MICS Household Questionnaire
Household Information Panel: HH
HH2B. Street name and number of khashaa/door ____
HH3. Interviewer's name and number
Number _ _
HH4. Supervisor's name and number:
Number _ _
[] 2 Aimag center
[] 3 Soum center
[] 4 Rural
HH7A. Aimag/city name and code
Code _ _
HH7B. Soum/district name and code
Code _ _
HH7C. Bag/Khoroo name and code
Code _ _
Code _ _
HH8. Is the household selected for questionnaire for men?
[] 2 No
We are from the National Statistics Office of Mongolia and conducting a survey about the situation of children, women, families and households. I would like to talk to you about these subjects nearly 40 minutes. According to the article 5, paragraph 4 of the Mongolian state "law on confidentiality of an individual" and article 22, paragraph 3 of the "law on statistics" all the information will remain strictly confidential. May I start now?
[] No, permission is not given (Circle 04 in HH9. Discuss this result with your supervisor.)
Date and result of the interview:
Number of times visited
HH5. Year/month/day of interview
[] 2 Second
[] 3 Third
HH9. Result of the interview* _ _
[] 02 No household member or no competent respondent at home at time of visit
[] 03 Entire household absent for extended period of time
[] 04 Refused
[] 05 Dwelling vacant/address not a dwelling
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 96 Other (specify) ____
After the household questionnaire has been completed, fill in the following information:
HH10. Respondent to household questionnaire:
After the household questionnaire has been completed, fill in the following information:
HH11. Total number of household members: _ _
After the household questionnaire has been completed, fill in the following information:
HH12. Number of women age 15-49 years: _ _
After all questionnaires for the household have been completed, fill in the following information:
HH13. Number of women's questionnaires completed: _ _
After the household questionnaire has been completed, fill in the following information:
If the household is selected for Questionnaire for Men
HH13A. Number of Men age 15-54 years:_ _
After all questionnaires for the household have been completed, fill in the following information:
HH13B. Number of man's questionnaires completed: _ _
After the household questionnaire has been completed, fill in the following information:
HH14. Number of children under age 5: _ _
After all questionnaires for the household have been completed, fill in the following information:
HH15. Number of under-5 questionnaires completed: _ _
_ _ Minuets
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?
If yes, complete listing for questions HL2-HL4. Then, ask questions starting with HL5 for each person at a time. Use an additional questionnaire if all rows in the list of household members have been used.
HL3. What is the relationship of (name) to the head of household?
HL4. Is (name) Male or Female?
[] 2 Female
HL5. What is (name's) date of birth?
Year (9998 DK): _ _ _ _
HL6. How old is (name)?
Record in completed years. If age is 95 or above '95':
For women age 15-49
HL7. Circle line no. if woman age 15-49
[] 2 No
For men age 15-54
HL7A. Circle line no. If man age 15-49 and the household is selected for Questionnaire for men.
For children age 0-4
HL7B. Circle line no. If children age 0-4.
I would like to ask you several questions about natural parents of children aged 0-17. Please do not take it seriously since these questions will only be used for the survey.
For children age 0-17 years
HL11. Is (name)'s natural mother alive
[] 2 No (Go to HL13)
[] 8 DK (Go to HL13)
I would like to ask you several questions about natural parents of children aged 0-17. Please do not take it seriously since these questions will only be used for the survey.
For children age 0-17 years
HL12. Does (name)'s natural mother live in this household? _ _
If "Yes", record line no. of mother and go to HL13. Record 00 for "no".
I would like to ask you several questions about natural parents of children aged 0-17. Please do not take it seriously since these questions will only be used for the survey.
For children age 0-17 years
HL12A. Where does (name)'s natural mother live?
[] 2 Institution in this country
[] 3 Abroad
[] 8 DK
I would like to ask you several questions about natural parents of children aged 0-17. Please do not take it seriously since these questions will only be used for the survey.
