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URBAN INDIVIDUAL QUESTIONNAIRE-Education 1 Panel Study 2009- Urban Individual Questionnaire INDIVIDUAL questionnaire Serial No. a State khepyk; Tamil Nadu jkpH;ehL 33 b District name and CODE khtl;lk; bgah; kw;Wk; FwpaPL ________________________________________ c CD Block name and CODE Rpo gpshf; bgah; kw;Wk; FwpaPL ________________________________________ d Taluk/PS name and CODE jhYfh-gpv!; bgah; kw;Wk; FwpaPL ________________________________________ e Town NAME and Census CODE rpWefuk; efuk; , fbzf;bfLg;g[ 2001 rpWefu FwpaPL ________________________________________ f Investigator Unit (IV) No. ,d;bt!;onfl;lu; a{dpl; (Itp) vz; g UFS Block within IV Unit Itp a{dpl;od; cs; a{ v`g; v!; g;shf; vz; h Sample UFS Block Number (Sl.no) rhk;gps; a{ v`g; v!; g;shf; vz; i HH questionnaire Serial No. FLk;g gotj;jpd; thpir vz; j Household Sampling ID (Sl. No) CO FROM COLUMN 4, LISTING QUESTIONNAIRE FLk;gjpd; rhk;gpsp;’; milahs vz; (tupir vz;) yp!;o’; nfs;tpjhspy; tupir 4 y;ypUe;J vLj;J vGjt[k; k Member NAME: cWg;gpdu; bgau; : l Member ID: cWg;gpdu; milahs vz; m Member Age cWg;gpdu; taJ n Member Sex cWg;gpdu; ghypdk; Male Mz; 01 Female bgz; 02 o Member Education cWg;gpdu; fy;tp jFjp p Member Occupation cWg;gpdu; bjhHpy; ; q Respondent Name: gjpyspg;gthpd; bgah; r Respondent ID: gjpyspg;gthpd; milahs vz; s IF PROXY: Reason khw;W eguhf ,Ug;gpd; : khw;W egiuj; nju;t[ bra;jjw;fhd fhuzj;ijf; Fwpg;gplt[k; ? PROXY CODE khw;W egu; FwpaPL

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Page 1: 1 EDUCATION Urban FINAL-June 28 correction formatting …1 URBAN INDIVIDUAL QUESTIONNAIRE-Education Panel Study 2009- Urban Individual Questionnaire INDIVIDUAL questionnaire Serial

URBAN INDIVIDUAL QUESTIONNAIRE-Education 1

PPaanneell SSttuuddyy 22000099-- UUrrbbaann

Individual Questionnaire

INDIVIDUAL questionnaire Serial No.

a State khepyk;

Tamil Nadu jkpH;ehL 33

b District name and CODE khtl;lk; bgah; kw;Wk; FwpaPL

________________________________________

c CD Block name and CODE Rpo gpshf; bgah; kw;Wk; FwpaPL

________________________________________

d Taluk/PS name and CODE

jhYfh-gpv!; bgah; kw;Wk; FwpaPL

________________________________________

e Town NAME and Census CODE rpWefuk; efuk;, fbzf;bfLg;g[ 2001 rpWefu FwpaPL

________________________________________

f Investigator Unit (IV) No.

,d;bt!;onfl;lu; a{dpl; (Itp) vz;

g UFS Block within IV Unit

Itp a{dpl;od; cs; a{ v`g; v!; g;shf; vz;

h

Sample UFS Block Number (Sl.no)

rhk;gps; a{ v`g; v!; g;shf; vz;

i HH questionnaire Serial No. FLk;g gotj;jpd; thpir vz;

j Household Sampling ID (Sl. No) CO FROM COLUMN 4, LISTING QUESTIONNAIRE FLk;gjpd; rhk;gpsp;’; milahs vz; (tupir vz;) yp!;o’; nfs;tpjhspy; tupir 4 y;ypUe;J vLj;J vGjt[k;

k Member NAME:

cWg;gpdu; bgau; :

l Member ID:

cWg;gpdu; milahs vz;

m Member Age cWg;gpdu; taJ

n Member Sex

cWg;gpdu; ghypdk; Male Mz; 01

Female bgz; 02

o Member Education cWg;gpdu; fy;tp jFjp

p Member Occupation cWg;gpdu; bjhHpy; ;

q Respondent Name: gjpyspg;gthpd; bgah;

r Respondent ID:

gjpyspg;gthpd; milahs vz;

s IF PROXY: Reason

khw;W eguhf ,Ug;gpd; : khw;W egiuj; nju;t[ bra;jjw;fhd fhuzj;ijf; Fwpg;gplt[k; ? PROXY CODE

khw;W egu; FwpaPL

Page 2: 1 EDUCATION Urban FINAL-June 28 correction formatting …1 URBAN INDIVIDUAL QUESTIONNAIRE-Education Panel Study 2009- Urban Individual Questionnaire INDIVIDUAL questionnaire Serial

URBAN INDIVIDUAL QUESTIONNAIRE-Education 2

SURVEY PARTICULARS ru;nt gw;wpa tptu’;fs;ru;nt gw;wpa tptu’;fs;ru;nt gw;wpa tptu’;fs;ru;nt gw;wpa tptu’;fs;

t INTERVIEWER NAME: ngl;obaLg;gtupd; bgah;

______________________________________

u Name of Head of Household FLk;gj;jiytupd; bgah;

_______________________________

v

Interview Dates and Time ngl;o fz;l njjpfs; kw;Wk; VLj;Jf;bfhz;l neuk;

1st Day Month Year njjp khjk; tUlk;

Hr Min kzp epkplk;

2nd Day Month Year

njjp khjk; tUlk; Hr Min kzp epkplk;

3rd Day Month Year

njjp khjk; tUlk; Hr Min kzp epkplk;

4th Day Month Year

njjp khjk; tUlk; Hr Min kzp epkplk;

To be filled after completing survey: rh;ntia Koj;j gpwF . ,e;jg; gFjp epurh;ntia Koj;j gpwF . ,e;jg; gFjp epurh;ntia Koj;j gpwF . ,e;jg; gFjp epurh;ntia Koj;j gpwF . ,e;jg; gFjp epug;gg;gl ntz;Lk;g;gg;gl ntz;Lk;g;gg;gl ntz;Lk;g;gg;gl ntz;Lk;

A

INTERVIEWER Signature if survey complete rh;nt KGtJk; Kof;fg;gl;lhy; ngl;obaLg;gtupd; ifbaGj;J

__________________________________________

Code FwpaPL

B

Is this interview is accompanied by supervisor / Executive / Others? ,e;jg;ngl;oapd; nghJ nkw;ghh;itahsu; cld; brd;whuh >

Yes Mk; 01 Name________________ bgau;

Code FwpaPL

No ,y;iy 02

C

Is this interview is accompanied by CMF Quality Monitor? ,e;j ngl;oapd; nghJ rpvk; v`g; Fthypl;o khdpl;lh; cld; brd;whuh >

Yes Mk; 01 Name________________ bgau;

Code FwpaPL

No ,y;iy 02

D

Whether questionnaire was scrutinised nfs;tpj;jhs; Kiwahf rupghh;f;fg;gl;ljh>

Yes Mk; 01 Name________________ bgau;

Code FwpaPL No ,y;iy 02

E

Whether Back Checked by supervisor / Executive / Others? nkw;ghh;itahsuhy; ngf; brf; bra;ag;gl;ljh>

Yes Mk; 01 Name________________ bgau;

Code FwpaPL No ,y;iy 02

F

Whether Back Checked by CMF Quality Monitor? rpvk; v`g; Fthypl;o khdpl;luhy; ngf; brf; bra;ag;gl;ljh>

Yes Mk; 01 Name________________ bgau;

Code FwpaPL

No ,y;iy 02

G

Whether survey needs to be sent back toHH ,e;j rh;nt FLk;gj;jpw;F jpUg;gp mDg;gg;gl ntz;oa njit ,Uf;fpwjh >

Yes Mk; 01 Name________________ bgau;

Code FwpaPL

No ,y;iy 02

H

Whether the survey has been sent back to the HH and all mistakes corrected? ,e;j rh;nt. FLk;gj;jpw;F jpUg;gp mDg;gg;gl;ljh kw;Wk; midj;J jtWfSk; rup bra;ag;gl;ljh>

Yes Mk; 01 Name________________ bgau;

Code FwpaPL Date____________ Njjp

No ,y;iy 02

Data Entry Details: g[s;sp tpgug; gjpt[f; Fwpg;g[f;fs; g[s;sp tpgug; gjpt[f; Fwpg;g[f;fs; g[s;sp tpgug; gjpt[f; Fwpg;g[f;fs; g[s;sp tpgug; gjpt[f; Fwpg;g[f;fs;

i. 1st Data Entry Kjy; tpgug;gjpt[

Operator name__________ gjpt[ bra;jtu; bgau;

Operator Code gjp[t[ bra;jtu; FwpaPL

Date_____ njjp

ii. 2nd Data Entry ,uz;lhtJ tpgug;gjpt[

Operator name__________ gjpt[ bra;jtu; bgau;

Operator Code gjp[t[ bra;jtu; FwpaPL

Date______ Njjp

iii.

Whether Random Checked nuz;lk; nrhjid bra;ag;gl;ljh

Yes Mk; 01

Sup Name _________________ nkw;ghu;itahsu; bgau;

Sup Code nkw;ghu;itahsu; FwpaPL

Date______ Njjp

No ,y;iy 02

Page 3: 1 EDUCATION Urban FINAL-June 28 correction formatting …1 URBAN INDIVIDUAL QUESTIONNAIRE-Education Panel Study 2009- Urban Individual Questionnaire INDIVIDUAL questionnaire Serial

URBAN INDIVIDUAL QUESTIONNAIRE-Education 3

Section 1: EDUCATION f¯É¢r«gªjkhd jft¯f²f¯É¢r«gªjkhd jft¯f²f¯É¢r«gªjkhd jft¯f²f¯É¢r«gªjkhd jft¯f²

Q.no Questions Options Codes Skips

1001.

INVESTIGATOR: Is [NAME] 5 years or older? ngl;obaLg;gth; ? (bgah;) 5 taJ my;yJ mjw;fjpf taJs;stuh>

Yes Mk; 01

No ,y;iy 02 ����1134

1002.

Can [NAME] read (for example, a small book or newspaper)?

(bgah;) gof;f bjhpa[kh> (cjhuzkhf rpwpa g[j;jfk; my;yJ bra;jpj;jhs;)

Yes Mk; 01

No ,y;iy 02

1003. Can [NAME] write (for example, a short letter)? (bgah;) vGj Koa[kh (cjhuzkhf rpwpa th®¤ij)

Yes Mk; 01

No ,y;iy 02

1004.

Did [NAME] ever attend pre – school? (bgah;) vg;bghGjhtJ g;uP !;Ty; (gh¯tho) goj;jpUf;fpÕ®fsh> Yes Mk; 01

No ,y;iy 02 ���� 1006

1005. If Yes, age began Pre- School Mk; vdpy;. g;uP !;Ty; (gh¯tho) nrU«nghJ nghJ taJ vd;d>

Age in completed years Kotile;j tUl';fspy; taJ

1006. Has [NAME] ever attended school or College? (bgah;) vg;bghGjhtJ gs;sp - fy;Y}upƯ go¤½U¡»Õ®fsh>

Yes Mk; 01

No ,y;iy 02 ���� 1132

1007. What age did [NAME] begin school? [not includ pre-school] (bgah;); ve;j tajpy; gs;spg;gog;ig Muk;gpj;jPh;fs;> (g;uP !;Ty; (gh¯tho) brd;wij nrh;f;fhky;)

Age in completed years Kotile;j tUl';fspy; taJ

1008. Has [NAME] ever repeated a grade? (bgah;) vg;bghGjhtJ xnu tFg;ig kPz;Lk; goj;jhuh>

Yes Mk; 01

No ,y;iy 02 ���� 1010

1009. How many times has [NAME] repeated a grade? (bgah;) vj;jid jlitfs; xnu tFg;ig kPz;Lk; goj;jPh;fs;>

No. of times jlitfspd; vz;zpf;if

1010.

How many years did [NAME] spend studying, [not including preschool,breaks in education, including repeats of grades?] g;uP !;Ty; (gh¯tho) gog;igr; nrh;f;fhky; kw;Wk; fy;tpapy; V¦g£l ,ilbtsp fhy¤ij¢ nrh;f;fhky;;. Mdhy; xnu tFg;ig kPz;Lk; goj;jtw;iwr; nrh;j;J (bgah;) bkhj;jj;jpy; vj;jid tUl';fs; gog;gjpy; brytHpj;jPh;fs;>

No. of Years tUl';fspd; vz;zpf;if

1011.

Did[NAME] attend school or college during last12 months? (bgah;) fle;j 12 khj';fspd; nghJ vg;bghGjhtJ gs;sp my;yJ fy;Y}upf;Fr; brd;wpUf;fpÕ®fsh>

Yes Mk; 01 ���� 1013

No ,y;iy 02

1012.

What is the highest level [NAME] has achieved? (bgah;) ; m½fg£r« goj;j gog;g[ vd;d>

1st standard 1tJ tFg;g[ 01

����1014

2nd standard 2tJ tFg;g[ 02

3rd standard 3tJ tFg;g[ 03

4th standard 4tJ tFg;g[ 04

5th standard 5tJ tFg;g[ 05

6th standard 6tJ tFg;g[ 06

7th standard 7tJ tFg;g[ 07

8th standard 8tJ tFg;g[ 08

9th standard 9tJ tFg;g[ 09

10th standard / SSLC

10tJ tFg;g[-v³v³v¯¼

10

11th standard / Junior college

11tJ tFg;g[-,isat®f² f¯òÇ 11

12th std /HSC/ Junior college

12 tJ tFg;g[- nky; epiyg;gs;sp -

,isat®f² f¯òÇ 12

Diploma Course g£la go¥è 13

����1087

Degree g£l go¥è 14

Post Graduation g£l nk¦ go¥è 15

Professional Degree

bjhʯ be¿"u;f² g£l go¥è 16

Professional Post Graduation

bjhʯ be¿"u;f² g£l nk¦ go¥è 17

Certificate course rh¬¿j± go¥è 18 Others (Specify)

______________ kw;wit (Fwpg;gplt[k;) 19

Page 4: 1 EDUCATION Urban FINAL-June 28 correction formatting …1 URBAN INDIVIDUAL QUESTIONNAIRE-Education Panel Study 2009- Urban Individual Questionnaire INDIVIDUAL questionnaire Serial

URBAN INDIVIDUAL QUESTIONNAIRE-Education 4

Q.no Questions Options Codes Skips

1013.

What is the level [NAME] are Currently attending / attended in the last 12 months? (bgah;); jw;rkak; vd;d goj;Jf; bfhz;oUf;fpwPh;fs; - fle;j 12 khj';fspy; vd;d goj;jPh;fs;> jw;rkak; goj;J bfhz;oUg;gij itj;jw;rkak; goj;J bfhz;oUg;gij itj;jw;rkak; goj;J bfhz;oUg;gij itj;jw;rkak; goj;J bfhz;oUg;gij itj;J J J J mLj;J mLj;J mLj;J mLj;J nfl;fntz;oa nfl;fntz;oa nfl;fntz;oa nfl;fntz;oa gFjpia Kot[ bra;J bfhs;gFjpia Kot[ bra;J bfhs;gFjpia Kot[ bra;J bfhs;gFjpia Kot[ bra;J bfhs;st[k;st[k;st[k;st[k;

1st standard 1tJ tFg;g[ 01

����1014

2nd standard 2tJ tFg;g[ 02

3rd standard 3tJ tFg;g[ 03

4th standard 4tJ tFg;g[ 04

5th standard 5tJ tFg;g[ 05

6th standard 6tJ tFg;g[ 06

7th standard 7tJ tFg;g[ 07

8th standard 8tJ tFg;g[ 08

9th standard 9tJ tFg;g[ 09

10th standard / SSLC

10tJ tFg;g[-v³v³v¯¼

10

11th standard / Junior college

11tJ tFg;g[-,isat®f²

f¯òÇ 11

12th std /HSC/ Junior college

12 tJ tFg;g[- nky;epiyg; gs;sp

- ,isat®f² f¯òÇ

12

Diploma Course g£la go¥è 13

���� 1087

Degree g£l go¥è 14

Post Graduation g£l nk¦ go¥è 15

Professional Degree

bjhʯ be¿"u;f² g£l

go¥è 16

Professional Post Graduation

bjhʯ be¿"u;f² g£l

nk¦ go¥è

17

Certificate course rh¬¿j± go¥è 18

Others (Specify) ______________

kw;wit (Fwpg;gplt[k;) 19

RESPONDENTS WITH 12TH STANDARD SCHOOL OR BELOW ngl;obfhLg;gthpd;ngl;obfhLg;gthpd;ngl;obfhLg;gthpd;ngl;obfhLg;gthpd; fy;tp 12tJ tFg;g[ fy;tp 12tJ tFg;g[ fy;tp 12tJ tFg;g[ fy;tp 12tJ tFg;g[ my;yJmy;yJmy;yJmy;yJ mjw;F mjw;F mjw;F mjw;F ѱѱѱѱ

(If not currently enrolled, refer to school last attended) ((((jw;rkak; gs;spƯ goj;Jbfh¬oU¡ftpy;iy vdpy;. filrpahfg; goj;j gs;spia nk¦nfh²jw;rkak; gs;spƯ goj;Jbfh¬oU¡ftpy;iy vdpy;. filrpahfg; goj;j gs;spia nk¦nfh²jw;rkak; gs;spƯ goj;Jbfh¬oU¡ftpy;iy vdpy;. filrpahfg; goj;j gs;spia nk¦nfh²jw;rkak; gs;spƯ goj;Jbfh¬oU¡ftpy;iy vdpy;. filrpahfg; goj;j gs;spia nk¦nfh² fh£læ«)fh£læ«)fh£læ«)fh£læ«)

1014. INVESTIGATOR: DID [NAME] complete 10TH standard? ngl;obaLg;gtUf;F ? (bgah;) 10tJ tFg;g[ Koj;jhuh>

Yes Mk; 01 No ,y;iy 02 ����1019

1015. Did [NAME] take a 10th standard test? 10tJ tFg;g[ njh;t[ vG½Û®fsh>

Yes Mk; 01

No ,y;iy 02 ����1019

1016.

What type of test? njh;tpd; tif vd;d>

State board (SSLC) khepyf; fy;tp thupak; 01

Matriculation bkl;upFny&d; 02

Central board (CBSE) kj;jpaf; fy;tp thupak; (rpgpv!;,) 03

Anglo Indian (AISC) M';fpnyh ,e;jpad; 04

Others (Specify) _______________ kw;wit (Fwpg;gplt[k;) 05

1017. What was the total mark scored on this 10th standard test? ,ªj 10tJ tFg;g[ njh;tpy; th§»a bkhj;j kjpg;bgz; v¬d>

Total marks scored th§»a bkhj;j kjpg;bgz;

1018. What was the Score on this 10th standard test in maths? ,ªj 10tJ tFg;g[ njh;tpy; fzpjj;jpy; th’;fpa kjpg;bgz; v¬d>;

Marks kjpg;bgz;

1019.

What is/was the primary language of instruction? [spoken language of teaching] Kjd;ikahd f¦¾¡F« bkhHp vd;dthf cs;sJ - vd;dthf ,Ue;jJ> (f¦¾¡F« nghJ ngr[k; bkhHp)

Tamil jkpH; 01 English M';fpyk; 02

Hindi ,e;jp 03 Telugu bjY';F 04

Kannada fd;dlk; 05 Malayalam kiyahsk; 06

Urudu cUJ 07 Others (specify)_____________

kw;wit (Fwpg;gplt[k;) 08

Page 5: 1 EDUCATION Urban FINAL-June 28 correction formatting …1 URBAN INDIVIDUAL QUESTIONNAIRE-Education Panel Study 2009- Urban Individual Questionnaire INDIVIDUAL questionnaire Serial

URBAN INDIVIDUAL QUESTIONNAIRE-Education 5

Q.no Questions Options Codes Skips

1020.

What is/was the language of the textbooks? ghlg;g[j;jf';fspd; bkhHp vd;dthf cs;sJ - vd;dthf ,Ue;jJ>

Tamil jkpH; 01

English M';fpyk; 02

Hindi ,e;jp 03

Telugu bjY';F 04

Kannada fd;dlk; 05

Malayalam kiyahsk; 06

Urudu cUJ 07

Others (specify)_____________ kw;wit (Fwpg;gplt[k;) 08

1021.

What is/was the second language studied? ,uz;lhtjhf gof;fg;gl;l bkhHp vd;dthf cs;sJ - vd;dthf ,Ue;jJ>

Tamil jkpH; 01 English M';fpyk; 02

Hindi ,e;jp 03 Telugu bjY';F 04

Kannada fd;dlk; 05 Malayalam kiyahsk; 06

Urudu cUJ 07 Others (specify)

_____________

kw;wit (Fwpg;gplt[k;)

08

No second language ,uz;lhtJ bkhHp vJæ« ,¯iy

09 ����1023

1022.

How many hours per week do/did [NAME]second language (Round to closest ½ hour)? (bga®) xU thuj;jpy; vj;jid kzp neu';fSf;F me;j ,uz;lhtJ bkhHpiag; gof;fpwPh;fs;? (brh¯y¥gL« fhy msɯ mUfhikƯ c²s 1-2 k neu¤½¦F fz¡»læ«)

Hours kzp neu';fs;

1023.

What type of management is/was this school? ,e;j gs;sp vd;d tifahd Ãh;thf¤½¬ ѱ cs;sJ - ,Ue;jJ>

Dept of education fy;tpj;Jiw 01

tribal/social welfare dept gH';Foapdh; - rK:f eyj;Jiw 02

local body school cs;shl;rp mikg;g[ gs;sp 03

private aided school muR cjtp bgWk; jdpahh; gs;sp 04

private unaided school muR cjtp bgwhj jdpahh; gs;sp 05

other recognized schools kw;w m';fPfupf;fg;gl;l gs;spfs; 06

unrecognized schools – religious m';fPfupf;fg;glhj gs;spfs; ? kjk;

rk;ge;jg;gl;lit 07

Other unrecognized schools kw;w m';fPfupf;fg;glhj gs;spfs; 08

other (specify) __________________

kw;wit (Fwpg;gplt[k;) 09

1024.

What was / is the educational system followed? gpd;gw;wg;gLk; fy;tp Kiw[ vd;dthf ,Ue;jJ - cs;sJ>

State board khepyf; fy;tp thupak; 01

Matriculation bkl;upFny&d; 02

Central board (CBSE) kj;jpaf; fy;tp thupak; (rpgpv!;,) 03

Anglo Indian (AISC) M';fpnyh ,e;jpad; 04

Others (Specify)

_______________ kw;wit (Fwpg;gplt[k;)

05

Page 6: 1 EDUCATION Urban FINAL-June 28 correction formatting …1 URBAN INDIVIDUAL QUESTIONNAIRE-Education Panel Study 2009- Urban Individual Questionnaire INDIVIDUAL questionnaire Serial

URBAN INDIVIDUAL QUESTIONNAIRE-Education 6

Q.no Questions Options Codes Skips

1025.

NAME AND LOCATION OF SCHOOL gs;spapd; bgah; gs;spapd; bgah; gs;spapd; bgah; gs;spapd; bgah; kw;Wk; miktplk;kw;Wk; miktplk;kw;Wk; miktplk;kw;Wk; miktplk;

a. Name of school gs;spapd; bgah; vd;d>

b. Village/town name (write exactly) fpuhkk; - efuj;jpd; bgah; (rupahf vGjt[k;)

c. Census village/town code (enter during editing) brd;r!; fpuhkk; - efuj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

d. Taluk name (write exactly) jhYfh bgah; (rupahf vGjt[k;)

e. Census Taluk code (enter during editing) brd;r!; jhYfh FwpaPL (vol;o';fpd; nghJ vGjt[k;)

f. District name (write exactly) khtl;lj;jpd; bgah; (rupahf vGjt[k;)

g. District code (enter during editing) khtl;lj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

h. State name (write exactly) khepyj;jpd; bgah; (rupahf vGjt[k;)

i. State Code (enter during editing) khepyj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

j. DISE CODE (ONLY IF PRIMARY SCHOOL) o I v³ , F¿ÜL (¥iukÇ) (Muk;g gs;spahf ,Ue;jhy; kl;Lk;)

1026. Distance to school from current residence, one way? (km) gs;spf;Fj; J}uk; jw;nghJ trpf;Fkplj;jpypUe;J. XU tÊk£L« (fp/kPl;lupy;)

IN KM: ROUND/ RECORD AS 00.00 fp /kP y; 00/00 vd;W Fwpf;ft[k;

1027.

INVESTIGATOR: IS THIS PERSON CURRENTLY ATTENDING / ATTENDED SCHOOL IN THE PAST 12 MONTHS? ngl;obaLg;gth; ? ,e;j egh; jw;rkak; gs;spapy; goj;Jf; bfhz;oUf;fpwhuh - fle;j 12 khj';fspy; gs;spapy; goj;jtuh>

Yes Mk; 01

No ,y;iy 02 ����1132

1028.

Of last 30 days school open, how many days was [NAME] required to attend? gs;sp jpwe;jpUe;j fle;j 30 ehl;fspy; (bga®) ; vj;jid ehl;fs; gs;spf;Fr; br¬¿U¡f ntz;L« >

No of days ehl;fspd; vz;zpf;if

1029. How many days of those required days did [NAME] miss? bry;y ntz;oapUe;j ehl;fspy; vj;jid ehl;fs; (bga®); gs;spf;Fr; bry;y Koaɯiy>

No of days g²Ë¡F¢ br¯yhj ehl;fspd; vz;zpf;if

EDUCATIONAL EXPENSES FOR PREVIOUS 12 MONTHS (IF NO: RECORD 0000 fle;j fle;j fle;j fle;j 12 khjj;jpw;fhd fy;tpr; bryt[fs; 12 khjj;jpw;fhd fy;tpr; bryt[fs; 12 khjj;jpw;fhd fy;tpr; bryt[fs; 12 khjj;jpw;fhd fy;tpr; bryt[fs; (,¯iyba¬wh¯ 0000 v¬W F¿¡fæ«)(,¯iyba¬wh¯ 0000 v¬W F¿¡fæ«)(,¯iyba¬wh¯ 0000 v¬W F¿¡fæ«)(,¯iyba¬wh¯ 0000 v¬W F¿¡fæ«)

1030. Tuition fees (amt in Rs), or DK f¯Éf;(oa{&d;) fl;lzk; (bjhif U:ghapy;) my;yJ bjupahJ

Rs. ø DK bjupahJ

__________

- 8

1031. Voluntary contributions jd;dhh;tg; g';fspg;g[fs;

Rs. ø

DK bjupahJ

__________

- 8

1032. Uniforms (amt in Rs), or DK rPUilfs; (bjhif U:ghapy;) my;yJ bjupahJ

Rs. ø DK bjupahJ

__________

- 8

1033. Books/Stationary (amt in Rs), or DK g[j;jf';fs; - !;nl&dup (vGJ bghU£f²) (bjhif U:ghapy;) my;yJ bjupahJ

Rs. ø DK bjupahJ

__________

- 8

1034. Transport (Rs or DK) nghf;Ftuj;J (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

__________

- 8

1035. Hostel (Rs or DK) ÉL½ (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

__________

- 8

1036. Private Coaching/ Extra classes (Rs or DK) jdpahh; gÆw;r;rp ;(oa{&d;) - TLjy; tFg;g[fs; (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

__________

- 8

1037. School pocket money (Rs or DK) gs;sp; ifr; bryt[g;gzk; (ghf;bfl; kzp) (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

__________

- 8

1038. Others (Specify) – and Rs value kw;wit (Fwpg;gplt[k;) ? kw;Wk; U:gha; kjpg;g[

Rs. ø DK bjupahJ

__________

- 8

1039. Others (Specify and Rs value kw;wit (Fwpg;gplt[k;) ? kw;Wk; U:gha; kjpg;g[

Rs. ø DK bjupahJ

__________

- 8

1040. IF UNABLE TO BREAK UP EXPENSES ABOVE nknya[s;s bryt[fisj; jdpj;jdpna gpupf;fKoatpy;iy vdpy;

Rs. ø DK bjupahJ

__________

- 8

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 7

Q.no Questions Options Codes Skips

DID [NAME] RECEIVE ANY OF THE FOLLOWING? ¾¬tU« vitna¾¬tU« vitna¾¬tU« vitna¾¬tU« vitnaD« « « « (bga®bga®bga®bga®) bg¦¿U¡»Õ®fsh> (ngl;obaLg;gth; ? bg¦¿U¡»Õ®fsh> (ngl;obaLg;gth; ? bg¦¿U¡»Õ®fsh> (ngl;obaLg;gth; ? bg¦¿U¡»Õ®fsh> (ngl;obaLg;gth; ? mid¤J nf²Éiaå« go¤Jf;fh£læ«)mid¤J nf²Éiaå« go¤Jf;fh£læ«)mid¤J nf²Éiaå« go¤Jf;fh£læ«)mid¤J nf²Éiaå« go¤Jf;fh£læ«)

1041. Free textbooks/ stationary? ,ytr ghlg;g[j;jf';fs; - !;nl&dup(vGJ bghU£f²)>

Yes Mk; 01

No ,y;iy 02

1042. Free school uniforms? ,ytr gs;spr; rPUilfs; >

Yes Mk; 01

No ,y;iy 02

1043. Mid-day meals? kjpa czt[>

Yes Mk; 01

No ,y;iy 02

1044. Free bicycle? ,ytr irf;fps; >

Yes Mk; 01

No ,y;iy 02

1045. Partial or full tuition waivers? gFjp mstpy; my;yJ KG mstpy; f¯Éf;(oa{&d;) fl;lzk; js;Sgo>

Yes Mk; 01

No ,y;iy 02 ����1047

1046. If yes, value in Rs. Mk; vdpy;. kjpg;g[ U:ghapy; Rs. U:

1047. Government Stipend/scholarship? murh';f C¡f¤ bjhif - f¯É cjtpj;bjhif (!;fhyh;&pg;) >

Yes Mk; 01

No ,y;iy 02 ����1049

1048. If yes, value in Rs. Mk; vdpy;. kjpg;g[ U:ghapy; Rs. U:

1049. Private Stipend/scholarship? jÅah® C¡f¤ bjhif - f¯Écjtpj;bjhif (!;fhyh;&pg;) >

Yes Mk; 01

No ,y;iy 02 ����1051

1050. If yes, value in Rs. Mk; vdpy;. kjpg;g[ U:ghapy; Rs. U:

1051. Free Bus Pass ,ytr g!; gh!; >

Yes Mk; 01

No ,y;iy 02

1052. Other fee waivers (such as examination fees) kw;w fl;lz js;Sgofs; (njh;t[f;fl;lzk; nghd;wit)

Yes Mk; 01

No ,y;iy 02

1053. Other (specify) kw;wit (Fwpg;gplt[k;)

Yes Mk; 01

No ,y;iy 02 ����1057

1054. If applicable Value in Rs. bghUe;JfpwJ vdpy; kjpg;g[ U:ghapy; Rs. U:

1055. Other (specify) kw;wit (Fwpg;gplt[k;)

Yes Mk; 01

No ,y;iy 02 ����1057

1056. If applicable Value in Rs. bghUe;JfpwJ vdpy; kjpg;g[ U:ghapy; Rs. U:

SCHOOL PERFORMANCE AND PARENTAL INVOLVEMENT gs;spapd; bray;gLjpwd; kw;Wk; bgw;nwhupd; <LghLgs;spapd; bray;gLjpwd; kw;Wk; bgw;nwhupd; <LghLgs;spapd; bray;gLjpwd; kw;Wk; bgw;nwhupd; <LghLgs;spapd; bray;gLjpwd; kw;Wk; bgw;nwhupd; <LghL

1057. Is [NAME] currently studying English? (bga®) jw;rkak; M';fpyk; goj;Jf; bfhz;oUf;fpÕ®fsh>

Yes Mk;

01

No ,y;iy

02 ����1059

1058.

If yes, what is [NAME] most recent % of marks in English? Mk; vdpy;. (bga®) M';fpyj;jpy; kpfr; rkPgj;jp¯ bg¦w kjpg;bgz; rjtPjk; vd;d>

%

1059.

Are [NAME] currently studying another language? (bga®) jw;rkak; ntW XU bkhHpg;ghlj;ij goj;Jf; bfhz;oUf;fpÕ®fsh> (jkpH;. ,e;jp. bjY';F. fd;dlk;. kiyahsk.; cUJ ngh¬wit )

Yes Mk; 01

No ,y;iy 02 ����1062

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 8

Q.no Questions Options Codes Skips

1060.

