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Household Template 35 -Form Fill

Identification
Q01

Household Number

Q02

Village (Hamlet Name)

Q03

Block

Q04

District

Q05

State

Q06

Name of the Respondent

Q07

Name of the Household Head

Q08

Religion of the Respondent

Q09

Caste of the Respondent

Q10

Interviewer

Q11

Supervisor

HOUSEHOLD COMPOSITION
A01

Please tell me the name of all the persons who live in your house, starting with your name

A02

Relation to respondent woman.

A03

Sex

A04

Age

A05

Education

A06

Marital status?

A07

Main Occupation

HOUSEHOLD CHARACTERISTICS
B01

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

B02

LOOK AT THE FLOOR AND CODE THE MAIN MATERIAL OF THE FLOOR

B03

LOOK AT THE ROOF AND CODE THE MAIN MATERIAL OF THE ROOF

B04

LOOK AT THE EXTERIOR WALLS AND CODE THE MAIN MATERIAL OF THE WALLS

B05

How many rooms in total is there in this house?

B06

Do you have a separate room for cooking?

B07

Do you have a window in your house?

B08

Type of window

B09

Do you have a homestead?

B10

What type of toilet facility do you have?

B11

What is the main source of lighting

B12

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

B13

Does your household own any of the following items

B13_1

Mattress

B13_2

Pressure cooker

B13_3

Chair

B13_4

Cot/ Bed

B13_5

Table

B13_6

Electric fan

B13_7

Radio/Transistor

B13_8

Sewing machine

B13_9

Clock or watch

B13_10

Bicycle

B13_11

Animal-drawn cart

B13_12

Black & White television

B13_13

Colour television

B13_14

Mobile Phone

B13_15

Landline Phone

B13_16

Water pump

B13_17

Thresher

B13_18

Refrigerator

B13_19

Air conditioner / Cooler

B13_20

Washing Machine

B13_21

Internet

B13_22

Computer

B13_23

Motorcycle/scooter

B13_24

Car/Jeep

B13_25

Tractor

B14

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

B14_1

Summer

B14_2

Monsoon

B14_3

Winter

B15

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

B16

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

B17

Have you constructed any Goat shed/Cattle shed for your livestock?

B18

If yes, what kind of flooring does it have?

LAND OWNERSHIP AND USE OF LAND FOR FARMING
C01

Does your household own any land?

C02

How much land does your household own?

C02A

Unit

C03

How much of this land is appropriate for agriculture?

C03A

Unit

C04

How much of your owned land do you cultivate?

C04A

Unit

C05

Have you also taken any land on lease from others?

C06

How much land have you leased in?

C06A

Unit

C07

Have you mortgaged or leased out your land to someone else?

C08

How much land have you leased/mortgaged out?

C08A

Unit

C09

Do you have any source of irrigation on your land?

C10

What are the sources

C10_1

Farm pond (Hapa, other local names)

C10_2

Dugwell

C10_3

Lift/Flow irrigation

C10_4

Canal

C10_5

Earthern dam/Check dams

C10_6

Borewell

C11

Is your land bunded and levelled?

C12

How much area is bunded and levelled?

C12A

Unit

C13

Are you aware of any land reform provisions of government?

C14

If yes, which all government schemes are you aware of?

C15

Have you or anyone in your household received any training/workshop on land rights and allocation?

C16

Who had provided the training?

C17

Have you ever received any land from government?

C17A

If yes, under

C18

Do you have a patta for the land?

C19

On whose name is the land claim?

C20

Do you have the possession of the land?

C21

Is your name present in State Government’s record of rights?

CROP PRODUCTION, FARMING PRACTICES AND TRAININGS
D01

Crop Code

D02

How much of the agricultural land was used in the cultivation of this crop?

D03

What is the total quantity produced? (Quantity in KG.)

D04

What was the average market rate you got for this crop? (price per kg)

D05

What was the income from the sale of ___?

D06

First, please remind me whether you currently produce ______?

D07

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

D08

Do you treat the seeds in some way before planting?

D09

Do you raise nursery for the crop ( raised bed , line sowing, use of fertilizer, Use of pesticide, net covering, irrigation) (If any two is practised then put yes)

D10

In how many days do you transplant the seedling?

D11

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

D12

Did you apply fertilizer in the main field?

D13

How do you prepare the field before transplanting/sowing?

D14

Do you practice intercultural operations in the main field?

D15

How many times during the crop cycle do you practice intercultural operations?

D16

Do you use farm tools and implements (weeders, markers, sprayers etc) in this crop?

D17

Do you apply any control measures of insect and pest?

FARMING PRACTICES & TRAININGS
E01

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

E02

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

E02_1

Crop planning

E02_2

Cropping practices

E02_3

Nursery raising

E02_4

Pest management

E02_5

Composting/Vermicompost

E02_6

Production of bio-pesticides like agniastra, neemastra

E02_7

Poultry

E02_8

Goat rearing

E02_9

Marketing of produce

E03

Who provided the training?