For children age 0-17 years
HL13. Is (name)'s natural father alive
[] 2 No (Go to HL15)
[] 8 DK (Go to HL15)
I would like to ask you several questions about natural parents of children aged 0-17. Please do not take it seriously since these questions will only be used for the survey.
For children age 0-17 years
HL14. Does (name)'s natural father live in this household? _ _
If "Yes", record line no. of father and go to HL15. Record 00 for "no".
I would like to ask you several questions about natural parents of children aged 0-17. Please do not take it seriously since these questions will only be used for the survey.
For children age 0-17 years
HL14A. Where does (name)'s natural father live?
[] 2 Institution in this country
[] 3 Abroad
[] 4 DK
HL15. Record line no. of mother from HL12 if indicated.
If HL12 is blank or '00' ask: who is the primary caretaker of (name)?
For children age 0-14
[] Tick here if additional questionnaire used [After HL1 to HL4 questions]
Probe for additional household members. Probe especially for any infants or small children not listed, and others who may not be members of the family (such as servants, friends) but who usually live in the household. Insert names of additional members in the household list and complete form accordingly.
Now for each woman age 15-49 years, write her name and line number and other identifying information in the information panel of a separate individual women's questionnaire.
For each man age 15-54 years, write his name and line number and other identifying information in the information panel of a separate individual man'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 a separate under-5 questionnaire.
You should now have a separate questionnaire for each eligible woman, each eligible man, and each child under five in the household.
Code for HL3 Relationship to head of household
[] 02 Wife/husband
[] 03 Son/daughter
[] 04 Son-in-law/daughter-in-law
[] 05 Grandchild
[] 06 Parent
[] 07 Parent-in-law
[] 08 Brother/sister
[] 09 Brother-in-law/sister-in-law
[] 10 Uncle/aunt
[] 11 Niece/nephew
[] 13 Adopted/foster/stepchild
[] 14 Servant (live-in)
[] 15 Grand parent
[] 16 Other relative
[] 96 Other (not related)
[] 98 DK
ED2. Name and age
Copy from HL2 and HL6.
Age: _ _
ED3. Has (name) ever attended school or pre-school?
For household members age 5 and above
[] 2. No (Go to next line)
ED4A. What is the highest level school (name) has ever attended?
For household members age 5 and above. If completed non-formal equivlent education program (NFEEP) circle '2'.
[] 2 Secondary
[] 3 Higher
[] 4 Vocational training
[] 8 DK
ED4B. What is the highest grade (name) completed at this level?
For household members age 5 and above. If less than 1 grade at this level, record '00'. If has attended primary school of NFEEP, record '21', if basic or high school, record '22' and '23' respectively .
[]98. DK
ED4C. Has (name) completed school he or she has attended?
[] 2 No
ED5. During the 2013/2014 school year, did (name) attend school or preschool at any time?
For household members age 5-24 years
[] 2. No (Go to ED7)
ED6. During 2013/2014 school year, which level and grade is (name) attending?
[] 2 Secondary
[] 3 Higher
[] 4 Vocational training
[] 8 DK
[] 98 DK
ED7. During the previous school year, that is 2012-2013, did (name) attend school or preschool at any time?
For household members age 5-24 years
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
ED8. During that previous school year, which level and grade did (name) attend?
For household members age 5-24 years
If level=0 skip to ED7
[] 2 Secondary
[] 3 Higher
[] 4 Vocational training
[] 8 DK
[] 98. DK
Selection of One Child For Child Labour/Child Discipline: SL
SL1. Check HL6 in the list of household members and write the total number of children age 1-17 years.
SL2. Check the number of children age 1-17 years in SL1:
[] One (Go to SL9 and record the rank number as "1", enter the line number, child's name and age.)
[] Two or more (Continue with SL2A.)
SL2A. List each of the children age 1-17 years below in the order they appear in the List of household members. Do not include other household members outside of the age range 1-17 years. Record the line number, name, sex, and age for each child.
SL4. Line number from HL1: _ _
[] 2 Female
SL8. Check the last digit of the household number (HH2) from the cover page. This is the number of the row you should go to in the table below.
