V I LL11GE :

UNI ON

UPAZILLI~:

ZILLA:

IDENTIFYING FEATURGS OF HOUSE}IOLD:

Father's Name:

Name of Primary Respondent: --

FIOUSBIIOLD ID CODE:

Bangladesh K Institute J !)F Development StudiesAgargson, Shpr-A-Aangla Nagar, Dhaka

SURVEY QU~:STIOPIPIATI~E: FIRST ROUNDResearch Froject-: Credit hrog~:ams for tl~e Poor

Name of Field Supervisor

Date of Interview

DAY

MONTIi

YEAR

DAY

MONTH

YEAR

English: Bangla:

Name of HOUSEHOLD HEAD: _

_

_

-__

u Religion:

rvn rt~~~ntc~tl ur~r~ vlvlrY

SECTION

1.HouseholdInformation PART

B.

ON ONPARENISOFHOUSEHOLDMEHBRS

3 _ Q.-,-. T1T"

I s the Is the COPY THE What was the What is/was his Where was Is the Is the COPY THE Is/was What was the What kind of Where wasfather of father of IDENTI- highest level primary occupation? ..(NAME'S).. father nature[ natural IDENTI- the highest level work [s/was she ..(NAME'S).. mother..[NAME].. ..[NAME).. FICATION of schooling born? mother mother of FICATION mother of of schooling primarily born?still living in CODE FOR that he of ..[NAME].. CODE FOR ..[NAME].. that she engaged in?alive? this THE completed? Agriculture=l .[NAME).. living in THE literate? completed?

household? FATHER Agricultural labor=2 Still this MOTHERFisherman-3 alive? household?

(For BRAC Blacksmith=4school Potter=5use 91; Weaver=6 BRAC........ 91for any Small buslness=7 OTHER ADULT (USE OCCUPATIONadult Big business=8 LITERACY CODES FROM COL.61literacy Rickshaw driver=9; Boatman=10 PROGRAM .... 92program Carpenter=ll; Mason/helper=12use 92) Household-work=13

YES ...1 YES ...1 Student-14 YES ...1 YES... 1 YES.... INO.... 2 NO.... 2 Invalid=15 NO.... 2 NO....2 NO..... 2

( 5) ( 5) Unemployed=16 ( 11) ( 11) ( 13)k ' leaching=l7; Service-18 k k k

Other day laborer=19Other=20

DISTRICT CODE DISTRICT CODE

-SECTION 2. EDUCATION

PART A.

FORM t i10N( [-1 t1 S

con-

11-24

t

How mxh has your household spent during the past 12 monthsD

memt~er proem{ily enrolled in school?EN

IF NOTHING WAS SPENT, WRITE ZERO.1tF1CA

1

I il

18

19

20

210

N

Admission, Uniforms

Books and

Transpor-

PrivateAegistre-

school cation tutoringC

Hon and

supplieso TuitionDE

IT THE RESPONDENT CAN ON-' GIVE A TOTAL AMOUNT OF All.AND NOT THE AREAKDOWN PER 1YPE, WRITE DK (DON'T KNOW)17 TO 23, AND THE 10TA1 AMOUNT !N COLUMN 24.

TAKA TAKA TAKA TAKA TAKA

PRESENT ENRITf.LAENT-~~~

zz

fo

s

a ExdoFee

rA

eb Tr 3r~ 34

r each household Who in the Did you Whet was Did any If yes,who Which school did last attend? What was Now oldhousehold have a the value person paid these the were youpays most scho- of these living expenses? highest when youof your larship/ scholar- outside IN-LAWS..1 level finishededucation stipend/ ship or the UNCLES ...2 of educa- yourexpenses? tuition- stipend or household BROTHER/ tion com- schooling?EXPENSES waiver tuition- help you SISTER.3 Plated?

I N COLUMNS during waiver pay your GRAND-the past for the school PARENTS;12 mths? past 12 expenses? PATERNALAIf yes, months? MATERNAL.5

73_~

2b which YES..1 OTHERS...6sources? N0...2

mino- Other ex- Total No.... 0n penses GOVT.A ow much

(i.e. NGO...2 i d youmeals, SCHOOL4 eceiveroom,...) WRITE OTHER.5 n the

PERSON ID ( 17 IF ast 12FROM %10-0) nths? NAME OF THE SCHOOLSECTION 1A SOURCE YEARS

KA IAKA TAKA AIN 1EXT TAKA TAKA

:SECT,.1 QN 3.

