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Household Template New 47 -Form Fill

HOUSEHOLD IDENTIFICATION
Q01

Schedule Identification Number
Q02

Province Code
Q03

District Code
Q04

District Name
Q05

Village/Town Code
Q06

Village/Town Name
Q07

Replaced Village/Town  Code
Q08

Replaced Village/Town Name
Q09

Type of Unit

Q10

Household Structure Number
Q11

Name of the Household Head
Q12

Address of the Household (Mention the Landmark)
Q13

Household Head Phone Number
Q14

INTERVIEW DETAILS

Q15

Interviewer’s Code
Q16

Interviewer’s Name
Q17

Supervisor’s Code
Q18

Supervisor’s Name
Q19

Data Entry Operator’s Code
Q20

Data Entry Operator Name
Q21

Date of Data Entry

Q22

Start time of the Interview
Q23

End time of the Interview
Q24

Interviewer’s Visits - 1

Q24_1

Date
Q24_2

Result
Q25

Interviewer’s Visits - 2

Q25_1

Date
Q25_2

Result
Q26

Interviewer’s Visits - 3

Q26_1

Date
Q26_2

Result
HOUSEHOLD PROFILE
A01

Name of the respondent (Full Name with Surname)
A02

Age of the respondent (in Years)
A03

What is the gender of the respondent?
A04

What is the marital status of the respondent?
A05

Is the respondent the household head?
A06

Age of the household head
A07

What is the gender of the household head?
A08

What is the marital status of the household head?
A09

How many members reside in your household?

A10

Details of children in the age group 5-21 years in the household
A11

Number of children attending school/college?
A12

What is the ethnicity of the household?

A13

What is the level of education of the head of the household?

A14

What is the principal occupation of the Household members?

A15

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

A16

Type of toilet facility
A17

Does your household have the following?

A17_1

Electricity
A17_2

Landline Phone
A17_3

Table
A17_4

Chair
A17_5

Sofa
A17_6

Bed
A17_7

Cupboard
A17_8

Sewing Machine
A18

Details of generator used by household?

A18_1

Does your household use a generator?
A18_2

Is it owned or rented?
A18_3

On an average, for how many hours a day do you run it?
A18_4

How many households use it?
A19

Does any member of this household own a mobile phone?
A19_1

Type of Phone
A19_2

Name of the Service Provider
A19_3

Quality of Network
A19_4

Quality of the Data
A20

For how many days in the last 30 days did you have data connectivity/internet?

A21

On an average, for how many hours a day (out of 24 hours) is the data connectivity/internet available?

A22

What type of fuel/energy does your household mainly use for cooking?
A23

Main material of the floor
A24

Main material of the roof
A25

Main material of the walls
A26

Does any member of this household own any of the following?

A26_1

Watch

A26_2

Bicycle
A26_3

Motorcycle or motor scooter
A26_4

Animal-drawn cart
A26_5

Car or truck
A26_6

Tractor
A26_7

Rickshaw
A27

Does any member of this household own a bank account?

A28

How many members of this household own a Bank account?
A29

Does any member of this household use any digital finance services such as Mobile Money, M-Paisa, M-Hawala, etc.?
A30

For what all services do you use the digital finance services?
A31

How many times in the last 3 months (90 days) have you used a digital finance service?

A32

Where do you generally conduct your digital financial transaction?
A33

How far do you have travel to avail digital finance service?

A33A

Unit
A34

Does your household own this house or any other house?

A35

Does any member of this household own any agricultural land
A36

What is the size of your agricultural land?

A36A

Unit
A37

Has any member of your household taken any agricultural land on rent?
A38

What is the size of the agricultural land taken on rent?
A38A

Unit
A39

How many rooms in this household are used for sleeping

A40

Does this household own any livestock, herds, other farm animals, or poultry?
A41

How many of the following animals does this household own?

