Please Wait...
Impact Assessment Template -Form Fill
Identification
Q01
State
Q02
District
Q03
Block
Q04
Village (Hamlet Name)
Q05
Household No
Q06
Village type
Q07
Interviewer
Q08
Date of interview
Q09
Result of interview completion
Interview completed
Interview incomplete
Others (Specify)
Q10
Interview start time
Q11
Interview end time
Q12
Name of the respondent
Q13
What is the sex of respondent?
Male
Female
Q14
Religion of the respondent
Muslim
Hindu
Christian
Buddhist
Sarna
Sikh
Jain
Other [specify]
Q15
Caste of the respondent
General
Scheduled caste
Scheduled tribe
Other backward class
Q16
Which ration card does your household possess?
Priority HouseHold (PHH)
Antodaya Anna Yojana (AAY)
Annapurna Yojana
Other State Scheme
Non-Priority Household (NPHH)
No ration card
Don’t Know
Q17
Now we would like information on the different persons who usually live in your household.
Q18
Name
Q19
Relation to head of the household.
Head of Household
Husband/wife
Son or daughter
Son in-law or daughter-in-law
Grand father or grand mother
Grand son or grand daughter
Father or mother
Father in law or mother in law
Brother or sister
Brother in law or sister in law
Uncle or aunt
Other relatives
Step/adopted children
Not related
Q20
Sex
Male
Female
Others (Specify)
Q21
Age
Q22
Main Occupation
Farmer (Crops)
Agricultural day labor
MGNREGA labor
Non-agricultural day labor
Service/Salaried worker
Small/cottage industry
Business/Traders
Skilled worker
Other Self-employment
House Work /Housewife
Migrant labor
Jobless
Other
Q23
Education
Currently in class I
Completed class 1
Completed class 2
Completed class 3
Completed class 4
Completed class 5
Completed class 6
Completed class 7
Completed class 8
Completed class 9
Completed Secondary School
Completed Higher Secondary
BA/BSC pass/Fazil
BA/BSC honors/Fazil (Hons)
MA/MSC/Kamil & above
Hafezia/Kiratia/Nurani madrasa
Child less than 5 years
Never attended school
Currently in Aanganwadi/Pre-school Education
Household Characteristics
A01
Does your household own this house or any other house?
Yes
No
A02
What is the type of house you are currently living in?
Pucca
Semi Pucca
Kuccha
A03
What is the main material of which the floor is made of?
Natural floor (mud/clay/sand/dung)
Rudimentary floor (raw wooden planks/ bamboo/stone/brick)
Finished floor (Marble/cement/tiles/polished wood or stone)
A04
What is the main material of which the roof is made of?
Natural roof (no roof/thatch/grass/mud/plastic or polythene sheet)
Rudimentary roof ((Mat/Bamboo/Unburnt Brick/raw wooden planks/stones)
Finished roof (Metal/cement/wood/asbestos sheets/tiles/concrete/burnt bricks)
A05
What is the main material of which the exterior walls are made of?
Natural wall (no wall/thatch/grass/mud/cane /bamboo)
Rudimentary wall ((Mat/Bamboo/Unburnt Brick/raw wooden planks/stones)
Finished wall (Metal/cement/wood/asbestos sheets/tiles/concrete/burnt bricks)
A06
Do you have any window at home?
Yes
No
A07
How many rooms in this house are used for sleeping?
A08
What is the main source of drinking water for members of your household?
Piped water in residence/yard/plot
Hand pump in residence/yard/plot
Well water in residence/yard/plot
Public hand pump
Public tap
Public well
Bore well
Canal
Other source (specify)
A09
What kind of toilet facility does your household have?
Open Defecation
Flush to piped sewer system
Flush to septic tank
Flush to pit latrine
Flush to somewhere else
Ventilated improved pit biogas latrine
Pit latrine with slab
Pit latrine without slab/ open pit
Twin pit/composting toilet
Dry toilet
Others (specify)
A10
What is the waste disposal mechanism for your toilet?
Clean it yourself
Somebody else picks and thorws it
Others (specify)
A11
What is the main source of lighting for your household?
Electricity
Kerosene lamp
Gas lamp
Candle
Solar energy
Other (specify)
A12
What is the main source of fuel used for cooking in your household?
