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Household Template 13 -Form Fill

Socio Economic Profile of the Household
Q01

Name of the respondent

Q02

What is the sex of respondent?
Q03

What is the religion of the household?
Q04

What is the category of caste of the household

Q05

Please specify the caste/Tribe
Q06

What is the type of your family ?
Q07

Whether your household is women headed household
Q08

Please specify whether you belong to APL/BPL?

Q09

Please tell the names of the persons who usually live in your household starting with the head of the household
Q10

What is the relationship of (NAME) to the head of the household?
Q11

Is (NAME) male or Female?
Q12

What is the age of (Name)?
Q13

What is the current marital status of (NAME)?
Q14

Whether (NAME) has any kind of disability?
Q15

Can (NAME) read and write?
Q16

Has (NAME) ever Attended school?
Q17

What is the Number of years of education (NAME) has completed?
Q18

What is the Primary Occupation of (NAME)?
Q19

Does your household own this house or any other house?
Q20

What is the type of the house owned?
Q20A

What is the main material of which the floor is made of?
Q20B

What is the main material of which the roof is made of?
Q20C

What is the main material of which the exterior walls are made of?
Q20D

Do you have any window at home?
Q20E

How many rooms in this house are used for sleeping?
Q21

What is the main source of drinking water for members of your household?
Q22A

What kind of toilet facility does your household have?
Q22B

What is the waste disposal mechanism for your toilet?
Q23

What is the main source of lighting for your household?

Q24

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

Q25

Does your household own any of the following items:

Q25_1

Electric connection
Q25_2

Pressure cooker
Q25_3

Mixer/grinder
Q25_4

Motorcycle/scooter
Q25_5

Car/Jeep
Q25_6

Tractor
Q25_7

Bicycle
Q25_8

Animal-drawn cart
Q25_9

Chair
Q25_10

Table
Q25_11

Cot/ Bed
Q25_12

Mattress
Q25_13

Clock or watch
Q25_14

Electric fan
Q25_15

Water pump
Q25_16

Thresher

Q25_17

Radio/Transistor
Q25_18

Sewing machine
Q25_19

Refrigerator
Q25_20

B & W television
Q25_21

Colour television
Q25_22

Telephone
Q25_23

Computer
Q25_24

Mobile
Q26

Does your household have a bank account or post-office account?
Q27

Does your household own livestock?
Q28

What all does livestock include:

Q28_1

Bullocks
Q28_2

Cow

Q28_3

Cross bred cow
Q28_4

Buffalo

Q28_5

Goats/Lambs

Q28_6

Poultry
Q29

Does this household own any agricultural land?
Q30

How much agricultural land does this household own?

Q31

Out of this land, how much is irrigated?
MGNREGA
A01

Are you aware of MGNREGA scheme?
A02

Can you highlight some of the key provisions of MGNREGA?

A02_1

Every adult member of the HH whose name appears on the job card can apply for unskilled work under MGNREGA

A02_2

Registration for job card has to be made at Gram Panchayat
A02_3

A registered HH can get employment for maximum 100 days in a year
A02_4

Wages paid within a fortnight of the end of the work
A02_5

Work under MGNREGA has to be provided within a period of 15 days of application by HH

A02_6

Work site facilities like toilet, drinking water, crèche for children, first aid etc.
A02_7

Social audit in MGNREGA

A03

Does your household have a job card under MGNREGA?
A04

Where is your job card?
A05

Whether your household ever demanded for work under MGNREGA?