If yes, what is the language? M« vů v¬d bkhHp>

Tamil jkpH; 01 English M';fpyk; 02

Hindi ,e;jp 03 Telugu bjY';F 04

Kannada fd;dlk; 05 Malayalam kiyahsk; 06

Urudu cUJ 07 Others (specify)_____________

kw;wit (Fwpg;gplt[k;) 08

1061.

What is [NAME] most recent % of marks in that language test? m« bkhHpg;ghlj;jpy; (bga®) kpfr; rkPgj;jp¯ bg¦w kjpg;bgz; rjtPjk; vd;d>

%

1062. Are [NAME] currently studying Maths? (bga®); jw;rkak; fzpjk; goj;Jf; bfhz;oUf;fpwPh;fsh>

Yes Mk; 01

No ,y;iy 02 ����1064

1063. If yes, what is [NAME] most recent % of marks in Maths? Mk; vdpy;. fzpjj;jpy; (bga®) kpfr; rkPgj;jp¯ bg¦w kjpg;bgz; rjtPjk; vd;d>

%

1064.

Are [NAME] assigned homework every week? thuh thu« (bga®) tPl;Lg;ghlk; jug;gLfpwjh> Yes Mk; 01

No ,y;iy 02 ���� 1068

1065.

If assigned homework, how many times per week do [NAME] do homework, and how many hours per week total? tPl;Lg;ghlk; jug;gl;lhy;. (bga®); xU thuj;jpy; vj;jid jlitfs; tPl;Lg;ghlk; bra;fpwPh;fs;. xU thuj;jpw;F bkhj;jk; vj;jid kzp neuk; bra;fpwPh;f;s>

No. of times per week xU thuj;jpy; jlitfspd;

vz;zpf;if

Hours per week xU thuj;jpy; kzp neu';fs;

1066.

If assigned homework, do [NAME] receive help with homework, or checking of homework regularly by parent (s)? tPl;Lg;ghlk; jug;gl;lhy;. (bga®) tPl;Lg; ghlj;jpy; cjtp bgWfpwPh;fsh my;yJ tHf;fkhfg; bgw;nwhuhy; tPl;Lg;ghlk; rupghh;f;fg;gLfpwjh>

Yes Mk; 01

No ,y;iy 02 ����1068

1067.

If yes, how many times per week, for how many hours per week total? Mk; vdpy;. xU thuj;jpy; vj;jid jlitfs;. xU thuj;jpw;F bkhj;jk; vj;jid kzp neu';fs;>

No. of times per week xU thuj;jpy; jlitfspd;

vz;zpf;if

Hours per week xU thuj;jpy; kzp neu';fs;

1068.

Are [NAME] assigned extra work (Home work or practice given by parents)? (bga®) TLjy; ntiy jug;gLfpwjh> (*bgw;nwhh;fshy; jug;gLk; tPl;Lg;ghlk; my;yJ gapw;rp)

Yes Mk; 01

No ,y;iy 02 ���� 1070

1069.

If yes, how many times per week, for how many hours per week total? Mk; vdpy;. xU thuj;jpy; vj;jid jlitfs;. xU thuj;jpw;F bkhj;jk; vj;jid kzp neu';fs;>

No. of times per week xU thuj;jpy; jlitfspd;

vz;zpf;if

Hours per week xU thuj;jpy; kzp neu';fs;

1070. Tutored (Tution) in extra subjects after reg. schoolhours? tHf;fkhd gs;sp neuj;jpw;Fg; gpwF (bga®); TLjy; ghl';fspy; l;a{&d; gof;fpwPh;fsh>

Yes Mk; 01

No ,y;iy 02 ���� 1072

1071.

If yes, how many times per week, for how many hours per week total? Mk; vdpy;. xU thuj;jpy; vj;jid jlitfs;. xU thuj;jpw;F bkhj;jk; vj;jid kzp neu';fs;>

No. of times per week xU thuj;jpy; jlitfspd;

vz;zpf;if

Hours per week xU thuj;jpy; kzp neu';fs;

QUALITY OF SCHOOLS : gs;spfËd; ju« gs;spfËd; ju« gs;spfËd; ju« gs;spfËd; ju«

1072. What is the total enrollment of the school (approximately)? gs;spapd; bkhj;j nrh;f;if vd;d> (njhuhakhf)

Numbers v©Â¡if

1073. What is the total enrollment of the Class (approximately)? tFg;gpd; bkhj;j nrh;f;if vd;d> (njhuhakhf)

Numbers v©Â¡if

1074.

Does the school have a library? gs;spapy; E}yfk; cs;sjh>

Yes Mk; 01

No ,y;iy 02

1075. Does the school have electricity? gs;spapy; kpd;rhuk; cs;sjh>

Yes Mk; 01

No ,y;iy 02

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 9

Q.no Questions Options Codes Skips

1076.

Does the school have a functional toilet; gs;spapy; cgnah»¡f¡Toa epiyapy; fHpg;giw cs;sjh>

Yes Mk; 01

No ,y;iy 02

1077.

Does the school have a separate toilet for girls? gs;spapy; khztpfSf;fhfj; jdpahf fHpg;giw cs;sjh>

Yes Mk; 01

No ,y;iy 02

NA, school is boys only bghUe;jhJ. gs;sp khzth;fSf;fhdJ

kl;Lk; 03

1078.

Does the school have a computer for the usage of students? gs;spapy; khzth;fs; gad;ghl;ow;fhf fk;g;a{l;lh; cs;sjh>

Yes Mk; 01

No ,y;iy 02

1079.

Does the school have furniture for teachers? gs;spapy; Mrpupah;fSf;fhf nki$. eh¦fhÈf² (`gh;dpr;rh); cs;sjh>

Yes Mk; 01

No ,y;iy 02

1080. Does the school have a blackboard? gs;spapy; fUk;gyif cs;sjh>

Yes Mk; 01

No ,y;iy 02

1081. Does the school have a Parent Teacher Association? gs;spapy; bgw;nwhh; Mrpupah; r';fk; cs;sjh>

Yes Mk; 01

No ,y;iy 02

1082.

Does the school have a playground/ gs;spapy; tpisahl;L ikjhdk; cs;sjh>

Yes Mk; 01

No ,y;iy 02

1083.

Does the school have a First Aid Station? gs;spapy; Kjy; cjtp ikak; cs;sjh>

Yes Mk; 01

No ,y;iy 02

1084.

How much time does [NAME] spend going to school (one way)? (bga®) jpdrup gs;spf;Fr; brd;W mila ¾uahz¤½¦fhf vt;tst[ neuk; brytHpf;fpÕ®f²> (xU tHp)

Hours kzp neuk;

Minutes epkpl';fs;

Boarding lj';fpg; gof;Fk; gs;sp 01 ����1132

1085.

What is/was the most common mode of transportation to school? gs;spf;Fr; bry;tjw;F kpft[k; bghJthd nghf;Ftuj;J tHpKiw vd;dthf cs;sJ - vd;dthf ,Ue;jJ>

Train uapy; 01

Bus – (Govt. Private)

ngUªJ (muR - jÅah®) 02

School / company bus

g²Ë-f«bgÅ ngUªJ (g!;) 03

4-wheeler 4 rf;fu thfdk; 04

Share auto/auto

n&h; Ml;nlh - Ml;nlh 05

2 wheeler 2 rf;fu thfdk; 06 cycle rickshaw irf;fps; hpf;&h 07

cycle irf;fps; 08 Horse cart F½iu t©o 09

Bullock cart kh£L t©o 10 Boat /

Waterways glF - Ù® tÊahf 11

foot ele;J bry;tJ 12 Other mode (Specify) kw;wit (Fwpg;gplt[k;)

______________ 13

1086. What is the daily cost of transportation? (Round trip) jpdrup nghf tu nghf;Ftuj;jpw;F m{F« bryt[ Rs ø ����1132

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 10

RESPONDENTS WITH ABOVE 12TH STANDARD ACHIEVEMENT:

12tJ tFg;gpw;F nky; fy;tp go¤½U¥gt®12tJ tFg;gpw;F nky; fy;tp go¤½U¥gt®12tJ tFg;gpw;F nky; fy;tp go¤½U¥gt®12tJ tFg;gpw;F nky; fy;tp go¤½U¥gt®

SCHOOLING HISTORY gs;spapd; tuyhWgs;spapd; tuyhWgs;spapd; tuyhWgs;spapd; tuyhW

1087. Did [NAME] take a 10th standard test? 10tJ tFg;g[ njh;t[ vG½Û®fsh>

Yes Mk; 01

No ,y;iy 02 ����1091

1088.

What kind of test? njh;tpd; tif vd;d>

State board (SSLC) khepyf; fy;tp thupak; 01

Matriculation bkl;upFny&d; 02

Central board (CBSE) kj;jpaf; fy;tp thupak; (rpgpv!;,) 03

Anglo Indian (AISC) M';fpnyh ,e;jpad; 04

Others (Specify) ________________ kw;wit (Fwpg;gplt[k;) 05

1089. Total marks scored on this 10th standard test. 10tJ tFg;g[ njh;tpy; th§»a bkhj;j kjpg;bgz;

Total marks scored th§»a bkhj;j kjpg;bgz;

1090. score on this 10th standard test in maths. 10tJ tFg;g[ njh;tpy; fzpjj;jpy; kjpg;bgz;

Marks kjpg;bgz;

1091.

What was the primary language of instruction in the last standard / class studied? [spoken language of teaching] fil¼ahf go¤j tF¥¾¯ Kjd;ikahd f¦¾¡F« bkhHp vd;dthf ,Ue;jJ> (f¦¾¡F« nghJ ngr[k; bkhHp)

Tamil jkpH; 01

English M';fpyk; 02

Hindi ,e;jp 03

Telugu bjY';F 04

Kannada fd;dlk; 05

Malayalam kiyahsk;

06

Urudu cUJ 07

Others (Specify) _____________

kw;wit (Fwpg;gplt[k;) 08

1092.

What was the language of the textbooks in the last standard / class studied? fil¼ahf go¤j tF¥¾¯ ghlg;g[j;jf';fspd; bkhHp vd;dthf ,Ue;jJ>

Tamil jkpH; 01

English M';fpyk; 02

Hindi ,e;jp 03

Telugu bjY';F 04

Kannada fd;dlk; 05

Malayalam kiyahsk; 06

Urudu cUJ 07

Others (Specify) ________________

kw;wit (Fwpg;gplt[k;) 08

1093.

What was the second language studied (in the last standard / class studied)? fil¼ahf go¤j tF¥¾¯ ,uz;lhtjhf f¦w bkhHp vd;dthf ,Ue;jJ>

Tamil jkpH; 01 English M';fpyk; 02

Hindi ,e;jp 03 Telugu bjY';F 04

Kannada fd;dlk; 05 Malayalam kiyahs

k; 06

Urudu cUJ 07

Others (Specify) ________________

kw;wit (Fwpg;gplt[k;) 08

None vJæ«Ä¯iy 09 ����1095

1094.

How many hours /week do/did [NAME] study second language (Round to closest ½ hour)? (bga®) ; xU thuj;jpy; vj;jid kzp neu';fSf;F me;j ,uz;lhtJ bkhHpiag; gof;fpwPh;fs; - go¤jPh;fs;;? (brh¯y¥gL« fhy msɯ mUfhikƯ c²s 1-2 k neu¤½¦F fz¡»læ«)

Hours k neu§f²

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 11

1095.

What type of management was this school? ,e;j gs;sp vd;d tifahd Ãh;thf¤½¬ ѱ ,Ue;jJ>

Dept of education fy;tpj;Jiw 01

tribal/social welfare dept gH';Foapdh; - rK:f eyj;Jiw 02

local body school cs;shl;rp mikg;g[ gs;sp 03

private aided muR cjtp bgWk; jdpahh; gs;sp 04

private unaided school muR cjtp bgwhj jdpahh; gs;sp 05

other recognized schools kw;w m';fPfupf;fg;gl;l gs;spfs; 06

unrecognized schools – religious m';fPfupf;fg;glhj gs;spfs; ? kjk;

rk;ge;jg;gl;lit 07

Other unrecognized schools kw;w m';fPfupf;fg;glhj gs;spfs; 08

other (specify) _________________

kw;wit (Fwpg;gplt[k;) 09

1096.

what was the educational system followed gpd;gw;wg;gLk; fy;tp Kiw[ vd;dthf ,Ue;jJ>

State board khepyf; fy;tp thupak; 01

Matriculation bkl;upFny&d; 02

Central board (CBSE) kj;jpaf; fy;tp thupak; (rpgpv!;,) 03

Anglo Indian (AISC) M';fpnyh ,e;jpad; 04

Others (Specify) ________________

kw;wit (Fwpg;gplt[k;) 05

Q.no Questions Options Codes Skips

1097.

Name and Location of School gs;spapdgs;spapdgs;spapdgs;spapd;; ;; bgah; kw;Wk; miktplk;bgah; kw;Wk; miktplk;bgah; kw;Wk; miktplk;bgah; kw;Wk; miktplk;

a. Name of school gs;spapd; bgah;

b. Village/town name (write exactly) fpuhkk; - rpW efuj;jpd; bgah; (rupahf vGjt[k;)

c. Census village/town code (enter during editing) brd;r!; fpuhkk; - rpW efuj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

d. Taluk name (write exactly) jhYfh bgah; (rupahf vGjt[k;)

e. Census Taluk code (enter during editing) brd;r!; jhYfh FwpaPL (vol;o';fpd; nghJ vGjt[k;)

f. District name (write exactly) khtl;lj;jpd; bgah; (rupahf vGjt[k;)

g. District code (enter during editing) khtl;lj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

h. State name (write exactly) khepyj;jpd; bgah; (rupahf vGjt[k;)

i. State Code (enter during editing) khepyj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

j. DISE CODE ( Primary, enter during editing) o I v³ , F¿ÜL (¥iukÇ) ONLY IF PRIMARY SCHOOL

1098. Distance to school from current residence, one way? (km) gs;spf;Fj; J}uk; jw;nghJ trpf;Fkplj;jpypUe;J. XU tÊk£L« (fp/kPl;lupy;)

In km, record as 00.00 fp /kP y; 00/00 vd;W Fwpf;ft[k;

HIGHER EDUCATION DETAILS (COLLEGE, UNIVERSITY, ETC) nk¦go¥gpd; tptu';fs; (fy;Y}up. gy;fiyf; fHfk;. GjÈad)nk¦go¥gpd; tptu';fs; (fy;Y}up. gy;fiyf; fHfk;. GjÈad)nk¦go¥gpd; tptu';fs; (fy;Y}up. gy;fiyf; fHfk;. GjÈad)nk¦go¥gpd; tptu';fs; (fy;Y}up. gy;fiyf; fHfk;. GjÈad)

1099.

Are [NAME] currently attending / attended in the last 12 months any course in college or University? (either regular course OR through correspondence course) (bga®); jw;rkak; - fle;j 12 khj';fspy; fy;Y}upapy; my;yJ gy;fiyf; fHfj;jpy; VnjDk; nfhh;!; goj;Jf; bfhz;oUf;fpwhuh - goj;Jf;bfhz;oUe;jhuh> (tHf;fkhd nfhh;n!h my;yJ m";ry; tHpf; fy;tp K:ykhfnth)

Yes Mk; 01

No ,y;iy 02 ���� 1101

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 12

Q.no Questions Options Codes Skips

1100.

What is the Course [NAME] are attending / last attended in the past 12 months? (like B.A., M.A., etc) (bga®) goj;Jf; bfhz;oUf;fpw - fle;j 12 khj';fspy; goj;j nfhh;!; vd;d> (¾V. v«V ngh¬wit)

B.A g/pV 01

B.B.A gp/gp/V 02

B.com gp/fhk; 03

B.C.A gp/rp/V 04

B.Sc gp/v!;rp 05

B.E gp/, 06

B.L ¾/v¯ 07

B. Tech gp/ bl¡ 08

M.A vk/;V 09

MBA vk;gpV 10

M.C.A. vk;/rp/V 11

M.com vk;/fhk; 12

ML v« v¯ 13

M.S vk;.v!; 14

M.Sc vk;/v!/;rp 15

M.E vk/;, 16

M. Tech vk;/ bl¡ 17

M.B.B.S vk;.gp.gp.v!; 18

M.D v/k;o 19

Post Graduate Diploma (PGD) KJ Ãiy o¥nshkh (PGD)

20

Others (Specify) ________________

kw;wit (Fwpg;gplt[k;) 21

1101.

What are all the degrees [NAME] have completed? (bga®) ; Koj;jpUf;fpw gl;lg;gog;g[fs; vd;d> CIRCLE ALL THAT APPLY. (bghUe;Jfpw midj;ija[k; tl;lkplt[k;)

BA gpV 01

BBA gpgpV 02 B.com gpfhk; 03

B.C.A gprpV 04 B.Sc gpv!;rp 05

BE gp, 06 BL ¾ v¯ 07

B. Tech gp/ bl¡ 08 MA vk;V 09

MBA vk;gpV 10 M.C.A. vk;rpV 11

M.com vk;fhk; 12 M. L v« v¯ 13

M. S vk/;!; 14 M. Sc vk;v!;rp 15

M.E vk;, 16 M. Tech vk;/ bl¡ 17

MBBS vk;gpgpv!; 18 MD vk;o 19

Post Graduate Diploma (PGD) KJ Ãiy o¥nshkh (PGD) 20

Others (Specify) kw;wit (Fwpg;gplt[k;)

_________________________________

21

1102.

Management of College most attending/ recently attended go¥gj¦F m½fgoahf g§nf¦F« - m©ikƯ g§nf¦;w fy;Y}upapd; îthf«

Government College muR fy;Yhhp 01

Private Aided College muR cjtp bgWk; jdpahh; fy;Y}up 02

Private Unaided College muR cjtpbgwhj jdpahh; fy;Y}up 03

Others (Specify) kw;wit (Fwpg;gplt[k;)

04

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 13

Q.no Questions Options Codes Skips

COLLEGE DETAILS fy;Y}upapd; tptu';fs;fy;Y}upapd; tptu';fs;fy;Y}upapd; tptu';fs;fy;Y}upapd; tptu';fs;

1103.

Name/ Census Code bgah; - brd;!!; FwpaPL

a. Name of College / Institution / University fy;Y}upapd; - gy;fiyf; fHfj;jpd; - ÃWtd¤½¬ bgah;

b. Village/town name (write exactly) efuj;jpd; bgah; (rupahf vGjt[k;)

c. Census village/town code (enter during editing) brd;r!; efuj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

d. Taluk name (write exactly) jhYfh bgah; (rupahf vGjt[k;)

e. Census Taluk code (enter during editing) brd;r!; jhYfh FwpaPL (vol;o';fpd; nghJ vGjt[k;)

f. District name (write exactly) khtl;lj;jpd; bgah; (rupahf vGjt[k;)

g. District code (enter during editing) khtl;lj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

h. State name (write exactly) khepyj;jpd; bgah; (rupahf vGjt[k;)

i. State Code (enter during editing) khepyj;jpd; FwpaPL (vol;o';fpd; nghJ vGjt[k;)

1104.

Distance to College / University from current residence?(km) fy;Y}up - gy;fiyf; fHfk; - ÃWtd¤½¦fhd J}uk; jw;nghJ trpf;Fkplj;jpypUe;J. XU tÊk£L« (fp/kPl;lupy;)

Km [record as 00.00] fp /kP y; 00/00 vd;W Fwpf;ft[k;

1105.

INVESTIGATOR CHECK Q. 1099: Do [NAME] currently attend College/ Univ. IN LAST 12 MOS? ngl;o vLg;gtUf;fhd Fwpg;g[ ? nf.1099 ?Ir; rupghu;f;ft[k;. (bga®) ; jw;rkak; fy;Y}up - gy;fiyf; fHfk; - ÃWtd¤½y; fle;j 12 khj’;fspy; goj;Jf; bfhz;oUf;fpwhuh>

Yes Mk; 01

No ,y;iy 02 ����1132

1106.

How much time did / does [NAME] spend going to College / Institution / University ? (one way) (bga®) jpdrup fy;Y}up - gy;fiyf; fHfk; - ÃWtd¤½¦;Fr; brd;W mila ¾uahz¤½¦fhf vt;tst[ neuk; brytHpf;fpÕ®f²> (xU tHp)

Hours kzp neuk;

Minutes epkpl';fs;

Boarding College j';fpg; gof;Fk; fy;Yhp 01

����1109 Correspondence m";ry; tHpf; fy;tp 02

1107.

What is/was the most common mode of transportation to College? bghJthf fy;Y}upf;Fr; bry;tjw;fhd nghf;Ftuj;J tHptif vd;dthf cs;sJ - ,Ue;jJ>

Train uapy; 01

Bus – (Govt./ Private)

ngUªJ (muR - jÅah®) 02

School / company bus

g²Ëg; - f«bgÅ

ngUªJ (g!;) 03

4-wheeler 4 rf;fu thfdk; 04

Share auto/auto

n&h; Ml;nlh-Ml;nlh 05

2 wheeler 2 rf;fu thfdk; 06

cycle rickshaw

irf;fps; hpf;&h 07

cycle irf;fps; 08

Horse cart F½iu t©o 09

Bullock cart kh£L t©o 10

Boat / Waterways

glF - Ù® tÊahf 11

foot ele;J bry;tJ 12

Other mode (Specify)

______________ kw;wit (Fwpg;gplt[k;)

13

1108. What is the daily cost of transportation? (Round trip) nghf tu nghf;Ftuj;jpw;F m{F« bryt[ Rs ø

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 14

EDUCATIONAL EXPENSES IN THE PREVIOUS 12 MONTHS: FEE S (AMT IN RS), OR DK fle;j 12 khj';fspy fy;tpr; bryt[fs; = fl;fle;j 12 khj';fspy fy;tpr; bryt[fs; = fl;fle;j 12 khj';fspy fy;tpr; bryt[fs; = fl;fle;j 12 khj';fspy fy;tpr; bryt[fs; = fl;lzk; (bjhif U:ghapy;) my;yJ bjupahJlzk; (bjhif U:ghapy;) my;yJ bjupahJlzk; (bjhif U:ghapy;) my;yJ bjupahJlzk; (bjhif U:ghapy;) my;yJ bjupahJ

1109. Tuition fees (amt in Rs), or DK fy;tpf; fl;lzk; (bjhif U:ghapy;) my;yJ bjupahJ

Rs. ø DK bjupahJ

_________

- 8

1110. Donations e¬;bfhilf²

Rs. ø DK bjupahJ

_________

- 8

1111. Uniforms (amt in Rs), or DK rPUilfs; (bjhif U:ghapy;) my;yJ bjupahJ

Rs. ø DK bjupahJ

_________

- 8

1112. Books/Stationery (amt in Rs), or DK g[j;jf';fs; - !;nl&dup (bjhif U:ghapy;) my;yJ bjupahJ

Rs. ø DK bjupahJ

_________

- 8

1113. Transport (Rs or DK) nghf;Ftuj;J (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

_________

- 8

1114. Hostel (Rs or DK) ÉL½ (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

_________

- 8

1115. Private Coaching (Rs or DK) jdpahh; nfhr;rp';; (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

_________

- 8

1116. College pocket money (Rs or DK) fy;Y}up ghf;bfl; kzp (ifr; bryt[g;gzk;) (U:gha; my;yJ bjupahJ)

Rs. ø DK bjupahJ

_________

- 8

1117. Others (Specify) - and Rs value kw;wit (Fwpg;gplt[k;) ? kw;Wk; U:gha; kjpg;g[

Rs. ø DK bjupahJ

_________

- 8 ���� 1119

1118. Others (Specify and Rs value kw;wit (Fwpg;gplt[k;) ? kw;Wk; U:gha; kjpg;g[

Rs. ø DK bjupahJ

_________

- 8

1119. IF UNABLE TO BREAK UP EXPENSES ABOVE nknya[s;s bryt[fisj; jdpj;jdpna gpupf;fKoatpy;iy vdpy; bkhj;jkhf

Rs. ø DK bjupahJ

_________

- 8

EDUCATIONAL BENEFITS – DID [NAME] RECEIVE ANY OF TH E FOLLOWING? flªj 12 khj¤½¯ »il¤j f¯É r«gªjkhd rYiff² = ¾¬tU« vitnflªj 12 khj¤½¯ »il¤j f¯É r«gªjkhd rYiff² = ¾¬tU« vitnflªj 12 khj¤½¯ »il¤j f¯É r«gªjkhd rYiff² = ¾¬tU« vitnflªj 12 khj¤½¯ »il¤j f¯É r«gªjkhd rYiff² = ¾¬tU« vitnaD« (bga®)aD« (bga®)aD« (bga®)aD« (bga®) bg¦¿U¡»Õ®fsh>bg¦¿U¡»Õ®fsh>bg¦¿U¡»Õ®fsh>bg¦¿U¡»Õ®fsh>

1120.

Free textbooks/ stationary? ,ytr ghlg;g[j;jf';fs; - !;nl&dup(vGJ bghU£f²)

Yes Mk; 01

No ,y;iy 02

1121. Free uniforms? ,ytr rPUilfs;

Yes Mk; 01

No ,y;iy 02

1122. Government partial or full tuition waivers? murh';fj;jhy; gFjp mstpy; my;yJ KG mstpy; f¯Éf;(oa{&d;) fl;lzk; js;Sgo

Yes Mk; 01

No ,y;iy 02 ����1124

1123. If yes, value in Rs. Mk; vdpy;. kjpg;g[ U:ghapy; Rs. ø

1124.

Government Stipend/scholarship? murh';f C¡f¤ bjhif -cjtpj;bjhif (!;fhyh;&pg;)

Yes Mk; 01

No ,y;iy 02 ����1126

1125. If yes, value in Rs. Mk; vdpy;. kjpg;g[ U:ghapy; Rs. ø

1126. Private Stipend/scholarship? jdpahh; C¡f¤ bjhif -cjtpj;bjhif (!;fhyh;&pg;)

Yes Mk; 01 No ,y;iy 02 ����1128

1127. If yes, value in Rs. Mk; vdpy;. kjpg;g[ U:ghapy; Rs. ø

1128. Free Bus Pass ,ytrg!; gh!;>

Yes Mk; 01

No ,y;iy 02

1129. Other fee waivers (such as examination fees) kw;w fl;lz js;Sgofs; (njh;t[f;fl;lzk; nghd;wit)

Yes Mk; 01

No ,y;iy 02

1130. Others (specify) kw;wit (Fwpg;gplt[k;)

Yes Mk; 01

No ,y;iy 02 ����1132

1131. If applicable, value in Rs. bghUe;JfpwJ vdpy; kjpg;g[ U:ghapy; Rs. ø

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 15

SPECIAL / VOCATIONAL TRAINING

tpnr& tpnr& tpnr& tpnr& ---- bjhHpw;fy;tp gapw;rpbjhHpw;fy;tp gapw;rpbjhHpw;fy;tp gapw;rpbjhHpw;fy;tp gapw;rp

1132.

Have [NAME] ever attended any vocational or special training? (bga®) vg;bghGjhtJ VnjDk; tpnr& - bjhHpw;fy;tp gapw;rpapy; fye;J bfhz;oUf;fpwPh;fsh>

Yes Mk; 01

No ,y;iy 02 ����

SECT.2

1133.

If yes, what type of training? Mk; vdpy;. vd;d tifg; gapw;rp (F¿ÜLfS¡F F¿Ü£L è¤jf¤ij x¥¾£L gh®fæ«) LIST UP TO THREE K:d;W gapw;rp tiu Fwpf;ft[k;

SPECIFY Fwpg;gplt[k;

���� SECT.2

CODE FwpaPL SPECIFY Fwpg;gplt[k;

CODE FwpaPL SPECIFY Fwpg;gplt[k;

CODE FwpaPL

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URBAN INDIVIDUAL QUESTIONNAIRE-Education 16

AGES 0 – 6 COMPLETED YEARS:0?6 taJ Kotile;j0?6 taJ Kotile;j0?6 taJ Kotile;j0?6 taJ Kotile;j tUl’;fs;tUl’;fs;tUl’;fs;tUl’;fs; CHILD DEVELOPMENT/ ECE FHe;ij tsh;rrp FHe;ij tsh;rrp FHe;ij tsh;rrp FHe;ij tsh;rrp ---- Muk;gfhy FMuk;gfhy FMuk;gfhy FMuk;gfhy FHe;ijg;gUtf; fy;tpHe;ijg;gUtf; fy;tpHe;ijg;gUtf; fy;tpHe;ijg;gUtf; fy;tp INVESTIGATOR CHECK:IS PERSON BELOW AGE 6? (AGE 0-6) IF NO���� NEXT SECTION

ngl;obaLg;gth; rupghh;f;ft[k; ? ,e;j egh; 6 tangl;obaLg;gth; rupghh;f;ft[k; ? ,e;j egh; 6 tangl;obaLg;gth; rupghh;f;ft[k; ? ,e;j egh; 6 tangl;obaLg;gth; rupghh;f;ft[k; ? ,e;j egh; 6 taJ my;yJJ my;yJJ my;yJJ my;yJ mjw;F mjw;F mjw;F mjw;F fPGs;stuh> fPGs;stuh> fPGs;stuh> fPGs;stuh> (0 ?6 taJ) (0 ?6 taJ) (0 ?6 taJ) (0 ?6 taJ) ,y;iy vdpy;. mLj;j gFjpf;Fr; bry;yt[k;,y;iy vdpy;. mLj;j gFjpf;Fr; bry;yt[k;,y;iy vdpy;. mLj;j gFjpf;Fr; bry;yt[k;,y;iy vdpy;. mLj;j gFjpf;Fr; bry;yt[k;

S.No Questions Options Codes Skip

1134.

Has [NAME] Attended an Anganwadi/ balwaldi/ other Public/ NGO/ Pre School / Nursery or childhood programs during the past1 months? (bga®) fle;j 1 khjj;jpd; nghJ m’;fd;tho-ghy;tho-kw;w bghJ-muR rhuh epWtdk; - g;uP !;Ty; - eh;!up my;yJ FHe;ijgUt jpl;l’;fspy; fye;J bfhz;oUf;fpwjh>

Yes Mk; 01

No ,y;iy 02 ���� SECT.2

1135.

Which Program did [NAME] attend? (bga®) ve;j jpl;lj;jpy; fye;J bfhz;lJ>

Anganwadi/ICDS program m’;fd;tho- ICDS jpl;lk; 01

Other government pre primary program kw;w murh’;f Muk;g bjhlf;f jpl;lk; 02

NGO/non profit educational program vd;$pX-yhg nehf;fpy;yhj gog;g[ jpl;lk; 03

Private pre-school/ Nursery jdpahh; g;uP !;Ty; - eh;!up 04

Other early childhood program kw;w . FHe;ijg; gUt Muk;g fy;tp jpl;lk; 05

1136.

At what age [NAME] First visit the program? ve;j tajpy; (bga®) Kjd; Kjypy; jpl;lj;jpy; fye;J bfhz;lhu;>

Number vz;zpf;if

Months [IF LESS THAN 2 YEARS WHEN BEGAN, WRITE MONTHS]

khj';fs; (Muk;gpj;j nghJ 2 taijtplf; Fiwthf vdpy; khj';fspy; taij vGjt[k;)

01

Years tUl’;fs; 02

1137.

During the past 30 days how many days did [NAME] attend the program? fle;j 30 ehl;fspd; nghJ (bga®) vj;jid ehl;fs; jpl;lj;jpy; fye;J bfhz;lhu;>

No. of days ehl;fspd; vz;zpf;if

Services received on the days attended? mth;fs; fye;J bfhz;l ehlmth;fs; fye;J bfhz;l ehlmth;fs; fye;J bfhz;l ehlmth;fs; fye;J bfhz;l ehl;fspy; cz;ikapy; vd;d nritfisg; bgWfpwhh;fs;>;fspy; cz;ikapy; vd;d nritfisg; bgWfpwhh;fs;>;fspy; cz;ikapy; vd;d nritfisg; bgWfpwhh;fs;>;fspy; cz;ikapy; vd;d nritfisg; bgWfpwhh;fs;>

1138.

Out of the last 5 days attended, how many days [NAME] child receive Pre-school Education? fye;J bfhz;l filrp 5 ehl;fspy; (bga®) vj;jid ehl;fs; g;uP !;Ty; fy;tpiag; bgw;whh;>

No. of days ehl;fspd; vz;zpf;if

1139.

In the last 5 attended days, how many times did your child receive supplementary food? fye;J bfhz;l filrp 5 ehl;fspy; v¤jid Kiw c§f² FHªij C£l rj;J czit bg¦wJ>

No. of times Kiwfspd; vz;zpf;if

1140.

