Please Wait...

Household Template 1 -Form Fill

Household Identification
A01

State Name

A02

State Code

A03

District name

A04

District code

A05

Block Name

A06

Block code

A07

Panchayat Name

A08

Panchayat Code

A09

Village Name

A10

Village Code

A11

Number of Tolas/Hamlets

A12

Segment Code for Survey

A13

Self Help Group (SHG)

A14

Household No.

A15

Unique Reference ID

A16

Name of the Household Head

A17

Address with Landmark

A17A

Household GPS Co-ordinates

A18

Contact Number

A19

Religion

A20

Caste Category

A21

Household Ration Card Type

A22

Name of Respondent (SHG Member)

A23

Gender of Respondent

A24

Age of Respondent

A25

Investigator Name

A26

Interview Attempt

A27

Date of Interview

A28

Start Time of Interview

A29

Interview Status

A30

Process Monitoring Round

Household Roster
B01

How many members live in this household?

B02

Member ID

B03

Please tell me the names of all the persons who usually live in your household, starting with SHG member followed by the oldest to the youngest member of this household

B04

What is the relationship of [NAME] to the SHG member of the household?

B05

What is the sex of [NAME]?

B06

How old is [NAME]?

B07

What is the educational qualification of [NAME]?

B08

Does [NAME] hold any important position in the village?

B09

What is the marital status of [NAME]?

B10

Whether the [NAME] is currently a member of SHG/ Producer Group (PG)/ Producer Organisation (PO)?

B11

Name of SHG/ PG/ PO

B12

Date of joining SHG/ PG/ PO

Household Occupation and Source of Income
C01

S.No

C02

At present, what are the occupations that serve as a source of income in your household?

C03

Please specify details of your occupation

C04

In your household, who all are engaged in each of these occupations?

C05

Were any of these sources of income introduced or upgraded through your participation in SHG?

C06

When was the source of income introduced/ upgraded through your participation in SHG?

C07

How was the source of income introduced/ upgraded through your participation in SHG?

C08

What was the annual income from [C03  ] occupation prior to your participation in SHG?

C09

What is the present annual income from [C03] occupation?

Household Land ownership, Cultivation and Leasing
D01

Does your household own any agricultural land?

D02

How much total agricultural land does your household own at present?

D03

Of the total agricultural land owned, how much have your household bought after SHG membership?

D04

Do you attribute the increase in ownership of total agricultural land after SHG Membership to the efforts or support of MSRLM?

D05

What kind of support did MSRLM provide for increasing your land ownership?

D06

Of the total agricultural land owned, how much did you cultivate prior to SHG Membership?

D07

How much additional land have you leased in for cultivation prior to SHG Membership?

D07A

How much rent did you pay for leasing in land prior to SHG membership?

D08

Of the total agricultural land owned, how much did you cultivate after SHG Membership?

D09

How much additional land have you leased in for cultivation after SHG Membership?

D09A

How much rent did you pay for leasing-in land after SHG membership?

D10

What is the change in total cultivated land after SHG membership?

D11

Do you attribute the increase in total cultivated land after SHG Membership to the efforts or support of MSRLM?

D12

What kind of support did MSRLM provide for increasing your total cultivated land?

D13

What is the reason for decrease in total cultivated land after SHG Membership?

D14

Of the total cultivated land, how much area was irrigated in the past 12 months?

D15

Of the total cultivated land, how much area was irrigated prior to SHG Membership?

D16

Of the total cultivated land, how much area was irrigated after SHG Membership?

D17

What is the change in total irrigated land after SHG membership?

D18

Do you attribute the increase in an irrigated area in land cultivated after SHG Membership to the efforts or support of MSRLM?

D19

What kind of support did MSRLM provide for increasing irrigated area in land cultivated?

D20

What is the reason for decrease in total irrigated area after SHG Membership?

D21

Have you leased out your land anytime for some reason?

D22

How much rent did you receive for leased-out land for the last 12 months?

D23

How much rent did you receive for leased-out land prior to SHG membership?

D24

How much rent did you receive for leased-out land after SHG membership?

D25

What is the change in rent received on leased out land after SHG membership?

D26

Do you attribute the increase in rent you receive for leased-out land after SHG Membership to the efforts or support of MSRLM?

D27

What kind of support did MSRLM provide for boosting the rent you receive for leased-out land?

D28

What is the reason for decrease in rent received from leased out land after SHG Membership?

Household Farm practices, Management, Production and sales
E01

Which farm practices are adopted by your household for the cultivation of crops?

E02

Were any of these farm practices introduced to your household through MSRLM?

E03

Did MSRLM facilitate training on-farm practices for you or any member in the household?

E04

For which crop did your household receive training on-farm practices?

E05

Who provided you with this training?

E06

Where was the training conducted?

E07

What was the duration of the training?

E08

Did you adopt this practice for cultivation after receiving training?

E09

Why did you not adopt this practice for cultivation even after receiving training?

E10

Has the adoption of these farm practices benefitted your household in any way?

E11

In what ways has it benefitted?

E12

Has the adoption of these farm practices led to an increase in income from farm production?

E13

Why do you feel that adoption of these farm practices has not benefitted your household or led to an increase in your household income from farm production?