E03_1

Crop planning

E03_2

Cropping practices

E03_3

Nursery raising

E03_4

Pest management

E03_5

Composting/Vermicompost

E03_6

Production of bio-pesticides like agniastra, neemastra

E03_7

Poultry

E03_8

Goat rearing

E03_9

Marketing of produce

ANIMAL OWNERSHIP AND PRODUCTION AND SALE OF ANIMAL PRODUCTS
F01

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

F02

Which all animals do you have?

F02_1

Cattle(buffalo/oxen/cow)

F02_2

Goat

F02_3

Sheep

F02_4

Pig

F02_5

Chicken/ Guinea fowl/Pigeons/Duck/ Hen

F02A

How many ______ does your household currently own?

F02A_1

Cattle(buffalo/oxen/cow)

F02A_2

Goat

F02A_3

Sheep

F02A_4

Pig

F02A_5

Chicken/ Guinea fowl/Pigeons/Duck/ Hen

F02B

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

F02B_1

Cattle(buffalo/oxen/cow)

F02B_2

Goat

F02B_3

Sheep

F02B_4

Pig

F02B_5

Chicken/ Guinea fowl/Pigeons/Duck/ Hen

F02C

How many ___ died in the last 12 months?

F02C_1

Cattle(buffalo/oxen/cow)

F02C_2

Goat

F02C_3

Sheep

F02C_4

Pig

F02C_5

Chicken/ Guinea fowl/Pigeons/Duck/ Hen

F02D

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

F02D_1

Cattle(buffalo/oxen/cow)

F02D_2

Goat

F02D_3

Sheep

F02D_4

Pig

F02D_5

Chicken/ Guinea fowl/Pigeons/Duck/ Hen

CONTRIBUTION OF WAGES, SERVICES, REMITTANCE AND NTFP COLLECTION TO HOUSEHOLD INCOME
G01

What type of work were you engaged in?

G01_1

Agriculture operations

G01_2

MGNREGA

G01_3

Masonry

G01_4

Carpentry

G01_5

Construction labour

G01_6

Labour work in brick kiln

G02

No. of days-Male

G02_1

Agriculture operations

G02_2

MGNREGA

G02_3

Masonry

G02_4

Carpentry

G02_5

Construction labour

G02_6

Labour work in brick kiln

G03

No of days-female

G03_1

Agriculture operations

G03_2

MGNREGA

G03_3

Masonry

G03_4

Carpentry

G03_5

Construction labour

G03_6

Labour work in brick kiln

G04

What was the daily wage rate?

G04_1

Agriculture operations

G04_2

MGNREGA

G04_3

Masonry

G04_4

Carpentry

G04_5

Construction labour

G04_6

Labour work in brick kiln

G05

Total wages (Interviewer to check the figure with the respondent)

G05_1

Agriculture operations

G05_2

MGNREGA

G05_3

Masonry

G05_4

Carpentry

G05_5

Construction labour

G05_6

Labour work in brick kiln

G06

Income in one month (female members)

G06_1

ASHA/AWW

G06_2

Tuition

G06_3

Micro-enterprises

G06_4

CSP

G07

No of months in a year that the female members work

G07_1

ASHA/AWW

G07_2

Tuition

G07_3

Micro-enterprises

G07_4

CSP

G08

Income in one month (male members)

G08_1

ASHA/AWW

G08_2

Tuition

G08_3

Micro-enterprises

G08_4

CSP

G09

No of months in a year that the male members work

G09_1

ASHA/AWW

G09_2

Tuition

G09_3

Micro-enterprises

G09_4

CSP

G10

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

G11

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

G11A

Number of men

G11B

Number of women

G12

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

G13

In the last 12 months, has anyone in your household received remittances from a member of the family or other person who is somewhere else in India or abroad?

G14

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

G15

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

G16

What all NTFPs were collected last year ?

G16_1

Mahua Flowers

G16_2

Mahua Fruit

G16_3

Processed

G16_4

Kossum fruit

G16_5

Kossum Oil

G16_6

Karanj fruit

G16_7

Chiraunjee

G16_8

Lac

G16_9

Honey

G16_10

Aonla

G16_11

Ber

G16_12

Tendu leaves

G16_13

Harra

G16_14

Baher

G16_15

Tasar

G16_16

Custard Apple

G16_17

Tamrind

G16_18

Jackfruit

G16_19

Sal Seed 

G17

Amount collected (Kg)

G17_1

Mahua Flowers

G17_2

Mahua Fruit

G17_3

Processed

G17_4

Kossum fruit

G17_5

Kossum Oil

G17_6

Karanj fruit

G17_7

Chiraunjee

G17_8

Lac

G17_9

Honey

G17_10

Aonla

G17_11

Ber

G17_12

Tendu leaves

G17_13

Harra

G17_14

Baher

G17_15

Tasar

G17_16

Custard Apple

G17_17

Tamrind

G17_18

Jackfruit

G17_19

Sal Seed 

G18

Amount sold (Kg)

