Nepal Multiple Indicator Cluster Survey 2075/76
MICS 6: Household Questionnaire
Nepal 2019
Household Information Panel: HH
HH1. Cluster number: _ _ _
HH2. Household number: _ _
HH3. Interviewer's name and number:
Name ____
Number _ _
Number _ _
HH4. Supervisor's name and number:
Name ____
Number _ _
Number _ _
HH5. Interview date (day, month and year in BS):
_ _/_ _ /207 _
HH6. Settlement Area
[] 1 Urban
[] 2 Rural
[] 2 Rural
HH7. Provinces:
[] 1 Province number 1
[] 2 Province number 2
[] 3 Province number 3
[] 4 Gandaki province
[] 5 Province number 5
[] 6 Karnali province
[] 7 Far-western province
[] 2 Province number 2
[] 3 Province number 3
[] 4 Gandaki province
[] 5 Province number 5
[] 6 Karnali province
[] 7 Far-western province
HH8. Is this household also selected for the questionnaire for men?
[] 1 Yes
[] 2 No
[] 2 No
HH9. Is this household selected for the water quality testing?
[] 1 Yes
[] 2 No
[] 2 No
HH10. Is this household selected for blank water test?
[] 1 Yes
[] 2 No
[] 2 No
Check that the respondent is a knowledgeable member of the household and at least 18 years old before proceeding. You may only interview a child age 15-17 if there is no adult member of the household or all adult members are incapacitated. You may not interview a child under age 15
HH11. Record the time.
_ _: _ _ Hours : Minutes
HH12. Namaskaar! We are staff of the Central Bureau of Statistics. Currently, we are involved in the Nepal Multiple Indicator Cluster Survey, 2075/76 project to know the situation of children, women and household. I would like talk to you on these issues. The interview will take about 40 minutes. Following this, I may ask to conduct additional interviews with you or other individual members of your household. The personal data provided by you in this questionnaire will be kept confidential as per the Statistics Act 2015 and these details will not be shown, given or told to any other persons other than the divisional staff involved in this project. If you do not wish to answer a question or stop the interview, please let me know. Can I now start the interview?
[] Yes (List of household members)
[] No/not asked (Go to HH46)
[] No/not asked (Go to HH46)
HH46. Household questionnaire interview result:
Discuss any result not completed with supervisor.
[] 01 Completed
[] 02 No household member at home or no competent
[] 03 Entire household absent for extended period of time
[] 04 Refused
[] 05 Dwelling vacant or address not a dwelling
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 96 Other (specify) ____
[] 02 No household member at home or no competent
[] 03 Entire household absent for extended period of time
[] 04 Refused
[] 05 Dwelling vacant or address not a dwelling
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 96 Other (specify) ____
HH47. Name and line number of the respondent to household questionnaire interview:
Name ____
Line number _ _
Line number _ _
To be filled after the Household Questionnaire is completed
Total number
HH48. Household members: __ __
HH49. Women age 15-49: __ __
HH50. If the household is selected for the male questionnaire Men age 15-49: __ __
HH51. Children under 5 years: __ __
HH52. Children age 5-17: __ __
To be filled after all the questionnaires are completed
Completed number
HH53. Women age 15-49: __ __
HH54. If the household is selected for the male questionnaire Men age 15-49: __ __
HH55. Children under 5 years: __ __
HH56. Children age 5-17
[] 0 Zero
[] 1 One
[] 1 One
List Of Household Members: HL
First complete HL2-HL4 vertically for all household members, starting with the head of the household. Once HL2-HL4 are complete for all members, make sure to probe for additional members: Those that are not currently at home, any infants or small children and any others who may not be family (such as servants, friends) but who usually live in the household.
Then, ask questions HL5-HL20 for each member one at a time. If additional questionnaires are used, indicate by ticking this box: ____
HL1. Line number: _ _
HL2. First, please tell me the name of each person who usually lives here, starting with the head of the household.
Probe for additional household members.
Name: ____
HL3. What is the relationship of (name) to (name of the head of household)?
Relation: _ _
HL4. Is (name) male or female?
[] 1 Male
[] 2 Female
[] 2 Female
HL5. What is (name)'s date of birth?
Month (DK98): _ _
Year (DK9998): _ _ _ _
Year (DK9998): _ _ _ _
HL6. How old is (name)?
Record in completed years.
If age is 95 or above, record "95".
Age _ _
HL8. Record line number if woman and age 15-49: _ _
HL9. Record line number if man, age 15-49 and HH8 is yes: _ _
HL10. Record line number if age 0-4: _ _
HL11. Age 0-17?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
HL12. Is (name)'s natural mother alive?
[] 1 Yes
[] 2 No (Go to HL16)
[] 8 DK (Go to HL16)
[] 2 No (Go to HL16)
[] 8 DK (Go to HL16)
HL13. Does (name)'s natural mother live in this household?
[] 1 Yes
[] 2 No (Go to HL15)
[] 2 No (Go to HL15)
HL14. Record the line number of mother and go to HL16: _ _
HL15. Where does (name)'s natural mother live?
[] 1 Abroad
[] 2 In another household in the same province
[] 3 In another household in another province
[] 4 Institution in this country
[] 8 DK
[] 2 In another household in the same province
[] 3 In another household in another province
[] 4 Institution in this country
[] 8 DK
HL16. Is (name)'s natural father alive?
[] 1 Yes
[] 2 No (Go to HL20)
[] 8 DK (Go to HL20)
[] 2 No (Go to HL20)
[] 8 DK (Go to HL20)
HL17. Does (name)'s natural father live in this household?
[] 1 Yes
[] 2 No (go to HL19)
[] 2 No (go to HL19)
HL18. Record the line number of father and go to HL20: _ _
HL19. Where does (name)'s natural father live?
[] 1 Abroad
[] 2 In another household in the same province
[] 3 In another household in another province
[] 4 Institution in this country
[] 8 DK
[] 2 In another household in the same province
[] 3 In another household in another province
[] 4 Institution in this country
[] 8 DK
HL20. Copy the line number of mother from HL14. If blank, ask: Who is the primary caretaker of (name)?
If "No one" for a child age 15-17, record "90".
Number: _ _
Codes for HL3. Relationship to head of household
[] 01 Head
[] 02 Spouse/partner
[] 03 Son/daughter
[] 04 Son-in-law/daughter-in-law
[] 09 Brother-in-law/sister-in-law
[] 10 Uncle/aunt
[] 11 Niece/nephew
[] 12 Other Relative
[] 13 Adopted/foster/stepchild
[] 14 Servant (live-in)
[] 96 Other (not related)
[] 98 DK
[] 02 Spouse/partner
[] 03 Son/daughter
[] 04 Son-in-law/daughter-in-law
[] 09 Brother-in-law/sister-in-law
[] 10 Uncle/aunt
[] 11 Niece/nephew
[] 12 Other Relative
[] 13 Adopted/foster/stepchild
[] 14 Servant (live-in)
[] 96 Other (not related)
[] 98 DK
Education 1: ED
ED1. Line number: _ _
ED2. Name and age
Copy names and ages of all members of the household from HL2 and HL6 to below and to next page of the module.