In last 30 days did [NAME] receive Weight/ height measurement fle;j 30 ehl;fspy; (bga®) f;F vil kw;Wk; cau mst[ vLf;fg;gl;ljh>

Yes Mk; 01

No ,y;iy 02

1141. In the last 30 days, did [NAME] child received a health check fle;j 30 ehl;fspy; (bga®) cly; ey gupnrhjid bra;ag;gl;ljh>

Yes Mk; 01

No ,y;iy 02

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17 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Section 2: HEALTH cly; eyk;cly; eyk;cly; eyk;cly; eyk;

I. Member NAME:

cWg;gpdu; bgau; :

II. Member ID:

cWg;gpdu; milahs vz; :

III. Respondent Name:

gjpyspg;gthpd; bgah;

IV. Respondent ID:

gjpyspg;gthpd; milahs vz;

V.

IF PROXY: Reason for Substition/ Proxy khw;W eguhf ,Ug;gpd; : khw;W egiuj; nju;t[ bra;jjw;fhd fhuzj;ijf; Fwpg;gplt[k; ? NO PROXY :SMOKING/DRINKING; ANTHROP. ftdpf;f? g[ifg;gJ-kJ mUe;JtJ-msbtLg;gJ Mfpa nfs;tpfSf;;F khw;W egu; TlhJ PROXY CODE khw;W egu; FwpaPL

TO HOUSEHOLD MEMBERS AGE 14 AND OLDER: ACTIVITIES O F DAILY LIFE jpdrup thH;f;ifapd; bray;ghLfs; ? 14 taJ kw;Wk; mjw;fjpfkhd taJs;s FLk;g cWg;gpdh;fSf;F If you had [….] could you do it: c§fS¡F (////////) ,it bra;a ,aYkh> Q. no Questions Options Codes Skips

2001. To dress, without help gpwUila cjtpapy;yhky; Mil mzptJ

Easily vspjhf 01 ���� 2003 With difficulty rpukj;Jld; 02

Unable to do it ,ijr; bra;a Koatpy;iy

03

2002. How long have you had (difficulty/been unable to?)? ,J c';fSf;F vt;tst[ fhykhf (rpukkhf ,Uf;fpwJ- KoahkypUf:;f;pwJ)>

Value

kjpg;g[

Years tUl';fs; 01

Months khj';fs; 02

Weeks thu’;fs; 03

2003. To go to bathroom (Bowel movement – BM), without help ve;j cjtpa[k; ,t;yhky; Fspayiwf;Fr; bry;tJ my;yJ fHptiwf;F bry;tJ

Easily vspjhf 01 ���� 2005 With difficulty rpukj;Jld; 02

Unable to do it ,ijr; bra;a Koatpy;iy

03

2004. How long have you had (difficulty/been unable to?)? ,J c';fSf;F vt;tst[ fhykhf (rpukkhf ,Uf;fpwJ - KoahkypUf;f;pwJ)>

Value

kjpg;g[

Years tUl';fs; 01

Months khj';fs; 02

Weeks thu’;fs; 03

2005. INVESTIGATOR ARE Q.2001 AND Q. 2003 CODED 3 ? ngl;o vLg;gth; rhp ghh;ft[k; nfs;tp 2001 kw;Wk; nfs;tp 2003 f;F 3 FwpaPL bgw;Ws;sdth> (gpwh; cjtpapy;yhky; bra;a Koatpy;iy)

Yes Mk; 01 ���� 2014

No ,y;iy 02

2006. To Carry heavy load (like 10 kg pail/pot of water) for 20 meters 20 kPl;lh;kPl;lh;kPl;lh;kPl;lh; J}uj;jpw;F fdkhd viliaf; bfhz;L bry;tjw;F Kotjw;F (10»nyh vil bfhz;l Rik-jz;zPh; ghid nghd;wit)

Easily vspjhf 01 ���� 2008 With difficulty rpukj;Jld; 02

Unable to do it ,ijr; bra;a Koatpy;iy

03

2007. How long have you had (difficulty/been unable to?)? c';fSf;F vt;tst[ fhykhf (rpukkhf ,Uf;fpwJ - KoahkypUf;f;pwJ)>

Value

kjpg;g[

Years tUl';fs; 01

Months khj';fs; 02

Weeks thu’;fs; 03

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18 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q. no Questions Options Codes Skips 2008. To walk 5 kms

5 fp/kPl;lh; elg;gjw;F Easily vspjhf 01 ���� 2010

With difficulty rpukj;Jld; 02

Unable to do it ,ijr; bra;a Koatpy;iy

03

2009. How long have you had (difficulty/been unable to?)? c';fSf;F vt;tst[ fhykhf (rpukkhf ,Uf;fpwJ - KoahkypUf;f;pwJ)>

Value

kjpg;g[

Years tUl';fs; 01

Months khj';fs; 02

Weeks thu’;fs; 03

2010. To sit on the floor with bent kees for at least half an hour. Fiwªjg£r« 1-2k neu« jiuƯ KH§fh¯ kl¡» c£fhUtjw;F>

Easily vspjhf 01 ���� 2012 With difficulty rpukj;Jld; 02

Unable to do it ,ijr; bra;a Koatpy;iy

03

2011. How long have you had (difficulty/been unable to?)? ,g;go c';fSf;F vt;tst[ fhykhf (rpukkhf ,Uf;fpwJ - KoahkypUf;f;pwJ)>

Value

kjpg;g[

Years tUl';fs; 01

Months khj';fs; 02

Weeks thu’;fs; 03

2012. To stand up from sitting on the floor without help jiuapy; cl;fhh;e;jpUf;Fk; nghJ cjtpapy;yhknyna vGe;J epw;gjw;F

Easily vspjhf 01 ���� 2014 With difficulty rpukj;Jld; 02

Unable to do it ,ijr; bra;a Koatpy;iy

03

2013. How long have you had (difficulty/been unable to?)? ,J c';fSf;F vt;tst[ fhykhf (rpukkhf ,Uf;fpwJ - KoahkypUf;f;pwJ)>

Value

kjpg;g[

Years tUl';fs; 01

Months khj';fs; 02

Weeks thu’;fs; 03

ALL HOUSEHOLD MEMBERS - ILLNESS /MISSED ACTIVITIES, PAST 1 YEAR FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 tUlj;jpy; cly; eyf;Fiwt[ FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 tUlj;jpy; cly; eyf;Fiwt[ FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 tUlj;jpy; cly; eyf;Fiwt[ FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 tUlj;jpy; cly; eyf;Fiwt[ fhuzkhf fhuzkhf fhuzkhf fhuzkhf tpLgtpLgtpLgtpLgl;ll;ll;ll;l bray;ghLfs;bray;ghLfs;bray;ghLfs;bray;ghLfs; Q.no Questions Options Code Skip 2014. In the past one year, that is, since [DATE], approximately how many days

of [NAME]’s primary activities did [NAME] miss due to poor health? fle;j 1 tUlj;jpy;. /////////// njjpapypUe;J. njhuhakhf vj;jid ehl;fs; c’;fSila mog;;gil bray;fis cly;eyf; Fiwt[ fhuzkhf bra;a Koahky; nghdJ>

No. of days ehl;fspd;

vz;zpf;if

2015. Over the past 1 YEAR, that is, since [DATE]; have [NAME] found it difficult to perform normal activities FOR A WEEK OR MORE because illness or injuries? fle;j 1 tUlj;jpy;. mjhtJ [(//////) njjpapypUe;J eP';fs; cly; eyf; Fiwt[ my;yJ fha';fs; fhuzkhf xU thuk; my;yJ mjw;fjpfkhd fhyj;jpw;F c';fsJ rhjhuz bray;ghLfisr; bra;tjpy; rpukj;ij czh;e;jpUf;fpwPh;fsh>

Yes Mk; 01

No ,y;iy 02

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19 URBAN INDIVIDUAL QUESTIONNAIRE- Health

ALL HOUSEHOLD MEMBERS - SYMPTOMS IN THE PAST 1 MONT H (30 DAYS) FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 khjj;jpy; (30 ehl;fs;) mwpFwpfsFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 khjj;jpy; (30 ehl;fs;) mwpFwpfsFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 khjj;jpy; (30 ehl;fs;) mwpFwpfsFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 1 khjj;jpy; (30 ehl;fs;) mwpFwpfs;

kf;fs; rpy rkak; g[fhh;fs; bra;fpw rpy Mnuhf;fpa Fiwt[ rk;ge;jkhd mwpFwpfs; kw;Wk; epiyikfs; gw;wp ehd; c';fsplk; nfl;gjw;F tpUk;g[fpnwd;/ ,g;bghGJ eP';fs; fle;j 30 ehl;fspd; nghJ mjhtJ [bgah;] njjpapypUe;J vg;bghGjhtJ bgw;w Mnuhf;fpa Fiwt[ rk;ge;jkhd mwpFwpfs; gw;wpj; bjupe;J bfhs;tjw;F eh';fs; tpUk;g[fpnwhk;/ (gjpy;fs; 01 ? Mk;. 02 ? ,y;iy) 2016.

Have you experienced [SYMPTOM] in the last 30 days? eP';fs; fle;j 30 ehl;fspy; [SYMPTOM]?I mDgtpj;jpUf;fpwPh;fsh> If coded 2 go to next symptom: 2 Fwpaplg;gl;lhy; mLj;j mwpFwpf;Fr; bry;yt[k;

If Yes When did you start to have the latest [SYMPTOM]? Mk; vdpy;. c’;fSf;F rkPgj;jpy; [SYMPTOM]? mwpFwp bjhl';fpaJ vg;nghJ> Months ago 01 Weeks ago 02 Days ago 03 khj';fSf;F Kd;dhy; 01 thu';fSf;F Kd;dhy; 02 ehl;fSf;F Kd;dhy; 03

Symptoms mwpFwpfs;

Yes Mk;

No ,y;iy

-->NEXT -->mLj;j mLj;j mLj;j mLj;j thpirthpirthpirthpir

a. Cold symptoms $ynjh& mwpFwpfs; 01 02 Value Code

b. Dry Cough twl;;L ,Uky; 01 02 Value Code

c. Productive cough nfhiH - rsp tuf;Toa

,Uky; 01 02 Value Code

d. Cough with blood ,uj;jj;Jld; ,Uky; 01 02 Value Code

e. Blood in Spit vr;rpypy; ,uj;jk; 01 02 Value Code

f. Trouble breathing/respiratory problems

Rthrpg;gjpy; rpukk; Rthr gpur;;ridfs; 01 02

Value Code

g. Fever/Chills fha;r;ry; - Fsph; fha;r;ry; 01 02 Value Code

h. Body Ache cly; typ 01 02 Value Code

i. Rheumatism [joint pain] K:l;L typ 01 02 Value Code

j. Head Ache [dizziness] jiy typ (jiy Rw;wy;) 01 02 Value Code

k. Vomiting the;jp vLj;jy;/ 01 02 Value Code

l. Diarrhea ngjp 01 02 Value Code

m. Nausea/heartburn/Abdominal pains thª½ tUtJ ngh¬w cz®æ

- be";brupr;ry; - motapw;wpy; typ

01 02 Value Code

n. Painful Urination typa[ld; rpWePh; fH[pg;gJ 01 02 Value Code

o. Skin problems /scabies/ulcers/boils njh¯ r«gªjkhd

¾u¢ridf² ? brhwp. g[z; - bfh¥gs’;fs;

01 02 Value Code

p. Ear pain/ Ear ache fhJtyp 01 02 Value Code

q. Eye sore fz; typ 01 02 Value Code

r. Toothache gy; typ 01 02 Value Code

s. Chest Pain be";Rtyp 01 02 Value Code

t.

Any Other ( Specify) kw;wit (Fwpg;gplt[k;)

01 02

Value Code

u.

Any Other ( Specify) kw;wit (Fwpg;gplt[k;)

01 02

Value Code

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20 URBAN INDIVIDUAL QUESTIONNAIRE- Health

ALL HOUSEHOLD MEMBERS – ILLNESS/ MISSED ACTIVITIES , LAST 30 DAYS (ONE MONTH) FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fsps; (1 khjj;jpy;) cly; eyf;Fiwt[FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fsps; (1 khjj;jpy;) cly; eyf;Fiwt[FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fsps; (1 khjj;jpy;) cly; eyf;Fiwt[FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fsps; (1 khjj;jpy;) cly; eyf;Fiwt[ fhuzkhf tpLgl;l bray;ghLfs;fhuzkhf tpLgl;l bray;ghLfs;fhuzkhf tpLgl;l bray;ghLfs;fhuzkhf tpLgl;l bray;ghLfs;

Q.no Questions Options Code Skip

2017. In the last one month, how many days of primary daily activity did [NAME] miss due to poor health? (No. of days) fle;j xU khjj;jpy;. eP';fs; vj;jid ehl;fs; Kjd;ik jpdrhp bray;ghLfis cly;epiy Fiwthy; bra;a Koahky; nghdJ> (ehl;fspd; vz;zpf;if)

No. of days ehl;fspd;

vz;zpf;if

ALL HOUSEHOLD MEMBERS: SELF TREATMENT IN THE LAST 3 0 DAYS FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Rakhf rpfpr;irFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Rakhf rpfpr;irFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Rakhf rpfpr;irFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Rakhf rpfpr;ir Now we’d like to know whether you have treated yourself for symptoms/illness during past 30 days, namely since [DATE] date, 1 month ago eP';fs; VnjDk; mwpFwpfs; - cly; eyf; FiwfSf;fhf fle;j 30 ehl;fspd; nghJ mjhtJ [NAME] njjpapypUe;J. 1 khjj;jpw;F Kd;dhy; eP';fns rpfpr;ir bra;J bfhz;oUf;fpwPh;fsh vdj; bjupe;J bfhs;tjw;F ,g;bghGJ eh';fs; tpUk;g[fpnwhk;/

Q.no Questions Options Code Skip

2018. During the past one month, have you purchased any modern medicines on your own that is without the prescription to treat any health problem? kUj;JtUila kUe;J rPl;L ,y;yhky; c';fSila cly;ey Fiwitg; nghf;f fle;j 1 khjj;jpy; eP’;fshfnt etPd (khh;ld;) kUe;Jfs; vitnaDk; th’;fpapUf;fpwPh;fsh>

Yes Mk; 01

No /,y;iy 02 ���� 2020

2019. If Yes, how much did you pay for all modern medicines purchased on your own in the last one month? INCLUDE IN KIND (Value in Rs) /Mk; vd;why;. eP’;fshfnt th’;fpa etPd kUe;JfSf;F fle;j 1 khjj;jpy; vt;tst[ brytHpj;jPh;fs;> bghUshf bfhLj;jija[k; nrh;j;J (kjpg;ig U:ghapy; Fwpg;gplt[k;)

Rs ø

2020. During the past one month, have you purchased any traditional herbs or medicines on your own that is without consulting a health care practitioner to treat any health problem? /kUj;Jtu; ahiua[k; fye;jhnyhrid bra;ahky;. c';fSila cly;eyf; Fiwitg; nghf;f fle;j 1 khjj;jpy; ghuk;gupa ÷ypiffs; my;yJ kUe;Jfis eP’;fshfnt th’;fpapUf;fpwPu;fsh>

Yes Mk; 01

No ,y;iy 02 ���� 2022

2021. If Yes, how much did you pay for all traditional herbs or medicines purchased on your own in the last one month? INCLUDE IN KIND Mk; vdpy;. eP’;fshfnt th’;fpa ghuk;gupa ÷ypiffs; my;yJ kUe;Jf;fhf fle;j 1 khjj;jpy; vt;tst[ gzk; brytHpj;jPh;fs;> bghUshf bfhLj;jija[k; nrh;j;J

Rs ø

ALL HOUSEHOLD MEMBERS: HEALTH TREATMENT IN THE LAST 30 DAYS FLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Mnuhf;fpar; rpfpr;irFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Mnuhf;fpar; rpfpr;irFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Mnuhf;fpar; rpfpr;irFLk;g cWg;gpdh;fs; midtUf;Fk; ? fle;j 30 ehl;fspy; Mnuhf;fpar; rpfpr;ir Q.no Questions Options Codes Skips

2022. In the past 1 month, did you visit any health provider for treatment of symptoms or sickness? cly; eyf; Fiwt[ my;yJ neha;f;fhf rpfpr;ir bgw fle;j 1 khjj;jpy; kUj;Jtiug; ghh;j;jPu;fsh>

Yes Mk; 01

No ,y;iy 02 ���� 2044

TO PEOPLE WHO’VE SEEN PROVIDER FOR SYMPTOMS IN LAST 30 DAYS fle;j 30 fle;j 30 fle;j 30 fle;j 30 ehl;fspy; ehl;fspy; ehl;fspy; ehl;fspy; cly;eyf; Fiwt[ cly;eyf; Fiwt[ cly;eyf; Fiwt[ cly;eyf; Fiwt[ mwpFwpfSf;fhf mwpFwpfSf;fhf mwpFwpfSf;fhf mwpFwpfSf;fhf Mnuhf;fpag; guhkupg;g[ mspg;gtiug; ghh;j;jpUf;fpw egh;fSf;FMnuhf;fpag; guhkupg;g[ mspg;gtiug; ghh;j;jpUf;fpw egh;fSf;FMnuhf;fpag; guhkupg;g[ mspg;gtiug; ghh;j;jpUf;fpw egh;fSf;FMnuhf;fpag; guhkupg;g[ mspg;gtiug; ghh;j;jpUf;fpw egh;fSf;F

2023. How many times did you visit / consult someone about any of these conditions in the last 30 days? eP';fs; fle;j 30 ehl;fspy; ,e;j cly;eyf; Fiwt[fSf;fhf; vijnaDk; gw;wp kUj;Jtuplk;; vj;jid jlitfs; Mnyhrid bgw;wPh;fs;>

No. of times jlitfspd; vz;zpf;if

2024. How long ago was your last (most recent visit) visit / consultation with someone about these conditions in the last 30 days? fle;j 30 ehl;fspy; ,e;j Mnuhf;fpa Fiwt[ gw;wp Mnuhf;fpa guhkupg;g[ mspg;gtu; xUtUld; c';fsJ filrp (kpfr; rkPgj;jpa tprpl;) Mnyhrid vt;tst[ ehl;fSf;F Kd;dhy; ,Ue;jJ>

No. of days ehl;fspd; vz;zpf;if

2025. For which conditions did you make MOST RECENT visit / consultation? eP';fs; kpeP';fs; kpeP';fs; kpeP';fs; kpfr; rkPgj;jpafr; rkPgj;jpafr; rkPgj;jpafr; rkPgj;jpa Mnyhridia ve;j cly;eyf; Fiwt[ epiyikfSf;fhf bgw;wPh;fs;> INVESTIGATOR: RECORD THE ALPHABET AND EACH CONDITION FROM THE ABOVE GRID (Q.2016). ngl;obaLg;gth; ? nknya[s;s fpupl;oypUe;J (nf/ 2016) xt;bthU epiyik kw;Wk;; vz;iz gjpt[ bra;at[k;

Others (Specify)____________ kw;wit (Fwpg;gplt[k;)

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21 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips

2026. I’d like to talk about your most recent visit in the last 30 days. Which type of facility did you visit, or which type of health provider did you consult? ehd; fle;j 30 ehl;fspy; c';fsJ kpfr; rkPgj;jpa tprpl; gw;wp ngRtjw;F tpUk;g[fpnwd;/ eP';fs; ve;j tif trjpf;Fr; brd;wPh;fs; my;yJ eP';fs; ve;j tif Mnuhf;fpa guhkupg;g[ mspg;gtuplk; Mnyhrid bgw;wPh;fs;>

Public Medical Sector: bghJ kUj;Jtj;JiwbghJ kUj;Jtj;JiwbghJ kUj;Jtj;JiwbghJ kUj;Jtj;Jiw

Govt./Municipal Hospital murh';f-Kdp!pgy; kUj;Jtkid 01

Govt. Dispensary murh';f kUe;jfk; 02

UHV/UHP/UFWC a[b\;tp-a[b\r;gp-a[v`g;lgps;a[rp 03

CHC/Rural Hospital/PHC rpb\r;rp- fpuhkg;g[w kUj;Jtkid-

bghJ Rfhjhu ikak; 04

Sub Centre Jiz ikak; 05

Govt. Mobile Clinic murh';f elkhLk; fpspdpf; 06

Camp Kfhk; (nfk;g;) 07

Anganwadi/ICDS center m';fd;tho-Irpov!; brd;lh; 08

Other Public sector health facility kw;w bghJj;Jiw Mnuhf;fpa trjp 09

Other Gvmt/ Public medical facility kw;w murh';f - bghJ kUj;Jt trjp 10

NGO or Trust Hospital/Clinic vd;$pX my;yJ mwf;fl;lis

kUj;Jtkid-fpspdpf; 11

Private Medical Sector: jdpahh; kUj;Jtj;Jiwjdpahh; kUj;Jtj;Jiwjdpahh; kUj;Jtj;Jiwjdpahh; kUj;Jtj;Jiw Private Hospital

jdpahh; kUj;Jtkid 12

Private Doctor/Clinic; jdpahh; kUj;Jth; - fpspdpf; 13

Private mobile clinic jdpahh; bkhigy; f;spdpf; 14

Ayurvedic doctor [Vaidya/Hakim/Homeopath]

Ma[h;ntj kUj;Jth; (it¤½a®. \¡»«. n\hÄnahg½);

15

Traditional Healer ghuk;gupa kUj;Jth; 16

Pharmacy/ Dispensary `ghh;k!p - kUe;jfk; 17

Dai (TBA) jha; (ghu«gupa ¾urt« gh®g;gt®) 18

Other private sector health facility kw;w jdpahh; Jiw Mnuhf;fpa trjp 19

Other kw;wit 20

2027. Was consultation with provider in your own home? Mnuhf;fpag; guhkupg;g[ mspg;gtUldhd ,e;j Mnyhrid c';fsJ tPl;oy; ele;jjh>

Yes Mk; 01

No ,y;iy 02 ���� 2029 2028. Where is this health provider based?

,e;j Mnuhf;fpa guhkupg;g[mspg;gth; v';F cs;shh;> INVESTIGATOR: WRITE THE NAME AND PLACE OF THIS HEALTH PROVIDER’S PRIMARY LOCATION ngl;obaLg;gth; ? ,e;j Mnuhf;fpa guhkupg;g[ mspg;gtupd; Kjd;ikahd ,Ug;gplj;jpd; bgau; kw;Wk; miktplk; vGjt[k;

NAME OF PROVIDER/FACILITY guhkupg;g[ mspg;gth; - trjpapd; bgah;; _____________________________________

����2036

Name of Village/Town fpuhkk; - Ch; bgah;; ______________________ Village / Town Census ID [Editing] fpuhk - Ch; brd;!!; milahs vz; (vol;o';) _________________ Name of Taluk jhYfh bgah; ___________________________ Taluk ID jhYfh milahs vz; ___________________ District Name khtl;lj;jpd; bgah; _____________________ District ID khtl;lj;jpd; milahs vz; ______________ State Name khepyj;jpd; bgah; _______________________

State ID khepyj;jpd; milahs vz; ________

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22 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips

2029. Where is this facility located, or where did you consult this health provider? ,e;j trjp v';F mike;jpUf;fpwJ my;yJ eP';fs; ,e;j Mnuhf;fpa guhkupg;g[ mspg;gtuplk; v';F Mnyhrid bgw;wPh;fs;>

NAME OF PROVIDER/FACILITY guhkupg;g[ mspg;gth; - trjpapd; bgah;; _____________________________________

Name of Village/Town fpuhkk; - Ch; bgah;; ______________________

Village / Town Census ID [Editing] fpuhk - Ch; brd;!!; milahs vz; (vol;o';) _____________________________________

Name of Taluk jhYfh bgah; ___________________________

Taluk ID jhYfh milahs vz; ___________________

District Name khtl;lj;jpd; bgah; ______________________

District ID khtl;lj;jpd; milahs vz; ______________

State Name khepyj;jpd; bgah; _______________________

State ID khepyj;jpd; milahs vz; _______________

2030. Distance from residence (km)[one way] trpg;gplj;jpypUe;J J}uk; vt;tst[> (fp/kPl;lh;) (xU tHp)

In kms to 00.00 fp/ kPl;lh;fspy;

2031. Transportation cost, round trip nghf tu nghf;Ftuj;Jr; bryt[

In Rs. U:ghapy;

2032. What was the mode of transportation? nghf;Ftuj;J tHp tif vJ>

Train uapy; 01 Bus – (Govt./

Private) ngUªJ (muR -

jdpah®) 02

School / company bus

g²Ë - f«bgdp ngUªJ (g!;) 03

4-wheeler 4 rf;fu thfdk; 04

Share auto/auto

n&h; Ml;nlh - Ml;nlh 05

2 wheeler 2 rf;fu thfdk; 06

cycle rickshaw

irf;fps; hpf;&h 07

cycle irf;fps; 08 Horse cart F½iu t©o 09

Bullock cart kh£L t©o 10 Boat /

Waterways glF - Ù® tÊahf 11

foot ele;J bry;tJ 12

Other mode (Specify) _______ kw;wit (Fwpg;gplt[k;)

13

2033. What was the travel time, one way, to this facility? ,e;j kUj;Jt trjpf;F bry;tjw;F mjhtJ xU tHpf;F gaz neuk; vd;d>

Hours kzp neu';fs;

Minute epkpl';fs;

2034. Upon arrival, how long did you wait to be examined by a health officer? ngha;r; nrh;e;jt[ld;. eP';fs; Mnuhf;fpa mjpfhupahy; gupnrhjpf;fg;gLtjw;F vt;tst[ neuk; fhj;jpUe;jPh;;fs;>

Hours kzp neu';fs;

Minute epkpl';fs;

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23 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips

2035. How much time, in total, did you spend at the health facility (from arrival to the end of treatment?) eP';fs; kUj;Jt trjpapy; bkhj;jj;jpy; vt;tst[ neuk; (ngha;r; nrh;e;jjpypUe;J rpfpr;irapd; ,Wjp tiuapy;) brytHpj;jPh;fs;>

Hours kzp neu';fs;

Minute epkpl';fs;

2036. Who examined you? ahh; c';fis gupnrhjpj;jhh;fs;> RECORD ALL PERSONS SEEN ghh;f;fg;gl;l midj;J egh;fisa[k; gjpt[ bra;at[k;

Doctor kUj;Jth; 01

Nurse eh;!; 02 Compounder/Pharmacist fk;gt[z;lh; - `ghh;k!p!;l; 03

ANM/LHV Vvd;vk;-vy;b\r;tp 04

Male MPW/ Supervisor Mz; nkw;ghh;itahsh; 05

Lab technician/radiographer Ma;tf blf;dP&pad; - nuonah

fpuh`gh; 06

Clerk vGj;jh; 07

Anganwadi worker m';fd;tho CHpah; 08

Village Health Guide fpuhkj;jpd; Mnuhf;fpa tHpfhl;o 09

Asha M&h 10

Other Public Health worker kw;w bghJr; Rfhjhu CHpah; 11

NGO worker muR rhuh epWtdj;jpd; CHpah; 12

Private doctor jdpahh; kUj;Jth; 13

Private Nurse jdpahh; eh;!; 14

Private Compounder/Pharmacist jdpahh; fk;gt[z;lh; - `ghh;k!p!;l; 15

Vaidya/Hakim/Homeopath itj;jpah; - n\hkpnahgjp kUj;Jth; 16

Dai (TBA) jha; (ghu«gupa ¾urt« gh®g;gt®) 17

Traditional Healer ghuk;gupa kUj;Jth; 18

Other private sector Health worker kw;w jdpahh; Jiw Mnuhf;fpa

CHpah; 19

Other ministerial staff kw;w eph;thf CHpah; 20

Others specify ________________

kw;wit Fwpg;gplt[k; 21

2037. Were you Hospitalized for this illness? ,e;j cly; eyf;Fiwtpw;fhf eP';fs; kUj;Jtkidapy; mDkjpf;fg;gl;Oh;fsh>

Yes Mk; 01

No ,y;iy 02 ���� 2039

2038. Did you have to go to a different place to get admitted as an inpatient eP';fs; cs; nehahspahf mDkjpf;fg;gLtjw;F ntW kUj;Jtkidf;Fr;; bry;y ntz;oapUe;jjh>

Yes Mk; 01

No ,y;iy 02

2039. FOR THIS VISIT: did you get _____________________? ,e;j tUifapy; eP';fs; / / / / /Ig; bgw;wPh;fsh> Read out all the options and code (Multiple answers possible) midj;J rhj;jpaf;TWfisa[k; goj;Jf; fhl;o Fwpaplt[k; (gy gjpy;fs; brhy;yyhk;;)

Consultation Mnyhrid 01 Medication given in facility trjpapy; kUj;J jug;gl;lJ 02

Injection Crp 03

Drip l;upg; 04 Operation/Surgery mWit rpfpr;ir 05

Lab test Ma;tfg; gupnrhjid 06

Other treatment (Specify)________ kw;w rpfpr;ir (Fwpg;gplt[k;)

07

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24 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips

2040. What was the total cost of treatment, including medications that may have been administered, (do not include the cost incurred for purchasing the medicines from outside) not including prescription cost? kUe;J rPl;ow;fhd bryitr; nrh;f;fhky.; Mdhy; kUj;Jt trjpapy; jug;gl;l kUe;Jfisr;; nrh;j;J rpfpr;irf;fhd bkhj;j bryt[ vd;d> (btspapypUe;J kUe;Jfis th';Ftjw;fhf Vw;gl;l bryitr; nrh;f;f ntz;lhk;)

In Rs. U:ghapy;

2041. Did the Doctor also give you a prescription? kUj;Jth; c';fSf;F kUe;J rPl;Lk; vGjpf; bfhLj;jhuh>

Yes Mk; 01

No ,y;iy 02 ���� 2066

2042. Did you buy the medicines prescribed by the Doctor? eP';fs; kUj;Jtuhy; gupe;Jiu bra;ag;gl;l kUe;Jf;fis th';fpdPh;fsh>

Yes, partially Mk;. gFjpast[ 01

Yes, fully Mk;. KGtJk; 02

No ,y;iy 03 ���� 2066

2043. What was the cost to buy (partial/entire) prescription? kUj;Jtuhy; gupe;Jiu bra;ag;gl;l kUe;Jf;fis (gFjpast[ - KGikahf) th';Ftjw;fhd bryt[ vd;d>

In Rs

.U:ghapy;

���� 2066

MEMBERS WHO HAVE NOT BEEN TO DOCTOR IN LAST 30 DAYS : MOST RECENT VISIT FOR SYMPTOMS IN THE PAST 12 MONTH S fle;jfle;jfle;jfle;j 30 ehl;fspy; cly;eyf; Fiwt[fSf;fhf lhf;liu ghu;f;f njitg;glhky;. fle;j 12 khj’;fspy; lhf;liu 30 ehl;fspy; cly;eyf; Fiwt[fSf;fhf lhf;liu ghu;f;f njitg;glhky;. fle;j 12 khj’;fspy; lhf;liu 30 ehl;fspy; cly;eyf; Fiwt[fSf;fhf lhf;liu ghu;f;f njitg;glhky;. fle;j 12 khj’;fspy; lhf;liu 30 ehl;fspy; cly;eyf; Fiwt[fSf;fhf lhf;liu ghu;f;f njitg;glhky;. fle;j 12 khj’;fspy; lhf;liu ghu;j;j egu;fsplk;. mtu;fSila filrpahf epfH;e;j re;jpg;g[ gw;wpghu;j;j egu;fsplk;. mtu;fSila filrpahf epfH;e;j re;jpg;g[ gw;wpghu;j;j egu;fsplk;. mtu;fSila filrpahf epfH;e;j re;jpg;g[ gw;wpghu;j;j egu;fsplk;. mtu;fSila filrpahf epfH;e;j re;jpg;g[ gw;wp Q.no Questions Options Codes Skips 2044. Now I would like to ask you about your last visit to a health

facility or consultation with a health provider. Did you consult anyone for any SYMPTOMS (problems, complaints), or illnesses inthe last 12 months? eP';fs; filrpahf tprpl;; bra;j Mnuhf;fpa trjp my;yJ Mnuhf;fpag; guhkupg;g[ mspg;gtUld; Mnyhrpj;jij gw;wp ,g;bghGJ ehd; nfl;f tpUk;g[fpnwd;/ fle;j 12 khj';fspy; VnjDk; mwpFwpfs; my;yJ cly; eyf;Fiwt[fSf;fhf kUj;Jtu; vtuplkhtJ Mnyhrid bgw;wPh;fsh> (ngl;obaLg;gth; bghJr; Rfhjhu ikak;. kUj;Jth; ,jutw;Wf;fhfj; J}z;of; nfl;ft[k;)

Yes Mk; 01

No ,y;iy 02 ���� 2066

2045. If yes, How many times did you consult someone for any health reason in the last 12 months? (No. of times) Mk; vdpy;. eP';fs; fle;j 12 khj';fspy; VnjDk; Mnuhf;fpak; rk;ge;jg;gl;l fhuzj;jpw;fhf kUj;Jtu; xUtuplk; vj;jid jlitfs; Mnyhrid bgw;wPh;fs;> (jlitfspd; vz;zpf;if)

No. of times (jlitfspd; vz;zpf;if)

2046. How long ago was your last [MOST RECENT] visit to a health facility or consultation with a health provider? xU Mnuhf;fpa trjpf;F my;yJ xU Mnuhf;fpa guhkupg;g[ mspg;gtuplk; Mnyhridf;F c';fsJ fle;j (kpfr; rkPgj;jpa) tprpl; vt;tst[ ehl;fSf;F Kd;dhy; ,Ue;jJ>

Value

Units

Months khj§f² 01

Weeks thu';f²

02

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25 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips 2047. For which conditions did you make the MOST recent

Visit? eP';fs; kpfr; rkPgj;jpa Mnyhridia ve;j Mnuhf;fpa Fiwt[ epiyikfSf;fhf bgw;wPh;fs;> INVESTIGATOR: RECORD THE NUMBER OF EACH CONDITION FROM THE ABOVE GRID (Q. 2016). ngl;obaLg;gth; ? nknya[s;s fpupl;oypUe;J (Q. 2016) xt;bthU epiyikapd; vz;iz gjpt[ bra;at[k; INVESTIGATOR: IF CONSULTATION MADE FOR ROUTINE EXAM/ MEDICAL CHECK UP, PRENATAL, IMMUNIZATION, DO NOT INCLUDE HERE. ngl;obaLg;gtUf;F ? ,e;j MnyhridahdJ. tHf;fkhd gupnrhjid - kUj;Jtg; gupnrhjidf;fhf. fh;g;gj;jpw;fhf. neha;j;jLg;g{rpf;fhf bra;ag;gl;lJ vdpy; ,';F nrh;f;f ntz;lhk;

Others (Specify)__________ kw;iwit (Fwpg;gplt[k;)

2048. I’d like to talk about your most recent visit in the last 12 months. Which type of facility did you visit, or which type of health provider did you consult? fle;j 12 khj';fspy; c';fsJ kpfr; rkPgj;jpa tprpl; gw;wp ehd; ngRtjw;F tpUk;g[fpnwd;/ eP';fs; ve;j tif trjpf;Fr; brd;wPh;fs; my;yJ eP';fs; ve;j tif Mnuhf;fpa guhkupg;g[ mspg;gtuplk; Mnyhrid bgw;wPh;fs;>

Public Medical Sector: bghJ kUj;Jtj;Jiw

Govt./Municipal Hospital murh';f-Kdp!pgy; kUj;Jtkid 01

Govt. Dispensary murh';f kUe;jfk; 02

UHV/UHP/UFWC a[b\r;;tp-a[b\r;gp-a[v`g;lgps;a[rp 03

CHC/Rural Hospital/PHC rpb\r;rp- fpuhkg;g[w kUj;Jtkid-

Muk;g Rfhjhu ikak 04

Sub Centre Jiz ikak; 05 Govt. Mobile Clinic

murh';f elkhLk; fpspdpf; 06

Camp Kfhk; (nfk;g;) 07 Anganwadi/ICDS center

m';fd;tho-Irpov!; brd;lh; 08

Other Public sector health facility kw;w bghJj;Jiw Mnuhf;fpa trjp 09

Other Government/ Public medical facility

kw;w murh';f - bghJ kUj;Jt trjp 10

NGO or Trust Hospital/Clinic vd;$pX my;yJ mwf;fl;lis

kUj;Jtkid-fpspdpf; 11

Private Medical Sector: jdpahh; kUj;Jtj;Jiw Private Hospital

jdpahh; kUj;Jtkid 12

Private Doctor/Clinic; jdpahh; kUj;Jth; - fpspdpf; 13

Private mobile clinic jdpahh; bkhigy; f;spdpf; 14

Ayurvedic doctor [Vaidya/Hakim/Homeopath]

Ma[h;ntj kUj;Jth; (it¤½a®. \¡»«. n\hÄnahg½);

15

Traditional Healer ghuk;gupa kUj;Jth; 16

Pharmacy/ Dispensary `ghh;k!p - kUe;jfk; 17

Dai (TBA) lha; (ghu«gupa ¾urt« gh®g;gt®) 18

Other private sector health facility kw;w jdpahh; Jiw Mnuhf;fpa trjp 19

Other kw;wit 20

2049. Was this consultation in your own home? Mnuhf;fpag; guhkupg;g[ mspg;gtUldhd ,e;j Mnyhrid c';fsJ tPl;oy; ele;jjh>

Yes Mk; 01

No ,y;iy 02 ����2051

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26 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips 2050. Where is this health provider based?

