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Ldf Template -Form Fill

Identification
Q01

Household No

Q02

Village (Hamlet Name)

Q03

Block

Q04

District

Q05

State

Q06

Self-help group (SHG) name

Q07

Village Organization (VO) name

Q08

Cluster Level Federation (CLF) name

Q09

Name of the respondent

Q10

Are you the head of your HH?

Q11

Name of the household head

Q12

Gender of the head of the household

Q13

Relationship with the household head

Q14

Caste of the respondent

Q15

Date of interview

Q16

Interviewer ID

Q17

Interviewer name

Q18

SHG membership type

HOUSEHOLD COMPOSITION
A01

Number  of male children (less than 18 years)

A02

Number of female children (less than 18 years)

A03

Number of Male (18 years or above)

A04

Number of Female (18 years or above)

A05

Number of Transgender

A06

Total number of earning members

A07

Highest education of the respondent

A08

Are any of the household members engaged in ___ occupation?

A08_1

Farming/Agriculture (Crops)

A08_2

NTFP Collection

A08_3

Livestock rearing (goats, poultry, piggery, fishery & dairy)

A08_4

Unskilled wage labor (agricultural labor, MGNREGA labor, construction work, brick kiln labor etc.)

A08_5

Skilled worker (tailoring, masonry, electrician, plumbing, carpentry, welding, driving, etc.)

A08_6

Salaried worker (teachers, ASHA, AWW, ANM, etc.)

A08_7

Contractual or task-based work (CSPs, Tuitions, para-teachers etc.)

A08_8

Micro-enterprises (kirana shops, dhabas, mobile shops, ferry shops etc.)

A08_9

Pensioner

A09

How many male members are involved in the occupation in the last one year?

A09_1

Farming/Agriculture (Crops)

A09_2

NTFP Collection

A09_3

Livestock rearing (goats, poultry, piggery, fishery & dairy)

A09_4

Unskilled wage labor (agricultural labor, MGNREGA labor, construction work, brick kiln labor etc.)

A09_5

Skilled worker (tailoring, masonry, electrician, plumbing, carpentry, welding, driving, etc.)

A09_6

Salaried worker (teachers, ASHA, AWW, ANM, etc.)

A09_7

Contractual or task-based work (CSPs, Tuitions, para-teachers etc.)

A09_8

Micro-enterprises (kirana shops, dhabas, mobile shops, ferry shops etc.)

A09_9

Pensioner

A10

How many female members are involved in the occupation in the last one year?

A10_1

Farming/Agriculture (Crops)

A10_2

NTFP Collection

A10_3

Livestock rearing (goats, poultry, piggery, fishery & dairy)

A10_4

Unskilled wage labor (agricultural labor, MGNREGA labor, construction work, brick kiln labor etc.)

A10_5

Skilled worker (tailoring, masonry, electrician, plumbing, carpentry, welding, driving, etc.)

A10_6

Salaried worker (teachers, ASHA, AWW, ANM, etc.)

A10_7

Contractual or task-based work (CSPs, Tuitions, para-teachers etc.)

A10_8

Micro-enterprises (kirana shops, dhabas, mobile shops, ferry shops etc.)

A10_9

Pensioner

A11

What is the engagement of female members in the occupation in the last one year? (see the code list below)

A11_1

Farming/Agriculture (Crops)

A11_2

NTFP Collection

A11_3

Livestock rearing (goats, poultry, piggery, fishery & dairy)

A11_4

Unskilled wage labor (agricultural labor, MGNREGA labor, construction work, brick kiln labor etc.)

A11_5

Skilled worker (tailoring, masonry, electrician, plumbing, carpentry, welding, driving, etc.)

A11_6

Salaried worker (teachers, ASHA, AWW, ANM, etc.)

A11_7

Contractual or task-based work (CSPs, Tuitions, para-teachers etc.)

A11_8

Micro-enterprises (kirana shops, dhabas, mobile shops, ferry shops etc.)

A11_9

Pensioner

A12

For how many of your family members’ education, is your family spending money ?

A13

What is your average monthly expense on education of all the above members?