E14

Apart from support for training on-farm practices have you received any kind of service/ support for farm activities from MSRLM?

E15

What service/ support have you received from MSRLM apart from support for training on-farm practices?

E16

Which crop do you cultivate?

E17

Area under cultivation

E18

What was the total quantity produced?

E19

How much did you sell?

E20

What was the average market rate for this crop?

E21

Revenue from the crop

E22

How has the productivity of this crop changed since your SHG membership?

E23

Has this change happened due to the training or any other support received from MSRLM for this crop?

E24

Did you start cultivating this crop after receiving support from MSRLM?

E25

Where and how do you sell your produce at present?

E26

Where and how did you sell your produce prior to your SHG membership?

E27

Have you been able to access the markets where you sell your produce because of support from MSRLM?

E28

Have you been able to access the storage facilities (godown, cold storage) for your produce because of support from MSRLM?

E29

Have you been able to process your agricultural produce because of support from MSRLM?

E30

Are you able to secure better prices for your produce after receiving support from MSRLM?

E31

How much money did you spend last year on hired labour?

E32

How much money was spent on purchasing seeds in the last 12 months?

E33

How much money did you spend last year on fertilizer and manures?

E34

How much money did you spend last year on pesticides and herbicides?

E35

How much money did you spend last year on irrigation?

E36

How much money did you spend last year on hiring animals and renting farm machinery for working on your farm?

E37

How much money did you spend on buying or hiring farm tools?

E38

How much money did you spend on the maintenance of farm equipment and machinery?

E39

How much money did you spend on transporting produce or inputs?

E40

Any other/ miscellaneous expenses apart from those mentioned above

E41

From where do you procure the agricultural inputs at present?

E42

From where did you procure the agricultural inputs prior to your SHG membership?

E43

Have you been able to access these markets from where you buy the agricultural inputs because of the support from MSRLM?

E44

Are you able to purchase any of these agricultural inputs at a lower price because of the support from MSRLM?

E45

Is the quality of inputs (includes seeds, fertilizers, pesticides etc.) procured through the support of MSRLM better?

E46

Are the required inputs (seeds, fertilizers, pesticides etc.) available timely as per your need because of the support from MSRLM?

Livestock Ownership, Management, Production and sales
F01

Which all livestock did you own at present?

F02

What is the count of each livestock you own at present?

F03

What was the count of each livestock you own before your participation in SHG?

F04

Do you attribute the increase in livestock count to efforts or support of MSRLM?

F05

Please specify the salable products you derive from each of your livestock

F06

Please specify the quantity of annual production

F07

What is the market rate per unit of each product?

F08

Has the income from the sale of these livestock products changed after receiving support from MSRLM?

F09

Which livestock management practices are adopted by your household for maintaining the livestock?

F10

Were any of these livestock management practices introduced to your household through MSRLM?

F11

Did MSRLM facilitate training on livestock management practices for you or any member in the household?

F12

For which livestock did your household receive training on livestock management practices?

F13

Who provided you with this training?

F14

Where was the training conducted?

F15

What was the duration of the training?

F16

Did you adopt this livestock management practice after receiving training?

F17

Why did you not adopt these livestock management practices even after receiving training?

F18

Has the adoption of these livestock management practices benefitted your household in any way?

F19

In what ways has it benefitted?

F20

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

F21

Why do you feel that adoption of these livestock management practices has not led to an increase in income from the sale of livestock products?

F22

Apart from these training have you received any service/ support for livestock management from MSRLM?

F23

What service/ support have you received from MSRLM apart from training on livestock management practices?

F24

What all livestock products have you produced in the last 12 months?

F25

How much quantity of product did you produce in the last 12 months?

F26

How much quantity of the livestock product did you sell last year?

F27

What was the market price at which the produce was sold?

F28

Total income from the sale of livestock product

F29

Has the income from the sale of these livestock products changed after receiving support from MSRLM?

F30

Where do you sell these livestock products?

F31

Where did you sell these livestock products prior to your SHG membership?

F32

Have you been able to access the markets where you sell your products through the support from MSRLM?

F33

Livestock

F34

How much did you spend on feed and fodder in the last 12 months?

F35

How much was the cost of veterinary services in the last 12 months?

F36

How much was the cost of hired labour (if any) in the last 12 months?

F37

Other costs

F38

Total expense

F39

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

F40

From where did you get the veterinary services prior to your SHG membership?

F41

From where do you buy the feed and fodder?

F42

From where did you buy the feed and fodder prior to your SHG membership?

F43

Have you been able to access the markets from where you procure feed and fodder through the support from MSRLM?

F44

Are you able to purchase feed and fodder at a lower price after receiving support from MSRLM?

F45

Is the quality of feed and fodder procured through the support of MSRLM better?

F46

Has the availability of feed and fodder improved after receiving support from MSRLM?

F47

Is your household engaged in rearing fish?

F48

What was the quantity of fish produced in the last 12 months?

F49

How much fish did you sell in the last 12 months?

F50

What was the value of sale for the last 12 months?

F51

Income from renting pond in the last 12 months

F52

Total income (Auto calculate)

F53

How much money did you spend on buying fish seeds/ fish eggs?