,e;j Mnuhf;fpa guhkupg;g[ mspg;gth; v';F cs;shh;> INVESTIGATOR: WRITE THE NAME AND PLACE OF THIS HEALTH PROVIDER’S PRIMARY LOCATION ngl;obaLg;gth; ? ,e;j Mnuhf;fpa guhkupg;g[ mspg;gtupd; Kjd;ikahd ,Ug;gplj;jpd; bgau; kw;wk; miktplk; vGjt[k;

NAME OF PROVIDER/FACILITY guhkupg;g[ mspg;gth; - trjpapd; bgah;; _____________________________________

���� 2058

Name of Village/Town fpuhkk;- efuj;jpd;; bgah;; ______________________ Village / Town Census ID [Editing] fpuhkk;- efuj;jpd;; brd;!!; milahs vz; (vol;o';) _____________ Name of Taluk jhYfh bgah; __________________________ Taluk ID jhYfh milahs vz; ___________________ District Name khtl;lj;jpd; bgah; ______________________ District ID khtl;lj;jpd; milahs vz; ______________ State Name khepyj;jpd; bgah; _______________________ State ID khepyj;jpd; milahs vz; _______________

2051. Where is this facility located, or where did you consult this health provider? ,e;j trjp v';F mike;jpUf;fpwJ my;yJ eP';fs; ,e;j Mnuhf;fpa guhkupg;g[ mspg;gtuplk; v';F Mnyhrid bgw;wPh;fs;>

NAME OF PROVIDER/FACILITY guhkupg;g[ mspg;gth; - trjpapd; bgah;; _____________________________________

Name of Village/Town fpuhkk; - Ch; bgah;; ______________________

Village / Town Census ID [Editing] fpuhk - Ch; brd;!!; milahs vz; (vol;o';) _____________

Name of Taluk jhYfh bgah; __________________________

Taluk ID jhYfh milahs vz; ___________________

District Name khtl;lj;jpd; bgah; ______________________

District ID khtl;lj;jpd; milahs vz; ______________

State Name khepyj;jpd; bgah; _______________________

State ID khepyj;jpd; milahs vz; _______________

2052. Distance from residence (km) trpg;gplj;jpypUe;J J}uk; (fP/kPl;lh;)

In kms to 00.00 fp/ kPl;lh;fspy; 00/00

2053. Transportation cost, round trip nghf tu nghf;Ftuj;Jr; bryt[

In Rs. U:ghapy;

2054. What was the mode of transportation? nghf;Ftuj;Jf;fhd tHp tif vJ>

Train uapy; 01

Bus – (Govt./ Private)

ngUªJ (muR - jdpah®) 02

School / company

bus

g²Ëg; - f«bgdp ngUªJ (g!;) 03

4-wheeler 4 rf;fu thfdk; 04

Share auto/auto

n&h; Ml;nlh - Ml;nlh 05

2 wheeler 2 rf;fu thfdk; 06

cycle rickshaw

irf;fps; hpf;&h 07

cycle irf;fps; 08

Horse cart F½iu t©o 09

Bullock cart kh£L t©o 10

Boat / Waterways

glF - Ù® tÊahf 11

foot ele;J bry;tJ 12

Other mode (Specify) _______

kw;wit (Fwpg;gplt[k;) 13

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27 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips 2055. What was the travel time, one way, to this facility?

,e;j trjpf;F bry;tjw;F xU tHpf;F gaz neuk; vt;tst[>

Hours kzp neu';fs;

Minute epkpl';fs;

2056. Upon arrival, how long did you wait to be examined by a health officer? ngha;r; nrh;e;jt[ld;. eP';fs; Mnuhf;fpa mjpfhupahy; gupnrhjpf;fg;gLtjw;F vt;tst[ neuk; fhj;jpUe;jPh;fs;>

Hours kzp neu';fs;

Minute epkpl';fs;

2057. How much time, in total, did you spend at the health facility (from arrival to the end of treatment?) eP';fs; Mnuhf;fpa trjpapy; bkhj;jj;jpy; vt;tst[ neuk; (ngha;r; nrh;e;jjpypUe;J rpfpr;irapd; ,Wjp tiuapy;) brytHpj;jPh;fs;>

Hours kzp neu';fs;

Minute epkpl';fs;

2058. Who examined you? ahh; c';fis gupnrhjpj;jhh;fs;> RECORD ALL PERSONS SEEN ghh;f;fg;gl;l midj;J egh;fisa[k; gjpt[ bra;at[k;

Doctor kUj;Jth; 01

Nurse eh;!; 02

Compounder/Pharmacist fk;gt[z;lh; - `ghh;k!p!;l; 03

ANM/LHV Vvd;vk;-vy;b\r;tp 04

Male MPW/ Supervisor Mz; nkw;ghh;itahsh; 05

Lab technician/radiographer Ma;tf blf;dP&pad; - nuonah fpuh`gh; 06

Clerk vGj;jh; 07

Anganwadi worker m';fd;tho CHpah; 08

Village Health Guide fpuhkj;jpd; Mnuhf;fpa tHpfhl;o 09

Asha M&h 10 Other Public Health worker kw;w bghJr; Rfhjhu CHpah; 11

NGO worker muR rhuh epWtdj;jpd; CHpah; 12

Private doctor jdpahh; kUj;Jth; 13

Private Nurse jdpahh; eh;!; 14

Private Compounder/Pharmacist jdpahh; fk;gt[z;lh; - `ghh;k!p!;l; 15

Vaidya/Hakim/Homeopath itj;jpah;-\f;fPk-;n\hkpnahgjp

kUj;Jth; 16

Dai (TBA) jha; (ghu«gupa ¾urt« gh®g;gt®) 17

Traditional Healer ghuk;gupa kUj;Jth; 18

Other private sector Health worker kw;w jdpahh; Jiw Mnuhf;fpa CHpah; 19

Other ministerial staff kw;w eph;thf CHpah; 20

Others (specify) kw;wit (Fwpg;gplt[k); _______________________

21

2059. Were you Hospitalized (OVERNIGHT) for this illness? eP';fs; ,e;j cly; eyf;Fiwtpw;fhf (xU ,ut[ ) kUj;Jtkidapy; mDkjpf;fg;gl;Oh;fsh>

Yes Mk; 01

No ,y;iy 02 ���� 2061 2060. Did you go to a different place to get admitted as an inpatient

eP';fs; cs; nehahspahf mDkjpf;fg;gLtjw;F ntW kUj;Jtkidf;Fr; bry;y ntz;oapUe;jjh>

Yes Mk; 01

No ,y;iy 02

2061. FOR THIS Visit: did you get _____________________? ,e;j tUifapy; eP';fs; / / / / /Ig; bgw;wPh;fsh> Read out all the options and code (Multiple answers possible) midj;J rhj;jpaf;TWfisa[k; goj;Jf; fhl;o Fwpaplt[k; (gy gjpy;fs; tuyhk;)

Consultation Mnyhrid 01 Medication given in facility trjpapy; kUe;;J jug;gl;lJ 02

Injection Crp 03

Drip l;upg; 04

Operation/Surgery mWit rpfpr;ir 05

Lab test Ma;tfg; gupnrhjid 06 Other treatment (Specify) kw;w rpfpr;ir (Fwpg;gplt[k;)

07

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28 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips 2062. What was the total cost of treatment, including medications

that may have been administered, (do not include the cost incurred for purchasing the medicines from outside) not including prescription cost? kUe;J rPl;ow;fhd bryitr; nrh;f;fhky.; Mdhy; kUj;Jt trjpapy; jug;gl;l kUe;Jfisa[k;; nrh;j;J rpfpr;irf;fhd bkhj;j bryt[ vd;d> (btspapypUe;J kUe;Jfis th';Ftjw;fhf Vw;gl;l bryitr; nrh;f;f ntz;lhk;)

In Rs. U:ghapy;

2063. Did the Doctor also give you a prescription? kUj;Jth; c';fSf;F kUe;Jr; rPl;L vGjpf; bfhLj;jhuh>

Yes Mk; 01

No ,y;iy 02 ���� 2066

2064. Did you buy the medicines prescribed by the Doctor? eP';fs; kUj;Jtuhy; gupe;Jiu bra;ag;gl;l kUe;Jfis th';fpdPh;fsh>

Yes partially Mk;. gFjpast[

01

Yes, fully Mk;. KGtJk;

02

No ,y;iy

03 ���� 2066

2065. What was the cost to buy that (partial/entire) prescription? kUj;Jtuhy; gupe;Jiu bra;ag;gl;l kUe;Jfis (gFjpast[ - KGikahf) th';Ftjw;fhd bryt[ vd;d>

In Rs. U:ghapy;

ALL HOUSEHOLD MEMBERS: HEALTH CHECK-UPS IN THE LAST ONE YEAR FLk;gj;jpd; cWg;gpdh;fs; midtUk; ? fle;j xU tUlj;jpy; Mnuhf;fpaj;jpw;fhd gupnrhjid Q.no Questions Options Codes Skips 2066. Did you consult anyone [INVESTIGATOR: PROBE FOR

PHC, DOCTOR, ETC] when not sick in the last one year for medical check ups, including general health, chronic care, etc (excluding prenatal care, immunization)? cl¯ eykhf ,UªjnghJ eP';fs; fle;j xU tUlj;jpy; bghJthd Mnuhf;fpag; guhkupg;g[.[ ,ju ehs; gl;l neha; cs;sl';fpa kUj;Jtg; gupnrhjidfSf;fhf (fh;g;gfhyg; guhkupg;g[. neha;j;jLg;g{rp nrh;f;fhky;) vtuplnkDk; Mnyhrid bgw;wPh;fsh> (ngl;obaLg;gth; bghJr; Rfhjhu ikak;. kUj;Jth; nghd;wtw;Wf;F J}z;of; nfl;ft[k;)

Yes Mk; 01

No ,y;iy 02 ���� 2085

2067. How many times did you consult someone for Medical check up in the last one year? eP';fs; fle;j xU tUlj;jpy; kUj;Jtg; gupnrhjidf;fhf vj;jid jlitfs; kUj;Jtu; vtuplkhtJ Mnyhrid bgw;wPh;fs;>

No. of times jlitfspd; vz;zpf;if

2068. How long ago did you mostly recently visit for general Medical check up in the last twelve months? fle;j 12 khj’;fspy;. bghJthd kUj;Jtg; gupnrhjidf;fhf vt;tst[ fhyj;jpw;F Kd;g[ filrpahf eP’;fs; brd;wPh;fs;>

Write value, circle units vz;zpf;ifia vGjp mstPLfis

tl;lkplt[k;

Day ehs; 01

Month khjk; 02

Year tUlk; 03

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29 URBAN INDIVIDUAL QUESTIONNAIRE- Health

2069. I’d like to talk about your most recent visit in the

last 1 year. Which type of facility did you visit, or which type of health provider did you consult? fle;j xU tUlj;jpy; kpfr; rkPgj;jpa tprpl; gw;wp ehd; ngRtjw;F tpUk;g[fpnwd;/ eP';fs; ve;j tif trjpf;Fr; brd;wPh;fs; my;yJ eP';fs; ve;j tif Mnuhf;fpa guhkupg;g[ mspg;gtuplk; Mnyhrid bgw;wPh;fs;>

Public Medical Sector: bghJ kUj;Jtj;Jiw Govt./Municipal Hospital murh';f-Kdp!pgy;

kUj;Jtkid 01

Govt. Dispensary murh';f kUe;jfk; 02 UHV/UHP/UFWC a[[b\r;tp-a[b\r;gp-

a[v`g;lgps;a[rp 03

CHC/Rural Hospital/PHC rpb\r;rp- fpuhkg;g[w kUj;Jtkid- Muk;g

Rfhjhu ikak 04

Sub Centre Jiz ikak; 05 Govt. Mobile Clinic murh';f elkhLk;

fpspdpf; 06

Camp Kfhk; (nfk;g;) 07 Anganwadi/ICDS center m';fd;tho-Irpov!;

brd;lh; 08

Other Public sector health facility

kw;w bghJj;Jiw Mnuhf;fpa trjp 09

Other Government/ Public medical facility

kw;w murh';f - bghJ kUj;Jt trjp 10

NGO or Trust Hospital/Clinic

vd;$pX my;yJ mwf;fl;lis

kUj;Jtkid-fpspdpf; 11

Private Medical Sector: jdpahh; kUj;Jtj;Jiw Private Hospital jdpahh; kUj;Jtkid 12

Private Doctor/Clinic; jdpahh; kUj;Jth; - fpspdpf; 13

Private mobile clinic jdpahh; bkhigy; f;spdpf; 14

Ayurvedic doctor [Vaidya/Hakim/Homeopa

th]

Ma[h;ntj kUj;Jth; (it¤½a®. \¡»«.

n\hÄnahg½); 15

Traditional Healer ghuk;gupa kUj;Jth; 16 Pharmacy/ Dispensary `ghh;k!p - kUe;jfk; 17

Dai (TBA) jha; (ghu«gupa ¾urt« gh®g;gt®) 18

Other private sector health facility

kw;w jdpahh; Jiw Mnuhf;fpa trjp 19

Other kw;wit 20

Q.no Questions Options Codes Skips 2070. Was this consultation with health provider in your home?

Mnuhf;fpag; guhkupg;g[ mspg;gtUldhd ,e;j Mnyhrid c';fsJ tPl;oy; ele;jjh>

Yes Mk;

01

No ,y;iy

02 ���� 2072

2071. Where is this health provider based? ,e;j Mnuhf;fpa guhkupg;g[mspg;gth; v';F cs;shh;> INVESTIGATOR: WRITE THE NAME AND PLACE OF THIS HEALTH PROVIDER’S PRIMARY LOCATION ngl;obaLg;gth; ? ,e;j Mnuhf;fpa guhkupg;g[ mspg;gtupd; Kjd;ikahd ,Ug;gplj;jpd; bgah; kw;Wk; miktplk;; vGjt[k;

NAME OF PROVIDER/FACILITY guhkupg;g[ mspg;gth; - trjpapd; bgah;; _____________________________________

���� 2079

Name of Village/Town fpuhkk; - Ch; bgah;; ______________________

Village / Town Census ID [Editing] fpuhk - Ch; brd;!!; milahs vz; (vol;o';) _____________ Name of Taluk jhYfh bgah; __________________________ Taluk ID jhYfh milahs vz; ___________________ District Name khtl;lj;jpd; bgah; ______________________ District ID khtl;lj;jpd; milahs vz; ______________ State Name khepyj;jpd; bgah; _______________________ State ID khepyj;jpd; milahs vz; _______________

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30 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips 2072. Where is this facility located / where did you

consult this health provider? ,e;j trjp v';F mike;jpUf;fpwJ my;yJ eP';fs; ,e;j Mnuhf;fpa guhkupg;g[ mspg;gtuplk; v';F Mnyhrid bgw;wPh;fs;>

NAME OF PROVIDER/FACILITY guhkupg;g[ mspg;gth; - trjpapd; bgah;; _____________________________________

Name of Village/Town fpuhkk; - Ch; bgah;; ______________________

Village / Town Census ID [Editing] fpuhk - Ch; brd;!!; milahs vz; (vol;o';) _____________

Name of Taluk jhYfh bgah; __________________________

Taluk ID jhYfh milahs vz; ___________________

District Name khtl;lj;jpd; bgah; ______________________

District ID khtl;lj;jpd; milahs vz; ______________

State Name khepyj;jpd; bgah; _______________________

State ID khepyj;jpd; milahs vz; _______________

2073. Distance from RESIDENCE (km) trpg;gplj;jpypUe;J J}uk; (fp/kPl;lh;)

In kms to 00.00 fp/ kPl;lh;fspy; 00/00

2074. transportation cost, round trip nghf tu nghf;Ftuj;Jr; bryt[

In Rs. U:ghapy;

2075. what was the mode of transportation? nghf;Ftuj;Jf;fhd tHp tif vJ>

Train uapy; 01 Bus – (Govt./ Private) ngUªJ (muR

- jdpah®) 02

School / company bus

g²Ë - f«bgdp

ngUªJ (g!;) 03

4-wheeler 4 rf;fu thfdk; 04

Share auto/auto n&h; Ml;nlh - Ml;nlh 05

2 wheeler 2 rf;fu thfdk; 06

cycle rickshaw irf;fps; hpf;&h 07

cycle irf;fps; 08 Horse cart F½iu t©o 09

Bullock cart kh£L t©o 10 Boat / Waterways glF - Ù®

tÊahf

11

foot ele;J bry;tJ 12

Other mode (Specify)

______________ kw;wit (Fwpg;gplt[k;)

13

Q.no Questions Options Codes Skips 2076. What was the travel time, one way, to this facility?

,e;j trjpf;F bry;tjw;F mjhtJ xU tHpf;F gaz neuk; vt;tst[>

Hours kzp neu';fs;

Minute epkpl';fs;

2077. Upon arrival, how long did you wait to be examined by a health officer? ngha;r; nrh;e;jt[ld;. eP';fs; Mnuhf;fpa mjpfhupahy; gupnrhjpf;fg;gLtjw;F vt;tst[ neuk; fhj;jpUe;jPh;fs;>

Hours kzp neu';fs;

Minute epkpl';fs;

2078. How much time, in total, did you spend at the health facility (from arrival to the end of treatment?) eP';fs; Mnuhf;fpa trjpapy; bkhj;jj;jpy; vt;tst[ neuk; (ngha;r; nrh;e;jjpypUe;J rpfpr;irapd; ,Wjp tiuapy;) brytHpj;jPh;fs;>

Hours kzp neu';fs;

Minute epkpl';fs;

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31 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skips 2079. Who examined you?

ahh; c';fis gupnrhjpj;jhh;fs;> RECORD ALL PERSONS SEEN ghh;f;fg;gl;l midj;J egh;fisa[k; gjpt[ bra;at[k;

Doctor kUj;Jth; 01

Nurse eh;!; 02 Compounder/Pharmacist fk;gt[z;lh; - `ghh;k!p!;l; 03

ANM/LHV Vvd;vk;-vy;b\r;tp 04

Male MPW/ Supervisor Mz; nkw;ghh;itahsh; 05

Lab technician/radiographer Ma;tf blf;dP&pad; - nuonah

fpuh`gh; 06

Clerk vGj;jh; 07

Anganwadi worker m';fd;tho CHpah; 08

Village Health Guide fpuhkj;jpd; Mnuhf;fpa tHpfhl;o 09

ASHA M&h 10 Other Public Health worker kw;w bghJr; Rfhjhu CHpah; 11

NGO worker muR rhuh epWtdj;jpd; CHpah; 12

Private doctor jdpahh; kUj;Jth; 13

Private Nurse jdpahh; eh;!; 14

Private Compounder/Pharmacist jdpahh; fk;gt[z;lh; - `ghh;kh!p!;l; 15

Vaidya/Hakim/Homeopath itj;jpah; - n\hkpnahgjp kUj;Jth; 16

Dai (TBA) jha; (ghu«gupa ¾urt« gh®g;gt®) 17

Traditional Healer ghuk;gupa kUj;Jth; 18

Other private sector Health worker kw;w jdpahh; Jiw Mnuhf;fpa CHpah; 19

Other ministerial staff kw;w eph;thf CHpah; 20

Others (specify) _______________ kw;wit (Fwpg;gplt[k); 21

2080. FOR THIS CONSULTATION: did you get _____________________? ,e;j Mnyhridapd;nghJ eP';fs; / / / / /Ig; bgw;wPh;fsh> Read out all the options and code (Multiple answers possible) midj;J rhj;jpaf;TWfisa[k; goj;Jf; fhl;o Fwpaplt[k; (gy gjpy;fs; brhy;yyhk;)

Consultation Mnyhrid 01

Medication given in facility trjpapy; kUj;J jug;gl;lJ 02

Injection Crp kUe;J 03

Drip l;upg; 04

Operation/Surgery mWit rpfpr;ir 05

Lab test Ma;tfg; gupnrhjid 06

Other treatment kw;w rpfpr;ir 07

2081. What was the total cost of treatment, including medications that may have been administered, (do not include the cost incurred for purchasing the medicines from outside) not including prescription cost? kUe;J rPl;ow;fhd bryitr; nrh;f;fhky.; Mdhy; kUj;Jt trjpapy; jug;gl;l kUe;Jfisa[k;; nrh;j;J rpfpr;irf;fhd bkhj;j bryt[ vd;d> (btspapypUe;J kUe;Jfis th';Ftjw;fhf Vw;gl;l bryitr; nrh;f;f ntz;lhk;)

In Rs. U:ghapy;

2082. Did the Doctor also give you a prescription? kUj;Jth; c';fSf;F kUe;Jr;rPl;L vGjpf; bfhLj;jhuh>

Yes Mk; 01

No ,y;iy 02 ���� 2085

2083. Did you buy the medicines prescribed by the Doctor? eP';fs; kUj;Jtuhy; gupe;Jiu bra;ag;gl;l kUe;Jfis th';fpdPh;fsh>

Yes partially Mk;. gFjpast[ 01 Yes, fully Mk;. KGtJk; 02

No ,y;iy 03 ���� 2085 2084. What was the cost to buy (partial/entire) prescription?

kUj;Jtuhy; gupe;Jiu bra;ag;gl;l kUe;Jfis (gFjpast[ - KGikahf) th';Ftjw;fhd bryt[ vd;d>

In Rs. U:ghapy;

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32 URBAN INDIVIDUAL QUESTIONNAIRE- Health

AGES 0-8 COMPLETED YEARS: ASTHMA, RHINITIS (HAY FEV ER), & ECZEMA taJ 0=8 Gotilªj tUl« = M!;j;kh. iudpo!;(n\ $%uk;). Jhrpapdhy Vw;gLk; Jk;kYld; Tloa $%uk;. vf;!pkh (brhwp. rpu’;F neha;) Mfpatw;wpd; tptu’;fs;

Q.no Questions Options Codes Skip to 2085. INVESTIGATOR: IS [NAME] 8 OR YOUNGER?

ngl;obaLg;gth; rupghh;f;ft[k; ? ,e;j egh; 8 taJ my;yJ mjw;F Fiwthd taJs;stuh>

Yes Mk; 01

No ,y;iy 02 ����2121

2086. Has [NAME] Ever had wheezing or whistling noise in the chest at anytime in the past? fle;j fhyj;jpy; vg;nghjhtJ (bgau;) f;F K:r;Rj; jpzwy; my;yJ khu;gpy; tprpy; rg;jk; nghd;W Vw;gl;Ls;sjh>

Yes Mk; 01

No ,y;iy 02 ���� 2092

2087. Has [NAME] had wheezing or whistling noise in the chest at anytime in the last 12 months? fle;j 12 khj’;fspy;; vg;nghjhtJ (bgau;) f;F K:r;Rj; jpzwy; my;yJ khu;gpy; tprpy; rg;jk; nghd;W Vw;gl;Ls;sjh>

Yes Mk; 01

No ,y;iy 02 ���� 2092

2088. How many attacks of wheezing has [NAME] had in the last 12 months? [Number of attacks] fle;j 12 khj’;fspy;; (bgau;) f;F vj;jid Kiw K:r;Rj; jpzwy; Vw;gl;Ls;sJ>

Number of attacks Vw;gl;l jlitfspd;

vz;zpf;if

2089. In the last 12 months, on average, how many nights per week has your child’s sleep been disturbed due to wheezing? fle;j 12 khj';fspy; K:r;Rj; jpzwy; fhuzkhf c’;fs; FHe;ijapd; J}f;fk; ruhrupahf xU thuj;jpy; vj;jid ,ut[fs; ghjpf;fg;gl;lJ>

Number of Nights ,ut[fspd; vz;zpf;if

2090. In the last 12 months, has the wheezing been severe enough to limit your child’s speech to only one or two words at a time between breaths? fle;j 12 khj’;fspy; c’;fs; FHe;ijapDila ngr;R K:r;Rj; jpzwy;fSf;fpilna xd;wpuz;L thu;j;ijfs; kl;Lk; xU neuj;jpy; ngrf;Toa mstpw;F K:r;Rj; jpzwy; fLikahdjhf ,Ue;Js;sjh>

Yes Mk; 01

No ,y;iy 02

2091. In the last 12 months has [NAME] Chest sounded wheezy during or after exercise or any physical activity fle;j 12 khj’;fspy; (bgau;) clw;gapw;rp my;yJ VjhtJ bray;fisr; bra;a[k; nghJ my;yJ bra;jgpwF khu;gpy; glglg;g[ld; tprpy; rg;jk; Vw;gl;Ls;sjh>

Yes Mk; 01

No ,y;iy 02

2092. In the last 12 months has [NAME] Had dry cough at night apart from a cough linked to a cold or chest infection? fle;j 12 khj';fspy; (bgau;)/f;F $ynjh&j;Jld; bjhlh;g[s;s ,Uky; my;yJ khh;g[j; bjhw;Wld; bjhlh;g[s;s ,Ukiyj; jtput[k; ,utpy; twl;L ,Uky; ,Ue;jpUf;fpwjh>

Yes Mk; 01

No ,y;iy 02

2093. Has [NAME] ever had problems with sneezing or a runny/blocked nose, even when [NAME] did NOT have a cold or the flu? c’;fs; FHe;ijf;F rsp my;yJ `g;S ,y;yhj nghJk; Jk;ky; my;yJ K:f;F xGFjy;-K:f;F milg;g[ nghd;w gpur;rpidfs; vg;nghjhtJ Vw;gl;Ls;sjh>

Yes Mk; 01

No ,y;iy 02 ����2097

2094. In the last 12 months has [NAME]] had sneezing, runny nose & accompanied by itchy watery eyes which is not related to a cold or the flu? fle;j 12 khj’;fspy (bgau;) f;F rsp my;yJ `g;Stpw;F rk;ge;jk;,y;yhky;; Jk;ky.; K:f;F xGFtJ fz; vupr;ry; kw;Wk; fz;fspy; fz;zPUld; nrh;e;J tUtJ nghd;W gpur;rpidfs; ,Ue;Js;sjh>

Yes Mk; 01

No ,y;iy 02 ���� 2097

2095. In which of the past month/s did his nose problem occur? Multiple answers possible fle;j fhyj;jpy; ve;j khjk;-khj’;fspy; ,e;j K:f;F gpur;rpid Vw;gl;lJ> (xd;Wf;F nkw;gl;l gjpy;fs; juyhk;;/ khj’;fSf;F FwpaPL bfhLj;J ml;ltizapy; Fwpg;gplt[k;)

January 01 February 02

March 03 April 04 May 05 June 06 July 07

August 08 September 09

October 10 November 11 December 12

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33 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skip to 2096. In the past 12 months how much did this nose problem

interfere with your child's daily activities? fle;j 12 khj’;fspy; ,e;j K:f;Fg; gpur;rpid c’;fs; FHe;ijapd; md;whl bray;ghLfspy; ve;j mstpw;F gpur;rpid Vw;gLj;jpa[s;sJ>

A little rpwpjst[ 01

Not at all vJt[kpy;iy 02

A lot bgUkstpw;F 03

2097. Has [NAME] EVER had an itchy rash which was coming and going for at least 6 months? (bgau;) f;F Fiwe;j gl;rk; 6 khj';fSf;F mt;tg;nghJ te;J nghfpw mupg;g[ld; Toa jog;g[ vg;bghGjhtJ ,Ue;jpUf;fpwjh>

Yes Mk; 01

No ,y;iy 02 ���� 2103

2098. At what age did this itchy rash first occur? [if LESS THAN 2 YEARS, WRITE MONTHS] ve;j tajpy; ,e;j mupg;g[ld; Toa jog;g[ Kjypy; Vw;gl;lJ> (2ta½¦F Fiwthf v¬wh¯ khj§fspy; F¿¡fæ«)

Months. khj’;fs;

Years tUl’;fs;

2099. Has this itchy rash at any time affected any of the

following places: the folds of the elbows, behind the knees, in front of the ankles, under the buttocks, around the neck, ears, or eyes? ,e;j mupg;g[ jog;g[ gpd;tUk; ,l’;fis vg;bghGjhtJ ghjpj;Js;sjh> KH’;iffspd; kog;gpy;;. Kl;ofSf;F gpd;dhy;.;;;;;;;;;; kzpf;fl;ow;F Kd;dhy.; cl;fhUkplj;jpw;F fPnH. fGj;ijr; Rw;wp. fhJfisr; Rw;wp; my;yJ fz;fisr; Rw;wp;;>

Yes Mk; 01

No ,y;iy 02

2100. Has [NAME]had this itchy rash at any time in the last

12 months? (bgau;) f;F ,e;j mupg;g[ jog;g[ fle;j 12 khj’;fsp;y; vg;nghjhtJ te;Js;sjh>

Yes Mk; 01

No ,y;iy 02 ���� 2103

2101. Has this rash cleared completely at anytime during the last 12 months? ,e;j jog;g[ fle;j 12 khj’;fspy; vg;bghGjhtJ Kw;wpYk; FzkhfpapUf;fpwjh>

Yes Mk; 01

No ,y;iy 02

2102. In the last 12 months, on average how many nights per week, has [NAME]been kept awake at night by this itchy rash? fle;j 12 khj';fspy; (bgau;) ,e;j mupg;g[ld; Toa jog;gpdhy; ruhrupahf xU thuj;jpy; vj;jid ,ut[fspy; cw’;f Koahky;; tpHpj;Jf; bfhz;oUe;jJ>

Numbers vz;zpf;if

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34 URBAN INDIVIDUAL QUESTIONNAIRE- Health

AGES 0-5 COMPLETED YEARS: IMMUNIZATION AND DIARRHOE A taJ 0 = 5 Kotile;j tUl';fs; ? neha; jLg;g[ kw;Wk; ngjp Q.no Questions Options Codes Skip 2103.

