Document Sample
					Draft 1

HOUSEHOLD QUESTIONNAIRE 1. Identification Data 1. 1Ref No----------------------------------------------1.2 Full Name of Household Head-----------------------------------------------1.3 Ethnicity-------------------------1.4 Gender---------------1.5 Place of Birth-----------------1.6 Where else have you lived-----------------------------------------------------1.7 Name of Interviewers---------------------------------------------------------1.8 Date of Interview----------------------------------1.9 Name of Village------------------------------------1.10 Type of Community: Village/Colony/Resettlement/Relocated Population/ Encroachment/ Other Specify------------------------------------------------------------------1.11 GS Division------------------------ 1.12 DS Division---------------------------------------2. Household Composition Relation to HH 1 2 3 4 5 6 7 8 9 10 11 12 13 Age Education Level In/Out Primary Secondary School Occupation Occupation Dependency Disability


3. Housing and Assets 3. 1Type of house (permanent, semi-permanent, temporary or under construction)

3.2 Latrine Type (None, Pit or Water seal)

3.3 Do you have electricity?

3.4 Extent of land owned or operated.   paddy highland

3.5 No of livestock  Cattle  Poultry  Goats  Pigs  Other, specify 3.6 Assets       Bicycle Tractor Sprayer Fishing gear, specify Radio TV


4. Income Transfers/ Subsidies

Type of Subsidy Type of Support Samurdhi Public Assistance Dry Rations, specify Other, Specify

Volume of Support

HH Members Covered

If not covered why

5. Livelihood Strategies 5.1 Crops grown, income, contribution to food supply and any constrains experienced (eg. Irrigation facilities)

5.2 Any livestock raised, income, contribution to food supply and any constrains experienced

5.3 Contribution of any forest products or game to income and/or food supply

5.4 Contribution of following categories of employment/income to household income       middle-east employment employment in factories casual wagelabour security forces home guards remittances

6. Diet/Hunger 6.1 No of meals per day 6.2 Describe your typical    Breakfast Lunch Dinner 3

6.3 Any Food Taboos in the household 6.4 Are there times when you do not have enough food? When and why? 6.5 Are there times when you do not have enough money to buy food? When and why? 6.6 How often does the household consume the following food items      milk fish/dried fish meat eggs cooking oil

6.7 Is there any malnutrition within the household, who and why? 6.8 Details of any illnesses that can be attributed to malnutrition?

7. Food Security 7.1 How many months is your household food production usually sufficient for? 7.2 How many months was your production sufficient last year? 7.3 Which months did you experience food shortages last year?













7.4 What were the three most important causes of food shortages? 1. 2. 3. 8. Violence-related Outcomes 8.1 Details of any deaths or injury within the household due to war or other forms of violence during the past 10 years 8.2 Did you experience any displacement over the past 10 years? If so give details as to how it happened, when and why?


8.3 Did you experience any loss of livelihoods due to war or any other forms of conflict? If so give details as to when it happened, why and cost of looses incurred 8.4 Details of any alcohol or drug use within the household and its impact on household expenditure pattern and household harmony

9. Coping Strategies 9.1 If there is not enough food within the household, which household members get priority and why? 9.2 Do you typically obtain food on credit, from what sources and under what terms and conditions? 9.3 Assistance received from family, small groups, government agencies, NGOs and any other organizations to overcome food insecurity 9.4 Have you ever sold/mortgaged household assets to meet household emergencies? If so give details. 9.5 What did the household do in response to food shortages last year?

1. Ate fewer meals/went hungry 2.Food substitution 3. Borrowed from relatives/friends 4. Credit 5. Migration 6. Changed jobs 7. Redistributeed family members 8. Sold household assets 9. Sold livestock 10. Mortgaged assets/livestock 11. Food stamps 12. Food aid 13. Begging 14. Other, specify

Yes/No Yes/No

10. Perceptions 10.1 What are the constraints that your household experience in having an adequate supply of food throughout the year?


10.2 How do you plan to overcome these constraints? 10.3 What additional services do you expect from community organizations? 10.4 What additional services do you expect from the central government? 10.5 What additional services do you expect from local government entities? 10.6 What additional services do you expect from NGOs?

10.7 Have things got better, worse or remained the same for you as regards food security over the past 10 years?

10.8 What has improved over tha past 10 years?

10.9 What has got worse over the past 10 years?

11. Interviewer Comments