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MICS 6: Household Questionnaire


2019 Turkmenistan Multiple Indicator Cluster Survey

Household Information Panel: HH

HH1. Cluster number: _ _ _

HH2. Household number: _ _

HH3. Interviewer name and number:

Name ____
Number _ _ _

HH4. Supervisor name and number:

Name ____
Number _ _

HH5. Day/Month/Year of interview:

_ _/_ _ /201 _

HH6. Area

[] 1 Urban
[] 2 Rural

HH7. Region

[] 1 Ashgabat City
[] 2 Akhal Velayat
[] 3 Balkan Velayat
[] 4 Dashoguz Velayat
[] 5 Lebap Velayat
[] 6 Mary Velayat

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.

_ _ Hour
_ _ Minutes

HH12. Hello, my name is (your name). We are from State Statistics Committee of Turkmenistan. We are conducting a survey about the situation of children, families and households. I would like to talk to you about these subjects. This interview usually takes about 20 minutes. Following this, I may ask to conduct additional interviews with you or other individual members of your household. All the information we obtain will remain strictly confidential and anonymous. If you do not wish to answer a question or stop the interview, please let me know. May I start now?

[] Yes (List of household members)
[] No/not asked (Go to HH46)

HH46. Result of household questionnaire interview:
Discuss any result not completed with supervisor.
[] 01 Completed
[] 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 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 _ _

To be filled after the Household Questionnaire is completed
Total number


HH48. Household members: __ __

HH49. Women age 15-49: __ __

HH51. Children under age 5: __ __

HH52. Children age 5-17: __ __

To be filled after all the questionnaires are completed
Completed number


HH53. Women age 15-49: __ __

HH55. Children under age 5: __ __

HH56. Children age 5-17

[] 0 Zero
[] 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

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

Month: _ _
[] 98 DK
Year: _ _ _ _
[] 9998 DK

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: _ _

HL10. Record line number if age 0-4: _ _

HL11. Age 0-17?

[] 1 Yes
[] 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)

HL13. Does (name)'s natural mother live in this household?

[] 1 Yes
[] 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 region
[] 3 In another household in another region
[] 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)

HL17. Does (name)'s natural father live in this household?

[] 1 Yes
[] 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 region
[] 3 In another household in another region
[] 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: _ _

Code for HL3. Relationship to head of household

[] 01 Head
[] 02 Spouse/partner
[] 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 Servant (live-in)
[] 96 Other (not related)
[] 98 Don't Know

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: _ _

ED3. Age 3 or above?

[] 1 Yes
[] 2 No (Go to next line)

ED4. Has (name) ever attended school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to next line)

ED5. What is the highest level and grade or year of school (name) has ever attended?

Level
[] 0 Pre-School/Kindergarten (Go to ED7)
[] 1 Secondary
[] 2 Primary vocational
[] 3 Secondary vocational
[] 4 Higher
[] 8 DK
Grade/year:
[] 98. DK (Go to ED7)

ED6. Did (name) ever complete that (grade/year)?

[] 1 Yes
[] 2 No
[] 8 DK

ED7. Age 3-24?

[] 1 Yes
[] 2 No (Go to next line)

ED8. Check ED4: Ever attended school or preschool/kindergarten?
[] 1 Yes
[] 2 No (Go to next line)

Education 2: ED

ED1. Line number _ _

ED2. Name and age

Name: ____
Age: _ _

ED9. At any time during the 2018-2019 school year did (name) attend school or any early childhood education programme?

[] 1 Yes
[] 2 No (Go to ED15)

ED10. During 2018-2019 school year, which level and grade or year is (name) attending?

Level
[] 0 Preschool/kindergarten (Go to ED15)
[] 1 Secondary (1-11)
[] 2
[] 4 Higher
[] 8 DK
Grade/year:
[] 98. DK

ED15. At any time during the 2017-2018 school year did (name) attend school preschool or kindergarten?

[] 1 Yes
[] 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?

Level
[] 0 Preschool/Kindergarten (Go to next line)
[] 1 Secondary (1-11)
[] 2 Primary vocational
[] 3 Secondary vocational
[] 4 Higher
[] 8 DK
Grade/Year:
[] 98. DK

Household Characteristics: HC

HC1B. What is the /native language of (name of the head of the household from HL2)?

[] 1 Turkmen
[] 2 Uzbek
[] 3 Russian
[] 6 Other Language (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.
Rudimentary floor
[] 21 Wood planks
Finished Floor
[] 31 Parquet/laminate or polished wood fiberboard
[] 32 Vinyl/linoleum
[] 33 Ceramic Tiles
[] 35 Carpet
[] 36 Wall-to-wall carpet
[] 96 Other (specify) ____

HC5. Main material of the roof.
Record observation.
Rudimentary roofing
[] 23 Wood planks
Finished roofing
[] 31 Metal/ metal slate
[] 32 Wood
[] 34 Ceramic tiles
[] 35 Concrete
[] 37 Asbestos Concrete Slate
[] 38 Ruberoid
[] 96 Other (specify) ____

