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Fps Template -Form Fill

SOCIO-DEMOGRAPHICS
Q01

What is your age?

Q02

What is your gender?

Q03

What is the highest level of education that you have attained?

Q04

Please tell us about your marital status?

Q05

Could you please tell which religion do you follow?
Q06

What caste do you belong to?

FPS Establishment and Its Operations
A01

What type of FPS ownership is it?

A02

What was your reason for opening the Fair Price Shop?

A03

What was the year of establishment of your Fair Price Shop?

A04

Do you have your own license for running the FPS or do you pay rent to someone for the license?

A05

What are the types of license you possess as per commodity?

A05_1

Rice
A05_2

Wheat

A05_3

Kerosene Oil

A05_4

Sugar

A05_5

Others (Please specify)
A05A

Money given to obtain the liscence ( Rupees)

A05A_1

Rice
A05A_2

Wheat

A05A_3

Kerosene Oil

A05A_4

Sugar

A05A_5

Others (Please specify)
A05B

Present ly selling the commodity in the FPS

A05B_1

Rice
A05B_2

Wheat

A05B_3

Kerosene Oil

A05B_4

Sugar

A05B_5

Others (Please specify)
A06

How much did you pay to obtain license for the first time?

A07

When was the license renewed last time?

A08

How much do you have to pay for subsequent renewal?
A09

Is there any time lapse between the renewals?
A10

What is the duration of the time lapse? Record in days, months and years, as applicable.

A11

Has your license ever been suspended?

A12

How many times in the past, your license has been suspended?

A13

Please specify the period for the latest suspension.

A14

Why was it suspended last time?

A15

If yes, how much did you have to pay for its re-activation ?

A16

How many days in a week is your shop open?

A17

What are the working hours of your shop? (Record opening and closing timings)
A18

Do you inform the beneficiaries in advance that the PDS outlet would be closed?

A19

Who usually raises the indent?

A20

When are requests for the next indent of commodities raised?
A21

Do you receive the delivery of the commodities before or after your present stock is over?

A22

If you receive the commodities after the stock is over, usually how much is the time lag.
A23

At the time of receiving grain commodities at FPS; what type of weighing scale do you use for taking weight measurements?

A24

At the time of sale of grain commodities at FPS; what type of weighing scale do you use for taking weight measurement?

A25

What is the number of ration cards enrolled in the following type of the cards in your shop

A25_1

Total card holders
A25_2

Below Poverty line (BPL)
A25_3

Above Poverty line (APL)
A25_4

Antyodaya (AAY)
A25_5

Anapurna
A25_6

Rice for Differently abled Person (RDP)
A25_7

Priority Households (PHH) card
A25_8

Any other, please specify

A26

In your opinion will it be beneficial for the beneficiaries to come and collect their ration even if they are not registered under your FPS?

A27

Please provide an answare for your response ?

A28

If stock is replenished in time, will it be feasible (in future) for the FPS owner, to provide the ration to the beneficiaries who are not registered under their FPS?
A29

If yes, in what way will it affect the FPS?

A30

On an average in a month, what was the frequency of TPDS Commodities received / lifted by your FPS?

A30A

Received

A30A_1

Rice

A30A_2

Wheat

A30A_3

Kerosene

A30A_4

Sugar

A30A_5

Other (specify)
A30B

Lifted

A30B_1

Rice

A30B_2

Wheat

A30B_3

Kerosene

A30B_4

Sugar

A30B_5

Other (specify)
A31

Did you record any delay in receiving?

A32

If yes, what was the reason for the delay? Please specify.
A33

How do you make the payment for the commodities you receive from the depot?

A33_1

Rice

A33_2

Wheat

A33_3

Sugar

A33_4

Kerosene
A33_5

Any other, please specify.
SUPPLY OF STOCK
B01

Which commodities are you supposed to receive at your Fair Price shop every month?

B01A

Total monthly entitlement quantities (kg / ltr)

B01A_1

Rice

B01A_2

Wheat

B01A_3

Kerosene

B01A_4

Sugar

B01A_5

Others (Please specify)
B01B

Total monthly allocation quantities (kg / ltr)

B01B_1

Rice

B01B_2

Wheat

B01B_3

Kerosene

B01B_4

Sugar

B01B_5

Others (Please specify)
B01C

Total last month received quantities (kg / ltr)

B01C_1

Rice

B01C_2

Wheat

B01C_3

Kerosene

B01C_4

Sugar

B01C_5

Others (Please specify)
B02

Are there times when the received quantities of commodities are less than allocated quantities?
B03

Whom do you report about differences in quantities? Please specify
B04

Do such differences get rectified?
B05

Why differences are not reported?

