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Household Template 37 -Form Fill
Section One
Q01
Name of the State
Q02
Name of the District
Q03
Name of the Block
Q04
Name of Panchayat
Q05
Name of the Village (PSU)
Q06
Village Census Code
Q07
Whether HH is a SPRD customer or not?
Yes
No
Q08
Household Structure Number
Q09
Address
Q10
Investigator Name
Q11
Investigator Code
Q12
Start Time
Q13
End Time
Q14
Interviewer’s Visits
Q15
Date
Q16
Result
Completed
Not at home
Postponed
Refused
Partly Completed
No Eligible Person
Eligible Person Incapacitated
Others (specify)
HOUSEHOLD DEMOGRAPHIC PROFILE
A01
Name of the head of the household
A02
Name of the members of the household above 15 years
A03
Phone number of a member of the household
A04
Name of the respondent
A05
What is the sex of respondent?
Male
Female
Transgender
A06
What is the religion of respondent?
Hindu
Muslim
Christian
Sikh
Buddhist/Neo-Buddhist
Jain
Jewish
Parsi/Zoroastrian
No Religion
Other (Specify)
A07
Do you belong to a scheduled caste, scheduled tribe, other backward class or general class?
Scheduled Caste
Scheduled Tribe
Other Backward Caste
General
Other (Specify)
A08
How many members are there in your household?
A09
How many working members are there in your household?
A10
What is the combined monthly income of your household?
A11
What is the type of your family?
Nuclear
Joint
Extended
A12
Whether your household is women headed household?
Yes
No
A13
What is the primary occupation of the head of the household?
AGRICULTURE
AGRICULTURAL LABOUR
NON-AGRICULTURAL LABOUR
LIVESTOCK
SALARIED
SELF-EMPLOYED
PETTY BUSINESS/SHOP
BUSINESS/TRADER
SKILLED WORKER
PENSION
UNEMPLOYED
OTHER (SPECIFY)
DON’T KNOW
A14
Please specify whether you belong to APL/BPL?
APL
BPL
Don’t have any card
Don’t know/can’t say
A15
Does your household have a bank account?
Yes
No
A16
Does your household have a post-office account?
Yes
No
A17
Do you have government grid connection in your household?
Yes
No
A18
How many hours of electricity supply do you get from the government grid?
HOUSEHOLD ELECTRICITY SOURCE AND USAGE
B01
What are the sources of energy used in your HH?
B01A
Before 2015
Grid Electricity
Solar panel at home
Diesel generator
Kerosene
Others(Specify)
No source
B01A_1
Primary source
Grid Electricity
Solar panel at home
Diesel generator
Kerosene
Others(Specify)
No source
B01A_2
Other sources
Grid Electricity
Solar panel at home
Diesel generator
Kerosene
Others(Specify)
No source
B01B
Current
Grid Electricity
Solar panel at home
Diesel generator
Kerosene
Others(Specify)
No source
B01B_1
Primary source
Grid Electricity
Solar panel at home
Diesel generator
Kerosene
Others(Specify)
No source
B01B_2
Other sources
Grid Electricity
Solar panel at home
Diesel generator
Kerosene
Others(Specify)
No source
B02
What is/was the daily hours of electricity usage from each of the sources of electricity?
B02_1
Grid Electricity
B02_2
Solar panel at home
B02_3
Diesel generator
B02_4
Kerosene
B02_5
Others(Specify)
B03
What are the appliances used in the HH?
LED bulb
CFL bulb
Incandescent bulb
An electric fan
A radio or transistor
A black and white television
A color television
A sewing machine
Mobile charging point
A computer/laptop
A refrigerator
A water pump
Irrigation pump
A thresher
Internet
Air Conditioner or Cooler
Washing Machine
B03A
Before 2015
B03A_1
Do you own?
Yes
No
B03B
Current
B03B_1
Do you own?
Yes
No
B03B_2
How many do you own?
B03B_3
What is the primary source of energy/electricity for this appliance
Grid Electricity
Solar panel at home
Diesel generator
Kerosene
Others(Specify)
B04
What was the daily requirement of running each appliance and how many hours can you use it for?