HEALTH

PARE At

vi 2

1

0

E

N

T

I

F

1

C

A

T

I

0

N

C0DE

WRITE IDOF RES~PONOEUTfRamHOUSEHOLDROSTER

!D COOE

f L~IFSSfS O~IHJURIES

(i'ord1T'~use~o

rs)dm~eHOtISFHnLD ID COQE

iii

What type of How many Is Old you Who did you consult? What was Did ..III:AMEl.. New mny How longillness or days ..IRAME).. consult the cost have to 'top days did hasinjury? has still anybody of the doing hia/ ..(NAME).. ..INAMEI..

Has ..(NAME).. suffering (far ex- consults- her usual have to had this..[NAME).. been/were frm this ample, a HOMEOPATH .......... I tlon, In- activities stop illnesshad eny ill or illness doctor, HERBALIST/HAKIM/ chiding because of doing or injuryi( lness injured or In- nurse, KABIRAJ........... 2 any medi- his/her his/her i n TOTAL?or injury during the jury? kabirej COMPOUNDER/MEDICAL cines illness? WORK due.du r ing the past 30 or other STORE ............. 3 provided? to thispest 30 COUGH/FLU/ days? healer) CHARITABLE CENTER.A illness?days? FEVER ....... I for the GOVT HOSPITAL ...... 5

DIARRHEA .... 2 illness PRIVATE DOCTOR ..... 6STOMACH or PRIVATE HOSPITAL ...T YES......... IPROBLEMS ...3 i njury? FAITH HEALER ....... 8 No.......... 2

MEASLES ..... 4 GOVT RURAL HEALTH ( » 12)MALARIA ... ..5 CENTER ............ 9

YES......1 TB/RE S PIRA- YES...1 YES.... I MATERNAL CHILD NOT APPLICABLE (WRITE 0NO.......2 TORY ....... 6 NO.... 2 No..... 2 HEALTH CENTER .... 10 (IF LESS THAN IF LESS( NEXT OTHER ( 10) OTHER ............. 11 10 YRS).... 3 THAN ONEIi~1VIDUAI) ILLNESS....? (Specify ( »12) MONTH)

INJURY ...... 8 )

DAYS TAKA DAYS MONTHS

. ; SECTION

4.

W A G E

E M P L 0 Y M E N 1

PART

A.

EMPLOYMENT

N

GAiCUI.TURE (

persons

1 0 years a

o

er)HOUSEHOLD ID CODE

EAr,H MENBf_R OF THE NOII5FNOlD SHOULD ANSNER FOR NtMSEIF/IIERSEIF.

tF NOT, uRt1E ID CODE of RESPONDENT 9E1.0U.

.__~__~__.. _~~_._,._ _~-~RRAAEAT - ATREITilt~tt~ __31:AAA)4C -TSR .~ASUAC -AiKEQCABtAt~""'~ - ~ -TIAFAIQ -Titt"~XCRAiirEZA9i3tt'

3 - For the LAST 30 DAYS: 8 - 10 Forthe LAST U DAYS: i

D D Did you Did you perform How many TOTALE ODE work as: During this How many How much During this How many Now much any unpaid or DAYS of unpaidN ~!F RES- Over the month, how hours did have you month, how hours did have you exchange tabor or exchangeT ~ ONDENT last AMAN many days you received many days you received in the LAST 30 t abor have youI ROM season, did you normally in pay- did you normatty i n pay- DAYS (e.g. for worked in theF OUSE- did you spend working work per ments in spend working work per merits? a landlord or last 30 DAYS?I OLD work for on someone day? cash and on someone day? another farm toC OTHER payment in else's farm? i n kind? else'. farm? help in plantingA cash and/or Permanent or harvesting?)T In - kind on tabor?... 1I some OTHER Seasonal0 person's labor?...2 YES.... IN farm?

Casuals ( 8)NO..... 2

labor?...3 (INCLUDE INCLUDE (PART 6) )

0 ( 8) TIME FOR CASH AND TIME FOR CASH ANDD MEALS) IN KIND MEALS) IN KINDE YES...... I VALUE VALUE

No....... 2TOW L NORMAL TOTAL NORMAL TOTAL DAYSDAYS HOURS TAKA DAYS HOURS TAKA

S E C T I O N

S.

S E L F - E M P l 0 Y M E N T

~~- ~'"SELF~ERPLTTTAEAT-- ~"° -"

,(All persons aged 10 years end older)

HOUSEHOLD ID CODE

iFARMING 6 L1vES10CK)

'1.

s your household sow crops either on your own land or land rented In/sharecroppeddoes your household tend livestock (for example, cAttle, goats, sheFp etc.Do

FARMING 1 Which household

members contra- holed labor to the household's

farm In THE IA ST 30 DAYS?

