Household Questionnaire

Questionnaire Number Date entry No.

Impact of Remittances and Out Migration on Socio-economic and Agricultural Production in Nepal (For both remittance receiving and non-receiving household) (Project funded by Agriculture and Forestry University) Introductory Structure The main objective of the project is to study Impact of Remittances and Out Migration on Socio-economic and Agricultural Production in Nepal. To achieve this objective of the research, the researchers would kindly like to ask for your cooperation. We assure you that all information you give during the interview will be kept strictly confidential. Data will be used for scientific purpose only and will not give to any other outside person. Date of Survey: Name of Interviewer:. Time started:.. Time finished: Signature of Interviewer:. Signature of Supervisor: Date of Approval: Survey District: Nawalparasi Syangja

Section 1: Identification Particulars:

1. 2. 3. 4. Name of Respondent:Is he/she HH head: Yes ( ) No ( ) Age: Gender: Male Female Address: VDC/Municipality Word No.. Telephone No.: (if have)... Social background of the household: (1-Brahmin, 2-Chhetri, 3-Indigenous/ethnic, 4-Dalits, 5-Other (specify.)

Section 2: Socio-Demographic Information of Household** (as on the date of interview):

ID Code HH members (Start with household head ) Gender 1=Male 0=Female Age No of children Marital status 1-Unmarried, 2-Married, 3-Widow, 4-divorced 5-separated. Education (Completed degree) Write 00 if Member has not ever attended school. Write 97 for Nursery to KG 01-09 = Grade to 9 10 = Completed SLC 11 = Intermediate(not completed) 12 = Intermediate (completed) 13= Bachelors (not completed) l4Bachelors Completed/Higher 96 = Not formal education 98= Dont know

1. 2. 3. 4. 5. 6. 7. **Household: is a person or group of people sharing accommodation and food for at least 3 months over the past 12 months calculating from the time of the survey.

Q.N.

Question What is your religion?

What is your ethnicity and caste? What is your major source of drinking water

Codding category 1-Hindu, 2-Budhish, 3-Muslim, 4-Christian, 5-Other, please specify Ethnicity.. Cast. 1. Tube well 2. River 3. Piped water 4. Other. 1. Electricity 2. LPG 3. Bio-gas 4. Wood 5. Straw/shrubs and Grass 6. Animal dung 7. Agricultural materials 8. Other if specify 1. Government job 2. Own business 3. Agriculture 4. Wage labor 5. Foreign employment 6. If Other specify 1.Yes 2. No 3. If Other please specify.. 1. Yes 2. No 3. If other please specify

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What type of fuel does your household mainly used for cooking

What is the occupation of your household head?

Did any member of household receive the pension during last year? Did any member of household receive the old age or any other kind of the allowances from the governments during last year? What kinds of the toilet facilities do the members of the household normally use? ( Observe if necessary ) Did the household purchase or reconstruct the house during last 3 years? Main material of the floor (record by observation for current and ask for the past)

1. 2. 3. 4.

Flush or poor flush toilet Pit latrine Composite toilet No facility of the ( Bush field 1. Yes 2. No Before 3 year Current

Id code 1. Natural floor 2. Rudimentary floor 3. Finished floor 4. If other please specify Id code 1. 2. 3. 4. (RUSTIC MAT, BAMBOO,WOOD) PLANKS. THATCH. STRAW) CIMENTED TIN TILE

Main material of the roof (record by observation for current and ask for the past)

Before 3 year

Current

5.

OTHER(SPECIFY)

How many rooms did/does the house have?

Before 3 year

Current

Does the house have electricity?

1. 2.

YES NO

Section 3 Education
List the line no of all family members who is between 5 to 20 years and those currently studying Drop out Did (Name) stop going school? 1= Yes 0 = No Scores What is score secured by ( Name ) in his/her last completed grade ? (Interviewer, please ask for the Percentage and Division) % Div Study hours How many hours does/ Did (Name studying at home ? (write 00 if dont study at home) Hrs Min Work at home Does(name) Help in household work? (Ask the no of hours the member spend working at home) Expenditure How much do you spend for the education of (Name) during last year

Hrs

Min

NRs

SECTION 4: HEALTH
4.1 Did any of the family members suffer is suffering from respiratory diseases or eye infection the last one year? (Refer Diseases section below for the list of diseases) 1 Yes 2 No -skip this table. LINE NO. Q.4.1.1 DESEASES Q.4.1.2 HEALTH INSTITUTION Q.4.1.3 TYPE OF HEALTH INSTITUTION Q.4.1.4 1=Health Post 2= Hospital 3= Clinic 4=Nursing Home MONEY Q.4.1.5