F54

How much money did you spend on buying fish feed or fertilizer?

F55

How much cost did you incur in disinfectants/ antibiotics/ growth promoters?

F56

How much cost did you incur on transportation?

F57

Any other costs (Please specify)

F58

Total cost (Auto calculated)

F59

Is your HH engaged in catching fish?

F60

How much fish did you catch in the past 12 months?

F61

How much fish did you sell in the past 12 months?

F62

What was the value of the sale in the last 12 months?

F63

How much money did you spend on purchasing/renting fishing equipment (net, fishing gear, fishing line, tub etc.)?

F64

How much cost did you incur on transportation?

F65

Any other costs (Please specify _____)

F66

Total cost (Auto calculated)

F67

Where do you sell the fish reared or caught?

Wage and Salary Work
G01

Does anyone from your household earn a wage or salaried income?

G02

[NAME] of a household member

G03

What kind of work does [NAME] do?

G04

Was [NAME] employed working prior to your SHG membership?

G05

What kind of work did [NAME] do 5 years ago?

G06

For how many days did [NAME] work in the last 12 months?

G07

What is the frequency of wage/ salary payment?

G08

What was the wage/salary rate at which [NAME] got paid?

G09

Total Income (Auto-calculate)

G10

Has the total income of the [NAME] increased since your SHG membership?

G11

Do you attribute the boost in household income from [NAME] to any support received from MSRLM?

Household non-farm Activities/ Business
H01

After your SHG membership, did you or any member from your household receive any training on non-farm livelihood activities?

H02

Who provided the training?

H03

Have you been able to adopt the skillsets/ knowledge/ technology acquired during this training?

H04

How did the adoption of these training help you?

H05

Why have you not been able to adopt skillsets/knowledge/technology acquired during these training (pick from 4F01)?

H06

Has the adoption of any of these non-farm livelihood activities led to an increase in household income?

H07

Is your household engaged in any non-farm business? (E.g. Tailoring, candle making, handloom etc.)

H08

Which non-farm business unit do you have?

H09

When did you start this non-farm business?

H10

Have you started this non-farm business by using the support received from MSRLM?

H11

Did you receive any training for setting up or expansion of this non-farm business?

H12

Who provided \you this training?

H13

Did you receive any financial support for setting up or expansion of this non-farm business?

H14

Who provided you with this financial support?

H15

Apart from the training and financial support have you received any other support from MSRLM for setting up or expanding this non-farm business?

H16

What other support have you received?

H17

What was the gross receipt from this non-farm business over the last 12 months?

H18

How much did it cost to operate this non-farm business in the last 12 months for the following?

H18_1

Rent of equipment, property

H18_2

Cost of electricity, water, transport

H18_3

Cost of labour

H18_4

Cost of materials & miscellaneous inputs

H18_5

Loan (Principal + Interest)

H18_6

Any other costs including taxes

H18_7

Total cost (Auto calculate)

H19

Where do you sell the product/s from this non-farm business at present?

H20

Where did you sell the product/s from this non-farm business prior to your SHG membership?

H21

Have you been able to access the current markets where you sell your products because of the support you received from MSRLM?

Migration and Remittance
I01

Has any member from your household migrated to another place for work?

I02

Has the migrated member sent you money in the last 12 months?

I03

Relationship of the migrated member to the respondent

I04

Place of residence after migration

I05

Occupation of migrated member

I06

How much money did migrated member sent in past 12 months (INR)

I07

Was the migrated member trained and placed through support received from MSRLM?

Household Income from other sources
J01

Income from renting out property/ house (except agricultural land)?

J02

Income from interest, dividends, share sale, or capital gains?

J03

Annual income from pensions?

J04

Income from scholarships or gifts?

J05

Income from any government sources like assistance for drought/ flood, NGOs, charities, compensation, Insurance payout or any other schemes?

J06

Does your household engage in NTFP (Non-Timber Forest Produce) collection?

J06_1

What were all NTFPs collected last year?

J06_2

What was the quantity of NTFP collected?

J06_3

How much quantity of NTFP you sold last year?

J06_4

What was the total income from NTFP last year?

J07

Income from any other source? Please specify ______

Loans or investment for Upscaling Livelihood Activities
K01

Have you or any member of your household taken any loan/s after your SHG membership?

K02

When was the loan availed?

K03

What was the loan amount?

K04

From which credit agency was the loan availed?

K05

What was the rate of interest at which the loan was availed?

K06

What was the purpose for which the loan was availed?

K07

Against which type of security was the loan issues?

K08

How much of loan have you repaid?

K09

Because of some reasons, you were not able to pay instalments for this loan on time.

K10

Can you recall the difficulties you faced in repaying the loan?

K11

Do you feel that you require more credit for livelihoods from the SHG or the amount you have availed till now is sufficient?

K12

According to you, which are the most preferred sources for availing credit at present?

K13

From which sources of credit were you borrowing prior to your SHG membership?

K14

Has your household made any investment in existing livelihood activities after your SHG membership?

K14_1

Any investment in agriculture

K14_2

Any investment in livestock

K14_3

Has your HH made any investment in non-farm activities in the last 5 years?