A06

Have you ever received or Are you receiving any employment benefits under MGNREGA?
A07

How many person days of employment have been provided till date last year
A08

Did your household participate in identification and planning of MGNREGA work?
A09

What changes have you observed due to MGNREGA work in your village?
A10

Access to Services under MGNREGA (Refer to the application submitted last year)

A10_1

Did you apply for employment under MGNREGA?
A10_2

After how many days of application was employment provided to you?
A10_3

When work was not allocated within 15 days of application (or a pre-decided date), did your household receive unemployment allowance?
A10_4

Received minimum wages for the number of days for which the household got employment under MGNREGA

A10_5

When did you receive payment of wages after the end of the work (For the last employment received)
A10_6

Were worksite facilities under MGNREGA such as Safe drinking water, shade, children, crèche, and rest hours provided or not?
A11

Satisfaction on the quality of services

A11_1

Did you apply for employment under MGNREGA?
A11_2

After how many days of application was employment provided to you?
A11_3

When work was not allocated within 15 days of application (or a pre-decided date), did your household receive unemployment allowance?
A11_4

Received minimum wages for the number of days for which the household got employment under MGNREGA

A11_5

When did you receive payment of wages after the end of the work (For the last employment received)
A11_6

Were worksite facilities under MGNREGA such as Safe drinking water, shade, children, crèche, and rest hours provided or not?
A12

In your opinion, is there any discrimination in implementation of MGNREGA?

A13

Have you ever experienced any discrimination in implementation of MGNREGA?

A14

Read the different types of discriminations given below.

A14_1

Not allocated work when required
A14_2

Separate team to work under MGNREGA
A14_3

Wrongful estimation of work done for payment

A14_4

Separate arrangement for drinking water
A14_5

Separate shade to take rest
A14_6

Separate crèche for children
A15

Reasons for discrimination

A15_1

Not allocated work when required
A15_2

Separate team to work under MGNREGA
A15_3

Wrongful estimation of work done for payment

A15_4

Separate arrangement for drinking water
A15_5

Separate shade to take rest
A15_6

Separate crèche for children
Land Rights
B01

What is the nature of land used by you?
B02

Are you aware of Forest Right Act (FRA) which vests ownership of forest land for Scheduled Tribes and Other Forest Dwellers?
B03

What are the key provisions of FRA?

B03_1

Right to live in the forest

B03_2

Community rights such as nistar

B03_3

Right to collect, use or dispose NTFPs
B03_4

Right to rehabilitation in case of eviction or displacement from forest land
B03_5

Rights for conversion of leases or grants on forest land to titles
B03_6

Right to conserve and manage any forest produce which has been traditionally protected and conserved
B04

Did your household ever have any issues of land rights and ownership under FRA?

B05

Did your household submit any application for settlement of land rights to the village-level Forest Rights Committee?

B06

Did the Forest Rights Committee take examined your land right?
B07

Did any member from the Forest Rights Committee visit the land under settlement claim?
B08

Did the Forest Rights Committee conduct the survey for measurement/demarcation of the land under settlement claim?

B09

Did the Gram Sabha approve your land claim?
B10

What is the status of land claim now?
B11

If no, then since when is the case pending?
B12

Did you pay any fee to get the land claim settled?
B13

If yes, then please mention the amount of fees paid.

B14

What is the nature of the land claim?
B15

Have you ever applied for community land claim under FRA?
B16

Was the community land title awarded?
B17

Has there been any change for your household in the access to common property resources like well, pond, NTFPs like tendu, amla etc. under FRA?
B18

Services under FRA

B18_1

Have you applied for land settlement under FRA?
B18_2

Has the Forest Rights Committee taken cognizance of your land rights?

B18_3

Has the survey/measurement of land under dispute been conducted by the Forest Right Committee?
B18_4

Has the title for the discussed land been awarded to you?
B19

Satisfaction on the quality of services

B19_1

Have you applied for land settlement under FRA?
B19_2

Has the Forest Rights Committee taken cognizance of your land rights?

B19_3

Has the survey/measurement of land under dispute been conducted by the Forest Right Committee?
B19_4

Has the title for the discussed land been awarded to you?
B20

In your opinion, is there any discrimination in implementation FRA?
B21

Did you ever experience any discrimination with respect to FRA?
B22

Read the different types of discriminations given below.