B06

How do you usually receive the commodities from the depots to your shop?

B07

Do you have to pay anything to receive food grains from the depots to your shop?
B08

If yes, for what do you have to pay to receive these commodities from the depots to your shop?

B09

Do you face any loss due to wastage of the commodities while transporting or unloading the commodities?
B10

Do you receive any SMS from the Departmental Storage Centers intimating you about the release of the commodities from the depot?
B11

What is the mechanism of intimation that the TPDS commodities have been released?
B12

At which price do you usually sell empty grain gunny bag? Please note price per bag.
B13

At which price do you usually sell empty sugar gunny bag? Please note price per bag.

B14

How many times in a month you carry out recording/ documentation activities?

B15

How much time is spent in maintaining the records in a day?

FPS Viability
C01

Is your shop connected to a pakka road?
C02

Is the FPS accessible by a four-wheeler?
C03

Approximate distance to accessible point (km) (instruction: accessible point to be measured by nearest pakka road)
C04

How far is the nearest beneficiary’s house located?

C05

How far is the farthest beneficiary’s house located?

C06

Is your shop rented or your own property?

C07

If the shop is rented, how much rent do you pay every month?

C08

In case you had to pay rent for this shop, then what would be the approximate rent?

C09

What is your primary source of income?

C10

How many people work in the FPS?
C11

For each person, provide details as follows

C11A

Paid/ unpaid

C11A_1

FPS Owner
C11A_2

FPS Owner cum Operator
C11A_3

FPS Operator

C11A_4

Individual 4
C11A_5

Individual 5
C11A_6

Individual 6
C11B

Number of day worked per month

C11B_1

FPS Owner
C11B_2

FPS Owner cum Operator
C11B_3

FPS Operator

C11B_4

Individual 4
C11B_5

Individual 5
C11B_6

Individual 6
C11C

Salary /wages paid in Rupees (monthly)

C11C_1

FPS Owner
C11C_2

FPS Owner cum Operator
C11C_3

FPS Operator

C11C_4

Individual 4
C11C_5

Individual 5
C11C_6

Individual 6
C12

How much do you pay as the electricity bill per month?
C13

Please ask the respondent to show the electricity bill, and verify the amount

C14

Do you pay any tax for the Fair price shop?
C15

How much tax do you pay annually for FPS?

C16

Does FPS have to pay any other cost for its functioning?

C17

If yes, then please tell us about the purpose and the amount paid?

C18

Do you sell any non- TPDS commodity?

C19

If yes, please specify the non- TPDS commodity?

C20

Usually how many ration cards were entered/ recorded manually and electronically?

C20A

Manually
C20B

Electronic ally

C21

In months when you have not been getting the full quota supply of grain (during the last three months), what was the main reason for not getting the full quota?”
SATISFACTION
D01

How is the quality of commodities received the last time in your FPS?

D01_1

Rice
D01_2

Wheat
D01_3

Kerosene Oil
D01_4

Sugar
D01_5

Others Specify
D02

Have you ever reported on the poor quality of commodities?

D03

Why have you not reported about poor quality of FPS commodities? Please explain.

D04

If yes, to whom it was reported to? Please specify

D05

Was the issue addressed?
D06

How was the issue addressed?
D07

Are you satisfied with how the issue has been addressed?
D08

In a period of last 6 months, how many times were inspection visits conducted by the officials?

D09

When was the last time officials visited your FPS?
D10

What do the officials do during their visit?
D11

Do you inform the beneficiaries in advance that the PDS outlet would be closed for inspection?

D12

How would you rate the PDS today compared with 3 years ago in the following respects: pertaining to beneficiary’s accessibility of FPS, quality of ration received from depots and behavior of beneficiaries?

