Household Questionnaire.docx

7/27/2019 Household Questionnaire.docx

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Household Questionnaire

Questionnaire Number Date entry No.

Impact of Remittances and Out Migration on Socio-economic and Agricultural Production in Nepal (For both remittancereceiving and non-receiving household)

(Project funded by Agriculture and Forestry University)Introductory Structure

The main objective of the project is to studyImpact of Remittances and Out Migration on Socio-economic and AgriculturalProduction in Nepal. To achieve this objective of the research, the researchers would kindly like to ask for your cooperation. Weassure you that all information you give during the interview will be kept strictly confidential. Data will be used for scientific

purpose only and will not give to any other outside person.

Date of Survey:Name of Interviewer:. Time started:.. Time finished:Signature of Interviewer:. Signature of Supervisor: Date of Approval:

Survey District:

Nawalparasi Syangja

Section 1: Identification Particulars:

1. Name of Respondent:Is he/she HH head: Yes ( ) No ( )2. Age: Gender: Male Female3. Address: VDC/Municipality Word No.. Telephone No.: (if have)...4. Social background of the household:

(1-Brahmin, 2-Chhetri, 3-Indigenous/ethnic, 4-Dalits, 5-Other (specify.)

Section 2: Socio-Demographic Information of Household** (as on the date of interview):

IDCode

HH members(Start with

household head )

Gender1=Male

0=Female

Age No ofchildren

Marital status1-Unmarried,

2-Married,3-Widow,4-divorced5-separated.

Education (Completed degree)Write 00 if Member has not ever

attended school.Write 97 for Nursery to KG01-09 = Grade to 910 = Completed SLC

11 = Intermediate(not completed)12 = Intermediate (completed)13= Bachelors (not completed)l4Bachelors Completed/Higher

96 = Not formal education98= Dont know

1.2.3.4.5.6.7.

**Household: is a person or group of people sharing accommodation and food for at least 3 months over the past 12 monthscalculating from the time of the survey.


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Q.N. Question Codding category Skip

What is your religion? 1-Hindu,2-Budhish,

3-Muslim,4-Christian,5-Other, please specify

What is your ethnicity andcaste?

Ethnicity..Cast.

What is your major source ofdrinking water

1. Tube well2. River3. Piped water

4. Other.

What type of fuel does your

household mainly used forcooking

1. Electricity2. LPG3. Bio-gas4. Wood5. Straw/shrubs and Grass6. Animal dung7. Agricultural materials8. Other if specify

What is the occupation ofyour household head?

1. Government job2. Own business3. Agriculture4. Wage labor5. Foreign employment6. If Other specify

Did any member ofhousehold receive the

pension during last year?

1.Yes2. No3. If Other please specify..

Did any member ofhousehold receive the old -

age or any other kind of theallowances from the

governments during lastyear?

1. Yes2. No3.

If other please specify

What kinds of the toiletfacilities do the members of

the household normally use?( Observe if necessary )

1. Flush or poor flush toilet2. Pit latrine3. Composite toilet4. No facility of the ( Bush field

Did the household purchase

or reconstruct the houseduring last 3 years?

1. Yes2. No

Main material of the floor

(record by observation for

current and ask for the past)

Id code Before 3 year Current

1. Natural floor2. Rudimentary floor3. Finished floor4. If other please specify

Main material of the roof(record by observation for

current and ask for the past)

Id code Before 3 year Current

1. (RUSTIC MAT,BAMBOO,WOOD)

2. PLANKS.THATCH. STRAW)

3. CIMENTED4. TIN TILE


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5. OTHER(SPECIFY)

How many rooms did/does

the house have?

Before 3 year Current

Does the house haveelectricity?

1. YES2. NO

Section 3 Education

Drop out Scores Study hours Work at home Expenditure

List the line no of allfamily members whois between 5 to 20years and those

currently studying

Did(Name)stop goingschool?

1= Yes0 = No

What is scoresecured by ( Name )in his/her lastcompleted grade ?

(Interviewer, pleaseask for thePercentage and

Division)

How manyhours does/ Did(Name studyingat home ?

(write 00 ifdont study athome)

Does(name) Help inhousehold work? (Askthe no of hours themember spend working

at home)

How much do youspend for theeducation of(Name) during last

year

% Div Hrs Min Hrs Min NRs

SECTION 4: HEALTH

4.1 Did any of the family members suffer is suffering from respiratory diseases or eye infection the last one year? (Refer Diseasessection below for the list of diseases)1 Yes

2 No -skip this table.

LINE NO.

Q.4.1.1

DESEASES

Q.4.1.2

HEALTH INSTITUTION

Q.4.1.3

TYPE OF

HEALTHINSTITUTIONQ.4.1.4

MONEY

Q.4.1.5

List the line no of

members who weresuffered/ are sufferingfrom such disease

1=Runny Nose!