Check the total number of children age 1-17 years in SL1 above. This is the number of the column you should go to in the table below.
Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number (SL3) of the selected child.
Total Number of Eligible Children in the Household (from SL1): [2 to 8+] _
SL9. Record the rank number (SL3), line number (SL4), name (SL5) and age (SL7) of the selected child.
Line number: _ _
Name: ____
Age: _ _
CL1. Check selected child's age from SL9:
[] 5-17 years (Continue with CL2)
CL2. Now I would like to ask about any work children in this household may do.
Since last (day of the week), did (name) do any of the following activities, even for only one hour?
A. Did (name) do any work or help on his/her own or the household's plot/farm/food garden or looked after animals? For example, growing farm produce, harvesting, or feeding, grazing, milking animals?
[] 2 No
B. Did (name) help in family business or relative's business with or without pay, or run his/her own business?
[] 2 No
C. Did (name) produce or sell articles, handicrafts, clothes, food or agricultural products?
[] 2 No
D. Did (name) engage in any other activity in return for income in cash or in kind, even for only one hour?
If "No", Probe: Please include any activity (name) performed as a regular or casual employee, self-employed or employer; or as an unpaid family worker helping out in household business or farm.
[] 2 No
[] All answers are "No" (Go to CL8)
CL4. Since last (day of the week) about how many hours did (name) engage in this activity/these activities, in total?
If less than one hour, record "00"
CL4A. What did (name) do since last (day of the week)?
If did several works simultaneously, ask question only for main field of activities
Code: _ _ _ _
CL4B. What is the main field of activity (name) did in the last week?
If did several works simultaneously, ask question only for main field of activities
Code: _ _ _ _
CL4C. Please tell me (name)'s employment status?
If did several works simultaneously, ask question only for main field of activities
[] 2 Employer
[] 3 Self employed
[] 4 Member of partnership/cooperative
[] 5 Employed in animal husbandry
[] 6 Unpaid participant in family business
CL5. Does the activity/do these activities require carrying heavy loads?
[] 2 No
CL6. Does the activity/do these activities require working with dangerous tools (knives etc.) or operating heavy machinery?
[] 2 No
CL7. How would you describe the work environment of (name)?
[A] Is (name) exposed to dust, fumes or gas?
[] 2 No
[B] Is (name) exposed to extreme cold, heat or humidity?
[] 2 No
[C] Is (name) exposed to loud noise or vibration?
[] 2 No
[D] Is (name) required to work at heights?
[] 2 No
[E] Is (name) required to work with chemicals (pesticides, glues, etc.) or explosives?
[] 2 No
[F] Is (name) exposed to other things, processes or conditions bad for (name)'s health or safety?
[] 2 No
CL8. Since last (day of the week), did (name) fetch water or collect firewood for household use?
[] 2 No (Go to CL10)
CL9. In total, how many hours did (name) spend on fetching water or collecting firewood for household use, since last (day of the week)?
If less than one hour, record "00"
CL10. Since last (day of the week), did (name) do any of the following for this household?
[] 2 No
[B] Repair any household equipment?
[] 2 No
[C] Cooking or cleaning utensils or the house?
[] 2 No
[] 2 No
[] 2 No
[F] Caring for the old or sick?
[] 2 No
[] 2 No
[] All answers are "no" (Go to next module)
CL12. Since last (day of the week), about how many hours did (name) engage in this activity/these activities, in total?
CD1. Check selected child's age from SL9
[] 15 years (Go to next module)
[] 16-17 years (Go to household characteristics module)
CD2. Write the line number and name of the child from SL9.
Name: ____
CD3. Adults use certain ways to teach children the right behaviour or to address a behaviour problem. I will read various methods that are used. Please tell me if you or anyone else in your household has used this method with (name) in the past month.
[A] Took away privileges, forbade something (name) liked or did not allow him/her to leave the house.
[] 2 No
[B] Explained why (name)'s behaviour was wrong.