1 0 CODE

DAYS

NO..........2 ( PART B )1

2. Among the household members, who knows most about it?

_NEMBER's 1D CODE

OBTAIN INFORMATION ON EACH MEMBER'S LABOR CONTRIBUTION TO THE ACTVITY(IES), INCLUDING THE PERSON 1N-CHARGE AS WEII A5 OTHER MEMBERS, FROM THE BEST - INFORMED PERSON.

HOURS

C7

S E L F - E N P L 0 Y N E N T

I N FARMING, LIVESTOCK AND NON-FARM ENTERPRISES

ID CODE DAYS HOURS

IATlR=TxRN ~ATERT'R1SE';3. Does your household own any non-farm enterprise?

YES.... 1;

NO..... 5

k. If YES=1, what type of enterprise?SPECIFY..........................; CODE

5. Among the household members,who knows most shout these?

NENBER's ID CODE f

nu

D

F1RfiT - AOa=F1lAR"EATERPRt`~E SE>;OgO'AOTT=T1IRFf~ATERPRTl'Ei~"' TAT R6 °AOA=FXRFC~AT GRr4lJC1 8 10 11 2 13 4 SWhich household Which household Which householdmembers provid- How rtuch d d each members provid- Now Both d d each members provid- Now such d d eached labor to this member provide? ed labor to this member provide? ed labor to this member provide?enterprise in enterprise in enterprise InTHE LAST 30 10TA1 N0. VERAGE THE LAST 30 TOTAL NO. VERAGE THE LAST 30 TOTAL NO. VERAGEDAYS? OF DAYS 0. OF DAYS? OF DAYS 0. OF DAYS? OF DAYS ~0. OF

IN THESE OURS IN THESE OURS IN THESE OURS30 DAYS * ER DAY 30 DAYS ~ ER DAY 30 DAYS ' ER DAY

ID CODE DAYS HOURS 10 CODE DAYS HOURS ID CODE DAYS HOURS

°2 3

L70E8TT1CK4 6Which household

How much h s each members contri- How much hhs eachme+rber contributed? buted tabor to member contributed?

the household'sTOTAL NO. AVERAGE livestock in THE TOTAL No. AVERAGEOF DAYS NO. OF LAST 30 DAYS? OF DAYS N0 . OFIN THESE HOURS IN THESE HOURS30 DAYS PER DAY 30 DAYS PE DAY

. S E C T I O N

6.

F A R M I N G

AND

l I V E S TUCK

PART A.

LANDN7LDING AND~TENIIRE (cont)

13. Did your household rent-in orNON-IRRIGATED LAND IRRIGATED LAND TOTAL

sharecrop-in any land during thelast 12 months?

YES...,.?No. ....2

c ~1e~

14. Now much tend did you rent fnDECIMALS DECIMALS DECIMALS

for FIXED RENT?

15. How much TOTAL cash and in-kind TAKA

rent did you pay for the lend?tin TAKA)

DECIMALS DECIMALS DECIMALS15. Now much land did you rent in

under SHARECROPPING arrangements?

DECIMALS DECIMALS DECIMALS17. What was your total operational

tend holding during the recent -aman season?

;SEC110fa,6.

F ARMING ANO L [ FESTOCK P A R T B2

HOUSEHOIb INCOME FROM AGR CULTURE

~U"LrT-7-6~f"~CFD~THE~CUI[QEAT~7IRUA-SEAT`1

Name ofCROPS

CR0P

ID

__W.o. w m u ~-4 5-6 7-10 11 12-13 14-15 16-17 18

SEEDS FERTILIZERS IRRIGATION WATER PESTICIDES CONTRACTUAL DAILY WAGE TILLAGE COSTS OTHERLABOR LABOR POWER ANIMAL- EXPENSES

G total) TILLER DRIVEN

' OR lICITY DAYS TAKA

_

TAKA TAKA TAKA

AMAN (Tr) 01

ARAN (HYV) 02

uHEAT 03

JUTE

IULLS S/DAL

SUGARCANE

TOBACCO

0 SE S ~•

OTHER

OTHER

~SECITOH 6, fARMiNG AND LIVESTOCK PART D.

1.

Did you or any member of your household process arei market craps you grey during the pest 12 months?

NO......,2 ( PART E)1

I NTERVIEWER:

PROBE TD 9E SURE AC11VT1Y USES

PRIMARILY RAW INPUTS PRt~UCED ON

1HE HOl1SEHOlD'S OWN FARM.LARGF°SCALE, C(RVIERC1Al

W1

ACTIVITIES1H EXTENSIVE PURCHASED INFIITS

SHOUID BE REPORTED

III SECT ION l.