Wood
Crop residues
Dung cakes
Coal/ charcoal
Kerosene
Electricity
Liquified petroleum gas
Bio-gas
Other (specify)
A13
Does your household own any of the following items
A13_1
Electric connection
Yes
No
A13_2
Pressure cooker
Yes
No
A13_3
Mixer/grinder
Yes
No
A13_4
Motorcycle/scooter
Yes
No
A13_5
Car/Jeep
Yes
No
A13_6
Tractor
Yes
No
A13_7
Bicycle
Yes
No
A13_8
Animal-drawn cart
Yes
No
A13_9
Chair
Yes
No
A13_10
Table
Yes
No
A13_11
Cot/ Bed
Yes
No
A13_12
Mattress
Yes
No
A13_13
Clock or watch
Yes
No
A13_14
Electric fan
Yes
No
A13_15
Water pump
Yes
No
A13_16
Thresher
Yes
No
A13_17
Radio/Transistor
Yes
No
A13_18
Sewing machine
Yes
No
A13_19
Refrigerator
Yes
No
A13_20
B & W television
Yes
No
A13_21
Colour television
Yes
No
A13_22
Telephone
Yes
No
A13_23
Computer
Yes
No
A13_24
Mobile
Yes
No
A14
Does your household have a bank account or post-office account?
Yes, bank account
Yes, post office account
Both Bank and Post Office account
None
Land ownership; use of land for farming and irrigation practices
B01
Does your household own agricultural land?
Yes
No
B02
Total agricultural land owned
B02A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
B03
How much of your owned land do you cultivate?
B03A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
B04
Have you also taken any land on lease from others in last 2 years?
Yes
No
B05
How much land have you leased in?
B05A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
B06
Do you pay cash for this land or do you divide the crop between you and the land owner?
Cash
Crop
Both
B07
About how much do you pay duAring a year for this land?
B08
Have you leased out your land to someone else?
Yes
No
B09
How much land have you leased out?
B09A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
B10
Do you receive cash for this land or do you divide the crop between you and the tenant?
Cash
Crop
Both
B11
[IF CASH] How much cash do you receive during a year for this land?
B12
[IF CROP]: What portion of the crop do you receive?
B13
About how much was that worth (in INR) last year?
B14A
Have you mortgaged your land to someone else?
Yes
No
B14B
How much land have you mortgaged out?
B14B1
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
B15
Do you have any source of irrigation on your land/the land that you cultivate?
Yes
No
B16
What are the sources
B16_1
Farm pond
Yes
No
B16_2
Dugwell
Yes
No
B16_3
Lift/Flow irrigation
Yes
No
B16_4
Canal/River
Yes
No
B16_5
Earthern dam/Check dams
Yes
No
B16_6
Borewell
Yes
No
B16A
Was it created under MGNREGA?
B16A_1
Farm pond
Yes
No
B16A_2
Dugwell
Yes
No
B16A_3
Lift/Flow irrigation
Yes
No
B16A_4
Canal/River
Yes
No
B16A_5
Earthern dam/Check dams
Yes
No
B16A_6
Borewell
Yes
No
B17
What is the land area irrigated
B17A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
B18
Is your land bunded and levelled?
Yes
No
B19
How much area is bunded and levelled?
B19A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
B20
Who did the bunding & levelling?
On my own
Hired labour to get it done
It was done under MGNREGA work in the village
Land was already bunded and levelled
Others
Cultivated crops
C01
Crop Code
Paddy
Wheat
Maize
Millet
Sorghum
Barley
Oat
Groundnut
Mustard
Rapeseed
Nizer
Sunflower
Soyabean
Linseed
Til
Pigeonpea
Blackgram
Chickpea
Greengram
Horsegram
Lenti
Lathyrus (Cheakling pea)
Potato
Tomato
Cabbage
Cauliflower
Chilli
Capsicum
Spongegourd
Bittergourd
Bottlegourd
Spinegourd
Snakegourd
Pointed gourd
Ridge gourd
Leafy vegetable
Sweet Potato
Brinjal
Cucumber
French bean
Green pea
Broccoli
Radish
Carrot
Coriander
Ladiesfinger
Coccinia (kundru)
Elephant foot yam
Colocasia (Kacchu)
Aru
Flat bean (Saim)
Drumstick
Beet root
Pupmkin
Cowpea
Bean
Kakri
Ashgourd
Guava
Mango
Lemon/Lime
Orange
Papaya
Water Melon
Litchi
Berries
Banana
Sugarcane
Beal(woodapple)
Pomelo
Pomegranate
Pineapple
Onion
Garlic
Turmeric
Ginger
Tobacco
Jute
Dhaincha
Makhana
Water chestnut
Bamboo
Marigold
Others Specify
C02
How much of the agricultural land was used in the cultivation of this crop?