[] 2 No
[] 2 No
[D] Shouted, yelled at or screamed at him/her.
[] 2 No
[E] Gave him/her something else to do.
[] 2. No
[F] Spanked, hit or slapped him/her on the bottom with bare hand.
[] 2 No
[G] Hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object.
[] 2 No
[H] Called him/her dumb, lazy, or another name like that.
[] 2 No
[I] Hit or slapped him/her on the face, head or ears.
[] 2 No
[J] Hit or slapped him/her on the hand, arm, or leg.
[] 2 No
[K] Beat him/her up, that is hit him/her over and over as hard as one could.
[] 2 No
CD4. Do you believe that in order to bring up, raise, or educate a child properly, the child needs to be physically punished?
[] 2 No
[] 8 DK/no opinion
Ask this module from every child aged 4-15. For other members of the household, leave the corresponding lines empty.
HR2. Name and age
Copy from HL2 and HL6.
Age: _ _
HR3. Did (name) participate in the horse racing since January of 2013?
Does not include training activities for horse racing. Only include actual competition such as national and aimag horse racing.
[] 2 No (Go to next line)
[] 3 DK (Go to next line)
HR4. How many times did (name) participate in horse racing?
If rode three different horses in one horse racing game, write 3 times.
[] 98 DK
HR5. What was the most recent horse racing game (name) participated?
[] 2 Regional festival
[] 3 Aimag festival
[] 4 Soum festival
[] 5 Other festival/game
HR6. Did (name) wear any of following protective clothing during his/her most recent horse racing?
[] B Goggles
[] C Vest
[] D Knee pad
[] E Shoes
HR7. In what season (name) participated his/her most recent horse racing?
[] 2 Spring
[] 3 Summer
[] 4 Fall
HR8. Did (name) ride the horse without saddle when participated his/her most recent horse racing?
[] 2 No
[] 8 DK
HR9. Was (name) insured when participated in his/her most recent horse racing?
[] 2 No
[] 8 DK
HR10. Was (name) injured when participated in his/her most recent horse racing?
[] 2 No
[] 8 DK
HR11. Whose horse did (name) ride when participated in his/her most recent horse racing?
[] 2 Relatives'
[] 3 Others'
HR12. Did (name) receive any sort of incentives when preparing or participating in his/her most recent horse racing?
[] 2 No
[] 8 DK
HR13. Did (name) sign a contract with the horse owner when participated in his/her most recent horse racing?
[] 2 No
[] 8 DK
HR14. At what age (name) started riding in horse racing?
HC1A. What is the religion of the head of this household?
[] 3 Christianity
[] 4 Islam
[] 5 Shamanism
[] 8 Don't know
HC1C. What is the ethnicity of the head of your household?
[] 12 Kazakh
[] 13 Durvud
[] 14 Buriad
[] 15 Bayad
[] 16 Dariganga
[] 96 Other (specify) ____
[] 98 Don't know
HC1D. Type of dwelling?
Record observation. If necessary, clarify.
[] 2 Apartment, condominium
[] 3 Convenient single family house
[] 4 Single family house
[] 5 Public accommodation, dormitory
[] 6 Other (specify) ____
HC1E. What is the size of the living area of your dwelling?
The size of kitchen, corridor/hallway, and bathrooms are included.
[] 998 Don't know
HC1F. How many rooms does your dwelling have?
Kitchen, corridor/hallway, and bathrooms are not included in the number of rooms.
HC2. How many rooms in this household are used for sleeping?
Those rooms, which are not called as bedrooms, but used for sleeping in a regular basis are included.
HC2A. How many walls does your ger have?
HC2B. What is the main material of your ger floor?
[] 12 Dung/manure (Go to HC4A)
HC3. Main material of the dwelling floor.
Record observation. If necessary, clarify.
[] 32 Concrete, vinyl/ asphalt strips
[] 33 Ceramic tiles
[] 34 Cement
HC4. Main material of the roof.
