Questionnaire

(Field Survey on Poverty)

House No________

1.

Name of the Head of Family

_______________________

2.

Total Family Income

3.

Number of Working Members in Family______________________

4.

Number of Dependents

5.

Occupation

Agriculture

Service

6.

No. of School Going Children

_______________________

7.

No. of Children Below 14 years

_______________________

_______________________

_______________________
_______________________

Working

Self Employed

not going to school

8.

Size and Condition of House

( )

Roof Structure

9.

Expenditure in activities

( )

_______________________
Brick Built

( )

Clay Built

_______________________

Other than necessities

10.

Is Government helping in
eradication of poverty

_______________________