G18_1

Mahua Flowers

G18_2

Mahua Fruit

G18_3

Processed

G18_4

Kossum fruit

G18_5

Kossum Oil

G18_6

Karanj fruit

G18_7

Chiraunjee

G18_8

Lac

G18_9

Honey

G18_10

Aonla

G18_11

Ber

G18_12

Tendu leaves

G18_13

Harra

G18_14

Baher

G18_15

Tasar

G18_16

Custard Apple

G18_17

Tamrind

G18_18

Jackfruit

G18_19

Sal Seed 

G19

Unit price (INR)

G19_1

Mahua Flowers

G19_2

Mahua Fruit

G19_3

Processed

G19_4

Kossum fruit

G19_5

Kossum Oil

G19_6

Karanj fruit

G19_7

Chiraunjee

G19_8

Lac

G19_9

Honey

G19_10

Aonla

G19_11

Ber

G19_12

Tendu leaves

G19_13

Harra

G19_14

Baher

G19_15

Tasar

G19_16

Custard Apple

G19_17

Tamrind

G19_18

Jackfruit

G19_19

Sal Seed 

HOUSEHOLD NUTRITION, FOOD SECURITY AND COPING STRATEGY
H01

Have you received any trainings around nutrition?

H02

If yes, by whom?

H03

Have you attended any BMI camps/nutrition awareness camps?

H04

What were topics discussed during these events?

H05

Was yesterday a special day (celebration, feast day, or fasting) where anyone in the HH ate special foods or more or less than usual)?

H06

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

H07

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

H08

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

H09

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

H09_1

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

H09_2

Beans and peas, groundnuts and cashew nuts

H09_3

Vegetables (including relish and leaves)

H09_4

Fruits

H09_5

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

H09_6

Milk/yogurt/other dairy product

H09_7

Sugar or sugar products, honey

H09_8

Oils/fats/butter

H10

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

H10_1

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

H10_2

Beans and peas, groundnuts and cashew nuts

H10_3

Vegetables (including relish and leaves)

H10_4

Fruits

H10_5

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

H10_6

Milk/yogurt/other dairy product

H10_7

Sugar or sugar products, honey

H10_8

Oils/fats/butter

H11

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

H11_1

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

H11_2

Beans and peas, groundnuts and cashew nuts

H11_3

Vegetables (including relish and leaves)

H11_4

Fruits

H11_5

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

H11_6

Milk/yogurt/other dairy product

H11_7

Sugar or sugar products, honey

H11_8

Oils/fats/butter

H12

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

H12_1

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

H12_2

Beans and peas, groundnuts and cashew nuts

H12_3

Vegetables (including relish and leaves)

H12_4

Fruits

H12_5

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

H12_6

Milk/yogurt/other dairy product

H12_7

Sugar or sugar products, honey

H12_8

Oils/fats/butter

H13

Normally, how many months does the food produced from your land suffice your household’s requirement?

H14

In the last 12 months, did your household face food shortage in any month?

H15

In the past four weeks did you worry that your household would not have enough food?

H16

Did your household adopt any of these coping strategies during the period of food shortage?

H16_1

Skip entire days without eating?

H16_2

Limit portion size at mealtimes?

H16_3

Reduce number of meals eaten per day?

H16_4

Borrow food or rely on help from friends or relatives?

H16_5

Rely on less expensive or less preferred foods?

H16_6

Purchase/borrow food on credit?

H16_7

Gather unusual types or amounts of wild food / hunt?

H16_8

Send household members to eat elsewhere?

H16_9

Send household members to beg?

H16_10

You or other female members eat less?

H16_11

Have you sold any household assets to buy food?

H16_12

Had to eat a limited variety of food due to lack of resources?

H16_13

Was there ever in your HH no food of any kind to eat because of lack of resources?

H16_14

Did you or any HH member go to sleep at night hungry because there was not enough food?

H16_15

Did you or any HH member go whole day and night without eating because there was not enough food?

H16_16

In the past 30 days were you or any household members not able to eat the kinds of foods you preferred because of a lack of resources?

H17

How long did you exclusively breastfeed [CHILD NAME]?

H18

During the time you exclusively breastfeed [CHILD NAME] did you occasionally give him/her a little water from time to time?

H19

Apart from mother’s milk did you feed your child any solid or liquid food in the past 24 hours?

H20

From what age did you start feeding [CHILD NAME] solid, semi-solid, mashed or soft foods?

H21

Excluding oil for cooking, did you add oil/ghee/butter to the food you gave [CHILD NAME] in the last 24 hours?

WOMEN’S TIME USE
I01

In the previous 24 hours, how much time did you spend on

I01_1

Spend resting or sleeping?

I01_2

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

I01_3

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

I01_4

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

I01_5

Spend caring for children or the elderly?

I01_6

Spend on leisure, social, and religious activities?

WOMEN’S DECISION-MAKING, AUTONOMY IN PRODUCTIVE DECISIONS & INCOME CONTROL
J01

Did you yourself participate in ______ in the past 12 months?

