MICS Household Questionnaire

[16 January 2012, v3.0]
Punjab
Household Information Panel: HH

HH1a. District Code: _ _ _

HH1b. Tehsil/ Town Code: _ _ _

HH1. Cluster number (as per survey): _ _ _

HH2. Household number (as per survey): _ _

HH3. Interviewer name and number

HH4. Team Supervisor name and number:

HH5. Date of interview

HH6. Area

HH7a. The cluster affected by flood in 2010:

After all questionnaires for the household have been completed, fill in the following information:
[Note: for question HH8 to HH18]

HH8. Name of head of household: ____

HH9. Result of household interview:

HH10. Respondent to household questionnaire:

HH11. Total number of household members: _ _

HH12. Number of women age 15-49 years: _ _

HH13. Number of woman's questionnaires completed: _ _

HH14. Number of children under age 5: _ _

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

HH16. Field edited by (name and number)

HH17. Date entry clerk (name and number)

HH18. Record the time

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?
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 household listing form have been used.

HL1. Line number: _ _

HL2. Name: ____

HL3. What is the relation-ship of (name) to the head of household?

HL4. Is the (name) male or female?

HL5. What is (name's) date of birth?

HL6. How old is (name)?
Record in completed years. If age is 95 or above '95'
HL6A. What is Marital status of (name)?
[] 1 Married
[] 2 Widowed
[] 3 Divorced
[] 4 Separated Never
[] 5 Married
[] 8 DK

HL7. Circle line no.
If woman is age 15-49 (for woman age 15-49)

HL7A. Circle line no.
If man is age 15-49 (for men age 15-49)

HL8. Who is the mother or primary caretaker of this child?
Record line no. of mother/caretaker (for children age 5-14.)
HL9. Who is the mother or primary caretaker of this child?
Record line no. of mother/ caretaker (for children under age 5)
HL10A. Can (name) read in any language with understanding.

HL10B. Can (name) write in any language with understanding.

For children age 0-17 years [HL11 to HL14]

HL11A. Had (name's) been having cough and fever for last 3 weeks?

HL11B. Had (name) been diagnosed as having TB in the past year?

HL11C. Had (name) been diagnosed as having hepatitis in the past year?

Code for HL3. Relationship to head of household

Education: ED

For household member age 3 and above [ED1 to ED4B]

ED1. Line number: _ _

ED2. Name and age
Copy from Household Listing Form, HL2 and HL6
ED3. Has (name) ever attended school or pre-school?

ED4A. What is the highest level of school (name) has attended?
If level=0, skip to ED5
ED4B. What is the highest grade (name) completed at this level?
If less than 1 grade, enter 00
For household members age 5-24 years [ED5 to ED8]

ED5. During the (2011-2012) school year, did (name) attend school or preschool at any time?

ED6. During this/that school year, which level and grade is/was (name) attending?
If level=0, skip to ED5
ED6C. What type of school is (name) attending?

ED7. During the previous school year, that is (2010-2011), did (name) attend school or preschool at any time?

ED8. During that previous school year, which level and grade did (name) attend?
If level=0, skip to ED5
E8C. What type of school was (name) attending that previous year?

Water and Sanitation: WS

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

WS1A. Do you know that water in your connection comes from underground or from river/canal?

WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing?

WS3. Where is that water source located?

WS4. How long does it take to go there, get water, and come back?

WS5. Who usually goes to this source to collect the water for your household?
Probe: Is this person under age 15? What sex?

WS6. Do you do anything to the water to make it safer to drink?

WS7. What do you usually do to make the water safer to drink?
Probe: Anything else? Record all items mentioned.
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 necessary, ask permission to observe the facility.
WS9. Do you share this facility with others who are not members of your household?

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?

WS11. How many households in total use this toilet facility, including your own household?

Household characteristics: HC

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

HC1D. What is the status of your residence? (circle an appropriate code)

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

HC3. Main material of dwelling floor
Record observation
HC4. Main material of the roof
Record observations
HC5. Main material of the exterior walls.
Record observations
HC6. What type of fuel does your household mainly use for cooking?

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?