How many days Which household How much in Did you spend any New much in totaldid members of members helped? total did you money on the ..(AC- did you spend onyour household earn from TIVITY).. i.e. for this activity overspend doing ..(ACTIVITY).. tools, transport, the past 4 months?..(ACTIVITY).. over the past chemicals for gurover the last [WRITE HOUSEHOLD 4 months? making, labor etc?12 months? MEMBER ID CODE)

YES...?PROCESSING TOTAL NO .... 2 ( PART E)ACTIVITY

_~~ MAN DAYS TAKA TAKA

CAN CRUSHING/__GUR PRODUCTION

TOBACCO-RELATED

FISH

OTHER (Spci y)

SEC IOW ?,

NON • f ARM

E W t E R P R I S E S

PART

A.

I'~iiF1:Zlili~CciE~l~f1i,`~'TA

or sac eh erpr se

HN ID

I would llke to ask some questions about any femlly enterprises or Bell-enployment activities listedd to SECTION 5 PART 8.

Please do not include activities which primarily involve processing afxd selling outputs iron your own crops, e.g. go, making listed in Sectlon 6D,processing and selling outputs from your own crops -- i.e. gur making tasted in SECTION 6D.

1. DID YOU OR ANY MEMBER OF YOUR HOUSEHOLD OWN SUCH AN ENTERPRISE DURING THE PAST 12 MONTHS?

YES... 1

N0..,2(>SEC B)

2. IF YES, DID ANY ENTERPRISE OPERAtE IN THE PAST 12 MONIHSI

1

2

3

4

YES...1 N0,..2(PART B1)

~-w ~ f rn

How many During these Where do Who owns the What share Who buys the goods and What was your main source ofMONTHS over months, how you business? of the services you produce? money for setting up thethe past 12 many days operate profits business?months did a week does the enter- i s kept byyou operate the business prise? the other OTHER HOUSEHOLDS OR OWN SAVINGS............... ithis enter- normally owners? INDIVIDUALS.......... 1 LOANS OR ASSISTANCE FROMprise? operate? SMALL ENTERPRISES ..... 2 RELATIVES/FRIENDS ........ 2

HOME ....... 1 BELONGS ENTIRELY LARGER ENTERPRISES .... 3 SALE OF ASSETS ............ 3OTHER FIXED TO RESPONDENT/ GOVT OR OTHER PUBLIC LOAN FROM BRAC............ 4

LOCATION..2 HOUSEHOLD MEMBER FIRMS ................ 4 LOAN FROM BRD8............ 5VARIABLE (ID#) .........1 LOCAL TRADERS OR LOAN FROM GRAMEEN BANK .... 6LOCATION.3 SHARED WITH RETAILERS ............ 5 LOAN FROM COMM. BANK ...... 7

OTHER OWNERS/ EXPORTERS OR FOREIGN GOVT. AGENCY (e.g. 8SIC)..SHOUSEHOLD ...... 2 PURCHASERS ........... 6 DIDN'T NEED ANY MONEY ..... 9

CONTRACTOR/THIKADAR...7 OTHER .................... 10(IF YES, -11) (Specify: )

MONTHS DAYS PER WEEK PERCENT PRIMARY SECONDARY

1 2 3 4-5

E R What kind of enterprise do For howN E you op~~ete? long has1 S the enter-E P pr i se beenR 0 operating?P NR D1 ES N TOTAL TIME

E T IS SUM OFYEARS AND

C 1 MONTHSO DDE C WRITE DESCRIPTION

0 IN FULLD OFFICEE DESCRIPTION CODE YRS, MOS.

S E C Td 0 N 7. NON-FARM ENTERPRISES D ART

B?.

ASSETS

REVENUES !coat .)

11-14HERE IN T5

__

BANGLA How crony I n the Past In the past When your business is Now much of what your Do you What isVERSION- months has 30 days, how 30 days, how operating, how much business produces is Ian normally the current

your firm much have you much have the do you normally normally consumed by maintain sales valuebeen in received from members of receive from sale of men~lxrs of your Inven- of youroperation the sale of your hmmeholtd goods or services ho<.ehold EACH WEEK? tory of total in-i n the past goods and consumed of EACH WEEK? products ventory74 months? services? the goods and or goods

services pro- not yetduced by your sold?business 7 CASH AND IN-KIND VALUE

YES ...1NO .... 2

CASH AND IN- (PROBE FOR ( WEKTKIND VALUE ESTIMATE) PART)

ENTERPRISE MONTHS TAKA TAKA TAKA TAKA TAKA

SECTION 8.

During the past 4 months, hasyour household purchased ((n cashor in kind? any ...(FOMI... ORhave you received ...(FOOD]...as a gift or payment in-kind ORconsumed ...(FOOD)... that .asproduced in your household?

YES.

