Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household Number _ _ _

HH3. Interviewer name and number:

HH4. Supervisor name and number:

HH5. Day/month/year of interview _ _ / _ _ / _ _ _ _

HH6. Location *

HH7. Aimag/Capital city:

HH7A._ _ Soum/district
HH76._ _ Bagh/khoroo
HH7B. _ _ Household adress

HH8. Name of head of household: ____

After all questionnaires for the household have been completed, fill in the following information:
[Note: HH9 to HH16]

HH9. Result of HH interview:

HH9A. Number of HH visit: _

HH10. Respondent?s line number: _

HH11. Total number of HH members: _ _

HH12. Number of women eligible for interview: _ _

HH13. Number of women questionnaires completed: _ _

HH14. Number of children under age 5 eligible to interview: _ _

HH15. Number of children of under-5 questionnaires completed: _ _

Interviewer/supervisor notes: Use this space to record notes about the interview with this household, such as call-back times, incomplete individual interview forms, number of attempts to re-visit, etc.

HH16. Name and code of data entry clerk: _ _

Household listing form: HL

First, please tell me the name of each person who usually lives here, starting with the head of the household.
List the head of the household in line 01. List all household members (HL2), their relationship to the household head (HL3), and their sex (HL4).
Then ask: are there any others who live here, even if they are not at home now? (These may include children in school or at work). If yes, complete listing.
Then, ask questions starting with hl5 for each person at a time. Add a continuation sheet if there are more than 15 household members.

[] Tick here if continuation sheet used

HL1. Line no.: _ _

HL2. Name: ____

HL3. Relationship to head of household:

HL4. Is (name) male or female?

HL4A. Year of birth _ _

HL5. Record in completed years:

HL6. Eligible for women's interview

HL7. Eligible for child labour module

For each child age 5-14: Who is the mother or primary caretaker of this child?

HL8. For each child under 5: Who is the mother or primary caretaker of this child

For children age 0-17 years ask HL9-HL12

HL9. Is (name's) natural mother alive?

HL10. If alive: Does (name's) natural mother live in this household?

HL11. Is (name's) natural father alive?

HL12. If alive: Does (name's) natural father live in this household?

Are there any other persons living here - even if they are not members of your family or do not have parents living in this household?
Including children at work or at school? If yes, insert child's name and complete form.
Then, complete the totals below.

Totals

Now for each woman age 15-49 years, write her name and line number and other identifying information in the information panel of the women's questionnaire.
For each child under age 5, write his/her name and line number and the line number of his/her mother or caretaker in the information panel of the questionnaire for children under five.
You should now have a separate questionnaire for each eligible woman and each child under five in the household.

Education Module: ED

For household members age 5 and above

ED1. Line no. _ _

ED1A. Name ____

ED2. Has (name) ever attended school or preschool?

ED3. What is the highest level of school (name) attended? What is the highest grade (name) completed at this level?

For household members age 5-24 years

ED4. During the (2005-2006) school year, did (name) attend school or preschool at any time?

ED5. Since last (day of the week), how many days did (name) attend school?

ED6. During this/that school year, which level and grade is/was (name) attending?

ED7. Did (name) attend school or preschool at any time during the previous school year, that is (2005-2006)?

ED8. During that previous school year, which level and grade did (name) attend?

Water and sanitation module: WS

WS1. What is the main source of drinking water for members of your household?

WS3. How long does it take to go there, get water, and come back?

WS4. Who usually goes to this source to fetch the water for your household?

Probe: Is this person under age 15? What sex?
Circle code that best describes this person.

WS5. Do you treat your water in any way to make it safer to drink?

WS6. What do you usually do to the water to make it safer to drink?
Anything else?
Record all items mentioned.

WS7. What kind of toilet facility do members of your household usually use?
If "flush" or "pour flush", probe: Where does it flush to?
If necessary, ask permission to observe the facility.

WS8. Do you share this facility with other households?

WS9. How many households in total use this toilet facility

Household characteristics module: HC

HC1A. What is the religion of the head of this household?