A14

What is your average monthly medical expense?

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 are there in this house?

B06

Do you have a separate room for cooking?

B07

Do you have a homestead?

B08

What type of toilet facility do you have?

B09

What is the main source of lighting?

B10

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

B11

Does your household own any of the following items?

B11_1

Mattress

B11_2

Pressure cooker

B11_3

Chair

B11_4

Cot/ Bed

B11_5

Table

B11_6

Electric fan

B11_7

Almirah

B11_8

Radio/Transistor

B11_9

Sewing machine

B11_10

Clock or watch

B11_11

Bicycle

B11_12

Animal-drawn cart/Bullock Cart

B11_13

Black & White television

B11_14

Colour television

B11_15

Mobile Phone

B11_16

Landline Phone

B11_17

Water pump

B11_18

Thresher

B11_19

Power Tiller

B11_20

Spray Machine/Sprayer

B11_21

Refrigerator

B11_22

Air conditioner / Cooler

B11_23

Washing Machine

B11_24

Internet

B11_25

Computer

B11_26

Motorcycle/ scooter

B11_27

Car/Jeep

B11_28

Tractor

B12

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

Information regarding cultivated crops
C01

Crop Code

C02

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

C03

How much input cost[1] (in INR) was incurred in growing the crops in a season?

C04

What is the total quantity produced in the last year? (Quantity in kg)

C05

How much of the total quantity produced last year did you sell? (in kg) 

C06

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

C07

Was the market price received equal to or more than the Minimum Support Price (MSP) for that crop?

C08

Where do you normally sell the crop?

C09

How much do women contribute in production of agricultural crops in your family?

ANIMAL OWNERSHIP, PRODUCTION AND SALE OF ANIMAL PRODUCTS
D01

During the last 12 months, did anyone in the household own any animals including Cow/ Buffalo/ Ox; Goat; Sheep; Pig; Chicken/ fowl/ duck?

D02

How many animals do you have since the last 1 year?

D03

What was the source of money to buy the animals?

D04

How much money do you spend every month in taking care of your animals (in INR)?

D05

What is the contribution of women in taking care of these animals?

D06

How many of your animals died in the last 1 year?

D07

Are your animals insured?

D08

Who informed you about insurance of animals?

D09

Are your animals vaccinated?

D10

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

D11

How much money did your household receive for the sale of your animals in the last 12 months?

D12

How much milk do they produce everyday (in Litre)?

D13

How much milk from these animals do you sell every day (in Litre)?

D14

How much do you earn from sale of this milk every day?

D14A

Do you convert milk to milk-based products and sell them?

D15

For the purpose of sale, how much milk is converted to milk-based products (in Litre) and sold, on a day to day basis ?

D16

How much do you earn from the sale of milk-based products in a month (INR)?

D17

To whom do you sell these milk-based products?

CONTRIBUTION OF WAGES, SERVICES, REMITTANCE AND NTFP COLLECTION TO HOUSEHOLD INCOME
E01

In the last one year, did your family do this labour work for someone else?

E01_1

Agriculture labor operations

E01_2

MGNREGA

E01_3

Carpentry labor

E01_4

Construction labor

E01_5

Labor work in brick kiln

E01_6

Labor in other work

E02

How many days in the last one year did the male members engage in this work?

E02_1

Agriculture labor operations

E02_2

MGNREGA

E02_3

Carpentry labor

E02_4

Construction labor

E02_5

Labor work in brick kiln

E02_6

Labor in other work

E03

What was the daily wage rate for male?

E03_1

Agriculture labor operations

E03_2

MGNREGA

E03_3

Carpentry labor

E03_4

Construction labor

E03_5

Labor work in brick kiln

E03_6

Labor in other work

E04

How many days in the last one year did the female members engage in this labor work?

E04_1

Agriculture labor operations

E04_2

MGNREGA

E04_3

Carpentry labor

E04_4

Construction labor

E04_5

Labor work in brick kiln

E04_6

Labor in other work

E05

What was the daily wage rate for female?

