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EGC Ghana HH THP 053007

VIEWS: 3 PAGES: 134

									3/29/07:
1. I've added another mental health module based on the CES-D Depression Scale. Should we delete the old one?
2. In Section 6B - Land info 3, we need codes for traditional positions.
3. Can you adjust section 11 part C for the MCC version?
4. We've added modules including social participation, digist span assessment, and pattern recognition at the end of the survey, which should be completed separately for each child / member of the household.
  Can you determine where to put them in the survey and adjust the contents accordingly?
5. On the social partipication questionnaire (at the end of the survey), is it okay to ask people who they voted for?
6. Should section 10 part 3 (misc income and expenditures) be included in the GLSS5+ survey?

 4/10/2007
7. We need codes for section 11 part c (Savings) relating to the savings institutions (including a code for the epicenter)
8. We need codes for The Hunger Project - 1 for potential epicenter committees
9. Should we ask in The Hunger Project - 2 for how many times people have used the epicenter resources or how many times per some unit of time (currently at times / month)?

 4/11/2007
10. We need codes for the community participation section, question 9.
11. We need codes for Section 13, part b #4 (in which activities can't you participate), #10 (things you want to change)

 4/16/2007
12. On section 8, part e (revenue for enterprises in wholesale/retail trade): Can the GLSS people comment on whether or not "last purchased" is comparable to sales in the last two weeks?
13. Section 12 Part b (Ownership of Durables) is very similar to section 11, part b (household assets). We need to determine which one to keep.
     Portions of the MCC Survey that Melissa and Treb think can be gotten rid of for the THP version: To do:
     DONE - 4/16/07
                                                                                                                                            get rid of these = potentiall drop (just mark in red)

1 Section 2, Part 1 (General Education): Questions 5 and 7 are very similar to questions 24 and 26.       don't change
  Section 2, Part 1 (General Education): Questions 28-30 may not be necessary (especially if we
2 do not have a village census).                                                                          get rid of these
3 Section 2, part b (Education Career): Questions 11-15 could probably be dropped                         get rid of these
  Section 2, part c: Questions 1-4 are very similar to Section 2, part b Questions 15 and 16 (both
4 about language capabilities).                                                                           Get rid of question 15-16, add question 15 to section part c *for all surveys*

     Section 3, Part 1 – Health in the last two weeks: Questions 22-24 could probably be dropped
5    (only capture overnight stays at health centers, already have visits to health centers)              get rid of these
     Section 3, part c (Child Health / Development): Questions 5 and 6 optional (already have
6    extensive intelligence tests, this only captures 0-5 children)                                       (fix the multiple part c *for all surveys*, get rid of these questions *for all surveys*)
     Section 3, part d (Fertility / Women’s Health): Questions 27-28 and 32-35 look optional (not sure
7    what we’re trying to capture)                                                                        get rid of these
     Section 3, part f (Insurance – individual specific questions): whole section optional (couldn’t we
8    just ask one question about whether they have insurance?)                                            keep question 1, get rid of rest of section
     Section 3, part g (Mental health): whole section optional (do we really need this mental health
 9   section? If so, do we need three pages of it?)                                                       get rid of entire section
10   Section 3, part h (Activities of Daily Living): Is this section necessary?                           do not get rid of
     Section 3, part h (Miscellaneous Health): Is this section necessary? (perhaps just keep question
11   #1?)                                                                                                 do not get rid of
     Section 4, part a & b: Activity Status and characteristics of main/secondary occupation in last 7
12   days/1 year: Do we need questions on both the past week and the past year?                           think about it
     Section 4, part d (Unemployment): Do we need questions on both unemployment in the past 7
13   days and unemployment in the last year?                                                              think about it
     Section 4, part e (Time Use): Can we combine question 7 with question 10 (do we need to
14   disaggregate between shopping and running errands?)                                                  put them together
     Section 4, part e (Time Use): Can we combine questions 1 and 4 (do we need to disaggregate
15   between taking care of the sick and the elderly?)                                                    keep them apart
     Section 4, part e (Time Use): Should we add an additional category for sleeping? Time for
16   yourself? (to attempt to make the hours sum to 24)                                                   add sleeping
     Section 5, part b (Temporary migration concluded): Do we need questions 16 – 23 (do we care
17   about secondary location?)                                                                           (fix ordering of part c and b)
18   Section 5, part c (Migration History): Is this section necessary?                                    get rid of these
     Section 6, part e (Transactions): Questions 2-4 are very similar to questions 13-15 (do we need
19   to know both about the original and current contracts?)                                              get if 2-4
     Section 7 (Information): Can part a and part b be combined and just act what type of information
20   was provided?                                                                                        do this *for all surveys*
     Section 8, part c (Expenditures in household enterprise): Are questions 3, 4 and 7 (for both first
21   and second enterprise) necessary?                                                                    get rid fo 3-4
     Section 8, part d (Inventories and recent sales / purchases): Do we need this section (we already
22   have expenditures and revenue, do we care about inventories?)                                        keep this
     Section 8, part e (Revenue for enterprises in wholesale/retail trade): What does “Last purchased”
23   mean? Is it necessary?                                                                               talk with GLSS guys about this
     Section 9: Do we need information on non-household members? (It’s a very long module and
24   we’re not sure the benefits)                                                                         keep
     Section 12, Part B (Ownership of Durables): This seems very similar to Section 11, part b
25   (Household assets). Which should we keep?                                                            keep 1, compare later
     Section 12, Part B (Food items consumed): Do we really need last 30 days, and all three
26   seasons? What about a gifts section?                                                                 get rid of seasons

     Sections to add to THP version:

1 Participation in THP Epicenter (courses, meetings, volunteered time, etc) (DONE)
2 Perception of control over life, women empowerment, decision making in household
Village / Community Survey

There are no differences between the three sampling frames in the village / community survey.

Household Survey

For the time being, there is no difference between the MCC version and the Hunger Project (THP) version of the survey. The THP / MCC version
of the survey differs from the GLSS5+ version because the THP / MCC version will not necessarily be administered to households that have
already responded to the GLSS5 survey. Hence, some sections are expanded and additional sections are included to capture the information
gathered in the GLSS5 survey. Additionally, several questions asking about updates to GLSS5 responses have been removed.



The THP / MCC survey includes the following different (expanded) sections that ARE NOT included in the GLSS5+ version:
Activity Status and Main Occupation
Activity Status and Secondary Occupation
Livestock and Assets
Output and Stored Crops
Misc. Income
Savings

The THP / MCC survey includes the following sections that ARE NOT included in the GLSS5+ version:
Housing Characteristics
Consumption

The specific pages of the THP / MCC survey which are new or modified have a purple background and the CONTENTS tab also includes purple
highlights of the sections that differ from the GLSS 5+ survey.
Sections that will be in the MCC version but not THP version (to be reviewed)

Sections that are in the MCC and THP versions, but not the GLSS5+ version

Sections that are in the THP version but not the MCC version
SECTIONS INCLUDED:
1   Roster                                           7    Agriculture
                                                          A     Livestock and Assets
2   Education                                             B     Land Information
    A General Education                                   C     Output and Stored Crops
    B Educational Career                                  D     Inputs
    C Literary and Apprenticeship                         E     Land Transactions

3   Health                                           8    Information
    A Health in last two weeks
    B Preventative (Immunizations)                   9    Household Enterprise
    C Postnatal Care/ Child Health and Development        A    HH Enterprise Information
    D Fertility / Other Women's Health                    B    Labor
    E Contraception and AIDS                              C    Expenditures
    F Insurance                                           D    Inventory, Sales, Purchases
    G Mental Health                                       E    Other Revenue
    H Activities of Daily Living and Misc. Health
    I   Anthropometry                                10   Misc. Income and Expenses
                                                          A      Transfers out
4   Labor / Time use                                      B      Transfers in
    A Activity Status and Main Occupation                 C      Misc. Income
    B Activity Status and Secondary Occupation
    C Unemployment                                   11   Credit, Assets, and Savings
    D Time Use                                            A      Borrowing
                                                          B      Assets
5   Migration                                             C      Saving
    A Migration                                           D      Lending
    B Migration History
                                                     12   MCC & THP Specific Modules
6   Relatives                                             A    Housing Characteristics
    A Parents, Children, and Siblings                     B    Consumption
    B Absent Spouses
                                                     13   THP Specific Modules
                                                          A     Epicenter Participation
                                                          B     Empowerment

                                                     14   Cognitive Testing
Section 1 -- MEMBERS OF THE HOUSEHOLD
Fill out for all household members
                                                                                                                          If 12 years or older,                                                                     In what region/country was
                                               What is [name's]                           How old is                                                                                                                      [name] born?
                                                                                                                                                                                                   What is [name's]




                                                                                                                                           (if more than one spouse, the first one)
                                          relationship with head of                                                                                                                                                         1=Western
                                                                      What is [name's]     [name]?
             Sex (Male = 1; Female = 2)


                                                                                                         What is [name's]                                                                               religious
                                                  household?                                                                                                                                                                 2=Central




                                                                                                                                               If spouse is in HH, spouse's ID
                                                                        date of birth?    (years and   current marital status?                                                        At what       denomination?
                                                   1= Head                                                                       Does                                                                                      3=Gt. Accra
                                                                                           months if        1=married,                                                                age did         1=Catholic
                                          2=Spouse (wife/husband)                                                              [name's]                                                                                       4=Volta
                                                                                                                                                                                                      2=Anglican
 Member ID




                                                                                                        2=consensual union,                                                           [name]
                                           3=Child (son/daughter)     (if not available    under 5,                             spouse                                                                                       5=Eastern
                                                                                                            3=separated                                                                             3=Presbyterian
                                                4=Grandchild                code        otherwise only                          live in                                               first get                             6=Ashanti
                                                                                                               (>> 9)                                                                                4=Methodist
                                           5=Parent/parent-in-law                                                               house-                                                married                            7=Brong Ahafo
                                           6=Son/daughter-in-law
                                                                          DD = 99           years)          4=divorced                                                                             5=Pentecostalist
                                                                                                                                                                                                                            8=Northern
                                                                                                                                 hold?                                                or start
                                                                          MM = 99                              (>> 9)                                                                                6=Spiritualist
                                               7=Other relative                                                                Yes = 1                                                                                    9=Upper East
                                              8=Adopted/foster/        Year = 9999) (if less than 12        5=widowed                                                                  living     7=Other Christian
                                                                                                                                                                                                                         10=Upper West
                                                                                                                                No = 2
                                                                                                               (>> 9)                                                                  with a          8=Muslim
                                                   stepchild                            years >> 10)                            (>> 9)                                                                                 96=Other ECOWAS
                                                                                                          6=never married                                                                            9=Traditional
                                                 9=Househelp                                                                                                                          partner?     10=No religion
                                                                                                                                                                                                                       97=Africa other than
                                                                                                                (>> 10)
                                               10=Non-relative                                                                                                                                                               ECOWAS
                                                                      DD    MM    Year    Years       Months                                                                                                            98=Outside Africa
   1                2                                 3                       4                   5                6                7                      8                              9              10                     11
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Section 1, PAGE 2 -- MEMBERS OF THE HOUSEHOLD (continued)
Fill out for all household members
                                                                                                                                                                                                             Ethnic group codes
                                                                                                                       What kind of work has
                                                                                                                                                                                                                  1=Asante
                                                                                             What was [name's]        [name's] father done for                                         What was [name's]        2=Akwapim
              What is [name's]
                                                                                          father's highest education      most of his life?                                             mother's highest           3=Fanti
                 nationality?
                                                                                              level completed?        1=Professional/technical                                           education level            4=Ga
             1= Ghanaian (birth)                                                                                                                                                           completed?
                                                                                                    1=None           2=Administrative/manageri                                                                   5=Dangme
                2=Ghanaian                                                                                                                                                                   1=None
                                                                                                  2=Primary                       al                                                                              6=Krobo
                (naturalized)      To what ethnic group   Does [name's]                                                                            Does [name's]                           2=Primary               7=Ewe
                                                                                                3=Middle/JSS                 3=Clerical




                                                                                                                                                                        ID of Mother
                                                                           ID of Father
                3=Burkinabe        does [name] belong?    father live in                                                                        mother live in house-                    3=Middle/JSS
 Member ID




                                                                                                4=Voc/Comm                     4=Sales                                                                             8=Guan




                                                                             (>> 18)




                                                                                                                                                                          (>> 22)
                  4=Malian                                 house-hold?                                                                                 hold?                             4=Voc/Comm               9=Nzema
                                                                                                  5='O' level                5=Service
                 5=Nigerian                                  Yes = 1                                                                                  Yes = 1                              5='O' level           10=Hausa
                                                                                                    6=SSS                  6=Agric./Ani-                                                      6=SSS
                  6=Ivorian                                  No = 2                                                                                   No = 2                                                    11=Dagomba
                                                                                                  7='A' level        Husb./Forest/Fishing/Hunti                                            7='A' level
                 7=Togolese                                  (>> 16)                                                                                  (>> 20)                                                  12=Mamprusi
                                                                                             8=Training college                   ng                                                   8=Training college        13=Gonja
                 8=Liberian
                                                                                                 9=Tech/prof             7=Production &                                                   9=Tech/prof         14=Grussi/ Frafra
             9=Other ECOWAS
                                                                                                 10=Tertiary                related works                                                 10=Tertiary            15=Dagati
              10=Other African                                                                                                                                                            11=Koranic
                                                                                                 11=Koranic              8=Workers NEC                                                                           16=Kusasi
             11=Other (specify)                                                                                                                                                         12=Don't know
                                    Ethnicity      Code                                        12=Don't know              9=Homemaker                                                                       17=Kassena-Nankani
                                                                                                                        10=Other (specify)                                                                      18=Kankoma
                                                                                                                                                                                                                19=Nanumba
                     12                     13                  14            15                     16                         17                       18                19                 20                 20=Builsa
         1                                                                                                                                                                                                   21=Other (specify)

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Section 1, PAGE 3 -- MEMBERS OF THE HOUSEHOLD (concluded)
Fill out for all household members

             What kind of work has [name's]                     While
                                                  For how
             mother done for most of her life?                 absent,
                                                    many
                1=Professional/technical                        is/was
                                                   months
              2=Administrative/managerial                     [name] a
                                                 has [name]
                        3=Clerical                           member of
                                                 been away
                          4=Sales                              another
 Member ID




                                                  from this
                        5=Service                           household?
                                                 household
                      6=Agric./Ani-                          (including
                                                       ?
              Husb./Forest/Fishing/Hunting                     single-
                     7=Production &                            person
                                                     (if 6
                       related works                        household?)
                                                 months or
                    8=Workers NEC
                                                     less,
                      9=Homemaker                              1=Yes
                                                   >> 24)
                   10=Other (specify)                           2=No

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Section 2 (Education), Part a -- GENERAL EDUCATION
Fill out for all household members                                                                                                                 GRADE LEVEL
                      1            2              3               4                5            6             7             8     QUALIFI-         CODES
                     Has     What was the   What was the     Did (NAME)            Is      Is the school                          CATION
                                                                                                           What is How much time does              None = 0
                  (NAME) highest grade        highest       attend school /   (NAME)         (NAME)          the                  CODES
                                                                                                                   (NAME) spend going              Pre-school = 01
                 ID of person interviewed



                                                             college at any                  attending                            None = 01        P1 = 11
                     ever    successfully   educational                         still in                   current to and from school
                                                            time during the                  Public or                            MSLC = 02        P2 = 12
                  attended   completed?     qualification                      school?                     grade?        daily?
 Member ID




                                                                past 12                       Private?                            BECE = 03        P3 = 13
                   school?                   attained?                                                                                             P4 = 14
                                                                months?                                                           Voc/Comm =
                              (see grade                                      Yes = 1                       (see IF IN A BOARDING 04               P5 = 15
                                                                                            Public = 1                                             P6 = 16
                   Yes = 1      codes)          (see          Yes = 1         No = 2          Private      grade       SCHOOL     Teacher Tra.     JSS1 = 17
                 No = 2 (>>                 qualification    No = 2 (>>       (>>12)       religious = 2   codes)       CODE      A = 05           JSS2 = 18
                  Part 2C)                     codes)         Part 2B)                     Private non-               HRS … 00    Teacher Post     JSS3 = 19
                                                                                           religious = 3             MINS … 00    Sec = 06         M1 = 20
                                                                                                                                  GCE O Level      M2 = 21
                                                                                                                    HRS     MINS  = 07             M3 = 22
                                                                                                                                  SSCE = 08        M4 = 23
             1                                                                                                                                     SSS1 = 24
                                                                                                                                  GCE A Level      SSS2 = 25
             2
                                                                                                                                  = 09             SSS3 = 26
             3                                                                                                                    Tech/Prof.       S1 = 27
             4                                                                                                                    Cert = 10        S2 = 28
                                                                                                                                  Tech/Prof Dip    S3 = 29
             5                                                                                                                    = 11             S4 = 30
             6                                                                                                                    HND = 12         S5 = 31
                                                                                                                                  Bachelor = 13    L6 = 32
             7                                                                                                                                     U6 = 33
                                                                                                                                  Masters = 14
             8                                                                                                                                     Voc/Technical/C
                                                                                                                                  Doctorate = 15   omputer/Comm/
             9                                                                                                                    Other = 16       Agric = 41
                                                                                                                                  (specify)        Teacher Train =
      10
                                                                                                                                                   42
      11                                                                                                                                           Nursing = 43
                                                                                                                                                   Polytechnic = 51
      12                                                                                                                                           University = 52
      13                                                                                                                                           Other tertiary =
                                                                                                                                                   53
      14                                                                                                                                           Other = 61
      15                                                                                                                                           (specify)

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Section 2, Part a -- GENERAL EDUCATION (continued)
Fill out for all household members
                   9       10                                        11          12        13        14        15         16       17        18        19         20            21             22             23
                                               How      How     How many                                                                                                 Who paid for          Did          What was
                                                                                I want to ask you about the educational expenses for (NAME) during the past 12 months.
                 ID OF PERSON INTERVIEWED



                                               many    many      hours and                                                                                                most of the       (NAME)        the amount
                                             hours ofhours of    minutes of                                    How much was spent on….                                   educational         have a           of the
                                             class did
                                                     class did homework did                                      (AMOUNT IN CEDIS)                                        expenses?       scholarship /   scholarship
                                             (NAME)  (NAME) (NAME) do                                                                                                                        bursary        / bursary
                                                                             School Contri- Uniforms Books                Trans-    Food, Expenses In-kind         (IF
 Member ID




                                                     miss last
                                            attend last          last week?                                                                                               Father = 1       during the     received for
                                                                            fees and butions and sports         and     portation board, on extra expenses? CANNOT
                                               week?   week?                                                                                                              Mother = 2         past 12       the past 12
                                                                              regis- to parent/ clothes?      school      to and    and/or classes?             BREAK
                                             (exclude(exclude                                                                                                          Both parents = 3     months?         months?
                                                                             tration teacher                 supplies?     from    lodging                      DOWN)
                                               extra   extra                                                                                                              Other HH
                                                                              fees?      assoc-                          school?      at
                                              classes)classes)                                                                                                           member = 4          Yes = 1
                                                                                         iation                                    school?
                                                                                                                                                                       Other relative = 5 No = 2 (next
                                                                                        (PTA)?
                                            vacation vacation                                                                                                          Non-relative = 6      person)
                                            code 99 code 99                                                                                                                Self = 7
                                                                                                                                                                          Other = 8
                                             hours     hours   HRS MINS                                                                                                                                   AMOUNT

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Section 2, Part a -- GENERAL EDUCATION (continued)                                                                                                  GRADE LEVEL
NEW -- fill out this sheet for all household members currently enrolled in school                                                                   CODES
                                                                                                                                                    None = 0
                  24                    25                 26         27                      28                              29                    Pre-school = 01
                  Is      Name of school and code (if What is Does NAME          What is the name of NAME's      What is the name of NAME's         P1 = 11
                                                                   have one
              (NAME) on village roster, otherwise         the                  teacher? (if NAME has the same     ENGLISH LANGUAGE                  P2 = 12
             ID OF PERSON INTERVIEWED



                                                                  teacher for
              currently     code NV if not on roster)   current most or all of          teacher all day)                   teacher?                 P3 = 13
                                                                                                                                                    P4 = 14
             in school?                                 grade? the school
                                                                                                                                                    P5 = 15
                                                                            day?                                (or code NV if the teacher is not   P6 = 16
 Member ID




                                        Yes = 1                 (see                                                  on the village roster)        JSS1 = 17
                                                                           1 = Yes                                                                  JSS2 = 18
                                         No = 2                grade       2 = No,
                                        (>> part               codes)                                                                               JSS3 = 19
                                                                          NAME has                                                                  M1 = 20
                                          B)                               different                                                                M2 = 21
                                                                         teachers for                                                               M3 = 22
                                                                        math, science,                                                              M4 = 23
                                                                        language, etc.                                                              SSS1 = 24
                                                                                                                                                    SSS2 = 25
                                                                                                                                                    SSS3 = 26
                                                                                                                                                    S1 = 27
                                                   name   ID                             name           ID              name               ID       S2 = 28
      1                                                                                                                                             S3 = 29
      2                                                                                                                                             S4 = 30
                                                                                                                                                    S5 = 31
      3                                                                                                                                             L6 = 32
      4                                                                                                                                             U6 = 33
      5                                                                                                                                             Voc/Technical/Co
                                                                                                                                                    mputer/Comm/Ag
      6                                                                                                                                             ric = 41
      7                                                                                                                                             Teacher Train =
                                                                                                                                                    42
      8
                                                                                                                                                    Nursing = 43
      9                                                                                                                                             Polytechnic = 51
     10                                                                                                                                             University = 52
                                                                                                                                                    Other tertiary =
     11
                                                                                                                                                    53
     12                                                                                                                                             Other = 61
     13                                                                                                                                             (specify)
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                                                                        2 part a _ general educ 4 NEW
            Section 2, part a -- GENERAL EDUCATION (concluded)
            NEW -- fill out this sheet for students currently in school
                            30                      31                        32                    33            34                35               36
             What is the name of NAME's            Does           How does (NAME) obtain the       Does      What kinds of     How many         What mode of
              MATHEMATICS teacher?               (NAME)                   textbooks?            (NAME) meals or snacks           times a     transportation does
                                              have all the                                     participate does (NAME)         week does   (NAME) use to go to
                                               textbooks 1 = provided by school, can take home                                                     school?
             (or code NV if the teacher is                                                         in a   receive at school?    (NAME)
                                               needed for  2 = provided by school, cannot take                                            (if boarding, how does
               not on the village roster)                                                        feeding                         receive
                                                school?                    home                                                             (NAME) get there?)
Member ID




                                                           3 = newly purchased from the school
                                                                                               program at    1 = breakfast     this food?         1 = walk
                                              1 = yes, has   4 = newly purchased from private    school?       2 = snack                         2 = bicycle
                                                   all                    market                               3 = lunch                           3 = car
                                                2 = has                   5 = gift                1 =yes 4 = other (specify)                       4 = bus
                                               some, but    6 = passed down from older sibling    2 = no                                          5 = train
                                                 not all            7 = purchased used                    (separate multiple                      6 = boat
                                              3 =has none           8 = other (specify)                     responses with                       7 = animal
                                                                                                               commas)                       8 = other (specify)


                     name              ID
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                                                                                       Page 12
Section 2, part b – Educational Career
Fill out for all household members
             1               2                 3                      4                 5          6              7                 8                9
 ID         Has      How many course- What was the highest   Was the technical / Has (NAME)      How      What was the What was the highest      Was the
         (NAME) years did (NAME) certificate (NAME)              computer /      ever attended   many     last institution    qualification       tertiary
            ever          complete?        obtained?         vocational school     a tertiary  years did    attended?      (NAME) achieved?     institution
         attended                                            (NAME) attended educational (NAME)             Advanced/                            Public or
                                           None = 1
         technical        None = 1                           public or private?   institution   attend?     Specialist         None = 1          Private?
                                        NACVET = 2
           and/or       3 months = 2       IMIS = 3
                                                                                     (e. g..             teacher training    Certificate = 2
        vocational      6 months = 3       NVTI = 4              Public = 1       University,                    =1           Diploma = 3       Public = 1
          school?        1 Year = 4    City & Guild = 5      Private religious = polytechnic,            Polytechnic = 2       HND = 4            Private
                         2 Years = 5    Certificate = 6               2               etc)?               University = 3     Bachelor = 5      religious = 2
          Yes = 1        3 Years = 6     Diploma = 7            Private non-       Yes = 1                  Other = 4         Masters = 6      Private non-
          No = 2 4 Years and above = Other = 8 (specify)        religious = 3     No = 2 (>>                 (specify)       Doctorate = 7     religious = 3
           (>>5)             7                                                      part 2c)                               Other = 8 (specify)
                                                                                               YEARS
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Section 2, part b -- EDUCATION CAREER (concluded)
NEW -- fill out whole sheet for all current household members ages twelve and older
              10           11          12         13                           14                      Language codes
 ID Has (NAME) How many                Has       How        If (NAME) ever attended a secondary
     ever repeated times has (NAME)              many      institution, what was (NAME)'s major        English = 1
            / did      (NAME) ever / did times has       field(s) of study? (list one or more codes)   Twi/Fanti = 2
                                                                          1 = science                  Ewe = 3
     (NAME) ever repeated / (NAME) (NAME)
                                                                        2 = humanities                 Ga-Dangme = 4
         repeat a          did      ever skip skipped /                                                Dagbani = 5
                                                                       3 = social science
          grade?       (NAME) a grade?            did                   4 = engineering                Frafra/Grusi = 6
                        repeat a               (NAME)                    5 = medicine                  Nzema = 7
          1 = yes        grade?      1 = yes    skip a                      6 = law                    Wali/Dagari = 8
          2 = no                     2 = no     grade?                   7 = education
                                                                       8 = other (specify)             French = 10
                                                                                                       German = 11
    1                                                                                                  Spanish = 12
    2                                                                                                  Portuguese = 13
                                                                                                       Chinese = 14
    3                                                                                                  Japanese = 15
    4
    5                                                                                                  Other = 78(specify)

