VO and take to the Gram panchayat for further action?

D14

Did your SHG/VO participate in any such process and submit a consolidated request to Gram Panchayat for inclusion in Gram panchayat development plan?

D15

Were any of your demands met by the Panchayat?

D16

Did anyone (CRP) collect information on demand for building income generating asset from you?

Mahila mate
E01

Are there any Mahila Mates in your village?

E02

How many mahila mates are in your village?

E03

Are you a mahila mate?

E04

Have you worked with a mahila mate supervisor in the past year (jan 2022-dec 2022)

E05

What would you prefer? working with a male mate supervisor or with a Mahila Mate supervisor?

E06

You mentioned a preference for female MGNREGA Supervisor, Why

Knowledge of MGNREGA provisions
F01

Did you receive all your MGNREGA wages for the work done during January 2022-Dec 2022?

F02

Did you receive MGNREGA work within 15 days of raising demand?

F03

Are you aware that you are eligible for unemployment benefits if you do not get work under MGNREGA?

F04

What is the daily wage rate under MGNREGA?

F05

How many days of employment are provided by MGNREGA?

Access and awareness to individual government scheme
G01

Have you ever heard about _?

G01_1

Pradhan Mantri Jan Dhan Yojana

G01_2

Pradhanmantri Surakha Beema Yojana (accidental death insurance)

G01_3

Pradhan Mantri Jeevan Jyoti Beema Yojana (Life Insurance)

G01_4

Old Age Pension

G01_5

Antyodaya Ann Yojana

G01_6

Satat Jeevikoparjan Yojana (SJY)

G01_7

PM Jan Arogya Bima Yojana

G01_8

Ujjwala Yojana

G01_9

Widow Pension

G01_10

Disability Pension

G02

Is your household / anyone in your household eligible for this scheme?

G02_1

Pradhan Mantri Jan Dhan Yojana

G02_2

Pradhanmantri Surakha Beema Yojana (accidental death insurance)

G02_3

Pradhan Mantri Jeevan Jyoti Beema Yojana (Life Insurance)

G02_4

Old Age Pension

G02_5

Antyodaya Ann Yojana

G02_6

Satat Jeevikoparjan Yojana (SJY)

G02_7

PM Jan Arogya Bima Yojana

G02_8

Ujjwala Yojana

G02_9

Widow Pension

G02_10

Disability Pension

G03

Has anyone in your household ever availed this scheme?

G03_1

Pradhan Mantri Jan Dhan Yojana

G03_2

Pradhanmantri Surakha Beema Yojana (accidental death insurance)

G03_3

Pradhan Mantri Jeevan Jyoti Beema Yojana (Life Insurance)

G03_4

Old Age Pension

G03_5

Antyodaya Ann Yojana

G03_6

Satat Jeevikoparjan Yojana (SJY)

G03_7

PM Jan Arogya Bima Yojana

G03_8

Ujjwala Yojana

G03_9

Widow Pension

G03_10

Disability Pension

G04

Have you ever heard about _?

G04_1

National Family Support Scheme(MP) only to be asked if coded 2 in I.a.B in Module A

G04_2

Land Right :- (MP) only to be asked if coded 2 in I.a.B in Module A

G04_3

Ayushman Card Scheme :- (MP) only to be asked if coded 2 in I.a.B in Module A

G04_4

Absolute Pension Scheme :- (MP) only to be asked if coded 2 in I.a.B in Module A

G04_5

Tribal Scholarship:- (MP) only to be asked if coded 2 in I.a.B in Module A

G04_6

Chief Minister Fund

G04_7

Chief Minister Self Employment Scheme :- only to be asked if coded 2 in I.a.B in Module A

G04_8

Deendayal Upadhyay Rural Skills :- only to be asked if coded 2 in I.a.B in Module A

G04_9

Prime Crop Insurance Scheme :- only to be asked if coded 2 in I.a.B in Module A

G04_10

Farm Pond Scheme :- only to be asked if coded 2 in I.a.B in Module A

G04_11

Ration Card :- only to be asked if coded 2 in I.a.B in Module A

G04_12

Livelihood Mission :- only to be asked if coded 2 in I.a.B in Module A

G05

Is your household / anyone in your household eligible for this scheme?