IF "YES", ASK Q. 2CODE YES

Coarse Rice

01

Flne Rice

02

wheat

03

Dal

CS

Goat/Beef/Lamb/Buffalo OS

Chicken/duck/pouttry 06

Eggs

OT

Fish

08

Vegetables

09

Fruits

10

Biscuits/Tea

11

Spices and condiments

12

Its and ghee

13

Milk and milk products

14

Baby Formula

15

Sugar/Gur

16

Miscellaneous other

17

4-7

F O O D

E X r E N S E 5

(-NARkET FURCN1l5E ~N(111E ~'RODUCTION

u What is the market valthat has been construed

O household in the past

IN TPRODUCED]N THENOOSE- CASH

HOLDNO 1AKA TAKA

PURCHASED

CREbI

TAKA

H(A1S Olb C04

e of , (FOOD] ,i n yourNE WEEK?

OTHERSOURCES

T

TAKA

How manymonths inthe last4 monthsdid youpurchase..(FOOD]..from themarket?

MONTHS

How much didyou normallyspend on..(FOOD)..during oneof the monthsthat you dopurchase it?

TAKA

Now ponymonths inthe past4 monthsdid youconsume. .(FOOD]..that youproducedat home?

MONTHS

Now much..(FOOD).did yourhouseholdconsumeeach dayduringthesemonths?

DAYS

l

of What is themarket price

thisamount of..(FOOD]..that yourhouseholdconsumedeach day?

1AKA

During thesemonths, howmany days

was the home-produced food

consumed eachmonth?

DAYS

How much of..)FOOD]..is consumednormally inthe householdDAILY?

KG

On the average,what Is themarket price ofthis ..[FOOD]..consumed?

TAKA

w-SItC11gN 10. MARKtAgE AND MA1RRNtTY NIRTARY

CART A,

ore wnr~rn ~yearaen o er

OBTAIN INFORMATION ON EACH WOMAN WHO IS 14 YEARS OR OLDER PPF1SENTLY LIVING IN THE HOIISEN~LD. Ir V`1MAN NOT

T-TAT

S

ITE ID eve you ow At what How much dowry did Now far is Since your If you were Have you Have you Have you given Have you had re you ow manyI ODE OF ver been ny age did your parents give to your marriage starting your fa- ever been ever given birth to a boy any mtsce- - the9 ESPOW- rried? imes you first or receive from your parent's have you mity today, how pregnant, birth to or girl who was rriages or regnantE ENT FROM eve you marry? spouse/In-laws? homestead and your many children in regardless a child? born at Ive but stillbirths, re you?N OUSEHOLD en from your husband total would you of the later died, even that is, gf-1 OSTER married? husband's ever lived like to have? outcome of If he or she van birth toI homestead? apart? If the preg- only lived for a child who S ONLY

F YES, how nancy? a few minutes was born too ORI tong in How many boys? or hours? early to RENTLYC total did live? RRIEDA you live How many boys EN AGEDT apart? How many girls? have died? 0 YEARSI How many in NO YOUNGER0 How many girls total?N have died?

C ES ...I YES..... I YES.... I ES..... 10 0....2 NO.... 0 No...... 2 No..... 2 0......2D NEXT ( NEXT ( 12) PART B)E 4 0MAN) GIVEN RECEIVED 4bMAN)

__ No. No. No. No. No. OFMOS OF OF OF OF STILLBIRTHS/

10 CODE YEARS ?AKA ?AKA ILOMETERS BOYS GIRLS SONS tAl1GHTERS MISCARRIAGES MONTHS

.'S E C T I O N

1 0.

N A R R i A G E

AND

M A T E R N I

T Y

H I S T O R Y

PART

C.1

MAIERNI Y HISTORY

( or a

ever-nwr

woman

to

years o

o

ave given bTrtF- to ot

ees~Ctone s

)

ADMINISTER TO ALL EVER-MARRIED AGED 14 TO SO YEARS WI10 NAVE GIVCN BIRTH TO AT LEAST ONE CHILD.

