20731 C: DMay 2000 Volume three ~QQ '0 FDesigning Household Survey DQ ~Questionnaires for 0 Developing Countries FD' ~~Lessons from 1 5 years of the Living Standards Measurement Study .r The World Bank Oxford The woLMs Volume three 0 ~~~0 FD esigning Household Survey Questionnaires for Developing Countries Lessons from 1 5 years of the Living Standards Measurement Study Draft Questionnaire Modules Edited by Margaret Grosh and Paul Glewwe The World Bank "Household surveys are essential for the analysis of most policy issues. This book has carefully assessed recent experience and developed today's best-practice technique for household surveys. Indeed, much of this technique was developed and pioneered by the authors.This book is clear, systematic, and well structured. It is also wise and scholarly. It will be indispensable to anyone involved in carrying out or analyzing household surveys, and thus it is required reading for all those who wish to take evidence seriously when they think about policy." -Nicholas Stern, senior vice president, Development Economics and chief economist, the World Bank "This book is an ambitious undertaking, but it quickly exceeded my expectations. It has many strengths: .. com- prehensiveness, ...emphasis on practical application, ... and a sense of balance. For both my domestic and interna- tional survey research, this volume will serve as a valued reference tool that I will consult regularly." -David R.Williams, professor of sociology and senior research scientist, Survey Research Center, University of Michigan "This is a comprehensive guide to planning household surveys on a range of socioeconomic topics in develop- ing countries. It is authoritative, clear, and balanced. The work is a valuable addition to the library of any survey statistician or data analyst concerned with socioeconomic surveys in the developing world." -William Seltzer, former head, United Nations Statistical Office Household survey data are essential for assessing the impact of development policy on the lives of the poor.Yet for many countries household survey data are incomplete, unreliable, or out of date.This handbook is a compre- hensive treatise on the design of multitopic household surveys in developing countries. It draws on 15 years of experience from the World Bank's Living Standards Measurement Study surveys and other household surveys conducted in developing countries. The handbook covers key topics in the design of household surveys, with many suggestions for customizing sur- veys to local circumstances and improving data quality. Detailed draft questionnaires are provided in written and electronic format to help users customize surveys. This handbook serves several audiences: * Survey planners from national statistical and planning agencies, universities, think tanks, consulting firms and international organizations. * Those working on either multitopic or topic-specific surveys. * Data users, who will benefit from understanding the challenges, choices, and tradeoffs involved in data collection. FD es ign ing Household Survey Questionnaires for Developing Countries Lessons from I 5 years of the Living Standards Measurement Study Edited by Margaret Grosh and Paul Glewwe Copyright C 2000 The International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street, N.W Washington, D.C. 20433, U.S.A. All rights reserved Manufactured in the United States of America First printing May 2000 The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations, or to members of its Board of Executive Directors or the countries they repre- sent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any conse- quence of their use. The boundaries, colors, denominations, and other information shown on any map in this volume do not imply on the part of the World Bank Group any judgment on the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. The World Bank encourages dissemination of its work and will normally grant per- mission prompdy. Permission to photocopy items for internal or personal use, for the internal or personal use of specific clients, or for educational class- room use, is granted by the World Bank, provided that the appropriate fee is paid direcdy to Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923,U.S.A.,telephone 978-750-8400, fax 978-750-4470. Please contact the Copyright Clearance Center before photocopying items. For permission to reprint individual articles or chapters, please fax your request with complete information to the Republication Department, Copyright Clearance Center, fax 978-750-4470. All other queries on rights and licenses should be addressed to the World Bank at the address above or faxed to 202-522-2422. ISBN:0-19-521595-8 Library of Congress Cataloging-in-Publication Data has been applied for. Contents Foreword ix Acknowledgments xi Contributors xiii Volume I Part I Survey Design I. Introduction 5 Margaret Grosh and Paul Glewwe 2. Making Decisions on the Overall Design of the Survey 21 Margaret Grosh and Paul Glewwe 3. Designing Modules and AssemblingThem into Survey Questionnaires 43 Margaret Grosh, Paul Glewwe, andJuan Munioz Part 2 Core Modules 4. Metadata-Information about Each Interview and Questionnaire 77 Margaret Grosh andJuan Murioz 5. Consumption 91 Angus Deaton and Margaret Grosh 6. Household Roster 135 Paul Glewwe 7. Education 143 Paul Glewwe 8. Health 177 Paul J. Gertler, Elaina Rose, and Paul Glewwe 9. Employment 217 Julie Anderson Schaffner 10. Anthropometry 251 Harold Alderman v CONTENTS I 1. Transfers and Other Nonlabor Income 273 Andrew McKay 12. Housing 293 Stephen Malpezzi 13. Community and Price Data 315 Elizabeth Frankenberg Volume 2 Part 3 Additional Modules 14. Environmental Issues 5 Dale Whittington 15. Fertility 3 1 lndu Bhushan and Raylynn Oliver 16. Migration 49 Robert E. B. Lucas 17. Should the Survey Measure Total Household Income? 83 Andrew McKay 18. Household Enterprises 105 Wim P M. Vijverberg and Donald C. Mead 19. Agriculture 139 Thomas Reardon and Paul Glewwe 20. Savings 183 Anjini Kochar 21. Credit 211 Kinnon Scott 22. Time Use 249 Andrew S. Harvey and Maria Elena Taylor Part 4 Special Topics 23. Recommendations for Collecting Panel Data 275 Paul Glewwe and Hanan Jacoby 24. Intrahousehold Analysis 315 Nobuhiko Fuwa, Shahidur RP Khandker,Andrew D. Mason, and Tara Vishwanath 25. Qualitative Data Collection Techniques 337 Kimberly Chung 26. Basic Economic Models and EconometricTools 365 Jere RP Behrman and Raylynn Oliver Volume 3 Draft Questionnaire Modules Introduction I Module for Chapter 4: Metadata 5 Margaret Grosh andJuan Munoz Module for Chapter 5: Consumption 1 5 Angus Deaton and Margaret Grosh vi CONTENTS Module for Chapter 6: Household Roster 31 Paul Glewwe Module for Chapter 7: Education 37 Paul Glewwe Module for Chapter 8: Health 73 Paul J. Gertler, EJaina Rose, and Paul Glewwe Module for Chapter 9: Employment 147 Julie Anderson Schaffner Module for Chapter I0:Anthropometry 219 Harold Alderman Module for Chapter I I:Transfers and Other Nonlabor Income 221 Andrew McKay Module for Chapter 12: Housing 229 Stephen Malpezzi Module for Chapter 13: Community Data 247 Elizabeth Frankenberg Module for Chapter 14: Environment 285 Dale Whittington Module for Chapter 15: Fertility 325 Indu Bhushan and Raylynn Oliver Module for Chapter 16: Migration 333 Robert E B. Lucas Module for Chapter 18: Household Enterprise 349 Wim P. M.Vijverberg and Donald C. Mead Module for Chapter 19:Agriculture 407 Thomas Reardon and Paul Glewwe Module for Chapter 20: Savings 453 Anjini Kochar Module for Chapter 21: Credit 461 Kinnon Scott Module for Chapter 22:Time Use 483 Andrew S. Harvey and Maria Elena Taylor Module for Chapter 23: Panel Data 495 Paul Glewwe and Hanan Jacoby vii Foreword Multitopic household surveys have become an indis- The household surveys treated in this book truly pensable instrument for understanding development. are multitopic surveys, covering such topics as house- They are fundamental to serious microeconomic analy- hold size and composition, education, health, anthro- sis of the incentive and distributional aspects of policy, pometry, fertility, income and consumption, employ- and therefore to the analysis of most policy issues. ment, agricultural production, household enterprises, Researchers draw on them to test behavioral theories. transfers and nonlabor income, savings and credit, Policymakers need them to assess public interventions. housing, the environment, migration, and time use. The development conmrnunity uses them to locate the The editors have greatly increased the value of the poor. Developing countries, without adequate house- basic approach by incorporating chapters on commu- hold survey data, are forced to make policy decisions in nity data, panel data, and the allocation of resources an environment with many blind spots, where crucial within the household. information can be seen only dimly or not at all. As the World Bank and other development Household surveys are also expensive, both in organizations increase their efforts to reduce poverty terms of money and institutional capacity. Ultimately and raise living standards in developing countries in their value depends on their design and execution. the 21st century, the need for comprehensive, reliable Errors in their design or execution are wasteful, and and up-to-date information on economic and social can lead to policies that are harmful to the poor. It is conditions in these countries will be greater than therefore important to design and implement surveys ever. The vast store of knowledge in this book will correctly from the outset. contribute significantly to meeting this need. Failure Margaret Grosh and Paul Glewwe have put to use this knowledge will consign policymakers to together one of the most comprehensive and inform- making their decisions without adequate information ative documents ever written on the design, imple- for many years to come, while systematic use of this mentation, and use of household surveys in develop- knowledge will do much more for the poor than the ing countries. If you are engaged in any of these tasks, innumerable speeches made and summits convened this book is essential reading. on their behalf. Lyn Squire Director, Global Development Network World Bank ix Acknowledgments A project of this size and scope depends on many peo- the surveys, the many agencies that provided techni- ple playing many roles. Space limitations preclude us cal assistance and funding, and the academic partici- from naming all of the hundreds of people who made pants who provided advice and criticism over the contributions along the way, but we would like to years. acknowledge some of the most important. The project as a whole was strongly supported The authors of the individual chapters deserve from original vision to final printing by our immedi- thanks for their gracious willingness to go through ate manager for most of that time, Emmanuel Jimenez, many rounds of revisions, spread over a longer time who provided us with useful technical input and a than anyone originally envisioned. Producing a book great deal of enthusiasm, patience, and bureaucratic on the design of multitopic questionnaires requires support. We also greatly appreciate the support of his much more cooperation among authors and several directors, Lyn Squire and Paul Collier.The project was more iterations than does the standard edited volume. primarily financed by a grant from the World Bank We are extremely grateful for the forbearance of the Research Committee (679-61), managed by Greg authors in this difficult process.The authors themselves Ingram and administered by Clara Else. were helped by a large number of peer reviewers.They Many people reviewed the book and project as a are recognized in the individual chapters, but we whole. We greatly appreciate these contributions by would like to extend our thanks to them here as well. Pat Anderson, Jere Behrman, Elisa Lustosa Caillaux, Much of the work in these volumes was based on Courtney Harold, John Hoddinott, Anna Ivanova, past practice in LSMS and other household surveys Alberto Martini, Raylynn Oliver, Prem Sangraula, including, but not limited to, the World Fertility/ Salman Zaidi, and three anonymous reviewers.To have Demographic and Health Surveys, the RAND Family input on the project as a whole from these outsiders Life surveys, the Social Dimensions of Adjustment was very helpful. In addition, participants at three surveys, and several special topic surveys such as workshops held at the World Bank, plus various train- household budget surveys, water and sanitation sur- ing events sponsored jointly by the World Bank and veys, housing surveys, and time use surveys.While the the Inter-American Development Bank, critiqued the authors pulled together the lessons from past experi- project while it was in progress. ence, it is also important to acknowledge the irre- In the course of creating the book, Diane Steele placeable contributions made by the thousands and answered questions from all authors on the details of thousands of household members who served as LSMS data sets. Fiona Mackintosh edited early drafts and respondents, the dozens of agencies that implemented helped to transform the disparate chapters into a single xi ACKNOWLEDGMENTS whole. Lyn Tsoflias provided us with valuable research Communications Development Inc. Communication assistance.Word processing and conference logistics were with the World Bank's Publications Committee and ably handled by Thomas Hastings, Patricia Sader, Jim with the publishers and printers was efficiently handled Schafer, and Daniel O'Connell. Questionnaire layout by Paola Scalabrin and Randi Park. was mastered by Thomas Hastings, Andrea Ramirez, and Finally, effusive and endless thanks to our families Heidi Van Schooten. Contracting support from Liliana and friends who put up with the excessively long hours Longo, Selina Khan, and Patricia Sader was timely and that we spent on this project, who cheered and calmed organized. The final editing, layout, and design were us through the frustrating times, and who helped us to handled dextrously by Meta de Coquereaumont,Wendy bring this long project to a successful conclusion with- Guyette, Kate Hull, Daphne Levitas, Heidi Manley, out completely losing track of other important aspects Laurel Morais, and Derek Thurber, all with of our personal and professional lives. xii Contributors Harold Alderman World Bank Jere R. Behrman University of Pennsylvania Indu Bhushan Asian Development Bank Kimberly Chung Michigan State University Angus Deaton Princeton University Elizabeth Frankenberg RAND Nobuhiko Fuwa World Bank Paul J. Gertler University of California, Berkeley Paul Glewwe World Bank and University of Minnesota Margaret Grosh World Bank Andrew S. Harvey St. Mary's University, Halifax, N.S. Canada Hanan Jacoby World Bank Shahidur R. Khandker World Bank Anjini Kochar Stanford University Robert E.B. Lucas Boston University Stephen Malpezzi University ofWisconsin Andrew D. Mason World Bank Andrew McKay University of Nottingham, United Kingdom Donald C. Mead Michigan State University Juan Mufioz Sistemas Integrales Raylynn Oliver Consultant, World Bank Thomas Reardon Michigan State University Elaina Rose University ofWashington Julie Anderson Schaffier Fletcher School of Law and Diplomacy,Tufts University Kinnon Scott World Bank Maria Elena Taylor St. Mary's University, Halifax, N.S. Canada Wim P.M.Vijverberg University ofTexas at Dallas Tara Vishwanath World Bank Dale Whittington University of North Carolina at Chapel Hill xiii Volume 3 Introduction Many of the chapters in Volumes 1 and 2 of this handbook modules there are two or three different versions, only introduce draft questionnaire modules. For ease of refer- one of which will be used in any household survey ques- ence, all of these modules have been placed in this volume. tionnaire. Second, no household survey will include all This allows the reader to study the text of any of the chap- of the topics covered in Volumes 1 and 2 of this hand- ters in Volumes 1 and 2 while simultaneously viewing the book, because survey designers must drop some topics to draft module in Volume 3. This is much more convenient keep the household questionnaire to a reasonable length. than flipping back and forth between different pages in a * In a well-formatted questionnaire, the modules that con- single volume, especially since the page layout of the text is tain individual-specific information in a "grid" with one "portrait" while that of the questionnaires is "landscape." line (row) for each household member need to be care- This feature is not only convenient but also very important, fully aligned so that the rows all line up with the fold- since reading the text and the draft questionnaire modules out roster described in Chapter 3 (see Figure 3.4 and in close conjunction is essential for developing a well associated text).This is only approximated in this volume designed questionnaire. and should be done much rigorously in a polished At the same time, readers should take care when exam- questionnaire. ining these draft questionnaires. In particular, putting all of * In some modules the different pages can be on opposite the questionnaire pages into a single volume may create sides of the same piece of paper (as in double-sided copy- several false impressions. We therefore list the following ing) while in other modules this cannot be done. In par- warnings: ticular, modules that have a grid with one line (row) for The order in which the modules appear in this volume each household member cannot be printed "double- is not the right order for a well designed household sur- sided." Instead, they must be printed "single-sided" vey questionnaire, rather it simply follows the order of because those pages must line up with the list of names the chapters inVolumes 1 and 2. For advice on ordering of household members given in the household roster. modules for the household questionnaire, see Chapter 3 This can only be done on one side of a given page in the ofVolume 1. questionnaire.The other side should be left blank, or per- • The modules are not ready for immediate use, but must haps can have some useful information such as common- be customized in hundreds of ways, large and small, to fit ly used response codes or instructions to interviewers. the objectives and constraints of each survey and the par- These warnings can be summarized in a single piece of ticular circumstances of each country. A general discus- advice, which is that survey designers must carefully read sion of how to do this is presented in Chapters 2 and 3 Chapters 1, 2 and 3 inVolume 1 and must carefully read all ofVolume 1. In addition, more detailed advice on cus- chapters inVolumes 1 and 2 pertaining to the questionnaire tomizing each module is given in the associated chapters modules that they want to include in their survey. Failure to in Volumes 1 and 2. do this is likely to reduce the quality of the questionnaire * The finished household questionnaire should be much design, and ultimately the quality and usefulness of the data shorter than this volume, for two reasons. First, for many collected. 3 Module for Chapter 4 M etadata Margaret Grosh and Juan Munoz The following draft questionnaire pages demonstrate how metadata-on the length of the module, who the respon- metadata should be collected.They are discussed in detail in dent was, and so on-within those modules. Next, the Chapter 4 ofVolume 1, but it is useful to summarize some information on the characteristics and costs of interviewing basic points here. These questionnaire pages are unusual in in the primary sampling unit can be included in the com- that they should not appear together in a single module in munity questionnaire, or can be used as a separate form (see the household questionnaire. Instead, they should be used as Chapter 4 for further discussion). Finally, the sampling and follows.The first three pages-the household identification staff information spreadsheets should always be forms that and control information, the summary of visits and inter- are separate from any of the questionnaires. views, and space for comments by field staff-should appear Only a single version of each component of the meta- together as the first three pages of the household question- data "module" is shown. Chapter 4 explains how more or naire. Then the following several pages show how modifi- less information can be collected by making small modifi- cations can be made to other modules to collect cations to each component part. 5 Household Identification and Control Information HOUSEHOLD INDENTIFICATION CONTACT ATTEMPTS HEAD OF HOUSEHOLD HOUSEHOLD DATE ADDRESS PSU No. No. IN THE 1 DATE _ _ _ _ _ _ _3 I PSU 2 1 ~~~~~~~~~DATE NAME OF THE HEAD OF THE HOUSEHOLD DATE 41 THIS HOUSEHOLD REASON FOR REPLACING ETHNIC GROUP OF THE RELIGION OF THE [ WAS REPLACED BY HEAD OF THE HEAD OF THE [ HOUSEHOLD No Dwelling not found.l HOUSEHOLD HOUSEHOLD THIS HOUSEHOLD Household absent ... 2 Code 2 .. 2 Code 1 ... 1 REPLACES [RRefusal ..... 3 Code 3 .3 Code 2 . . 2 HOUSEHOLD No. Code 4 ..4Code3....4 Other ~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ode 4 .......4 GEOCODES Field staff DEPARTMENT CODE INTERVIEWER STAFF No. COUNTY CODE ANTHROPOMETRIST STAFF No. INTERVIEW Q% URBAN(1) OR RURAL (2) CODE SUPERVISOR STAFF No. DATE DISTRICT CODE DATA ENTRY OPERATOR STAFF No. ZONE CODE ENUMERATION AREA CODE SEGMENT CODE GEOPOSITIONING LATITUDE LONGITUDE ALTITUDE Summary of Visits and Interviews 1. 2. 3. 4 5. 6. 7. 9 10. Cross (xl SctionsComleted 11. 12. Sitting Interviewer Date Time Respon- Answer REASON. Language of Translator Other people present? Interviewer Comment No. No. dent ing for Too young.. 1 the interviewer needed? DON'T COUNT SMALL assessment of Respondent Languagel1 1 CHILDREN _ '1° Dinterview Unable to Language ..2 - 6- E r E No. .2 No.2 o- om E~ 0u 0 oUnreliable.2 answer.3 Other.3u J - Staff No. Start 1Finish ID Code ID Code Members Non-members 1 2 3 4 5 6 7 18 g 10 1 12 13 23 = ____ ______ _____ _______ 13 _ ______________lil l 19 = = - ,__ ____ I____ I_____ I II II II II II II Staff~ ~ ~ ~ ~ ~ ~ ~~~~~~~~~~~~ ~hc x here section Finot Immequ redihs hoshod- 5. 2 131 102_ _ __ _ _ _ _ 113_ _ _ _ _ _ _ _ _ _ 124_ _ _ _ _ _ _ _ 135____ 14 141_____ 15 _ _ _ _ _ __ _ _ _ _ 16 _ _ __ _ _ _ _ _ _ _ _ _ 17 _ _ _ _ _ Check [x] here sections not required in this household--> Comments of the Field Staff No. Respondent Section Question Comment 1 2 3 4 5 6 7 8 9 10 11 12 FOOD EXPENSES AND HOME PRODUCTION Respondent ||J IL ID CODE ll |lDate 1 ||Started at. D FOOD PURCHASES HOME PRODUCTION IN KIND 1. 2. 3. 4. 5. 6. 7 8. Have you consumed [FOOD] during the past 12 How many In a typical month How much would How many months in In a typical month How much would What is the total months? months in the during which you you normally have the past 12 months during which you your household have value of the past 12 months purchased .. to spend in total to did you consume ate [FOOD].. how to spend in the ..[FOOD]. consumed PUT A CHECK (X) IN THE APPROPRIATE BOX FOR did you [FOOD] .. how much buy this quantity? . [FOOD] . that you much did your market to buy this that you received in- EACH FOOD ITEM purchase did you purchase? grew or produced household consume quantity of ..[FOOD].. kind over the past 12 [FOOD]? yourself? of [FOOD]..? (i.e. the amount months (wages for IF ANSWER TO Q. 1 IS YES ASK Q. 2-8 consumed in a typical work, etc.)? IF NONE month)? WRITE ZERO IF NONE WRITE AND >v 5 ZERO AND )) 8 IF NONE WRITE ZERO YES NO CODE MONTHS QUANTITY UNITS RUPPES MONTHS QUANTITY UNITS RUPEES RUPEES 1. GRAINS AND CEREALS 10 Fine rice 11 _ Course rice 12 ID Beaten, flattened rice 13 = = Maize 14 = Maize flour 15 Wheat flour 16 Millet 17 _ = Other grains/cereals =_ =_18 = 2. PULSES AND LENTILS: 20 Black Pulse .. .... ____= 21 _ . .. . . ...... . _ - .........._ __. . _ Other tarda, khaini) 124 | | l l l l l l l l l l l 13. MISC. FOOD PRODUCTS I _I _|_130 | |I Meals taken outside home l _l _| 131 | | I I I I I I I.I Misc. other food 132 | | I _ T I I I I I I I I Ended at: MAIN WAGE JOB 1. 2. 3. 4. 5. 6. 7. 8. 9. 18. 19. I Is [NAME]. Respondent Reason Interview started Job Industrial Sector Were you paid Were you pain How much did I I Durng the past Interview D answenng Illness ......1 at: on a piece-rate on a daily you get in cash I 112 months, how ended at: personally? Absence .... 2 basis? basis? per day for this I I much did you c [NAME] job? I I receive from 0 refused....3 piece-wise work? D Yes.. 1(v4) Respondent Yes. 1 (>> 16) Yes.1 (cash+in-kind E No .. 2 insisted .....4 No . 2 No...2()v12) payments) Other..... 5 _ ________ ID CODE Other_I SODE DATE TIME C ODE CDE RUPEES RUPEES TIME 2 _ __ __ __ __ __ _ _ =._ .l__ =_ _ __ 4 7 11 111 1 1 12 1 Characteristics of the survey in PSU No:_ (to be completed by the team supervisor) 1 Did you come to this PSU directly from the 9 Mileage on the vehicle when you left this PSU: 17 How much per diem did you get whife previous PSU or did you visit your headquarters in interviewing in this PSU? between? 1 Directly for previous PSU ))3 ] Km j M/U 2 .Visited headquarters 2 How far is the PSU from your headquarters? 10 Besides the time required for initial contacts, were 18 How much per diem did the other members there any days when you could not conduct of your team get while interviewing in this interviews in this PSU? pSu? Km by road I Yes ......llM/U|i 2 No ))13 3 How far is this PSU from the PSU you visited I1 What were the reasons? (circle all 1 9 Where did the data entry operator work most previously? that applies) of the time while in this PSU? Km by road I National holiday 1 In the vehicle ~)22 2 Local holiday 2... n the open air ))22 3 Weather 3... n an official building 4 Strikes/riots/unrest 4... In other fixed premises 5 Other (Specify) 5 5 Other (Specity) 12 How many days were lost because of these 20 How much did you have to pay to use these - 4 How long did it take to reach this PSU? reasons? premises for data entry? Days/Hours | Days [ M/U [I J [I IgIF NOTHING, WRITE ZERO 5 The team arnved in this PSU on: 13 Were you visited by members of the Survey core staff while in this PSU? 21 Did the data entry operator have a desk? Date: 1 .Yes [ ]1-.Yes 2... No 2 No 6 Mileage on the vehicle when you arrived in this 14 Did any members of your team have to stay 22 What was the main source of electicity for PSU: overnight while interviewing in this PSU? the computer in this PSU? Km: 1... Yes 1 Car batteries ANEXT SECTION .2 No )16 2.. Solar panels ))NEXT SECTION 3 Wall outlet 15 What was the main kind of lodging you used in this 7 The first interview was conducted on: PSU? 23 How many hours per day was electricity Date: | |Household available in this PSU? Hours [ L JJ ~~~~~~~~2... Hotel 3... Other ))17 8 The team lefl this PSU on; Date: I I I 16 Did you or the members of your team have to pay for meals while interviewing in this PSU? 1...Yes 2... No Sampling _ HH Surve Geocodes First samplin stage Second sampling stage Stratum Department County Coordinates PSU Number of households PSU tUrban=l Enum Seg- Lati- Longi- Alti- Stratum PSU selected in Selection Sampling Listed in Inter- Non res- Selection Sampling No Code Name Code Name Code Name Rural=2 District Zone Area ment tude tude tude Size Size the stratum probability weight the PSU viewed ponding probability weight A B C D| E F G H I J K L M N 0 P | R S T U V W X 001 1 Metropolitan 1 Alarma 1 Center 1 2 3 23 3 5.01 62.49 10 200000 50 25 0.006250 160.00 55 12 0 0.218182 4.58 002 1 Metropolitan 1 Alarma 1 Center 1 5 4 7 1 4.58 62.50 12 200000 66 25 0.008250 121.21 72 12 0 0.166667 6.00 024 1 Metropolitan 1 Alarma 15 Tazenda 1 4 4 31 2 4.58 62.49 15 200000 110 25 0.013750 72.73 97 12 1 0.123711 8.08 025 1 Metropolitan 1 Alarma 16 Jackson 1 1 2 11 1 5.00 62.53 1 200000 75 25 0.009375 106.67 83 11 0 0.132530 7.55 026 2 Other Urban 2 Barisal 1 Barisal 1 14 2 18 2 1.01 63.50 23 300000 54 30 0.005400 185.19 60 12 0 0.200000 5.00 027 2 Other Urban 3 Codama 3 Hark 1 7 3 1 1 7.43 65.32 208 300000 64 30 0.006400 156.25 62 12 0 0.193548 5.17 064 2 Other Urban 21 Andapa 2 Anda-Anda 1 3 1 14 1 4.02 63.14 0 300000 73 30 0.007300 136.99 73 12 0 0.164384 6.08 065 2 Other Urban 21 Andapa 6 Riverside 1 2 7 18 2 4.03 62.01 104 300000 53 30 0.005300 188.68 50 12 0 0.240000 4.17 066 3 Rural North 1 Alarma 3 Curibi 2 2 6 8 1 9.17 67.18 770 125000 52 20 0.008320 120.19 52 13 1 0.250000 4.00 067 3 Rural North 1 Alarma 5 Maradona 2 3 3 7 1 8.45 65.03 23 125000 80 20 0.012800 78.13 79 12 0 0.151899 6.58 084 3 Rural North 8 Bishkek 2 Makoti 2 1 4 14 2 8.16 63.00 435 125000 81 20 0.012960 77.16 88 12 0 0.136364 7.33 085 3 Rural North 9 Hiram 1 Hiram Lake 2 1 33 17 1 7.14 62.47 200 125000 79 20 0.012640 79.11 80 12 0 0.150000 6.67 086 4 Rural South 10 Ribaroga 3 Brown Falls 2 7 2 2 1 0.17 66.59 190 75000 39 15 0.007800 128.21 45 10 0 0.222222 4.50 087 4 Rural South 10 Ribaroga 6 Simpson 2 11 1 6 2 2.17 64.12 345 75000 44 15 0.008800 113.64 47 12 0 0.255319 3.92 099 4 Rural South 20 Coari 1 Coari 2 1 22 12 1 3.14 63.55 17 75000 42 15 0.008400 119.05 44 12 0 0.272727 3.67 - 100 4 Rural South 21 Andapa 3 Hark 2 1 8 11 1 5.16 63.02 650 75000 101 15 0.020200 49.50 123 12 0 0.097561 10.25 Sampling Final Interviewed Dates PSU Selection Sampling Team No. probability weight No. Planned Actual start Actual end A ZAB AC AD AE 001 0.001364 733.33 11 Jun-96 15-Jun-96 20-Jun-96 002 0.001375 727.27 12 Jul-96 7-Jul-96 17-Jul-96 ... ... ... ... ... . 024 0.001701 587.88 11 Sep-96 7-Sep-96 18-Sep-96 025 0.001242 804.85 12 May-96 30-Apr-96 6-May-96 026 0.001080 925.93 21 Mar-96 28-Mar-96 5-Apr-96 027 0.001239 807.29 21 Jan-96 1-Jan-96 7-Jan-96 064 0.001200 833.33 22 Oct-96 29-Sep-96 4-Oct-96 065 0.001272 786.16 21 Sep-96 29-Sep-96 5-Oct-96 066 0.002080 480.77 31 Feb-96 12-Feb-96 17-Feb-96 067 0.001944 514.32 31 Jul-96 20-Jul-96 25-Jul-96 084 0.001767 565.84 31 Apr-96 2-Apr-96 8-Apr-96 085 0.001896 527.43 31 Aug-96 10-Aug-96 25-Aug-96 086 0.001733 576.92 41 Jun-96 1-Jun-96 9-Jun-96 087 0.002247 445.08 41 Dec-96 30-Dec-96 3-Jan-97 099 0.002291 436.51 41 Mar-96 16-Mar-96 31-Mar-96 100 0.001971 507.43 41 Feb-96 5-Feb-96 13-Feb-96 Staff Information Staff No. First Name Last Name Sex Age Position Education Years of Contractual Ethnic Group Survey Status Male. 1 Supervisor . 1 Code 1. -1 Experience Code I . 1 Code 1 1 Female ... 2 Interviewer 2 Code.2. 2 Code 2.. 2 Code 2 ...2 Code 2... 2 Anthropometrist. 3 Code 3.. 3 Code 3 ...3 Code 3 ...3 Data Entry Operator..4 Driver. 5 Central office. 6 A B C D E F G H I J Module for Chapter 5 Consumption Angus Deaton and Margaret Grosh The following pages present draft questionnaire pages for modules.The main exception would be that Part D; expen- the collection of consumption data.They should be exam- ditures on private interhousehold transfers could be moved ined in light of the detailed discussion on consumption data from the consumption module by combining it with the given in Chapter 5 of Volume 1. The organization of the analogous information on transfers coming into the house- consumliption module should usually be very similar to the hold (see Chapter 11 in Volume 1 for further explanation) questionniaire pages shown here, though the specific list of and made into a separate free-standing module. itemls used and their recall periods will be customized for Only a single version of the consumption mzodule is each survey As discussed in Chapter 5, there are also sever- shown (except for Part D), for reasons explained in Chapter al choices that can be made regarding whether specific 5. That chapter also explains how more or less information types of expenditure should be collected in this module or can be collected by making simple modifications to each in the education, health, housing, environment or credit component part. 15 PART A: DAILY EXPENSES MOST KNOWLEDGEABLE MEMBER 1. ~~~~~~~~~~~~~~~2. 3. 4. In the past 7 days, has any member of your household How much did How many [MEALS/SNACKS] were What was the value spent money on any of the following items? your eaten by household members of these [MEALS] household outside of the home during the past eaten outside of the PUT A CHECK ( j ) IN THE APPROPRIATE BOX FOR spend for 7 days? home in the last 7 EACH ITEM. ASK QUESTION 1 FOR ALL ITEMS [ITEM]? days? BEFORE GOING TO 2. NO YES CURRENCY l NUMBER CURRENCY Tobacco, cigarettes, cigars Breakfast l 2 Newspapers or magazines = = Lunch _ 3 Lottery tickets Dinner/supper 4 Snack or beverages _Fares for busses, trams, taxis, etc. (including alcohol) 5 Parking 6 Regular worship 7 Alms _Shoeshines PART B: FOOD AND FUEL MOST KNOWLEDGEABLE MEMBER PURCHASES SINCE LAST VISIT PURCHASES TYPICAL MON HOME PRODUCTION GIFTS UNIT CODES: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. USE CODES WITH STAR In the following questions, I want to ask Have the How much How much How many How much How many How much What was What is the WHENEVER about all purchases made for your members of did you pay did you buy? months in do you months in did you the value of total value of POSSIBLE household, regardless of which person your in total? the past 12 usually the past 12 consume in the [FOOD] the [FOOD] made them. household months did spend on months did a typical you consumed KILO*. 1 bought any your [FOOD] in your month? consumed in that you GRAM* .2 Has your household consumed [FOOD] [FOOD] since household one of the household a typical received as POUND* 3. 3 during the past 12 months? Please my last visit, purchase months that consume month from a gift over OUNCE*. .4 exclude from your answer any [ITEM] that is since [FOOD]? you [FOOD] that your own the past 12 LITER'. ..5 purchased for processing or resale in a [DAY/DATE]? purchase you grew or production? months? CUP, ..... 6 household enterprise. [FOOD]? produced at PINT. . ..7 home? QUART*.. .8 PUT A CHECK (,/) IN THE GALLON*. 9 APPROPRIATE BOX FOR EACH FOOD BUNCH ... 10 ITEM. IF THE ANSWER TO Q.1 IS YES, IF NONE .IF.I. PEC... 11 ASK Q.2-13. WRT OENN, BUSHEL.. 12 7 ZEO EO TIN....13 1 ~~~~~~~~~~~~~~~~~~~~~~~~PIECES. .14 YES ______)OZENS. .1.5 NO.2 _1BTLS1 NO YES CODE (H5) MT UNIT MONTHS CURRENCY MONTHS MT UNI CURREURR EURRENCY Wheat (grain) 1 l Wheat (flour or maida) 2 l l Maize (flour or grain) 3 l l Jawar/Bajra _ 4 1 l Fine rice (basmati) 5 l - Coarse rce 6 l l Other grains/cereals 7 Gram 8 _ _ _ Dal 9 _ l l Groundnuts _ - 10 - - - - Liquid vegetable oils odalda) _ - 11 - - l Ghee, Desi ghee 12 Fresh milk 13 = = = = = l l Yogurt and Lassi 14 1 _ l l PART B: FOOD AND FUEL MOST KNOWLEDGEABLE MEMBER PURCHASESSINCELASTVISIT PURCHASESTYPICALMON HOME PRODUCTION GIFTS UNIT CODES: 1. 2. 3. 5. 6. 7. 8. 9. 10. USE CODES WITH STAR In the following questions, I want to ask Have the How much How much How many How much How many How much What was What is the WHENEVER about all purchases made for your members of did you pay did you buy? months in do you months in did you the value of total value of POSSIBLE household, regardless of which person your in total? the past 12 usually the past 12 consume in the [FOOD] the [FOOD] made them. household months did spend on months did a typical you consumed KILO*. 1 bought any your [FOOD] in your month? consumed in that you GRAM ... 2 Has your household consumed [FOOD] [FOOD] since household one of the household a typical received as POUND* .3 during the past 12 months? Please my last visit, purchase months that consume month from a gift over OUNCE*. ..4 exclude from your answer any [ITEM] that is since [FOOD]? you [FOOD] that your own the past 12 LITER*.. .5 purchased for processing or resale in a [DAY/DATE]? purchase you grew or production? months? CUP* ..... 6 household enterprise. [FOOD]? produced at PINT*. . . .7 home? QUART*.. .8 PUT A CHECK (/) IN THE GALLON* ..9 APPROPRIATE BOX FOR EACH FOOD BUNCH .. 10 ITEM. IF THE ANSWER TO 0.1 IS YES, IF NONE IF IF PECK ... 11 ASK Q.2-13. WRITE NONE NONE, BUSHEL. .12 ZERO, ~~~~~~~~~~~~~~~~~~~TINH..... 13 YES. ~ ~ ~ ~~~ ER,ZEO PIECES. .14 _________ )OZENS. .15 NO YES CODE HO. .2 CURRE_CY MONTHS _ CURRENCY CURRENCY BOTTLES. 16 | 2 AMT U M5H CURRENCY AOHMONTY HS IAMT |UNIT CURRE - Milk Powder 15 _ ________ Baby Formula 16 _ _______: Sugar (refined) 17 _ _ _ _z Gur/Desi sugar 18 _ _ _ _ _ _ | Mutton/lamb/goat 19 Beef/Buffalo 20 Chicken and other poultry 21 Eggs 221 Fish 23 ____________ ___I _____ Vegetables 24 1 1 1 1 1 1 1 1 1 1 1 Melon 25 Bananas 261 Citrus Fruits 27 Mango 28 _ _ _ _ _ _ _________ PART B: FOOD AND FUEL MOST KNOWLEDGEABLE MEMBER PURCHASES SINCE LAST VISIT PURCHASES TYPICAL MON HOME PRODUCTION GIFTS UNIT CODES: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. USE CODES WITH STAR In the following questions, I want to ask Have the How much How much How many How much How many How much What was What is the WHENEVER about all purchases made for your members of did you pay did you buy? months in do you months in did you the value of total value of POSSIBLE household, regardless of which person your in total? the past 12 usually the past 12 consume in the [FOOD] the [FOOD] made them. household months did spend on months did a typical you consumed KI3LO* ... bought any your [FOOD] in your month? consumed in that you RAM.... 2 Has your household consumed [FOOD] [FOOD] since household one of the household a typical received as POuND* ... 3 during the past 12 months? Please my last visit, purchase months that consume month from a gift over OUNCE*. .4 exclude from your answer any [ITEM] that is since [FOOD]? you [FOOD] that your own the past 12 LITER . 5 purchased for processing or resale in a [DAY/DATE]? purchase you grew or production? months? CUP, ..... 6 household enterprise. [FOOD]? produced at PINT* ..7 home? QUART. ...8 PUT A CHECK (,/) IN THE GALLON. ..9 APPROPRIATE BOX FOR EACH FOOD BUNCH ... 10 ITEM. IF THE ANSWER TO Q.1 IS YES, YFNONE I I PECK.... .11 ASK 0.2-13. WRT OENN, BUSHEL. .12 7 ZERO, ZERO ~~~~ ~~~~~~~~~~~~~~~~TIN....13 YES. 1 )1 IECES. .14 DOZENS. .15 NO..2 ~~~~~~~~~~~~~~~~~~~~~~~BOTTLES. 16 NO YES CODE (5) CURRENCY UNIT MONTHS CURRENCY MONTHS ANT UNIT CURRENCY CURRENCY Other Fruits 29 Canned Foods 30 _ (Coca cola, roohafza, squahs, etc.) 31 Beer 32 = = I] Other alcoholic beverages 33 Chapatti, Nan, other breads 34 : Fried items such as somosas, pakoras 351 Biscuits and cakes 36 ___= = = _ Spices and condiments 37 Tea 38 = = Coffee 391 Misc. other food expenses 40 Firewood 41 __l .... _ , Charcoal 42__ _ _ PART B: FOOD AND FUEL MOST KNOWLEDGEABLE MEMBER PURCHASES SINCE LAST VISIT PURCHASES TYPICAL MON HOME PRODUCTION GIFTS UNIT CODES: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. USE CODES WITH STAR In the following questions, I want to ask Have the How much How much How many How much How many How much What was What is the WHENEVER about all purchases made for your members of did you pay did you buy? months in do you months in did you the value of total value of POSSIBLE household, regardless of which person your in total? the past 12 usually the past 12 consume in the [FOOD] the [FOOD] made them. household months did spend on months did a typical you consumed KILO* 1 bought any your [FOOD] in your month? consumed in that you GRAM- .2 Has your household consumed [FOOD] [FOOD] since household one of the household a typical received as POUND; 3 during the past 12 months? Please my last visit, purchase months that consume month from a gift over OUNCE* ., 4 exclude from your answer any [ITEM] that is since [FOOD]? you [FOOD] that your own the past 12 LITER* ...5 purchased for processing or resale in a [DAY/DATE]? purchase you grew or production? months? CUP . 6 household enterprise. [FOOD]? produced at PINT* 7 home? QUART* 8 PUT A CHECK (,/) IN THE GALLON*. 9 APPROPRIATE BOX FOR EACH FOOD BUNCH... 10 ITEM. IF THE ANSWER TO Q.1 IS YES, IF N I PECK... .11 ASK 0.2-13. BUSHEL.. 12 ZERO,>' ~~~~~~~~~~~~~~~~~~~TINH.....13 YES.1 ~~~~~~~~~~~~~~~~~~~~~~~PIECES. .14 -1------ ~ ~ ~ ~~1OZENS. .15 HO. .2 OTE. NO |YES CODE (>5) CURREHCY AMT |UNIT MONTHS CURRENCY MONTHS AMT UNIT CURRENCY CURRENCY Paraffin 431 _ _ __l Cooking gas 44 PART C: NON-FOOD MOST KNOWLEDGEABLE MEMBER PURCHASES 30 DAYS 12 MONTHS GIFTS 12 MONTHS 1. 2. 3. 4. 5. 6. In the following questions, I want to ask about all purchases Have the How much How much did Did you receive What is the value made for your household, regardless of which person made members of did you your household any [ITEM] as a of all the [ITEM] them. your spend? spend for gift during the past that you received household [ITEM] during 12 months? as a gift during the Has your household bought, spent money on or received bought any the past 12 past 12 months? gifts of any [ITEM] during the past 12 months' Please [ITEM] in the months? exclude from your answer any [ITEM] purchased for last 30 days? processing or resale in a household enterprise. PUT A CHECK (C') IN THE APPROPRIATE BOX FOR EACH FOOD ITEM. IF THE ANSWER TO Q.1 IS YES, ASK Q.2-13 Y'ES. 1 'YES. . 1 NO. .2 NO. ..2 | NO YES CODE (t4) CURRENCY MONTHS (>FNEXT ITEM) MONTHS Personal care items (soap, shampoo, toothpaste, etc.) 1 Cosmetics 2 Women's clothing 3 Men's clothing 4_ Children's clothing _ ,_ __ ...... ... .... Women's footwear 6_ =- Men's footwear 7 Children's footwear 8 _ Cloth and sewing supplies 9 Tailoring expenses 10 _ Laundry and dry cleaning 11 Personal services (haircuts, shaving, manicures, etc.) _ 12- PART C: NON-FOOD MOST KNOWLEDGEABLE MEMBER PURCHASES 30 DAYS 12 MONTHS GIFTS 12 MONTHS 1. 2. 3. 4. 5. 6. In the following questions, I want to ask about all purchases Have the How much How much did Did you receive What is the value made for your household, regardless of which person made members of did you your household any [ITEM] as a of all the [ITEM] them. your spend? spend for gift during the past that you received household [ITEM] during 12 months? as a gift during the Has your household bought, spent money on or received bought any the past 12 past 12 months? gifts of any [ITEM] during the past 12 months? Please [ITEM] in the months? exclude from your answer any [ITEM] purchased for last 30 days? processing or resale in a household enterprise. PUT A CHECK (,/) IN THE APPROPRIATE BOX FOR EACH FOOD ITEM. IF THE ANSWER TO Q.1 IS YES, ASK Q.2-13 YES.1 YES. .1 NO .2 NO... 2 |NO YES CODE (t'4) CURRENCY MONTHS (>NEXT ITEM) MONTHS Traditional remedies and over the counter remedies 13 Modern medicines and health services (doctor fees, hospital charges, etc.) 14 Books, stationery (excluding textbooks) 15 Postal expess telegrams, ___ 16 rentals, cultural and sporting events, etc.) 17 Household cleaning articles (soap, washing powder, bleach, etc.) 11 :: Kitchen supplies (napkins, matches, garbage bags, etc.) 19 Toilet supplies (toilet paper, cleanser, etc.) 20 Electrical items (light bulbs, cords, plugs, batteries, etc.) 21 Repair and maintenance of household articles __ 22 Household linens (sheets. blankets, towels, etc.) ___ 231 Small kitchen appliances (blender, mixer, etc.) 24 l PART C: NON-FOOD MOST KNOWLEDGEABLE MEMBER PURCHASES 30 DAYS 12 MONTHS GIFTS 12 MONTHS 1. 2. 3. 4. 5. 6. In the following questions, I want to ask about all purchases Have the How much How much did Did you receive What is the value made for your household, regardless of which person made members of did you your household any [ITEM] as a of all the [ITEM] them. your spend? spend for gift during the past that you received household [ITEM] during 12 months? as a gift during the Has your household bought, spent money on or received bought any the past 12 past 12 months? gifts of any [ITEM] during the past 12 months? Please [ITEM] in the months? exclude from your answer any [ITEM] purchased for last 30 days? processing or resale in a household enterprise. PUT A CHECK (,/) IN THE APPROPRIATE BOX FOR EACH FOOD ITEM. IF THE ANSWER TO Q.1 IS YES, ASK Q.2-13 YES.1 YES.A. NO. .2 NO.. .2 |NO YES CODE (>>4) CUNENCY MONTHS (NEXT ITEM) MONTHS (rJ Dishes (crockery, cutlery, glassware, etc.) 25 Kitchen utensils (pots, pans, buckets, tools, etc.) 26 Small electrical items (radio, walkman, watch, clock, etc.) 27 Household tools 281 Sports and hobby equipment : 29 Toys _ 30 3 Musical instruments 31 Vehicle repair, maintenance, parts and licenses (do not include gasoline) 321 Repair and maintenance of the house 331 = _ Home improvements and additions 34 Insurance (auto, property) 35 Health insurance 36C PART C: NON-FOOD MOST KNOWLEDGEABLE MEMBER PURCHASES 30 DAYS 12 MONTHS GIFTS 12 MONTHS 1. 2 3. 4. b. 6. In the following questions, I want to ask about all purchases Have the How much How much did Did you receive What is the value made for your household, regardless of which person made members of did you your household any [ITEM] as a of all the [ITEM] them. your spend? spend for gift during the past that you received household [ITEM] during 12 months? as a gift during the Has your household bought, spent money on or received bought any the past 12 past 12 months? gifts of any [ITEM] during the past 12 months? Please [ITEM] in the months? exclude from your answer any [ITEM] purchased for last 30 days? processing or resale in a household enterprise. PUT A CHECK (/) IN THE APPROPRIATE BOX FOR EACH FOOD ITEM. IF THE ANSWER TO OIA IS YES, ASK Q.2-13 YES.1 YES. .1 NO. .2 NO .. 2 |NO TYES ICODEI (-4) CURRENCY MONTHS I(,NEXT ITEM) MONTHS Membership fees 37 Excursion, holiday (including travel and lodging) 38 Charity, donations 39 Income tax ___40_ Land tax 41 Housing and property taxes 42 Gambling losses 431 Cash losses 44 Contributions to ROSCAs, tontins, Christmas clubs, etc. 45 Deposits to savings accounts 46 Legal or notary services 47 Marrages, births, and other ceremonies 48 PART C: NON-FOOD MOST KNOWLEDGEABLE MEMBER PURCHASES 30 DAYS 12 MONTHS GIFTS 12 MONTHS 1. 2. 3. 4. 5. 6. In the following questions, I want to ask about all purchases Have the How much How much did Did you receive What is the value made for your household, regardless of which person made members of did you your household any [ITEM] as a of all the [ITEM] them. your spend? spend for gift during the past that you received household [ITEM] during 12 months? as a gift during the Has your household bought, spent money on or received bought any the past 12 past 12 months? gifts of any [ITEM] during the past 12 months? Please [ITEM] in the months? exclude from your answer any [ITEM] purchased for last 30 days? processing or resale in a household enterprise. PUT A CHECK (I/) IN THE APPROPRIATE BOX FOR EACH FOOD ITEM. IF THE ANSWER TO Q.1 IS YES, ASK Q.2-13 YES.1 YES. .1 NO. .2 NO.. .2 | NO | YES lCODE (-4) CURRENCY MONS (.NEXT ITEM) MONTHS Dowry or bride price | 49 Funeral expenses 50 PART D: EXPENDITURES ON PRIVATE INTER-HOUSEHOLD REMITTANCES MOST KNOWLEDGEABLE PERSON 1. During the past 12 months has any member of your household provided money or goods to persons YES. .1 who are not members of your household? For example for relatives living elsewhere, child support or NO... 2 (>>NEXT SECTION) alimony, or to friends or neighbors? 2. 3. 4. 5. 6. 7. What are the names of the persons Is this Which Is [NAME OF How is [NAME OF RECIPIENT] related How is [NAME OF RECIPIENT] related to to whom household members have assistance sent household RECIPIENT] to [NAME OF DONOR]? the head of the household? sent assistance during the past 12 to [NAME OF member sends related to months? RECIPIENT] [NAME OF [NAME OF RECIPIENT IS OF DONOR RECIPIENT IS... OF DONOR given by a RECIPIENT]? DONOR]? SPOUSE ............... 2 (*10) SPOUSE ................. 2 (>10) specific member CHILD ................ 3 (8) CHILD .................. 3 (8) of this GRANDCHILD ........... 4(»10) GRANDCHILD ............. 4(010) household? NIECE OR NEPHEW ...... 5(010) NIECE OR NEPHEW ........ 5(010) PARENT ............... 6(09) PARENT ................. 6(>>9) LIST ALL NAMES SISTER/BROTHER ....... 7(0>10) SISTER/BROTHER ......... 7(010) BEFORE GOING COPY ID SON/DAUGHTER-IN-LAW ..8(010) SON/DAUGHTER-IN-LAW .... 8(010) TO 3-20 CODE OF BROTHER/SISTER-IN BROTHER/SISTER-IN LAW ..9(>>10) PERSON LAW ..... 9(>>10) GRAND FROM GRAND FATHER/MOTHER .10(10) ROSTER FATHER/MOTHER ..... 10(010) FATHER/MOTHER-IN- FATHER/MOTHER-IN- LAW .11(»10) LAW ............ 11.(10) OTHER RELATIVE ........ 12(>10) YES .1 YES. .1 OTHER RELATIVE ...... 12(010) NO RELATION ........... 13(>10) 0N NO .. 2 ID NO... 2 NAME (*7) CODE (*9) 3 4 6~ 7- 8T 9 10 11 12 PART D: EXPENDITURES ON PRIVATE INTER-HOUSEHOLD REMITTANCES MOST KNOWLEDGEABLE PERSON 8. 9. 10. 11. 12. 13 14. 15. 16. 17. Is [RECIPIENT] Does What kind of place In what region is How much Has the What is the Is the male or [RECIPIENT] does [RECIPIENT] this place? money have household approximate assistance female? live in this live in? members of also given value in cash sent to place? the household any of the [RECIPIENT] sent to assistance to assistance provided for a COPY ID COPY ID [RECIPIENT] [RECIPIENT] given in food or specific CODE OF CODE ID in the past 12 in the form of other goods? reason? RECIPIENF RECIIENT Omonths? food or other RECIPIENT RECIPIENT . gos FROM FROM CODE LIST goods? ROSTER C ROSTER B OF AREAS USED ON MIGRATION PAGE CAPITAL CITY ... 1 LARGE ___________ ID_______ IDMALE ..... 1 YES .1 CITY ...... 2 YES .1 YES. .1 TOWN NO.....23NO... .2 ~~4 ~~ ID DEMAL.. .2 NO ... 2 VILLAGE. .... 4 AON O..2AON CCODE ODE ( 14) AMOUNT (t17) ANOUNT ('>19) 2 4 5 9 10 12 ==-_-_ PART D: EXPENDITURES ON PRIVATE INTER-HOUSEHOLD REMITTANCES MOST KNOWLEDGEABLE PERSON 18. 19. 20. What is the main reason How many times Do you expect why [RECIPIENT] was per year does [RECIPIENT] to sent this assistance? [DONOR] repay the send this assistance sent CHILD assistance? by this SUPPORT ......1 household? EDUCATIONAL EXPENSES .....2 MEDICAL EXPENSES .....3 WEDDING ....... 4 FUNERAL ....... 5 INVESTMENT IN HOUSEHOLD ENTERPRISE.... 6 PURCHASE OF A DURABLE GOOD.7 YES ..1 OTHER .....2 00 ~~~~~~~~~~~~No... .2 _ ________________ ___________ ("NEXT) 2 3 4 6 7 8 9 10 12 _ PART D: EXPENDITURES ON PRIVATE INTER-HOUSEHOLD REMITTANCES - SHORT MOST KNOWLEDGEABLE PERSON 1. During the past 12 months has any member of your household provided money or goods to persons YES. .1 who are not members of your household? For example for relatives living elsewhere, child support or NO... 2 (-NEXT SECTION) _ alimony, or to friends or neighbors? . 2. 3. 4. 5. 6. 7. What are the names of the persons Is this Which Is [NAME OF How much What is the to whom household members have assistance sent household RECIPIENT] money have approximate sent assistance during the past 12 to [NAME OF member sends related to members of value in cash months? RECIPIENT] [NAME OF [NAME OF the household of the given by a RECIPIENT]? DONOR]? sent to assistance specific member [RECIPIENT] given in food or of this in the past 12 other goods? household? months? LIST ALL NAMES BEFORE GOING COPY ID TO 3-7 CODE OF PERSON FROM ROSTER YES. .1 YES. .1 NO... .2 ID NO... .2 NAME ('>6) CODE AMOUNT 2 3 4 5 6 7 8 9 10 1 1 12 PART E: DURABLE GOODS MOST KNOWLEDGEABLE PERSON 2. 3. 4. 5. 6. 7. 1. Does your household own any of the LIST ALL THE ITEMS OWNED BY How many Did you How much did How much If you wanted following items? THE HOUSEHOLD, THEN years ago purchase it or you pay for it? was it worth to sell this PROCEED TO ASK Q.3-7. did you receive it as a when you [ITEM] today, acquire this gift or payment received it? how much [ITEM]? for services? would you DETERMINE WHICH DURABLES THE Treceive? HOUSEHOLD OWNS BY ASKING 0.1. E FOR EACH DURABLE OWNED, WRITE M THE DESCRIPTION AND CODE IN THE SPACE PROVIDED UNDER Q.2, AND PROCEED TO ASK Q.3-7 FOR EACH ITEM. PURCHASE.1 GIFT OR PAYMENT. .2 ITEM ICODE YES NO DESCRIPTION I CODE YEARS ('6) CURRENCY CURRENCY CURRENCY 0 Stove 201 1 Refrigerator 202 = = 2 = Washing Machine 203 3 Sewing/knitting machine 204 4 Fan 205 = = 5 = _ Television 206 6 6_______0 0 Video player 207 7 = 7 _ Tape player/CD player 208 8 Camera, video camera 209 9 Bicycle 210 10 Motorcycle/scooter 211 11 _ Car or truck 212 12 13 14 15 16 Module for Chapter 6 Household Roster Paul Glewwe The household roster module is presented in the following There are two specific points to keep in mind for the pages. There are four parts, A, B, C, and D. As explained in household roster. First, the questionnaire should be Chapter 6 ofVolume 1, there are three versions, a short ver- designed so that the names of the household members on sion, a standard version, and an expanded version. The short the household roster are visible when filling out other indi- version consists of PartA alone.The standard version is com- vidual-level modules.This is explained in detail in Chapter posed of Parts A, B, and C.The expanded version includes all 3 ofVolume 1. Second, the migration module contains sev- four parts, A-D. The expanded version also adds some ques- eral additions to the household roster. This is explained in tions to Part A. These questions are not shown in the ques- Chapter 16 ofVolume 2. tionnaire pages in this volume but are presented in Chapter 6. 31 PART A: HOUSEHOLD ROSTER PERSON INTERVIEWED: PREFERABLY THE HEAD OF THE HOUSEHOLD. IF HE/SHE IS NOT AVAILABLE, FIND A "PRINCIPAL RESPONDENT" TO ANSWER THE QUESTIONS IN HIS/HER PLACE. THE PERSON SELECTED WRITE DOWN THE NAME, SEX AND RELATIONSHIP TO THE HEAD OF MUST BE A MEMBER OF THE HOUSEHOLD WHO IS ABLE TO GIVE HOUSEHOLD. INFORMATION ON THE OTHER HOUSEHOLD MEMBERS. * Are there any other persons who slept here last night but do not normally live RESPONDENT: ID CODE: here? 1-3. I would like to make a complete list of all the people who normally live and WRITE DOWN THE NAME, SEX AND RELATIONSHIP TO THE HEAD OF eat their meals together in this dwelling. HOUSEHOLD. First, I would like to have the names of all the members of your immediate FOR EACH PERSON LISTED IN QUESTION 1, ASK THE QUESTIONS 4-11 AND family, who normally live and eat their meals together in this dwelling. Start CLASSIFY THE PERSON ACCORDINGLY IN Q.12. COMPLETE THE ENTIRE with the head of the household, wife/husband of household head, his/her LINE BEFORE GOING ON TO THE NEXT PERSON LISTED. children in order of age. 4-11. Now I would like to have some information about each of the persons you ALWAYS WRITE DOWN THE HEAD OF THE HOUSEHOLD FIRST, mentioned. FOLLOWED BY HIS/HER SPOUSE AND THEIR CHILDREN IN ORDER OF AGE. IF THE RESPONDENT HAS ANY DIFFICULTY WITH HIS AGE OR DATE OF BIRTH (QUESTIONS 5 AND 6), USE THE CALENDAR OF EVENTS TO MAKE AN IF THERE IS MORE THAN ONE WIFE, START WITH THE FIRST WiFE, ESTIMATE. FOLLOWED BY HER CHILDREN IN ORDER OF AGE, THEN THE SECOND WIFE AND HER CHILDREN IN ORDER OF AGE, AND SO ON. 12. CLASSIFY EACH PERSON ACCORDING TO THE FOLLOWING CRITERIA w.' WRITE DOWN THE NAME IN CAPITAL LETTERS, SEX AND RELATIONSHIP t'i ~~~~~~~~~~~~~~~~~~LOOK AT THE ANSWER TO QUESTION 1 1. TO THE HEAD OF HOUSEHOLD FOR EACH PERSON. * ALL PERSONS ALIVE FOR WHOM THE ANSWER IS 9 MONTHS OR LESS ARE * Please give me the names of any other persons related to the head of the CLASSIFIED AS HOUSEHOLD MEMBERS. DECEASED INDIVIDUALS ARE NEVER household or to his/her wife/husband, together with their families, who CLASSIFIED AS HOUSEHOLD MEMBERS. LODGERS ARE NOT CLASSIFIED AS normally live and eat their meals here. HOUSEHOLD MEMBERS. HIRED WORKERS AND SERVANTS, IF THEY HAVE THEIR OWN FAMILY IN A DIFFERENT PLACE, ARE ALSO NOT CLASSIFIED AS WRITE DOWN THE NAME, SEX AND RELATIONSHIP TO THE HEAD OF HOUSEHOLD MEMBERS. GUESTS WHO HAVE COME TO VISIT FOR 3 OR MORE HOUSEHOLD. MONTHS ARE CLASSIFIED AS MEMBERS OF HOUSEHOLD. 'Please give me the names of any other persons not related to the head of IF THE ANSWER IS MORE THAN 9 MONTHS, ONLY THE FOLLOWING ARE household or to his/her wife/husband but who normally live and eat their HOUSEHOLD MEMBERS: meals here. For instance, tenants, lodgers, servants or other persons who are not relatives. ~ ~ ~ ~ ~ ~ ~ -THE HEAD OF HOUSEHOLD -- INFANTS LESS THAN 3 MONTHS OLD WRITE DOWN THE NAME, SEX AND RELATIONSHIP TO THE HEAD OF HOUSEHOLD. 'APART FROM THE CASES LISTED ABOVE, ALL OTHER PERSONS FOR WHOM THE ANSWER IS MORE THAN 9 MONTHS ARE NOT HOUSEHOLD MEMBERS. * Are there any other persons not now present but who normally live and eat ENTER CODE 1 FOR EACH HOUSEHOLD MEMBER AND CODE 2 FOR ALL OTHER their meals here? For example, any person studying somewhere else or who PERSONS. GO ON TO THE NEXT PERSON LISTED. is on vacation or who is visiting other people. PART A. HOUSEHOLD ROSTER HEAD OF HOUSEHOLD 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. MAKE A COMPLETE SEX RELATIONSHIP TO HEAD: Can you COPY THE DATE How old is What is the Does the COPY THE What is For how HOUSE- LIST OF ALL HEAD .1 tell me OF BIRTH [NAME]? present marital husband/ ID CODE his/her many HOLD CONCERNED WIFE/HUSBAND .......... 2 the date status of wife of OF THE nation- months MEMBER? I BEFORE GOING TO CHILD/ADOPTED CHILD ...3 of birth of [NAME]? [NAME] WIFE/ ality? during the D QUESTIONS 4-12 GRANDCHILD ............ 4 [NAME]? YEARS IF 12 live in this HUSBAND. past 12 CHECK NIECE/NEPHEW ............ 5 YEARS OR household IF MORE months THE C FATIEC/METHER ......... 6 CALCULATE OLDER MARRIED. .1 now? THAN ONE (since CRITERIA O SISTER/BROTHER. .............. 7 P PERSON'S DIVORCED.2 WIFE, MONTH! ABOVE D SON/DAUGHTER-IN-LAW ... PROBER AGE, ASK THE YEARS AND (t10) COPYTHE YEAR) has E BROTHER/SISTER-IN- BFIORH RESPONDENT MONTHS IF SEPARA- ID CODE he/she LAW .......... 9 BCERTI- TO CONFIRM <12 YEARS TED ..... 3 OF THE been away >)NEXT GRANDATHE/MOTER...0 CETI- O CONIRM 12 EARS WIDOW OR FIRST. from this PERSON GRANDFATHER/MOTHER..AO FICATE ITIN WIDOWER. .4 household? IF LAST FATHER/MOTHER-IN-LAW.11 QUESTION 6 IF < 12 ("10) PERSON, OTHR ELTIV .....12 YEARS THEN NEER)PART B SERVANT OR SERVANT'S )>lo MALE.1 RELATIVE ........ 13 MARRIED. .5 NATION- FE- TENANT OR TENANT'S YES ..1 .10) YES ..1 ALITY YES ..1 MALE.2 RELATIVE . .14 NO ... .2 NO ... 2 CODES CUMULATED NO... 2 - ~~~~~~~~~OTHER(SPECIFY )..15 W _ ~~~NAME (-6) 1DAY IMONTHI YEAR IYEARS IMONTHS (.10) ID CODE MONTHS W. 1______ __ =__ I_ =___ = =__II_II 2= 7 8 9h 12 PART B: INFORMATION ON PARENTS OF HOUSEHOLD MEMBERS HEAD OF HOUSEHOLD 1. 2. 3. 4. 5. 6. 7. 8. 9 10. 11 12. 13. 14. 15. 16. Is the COPY Is the Did the What was What was What kind Is the COPY Is the Did the What was What was What kind ASKEACH ASK EACH natural THE ID father of father of the highest the highest of work did natural THE ID mother mother the highest the highest of work HOUSE- HOUSE- father of CODE [NAME] [NAME] grade he diploma or the father mother CODE of of grade she diploma or did the HOLD HOLD I [NAME] FORTHE still attend completed? degree of [NAME] of FOR THE [NAME] [NAME] completed? degree mother of MEMBER MEMBER D living in FATHER alive? school? obtained do for [NAME] MOTHER still attend obtained by [NAME] AGE 21 AND AGE 21 AND this by the most of his living in alive? school? the mother do for OLDER: OLDER- C house- father of life? this of [NAME]? most of 0 hold? [NAME]? house- her life? How many How many D hold? EC brothers do sisters do E _ 1a15 you have you have that are that are currently currently alive? alive? CODES CODES CODES CODES YES. .1 YES. .1 YES. .1 CODES FOR FOR YES. .1 YES. .1 YES. .1 CODES FOR FOR |ARTC NO.. .2 NO ... 2 NO.. ..2 FOR DIPLOMAS OCCUPA- NO... .2 NO... .2 NO.. .2 FOR DIPLOMAS OCCUPA- _ (,,3) IID CODE (1 ,,7) GRADES TIONS (-9) I D CODE (I > 14) GRADES TIONS 4- 5 8 9 I 2 PART C: CHILDREN OF HOUSEHOLD MEMBERS WHO ARE LIVING ELSEWHERE AND NOT MEMBERS OF THE HOUSEHOLD HEAD OF HOUSEHOLD 1. Does any member of your household have children not living here in this household? YES... 1 NO. .2 (,,NEXT SECTION) 2. 3. 4. 5 6. 7. 8. 9. 10. 11 12. 13. 14. O What are their names? SEX How Does the COPY Does the COPY Has Is What was/is What was the In what province Where does R LIST ALL THE CHILDREN old is natural THE ID natural THE ID [NAME] [NAME] the highest highest diploma or does [NAME] [NAME] live? D REGARDLESS OF AGE [NAME] father of CODE OF mother CODE OF ever attending grade degree obtained by live? Is it a... E WHO DO NOT LIVE IN now? [NAME] THE of THE aftended school completed by [NAME]? READ TO THE R THIS HOUSEHOLD live in FATHER [NAME] MOTHER school? now? [NAME]? RESPONDENT this live in O house- this F hold? house- ,,NEXT COMPLETE THE hold? PERSON C LIST BEFORE PROVINCE H GOING TO 4-14 CODES City?... 1 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Large L town?. .2 D small town?. .3 ODES Rural MALE... .1 YES. .1 YES. .1 YES. .1 YES. .1 GRADE FOR area?. .4 ui FEMALE.2 NO ... .2 NO... .2 NO...2 NO... .2 CODES DIPLOMAS Other?. .5 NAME YEARS (>7) ID CODE (>>9) ID CODE (>13) 2 3 4 7 7ll 9 10 {11 PART D: INFORMATION ON NON-RESIDENT SIBLINGS OF ADULT HOUSEHOLD MEMBERS HEAD OF HOUSEHOLD 1. Do any of the adult members of your household (individuals age 21 years and older) YES ..1 Zi have any brothers or sisters who live somewhere else? NO . 2 (>NEXT SECTION) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Please give me the names of Is [NAME] How old Who in this Has Is What What was the In what Where does What is all these siblings. male or is household is the [NAME] [NAME] was/is the highest diploma or province [NAME] live? [NAME'S] female? [NAME]? brother or sister of ever attending highest degree obtained by does Is it a... current [NAME]? attended school grade [NAME]? [NAME] READ TO THE occupation school? now? completed live? RESPONDENT or activity? FOR EACH ADULT by HOUSEHOLD MEMBER, WRITE DOWN [NAME]? LIST ALL BROTHERS AND THE ID CODES. >NEXT SISTERS WHO ARE STILL ALIVE BUT ARE NOT ALLOW UP TO 4 MEMBERS OF THIS RESPONSES. PROVINCE OCCU- HOUSEHOLD. CODES city? ..1 PATON Large town?. .2 AND Small ACTXVITY town?. .3 CODES CODES Rural YES. .1 YES ..1 GRADE FOR area? ..4 MALE.. .1 NO... .2 NO... .2 CODES DIPLOMAS Other? ..5 _,.' NAME FEMALE.2 YEARS 1ST 2ND 3RD 4T5 (10) 2 3 47 i i I : 12~ : : = : Module for Chapter 7 Education Paul Glewwe The following pages contain the education module for the When the standard module is used, it is often useful to add household questionnaire. As explained in Chapter 7 of the school questionnaire. Finally, the expanded module Volunme 1, there are three different versions: short, standard should include both the school questionnaire and the teacher and expanded. The following pages also contain a draft questionnaire.This is explained in detail in Chapter 7. questionlnaire for local schools and a draft questionnaire for There are two aspects that need particular attention the teachers in those schools. when designing the education module. First, survey design- The short module for the household questionnaire con- ers should consider whether the questions in Part C of the sists of a single page of only 11 questions.The standard mod- household roster module collect sufficient information on ule is much longer. It is divided into four parts, A, B, C, and the education for non-resident children of current house- D. The expanded module takes the standard module as its hold members. That module is described in Chapter 6 of starting point and adds additional questions to Part B. If the Volume 1. Second, questions on job training should be short module is used, neither the school questionnaire nor coordinated with any similar questions in the employment the teacher questionnaire should be included in the survey. module, which is described in Chapter 9 ofVolume 1. 37 EDUCATION MODULE (SHORT VERSION) ALL HOUSEHOLD MEMBERS AGE 5 AND OLDER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Have Are you What is What is Were In what What is Is the school How much has your household spent on your education in the last 12 Have How many you currently the the highest you grade are the highest you are months for: you ever times have ever enrolled highest diploma enrolled you diploma currently repeated you I attended in grade you you have in school currently you have enrolled in a grade repeated a D school? school? have attained? during enrolled in attained so public or of grade of completed the past school? far? private? school? school? C in school? 12 0 months? PUT PUBLIC ..1 CORES pErS CODES CP7E PRIVATE A. Tuition B. Parent C. Uni- D. Text- E. Other F. Meals, G. Other DIFFER- FOR DIFFER- FOR LAR .2 and other Associ- forms books? educational transpor- expenses YES..1 ENT DI PLO- YES ..1 ENT DXPLO- PRIVATE required ation and materials tation (extra YES..1 NO..2 YES ..1 GRADES MAS (.9) GRADES MAS RELIG- fees? fees? other (exercise and/or classes, NO ... 2 NUMBER OF (»NEXT (-6) HERE HERE NO ... 2 HERE HERE IOUS .. 3 clothing? books, odging? optional ('NEXT REPEATED I PERSON) NO ....21.. 2 1>'10) I_ I I I I I jpens, etc.)? fees)? PERSON) GRADES w 1 2 3 4- 7 iT 412: :: : : : :: :: : : EDUCATION MODULE (STANDARD VERSION) PART A: GENERAL EDUCATION ALL HOUSEHOLD MEMBERS AGE 3 AND OLDER 1. 2 3. 4. 5. 6. 7. 8. 9. 10. IS THIS COPY THE ID Can you read the Can you solve Have you Are you Was the school you last How many How many What post-secondary PERSON CODE OF following sentence? the following ever currently attended a preschool, a years did years did diplomas did you attain? ANSWERING RESPONDENT written attended attending primary school, a lower you attend you attend I FOR FROM calculation? school? school? secondary school, an preschool? post- D HIMSELF/ ROSTER upper secondary school or secondary HERSELF? a post-secondary education? C institution? 0 SHOW SENTENCE SHOW D ____TO THE WRITTEN SPR E RESPONDENT CALCULATIONB E I 1 RESTPOoTNHDEENT AlTO THE BACHELOR'S . .....I RESPONDENT PRESCHOOL ..1 MASTER'S .2 PRIMARY.... .2("21) DOCTORATE.... 3 YES, WITHOUT IOWR MEDICAL. 4 ERRORS OR CORRECT SECONDARY.3(>17) LAW. 5 DIFFICULTY... .1 COWRRECT UPECODRY. 1)OTHER (SPECIFY YES, BUT WITH SECSNDR.Y.1 UPPER YES. .1 ERRORS OR INCORRECT SCNAY4"3 . DIFFICULTY ...2 OR NO YES ..1 YES ..1 POST- (3) NO ...........O3 ANSWER ..2 NO.. 2 (t25) SECONDARY.5 (o9) No... 2 ID CODE (>>PART C) NO ... 2 YEARS YEARS FIRST SECOND THIRD 2- 3l l 5l l 7 8 10 12 EDUCATION MODULE (STANDARD VERSION) PART A: GENERAL EDUCATION ALL HOUSEHOLD MEMBERS AGE 3 AND OLDER 11. 12. 13. 14. 15. 16. 17. 18. What were your major In what year Did you successfully What was In what year Was the upper Did you successfully What was the fields of study in post- and month did complete upper secondary the highest and month secondary school you complete lower secondary highest grade secondary education? you finish your school and obtain your grade you did you finish last attended public or school and obtain your you I ~~~~~post- diploma? successfully your upper private? diploma? successfully D SCIENCE ....1 secondary completed secondary completed HUMANITIES. .. .2 studies? before school bfr evn O BUIECOOIS.. YES, FINISHED leaving upper studies? YES, FINISHED lower 0 ECONOMICS ... 3 FINAIL GRADE AN secondary FINAL GRADE AN secondary D SOCIAL ~ ~ mRECEIVED schol?RECEIVED school? E SCIENCE ...I IPOA.....1DILM1....I ENGINEERING. .5 ( ILOA15 DILOA19 MEDICINE ..... 6 FINISHED FINAL FINISHED FINAL EDUATION...... .8 GRAE BUT DID GRADE BUT DID EDUCATION .... 8 NOT RECEIVE NOT RECEIVE OTHER(SPECI- DIPLOMA .....2 PUBLIC ....1 DIPLOMA .....2 FY ).9 (*15) PRIVATE (*19) NO, DID NOT FINISH SECULAR.... 2 NO, DID NOT FINISH FINAL GRAE.... 3 PRIVATE FINAL G.ME.... 3 rFIRST SECO HR OT jYEA GRADE MrONTHFYFAIR REIIU.3GRADE 40 - _ _ __ _ _ _ _ _ _ _ _ 3- 4 7 iT - - -- ________ ___ EDUCATION MODULE (STANDARD VERSION) PART A: GENERAL EDUCATION ALL HOUSEHOLD MEMBERS AGE 3 AND OLDER 19. 20 21 22. 23. 24. 25. 26. In what year Was the lower Did you successfully What was the In what year Was the primary Is the school you are currently How many and month secondary school you complete primary school highest grade and month school you last attending a preschool, a primary years and did you finish last attended public and obtain your diploma? you did you finish attended public or school, a lower secondary school, months have I your lower or private? successfully your primary private? an upper secondary school or a post you attended D secondary completed school secondary institution? preschool? school before studies? C studies? leaving O YES, FIN1SHED primary D RECEIVEGD school? l,,,PART B DIPLOMA ........ 1 (-23) FINISHED FINAL GRADE BUT DID NOT RECEIVED PUBLIC ......1 DIPLOMA . 2 PUBLIC ..... 1 PRESCHOOL ........ 1 PRIVATE (>23) PRIVATE PRIMARY .2 (>,27) SECULAR ....2 NO, DID NOT FINISH SECULAR ...2 LOWER SECONDARY ..3 (.27) PRIVATE FINAL GRADE .... 3 PRIVATE UPPER SECONDARY. 4 (,>27) RELIGIOUS. .3GRD MOT Y RELIGIOUS.3 POST-SECONDARY. ..5 (.32) _MONTH YEAR GRADE MONTH YEAR ....MONTHS YEARS 4- 5-- 7 10 11 12 EDUCATION MODULE (STANDARD VERSION) PART A: GENERAL EDUCATION ALL HOUSEHOLD MEMBERS AGE 3 AND OLDER 27. 28 29. 30. 31. 32. 33. 34. 35. 36. Do you What is the name of How many How CHECK THE How many What post-secondary What are your major What Is the upper live at the school that you days has many ANSWER TO years have diplomas have you fields of study in post- grade are secondary home are currently your days QUESTION 25, AND you been already obtained? secondary education? you school you are I while attending? school have you THEN APPLY THE enrolled in currently attending public D attending been open attended FOLLOWING SKIP post- enrolled in or private? the in the past school in CODES: secondary L at upper C school in 7 days? the past education, secondary 0 which you 7 days? including SCIENCE . school? D are this year? BACHELOR'S . 1 HUMANITIES . 2 ....4 E currently MASTER'S . 2 SOCIAL SCIENCE. .3 enrolled? DOCTORATE .3 ENGINEERING .....4 IF MEDICAL ........4 MEDICINE ........ 5 ZERO LAW ...........5 LAW ............. 6 DAYS NONE ...........6 EDUCATION ....... 7 ))))31 P LOWER OTHER (SPECIFY) OTHER (SPECIFY PRIVATE ins. .1 SECONDARY.2(,,37) 7.. S ECU8 PRIVATE YES... UPPER SECULAR .. .2 NO.. 2 SECONDARY.3(35) PRIVATE (p>31) NAME CODE DAYS DAYS YEARS FIRST SECOND THIRD FIRST SECOND THIRD GRADE LIG 2 4 5 12 1 1I XIIII 12 lll EDUCATION MODULE (STANDARD VERSION) PART A: GENERAL EDUCATION ALL HOUSEHOLD MEMBERS AGE 3 AND OLDER 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. What Is the lower What Is the primary Did you How many Did you How many Did you How How old What Before How many grade are secondary school grade school you are repeat any years did repeat any years did repeat many were you year entering years did you you you are currently are you currently attending years in you repeat years in you repeat any years when was primary attend I currently attending public or currently public or private? upper in upper lower in lower years in did you you first that? school, did preschool? D enrolled in private? enrolled secondary secondary secondary secondary primary repeat entered you ever at lower in at school? school? school? school? school? in primary attend a C secondary primary primary school? preschool? O school? 3 school? s school? W PRIVATE .... 1 PRIVATE ....1 PRIVATE PRIVATE SECULAR .... . . 2 SECULAR ....... 2 YES ..1 YES ..1 YES ..1 YES ..1 PRIVATE RELIGIOUS.3 NO. ..2 No. .2 NO. .2 AGE IN No. .2 GRADE GRADE (»43) YEARS (.45) YEARS (-47) YEARS YEARS YEAR (>PART B) YEARS 2 31 4- 12 31 TIIX>6) IST _ _2ND |_3RD 2 3 4 ~6 7 80 12 8T __= =_ EDUCATION MODULE (STANDARD VERSION) PART 8: EDUCATION IN LAST 12 MONTHS ALL HOUSEHOLD MEMBERS AGE 3 AND OVER 5. 6 7. 8. 9. 10. How much Are you What is the How far away How long does it How do you go to school? money did currently value of the from your take you to travel this person receiving a scholarship home is the to your school? I (these scholarship or subsidy school you D people) pay or subsidy received have been for your to support during the attending in )))PART C C educational your past 12 the last 12 0 expenses education? months? months? D during the E past 12 WALK ............. 1 months? BICYCLE .......... 2 CAR .............. 3 BiaS .................... 4 TRAIN ............ 5 BOAT ............. 6 TIME ONE WAY AN~IMAL .........N......... 7 YES ..1 OTHER (SPE- NO .... 2 CIFY ).8 DOLLARS (t8) DOLLARS KILOMETERS HOURS MINUTES Ln 1 2_ 4- 6 . 7 t 12 EDUCATION MODULE (STANDARD VERSION) PART C: APPRENTICESHIP AND TRAINING ALL HOUSEHOLD MEMBERS AGE 3 AND OLDER 1. 2. 3. 4. 5 6. Have you ever been an How many What kind of trade Have you ever received formal What kind of For how many years or months did apprentice or received a similar years were did you learn in this professional or technical training was you receive this training? form of informal training? you an apprenticeship? training in a school or training received? apprentice? center? D 0 D )))>NEXT PERSON. E AFTER ALL PERSONS HAVE ANSWERED, aa PART D YES, CURRENTLY AN YES, CURRENTLY C APPRENTICE ........ 1 ENROLLED ........1 CODES FO YES, WAS AN A.PPREWXCESHIP YES, WAS ENROLLED APPRENTICE ........ 2 CODES IN THE PAST .....2 NO ............ 3 NO .......... 3...3 (-4) (-PART D) FIRST SECOND YEARS FIRST SECONDj FIRST SECOND YEARS MONTHS YEARS MONTHS 2 3 4 5 6 7 B 9 10 12 EDUCATION MODULE (STANDARD VERSION) PART D: DISTANCES TO LOCAL SCHOOLS HOUSEHOLDS WITH CHILDREN BETWEEN 5 AND 20 YEARS OF AGE 1. CHECK HOUSEHOLD ROSTER. ARE THERE ANY HOUSEHOLD MEMBERS, YES. .1 1IiXhIZ INCLUDING CHILDREN LIVING AWAY FR M HOME (PART 1C), BET EEN AGE 5 AND 20? NO . 2 (>>END OF MODULE) 2. 3. 4. 5. 6. 7. B. What is the name of the What is the name of the How far What mode of How much How much time Is there another [... ] that is nearest your [... ] that is second/third away from transportation would money does it take to [ ] located within home? nearest your home? your you use to travel to does it travel to this [...1 kilometers of home is this [... ] from your cost to [... ] from your your home? this [.]? home? use this home using mode of this mode of transporta- transportation? tion to go to this )>)4 WALKING... 1(>7) BICYCLE;.. .2(>7) CAR.....3 BUST .. 4 TIME ONE WAY YES..1 TRAIN ...5 BOAT . 6 (-NEXT LINE) ANIMAL .7 QUESTION 3) OTHER ROUND NO.. 2 -t | DISTANCE K ID | ID XILO- (SPECIFY_)... .8 TRIP MINU- (>>NEXT TYPE) Iw SCHOOL CUT-OFF METERS COST HOURS TES OF SCHOOL) Primary School #1 10 _ | . Primary School #2 10 _ Primary School #3 10 Lower Secondary School #1 15 Lower Secondary School #2 15 Lower Secondary School #3 15 Upper Secondary School #1 20 - _ Upper Secondary School #2 20 . Upper Secondary School #3 20 , EDUCATION MODULE (EXPANDED VERSION) ADDITIONAL QUESTIONS FOR PART B ALL HOUSEHOLD MEMBERS AGE 3 AND OLDER 11. 12. 13. 14. 15. 16. 17- 18. Do you have a How did you obtain the textbooks that you Do you share How many Do you What kind of meal or How many times per How much complete set of have? these hours of participate snack do you receive at week do you receive does your textbooks for your use? ALLOW UP TO 3 RESPONSES textbooks homework in any your school? this? family pay for PROVIDED BY THE SCHOOL, with other do you do feeding this f oo D CAN TAKE HOME .I students or in a typical program at ALLOW UP TOod? PROVIDED BY THE SCHOOL, are they for week? your ALLOW UP TO THREE THREE RESPONSES C CANNOT TAKE HOME .......2 your school? RESPONSES O NEWLY PURCHASED FROM exclusive D THE SCHOOL ........ 3 use? E NEWLY PURCHASED FROM TIME UNIT PRIVATE MARKET 4.BREAXFABREAKFAST .... 1 CODES- GIFT .5 SNACK ..... 2 DAY .. 3 PASSED DOWN FROM OLDER LUNCH . 3 WEEK. .4 BROTHER OR SISTER . 6 OTHER (SPECI- FORT- YES, COMPLETE.1 PURCHASED USED ..........7 FY ). .4 NIGHT.5 NO, HAS OTHER (SPECIFY )..8 MONTH..6 ONLY SOME ....2SA .. 1 YES.. 1 NO, NONE....3 SAE.1YS. I >44) EXCLUS~~~ ~ ~~~~~~IVEI NO... .2 FIRST SECOND THIRD USE .... 2 HOURS (»PART C) FIRST SECOND THIRD FIRST|SECOND|THIRD AMOUNT [ UNIT co0- 1 1 mq 2 4- 7 8 9__ 10 11 SCHOOL QUESTIONNAIRE NAME OF COMMUNITY CODE: lII NAME OF SCHOOL CODE: (ASSIGN SCHOOL CODES OF P1, P2, P3...FOR PRIMARY, LS1, LS2, ETC. LOWER SECONDARY US1, US2, UPPER SECONDARY) ADDRESS OF SCHOOL NAME OF RESPONDENT POSITION OF RESPONDENT _ _ _ HEADMASTER ......................1 OTHER ADMINISTRATOR ..................... . 2 TEACHER ......................3 OTHER (SPECIFY ) .4 NAME OF INTERVIEWER CODE: DATE OF INTERVIEW DAY: MONTH: YEAR: TIME INTERVIEW BEGAN: TIME INTERVIEW COMPLETED: COMMENTS: 49 PART A: BASIC CHARACTERISTICS 1. Is this school located in [NAME OF COMMUNITY]? YES. . 1(>3) NO. .. .2 2. How many kilometers is this school from KILOMETERS: the center of [NAME OF COMMUNITY]? 3. Is this a primary, lower secondary or upper secondary school? PRIMARY ....................... 1 LOWER SECONDARY ............... 2 UPPER SECONDARY ............... 3 OTHER (SPECIFY )_____ _..4 4. Is this a public school or a private school? PUBLIC. 1 PRIVATE SECULAR. 2 PRIVATE RELIGIOUS. 3 OTHER (SPECIFY )_ _4 5. Is this school all-male, all-female or coeducational? ALL-MALE .......1 ALL-FEMALE .....2 COEDUCATIONAL ..3 6. In which year did this school first open? YEAR: 50 7. How many male and female students are enrolled in each grade? How many of these students are repeaters? FILL OUT THE FOLLOWING TABLE: MALE FEMALE MALE FEMALE GRADE STUDENTS STUDENTS REPEATERS REPEATERS 1 K ==== 3 . ___ _ 4 2 ___ 3 How many strh ihs lie N E F 10. How many shifts wareteei this school athislyer NUMBER OFE open during the last academic year? LAST ACADEMIC Y'EAR: 51 11. What language is used for ... ... Mathematics instruction? PUT LANGUAGE ... Reading instruction? CODES HEREll ... General conversation? 12. During this school year, were all students who wanted to enroll in this school admitted? YES ..1 (>PART B) NO... 2 13. What are the most important criteria for determining whether a child can enter? ALLOW UP TO 3 RESPONSES AGE OF CHILD .............1 l PARENT'S ABILITY TO PAY FEES ...2 FIRST: WAITING LIST ................... 3 ENTRANCE EXAM ..................4 SECOND: RELIGION .......................5 AREA OF RESIDENCE ..............6 THIRD: OTHER (SPECIFY ) ....__ 7 PART B: PERSONNEL CHARACTERISTICS 1. How many teachers are currently teaching in this NUIBER OF school, including part-time and temporary teachers? TEACHERS: 2. How many of these teachers are female? NUMBER OF FEMALE TEACHERS: 3. How many of these teachers have a TEACHERS post-secondary degree? WITH POST- SECONDARY DEGREE: 52 4. Now I would like some information on the teaching experience of these teachers. How many of these teachers... ... have less than 5 years teaching experience? ... have at least five years but less than 10 years teaching experience? I I ... have 10 or more years of teaching experience? il 5. How often is a typical teacher absent? ONCE PER WEEK ............. 1 2-3 TIMES PER MONTH ....... 2 ONCE PER MONTH ............ 3 LESS THAN ONCE PER MONTH..4 6. Is the headmaster of this school male or female? MALE.... 1 FEMALE..2 7. What post-secondary degrees does the headmaster have? ALLOW FOR UP TO TWO RESPONSES FIRST: PUT THE CODES FOR POST-SECONDARY SECOND: l I DEGREES HERE: 8. How many years of teaching experience does the YEARS OF headmaster have? TEACHING EXPERIENCE: DO NOT COUNT YEARS AS HEADMASTER 9. How many years of experience as a headmaster YEARS OF does the headmaster have? HEADMASTER EXPERIENCE: 53 PART C: PHYSICAL STRUCTURE 1. How many classrooms does this school have? NUMBER OF CLASSROOMS: 2. How many of these classrooms are useable? NUMBER OF USEABLE CLASSROOMS: 3. How many of these useable classrooms NUMBER WITH have a legible blackboard? LEGIBLE BLACKBOARDS: 4. How many classrooms cannot be used when NUMBER OF it rains? CLASSROOMS: 5. Are there enough desks and/or chairs for all the students in this school? YES. .1(>7) NO ... .2 6. What percentage of students do not have PERCENTAGE desks or chairs? WITHOUT DESKS OR CHAIRS: 7. Do any classes meet outside because of lack of classrooms? YES..1 NO.. 2(»>9) 8. How many classes meet outside? NUMBER OF CLASSES 54 9. Does this school have a water supply? YES. .1 NO... 2 10. Does this school have electricity? YES. . 1 NO .. 2(>>12) 11. How often does the electricity fail? EVERY DAY ...............1 ONCE OR TWICE PER WEEK ..2 ONCE OR TWICE a MONTH .. .3 RARELY .................. 4 NEVER ................... 5 12. Does this school have toilet facilities for students? YES . 1 NO-. 2(>PART D) 13. Do girls and boys have separate toilet facilities? YES..1 NO.. .2 55 PART D: TEACHING MATERIALS 1. Does this school have a library? YES. . I NO.. 2(>>3) 2. How many books does this library have? LIBRARY BOOKS: 3. Does this school have a science laboratory? YES.. 1 NO... 2 4. How many textbooks does this school have NUMBER OF for rental or loan to students? TEXTBOOKS: 5. What percentage of teachers have teacher guidebooks? PERCENTAGE: 6. Is distance education (radio instruction) used in this school? YES..1(»>8) NO... 2 7. Why is distance education not used in this school? SCHOOL HAS NO RADIO ................ 1 REMOTE AREA/CANNOT RECEIVE SIGNAL ..2 TEACHERS NOT TRAINED IN IT ......... 3 DO NOT THINK IT IS WORTHWHILE ......4 OTHER (SPECIFY )....... 5 ->>PART E 56 8. In which grades is distance education used? In which subjects in those grades? How many hours per week is it used? FILL OUT THE FOLLOWING GRID BASED ON ANSWERS TO THESE QUESTIONS FIRST SUBJECT SECOND SUBJECT THIRD SUBJECT GRADE HOURS/ HOURS/ HOURS/ CODE WEEK CODE WEEK CODE WEEK SUBJECT CODES: READING .............1 MATHEMATICS ............ 2 SCIENCE ............ 3 OTHER(SPECIFY )_ _4 PART E: EXAMINATION PERFORMANCE 1. How many students took a national NUMBER OF examination last year? STUDENTS WHO l TOOK EXAM: 2. Of these students who took the national NUMBER OF examination last year, how many were girls? GIRLS WHO TOOK EXAM: 3. How many students passed the examination? NUMBER OF STUDENTS WHO ll PASSED: 4. Of these students who passed the national NUMBER OF examination last year, how many were girls? GIRLS WHO PASSED: 57 PART F: SCHOOL FEES AND FINANCE 1. For one academic year, how much is a typical student expected to pay to the school for... ... tuition and registration fees? ... contributions to parents association? ...textbook purchase or rental? ... other purchases of required instructional materials? ... other payments to school or teachers? (e.g. fundraising levees, extra classes, exam fees) IF PAYMENTS VARY BY GRADE, GIVE THE AVERAGE FEE 2. Are any of the students allowed to pay less than the standard fee? YES.. I1 NO ... 2(>>7) 3. How many students pay a partial fee? NUMBER OF STUDENTS: 4. By what criteria are these students allowed to pay only a partial fee? HANDICAPPED ........... 1 FIRST: ORPHAN ................ 2 ETHNIC MINORITY .......3 SECOND: LOW INCOME ............ 4 GENDER OF STUDENT .....5 THIRD: OTHER (EXPLAIN ) . .6 LIST THREE MOST COMMON REASONS 58 5. How many students pay no fee? NUMBER OF STUDENTS: 6. By what criteria are these students allowed not to pay any fee? HANDICAPPED ........... 1 FIRST: l ORPHAN ................ 2 ETHNIC MINORITY .......3 SECOND: LI LOW INCOME ............ 4 GENDER OF STUDENT .....5 THIRD: OTHER (EXPLAIN ) . .6 LIST THREE MOST COMMON REASONS 7. Are students in this school required to wear uniforms? YES..1 NO...2(>>PART G) 8. Is this requirement strictly enforced? YES..1 NO...2 l2l 9. How much do boy's and girl's uniforms cost? BOYS (IN DOLLARS) EXCLUDE COST OF SHOES GIRLS (IN DOLLARS) 59 PART G: SCHOOL MANAGEMENT, DECISIONMAKING AND COMMUNITY INVOLVEMENT 1 How often do teachers in this school receive in-service training during a school year? ONCE PER MONTH ............... 1 FOUR TO SIX TIMES PER YEAR... 2 TWO OR THREE TIMES PER YEAR ..3 ONCE PER YEAR ................ 4 ONCE EVERY FEW YEARS .........5 NEVER ........................ 6 OTHER (SPECIFY )____.._7 2. What individual or group has the most influence over.. .(READ EACH ITEM TO RESPONDENT) ... selecting and dismissing teachers for the school? El I ... evaluating teacher performance? Il ... adapting the curriculum to local conditions? li ... establishing standards for student promotion? ... .improving instructional practices? ... choosing textbooks? l Z ... setting school fees? ... decisions on how to spend the school budget? CODES: NATIONAL OFFICE, MINISTRY OF EDUCATION ..1 REGIONAL OFFICE, MINISTRY OF EDUCATION..2 SCHOOL PRINCIPAL ........................ 3 TEACHERS ................................ 4 PARENTS OR PTA .......................... 5 TEACHERS AND SCHOOL PRINCIPAL JOINTLY .. .6 OTHER(SPECIFY )........... 7 60 3. How often is there a staff meeting with all the teachers? ONCE A WEEK OR MORE ...........1 TWO OR THREE TIMES PER MONTH ..2 ONCE PER MONTH ................3 FOUR TO SIX TIMES PER YEAR ....4 TWO TO THREE TIMES PER YEAR .... .5 ONCE PER YEAR .................6 LESS THAN ONCE PER YEAR .......7 4. What kinds of rewards are given to good teachers in this school? ALLOW UP TO THREE RESPONSES. PROMOTION TO HIGHER POSITION .1 FIRST: GIVEN LESS TEACHING AND MORE OTHER WORK.2 GIVEN TIME FOR TRAINING OR PROFESSIONAL MEETINGS .3 SECOND: GIVEN AWARDS BY SCHOOL OR BY COMMUNITY 4 GIVEN SALARY INCREASES .5 l OTHER (SPECIFY ) .6 THIRD: [ NO REWARDS. 7 5. Is there a formal process for evaluating teachers in this school? YES .l1 NO. .2(>>7) 61 6. What are the most important criteria by which teachers are evaluated ALLOW UP TO THREE RESPONSES ATTENDANCE ......................... 1 FIRST: PREPARATION FOR CLASS ..............2 TEACHING SKILLS .................... 3 SECOND: ABILITY TO MOTIVATE STUDENTS .......4 STUDENT PERFORMANCE ON STANDARDIZED THIRD: EXAMINATIONS ...................... 5 OTHER(SPECIFY ) ...6 7. Schools reward students for different things. During the last school year, did students in this school receive formal recognition or awards for... [READ ALOUD TO RESPONDENT] ... academic achievement? .. .non-academic skills (art, music, sports)? ... attendance/timeliness? Il ...community service? YES . 1 NO .. .2ll ... good conduct/behavior? ..l2 END OF INTERVIEW. PLEASE THANK THE RESPONDENT FOR HIS OR HER COOPERATION 62 TEACHER QUESTIONNAIRE INSTRUCTIONS: PLEASE COMPLETE THE FOLLOWING QUESTIONNAIRE. IT IS NOT NECESSARY TO WRITE YOUR NAME. ALL INFORMATION IS CONFIDENTIAL AND WILL NOT BE DISCLOSED TO ANYONE EXCEPT FOR RESEARCH PURPOSES. THANK YOU FOR YOUR COOPERATION. NAME OF COMMUNITY CODE: NAME OF SCHOOL CODE: ADDRESS OF SCHOOL NAME OF TEACHER (OPTIONAL): CODE: NAME OF INTERVIEWER CODE: DATE OF INTERVIEW DAY: MMONTH: YEAR: COMMENTS: 63 1. How old were you on your last birthday? AGE: 2. Are you male or female? MALE.... 1 FEMALE ..2 l] 3. What level of general education do you have? NONE. 1 PRIMARY .2 2 LOWER SECONDARY. .3 UPPER SECONDARY. 4 UNIVERSITY. 5 4. What is the highest general degree you have obtained? PUT DIPLOMA CODES HERE 5. Do you have a teacher training certificate or diploma? l Y YES..1 NO.. .2 IF THE ANSWER TO QUESTION 5 IS NO, GO TO QUESTION 7. 