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Section 2, part c -- LITERARY AND APPRENTICESHIP
Fill out for all household members 5 years and older
          1            2         3          4                                  5               6          7              8               9            10              11             12          13           14           15          16
                   Can   In what Ghanaian      Can        In what             What             Can        Has     If not attending/   For how Is (NAME)           How long What is the main       Did      How much Has (NAME) What was
                (NAME)      language can     (NAME)      Ghanaian       languages does      (NAME) (NAME)          attended, why?       many        or has                                     (NAME)          did     ever attended the main
                                                                                                                                                                   (is) the  trade (NAME) is
                  read a  (NAME) read a       write a  language can         (NAME)         do written    ever     Low quality = 1 months has (NAME)                                            pay a fee    (NAME)      other short subject of
                 phrase/ phrase/ sentence?   sentence (NAME) write           speak            calc-   attended a Not available = 2 (NAME) ever been an           apprentice-     learning?      for this   pay for the    training   the most
                sentence (SHOW FLASH            in       a phrase/       comfortably?       ulations? literacy    Do not need = 3        been    apprentice?        ship?                      training?    training?     courses     recent
 Household ID




                    in         CARD)         English?    sentence?       (list all - see               course?     Too costly = 4    attending /                                (REFER TO                               lasting not training?
                English? State the one in              State the one       language           (USE               Takes much time = attended a        Yes,                        SECTOR         Yes, in                 more than 6
                          which (NAME)        Yes = 1    in which        codes below )       FLASH       Yes =            5            literacy currently = 1                                  kind = 1                  months? (see codes
                                                                                                                                                                             TRADE/SKILLS
                 (SHOW is most proficient     No = 2    (NAME) is                          CARDS) 1(>>9)           Not useful = 6      course? Yes, in past                                     Yes, in                               below)
                 FLASH     (see language              most proficient                                   No = 2       Too far = 7                     =2                        GLSS CODE       cash = 2                   Yes = 1
                 CARD)      codes below)              (see language                          Yes = 1              Spouse does not                No = 3 (if no                    BOOK)        Both = 3                    No = 2
                                                       codes below)                          No = 2                    want = 8                    >> 15)                                       No = 4                   (>>Next
                1 = Yes                                                                                          Other = 9 (specify)                                                            (>>14)                   member)
                2 = No
                                                                                                                       >>10
                                                                                                                                     MONTHS                                   MAIN
                                                                                                                                                                 YRS MTHS    TRADE CODE
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LANGUAGE CODES: Ghanaian codes : None = 1; Twi/Fanti = 2; Ewe = 3; Ga-Dangme = 4; Dagbani = 5; Frafra/Grusi = 6; Nzema = 7; Wali/Dagari = 8; Other = 9 (specify)
Other language codes : French = 10; German = 11; Spanish = 12; Portuguese = 13; Chinese = 14; Japanese = 15
TRAINING CODES: Clerical = 1; Prof/Managerial = 2; Computer = 3; Marketing = 4; Teaching = 5; Leadership = 6; Medicine = 7; Accountancy = 8; Trade/Skill = 9; Other = 10 (specify)
Section 3 (Health), part a -- HEALTH IN LAST TWO WEEKS
Fill out for all household members
             1                 2              3                  4             5             6          7         8                 9                       10               11                            12                            13          WHO
ID During the           What was the        Was     Was (NAME) given any For how        During the For how During the     Was the health facility    What time of On the most recent visit   What was the main reason for the      Where did the     tropical
      last 2 weeks        illness that   (NAME)       of the following to   many           last 2    many last 2 weeks           open?                   day did      whom did (NAME)               most recent visit?            consultation take  diseases:
      has (NAME) (NAME) suffered? given the                   drink:         days       weeks, did   days? has (NAME)                               [NAME] arrive         consult?                     Illness … 1                     place?        Trypanosomi
     suffered from                         same                             during       (NAME)              consulted           1 = yes             at the facility?   Doctor … 01                    Injury … 2                                    asis (tsetse
                                                                                                                                                                         Dentist … 02                Follow-up … 3
      either illness   Fever…1 (>>5)    amount to    1 = Oral Rehydration the last 2   have to stop          any health          2 = no                                                                                             Hospital … 1     fly)
                                                                                                                                                                         Nurse … 03                  Check-up… 4
        or injury?      Diarrhea with     drink as         salt (ORS)       weeks        the usual  (1 - 14)  facility?                                               Medical Asst … 04            Prenatal care … 5
                                                                                                                                                                                                                                      Clinic … 2     Dengue
                       blood…2 (>>5)    before the      2 = Rice water       has         activities DAYS                                                                Midwife … 05               Postnatal care … 6             MCH Clinic … 3     fever
       Neither ...1          Watery        watery           3 = Soup      (NAME)        because of            Yes ...1                                                 Pharmacist … 06              Vaccination … 7             Maternity Home … 4 Malaria
          (>>8)          Diarrhea…3    diarrhea, or 4 = Home-made sugar/ suffered           this              No … 2                                                Drug/Chemical Seller …        Other … 8 (specify)              Pharmacy … 5      Bilharzia
      Illness …. 2 Cold / Cough…4        more, or      saltwater solution from this     condition?             (>>22)                                                         07                                                 Chemical store … 6 Tuberculosis
       Injury …. 3           (>>5)          less?      5 = Milk or infant condition                                                                                   Trad. Healer … 08                                         Consultant's Home … River           Symptoms:
          (>>5)       Guinea Worm…5                          formula           ?        Yes … 1                                                                       Trained TBA … 09                                                     7         blindness      Fever
        Both …. 4            (>>5)      1 = same      6 = Coconut water                 No … 2                                                                       Untrained TBA … 10                                          Patient's Home … 8 Guinea          Diarrhea
                                                                                                                                                                       Spiritualist … 11
                     Bilharzia…6 (>>5) 2 = more            7 = Water       (1 - 14)      (>> 8)                                                                                                                                 Community epicenter worm            Cough
                                                                                                                                                                         Other … 12                                                                  Polio          Vomiting
                       Other…7 (>>5)      3 = less          8 = herbs       DAYS                                                                                                                                                          …9
                                                      9 = Other (specify)                                                                                                                                                       Other (specify) … 10
                                                                                                                                                                                                                                                     Others:
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                                                               3 part a_health in past 2 weeks
Section 3, Part a -- HEALTH IN LAST TWO WEEKS continued
Fill out for all household members
                   14                      15             16                17                   18               19                20                  21
 What was the name of the facility? Is this a public How much did    What mode of          How much did How much time How long did you How much TOTAL
                                       or private    (NAME) pay transport did (NAME)       (NAME) pay did it take to travel have to wait at the time (waiting and
 (enter name and code if in village     facility?       for this   use to travel to the    to travel there to and from the    health facility        receiving
                                                                     health facility?
     or code NV if not in village)                   consultation?                         and to return?      facility?       before being       treatment) did
                                                                      1 = walking
                                      Public … 1                                                                             attended to by a   (NAME) spend at
                                                                       2 = bicycle
                                      Private … 2       CEDIS       3 = motorcycle
                                                                                               CEDIS       TRAVEL TIME        health officer?   the health facility?
                                      Private non-                       4 = car
                                     religious … 3                   5 = bus/public                                           WAITING TIME CONSULTATION
                                                                          transport                                                            TIME
                                                                     6 = other (specify)

         NAME              CODE                                                                             HRS      MINS      HRS      MINS       HRS      MINS




                                                                             Page 17
Section 3, part a -- HEALTH IN LAST TWO WEEKS concluded
Fill out for all household members
                  22                   23                   24             25            26             27              28           29                      30
 ID      During the last two How many nights          How much did     During the   How much      Total medical      Were the  For the past Who pays for the greatest portion of
         weeks was (NAME) did (NAME) stay           (NAME) or will last 2 weeks did (NAME) expenses over            medicine/   12 months        the health expenses incl.
        admitted to a hospital in hospital/health   (NAME) pay for did (NAME)           pay       the past two 2     medical was (NAME)      consultations and hospital stays (if
          or health center on                                                                                                                               any)?
                               center during the       staying in a      buy any   altogether for     weeks          supplies  hospitalized
              account of
                                last two weeks?      hospital / health medicine or     these                        available/    for any
           illness/injury?                                                                                                                       Household member … ID
             (INCLUDE
                                                    center during the    medical   medicine and (IF CANNOT          obtainable    injury?           Other relative … 80
          TRADITIONAL              ( 1- 14)          last two weeks?    supplies?     medical         GIVE         in the same                       Government … 81
             HEALING                                                                 supplies? BREAKDOWN)             place?     Yes … 1              Employer … 82
             CENTERS)             NIGHTS                AMOUNT          Yes … 1    (AMOUNT)                                      No … 2     Household member's employer … 83
               Yes… 1                                                    No … 2                                                                      Health insurance … 84
          No … 2 (>>25)                                                                                                                              Other … 85 (specify)


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Section 3, part b – PREVENTATIVE HEALTH – IMMUNIZATIONS
Fill out for all household members
            1                                                        2                                            3              4             5
 ID        Has                             Has (NAME) ever received the following vaccines?                Did you have to     How        Why was
        (NAME)                             1 = yes; 2 = no; 3 = don't know; 4 = not applicable              pay any fee for    much     (NAME) not
       ever been                COPY FROM IMMUNIZATION BOOK / (WEIGH -IN) CARD IF AVAILABLE                      these          was     immunized?
                                                                                                           immunizations?              Too young .. 1
      immunized?                                                                                                               paid?
                                                                                                                                         Don't know
                                        IF ALL ANSWERS EQUAL 3 AND/OR 4>>> PART 3C
                                                                                                             Yes .. 1                 (NAME) had to
        Yes … 1                                                                                            No … 2 (Next
                                                                                                                              (CEDIS)        …2
         No … 2                                          Type of immunization                                 person)                 Health center too
      (if no >> 5)                                                                                                               >>        far … 3
                                                                                                                               NEXT      Shortage of
                                                                                                                               PERSO     supply … 4
                                                                      FIVE IN           VITAMIN   YELLOW                                 Other … 5
               BCG                POLIO                    DPT          ONE   MEASLES      'A'     FEVER                                  (specify)
                       0     1     2    3    Booster   1    2     3
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Section 3 part c – Child Health / Postnatal care
Fill out for all household members
                    1               2            3              4            5         6             7               8         9           10              11
ID             Did you or    How many Did you have to How much          Does (or At what age At what age         At what  At what age      Does   Who usually looks
             someone else      times did      pay for        do you      did) the     was     did (NAME)         age was did (NAME) (NAME)          after (NAME)
            take [name] to    [name] go    consultations? usually pay    mother    (NAME)       receive any     (NAME)    receive any participate     during the
      ID of person interviewed




                                              1 = yes                                         liquid (except               food other                  daytime?
            a health center     there for                    for one   breastfeed? weaned?                         first                    in a
                                           2 = no (>> 5)                                       water) other                   than                    1 = mother
               for a post-  consultations                 consulation? (NAME)                                     given                 community
                                                                                                   than                 breastmilk for              2 = adult male
              natal care in in the past 12                                         REPORT breastmilk for          water? the first time? feeding   3 = adult female
               the past 12      months?                     (CEDIS)      1 = yes      IN      the first time?             REPORT IN program?        4 = male child
                 months                                                   2 = no   MONTHS REPORT IN             87 = not MONTHS                    5 = female child
                 1 = yes                                                  (>> 9)   87 = still   MONTHS            yet     87 = not yet    1 = yes     6 = creche
             2 = no (>> 5)                                                          breast-    87 = not yet                               2 = no  7 = other (specify)
                                                                                    feeding


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Section 3, part c – Child Health / Development
NEW -- complete for all children in household ages 9 and younger
                      12                 13                 14                        15               16            17
 ID         Does (NAME) attend         In the How many children's/ picture How many other         In the past   In the past
           any organized learning last 7       books are there in the house.    books (adult      week, how     week, how
              or early childhood       days, (answer once for entire house)         books,       many times many times
       ID of Person Interviewed




           education programme,         how                                  schoolbooks, etc.) was (NAME) was (NAME)
             such as a private or      many                                    are there in the left in care of left alone?
            government facility, hours did                                    house? (answer another child
           including kindergarten (NAME)                                       once for entire      (that is,
             or community child       attend?                                       house)         someone
                     care?                                                                         under 10
                                                                                                 years old)?
                   Yes … 1
                   No … 2

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Section 3, part d – Fertility and Prenatal care
Fill out for all women ages 12-49
           1              2        3         4          5            6      7              8              9           10        11        12
 ID    Have you      Have you    How       How     I would like How        How     I would like to     Did you   How many Are you During the
       ever been     ever given many       many to make sure many          many    make sure you      have any     of those  pregnant   past 12
       pregnant?      birth to a
                              girls have boys have you have        girls boys are have total number pregnancy    pregnancies   now?     months
                       child?
                              you given you given given birth to are still still   of …. Children which did did not end                have you
                                                                                                                   in a live
       Yes … 1                 birth to? birth to?     …          alive? alive?         alive?      not end in a             Yes … 1     been
                  IF NO,                                                                                            birth?
       No … 2    PROBE:
                                                                                                     live birth?              (>>16) pregnant?
       (>> 30)   Even one                 BOYS       TOTAL       GIRLS BOYS            TOTAL                     NON-LIVE    No … 2
                 who lived      GIRLS               NUMBER                         NUMBER OF          Yes … 1     BIRTHS               Yes … 1
                only a few                             OF                           CHILDREN           No … 2                           No … 2
               hours or less?                      CHILDREN                            ALIVE           (>>11)                         (>>Part 25)
                                                   (Q.3 + Q.4)                       (Q.6 + Q.7)

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S ection 3, part d – Fertility and Prenatal Care
Complete entire sheet for women ages 12-49
            15              16           17            18          19                20                    21                 22           23               24
ID     How did this     Is that    Are y ou now During this    How old       From where did      From whom did you         How       How much        Why didn't y ou
     pregnancy end?      child    breastfeeding? pregnancy     was y our     y ou receive that      receive that care?    many      did y ou pay     go for prenatal
                                                                                   care?              Doctor … 01                                        care?
                          still                    did y ou    pregnanc                                                    times     for the first
                                                                                                      Nurse … 02
     Live birth … 1     alive?       Yes … 1       receive      y when                            Medical Asst … 03      did y ou      prenatal
                                                                              Prenatal clinic                                                        Can't afford … 1
      Still birth … 2                No … 2       any pre-     y ou first                            Midwife … 04            go     consultation
                                                                              (private ) … 1                                                          No health care
      ( 7+ months)      Yes …                    natal care?   received                            Pharmacist … 05        there?           ?
                                                                              Prenatal clinic    Chemical Seller … 06                                 available … 2
          (>>18)           1                                   prenatal        (public) … 2                                                           Health care too
                                                                                                   Trad Healer … 07
     Mis-carriage …     No … 2                     Yes ... 1     care?         Hospital … 3       Trained TBA … 08                     >> 25              far … 3
         3 (>>18)       (>>18)                     No … 2                   Maternity Home …     Untrained TBA … 09                                  Not necessary …
        Other … 4                                  (>>24)      WEEKS                  4            Spiritualist … 10                AMOUNT                    4
        (specify )                                                               Home of         Other … 11 (specify)                                   Other … 5
          (>>18)                                                             practitioner … 5                                                            (specify )
                                                                               Community
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S ection 3, part d – Fertility / Women's Health
NEW -- complete for all women in household ages 12 to 49
             25               27            28             29             30            31                32                33
ID      How many         After y our   How many        For how        How old       Do y ou still   How old were          If still
      y ears/ months      last child,     months         many        were y ou at      have           y ou when       menstruating,
       have passed       how many         passed     months did       y our first   menstruation     y ou stopped    have y ou gone
     since second to        months        before          y ou       menstruatio         ?          menstruating?   more than three
         last child?        passed     y our period breastfeed?           n?                                         months without
                         before y ou   came back?                                     Yes … 1                       menstruating one
                           resumed                    Still breast     Not y et       No … 2                        or more times in
                            sexual        Not y et     feeding          …87                                           the past y ear?
                        relationships?     …87           …87                                                             1 = y es
       y ears months
                                                                                                                          2 = no
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Section 3, part e -- Contraceptive use and HIV/AIDS awareness
Complete entire sheet for household members ages 12 and older
           1                       2                        3                   4                     5                6                 7         CODES FOR QUESTION 5
ID     Are you or    What main method are you using?    IF Q.2 = 01 If Q.2 = 01 TO 09, ASK:     Why are you Do you think you Which main Not married … 11
                                Pill … 01                                                                         will use a                       Fertility-related reasons
      your partner                                     TO 09, ASK:                              not using any                    contraceptive
                           Male condom … 02                            Where did you get the                    contraceptive                   Infrequent sex / no sex … 22
       using any          Female condom … 03                                                    contraceptive                     would you Menopausal/Hysterectomy … 23
                                                                            method?                           method to delay or
       method to               IUD … 04                How much                                   method?                        prefer to use? Wants as many children as
                                                                                                               avoid pregnancy in
       prevent or            Injection … 05            did you pay                                                                                 possible … 26
                            Female sterl … 06                      Prenatal clinic (private) …                     the future?                        Opposition to use
         delay                                           for that                1              See codes at                        See codes at
                             Male sterl … 07                                                                                                       Respondent opposed … 31
      pregnancy?             Implants … 08
                                                        during the Prenatal clinic (public) … 2    right       Yes, Delay/Avoid        right
                                                                                                                                                   Husband opposed … 32
                            Foam/Jelly … 09            last month?        Hospital … 3                          Pregnancy … 1                      Religious prohibition ... 34
       Yes … 1                 LAM … 10                                Maternity home … 4                      Yes Other reason                       Lack of knowledge
       No … 2               Abstinence … 11             AMOUNT       Home of practitioner … 5                         …2                           Knows no method ... 41
                              Rhythm … 12                             Pharmacy/Chemist/Drug                         No … 3                         Knows no source ... 42
        (>>5)
                            Withdrawal … 13                                  store .. 6                        Don't know … 4                         Method-related reasons
                          Other … 14 (specify)                                                                                                     Health concerns ... 51
                                                                     Community epicenter … 7                         (>>8)
                           IF Q=10 - 14 >> 8)                                                                                                      Fear of side effects ... 52
                                                                        Other … 8 (specify)
                                                                                                                                                   Lack of access / too far ... 53
                                                                                                                                                   Costs too much ... 54
                                                                                                                                                   Inconvenient to use ... 55
                                                                                                                                                   Interferes with body's normal
  1                                                                                                                                                processes ... 56
  2                                                                                                                                                Other (specify) ... 96
                                                                                                                                                   Don't know ... 98
  3
  4
  5
  6                                                                                                                                                CODES FOR QUESTION 7
                                                                                                                                                   Pill … 01
  7
                                                                                                                                                   Male condom … 02
  8                                                                                                                                                Female condom … 03
  9                                                                                                                                                IUD … 04
                                                                                                                                                   Injectibles … 05
 10
                                                                                                                                                   Female sterilization … 06
 11                                                                                                                                                Male sterilization … 07
 12                                                                                                                                                Implants … 08
                                                                                                                                                   Foam/Jelly … 09
 13
                                                                                                                                                   Lactational Amen. Method …
 14                                                                                                                                                10
 15                                                                                                                                                Periodic abstinence … 11
                                                                                                                                                   Withdrawal … 12
 16
                                                                                                                                                   Diaphragm ... 13
 17                                                                                                                                                Other (specifiy) ... 96
 18                                                                                                                                                UNSURE ... 98
Section 3, part e -- Contraceptive use and HIV/AIDS awareness (concluded)
Complete entire sheet for household members ages 12 and older
             8                          9                        10               11             12                     13              14           15
 ID Now I would           What can people do to prevent   Is it possible    Can the virus If yes, by what    What would you do to     Do you    If yes, how   CODES FOR QUESTION
      like to talk to               HIV/AIDS              for a healthy-     that causes      means?         prevent yourself from     know        many       9
        you about                                            looking           AIDS be                      being infected with the anyone that   people?     Abstain from sex … 01
    something else.         (UP TO 3 MAIN WAYS)             person to        transmitted      During        virus that causes AIDS? has died of               Use condom … 02
     Have you ever                                           have the      from a mother pregnancy … 1                              AIDS in the               Limit sex to one
       heard of an              see codes at right         AIDS virus?         to child?  During delivery    Abstain from sex … 1 past year?                  partner/stay faithful to one
      illness called                                                                            …2          Be faithful to partner … 1 = yes                  partner … 03
       HIV/AIDS?                                            Yes … 1            Yes … 1        During                    2             2 = no                  Limit number of sexual
                                                             No … 2             No … 2     breastfeeding       Have safe sex … 3                              partners … 04
         Yes … 1                                           Don't know           (>>13)          …3             Use a condom … 4                               Avoid sex with prostitutes
       No … 2 (>>                                               …8          Don't Know                        Other … 5 (specify)                             … 05
      Next Person)         1st         2nd         3rd                      … 3 (>>13)                                                                        Avoid sex with persons
                                                                                                                                                              who have many partners …
   1
                                                                                                                                                              06
   2                                                                                                                                                          Avoid sex with
   3                                                                                                                                                          homosexuals ... 07
                                                                                                                                                              Avoid sex with persons
   4
                                                                                                                                                              who inject drugs
   5                                                                                                                                                          intravenously ... 08
   6                                                                                                                                                          Avoid blood transfusions
                                                                                                                                                              ... 09
   7                                                                                                                                                          Avoid injections ... 10
   8                                                                                                                                                          Avoid sharing razors/blads
   9                                                                                                                                                          ... 11
                                                                                                                                                              Avoid kissing ... 12
 10                                                                                                                                                           Avoid mosquito bites ... 13
 11                                                                                                                                                           Seek protection from
                                                                                                                                                              traditional practioner ... 14
 12
                                                                                                                                                              Other (specify) ... 96
 13                                                                                                                                                           Don't know ... 98
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Section 3, part f -- Insurance -- individual specific questions
Fill out for all household members
             1               2          3                         4                        5                   6           7                   8                    9         10        11
 ID Has (NAME) If (NAME) has never Is (NAME)                If (NAME) is no          If (NAME) is         What are the    Does      Has (NAME) paid premium or       Has       Is       Does
         ever been   been registered, why?     still        longer a member,     registered or covered,     expected    (NAME) expected to pay for the current   (NAME) (NAME) (NAME)
       registered or Premium is too high registered                why?           what type of scheme      benefits of pay all/part       insurance year?        benefitted covered     have
      covered with a         …1            or covered?   Premium is too high …    is he/she registered    this scheme?   of the                                   from the under the informal
           health        Does not have                               1                    with?                        premium?                                   scheme? national     health
         insurance       confidence in         Yes,             Do not have             (CHECK             Only OPD                                                          health  insurance
          scheme?       operators of the    registered         confidence in        MEMBERSHIP            services … 1 All … 1                                    Yes …1 insurance coverage
                         scheme … 2        … 1 (>>5)      purveyors of scheme            CARD)              Only in-    Part … 2                                  No … 2 scheme?        (e. g.
      Yes registered   Covered by other        Yes,                …2             District mutual … 1        patient   Exempted                                             1 = Yes through a
        … 1 (>>3)        avenues … 3       covered …        Covered by other      Private mutual … 2      services … 2    …3                                                2 = No     susu)?
       Yes covered No knowledge of any        (>>5)          alternatives … 3    Private company … 3        Both … 3     (>>9)                                                        1 = Yes
        … 2 (>>3)        scheme … 4          No … 3          Was not getting      Other … 4 (specify)                   N/A … 4       a PAID      b EXPECTED                           2 = No
          No … 3      Other … 5 (specify)                      benefits … 4                                              (>>9)      (AMOUNT)         TO PAY
                       NEXT PERSON                        Other … 5 (specify)                                                                      (AMOUNT)
                                                           (NEXT PERSON)

  1
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 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 3, part g -- MENTAL HEALTH (ALTERNATIVE MODULE)
NEW -- fill out for all household members ages 10 and older

In the past week, how many days have you:
                  Been        Had       Felt     Felt that Fel hopeful     Felt       Had
                bothered    trouble  depressed? everything about the     fearful?   restless
               by things    keeping              you did     future                  sleep?
              that usually your mind              was an
    ID            don't     on what               effort?
                 bother    you were
                  you?      doing?

                  1          2            3           4         5           6          7
          1
          2
          3
          4
          5
          6
          7
          8
          9
         10
         11
         12
         13
         14
         15
         16
         17
         18
Section 3, part h --ACTIVITIES OF DAILY LIVING
NEW -- fill out for all household members ages 10 and older
ID                 1            2              3           4                                       5             6             7             8             9            10              11              12            13            14            15            16
       ID of Person Being Interviewed



              If (NAME) How long If (NAME) How long                                            If (NAME) How long If (NAME) How long If (NAME) How long If (NAME) had How long If (NAME) How long If (NAME) How long
            had to carry a     has      had to sweep      has                                 had to walk        has      had to draw        has       had to bend,       has      to stand up from     has      had to bathe       has       had to feed       has
            heavy load for (NAME)        the floor or  (NAME)                                    for 5 km     (NAME) water from a (NAME)                 kneel, or     (NAME) a seated position (NAME) his/herself (NAME) his/herself (NAME)
               20 meters                yard without                                          without any                 well without                stoop without                   on the floor               without any                 without any
                               had                        had                                                    had                         had                          had                           had                         had                        had
             without any                  any help,                                            help, could                  any help,                    any help,                    without any                 help, could                 help, could
                           difficulty /               difficulty /                                           difficulty /                difficulty /                 difficulty /                  difficulty /                difficulty /                difficulty/
             help , could               could he/she                                          he/she do it?               could he/she                 could he/she                   help, could                he/she do it?               he/she do it?
             he/she do it?
                              been          do it?       been                                   1 = easily      been          do it?        been           do it?        been        he/she do it?     been                        been                        been
               1 = easily   unable to     1 = easily   unable to                                 2 = with     unable to    1 = easily     unable to                    unable to                     unable to     1 = easily    unable to     1 = easily   unable to
                2 = with     do this?      2 = with     do this?                                difficulty     do this?     2 = with       do this?     1 = easily      do this?       1 = easily     do this?      2 = with      do this?      2 = with     do this?
                                          difficulty                 difficulty               3 = not at all                difficulty                   2 = with                       2 = with                   difficulty                  difficulty
                                        3 = not at all             3 = not at all                                         3 = not at all                 difficulty                    difficulty                3 = not at all              3 = not at all
                                                                                                                                                       3 = not at all                3 = not at all

                                                         YRS MOS                    YRS MOS                YRS MOS                     YRS MOS                     YRS MOS                         YRS MOS                     YRS MOS                     YRS MOS
  1
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 11
 12
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 15
 16
 17
 18
 19
 20
 21
Section 3, part h – Miscellaneous Health
NEW -- fill out for all household members ages 10 and older
 ID   In general, how       Have you         In the past 3     Have you ever     At what   Do you still  How long   In one day     In the past Would you        If so, when?       Will you        Are you so     How many
      would you rate ever had any months, have you had the habit of age did smoke, or have ago did you              how many       12 months, like to quit                       actually quit     addicted to   days in one
        your health?          sores or    had numbness or         chewing       you begin you completely  quit?       cigars/       have you      smoking         DO NOT        smoking in the   smoking that    week do you
                            irritations tingling in the hands     tobacco,     this habit?     quit?                 cigarettes   tried to stop sometime in      PROMPT:        next 6 months?   you will need     consume
                                          or feet, other than smoking a pipe,
     1="Very healthy" on the feet                                                                        YEARS        did you       smoking?     your life?    1 = In the next                    some sort of     alcoholic
                                         numbness /tingling    smoking self-
       2="Somewhat           that took                                           AGE IN 1= still smokes              consume                                       30 days          1 = yes      help to quit?    beverages?
                                         from hands or feet rolled cigarettes,
           healthy"         more than falling asleep, foot      or smoking
                                                                                 YEARS        (>>24)                now/before      1 = yes      1 = yes       2 = In the next      2 = no
       3="Somewhat         four weeks aches or long walks?       cigarettes/               2 = has quit                totally      2 = no       2 = no             year                            1 = yes
         unhealthy"           to heal?                             cigars?                                           quitting?                   (>>29)       3 = In the next 5                     2 = no
      4="Unhealthy"                             1 = yes                                                                                                             years
                              1 = yes           2 = no             1 = yes                                                                                        4 = Later
                               2 = no                          2 = no (>>30)                                                                                   5 = When I get
                                                                                                                                                                    sick
             17              18              19                20            21            22             23            24            25            26                27              28              29             30
  1
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Section 3, part i – ANTHROPOMETRY
NEW -- fill out for all household members
 ID Name of Household            Was        If not, why not?     Was height measured      Height        Weight   Hip Size   Waist Size         Arm
            Member             (NAME)                             standing of lying                                                       circumference
                              measured?   1 = not home during          down?                                                             (mid-upper arm)
                                              survey period
                                1 = yes         2 = too ill         1 = standing
                                2 = no     3 - handicapped or      2 = lying down
                                                deformed
                                             4 = not willing
                                           5 = other (specify)
                                                                                       MTRS        CM   KGS        CM          CM             CM
              1                 2                  3                     4                    5          6          7           8              9
   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days
Complete entire sheet for new household members ages 7 and older
         Did [name] do any During In total,                                                                                  During      Has                            Are taxes
                                                                                                                                                 What is the amount
            work for pay,     the last 7   how                                                                               the last [name]                             already
         profit, family gain days, how many
                                                                                                                                                    (including any
                                                                                                                             7 days, received or                        deducted
            ID of Person Interviewed



            or did [name]                         During the last 7 days, what                               How long has                               bonuses,
                                many      hours    were the main tasks and         What kind of trade,       [name] been       how       will        commissions,         from
          produce anything
                               jobs did    did     duties in the job [name]    services, or industry is this   doing this   long did [name]      allowances or tips)    [name's]
Member ID




         for barter or home
         use during the last
                             [name] do [name] spent most of his/her time         work connected with?           work all     [name] receive            received?          pay?
                7 days?           all    work in              on?                                              together?     actually money for
               Yes = 1        together? all these                                                                           work on this work? (see time unit codes     1 = Yes
                No = 2        (number) jobs                                                                                 this job? Yes = 1            below)         2 = No
          (if no >> part 4c)             over the                                                                            (hours)    No=2
                                          last 7        main            ISCO                         ISIC                             (if no >>                  time
                                                                                    industry                 years months                          amount
                                          days?      occupation          code                        code                                 11)                    unit
                   1               2         3                 4                             5                     6            7          8                9              10
  1
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  4
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  6
  7
  8
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 10
 11
 12
 13
 14
 15
 16
 17
 18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
    Cell: A1
Comment: dwa6:
          Do we want a module for both the past 7 days and the past 12 months for employment?
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (cont.)
Complete entire sheet for new household members ages 7 and older
                                        What was     For  Does [name]                          When       Is there a   In this job,    Is [name]        Will      Codes for question 11:
                                        the status whom receive any                           [name]        trade       is [name]   entitled to paid   [name]     Paid employee = 1
                                                                                                                       entitled to sick leave and/or receive a    AGRICULTURE
             ID of Person Interviewed