Name: ____
Age: _ _
Age: _ _
ED3. Age 3 or above?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
ED4. Has (name) ever attended school or any early childhood education programme?
[] 1 Yes (Go to ED5)
[] 2 No
[] 2 No
ED4A. Has (name) ever attended any non-formal education or literacy programs?
[] 1 Yes (Go to next line)
[] 2 No (Go to next line)
[] 2 No (Go to next line)
ED5. What is the highest class (name) has studied?
Class:
[] 00 ECE (Go to ED7)
[] 01-12. class 1 to 12
[] 13 Bachelors
[] 14 Masters or above
[] 98 DK (Go to ED7)
[] 01-12. class 1 to 12
[] 13 Bachelors
[] 14 Masters or above
[] 98 DK (Go to ED7)
ED6. Did (name) ever complete that class?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
ED7. Age 3-24 years?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
ED8. Check ED4: Ever attended school or ECE?
[] 1 Yes
[] 2 No (Go to next line)
[] 2 No (Go to next line)
Education 2: ED
ED1. Line number _ _
ED2. Name and age
Name: ____
Age: _ _
Age: _ _
ED9. At any time during the 2076 school year did (name) attend school or any early childhood education programme?
[] 1 Yes
[] 2 No (Go to ED15)
[] 2 No (Go to ED15)
ED10. During 2076 school year, which class is (name) attending?
Class:
[] 00 ECE (Go to ED15)
[] 01-12. class 1 to 12
[] 13 Bachelors
[] 14 Masters or above
[] 98 DK (Go to ED15)
[] 01-12. class 1 to 12
[] 13 Bachelors
[] 14 Masters or above
[] 98 DK (Go to ED15)
ED11. Is (he/she) attending a public school?
If ?Yes?, record "1". If ?No?, probe to code who controls and manages the school.
[] 1 Government/public
[] 2 Religious/faith org
[] 3 Private
[] 6 Other
[] 8 DK
[] 2 Religious/faith org
[] 3 Private
[] 6 Other
[] 8 DK
ED12. In the 2076 school year, has (name) received any school tuition support?
If ?Yes?, probe to ensure that support was not received from family, other relatives, friends or neighbours.
[] 1 Yes
[] 2 No (Go to ED14)
[] 8 DK (Go to ED14)
[] 2 No (Go to ED14)
[] 8 DK (Go to ED14)
ED13. Who provided the tuition support?
Record all mentioned.
[] A Govt/public
[] B Religious/faith org
[] C Private
[] X Other
[] Z DK
[] B Religious/faith org
[] C Private
[] X Other
[] Z DK
ED14. For the 2076 school year, has (name) received any material support or cash to buy shoes, exercise books, notebooks, school uniforms or other school supplies?
If ?Yes?, probe to ensure that support was not received from family, other relatives, friends or neighbours.
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
ED15. At any time during the 2075 school year did (name) attend school or any early childhood education programme?
[] 1 Yes
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
[] 2 No (Go to next line)
[] 8 DK (Go to next line)
ED16. During that previous school year, which level and grade or year did (name) attend?
Class:
[] 00 ECE
[] 01-12. class 1 to 12
[] 13 Bachelors
[] 14 Masters or above
[] 98 DK
[] 01-12. class 1 to 12
[] 13 Bachelors
[] 14 Masters or above
[] 98 DK
Household Characteristics: HC
HC1A. What is the religion of (name of head of household from HL2)?
[] 1 Hindu
[] 2 Buddhist
[] 3 Islam
[] 4 Kirat
[] 5 Christian
[] 6 Nature
[] 7 Bon
[] 8 Jain
[] 9 Bahai
[] 10 Sikh
[] 11 No Religion
[] 96 Other (specify) ____
[] 2 Buddhist
[] 3 Islam
[] 4 Kirat
[] 5 Christian
[] 6 Nature
[] 7 Bon
[] 8 Jain
[] 9 Bahai
[] 10 Sikh
[] 11 No Religion
[] 96 Other (specify) ____
HC1B. What is the mother tongue of (name of head of household from HL2)?
(Please refer to an annex of list of names and codes of mother tongues and record the respective code)
_ _ _ Mother tongue
[] 996. Other languages (specify) ____
[] 996. Other languages (specify) ____
HC2. What is the caste/ethnicity of (name of head of household from HL2)?
(Please refer to an annex of list of names and codes of caste/ethnicity and record the respective code)
_ _ _ Caste/ethnicity
[] 996. Other (specify) ____
[] 996. Other (specify) ____
HC3. How many rooms do members of this household usually use for sleeping?
_ _ Number of rooms
HC4. Main material of the dwelling floor.
Record observation.
If observation is not possible, ask the respondent to determine the material of the dwelling floor.
Natural floor
[] 11 Earth/sand
[] 12 Dung
[] 12 Dung
Rudimentary floor
[] 21 Wood planks
[] 22 Palm/bamboo
[] 22 Palm/bamboo
Finished Floor
[] 31 Parquet or polished wood
[] 32 Vinyl or asphalt strips
[] 33 Ceramic tiles
[] 34 Cement
[] 35 Carpet
[] 32 Vinyl or asphalt strips
[] 33 Ceramic tiles
[] 34 Cement
[] 35 Carpet
[] 96 Other (specify) ____
HC5. Main material of the roof.
Record observation.
[] 11 No roof
Natural roofing
Natural roofing
[] 12 Thatch/palm leaf
[] 13 Sod
[] 13 Sod
Rudimentary roofing
[] 21 Rustic mat
[] 22 Palm/bamboo
[] 23 Wood planks
[] 24 Cardboard
[] 22 Palm/bamboo
[] 23 Wood planks
[] 24 Cardboard
Finished roofing
[] 31 Metal/tin
[] 32 Wood
[] 33 Calamine/cement fibre
[] 34 Ceramic tiles
[] 35 Cement
[] 36 Roofing shingles
[] 32 Wood
[] 33 Calamine/cement fibre
[] 34 Ceramic tiles
[] 35 Cement
[] 36 Roofing shingles
[] 96 Other (specify) ____
HC6. Main material of the exterior walls.
Record observation.
[] 11 No walls
Natural walls
[] 12 Cane/palm/trunks
[] 13 Dirt
[] 13 Dirt
Rudimentary walls
[] 21 Bamboo with mud
[] 22 Stone with mud
[] 23 Uncovered adobe
[] 24 Plywood
[] 25 Cardboard
[] 26 Reused wood
[] 22 Stone with mud
[] 23 Uncovered adobe
[] 24 Plywood
[] 25 Cardboard
[] 26 Reused wood
Finished walls
[] 31 Cement
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement blocks
[] 35 Covered adobe
[] 36 Wood planks/shingles
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement blocks
[] 35 Covered adobe
[] 36 Wood planks/shingles
[] 96 Other (specify) ____
HC7. Does your household own:
A. A fixed telephone line?
[] 1 Yes
[] 2 No
[] 2 No
B. A radio?
[] 1 Yes
[] 2 No
[] 2 No
C. A wall clock?
[] 1 Yes
[] 2 No
[] 2 No
HC8. Does your household have electricity?