List the line no of members who were suffered/ are suffering from such disease

1=Runny Nose! Cold 2= Sinusitis 3= Headache 4= Flue/Fever in past one year 5= Cough dry 6= Asthma 7= Bronchitis 8= Tuberculosis 9=Eye infection 10=Other specify

How many times did (name) visit the health institution due to this illness? Write 00 if no visit is made

How much money did you spend to cure the disease ( Including Transportation cost ) Write amount in words) Write 00 if no money is spent)

Q.NO 4.2

4.3

Question Did any members of your family have been suffered from water related disease ( Typhoid, Pneumonia, Diarrhea, Cholera etc.) During last one year? How many times did you make regular health checkup? (write 00 if not) Is your vaccinated? child being

Codding categories Yes.1 No..2

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Total No..

4.4

4.5

Did any member of your family give birth during last year? How many times did you visit health care center for ANC (Antenatal Care) Where did she give birth What is the total cost for ANC or/and for birth of the last child

Yes.1 No..2 Not regular.3 ( mention which vaccines were not completed) Yes.1 No..2 Visit. At home..1 Health care Center.2

4.6

4.7 4.8

Section 5 Access to information

Q. No 5.1.1 Questions How many times in the last month have you or anyone I our household read newspaper Codding Categories Write in Number Didnt read at all = 00 Do not know =99 Yes 1 1 1 1 1 No 2 2 2 2 2 Skip

5.1.2

Does your household have the following items? Radio Telephone Mobile phone VCD/DVD player Television How often do you or anyone in your household listen to radio?

Radio Telephone Mobile phone VCD/DVD player Television

5.1.3

5.1.4

What kind of programs do you listen to radio?

5.1.5

How often do you or anyone in your household watch television?

Everyday..1 A few times a week2 Once a week...3 Less than once a week4 Never..5 News..1 Entertaining2 Others.3 Everyday.............1 A few times a week.2

5.1.5

What is the total monthly bill of your household for using all these services (Radio, TV, Phone etc.)?

5.1.5

What are the most important sources of your information regarding government activities such as constitution drafting, peace process and other government programs? (Rank the different sources starting 1 for the most important)

5.1.6

5.1.7

Compared to the last five year ago, has the access to information improved, deteriorated or remained same in general? How long does it take time to reach the nearest market center? How long does the it take time to reach the nearest road? ( refers to the road where motor vehicles run)

Once a week3 Less than once a week.4 Never5 No at all Below 1000 NRs 1000-2000 NRs 2000-3000 Above 3000 Relatives/ Friends and Neighbour Community Local market Local Newspaper Radio Television Community leader An agent of the government NGOs Internets Other specify.. Improved1 Deteriorated....2 Remained same3 Hours. Minutes.. Hours. Minutes..

5.1.8

Section 6 household income

6.1 Farm income 6.1.1 How many kattha/bigha of agricultural land do all the member of the household own? BIGHAKATTHADHUR.. DONOT KNOW..( Write 00) NONE.(SKIP TO 6.2) 6.1.2 Did the household purchase the agricultural land during the last three years? Yes1 No2 ( if yes BIGHA.KATHA..DHUR..) TABLE 6.1 FARM INCOME OF LAST ONE YEAR TYPES CROPS OF UNIT( Kg/quintal) TOTAL HARVEST PRICE PER UNIT TOTAL INCOME TOTAL SPENDING INCLUDING FERTILIZER, PESTICIDES, HIRED LABOR Q.6.1.8 NRS.

Q.6.1.4 Q.6.1.3 FOOD CROPS RICE MAIZE WHEAT MILLATE BARLY OTHER CASH CROPS OIL SEED PULSES SUGARCANE VEGETABLE 1 2 3 FRUITS 1 2 3 OTHER Q.6.1.5

Q.6.1.6

Q.6.1.7

NRS..

NRS

NRS

6.2 Do you use advanced seeds and fertilizers in your farm ? Yes.1 No..2 6.3 How many times many hired labor did you use for producing crops? ( No of persons) wage rate.( NRs) 6.4 Do you or any member of your family work in farm? Yes.1 No.2

6.2 LIVESTOCK INCOME

6.2.1 Does this household own any livestock, herds other farm animals or poultry ? Yes..1 No2 (skip table 5.1, 6.2, 5.3) 6.2.2 Did your household sell any livestock in past one year? Yes.1 livestock No..2 ( skip Table 1) 6.2.3 Livestock income Cow Buffalo Goat Pig Chicken Fish Other specify Transportation Hired labor