                                        of [name]    did   payment for                        started      union in
                                                                       What is the value of                                         maternity leave                Self employed
                                          in this  [name] this work in                      doing this    the place        paid                      retirement
                                                                        goods or services                                             on this job?                   2 = with employees
                                           job?    work? the form of                         work, did      where       holidays?                     pension?
 Member ID




                                                                           provided?                                                 1 = yes, sick                   3 = without employees
                                                            goods and                       he/she sign    [name]                        leave                     4 = Contributing family
                                        See code, See code services?                         a written     works?       1 = Yes        2 = yes,       1 = yes     worker
                                        If code is           1 = Yes                         contract?                  2 = No      maternity leave   2 = no       NON-AGRICULTURE
                                         02 - 07             2 = No                           1 = Yes     1 = Yes                    3 = yes, both                 Self employed
                                         (>>21)              (>> 15)                 time     2 = No      2 = No                        4 = no                       5 = with employees
                                                                         value
                                                                                      unit                                                                           6 = without employees
                                                                                                                                                                   7 = Contributing family
                                           11        12         13               14             15           16            17             18            19        worker
     1                                                                                                                                                            Domestic employee = 8
     2                                                                                                                                                                 (househelp)
                                                                                                                                                                  Apprentice = 9
     3                                                                                                                                                            Other (specify) = 10
     4
     5
     6
     7
                                                                                                                                                                  Codes for question 12
     8
                                                                                                                                                                  GOVERNMENT SECTOR
     9                                                                                                                                                             1 = Civil Service
    10                                                                                                                                                             2 = Other public service
    11                                                                                                                                                             3 = Parastatals
                                                                                                                                                                  NGO's = 4
    12
                                                                                                                                                                  Cooperatives = 5
    13                                                                                                                                                            International Org.
    14                                                                                                                                                             / Diplomatic Mission = 6
    15                                                                                                                                                            Private Sector formal = 7
                                                                                                                                                                    (including paid apprentice)
    16                                                                                                                                                            Private Sector informal = 8
    17                                                                                                                                                            Agricultural business = 9
    18                                                                                                                                                            Other (specify) = 10




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (cont.)
Complete entire sheet for new household members ages 7 and older
           Is [name]       Is     Where does                              How many                                             Codes for question
          entitled to [name's]      [name]       How far                                 During the last 6
                                                                             people                                            23:
                                                                                            months, has
             ID of Person Interviewed

             free or    place of usually do his away is How often does altogether                                              Office = 1
          subsidized work in or her work? [name's]            [name] go                  [name] received
                                                                          work in the                                          Home = 2
                                                                                            any training    How long was the
            medical       this                                                                                                     (>> 26)
 Member ID




                                                 place of  between his or place where
                                                                                         related to his/her    training?       Factory = 3
          care in this village / (see codes) work from her house and         [name]
              job?       town?                  his or her place of work?                 work, including                      Workshop = 4
                                                                             works?
                                                  home?                                      on-the-job                        Own land/farm = 5
            1 = Yes 1 = Yes                                                                   training?                        Other land/farm = 6
                                                                          Code "DK"                                            River/ocean = 7
            2 = No      2 = No                                                                 1 = yes
                                                           no. of    time   for don't                                          Hotel/restaurant/
                                                   km.                                          2 = no      months weeks
                                                            trips    unit     know                                               chop bar = 8
               20          21          22           23            24           25                 26              27           Store/shop/
   1                                                                                                                             tabletop = 9
                                                                                                                               Street at a fixed
   2                                                                                                                             location = 10
   3                                                                                                                           Street not at a fixed
   4                                                                                                                             location = 11
   5                                                                                                                           Lorry park = 12
                                                                                                                               Somebody's home
   6                                                                                                                              or veranda = 13
   7                                                                                                                           School = 14
   8                                                                                                                           Hospital/clinic = 15
                                                                                                                               Other (specify) =
   9
                                                                                                                                  16
  10
  11
  12
  13
  14
  15
  16
  17
  18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 7 days (concluded)
Complete for household members ages 7 and older

                                       What type of training                                 By how much was
                                                                Who paid for the Did [name]            it?
                                       did [name] receive?
                                                                    training?        lose an
            ID of Person Interviewed


                                            Clerical = 1
                                                               1 = [name] entirely entitlement
                                       Prof / managerial = 2                                   Write difference
                                                                  2 = Employer      or benefit
                                          Computer = 3                                         between normal
Member ID




                                                                     entirely      during the
                                          Marketing = 4                                          entitlement /
                                                                3 = Both (shared    period of
                                           Teaching = 5                                         benefit while
                                                                       cost)         his/her
                                          Leadership = 6
                                                                     4 = Free       training?   training and
                                           Medicine = 7
                                                                5 = International              before training
                                         Accountancy = 8
                                                                      agency         1 = Yes
                                         Skills / trade = 9
                                                               6 = Other (specify)   2 = No    amount      time
                                       Other (specify) = 10
                                                                                               (cedis)    unit
                                                28                    29              30             31
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TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 12 months
Complete entire sheet for household members ages 7 and older
         Did [name] do any During In total,                                                                              Has                           Are taxes
            work for pay,      the past   how                                                                          [name]                           already
         profit, family gain                                                                                                     What is the amount
                                  12      many                                                                       received or                       deducted
            or did [name]                                                                                                            (including any
                               months, weeks                                                                             will                            from
            ID of Person Interviewed




          produce anything                        During the past 12 months,                            How long has                     bonuses,
                             how many did                                                                              [name]                          [name's]
         for barter or home                        what were the main tasks   What kind of trade,       [name] been                   commissions,
         use during the past jobs did [name] and duties in the job [name] services, or industry is this   doing this
                                                                                                                       receive
                                                                                                                                  allowances or tips)
                                                                                                                                                         pay?
Member ID




             12 months?      [name] do work in                                                                        money for
                                                  spent most of his/her time work connected with?          work all                     received?
               Yes = 1            all   all these                                                                    this work?                        1 = Yes
                                                             on?                                          together?
               No = 2         together?   jobs                                                                         Yes = 1                          2 = No
                                                                                                                                 (see time unit codes
         (if no >> page 47) (number) over the                                                                           No=2
                                                                                                                                          below)
                                         last 12                                                                      (if no >>
                                        months?                                                                           10)
                                                        main           ISCO                     ISIC                                              time
                                                                               industry                 years months                amount
                                                     occupation         code                    code                                              unit
                   1               2         3                4                         5                     6            7                 8             9
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18



TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 12 months (cont.)
Complete entire sheet for household members ages 7 and older
          What was        For   Does [name]                      During the During these      During the last 5                       Codes for question 10:
          the status whom        receive any                       past 12   weeks, how      years has [name]                         Paid employee = 1
             ID of Person Interviewed




          of [name]       did    payment for                     months, for many hours         received any                          AGRICULTURE
            in this     [name] this work in What is the value of how many per week did       training lasting at                       Self employed
                                                                                                                 How long was the        2 = with employees
 Member ID




              job?       work?   the form of   goods or services weeks did     [name]         least one month
                                                                                                                   last training?        3 = without employees
                                  goods and        provided?     [name] do    usually        relating to his/her
                                                                                                                                       4 = Contributing family
          See code, See code      services?                      this work?     work?               work?                             worker
          If code is               1 = Yes                                                                                             NON-AGRICULTURE
           02 - 07                 2 = No                                                         1 = Yes                              Self employed
           (>>14)                  (>> 14)                  time                              2 = No (>> Next                            5 = with employees
                                                value              weeks        hours                           months        weeks      6 = without employees
                                                            unit                                  Person)
               10         11          12              13              14         15                  16                  17            7 = Contributing family
                                                                                                                                      worker
  1
                                                                                                                                      Domestic employee = 8
  2                                                                                                                                        (househelp)
  3                                                                                                                                   Apprentice = 9
  4                                                                                                                                   Other (specify) = 10
  5
  6
  7
                                                                                                                                      Codes for question 11
  8
                                                                                                                                      GOVERNMENT SECTOR
  9                                                                                                                                    1 = Civil Service
 10                                                                                                                                    2 = Other public service
 11                                                                                                                                    3 = Parastatals
                                                                                                                                      NGO's = 4
 12
                                                                                                                                      Cooperatives = 5
 13                                                                                                                                   International Org.
 14                                                                                                                                    / Diplomatic Mission = 6
 15                                                                                                                                   Private Sector formal = 7
                                                                                                                                        (including paid apprentice)
 16                                                                                                                                   Private Sector informal = 8
 17                                                                                                                                   Agricultural business = 9
 18                                                                                                                                   Other (specify) = 10




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part a -- Activity Status and characteristics of main occupation in last 12 months (cont.)
Complete entire sheet for household members ages 7 and older
                                 Did [name]                                     Codes for question 19:
             How
                                    lose any  By how much was                   Myself entirely = 1
            many
             ID of Person Interviewed



                                 entitlement          it?                       Employer entirely = 2
           hours a Who paid                                                     Both (cost was shared) = 3
                                  or benefit
          week did for the                                                      Free = 4
 Member ID




                                  during the   Write difference
           [name] training?                                                     International Agency = 5
                                  period of    between normal
           receive                                                              Other = 6 (specify)
                                     his/her  entitlement/benefit
             this        (see
                                   training?    while training
          training? codes)
                                                     1 = yes             time
                                        hours                  amount
                                                     2 = no              unit
                                         18     19     20           21
     1
     2
     3
     4
     5
     6
     7
     8
     9
    10
    11
    12
    13
    14
    15
    16
    17
    18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Characteristics of secondary occupation in last 7 days
Complete entire sheet for household members ages 7 and older
                                                                                                                                           Has                      What    For    Codes for question 8:
                                                                                                                        Did [name]       [name]        What is the
                                                                                                                                                                 was the whom      Paid employee = 1
                                                                                                                                        received         amount                    AGRICULTURE
                                                                                                            During   work on this job                            status of  did
                                        Describe the main tasks                                                                          or will                                    Self employed
                                                                                              How long has the last   at same time as               (including any[name] [name]
            ID of Person Interviewed




                                        and duties in the other     What kind of trade,                                                  [name]                                       2 = with employees
                                                                                              [name] been 7 days,    his/her main job                   bonuses,   in this work?      3 = without employees
                                       kind of work that [name]    services, or industry is                   how     over the last 7    receive
                                                                                               doing this                                            commissions,   job?            4 = Contributing family
Member ID




                                       spent most time on, apart    this work connected                    long did         days?        money                                     worker
                                                                                                 work all                                for this   allowances or           See
                                          from his/her main                 with?                           [name]   If yes, how long                                              NON-AGRICULTURE
                                                                                                together?                                 work?      tips) received See    codes    Self employed
                                             occupation?                                                    actually  did [name] do
                                                                                                           work on          both        1 = Yes       in the past 7code,              5 = with employees
                                                                                                           this job?    altogether?      2 = No           days?   If code             6 = without employees
                                                                                                                                          (if no,                 is 02 -           7 = Contributing family
                                                                                                                     Less than 1 day
                                                                                                                                          >> 8)                                    worker
                                                                                                             (hours)         =0                                      07            Domestic employee = 8
                                          secondary       ISCO                        ISIC                                                          amount time
                                                                      industry                years months              . . . No = 9                             (>>22)                  (househelp)
                                          occupation       code                       code                                                          (cedis) unit
                                                                                                                                                                                   Apprentice = 9
                                                  1                           2                    3           4            5              6              7           8     9      Other (specify) = 10
  1
  2
  3
  4
  5
                                                                                                                                                                                   Codes for question 9:
  6                                                                                                                                                                                GOVERNMENT SECTOR
  7                                                                                                                                                                                  1 = Civil Service
  8                                                                                                                                                                                  2 = Other public service
                                                                                                                                                                                     3 = Parastatals
  9                                                                                                                                                                                NGO's = 4
 10                                                                                                                                                                                Cooperatives = 5
 11                                                                                                                                                                                International Org.
                                                                                                                                                                                     / Diplomatic Mission = 6
 12                                                                                                                                                                                Private Sector formal = 7
 13                                                                                                                                                                                (including paid apprentice)
 14                                                                                                                                                                                Private Sector informal = 8
                                                                                                                                                                                   Agricultural business = 9
 15                                                                                                                                                                                Other (specify) = 10
 16
 17
 18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Characteristics of secondary occupation in last 7 days (continued)
Complete entire sheet for new household members ages 7 and older
                                                   When     Is there a   In this job,   Is [name] entitled    Will    Are taxes Is [name] Is [name]        Where How many        Codes for question
          Does [name]
                                                  [name]      trade       is [name]     to paid sick leave [name]      already entitled to entitled to       does     people     19:
           receive any
                                                                                         and/or maternity receive a deducted                                                     Office = 1
            ID of Person Interviewed



          payment for                             started   union in     entitled to                                              free or  any other       [name] altogether
                                                                                        leave on this job? retirement                                                            Home = 2
           this work in What is the value of doing this the place            paid                                       from    subsidized   social        usually work in
                                                                                                                                                                                    (>> 26)
                                                 work, did    where       holidays?                          pension?   [name's] medical        security      do    this place
Member ID




           the form of      goods or services                                              1 = yes, sick                                                                         Factory = 3
            goods and          provided?        he/she sign [name]                            leave
                                                                                                                          pay?   care in this   benefits   his/her    where
                                                                                                                                                                                 Workshop = 4
             services?                           a written   works?       1 = Yes       2 = yes, maternity   1 = yes                job?         on this    work?    [name]      Own land/farm = 5
                                                 contract?                2 = No              leave          2 = no     1 = Yes   1 = Yes         job?               works?      Other land/farm = 6
              1 = Yes                                        1 = Yes                      3 = yes, both                  2 = No    2 = No                    See                 River/ocean = 7
              2 = No                              1 = Yes    2 = No                           4 = no                                            1 = Yes     codes Code DK        Hotel/ restaurant/
              (>> 12)        value     time unit 2 = No                                                                                         2 = No             for "don’t    chop bar = 8
                                                                                                                                                                     know"       Store/shop /table top
           10                11                12           13         14              15                      16          17         18          19          20        21       =9
  1                                                                                                                                                                              Street at a fixed
  2                                                                                                                                                                                location = 10
                                                                                                                                                                                 Street not at a fixed
  3
                                                                                                                                                                                   location = 11
  4                                                                                                                                                                              Lorry park = 12
  5                                                                                                                                                                              Somebody's home or
  6                                                                                                                                                                                veranda = 13
                                                                                                                                                                                 School = 14
  7                                                                                                                                                                              Hospital/clinic = 15
  8                                                                                                                                                                              Other (specify) = 16
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Activity Status and characteristics of secondary occupation in last 12 months
Complete entire sheet for household members ages 7 and older
                                       During the past 12                                                                        Has                           Are taxes
                                       months, did [name]                                                                      [name]                           already
                                       do any other work                                                                                 What is the amount
                                                                                                                             received or                       deducted
                                        beside the MAIN                                                                                      (including any
                                                                                                                                 will                            from
            ID of Person Interviewed




                                        OCCUPATION? Describe the main tasks and                                 How long has                     bonuses,
                                                                                                                               [name]                          [name's]
                                                       duties in the other kind of    What kind of trade,       [name] been                   commissions,
                                           1 = yes                                                                             receive                           pay?
                                                      work that [name] spent most services, or industry is this   doing this              allowances or tips)
Member ID




                                           2 = no                                                                             money for
                                                       time on apart from his/her   work connected with?           work all                     received?
                                                                                                                             this work?                        1 = Yes
                                                           main occupation?                                       together?
                                                                                                                               Yes = 1                          2 = No
                                                                                                                                         (see time unit codes
                                                                                                                                No=2
                                                                                                                                                  below)
                                                                                                                              (if no >>
                                                                                                                                  7)
                                                          secondary          ISCO                       ISIC                                              time
                                                                                       industry                 years months                amount
                                                          occupation          code                      code                                              unit
                                             1                      2                           3                     4            5                 6             7
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18



TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part b -- Activity Status and characteristics of secondary occupation in last 12 months (cont.)
Complete entire sheet for household members ages 7 and older
          What was        For   Does [name]                      During the During these Did [name] work on this    Codes for question 8:
          the status whom        receive any                       past 12   weeks, how job at the same time as     Paid employee = 1
             ID of Person Interviewed




          of [name]       did    payment for                     months, for many hours       his/her main job?     AGRICULTURE
            in this     [name] this work in What is the value of how many per week did                               Self employed
                                                                                                                       2 = with employees
 Member ID




             job?        work?   the form of   goods or services weeks did    [name]       If YES, how long did
                                                   provided?                                                           3 = without employees
                                  goods and                      [name] do    usually    [name] do both together?
                                                                                                                     4 = Contributing family
          See code, See code      services?                      this work?    work?                                worker
          If code is               1 = Yes                                                Less than 1 week = 00      NON-AGRICULTURE
           02 - 07                 2 = No                                                          No = 99           Self employed
           (>>12)                  (>> 12)                  time                                                       5 = with employees
                                                value              weeks       hours                weeks              6 = without employees
                                                            unit
               8           9          10              11              12         13                   14             7 = Contributing family
                                                                                                                    worker
  1
                                                                                                                    Domestic employee = 8
  2                                                                                                                      (househelp)
  3                                                                                                                 Apprentice = 9
  4                                                                                                                 Other (specify) = 10
  5
  6
  7
                                                                                                                    Codes for question 9:
  8
                                                                                                                    GOVERNMENT SECTOR
  9                                                                                                                  1 = Civil Service
 10                                                                                                                  2 = Other public service
 11                                                                                                                  3 = Parastatals
                                                                                                                    NGO's = 4
 12
                                                                                                                    Cooperatives = 5
 13                                                                                                                 International Org.
 14                                                                                                                  / Diplomatic Mission = 6
 15                                                                                                                 Private Sector formal = 7
                                                                                                                      (including paid apprentice)
 16                                                                                                                 Private Sector informal = 8
 17                                                                                                                 Agricultural business = 9
 18                                                                                                                 Other (specify) = 10




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part c - Unemployment in last 7 days
Complete entire sheet for all household members ages 7 and older
                                                                                   Why has        What did       During this How long      Codes for question 3:
                                                             Has [name] made any                                                           1 = thought no work available
                                            Was [name]                               [name] not [name] do       period what        has
                                                             effort during the last                                                        2 = awaiting reply to earlier enquiries
             ID of Person Interviewed



                                         available for work                           made any        in this      type of      [name]
                                                               7 days or past 30                                                           3 = waiting to start arranged job, business or agri.
                                          during the last 7                         effort to find period to    employment        been
                                                              days to find work?                                                           4 = off season in agri.
                                         days or within the                                                      was [name]
 Member ID




                                                                                        work?      find work?                   seeking    5 = occupied with home duties
                                           next 30 days?                                                           mainly                  6 = illness / injury
                                                              1 = Yes, last 7 days                                               and/or
                                                                                                                   seeking                 7 = full-time student
                                                                     (>> 4)             (most         (most                    available
                                        1 = Yes, last 7 days                                                    (available, if             8 = on vacation
                                                               2 = Yes, but only      important     important                   to find
                                         2 = Yes, but only                                                       not seeking               9 = other
                                                              within next 30 days       only)          only)                     work?
                                        within next 30 days                                                         for)?
                                                                     (>> 4)
                                          3 = No (>> 10)
                                                                    3 = No
                                                                                   see codes     see codes       see codes   see codes Code for question 4:
                                                                                                                                       1 = applied to prospective employer
                                                1                    2                  3             4              5            6
                                                                                                                                           2 = checked at farms / factories / worksites
         1                                                                                                                                 3 = asked friends and relatives
         2                                                                                                                                 4 = took action to start business (capital, land, equipment, etc.)
                                                                                                                                           5 = took action to start agricultural activity
         3                                                                                                                                 6 = upgrading skills
         4                                                                                                                                 7 = searched newspaper adverts
                                                                                                                                           8 = searched employment services
         5                                                                                                                                 9 = other
         6
         7
                                                                                                                                           Codes for question 5:
         8                                                                                                                                 Wage employment in:
         9                                                                                                                                   1 = government or state enterprise
                                                                                                                                             2 = large private firm
    10                                                                                                                                       3 = small / medium scale enterprise
    11                                                                                                                                     4 = Self employment
                                                                                                                                           5 = any job
    12
    13                                                                                                                                     Codes for question 6:
    14                                                                                                                                     1 = Less than one month
                                                                                                                                           2 = 1 month but less than 3 months
    15                                                                                                                                     3 = 3 months but less than 6 months
    16                                                                                                                                     4 = 6 months but less than 1 year
                                                                                                                                           5 = 1 year but less than 2 years
    17                                                                                                                                     6 = 2 years
    18                                                                                                                                     7 = more than 2 years
    Cell: A2
Comment: dwa6:
          Do we want a module on unemployment for both the past 7 days and the past 12 months?
Section 4, part c - Unemployment in last 7 days continued
Complete for all HH members not currently working outside of the home (i. e. answered NO to page 42 question 37)
                                          What kind of work did [name] do in                                    Why was [name] not                        Codes for question 11:
                                                                                                              available for work during   Under what      1 = high income potential
                                                      his/her last job?
             ID of Person Interviewed



                                                                                   What is the lowest wage the last 7 days or within       conditions,    2 = availability of training
                                          (i. e. what was [name's] main task or                                                                           possibilities
                                                                                  for which [name] is willing     the next 30 days?          if any,
                                                           duties                                                                                         3 = well-defined earnings
 Member ID




                                                                                     to work for someone?           1 = in school             would       (secured)
                                                 -- describe activity fully)
                                                                                                                2 = household duties         [name]       4 = within easy reach of residence
                                                                                          >> part 4E                  3 = too old           become        5 = join spouse
                                        if never worked, write none and code 00                                        4 = sick                           6 = other (specify)
                                                                                                                                          available for
                                                       for ISCO                                                      5 = disabled             work?
                                                                          ISCO                                      6 = pensioner
                                                                                                                                           See codes
                                              OCCUPATION                               amount       time unit          7 = other
                                                                          CODE
                                                           7                                   8                          9                    10
         1
         2
         3
         4
         5
         6
         7
         8
         9
    10
    11
    12
    13
    14
    15
    16
    17
  18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part c -- Unemployment in last 12 months
Complete entire sheet for household members ages 7 and older
                                                                                          What did [name] do in the past 12 months
                                                                                                                                                                                   What type of work did [name] want
                                                                                                       to find work?
                                                                                                                                                                                   when he/she was available or looking
                                        During the past                                                                                   Why did [name] not look for work                                                 What was [name] doing
                                                         During the                                                                                                                            for work?
                                        12 months, for                                            Write most important only               throughout the period he/she was                                                when not working and not
                                                          past 12       During the past                                                         available for work?                                                          avilable to work?
             ID of Person Interviewed




                                          how many                                                                                                                                        Wage employment in:
                                                        months, how     12 months, how       1 = Applied to prospective employers
                                            weeks                                                                                                                                    1 = Government/State Enterprise
                                                        many weeks      many weeks did     2 = Checked at farms/factories/work sites           Write most important only                                                        1 = Student
                                        altogether was
 Member ID




                                                        was [name]      [name] actively                                                                                                   2 - Large private firm
                                        [name] without                                          3 = Asked friends and relatives                                                                                               2 = Housework
                                                        available for    look for work?                                                                                             3 = Small/medium scale enterprise
                                            work?                                              4 = Took action to start business             1 = Thought no work available                                                      3 = Disabled
                                                           work                                                                                                                             Self-employment:
                                                                                          5 = Took action to start agricultural activity 2 = Awaiting reply to earlier enquiries                                                  4 = Sick
                                                                           If 0 >> 5                                                                                                       4 = Non-agriculture
                                          (0 >> next                                                 6 = Upgrading skills                  3 = Waiting to start arranged job,                                               5 = Retired / Aged
                                                          If 0 >> 7                                                                                                                           5 = Agriculture
                                            person)                                            7 = Searched newspaper adverts                    business or agriculture                                                   6 = Income receipient
                                                                                                                                                                                                6 = Any job
                                                                                              8 = Searched employment services                4 = Off season in agriculture                                                   7 = Too young
                                                                                                                                                                                           7 = Other (specify)
                                                                                                      9 = Other (specify)                         5 = Other (specify)                                                       8 = Other (specify)
                                                                                                                                                                                             >> Next person
                                            weeks          weeks            weeks                             >>6
                                              1              2                3                                4                                           5                                        6                                7
     1
     2
     3
     4
     5
     6
     7
     8
     9
    10
    11
    12
    13
    14
    15
    16
    17
    18




TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 4, part d - Time use
Fill in for all household members ages 7 and older
How much time on a typical working day do you spend on any of the following activities for the household?
       Collecting                                            Fetching                                            Shopping or                                            Running
        firewood?                          without             water?                           without            running                           without         errands (other                        without
          1 = yes     while caring                             1 = yes     while caring                            errands?     while caring                        than shopping?    while caring
                                           children                                             children                                             children                                              children
          2 = no      for children                             2 = no      for children                             1 = yes     for children                             1 = yes      for children
                                           present                                              present                                              present                                               present
       (if no, next                                         (if no, next                                            2 = no                                               2 = no
         activity)                                            activity)                                          (if no, next                                         (if no, next
                      hours    minutes   hours    minutes                  hours    minutes   hours    minutes     activity)    hours    minutes   hours    minutes     activity)     hours    minutes   hours    minutes
            1a                1b                 1c             2a                 2b                 2c              3a                3b                 3c             4a                  4b                 4c

   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 4, part d - Time use continued
Fill in for all household members ages 7 and older
How much time on a typical working day do you spend on any of the following activities for the household?
        Caring for clothes:                                          Washing                                           Cleaning and                                          Cooking and
        washing, mending,                            without           dishes/                          without          upkeep of                          without            preparing                          without
       ironing, sewing new      while caring                            pots?      while caring                          dwelling?     while caring                               food?      while caring
                                                     children                                           children                                            children                                              children
               clothes          for children                          1 = yes      for children                           1 = yes      for children                             1 = yes      for children
                                                     present                                            present                                             present                                               present
              1 = yes                                                  2 = no                                              2 = no                                                2 = no
               2 = no                                               (if no, next                                        (if no, next                                          (if no, next
       (if no, next activity)   hours    minutes   hours    minutes   activity)    hours    minutes   hours    minutes    activity)    hours    minutes   hours    minutes      activity)    hours    minutes   hours    minutes
                5a                      5b                 5c            6a                6b                 6c            7a                 7b                 7c              8a                 8b                 8c