HC8. Does your household have:

A. Electricity?

B. A radio?

C. A television?

D. A telephone?

E. A refrigerator?

F. A gas?

G. A computer?

H. An air conditioner?

I. A washing machine/dryer?

J. An air cooler/fan?

K. A cooking range/microwave?

L. A sewing/knitting machine?

M. An Iron?

N. A water filter?

O. A dunky pump/turbine?

HC9. Does any member of your household own:

A. A watch?

B. A mobile telephone?

C. A bicycle?

D. A motorcycle or scooter?

E. An animal drawn cart?

F. A car or truck?

G. A boat with a motor?

H. A Bus / Truck?

I. A Car/Van?

J. A Tractor/Trolley?

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? If "Rented from someone else", circle "2". For other responses, circle "6".
HC10A. If owned, what is area of the house?

HC11. Does any member of this household own any land that can be used for agriculture?

HC12. How many hectares of agricultural land do members of this household own?
If less than one, record "00". If 95 or more, record '95'. If unknown, record '98'.
HC13. Does this household own any livestock, herds, other farm animals, or poultry?

HC14. How many of the following animals does this household have?
If none, record '00'. If 95 or more, record '95'. If unknown, record '98'.

A. Milk cows/ Buffaloes / Ox, or bulls?

B. Horses, donkeys, mules, camels?

C. Goats?

D. Sheep?

E. Chickens?

G. Other (specify)?

HC15. Does any member of this household have account in the bank, post office or national saving centre?

Remittances and Zakat
RZ1. Is any family member of this household working outside this village, city, or country?

RZ2. If yes, what is the number of these members?
Number of persons _ _
Rz3. If yes, where are they working?
More than one answer are possible

RZ4. Did the household receive (from within the country and/or oversees) any remittances (in cash) during the last year? (Money which will not be paid back)

RZ5. How much amount was received from inside the country?

RZ5A. How much amount was received from oversees?

Zakat
RZ6. Did the household receive any cash donations from Zakat or other means during the past year?

RZ7. How much amount was received?

Pension Benefits: PB
PB1. Did any member(s) of the household receive any pension benefits during the last year?

PB2. How much amount was received?

PB3. What was the source of pension?
(More than one answer are possible.)

Safety Nets: SN
SN1. Did the household receive any benefits from the government initiatives during last year?

SN2. What was the source?
(More than one answer are possible.)

SN3. Did the household purchase the consumable items from a utility store during last year?

SN4. If yes, what was routine?

SN5. Do you feel that government initiatives are benefiting the low income groups?

Child Labour: CL

To be administered for children in the household age 5-14 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 number: _ _

CL2. Name and age copy from Household Listing Form, HL2 and HL6

CL3. During the past week, 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?
CL4. 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?
If more than one job, include all hours at all jobs.
CL5. During the past week, did (name) fetch water or collect firewood for household use?

CL6. Since last (day of the week), about how many hours did he/she fetch water or collect firewood for household use?

CL7. During the past week, did (name) do any paid or unpaid work on a family farm or in a family business or selling goods in the street?
Include work for a business run by the child, alone or with one or more partners.
CL8. Since last (day of the week), about how many hours did he/she do this work for his/her family or himself/herself?

CL9. During the past week, did (name) help with household chores such as shopping, cleaning, washing clothes, cooking; or caring for children, old or sick people?

CL10. Since last (day of the week), about how many hours did he/she spend doing these chores?

Hand washing: HW

HW1. Please show me where members of your household most often wash their hands.

HW2. Observe presence of water at the specific place for handwashing.
Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water.
HW3. Record if soap or detergent is present at the specific place for handwashing.
Circle all that apply.
Skip to HH19 if any soap or detergent code (A, B, C or D) is circled. If "None" (Y) is circled, continue with HW4.
HW4. Do you have any soap or detergent (or other locally used cleansing agent) in your household for washing hands?

HW5. Can you please show it to me?
Record observation. Circle all that apply.
HH19. Record the time

Salt Iodization: SI
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.
HH20. Thank the respondent for his/her cooperation and check the Household Listing Form:

Return to the cover page and make sure that all information is entered, including the number of eligible women (HH12), under-5s (HH14) and men (HH13A).
Make arrangements for the administration of the remaining questionnaire(s) in this household.

Interviewer's observations ________

Field editor's observations ________

[IPUMS Note: Employment and Household expenditure modules are not found in the data available for public use.]