[] 1 Yes, Interconnected gird
[] 2 Yes, off-grid (generator/isolated system)
[] 3 No (Go to HC10)
[] 2 Yes, off-grid (generator/isolated system)
[] 3 No (Go to HC10)
HC9. Does your household have:
A. Television?
[] 1 Yes
[] 2 No
[] 2 No
B. Refrigerator?
[] 1 Yes
[] 2 No
[] 2 No
C. Microwave oven
[] 1 Yes
[] 2 No
[] 2 No
D. Washing machine
[] 1 Yes
[] 2 No
[] 2 No
E. Electric fan
[] 1 Yes
[] 2 No
[] 2 No
HC10. Does any member of your household own:
A. Wristwatch?
[] 1 Yes
[] 2 No
[] 2 No
B. Bicycle?
[] 1 Yes
[] 2 No
[] 2 No
C. Motorcycle or scooter?
[] 1 Yes
[] 2 No
[] 2 No
D. An animal-drawn cart?
[] 1 Yes
[] 2 No
[] 2 No
E1. A truck or van?
[] 1 Yes
[] 2 No
[] 2 No
E2. Bus?
[] 1 Yes
[] 2 No
[] 2 No
F. Boat with a motor?
[] 1 Yes
[] 2 No
[] 2 No
G. Car
[] 1 Yes
[] 2 No
[] 2 No
G. Rickshaw/electric rickshaw
[] 1 Yes
[] 2 No
[] 2 No
HC11. Does any member of your household have a computer or a tablet?
[] 1 Yes
[] 2 No
[] 2 No
HC12. Does any member of your household have a mobile telephone?
[] 1 Yes
[] 2 No
[] 2 No
HC13. Does your household have access to internet at home?
[] 1 Yes
[] 2 No
[] 2 No
HC14. 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?
If "Rented from someone else", record "2". For other responses, record "6" and specify.
[] 1 Own
[] 2 Rented
[] 6 Other (specify) _____
[] 2 Rented
[] 6 Other (specify) _____
HC15. Does any member of this household own any land that can be used for agriculture?
[] 1 Yes
[] 2 No (Go to HC17)
[] 2 No (Go to HC17)
HC16. How many ropanis/bighas of agricultural land do members of this household own?
If any answer is 95 or more than that write ?95?. Convert the answer into appropriate unit (either into Ropani or Bigha).
_ _/_ _/_ _ 1 Ropani (Ropani, Aana, Paisa)
_ _/_ _/_ _ 2 Bigha (Bigha, Kattha, Dhur)
[] 98 DK
_ _/_ _/_ _ 2 Bigha (Bigha, Kattha, Dhur)
[] 98 DK
HC17. Does this household own any livestock, heards, or other farm animals, or poultry?
[] 1 Yes
[] 2 No (Go to HC19)
[] 2 No (Go to HC19)
HC18. How many of the following animals does this household have?
If none, record "00". If more than 95, write "95". If the answer is don't know, write "98".
A. Milk cows or bulls?
Number: _ _
B. Other cattle?
Number: _ _
C. Horses, donkeys or mules?
Number: _ _
D. Goats?
Number: _ _
E. Sheep?
Number: _ _
F. Chickens?
Number: _ _
G. Pigs?
Number: _ _
H. Yak/Naak/mountain cow?
Number: _ _
HC19. Does any member of this household have a bank account?
[] 1 Yes
[] 2 No
[] 2 No
Social Transfers: ST
ST1. I would like to ask you about various external economic assistance programmes provided to households. By external assistance I mean support that comes from the government or from non-governmental organizations such as religious, charitable, or community-based organizations. This excludes support from family, other relatives, friends or neighbours.
ST2. Are you aware of (programme name)?
A. Senior citizen allowance
[] 1 Yes (Go to ST3)
[] 2 No (Go to B)
[] 2 No (Go to B)
B. Single woman allowance
[] 1 Yes (Go to ST3)
[] 2 No (Go to C)
[] 2 No (Go to C)
C. Widow allowance
[] 1 Yes (Go to ST3)
[] 2 No (Go to D)
[] 2 No (Go to D)
D. Retirement pension
[] 1 Yes (Go to ST3)
[] 2 No (Go to X)
[] 2 No (Go to X)
E. Child support/grant
[] 1 Yes (Go to ST3)
[] 2 No (Go to F)
[] 2 No (Go to F)
F. Disabled allowance
[] 1 Yes (Go to ST3)
[] 2 No (Go to G)
[] 2 No (Go to G)
G. Minority/indigenous allowance
[] 1 Yes (Go to ST3)
[] 2 No (Go to X)
[] 2 No (Go to X)
X. Any other external assistance programme
[] 1 Yes (specify) ____ (Go to ST3)
[] 2 No (Go to end of module)
[] 2 No (Go to end of module)
ST3. Has your household or anyone in your household received assistance through (name of programme)?
A. Senior citizen allowance
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to B)
[] 2 No (Go to ST3A)
[] 8 DK (Go to B)
B. Single woman allowance
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to C)
[] 2 No (Go to ST3A)
[] 8 DK (Go to C)
C. Widow allowance
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to D)
[] 2 No (Go to ST3A)
[] 8 DK (Go to D)
D. Retirement pension
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to E)
[] 2 No (Go to ST3A)
[] 8 DK (Go to E)
E. Child support/grant
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to F)
[] 2 No (Go to ST3A)
[] 8 DK (Go to F)
F. Disabled allowance
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to G)
[] 2 No (Go to ST3A)
[] 8 DK (Go to G)
G. Minority/indigenous allowance
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to X)
[] 2 No (Go to ST3A)
[] 8 DK (Go to X)
X. Any other external assistance programme
[] 1 Yes (Go to ST4)
[] 2 No (Go to ST3A)
[] 8 DK (Go to end of module)
[] 2 No (Go to ST3A)
[] 8 DK (Go to end of module)
ST3A. What is the main reason that none of your household members have received assistance through (programme name)?