E05_1

Agriculture labor operations

E05_2

MGNREGA

E05_3

Carpentry labor

E05_4

Construction labor

E05_5

Labor work in brick kiln

E05_6

Labor in other work

Services
F01

Do you or any member of your family work as any of the following?

F01_1

ASHA/AWW

F01_2

Tuition

F01_3

Micro-enterprises

F01_4

Community service providers (CSP)

F01_5

Govt. or Private Job

F02

Income in one month (female members)

F02_1

ASHA/AWW

F02_2

Tuition

F02_3

Micro-enterprises

F02_4

Community service providers (CSP)

F02_5

Govt. or Private Job

F03

No of months in a year that the female members work

F03_1

ASHA/AWW

F03_2

Tuition

F03_3

Micro-enterprises

F03_4

Community service providers (CSP)

F03_5

Govt. or Private Job

F04

Income in one month (male members)

F04_1

ASHA/AWW

F04_2

Tuition

F04_3

Micro-enterprises

F04_4

Community service providers (CSP)

F04_5

Govt. or Private Job

F05

No. of months in a year that the male members work

F05_1

ASHA/AWW

F05_2

Tuition

F05_3

Micro-enterprises

F05_4

Community service providers (CSP)

F05_5

Govt. or Private Job

Remittance
G01

Does any member of your family live outside for work and sends you money?

G02

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?

G03

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

G04

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

G05

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

G06

How much NTFP collection is carried out by women in your household?

G07

How much did the household earn from the sale of NTFP in last year?

G08

Does someone in the household receive pension?

G09

Who gets the pension?

G10

Which type of Pension?

G11

Amount received in last 12 months

G11_1

Old age pension

G11_2

Widow pension

G11_3

Disability pension

G11_4

Retirement pension

G12

Who linked/facilitated the pension?

G12_1

Old age pension

G12_2

Widow pension

G12_3

Disability pension

G12_4

Retirement pension

WOMEN’S DECISION-MAKING, AUTONOMY IN PRODUCTIVE DECISIONS & INCOME CONTROL
H01

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

H01_1

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

H01_2

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

H01_3

Cattle rearing

H01_4

Goat rearing

H01_5

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

H01_6

Fishing or fishpond culture

H01_7

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

H01_8

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

H01_9

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

H01_10

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

H01_11

Education of family members

H01_12

Health of family members

H02

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

H02_1

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

H02_2

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

H02_3

Cattle rearing

H02_4

Goat rearing

H02_5

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

H02_6

Fishing or fishpond culture

H02_7

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

H02_8

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

H02_9

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

H02_10

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

H02_11

Education of family members

H02_12

Health of family members

H03

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

H03_1

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

H03_2

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

H03_3

Cattle rearing

H03_4

Goat rearing

H03_5

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

H03_6

Fishing or fishpond culture

H03_7

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

H03_8

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

H03_9

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

H03_10

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

H03_11

Education of family members

H03_12

Health of family members

H04

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

H04_1

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

H04_2

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

H04_3

Cattle rearing

H04_4

Goat rearing

H04_5

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

H04_6

Fishing or fishpond culture

H04_7

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

H04_8

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

H04_9

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

H04_10

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

H04_11

Education of family members

H04_12

Health of family members

H05

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

H05_1

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

H05_2

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

H05_3

Cattle rearing

H05_4

Goat rearing

H05_5

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

H05_6

Fishing or fishpond culture

H05_7

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

H05_8

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

H05_9

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

H05_10

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

H05_11

Education of family members

H05_12

Health of family members

WOMEN’S ACCESS TO FINANCIAL SERVICES AND CREDIT
I01

Do you have a bank account/ Post Office account?

I01A

How often do you visit bank/PO to make transactions?

I02

What type of bank account do you operate?

I03

Who facilitated opening your personal account?

I03A

Who facilitated opening the SHG/VO/CLF bank account?

I04

What do you use your personal bank account for?

I05

Who operates your personal bank account?

I05A

Who accompanies you when you visit bank?

I05B

Do you use ATM to withdraw money?

I05C

How frequently do you use ATM to withdraw money?