B22_1

Was there a Delay in acceptance of application for land settlement because of discrimination?
B22_2

Forest Right Committee or Gram Sabha taking little/no cognizance of your land right
B22_3

Was there a wrongful measurement of land for settlement because of discrimination
B22_4

Was there a Delay in award of disputed land because of discrimination?
B23

Reasons for discrimination

B23_1

Was there a Delay in acceptance of application for land settlement because of discrimination?
B23_2

Forest Right Committee or Gram Sabha taking little/no cognizance of your land right
B23_3

Was there a wrongful measurement of land for settlement because of discrimination
B23_4

Was there a Delay in award of disputed land because of discrimination?
B24

Are you aware of any land reform provisions of government?
B25

What are the key land reform provisions?

B25_1

Distribution of ceiling surplus land to landless people
B25_2

Distribution of government wasteland to landless
B25_3

Distribution of Bhoodan land to poor
B25_4

Distribution of homestead land to houseless households
B26

Have you ever received any land from government?
B26A

Have you ever applied for land claim under land reforms act?
B27

What is the status of land claim now?
B28

If no, then since when is the title pending?
B29

Did you pay any fee to get the land claim?
B30

If yes, then please mention the amount of fees paid.
B31

What is the nature of the land claim?
B32

Services under Land Reforms

B32_1

Have you been allocated land to you when you were landless-
B32_2

Have you received fertile land?
B32_3

Have you obtained the patta/title of the land?
B32_4

Have you obtained the possession of land

B32A

Satisfaction on the quality of services

B32A_1

Have you been allocated land to you when you were landless-
B32A_2

Have you received fertile land?
B32A_3

Have you obtained the patta/title of the land?
B32A_4

Have you obtained the possession of land

B33

In your opinion, is there any discrimination in implementation of land reform provisions?
B34

Did you ever experience any discriminate -ion with respect to land reform provisions?

B35

Read the different types of discriminations given below.

B35_1

Unfair allocation of land to rich instead of landless

B35_2

Poor quality of land or Land unfit for cultivation or fallow

B35_3

Delay in award of patta of land
B35_4

Delay in obtaining possession of land
B36

Reasons for discrimination

B36_1

Unfair allocation of land to rich instead of landless

B36_2

Poor quality of land or Land unfit for cultivation or fallow

B36_3

Delay in award of patta of land
B36_4

Delay in obtaining possession of land
B37

Are you aware of Right To Information (RTI) Act which lets citizens secure access to information under control of public authorities?
B38

What are the key provisions under RTI? (Record spontaneous answer first and then prompt)

B38_1

To get information from the Government as a matter of right
B38_2

Rs. 10 as prescribed fee for APL for seeking information
B38_3

No fee prescribed for BPL for seeking information

B38_4

No prescribed format for seeking information
B38_5

Information to an applicant to be supplied within 30 days
B39

Have you received any training on how to file an application?
B40

Have you ever filed an application to seek information using RTI?
B41

Did you receive the relevant information as desired?
B42

Was the information provided to you within 30 days of application?

B43

If no, then what was the approximate no. of days to get the relevant information?
Prevention of Atrocities against SC & STs Act 1989
C01

Are you aware of SC/ST Atrocities Act which?
C02

What all offences/activities can be considered as atrocities?

C02_1

Caste or tribe based discrimination
C02_2

Insult/injury with respect to caste or tribe
C02_3

Forced not to vote or vote to a particular candidate in any election
C02_4

Denied access or passage to a public place
C02_5

Forced to leave your house/village/land/other place of residence
C03

Have you ever filed an application under SC&ST Atrocities Act?
C04

Did you receive any relevant support?
C05

Were you satisfied with the support received?
Protection of Women from Domestic Violence Act, 2005
D01

Are you aware of Domestic Violence Act which protects the women against atrocities committed against them within the family?

