Household Questionnaire

# Parameter Name Option

Whether LPG gas connection is available in the From Ujjawala-1; From Other Source - 2, Not
1
Household ?* Available-3
2 If Yes, Please enter LPG consumer ID
1 If Yes, then Number of times the cylider is
3
refilled in last one year
Applied But Not alloted -1, Applied and in
4 If No, Please select the option reason
Process - 2, Not Applied - 3
Whether electricity connection is available in
5 (Yes-1; No-2)
the household ? *
2 Under UJALA (Unnat Jyoti by Affordable LEDs
6 If Yes, whether the household has LED Bulbs? for All) - 1, From other Source - 2, Not
Available - 3
Does any member of the household have bank PM Jan Dhan Account - 1, Other Account -2,
3 7
Account ?* Both - 3, None - 4
PM Jeevan Jyoti Bima Yojana - 1, Other
Whether any member of the household has life
4 8 Insurance Scheme - 2, Not Applicable (All
insurance cover?*
members are above 50 years) -3, No - 4
PM Suraksha Bima Yojana - 1, Other
Whether any member of the household has
5 9 Insurance Scheme - 2, Not Applicable (All
accidental insurance cover?*
members are above 70 Years) -3, No - 4
Under Mission Indra-Dhanush - 1, From
whether any member of the household has
6 10 Other Source - 2, Not Immunized - 3, Not
been immunised ?*
Applicable - 4
Is there any child (0-6 yrs.) or pregnant woman
11 (Yes-1; No-2)
available in the household ?*
If Yes, then whether Nutrition Supplement From ICDS - 1, From State Scheme -2, Not
12
services availed ? Received - 3
7
From ICDS -1, From State Scheme -2, Not
13 If Yes, then whether Health services availed ?
Received - 3
If Yes, then whether pre school education From ICDS -1, From State Scheme -2, Not
14
services availed ? Received - 3
Whether any member of the household is a SHG Under DAY - NRLM - 1, Other SHG - 2, No
8 15
member of the Self Help Group (SHG) ?* -3
What is the type of House used by the
16 Pucca=1, Kutcha=2, No House - 3
household for living?*
Whether the household is a beneficiary of any PMAYG - 1, State Housing Scheme - 2, Other
17
Government Housing Scheme ?* Housing Scheme - 3, No - 4
9
If PMAY-G beneficiary, Please provide PMAY-G
18
ID ;
If No, then Housing application status for any
19 Wait Listed - 1, Rejected - 2, Not Aware -3
Govt. housing scheme
Ayushman Bharat Pradhan Mantri Jan Arogya
Whether the household is registered in any
10 20 Yojana - 1, State health Scheme - 2, Other
health scheme?*
health Scheme - 3, Not Registered - 4
 If registered in Ayushman Bharat PMJAY, Please
21
enter PMJAY family Health card Number
Whether any member of the household is
22 getting pension under any Governmant Old Age -1, Widow - 2, Disability -3, None -4
Scheme? *
NSAP-National Social Assistance Program -1,
23 If Old Age, Select the pension scheme
11 State Pension Scheme - 2
NSAP-National Social Assistance Program -1,
24 If Widow, Select the pension scheme
State Pension Scheme - 2
NSAP-National Social Assistance Program -1,
25 If Disability, Select the pension scheme
State Pension Scheme - 2
Whether any member of the Household has
26 (Yes-1; No-2)
ever worked under MGNREGA*
If Yes, then Please provide MGNREGA job card
27
number;
12 If Yes, Number of days worked under
28
MGNREGA during last one year
Not Aware -1, Job Card Applied but not given
If not worked under MGNREGA, please select
29 - 2, Work Demanded Not Given -3, Not
reason
Demanded -4
Whether any member of the household
30 undergone training under any Skill (Yes-1; No-2)
development/orientation scheme ? *
(DUGKY - Deen Dayal Upadhyay Gramin
13
Kaushal Yojana-1; PMKVY-Pradhan Mantri
31 If yes, Please select the scheme type; Kaushal Vikas Yojana 2; PMEGP-Pradhan
Mantri Employment Generation Programme-
3; Any Other -4;
14 32 Whether the household has a functional toilet * (Yes-1; No-2)
Please provide Mobile Number to receive
33
information on Government services/schemes
15
Household Member - 1
34 Mobile Number for Contact belongs to
Other Contact - 2
Whether the Household is availing ration under
35 NFSA - 1, Other Scheme -2, Not Availing - 3
any food security/food subsidy scheme?*
16 If availing ration under any food security/food
36 subsidy scheme, then Provide the NFSA Ration
Card Number
37 Respondent Name
17 If not available in the list; enter the respondent
38
name