LED bulb
CFL bulb
Incandescent bulb
An electric fan
A radio or transistor
A black and white television
A color television
A sewing machine
Mobile charging point
A computer/laptop
A refrigerator
A water pump
Irrigation pump
A thresher
Internet
Air Conditioner or Cooler
Washing Machine
B04A
Before 2015
B04A1
Required (hrs)
B04A2
Used (hrs)
B04B
Current
B04B1
Required (hrs)
B04B2
Used (hrs)
B05
What is your monthly expenditure for different source of energy for the HH (if applicable)
B05A
Before 2015
B05A1
Grid Electricity
B05A2
Solar panel at home
B05A3
Diesel generator
B05A4
Kerosene
B05A5
Others(Specify)
B05B
Current
B05B1
Grid Electricity
B05B2
Solar panel at home
B05B3
Diesel generator
B05B4
Kerosene
B05B5
Others(Specify)
B06
What is monthly expenditure on
B06A
Before 2015
B06A_1
Food expenditure
B06A_2
Healthcare
B06A_3
Basic Education (Expense on books, clothes, coaching)
B06A_4
Toilet Articles (Includes toothpaste, hair oil, shaving blades etc.)
B06A_5
Household Items (Includes bulb, tube light, glassware, soaps, bucket etc.)
B06A_6
Clothing and footwear
B06A_7
Gift to relatives, ceremony, social functions
B06A_8
Travel/Transport
B06A_9
Miscelleneous
B06B
Current
B06B_1
Food expenditure
B06B_2
Healthcare
B06B_3
Basic Education (Expense on books, clothes, coaching)
B06B_4
Toilet Articles (Includes toothpaste, hair oil, shaving blades etc.)
B06B_5
Household Items (Includes bulb, tube light, glassware, soaps, bucket etc.)
B06B_6
Clothing and footwear
B06B_7
Gift to relatives, ceremony, social functions
B06B_8
Travel/Transport
B06B_9
Miscelleneous
HOUSEHOLD ENERGY NEEDS
C01
Do you plan to purchase new electrical devices for the HH in coming future?
Yes
No
C02
Which all appliances would you like to buy?
Yes
No
C02_1
LED bulb
Yes
No
C02_2
CFL bulb
Yes
No
C02_3
Incandescent bulb
Yes
No
C02_4
An electric fan
Yes
No
C02_5
A radio or transistor
Yes
No
C02_6
A black and white television
Yes
No
C02_7
A color television
Yes
No
C02_8
A sewing machine
Yes
No
C02_9
Mobile charging point
Yes
No
C02_10
A computer/laptop
Yes
No
C02_11
A refrigerator
Yes
No
C02_12
A water pump
Yes
No
C02_13
Irrigation pump
Yes
No
C02_14
A thresher
Yes
No
C02_15
Internet
Yes
No
C02_16
Air Conditioner or Cooler
Yes
No
C02_17
Washing Machine
Yes
No
BENEFITS OF ELECTRICITY ON EDUCATION
D01
How many children in your household go to school?
D02
For how many hours, do the children study after dark?
D03
Do children use electricity to study after dark?
Yes
No
D04
What was the primary source of the lighting electricity used for studying before 2015?
Grid Electricity
Solar panel at home
Diesel generator
Others, specify
D05
What is the primary source of electricity for lighting used for studying now?
Grid Electricity
Solar panel at home
Diesel generator
Children do not use electricity right now for studying
D06
Have the study hours increased and what are the main reasons for increase in study hours after dark?
Light flickers less now
Light is more consistent in supply
Children complain less of eye irritation
Improved facility of evening classes
No, study hours have not increased
Others (specify)
D07
Have the number of educational institutes/evening schools in the village increased after 2015
Yes
No
don't know
D08
Since 2015, Do the existing schools or educational facilities operate longer due to availability of electricity
Yes
No
don't know
BENEFITS OF ELECTRICITY ON HEALTH
E01
Has there been a decrease in the injuries in the dark due to availability of electricity?