D02

What are the provisions that come under DV Act? (Record spontaneous answer first and then prompt)

D02_1

Any kind of abuse that endangers health and safety or cause harassment or harm by forcing her to meet any unlawful demand such as dowry or threatening to is considered as abuse

D02_2

Aggrieved woman has the right to make an application to the magistrate to seek relief
D02_3

Relief can be obtained by way of a protection order, monetary relief order, custody order
D02_4

If an aggrieved woman requests for shelter or medical aid, then the person in charge of the shelter home and medical facility will have to provide the facility to aggrieved woman
D02_5

Hearing of the application has to be done within 3 days of receipt of application by the court
D02_6

Right to free legal service to file a complaint
Rashtriya Swastha Bima Yojana
E01

Are you aware of RSBY scheme?
E02

Can you highlight some of the key provisions of RSBY?

E02_1

The scheme provides health insurance coverage for family members who have been enrolled
E02_2

Coverage limit is Rs 30000/- for one year
E02_3

Beneficiary has to pay only Rs 30/- as registration fee during enrolment and Smarcard is provided immediately

E02_4

5 family members can be enrolled (HoF, Spouse and 3 dependents)
E02_5

Beneficiary who has been enrolled in a particular district will be able to use his/ her smart card in any RSBY empanelled hospital across India.

E02_6

Insurance coverage availed without involvement of cash or any paperwork
E02_7

Scheme is applicable for medical cases involving hospitalisation only
E03

Does your household have a smart card under RSBY?(Ask them to bring the card and the materials received during enrolment)
E04

Do you know which hospitals are empanelled in your district under RSBY?

E05

Can you name any of the empanelled hospitals
E06

Has anyone in your household been hospitalized in the last one year?
E07

Whether your household has availed treatment under the RSBY scheme in the last one year
E08

Did you receive adequate support from the hospital while availing the treatment?
E09

Whether any other household in your community has availed treatment under the RSBY scheme in the last one year

E10

Did they receive adequate support from the hospital while availing the treatment?
E11

What changes have you observed due to RSBY implementation in your village?
E12

Access to Services under RSBY

E12_1

Have you enrolled your household for RSBY card after receiving information about the scheme?
E12_2

Availing the insurance coverage in the empanelled hospitals
E13

Satisfaction on the quality of services

E13_1

Have you enrolled your household for RSBY card after receiving information about the scheme?
E13_2

Availing the insurance coverage in the empanelled hospitals
E14

In your opinion, is there any discrimination in implementation of RSBY
E15

Have you ever experienced any discrimination in implementation of RSBY?
E16

Read the different types of discriminations given below

E16_1

Were you not allowed to enroll during enrolment activity in village
E16_2

Were you made to stand in a separate queue/enrolment station
E16_3

Non issuance/delayed issuance of card
E16_4

Extra charges for card issuance
E16_5

Poor cooperation by hospital staff during treatment
E17

Reasons for discrimination

E17_1

Were you not allowed to enroll during enrolment activity in village
E17_2

Were you made to stand in a separate queue/enrolment station
E17_3

Non issuance/delayed issuance of card
E17_4

Extra charges for card issuance
E17_5

Poor cooperation by hospital staff during treatment
Janani Suraksha Yojana (JSY)
F01

Are you aware of the JSY scheme which encourages delivery in hospitals and also payscash for getting the child delivered in the hospital?
F01A

Is there any woman in the household who has delivered a child after November 2012?
F02A

Name (Go to Family Chart and write the name of women in the HH)
F02B

Was the delivery done in hospital?
F02C

Did (NAME) register under JSY during the pregnancy?
F02D

Did (NAME) receive the cash benefit under JSY?
F02E

Amount received under JSY? (In rupees)
F03

Access to Services

F03_1

Did the ASHA play any role in getting the child delivered in hospital?
F03_2

Were you escorted by ASHA to the pre-determined health centre and stayed till you were discharged?
F03_3