C02A
Unit
Decimal
Biswa
Katha
Bigha
Acre
Hectare
Guntha
Cents
Others (specify)
C03
Do you irrigate this crop?
Yes
No
C04
Who is primarily responsible for cultivating this crop?
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
C05
What is the total quantity produced last year? (Quantity in KG.)
C06
How much did you keep for home consumption?
C07
How much did you give (in k.g.) to the landlord?
C08
How much did you sell? (Enter 0 if you did not sell)
C09
Where do you sell the crop?
Local market in the village
Sold to other people in the village
Middlemen
Retail market in panchayat, block or town
Wholesale market
Producer Company
Barter
Co-operative Society
C10
What was the average market rate you got for this crop? (price per kg)
C11
What was/would be the income from the sale of this crop?
C12
Did you sell any crop residue?
Yes
No
C13
What was the value of Crop residue sold?
C14
Do you own any of these farm equipment ?
C14_1
Spade/Sickle
Yes
No
C14_2
Wooden plough
Yes
No
C14_3
Moldbord plough
Yes
No
C14_4
Harrow
Yes
No
C14_5
Thresher
Yes
No
C14_6
Harvester
Yes
No
C14_7
Tractor
Yes
No
C14_8
Trolley/ Bullock Cart
Yes
No
C15
Do you rent out any of these equipment?
C15_1
Spade/Sickle
Yes
No
C15_2
Wooden plough
Yes
No
C15_3
Moldbord plough
Yes
No
C15_4
Harrow
Yes
No
C15_5
Thresher
Yes
No
C15_6
Harvester
Yes
No
C15_7
Tractor
Yes
No
C15_8
Trolley/ Bullock Cart
Yes
No
C16
How much do you earn annually from renting out (INR)?
C16_1
Spade/Sickle
C16_2
Wooden plough
C16_3
Moldbord plough
C16_4
Harrow
C16_5
Thresher
C16_6
Harvester
C16_7
Tractor
C16_8
Trolley/ Bullock Cart
ANIMAL OWNERSHIP AND PRODUCTION AND SALE OF ANIMAL PRODUCTS
D01
During the last 12 months, did your household own any animals including livestock, poultry, fish, etc?
Yes
No
D02
How many ________ has your household owned in the last 12 months?
D02_1
Cattle/buffalo/oxen/cow/yak
D02_2
Goat
D02_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen
D02_4
Sheep
D02_5
Pig
D02_6
Fish
D03
How many ______ does your household currently own?
D03_1
Cattle/buffalo/oxen/cow/yak
D03_2
Goat
D03_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen
D03_4
Sheep
D03_5
Pig
D03_6
Fish
D04
How many ___ did you sell in the last 12 months?
D04_1
Cattle/buffalo/oxen/cow/yak
D04_2
Goat
D04_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen
D04_4
Sheep
D04_5
Pig
D04_6
Fish
D05
How much did your household receive for the sale of these ___ in the last 12 months?
D05_1
Cattle/buffalo/oxen/cow/yak
D05_2
Goat
D05_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen
D05_4
Sheep
D05_5
Pig
D05_6
Fish
D06
Who is primarily responsible for taking care of the animal/s?
D06_1
Cattle/buffalo/oxen/cow/yak
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D06_2
Goat
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D06_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D06_4
Sheep
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D06_5
Pig
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D06_6
Fish
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D07
Who is primarily responsible for selling this/these animal/s?
D07_1
Cattle/buffalo/oxen/cow/yak
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D07_2
Goat
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D07_3
Chicken/ Guinea fowl/Pigeons/Duck/ Hen
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D07_4
Sheep
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D07_5
Pig
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D07_6
Fish
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D08
Did you produce any ___ during the last 12 months?
D08_1
Animal meat/offal
Yes
No
D08_2
Poultry meat/offal
Yes
No
D08_3
Milk (including that produced for milk products)
Yes
No
D08_4
Eggs
Yes
No
D08_5
Cow Dung/ Cow Dung Cakes
Yes
No
D09
Did your household sell any of the ___ produced?