   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 4, part d - Time use concluded
Fill in for all household members ages 7 and older
How much time on a typical working day do you spend on any of the following activities for the household?
          Taking                                            Taking care                                            Caring for                                            Reading
          care of                                             of sick?                                              children –                                         newspapers,
         elderly?                                             1 = yes                                               while not                                           books, or                                                                 In an
         1 = yes                                               2 = no                                               doing any     Helping with        Other activities magazines?                                                                average
                                           without                                               without                                                                                                   without
          2 = no      while caring                          (if no, next   while caring                                other       homework,           (e. g. playing     1=yes      while caring                                               week, how
       (if no, next                        children           activity)                          children            activity?                                            2=no                             children           Sleeping?
                      for children                                         for children                                             teaching,         outside, giving                for children                                               many days
         activity)                         present                                               present              1=yes                                                                                present
                                                                                                                                  reading, etc.           a bath)                                                                                do you
                                                                                                                       2=no
                                                                                                                                                                                                                                                  work?
                                                                                                                   (if no, next
                                                                                                                     activity)

                      hours    minutes   hours    minutes                  hours     minutes   hours     minutes                  hours     minutes    hours     minutes             hours     minutes   hours     minutes   hours    minutes     days
           9a                 9b                 9c             10a                10b                 10c             11a                11b                  11c         12a               12b                 12c                 13            14

   1
   2
   3
   4
   5
   6
   7
   8
   9
  10
  11
  12
  13
  14
  15
  16
  17
  18
Section 5, part a - Migration
Complete entire sheet for all household members ages 7 and older
                                                                                                                                     Where was [name] born?
                                                                                                                               In Ghana                           Outside of Ghana     What was     What was
                                                                                                                                                                                       [name's]       [name's]
                                                                                                                                                                                          daily     daily wage
                                              Was [name]                    Does [name]      What was
                                                                                                             1 = Kumasi                                                                wage in       in the job
                   ID of person interviewed




                                              born in this                 intend to stay     the main                                             REGION:
                                                                                                             2 = Sunyani                                                                the job    that [name]
Household Member




                                               village or  How long ago for a year or        reason for                                           2=Western
                                                                                                           3 = Cape Coast                                                                 that        had just
                                                                                                                                                   3=Central
                                                 town?     did [name] last more in this      moving to      4 = Koforidua
                                                                                                                                                 4=Gt. Accra                            [name]         before
                                                           move/return to     village /     this village      5 = Accra
                                                                                                                                                    5=Volta
                                                                                                             6 = Tamale                                                                first had   leaving the
                                                1 = Yes      this place?       town?           / town?                      give name of city      6=Eastern    give name of country
                                                                                                           7 = Bolgatanga                                                                in this      previous
                                               (>> next                                     (see codes                                             7=Ashanti
                                                                                                            8 = Koforidua                                                               village?       place?
                                                person)                       1 = Yes          below)                                           8=Brong Ahafo
                                                                                                               9 = Wa
                                                                               2 = No                                                             9=Northern
                                                2 = No                                                      10 = Sekondi-
                                                                                                               Takordi
                                                                                                                                                10=Upper East                          No job =     No job =
                                                                                                                                                11=Upper West                            99           99
                                                                                                               11 = Ho

                                                            Years       Months                                                                                                          (cedis)      (cedis)
                                                   1                2             3              4               5                 6                  7                  8                9            10
           1
           2
           3
           4
           5
           6
           7
           8
           9
  10
  11
  12
  13
  14
  15
  16
 17
 18
REASONS FOR MOVING: 1 = job transfer; 2 = seeking employment; 3 = own business; 4 = spouse's employment; 5 = accompanying parent; 6 = marriage;
    7 = other family reasons; 8 = political / religious reasons; 9 = education; 10 = war; 11 = fire; 12 = flood/famine/drought; 13 = other (specify)
                                                                                       5 part a _ migration2
Section 5, part a -- Migration continued
Continued from previous sheet
                                                                        When [name] first moved to this village,
                    If anyone (HH member or other village resident)        If [name] worked for a specific person just after   If [name] knew anyone other than a
Household Member




                   other than him/herself helped [name] get his or her       arriving in this village, who was this person?       household member who was an
                      first job in this village, who was this person?                                                           important reason for moving here,
                                                                          List HH ID or name and village ID; or code NV               who was this person?
                   List HH ID or name and village ID; or code NV if         if this person does not appear on the village
                    this person does not appear on the village roster                           roster                          Code NV if this person does not
                                                                                                                                   appear on village roster
                                                     village                                                village                                       village
                               name                            HH ID                   name                           HH ID           name
                                                       ID                                                     ID                                            ID
                                           11                                                     12                                           13
           1
           2
           3
           4
           5
           6
           7
           8
           9
  10
  11
  12
  13
  14
  15
  16
  17
  18



                                                                                               Page 54
Section 5, part b - Migration History
Fill in a page for each HH member who answers '1' to the following question.
0. Has [name] ever lived away from this town for a year or more?
   1 = Yes (>> 1)         2 = No (>> next person)                             ______________
Member ID _____________________              ID of person answering ___________________
                                                                                                                              Migration Number
                                                                                                            To current
                                                                                                                           second most   third most   fourth most   fifth most
                                                                                                             residence
                                                                                                                              recent       recent        recent       recent
                                                                                                           (most recent)
                    1 = Kumasi; 2 = Sunyani; 3 = Cape Coast; 4 = Koforidua; 5 = Accra; 6 = Tamale; 7
                    = Bolgatanga; 8 = Koforidua; 9 = Wa; 10 = Sekondi-Takordi; 11 = Ho
  What is the
  name of the       name of city in Ghana
1
  […]               2=Western; 3=Central; 4=Gt. Accra; 5=Volta; 6=Eastern; 7=Ashanti; 8=Brong
  destination?      Ahafo; 9=Northern; 10=Upper East; 11=Upper West

                name of country
2 How old were you when you moved to destination?
  Why did you move (most important reason)?
   1 = job transfer; 2 = seeking employment; 3 = own business; 4 = spouse's employment; 5 =
3 accompanying parent; 6 = marriage; 7 = other family reasons; 8 = political / religious reasons; 9 =
  education; 10 = war; 11 = fire; 12 = flood/famine/drought; 13 = inability to access land; 14 = loss of
  land; 15 = other (specify)
     Whom did you know at destination? (1=parents, 2=children, 3=spouse/fiance, 4=Other
4
     relative, 5=acquaintance) -- for multiple entries, enter with commas
5 Did you ever work for wages at DESTINATION? (1=yes; 2=no, if no >> 12)
     How did you find a job at DESTINATION? (1=own search before moving, 2=arranged by family,
6 3=arranged by friends, 4=own search after moving)

  During the time between arriving at DESTINATION and finding a job, what was your main
7 means of support? (1=own savings, 2=family at DESTINATION, 3=family at PREVIOUS
  PLACE, 4=friends, 5=menial work/begging, 6=no means of support)
8 How long after coming to DESTINATION did you find a job for wages? (months)
9 Did you work for a family member at DESTINATION? (1=yes; 2=no)
10 What type of industry was your first job in DESTINATION? (see industry codes)

11 What were the main duties of your first job in DESTINATION? (see ISCO codes)
     Were you working for a wage just before you left PREVIOUS PLACE?
12
     (1=yes; 2=no, if no >> next migration)
     What type of industry was the job in PREVIOUS PLACE just before you moved?
13
     (see industry codes)
     What were the main duties of the job in PREVIOUS PLACE just before you moved? (see
14
     ISCO codes)
Section 6 -- INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS
Part a: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
                     Name                                                                               In what At what age Highest Age at first       Highest level       To what         Ethnic group




                                              Sex (1 = Male; 2 = Female)
                                                                                  Relationship:
                                                                                                                                                                                               codes
                                                                             1 = parent of HH head     year was did [name]     level of   marriage      of education     ethnic group
                                                                            2 = parent of HH head's              stop living education                                                       1=Asante
                                                                                                        [name]                                         completed of     does [name's]      2=Akwapim
 Relative number




                                                                                      spouse
                                                                             3 = sibling of HH head
                                                                                                         born? with his / her completed (if never or   current / most   current / most        3=Fanti
                                                                                                                   parents?
                                                                            4 = sibling of HH head's                                       not yet     recent spouse    recent spouse          4=Ga
                                                                                      spouse                                     (see     married                          belong?          5=Dangme
                                                                                                                (code 888 if                                                                 6=Krobo
                                                                           5 = child of HH head with                            codes    code 888       (see codes
                                                                                 current spouse
                                                                                                                 still living                                                                 7=Ewe
                                                                                                                with parents)   below)    and then        below)         (see codes)          8=Guan
                                                                           6 = child of HH head with
                                                                                 another person                                            >> 10)                                            9=Nzema
                                                                                                                                                                                            10=Hausa
                       1                           2                                  3                   4           5           6           7              8                9            11=Dagomba
                                                                                                                                                                                          12=Mamprusi
R1                                                                                                                                                                                          13=Gonja
                                                                                                                                                                                         14=Grussi/ Frafra
R2
                                                                                                                                                                                            15=Dagati
R3                                                                                                                                                                                          16=Kusasi
                                                                                                                                                                                           17=Kassena-
R4                                                                                                                                                                                           Nankani
R5                                                                                                                                                                                         18=Kankoma
                                                                                                                                                                                           19=Nanumba
R6                                                                                                                                                                                          20=Builsa
                                                                                                                                                                                             21=Other
R7                                                                                                                                                                                           (specify)
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Codes for col. 6 and 8: 1=None; 2=Primary; 3=Middle/JSS; 4=Voc/Comm; 5='O' level; 6=SSS; 7='A' level; 8=Training college; 9=Tech/prof; 10=Tertiary; 11=Koranic; 12=Don't know
Section 6 – INFO ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 2)
Part 1: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
                                        Has [name] ever held a political      Is   Year of Number of     Year of last      How many         Current Total landholding of Does [name] Do you
                                                     office?               [name]   death      visits       visit          phone calls, number of current household live in your       farm
                                                    0 = None                 still            [name]                    letters, or other   people      Unit codes:        village?  together?
                                           1 = Member of Parliament                                                      contacts (other
                                                                            alive? >> next made to       code 888 if                       living in      1 = acre
                                                                                                                          than visits in
 Relative number




                   Number of live         2 = District Chief Executive             relative    your      [name] has                        [name]'s       2 = pole        1 = Yes;    1 = Yes
                                          3 = Assembly Man/Woman                                                           person) has
                     children                                               1=yes           household       never       [name] made to    household       3 = rope         2 = No     2 = No
                                         4 = Unit Committee Member
                                                                           (>> 15)           last year   visited this    the household                    4 = plot        (if no >>
                                         5 = National Political Office
                                       [Minister, Deputy Minister, etc.]
                                                                            2=no                          household       in the past 12                                      22)      >> 26
                                       6 = Paramount chief (Omanhene)                        (if more                        months?
                                                 7 = Sub-chief                              than zero,
                                              8 = Regent (Odikro)                             >> 17)                                                              unit
                   sons    daughters           9 = Other (specify)                                                                                  amount
                                                                                                                                                                  code
                    10        11                      12                     13       14        15            16             17           18                 19             20          21
R1
R2
R3
R4
R5
R6
R7
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Section 6 – INFO ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 3)
Part 1: NEW -- fill out for all non co-resident siblings, parents and children of the Household Head and spouse
For columns 22-25, either fill out column 22 (if the respondent lives in a city in Ghana listed in column 22) OR columns 23 and 24 (if the respondent
      lives in a city in Ghana not listed in column 22) OR column 25 (if the respondent left Ghana)
                                                                                     What is       FOSTER STATUS FOR CHILDREN UNDER 18
                                Where does [name] live?                                                                                                 Codes for
                                                                                     [name's]         (who are not living with biological parents)      column 21:
                                                                                     primary    With whom does [name]                                   1=Professional
                             In Ghana                        Outside of Ghana
                                                                                   occupation?             live?                        Why did you     / technical
          1 = Kumasi
                                                  REGION:                                       [give relative number if               send [name] to 2=Administra-
                                                                                  (give primary                                                         tive /
 Relative number




          2 = Sunyani
                                                 2=Western                                         one of the relatives      Does         live away?    managerial
        3 = Cape Coast                                                             occupation
                                                  3=Central                                     named in this section or [name]        1 = availability 3=Clerical
         4 = Koforidua                                                                 while
                                                4=Gt. Accra
           5 = Accra                                                                working if             code             attend     of better school 4=Sales
                                                   5=Volta
          6 = Tamale                                          give name of            retired)   777 = another relative    school?     2 = to live in a 5=Service
        7 = Bolgatanga
                          give name of city       6=Eastern
                                                                                                                                                        6=Agric./Ani-
                                                 7=Ashanti        country                         (specify relationship)   1 = Yes family with better
         8 = Koforidua                                                                                                                                  Husb./Forest/
                                               8=Brong Ahafo                       (see codes)      888 = not with a        2 = No economic status Fishing/
            9 = Wa
                                                 9=Northern                                              relative                          3 = other
         10 = Sekondi-                                                                                                                                  Hunting
                                               10=Upper East                                                                                            7=Production
            Takordi
                                              11=Upper West
                                                                                                999 = don't know/can't                     (specify)
            11 = Ho                                                                                        say]                                         &
                                                                                                                                                         related works
                   22           23                 24               25               26                  27                 28              29          8=Workers
R1                                                                                                                                                      NEC
R2                                                                                                                                                      9=Homemaker
                                                                                                                                                        10=In school
R3                                                                                                                                                      full time
R4                                                                                                                                                      11 = other
                                                                                                                                                        (specify)
R5                                                                                                                                                      12=Don't know
R6
R7
R8
R9
R10
R11
R12
R13
R14
R15
R16
R17
R18
Section 6 - INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 4)
Part b: Applied to all absent spouses of any household member
                                                                          When At what age did Age of        To what What is the When did What is the      Number       Year of     Ethnic group
                                                                           was          [absent      [absent  ethnic    highest      [absent  profession   of visits   last visit        codes
                                                                                                                                                                                       1=Asante




                                               Present spouse's ID no.
                                                                         [absent spouse's name] spouse] at group        level of spouse] last      of          to
 Absent Spouse Number




                                                                                                                                                                                     2=Akwapim




                                                   from HH roster
                                                                         spouse's stop living with marriage    does   schooling     live with   [absent    [present                     3=Fanti
                                                                          name]        his / her        to   [absent completed      [present   spouse]?    spouse]                       4=Ga
                        Absent spouse's name                              born?        parents?     [present spouse's by [absent    spouse]?  (see codes    in past                   5=Dangme
                                                                                                                                                                                       6=Krobo
                                                                                                    spouse]   name]    spouse's                 below)       year
                                                                                                                                                                                        7=Ewe
                                                                                    (code 888 if             belong?    name]?   (code 888 if                                           8=Guan
                                                                                  still living with                   (see codes they have                  if more                    9=Nzema
                                                                                      parents)                 (see     below)    never lived              than zero                  10=Hausa
                                                                                                              codes)               together)                 >> 12                  11=Dagomba
                                                                                                                                                                                    12=Mamprusi
                                 1                     2                    3           4           5          6         7            8           9           10          11          13=Gonja
S1                                                                                                                                                                                    14=Grussi/
                                                                                                                                                                                         Frafra
S2                                                                                                                                                                                    15=Dagati
                                                                                                                                                                                      16=Kusasi
S3                                                                                                                                                                                   17=Kassena-
                                                                                                                                                                                       Nankani
S4                                                                                                                                                                                  18=Kankoma
S5                                                                                                                                                                                  19=Nanumba
                                                                                                                                                                                      20=Builsa
S6                                                                                                                                                                                     21=Other
                                                                                                                                                                                       (specify)
S7
S8
S9
S10
Codes for column 7: 1=None; 2=Primary; 3=Middle/JSS; 4=Voc/Comm; 5='O' level; 6=SSS; 7='A' level; 8=Training college;
    9=Tech/prof; 10=Tertiary; 11=Koranic; 12=Don't know
Codes for column 9: 1=Professional/technical; 2 = Administrative/managerial; 3 = Clerical; 4 = Sales; 5=Service;
    6=Agric./Ani-Husb./Forest/ Fishing/Hunting; 7=Production & related works; 8=Workers NEC; 9 = Homemaker;
    10=full time student; 11=other (specify) 12=Don't know
Section 6 - INFORMATION ON SIBLINGS, PARENTS, AND OTHER NON-HOUSEHOLD MEMBERS (page 5)
Part b: Applied to all absent spouses of each household members (concluded)
                           How many       Has [absent spouse's name] ever                           Where does [name] live primarily?
                           phone calls,         held political office?
                        letters, or other             0 = None                                    In Ghana                                Outside of Ghana
                        contacts (other      1 = Member of Parliament
 Absent Spouse Number




                                                                                1 = Kumasi
                          than visits in    2 = District Chief Executive                                               REGION:
                                                                                2 = Sunyani
                                                                                                                      2=Western
                           person) has      3 = Assembly Man/Woman            3 = Cape Coast
                                                                                                                       3=Central
                        [absent spouse]    4 = Unit Committee Member           4 = Koforidua
                                                                                                                     4=Gt. Accra
                                                                                 5 = Accra
                             made to        5 = National Political Office                                               5=Volta
                                                                                6 = Tamale
                             [present     [Minister, Deputy Minister, etc.]   7 = Bolgatanga
                                                                                               give name of city       6=Eastern        give name of country
                                                                                                                      7=Ashanti
                         spouse] in the 6 = Paramount chief (Omanhene)         8 = Koforidua
                                                                                                                    8=Brong Ahafo
                              past 12              7 = Sub-chief                  9 = Wa
                                                                                                                      9=Northern
                            months?             8 = Regent (Odikro)           10 = Sekondi-
                                                                                                                    10=Upper East
                                                                                  Takordi
                                                 9 = Other (specify)              11 = Ho
                                                                                                                    11=Upper West

                              12                        13                         14                 15                 16                     17
S1
S2
S3
S4
S5
S6
S7
S8
S9
S10
Section 7 (Agriculture), part a -- update on stocks and last year's spending by animal
Complete entire sheet
                                          Current              In the past twelve months, how much did you spend on . . . for this animal
                                          number                                Veterinary    Enclosure,    Hired labor        Access to     Other
                                          owned         Fodder/feed --           expenses       shelter,      (cedis)            water      expenses
                                                           expenses               (cedis)    restraint and
                 Type                                              Home                         related
                                                    Purchase     produced                      expenses
                                                     (cedis)       (cedis)                      (cedis)
                                            1          2             3              4              5               6              7            8
Draught animal (donkey, horse, bullock)

Cattle

Sheep

Goats

Pigs

Rabbits

Chicken

Fish

Snail

Other
Section 7 (Agriculture), part a -- update and new tools
                                         Does any member                                                                         Did you sell any
                                                                                             Was any […]
                                         of the household                What would be                                          […] in the past 12
                                                                                           rented out in the   What was the                          What was the
                                           own any […]                  the total value of                                          months?
                                                            How many?                      past 12 months?     total value of                        total value of
                                               now?                       […] if it were
                   Tools                                                                                        the rental?                            the sales?
                                                                           sold now?                                                 1 = Yes
                                                                                                1 = Yes
                                              1 = Yes                                                                            2 = No (>> next
                                                                                             2 = No (>>6)
                                           2 = No (>>6)                                                                               item)
                                                             Number          Value                                Value                                 Value
                                                9              10             11                  12               13                  14                15
Tractor
Plough
Trailer/cart
Spraying machine
Other animal drawn equipment
Other tractor drawn equipment
Outboard motor
Canoe
Fishing net
Protective clothing / safety equipment
2 Wheel Tractor
4 Wheel Tractor
Cane crusher
Hoe
Axe
Rake
Shovel
Pick
Sickle/ reaping hook
Harrow
Tiller
Water pump
Irrigation pipe
Cutlass
Other (specify:____________)
Section 7 (agriculture), part b – LAND INFORMATION

Complete entire sheet for any farms owned or used.
                  Size of farm    Is the farm  Does the                               If the farm                          How        What        Was the
                                                           owned by    household      were to be How did you obtain much did proportion            farm
                                                              the    have the right                    the land?
                                                                                       sold now,                        it cost to of crops go   cultivated If you obtained the land from
                                                          household? to sell the                   Bought = 1 (>>12)                    to       during the a specific person, please give
                                                                                      how much                            rent it
          Person interviewed




                                                                     farm or use it               Rented for cash or in             landlord?     past 12
                                                                                        would it                        over the                             his or her name if he or she
                               Farm Number




                                                           Yes, with as collateral                      kind =2                    (see codes)    months?
                                             UNIT OF AREA                             be worth? Sharecropped by          past 12                                 lives in this village
 Holder




                                                           deed = 1 for security?
                                              Acres    1                                             household = 3      months?
                                                             Yes,                                                                                 1=yes
                                              Poles    2    without     Sell = 1                         (>>11)                                   2=no
                                              Ropes    3   deed = 2   Security = 2                Use free of charge = 4
                                                            No = 3      Both = 3                         (>>12)                                            (or write NV if not currently a
                                               Plot    4
                                                            (>> 9)    No right = 4                Distributed by village                                       resident of this village)
                                                                         (>> 9)                       or family = 5
                                              No. of   unit                              value           (>>12)            (cedis)                                 name                  ID
                                              units    code                             (cedis)
  1      3   2                 6            7   4        5              9              10  8                                           11           12                    13
         1
         2
         3
         4
         5
         6
         7
         8
         9
        10
        11
        12
        13
        14
        15
        16
        17
        18
PROPORTION CODES: 1 = 2/3 (67%); 2 = 1/2 (50%); 3 = 1/3 (33%); 4 = 1/4 (25%); 5 = 1/5 (20%)
                                                                                           7 part b _ land info 2

Section 7, part b – Land Information, continued
Answer about all plots of land currently owned or used.
       Year      Year        Year                  Soil                How long Is the land If so, what                                                                                                         Is this farm    How      How      Does this   If yes, did you or
                                                                                                           If pond or well,                                                   If pump,
      when       when        when Is this land Depth                     does it   watered   method?                                                                                                              bigger or many of many of land have         someone else do
       land       last        last  more or less 1 = Up                 take for    from a   (primary                                                                                                               smaller     the     these       clear        something to
    began to fallow         fallow wet than the to 1 foot              this land    source   method if                                                                                                             than the measured    farms    boundaries       create these




                                                                                                             Month filled (see code)




                                                                                                                                                                                       Hours/day in operation
                                                                                                                                                              Days/year in operation
                                                                                                                                       Month Dry (see code)
        be      period      period other lands 2 = 1 to Soil Soil Type to drain other than more than                                                                                                             measured      farms   would fit      ?        boundaries? (e.
 Farm number




     farmed      began       ended    in your     3 feet Colour          after a rainwater?     one)                                                                                                                 farm?   would fit into the    1= yes       g. plant trees,
                                                                 (see
      (enter (enter 888 (enter 000 community       3=     (see
                                                                codes    heavy               1=pump                                                                                                              1 = bigger in this measured       2 = no      make a fence)?
     888 for for "don't        if         ?       more codes below)    rainfall?    1=Yes     2=weir                                                                                                            2 = smaller farm?       farm?                       1 = yes
                know") currently 1 = more
      "don't                                     than 3 below)                                3=well                                                                                                               (>> 31)                                    2 = no, naturally
                           fallowed   2 = less
     know)                                         feet                 (hours)     2=No,   4=borewell                                                                                                           3 = about    (>>32)                             occuring (for
                          or 888 for 3 = about
                             "don't                                               (if no >>                                                                                                                       the same                                    instance, a river)
                                     the same                                         29)
                            know")
               15   16     17        18         19      20       21        22         23           24        25                        26                     27                       28                           29         30        31          32              33
   1
   2
   3
   4
   5
   6
   7
   8
   9
10
11
12
13
14
15
16
17
18
Soil colour codes (column 6): Red =1; Black = 2; Grey = 3; Yellow = 4; Brown = 5; White = 6
Soil characteristic codes (column 7): Sand =1; Loam = 2; Light Clay = 3; Heavy Clay = 4; Gravely = 5; Mixed = 6
Code for columns 12 and 13: 1=January; 2=February; 3=March; 4=April; 5=May; 6=June; 7=July; 8=August; 9=Sept.; 10=Oct.; 11=Nov.; 12=December




                                                                                                 Page 64
Section 7, part b – Land Information, continued
Answer about all plots of land currently owned or used.
     What      From whom did you        Did this person occupy a special       Was this    Is this   If acquired from a specific person give      What was the          What was the     How many Could you If yes, how              If no, why
    year did obtain the land when        political or traditional position?    person a   person                 name of person               payment when you        formality of the days after     leave the   long do you     would you lose
      you you began to own or use                    0 = None                  resident currently a                                          first began to own or     contract at that   reaching   land empty     think you         the land?
    begin to             it?                1 = Member of Parliament            of your resident of (or write NV if not currently a resident      use the land?             time?        agreement for a period could leave        1 = lose title
                                                                                                                                              1 = bought (cash, in       1 = formal         about     of several the land alone     2 = the land
    own or        1 = family head          2 = District Chief Executive        village at   your                 of your village)
                                                                                                                                                 kind, or both)       written contract owning or       months        without      would be given
 Farm Number




    use this         2 = chief             3 = Assembly Man/Woman             that time? village?                                               2 = used free of       2 = registered     using the    without      losing it?      to someone
     land? 3 = government (>> 41) 4 = Unit Committee Member                     1 = Yes   1 = Yes                                                    charge                 tenant      land did you    being      (answer in            else
              4 = other male relative     5 = National Political Office         2 = No    2 = No                                               3 = sharecropping      3 = oral contract begin to use   worried years, or code      3 = someone
             5 = other female relative [Minister, Deputy Minister, etc.]                                                                        4 = renting/leasing       4 = other       the land? about losing     888 for      else might start
                  6 = nonrelative       6 = Paramount chief (Omanhene)                                                                          5 = other (specify)       (specify)                       it?     indefinitely)        using it
                    7 = no one                     7 = Sub-chief                                                                                                                                       1 = yes                        4 = other
                8 = other (specify)             8 = Regent (Odikro)                                                                                                                                  2 = no (>>      (>>47)           (specify)
                                                 9 = Other (specify)                                                                                                                                     46)
                                                                                                                 name                  ID

               34        35                             36                       37          38                   39                   40               41                  42             43            44            45               46
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 7, part b – Land information (continued)
Answer about all plots of land currently owned (questions 47 through 53) or used (questions 54 through 58).
    Continue to use the same farm numbers from the previous pages.
                       for land currently owned (see question 6 of this section)                              For land not currently owned (Q6 in land ID section)
     How much, What is the [if money If so,            [if land Have you If yes, what was the         Contract type Nature of      Duration of        Is your   For how long
     if any, cash total value of paid for     how      was not ever had          type of dispute?     when the land the contract contract at first: current    have you been
     did you pay      in kind     land], did many? originally a dispute 1 = boundaries of land was first used when the               No fixed        landlord renting from the
                                 you buy the                                  2 = multiple claims to   rented = 1     land was     duration = 1         the   current landlord?
      in total for contribution                      owned], in with
 Farm number




                                   land on                                             land          sharecropped = first used     Seasonal = 2      original
       the land    you gave for                       what year anyone
                                    install-                                  3 = breach of contract        2        1 = written    Yearly = 3      landlord?
       when you      the land       ments?
                                                       did you over this         by former owner     no payment = 3 2 = oral Multiple year = 1 = yes
       began to     when you       1 = Yes             begin to     land?     4 = breach of contract mortgaged = 4 3 = other             4            (>> 59)
        own it?      began to       2 = No             own the     1=yes             by buyer        other (specify) (specify) Other (specify) 2 = no
                      own it?                           land?       2=no        5 = other (specify)        =5                          =5
        (cedis)       (cedis)
                                                                                                                                                               Years    Months

               47        48            49        50         51          52               53                  54            55            56            57              58
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 7, part b – Land information (continued)
Answer about all plots of land currently used but not owned. Continue to use the same farm numbers from the previous pages (some lines may be blank).
                                            For land not currently owned (from Q6) of land ID -- CONT. FROM PREVIOUS PAGE
       Is the     If this person is a resident of your                  Payment for land             Does the From whom did the landlord   How did the     Do you engage
      current         village, give his or her name                                                  landlord obtain the land (owned)? landlord obtain the     in other
    landlord a                                                                              Other                                                              business
                                                                    Sharecrop                        own the           1 = chief            land? (not
                                                                                        arrangements
    resident of                                                                                                    2 = family head            owned)        transactions
                   (or write NV for not currently a                                                    land?
        your                                                                                                                              1 = rent from        with the
                         resident of this village)                                                                 3 = government
                                                                                        How much 1 = Yes
 Farm Number




      village?                                                                                                                                                landlord?
                                                                                                               4 = other male relative        another
      1 = Yes                                                What is the      What      do you pay 2 = No                                                    (e. g. other
                                                           value of inputs percent (if                        5 = other female relative     household
    2 = No (if                                                                         in cash or in (>> 66)                                                agricultural,
    no >> 61)                                                provided by     any) of                             5 = another landlord    2 = allocated by household
                                                                                        kind to use
                                                            the landlord?   output is                             6 = another person       family head       enterprise)
                                                             (zero value given to the this land?                    77 = unknown         3 = allocated by      1 = Yes
                                                              possible)    landlord? (zero value                 88 = other (specify)      village head         2 = No
                                                                                         possible)
                                                                                                                        >> 67                4 = other
                                                                                                                                             (specify)
                           Name                    ID           cedis         (%)           cedis
               59                  60                          61           62            63          64                 65                     66              67
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 7, part b – Land information (continued)
Answer about all plots of land currently used but not owned. Continue to use the same farm numbers from the previous pages (some lines may be blank).
                                         For land not currently owned (from Q6) of land ID -- CONT. FROM PREVIOUS PAGE
    Type of current Duration of current     Do you have       Can you rent the   Have you           If so, was this      Have you and anyone    If so, was this
        contract           contract       complete control       land out?        and the      disagreement related to other than the landlord   disagreement
      1 = written                         over the farming         1 = yes     landlord ever               ...          ever had a disagreement    related to
        2 = oral
 Farm Number




                    No fixed duration = decisions you        2 = yes, but must     had a      1 = breach of contract by      over this land?           ...
        contract
                              1            make regarding be approved by disagreement                  landlord?                 1=Yes          1 = boundaries
       3 = other
       (specify)
                        Seasonal = 2          this land?          landlord       over this     2=breach of contract by           2=No            2 = multiple
                         Yearly = 3             1=yes;             3 = no          land?                 tenant                                      claims
                     Multiple year = 4     2=no, landlord                         1=Yes       3 = management of land?                               3 = other
                    Other (specify) = 5     must approve                           2=No          4 = other (specify)?                              (specify)?


