SERIAL NO.
	QUESTION ID	QUESTION	ANSWER CHOICES/DIRECTIONS
		
1	fwid	Field worker ID
	Enumerator enters their ID number	
2	villageid	Village ID (official)	Enumerator enters village ID 	
3	HHid	Enter the HH ID assigned on Eligibility/Participation Form	Enumerator enters assigned HH ID number	
	HOUSEHOLD COMPOSITION & DEMOGRAPHICS	
4	HoHname	What is the head of the household’s name? 	Enumerator enters name 

5	HHsize	How many people have been living in this household in the last six months?

< Enumerator makes sure Q5 = Q6 + Q7 + Q8 > 
	Enumerator enters integer	
6	men	How many men have been living in this household in the last six months?	Enumerator enters integer	
7	women	How many women have been living in this household in the last six months?	Enumerator enters integer	
8	children	How many children have been living in this household in the last six months?	Enumerator enters integer	
9	caste	What is the caste or religion of your household?	01 - General
02 - Other Backward Caste
03 - Scheduled Caste
04 - Scheduled Tribe
05 - Muslim
06 - Christian
66 - Other (Enumerator enters answer)
88 - Preferred not to answer	
10	fatheredu	What is the highest level of education the father of the family has received? 

Primary = Standards 1-4
Secondary = Standards 5-8
Higher = Standards 9 and above	00 - None
01 - Some primary
02 - Primary completed
03 - Some secondary
04 - Secondary completed
05 - Higher
77 - Don’t know/not sure
88 - Preferred not to answer	
11	motheredu	What is the highest level of education the mother of the family has received?

Primary = Standards 1-4
Secondary = Standards 5-8
Higher = Standards 9 and above	00 - None
01 - Some primary
02 - Primary completed
03 - Some secondary
04 - Secondary completed
05 - Higher
77 - Don’t know/not sure
88 – Preferred not to answer	
12	HHsizechild	How many children less than 5 years old sleep in your household? 	Enumerator enters integer	
	HOUSEHOLD ASSETS	
13	HHbeds	How many beds does this household have (single, double, bunkbeds? 	00 - None
01 - One
02 - Two or more	
14	mattress	How many mattresses does this household have?	00 - None
01 - One
02 - Two or more	
15	bicycle	Does this household own a working bicycle?	00 – No
01 – Yes	
16	car	Does this household own a working car?
	00 – No
01 – Yes	
17	motorcycle	Does this household own a working motorcycle?	00 – No
01 – Yes	
18	cellphone	How many cell phones does this HH have?	Enumerator enters integer
	
19	electricity	Does this household have electricity?	00 – No
01 – Yes	
20	television	Does this household own a working TV? 	00 – No
01 – Yes
	
21	fan	Does the household have a working fan?	00 – No
01 – Yes	
22	stove	What is the primary type of stove used in this household?	01 - Chullah
02 - Gas stove
66 - Other (Enumerator enters answer)	
23	fuel	What is the main source of fuel for the stove in this household?	01 - Wood
02 - Gas
03 – Cow dung cakes
66 - Other (Enumerator enters answer)	
24	fridge	Does this household own a working fridge?
	00 – No
01 – Yes	
25	chair	How many chairs does this household have? 	Enumerator enters integer
	
26	table	Does this household own a table?
	00 – No
01 – Yes	
27	kitchen	Where is the kitchen located?
	01 - Inside house 
02 - Outside house 	
28	housetype	What can the main house be classified as? 

< Enumerator records answer by observation >
	01 - Pukka
02 - Semi pukka
03 – Kuhcha	
29	rooftype	What is the roof of the main house made of?

< Enumerator records answer by observation >	01 - Cement
02 - Wood
03 - Bamboo/Thatch/Palm/Leaves
04 - Mud/Mud mixture
05 - Plastic/Polythene Sheeting
06 - Asbestos Sheets
07- Tiles
66 - Other (Enumerator enters answer)
77 - Don’t know/not sure

	
30	drinkwat	What kind of water supply does the household normally use for collecting drinking water?

<If more than one source is used, choose the source most often used during the year>

	01 - Private handpump 
02 - Private tubewell
03 - Public tap 
04 - Collected rain water
05 - Borehole
06 - Dugwell
07 - Public handpump (shares with other HHs)
08 - Pond/River
66 - Other (Enumerator enters answer)
77 - Don’t know /Not sure	
31	waterlocation	Where is the water supply most commonly used by household members located?	01 - Inside the house
02 - Inside the compound
03 - Outside the house/compound	
32	latrine	Does this household have a latrine/toilet facility?	00 - No (Skip to Q39)
01 - Yes
88 - Preferred not to answer	
33	sharedlat	If yes, do you share this toilet facility with other households?	00 - No
01 – Yes
88 - Preferred not to answer
99 - Not Applicable (No facility/ uses open defecation)	
34	Sharedno	If the latrine is shared, how many households use this toilet facilty?

< Enumerator: include respondent’s HH when counting number of HHs that share the toilet facility> 
	Enumerator enters integer
77 - Don’t know/not sure
88 - Preferred not to answer
99 - Not Applicable (No facility/ uses open defecation)	
35	latfunc	If yes, is this household latrine functional?	00 - No
01 - Yes
77 - Don’t know/not sure
88 - Preferred not to answer
99 - Not Applicable (No facility/ uses open defecation)	
36	latloc	If yes, where is this latrine located?	01 - Within house
02 - Within compound/plot
03 - On a neighbor’s plot
04 - Community Toilet
66 - Other  (Enumerator enters answer)
88 - Preferred not to answer
99 - Not Applicable (No facility/ uses open defecation)	
37	hhsan	If yes, what kind of latrine do household members use most often?

< Enumerator records answer by observation >	01 - Flush/pour flush toilet to piped sewer system
02 - Flush/pour toilet to onsite, underground pit/tank
03 - Flush/pour toilet to onsite, aboveground
04 - Pit latrine with concrete slab (not pour flush)
05 - Pit latrine without slab (not pour flush)
66 - Other (Enumerator enters answer)
77 - Don’t know/not sure
88 - Preferred not to answer
99 - Not Applicable  (No facility/ uses open defecation)	
38	sanother	If yes, who is NOT using this latrine for defecation in the morning, i.e. who is going to the field?	01 - Females unmarried
02 - Females married
03 - Males unmarried
04 - Males married
05 - Children
77 - Don’t know/not sure
88 - Preferred not to answer
99 - Not Applicable (all members use household latrine)	
39	howdef	If the household does not have a latrine, how do the children under 5 years usually defecate?	01 - Bucket
02 - Bag
03 - Leaves/Newspaper
04 - Open defecation
66 - Other (Enumerator enters answer)
77 - Don’t know/not sure
88 - Preferred not to answer
99 - Not Applicable (has household latrine)	
40	wheredef	If the household does not have a latrine, where do the children under 5 years usually defecate?	01 - On house floor
02 - Outside house/compound
03 - Open defecation
66 - Other (Enumerator enters answer)
77 - Don’t know/not sure
88 - Preferred not to answer
99 - Not Applicable (has household latrine)