J01_1

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

J01_2

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

J01_3

Livestock raising

J01_4

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

J01_5

Fishing or fishpond culture

J01_6

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

J01_7

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

J01_8

Major household expenditures ( such as large appliance for the house like refrigerator)

J01_9

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

J02

When decisions are made regarding _____, who is it that normally takes the decision?

J02_1

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

J02_2

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

J02_3

Livestock raising

J02_4

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

J02_5

Fishing or fishpond culture

J02_6

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

J02_7

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

J02_8

Major household expenditures ( such as large appliance for the house like refrigerator)

J02_9

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

J03

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

J03_1

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

J03_2

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

J03_3

Livestock raising

J03_4

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

J03_5

Fishing or fishpond culture

J03_6

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

J03_7

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

J03_8

Major household expenditures ( such as large appliance for the house like refrigerator)

J03_9

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

J04

To what extent do you feel you can make your own personal decisions regarding ____, if you wanted to?

J04_1

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

J04_2

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

J04_3

Livestock raising

J04_4

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

J04_5

Fishing or fishpond culture

J04_6

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

J04_7

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

J04_8

Major household expenditures ( such as large appliance for the house like refrigerator)

J04_9

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

J05

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

J05_1

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

J05_2

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

J05_3

Livestock raising

J05_4

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

J05_5

Fishing or fishpond culture

J05_6

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

J05_7

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

J05_8

Major household expenditures ( such as large appliance for the house like refrigerator)

J05_9

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

WOMEN’S ACCESS TO CAPITAL AND CREDIT
K01

Does anyone in your household currently have any _____?

K01_1

Agricultural land

K01_2

Other land not used for agriculture

K01_3

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

K01_4

Small livestock (e.g. goats, pigs, sheep)

K01_5

Chickens, ducks, turkeys, pigeons

K01_6

Fish pond or fishing equipment

K01_7

Farm equipment (non-mechanized)

K01_8

Farm equipment (mechanized e.g. tractor)

K01_9

Non farm business equipment

K01_10

House (and other structures)

K01_11

Large consumer durables (Fridge, TV, sofa)

K01_12

Small consumer durables (radio, cookware)

K01_13

Cell phone

K01_14

Means of transportation (bicycle, motorcycle, car)

K02

Who would you say owns most of the _____?

K02_1

Agricultural land

K02_2

Other land not used for agriculture

K02_3

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

K02_4

Small livestock (e.g. goats, pigs, sheep)

K02_5

Chickens, ducks, turkeys, pigeons

K02_6

Fish pond or fishing equipment

K02_7

Farm equipment (non-mechanized)

K02_8

Farm equipment (mechanized e.g. tractor)

K02_9

Non farm business equipment

K02_10

House (and other structures)

K02_11

Large consumer durables (Fridge, TV, sofa)

K02_12

Small consumer durables (radio, cookware)

K02_13

Cell phone

K02_14

Means of transportation (bicycle, motorcycle, car)

K03

Do you own any of the ____?

K03_1

Agricultural land

K03_2

Other land not used for agriculture

K03_3

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

K03_4

Small livestock (e.g. goats, pigs, sheep)

K03_5

Chickens, ducks, turkeys, pigeons

K03_6

Fish pond or fishing equipment

K03_7

Farm equipment (non-mechanized)

K03_8

Farm equipment (mechanized e.g. tractor)

K03_9

Non farm business equipment

K03_10

House (and other structures)

K03_11

Large consumer durables (Fridge, TV, sofa)

K03_12

Small consumer durables (radio, cookware)

K03_13

Cell phone

K03_14

Means of transportation (bicycle, motorcycle, car)

K04

Do you have a bank account?

K05

What type of bank account do you have? Individual or joint? If it is joint, with whom?

K06

For how many years do you have this bank account?

K07

What were the reasons for opening this bank account?

K08

Who operates your bank account?

K09

Did you make any transaction from your bank account in the past three months?

K10

What are the reasons for not having a bank account?

K11

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

K11_1

Non-governmental organization (NGO)

K11_2

Money lender

K11_3

Formal lender (direct credit from bank/financial institution)

K11_4

Friends or relatives or neighbours

K11_5

Self - Help Group (SHG)

K12

Who made the decision to borrow from _____?

K12_1

Non-governmental organization (NGO)

K12_2

Money lender

K12_3

Formal lender (direct credit from bank/financial institution)

K12_4

Friends or relatives or neighbours

K12_5

Self - Help Group (SHG)

K13

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

K13_1

Non-governmental organization (NGO)

K13_2

Money lender

K13_3

Formal lender (direct credit from bank/financial institution)

K13_4

Friends or relatives or neighbours

K13_5

Self - Help Group (SHG)

K14

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

K14_1

Non-governmental organization (NGO)

K14_2

Money lender

K14_3

Formal lender (direct credit from bank/financial institution)

K14_4

Friends or relatives or neighbours

K14_5

Self - Help Group (SHG)

WOMEN’S GROUP MEMBERSHIP AND LEADERSHIP
L01

Is there a ____ in your village?