Did you receive cash assistance for Institutional Delivery?
F03_4

Did you receive transport cost for reaching the health institution?
F03_5

Did you receive timely payment done in one installment?
F04

Satisfaction on the quality of services

F04_1

Did the ASHA play any role in getting the child delivered in hospital?
F04_2

Were you escorted by ASHA to the pre-determined health centre and stayed till you were discharged?
F04_3

Did you receive cash assistance for Institutional Delivery?
F04_4

Did you receive transport cost for reaching the health institution?
F04_5

Did you receive timely payment done in one installment?
F05

In your opinion, is there any discrimination in implementation of Janani Suraksha Yojana in this village?
F06

Did you ever experience any discrimination while availing benefit under Janani Suraksha Yojana?

F07

What is the kind of discrimination that was faced?

F07_1

Was there any discrimination in the support and counselling provided by ASHA?
F07_2

Did you face any discrimination because of which referral services were not provided?
F07_3

Did you receive Differential treatment by staff at health facility
F07_4

Due to discrimination did you receive Delayed payment under JSY
F07_5

Due to discrimination did you receive less payment under JSY
F08

Reasons for discrimination

F08_1

Was there any discrimination in the support and counselling provided by ASHA?
F08_2

Did you face any discrimination because of which referral services were not provided?
F08_3

Did you receive Differential treatment by staff at health facility
F08_4

Due to discrimination did you receive Delayed payment under JSY
F08_5

Due to discrimination did you receive less payment under JSY
Education
G01

Are there any children in the HH of the school going age (6-13 years)? (refer family chart)
G02A

Child 1

G02A1

Line Number
G02A2

Name
G02A3

Age (Complete Yrs)
G02A4

Sex
G02A5

Whether child is ever enrolled in school
G02A6

What is the type of School?
G02A7

Is (NAME) regular to school?
G02A8

How many days did (NAME) attend the school in the last month?
G02A9

On an average, how many days did (NAME) get mid-day meal in school in the last month?
G02A10

What is the reason for never enrolling the child in school? (MULTIPLE RESPONSE)
G02A11

What is the reason for drop out? (MULTIPLE RESPONSE)
G02B

Child 2

G02B1

Line Number
G02B2

Name
G02B3

Age (Complete Yrs)
G02B4

Sex
G02B5

Whether child is ever enrolled in school
G02B6

What is the type of School?
G02B7

Is (NAME) regular to school?
G02B8

How many days did (NAME) attend the school in the last month?
G02B9

On an average, how many days did (NAME) get mid-day meal in school in the last month?
G02B10

What is the reason for never enrolling the child in school? (MULTIPLE RESPONSE)
G02B11

What is the reason for drop out? (MULTIPLE RESPONSE)
G02C

Child 3

G02C1

Line Number
G02C2

Name
G02C3

Age (Complete Yrs)
G02C4

Sex
G02C5

Whether child is ever enrolled in school
G02C6

What is the type of School?
G02C7

Is (NAME) regular to school?
G02C8

How many days did (NAME) attend the school in the last month?
G02C9

On an average, how many days did (NAME) get mid-day meal in school in the last month?
G02C10

What is the reason for never enrolling the child in school? (MULTIPLE RESPONSE)
G02C11

What is the reason for drop out? (MULTIPLE RESPONSE)
G02D

Child 4

G02D1

Line Number
G02D2

Name
G02D3

Age (Complete Yrs)
G02D4

Sex
G02D5

Whether child is ever enrolled in school
G02D6

What is the type of School?
G02D7

Is (NAME) regular to school?
G02D8

How many days did (NAME) attend the school in the last month?
G02D9

On an average, how many days did (NAME) get mid-day meal in school in the last month?
G02D10

What is the reason for never enrolling the child in school? (MULTIPLE RESPONSE)
G02D11