INVESTIGATOR:IS PERSON AGE 5 OR YOUNGER? ngl;obaLg;gth; ? ,e;j egh; 5 taJ my;yJ ; mjw;F Fiwthd taJs;stuh>

Yes Mk; 01

No

,y;iy 02 ���� 2121

2104. Do you have a card where [NAME] vaccinations are written down? If yes: may I see the card please? (bgau;) jLg;g[ kUe;J nghd;wd nghlg;gl;ljd; tptuk; vGjg;gl;Ls;s xU ml;il (fhu;L) c’;fsplk; ,Uf;fpwjh> Mk; vdpy; me;j ml;ilia ehd; ghh;f;fyhkh>

Yes, Seen card Mk.; ml;il ghh;f;fg;gl;lJ 01 ���� 2106

Yes, not seen card Mk.; Mdh¯ ml;il

ghh;f;ftpy;iy

02

No card ml;il ,y;iy 03

2105. Did you ever have a vaccination card for [NAME]? eP’;fs; (bgau;) f;F vg;nghjhtJ neha; jLg;g[ kUe;JfSf;fhd ml;il itj;jpUe;jPu;fsh>

Yes Mk; 01 ���� 2108

No ,y;iy 02

2106. Copy vaccination dates for each vaccine from the card. And write 88 in the DAY column if card shows that a vaccination was given but no date is recorded. xt;;bthU neha; jLg;gpw;Fk; kUe;J nghlgl;l njjpfis ml;ilapypUe;J Fwpj;Jf;bfhs;st[k;/ ml;ilapy; jLg;g[ kUe;J bfhLf;fg;gl;ljhf Fwpg;gplg;gl;L Mdhy; njjp Fwpg;gplg;gltpy;iy vdpy; 88 /I fl;lj;jpy; vGjt[k; IF ALL THE VACCINES FILLED IN, SKIP TO 2116

vy;yh jLg;g[ kUe;JfSk; g{h;j;jp bra;ag;gl;oUe;jhy;. 2116 f;Fr; bry;yt[k;

DD MM YYYY

BCG gprp$p Polio 0 nghypnah 0 DPT 1 ogpo 1 DPT 2 ogpo 2 DPT 3 ogpo 3 Polio 1 nghypnah 1 Polio 2 nghypnah 2 Polio 3 nghypnah 3 Measles jl;lk;ik jLg;g{rp

2107. Has [NAME] Received vaccinations that are not recorded on this card? Record Yes only if respondent mentions BCG, DPT 1-3, Polio 0-3 and /or measles vaccine. ,e;j fhu;oy; gjpt[ bra;ag;glhj jLg;g[ kUe;Jfis (bgau;) f;F ; nghlg;gl;oUf;fpwjh> (ngl;o mspg;gtu; BCG, DPT 1-3, Polio 0-3 kw;Wk;- my;yJ jl;lk;ik kUe;J Fwpg;gpl;lhy; kl;Lk; Mk; vd;W gjpt[ bra;at[k;) Instruction: If Yes ( probe for vaccinations and write -99 in the corresponding DAY column in Q. 2106 and skip to Question no. 2116 ), tHpfhl;Lk; Fwpg;g[ ? Mk; vdpy; (jLg;g[ kUe;Jfis tpsf;fkhff; nfl;L nfs;tp 2106?y; bghUj;jkhd ehs; fhyj;jpy; 99 vGjt[k;;/ mLj;J nfs;tp vz; 2116f;F nghft[k;)

Yes Mk; 01

Follow instruction to left nfs;tpapd; fPnH cs;s Fwpg;ig gpd;gw;wt[k;

No ,y;iy 02 ���� 2116

IF NO CARD AVAILABLE, ASK fhh;l; fpilf;ftpy;iy vd;why;. nfl;ft[k;fhh;l; fpilf;ftpy;iy vd;why;. nfl;ft[k;fhh;l; fpilf;ftpy;iy vd;why;. nfl;ft[k;fhh;l; fpilf;ftpy;iy vd;why;. nfl;ft[k;

2108. Did [NAME] Ever received any vaccinations to prevent him/her from getting diseases? neha;fspy; ,Ue;J mtiu ghJfhj;Jf; bfhs;tjw;fhf (bgau;)////f;F vg;nghjhtJ jLg;g[ kUe;Jfs; VjhtJ nghlg;gl;oUf;fpwjh>

Yes Mk; 01

No ,y;iy 02 ���� 2117

Please tell me if [NAME] Has received any of the following vaccinations: (bgau;)///// f;F gpd;tUk; jLg;g[ kUe;Jfs; VjhtJ nghlg;gl;oUf;fpwjh vd;gijr; brhy;Y’;fs;

2109. A BCG Vaccination against tuberculosis, that is, an

injection in the arm that caused a scar? fhr nehapypUe;J jLg;gjw;F nghlg;gLk; BCG jLg;g[ Crp. ifapy; jGk;g[ Vw;gLj;jf;Toa xU Crp>

Yes Mk; 01

No ,y;iy 02

2110. A DPT vaccination against diphtheria, whooping

cough, and tetanus given as an injection? og;jPupah. (bjhz;il milg;ghd; neha;) bjhlh;r;rpahd ,Uky; kw;Wk; bll;ld!;f;F ($d;dpf;F) vjpuhf Crp kUe;jhf nghlg;gLk; ogpo jLg;g[ kUe;J>

Yes Mk; 01

No ,y;iy 02 ���� 2112

2111. How many times ( write number of times) vj;jid Kiwfs;> (vz;zpf;ifia Fwpg;gplt[k;)

No. of times vz;zpf;ifia Fwpg;gplt[k;)

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35 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q.no Questions Options Codes Skip 2112. Polio Vaccine, that is drops in the mouth?

thapy; bfhLf;fg;gLk; nghypnah brhl;L kUe;Jfs;>

Yes Mk; 01

No

,y;iy 02 ���� 2115

2113. How many times ( write number of times) vj;jid Kiwfs;> (vz;zpf;ifia Fwpg;gplt[k;)

No. of times vz;zpf;ifia Fwpg;gplt[k;)

2114. When was the first polio vaccine given - just after birth or

later? nghypnah brhl;L kUe;J Kjypy; vg;nghJ bfhLf;fg;gl;lJ> ? FHe;ij gpwe;j clndah my;yJ gpd;duh>

Just after birth gpwe;jt[ld; 01

Later gpd;dh; 02

2115. An injection against Measles?

jl;lk;ik jLg;g[ Crp> Yes Mk; 01

No

,y;iy 02

2116. Where did [NAME] Receive most of [NAME] vaccinations? (bgau;) bgUk;ghyhd jLg;g[ kUe;Jfis v’;nf nghl;Lf; bfhz;lhh;> SINGLE CODE xU gjpy ; kl ;Lk ;

PHC/CHC/Rural Hospital Muk;g Rfhjhu epiyak; -

rpb\r;rp- fpuhk kUj;Jt kid 01

Govt. Municipal Hospital murh’;f Kdprpgy; kUj;Jt

kid 02

Govt. Dispensary murh’;f

kUe;jfk; 03

Sub-centers Jiz kUj;Jt ika’;fs; 04

Govt. Mobile clinic

murh’;f elkhLk; fpspdpf;Ffs; 05

Camp Kfhk;fs; 06

Pulse polio location

gy;!; nghypnah nghlg;gl;l ,lk;

07

School / Anganwadi gs;spf;Tlk;-m’;fd;tho 08

Pvt. Hospital/clinic

jdpahu; kUj;Jt kid- fpspdpf; 09

Pvt. Doctor jdpahu; lhf;lu; 10

Pvt. Mobile Clinic

jdpahu; elkhLk; fpspdpf; 11

Vaidhya/hakim/homeopathy itj;jpau;-\f;fpk;-n\hkpnahgjp 12

Pharmacy/drug store ghu;krp-kUe;Jfil 13

Other (Specify)

kw;wit (Fwpg;gplt[k;)

__________________________

14

2117. Has [NAME] suffered from diarrhea over the past 7

days? fle;j 7 ehl;fspy; (bgau;) tapw;Wg;nghf;fpdhy; ghjpf;fg;gl;Ls;shuh>

Yes Mk; 01

No ,y;iy 02 ���� 2121

2118. Did you give anything to treat the diarrhoea tapw;Wg;nghf;if Fzg;gLj;j eP’;fs; VjhtJ bfhLj;jPh;fsh>

Yes Mk; 01

No ,y;iy 02

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36 URBAN INDIVIDUAL QUESTIONNAIRE- Health

2119. How did you treat it?

eP’;fs; mjw;F vg;go rpfpr;ir mspj;jPh;fs;> Multiple coding possible gy gjpy;fs; tuyhk;gy gjpy;fs; tuyhk;gy gjpy;fs; tuyhk;gy gjpy;fs; tuyhk;

Pill or syrup antibiotic khj;jp[iu my;yJ

Md;l;;ogahof; rpug; 01

Pill or Syrup Antimotility

jPtpu tapw;Wg;nghf;if fl;Lg;gLj;Jk; khj;jp[iu my;yJ

rpug; (Md;l;obkhl;ypl;o)

02

Zinc

$p’;f; (Jj;jehfk;) 03

Other (not anti-biotic, antimotility, Zinc)

kw;wit (Md;l;;ogahof;. jPtpu tapw;Wg;nghf;if fl;Lg;gLj;Jk;

kUe;J (Md;l;obkhl;ypl;o) my;yJ $p’;f; (Jj;jehfk;);

my;yhky;)

04

Unknown Pill OR syrup

bgah; bjhpahj khj;jpiu my;yJ rpug;

05

Injection Antibiotic Md;l;;ogahof; Crp 06

Injection Non – Antibiotic

Md;l;;ogahof; my;yhj Crp 07

Unknown Injection bgah; bjhpahj Crp 08

Intravenous (IV)

rpW euk;gpDs; brYj;jg;gLk; kUe;J

09

Home remedy / Herbal medicine

tPl;L kUe;J - K:ypif kUe;J 10

ORS

rh;f;fiu cg;g[ fiury; 11

Reduced food or liquid given to child

FHe;ijf;F bfhLf;Fk; czt[ my;yJ ePuj;j czt[

Fiwf;fg;gl;lJ

12

Gave special food to child ,jw;bfd rpwg;g[ czit FHe;ijf;F bfhLj;njd;

13

Other (specify)_____________

kw;wit (Fwpg;gplt[k;)

14

No treatment

Rpfpr;ir vJt[k; jutpy;iy 15

2120. Did you consult any health practitioner for treatment? rpfpr;irf;fhf eP’;fs; kUj;Jtu;fs; ahiuahtJ Mnyhrpj;jPu;fsh>

Yes Mk; 01

No

,y;iy 02

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37 URBAN INDIVIDUAL QUESTIONNAIRE- Health

AGE 14 COMPLETED YEARS AND OLDER: TOBACCO AND ALCOH OL USE Now I will ask whether you have habit of chewing tobacco/paan/supari, smoking cigarettes or bidis, NOW OR IN THE PAST. 14 taJ Koe;j kw;Wk; mjw;fjpfkhd taJs;sthfs;; ? g[ifapiy kw;Wk; kJ cgnahfk; rk;ge;jkhf c';fSf;F jw;rkak; my;yJ Kd;è. g[ifapiy. btw;wpiy my;yJ Rghup bky;Yk;. rpfbul; my;yJ gPofs; g[iff;Fk; gHf;fk; cs;sjh vdf; nfl;gjw;F ehd; tpUk;g[fpnwd.; Q .no Questions Options Code Skip 2121. INVESTIGATOR:IS PERSON AGE 14 OR OLDER?

ngl;obaLg;gth; ? ,e;j egh; 14 taJ my;yJ mjw;fjpfkhd taJs;stuh>

Yes Mk; 01

No ,y;iy 02

���� SECTION 7 gFjp 7?w;F bry;f

2122. Do [NAME] CURRENTLY have the habit of smoking at least 1 cigarette or bidi or using at least any other tobacco or paan product on a daily basis? (bgah;) jw;rkak; Fiwe;j gl;rk; 1 rpfbul; my;yJ gPo g[iff;Fk; gHf;fk; my;yJ Fiwe;jgl;rk; kw;w VnjDk; g[ifapiy my;yJ btw;wpiy bghUis jpdrup gad;gLj;Jk; gHf;fk; cs;sjh>

Yes Mk; 01

No ,y;iy 02 ���� 2125

2123. If yes, what do [NAME] currently use? [ANSWER MAY BE MORE THAN ONE] Mk; vdpy;. (bgah;) jw;rkak; vd;d gad;gLj;JfpwPh;fs; (xd;Wf;Fk; mjpfkhd gjpy;fs; ,Uf;fyhk;)

Chewing tobacco /

g[ifapiy bky;YtJ 01

Chewing paan

btw;wpiy bky;YtJ 02

Smoking cigarettes

rpfbul; g[ifg;gJ 03

Smoking bidis

gPofs; g[ifg;gJ 04

2124. How much do [NAME] use per day? (bgah;) xU ehisf;F vt;tst[ gad;gLj;JfpwPh;fs;> [WRITE IN EXACT AMOUNT – FOR EXAMPLE, 3 CIGARETTES AND 2 PAAN] rupahd mst[ vGjt[k; ? cjhuzkhf. 3 rpfbul;fs; kw;Wk; 2 ghd;)

No of times tobacco Chewing per day

xU ehSf;F g[ifapiy bky;Yk; jlitfspd;

vz;zpf;if

���� 2129

No of times pan Chewing per day xU ehSf;F btw;wpiy bky;Yk; jlitfspd;

vz;zpf;if

No of cigarettes Smoking per day xU ehSf;F g[iff;Fk;

rpfbul;Lfspd; vz;zpf;if

No of bidis Smoking per day xU ehSf;F g[iff;Fk; gPofspd;

vz;zpf;if

Others (Specify) kw;wit (Fwpg;gplt[k;)

2125. Have [NAME] EVER had the habit of smoking at least 1 cigarette or bidi or using at least any other tobacco or paan product on a daily basis? (bgah;) vg;bghGjhtJ jpdrup Fiwe;j gl;rk; 1 rpfbul; my;yJ gPo g[iff;Fk; gHf;fk; my;yJ Fiwe;jgl;rk; kw;w VnjDk; g[ifapiy my;yJ btw;wpiy bghUs; gad;gLj;Jk; gHf;fk; ,Ue;jpUf;fpwjh>

Yes Mk; 01

No ,y;iy 02 ���� 2130

2126. What did [NAME] PREVIOUSLY use? (bgah;) Kd;djhf vd;d gad;gLj;jpdPh;fs;> [ANSWER MAY BE MORE THAN ONE] (xd;Wf;Fk; mjpfkhd gjpy;fs; ,Uf;fyhk;)

Chewing tobacco /

g[ifapiy bky;YtJ 01

Chewing paan

btw;wpiy bky;YtJ 02

Smoking cigarettes

rpfbul; g[ifg;gJ 03

Smoking bidis

gPofs; g[ifg;gJ 04

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38 URBAN INDIVIDUAL QUESTIONNAIRE- Health

Q .no Questions Options Code Skip 2127. BEFORE QUITTING, How much did [NAME] use

per day? gHf;fj;ij epWj;Jtjw;F Kd;g[(bgah;); xU ehisf;F vj;jid gad;gLj;jpdPh;fs;> [WRITE IN EXACT AMOUNT – FOR EXAMPLE, 3 CIGARETTES AND 2 PAAN] rupahd mst[ vGjt[k; ? cjhuzkhf. 3 rpfbul;fs; kw;Wk; 2 ghd;)

No of times tobacco Chewed per day

xU ehSf;F g[ifapiy bkd;w jlitfspd;;

vz;zpf;if

No of times pan Chewed per day xU ehSf;F btw;wpiy bkd;w jlitfspd;;

vz;zpf;if

No of cigarettes Smoked per day xU ehSf;F g[ifj;j

rpfbul;Lfspd; vz;zpf;if

No of bidis Smoked per day xU ehSf;F g[ifj;j gPofspd;

vz;zpf;if

Others (Specify) kw;wit (Fwpg;gplt[k;)

2128. How long have [NAME] totally quit from using all cigarettes, bidis, paan, or other tobacco products? (bgah;); rpfbul;fs;. gPofs;. ghd; my;yJ kw;w g[ifapiyg; bghUl;fisg; gad;gLj;Jtij KGtJkhf epWj;jp vt;tst[ fhyk; MfpwJ>

Value vz;zpf;if

Years tUl';fs; 01

Months khj';fs; 02

Weeks thu';fs; 03

2129. At what age did [NAME] start to use tobacco products on a regular basis? (bgah;) ve;j tajpy; g[ifapiy bghUl;fis bjhlh;e;J gad;gLj;j Muk;gpj;jPh;fs;>

Years tUl';fs;

2130. In the past one year, have [NAME] consumed alcohol or toddy (including festivals or just with guests)? fle;j xU tUlj;jpy; (bgah;) vg;bghGjhtJ kJ my;yJ fs; Foj;jpUf;fpwPh;fsh (gz;oiffs; my;yJ tpUe;jpdh;fSlDk; nrh;e;J Foj;jija[k; nrh;j;J) >

Yes Mk; 01

No ,y;iy 02

���� SECTION 3 gFjp 3?w;F bry;f

2131. How often do [NAME] consume alcoholic beverages? (bgah;) vt;tst[ mof;fo kJ ghd';fisf; Fof;fpwPh;fs;> [WRITE VALUE AND CIRCLE APPROPRIATE REFERENCE PERIOD] (kjpg;ig vGjp bghUj;jkhd fhy mst[ tl;lkplt[k;)

Value / Unit vz;zpf;if-Kiwfs;

���� SECTION 3 gFjp 3?w;F bry;f

Per Week thuj;jpw;F 01

Per month khjj;jpw;F 02

Per year tUlj;jpw;F 03

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39 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Section 3: AGE 14 COMPLETED YEARS AND OLDER-MIGRATION Any migration during lifetime FOR ONE YEAR or longer, for any reason 14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; ? ,lk;; bgah;jy;14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; ? ,lk;; bgah;jy;14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; ? ,lk;; bgah;jy;14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; ? ,lk;; bgah;jy; thH;ehspd; nghJ VnjDk; fhuzj;jpw;fhf. xU tUlj;jpw;F my;yJ mjw;Fk; mjpfkhf ,lk;; bgah;jy;

I. Member NAME:

cWg;gpdu; bgau; :

II. Member ID:

cWg;gpdu; milahs vz; :

III. Respondent Name:

gjpyspg;gthpd; bgah;gjpyspg;gthpd; bgah;gjpyspg;gthpd; bgah;gjpyspg;gthpd; bgah;

IV. Respondent ID:

gjpyspg;gthpd; milahs vz;gjpyspg;gthpd; milahs vz;gjpyspg;gthpd; milahs vz;gjpyspg;gthpd; milahs vz;

V.

IF PROXY: Reason for Substitution/ Proxy

khw;W eguhf ,Ug;gpd; : khw;W egiuj; nju;t[ bra;jjw;fhd fhuzj;ijf; Fwpg;gplt[k; ?

PROXY CODE

khw;W egu; FwpaPL ;

S. No. Questions Options Codes Skips 3001. Have you ever lived in another place, such as another village,

town or abroad, for one year or more? ntbwhU fpuhkk;. efuk; my;yJ btspehL nghd;w ntbwhU ,lj;jpy;. xU tUlkhf my;yJ mjw;Fk; mjpfkhf vg;nghjhtJ eP’;fs; trpj;jPh;fsh>

Yes Mk; 01

No ,y;iy 02 � 3039

3002. Where were you born? (If name has changed, obtain current name in each field) eP';fs; v';F gpwe;jPh;fs;>; (Chpd; bgah; khwpapUe;jhy;. jw;nghija bgaiug; bgwt[k;)

OUTSIDE INDIA:COUNTRY NAME AND CODE ONLY. ,e;jpahtpw;F btspna vdpy.; ehl;od; bgah; kw;Wk; FwpaPL kl;Lk; jut[k;

Village/Town fpuhkk; - efuk; __________________ CODE FwpaPL ____________________ Taluk jhYfh ____________________ CODE FwpaPL ____________________ District khtl;lk; __________________ CODE FwpaPL ____________________ State khepyk; ____________________ CODE FwpaPL ____________________ Country ehL _____________________ CODE FwpaPL ____________________

3003. When you were 14 years old, did you live in the same place where you were born? 14 tajhf ,Ue;j nghJ. eP';fs; v’;F gpwe;jPh;fnsh mnj ,lj;jpy; trpj;jPh;fsh>

Yes Mk; 01 �3005

No ,y;iy 02

3004. Where did you live when you were 14 years old? c';fSf;F 14 tajhf ,Ue;j nghJ eP';fs; v';F trpj;jPh;fs;>

Village/Town fpuhkk; - efh; ___________________

CODE FwpaPL ____________________

Taluk jhYfh ____________________

CODE FwpaPL ____________________ District khtl;lk; __________________

CODE FwpaPL ____________________

State khepyk; ____________________

CODE FwpaPL ____________________

Country ehL _____________________

CODE FwpaPL ____________________ 3005. How many times did you move across village/town to live at

new location for MORE THAN 1 YEAR since 14? IF ZERO, LOCATION IN Q3004 SHOULD BE THIS TOWN

eP';fs; 14tJ tajpypUe;J fpuhkk; - efuj;jpypUe;J xU g[jpa ,Ug;gplj;jpy; xU tUlj;jpw;Fk; mjpfkhd fhyj;jpw;F trpg;gjw;fhf vj;jid jlitfs; ,lk; khwp brd;wPh;fs;> g{$;$pak; vdpy;. nfs;tp Q3004 = y; Fwpg;gpl;l ,Ug;gplk;jhd; mtUila efukhf ,Uf;Fk;.

No. of times.jlitfspd; vz;zpf;if

IF 00 ����3039

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40 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Details of each Migration lasting one year or longer, starting at age 14 xt;bthU jlita[k; xt;bthU jlita[k; xt;bthU jlita[k; xt;bthU jlita[k; ,lk;,lk;,lk;,lk;; bgah;e;jjw;fhd tptu';fs;; bgah;e;jjw;fhd tptu';fs;; bgah;e;jjw;fhd tptu';fs;; bgah;e;jjw;fhd tptu';fs;. 14 tajp;y; bjhl’;fp xU tUlk; my;yJ mjw;Fk; mjpfkhd fhy’;fs; trpj;jit. 14 tajp;y; bjhl’;fp xU tUlk; my;yJ mjw;Fk; mjpfkhd fhy’;fs; trpj;jit. 14 tajp;y; bjhl’;fp xU tUlk; my;yJ mjw;Fk; mjpfkhd fhy’;fs; trpj;jit. 14 tajp;y; bjhl’;fp xU tUlk; my;yJ mjw;Fk; mjpfkhd fhy’;fs; trpj;jit

Place ,lk;

Duration of stay j';fpapUe;j fhy mst[

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3006. What is the name of the destination you migrated to? ; eP';fs; ,lk; bgah;e;J brd;wile;j ,lj;jpd; bgah; vd;d> [IF FOREIGN COUNTRY, CODE COUNTRY ONLY] btsp ehL vdpy; ehl;il kl;Lk; Fwpaplt[k;)

Vil/Townfpuhkk; - efh;

CURRENT RESIDENCE

jw;nghJ trpf;Fk; ,lk;

Census CODE FwpaPL

Taluk jhYfh

Census CODE FwpaPL

Dist khtl;lk;

Census CODE FwpaPL

State khepyk;

Census CODE FwpaPL

Country ehL CODE FwpaPL

3007. distance between the PREVIOUS PLACE and DESTINATION (km) Ke;ija ,lj;jpw;Fk; brd;wile;j ,Ug;gplj;j;pw;Fk; ,ilnaahd J}uk; vd;d> (fp/kP)

3008. When did you move to [DESTINATION] mm/yyyy eP';fs; (brd;wile;j) ,lj;jpw;)F vg;bghGJ khwpdPh;fs; khjk; - tUlk;

3009. How long did you stay at PREVIOUS PLACE (MONTHS, YEARS) eP';fs; Ke;ija ,lj;jpy; vt;tst[ fhyk; trpj;jPh;fs;> (khj';fs;. tUl’;fs;)

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41 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3010. What was your employment status at PREVIOUS PLACE just before you moved? ,lk; khWtjw;F rw;W Kd; Ke;ija ,lj;jpy; c';fsJ gzp epiy vd;dthf ,Ue;jJ>

STATUS ;gzp epiy

CODE /FwpaPL

NON-EMPLOYED -->3014 ntiy ,y;yhjtu; vdpy; ->3014

3011. If employed in PREVIOUS PLACE just before you moved, what type of industry was the job? ,lk; khWtjw;F rw;W Kd; Ke;ija ,lj;jpy; gÂèǪ½Uªjh¯;.[ m’;F c’;fsJ gzp; Jiwapd; tif vd;d>

INDUSTRY gzpapd; Jiw

NIC CODE /vd; I rp nfhl;

3012. If employed in PREVIOUS PLACE just before you moved, What was your occupation at previous place? ,lk; khWtjw;F rw;W Kd; Ke;ija ,lj;jpy; gÂèǪ½Uªjh¯;.[ m’;F c’;fsJ bjhHpy; vd;dthf ,Ue;jJ>

OCCUPATION /bjhHpy;

NCO CODE /vd; rp X nfhl;

3013. If employed in PREVIOUS PLACE just before you moved, how frequently were you paid, and how much were you paid each time? [write Rs and CODE appropriate unit] ,lk; khWtjw;F Kd; Ke;ija ,lj;jpy; eP’;fs; gÂèǪ½Uªjh¯;.[ m’;F c';fSf;F vt;tst[ mof;fo Typ - rk;gsk; tH';fg;gl;lJ kw;Wk; c';fSf;F xt;bthU jlita[k; vt;tst[ tH';fg;gl;lJ> (U:ghia vGjp bghUj;jkhd a{dpl;il FwpaPL bra;at[k;)

Rs.

Rs.

Rs.

Rs.

Rs.

TIME UNITS: neuj;jpw;fhd a{dpl;fs; Hourly kzp neuj;jpw;F 01

Daily jpdrup 02

Weekly thuk; xU Kiw 03

Fortnight 15 ehl;fS¡F XU Kiw 04

Monthly khj« XU Kiw 05

Quarterly fhyhz;ow;F XU Kiw 06

Half yearly miuahz;ow;F XU Kiw 07

Yearly tUlj;jpw;F XU Kiw 08

others kw;wit 09

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42 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3014. Who did you know that already lived at [DESTINATION]? (brd;wile;j ,lj;jpy;) Vw;fdnt ahh; trpj;J te;jhh;fs; vd;W c’;fSf;F bjupa[kh> Parents bgw;nwhh; 01

Children FHe;ijfs; 02

Spouse/fiancé Jizth;-tU';fhyj;Jiz 03

other relative kw;w cwtpdh; 04

People from native place/ village / town brhe;j ChpypUe;J - fpuhkj;jpypUe;J - efuj;jpypUe;J te;j egh;fs;

05

Acquaintance of different jati khWgl;l $hjpiaj; nrh;e;j bjupe;j egh;

06

Acquaintance of same jati mnj $hjpiar; nrh;e;j bjupe;j egh; 07

Friends ez;gh;fs; 08

Employer gzp mspg;gth; 09

Colleague cld; gzpahw;Wgth; 10

Classmate/ schoolmate tFg;g[j;njhHh; - gs;spj;njhHh; 11

Others SPECIFY kw;wit Fwpg;gplt[k; 12

None ahUk; ,y;iy 13

Person 1

Person 2

Person 3

Person 1

Person 2

Person 3

Person 1

Person 2

Person 3

Person 1

Person 2

Person 3

Person 1

Person 2

Person 3

3015. What was your employment status on arriving at destination? eP';fs; m’;F brd;wile;jnghJ c';fsJ ntiy epiyik vd;dthf ,Ue;jJ>

STATUSepiy

CODEFwpaPL

3016. Did you ever work at [DESTINATION], either for wages or self-employed? eP';fs; (brd;wile;j ,lj;jpy;;) vg;nghjhtJ rk;gsj;jpw;fhf ntiy bra;jPh;fsh my;yJ brhe;jkhf bjhHpy; bra;jPh;fsh>

Yes Mk; 01 01 01 01 01

No ,y;iy

02 � NEXTMIGRATION

mLj;jjhf ,lk;bgah;e;jJ

02 � NEXT MIGRATION mLjj;jhf ,lk;bgah;e;jJ

02 � NEXT mLj;jjhf

,lk;bgah;e;jJ

02 � NEXT mLj;jjhf

,lk;bgah;e;jJ;

02

�.3039

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43 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3017. If yes, What type of industry was the first job in [DESTINATION]? Mk; vd;why;;. (brd;wile;j ,lj;jpy;;) Kjy; gzp ve;j Jiw tifapy; ,Ue;jJ>

INDUSTRY gzp Jiw

NIC CODE vd;Irp FwpaPL

3018. If yes, what was occupation in first job at [DESTINATION]? Mk; vdpy;. (brd;wile;j ,lj;jpy;;) c';fSila Kjy; ntiy - bjhHpy; vd;dthf ,Ue;jJ>

OCCUPATION bjhHpy;

NCO CODE vd; rp X FwpaPL

3019. At DESTINATION how frequently were you paid, and how much were you paid each time? [write Rs and Circle unit] brd;wile;j ,lj;jpy;; c';fSf;F vt;tst[ mof;fo Typ - rk;gsk; tH';fg;gl;lJ kw;Wk; c';fSf;F xt;bthU jlita[k; vt;tst[ tH';fg;gl;lJ> (U:ghia vGjp bghUj;jkhd a{dpl;il tl;lkplt[k;)

Rs.

Rs.

Rs.

Rs.

Rs.

Hourly kzp neuj;jpw;F 01 01 01 01 01

Daily jpdrup 02 02 02 02 02

Weekly thuk; xU Kiw 03 03 03 03 03

Fortnight 15 ehl;fS¡F XU Kiw 04 04 04 04 04

Monthly khj« XU Kiw 05 05 05 05 05

Quarterly fhyhz;ow;F XU Kiw 06 06 06 06 06

Half yearly miuahz;ow;F XU Kiw 07 07 07 07 07

Yearly tUlj;jpw;F XU Kiw 08 08 08 08 08

Others (Specify) kw;wit Fwpg;gplt[k; 09 09 09 09 09

3020. Who did you work for at [CURRENT RESIDENCE]: What is that person’s relationship to you? eP’;fs; brd;wile;j ,lj;jpy; ahUf;fhf - ve;j epWtdj;jpw;fhf ntiy bra;jPu;fs; > mth; c’;fSf;F vd;d cwt[> Relationship code cwt[Kiw FwpaPL

If Non-kin, ����3022

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44 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3021. [if they say kin code] other relationship to you ? [PROBE NON-KIN CODES] (mth; Fwpg;gpl;l cwtpdh; FwpaPl;il; Twpdhy;); c';fSf;F ntW VnjDk; cwt[Kiw cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;)

Relationship Code cwt[Kiw FwpaPL ���� 3023

3022. [if they say non-kin code, etc]: is this person also kin? [PROBE FOR SPECIFIC KIN CODE] (mth; cwtpdh; my;yhj FwpaPl;il Twpdhy;) ,e;j egh; cwtpduh> (Fwpg;gpl;l cwtpdh;[ FwpaPl;ow;F J}z;of; nfl;ft[k;)

Yes Mk;; 01

No /,y;iy 02 ���� 3024

If Yes, Write kinship /Mk; vd;why;. cwt[Kiwia vGjt[k;

Kinship Code cwt[Kiw FwpaPl;L

3023. [For those with some kin relation]: What is NAME of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

����3025

3024. [For those with no kin relation]: What is JATI? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp>

Caste Code $hjp FwpaPL

3025. Did you receive assistance in finding/ obtaining job at [CURRENT RESIDENCE? (jw;rkak; trpf;Fk; ,e;j ,lj;jpy;) ,e;j ntiyiaj; njlt[k;. bgwt[k; eP’;fs; ahhplkhtJ cjtpia bgw;wPh;fsh>

Yes Mk; 01 � 3027

No ,y;iy 02

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45 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3026. If no, how did you find this WORK? ,y;iy vdpy;. eP';fs; vt;thW ,e;j ntiyia njof; bfhz;Oh;fs;>;

Own search before moving m';F nghtjw;F Kd;djhf ehnd njof;bfhz;nld;

01

���� 3032 Own search after moving m';F ngha; nru;e;j gpwF ehnd njof;bfhz;nld;

02

Job transfer gzp khw;wk; 03 Other [SPECIFY] kw;w tifapy; (Fwpg;gplt[k;) 04

3027. If You received assistance in finding this work, who provided the assistance?

(if multiple answers, name person who provided the most support)

,e;j ntiyia bgw eP’;fs; cjtp bgw;wPh;fs; vd;why;. c’;fSf;F cjtpaJ ahh;>(gy gjpy;fs; vd;why;. kpf mjpfkhf cjtp mspj;j eghpd; bgah;)

Relationship code cwt[Kiw FwpaPL

If non-kin, ����3029

3028. [if they say specific kin code]: any other relationship to you ? [PROBE FOR NON-KIN CODES] (mth;; Fwpg;gpl;l cwtpdh; FwpaPl;il; Twpdhy;) c';fSf;F ntW VnjDk; cwt[Kiw cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;)

Relationship Code cwt[Kiw FwpaPL ���� 3030 3029. [if non-kin code, etc]: is person also kin?