1eIRTH

0RDER

1

2

3

4

5

6

7

8

9

10

11

12

13

WRITE WOFIAN'S !D CODE

FROM ROSTER

WRITE ID CODE of FERSONACTUALLY INTERVIEWED

8When was your Whet was the child's What was Did you New many Is he/she How long did the When you were pregnant I lfio assisted Where did you give Does that If not, howORDER) child name? the sex breast-fed months? still alive? child live? ..(NAME).. where R you at birth? birth to ..(NAME)..? child now long has

born? of the ..(NAME)..? did you get pre-natal T live with ..(NAME)..child? care from? H you? been living

elsewhere?STILL NOBODY .............. 0 0

RITE 1D CODE FROM BREAST- PRIVATE DOCTOR OR R DOCTOR.....1 PRIVATE DOCTOR OR YES....)OSIER IF CURRENTLY FEEDING..T8 CLINIC ............. 1 0 NURSE ...... 2 CLINIC ............. 1 ( -22)

.IV ING IN HOUSEHOLD PRIVATE HOSPITAL .... 2 E MIDWIFE OR PRIVATE HOSPITAL .... 2 NO.....2GOVT HOSPITAL OR R TRAINED GOVT HOSPITAL

3 DAI....... 3 DISPENSARY ......... 3MATERNAL DISPENSARY..,...... AND CHILDUNTRAINED MATERNAL AND CHILD

F NOT KNOWN, HEALTH CARE CENTERA DA1....... 4 HEALTH CARE CENTERASTIMATE USING MALE... I YES...1 YES ...1 ( 12) LOCAL PHARMACY ...... 5 FEMALE LOCAL PHARMACY ...... 5

SUPPLEMENTARY FEMALE.2 NO.... 2 NO.... 2 GOVT RURAL HEALTH RELATIVE.3 GOVT RURAL HEALTH

CALENDAR ( 8) CENTER (RHC).......6 OTHER ...... 6 CENTER (RHC)....... 6

OT HER....... .......7 OTHER ............... 7

__MONTH "MIN "_ m

S E C T 'l 0 N

. ..

M 1q... A G E AND H A T E R N 1 T Y HIS 1 0 R Y

PART D

MENDS MARRIAGE NISTOAY (For all mean 14 -'.a older)

OBTAIN INFORMATION ON EACH MFN WHO IS 14 YEARS OR OLDER PRESENTLY LIVING IN THE HOUSEHOLD.

I F HEN NOT ABLE

0 INS11E~~~O~

WK-1E-sFN FORMED PERSON.

10EN1IFICATI0N

C0DE

1 2

NRiC00aEsOANTNOUROS

ID

r

TE ID Have you How many

ly-Ai

At what How much How much did Are you what is lin is she Please How Mich How much did Are you What is

lin

zu-__

Is she

i _

Please

ImftyIf you were

E OF ever been times aae did dowry in you spend for still the main living write dowry in you spend for still the main living write starting your fa-POiI- married? have you first total did the wedding married reason your her ID total did the wedding married reason your her iD today, how

FROM been marry? you (do not include to her? for not house- CODE from you (do not include to her? for not house- CODE from many children in#OLD married? receive ceremony ex- being hold? SECTION receive OR ceremony ex- being hold? SECTION total would you1ER OR gave to penses)? married 1A gave to penses) married to like to have?

your in- to her in-laws? to herlaws? anymore? anymore?

YES..1 YES-.I YES..1 YES..1 How many boys?NO..2 N0...2

( 13)(

No~.2 20)N0...2

( 22)DIVORCED ..1 DIVORCED.: How many girls?DIED......2 OIED......2SEPARATE0.3 SEPARATE0.3ABANDONE0.4 ABANDONED. 4OTHER ..... 5 OTHER.....5

YES ...iNO.... 2 F MARRIED CURRENT( NEXT CURRENT LY ONCE TAKA

SE0Ilow) TAKA 22 [F MARRIHERWISE LY ONCE YOU YOU LN No. No.

YOU YOU CURRENT 15-16 22 GOT GAVE CURRENT OF OFCODE YEARS GOT GAVE TAKA TAKA BOYS GIRLS

:-SECT ! 0N 11.

LOANCODE

1

2

3

4

5

6

7

8

9

10

AGRlcuInIRE:

WON-AGRI./BUSINESS:

CgED1T

For whet purpose did you oiatain it?

FARM INPUTS..........1

FURCNASEJLEASE OFTUBEDEII............ 2

01HER FARM EQt1lFMEN1PURCHASE............3

PURCHASE OF ANIMALS..4

PURCHASE/LEASE OFAGRICULTURAL LAND .„ 5

OTHER AGRICULTURECO STS............... 6

PURCHASE RICKSAH41/BOATOR FISHING NE1......T

PURCHASE DAIRY CO11...8

AND SAVINGS

PURCHASE OF INPUTS OR

DORKING CAPITAI..,....9PURCHASE /IMPROVE OFLAND/BUILDING/ECUIP.10

OTHER BUSINESSEf(FENSES............ 11

PERSONAL USE:

CONS UMPTION NEEDS....12PURCHASE/IMPROVEDDEII

MARRIING UNIT ....... 13

AGE/FAM1lYEVENTS............... 4

CONSUMER DURABLES.... 15OTHER................ 16

1e

Now n+uch itotal didborrow?

n (INCLUDE

.THE LOVINPRINf,IPAI

TAKA

P ART

A ,

on

,m~ROwING AND R111S1ANnINB tt1ANS tC t )

ny±u

tllY

that was/i s themarkup ori nterestrate forthe loan?

noes the ler+derrequire a fixedinitiation ordocumentationfee beforegiving outany loan?