What is the reason for drop out? (MULTIPLE RESPONSE)
G02E

Child 5

G02E1

Line Number
G02E2

Name
G02E3

Age (Complete Yrs)
G02E4

Sex
G02E5

Whether child is ever enrolled in school
G02E6

What is the type of School?
G02E7

Is (NAME) regular to school?
G02E8

How many days did (NAME) attend the school in the last month?
G02E9

On an average, how many days did (NAME) get mid-day meal in school in the last month?
G02E10

What is the reason for never enrolling the child in school? (MULTIPLE RESPONSE)
G02E11

What is the reason for drop out? (MULTIPLE RESPONSE)
G03

Satisfaction on MDM

G03_1

Quality of food served in mid-day meal
G03_2

Quantity of food served in mid-day meal
G03_3

Regularity of meals provided in mid-day meal
G03_4

Adoption of hygienic practices in cooking/serving mid-day meal

G04

In your opinion, is there any discrimination in implementation of mid-day meal in school?
G05

Did your child ever experience any discrimination with respect to mid-day meal in school?

G06

What is the kind of discrimination that was faced?

G06_1

Is there a Separate seating arrangement for your child
G06_2

Are there Different timings to serve mid-day meal to your child
G06_3

Reduced quantity of mid-day meal served to your child

G06_4

Inferior quality of mid-day meal served to your child

G06_5

Separate arrangement for drinking water
G06_6

Separate arrangement for keeping utensils
G07

Reasons for discrimination

G07_1

Is there a Separate seating arrangement for your child
G07_2

Are there Different timings to serve mid-day meal to your child
G07_3

Reduced quantity of mid-day meal served to your child

G07_4

Inferior quality of mid-day meal served to your child

G07_5

Separate arrangement for drinking water
G07_6

Separate arrangement for keeping utensils
G08

Are you aware of the social background (caste and religion) of the cook for mid day meal in the school?
G09

Does the caste and religion of cook affect the decision of consumption of mid day meal by children in school?
Nutrition
H01

Is there AWC in this village?

H02

How far is nearest AWC from your place?

H03

Has any member of your household ever availed any service from the AWC?

H04

Are there any children in the HH below the age of 5 years?
H05

If yes, then specify

H05_1

Name
H05_2

Age
H05_3

Sex
H05_4

Whether registered at AWC
H05_5

Did (NAME) get supplementary nutrition from AWC?
H05_6

How many days’ supplementary nutrition was given for (NAME) in last month?
H06

Access to Services from AWC for eligible women and children

H06_1

Did you/your children receive supplementary nutrition/food from the angawadi worker?
H06_2

Did your child receive timely or age appropriate immunization at the anganwadi centre?
H06_3

Was your child weighed regularly to monitor the growth of the child at the AWC?
H06_4

Did you or your household receive regular Health check-up or health related services at the anganwadi centre as and when required?
H06_5

During health check up at the AWC, have you/ your child been asked to immediately visit the hospital for further treatment?
H06_6

Have you ever sent your child to the AWC for pre-school education where the child is made to play with building blocks and taught through charts and pictures?
H06_7

Were you or your family ever invited by AWC to attend awareness programs on health and nutrition organized in your village?
H07

Satisfaction on the quality of services

H07_1

Did you/your children receive supplementary nutrition/food from the angawadi worker?
H07_2

Did your child receive timely or age appropriate immunization at the anganwadi centre?
H07_3

Was your child weighed regularly to monitor the growth of the child at the AWC?
H07_4

Did you or your household receive regular Health check-up or health related services at the anganwadi centre as and when required?
H07_5

During health check up at the AWC, have you/ your child been asked to immediately visit the hospital for further treatment?
H07_6

Have you ever sent your child to the AWC for pre-school education where the child is made to play with building blocks and taught through charts and pictures?
H07_7

Were you or your family ever invited by AWC to attend awareness programs on health and nutrition organized in your village?
H08

In your opinion, is there any discrimination in delivery of services by AWC?
H09

Did you/ your child ever experience any discrimination in availing services from AWC?
H10

What is the kind of discrimination that was faced?