Cold2= Sinusitis3= Headache

4= Flue/Fever in

past one year5= Cough dry6= Asthma7= Bronchitis

8= Tuberculosis9=Eye infection10=Otherspecify

How many times did (name)

visit the health institutiondue to this illness?Write 00 if no visit is made

1=Health Post

2= Hospital3= Clinic4=Nursing

Home

How much money did you

spend to cure the disease (Including Transportation cost)

Write amount in words)

Write 00 if no money is spent)


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Q.NO Question Codding categories Skip4.2 Did any members of your

family have been sufferedfrom water related disease (

Typhoid, Pneumonia,Diarrhea, Cholera etc.)During last one year?

Yes.1No..2

4.3 How many times did youmake regular health checkup?(write 00 if not)

Total No..

4.4 Is your child beingvaccinated?

Yes.1No..2Not regular.3 ( mention whichvaccines were not completed)

4.5 Did any member of yourfamily give birth during lastyear?

Yes.1No..2

4.6 How many times did you visithealth care center for ANC(Antenatal Care)

Visit.

4.7 Where did she give birth At home..1Health care Center.2

4.8 What is the total cost forANC or/and for birth of the

last child

Section 5 Access to informationQ.

NoQuestions Codding Categories Skip

5.1.1 How many times in the last month have you or anyone I ourhousehold read newspaper

Write in NumberDidnt read at all = 00Do not know =99

5.1.2 Does your household have the following items?RadioTelephone

Mobile phoneVCD/DVD playerTelevision

Yes NoRadio 1 2Telephone 1 2

Mobile phone 1 2VCD/DVD player 1 2Television 1 2

5.1.3 How often do you or anyone in your household listen toradio?

Everyday..1A few times a week2

Once a week...3Less than once a week4

Never..5

5.1.4 What kind of programs do you listen to radio? News..1Entertaining2

Others.3

5.1.5 How often do you or anyone in your household watchtelevision?

Everyday.............1A few times a week.2


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Once a week3Less than once a week.4

Never5

5.1.5 What is the total monthly bill of your household for using allthese services (Radio, TV, Phone etc.)?

No at allBelow 1000

NRs 1000-2000NRs 2000-3000

Above 30005.1.5 What are the most important sources of your information

regarding government activities such as constitution drafting,peace process and other government programs?(Rank the different sources starting 1 for the most important)

Relatives/ Friends and Neighbour

CommunityLocal marketLocal NewspaperRadio

TelevisionCommunity leaderAn agent of the government

NGOs

InternetsOther specify..

5.1.6 Compared to the last five year ago, has the access to

information improved, deteriorated or remained same ingeneral?

Improved1

Deteriorated....2Remained same3

5.1.7 How long does it take time to reach the nearest marketcenter?

Hours.Minutes..

5.1.8 How long does the it take time to reach the nearest road? (refers to the road where motor vehicles run)

Hours.Minutes..


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Section 6 household income6.1 Farm income6.1.1 How many kattha/bigha of agricultural land do all the member of the household own?BIGHAKATTHADHUR.. DONOT KNOW..( Write 00) NONE.(SKIP

TO 6.2)6.1.2 Did the household purchase the agricultural land during the last three years?Yes1 No2 ( if yes BIGHA.KATHA..DHUR..)

TABLE 6.1 FARM INCOME OF LAST ONE YEAR

TYPES OF

CROPS

Q.6.1.3

UNIT( Kg/quintal)

Q.6.1.4

TOTAL

HARVEST

Q.6.1.5

PRICE PER UNIT

Q.6.1.6

TOTAL INCOME

Q.6.1.7

TOTAL

SPENDINGINCLUDINGFERTILIZER,PESTICIDES,

HIRED LABORQ.6.1.8

FOOD CROPS NRS.

RICE

MAIZE

WHEAT

MILLATEBARLY

OTHER

CASH CROPS NRS..

OIL SEED

PULSES

SUGARCANE

VEGETABLE NRS

1

2

3

FRUITS NRS

12

3

OTHER

6.2 Do you use advanced seeds and fertilizers in your farm ?Yes.1 No..26.3 How many times many hired labor did you use for producing crops?

( No of persons) wage rate.( NRs)6.4 Do you or any member of your family work in farm?Yes.1 No.2


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6.2 LIVESTOCK INCOME

6.2.1 Does this household own any livestock, herds other farm animals or poultry ?Yes..1 No2 (skip table 5.1, 6.2, 5.3)6.2.2 Did your household sell any livestock in past one year?