               68           69                  70                71               72                  73                       74                    75
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 7, part b – Land information -- LAND IMPROVEMENTS
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
In the past three years, have you made any land-related investment (e.g., bunding, leveling the terrain, fencing) on land you currently own or use? (Yes=1; No=2) _________
                             Irrigation related investments                      Soil and water conservation improvements
                              If yes, list up      What was the total                      If yes, list up What was the total
                    Any        to two most cash/days spending on all                        to two most cash/days spending on Number
                                important       the related investments/     Any soil and    important         all the related
                 irrigation                                                                                                       of trees
 Farm Number




                                   such        improvements during the          water           such       improvements during planted
                   related
                                                                             conservation investments
                investment investments                last 3 years?                                           the last 3 years?    in last
                                (See code                                   improvements (see code
                   made?                                                                                                            three
                                  below)                                      made? [1 =       below)
               [1 = Yes; 2 =                        Cash          Family                                      Cash        Family    years
                                                                             Yes; 2 = No]
                     No]                                           labour                                                  labour
                                 a        b        (cedis)        (hours)                     a        b     (cedis)      (hours)
                    76          77     78           79             80             81         82     83        84           85          86
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12

  =
314
 15
 16
 17
 18
Irrigation codes: Bore well = 1 ; Deepening Well = 2; Dig a pond = 3; Installing dug well = 4; Other (specify) = 5
Soil/water conservation codes: Leveling the terrain = 1; Land leveling/terracing = 2; Bunding for soil and water conservation = 3; Mulching = 4
      ; Fencing = 5; Reclamation = 6; Other (specify) = 7



                                                                                       7 part b _ land improvement                                                            Page 69
Section 7, part b – Land information (concluded) LAND IMPROVEMENTS (concluded)
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
In the past three years, have you made any land-related investment (e.g., bunding, leveling the terrain, fencing) on land you currently own or use? (Yes=1; No=2) _________
                                                                    Permanent and semi-permanent structures                                                                       Other other
                                                        List up to two Have you What was the         What was the total cash/days              If someone other than          improvements made?
                 Are there                                   most        made any nature of the        spending on all the related            your family helped make
                    any                   How much        important improveme improvement? investments/ improvements during                   the improvements, what                 (list)
                permanent                  would the      structures     nts to the                         the last 2 years?                   was the name of the
 Farm Number




               and/or semi- How many        land be       (See code      structures NEED CODES                                                 person who helped the
                permanent    structures      worth          below)      in the past                                                                     most?
                 structures  are there?   without the                   two years?                                                            (enter code from village
               on this land?              structures?                     1 = yes                                                            roster or code NV if not a
               [1 = Yes; 2 =                (cedis)                        2 = no                         Cash (cedis)        Family           member of the village)
                    No]                                                                                                        labour
                                                           a       b                                for labor    other costs (hours)               name            ID
                    87           88           89          90     91        92             93              94             95           96             97             98                99
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12

  =
314
 15
 16
 17
 18
Structure codes: Farm bunding = 1; Animal Shed = 2 ; Fence = 3; Other (specify) = 4
Section 7, part c -- Output details, Season 1                                                                                                                                   Unit codes:
Note that each crop planted on a particular farm should have its own line                                                                                                       American tin = 02
                                                                                                                                                                                Balls = 27
                                                       transportation to selling location
                                                                                                                                            After being                         Bar = 28
                                                                                                              While in                                                          Barrel = 03
                                                               how far did                                                                 harvested but
                                                                                                              the field, If yes,
                                                              you transport did you                                               What before being                   What      Basket = 04
                                                                            transport                          was any    what                                                  Beer bottle = 05
                             quantity               Second- the crops to                              Total                      was the      sold or                was the
                                                                                          total
  Farm number




                                                                                                                of the   percent                                                Bowl = 06
                crop code




                                           primary    ary      the primary     other                revenue                        crop    consumed at                 crop
                            harvested                                                  transpor-              crop lost of the                                                  Box = 07
                                            outlet outlet (if location?      crops at tation costs from this                     lost to? home, was any              lost to?   Bucket = 29
                                                                                                             to rotting/ crop
                                          see codes any), see (enter 000 if the same                  crop                         (see     of the crop                (see     Bunch = 08
                                                                                                                pests,   planted
                                            below    codes crops picked       time?                  (cedis)                      codes lost to rotting,              codes     Bundle = 09
                                                                                                                etc.?      was
                                                     below up by buyer) (if so, list                                             below) pests, ec.?                  below)     Crate = 30
                                                                                                               1=Yes      lost?
                                   unit                                                                                                       1 = yes                           Dozen = 31
                                                                              codes)                            2=No
                            Amt.                                  (km.)                  (cedis)                                              2 = no                            Fanta /
                                   code                                                                                                                                           coke bottle = 10
                  1          2      3         4         5            6              7        8            9           10         11        12            13            14       Fingers = 11
                                                                                                                                                                                Fruits = 12
                                                                                                                                                                                Gallon = 14
                                                                                                                                                                                Kilogram = 14
                                                                                                                                                                                Litre = 15
                                                                                                                                                                                Loaf = 32
                                                                                                                                                                                Log = 16
                                                                                                                                                                                Margarine tin = 17
                                                                                                                                                                                Maxi bag = 18
                                                                                                                                                                                Mini bag = 19
                                                                                                                                                                                Nut = 20
                                                                                                                                                                                Pair = 33
                                                                                                                                                                                Pieces = 34
                                                                                                                                                                                Pots = 35
                                                                                                                                                                                Pounds = 21
                                                                                                                                                                                Set = 36
                                                                                                                                                                                Sheet = 22
                                                                                                                                                                                Singles = 37
                                                                                                                                                                                Stick = 23
                                                                                                                                                                                Tonne = 24
                                                                                                                                                                                Tree = 25
                                                                                                                                                                                Tubers = 26
                                                                                                                                                                                Yards/metres = 38
                                                                                                                                                                                Other (specify) = 99


OUTLET CODES: 1 = pre-harvest contractor; 2 = farm gate buyer; 3 = market trader; 4 = consumer; 5 = state trading org.; 6 = coop; 7 = exporter; 8= other (specify)
CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease;
     77=other known (specify); 88 = unknown
Section 7, part c -- Output details, Season 2 (if applicable)                                                                                                              Unit codes:
Note that each crop planted on a particular farm should have its own line                                                                                                  American tin = 02
                                                      transportation to selling location                                                                                   Balls = 27
                                                                                                                                                    After being            Bar = 28
                                                                                                            While in
                                                               how far did                                                                         harvested but           Barrel = 03
                                                              you transport  did you Non-labor              the field, If yes,
                                                                                                                                What               before being What Basket = 04
                                                                                         trans-              was any    what
                             quantity               Second- the crops to transport                  Total                      was the                sold or      was the Beer bottle = 05
                                                                                       poration
  Farm number




                                                                                                              of the   percent
                crop code




                                           primary    ary      the primary     other              revenue                        crop              consumed at crop Bowl = 06
                            harvested                                                    costs              crop lost of the                                               Box = 07
                                            outlet outlet (if location?      crops at            from this                     lost to?           home, was any lost to?
                                                                                        (labor             to rotting/ crop                                                Bucket = 29
                                          see codes any), see (enter 000 if the same                crop                         (see               of the crop     (see
                                                                                      discussed               pests,   planted                                             Bunch = 08
                                            below    codes crops picked       time?                (cedis)                      codes             lost to rotting, codes Bundle = 09
                                                                                      in part d)              etc.?      was
                                                     below up by buyer) (if so, list                                           below)               pests, ec.? below) Crate = 30
                                                                                                             1=Yes      lost?
                                   unit                                                                                                               1 = yes              Dozen = 31
                                                                              codes)                          2=No
                            Amt.                                  (km.)                 (cedis)                                                       2 = no               Fanta /
                                   code                                                                                                                                      coke bottle = 10
                  1          2      3         4        5            6              7         8            9           10         11        12            13          14    Fingers = 11
                                                                                                                                                                           Fruits = 12
                                                                                                                                                                           Gallon = 14
                                                                                                                                                                           Kilogram = 14
                                                                                                                                                                           Litre = 15
                                                                                                                                                                           Loaf = 32
                                                                                                                                                                           Log = 16
                                                                                                                                                                           Margarine tin = 17
                                                                                                                                                                           Maxi bag = 18
                                                                                                                                                                           Mini bag = 19
                                                                                                                                                                           Nut = 20
                                                                                                                                                                           Pair = 33
                                                                                                                                                                           Pieces = 34
                                                                                                                                                                           Pots = 35
                                                                                                                                                                           Pounds = 21
                                                                                                                                                                           Set = 36
                                                                                                                                                                           Sheet = 22
                                                                                                                                                                           Singles = 37
                                                                                                                                                                           Stick = 23
                                                                                                                                                                           Tonne = 24
                                                                                                                                                                           Tree = 25
                                                                                                                                                                           Tubers = 26
                                                                                                                                                                           Yards/metres = 38
                                                                                                                                                                           Other (specify) = 99


OUTLET CODES: 1 = pre-harvest contractor; 2 = farm gate buyer; 3 = market trader; 4 = consumer; 5 = state trading org.; 6 = coop; 7 = exporter; 8= other (specify)
CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease;
     77=other known (specify); 88 = unknown
Section 7, part c -- Agricultural Seasonality and Other Income
Indicate with a '1' the months in which harvest, sales and purchases mainly take place:
                                      Harvest                          Sales                      Consumption                              Stocks                      Unit Code:
              Was this                                                                                                                                                 00 = None
            crop grown                                                                                                                                                 01 = All
             during the                                                                  In which months was this crop                         What was the quantity   02 = American tin
              past 12      In which months was this crop In which month(s) was this crop                               What is the quantity in                         03 = Barrel
                                                                                             mainly bought for home                              in store 12 months
              months?            mainly harvested?                  mainly sold?                                           store now?                                  04 = Basket
   Crop                                                                                          consumption?                                            ago?
              1 = Yes                                                                                                                                                  05 = Beer bottle
               2 = No                                                                                                                                                  06 = Bowl
                (>>4)                                                                                                                                                  07 = Box
                          J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D No. of Units Unit Code No. of Units Unit Code                        08 = Bunch
                  1                      2                               3                             4                         5                         6           09 = Bundle
Maize                                                                                                                                                                  10 = Fanta bottle
Rice                                                                                                                                                                   11 = Fingers
Cassava                                                                                                                                                                12 = Fruit
Yam                                                                                                                                                                    13 = Gallon
Plantain                                                                                                                                                               14 = Kilogram
Sorghum                                                                                                                                                                15 = Litre
                                                                                                                                                                       16 = Log
Millet
                                                                                                                                                                       17 = Margarine Tin
Cocoyam
                                                                                                                                                                       18 = Maxi bag
                                                                                                                                                                       19 = Mini bag
Now I would like to ask you about other household sales of produce during the past 12 months. How much were your sales of / from […]?                                  20 = Nut
 Hunting                Fruit, Berries,   Milk from       Other dairy                                     Snail / crab                                                 21 = Pounds
             Honey?                                                         Eggs?        Mushroom?                                                                     22 = Sheet
 (game)?                     etc?          cows?          products?                                       collection?
                                                                                                                                                                       23 = Stick
  Value       Value         Value           Value           Value           Value           Value            Value                                                     24 = Tonne
    7           8             9              10              11              12              13               14                                                       25 = Tree
                                                                                                                                                                       26 = Tubers
Section 7, part c -- Agricultural Processing
I would now like to ask about processing of crops and smoking of fish/meat. This means any crops/fish processed by the household, whether grown or caught by your household or
anyone else.
                                                                     What were
                                                                     your labour
                               How                                                Where did the
             What type of                                           costs both in
 Person responsible

                      Person Interviewed




                               many     Did you                                   raw materials
           food processing                                           cash and in
                             months in make any                       kind in the
                                                                                   mainly come
          or transformation                        What quantity                                    What other      Did you sell any
                             the past […] in the                                       from?                                                           What was     For how much
          have you carried                        did you process        last 2                     cost did you    […] in the last 2 What quantity
                                12      last two                                                                                                      the value of  could you sell
          out in the past 12                        in the last 2      weeks?                     incur in the last     weeks?         did you sell?
                              months weeks?                                          1 = Own                                                           the sale?      one unit?
               months?                                weeks?                                         2 weeks?
                              did you                                                 produce
                                                                     Be sure to                                         1 = Yes
                              do this   1 = Yes                                   2 = Purchased                                                      (>> next line)
          see codes below                                               include                                      2 = No (>>13)
                             activity? 2 = No                       respondent
                                                                                      3 = Gift
                                         (>>10)                                      4 = Other
                                                                    time (labour
                                                                                     (specify)
                                                   No. of    Unit        cost)                                                        No. of    Unit                Unit
 ID ID      Item     Code     Months                                     Value                         Value                                                                 Value
                                                   Units     Code                                                                     Units     Code                Code
  1    2           3             4          5             6                 7             8               9                10                11            12             13




Codes for Processed / Transformed Goods:                                                 Unit Code:
01 = Cassava flour 02 = Cooking oils 03 = Flour from other grains                        01 = All 02 = American tin 03 = Barrel 04 = Basket 05 = Beer bottle 06 = Bowl
04 = Gari 05 = Groundnut paste    06 = Home-brewed drink                                 07 = Box 08 = Bunch 09 = Bundle 10 = Fanta bottle 11 = Fingers 12 = Fruit
07 = Husked / Polished rice 08 = Maize flour 09 = Processed fish 10 = Processed meat     13 = Gallon 14 = Kilogram 15 = Litre 16 = Log 17 = Margarine Tin 18 = Maxi bag
11 = Sheabutter 12 = Cassava dough 13 = Corn dough      16 = Other (specify)             19 = Mini bag 20 = Nut 21 = Pounds 22 = Sheet 23 = Stick 24 = Tonne 25 = Tree
                                                                                         26 = Tubers
Section 7, part c – Output – Crop Stores                                                                                                                                            Unit codes:
0. Does your household typically keep any dried/preserved crops?_________ (1 = Yes; 2 = No, if no >> next page)                                                                     American tin = 02
                                                                                                                                                                                    Balls = 27
                                                                             Where is the stock                                                                                     Bar = 28
                                                                                    stored?                                                    During the                           Barrel = 03
                                How much [ ]                                                                                                 previous year,                   What Basket = 04
              How much [ ]                                                    1 = underground      Is the stock
                               was left prior to the                                                                                           was any of                     was Beer bottle = 05
                is stored                             How much [ ]          2 = above ground, in treated with
                                  most recent
                                                                                  household                                                    the stored                      the Bowl = 06
               currently?                            was stored after the                               any                                                      If so,
                                    harvest?                                                                                                  crop lost to                   source Box = 07
 Crop code




                                                        most recent         3 = in special storage chemicals?                                                how much?              Bucket = 29
                                                                                                                  If so, what chemical(s)?      rotting,                     of the
                                                                                                                                                                                    Bunch = 08
             (zero response                               harvest?           facility (specific to
                                (zero response                                                                                                  insects,                      loss Bundle = 09
                possible)                                                         household)         1 = Yes
                                    possible)                                                                                                rodents, etc.?                   (see Crate = 30
                                                                               4 = in the bush        2 = No
                                                                                                                                                1 = Yes                      codes Dozen = 31
                                                                             5 = in a community       (>> 7)
                                                                                                                                                 2 = No                      below) Fanta /
                                                                               storage facility                                              (>>next crop)                            coke bottle = 10
                        Unit                   Unit                  Unit                                                                                               Unit
                                                                             6 = other (specify)                                                                                    Fingers = 11
             Quantity   Code    Quantity       Code   Quantity       Code                                                                                   Quantity Code           Fruits = 12
                    1                      2                     3                    4                 5                    6                      7          8         9     10 Gallon = 14
                                                                                                                                                                                    Kilogram = 14
                                                                                                                                                                                    Litre = 15
                                                                                                                                                                                    Loaf = 32
                                                                                                                                                                                    Log = 16
                                                                                                                                                                                    Margarine
                                                                                                                                                                                      tin = 17
                                                                                                                                                                                    Maxi bag = 18
                                                                                                                                                                                    Mini bag = 19
                                                                                                                                                                                    Nut = 20
                                                                                                                                                                                    Pair = 33
                                                                                                                                                                                    Pieces = 34
                                                                                                                                                                                    Pots = 35
                                                                                                                                                                                    Pounds = 21
                                                                                                                                                                                    Set = 36
                                                                                                                                                                                    Sheet = 22
                                                                                                                                                                                    Singles = 37
                                                                                                                                                                                    Stick = 23
                                                                                                                                                                                    Tonne = 24
                                                                                                                                                                                    Tree = 25
                                                                                                                                                                                    Tubers = 26
                                                                                                                                                                                    Yards/metres = 38




CROP LOSS CODES: 1=insect; 2=birds; 3=deer; 4=monkeys; 5=grasscutter/rat/other rodent; 6=mold/other plant disease; 77=other known (specify); 88 = unknown
Section 7, part d -- Input details -- chemical inputs for previous harvest (fertilizer, weedicide, pesticide, etc.)
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.
                                     Chemical 1                                                             Chemical 2                                      Unit codes:
                                                                                                                                                            American tin = 02
                                                                                                                                                            Balls = 27
                                              amount used                                                             amount used                           Bar = 28
                                                                    To which                                                                 To which       Barrel = 03
Farm Number




               type of                                              crops was     type of                                                    crops was      Basket = 04
                                                                                                                                                            Beer bottle = 05
              chemical    name of                                      this      chemical        name of                                        this        Bowl = 06
              (see code   chemical                                  chemical (see code           chemical                                    chemical       Box = 07
               below)                  number       unit     value applied (list below)                        number         unit    value applied (list   Bucket = 29
                                       of units     code    (cedis)                                            of units       code   (cedis)                Bunch = 08
                                                                       all)                                                                     all)        Bundle = 09
                                                                                                                                                            Crate = 30
                                                                                                                                                            Dozen = 31
                 1a          1b                1c             1d        1e         2a               2b                   2c            2d         2e        Fanta /
                                                                                                                                                              coke bottle = 10
 1                                                                                                                                                          Fingers = 11
                                                                                                                                                            Fruits = 12
 2                                                                                                                                                          Gallon = 14
                                                                                                                                                            Kilogram = 14
 3                                                                                                                                                          Litre = 15
                                                                                                                                                            Loaf = 32
 4                                                                                                                                                          Log = 16
                                                                                                                                                            Margarine tin = 17
 5                                                                                                                                                          Maxi bag = 18
                                                                                                                                                            Mini bag = 19
 6                                                                                                                                                          Nut = 20
                                                                                                                                                            Pair = 33
 7                                                                                                                                                          Pieces = 34
                                                                                                                                                            Pots = 35
 8                                                                                                                                                          Pounds = 21
                                                                                                                                                            Set = 36
 9                                                                                                                                                          Sheet = 22
                                                                                                                                                            Singles = 37
10                                                                                                                                                          Stick = 23
                                                                                                                                                            Tonne = 24
11                                                                                                                                                          Tree = 25
                                                                                                                                                            Tubers = 26
12                                                                                                                                                          Yards/metres = 38
13                                                                                                                                                          Other (specify) = 99

14
15
16
17
18
TYPE CODES: 1 = Fertilizer (organic); 2= Fertilizer (inorganic) 3 = Herbicide; 4 = Insecticide; 5 = Fungicide; 6 = Other chemical input (specify purpose)
Section 7, part d-- Input details -- seeds used for previous harvest
Answer about all plots of land currently owned or used. Use the same farm numbers as the previous pages.

                                       Seed 1                                                   Seed 2                                                   Seed 3                                                   Seed 4

                                      How was the seed                                         How was the seed                                         How was the seed                                         How was the seed
                                         obatined?                                                obatined?                                                obatined?                                                obatined?
Farm Number

              crop code




                                                                       crop code




                                                                                                                                crop code




                                                                                                                                                                                         crop code
                                      1 = seed from own     spending                           1 = seed from own     spending                           1 = seed from own     spending                           1 = seed from own     spending
                           name of                                                  name of                                                  name of                                                  name of
                                            harvest          on seed                                 harvest          on seed                                 harvest          on seed                                 harvest          on seed
                          seed used                                                seed used                                                seed used                                                seed used
                                        2 = purchased        (cedis)                             2 = purchased        (cedis)                             2 = purchased        (cedis)                             2 = purchased        (cedis)
                                        3 = exchanged                                            3 = exchanged                                            3 = exchanged                                            3 = exchanged
                                            4 = gift                                                 4 = gift                                                 4 = gift                                                 4 = gift
                                      5 = other (specify)                                      5 = other (specify)                                      5 = other (specify)                                      5 = other (specify)
              3a             3b               3c               3d      4a             4b               4c               4d      5a             5b               5c               5d      6a             6b               6c               6d
 1

 2

 3

 4

 5

 6

 7

 8

 9

10

11

12

13

14

15

16

17

18
Section 7, part d – Inputs - Detailed labor (family and hired) use on crop production by plot and season
                Labor use on land preparations (e. g. clearing or weeding before planting),    Labor use on field management (weeding after planting, fertilizer and pesticide
                               seedling/nursery, planting and transplanting                                       applications, irrigation management, etc.)
 Farm number


                Casual Labour (hours)    Permanent Labour (hours)     Family (incl’d exch’ge     Casual Labour (hours)    Permanent Labour (hours)    Family (incl’d exch’ge
                                                                         labor) (hours)                                                                  labor) (hours)
               Male   Female     Child      M        F        C        M        F        C       M         F       C        M        F        C        M        F        C
               (M)      (F)       (C)
               1a1     1a2        1a3      1b1      1b2      1b3      1c1      1c2      1c3      2a1      2a2      2a3     2b1      2b2      2b3      2c1      2c2      2c3
Season 1 (_________________to ___________________)                                             Season 1




Season 2 (___________________to __________________)                                            Season 2
Section 7, part d – Inputs - Detailed labor (family and hired) use on crop production by plot and season
Note that each crop planted on a particular farm should have its own line
                                                    Labor use on harvesting                                                       Post harvest labor use
  Farm number

                Crop code

                            Casual Labour (hours)   Permanent Labour (hours)   Family (incl’d exch’ge    Casual Labour (hours)   Permanent Labour (hours)   Family (incl’d exch’ge
                                                                                   labor) (hours)                                                               labor) (hours)
                            M        F         C       M       F       C        M        F         C     M          F      C       M        F       C        M        F         C
                 3          4a1     4a2       4a3     4b1     4b2     4b3      4c1      4c2       4c3    5a1       5a2    5a3     5b1      5b2     5b3      5c1      5c2       5c3
Season 1                                                                                                Season 1




Season 2                                                                                                Season 2
Section 7, part e – Transactions -- Characteristics of land leased/sharecropped/rented/allocated out
Fill out for all plots of land controlled but leased/sharecropped/rented/allocated out (i. e. farmed by someone not a member of this HH).
Continue to use the same farm numbers from the previous pages (some lines will likely be blank).
                            Nature of the Duration of Contract type at                           If not renting to original tenant,  Relationship
                            contract when contract at           first:                                                                of current
                                                                                                  regarding the previous tenant
                              it was first     first:      rented out = 1 How long has it                                              tenant to
      How long has the                                   sharecropped = 2
                                 rented/     No fixed                       been rented/                                               you (see
       land been rented                                   no payment = 3                         Who
 Farm Number




                                                                           sharecropped/                                       If
       / sharecropped / sharecropped/ duration = 1 mortgaged = 4                             terminated          If                      code)
                             mortgaged/ Seasonal = 2 other (specify) = 5     mortgaged                                    terminated
       mortgaged / lent                                                                            the      terminated
                                lent out    Yearly = 3                       out to the                                     by your
              out?                                                                             contract? by tenant,
                             1 = written     Multiple                     current tenant?                                household,
                                                                                              1 = tenant why? (see
                                2 = oral     year = 4                                                                      why? (see
                                                                                               2 = your        code)
                               3 = other       Other                                                                         code)
                                                                                              household
        years months           (specify)   (specify) = 5                  years months
                 1                     2                  3                   4                      5                   6               7                8                9
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Code for column 7 (TENANT TERMINATED) 1 = Find better land; 2=Better off-farm opportunity; 3=Reduction in labor; 4 = Other reason
Code for column 8 (HOUSEHOLD TERMINATED) 1 = Rent to other tenant; 2 = Fail to pay rent; 3 = Cultivate yourself; 4 = Other reason
Code for column 9: Relative/friend in this village = 1, Relative/friend outside village=2, Landlord within this village = 3, Landlord outside this village = 4, Landless inside
                   this village = 5, Landless outside this village = 6, Other household in this village = 7, other household outside this village=8., government=9.
Section 7, part e – Transactions -- Characteristics of land leased/sharecropped/rented/allocated out (concluded)
Fill out for all plots of land controlled but leased/sharecropped/rented/allocated out (i. e. farmed by someone not a member of this HH). Continue to use the same farm
numbers from the previous pages (some lines will likely be blank).
          Give name of current tenant           What is Do you allow Nature of Duration of contract                Contract type
                                               the main    the tenant to the contract No fixed duration = 1        rented out = 1                    If sharecropped out,
                                                 reason      make all     1 = written       Seasonal = 2         sharecropped = 2      If rented
         code NV if not included in the
                                               why you        farming       2 = oral          Yearly = 3          no payment = 3      out, rental
                   village roster
 Farm Number