K14_4

Any investment in any other activity

K15

What is the source of credit for this investment?

K16

Has this investment been triggered by your exposure to MSRLM interventions?

Asset Ownership and Standard of Living
L01

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

L01_1

Prior to your SHG membership, were you living in your own house, rented accommodation or a house given to you by the government?

L02

Do you own any land?

L02_1

Did you own any land prior to your SHG membership?

L03

Do you or any member in your household have a personal bank account?

L03_1

Did you or any member in your household have a personal bank account prior to your SHG membership?

L04

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

L04_1

What was the main material of the floor prior to your SHG membership?

L05

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

L05_1

What was the main material of the roof prior to your SHG membership?

L06

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

L06_1

What was the main material of the walls prior to your SHG membership?

L07

How many rooms are there in this house?

L07_1

How many rooms were there prior to your SHG membership?

L08

Do you have a separate room for cooking?

L08_1

Did you have a separate room for cooking prior to your SHG membership?

L09

Do you have a window in your house?

L09_1

Did you have a window in your house prior to your SHG membership?

L10

What type of window(s)?

L10_1

What type of window(s) did you have prior to your SHG membership?

L11

What type of toilet facility do you have?

L11_1

What type of toilet facility did you have prior to your SHG membership?

L12

What is the main source of lighting?

L12_1

What was the main source of lighting prior to your SHG membership?

L13

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

L13_1

What type of fuel did your household mainly use for cooking prior to your SHG membership?

L14

Does your household own any of the following items

L15

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

L15_1

What was the main source of drinking water for the members of your household prior to your SHG membership?

Process of Social Inclusion & Institution Building
M01

Do you recall any community mobilization activity/ initiative undertaken by MSRLM staff in your village?

M02

What type of community mobilization activity/ initiative was undertaken in your village?

M03

How many such events per week/ month were conducted in your village?

M04

What was the average time spent by MSRLM staff on such events?

M05

Do you recall any corner or ward meeting/ consultation/ discussion for community mobilization undertaken by MSRLM staff in your village?

M06

With whom was the meeting/ consultation/ discussion for community mobilization conducted?

M07

How many such meetings per week/ month were organized in your village?

M08

Do you recall any exposure visits for community mobilization organized by MSRLM staff for any person in your village?

M09

How many were such exposure visits for community mobilization organized per week/ month?

M10

Who in your village were included in such exposure visit?

M11

Were you or any member of your household invited to participate in community mobilization activities/ initiatives/ meetings/ discussions/ consultation/ exposure visits?

M12

Could you please provide details of community mobilization activities/ initiatives/ meetings/ discussions/ consultation/ exposure visits of which you or your household member were part of?

M13

Do you feel the efforts taken by the MSRLM staff for community mobilization were sufficient for motivating you to join an SHG?

M14

How did MSRLM team approach your household?

M15

What communication tools/ methods were used by the MSRLM team to introduce your household to the concept of SHG?

M16

Could you please let us know the concept of SHG and objective of forming your group?

M17

Do you have any idea about how your household was selected among the list of target households considered for the formation of SHG in your village?

M18

Was the list of target households considered for the formation of SHG in your village approved in Gram Sabha?

M19

Was the list of target households considered for the formation of SHG in your village displayed in public space?

M20

Was your household included in the initial or first list of target household?

M21

Where there any other cases of non-inclusion of households in villages which are known to you?

M22

What are the major vulnerability and risk factor which affect the poverty status of the community in your villages?

M23

According to you, have all households in the village at least have one member in an SHG?

M24

According to you, how many households do you think could not be included?

M25

Could be specified any reason for non-inclusion of any household in your village?

M26

Did the Mission team conduct any start-up and de-briefing meetings for orientation at Cluster Block and District levels?

M27

If yes, how many start-up and de-briefing meetings for orientation were conducted?

Involvement in Institution Building
N01

Who encouraged/supported you to become a member of the SHG?

N02

What criteria were adopted for the formation of SHGs in your village?

N03

How many SHGs have been formed in your village?

N04

on an average, how many members are there in each SHG?

N05

How was your SHG incorporated?

N06

Did you participate in the meeting in which your SHG was incorporated?

N07

Are the rules/ norms for your SHG formulated?

N08

Do you recall who formulated the rules/ norms for your SHG?

N09

Do you recall the rules/ norms formulated for the functioning of your SHG?

N10

Do you think that the SHG rules/norms so formulated are pro-poor?

N11

Do the members and office bearer of your SHG follow its rules/ norms meticulously?

N12

Has any member of your SHG been penalized in the past according to the set rule/ norm?

N13

Do you recall how the office bearers (i.e. president, secretary, treasurer and bookkeeper) for your SHG selected and appointed?

N14

Has any member of your household ever been appointed for any position in SHG office?

N15

Is your SHG saving account opened in a bank?

N16

Do you recall procedure for opening your SHG saving account in a bank?

N17

Whether any resolution was passed prior to opening the SHG savings account in a bank?

N18

Was the SHG savings account in a bank opened within three months of passing the resolution?

N19

Is the bank branch, in which your SHG has a savings account, near to your village?

N20

Did bank issue savings accounts passbook to your SHG?

N21

Who in your SHG are authorized to operate the saving account in a bank and update the passbook?

