Household Survey Questionnaire
I. General Information
Form Filler
Village Name
Respondent’s Name
Household Head’s Name
Caste Category
Select
General
SC
ST
OBC
II. Household Background Information
Sr. No
Category
Males
Females
1
Number of Boys/Girls between 0 to 6 years
2
Number of Boys/Girls between 6 to 18 years
3
Number of Boys/Girls 18 year & above
4
Total family members
III. Occupation
Earning Members Total
Male
Female
IV. Assets
a. Land Particulars
Land Particulars
Area in Size
Area in Type
Irrigated
Select...
Biswa
Acre
Gaj
Killa
Non-Irrigated
Select...
Biswa
Acre
Gaj
Killa
b. Medium Land (Stagnant Water for less time)
Area in Size
Area in Type
Select...
Biswa
Acre
Gaj
Killa
c. Wet Land (Stagnant Water Always)
Area in Size
Area in Type
Select...
Biswa
Acre
Gaj
Killa
d. Irrigation Assessts Functioning
None
Electric Pump
Diesel Pump
Both
e. Type of Irrigation
Type
Yes/No
Private/Public
Working Status
Others (Specify)
Borewell
Yes
No
Select...
Private
Public
Select...
Working Throughout Year
Not Working Throughout Year
Pond
Yes
No
Select...
Private
Public
Select...
Working Throughout Year
Not Working Throughout Year
Canal
Yes
No
Select...
Private
Public
Select...
Working Throughout Year
Not Working Throughout Year
Others
Yes
No
V. Crop production
a. Fill food Availability
Crop Production/ Food
Utility
Cereals (paddy, Wheat, Maize)
Select...
Used for Food
Animal Feed
Both
None
Pulses
Select...
Used for Food
Animal Feed
Both
None
Oil Seeds
Select...
Used for Food
Animal Feed
Both
None
Vegetables
Select...
Used for Food
Animal Feed
Both
None
Fruits
Select...
Used for Food
Animal Feed
Both
None
b. Livestock and Poultry Assets
Category
Animal Count
Present market value (Rs.)/Per Unit.
Milk Produced (in litres)/Per Unit.
Breeding Process
Cow
NONE
Traditional
Artificial
Both
Bullock
NONE
Traditional
Artificial
Both
Buffalo
NONE
Traditional
Artificial
Both
Calf
NONE
Traditional
Artificial
Both
Goat
NONE
Traditional
Artificial
Both
Poultry
NONE
Traditional
Artificial
Both
Others (specify)
c. What do you think are the primary reasons for the suboptimal use of resources in your area?
Multiple selection can be done
Lack of knowledge
Lack of finance
Lack of motivation
No market
Veterinary or Agricultural services / Lack of services
Due to stagnant water yearly
Due to stagnant water seasonly
d. Do you have an Kitchen Garden?
Yes
No
Question
Input
What is the area of your orchid (in Gaj.)
How many plants do you have?
What are the names of the plants in your orchid?
What is the yearly income generated from your orchid (if it is financed)?
VI. Housing
Question
Options
Type of House
Select...
Raw
Semi-Pucca
Pucca
Other
Cooking Fuel
Select...
Heater
LPG-Gas
Wood
Cow dung Cake
Straw
VII. Capital Assets
Assets
Quantity
Tractor
Thrasher
Four wheeler
Telephone/Mobile
VIII Household Income and Expenditure
Types of Main Expenditure
Amount (Rs.)
Sources of Income
Amount (Rs.)
Health Care
Agricultural
Education
Salaried job
Irrigation water
Livestock
HYV Seeds
Others
Pesticides
Total
Total
IX. Poverty Parameters
a. Economic Status
Question
Options
Economic Status
Select...
Rs. 1,00,000 or less
Rs. 1,00,000 to Rs. 3,00,000
Rs. 3,00,000 or more
b. Did your family face any crisis in the last three years?
Year
Did your family face a crisis?
Type of crisis
How did you cope?
2022-2024
Yes
No
Select...
Death of a family member
Illness with high medical costs
Crop failure
Loss of job or business
Theft or robbery
Natural disaster (flood, drought, etc.)
Social injustice
Agriculture Loss
Death or illness of livestock
Land dispute
Dowry expenses
Financial
Select...
Used savings
Took a loan
Sold land
Mortgaged land
Sold livestock
Sold household items
Children had to work
Help from NGO/public aid
Marriage-related support
Sold grains at a lower price
Other
c. How would you rank your household’s economic strength in meeting/bearing educational expenses of members/children?
Difficult
Not Difficult
d. How would you rank your household’s economic strength in meeting/bearing health care related expenses of members?
Difficult
Not Difficult
X. Migration for Job/Labor
Yes
No
Migration for Job/Labor
Number of Persons Migrated Because of
Marriage
Job
Which place migrated to?
Select...
Village
Inter-state
Outside country
All of the above
Number of days or years migrated for?
Select...
Less than 6 months
6 months to 1 year
1 year or more
XI. Credit
a. Did you ever borrow money?
Yes
No
Major Source of Borrowing
Amount Borrowed (Rs)
Purpose of Borrowing
Duration of loan (in months)
Select...
Bank
Cooperative
Money Lender
Friends
Family
NGO
Other
b. Involved in any Government/NGO-run Employment Scheme
Yes
No
Entity
Wage per day
For how long worked there? (in months)
Government
Private
Others
XII. Health Status
Family-members age
Gender
In Number
Male
Female
Healthy
Not-healthy
Malnourished
Children from 0-1 year
Children from 1-6 year
6-18 years
18-60 years
More than 60 years
XIII. Awareness and Participation
a. Knowledge of MNREGA?
Yes
No
b. Membership in Institutions?
Yes
No
Type of Institution
Select...
Co-operative
CBO
SHG
Panchayats
Others
Number of Female Members in Institutions
Number of Male Members in Institutions
XIV. What is the availability of irrigation water in your area?
Multiple selection can be done
Across the year
Only in Kharif season
Only in Rabi season
Only in Zaid season
XV. What is the current practice of cattle feed in your village?
XVI. Water Bodies in the Village?
Yes
No
How many ponds are present in your village?
Count (Integer)
Total Area (in acres/hectares)
Old Ponds
New Ponds
XVII. Are you engaged in fish farming?
Yes
No
Please provide the following details of Fish Farming
Total area used for fish farming (in acres/hectares)
Annual fish production (in kg/tons)
Income generated from fish farming (in ₹)
XVIII. Are you interested in an agro-forestry model, cultivating agriculture with a fruit-bearing tree on the same plant?
Yes
Maybe
No
XIX. Do you provide vaccination and deworming?
Yes
Sometimes
No
Submit