Yes
No
Never Happened
E02
Has there been a decrease in the incidence of fire due to explosion of kerosene lanterns after availability of electricity?
Yes
No
Never Happened
E03
Has there been a decrease in the eye problems due to change in fuel for electricity?
Yes
No
Never Happened
E04
Has there been a decrease in coughing due to change in fuel for electricity?
Yes
No
Never Happened
E05
Have the number of health facilities (hospitals, nursing homes etc.) in the village increased after 2015 due to availability of electricity
Yes
No
don't know
E06
What changes have occurred in the facilities since 2015?
They operate for longer hours
The availability of critical services such as operations, sonography have been made available
Presence of better and more medical professional increased
Don’t know
Customer Satisfaction and Quality
F01
Do you face any of the following issues with respect to the electricity used through your primary source?
F01_1
Light Fluctuation
Never
Yes, Sometimes
Yes, Frequently
Always
Not Relevant
F01_2
Low Voltage
Never
Yes, Sometimes
Yes, Frequently
Always
Not Relevant
F01_3
Disruption in Supply (Irregular Supply)
Never
Yes, Sometimes
Yes, Frequently
Always
Not Relevant
F01_4
Bad or poor supply during Rainy season or during bad weather
Never
Yes, Sometimes
Yes, Frequently
Always
Not Relevant
F01_5
Meter Availability (There is no meter and they want one)
Never
Yes, Sometimes
Yes, Frequently
Always
Not Relevant
F01_6
Difficult to contact Operator
Never
Yes, Sometimes
Yes, Frequently
Always
Not Relevant
F02
Are you satisfied with
F02_1
Timely and hours of electricity supply
Not Satisfied
Somewhat satisfied
Neutral
Satisfied
Very Satisfied
Not Relevant
F02_2
Consistency in terms of voltage
Not Satisfied
Somewhat satisfied
Neutral
Satisfied
Very Satisfied
Not Relevant
F02_3
Are you satisfied with the schedule at which the electricity is supplied / is available
Not Satisfied
Somewhat satisfied
Neutral
Satisfied
Very Satisfied
Not Relevant
F02_4
Quality of service provided by service providers such as maintenance
Not Satisfied
Somewhat satisfied
Neutral
Satisfied
Very Satisfied
Not Relevant
F02_5
Accuracy of billing
Not Satisfied
Somewhat satisfied
Neutral
Satisfied
Very Satisfied
Not Relevant
F02_6
Tariff
Not Satisfied
Somewhat satisfied
Neutral
Satisfied
Very Satisfied
Not Relevant
F02_7
Timeliness in addressing complaints
Not Satisfied
Somewhat satisfied
Neutral
Satisfied
Very Satisfied
Not Relevant
ECONOMIC USE OF ELECTRICITY
G01
Does anyone from your family engage in any kind of economic activity from within the household?
Yes, only the male members of the households
Yes, only the female members of the households
Yes, both female & male members of the households
No, no one engages in any economic activity
G02
What is the activity?
Stitching
Embroidery
Zari work
Bidi making
Grocery shop
Rice huller/ Flour mill
Carpenter
Community worker
Other (Specify)
G03
Do you use any kind of electricity to aid you in the work?
Yes
No
G04
For what purpose is electricity used in the activity?
Lighting
Connecting rice huller/flour mill
Connecting sewing machine motors
Connecting wood smoothening/cutting machine
Other (Specify)
G05
What is the primary electricity source you use for this purpose?
Grid Electricity
Solar panel at home
Diesel generator
Impact of Street light
H01
Are there street-lights in your village?
Yes
No
don't know
H02
Since when are the streetlights functional?
H03
What is the source of electricity for these streetlights?
National Grid Electricity
Solar Mini-grid in the village
Diesel Generator
Others, Specify
Don’t Know
H04
Do you perceive any benefit from street-light in your Household?
Yes
No
H05
What all benefits do you perceive after the street-light has come to your village?
We are now able hold community events (festival celebrations, fairs, religious meetings etc.) at night
We are able to hold community meetings under the street light ( panchayat meetings, SHG meetings etc.)