N22

Do you recall to whom and how was the authorization to operate the saving account in bank given?

N23

Was the opening of the savings account in the bank for your SHG facilitated by a financial inclusion specialist or bank Sakhi or bank Mitra from the MSRLM?

N24

Is there any signboard installed in your village which displays your SHG name?

N25

How the persons in leadership position elected in your SHG?

N26

Do you think that there is enough transparency in selecting a person for a leadership position in your SHG?

N27

Have you or any person in your household elected for a leadership position in your SHG?

N28

If yes, how many times were you elected?

N29

What was the process followed for your appointment as a leader?

N30

Do you think that every member in your SHG has an equal chance for being elected for a leadership position?

N31

How many times a leader from household belong to SC, ST and most Vulnerable in the village were appointed to a leadership position?

N32

Which position have they been elected to?

N33

How many households belong to SC, ST and most Vulnerable in the village got an opportunity for getting elected to a leadership position?

Participation in SHG/ PG/ PO Activities
O01

Why did you join/ form this SHG?

O02

Being a member of SHG, have you received any training from MSRLM?

O03

If yes, which trainings have you received?

O04

Who provided these training?

O05

Were these training helpful?

O06

How were these training helpful?

O07

Why do you feel that these training were not helpful?

O08

How frequently was the training related to SHG conducted?

O09

How many total numbers of training have you attended?

O10

How many total days of training have you attended

O11

What was the average duration of training per day?

O12

Where did MSRLM conduct your training?

O13

What kinds of facilities were ensured during training sessions?

O14

Did MSRLM share any training material with you during the training sessions?

O15

Was training imparted to you through a training partner?

O16

Did the training partner meet your expectations from training?

O17

Can you recall ten sutras of Dashsutra?

O18

How many meetings are held usually per month in your SHG?

O19

How many meetings were held in your SHG during the lockdown?

O20

Of the total number of meetings held usually per month in your SHG, how many do you attend?

O21

Of the total number of meetings held during the lockdown in your SHG, how many did you attend?

O22

What is the reason for not attending the SHG meeting?

O23

What topics do you discuss in the self-help group meetings?

O24

Is the SHG meeting conducted as per the agenda?

O25

On average, how many agenda points are discussed in the SHG meeting?

O26

According to you, are Minutes of Meeting noted and read out to all members before ending the meeting?

O27

Is tallying of cash book, ledger and bank passbook (Savings and loan account) taken up during the SHG meeting?

O28

How many meeting was held in your SHG in the last six months?

O29

What is the average attendance in meetings of your SHG?

O30

Is the venue for conducting a meeting of your SHG changed?

O31

Usually, where are meetings of your SHG conducted?

O32

What procedures are adopted for conducting a meeting in your SHG?

O33

Do you attend gram sabha meeting?

O34

Please specify the reason why you do not attend Gram Sabha meetings?

O35

What kind of issues have you raised in Gram Sabha meetings?

O36

What types of activities are carried out by your SHG?

O37

Does your SHG have a bank account?

O38

Have you made any savings in your SHG in the last two months?

O39

How much do you save per meeting?

O40

How much have you been able to save till date?

O41

How do you plan to utilize your savings in SHG?

O42

What do you do when you are not able to contribute to savings in SHG?

O43

How was the amount to be saved by each member decided?

O44

At what frequency do members have to deposit their savings in the SHG?

O45

At what frequency do members usually deposit their savings in the SHG?

O46

When do members usually deposit their savings in the SHG?

O47

When are the savings deposited in the bank?

O48

What are the provisions for depositing savings of an absent member?

O49

How is loan disbursement prioritized?

O50

How is the loan repayment decided?

O51

Are you satisfied with the loan interest rate?

O52

In the last six months, is loan repayment being made as per schedule?

O53

Who maintains Record / Bookkeeping?

O54

Which accounting system is followed by the SHG?

O55

What was the process followed for the opening of the SHG bank account?

O56

Is the process for bank account opening, deposit and withdrawal transparent?

O57

Has any conflict occurred in your SHG?

O58

How are conflicts within the SHG resolved?

O59

At what frequency records/books of accounts updated by BookKeeper?

O60

Who keeps possession of the records / books of accounts?

O61

What type of assistance is provided from MSRLM team to SHG?

O62

How do members participate in the preparation of MCP/micro plan?

O63

Did you get access to vulnerability reduction funds?

O64

How did you utilize these funds for?

O65

How did the vulnerability status decide among the community members?

O66

What proportion of fund did you receive?

O67

How did CRPs decide for your community?

O68

How many target households attend those meetings to elect CRPs?

O69

How many meetings generally happen to elect CRPs?

O70

Do you feel that your household is given preference for public service delivery?

O71

Do you feel that your SHG extends support to you in accessing any of the following public services?

O72

What support did the SHG extend to you for accessing the public services?

O73

When you have a problem or worry, how often do you let someone else in the SHG know?

O74

If there was a problem that affected all or some of the group members, how many women would work together to deal with the problem from the SHG?

O75

If there was a problem that affected all or some of the group members, how many women would work together to deal with the problem from the village?

Participation in PG Activities
P01

When was this PG formed?