Record observation. If necessary, clarify
[] 33 Concrete/cement fibre (Go to HC5)
[] 34 Ceramic tiles (Go to HC5)
[] 35 Cement (Go to HC5)
[] 37 Sandwich panel (Go to HC5)
[] 38 Roof lead (Go to HC5)
[] 96 Other (specify) ____ (Go to HC5)
HC4A. Is your ger roof single layered or double layered?
[] 42 Double (Go to HC5A)
HC5. Main material of the exterior walls.
Record observation. If necessary, clarify.
[] 22 Stone with mud (Go to HC5B)
[] 23 Uncovered adobe (Go to HC5B)
[] 24 Plywood (Go to HC5B)
[] 25 Cardboard (Go to HC5B)
[] 32 Stone with lime/cement (Go to HC5B)
[] 33 Bricks (Go to HC5B)
[] 34 Cement blocks (Go to HC5B)
[] 36 Wood planks, shingles, logs (Go to HC5B)
[] 37 Concrete/cement board (Go to HC5B)
[] 38 Sandwich panel (Go to HC5B)
HC5A. Is your ger wall single layered or double layered?
[] 42 Double
HC5B. What type of heating does your dwelling have?
[] 2 Electric heater (Go to HC6)
[] 3 Boiler
[] 4 Fire stove
[] 6 Other (specify) ____
HC5C. What type of fuel does your household mainly use for heating?
[] 07 Charcoal
[] 08 Wood
[] 10 Dung
[] 11 Sawdust
[] 96 Other (specify) ____
HC6. What type of fuel does your household mainly use for cooking?
[] 02 Liquefied petroleum gas (LPG) (Go to HC8)
[] 06 Coal (stone coal/lignite)
[] 07 Charcoal
[] 08 Wood
[] 10 Dung
[] 11 Sawdust
[] 95 No food cooked in household (Go to HC8)
[] 96 Other (specify) ____
HC7. Is the cooking usually done in the house, in a separate building, or outdoors?
If 'In the house', probe: is it done in a separate room used as a kitchen?
[] 2 Elsewhere in the house
[] 4 Outdoors
[] 6 Other (specify) ____
HC8. Does your household have:
[] 2 No
[F] A renewable-energy generator
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
[] 2 No
HC9. Does any member of your household own:
[] 2 No
[] 2 No
[] 2 No
[] 2. No
HC10. Do you or someone living in this household own this dwelling?
If "No", then ask: Do you rent this dwelling from someone not living in this household?
[] 3 Free of rent
HC11. Does any member of this household own any land that can be used for agriculture?
[] 2 No (Go to HC13)
HC12. How many hectares of agricultural land do members of this household own?
[] 2 Sq. meters _ _ _ _
[] 99998 Don't know
HC13. Does this household own any livestock, herds, other farm animals, or poultry?
[] 2 No (Go to HC15)
HC14. How many of the following animals does this household have?
If none, record '0000? If unknown, record '9998'.
[A] Cattle, milk cows, or bulls?
[B] Horses, donkeys, or mules?
HC15. Does any member of this household have a bank account?
[] 2. No
WS1. What is the main source of drinking water used by members of your household?
[] 16 Piped into dwelling from individual system (Go to WS6)
[] 17 Public water kiosk connected with centralized system (Go to WS4)
[] 32 Unprotected well (Go to WS3)
[] 42 Unprotected spring (Go to WS4)
[] 63 Public water kiosk (Go to WS4)
[] 81 Surface water (river, stream, dam, lake, pond, canal, irrigation channel) (Go to WS3)
[] 91 Bottled water
[] 96 Other (specify) ____(Go to WS3)
WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing?
[] 16 Piped into dwelling from individual system (Go to WS6)
[] 17 Public water kiosk connected with centralized system (Go to WS4)
[] 32 Unprotected well
[] 42 Unprotected spring (Go to WS4)
[] 63 Public water kiosk (Go to WS4)
[] 81 Surface water (river, stream, dam, lake, pond, canal, irrigation channel) (Go to WS4)
[] 96 Other (specify) ____(Go to WS3)
WS3. Where is that water source located?
