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
Number: _ _
HH4. Team Supervisor name and number:
Number: _ _
HH5. Date of interview
HH6. Area
[] 2 Rural
HH7a. The cluster affected by flood in 2010:
[] 2 No
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:
[] 02 No household member or no competent respondent at home
[] 03 Entire household member were absent for extended period of time
[] 04 Refused
[] 05 Dwelling vacant/address not a dwelling
[] 06 Dwelling destroyed
[] 07 Dwelling not found
[] 08 Incomplete interview
[] 96 Other (specify) ____ ____
HH10. Respondent to household questionnaire:
Line number: _ _
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)
Line number: _ _
HH17. Date entry clerk (name and number)
Line number: _ _
HH18. Record the time
_ _ Minutes
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?
[] 2 Female
HL5. What is (name's) date of birth?
[] 98 DK
Year: _ _ _ _
[] 9988 DK
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.
[] B English
[] C Punjabi/Saraiki
[] D Cannot read
[] E Nazra
[] X Other specify
[] Z DK
HL10B. Can (name) write in any language with understanding.
[] B English
[] C Punjabi/Saraiki
[] D Cannot write
[] X Other specify
[] Z DK
For children age 0-17 years [HL11 to HL14]
HL11A. Had (name's) been having cough and fever for last 3 weeks?
[] 2 No
[] 8 DK
HL11B. Had (name) been diagnosed as having TB in the past year?
[] 2 No
[] 8 DK
HL11C. Had (name) been diagnosed as having hepatitis in the past year?
[] 2 No
[] 8 DK
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
[] 12 Other relative
[] 13 Adopted/foster/stepchild
[] 14 Not related
[] 98 Don't know
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
Age: _ _
ED3. Has (name) ever attended school or pre-school?
[] 2 No (Go to next line)
ED4A. What is the highest level of school (name) has attended?
If level=0, skip to ED5
[] 1 Primary
[] 2 Middle
[] 3 Matric
[] 4 Above Matric
[] 8 DK
ED4B. What is the highest grade (name) completed at this level?
If less than 1 grade, enter 00
[] 98 DK
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?
[] 2 No (Go to ED7)
ED6. During this/that school year, which level and grade is/was (name) attending?
If level=0, skip to ED5
[] 1 Primary
[] 2 Middle
[] 3 Matric
[] 4 Above Matric
[] 8 DK
[] 98 DK
ED6C. What type of school is (name) attending?
[] 2 Private
[] 3 Deeni Madrassa
[] 4 Non-formal basic education
[] 8 DK
ED7. During the previous school year, that is (2010-2011), did (name) attend school or preschool at any time?
[] 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?
If level=0, skip to ED5
[] 1 Primary
[] 2 Middle
[] 3 Matric
[] 4 Above Matric
[] 8 DK
[] 98. DK
E8C. What type of school was (name) attending that previous year?
[] 2 Private
[] 3 Deeni Madrassa
[] 4 Non-formal basic education
[] 8 DK
Water and Sanitation: WS
WS1. What is the main source of drinking water for members of your household?
[] 12 Piped into compound, yard or plot
[] 13 Piped into neighbourhood
[] 14 Public tap/standpipe (Go to WS3)
[] 22 Hand pump (Go to WS3)
[] 23 Motorized Pump (Dunky/turbine) (Go to WS3)
[] 32 Unprotected well (Go to WS3)
[] 42 Unprotected spring (Go to WS3)
[] 61 Water Tanker-truck (Go to WS3)
[] 71 Drum/cane (on the cart) with small tank/drum (Go to WS3)
[] 81 River, stream, dam, lake, pond, canal water(Go to WS3)
[] 91 Mineral water (Mineral)
[] 96 Other (specify) ____ (Go to WS3)
WS1A. Do you know that water in your connection comes from underground or from river/canal?
[] 2 River / Cannal (Go to WS6)
[] 8 DK
WS2. What is the main source of water used by your household for other purposes such as cooking and handwashing?
[] 12 Piped into compound, yard or plot (Go to WS6)
[] 13 Piped into neighbourhood (Go to WS6)
[] 14 Public tap/standpipe
[] 22 Hand pump (Go to WS3)
[] 23 Motorized Pump (Dunky/turbine) (Go to WS3)
[] 32 Unprotected well
[] 42 Unprotected spring
[] 61 Water Tanker-truck (Go to WS3)
[] 71 Drum/cane (on the cart) with small tank/drum (Go to WS3)
[] 81 River, stream, dam, lake, pond, canal water(Go to WS3)
[] 91 Mineral water (Mineral)
[] 96 Other (specify) ____ (Go to WS3)
WS3. Where is that water source located?
[] 2 In own yard/plot (Go to WS6)
[] 3 Elsewhere
WS4. How long does it take to go there, get water, and come back?
[] 998 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 WS8)
[] 8 DK (Go to WS8)
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
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.
[] 12 Flush to septic tank
[] 13 Flush to pit (latrine)
[] 14, Flush to somewhere else
[] 15 Flush to unknown place/not sure/DK where
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 41 Bucket
[] 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?
[] 2 No (Go to next module)
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 next module)
WS11. How many households in total use this toilet facility, including your own household?
[] 10 Ten or more households
[] 98 DK
Household characteristics: HC
HC1B. What is the mother tongue/native language of the head of this household?
[] 2 Punjabi
[] 3 Saraiki
[] 6 Other language (specify) ____
HC1D. What is the status of your residence? (circle an appropriate code)
[] 2 Apartment/Flat
[] 3 Part of house
[] 4 part of com
[] 6 Other (specify) ____
HC2. How many rooms in this household are used for sleeping?