6. What kind of teaching certificate or diploma FIRST: do you have? IY IF MORE THAN TWO DEGREES. PLEASE SECOND: PUT THE TWO THAT ARE THE HIGHEST PUT TEACHING CERTIFICATE AMD DIPLOMA CODES HERE 7. Not counting this year, for how many years YEARS: have you been a school teacher? K 64 8. Not counting this year, for how many years YEARS: have you been a teacher in this school? 9. Does your current school have more than one shift? YES. . 1 NO... 2 IF THE ANSWER TO QUESTION 9 IS NO, GO TO QUESTION 11. 10. How many shifts do you teach per day? NUMBER OF SHIFTS: 11. What grade levels have you been teaching FIRST: during this school year? IF MORE THAN THREE GRADES, PUT SECOND: THE THREE WHERE THE MOST TIME IS SPENT THIRD: l_ l PUT GRADE CODES HERE 12. Are you teaching mathematics this school year? YES . 1 NO . 2 IF THE ANSWER TO QUESTION12 IS NO, GO TO QUESTION 17. 13. How often do you use textbooks when you teach mathematics? IN EVERY LESSON- .1 IN MOST LESSONS ..2 OCCASIONALLY ..... 3 RARELY ........... 4 NEVER ............ 5 14. What language do you use when you teach mathematics? PUT LANGUAGE CODES HERE 65 15. How would you rate the physical condition of your school's mathematics textbooks? EXCELLENT .....1 GOOD .......... 2 FAIR .......... 3 POOR .......... 4 16. How would you rate the level of difficulty of your mathematics textbooks for your students? JUST RIGHT.... 1 TOO DIFFICULT.2 l TOO EASY ......3 17. Are you teaching reading this school year? YES ..1 iL NO... 2 IF THE ANSWER TO QUESTION 17 IS NO, GO TO QUESTION 22. 18. How often do you use textbooks when you teach reading? IN EVERY LESSON.. 1 IN MOST LESSONS ..2 OCCASIONALLY .....3 E RARELY ........... 4 NEVER ............ 5 19. What language do you use when you teach reading? PUT LANGUAGE CODES HERE EL 66 20. How would you rate the physical condition of your school's reading textbooks? EXCELLENT. .1 GOOD ....... 2 FAIR ....... 3 POOR ....... 4 21. How would you rate the level of difficulty of your reading textbooks for your students? JUST RIGHT .1 TOO DIFFICULT 2 TOO EASY. 3 22. How many hours per week are you required to HOURS PER work in this school this year? WEEK: (INCLUDE ALL WORK, NOT JUST TEACHING) 23. Out of these total hours of work per week, how many HOURS PER hours were spent holding class (i.e. teaching)? WEEK: 67 QUESTIONS 24 TO 33 ASK ABOUT THE NUMBER OF HOURS YOU SPEND ON CERTAIN ACTIVITIES WHILE HOLDING CLASS. DURING A TYPICAL SCHOOL WEEK, PLEASE ESTIMATE THE TIME (IN HOURS) YOU SPEND ON EACH OF THE FOLLOWING WHILE HOLDING CLASS. NOTE: ANSWERS IN QUESTIONS 24-33 SHOULD ADD UP TO THE TOTAL NUMBER OF HOURS SPENT HOLDING CLASS GIVEN IN QUESTION 23. 24. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: how many hours per week do you teach or discuss lessons to the class as a whole? 25. Do you ever teach or discuss lessons to small groups of students in class? YES .,1 NO ... .2 IF THE ANSWER TO QUESTION 25 IS NO, GO TO QUESTION 27. 26. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: how many hours per week do you teach or discuss lessons to small groups of students in class? 27. Do you ever teach or discuss lessons to individual students in class? YES. .1 NO ... .2 IF THE ANSWER TO QUESTION 27 IS NO, GO TO QUESTION 29. 28. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: how many hours per week do you teach or discuss lessons to individual students in class? 68 29. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: l how many hours per week do you spend copying notes onto the blackboard, or dictating notes in class? 30. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: how many hours per week do you spend maintaining order or disciplining students in class? 31. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: how many hours per week do you spend administering tests or quizzes in class? 32. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: how many hours per week do you spend performing routine administrative tasks, such as taking attendance and making announcements, in class? 33. From the total number of hours that you hold class HOURS PER in a typical week (i.e. your answer in question 23), WEEK: l how many hours per week do you spend reviewing homework and tests or quizzes in class? THE FOLLOWING QUESTIONS DO NOT REFER TO CLASSROOM (TEACHING) TIME 34. How many hours per week do you spend planning HOURS PER and preparing for class? WEEK: l 35.How many hours per week do you spend grading HOURS PER tests and homework? WEEK: l 69 36. Do you supervise students doing academic work outside of class? YES. .1 NO.. .2 IF THE ANSWER TO QUESTION 36 IS NO, GO TO QUESTION 39. 37. Is this a tutoring arrangement, for which you are paid by the students or their families, or do you do it without compensation? RECEIVE PAYMENT ......... 1 DO NOT RECEIVE PAYMENT ..2 L 38. How many hours per week do you spend HOURS PER supervising students doing academic work outside WEEK: l i of class? 39. How many hours of mathematics homework do HOURS PER you usually assign to your students per week? WEEK: l I 40. How many hours of reading homework do you HOURS PER usually assign to your students per week? WEEK: L i 41. During the last full term (semester), how many staff NUMBER OF l i meeting were held in this school? MEETINGS: IF NONE, GO TO QUESTION 43. 42. What were the two most frequent topics discussed FIRST: at these staff meetings? L I SECOND: NEW ADMINISTRATIVE PROCEDURES ... .1 CURRICULUM CONTENT ............... 2 SPECIFIC TEACHING PRACTICES ......3 STUDENT DISCIPLINE ............... 4 OTHER (SPECIFY )___________ 70 43. Have you had any in-service teacher training in the last 3 years? YES. .1 NO ... 2 IF THE ANSWER TO QUESTION 43 IS NO, GO TO QUESTION 45. 44. How many days of training have you received in the DAYS: past three years? 45. During the last full term (semester), how many DAYS: days were you absent for any reason? THANK YOU FOR YOUR COOPERATION! 71 Module for Chapter 8 Health Paul J. Gertler, Elaina Rose, and Paul Glewwe The following pages contain the health module for the vey. When the standard or expanded modules are used, the household questionnaire. As explained in Chapter 8 of health facility questionnaire should be included. This is Volume 1, there are three different versions: short, standard explained in detail in Chapter 8. and expanded. The following pages also contain a draft There are two additional points to note regarding the questionniaire for collecting data from local health facilities, health module. First, anytime the standard (or expanded) such as clinics and hospitals. version of the health module is used, anthropometric data The three versions of the health module for the house- should also be collected, both for children and adults. The hold questionnaire vary by length: short, standard, and collection of anthroponietric data is explained in detail in expanded. The short module contains 39 questions and is Chapter 10. Second, whenever the standard or the expand- not divided into different parts. The standard module is ed health module is used, the survey team supervisor must divided into six parts: A, B, C, D, E, and E The expanded draw up a master list of codes for all of the health service module adds questions to parts A and E, and adds two more providers in the community. This list is used to match dif- parts, C and H. If the short module is used, there is no rea- ferent information from different parts of the question- soni to include the health facility questionnaire in the sur- naires. See Chapter 8 for further discussion. 73 HEALTH MODULE (SHORT VERSION) INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR CHILDREN LESS THAN AGE 15 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. I During the Compared with your IS THIS Did [NAME] Was it Was it Was it a How did you treat it? During the How many How much did you pay, D last four health one year ago, PERSON 7 experience mixed mixed pale past 4 times did either in money or in weeks, how would you say that your YEARS diarrhea in with with liquid? weeks, did you make kind, for all costs C many days of health is: OLD OR the last 7 blood? mucus? you visit any outpatient associated with these O your primary [READ OUT ANSWERS OLDER? days? public visits outpatient visits to a D daily TO RESPONDENT] hospital to to a public public hospital during E activities did obtain hospital the past 4 weeks? you miss due REDUCED FOOD OR outpatient during the Include any medicines to poor LIQUID GIVEN TO health care? past 4 prescribed during these health? CHILD.1 . weeks? visits, even if GAVE SPECIAL FOODS purchased elsewhere. TO CHILD. 2 ORAL REHYDRATION EXCLUDE TRANSPORT Much better now ................1 l THERAPY ....... 3 COSTS. Somewhat better OTHER now ............. 2 ~~~~~(SPECIIFY l.4 EXCLUDE COSTS TOBE About the same .. 3 YES..1 YES..1NO TREATENUTT...5 REIMBURSED BY About the same .. . YES. .1.YES. .1 YES ..1 YES ..1 YES ..1 YES ..1 INSURANCE Somewhat worse ... 4 No... 2 (>>9) NO.. 2 NO.. 2 NO.. 2 NO... 2 DAYS Much worse ....... 5 (>,9) NO.. 2 1ST 2ND 3RD (>>12) TIMES 2 3. 4: 7 12 :.7 ::: HEALTH MODULE (SHORT VERSION) INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERSIGUARDIAN ANSWER FOR CHILDREN LESS THAN AGE 15 12. 13. 14. 15. 16. 17. 18. 19. 20. I During the How many times How much did you pay, During the How many How much did you pay, During the How many How much did you pay, D past 4 did you make either in money or in past 4 weeks, times did you either in money or in kind, past 4 weeks, times did you either in money or in weeks, did outpatient visits kind, for all costs did you visit make for all costs associated with did you visit make kind, for all costs C you visit any to a public health associated with these any private outpatient these outpatient visits to a any private outpatient associated with these 0 public health clinic during the outpatient visits to a hospital or visits private hospital or health doctor to visits outpatient visits to a D clinic to past 4 weeks? ubic theealt Inic prvate health to any private clinic during the past 4 obtain to a private private doctor during E obtain drnthpat4 clinic to hospital or weeks? Include any outpatient doctor during the past 4 weeks? outpatient weeks? Include any obtain private health medicines prescribed during health care? the past 4 Include any medicines health care? medicines prescribed outpatient clinic during these visits, even if weeks? p.rescribed during these during these visits, even health care? the past 4 p ed elsewh eret cie?th,pevenpe f if purchased elsewhere. wes purchased elsewhere. vitseenf EXCLUDE TRANSPORT EXCLUDE TRANSPORT EXCLUDE TRANSPORT COSTS. COSTS. COSTS. EXCLUDE COSTS TO BE EXCLUDE COSTS TO BE EXCLUDE COSTS TO BE REIMBURSED BY REIMBURSED BY REIMBURSED BY YES . .1 INSURANCE YES . .1 INSURANCE YES. . 1 INSURANCE NO... .2 NO... .2 NO... .2 (>'15) TIMES t>18) TIMES (>>21) TIMES U, _ ___ 2 3 4 6 7- 8 HEALTH MODULE (SHORT VERSION) INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIAN ANSWER FOR CHILDREN LESS THAN AGE 15 21. 22. 23. 24. 25. 26. 27. 28. 29. I During the past 4 How many times How much did you pay, During the How many How much did you pay, During the How many How much did you pay, I weeks, did you did you visit a either in money or in kind, past 4 times did ther in money or in either in money or in D weeks, did you diforoallicosts associateds kin past 12 days did you kind, for all costs visit any private private nurse, for all costs associated weeks, did you visit a kind, for all costs months, have spend in a aiate with thes C nurse, paramedic paramedic or with these visits to a associated with these you stayed at public associated with these C nuse, araedicparmedi or private nurse, trained yuvst raionliistoardtoaldays spent in a public O or trained midwife trained midwife midwfe nurs, pranedic any health visits to a traditional a public hospital over hospit in a past ED to obtain health during the past 4during the past 4 weeks? traditional practitioner he pastier during hospital the last 12 hospita during the past Include any medicines heal th tu4g Include any medicines . . medicines prescribed prescbed dring hese practitioner the past 4 prescribed during these to obtain weeks? prescribed during these during these visits, even visits, even if purchased health visits, even if purchased if purchased elsewhere. elsewhere, care? elsewhere. care'? EXCLUDE TRANSPORT EXCLUDE TRANSPORT EXCLUDE TRANSPORT COSTS. COSTS. COSTS. EXCLUDE COSTS TO EXCLUDE COSTS TO BE EXCLUDE COSTS TO BE REIMBURSED BY REIMBURSED BY BE REIMBURSED BY INSURANCE. YES . 1 INSURANCE. YES. .1 INSURANCE. YES. .1 NO.. .2 NO... .2 NO... .2 _ j24) TIMES ('27) TIMES (l30) DAYS 1= 2 3 4 6 7 8 9 if 4 _ -; ;0: f-y;:;0 T:;D;0;_-0--;-10-- X -fV-;-:: 12 : : : :: : ::0:: ::: :: :0 ::: :: : :: : ::: :: : : :C::: :: : ; : :: : ::::: : :000::: HEALTH MODULE (SHORT VERSION) INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIAN ANSWER FOR CHILDREN LESS THAN AGE 15 30. 31. 32. 33. 34. 35. 36. 37. 38 39. I During the How many How much did you pay, During the How How much did you pay, During the past 4 How much Are your health From whom do you D past 12 days did either in money or in past 12 many either in money or in kind, weeks, have you did you pay care costs covered obtain insurance? months, you spend kind, for all costs months, days did for all costs associated purchased any for all by any kind of C have you in a public associated with these have you you with these days spent in a medicines on medicines insurance? O stayed at a health days spent in a public stayed at a spend in private hospital or clinic your own, that is purchased >NEXT D public clinic over health clinic during the private a private during the past 12 without a on your PERSON E health the last 12 past 12 months? Include hospital or hospital months? Include any prescription, to own in the clinic months? any medicines prescribed private or private medicines prescribed treat any health past 4 ovemight? during these visits, even clinic clinic over during these visits, even if problems? weeks? if purchased elsewhere. overnight? the last purchased elsewhere. EMPLOYER .....1 12 EXCLUDE TRANSPORT months? EXCLUDE TRANSPORT PRNMENTE...2 COSTS. COSTS. PRIVATE PROVIDER. ..3 EXCLUDE COSTS TO EXCLUDE COSTS TO PROVI DER BE REIMBURSED BY BE REIMBURSED BY HOUSEHOLD INSURANCE INSURANCE MEMBER . 4 YES ..1 YES ..1 YES ..1 YES ..1 OTHER NO.. 2 NO.. 2 NO... 2 NO.. 2 (SPECIFY_)..5 (-33) DAYS ("36) DAYS (>38) (,>NEXT PERSON) s 14 -4 2 3 4 5 6 7 8 9 10 11 12_ HEALTH MODULE (STANDARD VERSION) PART A: SELF REPORTED HEALTH STATUS INDIVIDUALS AGE 15 AND OVER SELF REPORT;- MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. I IS THIS COPY THE ID During the last Compared with your health one CHECK THE AGE IN Did [NAME] Was it Was it Was it a How did you treat it? D PERSON CODE OF four weeks, how year ago, would you say that YEARS OF THIS experience mixed with mixed with pale ANSWER- THE many days of your health is: PERSON diarrhea in blood? mucus? liquid? C ING FOR RESPOND- your primary dail [READ OUT ANSWERS TO the last 7 ,>PART 0 HIMSELF/ ENT FROM activities did you RESPONDENT] days? B D HERSELF? THE miss due to poor E HOUSEHOLD health? ROSTER REDUCED FOOD OR LIQUID GIVEN TO CHILD ........... 1 GAVE SPECIAL FOODS TO CHILD ........ 2 ORAL REHYDRATION THERAPY ......... 3 Much better now ......1 0-6 ....... 1 OTHER Somewhat better now..2 7-14 .2 YES..1 (SPECIFY )...4 YES . 1 About the seme ....... 3 (-PART B) NO.. .2 YES ..1 YES ..1 YES ..1 NO TREATMENT .....5 ('-3) Somewhat worse . 4 15-39. 3(24) (aPART B) NO.. 2 NO.. .2 NO.. 2 NO... 2 ID CODE DAYS Much worse ........... 5 40 AND OVER.4(.11) 1ST 2ND 3RD 2- 3 4 7 10 : 11_ 12: X__ PART A: SELF REPORTED HEALTH STATUS INDIVIDUALS AGE 15 AND OVER SELF REPORT MOTHERSIGUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 1 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. I If you had to How long If you had to How long If you had to go How long CHECK THE ANSWERS If you had to How long If you had to D dress without have you stand up from a have you to the bathroom have you TO QUESTIONS 11, 13 sweep the house have you draw a pail of help, could you had sitting position had difficulty/ (BM) without had difficulty/ AND 15. floor or yard, had water from a C do it easily, with difficulty/ (chair) without been unable help, could you been unable could you do it difficulty/ well, could you O difficulty or not at been unable help, could you to do it? do it easily, with to do it? easily, with been unable do it easily, with D all? to do it? do it easily, with difficulty or not at difficulty or not at to do it? difficulty or not at E difficulty or not at all? all? all? all? PERSON CAN DO ALL EASILY ..... 1 EASILY ..... 1 EASILY.....1 THREE EASILY .... 1 EASILY ..... 1 EASILY ..... 1 (>13) (-15) (0,17) PERSON CANNOT (>>20) ('22) WITH WITH WITH DO ALL THREE WITH WITH DIFFICULTY.2 TIME DIFFICULTY.2 TIME DIFFICULTY.2 TIME EASILY .2 DIFFICULTY.2 TIME DIFFICULTY.2 NOT AT ALL.3 TIMES UNIT NOT AT ALL.3 TIMES UNIT NOT AT ALL.3 TIMESI UNIT (>>PART B) NOT AT ALL.3 TIMESI UNIT NOT AT ALL.3 5 11 {. 1--______ _____ ____ I . 12 IT = . 3 = = F TIE.UNITS: DAY........... 3 WE-EK.. .4 FORTNIGHT... .5 IONTH. .. 6 QUARTER... .7 HALF ..YEAR... .8 ........ YEAR .. 9 PART A: SELF REPORTED HEALTH STATUS INDIVIDUALS AGE 15 AND OVER SELF REPORT; MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 21. 22. 23. 24. 25. 26. 27. 28. 29. I How long If you had to stand How long If you had to carry How long If you had to walk How long If you had to bow, squat or How long D have you up from sitting on have you a heavy load, such have you 5 kilometers, could have you kneel, could you do it have you had the floor without had difficulty/ as a pail of water, had difficulty/ you do it easily, had difficulty/ easily, with difficulty or not had difficulty/ C difficulty/ help, could you do been unable for 20 meters, been unable with difficulty or not been unable at all? been unable O been unable it easily, with to do it? could you do it to do it? at all? to do it? to do it? D to do it? difficulty or not at easily, with E all? difficulty of not at all? EASILY ..... 1 EASILY ..... 1 EASILY ..... 1 EASILY ..... 1 (,,24) (.26) (I'28) (-PART B) WITH WITH WITH WITH TIME DIFFICUL .2 2 | TIME DIFFICULTY.2 TIME DIFFICULTY.2 TIME _TIMES UNIT NOT AT ALL.3 TIMES UNIT NOT AT ALL.3 TIMES UNIT NOT AT ALL.3 TIMES UNIT NOT AT ALL.3 TIMES UNIT 01 2_ _ 3__ 4 6 8 TIME UNITS: DAY... 3 WEEK... .4 FORTNIGHT... .5 MONTH... .6 QUAR TER... .7 HALF YEAR.. .8 YA. . .9 PART B: HEALTH RELATED BEHAVIORS INDIVIDUALS AGE 15 AND OVER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. I IS THIS PERSON Have you ever At what age did Do you still How long Do you roll your In one week, In one week, Have you At what age D AGE 15 OR OLDER? smoked you start to smoke or have ago did you own cigarettes? how many how many ever did you sta cigarettes on smoke you totally quit? totally quit ounces of factory pre-rolled chewed to chew C a regular a cigarettes on a smoking? tobacco do you cigarettes do tobacco on tobacco on O basis? regular basis? smoke in hand you smoke? a regular a regular D rolled basis? basis? E cigarettes? STILL YES. .1 YES. .1 SMOKES ...1 YES. .1 YES. .1 NO ... .2 NO... 2 (>>6) TINdE NO. ..2 NO... .2 _ (PART C) l('"9) YEARS QUIT ... 2 TIMES UNIT (,8) OUNCES CIGARETTES (">>14) YEARS 00 2 7 8_ 9_ 10 11 _ 12= = TIM4E UNITS: DAY. .. .3 WEER:. .. 4 FORTNIGHT. .. 5 MOTH. .. 6 QURJTER. .. 7 HAF YEA... 8 YEA .. .9 l PART B: HEALTH RELATED BEHAVIORS INDIVIDUALS AGE 15 AND OVER 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. I Do you still How long In one week, Do you drink How many How many Do you do What kind of exercise or Do you exercise How many days D chew or have ago did you how many alcoholic bottles of bottles of other physical sports do you do? or play sports do you exercise you totally totally quit ounces of beverages? beer do you alcoholic exercise or every week? or play sports in C quit? chewing? tobacco do drink in a beverages do play sports? SOCCER, a typical week? O you chew? week? you drink in a VOLLEYBALL, D week? BASKETBALL ......1 E RUNNING, WALKING, CYCLING. 2 CALISTHENICS, AEROBICS, WEIGHT LIFTING. 3 SWIMMING. 4 JUDO, KARATE, OTHER MARTIAL ARTS .5 STILL ~~~~~~~~~~~~~~~~~OTHER STILL ~~~~~~~~ ~ ~~~~~~~(SPECIFY ) ..6 CHEWS..1 YES ..1 YES. .1 YES ..1 (.13) TIME NO... 2 NO-..2 NO.. 2 QUIT ... 2 TIMES| UNIT OUNCES ('17) BOTTLES BOTTLES (-24) 1ST 2ND 3RD ('24) DAYS 00 2 3 4 6 7 8 9 10 11 12 TIME UNITS: DAY... 3 WEEK. . . 4 FORTNIGHT ... 5 MONTH... .6 QUARTER..-7 HALF YA ... .8 YEAR. .. .9 PART B: HEALTH RELATED BEHAVIORS INDIVIDUALS AGE 15 AND OVER 21. 22. 23. 24. 25. 26. I How long do What is your respiration Why do you exercise or Have you ever What diseases have you What can people do to D you exercise or when exercising or practice sports? heard about heard of that can be protect themselves from play sports in a playing sports? Is it... diseases that can transmitted through these diseases? C typical day? be transmitted sexual intercourse? O through sexual HAVE ONLY ONE SEX D intercourse? PARTNER/REDUCE E READ OUT TO THE NUMBER OF SEX RESPONDENT PARTNERS . 1 SYPHILIS ......... 1 ABSTINENCEO. 2 GONORRHEA .....2 UScNDm...3 AIDS .............3 AVOID SEX WITH GENITALWARTS/ 3PROSTITUTES ..4 ... normal? ...... PLEASURE ......... 1 GENI TAL WARTS/ SEEK MEDICAL . a little out HEDICAL BENEFIT. .2 CONDYLOMATA. . A.....5 of breath? .....2 PHYSICAL OTHER DON'T KNOW 6 ... significantly APPEARANCE ...... 3 (SPECIFY ) .... 5 OTHER out of breath?.3 OTHER CANNOT REMEMBER (SPECIFY 7 ... very out of (SPECIFY 4 YES..1 NAMES ..... 6 (SECFY breath? .......4 NO 2 rHRS. MINS. 1ST 2ND 3RD (1PART D) 1ST 2ND 3RD 4TH 5TH 1ST 2ND 3RD 4TH 5TH 2 4- 6 7 12 PART C: CHILD IMMUNIZATION FOR CHILDREN 6 YEARS AND YOUNGER, TO BE ANSWERED BY THEIR MOTHERS 1. 2. 3. 4. 5. 6. 7. I Do you have a FROM THE Is this card up to Has [NAME] In what Has [NAME] In what month and year did he/she get polio vaccine? D card that shows CARD, date, or has [NAME] received a month and been given polio which RECORD received vaccinations BCG year did vaccine, that is C vaccinations THE that are vaccination he/she pink or white 0 [NAME] has NUMBER OF not on this card? against receive this drops in the D received? TIMES tuberculosis, vaccination? mouth? How E VITAMIN A that is an many times did WAS injection in the he or she get GIVEN. IF UP TO DATE, upper arm that this? ASK TO SEE THE left a scar? CARD AND USE IT TO FILL OUT THE REMAINING IF ZERO QUESTIONS. TIMES, *8 YES.. 1 UP TO DATE ... 1 YES.. 1 NO.. 2 NOT UP TO NO .. 2 1ST TIME 2ND TIME 3RD TIME 4TH TIME (>,4) TIMES DATE . 2 (6) MONTH YEAR TIMES MONTH YEAR MONTH YEAR MONTH YEAR MONTH YEAR ao 5- :_ _ _00 0-011]ll 4- X_ 5- 6- 7T_ {T__ _ PART C: CHILD IMMUNIZATION FOR CHILDREN 6 YEARS AND YOUNGER, TO BE ANSWERED BY THEIR MOTHERS 8. 9. 10. 11. I Has [NAME] been In what month and year did he/she get DPT Has In what D given a DPT vaccination? [NAME] month and vaccination, that is been given year did C an injection usuall an injection he/she 0 given at the same against receive this D time as polio measles? injection? E drops? How many times did he or she get this? IF ZERO TIMES, >10 YES ..1 NO.. .2 1ST TIME 2ND TIME 3RD TIME (>>NEXT TIMES MONTH YEAR MONTH YEAR MONTH YEAR CHILD) MONTH YEAR CO 4 7 9 10 l l l 11lll l 12=l l l _ PART D: INSURANCE COVERAGE INDIVIDUALS AGE 15 AND OVER SELF REPORT; MOTHERSIGUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 1. Is any one in your household covered by health insurance? YES ..1 No ... 2 (-PART E) E. 2. 3. 4. 5. 6. 7. 8. 9. I Are you covered by Where does your insurance coverage Which household Does this Do you have to How much do you Does this Do you have to D health insurance, come from? Is it... member are you policy pay for pay any money have to pay for policy pay for pay any money either directly or READ OUT TO THE RESPONDENT insured through? outpatient (copayment) for outpatient care? inpatient (copayment) for C through another WRITE CODE OF care? outpatient care? IF THERE IS A care? inpatient care? 0 member of your HOUSEHOLD DEDUCTIBLE, GET D household? MEMBER INFORMATION FOR E ... provided by/through COSTS AFTER another family DEDUCTIBLE IS member? ....... 1 EXCEEDED. ... provided through your employer? ........ 2(5) NEXT ... provided by a PERSON government program?.3(>5) ...purchased directly from a private insurer? ............ 4(>5) YES. .1 OTHER YES ..1 YES ..1 YES ..1 YES ..1 .. SPECIFY____5(_5) NO...2 NO...2 NO ...2 AN AMOUNT NO. ..2 NO... 2 OO _ (>>NEXT PERSON) ID CODE (8) (8) CODE (11) (>11) 0O 2 3 4 5 6 8 10 : 12 AMOUNT CODES: PERCENT... .1 MONEY... 2 PART D: INSURANCE COVERAGE INDIVIDUALS AGE 15 AND OVER SELF REPORT; MOTHERSIGUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 10. 11. 12. 13. 14. 15. 16. 17. I How much do you Does this Do you have How much do you Does this policy What is the amount of Is there a maximum What is that amount? D have to pay for policy pay for to pay any have to pay for have the deductible? amount that this inpatient care? medicines? money medicines? deductible? insurance will cover? C IF THERE IS A (copayment) IF THERE IS A O DEDUCTIBLE, GET for DEDUCTIBLE, GET D INFORMATION FOR medicines? INFORMATION FOR E COSTS AFTER COSTS AFTER DEDUCTIBLE IS DEDUCTIBLE IS EXCEEDED. EXCEEDED. YES . 1 YES ..1 YES..1 YES . 1 |MOUNT NO.. .2 NO.. .2 AMOUNT .2.. 2 | AMOUNT NO... .2 | TAMOUNT CODE (t14) (>.14) AMOUNT CODE ('16) UNT CODE (>NEXT PERSON) CODE 2 4- 6 7- AMOUT COES: ERCET-1 -~--2 F~XMEUNITS:DAY. . 3 WEEK. .4 FORTNIGHT. . 5 MONTH. . 6 QUARTER. . 7 HALF YEAR. .8 YEAR. .9 PART E: HEALTH CARE UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. I During the How many How much did How much did CHECK PART D. How much did you pay During the How many How much did How much did D past 4 weeks, times did you you pay, either you pay for any IF THIS PERSON IS for transportation for past 4 weeks, times did you you pay, either you pay for any did you visit make an in money or in medicines that COVERED BY these visits to a public did you visit make an in money or in medicines that C any public outpatient kind, for all were prescribed INSURANCE, ASK: hospital during the pas any public outpatient visit kind, for all were prescrbed 0 hospital to visit to a outpatient during these 4 weeks? Include the health clinic to a public outpatient during these D obtain public hospital visits to a visits but How much of these transportation costs of to obtain health clinic visits to a visits but E outpatient during the last public hospital purchased costs for health care anyone who outpatient during the last public health purchased health care? 4 weeks? during the last elsewhere? and medicine will be accompanied you. health care? 4 weeks? clinic during elsewhere? 4 weeks? reimbursed by the last 4 insurance? weeks? INCLUDE INCLUDE PAYMENTS PAYMENTS IN KIND INCLUDE IN KIND INCLUDE PAYMENTS PAYMENTS IN KIND IN KIND YES.-1 YES..1 NO... .2 NO... .2 _ (,7) TIMES ('s13) TIMES OD 2 3 4 5 6 7 8 9 4 0 :1 2 D D PART E: HEALTH CARE UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 11. 12. 13. 14. 15. 16. 17. 18. I CHECK PART D. How much did you pay During the How many times How much did How much did CHECK PART D. How much did you pay D IF THIS PERSON IS for transportation for past 4 weeks, did you make an you pay, either in you pay for any IF THIS PERSON IS for transportation for COVERED BY these visits to a public did you visit outpatient visit to money or in kind, medicines that COVERED BY these visits to a private C INSURANCE, ASK: health clinic during the any private a private hospital for all outpatient were prescribed INSURANCE, ASK: hospital or health clinic 0 past 4 weeks? Include hospital or or health clinic visits to a private during these during the past 4 D How much of these the transportation private health during the last 4 hospital or health visits but How much of these weeks? Include the E costs for health care costs of clinic to obtain weeks? clinic during the purchased costs for health care transportation costs of and medicine will be anyone who outpatient last 4 weeks? elsewhere? and medicine will be anyone who reimbursed by accompanied you. health care? reimbursed by accompanied you. insurance? insurance? INCLUDE INCLUDE PAYMENTS PAYMENTS IN KIND IN KIND YES. . 1 No.. .2 ( 19) TIMES 2 3 4 5 6 7 8 9 10 11 12 PART E: HEALTH CARE UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT MOTHERSIGUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. I During the How many How much did How much did CHECK PART D. How much did you pay During the How many How much did How much did D past 4 weeks, times did you you pay, either you pay for any IF THIS PERSON IS for transportation for past 4 weeks, times did you you pay, either in you pay for any did you visit make an in money or in medicines that COVERED BY these visits to a private did you visit visit a private money or in kind, medicines that C any private outpatient kind, for all were INSURANCE, ASK: doctor during the past any private nurse, for all visits to a were O doctor to visit to a visits to a prescribed 4 weeks? Include the nurse, paramedic or private nurse, prescribed D obtain private private doctor during these How much of these transportation costs of paramedic or trained midwife paramedic or during these E outpatient doctor during during the last visits but costs for health care anyone who trained during the last trained midwife visits but health care? the last 4 4 weeks? purchased and medicine will be accompanied you. midwife to 4 weeks? dunng the last 4 purchased weeks? elsewhere? reimbursed by obtain health weeks? elsewhere? insurance? care? INCLUDE INCLUDE INCLUDE INCLUDE IKIDPAYMENTS PAYMENTS PAYMENTSINLD IN KIND IN KIND IN KIND PAINYMKIENDTS YES- 1 YES.-1 No ... 2 NO-.2 ('.25) TIMES (>31) TIMES '0 2 3 4 5 6 7 8 9 50 10 12 PART E: HEALTH CARE UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT; MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 29. 30. 31. 32. 33. 34. 35. 36. I CHECK PART D. How much did you pay During the past How many How much did How much did CHECK PART D. How much did you pay D IF THIS PERSON IS for transportation for 4 weeks, did times did you you pay, either in you pay for IF THIS PERSON IS for transportation for COVERED BY these visits to a private you visit any visit a money or in kind, any medicines COVERED BY these visits to a C INSURANCE, ASK: nurse, paramedic or traditional traditional for all visits to a that were INSURANCE, ASK: traditional health 0 trained midwife during health health traditional health prescribed practitioner during the D How much of these the past 4 weeks? practitioner to practitioner practitioner during these How much of these past 4 weeks? Include E costs for health care Include the obtain health during the last during the last 4 visits but costs for health care the transportation and medicine will be transportation costs of care? 4 weeks? weeks? purchased and medicine will be costs of reimbursed by anyone who elsewhere? reimbursed by anyone who insurance? accompanied you. INCLUDE insurance? accompanied you. PAYMENTS INCLUDE IN KIND PAYMENTS IN KIND YES-1 NO.. .2 ___________ ____ _____ __________ (-37) TIMES 5- 5- 7 PART E: HEALTH CARE UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 37. 3B. 39. 40. 41. 42 43. 44. 45. I During the past How many What was the How much did you CHECK PART D. How much did you pay During the How many What was the D 12 months, days did you total cost of spend for any IF THIS PERSON IS for transportation for past 12 days did you total cost of have you spend in a these days medicines that COVERED BY these overnight stays months, have spend in a these days C stayed at a public hospital spent in a were prescribed INSURANCE, ASK: to a public hospital you stayed at public health spent in a 0 public hospital over the past public during these during the past 12 a public health clinic over the public health D overnight? 12 months? hospital over hospitalizations, months? Include the clinic past 12 clinic over the E the last 12 but were How much of the transportation costs of overnight? months? last 12 months? purchased from costs you paid for the anyone who months? another source? days spent in the accompanied you. public hospital and INCLUDE INCLUDE for any medicines INCLUDE PAYMENTS INCLUDE purchased will be PYET IN PA ENTS PAYMENTS reimbursed by INYMENT IN KIND IN KIND insurance? IN KIND YES.. 1 YES. .1 NO.. .2 NO... .2 (_>43) DAYS _(>>49) DAYS "0 3 4- 5 6 7 8 9 10 12 PART E: HEALTH CARE UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 46. 47. 48. 49. 50. 51. 52. 53. I How much did you CHECK PART D. How much did you pay During the How many What was How much did you CHECK PART D. D spend for any IF THIS PERSON IS for transportation for past 12 days did you the total cost spend for any IF THIS PERSON IS medicines that COVERED BY these overnight stays months, have spend in a of these medicines that were COVERED BY C were prescribed INSURANCE, ASK: to a public health clinic you stayed at private days spent in prescribed during INSURANCE, ASK: 0 during these during the past 12 a private hospital or a private these D hospitalizations, How much of the months? Include the hospital or clinic over the hospital or hospitalizations, but E but were cow much or the transportation costs of private clinic past 12 clinic over were purchased from cow much or the purchased from costs you paid for the anyone who ovemight? months? the last 12 another source? costs you paid for the another source? public health clinic accompanied you. months? private hospital or and any medicines NCLUDE clinic and any purchased will be ICUE NCDE medicines purchased INCLUDE reimbursed by PAYM~~~~~~~~~~~INLUENT PAYMENTS will be reimbursed by INCLUNDE reimbursed by.INKD PAYMENTS INsurKIND PAYMENTS insurance? insurance? IN KINDINKD YES.-1 No... .2 ______ ______ ______ ______ ______ ______ _____ (>~55) DAYS 3- 10 12 PART E: HEALTH CARE UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 54. 55. 56. 57. 58. I How much did you pay During the past How much did During the past 4 How much did D for transportation for 4 weeks, have you pay for all weeks, have you you pay for all these overnight stays you purchased modern purchased any traditional herbs C to a private hospital or any modem medicines traditional herbs or or medicines O clinic during the past medicines on purchased on medicines on your purchased on D 12 months? Include your own, that is your own in own, that is without you own in the E the transportation without a the past 4 consulting a health past 4 weeks? costs of prescription, to weeks? care practitioner, to anyone who treat any health treat any health accompanied you. problem? problem? INCLUDE INCLUDE PAYMENTS PAYMENTS IN KIND IN KIND YES.-1 YES.-1 NO.....2 NO... .2 _ ___________________ ( .57) (->PART F) 2 3 4 6 7 8 9 10 11 L : ;_ A 12 :: : : C PART F: HEALTH PROVIDER KNOWLEDGE TO BE ASKED OF MOST KNOWLEDGEABLE ADULT WOMAN 1 . 2. 3. 4. 5. 6. 7. 8. F Do you know What is the name of the What is the name of the How far What mode of How much How much Is there another A of any [... that is nearest to your [... ] second/third nearest away from transportation money time does it [...] located within C [..... home? to your home? your home would you use to does it cost take to travel [.1 kilometers of I located is this travel to this [... to use this to this [... ] from your home? L within [... [... ]? from your home? mode of your home I kilometers of transporta- using this T your home? tion to go mode of Y ..... to this [.1]? transportation? C )>54 WALKING .1 O 0 (.7) D BICYCLE .2 E (»7) cAR ..... 3 BUS . 4 TIME ONE WAY YES. .1 TRAIN . 5 ('NEXT LINE, YES ..1 BOAT . 6 QUESTION 3) DIS- NO... 2 ANIMAL . 7 NO... 2 TANCE (.NEXT OTHER ROUND (>NEXT TYPE CUT- HEALTH | ID I ID KILO- (SPECIFY_).8 TRIP |INU- OF FACILITY, - HEALTH FACILITY OFF FACILITY) ODE ODE METERS COST HOURS TES QUESTION 1) 1 Public Hospital #1 | 30 | l l l l l_l_ l 2 Public Hospital #2 30 3 Public Hospital #3 30 4 Public Health Clinic #1 15 l 1E = = 5 Public Health Clinic #2 15 6 Public Health Clinic #3 15 7 Private Hospital/Clinic #1 30 | _ _ _ __= = 8 Private Hospital/Clinic #2 30 9 Private Hospital/Clinic #3 30 ADDITIONAL QUESTIONS FOR HEALTH MODULE (EXPANDED VERSION) PART A: SELF REPORTED HEALTH STATUS INDIVIDUALS AGE 15 AND OVER 30. 31. 32. 33. 34. 35. 36. 37. 38. I Have you ever How long How long ago Have you ever How long How long ago Have you ever How long ago How long ago D experienced ago did your did you last experienced fatigue ago did your did you last been short- did your latest did you last feel insomnia during latest feel or exhaustion during latest period feel fatigue or tempered or period of short- short-tempered C the past 4 insomnia insomnia? the past 4 weeks? of fatigue or exhaustion? hyper-sensitive temperedness or 0 weeks? begin? exhaustion during the past 4 or hypersensitive? D IF STILL begin? IF STILL weeks? hypersensitivity E HAS THE HAS THE begin? IF STILL HAS CONDITION, CONDITION, THE CODEAS CODEAS CONDITION, ZERO DAYS ZERO DAYS CODE AS ZERO DAYS OFTEN ......1 OFTEN ...... 1 OFTEN ...... 1 SOMETIMES ..2 TIME TIME SOMETIMES ..2 TIME TIME SOMETIMES ..2 | TIME I TIME I NEVER.3(>>33) TIMES UNIT TIMESI UNIT NEVER.3(>>36) TIMES UNIT TIMES UNIT NEVER.3(>>39) TIMESI UNIT TIMES UNIT '0 _' ___ - _ __ __=___ =_ 10 2 4 5 6 7 8 9 11 12 - == TIMfE UNITS: DAY... 3 WEEK... 4 FORTNIGHT... 5 MONTH... 6 QUARTER... 7 HALF =... 8 YEAR... 9 PART A: SELF REPORTED HEALTH STATUS INDIVIDUALS AGE 15 AND OVER 39. 40. 41. 42. 43. 44. 45. 46. 47. I Have you ever How long ago How long ago Have you ever How long ago How long ago Have you ever How long ago How long ago D felt body pains did your latest did you last feel felt sad during did your latest did you last feel felt anxiety or did your latest did you last feel during the past 4 period of body body pains? the past 4 period of sad? fear during the period of anxiety or fear? C weeks? pains begin? weeks? sadness begin? past 4 weeks? anxiety or fear O IF STILL HAS begin? IF STILL HAS D IF STILL HAS THE THE E THE CONDITION, CONDITION, CONDITION, CODE AS CODE AS CODE AS ZERO DAYS ZERO DAYS ZERO DAYS OFTEN ...1. OFTEN ......1 OFTEN . 1.....I SOMETIMES. .2 SOMETIMES. 2TIME TIME SOMETIMES. .2 TIME IME NEVER .. 3 | TIME v IME I NEVER.3(.42) ITIMES UNIT ITIMES UNIT NEVER.3('>45) TIMES| UNIT TIMES UNIT (>PART B) TIMES UNIT ITIMES UNIT 1 2 3 4 6 7 8 9 TxIF uNITs: DA... .3 ..-E... .4 FORTNIGHT... .5 MONTH... 6 QuARTER... .7 HALF YEAR... .8 YEAR. .. .9 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 1. 2. 3. 4. 5. 6 7. 8. I Have you visited What kind of health care What is the name of this What was the Was this a Did the What mode of What was the D any kind of health facility or health care provider medical facility or provider? purpose of this visit? first visit or provider transportation did you total cost of care provider for did you visit most recently in a follow-up visit you at use to visit this your travel to C outpatient care, the past 4 weeks? IMMUNIZATION. 1 visit? home? provider? this provider? O such as a CONSULTATION .Include the D hospital, a clinic, PUBLIC HOSPITAL ..1 MEDICAL transpodation E a private doctor, a PUBLIC HEALTH CHECK-UP ...... 3 costs of nurse, a midwife, CLINIC.......2 MEDICATIONS ...4 ayn h or a traditional PRIVATE HOSPITAL.3 INJECTION . 5 WALKING. .(>9) anyone who healer, in the past PRIVATE HEALTHTRAMNBIYL.29) yu 4 weeks? CLINIC ........... 4 FOR INJURY .... 6 CAR ....... 3 PRIVATE DOCTOR... 5 TREATMENT FOR BUS. 4 PRIVATE NURSE, ILLNESS ....... 7 TRAIN. 5 PARAMEDIC, OR MASSAGE ....... 8 BOAT. 6 TRAINED MIDWIFE. .6 PRENATAL CARE.9 ANIMAL.... 7 TRADITIONAL OTHER OTHER HEALER ..... 7 (SPECIFY_) ... 10 (SPECIFY _)..8 YES..1 OTHER (SPECIFY ).8 FIRST ..1 YES ..1 ROUND NO.. 2 ID FOLLOW- (>12) TRIP (,58) NAME | _CODE FIRST SECOND| THIRD UP.... 2 NO ... 2 COST 110 F 00 21 31 4 tL0 :::_:: P 9 10:_ 11 12 |==_ PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. I How many What is the travel When you arrived What treatment did Did you What was What was the CHECK CHECK PART Was any D kilometers time from your there, how long you receive? receive a the total total cost of this PART D. IF THIS payment is it from home to this did you wait to be prescription cost to fill visit, including D. IF THIS PERSON IS in kind? C this provide provider? examined? CHECK-UP/ for this all the any medicines PERSON IS COVERED BY 0 to your CONSULTATION. 1 visit? prescrip- provided by the COVERED BY INSURANCE, ASK: D home? INJECTION. 2 tions you health care INSURANCE, E LABORATORY received provider (but not ASK: StRGERY 4 during this counting costs of How much of the XSRGY visit? prescriptions total cost of X-RAY .. 5 filled elsewhere)? How much of treatment, BIRTH these costs for . all TIME ONE CONTROL ....... 6 treatment and medicines, will TIME ONE MEDICATIONS .. .7 prescriptions mediines,rwil WAY youriASSAGE ....... will be y Insuranc e PRENATAL CARE.9 reimbursed b y providere OTHER insurance? (SPECIFY) ... 10 YES ..1 YES ..1 KILO- NO.. .2 NO... 2 M METERS HOURS )MINUTES HOURSM |INUTESI1ST_|_2ND_| 3RD (_15) (-20) 2 3 4 5 6 7 8 9 11 12 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT; MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 19. 20. 21. 22. 23. 24. 25. 26. What was the I What was Did you What type of facility or What is the name of this purpose of this visit? Was this a Did the What mode of D the have any provider did you visit most medical facility or provider? first visit or provider transportation did you approxi- other visits recently before the visit just IMMUNIZATION.1 a follow-up visit you at use to visit this provider? C mate to a health discussed? CONSULTATION.2 visit? home? MEDICAL o value of care UBLIC HOSPITAL. .1 CHECK-UP . 3 D the goods provider in PUBLIC HEALTH MEDICATIONS ...4 4AKN..l-8 E used to the past 4 LINIC .... 2 INJECTION .....5 WAKINGCY .... 1(>>288) pyind weeks? PRIVATE HOSPITAL.3 TREATMENT B I 3 kind? RIVATE HEALTH FOR INJURY ....6 CAR .3 LINIC 4 TREATMENT FOR BUS .4 RIVATE DOCTOR.5 ILLNESS. 7 BOAT ........6 RIVATE NURSE, MASSAGE .......8......7 PARAMEDIC, OR PRENATAL CARE.9 RAINED MIDWIFE. .6 OTHER OTHER RADITIONAL (SPECIFY ) ... 10 (SPECIFY-).8 EALER .7 YES..1 OTHER (SSPECIFY_).8 FIRST. .1 YES. .1 NO ... .2 TWID FOLLOW- (>31) _______ ("58) _ NAME CO31 E FIRST|SECONDTHIRD UP... 2 NO... 2 2 3 4 6 7 8 9 12 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. I What was How many What is the travel When you arrived What treatment did Did you What What was the CHECK PART CHECK PART D the total cost kilometers time from your there, how long you receive? receive a was the total cost of this D. IF THIS D. IF THIS of your travel is it from home to this did you wait to be CHECK-UP/ prescription total cost visit, including PERSON IS PERSON IS C to this this provider? examined? CONSULTATION ..1 for this to fill all any medicines COVERED BY COVERED BY O provider? provider to INJECTION .....2 visit? the provided by the INSURANCE, INSURANCE, ASK: D Include the your LABORATORY prescrip- health care ASK: How much of the E transportation home? TEST ..........3 tions you provider (but not total cost of costs of SURGERY . 4 received counting costs of How much of treatment, anyone who X-RAY .5 during prescriptions these costs for including all accompanied BIRTH this filled elsewhere)? treatment and medicines, will your you. CONTROL . 6 visit? prescriptions will insurance pay TIME ONE MEDICATIONS.7 be reimbursed by directly to the WAY MASSAGE .. 8 insurance? Drovider? PRENATAL CARE. 9 OTHER (SPECIFY) ... 10 ROUND YES. .1 TRIP KILO- NO... 2 COST METERS HOURS IMINUTES HOURS NMINUTES 1ST I 2ND I 3RD (.34) 4 5 6 7 8 9 10 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 37. 38. 39. 40. 41. 42. 43. 44. 45. I Was any What Did you What type of facility or What is the name of this medical What was the Was this a Did the What mode of D payment was the have any provider did you visit most facility or provider? purpose of this visit? first visit or a provider transportation did you in kind? approxi- other visits recently before the visit just IMMUNIZATION. 1 follow-up visit you at use to visit this C mate to a health discussed? CONSULTATION.2 visit? home? provider? 0 value of care PUBLIC HOSPITAL.1 MEDICAL D the provider in PUBLIC HEALTH CHECK-UP ...... 3 E goods the past 4 CLINIC ........... 2 MEDICATIONS ...4 WALKING.. 1(47) used to weeks? PRIVATE HOSPITAL.3 INJECTION 5 BICYCLE. .2(>47) pay in PRIVATE HEALTH TREATMENT CAR. 3 kind? CLINIC ........... 4 FOR INJURY 6 BUS. 4 PRIVATE DOCTOR. .5 TREATMENT FOR TRAIN.....5 PRIVATE NURSE, ILLNESS 7 BOAT ...... 6 PARAMEDIC, OR MASSAGE . 8 ANIMAL .... 7 TRAINED MIDWIFE. .6 PRENATAL CARE ..9 OTHER TRADITIONAL OTHER (SPECIFY ).8 EALER. 7 (SPECIFY-) ... 10 YES..1 YES..1 OTHER (SPECIFY_).8 FIRST ..1 YES ..1 NO.. 2 NO.. 2 ID FOLLOW- ('>50) _(>,39) (" 58) NAME CODE FIRST|SECOND THIRD UP .... .2 NO... 2 2 3 4 6 7 8 9 I10 12 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. I What was the How many What is the When you What treatment did Did you What was What was the CHECK CHECK PART D total cost of kilometers is travel time from arrived there, you receive? receive a the total total cost of this PART D. IF THIS your travel to it from this your home to how long did prescription cost to fill visit, including D. IF THIS PERSON IS C this provider? provider to this provider? you wait to be CHECK-UP/ for this all the any medicines PERSON IS COVERED BY O Include the your home? examined? CONSULTATION. .1 visit? prescrip- provided by the COVERED BY INSURANCE, ASK: D transportation INJECTION .....2 tions you health care INSURANCE, E costs of LABORATORY received provider (but no ASK: How much of the anyone who TEST ..... 3 during counting costs total cost of accompanied SURGERY ..... 4 this visit? of prescriptions How much of treatment, you. X-RAY .. . 5 filled these costs for including all BIRTH CONTROL .6 elsewhere)? treatment and medicines, will TIME ONE MEDICATIONS. .7 prescriptions will your insurance WAY MASSAGE 8 be reimbursed pay directly to the PRENATAL CARE.9 by insurance? provider? OTHER (SPECIFY ) ... 10 ROUND YES. .1 TRIP KILO- NO.. .2 COST METERS HOURS IMINUTES HOURS |MINUTES 1ST I 2ND I 3RD (s53) 2 3 4 5 6 7 8 9 12 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 56. 57. 58. 59. 60. 61. 62. 63. I Was any What was Have you What kind of health care What is the name of this health care How many What was the reason for What type of room was D payment the approxi- ever spent facility did you stay over facility? night were this hospitalization? it? in kind? mate value the night at night during your most you C of the a health recent hospitalization? hospitalized O goods used care facility there? D to pay in in the past E kind? 12 months? PUBLIC HOSPITAL ..1 PUBLIC HEALTH CLINIC ........... 2 PRIVATE ....... 1 PRIVATE HOSPITAL.3 ILLNESS .1 SEMI-PRIVATE. .2 PRIVATE HEALLTH ....................ACCIDENT .2 GENERAL WARD. .3 CLINIC ........... 4 GIVING BIRTH .....3 CHARITY WARD. .4 OTHER (SPECIFY ).5 OPERATION ........4 OTHER (SPECIFY ).5 YES . 1 YES ..1 NO .. 2 NO.. 2 ID _(58) (>>91) NAME CODE NIGHTS 1ST 2ND 3RD 2 3 4 5 6 7 8 9 10 12 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORTL MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 64. 65. 66. 67. 68. 69. 70. 71. l During this What was the Upon CHECK CHECK PART Have you also What kind of health care What is the name of this health D hospitalization, what total cost to fill discharge, PART D. IF THIS spent the night facility did you stay over care facility? kind of treatment did any what was D. IF THIS PERSON IS at a health night during your second C you receive? prescriptions the total PERSON IS COVERED BY care facility at most recent hospitalization? 0 received cost of the COVERED BY INSURANCE, ASK: some other D during this hospitaliza- INSURANCE, time in the E PHYSICAIXAMI visit? tion? ASK: How much of the past 12 CONSULT ........ 1 Exclude any total cost of months? INJECTION ...... 2 drugs How much of the treatment, PUBLIC HOSPITAL-1 LABORATORY purchased total cost, including PUBLIC HEALTH TEST.......3 CLINIC.......2 SURGERY . 4... 4 elsewhere. including medicines, did X-RAY .......5 medicines, was your insurance PRIVATE HOSPITAL.3 BIRTHCONTROL ... 6 WRITE ZERO or will be pay directly to the PRIVATE HEALTH MEDICATIONS .... 7 IF NO reimbursed by hospital? CLINIC. 4 PRENATALCARE ... 8 PRESCRIP- your insurance? OTHER (SPECIFY ).5 OTHER TION (SPECIFY). 9 YES. .1 No.. .2 ID I 1ST| 2ND| 3RD| 4THI 5TH ( .91) NAME CODE Ln ' 2 3 4 5 6 7 8 10 I11 12 PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT, MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 72. 73. 74. 75. 76. 77. 78. 79. 80. During this I How many What was the reason for What type of room was hospitalization, what What was the CHECK PART CHECK How much Have you also D night were this hospitalization? it? kind of treatment did total cost to D. IF THIS PART of the total spent the night you you receive? fill any PERSON IS D. IF THIS cost of at a health care C hospitalized PHYSICAL EXAM/ prescriptions COVERED BY PERSON IS treatment, facility at some 0 there? CONSULT . 1 received INSURANCE, COVERED BY including other time in D INJECTION . 2 during this ASK: INSURANCE, medicines, the past 12 E LORATORY visit? ASK: did your months? ILLNESS ..........1 TEST ..... 3 Upon discharge, insurance ACCIDENT .........2 PRIVATE. SURGERY ..... 4 what was the pay directly GIVING BIRTH E.....3 HSMI-PRIVATE ..2 X-RAY ..........5 total cost of the to the OPERATION .......4 GENERAL WARD. .3 BIRTH CONTROL.. 6 hospitalization? How much of the hospital? OTHER (SPECIFY_).5 CHARITY WARD. .4 MEDICATIONS ... 7 WRITE Exclude any total cost, PRENATAL CARE..8 ZERO IF drugs purchased including OTHER NO elsewhere. medicines, was (SPECIFY-) ..9 PRESCRIP- or willI be TION reimbursed by your insurance? YES ..1 NO.. .2 NIGHTS 1ST I 2ND 3RD ST 2ND 3RDT4TH|5TH (>91) S ___ :__ _ ____ _ _ _ _ 6, _ ___ ________ _ _ _ ____ CD a, 7 8_ _ _ _ 9____ 11 0 TT7_____ _ 12 0=_ __0~00000 0 __00 X PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORT: MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 81. 82. 83. 84. 85. 86. 87. I What kind of health care What is the name of this How many night What was the reason What type of room was Duhing this What was the D facility did you stay over health care facility? were you for this hospitalization? it?kind of treatment did total cost to fill night during your third hospitalized you receive? any C most recent there? prescriptions 0 hospitalization? PHYSICALEXAM/ received during D CONSULT ........ 1 this visit? E PUBLIC INJECTION ...... 2 HOSPITAL ....... 1 LABORATORY PUBLIC HEALTH TEST ........... 3 CLINIC ......... 2 SURGERY ........ 4 PRIVATE PRIVATE . 1.... I X-RAY .......... 5 HOSPITAL.....3 SMPRVT.2 BIRTH CONTROL. .6 PRIVATE HEALTH MEDICATIONS ....7 WRITE ZERO CLINIC ..... 4 ACCIDENT ........ 2 GENERAL WARD. .3 PRENATALCARE ... 8 IF NO PRENATAL CARE ............... 5 GIVING BIRTH .... 3 CHARITY WARD.. OTHER PRESCRIP- OTHER OPERATION 4 (SPECIFY ). 9 TION (SPECIFY . 6 OTHER (SPECIFY . 5 ID NAME CODE NIGHTS 1ST 2NDI 3RD lIST 2ND 3RD 4TH|5TH 0 __ _ _ _ _ l_ _ _ l_ _ l l l l l l l 2 3 4 5 6 7 8 9 12 l X A X 6 f _ _ _ 7 { l l l PART E: DETAILED UTILIZATION AND EXPENDITURES INDIVIDUALS AGE 15 AND OVER SELF REPORTL MOTHERS/GUARDIANS ANSWER FOR INDIVIDUALS LESS THAN AGE 15 88. 89. 90. 91. 92. 93. 94. I CHECK CHECK How much During the past How much did During the past 4 How much did D PART PART of the total 4 weeks, have you pay for all weeks, have you you pay for all D. IF THIS D. IF THIS cost of you purchased modern purchased any traditional herbs C PERSON IS PERSON IS treatment, any modern medicines traditional herbs or or medicines O COVERED BY COVERED BY including medicines on purchased on medicines on your purchased on D INSURANCE, INSURANCE, medicines, your own, that is your own in own, that is without you own in the E ASK: ASK: did your without a the past 4 consulting a health past 4 weeks? insurance prescription, to weeks? care practitioner, to pay directly treat any health treat any health Upon How much of the to the problem? problem? INCLUDE Upon How ~much of the hospital? PYET discharge, total cost, INCLUDE PAYMENTS what was the including PAYMENTS IN KIND total cost of medicines, was IN KIND the hospitaliza- or will be tion? Exclude reimbursed by any drugs your insurance? purchased YES.. .1 YES. .1 elsewhere. NO... .2 NO ... .2 (>>93) (-PART F) 2 3 4 6 7 8 9 10 1 1 12 PART G: DIRECTLY OBSERVED ACTIVITIES OF DAILY LIVING INDIVIDUALS AGE 40 AND OVER Now I would like to ask you to do some simple tasks or exercises to get an idea of your health. FILL OUT THE FOLLOWING INFORMATION 1. 2. 3. 4. 5. 6. 7. 8. I SEMI TANDEM SIDE BY STAND UP FROM A CHAIR REPEATED CHAIR IF RESPON- Do you need a TIME TO WALK The next action D STAND SIDE STAND STANDS DENT cain or walking THREE METERS involves bending (SECONDS THAT (SECONDS WITHOUT USING CANNOT aid for your over. If you have C SUBJECT CAN THAT ARMS STAND FROM normal daily had an operation 0 STAND WITH ONE SUBJECT A CHAIR activities? for cataracts D FOOT IN FRONT CAN STAND WITHOUT within the past 6 E OF THE OTHER WITH FEET USING weeks, you WITH SPACE NEXT TO TIME FOR FIVE HIS/HER should not try BETWEEN FEET) EACH CHAIR STANDS ARSthis. Have you OTHER AT WITHOUT USING had a cataract SHOULDER ARMS. operation in the WIDTH) past 6 weeks? RISE RISE WITH STOP STOP HEIGHT WITHOUT USING ARMS AFTER 30 AFTER 30 OF USING ARMS YES ..1 NUMBER OF SECONDS SECONDS CHAIR YES.. 1 (-5) TIMES YES.. 1 1ST 2ND YES.. 1 USED (-4) NO.. .2 RISING NO.. .2 TIME TIME ("10) 0 _ SECONDS SECONDS (CM.) NO... 2 ("6) SECONDS USING ARMS (SECONDS) (SECONDS) NO... 2 2 3 4 5 6 7 8 9 10 1 1 12 PART G: DIRECTLY OBSERVED ACTIVITIES OF DAILY LIVING INDIVIDUALS AGE 40 AND OVER 9. 10.1. I BENDING FOOT TAPPING. SHOULDER D OVER ROTATION C FIRST CHECK FOR EACH FOOT, TIME HOW LONG IT TAKES HOLD OUT ARM O WHETHER THE RESPONDENT TO TAP HIS/HER FOOT STRAIGHT OUT IN D RESPONDENT CAN ON THE FLOOR TEN TIMES. IF HE/SHE FRONT, RAISE E BEND OVER TO PICK CANNOT DO TEN TAPS, RECORD THE OVER HEAD AND UP A PENCIL OFF NUMBER DONE BEFORE STOPPING. LOWER THE FLOOR. IF BACKWARD UNTIL HE/SHE CAN, THEN POINTING RECORD THE STRAIGHT BEHIND. AMOUNT OF TIME IT TAKES. ._____________________ UNABLE ........1 RIGHT FOOT LEFT FOOT PARTIALLY ..... 2 CAN HE/SHE TIME TO NUMBER NUMBER FULLY. 3 BMED OVER? PICK UP OF TAPS SECONDS OF TAPS SECONDS REFUSED. 4 YES 1 PENCIL (IF <10, | TO DO (IF <10, TO DO NO ... 2 'LEFT |10 FOOT '11) 10 FOOT RIGHT LEFT _- _ . ('10) SECONDS FOOT) TAPS TAPS SHOULDER SHOULDER 2 3l 4- 5 7- 9 11 PART H: COGNITIVE FUNCTIONING INDIVIDUALS 40 AND OVER Now I would like to ask you some qu stions about your memory. 1. 2. 3. 4. 5. 6. 7. 8. 9. I What day of the What is the date What is the What is the year? What country are What province What is the name Was is the name I am going to name D week is it? today? month? we in? are we in? of this of the [PRIME three objects. After village/district? MINISTER] of the I have said them, I C country? want you to repeat O them. Remember D what they are E because I am going to ask you to name them again in a few minutes: READ TO THE RESPONDENT: orange, house, cat CORRECT. .1 CORRECT. .1 CORRECT. .1 CORRECT. .1 CORRECT. .1 CORRECT. .1 CORRECT. .1 CORRECT. .1 INCORRECT. .2 INCORRECT. .2 INCORRECT.. 2 INCORRECT. .2 INCORRECT. .2 INCORRECT.. 2 INCORRECT.. 2 INCORRECT. .2 2 3 4 5 6 7 8 9 10 11 12 PART H: COGNITIVE FUNCTIONING INDIVIDUALS 40 AND OVER Now we are going to do some things with numbers. This is sometimes hard for people. Just do the best you can. 10. 11. 12. 13. 14. 15. 16. 17. I If I have 20 If one large bag of How much would How much would SHOW THE If someone gave Do you remember Now can you subtract 7 from D dollars, and I give rice costs 20 three large bags four large bags of SUBJECT TWO you this amount the three objects I 100, and then subtract 7 you 5 dollars, how dollars, how much of rice cost? rice cost? DIMES. as change from asked you to from the answer you get and C many dollars do I would two large How many cents one dollar, how remember a few keep subtracting 7 until I tell O have left? bags of rice cost? does this make? much would you minutes ago? you to stop? D have spent? Please name them E STOP AFTER THREE SUBTRACTIONS. COUNT ONE ERROR EACH TIME THE DIFFERENCE BETWEEN THE NUMBERS IS NOT 7 CORRECT- .1 CORRECT ..1 CORRECT.. 1 CORRECT. .1 CORRECT ..1 CORRECT .1 NUMBER OF INCORRECT ..2 INCORRECT.. 2 INCORRECT.. 2 INCORRECT.. 2 INCORRECT. .2 INCORRECT.. 2 OBJECTS REMEMBERED ERRORS 2 6 7 9 10:: 11 12: PART H: COGNITIVE FUNCTIONING INDIVIDUALS 40 AND OVER Now I will point to something and I would like you to name the object. 18. 19. 20. 21. 22. 23. 24. 25. 26. I (INTERVIEWER: (INTERVIEWER: (INTERVIEWER: (INTERVIEWER: (INTERVIEWER: (INTERVIEWER: I going to give you Please Fold paper Please put the D HOLD UP A PEN) POINT TO A POINT TO SHOW YOUR POINT TO YOUR POINT TO YOUR a piece of paper in half. paper on your lap. What is this WATCH) TABLE) KNUCKLES) ELBOW) SHOULDER) and ask you to do C called? What is this What is this What do we call What do we call What do we call something with it. 0 called? called? these? these? these? Please take this D paper with your E rght hand. DO NOT REPEAT THE INSTRUCTION OR COACH CORRECT. .1 CORRECT. .1 CORRECT.. 1 CORRECT.. 1 CORRECT. .1 CORRECT.. 1 CORRECT. .1 CORRECT. .1 CORRECT.. 1 INCORRECT. .2 INCORRECT.. 2 INCORRECT.. 2 INCORRECT 2 INCORRECT 2 INCORRECT. .2 INCORRECT. .2 INCORRECT.. 2 INCORRECT 2 2 3 4 5 6 7 8 9 10 11 12 PART H: COGNITIVE FUNCTIONING INDIVIDUALS 40 AND OVER Now I would like to ask you to try to remember a short story. I am going to read you the story first and when I am through I am going to wait a few seconds and then ask you to tell me as much as you remember. The story is 27. 28. 29. 30. 31. 32. I Three children were alone at home and the THREE HOUSE ON FIRE PERSON CHILDREN MINOR INJURIES EVERYONE D house caught on fire. A brave person CHILDREN CLIMBED IN RESCUED WELL managed to climb in and carry them to safety. C Aside from minor cuts and bruises all were 0 well. D E WAIT A FEW SECONDS, THEN SAY: Please tell me the story RECORD THE SUBJECTS RESPONSES VERBATIM ON SCRAP PAPER. THEN SCORE THE SIX BASIC IDEAS IN THE STORY AS PRESENT OR ABSENT. PRESENT. .1 PRESENT. .1 PRESENT.. 1 PRESENT.. 1 PRESENT. . 1 PRESENT. .1 ABSENT. .2 ABSENT. .2 ABSENT. .2 ABSENT. .2 ABSENT. .2 ABSENT. .2 2 3 4 5 6 7 8 9 12 I_ - - 121 L : L 1 HEALTH FACILITY QUESTIONNAIRE NAME OF COMMUNITY CODE: NAME OF HEALTH FACILITY CODE: | ADDRESS OF HEALTH FACILITY NAME OF RESPONDANT POSITION OF RESPONDANT DIRECTOR ...................................... 1 HEAD DOCTOR ................................... 2 OTHER DOCTOR .................................. 3 NURSE ....................................... 4 OTHER HEALTH CARE PROFESSIONAL ................ 5 OTHER (SPECIFY ) . 6 NAME OF INTERVIEWER CODE: DATE OF INTERVIEW DAY: MONTH: YEAR: TIME INTERVIEW BEGAN: : TIME INTERVIEW COMPLETED: W COMMENTS: 115 PART A: BASIC CHARACTERISTICS OF HEALTH CARE FACILITY First, I would like to ask you a few basic questions about this health facility. 1. What type of facility is this? For example, is it a government hospital, a government clinic, a private hospital, a private clinic, or something else? PUBLIC HOSPITAL ................. 1 (>>4) PUBLIC HEALTH CLINIC ............ 2 (>4) PUBLIC FAMILY PLANNING CENTER ... 3 (>4) PRIVATE HOSPITAL .. 4 PRIVATE HEALTH CLINIC .. 5 PRIVATE DOCTOR . ........... 6 (>>4) PRIVATE NURSE, PARAMEDIC OR TRAINED MIDWIFE . ......... 7 (>>4) OTHER (SPECIFY ) ......... 8 (>4) 2. Does this private facility receive funding and/or other support from any organization, such as a religious group, a non- religous charity, or even the government? YES . .1 NO . 2 (>>4) 3. What kind of organizations fund or support this clinic? 1ST NONE . ........................... 1 RELIGIOUS ORGANIZATION ........ 2 2ND NON-RELIGIOUS CHARITY ..3 mj GOVERNMENT . ..................... 4 OTHER (SPECIFY ) .5 3RD 4 In what year did this health facility open? YEAR: l 5 Does this health facility have electricity? YES.. 1 NO... 2 (>8) 6 What is the source of this electricity? NATIONAL OR STATE ELECTRIC COMPANY ... 1 LOCAL GOVERNMENT ..................... 2 PRIVATE ELECTRIC COMPANY ............. 3 GENERATOR OWNED BY FACILITY .......... 4 OTHER (SPECIFY )......... 5 116 PART A: BASIC CHARACTERISTICS OF HEALTH CARE FACILITY 7 How often is electric service interrupted? ALMOST EVERY DAY .. 1 ONCE OR TWICE PER WEEK . . 2 ONCE OR TWICE PER MONTH . . 3 A FEW TIMES A YEAR .. 4 NEVER OR ALMOST NEVER . . 5 OTHER (SPECIFY ) ........ 6 8 What is the main source of water used in the health facility? PIPED WATER .......................... 1 TUBEWELL..........................2 SIMPLE OPEN WELL . ............. 3 (>>9) SPRING ................... 4 (>>9) RAINWATER . ................. 5 (>>9) RIVER/LAKE . . 6 (>9) OTHER (SPECIFY ) ........... 7 (>>9) NO WATER SOURCE . .............. 8 (>>10) 9 Is this source of water located inside this health facility? YES . 1 (»,11) NO... 2 1 0 How far is this source of water from this health facility? DISTANCE: DISTANCE CODES: METER ................. 1 DISTANCE KILOMETER ................. 2 CODE: 11 What toilet facilities are available for use at this clinic? TOILET CONNECTED TO SEWAGE SYSTEM .... 1 TOILET CONNECTED TO SEPTIC TANK ...... 2 PIT LATRINE .......................... 3 OTHER (SPECIFY ) .... 4 NO TOILET ............................ 5 117 PART A: BASIC CHARACTERISTICS OF HEALTH CARE FACILITY 12 Can you tell me, for each day of the week, whether the clinic is OPEN? open, and for the days it is open what time does it open and YES. . 1 what time does it close? NO... 2 HOUR HOUR (-NEXT DAY) OPENS CLOSES MONDAY: TUESDAY: WEDNESDAY: THURSDAY: FRIDAY: SATURDAY: SUNDAY: 13 What is the registration fee charged by this clinic for first visits? L IF NO REGISTRATION FEE, WRITE ZERO 14 What is the registration fee charged by this clinic for follow-up visits? IF NO REGISTRATION FEE, WRITE ZERO 118 PART B: SERVICES OFFERED Now I would like to ask you some questions about the health services available at this facility. 1. 2. 3. 4. Does this How many days In what What is the price charged clinic per week is this year did for this service, excluding provide service offered? this health the registration fee? [I]? facility first ASK offer this )UESTION 1 service? FOR ALL IF ONLY BY TYPES OF SPECIAL SERVICES ARRANGEMENT, BEFORE WRITE "8'. ASKING :UESTIONS 2-4 YES..1 NO...2 (>NEXT SERVICES SERVICE) DAYS/WEEK YEAR AMOUNT UNIT a Inpatient Care per diem b Curative Care Examination _ ~ ~ ~ ~ ~ ~ ~ ~ ~~~________ ____ per visit c Stitching wounds: first stitch er stitch d additional stitches e Changing of wound dressing per visit f Incision of abcess / piercing of boils er artin g Circumcisions _______ per time h Medical treatment for tuberculosis er visit i Check up I health examination P _ ~ ~ ~ ~ ~ ~ ~ ~~~~~________ per visit j Dental exam ______________ _ per exam k Prenatal care I Aid for childbirth _ exam per delivery m Child Immunization: BCG per injection n DPT __________ ________ o~~~~~er iniection o Anti polio oer iniection P Measles Measls_ l per injection q Immunization of pregnant women . . r Immunization against Hepatitis B _ _____________________________ _________ _______________ _________ _______ p er inje cton 119 PART B: SERVICES OFFERED 5. Does this health facility offer contraceptive services, such as YES... 1 birth control pills, IUD's, injections or sterilization? NO .. 2 (>>10, NEXT PAGE) CONTRACEPTIVE SERVICES 6. 7. 8. 9. Does this How many days per In what What is the price clinic week is this service year did charged for this provide offered? this service, excluding I ....]I? health the registration fee? ASK facility UESTION 6 first offer FOR ALL IFOL Y this TYPES OF IF ONLY BY shersvice? TYPES OF SPECIAL srie SERVICES ARRANGEMENT, BEFORE WRITE "8". ASKING QUESTIONS 7-9 YES..1 NO.. .2 CONTRACEPTIVE (>>NEXT SERVICE SERVICE) DAYS/WEEK YEAR AMOUNT| UNIT a Oral Contraceptives: Microgynon. l l l | one month b marvelon 28 | l l one month c Excluton 28 _ _ _ _ X X [ |one month d Schering -one month e Other - : : _ _ one month f IUD Plastic / Lipes loop/spiral: insertion ________ one time IUD removal one time h IUD Copper T: insertion one time I removal one time i Contraceptive injection: Depo-Provera _ : ier inject. k Noristrat : : :er iect. I NORPLANT: insertion ________one time m removal one time n Sterilization: for men per procedure o for women per procedure Treatment of contraceptive side effects _ _ _ _ __:____ per treatment 120 PART B: SERVICES OFFERED LABORATORY EXAMINATION 10. 11. 12. 13. Does this How much is For lab work not done here, is the How far is this facility have the the charge to patient referred outside? facility from the capacity to do the patient? health center? lab work for ASK QUESTION >)NEXT 10 FOR ALL TYPE OF TYPES OF LAB WORK SERVICES BEFORE ASKING QUESTIONS 11-13 YES ..1 YES ..1 TYPEOF NO... 2 NO .. 2 LABWORK (I>12) (>NEXT TYPE OF LAB WORK) KILOMETERS a Hemoglobin (Hb) b Leucosit calculation c Blood Type calculation d Eritrosit calculation e Uinalysis f Pregnancy test 9 Feces examination h Sputum examination 121 PART C: HEALTH CENTER EMPLOYEES Now I would like to ask you about the people who work at this health facility. Can you please tell me about each one, beginning with the head of the facility. 1 . 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. I Please give me the What is [NAME]'s How many Does What kind of How many During the How many How many During the Does How far is his/her D name of everyone position. Is he/she years has [NAME] degrees does hours per past 30 hours per week patients does last 30 [NAME] private health practice who works at this a doctor, a nurse, or [NAME] speak the [NAME] have? week does days, how does [NAME] [NAME] days, ho have a from this health facility? C health facility. something else? worked at local [NAME] many hours usually spend usually see many private 0 this health language? usually per week providing each week? hours per health D facility? work at this has [NAME] medical week has practice? E health worked at care to [NAME] WRITE DOWN NONE . 1 facility? this health patients? spent ALL NAMES, HIGH SCHOOL facility? doing THEN ASK DIRECTOR... . GRADUATE. 2 administra QUESTION 2- DOCTOR.2 BACHELORS . 3 tive work? DISTANCE CODES 12 FOR EACH NUR .SE . 3 MASTERS . 4 IF ZERO, METERS ..........1 PERSON PARAMEDIC. 4 DOCTORATE ... 5 10 KILOMETERS ...2 BEFORE TECHNICIAN.5 M.D..... 6 GOING TO OFFICE R.N .7 YES.. 1 THE NEXT WORKR...6 Ys OTHER NO... 2 HPERSON. OTHER NO.. 2 (SPECIFY_).8 HOURS/ HOURS/ PATIENTS/ HOURS/ (-NExT DISTANCE NAME (SPECIFY_).7 YEAR1S lSP 2ND WEEK WEEK HOURS/WEEK WEEK WEEK PERSON) ISTANCE CODE 21- 1__ 1___T17__ 1IT 11j 3 4 1 --?-7:T7 :TC:- 0 T : 7 X : T777707 7 1- 1 : : _ :: ::5: ::: ::: ::: ::: ::::0 :: : ::::t:::0::: :C::: 0: ::: ::::: :: _ 0 :::::I : :::::::: 6 00 0 . X : Tf77V : t : i :: 7 : ;:::0 :: :t :i 69 0: t 0 :0:; t t::t0 : 4 0t<:0 0::00: i: t01:0::<0 10:::0t:00l0000: l0T0 0 _ 1 : 1 PART D: MEDICAL EQUIPMENT Now I would like to ask you some questions about the medical equipment in this health facili 1. 2. 3. 4. 5. Do you have any How many How many[ .] How many If you had to [ ] in this health [.... ] do you do you have in [..... I do you replace your facility? have in this this health have in this stock of [ ..... ], health facility facility that are health facility how much ASK that are in not that are the would it cost? QUESTION 1 good working private FOR ALL working properly? property of the TYPES OF order? staff? EQUIPMENT BEFORE ASKING QUESTIONS 2-5 YEs. .1 NO... .2 EQUIPMENT TYPE (.NEXT ITEM) a Regular stethoscope b Stethoscope for pregnant mothers c Tensimeters d Sterilization / autoclaves e Scales for adults f Scales for infants g Measures for body height h Thermometer i Beds Delivery Kit k Forceps I Vaginal speculum m Sahli set n Microscopes o Centrifuges p Refrigerator 123 PART D: MEDICAL EQUIPMENT 6. 7. 8. 9. Does this health How many [....] do How many[ .....] do If you had to replace facility have any you have in this you have in this your stock of [ ..... ], I..... I? health facility that health facility that how much would it are in good are not cost? working order? working properly? ASK QUESTION 6 FOR ALL TYPES OF EQUIPMENT BEFORE ASKING QUESTIONS 7- 9 YES. .1 NO. .. .2 EQUIPMENT TYPE (,.NEXT ITEM) a Alcohol antiseptic b Betadine antiseptic c Bandages d Oxygen Tubes e Incubators f Minor surgical instruments g SSB Radios h Infuse instruments and needles li |Gloves r j Scissbrs :: : ::: : :: ::: :: :; : :::: : : : k Giemsa dyeing solutions I Benedict solutions m Wright solutions n Pregnancy test (strips) o Protein urine tests (strips) p Glucose urine tests (strips) 124 PART E: DIRECT OBSERVATION Now I would like to look at some of the rooms in this health facilitv and take some notes. Could vou olease take me to the rooms where Datients are examined? ONCE YOU ARRIVE IN THE ROOM. WRITE DOWN THE ANSWERS TO QUESTIONS 1-8 WITHOUT ASKING ANY QUESTIONS DIRECTLY. 1. IS THE FLOOR CLEAN, OR DO YOU SEE A LOT OF DUST, OR FOOD REMNANTS. OR GARBAGE ON THE FLOOR? FLOOR: CLEAN .....1 DIRTY .... 2 2. ARE THE WALLS CLEAN, OR DO YOU SEE MANY SPIDER WEBS, OR SCRIBBLING, OR MOISTURE. OR PEELED OFF PAINT? WALLS: CLEAN ..... DIRTY .... 2 3. ARE THERE CURTAINS FOR CLOSING OFF ALL OR PART OF THE YES ..1 l _l EXAMINATION ROOM? NO... 2 (>5) 4. ARE THE CURTAINS CLEAN, OR DO YOU SEE STAINS, BLOODSTAINS OR OTHER DROPPINGS? CURTAINS: CLEAN ................................ 1 DIRTY ................................ 2 5. WHAT PROVISIONS ARE AVAILABLE FOR WASHING HANDS IN THIS ROOM? SINK OR BASIN WITH PIPED WATER . ...... I SINK OR BASIN WITH OTHER WATER ....... 2 NO PROVISION ..............., 3 6. ARE THERE ANY GARBAGE CANS ORWASTE BASKETS YES..1 IN THIS ROOM? NO.. 2 l z 7. IS THERE AN EXAMINATION TABLE IN THIS ROOM? YES ..1 NO .. 2 l z 8. IS THERE AN GYNECOLOGICAL TABLE IN THIS ROOM? YES.. 1 NO-.. 2 125 PART E: DIRECT OBSERVATION NOW ASK THE RESPONDANT THE FOLLOWING QUESTIONS: 9. Can I see what you use to give patients injections and immunizations? WRITE DOWN THE TYPE OF NEEDLE DISPOSABLE NEEDLE ............... 1 (>>11) NON-DISPOSABLE NEEDLE ........ll2 BOTH KINDS OF NEEDLES. 3 NO NEEDLES ...................... 4 (>>11) 10. Can you show me how you sterilize your non-disposable needles? ALLOW UP TO THREE RESPONSES STERILIZER .1 ST PUT NEEDLE IN BOILING WATER .2 2 RINSE WITH ALCOHOL .3 2ND lz PUT NEEDLE INTO FLAME. 4 OTHER (SPECIFY ) .5 3RD NOT STERILIZED. 6 1 1. Do you provide vaccinations in this health facility? YES . 1 NO.. 2 (>18) [j 12. Can you please show me where the vaccines are stored in this health facility? FILL OUT QUESTIONS 13-15 WITHOUT ASKING ANY QUESTIONS, UNLESS CLARIFICATION IS NECESSARY. 13. HOW ARE VACCINES STORED IN THIS HEALTH FACILITY? SPECIAL REFRIGERATOR/FREEZER/COOLING BOX FOR VACCINES .. 1 STORED IN REFRIGERATOR ALSO USED FOR l l OTHER PURPOSES ...................... 2 NON-ELECTRIC REFRIGERATOR ............ 3 NON-REFRIGERATED STORAGE SPACE ....... 4 (>>16) NO REGULAR STORAGE SPACE ............. 5 (>>16) 14. IS THERE A CHART/RECORD CONCERNING THE FREEZER'S YES ..1 TEMPERATURE? NO... 2 (>16) 126 PART E: DIRECT OBSERVATION 15. WRITE DOWN THE DATE AND TEMPERATURE FOR THE MOST RECENT RECORDING OF THE FREEZER'S TEMPERATURE. TEMPERATURE DAY LII MONTHEI] YEAR [I (CELSIUS): l l 16. Does this health facility have any thermos flasks for taking YES ..1 jj vaccines to the field? NO.. 2 (>>18) 17. Can you please show me how many thermos flasks you have for taking vaccines to the field? NUMBER OF CHECK TO MAKE SURE THE FACILITY HAS THEM, AND THEN THERMOS ll WRITE DOWN THE NUMBER FLASKS: 18. Do you do laboratory tests in this health facility? YES. .1 NO... 2 (>>PART F) 19. Can I please see this room where you do laboratory tests? SEPARATE ROOM NOT SEEN BEFORE ........ 1 SAME AS EXAMINATION ROOM ............. 2 (>>24) l COMPLETE QUESTIONS 20-23 BY DIRECT OBSERVATION, WITHOUT ASKING THE RESPONDANT. 20. IS THE FLOOR CLEAN, OR DO YOU SEE A LOT OF DUST, OR FOOD REMNANTS. OR GARBAGE ON THE FLOOR? FLOOR: lI l CLEAN.1 DIRTY ................................ 2 21. ARE THE WALLS CLEAN, OR DO YOU SEE MANY SPIDER WEBS, OR SCRIBBLING. OR MOISTURE. OR PEELED, OFF PAINT? WALLS: CLEAN ................................ 1 DIRTY ................................ 2 22. WHAT PROVISIONS ARE AVAILABLE FOR WASHING HANDS IN THIS ROOM? SINK OR BASIN WITH PIPED WATER ....... 1 SINK OR BASIN WITH OTHER WATER .......2 l NO PROVISION ......................... 3 23. ARE THERE ANY GARBAGE CANS OR WASTE BASKETS YES.. 1 IN THIS ROOM? NO... 2 l 127 PART E: DIRECT OBSERVATION 24. Does this lab have a....microscope? lIl ... .microscope? ...... YES. .1 NO ...2 ... centrifuge? lIII9 ... spirit lamp? ... slides or readymade glasses? 128 PART F: STOCK OF MEDICINES Now I would like to ask you about the medicines that you have in stock in this health facility. 1. 2. 3. 4. 5. Do you have Have you had During the How much do Where do you obtain any [.. ] in any [...... I in past 12 you charge a this [.. ]? stock today? stock during the months, how patient for past 12 many months [........... ]? months? was [......] out ASK of stock? QUESTIONS 1 AND 2 FOR ALL TYPES OF SERVICES BEFORE PILL .......1 ASKING BOTTLE ..... 2 QUESTIONS INJECTION ..3 GOVERNMENT 3-5. OTHER PROVISION .. . .1 YES .1 YES ..1 (SPECIFY ).4 PRIVATE (>,3) NO.. 2 UNIT SUPPLIER .2 MEDICINES NO.. 2 (>>NEXT ITEM) MONTHS AMOUNT CODES BOTH ... 3 _~~~~~~~~~~~~~~~~~~~ a Penicillin b Ampicilin c Tetracycline d Chloroamphenicol e Antalgin f Acetosal g Paracetamol h [NH i Rifampicin J Ethambutol k Stretomicyn i Anti malaria m Skin ointment n Cough syrup o Oralit p Contraceptive injections q Iron tablets / FES04 r Vitamin A s BCG t DPT u Anti polio v Measles w Tetanus Toxoid x Hepatitis B y Condoms z Female sheath aa Spermacide ,, ,.,,,,,,. bb Diaphragm 129 PART G: PROTOCOL FOR A COUGH AND FEVER CASE INSTRUCTIONS: ASK THESE QUESTIONS TO THE PERSON IN THE FACILITY WHO IS MOST LIKELY TO HANDLE AN ADULT PATIENT WHO REPORTS BEING ILL WITH A COUGH OR FEVER. 1. POSITION OF RESPONDANT DIRECTOR . . .. DOCTOR .............................. 2 NURSE ............................... 3 PARAMEDIC ........................... 4 TECHNICIAN .......................... 5 OFFICE WORKER ...................... 6 OTHER (SPECIFY ) ............. 7 We would like to understand the process by which you examine an adult person suffering from a fever. We would like to find out what is done beginning with the arrival of the patient and ending when the patient goes home. We shall describe a case, subsequently we will ask you to explain what you do regularly. Now I will read out the case (READ OUT 2 TIMES): Mr. XX came to the health center with a complaint of coughing and a fever. Now I would like to ask you exactly what you would do for this patient. 2. What questions do you ask the patient when you start examining him? FIRST LISTEN TO THE RESPONDENT. ANY QUESTION THAT HE OR SHE MENTIONS SHOULD BE MARKED WITH CODE 1. AFTER THE RESPONDENT IS FINISHED, FOR ANY QUESTION THAT HE OR SHE DOES NOT MENTION, ASK EXPLICITLY IF THIS QUESTION WOULD BE ASKED, AND CODE THE APPROPRIATE RESPONSE: RESPONSE CODES: MENTIONED WITHOUT PROMPTING . ... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-e ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. How long have you suffered from this cough or fever? l_ l b. Do you have asthma or difficulty breathing? c. Is there any blood when you cough? d. What was the color of the sputum? e. Do you have any pain in the chest? 130 PART G: PROTOCOL FOR A COUGH AND FEVER CASE 3. What do you do when you conduct a physical examination of the patient? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-f ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Examine the consciousness of the patient? _ b. Take the patient's temperature? c. Listened to the sound of the respiration? d. Observed the ear lobe? Li e. Observed the patients chest for any retraction of the ribs? f. Looked for any signs of cyanosis? 4. What laboratory examinations would you conduct? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-d ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Routine blood examination? l l b.Thorax / rontgen photographs? l c. Mantoux test? [.X1 d. Sputum examinations? l i 131 PART H: PROTOCOL FOR VOMITING AND DIARRHEA CASE INSTRUCTIONS: ASK THESE QUESTIONS TO THE PERSON IN THE FACILITY WHO IS MOST LIKELY TO HANDLE A CHILD PATIENT WHOSE MOTHER REPORTS THAT HE OR SHE IS ILL WITH VOMITING AND DIARRHEA. 1. POSITION OF RESPONDANT DIRECTOR . ........................... 1 DOCTOR .............................. 2 NURSE ............................... 3 PARAMEDIC .. 4 TECHNICIAN .. 5 OFFICE WORKER .. 6 OTHER (SPECIFY ) ............. 7 Now I would like to understand the process by which you examine a child suffering from diarrhea. I would like to know the steps you take from the moment the patient arrives, is waited upon, until he or she leaves for home. I will describe a case where a mother comes with her daughter. After that I would like you to explain what you usually do for such cases. Now I will read out the case (READ OUT 2 TIMES): Mrs. XX came to the clinic together with her daughter, an 8 month old baby. She says that her daughter has had diarrhea for two days, with vomiting. Now I would like to ask you exactly what you would do for this patient. 2. What questions do you ask about the patient when you start examining her? FIRST LISTEN TO THE RESPONDENT. ANY QUESTION THAT HE OR SHE MENTIONS SHOULD BE MARKED WITH CODE 1. AFTER THE RESPONDENT IS FINISHED, FOR ANY QUESTION THAT HE OR SHE DOES NOT MENTION, ASK EXPLICITLY IF THIS QUESTION WOULD BE ASKED, AND CODE THE APPROPRIATE RESPONSE: RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-f ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. When did the diarrhea start? b. How many times a day does diarrhea occur? c. What did the feces look like? d. How many feces were solid? e. Was there any blood on the feces? _ f. Was there any fever? 132 PART H: PROTOCOL FOR VOMITING AND DIARRHEA CASE 3 What do you do when you conduct a physical examination of the patient? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES ...... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-g ONLY IF THE RESPONDENT DID NOT MENTION THEM. a.Check her consciousness? b.Take her temperature? l c. Examine the crown of the head? d.Check whether pulse is weak or strong? e. Check for difficulties in breathing? f. Check for cyanosis? g. Look for any tumor of the skin? 4. If this baby has mild dehydration, what do you do? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-d ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Consult with someone who has more expertise? b. Supply oral antibiotics? c. Administer oralite? d. Supply a Ringer Lactat infuse medicine? li l 133 PART H: PROTOCOL FOR VOMITING AND DIARRHEA CASE 5. What instructions do you give the mother before sending her home with the patient? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES ... .2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-f ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Give instructions for making an oralite liquid? ___ b. Give instructions on how to supply oralite? l c. Instruct the mother to continue to breastfeed the baby? d. Instruct the mother to feed other food that is permitted? e. Tell mother that if condition worsens, come back at once? f. Tell mother to return for a checkup before medicine runs out? _ 6. What are the follow-up steps you take if the case turns out to be a vomiting and diarrhea disease? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-e ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Take a spare rectal swab? _ b. Look for a different case near the patient's home? _ c. Report to the local health service? d. Check the oralite stock? m e. Check the Ringer Lactat stock? lI l 134 PART 1: PROTOCOL FOR A PREGNANCY EXAMINATION CASE 1 Does this health facility provide prenatal care? Y l YES. . 1l .....l NO...2 (>>PART J) INSTRUCTIONS: ASK THESE QUESTIONS TO THE PERSON IN THE FACILITY WHO IS MOST LIKELY TO HANDLE A PREGNANCY EXAMINATION CASE. 2. POSITION OF RESPONDANT DIRECTOR ........................... 1 DOCTOR ...........................2 NURSE ...........................3 PARAMEDIC .......................... . 4 TECHNICIAN ......................... . 5 OFFICE WORKER ..................... . 6 OTHER (SPECIFY ) .............7 We would like to understand the process by which you provide a pregnancy examination. We would like to know everything you do, beginning with the arrival of the patient, waiting upon the patient and ending when she goes home. I shall describe a pregnant mother, then I will ask you to explain anything you perform regularly. Now I will read out the case (READ OUT 2 TIMES): Mrs. XX, a married woman, says she has not had her periods for 3 months. She has come to you for a pregnancy examination. This is her first visit. She appears to be in good health. Please describe everything you would do during Mrs. XX's first visit. INTERVIEWER: DO NOT READ THIS OUT!! THIS INFORMATION IS ONLY PROVIDED IF THE RESPONDENT ASKS THE RELEVANT QUESTIONS: Mrs. XX is 23 years old. This is her second pregnancy. She has a son aged 2 years. 3. Do you record this first visit on a card? YES.-.1 NO...2 [ 135 PART I: PROTOCOL FOR A PREGNANCY EXAMINATION CASE 4. What general information do you ask about Mrs. XX? FIRST LISTEN TO THE RESPONDENT. ANY QUESTION THAT HE OR SHE MENTIONS SHOULD BE MARKED WITH CODE 1. AFTER THE RESPONDENT IS FINISHED, FOR ANY QUESTION THAT HE OR SHE DOES NOT MENTION, ASK EXPLICITLY IF THIS QUESTION WOULD BE ASKED, AND CODE THE APPROPRIATE RESPONSE: RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-f ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Name? ___ b. Age? l_ l c. Address? li l d. Husband's name? l_ l e. Husband's age? f. Husband's employment? _ 5. How do you determine that Mrs. XX is pregnant? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-c ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Latest menstruation date? rI l b. Feeling of nausea? l11 c. Check her urine? l l 136 PART 1: PROTOCOL FOR A PREGNANCY EXAMINATION CASE 6. What do you ask her about her pregnancy history? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING ....I. HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-d ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. The number of previous pregnancies that Mrs. XX has had? lI l b- Has she had a miscarriage? _ c. Did she once have bleeding? _ d. Did she receive tetanus immunization during her previous pregnancy? 7. What do you ask about Mrs. XX's previous delivery? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-d ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Where did delivery take place? b. Who assisted at the delivery? c. Any complications during delivery, such as bleeding or long labor? |Z l d. Previous baby's weight at delivery? L 137 PART 1: PROTOCOL FOR A PREGNANCY EXAMINATION CASE 8. What do you ask about Mrs. XX's health history? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-d ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Hiqh blood pressure? lXl b. Diabetes? c. Heart disease? l l d. Any hereditary diseases? e. Does patient smoke? | X 9. What do you do when you conduct a physical examination of Mrs. XX? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING.... 1 HAD TO PROMPT, ANSWERED YES.... 2 HAD TO PROMPT, ANSWERED NO .3 READ OUT QUESTIONS a-i ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Body height? _ b. Body weight? c. Blood pressure? _ d. Eye examination, for pale look? l l e. Abdominal examination, for determining the size of the uterus? f. Check leqs for varicose veins? g. Immunization for tetanus? m h. Breast examination? | X i. Determining whether a patient belongs to a high risk group? m 138 PART 1: PROTOCOL FOR A PREGNANCY EXAMINATION CASE 10. What laboratory examinations would you conduct? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-d ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Pregnancy test? _ b. Hemoglobin test? c. Urine examination for diabetes? d. Urine examination for proteins? 11. What advice and instructions do you give Mrs. XX before sending her home? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES ... .2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-g ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Advice about nutrition for expectant mothers? _ b. Supply of vitamins? _ c. Supply of iron tablets? d. Advice about sexual relations? e. Advice about potential pregnancy problems? _ f. Schedule her for another prenatal visit? _ g. Schedule her for childbirth? 139 PART I: PROTOCOL FOR A PREGNANCY EXAMINATION CASE I would also like to talk briefly about another case. Mrs. ZZ is at an advanced stage of pregnancy, estimated to give birth in another two weeks. So far, Mrs. ZZ's conditions has been good and she is expected to give birth without complications. I would like to know exactly what services Mrs. ZZ should have received up to now. 12. What examinations and actions should have been done for Mrs. ZZ? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-j ONLY IF THE RESPONDENT DID NOT MEN-T ION THEM. a. Hemoglobin for anemia? b. Urine for diabetes? c. Urine for preteinuria? Lii d. Test for any venereal disease? l_ l e. Pregnancy examination for determining the size of the fetus? _ f. Pregnancy examination for determining the position of the fetus? g. Pelvic examination in order to assess the proportionality between the size of the fetal head and the mother's hips? h. Leg examination for any swelling? i. Monitoring of blood pressure? j. Injection of tetanus toxoid (2 times)? 140 PART J: PROTOCOL FOR PROVISION OF IUD 1 Does this health facility provide IUD or Sprial service for women of childbearing age? YES. . 1 l l NO... 2 (>PART K) INSTRUCTIONS: ASK THESE QUESTIONS TO THE PERSON IN THE FACILITY WHO IS MOST LIKELY TO HANDLE THE INSERTION OF AN IUD. 2. POSITION OF RESPONDANT DIRECTOR .. 1 DOCTOR . ............................. 2 NURSE ............................... 3 PARAMEDIC . .4............... TECHNICIAN .. 5 OFFICE WORKER .. 