[] 2 In own yard/plot (Go to WS6)
[] 3 Elsewhere
WS4A. How long does it take to go there, get water, and come back?
[] 2 15-29 minutes
[] 3 30 and more minutes
[] 8 DK
WS5. Who usually goes to this source to collect the water for your household?
Probe: is this person under age 15? What sex?
[] 2 Adult man (age 15+ years)
[] 3 Female child (under 15)
[] 4 Male child (under 15)
[] 8 DK
WS6. Do you do anything to the water to make it safer to drink?
[] 2 No (Go to WS7A)
[] 8 DK (Go to WS7A)
WS7. What do you usually do to make the water safer to drink?
Probe: Anything else?
Record all items mentioned
[] B Add bleach/chlorine
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, etc)
[] E Solar disinfection
[] F Let it stand and settle
[] X Other (specify) ____
[] Z DK
WS7A. How much water does your household use on average per day?
[] 2 15-29 litres
[] 3 30-44 litres
[] 4 45-59 litres
[] 5 60 and more litres
[] 8 Don't know
WS8. What kind of toilet facility do members of your household usually use?
If "flush" or "pour flush", probe: Where does it flush to?
If not possible to determine, ask permission to observe the facility.
[] 12 Flush to septic tank
[] 13 Flush to pit (latrine)
[] 15 Flush to unknown place/not sure
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 95 No facility, bush, field (Go to next module)
[] 96 Other (specify) ____
WS9. Do you share this facility with others who are not members of your household that you know, or is the facility open to the use of the general public?
[] 2 No (Go to WS12)
WS10. Do you share this facility only with members of other households that you know, or is the facility open to the use of the general public?
[] 2 Public facility (Go to WS12)
WS11. How many households in total use this toilet facility, including your own household?
[] 10 Ten or more households
[] 98 DK
WS12. Check answers from WS8, is the answer code "21, 22, 23, 31".
[] No (Go to next module)
WS13. Where does your household dispose waste water?
[] 31 Soak pit
[] 95 No facility, bush, field
[] 96 Other (specify) ____
HW1. We would like to learn about the places that household use to wash their hands. Can you please show me where members of your household most often wash their hands?
Not Observed
[] 3 No permission to see (Go to HW4)
[] 6 Other reason (specify) ____ (Go to HW4)
HW2 Observe presence of water at the place for handwashing. Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water
[] 2 Water is not available
HW3A. Observe presence of soap or detergent at the place for handwashing
[] 2 Soap is not available (Go to HW4)
HW3B Record you observation
Circle all that apply
[] B Detergent (powder/liquid/paste) (Go to HW5C)
[] C Liquid soap (Go to HW5C)
HW4 Do you have any soap or detergent in your house for washing hands?
[] 2 No (Go to HH19)
HW5A. Can you please show it to me?
[] 2 No, not shown (Go to HH19)
HW5B Record your observation
Circle all that apply
[] B Detergent
[] C Liquid soap
HW5C. Observe presence of bucket, vessel, or pot for waste water at the place for handwashing.
[] 2 No, not present
SI1. We would like to check whether the salt used in your household is iodized. May I have a sample of the salt used to cook meals in your household?
Once you have tested the salt, circle number that corresponds to test outcome.
[] 2 More than 0 PPM and less than 15 PPM
[] 3 15 PPM or more
[] 4 15 PPM or more (Go to HH20)
[] 5 Salt not tested (specify reason) ____(Go to HH20)
[] 2 Domestic
[] 8 Don't know
SI3. What kind of salt is this?
[] 2 White salt
[] 3 Natural salt
HH20. Thank the respondent for his/her cooperation and check the list of household members:
Return to the cover page and make sure that the result of the household interview (HH9), the name and line number of the respondent to the household questionnaire (HH10), and the number of eligible women (HH12), men (HH13A), and under-5s (HH14) are entered. Make arrangements for the administration of the remaining questionnaire(s) in this household.
Interviewer's Observations ________