H10_1

Reduced quantity of supplementary nutrition given to your child

H10_2

Inferior quality of supplementary nutrition given to your child

H10_3

Supplementary nutrition not provided regularly
H10_4

Irregular/No immunization services from the AWC
H10_5

Growth monitoring of children
H10_6

No referral services from the AWC
H10_7

During Pre-school education (like seating arrangement, rude behavior, quality of education etc.)
H11

Reasons for discrimination

H11_1

Reduced quantity of supplementary nutrition given to your child

H11_2

Inferior quality of supplementary nutrition given to your child

H11_3

Supplementary nutrition not provided regularly
H11_4

Irregular/No immunization services from the AWC
H11_5

Growth monitoring of children
H11_6

No referral services from the AWC
H11_7

During Pre-school education (like seating arrangement, rude behavior, quality of education etc.)
Protection of Women from Domestic Violence Act,2005
I01

Are you aware of Protection of women from Domestic Violence Act which protects thewomen against atrocities committed against them within the family?
I02

What are the provisions that come under DV Act? (Record spontaneous answer first and then prompt)

I02_1

Any kind of abuse that endangers health and safety or cause harassment or harm by forcing her to meet any unlawful demand such as dowry or threatening to is considered as abuse

I02_2

Aggrieved woman has the right to make an application to the magistrate to seek relief
I02_3

Relief can be obtained by way of a protection order, monetary relief order, custody order
I02_4

If an aggrieved woman requests for shelter or medical aid, then the person in charge of the shelter home and medical facility will have to provide the facility to aggrieved woman
I02_5

Hearing of the application has to be done within 3 days of receipt of application by the court
I02_6

Right to free legal service to file a complaint
I03

Have you ever approached any individual/organisation on the issue of domestic violence?
I04

Did the CSO representatives extend any support with respect to your complaint on domestic violence?
Responsiveness of Gram Sabha and CSOs
J01

Does any member of your household participate in Gram Sabha meetings?
J02

Do women in your household participate in Gram Sabha meetings?
J03

Do you give your opinion in the discussions?
J04

Is your opinion deliberated and considered while arriving at decisions?
J05

Are you or any member of your household, member of any village level committee?
J06

Do you hold any position of leadership in the committee such as post of president, secretary or treasurer?
J07

Are you aware of any individual or organisation working in your area for the benefit of the excluded communities?
J08

Do you know which type of organization these individuals/ organisations represent?
J09

Which type of organization these individuals/ organisations represent?

J10

On which issues do these individuals/organisation work with the excluded communities?

J11

Do these individuals/organisation identify and raise the issues of discriminations faced by the communities in this area?
J12

In what areas are issues of discrimination identified and raised by se individuals/organisation?
J13

Have these individuals/organisation in your village conducted any programmes on the various schemes in your village?
J14

What kinds of programs have been conducted?
J15

How often are these programs held?
J16

Which schemes were discussed in those programmes?
J17

Have you attended such programs?
J18

Have you ever approached any authority to raise any issues of discrimination?

J19

Were the authority representatives receptive to your complaint?
J20

Did they exdend any support in your case?
J21

Were you satisfied with the support provided by the authority on your complaint of discrimination?
J22

Over the last five years have you perceived any change in your ease of approaching the authorities to discuss about your entitlements?
J23

What kind of change do you perceive?
Community Participation
K01

Are there any CBOs in your village?
K02

Are you a member of any CBO?
K03

Which type of CBO are you a member of?
K04

Do you hold any position of leadership in your CBO such as post of President, Secretary or Treasurer?
K05

Are you aware of any Social Audits being done by the CBO?
K06

Have you been a part of any Social Audit?
K07

For which scheme have you been a part of the Social Audit?
K08

Does your CBO raise matters pertaining to discrimination in access to government services?
K09

For which schemes does your CBO raise matters on discrimination?
K10

Do you perceive any contribution of the CSOs on strengthening the roles of your CBO while raising issues with the authorities?