D09_1
Animal meat/offal
Yes
No
D09_2
Poultry meat/offal
Yes
No
D09_3
Milk (including that produced for milk products)
Yes
No
D09_4
Eggs
Yes
No
D09_5
Cow Dung/ Cow Dung Cakes
Yes
No
D10
How much in total did your household receive for the sale of ________?
D10_1
Animal meat/offal
D10_2
Poultry meat/offal
D10_3
Milk (including that produced for milk products)
D10_4
Eggs
D10_5
Cow Dung/ Cow Dung Cakes
D11
Who is primarily responsible for this activity?
D11_1
Animal meat/offal
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D11_2
Poultry meat/offal
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D11_3
Milk (including that produced for milk products)
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D11_4
Eggs
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
D11_5
Cow Dung/ Cow Dung Cakes
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
CONTRIBUTION OF WAGES, SERVICES 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 operations
Yes
No
E01_2
MGNREGA
Yes
No
E01_3
Masonry
Yes
No
E01_4
Carpentry
Yes
No
E01_5
Construction labour
Yes
No
E01_6
Labour work in brick kiln
Yes
No
E02
Who is primarily responsible for this activity?
E02_1
Agriculture operations
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E02_2
MGNREGA
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E02_3
Masonry
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E02_4
Carpentry
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E02_5
Construction labour
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E02_6
Labour work in brick kiln
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E02A
How many members are responsible for the activity ?
E02A_1
Agriculture operations
E02A_2
MGNREGA
E02A_3
Masonry
E02A_4
Carpentry
E02A_5
Construction labour
E02A_6
Labour work in brick kiln
E03
How many days in last 12 months did the members engage ?
E03_1
Agriculture operations
E03_2
MGNREGA
E03_3
Masonry
E03_4
Carpentry
E03_5
Construction labour
E03_6
Labour work in brick kiln
E04
What was the daily wage rate for members ?
E04_1
Agriculture operations
E04_2
MGNREGA
E04_3
Masonry
E04_4
Carpentry
E04_5
Construction labour
E04_6
Labour work in brick kiln
E05
Did anyone receive meals and/or housing from the employer ?
E05_1
Agriculture operations
No
Yes meals
Yes housing
Yes both
E05_2
MGNREGA
No
Yes meals
Yes housing
Yes both
E05_3
Masonry
No
Yes meals
Yes housing
Yes both
E05_4
Carpentry
No
Yes meals
Yes housing
Yes both
E05_5
Construction labour
No
Yes meals
Yes housing
Yes both
E05_6
Labour work in brick kiln
No
Yes meals
Yes housing
Yes both
E06
Did anyone receive any bonus, clothes or any other item from employer?
E06_1
Agriculture operations
Yes
No
E06_2
MGNREGA
Yes
No
E06_3
Masonry
Yes
No
E06_4
Carpentry
Yes
No
E06_5
Construction labour
Yes
No
E06_6
Labour work in brick kiln
Yes
No
E06A
If yes, what was the total value of these item over last one year?
E06A_1
Agriculture operations
E06A_2
MGNREGA
E06A_3
Masonry
E06A_4
Carpentry
E06A_5
Construction labour
E06A_6
Labour work in brick kiln
E07
Who is primarily responsible for this activity?
E07_1
ASHA/AWW
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E07_2
Tuition
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E07_3
CSP/PRI
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E07_4
Government Job
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E07_5
Private Job
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E07A
How many members are responsible for the activity ?
E07A_1
ASHA/AWW
E07A_2
Tuition
E07A_3
CSP/PRI
E07A_4
Government Job
E07A_5
Private Job
E08
Income in one month
E08_1
ASHA/AWW
E08_2
Tuition
E08_3
CSP/PRI
E08_4
Government Job
E08_5
Private Job
E09
No of months in a year that the members worked
E09_1
ASHA/AWW
E09_2
Tuition
E09_3
CSP/PRI
E09_4
Government Job
E09_5
Private Job
E10
Did anyone receive meals and/or housing from the employer ?
E10_1
ASHA/AWW
No
Yes meals
Yes housing
Yes both
E10_2
Tuition
No
Yes meals
Yes housing
Yes both
E10_3
CSP/PRI
No
Yes meals
Yes housing
Yes both
E10_4
Government Job
No
Yes meals
Yes housing
Yes both
E10_5
Private Job
No
Yes meals
Yes housing
Yes both
E11
Did anyone receive any bonus, clothes or any other item from employer ?