G05_1

National Family Support Scheme(MP) only to be asked if coded 2 in I.a.B in Module A

G05_2

Land Right :- (MP) only to be asked if coded 2 in I.a.B in Module A

G05_3

Ayushman Card Scheme :- (MP) only to be asked if coded 2 in I.a.B in Module A

G05_4

Absolute Pension Scheme :- (MP) only to be asked if coded 2 in I.a.B in Module A

G05_5

Tribal Scholarship:- (MP) only to be asked if coded 2 in I.a.B in Module A

G05_6

Chief Minister Fund

G05_7

Chief Minister Self Employment Scheme :- only to be asked if coded 2 in I.a.B in Module A

G05_8

Deendayal Upadhyay Rural Skills :- only to be asked if coded 2 in I.a.B in Module A

G05_9

Prime Crop Insurance Scheme :- only to be asked if coded 2 in I.a.B in Module A

G05_10

Farm Pond Scheme :- only to be asked if coded 2 in I.a.B in Module A

G05_11

Ration Card :- only to be asked if coded 2 in I.a.B in Module A

G05_12

Livelihood Mission :- only to be asked if coded 2 in I.a.B in Module A

G06

Has anyone in your household ever availed this scheme?

G06_1

National Family Support Scheme(MP) only to be asked if coded 2 in I.a.B in Module A

G06_2

Land Right :- (MP) only to be asked if coded 2 in I.a.B in Module A

G06_3

Ayushman Card Scheme :- (MP) only to be asked if coded 2 in I.a.B in Module A

G06_4

Absolute Pension Scheme :- (MP) only to be asked if coded 2 in I.a.B in Module A

G06_5

Tribal Scholarship:- (MP) only to be asked if coded 2 in I.a.B in Module A

G06_6

Chief Minister Fund

G06_7

Chief Minister Self Employment Scheme :- only to be asked if coded 2 in I.a.B in Module A

G06_8

Deendayal Upadhyay Rural Skills :- only to be asked if coded 2 in I.a.B in Module A

G06_9

Prime Crop Insurance Scheme :- only to be asked if coded 2 in I.a.B in Module A

G06_10

Farm Pond Scheme :- only to be asked if coded 2 in I.a.B in Module A

G06_11

Ration Card :- only to be asked if coded 2 in I.a.B in Module A

G06_12

Livelihood Mission :- only to be asked if coded 2 in I.a.B in Module A

Financial Inclusion and savings
H01

An account can be used to save money, to make or receive payments, or to receive wages or financial help. Do you, either by yourself or together with someone else, currently have an account at a bank or another financial institution?

H02

An ATM is a card from a bank card that allows you to withdraw money, and the money is withdrawn from that account immediately. Do you personally have an ATM debit card?

H03

Please tell me whether each of the following is A REASON why you, personally, DO NOT have an account at a bank or another type of formal financial institution. Is it:

H03_1

Because financial institutions are too far away

H03_2

Because financial services are too expensive

H03_3

Because you don’t have the necessary documentation (identity card, wage slip, etc.)

H03_4

Because you don’t trust financial institutions

H03_5

Because of religious reasons

H03_6

Because you don’t have enough money to use financial institutions

H03_7

Because someone else in the family already has an account

H03_8

Because you have no need for financial services at a formal institution

Savings
I01

In the PAST 12 MONTHS, have you, personally, saved or set aside any money to start, operate, or grow a business or farm?

I02

In the PAST 12 MONTHS, have you, personally, saved or set aside any money FOR OLD AGE?

I03

In the PAST 12 MONTHS, have you, personally, saved or set aside any money by _________?

I03_1

Using an account at a bank or another type of formal financial institution (This can include using another person’s account)

I03_2

Using an informal savings group such as SHG

I03_3

In the PAST 12 MONTHS, have you, personally, saved or set aside any money for any reason?

Loan, decision making and utilisation
J01

Have you ever taken a loan from either your SHG or VO?

J02

Have you ever taken a loan from a bank?

J03

Whose idea was it to take the loan?

J04

Who majorly determined the amount of the loan you requested?

J05

Who majorly decided how to spend the loan?

J06

For what purpose have you used the loan?

J07

What is the total amount of loan you have taken in the past 2 years January 2021 to Dec 2022

Income sources, asset ownership, SHG meetings
K01

Is your name or the name of another female of the HH on the ownership or rental papers for your home?

K02

Is your name on the ownership of any agricultural land?

K03

Is your name on the ownership of any non-agriculture land?

SHG meetings
L01

How often does/did your group meet for discussions or activities in a month?

L02

How often did you participate in group meetings in a month?

L03

Do/did you personally participate in the savings activities (periodic contribution of a fixed amount by all members)?

L04

How often do/did you deposit\save?

L05

How much do you contribute every time?

Economic agency
M01

Are you able to spend the money you earn how you want yourself, or do you have to give all or part of the money to your husband/partner/other family member?

M02

Who do you think should have control over the money that a woman earns?

M03

Do you have access to any cash available with you now for buying HH food or medicine if you suddenly needed something?

M03A

Who makes most decisions about whether to buy clothing items?