A41_1

Cows/Bulls
A41_2

Horses/Donkeys/Mules
A41_3

Goats
A41_4

Sheep
A41_5

Camel
A41_6

Chickens
A41_7

Ducks
INCOME AND EXPENDITURE PATTERN OF THE HOUSEHOLD
B01

How much did you earn from the following sources and what was the expenditure incurred in each of them?

B01A

Was this activity undertaken by any member of the household in the last one year?

B01A_1

Agriculture
B01A_2

Unskilled Labor
B01A_3

Skilled Worker

B01A_4

Salary
B01A_5

Small/petty shop/business

B01A_6

Business

B01A_7

Self-Employed

B01A_8

Sale of Livestock
B01A_9

Pension

B01A_10

Remittance

B01A_11

Rent

B01B

What was the annual income from this activity?

B01B_1

Agriculture
B01B_2

Unskilled Labor
B01B_3

Skilled Worker

B01B_4

Salary
B01B_5

Small/petty shop/business

B01B_6

Business

B01B_7

Self-Employed

B01B_8

Sale of Livestock
B01B_9

Pension

B01B_10

Remittance

B01B_11

Rent

B01C

What was the annual expenditure on this activity?

B01C_1

Agriculture
B01C_2

Unskilled Labor
B01C_3

Skilled Worker

B01C_4

Salary
B01C_5

Small/petty shop/business

B01C_6

Business

B01C_7

Self-Employed

B01C_8

Sale of Livestock
B01C_9

Pension

B01C_10

Remittance

B01C_11

Rent

B02

Has any member of your household borrowed money from any sources in the past and it has been closed?
B03

Please provide the details of the previous borrowings (closed)

B03_1

Purpose of Borrowing
B03_2

Source
B03_3

Amount Borrowed

B03_4

Amount Paid

B04

Is there any amount that any member of the household has borrowed and is currently outstanding?

B05

Please provide the details of the outstanding borrowings

B05_1

Purpose of Borrowing
B05_2

Source
B05_3

Amount Borrowed

B05_4

Amount Paid

B05_5

Amount Outstanding
B05A

Reasons for selecting a source of finance:
B06

Please provide us details of the expenses on the following items in the last 30 days (1 Month)

B06_1

Food items (consumed at home and outside)
B06_2

Cigarettes, tobacco/snuff, alcohol etc.
B06_3

Toiletries Items (soaps, toothpaste, body lotions/creams, hair oil, shaving items, shampoo, etc.)
B06_4

Other household items (detergents, shoe polish, bulb, tube light, buckets, matchsticks, etc.)
B06_5

Fixed phone line, mobile phone, and internet service
B06_6

Travel (bus, taxis)
B06_7

Fuel for car/motor bike
B06_8

Fuel for diesel generator (Owned)
B06_9

Fuel for diesel generator (Shared)
B06_10

Fuel for diesel generator (Rented)
B06_11

Firewood, coal, etc. used for cooking purpose
B06_12

Taxes (formal and informal)
B06_13

Entertainment (cable, sports, picnic, etc.)
B06_14

Rent/housing

B07

Please provide us details of the expenses on the following items in the last 12 months (1 year)

B07_1

Healthcare

B07_2

Education (tuition fees)

B07_3

Other Expenses on Education (uniforms, text books, pen pencils, notebooks, other stationeries)
B07_4

Clothing and foot wear
B07_5

Gifts to relatives
B07_6

Wedding, funerals, haj
B07_7

Annual celebrations and charitable donations (khair-o-khairat)
B07_8

Household (construction and repair)
B08

Please provide us details of expenses on purchase of the following assets in the last one year

B08A

Did you purchase this ?

B08A_1

Land, house, or other property
B08A_2

Livestock

B08A_3

Jewelry

B08A_4

Vehicle (scooter, tractor, etc.)