E11_1
ASHA/AWW
Yes
No
E11_2
Tuition
Yes
No
E11_3
CSP/PRI
Yes
No
E11_4
Government Job
Yes
No
E11_5
Private Job
Yes
No
E11A
If yes, what was the total value of these item over last one year?
E11A_1
ASHA/AWW
E11A_2
Tuition
E11A_3
CSP/PRI
E11A_4
Government Job
E11A_5
Private Job
E12
Who is primarily responsible for this activity?
E12_1
Mahua Flowers
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_2
Mahua Fruit
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_3
Mahua seeds
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_4
Kossum fruit
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_5
Kossum seeds
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_6
Karanj fruit
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_7
Chiraunjee
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_8
Lac
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_9
Honey
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_10
Aonla
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_11
Ber
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_12
Tendu leaves
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_13
Harra
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_14
Baher
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_15
Tasar
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_16
Custard Apple
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_17
Tamrind
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_18
Jackfruit
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_19
Sal Seed
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E12_20
Sakhua leaf and stem
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E13
How many members are responsible for the activity ?
E13_1
Mahua Flowers
E13_2
Mahua Fruit
E13_3
Mahua seeds
E13_4
Kossum fruit
E13_5
Kossum seeds
E13_6
Karanj fruit
E13_7
Chiraunjee
E13_8
Lac
E13_9
Honey
E13_10
Aonla
E13_11
Ber
E13_12
Tendu leaves
E13_13
Harra
E13_14
Baher
E13_15
Tasar
E13_16
Custard Apple
E13_17
Tamrind
E13_18
Jackfruit
E13_19
Sal Seed
E13_20
Sakhua leaf and stem
E14
Quantity collected (Kg)
E14_1
Mahua Flowers
E14_2
Mahua Fruit
E14_3
Mahua seeds
E14_4
Kossum fruit
E14_5
Kossum seeds
E14_6
Karanj fruit
E14_7
Chiraunjee
E14_8
Lac
E14_9
Honey
E14_10
Aonla
E14_11
Ber
E14_12
Tendu leaves
E14_13
Harra
E14_14
Baher
E14_15
Tasar
E14_16
Custard Apple
E14_17
Tamrind
E14_18
Jackfruit
E14_19
Sal Seed
E14_20
Sakhua leaf and stem
E15
Quantity sold (Kg or Bundle or any primary unit for the NTFP)
E15_1
Mahua Flowers
E15_2
Mahua Fruit
E15_3
Mahua seeds
E15_4
Kossum fruit
E15_5
Kossum seeds
E15_6
Karanj fruit
E15_7
Chiraunjee
E15_8
Lac
E15_9
Honey
E15_10
Aonla
E15_11
Ber
E15_12
Tendu leaves
E15_13
Harra
E15_14
Baher
E15_15
Tasar
E15_16
Custard Apple
E15_17
Tamrind
E15_18
Jackfruit
E15_19
Sal Seed
E15_20
Sakhua leaf and stem
E16
Unit price (INR)
E16_1
Mahua Flowers
E16_2
Mahua Fruit
E16_3
Mahua seeds
E16_4
Kossum fruit
E16_5
Kossum seeds
E16_6
Karanj fruit
E16_7
Chiraunjee
E16_8
Lac
E16_9
Honey
E16_10
Aonla
E16_11
Ber
E16_12
Tendu leaves
E16_13
Harra
E16_14
Baher
E16_15
Tasar
E16_16
Custard Apple
E16_17
Tamrind
E16_18
Jackfruit
E16_19
Sal Seed
E16_20
Sakhua leaf and stem
E17
Does someone in the household receive pension?
Yes
No
E18
Who gets the pension?
You
Spouse
Other female member of the household
Other male member of the household
E19
What type of Pension?
Old age pension
Widow pension
Disability pension
Retirement pension
Others
E20
Amount received in last 12 months
E21
Who linked/facilitated the pension
PRI Member
SHG/Federation
No one
Organization where worked
Other
E22
In the past one year, did anybody in this household run their own business, however big or small?
Yes
No
E22A
In which of the following months was/were the business/businesses operational ?
