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Part I. Socio-Demographic Profile

Name (Optional): _________________________________________

Address (Optional): ______________________________________

Age: _______________ Sex: _______________________

Civil Status:
( ) Single
( ) Married
( ) Separated
( ) Widow/widower
Others, please specify. ___________________________________

Number of children: _______________________________________

Educational Attainment:
( ) Elementary Level ( ) College Level
( ) Elementary Graduate ( ) College Graduate
( ) High School Level ( ) Post-College Level
( ) High School Graduate ( ) Post-College Graduate
Others, please specify. ___________________________________

Occupation. _______________________________________________

( ) Roman Catholic
( ) Protestant
( ) Born Again
( ) Jehovahs Witnesses
( ) Seventh Day Adventist
Others, please specify. __________________________________
( ) Within San Vicente
( ) Within Victoria
( ) Outside of the two municipalities

Part II. On the Poverty Causations of the 4Ps Grantees.

1. Do you consider yourself as poor?

____ Yes ____ No
If yes, in what ways/aspects you consider yourself as
poor. Below are statements formulated to determine your
poverty causations as a 4Ps grantee. Please indicate a check
mark () after each statement if you are, strongly agree
(SA), agree (A), neutral (N), disagree (D), or
strongly disagree (SD).

Statement SA A N D SD
1. The main cause of poverty
is when you are
susceptible by natural
2. Poverty is caused by
having too many children.
3. Poverty is caused by lack
of interest to any
implemented by the
4. Poverty is caused by the
wrong/negative values of
the people.
5. The main cause of poverty
is cultural beliefs in a
6. Poverty is caused by
economic inequality.

7. Poverty is caused by
ignorance to any
8. Poverty is caused by
unending conflicts.

9. The main cause of poverty

is the lack of medical
10. Poverty is caused by
lack of the governments
action to reduce its

Others, please specify. ___________________________________


Part III. On the Perception Towards the Poverty Reduction

Capacity of the Pantawid Pamilyang Pilipino Program (4Ps).
The statements below will determine your perception
towards the poverty reduction capacity of the 4Ps. Please
indicate a check mark () after each statement if you are,
strongly agree (SA), agree (A), neutral (N),
disagree (D), or strongly disagree (SD).
Statement SA A N D SD
1. With cash grants of 4Ps, we are able
to eat properly.
2. With 4Ps, I become lazy to find a
3. With 4Ps cash grants, we are able
to buy our clothes.
4. With cash grants, we are able to
build our own house/dwellings
5. The 4Ps makes me independent and the
program motivates me to find a job.
6. With 4Ps, we are able to sustain our
basic/daily needs.
7. 4Ps expands our knowledge about
family planning.
8. 4Ps pave way to the growth of some
other welfare programs of the
9. 4Ps cash grant is so small that it
cannot be enough to assist the
health and educational needs of the
10. With 4Ps, I have better chance
of supporting the education of my
children until I find a better job.
11. For me, 4Ps cannot pull from
having a stable job.
12. With 4Ps, I develop a positive
outlook towards economic improvement
of my family.
13. Due to cash grants of 4Ps, I am
not motivated to look for a better
and more stable job.
14. With 4Ps cash grants, I have a
better chance of maintaining my
vices such as drinking liquor,
smoking, gambling, etc.
15. With 4Ps, I become less
important to my family, especially
to my husband/wife.
16. I find the 4Ps conditionalities
difficult to comply, as part of
their cash incentive.
17. With 4Ps, my financial worries
have lessened due to 4Ps cash
18. 4Ps cash grant is not enough
to sustain our basic needs.
19. 4Ps cash grants motivate me in
encouraging my family to help our
community in maintaining cleanliness
and orderliness.
20. In general, 4Ps is greatly/
substantially reduce poverty.