                                             decided to decisions about 3 = other        Multiple year = 4        mortgaged = 4        payment      value of percent of
                                                rent out     the land?     (specify)    Other (specify) = 5     other (specify) = 5        you    inputs your output
                                              this land?       1=yes                                                                   received household given to
                 name                 ID          (see     2=no, I must                                                                this year   provided        your
                                                 codes)   approve some                                                                  (cedis)     this year household
                                                         or all decisions                                                                            (cedis)       (%)

                           10                            11                12                 13                     14                           15             16   17   18
   1
   2
   3
   4
   5
   6
   7
   8
   9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Code for column 11: Needed money = 1, plot undesireable = 2, wanted to leave farming = 3, already had enough land = 4, help recipient = 5, other (specify) = 6
Section 7, part e – Transactions -- Characteristics of land sold
NEW -- fill out for all plots of land sold in the past three years
      When        Area      Was the If yes, with whom Were any            If yes, how How long was        How long was Main           Total    For what                                                                                                                                   Amount      Amount       Current
     did you (Acres) transaction was the transaction taxes or                much?       it from the        it from the    reason amount you   purpose                                                                                                                                   paid prior paid during   amount




                                                                                                                                                                                                                     Sold on installments? [Yes = 1,


                                                                                                                                                                                                                                                       If yes, number of installments
                                                                                                                                                                                                                       No = 2, if no >> next sale]
     sell it?             recorded in      recorded?       other fees        (cedis)   beginning of        beginning of      for    received     is the                                                                                                                                      to     the past 12 outstanding?
                            writing?                         such as                    the time that      the time that selling it               land                        Give name of buyer, if he or she is                                                                       the past 12   months       (cedis)




                                                                                                                                                          Who purchased it?
      (year)




                                                                                                                                                          (see code below)
                                        1. village head      registration                you tried to       you tried to (see code   (cedis)   used by                        currently a resident of your village                                                                        months      (cedis)
 Sale number




                            Yes=1        2. family head     fees paid on              start selling the     start selling below)                   the                                                                                                                                    (cedis)
                            No=2        3. administer of      the sale?                  land to the      the land to the                       buyer?                          (or write NV if not currently a
                                           stool lands                                    time you            time you                             (see                              resident of village)
                                           4. registry         Yes=1                       actually           received                          code)
                                       5. other [specify]       No=2                   received the       money for the
                                                                                             title?             land?
                                                                                           (weeks)             (weeks)                                                                  name                ID
               1   2          3                4                 5             6              7                8           9         10          11          12                                13                       14                             15                                  16          17           18
   1

   2

   3

   4

   5

   6

   7

   8

Code for column 7:  9:                                           8 = health,                                                                   Code for column                                       12:
                                                                                                                                                                                   Code for column 11:
1= consumption,                                                  9 = to buy ornaments                                                          11:
                                                                                                                                               8:                                  1=Relative/friends within this village
2 = education ,                                                  10=poor land quality,                                                         1=Using it for farm                 2=Relative/friend outside this village
3 = startup or expand non-farm enterprises                       11=poor accessibility of that subdivision,                                    purposes                            3=Landlord within this village
4 = migration,                                                   12=poor irrigation & drainage facility,                                       2=Using it for                      4=Landlord outside this village
5= house construction / repair,                                  13=litigation                                                                 Non-farm                            5=Other households in this village
6 = marriage,                                                                                                                                  purposes.                           6=Other households outside this village
7 = funeral / religious function / birth,                                                                                                      3=Not using it.                     7=Other (specify)
                                                                                                        7 part e _ transactions _ bough

Section 7, part e – Land transactions -- Characteristics of land purchased
NEW -- fill out for all plots of land purchased in the past three years
              When       Area      Was the    If yes, with   Were any   If yes, how How long was How long was     Total                                                                                                                                        Amount Amount paid      Current




                                                                                                                                                                                        Bought on installments? [Yes = 1,
             did you (Acres) transaction whom was the         taxes or     much?      it from the   it from the amount you                                                                                                                                    paid prior during the   amount




                                                                                                                                                                                                                            If yes, number of installments
                                 recorded in  transaction    other fees    (cedis)  beginning of beginning of      paid




                                                                                                                                                                                           No = 2, if no >> next sale]
             buy it?                                                                                                        From                                                                                                                                  to      past 12   outstanding?
                                                                                                                                    Give name of seller, if he or she is
                                   writing?    recorded?      such as                the time that the time that                                                                                                                                             the past 12  months       (cedis)
              (year)                                                                                                       whom did currently a resident of your village
                                                                            registration         you tried to    you tried to include the    you                                                                                                               months     (cedis)
               Farm number
 Sale number




                                                 Yes=1     1. village head fees paid on          start buying   start buying value of in- purchase                                                                                                             (cedis)
                                                                                                                                                      (or write NV if not currently a
                                                 No=2       2. family head    the sale?        the land to the the land to the   kind     the land?        resident of village)
                                                           3. administer of                        time you       time you     payments
                                                              stool lands      Yes=1            received the started using                See codes
                                                              4. registry       No=2                 title?      the land ?     (cedis)     below
                                                                5. other                            (weeks)        (weeks)
                                                               [specify]                                                                                     name                 ID

                                1        2         3             4               5         6        7               8             9          10                     11                     12                               13                                  14          15           16
   1

   2

   3

   4

   5

   6

   7

   8

                             Code for column 9:10:
                             1=Relative/friends within this village
                             2=Relative/friend outside this village
                             3=Landlord within this village
                             4=Landlord outside this village
                             5=Other households in this village
                             6=Other households outside this village




                                                                                                                        Page 83
Section 8 (Information Seeking)
                                                                                                                                                 What livestock did you
                                                                                                                         What were your crop
                                                                                                                                                   request assistance       What were your     Asked advice
                                                                                                                         concern(s) regarding
                                                                        What type of information                                                   about? (list all that livestock concern(s)     regarding:
                                                                                                                          (list all that apply)
                                                                            was requested?                                                                apply)           regarding (list all
                                                                                                                                                   1 = draught animal         that apply)       1 = activities
                                                                                                                          1 = use of fertilizer
                                                      Did you have to         1 = agriculture                                                   (donkey, horse, bullock)                       for household
                                      Number of                                                 What crops did you           2 = irrigation
                                                           pay?            2 = non-agricultural                                                         2 = cattle          1 = vaccination          only
                                   contacts made in                                              request assistance      3 = new seed varieties
                                                                                production                                                              3 = sheep             2 = disease       2 = activities
       Type of organization           the past 12                                               about? (list all crop     4 = pest infestation
                                                          1 = yes       3 = resource management                                                         4 = goats          3 = feed/nutrition    related to a
                                        months                                                   codes that apply)            5 = weather
                                                          2 = no               4 = business                                                              5 = pigs          4 = insemination business/enterp
                                                                                                                             6 = marketing
                                                                            5 = other (specify)                                                        6 = rabbits        5 = other (specify)         rise
                                                                                                                        7 = blight/crop disease
                                                                                                                                                       7 = chicken                                 3 = both
                                                                                                                          8 = access to credit
                                                                          if answered 2-5, >> 8                                                          8 = fish               >> next            4 = other
                                                                                                                        9 = general information
                                                                                                                                                        9 = snail            organization          (explain)
                                                                                                                          10 = other (specify)
                                                                                                                                                  10 = other (specify)
                                           1                 2                       3                       4                     5                       6                       7                 8
  Government Extension Office

          Input Supplier
  Farmer Based Organization
          (registered)
  Farmer Based Organization
         (unregistered)
 Nonprofit Organization / NGO
 (specify):________________
 Nonprofit Organization / NGO
 (specify):________________
 Nonprofit Organization / NGO
 (specify):________________
 Nonprofit Organization / NGO
 (specify):________________

9.a. Did you receive any home visits from agriculture extension agents in the past year?           Yes                  No
9.b. How many? __________________                   9.c. Were these visits solicited?              Yes                  No

  10 Did you receive an extension service in any of the following media in the past year?
             Service
10.a Gov't                        radio              television      newspaper                     pamplet              other _________________________
10.b NGO                          radio              television      newspaper                     pamplet              other _________________________
10.c Input Supp                   radio              television      newspaper                     pamplet              other _________________________
10.d Other                        radio              television      newspaper                     pamplet              other _________________________

11.a Did you receive agricultural advice from relatives/friends/neighbors in the past year?                             Yes            No
11.b if so, how frequently?                            several times a week or more                about once a week
                                                       about once a month                          occasionally
12.a Did you give agricultural advice to relatives/friends/neighbors in the past year?                                  Yes            No
12.b if so, how frequently?                            several times a week or more                about once a week
                                                       about once a month                          occasionally

13.a Did you receive business/production/management advice from relatives/friends/neighbors in the past year?                               Yes      No
13.b if so, how frequently?                      several times a week or more                     about once a week
                                                 about once a month                               occasionally
14.a Did you give business/production/management advice to relatives/friends/neighbors in the past year?                                    Yes      No
14.b if so, how frequently?                      several times a week or more                     about once a week
                                                 about once a month                               occasionally
Section 9, part a -- Household enterprise update
whole page inputted from responses to GLSS5; fill out all items for new enterprises
                                                                                                                                                                                                                         Does the        What




                                                                      ID of person interviewed
                                                                                                                                                                                                           How
                                                                                                                                                                                                                        income of     percentage
                                                                                                                                                                                                           many
                                                                                                                                                                              How long has this                             the         of the
Enterprise number




                                               Person                                                 What is the principal activity What is the main secondary                                          months
                                                                                                                                                                              enterprise actively                       enterprise    income of
                       Name of               responsible                                                  of this enterprise?        activity of the enterprise?                                        during the
                                                                                                                                                                               been operating?                            belong         this
                      enterprise                                                                                                                                                                         past 12
                                                                                                                                                                                                                        entirely to   enterprise
                                                                                                                                                                                                         months
                                                                                                                                                                                                                           you?       belongs to
                                                                                                                                                                                                          did the
                                                                                                                                                                                                                       1 = yes (>>       you?
                                                                                                                                                                                                        enterprise
                                                                                                                                  ISIC                                ISIC                                                  11)       (see codes
                                            Name             ID                                         Name of activity                  Name of activity                     years          months     operate?
                                                                                                                                  Code                                Code                                                2 = no        below)
                           1                       2                       3                                                  4                            5                              6                  7              8             9

           1

           2
                                                                                                                                                                                                                       Codes for column 13:
                                                                                                                                                                                                                       1 = household savings
                                                                                                                                              During the past 12 months, from where                                    2 = bank
                       Is this enterprise                                                                                                      has this enterprise tried to get credit?   During the                   3 = remittances from
                                             What was the most                                             What is     During the past 12                                                               During the     abroad
                      registered with any                                                                                                                1 = no credit used                 past 12
                                             serious difficulty in    What was                               the         months, has this                                                                 past 12      4 = proceeds from
                     government agency?                                                                                                                       2 = bank                      months,
                                               establishing this       the main                                         enterprise tried to                                                               months,
Enterprise number




                                                                                                          nature of                                                                                                    family farms
                              YES                                                                                                                   3 = other financial agencies          how much
                                                  enterprise?         source of                                          get credit from                                                                how much       5 = proceeds from
                    1 = Registrar general's                                                                  this                                         4 = cooperative                  altogether                  family nonfarm
                                               1 = no difficulty      capital in                                         banks and other                                                                of the total
                             Dept.                                                                        capital?                                       5 = money lender                   has the                    enterprise
                                             2 = Capital / credit     setting up                                       financial agencies?                                                               loans has
                         2 = Dept. of                                                                     1 = loan                                       6 = family/friend                 enterprise                  6 = income from family
                                            3 = Technical know-           this                                        1 = Yes, succesfully                                                                  this
                         Cooperatives                                                                      2 = gift                             7 = procedes from other enterprise        borrowed?                    propert(ies)
                                                     how             enterprise?                                            2 = Yes,                                                                    enterprise
                    3 = District Assembly                                                                                                                 8 = govt. agency                (new loans                   7 = NGO support
                                            4 = Govt. regulation     (see codes)                          3 = self-       unsuccesfully                                                                   repaid?
                      4 = Other (specify)                                                                                                                    9 = NGO                          only)                    8 = District assembly /
                                             5 = Other (specify)                                          financed       3 = No (>>18)                                                                    CEDIS        town Dev. Assoc.
                            NO = 5                                                                                                                   10 = community epicenter               CEDIS
                                                                                                                                                        11 = other (specify)                                           support
                                                                                                                                                                                                                       9 = church assistance
                               10                      11                                        12                               14                             15
                                                                                                                                                                                                                       10 = moneylenders
                                                                                                              13                                                                                16          17
                                                                                                                                                                                                                       11 = relatives/friends
                                                                                                                                                                                                                       12 = other partners
           1                                                                                                                                                                                                           96 = other (specify)

  2
SHARE CODES: 1 = 75% (3/4); 2 = 50% (1/2); 3 = 33% (1/3); 4 = 25% (1/4); 5 = 20% (1/5); 6 = 10% (1/10); 7 = 5% (1/20)
Section 9, part a -- Additional characteristics of HH enterprise
fill out for all current (i. e. currently operating or planning to resume operation within the year) HH enterprises


                                                         In a typical year, are your sales high, average, low, or none
                                                       (i. e., business is not in operation) in the month of [MONTH]?
 Enterprise number




                                                                                    1 = High
                                                                                  2 = Average
                                                                                    3 = Low
                                                                            4 = None: not in operation


                          Jan          Feb     March         April    May          June    July      Aug.      Sept.     Oct.     Nov.      Dec.
                           18             19     20             21     22             23    24           25     26        27        28        29

                     1

                     2




                          What is your           What is your          What is your
 Enterprise number




                         average level of       average level of     average level of




                                                                                                                                                           Enterprise 1


                                                                                                                                                                          Enterprise 2
                         sales in a "low"         sales in an        sales in a "high"
                             month?            "average" month?           month?



                                (cedis)               (cedis)               (cedis)
                                                                                                   (36) Has this business operated in the last 3 months?
                                  33                    34                    35
                                                                                                   (37) In this last 1 month?                                                            (1 = Yes; 2 = No)

                     1                                                                             (38) In the last 2 weeks?

                     2                                                                             (39) In the last 1 week?
Section 9, part b -- Detailed labor allocation of employees in household enterprise
NEW -- list all people who worked in one or both of the household enterprises you managed in the last year
                                                                                                                           Status    How is [name]                                         Enterprise 1           Enterprise 2
             Is worker a household member?
               1 = yes; 2 = no (if no, >> 3)

                                                                                                                        1 = skilled        paid?     What is the salary                              On
                                                                       Employee's name                                                                                                                                      On




                                                                                             (1 = Male; 2 = Female)
                                               If household member,
                                                                                                                          regular      1 = fixed     paid to [name], or     What                  average,      About
                                                                        and village ID                                                                                               About how                           average,
                                                                                                                         employee         salary    the value of in kind percentage many days how many        how many
                                                   list ID (>> 10)

                                                                                                                       2 = unskilled 2 = percent of                                                            days did how many
Worker no.




                                                                                                                                                      goods given to      of profits did [name] hours per




                                                                                                    Gender
                                                                      code NV if employee                                 regular         profits                        are given to work in                   [name]   hours per
                                                                                                                                                          [name]?                                 day does
                                                                       does not appear on                                employee         (>> 8)                           [name]?                             work in   day does
                                                                                                                                                                                         this      [name]
                                                                         village roster                               3 = apprentice  3 = in kind                                                                 this    [name]
                                                                                                                                                          (>> 10)                     enterprise work in
                                                                                                                        4 = casual    4 = not paid                                                            enterprise work in
                                                                                                                                                                                      during the     this
                                                                                                                          worker         (>> 10)                                                              during the    this
                                                                                                                                                                                      past year?
                                                                                                                       5 = working     5 = other       value       time                          enterprise   past year?
                                                                       name            ID                                                                                    (%)                                       enterprise?
                                                                                                                        proprietor      (specify)     (cedis)     code                                ?
                         1                             2                  3              4            5                     6              7                 8               9          10          11           12         13
 1
 2
 3
 4
 5
 6
 7
 8
 9
10
11
12
13
14
15
16
17
18
TIME UNIT CODES: 1 = daily; 2 = weekly; 3 = fortnightly; 4 = monthly; 5 = quarterly; 6 = yearly
Section 9, part c -- Expenditures in household enterprise (enterprise 1)
Fill out for enterprise #1
                                                                                  How                         During the past
                                                 During the past How much      much did                      12 months, was [
                                                 12 months, has did you        you spend
                                                                                            How much did     ] available when
                                                  the enterprise spend on                   you spend on       you needed /
                                                                                   on                            wished to
                             Item
                                                 spent anything [ ] during     [ ] during
                                                                                            [ ] during the
                                                                 the past 12                past 2 weeks?       purchase it?
                                                      on [ ]?                  the past 3
                                                                  months?                                        1 = always
                                                     1 = Yes                    months?                           2 = often
                                                 2 = No (>> 5)                                                 3 = not often
                                                                   (cedis)      (cedis)        (cedis)
                                                                                                              4 = not needed
                                                        1             2            3              4                 5
    1 Taxes on product
    2 Articles for resale
    3 Rents on assets/land and buildings
    4 Raw materials
    5 Travelling and Transport (T & T)
    6 Fuel & lubricants
    7 Electricity
    8 Water
    9 Telephones
  10 Printing / stationary / postage / packing
  11 Spare parts
  12 Repairs / maintenance of fixed assets
  13 Lease of machinery or transport equipment
  14 Advertising / computer service
  15 Bank charges (excluding int.)
  16 Training
  17 Treatment / disposal of waste products
  18 Uniform and clothing
  19 Accident claims
  20 Other (specify)
Section 9, part c -- Expenditures in household enterprise (enterprise 2)
Fill out for enterprise #2
                                                                                  How                         During the past
                                                 During the past How much      much did                      12 months, was [
                                                 12 months, has did you        you spend
                                                                                            How much did     ] available when
                                                  the enterprise spend on                   you spend on       you needed /
                                                                                   on                            wished to
                             Item
                                                 spent anything [ ] during     [ ] during
                                                                                            [ ] during the
                                                                 the past 12                past 2 weeks?       purchase it?
                                                      on [ ]?                  the past 3
                                                                  months?                                        1 = always
                                                     1 = Yes                    months?                           2 = often
                                                 2 = No (>> 8)                                                 3 = not often
                                                                   (cedis)      (cedis)        (cedis)
                                                                                                              4 = not needed
                                                        1             2            3              4                 5
    1 Taxes on product
    2 Articles for resale
    3 Rents on assets/land and buildings
    4 Raw materials
    5 Travelling and Transport (T & T)
    6 Fuel & lubricants
    7 Electricity
    8 Water
    9 Telephones
  10 Printing / stationary / postage / packing
  11 Spare parts
  12 Repairs / maintenance of fixed assets
  13 Lease of machinery or transport equipment
  14 Advertising / computer service
  15 Bank charges (excluding int.)
  16 Training
  17 Treatment / disposal of waste products
  18 Uniform and clothing
  19 Accident claims
  20 Other (specify)
Section 9, part d -- Inventories and recent sales / purchases - FIRST ENTERPRISE
Fill out for first enterprise                                                                                                                   Unit codes:
                                              How much of the following items does the             How much / what How much / what was          American tin = 02
                                                                                                                                                Balls = 27
                                                   enterprise currently possess?                  was the value of the the value of the items   Bar = 28
                                                                                                     items sold or     bought or imported in    Barrel = 03
                                                    (respondent can choose to give               exported in the past 3 the past 3 months?      Basket = 04
                                                                                                                                                Beer bottle = 05
                        Item                        answer in units, or the value of                    months?                                 Bowl = 06
                                                       the inventory as a whole)                                                                Box = 07
                                                                                                                                                Bucket = 29
                                          Product   Unit    Unit price                  Value                 Value                  Value      Bunch = 08
                                                                       Quantity                  Quantity               Quantity
                                           code     code     (cedis)                   (cedis)               (cedis)                (cedis)     Bundle = 09
                                                                                                                                                Crate = 30
                                              1       2          3           4            5          6          7          8           9
                                                                                                                                                Dozen = 31
  10 Principal finished product                                                                                                                 Fanta /
                                                                                                                                                  coke bottle = 10
  20 Principal raw material                                                                                                                     Fingers = 11
                                                                                                                                                Fruits = 12
  30 Principal product work in progress                                                                                                         Gallon = 14
  40 Principal goods for resale                                                                                                                 Kilogram = 14
                                                                                                                                                Litre = 15
       Secondary Finished Products                                                                                                              Loaf = 32
                                                                                                                                                Log = 16
  51                                                                                                                                            Margarine
                                                                                                                                                  tin = 17
  52                                                                                                                                            Maxi bag = 18
  53                                                                                                                                            Mini bag = 19
                                                                                                                                                Nut = 20
       Secondary Raw Materials                                                                                                                  Pair = 33
                                                                                                                                                Pieces = 34
  61                                                                                                                                            Pots = 35
                                                                                                                                                Pounds = 21
  62                                                                                                                                            Set = 36
  63                                                                                                                                            Sheet = 22
                                                                                                                                                Singles = 37
       Secondary Works in Progress                                                                                                              Stick = 23
                                                                                                                                                Tonne = 24
  71                                                                                                                                            Tree = 25
                                                                                                                                                Tubers = 26
  72
                                                                                                                                                Yards/metres = 38
  73
       Secondary goods purchased for resale
  81
  82
  83
Section 9, part d -- Inventories and recent sales / purchases - SECOND ENTERPRISE
Fill out for second enterprise
                                              How much of the following items does the            How much / what      How much / what       Unit codes:
                                                                                                                                             American tin = 02
                                                   enterprise currently possess?                 was the value of the was the value of the   Balls = 27
                                                                                                    items sold or       items bought or      Bar = 28
                                                    (respondent can choose to give               exported in the past imported in the past   Barrel = 03
                                                                                                                                             Basket = 04
                      Item                          answer in units, or the value of                  3 months?            3 months?         Beer bottle = 05
                                                       the inventory as a whole)                                                             Bowl = 06
                                                                                                                                             Box = 07
                                          Product   Unit Unit price                     Value                Value                Value      Bucket = 29
                                                                    Quantity                     Quantity             Quantity
                                           code     code  (cedis)                      (cedis)              (cedis)              (cedis)     Bunch = 08
                                                                                                                                             Bundle = 09
                                              1       2         3          4              5         6          7         8          9
                                                                                                                                             Crate = 30
  10 Principal finished product                                                                                                              Dozen = 31
                                                                                                                                             Fanta /
  20 Principal raw material                                                                                                                    coke bottle = 10
                                                                                                                                             Fingers = 11
  30 Principal product work in progress
                                                                                                                                             Fruits = 12
  40 Principal goods for resale                                                                                                              Gallon = 14
                                                                                                                                             Kilogram = 14
       Secondary Finished Products                                                                                                           Litre = 15
  51                                                                                                                                         Loaf = 32
                                                                                                                                             Log = 16
  52                                                                                                                                         Margarine
                                                                                                                                               tin = 17
  53                                                                                                                                         Maxi bag = 18
       Secondary Raw Materials                                                                                                               Mini bag = 19
                                                                                                                                             Nut = 20
  61                                                                                                                                         Pair = 33
                                                                                                                                             Pieces = 34
  62                                                                                                                                         Pots = 35
  63                                                                                                                                         Pounds = 21
                                                                                                                                             Set = 36
       Secondary Works in Progress                                                                                                           Sheet = 22
                                                                                                                                             Singles = 37
  71                                                                                                                                         Stick = 23
  72                                                                                                                                         Tonne = 24
                                                                                                                                             Tree = 25
  73                                                                                                                                         Tubers = 26
                                                                                                                                             Yards/metres = 38
       Secondary goods purchased for resale
  81
  82
  83
Section 9, part e – Revenue for enterprises in wholesale/retail trade                                                                    Unit codes:
                                                                                                                                         American tin = 02
                                                                                                                                         Balls = 27
                                                Last purchased                                 Sales during last two weeks               Bar = 28
                                                                                                                                         Barrel = 03
                                                                                       (answer about a typical two weeks if enterprise   Basket = 04
                                (respondent can choose to give answer in units,                                                          Beer bottle = 05
                                  or the value of units purchased as a whole)               has not operated in past two weeks)          Bowl = 06
          Main Items sold                                             Value of total                                                     Box = 07
                             Product Unit Unit price Quantity                          Unit    No. units Unit price Value of total       Bucket = 29
                                                                        purchases                                                        Bunch = 08
                              code     code     (cedis) purchased                      code      sold     (cedis) sales (cedis)          Bundle = 09
                                                                         (cedis)
                                                                                                                                         Crate = 30
                                1        2         3          4             5            6          7            8             9
                                                                                                                                         Dozen = 31
FIRST ENTERPRISE                                                                                                                         Fanta /
                                                                                                                                           coke bottle = 10
  1                                                                                                                                      Fingers = 11
                                                                                                                                         Fruits = 12
  2                                                                                                                                      Gallon = 14
  3                                                                                                                                      Kilogram = 14
                                                                                                                                         Litre = 15
  4                                                                                                                                      Loaf = 32
  5                                                                                                                                      Log = 16
                                                                                                                                         Margarine
  6                                                                                                                                        tin = 17
                                                                                                                                         Maxi bag = 18
  7                                                                                                                                      Mini bag = 19
  8                                                                                                                                      Nut = 20
                                                                                                                                         Pair = 33
  9                                                                                                                                      Pieces = 34
                                                                                                                                         Pots = 35
 10                                                                                                                                      Pounds = 21
SECOND ENTERPRISE                                                                                                                        Set = 36
                                                                                                                                         Sheet = 22
  1                                                                                                                                      Singles = 37
                                                                                                                                         Stick = 23
  2                                                                                                                                      Tonne = 24
  3                                                                                                                                      Tree = 25
                                                                                                                                         Tubers = 26
  4                                                                                                                                      Yards/metres = 38
  5
  6
  7
  8
  9
 10
Section 9, part e -- Revenue for food enterprises                                                           Unit codes:
                                                                                                            American tin = 02
From GLSS5 -- if business has operated in last 7 days repeat to get current information; otherwise skip     Balls = 27
                                        In the past week, how       How many days during the past 7 days    Bar = 28
                                                                                                            Barrel = 03
                                      much on average did you          did you prepare meals for sale?
        Enterprise number                                                                                   Basket = 04
                                         earn from the sale of                                              Beer bottle = 05
                                          (amount in cedis)                                                 Bowl = 06
                                                                                                            Box = 07
                 1                                 2                                  3                     Bucket = 29
                                                                                                            Bunch = 08
                                                                                                            Bundle = 09
                                                                                                            Crate = 30
                                                                                                            Dozen = 31
                                                                 What is the cost of the following inputs   Fanta / coke bottle = 10
     What is the total cost of ingredients purchased in a day?
                                                                             used in 7 days?                Fingers = 11
                                                                                                            Fruits = 12
             Item          Ingredient                  Amount                                 Amount        Gallon = 14
                                      Unit Code                             Input                           Kilogram = 14
                              code                     (cedis)                                (cedis)
                                                                                                            Litre = 15
                                                                                                            Loaf = 32
              4                 5            6             7                  8                  9          Log = 16
                                                                                                            Margarine tin = 17
                                                                 1. Firewood / charcoal                     Maxi bag = 18
                                                                                                            Mini bag = 19
                                                                 2. Gas                                     Nut = 20
                                                                                                            Pair = 33
                                                                 3. Water                                   Pieces = 34
                                                                                                            Pots = 35
                                                                 4. Soap                                    Pounds = 21
                                                                                                            Set = 36
                                                                 5. Other: __________                       Sheet = 22
                                                                                                            Singles = 37
All others                                                       All others                                 Stick = 23
                                                                                                            Tonne = 24
                                                                                                            Tree = 25
                                                                                                            Tubers = 26
                                                                                                            Yards/metres = 38
Section 9, part e -- Revenue for service enterprise and other enterprise
Fill out for service industries if enterprise has been operational in the past 1 or 3 months
                                                                                  ENTERPRISE 1                              ENTERPRISE 2
                                                                        How much was earned through the                  How much was earned
                                                                        provision of service during the last .          through the provision of
                                  SERVICE                                                . .?                          service during the last . . .?
                                                                                 (amount in cedis)                          (amount in cedis)
                                                                                   1 month          3 months            1 month          3 months
                                                                                      1                  2                  3                4
            1 Delivery of goods sold
            2 Provision of other services
            3 Rental of buildings
            4 Rental of machinery and transport equipment
            5 Commissions
            6 Royalties, copyrights, etc. belonging to the enterprise
            7 Storage and handling fees
            8 Inspection and valuation fees
            9 Sale of scrap
  10 Profit of sales and fixed assets
  11 Other (specify)