E22A_1
January
Yes
No
E22A_2
February
Yes
No
E22A_3
March
Yes
No
E22A_4
April
Yes
No
E22A_5
May
Yes
No
E22A_6
June
Yes
No
E22A_7
July
Yes
No
E22A_8
August
Yes
No
E22A_9
September
Yes
No
E22A_10
October
Yes
No
E22A_11
November
Yes
No
E22A_12
December
Yes
No
E23
What was the gross earning from this business over the last 12 months?
E24
Who is primarily responsible for this activity?
Male member of the HH
Female member of the HH
Both are equally responsible
Hired labour
E25
Income from renting property (other than agricultural land)
E26
Income from interests or dividends or capital gains?
E27
Income from sale of property?
E28
Income from any other source?
E29
Does anybody in the HH have Kisan credit card?
Yes
No
E30
Do you/or anyone in your household practice regular savings?
Yes
No
E31
How regularly do you save?
Weekly
Fortnightly
Monthly
Once in 6 months months
Once a year
Daily
Once in 3 months
Others
E32
Where do you save?
SHG
Cooperative
Bank
Post Office
At home
Microfinance
Others(specify)
E33
Do you have access to credit?
Yes
No
E34
Have you taken any loan in the last 12 months?
Yes
No
E35
Where did you take the loan from?
SHG
Cooperative
Bank
Post Office
Local Moneylender
Friends/ Relatives
Microfinance
Others(specify)
E36
What was the purpose of taking the loan?
Purchase agricultural inputs
Purchase agricultural machinery
Small business
Large business
Education
Personal (Construction of house , Wedding, Death, Buying food)
Medical purposes
Others(specify)
E37
Were you able to repay the loan?
Yes
No
E38
What were the reasons for the failure?
Less Income
No earning member
Other large expenditure
Crop failure
Business failure
Others (specify)
E39
Does your houshold have access to insurance?
Yes
No
E40
What type of insurance does your household/ Crop/ Livestock have have?
Health
Accidental
Life
Vehicle
Regular Crop Insurance
Weather based crop insurance
Livestock Insurance
Do not have insurance
Others(specify)
E41
In the last 12 months, has anyone in your household migrated?
Yes
No
E42
How many adults in your household have migrated because of work (seasonally and permanently)? Please tell me how many women and how many men
E43
What was/were the reason(s) for migration?
We go every year during the dry season for additional earning
Intense climate incidecne (such as drought/flood) had destroyed all scope for agriculture
Education
Due to some family member of relative falling ill
Marriage/divorce
Income from agriculture was not enough
To look for better employment opportunities
Other (specify)
Don’t know
E44
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?
Yes
No
E45
How much money did your household received as remittances in the last 12 months?
E46
How often has your household received remmitances in the last 12 months?
Each month
Many times/ year
Twice a year
Once a year
Don’t know
ICRG Programme
F01
Does any male member of your household participate in Gram Sabha meetings? (Explain: Common village meetings)
Yes
No
F02
Do women in your household participate in Gram Sabha meetings?
Yes
No
F03
To what extent do male members of your HH give their opinion in the discussions?
Never
Very few times
Sometimes
Mostly
Always
F04
Is the opinion of male members from your household deliberated and considered while arriving at decisions in the Gram Sabha?
No, never considered
Yes, but very few times
Yes, but sometime
Yes, mostly everytime
Yes, always
F05
Is the opinion of female members from your household deliberated and considered while arriving at decisions in the Gram Sabha?
No, never considered
Yes, but very few times
Yes, but sometime
Yes, mostly everytime
Yes, always
F06
Does your household have a MGNREGA job card?
Yes
No
F07
Did your household participate in identification and planning of MGNREGA work?
Yes
No
F08
Can you tell me what kind of work was conducted under MGNREGA in your village in the last two year?
Check-dams were created
Old watershed structures were renovated
Land levelling and bunding
Boundary Trench
Gully plugs were built
Farm ponds were created
Cattle ponds were created
Fish/Duck breeding ponds were created
Composting pits were created
Wells were built
Percolation tanks were built
Water Absorption Trenches were built
Canals were created
Feeder channels were constructed
Road construction
Plantation
No work done
Others (specify)
F09
How was the decision regarding the type of work to be done taken?
Decision was taken in a GS meeting consulting all members
The panchayat members took the decision without involving us
Decision was taken by panchayat members & NREGA officials
Others (specify)
Don’t know
F10
Do you see any change(s) in the way the planning of MGNREGA activities are carried out now and the way they were carried out 2 years back?