I06

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

I06_1

Non-governmental organization (NGO)

I06_2

Money lender

I06_3

Formal lender (direct credit from bank/financial institution)

I06_4

Friends or relatives or neighbors

I06_5

Self – Help Group

I07

What was the purpose of borrowing?

I07_1

Non-governmental organization (NGO)

I07_2

Money lender

I07_3

Formal lender (direct credit from bank/financial institution)

I07_4

Friends or relatives or neighbors

I07_5

Self – Help Group

I08

Who made the decision to borrow from _____most of the time?

I08_1

Non-governmental organization (NGO)

I08_2

Money lender

I08_3

Formal lender (direct credit from bank/financial institution)

I08_4

Friends or relatives or neighbors

I08_5

Self – Help Group

I09

Who makes the decision about what to do with the money/ item borrowed most of the time?

I10

With whom of the following, have you ever wanted to take a loan, but couldn’t take?

I11

Why did you borrow from money lender and not your SHG? 

ACCESS TO AND KNOWLEDGE OF GOVERNMENT SCHEMES
K01

Have you ever heard about_______?

K01_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

K01_2

Pradhan Mantri Ujjwala Yojana

K01_3

Antyodaya Anna Yojana (AAY)

K01_4

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

K01_5

Old Age Pension Yojna

K01_6

Protection of Women against Domestic Violence Act

K01_7

National Agricultural Insurance Scheme and WBCIS

K01_8

Pradhan Mantri Kisan Samman Nidhi Yojna

K01_9

Dairy Development Scheme

K01_10

Kisan Credit Card Yojna on Animal Husbandry

K01_11

Mukhya Mantri Bhed Bakri Palak Yojna (General) 2019-20

K01_12

Mukhya Mantri Bhed Bakri Palak Yojna (SCSP) 2019-20

K01_13

Scheme for providing employment opportunities to scheduled castes 2019-20

K01_14

Scheme for the establishment of Backyard Poultry units for the year 2019-20.

K01_15

Scheme for Promotion of Cotton Cultivation

K01_16

Pradhan Mantri Kaushal Vikas

K02

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

K02_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

K02_2

Pradhan Mantri Ujjwala Yojana

K02_3

Antyodaya Anna Yojana (AAY)

K02_4

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

K02_5

Old Age Pension Yojna

K02_6

Protection of Women against Domestic Violence Act

K02_7

National Agricultural Insurance Scheme and WBCIS

K02_8

Pradhan Mantri Kisan Samman Nidhi Yojna

K02_9

Dairy Development Scheme

K02_10

Kisan Credit Card Yojna on Animal Husbandry

K02_11

Mukhya Mantri Bhed Bakri Palak Yojna (General) 2019-20

K02_12

Mukhya Mantri Bhed Bakri Palak Yojna (SCSP) 2019-20

K02_13

Scheme for providing employment opportunities to scheduled castes 2019-20

K02_14

Scheme for the establishment of Backyard Poultry units for the year 2019-20.

K02_15

Scheme for Promotion of Cotton Cultivation

K02_16

Pradhan Mantri Kaushal Vikas

K03

Has anyone in your household ever availed this scheme?

K03_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

K03_2

Pradhan Mantri Ujjwala Yojana

K03_3

Antyodaya Anna Yojana (AAY)

K03_4

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

K03_5

Old Age Pension Yojna

K03_6

Protection of Women against Domestic Violence Act

K03_7

National Agricultural Insurance Scheme and WBCIS

K03_8

Pradhan Mantri Kisan Samman Nidhi Yojna

K03_9

Dairy Development Scheme

K03_10

Kisan Credit Card Yojna on Animal Husbandry

K03_11

Mukhya Mantri Bhed Bakri Palak Yojna (General) 2019-20

K03_12

Mukhya Mantri Bhed Bakri Palak Yojna (SCSP) 2019-20

K03_13

Scheme for providing employment opportunities to scheduled castes 2019-20

K03_14

Scheme for the establishment of Backyard Poultry units for the year 2019-20.