6 OTHER (SPECIFY ).............7 We would like to understand the process by which you provide lUDs to a woman of childbearing age. We will explain a case to you. Then we would like to know everything you do, beginning with the arrival of the patient, waiting upon the patient, until the service is finished. If in rendering the service there is someone who assists you, please mention also the steps taken by that assistant. Now I will read out the case (READ OUT 2 TIMES): Mrs. XX, age 22, married and in good health, comes here to have an IUD inserted. She is not currently using any contraceptive device. Please describe everything you would do during her visit. 3. In order to determine whether the IUD instruments are appropriate for Mrs. XX what matters should be discussed with her about her health history? FIRST LISTEN TO THE RESPONDENT. ANY QUESTION THAT HE OR SHE MENTIONS SHOULD BE MARKED WITH CODE 1. AFTER THE RESPONDENT IS FINISHED, FOR ANY QUESTION THAT HE OR SHE DOES NOT MENTION, ASK EXPLICITLY IF THIS QUESTION WOULD BE ASKED, AND CODE THE APPROPRIATE RESPONSE: RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO.....3 READ OUT QUESTIONS a-i ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Has she given birth before? b. Number of children she has? c. Is she currently pregnant? d. Does she still shed blood at childbirth? | I 141 PART J: PROTOCOL FOR PROVISION OF IUD e. Date of last menstruation (period)? C = f. Date of hip inflammation? ii g. History of irregular periods? I h. History of pains in the lower abdomen or above the urinal pouch? I i. History of leucorrhea? L 4. What matters should be discussed with Mrs. XX concerning the use of the IUD? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .... 1 HAD TO PROMPT, ANSWERED YES ....2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-n ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Benefits of IUD? I b. Drawbacks of contraception aside from the IUD? c. Types of IUDs and appropriateness of prices? d. Possible side effect: bleeding after IUD insertion? e Possible side effect: pain when period occurs? f. Possible side effect: more menstruation than usual? g. Possible side effect: pain during sexual intercourse? h. Possible side effect: pain after insertion of IUD? i. Possible side effect: expulsion of IUD? j. Possible side effect: IUD moved? k. Possible side effect: leucorrhea after insertion of IUD? 1. What to do after occurrence of a side effect? m. When is intercourse allow after IUD is attached? l n. When must the patient come in for a check-up? 142 PART J: PROTOCOL FOR PROVISION OF IUD 5. Please explain all the steps taken in inserting the IUD, from the moment of preparing the instrument until the insertion of the IUD. AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING .. . .1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-h ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Washing one's hands? _ b. Putting on one's gloves? m c. Sterilization of instruments and of IUD? ___ d. Internal examination to check for infection, erosion, polypus tumor, or abcess of the womb (uterus)? e. Internal examination to ensure that there is no pregnancy? l__ f. Internal examination to determine the position of the uterus? I7I g. Internal examination (with uterus sonde) to determine the measure of womb cavity? l_ l h. Supplying medicines such as antibiotics? l_ l 143 PART K: PROTOCOL FOR PROVISION OF ORAL CONTRACEPTIVES 1 Does this health facility provide oral contraceptives for women of childbearing age? YES. . 1 NO... 2 (>END OF INTERVIEW) INSTRUCTIONS: ASK THESE QUESTIONS TO THE PERSON IN THE FACILITY WHO IS MOST LIKELY TO HANDLE A CASE OF A WOMAN WHO WOULD LIKE ORAL CONTRACEPTIVES. 2. POSITION OF RESPONDANT DIRECTOR..1 DOCTOR .............................. 2 NURSE ............................... 3 PARAMEDIC .. 4 TECHNICIAN .. 5 OFFICE WORKER .. 6 OTHER (SPECIFY ) ............. 7 We would like to understand the process by which you provide oral contraceptives to a woman of childbearing age. We will explain a case to you. Then we would like to know everything you do, beginning with the arrival of the patient, waiting upon the patient, until the service is finished. If in rendering the service there is someone who assists you, please mention also the steps taken by that assistant. Now I will read out the case (READ OUT 2 TIMES): Suppose that Mrs. ZZ, age 25 and married, comes here wishing to obtain and use oral contraception. She is not currently using any form of contraceptive. She appears healthy. Please describe everything you would do during Mrs. ZZ's visit. 3. In order to determine whether the oral contraceDtives are aDDroDriate for Mrs. ZZ. what matters should be discussed with her about her health historv? FIRST LISTEN TO THE RESPONDENT. ANY QUESTION THAT HE OR SHE MENTIONS SHOULD BE MARKED WITH CODE 1. AFTER THE RESPONDENT IS FINISHED, FOR ANY QUESTION THAT HE OR SHE DOES NOT MENTION, ASK EXPLICITLY IF THIS QUESTION WOULD BE ASKED, AND CODE THE APPROPRIATE RESPONSE: RESPONSE CODES: MENTIONED WITHOUT PROMPTING ... . 1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO ..... 3 READ OUT QUESTIONS a-h ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Date of last menstruation (period)? b. Did she ever take contraceptive pills before this? l1 l c. Is she currently pregnant? l I 144 PART K: PROTOCOL FOR PROVISION OF ORAL CONTRACEPTIVES d. Is she currently breastfeeding a baby? e. Does she have varices on her foot? f. History of heart disease? m g. History of jaundice? h. History of hypertension? I 4. What matters should be discussed with Mrs. ZZ concerning the use of oral contraceptives? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING ....1 HAD TO PROMPT, ANSWERED YES .... 2 HAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-h ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Rules for taking contraceptives? b. What to do if she forgets to take a pill? _ c. When should she make a return visit to the facility? d. When and where to obtain additional pills? e Possible side effect: menstruation lengthening, shortening, or not occurring at all? f. Possible side effect: nausea or vomiting? g. Possible side effect: weight gain? h. Possible side effect: brown spots on face? 145 PART K: PROTOCOL FOR PROVISION OF ORAL CONTRACEPTIVES 5. What laboratory examinations would you conduct for Mrs. ZZ? AGAIN, FIRST LET THE RESPONDENT ANSWER. AFTER HE OR SHE IS FINISHED, ASK EXPLICITLY ABOUT ANYTHING NOT MENTIONED BY THE RESPONDENT. RESPONSE CODES: MENTIONED WITHOUT PROMPTING ....I. HAD TO PROMPT, ANSWERED YES ... .2 EAD TO PROMPT, ANSWERED NO .....3 READ OUT QUESTIONS a-f ONLY IF THE RESPONDENT DID NOT MENTION THEM. a. Check weight? b. Check blood pressure? c. Check swelling of goiter? _ d. Check breasts? _ e. Laboratory test: Hb? l_ l f. Laboratory test: urine? END OF INTERVIEW. THANK ALL OF THE RESPONDENTS FOR THEIR COOPERATION. 146 Module for Chapter 9 Employment Julie Anderson Schaffner The eimiploymiient module for the household questionnaire sions to the standard version. Survey designers should pur- is presented on the following pages. As explained in sue the extensions in which they are interested, but should Chapter 9 of Volume 1, there are three different versions: not pursue all of them1 because doing so would make the short, standard and expanded. The short and standard ver- module too long. Second, details on self-employnment activ- sions are each divided into four parts: A, B, C, and D. The ities are best captured in the modules on agriculture and expanded version includes longer versions of those four non-farm household enterprises.This is explained in detail parts plus two new parts on employment history, E and F in Chapter 9, and in Chapters 18 and 19 ofVolume 2. If the There are two points to keep in mind when adapting survey does not contain those maodules, then the informa- these draft modules to a particular country. First, the tion must be captured in the employment module, though expanded version is presented to illustrate a variety of exten- this will be on a more limited level of detail. 147 LABOR MODULE (SHORT VERSION) PART A. LABOR FORCE PARTICIPATION ALL PERSONS 6 YEARS AND OLDER 1. 2 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. I IS THIS During the At any During the past 7 At any time During the past 7 At any time CHECK Do you What is the main Have What is the main reason CHECK D PERSON past 7 days, time days, have you during the last days, have you during the THE have a reason that you you you did not look for a ANSWERS ANSWER- have you during the worked on a farm 12 months worked on your last 12 ANSWERS perma- did not work in looked job in the last 7 days? TO C ING FOR worked for last 12 owned or rented have you own account or months did TO QUES- nent job the last 7 days? for work (MOST IMPORTANT QUESTIONS 0 HIMSELF someone who months by a member of worked on a in a business you work on TIONS 2, 4 even in the REASON) 3, 5 AND 7 D /HER- is not a have you your household, farm owned or enterprise your own AND6. though last 7 STUDENT ..... 1 (WORKED IN E SELF? member of worked for either in rented by a belonging to you account or in (WORKED you did days? HOUSEWIFE/ LAST 12 your house- anyone cultivating crops member of or s e in ab NLAST7 no wor S s.. CHILDCARE . 2 MONTHS) hold fo whois ot o inothe yor hose- your household, enterprise DAYS) in the last MATERNITY. .2 TOO OLD/RETIRED.3 exapl, a amemerfarin taks orhod,or cared 7dy?HOUSEHOLD HANnICAPPED... 4 enexaplie, an aymmbr harmingu tasks, for hld,stck for example, as a belonging to 7dy? MEMBER ILL. 3 WAITING FOR conpany, the house- for livestock belonging to a trader, shop- you or some- VACATION. . 4 REPLY FROM comrany ther hold? belonging to a keeper, barber, one in your STRIKE/ EMPLOYER. 5 govranm tenthl? blnigtr member ofyor ou dressmaker, household? SUSPENSION. 5 WAITING FOR individual? household? household? carpenter or axi TEMPORARY RECALL BY driver? ANY WORK LOAD EMPLOYER ....6 ANY YES. 1 YES . 1 REDUCTION ..6 WAITING FOR BUSY (>>PART B) YES .. 1 YES ...1 YES .. 1 YES .. 1 YES .. 1 YES ... 1 YES .. 1 (-PART B) YES ..1 OTHER (SPE- YES ..1 SEASON ...... 7 ALL NO. .. 2 NO.. ..2 (-4) NO ....2 (>>6) NO . 2 ('>8) NO... 2 ALL NO.. 2 CIFY -_ ).7 (>>13) OTHER(SPE- (, NEXT I NO.... 2 NO.... 2 NO ....2 NO... 2 (.11) NO... 2 CIFY__ 8 PERSON) -1 2 3 4 6 7 9 11 1 12 : LABOR MODULE (SHORT VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS AND LAST 12 MONTHS I would like to ask you some questions about the work you did in the last 7 days and the last 12 months, whether work on a farm, on your own account, in a household business enterprise, or for someone else. Lets start with the work that you did in the past 7 days. If you did not work in the last 7 days but had a permanent job, please describe your permanent job. If you did not work or have a job during the past 7 days, describe the work that you did in the past 12 months. 1. 2. 3. 4. 5. 6. A I What did you do? What kind of trade or business is it connected In this work were you working on a Which of these For how For how C D with? farm owned or rented by you or a enterpnses is this work many many T member of your household were associated with? different different I C you working on own account or in REVIEW employers employers V O a nonfarn business enterprse ENTERPRISES did you did you do I D belonging to you or a member of REPORTED IN do this this work T E your household, or were you HOUSEHOLD work in the last Y working for someone who is not a ENTERPRISE during the 7 days? member of your household? OVERVIEW last 12 c MDL.IF THS months? IF NO 0 MODULE. I NTHI DAYS D FARM OWED OR RENTED ACV THEREY I NT WORKED D ~~~~~~~~~~~~ ~ ~~~~~~~~BY HOUSEHOLD REVISE THAT IN DAYS, K01BER ........1('-7) MODULE. ENDAER OWN ACCOUNT/HOUSEHOLD ENERO EMFtsPRISE .........a..2[El ZERO WORi FOR NON-HOUSEHOLD AND X 9 WRITTEN OCCUPATION WRITrEN INDUSTRY MEMBER .....3 ( ENTERPRISE _ - _ _DESCRIPTION CODE DESCRIPTION| CODE CODE NUMBER NUMBER A __ B_ H _ J __ IK I ,,,,, ,,,,I, IL I I LABOR MODULE (SHORT VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS AND LAST 12 MONTHS 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. A I For how For how For how During MULTIPLY CHECK THE Did you do CHECK FOR FIRST AND In addition CHECK FOR THE FIRST C D many days many hours many these ANSWER ANSWERS TO any other SECOND HIGHEST ANSWERS to the work AND SECOND HIGHEST T in the last 7 in the last 7 weeks in weeks, how TO Q. 9 QUESTION 6 OF work in the TO QUESTION 8 (HOURS you have ANSWERS TO QUESTION I C days did days did the last 12 many hours BY PART B AND last 7 days, WORKED IN LAST 7 DAYS) FOR already 11 (HOURS WORKED IN V 0 you do this you do this months did per week ANSWER QUESTION 9 OF or did you THIS INDIVIDUAL. (IF HE OR described, LAST 12 MONTHS) FOR I D work, for work? you do this did you TO Q. 10 PART A have any SHE REPORTED ONLY ONE did you do THIS INDIVIDUAL. T E any work? usually do (HOURS (CHECKING FOR other ACTIVITY, MARK IT AS CODE 1.) any other Y employer? this work? WORKED NO JOB AT ALL IN permanent work during ACTIVITY FOR WHICH IN THE LAST 7 DAYS). job from ACTIVITY FOR W the past 12 ACTIVITO ICN C LAST 12 which you ANSWER TO 8BE months? ANSWER TO lIS 0 MONTHS) were HIGHEST ..... 1 HIGHEST .......... 1 D Q.6 OF PART B temporarily ACTIVITY FOR WHICH ACTIVITY FOR WHICH D EQUALS 0 AND absent? ANSWER TO 83E ANSWER TO 1tS Q.9 OF PART A SECOND HIGHEST ... 2 SECOND HIGHEST... 2 E EQUALS 2.. 1 ACTIVITY FOR WHICH ACTIVITY FOR WHICH (>>15) YES... 1 ANSWER TO 8BE YES... 1 ANSWER TO lIS ALL OTHER (>>NEXT NEITHER FIRST NOR (>NEXT NEITHER FIRST NOR -n DAYS HOURS WEEKS HOURS HOURS CASES ......2 LINE) SECOND HIGHEST... 3 LINE) SECOND HIGHEST ..3 U' O _ PER WEEK PER WEEK PER YEAR PER WEEK PER YEAR NO... 2 NO.... 2 A _. B5_ C _ D-- L~~~~~~~~~~~~~~~_ LABOR MODULE (SHORT VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS AND LAST 12 MONTHS 17. 18. 19. 20. A I CHECK THE ANSWERS TO CHECK THE ANSWERS CHECKTHE CHECK THE ANSWERS c D QUESTIONS 14 AND 16. TO QUESTIONS 14 AND ANSWERS TO TO QUESTION 14. T FOR THE ACTIVITY WITH 16. FOR THE ACTIVITY QUESTIONS 14 AND HOW MANY ACTIVITIES I C CODE 1 IN QUESTION 16, WITH CODE 2 IN 16. FOR THE HAS THIS PERSON HAD V 0 WHAT IS THE CODE IN QUESTION 16, WHAT IS ACTIVITIES WITH IN THE PAST 7 DAYS? I D QUESTION 14? (CHECKING THE CODE IN QUESTION CODE 3 IN QUESTION T E TO SEE IF MAIN JOB IN 14? (CHECKING TO SEE 16, WHAT ARE THE y PAST 12 MONTHS IS MAIN IF SECOND JOB IN PAST CODES IN QUESTION OR SECOND JOB IN LAST 7 12 MONTHS IS MAIN OR 14? C DAYS.) SECOND JOB IN LAST 7 0 DAYS.) D D 0.14 CODE IS AT LEAST ONE E 1 OR 2.....1 ACTIVITY HAS ZERO .... 0 (PART D) Q. 14 CODE IS Q. 14 CODE IS CODE 3 OR IS ONE . 1 (PART C) 1 OR 2 ... 1 3 OR BLANK.. 2 BLAN IN Q.14.. 1 TWO. 2 (PART C) Q. 14 CODE IS NO CODE 2 IN ALL OTHER THREE _ _ 3 OR BLANK. .2 Q.16... 3 CASES ... . 2 OR NORE.3 (PART C) A__ E __ F_ G_ H__- LABOR MODULE (SHORT VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 1. ~~~~~~~~~2. 3. 4. 5. 6. FOR EACH PERSON, LOOK AT Now I would like to ask you about your work as In this work were you... Is your employer for this How many Are you D THE ANSWERS TO QUESTION [READ OUT OCCUPATION FROM QUESTION 1]. (READ ALL RESPONSES) work... (READ ALL people entitled to C 14 OF PART B. WRITE DOWN If you did this work for more than one employer in aRESPONSES) altogether the benefits THE OCCUPATION WITH CODE the last 7 days, please think about the employer forwork at of socia 0 1 IN THAT QUESTION (MAIN whom you worked the most hours during the last 7 - private company, the place security D a worker on own accounto enterprise or where you program in E OCCUPATION IN THE LAST 7 days. Where did you carry out most of this work in unpaid worker in a house- cooperative?. 1 do this rthisrnobn DAYS) the last 7 days? holdatve farm1doths or jb hold farm or ~~~~~~~~work? nonfarm business a rural public FARM OWNED OR .............ETE enterprise? ..... 2(>22) works program? .... 2 HOUSEHOLD MEMBER ..................1 OCCUPATION CODE TO BE OTHER FARM . ............. 2 a paid worker in a household the government, FILLED IN BY SUPERVISOR YOUR HOME . . . 3 farm or nonfarm business public sector OTHER HOME . . . 4 enterprise? ........ 3(-12) or army? .......... 3 VEHICLE.. 5 FROM DOOR TO DOOR . . 6 an employee of someone who a state-owned IN THE STREET, NO FIXED PLACE .7 is not a member of your enterprise? . 4 IN THE STREET, FIXED PLACED .8 household? .......... 4 YES . .1 OCCUPATION OFFICE/FACTORY . ........... 9 a private NO . . .2 _COCCUP ATION CODE OTHER (SPECIFY__ ). 10 individual? ....... 5 NUMBER 5- 5- 9 10 8- 12 LABOR MODULE (SHORT VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. I Is this job How often do How long does it Do you What is the main How much was your How many Are any Do you What is the value of D covered by you travel take you to get to receive reason you receive no last payment? hours did you income, receive those payments? a collective from home to work from here? wages, salary payment for this IF RESPONDENT work (or will social any Over what time C bargaining work (for or other work? HAS NOT YET BEEN you work) for security or payment interval? O agreement? example, (TIME ONE WAY payments PAID, ASK: What the pay you workers' for this D twice a day or ONLY) either in cash payment to do you just reported? compensation work in E once a week)? or in other ,,17 expect? What period Please taxes any other forms from of time did this include any deducted form? this employer payment cover? hours of paid from your for this work? vacation or pay? sick leave. APPRENTICESHIP OR UNPAID TRAINEESHIP.. .1 LABOR EXCHANGE.2 YES. .1 YES... 1 OTHER .3 YES .. 1 YES ... 1 NO ....2 TIME (>12) (SPECIFY) .. 4 TIME NO... 2 NO .... 2 TIME _UMBER UNI ..............UR..MENUTES NO.... .2 (SEIY).. UNIT HOURS (|>17) AMOUNT UNIT 4 7 9 2 H OUR .... 2 DAY.... 3 WEEK.... 4 FORTNIGHT ...... 5 MONTN. . .. ... 6 QUARTER.o....... 7 HALF YEAR ...... 8 YEAR... 9j LABOR MODULE (SHORT VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 17. 18. 19. 20, 21. 22. 23. 24. I Is this the During the During the During the During the CHECK FOR THIS PERSON, LOOK AT Now I would like to ask you about your work as [READ D only last 7 days, last 7 last 12 weeks you QUESTION THE ANSWERS TO QUESTION OUT OCCUPATION FROM QUESTION 23]. If you did employer for how many days, how months, worked for 20 IN PART 14 OF PART B. WRITE DOWN this work for more than one employer in the last 7 days, C whom you days did many for how this B. DID THE THE OCCUPATION WITH CODE please think about the employer for whom you worked the 0 did this work you work hours did many employer in INDIVIDUAL 2 IN THAT QUESTION most hours during the last 7 days. Where did you carry D in the last 12 for this you work weeks did the last 12 REPORT (SECONDARY OCCUPATION IN out most of this work in the last 7 days? E months? employer? for this you work months, for MORE THE LAST 7 DAYS). employer? for this how many THAN ONE employer? hours did KIND OF employer? hours did KIND OF FARM4 OWNED OR RENTEID BY HOUSEHOLD MEMBER..1 you usually WORK IN OTHER FARM ......... 2 work per THE PAST?7 YOTHR FAOME.2................ week? DAYS? OCCUPATION CODE YOUR HOME.3 TO BE FILLED IN BY OTHER HOME ......... 4 SUPERVISOR. VEHICLE.................. 5 FROM DOOR TO DOOR .6 IN THE STREET, NO FIXED PLACED ...... 7 IN THE STREET, FIXED PLACED ...... 8 YES.. 1 DAYS HOURS WEEKS HOURS YES... 1 OFFICE/FACTORY . ................ 9 (.21) PER PER PER PER NO... |2 OCCUPATIONI OTHER (SPECIFY - ) .10 NO.... 2 WEEK WEEK YEAR WEEK ("45) OCCUPATION CODE 4- 7 8 12 _ iT.. LABOR MODULE (SHORT VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 25. 26. 27. 28. 29. 30. 31. 32. 33. I In this work were you... Is your employer for this How many Are you Is this job Do you What is the main How much was your How many D (READ ALL RESPONSES) work... (READ ALL people entitled to covered by receive reason you receive no last payment? hours did you an employer? .......... 1(>42) RESPONSES) altogether the benefits a collective wages, payment for this work? IF RESPONDENT work (or will you C a private company, work at the of social bargaining salary or HAS NOT YET work) for the 0 a worker on own account enterprise or place security agreement? other BEEN PAID, ASK: pay you just D or unpaid worker in a cooperative? . 1 where you program in payments What payment to do reported? E household farm or do this this job? either in you expect? What Please include nonfarm business a rural public work? cash or in period of time did any hours of enterprise? ......... 2(>42) works program? ..... 2 other forms this payment cover? paid vacation or from this sick leave. a paid worker in a the government,pub- employer for household farm or lic sector or army?.3 this work? nonfarm business APPRENTICESHIP enterprise? .......... 3(>>32) a state-owned OR UNPAID enterprise? ........ 4 TRAINEESHIP... 1 an employee of someone LABOR EXCHANGE.2 who is not a member of a private YES . 1 YES. 1 YES .1 PAYING OF DEBT.3 your household? ...... .individual? ........ 4 i No .... 2 NO .... 2 ("32) (SPECIFY _ )...4 TINE NUMBER NO.... 2 AMOUNT |UNIT HOURS 6- = ,10 7 12 E NOUR..2 DAY ... 3 WEEK.... 4 FORTNIGZAT ....... 5 moNTH ...... 6 QUARTER ..... 7 HALF YEA4R.8 YEAR-9l LABOR MODULE (SHORT VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. I Are any Do you What is the value of Is this the During the During the During the During the CHECK You reported having done How much did you D income, receive any those payments? only last 7 days, last 7 days, last 12 weeks you QUESTION 20 work in the last 7 days receive for this other social payment for Over what time employer how many how many months, for worked for IN PART B. besides the two jobs you work, including tips, C security or this work in interval? for whom days did hours did how many this DID THIS have just described to me gratuities, bonuses, 0 workers' any other you did this you work for you work fo weeks did employer in PERSON in detail. In any of these and the value of any D compen- form? work in the this this you work for the last 12 REPORT jobs did you work for payment in kind, E sation last 12 employer? employer? this months, for THREE OR someone who is not a after subtracting taxes months? employer? how many MORE KINDS member of your taxes deducted? deducted hours did OF WORK IN household, or were you a What period of time from your you usually THE PAST 7 paid employee on a family did this payment pay? work per DAYS? farm or in an enterprise or cover? week? money making activity belonging to a member of your household? YES ... 1 YES ...1 YES...1 DAYS HOURS WEEKS HOURS YES ... 1 YES ... 1 NO ....2 NO ....2 TIME ("42) PER PER PER PER NO ....2 NO ....2 TIME _("37) AMOUNT UNIT NO.... 2 WEEK WEEK YEAR WEEK (.45) (>>45) AMOUNT UNIT 3 4 9 10 11_ 12= 1 '= HOUR_2 AY.. .. 3 WEEK.... 4 FORTNIGHT... 5 MONTH ..... 6 QUARTER.... 7 HALF YEAR...3 YEAR..9 LABOR MODULE (SHORT VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 45. 46. 47. I FOR THIS CHECK QUESTION CHECK QUESTION D PERSON, CHECK 18 IN PART B. 19 IN PART B. THE ANSWER TO WHAT IS THE WHAT IS THE C QUESTION 17 IN CODE FOR THE CODE FOR THE O PART B. WHAT IS ANSWER TO THAT ANSWER TO THAT D THE CODE FOR QUESTION? QUESTION? E THE ANSWER TO THAT QUESTION? CODE 1 ... .1 CODE 2 ... .2 CODE 1... .1 CODE 1.. .1 (-PART D Q.20) (-sPART D Q.38) CODE 2. ..2 CODE 3... .3 CODE 2. ...2 (,,PART D, Q. 1) (>NEXT PERSON) (>>NEXT PERSON) in 1 2 3 4 5- 7 8__ 10L L 12 LABOR MODULE (SHORT VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 1. 2. 3. 4. 5. 6. FOR THIS PERSON, LOOK AT Now I would like to talk about your work as [READ in this work were you... Is your employer for this work... How many Are you D THE ANSWERS TO QUESTION OUT OCCUPATION FROM QUESTION 1]. If (READ ALL RESPONSES) (READ ALL RESPONSES) people entitled to 16 OF PART B. WRITE DOWN you did this work for more than one employer in altogether the benefits C THE OCCUPATION WITH CODE the last 12 months, please think about for the an employer? .......... 1(>19) a private company, work at the of social O 1 IN THAT QUESTION employer for whom you worked the most hours enterprise or place where security D (MAIN OCCUPATION IN THE during the last 12 months. Where did you carry a worker on own account cooperative? .......... 1 you do this program in E LAST 12 MONTHS). out most of this work in the last 12 months? or unpaid worker in a work? this job? household farm or rural public works nonfarm business program? .2 FARM OWNED OR RENTED OCCUPATION CODE TO BY HOUSEHOLD MEMBER .......... 1 enterprise? ......... 2(>>19) BE FILLED IN BY OTHER FARM.2 a paid worker in a house- tor oblrc SUPERVISOR. YOUR HOME ..................... 3 hold f arm or nonfarm OTHER HOME .................... 4 business nterprse?.3(l) a state-owned VEHICLE ................ ...... 5 enterprise? ........... 4 FROM DOOR TO DOOR.6 FROMDOORTO DOR .......... 6 an employee of someone IN THE STREET, NO FIXED PLACE.7 who is not a member of a private IN THE STREET, FIXED PLACE .... 8 your household? ...... 4 individual? YES... 1 OCCUPATION OFFICE/FACTORY ................ 9 NO ... 2 OCCUPATION CODE OTHER (SPECIFY ) 10 NUMBER Un 2 3 4 5 6 iT~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~L 7 8 9 10 11: 12i : : :i: : :: : : : :: -::: : : LABOR MODULE (SHORT VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. I Is this job Did you What is the main How much was your How many Are any Did you What was the Is this the only During the During the During the D covered by receive reason you received last payment? What hours did you income, receive any value of those employer for last 12 weeks you weeks you a collective wages, no payments for this period of time did work for the social additional payments? Over whom you did months, worked for worked for C bargaining salary or work? this payment cover? pay you just secunty or payments, in what time interval? this work in for how this this 0 agreement? other reported? workers' the form of the last 12 many employer employer D payments Please compensation tips, gratuities, months? weeks did in the last in the last E either in ('15) include any taxes bonuses, you work 12 months, 12 cash or in hours of paid deducted food, clothing, for this how many months, other forms vacation or from your housing or employer? days did how many from this sick leave. pay? transportation you usually hours did employer in this work? work per you for this week? usually work? APPRENTICESHIP work per OR UNPAID week? TRAINEESHIP... 1 LABOR EXCHANGE.2 PAYING OF DEBT.3 YES .. 1 YES ... 1 OTHER .YES... 1 YES .. 1 YES ... 1 WEEKS DAYS HOURS NO ....2 (.10) (SPECIFY ) 4 TIME NO ...2 NO ...2 TIME (19) PER PER PER NO .... 2 1 AMOUNT UNIT HOURS (.15) AMOUNT UNIT NO.... 2 YEAR WEEK WEEK 4 5 7~~~HOR. .2 A... .3 WE... .4 OTIH.. .5 OT. 6 URE... . HAL =ER =. YEAR.l 10.I I 12 ........==lll HOUR .. 2 DAY ... 3 WEEK .... 4 FORTNIGHT ....... 5 JfONTH ...... 6 QusARTER ..... 7 HALnF YF-AR ... 8 YAR ... 9l LABOR MODULE (SHORT VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 19. 20. 21. 22. 23. 24. 25. I FOR THIS LOOK AT THE ANSWERS TO Now I would like to talk about your work as In this work were you... Is your employer for this How many Are you D PERSON, QUESTIONS B1 AND B16. WRITE [READ OUT OCCUPATION FROM (READ ALL RESPONSES) work... (READ ALL people entitled CHECK THE DOWN THE SECOND MOST QUESTION 20]. If you did this work for more an em ployer? l(-37) RESPONSES) altogether to the C ANSWER TO IMPORTANT OCCUPATION than one employer in the last 12 months, a private work at the benefits 0 QUESTION 18 (ACTIVITY WITH CODE 2 IN PAST please think about for the employer for whom a worker on own account company, place of social D OF PART B. 12 MONTHS). you worked the most hours during the last 12 or unpaid worker in a enterprise or where you security E WHAT IS THE months. Where did you carry out most of this house- hold farm or cooperative? ... I do this program CODE FOR work in the last 12 months? nonfarm business work? in this THAT OCCUPATION CODE TO BE FARM OWNED OR RENTED BY enterprise? . 2(>'37) rural public job? QUESTION? FILLED IN BY SUPERVISOR. HOUSEHOLD MEMBER .1 works program?.2 OTHER FARM .2 a paid worker in a YOUR HOME .3 household farm or the government, OTHER HOME .4 nonfarm business public sector CODE 1 ... 1 VEHICLE ....... 5 enterprise?.....3(>29) or army? ....... 3 (>>37) FROM DOOR TO DOOR .............. 6 CODE 2 .. .2 IN THE STREET, NO FIXED PLACE ..7 an employee of someone a state-owned CODE 3 ... 3 IN THE STREET, FIXED PLACE ..... 8 who is not a member of enterprise?... 4 YES .. 1 OFFICE/FACTORY . .9 your household' ...4 (-NEXT OCCUPATION OTHER (SPECIFY ) . 10 a private NO.... 2 PERSON) OCCUPATION CODE individual? .... 5 NUMBER 12 3 4- 6 7 8 9 10 11 12 HOUR .... .2 DAY.... .3 WEEK. ... 4 FORTNIGHT... .5 MONTH ....6 QUARTER.... .7 HALF YR... .8 YEAR... .9 LABOR MODULE (SHORT VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. I Is this job Did you What is the main How much was How many Are any Did you What was the Is this the During the During the CHECK D covered by receive reason you received your last payment? hours did income, receive any value of those only last 12 weeks you QUESTION a collective wages, no payments for this What period of time you work for social additional payments? Over employer months, for worked for 19 IN PART C bargaining salary or work? did this payment the pay you security or payments, in what time for whom how many this B. WHAT IS O agreement? other cover? just workers' the form of interval? you did this weeks did employer THE CODE D payments reported? compen- tips, work in the you work in the last FOR THAT E either in 534 Please sation gratuities, last 12 for this 12 QUESTION? cash or in include any taxes bonuses, months? employer? months, other forms hours of deducted food, clothing, how many from this paid from your housing or hours did employer vacation or pay? transportation you for this sick leave. in this work? usually work? APPRENTICESHIP work per OR UNPAID week? TRAINEESHIP... 1 LABOR EXCHANGE.2 CODE 1 1 PAYING OF DEBT.3 YES .. 1 YES .. .1PYGODT YES.. .1 YES ... 1 YES... 1 WEEKS HOURS CODE 2. .2 OTHER NO ....2 (»29) (SPECIFY-) ... 4 TIME NO.... 2 NO ....2 TIME (>.37) PER PER (-NEXT NO ... 2 AMOUNT UNIT HOURS (-34) AMOUNT UNIT NO .... 2 YEAR WEEK PERSON) - 1II 2ll 4 6II 7 8 HOUR .... 2 DAY .... 3 WEEK..... 4 FORTNIGHT... .5 MONTH ....6 QUARTER.... .7 HALF YA... .8 YEAR. ..9 LABOR MODULE (SHORT VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 38. 39. You reported having done work in the last 12 During the past 12 months besides the jobs months, how much did C you have already you receive for this other C described to me in detail. work, including wages, D In any of these jobs did salary, tips, gratuities, E you work for someone bonuses, and the value who is not a member of of any payment in kind, your house-hold, or were after subtracting taxes you a paid employee on a deducted? What period family farm or in an of time did this payment enterpinse or money cover? making activity belonging to a member of your household? -NXT PERSON YES.. .1 NO... .2 TIME (->NEXT PERSON) UNIT a, 1'J 1 2 3 5: 7 8 12 3 |HIOUR.... 2 DAY.... 3 WEEK.... 4 FORTNIGHT ...... 5 MONTH ...... 6 QUARTER ..... 7 HAF yER... S YEAR ... 9l LABOR MODULE (STANDARD VERSION) PART A: LABOR FORCE PARTICIPATION ALL PERSONS 6 YEARS AND OLDER 1 . 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. I IS THIS COPY THE During the past At any time During the past 7 At any time During the past 7 At any time CHECKTHE Do you What is the main Have you D PERSON ID CODE 7 days, have during the days, have you during the last days, have you during the ANSWERS have a reason that you did not looked for ANSWER- OF you worked for last 12 worked on a farm 12 months worked on your last 12 TO permanent work in the last 7 work in C ING FOR RESPOND- someone who months owned or rented have you own account or months did QUESTIONS job even days? the last 7 O HIMSELF/ ENT FROM is not a have you by a member of worked on a in a business you work on 3, 5 AND 7. though F7,14 days? D HER- HOUSE- member of worked for your household, farm owned or enterprise your own (WORKED IN you did not E SELF? HOLD your anyone whether in rented by a belonging to you account or LAST 7 work in the ROSTER household, for who is not cultivating crops or member of or someone in in a DAYS) last 7 SICK.1 example, an a member in other farm your house- your household, business days? M ATERNITY 2 enterprise, of your maintenance hold, or cared for example, as a enterprise HOUSEHOLD company, the household? tasks, or have you for livestock trader, shop- belonging to MEMBER S CH O3 government or cared for livestock belonging to a keeper, barber, you or some- VACATION 4 any other belonging to a member of dressmaker, one in your STRIKE/ individual? member of your your carpenter or taxi household? SUSPENSION .... 5 household? household? driver? TEMPORARY WORK LOAD REDUCTION.6 YES ..1 YES .. 1 YES .. 1 YES. .. 1 YES.. .1 YES.. .1 YES .. 1 ANY YES ..1 YES . 1 OTHER YES .. 1 (-3) ('5) NO ....2 (-7) NO ....2 (t9) NO ....2 (t14) NO ....2 (SPECIFY )..7 (.19) _ NO.... 2 NO... 2 NO ....2 NO... 22 ALL NO.. 2 (-12) NO.. 2 4- 9 _10 I~ = 12 . LABOR MODULE (STANDARD VERSION) PART A: LABOR FORCE PARTICIPATION ALL PERSONS 6 YEARS AND OLDER 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. I What is the main reason you In the last 7 In the last 7 CHECK Who did you consult At any During Were those How many Who did you consult in CHECK D did not look for a job in the days have yOu days have you ANSWERS in your search for point in how weeks you times were your search for work? ANSWERS TO last 7 days? looked for work looked for a TO additional or the last many were looking you QUESTIONS C (MOST IMPORTANT to do in addition work to replace QUESTIONS replacement work? 12 weeks of for work all at unemployed? 4, 6 AND 8 0 REASON) to your current your current 14 AND 15. months, the last once, or at (WORKED IN D work, whether work, whether ALLOW UP TO were you 12 different ALLOW UP LAST 12 E I I on your own work on your THREE without months times? TO THREE MONTHS) STUDENT .........,.1 account, in a own account, RESPONSES work and were you RESPONSES HOUSEWIFE/ household in a household looking without CHILDCARE ....... 2 business enteirpise or BOSS/EMPLOYER ..1 for work? work and TOO OLD/ RETIRED .... 3 enterprise or for for someone EMPLOYMENT looking BOSS/EMPLOYER .1 HANDICAPPED ......... 4 someone who is who is not a AGENCY ........ 2 for work? BOSS.EM PLOYMENT WAITING FOR REPLY not a member member of FRIENDS/ AGENCYM.E2 FRO EMLOER ... 5of your your RELATIVES ....3 ANYNC YE....OR WAITINGFROM REMPLOYhousehold? household? NEWSPAPER ...... ALL AT FRIENDS/ ANY YE OR WAITING FOR RECALL INTERMEDIARY ... 5 ALA EAIE ...3 BAK. BY EMPLOYER ....... 6 ONCE ... 1 NEWSPAPER ...... 4 (-PART B) WAITING FOR BUSY ANY YES.1 YES .. 1 ('22) INTERMEDIARY 5 ALL NO.... 2 SEASON . ....... 7 YES .. 1 YES... 1 ALL NO. .2 NO... 2 DIFFERENT NUMBER (-NEXT) _ OTHER (SPECIFY ).8 NO .... 2 NO .... 2 (-I) 1ST |82ND |3RD (>>23) WEEKS TIMES... 2 OF TIMES lST 2ND 3RD PERSON) 3 7 9 10 _121. LABOR MODULE (STANDARD VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS I would like to ask you some questions about the work you did in the last 7 days and the last 12 months, whether work on a farm, on your own account, in a household business enterprise, or for someone else. Let's start with work that you did in the last 7 days. If you did not work in the last 7 days but had a permanent job, please describe your permanent job. If you did not work or have a job during the past 7 days, describe the work that you did in the past 12 months. 1 . 2. 3. A I What did you do? What kind of trade or business is it connected with? In what crop or with what type of livestock did you C D spend most time in this work in the last 7 days? T I C V 0 I D T E Y IF NOT RELATED TO C AGRICULTURE o4 0 E G' CROP OR WRITTEN OCCUPATION WRITTEN INDUSTRY WRITTEN ANIMAL DESCRIPTION CODE DESCRIPTION CODE DESCRIPTION CODE C F G L LABOR MODULE (STANDARD VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. A I In this work were you working on a Which of these Do you For how For how For how For how For how During MULTIPLY C D farm owned or rented by you or a enterprises is this contribute many many many days many hours many these ANSWER T member of your household, were you work associated to public different different in the last 7 in the last 7 weeks in weeks, how TO Q. 11 BY I C working on own account or in a with? pension employers employers days did days did the last 12 many hours ANSWER V O nonfarm business enterprise belonging scheme did you do did you do you do this you do this months did per week TO Q. 12 I D to you or a member of your household, REVIEW relevant for this work in this work in work? work? you do this did you (HOURS T E or were you working for someone who ENTERPRISES the self the past 12 the last 7 work? usually do WORKED IN C is not a member of your household? REPORTEDIN employed in months? days? this work? THE LAST HOUSEHOLD this work? 12 C ENTERPRISE IF NO MONTHS) 0 OVERVIEW DAYS D ~~~~~~~MODULE. IF ___ WORKED E THSCTVIYIN PAST 7 FARM OWNED OR RENTED HIS AOCTFUIVI TY DAYS, BY HOUSEHOLD MEMBER .. l(9) IS WRITE OWN ACCOUNT/HOUSEHOLD THERE, REVISE ENTERPRISE .2 THAT MODULE. AZNEDRO1 1 a, WORK FOR NON-HOUSEHOLD MEMBER ..... 3('7) YES .. .1 ENTERPRISE NO .... 2 DAYS HOURS WEEKS HOURS HOURS CODE NUMBER NUMBER PER WEEK PER WEEK PER YEAR PER WEEK PER YEAR A F C-- H j L LABOR MODULE (STANDARD VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS 14. 15. 16. 17. 18. 19. 20. A I CHECK THE Did you do CHECK FOR FIRST AND In addition to CHECK FOR THE FIRST AND CHECK THE CHECK THE C D ANSWERS TO any other SECOND HIGHEST ANSWERS the work you SECOND HIGHEST ANSWERS TO ANSWERS TO T QUESTION 8 OF work in the TO Q.10 (HOURS WORKED IN have already ANSWERS TO QUESTION 13 QUESTIONS 16 AND QUESTIONS 16 AND I C PART B AND last 7 days, LAST 7 DAYS) FOR THIS described, did (HOURS WORKED IN LAST 12 18. FOR THE 18. FOR THE V 0 QUESTION 10 OF or did you INDIVIDUAL. (IF THIS you do any MONTHS) FOR THIS ACTIVITY WITH ACTIVITY WITH CODE I D PART A have any INDIVIDUAL REPORTED ONLY other work INDIVIDUAL. CODE 1 IN 2 IN QUESTION 18, T E (CHECKING FOR other ONE ACTIVITY, MARK IT AS during the QUESTION 18, WHAT IS THE CODE Y NO JOB AT ALL IN permanent CODE 1.) past 12 WHAT IS THE IN QUESTION 16? LAST 7 DAYS) job from months? CODE IN QUESTION (CHECKING TO SEE C which you 16? (CHECKING TO IF SECOND JOB IN 0 were ACTIVITY FOR WHICH SEE IF MAIN JOB IN PAST 12 MONTHS IS D Q.8 OF PART B temporarily ACTIVITY FOR WHICH ANSWER TO 13 IS PAST 12 MONTHS IS MAIN OR SECOND E EQUALS 0 AND absent? ANSWER TO 10 IS HIGHEST. 1 MAIN OR SECOND JOB IN LAST 7 DAYS.) Q.10 OF PART HIGHEST ....... 1 ACTIVITY FOR WHICH JOB IN LAST 7 A EQUALS 2. .1 ACTIVITY FOR WHICH ANSWER TO 13 Is DAYS.) (-17) ANSWER TO 10 IS SECOND HIGHEST ...... 2 _ ALL OTHER SECOND HIGHEST ....... 2 ACTIVITY FOR WHICH Q.16 CODE IS CASES .... 2 ACTIVITY FOR WHICH ANSWER TO 13 IS 1 OR 2 ....... 1 YES. .1 ANSWER TO 10 IS YES... 1 NEITHER FIRST NOR Q.16 CODE IS Q.16 CODE IS (>NEXT NEITHER FIRST NOR (>NEXT SECOND HIGHEST ...... 3 1 OR 2 ...... 1 3 OR BLANK 2 LINE) SECOND HIGHEST ....... 3 LINE) Q.16 CODE IS NO CODE 2 IN NO ... 2 NO.... N2 3 OR BLANK. .2 Q.18 ......... 3 A F:- H K _. _L _ LABOR MODULE (STANDARD VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS 21. 22. A I CHECK THE ANSWERS CHECK THE ANSWERS C D TO QUESTIONS 16 AND TO QUESTION 16. T 18. FOR THE HOW MANYACTIVITIES I C ACTIVITIES WITH CODE HAS THIS PERSON HAD V 0 3 IN QUESTION 18, IN THE PAST 7 DAYS? I D WHAT ARE THE CODES T E IN QUESTION 16? Y C 0 D E AT LEAST ONE C0 ACTIVITY HAS ZERO ... 0 (PART D) CODE 3 OR IS ONE ... 1 (PART C) BLANK IN Q.16. .1 TWO .. 2 (PART C) ALL OTHER THREE CASES .......... 2 OR MORE.3 (PART C) A B C_ D E F G H J_ K L LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 1. 2. 3. 4. 5. D FOR EACH PERSON, LOOK AT THE Now I would like to ask you about your work as (READ In this work were you ..... Is your employer for this How many D ANSWERS TO QUESTION 16 OF OUT OCCUPATION FROM QUESTION 1]. If you did (READ ALL RESPONSES) work... people PART B. WRITE DOWN THE this work for more than one employer in the last 7 days, an employer? .......... 1(',50) (READ ALL RESPONSES) altogether O OCCUPATION WITH CODE 1 iN please think about for the employer for whom you work at the D THAT QUESTION (MAIN worked the most hours during the last 7 days. Where did a worker on own account a private company, place where D OCCUPATION IN THE LAST 7 you carry out most of this work in the last 7 days? or unpaid worker in a enterprise or you do this E DAYS) household farm or cooperative? .....1 work? nonfarm busine6s FARM OWNED OR RENTED BY enterprise? .......... 2(-50) rural public works HOUSEHOLD MEMBER ............. 1 program? .2 OCCUPATION CODE TO BE FILLED OTHER FARM ................ 2 a paid worker in a IN BY SUPERVISOR YOUR HOME .......... 3 household farm or the government, OTHER HOME .......... 4 nonfarm business public sector VEHICLE ...5..... S enterprise? .......... 3(-18) or army? ......... 3 FROM DOOR TO DOOR . 6 IN THE STREET, NO FIXED PLACE.7 an employee of someone a state-owned IN THE STREET, FIXED PLACE . . .8 who is not a member of enterprise? .4 OCCUPATION OFFICE/FACTORY ................ 9 your household? 4 a private _ OCCUPATION CODE OTHER (SPECIFY__ _ ) ..10 individual? ......5 NUMBER a, 12. 7 Th 9i LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. I Are you Is this job How often do How do you get to How much would How much do you How long does it Do you or your How much in For how long in D entitled to covered by you travel from work? you pay for this pay for this take you to get to family pay total have you total will this period the benefits a collective home to BUS, VAN OR CAR transportation by transportation? work from here? apprenticeship paid or will you of apprenticeship, C of social bargaining work(for SENT BY YOUR a commercial Over what time fees or make pay this training or O security agreement? example, twice a EMPLOYER ...... 1 bus, van or car? interval? (TIME ONE WAY any other employer for experience for D program in day or once a COMMERCIAL BUS Over what time ONLY) payments for this which you are E this job? week)? VAN OR CAR 2 interval? the training apprenticeship, paying last? (-II) ~~~ ~ ~~~~~~~~~and training or PRIVATE CAR OR11) experience this experience? MOTORBIKE . 3A 3 employer (IF LESS THAN 0>11) MOTORBIKE 3provides? TWO YEARS, B(>.11) RECORD YEARS BICYCLE 4 AND MONTHS. IF (>>12) MORE THAN WALK (-2)TWO YEARS, OTHER (>42)RECORD YEARS YES ...1 YES ...1 (SPECIFY )..6 YES-1 ONLY.) NO... 2 NO ... 2 TIME (-12) TIE TIME NO.... 2 NUMBER UNIT AMOUNT_|UNIT NOUNT |UNIT HOURS MINUTES (>16) YEARS IMONTHS 014 4- 5 10 . D . 12 ==== |HOUYR.. 2 DAY.... 3 WEEK.... 4 FORTNIXGHT ...... 5 MONTE ...... 6 QUARTER ..... 7 HALF YEAR ... 8 YEAR ... 9| LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 16. 17. 18. 19. 20. 21. 22. 23. 24. I Do you What is the main How much was your How many Are any Was the How much was Do you How much do your D receive reason you receive no last payment? hours did you income, payment you your payment receive any eam in tips, wages, salary payment for this work? IF RESPONDENT work (or will social reported after deducting tips, gratuities or cash C or other HAS NOT YET BEEN you work) for security or before or taxes? gratuities or allowances? D payments PAID, ASK: What the pay you workers' after allowances D either in o ash payment to do you just reported? compensation deducting the that were not E or in other l l expect? What period Please include taxes taxes? included in forms from (>41) of time did this any hours of deducted the pay you this employer payment cover? paid vacation from your have already for this work? or sick leave, pay? reported? APPRENTICESHIP OR UNPAID TRAINEESHIP...1 LABOR EXCHANGE.2 PAYING OF DEBT.3 YES . OTHER. YES... 1 BEFORE. .1 YES .. 1 (>18) (SPECIFY_)...4 TIHE NO.. ..2 AFTER... 2 NO .... 2 TIME NO... 2 AMOUNT UNIT HOURS (>23) (>>23) (>>25) AMOUNT UNIT -1 3 4 |HOUR... .2 DAY.. . 3 WEFic... .4 FORTNIGHT. ......5 M lONTH . .6 QUARTErR ~... 7 HALtF YEAR. .. 8 YEAR ...g LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. i Is your pay determined Do you How much How Do you What is the value Do you How much would How much do you Do you What is the value of D mainly by a fixed rate receive was your last many receive any of the free or receive the you pay to rent pay your employer receive free this clothing? How per hour worked, per bonuses bonus? months free or subsidized food or use of free housing like yours for the housing? clothing often do you C day worked, per task or (such as usually subsidized meals you received housing from someone Over what time from this receive it? 0 project completed, or do 13th pass food or from this from this other than your interval? employer? D you receive a salary or a month between meals from employer? How employer, employer? Over E share of production or salary ...) bonus this often do you or do you what time interval? revenue? in this payments employer? receive this much rent IF NO work? in this in free or housing PAYMENT, PER HOUR ...... I job? subsidized food or from your WRITE ZERO IN PER DAY ....... 2 meals? employer? BOTH BOXES PER TASK/ PROJECT ...... 3 SALARY ........ 4 SHARE OF PRODUCTION OR REVENUE ... 5 OTHER YES. *1 YES .. 1 YES...1 YES, .1 (SPECIFY ).6 NO N... 2 ENO.. 2 ITIMEI NO .... 2 TIME ("29) AMOUNT MONTHS ("31) AMOUNT UNIT (-34) jAMOUNT |UIT AM |NIT (36) AMOUNT UNIT - 1 ___ __ _ _ L I I 2 3 4 f | NOUR.... . 2 DAY .. 3 WTEEK . .. 4 FORTNrIG ..T.... .5 MONTHM. ...6 QUARTER. . .. .7 HAF YEAR.. ....... aY.9.g LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. I Do you What is the value Are you Are you Are you For how long have you During Is this the During the During the During the During the Are you Have you D receive of those entitled entitled to entitled to worked for this employer, these only last 7 last 7 last 12 weeks you currently ever any payments? Over to paid paid sick a pension whether doing the work years, for employer days, how days, how months, for worked for attending a completed C payment what time holidays leave in (other you did in the last 7 days how for whom many days many how many this training any training 0 for this interval? in this this than or any other work? many you did did you hours did weeks did employer course, or course, or D work in work? work? public months this work work for you work you work in the last are you an been an E any social per year in the last this for this for this 12 months, apprentice apprentice other security (IF LESS THAN TWO did you 12 employer? employer? employer? for how or unpaid or unpaid form? pension) YEARS, RECORD usually months? many trainee, as trainee, as in this YEARS AND MONTHS. work? hours did part of your part of your work? IF MORE THAN TWO you usually work for work for this YEARS,RECORD work per this employer? YEARS ONLY.) week? employer? IF ONE YEAR OR YES... YES. .1 YES ... 1 YES ...1 LESS 1)43 MONTHS YES. 1 DAYS HOURS WEEKS HOURS YES.. 1 YES.. .1 NO... .2 TIME NO... 2 NO... 2 NO ....2 PER (>48) PER PER PER PER (>>5O) NO... 2 _ _ (-38) AMOUNT UNIT YEARS | MONTHS YEAR NO 2 WEEK WEEK YEAR WEEK NO... 2 P - ui 2~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4- 8 9 H..l?.... .2 DAY.... .3 WiEEK.... .4 FOR TNIGHT... 5 MOINTH ....6 QUARTER. ... 7 HALF YEAR... .8 Y.L... 9 LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 50. 51. 52. 53. 54. I CHECK FOR THIS PERSON, LOOK AT Now I would like to ask you about your work as [READ In this work were you... Is your employer for this work... D QUESTION THE ANSWERS TO QUESTION OUT OCCUPATION FROM QUESTION 51]. If you did (READ ALL RESPONSES) (READ ALL RESPONSES) 22 IN PART 16 OF PART B. WRITE DOWN this work for more than one employer in the last 7 days, an employer? .......... 1(>84) a private company, C B. DID THE THE OCCUPATION WITH CODE please think about the employer for whom you worked enterprise or 0 INDIVIDUAL 2 IN THAT QUESTION the most hours during the last 7 days. Where did you a worker on own account cooperative? ...1 D REPORT (SECONDARY OCCUPATION IN carry out most of this work in the last 7 days? or unpaid worker in a E MORE THE LAST 7 DAYS). household farm or rural public THAN ONE nonfarm business works program?... 2 KIND OF FARM4 OWNED OR RENTED BY enterprise? 2(>>841 WORK IN HOUSEHOLD MEMBER .............. 1 the government, THE PAST OTHER FARM ..................... 2 a paid worker in a public sector 7 DAYS? OCCUPATION CODE YOUR HOME .3........ household farm or or army? ......... 3 TO BE FILLED IN BY OTHER HOME .4........ nonfarm business SUPERVISOR. VEHICLE ........ ................ 5 enterprise? .......... 3(I60) a state-owned FROM DOOR TO DOOR .6 enterprise? ...... 4 IN THE STREET, NO FIXED PLACE. .7 an employee of someone IN THE STREET, FIXED PLACED .. 8 who is not a member of a private Y'ES ...1 OCCUPATI1, OFFICE/FACTORY .9 your household? ...... 4 individual?. 5 NO ....2 OCCUPATION OTHER (SPECIFY ___)_10 (.84) OCCUPATION CODE A1 2 3 4 5 6 901 11 12X HouR ... 2 DAY ... 3 wEzK .... 4 FORJNIGNH ........5 MONTH ...... 6 QuZARTE:R ..... 7 INALF YEAR ... 8 Y}3A ... 9l LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. I How many Are you Is this job Do you What is the main How much was your last How many Are any Was the How much was Do you D people entitled to covered by receive reason you receive no payment? hours did you income, payment you your payment receive any altogether the benefits a collective wages, salary payment for this work? IF RESPONDENT work (or will social reported after deducting tips, C work at the of social bargaining or other HAS NOT YET BEEN you work) for security or before or after taxes? gratuities or O place where security agreement? payments PAID, ASK: What the pay you workers' deducting the allowances D you do this program in either in cash payment to do you just reported? compensation taxes? that were E work? this job? or in other expect? What period of Please include taxes not included forms from >>7I time did this payment any hours of deducted in the pay this employer cover? paid vacation from your you have for this work? or sick leave. pay? already reported? APPRENTICESHIP OR UNPAID TRAINEESHIP.. .1 LABOR EXCHANGE.2 PAYING OF DEBT.3 YES ... 1 YES... 1 YES .. 1 OY... 1 BEFORE. .1 YES ...1 NO ....2 NO .... 2 (t>>60l) (SPECIFY_) ... 4 TIME NO ....2 AFTER... 2 NO ..2 NUMBER NO... 2 AMOUNT UNIT HOURS (>65) (>>65) ('-67) 114_ 12= 5- 7 8 HOUR. . ...2 DAY.... .3 WEEK... .4 FORTNIGH-T... .5 MONTH ....6 QuA.RTER.... .7 HALF YEAR. .. YER .. LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. How much do your Do you How much How many Do you What is the value of How often do How do you get to How long does it take Are you Are you D eam in tips, receive was your last months receive those payments? you travel from work? you to get to work entitled to entitled to gratuities or cash bonuses bonus? usually any Over what time home to work from here? (TIME paid paid sick C allowances? (such as pass payment interval? (for example, ONE WAY ONLY) holidays in leave in this 0 1 3th between for this twice a day or BUS, VAN OR CAR this work? work? D ~~~~month bns wrinonce a week)? SENT BY YOUR E salary,..) payments in any other EMPLOY YOUR in this this job? form? EMPLOYERC.IAL 1 work? COMM~ERCIAL BUS VAN OR CAR. 2 PRIVATE CAR OR MOTORBIKE. 3 BICYCLE. 4 WALK. 5 OTHER (SPECIFY _)..6 YES ..... 1 YES .. 1 YES ... 1 YES ..... I |TIME NO .... 2 NO... 2 TIME ITIME NO ... 2 No .... 2 _ AMOUNT |UNIT ('70) AMOUN MONTHS (a72) AMOUNT UNIT NUMBER UNIT HOUR '-. __ _ _____ =____I_L_ __ l_l_I 4 6 7 101 . 2 1 1.. . EU H oErR ...... 2 DAY . 3 WEEK.... 4 FORTNIGHT ..... 5 MfONTH ....... 6 QrJARTE-R ....... 7 HALF YE"........ e FA ... g LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. I Are you For how long have you Is this the During the During the During the During the CHECK You reported having done How much did you D entitled to a worked for this employer, only last 7 last 7 last 12 weeks you QUESTION 22 work in the last 7 days receive for this other pension whether doing the work employer for days, how days, how months, worked for IN PART B. besides the two jobs you work, including tips, C (other than you did in the last 7 days whom you many days many for how this DID THIS have just described to me gratuities, bonuses, 0 public or any other work? did this work did you hours did many employer in PERSON in detail. In any of these and the value of any D social in the last 12 work for you work weeks did the last 12 REPORT jobs did you work for payment in kind, E security months? this for this you work months, for THREE OR someone who is not a after subtracting pension) in (IF LESS THAN TWO employer? employer? for this how many MORE KINDS member of your taxes deducted? this work? YEARSS HAND ORD employer? hours did OF WORK IN household, or were you a What penod of time YEARS,AN REORDHS you usually THE PAST 7 paid employee on a family did this payment IF MORE THAN TWO work per DAYS? farm or in an enteprise or cover? YEARS,RECORD week? money making activity YEARS ONLY.) belonging to a member of your household? YES. ..1 YES... 1 DAYS HOURS WEEKS HOURS YES ... 1 YES .. .1 NO ... 2 (>>84) PER PER PER PER NO .... 2 NO ....2 TIME YEAR S NO.... .2 WEEK WEEK YEAR WEEK (>87) (.87) AMOUNT |UNIT 4- H OUR. .2 DAY.. 3 WEEK.. .4 FORT!NIGHT. .5 MONTH . 6 QUARTER.. .7 HALF YEAR. .8 YEAR ...9l LABOR MODULE (STANDARD VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 87. 88. 89. I FOR THIS CHECK QUESTION CHECK D PERSON, CHECK 20 IN PART B. QUESTION 21 IN THE ANSWER TO WHAT IS THE PART B. WHAT IS C QUESTION 19 IN CODE FOR THE THE CODE FOR O PART B. WHAT IS ANSWER TO THAT THE ANSWER TO D THE CODE FOR QUESTION? THAT QUESTION? E THE ANSWER TO THAT QUESTION? CODE 1.. .1 CODE 2... .2 CODE 1... .1 CODE 1. . .1 (-PART D Q.25) (-,PART D Q.44) CODE 2... .2 CODE 3.. 3 CODE 2... .2 _ (-PART D, Q.1) (,,NrXT PERSON) (,NEXT PERSON) -4 12_ 4- 5 LABOR MODULE (STANDARD VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 1. 2. 3. 4. 5. 6. 7. FOR THIS PERSON, LOOK AT THE Now I would like to talk about your work as In this work were you... Is your employer for this How many Are you Is this job D ANSWERS TO QUESTION 18 OF [READ OUT OCCUPATION FROM QUESTION (READ ALL RESPONSES) work... people entitled to covered by PART B. WRITEDOWN THE 1]. If youdidthisworkformorethanone an employer? .......... l('24) (READ ALL altogether the a collective C OCCUPATION WITH CODE 1 IN employer in the last 12 months, please think RESPONSES) work at the benefits of bargaining 0 THAT QUESTION about for the employer for whom you worked a worker on own account a private company, place social agreement? D (MAIN OCCUPATION IN THE LAST the most hours during the last 12 months. or unpaid worker in a enterprise or where you secunty E 12 MONTHS). Where did you carry out most of this work in the household farm or cooperative? .... 1 do this program last 12 months? nonfarm business work? in this job? FARM OWNED OR RENTED BY enterprise? ......... 2(-24) rural public OCCUPATION CODE TO HOUSEHOLD MEMBER .............. 1 works program?..2 BE FILLED IN BY OTHER FARM ..................... 2 a paid worker in a SUPERVISOR. YOUR HOME . ....... 3 household farm or the government, OTHER HOME . ....... 4 nonfarm business public sector VEHICLE. 5 enterprise' .......... 3 (,10) or army? ...... 3 FROM DOOR TO DOOR. 6 IN THE STREET, NO FIXED PLACE. .7 an employee of someone a state-owned IN THE STREET, FIXED PLACED... 8 who is not a member of enterprise? 4 YES ... 1 YES. ..1 OCCUPATION OFFICE/FACTORY ................. 9 your household? ...... 4 a private NO.. .2 NO.... 2 OCCUPATION CODE OTHER (SPECIFY ) . 10 individual .... 5 NUMBER 11 4- f 9 iT LABOR MODULE (STANDARD VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. I Did you What is the main How much was How many Are any Did you What was the During how many During Is this the During the During the D receive reason you received your last payment? hours did income, receive any value of those years have you these only last 12 weeks you wages, no payments for this What period of you work social additional payments? Over worked for this years, for employer months, worked for C salary or work? time did this for the pay secunty or payments, in what time employer, whether how many for whom for how this 0 other payment cover? you just workers' the form of interval? doing the work you months per you did many employer D payments reported? compensati tips, gratuities, did in the last 12 year did this work weeks did in the last E either in Please on taxes bonuses, months or any other you usually for in the you work 12 cash or in include any deducted food, clothing, work? work for last 12 for this months, other forms hours of from your housing or this months? employer? how many from this paid pay? transportation IF LESS T employer? days did employer vacation or in this work? IW LEHAN you for this sick leave. TWO YEARS, usually work? APPRENTICESHIP RECORD YEARS I work per OR UNPAID AND MONTHS. IF week? TRAINEESHIP... 1 MORE THAN LABOR EXCHANGE.2 TWO YEARS, PAYING OF DEBT.3 RECORD YEARS YES .. 1 OTHER YES.. .1 YES ... I ONLY. MONTHS YES ... I WEEKS DAYS (>10) (SPECIFY )..4 TIME NO.... 2 NO .... 2 TIME PER (t21) PER PER NO .... 2 AMOUNT UNIT HOURS ( > >15) AMOUNT UNIT YEARNTHS YEAR NO.... 2 YEAR WEEK 00 4 7 _L 8ll 9lI 10 11 - . . F . : M Q 12:::::::ll |HOUR . ... .2 DAY. .... .3 WEEK .... .4 FORTNIGHT. ... 5 MONTH. . .. ... 6 QuJARTER. ...... .7 HALF YEALR. ...... 8 YEAR. .... 9| LABOR MODULE (STANDARD VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 20. 21. 22. 23. 24. 25. 26. I During the Did you What is the main reason you did not work in What is the main FOR THIS LOOK AT THE ANSWERS TO Now I would like to talk about your work as D weeks you work in this job in the last 7 days? reason you lost PERSON, QUESTIONS B1 AND B18. [READ OUT OCCUPATION FROM QUESTION worked for this job in LOST JOB, LAID OFF OR that job? CHECK THE WRITE DOWN THE SECOND 25]. If you did this work for more than one C this the last 7 BUSINESS FAILED ........... 1 ANSWER TO MOST IMPORTANT employer in the last 12 months, please think 0 employer days? DECIDED TO CONCENTRATE ONi PLANT CLOSED QUESTION 20 OCCUPATION (ACTIVITY WITH about for the employer for whom you worked the D in the last OTHER JOB ALREADY DOING ..2(>>24) DOWN OR OF PART B. CODE 2 IN PAST 12 MONTHS). most hours during the last 12 months. Where did E 12 FOUND JOB WITH BETTER PAY mOVED ... i WHAT IS THE you carry out most of this work in the last 12 months, OR WORKING CONDITIONS ... 3( 24) POSITION CODEFOR months? how many FOUND JOB WITH OR SHIFT THAT OCCUPATION CODE TO FARM OWNED OR RENTED BY hours did BETTER HOURS .4(>>24) ABOLISHED.2 QUESTION? BE FILLED IN BY THE HOUSEHOLD MEMBER ............ 1 you MOVED TO DIFFERENT FIXED DURA- SUPERVISO ................... 2 usually RESIDENCE .5(-24) TION JOB YOUR HOME. 3 work per RETIRED .6('24) COMPLETED.3 OTHER HOME .4 week? BECAME DISABLED .7(-24) OWN BUSINESS CODE 1 ... 1 VEHICLE ....... 5 STARTED SCHOOL OR TRAINING FAILED .... 4 ("43) FROM DOOR TO DOOR. 6 PROGRAM 8(>>24)FIRED5...................82 D...... CODE 2.. 2 IN STREET, NO FIXED PLACE .... 7 HOU'RS YES... 1 HOUSEHOLD RESPONSIBILITIES.9(-24) OTHER(SPE- ... IN THE STREET, FIXED PLACED S JOB WAS SEASONAL .10('24) CIFY ).6 CODE 3.3 OFFICE/FACTORY. 9 PER (-24) OTHER SPECIFY(_-) ....... 11("24) (-NEXT ATION OTHER (SPECIFY_____) 10 I WEEK NO .... .1 PERSON) OCCUPATION CODE 0 'I- 21 3 . 4 5 8_ 9 10 LABOR MODULE (STANDARD VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 27. 28. 29. 30. 31. 32. 33. 34. 35. I In this work were you... Is your employer for this How many Are you Is this job Did you What is the main How much was How many D (READ ALL RESPONSES) work... people entitled to covered by receive reason you received your last hours did an employer? ....... 1(>43) (READ ALL altogether the benefits a collective wages, no payments for this payment? What you work C RESPONSES) work at the of social bargaining salary or work? period of time did for the pay O a worker on own account place secunty agreement? other this payment you just D or unpaid worker in a a private company, where you program in payments cover? reported? E household farm or enterprise or do this this job? either in '39 Please nonfarm business cooperative? .... l work? cash or in include any enterprise? ........ 2(>43) other forms hours of rural public from this paid a paid worker in a works program? ..2 employer vacation or household farm or for this sick leave. nonfaxrm business the government, work? APPRENTICESHIP enterprise? ........ 3(>>34) public sector OR UNPAID or army? ........' 3 TRAINEESHIP... 1 an employee of someone a state-owned LABOR EXCHANGE.2 who is not a member of enterprise? 4 YES .. I Y ES. I Y ES .1 PAYING OF DEBT.3 your household? ... 4 e.. . .. OTHER a private. NO.... 2 NO .... 2 (-34) (SPECIFY) ... TIME individual? ... 5 NUMBER NO. ... 2 AMOUNT UNIT HOURS 3 4 5- 7 9 12 HOUR.... .2 DAY......3 WEEK.... .4 FOR TNXGfT ... 5 MONTHf....6 QUARTER.. .. 7 H.ALF YE.R... . 8 YEAR... .9 LABOR MODULE (STANDARD VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. I Are any Did you receive What was the Is this the During the During the During the CHECK You reported having D income, any additional value of those only last 12 weeks you weeks you QUESTION done work in the last 12 How much did you months besides the jobs receive for this other social payments, in the payments? Over employer months, for worked for worked for 21 IN PART you have already work, including wages, C security or form of tips, what time for whom how many this this B. WHAT IS yod aes arieadyt eieal salrk, tinclgraudingwaes, 0 workers' gratuities, interval? you did weeks did employer in employer in THE CODE In an of these obs did bonuses, and the value D compensati bonuses, food, this work you work the last 12 the last 12 FOR THAT y o sejo of any payment n E on taxes clothing, for in the for this months, how months, how QUESTION? you work for someone of aftr pybtactin tkind deducted housing or last 12 employer? many days many hours worhouisenot d a omemere ofaferdubtractingt taesio from your transportation in months? did you did you yo a pa ember pay? this work? usually work usually work yua pamidy eamploye on a ofvierddthspamn per week? per week? enterprise or money making activity belonging to a member of your 'NEXT household? PERSON CODE 1._1 YES ..1 YES.. 1 YES...1 WEEKS DAYS HOURS CODE 2 2 YES.. I1 NO ....2 NO... 2 TIME (>43) PER PER PER (>>NEXT NO ... 2 | TIME (-39) AMOUNT UNIT NO.. 2 YEAR WEEK WEEK PERSON) (.NEXT PERSON) AMOUNT UNIT 3 5- 7 9- 10_= 11 0-___ 12 = = HOUR ... 2 DAY .... 3 WEEK .... 4 FORTNIGHT ... 5 MONTH ..... 6 QUA.RTZ.R.... 7 HALIF YEAR. . . 8 YEAR... 9 LABOR MODULE (EXPANDED VERSION) PART A: LABOR FORCE PARTICIPATION ALL PERSONS 6 YEARS AND OLDER 1 . 2. 3. 4. 5. 6. 7, 8. 9. 10. 11. 12. I IS THIS COPY THE During the past At any time During the past?7 At any time During the past 7 At any time CHECK THE Do you What is the main Have you D PERSON ID CODE 7 days, have during the days, have you during the last days, have you during the last ANSWERS have a reason that you did looked for ANSWER- OF you worked for last 12 worked on a farm 12 months have worked on your 12 months did TO permanent not work in the last work in C ING FOR RESPOND- someone who is months owned or rented by you worked on aown account or in a you work on QUESTIONS lob even 7 days? the last 7 0 HIMSELF/ ENT FROM not a member of have you a member of your farm owned or business enterprise your own 3, S AND?7. though 7,, 47days? D HER- HOUSE- your household, worked for household, whether rented by a belonging to you or account or in (WORKED IN you did not L~. E SELF? HOLD for example, a anyone who in cultivating c-rops member of your someone in your a business LAST 7 work in the ROSTER firm, enterprise, is not a or in other farm household, or household, for enterprise DAYS) last 7 SICK .1.... company, the member of maintenance tasks, cared for example, as a belonging to days? MATERNITY. .... 2 government or your or have you cared livestock trader, shopkeeper, you or HOUSEHOLD any other household? for livestock belonging to a barber, someone in MEMBER SICK. 3 individual? belonging to a member of your dressmaker, your VACATION....4 member of your household? carpenter or taxi household? STRIKE/ household? driver? SUSPENSION. .5 TEMPORARY WORK LOAD REDUCTION. .. .6 YES... I1 YES... I1 YES... .1 YES... I1 YES ... 1 YES. .. I YES.. .1 ANY YES.1 YES.. .1 OTHER(SPE- YES ... 1 11NO.... .21 NO.... .2 1 NO.... .2 1 NO.... .2 1 ALL NO. .2 (-12) 1 NO.... 21 6 7 9T_ _ LABOR MODULE (EXPANDED VERSION) PART A: LABOR FORCE PARTICIPATION ALL PERSONS 6 YEARS AND OLDER 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. I What is the main reason you In the last 7 In the last 7 CHECK Who did you consult At any During Were those How many Who did you consult D did not look for a job in the days have you days have you ANSWERS in your search for point in how weeks you times were in your search for last 7 days? looked for work looked for a TO additional or the last 12 many were looking you work? C (MOST IMPORTANT to do in addition work to replace QUESTIONS replacement work? months, weeks of for work all unemployed? O REASON) to your current your current 14 AND 15. were you the last at once, or D i,1 work, whether work, whether ALLOW UP TO without 12 at different ALLOW UP TO E I7~ I--E on your own work on your THREE work and months times? THREE STUDENT ........... 1 account, in a own account, in RESPONSES looking for were you RESPONSES HOUSEWIFE/ household a household work? without CHILDCARE ....... 2 business enterprise or for work and TOO OLD/ RETIRED ..3 enterprise or for someone who looking HANDICAPPED ....... 4 someone who is is not a BOSS/EMPLOYER ..1 for work? BOSS/EMPLOYER ..1 WAITING FOR REPLY not a member member of your EMPLOYMENT EMPLOYMENT FROM EMPLOYER ... 5 of your household? AGENCY . 2 AGENCY .... 2 WAITING FOR RECALL household? FRIENDS/ALL AT RELATIVES.3 BY EMPLOYER ...... 6 RELATIVES ..... 3 WAITING FOR BUSY NEWSPAPER . 4 ONCE ... 1 NEWSPAPER ...... 4 SEASON ..... 7 YES .. 1 YES .. 1 ANY YES ..1 INTERMEDIARY ... 5 YES...1 (>22) INTERMEDIARY .. .5 OTHER (SPECIFY ).8 NO ....2 NO .... 2 ALL NO ...2 NO.... 2 DIFFERENT NUMBER (>18) 1SL|2N |3RD ("2 3) WEEKS TIMES ... 2 OF TIMES 1ST 2ND 3RD cv Inf- II < 4- _ 8 9 7T _ __ 10v < LABOR MODULE (EXPANDED VERSION) PART A: LABOR FORCE PARTICIPATION ALL PERSONS 6 YEARS AND OLDER 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. I CHECK What method did you CHECK Have you At what age Have you How many Five years What was the main CHECK THE CHECK D ANSWERS use to find your main ANSWERS ever worked, did you first worked, years since ago, that is, reason you were ANSWER TO ANSWER TO work of the last 7 TO either on a work, either either on a that time in [YEAR], not working 5 years QUESTION TO C QUESTIONS days? QUESTIONS household on a farm, on have you were you ago? 25 QUESTION 0 9 AND 10 4, 6 AND 8 farm, on household your own worked eithe working on 30 D (HAD JOB IN ALLOW UP TO (WORKED IN your own farm, on your account, in a on a farm, or a farm, on (WORKED E LAST 7 THREE LAST 12 account, in a own account, household your own your own STUDENT ......1 FIVE DAYS) RESPONSES MONTHS) household in a business account, in a account, in HOUSEWIFE/ YEARS business household enterprise, household a CHILDCARE... 2 AGO) enterprise, business or for business household TOO OLD/ or for enterprise, or someone enterprise or business RETIRED .3 BOSS/EMPLOYER ...1 someone for someone else, in every for someone enterprise HANDICAPPED. .4 EMPLOYMENT else? else? year since else? or for TOO YOUNG.... 5 AGENCY ......... 2 that time? someone COULDN'T FRIENDS/ else? FIND WORK/ YES. . 1 RELATIVES ........6 3 NEWSPAPER .......4 ANY YES YES .. UNEMPLOYD..16 (aPART E) ANY YES. .1 INTERMEDIARY... 5 OR BLANK.1 NO .... .2 YES... 1 YES... 1 OTHER CODE 1..1 NO ... .2 BOTH NO ..2 _.27) (-NEXT AGE IN (>'30) ("32) (SPECIFY ).7 (sPART B) (-NEXT _ (a25) 1ST 2ND 73RD ALL NO ... 2 PERSON) YEARS NO... 2 YEARS NO... 2 CODE 2 ..2 PERSON) 12 3x 1 4 7 _ 9 10 = = = : 11 T 0 Xff 7 12 . = = =: LABOR MODULE (EXPANDED VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS I would like to ask you some questions about the work you did in the last 7 days and the last 12 months, whether work on a farm, on your own account, in a household business enterprise, or for someone else. Let's start with work that you did in the last 7 days. If you did not work in the last 7 days but had a permanent job, please describe your permanent job. If you did not work or have a job during the past 7 days, describe the work that you did in the past 12 months. 1. 2. 3. A I What did you do? What kind of trade or business is it connected with? In what crop or with what type of livestock did you CD spend most time in this work in the last 7 days? T I C V D T E y C IF NOT RELATED TO 0 AGRICULTURE s4 D E CROP OR 00 WRITTEN OCCUPATION WRITTEN INDUSTRY WRITTEN ANIMAL DESCRIPTION CODE DESCRIPTION CODE DESCRIPTION CODE D_ E0 F0 KG . H LABOR MODULE (EXPANDED VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. A I In this work were you working on a Which of these Do you For how For how For how For how For how During MULTIPLY C D farm owned or rented by you or a enterprises is this contribute many many many days many hours many these ANSWER T member of your household, were you work associated with? to public different different in the last 7 in the last 7 weeks in weeks, how TO Q. 11 BY I C working on own account or in a pension employers employers days did days did the last 12 many hours ANSWER V 0 nonfarm business enterprise belonging REVIEW scheme did you do did you do you do this you do this months did per week TO Q. 12 0 D to you or a member of your household, ENTERPRISES relevant for this work in this work in work? work? you do this did you (HOURS T E or were you working for someone who REPORTED IN the self the past 12 the last 7 work? usually do WORKED IN Y is not a member of your household? HOUSEHOLD employed in months? days this work? THE LAST C ENTERPRISE this work? 1 2 0 OVRIWMONTHS) E MODULE. IF THIS DAYS ACTIVITY IS NOT WORYKSED FARM OWNED OR RENTED FOUND THERE, IN PAST 7 BY HOUSEHOLD MEMBER.... 1(,9) REVISE THAT DAYS, OWN ACCOUNT/HOUSEHOLD MODULE. WRITE ENTERPRISE .2 ZERO AND WORK FOR NON-HOUSEHOLD _ MEMBER .3(-7) YES. .1 1)11 O00 ENTERPRISE NO.... 2 DAYS HOURS WEEKS HOURS HOURS I I I I CODE NUMBER NUMBER PER WEEK PER WEEK PER YEAR PER WEEK PER YEAR A_ B D F I- K-: E : :::: LABOR MODULE (EXPANDED VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS 14. 15. 16. 17. 18. 19. 20. A I CHECK THE Did you do CHECK FOR FIRST AND SECOND In addition to CHECK FOR THE FIRST AND CHECK THE ANSWERS CHECK THE ANSWERS C D ANSWERS TO any other HIGHEST ANSWERS TO Q.10 the work you SECOND HIGHEST ANSWERS TO QUESTIONS 16 AND TO QUESTIONS 16 AND T QUESTION 8 OF work in the (HOURS WORKED IN LAST 7 have already TO QUESTION 13 (HOURS 18. FOR THE ACTIVITY 18. FOR THE ACTIVITY I C PART B AND last 7 days, DAYS) FOR THIS INDIVIDUAL. (IF described, did WORKED IN LAST 12 MONTHS) WITH CODE 1 IN WITH CODE 2 IN V 0 QUESTION 10 OF or did you THIS INDIVIDUAL REPORTED you do any FOR THIS INDIVIDUAL. QUESTION 18, WHAT QUESTION 18, WHAT IS I D PART A have any ONLY ONE ACTIVITY, MARK IT other work IS THE CODE IN THE CODE IN T E (CHECKING FOR other AS CODE 1.) during the QUESTION 16? QUESTION 16? Y NO JOB AT ALL IN permanent past 12 (CHECKING TO SEE IF (CHECKING TO SEE IF C LAST 7 DAYS) job from months? MAIN JOB IN PAST 12 SECOND JOB IN PAST 12 0 which you ACTIVITY FOR WHICH ACTIVITY FOR WHICH MONTHS IS MAIN OR MONTHS IS MAIN OR D were ANSWER TO 10 IS ANSWER TO 13 IS SECOND JOB IN LAST SECOND JOB IN LAST 7 E temporarily HIGHEST .............. 1 HIGHEST ............. 1 7 DAYS.) DAYS.) Q.8 OF PART B absent? ACTIVITY FOR WHICH ACTIVITY FOR WHICH EQUALS 0 AND ANSWER TO 10 IS ANSWER TO 13 IS Q.10 OF PART A SECOND HIGHEST ....... 2 SECOND HIGHEST ....... 2 Q.16 CODE IS EQUALS 21. ACTIVITY FOR WHICH ACTIVITY FOR WHICH 1 OR 2. 1 ("17) ANSWER TO 10 IS ANSWER TO 13 IS ALL OTHER YES... I NEITHER FIRST NOR . .................. YES-@ l NEITHER FIRST NOR Q.16 CODE IS Q.16 CODE IS CASES .... 2 (>>NEXT SECOND HIGHEST ....... 3 (-NEXT SECOND HIGHEST ....... 3 1 OR 2 .... 1 3 OR BLANK ...2 OO LINE) LINE) Q.16 CODE IS NO CODE 2 IN NO ... 2 NO ...2 3 OR BLANK.2 Q.18. 3 A D E G J _ - K- LABOR MODULE (EXPANDED VERSION) PART B: OVERVIEW OF WORK IN LAST 7 DAYS 21. 22. A I CHECK THE ANSWERS CHECK THE ANSWERS C D TO QUESTIONS 16 AND TO QUESTION 16. HOW T 18. FOR THE MANY ACTIVITIES HAS I C ACTIVITIES WITH THIS PERSON HAD IN V 0 CODE 3 IN QUESTION THE PAST 7 DAYS? I D 18, WHAT ARE THE T E CODES IN QUESTION Y 16? C 0 D E AT LEAST ONE ACTIVITY HAS ZERO ... 0 (PART D) CODE 3 OR IS ONE ... 1 (PART C) BLANK IN Q.16 ..1 TWO . 2 (PART C) O0 ALL OTHER THREE CASES .2 OR MORE.3 (PART C) AC| B_ D:: :c ;7 t0 00;: t;::: 0 5 ;t:t 0 0t 0 00t 7: _D : : .. : ::i E: :: : :: :: :::::::::::::::::: :V: : :: : :: : : : S: G _. :: J:_ ::-:H K : : ::: ::: : ::: ;: L :7 7= -S--5 70 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 1. 2. 3. 4. FOR EACH PERSON, LOOK AT Now I would like to ask you about your work as [READ OUT In this work were you... Is your employer for this work... D THE ANSWERS TO QUESTION OCCUPATION FROM QUESTION 1]. If you did this work (READ ALL RESPONSES) (READ ALL RESPONSES) C 16 OF PART B. WRITE DOWN for more than one employer in the last 7 days, please think an employer? .......... 1 ('7 4) C THE OCCUPATION WITH CODE about the employer for whom you worked the most hours D1 IN THAT QUESTION (MAIN during the last 7 days. Where did you carry out most of this a worker on own account a private company, D OCCUPATION IN THE LAST 7 work in the last 7 days? or unpaid worker in a enterprise or E DAYS) household farm or cooperative? .........1 nonfarm business FARM OWNED OR RENTED BY HOUSEHOLD MEMBER..l enterprise7 .......... 2(>>74) rural public works OTHER FARM ................................ 2 program? ....... 2 OCCUPATION CODE TO BE YOUR HOME .................................. 3 a paid worker in a FILLED IN BY SUPERVISOR OTHER HOME ................................ 4 household farm or the government, public VEHICLE ...... 5 nonfarm business sector or army? ...... 3 FROM DOOR TO DOOR .................. 6 enterprise? .......... 3(r27) IN THE STREET, NO FIXED PLACED ............ 7 a state-owned IN THE STREET, FIXED PLACED ............... 8 an employee of someone enterprise? .......... 4 OFFICE/FACTORY ............................ 9 who is not a member of | OCCUPATION OTHER (SPECIFY ___ ) .10 your household? ......4 privte individual?.5 _ OCCUPATION | CODE -0 1 2 3 4- 5 7 8 9 12 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 5. 6. 7. 8. 9. 10. 11. 12. 13. I How many Is the In this place the owner or Are you Is this job How often do you How do you get to work? How much would How much do you D people employer, owners... entitled to covered by travel from home you pay for this pay for this altogether director or (READ ALL the benefits a collective to work(for transportation by a transportation? C work at the manager of this RESPONSES) of social bargaining example, twice a commercial bus, Over what time 0 place where place related to security agreement? day or once a van or car? Over interval? D you do this you? program in week)? what time interval? E work? do not work? ... 1 this job? BUS, VAN OR CAR work only in SENT BY YOUR management EMPLOYER ....... I and admini- CONMERCIAL BUS stration? ..... 2 VAN OR CAR . 2('13) PRIVATE CAR OR participate in MOTORBIKE ... 3(-13) production, BICYCLE ......... 4(>>14) sales or WALK ............ 5(-14) YES ... 1 provision of YES ...1 YES ... I OTHER services?....3 (PCF (1) NO ....2 NO.... 2 NO .... 2 NUMBER TIME AMOUNT TIME TIME _ NUMBER NMBER UNIT ANOUNT_|UNIT AMOUNT |UNIT 3 4- 6 7 8 10.. .0.UR.... 2 DAY .... 3 WEE.... .4 FORTNIGHT ... 5 MONTH ....6 QuA.RTER.... .7 HALF YEAR... .8 YEAR... .9 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. How long does it take Are you employed Do you What type of When you first took this job, Does the Does the Can you Do you or your How much in D you to get to work from and paid directly by have a contract do you how long did you expect it to place place easily take family pay total have you here? the firm, company or written have? last? where you where time off or apprenticeship paid or will you C enterprise at which contract for do this you do reschedule fees or make pay this O (TIME ONE WAY you did this work, or this work? ONE DAY OR LESS work have this work your hours any other employer for D ONLY) were you employed BOT LESS THAN ONE electricity? have in this payments for this E or paid by a MOT .......2piped work? the training apprenticeship, contractor,COTAT MRTH ON MONTH 2 water? and training or intermediary or CONTRACT MORE THAN ONE MONTH experience this experience? middleman? CODES THREE MONTHS 3 employer MORE THAN THREE provides? MONTHS BUT NO MORE THAN ONE YEAR ......4 MORE THAN ONE YEAR BUT NO MORE THAN DIRECT ....... 1 THREE YEARS ........ 5 CONTRACTOR/ YES... 1 MORE THAN THREE YES .. 1 YES... Es... 1 YES .. .1 _INUTERMEDID AN .O... 2 YEARS.. No... .2 NO... .2 NO... .2 NO ... .2 MIDDLEMAZN... .2 HOURS I NUTE S. _ _ _ _ _ _ _ _ ' 1 ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ('>25) _ _ _ _ _ _ '0J - 4- 6~ 121 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. For how long in Do you What is the main How much was your How many Are any Was the How much Do you How much do your D total will this period receive reason you receive no last payment? IF hours did income, payment was your receive any earn in tips, of apprenticeship, wages, salary payment for this work? RESPONDENT you work (or social you payment tips, gratuities or cash C training or or other HAS NOT YET BEEN will you security or reported after gratuities or allowances? O experience for payments PAID, ASK: What work) for the workers' before or deducting allowances D which you are either in cash payment to do you pay you just compensation after taxes? that were E paying last? or in other >50 expect? What period of reported? taxes deducting not included forms from time did this payment Please deducted the taxes? in the pay (IF LESS THAN this employer cover? include any from your you have TWO YEARS, for this work? hours of paid pay? already RECORD YEARS vacation or reported? AND MONTHS. IF APPRENTICESHIPsiklae MORE THAN OR UNPAID TWO YEARS, TRAINEESHIP ... 1 RECORD YEARS LABOR EXCHANGE.2 ONLY.) PAYING OF DEBT.3 YES...1 OTHER YES .. 1 BEFORE.1 YES .. .1 (>27) (SPECIFY ).. 4 TIME NO ...2 AFTER..2 NO....2 NT TIME YEARS IMONTHS NO.... 2 AMOUNT LNIT HOURS (-32) (s32) (-34) AMOUNT UNIT 2 4- 5 _= 7: HOUR. ... 2 DAY. ... 3 WEE..... 4 FORTNXGHT... .5 MONTH ....6 QUARTER.... 7 HAZF YEAR. . .8 YEAR.. .9 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. I Is your pay determined Do you How much How many Do you What is the value Do you How much would How much do you Do you What is the value D mainly by a fixed rate per receive was your months receive of the free or receive the you pay to rent pay your employer receive of this clothing? hour worked, per day bonuses last bonus? usually any free or subsidized food or use of free housing like yours for the housing? free How often do you C worked, per task or (such as pass subsidized meals you received housing from someone Over what time clothing receive it? 0 project completed, or do 13th between food or from this from this other than your interval? from this D you receive a salary or a month bonus meals from employer? How employer, employer? Over employer? E share of production or salary ...) payments this often do you or do you what time interval? revenue? in this in this job? employer? receive this much rent IF NO work? in free or housing PAYMENT, PER DOUR ........ 1 subsidized food or from your WRITE ZERO IN PER TAYSY meals? employer? BOTH BOXES PROJECT ... 3 SALARY .. 4 SHARE OF PRODUCTION OR REVENUE ... 5 OTHER YES.. .1 YES ...1 YES ... 1 YES .. .1 (SPECIFY) ...... 6 NO.... 2 NO ....2 TIME No ...2 TIME TIME NO ... .2 AO TIME (_3 8) AMOUNT MONTHS (>>40) AMOUNT UNIT ,>4 3) AMOUNT UNIT AMOUNT UNIT (>>45) AMOUNT UNIT '0 - l______ l__ _ l = 4- 8 l 3 H OUR .... 2 DAY ... 3 WEEK.... 4 FOR2NIGHT .......5 SfONTH ...... 6 QuARTER ..... 7 HAF YEAR ... 8 YA . LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS _45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. I Do you What is the value of Are you Are you Are you For how long have you During Is this the During the During the During the During the Have you ever D receive those payments? entitled to entitled to entitled to worked for this employer, these only last 7 last 7 last 12 weeks you worked for any Over what time paid paid sick a pension whether doing the work you years, for employer days, how days, how months, worked for other C payment interval? holidays leave in (other did in the last 7 days or any how many for whom many many for how this employers in O for this in this this work? than other work? months you did days did hours did many employer the same trade, D work in work? public per year this work you work you work weeks did in the last industry or E any other social (IF LESS THAN TWO did you in the last for this for this you work 12 months, business, or for form? secunty YEARS, RECORD YEARS sually 12 employer? employer? for this for how a household pension) AND MONTHS. IF MORE work? months? employer? many enterprise in in this THAN TWO YEARS, hours did the same trade, work? RECORD YEARS ONLY.) you usually industry or RECORD YEARS ONLY.) ~~~~~~~~~~~~~work per business? week? IF ONE YEAR OR YES .. 1 YES.. . 1 YES.. . 1 YES .. .1 LESS )>52 MONTHS YES... 1 DAYS HOURS WEEKS HOURS YES .. .1 NO... .2 TIME NO .... 2 NO... 2 NO. . 2 PER (-57) PER PER PER PER NO.. ..2 (,47) AMOUNT UNIT YEARS | MONTHS YEAR NO.... 2 WEEK WEEK YEAR WEEK (-59) as' 1 == _ ====- 3 4 7 9 :10-2 r: 0 ==: ;00 0:0 X _=_. LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. I For how Have you For how Did you Did you Where did you get these When you When you first started Would you say How much longer do you think it D many years ever done many need obtain skills, training or experience? first started doing this work, were that you are will take until you have learned altogether the same years specific these PRIMARY/SECONDARY doing this you working for ... still learning to most of what there is to learn C over your work you altogether skills, skills, SCHOOL ........... 1 work, were do this work about this work? O whole life did in the over your training or training or TECHNICAL SCHOOL..2 you household well, or have D have you work of the whole life experienc experience UNIVERSITY ........ 3 working for enterprise? ... 1 you learned E worked for last 7 days have you e before as part of GRADUATE/PROFES- your most of what IF LESS THAN TWO YEARS, employers or for another done the starting to your work SIONAL SCHOOL ..... 4 current there is to learn RECORD MONTHS AND enterprises in employer or same sort do this for your HOUSEHOLD employer? government about this YEARS. IF MORE THAN 2 this same household of work? work? current ENTERPRISE . 5 employer? ..... 2 work? YEARS, RECORD YEARS trade, enterprise? employer? GOVERNMENT ONLY. USE 99 IN BOTH industry or EMPLOYER .6 COLUMNS FOR ANSWERS business? PRIVATE EMPLOYER private SUCH AS "A LIFETIME" OR WITH FEWER THAN employer with "ONE IS ALWAYS LEARNING". 10 EMPLOYEES . 7 fewer than 10 STILL PRIVATE EMPLOYER employees?... .3 LEARNING. .1 9 YES.. . 1 YES ... 1 WITH 10 OR MORE YES... 1 LEARNED NO... 2 NO ....2 (>64) EMPLOYEES ........ 8 ( 66) MOST ... 2 YEARS ( >>61) YEARS ("64) NO... 2 NO... 2 (>68) YEARS MONTHS 3 4 6 10 11 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 68. 69. 70. 71. 72. 73. 74. 75. How long did you do Are you How long have How long Have you How long CHECK FOR THIS PERSON, LOOK AT D this work before you currently you attended altogether will ever altogether did QUESTION THE ANSWERS TO QUESTION had learned most of attending a training you attend completed you attend 22 IN PART 16 OF PART B. WRITE DOWN C what there is to learn training courses or training courses any training training courses, B. DID THE THE OCCUPATION WITH CODE O about this work? course, or worked in this or will you work course, or or work as an INDIVIDUAL 2 IN THAT QUESTION D are you an apprenticeship in this been an apprentice or REPORT (SECONDARY OCCUPATION IN E apprentice or unpaid apprenticeship or apprentice unpaid trainee, MORE THE LAST 7 DAYS). IF LESS THAN or unpaid traineeship until unpaid or unpaid as part of your THAN ONE TWO YEARS, trainee, as now? traineeship? trainee, as work for this KIND OF RECORD MONTHS part of your part of your employer? WORK IN AND YEARS. IF work for this work for this THE PAST MORE THAN 2 employer? employer? 7 DAYS? OCCUPATION CODE YEARS, RECORD >,74 TO BE FILLED IN BY YEARS ONLY SUPERVISOR. YES ...1 YES ... I1I YES ... I1 NO.... 2 TIME TIME NO .... 2 TIME NO .... .2 OCCUPATION _ YARS MONTHS (>>72) NUMBER UNIT NUMBER UNIT (>>74) NUMBER UNIT (>121) OCCUPATION CODE OD 1= =lll llll 4- 6 7__ 8 OUR .... 2 DAY.... 3 WEK.... 4 FORTNIGHT... 5 MONTH ....6 QUARTER.... 7 HALF YSAR .. .8 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 76. 77. 78. 79. 80. 81. 82. I Now I would like to ask you about your work as In this work were you... Is your employer for this How many Is the Are you Is this job D [READ OUT OCCUPATION FROM QUESTION 75]. (READ ALL RESPONSES) work.., people employer, entitled to covered by C If you did this work for more than one employer in the an employer? ..........1 (118) (READ ALL RESPONSES) altogether director or the benefits a collective last 7 days, please think about the employer for work at the manager of of social bargaining 0 whom you worked the most hours during the last 7 a worker on own account a private company, place where this place security agreement? D days. Where did you carry out most of this work in or unpaid worker in a enterprise or you do this related to program in E the last 7 days? household farm or cooperative? ..... 1 work? you? this job? nonfarm business FARM OWNED OR RENTED enterprise? .......... 