M03B

Who makes most decisions about consumer durable items

M03C

Who makes most decisions about what health expenditures

M03D

Who makes most decisions about expenses for home

Right to employment
N01

When jobs are scarce, men should have more right to a job than women.

N02

If a woman earns more money than her husband, it’s almost certain to cause problems

N03

Having a job is the best way for a woman to be an independent person.

Decision making on labour market choices of a women
O01

Pooja, a 21-year-old girl, belongs to a village in Bihar. Since childhood, she has had aspirations of becoming a police officer. After graduating she is selected for a job as a police officer. Her parents are worried about her job as they think that is not suitable for a woman. They also believe that it is her age to get married and they have found a prospective groom for her from a good family. Pooja, however, wants to take up the job and does not wish to get married. According to her parents, Pooja would not need to work after she gets married as her husband will take care of her. Pooja should instead focus on household work, help out her mother-in-law and eventually have children. Finally, her parents decide that instead of taking up the job, she should get married.

O01_1

What do you think, is it the right time for Pooja to get married

O01_2

Should Pooja work after marriage

O01_3

After Pooja is married, do you think it’s her husband’s responsibility to take care of her

O01_4

Do you think Marriage should be more important for Pooja than her job

O01_5

Pooja will not be a good police officer after marriage

O01_6

Do you think Pooja should follow her parents’ wishes and not take the police job

O01_7

Would being a teacher be a more suitable job for Pooja

Work Choices Decisions
P01

Who has the most say in decisions about your work?

P02

If you found a suitable job, would you be willing to work?

P03

If you found a suitable job, would you be allowed to work?

Independent mobility
R01

In the past 30 days, how many time have you visited the following

R01_1

Bank/Credit Cooperative

R01_2

Post office

R01_3

Local health centre

R01_4

Market/ Bazaar

R02

Are you allowed to go to any place using public transport such as bus or rickshaw or train?

R03

Are you permitted to visit women in other neighbourhoods to talk with them?

R04

Can you go unescorted to your parents’ house/village?

R05

Can you go unescorted to the next village?

R06

Are you allowed to go alone to a relative’s house inside the village?

Gender based violence
S01

If a women goes out without telling her husband, is the husband justified in beating her?

S02

Has this happened in your community in the last 12 months?

S03

And If she argues with him, is the husband justified in beating her?

S04

Has this happened in your community in the last 12 months?

S05

And If she refuses to have sex with him, is the husband justified in beating her?

S06

Has this happened in your community in the last 12 months?

Public participation/speaking and, assembly
T01

Have you participated at the Gram Sabha in the last few years?

T02

When you did not attend the Gram Sabha because. I was not interested in going... (please answer agree or disagree or don’t know)

T03

Do you think that women from your community usually participate in the Gram Sabha?

T04

Have you, in the last few years, spoken in public at the Gram Sabha or other similar village level forums regarding a problem or an issue that you or your community had?

T05

I have not spoken out in public in the last few years because I had nothing to say

T06

Do you think that, generally speaking, women from your community speak at the Gram Sabha?

Section H: Poverty Index (PPI)
U01

What is the general education level of the female head/spouse?

U02

Does your household have a Refrigerator

U03

Does your household have a Stove/Gas burner

U04

Does your household have a LPG gas cylinder

U05

Does your household have a Pressure Cooker

U06

Does your household have a Television

U07

Does your household have a Electric Fan

U08

Does your household have a Almirah/Dressing table

U09

Does your household have a Motorcycle/Scooter/Car/Jeep

U10

Does your household have a Color Television

U11

Does your household have a Basic mobile phone

U12

Does your household have a smartphone

U13

Does your household have access to Internet

U14

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

U15

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

U16

What kind of toilet facility do members of your household majorly use?

U17

Do you/your household have a BPL card?

Skilling, employment and migration
V01

Display name of all women (option 2 in A12) who are above 18 years of age (A13) and asked if they went through any training in the past 1 year

V02

Did you go through any tests or assessments before you were enrolled for a particular training?

V03

What kind of training you have gone through?

V04

Were you offered any choices on the type of training?

V05

Were you given any employment/job post-training?

V06

Are you currently employed by the same employer for which you have first employed post-training?

V07

How has this training supported you?

V08

Who provided the training?

V09

Has any member of your household migrated out of the village in search of work?

V10

Who has migrated in search of work?

V11

What was the nature of migration? (Select all that apply)

V12

What was the most important reason for migrants’ most recent migration

V13

Are you aware of the Naari Adhikaar Kendra?

V14

What are some of the activities that NAARI ADHIKAR KENDRA can help a woman with?

V15

Have you or someone in your family have taken any kind of support from the NAARI ADHIKAR KENDRA, which ones?