HC1B. What is the mother tongue/native language of the head of this household?

HC1C. To what ethnic group does the head of this household belong? Khalkha-01, Kazakh-02,Derved -03, Bayad-04, Buriad-05,Dariganga-06, Zahshin-07, Urianhai-08, Other-96

HC1D. Types of your dwelling

HC1F. The size of your dwelling living area (sq.m)

HC1G. The number of rooms

HC2. How many rooms in this household are used for sleeping?

HC2A. No. of ger wall

HC3. Main material of the dwelling floor:
Record observation.

HC4. Main material of the roof.
Record observation.

HC5. Main material of the walls.
Record observation.

HC5A. Ownership of dwelling

HC6. What type of fuel does your household mainly use for cooking?

HC7. In this household, is food cooked on an open fire, an open stove or a closed stove?
Probe for type.

HC8. Is the cooking usually done in the house, in a separate building, or outdoors?

HC9. Does your household have:

HC10. Does any member of your household own:

HC11. Does any member of this household own any land that can be used for agriculture?
[This question is from optional modules]

HC12. How many hectares of agricultural land do members of this household own?
[This question is from optional modules]
If more than 97, record '97'. If unknown, record '98'.

HC13. Does this household own any livestock, herds, or farm animals?
[This question is from optional modules]

HC14. How many of the following animals does this household have?
[This question is from optional modules]

Child labour module: CL

To be administered to mother/caretaker of each child in the household age 5 through 14 years. For household members below age 5 or above age 14, leave rows blank.
Now I would like to ask about any work children in this household may do.

CL1. Line no. _ _

CL3. During the past week did (name) any kind of work for someone who is not a member of this household?
If yes: For pay in cash or kind?

CL4. If yes: Since last (day of the week), about how many hours did he/she do this work for someone who is not a member of this household?

CL5. At any time during the past year, did (name) do any kind of work for someone who is not a member of this household?
If yes: For pay in cash or kind?

CL6. During the past week, did (name) help with household chores such as shopping, collecting firewood, cleaning, fetching water, or caring for children?

CL7. If yes: Since last (day of the week), about how many hours did he/she spend doing these chores? _ _

CL8. During the past week, did (name) do any other family work (on the farm or in a business or selling goods in the street)

CL9. If yes: Since last (day of the week), about how many hours did he/she do this work? _ _

CL10. Types of family business:

Child discipline module: CD

Table 1: Children aged 2-14 years eligible for child discipline questions

Review the household listing and list each of the children aged 2-14 years below in order according to their line number (HL1). Do not include other household members outside of the age range 2-14 years. Record the line number, name, sex, age, and the line number of the mother or caretaker for each child. Then record the total number of children aged 2-14 in the box provided (CD7).

CD1. Rank no.

CD2. Line no. from HL1.

CD3. Name from HL2.

CD4. Sex from HL4.

CD5. Age from HL5.

CD6. Line no. of mother/caretaker from HL7 or HL8.

CD7. Total children aged 2-14 years _ _

If there is only one child age 2-14 years in the household, then skip table 2 and go to CD9; write down the rank number of the child and continue with CD11

Table 2: Selection of random child for child discipline questions

Use this table to select one child between the ages of 2 and 14 years, if there is more than one child in that age range in the household. Look for the last digit of the household number from the cover page. This is the number of the row you should go to in the table below. Check the total number of eligible children (2-14) in CD7 above. This is the number of the column you should go to. Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the child about whom the questions will be asked. Record the rank number in CD9 below. Finally, record the line number and name of the selected child in CD11 on the next page. Then, find the mother or primary caretaker of that child, and ask the questions, beginning with CD12.

CD8. Last digit of the questionnaire number 0-9
Total number of eligible children in the household 1-8+
[Table omitted]

CD9. Record the rank number of the selected child

Identify eligible child aged 2 to 14 in the household using the tables on the preceding page, according to your instructions. Ask to interview the mother or primary caretaker of the selected child (identified by the line number in CD6).