A. Senior citizen allowance
[] 1 Not eligible (Go to B)
[] 2 Eligible but don't have legal documents (Go to B)
[] 3 Eligible but incorrect date of birth (Go to B)
[] 4 Eligible but not applied for the programme (Go to B)
[] 6 Others (specify) ____ (Go to B)
[] 8 DK (Go to B)
[] 2 Eligible but don't have legal documents (Go to B)
[] 3 Eligible but incorrect date of birth (Go to B)
[] 4 Eligible but not applied for the programme (Go to B)
[] 6 Others (specify) ____ (Go to B)
[] 8 DK (Go to B)
B. Single woman allowance
[] 1 Not eligible (Go to C)
[] 2 Eligible but don't have legal documents (Go to C)
[] 3 Eligible but incorrect date of birth (Go to C)
[] 4 Eligible but not applied for the programme (Go to C)
[] 6 Others (specify) ____ (Go to C)
[] 8 DK (Go to C)
[] 2 Eligible but don't have legal documents (Go to C)
[] 3 Eligible but incorrect date of birth (Go to C)
[] 4 Eligible but not applied for the programme (Go to C)
[] 6 Others (specify) ____ (Go to C)
[] 8 DK (Go to C)
C. Widow allowance
[] 1 Not eligible (Go to D)
[] 2 Eligible but don't have legal documents (Go to D)
[] 3 Eligible but incorrect date of birth (Go to D)
[] 4 Eligible but not applied for the programme (Go to D)
[] 6 Others (specify) ____ (Go to D)
[] 8 DK (Go to D)
[] 2 Eligible but don't have legal documents (Go to D)
[] 3 Eligible but incorrect date of birth (Go to D)
[] 4 Eligible but not applied for the programme (Go to D)
[] 6 Others (specify) ____ (Go to D)
[] 8 DK (Go to D)
D. Any Retirement pension
[] 1 Not eligible (Go to E)
[] 2 Eligible but don't have legal documents (Go to E)
[] 3 Eligible but incorrect date of birth (Go to E)
[] 4 Eligible but not applied for the programme (Go to E)
[] 6 Others (specify) ____ (Go to E)
[] 8 DK (Go to E)
[] 2 Eligible but don't have legal documents (Go to E)
[] 3 Eligible but incorrect date of birth (Go to E)
[] 4 Eligible but not applied for the programme (Go to E)
[] 6 Others (specify) ____ (Go to E)
[] 8 DK (Go to E)
E. Child support/grant
[] 1 Not eligible (Go to F)
[] 2 Eligible but don't have legal documents (Go to F)
[] 3 Eligible but incorrect date of birth (Go to F)
[] 4 Eligible but not applied for the programme (Go to F)
[] 6 Others (specify) ____ (Go to F)
[] 8 DK (Go to F)
[] 2 Eligible but don't have legal documents (Go to F)
[] 3 Eligible but incorrect date of birth (Go to F)
[] 4 Eligible but not applied for the programme (Go to F)
[] 6 Others (specify) ____ (Go to F)
[] 8 DK (Go to F)
F. Disabled allowance
[] 1 Not eligible (Go to G)
[] 2 Eligible but don't have legal documents (Go to G)
[] 3 Eligible but incorrect date of birth (Go to G)
[] 4 Eligible but not applied for the programme (Go to G)
[] 6 Others (specify) ____ (Go to G)
[] 8 DK (Go to G)
[] 2 Eligible but don't have legal documents (Go to G)
[] 3 Eligible but incorrect date of birth (Go to G)
[] 4 Eligible but not applied for the programme (Go to G)
[] 6 Others (specify) ____ (Go to G)
[] 8 DK (Go to G)
G. Minority/indigenous allowance
[] 1 Not eligible (Go to X)
[] 2 Eligible but don't have legal documents (Go to X)
[] 3 Eligible but incorrect date of birth (Go to X)
[] 4 Eligible but not applied for the programme (Go to X)
[] 6 Others (specify) ____ (Go to X)
[] 8 DK (Go to X)
[] 2 Eligible but don't have legal documents (Go to X)
[] 3 Eligible but incorrect date of birth (Go to X)
[] 4 Eligible but not applied for the programme (Go to X)
[] 6 Others (specify) ____ (Go to X)
[] 8 DK (Go to X)
X. Any other external assistance programme
[] 1 Not eligible (Go to end of module)
[] 2 Eligible but don't have legal documents (Go to end of module)
[] 3 Eligible but incorrect date of birth (Go to end of module)
[] 4 Eligible but not applied for the programme (Go to end of module)
[] 6 Others (specify) ____ (Go to end of module)
[] 8 DK (Go to end of module)
[] 2 Eligible but don't have legal documents (Go to end of module)
[] 3 Eligible but incorrect date of birth (Go to end of module)
[] 4 Eligible but not applied for the programme (Go to end of module)
[] 6 Others (specify) ____ (Go to end of module)
[] 8 DK (Go to end of module)
ST4. When was the last time your household or anyone in your household received assistance through (name of programme)?
If less than one month, record "1" and record "00" in Months. If less than 12 months, record "1" and record in Months. If 1 year/12 months or more, record "2" and record in Years.
A. Senior citizen allowance
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
B. Single woman allowance
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
C. Widow allowance
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
D. Retirement pension
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
E. Child support/grant
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
F. Disabled allowance
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
G. Minority/indigenous allowance
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
X. Any other external assistance programme
1. Months ago _ _
2. Years ago_ _
[] 998. DK
2. Years ago_ _
[] 998. DK
ST4A. How many members in your household are receiving assistance through (programme name)?
A. Senior citizen allowance
_ _ Total number
B. Single woman allowance
_ _ Total number
C. Widow allowance
_ _ Total number
D. Any Retirement pension
_ _ Total number
E. Child support/grant
_ _ Total number
F. Disabled allowance
_ _ Total number
G. Minority/indigenous allowance
_ _ Total number
X. Any other external assistance programme
_ _ Total number
ST5. How many times such assistance was received since Srawan 2074 to Asar 2075 through (programme name)?
A. Senior citizen allowance
_ _ Times
[] 98 DK
[] 98 DK
B. Single woman allowance
_ _ Times
[] 98 DK
[] 98 DK
C. Widow allowance
_ _ Times
[] 98 DK
[] 98 DK
D. Any Retirement pension
_ _ Times
[] 98 DK
[] 98 DK
E. Child support/grant
_ _ Times
[] 98 DK
[] 98 DK
F. Disabled allowance
_ _ Times
[] 98 DK
[] 98 DK
G. Minority/indigenous allowance
_ _ Times
[] 98 DK
[] 98 DK
X. Any other external assistance programme
_ _ Times
[] 98 DK
[] 98 DK
ST6. How much money has been received as assistance since Srawan 2074 to Asar 2075 through (programme name)?
A. Senior citizen allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
B. Single woman allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
C. Widow allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
D. Any Retirement pension
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
E. Child support/grant
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
F. Disabled allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
G. Minority/indigenous allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
X. Any other external assistance programme
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
ST7. Have you or anyone from your household received any of these assistance amounts through (programme name) directly to your bank account?
A. Senior citizen allowance
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
B. Single woman allowance
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
C. Widow allowance
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
D. Any Retirement pension
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
E. Child support/grant
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
F. Disabled allowance
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
G. Minority/indigenous allowance
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
X. Any other external assistance programme
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
ST8. When you or your household member received the assistance amount last time, how much time (travel time) was spent to acquire the amount through (programme name)?
If greater than 24 hours write in days. If less than 1 hour record 00
A. Senior citizen allowance
_ Day
_ _ Hour
_ _ Hour
B. Single woman allowance
_ Day
_ _ Hour
_ _ Hour
C. Widow allowance
_ Day
_ _ Hour
_ _ Hour
D. Any Retirement pension
_ Day
_ _ Hour
_ _ Hour
E. Child support/grant
_ Day
_ _ Hour
_ _ Hour
F. Disabled allowance
_ Day
_ _ Hour
_ _ Hour
G. Minority/indigenous allowance
_ Day
_ _ Hour
_ _ Hour
X. Any other external assistance programme
_ Day
_ _ Hour
_ _ Hour
ST9. When you went to receive the assistance amount through (programme name) last time, how much did it cost you to go and return?