D12_1

pertaining to beneficiary’s accessibility of FPS
D12_2

quality of ration received from depots
D12_3

behavior of beneficiaries
D13

What is your or FPS total profit by selling the TPDS commodities in a month?
D14

What is your or FPS’s total income by selling the non- TPDS commodities in a month ?
D15

Whether FPS can make sufficient profit to sustain the business?
D16

Do you receive the commodities on time from the depot after the money has been deposited for the raised indent?
D17

What is the usual time gap? Please specify.
D18

What is the average number of times when the stock at FPS was not available at the time of distribution in the last 6 months after you have made the payment?
D19

Is the digitization of beneficiaries complete in your area?
D20

How do the beneficiaries access the automated FPS?
D21

Has a Point of Sale (PoS) installed in your FPS?
D22

Have you been given sim cards for PoS?
D23

Is the Point of Sale (PoS) device at your FPS linked with Aadhaar?
D24

What is the mode of operation for PoS?
D25

Do you access a technical helpline for resolving any errors/glitches?
D26

What is the time taken for resolution of these errors/glitches?
D27

Have you received training for using PoS?
D28

What do you think the digitization of beneficiary list most useful in?

D29

In your opinion, do you think digitizing the beneficiary list is helpful for you?
D30

If yes, in what respect is it beneficial for FPS?
D31

What has is FPS automation most useful in? Please specify.
D32

Do you think FPS automation is beneficial for you?
D33

If yes, in what respect it will be beneficial?
GREIVANCE REDRESSAL MECHANISM
E01

Are you aware about the Sanjog Helpline?
E02

If yes, what is their function? Please specify. Don’t probe responses
E03

Have you ever heard that any beneficiary has registered any complaint with the Sanjog helpline?
E04

Did anyone from the Sanjog helpline ever contact you regarding any complaint which has been registered with them?
E05

Does FPS Vigilance Committee exist in your area?
E06

What is the role of such committees?
E07

Did anyone from the FPS Vigilance Committee ever contact you regarding any complaint which has been registered with them for your FPS?
E08

Do beneficiaries ever directly complain to you?
E09

If yes, what are the issues for such complaints?
E10

How do you resolve such complaints?
PERCEPTION AND USE ABOUT TECNOLOGY
F01

Do you use a Mobile Phone?
F02

Are you comfortable receiving/sending SMS?
F03

Which language you are comfortable in sending the sms? (Multiple response possible)

F04

Do you receive any SMS forTPDS services?
F05

Does FPS have landline telephone?
F06

Does FPS have internet connectivity?
F07

Do you think that technology used for transactions has increased the efficiency in terms of food grain distribution to beneficiary?
F08

Do you think SMS alerts of delivery of grains from DSCs to FPS sent to all the registered beneficiary households is helpful in increasing the transparency and improving accountability?
F09

Do you think automation of the maintenance of stock registers, issues and delivery orders has reduced your work and proved beneficial?
F10

Do you think payment module for FPS dealers to deposit funds to the OSCSC via direct bank transfers is beneficial?
F11

Do you think Point of Sale enabled transactions to facilitate beneficiary authentication are helpful in efficient delivery?
F12

Do you think using bar- coded coupons for transactions in rural locations and automated allocations based on MIS data on previous month’s off-take has improved transparency?
Capacity Building
G01

Have you received any type of training in the last year?
G02

If yes, what was the subject of the training programme? Please specify.
G03

When did you receive the training?
G04

Do you require or need any kind of training in the future?
G05

If yes, please specify the training need.
OBSERVATION OF THE FAIR PRICE SHOP
H01

Do you find the shop and its surroundings clean?
H02

Do you think the shop has adequate space for its operation?
H03

Does FPS have separate storage place for TPDS commodities?
H04

What is the approximate size of the FPS?
H05

Is FPS
H06

Does the shop have a blackboard / information display/ declaration board?
H07

If yes, where is it located / displayed?
H08

Please observe and record information displayed on the blackboard / information display / declaration board.

H08_1

Stock details of commodities
H08_2

Stock receipt details – date, quantities, etc
H08_3

FPS Timings
H08_4

List of various commodities
H08_5

Price of various commodities
H08_6

Number and type of card details
H08_7

Shop identification details – FPS Code, owner, license number, address, etc
H09

Please ask the respondent to show the stock registers of the last month.
H10

Please observe and record the type of registers present in the FPS.

H10_1

Commodity Stock

H10_2

Card / beneficiary list

H10_3

Commodities Sales
H10_4

Supervision / monitoring visit

H10_5

Tally Register
H10_6

Complaint book / register
H10_7

Other (specify)