CD11. Write name and line no. of the child selected for the module from CD3 and line number ( CD2= HL1), based on the rank number in CD9.

CD12B. Explained why something (the behavior) was wrong.

CD12D. Shouted, yelled at or screamed at him/her.

CD12E. Gave him/her something else to do.

CD12H. Called him/her dumb, lazy, or another name like that.

CD12K. Beat him/her up

CD13. Do you believe that in order to bring up (raise, educate) (name) properly, you need to physically punish him/her?

CD14. Who cares of his/her development and discipline?

CD15. Have you obtained any information on his/her development and discipline in the last month?

CD16. Where do you get information on child development and discipline?

CD17. How often do you listen to his/her demand?

CD18. How often do you listen to his/her demand?

CD19. How often do you praise him/her?

CD20. Do you buy him/her toys?

CD21. Do you him/her with drawing materials?

CD22. Has he/she had an accident in the last month?

CD23. Accidents resulted from

CD24. Does he/she feed regularly?

CD25. Does he/she sleep at regular time?

CD26. Does he/she brush his/her teeth in the morning?

CD27. Does he/she wash his/her hands before dining?

CD28. Does he/she wash his/her hand after using toilet?

CD29. Does he/she bath regularly?

CD30 Does he/she brush his/her teeth before he/she goes to bed?

CD31 Does he/properly dress for weather?

Disability: DA

To be administered to caretakers of all children 2 through 9 years old living in the household. For household members below age 2 or above age 9, leave rows blank
I would like to ask you if any children in this household aged 2 through 9 has any of the health conditions I am going to mention to you.

DA1. Line no.

DA3. Compared with other children, does or did (name) have any serious delay in sitting, standing, or walking?

DA4. Compared with other children, does (name) have difficulty seeing, either in the daytime or at night?

DA5. Does (name) appear to have difficulty hearing? (uses hearing aid, hears with difficulty, completely deaf?)

DA6. When you tell (name) to do something, does he/she seem to understand what you are saying?

DA7. Does (name) have difficulty in walking or moving his/her arms or does he/she have weakness and/or stiffness in the arms or legs?

DA8. Does (name) sometimes have fits, become rigid, or lose consciousness?

DA9. Does (name) learn to do things like other children his/her age?

DA10. Does (name) speak at all (can he/she make him or herself understood in words; can say any recognizable words)?

DA11. (For 3-9 year olds): Is (name)'s speech in any way different from normal (not clear enough to be understood by people other than the immediate family)?

DA12. (For 2-year-olds): Can (name) name at least one object (for example, an animal, a toy, a cup, a spoon)?

DA13. Compared with other children of the same age, does (name) appear in any way mentally backward, dull or slow?

IH Household income

Salary, wage, pension, and allowances

101.Salary, un cash

102. Remuneration, non-cash

103. Pension

104. Compensation

105. Allowance

106. Child allowance

199. SUB TOTAL

Income derived from household production and services

201. Animal husbandry

202. Agriculture

203 Other production and services

299. SUB TOTAL

OTHER INCOME

301. Sale of real estate

302. Stock share dividends

303. Premise rend, property leasing

304. Intellectual property, patent, copyright

305. Deposit withdrawal, repayment of money borrowed to others

306. Interests form deposit and money borrowed to others

307. Gifts and assistance from others

308. Bonus, prize

309. Non-production credit

310. Other sources

399. SUB TOTAL

499. TOTAL

Salt iodization module: SI

SI1. We would like to check whether the salt used in your household is iodized

SI1A.What kind of salt do your family use?

SI1B. Have you ever heard about the enriched flour?

SI1C. Have you ever heard about the enriched flour?

SI2. Does any eligible woman age 15-49 reside in the household?
Check household listing, column HL6. You should have a questionnaire with the information panel filled in for each eligible woman.

SI3. Does any child under the age of 5 reside in the household?
Check household listing, column HL8. You should have a questionnaire with the Information Panel filled in for each eligible child.