K03_15

Scheme for Promotion of Cotton Cultivation

K03_16

Pradhan Mantri Kaushal Vikas

K04

How many months ago did someone in your household used this scheme?

K04_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

K04_2

Pradhan Mantri Ujjwala Yojana

K04_3

Antyodaya Anna Yojana (AAY)

K04_4

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

K04_5

Old Age Pension Yojna

K04_6

Protection of Women against Domestic Violence Act

K04_7

National Agricultural Insurance Scheme and WBCIS

K04_8

Pradhan Mantri Kisan Samman Nidhi Yojna

K04_9

Dairy Development Scheme

K04_10

Kisan Credit Card Yojna on Animal Husbandry

K04_11

Mukhya Mantri Bhed Bakri Palak Yojna (General) 2019-20

K04_12

Mukhya Mantri Bhed Bakri Palak Yojna (SCSP) 2019-20

K04_13

Scheme for providing employment opportunities to scheduled castes 2019-20

K04_14

Scheme for the establishment of Backyard Poultry units for the year 2019-20.

K04_15

Scheme for Promotion of Cotton Cultivation

K04_16

Pradhan Mantri Kaushal Vikas

K05

As a result of joining SHG/VO/CLF, how has your level of awareness/ knowledge about ___ scheme changed ?

K05_1

Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

K05_2

Pradhan Mantri Ujjwala Yojana

K05_3

Antyodaya Anna Yojana (AAY)

K05_4

Pradhan Mantri Jeevan Jyoti Bima Yojna (PMJJBY)

K05_5

Old Age Pension Yojna

K05_6

Protection of Women against Domestic Violence Act

K05_7

National Agricultural Insurance Scheme and WBCIS

K05_8

Pradhan Mantri Kisan Samman Nidhi Yojna

K05_9

Dairy Development Scheme

K05_10

Kisan Credit Card Yojna on Animal Husbandry

K05_11

Mukhya Mantri Bhed Bakri Palak Yojna (General) 2019-20

K05_12

Mukhya Mantri Bhed Bakri Palak Yojna (SCSP) 2019-20

K05_13

Scheme for providing employment opportunities to scheduled castes 2019-20

K05_14

Scheme for the establishment of Backyard Poultry units for the year 2019-20.

K05_15

Scheme for Promotion of Cotton Cultivation

K05_16

Pradhan Mantri Kaushal Vikas

K06

Does anyone in the household have health insurance?

K07

Does anybody in the HH have LIC/Life Insurance?

WOMEN’S PARTICIPATION IN SOCIAL AND POLITICAL SPHERE
L01

Do you usually participate in Gram Sabha meetings?

L02

Did you attend last gram sabha meeting?

L03

What was the reason to attend Gram sabha meetings?

L04

What was the reason for not attending gram sabha meeting?

L05

As a result of joining SHG/VO/CLF, how much more/less comfortable do you feel speaking up in public to help decide on infrastructure (like small wells, roads, water supplies) to be built in your community?

L06

As a result of joining SHG/VO/CLF, how much more/less comfortable do you feel speaking up in public to ensure proper payment of wages for public works or other similar programs?

L07

As a result of joining SHG/VO/CLF, how much more/less comfortable do you feel speaking up in public to protest the injustice of authorities or elected officials?

L08

As a result of joining SHG/VO/CLF, how much more/less comfortable do you feel speaking your opinion in any training or SHG meeting?

L09

As a result of joining SHG/VO/CLF, how much more/less comfortable do you feel when you have to talk to a bank officer/manager/teacher/AWW?

L10

As a result of joining SHG/VO/CLF, how much more/less comfortable do you feel when you have to talk to Sarpanch/ Pradhan?

LIVELIHOOD TRAINING
M01

Have your ever received Pashu Sakhi training?

M02

Have you or anyone else from your household ever received any other livelihood enhancement training?

M03

What was the theme of the training?

M04

What was the training about?

M05

Who facilitated the training?

M06

Did you or members of your household know about these practices before the organization provided the training?

M07

Did you or other members of your household found this training useful and adopted it in your livelihood activities?

M08

What barriers do you face in adopting the training in your livelihood activities?