Yes.1

No..2 ( skip Table 1)

6.2.3 Livestock income

Table 6.2.4 Expenditure on livestockWrite the money spend on

livestock Feed medicine Veterinary services Transportation Hired labor Other expenditure if any

Buffalo

Goat

Pig

Chicken

FishOther specify

6.2.5 Does your household make any income through the sale of livestock products?Yes1

No.2 (skip 6.2.3)

Table 6.2.6 INCOME FROM SALE OF LIVESTOCK PRODUCTS

PRODUCTS UNIT TOTAL PRODUCTION PRICE PER UNIT

(NRs)

TOTAL INCOME (NRs)

livestock Sale

Unit Price per unit Total incomeCow

Buffalo

Goat

Pig

Chicken

Fish

Other specify


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6.3Salary/wage income6.3.1 Does any member of your household earn wage?

Yes..1

No...2 (skip the following table)

Line No of HHmember who are

involved in wage

earning

Number of daysemployed

Cash wage per day Wage in kind per day Total wage income perday

Does any member of your household earn wage ?Yes1

No.2 (skip the following table)

Line No of HHmember who are

involved in salaryearning

Cash salary per month Fringe benefit Total salary income

6.4 Remittance income (this parts is only for treatment group)Line No of

HH memberwho aremigratedoverseas

Is (name)

male orfemale?Male=1Female=2

His or her

last degreeand division

Year of

migration

country Expenditure

( write 00for free)(NRs)

Source of

expenditure(separatelymention loanand saving in

NRs)

Income (

amountannually sentincludinggoods sent)

DEG..DIV

Loan.Saving..

DEG..DIV

Loan.Saving..

DEG..

DIV

Loan.

Saving..

DEG..

DIVLoan.

Saving..

Q.N. Questions Coding categories Skip

Did the household purchase land or home after migration Yes1

No.2

What is the purpose of purchasing land ? To construct house1To use for farming.2

How much land did the household purchase? .Bigha Kattha Dhur

Are you inspired to go abroad to work when you see other people are doing so? Yes1

No.2

Did you take any advice from your relatives regarding your plan to go abroad? Yes1No.2

How do you receive your money sent from abroad? BFIs1Hundi..2Friends3Others..4


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SECTION 8 BUSINESS OWNERSHIPAs you know, aside from household work, some people have a small business such as hotel, restaurant, rice, mills etc or somemake and sell handicrafts such as utensils made from mud, khukuri, etc from which they earn income. Does your householdown such business?

Yes.1No...2 ( Skip the following table)

SPECIFYACTIVITIES

STARTINGDATE

TOTALREVENUE(monthly)

NO OF HHMEMBERSEMPLOYED

AVERAGENO OFHIREDEMPLOYED

AVERAGEMONTHLYWAGES PAIDTO HIRED

LABOR

OTHEREXPENDITURE(monthly)

SECTION 9 HOUSEHOLD EXPENDITURE

EXPENDITURE ON AMOUNT EXPENDITURE ON AMOUNT

DURABLES FESTIVAL/CEREMONIESCLOTHING HOME

PURCHASE/MAINTENANCE

FOOD CLOTHING

ALCOHOL TRANSPORTATION

TOBACCO OTHER

ENTERTAINMENT

SECTION 10 FINANCIAL STATEMENTQ.NO QUESTIONS CODDING CATEGORIES SKIP

10.1 Have you had any insurance? Yes1

No..2

10.2 What type of insurance do you have? Life insurance1Health insurance2

Other3(specify)

10.3 How much insurance premium do you pay per

month?NRs

10.4 Do you have any account in any bank andfinancial institution?

Yes1No..2

10.5 Please mention your deposit balance. NRs.

10.6 Borrowing From Amount (in NRs) Interest rate permonth (%)

Relatives

Friends

Savingclubs

Banks

Moneylenders(Landlords,shopkeeper,

villagers,etc)

other

10.7 Lending Interest-bearing NRs.Interest-free NRs.


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SECTION 11 GENDER EMPOWERMENTQ.NO QUESTIONS CODING CATEGORIES SKIP

11.1 Who does the decision regarding the education ofyour children in your household? ( e.g. whether toenroll children in private or governmentschool/collage.

Male1Female2Both3Dont know4

11.2 Who does take decision of women health relatedproblems in your household ?( e.g. whether to visit doctor after child birth or give

birth of child whether in hospital or at home)

Male1Female2Both3Dont know4

11.3 Who does take the decision of giving birth of newchild?

Father.1Mother2Both3

Dont know4

11.4 Who does take decision of financial transaction inyour household?

Male1Female2 Both3

Dont know4

11.5 Who does take the decision regarding theparticipation in community activities?

Male1Female2

Both3

Dont know4( Ask only to the female informants)

11.6 Do you need to take the permission of your husbandor other family member to get out of home? ( e.g.shopping, visiting relatives and friends, etc)

Need to take..1Need not to take2Need to inform..3Need not to inform4

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