A. Senior citizen allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
B. Single woman allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
C. Widow allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
D. Any Retirement pension
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
E. Child support/grant
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
F. Disabled allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
G. Minority/indigenous allowance
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
X. Any other external assistance programme
_ _ _ _ Total of NRS.
[] 9998 DK
[] 9998 DK
ST10. For what purposes were the amount received through (programme name) spent?
Record all mentioned
A. Senior citizen allowance
[] A Food (Go to B)
[] B Clothes (Go to B)
[] C Education (Go to B)
[] D Treatment (Go to B)
[] E Household purpose (Go to B)
[] F Income generation (Go to B)
[] G Savings (Go to B)
[] X Others (specify) ____ (Go to B)
[] B Clothes (Go to B)
[] C Education (Go to B)
[] D Treatment (Go to B)
[] E Household purpose (Go to B)
[] F Income generation (Go to B)
[] G Savings (Go to B)
[] X Others (specify) ____ (Go to B)
B. Single woman allowance
[] A Food (Go to C)
[] B Clothes (Go to C)
[] C Education (Go to C)
[] D Treatment (Go to C)
[] E Household purpose (Go to C)
[] F Income generation (Go to C)
[] G Savings (Go to C)
[] X Others (specify) ____ (Go to C)
[] B Clothes (Go to C)
[] C Education (Go to C)
[] D Treatment (Go to C)
[] E Household purpose (Go to C)
[] F Income generation (Go to C)
[] G Savings (Go to C)
[] X Others (specify) ____ (Go to C)
C. Widow allowance
[] A Food (Go to D)
[] B Clothes (Go to D)
[] C Education (Go to D)
[] D Treatment (Go to D)
[] E Household purpose (Go to D)
[] F Income generation (Go to D)
[] G Savings (Go to D)
[] X Others (specify) ____ (Go to D)
[] B Clothes (Go to D)
[] C Education (Go to D)
[] D Treatment (Go to D)
[] E Household purpose (Go to D)
[] F Income generation (Go to D)
[] G Savings (Go to D)
[] X Others (specify) ____ (Go to D)
D. Any Retirement pension
[] A Food (Go to E)
[] B Clothes (Go to E)
[] C Education (Go to E)
[] D Treatment (Go to E)
[] E Household purpose (Go to E)
[] F Income generation (Go to E)
[] G Savings (Go to E)
[] X Others (specify) ____ (Go to E)
[] B Clothes (Go to E)
[] C Education (Go to E)
[] D Treatment (Go to E)
[] E Household purpose (Go to E)
[] F Income generation (Go to E)
[] G Savings (Go to E)
[] X Others (specify) ____ (Go to E)
E. Child support/grant
[] A Food (Go to F)
[] B Clothes (Go to F)
[] C Education (Go to F)
[] D Treatment (Go to F)
[] E Household purpose (Go to F)
[] F Income generation (Go to F)
[] G Savings (Go to F)
[] X Others (specify) ____ (Go to F)
[] B Clothes (Go to F)
[] C Education (Go to F)
[] D Treatment (Go to F)
[] E Household purpose (Go to F)
[] F Income generation (Go to F)
[] G Savings (Go to F)
[] X Others (specify) ____ (Go to F)
F. Disabled allowance
[] A Food (Go to G)
[] B Clothes (Go to G)
[] C Education (Go to G)
[] D Treatment (Go to G)
[] E Household purpose (Go to G)
[] F Income generation (Go to G)
[] G Savings (Go to G)
[] X Others (specify) ____ (Go to G)
[] B Clothes (Go to G)
[] C Education (Go to G)
[] D Treatment (Go to G)
[] E Household purpose (Go to G)
[] F Income generation (Go to G)
[] G Savings (Go to G)
[] X Others (specify) ____ (Go to G)
G. Minority/indigenous allowance
[] A Food (Go to X)
[] B Clothes (Go to X)
[] C Education (Go to X)
[] D Treatment (Go to X)
[] E Household purpose (Go to X)
[] F Income generation (Go to X)
[] G Savings (Go to X)
[] X Others (specify) ____ (Go to X)
[] B Clothes (Go to X)
[] C Education (Go to X)
[] D Treatment (Go to X)
[] E Household purpose (Go to X)
[] F Income generation (Go to X)
[] G Savings (Go to X)
[] X Others (specify) ____ (Go to X)
X. Any other external assistance programme
[] A Food (Go to end of module)
[] B Clothes (Go to end of module)
[] C Education (Go to end of module)
[] D Treatment (Go to end of module)
[] E Household purpose (Go to end of module)
[] F Income generation (Go to end of module)
[] G Savings (Go to end of module)
[] X Others (specify) ____ (Go to end of module)
[] B Clothes (Go to end of module)
[] C Education (Go to end of module)
[] D Treatment (Go to end of module)
[] E Household purpose (Go to end of module)
[] F Income generation (Go to end of module)
[] G Savings (Go to end of module)
[] X Others (specify) ____ (Go to end of module)
Household Energy Use: EU
EU1. In your household, what type of cookstove is mainly used for cooking?
[] 01 Electric stove (Go to EU5)
[] 02 Solar cooker (Go to EU5)
[] 03 Liquefied petroleum gas (LPG)/cooking gas stove (Go to EU5)
[] 04 Piped natural gas stove (Go to EU5)
[] 05 Biogas stove (Go to EU5)
[] 06 Liquid fuel stove (Go to EU4)
[] 07 Manufactured solid fuel stove
[] 08 Traditional solid fuel stove
[] 09 Three stone stove/open fire (Go to EU4)
[] 96 Other (specify)____ (Go to EU4)
[] 97 No food cooked in household (Go to EU6)
[] 02 Solar cooker (Go to EU5)
[] 03 Liquefied petroleum gas (LPG)/cooking gas stove (Go to EU5)
[] 04 Piped natural gas stove (Go to EU5)
[] 05 Biogas stove (Go to EU5)
[] 06 Liquid fuel stove (Go to EU4)
[] 07 Manufactured solid fuel stove
[] 08 Traditional solid fuel stove
[] 09 Three stone stove/open fire (Go to EU4)
[] 96 Other (specify)____ (Go to EU4)
[] 97 No food cooked in household (Go to EU6)
EU2. Does it have a chimney?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
EU3. Does this stove have fan?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
EU4. What type of fuel or energy source is used in this cookstove?
If more than one, record the main energy source for this cookstove.