2(l118) rural public works BY HOUSEHOLD MEMBER ........... 1 program? .2 OTHER FARM ........................ 2 a paid worker in a YOUR HOME .......... 3 household fx-govrnment, OTHER HOME .......... 4 nonfarm business public sector VEHICLE ........................ 5 enterprise? .......... 3(-90) or army? ......... 3 FROM DOOR TO DOOR .............. 6 .... ~~~~~~~~~a state-owned IN THE STREET, NO FIXED PLCE ...7 an employee of someone enterprise? ...... 4 IN THE STREET, FIXED PLACE ..... 8 who is not a member of YES .. 1 YES ... 1 YES ...1 OFFICE/FACTORY ................. 9 your household? ...... 4 a private NO. .. .2 NO ... .2 NO ... 2 OTHER (SPECIFY ) . 10 individual? ...... 5 NUbER 4 7 8 90 12 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. How often do How do you get to work. Do you What type of Can you Do you What is the main How much was your How many Are any D you travel from have a contract do you easily take receive reason you receive no last payment? IF hours did you income, home to written have? time off or wages, salary payment for this RESPONDENT work (or will social C work(for contract reschedule or other work? HAS NOT YET BEEN you work) for secunty or 0 example, twice for this your hours payments PAID, ASK: What the pay you workers' D a day or once a work? in this either in cash payment to do you just reported? compensation E week)? work? or in other >i06 expect? What period Please taxes BUS, VAN OR CAR CONTRACT forms from of time did this include any deducted from SENT BY YOUR TYPE this employer payment cover? hours of paid your pay? EMPLOYER ....... 1 CODES for this work? vacation or COMMERCIAL BUS sick leave. VAN OR CAR ..... 2 PRIVATE CAR OR APPRENTICESHIP MOTORBIKE ...... 3 OR UNPAID BICYCLE ...... 4 TRAINEESHIP... 1 WALK .. 5 LABOR EXCHANGE.2 OTHER YES .. .1 YES .. 1 YES... 1 PAYING OF DEBT.3 YES .. 1 (SPECIFY 6 ~~~~~~~~~~OTMER TIME (SPECIFY _ ).6 NO ....2 NO.... 2 (>90) (SPECIFY )...4 TINE NO.... 2 NUMBER UNIT (">87) NO 2 ....2 AMOUNT UNIT HOURS ("95) l'3 0 - - _ _ _W] 4 6 10 _ ==== 12 HOUR .... .2 DAY.... 3 WEEK.... 4 FORTNIGHT.. .5 MONTH ......6 QUARTER... .7 HALF YEAR. . . 8 YAR... .9 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. I Was the How much Do you How much do your Is your pay determined Do you How much How many Do you What is the value Are you Are you D payment you was your receive eam in tips, mainly by a fixed rate receive was your last months receive of those entitled to entitled to reported payment any tips, gratuities or cash per hour worked, per bonuses bonus? usually any payments? Over paid paid sick C before or after gratuities allowances? day worked, per task (such as pass payment what time interval? holidays in leave in 0 after deducting or or project completed, 1 3th between for this this work? this work? D deducting taxes? allowance or do you receive a month bonus work in E the taxes? s that were salary or a share of salary ...) payments any other not production or revenue? in this in this job? form? included in work? the pay PER HOUR. 1 you have PER DAY. 2 already PER TASK/ reported? PROJECT. 3 SALARY. 4 SHARE OF PRODUCTION OR REVENUE. .5 BEFORE- .1 YES.. .1 OTHER YES .. .1 YES .. 1 YES ... 1 YES .. .1 AFTER ... 2 NO.... 2 TIME (SPECIFY). 6 NO....2 NO.... 2 TIME NO .... 2 NO ....2 (-95) (,97) AMOUNT UNIT (101) AMOUNT MONTHS (s103) AMOUNT UNIT 10 =- 4 6 9 F- HOUR .... 2 DAY. ... 3 WEEK.... 4 FORTNIGT-... 5 MONTH ..... 6 QUARTER.... 7 HALF YEAR... 8 YEAR... 9 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 105. 106. 107. 108. 109. 110. 111. 112. 113. 114. 115. 116. I Are you For how long have you During Is this the During the During the During the During the Did you Did you Where did you get these Are you D entitled to worked for this these only last 7 last 7 last 12 weeks you need obtain skills, training or experience? currently a pension employer, whether years, for employer days, how days, how months, worked for specific these skills, PRIMARY/SECONDARY attending a C (other than doing the work you did how many for whom many many for how this skills, training or SCHOOL ........... 1 training 0 public in the last 7 days or months you did days did hours did many employer training or experience TECHNICAL SCHOOL ..2 course, or D social any other work? per year this work you work you work weeks did in the last experience as part of UNIVERSITY ........ 3 are you an E security did you in the last for this for this you work 12 before your work GRADUATE/PROFES- apprentice or pension) in (IF LESS THAN TWO usually 12 employer? employer? for this months, starting to for your SIONAL SCHOOL . 4 unpaid this work? YEARS, RECORD work? months? employer? for how do this current HOUSEHOLD trainee, as YEARS AND many work? employer? ENTERPRISE . 5 part of your MONTHS. IF MORE hours did GOVERNMENT work for this THAN TWO YEARS, you EMPLOYER .6 employer? RECORD YEARS usually PRIVATE EMPLOYER ONLY.) work? WITH FEWER THAN 10 EMPLOYEES. 7 PRIVATE EMPLOYER YES ...1 ORLESS 108 MONTHS YES... 1 DAYS HOURS WEEKS HOURS YES. ..1 YES...1 WITH 10 OR MORE YES ... 1 NO ....2 PER (>113) PER PER PER PER NO.... .2 (>116) ........ .2 YEARS MONTHS YEAR NO.... 2 WEEK WEEK YEAR WEEK (>>116) NO.... 2 (>118) : T _: 7 9 10I 11 l7;- 12 000: :7 LABOR MODULE (EXPANDED VERSION) PART C: MAIN AND SECONDARY JOB IN THE LAST 7 DAYS ALL PERSONS WHO HAVE REGULAR JOBS 117. 118. 119. 120. 121. 122. 123. I Have you CHECK You reported having done How much did you FOR THIS PERSON, CHECK QUESTION CHECK QUESTION D ever QUESTION work in the last 7 days receive for this CHECK THE 20 IN PART B. 21 IN PART B. completed 22 IN besides the two jobs you other work, ANSWER TO WHAT IS THE CODE WHAT IS THE C any training PART B. have just described to me including tips, QUESTION 19 IN FOR THE ANSWER CODE FOR THE 0 course, or DID THE in detail. In any of these gratuities, bonuses, PART B. WHAT IS TO THAT ANSWER TO THAT D been an INDIVIDUAL jobs did you work for and the value of THE CODE FOR QUESTION? QUESTION? E apprentice or REPORT someone who is not a any payment in THE ANSWER TO unpaid THREE OR member of your kind, after THAT QUESTION? trainee, as MORE household, or were you a subtracting taxes part of your KINDS OF paid employee on a family deducted? What work for this WORK IN farm or in an enterpnse or period of time did employer? THE PAST 7 money making activity this payment DAYS? belonging to a member of cover? your household? CODE 1 ... 1 CODE 2 ... 2 CODE 1... 1 YES .. 1 YES .. .1 YES .. .1 CODE 1.. 1 (,PART D Q.31) (|PART D Q.52) NO ....2 NO ....2 NO ....2 TIME CODE 2-2 CODE 3...,3 CODE 2 2 ('121) (t121) AMOUNT UNIT (>PART D, Q.1) (>NEXT PERSON) (-NEXT PERSON) 2 _ 3 4F 7- .9 Hou..... 2 n.y... . .3 WEEK. .... .4 FORTNIGHT... .5 MONTH ....6 QuARTER.. .. 7 HALF YEAR... .8 LABOR MODULE (EXPANDED VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 1. 2. 3. 4. 5. FOR THIS PERSON, LOOK AT Now I would like to talk about your work as In this work were you Is your employer for this work... How many D THE ANSWERS TO QUESTION 18 [READ OUT OCCUPATION FROM QUESTION (READ ALL RESPONSES) (READ ALL RESPONSES) people OF PART B. WRITE DOWN THE 1]. If youdidthisworkformorethanone an employer? .1(30) altogether C OCCUPATION WITH CODE 1 IN employer in the last 12 months, please think work at the O THAT QUESTION about for the employer for whom you worked the a worker on own account a private company, place D (MAIN OCCUPATION IN THE LAST most hours during the last 12 months. Where did or unpaid worker in a enterprise or where you E 12 MONTHS). you carry out most of this work in the last 12 household farm or cooperative? ......... l do this months? nonfarm business work? enterprise? .......... 2(-30 rural public works FARM OWNED OR RENTED BY program? ............. 2 OCCUPATION CODE TO HOUSEHOLD MEMBER .............. 1 a paid worker in a BE FILLED IN BY OTHER FARM ................... 2 household farm or the government, public SUPERVISOR. YOUR HOME . ........ 3 nonfarm business sector or army? ...... 3 OTHER HOME . .................... 4 enterprise? .......... 3(t16 VEHICLE ....... 5 a state-owned FROM DOOR TO DOOR ......... .6 an employee of someone enterprise? .4 IN THE STREET, NO FIXED PLACE. .7 who is not a member of IN THE STREET, FIXED PLACE ..... 8 your household? 4 A private individual?.5 OCCUPATION OFFICE/FACTORY.yuhuhl.Apvt ndi.. 9 _ OCCUPATION CODE OTHER (SPECIFY ). 10 H UMsER OJ 1 0 4 2 6 7 8 11 , 12 LABOR MODULE (EXPANDED VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. I Is the In this place the Are you Is this job Are you employed Do you What type of When you first took this job, Did you What is the main D employer, owner or owners... entitled to covered by and paid directly by have a contract do how long did you expect it to receive reason you received director or (READ ALL the a collective the firm, company or written you have? last? wages, no payments for this C manager of RESPONSES) benefits bargaining enterprise at which contract ONE DAY OR LESS. 1 salary or work? 0 this place of sociai agreement? you did this work, or for this MORE THAN ONE DAY other D related to do not work?.. 1 security were you employed work? BUT LESS THAN ONE payments E you? program or paid by a MONTH ............ 2 either in . 2 1 work only in in this contractor, MORE THAN ONE MONTH cash or in management job? intermediary or CONTRACT BUT NO MORE THAN other forms and admini- middleman? TYPE THREE MONTHS 3 from this stration? .... 2 CODES MORE THAN THREE employer MONTHS BUT NO MORE for this participate in THAN ONE YEAR . 4 work? APPRENTICESHIP production, MORE THAN ONE YEAR OR UNPAID sales or BUT NO MORE THAN TRAINEESHIP... 1 provision of DIRECT ..... 1 THREE YEARS ........ 5 LABOR EXCHANGE.2 services? 3 CONTRACTOR/ ~~~~~~~~MORE THAN THREE PAYING OF DEBT.3 YES_...1 s YES ... .1 YES ... I. COTACT1 (SPYES ...I YES... 1 No... 22 NO.... 2.2Y(16) (SPECIFY__IIIII MIDDLEMAN ... 2 NO.4 ____________________________ _________ t -13) N o .... .2 CD 2 5 7 9 10 I11 12=_ H OUR .... 2 DAY ... 3 WEEK.... 4 FORTNIGHT ...... 5 moNTH ...... 6 QUARTER ..... 7 HALJF YEAR ... 8 YEAR ... 9| LABOR MODULE (EXPANDED VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. How much was your How many Are any Did you What was the During how many years During Is this the During the During the During the D last payment? What hours did income, receive any value of those have you worked for these only last 12 weeks you weeksyou period of time did this you work social additional payments? Over this employer, whether years, for employer months, for worked for worked for C payment cover? for the pay security or payments, in what time interval? doing the work you did how many for whom how many this this 0 you just workers' the form of in the last 12 months or months per you did this weeks did employer in employer in D reported? compensation tips, any other work? year did work in the you work the last 12 the last 12 E Please taxes gratuities, you usually last 12 for this months, months, include any deducted bonuses, IF LESS THAN TWO work for months? employer? how many how many hours of from your food, clothing, YEARS, RECORD this days did hours did paid pay? housing or YEARS AND employer? you usually you usually vacation or transportation S IF work per work per sick leave. in this work? THAN TWO YEARS, week? week? RECORD YEARS ONLY. IF LESS T'HAN I YES .. 1 YES .. 1 YwEAR TAN MONTHS YES ... 1 WEEKS DAYS HOURS TIME NO... 2 NO... 2 | TIME PER ('27) PER PER PER _AMOUNT UNIT HOURS ( 21) AMOUNT UNIT YEARS Y MONTHS EAR NO.... 1 YEAR WEEK WEEK o~ 11 0 27 _____ :::_:_:__ _ _-== a, 2 3 7 HOUR... - 2 DAY.... .3 WEEK.... .4 FORTNIGHT... .5 MONTH ....6 QUARTER....?7 HALF YEAR.,. .8 YEA-R. LABOR MODULE (EXPANDED VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 27. 28. 29. 30. 31. I Did you What is the main reason you did not work in What is the main reason FOR THIS LOOK AT THE ANSWERS TO D work in this this job in the last 12 months? you lost that job? PERSON, QUESTIONS Bl AND B18. WRITE job in the CHECK THE DOWN THE SECOND MOST C last 7 days? LOST Jos, LAID OFF OR ANSWER TO IMPORTANT OCCUPATION 0 BUSINESS FAILED ............ 1 QUESTION 20 (ACTIVITY WITH CODE 2 IN PAST D DECIDED TO CONCENTRATE ON OF PART B. 12 MONTHS.) E OTHER JOB ALREADY DOING ... 2(130) WHATISTHE FOUND JOB WITH BETTER PAY PLANT CLOSED DOWN CODE FOR OR WORKING CONDITIONS. 3(>>30) OR MOVED ........ 1 THAT OCCUPATION CODE TO FOUND JOB WITH BETTER HOURS.4(*30) POSITION OR SHIFT QUESTION? BE FILLED IN BY THE MOVED TO DIFFERENT ABOLISHED . 2 SUPERVISOR RESIDENCE .................. 5(130) FIXED DURATION RETIRED ...... 6(130) JOB COMPLETED ... 3 BECAME DISABLED ............. 7(*30) OWN BUSINESS CODE 1... 1 STARTED SCHOOL OR FAILED 4.(.51) TRAINING PROGRAM ............ 8(30) FIRED ............5 5 HOUSEHOLD RESPONSIBILITIES.9(>30) OTHER CODE 2 ... 2 YES.. 1 JOB WAS SEASONAL ........... 10(*30) (SPECIFY_)..6 CODE 3 ... 3 (129) OTHER SPECIFY(-) .......... 11(*30) (*54) OCCUPATION NO.... 1 OCCUPATION CODE 2 3 4 5 _ 7 10 I11_. . 12 =__ LABOR MODULE (EXPANDED VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 32. 33. 34. 35. 36. 37. 38. Now I would like to talk about your work as [READ I OUT OCCUPATION FROM QUESTION 31]. If you In this work were you... Is your employer for this How many Are you Is this job Do you D did this work for more than one employer in the last (READ ALL RESPONSES) work... (READ ALL people entitled to covered by have a 12 months, please think about for the employer for an employer?'........ s51 RESPONSES) altogether the benefits a collective written C whom you worked the most hours during the last 12 work at the of social bargaining contract for 0 months. Where did you carry out most of this work in a worker on own account a private company, place where security agreement this work? D the last 12 months? or unpaid worker in a enterprise or you do this program in ? E household farm or cooperative? .....I work? this job? nonfarnm business FARM OWNED OR RENTED aY enterprise? .......... 2(-51 rural public HOUSEHOLD MEMBER .................................. 1 works program? ...2 OTHER FARM ..................... 2 a paid worker in a YOUR HOME ......... 3 household farm or the government, OTHER HOME . ........ 4 nonfarm business public sector VEHICLE . .......... S enterprise? .......... 3(t42 or army? .3 FROM DOOR TO DOOR .............. 6 IN THE STREET, NO FIXED PLACE ..7 an employee of someone a state-owned IN THE STREET, FIXED PLACE .....8 who is not a member of enterprise .4 OFFICE/FACTORY .............. 9 your household? ...... 4 YES .. 1 YES ...1 YES ... 1 OTHER (SPECIFY ). 10 A private NO ....2 NO ....2 NO.... 2 individual?. 5 NUMBER -(40) i.: 1: 00 2 4- F 7 8 9 {T 11 12 :: LABOR MODULE (EXPANDED VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. I What type of Did you What is the main How much was your How many Are any Did you receive What was the Is this the During the D contract do you receive reason you received last payment? What hours did you income, social any additional value of those only last 12 have? wages, no payments for this period of time did this work for the securit or payments, in payments? Over employer months, for C salary or work? payment cover? pay you just workers' the form of tips, what time interval? for whom how many 0 other reported? compensation gratuities, you did this weeks did D payments Please taxes bonuses, food, work in the you work E either in include any deducted from clothing, last 12 for this cash or in I hours of paid your pay? housing or months? employer? CONTRACT other forms vacation or transportation TYPE from this sick leave. in this work? CODES employer for this work? APPRENTICESHIP OR UNPAID TRAINEESHIP... 1 LABOR EXCHANGE.2 PAYING OF DEBT.3 YES.. 1 OTHER YES .. .1 YES .. 1 YES ... 1 WEEKS (t42) (SPECIFY-) ... 4 TIME NO ....2 NO ....2 TIME (>>51) PER NO... 2. AMOUNT IUNIT HOURS (l47) AMOUNT UNIT No .... 2 YEAR 12== 4- 6 7 10 {i HIOUR.... .2 DAY.... .3 WEE... . .4 FORTNIGHT... 5 MONTH ....6 QUARTER.... 7 HALF YEA... .8 LABOR MODULE (EXPANDED VERSION) PART D: MAIN AND SECONDARY JOB IN THE LAST 12 MONTHS ALL PERSONS WHO HAVE REGULAR JOBS (WHEN DIFFERENT FROM JOBS OF LAST 7 DAYS) 49. 50. 51. 52. 53. 54. I During the During the CHECK You reported having done How much did you CHECK ANSWER D weeks you weeks you QUESTION work in the last 12 months receive for this TO QUESTION 30 worked for worked for 21 IN PART besides the jobs you have other work, IN PART A C this this B. WHAT IS already described to me in including wages, (WORKED 5 0 employer in employer in THE CODE detail. In any of these jobs salary, tips, YEARS AGO). D the last 12 the last 12 FOR THAT did you work for someone gratuities, E months, months, QUESTION? who is not a member of bonuses, and the how many how many your household, or were value of any days did hours did you a paid employee on a payment in kind, you usually you usually family farm or in a after subtracting work per work per enterprise or money taxes deducted? week? week? making activity belonging What period of to a member of your time did this household? payment cover? YES... .1 DAYS HOURS CODE 1.. 1 YES .. 1 (-SECTION E) PER PER CODE 2. .2 NO.... 2 N TIME NO.... 2 WEEK WEEK (-54) (-54) AMOUNT UNIT (>>NEXT PERSON) Oj 1 === === 0 ~~~~ : 2 4- 5 6 7 8 9 10 12 .. H OUR .... 2 DAY.... 3 WEEK.... 4 FORTNIGHT ...... 5 MONTH ...... 6 QUARTER ..... 7 HAF YEAR ....... S LABOR MODULE (EXPANDED VERSION) PART E: OVERVIEW OF WORK FIVE YEARS AGO ALL PERSONS WHO HAVE REGULAR JOBS 1 . 2. 3. A I I would like to ask you some questions about the kinds of work What kind of trade or business was this work connected In what crop or with what type of livestock did you C D you were doing five years ago, that is, in the year with? [YEAR 5] spend most time in this work five years ago? T YEARS AGOI This includes work on a farm, on your own I C account, for a household business enterprise, or for someone V 0 else. I D T E What kind of work did you do?. Y C 0 IF NOT RELATED TO AGRICULTURE *4 D E CROP OR OCCUPATION INDUSTRY 1 ANIMAL _j _ _WRITTEN DESCRIPTION CODE WRITTEN DESCRIPTION CODE WRITTEN DESCRIPTION | CODE A B-- F_ H_= K LABOR MODULE (EXPANDED VERSION) PART E: OVERVIEW OF WORK FIVE YEARS AGO ALL PERSONS WHO HAVE REGULAR JOBS 4. 5. A I Were you Which of these activities was the C D doing any most important five years ago, in T other kind of the sense that you worked the I C work five most hours in it? And which was V 0 years ago? the next most important? I D T E Y C | >PART F| 0 D E ACTIVITY REPORTED YES...1 AS MOST IMPORTANT.. .1 ACTIVITY REPORTED AS (>>NEXT NEXT MOST IMPORTANT.2 LINE) OTHER ACTIVITIES ..... 3 NO .... .2 c F- G_ H_ K LABOR MODULE (EXPANDED VERSION) PART F: MAIN AND SECONDARY JOB FIVE YEARS AGO ALL PERSONS WHO HAVE REGULAR JOBS 1. ~~~~~~~~~~2. 3. 4. 5. Now I would like to ask you about your work In this work were you: Were you CHECK QUESTIONS 1 AND 73 OF D FOR EACH PERSON, LOOK AT five years ago as [READ OCCUPATION THE ANSWERS TO QUESTION 5 FROM QUESTION 1]. If you did this work for (READ ALL RESPONSES) stll PART C AND QUESTIONS 1 AND 28 C OF PART E. WRITE DOWN THE more than one employer five years ago, this SECONDARY JOB OF THE LAST 7 C OCCUPATION WITH CODE 1 IN please think about your work for the employer business DAYS OR LAST 12 MONTHS? D THAT QUESTION (MAIN for whom you worked the most hours when enese COR WIT RESPONTHS? E OCCUPATION FIVE YEARS AGO) answering the following questions. Where did an employer ...........1 in the last ASKING 'Is this the same as the work you carry out most of this work five years ago? a worker on own account 12 reported earlier as [READ THE or unpaid worker in a months? OCCUPATION THAT APPEARS TO BE household farm or THE SAME]. FARM OWNED OR RENTED BY nonf arm business OCCUPATION CODE TO BE HOUSEHOLD MEMBER ............... 1 enterprise . 2 FILLED IN BY SUPERVISOR OTHER FARM ......... ............ 2 SAME AS MAIN JOB OF YOUR HOME ....................... 3 a paid worker in a LAST 7 DAYS ......... 1(>>7) OTHER HOME ...................... 4 household farm or SAME AS SECONDARY VEHICLE . ........................ 5 nonfarm business JOB OF LAST 7 DAYS..2(>>7) FROM DOOR TO DOOR ............... 6 enterprise ........... 3(>5) SAME AS MAIN JOB OF IN THE STREET, NOT FIXED PLACE ..7 LAST 12 MONTHS ...... 3(>>7) IN THE STREET, FIXED PLACE ...... 8 an employee of someone SAME AS SECONDARY JOB OFFICE/FACTORY . .......... 9 who is not a member of YES.. 1 OF LAST 12 MONTHS... 4(t7) NOT THE SAME OF ANY your household ....... 4('5) .(25) OF THOSE JOBS ....... 5 OCCUPATION No .... 2 OCCUPATION CODE (>>19) 8 9 10 12 LABOR MODULE (EXPANDED VERSION) PART F: MAIN AND SECONDARY JOB FIVE YEARS AGO ALL PERSONS WHO HAVE REGULAR JOBS 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. i Was your employer for When you first took this job, How many Were you Was this Were you employed Did you What type of Were you Were you Were you D this work... how long did you expect it to people entitled to job covered and paid directly by have a contract did entitled to entitled to entitled to (READ ALL last? altogether the by a the firm, company or written you have? paid paid sick a pension C RESPONSES) worked at benefits o collective enterprise at which contract holidays leave in (other than 0 the place social bargaining you did this work, or for this in this this work? public D where you security agreement? were you employed o work? work? social E A private company, ONE DAY OR did this system in paid by a contractor, security enterprise or ORE DAN ON E DAY work? this work? intermediary or pension) in cooperative? .... 1 BUT ONE T AY . middleman? CONTRACT this work? BUT LESS THAN ONE TYPE Rural public MONT .............. 2 CODES works program? . .2 MORE THAN ONE MONTH BUT NO MORE THAN THREE MONTHS ....... 3 The government, public sector MORE THAN THREE or army? ........ 3 MONTHS BUT NO MORE . ~~~~~~~~THAN ONE YEAR ........... 4 MOETHAN ONE YEJAR. A state-owned MORE THAN ONE YEAR enterprise? ..... 4 BUT NO MORE THAN THREE YEARS ........ S A private MORE THAN THREE individual? ..... 5 YEARS .... 6 YES .. 1 YES .. 1 DIRECT ...... 1 YES.. .1 YES .. 1 YES .. 1 YES .. 1 NO... 2 NO... 2 CONTRACTOR No... .2 NO... 2 NO... 2 No .... 2 NUMBER INTERMEDIARY. 2 ( >>14) 2 3 4 6 7 8 9 10 611 :X 00: 00;; 0;0 0 _ = 00 0 0; - ; _ 12: LABOR MODULE (EXPANDED VERSION) PART F: MAIN AND SECONDARY JOB FIVE YEARS AGO ALL PERSONS WHO HAVE REGULAR JOBS 17. 18. 19. 20. 21. 22. 23. 24. 25. I Had you Were you What is the main reason you no longer What is the main reason Did you How many How many How long have CHECK D ever still working work in that job? you lost that job? find work weeks after jobs have you you been without QUESTION completed for this to replace losing that had since work since 5 OF PART C a training employer in LOST JOB, LAID OFF OR that job? job did you then? losing that job? E. DID O course or the last 12 BUSINESS FAILED .......... 1 start working THIS D been an months? DECIDED TO CONCENTRATE ON in the INDIVIDUAL E apprentice OTHER JOB ALREADY DOING.2(a21) replacement REPORT or unpaid FOUND JOB WITH BETTER PAY job? MORE trainee for OR WORKING CONDITIONS.... 3(.21) THAN ONE this FOUND JOB WITH BETTER ACTIVITY 5 employer?HOURS. ...4(~21) IF MORE YEARS employer? MOVED TO DIFFERENT X THAN 2 AGO? RESIDENCE..........5(.21) [ jYEARS, RETIRED .6(>21) PLANT CLOSED DOWN LEAVE BECAME DISABLED ........... 7(.22) OR MOVED ........1 MONTHS STARTED SCHOOL OR POSITION OR SHIFT BLANK TRAINING PROGRAM ......... 8(.22) ABOLISHED .......2 HOUSEHOLD FIXED DURATION RESPONSIBILITIES ......... 9("22) JOB COMPLETED ...3 JOB WAS SEASONAL. 10(22) OWN BUSINESS 1`J OTHER SPECIFY( ).11("22) FAILED .......... 4 YES .. .1 YES .. 1 YES ... 1 OTHER (INCLUDING YES .. .1 NO.... 2 NO... 2 ("25) FIRED) ..... ... NO....2 (-NEXT NO... 2 (s24) WEEKS NUMBER YEARS MONTHS PERSON) 3 4 6_ 12 _,- LABOR MODULE (EXPANDED VERSION) PART F: MAIN AND SECONDARY JOB FIVE YEARS AGO ALL PERSONS WHO HAVE REGULAR JOBS 26. 27. 28. 29. 30. 31. I LOOK AT ANSWERS FOR Now I would like to ask you about your In this work were you: Were you CHECK QUESTIONS 1 AND 73 OF Your employer for D QUESTIONS 1 AND 5 IN PART E. work five years ago as [READ (READ ALL RESPONSES) still PART C AND QUESTIONS 1 AND this work was: WRITE DOWN THE OCCUPATION OCCUPATION FROM QUESTION 26]. working in 28 OF PART D. WAS THIS THE (READ ALL C WITH CODE 2 IN QUESTION 5 If you did this work for more than one an employer ........ 1 this MAIN OR SECONDARY JOB OF RESPONSES) 0 (SECONDARY OCCUPATION 5 employer five years ago, please think business THE LAST 7 DAYS OR LAST 12 A private D YEARS AGO) about your work for the employer for a worker on own enterprise MONTHS CONFIRM WITH company, E whom you worked the most hours account or unpaid in the last RESPONDENT BY ASKING "Is this enterprise or when answering the following worker in a 12 the same as the work reported earlier cooperative. .1 questions. Where did you carry out household farm or most of this work five years ago? nonfarm business months? as [READ THE OCCUPATION THAT enterprise. 2 APPEARS TO BE THE SAME]. Rural public OCCUPATION CODE TO BE FARM OWNED OR RENTED works FILLED IN BY SUPERVISOR BY HOUSEHOLD MEMBER.1 a paid worker in a SAME AS MAIN J OB OF program . 2 OTHER FARM ........... 2 household farm or LAST 7 DAYS .........1(32) The goveranment YOUR HOME ............ 3 nonfarm business SAME AS SECONDARY public sector OTHER HOME .......... 4 enterprise ........ 3 JOB OF LAST 7 DAYS. .2(>>32) public sector VEHICLE .......... 5 (>30) SAME AS MAIN JrOB OF or army ...... 3 FROM DOOR TO DOOR .... 6 an employee of LAST 12 MONTHS ...... 3(>32) IN THE STREET, someone who is A state-owned NOT FIXED PLACE ..... 7 not a member of YES... 1 SAME AS SECONDARY JOB enterprise... 4 IN THE STREET, your household.... 4 ('NEXT NOT THE SAME OF ANY A prate 0' FIXED PLACE .8 (>'30) PERSON) OF THOSE JOBS home . 5 OCCUPATION OFFICE/FACTORY. 9 NO....2....... ..home.......... 9 OCCUPATION CODE (>41) 2 3 4 5 6 7 8 9 {rl 11 12I LABOR MODULE (EXPANDED VERSION) PART F: MAIN AND SECONDARY JOB FIVE YEARS AGO ALL PERSONS WHO HAVE REGULAR JOBS 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. I How many Were you Was this Did you What type of Were you Were you Were you Were you What is the main reason you no longer What is the main D people entitled to job covered have a contract did entitled to entitled to entitled to still working work in that job? reason you lost that altogether the by a written you have? paid paid sick a pension for this IF CODE 1, GO TO QUESTION 42. job? C worked at benefits of collective contract holidays leave in (other than employer in FOR ALL OTHER RESPONSES GO O the place social bargaining for this in this this work? public the last 12 TO NEXT PERSON >NExT D where you security agreement? work? work? social months? E did this system in security LOST JOB, LAID OFF OR work? this work? CONTRACT pension) in BUSINESS FAILED ............. 1 TYPE thswr?DECIDED TO CONCENTRATE ON PLANT CLOSED CODES OTHER JOB ALREADY DOING ..... 2 DOWN OR MOVED..1 FOUND JOB WITH BETTER PAY POSITION/SHIFT OR WORKING CONDITIONS ....... 3 ABOLISHED.....2 FOUND JOB WITH BETTER HOURS ..4 FIXED DURATION MOVED TO DIFFERENT RESIDENCE.5 JOB COMPLETED 3 RETIRED ...................... 6 OWN BUSINESS BECAME DISABLED .............. 7 FAILED ......... 4 STARTED SCHOOL OR FIRED . 5 . . . TRAINING PROGRAM .8 OTHER HOUSEHOLD RESPONSIBILITIES-9 (SPECIFY ).6 YE .... J1 OB WAS SEASONAL ............ 10 _4 YES ...1 YES ... 1 YES ...1 YES...1 YES ... 1 YES ...1 NO ....2 OTHER SPECIFY( ) ...... 11 NO .... 2 NO .... 2 NO....2 NO .... 2 NO... 2 NO... 2 (-NEXT NUMBER (-37) PERSON) 2 3 4 6 7 8 9 11 Module for Chapter 10 Anthropometry Harold Alderman The following page presents the draft questionnaire page the name of the person to whom the information applies. for collecting anthropometric data. Such data are discussed This is done because some surveys allow this page to be in detail in Chapter 10 ofVolume 1. Only a single version detached from the rest of the questionnaire, which allows a of the anthropometric module is shown. The main change special survey team member, the anthropometrist, to collect that could be made occurs when anthropometric informa- anthropometric data independently of the interviewer, who tion is a major focus of the survey, in which case informa- has the rest of the questionnaire.This gives each team mem- tion should be collected for all household menmbers, rather ber added flexibility to use their time more efficiently. In than only for young children. other surveys, the interviewer may be the person that Unlike all other questionnaire pages that use a grid records the anthropometric measurements, in which case format to collect information from each individual in the there are no specialist team members for this task. In this household, the anthropometric page shows a column for case the name column can be omitted. 219 ANTHROPOMETRY (Household ID Code L=i) ALL CHILDREN 8 YEARS AND UNDER 1. 2. 3. 4. 5. 6. 7. 8. 9 10. NAME When was IS INFOR- This means WAS [NAME] WHY NOT? HEIGHT WAS HEIGHT WEIGHT ARM HEALTH, [NAME] born? MATION that [NAME) is MEASURED? MEASURED CIRCUM- IMMUNI- I ~~~~~~~~PROVIDED ___ years STANDING FERENCE ZA TION D FROM and/or ___OR LYING AND BIRTH months old. Is DOWN? POSSIBLE o ~~~~~~~ASK TO SEE CERTIFI- this correct? BREAST O BIRTH CATE OR FEEDING D REGISTRATION OTHER DATA MAY E OR OTHER OFFICIAL FOLLOW CERTIFICATE OF PAPER? PROBE NOT HOME HERE. BIRTH. IF NOT AND DURING ENTIRE (SEE TEXT) AVAILABLE, ASK RECORD SURVEY TO SEE CORRECT PERIOD....1 IMMUNIZATION AGE IN TOO ILL.. .2 CARD. MONTHS HANDI- CAPPED OR DEFORMED... .3 YES. .1 YES. .1 NOT WILLING 4 STANqDING. 1 NO... 2 AGE IN (6 OTHER ..... CENTI-I LYING.... .2 KILOS rAC-I CENTI-I I f n~~~AY mTH YR MONTHS NO... 2 IMETERS TIN METERS 4- 9 iT Module for Chapter I I Transfers and Other Nonlabor Income Andrew McKay The following pages present the draft questionnaire to col- the standard or short version is used. The standard version lect data on transfers and other non-labor income. As is divided into two sub-parts that vary in terms of the type explained in Chapter 11 ofVolume 1, the module has two of income-one for regular and frequent income sources, versions: standard and short. For both versions, the module where some detail is gathered at the individual-specific consists of two parts.The first part collects data on income level, and one for less frequent sources. The latter gathers from private inter-household transfers. One option that information only at the level of the household. The appro- survey designers may consider is to combine this part with priate place to put specific income sources will depend on the questionnaire pages in the consumption module on the country context. In situations where nonlabor income transfers to other households, which would create a sepa- is of little analytic interest, or where it is not a large source rate, stand alone module. This would not affect the analytic of income, the individual-specific detail on regular and fre- content at all; the reason for doing this is that it may be quent income sources could be dropped, which would more sensible to ask the respondent to talk about incoming allow the two sub-parts to be merged into a single set of and outgoing transfers together, rather than in different questions. Finally, if the short version is used there would be parts of the questionnaire. only one part, which would collect information on The second part of this module collects data on other incomes at the household level only, and only for the most kinds of nonlabor income. Its structure depends on whether important income sources. 221 MISCELLANEOUS INCOME PART A: INCOME FROM PRIVATE INTER-HOUSEHOLD TRANSFERS (SHORT VERSION) MOST KNOWLEDGEABLE PERSON 1. During the past 12 months has your household or any of its members received any money or goods from persons who are not members of your household? For example for relatives living elsewhere, child support or alimony, or from friends or neighbors? YES. . .1 NO .... 2 (-NEXT SECTION) 2. 3. 4. 5. 6. 7. I What are the names of the persons who Is this Which Is [NAME OF How much What is the D sent assistance to this household during assistance sent household DONOR] money have approximate the past 12 months? by [DONOR] member does related to members of value in cash C given to or for [DONOR] send [NAME OF the household of the 0 specific this assistance RECIPIENT]? received assistance D member of this for? from[DONOR] given in food E household? in the past 12 or other months? goods in the past 12 LIST ALL NAMES months? BEFORE GOING TO 3-20 COPY ID CODE OF PERSON FROM ROSTER YES. .1 YES. .1 NO.. .2 NO... .2 NAMES ('p6) AMOUNT AMOUNT 4 6 7 10 _ 3 i_X MISCELLANEOUS INCOMES PART A: INCOME FROM PRIVATE INTER-HOUSEHOLD TRANSFERS (STANDARD VERSION) MOST KNOWLEDGEABLE PERSON 1. During the past 12 months has your household or any of its members received any money or goods from persons who are not members of your household? For example for relatives living elsewhere, child support or alimony, or from friends or neighbors? YES...1 NO.... 2 (>NEXT SECTION) 2. 3. 4. 5. 6. 7. I What are the names of the persons Is this Which Is [NAME OF How is [NAME OF DONOR] related to How is [NAME OF DONOR] related to the D who sent assistance to this household assistance sent household DONOR] [NAME OF RECIPIENT]? head of the household? during the past 12 months? by [DONOR] member does related to C given to or for [DONOR) send [NAME OF DONOR IS .... OF RECIPIENT 0 a specific this assistance RECIPIENT]? DONOR IS OF RECIPIENT SPOUSE .............. 2(-10) D member of this for? SPOUSE .2('10) CHILD ................ 3 (.8) E household? CHILD .3 (-8) GRANDCHILD ........... 4('10) GRANDCHILD .4(.. 1 ) ..10 NIECE OR NEPHEW ...... 5(>10) NIECE OR NEPHEW ...... 5(-10) pARENT ........... .... 6 (.9) LIST ALL NAMES PARENT. 6 (-9) SISTER/BROTHER ..... 7(.10) BEFORE GOING SISTER/BROTHER. 7(-10) SON/DAUGHTER-IN-LAW .. 8(10) TO 3-20 COPY ID SON/DAUGHTER-IN-LAW..8(10) BROTHER/SISTER-IN- CODE OF BROTHER/SISTER-IN- LAW .9(10) PERSON LAW .9(10) GRAND FATHER/MOTHER.10('10) FROM GRAND FATHER/MOTHER.10('10) FATHER/MOTHER-IN- ROSTER FATHER/MOTHER-IN- LAW ................ 11(>10) t-J LAW ................ 11('10) OTHER RELATIVE ...... 12(-10) t'J YES ..1 YES ..1 OTHER RELATIVE ...... 12(410) NO RELATION ......... 13(.10) NO .. 2 NO .. 2 NAMES (-7) (>9) 2 3 4 5 6 7 8 9 12 MISCELLANEOUS INCOMES PART A: INCOME FROM PRIVATE INTER-HOUSEHOLD TRANSFERS (STANDARD VERSION) MOST KNOWLEDGEABLE PERSON 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Is [DONOR] Does What kind of place In what region is How much Has the household What is the Is the D male or [DONOR] live does[DONOR] live this place? money have also received any approximate assistance female? in this place? in? members of assistance from value in cash sent by C OP DCD COPY ID CODE the household [DONOR] in the of the [DONOR] O COPY ID CODE OF DONOR received form of food or assistance provided for a D OF DONOR FROM ROSTER from[DONOR] other goods in the given in food specific E FROM ROSTER B in the past 12 past 12 months? or other reason? C months? goods in the CODE LIST past 12 OF AREAS months? USED ON MIGRATION PAGE CAPITAL CITY ...... 1 LARGE )i . CITY ...... 2 MALE .... 1 YES..1 TOWN ....... 3 YES..1 YES..1 ID ID FEMALE ..2 NO... 2 VILLAGE .... 4 NO... 2 NO .. 2 CODE CODE ('144) AMOUNT ( 17) AMOUNT (419) 2 3 4: T 6i 8 9 10::.: 11 12: : ::: ::: MISCELLANEOUS INCOMES PART A: INCOME FROM PRIVATE INTER-HOUSEHOLD TRANSFERS (STANDARD VERSION) MOST KNOWLEDGEABLE PERSON 18. 19. 20. i What is the main reason How many Must the household D why [DONOR] sent this times per repay the assistance assistance? year does sent by [DONOR]? C [DONOR] 0 CHILD send this D SUPPORT ...... 1 assistance? E EDUCATIONAL EXPENSES ..... 2 MEDICAL EXPENSES ..... 3 WEDDING ....... 4 FUNERAL ....... 5 INVESTMENT IN HOUSEHOLD ENTERPRISE .... 6 PURCHASE OF A DURABLE GOOD.7 U' OTHER.. .E.. .1 No.. .2 _ ________________ _________ (-NEXT DONOR) 1~ 2 3_ 4- 5- 6 7 8 10 t1 3 MISCELLANEOUS INCOMES PART B (STANDARD VERSION): 1. REGULAR AND FREQUENT INCOME SOURCES MOST KNOWLEDGEABLE PERSON 1. 2 3. 4. 5. 6. 7. 8. 9. In the last 12 Who is the first How much Did any other Who is the How much Did any other Who is the third How much months, has any member of your did [NAME member of your second member did [NAME member of your member of your did [NAME member of your household who OF household receive of your OF household receive household who OF household received received income PERSON] income from this household who PERSON] income from this received income PERSON] any payment from from this receive source? received income receive source? from this receive the following source? from this from this from this source? from this sources? source in source? source in source in the past the past the past month? month? month? COPY ID COPY ID COPY ID CODE OF CODE OF CODE OF PERSON PERSON PERSON FROM FROM FROM ROSTER ROSTER ROSTER YES . 1 YES ..1 YES . 1 NO.. 2 NO.. .2 NO .. 2 SOURCE (-NEXT SOURCE) AMOUNT (-NEXT SOURCE) AMOUNT (>>NEXT SOURCE) AMOUNT s 1 1 State pension 2 Company or private pension 3 Survivors pension 4 Unemptoyment benefit 5 Illness or disability payments 6: Job search programs 7 Maternity payments 8 Child allowances 9 Social assistance payment 10 Etc. MISCELLANEOUS INCOMES PART B (STANDARD VERSION): 2. LESS FREQUENT INCOME SOURCES MOST KNOWLEDGEABLE PERSON 1. ~~~~~~~~~2. 3. 4. In the last 12 months, did your How much did your household Was this payment received by a specific household Who in the household was household, or any of its members, receive in the last 12 months from member, or by the household as a whole? the principal recipient of receive any payments, in cash or [SOURCE] including the value of this payment? in any other form, from the any payment in the form of goods? following sources? COPY ID CODE OF PERSON FROM ROSTER YES. .1 SPECIFIC HOUSEHOLD MEMBERYES. .1 No... 2 HOUSEHOLD AS A WHOLE .......... 2 SOURCE ( -NEXT SOURCE) AMOUNT ( NEXT SOURCE) 1 Rental income: .. - Source 1 Source 2 Source 3 Etc.. _ 2 Transfers:__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Source 1 Source 2 Source 3 Etc. 3 Revenue from sate of assets: _______________ Source 1 Source 2 Source 3 Etc.. . 4 Other Income: Source 1 Source 2 Source 3 5 Other: (Specify) _ _ MISCELLANEOUS INCOMES PART B (SHORT VERSION): OTHER NONLABOR HOUSEHOLD INCOME MOST KNOWLEDGEABLE PERSON 1. 2. In the last 12 months, did your household, or any of its How much did your household receive in the last 12 members, receive any payments, in cash or in any other months from [SOURCE] including the value of any form, from the following sources? payment in the form of goods? YES. .1 NO. ..2 LOCAL SOURcE ( .NEXT SOURCE ) CURRENCY UNIT 1 Transfers: Source 1 Iis _ Source 2 Source 3 Etc.. 2 Rental income: Source 1 Source 2 Source 3 Etc. 3 Revenue from sale of assets'. Source 1 Source 2 Source 3 Etc.. . 4 Other Income: Source 1 Source 2 Source 3 Etc. (Specify) 5 O0ther: (Specify) ________________________________________________ Module for Chapter 12 Housing Stephen Malpezzi Two versions of the housing module are given in the fol- where the water supply is seasonal.Thus in some countries lowing pages. They are discussed in detail in Chapter 12 of the short module should incorporate some of the questions Volume 1. The shorter module collects information that provided in the long module. can be used to describe basic household amenities and to An important issue to settle regarding the housing calculate the use value of housing, which is one component module is whether the minimal water, sanitation and fuel of aggregate consumption.The longer module collects con- use questions that it contains are adequate. If not, the mod- siderably more data, which can be used to analyze housing ules on these topics that are presented Chapter 14 of markets. This distinction is, however, somewhat simplistic. Volume 2, which discusses environmental issues, are more The long module contains many detailed questions that can appropriate. be used to expand basic descriptive work under certain A final point to note is that the electronic files of the conditions. For example, in some countries housing prices housing nmodule are in MS Word, not Excel. In some cases include complexities such as "key money." It also collects it may be useful to convert them to Excel so that the entire useful information in countries where climates are cold, or questionnaire is in a single software package. 229 HOUSING MODULE (SHORT VERSION) PART A. DESCRIPTION OF THE DWELLING 4. WHAT TYPE OF DWELLING IS IT? Now I would like to ask you about your housing conditions. I mean by DETACHED HOUSE .............................1.....,1 housing all the rooms and all separate buildings used by your household MULTI-FAMILY HOUSE 2 members. What buildings or rooms do the members of your household SEPARATE APARTMENT 3 occupy? COMMUNAL APARTMENT 4 ROOM IN A LARGER DWELLING 5 BEFORE ASKING QUESTION 5, OBSERVE AND NOTE THE SEVERAL BUILDINGS CONNECTED 6 FOLLOWING: SEVERAL SEPARATE BUILDINGS . 7 IMPROVISED HOUSING UNIT . 8 1. WHAT IS THE MAJOR CONSTRUCTION MATERIAL OF THE EXTERNAL OTHER (SPECIFY ___________ .9 WALLS? BRICK .............................1 5. How many rooms do the members of your household occupy, including CONCRETE PLATES .............................2 bedrooms, living rooms and rooms used for household enterprises? CONCRETE BLOCKS ................................. 3 UNBAKED BRICK, ADOBE .................................4 DO NOT COUNT BATHROOMS, KITCHENS, BALCONIES AND CORRIDORS WOOD, LOGS ......................5.......... 5 TIN, ZINC SHEETING ................................. 6 NUMBER OF ROOMS FLATTENED TIN CANS ................................. 7 MUD 8 6. How many, if any, of these rooms are used primarily for family enterprise BAMBOO................................... 9ortae CANVAS, FELT . .0 or trade? OTHER (SPECIFY ) .......... 11 WRITE ZERO IF ROOMS ARE NOT USED FOR BUSINESS OR TRADE 9 2. WHAT IS THE MAJOR MATERIAL OF THE ROOF? NUMBER OF ROOMS CONCRETE ................................ 1 SHINGLES ..2 7. What is the space of your dwelling including living and accessory ASBESTOS SHEETS.3 ~~~~~~~~~rooms? METAL SHEETS ......... ..4 SQUARE METERS TILE ...........5 WOOD.*7 8. How long has your household been living in this dwelling? WO D.............................................. .........................78 Ho lngh sy u h u e odb en iv gint sdw ln ? UNBAKED BRICKS (SAMAN) .................................8 THATCH ................................9 YEARS OTHER (SPECIFY ________) . ...............10 9. In approximately what year was this dwelling built? 3. WHAT IS THE PRIMARY MATERIAL OF THE FLOOR? ASK THE RESPONDENT TO PROVIDE AN ESTIMATE IF UNSURE PARQUET.1 rOF THE EXACT YEAR P R U T.................................................................1 FT E E A TY A PAINTED WOOD ..................2 YEAR BUILT TILE ..................3 LINOLEUM ................. 4 CONCRETE ..................5 CLAY/EARTHEN FLOOR 6.................6 OTHERS(SPECIFY ..........).7 PART B. HOUSING SERVICES 5. How do you treat your drinking water? 1 In the rainy season, what is the main source of water for drinking and BOIL IT (ONLY) ..............................1........1.l. cooking for your household? FILTER IT (ONLY) ..................................... 2 ADD CHEMICALS/DISINFECTANT/SETTLING AGENT ..3 PRIVATE CONNECTION TO PIPELINE BOIL AND FILTER BUT DO NOT ADD CHEMICALS .4 PRI VATE WELL .....................-....2 BOIL AND ADD CHEMICALS BUT DO NOT FILTER ....5 PUBLIC TAPS! STANDPIPE . 3 FILTER AND ADD CHEMICALS BUT DO NOT BOIL .6 PUBLIC WELL.4 BOIL, FILTER AND ADD CHEMICALS. ............ NEIGHBORS ............ 5 WATER VENDOR ............ 6 SPRING .7 6. In the rainy season, do you use the same main source of water for RIVER, STREAM, LAKE, POND ........................... 8 bathing and washing as you do for drinking and cooking in the rainy RAINWATER .................................. 9 season? OTHER (SPECIFY ) ... 10 BOTTLED ..... 11 YES . , 1 (>N8) NO.2 2. In the dry season, is the main source of water for drinking and cooking for your household the same as is your main source in the rainy season? 7. In the rainy season, what is the main source of water for bathing and YES .1 (>> 4) washing for your household? NO 2 ...2 l PRIVATE CONNECTION TO PIPELINE.. 1 PRIVATE WELL.. 2 3. In the dry season, what is the main source of water for drinking and cooking PUBLIC TAPS/ STANDPIPE . . 3 for your household? PUBLIC WELL . . 4 NEIGHBORS.. 5 PRIVATE CONNECTION TO PIPELINE ................. I WATER VENDOR . . 6 PRIVATE WELL ............................2 . SPRING .. 7 PUBLIC TAPS/ STANDPIPE ............................ 3 RIVER, STREAM, LAKE, POND. . 8 PUBLIC WELL .........4............. ., 4 RAINWATER .........,.,,,,.,., .. 9 NEIGHBORS ,,,....................................... OTHER (SPECIFY ) 10 WATER VENDOR ............ 6 SPRING ............ 7 RIVER, STREAM, LAKE, POND .................... 8 8. In the dry season, does your household use the same main source of RAINWATER .................... 9 water for bathing and washing as it does for drinking and cooking? OTHER (SPECIFY ). ._._...10 BOTTLED ...11 YES . 1 (>11) NO ..2..... 2 9. In the dry season does your household use the same main source of 4. Does your household treat your drinking water in any way? water for bathing and washing as it uses for bathing and washing in the YES...............................1 rainy season? NO.2 (sN6) . .YES1 (>> 11) NO. .........2 10. In the dry season, what is the main source of water for bathing and 14. Is this toilet or latrine used only by members of your household or do washing for your household? other household members use it as well? PRIVATE CONNECTION TO PIPELINE ..................1 THIS HOUSEHOLD ONLY .............. . 1...1.l. PRIVATE WELL .......... ....................... 2 OTHER HOUSEHOLDS AS WELL 2 l l PUBLIC TAPS/STANDPIPE ...3_....................... 3 PUBLIC WELL ............ ,. 4 VENDOR (TRUCK) ............ 5 15. What is the main source of lighting in your dwelling? NEIGHBORS.............. 6 SPRING .................................7 .............................. ELECTRICITY .1 RIVER, STREAM, LAKE, POND ................................8 KEROSENE, OIL OR GAS LAMPS .2 (> 17) RAINWATER .................................g...........................9 CANDLES OR BATTERY FLASHLIGHTS .3 (,>17) OTHER(SPECIFY )......... 10 NOLIGHTING 4 (>>17) 16. How many hours a day on average was electricity available in your dwelling last month? 11. Where do members of your household bathe? NUMBER OF HOURS INDOOR BATH/SHOWER FOR HOUSEHOLD ONLY_. 1... INDOOR BATH/SHOWER SHARED WITH OTHER HOUSEHOLDS ..... SHARED.........ER.....2 17. What fuel do you use most often for cooking? OUTDOOR BATH/SHOWER FOR HOUSEHOLD ONLY .. 3 OUTDOOR BATH/SHOWER SHARED WITH OTHER ....................................................................I HOUSEHOLDS R.....ED......R. .4 ELECTRICITY ............2. ., ....,.,. _2 PUBLIC BATHS W3..................................................OOD ..................................3................... ............3I RIVER, POND, ETC ............. ,,,,,,........ 6 COAL '''''''''...4 s OTHER (SPECIFY ).7 KEROSENENURE.5 PEAT, MANURE.............................6 OTHER (SPECIFY )_,__ _ _ .........._). 7 12. What is the type of toilet that is used in your household? 18. Does your household heat your dwelling in winter? FLUSH TOILET ...........1.... Y E S . .1 TRADITIONAL LATRINE... . 2 ( 14) YES............... ....1 ....... ...2 VENTILATED IMPROVED PIT LATRINE .... 3 (, 14) NO .... 2 (>> 20) BOWL/BUCKET .... 4 (>> 15) OTHER (SPECIFY )T. ......5 15) 19. How does your household heat your dwelling? NO TO ILET ....................................6 15) WATER RADIATORS-CENTRALIZED HOT WATER. 1 WATER RADIATORS IN ROOMS FROM A GAS, 13. What disposal system is this toilet connected to? COAL OR ELECTRIC BOILER WITHIN THE HOUSE 2 ELECTRIC HEATERS ......................................3 SEWER SYSTEM ........... 1 COAL STOVE. 4 SEPTIC TANK ........... 2 WOOD STOVE .5 NONE/DISCHARGES TO SURFACE OR KEROSENE STOVE .............. 6 GROUNDWATER ........... 3 STOVES FOR STRAW, BRUSH, MANURE, PEAT .7 OTHER (SPECIFY ...........).8 20. How many months during the last 12 months was your dwelling heated? NUMBER OF MONTHS 21. During how many of those months was your dwelling sufficiently warm? NUMBER OF MONTHS PART C: DWELLING EXPENDITURES 7. Do you rent this dwelling for goods, services or cash? 1 Is this dwelling owned by a member of your household? Y E S .. . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . .. . 1 Y E S . .................................................... .................................N O ........2 (> 13) l N O ........................... 2 (>> 7) 8. From whom do you rent this dwelling? 2. Do you have legal title to the dwelling or any document that shows ownership? RELATIVE ............... .................1 PRIVATE EMPLOYER 2 l.l YES ~~~~~~~~1 STATE ENTERPRISE3 NO .....2 (>> 4) STATE .4 PRIVATE PERSON/AGENCY PRIVATEPERSON/AGENCY.5 3. What type of title is it? FULL LEGAL TITLE, REGISTERED .......................21 9. How much does your household pay in cash to rent this dwelling? LEGAL TITLE, UNREGISTERED . ............................2ll PURCHASE RECEIPT .................,.3 IF THEY DO NOT PAY, WRITE ZERO OTHER4 .... , . 4 AMOUNT (UNITS OF CURRENCY) 4. If you make installment payments for your dwelling, what is the amount of TIME UNIT the installment? WRITE ZERO IF THE HOUSEHOLD DOES NOT MAKE 10. Does your household pay any of the rent by goods or services? INSTALLMENT PAYMENTS AMOUNT (UNITS OF CURRENCY) YES .2 (. 12) TIME UNIT 11. What is the approximate value of the goods and services paid by your 5. If you sold this dwelling today how much would you receive for it? household? AMOUNT (UNITS OF CURRENCY) AMOUNT (UNITS OF CURRENCY) PER TIME UNIT l 6. Estimate, please, the amount of money you could receive as rent if you l l let this dwelling to another person? AMOUNT (UNITS OF CURRENCY) TIME UNITS: DAY .... 3 MONTH ........6 YEAR ... 9 PER TIME UNIT WEEK ... 4 QUARTER ....... 7 l>>> QUESTI~~3 FORTNIGHT ...5 HALF YEAR .. 8 »»> QUESTION 13 12. Does your rent include any of the following? How much did your household pay in the last month for the following services? a. Furniture YES .1 IF THE HOUSEHOLD DIDN'T PAY ANYTHING, WRITE ZERO 13. Centralized heating b. Electricity NO.. .2 14. Electricity c. Heating 15. Gas YES 2 l...1 16. Coal d. Water YES.1. 1 NO ..2 17. Oil 18. Wood 19. Other fuel 20. Water U' 21. Disposal of human excreta 22. Trash collection 23. Telephone 24. Apartment building fees HOUSING MODULE (LONG VERSION) 4. WHAT IS THE PRIMARY MATERIAL OF THE FLOOR? Now I would like to ask you about your housing conditions. I mean by PARQUET ..................................1 ............l.l housing all the rooms and all separate buildings used by your household PAINTED WOOD ............................2...... ...........2 members. What buildings or rooms do the members of your household TILE ..................................3 occupy? ~~~~~~~~~~~~~~LINOLEUM ........... . ......... .....4 occupy? CONCRETE . 5 PART A. DESCRIPTION OF THE DWELLING CLAY/EARTHEN FLOOR ........... 1. Is this housing unit your household's primary (year round) place of 5. WHAT TYPE OF DWELLING IS IT? residence? DETACHED HOUSE .................................. 1 (> 11) PRIMARY RESIDENCE ....................1 MULTI-FAMILY HOUSE .2 SECONDARY RESIDENCE ....................2 SEPARATE APARTMENT .3 ,,INSTRUCTION COMMUNAL APARTMENT ..................................4 ROOM IN A LARGER DWELLING ......................... 5 INSTRUCTION: I would now like to talk about your primary residence. In all SEVERAL BUILDINGS CONNECTED ...................6 (>, 11) the questions that follow, please give answers about your primary SEVERAL SEPARATE BUILDINGS . ....................7 (> 11) residence, not for the dwelling we are now in. INTERVIEWER: READ IMPROVISED HOUSING UNIT . ......................8 (,> 11) QUESTIONS 2-5 AND 7-9 ALOUD. OTHER (SPECIFY ) ............9 (>> 11) 2. WHAT IS THE MAJOR CONSTRUCTION MATERIAL OF THE EXTERNAL 6. How many dwelling units (including your own) are there in WALLS? this building? BRICK ..................................1 CONCRETE PLATES .................................. 2 7. HOW MANY FLOORS ARE THERE IN THE BUILDING? w~' CONCRETE BLOCKS .................................. 3 UNBAKED BRICK, ADOBE ..................................4 NUMBER OF FLOORS WOOD, LOGS ..................................5 TIN, ZINC SHEETING .................................. 6 8. WHICH FLOOR DOES THE HOUSEHOLD LIVE ON? FLATTENED TIN CANS .................................. 7 MUD ..................................8 CODE BASEMENT = 0; GROUND FLOOR =1, ETC. BAMBOO ..................................9 LIST THE FLOOR WITH THE MAJORITY OF SPACE IN THE DWELLING CANVAS, FELT ................................. 10 OTHER (SPECIFY ) ..........___ 1_1 9. IS THERE AN ELEVATOR IN THE BUILDING? 3. WHAT IS THE MAJOR MATERIAL OF THE ROOF? YES .......................1 NO ...................... 2 (>> 11) CONCRETE .1 SHINGLES .2 10. How often does the elevator in this building work? ASBESTOS SHEETS .3 METAL SHEETS 4 ...................... ALWAYS 1 TILE 5 ............5 CERTAIN HOURS EACH DAY 2 WOOD S ...................... SOMETIMES . 3 UNBAKED BRICKS (SAMAN) ...................... 8 NEVER ..............................4 THATCH .9 OTHER (SPECIFY ) ...........110 11. How many rooms do the members of your household occupy, including bedrooms, living rooms and rooms used for household enterprises? DO NOT COUNT BATHROOMS, KITCHENS, BALCONIES AND CORRIDORS NUMBER OF ROOMS 12.How many, if any, of these rooms are used primarily for family enterprise or trade? WRITE ZERO IF ROOMS ARE NOT USED FOR BUSINESS OR TRADE NUMBER OF ROOMS 13.How many, if any, of these rooms are used primarily as bedrooms? WRITE ZERO IF ROOMS ARE NOT USED FOR BEDROOMS NUMBER OF ROOMS 14. What is the space of your dwelling including living and accessory rooms? SQUARE METERS , 15. How long has your household been living in this dwelling? 14 YEARS 16. In approximately what year was this dwelling built? ASK THE RESPONDENT TO PROVIDE AN ESTIMATE IF UNSURE OF THE EXACT YEAR YEAR BUILT PART B. HOUSING SERVICES 5. In the dry season, what is the main source of water for drinking and cooking for your household? 1. In the rainy season, what is the main source of water for drinking and cooking for your household? PRIVATE CONNECTION TO PIPELINE ................ 1 (, 7) PRIVATE W ELL .................................... .2 PRIVATE CONNECTION TO PIPELINE ............ .. 1 (>> 3) PUBLIC TAPS/ STANDPIPE .... 3 (>> 7) PRIVATE W ELL ................................................ 2 PUBLIC W ELL ............4 PUBLIC TAPS/ STANDPIPE ..................... 3 (,, 3) NEIGHBORS ........... . 5 PUBLIC WELL ..................... 4 WATER VENDOR ............ .6 NEIGHBORS ..................... 5 SPRING ............ .7 WATER VENDOR ......................6 RIVER, STREAM, LAKE, POND ............ 8 SPRINGt 7 RAINWATER .....9 (,, 8) RIVER, STREAM, LAKE, POND ........................8 OTHER (SPECIFY ) .... 10 RAINWATER ....................... 9 (, 4) BOTTLED ..... 11 (>> 8) OTHER (SPECIFY )._. .10 BOTTLED .... 11 (>> 4) 6. How far is this source from your dwelling? METERS: 2. How far is this source from your dwelling? | ->QUESTION 8 | |>>> QUESTION 4 METERS: 7. How many hours per day is water available on average during the rainy season? 3. How many hours per day is water available on average during the rainy season? 8. Does your household treat your drinking water in any way? NO .......YES 2 (>> 10) 4. In the dry season, is the main source of water for drinking and cooking 9. How do you treat your drinking water? for your household the same as is your main source in the rainy season? BOIL IT (ONLY) .............................................1 YES .1 (, 8) FILTER IT (ONLY).2.... 2 NO 2 ADD CHEMICALS/DISINFECTANT/SETTLING AGENT.. 3 BOIL AND FILTER BUT DO NOT ADD CHEMICALS ....4 BOIL AND ADD CHEMICALS BUT DO NOT FILTER ....5 FILTER AND ADD CHEMICALS BUT DO NOT BOIL ....6 BOIL, FILTER AND ADD CHEMICALS ... 7 10. In the rainy season, do you use the same main source of water for bathing and washing as you do for drinking and cooking in the rainy season? YES . 1 (>> 14) NO .2 11. In the rainy season, what is the main source of water for bathing and 16. In the dry season, what is the main source of water for bathing and washing for your household. washing for your household? PRIVATE CONNECTION TO PIPELINE ...................... 1 (>> 13) PRIVATE CONNECTION TO PIPELINE .....................1 (> 18) PRIVATE WELL ...................................2 .....l.l PRIVATE WELL .............................2........... 2 l PUBLIC TAPS/ STANDPIPE .................................. 3 (> 13) PUBLIC TAPS/STANDPIPE ...................................3 (, 18) PUBLIC WELL ...................................4 PUBLIC WELL .................................. 4 NEIGHBORS ............,,, ........5 VENDOR (TRUCK). ...... ....... 5 WATER VENDOR ............6 NEIGHBORS. 6 SPRING ............................................................. ....7 SPRING ................................................................... ..7 RIVER, STREAM, LAKE, POND. ......................8 RIVER, STREAM, LAKE, POND. 8 RAINWATER ........9.. ... . .......... 9 (>> 14) RAINWATER ..................................................... ..... 9 (>> 19) OTHER (SPECIFY .........) 10 OTHER (SPECIFY ) 10 12. How far is this source from your dwelling? 17. How far is this source of water from your dwelling? l l ~~~METERS: llll METERSL >> >> QUESTION 14 M Q QUESTION 19 M 13. How many hours per day is water available on average during the rainy 18. How many hours per day was water available on average in the dry season? season? NUMBER OF HOURS 19. What is the major source of hot water in your household ? r 14. In the dry season, does your household use the same main source of w water for bathing and washing as it does for drinking and cooking? CENTRALIZED SUPPLY ...................................... 1 GAS WATER HEATER ........................................ 2 YES .1 (>> 19) ELECTRIC WATER HEATER. 3 NO .2 l............ COAL STOVE. 4 WOOD STOVE. 5 15. In the dry season, does your household use the same main source of OTHER (SPECIFY ) 6 water for bathing and washing as it uses for bathing and washing in the NO HOT WATER. 7 rainy season? 20. Where do members of your household bathe? YES .1 (»> 19) INDOOR BATH/SHOWER FOR HOUSEHOLD ONLY .......1 NO .2 INDOOR BATH/SHOWER SHARED WITH OTHER HOUSEHOLDS .2 OUTDOOR BATH/SHOWER FOR HOUSEHOLD ONLY ...3 OUTDOOR BATH/SHOWER SHARED WITH OTHER HOUSEHOLDS ..4 PUBLIC BATHS .5 RIVER, POND, ETC . . 6 OTHER (SPECIFY ). 7 21. What is the type of toilet that is used in your household? 29. How many hours a day on average was electricity available in your dwelling last month? FLUSH TOILET 1................................... 1 .... . TRADITIONAL LATRINE .................................... 2 (» 24) NUMBER OF HOURS VENTILATED IMPROVED PIT LATRINE ...................3 ( 24) BOWUBUCKET . .................................. 4 (, 24) 30. Does this unit have its own kitchen? OTHER (SPECIFY ) ......... 5 ( 24) No TOILET..6N .................................... 6 27) YES 1 22. How many flush toilets are in this dwelling? 23. What disposal system is this toilet connected to? 31. Is it inside or outside? SEWERSSTEM. 1INSIDE ...1l SEPTIC TANK ..........2 OUTSIDE ........................ 2 NONE/DISCHARGES TO SURFACE OR GROUNDWATER TO SURFACE ....3 32. Does your household share the kitchen or do you have exclusive use of it? 24. Is this toilet or latrine used only by members of your household or do other household members use it as well? EXCLUSIVE USE 2..1 SHARE .....................................2 THIS HOUSEHOLD ONLY ............... ......... 1 (> 26) 33. What fuel do you use most often for cooking? OTHER HOUSEHOLDS AS WELL ...................2 33. 2 25. How many people currently use your household's toilet or latrine? GAS ...................................1 NUMBER OF PEOPLE W3ELECTRICITY .3 . YES.1D o aet ooto h wlinorahtetierltie PEATL MANURE..6................................. Y E S ............................................................ IMP E T ,UM N U R E ...................................... ........ NO .2 OTHER (SPECIFY ) .......... 7 27. What is the main source of lighting in your dwelling? 34. Does your household heat your dwelling in winter? ELEC TR IC IT~~~ ~~~~~~~~~~~~~~~~~~~~~~~~YE ....... ....................................................1Y S ........ .................................................1 ELECTR ICITY1 S, NO ..........................................1.................. 2 (> 38) KEROSENE, OIL OR GAS LAMPS.2 (> 30) N.2 (»38). CANDLES OR BATTERY FLASHLIGHTS .......... 3 (> 30) NO LIGHTING .......... 4 (>, 30) 28. Do you have an individual electric meter or do you share it with other persons? JOINT METER.1 ...........1 INDIVIDUAL METER ..............2 35. How does your household heat your dwelling? 41. How would you rate these problems? WATER RADIATORSCENTRALIED HOT WATER, 1 SEVERE PROBLEM, WOULD LIKE TO MOVE . .........1 WATER RADIATORS IN ROOMS FROM A GAS, SERIOUS PROBLEM, BUT NOT ENOUGH COAL OR ELECTRIC BOILER WITHIN THE HOUSE 2 TO WANT TO MOVE .2 ELECTRIC HEATERS ..................................3 MINOR, NOT MUCH OF A PROBLEM . 3 COAL STOVE 4..................................4 WOOD STOVE ...................................5 KEROSENE STOVE ................................... 6 STOVES FOR STRAW, BRUSH, MANURE. PEAT .....7 OTHER (SPECIFY ) ............__).8 36. How many months during the last 12 months was your dwelling heated? NUMBER OF MONTHS C X 37. During how many of those months was your dwelling sufficiently warm? NUMBER OF MONTHS 38. Where is the nearest telephone that is used by the members of your household, is it... inside the dwelling? ................................ 1 in the neighbor's house? ...............................2 in a public place sJ within 5 minutes walk from the dwelling? ..........3 b in a public place more than 5 minutes from the dwelling? .4 other (specify )? . telephone not accessible? . . 6 39. How does your household dispose of garbage? REFUSE CHUTE IN BUILDING . . 1 COLLECTED BY TRUCK ..2 DUMPED ..3 BURNED ..4 BURIED ..5 40. Is the dwelling exposed to noise, odor or pollution problems? YES . 1 NO. 2 NEXT PAGE PART C: DWELLING EXPENDITURES 7. Do you have legal title to the dwelling or any document that shows ownership? 1. Is this dwelling owned by a member of your household? YES . ....... ...... ...Y....1 NO . . . 2 (> .9) l l NO ....... .........(............ ....2 (,,13) 8. What type of title is it? 2. How did your household obtain this dwelling? FULL LEGAL TITLE, REGISTERED ..........................1 PRIVATIZED ........1 LEGAL TITLE, UNREGISTERED . .............................2 PURCHASED FROM A PRIVATE PERSON ............. 2 PURCHASE RECEIPT ..3 NEWLY BUILT ..............................3 OTHER ...4.................. .......... ....4 COOPERATIVE ARRANGEMENT ............................4 SWAPPED ...... .................. ........5(>> 6) INHERITED ...... ............... .. ................(........6 »(> 6) 9. Which household member(s) holds the title or document to this dwelling? OTHER .7... ... . (> 6) WRITE ID CODE OF THIS PERSON FROM THE ROSTE 3. How much did you pay for the unit ? AMOUNT: 1ST ID CODE: YEAR: 2ND ID CODE: 4. If you make installment payments for your dwelling, what is the amount of 10. Could you sell this dwelling if you wanted to? the installm ent? YES ........................................ 1 WRITE ZERO IF THE HOUSEHOLD DOES NOT MAKE NO ............. 2 (> 12) INSTALLMENT PAYMENTS AMOUNT (UNITS OF CURRENCY) 11. If you sold this dwelling today how much would you receive for it? AMOUNT (UNITS OF CURRENCY) TIME UNIT 5. In what year do you expect to make your last installment payment? 12. Estimate, please, the amount of money you could receive as rent if you let this dwelling to another person? YEAR AMOUNT (UNITS OF CURRENCY) 6. Do you have legal title to the land or any document that shows PER TIME UNIT ownership? l l YES 1 1 l >>>> ~~~~~~~~~~~~~~QUESTION 28 Y S ...........................................................................I NO ...................................................2 13. Do you rent this dwelling for goods, services or cash? Y E S ....................................1 NO. ....... . .....2 . ................ ...... ... .. 2 (,> 26) TIME UNITS: DAY. .3 MONTH. . 6 YEAR. ..9 WEEK . 4 QUARTER. 7 FORTNIGHT ...5 HALF YEAR...8 14. From whom do you rent this dwelling? 20. How much was the deposit? RELATIVE ...................1. - l AMOUNT (UNITS OF CURRENCY) PRIVATE EMPLOYER .................... 2 STATE ENTERPRISE ...... ................,.3 STATE ...................4 21. Will any of this deposit be returned? PRIVATE PERSON/AGENCY ................... ...5 DOES NOT KNOW ......................6 YES 2 _.1 NO .......................................2 (24) 15. Does the owner live in the building? YES ............................................... ..........................1 l22. W hen will any of this deposit be returned? NO . .. , .2 TIME UNIT 16. How much does your household pay in cash to rent this dwelling? 23. If any of this deposit will be returned, how much will the amount be? IF THEY DO NOT PAY, WRITE ZERO AMOUNT (UNITS OF CURRENCY) AMOUNT (UNITS OF CURRENCY) TIME UNIT TIME UNIT 17. Does your household pay any of the rent by goods or services? 24. Does your rent include any of the following? YES N.2 1...... 1 a. Furniture NO YES.....19 ) .. ...........2 18. What is the approximate value of the goods and services paid by your b. Electricity household? YES ........ .. 1 AMOUNT (UNITS OF CURRENCY) c. Heating PER TIME UNIT YES .1 19. Did you pay any deposit or up-front payment when you moved to this d. Water dwelling? YES ..........1 NO. 2 (> 24) 25. How much would a unit like this sell for in today's market? AMOUNT (UNITS OF CURRENCY) TIME UNITS: DAY .... 3 MONTH .......6 YEAR .... 9 WEEK ......4 QUARTER .7 FORTNIGHT.. .5 HALF YEAR. . .8 26. Does any person who is not member of this household pay all or part of 38. Trash collection the rent or provide this housing free of charge? For example, a relative, El private employer, governmental or public organization, private person or organization? 39. Telephone YES, PAYS RENT ... ...1.......1 YES, PROVIDES DWELLING FREE OF CHARGE ...2 40. Apartment building fees NO ........... ........(......... ..3(, 28) 27. Who pays part or all of the rent for this dwelling or provides this dwelling 41. Do you rent rooms or part of the dwelling to other people? free of charge? YES .....1..... ..................1.L.. RELATIVE 1 No........ .. ... ...................... .............. .. .2 PART D. STATE ..MPLOYER...................................................2 STATE EMPLOYER .......... .... .2 PRIVATE EMPLOYER ..............3.....................3 PUBLIC AGENCY ...........................4 42. How many rooms do you rent out? PRIVATE PERSON/AGENCY . 5 OTHER .6 43. How much do you receive in rent each month? 28. How much did your household pay in the last month for the following services? CURRENCY IF THE HOUSEHOLD DIDN'T PAY ANYTHING, WRITE ZERO 29. Centralized heating 30. Electricity 31. Gas 32. Coal 33. Oil 34. Wood 35. Otherfuel 36. Water 37. Disposal of human excreta PART D. OPINIONS PART E. PLANNED MOVES AND UPGRADES 1. In general, how satisfied are you with this housing unit? 1. Do you plan to move to another unit within the next 12 month? VERY SATISFIED ..................1 ... l YES, DEFINITELY ............. 1................... l SOMEWHAT SATISFIED ................. 2 YES, PROBABLY .............2..................l NOT SATISFIED ..................3 YES, POSSIBLY ..............3 NO ............. 4 > END OF MODULE 2. In general, how satisfied are you with this neighborhood as a place to live? 2. Why are you thinking of moving? VERY SATISFIED .1..,. ..................,,,,,,.1 LARGER UNIT ...........................1 SOMEWHAT SATISFIED 2 NOT SATISFIED .3 SMALLER UNIT ...........................2 CHEAPER UNIT .3 CHANGE IN HOUSEHOLD (DEATH/DIVORCE) .4 CLOSER DISTANCE ..5 SAFER/BETTER NEIGHBORHOOD . 6 OTHER .7 3. Do you plan to buy or rent? BUY ,,,..,,,,,..,,,,,,,,, ..,,..,,,,..,,,....1 RENT .2 |> NEXT MODULE Module for Chapter 1 3 Community Data Elizabeth Frankenberg The community questionnaire and two different versions The community questionnaire is longer than most of the price questionnaire are presented on the following community questionnaires used in past LSMS surveys, yet it pages. These questionnaires are explained in detail in is still much shorter than the typical household question- Chapter 13 ofVolumne 1.The community questionnaire is naire of an LSMS or similar multi-topic survey. Individual the larger of the two and is composed of 11 sections (mod- sections can be expanded or contracted to reflect the par- ules). It is designed to be administered to a group of ticular policy focus of the household questionnaire.Within informants from the community, but it can be amended to the questionnaire, items that may not be essential have been include data from administrative sources and/or from vis- marked with an asterisk to indicate that survey designers its to community facilities such as schools and health clin- may wish to drop them in order to shorten the question- ics. Two price questionnaires are presented: one to be naire. If all of these items are dropped, the questionnaire administered to community informants and another to be shrinks from about 35 pages to about 20 pages. Of course, used at markets or with vendors. See Chapter 13 for the specific context and purpose of the survey should be detailed discussion of both the community and the price considered when deciding which questions to drop and questionnaires. which to retain. 247 COMMUNITY QUESTIONNAIRE NAME OF DEPARTMENT _ _ _ _ _ _ _ CODE: NAME OF MUNICIPALITY _ _ _ _ _ _ _ CODE: NAME OF COMMUNITY _ _ _ _ _ _ _ CODE: NAME OF INTERVIEWER _ _ _ _ _ _ _ CODE: NAME OF SUPERVISOR _ _ _ _ _ _ _ CODE: NAME OF DATA ID ENTRY OPERATOR __ _ __ CODE: COMMENTS RECORD OF VISITS RESULT CODES: COMPLETE .1 FIRST SECOND THIRD PARTIALLY COMPLETE ..................2 DATE OF VISIT NO RESPONDENT AVAILABLE .......3 START TIME REFUSED .........................4 FINISH TIME OTHER (SPECIFY) ...................5 RESULT CODE SECTION 1: RESPONDENT CHARACTERISTICS ASK OF ALL RESPONDENTS PARTICIPATING IN THE COMMUNITY INTERVIEW Could you please answer a few questio s about yourselves before we begin the interv iw? 1. 2. 3. 4. 5* 6. 7. 8. I What is your full name? How old SEX What position do you have in How many years have you held this position? What is the How long have you What ethnic D are you? this community? highest lived in this group do grade you community? you belong c ~~~~~~~~~~~~~~~~~~~~~~~~~~~~have to? D attained in D ALLOW UP TO THREE general E RESPONSES schooling? IF 5 OR MORE YEARS, LEAVE EHI ELECTED LEADER...... 1 GRADE MONTHS BLANK CRODEP APPOINTED LEADER ..2 GRADE MONTHS2 CODES GOUP SECRETARY ......... 3 TEACHER/PRINCIPAL.4 AGRIC. EXT. WORKER ........... 5 HEALTH PROVIDER ... 6 OTHER (SPECIFY_).7 MALE.... 1 1ST 2ND 3RD YEARS FEMALE. .2 1ST 2ND 3RD YEARS MONTHS YEARS MONTHS YEARS MONTHS YEARS MONTHS ~~~~~~~~~YAS F.AE _2 __ _0I _ _EARs I mis 4 5 SECTION 2: BASIC PHYSICAL AND DEMOGRAPHIC CHARACTERISTICS OF THE COMMUNITY 1 What is the most common use of land in this community? 6. RECORD THE LONGITUDE OF THE COMMUNITY FROM THE GPS MONITOR PLANNED HOUSING ................ 1 SQUATTER SETTLEMENT .2 1ST READING FARMING/FISHERIES/ESTATES .3 INDUSTRY/MINING/MANUFACT . 4 2ND READING SHOPS/TRADE. 5 OTHER (SPECIFY ) . 6 3RD READING 2. Which term best describes the topography of this community? 4TH READING 5TH READING COASTAL PLAINS.. 1 INLAND PLAINS . .2 7 RECORD THE ALTITUDE OF THE COMMUNITY FROM THE GPS MONITOR HILLS.. 3 MOUNTAINS.. 4 DESERT 5 1 ST READING OTHER (SPECIFY ).6 2ND READING 3. Is any border of this community adjacent to the ocean? 7 3RD READING YES.. 1 NO.. ..2 4TH READING o 4. How large is the land area of this community? 5TH READING HECTARES [ 5. RECORD THE LATITUDE OF THE COMMUNITY FROM THE GPS MONITOR 8. How many people live in this community? NUMBER OF 1ST READING PEOPLE: 2ND READING 9* How many households are found in this community? NUMD3ER OF| 3RD READING HOUSEHOLDS: 4TH READING 5TH READING SECTION 2: BASIC PHYSICAL AND DEMOGRAPHIC CHARACTERISTICS OF THE COMMUNITY 10. What are the principle ethnic groups found in this community? 15. How is the leader of this community chosen? 1ST E ELECTED ........................ 1 ETHNIC GROUP CODES 2ND APPOINTED BY ELDERS ............ 2 l j l APPOINTED BY ADMIN ............. 3 INHERITED ...................... 4 11. What are the major religions practiced by residents OTHER (SPECIFY . ) ....... 5 of this community? 1ST BUDDHIST ....................... 1 CATHOLIC ..................... 2 16* Are there organized meetings of community residents to PROTESTANT ..................... 3 2ND discuss community issues and events? YES. ..1 HINDU . ......................... 4 No ...2 MUSLIM . ........................ 5 TRADITIONALIST/ANIMIST ........6 3RD 17* How often are these meetings held? OTHER (SPECIFY )..........7 TIMES DAY .......... 3 12* What are the major languages spoken by residents llWEEK ....... 4 TIME UNIT: of this community? MONTH ....... 6 CREATE CATEGORIES TO REFLECT QUARTER ....... 7 COUNTRY'S LANGUAGE MIX HALF YEAR ....... 8 YEAR .......... 9 a 13. Do individuals in this community trace their descent through their I 18* About how many people attend? father, their mother, or are both kinds of descent traced? [ NUMBER OF PEOPLE: [ MOTHER ......... 1 FATHER ....... 2 19* Does this community contain land that is owned by the BOTH ....... 3 community itself, rather than by individual owners? OTHER (SPECIFY )..14 YES .. .1 NO... .2(0SECTION 3) 14. In this community can women... 20* What percentage of land in this community is actually YES.. .1 .... purchase land? owned by the community? PERCENT NO .... 2 ..... inherit land? [ | 21 * Who decides how the community land is to be used? [2] COMMUNITY LEADER . 1 1ST [ ..... sell land? [ COMMUNITY ELDERS. 2 ELECTED REPRESENTATIVES ........ 3 2ND ..... leave land as a bequest when they die? TRADITION .................... 4 POPULAR VOTE.......... 5 HIGHEST BIDDERS ................ 6 3RD OTHER (SPECIFY__ ) .......... 7 SECTION 2: BASIC PHYSICAL AND DEMOGRAPHIC CHARACTERISTICS OF THE COMMUNITY 22* Who has access to the community land? l HIGHEST BIDDERS ................ 1 1ST SELECTED FAMILIES/CLANS ........ 2 SELECTED ETHNIC GROUPS ......... 3 INHERITED RIGHT ................ 4 2ND ALDOMMUNITY MEMBERS .......... 5 ANYONE, INCLUDING OUTSIDERS ... .6 OTHER (SPECIFY_ __) ........... 7 3RD 23* What is the land currently used for? GRAZING ........................ 1 1ST | l ANNUAL CROPS ................... 2 PERENNIAL CROPS ................ 3 AQUACULTURE .................... 4 2ND INDUSTRIAL USE ................. 5 COMMERCIAL USE ................. 6 RESIDENTIAL USE ................ 7 3RD 24* WRITE THE ID CODES OF THE RESPONDENTS WHO PARTICIPATED IN ANSWERING THE QUESTIONS OF THIS SECTION. _ SECTION 3: TRANSPORTATION Now I would like to know about transportation in this community to pla es that community residents sometimes use, such as bus terminals,markets and post offices. 1. 2. 3- 4* 5. 6. 7. Is the [.1 located within or outside the boundaries How far is the Is it possible to How often is What is the most common mode How much How long does it of the community? [... ] from the travel from the public of transportation to travel from does it cost to take to travel from community community transportation the community center to the [.]? travel to the the community center, in center to the available for [.. .] from the center to the [...] FIRST ASK QUESTION 1 FOR kilometers? [.] using public travel to the [.]? community using this mode of EACH LINE, THEN ASK transportation? center using transportation? EACH LINE, THEN ASK ~~~~~~~~~~~~~~~~~~~~~~~this mode of QUESTIONS 2-7 FOR EACH LINE transportation? BEFORE GOING TO THE NEXT IF < 1 KM, LINE GO TO HOUR.....2 NEXT TYPE DAY . 3 BUS OR MINIBUS ....1 OF TRANS- WEEK.....4 TAXI........ 2 PORTATION FORTNIGHT. .5 PEDICABS. 3 MONTH . 6 CART DRAWN BY QUARTER .... 7 ANIMAL. 4 HALF-YEAR ..8 BOAT. 5 YES .1 YEAR ....... 9 TRAIN. 6 WITHIN... .1 NO.. 2 TIME WALKING ........... 7(*7) OUTSIDE..2 KILOMETERS (*5) TIMES UNIT OTHER (SPECIFY ).8 HOURSI MINUTES A Nearest local bus terminal B Nearest intercity bus terminal C Nearest daily market D Nearest periodic market E Nearest place to use a telephone F Nearest post office G Administrative Capital (Level 1) H Administrative Capital (Level 2) = = SECTION 3: TRANSPORTATION 8* Is motorized public transportation regularly 12. Can 4-wheeled motor vehicles travel on the available to transport people within this main road in this community? community? YE ...1 YESO...2(>1O NO .... 2(14) NO .... 2(>10) 9* What types of transportation are regularly 13* How many years has years has it been since available? this road was graded? YEARS MOTORBIKES ..................... 1 1ST MOTORIZED TRICYCLES ............ 2 CAR TAXIS . . .................... 3 MINIBUSES . . . ....... 4 2ND 14. During the past 12 months how many months was BUSES ...................... 5 TRAINS ........... . . 6 the main road passable by car? How many BOATS . . . 7 months was it passable by a heavy truck? OTHER (SPECIFY )........... 3RD MONTHS PASSABLE BY CAR MONTHS PASSABLE BY HEAVY TRUCK[ j 1 10 Is motorized public transportation available to 15. Are boats an important means of transportation in transport people out of this community to other this community? YES ... 1 towns or regions? NO .... 2( *17) YES ..1 NO ....2 16. For how many months in the last year could motorboats travel on the main waterway?I -What is the most common type of road surface in this motorboat.travel.n.the.maMONTHS I community? IF THERE IS NO ROAD REPORT ON THE ROAD THAT PASSES CLOSEST TO THE 17. What is the price per liter of [...J in this COMMUNITY community? NO ROADS, ONLY WATERWAYS ....... 1(,15) . ..gasoline ... l ASPHALT OR CEMENT .............. 2 PAVED ROADS (STONES, PEBBLES, ... Oi. ETC.) ......... 3 DIRT ROADS ......... 4 ... kerosene ... OTHER (SPECIFY ). 5 SECTION 3: TRANSPORTATION 18. What is the price for charcoal in this community? AMOUNT: QUANTITY CODE: 19 What is the price for dung in this community? QUANTITY CODES: KILOGRAMS ..........1 AMOUNT: l 50 LB. SACK ........2 100 LB. SACK .......3 QUANTITY CODE: LITER ..............4 L J ~~~~~~~~~CARTLOA.D...... 5 20 What is the price for wood in this community? AMOUNT: QUANTITY CODE: H Ln Ln 21* WRITE THE ID CODES OF THE RESPONDENTS WHO PARTICIPATED IN ANSWERING THE QUESTIONS OF THIS SECTION. SECTION 4: INDUSTRY I would like to ask you some questions about employment opportunities in and around this community. 1. Which activities are the most important sources 4. What type of work do they look for? of employment for individuals in this community? PROFESSIONAL . ..................1 | CLERICAL . ........................ 2 FARMING, FORESTRY, HUNTING, FISHING.1 1ST SALES . ........................... 3 MINING .............................. 2 SERVICE. 4 INDUSTRY ............................ 3 2ND FARM, FORESTRY, FISHING. 5 ELECTRICITY, WATER, GAS ............. 4 FACTORY. 6 BUILDING CONSTRUCTION ............... 5 TRANSPORTATION/VEHICLE OPERATION.7 LARGE TRADE, RETAIL TRADE, 3RD CONSTRUCTION. 8 RESTAURANTS, HOTELS ........ ................ 6 OTHER (SPECIFY ).......... 9 TRANSPORTATION AND COMMUNICATION . . .7 OTHER SERVICES (HAIRCUTTING, TAILORS, ETC ....................... 8 5. Do people come to this community CRAFTS, SMALL-SCALE TRADE ........... 9 temporarily during certain times of the OTHER (SPECIFY )........... 10 year to look for work? In a, 2. Do people in this community leave temporarily 6* Where do they come from? during certain times of the year to look for work URBAN AREAS .................. 1 elsewhere? RURAL AREAS ...................2 2 YES ... 1 OVERSEAS .............. 3 NO ... 2(-5) .. 7. What type of work do they look for? * PROFESSIONAL. 1 3 Where do most of them go? CLERICAL. 2 SALES. 3 URBAN AREAS ...................1. SERVICE . ....... .................. 4 RURAL AREAS .................... 2 FARM, FORESTRY, FISHING .......... 5 OVERSEAS ...................... 3 FACTORY ................ . 6 TRANSPORTATION/VEHICLE OPERATION.7 CONSTRUCTION.. 8 OTHER (SPECIFY ) .9 SECTION 4: INDUSTRY 8. 9. 10. 11. Are there any employers About how many of these employers About how many of these About how many of these within a one-hour commute are state-owned enterprises? employers are privately- employers are privately- from this community that are owned enterprises owned but very small- involved in the employing at least 20 scale enterprises manufacturing of [...? people? employing less than 10 YES... I people? NO ... 2(*NEXT LINE) A. Food Products B. Textiles C. Consumer goods (light industry) 12t INTERVIEWER CHECK: ARE THERE ANY FACTORIES WITHIN A ONE-HOUR COMMUTE OF THIS COMMUNITY? YES .1 I ANSWER MUST BE YES IF 9 OR 10 IS GREATER THAN 0 IN ANY LINE. NO... 2( 23) 13* 14^ 15' 16* 17^ 18' 19' 20^ 21^ 22* How far is it How much In what year Who owns the [...] How many What is the What is the Do children What is the 4 Please list the names of six from the center does it cost to did the [...] factory? people work at average daily average daily less than 15 average daily factories that employ the of the travel from the factory open? the [.] factory? wage of wage of years old work wage of largest number of residents in community to center of the STATE ...... 1 unskilled adult unskilled adult in this industry? unskilled child this community the [..] factory? community to PRIVATE male laborers female laborers laborers the FIRST LIST ALL FACTORIES. the [...] DOMESTIC . 2 the [..] factory? the [.1 factory? YES . 1 [] factory? THEN ASK QUESTIONS 14- factory? PRIVATE NO ... .2 22 FOR EACH FACTORY FOREIGN .3 (>NEXT BEFORE GOING TO THE OTHER . 4 LINE) NEXT FACTORY. KILOMETERS A. B. _ C. . D. E.~~~~~~~~~~~~~~~~~~~~~~~~~~~~ IF.. SECTION 4: INDUSTRY 23* Are there any small-scale industries in this 26* 27* 28* 29* 30* 31* village, with few employees and perhaps run out What products are Do these What is the What is the Do children What is the made by the three enterprises average average work in this average of people's homes? l most common generally daily wage daily wage cottage daily wage YES. . . .1 i ltypes of cottage employ any of an of an industry? of a child? NO.... 2 (,32) industries in this laborers? unskilled unskilled community? adult male? adult FOOD PROD ..1 female? 24* Is there a requirement that these businesses be OTHER AGRICULTURAL registered or licensed in order to operate PRODUCTS. .2 legally? SHOES. 3 YES ... 1 TEXTILES ... 4 NO .... .2026) FURNITURE.. 5 ELECTRIC OR ELECTRONIC 25* What is the amount of the registration fee? GOODS. 6 WOOD DAY ........ 3 AMOUNT PRODUCTS ..7 YES ..1 YES ..1 WEEK .. A METAL NO.. 2 NO... 2 FORTNIGHT. .5 PRODUCTS. .8 MONTH . 6 TIME CODE OTHER (-NEXT (>*NEXT X0 QUARTER ....? (SPECIFY ).9 LINE) LINE) HALF YEAR. .8 A YEAR .. 9 NO TIME LIMIT.... 10 B C SECTION 4: INDUSTRY 32. In this community is there any Public Works Project that hires community residents who are in need of work? YES. . .1 _ NO.... 2(NEXT [ SECTION) 33. What is the name of this project? CODES FOR TYPES OF PUBLIC WORK PROJECTS 34. What is the daily wage of an adult male laborer in this Public Works Project ? 35 What is the daily wage of an adult female r-i laborer in this Public Works Project ? Ln 36* WRITE THE ID CODES OF THE RESPONDENTS WHO PARTICIPATED IN ANSWERING THE QUESTIONS OF THIS SECTION. SECTION 5: AGRICULTURE 1. is agriculture an important source of income for some households in this community? YES. .1 NO... .2 (>>SECTION 6) 2* 3* i would like to know something about land tenure in this community. Do any families in this community... How common is this arrangement? VERY COMMON .......... 1 YES.. 1 SOMETIMES HAPPENS ....2 NO .. 2 RARE 3 EXTREMELY RARE. 4 ( *NEXMINE) A ..farm land that they own? B ..farm land that they rent from someone else for a fixed price? C ..farm land that others own in return for a portion of the crop? D -rent land that they own for a fixed price to others who farm it? _________ .E allow others to farm land that they on in return for a specified portion of the crop,? ______________ F work in agricultuire for a wage? ______________________________________________ 4. 5. 6. 7. 8. 9. 10. Please list the three most How many times is What varieties In which months In which months In general to whom is What government services important crops cultivated by this crop harvested of this crop are is [... ] generally is [...] generally the harvest of [.] sold? are available to support residents of this community, in each year? generally grown planted? harvested? production of this crop? 0 order of importance. in this WHEA . 1 community? CODE 1 FOR CODE 1 FOR MONEY/CREDIT .....1 MAIZE ........ 3 JANUARY, 2 JANUARY, 2 NEW SEEDS CASSAVA ...... 4( 7) FOR FOR VARIETIES .. . 2 YAMS .... 5 (>7) VARIETY FEBRUARY, FEBRUARY, IFERTILIZER. 3 VEGETABLES ... 6(-7) CODES AND SO AND S O LOCAL MARET ....... 1 PESTICIDES/ BAHAMAS ...... 7 (>7) FORTH. IF No FORTH. IF N O COOPERATIVE ...... 3 HERBICIGES ...MN. 4 COTTON ... 8 (>7) PARTICULAR PARTICULAR PRIVATE BUYER.. 4 A DVICE.. 5 COCOA ..... 9 (>,7) MONTH CODE MONTH CODE PRIVATES ......... ... 6 COCONUTS .... 10(*>7) AS 13. AS 13. OTHER (SPECIFY )D6 NONTE . . ......... 7 OTHER (SPECIFY ) .11(>*7) TIMES 1ST 2ND 3RD 1ST| 2ND| 3RD 1ST| 2ND I 3RD 1ST I 2ND I 3RD 1ST | 2ND | 3RD B I I SECTION 5: AGRICULTURE 11* Have there been any land reform programs in 16* What is the average value of this compensation this community in the past 10 years? per hectare of land? YES ..1 NO ... .2 (19) I I 17* What percentage of the households in the community received land? PERCENTAGE: 12* Who initiated the most recent land reform program? NATIONAL GOVERNMENT ............ 1 18* What percentage of the households in the LOCAL GOVERNMENT ............... 2 community had to give up land? PERCENTAGE: [7 NON-LOCAL GOVERNMENT ORGANIZATION. 