YES..... INo...... 2

( -22)

-

How much weresuch fees intotal thatyou had topay beforereceivingthe loan?

Other thanthe markupand initia-ting fee, didthe loancarry anyadditionalpayments(for example,l abor contri-butions orin-kindpayments)?

YES.... INO.....2

Now much werethese additionalpayments?

Now much intotal wouldyou borrowat the samerate ofInterest IFthere wasno limit tothe amountyou couldborrow fromsame sourcefor the samepurpose atthat time?

What collaterel(s) did youuse to secure the loan?

AGRICULTURAL LAND .......... IBUILDINGS AND OTHER

PROPERTY .................. 2GOLD ....................... 3LAND REGISTRATION BOOK/PROPERTY DOCUMENTS ........ 4

CROPS ...................... 5SIGNATURE OR PERSONAL

GUARANTEE ................. 6GROUP BORROWING............?

NONE ....................... aOTHER ...................... 9

Now many weeksdid it take toobtain the loancounting fromthe time youformally re-quested orapplied for theloan to the timeyou received themoney?

( 25) No. DAYSOF

V U OIN-KIND

(SPECIFY: )

DERCENT TAKA LABOR PAYMENT TAKA PRIMARY SECONDARY WEEKS

' .'SECaION

1 1.

CREDl1

ANp

SAVINGS

FART

C1.

CRED

OR COOPPROGRMS

Is anybody If YES, Nes s/ he i f YES, s s/hurrentl

ey

'~I .id [ !+ / he )r

uh y did R( / he I 11h Y did tat Heu lot ~ sincer

Besides credit ~v

How ny How m~ nYr"at IfIed write ID Joined which loan -'e r Join nny drop out frae [s/he) s tha was !,/h 0', Joining, whet other weeks does membersto be group code of any loan program m-nber Jroup? the program? Join the gem- (has been how merry services, Irhxos It take to are inmembers members program did s/he - f this program? r- is still In -ks of or facilities ore get a loan the groupfray this join? redit 10 NOT VANT..O DID NOT LIKE hip program) training available for after or societyhousehold? rogram? RIED TO BUT IT ANY MORE..O CIIFAPER ee to a mrr&er of hns Is/hel members of this Joining of which

FAILED ....... I NO LONGER CREDIT-1 oin th(a group attended program? the group? [s/he] isAD BETTER QUALIFIED.... 1 EASIER his BEFORE any e member?

RAC....... I YES.... I ALT ERNATIVES.2 HAD BETTER ACCESS..2 roup? loan wasRAMEEN ...2 ( -8) ALTERNATIVES.2 GROUF given? PRIMARY HEALTH..1

YES ....1 YES... 1 RDB RD 1Z..3 FEELING.3 BASIC LITERACY..2NO ....2 THER NGO..4 NO .....2 NO NEED OF MARKETING INFO..3

( »PART,;PART E) ( »6) rTHER COOP.5 ( » 7) COLATRLA OCCUPATIONAL ANDNY OTHER..6 COMBO OF SKILL TRAININGA

' ABOVE-5 OTHER ........... 5

TAKA EARS ONTNS

[ I WEEKS WEEKS NUMBER

~5fCr10N i1.

C R E D I T

AND

S A Y I N G S

DART ~

SAVINGS

ilrasr prrwide the fol~nwing inforratinn on the accunr.iLated savingsof FArli mCrT~i1!~ of ynur h-sehM,d.

tihichmembersof yourhouseholdhave ANYsavingsanywhere?

NRITE THEPERSON IDFROM THEHOUSEHOLDROSTER

iveDode4heRESP0NDENT

i ve the.urrentslue ofhese

. evings?

TAKA

Now marchhas henadded tothe savingsIn the past4 months?

TAKA

Haw muchhas beenwithdrawnfrom thesavings inthe past4 months?

TAKA

If...IID)..,lor is a ARAC,

BRDA M/BSSGrameen

Rank member,how much hasbeen savedin program-relatedgroup funds?

(CURRENTVALUE)

TAKA

Now muchinteresthas beenpaid onthesesavingsin thepast 4months?

TAKA

SECTION 12. TRANSFERS AND REMITTANCES PART H. ~1~ AN

S:

1. puring the FAS1 4 MONTHc, ~iid you or any memher of your household REf.Etl'E money or other ps~ments in-kind (for exa!nple, food or clothing) fROMsomeone t win? away frc+n the hc~useheld?