L01_1

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

L01_2

Water users’ group

L01_3

Land/forest users’ groups

L01_4

Credit or microfinance group (SHG)

L01_5

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

L01_6

Trade and business association

L01_7

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

L01_8

Religious group

L01_9

Mother’s group

L01_10

School management committee

L01_11

Watershed committee

L01_12

Village health and sanitation committee

L01_13

Other women’s group like VO and federation (only if it does not fit into one of the other categories)

L02

Are you a member/active member of any ______?

L02_1

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

L02_2

Water users’ group

L02_3

Land/forest users’ groups

L02_4

Credit or microfinance group (SHG)

L02_5

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

L02_6

Trade and business association

L02_7

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

L02_8

Religious group

L02_9

Mother’s group

L02_10

School management committee

L02_11

Watershed committee

L02_12

Village health and sanitation committee

L02_13

Other women’s group like VO and federation (only if it does not fit into one of the other categories)

L03

Why are you not a member of ________?

L03_1

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

L03_2

Water users’ group

L03_3

Land/forest users’ groups

L03_4

Credit or microfinance group (SHG)

L03_5

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

L03_6

Trade and business association

L03_7

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

L03_8

Religious group

L03_9

Mother’s group

L03_10

School management committee

L03_11

Watershed committee

L03_12

Village health and sanitation committee

L03_13

Other women’s group like VO and federation (only if it does not fit into one of the other categories)

SELF HELP GROUPS & SOCIAL COHESION
M01

Do you currently belong to a self-help group?

M02

When you expressed desire to become SHG member, did you have to face any challenges?

M03

What challenges did you have to overcome to become SHG member?

M04

How did they finally agree to you becoming an SHG member?

M05

Why is SHG membership important for you? 

M06

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

M07

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

M08

Which organization started or supports this self-help group?

M09

Name of the NGO

M10

Has a representative from this NGO visited you and talked about agricultural practices?

M11

Has the NGO conducted any training on livelihood practices?

M12

Does your self-help group have savings and credit activities?

M13

Do you personally participate in these savings and credit activities?

M14

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

M15

Are you currently a portfolio-holder?

M16

Which position do you hold?

M17

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

M17_1

Livelihoods/socio-economic problems in the community

M17_2

Agriculture problems

M17_3

Education problems

M17_4

Health and nutrition problems

M17_5

Gender dynamics

M17_6

Rights and entitlements

M17_7

Savings and loans

M17_8

Sanitation

M18

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

M19

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

M20

When was the last time that you participated in a group meeting?

M21

Do you save money in SHG?

M22

How much money do you save in each meeting?

M23

How often do you save?

M24

Have you participated in the maintenance of books of accounts of the SHG?

M25

How responsible do you feel for achieving the objectives of your group?

M26

How much do you agree or disagree with the following statements

M26_1

I feel that I belong to this SHG 

M26_2

I would rather go with a different SHG 

M26_3

I would rather prefer this SHG than any others I know of

M26_4

Members in this SHG are all striving for the same goals

M26_5

Everyone in our SHG wants to pursue their own goals rather than working for the good of the community

M26_6

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

M26_7

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

M26_8

SHG members worry about themselves only

M26_9

I can count on fellow SHG members if I need advice

M26_10

I can count on fellow SHG members to help me in accessing services

M26_11

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

M27

Were you previously a member of a self-help group?

M28

Were you previously a portfolio holder?

M29

Why do you not belong to a self-help group?

WOMEN’S STATUS & SOCIAL NORMS AND BELIEFS
N01

Do you currently live with your partner or husband?

N02

At what age did you get married?

N03

At what age did you first get pregnant?

N04

How many times have you been pregnant?

N05

At what age did you first give birth?

N06

How many times have you given birth?

N07

Now, I would like to have your opinion on some ideas regarding how people live within a household.

N07_1

In a household, the man should take the important decisions

N07_2

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

N07_3

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

N07_4

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

N07_5

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

N07_6

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

N08

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

N09

Do you talk to someone when you have any problem?

N10

Whom do you talk to in case of any problem?

N11

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

N12

How often can you visit the following spaces freely?

N12_1

To the market?

N12_2

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

N12_3

To the temple, church or mosque?

N12_4

To a public village meeting?

N12_5

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

N12_6

Outside your village?

N12_7

To see a health care provider for your own treatment?

N12_8

Going to a movie

N12_9

Buying new clothes for yourself

N12_10

Taking child to health care center

N12_11

Shopping within the village

N12_12

Shopping outside the village

N12_13

Attending a religious festival/social function within the village

N13

First, I am going to ask you about some situations which happen to some women. Please tell me if these apply to your relationship with your husband/last husband.

N13_1

He is jealous or angry if you talk to other men.

N13_2

He frequently accuses/accused you of being unfaithful.