B08A_5

Electrical appliances

B08A_6

Solar panels

B08B

Amount Spent

B08B_1

Land, house, or other property
B08B_2

Livestock

B08B_3

Jewelry

B08B_4

Vehicle (scooter, tractor, etc.)

B08B_5

Electrical appliances

B08B_6

Solar panels

B09

Please provide us details of savings made by household members in the last one year

B09_1

Bank

B09_2

Microfinance Institutions
B09_3

Informal Savings Groups
B09_4

Self Help Groups
B09_5

Friends/Relatives
B09_6

At Home

B10

How frequently do you make savings in the above-mentioned institutions?
B11

How much amount do you generally save in the above-mentioned frequency of time?

ELECTRICITY SUPPLY AND DEMAND
C01

What kind of electricity connection do you have in your household?

C01_1

Government Grid Electricity (DABS) – Any Type

C01_2

Hydro-Grids/Mini-Hydro Grid/Pico Grid
C01_3

Solar Based Mini-Grid/Micro/Pico Grid
C01_4

Diesel Generator Powered Electricity (Owned)

C01_5

Diesel Generator Powered Electricity (Shared)
C01_6

Diesel Generator Powered Electricity (Rented)
C01_7

Diesel Generator Powered Electricity (Provider)
C01_8

Solar Powered Home System (Solar Home Systems)
C01_9

No Electricity in the Household
C02

How are you billed for electricity consumed from grid source?

C03

How much do you spend monthly on grid electricity?

C04

Does your household experience frequent black-outs/disruptions in supply?

C05

How frequent is the disruption?

C06

In a day on an average out of 24 hours for many hours do you experience black-out/disruptions in supply?
C07

What are the current sources of lighting in your household?

C07A

Primary Source
C07B

Average daily supply of the following (out of 24 Hours)

C07B_1

Government Grid Electricity (DABS)
C07B_2

Hydro-Grids/Mini-Hydro Grid/Pico Grid

C07B_3

Solar Based Mini-Grid/Micro/Pico Grid
C07B_4

Solar Home Systems

C07B_5

Diesel Generator Powered Electricity (Owned)
C07B_6

Diesel Generator Powered Electricity (Shared)
C07B_7

Diesel Generator Powered Electricity (Rented)
C07B_8

Diesel Generator Powered Electricity (Provider)
C07B_9

Kerosene Lantern/Lamps
C07B_10

LED Lights with dry Battery Cells
C07B_11

Gas
C07B_12

Candles
C07B_13

No Lighting
C07C

Average daily usage (out of 24 hours)

C07C_1

Government Grid Electricity (DABS)
C07C_2

Hydro-Grids/Mini-Hydro Grid/Pico Grid

C07C_3

Solar Based Mini-Grid/Micro/Pico Grid
C07C_4

Solar Home Systems

C07C_5

Diesel Generator Powered Electricity (Owned)
C07C_6

Diesel Generator Powered Electricity (Shared)
C07C_7

Diesel Generator Powered Electricity (Rented)
C07C_8

Diesel Generator Powered Electricity (Provider)
C07C_9

Kerosene Lantern/Lamps
C07C_10

LED Lights with dry Battery Cells
C07C_11

Gas
C07C_12

Candles
C07C_13

No Lighting
C07D

Other Source of Lighting (Multiple Responses)

C07D_1

Government Grid Electricity (DABS)
C07D_2

Hydro-Grids/Mini-Hydro Grid/Pico Grid

C07D_3

Solar Based Mini-Grid/Micro/Pico Grid
C07D_4

Solar Home Systems

C07D_5

Diesel Generator Powered Electricity (Owned)
C07D_6

Diesel Generator Powered Electricity (Shared)
C07D_7

Diesel Generator Powered Electricity (Rented)
C07D_8

Diesel Generator Powered Electricity (Provider)
C07D_9

Kerosene Lantern/Lamps
C07D_10

LED Lights with dry Battery Cells
C07D_11

Gas
C07D_12

Candles
C07D_13

No Lighting
C07E

Average supply of the following (out of 24 Hours)