HOUS l~Olb T COD

he Who is primarily What is the What is the What is Where does Wes assistance Now much total lfiat do you Whet was them the RECIPIENT relationship occupation of the sex the (DONOR) or payments cash has been sent estimate was total value ofiT of this money of this ..(DONOR)..? of the currently received on a by the [DONOR) the total all other in-

mber or other transfers? (DONOR) to (DONOR)? live? regular basis? over the past value of all kind assistance~la the person in 4 months? food sent by sent by therhold, your house- Is it an urban or e the (DONOR) (DONOR) over

the hold receiv- rural area? YES: over the pest the past 4for ing this MONTHLY ........ 1 4 months? months?lion transfer or BIMONTHLY ...... 2u assistance? MALE....1 QUARTERLY ...... 3ehold FEMALE..2 SEMI-ANNUALLY..4

ANNUALLY ....... 5M USE RELATION- NO.............. 6 I F ..[RECIP(ENTM IS A RF1 ER YOUR

A SHIP CODES HOUSEHOLD TEMPORARILY RESIDING~e FROM ROSTER ELSEWHERE, INCLUDE ONLY PAYMENTSehold (SECTION 1A). NOT COUNTED PREVIOUSLY IN EXPENDITUREer) SECTION OF THE QUESTIONNAIRE

WRITE DESCIPTION~NSlip WRITE THE IN FULLROM DERSON'S DDS IC1 A-8-AN.. _1

N 1A 1D CODE . ESCRlPtIONj

CCUP. ODECODE MAL- 2 TAKA TAKA TAKA

1WRITE Ib

2-3WHO WERE THE DONOR(s)?

CODE Of is the ... if tPERSON (DONOR)., a ears

ACTUALLY mender of i s NPROVl01NG your hoUSe - e meINFORMA- hold 0, of t'TION included In hous

the house- writhold roster codeI n SECTION rol eIA) who is t o fIemporar(ly h ousliving else- headwhere (for, (FR Oexample, a PARTstudent away of tet school)? hous

cost

WRITE THEIb CODE REIATiFROM CODE f

(D CODE SECTION 1A SECT) O

,S~ ~ i`I°ON

1 I:

OWN E R S H I P

OF

A S SE T S

PAR1 B:

HOUSE HOL D

A

T RAN S POR T

CI1AREptVillilE - df"fiOtJ~A~iD'~}Rf~llp~lT"ASSTTB't +r F .. te ;ij'C~: ~'1.1'e~"'joi~'ing-Trfiie cr~i~ progrwnj~;"n'.11rX1(~`"""`W"_,_

2-3~ __3.TTT -

W0_"_0Pr0_fW7-

°-g. U-71-

1"3".""

HOUSING BRAG, BROB OR GB BICYCLE/ HANDCART/BULLOCK OTHER TRANSPORT

` ow e • the house o STRUCTURE HOUSING LOAN MOTORBIKE BOAT/RICKSHAW OR HORSE CARTS

meeber acquire assetscurrently owned? R C'' 31~ • KOR ER i fi FI11

purchase 01inherit 02gift 03dowry 04other 05

RA me beer I » - _purchase 01inherit 02gift 03dowry 04other OS

purchase 01inherit 02gift 03dowry 04other 05

E C T i 0 N

1 3:

O W N E R S H I P

O F

A S S E T S

PART 0:

NON-AGRICULTURAL EQUIPMENT A OTHER GOODS

_:,.-_... _._..~_ _---.GREAT- VAL(IE- Ur - pnN~hGRiClJC.11JRifC EOUIf'HEAT - B .hI~fiS tpiiorio- aix~ eiEcr~jotniiig tTie - c"rail Iitog~aml~tn 1AKA -_

i- - -If TF-11 TT 13TOOLS e.g. SPADE/ PROCESSING EUIP. HOUSEHOLD UTENSILS ELECTRONIC GOODS GOLD/SILVER

N-w did the household HAMMER/SCYTHE/AXE (DNEKI/LOOMS ETC.) FURNITURE AND KITCHENWARE AND APPLIANCES ORNAMENTS/JEWELRYmert+Wer acquire assetscurrently owned? CODE PRIOR AFTER PRIOR fT R R OR AFTER PRIOR AFTER PRIOR AFTER PRIOR AFTER

Wr1lr.. ..- ~_ _

purchase 01i nherit 02

gift 03dowry 04other 05

lit member IDpurchase 01i nherit 02gift 03dowry 04other 05

HN r ID »purchase 01i nherit 02gift 03dowry 04other 05