[PROBE FOR SPECIFIC KIN CODE] (mth; cwtpdh; my;yhj FwpaPl;il Twpdhy;) ,e;j egh; c’;fSf;F cwtpduh> (Fwpg;gpl;l cwt[ Kiw FwpaPl;ow;F J}z;of; nfl;ft[k;)

Yes Mk; 01

No ,y;iy 02 ���� 3031

If Yes, Write kinship /Mk; vd;why;. cwt[Kiwia vGjt[k;

Kinship Code cwt[Kiw FwpaPl;L

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46 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3030. [For those with any kin relationship], What is the NAME of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

���� 3032

3031. [For those without any kin relationship,] what is jati? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp> Caste Code $hjp; FwpaPL

3032. How long after coming to [CURRENT RESIDENCE] did you begin work, either for wages or self-employment? (jw;rkak; trpf;Fk; ,e;j ,lj;jpy;) te;j vt;tst[ fhyj;jpw;Fg; gpwF eP';fs; ntiy bra;a bjhl’;fpdPh;fs;> mJ rk;gsj;jpw;fhf my;yJ brhe;j bjhHpyhf ,Uf;fyhk;> WRITE NUMBER AND CIRCLE CODE. vz;zpf;ifia vGjt[k; kw;Wk; FwpaPl;il tl;lkplt[k;

Days ehl;fs; 01 IF LESS THAN ONE MONTH xU khjj;jpw;F Fiwt[ vdpy; ����3039

Weeks thu’;fs; 02

Months khj’;fs; 03

3033. Until you began work at [CURRENT RESIDENCE], who provided support? (jw;rkak; trpf;Fk; ,e;j ,lj;jpy;)ntiy bra;a bjhl’;Fk; tiu. ahh; c’;fSf;F Mjut[ mspj;jhh;> THIS ANSWER COULD BE A TEMPLE, A PERSON, AN NGO, ETC. ,jw;fhd gjpy; xU nfhapy;. xU egh;. xU muR rhuh epWtdk; nghd;witahf ,Uf;fyhk;

Person egh; 01

Own savings / No means of supportbrhe;j nrkpg;g[ - Mjut[ tHptif vJt[kpy;iy 02 ���� 3039

Menial work/beggingmokl;l ntiy bra;J - cjtpf;fhfg; gpwuplk; bf";rpf; nfl;gJ 03 ����3039

Other-SPECIFYkw;wit (Fwpg;gplt[k;) 04 ����3039

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47 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q. No Starting from Residence at Age 14

14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J14 tajpy; tPl;oypUe;J

MIGRATIONS g[yk; bgah;e;j tptu’;fs; DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

DESTINATION #___ brd;wile;j,lk; vz;

CURRENT RESIDENCE jw;nghJ trpf;Fk; ,lk; Skips[

3034. [If received support from a person] what is this person to you? (if multiple answers, person that provided most support (xUtuplkpUe;J Mjut[ bgw;wpUe;jhy;) ,e;j egh; c';fSf;F vd;d cwt[Kiw> (gy gjpy;fs; vdpy;. kpf mjpfk; Mjut[ tH';fpa egh; )

Relationship code /cwt[Kiwapd; FwpaPL

If non-kin code given ���� 3036

3035. [if they say specific kin code]: any other relationship to you ? [PROBE FOR NON-KIN CODES] (mth; Fwpg;gpl;l cwtpdh; FwpaPl;il Twpdhy;); c';fSf;F ntW VnjDk; cwt[Kiw cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;)

Relationship Code /cwt[Kiw FwpaPL

���� 3037

3036. [if they say non-kin code, etc]: is this person also kin? [PROBE FOR SPECIFIC KIN CODE] (mth; cwtpdh; my;yhj FwpaPl;il Twpdhy;) ,e;j egh; c’;fSf;F cwtpduh> (Fwpg;gpl;l cwtpdh; Kiw FwpaPl;ow;F J}z;of; nfl;ft[k;)

Yes Mk; 01

No ,y;iy 02 ���� 3038

If Yes, Write kinship /Mk; vd;why;. cwt[Kiwia vGjt[k;

Kinship Code cwt[Kiw FwpaPL

3037. [ For those with some kin relationship], What is the name of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

���� 3039

3038. [For those with no kin relationship:] what is the person jati? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp> Caste Code $hjp FwpaPL

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48 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

AGE 14 COMPLETED YEARS AND OLDER: TEMPORARY WORK MIGRATION 14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; gzp14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; gzp14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; gzp14 taJ Kotile;j kw;Wk; mjw;fjpfkhd taJs;sth;fs; gzp bjhlh;ghf bjhlh;ghf bjhlh;ghf bjhlh;ghf jw;fhypfjw;fhypfjw;fhypfjw;fhypfkhfkhfkhfkhf ,lk; bgah;jy;,lk; bgah;jy;,lk; bgah;jy;,lk; bgah;jy;

Q.no Questions options Options Skips 3039. Has [NAME] spent at least 2 consecutive nights in the last year away

from household for work or to find work? (bgah;) ntiyf;fhf my;;yJ ntiy njLtjw;fhf ,e;j FLk;gj;ij tpl;L btspna fle;j tUlj;jpy; Fiwe;jgl;rk; bjhlh;e;J ,uz;L ,ut[fisf; fHpj;jpUf;fpwPh;;fsh>

Yes Mk; 01

No ,y;iy 02 ���� SECTION 4

3040. Is [NAME] away for work now? (for at least 2 nights) ,d;W (bgah;); ntiyf;fhf btspna brd;wpUf;fpwhuh> (Fiwe;jgl;rk; 2 ,ut[fs;);

Yes Mk; 01

No ,y;iy 02 ���� 3044

3041. IF ANSWERING BY PROXY:kw;bwhU egh; gjpyspj;jhy; How long ago did [NAME] leave?(Write number and circle time standard) (bgah); vt;tst[ ehl;fSf;F Kd;dh; brd;whh;> (vz;iz kw;Wk; bghUj;jkhd fhy msit vGjp tl;lkplt[k;)

Value kjpg;g[ Units

mst[

Days ehl;fs; 01 Weeks thu';fs; 02

Months khj';fs; 03 3042. IF ANSWERING BY PROXY: kw;bwhU egh; gjpyspj;jhy;

In how much time do you expect[NAME] to return? Write the number and circle time standard) (bgah;) vt;tst[ fhy neuj;jpy; jpUk;gptUthh; vd;W eP';fs; vjph;ghh;f;fpwPh;fs;> (vz;iz kw;Wk; bghUj;jkhd fhy msit vGjp tl;lkplt[k;)

Value kjpg;g[ Units mst[

Days ehl;fs; 01 Weeks thu';fs; 02

Months khj';fs; 03 3043. IF ANSWERING BY PROXY: kw;bwhU egh; gjpyspj;jhy;

Where is [NAME] right now? (Question pertains to destination of last visit. Write exactly.) (bgah;) ,g;bghGJ v';F ,Uf;fpwhh;> (nfs;tpfs; filrpahf brd;wile;j ,lj;jpw;Fj; bjhlh;g[ilait/ rupahf vGjt[k;)

Name of Village/Town fpuhkk; - Ch; bgah;; ______________

� 3046

Village / Town Census ID [Editing] fpuhk - Ch; brd;!!; milahs vz; (vol;o';) _________ Name of Taluk jhYfh bgah; ___________________

Taluk ID jhYfh milahs vz; ___________ District Name khtl;lj;jpd; bgah; ______________ District ID khtl;lj;jpd; milahs vz; ______ State Name khepyj;jpd; bgah; _______________ State ID khepyj;jpd; milahs vz; ________

3044. How long ago did [ NAME] LAST go from the household for work? (bgah;); ntiyf;fhf vt;tst[ ehl;fSf;F Kd;dhy; FLk;gj;jpypUe;J btspna brd;wPh;fs;> (,';F ,e;j egh; ntiyf;fhf my;yJ ntiy njLtjw;fhfr; filrpahf brd;w gazk; gw;wp nfl;ft[k;) (vz;iz kw;Wk; bghUj;jkhd fhy msit vGjp tl;lkplt[k;)

Value kjpg;g[ Units mst[mst[mst[mst[

Days ehl;fs; 01

Weeks thu';fs; 02

Months khj';fs; 03

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49 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q.no Questions options Options Skips 3045.

Where did [NAME] go on last trip? (Question pertains to destination of last visit. Write exactly.)- if trip involved multiple destinations, list furthest destination (bgah;) c';fsJ filrp gazj;jpy; v';F brd;wPh;fs; (,e;j nfs;tp filrpahf ; brd;wile;j ,lj;jpw;F bjhlh;g[ilaJ ? kpfr; rupahf vGjt[k;) ,e;j gazj;jpy; gy brd;wile;j ,l';fs; ,Ue;jhy;. kpft[k; ePz;l J}u ,Ug;gplj;ij gl;oayplt[k;

Name of Village/Town fpuhkk; - Ch; bgah;; ______________

Village / Town Census ID [Editing] fpuhk - Ch; brd;!!; milahs vz; (vol;o';) _________

Name of Taluk jhYfh bgah; ___________________

Taluk ID jhYfh milahs vz; ___________

District Name khtl;lj;jpd; bgah; ______________

District ID khtl;lj;jpd; milahs vz; ______

State Name khepyj;jpd; bgah; _______________

State ID khepyj;jpd; milahs vz;

3046. Distance from residence (km) RECORDED TO 00.00 trpf;Fk; ,lj;jpypUe;J J}uk; (fp/kP) 00 /00 vd;W Fwpf;ft[k;

3047. What was [NAME] status while [NAME] is/was outside? (bgah;) btspa{upy; ,Uf;fpd;w - ,Ue;jnghJ gzpapd; epiy vd;d>

STATUSepiy

CODEFwpaPL

3048. What type of work/industry is/was [NAME] doing while [NAME] is/was outside? [NIC codes] (bgah;); btspa{upy; ,Uf;fpd;w - ,Ue;jnghJ vd;d tif ntiy - ve;j Jiwapy; ntiy bra;fpwPh;fs;; - bra;jPh;fs;;> (vd; I rp FwpaPL)

NIC SPECIFY vd; I rp Fwpg;gplt[k;

NIC-CODES vd; I rp FwpaPL

3049.

[NAME]’s occupation? (bgah;)d; bjhHpy; vd;d>

Occupation (SPECIFY) bjhHpy;

(Fwpg;gplt[k;)

[NCO codes] vd; rp X FwpaPL

3050. Was this trip part of/ an assignment for an existing job? ,e;j gazk; ,g;nghJ cs;s ntiyapd; xU gFjpahf ,Ue;jjh>

Yes Mk; 01 ���� 3057

No ,y;iy 02

3051. Did [NAME] receive assistance/help in obtaining this job? (bgah;);; ,e;jg; gzpiag; bgWtjw;F cjtpbgw;wPh;fsh>

Yes Mk; 01

No ,y;iy 02 ���� 3057

3052. If [NAME] received assistance in finding this work, who provided the assistance? ,e;j ntiyia bgw eP’;fs; cjtp bgw;wPh;fs; vd;why;. c’;fSf;F cjtpaJ ahh;> (ALLOW CONTRACTORS, COMMISSION AGENTS, ETC ) (fhd;l;uhf;lh;. fkp&d; Vb$d;l;. khd;!;lh; lhl; fhk; nghd;wtw;iw mDkjpf;fyhk;)

Relationship Code cwt[Kiw FwpaPL

If non-kin ���� 3054

3053. [if they say specific kin code]: any other relationship to you ? [PROBE FOR NON-KIN CODES] (mth;fs; Fwpg;gpl;l cwtpdh; FwpaPl;il Twpdhy;) c';fSf;F ntW VnjDk; cwt[cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;) Kiw

Relationship code cwt[Kiw FwpaPL

���� 3055

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50 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q.no Questions options Codes Skips

3054. [if non-kin code, etc]: is person also kin? [PROBE KIN CODE (mth;fs cwtpdh; my;yhj FwpaPl;il Twpdhy;) ,e;j egh; cwtpduh> (Fwpg;gpl;l cwtpdh; FwpaPl;ow;F J}z;of; nfl;ft[k;)

Yes Mk; 01

No,y;iy 02 � 3056

If Yes, Write kinship /Mk; vd;why;. cwt[Kiwia vGjt[k;

Kinship code cwt[Kiw FwpaPL

3055. [For those with any kin relationship], What is the name of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

����3057

3056. [For those with no kin relationship]: what is jati? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp>

Caste Code $hjp FwpaPL

3057. At DESTINATION how frequently was [NAME] paid, and how much each time? [write Rs and Circle unit] brd;wile;j ,lj;jpy; (bgah;) vt;tst[ mof;fo Typ - rk;gsk; tH';fg;gl;lJ kw;Wk; (bgah;) xt;bthU jlita[k; vt;tst[ tH';fg;gl;lJ> (U:ghia vGjp bghUj;jkhd msit tl;lkplt[k;)

Rs. U:

Units: mst[mst[mst[mst[

Hourly kzp neuj;jpw;F 01 Daily jpdrup 02 Weekly thuk; 03 Fortnight 15 ehl;fS¡F XUKiw

04

Monthly khj« XUKiw 05 Quarterly fhyhz;Lf;F XUKiw

06

Half yearly miuahz;Lf;F XUKiw

07

Yearly tUlk; XUKiw 08 others kw;wit SPECIFY Fwpg;gplt[k;

09

3058. What is the transportation cost of migration (round trip)? (Rs.) [do not include transportation costs paid by company/employer]. ,e;j gazj;jpw;fhf (nghf tu) nghf;Ftuj;J bryt[ vt;tst[> (U:gha;) (epWtdj;jhy; - ntiyaspg;gtuhy; brYj;jg;gl;l nghf;Ftuj;Jr; bryt[fisr; nrh;f;f ntz;lhk;)

Rs. U:

Q.no Questions options Options Skips

3059. Mode of transportation nghf;Ftuj;J tHptif

Train uapy; 01 Bus – (Govt./ Private)

ngUªJ (muR - jdpah®) 02

School / company busg²Ë - f«bgdp ngUªJ

(g!;)03

4-wheeler 4 rf;fu thfdk; 04

Share auto/auton&h; Ml;nlh - Ml;nlh 05

2 wheeler2 rf;fu thfdk; 06

cycle rickshawirf;fps; hpf;&h 07

Cycle irf;fps; 08 Horse cart

F½iu t©o 09

Bullock cartkh£L t©o 10

Boat / WaterwaysglF - Ù® tÊahf 11

footele;J bry;tJ 12

Other mode (Specify) kw;wit (Fwpg;gplt[k;)_________________

13

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51 URBAN INDIVIDUAL QUESTIONNAIRE-Migration

Q.no Questions options Options Skips 3060. What is the travel time to the place of work, one way?

WRITE NUMBER AND CIRCLE TIME UNIT. gzpg[hpa[k; ,lj;jpw;F bry;y vt;tst[ neuk; MfpwJ. xU tHp> vz;iz vGjt[k; kw;Wk; neu msit tl;lkplt[k;

Value kjpg;g[ Units mst[/

Minutes epkpl’;fs; 01 Hours kzp neuk; 02 Days ehl;fs; 03 Week thuk; 04

3061. Amount remitted to this Household on the last trip [or expected to be remitted] (Rs) ,e;jf; FLk;gj;jpw;F filrp gazj;jpy; bfhLj;j bjhif (my;yJ brYj;j ntz;o vjph;ghh;f;fg;gLtJ)> (U:gha;)

Rs. U:

3062. How many weeks or months in total were [NAME] gone for work in the last year? bkhj;jj;jpy; vj;jid thu';fs; my;yJ khj';fs; (bgah;) fle;j tUlj;jpy; ntiyf;fhfr; brd;wPh;fs;;> (Write number and circle the appropriate time standard) (vz; kw;Wk; bghUj;jkhd fhy msit vGjp tl;lkplt[k;)

Value kjpg;g[

Unitsmst[/

Weeks thuk; 01

Months khj';fs; 02

3063. How many trips for more than 2 consecutive nights did [NAME] make in the last year? fle;j tUlj;jpy; (bgah;) bjhlh;e;J 2 ,ut[fis tpl mjpfkhf j’;FkhW vj;jid gaz';fisr; bra;jPh;fs;;>

;

3064. How much [NAME] remitted to this household over the last 12 months? fle;j 12 khj';fspy; (bgah;) ,e;j FLk;gj;pw;F vt;tst[ U:gha; bfhLj;jPh;fs;>

Rs. U:

3065. In which months was [NAME] gone for work in the last year? CODE ALL MONTHS THAT APPLY (bgah;); fle;j tUlj;jpy; ve;j ve;j khj’;fspy; ntiyf;fhfr; brd;wPh;fs;;> (bghUe;jf;Toa midj;J khj';fisa[k; tl;lkplt[k;)

January $dthp 01

-->SECTION 4

February bgg;uthp 02 March khh;r; 03 April Vg;uy; 04 May nk 05 June $%d; 06 July $%iy 07 August Mf!;l; 08 September brg;lk;gh; 09 October mf;nlhgh; 10 November etk;gh; 11 December ork;gh; 12

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52 URBAN INDIVIDUAL QUESTIONNAIRE-Labor

Section 4: AGES 14 COMPLETED YEARS AND OLDER: LABOR (1(1(1(14444 taJ taJ taJ taJ kw;Wk;kw;Wk;kw;Wk;kw;Wk; mjw;F nkw;gl;l taJilamjw;F nkw;gl;l taJilamjw;F nkw;gl;l taJilamjw;F nkw;gl;l taJilath;fs; ? tptu';fSld; CHpah; gpupt[th;fs; ? tptu';fSld; CHpah; gpupt[th;fs; ? tptu';fSld; CHpah; gpupt[th;fs; ? tptu';fSld; CHpah; gpupt[

I. Member NAME:

cWg;gpdu; bgau; :

II. Member ID:

cWg;gpdu; milahs vz; :

III. Respondent Name:

gjpyspg;gthpd; bgah;

IV. Respondent ID:

gjpyspg;gthpd; milahs vz;

V.

IF PROXY: Reason for Substition/ Proxy

khw;W eguhf ,Ug;gpd; : khw;W egiuj; nju;t[ bra;jjw;fhd fhuzj;ijf; Fwpg;gplt[k; ?

PROXY CODE- khw;W egu; FwpaPL

A. SALARIED WORKERS rk;gsk; bgWk; CHpah;fsrk;gsk; bgWk; CHpah;fsrk;gsk; bgWk; CHpah;fsrk;gsk; bgWk; CHpah;fs;;;; S.no Questions Options Codes Skips

4001.

Has [NAME] been Employed as salary worker in last 12months? (bgah;) fle;j 12 khj’;fspy; rk;gsk; bgWk; CHpauhf ntiy bra;jpUf;fpwPh;fsh>

Yes Mk; 01

No ,y;iy 02 ����4032

4002.

What is [NAME] employment status? (bgah;) ntiyapd; epiy vd;d>

STATUS epiy

CODE FwpaPL

4003.

What kind of work did [NAME] do? [if worked for more than one employer, list that of longest employment] (bgah;) gzpg[hpa[k; bjhHpw;Jiw vJ> kw;Wk; mJ vd;d ntiy> (xd;Wf;Fk; mjpfkhd ntiyaspg;gtuplk; ntiy bra;jpUe;jhy;. ePz;l fhyk; ntiy bra;jijg; gl;oayplt[k;)

Description tptuk;

3 digit NIC-CODE_ 3 ,yf;f vd;Irp FwpaPL

3 digit NCO code 3 ,yf;f vd;rpX FwpaPL;

4004.

What is Name of enterprise [NAME] works in, or name of the employer (if enterprise does not have a name)? (bgah;) gzpg[hpa[k; epWtdj;jpd; bgah; vd;d. my;yJ (epWtdj;jpw;F bgah; ,y;iybad;why;) ntiyaspg;gthpd; bgah; vd;d>

Name bgah;

4005.

What type of business or enterprise is this? ,J ve;j tifahd epWtdk; my;yJ bjhHpiy nrh;e;jJ>

DESCRIPTION tptuk;

5-DIGIT NIC code 5 ,yf;f vd;Irp FwpaPL;

4006. Is this a Registered enterprise? ,J gjpt[ bra;;ag;gl;l epWtdkh>

Yes Mk; 01 No ,y;iy 02

4007. What is the total number of people working in this place? ,ªj ,l¤½¯ ntiy bra;a[k; CHpah;fspd; bkh¤j vz;zpf;if vd;d>

Number vz;zpf;if

4008.

Out of the total number of workers, how many are salaried or permanent workers? bkhj;j CHpah;fspd; vz;zpf;ifapy;. vj;jid CHpah;fs; rk;gsk; bgWgth; my;yJ epue;ju CHpah;fs;>

Number vz;zpf;if

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S.no Questions Options Codes Skips

4009.

WHERE IS [NAME]’s WORKPLACE LOCATED? (bgah;) ntiy bra;a[k; ,lk; v’;F mike;Js;J>

Name of village/town fpuhkk; - efuj;jpd; bgah;

Village/town census code fpuhkj;jpd; - efuj;jpd;

FwpaPL

Taluk name jhYfh bgah;

Taluk code jhYfh FwpaPL

District name khtl;lj;jpd; bgah;

District Code khtl;lj;jpd; FwpaPL

State name khepyj;jpd; bgah;

State code khepyj;jpd; FwpaPL

4010. Distance from [NAME] residence to place [NAME]works (bgah;) trpg;gplj;jpypUe;J (bgah;) ntiy bra;a[k; ,lj;jpw;F J}uk; (xU tHp)

Kilometers TO 00.00 fpnyh kPl;lh;fs; 00/00 [ ] [ ].[ ] [ ]

4011. Time taken to reach the place [NAME] works (bgah;) epWtdj;ij brd;wiltjw;F vLj;Jf; bfhs;sg;gLk; neuk; (xU tHp) epkpl';fspy;

Minutes epkpl';fs;

4012. What is the cost of transportation (round trip) nghf;Ftuj;Jr; bryt[ vd;d> (nghf tu) U:ghapy;

In Rs. U:gha;

4013.

Mode of transportation nghf;Ftuj;J tHpKiw

Train uapy; 01

Bus – (Govt./ Private) ngUªJ (muR - jdpah®) 02

School / company bus g²Ë- f«bgdp ngUªJ

(g!;) 03

4-wheeler 4 rf;fu thfdk; 04

Share auto/auto n&h; Ml;nlh - Ml;nlh 05

2 wheeler 2 rf;fu thfdk; 06

cycle rickshaw irf;fps; hpf;&h 07

Cycle irf;fps; 08 Horse cart F½iu t©o 09

Bullock cart kh£L t©o 10 Boat / Waterways glF - Ù® tÊahf 11

Foot ele;J bry;tJ 12 Other mode (Specify) kw;wit (Fwpg;gplt[k;) _________________

13

4014.

When did [NAME] begin working at this job? (bgah;) ,ªj ntiyapy; vg;nghJ nrh;e;jPh;fs;>

Month ( khjk;)

Year (YYYY) tUl’;fs;

4015. How many months did [NAME] work at job in last 12 months? (bgah;) fle;j 12 khj';fspy; vj;jid khj’;fs; ntiy bra;jPh;fs;>

Number of Months khj’;fspd; vz;zpf;if

4016. On average, how many days per month do [NAME] work? ruhrhpahf. (bgah;) xU khjj;jpw;F vj;jid ehl;fs; ntiy bra;tPh;fs;>

Number of Days ehl;fspd; vz;zpf;if

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S.no Questions Options Codes Skips

4017. On average, how many hours per day do [NAME] work? ruhrhpahf. (bgah;) xU ehspy; vj;jid kzp neu’;fs; ntiy bra;tPh;fs;>

Hours per day kzp neu’;fs; xU ehspy;

4018.

What is the amount of money and in-kind payments [NAME] receive, and how often do [NAME] receive them? (bgah;) ntiy bra;tjw;fhf bgWfpw bjhif vd;d kw;Wk; bghUshf bgWfpw kjpg;g[ vd;d kw;Wk; (bgah;) mtw;iw vt;tst[ mof;fog; bgWfpwPh;fs;> TIME CODE fhyneu¡ FwpaPL

Hourly kzp neuj;jpw;F 01

Daily jpdrup 02

Weekly thuk; XU Kiw 03

Fortnight 15 ehl;fS¡F XU Kiw 04

Monthly khj« XU Kiw 05

Quarterly fhyhz;ow;;F XU Kiw 06

Half yearly miuahz;ow;;F XU Kiw 07

Yearly tUlk; XU Kiw 08

others kw;wit SPECIFY (Fwpg;gplt[k;)

09

Cash payment (in Rs) buhf;fg; gzk

TIME CODE

fhyneu¡ FwpaPL

In kind payment – (in Rs)

bghUshf bgWfpw kjpg;g[ =

(U:ghapy;)

TIME CODE

fhyneu¡ FwpaPL

4019. Additional increment received during the last 12 months? (Rs.) fle;j 12 khj';fspd; nghJ bgw;w TLjy; rk;gs cah;t[ (U:gha;)

In Rs. U:ghapy;

If 00(zero) ���� 4021

4020.

How many months was the increment received during the last 12 months? fle;j 12 khj';fspd;; nghJ rk;gs cah;t[ bgw;w khj';fspd; vz;zpf;if

No. of Months khj’;fspd; vz;zpf;if

4021.

How much was the bonus or other benefits received during the last 12 months (Rs.) fle;j 12 khj’;fspy; bgw;w nghd!; my;yJ fpilj;j gofspd; kjpg;g[ vd;d> (U:ghapy;)

Value of bonus / benefits nghd!; - gofspd; kjpg;g[

(In Rs).(U:ghapy;)

4022. Do [NAME] have Provident Fund? (bgah;) gpuhtpld;l; `gz;l; (nrkey epjp) cs;sjh>

Yes Mk; 01

No ,y;iy 02 ����4025

4023. Employer’s contribution to PF (% of salary) gp v`g; bjhiff;F. ntiy mspj;jthpd; g’;fspg;g[ (rk;gsj;jpy; vj;jid #)

% .

4024. [NAME] contribution to PF (% of salary) gp v`g; bjhiff;F (bgah;) g’;fspg;g[ (rk;gsj;jpy; vj;jid #)

% .

4025.

Did NAME receive any assistance in finding and obtaining job ? (bgah;) ,e;j ntiyia njlt[k; bgwt[k; ahUila cjtpiaahtJ bgw;wPh;fsh>

Yes Mk; 01

No ,y;iy 02 ����4031

4026.

If [NAME] received assistance, who or what provided the assistance? (bgah;) cjtp bgw;wpUe;jhy;. ahh; my;yJ vJ cjtp mspj;jJ>

Relationship Code cwt[Kiw FwpaPL

If Non –Kin

����4028

4027.

[if they say specific kin code]: any other relationship to you ? [PROBE FOR NON-KIN CODES] (mth; Fwpg;gpl;l cwtpdh; FwpaPl;il Twpdhy; c';fSf;F ntW VnjDk; cwt[Kiw cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;)

Relationship Code cwt[Kiw FwpaPL

����4029

4028.

[if they say non-kin code,]: is this person also kin? [PROBE FOR SPECIFIC KIN CODE] (mth;; cwtpdh; my;yhj FwpaPl; il Twpdhy;) ,e;j egh; c’;fSf;F cwtpduh> (Fwpg;gpl;l cwtpdh; FwpaPl;ow;F J}z;of; nfl;ft[k;);)

Yes Mk; 01

No ,y;iy 02 ����4030

If Yes, Write Kinship /Mk; vdpy;. cwt[Kiwia vGjt[k;

Kinship Code cwt[Kiw FwpaPL

4029.

[For those with some kin relationship:] What is the NAME of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

����4031

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S.no Questions Options Codes Skips

4030.

[For those without any kin relationship:] what is Jati? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp>

Caste Code $hjp FwpaPL

4031.

Besides the income earned from this job or work, what is the total income [NAME] have received in the last 12 months from any OTHER salaried work? ,e;j ntiy my;yJ bjhHpypy; ,Ue;J bgw;w tUkhdk; jtpu. fle;j 12 khj’;fspy; (bgah;) rk;gsk; jUfpw ntW ntiyapd; K:yk; bgw;w bkhj;j tUkhdk; vt;tst[>

Rs. U:/

B. NON-AGRICULTURAL CASUAL LABOR tptrhaky;yhj tptrhaky;yhj tptrhaky;yhj tptrhaky;yhj jpdf;jpdf;jpdf;jpdf;Typ ntiyTyp ntiyTyp ntiyTyp ntiyahs;ahs;ahs;ahs; (nf&%ty;)(nf&%ty;)(nf&%ty;)(nf&%ty;) S.no Questions Options Season 1 Season 2 Season 3 Skips

4032. List down the month for the season gUtj;jpd; khjj;ij gl;oayplt[k;

From bjhl’;fp

To Koa

4033.

During [season/ months] did [NAME] work as a NON AGRICULTURAL CASUAL LABORER? (gUtk; - khj’;fspy;) (bgah;) tptrhaky;yhj jpdf;Typ ntiyahsf gzpahw;wpdPh;fsh>

Yes Mk;

01 01 01

No ,y;iy 02 -> next season mLj;j gUtk;

02 ->next season mLj;j gUtk;

02

����4055

4034.

During [season/ months] how many different employers did [NAME] work for? (gUtk; - khj’;fspy;) (bgah;) btt;ntW ntiyaspg;gtu; vj;jid nghplk; ntiy bra;jPh;fs;>

No of employers ntiyaspj;jth;fspd;

vz;zpf;if

4035.

During [season/month], What kind of work did [NAME] do? [if worked for more than one employer, list that of longest employment] (gUtk; - khj’;fspy;) (bgah;) ve;j tifahd ntiyia ghh;j;jPh;fs;> (xd;Wf;Fk; nkw;gl;lthplk; ntiy bra;jpUe;jhy;. ePz;lfhyk; ntiy bra;jij Fwpg;g[lt[k;)

Description of work

ntiyapd; tptuk;

3 digit NIC-CODE_ 3 ,yf;f vd;Irp

FwpaPL

3 digit NCO code 3 ,yf;f vd;rpX

FwpaPL;

4036.

What is name of enterprise [NAME] works in, or name of the employer (if enterprise does not have a name)? (bgah;) ntiy bra;a[k; epWtdj;jpd; bgah; vd;d. (epWtdj;jpw;F bgah; ,i;iy vd;why;) ntiyaspg;gthpd; bgah; vd;d>

4037.

What type of business or enterprise is this ? ,J ve;j tifahd bjhHpy; my;yJ epWtdk;>

DESCRIPTION-specify

tptu’;fs;= Fwpg;gplt[k;

5-DIGIT NIC CODE 5 ,yf;f vd; I rp

FwpaPL

4038. Is this a Registered enterprise? ,J gjpt[ bra;ag;gl;l epWtdkh>

Yes Mk; 01 01 01 No ,y;iy 02 02 02

4039.

What is the total number of people working in this place? ,ªj ,l¤½¯ ntiy bra;a[k; CHpah;fspd; bkh¤j vz;zpf;if vd;d>

Nos. of workers CHpah;fspd; vz;zpf;if

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S.no Questions Options Season 1 Season 2 Season 3 Skips

4040.