3 LOCAL FARMERS.4 19. Is there an agricultural extension center in this OTHER PRIVATE INDIVIDUALS ......5 a community OTHER (SPECIFY ) . 6 community? YES. . .1 No 2>2 .... 2l l22 13* In what year did this most recent land reform 20. How far away is the agricultural extension program start? YEAR: center from the center of this community? KILOMETERS: 21. How many times has an agricultural extension 14* What proportion of land in the community was agent visited the farmers of this community in redistributed? the last 12 months? PERCENTAGE: TIMES 15* What compensation was paid to households 22. Is there an agricultural cooperative in or near from whom land was taken? this community? YES .. .I CURRENCY . .............. 1 1ST: | NO... 2(-24) IN KIND PAYMENT . . 2 GOVERNMENT BONDS . . ........ 3 2ND: [ 23. How far away is the agricultural cooperative OTHER (SPECIFY ) ...........4 .....I from the center of this communtiy? NOTHING ...... 5(*17) KILOMETERS: l_l SECTION 5: AGRICULTURE 24- Do other government or non-government agricultural programs provide services to farmers in this community? YEN. ...1 No.... .2(**29) E 25* 26^ 27* 28^ Please tell me the names of the three most What is the purpose of this Who sponsors this program? In what year did the program important of these other agricultural programs. program? beoin? INFORMATION ON NEW WRITE DOWN THE NAMES FOR ALL 3 TECHNOLOGY.1 1 PROGRAMS. THEN ASK QUESTIONS 26-28 ACCESS TO INPUTS ..... NON-GOVERNMENTAL FOR EACH PROGRAM BEFORE ASKING ABOUT ACCESS TO CREDIT . 3 ORGANIZATIONSM.A DAY .. 3 THE NEXT PROGRAM. MARKETING ASSISTANCE.4 LOCAL COMMUNITY ..... 3 WEEK ..... 4 ESTABLISHINGWNER- OTHER (SPECIFY_) ..... FORTNIGHT 5 SHIP RIGHTS ......... 5 MONTH ...... 6 OTHER (SPECIFY . ..6 QUARTER ....7 1ST 2ND _RD HALF YE.AR., 8 A. YEAR. 9 B. 29^ In this community, is there any system of irrigation? YES .. 1 .... l NO .. 2(*36) 30' 31* 32^ 33* 34* 35* Does [...] irrigation exist in this What percentage of land in this Must households pay How much does it Do households pay How much must community? community is irrigated by l...] to be hooked up to cost for a to use this system? households pay to use irrigation? this system? household to hook this system? YES . 1 up to this irrigation NO . 2(NEXT LINE) YES ...1 system? YES.1 NO .. 2(*34) NO. .2(*NEXT TYPDFIRRIGATIO N LINE) AMOUNT TIMKODE A. Mechanical B. Non-mechanicall freshwater C. Non-mechanicaV rainwater D. Non-mechanical/ tidal SECTION 5: AGRICULTURE 36. Do people in this community hire laborers to work on their land? YES.. 2 ( )l 37. 38. 39. 40. 41. 42. 43. 44. 45. FOR TILLING AND WEEDING, NO DISTINCTION IS MADE BY Do people How much is a Do people How much is a Do people How much is a Are How much are TYPE OF CROP. in this man paid per in this woman paid per in this child paid per workers workers paid per FOR PLANTING AND HARVESTING, WRITE DOWN THE community day for [.]? community day for [...]? community day for [.]? sometimes hectare of land NAMES AND THE ID CODES IN THE SPACES BELOW OF hire men for hire hire paid for [.]? THE THREE CROPS LISTED AS THE MOST IMPORTANT IN [ ...]? women for children for according QUESTION 4. [ ]? [ .? to the amount of land they have worked? YES.. .1 YES. .1 YES. .1 YES. .1 NO... .2 NO... .2 NO... .2 NO... .2 (->NEXT - _ TASK CROP NAME CROP CODE (>40) ("42) ("44) TASK) (-,J A Tilling B Planting C Planting D Planting I _ _ __ _ _ __ _ E Weeding F Harvesting G Harvesting H Harvesting t _ _ SECTION 5: AGRICULTURE 46. What is the price of l...] in this community? LITER.. .2 PRICE UNIT A. Urea nitrogen fertilizer B. Sulphate Nitrogen fertilizer C. Phosphoric fertilizer D. Kalium fertilizer E. INSECTICIDE #1 F. INSECTICIDE #2 47 WRITE THE ID CODES OF THE RESPONDENTS WHO PARTICIPATED IN ANSWERING THE QUESTIONS OF THIS SECTION. _ a, lhI SECTION 6: CREDIT 1. 2. 3. What are the ways that residents of this community If someone in this community needed What interest rate might someone typically save? a loan of approximately . . in the community expect to pay for GOLD/JEWELRY ................... 1 1ST 7 (FILL IN DEPENDING ON INCOME a loan of this size from this LA .2 LEVEL IN COUNTRY), for starting a source? LIVESTOCK ....... business, from what sources might LIVESTORES OFGRAIN.............. 3 2ND ALLOW UP TO THREE RESPONSES HOUSE ..................... 5 GOVERNMENT BANK ........ 1 BOUSINESS EQUIPMENT.6..... 5RD |PRIVATE BANK ........... 2 BUSINESS EQUIPMENT .............. 6 3RDl COOPERATIVE ............ 3 CASH .. . . . . . . ..... . . . ........... .7 . COMHUNITY GROUP ........ 4 SAVINGS ACCOUNT ................ 8 FAMILY/FRIEND. ....... 5 CHECKING ACCOUNT .9 4TH OTHER (SPECIFY -). .6 SAVINGS CERTIFICATE .10 DEPOSIT CERTIFICATE ..11 A STOCKS/BONDS ..12 5TH B OTHER (SPECIFY . 13 4* 5* 6' 7* 8* 9* 10* Please list the main Does the credit program For what purposes is What options does this How many kilometers is Who operates this In what year did this places to save or supply loans only for credit available from institution offer for it from the community activity? activity begin? borrow money that are specific purposes? this source? saving money? center to this available to community BUSINESS EQUIP.1 institution? in residents. HOUSEHOLD GOOD.2 NONE ........... 1 VEHICLE ... . 3 SAVINGS ACT .... .2 SPECIFIC LIVESTOCK ...... 4 CHECKING ACT.. .3 GOVERNMENT .....1 PURPOSE .. .1 HOME ........... 5 SAVINGS CERT ... .4 PRIVATE BAN ...2 ANY EDUCATION ...... 6 DEPOSIT CERT.. 5 MONEY LENDER ...3 PURPOSE .... 2(»7) GENERAL CONSUM.7 BONDS .......... 6 COOPERATIVE.... 4 OTHER .......... 8 OTHER .......... 7 OTHER .......... 5 A. B. C. 11 WRITE THE ID CODES OF THE RESPONDENTS WHO PARTICIPATED IN ANSWERING THE QUESTIONS OF E Em THIS SECTION. Eml SECTION 7: PHYSICAL INFRASTRUCTURE 1. Is electricity available in this community? By available, we YES. . 1 [ l mean do any households in this community have electricity? NO .2(>>11) 2* What percentage of households in this community PERCENTAGE: use electricity? 3* 4* 5* 6* 7 What is the main source of electricity in this community (THE MAIN SOURCE IS THE Does [ ... ] supply any electricity in this Are there How often does electricity In what year SOURCE AVAILABLE TO THE LARGEST community ? times from [...] quit working? did this NUMBER OF HOUSEHOLDS) when ..source whelectricity sou.rbecme STATE ELECTRICITY COMPANY .......1 electricity DAY........lble LOCAL GOVERNMENT AGENCY .........2 from [ ]. WEEK .4 available? PRIVATE CORPORATION/COOPERATIVE.3 is not FORTNIGHT ......5 INDIVIDUAL GENERATORS .. 4('9) available? MONTH .......... 6 OTHER (SPECIFY )......... 5 QUARTER ........ 7 YES. .1 HALF YEAR ...... - 8. How much is the one-time hook-up fee for NO.. 2 YES. .1 YEAR ....... 9 the main source? (>NEXT NO ... 2 ________________________ LINE) ('6) TIMES TIME UNIT YEAR 9. How much does electricity from the main A State Electricity Company source cost per kilowatt hr? t- B o Local Government Agency PC vate Corporation/Cooperative 10* In what year did electricity from a main D Individual Generator ~~~~~~~~~~~~~~~~~~~grid first become available in this community? i E Other:(SPECIFy ) ___ ___ ___ ______ __cn YEAR: [ 1I. Are telephone lines available in this community? Y'ES. . 1 No... .2 SECTION 7: PHYSICAL INFRASTRUCTURE 12* 13* 14* 15. What is the main source of drinking We would like to Do community We would like to know water for the residents of this community know about residents about sources of during the wet season? sources of drink [... ] during water for bathing in PIPED WATER . ........ I drinking water in the dry season? this community. Do PUMP WATER this community. community residents (ELECTRICAL/MANUAL).2 Do community bathe in [I? WELL WATER ........... 3 residents drink SPRING WATER ......... 4 [... ] during the RAIN WATER. 5 wet season? RIVER WATER .. 6 LAKE WATER .... 7 WATER DELIVERED BY TANKER TRUCK/ BARREL .... 8 BOTTLED WATER .... 9 YES ..1 YES ..1 OTHER (SPECIFY ).10 NO-.. 2 NO... 2 WATER SOURCES 16. What is the main source of drinking water for the residents of this community A during the dry season? _Piped water _______ Pump water (electrical/manual) PIPED WATER . C PUMP WATER 4 D Well water (ELECTRICAL/MANUAL).2 Spring water WELL WATER. 3 E P 9 .. . SPRING WATER. 4 Rain water RAIN WATER ........... 5 F RIVER WATER .......... 6 River water LAKE WATER . 7 G LAEWTR..........7 Lake water WATER DELIVERED H BY TANKER TRUCK/ Water delivered by tanker truck/barrel ____________ BARREL. 8 Bottled water BOTTLED WATER ........ 9 Bottledhwater (SPECIFYJ.. IOTHER (SPECIFY ).10 J Other (SPECIFY_) f . 17. What is the main source of water for bathing for the residents of this W community? USE THE SAME CODES AS IN QUESTION 16 SECTION 7: PHYSICAL INFRASTRUCTURE 18. During the dry season, are water shortages a 23. Are there ever service disruptions/water shut- problem in this community? offs? YES.. .1 YES.. .1 NOw ...2(20) No.... l2(2) 19. In what ways do the residents of this community respond to water shortages during the dry 24. How often do these disruptions occur? season ? SHORTAGES DO NOT REQUIRE 1ST: [ AT LEAST ONCE A DAY ............ 1 RESPONSE ................................ I AT LEAST ONCE A WEEK. 2 REDUCING USE OF WATER ........... 2 2ND: AT LEAST ONCE EVERY TWO WEEKS. .3 BUYING MORE WATER ............... 3 AT LEAST ONCE A MONTH. 4 TRAVELING LONGER TO FETCH WATER.4 3RD: IN THE DRY SASO N ..............I 5 USING POORER QUALITY WATER ...................S 6 OTHER (SPECIFY ) ........ 6 20. INTERVIEWER CHECK QUESTION 12, ROW A 25. How much is the one-time hook-up fee for IS PIPED WATER USED IN COMMUNITY? piped water? 0% YES .. .1 l NO .... .2(>27) lE= i 26. How much does piped water cost per liter? 21. In what year was the piped water introduced E= l into this community? YEAR. t l 27. How much does one liter of bottled drinking Y lA :ZZ lwater cost? l l 22. What is the main source of the piped water that flows in the community ? 28. During the rainy season, how much do vendors SPRING . . ...... 1 [ charge for 20 liter jerrican/bucket delivered to LAXE ..... 2 someone's house? RAIN .............. 3 RIVER ,.,. .. 4 GROUND WATER . ........... 5 29. During the rainy season, how much do vendors OTHER (SPECIFY ) . 6 charge for 20 liter jerrican/bucket obtained from a central distribution point? SECTION 7: PHYSICAL INFRASTRUCTURE 30. During the dry season, how much do vendors 36* Which is the most common method of disposing of charge for 20 liter jerrican/bucket delivered to waste water in this community? someone's house? I I (MOST COMMON IS THE METHOD USED BY THE W l LARGEST NUMBER OF HOUSEHOLDS) 31. During the dry season, how much do vendors CONNECTION TO SWAGE SYSTEM .......1 DRAINAGE DITCH (FLOWING) ........ 2 charge for 20 liter jerrican/bucket obtained from DRAINAGE DITCH (STAGNANT) ....... 3 a central distribution point? PONDS....................4 RIVERS . ......................... S THROWN BY HOUSE . . 6 OTHER (SPECIFY )........ 7 32. In this community, is there a system of sewage channels for the disposal of waste water? 37* What are the (other) methods for disposing of waster water used by households in this YES... l community ? NO. .... 2(36) ...... |DRAINAGE DITCH (FLOWING) ........ 1 2ND: DRAINAGE DITCH (STAGNANT) ....... 2 33. In what year was this sewage system PoNDS .................. 3 3RD: introduced? RIVERS.4 THROWN BY HOUSE ................. 5 4TH- YEAR: l OTHER (SPECIFY ) 4T.6 38* What is the most common place where the residents of 34. How much is the one-time charge to hook-up to this communitv defecate? the sewage system? PRIVATE TOILETS CONNECTED TO 1ST: CENTRAL SEWAGE SYSTEMS. 1 PRIVATE TOILETS WITH SEPTIC 35. What is th annual or monthly fee for being TANKS .2 connected to the sewage system? PRIVATE TOILETS WITHOUT SEPTIC TANKS .......... .. ..3 DAY ... 3 AMOUNT: TCOMMON TOILTS SHARED WITH WEEK. ... ...... ..... 4 NEIGHBORS. ........... .. ........ ....... .4 FORTNIGHT ......5IL S MONTH ......... 6 TIME PUBLIC LAVATORY . . 5 QUARTER ........ 7 UNIT: IN THE GARDEN/FIELD .............6 HALF YEAR ....8 IN THE RIVER .......... . 7 YEAR .........9 IN DRAINAGE DITCHES .. 8 OTHER (SPECIFY-) ........... 9 SECTION 7: PHYSICAL INFRASTRUCTURE 39. What other places do the residents of this community 42. INTERVIEWER CHECK QUESTIONS 40 AND 41. IS defecate? GARBAGE COLLECTED BY A SERVICE? PRIVATE TOILETS CONNECTED TO CENTRAL SEWAGE SYSTEMS ......... 1 2ND: YES ..1. PRIVATE TOILETS WITH SEPTIC NO .... 2(»>45) TANKS ... 2 PRIVATE TOILETS WITHOUT SEPTIC 3RD: TANKS ..3 ..............343. Is there a fee for having one's garbage COMMON TOILETS SHARED WITH 4TH: l collected? NEIGHBORS ...................... 4 YES. ..1 PUBLIC LAVATORY ................. 5 NO ... 2(>>45) IN THE GARDEN/FIELD ............. 6 IN THE RIVER .................... 7 IN DRAINAGE DITCHES ............. 8 44. What is the amount of the fee? OTHER (SPECIFY ) ........... 9 DAY ............ 3 AMOUNT: WEEK ........... 4 FORTNIGHT ...... 5 CODE: 40. What is the most common methods to dispose MONTH ....... 6 of the garbage in this community population? HALF YEAR ...... 8 NJ YEAR ........... 9 '4 PER PICK-UP ........ 10 0 PICKED UP BY GARBAGE COLLECTION SERVICE ....................... 1 1ST: BURNT .......................2.1.1 THROWN TO THE RIVER ............. 3 45* WRITE THE ID CODES OF THE DUMPED ON TO THE YARD/IN THE GARDEN, LET DECOMPOSE.4 RESPONDENTS WHO PARTICIPATED IN BURIED . ............... 5 ANSWERING THE QUESTIONS OF THIS OTHER (SPECIFY-) ........... 6 SECTION. l 41. What other methods to dispose of the garbage l in this community population? PICKED UP BY GARBAGE COLLECTION 2ND: [ ll SERVICE ........................ 1 BURNT ........................... 2 2ND: THROWN TO THE RIVER ............. 3 DUMPED ON TO THE YARD/IN THE GARDEN, LET DECOMPOSE .......... 4 3RD: w BURIED . ......................... 5 OTHER (SPECIFY ) .6 SECTION 8: HISTORY AND DEVELOPMENT Do you think that the life of the people in this community is better or 4- In the last five years, have there been more people who moved into worse than it was five years ago? this community or more people who moved away? BETTER .1I I MORE MOVED IN ....1 1 WORSE .......2................... MORE MOVED AWAY .................. 2 NO CHANGE ...................... 3(-3) ABOUT THE SAME OF BOTH . 3 NEITHER ARRIVALS NOR DEPARTURES..4 2* Why? ALLOW UP TO THREE ANSWERS 5. Please list three kinds of government or private development projects that exist in this community. CHANGES IN AGRICULTURAL POLICIES.1 EXPANSION IN NON-AGRICULTURAL EMPLOYMENT .2 1ST: 1ST: w WEATHER ............ 3 INFLATION ........................ 4 CHANGES IN CONDITIONS FOR 2ND: DEVELOPMENT 2ND: IMPROVING SKILLS ... ........... . PROJECT CHANGES IN ACCESSIBILITY OF MEDICAL CARE .... 6 3RD: CODES 3RD: CHANGES IN ACCESSIBILITY OF L I SOCIAL SERVICES.. 7 NATURAL DISASTER . ................ 8 NJ INSECT INFESTATION . . 9 >4 CROP DISEASE . ................... 10 OTHER (SPECIFY _ ) 11 6* In this community, has there been a community sponsored literacy program within the past 5 years? 3- In thinking about the poorest residents of your community, what YES .. 1 factors contribute to their situation? NO .. 2 LACK OF EMPLOYMENT OPPORTUNITIES. 71 POOR HEALTH ....................... 2 1ST: In this ommunity, has there been a community sponsored health LOW LEVEL OF EDUCATION AND SKILL.3 program within the past 5 years? POOR LAND PRODUCTIVITY .4.I.YES.1. YES. ...1 NO WAY TO BORROW MONEY ............ 5 2ND: NO ... 2 TO OLD TO WORK ........................ 6 LAZY . .......................... 7 BAD LUCK . ................ 8 3RD: _ OTHER (SPECIFY ). 9 SECTION 8: HISTORY AND DEVELOPMENT 8. In this community, has there been a community sponsored family planning program within the past 5 years? YES .1. NO.. ..2 9. In this community, have there been group efforts to build or repair infrastructure within the past 5 years? YES .. .1 NO.. ..2 10. In this community, have there been group efforts to clean up the environment within the past 5 years? YES ... 3. NO ... .2 11. In this community, are there community sponsored programs to provide mutual assistance? -14 YES. .. .1 NO ... .2 12. Now think about the weather conditions in the past 12 months. How does [....] this year compare to what you consider to be normal conditions? That is, is it much higher, somewhat higher, about normal, somewhat lower, or much lower compared to normal conditions? ... rainfall MUCH MORE/HIGHER THAN USUAL ......1 SOMEWHAT MORE/HIGHER THAN USUAL ..2 ... temperature | 1 ABOUT THE SAME ................... 3 SOMEWHAT LESS THAN USUAL .........4 MUCH LESS THAN USUAL ............. 5 ... flooding | ...... l SECTION 8: HISTORY AND DEVELOPMENT 13* 14* 14* 16* Please describe important events that have taken place in this community since [FIVE YEARS In what year did this Did this event What proportion of the AGO] including any events that have occurred this year. We are particularly interested in events event occur? make people in community was that have changed the well-being of people in this community. Examples of events that may this community affected ? have made people better off are new housing projects, a factory that opened, or construction of better off or worse a new road. Examples of events that might have made people worse off are fires, crop failures, off? famines, droughts, and other sorts of natural disasters. WRITE DOWN THE RESPONSE AND THE CODE. FIRE ... 1 DEVELOPMENT PROJECT ...7 FLOOD ........ ..... 2 EPIDEMIC .............. 8 EARTHQUAKE .......... 3 HEALTH FACILITY .......9 DROUGHT ............... 4 SCHOOL ............... 10 BETTER 1 FAMINE ....5.......... ROAD .11 WORSE ..... 2 FACTORY .6 INSECT/CROP BLIGHT 12 SOME OF OTHER (SPECIFY-) ....13 EOTH . 3 wA 4 D E Y P H 17* WRITE THE ID CODES OF THE RESPONDENTS WHO PARTICIPATED IN ANSWERING THE QUESTIONS OF THIS SECTION. W SECTION 9: HEALTH FACILITIES AND OUTREACH Now I would like to ask you to think about the sources of health care and family planning services available to members of your community, such as hospitals, community health clinics, practices of doctors, nurses, midwives and paramedics, and sources of traditional health care. I want to obtain as complete a list as possible of all the facility you can think of. We are interested in all services, government and private, that you believe residents of this community might know about or use. 1. 2. 3. 4' 5* 6. 7. 8. 9. C Please tell me the names of all the What type of facility Who operates In what Is this health How far is it to this What means of How much How long does it O health care providers available to the is this? this health year did this facility within facility from the center transportation is does it cost take to use this D members of this community facility? facility start or outside of the most often used to to use this mode of E providing the community? travel to the facility? mode of transportation to services? boundaries transportation travel to this facility LIST EACH FACILITY THAT THE of the to travel to from the RESPONDENT(S) NAME community? DISTANCE this facility community center? CODES from the BUS/MINIBUS. 1 community METER .. 1 TAXI .... . 2 center? HOSPITAL ..... 1 KILOMETER ..2 PEDICABS ..... 3 CLINIC ..... 2 CART DRAWN BY DOCTOR ....... 3 ANIMAL .... 4 NURSE ........ 4 BOAT......... 5 MIDWIFE ...... 5 TRAIN ..... 6 TRADITIONAL- .6 WALKING. 7 tQ (SPOTHER GOVERNMENT. 1 WITHIN. ..D1 |DISTANCE OTHER '4 _ NAME (SPECIFY ).7 PRIVATE... 2 YEAR OUTSIDE.2 DISTANCE CODE (SPECIFY) 8 HOURS MINUTES A B C_ D:::: ::: ::::f0 :::: :::::::::: ::: E : :: :: E::::::::::F::::::::i::::|:::0;:i::: :0:::X:X:::0: : E:::............: ::: :: SECTION 9: HEALTH FACILITY AND OUTREACH 10* In this community, has there ever been a mass 13. How often do staff visit this community to provide outreach services? immunization/vaccination campaign to give children shots to prevent them from getting sick? DAY ....... 3 YES ... 1 WEEK .4 TINES . NO .. 2(>>12) l......J FORTNIGHT . 5 MONTH. 6 11* Since 1980, in what years were there mass immunization QUARTER .. 7 TIME CODE campaigns? What kinds of immunizations or vaccinations were YEAR. 9 given? 14. What service do staff provide when they visit this community? IMMNWIZATION CODE _____ YEAR 1ST 2ND 3RD A -YEA - - EXANINE SICK PEOPLZ . 1 1ST: I A WRITE PRESCRIPTIONS .............. 2 ____________________ IMMUNIZE CHILDREN ................ 3 B GIVE INTECTIONS . ...... 4 2ND: - - GIVE VITAMINS .................... 5 C PROVIDE CONTRACEPTIVES ........... 6 ___________________ WEIGH PEOPLE ..................... 7 D MEASURE BLOOD PRESSURE ........... 8 3RD: _____ Z_________________ EXAMINE TEETH .................... 9 E OTHER (SPECIFY . ) .......... 10 4TH: 14~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~4H L'n F 15. Do staff from the Family Planning Agency ever visit this community to provide outreach services? IMMUNIZATION CODE YES .. .1 2EASLES ....... 1 DPT ................5 4 NO .2(18) BCG ....... 2 TETANUS ............O.... 5 POLIO ....... 3 HEPATITIS B ........ 6 OTHER (SPECIFY) ..7 16. How often do staff visit this community to provide outreach services? 12. Do government health workers ever visit this DAY ....... 3 TIMES | community to provide outreach health services? WEEK ....... 4 YES ... .1 FORTNIGHT ...... 5 NO... 2(a15) MONTH .......... 6 TIME CODE QUARTER ........ 7 HALF YEAR ...... 8 YEAR .......... 9 SECTION 9: HEALTH FACILITY AND OUTREACH 17* What services do staff from the Family Planning Agency provide? 21. Is there a pharmacy or shop selling basic drugs and family planning supplies in this community? PROVIDE CONDOMS .................. 1 YES... .1 PROVIDE ORAL CONTRACEPTIVES ...... 2 1ST: NO ... 2(e23) PROVIDE INJrECTABLES ......................... 3 INSERT IUDs ...................... 4 REMOVE IUDS ......... 5 2ND: 22 Does this shop sell.. INSERT NORPLANT .................. 6 REMOVE NORPLANT .. oral.................. 7 FEMALE STERILIZATION ............. 8 3RD: ...oral contraceptives? MALE STERILIZATION ............... 9 YES ...1 PROVIDE OTHER CONTRACEPTIVES .... 10 NO... 2 CONSULT ON SIDE EFFECTS ......... l l 4TH: ... condoms? OTHER (SPECIFY ) ......... 12 18' In the past year have there been any efforts to provide information in ... aspirin this community about... YES ...1 ... oral rehydration solution? F| NO.... .2 ..AIDS? - antibiotics? ... child nutrition? a l ... maternal health? 23* WRITE THE ID CODES OF THE RESPONDENTS WHO PARTICIPATED IN ANSWERING THE QUESTIONS OF l 19* In this community, about how much would you expect to pay if you THIS SECTION. souaht treatment for the flu? l 20* In this community, about how much would you expect to pay if you needed to have a tooth filled? E l El ElI SECTION 10: SCHOOL FACILITIES Now I would like to ask you to think about the primary and secondary schools available to children and young adults in your community. I would like to obtain as complete a list as possible. We are interested in all schools, government and private, religious or secular, that you believe residents of this community might know about or attend. 1. 2. 3' 4. 5. 6' 7. 8. 9. 10* 11' 12* C Please tell me the names of all the primary What is How Does this Who operates How How far is this What is the What are the In what Last year, Last year, O and secondary schools available to the the many school admit this school? many school total cost, biggest problems year did how many how many D children and young adults in this community. highest students boys and teachers from the as with the quality of this students in students in E Let's begin with primary schools and then go grade at attend girls? are at community measured this school? school grade X grade X to secondary schools. this this this center? by required start took the passed the school? school? school? fees and ALLOW UP TO providing national national LIST EACH SCHOOL THAT THE expenses, 3 RESPONSES services? examina- examina- RESPONDANT(S) NAME DISTANCE of enrolling TOO SMALL ..... 1 tion? tion? GRADE CODES a child in TOFEBOK2 PRIMARY ..........1 C.......... CODES this schil TOO FEW BOOKS .2 LOWER SECONDARY ........ 2 METER ..1 for one TOO FEW DE5KS.3 UPPER SECONDARY . ........ 3 KILO- year? SUPPIETOO.FEW COMBINED LOWER AND UPPER SUETLIES . SECONDARY . ........4.....2..... BUILDING COMBINED PRIMARY AND LOWER RUN DOWN ...... 5 SECONDARY . . .. 5 POOR COMBINED PRIMARY, LOWER AND BOYS AND GOVERN- TEACHERSP 6 UPPER SECONDARY . ....... 6 GIRLS. .1 MENT ... 1 OTHER(SPE- F*J OTHER(SPECIFY ) 7 BOYS PRIVATE CIFY_)___ ..ONLY . 2 RELIGIOUS.2 SCHOOL GIRLS PRIVATE DIST. STUDENTS STUDENTS NAME TYPE ONLY .... 3 SECULAR... 3 DISTANCE CODE 1ST 2ND 3RD YEAR TAKING PASSING B A|l ll lll|l D ___=_= FE == == SECTION 10: SCHOOL FACILITIES 13* Are there any preschools in this community or in a nearby community? YES.. 1 NO.. 2(*>21) 14* 15* 16^ 17* 18* 19* 20* C What is the name of this preschool? Who operates this school? When did How old must a How much How many How many 0 this child be to enroll does it cost children are hours per D preschool in this preschool? per year to enrolled in day does it E open? enroll a child this operate? in this preschool? school? GOVERNMENT ...........1 PRIVATE RELIGIGIOUS ..2 -o NAME PRIVATE SECULAR ......3 YEAR YEARS| MONTHS HOURS A F- SECTION 10: SCHOOL FACILITIES 21. Are there any children of primary school age that do not attend 24* Are there any children of lower secondary school age that do not primary school in this community? attend lower secondary school in this community? YES ... 1 YES .. .1 NO ... 2(>>23) NO ........ O. 2(>26) ..ll 22. What are the main reasons that these children are not attending 25* What are the main reasons that these children are not attending primary school? lower secondary school? SCHOOL TOO FAR ................... 1 SCHOOL TOO FAR ................... 1 1ST: CANNOT AFFORD SCHOOL FEES ........ 2 1ST: CANNOT AFFORD SCHOOL FEES ........ 2 CHILDREN ARE ILL/HANDICAPPED L......... 3 CHILDREN ARE ILL/HANDICAPPED ..... 3 SCHOOL CURRICULUM IS TOO SCHOOL CURRICULUM IS TOO DIFFICULT ..........4 [ND- . | DIFFICULT .4.......... 2ND [ CHILDREN NOT INTERESTED IN 2ND: CHILDREN NOT INTERESTED IN SCHOOL ..... 5 SCHOOL ...... ........ ......... 5 PARENTS NO INTERESTED IN PARENTS NOT INTERESTED IN 3RD: SCHOOL .......... 6 3RD: SCHOOL .......................... 6 SCHOOLS ARE FULL/NO PLACES ....... 7 SCHOOLS ARE FULL/NO PLACES ....... 7 CHILDREN NEEDED TO WORK .......... 8 CHILDREN NEEDED TO WORK .......... 8 OTHER (SPECIFY _ ).......... 9 OTHER (SPECIFY_ ) ........... 9 26* What are the main problems with lower secondary school education 23. What are the main problems with primary school education in this in this community? community? SCHOOL SUPPLIES ARE INSUFFICIENT.1 1ST: | l SCHOOL SUPPLIES ARE INSUFFICIENT.1 1ST: TEACHERS ARE POORLY PAID. 2 TEACHERS ARE POORLY PAID2 L.......... 2 SCHOOL BUDGET IS TOO SMALL ....... 3 SCHOOL BUDGET IS TOO SMALL ....... 3 SCHOOLS ARE OVER CROWDED ......... 4 2ND: SCHOOLS ARE OVER CROWDED ......... 4 2ND: NOT ENOUGH TEXTBOOKS ............. 5 NOT ENOUGH TZXTBOOKS .............5.... NOT ENOUGH DESKS ................. 6 NOT ENOUGH DESKS ................. 6 POOR QUALITY TEACHERS ............3RD: 7 POOR QUALITY TEACHERS ............7 73 CURRICULUM IS NOT RELEVANT ....... 8 CURRICULUM IS NOT RELEVANT ....... 3RD: OTHER (SPECIFY .......... 9 OTHER (SPECIFY ). 9 SECTION 10: SCHOOL FACILITIES 27 Are there any children of upper secondary school age that do not 30. Has there been an adult literacy campaign in this community during attend upper secondary school in this community? the last 10 years? NO... 2(,28) l l NO... 2(,,34) 28' What are the main reasons that these children are not attending 31 In what year was the most recent program started? uoper secondarv school? Y'EAR: SCHOOL TOO FAR ...................1 1 lST CANNOT AFFORD SCHOOL FEES ........ 2 CHILDREN ARE ILL/HANDICAPPED .....3 32 In what year was the most recent program finished? SCHOOL CURRICULUM IS TOO 2ND: l l DIFFICULT ....................... 4 . YEAR: CHILDREN NOT INTERESTED IN SCHOOL NO...E..R D3RD: IN 33' How many adults in this community participated in the most recent PARENTS NO INTERESTED IN SCHOOL .......................... 6 program? SCHOOLS ARE FULL/NO PLACES .......7 HEN: CHILDREN NEEDED TO WORK .......... 8 OTHER (SPECIFY ). ......... 9 WOMEN: ____ X 29. What are the main problems with upper secondary school education 0 in this communitv? SCHOOL SUPPLIES ARE INSUFFICIENT. 1 1 1 34* WRITE THE ID CODES OF THE RESPONDENTS WHO TEACHERS ARE POORLY PAID ........... ... .2 1ST: PARTICIPATED IN ANSWERING THE QUESTIONS OF SCHOOL BUDGET IS TOO SMALL ....... 3 THIS SECTION. SCHOOLS ARE OVER CROWDED ......... 4 2ND: |l NOT ENOUGH TZXTBOOKS ............. 5 NOT ENOUGH DESKS ................. 6 POOR QUALITY TEACHERS ............ 7 3RD: CURRICULUM IS NOT RELEVANT ....... 8 OTHER (SPECIFY ) ..........9 SECTION 11: DIRECT OBSERVATION 1* IS THE AIR IN THIS COMMUNITY POLLUTED? 8* IS THE GRASS GROWING IN PUBLIC SQUARES GENERALLY WELL CARED FOR? YES .. 1 YES .. 1 NO.... .2 NO..... 2 NO PUBLIC SQUARES. .3 2t ARE THERE PILES OF EXPOSED GARBAGE PILE VISIBLE ALONG THE ROADS? 9* DO THE HOUSES IN THIS COMMUNITY TYPICALLY USE GLASS YES ... .1 WINDOW PANES? NO... .2 YES.. .1 NO ... 2l 3* IS ANIMAL MANURE VISIBLE ALONG THE ROADS TO THE COMMUNITY CENTER? YES ..1 10' DO THE CHILDREN IN THIS COMMUNITY TYPICALLY WEAR NO.... 2 NEAT CLOTHING? YES... .1 NO....2 4' ARE THERE OBSTRUCTED SEWERS, GUTTERS, OR CANALS IN THIS VILLAGE? YES ...1 11* DO THE CHILDREN UNDER 10 IN THIS COMMUNITY TYPICALLY NO.... 2 WEAR SHOES? YES.. .l °° NO... 2 - 5* ARE THERE STANDING POOLS OF WATER (NOT INCLUDING MARSHES, LAKES) IN THIS VILLAGE? 12* DO THE ADULTS IN THIS COMMUNITY TYPICALLY WEAR NEAT YES ... 1 I CLOTHING? NO ... 2 YES .. .1 6* ARE THERE ANY LARGE LIVESTOCK VISIBLE ROAMING AROUND THE HOUSES? 13* DO THE ADULTS IN THIS COMMUNITY TYPICALLY WEAR SHOES? YES .. 1 YES.. .1l NO ... 2 NO ... 2 l m 7* ARE THE HOUSE YARDS IN THIS COMMUNITY SWEPT 14* WHAT PAVEMENT MATERIAL IS USED MOST FREQUENTLY CLEAN? FOR THE ROADS IN THIS COMMUNITY? ASPHALT ....... 1 YES. . .1 ROCKS ........2 . 2 NO ....2 DIRT ... 3 OTHER (SPECIFY ) ..4 SECTION 11: DIRECT OBSERVATION 15' WHAT MATERIAL IS MOST COMMONLY USED FOR THE 18* PLEASE RECORD OTHER IMPRESSIONS OF THE COMMUNITY OUTSIDE WALLS OF THE HOUSES IN THIS COMMUNITY? THAT ARE RELEVANT TO THE TOPICS COVERED IN THIS QUESTIONNAIRE CEMENT .......... 1 BOARDS .......... 2 BAMBOO .......... 3 MUD ..........4 OTHER (SPECIFY_ )..5 16* WHAT MATERIAL IS MOST COMMONLY USED FOR THE FLOORS OF THE HOUSES IN THIS COMMUNITY? STONE .......... 1 TILES .........2.....r.1 CEMENT .........3....... WOOD .......... 4 BAMBOO .......... 5 DIRT/SAND ..........6 OTHER (SPECIFY )..7 17* WHAT MATERIAL IS MOST COMMONLY USED FOR THE ROOFS OF THE HOUSES IN THIS COMMUNITY? CONCRETE ........ 1 LUMBER ........ 2 TIN ........3 ASBESTOS ......... 4 TILE ........5 LEAVES ........ 6 THATCH ........ 7 OTHER (SPECIFY ) ..8 PRICE QUESTIONNAIRE: COMMUNITY INFORMANT VERSION 1. ~~~~~~~2. 3. F In what units is [...] usually How much [...] is On average, what 0 purchased in this community? contained in one is the price for one O [UNIT FROM [UNIT FROM D QUESTION 1]? QUESTION 1] of KILOGRAM . 3I..... 1(>>3) D LITER ........ 2(>,3) KILOGRAM. .....2 E CAN ...........3 LITER ........3 PACK ..........4 cc...........4 PIECE .... 5 >>3) OTHER OTHER (SPECIFY ),.5 (SPECIFY) 6 ITEM UNIT AMOUNT UCODE AVERAGE 1 Rice 3 Maize 4 Cassava 5 Potatoes 7 Pork _ _ _ _ _ _ _ _ _ _ 8 Chicken 9 Fresh Fish 10 Dry Fish E , 1 1 Egg____ 12 Soybean 13 Spinach 14 Cabbage . 15 Tomatoes____ 16 Orange 17 Banana . l 18 Mango 19 IMilk _ _ _ _ _ _ _ _ 20 Beer 21 Cigarette = 22 Kerosene 23 Cotton cloth l 24 IShirt _ _ _ _ _ __ _ _ _ _ _ _ 25 Pants _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 26 Socks = 27 Etc. ________ _____________ ______28 283 PRICE QUESTIONNAIRE: MARKET VISIT VERSION FIRST VENDOR SECOND VENDOR THIRD VENDOR 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. F IS [ ... AVAILABLE IN PREFERRED PREFERRED VENDOR IS THIS PRICE AMOUNT VENDOR IS THIS PRICE AMOUNT VENDOR IS THIS PRICE AMOUNT O THIS COMMUNITY? UNIT BRAND TYPE THE TYPE THE TYPE THE O PREFER- PREFER- PREFER- D RED RED RED BRAND? BRAND? BRAND? C MARKET MARKET MARKET O VENDOR.1 VENDOR.1 VENDOR.1 D STREET KILOGRAM.1 STREET KILOGRAM.1 STREET KILOGRAM.1 E STALL. .2 GRAM . 2 STALL. .2 GRAM . 2 STALL. .2 GRAM. 2 CART LITER.... 3 CART LITER ....3 CART LITER.... 3 VENDOR.3 CC ... 4 VENDOR.3 CC. . 4 VENDOR.3 CC. 4 SMALL OTHER (SPE- SMALL OTHER (SPE- SMALL OTHER (SPE- SHOP ...4 CIFY-) .5 SHOP ...4 CIFY_).5 SHOP ...4 CIFY).5 SUPER- SUPER- SUPER- MARKET.5 MARKET.5 MARKET.5 YES. .1 OTHER OTHER OTHER NO ... 2 (SPCI- YES. .1 (SPECl YES. .l (SPECI- YES..l FY) .6 FY__ )6 FY__ ).6 (-NMEXT NO... .2 UNT O... 2 UNIT NO... .2UI FOOD ITEM ITEM) AMOUNT CODE AMOUNT CODE AMOUNT CODE Rice = = = = = = - = Wheat _ ______. Maize _ . _ _______=_ Cassava_____ ____ Potatoes_______ __ ___ Beef__ _ _ _ _ __ _ _ _ __ _ ___ _ _ _ 7 Pork 8 C hicken _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ _ _ _ _ _ _ E tc. _e_ __; _ _ _ _ _ __:;_ _ _ _ _ _ _ _ _ _ _ _ _ _ __:_ _ _ _ _ _ _ _ _ _ _ __:_:_ _ _ _ _ _ __:_ _ _ _ _ _ _ _ _ _ _ _ _ Modules for Chapter 14 Environment Dale Whittington The following pages present the draft questionnaires to col- est customization. In contrast, the modules on water, san- lect data on environmental topics. As explained in Chapter itation and fuel use are very detailed and consequently 14 ofVolume 2, there are many different modules that can there are a number of possibilities for customizing or be used, depending on the goals of the survey. Only in rare shortening them.The appropriate choices are context spe- cases would all be used in a single survey. For a fuller dis- cific, as opposed to generic, so survey designers should cussion see Chapter 14. consult Chapter 14 for advice on customization. Finally, The individual modules presented here require differ- the contingent valuation modules for water, sanitation and ent amounts of customization. The modules on general air quality also require a great deal of customization since environmental priorities in urban and rural areas, air qual- they must correspond to the specific interventions being ity, and time preference are all short and need only mod- contemplatcd. 285 1. GO TO HOUSEHOLD IDENTIFICATION PAGE. IS THIS HOUSEHOLD IN AN URBAN OR A RURAL AREA? URBAN... 1 >>MODULE 1 = RURAL.. .2 >>MODULE 2 MODULE 1: ENVIRONMENTAL PRIORITIES (URBAN) MODULE 2: ENVIRONMENTAL PRIORITIES (RURAL) Option 1: Option 1: I'd like you to think about the following list of environmental problems I'd like you to think about the following list of environmental problems that the Government needs to address over the next ten years: that the Government needs to address over the next ten years: Option 2: Option 2: Suppose that the Government had the money to make a serious Suppose that the Government had the money to make a serious effort to solve one of the following environmental problems in [NAME effort to solve one of the following environmental problems in [NAME OF CITY] over the next few years. The other problems would have OF DISTRICT/REGION] over the next few years. The other to wait until more funds were available in the future. problems would have to wait until more funds were available in the future. List of environmental problems: List of environmental problems: a. Air pollution a. Air pollution b. Contamination of drinking water b. Contamination of drinking water IQ C. Poor garbage collection and solid waste c. Poor garbage and solid waste disposal 0% disposal d. Poor disposal of human wastes (excreta) and d. Poor disposal of human wastes (excreta) and household waste water household waste water e. Poor drainage / flooding e. Poor drainage / flooding f. Water pollution in rivers and along the f. Water pollution in rivers and along the seashore seashore i. Improper disposal of hazardous wastes from g. Too much noise industry h. Improper disposal of hazardous wastes from g. Deforestation industry h. Desertification i. Soil erosion 2. Which one of these problems is the most important one to solve in j. Loss of wildlife this city? 2. Which one of these problems is the most important one to solve in Most important [ this district/region? Mnost important 3. Which one of these problems is the second most important? Most important ~3. Which one of these problems is the second most important? Most important [=Most important | "" MODULE 3 >> MODULE 4| MODULE 3: ENVIRONMENT ATTITUDES AND PERCEPTIONS - URBAN AIR QUALITY' MOST KNOWLEDGEABLE PERSON 1. How would you characterize the air quality in [NAME OF CITY]? 5. Does anyone in your household suffer from chronic, minor respiratory health problems? (e.g., bronchitis, colds, flu) VERY CLEAN .................... 1 FAIRLY CLEAN ..................2 YES .. 1 SOMEWHAT DIRTY ................ 3 NO .... 2 VERY DIRTY ............4 4 2. In your opinion, which of the following do you think is the most 6. How much do you feel that air pollution in [name of city] contributes important source of air pollution in [name of city]? to their illness? ELECTRIC POWER PLANTS ......... 1 AIR POLLUTION IS THE MAIN CAUSE ......... 1 STEEL AND CHEMICAL PLANTS .....2 AIR POLLUTION CONTRIBUTES A LOT ......... 2 CARS AND BUSES ................3 AIR POLLUTION IS ONE OF SEVERAL CAUSES ..3 HOUSEHOLD HEATING ............. 4 AIR POLLUTION IS A RELATIVELY MINOR [ OTHER (PLEASE SPECIFY) .5 CAUSE. 4 AIR POLLUTION IS NOT THE CAUSE. 5 3. How much do you think you personally contribute to air pollution problems? 7. Does anyone in your household suffer from major respiratory health problems? (e.g., asthma, emphysema, or lung or throat MUCH MORE THAN THE AVERAGE cancer) HOUSEHOLD .................... 1 SOMEWHAT MORE THAN THE YES ... 1 4 AVERAGE HOUSEHOLD .2 NO .... 2 ABOUT THE SAME AS OTHER HOUSEHOLDS ....... 3 m 8. How much do you feel that air pollution in [name of city] SOMEWHAT LESS THAN OTHER contributes to their illness? HOUSEHOLDS ........... 4 MUCH LESS THAN OTHER AIR POLLUTION IS THE MAIN CAUSE .......... 1 HOUSEHOLDS ................... 5 AIR POLLUTION CONTRIBUTES A LOT. 2 AIR POLLUTION IS ONE OF SEVERAL CAUSES 3|.| 4. Which of the following consequences from air pollution are you AIR POLLUTION IS A RELATIVELY MINOR most concerned about? CAUSE. 4 AIR POLLUTION IS NOT THE CAUSE. 5 REDUCED VISIBILITY ...................... 1 INCREASED COSTS FOR ALL TYPES OF CLEANING (E.G., LAUNDRY, CAR, WINDOWS).2 INCREASED COSTS FOR BUILDING MAINTENANCE ............................ 3 HEALTH EFFECTS .......................... 4 ADVERSE EFFECTS ON TREES AND OTHER PLANTS ................................. 5 OTHER: .............. 6 1. The questions were developed by Elizabeth McClelland. See "The Use of Attitudinal Indicators in Contingent Valuation Research: Validity Tests for Theoretical Computibility." PhD Dissertation, Department of City and Regional Planning, University of North Carolina at Chapel Hill, 1997. MODULE 3: ENVIRONMENT ATTITUDES AND PERCEPTIONS - URBAN AIR QUALITY' MOST KNOWLEDGEABLE PERSON 9. How strong do you think the linkage is between air quality and 13. Compared to other people, how would you describe your human health in the general population? knowledge about air pollution? AIR POLLUTION IS ONE OF THE MAIN CAUSES MUCH HIGHER ...................1 OF HEALTH PROBLEMS ......................1 SOMEWHAT HIGHER ...........2 AIR POLLUTION IS IMPORTANT, BUT NOT ABOUT THE SAME ..................3 ONE OF THE MAIN CAUSES .................. 2 SOMEWHAT LESS .4 AIR POLLUTION IS A RELATIVELY MINOR MUCH LESS ........... . . 5 CAUSE OF HEALTH PROBLEMS ................3 AIR POLLUTION DOES NOT CAUSE HEALTH PROBLEMS ................................4 10. How important an issue is air quality improvement to you? VERY IMPORTANT ........................... 1 SOMEWHAT IMPORTANT ....................... 2 NOT VERY IMPORTANT ....................... 3 NOT IMPORTANT AT ALL .....................4 11. Do you think that the implementation of an air quality tQ improvement program would affect your job and/or salary? ao DEFINITELY YES ......................... 1 PROBABLY YES ........................... 2 PROBABLY NOT ........................... 3 DEFINITELY NOT ......................... 4 12. Compared to other people, how would you describe your commitment to preserving and improving air quality? MUCH MORE COMMITTED .................... 1 SOMEWHAT MORE COMMITTED ................ 2 ABOUT THE SAME ......................... 3 SOMEWHAT LESS COMMITTED ................ 4 MUCH LESS COMMITTED .................... 5 1. The questions were developed by Elizabeth McClelland. See "The Use of Attitudinal Indicators in Contingent Valuation Research: Validity Tests for Theoretical Computibility." PhD Dissertation, Department of City and Regional Planning, University of North Carolina at Chapel Hill, 1997. MODULE 4: WATER MOST KNOWLEDGEABLE MEMBER 1. 2. 3. 4. 5. 6. Is it possible for In the rainy In the rainy In the rainy In the rainy season, Do any of these households in this season, how would season, how would season, how would how would you characteristics of area to get water from you judge the taste you judge the color you judge the judge the reliability the water from the following sources? of the water from of the water from health risk of the of the water from ...SOURCE...differ ... SOURCE...? ... SOURCE... ? water from ... SOURCE..? in the dry season (before any (before any ... SOURCE... ? from the rainy treatment the treatment the (before any season? (before household may do) household may do) treatment the any treatment the household may do) household may do) GO DOWN THE LIST TO VERIFY WHICH SOURCES ARE AVAILABLE TO THE HOUSEHOLD. THEN EXCELLENT.-1 EXCELLENT.-1 EXCELLENT- 1 EXCELLENT.-*1 FR AY WH A GOOD . 2HE 2 GOOD .......2 GOOD .....2 GOOD ....... 2 ASK QUESTIONS 2.43 / AR FI/ AR NORMAL ....3 NORMAL .... 3 NORMAL ... .3 Y L 1....3 POOR . 4 POOR .......4 POOR .......4 POOR . 4 YES-1 DON'T KNOW.5 DON'T XNOW.5 DON'T KNOW.5 DON'T KNOW.5 NO... 2 00 _ NO YES (>11) vo RPvate water connection _ Public taps - 3 Public well.. 4 Neighbors that sell or give water away S Private well . 6Vendors _ Springs 8 Other surface water sources nrve s/streams/lakes) _Rainwater BoWed water __ MODULE 4: WATER MOST KNOWLEDGEABLE MEMBER 7. 8. 9. 10. 11. 12 13. In the dry season, In the dry season, In the dry season, In the dry season, How far away is the During a normal Does one how would you how would you how would you how would you nearest week in the dry have to pay judge the taste of judge the color of judge the health risk judge the reliability ... season, how to collect the water from the water from of the water from of the water from SOURCE long does water from ..SOURCE...? ... SOURCE... ? ... SOURCE... ? ... SOURCE ... ? someone have ... SOURCE (before any (before any (before any to wait at ...? treatment the treatment the treatment the ... SOURCE... household may do) household may do) household may do) during the busiest time of UNITS day to collect METERS .............1 water? MINUTES OF ONE- WAY WALKING EXCELLENT.1 EXCELLENT. .1 EXCELLENT.1 EXCELLENT. .1 TIME WAL G. 2 GOOD .......2 GOOD ....... 2 GOOD . ....... 2 GOOD ....... 2 FAIR/ FAIR/ FAIR/ FAIR/ NORMAL. . . .3 NORMAL ....3 NRA....3 NORMAL. . ..3 POOR ... 4 POOR . 4 POOR . 4 POOR .... 4 YES-.1 DON'T KNOW.5 DON'T KNOW.5 DON'T XNOW.5 DON'T KNOW.5 NO. OF NO .. 2 %O I_I II NUMBER CtNITSI MINUTES (>>17) 1~* Private water connection Public taps Public well 4 Neighbors that sell or gqive water :5 Private well__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6 Vendors__ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ Springs _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 8 Other surface water sources i(rivers/streams/lakes)__________ 9 Rainwater [Bottled water MODULE 4: WATER MOST KNOWLEDGEABLE MEMBER ________________________ ______ PUBLIC WELL NEIGHBORS VENDORS 14 15. 16. 17. 18. 19. 20. Does one pay per What is What is How is water What is the source What is the main Does your household bucket or a fixed the price the price collected from the of the water that this source of water for the use water from amount each month? per per closest public neighbor water vendors? ... SOURCE ... ? bucket? month? well? sells/provides? [For bottled water, indicate PRIVATE price per CONNECTION.1 liter.] PRIVATE WELL ..... 2 PRIVATE PRICE PER WATER TANKER CONNECTIONS.1 BUCKET .... I BUKET AND TRUCK ....3 PUBLIC TAPS. .2 BUCKET.1 BUCKET ~~~~~ WATER FrROM A PRIVATEWELL. 3 FIXZD ROPE ..... 1 DISTRIBUTING STREAM/ AMOUNT PER HANDPUNP..2 VENDR....4 RIVER.... 4 MONTH.2("16) ELECTRIC RAINWATER... .5 RAINWATER ... .5 YES. .1 BOTH ...... 3 pUMp ..... 3 OTHER ......6 OTHER ......6 NO..2 OTHER.. 4(>>17) OTHER .....4 . .2 _______________________ _____________________ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (>>NEXT SOURCE) Private water connection Public taps I . Public well 4 Neighbors that sell or give water away .-. Private well Vendors 7 Springs l 8 Other surface water sources (rivers/streams/lakes) l Rainwater I Bottled water MODULE 4: WATER MOST KNOWLEDGEABLE MEMBER 21. 22. 23. In the rainy season, do you use water from In the rainy In the rainy .... SOURCE ... for the following activities? season, how season, much of the about how water that your many 20-liter household uses jerricans/cont for these ainers do purposes do members of you obtain from your RECORD ALL THAT APPLY this SOURCE? household collect and carry home? ALL/ALMOST ALL . 1.. YES ..1 ABOUT NO.. .2 HALF ..... 2 NONE/VERY LITTLE ...... .3 DRINXING COOKING BATHING WASHING OTHER NUMBER Private water connection _ 2 Public taps 3 Public well 4 Neighbors that, sell Or giive water ]away_____ vendors_____ Springs _ _ _ _ _ _ _ _ _ _ _ _ _ 8 Other surface water sources (rivers/streams/lakes)______ 9 Rainwater IBottled water _ _ _ _ __ _ _ _ _ MODULE 4: WATER MOST KNOWLEDGEABLE MEMBER 24. 25. 26. 27. In the dry season, do you use water from In the dry In the dry .... SOURCE.. for the following activities? season, how season, much of the about how water that your many 20-liter household uses jerricans/cont for these ainers do purposes do you members of RECORD ALL THAT ~ obtain from your RECORD ALL THAT this .... SOURCE? household l APPLY l collect and carry home? ALL/ALMOST YES . 1 ALL .. 1 NO ... 2 ABOUT NO.. .2~ ~~~~~IF.... NONE/VERY _______ _______ ______ _______ ______ LITTLE... .3 'O _DRINKING NG OTHER NUMBER Private water connection =SOURCE 1S PRIVATE CONNECTION)> 28 2 Public taps SOURCE IS PUBLIC TAPS)>> NEXT SOURCE 3 Public well SOURCE IS PUBLIC WELL)>> NEXT SOURCE 4 Neighbors that sell or give water away SOURCE IS NEIGHBORS _ NEXT SOURCE 5 Private well SOURCE IS PRIVATE WELL a) 39 6 _ Vendors SOURCE IS VENDORS > NEXT SOURCE 7 _ Springs . SOURCE IS SPRINGS ) NEXT SOURCE 8 Other surface water sources 9 (rivers/streams/lakes) . SOURCE IS SURFACE )) NEXT SOURCE 9 Rainwater .. SOURCE IS RAINWATER ) 40 Bottled water SOURCE IS BOTTLED WATER o> 42 MODULE 4: WATER MOST KNOWLEDGEABLE MEMBER _______________________ ______ ______ ______ PRIVATE CONNECTION | 28. 29. 30. 31. 32. 33. 34. 35. 36. 37 In the In the dry Do you Is the Do you How much How many Do you Do you charge your What rainy season, have a meter receive a was your months sell water neighbors a per- were your season, for how water working? water bill? water bill did it from your bucket price or a total for how many meter? last time cover? connectio fixed fee per month? revenues many hours per you n to your last month hours per day is received neighbors? from sales day is there one? to there water from neighbors? water from the tap? the tap? PRICE PER BUCKET. 1 FIXED YES. .1 YES. .1 YES. .1 YES. .1 AMOUN'T PER No . . 2 NO .. .2 No. .. 2 NO ... 2 MONTH. .2 N_ MZER NUMBER t (-35) ( '35) AMOUNT NUMBER (-38) .AMOUNT Private water connection 2 3 _Public welll 4 Neighbors that sell or give water _ away : : I Private well 6 IVendors 7 _Springsl 8 Other surface water sources _(rivers/strearns/lakes) 9 Rainwater 10 water I LBottled water : MODULE 4: WATER MOST KNOWLEDGEABLE MEMBER PRIVATE CONNECTION OWN WELL RAINWATER BOTTLED 38. 39. 40. 41. 42. What do you like least How is water What system do you How much would it How many about the water service collected from your use to collect cost today to build liters of from the piped water well? rainwater? this rainwater bottled system? collection system water does or purchase this your NEXT equipment (that is household SOURCE ROOF GUTTER gutters, buckets, buy in a MONTHLY ~ , NEXT INTO BARREL storage units, but typical BILL IS TOO SOURCE OR SHALL not roofing week? HIGH ......... 1 CONTAINER..1 materials?) LESS THAN 24 HURx ROOF GUTTER SERVICE... .2 INTO LARGE FREQUENT STORAGE BRE.AKDWNS.... 3 ROPE 1 BUCKCET UNDER QUALITY OF WATER ROE...I BCTUNR ISQUALITY......T HANDPUMP ...2 EDGE OF NO COMPLAINTS/ 4ELECTRIC ROOF .....3 NO COHPLAINTS/ PUMP .....3 OTHER .... 4 SATISFIED.SOHE5 OTHER....4 %O AMOUNT NUMBER Private water connection 2 Public taps 3 Public well 4 Neighbors that sell or give water ,away Private welt 6 Vendors 7 Springs 8 Other surface water sources (rivers/streams/lakes) 9 Rainwater _ Bottled water MODULE 5: HOUSEHOLD SANITATION: ATTITUDES AND PRACTICES MOST KNOWLEDGEABLE PERSON 7. Do you charge your neighbors for the use of your SANITATION SERVICE: WATER-SEALED TOILET toilet? YES.. 1 LiZ 1. Are there households in this neighborhood/area NO.. 2(>>10) that have private water-sealed toilets in their houses or apartments? 8. How much do you charge your neighbors? YES. . 1 NO.. 2(»>>23) TIME PERIOD USE ........0 AMOUNT DAY ........3 2. How would you judge water-sealed toilets in terms of WEEK .4 convenience? FORTNIGHT ..5 IM I MONTH . 6 TIME PERIOD EXCELLENT ............ 1 GOOD .............2 . 2 FAIR/NORMAL ........ 3 9. Where are the wastes from your toilet discharged? POOR ............ 4 SEPTIC TANK ..................... 1 3. How would you judge water-sealed toilets in terms of OPEN DRAINS IN NEIGHBORHOOD ..... 2(>17) reliability? ~~~~~~~~~~~COVERED DRAINS IN NEIGEBORHOOD. .3(>>17) reliability? SEWER SYSTEM ....................4>4(>17) RIVER/CANAL ..................... 5(-17) EXCELLENT ....................... 1 POND ............................ 6(»17) GOOD ........... ................. 2 OUTSIDE/LAND .................... 7(>17) FAIR/NORMAL ............ 3 OTHER (SPECIFY) .... 8(>>17) POOR ............................ 4 DON'T KNOW ................... 9(»>17) 4. Does your household have a water-sealed toilet 10. How many septic tanks do you have? here at this house/apartment? YES.. .1 L NUMBER OF l NO. . 2(>18) SEPTIC TANKS: 5. How many water-sealed toilets do you have here? 11. When was your main septic tank installed? No. OF TOILETS RECORD ONLY ONE YEAR ANSWER AS GIVEN NUMBER OF 6. Do any of your neighbors use your toilet on a BY RESPONDENT YEARS AGO lI l regular basis? YES ..1 NO.. 2(>>10) MODULE 5: HOUSEHOLD SANITATION: ATTITUDES AND PRACTICES MOST KNOWLEDGEABLE PERSON 12. Has your main septic tank ever been emptied? SANITATION SERVICE: SEWER SYSTEM YES ....... .. 18. Is there a sewer system in this neighborhood/area that NO ....... 2(»16) households can discharge their household wastewater DON'T KNOW.. 30(>16) and excreta into if they want to connect to the sewer pipe? (i.e., is it possible for a household in this neighborhood to 13. How long ago was it emptied? r _ connect to a sewer system if they want to?) YEAR :| NUMBER OF YES ............. 1 YEARS AGO No ............. 2(>>23) DON'T KNOW ............. 3(>,23) 14. How was it emptied? BY TRUCK ........................ 1 19. How would you judge the sewer system in terms of BY HAND.. 2 Reliability? SELF ................. 3 EXCELLENT.1 OTHER (SPECIFY) ...... 4 DON'T KNOW ................. 5 GOOD........................2 FAIR/NORMAL ............. 3 15. How much would it cost to have your (main) POOR ........ 4 septic tank emptied today? (CHECK RESPONDENT'S ANSWER TO QUES. 9) 16. How much would it cost to have a septic tank 20. Is your water-sealed toilet connected to a sewer system? as large as your main septic tank installed today? MATERIALS: YES .2(..23) LABOR: DON'T KNOW .....3(.>23) TOTAL: L 17. Overall, how satisfied are you with your 21. Is the water running continuously in your toilet today? water-sealed toilet? (i.e., is the toilet mechanism leaking?) VERY SATISFIED ..1....... YES.1.............. m SOMEWRAT SATISFIED ..............2 NO .............................. 2 LESS THAN SATISFIED/ SOMEWHAT DISSATISFIED ........ 3 NOT SATISFIED AT ALL ........ 4 MODULE 5: HOUSEHOLD SANITATION: ATTITUDES AND PRACTICES MOST KNOWLEDGEABLE PERSON 22. Overall, how satisfied are you with the sewer system? 28. How deep is the pit? (IF THERE IS MORE THAN ONE PIT LATRINE, ASK ABOUT THE VERY SATISFIED .................. 1 DEPTH OF THE PIT IN THE MAIN LATRINE). SOMEWHAT SATISFIED .............. 2 LESS THAN SATISFIED/ No. OF METERS: SOMEWHAT DISSATISFIED .......... 3 NOT SATISFIED AT ALL ............ 4 29. Do any of your neighbors use your pit latrine SANITATION SERVICE: PRIVATE PIT LATRINES on a regular basis? YES ..1 ..ll 23. Are there households in this neighborhood/area that NO .2(>32).... 1 have private pit latrines? 30. Do you charge your neighbors for the use of your pit latrine? YES .............1...... l NO ............ 2(>>39) YES .1..... 1 NO ..... 2(>32) 24. How would you judge pit latrines in terms of cleanliness? 31. How much do you charge your neighbors? EXCELLENT ...... 1 GOOD .. 2 TIME PERIOD '. FAIR/NORMAL .3 PER USE .......0 AMOUNT co POOR .4 DAY ...... 3 WEEK .......4 25. How would you judge pit latrines in terms of convenience? FORTNIGHT ....5 TIME PERIOD: [= EXCELLENT ..........M..1 GOOD ...............2F] FAIR/NORMAL ........ 32. When was your main pit latrine installed? POOR ............................ 4 RECORD ONLY ONE YEAR: 26. Does your household have a pit latrine at this ANSWER AS GIVEN NUMBER OF house/apartment? BY RESPONDENT YEARS AGO: II YES .1 77 33. Has your main pit latrine ever been emptied? NO . 2(>39) YES ..........1 27. How many pit latrines do you have here? NO ........ 2(»>36) DON'T KNOW ... 3(>>36) No. OF TOILETS MODULE 5: HOUSEHOLD SANITATION: ATTITUDES AND PRACTICES MOST KNOWLEDGEABLE PERSON 34. How long ago was it emptied? 40. How far is it to the closest public latrine from your home? RECORD ONLY ONE YEAR: RECORD ONLY ONE METERS: ANSWER AS GIVEN No. OF ANSWER AS GIVEN ONE-WAY WALKING BY RESPONDENT YEARS AGO: L BY RESPONDENT DISTANCE (MINUTES): LJ 35. How was it emptied? 41. During the busiest time of the day, how long is the queue at the nearest public latrine? BY TRUCK ..................... 1 BY HAND .......................... 2 1 l No. OF MINUTES: E SELF ......................... 3 (QUEUE TIME) OTHER (SPECIFY) __________.. 4 DON'T KNOW/ NOT SURE ......... 5 42. Is there a charge/fee for using the nearest public latrine? 36. How much would it cost to have your pit latrine YES . 1 emptied today ? NO. .2(»44) 37. How much would it cost to have a pit latrine 43. How much is the charge? like yours built today? TIME PERIOD MATERIALS: I 1PER USE .....0 AMOUNT LABOR: X DAY ............3 TOTAL: WEEK........4 FORTNIGHT ... .5 38. Overall, how satisfied are you with your pit latrine? MONTH.6 TIME PERIOD VERY SATISFIED .................. 1 44. When was the nearest public latrine built? SOMEWHAT SATISFIED .............. 2 LESS THAN SATISFIED/ E RECORD ONLY ONE YEAR: SOMEWHAT DISSATISFIED .......... 3 RE RD ON NE MBER: NOT SATISFIED AT ALL ............4 ANSWER AS GIVEN NUBER OF BY RESPONDENT YEARS AGO: E SANITATION SERVICE: PUBLIC LATRINES 39. Are there public latrines in this neighborhood/ area that households use as their main sanitation facility? YES..1 NO.. .2(54) MODULE 5: HOUSEHOLD SANITATION: ATTITUDES AND PRACTICES MOST KNOWLEDGEABLE PERSON 45. Where are the wastes from the nearest public 50. How would you judge the nearest public latrine in latrine discharged? terms of reliability? SEPTIC TANK ..................... 1 EXCELLENT ............ 1 OPEN DRAINS IN NEIGHBORHOOD .....2 GOOD ............ 2 COVERED DRAINS IN NEIGHBORHOOD.. 3 FAIR/NORMAL ............ 3 SEWER SYSTEM .................... 4 POOR ....................... 4 RIVER/CANAL ................. 5 POND ............ 6 51. Does your household use the public latrines on a OUTSIDE/LAND ............ 7 regular basis? OTHER (SPECIFY) ______......8 DON'T KNOW ...................... 9 Y .1L No.. -2(»54) 46. How many holes does the nearest public latrine have? No. OF 52. How much do members of your household spend HOLES: per week using (to use) the public latrines? WEEKLY EXPENDITURES 47. About how many households use this public latrine BY ALL HOUSEHOLD Li on a regular basis? MEMBERS: w, No. OF o HOUSEHOLDS: L 53. Overall, how satisfied are you with the public latrines? 48. How would you judge the nearest public latrine in VERY SATISFIED .................. 1 terms of cleanliness? SOMEWHAT SATISFIED .............. 2 LESS THAN SATISFIED/ EXCELLENT ................. 1 SOMEWHAT DISSATISFIED .......... l GOOD ................. 2 NOT SATISFIED AT ALL ...... 4 FAIR/NORMAL ................. 3 POOR.. 4 SANITATION SERVICE: NEIGHBOR'S TOILET 49. How would you judge the nearest public latrine in 54. Are there households in this neighborhood/area terms of convenience? that use a neighbor's toilet or pit latrine as their EXCELLENT ....................... 1 main sanitation facility? GOOD .2 Li YES.1Li FAIR/NORMAL NO................. 3l YES 1...... POOR ........................... 4 NO ........... 2(>>64) DON'T KNOW ... 3(>>64) MODULE 5: HOUSEHOLD SANITATION: ATTITUDES AND PRACTICES MOST KNOWLEDGEABLE PERSON 55. How far is it from your house to the closest 60. How would you judge the neighbor's toilet that you neighbor that allows other households to use use in terms of Cleanliness? (Check all that apply) his/her toilet? EXCELLENT ............. 1 RECORD ONLY ONE METERS: L GOOD .........2 i ANSWER AS GIVEN ONE-WAY WALKING FAIR/NORMAL ........ 3 BY RESPONDENT DISTANCE (MINUTES): POOR ............. 4 56. Is there a charge/fee for using a neighbor's toilet? 61. How would you judge the neighbor's toilet that you use in terms of Convenience? (Check all that apply) YES . 1 1 NO. . 2(>>58) EXCELLENT. 1 DON'T KNOW ... .3(58) GOOD ............................ 2 FAIR/NORMAL ............ 3 POOR ...... 4 57. How much is the charge? TIME PERIOD 62. How would you judge the neighbor's toilet that you PER USE ..... 0 AMOUNT * use in terms of Reliability? (Check all that apply) DAY ........ 3 WEEK . 4 EXCELLENT ....................... 1 FORTNIGHT .OOD.2 to MONTNIH, ....... TIME PERIOD * GOOD ........................ 2.... 2 _ MONTH.6 TFAIR/NORN AL .....................3 3 POOR. 4 58. Do members of your household use a neighbor's toilet on a 63. Overall, how satisfied are you with using a regular basis? neighbor's toilet? YES. .1 YES . 1... 2 .64 VERY SATISFIED. 1 NO.. .2(>64) ...................... SOMEWHAT SATISFIED. 2 LESS THAN SATISFIED/r 59. About how many households use this neighbor's SOLEWHAT DISSATISFIED3 toilet on a regular basis? NOT SATISFIED AT ALL. 4 No. OF OTHER SANITATION PRACTICES HOUSEHOLDS: L 64. Do members of this household relieve themselves outside on a regular basis? YES ..1 NO .... 2(>>66) MODULE 5: HOUSEHOLD SANITATION: ATTITUDES AND PRACTICES MOST KNOWLEDGEABLE PERSON 65. Where do members of this household go to relieve themselves? RIVER/POND ...................1 SURFACE DRAIN .................. 2 FIELD ..................3......... VACANT LAND/LOT ................. 4 OTHER (SPECIFY) ______......5 SANITATION PLANS 66. Does your household have plans to improve or upgrade your current sanitation system/facilities during the next two years? YES ..1 NO .. 2(»FINISH WITH THE SANITATION OF QUESTIONNAIRE) o 67. How much money do you think your household will spend over the next two years improving/upgrading < your current sanitation facilities? MODULE 6A: FUEL SOURCES AND USES MOST KNOWLEDGABLE PERSON _ ~~~~~~~~~~1. Please tell me which is the main source of fuel for each of the following activities. If you use two or more kinds of fuel to carry out the task, please tell me which is the first most important source of fuel and the second most source of fuel for that task. SECONDARY SOURCE ................. FOR ANY SOURCE WITH A SEONAR SURE .........2 1 OR 2IN ANY COLUMN, ASK THE QUESTIONS INDICATED IN SECTION 6B. COOKING |LIGHTING HEAETING | SES 0_______ _-____ ____ o 1 I_Wood QUESTIONS 1-11 2 Dung QUESTIONS 12-20 Thatchqrass QUESTIONS 21-25 4 , 4 Charcoal . QUESTIONS 26-30 6_ Kerosene, petrol QUESTIONS 31-35 7 Bottled gas . QUESTIONS 36-40 _ Electricity ___ QUESTIONS 41-44 FUEL 6B: DETAIL ON FUEL BY SOURCE MOST KNOWLEDGEABLE PERSON BELOW ARE QUESTIONS ABOUT EACH OF THE SEVEN TYPES 5. How long does it take an adult to walk to the area where members OF FUEL LISTED ABOVE. ASK THE RESPONDENT THE of your household usually go to gather wood? QUESTIONS FOR EACH OF THE TYPES OF FUEL THAT THE OR MINUTES. 1 RESPONDENT INDICATED THAT THIS HOUSEHOLD USE FOR ONE WAY TRAVEL TIME =HURS . 2 SOME PURPOSE (AS EITHER A PRIMARY OR SECONDARY UNITS L FUEL). 6. Do you harvest/collect any of your fuel wood on your own private WOOD: (ASK ONLY IF RESPONDENT INDICATED THAT land (property)? HIS/HER HOUSEHOLD USES WOOD AS A FUEL) YES ..1 I NO .2(>>8) 7. What proportion of the fuel wood that your household uses do you 1. Just so I'm clear, for what purposes do you use wood as a fuel?haesfrmyuowlnd harvest from your own land? COOKING ........ 1 A A LIGHTING ........ 2 ll ALMOST ALLL1 ............... HEATING.3 MORE THAN HALF ..........2 OTHER ................. ABOUT HALF.3 LESS THAN HALF ... 4 VERY LITTLE.......... 5 2. Who collects wood for use as a fuel in your household? AULT HALES .......... 1 8. Does your household plant trees on your land for later use as fuel ADULT FEMALES ............... 2 I wood? CHILDREN ONLY ............... 3 YES ......................... .1 MALE AND FEMALE ADULTS ......4 NO........................... 2 FEMALE ADULTS AND CHILDREN ..5 HALE ADULTS AND CHILDREN ....6 9. About how many kilograms of fuel wood did your household use ALL MEMBERS OF HOUSEHOLD ....7 last week? KILOGRAMS PER WEEK 3. How much time do members of your household spend each week collecting fuel wood? 10. Do you ever purchase fuel wood? HOURS PER WEEK YES ...,.1...... 1 NO .2(12) 4. How far away from your house do members of your household usually have to go to gather fuel wood? 11. About how much money did your household spend last week purchasing fuel wood? ONE WAY DISTANCE L METERS.. CURRENCY PER WEEK UNITS KILOMETERS.2 FUEL 6B: DETAIL ON FUEL BY SOURCE MOST KNOWLEDGEABLE PERSON DUNG: (ASK ONLY IF RESPONDENT INDICATED THAT 16. How long does it take an adult to walk to the area where HIS/HER HOUSEHOLD USES DUNG AS A FUEL) members of your household usually go to gather dung? 12. Just so I'm clear, for what purposes does your household use dung as a fuel? ONE WAY TRAVEL TIME I MINUTES UNITS jj OURS . COOKING ...... I7 LIGHTING ..... 2 17. About how many kilograms of dung did your household use for HEATING ...... 3 fuel last week? OTHER ........ 4 KILOGRAMS PER WEEK Z 13. Who collects dung for use as a fuel in your household? 18. Do you collect dung from your own animals or others' animals? ADULT MALES ................. 1 OWN ANIMALS ONLY ...............W MbIEXT ADULT FEMALES ............... 2 OWN ANIMALS AND OTHERS' ANIMALS.2 CHILDREN ONLY ............... 3 OTHERS' ANIMALS ONLY. 3 MALE AND FEMALE ADULTS ......4 FEMALE ADULTS AND CHILDREN ..5 MALE ADULTS AND CHILDREN .. 6 19. Do you ever pay for dung? ALL MEMBERS OF HOUSEHOLD .... 7>1 N...2. 11 14. How much time do members of your household spend each week collecting dung? 20. About how much money did your household spend last week HOURS PER WEEK purchasing dung? CNCY PER WEEK 15. How far away from your house do members of your household usually have to go to gather dung? ONE WAY DISTANCE I METERS ................1 UNITS JKILOMETERS ........ 2 FUEL 6B: DETAIL ON FUEL BY SOURCE MOST KNOWLEDGEABLE PERSON THATCH/GRASS: (ASK ONLY IF RESPONDENT INDICATED CHARCOAL: (ASK ONLY IF RESPONDENT INDICATED THAT THAT HIS/HER HOUSEHOLD USES THATCH/GRASS AS A FUEL) HIS/HER HOUSEHOLD USES CHARCOAL AS A FUEL) 21. Just so I'm clear, for what purpose do you use thatch/grass as a 26. Just so I'm clear, for what purposes do you use charcoal as a fuel? fuel? COOKING ......... 1 COOKING ......1 LIGHTING ......... 2 LIGHTING ....2 HEATING ........ ............. 3 HEATING..3 OTHER ....................... 4 OTHER ...... 4 22. Who collects thatch/grass for use as a fuel in your household? 27. How far away from your house do members of your household usually have to go to purchase charcoal? ADULT MALES .1 l. ADULT FEMALES .2 ONE WAY DISTANCE = METERS . 1 CHILDREN ONLY 3 UNITS KILOMETERS 2 MALE AND FEMALE ADULTS. 4 FEMALE ADULTS AND CHILDREN. .5 VENDOR DELIVERS TO HOUSE(>>29) MALE ADULTS AND CHILDREN.... 6 ALL MEMBERS OF HOUSEHOLD .. 7 28. How long does it take an adult to walk to the area where O 23. How much time do members of your household spend each week members of your household usually go to purchase charcoal? collecting thatch/grass? HOURS PER WEEK |'l HOUR PER WEEK ONE WAY TRAVEL TIME w MINUTES ....... 1 24. How far away from your house do members of your household UNITS lHOURS. 2 usually have to go to gather thatch/grass? ONE WAY DISTANCE EILOMETERS .. 29. About how many kilograms of charcoal did your household use UNITS KILOM TE~S~~~. 2j last week? KILOGRAMS PER WEEK 25. How long does it take an adult to walk to the area where members of your household usually go to gather thatch/grass? 30. About how much money did your household spend last week ONE WAY TRAVEL TIME LMINUTES 2 purchasing charcoal? UNITS HOURS 2.CURRENCY PER WEEK] FUEL 6B: DETAIL ON FUEL BY SOURCE MOST KNOWLEDGEABLE PERSON KEROSENE/PETROL: (ASK ONLY IF RESPONDENT BOTTLED GAS: (ASK ONLY IF RESPONDENT INDICATED INDICATED THAT HIS/HER HOUSEHOLD USES THAT HIS/HER HOUSEHOLD USES BOTTLED GAS AS A FUEL) KEROSENE/PETROL AS A FUEL) 36. For what purposes do you use boHtled gas as a fuel? 31. Just so I'm clear, for what purposes do you use kerosene/petrol as a fuel? COOKING ...... 1 COOKING . 1 IILIGHTING 2 LIGHTING . 2 HEATING . 3 HEATING 3 OTHER . 4 OTHER . 4 37. How far away from your house do members of your household 32. How far away from your house do members of your household usually have to go to purchase bottled gas? usually have to go to purchase kerosene/petrol? IS METERS .....1.I [ | METERS ........ 1 ONE WAY DISTANCE KILOMETERS .2 ONE WAY DISTANCE I I KLOMETERS:::::2 UNITS UNITS K VENDOR DELIVERS TO HOUSE (-34) VENDOR DELIVERS TO HOUSE (,>39) 38. How long does it take an adult to walk to the area where 33. How long does it take an adult to walk to the place where members of your household usually go to purchase bottled gas? -4 members of your household usually go to purchase kerosene/petrol? lI l kerosene|petrol? ONE WAY TRAVEL TIME t MINUTES ... 1 ONE WAY TRAVEL TIME HO MINUTES ... 1 UNITS m HOURS . 2 UNITS HOURS. 2 39. About how many liters of bottled gas did your household use last 34. About how many liters of kerosene/petrol did your household use week? last week for cooking, heating, and lighting (not transportation)? LITERS PER WEEK LITERS PER WEEK 40. About how much money does your household spend per week purchasing bottled gas? 35. About how much money did your household spend last week CURRENCY PER WEEK purchasing kerosene/petrol? CURRENCY PER WEEK FUEL 6B: DETAIL ON FUEL BY SOURCE MOST KNOWLEDGEABLE PERSON ELECTRICITY: (ASK ONLY IF RESPONDENT INDICATED THAT HIS/HER HOUSEHOLD USES ELECTRICITY AS A FUEL) (NOTE TO READER: QUESTIONS ABOUT ELECTRICITY BILL ARE IN HOUSING MODULE AND ARE NOT REPEATED HERE.) 41. When did you have an electricity connection installed in your house? YE NUMBER OF YEARS 42. How much did you pay for the electricity connection at that time? ON-TINE CONNECTION FEE CHARGED BY I ELECTRIC UTILITY COST TO HOUSEHOLD FOR MAKING THE CONNECTION TOTAL 0 43. Did you pay the one-time connection fee over time (i.e., finance the connection fee)? YES..1 NO.. .2 44. Just so I'm clear, for what purposes do you use electricity as a fuel? COOKING ...... 1 LIGHTING ..... 2 HEATING ...... 3 OTHER ........ 4 MODULE 6C: STOVES MOST KNOWLEDGABLE MEMBER 1. Does your household ever use a stove, lanterns, or hotplates to burn any of the fuels used by your household? YES. . .1 )) FILL OUT STOVES GRID [ 7 NO ...2» ) NEXT MODULE ___________ 2. 3. 4. 5. Please describe all the stoves, What fuel do you burn in this How much would How long do you lanterns and hotplates used by your appliance? If you burn more this ..[lTEM .. ]cost expect an household. List first the one of each than one,fuel, please mention all if you purchased it ... [ITEM]... like item that you use most often. fuels that you burn in this item, today? that to last? starting with the most important. WOOD ................. 1 COMPLETE THE LIST. DUNG ................. 2 THEN ASK QUESTIONS 2-4 THATCH, GRASS ................3 FOR EACH ITEM. CHARCOAL ................. 4 KEROSENE, PETROL ......... 5 BOTTLED GAS .................6 ELECTRICITY .................7 NAME OF STOVE 1ST 2NI) 3RD AMOUNT YEARS STOVES - - - I _. lI 2 3 4 |LANTERNS |_l_l_l_l_ l 7 HOTPLATES 9 10 11 12 MODULE 7: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED WATER SERVICE - AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO (URBAN) A modern urban water supply system such as exists in most connection would remain the same as it is today, or about $x. cities in the United States and Europe has several characteristics. Suppose that a vote were held in [NAME OF CITY] regarding Households have metered private connections, and they pay only for a project to build a modern water system here. If the price of water the water they actually use. Service is available 24 hours per day, from the new system were [Pi, P2, P3, p4, p5]2 per cubic meter, 365 days per year, with good pressure. The water is safe to drink would you vote for the new water supply project, or against it? directly from the tap; there is no need to treat the water before drinking it. Such a system does not exist in [NAME OF CITY] yet. Many 1. VOTE FOR A MODERN WATER households only have water for a few hours each day. Sometimes SUPPLY SYSTEM ........... 1 the water supply system breaks down, and some people do not have VOTE AGAINST ........... 2 service for several days. Many people in [NAME OF CITY] treat their DON'T KNOW ........... 3 water before they drink it. Today the typical household in [NAME OF CITY] has to pay Now, suppose that the improved water supply system were installed between $x and $y per cubic meter for the water they use, if they in [NAME OF TOWN]. Would your household want to be connected have a metered connection. The average household water bill is to this system if the price of water from the new system were one of about $z per month. [PI, P2, P3, P4, p5] per cubic meter, or would you make other Suppose that your family could have the type of water arrangements for obtaining your water supply? service I have just described. Water would be available 24 hours a day, 365 days a year, with sufficient pressure. It would be safe to 2. CONNECT TO (STAY CONNECTED) TO drink this water directly from the tap without any treatment. NEW WATER SYSTEM.1 Suppose that the price of water from this improved system DO NOT WANT RRANGEMENTSE 2 were [Pl, P2, P3, P4, P5] per cubic meter. Because you would pay for DON'T KNOW. 3 the amount of water you actually used, your water bill could vary from month to month. But, suppose that in a typical month an average household would use about 15 cubic meters of water and a receive a bill for [15p1 , 1512 115p3 ,115p4 ,15p5].1 The price of a water I The household would be asked about only one price in this question. Which price is asked about is determiined by which part of the split sample the household was assigned to. The assignments are random so that each split of the sample is a random subset of the whole. These questions depend on a head of household or spouse knowing how many cubic meters they use. In fact, in many developing countries households that have private metered connections do know much more about their water usage than households in industrialized countries. However, the LSMS survey designer will need to ensure that this assumption is generally valid in the country where the survey will be 2 An individual respondent would only receive one of these five prices. conducted. Which price a respondent received would be randomly assigned. MODULE 8: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED WATER SERVICE - AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO (RURAL - PUBLIC TAPS ONLY) I want to describe to you some of the kinds of improved The money collected would be used to pay for the operation water services that could be build in [NAME OF TOWN]. I will then and maintenance of the water system and the salary of the attendant. ask you several questions about what water services your household For example, there will be fuel costs to pump the water to [NAME OF would like if they were available at different prices. It is important that CITY] and costs of repairing the pipeline and pumping station. Each you give us honest answers. If you tell us a lower price than you can household would be free to decide for itself whether to purchase really afford, a system could be designed that you do not really want. water from the public tap or to continue using springs or water On the other hand, if you tell us a higher price than you can really vendors. afford, then a system could be designed that is too expensive to operate. In this case the system would be likely to fail because the 1. Suppose the community decided to adopt this way of paying people cannot afford to pay for the operation and maintenance. So for water from the public taps and that the monthly fee was one of please answer these questions as truthfully as you can. [$xI, $x2, $x3, $x4, $x5]1 per month. Would your household decide to pay the monthly fee and use the public taps, or would you decide to Public taps continue using vendors and/or springs? Remember that if you are now buying water from vendors, that you would probably spend more Suppose that a water pipeline were installed in your time collecting water from the public tap than if you continue to buy neighborhood, and that there were several public taps where people from vendors. like you could go to collect water. A public tap could have one or more water outlets or faucets where people could come to fill PAY THE MONTHLY FEE AND USE THE jerricans. PUBLIC TAPS .................. 1 NOT PAY THE MONTHLY FEE AND - [SHOW RESPONDENT PICTURES AND DIAGRAMS OF PUBLIC CONTINUE USING VENDORS AND/OR TAPS] SPRINGS......................2 DON'T MNOW / NOT SURE . 3 I want you to assume that a public water tap would be near your home. No one would have to walk more than 3 minutes to reach one 2. Suppose that instead of [$x,, $x2, $X3, $x4, $x5] per month, of these public taps--everyone in the neighborhood would have a the monthly fee was one of [$X1, $x2, $x3, $x4, $x5] per month. Would public tap within 100 meters of their house. Assume that the water your household decide to pay the monthly fee and use the public was reliable and of good quality, and that the public taps would be taps, or would you decide to continue using its vendors or springs? open from 7:00 am until 7:00 p.m. in the evening. PAY THE MONTHLY FEE AND USE THE Public taps: monthly fee PUBLIC TAPS ........ 1 NOT PAY THE MONTHLY FEE AND One way people may decide to pay for water from public taps is for CONTINUE USING VENDORS AND/OR every household that wanted to collect water from the public tap to SPRINGS. .;.NOT .SU. 2 pay a monthly fee. In this case there would be a public tap attendant DON'T KNOW / NOT SURE . 3 that would check to make sure that everyone that collected water had paid their monthly fee. One advantage of this payment system is that once a household has paid the monthly fee to the attendant, members from the household could collect as much water as they 1 The household would be asked about only one price in this question. wanted from the public tap for no additional charge. Which price is asked about is deternined by which part of the split sample the household was assigned to. The assignments are random so that each split of the sample is a random subset of the whole. MODULE 8: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED WATER SERVICE - AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO (RURAL - PUBLIC TAPS ONLY) 3. What is the most you would be willing to pay per month BUY WATER FROM THE PUBLIC TAPS ..1 to use the public taps ? BUY SOME WATER FROM PUBLIC TAPS AND COLLECT SOME WATER MAX WTP PER MONTH FOR PUBLIC TAPS i FROM SPRINGS ................... 2 NOT BUY WATER FROM PUBLIC TAP Public taps: pay-by-the-bucket AND CONTINUE USING VENDORS AND/OR SPRINGS ................. 3(>8) There is another way for people to pay for water from public DON'T KNOW / NOT SURE ........... 4 (>>8) taps. This is for the public tap attendant to charge for each jerrican 7. At this price, how many jerricans do you think your household collected. This system is more like buying water from a vendor. would buy per day in the dry season? in the rainy season? When you pay the attendant, you can collect water. If you don't want water from the public tap that day, you don't have to pay. NUMBER OF JERRICANS IN THE DRY SEASON: 4. Suppose that the price of water per jerrican at the public tap NUMBER OF JERRICANS IN THE RAINY SEASON: m was [pi, P2, P3, P4, P51. Would your household decide to buy water from the public taps, or would you decide to continue using vendors 8. What is the most you would be willing to pay per month to and/or springs? use the public taps if a pay-by-the-jerrican system was used and the price per jerrican was [PI, P2, P3, P4, ps]? BUY WATER FROM THE PUBLIC TAPS..1 BUY SOME WATER FROM PUBLIC MAX WTP PER MONTH FOR PUBLIC TAPS L TAPS AND COLLECT SOME WATER FROM SPRINGS ................. 2 [ . Public taps: Pay-by-the-bucket vs. Monthly fee NOT BUY WATER FROM PUBLIC TAP AND CONTINUE USING VENDORS 9. Both these systems of paying for water--fixed monthly fee AND/OR SPRINGS ................. 3(>6) and pay-by-the-jerrican-- are used successfully in many countries to DON'T KNOW / NOT SURE ........... 4(>>6) raise money for piped water systems. Suppose the community decided to vote on whether to pay for water from the public taps by a 5. At this price, how many jerricans do you think your household fixed monthly fee or to charge for every jerrican collected. Suppose would buy per day in the dry season? in the rainy season? that the monthly cost to your household would be the same under the pay-by-the-jerrican system and the fixed monthly fee system. In NUMBER OF JERRICANS IN THE DRY SEASON: L other words, you would spend the same amount of money each DON'T KNOW / NOT SURE: month on average. NUMBER OF JERRICANS IN THE RAINY SEASON: In this case which payment system would you choose? DON'T KNOW / NOT SURE: PAY-BY-THE-JERRICAN .............1 FIXED MONTHLY FEE ...............2 DON'T KNOW ...................... 3 6. Suppose that instead of [Pl, P2, P3, P4, ps] per jerrican, the price was [pi, P2, P3, p4, p5]. per jerrican. Would your household decide to buy water from the public taps, or would you decide to continue using vendors and/or springs? MODULE 9: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED SANITATION: AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO FOR SEWER CONNECTION (URBAN) 1. CHECK HOUSEHOLD IDENTIFICATION PAGE. people obtain from wells might thus improve. IS HOUSEHOLD RURAL OR URBAN? Wastewater from large industries would not be put into this sewer system. Most large industries would have to treat their waste URBAN ............. [ water separately. Also, it is important to understand that a sewer RURAL .. 2(>>NEXT MODULE) system would not carry away drainage water from rains or eliminate flooding problems. 2. CHECK HOUSEHOLD SANITATION MODULE, QUESTION 4. DOES HOUSEHOLD HAVE A WATER-SEALED TOILET? 3. How familiar were you with a sewer system before I came here and described it to you? YES ............... 1 NO . 2(>>NEXT MODULE) VERY FAMILIAR ................... 1 SOMEWHAT FAMILIAR ............... 2 PART A: NOT AT ALL FAMILIAR. 3 Most cities in industrialized (high-income) countries use the same The second part of a sanitation system is a waste water kind of sanitation system to remove human wastes from the city and treatment plant. The sewer pipes in town would join together and to protect the public health of their people. This kind of sanitation carry the waste water to the "waste water treatment plant" where it system has two parts: a sewer system and a waste water treatment would be cleaned. There are different ways of treating the waste plant. I'd like to take a few minutes and explain these two parts of a water collected in the sewer pipes. One kind of treatment plant w sanitation system to you. would look like a factory with a pond next to it and would purify the A sewer system is a network of pipes underground that is water. The water from the treatment plant could then be discharged used to carry human wastes and waste water, as well as waste water safely into a lake, river, or ocean. from commercial establishments and small industries, away from a neighborhood such as this and out of town. The sewer pipes are In most industrialized countries, cities built their sewer usually placed underground along streets and lanes. The attached system first and then later, when they could afford it, they built the figure illustrates how a system of sewer pipes would work. treatment plant. This staged approach improved public health If a household's toilet or septic tank is connected to the conditions in the cities because it removed the human waste from sewer pipe, the waste water from the house would flow into the pipe. town. However, the rivers and lakes were often badly polluted by the Kitchen water and waste water from bathing and the laundry could discharge of untreated waste water from the cities. also be discharged to the sewer. Both pour-flush toilets with septic tanks and flush toilets emptying into holding tanks could be If a sewer system with a treatment plant were built here, the connected to a sewer pipe. However, no animal wastes or garbage citizens of [NAME OF CITY] would obtain three kinds of benefits: should be put into the sewer. If a house connected to a sewer pipe, the waste water from the house would flow into the sewer pipe. In First, the public health and environmental conditions in [name of city] this case the household would not have to empty its septic tank, or would be improved because human excreta, kitchen, and bath water build a new septic tank when the old one is full. Because human would not be spread so easily around your neighborhood and other excreta would be collected and carried away, there would be less parts of town. chance of contamination of ground water. The quality of water Second, commercial waste water and waste water from some small MODULE 9: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED SANITATION: AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO FOR SEWER CONNECTION (URBAN) industries could be discharged to the sewer and treated at the sewer line so that the waste water from your house (including the treatment plant. This would reduce some of the harmful waste from the toilet, bath, and kitchen) would be discharged into this environmental effects of commercial and industrial water pollution. sewer pipe. If your household decided to connect to the sewer line then you would have to pay a monthly fee, just like a water bill. For Third, the quality of water people obtain from wells might improve example, for those households with a private water connection, this because there would be less chance of contamination of ground monthly fee would be included on their water bill. If you missed a water. payment one month, then the following month you would have to make two payments. Let's assume that the water or sanitation 4. How familiar were you with a wastewater treatment plant authority would not charge a fee to connect your house to the sewer before I came here and described it to you? pipe and that the costs of replumbing your existing toilet to connect to the sewer line could be paid over time on your monthly bill. VERY FAMILIAR . ..1 SOMEWHAT FAMILIAR . .. 2 Also assume that the majority of the other households in your NOT AT ALL FAMILIAR .......... 3 neighborhood with water-sealed toilets decided to connect to the sewer line. Valuation Questions 5. CHECK WHICH PART OF THE SPLIT SAMPLE THE I now want to ask you some questions about how much you HOUSEHOLD BELONGS TO. would be willing to pay to connect your house to a new sewer system and treatment plant in [NAME OF TOWN]. It is important to us that PART 1 ............1(PART B1) you think carefully about this and try to give realistic answers. Please PART 2 ... 2("PART B2) do not just agree to pay if you cannot afford it or if you feel you have PART 3 ... 3(>PART B3) other, more important things to spend your money on. It will hurt our PART 4 ... 4(>>PART B4) study if you agree to pay more than you are really willing to and then PART 5............... 5(>PART B5) later change your mind. Suppose that this sewer system was installed throughout [name of town], and a sewer pipe ran near your house. I want you to assume that it was decided that the project would have both parts of a sanitation system: a) underground sewer pipes, and b) a waste water treatment plant for [NAME OF TOWN]. In other words, the waste water would be collected from your neighborhood in a system of underground pipes, and then it would be treated before it was discharged. Suppose that it was possible to connect your house to this MODULE 9: HOUSEHOLDS' WLLINGNESS TO PAY FOR IMPROVED SANITATION: AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO FOR SEWER CONNECTION (URBAN) - SPLIT SAMPLE WITH INITIAL PRICE p 1 and P2- PART B1: Starting at P, PART B2: Starting at 02. 6. If the monthly fee to be connected to the sewer line was pi1, 6. If the monthly fee to be connected to the sewer line was P2, would you want to connect to the sewer line, or would you prefer not would you want to connect to the sewer line, or would you prefer not to be connected? to be connected? YES .......................... YES.1...................... I NO ......................... 