P02

Why did you (or your household member) join the PG?

P03

Does the PG meet on a regular basis?

P04

What is the interval at which this PG meets?

P05

Does your PG have a bank account?

P06

Has your PG received any fund from the MSRLM?

P07

What types of activities are carried out in this PG?

P08

What all activities have you participated in as a member of this PG?

P09

Have you or any member of your household received any training as a member of PG?

P10

What type of training have you or your HH member received?

P11

Have you or your HH member received any service/facility from MSRLM?

P12

What facility have you received?

P13

What service have you received?

P14

Do you feel you or your household members have been benefited from these service/facility?

P15

How have you or your household members been benefitted from these service/facility?

P16

Have these benefits led to higher income?

Participation in PO Activities
Q01

Is your group part of a producer organization

Q02

If yes, when was the PO formed?

Q03

What type of PO are you a member of?

Q04

What are some of the activities carried out by the PO?

Q05

How has the PO been beneficial to your group?

Q06

How do you think the PO would be beneficial to you?

Involvement in SHG Gradation
R01

Does your SHG ever carry out gradation process?

R02

Were you involved in SHG gradation process?

R03

When was the last time when you were involved in SHG gradation?

R04

On average, how many members were present in SHG gradation?

R05

How frequently is gradation done in your SHG?

R06

How was the gradation meeting conducted?

R07

Were you able to contribute to the SHG grading meeting?

R08

Did other members contribute to the SHG grading meeting?

R09

What was the point of discussion in the meeting?

R10

Who all were present in the SHG Gradation meeting?

R11

Does your SHG have any Livelihood Plan?

R12

Does your SHG has been granted any Livelihood loan?

Involvement in Micro Credit Planning
S01

Are you aware of microcredit planning?

S02

Does your SHG prepare micro-credit plans?

S03

How was sensitization done about the whole process of Microcredit planning?

S04

On average, how many members attended such training?

S05

Does your SHG do self-assessment of its performance with its members?

S06

How many members are usually present in these assessment meetings?

S07

What were the criteria on which assessment was done?

S08

How was this assessment process carried out?

S09

Have you taken any loan before micro credit plan?

S10

Does your microcredit plan got approved?

S11

For what purpose have you used that loan amount?

S12

Does the household regularly participate in Micro Investment Planning?

S13

Have you taken any loan after Household Investment plan was developed?

S14

Have you invested that amount in any income-generating activity?

S15

What was the activity in which you have invested to generate income?

S16

Do you take consent with your household members while selecting this particular income-generating activity?

S17

Was wealth ranking done for your SHG member households to determine economic vulnerability?

S18

Was ranking given to each member was unbiased and without dispute among the SHG members?

S19

What were the critical factors considered while wealth ranking of SHG household members?

S20

How frequently do you repay your loan amount?

S21

What is the time frame of complete repayment of the loan amount?

S22

Have you accessed loan again after repayment of the previous loan?

S23

Are you aware of ‘Term of partnership’ related to availing loan under micro-credit plan?

S24

Have you signed any ‘Term of partnership’ while availing loan under micro-credit plan from your SHG?

Ease of Access to Microcredit
T01

Have you ever accessed any amount of Microcredit?

T02

What was the amount of loan have you accessed?

T03

For what purpose have you received loan?

T04

What was the mode of fund transfer?

T05

For what purpose have you utilized loan?

T06

Have you been able to repay the loan on time?

T07

From where you have taken a loan?

T08

What was the reason for selecting this place to avail loan?

T09

What kind of credit do you normally request?

T10

What percentage of loan applied was granted to you?

T11

How long does it take to access credit?

T12

How often do you apply for loans?

Involvement in Fund Management
U01

Are you aware of the Revolving fund (RF) and community investment fund (CIF)?

U02

Does your SHG apply for RF/CIF?

U03

Does your SHG application got approved?

U04

Have you received any amount through RF/CIF fund?

U05

For what purpose you have utilized that fund?

Engagement in Value Chains: Farm & Non-Farm
V01

Do you supply your produce for value addition?

V02

Which products are value-added?

V03

How do you transport your produce?

V04

Do you sell your value-added products directly to consumers?

V05

On which platform do you sell?

V06

What is the volume of sale of the last 12 months?

V07

How much monthly income generated through sales of these products?

V08

Do you have access to the primary processing unit in your village?

V09

Which primary processing facility is available in your village?

V10

Are you able to access the district market to sell your products?

Engagement in Public-Private-Community Partnership
W01

In what business/ project are you involved in the partnership?

W02

Does this partnership help to expand your business/ project?

W03

Does it help to increase your income level?

W04

Have you received any training to upgrade your skills and knowledge required in this partnership business?

W05

Who facilitated training for upgrading skills and knowledge?

Engagement in Innovative Livelihood Projects
X01

Have you been part of any of these innovative livelihood projects?

X02

Is processing unit located in your village?

X03

Does this benefit you in increasing your income?

X04

Who provided you training related to the innovative livelihood project?

X05

Is there any difficulty you faced in the implementation of an innovative project?

Convergence
Y01

How do you get to know about various Government schemes?

Y02

Did you receive training in availing benefits from government schemes?