WHERE IS THIS ENTERPRISE LOCATED? ,e;j epWtdk; v’;F mike;Js;sJ>

Name of village/town fpuhkk; - efuj;jpd; bgah;

Village/town code fpuhkj;jpd; - efuj;jpd;

FwpaPL

Taluk name jhYfh bgah;

Taluk code jhYfh FwpaPL

District name khtl;lj;jpd; bgah;

District Code khtl;lj;jpd; FwpaPL

State name khepyj;jpd; bgah;

State code khepyj;jpd; FwpaPL

4041.

Distance from [NAME]’s residence to enterprise (one way) (bgah;) trpg;gplj;jpypUe;J epWtdj;jpw;F J}uk; (xUtHp;)

Kilometers TO 00.00 fpnyh kPl;lh;fs;

4042. Time to reach the enterprise (one-way) epWtdj;ij brd;wiltjw;F vLj;Jf; bfhs;sg;gLk; neuk; (xU tHp) epkpl';fspy;

Minutes epkpl';fs;

4043. Cost of transportation (round trip) nghf;Ftuj;Jr; bryt[ (nghf tu) U:ghapy;

Cost in Rs.

4044.

Mode of transportation nghf;Ftuj;J tHpKiw

Train uapy; 01 01 01 Bus – (Govt./ Private) ngUªJ (muR - jdpah®) 02 02 02

School / company bus g²Ë- f«bgdp ngUªJ

(g!;) 03 03 03

4-wheeler 4 rf;fu thfdk ; 04 04 04 Share auto/auto

n&h; Ml;nlh - Ml;nlh 05 05 05

2 wheeler 2 rf;fu thfdk; 06 06 06

cycle rickshaw irf;fps; hpf;&h 07 07 07

Cycle irf;fps; 08 08 08 Horse cart F½iu t©o 09 09 09

Bullock cart kh£L t©o

10 10 10

Boat / Waterways glF - Ù® tÊahf 11 11 11

Foot ele;J bry;tJ 12 12 12 Other mode (Specify) kw;wit (Fwpg;gplt[k;) _________________

13 13 13

4045.

How many days did [NAME] work at this job during [season/ months]? (bgah;) (gUtk; - khj’;fs;) y; vj;jid ehl;fs; ,e;j ntiyia bra;jPh;fs;>

No. of Days ehl;fspd;

vz;zpf;if

4046.

On average, how many hours per day did [NAME] work at this job? ruhrhpahf . (bgah;) y; xU ehspy; vj;jid kzp neuk; ,e;j ntiyia bra;jPh;fs;>

No.of Hours kzp neu’;fs;

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S.no Questions Options Season 1 Season 2 Season 3 Skips

4047.

What is the amount of money and in-kind payments [NAME] receive, and how often do [NAME] receive them? (bgah;) ntiy bra;tjw;fhf bgWfpw bjhif vd;d kw;Wk; bghUshf bgWfpw kjpg;g[ bjhif vd;d kw;Wk; (bgah;) mtw;iw vt;tst[ mof;fog; bgWfpwPh;fs;> TIME CODE fhyneu¡ FwpaPL

Hourly kzp neuj;jpw;F 01

Daily jpdrup 02

Weekly thuk; XU Kiw 03

Fortnight 15 ehl;fS¡F XU Kiw 04

Monthly khj« XU Kiw 05

Quarterly fhyhz;;ow;;F XU Kiw 06

Half yearly miuahz;;ow;;F XU Kiw

07

Yearly tUlk; XU Kiw 08

Others kw;wit SPECIFY (Fwpg;gplt[k;)

09

Cash payment (In Rs) buhf;fg; gzk

TIME CODE

fhyneu¡ FwpaPL

In kind payment– Rs

bghUshf bgWfpw kjpg;g[ = (U:ghapy;)

4048.

Did [NAME] receive any assistance in finding and obtaining this job? (bgah;) ,e;j ntiyia njlt[k; bgwt[k; ahUila cjtpiaahtJ bgw;wPh;fsh>

Yes Mk; 01 01 01

No ,y;iy 02 02 02 ����4054

4049.

If [NAME] received assistance, who or what provided the assistance? (bgah;) cjtp bgw;wpUe;jhy;. ahh; my;yJ vJ cjtp mspj;jJ>

Relationship Code cwt[Kiw FwpaPL

If Non – Kin

���� 4051

4050.

[If they say kin code]: Other relationship to you ? [PROBE NON-KIN CODES] (mth; Fwpg;gpl;l cwtpdh; FwpaPl;il Twpdhy;); c';fSf;F ntW VnjDk; cwt[Kiw cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;)

Relationship Code cwt[Kiw FwpaPL

����4052

4051.

[If they say non-kin code, etc]: Is this person also kin? [PROBE KIN CODE] (mth;; cwtpdh; my;yhj FwpaPl; il Twpdhy;) ,e;j egh; c’;fSf;F cwtpduh> (Fwpg;gpl;l cwtpdh; FwpaPl;ow;F J}z;of; nfl;ft[k;)

Yes Mk; 01 01 01

No ,y;iy 02 02 02 ����4053

If Yes, Write Kinship /Mk; vdpy;. cwt[Kiwia vGjt[k;

Kinship Code cwt[Kiw FwpaPL

4052.

[For those with some kin relationship:] What is the name of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

���� 4054

4053.

[For those without any kin relationship:] what is Jati? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp>

Caste Code $hjp FwpaPL

4054.

Besides this job, what is the total value of earnings from OTHER non-agricultural casual work in [season/ months]? ,e;j ntiyia jtpu. (gUtk; - khj’;fspy;) tptrhak; my;yhj kw;w Typ ntiyapd; K:yk; bgw;w bkhj;j tUkhdk; vt;tst[>

Rs U: �next

season mLj;j gUtk;

�next season mLj;j gUtk;

���� 4055

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C.AGRICULTURAL CASUAL LABOUR, OWN CROP OR LIVESTOCK PRODUCTION tptrha Typntiy bra;tJ. brhe;j gaph; tsh;g;gpy; ntiy bra;tJ my;yJ fhy; eil cw;gj;jp bjhHpypy; ntiy bra;tJ. S.no Questions Options Season 1 Season 2 Season 3 Skips Agricultural casual labour tptrha Typntiy bra;tJtptrha Typntiy bra;tJtptrha Typntiy bra;tJtptrha Typntiy bra;tJ

4055.

List down the month for the season gUtj;jpd; khjj;ij gl;oayplt[k;

From bjhl’;fp /

To

Koa/

4056.

During [season/ months] did [NAME] work as AGRICULTURAL CASUAL LABORER? (gUtk; - khj’;fspy;) fhyj;jpy; (bgah;) tptrha jpdf;Typ ntiyahshf gzpahw;wpdhuh>

Yes Mk; 01 01 01

No ,y;iy

02

--> next season mLj;j gUtk;

02

-->next season mLj;j gUtk;

02

����4078

4057.

How many different employers did [NAME] work for in [months / season] as agricultural casual labour? (gUtk; - khj’;fspy;) (bgah;) btt;ntW ntiyaspg;gtu; vj;jid nghplk; tptrha Typ ntiy bra;jPh;fs;>

Number of employers ntiyaspj;jth;fspd;;

vz;zpf;if

4058.

In [season/months] What kind of work did [NAME] do? [if worked for more than one employer, list that of longest employment] (gUtk; - khj’;fspy;) (bgah;) ve;j tifahd ntiyia ghh;j;jPh;fs;> (xd;Wf;Fk; nkw;gl;lthplk; ntiy bra;jpUe;jhy;. ePz;lfhyk; ntiy bra;jij Fwpg;g[lt[k;)

Description tpsf;fk;

3 digit NIC-CODE_ 3 ,yf;f vd;Irp FwpaPL

3 digit NCO code 3 ,yf;f vd;rpX FwpaPL;

4059.

What is Name of enterprise [NAME] works in, or name of the employer (if enterprise does not have a name)? (bgah;) ntiy bra;a[k; epWtdj;jpd; bgah; vd;d. (epWtdj;jpw;F bgah; ,i;it vd;why;) ntiyaspg;gthpd; bgah; vd;d>

4060.

What type of business or enterprise is this ? ,J ve;j tifahd bjhHpy; my;yJ epWtdk;>

DESCRIPTION tpgu’;fs;= Fwpg;gplt[k;

5-DIGIT NIC 5 ,yf;f vd; I rp

FwpaPL

4061. Is this a Registered enterprise? ,J gjpt[ bra;ag;gl;l epWtdkh>

Yes Mk; 01 01 01

No ,y;iy 02 02 02

4062.

What is the total number of people working in this place? ,ªj ,l¤½¯ ntiy bra;a[k; CHpah;fspd; bkh¤j vz;zpf;if vd;d>

Number of people CHpah;fspd; vz;zpf;if

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S.no Questions Options Season 1 Season 2 Season 3 Skips

4063.

WHEREIS THIS WORK LOCATED? ntiy bra;a[k;,e;j epWtdk; v’;F mike;Js;J>

Name of village/town fpuhkk; - efuj;jpd; bgah;

Village/town census code fpuhkj;jpd; - rpW efuj;jpd;

FwpaPL

Taluk name jhYfh bgah;

Taluk code jhYfh FwpaPL

District name khtl;lj;jpd; bgah;

District Code khtl;lj;jpd; FwpaPL

State name khepyj;jpd; bgah;

State code khepyj;jpd; FwpaPL

4064.

Distance from [NAME]’s residence to enterprise (one way) (bgah;) tPl;oypUe;J epWtdj;jpw;F J}uk; (xUtHp;)

Kilometersto 00.00 fpnyh kPl;lh;fs;

4065.

Time taken to reach the enterprise (one-way) in minutes epWtdj;ij brd;wiltjw;F vLj;Jf; bfhs;sg;gLk; neuk; (xU tHp) epkpl';fspy;

Minutes epkpl';fs;

4066. cost of transportation (round trip)

nghf;Ftuj;Jr; bryt[ (nghf tu) Cost in Rupees bryt[ U:ghapy;

4067.

Mode of transportation nghf;Ftuj;J tHpKiw

Train uapy; 01 01 01 Bus – (Govt./ Private)

ngUªJ (muR - jdpah®) 02 02 02

School / company bus g²Ë-f«bgdp ngUªJ (g!;) 03 03 03

4-wheeler 4 rf;fu thfdk; 04 04 04 Share auto/auto

n&h; Ml;nlh - Ml;nlh 05 05 05

2 wheeler 2 rf;fu thfdk; 06 06 06 cycle rickshaw irf;fps; hpf;&h 07 07 07

Cycle irf;fps; 08 08 08 Horse cart F½iu t©o 09 09 09

Bullock cart kh£L t©o 10 10 10 Boat / Waterways glF - Ù® tÊahf 11 11 11

Foot ele;J bry;tJ 12 12 12 Other mode (Specify) kw;wit (Fwpg;gplt[k;) _________________

13 13 13

4068.

How many days did [NAME] work at this job during [season/ months]? (bgah;) (gUtk; - khj’;fs;) y; vj;jid ehl;fs; ,e;j ntiyia bra;jPh;fs;>

Number of Days ehl;fspd; vz;zpf;if

4069.

On average, how many hours per day did [NAME] work in this job? ruhrhpahf . (bgah;) (gUtk; - khj’;fs;) y; xU ehspy; vj;jid kzp neuk; ,e;j ntiyia bra;jPh;fs;>

Number of Hours per day

xU ehspy; kzp neu’;fs;

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S.no Questions Options Season 1 Season 2 Season 3 Skips

4070.

What is the amount of money and in-kind payments [NAME] receive, and how often do [NAME] receive them? (bgah;) ntiy bra;tjw;fhf bgWfpw bjhif vd;d kw;Wk; bghUshf bgWfpw kjpg;g[ bjhif vd;d kw;Wk; (bgah;) mtw;iw vt;tst[ mof;fog; bgWfpwPh;fs;> TIME CODE fhyneu¡ FwpaPL

Hourly kzp neuj;jpw;F 01

Daily jpdrup 02

Weekly thuk; XU Kiw 03

Fortnight 15 ehl;fS¡F XU Kiw 04

Monthly khj« XU Kiw 05

Quarterly fhyhz;ow;;F XU Kiw 06

Half yearly miuahz;ow;;F XU Kiw

07

Yearly tUlk; XU Kiw 08

others kw;wit SPECIFY (Fwpg;gplt[k;)

09

Cash payments (Rs) buhf;fg; gzk

TIME CODE

fhyneu¡ FwpaPL

In kind payments – Rs

value

bghUshf bgWfpw kjpg;g[ = (U:ghapy;)

TIME CODE

fhyneu¡ FwpaPL

4071.

Did [NAME] receive any assistance in funding and obtaining this job? (bgah;) ,e;j ntiyia njlt[k; bgwt[k; ahUila cjtpiaahtJ bgw;wPh;fsh>

Yes Mk; 01 01 01

No ,y;iy 02 02 02 ����4077

4072.

If [NAME] received assistance, who or what provided the assistance? (bgah;) cjtp bgw;wpUe;jhy;. ahh; my;yJ vJ cjtp mspj;jJ>

Relationship Code cwt[Kiw FwpaPL

If Non – Kin ����4074

4073.

[If they say specific kin code]: any other relationship to you ? [PROBE FOR NON-KIN CODES] (mth; Fwpg;gpl;l cwtpdh; FwpaPl;il Twpdhy;); c';fSf;F ntW VnjDk; cwt[Kiw cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;)

Relationship Code cwt[Kiw FwpaPL

����4075

4074.

[if they say non-kin code, etc]: is this person also kin? [PROBE FOR SPECIFIC KIN CODE] (mth;; cwtpdh; my;yhj FwpaPl;il Twpdhy;) ,e;j egh; c’;fSf;F cwtpduh> (Fwpg;gpl;l cwtpdh; FwpaPl;ow;F J}z;of; nfl;ft[k;)

Yes Mk; 01 01 01

No ,y;iy 02 02 02 ���� 4076

If Yes, Write kinship Mk; vdpy;. cwt[Kiwia vGjt[k;

Kinship code cwt[Kiw FwpaPL

4075.

[For those with any kin relationship:] What is the name of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

���� 4077

4076.

[For those without any kin relationship:] what is jati? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp>

Caste Code $hjp FwpaPL

4077.

Besides this job, what is the total value of earnings from other agricultural casual labour work in [season / months] ? ,e;j ntiyia jtpu. (gUtk; - khj’;fspy;) ntW tptrha Typ ntiyapd; K:yk; bgw;w bkhj;j tUkhdk; vt;tst[>

Value in Rs. kjpg;g[ U:ghapy;

�Season gUtk; 2

�Season gUtk; 3

����4078

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61 URBAN INDIVIDUAL QUESTIONNAIRE-Labor

S.no Questions Options Season 1 Season 2 Season 3 Skips Own crop or livestock production brbrbrbrhe;j tptrhak; my;yJ fhy; eil cw;gj;jphe;j tptrhak; my;yJ fhy; eil cw;gj;jphe;j tptrhak; my;yJ fhy; eil cw;gj;jphe;j tptrhak; my;yJ fhy; eil cw;gj;jp

4078.

List down the month for the season gUtj;jpd; khjj;ij gl;oayplt[k;

From

bjhl';fp

To

tiu

4079.

In [SEASON/MONTHS] did [NAME] do any own cultivation or livestock production? (gUtk; - khj’;fspy;) (bgah;) brhe;jkhf VjhtJ tptrhak; bra;jpUf;fpwPh;fsh my;yJ fhy;eil cw;gj;jp bra;jPh;fsh>

Yes Mk; 01 01 01

No ,y;iy

02

�Season gUtk;2

02

�Season gUtk;3

02

����4083

4080.

How many days in [season/ months] did [NAME] do self cultivation including exchange labour? (gUtk; - khj’;fspy;) Typ ,y;yhky; xUtUf;bfhUth; ntiy bra;jija[k; nrh;j;J vj;jid ehl;fs; brhe;j tptrhak; bra;jPh;fs;> In [SEASON/MONTHS], on the days [NAME] did own cultivation, on average how many hours per day did [NAME] spend? (gUtk; - khj’;fspy;) (bgah;) brhe;jkhf tptrhak; bra;j ehl;fspy;. Ruhrhpahf xU ehspy; (bgah;) vj;jid kzp neuk; ntiy bra;jPh;fs;>

Number of days ehl;fspd; vz;zpf;if

Number of hours/ day

xU ehspy ;kzp neu’;fs;

4081.

In [SEASON/ MONTHS] how many days did [NAME] spend on DAIRY – such as animal care, grazing, and production of by-products? (gUtk; - khj’;fspy;) fhy;eil guhkhpg;g[. nka;r;ry;. Jizg; bghUl;fs; cw;gj;jp nghd;w ghy; gz;iz ntiyfspy; (bgah;) vj;jid ehl;fs; brytHpj;jPh;fs;> in SEASON/MONTHS, on the days [NAME] did this work, how many hours per day did [NAME] spend? (gUtk; - khj’;fspy;). (bgah;) ntiy bra;jnghJ. xU ehSf;F vj;jid kzp neu’;fs; (bgah;) brytHpj;jPh;fs;>

Number of days ehl;fspd; vz;zpf;if

Number of hours/ day

xU ehspy ;kzp neu’;fs;

;

4082.

In [SEASON/ MONTHS] how many days [NAME] you spend on OTHER LIVESTOCK – such as animal care, grazing, and production of by-products? (gUtk; - khj’;fspy;) fhy;eil guhkhpg;g[. nka;r;ry;. Jizg; bghUl;fs; cw;gj;jp nghd;w kw;w fhy;eilfhy;eilfhy;eilfhy;eil guhkhpg;g[guhkhpg;g[guhkhpg;g[guhkhpg;g[ ntiyfspy; (bgah;) vj;jid ehl;fs; brytHpj;jPh;fs;>

In SEASON/MONTHS, on the days [NAME] did this work, how many hours per day did [NAME] spend? (gUtk; - khj’;fspy;). (bgah;) ntiyia bra;jnghJ. xU ehSf;F vj;jid kzp neu’;fs; (bgah;) brytHpj;jPu;fs;>

Number of days ehl;fspd; vz;zpf;if

Number of hours/ day

xU ehspy ;kzp neu’;fs;

�Season gUtk; 2

�Season gUtk;3 ���� 4083

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62 URBAN INDIVIDUAL QUESTIONNAIRE-Labor

S.no Questions Options Season 1 Season 2 Season 3 Skips

Work for public works programs/any government funded program bghJg;gzpj; jpl;l';fSf;fhd ntiyfs; bghJg;gzpj; jpl;l';fSf;fhd ntiyfs; bghJg;gzpj; jpl;l';fSf;fhd ntiyfs; bghJg;gzpj; jpl;l';fSf;fhd ntiyfs; ----VnjDk; murh';f epjpa[jtp bgw;w jpl;l';fspy; nVnjDk; murh';f epjpa[jtp bgw;w jpl;l';fspy; nVnjDk; murh';f epjpa[jtp bgw;w jpl;l';fspy; nVnjDk; murh';f epjpa[jtp bgw;w jpl;l';fspy; ntiytiytiytiy

4083.

List down the month for the season gUtj;jpd; khjj;ij gl;oayplt[k;

From bjhl';fp

To tiu

4084.

During [season/ months] have [NAME] worked on on any public works or government employment schemes? (gUtk; - khj’;fspy;). (bgah;) bghJg; gzp ntiy my;yJ murh’;f ntiytha;g;g[ jpl;l’;;fspy; ntiy bra;jpUf;fpwPh;fsh>

Yes Mk; 01 01 01

No ,y;iy

02

�Season gUtk;2

02

�Season gUtk;3

02

���� 4104

4085.

How many different jobs did [NAME] work on in [season / months]? (gUtk; - khj’;fspy;) (bgah;) vj;jid khWgl;l ntiyfspy;; ntiy bra;jPh;fs;>

Number of jobs

ntiyfspd; vz;zpf;if

4086.

What kind of work did [NAME] do? [if worked for more than one employer, list that of longest employment] (bgah;) ve;j tifahd ntiyia ghh;j;jPh;fs;> (xd;Wf;Fk; nkw;gl;lthplk; ntiy bra;jpUe;jhy;. ePz;lfhyk; ntiy bra;jij Fwpg;g[lt[k;)

Description

tptuk;

3 digit NIC-CODE_ 3 ,yf;f vd;Irp FwpaPL

3 digit NCO code 3 ,yf;f vd;rpX FwpaPL;

4087. What was the name of the Program? jpl;lj;jpd; bgah; vd;d>

PROGRAME NAME jpl;lj;jpd; bgah;

4088.

What was the total number of people working on this program/project AT THAT TIME? mªj jpl;l¤½¯ ntiy bra;j CHpah;fspd; bkh¤j vz;zpf;if vd;d>

Total No.of workers ntiy bra;j

CHpah;fspd; bkh¤j vz;zpf;if

4089.

WHERE WAS THIS WORKSITE LOCATED? ,e;j gzpaplk; v’;F mike;Js;J>

Name of village/town fpuhkk; - rpW efuj;jpd;

bgah;

Village/town census code fpuhkj;jpd; - rpW efuj;jpd;

FwpaPL

Taluk name jhYfh bgah;

Taluk code jhYfh FwpaPL

District name khtl;lj;jpd; bgah;

District Code khtl;lj;jpd; FwpaPL

State name khepyj;jpd; bgah;

State code khepyj;jpd; FwpaPL

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63 URBAN INDIVIDUAL QUESTIONNAIRE-Labor

S.no Questions Options Season 1 Season 2 Season 3 Skips

4090. Distance from residence to work site (bgah;) trpg;gplj;jpypUe;J ntiy bra;a[k; ,lj;jpw;F J}uk; (xUtHp )

Kilometers to 00.00 fpnyh kPl;lh;fs; 00/00

4091.

Time taken to reach the work site ntiy bra;a[k; ,lj;jpw;F brd;wiltjw;F vLj;Jf; bfhs;sg;gLk; neuk; (xU tHp) epkpl';fspy;epkpl';fspy;epkpl';fspy;epkpl';fspy;

Minutes epkpl';fs;

4092. Cost of transportation (Round trip) nghf;Ftuj;Jr; bryt[ (nghf tu)

Rs. U:

4093.

Mode of transportation nghf;Ftuj;J tHpKiw

Train uapy; 01 01 01 Bus – (Govt./ Private)

ngUªJ (muR - jdpah®) 02 02 02

School / company bus g²Ë - f«bgdp ngUªJ

(g!;) 03 03 03

4-wheeler 4 rf;fu thfdk; 04 04 04

Share auto/auto n&h; Ml;nlh - Ml;nlh 05 05 05

2 wheeler 2 rf;fu thfdk; 06 06 06

cycle rickshaw irf;fps; hpf;&h 07 07 07

Cycle irf;fps; 08 08 08 Horse cart F½iu t©o 09 09 09

Bullock cart kh£L t©o

10 10 10

Boat / Waterways glF - Ù® tÊahf 11 11 11

Foot ele;J bry;tJ 12 12 12 Other mode (Specify) kw;wit (Fwpg;gplt[k;) _________________

13 13 13

4094.

How many days did [NAME] work at this job during [season/ months]? (bgah;) (gUtk; - khj’;fs;) y; vj;jid ehl;fs; ,e;j ntiyia bra;jPh;fs;>

No of Days ehl;fspd; vz;zpf;if

4095.

On average, how many hours per day did [NAME] work in this job? (bgah;) (gUtk; - khj’;fs;) y; xU ehspy; ruhrhpahf vj;jid kzp neuk; ,e;j ntiyia bra;jPh;fs;>

Hours per day

xU ehspy; kzp neu’;fs;

4096.

What is the amount of money and in-kind payments [NAME] receive, and how often do [NAME] receive them? (bgah;) ntiy bra;tjw;fhf bgWfpw bjhif vd;d kw;Wk; bghUshf bgWfpw kjpg;g[ bjhif vd;d kw;Wk; (bgah;) mtw;iw vt;tst[ mof;fog; bgWfpwPh;fs;> TIME CODE fhyneu¡ FwpaPL:

Hourly kzp neuj;jpw;F 01

Daily jpdrup 02

Weekly thuk; XU Kiw 03

Fortnight 15 ehl;fS¡F XU Kiw 04

Monthly khj« XU Kiw 05

Quarter fhyhz;;ow;;F XU Kiw 06

Half year miuahz;;ow;;F XU Kiw

07

Year tUlk; XU Kiw 08

others kw;wit SPECIFY (Fwpg;gplt[k;)

09

Cash payments (Rs) buhf;fg; gzk;

TIME CODE

fhyneu¡ FwpaPL

In kind payments – Rs

bghUshf bgWfpw kjpg;g[ =

(U:ghapy;)

TIME CODE

fhyneu¡ FwpaPL

4097.

[Did NAME]receiveassistance finding/obtaining job? (bgah;) ,e;j ntiyia njlt[k; bgwt[k; ahUila cjtpiaahtJ bgw;wPh;fsh>

Yes Mk; 01 01 01

No ,y;iy 02 02 02 ����4103

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64 URBAN INDIVIDUAL QUESTIONNAIRE-Labor

S.no Questions Options Season 1 Season 2 Season 3 Skips

4098.

If Yes, Who is this person to you? Mk; vd;why;. c';fSf;F ,e;j egh; vd;d cwt[Kiw?

Relationship Code cwt[Kiw FwpaPL

If Non – Kin

����4100

4099.

[if they say specific kin code]: any other relationship to you ? [PROBE FOR NON-KIN CODES] (mth; Fwpg;gpl;l cwtpdh; FwpaPl;il Twpdhy;); c';fSf;F ntW VnjDk; cwt[Kiw cs;sjh> (cwtpdh; my;yhj FwpaPl;ow;F J}z;of; nfl;ft[k;)

Relationship Code cwt[Kiw FwpaPL

���� 4101

4100.

[if they say non-kin code]: is this person also kin? [PROBE FOR KIN CODE] (mth;; cwtpdh; my;yhj FwpaPl;il Twpdhy;) ,e;j egh; c’;fSf;F cwtpduh> (Fwpg;gpl;l cwtpdh; FwpaPl;ow;F J}z;of; nfl;ft[k;)

Yes Mk; 01 01 01

No ,y;iy 02 02 02 ����4102

If Yes, Write Kinship Mk; vdpy;. cwt[Kiwia vGjt[k;

Kinship Code cwt[Kiw FwpaPL

4101.

[For those with some kin relationship:] What is the name of person? (ve;jtHpapyhtJ cwt[Kiw cs;stu;fSf;F) me;j egupd; bgah; vd;d>

����4103

4102.

[those without kin relation:] what is Jati? (ve;jtHpapYk; cwt[Kiw ,y;yhjtu;fSf;F) me;j egh; vd;d $hjp>

Caste Code $hjp FwpaPL

4103.

Besides this job in [season/months], what is the total earnings for OTHER work in public works or other employment guarantee programs?

,e;j ntiyia jtpu. (gUtk; - khj’;fspy;) kw;w ntiy my;yJ ntiytha;g;;g[ cWjp jp;l;l’;fs; K:yk; bgw;w bkhj;j tUkhdk; vt;tst[>

Value in Rs.

kjpg;g[ U:ghapy;

-->Next season mLj;j gUtk;

-->Next season mLj;j gUtk;

���� 4104

Construction and maintenance of house, farm and other self employment assets tPL fl;Ljy; kw;WktPL fl;Ljy; kw;WktPL fl;Ljy; kw;WktPL fl;Ljy; kw;Wk; guhkhpg;g[. gz;iz kw;Wk; ,ju Ra?ntiytha;g;g[ ntiyfs;; guhkhpg;g[. gz;iz kw;Wk; ,ju Ra?ntiytha;g;g[ ntiyfs;; guhkhpg;g[. gz;iz kw;Wk; ,ju Ra?ntiytha;g;g[ ntiyfs;; guhkhpg;g[. gz;iz kw;Wk; ,ju Ra?ntiytha;g;g[ ntiyfs;

4104.

In [months/season] was [NAME] involved in any maintenance or construction of house, farm, or business assets? (gUtk;-khj’;fs;) fhyj;jpy; (bgau;) tPL fl;Ljy; gz;iz ntiy nghd;w guhkupg;g[ my;yJ tu;j;jf epWtd’;fs; rk;ge;jg;gl;l ntiyfspy; <Lgl;lhuh>

Yes

Mk; 01 01 01

No

,y;iy 02 02 02 ����4107

4105.

How many days in [season/months] were [NAME] involved in construction and maintenance of house, farm, and other self-employment assets?

(bgah;) (gUtk; - khj’;fs;) y; vj;jid ehl;fs; tPL fl;Ljy; kw;Wk; guhkhpg;g[. gz;iz kw;Wk; ,ju Ra?ntiytha;g;g[ ntiyfspy;; <Lgl;Oh;fs;>

Number of days

ehl;fspd; vz;zpf;if

4106.

On average, how many hours per day did [NAME] work in this job? ruhrhpahf . (bgah;) xU ehspy; vj;jid kzp neuk; ,e;j ntiyia bra;jPh;fs;>

Number of Hours / day xU ehspy; kzp neu’;fs;

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65 URBAN INDIVIDUAL QUESTIONNAIRE-Labor

S.no Questions Options Season 1 Season 2 Season 3 Skips

Common Property Resources bghJ bghJ bghJ bghJ ts§f²ts§f²ts§f²ts§f²

4107.

In [months/season] was [NAME] involved in fishing, collecting fuel/wood for sale, herding cattle, cutting grass, hunting, or other activities using common property resources (CPR)? (bgah;) (gUtk; - khj’;fs;) ypy; kPd; gpog;gJ. tpw;gidf;fhf tpwF nrfupg;gJ. fhy;eil nka;g;gJ..g[y; btl;LtJ. ntl;ilahLtJ my;yJ bghJ ts§fis cgnahfpf;Fk; eltof;iffspy; <Lgl;Oh;fsh>

Yes Mk; 01 01 01

No ,y;iy 02 02 02 ���� 4112

4108.

If yes, What type of work on common property resources? Mk; vdpy;. bghJ ts§f² tif vd;d>

DESCRIPTIONtpsf;fk; Fishing kPd; gpog;gJ 01 01 01

Collecting wood / non-timber forest products

tpwF nrfupg;gJ-fhLfspypUe;J fpilf;Fk;

kuk; my;yhj ntW bghUl;fs;

02 02 02

Herding cattle fhy;eil nka;g;gJ 03 03 03

Cutting grass g[y; btl;LtJ 04 04 04

Hunting ntl;ilahLtJ 05 05 05 Others kw;wit

SPECIFY (Fwpg;gplt[k;)

06 06 06

4109.

How many days in [season/months] were [NAME] involved in this activity? (bgah;) (gUtk; - khj’;fs;) y; vj;jid ehl;fs; ,e;j eltof;ifapy; <Lgl;Oh;fs;>

Number of days ehl;fspd; vz;zpf;if;

4110.

On average, how many hours per day did [NAME] work in this activity? ruhrhpahf . (bgah;) xU ehspy; vj;jid kzp neuk; ,e;j eltof;ifapy; ntiyia bra;jPh;fs;>

Number of Hours per day

xU ehspy; kzp neu’;fs;

4111.

During [season/month] what was the Net income received from this activity? (Rs.) (bgah;) (gUtk; - khj’;fs;) y; ,e;j eltof;ifahy; bgwg;gl;l bkhj;j tUkhdk; vd;d>? (U:)

Rs. U:

4112.

In [months/season] how many days were [NAME] looking for work but unable to find it – unemployed? bgah;) (gUtk; - khj’;fs;) y; vj;jid ehl;fs; ntiy njodPh;fs; Mdhy; fpilf;ftpy;iy ? mjhtJ ntiy ,y;yhky; ,Ue;jPhfs;;>

days ehl;fs;

�Next season (4104) mLj;j gUtk;

-->Next season (4104) mLj;j gUtk;

����SEC.5 gFjp 5 gFjp 5 gFjp 5 gFjp 5 f;Fr; f;Fr; f;Fr; f;Fr;

bry;tt[bry;tt[bry;tt[bry;tt[k;k;k;k;

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66 URBAN INDIVIDUAL QUESTIONNAIRE- Governance

SECTION 5: AGES 18 COMPLETED YEARS AND OVER: VOTING PATTERNS 18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs; ? thf;fspf;Fk; Kiwfs;18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs; ? thf;fspf;Fk; Kiwfs;18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs; ? thf;fspf;Fk; Kiwfs;18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs; ? thf;fspf;Fk; Kiwfs;

I. Member NAME: cWg;gpdu; bgau; :

II. Member ID: cWg;gpdu; milahs vz; :

III. Respondent Name: gjpyspg;gthpd; bgah; NO PROXY ALLOWED

khw;W eguplk; ,e;j gFjpf;F ngl;o vLf;ff;TlhJ

IV. Respondent ID: gjpyspg;gthpd; milahs vz;

V. PROXY CODE: khw;W egu; FwpaPL

Q.no Question Options Code 5001. Is your name currently included on the electoral rolls?

thf;fhsh; gl;oaypy; jw;rkak; c’;fs; bgah; nrh;f;fg;gl;Ls;sjh > Yes Mk; 01

No ,y;iy 02 Did you vote during [….] election

(////////) njh;jypd; nghJ . eP’;fs; thf;fspj;jPh;fsh> 5002. Mayor/chairman/Panchayat pres: Oct 2006

nkah; - nrh;nkd; - g”;rhaj;J jiyth; ? mf;nlhgh; 2006

Yes Mk; 01

No ,y;iy 02

5003. Ward member/Council member: Oct 2006 thh;L cWg;gpdh; - ft[d;rpy; cWg;gpdh; ? mf;nlhgh; 2006

Yes Mk; 01

No ,y;iy 02 5004. MLA: Oct 2006

vk; vy; V ? mf;nlhgh; 2006 Yes Mk; 01

No ,y;iy 02 5005. MP: May 2009

vk; gp ? nk 2009 Yes Mk; 01

No ,y;iy 02

AGES 18 COMPLETED YEARS AND OVER: CITIZEN CONCERNS 18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs; ? Fokf;fs; gpur;ridfs; . murh’;fk; gpur;ridfis czh;e;J bray;gLtJ

Q. No Questions Code Skip

5006.