HC6. Main material of the exterior walls.
Record observation.
Rudimentary walls
[] 22 Stone with mud
Finished Walls
[] 31 Cement
[] 32 Stone with lime/cement
[] 33 Bricks
[] 34 Cement Blocks
[] 35 Covered Adobe
[] 36 Wood Planks/shingles
[] 37 Monolithic Concrete Design
[] 38 Plastered Wall
[] 39 Wall Sheeted With Marble Tile / Alucobond
[] 96 Other (specify) ____

HC7. Does your household have:

A. A fixed telephone line?

[] 1 Yes
[] 2 No

B. A radio?

[] 1 Yes
[] 2 No

C. Factory carpet?

[] 1 Yes
[] 2 No

D. A handmade carpet (wool or silk)?

[] 1 Yes
[] 2 No

E. A sofa?

[] 1 Yes
[] 2 No

F. A sideboard?

[] 1 Yes
[] 2 No

G. A mechanical sewing machine?

[] 1 Yes
[] 2 No

HC8. Does your household have electricity?

[] 1 Yes, Interconnected gird
[] 2 Yes, off-grid (generator/isolated system)
[] 3 No (Go to HC10)

HC9. Does your household have:

A. A television?

[] 1 Yes
[] 2 No

B. A refrigerator?

[] 1 Yes
[] 2 No

C. An air conditioner?

[] 1 Yes
[] 2 No

D. A washing machine?

[] 1 Yes
[] 2 No

E. A vacuum cleaner?

[] 1 Yes
[] 2 No

F. A DVD player?

[] 1 Yes
[] 2 No

G. A CD player?

[] 1 Yes
[] 2 No

H. An embroidery machine?

[] 1 Yes
[] 2 No

I. An electric sewing machine?

[] 1 Yes
[] 2 No

HC10. Does any member of your household own:

A. A wristwatch?

[] 1 Yes
[] 2 No

B. A bicycle?

[] 1 Yes
[] 2 No

C. A motorcycle or scooter?

[] 1 Yes
[] 2 No

E. A car, truck or van?

[] 1 Yes
[] 2 No

G. A tractor/combine harvester?

[] 1 Yes
[] 2 No

HC11. Does any member of your household have a computer or a tablet?

[] 1 Yes
[] 2 No

HC12. Does any member of your household have a mobile telephone?

[] 1 Yes
[] 2 No

HC13. Does your household have access to internet at home?

[] 1 Yes
[] 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 private individual", record "3". For other responses, record "6" and specify.
[] 1 Own
[] 3 Rented from a private individual
[] 4 Rented from the state
[] 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)

HC16. How many hectares or acres of agricultural land do members of this household own?
If 1 hectare or more, circle 1 and record hectares. If 95 or more hectares, circle 1 and record 95. If less than 1 hectare, circle 2 and record in acres. If less than 1 are, circle 2 and record 00. If unknown, circle 998.
[] 1 _ _ Hectares
[] 2 _ _ Ares
[] 998 DK

HC17. Does this household own any livestock, herds, other farm animals, or poultry?

[] 1 Yes
[] 2 No (Go to HC19)

HC18. 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 or bulls?

Number: _ _

B. Other cattle?

Number: _ _

D. Goats?

Number: _ _

E. Sheep?

Number: _ _

F. Chickens?

Number: _ _

G. Pigs?

Number: _ _

H. Horses?

Number: _ _

I. Donkeys or mules?

Number: _ _

J. Other poultry?

Number: _ _

K. Camels?

Number: _ _

L. Rabbits?

Number: _ _

HC19. Does any member of this household have a bank account?

[] 1 Yes
[] 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 (name of programme)?

A. State Allowance For Childcare
[] 1 Yes
[] 2 No (Go to B)
B. State Social Benefit
[] 1 Yes
[] 2 No (Go to C)
C. Retirement Pension
[] 1 Yes
[] 2 No (Go to D)
D.Disability Pension
[] 1 Yes
[] 2 No (Go to E)
E. State Allowance On Disability
[] 1 Yes
[] 2 No (Go to F)
E. Benefit For Children With Deceased Parents
[] 1 Yes
[] 2 No (Go to X)
X. Any other external assistance programme
[] 1 Yes (specify) ____
[] 2 No (Go to end of module)

ST3. Has your household or anyone in your household received assistance through (name of programme)?