N13_3

He does/did not permit you to meet your female friends.

N13_4

He tries/tried to limit your contact with your family.

N13_5

He (insists/insisted) on knowing where you (are/were) at all times.

N13_6

He does/did not trust you with any money.

N14

Now if you will permit me, I need to ask some more questions about your relationship with your husbandlast husband. Does/did your husband/last husband ever

N14_1

Say or do something to humiliate you in front of others?

N14_2

Threaten to hurt or harm you or someone close to you?

N14_3

Insult you or make you feel bad about yourself?

N15

How often did this happen in the last 12 months: often, only sometimes, or not at all?

N15_1

Say or do something to humiliate you in front of others?

N15_2

Threaten to hurt or harm you or someone close to you?

N15_3

Insult you or make you feel bad about yourself?

N16

Does/did your (last) husband ever do any of the following things to you

N16_1

Push you, shake you, or throw something at you

N16_2

Twist your arm or pull your hair

N16_3

Slap you

N16_4

Punch you with his fist or with something that could hurt you

N16_5

Kick you, drag you or beat you up

N16_6

Try to choke you or burn you on purpose

N16_7

Threaten or attack you with a knife, gun, or any other weapon

N16_8

Physically force you to have sexual intercourse with him even when you did not want to

N16_9

Physically force you to perform any other sexual acts you did not want to

N16_10

Force you with threats or in any other way to perform sexual acts you did not want to

N17

How often did this happen in the last 12 months

N17_1

Push you, shake you, or throw something at you

N17_2

Twist your arm or pull your hair

N17_3

Slap you

N17_4

Punch you with his fist or with something that could hurt you

N17_5

Kick you, drag you or beat you up

N17_6

Try to choke you or burn you on purpose

N17_7

Threaten or attack you with a knife, gun, or any other weapon

N17_8

Physically force you to have sexual intercourse with him even when you did not want to

N17_9

Physically force you to perform any other sexual acts you did not want to

N17_10

Force you with threats or in any other way to perform sexual acts you did not want to

N18

Has your husband ever prohibited you from getting a job, going to work, trading, earning money or participating in income generating projects?

N19

Did he try to stop you from working for earning in the last 12 months?

N20

Does/did your husband drink alcohol?

N21

How often does (did) he get drunk: often, only sometimes, or never?

N22

Are/Were you afraid of your husband/last husband: most of the time, sometimes, or never?

N23

Have you ever tried to seek help to stop your husband from doing this to you again?

N24

From whom have you sought help to stop this?

N25

Did you report to someone about the violence that you have experienced?

N26

Have you ever hit, slapped, kicked or done anything else to hurt your husband physically when he was not already beating or physically hurting you?

N27

In the last six months, how often have you done this to your husband?

N28

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

N29

How much do you contribute to the total household expenses?

N30

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

N31

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

N32

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

N33

When you leave home to go to the market or visit people, etc. do you take your youngest child (NAME) with you or do you leave the child with someone else?

N34

For these types of activities, how many times a week do you usually leave the child with someone else to take care of him/her?

N35

For how long each time do you usually leave the child with someone else at home?

N36

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

N37

Do you breastfeed your youngest child?

N38

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

N39

What else, if anything, was given to this youngest child to eat or drink in the previous 24 hours?

ACCESS TO AND KNOWLEDGE OF GOVERNMENT SCHEMES
O01

Have you ever heard about_______?

O01_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

O01_2

Pradhan Mantri Awas Yojana (PMAY)

O01_3

Antyodya Yojna (AYY)

O01_4

Swachh Bharat Abhiyan

O01_5

ICDS

O01_6

Janani Suraksha Yojana (JSY)

O01_7

Janani Shishu Suraksh Karykaram (JSSK)

O01_8

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

O01_9

Social Security Pension

O01_10

Protection of Women against Domestic Violence Act

O02

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

O02_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

O02_2

Pradhan Mantri Awas Yojana (PMAY)

O02_3

Antyodya Yojna (AYY)

O02_4

Swachh Bharat Abhiyan

O02_5

ICDS

O02_6

Janani Suraksha Yojana (JSY)

O02_7

Janani Shishu Suraksh Karykaram (JSSK)

O02_8

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

O02_9

Social Security Pension

O02_10

Protection of Women against Domestic Violence Act

O03

Has anyone in your household ever availed this scheme?

O03_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

O03_2

Pradhan Mantri Awas Yojana (PMAY)

O03_3

Antyodya Yojna (AYY)

O03_4

Swachh Bharat Abhiyan

O03_5

ICDS

O03_6

Janani Suraksha Yojana (JSY)

O03_7

Janani Shishu Suraksh Karykaram (JSSK)

O03_8

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

O03_9

Social Security Pension

O03_10

Protection of Women against Domestic Violence Act

O04

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

O04_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

O04_2

Pradhan Mantri Awas Yojana (PMAY)

O04_3

Antyodya Yojna (AYY)

O04_4

Swachh Bharat Abhiyan

O04_5

ICDS

O04_6

Janani Suraksha Yojana (JSY)

O04_7

Janani Shishu Suraksh Karykaram (JSSK)

O04_8

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

O04_9

Social Security Pension

O04_10

Protection of Women against Domestic Violence Act

O05

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

O06

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

O07

For this total number of days worked by household members, how many days were worked by men and how many days were worked by women?