Unit

Sale Price per unit

Total income

Table 6.2.4 Expenditure on livestock Write the money spend on livestock Feed medicine Veterinary services Buffalo Goat Pig Chicken Fish Other specify

Other expenditure if any

6.2.5 Does your household make any income through the sale of livestock products? Yes1 No.2 (skip 6.2.3) Table 6.2.6 INCOME FROM SALE OF LIVESTOCK PRODUCTS PRODUCTS UNIT TOTAL PRODUCTION PRICE PER UNIT (NRs) TOTAL INCOME (NRs)

6.3Salary/wage income
6.3.1 Does any member of your household earn wage? Yes..1 No...2 (skip the following table) Line No of HH Number of days Cash wage per day member who are employed involved in wage earning Wage in kind per day Total wage income per day

Does any member of your household earn wage ? Yes1 No.2 (skip the following table) Line No of HH member who are involved in salary earning Cash salary per month Fringe benefit Total salary income

6.4 Remittance income (this parts is only for treatment group)

Line No of HH member who are migrated overseas Is (name) male or female? Male=1 Female=2 His or her last degree and division Year of migration country Expenditure ( write 00 for free) (NRs) Source of expenditure (separately mention loan and saving in NRs) Loan. Saving.. Loan. Saving.. Loan. Saving.. Loan. Saving.. Income ( amount annually sent including goods sent)

DEG.. DIV DEG.. DIV DEG.. DIV DEG.. DIV Q.N. Questions Did the household purchase land or home after migration What is the purpose of purchasing land ? How much land did the household purchase? Are you inspired to go abroad to work when you see other people are doing so? Did you take any advice from your relatives regarding your plan to go abroad? How do you receive your money sent from abroad?

Coding categories Yes1 No.2 To construct house1 To use for farming.2 . Bigha Kattha Dhur Yes1 No.2 Yes1 No.2 BFIs1 Hundi..2 Friends3 Others..4

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SECTION 8 BUSINESS OWNERSHIP

As you know, aside from household work, some people have a small business such as hotel, restaurant, rice, mills etc or some make and sell handicrafts such as utensils made from mud, khukuri, etc from which they earn income. Does your household own such business? Yes.1 No...2 ( Skip the following table) SPECIFY ACTIVITIES STARTING DATE TOTAL REVENUE (monthly) NO OF HH MEMBERS EMPLOYED AVERAGE NO OF HIRED EMPLOYED AVERAGE MONTHLY WAGES PAID TO HIRED LABOR OTHER EXPENDITURE( monthly)

SECTION 9 HOUSEHOLD EXPENDITURE

EXPENDITURE ON DURABLES CLOTHING FOOD ALCOHOL TOBACCO ENTERTAINMENT AMOUNT EXPENDITURE ON FESTIVAL/CEREMONIES HOME PURCHASE/MAINTENANCE CLOTHING TRANSPORTATION OTHER AMOUNT

SECTION 10 FINANCIAL STATEMENT

Q.NO 10.1 10.2 QUESTIONS Have you had any insurance? What type of insurance do you have? CODDING CATEGORIES Yes1 No..2 Life insurance1 Health insurance2 Other3 (specify) NRs Yes1 No..2 NRs. From Amount (in NRs) Interest rate per month (%) SKIP

10.3 10.4 10.5 10.6

How much insurance premium do you pay per month? Do you have any account in any bank and financial institution? Please mention your deposit balance. Borrowing

10.7

Lending

Relatives Friends Saving clubs Banks Money lenders (Landlords, shopkeeper, villagers, etc) other Interest-bearing NRs. Interest-free NRs.

SECTION 11 GENDER EMPOWERMENT

Q.NO 11.1 QUESTIONS Who does the decision regarding the education of your children in your household? ( e.g. whether to enroll children in private or government school/collage. Who does take decision of women health related problems in your household ? ( e.g. whether to visit doctor after child birth or give birth of child whether in hospital or at home) Who does take the decision of giving birth of new child? CODING CATEGORIES Male1 Female2 Both3 Dont know4 Male1 Female2 Both3 Dont know4 Father.1 Mother2 Both3 Dont know4 Male1 Female2 Both3 Dont know4 Male1 Female2 Both3 Dont know4 Need to take..1 Need not to take2 Need to inform..3 Need not to inform4 SKIP

11.2

11.3

11.4

Who does take decision of financial transaction in your household?

11.5

Who does take the decision regarding participation in community activities?

the

11.6

( Ask only to the female informants) Do you need to take the permission of your husband or other family member to get out of home? ( e.g. shopping, visiting relatives and friends, etc)