Fill out for all other enterprises.
                                   Operating in the last 2 weeks                                                          Not operating in the last 2 weeks
        During the last 2 During the last 2 What was During the last 2      What was the        How much revenue       Does the    What is the usual     Are some of What is the value
      weeks, how much weeks, has this                   weeks, have any of                                                                                  the good
  ENTERPRISE NUMBER




                                                the                          value of the        is usually received  enterprise       value of                         of the products
                               enterprise                  the goods and                           from the sale ofusually receive payments in the           usually  usually consumed
       revenue has been         received
                                            estimated      services been
                                                                               products                                                                  consumed by by the household
                                                                                                 goods and servicespayments in the form of goods
       received from the payments in the value?          consumed by the   consumed by the                                                              the household
                                                                                                  by this enterpriseform of goods and services in a                    instead of being
       sale of goods and form of goods                       household     household in the                                                                instead of
                                                                                                in a 2 week period? and services?     two week                           sold over a 2
        services by this     and services?   (cedis) members instead of last 2 weeks?                                                                     being sold?
                                1 = Yes                     being sold?                                                1 = Yes         period?               1 = Yes     week period?
           enterprise?                                                          (cedis)          (amount in cedis) 2 = No (>> 13)                                            (cedis)
                                          2 = No (>> 8)            1 = Yes                                                                                2 = No (>>
                                                               2 = No (>> next                                                          (cedis)           next page)
                      (amount in cedis)                             page)        >> next page

                              5                6          7             8             9                 10                 11                12             13               14

            1
            2
Section 10 (Transfers), Part 1-- TRANSFERS OUT OF THE HOUSEHOLD
Is there anyone (including household members) not living in the household at the time to whom the household has sent money or goods in the past year?
Fill out entire page for all transfers
                                                              Were these         Will these   What was     What were the three         What was      What was      Where does this       If not a     If this Through what
                                                              remittances       remittances    the total  main uses of the cash          the total     the total    recipient live?   household person          means did
                                                              made on a         be repaid at amount of         sent / given?             value of      value of 1=this town/village member, is was one of you send the
                                                              regular basis?                              1 = daily consumption                                  2=Sekondi / Takordi                           remittance?
                                                                                some future the cash sent                               food sent        other                        this person       the
                                                              Yes,                                             2 = housing                                          3=Cape Coast
                                                                                   time?     to or given                                   to or        goods                            a blood    relatives
                                                                1 = weekly                                     3 = business                                            4=Accra                                  1 = Bank
                                                                2 = monthly
                                                                                                to this       4 = education
                                                                                                                                         given to     sent to or         5=Ho
                                                                                                                                                                                       relative or mentioned      account
                                    If household member, ID


                                                                3 = quarterly     1 = Yes    individual          5 = health                 this       given to      6=Koforidua      spouse of a        in    2 = Money
                                                                4 = annually      2 = No     during the         6 = funeral            individual         this        7=Kumasi        household previous          transfer
 Transfer number




                   Name of person                             No = 5                            past 12    7 = other ceremony          in the past   individual       8=Suyani          member? section,          agency
                   to whom money                              Other                           months?           8 = savings                  12      in the past      9=Tamale          1 = Yes;       give    3 = Sender
                       is sent                                  (specify) = 6                                    9 = agriculture         months?           12      10=Bolgatanga         2 = No      relative him or herself
                                                                                                                   10 = other                         months?           11=Wa                      number or 4 = Cash
                                                                                                                                                                   12=other urban       (if no >> code 999 carried by
                                                                                                                                                                       13=rural                               someone else
                                                                                                                                                                                            13)         if a
                                                                                                                                                                 96=Other ECOWAS                                5 = Other
                                                                                                                                                                                                     relative
                                                                                                                                                                 97=Africa other than                            (specify)
                                                                                                                                                                      ECOWAS                            not
                                                                                                                                                                  98=Outside Africa                mentioned


                                                                                                cedis        a         b           c      cedis        cedis
                         1                2                           3              4            5                    6                    7            8                9                10          11           12

    1

    2

    3

    4

    5

    6

    7

    8

    9

 10
Section 10, Part 2 -- TRANSFERS INTO THE HOUSEHOLD
Is there anyone (including household members) not living in the household from whom the household has received money / goods in the past year?
Fill out entire page for all transfers
                               Were these       Will these What was                 What were the three What was What was          Where does this       If not a      If this
                               remittances                                          main uses of the cash the total the total       recipient live?   household       person
                                               remittances the total Through what
                               made on a                                                sent / given?                             1=this town/village
                               regular basis?
                                               be repaid at amount of means did 1 = daily consumption value of value of 2=Sekondi / Takordi member, is              was one of
                                                                        you receive                        food sent     other                        this person        the
                               Yes,            some future the cash                      2 = housing                                3=Cape Coast
                                                                             the                              to or     goods                           a blood      relatives
                                 1 = weekly       time?      sent to or remittance?      3 = business                                  4=Accra
                                                                                                            given to sent to or                        relative or  mentioned
                         If household member, ID



                                 2 = monthly                  given to                  4 = education                                    5=Ho
                                 3 = quarterly                                            5 = health           this    given to      6=Koforidua      spouse of a      in the
                                                 1 = Yes        this     1 = Bank                         individual      this                        household      previous
                                 4 = annually                                             6 = funeral                                 7=Kumasi
 Transfer number




      Name of person                             2 = No     individual    account
                               No = 5                                                7 = other ceremony   in the past individual      8=Suyani          member?      section,
         from whom             Other                        during the 2 = Money         8 = savings            12    in the past     9=Tamale          1 = Yes;        give
                                                                          transfer
           money is              (specify) = 6                past 12     agency
                                                                                           9 = other        months?        12       10=Bolgatanga        2 = No       relative
           received                                          months?                                                   months?          11=Wa                       number or
                                                                        3 = Sender
                                                                                                                                     12=other urban       (if no >>    999 =
                                                                         him or herself
                                                                                                                                        13=rural
                                                                           4 = Cash                                                                          next     another
                                                                                                                                   96=Other ECOWAS
                                                                           carried by                                                                     transfer)   relative
                                                                                                                                   97=Africa other than
                                                                         someone else
                                                                                                                                       ECOWAS
                                                                           5 = Other
                                                                                                                                    98=Outside Africa
                                                                            (specify)

                                                               cedis                      a     b      c       cedis      cedis
                   1           2                   3   4          5            6                7                8          9              10                11         12
    1
    2
    3
    4
    5
    6
    7
    8
    9
 10
Section 10, part 3 -- Miscellaneous Income & Expenditures
During the past 12 months, how much income in cash or kind, did any member of the household receive
from the following sources?                                                                           During the past 12 months, how much did the household spend (in cash and in kind) on:
              From Central Government                            From Other Sources
                                                                                                                                                    Gifts and presents
                                                                                   Other (specify)
                                                                                                                                                     exclusing those
                                                                                                                                       Weddings,
                                                                                                        Taxes (TV                                mentioned as transfers
                                                                                 INCL. DONATIONS                       Contribution to   dowry,
 Member ID




                                                                                                         license,
              Social     State                      Retirement    Dowry or       FROM CHURCHES,                          self-help      funerals
                                  Other (specify)                                                      property tax,                                    (INCLUDE
             Security   Pension                      Benefits    inheritance       INSTITUTIONS,                         projects      and other
                                                                                                            etc)                                 CONTRIBUTIONS/DON
                                                                               DIVIDENDS, INTEREST.                                    cermonies
                                                                                                                                                 ATIONS TO CHURCES
                                                                                                                                                  INSTITUTIONS, ETC)
                                                                                 (EXCLUDE SUSU)
             Amount     Amount       Amount          Amount        Value              Amount             Amount           Amount      Amount             Amount
               1          2            3               4             5                  6                  7                8           9                  10
   1

   2

   3

   4

   5

   6

   7

   8

   9

10

11

12

13

14

15

16

17

18
Section 11 (savings, credit, assets) part a – Borrowing
Fill out entire sheet for any loans
           What is the source of What was      For what purpose was     What kind of      How    Do you                                              If so,    How frequently       How                                    If land is being
                  this loan?                    the loan contracted?    guarantee was                                                                            do you make
                                   the total                                           much of have to                                              what is                        much                                         used as
              Which household member obtained the loan? (give ID)


               1 = State bank                  1 = Agricultural land / required by the             pay                                                the        payments on                                                collateral (see
              2 = Private bank    amount of          equipment             lender?      the loan                                                                   this loan?     money is
                                                                                                 interest                                           interest                                                                 question 5),
              3 = Cooperative    the original 2 = Agricultural inputs     1 = None     has been                                                                    1 = Daily      currently
                                                                                                 on this                                             rate?                                                                   then who is
              4 = Govt. agency       loan?          3 = Business          2 = Land     repaid in                                                                  2 = Weekly       owed?      To whom is this money
                  5 = NGO                           4 = Housing           3 = Cattle              loan?                                                        3 = Forthnightly                                            using the land?
                                                                                        the past                                                                                                    owed?
             6 = Business firm                5 = Education / training   4 = House /                                                                 (%)        4 = Quarterly                                               1 = person to
                7 = Employer
                                    (cedis)          6 = Health            building
                                                                                         twelve 1 = Yes                                                          5 = Semester
                                                                                                                                                                                   (cedis)                                  whom money
             8 = Moneylender                      7 = Ceremonies        5 = Employer   months? 2 = No                                                             6 = Annual                  (give name of person or           is owed
Loan Number




                                                                        9 = Trader             (weddings, funerals,   6 = Relatives                              7 = Only one                   organization / bank)       2 = member(s)
                                                                       10 = Farmer                     etc.)            7 = Non-      (cedis)                   final payment                                                    of the
                                                                      11 = Relative /              8 = Vehicle          relatives                                8 = No fixed                                                 household
                                                                     neighbor / friend         9 = Other consumer       8 = Other                                   schedule                                                3 = someone
                                                                     12 = Community                   goods             (specify)
                                                                                                                                                                                                                                  else
                                                                         epicenter             10 = Other (specify)
                                                                    13 = other (specify)
                                                                                                                                                                                                                           8 = don't know

                                                                                                                                                                                                                 ID (if
                                                                                                                                                                                                  name          village
                                                                                                                                                                                                               resident)


                           1                                                 2             3            4                  5             6      7      8              9              10            11             12             13

       1
       2
       3
       4
       5
       6
       7
       8
Section 11, part b -- Household assets
Fill out entire sheet for any household assets

                                                                             What was the
                                                                           purchase price?
                                  How many […] does your household own?
                                                                           (if gift put zero)
 CODE




                 Item
                                                                          see currency codes
                                                                                below

                                           1                 2
                                                                                       currency
                                       working           not working      amount
                                                                                         code
                                                    1                              2
 301 Furniture
 302 Sewing machine
 303 Stove (kerosene)
 304 Stove (electric)
 305 Stove (gas)
 306 Refrigerator
 307 Freezer
 308 Air conditioner
 309 Fan
 310 Radio
 311 Radio cassette
 312 Record player
 313 3-in-one radio system
 314 Video player
 315 Desktop computer
 316 Laptop computer
 317 Printer
 318 Computer accessories
 319 Camcoder/video camera
 320 Satellite dish
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
    Cell: A1
Comment: dwa6:
          Very similar to section 12, part B
Section 11, part b -- Household assets concluded
Fill out entire sheet for any household assets


                                                                             What was the
                                  How many […] does your household own?    purchase price?
                                                                           (if gift put zero)
 CODE




                 Item                                                     see currency codes
                                                                                below

                                           1                  2
                                                                                       currency
                                       working          current status     value
                                                                                         code
                                                    1                              2
 321 Washing machine
 322 TV
 323 Camera
 324 Iron (electric)
 325 Bicycle
 326 Motorcycle
 327 Car
 328 House
 329 Land / plot
 330 Shares
 331 Boat
 332 Canoes
 333 Outboard motor
 334 Microwave
 335 Food processor
 336 Box iron
 337 Mobile phone
 338 Generator
 339 Jewellery
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
Section 11, part c -- Saving
1. Does any member of the household have a savings account or participate in Susu? 1 = yes, 2 = no (>> 7) ______________

                                                            In what                       How much has
               ID of member's name




                                        Where is this                                                    How much
                                                        currency is the                   been added to
                                         account?                                                          has been
                    on account




                                                           account?                       the savings in
 Item Number




                                                                         What is the                     withdrawn
                                                                                            the past 12
                                       (enter codes from             current balance of                    from the
                                                               SEE                           months?
                                     village survey, one of            these savings?                     savings in
                                                            CURRENCY
                                     which is community                                                  the past 12
                                                              CODES                        (EXCLUDE
                                           epicenter)                                                      months?
                                                             BELOW                         INTEREST)
                      1                       2                3              4                 5             6        (7) Does the household have any savings that are kept at home

           1                                                                                                                  (i. e., not in a bank or in a susu)?

           2                                                                                                           (1 = Yes; 2 = No)

           3                                                                                                                  _______

           4

           5                                                                                                           (8) If so, how much?

           6                                                                                                                                             amount
                                                                                                                                           currency code (see below)
           7

           8

           9

 10
CURRENCY CODES: 1 = cedi; 2 = naira; 3 = CFA; 4 = pound; 5 = dollar; 6 = euro; 7 = yen; 8 = other (specify)
Section 11, part d -- Lending
0. Is any member of the household owed money? ______ (1 = Yes; 2 = No, if no >> next page)
                                                                                                                                                                   How frequently are
                                                                                                                                   What kind of
                                                                                                                                                                   payments made on
                   To whom was                                                              When the                               guarantee was
                                                                                                                                                                        this loan?
                      this loan                                                             loan was                              required of the
                                                                       What was the                                                                                     1 = Daily
                       given?    Give receiver's name and village ID                      started, how                               receiver?        How much
                                                                        total amount                       How long ago                                                2 = Weekly
                   1 = Employee                                                           much in total                              1 = None          does the
 Loan Number




                                                                       of the original                      was the loan                                            3 = Forthnightly
                     2 = Tenant (code "NV" for ID if not a resident                          did the                                 2 = Land          recipient
                                                                       loan given to                         started?                                                4 = Quarterly
                    3 = Relative             of village)                                 recipient have                              3 = Cattle     currently owe?
                                                                       the recipient?                                                                                 5 = Semester
                   4 = Neighbor                                                            to pay you                          4 = House / building
                                                                                                                                                                       6 = Annual
                       / friend                                                               back?                                5 = Employer         (cedis)
                                                                          (cedis)                                                                                  7 = Only one final
                      5 = other                                                                                                    6 = Relatives
                                                                                                                                                                         payment
                      (specify)                                                             (cedis)                              7 = Non-relatives
                                                                                                                                                                      8 = No fixed
                                          name                ID                                          Years       Months    8 = Other (specify)
                                                                                                                                                                         schedule
                         1                        2                          3                 4                  5                      6                 7                 8

               1

               2

               3

               4

               5

               6

               7

               8
Section 12, Part A -- Housing Characteristics: Rent
                                                                        Amount            Time Unit   Time Units:
1. How much does the household pay in cash towards the rent?                                          1 = Daily
                                                                                                      2 = Weekly
2. Does your household also supply goods or services in exchange for                                  3 = Monthly
this dwelling?                                                                   Code                 4 = Quarterly
1 = Yes                                                                                               5 = Half yearly
                                                                                                      6 = Yearly
2 = No
                                                                                                      0 = N/A
3. What is the appropriate value of these goods and services provided   Amount            Time Unit
by your household?


4. Is part or all of the rent paid by someone who is not a member of
your household?
1 = Yes All                                                                      Code
2 = Yes Part
3 = No

5. Who pays?
1 = Relative
2 = Private employer
3 = Givernment                                                                   Code
4 = Private individual / agency
5 = Other

                                                                        Amount            Time Unit
6. How much is paid?

                                                                                 Amount
7. How much did your household spend for construction or repair costs
and painting in the last 12 months on this dwelling?
Section 12, Part A -- Housing Characteristics: Utilities
                                                                              Drinking             General Use                                                                                                      Amount
                                                                                                                                     16. Did your household sell any water to someone else?
8. What is the main source of water supply for this household?
                                                                                                                                     1 = Yes
See codes
                                                                                                                                     2 = No (>>18)



                                                                              Drinking distance    Drinking distance code            17. How much did your household receive for the water sold in the              Amount
9. How far is this source of water from your dwelling?
                                                                                                                                     last 2 weeks?


                                                                                                                                     18. What is the main source of lighting for your dwelling?
                                                                                                                                     1 = Electricity (mains)
                                                                              General use distance General use distance code         2 = Kerosene (>>20)                                                            code
                                                                                                                                     3 = Gas lamp (>>20)
                                                                                                                                     4 = Candles / Torches (flashlights) (>>20)
                                                                                                                                     5 = Solar energy (>>20)
                                                                                                                                     6 = Generator (>>20)
                                                                                                                                     7 = No light (>>20)
                                                                                                                                     8 = Other (specify) (>>20)

                                                                              General use          Drinking                                                                                                Amount            Time Unit
10. In the past 30 days, how many days has each of the above water sources                                                           19. How much was your last bill (Only your part if you have a joint
been unavailable, for whatever reason?                                                                                               meter or a shared bill)?


                                                                                                                                     20. What is the main fuel used by the household for cooking?
                                                                                                                                     1 = None, no cooking
                                                                                                                                     2 = Wood
11. How much water does your household use in a day?                                                                                 3 = Charcoal
Units:                                                                                                                               4 = Gas
                                                                              Quantity             Unit                                                                                                             Code
1 = Litres                                                                                                                           5 = Electricity
2 = Gallons                                                                                                                          6 = Kerosense
3 = Bucket (No. 34)                                                                                                                  7 = Crop residue/sawdust
                                                                                                                                     8 = Animal waste
                                                                                                                                     9 = Other (specify)


12. How is the water supply system operated and managed?
                                                                                                                                     21. How does your hosehold dispose of refuse?
1 = Self
                                                                                                                                     1 = Collected
2 = Community operated and managed
                                                                              General use          Drinking                          2 = Public dump (>>23)                                                         Code
3 = Community Water Sanitation Agency
                                                                                                                                     3 = Dumped elsewhere (>>23)
4 = Ghana Water Company Limited
                                                                                                                                     4 = Burned by household (>>23)
5 = NGO
                                                                                                                                     5 = Buried by household (>>23)
6 = Other (specify)
                                                                                                                                     6 = Other (>>23)
7 = Not Applicable

13. Does the household pay a regular bill for each water supply system?       General use          Drinking                                                                                                Amount            Time Unit
1 = Yes
                                                                                                                                     22. How much does this household pay for refuse disposal?
2 = No
If no to both, >>15
                                                                                                                                     23. What type of toilet is used by your household?
                                                                                                                                     1 = Flush toilet (W.C) (>>25)
                                                                                                                                     2 = Pit latrine (>>25)
                                                                              Amount               Time Unit                         3 = KVIP (>>25)                                                                Code
14. The last time you paid, what was the total amount for both sources?
                                                                                                                                     4 = Pan/bucket (>>25)
(only your part if joint meter or shared bill)
                                                                                                                                     5 = Public toilet (flush/bucket/KVIP)
                                                                                                                                     6 = Toilet in another house
                                                                                                                                     7 = No toilet facility (bush, beach) (>>25)
                                                                                                                                     8 = Other (specify) (>>25)
                                                                                         Amount                                                                                                            Amount            Time Unit
15. How much did your household pay to a private water vendor, neighbour or                                                          24. How much does the household pay for the use of the toliet
standpipe or any other source in the last 2 weeks?                                                                                   facility?

Question 8 codes:                                                                   Distance codes:       Time Units:
1 = Indoor plumbing 2 = Inside standpipe 3 = Water truck/tanker service 4 = Water   0 = In house 1 =      1 = Daily 2 = Weekly 3 = Monthly 4 =
vendor 5 = Pipe in neighbouring household 6 = Private outside standpipe/tap         Yard 2 = Metre        Quarterly 5 = Half yearly 6 = Yearly 0 = N/A
7 = Public standpipe 8 = Sachet/bottled water 9 = Borehole 10 = Protected well 11   3 = Kilometre 4 =
= Unprotected well 12 = River / Stream 13 = Rain water / spring                     Mile
Section 12, Part A -- Housing Characteristics: Structure and Amenities
                                    Does the       Does the
                                    household      household use
                                    have access    […]?
                                    to […]?        1 = Yes
                                    1= Yes         2 = No
                                    2 = No                                   29. Draw a detailed sketch of the dwelling:
                                         (i)             (ii)

25.a. Fixed Line Telephone

25.b. Mobile phone network

25.c. Personal Computers

25.d. Internet (other use)

25.e. E-commerce

25.f. Paid cable network (e.g. M-
NET CABLEGOLD)
26. What is the main construction material used for the outer wall?   Code
1 = Mud/Mud bricks
2 = Wood/Bamboo
3 = Metal sheet/Slate/Asbestos
4 = Stone
5 = Burned bricks
6 = Cement/Sandcrete blocks
7 = Landcrete
8 = Thatch
9 = Cardboard
10 = Other (specify)
27. What is the main construction material used for the floor?        Code
1 = Earth/Mud/Mud bricks
2 = Wood
3 = Stone
4 = Cement/Concrete
5 = Burnt bricks
6 = Vinyl tiles
7 = Ceramic/Marble/Tiles
8 = Terrazzo
9 = Other
28. What is the main material used for the roof?                      Code
1 = Palm leaves/Raffia/Thatch
2 = Wood
3 = Corrugated iron sheets
4 = Cement/Concrete
5 = Asbestos/Slate
6 = Roofing tiles
7 = Mud bricks/Earth
8 = Bamboo
9 = Other (specify)
Section 12, Part B -- Ownership of Durables

                                                        Owned until a
                                          Owned Now        year ago              Accquired between (specific date ) and now
                       Item                             (specific date )
                                                                                                                          Received as
                                                                           Purchased           Sold       Given as gift
                                          No.   Value   No.      Value                                                        gift
                                                                           No.   Value   No.      Value   No.    Value    No. Value
                        1                  2     3        4        5        6      7      8         9      10     11       12      13
 1    Radio, Cassette/CD player

 2    Telephone (mobile)

 3    Telephone (fixed)

 4    TV

 5    Parabolic/satellite receivers

 6    VCR / DVD Player

 7    Camera

 8    Video camera

 9    Refrigerator & freezers

 10   Air conditioners & air coolers

 11   Washing machines and driers

 12   Gas cookers, stoves, and coalpots

 13   Electric irons

 14   Electric fans

 15   Blenders

 16   Lanterns, gas lights

 17   Cups and plates

 18   Dining pots

 19   Utensils / cutlery

 20   Buckets

 21   Cutlasses
      Shovels, rakes, wheelbarrows,
 22
      etc.
 23   Motor driven lawn mower

 24   Generators (houshold use)
    Cell: A1
Comment: dwa6:
          Very similar to section 11, part b
Section 12, Part B -- Ownership of Durables (ctd.)

                                                       Owned until a
                                         Owned Now        year ago                 Accquired between (specific date ) and now
                     Item                              (specific date )
                                                                                                                           Received as
                                                                           Purchased            Sold       Given as gift
                                         No.   Value   No.      Value                                                          gift
                                                                          No.   Value     No.      Value   No.    Value    No.    Value
                       1                  2     3        4         5       6      7        8         9      10     11       12      13
 25   Water cans / water pumps

 26   Brooms

 27   Light bulbs

 28   Torches

 29   Car / truck

 30   Motorcycle

 31   Bicycle
 32   Car tyres and other spare parts

 33   Computers and accessories

 34   Musical instruments

 35   Game cards (chess, ludo, etc)

 36   Toys

 37   Football, volleyball, etc

 38   Video game equipment and
      software
 39   Bedsteads

 40   Mattresses

 41   Room furniture

 42   Bedsheets & blankets

 43   Towels and linen

 44   Floor mats, tiles, linoleum, and
      wollen carpets
 45   Travelling bags, umbrellas
 46   Office supplies (paper, pens,
      pencils, staplers, etc)
 47   Iron rods and roofing sheets

 48   Bricks and Cement blocks

 49   Paints including quicklime
S ection 12, Part B -- House Property
To be asked to the Househould head/part can be filled by surveyor as well

    In what ty pe of dwelling does the household live?