How serious do you consider [ISSUE] to be in this neighborhood? c’;fs; gpshf;fpy; gpd;tUk; gpur;ridfs; vt;tst[ jPtpukhf ,Ug;gjhf eP’;fs; fUJfpwPh;fs; >

very serious Problem kpft[k; jPtpukhd gpur;rid 01 Serious jPtpukhdJ 02

minor problem rpwpa gpur;rid 03 not a problem gpur;rid my;y 04

a. Drinking water supply Fo ePh; tpepnahfk;

b. Electricity Supply kpd;rhuk; tpepnahfk;

c. Quality of Education fy;tpapd; juk;

d. Transport & roads nghf;Ftuj;J & rhiyfs;

e. Civil supplies (ration shops) Foik bghUl;fspd; (rptpy; rg;is) tpepnahfk; (nu&d; filfs;)

f. Health facilities Mnuhf;fpa trjpfs;

g. Sewage/ sanitation fHpt[ePh; fhy;tha; - Rfhjhuk;

h. Availability of Credit fld; fpilf;ff;Toa jd;ik

i. Crime Fw;w’;fs; eilbgWtJ

j. Others (specify) kw;wit (jat[bra;J Fwpg;gplt[k;)

k. Others (specify) kw;wit (jat[bra;J Fwpg;gplt[k;)

l. Others (specify) kw;wit (jat[bra;J Fwpg;gplt[k;)

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67 URBAN INDIVIDUAL QUESTIONNAIRE- Governance

Q. No Questions Options Code Skip 5007. Have you ever contacted any local official, government

official, or concerned department with concerns related to ANY issues / problems / concerns? s; VnjDk; bjhlh;ghd mf;fiwa[ld; cs;S:u; mjpfhup my;yJ murh’;f mjpfhup my;yJ rk;ge;jg;gl;l Jiwia vg;nghjhtJ bjhlh;g[ bfhz;oUf;fpwPh;fsh>

Yes Mk; 01

No ,y;iy 02 ���� 5012

5008. If yes, which issues? (list all that apply) (use code given below) Mk; vdpy;. ve;j gpur;rpidfs; bjhlh;ghf> (bghUe;Jfpw midj;ija[k; gl;oayplt[k;) (ÑnH bfhL¡f¥g£L²s FwpaPl;il ga©gL¤jæ«)

Issue 1 (gpur;rid 1) SPECIFY Fwpg;gplt[k;

Issue CODE (gpur;rid FwpaPL) Issue 2 (gpur;rid 2) SPECIFY Fwpg;gplt[k;

Issue CODE (gpur;rid FwpaPL) Issue 3 (gpur;rid 3) SPECIFY Fwpg;gplt[k;

Issue CODE (gpur;rid FwpaPL)

5009. If yes, which was THE MOST RECENT issue you contacted official OR concerned department about? (use code given below) Mk; vdpy;. eP';fs; mJ gw;wp mYtyh;fis my;yJ rk;ge;jg;gl;l Jiwiaj; bjhlh;g[ bfhz;l kpfr; rkPgj;jpa gpur;rpid vd;dthf ,Ue;jJ>(ÑnH bfhL¡f¥g£L²s FwpaPl;il gad;L¤jæ«)

Issue gpur;rid SPECIFY Fwpg;gplt[k;

Issue CODE (gpur;rid FwpaPL)

5010. What government official or department did you contact? ve;j muR mjpfhhpia my;yJ Jiwia eP’;fs; bjhlh;g[ bfhz;Oh;fs;> WRITE EXACT RESPONSE gjpiy rhpahf vGjt[k;

“ANYONE ELSE?” /ntW ahiuahtJ> MULTICODE POSSIBLE: gy gjpy;fs; tuyhk;

5011. What was the Outcome of all these efforts? ,e;j Kaw;r[papd; gyd; vd;dthf ,Ue;jJ> WRITE EXACT RESPONSE rhpahd gjpiy vGjt[k;

Issues Code Q. 5008, 5009 gpur;ridgpur;ridgpur;ridgpur;ridfspd;fspd;fspd;fspd; FwpaPLFwpaPLFwpaPLFwpaPL Options Code Road rhiy rk;ge;jkhf 01 Transport nghf;Ftuj;J rk;ge;jkhf 02 Health Mnuhf;fpak; rk;ge;jkhf 03 Education fy;tp rk;ge;jkhf 04 Irrigation related ePh; ghrdk; rk;ge;jkhf 05 Drinking water FoePh; rk;ge;jkhf 06 Other agriculture related kw;w tptrhak; bjhlh;ghd gpur;rid 07 Ceremonies / Festivals bfhz;lhl;l’;fs; - jpUtpHhf;fs; bjhlh;ghf 08 Inter-block Disputes gpshf;FfSf;fpilna jfuhW bjhlh;ghf 09 Sewage / Sanitation fHpt[ ePh; - Rfhjhuk ;bjhlh;ghf 10 Construction other than roads or irrigation rhiyfs; my;yJ ePh; ghrdk; jtpu;j;J ntW fl;Lkhd gzpfs;

bjhlh;ghf 11

Access to and use of lands of the government murh’;f epy’;fis cgnahfpj;jy; kw;Wk; bjhlh;ghf 12 Unemployment schemes ntiyapy;yhnjhUf;fhd jpl;l’;fs; bjhlh;ghf 13 Civil Supplies (ration shops) Foikg; bghUl;fs; (nu&d; filfs;) bjhlh;ghf 14 Availability of credit fld; fpilg;gJ bjhlh;ghf 15 Usage of common property bghJ brhj;ij gad;gLj;JtJ bjhlh;ghf 16 Street light bjU tpsf;Ffs ;bjhlh;ghf 17 Electricity supply kpd;rhuk; tpepnahfk; bjhlh;ghf 18 Cremation ground kahd g{kp rk;ge;jkhf 19 Crime Fw;w’;fs; rk;ge;jkhf 20 Private property disputes jdpahh; brhj;J gpur;rpidfs; rk;ge;jkhf 21 Other (specify) kw;wit (Fwpg;gplt[k;) 22

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68 URBAN INDIVIDUAL QUESTIONNAIRE- Governance

AGES 18 COMPLETED YEARS AND OVER: SOCIAL INTEGRATION 18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs;18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs;18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs;18 taJ Koe;jth;fs; kw;Wk; mjw;fjpfkhf tajhdth;fs; ? rK:f xUikg;? rK:f xUikg;? rK:f xUikg;? rK:f xUikg;ghLghLghLghL

Q.no Group/Activity Name

FG - bray;ghl;od; bgah;

Ever participated in[….]? eP';fs; vg;nghjhtJ (FGtpy;) g’;nfw;wpUf;fpwPh;fsh >

What is the name of the group you participated in? (If

more than one- name one participated in most recently) eP’;fs; g’;nfw;w FGtpd; bgau; vd;d> (xd;Wf;F nkw;gl;l bgau;fisf; Twpdhy; kpfr; rkPgj;jpy; g’;nfw;w FGtpd; bgaiu vGjt[k;)

Yes Mk;; No ,y;iy �next mLj;j tupir

5012. Self help group(SHG) for women only bgz;fSf;fhd Ra cjtpf; FGf;fs; 01 02

5013. Other Self help group (SHG) kw;w Ra cjtpf; FGf;fs; 01 02

5014. Mothers’ Committee /Magalir Sangam jha;khu;fs; mikg;g[ - kfspu; r’;fk; 01 02

5014. Non government organization (NGO) muR rhuh bjhz;L epWtdk; (vd; $p X) 01 02

5015. Religious group Md;kPf FGf;fs; 01 02

5016. Political parties murpay; fl;rpfs; 01 02

5017. Caste Associations $hjp r’;f’;fs; 01 02

5018.

Area or Residential Development Committee Vupah my;yJ FoapUg;g[ nkk;ghl;Lf; FG 01 02

5019. Committees on Irrigation and water use or Water Users Association or Watershed Committee ghrdk; kw;Wk; jz;zPu; gad;ghl;ow;fhd fkpl;ofs; my;yJ jz;zPu; gad;gLj;Jnthupd; r’;fk; my;yJ ePh; gfph;t[f;fhd thl;lu;b&l; fkpl;o

01 02

5020. Cooperatives Tl;Lwt[r; r’;f’;fs; 01 02

5021. Business associations bjhHpy; r’;f’;fs; 01 02

5022. Other (specify) kw;wit ( Fwpg;gplt[k;/) 01 02

5023. Other (specify) kw;wit ( Fwpg;gplt[k;/) 01 02

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URBAN INDIVID. QUESTIONNAIRE-Anthropometrics 71

Section 7: ANTHROPOMETRICS

Sl.

Unit.

mst[

Measurements

mst[fs;

Date measured:

DD/ MM/YYYY

mst[ vLf;fg;gl;l

njjp

nj -kh -tU

How measured 01=standing

02=lying down

vt;thW msf;fg; gl;lJ

01?epw;fitj;J 02?gLf;fitj;J

If not measured, Reason for not

obtaining measure [CODE]

mst[ vLf;fg;gl tpy;iy vdpy;

mst[ vLf;fhjjw;fhd

fhuzk; (FwpaPL)

Q.no 7001. 7002. 7003. 7004. 1 Height of respondent (Cm)

gjpyspg;gtupd; cauk; Cm br/ Ú/

.

2 Weight of respondent (Kg) gjpyspg;gtupd; vil fp/fpuhkpy;

KG »/»/

.

3 Upper middle arm circum. of respondent (Cms). gjpyspg;gtupd; KH’;iff;Fk; njhs;gl;ilf;Fk; ,ilapy; cs;s eLg;gFjpapd; Rw;wst[[ (brd;o kPl;lupy);

Cm br/ Ú/

.

CODE FwpaPLFwpaPLFwpaPLFwpaPL Sick cly; eykpy;iy

01

Refused to be measured msbtLg;gjw;F kWj;jhh;

02

Mother refused on behalf of child FHe;ijapd; rhh;ghf jha; kWj;jhh;

03

Not available ?,Uf;ftpy;iy

04

Others (Specify) kw;wit Fwpg;gplt[k;

05

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CODING SHEETS FOR GAMES ghpl;irfSf;fhd FwpaPL jhs;ghpl;irfSf;fhd FwpaPL jhs;ghpl;irfSf;fhd FwpaPL jhs;ghpl;irfSf;fhd FwpaPL jhs;

T1.TO ALL MEMBERS BETWEEN AGE 5 - 13 COMPLETED YEARS.: BASIC READING TEST (use the given show card) mog;gil thrpj;jy; jpwd; (bfhLf;fg;gl;Ls;s fhz;gpf;Fk; ml;ilia gad;glj;jt[k;) - 5 taJ Kjy; 14 taJ tiu cs;s FLk;g cWg;gpdh;fSf;F kl;Lk;

READING TASK OUTCOME SINGLE

CODE

LETTERS

vHj;Jf;fs; Could not recognize letters

vGj;Jf;fis milahsk; fhz Koatpy;iy 01

LETTERS

vHj;Jf;fs; Could recognize 4 out of 5 letters she chose

mts; nju;t[ bra;j 5 vGj;Jf;fspy; 4 vGj;Jf;fis milahsk; fhz KofpwJ

02

WORDS

thu;j;ijfs; Could recognize 4 of 5 words she chose

mts; nju;t[ bra;j 5 thu;j;ijfspy; 4 thu;j;ijfis milahsk; fhz KofpwJ

03

START HERE ����

,’;fpUe;J Jt’;ft[k;

LEVEL 1

byty; 1

Could read easy paragraph [LEVEL 1]

vspikahd gj;jpfisg; gof;f KofpwJ (byty; 1) 04

LEVEL 2

byty; 2

Could read stories [LEVEL 2]

fijfisg; gof;f KofpwJ (byty; 2) 05

T2. TO ALL MEMBERS BETWEEN AGE 5 - 13 COMPLETED YEA RS: BASIC MATH TEST

(use the given show card) fzf;F ghpl;ir (bfhLf;fg;gl;Ls;s fhz;gpf;Fk; ml;ilia gad;glj;jt[k;) - 5 taJ Kjy; 14 taJ tiu cs;s FLk;g cWg;gpdh;fSf;F kl;Lk;

ARITHMETIC TASK OUTCOME SINGLE

CODE

NUMBERS

vz;fs; Could not identify 4 of 5 numbers

5 vz;fspy; 4 vz;fis milahsk; fhz Koatpy;iy

01

NUMBERS

vz;fs; Could identify at least 4 out of 5 numbers

5 vz;fspy; Fiwe;j gl;rk; 4 vz;fis milahsk; fhz Koe;jJ

02

START HERE ����

,’;fpUe;J Jt’;ft[k;

SUBTRACTION

fHpj;jy; Could solve 2 subtraction problems

2 fHpj;jy; fzf;Ffisr; bra;a Koe;jJ 03

DIVISION

tFj;jy; Could solve 1 division problem.

1 tFj;jy; fzf;ifr; bra;a Koe;jJ 04

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T3. ALL HOUSEHOLD MEMBERS AGES 5 AND OLDER: DIGIT S PAN ASSESSMENT 5 taJ kw;Wk; mjw;Fk; mjpf taJ cila FLk;g cWg;gpdh;fs; midth;fSf;Fk; g{h;j;jp bra;at[k; This section gives idea of (NAME)memory for number order. Each sequence of has more digits than the last. (bgau;) vz;fis tupirg;go epidtpy; itj;Jf;bfhs;tjw;F ,e;j gFjp xU fUj;ijf; bfhLf;fpwJ/ xt;bthU tupira[k; filrpahd xd;iwtpl mjpf ,yf;f’;fisf; bfhz;oUf;fpwJ. INSTRUCTIONS FOR ADMINISTERING THE DIGIT SPAN QUESTIONS o$pl; !;ngd; tpdhf;fis nfl;gjw;fhd Fwpg;g[fs;

(1) Read each digit span only once at an even rate of one digit per second. xU ,yf;fj;jpw;F xU tpdho bfhLj;J rPuhd ,ilbtspapy; xt;bthU o$pl; !;ngida[k; xnu xU Kiw kl;Lk; gof;ft[k;

(2) Read Part A of a question; pause for response; then score. xU nfs;tpapd; gFjp V?itg; gof;ft[k;. gjpYf;F rpwpJ neuk; fhj;jpUf;ft[k;;. gpwF gjpiy gjpt[ bra;at[k;

(3) Read Part B of a question; pause for response; then score. xU nfs;tpapd; gFjp gp?iag; gof;ft[k;. gjpYf;F epWj;jt[k;. gpwF gjpiy gjpt[ bra;at[k;//

(4) If [NAME] does not respond after reading the question, do not encourage further. xU ntis nfs;tpiag; goj;jgpwF gjpyspf;ftpy;iyahdhy;. nkYk; Cf;fg;gLj;j ntz;lhk;

(5) Stop when [NAME] misses Part A and Part B of any one question. (bgau;) gFjp V kw;Wk; gFjp gp ,tw;wpy; ,uz;Lf;Fk; gjpyspf;fj; jtWk;nghJ epWj;jt[k;.

(6) To be scored as “correct”, no digits may be omitted or be in reversed order. ve;j ,yf;f’;fSk; tpLglf;TlhJ my;yJ gpd;ndhf;fpa tupirapy;;;;; ,Uf;ff;TlhJ. mt;thwpUe;jhy; @rup@ vd;W gjpt[ bra;at[k;.

READ TO [NAME]: 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. (bgau;) ?lk; brhy;yt[k;;/ ehd; ,e;j Fwpg;g[fis c’;fSf;F xU Kiw kl;Lnk gog;ngd;/ ehd; mtw;iw (bgau;) ?lk; brhy;yt[k;;/ ehd; ,e;j Fwpg;g[fis c’;fSf;F xU Kiw kl;Lnk gog;ngd;/ ehd; mtw;iw (bgau;) ?lk; brhy;yt[k;;/ ehd; ,e;j Fwpg;g[fis c’;fSf;F xU Kiw kl;Lnk gog;ngd;/ ehd; mtw;iw (bgau;) ?lk; brhy;yt[k;;/ ehd; ,e;j Fwpg;g[fis c’;fSf;F xU Kiw kl;Lnk gog;ngd;/ ehd; mtw;iw jpUk;g gof;fkhl;nld;/ ehd; rpy vz;fis brhy;yg; nghfpnwd;/ ftdkhff; nfl;L ehd; goj;J jpUk;g gof;fkhl;nld;/ ehd; rpy vz;fis brhy;yg; nghfpnwd;/ ftdkhff; nfl;L ehd; goj;J jpUk;g gof;fkhl;nld;/ ehd; rpy vz;fis brhy;yg; nghfpnwd;/ ftdkhff; nfl;L ehd; goj;J jpUk;g gof;fkhl;nld;/ ehd; rpy vz;fis brhy;yg; nghfpnwd;/ ftdkhff; nfl;L ehd; goj;J Koj;jgpwF vdf;Fr; rupahfr; brhy;Y’;fs;/ Koj;jgpwF vdf;Fr; rupahfr; brhy;Y’;fs;/ Koj;jgpwF vdf;Fr; rupahfr; brhy;Y’;fs;/ Koj;jgpwF vdf;Fr; rupahfr; brhy;Y’;fs;/ xt;bthU nfs;tpf;Fxt;bthU nfs;tpf;Fxt;bthU nfs;tpf;Fxt;bthU nfs;tpf;Fk; Kd;ghf @jahuhf ,U’;fs;@ vd;W brhy;yt[k;/ k; Kd;ghf @jahuhf ,U’;fs;@ vd;W brhy;yt[k;/ k; Kd;ghf @jahuhf ,U’;fs;@ vd;W brhy;yt[k;/ k; Kd;ghf @jahuhf ,U’;fs;@ vd;W brhy;yt[k;/

DIGITS FORWARD ASK BOTH A AND B FOR EACH QUESTION. MARK IF CORRECT OR WRONG.

xt;bthU nfs;tpf;Fk; gFjp V kw;Wk; gp ? nfl;ft[k;/ rup my;yJ jtW vd;gijg; gjpt[ bra;at[k;/

INTERVIEWER: Say “Ready”, then say ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/QQ

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

1(A) “2-9” 1(B) “4-6”

IF BOTH A & B ARE CODED WRONG ����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

2(A) “3-8-6” 2(B) “6-1-2”

IF BOTH A & B ARE CODED WRONG ����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

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INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

3(A) “ 3-4-1-7” 3(B) “ 6-1-5-8”

IF BOTH A & B ARE CODED WRONG ����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

4(A)

“8-4-2-3-9”

4(B)

“5-2-1-8-6”

IF BOTH A & B ARE CODED WRONG ����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

5(A)

3-8-9-1-7-4

5(B)

7-9-6-4-8-3

IF BOTH A & B ARE CODED WRONG ����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

6(A)

5-1-7-4-2-3-8

6(B)

9-8-5-2-1-6-3

IF BOTH A & B ARE CODED WRONG ����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

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INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

7 (A)

1-6-4-5-9-7-6-3

7 (B)

2-9-7-6-3-1-5-4

IF BOTH A & B ARE CODED WRONG ����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;/

Response Code 1= [NAME] repeated the numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twpdhy; 0 ? (bgau;) vz;fis rupahfj; jpUk;gf; Twtpy;iy vdpy;

8(A)

5-3-8-7-1-2-4-6-9

8(B)

4-2-6-9-1-7-8-3-5

IF BOTH A & B ARE CODED W RONG����DIGITS BACKWARDS. @V@ kw;Wk; @gp@ ,uz;Lnk jtW vd;W gjpt[ bra;ag;gl;oUe;jhy; gpd;ndhf;fpr; brhy;Yk; gFjpf;Fr; bry;yt[k;;

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DIGITS BACKWARD ASK BOTH A AND B FOR EACH QUESTION

xt;bthU nfs;tpf;Fk; @V@ kw;Wk; @gp@ ,uz;ila[k; nfl;ft[k;

READ: 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? gof;ft[k;gof;ft[k;gof;ft[k;gof;ft[k;: ,g;nghJ ehd; nkYk; rpy vz;fisr; brhy;yg; nghfpnwd;. Mdhy; ,e;j Kiw ehd; ,g;nghJ ehd; nkYk; rpy vz;fisr; brhy;yg; nghfpnwd;. Mdhy; ,e;j Kiw ehd; ,g;nghJ ehd; nkYk; rpy vz;fisr; brhy;yg; nghfpnwd;. Mdhy; ,e;j Kiw ehd; ,g;nghJ ehd; nkYk; rpy vz;fisr; brhy;yg; nghfpnwd;. Mdhy; ,e;j Kiw ehd; epWj;jpa gpwF mtw;iw vdf;F eP’;fepWj;jpa gpwF mtw;iw vdf;F eP’;fepWj;jpa gpwF mtw;iw vdf;F eP’;fepWj;jpa gpwF mtw;iw vdf;F eP’;fs; gpd;ndhf;fp brhy;y ntz;Lk;/ cjhuzkhf. ehd s; gpd;ndhf;fp brhy;y ntz;Lk;/ cjhuzkhf. ehd s; gpd;ndhf;fp brhy;y ntz;Lk;/ cjhuzkhf. ehd s; gpd;ndhf;fp brhy;y ntz;Lk;/ cjhuzkhf. ehd 9-2-7; vd;W ; vd;W ; vd;W ; vd;W brhd;dhy; eP’;fs; vd;d brhy;tPu;fs;>brhd;dhy; eP’;fs; vd;d brhy;tPu;fs;>brhd;dhy; eP’;fs; vd;d brhy;tPu;fs;>brhd;dhy; eP’;fs; vd;d brhy;tPu;fs;> PAUSE FOR [NAME] TO RESPOND. DID [NAME] RESPOND CORRECTLY (7-2-9)? (bgau;) gjpyspg;gjw;;fhf epWj;jt[k;(bgau;) gjpyspg;gjw;;fhf epWj;jt[k;(bgau;) gjpyspg;gjw;;fhf epWj;jt[k;(bgau;) gjpyspg;gjw;;fhf epWj;jt[k;. (bgau;) rupahf gjpyspj;jhuh (bgau;) rupahf gjpyspj;jhuh (bgau;) rupahf gjpyspj;jhuh (bgau;) rupahf gjpyspj;jhuh (7-2-9)?

YES (7-2-9) .........SAY: That’s right. Let’s go on with the rest of the numbers. Mk;Mk;Mk;Mk; (7-2-9) ////////// brhy;yt[k;/ rupahfr; brhd;dPu;fs;/ ,g;nghJ ehk; kPjKs;s vz;fSf;Fr; bry;yyhk;/////////// brhy;yt[k;/ rupahfr; brhd;dPu;fs;/ ,g;nghJ ehk; kPjKs;s vz;fSf;Fr; bry;yyhk;/////////// brhy;yt[k;/ rupahfr; brhd;dPu;fs;/ ,g;nghJ ehk; kPjKs;s vz;fSf;Fr; bry;yyhk;/////////// brhy;yt[k;/ rupahfr; brhd;dPu;fs;/ ,g;nghJ ehk; kPjKs;s vz;fSf;Fr; bry;yyhk;/

NO........................SAY: No, you would say 7-2-9. I said 9-2-7, so to say it back wards you would say 7-2-9. Now try these numbers. Remember you are to say them backward. ,y;iy////////////////brhy;yt[k;/ ,y;iy/ eP’;fs; ,y;iy////////////////brhy;yt[k;/ ,y;iy/ eP’;fs; ,y;iy////////////////brhy;yt[k;/ ,y;iy/ eP’;fs; ,y;iy////////////////brhy;yt[k;/ ,y;iy/ eP’;fs; 7-2-9 vd;W brhy;y ntz;Lk;/ ehd; vd;W brhy;y ntz;Lk;/ ehd; vd;W brhy;y ntz;Lk;/ ehd; vd;W brhy;y ntz;Lk;/ ehd; 9-2-7 vd;W Twpndd;. eP’;fs; vd;W Twpndd;. eP’;fs; vd;W Twpndd;. eP’;fs; vd;W Twpndd;. eP’;fs; mijj; jpUg;gpr; brhy;Yk;nghJ mijj; jpUg;gpr; brhy;Yk;nghJ mijj; jpUg;gpr; brhy;Yk;nghJ mijj; jpUg;gpr; brhy;Yk;nghJ 7-2-9 vd;W brhy;y ntz;Lk;/ ,vd;W brhy;y ntz;Lk;/ ,vd;W brhy;y ntz;Lk;/ ,vd;W brhy;y ntz;Lk;/ ,g;nghJ ,e;j vz;fis brhy;ypg; ghU’;fs;/ g;nghJ ,e;j vz;fis brhy;ypg; ghU’;fs;/ g;nghJ ,e;j vz;fis brhy;ypg; ghU’;fs;/ g;nghJ ,e;j vz;fis brhy;ypg; ghU’;fs;/ eP’;fs; mtw;iw jpUg;gpr; brhy;y ntz;Lk; vd;gij epidtpy; itj;Jf;bfhs;S’;fs;/eP’;fs; mtw;iw jpUg;gpr; brhy;y ntz;Lk; vd;gij epidtpy; itj;Jf;bfhs;S’;fs;/eP’;fs; mtw;iw jpUg;gpr; brhy;y ntz;Lk; vd;gij epidtpy; itj;Jf;bfhs;S’;fs;/eP’;fs; mtw;iw jpUg;gpr; brhy;y ntz;Lk; vd;gij epidtpy; itj;Jf;bfhs;S’;fs;/

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;

Answer: DO NOT

READ gjpy;fs; gof;ff; TlhJ

Response Code 1= [NAME] repeated numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahf jpUg;gpr; brhd;dhy; 0 ? (bgau;) vz;fis rupahfr; jpUg;gpr; brhy;ypapUf;fhtpl;lhy;

9(A) “2-5”

(ANS=5-2)

9(B)

“6-3” (ANS=3-6)

IF BOTH A & B ARE CODED WRONG ����END. @V@ kw;Wk; @gp@ ,uz;Lnk jtwhf gjpt[ bra;ag;gl;oUe;jhy; Kot[ gFjpf;Fr; bry;yt[k;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;;

Answer: DO NOT READ

gjpy;fs;

gof;ff; TlhJ

Response Code 1= [NAME] repeated numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahf jpUg;gpr; brhd;dhy; 0 ? (bgau;) vz;fis rupahfr; jpUg;gpr; brhy;ypapUf;fhtpl;lhy;

10(A) 5-7-4

(ANS=4-7-5)

10(B)

2-5-9 (ANS=9-5-2)

IF BOTH A & B ARE CODED WRONG ����END. @V@ kw;Wk; @gp@ ,uz;Lnk jtwhf gjpt[ bra;ag;gl;oUe;jhy; Kot[ gFjpf;Fr; bry;yt[k;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;

Answer: DO NOT READ

gjpy;fs;

gof;ff; TlhJ

Response Code 1= [NAME] repeated numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahf jpUg;gpr; brhd;dhy; 0 ? (bgau;) vz;fis rupahfr; jpUg;gpr; brhy;ypapUf;fhtpl;lhy;

11(A)

7-2-9-6 (ANS=6-9-2-7)

11(B)

8-4-9-3 (ANS=3-9-4-8)

IF BOTH A & B ARE CODED WRONG ����END. @V@ kw;Wk; @gp@ ,uz;Lnk jtwhf gjpt[ bra;ag;gl;oUe;jhy; Kot[ gFjpf;Fr; bry;yt[k;

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INTERVIEWER: Say “Ready”, then

say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;

Answer: DO NOT READ

gjpy;fs; gof;ff; TlhJ

Response Code 1= [NAME] repeated numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahf jpUg;gpr; brhd;dhy; 0 ? (bgau;) vz;fis rupahfr; jpUg;gpr; brhy;ypapUf;fhtpl;lhy;

12(A)

4-1-3-5-7 (ANS=7-5-3-1-4)

12(B)

9-7-8-5-2 (ANS=2-5-8-7-9)

IF BOTH A & B ARE CODED WRONG ����END. @V@ kw;Wk; @gp@ ,uz;Lnk jtwhf gjpt[ bra;ag;gl;oUe;jhy; Kot[ gFjpf;Fr; bry;yt[k;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;

Answer: DO NOT READ

gjpy;fs;

gof;ff; TlhJ

Response Code 1= [NAME] repeated numbers exactly 0=[NAME] did not repeat numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahf jpUg;gpr; brhd;dhy; 0 ? (bgau;) vz;fis rupahfr; jpUg;gpr; brhy;ypapUf;fhtpl;lhy;

13(A)

1-6-5-2-9-8 (ANS=8-9-2-5-6-1)

13(B)

3-6-7-1-9-4 (ANS=4-9-1-7-6-3)

IF BOTH A & B ARE CODED WRONG ����END. @V@ kw;Wk; @gp@ ,uz;Lnk jtwhf gjpt[ bra;ag;gl;oUe;jhy; Kot[ gFjpf;Fr; bry;yt[k;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;

Answer: DO NOT READ

gjpy;fs;

gof;ff; TlhJ

Response Code 1= [NAME] repeated numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahf jpUg;gpr; brhd;dhy; 0 ? (bgau;) vz;fis rupahfr; jpUg;gpr; brhy;ypapUf;fhtpl;lhy;

14(A)

8-5-9-2-3-4-2 (ANS=2-4-3-2-9-5-8)

14(B)

4-5-7-9-2-8-1 (ANS=1-8-2-9-7-5-4)

IF BOTH A & B ARE CODED WRONG ����END. @V@ kw;Wk; @gp@ ,uz;Lnk jtwhf gjpt[ bra;ag;gl;oUe;jhy; Kot[ gFjpf;Fr; bry;yt[k;

INTERVIEWER: Say “Ready”, then say: ngl;o vLg;gtu;;;/ @buo@ vd;W brhy;yptpl;L gpwF brhy;yt[k;

Answer: DO NOT READ

gjpy;fs;

gof;ff; TlhJ

Response Code 1= [NAME] repeated numbers exactly 0=[NAME] did not repeat the numbers exactly gjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPLgjpy; FwpaPL 1 ? (bgau;) vz;fis rupahf jpUg;gpr; brhd;dhy; 0 ? (bgau;) vz;fis rupahfr; jpUg;gpr; brhy;ypapUf;fhtpl;lhy;

15(A) 6-9-1-6-3-2-5-8 (ANS=8-5-2-3-6-1-9-6)

15(B)

3-1-7-9-5-4-8-2 (ANS=2-8-4-5-9-7-1-3)

END of DIGIT SPAN ASSESSMENT

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T 4. ALL HOUSEHOLD MEMBERS AGES 5 AND OLDER : RAVEN ’S PATTERN 5 taJ kw;Wk; mjw;Fk; mjpf taJ cila FLk;g cWg;gpdh;fs; midth;fSf;Fk; g{h;j;jp bra;at[k;

Instructions: Show COLOR SHOWCARDS to [NAME] and have him/her point to one of the shapes labeled (a)-(f). Circle the letter that matches the shape [NAME] pointed to. tpjpKiwfs;/. tpjpKiwfs;/. tpjpKiwfs;/. tpjpKiwfs;/. fyh; ml;ilia (bgah; ) f;F fhz;gpj;J mtd; - mtis (a) – (f) vd;w xU nygpiy Fwpg;gpl;L fhz;gpf;fr; brhy;yt[k;/ (bgah; ) Fwpg;gpl;L fhz;gpj;j totj;jpw;F bghUe;Jk; vGj;ij tl;lkplt[k;/

Q. 1 Q. 2

a b c a b c

d e f d e f

Q. 3 Q. 4

a b c a b c

d e f d e f

Q. 5 Q. 6

a b c a b c

d e f d e f

Q. 7 Q. 8

a b c a b c

d e f d e f

Q. 9 Q. 10

a b c a b c

d e f d e f

Q. 11 Q. 12

a b c a b c

d e f d e f