O08

Do you feel that MGNREGA gives you employment security?

O09

Does anybody in the household have an Aadhar card?

O10

Does your household have a ration card?

O11

Which card do you have?

O12

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

O13

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

O13A

Whether purchased

O13A_1

Rice

O13A_2

Wheat

O13A_3

Sugar

O13A_4

Kerosene

O13B

Quantity Purchased

O13B_1

Rice

O13B_2

Wheat

O13B_3

Sugar

O13B_4

Kerosene

O14

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

O15

Did you or any member of your household ever receive any food from Anganwadi centre?

O16

Who received food from an Anganwadi centre

O17

Do you know how much money the beneficiary is supposed to get under the JSY scheme?

O18

Did anyone ever tell you/your HH members about constructing a toilet?

O19

Can you tell us from where did you/ any HH get to hear about constructing toilet for the first time?

O20

Does your household have a toilet?

O21

Who paid for construction of toilet?

O22

Do you think there is any disadvantage of having a toilet?

O23

What are the disadvantages of having a toilet?

O24

How satisfied are you with your toilet facility?

O25

What are the main reasons for the dissatisfaction?

O26

What is the main reason that your HH did not construct a toilet?

O27

Would you be willing to contribute money towards the construction of toilet in your house?

O28

Are there any public toilet in your locality?

O29

Do members of your HH use the community toilet facility?

O30

Do all female members of your HH use the toilet?

O31

Do all male members of your HH use the toilet?

O32

Do all children (above 4 years) of your HH use the toilet?

O33

Have you washed your hands with soap since this time yesterday?

O34

On what occasions, did you wash your hands with soap since this time yesterday?

O35

Why did you not wash hands with soap before/after doing any activity?

O36

In general, what do you wash your hands with?

O37

Do you think there can be any ill effects of not washing hands with soap before/after doing certain activities?

O38

What do you think are the ill effects of not washing hands with soap before/after doing certain activities?

O39

From where did you get information about ill effects of not washing hands before/after certain activities?

O40

Do you know about six steps of washing hands?

O41

Did any one demonstrate to you the 6 steps of handwashing?

O42

Did you receive any training on Protection of Women aginst Domestic Violence Act?

O43

Who provided the training?

O44

Did you know whom to approach when you/HH member filed a complaint under the Act?

O45

Have you or any woman you know ever been a victim of domestic violence?

O46

Who helped you/her file the complaint?

O47

Why did you not file a complaint?

O48

Did the protection officer take immediate action when you filed the complaint?

O49

After how long did the hearing take place?

O50

Do you think filing the complaint with help of a group helps/will help get better response from the authorities than when filed individually?

PARTICIPATION IN SOCIAL SPHERE
P01

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

P02

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

P03

If yes, for what?

P04

Do you have voter identification card?

P05

Did you vote in the last election?

P06

Why did you vote?

P07

In your house who decides to vote?

P08

Why did not you vote?

P09

Have you or any other woman from any SHG in your village contested in the recent elections?

P10

Have you ever participated in gram sabha meeting?

P11

Did you attend last gram sabha meeting?

P12

What was the reason to attend Gram sabha meeting?

P13

What was the reason for not attending gram sabha meeting?

P14

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

P15

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

P16

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

P17

Have you ever participated in the preparation of the village plan for your village under

P17_1

MGNREGA

P17_2

Yojana Banao Abhiyan?

P17_3

IPPE

P18

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?

P19

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

P20

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

P21

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

P22

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

P23

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

WEAI-Men
R01

Did you yourself participate in ______ in the past 12 months?

R01_1

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

R01_2

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

R01_3

Livestock raising

R01_4

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

R01_5

Fishing or fishpond culture

R01_6

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

R01_7

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

R01_8

Major household expenditures ( such as large appliance for the house like refrigerator)

R01_9

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

R02

When decisions are made regarding _____, who is it that normally takes the decision?

R02_1

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

R02_2

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

R02_3

Livestock raising

R02_4

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

R02_5

Fishing or fishpond culture

R02_6

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

R02_7

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

R02_8

Major household expenditures ( such as large appliance for the house like refrigerator)

R02_9

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

R03

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

R03_1

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

R03_2

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

R03_3

Livestock raising

R03_4

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

R03_5

Fishing or fishpond culture

R03_6

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

R03_7

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

R03_8

Major household expenditures ( such as large appliance for the house like refrigerator)

R03_9

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

R04

To what extent do you feel you can make your own personal decisions regarding ____, if you wanted to?