2(>9) NO ........................... 2(>>9) 7. Suppose that the engineers designing the project confronted 7. Suppose that the engineers designing the project confronted some unexpected technical problems, and that instead of pl, the some unexpected technical problems, and that instead of P2, the monthly fee was p5. In this case would you want to connect to the monthly fee was p5. In this case would you want to connect to the sewer line, or would you prefer not to connect? sewer line, or would you prefer not to connect? YES ......................... (i>Part C,14) I YES .(>Part C,14) 0 NO ........................... 2 NO ........................... 2 8. Suppose that instead of p5 the monthly fee was p3. In this case 8. Suppose that instead of p5 the monthly fee was p3. In this case would you want to connect to the sewer line, or would you prefer not would you want to connect to the sewer line, or would you prefer not W to connect? to connect? VI YES ......................... (i>Part C,14) YES .(.Part C,14) NO ........................ 2(>Part C,11) NO .2(>>Part C,11) 9. Suppose that instead of p, the monthly fee was [15 pesos.] In this 9. Suppose that instead of P2 the monthly fee was pi. In this case case would you want to connect to the sewer line, or would you prefer would you want to connect to the sewer line, or would you prefer not not to connect? to connect? YES ......................... (i>Part C,14) YES .(>Part C,14) m NO ........................ 2(>Part C,11) NO. 2 10. Suppose that instead of pi the monthly fee was 15 pesos. In this case would you want to connect to the sewer line, or would you prefer not to connect? YES .(.Part C,14) NO .2(Part C,11) 1 In all cases these skip pattems assume that PI9) NO ........................... 2(>9) 7. Suppose that the engineers designing the project confronted 7. Suppose that the engineers designing the project confronted some unexpected technical problems, and that instead of p3, the some unexpected technical problems, and that instead of p4, the monthly fee was p5. In this case would you want to connect to the monthly fee was p5. In this case would you want to connect to the sewer line, or would you prefer not to connect? sewer line, or would you prefer not to connect? YES ...... .(.>Part C,14) 0 YES ...... 1(>Part C,14) 0 NO ..... 2 NO ...... 2 8. Suppose that instead of p5 the monthly fee was p4. In this case 8. Suppose that instead of p5 the monthly fee was 175 pesos. In would you want to connect to the sewer line, or would you prefer not this case would you want to connect to the sewer line, or would you to connect? prefer not to connect? a, YEs 1(>Part C,14) YES .(.>Part C,14) NO .2(>>Part C,11) NO 2..(Part C,1l) 9. Suppose that instead of p3 the monthly fee was P2. In this case 9. Suppose that instead of p4 the monthly fee was p3. In this case would you want to connect to the sewer line, or would you prefer not would you want to connect to the sewer line, or would you prefer not to connect? to connect? YES .(.Part C,14) 0 YES .(>>Part C,14) 0 NO ........................... 2 NO ...... ......... .. 2 10. Suppose that instead of P2 the monthly fee was pi. In this case 10. Suppose that instead of p3 the monthly fee was P2. In this case would you want to connect to the sewer line, or would you prefer not would you want to connect to the sewer line, or would you prefer not to connect? to connect? YES ...... .(.>Part C,14) YES .1(>>part C,14) NO ..... 2(>>Part C,11) NO .2(»Part C,11) MODULE 9: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED SANITATION: AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO FOR SEWER CONNECTION (URBAN) - SPLIT SAMPLE WITH INITIAL PRICE p5. PART B5: Starting at PE5 6. If the monthly fee to be connected to the sewer line was p5, would you want to connect to the sewer line, or would you prefer not to be connected? YES ...(.>Part C,14) NO ..2 7. Suppose that the engineers designing the project confronted some unexpected technical problems, and that instead of p5, the monthly fee was p3. In this case would you want to connect to the sewer line, or would you prefer not to connect? YES . l(>Part C,14) NO ..2 8. Suppose that instead of p3 the monthly fee was P2. In this case would you want to connect to the sewer line, or would you prefer not to connect? YES . 1(>>Part C,14) NO . 2(>>Part C,11) MODULE 9: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED SANITATION: AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO FOR SEWER CONNECTION (URBAN) PART C: 11. What is the most you would be willing to pay per month to be connected to the sewer line? MAXIMUM AMOUNT PER MONTH 12. DID THE RESPONDENT INDICATE THAT HE/SHE WOULD BE WILLING TO PAY ANYTHING ? YES (GAVE A POSITIVE AMOUNT) .... 1(>14) NO (GAVE ZERO AMOUNT) ................ 2 13. There are several reasons why someone might not be willing to pay anything to connect to a sewer line. Could you please explain the reasons why you are not willing to pay? DON'T HAVE ANY MONEY; CANNOT AFFORD ................... 1 SATISFIED WITH THE EXISTING SITUATION ....................... 2 GOVERNMENT'S RESPONSIBILITY ......3 X0 INDUSTRIES' RESPONSIBILITY ....... 4 RE PLUMBING COST IS TOO HIGH .....5 OTHER (SPECIFY) ___....... 6 | >>» NEXT MODULE | 14. There are several reasons why someone might agree to connect to a sewer line. What was the most important reason why you agreed to pay? TO REDUCE RISK OF DRINKING CONTAMINATED WATER .............. 1 TO REDUCE SMELL AND IMPROVE APPEARANCE OF NEIGHBORHOOD ......2 TO IMPROVE QUALITY OF SURFACE WATER. 3 OTHER. 4 MODULE 9: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED SANITATION: AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO FOR SEWER CONNECTION (URBAN) 15. [CHECK TO SEE THE HIGHEST AMOUNT THE RESPONDENT INDICATED HE/SHE WAS WILLING TO PAY PER MONTH MAX. WILLINGNESS-TO-PAY PER MONTH: m 16. You indicated that your household would be willing to pay [MAX. WTP AMOUNT] per month to have your house connected to a sewer line. On which of the following items do you think your household would reduce its expenditures in order to be able to afford to pay this amount? FOOD ................. 1 TRANSPORT ................. 2 ENTERTAINMENT ..................3 3 CLOTHING ................. 4 MEDICINE ................. 5 LESS SAVINGS ................. 6 OTHER (SPECIFY) .......7 17. Do you think it is realistic that you could reduce your expenditure(s) on these items by this amount [MAX. WTP] every month in order to pay for a connection to a sewer line? YES.. .1(>NEXT MODULE) L No ....2 18. What do you think is a more realistic amount that you could actually afford every month for a connection to a sewer pipe? REVISED AMOUNT PER MONTH: MODULE 10: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED URBAN AIR QUALITY - AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO 1. CHECK HOUSEHOLD IDENTIFICATION PAGE. about x times higher in [NAME OF CITY] than in the average city in IS HOUSEHOLD IN A LARGE URBAN AREA? Western Europe. The concentration of sulfur dioxide in [NAME OF CITY] is about y times higher than in most cities in the developed URBAN ............. L countries, such as New York or London. However, air quality in cities RURAL ...2 (>>NEXT MODULE) such as Bangkok, New Delhi, and Mexico City is much worse than in [NAME OF CITY]. Background Scientists have proved that the current quality of air in [NAME OF CITY] is a serious threat to people's health. Air pollution There are many contaminants in the air in [NAME OF CITY], causes some discomfort in almost everyone, including such things as including toxic gases, chemically contaminated dust, automobile watering eyes, chest pain, coughing, sneezing, and shortness of emissions, and particulates (like smoke and dust). These breath. Air pollutants can cause or worsen a wide range of contaminants come from several main sources: respiratory illnesses, including: [SHOW RESPONDENT THIS LIST OR READ THE ITEMS ON THIS 1. chronic bronchitis (chest infections) LIST TO RESPONDENTS] 2. asthma 3. emphysema 1. steel and chemical plants 4. colds 2. electric power plants 3. small scale businesses and enterprises using inefficient coal Air pollution also increases the risk of lung cancer. Scientists w heating systems estimate that about x people die every year in [NAME OF CITY] from 0 4. private automobiles, taxis, and buses, and health problems and diseases related to air pollution, but it is difficult 5. household coal furnaces. to estimate precisely. The air quality in some districts in [NAME OF CITY] is worse than in Besides these health-related effects, air pollution reduces others. The center of the city and industrial areas have the highest visibility, and increases the economic costs to maintain buildings, and levels of most pollutants, largely because of the high traffic, increases cleaning costs of clothes, cars, and buildings. Air pollution concentrations of people, and wind patterns. This map shows very also causes stress on trees and other plants. roughly where air quality in [NAME OF CITY] is the worst. [SHOW RESPONDENT MAP] The air quality in [name of city] is the worst in Air Pollution Clean-Up Plan the winter when the air pollutants become trapped in the city by low clouds and poor weather. Thus, in the winter, the chances of an Suppose that the national government and the municipality of inversion are much higher. The winter is also the season when [NAME OF CITY] were considering a series of policies and projects people are burning coal for heating. designed to improve the air quality in the city. Suppose these actions included: The air quality in [NAME OF CITY] is worse than in many other cities. This table compares the concentration of total [SHOW RESPONDENT THE FOLLOWING LIST] particulates and sulfur dioxide in [NAME OF CITY] with levels in cities in the United States and Western Europe. [SHOW RESPONDENT 1. Installation of advanced air pollution abatement technologies on TABLE], For example the average number of particulates in the air is industrial facilities and power plants; MODULE 10: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED URBAN AIR QUALITY - AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO 2. Program to convert gas stations to also sell unleaded gasoline; price of unleaded gasoline might increase. The price of home 3. Replace old smoky buses with modern buses; heating would be higher, and the price of electricity might increase to 4. Connect the majority of households to central heating system so help pay for pollution abatement equipment on power plants. that they no longer have to use coal; this would reduce emissions of SO2 and particulates. Willinqness-to-Pav Question (Referendum elicitation procedure) Consequences of Air Pollution Clean-up Plan I want you to suppose that in total all of these price increases that would be needed to implement the air pollution abatement plan Suppose that if all these clean-up actions were completed, for [NAME OF CITY] would cost your household [Pl, P2, P3, p4, p511 the concentration of most air pollutants in [NAME OF CITY] would be per month. I want you to imagine that the people of [NAME OF CITY] a reduced by approximatelyx %. had an opportunity to vote on this air quality clean-up plan. If the majority of people voted for the plan, the plan would go into effect This reduction in air pollution would reduce: and every household would have to pay. If the majority of people voted against the plan, no one would have to pay and the air pollution 1. chronic bronchitis would stay as it is now. 2. asthma 3. emphysema Some people have told us they would support the plan and 4. colds pay this amount because cleaning up air pollution is a high priority for them. Others say they would vote against the plan because they Suppose that scientists estimated that this reduction in air have many other things to spend their money on, and cleaning up air pollution would save about y lives per year in [NAME OF CITY], quality will have to wait until the economy is stronger. Other benefits would include improved visibility, reduced There is no right or wrong answer; we really want to know damages to buildings, and reduced cleaning costs. how you would vote on this proposal. Costs of the Air Pollution Clean-up Plan 2. WRITE THE AMOUNT OF MONEY (See Footnote 1) m If the national government and the municipality decided to TO BE ASKED. implement this plan, it would be costly for all the sources of pollution: industries, transport, and households. Industries would be required to invest in air pollution abatement technology and Government would provide moneys for implementing some parts of the plan. Households such as yours would also have to pay for some of the costs of implementing this plan. You can think of these costs as an increase in the cost of living because your household would pay them in a variety of ways. For example, the costs of transport tickets might have to increase to pay for eco-friendly buses. The 1 The household would be asked about only one amount. Which amount is asked about is determined by which part of the split sample the household was assigned to. The assignments are random so that each split of the sample is a random subset of the whole. MODULE 10: HOUSEHOLDS' WILLINGNESS TO PAY FOR IMPROVED URBAN AIR QUALITY - AN EXAMPLE OF A CONTINGENT VALUATION SCENARIO 3. If this air pollution clean-up plan cost households like yours [pi, P2, P3, P4, P51 per month, would you vote for the plan or against it? [Show the respondent the following choices] YES (FOR THE AIR POLLUTION CLEAN-UP m PLAN)..1................. NO (AGAINST THE AIR POLLUTION CLEAN-UP PLAN) . ..2 NOT SURE/DON'T KNOW ............... 3 4. How certain / sure are you of your answer? +3 +2 +1 0 -1 -2 -3 Very Very Certain unsure 5.* What is the main reason you voted [FOR / AGAINST] the air quality improvement plan? 6. What is the most your household would be willingness to pay per month for the air quality improvement plan, assuming that other households in [NAME OF CITY] also paid their fair share? MAX WTP $ PER MONTH: 7. What else would you like to know to enable you to make a better decision on whether to vote for or against the air quality improvement program? (i.e., what additional information would you like to have) *If pre-coded answers can be substituted for these open-ended questions, the lengthy and expensive chore of ex-post coding can be avoided. Pre- coding responses to such questions is usual practice in LSMS surveys. MODULE 11: QUESTION DESIGNED TO ELICIT RESPONDENT'S RATE OF TIME PREFERENCE Choice between environmental improvement programs. Some kinds of reduction in pollution save lives immediately, while others save lives farther into the future. For example, a program to reduce cancer-causing chemicals in the air may reduce cancer deaths several years in the future, but not have an immediate effect on cancer rates. Suppose that the Ministry of Environment were considering two hypothetical environmental pollution clean-up programs. Suppose that the two programs cost the same but that there was only enough money for one of these programs to be implemented here. I want to ask you which one of these programs you would choose, or which one you would vote for. Program A would save 100 lives this year Program B would save [50 /200 / 500 /1000] lives in [2 1 5 / 10 / 20] years. 1. Which of the two programs would you vote for? PROGRAM A............ 1 PROGRAM B. Module for Chapter 15 Fertility Indu Bhushan and Raylynn Oliver The fertility module is presented in the following pages. As Whether the standard or the short module is chosen, explained in Chapter 15 of Volume 2, there are two ver- there are benefits to conmpleting this module for each sions, a short version and a standard version. The standard woman of child-bearing age in the household. This implies version is organized in three sections: maternity history, that the module should be repeated at least two or three reproductive health, and contraceptive use. The short ver- times in a single household questionnaire. For further dis- sion omits the questions about breastfeeding and abortion cussion see Chapter 15. and the detailed questions on methods of contraception. 325 PART A: MATERNITY HISTORY (SHORT FERTILITY MODULE) WOMEN BETWEEN AGE 15 AND AGE 49 Now I will like to talk to you about each of the births you 4. Have you ever been pregnant? YES . 1 (>6) have had, whether the child is still alive or not, starting NO.. . 2 with the first birth you had. 5. Was there a pregnancy that lasted only a few weeks or months? YES . 1 1. WRITE DOWN THE ID CODE OF THE WOMAN. ID CODE: lIl NO .. 22(>26) 2. IS THIS PERSON ANSWERING FOR HERSELF? YES 1(>,4) 6. Have you ever given birth to a child? YES . 1 (>>8) [ NO 2 NO . 2 3. WRITE ID CODE OF PERSON ACTUALLY 7. Have you had any baby who cried or showed any YES. . 1 INTERVIEWED ID CODE: L J sign of life? NO ... 2(>>26) 8. 9. 10. 11. 12. 13. 14 15. 16. 17. 18. B What name Was Is [NAME] a When was [NAME] Is [NAME] How long did the child Does WRITE What is the Have you Are you sure I was given [NAME] boy or a born? still alive? live? [NAME] [NAME'S] highest level of given birth that you have R to your born single girl? IF "1 YEAR" PROBE: currently ID CODE schooling that to any never had any T [first, next] or as twin How many months old live in your FROM [NAME] has/had other other children H child? triplet, etc. was [NAME]? household? HOUSE- completed? children? than the ones I ~~~~~~~IF NOT KNOWN, RECORD DAYS IF LESS HOLD we have already D ESTIMATE USING THEI 1 E USN ROSTER. talked about? SUPPLEMENTARY RECORD MONTHS IF CDSFO CALENDAR LESS THAN TWOEDCTOYS.1 YEARS. MOYL ESS1_1) O' SINGLE.1 BOY.. 1 YES. .1 | > 16 YES. .1 (>>NEXT NO. ..2 MULT ... 2 GIRL ..... 2 (,14) NO. 2 [E CHILD) (>>NEXT NAME MONTH YEAR NO. 2 DAYS|MONTHS YEARS (,>16) ID CODE NO.. 2 CHILD) 2 3 5: 7 8 PART A: MATERNITY HISTORY (SHORT FERTILITY MODULE) WOMEN BETWEEN AGE 15 AND AGE 49 19 LOOK AT THE ANSWERS TO QUESTIONS 8 AND 12 ON THE 26. Have you already had sexual relations with a man? PREVIOUS PAGE. WRITE TOTAL NUMBER OF CHILDREN AND YES ...... 1 NUMBER OF CHILDREN WHO DIED. NO . 2(>,32) TOTAL NUMBER OF CHILDREN 27. How old were you when you first had sexual relations with a TOTAL NUMBER OF CHILDREN WHO DIED man? AGE 20, LOOK AT THE ANSWERS TO QUESTION 18. 28. Some couples use contraception methods to avoid pregnancy or to I would like to be sure I have understood correctly. You have space births Are you currently using a method of contraception? given birth to ..... [TOTAL] children, of which .... [ ]... died. Is this (For example, the pill, condoms, withdrawal, rhythm, abstinence.) correct? YES . 1(,,21) YES .... 1 NO . 2 NO .... .2(>>30) (>>PROBE AND RECONCILE) 21. Did you want your last child? 29. What contraceptive method are you and your partner using at YES .1 present? WANTED CHILD LATER. .2 l DID NOT WANT . 3 ABSTINENCE.... ........ 1 DON'T KNOW .4 RHYTHM. .......2 WITHDRAWAL. ....... 3 22. Have your menses returned after the birth of your last child? HERBS/POTIONS. 4 '4 YES . 1 |Y ..... DOUCHE .............. 5 NO . 2(,,27) CONDOM .............. 6 FEMALE SHEATH ......... 7 23. Are you pregnant now? SPERMICIDE ...8....8 YES. 1 I..... DIAPHRAGM ............. 9 NO . 2(>>27) PILL . 10 IUD .11 24. How many months into your pregnancy are you? NORPLANT ............. 12 INJECTABLES ......13 MONTHS. . ..... .1 | | >)>>32 | MALE STERILIZATION ... 14 MONT1 [FEMALE STERILIZATION.15 25. At the time you became pregnant, did you want the pregnancy? 30. Have you ever used a contraception method to avoid pregnancy or to space births? YES ................. 1 I YES .. 1 I WANTED CHILD LATER ..2 [ NO . 2(>>32) DID NOT WANT ........ 3 DON'T KNOW .......... 4 PART A: MATERNITY HISTORY (SHORT FERTILITY MODULE) WOMEN BETWEEN AGE 15 AND AGE 49 31. What contraceptive method have you used? ABSTINENCE ............1 RHYTHM ................ 2 WITHDRAWAL , 3 HERBS/POTIONS. 4 DOUCHE ................ 5 CONDOM .. 6 FEMALE SHEATH. 7 SPERMICIDE.8 DIAPHRAGM . 9 PILL .......... 10 IUD .................. 11 NORPLANT ............. 12 INJECTABLES .......... 13 MALE STERILIZATION ... 14 FEMALE STERILIZATION.15 32. Do you want to have any children in the future? YES .................1 NO ..................2 CAN'T HAVE CHILDREN.3 00 DON'T KNOW ..........4 33. How many children would you like to have in the future? NUMBER 34. In what year do you want to have your next child? YEAR W PART A: MATERNITY HISTORY (STANDARD FERTILITY MODULE) WOMEN BETWEEN AGE 15 AND AGE 49 Now I would like to talk to you about each of the births you 4. Have you ever been pregnant? YES. . 1 (>6) have had, whether the child is still alive or not, starting NO. . .2 with the first birth you had. 5. Was there a pregnancy that lasted only a few weeks or months? YES . .1l l 1. WRITE DOWN THE ID CODE OF THE WOMAN. ID CODE: LrY NO.S. .2 (26) YES..1(>A) ~6. Have you ever given birth to a child? 2. IS THIS PERSON ANSWERING FOR HERSELF? YESN. .1(4) . H YES. .1(,8) I_ I NO. . .2 NO... .2 3. WRITE ID CODE OF PERSON ACTUALLY ID CODE 7. Have you had any baby who cried or showed any YES. .1 1 INTERVIEWED D sign of life? NO. . .2(,,26) L. l _8 9. 10. 11. 12. 13. 14. 15. 16. 17 18. B What name Was Is [NAME] a When was [NAME] Is [NAME] How long did the child Does WRITE What is the Have you Are you sure I was given [NAME] boy or a born? still alive? live? [NAME] [NAME'S] highest level of given birth that you have R to your born single girl? IF '1 YEAR" PROBE: currently ID CODE schooling that to any never had any T [first, next] or as twin How many months old live in your FROM [NAME] has/had other other children H child? triplet, etc. was [NAME]? household? HOUSE- completed? children? than the ones I | IF NOT KNOWN, HOLD we have already D ESTIMATE USING RECORD DAYS IF LESS ROSTER. talked about? SUPPLEMENTARY THAN 1 MONTH SCHOOLING CALENDAR RECORD MONTHS IF CODES FROM LESS THAN TWO EDUCATION YES. .1 'Y 0ARR MODULE YES. .1 (>>19) SINGLE.1 BOY. .1 YES .11 YES . 1 (>>NEXT NO_2 MLT.. .2 GIRL ... .2 (s>14) NO ... 2 CHILD) (>>NEXT NAME _ MONTH|_EA NO . . .2 DAYS MONTHS |YERS (> 16) ID CODE NO... .2 CHILD) 7 18H |X 90XX PART A: MATERNITY HISTORY (STANDARD FERTILITY MODULE) WOMEN BETWEEN AGE 15 AND AGE 49 19. LOOK'AT THE ANSWERS TO QUESTIONS 8 AND 12 ON THE 26. Have you already had sexual relations with a man? PREVIOUS PAGE. WRITE TOTAL NUMBER OF CHILDREN YES ...... AND TOTAL NUMBER OF CHILDREN WHO DIED. NO. 2(>>32) TOTAL NUMBER OF CHILDREN |III27. How old were you when you first had sexual relations with a TOTAL NUMBER OF CHILDREN WHO DIED man? AGE 20. LOOK AT THE ANSWERS TO QUESTION 18. 28. Have you had any miscarriages, even though the pregnancy lasted I would like to be sure I have understood correctly. You have only a short time, or have you had a stillborn child? given birth to ..... [TOTAL] children, of which .... [ ... died. Is this YES . 1 correct? NO .. 2(,»30) YES. 1(,21) NO . 2 29. How many miscarriages and stillbirths have you had in your life? (»>PROBE AND RECONCILE) lIIIl 21. Did you want your last child? 30. Have you had any abortions in the course of your life? YES..........1 YES .... 1LI WANTED CHILD LATER ..2 NO. 2(>>32) DID NOT WANT .......... 3 DON'T KNOW ......... 4 31. How many abortions have you had in the course of your life? 22. Have your menses returned after the birth of your last child? C YES ...... l 32. Do you want to have any children in the future? NO ..... 2(»>27) [ lJYES ...... ..... 1 NO. 2(,PART B) |J 23. Are you pregnant now? CAN'T HAVE CHILDREN.3(,,PART B) YES .. 1 DON'T KNOW .......... 4(,>PART B) NO . 2(»,27) [.j 33. How many children would you like to have in the future? 24. How many months into your pregnancy are you? IF 0, >PART BNUMBERfI~ MONTHS . 1 ... l 34. In what year do you want to have your next child? 25. At the time you became pregnant, did you want the pregnancy? |>PART B YEAR l YES . 1~~~~~~~~~~~~~~~~~~~~YA YES .................... 1 WANTED CHILD LATER .. 2 DID NOT WANT ........ 3 Es27 DON'T KNOW ........ 4 PART B: REPRODUCTIVE HEALTH (STANDARD FERTILITY MODULE) WOMEN BETWEEN AGE 15 AND AGE 49 1. HAS WOMAN GIVEN BIRTH TO A CHILD IN THE LAST THREE YEARS? YES..1 NO...2 (,>PART C) | Now we will talk about the health of all your children born in the last three years starting with your last child. We will talk about one child at a time. ENTER BIRTH ID FROM THE MATERNITY HISTORY 2. 3. 4. 5. 6. 7. 8. 9. 10. B NAME OF THE LAST (NEXT While you How many Who assisted you at Where did you give Did you Are you How many HAS WOMAN I LAST) BORN CHILD were pregnant times did you go birth? birth? breastfeed currently months did GIVEN BIRTH TO R with [NAME] for prenatal [NAME]? breast you ANOTHER CHILD T did you go for consult-ations? feeding exclusively IN LAST THREE H prenatal [NAME]? breastfeed YEARS consultations? [NAME]? D DOCTOR .....1 PRIVATE MIDWIFE ....2 HOSPITAL OR MATRON .3 CLINIC .... 1 TRADITIONAL GOVERNMENT ..1 MIDWIFE... 4 FACILITY 2 YES ..1 RELATIVE OR HOME ... 3 YES ..1 YES. .1 (>>NEXT BIRTH) NO.. 2 OTHER . 5 OTHER .... 4 NO 2 NO 2 NO... .2 NAME (,5) TIMES (,,10) MONTHS (>,PART C) PART C: CONTRACEPTIVE USE (STANDARD FERTILITY MODULE) WOMEN BETWEEN AGE 15 AND AGE 49 Some couples use methods to avoid pregnancy or space the births of their children. I would like to ask you about some of these methods. 1. 2 3. 4. 5. 6. 7. 8. 9. 10. 11 Have you Where did you Have you Are you Why aren't you using Where do you/did How far How long does it Do you How often do How much ever heard first hear about ever used currently [..]? you obtain [..]? away is generally take to have to you have to do you pay of [..] as a [..]? [.]? using [..] to this get there? pay for pay for this each time? method of avoid I))NEXT METHOD source? this method? avoiding or pregnancy MOH CLINIC.. .1 method? spacing or to space WANTED FP CLINIC.... 2 births? births? CHILDREN .... 1 PVT. CLINIC. .3 PREFER GOVERNMENT DIFFERENT HOSPITAL .... 4 )>NEXT METHOD ...... 2 PRIVATE METHOD SIDE EFFECTS.3 HOSPITAL... 5 FAMILY ..1 EXPENSE ...... 4 FRIENDS. 6 FRIEND ..2 NOT FAMILY. 7 CLINIC ..3 AVAILABLE ...5 PRIVATE SCHOOL..4 INEFFECTIVE..6 PH ACY.... 8 YES ..1 RADIO.. .5 RELIGIOUS FIELD WORKER.9 YES ..1 NO ... 2 TV,... YES..1 YES..1 REASONS . 7 CBD VOL . 10 NO ...ME PRINT... 7OTHER .....S OTHER.....11 KIO(ATM t~~NEXT OTHER... g NO. .. .2 (»>6) KILO-TE »NEXT TI SUME METHOD METHOD) (,, 5) NO ... 2 METERS HOURS MINUTES METHOD) TINES|UNIT W uj Abstinence 1 Rhythm 2 Withdrawal 3 Herbs/ Potions 4 _ _ _ __ _ Douche 5 : l Condom 6 Female Sheath 7 Spermicide 8 Diaphragm 9 Pill 10 : :_:_l IUD 11 _ : :___:::_::___ Norplant 12 : : : : _ I Injectables 13 Male sterilization 14 Female sterilization 15 HOUR .... 2 DAY .... 3 WEEK .... 4 FORTNIGHT ... 5 MONTH ...... 6 QUARTER .... 7 HALF YEAR ... 8 YEAR... 9 Module for Chapter 16 Migration Robert E. B. Lucas The following pages present three different versions of the which is discussed in detail in Chapter 6 ofVolume l.These migration module that is introduced in Chapter 16 of questions are not for household members but for house- Volumiie 2. The three versions differ in terms of size: short, hold "associates," who are non-resident children, parents, standard and expanded. Each version includes a set of ques- siblings or spouses of household members. See Chapter 16 tions that should be added to the household roster module, for an explanation of the purpose of these questions. 333 MIGRATION MODULE (SHORT) TO BE ASKED OF ALL PERSONS Now I would like to ask you some questions about the places you have lived for three or more months during your life. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13 14. I Have you How long is it When you In what During Other than How old In what Were you Besides CHECK In what Was this CHECK D ever lived in since you came were first province or the time the place you were you province or living in the places QUESTION 2. province or place you QUESTION 4. another to stay here, in born, did country did you lived were born when you country were an urban you have HAS PERSON country were were IF THE PLACE C place, such this place? you live in you live there, and the place first left you living area in mentioned BEEN LIVING you living 5 living in 5 OF BIRTH IS A O as another [CURRENT when you was that where you [PLACE before you that so far, HERE FOR 5 years ago? years FOREIGN D village, PLACE OF were first place an live now, OF moved to province/ have you YEARS OR ago an COUNTRY, E another RESI- born? urban have you BIRTH] ? your current country? ever lived MORE? urban ASK: town, or IF 5 YEARS DENCE]? area? ever lived place of anywhere area? In what year did abroad, for OR MORE, anywhere residence? else? you first come three or more LEAVE else for more PROVINCE to this country months at MONTHS PROVINCE than 3 AND for more than one time? BLANK AND months? COUNTRY three months? COUNTRY CODES CODES PROVINCE AND COUNTRY FIVE YEARS YES. .1 CODES OR MORE. .1 NO.. 2 YES. . 1 YES. . 1 YES. .1 YES. . 1 YES. . 1 (>>14) YES . 1 (>>NEXT (>,7) NO. .. 2 NO ... 2 AGE IN NO.. .2 NO.. 2 LESS THAN NO. 2 PERSON) YEARS MONTHS NO... 2 (>>14) YEARS (>>14) 5 YEARS. .2 YEAR 3l 4- 7 _ l :12 : : : ::1 MIGRATION MODULE (SHORT): QUESTIONS TO ADD TO HOUSEHOLD ROSTER INFORMATION ON HOUSEHOLD ASSOCIATES 1. 2. 3. 4. 5. 6. I Has How long has it Has In which Is the How long has D [NAME] been since [NAME] province or place he/she been living ever [NAME] last been living country has he/she is in this/that place? C stayed in stayed in this in this [NAME] been living in 0 this dwelling for three town or living during an urban D dwelling months or more? village the past 3 area? E for three during the months? months or past 3 more at months? any one IF 5 YEARS OR time? MORE, LEAVE MONTHS AN IF 5 YEARS OR BLANK. PRVNEMORE, LEAVE AND MONTHS COUNTRY BLANK. CODES YES. .1 YES. .1 YES. .1 NO... .2 (>>6) NO... .2 (»,3) YEARS MONTHS NO ... .2 YEARS MONTHS LrJ 2 3 4 6 7 8 9 12 12_ MIGRATION MODULE (STANDARD): TO BE ASKED OF ALL PERSONS Now I would like to ask you some questions about the places ou have lived for three or more months during your life. 1. 2. 3. 4. 5 6. 7. 8 9. 10 11. I Have you How long is it When you In what What is the name of During Other than How old In what What is the name of During the D ever lived in since you were first province or the place where you the time the place were you province or the place where you time you lived another came to stay born, did you country did lived when you were you lived you were when country were lived before you in [PLACE OF C place, such here, in this live in you live when first born? there, born and the you first you living moved here? PREVIOUS O as another place? [CURRENT you were first was that place where left before you RESIDENCE] D village, PLACE OF born? place an you live now, [PLACE moved to was that place E another RESI- urban have you OF your current an urban town, or IF 5 YEARS DENCE]? area? ever lived BIRTH]? place of area? abroad, for OR MORE, anywhere residence? three or more LEAVE PROVINCE else for months at MONTHS AND PLACE more than 3 one time? BLANK COUNTRY CODES months? PLACE CODES PROVINCE CODES AND COUNTRY YES. 1 CODES NO 2 YES ..1 YES ..1 (>>NEXT (>>8) YES. 1 NO .. 2 AGE IN YES ..1 PERSON) YEARS|MONTHS NO.. 2 PLACE NAME| CODE NO ... 2 (,,12) YEARS PLACE NAME| CODE NO. 2 0' 2 3 4 5 6 7 8 9 10 1 1 12 MIGRATION MODULE (STANDARD): TO BE ASKED OF ALL PERSONS 12. 13. 14. 15. 16. 17. 18. 19. 20. I Why did you move Did access Which facilities were At the time Who did you know that With whom did you CHECK Before you Why were you not D here? to better important in affecting your you moved already lived here? live when you first AGE OF came to working in that last schools, decision to move here? here, did moved here? RESPON- live here, month in your C PARENTS health your parents, DENT. were you previous place of O MOVED .... 1 facilities, ALLOW UP TO THREE children, ALLOW UP TO THREE working residence? D SCHOOLING ... 2 transport or CHOICES spouse, CHOICES PARENTS ..... 1 during the E MARRIAGE .... 3 water play PRIMARY SCHOOL.. 1 fiance, other CHILDREN. 2 last month LOOK FOR an SECONDARY relatives, or SPOUSE/ you lived in STUDENT. 1 WORE . 4 important SCHOOL .......... 2 other people PARENTS ......... 1 FIANCE .... 3 your HOUSEWORK/ START NEW role in your OTHER SCHOOL .... 3 you knew, CHILDREN . 2 OTHER previous CHILD CARE 2 JOB 5 decision to HEALTH already live SPOUSE/FIANCE 3 RELATIVE.... 4 place of TOO OLD/ ESCAPE WAR/ move here? FACILITY ........ 4 here? OTHER RELATIVE. 4 PEOPLE FROM residence? RETIRED ..... 3 VIOLENCE .... 6 TRANSPORTATION. .5 PEOPLE FROM PLACE PLACE OF SICK/ DROUGHT/ WATER SUPPLY .... 6 OF BIRTH ........ 5 BIRTH.... 5 HANDICAPPED.4 FAMINE/ OTHER OTHER OTHER COULD NOT DISEASE... .7 (SPECIFY ).7 ACQUAINTANCES 6 AQUAINTANCES.6 FIND WOREK ... 5 OTHER STRAGERS.... 7 (SPECIFY ).8 YES .1 YES ..1 LTDANE. .8 AGE<15 ..1 YES . 1 OTHER NO.. .2 NO.. .2~~~~~~~ I(LIVED LONE1)8(SPECIFY 1.6 _NO... 2 1ST C2ND 3RD NO... 2 1CST C2ND C3RDE... ... (>>37) (,,21) .. (C._) w _______________ (,,15) CHOICE CHOICE CHOICE (,>17) CHOICE CHOICE CHOICE AGE=15. .2 NO.. 2. 2 4- 5 6 X 7_ 8 9- iT MIGRATION MODULE (STANDARD): TO BE ASKED OF ALL PERSONS 21. 22. 23. 24. 25. 26. 27. 28. 29. I Have you How long after During the time between Did you visit Was the first work Was that Have you ever How long after How did you actually find D ever worked coming here did arriving here and finding this place to you found when you business or worked for arriving here did your first wage job here? here, in this you first find work, your first work, what was look for work arrived here wage farm operated wages since you first work for C place, in either for wages or your main means of before work or self- by someone coming to live wages? 0 any type of as a self- support? actually employment? else in your in this place? D activity, employed worker? moving household E either for l SAVINGS here? before you OWN SEARCH BEFORE wages or as OAVIENGS arrived? IF 5 YEARS MOVING . 1 2 LESS se, RLIVED WITH......2 OR MORE, (BF31) employed IF ONE FAMILY/FRIENDS INLEV ARNGDB worker? MOTS FAMILY ......2 MONTH OR PREVIOUS PLACE OF MNH LESS, ))24 RESIDENCE ....... 3 ~~~~~BLANK ARRANGED BY LESS, >24 RESIDENCE . 3 F~~~~~~~~~~~~~~~~~~~~~~~~~~~ERIENDS..... 3 OTHER FAMILY/ OWN SEARCH AFTER FRIENDS . 4 MOVING. 4 MENIAL WORK/ ( ..31) BEGGING ......,.,5 WAGE WORK. .1 OTHER YES..1 OTHER YES..1 (,,29) YES..1 YES.,1 (SPECIFY )....5 NO.. 2 (SPECIFY_) . 6 NO .. 2 SELF-EMPLOY- NO .. 2 NO... 2 (,37) YEARS MONTHS MENT ... 2 (,,36) YEARS MONTHS 00 2 3 4 _ 5ll 6 7 10=_ 1 1 12 MIGRATION MODULE (STANDARD): TO BE ASKED OF ALL PERSONS 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. I Were those Are you still When you When you When you Did you CHECK Besides the CHECK In what Was this CHECK D family or working for started that started that started that become a QUESTION places you QUESTION 2. province or place you QUESTION 4. IF friends the same first wage job, first first union 7, AND have HAS PERSON country were were THE PLACE OF C already employer, or how many wage job, did wage job, member CODE AS mentioned, BEEN LIVING you living 5 living in 5 BIRTH IS A 0 working for in the same hours a week your how many within the FOLLOWS: have you HERE FOR years ago? years FOREIGN D your first self-employ- did you work? employer pay people first year of ever lived MORE THAN 5 ago an COUNTRY, E employer? ment, you social worked at working at anywhere YEARS? urban ASK: had when security that place? that wage else? area? In what year did you first contributions? job? you first come to arrived? PROVINCE this country for AND more than three COUNTRY months? CODES YES. .1 MORE THAN (»>38) 5 YEARS. .1 YES ..1 YES . 1 HOURS YES ..1 YES ..1 NO.. 2 YES. .1 (,,41) YES . 1 NO.. 2 NO.. 2 PER NO.. 2 NO 2 (>,41) NO. 2 5 YEARS NO... 2 OR LESS.2 w _______ _______ WEEK BLANK.3 (,,41) YEAR '0 2 3 4 5 6 7 8 9 10 12 MIGRATION MODULE (STANDARD): QUESTIONS TO ADD TO HOUSEHOLD ROSTER INFORMATION ON HOUSEHOLD ASSOCIATES 1. 2 3 4 5 6 7 8 9 I Has How long has it Has In which Is the place Which of [NAME'S] How long has Did [NAME] stay How long has it been D [NAME] been since [NAME] province or he/she is relations, if any, are he/she been living in another since [NAME] last ever [NAME] last been living country has living in an currently living in the in this/that place? dwelling, in stayed in that C stayed in stayed in this in this [NAME] been urban area? same dwelling as which the head dwelling for O this dwelling for three town or living during [NAME]? of this household three months or more D dwelling months or more? village the past 3 was also the at any one time? E for three during the months? ALLOW UP TO head of that months or past 3 THREE RESPONSES. household, for more at months? IF MORE THAN 3 USE three months or any one IF 5 YEARS OR LOWEST CODES more at any one time? IFRE 5 LEARSEO time in the last MONTHS SPOUSE .... 1 IF 5 YEARS OR five years? IF 5 YEARS OR BLANK. AND CHILDPREN.... 3 MORE, LEAVE MORE, LEAVE COUNTRY SIBLING ...4 MONTHS MNH CODES OTHER BLANK. BLANK. YES. .1 YES..1 YES..1 RELATIVE. 5 .Y5 NOS ..2 YES ..1 YES. ..1 NONE .... 6 YES. 1 NO ..._2 (>>»6) NO. 2 NO .. 2 _J (,,3) YEARS MONTHS NO. 2 1ST 2ND 3RD YEARS |MONTHS (,,10) YEARS MONTHS 0 5 7 9 __- 12X MIGRATION MODULE (STANDARD): QUESTIONS TO ADD TO HOUSEHOLD ROSTER INFORMATION ON HOUSEHOLD ASSOCIATES 10. 11. 12. 13. 14. 15. 16. I What has been the CHECK THE ANSWER ASK ONLY IF PERSON Is the Was the last school or Did the last Who contributed to paying for the D principal activity of [NAME] TO QUESTION 4. COMPLETED SOME POST- school or college that [NAME] school or fees and costs? during the past 3 months? SECONDARY EDUCATION. college attended a public or college that ALLOW UP TO THREE CHOICES. C What was [NAME's] major field which private [NAME] 0 WORKING FOR of study in post secondary [NAME] establishment? attended in this FATHER. 1 D WAGES/SALARY... 1 education? attended country MOTHER ................ 2 E SELF-EMPLOYED ..2 most charge tuition or GRANDPARENTS .......... 3 UNEMPLOYED ..... 3 recently other fees, such SIBLINGS .............. 4 RETIRED/SICK/ SCIENCE .1 abroad? as boarding OTHER RELATIVES ....... 5 DISABLED ....... 4 HUMITIES.........2 costs? BANK OR OTHER HOUSEWORK/CHILD SOCIAL FINANCIAL ENTERPRISE.6 CARE .. 5 EMPLOYER OF FAMILY SCIENCE 3 MEMBER.. 7 IN SCHOOL/ ENGINEERING 4 GOVERNMENT . ........... 8 CHILD AT BLANK, OR MEDICINE 5 PUBLIC ..... 1 CHARITABLE OR OTHER CHOME . 7 LN,O LW......... PIAEORGANIZATION..... 9 HOME ........... 7 LIVES IN THIS EDUCATION .7 PRIVATE YES..1 OTHER COUNTRY... 1 BUSINESS/ECONOMICS.8 YES . 1 SECULARN.....2 N0 2 OTHER (SPECIFY _.... 10 (SPECIFY ) .8 PRIVATE (>>NEXT PERSON) OTHER (SPECIFY (,,16) RELIGIOUS ... 3 (>>NEXT I I _ LIVES ABROAD ...2 ........ 9 N NO. 2 PERSON) 1ST 2ND 3RD - 10 5- 7 5- 9- 12 MIGRATION MODULE (EXPANDED): TO BE ASKED OF ALL PERSONS Now I would like to ask you some questions about the places you have lived for three or more months during your life. 1. 2. 3. 4. 5 6. 7. 8. 10 I Have you How long is it When you In what What is the name of During Other than the How old In what What is the name D ever lived in since you were first province or the place where you the time place you were you province or of the place where another place, came to stay born, did you country did you lived when you were you lived were born and when you country were you lived before you C such as here, in this live in live when you first born? there, the place first left you living moved here? O another place? [CURRENT were first was that where you live [PLACE before you D village, PLACE OF born ... ? place an now, have OF moved to your E another town, RESIDENCE]? urban you ever lived BIRTH] ? current place of or abroad, for IF 5 YEARS area? anywhere residence? three or more OR MORE, else for more months at one LEAVE than 3 time? MONTHS PLACE months? BLANK PROVINCE CODES PLACE AND PROVINCE CODES COUNTRY AN D CODES COUNTRY YES. . 1 CODES NO.. 2 YES ..1 YES. .1 YES ..1 (>>NEXT (>>8) NO 2 NO ... 2 AGE IN PERSON) YEARS MONTHS NO 2 PLACE NAbME| CODE__ (,12) YEARS PLACE NAME CODE 2 3 4 5 6 7 10 1 7= == == 7t= MIGRATION MODULE (EXPANDED): TO BE ASKED OF ALL PERSONS 11. 12. 13. 14. 15. 16. 17. 18. I During the Why did you move Did access to Which facilities were At the time Who did you know that With whom did you CHECK AGE OF D time you lived here? better important in affecting your you moved already lived here? live when you first RESPONDENT in [PLACE OF schools, decision to move here? here, did moved here? C PREVIOUS PARENTS health your parents, 0 RESIDENCE] MOVED ....... 1 facilities, ALLOW UP TO THREE children, ALLOW UP TO THREE D was that place SCHOOLING ...2 transport or CHOICES spouse, CHOICES PARENTS ...... 1 E an urban MARRIAGE. ... .... 3 water play an PRIMARY SCHOOL.. 1 fiance, other CHILDREN ..... 2 area? LOOK FOR important role SECONDARY relatives, or SPOUSE/ WORK ....... 4 in your SCHOOL .2 other people PARENTS ......... 1 FIANCE .... 3 START NEW decision to OTHER SCHOOL .... 3 you knew, CHILDREN . 2 OTHER JOB. 5 move here? HEALTH already live SPOUSE/FIANCE 3 RELATIVE .... 4 ESCAPE WAR/ FACILITY . 4 here? OTHER RELATIVE. 4 PEOPLE FROM VIOLENCE... 6 TRANSPORTATION.. 5 PEOPLE FROM PLACE PLACE OF DROUGHT/ WATER SUPPLY.... 6 OF BIRTH ........ 5 BIRTH .... 5 FAMINE/ OTHER OTHER OTHER DISEASE ..... 7 (SPECIFY ),.7 ACQUAINTANCES.. 6 AQUAINTANCES.6 OTHER STRANGERS .... 7 (SPECIFY_).8 YES,.1 YES..1 LIVED ALONE..8 AGE<15..1 YES. .1 NO.. 2 1ST 2ND 3RD NO.. 2 1ST 2ND 3RD (>>48) 4iJ _ NO 2 (,15) CHOICE CHOICE CHOICE (,17) CHOICE C E CHOICE AGE 15 2 2 3 4 5 6 7 8 9 10_ = -=_ 12 ..__= ==_ MIGRATION MODULE (EXPANDED): TO BE ASKED OF ALL PERSONS 19. 20. 21. 22. 23. 24. 25. Other than any people with In the last place you Would you describe How much What was the principal activity of What was the At the time that you D whom you moved, who helped stayed, during most of the the household in land did the the head of that household, when occupation of moved, would you pay for any moving and initial last three months before which you lived, members of you left to move here? that head of describe yourself (and c living costs? coming to live here, with before coming here, that household? your spouse) as among O ALLOW UP TO THREE whom did you live? as among the richest household the richest third, in the D RESPONSES. third, in the middle own, at the middle third, or among E NO ONE .............. 1 third, or among the time that WORKING FOR the poorest third, of the PARENTS .... 2 IN INSTITUTIONAL poorest third, of you moved? WAGES/SALARY ... 1 households in the place SPOUSE ... 3 SETTING ..1(,,25) households in that SELF-EMPLOYED ..2 PUT where you lived before CHILDREN ...... 4 LIVED place? UNEMPLOYED .... 3 (,26) OCCUPA- coming here? SIBLING ............. 5 ALONE... 2(»>25) RETIRED/SICK/ TION OTHER RELATIVES ..... 6 WITH SPOUSE AND DISABLED ....... 4(,>26) CODES NON-RELATIVES CHILDREN.3(>>25) RICHEST HOUSEWORK/CHILD HERE RICHEST FROM HOME AREA ..... 7 WITH PARENT(S) ..4 THIRD 1 CARE ... 5(,,26) . THIRD 1 OTHER NON-RELATIVES.8 WITH OTHER THIRDD . 1IN SCHOOL/ [>2] THIRDD . 1 EMPLOYER .......... 9 RELATIVES ...... 5 TINDL ...... ING . .6(26) THIRD. 2 OTHER (SPECIFY_) ... 10 WITH NON- THIRES 2 OTHERPORS RELATIVES ...... 6 THIRD .... 3 (SPECIFY )..7(>>26) THIRD .... 3 IST 2ND 3RD HECTARES 2 4- 5 6_ 7 8 9 10= 1 2 MIGRATION MODULE (EXPANDED): TO BE ASKED OF ALL PERSONS 26. 27. 28. 29. 30. 31. 32. 33. 34 I Before you What was your What kind of Why were you not Have you How iong after During the time between Did you visit What was your D came to live occupation in trade, industry or working in that last ever worked coming here did arriving here and finding this place to occupation in that here, were that job? business was that month in your here, in this you first find work, your first work, what was look for work first job for wages C you working job connected previous place of place, in either for wages or your main means of before or on own 0 during the with? residence? any type of as a self- support? actually account? D last month activity, employed worker? moving E you lived in either for OWN SAVINGS 1 here? your previous STUDENT . 1 wages or as FAMILY/FRIENDS place of PUT HOUSEWORK/ a self- LIVED WITH .2 residence? PUT INDUSTRY CHILD CARE. .2 employed IF ONE FAMILY/FRIENDS IN PUT OCCUPATION CODES TOO OLD/ worker? OCCUPATION CODES HERE HEE RTRDMONTH OR PREVIOUS PLACE OF CODES HERE HERE RETIRD ..... 3LESS, ))33 RESIDENCE .... 3 SICK/ OTHER FAMILY/ Z30 HANDICAPPED.4 FRIENDS . 4 COULD NOT MENIAL WORK/ FIND WORK..... 5 BEGGING. ........5 YES ..1 OTHER YES ..1 OTHER YES..1 NO.. .2 (SPECIFY__).6 NO... 2 (SPECIFY-) 6 NO 2 w __ _2 (,,29) (,48) YEARS MONTHS Ln 2 3 4- 9= 11 12 MIGRATION MODULE (EXPANDED): TO BE ASKED OF ALL PERSONS 35 36. 37. 38. 39. 40. 41. 42. 43. 44. I What kind of trade, Was the first work Was that Have you ever How long after How did you actually find Were those Are you still When you When you D industry or you found when you business or worked for arriving here did your first wage job here? family or working for started that started that business was that arrived here wage farm operated wages since you first work for friends the same first wage job, first C first job connected work or self- by someone coming to live wages? already employer, or how many wage job, did O with? employment? else in your in this place? working for in the same hours a week your D household your first self-employ- did you work? employer pay E before you OWN SEARCH BEFORE employer? ment, you social arrived? IF 5 YEARS MOVING .......... 1 had when security OR MORE, (>>42) you first contributions? PUT LEAVE ARRANGED BY arrived? INDUSTRY MONTHS FAMILY .... 2 CODES BLANK ARRANGED BY HERE FRIENDS. 3 OWN SEARCH AFTER MOVING. 4 WAGE WORK ..1 OTE2) OTHER (>,40) YES..1 YES..1 (SPECIFY )..5 YES-.1 YES..1 HOURS YES..1 SELF-EMPLOY- NO.. 2 NO 2 NO-2 NO .2 PER NO 2 w~ _MENT ... 2 (,,47) YEARS MONTHS WEEK 4I 5- 7 8~ 9T 10 MIGRATION MODULE (EXPANDED): TO BE ASKED OF ALL PERSONS 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. I When you Did you CHECK Besides the CHECK In what Was this CHECK Besides the places In which country In which D started that become a QUESTION places you QUESTION 2. province or place you QUESTION 4. IF you have told me did you stay, year did you first union 7, AND have HAS PERSON country were were THE PLACE OF about so far, have most of the time, return from C wage job, member CODE AS mentioned, BEEN LIVING you living 5 living in 5 BIRTH IS A you ever lived the most recent living in that 0 how many within the FOLLOWS: have you HERE FOR years ago? years FOREIGN (elsewhere) abroad time country? D people first year of ever lived MORE THAN 5 ago an COUNTRY, for three months or you lived abroad E worked at working at anywhere YEARS? urban ASK: more at any one for more than that place? that wage else? area? In what year did time? three months. job? you first come to PROVINCE this country for AND more than three COUNTRY months? CODES COUNTRY YES. .1 MORE THAN CODES (,,49) 5 YEARS. 1 YES. .1 NO.. 2 YES ..1 (»52) YES. .1 YES ..1 NO... 2 (>>52) NO... 2 ORS NO.. 2 NO... 2 OR LESS.2 BLANK.3 (,,52) YEAR (»55) YEAR 2 3 4 6. 8 9 10 1 1 12._ ==_ MIGRATION MODULE (EXPANDED): TO BE ASKED OF ALL PERSONS 56. 57. 58. I What was your principal activity What was your What kind of D while you were living in that occupation in trade, industry country? that job? or business C was that job O WORKING FOR WAGES/ connected D SALARY ............... 1 with? E SELF-EMPLOYED ... ..... 2 UNEMPLOYED ............ 3 (>>NEXT PERSON) RETIRED/SICK/DISABLED.4 (>>NEXT PERSON) HOUSEWORK/CHILD CARE..5 (>>NEXT PERSON) IN SCHOOL/TRAINING ... 6 OCCUPATIO INDUSTRY (,,NEXT PERSON) N CODES CODES CHILD AT HOME ......... 7 (,>NEXT PERSON) OTHER (SPECIFY ) . . .8 X _ 2 3 4 5 6 7 8 9 11 ~12 Module for Chapter 18 Household Enterprise Wim P. M.Vijverberg and Donald C. Mead The household enterprise module is presented on the fol- As was mientioned in Chapter 18. it is essential to gath- lowing pages.As explained in Chapter 18 ofVolume 2, there er information about all the enterprises within any given are three versions: short, standard and expanded. The size of household. The method for doing so is explained in that each version is relatively large, which reflects the complex- chapter. The module has space for answers about three ity and variety of household enterprises in developing enterprises; if the household reports operations in a fourth, countries. In the expanded version the module is divided fifth or even sixth enterprise, the interviewer is to record into 8 parts, which are labeled A through H. The short and those answers in another copy of the household question- standard versions do not have Part A, but do have smaller naire. Another point to keep in mind is that the layout of the versions of Parts B though H. If the short or standard ver- chapter is designed so that a fold-out page with the name of sion is used, the parts should be "re-lettered" from A to G. each enterprise can be inserted, similar to the fold-out page That was not done here for ease of comparison across the for the household roster. See Chapter 3 ofVolume I for an three versions of this module. explanation of how to implement this useful device. 349 PART B: ESTABLISHING THE EXISTENCE OF NON-FARM ENTERPRISES (SHORT VERSION) HEAD OF THE HOUSEHOLD 1 . 2. 3. Over the past 12 months, has What kind of enterprise does your household operate? Who is most informed about and/or in charge of day-to-day operations anyone in your household operated of the enterprise? any non-agricultural enterprise PROBE TO DETERMINE INDUSTRIAL SECTOR IN which produces goods or services WHICH ENTERPRISE OPERATES. COLLECT THE INFORMATION ON THIS PAGE FOR ALL (for example, artisan, metalworking, ENTERPRISES BEFORE PROCEEDING TO PART C. THEN tailoring, repair work; also include COMPLETE PARTS C - H FOR THE FIRST ENTERPRISE, THEN THE processing and selling your outputs SECOND, ETC., UNTIL ALL ENTERPRISES ARE SURVEYED. from your own crops if done (THERE IS ROOM ON PARTS C - H FOR THREE ENTERPRISES. IF regularly) or has anyone in your THIS HOUSEHOLD HAS MORE THAN THREE ENTERPRISES, FILL household owned a shop or OUT A SEPARATE SET OF PAGES FOR PARTS C - H FOR THE operated a trading business? ADDITIONAL ENTERPRISES.) IF IT IS NOT POSSIBLE TO SPEAK TO THE PERSON WHO IS MOST INFORMED ABOUT AND/OR IN CHARGE OF THE ENTERPRISE, TRY TO SCHEDULE ANOTHER VISIT TO TALK TO THIS PERSON. C) YES . 1 NO .. 2 ENTERPRISEI (,,NEXT MODULE) ID FULL WRITTEN DESCRIPTION CODE NAME ID CODE 4 1 1 1 1 1 5 D _ _ _ _ . 6 _ 0 :~~~~~~~~~ PART C: GENERAL INFORMATION (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. 7. 8. 9. Are you IF THE I would like to talk to Where do you operate the How many Do you or In how What share Has this E READ RESPONDENT IS you about your enterprise? rooms of the many of the business been N ANSWER NOT THE business doing READ your members of households profits is in operation T TO PART PERSON ANSWER TO PART B, HOME, INSIDE THE residence your do the other kept by this during the past E B, Q.3? INDICATED IN Q.2. For how long has RESIDENCE ........... 1 do you use household owners household, 14 days? R PART B, Q.3, the enterprise been in HOME OUTSIDE THE for your own all of live? rather than P RECORD THE operation? RESIDENCE .2 business this the other R RESPONDENT'S INDUSTRIAL SITE ...... 3 during enterprise? owners? I ID HERE. TRADITIONAL MARKET ... 4 normal S COMMERCIAL DISTRICT business E SHOP .5 hours? ROADSIDE. 6 OTHER FIXED PLACE .... 7> PA C MOBILE. 8 0 D E YES .. 1 YES ... 1 YES .. 1 (,,3) ID lF IF > 1, >>6 (>9) NO. .2 NO.... 2 NUMBER YEARS |_MONTHS NUMBER NO.... 2 NUMBER PERCENT en I l * I _ - * - I_ PART D: EMPLOYMENT (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 41 5. 6 7. 8. 9 10 1 1 12. CHECK ANSWER Have you Please list for me the ENTER THE During the How many of Are there any Please list for me the ENTER THE During the past How many of Have you E TO PART C, Q 9 yourself spent names of all other ID CODES past 14 days, them did you family members names of all ID CODES 12 months, how them did you yourself spent N time working in household members FOR ALL how many pay, in cash who have spent household members FOR ALL many people did pay, in cash time working in T this enterprise who have worked in PEOPLE people did or in kind? time working in who have worked in PEOPLE this enterprise or in kind? this enterprise E at any time this enterprise during LISTED IN 3. this enterprise this enterprise this enterprise during LISTED IN 8 employ who are at any time R during the past the past 14 days. employ who during the past 12 the past 12 months not members of during the past P 14 days? are not months but not (but not during the this household? 14 days? R members of during the past 14 past 14 days). I this days? S household? E IF MORE THAN 6 IF MORE THAN 5 OTHER OTHER C WORKERS, LIST WORKERS, LIST 0 THE 6MOST THE 5 MOST D IMPORTANT |IF 0, 7 IMPORTANT IF 0, oPART E | E E ANtSWER IS 1- 1 YES... .1 YES... .1 YES... .1 ANSWER IS 2. .2 NO. 2 NO.. 2 No .2 (',12) NAME ID CODE NUMBER (N ,10 ) NAME ID CODE NUMBER NUMBER 2ll 3 PART D: EMPLOYMENT (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 13. 14. 15. 16. Please list for me the ENTER THE ID During the past How manyof E names of all other CODES FOR 12 months, how them did you N household members ALL PEOPLE many people did pay, in cash T who have worked in LISTED IN 13. this enterprise or in kind? E this enterprise during employ who are R the past 12 months not members of P this household? R S E IF MORE THAN 6 OTHER C WORKERS, LIST O THE 6 MOST l D IMPORTANT IF 0, >PARTE E >>>PARTE E NAME ID CODE NUMBER NUMBER 1 I Ul 2 |. 3 _ 2__ __ PART E: REVENUES AND OPERATION SCHEDULE (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2 3. 4. 5. 6. 7. 8 9. The next questions are about the During the During the past 14 During the past 14 days, What was the value of During the What was the value of During the During the E revenue you earn from your past 14 days, how much money has the business made these transactions (the past 14 the goods and services past 12 months that N business. Please include all days, for has the business any transactions using value of goods and days, has consumed by your months, for the business T revenues in your answers (that how many received from the sales something other than services received as your household over the past how many was in E is, the total cash and in-kind days was of its products, goods or money? For example, payment and the value household 14 days? months was operation, R value of goods and services that the services? has the business received of your own products consumed the how many P you receive from the sale of business in payments in the form of that you used for any goods business in days per R goods and services) before operation? goods and services, or payment) over the past or services operation? month did I subtracting any business have you paid for the 14 days? produced this business S expenditures and any expenses purchase of any items by this usually E for your household. with your own products? business? operate? C CHECK ANSWER O TO PART C, Q.9. D E ANSWER IS 1 ..... ..Y ..1... F YESO .. 1E........... 1 ANSWER IS 2_.......2 TIME NO ... 2 TIME NO ..... . . 2 TFIME _ (>>8) ~~~~~~~~DAYS AMOUNT UNIT (,,6) AMOUNT UNIT (,,8) AMOUNT UNIT MONTHS DAYS 1 4 II I| 2 l1 | 3n__ __n | ~~~~HU....2 DY..3 WE....4 FRNIGT. * MOT .... 6 QURE ...7 HLF FR.8 YA PART E: REVENUES AND OPERATION SCHEDULE (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 10 11. 12. 13. 14. 15 16. 17. In a typical year are your sales high, average, low, or none (when In a 'high sales' In an 'average In a'low sales' During the past 12 What was the value of During the What was the value of E the business is not in operation) in the month of [MONTH]? month, what is sales' month, month, what is months, has the business these transactions (the past 12 the goods or services N your level of what is your your level of made any transactions value of goods and months, did that your household T sales per level of sales sales per using something other services received as your consumes during a E month? per month? month? than money? For payment and the value household month with 'average R example, has the business of your own products ever sales'? p received payments in the that you used for consume any R form of goods and payment) dunng a goods or I READ EACH MONTH IN TURN, services, or have you paid month with 'average services S for the purchase of any sales'? produced by >>>PART F E items with your own this products? business? HIGH ,.. 1 C AVERAGE ...... 2 O LOW ...... 3 NONE: NOT IN OPERATION 4 D E .......................... YES. .1 YES. 1 NO.. 2 TIME NO.. 2 TINE JAN FEB MAR APR MAY JUN JUL AUG SEP | HOV |DEC AMOUNT AMOUNT AMOUNT (f16) AMoUNT UNIT (>PART F) AMOUNT UNIT rJAIIIE CTIINIIDI AON I AMUT I AON AMONTUN TIM Ln O6n 121 11 11111 11 1 1 1 1 1 1 1 1 1 HOUR... . 2 DAY.... 3 fWEEK. .. 4 FORTNGHT ...... 5 MOIVH ...... 6 QUARTER. . .... 7 HALF YEAR . .. a YEAR-..9l PART F: EXPENDITURES ON INPUTS (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. CHECK ANSWER During the past 14 days, In a month with E TO PART C, 0.9. how much have you spent 'average sales,' how N in total on the purchase of much have you spent in T inputs (labor, raw total on the purchase of E materials, items for resale, inputs (labor, raw R transport, electricity, materials, items for P water, fuel, rental, resale, transport, R maintenance, taxes, electricity, water, fuel, I registration fees, rental, maintenance, S insurance, etc.)? taxes, registration fees, E insurance, etc.)? C 0 D E ANSWER IS 1. .1 ANSWER IS 2 2 _ (,3) AMOUNT AMOUNT U, 2' 3 ;::: :: PART G: BUSINESS ASSETS (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1 2. 3. 4. 5. 6. 7. I would now like to ask you Is this enterprise the If you wanted During the During the past 12 During the During the past 12 questions about the assets (that sole owner of this to sell the past 12 months, how much in past 12 months, how much in is, equipment, buildings, vehicles, [ITEM], or is ownership [ITEM], how months, did total did this business months, did total did this business tools, etc.) that you use in your shared with another much could this business spend on the this business receive from the sale I business. enterprise? you sell it for acquire any purchase of business sell any of business assets? T today? business assets? business E At present, does this enterprise assets (like assets (like M own this [ITEM]? those we just those we just S talked about)? talked about)? )sNEXT ITEM, Q. 1. IF LAST as>PART H YES ...1 SOLE OWNER. ITEM,14 NO ... 2 SHARED WITH YES ..1 YES ..1 (>NEXT ITEM, Q.1. ANOTHER NO( .2 NO.2 IF LAST ITEM, >,4) ENTERPRISE .2.AMOUNT. . 2 AMOUNT (A PAR T H) AMOUNT Land _ _.__ _._l_l Buildings U, Equipment and machinery Furniture Small or large tools . Large vehicles (trucks, cars, boats, etc.) _ Small vehicles (bicycles, carts, etc.) Other durable goods Land Buildings Equipment and machinery Furniture Smali or large tools Large vehicles (trucks, cars, boats, etc.) . _ Small vehicles (bicycles, carts, etc.) Other durable goods Landll . .. ...l Buildings . ..l... Equipment and machinery Furniture.. Small or large tools . Large vehicles (trucks, cars, boats, etc.). Small vehicles (bicycles, carts, etc.). Other durable goods. PART H: GENERAL BUSINESS CONDITIONS (SHORT VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. 7 Finally, I would like to ask How much did If you did During the past During how After making purchases for How much money is E you a few mere questions your current not add to 12 months, when many months the business and after usually left? N about the general inventory cost your your business was your cash spending some for yourself T operations of your you? inventory, was in operation, sales revenue or your household, is there E business. how many were there not enough to usually any money left as R days of periods when cover your income for the household or P Does your business have production your cash sales cash for the purpose of saving? R an inventory of raw and/or revenue was not expenditures? I materials, items requiring sales enough to cover S further processing, or would this your cash )))NEXT ENTERPRISE E finished products? inventory expenditures? IF LAST ENTERPRISE, last? ,>NEXT MODULE C YES. .1 O NO... .2 D (>NEXT ENTERPRISE E YES. .1 YES..1 IF LAST ENTERPRISE, NO.. .2 NO ... .2 >NEXT MODULE) ( ,4) AMOUNT DAYS (6) MONTHSAMONT UNIT HOUR.... 2 DAY.... .3 WEEK.... .4 FORTNIGHET... 5 MONTE .. ..6 QUARTER .... .7 HALF YEAR... .8 YEA.R... 9 PART B: ESTABLISHING THE EXISTENCE OF NON-FARM ENTERPRISES (STANDARD VERSION) HEAD OF THE HOUSEHOLD 1. 2. 3. Over the past 12 months, has What kind of enterprise does your household operate? Who is most informed about and/or in charge of day-to-day operations anyone in your household operated of the enterprise? any non-agricultural enterprise PROBE TO DETERMINE INDUSTRIAL SECTOR IN which produces goods or services WHICH ENTERPRISE OPERATES. COLLECT THE INFORMATION ON THIS PAGE FOR ALL (for example, artisan, metalworking, ENTERPRISES BEFORE PROCEEDING TO PART C. THEN tailoring, repair work: also include COMPLETE PARTS C - H FOR THE FIRST ENTERPRISE, THEN THE processing and selling your outputs SECOND, ETC., UNTIL ALL ENTERPRISES ARE SURVEYED. from your own crops if done (THERE IS ROOM ON PARTS C - H FOR THREE ENTERPRISES. IF regularly) or has anyone in your THIS HOUSEHOLD HAS MORE THAN THREE ENTERPRISES, FILL household owned a shop or OUT A SEPARATE SET OF PAGES FOR PARTS C - H FOR THE operated a trading business? ADDITIONAL ENTERPRISES.) IF IT IS NOT POSSIBLE TO SPEAK TO THE PERSON WHO IS MOST INFORMED ABOUT AND/OR IN CHARGE OF THE ENTERPRISE, TRY TO SCHEDULE ANOTHER VISIT TO TALK TO THIS PERSON. YES...1 (,,3) ENTERPRISE| NO.... 2 ID FULL WRITTEN DESCRIPTION CODE NAME ID CODE trll ~ ~ ~ I________ = _________ ____ ui~~~~: 3 4 ___________________________ ___________ 5 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6 ___________________________ ___________ PART C: GENERAL INFORMATION (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. 7. 8. 9. Are you IF THE I would like to talk to Where do you operate the How many Do you or the In how What share Has this E READ RESPONDENT IS you about your business enterprise? rooms of members of many of the business been N ANSWER NOT THE PERSON doing READ ANSWER your your households profits is in operation T TO PART INDICATED IN TO PART B, Q.2. For HOME, INSIDE THE residence household do the other kept by this during the past E B, 0.3? PART B, Q.3, how long has the RESIDENCE ........... 1 do you use own all of this owners live? household, 14 days? R RECORD THE enterprise been in HOME OUTSIDE THE for your enterprise? rather than P RESPONDENT'S operation? RESIDENCE . 2 business the other INDUSTRIAL SITE .... 3 bsns h te R ID HERE. TRADITIONAL MARKET 4 during owners? I COMMERCIAL DISTRICT normal s SHOP ...........SHOP.5 business E ROADSIDE .6 hours? OTHER FIXED PLACE ....7 PART D C MOBILE. 8 0 D E YES ... .1 YES . .1 YES . .1 (,,3) ID IF > 1, ,,6 (9) NO. . . .2 NO .... 2 NUMBER YEARS MONTHS E_ NUMBER NO 2 NUMBER PERCENT W i 2 as PART D: EMPLOYMENT (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5 6. 7. 8. 9. 10. 11. 12. 13. CHECK Beginning with ENTER THE ID During the During Over the Over the During those Beginning with Over the During those E Including ANSWER yourself, please list for CODES FOR past 14 those past 12 past 12 weeks, how yourself, please list for ENTER THE ID past 12 weeks, how N yourself, TO PART me the names of all ALL PEOPLE days, how days, how months, how months, many hours me the names of all CODES FOR months, many hours T how many C, Q.9. household members LISTED IN 3. many days many many weeks how many per week did household members ALL PEOPLE how many per week did E household who have worked in MAKE SURE did hours per did weeks did [PERSON] who have worked in LISTED IN 10. weeks did [PERSON] R members this enterprise during THAT THE [PERSON] day did [PERSON] [PERSON usually this enterprise during MAKE SURE [PERSON] usually p have spent the past 12 months. NUMBER OF work in the [PERSON] work in the I work in contribute? the past 12 months. THAT THE work in the contribute? R time NUMBER OFCv r I enter- usually enterprise? the enter- NUMBER OF enter- I working in ROWS FILLED ene- uuly ntris? hene- E working In IN IS THE SAME prise? contri- prise? ROWS FILLED prise? C thuisglhc : 10 g bCO9MF%l,LREETTATHbute? IN IS THE SAME E enterprise AS THE A H at any time ANSWER TO 1. sa>>N EXT )))NEXT ))))cTCsN EXT during the IFMORE THAN 5 THEN PERSON, PERSON, IF MORE THAN 5 ASE O1 OTHER COMPLETE 0.Q.5 OTHER THEN PERSON, C past12 QOMLET12Q.12 months? ANWR WORKERS, LIST 5-9 FOR EACH IF LAST IF LAST WORKERS,' LIST CMLT12IF LAST 0 ANSWER THE 5 MOST PERSON IN IF o PERSON, PERSON, THE 5 MOST AND 13PFOR D iS 1.1 IMPORTANT TURN. ,,8 )>14 014 IMPORTANT IN TURNS PS14 E ANSWER I UN 1 IS 2.2 NUMBER (>10) NAME ID CODE DAYS HOURS WEEKS WEEKS HOURS NAME ID CODE WEEKS HOURS i ____ ____I;I ON' 3 _ __ _ _ PART D: EMPLOYMENT (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. During the past 12 CHECK ANSWER During the How many How many Did any of Including in- When in operation When in operation When in operation E months, did this TO 2. past 14 days, days did each hours per them receive kind benefits, during the past 12 during the past 12 during the past 12 N business employ how many one of them day? any how much per months, how many months, how many months, how T anyone who is not a people did work for the (AVERAGE compensation week did this people did the people did the many days per E member of this this enterprise PER or any in-kind business pay enterprise usually enterprise usually week did each of R household? enterprise each week? PERSON] benefits for to these employ who are not employ who are not them usually work P employ who [AVERAGE their work? workers members of this members of this for the enterprise? R are not PER together? household? household? [AVERAGE PER I members of PERSON] PERSON] S this E household? C IF 0 1 D L < ))7||IFO)2l E YES ..1 ANSWER IS1 ..1 YES ..1 NO. .. 2 ANSWER IS2 ..2 NO . 2 (>>27) (>>22) NUMBER DAYS HOURS (>,21) AMOUNT NUMBER NUMBER NUMBER 3 PART D: EMPLOYMENT (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 24. 25. 26. 27. 28 29. How many Did they Including in- For this question, During the During the past 12 E hours per receive any kind benefits, include anyone who past 12 months, how much did N day? compensation how much per worked in this months, did you spend on payments T [AVERAGE or any in-kind week did this business. How you make to social security E PER benefits for business pay many persons who any system ? R PERSON] their work? to these worked in your payments to P workers business during the social R together? past 12 months security I were covered by system ? S social security E system ? C D [>d>PARTEl l T l E YES..1 YES ..1 NO . 2 NO ... 2 TIME NUMBER (>>27) AMOUNT NUMBER (>>PART E) AMOUNT UNIT L . 1 ........... OUR.... 2 AY.... 3 WEEK.... 4 FORTNIGHT... 5 MJONTH ...... 6 QUARTER.... 7 HALF YEAR... 8 YEAR. . .9 PART E: REVENUES AND OPERATION SCHEDULE (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. 7. 8. 9. Next, I would Does this Does this Please tell me What is the price that you What is your cost of How many READ CHECK ANSWER How many READ UNIT E like to ask you business business about the five receive most frequently for purchasing this article? UNIT GIVEN IN Q.5 TO PART C, Q.9. GIVEN IN Q.5 did you N some offer any purchase articles that this article? are there in one sell during the past 14 T questions services? any goods provide you with READ UNIT GIVEN days? E about how you for resale? the most receipts IN Q.6? R operate your from sales. P business. R LIST THE FIVE I Does this ARTICLES S business BELOW. THEN IF THE UNIT E manufacture ASK Q.5 TO 10 GIVEN IN Q.5 any goods? FOR EACH IS THE SAME IF < 1, SA ARTICLE IN AS THE UNIT AND ASK C TURN. GIVEN IN 0.6 FOR A 0 >8 SMALLER D UNIT E YES..1 YES..1 YES..1 ANSWER IS 1. .1 NO.. .2 NO ... .2 NO... 2 ANSWER IS 2.. 2 NUMBER TIME ___________ (>14) ARTICLES PRICE UNIT PRICE UNIT NUMBER (,,10) OF UNITS UNIT O._____ _=__I 2 H.t..... 2 AY.... ..3 WEEK.... .4 FORTNIGHT. .. 5 MONTH . .... 6 QUARTER.... 7 C::LF YE ... 8 YEAR.. .X PART E: REVENUES AND OPERATION SCHEDULE (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 10. 11. 12. 13. 14. 15. 16. 17. During the past 12 CHECK ANSWER Over the past 14 days, During the months that The next questions are about the During the During the past 14 What E months, when the TO 8. how much did you the business is revenue you earn from your past 14 days, how much percentage N business was spend on goods for operating, how much do business. Please include all days, for money has the of this T operating, how many resale? you usually spend on revenues in your answers (that how many business received money came E did you usually sell? goods for resale? is, the total cash and in-kind days was from the sales of its from the sale R value of goods and services that the products, goods or of products P you receive from the sale of business services? that were R goods and services) before in purchased subtracting any business operation? and resold S expenditures and any expenses without E >>>>NEXT ARTICLE, for your household. processing? Q.5 IF LAST ARTICLE, C ,l11 CHECK ANSWER 0 TO PART C, Q.9. D E ANSWER IS 1 1 ANSWER IS 1. .1 NUMBER TIME ANSWER IS 2 2 TIME ANSWER IS 2 2TIME OF UNITS UNIT (t13) AMOUNT UNIT AMOUNT UNIT (>>24) DAYS AMOUNT UNIT PERCENT 1 I l l l l l lll e _ I III HO.T..... 2 DAY .... .3 WEEK.... 4 FO.R2WZGHT... 5 NONTH ....6 QuARTEzR... - 7 HALF YNA-R.. .8 YEAR.. .. T | | | | [ l l l l I~~~~~~~~~~~~~~~~~~~~~~~ PART E: REVENUES AND OPERATION SCHEDULE (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 18. 19. 20 21. 22. 23. 24. 25. 26. During the past 14 days, What was the value During the What was the value During the What was the reason that During the Why is the business not During the E has the business made of these transactions past 14 of the goods and past 12 the business was not in past 12 currently in operation? months that N any transactions using (the value of goods days, has services consumed months, for operation all year long? months, for the business T something other than and services your by your household how many how many was in E money? For example, received as payment household over the past 14 months NEW BUSINESS, months was operation, R has the business received and the value of your consumed days? was the STARTED IN THE the how many P payments in the form of own products that any goods business in PAST 12 MONTHS. . .1 business in LACK OF ESSENTIAL days per R goods and services, or you used for or services operation? LACK OF ESSENTIAL operation? MATERIALS OR month did I have you paid for the payment) over the produced MATERIALS OR SPARE PARTS ....... 1 this business S purchase of any items past 14 days? by this SPARE PARTS ...... 2 SEASONAL WORK ...... 2 usually E with your own products? business? SEASONAL WORK ..... 3 WEATHER IS BAD ..... 3 operate? WEATHER WAS BAD...4 EARN TOO EARNED TOO LITTLE INCOME. 4 C IF 12 LITTLE INCOME .... 5 ILLNESS. 5 O ,,2 6 ILLNESS ..............F 6 FOUND BETTER WORK. .6 D OTHER .7 NEED TO CARE FOR E YES.-.1 YES. .1 HOUSEHOLD MEMBERS.7 E YES .1 . YES. 1 _ _OTHER .. 8 NO.. 2 TIME NO 2 TIME (,,20) AMOUNT UNIT (,>22) AMOUNT UNIT MONTHS l lMONTHS DAYS 2 3_ PART E: REVENUES AND OPERATION SCHEDULE (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 27. 28. 29. 30. 31. 32. 33. 34 In a typical year, are your sales high, average, low, or none (when In a 'high sales' In an 'average In a 'low sales' In an 'average During the past 12 What was the value of During the E the business is not in operation) in the month of [MONTH]? month, what is sales' month, month, what is sales' month, months, has the business these transactions (the past 12 N your level of what is your your level of what made any transactions value of goods and months, did T sales per level of sales sales per percentage of using something other services received as your E month? per month? month? this money than money? For payment and the value household R comes from the example, has the business of your own products ever P sale of received payments in the that you used for consume any R products that form of goods and payment) during a goods or I READ EACH MONTH IN TURN. are purchased services, or have you paid month with 'average services S and resold for the purchase of any sales'? produced by E without items with your own this processing? products? business? HIGH ............... 1 C AVERAGE ..... 2 O LOW ...... 3 D NONE: NOT IN OPERATION .4 E YES .-.1 YES. .1 NO.-2 AMUT TIME NO..2 IJANIFEB MAR APR MAY JTUMIJUL AUG SEPIOCTINOVIDECI -AMOUNT IAMOUNT IAMOUNT IPERCENT (>>34) AMUT UNIT (,~PAXRT F) w1' 1 1 I I I I 1, I I I I I I I I I I I I .. a, '-41 12 IIIIII 1 . . 1- 1 1 11 1 PART E: REVENUES AND OPERATION SCHEDULE (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 35. What was the value of E the goods or services N that your household T consumes during a E month with 'average R sales'? P R 0 E TIME AMOUNT UNIT 0% 2 3 PART F: INPUT USE AND EXPENDITURES (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1 2 3. 4 5.6. 7. 8 I would like to ask you some questions Did you CHECK ANSWER During the past 14 During a month with During the If you had to purchase From this [ITEM] E about the materials and articles you buy any TO PART C, Q.9. days, how much did "average sales", how past 12 the quantity of this that you N use in your production or trade. These [ITEM] you spend on [ITEM] much did you spend months, [ITEM] that the acquired for your T questions refer only to your enterprise, with cash in cash or credit? on [ITEM] in cash or did you household provided to business, did the E I not to your household or to another or credit? credit? use any this enterprise, how household R T enterprise in your household. [ITEM] much would you be consume any? P E that the spending each month? R M In your business, did you use any household I S [ITEM] during the past 12 months? had paid S for? E ASK THIS QUESTION FOR EACH ITEM LISTED BELOW. AFTER LAST YES. . 1 C ITEM, GO TO FIRST ITEM USED NO . 2 o (WHERE ANSWER HERE IS 1) AND ,NEXT ITEM ASK QUESTIONS 2-8 FOR THAT USED, Q.2. D ITEM. IF LAST E I T EM. YES . I ANSWER IS 1..1 YES. 1 IF LAS YES..1 NO ...2 ANSWER IS 2.2 | TIME | TIME NO ... 2 TIME NO .2 (>6) ('>5) AMOUNT t UNIT AMOUNT IUNIT (,,8) AMOUNT IUNIT I Raw materials Freight, transport Fuel, oil Electricity Water Insurance _Other items 2 Raw materials Freight, transport Fuel, oil Electricity :_l_____l__ l_ Water Insurance Other items 3 Raw materials Freight, transport t___l I__r_l__ Fuel, oil Electricity Water Insurance Other items i j - I _ _ _ l I . PART F: INPUT USE AND EXPENDITURES (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 9. 10. 11. 12. 13. What Is this How much did During the How much did you E percentage of enterprise you spend on past 12 spend on these other N the total did the registered license or months, did taxes and fees over the T household with the registration this business past 12 months? E I typically use in a government? fees over the incur any R T month? past 12 expenses on P E months? any other R M taxes or fees I S (such as S examo/e)? E ,>NEXT ITEM |A RTG C USED, Q. 2. IF LAST 0 ~~~~ITEM, >,10 D E YES. .1 YES. .1 NO.. .2 NO.. .2 TIME _AMOUNT (>2) AMOUNT (,>PART G) IAMOUNT UNIT 1 Raw materials Freight, transport Fuel, oil O Electricity Water Insurance Other items Freight, transport : :Fuel, oii: : : :: :: aer : : : ri Surance O0ther:itemns: :000tti: 3 Raw materialsllll l Freight, transport Fuel, oil Electricity Water lInsurance _ Ot-her i t ems PART G: BUSINESS ASSETS (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. I would now like to ask you questions about the assets At present, Is this enterprise the If you wanted Did you rent or E (that is, equipment, buildings, vehicles, tools, etc.) that does this sole owner of this to sell the borrow any N you use in your business. enterprise [ITEM], or is ownership [ITEM], how [ITEM] from T own this shared with another much could someone E I Over the past 12 months when your enterprise was in [ITEM]? enterprise? you sell it for outside the R T operation, have you used [ITEM] for your business? today? household? P E R M S~~~~~ E ASK THIS QUESTION FOR EACH ITEM LISTED BELOW. AFTER LAST ITEM, GO TO FIRST c ITEM USED (WHERE ANSWER HERE IS 1) O AND ASK QUESTIONS 2-14 FOR THAT ITEM. D SOLE OWNER... 1 E YES. ..1 YES . 1 SHARED WITH YES .. 1 NO... 2 NO .2 ANOTHER NO.... 2 (,,5) ENTERPRISE ..2 A MOUNT (,8) 1 Land Buildings Equipment and machinery -4 Furniture Small or large tools Large vehicles (trucks, cars, boats, etc.) Small vehicles (bicycles, carts, etc.) Other durable goods 2 Land , ,, Buildings Equipment and machinery _ Furniture Small or large tools Large vehicles (trucks, cars, boats, etc.) Small vehicles (bicycles, carts, etc.) ____________ _ Other durable goods 3 Land Buildings Equipment and machinery Furniture Small or large tools Large vehicles (trucks, cars, boats, etc.) Small vehicles (bicycles, carts, etc.) Other durable goods PART G: BUSINESS ASSETS (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 6. 7. 8. 9. 10. 11. 12 13. 14. During the past 12 If you During How much did you CHECK In the past 12 How much did Have you sold any How much in E months, how much did wanted to the past spend on maintenance ANSWER months, have you pay in total [ITEM] from your total did you N you spend on rental buy this 12 and repair of [ITEM] TO Q.2. you acquired any for the [ITEM]? business in the receive from the T payments? [ITEM] that months, over the past 12 (ITEM] which you past 12 months? sale? E I you rented, have you months? use for your R T how much incurred business, or IF ACQUIRED P E would it any have you spent THROUGH R M cost you expenses on improvements GIFT OR I S today? to of [ITEM] that INHERITANCE, S maintain you already ESTIMATE THE E or repair own? VALUE. ))NEXT ITEM ENTER 0 IF [ITEM]? I USED, Q.2. IF ITEM WAS LAST ITEM, C BORROWED ANSWER YES. . . 1 >)PART H O FOR FREE. is 1..1 NO. 2 D (,11) (>>NEXT ITEM E YES. .1 ANSWER YES ... 1 USED, Q.2. | TIME : NO .2 TIME IS 2. .2 NO 2 IF LAST ITEM, _AMOUNT |UNIT AMOUNT (,10) AMOUNT | UNIT (u13) (-13) AMoUNT ,PART H) AMOUNT 1 Land _ _ Buildings = = Equipment and machinery -4 Furniture = = Small or large tools Large vehicles _ Small vehicles _ Other durable goods 2 Land = :_-_=______: Buildings __::i:::_:::: Equipment and machinery . _ Furniture _ . Small or large tools :_:_: Large vehicles Small vehicles Other durable goods _ : ____L_. 3 Land Buildings Equipment and machinery Furniture Small or large tools Large vehicles = = Small vehicles Other durable goods = PART H: GENERAL BUSINESS CONDITIONS (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE _1. 2. 3. 4. 5. 6. 7. 8. 9. 10 11. 12. 13. 14. Finally, I would How much did If you did Does your How much did If you did Does your What is the If you did On a typical On a good day, On a bad day, During the past During how E like to ask you your current not add to business your current not add to business value of these not add to day, how much how much do how much do 12 months, when many months N some questions inventory of your have an inventory of your have an products or your do you receive you receive you receive your business was your cash T about the raw materials inventory, inventory of these items inventory, inventory goods? inventory, from the sale from the sale from the sale was in operation, sales revenue E general cost you to how many items cost you? how many of finished how many of goods and of goods and of goods and were there not enough to R operations of buy? days of requiring days of products days of services (cash services (cash services (cash periods when cover your P your business. production further production not yet sales and credit)? and credit)? and credit)? your cash sales cash R would this processing? would this sold? would this revenue was not expenditures? I Does your inventory inventory inventory enough to cover S business have last? last? last? your cash E an inventory of expenditures? raw materials? C 0 D E YES..1 YES..1 YES..1 YES. .1 NO . 2 NO . 2 NO. . 2 NO.. .2 _ l ,, 4 l AMOUNT DAYS ( ,,7 ) AMorUNT DAYS ( ,,10Ol AMOUNT DAYS AMOUNT AMODUNT AMOUNT A A15 MONTHS U-. 2 w PART H: GENERAL BUSINESS CONDITIONS (STANDARD VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 15. 16. 17. 18. 19. What is the Do you or the What amount of money After making purchases for How much money is E usual amount family members from the business do the business and after usually left? N of monthly working in your you usually use for spending some for yourself T cash business yourself or your or your household, is there E expenditures sometimes use household? usually any money left as R on items for some of the sales income for the household or P use in your revenue from the for the purpose of saving? R business? enterprise for your I personal needs or S those of your >)>NEXT ENTERPRISE E household? IF LAST ENTERPRISE, )>NEXT MODULE C YES. .1 0 NO... .2 D YES.. ()NEXT ENTERPRISE E YES. I ~~~~~~~~~IF LAST ENTERPRISE, NO. 2 )) TNEXT MODULE) rIME _ AMOUNT (,18) AMOUNT UNIT AMOUNT I 11 s E 2 2 ::l:: :: :0:ll ::: 0:3 0 : l:::: PART A: HOUSEHOLD EXPOSURE TO ENTREPRENEURSHIP (EXPANDED VERSION) HEAD OF THE HOUSEHOLD 1. 2. I would like to ask you a few questions about work Was that a: on own account in your extended family. Work on farm? ......... .............1 own account means operating a farm or one's own manufacturing or construction business for the purpose of earning an income. enterprise?... ............... 2 Did [PERSONS] ever engage in work on own shop or trading account? business? .................... 3 enterprise that provided services? .................. 4 ASK 1 AND 2 FOR ALL THREE GROUPS OF PERSONS LISTED BELOW. PROMPT FOR MULTIPLE RESPONSES. RECORD EACH RESPONSE. YES ...1 )))DNEXT PERSONS NO....2 DON'T KNOW.... 3 IF LAST PERSONS, >>PART B IF 2 OR 3, »>NEXT PERSONS IF LAST PERSONS, >>PART B FIRST SECOND THIRD FOURTH RESPONSE RESPONSE RESPONSE RESPONSE Parents of head of household en Parents of wife of household Siblings of head or wife of household PART B: ESTABLISHING THE EXISTENCE OF NON-FARM ENTERPRISES (EXPANDED VERSION) HEAD OF THE HOUSEHOLD 1. 2. 3. Over the past 12 months, What are the major reasons that this What kind of enterprises does your household operate? has anyone in your household is not operating a non- household operated any agricultural business? non-agricultural HIGHER EARNINGS IN enterprise which OTHER WORK. ....... . 1 PROBE TO DETERMINE INDUSTRIAL produces goods or LACK OF FINANCES OR CREDIT.2 SECTOR IN WHICH ENTERPRISE services (for example, LACK OF OWN SKILL .3 OPERATES. artisan, metalworking, LACK OF ACCESS TO RAW tailoring, repair work; also MATERIALS ......... ..... 4 include processing and LACK OF CUSTOMERS .......... 5 selling your outputs from LACK OF ADEQUATE LABOR ..... 6 your own crops if done GOVERNMENT LICENSING regularly) or has anyone AND REGULATIONS ............ 7 in your household owned PROBLEMS WITH OBTAINING a shop or operated a POWER OR WATER CONNECTIONS.8 trading business? OTHER REASONS ........... 9 YES.. 1 F (>>NEXT MODULE) | (-3) PRIMARY SECONDARY ENTERPRISE INDUSTRY NO... 2 PROBLEM PROBLEM ID FULL WRITTEN DESCRIPTION CODE aI o1 I I 1 0%~ ~ ~ ~ ~ ~ ~~~~~~~~~~~~~,f fT ::00 :Tt0 0: 2:::I:: 3f :::::: : ::: C:: _~~~~~~~~~~~~~~~~~ , I 0 00 :5 t: : :: :: 0 :: _ :::: :::: :: ::: : ::: ::::::: : :0:: : PART B: ESTABLISHING THE EXISTENCE OF NON-FARM ENTERPRISES (EXPANDED VERSION) HEAD OF THE HOUSEHOLD 4. Who is most informed about and/or in charge of day-to-day operations of the enterprise? COLLECT THE INFORMATION ON THIS PAGE FOR ALL ENTERPRISES BEFORE PROCEEDING TO PART C. THEN COMPLETE PARTS C - H FOR THE FIRST ENTERPRISE, THEN THE SECOND, ETC., UNTIL ALL ENTERPRISES ARE SURVEYED. (THERE IS ROOM ON PARTS C - H FOR THREE ENTERPRISES. IF THIS HOUSEHOLD HAS MORE THAN THREE ENTERPRISES, FILL OUT A SEPARATE SET OF PAGES FOR PARTS C - H FOR THE ADDITIONAL ENTERPRISES.) IF IT IS NOT POSSIBLE TO SPEAK TO THE PERSON WHO IS MOST INFORMED ABOUT AND/OR IN CHARGE OF THE ENTERPRISE, TRY TO SCHEDULE ANOTHER VISIT TO TALK TO THIS PERSON. NAME IID CODE ui 14= 14= PART C: GENERAL INFORMATION (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. 7. 8. 9. Are you IF THE I would like to talk to Where do you operate the enterprise? How many Do you or In how What share Has this E READ RESPONDENT IS you about your rooms of the many of the business been N ANSWER NOT THE business doing READ your members of households profits is in operation T TO PART PERSON ANSWER TO PART B, HOME, INSIDE THE residence your do the other kept by this during the past E B, Q.4? INDICATED IN Q.3. For how long has RESIDENCE ..... ..1 do you use household owners household, 14 days? R PART B, 0.4, the enterprise been in HOME OUTSIDE THE for your own all of live? rather than P RECORD THE operation? RESIDENCE .2 business this the other R RESPONDENT'S INDUSTRIAL SITE . 3 during enterprise? owners? I ID HERE. TRADITIONAL MARKET. 4 normal S COMMERCIAL DISTRICT business E SHOP .5 hours? ROADSIDE. 6 OTHER FIXED PLACE 7 ART.D C MOBILE.. 8 0 D E YES ...1 YES.. YES ..1 (,,3) ID I (*9) NO .... 2 NO.... 2 NUMBER Y |_ M O N T H S __ NUMBER NO .... 2 NUMBER PERCENT 2 3 PART D: EMPLOYMENT (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Including CHECKANSWER Beginningwith ENTERTHE ID Duringthe During Duringthe Howmuch did you pay Overthe past 12 Overthe E yourself, how TO PART C, Q.9. yourself, please list for CODES FOR ALL past 14 those days, past 14 [PERSON] for his months, how past 12 N many me the names of all PEOPLE LISTED IN days, how how many days, did work? many weeks did months, T household household members 3. MAKE SURE many days hours per you pay [PERSON] work how many E members have who have worked in THAT THE NUMBER did day did [PERSON] in the enterprise? weeks did R spent time this enterprise during OF ROWS FILLED [PERSON] [PERSON] for his [PERSON] P working in this the past 12 months. IN IS THE SAME AS work in the usually work? work in the R enterprise at THE ANSWER TO 1. enterprise? contribute? enterprise? I any time during THEN COMPLETE p,)NEXT S the past 12 5-13 FOR EACH E months? PERSON IN TURN. PERSON, 0.5 IF LAST IF MORE THAN 5 PERSON, ),20 OTHER C WORKERS, LIST 0 THE 5 MOST D IMPORTANT L J.. E ANSWER IS 1. .1 YES . 