A. State Allowance For Childcare
[] 1 Yes (Go to ST4)
[] 2 No (Go to B)
[] 8 DK (Go to B)
B. State Social Benefit
[] 1 Yes (Go to ST4)
[] 2 No (Go to C)
[] 8 DK (Go to C)
C. Retirement Pension
[] 1 Yes (Go to ST4)
[] 2 No (Go to D)
[] 8 DK (Go to D)
D Disability Pension
[] 1 Yes (Go to ST4)
[] 2 No (Go to E)
[] 8 DK (Go to E)
E. State Allowance On Disability
[] 1 Yes (Go to ST4)
[] 2 No (Go to F)
[] 8 DK (Go to F)
F. Benefit For Children With Deceased Parents
[] 1 Yes (Go to ST4)
[] 2 No (Go to X)
[] 8 DK (Go to X)
X. Any other external assistance programme
[] 1 Yes (Go to ST4)
[] 2 No (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. State Allowance For Childcare
[] 1 Months ago _ _ (Go to B)
[] 2 Years ago_ _ (Go to B)
[] 998 DK (Go to B)
B. State Social Benefit
[] 1 Months ago _ _ (Go to C)
[] 2 Years ago_ _ (Go to C)
[] 998 DK (Go to C)
C. Retirement Pension
[] 1 Months ago _ _ (Go to D)
[] 2 Years ago_ _ (Go to D)
[] 998 DK (Go to D)
D. Disability Pension
[] 1 Months ago _ _ (Go to E)
[] 2 Years ago_ _ (Go to E)
[] 998 DK (Go to E)
E. State Allowance On Disability
[] 1 Months ago _ _ (Go to F)
[] 2 Years ago_ _ (Go to F)
[] 998 DK (Go to F) )
F. Benefit For Children With Deceased Parents
[] 1 Months ago _ _ (Go to X)
[] 2 Years ago_ _ (Go to X) )
[] 998 DK (Go to X)
X. Any other external assistance programme
[] 1 Months ago _ _ (Go to end of module)
[] 2 Years ago_ _ (Go to end of module)
[] 998 DK (Go to end of module)

Social Transfers (Disability): ST

ST5. Check HL6: Are there household members age 0-17 years in the household?
[] 1 Yes
[] 2 No (Go to end of module)

ST6. Check ST3[E]: Anyone in the household received assistance through state allowances on disability?
[] 1 Yes, ST3 [E] = 1
[] 2 No, ST3[E] = 2, 8 or blank (Go to end of module)

ST7. Can you please tell me is there any household member under age 18 who ever received assistance through state allowance on disability?

[] 1 Yes
[] 2 No (Go to end of module)

ST8. Please tell me the name and age of each household member under age 18 who ever received assistance through state allowance on disability.

Name: ____
Age: _ _

ST9. Line number: _ _
Copy from HL1.


ST10. Is (name) currently receiving assistance through state allowance on disability?

[] 1 Yes
[] 2 No

ST11. For how long (name) has been receiving or received state allowance on disability?
For any response, go to Next line.
[] 1 Less than 1 year
[] 2 1-3 years
[] 3 4-5 years
[] 4 6 years and more

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 into neighbour (Go to WS3)
[] 14 Public tap/standpipe (Go to WS3)
[] 21 Tube well/borehole (Go to WS3)
Dug well
[] 31 Protected well (Go to WS3)
[] 32 Unprotected well (Go to WS3)
Spring
[] 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)

[] 91 Bottled water

[] 96 Other (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 into yard/plot (Go to WS7)
[] 13 Piped into neighbour
[] 14 Public tap/standpipe
[] 21 Tube well/borehole
Dug well
[] 31 Protected well
[] 32 Unprotected well
Spring
[] 41 Protected spring
[] 42 Unprotected spring
[] 51 Rainwater
[] 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)
[] 96 Other (specify) ____

WS3. Where is that water source located?

[] 1 In own dwelling (Go to WS7)
[] 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

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: _ _

WS6. Since last (day of the week), how many times has this person collected water?

Number of times: _ _
[] 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)

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

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)

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
[] C Strain it through a cloth
[] D Use water filter (ceramic, sand, composite, ect)
[] 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
[] 12 Flush to septic tank
[] 13 Flush to pit latrine
[] 14 Flush to open
Pit latrine
[] 21 Ventilated improved pit latrine
[] 22 Pit latrine with slab
[] 23 Pit latrine without slab/open pit
[] 95 No facility/bush/field (Go to end of module)
[] 96 Other (specify) ____ (Go to WS14)

WS14. Where is this toilet facility located?

[] 1 In own dwelling
[] 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)

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)

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

HH13. Record the time.

Hours and minutes: _ _:_ _

HH14. Language of the Questionnaire.

[] 1 English
[] 2 Turkmen
[] 3 Russian

HH15. Language of the Interview.

[] 1 English
[] 2 Turkmen
[] 3 Russian
[] 6 Other language (specify) ____

HH16. Native language of the Respondent.

[] 1 English
[] 2 Uzbek
[] 3 Russian
[] 6 Other language (specify) ____

HH17. Was a translator used for any parts of this questionnaire?

[] 1 Yes, entire questionnaire
[] 2 Yes, part of 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): _

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

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): _

HH26. Record the rank number (HH20), line number (HH21), name (HH22) and age (HH24) of the selected child.

Rank number: _
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: _ _

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 HH 40)

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 HH 40)

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 HH40)

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.

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 HH41A)

HH41. Issue a separate questionnaire for children under five for each child age 0-4 years.

HH41A. Another survey related to the health of household members is planned in the next few months and we would like to get your permission to visit your household. May our colleagues visit your household again?

[] 1 Permission is given
[] 2 Permission is not given

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 ________