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Beneficiary Assessment Tool -Form Fill

Identification and occupational profile
Q01

State

Q02

District

Q03

Block

Q04

Village (Hamlet name) with location of house  

Q05

GPS Coordinates of house

Q06

House to the right  

Q07

House to the left  

Q08

Interviewer ‍name

Q09

Date of interview

Q10

Interview start time‍

Q11

Interview end time‍

Q12

Last/family Name of the respondent to be interviewed

Q13

First/given name of the respondent to be interviewed

Q14

Are you the head of the household?

Q15

Phone number (ask twice to verify)

Q16

Gender

Q17

Age

Q18

Caste

Q19

Education

Q20

How many members live in this household?

Q21

Please provide the contact information of two other household members so that we can reach you for a follow up survey after a year. In case we cannot reach you at your number, we will try to reach you through your household member, whose contact information you provide here.

Q22

In 2021, did you or any other household member have any earnings from _____?

Q22_1

Agriculture/ horticulture

Q22_2

Goat rearing

Q22_3

Dairy farming

Q22_4

Other livestock rearing (excluding dairy & goat)

Q22_5

Pisciculture/Aquaculture

Q22_6

Non-timber Forest Produce (NTFP) Collection

Q22_7

Wage

Q22_8

Salary/Job

Q22_9

Contractual work

Q22_10

Enterprise

Q22_11

Pension

Q22_12

Remittance

Q22_13

Rental income

Q23

In 2021, what was the share of income from ___ in your overall household income?

Q23_1

Agriculture/ horticulture

Q23_2

Goat rearing

Q23_3

Dairy farming

Q23_4

Other livestock rearing (excluding dairy & goat)

Q23_5

Pisciculture/Aquaculture

Q23_6

Non-timber Forest Produce (NTFP) Collection

Q23_7

Wage

Q23_8

Salary/Job

Q23_9

Contractual work

Q23_10

Enterprise

Q23_11

Pension

Q23_12

Remittance

Q23_13

Rental income

ASSET OWNERSHIP AND STANDARD OF LIVING
A01

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

A02

Do you currently own any land?

A03

Do you or any one in your household have a personal Bank Account?

A04

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

A05

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

A06

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

A07

How many rooms are there now?

A08

Do you have a separate room for cooking?

A09

Do you have window in your house?

A10

What type of window(s)?

A11

What type of toilet facility did you have?

A12

What is the main source of lighting?

A13

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

A14

Does your household own any of the following items?

A15

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

Land ownership and cropping practices
B01

Did your household own land in 2021?

B02

Total land owned currently

B02A

Unit

B03

How much of your owned land did you cultivate in 2021?

B03A

Unit

B04

How much of this owned land was under irrigation?

B04A

Unit

B05

Had you taken any land on lease for cultivation in 2021?

B06

How much land had you taken on lease for cultivation in 2021?

B06A

Unit

B07

How much did you pay during 2021 for the leased-in land?

B08

How much of this leased-in land was under irrigation in 2021?

B08A

Unit

Training and Capacity Building
C01

Have you, or any other household member, received any type of capacity building with respect to agriculture/ horticulture/ goat farming/ aquaculture/ microenterprise creation, between 2018-2021?

C02

In which of the following sectors, have you or anyone else from your household received/ been part of any related capacity building exercise in the last 3 years (2018-2021)?

C02_1

Training

C02_2

Exposure visits

C02_3

Seminar/ conference or workshop

C02_4

Webinar

C02_5

Demonstration activity

C03

Who participated?

C03_1

Training

C03_2

Exposure visits

C03_3

Seminar/ conference or workshop

C03_4

Webinar

C03_5

Demonstration activity

C04

What was the theme of the exercise?

C04_1

Training

C04_2

Exposure visits

C04_3

Seminar/ conference or workshop

C04_4

Webinar

C04_5

Demonstration activity

C05

Who provided the exercise?

C05_1

Training

C05_2

Exposure visits

C05_3

Seminar/ conference or workshop

C05_4

Webinar

C05_5

Demonstration activity

C06

Do you require training or capacity building in this regard?

C06_1

Crop management

C06_2

Nursery raising

C06_3

Use of modern and innovative methods (including machines)

C06_4

Making or using natural fertilizers/ insecticides

C06_5

Accessing credit

C06_6

Awareness around farmer laws, land rights, benefits of relevant government schemes

C06_7

Pest/ disease management

C06_8

Forming or working in collectives

C06_9

Goat Farming

C06_10

Other livestock rearing (cow, bullock, buffalo, sheep, chicken, duck, pig etc.)

C06_11

Aquaculture

C06_12

Value-added processing

C06_13

Improved packaging practices

C06_14

Marketing/sale of produce

C06_15

Financial management

C06_16

Digital literacy

C07

How has the adoption of these practices affected you?

C08

Why have you not been able to adopt practices you have received trainings/capacity building in?

C09

In what ways has adoption of these practices benefitted you?

C10

Has adoption of these practices led to increase in income?

Crop Production and Agricultural Income
D02

What was the total quantity of [crop] produced?

D03

How much [crop] did you sell?

D04

What was the average market rate for [crop]? (price per kg or whatever unit is applicable)

D05

Revenue from [crop]

D06

Where and how did you sell your produce/processed goods in 2021?

D07

Did you have access to storage facilities (godown, cold storage) in your village or near the village in 2021?

D08

Were you able to process your agricultural produce in 2021?