1 ANSWER IS 2. .2 NO.. .2 TIME NUMB3ER (»,14) NAME ID CODE DAYS HOURS >> 9) AMOUNT UNIT WEEKS WEEKS NOUR .... 2 DAY... 3 WEEK....4 FORTNIGHT... 5 MONTH ..... 6 QUARTER.... 7 HALF YEAR... 8 YEAR... 9 PART D: EMPLOYMENT (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 11. 12. 13. 14. 15. 16. 17. 18. 19. During Did you ever pay How much did you pay Beginning with ENTER THE ID Over the During Did you ever pay How much did you pay E those [PERSON] for his [PERSON] for his yourself please list for CODES FOR ALL past 12 those [PERSON] for his [PERSON] for his N weeks, how work? work? me the names of all PEOPLE LISTED IN months, weeks, how work? work? T many hours household members 14. MAKE SURE how many many hours E per week who have worked in THAT THE NUMBER weeks did per week R did this enterprise during OF ROWS FILLED IN [PERSON] did P [PERSON] the past 12 months IS THE SAME AS THE work in the [PERSON] R usually ANSWER TO 1. enterprise? usually I contribute? THEN COMPLETE 16- contribute? s ))))~~~~~~NEXT 19 FOR EACH )>>NEXT E PERSON, Q.5 PERSON IN TURN. PERSON, 0.16 IF LAST IF MORE THAN 5 IF LAST PERSON, s>20 OTHER PERSON, s>20 C YES. .1 WORKERS, LIST YES. .1 0 NO.. .2 THE 5 MOST NO.. .2 D (>>NEXT PERSON, IMPORTANT (.NEXT PERSON, E Q.5 Q.16 IF LAST TIME IF LAST TIME HOURS PERSON, >20) AMOUNT UNIT NAME ID CODE WEEKS HOURS PERSON, ,,20) AMOUNT UNIT HOUR.... .2 DAY.... 3 WEEK.... .4 FOR THIGHT... .5 MONTH.....6 QUARTER.. . .7 HALF YEAR... .8 YEA.R. . .9 PART D: EMPLOYMENT (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 20. 21. 22. 23. 24. 25 26. 27. 28. 29. CHECK ANSWER During the During the And during the past 14 FILL OUT EACH ROW During the How many How many Did they Including in- How many E TO 2. past 12 past 12 days? IN TURN. MAKE SURE past 14 days did each hours per receive any kind benefits, of these N months, did months, how THAT THE SUM OF days, how one of them day? compensation how much per [PEOPLE] T this many people THE THREE ROWS many work for the [AVERAGE or any in-kind week did this had at E business did this FOR 24 IS THE SAME [PEOPLE] enterprise PER benefits for business pay least 6 R employ business AS THE RESPONSE did the each week? PERSON their work? to these years of P anyone who usually TO 23, AND THAT THE enterprise [AVERAGE WITHIN [PEOPLE] schooling? R is not a employ who SUM OF THE THREE employ? PER THE together? I member of are not ROWS FOR 32 + 33 IS PERSON GROUP] S this members of IF 0, ENTER 0 THE SAME AS THE WITHIN THE E household? this AS AN ANSWER TO RESPONSE TO 22. GROUP] household? 24 FOR EACH GROUP OF WORKERS (WITHOUT ASKING C QUESTION 24), IF 0 D0 AND ,33 3 E ANSWER IS 1 ..1 YES ..1 YES ..1 ANSWER IS 2. .2 NO.. 2 NO. _2 (,,4l1 (~>51) NUMBER NUMBER NUMBER DAYS HOURS (>,29) AMOUNT NUMBER 1 PAID WORKERS, BELONGING TO I I. APPRENTICES UNPAID WORKERS, NOT BELONGING TO THE HOUSEHOLD APPRENTICES| UNPAID WORKERS,| NOT BELONGING TO| THE HOUSEHOLD| 2 t.".;.,B 3 I_ PART D: EMPLOYMENT (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 30. 31. 32. 33. 34. 35. 36. 37. 38. 39 40. How many How many When in operation When in operation When in How many Did they Including in- How many How many How many of these E of these of these during the past 12 durng the past 12 operation during hours per receive any kind benefits, of these of these [PEOPLE] were N [PEOPLE] [PEOPLE] months, how many months, how many the past 12 day? compensation how much per [PEOPLE] [PEOPLE] female? T have been are [PEOPLE] did the [PEOPLE] did the months, how [AVERAGE or any in-kind week did this had at have been E an female? enterprise usually enterprise usually many days per PER benefits for business pay least 6 an R apprentice employ? employ? week did each of PERSON their work? to these years of apprentice P either in them usually work WITHIN [PEOPLE] schooling? either in this R this for the enterprise? THE together? business or I business or [AVERAGE PER GROUP] with S with PERSON someone E someone WITHIN THE else? else? >>NEXT IF 0, >)NEXT GROUP] ,,,,NEXT GROUP, Q.24. GROUP, Q.24. GROUP, Q.24. C IF LAST IF LAST IF LAST 0 PEOPLE, ))51 PEOPLE, ,,51 PEOPLE, ,,51 D E YES. .1 . NUMBER NUMBER NUMBER NUMBER NUMBER NUMBER (,38) AMOUNT NUMBER NUMBER NUMBER (-. ____ co 2::: 3t: 0X::t;::0 ::X: 00:l : : :S0fi;XX:0ff: 00 :0:00fd00:000f::V:E::lf;0: :VV; ;i 0: 0:0:t:f : :0t f000:0 : PART D: EMPLOYMENT (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. During the During the FILL OUT EACH ROW When in operation When in How many Did they Including in- How many How many How many of If the E past 12 past 12 IN TURN. MAKE SURE during the past 12 operation during hours per receive any kind of these of these these [PEOPLE] government N months, did months, how THAT THE SUM OF months, how many the past 12 day? compensation benefits, [PEOPLE] [PEOPLE] were female? raises the T this many people THE THREE ROWS [PEOPLE] did the months, how [AVERAGE or any in-kind how much had at least have been minimum E business did this FOR 43 THE SAME AS enterprise usually many days per PER benefits for per week 6 years of an wage, would R employ business THE RESPONSE TO employ? week did each of PERSON their work? did this schooling? apprentice you increase P anyone who usually 42. them usually work WITHIN business either in this the wage of a R is not a employ who for the enterprise? THE pay to these business or hired I member of are not [AVERAGE PER GROUP] [PEOPLE] with worker? S this members of PERSON together? someone E household? this WITHIN THE else? household? IF 0, s)NEXT GROUP] >))NEXT GROUP. GROUP, Q.43. C IF LAST IF LAST O PEOPLE, ))51 PEOPLE, ))51 D E YES. .1 YES. .1 YES. .1 NO... .2 No... .2 NO.. .2 ( ,51) NUMBER NUMBER NUMBER (»,48) AMOUNT NUMBER NUMBER NUMBER (,51) . r ~~~~PAIDWRES O I BELONGING TO THE w l I I HOUSEHOLD UNPAID 9QU oQ,Le'; NOT BELONGING go] THE AUUYdEi uinuu 2 | PAIDWORKERS, NO BELONGING TO TH l HOUSEHOLD| I I 3 P~~~~~~~~~~AID WORKERS, NO BELONGING TO TH HOUSEHOL UNPAID 9 NOT BELONGN P THE HOL' !h_- ui nuu PART D: EMPLOYMENT (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 52. 53. 54 55. 56. 57 Would you increase the For this question, During the During the past 12 One year ago, how Two years ago, how E wage by the same include anyone who past 12 months, how much did many workers did many workers did N amount as the worked in this months, did you spend on payments this enterprise this enterprise T government raised the business. How you make to social security employ, including employ, including E minimum wage, or by a many persons who any system ? yourself, other yourself, other R smaller amount? worked in your payments household and non- household and non- P business during the to social household members? household members? R past 12 months security I were covered by system ? S social security E system ? IF IF ENTERPRISE ENTERPRISE C WAS NOT WAS NOT 0 IF OPERATING, OPERATING, D [,56 WRITE 0. WRITE 0. E SAME AMOUNT .... 1 YES ..1 SMALLER AMOUNT.2 NO. 2 TIME NUMBER (>>56) AMOUNT UNIT NUMBER NUMBER 1 J 2 _ 3___ PART E: REVENUES AND OPERATION SCHEDULE (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1 . 2. 3. 4. 5. 6. 7. 8. 9. Next, I would Does this Does this Please tell me What is the price that you What is your cost of How many READ CHECK How many READ UNIT E like to ask you business business about the five receive most frequently purchasing this article? UNIT GIVEN IN ANSWER GIVEN IN Q.5 did you N some offer any purchase articles that for this article? Q.5 are there in TO PART C, sell during the past 14 T questions services? any goods provide you with one READ UNIT Q.9. days? E about how you for resale? the most receipts GIVEN IN Q.6? R operate your from sales. P business. R LIST THE I Does this FIVE S business ARTICLES IF THE UNIT E manufacture BELOW. GIVEN IN Q.5 any goods? THEN ASK IS THE SAME 7 Q.5 TO 10 AS THE UNIT IF < 1, FO6 C FOR EACH GIVEN IN Q.6 A SMALLER o ARTICLE IN > UNIT ANSWdER D I TURN. is 1.-. E YES..1 YES..1 YES..1 ANSWER NO 2 NO.. 2 NO ... 2 IS 2. .2 NUMBER TIME ___________ ______ (>>17) ARTICLES PRICE UNIT PRICE UNIT NUMBER (,10) OF UNITS UNIT 2I I II n ~I I I__ =__ PART E: REVENUES AND OPERATION SCHEDULE (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 10. 11. 12 13. 14. 15. 16. During the past 12 CHECK Over the past 14 days, During the months that During the months that How did you, or will you, Within how many E months, when the ANSWER TO 8. how much did you the business is the business is pay for the goods for resale days, weeks or N business was operating, spend on goods for operating, how much do operating, what that you purchased on months did you, or T how many did you resale in cash or credit? you usually spend on percentage of goods for credit? do you, usually have E usually sell? goods for resale in cash resale did you purchase to make the last R or credit? with credit rather than payment in order to P with cash? fulfill these credit R CASH .1 obligations? I GOODS OR SERVICES )>>>NEXT ARTICLE, PRODUCED BY THE E )>)NEXT ARTICLE, ETRRS . . Q.5 ~~~~~~~~~~~~ENTERPRISE 2 Q.5 LASBOR .. ..3 IF LAST ARTICLE, COMBINATION. 4 0 ANSWER IF = 0, >>17 D is 1..1 E ANSWER NUBER | TIM IS 2 2 TIME | TIME NUMBER OF TIME _ OFUITS IT I AMOUNT UNIT UNIT PERCENT PERIODS UNIT HOUR.... .2 DlAY.... 3 FWEEK.... .4 FORTNIGHT... 5 MONTH ....6 QUARTER.... 7 HALF YEAR... .8 YEAR. .9 PART E: REVENUES AND OPERATION SCHEDULE (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 17. 18. 19. 20. 21. 22. 23. Who buys the goods and The next questions are about the During the During the past 14 What During the past 14 days, What was the value of E services that this enterprise revenue you earn from your past 14 days, how much money percentage has the business made these transactions (the N sells? business. Please include all days, for has the business of this any transactions using value of goods and T revenues in your answers (that is, how many received from the sales money came something other than services received as E the total cash and in-kind value of days was of its products, goods from the sale money? For example, payment and the value R goods and services that you the or services? of products has the business of your own products P OTHER HOUSEHOLDS OR receive from the sale of goods business in that were received payments in the that you used for R INDIVIDUALS.. ....... 1 and services) before subtracting operation? purchased form of goods and payment) over the past i SMALL ENTERPRISES. ..2 any business expenditures and and resold services, or have you 14 days? S LARGE ENTERPRISES .... 3 any expenses for your household. without paid for the purchase of E GOVERNMENT OR PUBLIC processing? any items with your own FIRMS ............... 4 products? NATIONAL TRADERS OR C RETAILERS ........... 5 CHECK ANSWER O EXPORTERS OR FOREIGN TO PART C, Q.9. D PURCHASERS .......... 6 E ANSWER IS 1 ..1 YES . 1 PRIMARY SECONDARY ANSWER IS 2 2 TIME NO .2 TIME BUYER BUYER (>,28) DAYS AMOUNT UNIT PERCENT (,,24) AMOUNT UNIT 2 I I I I I I I I I I X ~~~~ ~~I I I I I I I I I I | NOUR... 2 DAY .. .3 WES...... 4 FORTNfIGHT ...... 5 MONTH . ..6 QUARTER ...... 7 HALF YEAR. ..S YA ... .9 PART E: REVENUES AND OPERATION SCHEDULE (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 24. 25. 26. 27. 28. 29. 30. 31. 32. During the What was the value of During the What was the reason that the What was During the Why is the business not Will you start In how many E past 14 the goods and services past 12 business was not in operation the last past 12 currently in operation? operation of the months from N days, has consumed by your months, for all year long? month that months, for business again? now will you T your household over the pas how many the how many resume E household 14 days? months was NEW BUSINESS, business months was operation of R consumed the STARTED IN THE was in the the business P any goods or business in PAST 12 MONTHS...1 operation? business in LACK OF ESSENTIAL again? R services operation? LACK OF ESSENTIAL operation? MATERIALS OR I produced by MATERIALS OR SPARE PARTS 1 S this SPARE PARTS ...... 2 SEASONAL WORK ...... 2 E business? SEASONAL WORK ..... 3 WEATHER IS BAD ..... 3 WEATHER WAS BAD .4 EARN TOO EARNED TOO LITTLE INCOME ..... 4 c IF 12 LITTLE INCOME ......... 5 ILLNESS . . 5 YES . 1 o >>34 ILLNESS .6 FOUND BETTER WORK .6 NO .. 2 D OTHER . 7 NEED TO CARE FOR (,>34) E YES ..1 HOUSEHOLD MEMBERS.7 DON'T KNOW NO.. 2 TIME OTHER .....8 YET ..3 (*26) AMOUNT UNIT MONTHS, MONTH MONTHS (,,33) MONTHS 0 1 00 2~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ PART E: REVENUES AND OPERATION SCHEDULE (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 33. 34. What will determine whether During the E you will start operation of the months that N enterprise again? the business T was in E START OF SEASON 1 operation, R STR FSAO. .1 how many R AVAILABILITY OF days per INPUTS ....... 2 dy e R INUS 2 month did I BETTER MARKET FOR this business i PRODUCTS l........l3 usuy E AVAILABILITY OF usuate? CREDIT .......... 4 MANPOWER IN THE HOUSEHOLD .. 5 C NEED FOR INCOME IN 0 THE HOUSEHOLD 6 D LOSS OF JOB...... 7 E OTHER ............ 8 DAYS c I I 2~ ~ l PART E: REVENUES AND OPERATION SCHEDULE (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 35. 36. 37. 38. It is important for us to understand how much the activity in your business varies. In a typical year, are your sa es high, average, low, or none (when In a 'high In an 'average E Can you tell us how many workers this business has employed on any typical day the business is not in operation) in the month of [MONTH]? sales' month, sales' month, N in each of the past twelve months? Include yourself, any household members, what is your what is your T and anyone not belonging to the household who worked for the enterprise. level of sales level of sales E per month? per month? R R ENTER THE NUMBER OF WORKERS IN THE CELLS FOR READ EACH MONTH IN TURN. S THIRTEEN MONTHS, STARTING WITH THE CURRENT MONTH IN THE CURRENT YEAR AND WORKING E BACKWARD TO THE CURRENT MONTH IN THE PREVIOUS YEAR. C HIGH,............ 1 AVERAGE ... . ,...... 2 O LOW . . . . . . . . . ..3 D NONE: NOT IN OPERATION 4 E I JANIFEBIMAR APRIMAYIJUNIJULIAUGISEP I CTNOV DEC JAN FEB MAR APR NAY JUN JUL AUG SEP OCT NOV DEC AMOUNT AMOUNT 1 PREVIOUS YEAR 0 CURRENT YEAR. 2 PREVIOUS YEAR CURRENT YEAR 3 PREVIOUS YEAR CURRENT YEAR PART E: REVENUES AND OPERATION SCHEDULE (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 39. 40. 41. 42. 43. 44. In a 'low sales' In an 'average During the past 12 What was the value of During the What was the value of E month, what is sales' month, months, has the business these transactions (the past 12 the goods or services N your level of what made any transactions value of goods and months, did that your household T sales per percentage of using something other services received as your consumes during a E month? this money than money? For payment and the value household month with 'average R comes from the example, has the of your own products ever sales'? P sale of business received that you used for consume any R products that payments in the form of payment) during a goods or I are purchased goods and services, or month with 'average services S and resold have you paid for the sales'? produced by |,PART F E without purchase of any items with this processing? your own products? business? C 0 D E YES. . 1 YES . 1 NO. . 2 TIME NO ... 2 TIME AMorUNT PERCENT (t»43) AMOUNT UNIT (>>PART F) AMOUNT UNIT 21 1 1 1 1 1 T1 3 1. HOUR.... 2 DAY.... 3 WEEF K... 4 FORTNIGHiT ...... 5 MONTH ...... 6 QUARTER ..... ; 7 . HALF YEAR ... 8 YEAR ... 9| PART F: INPUT USE AND EXPENDITURES (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. I would like to ask you some questions about the During the During the last month During a month with During a month with During a month with E materials and articles you use in your production past 12 that the business was in "average sales", how "high sales", how much "low sales", how much N or trade. These questions refer only to your months, operation, how much much did you spend on did you spend on did you spend on T enterprise, not to your household or to another did you did you spend on [ITEM] in cash or [ITEM] in cash or [ITEM] in cash or E I enterprise in your household. buy any [ITEM] in cash or credit? credit? credit? R T [ITEM] credit? P E In your business, did you use any [ITEM] during with cash R M the past 12 months? or credit? I S S E ASK THIS QUESTION FOR EACH ITEM LISTED BELOW. AFTER LAST ITEM, GO TO FIRST ITEM USED (WHERE ANSWER c HERE IS 1) AND ASK QUESTIONS 2-25 O FOR THAT ITEM. IF NONE IS USED, SKIP D TO 26. E YES. .1 YES. .1 NO... .2 NO... 2 TINE | TIME TIME | TIME ___________________ (,,10) ~AMOUNT |UNIT T UNIT AMOUTNT UNIT A|UNIT 1 Raw materials Freight, transport Fuel, oil Electricity Water Insurance _Other items 2 Raw materials Freight, transport Fuel, oil Electricity Water Insurance _Other items 3 Raw materials Freight, transport Fuel, oil Electricity Water Insurance Other items HOUR. ... 2 AY. ... 3 WEEK.... 4 FORTNIGHT... 5 mONTH ..... 6 QUARTER. ... 7 HALF YEAR... 8 YEAR ... 9 PART F: INPUT USE AND EXPENDITURES (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 7. 8. 9. 10. 11. 12. 13. 14 15. 16. During the past How did you, or will you, Within how many During the In a month with During the From which During the During the During the E 12 months, pay for the [ITEM] days, weeks or past 12 average sales, past 12 enterprise? past 12 past 12 past 12 N what purchased on credit? months did you, or do months, did how much months, did months, months, did months, T percentage of you, usually have to you obtain were these you receive did you you receive did you E I [ITEM] did you make the last any [ITEM] products any [ITEM] use any any [ITEM] gather any R T purchase with payment in order to in exchange worth? from [ITEM] for free from [ITEM] P E credit rather fulfill these credit for products another that the others without R M than with cash? obligations? of this enterprise household outside the payment? I S business? in the had paid household? S CASH .. . 1 household? for? E GOODS OR SERVICES PRODUCED BY THE ENTERPRISE . 2 C LABOR .3 O IF = 0, COMBINATION . 4 D >> 1 o OTHER .5 E YES. .1 YES. .1 YES. .1 YES. .1 YES. .1 NUMsER OF TINE NO. ..2 NO... .2 ENTERPRISE NO.. .2 NO ... 2 NO ... .2 _PERCENT PERIODS UNIT (,12) AMOUNT (>>14) ID CODE 1 Raw materials Freight, transport w _Fuel, oil wi Electricity Water Insurance Other items 2 Raw materials Freight, transport Fuel, olt Electrdty Water Insurance Other items 3 Raw materials Freight, transport Fuel, oil l _ _ _ _ _ _ Electricity Water Insurance _Other items l l HOUR .... 2 DAY.... 3 WEEK. ... 4 FORTNIGHT... 5 MONTH ..... 6 QUARTER.... 7 HALF YEAR.... 8 YEAR. .. 9 PART F: INPUT USE AND EXPENDITURES (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 17. 18, 19. 20. 21. 22. 23. 24. 25A 25B 25C During CHECK If you had to purchase From this What From this [ITEM] Which What ADD THE SUBTRACT So about READ ANSWER E the past ANSWERS all that you did not pay [ITEM] that percentage that you acquired enterprise? percentage ANSWERS THE TO 25B percent of the N 12 TO Q.12, 14, for (received or you of the total for your business, of the total TO Q.21 ANSWER TO expenditures on this T months, 15, 16 AND gathered for free), how acquired did the did any other did they AND 24. Q.25A FROM [ITEM] are used by this E I did you 17., much would you be for your household enterprise in your typically 100. enterprise. Is that correct? R T obtain spending on this [ITEM] business, typically household use use in a P E any during a month with did the use in a any during the month? R M [ITEM] in 'average sales'? household month? past 12 months? I S any other consume S way? any during YES. 1 E the past 12 (>>NEXT ITEM months? USED, Q.2. IF LAST ITEM, ,,26) C YES... .1 NO....... 2 O NO ... 2 (>>20, REPEAT AND D (,,NEXT ITEM REVISE 20-25C E YES. . 1 ANY YES. 1 YES ..1 USED, Q.2. UNTIL ANSWER NO.. 2 ALL NO , 2 TIME NO... 2 IF LAST ENTERPRISE HERE IS 1.) __________ __ (,20) AMOUNT .UNIT (,22) PERCENT ITEM, >>26) ID CODE PERCENT PERCENT PERCENT 1 Raw materials Freight, transport c.j Fuel, oil Electricity Water Insurance - - Other items 2 Raw materials 2 Freight, transport _=- ; : : _== ; ;t; Fuel, oil : Eectricity: - ; ::0 : = : ;; ; : : ; y0: ;0: Water_ ____ ;:i :: :::: :::: : : ::::| : Insurance:___ Other items 3 Raw materials Freight, transport E Fuel, oil_ll Electricity=l| Water_ll lInsurance __ |HOEJR.... 2 DAY.... 3 WEJ .... 4 FORTNIGHT ...... 5 MONqTH ...... 6 QUARTE:R ..... 7 HALF YE"A .. S YE-AR... 9l PART F: INPUT USE AND EXPENDITURES (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 26. 27. 28, 29. 30. 31. 32. 33. 34. Is this How much did Do you know Do you know How much does it cost Have you What problems have During the How much did you E enterprise you spend on whether you how much it to register this encountered you encountered? past 12 spend on these other N registered license or must register costs to business? any problems months, did taxes and fees over the T with the registration the business register this from not this business past 12 months? E government? fees over the with the business with registering incur any R past 12 government? the this expenses on P months? government? business? any other R taxes or fees I (such as S example)? E El LOST SOME >RTG C SALES .... 1 O HAD TO MOVE BUSINESS ... .2 D BUSINESS GOT E YES. .1 YES. .1 YES. .1 YES. .1 RAIDED. 3 YES. .1 NO ... .2 NO ... .2 No ... .2 TIME No ... .2 OTHER ...4 NO.. .2 TIME (f28) AMOUNT _ (_31) AM4orNT UNIT (,>33) (>>PART G) AMOUNT UNIT VJl 2 l l I I I I I I I I I 1 ~~ ~~~ 1 1 1 1 1 1 1 1 1. 1. 1 HoUR... .a DAY... .3 W EE. ....4 FORTNXGH7M....... .5 MOETH. ....6 QUARTER. ..... 7 HALF YEAR .. .8 YEAR .. 8.l PART G: BUSINESS ASSETS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. I would now like to ask you questions about the assets At present, Is this enterprise the What type of title or similar document of E (that is, equipment, buildings, vehicles, tools, etc.) that does this sole owner of this ownership of this [ITEM] does this N you use in your business. enterprise [ITEM], or is ownership enterprise hold? T own this shared with another E I Over the past 12 months when your enterprise was in [ITEM]? enterprise? R T operation, have you used [ITEM] for your business? P E R M REGISTERED TITLE .......... 1 S LEGAL TITLE, S UNREGISTERED.......2 E ASK THIS QUESTION FOR EACH ITEM URCHASERED .......... 3 LISTED BELOW. AFTER LAST ITEM, GO TO PURCHASE RECEIPT.3 FIRST ITEM USED (WHERE ANSWER HERE (SPECIFY 4 C IS 1) AND ASK QUESTIONS 2-39 FOR THAT NONE .......... 5 O ITEM. IF NONE IS USED, SKIP TO PART H. D SOLE OWNER...1 E YES. ..1 YES .. 1 SHARED WITH NO .. 2 NO ... 2 ANOTHER (>>20) ENTERPRISE ..2 Land Buildings Equipment and machinery '0 es Furniture Small or large tools Large vehicles (trucks, cars, boats, etc.) Small veh cles (bicycles, carts, etc.)( Other durable goods __ 2 Land _ _ _ _ _ _--_:_:_: Buildings :_ ::: _i_:_._.___: Equipment and machinery :_:_: Furniture Small or large tools Large vehicles (trucks, cams, boats, etc.) . Small vehicles (bicycles, carts, etc.) . _ __ Other durable goods __ __ 3 Land Buildings Equipment and machinery Furnitire __ Small or large tools Large vehicles (trucks, cars, boats, etc.) Small vehicles (bicycles, carts, etc.) Other durable goods PART G: BUSINESS ASSETS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 5. 6. 7. 8. 9. In whose name is this title or If you wanted Does Is there Which other document of ownership to sell the anyone another business? written? [ITEM], how else use business much could the [ITEM] in the you sell it for some- household ENTER THE ID today? times? that CODE(S) OF THE sometimes PERSON IN WHOSE uses the NAME THE TITLE OR [ITEM] DOCUMENT OF which you OWNERSHIP IS own? WRITTEN. IF THE PERSON IS NOT A HOUSEHOLD MEMBER, ENTER 0. YES...1 YES.. .1 FIRST SECOND NO.. 2 NO... 2 ENTERPRISE RESPONS RESPONSE AMOUNT (»20) (>14) ID J0 -_- _ I I _ __ I _ _E % = PART G: BUSINESS ASSETS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 10. 11. 12. 13. 14. 15. 16. 17. 18. 19A 19B What Is there Which What Does any What Does Who is that? What ADD THE SUBTRACT E percent of any other business? percent of household percent of someone percent of ANSWERS THE N the time is business the time is member the time is outside the time is TO Q.10, 13, ANSWER T your in the your sometimes your the your 15 AND 18. TO Q.19A E I [ITEM] in household [ITEM] in use your [ITEM] in household [ITEM] in FROM 100. R T use by that use by that [ITEM] for use for sometime use by P E that sometime business? household household s use your someone R M business? s uses the purposes? purposes? [ITEM]? outside I S [ITEM] the house- S which you hold? E own? C 0 D E YES. 1 YES..l YES...1 A RELATIVE .... I NO. . ..2 ENTERPRISE NO. .2 NO .. 2 A NEIGHBOR ...2 _PERCENT (,,14) ID PERCENT (> 6) PERCENT ( 19) SOMEONE EL'SE.. .3 PERCENT PERCENT PERCENT 1 Land Buildings '0 Equipment and machinery Furniture Small or large tools Large vehicles Small vehicles _ Other durable goods _ 2 Land _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Buildings _ i_ _ _ _ _ ___________ _ Equipment and machinery : _ :: . : Furniture _ : _ - _ _ _ : :__ ___ _i Small or large tools _ ... _ . . : Large vehicles __::____ : i : : ___:_:_: Small vehicles : _ _ : _ : : Other durable goods : : : 3 Land Buildings Equipment and machinery Furniture Small or large tools Large vehicles . Small vehicles . _ Other durable goods PART G: BUSINESS ASSETS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 19C 20. 21. 22. 23. 24. 25. 26. 27. So this [ITEM] is used During the Did you rent or During the past 12 If you wanted Have you Which Have you What E by this enterprise past 12 borrow any [ITEM] months, how much did to buy this used any enterprise used percent of N about READ months, from someone you spend on rental [ITEM] that you [ITEM] does that [ITEM] that the time T ANSWER TO 19B have you outside the payments? rented, how that [ITEM] belong belongs to are you E I percent of the time. Is used any household? much would it belongs to to? the using this R T that correct? [ITEM] cost you and is household [ITEM]? P E thatthe today? owned by and not to R M enterprise another any other I S does not business business in S own? in the the E house- household? ENTER 0 IF hold? ITEM WAS C YES ...1 BORROWED O No ... 2 FOR FREE. D (>,8, REPEAT AND E REVISE 8-19C YES . 1 YES. .1 YES .. 1 YES .. 1 UNTIL ANSWER NO.... 2 NO... 2 TIME . . N 2 ENTERPRISE NO.... 2 HERE IS 1.) (»>29) (>,24) AMOUNT UNIT AMOUNT (>>26) ID (,,29) PERCENT 1 Land Buildings _ '0 Equipment and machinery _ Furniture ___ Small or large tools _ Large vehicles _ Small vehicles Other durable goods 2 Land Buildings _ Equipment and machinery Furniture Small or large tools _ _ : _ Large vehicles _ . ___________ Small vehicles . _ Other durable goods 3 Land Buildings _ Equipment and machinery _ _ Furniture _ Small or large tools Large vehicles Small vehicles . Other durable goods ._ PART G: BUSINESS ASSETS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 28. 29. 30. 31. 32. 33. 34. 35. If you wanted During the How much did you CHECK ANSWER In the past 12 How much did you Of this total How did you, or will you, E to sell this past 12 spend on maintenance TO Q 2. months, have pay in total for the expenditure, what pay for the [ITEM] N [ITEM], how months, and repair of [ITEM] you acquired any [ITEM]? percentage did purchased with credit? T much could have you over the past 12 [ITEM] which you you pay for with E I you sell it for incurred months? use for your credit rather than R T today? any business, or IF ACQUIRED with cash? P E expenses have you spent T OUGH R M to onGITO I ~ ~S maintain improvements of INHERITANCE, S or repair [ITEM] that you ESTIMATE THE CASH- ... 1 E [ITEM]? already own? VALUE. GOODS OR SERVICES PRODUCED BY THE ENTERPRISE.... 2 C LABOR.......3 0 COMBINATION... 4 IF = ~~~ OTHER...... 5 OD ANSWER IS 1. .1 | E YES . .1 (,,32) YES ...1 NO .2 TIME ANSWER IS 2.2 NO.... 2 AMOUNT (,,31) AMOUNT UNIT (>r37) (,,37) AMOUNT PERCENT 1 Land Buildings Equipment and machinery O Furniture Small or large tools )Large vehicles ISmail vehicles O0ther durable goods Eq;uipment and machinery= _; i:0;i Furniture:::::. :: : ::: :: : :: : : :: Smnall or large tools : :::: : : :: :v m0T Large vehicvleDs 0 Small vehicles Other durab.e Doods : : : : . 3 Land_ =: Buildings . Equipment and machinery Furniture Small or large tools._ lLarge vehicles= ISmall vehicles _ Other durable goods = _ HIOUR.... 2 DAY.... 3 WEEK.... 4 FORTNIGHT ...... 5 MOVTH ...... 6 QUARTER ..... 7 HALF YEAR ... 8 YEAR ... -79 PART G: BUSINESS ASSETS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 36. 37. 38. 39. Within how many Have you sold any How much in Why did you sell [ITEM]? E days, weeks, months [ITEM] from your total did you N or years did you, or business in the receive from T do you, have to past 12 rnonths? the sale? E I make the last >>))NEXT ITEM USED, Q.2. R T payment in order to IF LAST ITEM, ))PART H P E fulfill these credit R M obligations? I S S CHANGING METHODS E OF PRODUCTION ... 1 BUSINESS WAS NOT GOOD ........ 2 C YES... 1 NEEDED MONEY FOR 0 NO ... .2 DEBT REPAYMENT. .3 NEEDED MONEY FOR D (>>NEXT ITEM HOUSEHOLD E USED, Q.2. EXPENSES ........ 4 NUMBER OF TIME IF LAST ITEM, OTHER, SPECIFY . 5 PERIODS UNIT >PART H) AMOUNT 1 Land_= Buildings= Equipment and machinery o~ Furniture Small or large tools_ Lrge vehcles Small vehicles_ _ Other durable goods _ _. 2 LandC_. Buildings Eqtuipment and mac hinery :. Furniture _ Small or large toois _ _ _.. ILarge vehicles 1nmalt vehicles_ _lOther durable goods_ 3 Land Buildings Equipment and machineryl I Furniture_ Small or large tools___ iLarge vehicles= 2Sma.5 vehicies _ Other durable goods HorR... 2 DAY... 3 WEEK.... 4 FORTNIGHiT .... 5 MfONTH ..... 6 QUARTER .... 7 HAL Yr^AR .... s Yr AR... 9 PART H: GENERAL BUSINESS CONDITIONS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12, Finally, I would How much did If you did Do you How often do you Does your How much did If you did Does your What is the If you did Do you E like to ask you your current not add to ever encounter shortages in business your current not add to business value of these not add to ever N some questions inventory of your encounter the supply of raw have an inventory of your have an products or your encounter T about the raw materials inventory, shortages materials? inventory of these items inventory, inventory goods? inventory, shortages E general cost you to how many in the items cost you? how many of finished how many in the R operations of buy? days of supply of requiring days of products days of supply of P your business. production raw further production not yet sales articles R would this materials? processing? would this sold? would this that you I Does your inventory inventory inventory purchase S business have last? last? last? with the E an inventory of intent to raw materials? resell? C 0 D E YES. .1 YES. .1 YES. .1 YES. .1 YES. .1 NO.. .2 No. .2 TIME NO ... .2 NO ... .2 NO. . . 2 _ (,4) AMOUNT DAYS Nt'6) FREQUENCY UNIT (I>9) AMOUNT DAYS (.12) AMOUNT DAYS (>,14) 2 3 HOUR. ... 2 DAY.... 3 WEEK. ... 4 FORTNIGHT... .5 MONTH ....6 QUARTER.. .7 HALF YEAR... . YEAR... 9 PART H: GENERAL BUSINESS CONDITIONS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 13. 14. 15. 16. How often do you What were the greatest problems you What was the What were your sources of money for setting up your E encounter shortages in encountered in setting up your business? total amount of business? N the supply of articles money that you PROFITS FROM FARMING ............ 1 T that you purchase with needed to start PROFITS FROM ANOTHER BUSINESS ...2 E the intent to resell? NO MAJOR DIFFICULTY ......... 1 your business? OTHER SOURCE OF OWN SAVINGS .....3 R LACK OF FINANCES OR CREDIT ..2 INHERITANCE MONEY .......... 4....4 P LACK OF OWN SKILL ........... 3 LOANS OR GIFTS FROM RELATIVES OR R LACK OF ACCESS TO RAW OTHER FAMILY MEMBERS. 5 I MATERIALS .................. 4 LOANS OR GIFTS FROM FRIENDS .6 S LACK OF CUSTOMERS ........... 5 LOANS FROM BANK .7 E LACK OF ADEQUATE LABOR ...... 6 LOANS FROM PRIVATE NON-BANK GOVERNMENT LICENSING AND MONEY LENDER. 8 REGULATIONS .7 LOANS FROM GOVERNMENT AGENCY .... 9 C PROBLEMS WITH OBTAINING POWER SALE OF HOUSEHOLD ASSETS ....... 10 O OR WATER CONNECTIONS ....... a DID NOT NEED ANY MONEY .11 D OTHER PROBLEMS .............. 9 OTHER .12 E | TIME PRIMARY SECONDARY PRIMARY SECONDARY TERTIARY _ FREQUENCY | UNIT PROBLEM PROBLEM AMOUNT SOURCE SOURCE SOURCE Ill 1 I I I -I -I I 121 1 1 1 1 1 1 . I 13 H 1 1 3 l l G 5 l 1 OER.... 2 DAY.... 3 WF.... 4 FORTNIXGHT ...... 5 MONTH ...... 6 QUTARTR ..... 7 H?LF YEAR..... S EA... 9 PART H: GENERAL BUSINESS CONDITIONS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 17. 18. 19. 20. 21. 22. 23. 24. 25. During the past 12 months, have you received any assistance During the Were you During the Were you During the Is this How much How much does E from the government or business associations in the form of: past 12 able to past 12 able to past 12 business does this this business pay N months, acquire all months, have acquire all months, in debt to business each day, week, T have you of the you of the have you anyone owe in total? month, or year in E tried to desired purchased desired faced right now? order to pay off this R purchase amount, imported raw amount, foreign debt? P foreign some of materials, some of competition R currency the desired intermediate the desired in the sale I for amount, or products, or amount, or of your S business none at articles for none at products? E purposes? all? resale? all? C a. product b. quality c. enterprise d. bookkeeping e. product o design? control? management? methods? marketing? D YES.. 1 E YES . 1 YES.. 1 YES. 1 YES..1 YES.. 1 YES . 1 ALL. . .1 YES . 1 ALL .. .1 NO .2 YES . 1 NO... 2 NO... 2 NO .2 NO.. 2 NO. . .2 NO. ..2 SOME. .2 NO.. 2 SOME ..2 DOES NOT NO. ..2 TIME _______________________._____________________ (,,20) NONE. .3 (>22) NONE. .3 APPLY. .3 (>~26) AMOUNT AMOUNT UNIT HOUR.... 2 DAY.... .3 W~EEK.... .4 FORTNIGHT... .5 MONTEH.. 5. QUARTER. ... 7 HAZF YA... .8 YEAR..-9 PART H: GENERAL BUSINESS CONDITIONS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 26. 27. 28 29. 30. 31 32. 33 34. 35. 36. 37 During the What On average How do the majority of Within how many On a typical On a good day. On a bad day, During the past During how What is the Do you or the E past 12 percentage during a your customers pay you days, weeks or day, how how much do how much do 12 months, when many months usual family members N months, did of your month, what back for goods and months do you much do you you receive you receive your business was your cash amount of working in your T you ever customers percentage services purchased on require the majority receive from from the sale of from the sale was in operation, sales revenue monthly business E sell your purchase of your sales credit? of your customers to the sale of goods and of goods and were there not enough to cash sometimes use R products on goods and are made on make the last goods and services (cash services (cash periods when cover your expenditures some of the sales P credit? services credit? payment in order to services (cash and credit)? and credit)? your cash sales cash on items for revenue from the R from this fulfill their credit and credit)? revenue was not expenditures? use in your enterprise for your I business obligations? enough to cover business? personal needs or S on credit? your cash those of your E expenditures? household? C CASH. 1 O GOODS OR SERVICES ... .2 D LABOR .....3 E YES. .1 COMBINATION. 4 YES. .1 YES. .1 NO ..2 OTHER . 5 NUMBER OFITIME I NO.. 2 No .. 2 ( 31) PERCENT PERCENT PERIOD U s rJNIT AMOUNT AMOUNT AMOUNT (v,36) MONTHS AMOUNT (f39) 12~~~~~~~~~ l 1 1 3 211U1 2 3ONT QR..I Y I. .... .. I |HOUR ... .2 DAY .. . 3 WEEX. . .. 4 FORTNIGHT ...... .5 MONTH . ..6 QUARTER. ..... 7 HALF YEAR. ...8 YA ... .9l PART H: GENERAL BUSINESS CONDITIONS (EXPANDED VERSION) PERSON MOST INFORMED ABOUT EACH ENTERPRISE 38. 39. 40. 41. What After making How much money is What is the most important E amount of purchases for the usually left? thing that you usually do with N money from business and after this money? T the business spending some for E do you yourself or your R usually use household, is there o')NEXT ENTERPRISE P for yourself usually any money IF LAST ENTERPRISE, R or your left as income for ))NEXT MODULE I household? the household or S for the purpose of HOUSEHOLD E saving? EXPENSES .. 1 SCHOOL FEES. .2 PURCHASE OF LAND. 3 C REINVESTMENT 0 IN THE D ENTERPRISE ..4 E YES. .1 START A NEW TINE NO... 2 ITIME BUSINESS ... 5 UNIT (,41) AMOUNT UNIT HOUrR.... .2 DAY. ... 3 WEEK.... .4 FORTNIGHT... 5 MONVTH ....6 QUARTER. ... .7 HALF YE.AR... & YEAR. ..9 Module for Chapter 19 Agriculture Thomas Reardon and Paul Glewwe The following pages present three different versions of the countries implies that survey teams must adapt the agricul- agriculture module that is introduced in Chapter 19 of tuiral module to their circumstances and to the issues that Volume 2. The versions vary by size: short, standard and they want to explore. Second, the different versions of the expanded. All three versions are divided into 6 parts: A, B, agricultural module should be thought of as three points C, D, E, and F The short and the standard versions of the along a continuum of possible levels of detail. One could draft modules are presented in full. To avoid needless repe- create a hybrid version that lies halfway between the short tition, only those parts of the expanded module that differ and standard versions or halfway between the standard and from the versions in the standard module are presented. See expanded versions.Third, if one of the objectives of the sur- Chapter 1 9 for a detailed explanation of the differences of vey is to collect data that can be used to collect total these modules. income, either the standard or the expanded version must Three aspects of the agriculture module should be be used.The short version does not collect the information given particular attention by survey designers. First, all three needed to calculate income from agricultural activities. See versions of the module are merely starting points for devel- Chapter 17 of Volume 2 for a general discussion of whether oping a module to fit any particular country; the great vari- a survey should collect the data needed to collect total ecy of agricultural systems and issues across developing incomc. 407 AGRICULTURE MODULE (SHORT VERSION) PART A: LAND HOLDINGS ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE 1. Does any member of your household currently own any agricultural land, forest land, pasture land or water surface? YES..1 l NO.. .2 ("PART B) 2. 3. 4. 5. 6. 7. 8. 9. 10. P Please tell me What is the What kind of land is Did you use this land What crops have you Is this How did your What legal title or If you L about each plot of area of the this? Is it currently continually for the past grown on this plot plot household acquire ownership rights were to O land belonging to plot? being used to grow 12 months, or did you during the last 12 irriga- this land? do you have for sell this T your household? annual crops or tree rent it out to others for months? ted? this plot of land? plot of Please describe or crops, or is it forest all or part of the last land C give me the name SQUARE land, pasture land or 12 months? INHERITED ...1 today, O of each plot. METERS ..... 1water surface? CLEARED 2 how D PURCHASED.. .3 much E COMPLETE THIS HECTARES..2 ALLNNAL USE RIGHT could you QUESTIONGFIR G CROP LAND. .1 CROP CODES GIVEN sell it for? ALL PLO ~~~~~~~~~~~~~~~~~~BY LOCAL AL LTS. LOCAL TREE CROP (ONE OF LEADER(S)... .4 DEED.... 1 THEN) ASK UNIT. ....3 LAND .... 2 QUESTIONS 3-10 FOET...3-)USED ALL 12 WHICH IS RECEIVED SALES FOR EACH PLOT PORSTUR..34(-8) mONTHS.... I FALLOW) FROM RECEIPT .. .2 BEFORE GOING WTRRENTED ALL DECOLLECTI - CUSTOMARY TO THE NEXT SARE 12 MONTHS.2('7) VIZATION.... O5 RIGHT .3 PLOT. OTHRFSPE- .(~)BOTH USED AN OTHER OTHER CIFYT .. 6 RENTED ..... 3 SE ASO1 SEASON 2 YES.1 (SPECIFY_).6 (SPECIFY_).4 OCUN IT FY. MAIN 2 N D MAIN12ND NO ..2 NONE . 5 00 _ NAME OF PLOT AMOUNT CODE CROP CROP CROP CROP 3 4- 7 9 ioi 12 l l l l l AGRICULTURE MODULE (SHORT VERSION) PART B: FARM CAPITAL INVENTORY ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE 1. 2. 3. 4. 8. 6. Does your household own any [.-]? How many . - Does your How many What share of If you sold one of does your household ...I are these |....1 those I ... J today, household own? own any [. .1 owned with belong to your how much money U jointly with another household? could you get for it? lFIRST ASK QUESTION i FOR any other household? p ALL ITEMS. THEN ASK household? IF MORE THAN M QUESTIONS 2-6 FOR EACH ORE THAN M ITEM BEFORE GOING TO THE IF SHARE ONEITEM,ASK E NEXT ITEM. DO NOT OFFFERS AVERAGE T COU1ENT OVER VALUE. JOINTLY ItEMS, PUT AVERAGE C O T H ER SH A RE SH O U LD o WEDWT AVERAGE INCLUDE FULL OTHER SHARE. VALUE OF D HOUSEFIOLDS . VLEO E ITEMS SHARED YES. 1 YES-. 1 WITH T%YPE OF NO . . 2 NO ... .2 OTHER _FARM EQUIF}aEtT tEXT ITEM) ._ 0) HOUSEHOLDS. G Large tractor (>12 horse power) ..__..__ 2 Small tractor (<12 horse power) 3 Machine pulled plow or harrower 4 Animal, pulled plow 5 Mechanicat water pump 6 Sprinkler 7 Motorized thresher 8 Hand thresher Rice winnower 0 Mill 11 Machine to process fivestock feed 12 Motorized insectide pump 13 Hand insecticide pump 14 Ox cart I5 Small cart pulled by person ._._. AGRICULTURE MODULE (SHORT VERSION) PART C: DISPOSITION OF CROPS ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE 1. ~~~~~2. 34. 1.2. 3. 4. C Have you harvested VI-ow much j.)did you Homuhoth Haeyuarsed owuc diyu R any during the harvest in the past 12 How mu of te [...g]|What price Hav you hav et ed hw u c h Pt 1d yo u t d pric O past 1 months? months? you harvested during did you get Ran ..dungte hrstitepst1Homchfte[..] Wtpie 0 past 12 monthste?at 2 onhswa orth [..J 0 past 12 months? months? you harvested during did you get the last 12 months was for the [....I ~~~~~~~the last 12 months was for the [....I P sold? that you P sold? that you C sold? sold? O 0 D IFMR IF MORE E ASK QUESTION IFTMHORE E ASK QUESTION THEN I FOR ALL ONE 1 FOR ALL ONE CROPS BEFORE IF 0, ))NEXT CROP PRICE, CROPS BEFORE IF 0, ))NEXT CROP GET THE GOINGIONS TO4 GET THE GOING ON TOAVRG QUESTIONS 2-4 AVERAGE QUESTIONS 24 AVPERAGE PRICE. PIE Y'ES. YES. .1 N Y... 1 NO.. 2 CROP ( -NEXT UNIT UUNIT U IT CROP ( NEXT UNITUNIT UNIT NAME CROP) AMj R C AC P CODE _ NE CROP) A CDM T DE PRI EODE o 2 Rice = __=_=_ |Beans 2 1 Wheat _ _ Lentils ____|_| _ __|______ 3 12 millet _ _ ____ Peas -________________ ____|_____;_|_ 4 ~~~~~~~~~~~~~~~~~~~~~13 5 14-- - - 6 az ________ ---Cabb,age________ Cassava ____LettUce 7 16 Other leafy 8 Potatoes vegetables |_|_|_| _ __|____ 8 Sweet 17 potatoes _ _ Tomatoes |_____|_____|- 9 - _ _ - _ _ _ _ Yams _ _ Squash UNIT CODES: KILOGRAM..1 50 LB. SACK ..2 100 LB. SACK..3 LITER- .4 CARTLOAD..5 OTHER (SPECIFY ) 6 AGRICULTURE MODULE (SHORT VERSION) PART C: DISPOSITION OF CROPS ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE 1. 2. 3. 4. 1. 2. 3. 4. C Have you harvested How much [.]did y/ou Howavmuchuhafvtheed How..uchWhatpriceo R any [.] during the harvest in the past 12 How much of the [.1 What price hHeoavt Ho uh pas 1i youcharvete drg i youce O past 12 months? months? you harvested during did you get R any [...[I during the hreti h at1 O past 12 months? mots h at1 otswsfrte[............ ast 12 months? months? you harvested during did the ge] the last 12 months was for the [. 0 pas 12mnh? mnh?the last 12 months was for the [....] P sold? that you P sold? that you sold? sold? C C O 0 D D IF MORE E ASK QUESTION IMOE E ASK QUESTION THEN DE 1 FOR ALL [FTOHNOENE DE I1 FOR ALL IFTONE 1CFORS ALLOR ONE CRORS ALLOR PRICE, CROPS BEFORE IF 0, )NEXT CROP PRICE, CROPS BEFORE IF 0, >NEXT CROP GET THE GOING ON TO GET THE GOING ON TO QUESTIONS 2-4 AVERAGE QUESTIONS 2-4 AVERAGE PRICE. PRICE. YES. .1 YES. .1 No... 2 No. ...2 CROP (.NEXT NIT |UNIT tNIT CROP (.NEXT UNIT UNIT _ UNIT NAME CROP) AMOUNT' CODE AMOUNT CODE CODE NAME CROP) AMOUNT CODE AMOUNT CODE CODE 4 19 Other non- _ 28 - leafy vegs. Cfe ___ 20 Oranges Te29 IT..ee 21Bananas 'oICotton I___ ________ 1 Papaya I I iRubble I _ _ 23 Mangos _ 32 Jute 24 33 Other tree 1Pineapple cro-ps__ _ 25 34 Tree for Coconuts w ._._____34_wood O ther fruit _ _ _ _ _ _ _ __ _ _ _ _ _ _O h r_ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ Cocoa _______35_Other UNIT CODES: KILOGRAM. .1 50 LB. SACK. .2 100 LB. SACK. .3 ZITER. .4 CARTLOAD. .5 OTHER (SPECIFY ) . .6 AGRICULTURE MODULE (SHORT VERSION) PART D: INPUT PURCHASES ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE AND SOURCES 1. 2. 3. Did your household purchase any [..J during How much Where did you purchase N the past 12 months? [..] did you this [ ... purchased during U purchase the last 12 months? U during the T past 12 months? RECORD THE C RESPONSES IN O ORDER OF D IMPORTANCE E PRIVATE INDIVIDUA.L. .. .1 ASK QUESTION 1 FOR ALL INPUTS PRIVATE FIRN. .2 BEFORE GOING ON TO QUESTIONS 2 COOPERATIVE. 3 AND 3. GOVERNMENT .... 4 OTHER (SPECIFY_)...5 YES ..1 INPUT NO ... 2 | UNIT FIRST SECOND THIRDi TYPE (>NEXT ITEM) AMOUNT|CODE SOURCE| SOURCE - 1,__ FERTILIZER #1 _ FERTILIZER #2 FERTILIZER #3 4- IMANURE #1 IMANURE #2 ___ PIESTICIDE #1 ___ PESTICIDE #2 _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ HERBICIDE #1 _ _ _ _ _ _ _ _ __ _ _ 9HERBICIDE #2 FUNGICIDE #1 _____ ___ __ FUN GICIDE #2__ _ _ _ _ _ _ _ __ _ __ _ _ _ 4 NIT CODES: KILOGRAM. .1 50 LB. SACK..2 100 LB. SACK. 3 LITER. 4 CARTLAD. 5 oTHER (SPECIFY__ID #6 AGRICULTURE MODULE (SHORT VERSION) PART E: ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT LIVESTOCK 1. Does any member of your household currently own any large livestock, such as YES. .1 NO.. .2 (>>PART F) [ _ cattle, horses, pigs, sheep or g ats? 2. 3. 4. Does any member of your How many [...] does If you sold one of those household currently own any your household [..1 today, how much [II? currently own? money could you get for it? FIRST ASK QUESTION 2 FOR ALL ANIMALS, THEN ASK QUESTIONS 3-4 FOR EACH ANIMAL BEFORE GOING TO THE NEXT ONE. YES..1 NO ... .2 NUMBER ('aNEXT OF ANIMAL ANIMAL) ANIMALS 1 Beef cattle 2 Milk cows 3 Breeding bulls 4 Horses 5 Donkeys/Mules 6 Pigs for Breeding 7 Sows 8 Sheep 9 Goats AGRICULTURE MODULE (SHORT VERSION) PART F: ACCESS TO AND USE OF ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE AGRICULTURAL EXTENSION SERVICES 1. Did anyone in your household visit an agricultural extension agent 7. Did anyone in your household visit an agricultural extension agent or an agricultural extension center during the last 12 months to or an agricultural extension center during the last 12 months to seek advice or assistance on growing crops? seek advice or assistance on raising animals? YES ... 1 YES.. .1 NO ... 2(->7) NO ...2(>>13) 2. How many times during the last 12 months did members of your 8. How many times during the last 12 months did members of your household visit an agricultural extension agent or an agricultural household visit an agricultural extension agent or an agricultural extension center to discuss growing crops? extension center to discuss raising animals? DO NOT COUNT VISITS BY AN TIMES DO NOT COUNT VISITS BY AN TIMES r l EXTENSION AGENT EXTENSION AGENT TO THE HOUSEHOLD TO THE HOUSEHOLD 3. For what crops were these consultations made?l I CROP CODES 9 For what animals were these consultations made? IF MORE THAN 3, LIST 3 MOST ANIMAL CODES IMPORTANT | IF MORE THAN 3, LIST 3 MOST IMPORTANT - 4. What kinds of assistance or information were requested? USE OF FERTILIZER . 1 1ST [ | 10. What kinds of assistance or information were requested? 1ST r l IRRIGATION ............ j NEW SEED VARIETIES ..3 2ND VACCINATION SERVICES ..1 2ND PEST INFESTATION 4 ANIMAL DISEASESD.. ... [I BLIGHT PROBLEM . 5 3RD ANIMAL FEED/NUTRITION.3 3RD SOIL PROBLEMS . 6 INSEMINATION SERVICES.4 MARKETING ADVICE. 5 WEATHER PROBLEMS . 7 4TH HELP GETTING CREDIT ...6 MARKETING ADVICE. 8 EELP GETTING CREDIT. ...9 5TH GNRLAYIE.... GENERL AIVICE......E m OTHER (SPECIFY ) ....8 GENERAL ADVICE.10 OTHER (SPECIFY - ) ... 11 ALLOW UP TO THREE RESPONSES ALLOW UP TO FIVE RESPONSES 11. Did you have to pay for this assistance? 5. Did you have to pay for this assistance? YES ...1 E m YES...1 E m NO. .... .2(>>7) NO.. .2(>>13) 6. How much did you pay for this assistance during the [ 12. How much did you pay for this assistance during the last [ l last 12 months? 12 months? AGRICULTURE MODULE (SHORT VERSION) PART F: ACCESS TO AND USE OF ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE AGRICULTURAL EXTENSION SERVICES 13. During the past 12 months, did any agricultural extension agent visit your household? YES ..1 . NO ... 2(>>NEXT MODULE) 14. How many times did any agricultural extension agent visit your household during the last 12 months? TIMES 15. How many of these visits were requested by members of your household? How many of these visits were unsolicited? VISITS THAT WERE REQUESTED UNSOLICITED VISITS 16. Did you have to pay for any of these visits? YES...1 NO... .2(a18) 17. How much did you pay for these visits during the W last 12 months? 18. What kind of service did you get from these visits? USE OF FERTILIZER .........1 IRRIGATION ................ 2 NEW SEED VARIETIES ........3 1ST PEST INFESTATION .......... 4 BLIGHT PROBLEM ............ 5 SOIL PROBLEMS ............. 6 2ND WEATHER PROBLEMS .......... 7 GENERAL CROP ADVICE .......8 3RD VACCINATION SERVICES ......9 ANIMAL DISEASES ........... 10 4TH ANIMAL FEED/NUTRITION ..... 11 INSEMINATION SERVICES ..... 12 5TE MARKETING ADVICE .......... 13 HELP GETTING CREDIT ....... 14 GENERAL LIVESTOCK ADVICE..15 OTHER (SPECIFY - ) ........ 16 ALLOW UP TO FIVE RESPONSES AGRICULTURE MODULE (STANDARD VERSION) PART A: LAND HOLDINGS Al: LAND OWNED AND BEGIN WITH MOST KNOWLEDGEABLE PERSON, FARMED BY THE HOUSEHOLD THEN SWITCH TO PLOT MANAGERS 1. During the last two cropping seasons (from MONTH, YEAR to MONTH, YEAR), has any member of your household YES. . 1 cultivated crops, har ested fores products, raised aquatic products, or raised animals on any land owned by your household?" NO ... 2 ( PART A2) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. P Please tell me Who in this What is the What kind of land is What crops have you Is this How did your What legal title If you What What kind of From In general, L about each plot of household area of the this? Is it currently grown on this plot plot household or ownership were to soil doements tow what is the T land belonging to is most plot? being used to grow during the last two irriga- acquire this rights do you sell this type/ does this plot mawny slope of T your household familiar annual crops or tree cropping seasons (from ted? land? have for this plot of land have, such as ea this plot? that has been with this AREA crops, or is it forest MONTH, YEAR to plot of land? land quality terracing or has it C cultivated by a plot of CODES: land, pasture land or MONTH, YEAR)? INHERITED ..1 today, is this O member of your land? water surface? CLEARED.... 2 how plot? mulching? been D household during SQUARE m since the last two QWRIT METERS PURCHASED.. 3 much ROCK BUNDS .1 this plot FLAT E the last two WRITE METERS ......IANNUAL USE RIGHTcould SOIL aUNDS .2 was SLIGHT cropping seasons DOWN ID USEP RIGHT you sell MULCHING... 3 falloW, SLOPE. 2 (from MONTH, CODE OF HECTARES..2 CROP LAND.1 CROP CODES GIVEN it for? SOIL MULCES-4 or MODER2 YEAR to MONTH, HOUSE- TREE CROP (ONE OF BY LOCAL DEED .....1 QUALI- TERRACES 4 or MODER- YEAR)? Please HOLD LOCAL l LAND ...... 2 WHICH IS LEADER(S). 4 SALES LIMS . fcleared ATE describe or give MEMBER. UNIT . FOREST.... 3 ("8) FALLOW) RECEIVFD RECEIPT.2 DES OER e...... 5fro, SLTEEP3 desrib o gie MMBR. NIT....... PASTURE ... 4 ('") FRMOUTOARESPOTECIY.Rus? SOE. me the name of ASK THIS WATERFRMCSOAYSPIY)6th TP each plot. PERSON SURFACE ... 5(,7) DECOLLECT- RIGHT... 3 NONE ....... 7bush? SLOPE.4 QU EST- OTHER(SPE- IVIZATION ..5 OTHER(SPE- IONS 4-14 CIFY .)6 SEASON 1 SEASON 2 YES.1 OTHER(SPE- CIFY) ..4 NAME AREA MAIN 2ND MAIN 2ND NO.. 2 CIFY_) ... 6 NONE.-.5 OF PLOT ID CODE AMOUNT|CODE CROP|CROP CROP 1ST 2ND 3RD YEARS 1 4- 7 12 AGRICULTURE MODULE (STANDARD VERSION) PART A: LAND HOLDINGS A2: LAND RENTED IN BEGIN WITH MOST KNOWLEDGEABLE PERSON, OR BORROWED IN. THEN SWITCH TO PLOT MANAGERS 1. During the last two cropping seasons (from MONTH, YEAR to MONTH, YEAR), has your YES. . 1 _____________ household rented or borrowed agricultural land belonging to someone else? NO.. 2 (>>PART A3) E_ _ 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. p Please tell Who in this What is the What kind of land In which What crops have you Is this What soil What kind of From today, In general, L me about household is area of the is this? Is it being seasons grown on this plot in plot irri- type/land improvements how many what is the O each plot most familiar plot? used to grow have you or the last two cropping gated? quality is does this plot years has it slope of this T belonging with this plot of annual crops or the seasons (from this plot? have, such as been since plot? to land? tree crops, or is it members of MONTH, YEAR to bunding, this plot o someone WRITE AREA forest land, pasture your MONTH, YEAR)? terracing or was fallow, O else that DOWN ID CODES: land or water household mulching? or cleared D was rented CODE OF surface? farmed this from the E or len to HOUSEHOLD SQUARE land during SOIL bush? thousehol. MAS ETHI METERS.... ANNUA the last two CROP QUALI_ ROCK BUJNDS.1 househol. ASK TIS CROPLAND..1 cropping CODES TY SOIL BUNDS.2 Please PERSON HETRS2 TREE CROP seasons? (ONE OF CODES 14LCHING .. .3 describe QUESTIONS LECNARES......ND 2 WHICH IS TERRACES. .. 4 FLAT... 1 and give 4-17. LOCAL FOREST ..3(9) FALLOW) GRASS SLIGHT me the CT 3A PASTURE.4(9) SOEA-A LINES. 5 SLOPE. .2 name of UNIT . WATER SOI .IOTHER MODERATE each plot. ISORFACE.5('-8) ~ 1(SPECIFY-_).6 SLOPE..3 OTHER SEA- SASON 1 SEASON 2 YES.1 NONE. 7 STEEP SON 2._2 _ NANE |AREA (SPECIFY ).6 MAINX2ND MAIN 2ND NO ..2 SLOPE 4 OF PLOT ID CODE AMOUNT CODE CROP|CROP CROP CROP 1ST 2ND 3RD YEARS 21 22 243 _= = = = ===ll 25 __=_ _ - __ __ _ 30__ 31 _7_ - 32 __ == = = == = = . AGRICULTURE MODULE (STANDARD VERSION) PART A: LAND HOLDINGS A2: LAND RENTED IN BEGIN WITH MOST KNOWLEDGEABLE PERSON. OR BORROWED IN. THEN SWITCH TO PLOT MANAGERS 13. 14. 15. 16. 17. P From whom was During the last two What How much money How much did you or L this plot rented or cropping seasons (from share of did you or will you will you give to the O borrowed? MONTH, YEAR to the output give to the owner owner in kind for the T MONTH, YEAR) what kind is given for the use of this use of this land of arrangement was made to the land during the last during the last two UXT CODES: C with the owner of the land landlord? two cropping cropping seasons? O for you to use it? seasons? D RELATIVE .....1 RENTAL ..... 1(-16) EFRIEN .......2 SHARECROP ..2 50 LB. SACK ........ 2 OTHER NO IF NO MONEY HOUSEHOLD ....3 PAYMENT.... 3("NEXT PAYMENT, 100 LB. SACK .......3 LOCAL PLOT) WRITE ZERO. AUTHORITY ....4 EXCHANGE OF THIS IN KIND WRITE 0 LITER .............. 4 PRIVATE PLOT FORINALCUMS ORGANIZATION.5 ANOTHER....4(NEXT IN ALL COLUMNS. TLO........ 5 GOVERNMENT...6 PLOT) OTHER OTHER OTHER (SPECIFY__). .6 (SPECIFY__)..7 (SPECIFYj).5('>16) PER- A IMT CROP 00 _ ....................... CENTAGEA CODE CODE 21 23 25 26 27 28 29 31 32 AGRICULTURE MODULE (STANDARD VERSION) PART A3: LAND RENTED OUT OR LENT OUT. BEGIN WITH MOST KNOWLEDGEABLE PERSON, THEN SWITCH TO PLOT MANAGERS 1. Durng the last two cropping seasons (from MONTH, YEAR to MONTH, YEAR), YES. . I. has your household rented or lent out any of its land to another household? NO ... 2 (>>PART B) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. P Please tell me Who in this During the last COPY THE What is the What kind of land is Is this How did your What legal title or If you were What soil L about each plot household is two cropping PLOT CODE area of the this? Is it being used plot irri- household acquire ownership rights to sell this type/land O of land most familiar seasons, in FOR THIS plot? to grow annual crops gated? this land? do you have for plot of land quality is T belonging to with this plot of which seasons PLOT USED IN or tree crops, or is it this plot of land? today, how this plot? your household land? did you rent or PART Al. AREA forest land, pasture much could C that was rented WRITE lend this plot CODES: land or water INHERITED ... 1 you sell it O or lent out to DOWN ID out to another surface? CLEARED .....2 for? D another CODE OF household? SQUARE PURCHASED ... 3 E household? HOUSEHOLD METERS ......1 USE RIGHT SOIL Please describe MEMBER. METERS.L GIVEN SOAIL or give me the ASK THIS CROP LAND- .1 BY LOCAL TL name of each PERSON HECTARES..2 TREE CROP LEADER(S) .4 DED .......1 TY plot. QUESTIONS LAND . 2 RECEIVED SALES CODES 4-20. SEASON I1 1 )QUESTION LOCAL FOREST ..... 3(>9) FROM RECEIPT .. .2 SEASON 1. .1 16 UNIT.......3 PASTURE .... .4(.9) FRMCUSTOMARY SEASON 2-2 ~~~~~~~~~~~DECOLLECTIVI - SEASON 2. .2 l ATh ..... .45)..WATER ZATION ......5 RIGHT .....3 BOTH ...... 3 SURFACE.@ . .5 OTHER OTHER(SPE- IF BOTH, OTHER YES.1 (SPECIFYR )6 CI FY )S 4 -4. NAME ))QUESTION AR EA CIFY ).6 NO..2 NOY...C.....5 _0 OF PLOT ID CODE 6 PLOT CODE AMOUNT CODE 41l 42 53 44 45X Xf1 _46=: AGRICULTURE MODULE (STANDARD VERSION) PART A3: LAND RENTED OUT OR LENT OUT. BEGIN WITH MOST KNOWLEDGEABLE PERSON, THEN SWITCH TO PLOT MANAGERS 13. 14. 15. 16. 17. 18. 19. 20. p What kind of From In general, To whom is this plot During the last two What How much How much did you or will L improvements today, what is the rented or lent out? cropping seasons what share of money did you receive in kind for O does this plot how many slope of this kind of rental or use the output you or will the use of this land T have, such as years has plot? arrangement was made is given to you receive during the last two bunding, it been with the renter using the your for the use of cropping seasons? UNIT CODES: C terracing or since this land? household this land O mulching? plot was by the during the D fallow, or RELATIVE .....1 tenants? last two KILOGRAM.1 E ROCK BUNDS.1 cleared FRIEND ....... 2 RENTAL.....l(-19) cropping 50 LB. SACK ....... 2 SOIL BUNDS.2 from the OTHER SHARECROP .2 seasons? . M ULCHING ...3 bush? HOUSEHOLD .... 3 NO PAYMENT.3('NEXT IF NOTHING 100 B. SACK ....... 3 TERRACES ...4 LOCAL PLOT) RECEIVED IN KIND, GRASS FLAT...1 AUTHORITY .... 4 EXCHANGE OF IF NO WRITE 0 IN ALL LITER.............. 4 LINES .... 5 SLOSIGHT PRIVATE THIS PLOT FOR MONEY COLUMNS. OTHER SLOPE. .R2 ORGANIZATION.5 ANOTHER.... 4('NEXT PAYMENT, CARTLOAD ........... 5 (SPECIFY_).6 S LOPE.GMODERATE ....GOVRNMEN... 6 PLOT) WRITE NONE .. 7 SLOPE..3 OTHER OTHER (SPECI ZERO. OTHER (SPECIFY_)..6 tb). STEEPE .... 4(SPECIFY-) ... 7 FY_) .. 5('19) PERCEN- MIT CROP t'i ~~~~~~SLOPE..4 I O) _1ST 2ND 3RD YEARS TAGE AUNT CODECODE 41 11111 1111 47 = = 48 _ _ _ = ___= 49=-:0000T 000XXf-XXD: _ :: : : : ::51 : : : ::# :: : :#:: : 512X:;__ : AGRICULTURE MODULE (STANDARD VERSION) PART B1: FARM CAPITAL ASK OF HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE INVENTORY AND TRANSACTIONS _ 1. 2. 3. 4. 5. 6. 7. 8. During the last two How many [ At the end How many What share of If you sold one of Did your How many [.. E cropping seasons (from did your of the last [.. ] were these [ ....] those [... ] today, household were bought Q MONTH, YEAR to household own cropping owned with belonged to how much money buy any during the last u MONTH, YEAR), has any at the end of the season, did another your could you get for it? [.... ] in the two cropping I member of your last cropping your household household? during the seasons? p household owned a [.]? season? household at the end IF MORE THAN last two M own any [. ] of the last ONE ITEM, ASK cropping E jointly with cropping FRseasons? IF SHARED N FIRST ASK QUESTION DO NOT any other season? IF SHARE FOR WITH T 1 FOR ALL ITEMS, COUNT household? DIFFERS AVERAGE T ~~~~~~~THEN ASK SHREOERS VALUE. ANOTHER THEN ASK SHARES OVER AVERAG HOUSEHOLD, c QUESTIONS 2-16 JOINTLY ITEMS, PUT LDE PUT IN C FOR EACH ITEM OWNED BY IN SHOULD FRACTION D BEFORE GOING TO OTHER AVERAGE INCLUDE FULL BELONGING E THE NEXT ITEM. HOUSEHOLDS. SHARE. VALUE OF TO THIS ITEMS SHAREDTOHI YES. .1 YES. .1 WITH YES. .1 HOUSEHOLD. TYPE OF NO ... .2 NO. ..2 OTHER NO .. .2 FARM EQUIPMENT (-NEXT ITEM) (-6) HOUSEHOLDS. (.10) I Large tractor (>12 horse power) 2 Small tractor (<12 horse power) 3 Machine pulled plow or harrower 4 Animal pulled plow 5 Mechanical water pump 6 Sprinkler 7 Motorized thresher 8 Hand thresher 9 Rice winnower 10 MiLl 11 Machine to process livestock feed _________ _ 12 Motorized insecticide pump . 13 Hand insecticide pump 14 OxScart 15 Small cart pulled by person___________ __ ______________ AGRICULTURE MODULE (STANDARD VERSION) PART BI: FARM CAPITAL ASK OF HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE INVENTORY AND TRANSACTIONS 9. 10. 11. 12. 13. 14. 15. 16. What was the Did your How many [ ....] What was the Did your How much What is the How much did E total amount household were sold during total amount household rent money did your value of any in you spend on Q paid for all sell any [ ....] the last two received for all out any of its household earn kind payments maintenance u these [ ....] during the cropping these [ ... ] sold [.... ] during the from renting its eamed by your for all of your I bought during last two seasons? during the last last two [. ] during the household from [.... ] during the p the last two cropping two cropping cropping last two renting its [...] last two M cropping seasons? IF SHARED seasons? seasons? cropping during the last cropping E seasons? WITH seasons ? two cropping seasons? N ANOTHER season ? T HOUSEHOLD, PUT IN >NEXT C FRACTION DO NOT IF NO IN O BELONGING INCLUDE KIND D TO THIS THE VALUE PAYMENT, E HOUSEHOLD. OF PAYMENT YES. .1 YES. .1 IN KIND ZERO TYPE OF NO... .2 NO ... .2 PAYMENTS FA1RM EQUIPMENT (>>13) (>16 ) 1 Large tractor (>12 horse power) 2 Small tractor (<12 horse power) 3 Machine pulled plow or harrower 4 Animal pulled plow _ _ ________: 6 Mechanical water pump 6 ISprinkler _ _ :::: 7 Motorized thresher 8 Hand thresher 9 Rice winnower 10 Mill I IMachine to process livestock feed _ _ __:_::_:____ 12 Motorized insecticide'pump _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 13 Hand insecticide pump 14 Ox cart 15 Small cart pulled by person AGRICULTURE MODULE (STANDARD VERSION) PART B2: HAND TOOLS ASK OF HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE 1. 2. 3. How many [ ... ] How much How much H did your could you did you A household own sell one of spend N at the end of those [....] during the D the last for today? last two cropping IF HOUSE- cropping T season? HOLD HAS seasons to 0 MORE purchase O THAN ONE, [.]? L ASK FOR L IF 0, THE NEXT AVERAGE c ITEM. PRICE 0 D E HAMD TOOLS 1 Hoes 2 Knives 3 Axes 4 Rakes 5 Shovels 6 6 Picks 7 Sickles/Reaping Hooks AGRICULTURE MODULE (STANDARD VERSION) PART Cl: CROP OUTPUT ASK PLOT MANAGER OR PERSON MOST KNOWLEDGEABLE ABOUT THIS PLOT 1. 2. LOOK AT SECTIONS Al AND A2. ASK THIS QUESTION OF THE PERSON MOST KNOWLEDGEABLE OF THIS PLOT. WRITE DOWN THE PLOT NAMES, I would like to ask about the amounts harvested from each of the plots you or members of your household have farmed dunng the PLOT CODES, AND NAME OF last two cropping seasons. Let's begin with the plot [DESCRIBE PLOT]. Could you please tell me how much you harvested of each MOST KNOWLEDGEACPLE crop you grew on this plot during [SEASON 1]? How much did you harvest of each crop that you grew on this PERSON FOR EACH PLOT IN Al plot in [SEASON 2]9 AND A2 FOR WHICH THERE IS INFORMATION. UNIT CODES SEASON CODES KILOGRAM ........... 1 SEASON I..... 1 50 LE. SACK ........ 2 SEASON 2 .... 2 100 LB. SACK ....... 3 LITER .............. 4 CARTLOAD ........... 5 OTHER (SPECIFY ).6 NAME OF MOST FIRST CROP SECOND CROP THIRD CROP FOURTH CROP PLOT PLOT KNOWLEDGE- CROP UNIT SEASON CROP UNIT SEASON CROP UNIT|SEASON CROp UNIT|SEASON _ NAME CODE ABLE PERSON CODE CODE CODE|AMOUNT|CODE CODE CODE|AMOUNT|CODE CODE CODE AMOUNT | CODE CODE 4L 3__ 5~ 6 7 8 9 10 12 iTi : : : : : :: : ::: :::::: ::: ::e: f: : : i: : AGRICULTURE MODULE (STANDARD VERSION) PART C2: DISPOSITION ASK THE HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE OF CROPS 1. ~~~~~~~2. 3. 4. 5. 6. 7. 8. 9. 10. 11. LOOK AT THE USE QUESTION 2 IN Cl TO To whom did you After it was How much of How much How much of How much of How much of C CROPS LISTED IN CALCULATE TOTAL OUTPUT How much What price sell this [1? harvested, the [ ...] of the [...the ]....] the U ..] the [...I R QUESTION 2 OF Cl. FOR LAST TWO CROPPING of the [....] did you get how much harvested harvested harvested harvested harvested O FOR EVERY CROP SEASONS. WRITE IT DOWN. you for the [ ...] TRADER [.... ] was during the during the during the last during the last during the last P MENTIONED, MARK I would now like to ask about the harvested you sold? RELATIVE . 2 lost to last two last two two cropping two cropping two cropping THE YES/NO I.... ] that your household har- during the FRIEND/ insects, cropping cropping seasons was seasons has seasons is still C COLUMN BELOW vested during the last two crop- last two NEIGHBOR . 3 rodents, seasons was seasons used to already been being O AS -YES". FOR ping seasons. According to the cropping IF MORE OTHER rotting or given to pay was used produce consumed by stored by your D CROPSMNOT A inS you have harvestn e Ung to weasesons THIF OE INDIVIDUAL . some other laborers or for processed food members of household? EM NED ASK: you have harvested [AMOUNT) of was sold? PRICE, COOPERATIVE. . problem? make other animal products for your Did you harvest any [ ] during the last two cropping GET THE GOVERNMENT 6 payments? feed? sale? household? [.... ] during the last seasons. Is that correct? AVERAGE PRIVATE two cropping IF CORRECT, COMPLETE PRICE. COMPANY ..... 7 IF NONE, IF NONE, IF NONE, IF NONE, seasons? QUESTIONS 3-11. IF NOT, IF 0, O 6 OTHER(SPE- ENTER ENTER ENTER IF NONE, IF NONE, ENTER REVIEW Cl TO RESOLVE CIFY-ENTER ENER.ENTER ENTER ENTER ENR REVIEW C1 TO RESOLVE CIFY__). 8 .....ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN YES .1PROBLEMS, THEN ASK 3-11. BOTH BOTH BOTH BOTH BOTH BOTH .1 .2 COLUMNS COLUMNS COLUMNS COLUMNS COLUMNS COLUMNS CROP (>NEXT UNIT UNIT UNIT |UNIT | UNIT IUNIT |UNIT |UNIT NAME CROP) AMOUNT CODE CODE PRICECODE 1ST 2ND ANT CODE AT CODE AT CODE AT CODE AT CODE AMT CODE Rice I e ___ 2 lWheat __ _____R 3 M illet _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Maize__ _ _ _ _ _ _ _ _ _ _ _ Cassava ____ _______ Potatoes _____ 8 Sweet potatoes _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Yams UNIT CODES: KILOGRAM..I 50 LB, SACK. .2 100 LB. SACK..3 LITER..4 CARTLOAD. .5 OTHER (SPECIFY ). .6 AGRICULTURE MODULE (STANDARD VERSION) PART C2: DISPOSITION ASK THE HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE OF CROPS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. LOOK AT THE USE QUESTION 2 IN Cl TO To whom did you After it was How much of How much How much of How much of How much of C CROPS LISTED IN CALCULATE TOTAL OUTPUT How much What price sell this [.... J? harvested, the ( .1. of the [ ....] the [ ....] the [.] the [ ... R QUESTION 2 OF Cl. FOR LAST TWO CROPPING of the [...] did you get how much harvested harvested harvested harvested harvested O FOR EVERY CROP SEASONS. WRITE IT DOWN. you for the [ ... ] TRADER ...... 1 [.] was during the during the during the last during the last during the last P MENTIONED, MARK I would now like to ask about the harvested you sold? RELATIVE . . 2 lost to last two last two two cropping two cropping two cropping THE YES/NO [.... ] that your household har- during the FRIEND/ insects, cropping cropping seasons was seasons has seasons is still C COLUMN BELOW vested during the last two crop- last two NEIGHBOR. 3 rodents, seasons was seasons used to already been being OAS 'YES". FOR ping seasons. According to the cropping IF MORE OTHER rotting or given to pay was used produce consumed by stored by your DCROPS NOT information you have given me, seasons THEN ONE INDIVIDUAL 4 some other laborers or for processed food members of household? EMENTIONEDA:you have harvested [AMOUNT] of ICE, COOPERATIVE. S problem? make other animal products for your Did you harvest any [. ] during the last two cropping GET THE GOVERNMENT . 6 payments? feed? sale? household? [.] during the last seasons. Is that correct? AVERAGE PRIVATE two cropping IF CORRECT, COMPLETE PRICE. COMPANY.... 7 tworoppins? QUESTIF NS 3CORREC FT,C IF 0,D 6 PRICE. OTHER(SPE- IF NONE, IF NONE, IF NONE, IF NONE, IF NONE, IF NONE, REVIEW Cl TO RESOLVE CIFY__)....8 ENTER ENTER ENTER ENTER ENTER ENTER I_YES_._1 PROBLEMS, THEN ASK 3-1 1. ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN I s -1 BOTH BOTH BOTH BOTH BOTH BOTH NO..2 COLUMNS COLUMNS COLUMNS COLUMNS COLUMNS COLUMNS CROP (-NEXT UNIT T NIT |UNIT A UNIT |UNIT |UNIT |UNIT |UNIT NAME CROP) AMOUNT CODE A |CODEPRIC CODE 2ND CODE TCOE CODE ANT CODE OD AT CODE S h i-:~~~~~~~~~~~~~~~~~~~~M C0L XS AMT : I AMT 1 XX 0% Beans __ Lentils _ _ _ _ _ _ 12 Fleas _ _ _ 13Soybeans ____ 14Cabbage 15 Lettuce 16 Other leafy __ vegetables _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 17 Tomatoes _8 Squash __ __ _1__ _ _7__ __ _ _ __ __ ____ _ _ __ __ _ UNIT CODES: KXLOGRAM.1..1 50 LB. SACK. .2 100 LB. SACK. .3 LITER. .4 CAR TLOAD- 5 OTHER (SPECXFY J). .6 AGRICULTURE MODULE (STANDARD VERSION) PART C2: DISPOSITION ASK THE HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE OF CROPS 1, 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. LOOK AT THE USE QUESTION 2 IN Cl TO To whom did you After it was How much of How much How much of How much of How much of C CROPS LISTED IN CALCULATE TOTAL OUTPUT How much What price sell this [....]? harvested, the [...] of the [....] the [.] the [...] the [...] R QUESTION 2 OF Cl. FOR LAST TWO CROPPING of the [....] did you get how much harvested harvested harvested harvested harvested O FOR EVERY CROP SEASONS. WRITE IT DOWN. you for the [I j TRAER...1 [.... ] was during the during the during the last during the last during the last P MENTIONED, MARK I would now like to ask about the harvested you sold? RELATIVE . 2 lost to last two last two two cropping two cropping two cropping THE YES/NO [. ] that your household har- during the FRIEND/ insects, cropping cropping seasons was seasons has seasons is still C COLUMN BELOW vested during the last two crop- last two NEIGHBoR ..... 3 rodents, seasons was seasons used to already been being O AS "YES". FOR ping seasons. According to the cropping IF MORE OTHER rotting or given to pay was used produce consumed by stored by your D CROPS NOT information you have given me, seasons THEN ONE INDIVIDUAL ... 4 some other laborers or for processed food members of household? you have harvested [AMOUNT] of w PRICE, COOPERATIVE . .6 problem? make other animal products for your Did you harvest any [ I during the last two cropping GET THE GOVERNMENT.. 6 payments? feed? sale? ouseho [.... ] during the last seasons. Is that correct? AVERAGE PRIVATE two cropping QUESTIONS 3-11 IF NOT, IF 0, s 6 PRICE. OTHER(SPE IF NONE, IF NONE, IF NONE, IF NONE, IF NONE, IF NONE, seasonsREVIEWSCION -1 TOREOLVE IFCIFY6OTE)SE ENTER ENTER ENTER ENTER ENTER ENTER REVIEW CM TO RESOLVE CIFY) ...... 8 ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN YES.1 PROBLEMS, THEN ASK 3-11. BOTH BOTH BOTH BOTH BOTH BOTH No.1 2COLUMNS COLUMNS COLUMNS COLUMNS COLUMNS COLUMNS CROP (>NEXT I UNIT I,UNIT |UNITI JUNIT UNIT UNIT UNIT UNIT NAME CROP) AMOUNT CODE ATCODE CODE 1ST 2 CODE ANT | ANTMCODE CODE AJtT |CODE AT CO .9k. 19 Other non-- - - -- - - - - - - - - -- -.j leafy vegs. 20 Oranges _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 21 ,Bananas ____ 2Mangos _ 241 PineapCle ___ _ ._. E. R4. R C) 2 ICoconuts _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ O ther fruit __ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ __ _ _ 27 Cocoa _ _ _ _ _ _ _ _ _ _ _ __ _ _ VNTCODES: KILOGRAM- 1 50 LB. SACK. .2 100 LB. SACK. .3 LITER. .4 CARTLOAD..5 OTHER (SPECIFY ). .6 AGRICULTURE MODULE (STANDARD VERSION) PART C2:. DISPOSITION ASK THE HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE OF CROPS 1. 2. 3. 4. 5. 6. 7. &. 9. 10. 11. LOOK AT THE USE QUESTION 2 IN Cl TO To whom did y'ou After it was How much of How much How much of How much Of How much of C CROPS LISTED IN CALCULATE TOTAL OUTPUT How much What price sell this [..]? harvested, the [ ...] of the [ ....] h the [ ...] the [.th [... R QUESTION 2 OF Cl. FOR LAST TWO CROPPING of the [..] did you get how much harvested harvested harvested harvested harvested O FOR EVERY CROP SEASONS. WRITE IT DOWN. you for the [1.. TRADER .... 1 [... was during the during the during the last during the last during the last P MENTIONED, MARK I would now like to ask about the harvested you sold? RELATIVE....2 lost to last two last two two cropping two cropping two cropping THE YES/NO I.... ] that your household har- during the FRIEND/ insects, cropping cropping seasons was seasons has seasons is still C COLUMN BELOW vested during the last two crop- last two NEGBR .. rodents, seasons was seasons used to already been being O AS "YES'. FOR ping seasons. According to the cropping IMOE OTHER rotn o ien to pay was used produce consumed by stored by your D CROPS NOT infomatinEyorhaetgien m,rseson infomaton yu hvegvenme, seasold? THNOEINDIVIDUAL. .. 4 some other laborers or for processed food members Of household? E MENTIONED ASK: you have harvested [AMOUNT] of was od PRIE, N COOPERATIVE-.5 problem? make other animal products for your Did you havest any r..]. during the last two cropping GET THE GOVRMNT... 6 payments? feed? sale? hueod [1during the last seasons. Is that correct? AVERAGE PRIVATE two cropping IF CORRECT, COMPLETE PRICE. COMPANY.... 7 seasons? QUESTIONS 3-1 1. IF NOT, IF 0, a) 6 OTHER(SPE- IF NONE, IF NONE, IF NONE, IF NONE, IF NONE, IF NONE, REVIEW Cl TO RESOLVE CIFY-).... ENTER ENTER ENTER ENTER ENTER ENTER _______ ______ PROBLEMS, THEN ASK 3-1 1. ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN ZERO IN YES. 1 BOTH BOTH BOTH BOTH BOTH BOTH NO. .2COUN COUN COUN COUN COUN CO MS CRP (-NEXT UINITUIT UIUITNIUITUT NAN4E CROP) D ATCD ATCOEATCD AN COE AT OE J E Coffee ____ Cotton __ _ ___ _ _ _ 3 Rubber I__ _ __ _ _ _ _ __ _ _ _ _ 32 Jute__ _ _ _ _ ___ _ _ _ _ 33 Other tree crops __ _ _ __ _ _ _ _ ___ _ _ _ _ 34 Tree for IWOd______ __ O ther _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ENIT CODES: KILOGRAM. .1 50 LB. SACK. .2 100 LB. SACK. .3 LITER. . 4 CARTLOAD. . 5 OTHER (SPECIFY_). .6 AGRICULTURE MODULE (STANDARD VERSION) PART Dl: HOUSEHOLD MEMBER LABOR INPUTS ON PLOT TO BE ANSWERED BY THE PLOT MANAGER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. L LOOK AT SECTION Ca AND COPY, Now I would like to How days of How days of How days How many Did any How days How days How days How many I IN THE SAME ORDER, THE PLOT abcyu om questions about the labor did the labor did the of labor days of members of labor did of labor did of labor did days of N NAMES, PLOT CODES AND NAME labor that household members of members of did the labor did of your the the the labor did E QUESTIONS 2-11 SHOULD BE members have your your members the household members members of members the QUESTIONSWR 2B1 SHEPLOT B contributed to the household household of your members work on of your your of your members N ANSWERED BY THE PLOT contribute in contribute in household of your this plot in household household household of your U MANAGERS.pltcuivedb your household during [SEASON 1] [SEASON 1] contribute household [SEASON contribute contribute contribute household M the last two cropping to prepare or to apply in contribute 2]? in in in contribute B seasons. Let's begin sow this fertilizer, [SEASON in [SEASON [SEASON [SEASON in E with the plot plot? manure, 1] to weed [SEASON 2] to 2] to apply 2] to weed [SEASON R [DESCRIBE PLOT]. irrigation, or prune 1] to prepare or fertilizer, or prune 2] to Did any members of pesticides, this plot? harvest sow this manure, this plot? harvest your household work herbicides crops plot? irrigation, crops on this plot during other inputs grown on other inputs grown on [SEASON 1]? to this plot? this plot? to this plot? this plot? YES. I1 1 1 NAME OF NO.. 2 PLOT PLOT PLOT YES.. 1 LABOR LABOR LABOR LABOR (-NEXT LABOR LABOR LABOR LABOR NAME CODE MANAGER NO.. .2(>>7) DAYS DAYS DAYS DAYS PLOT) DAYS DAYS DAYS DAYS '01 4- 7- 9 10 11 .. 12 . .. AGRICULTURE MODULE (STANDARD VERSION) PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 1 . 2. 3. 4. 5. 6. 7. L LOOK AT SECTION Cl AND COPY, IN Now I would like to ask For this plot, how many What kind of tasks did How much Did you hire any labor to For this plot, how I THE SAME ORDER, THE PLOT NAMES, you some questions days of labor did you hire you hire this labor for on did you pay work on this plot during many days of N PLOT CODES AND NAME OF THE about labor that you in [SEASON 1] for this plot in [SEASON for these [SEASON 2] during the labor did you hire E PLOT MANAGER. QUESTIONS 2-31 hired and inputs that all tasks during that 1]? days of last two cropping in [SEASON 21 for SHOULD BE ANSWERED BY THE you used for each plot season? Include all tasks, labor? seasons? all tasks during N PLOT MANAGERS. that was farmed by your such as preparing and that season? U household during the sowing the plot, applying Include all tasks, M last two cropping fertilizer, manure, such as preparing B seasons. Let's begin pesticides and other and sowing the E with the plot inputs, weeding and PREPARING A IND IN plot, applying R [DESCRIBE PLOT]. pruning, and harvesting. SOWING ........ 1 FOR fertilizer, manure, Did you hire any labor to APPLYING INPUTS. .2 VALUE OF pesticides and work on this plot during WEEDING AND other inputs, [SEASON 1] during the PRUNING. 3PAYMENT weeding and last two cropping HARVESTING 4 pruning, and seasons? OTHER harvesting. NAME OF YES..1 (SPECIFY 5 YES. .1 PLOT PLOT PLOT NO... 2 NO... 2 NAME CODE MANAGER (s6) LABOR DAYS FIRSTISECOND| R (10) LABOR DAYS O 2 _ _ I- 4~ 6 7 8 9 :10 :f:: r :: : ii : : :: : :: :: ::::::::::::::::: : ::::: : ::: : :: :: ::T: : ,:::12 :V:::: : ::: 0: : : :::: :::: : : 00:: f Lf: f< : X :: ::: : :;:: AGRICULTURE MODULE (STANDARD VERSION) PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 8. 9. 10. 11. 12. 13. 14. L What kind of tasks did How much Now let's talk How much did Did you Please tell me the amount of each type of fertilizer applied to this plot Did you apply I you hire this labor for on did you pay about physical you pay for all apply in [SEASON 1). any manure to N this plot in [SEASON for these inputs for this purchased chemical this plot in E 21? days of plot, beginning seeds and fertilizer to [SEASON 1]? labor? wlth [SEASON seedlings this plot in N 11. Did you used on this [SEASON U use any plot in 11? M purchased [SEASON 1]? B IF PAID IN seeds or E PREPARING AND KIND, ASK seedlings on R SOWING .......... 1 FOR this plot in UREA ......... 1 APPLYING INPUTS ..2 VALUE OF [SEASON 1]? AMMONIA BICARBONATE 2 WEEDING AND PAYMENT IF PAID IN PHOSPHATE. 3 PRUNING .... 3 KIND, ASK NITROGEN. 4 HARVESTING .... 4 FOR OTHER (SPECIFY ).5 OTHER VALUE OF (SPECIFY-) ....5 YES 1 PAYMENT YES..1 FIRST FERTILIZER SECOND FERTILIZERI THIRD FERTILIZER YES..1 NO.. .2 NO...2 UNIT UNIT UNIT NO... 2 IFIRST|SECONDITHIRD (.12) (.14) TYPE AMOUNT CODE TYPE AMOUNT CODE TYPE AMOUNT CODE (.19) w 2 3 4 5 7 8 9 10 11 12 [rY nvIrT CODES: KILOGRAM..1 50 LB. SACK. .2 100 LB. SACK. .3 LITER. .4 CARTLOAD. .5 OTHER (SPECIFY_). . 6 AGRICULTURE MODULE (STANDARD VERSION) PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 15. 16. 17. 18. 19. L Was any of the How much of each kind of home-produced Did you purchase How much of each kind of purchased manure Did you apply any I manure that you manure did you apply in [SEASON 1]? any of the manure did you apply in [SEASON1[? pesticides, N applied in that you applied herbicides or E [SEASON 1] in [SEASON 1]? fungicides to this produced by plot in [SEASON N your household? 1]? U M B CHICKEN ........ 1 CHICKEN ............... 1 E PIG ....,............ 2 PIG . 2 R SMALL RUMINANT ........ 3 SMALL RUMINANT ........ 3 LARGE RUMINANT ........ 4 LARGE RUMINANT ........ 4 HUMAN ................. 5 HUMAN ................ 5 GREEN ................. 6 GREEN ...6... ..... 6 OTHER (SPECIFY___)..7 OTHER (SPECIFY )..7 YES ..1 FIRST MANURE SECOND MANURE YES ..1 FIRST MANURE SECOND MANURE YES ..1 NO... 2 |UNIT | UNI O.TNIT uNIT NO... 2 _ (l17) TYPE| U CODE TYPE AMOUNT CODE (>19) TYPEAOU CODE TYPE AMOUNT|CODE (.21) '9 2 __ _ _ == 7 10 i- - _ _ _ =- - __ _ --__ 11 C I I C LA I5 O S 6 12 I- I = = =I = == UNIT CODES: KILOGRAM. -I 50 LB, SACK__2 100 LB. SACK..3 LITER-.4 CARTLOAD..5 OTHER (SPECIF~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ AGRICULTURE MODULE (STANDARD VERSION) PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 20. 21. 22. 23. 24. L Please tell me how much you applied to this plot in [SEASON 1] for Now let's talk How much Did you appl Please tell me the amount of each type of fertilizer applied to this I each type of pesticide, herbicide or fungicide? about physical did you pay chemical plot in [SEASON 2]. N inputs for this for all fertilizer to E plot in purchased this plot in [SEASON 2]. seeds and [SEASON N Did you use seedlings 2]? U any purchased used on this M seeds or plot in B PUT CODES HERE seedlings on [SEASON E this plot in 2]? R [SEASON 2]? TUREA .............. AMMONIA BICARBONATE. 2 IF PAID IN PHOSPHATE. 3 KIND, ASK NITROGEN. 4 FOR OTHER (SPECIFY ) 5 VALUE OF FIRST SECOND THIRD YES..1 PAYMENT YES ..1 FIRST FERTILIZER| SECOND ITHIRD FERTILIZER UTNIT U ITI . .....UNIT NO ..... . ....... 2 NO ..2 UIT | U ITI . .......................UIT AMOUNT CODE TYPE AMOUNT CODE TYPE AMOUNT CODE ("23) (»25) TYPE AMOUNT CODE TYPE AMOUNT CODE TYPE AMOUNT CODE 5.' ___ _ _ ___ __ __ __ _ ____TL''r = r- 3 4 6 7 8 11 l l l l 1 12 WNIT CODESz KILOGRAM. .1 50 LB. SACK.. .2 100 LB. SACK. .3 LIT'ER..4 CAR TLOAD. .5 OTHER (SPECIFY __). .6 AGRICULTURE MODULE (STANDARD VERSION) PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 25. 26. 27. 28. 29. 30. L Did you apply Was any of the How much of each kind of home-produced Did you How much of each kind of purchased manure Did you apply I any manure to manure that manure did you apply in [SEASON 2]? purchase any did you apply in [SEASON 2]? any pesticides, N this plot in you applied in of the manure herbicides or E [SEASON 2]? [SEASON 21 that you fungicides to this produced by applied in plot in [SEASON N your [SEASON 2]? 2]? U household? M B CHICKEN ...............1 CHICKEN ...............1 E PIG ...................2 pIG .2 R SMALL RUMINANT ........3 SMALL RUMINANT. 3 LARGE RUMINANT ........4 LARGE RUMINANT. 4 HUMAN .................5 HUMAN ................. 5 GREEN ........... 6 GREEN ..... 6 OTHER (SPECIFY ) ..7 OTHER (SPECIFY ) ..7 YES . 1 YES . 1 FIRST MANURE [ SECOND MANURE YES . 1 FIRST MANURE SECOND MANURE YES. .1 NO.. 2 No. 2 [ UNIT [ | UNIT NO... 2 2UNIT NO 2 _ ("30) (s2S) TYPE|AMOUNT CODE TYPE AMOUNT CODE (:3O) TP|OUNCODEf TYPE AMOUNT CODE (.NEXT PLOT) a 1 _____==_ _ 12 9 UNIT CODES: KXLOGRAM. .1 50 LB. SACK. .2 100 LB. SACK. .3 LITSR. .4 CARTI,OAD. .5 OTHErR (SPSCIFY_) . .6l AGRICULTURE MODULE (STANDARD VERSION) PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 31. L Please tell me how much you applied to this plot in [SEASON 2] for I each type of pesticide, herbicide or fungicide? N E N U M B PUT CODES HERE E R FIRST SECOND THIRD |UNIT UNIT UNIT TYPE AMOUNT|CODE I TYPE AMOUNT CODE TYPE AMOUNT CODE L.J U, _-_ 2 3 5 7 9 UNIT CODES: KILOGRAN..I 50 LB. SACK. .2 100 LB. SACK..3 LITER. .4 CARTLOAD..5 OTHER (SPECIFY )..6 AGRICULTURE MODULE (STANDARD VERSION) PART D3: INPUT PRICES, ASK OF HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE EXPENDITURES AND SOURCES 1. 2. 3. 4. 5. 6. LOOK AT THE ANSWERS GIVEN FOR What was Where did you purchase I How Where did you N FERTILIZER, PURCHASED MANURE, the price of this [.. ] used during the N Did your household purchase any much did obtain this [..] P PESTICIDE, HERBICIDE AND FUNGICIDE the [... ] you last two cropping P [... ] during the last two cropping you purchased U IN SECTION D2. IF THE HOUSEHOLD used during seasons? U seasons? spend on during the last T HAS USED THEM, MARK THEM WITH the last two T L.] two cropping CODE 1. IF NOT, ASK THE FOLLOWING cropping during seasons? C QUESTION, seasons? RECORD IN ORDER C the last 0 OF IMPORTANCE 0 ASK FOR ALL ITEMS two PRIVATE D D BEFORE GOING TO cropping INDIVIDUAL.1 E Did your household use any [ during the PRIVATE E QUESTIONS 5 AND 6. THEN seasons? PRIVATE last two cropping seasons? INDIVIDUAL.... 1 ASK QUESTIONS 5 AND 6 FOR FIRM .. 2 PRIVATE FIRM..2 EACH ITEM COOPERA- IF YES, CLEAR UP ANY COOPERATIVE ... 3 BEFORE GOING TO THE NEXT TIVE . 3 DISCREPANCIES WITH SECTION D2 GOVERNMENT....4 ITEM GOVERNMENT.4 BEFORE ASKING QUESTION 2 AND 3. OTHER OTHER (SPECIFY_)...5 YES..1 (SPECIFY_).5 T YES. . 1 jNO... 2 INPUT NO 2 UNIT FIRST ISECOND| THIRD OTHER (>NEXT FIRST |SECOND TYPE (>NEXT ITEM) PRICE CODE SOURCE SOURCE SOURCE INPUT ITEM) SOURCE SOURCE 1 FERTILIZER #1 l l l l l l l 21 Bags/sacks 2 FERTILIZER #2 22 Boxes/crates 3 FERTILIZER #3 l 23 Other containers 4 MANURE#1 ______ 24 Twine/rope ____D_ 5 MANURE #2 __ _ 25 Plastic sheeting _ _ _:____ 6 PESTICIDE #1 26 Gasoline/oil ______ 7 PESTICIDE #2 27 Electricity 8 HERBICIDE #1 28 Renting draft 9 HERBICIDE #2 T _ _ animal 10 FUNGICIDE #1 29 Renting farm 1:1 FUNGICIDE #2 _ _ machinery 12 Hired labor for preparing 30 Taxes and sowing (PER DAY) :_::__ 13 Hired labor for applying inputs (PER DAY) _____ CODES UNIT CODES: 14 Hired labor for weeding KILOGRAM. .1 50 LB. SACK. .2 100 LB. SACK. .3 and pruning (PER DAY) LITER .... 4 CARTLOAD ..... 