R04_1

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

R04_2

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

R04_3

Livestock raising

R04_4

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

R04_5

Fishing or fishpond culture

R04_6

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

R04_7

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

R04_8

Major household expenditures ( such as large appliance for the house like refrigerator)

R04_9

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

R05

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

R05_1

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

R05_2

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

R05_3

Livestock raising

R05_4

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

R05_5

Fishing or fishpond culture

R05_6

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

R05_7

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

R05_8

Major household expenditures ( such as large appliance for the house like refrigerator)

R05_9

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

R06

Does anyone in your household currently have any _____?

R06_1

Agricultural land

R06_2

Other land not used for agriculture

R06_3

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

R06_4

Small livestock (e.g. goats, pigs, sheep)

R06_5

Chickens, ducks, turkeys, pigeons

R06_6

Fish pond or fishing equipment

R06_7

Farm equipment (non-mechanized)

R06_8

Farm equipment (mechanized e.g. tractor)

R06_9

Non farm business equipment

R06_10

House (and other structures)

R06_11

Large consumer durables (Fridge, TV, sofa)

R06_12

Small consumer durables (radio, cookware)

R06_13

Cell phone

R06_14

Means of transportation (bicycle, motorcycle, car)

R07

Who would you say owns most of the _____?

R07_1

Agricultural land

R07_2

Other land not used for agriculture

R07_3

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

R07_4

Small livestock (e.g. goats, pigs, sheep)

R07_5

Chickens, ducks, turkeys, pigeons

R07_6

Fish pond or fishing equipment

R07_7

Farm equipment (non-mechanized)

R07_8

Farm equipment (mechanized e.g. tractor)

R07_9

Non farm business equipment

R07_10

House (and other structures)

R07_11

Large consumer durables (Fridge, TV, sofa)

R07_12

Small consumer durables (radio, cookware)

R07_13

Cell phone

R07_14

Means of transportation (bicycle, motorcycle, car)

R08

Do you own any of the ____?

R08_1

Agricultural land

R08_2

Other land not used for agriculture

R08_3

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

R08_4

Small livestock (e.g. goats, pigs, sheep)

R08_5

Chickens, ducks, turkeys, pigeons

R08_6

Fish pond or fishing equipment

R08_7

Farm equipment (non-mechanized)

R08_8

Farm equipment (mechanized e.g. tractor)

R08_9

Non farm business equipment

R08_10

House (and other structures)

R08_11

Large consumer durables (Fridge, TV, sofa)

R08_12

Small consumer durables (radio, cookware)

R08_13

Cell phone

R08_14

Means of transportation (bicycle, motorcycle, car)

R09

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

R09_1

Non-governmental organization (NGO)

R09_2

Formal lender (direct credit from bank/financial institution)

R09_3

Informal money lender

R09_4

Friends or relatives or neighbours

R09_5

Savings and Credit cooperatives/groups

R09_6

Self - Help Group (SHG)

R10

Who made the decision to borrow from _____?

R10_1

Non-governmental organization (NGO)

R10_2

Formal lender (direct credit from bank/financial institution)

R10_3

Informal money lender

R10_4

Friends or relatives or neighbours

R10_5

Savings and Credit cooperatives/groups

R10_6

Self - Help Group (SHG)

R11

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

R11_1

Non-governmental organization (NGO)

R11_2

Formal lender (direct credit from bank/financial institution)

R11_3

Informal money lender

R11_4

Friends or relatives or neighbours

R11_5

Savings and Credit cooperatives/groups

R11_6

Self - Help Group (SHG)

R12

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

R12_1

Non-governmental organization (NGO)

R12_2

Formal lender (direct credit from bank/financial institution)

R12_3

Informal money lender

R12_4

Friends or relatives or neighbours

R12_5

Savings and Credit cooperatives/groups

R12_6

Self - Help Group (SHG)

R13

Is there a ____ in your community?

R13_1

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

R13_2

Water users’ group

R13_3

Land/forest users’ groups

R13_4

Credit or microfinance group (SHG)

R13_5

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

R13_6

Trade and business association

R13_7

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

R13_8

Religious group

R13_9

Farmer’s group

R13_10

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

R14

Are you a member/active member of any ______?

R14_1

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

R14_2

Water users’ group

R14_3

Land/forest users’ groups

R14_4

Credit or microfinance group (SHG)

R14_5

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

R14_6

Trade and business association

R14_7

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

R14_8

Religious group

R14_9

Farmer’s group

R14_10

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

R15

Why are you not a member of ________?

R15_1

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

R15_2

Water users’ group

R15_3

Land/forest users’ groups

R15_4

Credit or microfinance group (SHG)

R15_5

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

R15_6

Trade and business association

R15_7

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

R15_8

Religious group

R15_9

Farmer’s group

R15_10

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

MEN’S TIME USE
S01

In the previous 24 hours, how much time did you spend on

S01_1

Spend resting or sleeping?

S01_2

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

S01_3

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

S01_4

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

S01_5

Spend caring for children or the elderly?

S01_6

Spend on leisure, social, and religious activities?