Cost of cultivation
E01

Cost of buying/ using seeds

E02

Cost of buying

E02_1

Fertilizer

E02_2

Pesticide

E02_3

Weedicide

E02_4

Farm-yard manure

E03

Expenses of using (not buying) machines

E04

Labor cost

E05

Cost of transportation (fuel/ hiring etc.)

E06

Other costs (such as electricity, irrigation, storage, packaging etc.)

E07

From where do you procure the agricultural inputs mostly? (Seed, fertilizer, pesticide etc.)

Income from Fishery and Fishing
F01

Is your HH engaged in rearing fish?

F02

What was quantity of fish produced in 2021?

F03

How much fish did you sell in 2021?

F04

What was the value of sale for 2021?

F05

Income from renting pond in 2021

F06

Total income from fishery (Auto calculate)

F07

How much money did you spend on buying fish seeds/ fish eggs in 2021?

F08

How much money did you spend on buying fish feed or fertilizer in 2021?

F09

How much cost did you incur in disinfectants/antibiotics/growth promoters in 2021?

F10

Transportation cost incurred in 2021for fishery?

F11

Other costs related to fishery and fishing?

F12

Total cost (Auto calculated)

F13

Is your HH engaged in catching fish?

F14

How much fish did you catch in 2021?

F15

How much fish did you sell in 2021?

F16

What was the value of sale (total income from fishery) in 2021?

F17

How much money did you spend on purchasing/renting fishing equipment (net, fishing gear, fishing line, tub etc.) in 2021?

F18

Transportation cost incurred towards fishing activities in 2021?

F19

Other cost incurred towards fishing activities in 2021?

F20

Total cost of fishing (Auto calculated)

F21

Where do you sell the fish reared or caught?

Income from Livestock Rearing (Production, Sale, Expenditure)
G01

Which all livestock do you own?

G01_1

Goat

G01_2

Cow

G01_3

Buffalo

G01_4

Chicken

G01_5

Duck

G01_6

Bullock

G01_7

Pig

G01_8

Sheep

G02

How many [livestock] did you buy in 2021?

G02_1

Goat

G02_2

Cow

G02_3

Buffalo

G02_4

Chicken

G02_5

Duck

G02_6

Bullock

G02_7

Pig

G02_8

Sheep

G03

How many [livestock] did you sell in 2021?

G03_1

Goat

G03_2

Cow

G03_3

Buffalo

G03_4

Chicken

G03_5

Duck

G03_6

Bullock

G03_7

Pig

G03_8

Sheep

G04

How much money did you get by selling [livestock]? (Rs.)

G04_1

Goat

G04_2

Cow

G04_3

Buffalo

G04_4

Chicken

G04_5

Duck

G04_6

Bullock

G04_7

Pig

G04_8

Sheep

G05

Total Income from [livestock]

G06

What all livestock products did you produce in 2021?

G07

How much quantity of [livestock product] did you produce in 2021?

G08

How much quantity of [livestock product] did you sell in 2021?

G09

Market price at which [livestock product] was sold?

G10

Total income from sale of [livestock product]

G11

Where do you sell these livestock products?

G12

How much did you spend on feed and fodder for [livestock] in 2021?

G13

How much was the cost of Veterinary services for [livestock] in 2021?

G14

How much was the cost of Hired labor (if any) for [livestock] rearing in 2021?

G15

Other costs (transportation, ropes, chains etc.) used for [livestock] rearing in 2021

G16

Total expense

Other sources of income
H01

What was the income from ____ in the last year (Jan-Dec 2021)?

H01_1

Non-timber Forest Produce (NTFP) Collection

H01_2

Wage

H01_3

Salary/Job

H01_4

Contractual work

H01_5

Enterprise/Business

H01_6

Pension

H01_7

Remittance

H01_8

Rental income

Access to credit
I01

Did your household have a bank account in 2021?

I02

Did anybody in the household have Kisan Credit Card (KCC) in 2021?

I03

From what sources did you use to take loans till 2021?

I04

Who made the decision regarding securing additional financial resources?

SHG, PG, FPO Participation
J01

Are you or anyone in your household a member of an SHG?

J02

What is the name of your SHG?

J03

When was this group formed?

J04

Since when you have been a member of this SHG?

J05

Were you a member of any other SHG before joining this group?

J06

What happened to the previous group you were a part of?

J07

Why did you join/form this group?

J08

Does your SHG meet on regular basis?

J09

How often does your SHG meet?

J10

Have you attended meetings of this SHG in the last 2 months?

J11

What type of activities are carried out by your SHG?

J12

Does your SHG have a bank account?

J13

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

J14

How much do you save per meeting?

J15

How much have you been able to save till date?

J16

Have you taken any loan(s) from this SHG?

J17

What type of loan/s have you taken?

J18

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

J19

Have you received any trainings as a part of the SHG?

J20

If yes, which trainings have you received?

J21

Who provided these trainings?

J22

Were these trainings helpful?

J23

How were these trainings helpful?

J24

Why were these trainings not helpful?

J25

Why does your household not have a SHG member?

J26

Is there a producer group present in your village?

J27

Are you or any other member from your household part of a producer group (PG)?

J28

When was this PG formed?

J29

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

J30

Does the PG meet on a regular basis?

J31

What is the interval at which this PG meets?

J32

Does your PG have a bank account?

J33

Has your PG received any fund from the SRLM?

J34

What type of activities are carried out in this PG?

J35

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

J36

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

J37

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

J38

Why does your household not have a PG member?

J39

Is your group/PG part of a producer organization

J40

When was the PO formed?

J41

What type of PO are you a member of?

J42

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

J43

How has the PO been beneficial to your group?

J44

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

J45

Why is your group not a member of PO?