Y03

What kind of assistance do you receive from MSRLM team in availing benefits from such schemes?

Y04

What challenges do you face in availing benefits under government schemes?

Y05

What can all be done to ease down the overall process of availing benefits under government schemes?

Y06

What additional support you may require from MSRLM team in availing benefits under these schemes?

Assistance under Pradhan Mantri Jeevan Jyoti/ Suraksha Bima Yojna(PMJJBY/SBY)
Z01

Are you associated with Pradhan Mantri Jeevan Jyoti/ Suraksha Bima Yojna (PMJJBY/ SBY)?

Z02

Have you renewed your scheme last year?

Z03

How much premium do you pay every year?

Z04

How do you get to know about this scheme?

Z05

Have you received any assistance from MSRLM team in availing benefits from this scheme?

Z06

Have you faced any trouble in availing this scheme?

Z07

What kind of problems have you faced while availing this scheme?

Assistance under National Social Assistance Programme (NSAP)- Pension, death compensation & Maternity Benefits
1101

Are you associated with National social assistance Programme (NSAP)- Pension, death compensation & Maternity Benefits?

1102

Under what components have you or any other household member has enrolled under this scheme?

1103

Does female of your household receive benefit under NMBS?

1104

For how many successful deliveries have you received benefits from this scheme?

1105

How was awareness spread about this program?

1106

Have you received any handholding support from MSRLM?

1107

Have you faced any trouble in availing this scheme?

1108

What kind of problems have you faced while availing this scheme?

Assistance for Integrated Child Development Services
1109

Does any child of your household receive benefits under Integrated Child Development Services (ICDS)?

1110

What services have you received under ICDS?

1111

What kind of problems have you faced in availing these schemes?

1112

How did you come to know about this scheme?

1113

Have you received any assistance from MSRLM?

1114

Does a girl child from your household receive equal benefits under this scheme?

1115

Has the health status of children has improved?

Assistance for Food, Nutrition, Health and WASH (FNHW) Intervention
1116

Are you receiving benefits under Food, Nutrition, Health and WASH intervention (FNHW)?

1117

Do you own any nutrition garden?

1118

How many Nutri gardens do you own?

1119

How many Kgs of vegetables produced in your Nutri garden?

1120

Do you consume vegetables grown in these Nutri Gardens?

1121

How many kgs of vegetables do you consume in a week?

1122

How many kgs do you sell in a month?

1123

How much income can be generated through the sales of these vegetables? In a month

1124

Have you been sensitized about diversification in nutrient intake?

1125

Do you implement this concept in your daily food intake?

1126

Do mother till six months old child from your household exclusively do breastfeeding?

1127

Is complementary feeding has been initiated for a child older than six months?

1128

Has a pregnant lady/ lactating mother in your household have received immunization?

1129

Are children below the age of 2 years in your household have been immunized completely?

1130

Where do child deliveries happen if a lady is pregnant in your household?

1131

Have you been to any HB checkup camp organized in your village?

1132

What was your result after a checkup at HB camp?

1133

Are you able to access safe drinking water?

1134

What is the source of safe drinking water?

1135

Do you have individual latrine installed in your house?

1136

Do all members use latrines installed in your house?

1137

Have you been sensitized about handwashing practice?

1138

How frequently does your SHG conduct meetings on handwashing practices?

1139

How frequently do you wash your hand in a day?

1140

How many types of vegetable grown in your Nutri garden?

1141

Are you part of any Nutri enterprise developed in your village?

1142

What all Nutri snack products are developed in your enterprise?

1143

Does your enterprise market all those products?

1144

How many community Nutri gardens are developed in your village?

1145

How many have nutri gardens in your village undergone two cycles of production?

1146

How many nutri snacks in your village are produced with improved standardization?

1147

How many nutri snacks in your village marketed?

Assistance under ASMITA
1148

Are you registered under Asmita Yojna?

1149

Do you have Asmita card?

1150

Do you purchase Sanitary Napkins from your SHG through Asmita card?

1151

Whether you were using sanitary napkins before getting enrolled under this scheme?

1152

How was sensitization done to spread awareness about the usage of sanitary napkins?

1153

What was the reason for not using sanitary napkins before ASMITA?

1154

Are you satisfied with the quality of Sanitary napkins?

1155

How using Sanitary napkins changed your life?

1156

How many SHGs in your village are registered under the ASMITA Scheme?

1157

How many registered SHGs in your village has placed an order for ASMITA sanitary napkin?

1158

How many registered SHGs did receive the ASMITA sanitary napkins?

1159

How many SHGs were satisfied with the quality of the product?

1160

On average, how many sanitary napkin packs are sold by each SHG in the last financial year?

1161

What is the total income earned by your SHG under ASMITA Scheme in the last financial year?

1162

How many school girls (aged 11-19) in your village registered under ASMITA Yojana?

1163

How many school girls (aged 11-19) in your village hold the ASMITA card?

1164

At what unit price, did your SHG receive the sanitary napkins?

Assistance under MGNREGS
1165

Have you enrolled yourself in Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS)?

1166

Do you have MGNREGS job card?

1167

How many employment days you get under MGNREGS?

1168

Have you received employment under 15 days of applications?