C07E_1

Government Grid Electricity (DABS)
C07E_2

Hydro-Grids/Mini-Hydro Grid/Pico Grid

C07E_3

Solar Based Mini-Grid/Micro/Pico Grid
C07E_4

Solar Home Systems

C07E_5

Diesel Generator Powered Electricity (Owned)
C07E_6

Diesel Generator Powered Electricity (Shared)
C07E_7

Diesel Generator Powered Electricity (Rented)
C07E_8

Diesel Generator Powered Electricity (Provider)
C07E_9

Kerosene Lantern/Lamps
C07E_10

LED Lights with dry Battery Cells
C07E_11

Gas
C07E_12

Candles
C07E_13

No Lighting
C07F

Average daily usage (out of 24 hours)

C07F_1

Government Grid Electricity (DABS)
C07F_2

Hydro-Grids/Mini-Hydro Grid/Pico Grid

C07F_3

Solar Based Mini-Grid/Micro/Pico Grid
C07F_4

Solar Home Systems

C07F_5

Diesel Generator Powered Electricity (Owned)
C07F_6

Diesel Generator Powered Electricity (Shared)
C07F_7

Diesel Generator Powered Electricity (Rented)
C07F_8

Diesel Generator Powered Electricity (Provider)
C07F_9

Kerosene Lantern/Lamps
C07F_10

LED Lights with dry Battery Cells
C07F_11

Gas
C07F_12

Candles
C07F_13

No Lighting
C08

Which of the following lighting devices/equipment do you use at your household?

C08A

Do you own this?

C08A_1

Grid Powered bulbs/tubes

C08A_2

Solar Lanterns/Lamps/Lights
C08A_3

Solar Lamps with Mobile Charging Point
C08A_4

Kerosene Lamps
C08A_5

Candles
C08A_6

LPG based lamps/lights
C08A_7

Battery Backed Lights (LEDs/Torches)
C08B

How many such do you own?

C08B_1

Grid Powered bulbs/tubes

C08B_2

Solar Lanterns/Lamps/Lights
C08B_3

Solar Lamps with Mobile Charging Point
C08B_4

Kerosene Lamps
C08B_5

Candles
C08B_6

LPG based lamps/lights
C08B_7

Battery Backed Lights (LEDs/Torches)
C08C

What is your monthly expenditure on this during Summers?

C08C_1

Grid Powered bulbs/tubes

C08C_2

Solar Lanterns/Lamps/Lights
C08C_3

Solar Lamps with Mobile Charging Point
C08C_4

Kerosene Lamps
C08C_5

Candles
C08C_6

LPG based lamps/lights
C08C_7

Battery Backed Lights (LEDs/Torches)
C08D

What is your monthly expenditure on this during Winters?

C08D_1

Grid Powered bulbs/tubes

C08D_2

Solar Lanterns/Lamps/Lights
C08D_3

Solar Lamps with Mobile Charging Point
C08D_4

Kerosene Lamps
C08D_5

Candles
C08D_6

LPG based lamps/lights
C08D_7

Battery Backed Lights (LEDs/Torches)
C09

Does any member of your household have any of the following assets?

C09A

Do you own this?

C09A_1

Radio
C09A_2

Television
C09A_3

Refrigerator
C09A_4

Stand fan
C09A_5

Computer
C09B

What is the primary source of energy for this equipment?

C09B_1

Radio
C09B_2

Television
C09B_3

Refrigerator
C09B_4

Stand fan
C09B_5

Computer
C09C

What is the secondary source of energy for this equipment?

C09C_1

Radio
C09C_2

Television
C09C_3

Refrigerator
C09C_4

Stand fan
C09C_5

Computer
C09D

On an average for how many hours a day do you use it?