[] 01 Alcohol/ethanol
[] 02 Gasoline/diesel
[] 03 Kerosene/paraffin
[] 04 Coal/lignite
[] 05 Charcoal
[] 06 Wood
[] 07 Crop residue/grass/straw/shrubs
[] 08 Animal dung/waste
[] 09 Processed biomass (pellets) or woodchips
[] 10 Garbage/plastic
[] 11 Sawdust
[] 96 Other (specify) ____
[] 02 Gasoline/diesel
[] 03 Kerosene/paraffin
[] 04 Coal/lignite
[] 05 Charcoal
[] 06 Wood
[] 07 Crop residue/grass/straw/shrubs
[] 08 Animal dung/waste
[] 09 Processed biomass (pellets) or woodchips
[] 10 Garbage/plastic
[] 11 Sawdust
[] 96 Other (specify) ____
EU5. Is the cooking usually done in the house, in a separate building, or outdoors?
If in main house, probe to determine if cooking is done in a separate room. If outdoors, probe to determine if cooking is done on veranda, covered porch, or open air?
In main house
[] 01 No separate room
[] 02 In a separate room
[] 03 In a separate building
[] 02 In a separate room
[] 03 In a separate building
Outdoors
[] 04 Open air
[] 05 On veranda or covered porch
[] 05 On veranda or covered porch
[] 06 Other (specify) ____
EU6. What does your household mainly use for space heating when needed?
[] 01 Central heating (Go to EU8)
[] 02 manufactured space heater
[] 03 traditional space heater
[] 04 manufactured cookstove
[] 05 traditional cookstove
[] 06 three stone stove/open fire (Go to EU8)
[] 96 Other (specify) (Go to EU8)
[] 97 No space heating in house (Go to EU9)
[] 02 manufactured space heater
[] 03 traditional space heater
[] 04 manufactured cookstove
[] 05 traditional cookstove
[] 06 three stone stove/open fire (Go to EU8)
[] 96 Other (specify) (Go to EU8)
[] 97 No space heating in house (Go to EU9)
EU7. Does it have a chimney?
[] 1 Yes
[] 2 No
[] 8 DK
[] 2 No
[] 8 DK
EU8. What type of fuel and energy source is used in this heater?
If more than one, record the main energy source for this heater.
[] 01 Solar air heater
[] 02 Electricity
[] 03 Piped natural gas
[] 04 Liquefied Petroleum Gas (LPG)/cooking gas
[] 05 Biogas
[] 06 Alcohol/ethanol
[] 07 Gasoline/diesel
[] 08 Kerosene/paraffin
[] 09 Coal/lignite
[] 10 Charcoal
[] 11 Wood
[] 12 Crop residue/grass/straw/shrubs
[] 13 Animal dung/waste
[] 14 Processed biomass (pellets) or woodchips
[] 15 Garbage/plastic
[] 16 Sawdust
[] 96 Other (specify) ____
[] 02 Electricity
[] 03 Piped natural gas
[] 04 Liquefied Petroleum Gas (LPG)/cooking gas
[] 05 Biogas
[] 06 Alcohol/ethanol
[] 07 Gasoline/diesel
[] 08 Kerosene/paraffin
[] 09 Coal/lignite
[] 10 Charcoal
[] 11 Wood
[] 12 Crop residue/grass/straw/shrubs
[] 13 Animal dung/waste
[] 14 Processed biomass (pellets) or woodchips
[] 15 Garbage/plastic
[] 16 Sawdust
[] 96 Other (specify) ____
EU9. At night, what does your household mainly use to light the household?
[] 1 Electricity
[] 2 Solar lantern
[] 3 Rechargeable flashlight, torch or lantern
[] 4 Battery powered flashlight, torch or lantern
[] 5 Biogas lamp
[] 6 Gasoline lamp
[] 7 Kerosene or paraffin lamp
[] 8 Charcoal
[] 9 Wood
[] 10 Crop residue/grass/straw/shrubs
[] 11 Animal dung/waste
[] 12 Oil lamp
[] 13 Candle
[] 96 Other (specify) ____
[] 97 No lighting in household
[] 2 Solar lantern
[] 3 Rechargeable flashlight, torch or lantern
[] 4 Battery powered flashlight, torch or lantern
[] 5 Biogas lamp
[] 6 Gasoline lamp
[] 7 Kerosene or paraffin lamp
[] 8 Charcoal
[] 9 Wood
[] 10 Crop residue/grass/straw/shrubs
[] 11 Animal dung/waste
[] 12 Oil lamp
[] 13 Candle
[] 96 Other (specify) ____
[] 97 No lighting in household
Drinking Water and Sanitation: WS
WS1. What is the main source of drinking water used by members of your household?
If unclear, probe to identify the place from which members of this household most often collect drinking water (collection point).
Piped water
[] 11 Piped into dwelling (Go to WS7)
[] 12 Piped into yard/plot (Go to WS7)
[] 13 Piped to neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole (Go to WS2A)
[] 12 Piped into yard/plot (Go to WS7)
[] 13 Piped to neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole (Go to WS2A)
Dug well
[] 31 Protected well (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 32 Unprotected well (Go to WS3)
Spring water
[] 41 Protected spring (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 51 Rainwater (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 71 Cart with small tank (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 51 Rainwater (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 71 Cart with small tank (Go to WS4)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
Packaged water
[] 91 Bottled water
[] 93 Jar water
[] 93 Jar water
[] 96 Others (specify) ____ (Go to WS3)
WS2. What is the main source of water used by members of your household for other purposes such as cooking and handwashing?
If unclear, probe to identify the place from which members of this household most often collect water for other purposes.
Piped water
[] 11 Piped into dwelling (Go to WS7)
[] 12 Piped to yard/plot (Go to WS7)
[] 13 Piped to neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole
[] 12 Piped to yard/plot (Go to WS7)
[] 13 Piped to neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole
Dug well
[] 31 Protected well (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 32 Unprotected well (Go to WS3)
Spring water
[] 41 Protected spring (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 51 Rainwater (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 71 Cart with small tank (Go to WS4)
[] 72 Open water retailer/seller (Go to WS3)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 51 Rainwater (Go to WS3)
[] 61 Tanker-truck (Go to WS4)
[] 71 Cart with small tank (Go to WS4)
[] 72 Open water retailer/seller (Go to WS3)
[] 81 Surface water (river, dam, lake, pond, stream, canal, irrigation channel) (Go to WS3)
Packaged water
[] 91 Bottled water (Go to WS3)
[] 93 Jar water (Go to WS3)
[] 93 Jar water (Go to WS3)
[] 96 Others (specify) ____
WS2A. Where is the estimated depth of the tubewell/borewhole?
_ _ _ Estimated depth (in ft)
WS3. Where is that water source located?
[] 1 In own dwelling (Go to WS7)
[] 2 In own yard/plot (Go to WS7)
[] 3 Elsewhere
[] 2 In own yard/plot (Go to WS7)
[] 3 Elsewhere
WS4. How long does it take for members of your household to go there, get water, and come back?
[] 000. Members do not collect (go to WS7)
_ _ _Number of minutes
[] 998. DK
_ _ _Number of minutes
[] 998. DK
WS5. Who usually goes to this source to collect the water for your household?
Record the name of the person and copy the line number of this person from the list of household members module.