5 OTJ15R 15 Hired laborfor (SPECIFY-). . v 6 harvesting (PER DAY) AGRICULTURE MODULE (STANDARD VERSION) PART E: LIVESTOCK ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT LIVESTOCK 1. Has any member of your household raised or owned livestock, YES..1 l l poultry or any other domesticated animal during the last two cropping seasons? NO... 2 ('>PART F) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. During the last two cropping How many If you sold How many How much did How many How many How many How many How much did How many seasons, has any member [...] were one of of your [... ] your of your [ ... ] of your [... ] of your[ ...] [ ] did your you pay for [... ] were of your household raised owned by those [ ...] did you sell household did you eat died or were given household these [ ...] bom or anyE[ ]? your today, how during the receive for the during the were lost away during purchase purchased received as any . household much last two sale of all last two during the the last two during the during the last gifts by your at the end money cropping these [ ...] cropping last two cropping last two two cropping household of the last could you seasons? during the last seasons? cropping seasons? cropping seasons? during the cropping get for it? two cropping seasons? seasons? last two FIRST ASK QUESTION 2 season? seasons? cropping FOR ALL ANIMALS, THEN IF ZERO, IF ZERO, seasons? ASK QUESTIONS 3-20 FOR IF ZERO, GO TO GO TO EACH ANIMAL BEFORE GO TO QUESTION INCLUDE QUESTION INCLUDE QUESTION 7. VALUE OF 12. VALUE OF 5. IN KIND IN KIND PAYMENTS PAYMENTS YES ..1 NO .. 2 NUMBER NUMBER NUMBER NUMBER NUMBER NUMBER NUMBER (»NEXT OF OF OF OF OF OF OF -4 _ ANIMAL ANIMAL) ANIMALS ANIMALS ANIMALS ANIMALS ANIMALS ANIMALS ANIMALS 1 Beef cattle _ . 2 Milk cows 3 Breeding bulls . 4 Horses 5 Donkeys/Mules _ _ 6 Pigs for Breeding . 7 Sows 8 Sheep 9 Goats 10 Chickens 11 Ducks 12 Other Poultry 13 Rabbits 14 Bees _ 15 Other (Specify_) _I _ I I I _ I AGRICULTURE MODULE (STANDARD VERSION) PART E: LIVESTOCK ASK HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT LIVESTOCK 13. 14. 15. 16. 17. 18. 19. 20. Did your How much did How much did How much did How much did you Did your household What was that fresh How much did household you spend on you spend on you spend on spend on other sell any fresh byproduct? you obtain from buy any feed for your veterinary labor hired to expenses for your [...], byproducts from the sales of feed for [.] during the services and watch animals such as equipment, your [...] during the these [...] your [...] last two medicine for or build taxes, slaughter fees, last two cropping byproducts during the cropping your [... ] during enclosures for materials for seasons? during the last last two seasons? the last two your [ ...] enclosures, two cropping cropping cropping during the last transportation, seasons? seasons? seasons? two cropping insurance and stud EGGS ..........1 seasons? fees, during the last two EXCLUDE MILK ..........2 cropping seasons? PRODUCTS BLOOD .........3 USED BY SKIN .......... 4 INCLUDE INCLUDE INCLUDE OF IN HOUSEHOLD HONEY .6 IN KIND IN KIND KIND IN KIND KIND MANURE . .7 PAYMENTS PAYMENTS PAYMENTS PAYMENTS PAYMENTS YES. .1 OTHER YES.. 1 NO ... 2 (SPECIFY__) 8 NO.. 2 (>>NEXT 00 _ ANIMAL (>>15) ANIMAL) FIRST SECOND 1 Beef cattle 2 Milk cows 3 Breeding bulls 4 Horses 5 Donkeys/Mules : _ _ _ 6 Pigs for Breeding I 7 Sows 8 Sheep 9 Goats 10 Chickens 1 1 Ducks 12 Other Poultry 13 Rabbits 14 Bees 15 Other (Specify_) AGRICULTURE MODULE (STANDARD VERSION) PART F: ACCESS TO AND HOUSEHOLD MEMBER MOST KNOWLEDGEABLE OF AGRICULTURAL ACTIVITIES USE OF AGRICULTURAL EXTENSION SERVICES 1. Did anyone in your household visit an agricultural extension agent 7. Did anyone in your household visit an agricultural extension agent or an agricultural extension center during the last two cropping or an agricultural extension center during the last two cropping seasons (from MONTH, YEAR to MONTH, YEAR) to seek advice seasons (from MONTH, YEAR to MONTH, YEAR) to seek advice or assistance on growing crops? or assistance on raising animals? YES.. .1 [.I YES ... .1 [ NO... 2(7) ll NO .... 2(-13I 2. How many times during the last two cropping seasons did [ 8. How many times during the last two cropping seasons did members of your household visit an agricultural extension agent | members of your household visit an agricultural extension agent or an agricultural extension center to discuss growing crops? or an agricultural extension center to discuss raising animals? DO NOT COUNT VISITS BY AN TIMES DO NOT COUNT VISITS BY AN TIMES | EXTENSION AGENT EXTENSION AGENT TO THE HOUSEHOLD TO THE HOUSEHOLD 3. For what crops were these consultations made? 9. For what animals were these consultations made? CROP CODES I ANIMAL CODES IF MORE THAN 3, LIST 3 MOST IF MORE THAN 3, LIST 3 MOST IMPORTANT IMPORTANT 4. What kinds of assistance or information were requested? 10. What kinds of assistance or information were requested? SD0 USE OF FERTILIZER .... 1 1ST [ VACCINATION SERVICES..1 1ST IRRIGATION ............2 ANIMAL DISEASES .......2 NEW SEED VARIETIES .... 3 2ND [ ANIMAL FEED/NUTRITION.3 2ND PEST INFESTATION ...... 4 INSEMINATION SERVICES.4 BLIGHT PROBLEM ........ 5 3RD MARKETING ADVICE ......5 3RD [ 7 SOIL PROBLEMS ......... 6 HELP GETTING CREDIT ...6 I WEATHER PROBLEMS ...... 7 4TH [ GENERAL ADVICE ........ 7 MARKETING ADVICE ...... 8 OTHER (SPECIFY ) ....8 HELP GETTING CREDIT ... 9 5TH l l GENERAL ADVICE ....... 10 ALLOWUPTOTHREERESPONSES OTHER (SPECIFY ) ... 11 ALLOW UP TO FIVE RESPONSES 111. Did you have to pay for this assistance? YES . .1 .l NO... 2(>>13) 5. Did you have to pay for this assistance? YES ...1 NO.1drc2(>>7) 12. How much did you pay for this assistance? 6. How much did you pay for this assistance? I I AGRICULTURE MODULE (STANDARD VERSION) PART F: ACCESS TO AND HOUSEHOLD MEMBER MOST KNOWLEDGEABLE OF AGRICULTURAL ACTIVITIES USE OF AGRICULTURAL EXTENSION SERVICES 13. During the past two cropping seasons, did any agricultural 19. Have you also received information from other government extension agent visit your household? sources, such as radio, television, a newspaper article or a pamphlet, during the last two cropping seasons? YES ...1 YES...1 ll NO ... 2(>19) NO ... 2('END OF SECTION) 14. How many times did any agricultural extension agent visit your household during the last two cropping seasons? 20. What kind of information source was it? RAI ........1 1ST TIMES TELEVISION ............2 2 I I ~~~~~~~NEWSPAPER .......32ND 15. How many of these visits were requested by members of PAMPHLET ... 4 3RD your household? How many of these visits were unsolicited? OTHER (SPECIFY ) ....5 [ VISITS THAT WERE REQUESTED ALLOW UP TO THREE RESPONSES UNSOLICITED VISITS |_ l 16. Did you have to pay for any of these visits? YES. 1 ...1 | _| NO ... 2(>18) 17. How much did you pay for these visits? 18. What kind of service did you get from these visits? USE OF FERTILIZER .....1 IRRIGATION ............ 2 1ST NEW SEED VARIETIES ....3 PEST INFESTATION ...... 4 2ND BLIGHT PROBLEM ........ 5 SOIL PROBLEMS ......... 6 WEATHER PROBLEMS ...... 7 GENERAL CROP ADVICE ...8 4TH l l VACCINATION SERVICES ..9 ANIMAL DISEASES ....... 10 5TH l 7 ANIMAL FEED/NUTRITION. 11 INSEMINATION SERVICES.12 MARKETING ADVICE ...... 13 HELP GETTING CREDIT.. .14 GENERAL ANIMAL ADVICE.15 OTHER (SPECIFY )....16 ALLOW UP TO FIVE RESPONSES EXPANDED MODULE ASK OF HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE PART A4: LAND OBTAINED IN LAST 5 YEARS YES ..1 1. During the last past five y ears, has your household bo ght or acquired any plots of land? NO . 2 (>>PART A5) 2. 3. 4. 5. 6. 7. 8. 9. 10. P Please describe the plots Have you COPY PLOT What kind of land What is the How did you acquire this plot of How much What was the From whom did L of land that you have already CODE FROM did you acquire? area of the land? money did you money value of you purchase or O acquired in the last 5 told me PART Al OR plot? pay for this plot an goods inherit this land? T years, beginning with the about this A3 of land? provided to pay plot most recently plot of INHERITED... 1(.10) for this plot of C acquired. When did you land? CLEARED ...... 2('NEXT PLOT) land? O obtain this plot of land? AREA PURCHASED.... 3 D FIRST ASK QUESTION 2 ANNUAL CODES USE RIGHT GIVEN PARENT ..... I E FOR ALL PLOTS, THEN CROP LAND ..1 BY LOCAL DO NOT SIBLING.... 2 ASK QUESTIONS 3-10 *QUESTION TREE CROP SQUARE LEADER(S).... .4('NEXT PLOT) INCLUDE IF NO OTHER FOR EACH PLOT 8 LAND ....... 2 METERS .1 RECEIVED FROM THE VALUE GOODS RELATIVE... 3 BEFORE GOING TO THE FOREST .... 3 HECTARES..2 DECOLLEC- OF ANY PROVIDED, NEIGHBOR OR NEXT PLOT PASTURE .... 4 LOCAL UNIT.3 TIVIZATION... 5('NEXT PLOT) IN KIND WRITE FRIEND. 4 WATER TRADED FOR PAYMENTS ZERO OTHER LEAVE MONTH SURFACE .... 5 ANOTHER PLOT.6 PERSON .... 5 BLANK IF 3 OR OTHER OTHER (SPE- PRIVATE OR- MORE YEARS YES..1 (SPECIFY ).6 CIFY_) ..... 7('NEXT PLOT) GANIZATION.6 No .. 2 AREA GOVERNMENT.7 YEAR NONTH ('5) AMOUNT CODE 61 63 _ 064 0= 67 70 71 72 == =.. MODULE (EXPANDED VERSION) PART A5: LAND SOLD, GIVEN AWAY OR ASK OF HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE TAKEN IN THE PAST 5 YEARS YES. . 1 1. During the last past five years, has your household sold given away or lost any plots of land? NO... 2 (>PART B) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. P Please describe the plots of Have you COPY PLOT What kind of land What is the How did you part with this plot of How much What was the Why did you sell or Who L la.nd that sold,nalready CODE FROM did you sell, give area of the land? money did money value give away this land? purchased, O given away, or that has been told me PART Al OR away or lose? plot? SOLD ....... 1 you receive of any goods received or T taken from you duinng the about this A3 GAVE AWAY .... 2(.10) for this received to NEEDED MONEY took this land? last 5 years, beginning with plot of TAKEN BY plot of land? pay for this URGENTLY.... 1 C which this happened. When land? LOCAL plot of land? HAD ENOUGH PARENT... 1 D did you sell, give away or AREA AUTHORITY .... 3(tNEXT PLOT) LAND ALREADY.2 SIBLING .2 lose this plot of land? CODES TAKEN BY DID NOT LIKE OTHER E FIRST ASK QUESTION 2 [UAL INDIVIDUAL.. 4(t11) THAT PLOT.. 3 RELATIVE.3 FOR ALL PLOTS. THEN *QUESTION CROP LAND ..1 SQUARE TAKEN BY WANTED TO NEIGHBOR/ ASK QUESTION 3-11 FOR 8 TREE CROP METERS .... I GOVERNMENT... 5( NEXT PLOT) DO NOT HELP PERSON FRIEND...4 EACH PLOT BEFORE LAND .... 2 HECTARES..2 ABANDONED....6(tNEXT PLOT) INCLUDE IF NO WHO RECEIVED OTHER GOING TO THE NEXT FOREST .... ~ 3LOCAL UNIT3 TRADED FOR THE VALUE GOODS THE IAND.... 4 PERSON...A5 PLOT. PASTURE .... 4 ~~~~~~ANOTHER PLOT.7 OF ANY WRECIVED WANTED TO PRIVATE WATER ~~~~OTHER (SPE- IN KIND WERIT GET OUT OF ORGANI- LE-AVE MONTH BLANK NYOSU 12 WTER FACE CIFY )... 8(NEXT PLOT) PAYMENTS O FARMING..... 5 ZATION. .. 6 LEAVE MONTH BLANK SUOTHRFAE . 5OTHER GOVERN- IF 3 OR MORE YEARS YES ..12(PCF . OTHER (SPECIFY-). .6 MENT.. 7 - _ YEAR MONTH (t5) AMOUNT CODE 81 82 86 87 88 89_ 90 :_; 91 92 AGRICULTURE MODULE (EXPANDED VERSION) PART DI: HOUSEHOLD MEMBER LABOR INPUTS ON PLOTS ALL HOUSEHOLD MEMBERS AGE 7 AND OLDER 1. 2. 3. 14. 15. 6. 7. 8. 9. 110 11 12. |13. 114. 1'5. 16. FIRST PLOT, SEASON 1 SECOND PLOT, SEASON 1 THIRD PLOT, SEASON 1 I During On what plot How many How many How many How many On what How many How many How How On what How many How many How many How many D [SEASON 1] did you work days did days did days did days did plot did days did days did you many many plot did days did days did you days did days did (from MONTH, the most in you spend you spend you spend you spend you work you spend spend days did days did you work you spend spend you spend you spend C YEAR to [SEASON 1]? preparing applying weeding harvest- the preparing applying you you spend the third preparing applying weeding harvest- 0 MONTH, and sowing fertilizer, and/or ing this second and sowing fertilizer, spend harvest- most in and sowing fertilizer, and/or ing this D YEAR), did this plot in pesticides, pruning plot in most in this plot in pesticides, weeding ing this [SEASON this plot in pesticides, pruning plot in E you work on [SEASON irrigation, this plot in [SEASON [SEASON [SEASON irrigation, and/or plot in 1]? [SEASON irrigation, this plot in [SEASON any plot of 1? and other [SEASON 1]? 1]? 1]? and other pruning [SEASON 1]? and other [SEASON 1]? land belonging inputs to 1]? inputs to this this plot 1]? inputs to this 1]? to or rented by this plot in plot in in plot in your [SEASON [SEASON [SEASON [SEASON household? 1]? IF NO 1]? 1]? IF NO 1]? OTHER OTHER PLOTS IN PLOTSIN SEASON SEASON I ))17. 1 p17. YES. .1 NO... .2 PLOT PLOT PLOT (p17) ID DAYS DAYS DAYS DAYS ID DAYS DAYS DAYS DAYS ID DAYS DAYS DAYS DAYS 9 .I 2l 113 12L4L < 0X AGRICULTURE MODULE (EXPANDED VERSION) PART DI: HOUSEHOLD MEMBER LABOR INPUTS ON PLOTS ALL HOUSEHOLD MEMBERS AGE 7 AND OLDER 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. FIRST PLOT, SEASON 2 SECOND PLOT, SEASON 2 THIRD PLOT, SEASON 2 I During On what plot How many How many How many How many On what How many How many How How On what How many How many How many How many D [SEASON 21 did you work days did days did days did days did plot did days did days did you many many plot did days did days did you days did days did (from MONTH, the most in you spend you spend you spend you spend you work you spend spend days did days did you work you spend spend you spend you spend C YEAR to [SEASON 2]? preparing applying weeding harvest- the preparing applying you you spend the third preparing applying weeding harvest- 0 MONTH, and sowing fertilizer, and/or ing this second and sowing fertilizer, spend harvest- most in and sowing fertilizer, and/or ing this D YEAR), did this plot in pesticides, pruning plot in most in this plot in pesticides, weeding ing this [SEASON this plot in pesticides, pruning plot in E you work on [SEASON irrigation, this plot in [SEASON [SEASON [SEASON irrigation, and/or plot in 2]? [SEASON irrigation, this plot in [SEASON any plot of 21? and other [SEASON 2]? 2]? 2]? and other pruning [SEASON 2]? and other [SEASON 2]? land belonging inputs to 2]? inputs to this this plot 2]? inputs to this 2]? to or rented by this plot in plot in in plot in your [SEASON IF NO [SEASON [SEASON [SEASON household? 2]? OTHER 2]? 2]? IF NO 2]? PLOTS OTHER IN PLOTS IN SEASON SEASON 2 D33. 2 )>33. YES..1 NO.. 2 PLOT PLOT PLOT ("33) ID DAYS DAYS DAYS DAYS ID DAYS DAYS DAYS DAYS ID DAYS DAYS DAYS DAYS 4- 5 1 2 b I IITIIII AGRICULTURE MODULE (EXPANDED VERSION) PART Dl: HOUSEHOLD MEMBER LABOR INPUTS ON PLOTS ALL HOUSEHOLD MEMBERS AGE 7 AND OLDER 33. 34. 35. 36. 37. 38. 39. I Did you work on List the other plots you worked on in [SEASON Did you work on List the other plots you worked on in [SEASON How many How many How many D any other plots 1], and tell me how many any other plots 2], and tell me how many hours per week hours per week hours per farmed by your days you worked on each plot doing any kind farmed by your days you worked on each plot doing any kind of did you spend did you spend week did you C household during of work during [SEASON 1]. household during work during [SEASON 2]. working on working on spend on 0 [SEASON 1] other [SEASON 2] other animal animal animal D than the those we than the those we husbandry in a husbandry in a husbandry E have just have just typical week of typical week of during the discussed? discussed? [SEASON 1]? [SEASON 2]? time between agricultural seasons? FOURTH PLOT FIFTH PLOT SIXTH PLOT FOURTH PLOT FIFTH PLOT SIXTH PLOT YES. .1 PLOT PLOT PLOT YES. .1 PLOT PLOT PLOT No .. 2 ID DAYS ID DAYS ID DAYS NO... 2 ID DAYS ID DAYS ID DAYS - _ (-35) CODE WORKED CODE WORKED CODE WORKED (-37) CODE WORKED CODE WORKED CODE WORKED HOURS/WEEK HOURS/WEEK HOURS/WEEK 4i -1 __ ___ _ _ _ - _= _l 3 F1 - - - - l___l_ - - l__ 'If l - - l__ l ___ l I {2 - l ll_ - _ _ _____- _ __ ___l PART 02: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 1 . 2. 3. 4. 5. 6. 7. 8. 9. 1o. L LOOK AT SECTION Now I would like to How many How much How many How much How many How mnuch did How many How much I Cl AND COPY, IN THE SAME ask you some days of labor did you pay days of labor did you pay days of labor you pay for days of labor did you pay N ORDER, THE PLOT NAMES, PLOT questions about labor did you hire in for these did you hire in for these did you hire in these days of did you hire in for these E CODES AND NAME that you hired and [SEASON 1] days of [SEASON 1 ]to days of [SEASON 11 to labor? [SEASON 1] to days of OF THE PLOT MANAGER inputs that you used to prepare or labor? apply fertilizer, labor? weed or prune harvest crops labor? N for each plot that was sow this plot? manure, this plot? grown on this U FIRST COMPLETE QUESTION 1 farmed by your irrigation, plot? M FOR ALL PLOTS, THEN ASK THE household during the pesticides, B PLOT MANAGER QUESTIONS 2- last two cropping IFPI Nherbicides, or I ADI FPI NI ADI E 41 FOR EACH PLOT BEFORE seasons. Let's begin KFPIND, ASK other inputs to KIND PASKI KIND PASKINI KAIND, ASK R GOING TO THE NEXT PLOT. with the plot KN,AKti lt ID S ID S ID S [DESCRIBE PLOT]. FOR thspo?FOR FOR VALUE FOR VALUE Did you hire any labor IF ZERO VALUE OF VALUE OF OF O to work on this plot GO TO PAYMENT PAYMENT PAYMENT PAYMENT during [SEASON 1] ? QUESTION IF ZERO IF ZERO IF ZERO 5 GOTO GOTO GOTO _________ ~~~~~~~~~~~~~~~~~~~~~QUESTION QUESTION QUESTION 1 NAME OF YES. .1 7 911 PLOT PLOT PLOIT NO ... 2 NAME JCODE MANAGER (-6) ILABOR DAYSI LABOR DAYSI LABOR DAYS ILABOR DAYS 0' 2 3 4 6 7 8 9 10 12 PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. L Did you hire any labor to How many How much di How many How much How many How much How many days of How much Now let's talk I work on this plot in days of labor you pay for days of labor did you pay days of labor did you pay labor did you hire in did you pay about physical N [SEASON 2] during the did you hire in these days of did you hire in for these did you hire in for these (SEASON 21 to for these inputs for this E last two cropping [SEASON 2] to labor? [SEASON 2] to days of [SEASON 2] to days of harvest crops grown days of plot, beginning seasons? prepare or so apply fertilizer, labor? weed or prune labor? on this plot? labor? with [SEASON N this plot? manure, this plot? 1]. Did you U irrigation, use any M pesticides, purchased B IF PAID IN herbicides, or IF PAID IN IF PAID IN IF PAID IN seeds or E KIND, ASK other inputs to KIND, ASK KIND, ASK KIND, ASK seedlings on R FOR this plot? FOR FOR FOR this plot in IF ZERO VALUE OF VALUE OF VALUE OF VALUE OF [SEASON 1]? GO TO PAYMENT PAYMENT PAYMENT PAYMENT QUESTIO O IF ZERO IF ZERO N14 GFOERO GOTO GOTO QUESTION QUESTION QUESTION YES. . 1 1USTO 18 20 NO... .2 NO6Y. .2 _ ( 2 0 ) ILABOR DAYS[I LABOR DAYS LABOR DAYS LABOR DAYS ( 22) ) b 1 2 4 7 12i wrWXT COD)ES: KII2OGRAA-. . 1 50 LBe. BACK. .2 1 00 LB . SACIC. . 3 LITER . . 4 CARTLOAD. . 5 ORER (SPECIFY-) . . 6 PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 21. 22. 23. 24. 25. 26. L How much did Did you Please tell me the amount of each type of fertilizer applied to this plot Did you Was any of How much of each kind of home-produced I you pay for all apply in [SEASON 1]. apply any the manure manure did you apply in [SEASON 1]? N purchased chemical manure to that you E seeds and fertilizer to this plot in applied in seedlings this plot in [SEASON [SEASON N used on this [SEASON 1]? 1] produced U plot in 1]? by your M [SEASON 1]? UREA ......... 1 household? B AMMONIA BICARBONATE .......... 2 CHICKEN 1 E PHOSPHATE .3 PIG............. 2 R NITROGEN ........ ....... 4 SMALL RUMINANT ...... 3 OTHER (SPECIFY .5 LARGE RumiNANT .....4 IF PAID IN HUMAN ................ 5 KIND, ASK GREEN......... 6 FOR OTHER (SPECIFY _ .7 VALUE OF PAYMENT YES. .1 FIRST FERTILIZER SECOND FERTILIZER THIRD FERTILIZER YES.. .1 YES. .1 FIRST MANURE SECOND MANURE NO ... 2 UN UNIT UNIT NO... 2 NO ... 2 |UNIT UNIT ________ ~(24) TYPE AMOUNT CODE M CODE TYPEIJMOUITCODE (-29) (27) YPE|O TCODE TYPE|AMOUNTCODE 2 3 7 UNIT CODES: KILOGRAM. .1 50 LB. SACK..2 100 LB. SACK. .3 LXTER..4 CARTLOAD. .5 OTHER (SPECIFY ). .6 PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 27. 28. 29. 30. 31. 32. L Did you How much of each kind of purchased manure Did you Please tell me how much you applied to this plot in [SEASON 1] for Now let's talk How much did I purchase did you apply in [SEASON 1]? apply any each type of pesticide, herbicide or fungicide? about physical you pay for all N any of the pesticides, inputs for this purchased E manure herbicides plot in seeds and that you or [SEASON 2]. seedlings N applied in fungicides Did you use used on this U [SEASON to this plot any purchased plot in M 1]? in seeds or [SEASON 2]? B CHICXEN ............... I [SEASON PUT CODES HERE seedlings on E PIG .................. 2 1]? this plot in R SMALL RUMINANT ........ 3 [SEASON 2]? LARGE RUMINANT ........ 4 HUMAN ................. 5 IF PAID IN GREEN ................. 6 KIND, ASK OTHER (SPECIFY )..7 FOR VALUE OF YES . 1 FIRST MANURE I SECOND MANURE YES ..1 FIRST 1 SECOND THIRD YES ..1 PAYMENT NO.. 2 UNI- UNIT N.. .2 UNIM TUNIT NO.. 2 (-29) TYPE ANOUNT CODE TYPE CODE (>3 1) TYPE AMOUNT CODE TYPE AMOUNT CODE TYPEA N CODE (-3 3) 2 3 4 5 7 8 9 12 UNIT' CODES: ]CILOGRAM. .I 50 LB. SACK. .2 1 00 LB. SACK. . 3 LITER. .4 CARTLOAD. . 5 OSTHfR (SPECIFY ).6 PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 33. 34. 35. 36. 37. 38. L Did you Please tell me the amount of each type of fertilizer applied to this plot Did you Was any of How much of each kind of home-produced Did you I apply in [SEASON 2]. apply any the manure manure did you apply in [SEASON 2]? purchase N chemical manure to that you any of the E fertilizer to this plot in applied in manure that this plot in [SEASON [SEASON you applied N [SEASON 2]? 2] produced in U 2]? by your [SEASON M UREA ....................... 1 household? 2]? B AMMONIA BICARBONATE ..........2 CHICKEN............... E PHOSPHATE PIG3 PIG .......2 R NITROGEN SMALL RUMINANT ....... OTHER (SPECIFY ). 5 LAL RUMINANT 3 HUMAN......... 5 GREEN......... 6 OTHER (SPECIFY )..7 YES . 1 FIRST FERTILIZER SECOND FERTILIZER THIRD FERTILIZER YES ..1 YES ..1 FIRST MANURE I SECOND MANURE YES .-1 NO.. 2 UNIT | UNIT UNIT NO.. 2 NO ... 2 UNI T I|UNIT NO .. 2 (-35) TYPE|AMOUNT CODE TYPE AMOUNT|CODE TYPE|AMOUNTCODE (>40) (-38) TYPE|AMOUNT|CODE TYPE AMOUNT|CODE ("40) 0 ___ l___II=__11 11 T - - ===- - - = -_ _ - __ -1 - - - __1 X 12 |UNIT CODES: KILOGRAM .....1 50 LB. SACK. .2 100 LB. SACK. .3 LITER. .4 CARTLOAD ......5 OTHER (SPECIFY___......... ). .6l PART D2: HIRED LABOR AND NON-LABOR INPUTS, BY PLOT TO BE ANSWERED BY THE PLOT MANAGER 39. 40. 41. L How much of each kind of purchased manure Did you apply Please tell me how much you applied to this plot in [SEASON 2] for I did you apply in [SEASON 2]? any pesticides, each type of pesticide, herbicide or fungicide? N herbicides or E fungicides to this plot in [SEASON N 2]? U M B CHICEN . 1 PUT CODES HERE E PIG ..........2 R SMALL RUMINANT .. 3 LARGE RUMINANT. 4 HUMAN. 5 GREEN. 6 OTHER (SPECIFY )..7 FIRST MANURE SECOND MANURE YES. .1 FIRST SECOND THIRD DUNIT | UNIT NO... 2 UDNIT | UNIT UNIT TYPE O TCODE TYPEIANOUNT|CODE (-NEXT PLOT) TYPE|ANOUN CODE TYPE CODE TYPE AMOUNT|CODE U, 2 3 4 7 8 9 12 WIT CODES: KILOGRAM..1 50 LB. SACK. .2 100 LB. SACK..3 LITER..4 CARTLOAD..5 OTHER (SPECIFY_))..6 AGRICULTURE MODULE (EXPANDED VERSION) PART D3: INPUT PRICES, ASK OF HOUSEHOLD MEMBER MOST KNOWLEDGEABLE ABOUT AGRICULTURE EXPENDITURES AND SOURCES 1. 2. 3_ 4 5 6. LOOK AT THE ANSWERS GIVEN FOR What was Where did you purchase I How Where did you N FERTILIZER, PURCHASED MANURE, the price of this [...] used during the N Did your household purchase much did obtain this P PESTICIDE, HERBICIDE AND the [... ] you last two cropping P any ... ] during the last two you purchased U FUNGICIDE IN SECTION D2. IF THE used during seasons? U cropping seasons? spend on during the last T HOUSEHOLD HAS USED THEM, the last two T two cropping MARK THEM WITH CODE 1. IF NOT, cropping RECORD IN ORDER during seasons? C ASK THE FOLLOWING QUESTION. seasons? OF IMPORTANCE C ASK FOR ALL ITEMS BEFORE the last o 0 GOING TO QUESTIONS 5 two PRIVATE D D AND 6. cropping INDIVIDUAL. 1 E Did your household use any ..] during PRIVATE E THEN ASK QUESTIONS 5 seasons? PRIVATE the last two cropping seasons? INDIVIDUAL.... 1 AND 6 FOR EACH ITEM THE COOPERA PRIVATE FIRM. .2 BEFORE GOING TO THE COOPERA&- IF YES, CLEAR UP ANY COOPERATIVE... 3 NEXT ITEM TIVE. 3 DISCREPANCIES WITH SECTION GovERMENT. 4 GOVERMENT.4 D2 BEFORE ASKING QUESTION 2 OTHER OTHER AND 3. (SPECIFY )...5 YES..1 (SPECIFY_).5 YEg .1 NO... .2 INPUT NO... 2 UNIT FIRST SECOIID THIR OTHER ( NEXT FIRST ISECOND TYPE (-NEXT ITEM) PRICE CODE SOURCE SOUR( INPUT ITEM) SOURCE SOURCE rlJ 1 FT- 21 Bags/sacks __ FERTILIZER #1 ___ _ _ _ _ ______ _ _ _ _ ___ 2 FERTILIZER #2 22 Boxes/crates 3 23 Other containers FERTILIZER #3 ~4 24 Twine/rope MANURE #1 _ _ _ _ _ _ _ _ _ __ _ _ 5 25 Plastic sheeating __MANURE #2 6 - - -26 Gasoline/oil __ PESTICIDE #1 _ _ _ _ _ _ _ _ _ _ __ _ _ 7 PETCD 227 Electricity 8 2 ,HERBICIDE #1 28 Renting draft animal 9 HERBICIDE #2 9_ 2 Renting farm 10 FUNGICIDE#1 machinery 11FUNGICIDE#2 30 Taxes IUAIT CODES: KILOGRAM-.1 50 LB. SACK..2 100 LB. SACK..3 LITER..4 CARTZOAD..5 OTHER (SPECIFY )--6 Module for Chapter 20 Savings Anjini Kochar The savings module is presented in the following pages. As household assets are collected in other modules-see explained in Chapter 20 of Volume 2, there are two ver- Chapter 20 for details on this point. A final point to recall sions, a short version and a standard version.When adapting from the discussion in that chapter is that the savings mod- this module to fit the characteristics of a specific country, ule should be completed near the end of each household's survey researchers should keep in mind that some data on interview because of the sensitive nature of this topic. 453 MOST KNOWLEDGEABLE PERSON PART A: INVESTMENT PROPERTY (SHORT) PART B: CURRENCY (SHORT) 1 Does your household own any land or buildings which you rent to 1. How much money does your household now have? others for residential or business purpose (do not include (Include currency only, both foreign and domestic) agricultural land or property used for a business run by your Z household which was reported in SECTION XX, PART XX)? DOMESTIC CURRENCY l l YES ..1 . . . FOREIGN CURRENCY NO .. 2 (>>NEXT PART) E j 1 1 1 2. How much money would your household receive if you sold all this property today? I RUPEES: l 3. How much did your household receive in total from renting this property to others over the past 12 months? RUPEES: Lr PART C: FINANCIAL ASSETS (SHORT) MOST KNOWLEDGEABLE PERSON _1 2. I Does any member of your household have any of the How much is the D following kinds of savings? current value of such assets? C IF THE ANSWER TO QUESTION 1 IS YES, ASK O QUESTIONS 2 D E YES. . 1 No... .2 ().NEXT SAVING) RUPEES n | |Bonds, shares and security 3 Deposits with any financial institution _ Deposits with savings committee PART A: INVESTMENT PROPERTY (STANDARD) MOST KNOWLEDGEABLE PERSON 1. WRITE DOWN THE ID CODE OF THE RESPONDENT. 9. Did your household inherit any such property or receive it as a gift or payment in-kind? ID YES. . 1 2. Does your household currently own any land or buildings which No ... .2 (,1l) l you rent to others for residential or business purposes (do not include residential property which your household occupies or 10. What is the total value of all such property received as agricultural land or property used for a business run by your inheritance/gift over the last 12 months? l household which was reported in SECTION XX, PART XX)? RUPEES: YES. .1 11. Did your household sell any such property over the last 12 NO ... .2 l~4) months? 3. How much money would your household receive if you sold all YES. I1 this property today? lPl NO . . 2 (,,13) | jj5 RUPEES: ll 12. How much money has your household received from the sale? 4. Did your household ever own any such property over the last 12 months? RUPEES. YES. . 1 13. Did your household give away any such property over the past NO.. .2 (>>PART B) l 12 months? 5. Did you receive any income from renting this property over the YES. . 1 past 12 months? NO... .2 (>sPART B) YES. .1 14. What is the total value of all the property that your household NO.. .2 (>7) l provided as a gift, payment in-kind, inheritance or dowry? 6. How much did you receive in total from renting this property to RUPEES: others over the past 12 months? [ ] RUPEES: 7. Did your household purchase any such property over the last 12 months, that is, since [MONTH] [YEAR]? YES. .1 NO . . 2 (>>9) 8. How much did your household spend in purchasing the property? RUPEES: PART B: STOCKS, SHARES AND BONDS (STANDARD) MOST KNOWLEDGEABLE PERSON _ 1. 2. 3. 4. I Has any member of your household held [SECURITY] How much How much How much D over the past 12 months? is it worth have you was this today? received in total [SECURITY C IF THE ANSWER TO QUESTION 1 IS YES, ASK in dividends/ ] worth 12 O QUESTIONS 2-4 interest/profits months D over the past ago, that is E 12 months? in [MONTH] [YEAR]? YES. .1 NO... .2 (>»NEXT SECURITY) RUPEES RUPEES RUPEES 4 _ Government certificates 2 Prize bonds 3 Defense saving certificates 4 Federal bonds __ Shares of private domestic companies ._. 6 Provincial bonds 7 8 Foreign stocks and bonds _ Other (SPECIFY) PART C: BANK DEPOSITS AND POSTAL SAVINGS (STANDARD) MOST KNOWLEDGEABLE PERSON 1. 2. 3. I Do any member of your household have any [ACCOUNT]? What is the How much did D amount of the you have in this IF THE ANSWER TO QUESTION I IS YES, ASK current balance in [ACCOUNT] 12 C QUESTIONS 2-3 [ACCOUNT]? months ago, that 0 is in [MONTH] D [YEAR]? E YES. . 1 NO..-2 (»>NEXT ACCOUNT) RUPEES RUPEES OD ICurrent checking account Savings account Accounts in post offices/national savings centers _Othersavings accounts (SPECIFY}: _:: :_ ::_____if___: MOST KNOWLEDGEABLE PERSON PART D: INFORMAL SAVINGS ASSOCIATION (STANDARD) PART E: CURRENCY (STANDARD) 1. Has any member of your household participated in any informal 1. How much money does your household now have? savings association such as a [GIVE LOCAL NAME] over the past 12 months? DOMESTIC CURRENCY YES .1 FOREIGN CURRENCY [ NO.. .2 (,,PART E) 2. How much money do you estimate your household had at this time last year? 2. How much has your household contnbuted to the committee over DOMESTIC CURRENCY the past 12 months? RUPEES: [ FOREIGN CURRENCY 3. How much has your household received from the committee over the past 12 months? RUPEES: 10 Module for Chapter 21 Credit Kinnon Scott The credit module is presented in the following pages. As particular, a large amount of information on credit should explained in Chapter 21 ofVolume II, there are two ver- be collected in other modules, such as those on housing, sions, a short version and a standard version.The standard consumption, agriculture and nonagricultural household version is divided into four parts: A (use of credit), B businesses. Information on credit should also be coordinat- (costs and terms of credit obtained), C (credit history), ed with information on savings, which is described in and D (lending). The short version condenses Parts A and Chapter 20 of Volume 2. Finally, information on local cred- B substantially, makes only minor changes in C and drops it institutions could be gathered in the community ques- Part D. tionnaire. Community data are discussed in detail in Survey designers should read Chapter 21 carefully. In Chapter 13 of Volume 1. 461 CREDIT MODULE (STANDARD VERSION) PART A: USE OF CREDIT FOR ALL PERSONS AGE 15 AND OLDER I would now like to ask you about whether you have borrowed any money or goods or obtained funds that you must repay from family, friends or institutions in the last 12 months. 1 2 3 4 5 6 7 8 9 IS THIS [INTER- In the last 12 What was the When was the last time In total, how In the last 12 What was the When was the last time that PERSON VIEWER: months, how many total amount you borrowed or obtained much do you months, how total amount you borrowed or obtained fund P ANSWERING COPY THE ID times did you borrow borrowed funds that you had to (have owe family many times did borrowed that you had to (have to) repay E FOR HER OR CODE OF or obtain funds that from family to) repay from a family members, you borrow or from your from your employer or R HIMSELF? PERSON you had to (have to) members, member, friend or other friends or obtain funds that employer or landlord? S PROVIDING repay from a family friends or individual? other you had to (have landlord in 0 THE INFORM- member, friend or other individuals? to) repay from the last 12 N ATION] other individual? individuals in (including all your employer or months? (Include all loans the last 12 loans landlord? (Include I made this year, even months? IF NEVER outstanding all loans made IF NEVER, D if already repaid). I regardless of this year, even if WRITE 9999 when already repaid). WRITE 9999 AND ,>17 obtained) AND '11 YES.. 1 IF NONE, IF NONE, (,3) WRITE 'O' WRITE '0' CO. . .. 2 AND >5 MONTH YEAR AND 9 MONTE YEAR 0 , 9 2 L ___ _ _ L__1 1__ 1 _7 1 1 1 7 2 :::: =_ :_ ::: C :::::: 8. 9 12, 30 ::__ __ _ _ _ : :: : :: : : :: :: :: : :: :::::::: : : : :: :: : ::: : : : :: :: :: :::::___ __ ::::__ __ ::___ _ :__ _ __ _ _ ::___ _ _ :::___ _ 6_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ : _ _ _ _ _ _ _ _ : = D _ _ _: : X _ _ _ _X _ _ _ _ _ C _ _ 71 :_ _ _ _ __ _ _ _ ::::__ __ __ _ ::_ __ _ __ _ ::::: :: ::: :: :: ::: : : : : :: :: :: : : : : 8 : :_ _ _ _ _ _ _ _ :_ _ _ _ _ _ _ _ _ _ _ _ _ _ '_ _ _ _ _ _ _ _ ::_ _ _ _ _ _ : : _ _: :_ _ _ 9 _: : : :: :::: :__ : _ :: ::::: ::: :: ::: :::: : :::::::: ::: :: :: ___ __ : : ::: : :: :: : : : CREDIT MODULE (STANDARD VERSION) PART A: USE OF CREDIT FOR ALL PERSONS AGE 15 AND OLDER 10 11 12 13 14 15 16 17 18 In total, how In the last 12 What was When was the last time that In total, how In the last 12 What was the When was the last time In total, how much do you months, how many the total you borrowed or obtained much do you months, how many total amount that you borrowed or much do you P owe your times did you amount funds that you had to (have owe credit times did you borrowed obtained funds that you owe banks E employer or borrow or obtain borrowed to) repay from a credit unions, borrow or obtain from banks or had to (have to) repay and R landlord? funds that you had from a credit union, cooperative or NGO? cooperatives or funds that you had government from a bank or govemment S (including all to (have to) repay union, NGOs? to (have to) repay agencies in govemment agency? agencies? 0 loans from a credit union, cooperative (including all from a bank or the last 12 (including all N outstanding cooperative or or NGO in loans government months? loans regardless of NGO? (Include all the last 12 outstanding agency? (Include all outstanding I when loans made this months? IF NEVER regardless of loans made this IF NEVER regardless of D obtained) year, even if already when obtained) year, even if already when repaid). WRITE 9999 repaid). WRITE 9999 obtained) AND >15 AND "19 IF NONE, IF NONE, WRITE '0' WRITE '0' 4'1 _AND '13 MONTH _ _YEAR AND '17 MONTH r YEAR 2 a' -T I____ T_ _ 1 11 11 IT 31 4ITL 12 11_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 2 ,_ _ _ _ _ __ _ _ _ _ CREDIT MODULE (STANDARD VERSION) PART A: USE OF CREDIT FOR ALL PERSONS AGE 15 AND OLDER 19 20 21 22 23 24 25 26 27 28 In the last 12 What was When was the last time In the last 12 What was the When was the last time In total, how In the last 12 What was [CHECK months, how the total that you obtained funds months, how total amount that you borrowed or much do you months, how the total QUESTIONS 5, 9, 13, P many times did amount from a ROSCA? many times did borrowed obtained funds that you owe these many times did amount 17, 21, 24, 26. ARE E you obtain funds obtained you borrow or from these had to (have to) repay other you pawn any received for ANY OF THESE R from a ROSCA? from a obtain funds that other sources from this other source? sources? of your pawning DATES WITHIN THE S (Include all loans ROSCA in you had to (have in the last 12 (including all belongings? your LAST 12 MONTHS?] 0 made this year, the last 12 to) repay from any months? loans (Include all belongings N even if already months? other source? outstanding pawning even in the past repaid). (Include all loans regardless of if article has 12 months? i IF NEVER. made this year, IF NEVER, when been D even if already obtained) reclaimed). WRITE 9999 repaid). WRITE 9999 AND '26 IF NONE, WRITE '0' YES.. 1 AND >21 IF NONE, IF NONE, (-PART B) WRITE '0' WRITE 'o0 NO.... 2 th, _ NUMBER MONTH YEAR AND -24 MONTE YEAR AND -28 (aPART C) 1% I I _ _ I I _ 2 5 :_ _ _ _ __ _ _ _ :_ _ _ _ _ _ :_ _ _ _ _ :_ _ __ _ _ ::_ __ _ __ _ : : ::: :___::_ :__X::::: :: X :: :: :: 7 ==__ __ _ _ _ :_ _ _ _ _ _ _ _ i::_ __ _ : :::: ::: ,: : :: 8 9 1121 _ : ::::_:::::_ 9r: :________ :________ :::_____ : ::i:i :: ::: :: :: : _:X __:_: ::: : : __ 1 0: : : :: :: _ _ _: _:::_:::_ _ _ _ _ _ _ _:::: ::::: :: :::4:: ::::: :: :::;::: : : _ _ _ _ : : : : _ _ _ _ _ : : _ _ _ _ : : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 11: : ::::: :: : X : :: :: : : :::: : :_________:_:_:_:_:__:_::_:_:_:: ___:_____:::_:_:_:_::_:_:_:_:::______: :____:_::_:_: :_:_:_:_:_:::_::_:_:_::_:_:_: ::__:___:_:_:__:: :_::_:_ : :: :: : : : : : : :: : : : : 12: ::_::_:_::_::_:: :_::_:__ ______ ::_:: :___________ _______________ ____:_:_::_____ __::_:::::_ ____:_::_X __________ X ::__::: :: ::: :::::::: CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT I would like to ask you questions about the most recent loan that you received or funds obtained from pawning goods or from a ROSCA in the past 12 months. 1 2 3 4 5 6 7 8 In the last 12 What was the main Where precisely did you Did you How far from How many How much In order to obtain this loan, how much did you have to months, did reason for borrowing obtain this most recent loan? have to your dwelling visits did you time, in spend on: P you borrow or obtaining this loan? visit the is the office have to make total, did E or obtain lender at of the lender to obtain the you spend R funds for GOV T AGENCY ..... I his or her (or residence loan? in S agriculture AGR. DEVE. BANK. . 2 office or if individual obtaining O (purchasing FARM OTHER NAT'L BANK. 3 residence lender)? the loan? N equipment INPUTS... . 1 COMMERCIAL BANK 4 to obtain or inputs, BUY HEAVY CREDIT UNION ... 5 this loan? I buying EQUIP .... 2 OTHER COOPERAT .... 6 [IF NOTHING, WRITE °0 D agricultural BUY OTHER . N7 INTER land, and the EQUIP .... 3 PAWNSHOP ........ 8 VIEWER: like)? BUY ROSCA .9 IF LESS ANIMALS ... 4 LANDLOR D .10 THAN BUY AGR. EMPLOYER. 11 ONE OTHER AG 5 ........ 13 Application Promisory Transfer Closing In-kind Other COSTS. AG 6 OERIE13 Fees Note, of Title Costs payments [Specify] YES .. 1 INDIVIDUAL . 14 YES 1 Legal [value] NO .... 2 OTHER No.... .2 KILO- NUMBER stamps, a, I_ ( >>2 9) INSTITUTION. 15 (p7) METERS OF VISITS HOURS Notary _ 2 71_ - 2 _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7 _ - - _ _ _ _ _ _ _ _ _ = _ _ _ _ __ _ _ _ __ _ _ _ 8 _ _ 10 0= 11 , ,, ___:_ __- 12 . .__ _.._.__ _ _._ CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 9 10 11 12 13 14 15 Did the lender What training or services did you For this loan, how many What will you be paid If no credit arrangement What quantity of harvest What price will the provide you receive? days of labor were you (were you paid) for this were involved, what must you give (have you lender pay you for this P with any obligated to provide, labor? would you be paid for given) to the lender for harvest? E training or ASSISTANCE IN PREPARING including days not yet your labor? this loan? R services LOAN APPLICATON ........1 provided? S related to TECHNICAL ADVICE ON THE IF NONE 0 obtaining DESIGN OF THE [IF NO LABOR ))14 I 18 N and/or PROJECT.........2 IF ALL LABOR [FRSODN managing the TECHNICAL ADVICE ON PROVIDED IS SAYS ALR L ASK H IF PRESET VALUE I loan? PROJECT DURING THE LIFE FREE ))13] SK H IM IN CURRENCY TERMS D OF THE LOAN 3 ESTIMATE THEN 017 TRAINING IN LOAN QUANTITY] MANAGEMENT ............ 4 TRAINING IN BOOKKEEPING ........... 5 QUANTITY UNIT QUANTITY UNIT CLASSES ON GROUP NUMBER OF DAYS OF KILOGRAMS ... .... 1 KILOGRAMS .... I BORROWING ......... 6 LABOR TONS .2 TONS. 2 OTHER [SPECIFY ].7 YES ... 1 FREE AT MKT BELOW NO .... 2 RATE MKT iS _ (»11) RATE AMOUNT ITIME UNIT AMOUNT ITIME UNIT AMOUNT Q UNIT AMOUNT Q UNIT 2 3 7 8 _ _ 11 HOUR ... 2 DAY .... 3 EEX .... 4 FORTNIGHT... 5 MONTH ...... 6 QUARTER.... 7 HALF YEAR.. . 8 YEAR ... 9 CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 16 17 18 19 20 21 22 Please explain how the harvest If you could sell this What (other) kind of collateral did you What is the cash How much did Are you paying What is the rate of value will be calculated (was harvest elsewhere, what provide to obtain this loan? value of this asset? you borrow in interest on this interest you are paying? P calculated). (What percentage price would you receive this most loan, in other E markdown will be paid and of for it? recent loan? words is the R what price?) total amount of S money you are O AGRICULTURAL LAND ..1 paying back N BUILDING, OTHER more than you PROPERTY .2 received or DAILY ....... 3 i CODE CAR OR OTHER borrowed WEEKLY .... 4 D MINIMUM VEHICLENG...... .3 originally? MONTHLY .6 PRICE .......1 SVNS......4(2)QUARTERLY .. .7 ARTPRICE AT ....OTHER ASSET ........ 5 SEMESTER .... 8 MARKET PRICE AT SIGNATURE, PERSONAL ANNUAL . . 9 HARVEST .. . .. 2 . . QUANTITY UNIT GUARANTEE .6(.2.).... . OTHER KILOGRAMS .... 1 GROUP LENDING . 7(-20) (SPECIFY )..3 TONS ..... 2 CO-SIGNER .8('20) NONE .9(>>20) YES1...I NO 2... 2 _ % MARKDOWN CODE VALUE Q UNIT [MARK UP TO 3 RESPONSES] CURRENCY (-23) RATE |TIME UNIT 2 3 _ _________=__V_= - 4 = _ ____ _ ____ ____ 6_________ =_______=__ 73_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 84_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9 5_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10 _______ ________ ___________ 17 _________ _____________ _______ 12 _______ ____ ____ ____ _________________ CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 23 24 25 26 27 28 29 30 How often do you make What amount do you How many How much will When will you finish Are you In the last 12 What was the main reason for borrowing payments on this loan? pay at each payment? payments in you repay at the repaying this loan? presently months, did you or obtaining this loan? P [IF PAYMENT IS IN total will you end? [INTER- behind on borrow or obtain E KIND, ASK make to pay VIEWER: IF your loan funds for your R RESPONDENT TO back this PAYMENT IS IN payment(s) own, non- S ESTIMATE loan (or KIND, ASK (in arrears)? agricultural 0 MONETARY VALUE.] have made if RESPONDENT business or N loan already TO ESTIMATE enterprise PURCHASE DAILY . 3 paid off)? MONETARY (purchasing OF INPUTS/OR WORKING I WEEKLY ...... 4 VALUE]. equipment or CAPITAL .................. 1 D MONTHLY .....6 inputs, buying BUY OR IMPROVE LAND .......2 QUARTERLY...7 land or buildings, BUY OR IMPROVE BUILDINGS. .3 SEMESTER ....8 r--------t and the like)? BUY OR IMPROVE ANNUAL ..... 9 Ki2l EQUIPTMENT. 4 ONLY ONE FINAL OTHER BUSINESS EXPENSES... 5 PAYMENT... 10(>26) NO SET SCHEDULE..11(>26) YES .. .1 YES ...1 NO ... .2 CURRENCY NUMBER CURRENCY MONTH | EAR NO .2 ('53) 0 - 2 2 _ _____ ______ _____ 3 4 7 9 _ _____ _________ X _ _ =_ v _ V : : X D :: 9110 :::__: ::::::_____: :___: : ::::: 1_ _ _ _ _ _: :__ _ _ _ _ _ __: _ _ _ _::_ _ _ _ _ _ _:_ _ _ _:::_ _ _ _ _ _ _ __::_ _ _ _ _ __._ _ _ _ _ :: _ _ _ _ _ _ _: _ _ CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 31 32 33 34 35 36 Where precisely did you Did you How far from How many How much In order to obtain this loan, how much did you have to spend on: obtain this most recent loan? have to visit your dwelling is visits did you time, in total, P the lender at the office of the have to did you E his or her lender (or make to spend in R GOV'T AGENCY ... 2 office or residence if obtain the obtaining the S AGR. DEVE. BANK ..2 residence to individual loan? loan? O COMTERCIAL BANK. 4 obtain this lender)? N CREDIT UNION ...... S loan? OTHER COOPERAT....6 D NGO ......... 7 [INTER- IF NOTHING, WRITE '0'] PAWNSHOP .......... 8 VIEWER: IF ROSCA ............ LESS THAN LANDLORD ......... 10 ONE WRITE EMPLOYER ......... 11 .0 RELATIVE ......... 12 FRIEND ......... 13 Application Promisory Transfer of Closing In-kind Other OTHER Fees Note, Title Costs payments [Specify] INDIVIDUAL ....... 14 YES...1 Legal [value] OTHER ...Lea INSTITUTION ...... 15 No.... 2 KILO- NUMBER stamps, (>35) METERS OF VISITS HOURS Notary 10. -2 11 ___________ _ _ _ _ _ _ _ ___ 32 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 37 38 39 40 41 42 Did the lender What training or services did you For this loan, how many days of labor What will you be paid If no credit arrangement What (other) kind of collateral did you provide you with receive? were you obligated to provide, (were you paid) for this were involved, what provide to obtain this loan? P any training or ASSISTANCE IN PREPARING including days not yet provided? labor? would you be paid for E services related LOAN APPLICATON ....... 1 your labor? AGRICULTURAL LAND..1 R to obtaining TECHNICAL ADVICE ON THE BUILDING, OTHER S and/or managing DESIGN OF THE PROPERTY. 2 O the loan? PROJECT .......... 2 CAR OR OTHER N TECHNICAL ADVICE ON VEHICLE .......... 3 PROJECT DURING THE LIFE IF NO LABOR ))42 SAVINGS ....... 4(>>44) OF THE LOAN 3 IF ALL LABOR OTHER ASSET ...... 5 D TRAINING IN LOAN PROVIDED IS FREE )>41 SIGNATURE, PERSONAL MANAGEMENT 4 GUARANTEE ......... 6(>>44) TRAINING IN GROUP LENDING . 7(44) BOOKXEEPING ........... CO-SIGNER ...... 8(44) CLASSES ON GROUP NONE .9(,44) BORROWING. 6 OTHER (SPECIFY J.7 NUMBER OF DAYS OF LABOR YES .. .1 NO.. ..2 FREE AT MXT BELOW MKT -bl ~~~~~~~RATE RATE MEUIT MON O _ (39) RATE_RATE_AMOUNT I|TIME UIT |TIME UNIT [MARK UP TO 3 RESPONSES] 2 _ 4 e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _X__ _ _ _ _ _ 7 _____ 3 87: : : : __:::_:: i : - i :: X : _:: : : : _: HOUR .... 2 DAY ... 3 WEEK .... 4 FORTNIXGHT... 5 MONTH .... 6 QUARTER.... 7 BALF YEAR... 8 YEAR ... 9 CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 43 44 45 46 47 48 49 50 51 52 What is the How much Are you paying What is the rate of How often do you make What amount do How many How much will When will you finish Are you cash value of did you interest on this interest you are payments on this loan? you pay at each payments in you repay at repaying this loan? presently P this asset? borrow in loan, in other paying? payment? [IF total will you the end? behind on E this most words is the total PAYMENT IS IN make to pay [INTER- your loan R recent loan? amount of KIND, ASK back this VIEWER: IF payment(s) S money you are RESPONDENT loan (or PAYMENT IS (in arrears)? 0 paying back TO ESTIMATE have made if IN KIND, ASK N more than you MONETARY loan already RESPONDENT received or DAILY.....3 DAILY.....3 VALUE.] paid off)? TO ESTIMATE I borrowed WEEKLY . .4 WEEKLY....4 MONETARY D originally? MONTHLY....6 MONTHLY....6 VALUE]. QUARTERLY ...7 QUARTERLY... 7 SEMESTER .... 8 SEMESTER .... 8 l ] ANNUAL....9 ANNUAL...9 ONLY ONE FINAL PAYMENT.. .10(>50) NO SET SCHEDULE ..11(-50) YES... .1 NO.... 2 YES... I 14 _ CURRENCY (b47) RATE % TIM:E CURRENCY NUIMEER CURRENCY MONTH YEAR No.... 2 2 3 _=______ ,,;_____ , = = -- ,, _ ,,:,_1 4 S_ _ _.._ _'_.._''_ _ _ ._ _ _ _ _ _ _ _ _....._ _ _ _ _ _ _ _ _ ._ _ _ _ _ _ _ _ _ _ _ _ _ 6 .__ _ _ _ _ .__ _ _ _ .__ _ _ _ _ _ . .__ __ . _ 7 1z~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ . 8 I__ _ _ __ _ _ CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 53 54 55 56 57 58 59 In the last 12 What was the main reason for Where precisely did you Did you How far from How many How much months, did you borrowing or obtaining this loan? obtain this most recent loan? have to your dwelling visits did you time, in P borrow or obtain visit the is the office have to make total, did E funds for lender at of the lender to obtain the you spend R personal use GOV T AGENcY ...... 1 his or her (or residence loan? in obtaining S (food, consumer CONSUMPTION NEEDS .... 1 AGR. DEVE. BANK . 2 office or if individual the loan? 0 durables, PURCHASE/IMPROVE OTHER NAT'L BANK. .3 residence lender)? N housing, DWELLING .2 COMMERCIAL BANK ... 4 to obtain onlending or the IMPROVE DWELLING. . 3 CREDIT UNION ......5 this loan? I like? CEREMONIES OTHER COOPERAT .. 6 D (RELIG/WED/BURY) . 4 NGO . 7 CONSUMER DURABLES . 5 PAWNSHOP . 8 INTER- ONLENDING .6 ROSCA . 9 VIEWER: OTHER .7 LANDLORD . 10 IF LESS EMPLOYER . 11 THAN RELATIVE . 12 ONE FRIEND . 13 WRITE 0' OTHER YES ...1 INDIVIDUAL . 14 YES. .1 NO ....2 OTHER NO... 2 KILO- NUMBER a _ (-PART C) INSTITUTION 15 ( METERS OF VISITS HOURS 2 3 _ __ _ L L _L_____L ___; _; -7 8 0 UX <0 X X 12____________:_______________________________________ ___________________ ________:::::_______::____ :::_:________:_i___ 2 :::::_ A: ::::: :__::: ___::: ::::_:: __::: ::_:::: :::::::::::: ::::::::: :: ::::::::: ::: : :: :_:_::: : i:: A:; ::::__ ::: A : ::: : ::::::; _ 3 ________________ ______________________________ Xx::__; X __ ________:_:_;:_;: ;::;; f j0;X :: t ::00::;0;:X::0;:00: :: 4 _ _ _ _ ___ :_ _ _ _ _ _ _ __ _ _ _ _ _ _ _ ::::: __ __ __ __ __ 5 ___;_ __ _ ::; :__::: __ :: ___:::: __:::::_____::__:___:__::: :: _: :: ::::;::_:__ :::_:____:_:::: X X __ i;: : __ ____ _ _: X ; _ CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 60 61 62 63 64 In order to obtain this loan, how much did you have to Did the lender What training or services did you For this loan, how many days of What will you be paid spend on: provide you receive? labor were you obligated to (were you paid) for this p with any provide, including days not yet labor? E training or ASSISTANCE IN PREPARING provided? R services LOAN APPLICATON ....... 1 S related to TECHNICAL ADVICE ON THE 0 obtaining DESIGN OF THE N and/or PROJECT ..... 2 managing the TECHNICAL ADVICE ON I [IF NOTHING, WRITE 0'] loan? PROJECT DURING THE LIFE D OF THE LOAN . 3 TRAINING IN LOAN IF NO LABOR >66 MANAGEMENT 4 IF ALL LABOR TRAINING IN PROVIDED IS BOOKREEPING .5 FREE >)65 CLASSES ON GROUP Application Promisory Transfer Closing In-kind Other BORROWING. 6 Fees Note, of Title Costs payments [Specify] OTHER ESPECIFY ] .7 NUMBER OF DAYS OF LABOR Legal [value] . YES ..1 stamps, I NO ....2 FREE AT MKT BELOW MKT I.bJ __ ________ Notary (-63) RATE RATE AMOUNT TIME UNIT 3s- = _____= =-= 4 _ ,__,_, _ - -7 __._____.____ _ _ _ 7_ _ _ ___ _ _ _ = _ _ __ _ _ _ _ _ _ _ _ 10 _________ ______ _=_= H OuR. . . 2 DAY. .. 3 WEEK. . . 4 FORTNIXGHT..... 5 MONTHf. ..6 QUzARTER .... 7 HAF YEAR.. e8 ..a.. .9l CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 65 66 67 68 69 70 71 72 If no credit arrangement What (other) kind of collateral did you What is the How much Are you What is the rate of How often do you make What amount do were involved, what provide to obtain this loan? cash value of did you paying interest you are payments on this loan? you pay at each P would you be paid for this asset? borrow in interest on paying? payment? [IF E your labor? this most this loan, in PAYMENT IS IN R recent loan? other words KIND, ASK S AGRICULTURAL LAND .. 1 is the total RESPONDENT 0 BUILDING, OTHER amount of TO ESTIMATE N PROPERTY ...... 2 money you MONETARY CAR OR OTHER are paying DAILY ....... 3 DAILY ....... 3 VALUE.] VEHICLE ........... 3 back more WEEKLY ...... 4 WEEKLY ...... 4 D SAVINGS ............ 4(>68) than you MONTHLY ..... 6 MONTHLY ..... 6 OTHER ASSET ........ 5 received or QUARTERLY ... 7 QUARTERLY .7 SIGNATURE, PERSONAL borrowed SEMESTER8 .... 8 SEMESTER.... 8 GUARANTEE ...... 6(>>68) originally? ANNUAL . 9 ......ANNUAL 9 GROUP LENDING ..... 7('68) ONLY ONE FINAL CO-SIGNER .. .. 8(»68) PAYMENT... 10(74) NONE.........9(-68) NO SET SCHEDULE ..11(-74) YES.. .1 No .. _2 14 _ AMOUNT TIME UNIT MARK UP TO 3 RESPONSES CURRENCY (-71) RATE % TIME CURRENCY 2 3 8 HOU ... 2 DA.. :: ::K.. 4 :e:NG . MOeT .... 6 ::::RTER:.... 7 HAL ::.. :: YER. .:::: 1 ___:___: __ :__:__:___:::___::___::_________ __________________ i::::___________:::____________________ _____________________::_ _:__:__:__:::____:__::::____:: 9 } OR 2 D A Y _ _ _ _ _ _ _ _ _ _ 3 _ _..sFRTI} .... 5M_ _ ..6QrATR... _ _ _ ER .8YER. CREDIT MODULE (STANDARD VERSION) PART B: DETAILS OF CREDIT 73 74 75 76 How many How much will When will you Are you presently payments in you repay at the finish repaying this behind on your P total will you end? [INTER- loan? loan payment(s) E make to pay VIEWER: IF (in arrears)? R back this PAYMENT IS IN S loan (or KIND, ASK O have made if RESPONDENT N loan already TO ESTIMATE paid off)? MONETARY I VALUE]. D 5)75 YES... I _9N _ NNUMBER CURRENCY MONTH YEAR NO.... 2 Un 2 . . - 3 4 . -5 =_____ _ ________ ___ _______ 7 8 70 _ _ _ _ _ _ _ _ 11 _ _ _ __ _ __. _ _ 12 _1, __, , _ _ CREDIT MODULE (STANDARD VERSION) PART C: CREDIT HISTORY 1 2 3 4 5 During the Why were you turned down? Who turned you down? CHECK Why did you not attempt to Can a person like yourself obtain a loan from: last 12 fWR3TE UP TO THREE QUESTIONS 1. borrow money in the past P months did RESPONSES IN ORDER OF GOV'T AGENCY ...... 1 29 AND 63 IN 12 months? fWRITE UP E you try to IMPORTANCE] AaR. N TEV B 3 PART B. DID TO THREE RESPONSESAD EACH R borrow OTHIER NZATL BANX.. THE IN ORDER OFINEVWRRADAC S money from INVRaTMENT COMMERCIAL BAN ...4 RESPONDENT IMPORTANCEI LENDER AND WRITE DOWN O any person or ACTIVITY N CREPIT U HAVEAT NO NEED.......... I EACH RESPONSE N institution ACCEPTED ........ 1 OTHER COOPERAT ....6 LEAST ONE BELIEVED WOULD and were NOT ENOUGHN N OO ........ 7 LOAN .N PAST BE REFUSED ...... 2 I refused? INCOME .... 2 PAWNSHOP ...... a 12 MONTHS? TOO EXPENSIV_... 3 D RAD CREDIT ROSCA ........ 9 INADEQUATE fHISTORY . 3 LANDLORD ..... .104 INADEQUATE EMDLOYER .. . n11 DO NOT LIKE TO BE State Bank Private Credit Union Employer Money- Other COLLATERAL 4 RELATIVE ........ 12 IN DEBT......... 5 Bank or other Landlord Lender (Specify) OWE TOO UCH . 5 FRIEND ..... 13 P O NOT KNOW ANY Cooperative YES ... 1 OTHER REASONS... 6 OTHER YES-.. 1 LENDER ....... 6 NOa. .. 2 (I6) OTEtR .. . 7 YES..1. YES ...I YES ... .1YE.-1 YES_1 _t4) ST6) NO ..2 . T 3 NO_. .2 NO... 2 NO ...2 . 2 NO .... 2 No ...2 ri 2 ___ _ _ _ ___ _ _ _ _ ___. ._ a- 3- 3q0 i; tt:0 5i _ = _ t0 5 ^iii 0t5 0005;ii t f004 __ _ _ _ = ______ ______ : ____=-= _ 4 _2__=_ 7 9~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : 1 t : :_ _ _ _ _ _ _ _ _ _ _::_: :::__ _ _ _ _ _ _ _ _ _ _ _ _ _ :__ _ _ _:_::__ _ _ _ _ _ _ _ _ _ _ _ _ _ _:::_ _ _ _ :: : _ _ : : _ _ _::::__ _ _ _ _ _ _ _ _ _ _ _tf 7 ::19 t: ft:8 f 8 :! T ; :Ct SV: tS:X __ __ __ __ __ _ __ _ __ _ __ _ __ _ _ __ _ _ __ -__ - - _ __ __ __ _ __ _ ___;_;_ ___' __:_ ;: EC 0: 1 0 _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -_ _ _ _ _ _ ;_ _ __;_:_ _ _ _ _: ;_ ::::_:_; :_ _:: t :;:_ - 0 L ; ':0 : : ; CREDIT MODULE (STANDARD VERSION) PART D: LENDING ACTIVITIES Now I would like to ask you about anyone who owes you money. 1 2 3 4 5 6 7 8 Does How Is the person who How far from here When did this What was the main reason this person How much did What collateral did this person anyone many borrowed from you does this person person borrow borrowed money from you? this person provide you with? P owe you people most recently a live? from you? FARIN U .LTE borrow? E money at owe you relative, friend, BUY HEAVY EQUIP ............. 2 AGRICULTURAL LAND ..1 R present? money at employee or BUY OTHER EQUIP 3 BUILDING, OTHER S present? someone else? BUY ANIMALS .4 PROPERTY 2 0 BUY AGR. LAND .........CR OPROTY . 2 N OTHER AG. COSTS .6 V.CAR OR OTHER NONFARM BUSINESS VEHICLE . 3 PURCHASE SAVINGS. 4 OF INPUTS/WORKING CAP ...... .7 HARVEST............ 5 D BUY OR IMPROVE LAND/BUILD/EQUIP ........... 8 OTHER ASSET .. . 6 OTHER BUSINESSES EXPENSES . 9 SIGNATURE, PERSONAL PERSONAL USE GUARANTEE. 7 CONSUMPTION NEEDS .10 GROUP LENDING .8 PURCHASE/IMPROVE DWELLING. .11 CO-SIGNER. 9 RELATIVE ....1 LESS THAN CEREMONIES NONE .10 FRIEND ...... 2 1 KM .....1 (RELIG/WED/BURY) ... 12 YES ...1 EMPLOYEE .... 3 1-5 KM. ..2 CONSUMER NO .... 2 OTHER 6-10 KM ... 3 DURABLES...........13 [INTERVIEWER: MARK UP TO 3 (-NEXT INDIVIDUAL.4 MORE THAN ONLENDING .14 RESPONSES] IIPERSON) NUMBER 10 KM .... 4 MONTH YEAR OTHER .... 15 1ST 2ND :3RD 3 _ iONTH YE 6 _ 7 8 _ 9 41 __- __- _=- 1 2 _ _ _ _ 0 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CREDIT MODULE (STANDARD VERSION) PART D: LENDING ACTIVITIES 9 10 In what form will this person When should this repay the loan? person finish P repaying you for E this loan? R S 0 N i ONLY CASH .......1 [IF NO SET D ONLY GOODS ......2 PERIOD, ONLY LABOR ......3 WRITE CASH AND GOODS ..4 9999 IN CASH AND LABOR ..5 SPACE FOR GOODS AND YEAR] LABOR ....... 6 ALL ....... 7 OTHER ....... 8 14 MONT ______ONTH | EAR 2 3 7 8 __ 4 : : : : : 9_ ________: ::::: ::: __: : : 10::9:S _ _ _ _ _ _ _ _ _ _ _ _ _ __:_:_: _ _ : _: _ __5;:: AVA :: XX \; fa::0 11; 6 _____________________________0:t: 420T:20 it0040t:0 00:0:: ::40X0 12 . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CREDIT MODULE (SHORT VERSION) FOR ALL PERSONS AGE 15 AND OLDER I would new like to ask you about whether you have borrowed any money or goods or obtained funds that you must repay from family, friends or institutions. 1 2 3 4 5 6 7 8 9 10 IS THIS [INTER- In the last 12 What was the In total, how In the last 12 What was the In total, how In the last 12 What was the PERSON VIEWER: months, how many total amount much do you months, how total amount much do you months, how total amount P ANSWERING COPY THE times did you borrowed from owe family many times did borrowed owe your many times did borrowed E FOR HER OR ID CODE OF borrow or obtain family members, you borrow or from your employer or you borrow or from a credit R HIMSELF? PERSON funds that you had members, friends or other obtain funds that employer or landlord? obtain funds that union, S PROVIDING to (have to) repay friends or individuals? you had to (have landlord in (including all you had to (have cooperative or 0 THE from a family other (including all to) repay from the last 12 loans to) repay from a NGO in the N INFORM- member, friend or individuals in loans your employer or months? outstanding credit union, last 12 ATION) other individual? the last 12 outstanding landlord? (Include regardless of cooperative or months? i (Include all loans months? regardless of all loans made this when NGO? (Include all D made this year, when obtained) year, even if obtained) loans made this even if already already repaid). year, even if repaid). already repaid). YES... 1 IF NONE, IF NONE, IF NONE, (t3) WRITE '0' IF NOTHING, WRITE '0' IF NOTHING, WRITE '0' a NO ..NO. 2 AND -5 WRITE '0' AN4D 8 WRITE '0 AND '>11 14m| 4 2 ._ _ _ __ _ _ _ __ _ _ _ _ _ _ _ _ _ ,, _ _ _ _ _ __ _ _ _ _ _ _ _ 6 __ __ __ _ 7 _ -8. 9 10 11 12 _._ _ _ _ . - - . . . . CREDIT MODULE (SHORT VERSION) FOR ALL PERSONS AGE 15 AND OLDER 11 12 13 14 15 16 17 18 19 20 In total, how In the last 12 What was the In total, how In the last 12 What was In the last 12 months, What was the In total, how When did you most recently much do you months, how total amount much do you months, how many the total how many times did total amount much do you borrow money or obtain owe credit many times did borrowed owe banks and times did you amount you borrow or obtain borrowed owe these funds that need(ed) to be unions, you borrow or from banks or government obtain funds from obtained funds that you had to from these other repaid? [IF PERSON SAYS cooperatives or obtain funds that government agencies? a ROSCA? from a (have to) repay from other sources sources? THAT NEVER BORROWED NGOs? you had to (have agencies in (including all (Include all loans ROSCA in pawning your in the last 12 (including all MONEY WRITE IN 99 9999 (including all to) repay from a the last 12 loans made this year, the last 12 belongings or from months? loans AND >)24. IF MOST loans bank or months? outstanding even if already months? any other source? outstanding RECENT LOAN IS OLDER outstanding government regardless of repaid). (Include all loans regardless of THAN 12 MONTHS, WRITE regardless of agency? (Include when obtained) made this year, even when DATE AND )>24.[ when obtained) all loans made this if already repaid). obtained) year, even if already repaid). IF NONE, WRITE '0' AND ,17 IF NONE, IF NONE, IF NOTHING, WRITE '0' IF NOTHING, WRITE '0' CO WRITE '0' AND ,14 WRITE '0' NUMBER AND >20 MONTH o C~~~~~~~~~~~~:- CREDIT MODULE (SHORT VERSION) FOR ALL PERSONS AGE 15 AND OLDER 21 22 23 24 25 26 27 Where precisely did you What was the main reason for borrowing or How much During the Who turned you down? CHECK THE Why did you not attempt to obtain this most recent loan? obtaining this loan? did you last 12 GOV'T AGENCY ...... 1 ANSWERS TO borrow money in the last 12 AGRICULTURE borrow in months AGR. DEVE. BANK ... 2 QUESTIONS 21- months? [WRITE UP TO FARM INPUTS .......... 1 this most did you try OTHER NAT'L BANM. 3 23. DID THE THREE ANSWERS IN GOV'T AGENCY ....1 BUY HEAVY EQUIP........2 recent to borrow COME1ERCIAL BAN .. PERSON OBTAIN ORDER OF IMPORTANCE] AGR. DEVE. BANK 2 BUY OTHER EQUIP . 3 loan? money CREDIT UINX 4 A LOAN IN THE OTHER NAT'L BANK. .............. 3 BUY ANIALAS. ND from any OTHER COOPERAT .... 6 PAST 12 NO NEED .......... 1 OTERNA'LBAK.3 BUY AGR. LAND..S:...... COMMERCIAL BANK ... 4 OTHER AG. COSTS ............. 6 person or NGO .............. 7 MONTHS? BELIEVED WOULD CREDIT UNION ...... 5 NONFARM BUSINESS institution PAWNSHOP .......... 8 BE REFUSED. 2 OTHER COOPERAT .... 6 PURCHASE and were ROSCA ............. 9 TOO EXPENSIVE ... 3 NGO ..... 7 OF INPUTS/WORKING CAP ...... 7 refused? LANDLORD ......... 10 INADEQUATE BUY OR IMPROV'E PAWNSHOP .8 LAND/BUILD/EQUIP ........ 8 EMPLOYER .........11 COLLATERAL.. 4 ROSCA ........ 9 OTHER BUSINESSES EXPENSES... 9 RELATIVE .12 DO NOT LIKE TO BE LANDLORD ........ 10 PERSONAL USE FRIEND .13 IN DEBT.. 5 EMPLOYER ........ 11 CONSUMPTION NEEDS .10 OTHER DO NOT KNOW ANY RELATIVE ......... 12 PURCHASE/IMPROVE DWELLING ..11 INDIVIDUAL ....... 14 LENDER .......... 6 FRIEND ..... 13 CEREMONIES OTHER YES... 1 OTHER ........ 7 OTHER (RELIG/WED/BURY) .......... 12 INSTITUTION. . 15 CONSUMER YES.... 1 (»NEXT INDIVIDUAL . .. . ........ 14 DURABLES .13 NO . 2 2 MODULE) OTHER ONLENDING .14 NEXTL Jb INSTITUTION . 15 OTHER .....1.5 ( .2.6.) _ NO. 2 IST 2ND 3RD OD Module for Chapter 22 Time Use Andrew S. Harvey and Maria Elena Taylor The following pages present draft questionnaires that col- ForVersion 1 of the stylized activity list, as well as for lect data on time use. As discussed in Chapter 22 ofVolume the time use log and the time use diary, the draft ques- 2, there are two basic options for collecting information on tionnaire gathers information for only a single household time use. For full detail, a special purpose module will be member. Usually such information will be collected for required. The three options presented here-the stylized all members, so that module must appear multiple times activity list, the time use log and the time use diary-are in in the household questionnaire, and a clear place is need- increasing order in terms of more detail, better data quality, ed to identify the individual to whom thc data pertains. and higher cost. The alternative to full detail is partial Thus there might be 10 or 12 sets of pages along the lines information on time use, in which case limited information of those shown. ForVersion 2 of the stylized activity list, can be gathered from modules that are already part of the the illustration shown collects information for all house- household questionnaire. This is explained in Chapter 22 hold members on a single grid, so only one copy of it is and is illustrated in other chapters of this book. needed. 483 VERSION 1 OF STYLIZED ACTIVITY LIST ALL MEMBERS AGE 7 OR OLDER ID CODE L DATE (DY/MO/YR) [11 OPTIONAL 1. 2. 3. 4. 5. 6. Were you involved in [ACTIVITY] during the Were you involved in [ACTIVITY] Were you involved in How many Were you involved in [ACTIVITY] How many hours were last 6 months? last week? [ACTIVITY] hours were the day before yesterday? you involved in yesterday? you [ACTIVITY] the day involved in before yesterday? [ACTIVITY] yesterday? ,)))NEXT ACTIVITY YES ................... YES .................. YES ... 1 YES . 1 NO .. 2 (-,NEXT ACTIVITY) NO ..2 (-NEXT ACTIVITY) NO .. 2 (-5) HOURS NO ..2 (-NEXT ACTIVITY) HOURS Personal Sleep, rest ___________ Bathing, dressing Eating _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Other personal care, i:e._meddcal Household/Family Cooking, Washing dishes/pans _ __ __. House Cleaning (inside or outside) Shopping ________________ Other Household __________ r :Child/eldercare, physicalt ::: : : :::::::::::: : ChIld dllder care, readin a :ing ___________:: ::i : T ra v el (f r a n y p ur o se) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __:: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __:::_ _ _ _ _ _ Paid work Waged Employment ._ Commission work Self-Employrent _: :_:__:: _: : :___:::_::_: _ Otherpai:d:wrk.lLookingforWork:: :::::::::: ;:::::::::::::::::: :: :::::: : :: Work for own use _ . _ Animal Husbandry _ Agriculture Hunting/Gathering FetchMPrepare fuel _____:___________ Fetching water: Homernmanufacturing Food processing Other production own use . Selling home produced goods _ Non work/Non personal Education______________ ______________________________ Communit/rgizatnal ork ____________: ___:________ ______________ __ ; Visiting, movies, sports, events : Participation in sports, games, hobbies |_|__ _ _ | _ Reading, TV, radio | . | | |_._ _ _ _ Others I , I _ I |Hours 24 | Hours 24 VERSION 2 OF STYLIZED ACTIVITY LIST ALL MEMBERS AGE 7 OR OLDER Now I will like to ask you some questions about the activities that you had yesterday and the time that you spent on them. (FOR ACTIVITIES OUTSIDE THE HOUSEHOLD INCLUDE TIME USED IN TRANSPORTATION). WORK/JOB. ONLY FOR WORKING PERSONS (SEE SECTION 5) 1. 2. 3. 4. 5. I Did you spend time on Did you spend time yesterday Did you spend time yesterday Did you spend time yesterday Did you spend time D household agricultural or on non-agricultural household on a regular paid job? on a non paid job? yesterday searching for a job? livestock activities yesterday? enterprise or business? C (Work on plot of land owned by O household) D E How much time How much time How much time How much time How much time YES. . 1 did you spend? YES. . 1 did you spend? YES. . 1 did you spend? YES. I did you spend? YES. . 1 did you spend? NO... 2 NO... 2 NO... 2 NO... 2 NO... 2 CM _ (t2) HOURS MINUTES t (t3) HOURSIMINUTES (*4) HOURS MINUTES (>5) HOURS|MINUTES (-6) HOURS MINUTES 3 6 F - _ _ _=__ _ _ __-X__ _ 7 T-_ _ _ _ _ _ VERSION 2 OF STYLIZED ACTIVITY LIST ALL MEMBERS AGE 7 OR OLDER EDUCATION - ONLY FOR STUDENTS HOUSEHOLD MAINTENANCE 6. 7. 8. 9. 10. Did you spend time yesterday on Did you spend time Did you spend time cooking Did you spend time yesterday Did you spend time yesterday D school classes/university or other yesterday doing homework? yesterday? doing dishes, laundry, repairing your house/property training? ironing, or cleaning your (patio)? C house? 0 D E How much time How much time How much time How much time How much time YES. .1 did you spend? YES. .1 did you spend? YES. .1 did you spend? Y .1 did you spend? YES. .1 did you spend? NO. ..2 NO. . .2 NO... .2 NO... .2 NO.. .2 o _ ( 7) HOURS I OTES ES twa) HOURS |MINUTES (>9) HOURS MINUTES 0' 1__ 4 6 7 11: ___ 12 = ===- = VERSION 2 OF STYLIZED ACTIVITY LIST ALL MEMBERS AGE 7 OR OLDER HOUSEHOLD MAINTENANCE 14.15. 11. 12. 13. 14. 15. I Did you spend time Did you spend time yesterday Did you spend time yesterday Did you spend time yesterday Did you spend time cadng for D yesterday collecting collecting firewood? shopping for food, clothing, child caring (exclusive of the sick? water? household items? pregnancy) (ONLY FOR C WOMEN) 0 D E How much time How much time How much time How much time How much time YES..1 did you spend? YES. 1 did you spend? YES. .1 did you spend? YES 1 did you spend? YES 1 did you spend? NO...2 NO...2 NO...2 NO...2 NO.. .2 (-12) HOURS I MINUTES (>13) HOURS MINUTES (b14) HOURS MINUTES ("45) HOURS MINUTES (H46) HOURS MINUTES 4 _-_ _ _ _ 11 VERSION 2 OF STYLIZED ACTIVITY LIST ALL MEMBERS AGE 7 OR OLDER PERSONAL ACTIVITIES 16. 17. 18. 19. 20. I Did you spend time yesterday Did you spend time yesterday Did you spend time yesterday Did you spend time yesterday Did you spend time D feeding yourself (breakfast, sleeping? on your personal care (taking a resting (nap), recreation, reading yesterday visiting a lunch, dinner)? bath, dressing, etc.)? small talk, watch TV, drinking a doctor/health care? c soda? 0 E How much time YE..1 How much time YS How much time YE..1 How much time YE.IHow much time YES. .1 did you spend? YES,.1 did you spend? YES 1 did you spend? .1 did you spend? YES .1 did you spend? NO.. 2 NO... 2 NO.. 2 NO.. 2 NO.. 2 OD _ ('17) HOURSLMINUTES (.18) HOURS | MINUTES (.19) HOURS MINUTES ('20) HOURS MINUTES ('21) NOtURS -S 2 3 6 7 8 9 112 ai~ - _ _: : :: : : :: : :S f:::: : : : :;:S ;: ::; : :;; VERSION 2 OF STYLIZED ACTIVITY LIST ALL MEMBERS AGE 7 OR OLDER SOCIAL AND COMMUNITY ACTIVITIES OTHER TOTAL HOURS DATE CONCURRENT ACTIVITIES 21. 22. 23. 24. 25. 26. I Did you spend time Did you spend time Did you spend time yesterday in activities not INTERVIEWER: ADD TODAY'S Did you spend time yesterday D yesterday on social reurions yesterday on social mentioned before? UP HOURS AND DATE on childcare at the same time (weddings, birthdays, community MINUTES FROM that you did other activities? C funerals, etc.) or visiting services/community QUESTION 1 TO 23, 0 family or friends? tasks/parish tasks, etc.? VERIFY THAT THE D TOTAL ADDS UP TO E 24 HOURS How much time How much time What is this How much time YES. .1 How much time YES . .1 did you spend? YES. . 1 did you spend? YES. .1 other activity? did you spend? NO. . .2 did you spend? NO... .2 NO... .2 NO... 2 MIN- (NEXT OD _ ('22) HOURS | MINUTES (-23) HOURs MINUTES (.24) ACTIVITY HOURS UTES TO - __HOURSIMJjINTE i'isUTES TAIT DY/MO/YR SECTION) HOURS MINUTES 2 3 4 6B -- =- - = _____ _ - _-_ _ __ __ 7 INSTRUCTIONS FOR STYLIZED ACTIVITY LOG ALL MEMBERS AGE 7 OR OLDER THE AIM IS TO SHOW THE MAIN THING THE RESPONDENT WAS DOING THROUGH THE WHOLE DAY IN ORDER TO RECORD ACTIVITIES FOR THE WHOLE DAY, TURN THE PAGES OF THE MODULE TWICE FOR EACH PERSON IF THE RESPONDENT IS DOING TWO THINGS AT THE SAME TIME, HAVE THEM CHOOSE WHICH IS THE MAIN ACTIVITY. FOR EXAMPLE, KEEPING AN EYE ON CHILDREN WHILE DOING HOUSEWORK SHOULD BE RECORDED AS "HOUSE CLEANING' RATHER THAN 'CHILD BEARING/CARE'. IF BOTH ACTIVITIES ARE EQUALLY MAIN, THEN RECORD THE ONE THE RESPONDENT DID FOR THE LONGEST TIME AS THE MAIN ACTIVITY. THESE ARE THE CATEGORIES IN WHICH TO PLACE SOME COMMON ACTIVITIES Paid work -- People who travel in the course of their work, e.g. bus drivers, delivery men and sales people should classify this as paid work and not Travel SD Shopping - includes going to the Doctor/Dentist. House cleaning (inside and outside) - includes: taking out the garbage, mowing the lawn and washing up Community/organizational work - includes religious activities, praying alone. STYLIZED ACTIVITY LOG ALL MEMBERS AGE 7 OR OLDER ID CODE |IJ DATE DY/MO/YR NIGHT MORNING AFTERNOON ACTIVITIES 4:00 AM 5:00 AM 6:00AM |7:00 AM| 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM | 2:00 PM | 3:00 PM | 4:00 PM | 5:00PM Personal 1 Sleep, rest 2 Bathing dressing 3 Eating _ 9 Child care/elder care, read Ic in Other H ousehorl wnus 10 Chlild care/elder care, physical 11 Travel or any prpose) Paid Work [12 [Waged Employment [13 [Commission work( I I r1111I I I1 I I I I I TI I I I LL1II1 111I [14 Self-Employment 15Other pid work, Looking for work Work for own use 16 Animal Husbandry Non-work.Non.p.ersonal 2?viaiting.movres garnes,sports,e'venta 0 IiS 1 II I II I I Ii i i ii ii 1i 1i t ii i it1˘ 4˘t1 Remuneration type (Where applicable) 32 UnchPrpaid fulI Location of activity 33 Home l|| | | | | | | | | | | 324 Awalin frome hroduedod Child Respmosibility 35 tLookion afte cl de I 4:00 AM |5:00 AM 6:00 AM | 7.00 AM |8:00 AM | 9:00 AM | t0:00AM|11I:00 AM | 12:00 PM1 1:00 PM | 2:00 PM | 3:00 PM 4:00 PM 1 5:00 PM NICHT NORNINC AFTERNOON AFTERNOON STYLIZED ACTIVITY LOG ALL MEMBERS AGE 7 OR OLDER ID CODE NIGHT CIVIES 6:00 PM 7:00 PM F8:00 PM 9:00 PMI 10:00 PMI 11:00 PMI 12:00 AMI 1:00 AM 2:00 AM 3:00 AM Personal 10 Cthild peare/elde care, i.e Meical Pauehod WndFrk l Cooing edaEmp ng m ises/an 14 Self-Emnt monIt_ I 8 LOiherHaidework, LoLIkLn for Lork Work forkon s J 16 Animal Husbandr 18 Hunting/Gathering 19 FetchiPrepare fuel 20 Fetching water _ 21 Home manufacAuring 22 Food processing-IH 23Ohrroduction own use 124 ISeling home produced goods F F4 #- H Non-work.NWon-personal 25 Education I II I 26 Comnmunity/organizational work I I - .H II I I lIIII 27 V/siting, movies, games, sports, events I I I I i l I i IL l i 28 Read/ng, TV, radio II AL 29 Others, Remuneration type (Where applicable) 130Cash 1 1 1 131 ]In kind 132 jUnpaid Location of activity 33 1Home 134 jAwayfrom homneI I I H M U Child Responsibility F35 TLoo-ing after childrenILILIII III III III IIIIIIIIIII ]I III1 6:00 PM 7:00 PM j8:00 PM I9:00 PM I 10 00 PMJ 11:00 PMJ 12:00 AMI 1:00 AM 1 2:00 AM 13:00 AM NIGHT OPEN INTERVAL TIME DIARY ALL MEMBERS AGE 7 OR OLDER ID CODE DATE (DY/MO/YR) | Z l 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Principal activity What Start End What else are you Where are you? With whom are you? For whom are you Did you Remuneration type Comments were you doing? time time doing? doing this? use ALONE ... 1 machine WITH SPOUSE.2 equip. or WITH CHILDREN animal to PUT A CHECK (,O IN ONLY .. 3 do this THE COLUMN THAT WITH OTHER activity? APPLIES. HOUSEHOLD WHERE RELEVANT MEMBERS .... 4 AT HOE..lWITH CO- OW AT HOE. .1 WORKERS OR HOUSEHOLD.... 1 AT WORE.. 2 SCHOOLMATES.. EMPLOYER. 2 OTHER ~~~~ANOTHER PUBLIC WITH FRIENDS HOUSEHOLD......3 PLACE ... 3 OR RELATIVES VOLUNTARY Travelling FROM OUTSIDE VOLUANTARYN. BY FOOT .4 HOUSEHOLD.. 6 ORGANIZATION.4 BY CAR . .5 WITH OTHERS.7 ApplicabNl t9 YES. . BY OTHER.6Aplcbe.9 N..2 _ _ _ _Cash In kind Unpaid 1 2 |4:00am 2 4 6 l ~ ___ .___ __ 7 10 . _ 11 12 13 14 Modules for Chapter 23 Panel Data Paul Glewwe and Hanan Jacoby Questionnaire pages that demonstrate how to collect lect this information. The first is to start by collecting panel data are presented in the following pages. As information about individuals currently living in the explained in Chapter 23 of Volume 2, there are two dif- dwelling, and then ask whether these are the same people ferent pages. Both pages need to be included only in fol- that were living in the dwelling in the previous survey. low-up surveys, not in the initial survey. The first page This is called the "new ID code" method in Chapter 23. contains questions that determine whether the dwelling The second way is to ask about the household members was included in the sample for the previous survey and, if who lived in the dwelling in the previous survey and so, whether the dwelling was successfully located and its record who is still in the household and who has left, then inhabitants reinterviewed in the subsequent survey. These to ask about any individuals who have moved into the questions should be added to the household identification dwelling since the previous survey. This is called the "same page of the metadata module, which is discussed in ID code" method. See Chapter 23 for the advantages and Chapter 4 ofVolume 1. disadvantages of both methods. The second page matches the individuals who lived in A final point to note regarding the collection of panel the dwelling in the previous survey with the same indi- data is that there are several ways to modify other modules viduals still living in the dwelling at the time of the fol- in the initial survey that will increase the chances of low-up survey. For people who have left the dwelling, it matching households and people across different surveys. gathers information on where they are now and why they If panel data are to be collected, Chapter 23 should be left the original dwelling. This page should be added to consulted for detailed advice on how to modify other the household roster module. There are two ways to col- modules for this purpose. 495 ADDITIONAL QUESTIONS FOR THE HOUSEHOLD IDENTIFICATION AND INFORMATION CONTROL PAGE QUESTIONS 1-4 ARE FILLED OUT BY THE SUPERVISOR BEFORE THE INTERVIEWER VISITS THE DWELLING 1. WAS THIS DWELLING INCLUDED IN THE PREVIOUS SURVEY? 5. WHAT IS THE CURRENT STATUS OF THIS DWELLING? YES ....1(..5) [.] .................... 1 DWELLING FOUND, OCCUPANTS NO . ,...2 l................... l INTERVIEWED ............................. 1 ()NEXT SECTION) DWELLING FOUND, OCCUPANTS 2. WHY IS THIS DWELLING BEING INTERVIEWED FOR THE FIRST TIME? NOT INTERVIEWED. 2 DWELLING FOUND, BUT NOT TO FOLLOW PARTICIPANT IN A PREVIOUS CURRENTLY OCCUPIED.. 3 (7) SURVEY WHO MOVED .......... 1 i i DWELLING KNOWN NO LONGER ALL OTHER REASONS ................. 2 (,>5) .i TO EXIST .4 (JT) CANNOT FIND DWELLING, 3. WRITE DOWN THE CLUSTER CODE AND THE HOUSEHOLD ID CODE UNCLEAR IF IT EXISTS .5 (o7) USED IN THE PREVIOUS SURVEY FOR THE DWELLING OF ORIGIN. 6. WHY WERE THE OCCUPANTS NOT INTERVIEWED? CLUSTER l CODE l REFUSAL 1...... , HOUSEHOLD TEMPORARILY AWAY FROM AREA. 2 ID CODE l OTHER (SPECIFY ) 3 4. WRITE THE PERSONAL ID CODE(S) USED IN THE PREVIOUS 7. CHECK THE ANSWER TO QUESTION 2 ABOVE. SURVEY FOR EACH INDIVIDUAL WHO MOVED FROM THE _ DWELLING OF ORIGIN TO THE CURRENT DWELLING BLANK (DWELLING COVERED IN PREVIOUS SURVEY).. 1(ROSTER MATCHING PAGE) PERSONAL | CODE 1 (FOLLOWING INDIVIDUAL ID CODES WHO MOVED) .2 (>,END OF INTERVIEW) CODE 2 (NEW DWELLING) .3 (>FIND REPLACEMENT DWELLING) NEW ID CODE PAGE: IDENTIFICATION OF PERSONS INTERVIEWED IN THE PREVIOUS SURVEY I would now like to ask some information about the people who lived here when we visited in [YEAR] 1. WHO IS PROVIDING THE FOLLOWING INFORMATION (ALLOW UP TO 3 ANSWERS) CURRENT OCCUPANTS OF DWELLING.1 LOCAL OFFICIAL .... 4 NEIGHBOR .............. 2 OTHER (SPECIFY) ... 5 I= l l l l lRELATIVE . . ........ 3 NO ONE .......... 6 (-NEXT SECTION) 2. 3. 4 5 6 7. 8. 9. 10. 11 12. 13. 14. P NAME SEX AGE (IN RELATION- Is... [NAME] COPY THE Why is... Why did... Where does ... In what Is..[NAME]., When did When did R (INCLUDE YEARS) IN SHIP TO HEAD a member ID CODE [NAME] no [NAME] move out [NAME] live now? province/ living in an [NAME] [NAME] die? E ANY PREV. of this FROM longer living in of this country does institutional move? V NICKNAME) SURVEY household PART A OF this household? household? [NAME] now living this year? HOUSE- SAME VILLAGE.1 live? arrangement, S HEAD . . I HOLD ('12) such as a U QUESTIONS 2-5 SHOULD BE SPOUSE.... 2 ROSTER DIFFERENT military R FILLED OUT BEFORE THE CHILD ..... VILLAGE, SAME barracks, a v INTERVIEW BY THE GFRAND- DISTRICT... 2 university or E SUPERVISOR USING THE ID CHILD.... .4 12 factory y CODES FROM THE ORIGINAL NIECE! DSNEENXTritryo SURVEY NEPHEW. .5 YES... .1 PEPSON DIFF EaE retmirety ERSON P FATHER/ NO. 2 MOVED . 1 EMPLOYMENT.1 SAME h o rmen? D MOTHER.. 6 (>CHECK SET UP OWN MARRIAGE . 2 PROVINCE 3 SISTER HOUSE- HOUSEHOLD SCHOOLING ..3 (-12) PROVIATCE BROTHER. .7 HOLD IN SAME FOLLOW DIFFERENT AND OTHER ROSTER TO DWELL- FAmiLY .... 4 DROINFEENT .. AOLNDR ES RELATIVE.8 BE SURE, ING ...... 2 MILITARY PROVINCET... 4 COUNTR o ..E. .1 MA-LE. 1 OTHER THEN GO (-13) SERVICE ... 5 COUNTRY .5 -9D FE- (SPECZFY).9 TO Q.8) DTD . 3 OTHER ---- 6 U6 DON'T 14 _ MALE.2 (>14) UNKNOWN 7 (-12) KNOW.3 MONTH YEAR 2 7 12ll l ll l PART A: HOUSEHOLD ROSTER (FOR "SAME ID CODE" APPROACH] PERSON INTERVIEWED: PREFERABLY THE HEAD OF THE HOUSEHOLD. IF Are there any other persons who slept here last night but do not normally live HE/SHE IS NOT AVAILABLE, FIND A "PRINCIPAL RESPONDENT TO ANSWER here? THE QUESTIONS IN HIS/HER PLACE. THE PERSON SELECTED MUST BE A MEMBER OF THE HOUSEHOLD WHO IS ABLE TO GIVE INFORMATION ON THE WRITE DOWN THE NAME, SEX AND RELATIONSHIP TO THE HEAD OF OTHER HOUSEHOLD MEMBERS. HOUSEHOLD. RESPONDENT: ID CODE: 5. FOR EACH PERSON LISTED IN QUESTION 1, ASK QUESTION 5 AND USE THIS TO CLASSIFY THE PERSON ACCORDINGLY IN QUESTION 6. I have a list of all the people who were members of this household when we conducted a survey in this community in [MONTH, YEAR]. I will begin by CLASSIFY EACH PERSON ACCORDING TO THE FOLLOWING CRITERIA. asking questions about these individuals, after which I will ask about any 6. individuals who have joined this household since the last time we were here. 1-3. THESE QUESTIONS ARE TO BE FILLED OUT BEFORE THE INTERVIEW. LOOK AT THE ANSWER TO QUESTION 5. THEY SHOULD NOT BE CHANGED FOR ANY REASON, * ALL PERSONS ALIVE FOR WHOM THE ANSWER IS 9 MONTHS OR LESS ARE READ THE NAMES OF THE PEOPLE WHO WERE IN THE HOUSEHOLD CLASSIFIED AS HOUSEHOLD MEMBERS. DECEASED INDIVIDUALS ARE NEVER IN THE PREVIOUS SURVEY. CLASSIFIED AS HOUSEHOLD MEMBERS. LODGERS ARE NOT CLASSIFIED AS HOUSEHOLD MEMBERS. HIRED WORKERS AND SERVANTS, IF THEY HAVE 4. Who is currently the head of this household? Is it any of the persons I have THEIR OWN FAMILY IN A DIFFERENT PLACE, ARE ALSO NOT CLASSIFIED AS just mentioned? HOUSEHOLD MEMBERS. GUESTS WHO HAVE COME TO VISIT FOR 3 OR MORE MONTHS ARE CLASSIFIED AS MEMBERS OF HOUSEHOLD. IF YES, MARK THAT PERSON AS THE HEAD OF HOUSHOLD IN b * QUESTION 4. IF THE ANSWER IS MORE THAN 9 MONTHS, ONLY THE FOLLOWING ARE co HOUSEHOLD MEMBERS: IF NO, ASK: Who is currently the head of this household? -- THE HEAD OF HOUSEHOLD WRITE THE NAME AND SEX OF THIS PERSON IN QUESTIONS 1 AND 2 -- INFANTS LESS THAN 3 MONTHS OLD IN THE FIRST BLANK LINE ON THE HOUSEHOLD ROSTER. DO NOT WRITE THE AGE OF THAT PERSON IN QUESTION 3. WRITE DOWN APART FROM THE CASES LISTED ABOVE, ALL OTHER PERSONS FOR WHOM THE CODE FOR HOUSEHOLD HEAD FOR THAT PERSON IN QUESTION 4. THE ANSWER IS MORE THAN 9 MONTHS ARE NOT HOUSEHOLD MEMBERS. ENTER CODE 1 FOR EACH HOUSEHOLD MEMBER AND CODE 2 FOR ALL OTHER 1-4. Now I would like to have the names of any other people who normally live and eat PERSONS. GO ON TO THE NEXT PERSON LISTED. their meals together in this dwelling, both relatives and non-relatives, including tenants, servants and lodgers. COMPLETE THE REMAINING QUESTIONS FOR ALL INDIVIDUALS BEFORE GOING TO THE USING THE BLANK LINES, WRITE DOWN THE NAMES IN CAPITAL LETTERS. NEXT INDIVIDUAL. THERE ARE THREE POSSIBILITIES FOR EACH INDIVIDUAL ALSO WRITE THE SEX AND RELATIONSHIP TO THE HEAD OF HOUSEHOLD FOR EACH PERSON. DO NOT WRITE THE AGE OF THE PERSON IN * PEOPLE WHO ARE CURRENTLY HOUSEHOLD MEMBERS COMPLETE QUESTIONS QUESTION 3. 8-14, REGARDLESS OF WHETHER THEY WERE HOUSEHOLD MEMBERS IN THE PREVIOUS SURVEY. Are there any other persons not now present but who normally live and eat their meals here? For example, any person studying somewhere else or who * PEOPLE WHO WERE HOUSEHOLD MEMBERS IN THE PREVIOUS SURVEY (AS is on vacation or who is visiting other people. INDICATED IN QUESTION 7) BUT NOT IN THIS SURVEY COMPLETE QUESTIONS 15-21. WRITE DOWN THE NAME, SEX AND RELATIONSHIP TO THE HEAD OF * PEOPLE WHO ARE NOT HOUSEHOLD MEMBERS TODAY AND WERE NOT HOUSEHOLD HOUSEHOLD MEMBERS IN THE PREVIOUS SURVEY ARE ASKED NO FURTHER QUESTIONS PART A: HOUSEHOLD ROSTER (FOR "SAME ID CODE" APPROACH) HEAD OF HOUSEHOLD 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. I NAME (INCLUDE ANY SEX AGE (IN What is the relationship of this person to the For how HOUSE- WAS THIS Can you COPY THE DATE How old is D NICKNAME) YEARS) IN current head of the household? many HOLD PERSON A tell me OF BIRTH [NAME]? PREV. months MEMBER? MEMBER the date C SURVEY HEAD ........................... 1 during the OF THIS of birth of O WIFE/HUSBAND ................... 2 past 12 CHECK HOUSE- [NAME]? YEARS IF 12 D CHILD/ADOPTED CHILD ............ 3 months THE HOLD IN YEARS OR E QUESTIONS 1-3 SHOULD BE FILLED OUT BY GRANDCHILD ..... 4 (since CRITERIA THE CALCULATE OLDER THE SUPERVISOR BEFORE THE NIECE/NEPHEW ................... 5 MONTH! ABOVE PREVIOUS PERSON'S INTERVIEW, USING THE ID CODES FROM FATHER/MOTHER .................. 6 YEAR) has SURVEY? PROBE YEARS AND THE ORIGINAL SURVEY SISTER/BROTHER ................. 7 he/she been FOR AGE, ASK THE YEARS IF SON/DAUGHTER-IN-LAW ............ 8 BIRTH RESPONDENT MNS away from CERTI- TO CONFIRM <12 YEARS BROTHER- OR SISTER-IN-LAW ...... 9 this CE I- GRANDFATHER/MOTHER ............ c10 household? FICATE ITIN FATHER- OR MOTHER-IN-LAW ....11 QUESTION 10 IF < 12 OTHER RELATIVE .12 ... YEARS THEN SERVANT OR SERVANT'S RELATIVE.13 Y4 TENANT OR TENANT'S RELATIVE .14 (>15) OTHER (SPECIFY) ............ 15 YES..1 NO ... 2 YES..1 MALE... 1 CUMULATED (>8) (.NEXT NO... 2 FEMALE.2 MONTHS NO.. 2 PERSON) (>9) DAY IMONT YEAR YEARS MONTHS '0~ ~ ~~~1 1 1q I0 7 iT PART A: HOUSEHOLD ROSTER (FOR "SAME ID CODE" APPROACH) HEAD OF HOUSEHOLD 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. I What is the Does the COPY THE What is Why is Why did .. [NAME].. Where does.. [NAME].. live In what Is ..[NAME].. living When did.. When did.. D present marital husbandt ID CODE his/her ..[NAME]... no move out of this now? province/ in an institutional [NAME].. [NAME].. status of wife of OF THE nationality? longer living in household? country living arrangement, move? die? C [NAME]? [NAME] WIFE/ this household? does... such as a military 0 live in this HUSBAND. [NAME].. barracks, a D household IF MORE now live? university or factory E MARRIED. 1 now? THAN ONE SAME VILLAGE.. 1(19) dormitory or a DIVORCED.2 WIFE, DIFFERENT VILLAGE, retirement home? ("14) COPYTHE SAME SEPARA- ID CODE EMPLOYMENT ..1 DISTRICT. 2("9) TED ..... 3OF THE ~NET MOVED.... .1 MARRIAGE.... .2 DIFFERENT (>14 ) OFIRTHE S E EON FLO DISTRICT, SAME TED ~~~~~~~~~NEX~~~TT ET ("14) FIRST. ~~~~PERSON SET UP OWN SCHOOLING ... DSRIT3APRON PRO WIDOW OR HOUSEHOLD FOLLOW PROVINCE....3 t 9) WIDOWER ..4 IN SAME FAMILY .....4 DIFFERENT ("14) DWELLING.2 MILITARY PROVINCE ..... 4 PROVINCE NEVER NATION- ("20) SERVICE .... 5 DIFFERENT AND MARRIED ..5 YES. .1 ALITY DIED ..... 3 OTHER ....... 6 COUNTRY ...... 5 COUNTRY YES . 1 ("14) NO.. 2 CODES ("21) UNKNOWN .....7 UNKNOWN . 6(9) ...9 CODES NO. 2 _________ ("14) ID CODE DON' T KNOW ..3...T..YF 3 MONTH YEAR 0 1 2 3 8 12. 4if: : - - -iQ ?: i 0Df;:: 00 0 ::f : ;:::0y0 i: : :: :: ::::: : ji:i : :: :: 0:: The World Bank