C09D_1

Radio
C09D_2

Television
C09D_3

Refrigerator
C09D_4

Stand fan
C09D_5

Computer
C10

What is the primary source of energy for your mobile phone?
C10A

What is the secondary source of energy for your mobile phone?
C10B

On an average for how many hours a day do you use your mobile phone?
C10C

Where do you usually charge your mobile phone?
C10D

What is the monthly expenditure on charging the phone?
C11

How often do you go to the retailer’s shop to charge your mobile phone?

C12

What are the various issues that you face from sources of lighting other than electricity?

SOLAR WATER HEATERS AND SOLAR HOME SYSTEMS
D01

“Solar products are very reliable/trustworthy source for energy production”. To what extent do you agree with this statement?

D02

Does your household own a water heater?
D03

How many solar heaters do you own?

D04

Please provide the details of the equipment and technology that you use for heating water

D04A

Name of the device
D04B

Number of devices owned?
D04C

Source used for heating water
D04D

Monthly expenditure for heating water
D04E

Monthly expenditure on maintenance
D05

Does your household own any kind  of solar products?
D06

Details of the solar products owned by the households

D06A

Name of the Product (Model)
D06B

Type of Equipment
D06C

Since when are you using this?
D06D

Brand
D06E

Capacity of the Equipment
D06E1

Unit
D06F

Amount Paid for Purchase
D06G

Average Maintenance Cost (Per year)
D07

How often do you change the batteries of your solar lamps/torch/lantern?
D08

How often do you change the batteries of your solar home system?
D09

How often do you change the bulbs of your solar lamps/torch/lantern?

D10

How often do you change the bulbs of your solar home system?

D11

Where do you generally go to purchase the spare parts for your solar products?
D12

How would you rate the products you are currently using on the mentioned parameters?

D12_1

Price paid (Value for Money)
D12_2

Quality of the product
D12_3

Battery life
D12_4

Durability
D12_5

Design (Appearance/Shape)
D12_6

Application
D13

Are you aware of the following solar products available in the market?

D13_1

Solar Lamps/Torches/Lanterns
D13_2

Solar Lamps with Mobile Charging Point
D13_3

Solar Home System
D13_4

Solar Water Heater

PERCEPTION/PREFERENCES AND WILLINGNESS TO PAY
E01

Rank the following country of origin and brands in order of their preference for Solar Lanterns/Lamps/Torches. (Rank 1- Most prefered, Rank 6- Least Prefered)

E01_1

Made in India
E01_2

Made in China

E01_3

Made in Germany
E01_4

Made in Turkey
E01_5

Made in Iran
E02

Rank the following country of origin and brands in order of their preference for Solar Lamps with mobile charging points. (Rank 1- Most prefered, Rank 6- Least Prefered)

E02_1

Made in India
E02_2

Made in China

E02_3

Made in Germany
E02_4

Made in Turkey
E02_5

Made in Iran
E03

Rank the following country of origin and brands in order of their preference for Solar Home System? (Rank 1- Most prefered, Rank 6- Least Prefered)

E03_1

Made in India
E03_2

Made in China

E03_3

Made in Germany
E03_4

Made in Turkey
E03_5

Made in Iran
E04

Rank the following country of origin and brands in order of their preference for Solar Water Heaters? (Rank 1- Most prefered, Rank 6- Least Prefered)

E04_1

Made in India
E04_2

Made in China

E04_3

Made in Germany
E04_4

Made in Turkey
E04_5

Made in Iran
E05

How important are these features for you while taking a buying decision? (For Solar Lanterns/ For Solar Lamps/Torches)

E05_1

Quality of the product
E05_2

Durability
E05_3

Design
E05_4

Capacity
E05_5

Size (Compact)
E05_6

Ease of Use
E05_7

Color

E05_8

Warranty
E05_9

Price
E06

How important are these features for you while taking a buying decision? (For Solar Lamps with mobile charging points)