  1= Separate house (bungalow)
  2= Semi-detached house
  3= Flat/Apartment
1 4= Room(s) (Compound House)
  5= Rooms(s) (Other ty pe)
  6= Several Huts/Buildings (same Cpds)
  7=Several Huts/Buildings (diff. Cpds)
  8= Tents/Improvised home
  9= Other (specify )
2 How many rooms does this household occupy ? (count living rooms, dining rooms, bed rooms but
  not bathrooms, toilet & kitchen)
3
    Do other households share this dwelling with y ou (1= y es, 2= no)

4 What is y our present occupancy status? (1=Owning, 2=Renting, 3=Rent-free, 4=Perching) If
  owning >> 6
5 Who owns this dwelling? (1=Relative not household member, 2=Other private individual,
  3=Private employ er, 4=Other private agency , 5=Public/Gov't. ownership, 6=Other (specify ))

6 What is the condition of the house in which the household is living? (1=good, 2=livable, 3=badly
  damaged)
7 How are the surroundings of the house? (1=clean, 2=average, 3=dirty )


8 How many living rooms does the house have?

9 Is there a room used exclusively for cooking? (1=y es, 2=no)

10 Is there a window in the room where cooking is done? (1=y es, 2=no)

11 Is there a chimney /smoke outlet in the cooking place? (1=y es, 2=no)

12 Is cooking done outside in any season? (1=y es, 2=no)

13 If y es, which season?

14 Does y our house have electricity ? (1=y es, 2=no)

15 If y es, how regular is y our power supply after sunset? (1=regular, 2=cut once or twice a week,
   3=cut more than twice a week)
16 Distance to nearest public toilet (kms)

17 Average time spent traveling to and waiting at public toilet (minutes)

18 Number of other buildings owned

19 Number of vacant plots owned


20 Where are animals tied at night? (1=inside the house, 2=outside the house, 3=animal shed, 9=no
   animals)
21 Where are animals tied during the day ? (1=inside the house, 2=outside the house, 3=animal shed,
   9=no animals)
22 Where is hay (grass) kept? (1=inside the house, 2=outside the house, 3=animal shed, 9=no hay )

23 Open sewer/drain in/around the house? (1=y es, 2=no)


24 Trash in/around the house? (1=y es, 2=no)
Section 12, Part B -- Food Items Consumed (Part 1 of 3)

                                                    Last 30 days                                Season 1 _________ to ___________                                 Season 2 _________ to ___________                                  Season 3 _________ to __________
                                                                                                                           Gifts                                                              Gifts                                                              Gifts




                                    Home Produced




                                                                                Home Produced




                                                                                                                                                  Home Produced




                                                                                                                                                                                                                     Home Produced




                                                                                                                                                                                                                                                                                        Unit
                                                                   Purchase                                  Purchase    received   Gifts Given                                 Purchase    received   Gifts Given                                Purchase     received   Gifts Given
                    Items




                                                       From PDS




                                                                                                 From PDS




                                                                                                                                                                    From PDS




                                                                                                                                                                                                                                      From PDS
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                                      1a             1b            1c     1d       2a           2b           2c    2d    2e    2f    2g    2h       3a            3b            3c    3d    3e    3f    3g     3h       4a           4b           4c    4d    4e     4f   4g     4h     5
     1.1   Cereals
 1   1.1.1 Guinea corn/sorghum

 2   1.1.2 Maize

 3   1.1.3 Millet

 4   1.1.4 Rice - Local

 5   1.1.5 Rice - Imported

 6   1.1.6 Other cereals

     1.2   Pulses and Nuts
 7   1.2.1 Beans

 8   1.2.2 Groundnuts

 9   1.2.3 Palm nuts

10 1.2.4 Cola nuts

11 1.2.5 Other pulses and nuts
   1.3   Bread
12 1.3.1 Bread - sugar bread

13 1.3.2 Other bread

14 1.3.3 Biscuits

15 1.3.4 Flour (wheat)

16 1.3.5 Maize ground/corn dough
   1.3.6 Kenkey/banku (without
17
   sauce)
18 1.3.7 Baby food (cerelac, etc)
   2.3 Cooking oil
19 2.3.1 Coconut Oil

20 2.3.2    Groundnut oil

21 2.3.3    Palm kernel oil

22 2.3.4    Palm oil

23 2.3.5    Shea butter

24 2.3.6    Margarine/Butter
   2.3.7 Other vegetable oils
25
   including animal fats
Section 12, Part B -- Food Items Consumed (Part 2 of 3)

                                                    Last 30 days                                Season 1 _________ to ___________                                  Season 2 _________ to ___________                                   Season 3 _________ to __________

                                                                                                                            Gifts                                                               Gifts                                                              Gifts




                                    Home Produced




                                                                                Home Produced




                                                                                                                                                   Home Produced




                                                                                                                                                                                                                       Home Produced




                                                                                                                                                                                                                                                                                          Unit
                                                                   Purchase                                   Purchase    received   Gifts Given                                  Purchase    received   Gifts Given                                Purchase     received   Gifts Given




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                  Items
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                                      1a             1b            1c     1d       2a           2b            2c    2d    2e    2f    2g    2h       3a             3b            3c    3d    3e    3f    3g    3h        4a           4b           4c    4d    4e     4f   4g     4h     5
   2.4 Spices and Condiments
26 2.4.1 Black pepper
27 2.4.2 Salt
28 2.4.3 Ginger
   2.4.4 Other condiments (Royco,
29
   Maggie, etc)
   2.5 Milk and milk products
30 2.5.1 Milk (fresh)
31 2.5.2 Milk (powder)
32 2.5.3 Baby milk
33 2.5.4 Tinned milk
   2.5.5 Other milk products
34
   including cheese
   2.6 Eggs and Poultry
35 2.6.1 Eggs
36 2.6.2 Chicken
37 2.6.3 Game birds
   2.7 Meat
38 2.7.1 Corned beef
39 2.7.2 Pork
40 2.7.3 Beef
41 2.7.4 Goat meet
42 2.7.5 Mutton
43 2.7.6 Bushmeat/wild game
44 2.7.7 Fish
   2.8 Fruits
45 2.8.1 Coconut
46 2.8.2 Banana
47 2.8.3 Orange/tangerine
48 2.8.4 Pineapple
49 2.8.5 Mango
50 2.8.6 Avocado pear
51 2.8.7 Water melon
Section 12, Part B -- Food Items Consumed (Part 3 of 3)

                                                            Last 30 days                                Season 1 _________ to ___________                                  Season 2 _________ to ___________                                   Season 3 _________ to __________

                                                                                                                                    Gifts                                                               Gifts                                                             Gifts




                                            Produced Qnty




                                                                                        Produced Qnty




                                                                                                                                                           Produced Qnty




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                                                                                                                                                                                                                                                                                                  Unit
                                                                           Purchase                                   Purchase    received   Gifts Given                                  Purchase    received   Gifts Given                                Purchase    received    Gifts Given
                       Items




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                                                                          Qty   Value                                Qty   Value Qty   Value Qty   Value                                 Qty   Value Qty   Value Qty   Value                               Qty   Value Qty   Value Qty   Value

                                              1a             1b            1c     1d       2a           2b            2c    2d    2e    2f    2g    2h       3a             3b            3c    3d    3e    3f    3g    3h        4a           4b           4c    4d    4e     4f   4g     4h      5
     2.9 Vegetables
52   2.9.1 Cocoyam leaves (kontomire)

53   2.9.2 Garden eggs

54   2.9.3 Okro

55   2.9.4 Carrots

56   2.9.5 Pepper (fresh or dried)

57   2.9.6 Onions (large/small)

58   2.9.7 Tomatoes (fresh)

59   2.9.8 Tomato puree (canned)

60   2.9.9 Other vegetables

     2.10 Starchy Staples
61   2.10.1 Cassava

62   2.10.2 Cocoyam

63   2.10.3 Plantain

64   2.10.4 Yam

65   2.10.5 Cassava dough

66   2.10.6 Gari

67   2.10.5 Other starchy staples

     2.11 Confectionery
68   2.11.1 Sugar (cube, granulated)

69   2.11.2 Honey

70   2.11.3 Ice cream, ice lollies, etc.

71   2.11.4 Chocolate

72   2.11.5 Other confectionaries

     2.12 Beverages
73   2.12.1 Coffee, Tea, and Cocoa

     2.12.2 Bottled Water, Soft drinks,
74
     and Juices
75   2.12.3 Alcoholic Beverages

     2.13 Other
76   2.13.1 Tobacco

77   2.13.2 Cooked meals (as wages)

     2.13.3 Restaurants, Cafes, Canteens,
78
     Hotels, etc
Section 12, Part B -- Clothing and Footwear - Annual Purchases During (past 12 months)
                                         Expenditure during past   For children    For elderly over   For adult males 16- For adult females
                    Item                    12 months (cedis)      under 16 yrs.    60 yrs. (cedis)     60 yrs (cedis)    16-60 yrs. (cedis)
                      1                             2                    3                 4                  5                   6
   1
        Readymade garments
   2
        Cloth for garments
   3
        Suits
   4
        Smocks
   5
        Trousers
   6
        Shirts
   7
        Jeans
   8
        Underwear
   9
        Other garments and clothing
  10
        Footwear
  11
        Tailoring, laundry / cleaning,
        clothing repair charges
                                                                                                                    Total Expenditure
                                                                                                  Monthly average
Sl. no                                              Items                                                            during past 12
                                                                                                      (cedis)
                                                                                                                     months (cedis)

  1                                                   2                                                  3                  4

         Gifts and donations
  1      Regular remittances/gifts
  2      Gifts/support to help at the time of difficulty
  3      Cultural festivals (donations) (Homowo, Odwira, etc)

  4      Funerals

         Housing expenses

  5      Payment for rent
  6      Owner occupy housing rent (estimate)
  7      Plumbing, electrical, and carpentry services

  8      Sewerage removal, refuse desposal, expenditure on public toilets

  9      Water (pipe-borne, metered)

 10      Water (tanker services)

         Repairs

 11      Cement (for minor repairs of the dwelling)
 12      Hired labour for dwelling repairs
 13      Repairs to furniture and floor coverings

 14      Repairs to household appliances

 15      Car and truck repairs, maitenance, and other fees

         Services

 16      Lawn boys/gardeners
 17      Security guards
 18      House boys/house maids

 19      House keepers/caretakers

 20      Baby sitters, day care attendants, nannies, etc.

 21      Barbers and beauty shops

         Non-food non-durables

 22      Soaps, bleaches, disinfectants, cleaners, and toilet papers
 23      Matches and candles
 24      Insecticides - coils and sprays
         Medicine (pain killers, antibiotics, anti malaria medicines, condoms, tablets, syrups,
 25
         etc)
 26      Newspapers, magazines, and books
         Goods for personal care (toothpaste, razor blades, combs, scent sprays, cosmetics,
 27
         etc)
         Other expenses

 28      Postal, telephone, telegram, fax, internet/email, etc services and charges
 29      Pets, pet food, vetrinary services
 30      Gardening expenses (plants, pots, fertilisers, compost, etc)

 31      Entertainment

 32      Travel, transport and lodging

 31      Entertainment

 32      Travel, transport and lodging
Section 12, Part B -- Fuels Used in the Past 12 Months

                                                     Avg. value per
                                                                             Value (cedis)
                                                        months
                                            No. of
 Sl. No.                     Fuel type      months                      Home
                                             used       (cedis)
                                                                      produced/       Purchased
                                                                      collected
   1                            2             3            4             5                   6
   1       Electricity                                                *********
   2       Gas for household use                                      *********
   3       Kerosene                                                   *********
   4       Charcoal
   5       Firewood and other solid fuels
   6       Petrol                                                     *********
   7       Diesel                                                     *********
   8       Dung Cake
   9       Crop byproducts/waste
   10      Rubbish/plastic                            *********                       *********
S ection 13, Part A - Epicenter Participation
NEW - Ask for all household members



                         How far                                                                                                                                            Have y ou
                                                                                                                         Have y ou                                           attended
                         away is                                                     Did y ou   Have y ou                                         Have y ou
                                                               Do y ou                                                    donated                                               any
            Have y ou       the                                                        help      donated      If y es,                             donated
                                     How often do y ou go     serve on                                                     any of      If y es,                  If y es,   fundraiser
             heard of    nearest                                         If y es,   construct     any of        how                                 any of
                                       to the epicenter?         an                                                         y our       how                       how           s or
               the      communit                                         which          the     y our time     much                               y our land
Member ID




                                                             epicenter                                                   money to       much                      much       meetings
             Hunger          y                                            one?      epicenter      to the      hours                                 to the                             If so, how
                                     (See Time Unit Codes    committe                                                        the       money                   land have     related to
             Project?   epicenter?                                                  building?   epicenter?   have y ou                            epicenter?                              many ?
                                            Below)               e?                                                      epicenter?   have y ou                    y ou         the
                                                                         NEED                                donated?
                                                                                                                                      donated?                  donated?    epicenter?
             1 = Yes      Code                                           CODES      1 = Yes      1 = Yes                                           1 = Yes
                                                             1 = Yes                                                     1 = Yes
             2 = No      "999" if                                                   2 = No        2 = No                                           2 = No
                        not known                             2 = No                                                     2 = No (                                            1 = Yes
                                                                                                 (>> 10)                                             (14)
                                                                                                                          >>12)                                               2 = No
                                                                                                                                                                             (>>16)
                                     Number
                          Km                         Units                                                    Hours                     Cedis                   Acres
                                     of visits   4
    1           2            3                                   5           6          7            8           9           10           11          12           13           14           15

  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
TIME UNIT CODES: 1 = daily ; 2 = weekly ; 3 = fortnightly ; 4 = monthly ; 5 = quarterly ; 6 = y early
S ection 13, part a - Epicenter Participation (ctd.)
NEW - Ask for all household members

            Have y ou                                               Have y ou                  Have y ou                                                                                           Have y ou
                ever                   Have y ou                       ever                        ever                 Have y ou                                       Have y ou
                                                                                                                                       If y es, which                                               ever used
                                     ever attended                                                                       used the                             How       ever used
             attended                                                attended                   attended                                  services?                                               the day care
                                     any women's                                                                        communit                             many        the Food      If y es,                    If y es,
                any      If y es,                      If y es,    any Vision,      If y es,    any HIV     If y es,                                                                               / nursery /
                                     empowerme                                                                              y                                times        Bank at        how                         how
             literacy      how                           how       Commitme           how          and        how                    1 = Prenatal care                                              preschool
Member ID




                                      nt programs                                                                       epicenter'                         have y ou        the        many                        many
            courses at    many                          many          nt and        many         Gender      many                    2 = Postnatal care                                            services at
                 the                      at the                      Action                   Inequality have y ou      s health                           used the    communit        times                       times
                        have y ou                     have y ou                   have y ou                                          3 = immunizations                                                 the
                                      community                                                                         resources                         epicenter'         y       have y ou                    have y ou
            communit attended                         attended      workshops      attended    workshops attended                           4=                                                    community
                                       epicenter?                                                                            ?                              s health    epicenter?   used it in                  used them
                  y    in the past                   in the past       at the    in the past      at the  in the past                 pharmaceuticals                                              epicenter?
                                                                                                                                                           resources                 the past 6                  in the past
            epicenter? 6 months?                     6 months?     community     6 months?     communit 6 months?
                                       1 = Yes                                                                           1 = Yes                          in the past    1 = Yes      months?                    6 months?
                                                                    epicenter?                      y                                 (include all that                                              1 = Yes
             1 = Yes                   2 = No                                                  epicenter?                2 = No                           6 months?      2 = No
                                                                                                                                           apply )                                                 2 = No (>>
                                       (>>20)                                                                            (>>27)                                          (>>29)
              2 = No                                                1 = Yes                                                                                                                       next person)
             (>>18)                                                 2 = No                      1 = Yes
                16          17             18             19            20            21           22          23           24               25                26           27           28            29             30
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10
 11
 12
 13
 14
 15
 16
 17
 18
Section 13, part b - Empowerment (1/3)
NEW - Ask for all household members

                                                                                  Why do you think you are not                                            Why do you feel you cannot
                                                  Are there any
                                                                                    allowed to participate?       How often have you                      socialize with these people?
                                              community activities,
             In the last three                                                                                    met with and talked Are there any
                                                  such as those
              years, do you                                                       [Do not prompt, list up to 2]     to people from      people from       [Do not prompt, list up to 2]
                               In the past 12 organized by the local In which
              feel the roads                                                                                      other social groups different social
                               months, how government, religious activities
             leading to your                                                              1 = Poverty             outside your home groups that you               1 = Poverty
 Member ID




                                 many times     organizations, the   are you not
               community                                                                2 = Occupation             in the last week? feel you cannot,           2 = Occupation
                                  have you     school, etc, in which allowed to
                   have:                                                             3 = Lack of education                             or would have         3 = Lack of education
                                traveled to a you are not allowed to participate?
                                                                                           4 = Gender                1 = Not at all     difficulty in              4 = Gender
                                neighboring        participate?
              1 = Improved                                                                   5 = Age                   2 = Once       socializing with?              5 = Age
                                  village or                           NEED
              2 = Worsened                                                                6 = Religion             3 = Several times                              6 = Religion
                                    town?            1 = Yes          CODES
              3 = Remained                                                          7 = Political Affiliation          4 = Daily           1 = Yes          7 = Political Affiliation
                                                  2 = No, I can
                 the same                                                          8 = Ethnicity or language      5 = Several times a 2 = No (>>9)         8 = Ethnicity or language
                                                 participate in all
                                                                                    spoken/race/caste/tribe               day                               spoken/race/caste/tribe
                                                 activities (>>6)
                                                                                      9 = Other (specify)                                                     9 = Other (specify)
                    1               2                   3                 4                    5                           6                  7                         8
 1
 2
 3
 4
 5
 6
 7
 8
 9
10
11
12
13
14
15
16
17
18
Section 13, part b - Empowerment (2/3)
NEW - Ask for all household members

                                                                          Who do you think will       Do you feel that                                                                                                 How involved in the
                                                                          contribute most to any                                                                                                                        political process at                             How involved in
                                                                                                    people like yourself
                                                                                 change?                                                                                                                                         the                                   the political process
                                                                                                   can generally change
               Is there                                                                                                                                                                                                community/regional Were you                     at the national level
                            What thing(s)                When do you                                   things in your        Have you ever                                                Were you
             anything in                      Do you                                                                                                                                                       Did you                                        Did you       do you feel you are
                           would you most               think they will [Do not prompt, list up to community if they volunteered to help                                                  entitled to                    level do you feel   entitled to
              your life                     think these                            two]                                                                                                                   vote in the      you are at the                vote in the      at the moment?
                           like to change?                  change?                                        want to?       construct or maintain                                           vote in the                                        vote in the
 Member ID




               that you                      will ever                                                                                          What type of public   In total, how many                 last District       moment?                         last
                                                                                                                            any public good                                              last District                                          last
             would like                       change?                           1 = Myself                                                        good was it?        hours did you work                  Assembly                                        national      1 = Very involved
                               [Do not                  1 = Very soon                               1 = Yes, very easily (church, community                                               Assembly                                            national
             to change?                                                       2 = My family                                                                             constructing or                   elections? 1 = Very involved                   elections?    2 = Fairly involved
                           prompt, list up              2 = Fairly soon                            2 = Yes, fairly easily     garden, etc)?                                               elections?                                         elections?
                                              1 = Yes                         3 = Our group                                                     NEED CODES, list       maintaining these                               2 = Fairly involved                                  3 = Slightly
                           to three things]               3 = A long                                3 = Yes, but with a
               1 = Yes                      2 = No (>>                     4 = Our community                                                      all that apply         public goods?                     1 = Yes          3 = Slightly                  1 = Yes            involved
                                                          time in the                                  little difficulty         1 = Yes                                                   1 = Yes                                            1 = yes
             2 = No (>>                         14)                     5 = The local government 4 = Yes, but with a                                                                                        2 = No            involved                     2 = No      4 = Not involved at
                           NEED CODES                        future                                                          2 = No (>>18)                                                  2 = No                                             2 = no
                 14)                                                         6 = The national                                                                                                                          4 = Not involved at                                       all
                                                                                                        great deal of
                                                                               government                                                                                                                                        all                                     5 = Don't know /
                                                                                                           difficulty
                                                                           7 = Other (specify)                                                                                                                           5 = Don't know /                                     can't say
                                                                                                     5 = No, not at all
                                                                                                                                                                                                                              can't say
                  9              10             11            12                    13                      14                    15                    16                    17               18            19                20               21           22                 23
1
 2
3
 4
5
 6
7
 8
9
10
11
12
13
14
15
16
17
18
Section 13, part b - Empowerment (3/3)
NEW - Ask for all household members

                                            When decisions are made regarding aspects of household life, who
                                                                                                                                                                              To what degree do you
              How much                                  is it that normally makes the decision?
                                                                                                                                                                               feel you have control Where do you
             choice do you  How easy                                                                             To what degree do you feel you can make your own personal
                                                                                                                                                                                   over decisions     go on your
             feel you have would it be to                       1 = Male head of household                            decisions regarding these issues if you want to?          regarding your own      own?
              in deciding  change your                      2 = Adult male household members                                                                                     personal welfare,
                  your     occupation if
 Member ID




                                                               3 = Female head of household                                      1 = To a very high degree                       health and body?
              occupation? you wanted to?                                                                                                                                                            1 = Everywhere
                                                           4 = Adult female household members                                    2 = To a fairly high degree
                                                                                                                                                                                                       I want to
                                                         5 = Male and female heads of households                                   3 = To a small degree                        1 = To a very high
             1 = Complete 1 = Very easy                                                                                                                                                             2 = Most places
                                                            6 = All adult members of household                                         4 = Not at all                                degree
                 choice   2 = Fairly easy                                                                                                                                                              I want to
                                                     7 = All members of household, including children                                                                          2 = To a fairly high
               2 = Some    3 = Not very                                                                                                                                                                3 = Some
                                                                     8 = Other (specify)                                                                                             degree
                 choice        easy
                                                                                                                                                                              3 = To a small degree places I want to
                3 = No    4 = Impossible
                                            Household      Education     Political    Marriage    Religious /   Household     Education    Political   Marriage   Religious /     4 = Not at all     4 = Nowhere
                 choice
                                            expenditure    and Health    Decisions    Choices      Beliefs      expenditure   and Health   Decisions   Choices     Beliefs
                  24             25             26             27            28          29             30          31            32           33          34         35               36                  37

  1
   2
  3
   4
  5
   6
  7
   8
  9
10
11
12
13
14
15
16
17
18
Section 13, Part c – Community Participation
Ask of each household member                                                      Give household polling site (from village survey)
                                                                                                                                                                  CODE FOR
                                                                                                                                     How much does What is the    COLUMN 4:
                           List the social,                                                                                          being a member     most      1 = road or
                                                 Did you attend the                                                  How well do                                  transport
                       political, and religious                        If yes, did What was/were                                     of these groups important
                                                  previous village                                                  you think your                                 2 = health
                       organizations that you                          you speak    this issue(s)? Did you vote in                     benefit you benefit that
 Organization Number




                                                assembly meeting on                                                     current                                   3 = education
                       belong / participate in                         about any                    the previous                      individually?   you feel
                                                      [date]?                                                      representative is                              4 = irrigation or
                                                                      issue at the  (see codes at    election on                                      you gain
                                                                                                                        doing?                                    water
                              (give the                                 meeting?         right)        [date]?                         1 = Greatly from being
                                                     1 = yes                                                         1 = excellent                                 5 = other
                       Organization ID from                                                                                             2 = Fairly   a member
                                                     2 = no                                                         2 = very good                                 agriculture
                       organization roster in                            1 = yes        list all,      1 = yes                          3 = A little  of these
                                                                                                                      3 = average                                 related
                          village survey)                                2 = no    separating with     2 = no                         4 = Not at all  groups?
                                                 (give date from                                                        4 = bad                                   6 = ceremonies
                                                                      (if no >> 5)     commas                                         (If 4, >> next
                                                 village survey)                                                     5 = very bad                                 7=disputes
                                                                                                                                        household      NEED
                                                                                                                                                                  8 = sanitation
                                                                                                                                         member)      CODES
                                                                                                                                                                   9=
                                                                                                                                                                  construction
                                 1                      2                 3              4                5                 7              8             9
                                                                                                                                                                  other than
                   1                                                                                                                                              roads or
                   2                                                                                                                                              irrigation
                                                                                                                                                                  10 = access to
                   3
                                                                                                                                                                  and use of lands
                   4                                                                                                                                              of the assembly
                   5                                                                                                                                              11 =
                   6                                                                                                                                              unemployment
                                                                                                                                                                  schemes
                   7                                                                                                                                              12 = other
                   8                                                                                                                                              (specify)
                   9
         10
         11
         12
         13
         14
         15
         16
         17
         18
                                                                                        section 14 digits1

Section 14, Part a: Digit Span Cognitive Assessment
Complete for each child under ages 5 - 12 in the household. Complete Part 1 first.

Child name:____________________________________                              Child Household ID:_____________________

Instructions:
(1) Read each digit span only once at an even rate of one digit per second.
(2) Read Part A of a question; pause for response, then score.
(3) Read Part B of a question; pause for response; then score.
(4) If child does not respond after reading the question, do not encourage further.
(5) Stop when child misses Part A and Part B of any one question.
(6) To be scored as "correct", no digits may be omitted or be in reversed order.


Part 1: Digits Forward

Read outloud to child: "I can only read these instructions to you one time. I cannot
repeat them. I am going to say some numbers. Listen carefully, and when I am through,
say them right after me"
0. Exact Time Now ______________________
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q1(a) "2-9"
Q1(b) "4-6"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q2(a) "3-8-6"
Q2(b) "6-1-2"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q3(a) "3-4-1-7"
Q3(b) "6-1-5-8"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q4(a) "8-4-2-3-9"
Q4(b) "5-2-1-8-6"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q5(a) "3-8-9-1-7-4"
Q5(b) "7-9-6-4-8-3"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q6(a) "5-1-7-4-2-3-8"
Q6(b) "9-8-5-2-1-6-3"
      If the child got both questions wrong >> Part 2
                                 Correct response:
                                 1 = Child repeated the numbers exactly
                                 0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q7(a) "1-6-4-5-9-7-6-3"
Q7(b) "2-9-7-6-3-1-5-4"
      If the child got both questions wrong >> Part 2
                              Correct response:
                              1 = Child repeated the numbers exactly
                              0 = Child did not repeat the numbers
       Say "Ready", then say: exactly
Q8(a) "5-3-8-7-1-2-4-6-9"
Q8(b) "4-2-6-9-1-7-8-3-5"
      >> Part 2



                                                                                            Page 126
                                                                                         digits2

Section 14, Part a: Digit Span Cognitive Assessment (concluded)
Complete for each child under ages 5 - 12 in the household. Complete Part 1 first.

Part 2: Digits Backward

Read outloud to child: "Now, I am going to say some more numbers, but this time
when I stop, I want you to say them backward. For example, If I say 9-2-7, what
would you say?"

If child says "7-2-9", say: "That's right. Let's go on with the rest of the numbers"

If child does not say "7-2-9", say: "No, you would say 7-2-9. I said 9-2-7, so to say
it backwards you would say 7-2-9. Now try these numbers. Remember to say them
backward."

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO       answer exactly
                 Say "Ready", then      NOT READ         0 = Child did not repeat the
                       say:                              answer exactly
Q9(a)           "2-5"                "5-2"
Q9(b)           "6-3"                 "3-6"
                If the child got both questions wrong >> Question 16

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO       answer exactly
                 Say "Ready", then      NOT READ         0 = Child did not repeat the
                       say:                              answer exactly
Q10(a)          "5-7-4"              "4-7-5"
Q10(b)          "2-5-9"               "9-5-2"
                If the child got both questions wrong >> Question 16

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO
                                                         answer exactly
                                        NOT READ
                 Say "Ready", then                       0 = Child did not repeat the
                       say:                              answer exactly
Q11(a)          "7-2-9-6"            "6-9-2-7"
Q11(b)          "8-4-9-3"             "3-9-4-8"
                If the child got both questions wrong >> Question 16


                                                         Correct response:
                                        Answer: DO       1 = Child repeated the
                                        NOT READ         answer exactly
                 Say "Ready", then                       0 = Child did not repeat the
                       say:                              answer exactly
Q12(a)          "4-1-3-5-7"          "7-5-3-1-4"
Q12(b)          "9-7-8-5-2"           "2-5-8-7-9"
                If the child got both questions wrong >> Question 16

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO
                                                         answer exactly
                                        NOT READ
                 Say "Ready", then                       0 = Child did not repeat the
                       say:                              answer exactly
Q13(a)          "1-6-5-2-9-8"        "8-9-2-5-6-1"
Q13(b)          "3-6-7-1-9-4"         "4-9-1-7-6-3"
                If the child got both questions wrong >> Question 16

                                                         Correct response:
                                                         1 = Child repeated the
                                        Answer: DO       answer exactly
                Say "Ready", then       NOT READ         0 = Child did not repeat the
                        say:                             answer exactly
Q14(a)          "8-5-9-2-3-4-2"       "2-4-3-2-9-5-8"
Q14(b)          "4-5-7-9-2-8-1"       "1-8-2-9-7-5-4"
                If the child got both questions wrong >> Question 16


                                                         Correct response:
                                        Answer: DO       1 = Child repeated the
                                        NOT READ         answer exactly
                 Say "Ready", then                       0 = Child did not repeat the
                       say:                              answer exactly
Q15(a)          "6-9-1-6-3-2-5-8" "8-5-2-3-6-1-9-6"
Q15(b)          "3-1-7-9-5-4-8-2" "2-8-4-5-9-7-1-3"

16: Exact Time Now ______________________


                                                                                        Page 127
Section 14, Part b: Raven's Pattern Cognitive Assessment (page 1 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)
Record below the pictures which shape the child pointed to.

Example
Show the child the picture and then point to shape d
Section 14, Part b: Raven's Pattern Cognitive Assessment (page 2 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK1. Shape pointed to ______________________                                                     EK2. Shape pointed to ____________________________
Section 14, Part b: Raven's Pattern Cognitive Assessment (page 3 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK3. Shape pointed to ______________________                                                     EK4. Shape pointed to ____________________________
Section 14, Part b: Raven's Pattern Cognitive Assessment (page 4 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK5. Shape pointed to ______________________                                                     EK6. Shape pointed to ____________________________
Section 14, Part b: Raven's Pattern Cognitive Assessment (page 5 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK7. Shape pointed to ______________________                                                     EK8. Shape pointed to ____________________________
Section 14, Part b: Raven's Pattern Cognitive Assessment (page 6 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK9. Shape pointed to ______________________                                                     EK10. Shape pointed to ____________________________
Section 14, Part b: Raven's Pattern Cognitive Assessment (page 7 / 7)
Complete for each child under ages 5 - 12 in the household.

                               Child Household ID:_____________________
Child name:____________________________________

Instructions:
Show the picture below to the child and have them point to one of the shapes labeled (a) - (f)




EK11. Shape pointed to ______________________                                                    EK12. Shape pointed to ____________________________

								
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