HC3. Main material of dwelling floor
Record observation
[] 12 Dung plastered
[] 34 Cement
[] 35 Carpet
[] 36 Brick paved
[] 37 Chips
HC4. Main material of the roof
Record observations
[] 12 Thatch/palm leaf
[] 13 Sod
[] 22 Palm/bamboo
[] 23 Wood planks
[] 32 Wooden roof
[] 34 Ceramic tiles
[] 35 Cement / Lintel
HC5. Main material of the exterior walls.
Record observations
[] 12 Cane/palm/trunks
[] 13 Dirt
[] 22 Stone with mud
[] 23 Uncovered adobe
[] 24 Plywood
[] 25 Cardboard / Crate
[] 26 Reused wood
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement bricks
[] 35 Covered adobe
HC6. What type of fuel does your household mainly use for cooking?
[] 02 Liquefied petroleum gas (LPG) (Go to HC8)
[] 03 Natural gas (Go to HC8)
[] 04 Biogas (Go to HC8)
[] 05 Kerosene (Go to HC8)
[] 06 Coal/lignite
[] 07 Charcoal
[] 08 Wood
[] 09 Straw/shrubs/grass
[] 10 Animal dung
[] 11 Agricultural crop residue
[] 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/in the open
[] 6 Other (specify) ____
HC8. Does your household have:
A. Electricity?
[] 2 No
B. A radio?
[] 2 No
C. A television?
[] 2 No
D. A telephone?
[] 2 No
E. A refrigerator?
[] 2 No
F. A gas?
[] 2 No
G. A computer?
[] 2 No
H. An air conditioner?
[] 2 No
I. A washing machine/dryer?
[] 2 No
J. An air cooler/fan?
[] 2 No
K. A cooking range/microwave?
[] 2 No
L. A sewing/knitting machine?
[] 2 No
M. An Iron?
[] 2 No
N. A water filter?
[] 2 No
O. A dunky pump/turbine?
[] 2 No
HC9. Does any member of your household own:
A. A watch?
[] 2 No
B. A mobile telephone?
[] 2 No
C. A bicycle?
[] 2 No
D. A motorcycle or scooter?
[] 2 No
E. An animal drawn cart?
[] 2 No
F. A car or truck?
[] 2 No
G. A boat with a motor?
[] 2 No
H. A Bus / Truck?
[] 2 No
I. A Car/Van?
[] 2 No
J. A Tractor/Trolley?
[] 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? If "Rented from someone else", circle "2". For other responses, circle "6".
[] 2 Rent(Go to HC11)
[] 6 Other (Go to HC11)
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?
[] 2 No (Go to HC13)
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?
[] 2 No (Go to HC15)
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?
[] 2. No
Remittances and Zakat
RZ1. Is any family member of this household working outside this village, city, or country?
[] 2. No (Go to RZ6)
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
[] B Other district
[] C Other province
[] D Overseas
[] Z DK (Go to RZ6)
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)
[] 2. No (Go to RZ6)
[] 8.DK (Go to RZ6)
RZ5. How much amount was received from inside the country?
RZ5A. How much amount was received from oversees?
RZ6. Did the household receive any cash donations from Zakat or other means during the past year?
[] 2. No (Go to PB1)
RZ7. How much amount was received?
PB1. Did any member(s) of the household receive any pension benefits during the last year?
[] 2. No (Go to SN1)
[] 8.DK (Go to SN1)
PB2. How much amount was received?
PB3. What was the source of pension?
(More than one answer are possible.)
[] B EOBI
[] C Other (specify) ____
[] Z Do not know
SN1. Did the household receive any benefits from the government initiatives during last year?
[] 2. No (Go to SN3)
SN2. What was the source?
(More than one answer are possible.)
[] B Bait-ul-Mall
[] C Sasta Ration
[] D Benazir Income Support Program (BISP)
[] E Watan Card
[] X Other (specify) ____
[] Z Do not know
SN3. Did the household purchase the consumable items from a utility store during last year?
[] 2. No (Go to SN5)
SN4. If yes, what was routine?
[] 2 Casual
SN5. Do you feel that government initiatives are benefiting the low income groups?
[] 2. No
[] 8.DK
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
_ _ Age
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?
[] 2 Yes, unpaid
[] 3 No (Go to CL5)
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?
[] 2 No (Go to CL7)
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.
[] 2 No (Go to CL9)
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?
[] 2 No (Go to next line)
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.
Not observed
[] 3 No permission to see(Go to HW4)
[] 6 Other reason(Go to HW4)
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.
[] 2 Water is not available
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.
[] B Detergent (powder/liquid/paste) (Go to HH19)
[] C Liquid soap (Go to HH19)
[] D Ash/mud/sand (Go to HH19)
[] Y None
HW4. Do you have any soap or detergent (or other locally used cleansing agent) in your household for washing hands?
[] 2 No (Go to HH19)
HW5. Can you please show it to me?
Record observation. Circle all that apply.
[] B Detergent (powder/liquid/paste)
[] C Liquid soap
[] D Ash/mud/sand
[] Y Not able/does not want to show
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.
[] 2 More than 0 PPM and less than 15 PPM
[] 3 15 PPM or more
[] 6 No salt in the house
[] 7 Salt not tested
HH20. Thank the respondent for his/her cooperation and check the Household Listing Form:
[] A separate Questionnaire for Individual Men has been issued for each man age 15-49 years in the household list (HL7A)
[] A separate Questionnaire for Children Under Five has been issued for each child under age 5 years in the household list (HL9)
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.]