E06_1

Quality of the product
E06_2

Durability
E06_3

Design
E06_4

Capacity
E06_5

Size (Compact)
E06_6

Ease of Use
E06_7

Color

E06_8

Warranty
E06_9

Price
E06A

How important are these features for you while taking a buying decision? (For Solar Home System)

E06A_1

Quality of the product
E06A_2

Durability
E06A_3

Design
E06A_4

Capacity
E06A_5

Size (Compact)
E06A_6

Ease of Use
E06A_7

Color

E06A_8

Warranty
E06A_9

Price
E07

How important are these features for you while taking a buying decision? (For Solar Water Heaters)

E07_1

Quality of the product
E07_2

Durability
E07_3

Design
E07_4

Capacity
E07_5

Size (Compact)
E07_6

Ease of Use
E07_7

Color

E07_8

Price
E08

How important are these factors in influencing your buying decision of any solar products?

E08_1

Place of Availability
E08_2

Price

E08_3

Brand name

E08_4

Social Influence (social status/community leader)
E08_5

Product Features
E08_6

After Sales Service
E08_7

Promotion Activities
E09

What according to you are the pros of using solar products?
E10

What according to you are the cons of using solar products?
E11

WILLINGNESS TO PAY

E11A

Solar Lanterns/Torches

E12

Would you be willing to pay AFN 727 for this solar device? (120% Price)
E13

Why would you not buy this solar device?

E14

Would you be willing to pay AFN 606 for this solar device? (100% Price)
E15

Would you be willing to pay AFN 485 for this solar device? (80% Price)
E16

How much can you pay for this device?
E17

Solar Lamps with Mobile Charging Point

E18

Would you be willing to pay AFN 727 for this solar device? (120% Price)
E19

Why would you not buy this solar device?

E20

Would you be willing to pay AFN 606 for this solar device? (100% Price)
E21

Would you be willing to pay AFN 485 for this solar device? (80% Price)
E22

How much can you pay for this device?
E23

Solar Home Systems (SHS)

E24

Would you be willing to pay AFN 727 for this solar device? (120% Price)
E25

Why would you not buy this solar device?

E26

Would you be willing to pay AFN 606 for this solar device? (100% Price)
E27

Would you be willing to pay AFN 485 for this solar device? (80% Price)
E28

How much can you pay for this device?
E29

Solar Water Heaters (SWH)

E30

Would you be willing to pay AFN 727 for this solar device? (120% Price)
E31

Why would you not buy this solar device?

E32

Would you be willing to pay AFN 606 for this solar device? (100% Price)
E33

Would you be willing to pay AFN 485 for this solar device? (80% Price)
E34

How much can you pay for this device?
CULTURAL/MEDIA FCTORS
F01

Where did you get to know about this solar product that you currently possess?

F02

Which radio station have you listened in the past seven days?
F02A

Which one radio station have you listened the most in the past seven days?
F03

Which TV station have you watched in the past seven days?
F03A

Which one TV station have you watched the most in the past seven days?
DISTRIBUTION NETWORK
G01

Where did you purchase/get your recent solar product? Solar Lantern/Lamps
G02

Where is the outlet located?
G03

How far is the outlet?

G03A

Unit
G04

Where did you purchase/get your recent solar product? Solar Lantern/Lamps with Mobile Charger
G05

Where is the outlet located?
G05A

How far is the outlet?

G05A1

Unit
G06

Where did you purchase your recent solar product? Solar Home System

G07

Where is the outlet located?
G08

How far is the outlet?

G08A

Unit
G09

Where did you purchase your recent solar product? Solar Water Heater

G10

Where is the outlet located?
G11

How far is the outlet?

G11A

Unit
G12

How important are these factors while selecting a store

G12_1

Location of Store
G12_2

Price

G12_3

Convenience
G12_4

Quality product
G12_5

Wide range of options
G12_6

EMI/Finance Facility
G12_7

After-sales service
G12_8

Store staff
G12_9

Operating hours
G12_10

Store appearance