Yes
No
F11
What change(s) do you see in the way the planning of MGNREGA activities are carried out now and the way they were carried out 2 years back?
Community engagement in the planning process has increased
Community engagement in the monitoring of structures have increased
Community demand for new structures have increased
Community demand for building climate resilient structures have increased
Govt. officials show increased concern for the MGNREGA work
Others (specify)
F12
Do you see any change(s) in the structures that are built now compared to the structures that were built 2 years backago ?
Yes
No
F13
What change(s) do you see in the structures that are built now compared to the structures that were built 2 years back?
The structures currently built under MGNREGA are more durable
The structures currently built under MGNREGA are more effective
The structures currently built under MGNREGA are more efficient
New structures are being built which we had not seen before
Others (specify)
F14
Has any other government department/scheme utilised the MGNREGA structure built/work done in the last two years?
Yes
No
F15
Can you tell us what have been those schemes/work/departments?
Horticulture/Agriculture Dept. provides seed and other agri inputs
Support from irrigation department on installation of irrigation mechanisms in farm
Plantation of saplings in community area with the help of Forest Dept.
Plantation of saplings in own area with the help of Forest Dept.
Others (specify)
F16
Have you availed any of the benefits?
F16_1
Horticulture/Agriculture Dept. provides seed and other agri inputs
Yes
No
F16_2
Support from irrigation department on installation of irrigation mechanisms in farm
Yes
No
F16_3
Plantation of saplings in community area with the help of Forest Dept.
Yes
No
F16_4
Plantation of saplings in own area with the help of Forest Dept.
Yes
No
F17
When was the first time you availed the benefit?
F17_1
Horticulture/Agriculture Dept. provides seed and other agri inputs
Less than one month
Less than 3 months
Less than 6 months
Less than 1 year
More than a year ago
F17_2
Support from irrigation department on installation of irrigation mechanisms in farm
Less than one month
Less than 3 months
Less than 6 months
Less than 1 year
More than a year ago
F17_3
Plantation of saplings in community area with the help of Forest Dept.
Less than one month
Less than 3 months
Less than 6 months
Less than 1 year
More than a year ago
F17_4
Plantation of saplings in own area with the help of Forest Dept.
Less than one month
Less than 3 months
Less than 6 months
Less than 1 year
More than a year ago
F18
How beneficial do you think this convergence has been for you?
F18_1
Horticulture/Agriculture Dept. provides seed and other agri inputs
No benefit seen
Very few benefits
Some benefits
Highly beneficial
F18_2
Support from irrigation department on installation of irrigation mechanisms in farm
No benefit seen
Very few benefits
Some benefits
Highly beneficial
F18_3
Plantation of saplings in community area with the help of Forest Dept.
No benefit seen
Very few benefits
Some benefits
Highly beneficial
F18_4
Plantation of saplings in own area with the help of Forest Dept.
No benefit seen
Very few benefits
Some benefits
Highly beneficial
F19
Do you know/have heard anything about climate change?
Yes
No
F20
What have you heard about climate change?
It affects crop productivity
It affects cropping pattern
It reduces the ground water level
It increases the climatic temperature
It causes more natural calamities like drought/flood
It negatively affects the bio-diversity
Others (specify)
F21
From where have you heard about climate change?
Government officials
PRI member
CSO/local NGO member
Have felt the changes on my own
Others (specify)
Don’t know
F22
How do you think your household can cope with changing climate?
Increase portfolio no. and types of crops cultivated
Diversify into other livelihood activities
Build more watershed structures
Build structures that are durable and effective
Use of efficient irrigation system
Practice soil and water conservation measures
Plant more trees
Receive weather related information on a periodic basis to avoid crop failure
Others (specify)
Don’t know
F23
Have there been any discussion on construction of climate resilience works in the Gram Sabha?
Yes
No
F24
What all was discussed in such sessions?
Building of new climate resilient works (CRWs)/infrastructures to help deal with climate shocks better
Engaging community to increase demand for new MGNREGA structures
Focus on design of structures to be built to ensure durability and effectiveness
Engaging with other government departments (agri/horti, irrigation dept.) for convergence
Others (specify)
Don’t know
F25
Have you been exposed to any training/discussion sessions on building community resilience against climate change?
Yes
No
F26
Who conducted these sessions?
Government officials
PRI member
CSO/local NGO member
Others (specify)
Don’t know
F27
What all was discussed in such sessions?