1169

Have you received any compensation (unemployment allowances) from the government?

1170

How does MGNREGS change your life?

1171

How far is the place of employment under MGNREGS?

1172

Have you received any support from MSRLM team?

Assistance under Integrated Watershed Management Programme
1173

Are you getting benefited under the Integrated Watershed Management Programme?

1174

Does your village have any watershed project?

1175

Does this watershed help you in irrigation and harvesting?

1176

Has soil health of your farm improved?

1177

How has productivity of crops changed after watershed intervention?

1178

Does it provide you with any employment opportunity?

1179

Have you faced any difficulty in accessing benefit from the common resource (watershed)?

1180

Were you involved in developing a watershed plan in your village?

1181

What were all tools used for data collection?

1182

Does any training was conducted to sensitize about watershed?

1183

Have you attended this training?

Assistance under Swacch Bharat Mission
1184

Have you received any assistance under Swachh Bharat Mission?

1185

Do you have access to a functional toilet?

1186

Is water available in/for the toilet?

1187

Is the toilet “Fly-Proof” or Hygienic?

1188

Where is the human waste disposed of from the toilet?

1189

Did any member of the Household defecate in the open after gaining access to a toilet?

1190

Have you faced any difficulty in accessing benefit under this scheme?

1191

What kind of difficulty have you faced?

Effect on Household Income
1192

How many people are currently earning an income in your household?

1193

Does MSRLM help to increase the overall income of your household?

1194

How an increase in income helped to improve your standard of living?

1195

Does it increase your expenditure capacity?

1196

Have you invested some amount in your livelihood to expand it?

1197

Whether you were able to repay loans (if taken) on time?

1198

Were you involved in multiple livelihood opportunities?

General Household Health Care, Nutrition, Hygiene, Immunization & Emergencies
1199

When was the last time that either you or any other household member needed health care?

1200

Was the last need for health care for you/adult member of household or child?

1201

Which reason best describes why you last needed health care?

1202

Whether you were able to access the healthcare facility or not when needed last time?

1203

Which reason best explain why you did not get health care?

1204

Of the medicines that were prescribed, How many of them were you able to get?

1205

What kind of toilets does your household member use?

1206

Does latrines in the house are used by all household members?

1207

How do you feel about cleanliness in your local environment?

1208

Do you wash your hands before having food?

1209

Do you use soap to wash your hands?

1210

Do you wash your hands after using the toilet?

1211

Do you take a bath daily?

Effect on Education- Adult and Children
1212

How many years have you taken formal education?

1213

What is your highest level of education?

1214

Are you pursuing any kind of training or Vocational course?

1215

Please specify member ID (from 302) whose age is below 18 years

1216

Which grade is he/she in currently?

1217

What is the medium of education?

1218

How far is the school which she is attending? (in Km)

1219

Has he/she been dropped out of school at any point of education?

1220

What is the main reason for dropping out?

1221

Are you satisfied with the quality of education?

Opinion on Women’s Role in Economic development
1222

Who has the most say in decision-making regarding the following issues:

1223

Has there been any change in your contribution towards decision making on this household issue after you joined SHG?

1224

What food items to purchase?

1225

How many children to have?

1226

What to do if you fall sick?

1227

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

1228

What to do if a child falls sick?

1229

Whom your children should marry?

1230

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

1231

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

1232

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

1233

Has there been any change in the inputs provided by you for this activity after you joined SHG?

1234

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

1235

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

1236

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

1237

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

1238

Fishing or fishpond culture

1239

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

1240

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

1241

Borrowing from SHGs

1242

Borrowing from MFIs/Banks

1243

Borrowing from informal credit sources

1244

Use of savings in the household

1245

Use of income earned by you/husband in the household

1246

Now, I would like to ask you about going to the following places, and please tell us whether you have to ASK PERMISSION of your husband or a senior household member to go

1247

Can you go unaccompanied to the following locations?

1248

To the local health centre?

1249

To the home of relatives or friends [in the village neighbourhood?

1250

To the grocery shop?

1251

To short distance by train or bus?

1252

Market?

1253

To natal home from in-law’s place?

1254

In the last five years, has there been any change in your freedom of mobility?

1255

What has led to this change?

1256

How much do you agree or disagree with the following statements?

1257

I can count on fellow SHG members if I need to borrow money

1258

I can count on fellow SHG members to talk about my problems

1259

SHG members worry about themselves only

1260

I can count on fellow SHG members to help me address the problems I am unable to solve on my own (E.g. Violence)

1261

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

1262

Have you ever participated in any mass events like rallies, campaigns, vigils, etc. for social change or to demand something (for ex. Against alcoholism)?

1263

Did you vote in the last election?

1264

Why did you vote?

1265

Why did you not vote?

1266

Have you ever participated in Gram Sabha meetings?

1267

What was the reason for attending a Gram Sabha meeting?

1268

What was the reason for not attending the Gram Sabha meeting?

1269

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?

1270

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

1271

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

1272

How confident do you feel speaking your opinion in any training or SHG meeting?

1273

How confident do you feel when you have to talk to a bank officer/ manager/ teacher/ AWW?

1274

How confident do you feel when you have to talk to Sarpanch/Pradhan?