Our ability to travel/stay out longer at night has increased
We feel good that there is light, instead of darkness
We feel safe in venturing out at night/ sending our family to venture out in the dark.
Facilities like markets, hospitals and schools are open for longer hours because of street lights.
There is more flexibility in daily schedules
H06
Who usually benefits from these in the house?
Male Adult
Female Adult
Male Elderly
Female Elderly
Girl Child
Boy Child
H07
After street-light in your village, for what all purposes do you find yourself stepping out in the dark?
It is easier to stay for longer hours at the work place
We feel safer in sending our children to school in the dark
We are able to go to the market even at night, after the street light
We go to attend community meetings.
We go to meet friends and relatives/ they are able to come to our house for longer hours after dark
Our house does not have a restroom, it is easier to step out in the dark to relieve ourselves
Other (Please Specify)
H08
Who usually goes outside the house?
Male Adult
Female Adult
Male Elderly
Female Elderly
Girl Child
Boy Child
H09
Why do you not feel that the street light has not made/ will not make a difference?
The street light is located too far away from the house to make any difference
Street light is not functional
The street-light is functional, but does not operate at hours of our need
We do not require venturing out in the early hours or after sunset
We were able to manage with mobile torch/ torch to venture out.
There is no safety issue for us or our children in the village
Facilities of markets/ hospitals/ coaching centers etc. were operating as required before street-light
Village is still unsafe
Other, specify
H10
When do you require the street-light
Early morning hours
Late at night
H11
Do you feel overall mobility and safety has improved in your village after street lights?
Yes
No
H12
To what extent do you perceive a difference?
Very Low
Low
Moderate
High
Very High
Module 16
I01
What are the main activities that the women of the HH engage in?
Cleaning
Cooking
Economic activity within home
Economic activity outside of home
Others, specify
I02A
For which of the above mention activities do you use electricity?
I02A1
Cleaning
Yes
No
I02A2
Cooking
Yes
No
I02A3
Economic activity within home
Yes
No
I02A4
Economic activity outside of home
Yes
No
I02A5
Others, specify
Yes
No
I02B
What do you use electricity for?
Lighting
Run an appliance
Lighting + run an appliance
I03
What was/is the time spent on these activities
I03A
Before 2015
I03A1
Cleaning
I03A2
Cooking
I03A3
Economic activity within home
I03A4
Economic activity outside of home
I03A5
Others, specify
I03B
Current
I03B1
Cleaning
I03B2
Cooking
I03B3
Economic activity within home
I03B4
Economic activity outside of home
I03B5
Others, specify
I04
Have you purchased any new appliance to help you in these activities?
I04_1
Cleaning
Yes
No
I04_2
Cooking
Yes
No
I04_3
Economic activity within home
Yes
No
I04_4
Economic activity outside of home
Yes
No
I04_5
Others, specify
Yes
No
I05
What was/is the time spent on these activities after buying the new appliance?
I05A
Before 2015
I05A1
Cleaning
I05A2
Cooking
I05A3
Economic activity within home
I05A4
Economic activity outside of home
I05A5
Others, specify
I05B
Current
I05B1
Cleaning
I05B2
Cooking
I05B3
Economic activity within home
I05B4
Economic activity outside of home
I05B5
Others, specify
I06
Who took the decision to buy these appliances?
Male members of the household
Female members of the household
Both male and female members
Self
HH ASSET INDEX
J01
Does your household own this house or any other house?