Name: ____
Line number: _ _
Line number: _ _
WS6. Since last (day of the week), how many times has this person collected water?
Number of times: _ _
[] 98 DK
[] 98 DK
WS7. In the last month, has there been any time when your household did not have sufficient quantities of drinking water?
[] 1 Yes, at least once
[] 2 No, always sufficient (Go to WS9)
[] 8 DK (Go to WS9)
[] 2 No, always sufficient (Go to WS9)
[] 8 DK (Go to WS9)
WS8. What was the main reason that you were unable to access water in sufficient quantities when needed?
[] 1 Water not available from source
[] 2 Water too expensive
[] 3 Source not accessible
[] 6 Other (specify) ____
[] 8 DK
[] 2 Water too expensive
[] 3 Source not accessible
[] 6 Other (specify) ____
[] 8 DK
WS9. Do you or any other member of this household do anything to the water to make it safer to drink?
[] 1 Yes
[] 2 No (Go to WS11)
[] 8 DK (Go to WS11)
[] 2 No (Go to WS11)
[] 8 DK (Go to WS11)
WS10. What do you usually do to make the water safer to drink?
Probe: Anything else?
Record all methods mentioned.
[] A Boil
[] B Add bleach/chlorine (piyush, aqyatab, etc.)
[] 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
[] B Add bleach/chlorine (piyush, aqyatab, etc.)
[] 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
WS11. 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.
Flush/pour flush
[] 11 Flush to piped sewer system (go to WS14)
[] 12 Flush to septic tank
[] 13 Flush to pit latrine
[] 14 Flush to open drain (go to WS14)
[] 18 Flush to DK where (go to WS14)
[] 12 Flush to septic tank
[] 13 Flush to pit latrine
[] 14 Flush to open drain (go to WS14)
[] 18 Flush to DK where (go to WS14)
Pit latrine
[] 21 Ventilated improved pit latrine
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 31 Composting toilet
[] 41 Bucket (Go to WS14)
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 31 Composting toilet
[] 41 Bucket (Go to WS14)
[] 95 No facility/bush/field (Go to end of module)
[] 96 Other (specify) ____ (Go to WS14)
[] 96 Other (specify) ____ (Go to WS14)
WS12. Has your (answer from WS11) ever been emptied?
[] 1 Yes, emptied
[] 4 No, never emptied (Go to WS14)
[] 8 DK (Go to WS14)
[] 4 No, never emptied (Go to WS14)
[] 8 DK (Go to WS14)
WS13. The last time it was emptied, where were the contents emptied to?
Probe: Was it removed by a service provider?
Removed by service provider
[] 1 To a treatment plant
[] 2 Buried in a covered pit
[] 3 To don't know where
[] 7 To uncovered pit, open ground, water body or elsewhere
[] 2 Buried in a covered pit
[] 3 To don't know where
[] 7 To uncovered pit, open ground, water body or elsewhere
Emptied by household
[] 4 Buried in a covered pit
[] 5 To uncovered pit, open ground, water body or elsewhere
[] 6 Other (specify) ____
[] 8 DK
[] 5 To uncovered pit, open ground, water body or elsewhere
[] 6 Other (specify) ____
[] 8 DK
WS14. Where is this toilet facility located?
[] 1 In own dwelling
[] 2 In own yard/plot
[] 3 Elsewhere
[] 2 In own yard/plot
[] 3 Elsewhere
WS15. Do you share this facility with others who are not members of your household?
[] 1 Yes
[] 2 No (Go to end of module)
[] 2 No (Go to end of module)
WS16. 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?
[] 1 Shared with known households (not public)
[] 2 Shared with general public (Go to end of module)
[] 2 Shared with general public (Go to end of module)
WS17. How many households in total use this toilet facility, including your own household?
0 _ Number of households (if less than 10)
[] 10 Ten or more households
[] 98 DK
[] 10 Ten or more households
[] 98 DK
Handwashing: HW
HW1. We would like to learn about where members of this household wash their hands.
Can you please show me where members of your household most often wash their hands?
Record result and observation.
Observed
[] 1 Fixed facility observed (sink/tap) in dwelling
[] 2 Fixed facility observed (sink/tap) in yard /plot
[] 3 Mobile object observed (bucket/jug/kettle/aamkhora)
[] 2 Fixed facility observed (sink/tap) in yard /plot
[] 3 Mobile object observed (bucket/jug/kettle/aamkhora)
Not observed
[] 4 No handwashing place in dwelling/yard/plot (Go to HW5)
[] 5 No permission to see (Go to HW4)
[] 5 No permission to see (Go to HW4)
[] 6 Other reason (specify) ____(Go to HW5)
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.
[] 1 Water is available
[] 2 Water is not available
[] 2 Water is not available
HW3. Is soap or detergent, ash/mud/sand at the handwashing place?
[] 1 Yes, present (Go to HW7)
[] 2 No, not present (Go to HW5)
[] 2 No, not present (Go to HW5)
HW4. Where do you or other members of your household most often wash your hands?
Fixed facility (sink/tap)
[] 1 In dwelling
[] 2 In yard/plot
[] 2 In yard/plot
[] 3 Mobile object (bucket/jug/kettle/aamkhora)
[] 4 No handwashing place in dwelling/yard/plot
[] 6 Other (specify) ____
[] 4 No handwashing place in dwelling/yard/plot
[] 6 Other (specify) ____
HW5. Do you have any soap or detergent or ash/mud/sand in your house for washing hands?
[] 1 Yes
[] 2 No (Go to end of module)
[] 2 No (Go to end of module)
HW6. Can you please show it to me?
[] 1 Yes, shown
[] 2 No, not shown (Go to end of module)
[] 2 No, not shown (Go to end of module)
HW7. Record your observation.
Record all that apply.
[] A Bar or liquid soap
[] B Detergent (powder/liquid/paste)
[] C Ash/mud/sand
[] B Detergent (powder/liquid/paste)
[] C Ash/mud/sand
HH13. Record the time.
Hour and minute: _ _:_ _
HH14. Language of the Questionnaire.
[] 1 Nepali
[] 2 Bhojpuri
[] 3 Maithili
[] 2 Bhojpuri
[] 3 Maithili
HH15. Language of the Interview.
[] 1 Nepali
[] 2 Bhojpuri
[] 3 Maithili
[] 6 Other language (specify) ____
[] 2 Bhojpuri
[] 3 Maithili
[] 6 Other language (specify) ____
HH16. Native language of the Respondent.
_ _ _ Language codes (specify)
[] 996. Other language (specify) ____
[] 996. Other language (specify) ____
HH17. Was a translator used for any parts of this questionnaire?
[] 1 Yes, whole questionnaire
[] 2 Yes, some part of the questionnaire
[] 3 No, not used
[] 2 Yes, some part of the questionnaire
[] 3 No, not used
HH18. Check HL6 in the "List of household members" and indicate the total number of children age 5-17 years:
[] 0 No children (Go to HH29)
[] 1 1 child (Go to HH27)
2 or more children (number): _
[] 1 1 child (Go to HH27)
2 or more children (number): _
HH19. List each of the children age 5-17 years below in the order they appear in the list of household members. Do not include other household members outside of the age range 5-17 years. Record the line number, name, sex, and age for each child.