Building of new climate resilient works (CRWs)/infrastructures to help deal with climate shocks better
Engaging community to increase demand for new MGNREGA structures
Focus on design of structures to be built to ensure durability and effectiveness
Engaging with other government departments (agri/horti, irrigation dept.) for convergence
Others (specify)
Don’t know
F28
What are the CRW structures built under MGNREGA in your village since 2016?
F28_1
Check-dams
Yes
No
F28_2
Boundary Trench
Yes
No
F28_3
Gully plugs
Yes
No
F28_4
Farm ponds
Yes
No
F28_5
Cattle ponds
Yes
No
F28_6
Fish/Duck breeding ponds
Yes
No
F28_7
Composting pits
Yes
No
F28_8
Wells
Yes
No
F28_9
Percolation tanks
Yes
No
F28_10
Water Absorption Trenches
Yes
No
F28_11
Canals
Yes
No
F28_12
Feeder channels
Yes
No
F28_13
Aahar-Pyne
Yes
No
F28_14
Plantation
Yes
No
F29
What is the current status of the structure?
F29_1
Check-dams
Functional
Washed away
Requires renovation
F29_2
Boundary Trench
Functional
Washed away
Requires renovation
F29_3
Gully plugs
Functional
Washed away
Requires renovation
F29_4
Farm ponds
Functional
Washed away
Requires renovation
F29_5
Cattle ponds
Functional
Washed away
Requires renovation
F29_6
Fish/Duck breeding ponds
Functional
Washed away
Requires renovation
F29_7
Composting pits
Functional
Washed away
Requires renovation
F29_8
Wells
Functional
Washed away
Requires renovation
F29_9
Percolation tanks
Functional
Washed away
Requires renovation
F29_10
Water Absorption Trenches
Functional
Washed away
Requires renovation
F29_11
Canals
Functional
Washed away
Requires renovation
F29_12
Feeder channels
Functional
Washed away
Requires renovation
F29_13
Aahar-Pyne
Functional
Washed away
Requires renovation
F29_14
Plantation
Functional
Washed away
Requires renovation
F30
For what purpose does your HH use/have used in the past this structure?
F30_1
Check-dams
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_2
Boundary Trench
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_3
Gully plugs
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_4
Farm ponds
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_5
Cattle ponds
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_6
Fish/Duck breeding ponds
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_7
Composting pits
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_8
Wells
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_9
Percolation tanks
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_10
Water Absorption Trenches
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_11
Canals
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_12
Feeder channels
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_13
Aahar-Pyne
Household domestic consumption
Productive purpose
Both
Doesn’t use
F30_14
Plantation
Household domestic consumption
Productive purpose
Both
Doesn’t use
F31
Have you received any training on use of these structure?
F31_1
Check-dams
Yes
No
F31_2
Boundary Trench
Yes
No
F31_3
Gully plugs
Yes
No
F31_4
Farm ponds
Yes
No
F31_5
Cattle ponds
Yes
No
F31_6
Fish/Duck breeding ponds
Yes
No
F31_7
Composting pits
Yes
No
F31_8
Wells
Yes
No
F31_9
Percolation tanks
Yes
No
F31_10
Water Absorption Trenches
Yes
No
F31_11
Canals
Yes
No
F31_12
Feeder channels
Yes
No
F31_13
Aahar-Pyne
Yes
No
F31_14
Plantation
Yes
No
F32
Who provided the training?
F32_1
Check-dams
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_2
Boundary Trench
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_3
Gully plugs
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_4
Farm ponds
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_5
Cattle ponds
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_6
Fish/Duck breeding ponds
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_7
Composting pits
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_8
Wells
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_9
Percolation tanks
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_10
Water Absorption Trenches
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_11
Canals
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_12
Feeder channels
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_13
Aahar-Pyne
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F32_14
Plantation
Govt. officials
PRI member
CSO/local NGO
Others (specify)
F33
What changes have you observed due to MGNREGA work in your village?
Enhanced water management
Increase in ground-water recharge
Increase in crop productivity
Increase in crop portfolio
Increased forestry planatation and products
Increase in regulating temperature
Increase in green-cover/forest cover
Protection of bio-diversity
Prevention of soil-erosion
Diversified HH Livelihood
Increased access to rural market
Reduction in migration
Others (specify)
None
Dear user, please upgrade your plan to access this feature
See Plans
Please Wait