YES
NO
DO NOT KNOW
J02
LOOK AT THE FLOOR AND CODE THE MAIN MATERIAL OF THE FLOOR
MUD/CLAY/EARTH
SAND
DUNG
RAW WOOD PLANKS
PALM/BAMBOO
BRICK
STONE
PARQUET OR POLISHED WOOD
VINYL OR ASPHALT
CERAMIC TILES
CEMENT
CARPET
POLISHED STONE/MARBLE/GRANITE
OTHER (SPECIFY)
J03
LOOK AT THE ROOF AND CODE THE MAIN MATERIAL OF THE ROOF
NO ROOF
THATCH/PALM LEAF/REED/GRASS
MUD
SOD/MUD AND GRASS MIXTURE
PLASTIC/POLYTHENE SHEETING
RUSTIC MAT
PALM/BAMBOO
RAW WOOD PLANKS/TIMBER
UNBURNT BRICK
LOOSELY PACKED STONE
METAL/GI
WOOD
CALAMINE/CEMENT FIBER
ASBESTOS SHEETS
RCC/RBC/CEMENT/CONCRETE
ROOFING SHINGLES
TILES
SLATE
BURNT BRICK
OTHER (SPECIFY)
J04
LOOK AT THE EXTERIOR WALLS AND CODE THE MAIN MATERIAL OF THE WALLS1
NO WALLS
CANE/PALM/TRUNKS/BAMBOO
MUD
GRASS/REEDS/THATCH
BAMBOO WITH MUD
STONE WITH MUD
PLYWOOD
CARDBOARD
UNBURNT BRICK
RAW WOOD/REUSED WOOD
CEMENT/CONCRETE
STONE WITH LIME/CEMENT
BURNT BRICKS
CEMENT BLOCKS
WOOD PLANKS/SHINGLES
GI/METAL/ASBESTOS SHEETS
OTHER (SPECIFY)
J05
Do they have any window in their house?
YES
NO
J06
How many rooms in this house are used for sleeping?
J07
Do you have a separate room which is used as a kitchen?
YES
NO
J08
What type of fuel does your household mainly use for cooking?
ELECTRICITY
LPG/NATURAL GAS
BIOGAS
KEROSENE
COAL/LIGNITE
CHARCOAL
WOOD
STRAW/SHRUBS/GRASS
AGRICULTURAL CROP WASTE
DUNG CAKES
OTHER (SPECIFY)
J09
What is the main source of drinking water for members of your household?
PIPED INTO DWELLING
PIPED TO YARD/PLOT
PUBLIC TAP/STANDPIPE
TUBE WELL/BOREHOLE
PROTECTED WELL
UNPROTECTED WELL
PROTECTED SPRING
UNPROTECTED SPRING
RAINWATER
TANKER TRUCK
CART WITH SMALL TANK
SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL/IRRIGATION CHANNEL)
BOTTLED WATER
GOVERNMENT HAND PUMP
HAND PUMP AT HOME
NEIGHBOUR’S HAND PUMP
OTHER (SPECIFY)
J10
What kind of toilet facility do members of your household usually use?
FLUSH TO PIPED SEWER SYSTEM
FLUSH TO SEPTIC TANK
FLUSH TO PIT LATRINE
FLUSH TO SOMEWHERE ELSE
FLUSH, DON'T KNOW WHERE
VENTILATED IMPROVED PIT (VIP)/BIOGAS LATRINE
PIT LATRINE WITH SLAB
PIT LATRINE WITHOUT SLAB/ OPEN PIT
TWIN PIT/COMPOSTING TOILET
DRY TOILET
NO FACILITY/USES OPEN SPACE OR FIELD
OTHER (SPECIFY)
J11
Does your household have
J11A
Currently
J11A1
A pressure cooker
YES
NO
J11A2
A chair
YES
NO
J11A3
A cot or bed
YES
NO
J11A4
A table
YES
NO
J11A5
Any other type of telephone
YES
NO
J11A6
A watch or clock
YES
NO
J11A7
A bicycle
YES
NO
J11A8
A motorcycle or scooter
YES
NO
J11A9
An animal-drawn cart
YES
NO
J11A10
A car
YES
NO
J11A11
A tractor
YES
NO
J11B
Current
J11B1
A pressure cooker
YES
NO
J11B2
A chair
YES
NO
J11B3
A cot or bed
YES
NO
J11B4
A table
YES
NO
J11B5
Any other type of telephone
YES
NO
J11B6
A watch or clock
YES
NO
J11B7
A bicycle
YES
NO
J11B8
A motorcycle or scooter
YES
NO
J11B9
An animal-drawn cart
YES
NO
J11B10
A car
YES
NO
J11B11
A tractor
YES
NO
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