HH20. Rank number: _
HH21. Line number from HL1: _ _
HH22. Name from HL2: ____
HH23. Sex from HL4
[] 1 Male
[] 2 Female
[] 2 Female
HH24. Age from HL6: _ _
HH25. Check the last digit of the household number (HH2) from the household information panel. This is the number of the row you should go to in the table below.
Check the total number of children age 5-17 years in HH18 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 record the number that appears in the box. This is the rank number (HH20) of the selected child.
Last digit of household number (from HH2): _
Total number of eligible children in the household (from HH18): _
Total number of eligible children in the household (from HH18): _
HH26. Record the rank number (HH20), line number (HH21), name (HH22) and age (HH24) of the selected child.
Rank number: _
Line number: _ _
Name: ____
Age: _ _
Line number: _ _
Name: ____
Age: _ _
HH27. (When HH18=1 or when there is a single child age 5-17 in the household): Record the rank number as "1"and record the line number (HL1), the name (HL2) and age (HL6) of this child from the list of household members.
Rank Number: _
Line Number: _ _
Name: ____
Age: _ _
Line Number: _ _
Name: ____
Age: _ _
HH28. Issue a questionnaire for children age 5-17 to be administered to the mother/caretaker of this child.
HH29. Check HL8 in the list of household members: Are there any women age 15-49?
[] 1 Yes, at least one woman age 15-49
[] 2 No (Go to HH34)
[] 2 No (Go to HH34)
HH30. Issue a separate questionnaire for individual women for each woman age 15-49 years.
HH31. Check HL6 and HL8 in the list of household members: Are there any girls age 15-17?
[] 1 Yes, at least one girl age 15-17
[] 2 No (Go to HH34)
[] 2 No (Go to HH34)
HH32. Check HL20 in the list of household members: Is consent required for interviewing at least one girl age 15-17?
[] 1 Yes, at least one girl age 15-17 with HL20 does not equal 90
[] 2 No, HL20 equals 90 for all girls age 15-17 (Go to HH34)
[] 2 No, HL20 equals 90 for all girls age 15-17 (Go to HH34)
HH33. As part of the survey we are also interviewing women age 15-49. We ask each person we interview for permission. A female interviewer conducts these interviews.
For girls age 15-17 we must also get permission from an adult to interview them. As mentioned before, all the information we obtain will remain strictly confidential and anonymous.
May we interview (name(s) of female member(s) age 15-17) later?
[] "Yes" for all girls age 15-17. Continue with HH34.
[] "No" for at least one girl age 15-17 and "Yes" to at least one girl age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on individual questionnaires for those adult consent was not given. Then continue with HH34.
[] "No" for all girls age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on all individual questionnaires for whom adult consent was not given. Then continue with HH34.
[] "No" for at least one girl age 15-17 and "Yes" to at least one girl age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on individual questionnaires for those adult consent was not given. Then continue with HH34.
[] "No" for all girls age 15-17. Record "06" in WM17 (also in UF17 and FS17, if applicable) on all individual questionnaires for whom adult consent was not given. Then continue with HH34.
HH34. Check HH8 in the household information panel: Is the household selected for Questionnaire for Men?
[] 1 Yes, HH8=1
[] 2 No, HH8=2 (Go to HH40)
[] 2 No, HH8=2 (Go to HH40)
HH35. Check HL9 in the "List of household members": Are there any men age 15-49?
[] 1 Yes at least one man age 15-49
[] 2 No (Go to HH40)
[] 2 No (Go to HH40)
HH36. Issue a separate questionnaire for individual men for each man age 15-49 years.
HH37. Check HL6 and HL8 in the list of household members: Are there any boys age 15-17?
[] 1 Yes, at least one boy age 15-17
[] 2 No (Go to HH40)
[] 2 No (Go to HH40)
HH38. Check HL20 in the "List of household members": Is consent required for interviewing at least one boy age 15-17?
[] 1 Yes at least one boy age 15-17 with HL20 does not equal 90
[] 2 No, HL20 equals 90 for all boys age 15-17 (Go to HH40)
[] 2 No, HL20 equals 90 for all boys age 15-17 (Go to HH40)
HH39. As part of the survey we are also interviewing men age 15-49. We ask each person we interview for permission. A male interviewer conducts these interviews.
For boys age 15-17 we must also get permission from an adult to interview them. As mentioned before, all the information we obtain will remain strictly confidential and anonymous.
May we interview (name(s) of male member(s) age 15-17) later?
[] "Yes" for all boys age 15-17. Continue with HH40.
[] "No" for at least one boy age 15-17 and "Yes" to at least one boy age 15-17. Record "06" in MWM17 (also in UF17 and FS17, if applicable) on individual questionnaires for those adult consent was not given. Then continue with HH40.
[] "No" for all boys age 15-17. Record "06" in MWM17 (also in UF17 and FS17, if applicable) on all individual questionnaires for whom adult consent was not given. Then continue with HH40.
[] "No" for at least one boy age 15-17 and "Yes" to at least one boy age 15-17. Record "06" in MWM17 (also in UF17 and FS17, if applicable) on individual questionnaires for those adult consent was not given. Then continue with HH40.
[] "No" for all boys age 15-17. Record "06" in MWM17 (also in UF17 and FS17, if applicable) on all individual questionnaires for whom adult consent was not given. Then continue with HH40.
HH40. Check HL10 in the "List of household members": Are there any children age 0-4?
[] 1 Yes, at least one
[] 2 No (Go to HH42)
[] 2 No (Go to HH42)
HH41. Issue a separate questionnaire for children under five for each child age 0-4 years.
HH42. Check HH9 in the household information panel: Is the household selected for water quality testing questionnaire?
[] Yes, HH9=1
[] No, HH9=2 (Go to HH45)
[] No, HH9=2 (Go to HH45)
HH43. Issue a separate water quality testing questionnaire for this household
HH44. As part of the survey we are also looking at the quality of drinking water. We would like to do a simple test of your drinking water. A colleague will come and collect the water samples. May we do such a test?
If the respondent requests to learn the results, explain that results will not be shared with individual households but will be made available to local authorities.
[] 1 Yes permission is given
[] 2 No, permission is not given (Record 02 in WQ31 on the water quality testing questionnaire)
[] 2 No, permission is not given (Record 02 in WQ31 on the water quality testing questionnaire)
HH45. Now return to the household information panel and,
Record "01" in question HH46 (Result of the Household Questionnaire interview). Record the name and the line number (from the list of household members) of the respondent to the household questionnaire interview in HH47. Fill the questions HH48 ? HH52. Thank the respondent for his/her cooperation and then proceed with the administration of the remaining individual questionnaire(s) in this household.
If there is no individual questionnaire and no water quality testing questionnaire to be completed in this household thank the respondent for his/her cooperation and move to the next household you have been assigned by your supervisor.
Interviewer's Observations
Supervisor's Observations