House No.

- Head of HH:__________________________________ Caste:_____(______ ) Religion:___________ Language/es:_________________

Number of members:
Name Sex Relation with HH head Literate / Illiterate Education Level Working / Non-working Doing what?

Land: Type of House: Pukka ⃝ Semi-Pukka ⃝ Kuccha ⃝ LPG: Yes ⃝ No ⃝

Type of Land Home land Farm land Leased Asset: Water Source:
No. of Acres
Skill:
Toilet: _______ Why not: _____________________________________________________________________________________________________________________

Employment Avenue: Wage Labour ⃝ ( Own ⃝ Leased ⃝ Crop:_______ ) Farmer ⃝ Artisan ⃝ Other_____________________

I & E Analysis:

SOURCES OF INCOME TOTAL EXPENDITURE (rupees PA) TOTAL SAVINGS

INCOME EXPENDITURE Rupees
rupees P.A rupees P.A. P.A.
PRIMARY SECONDARY FOOD & EDUCATION HEALTH CLOTHING MISC
NUTRITION LUXARIES
COMFORT
Livestock:

Type Number Purpose (milk/meat) Amount of milk / meat Pasture Amount of pasture consumed

Inter-caste and inter-class relationships

Rules and Regulations in the village

Social and cultural aspects – different social groups, social issues

Political aspects

Major groups present in the village

Conflicts in the recent past and conflict resolution mechanisms present

Example activities where mutual support was exhibited in the recent past
Whom does the community approach for help and advice? How many such persons exist in the village and nearby vicinity?

Who take up the causes of the community? Who lead the community in discussions with outsiders?

Types of livelihoods pursued: farm ⃝ (agriculture ⃝ horticulture ⃝ fisheries ⃝ forestry ⃝ NTFP ⃝ Others ____________________ )
Off-farm __________________________________________
Non-farm __________________________________________
Terms and conditions of profit sharing in the terms of leased lands

Survival strategies, coping mechanisms i. What were the major crises faced by the people in the village in the past?

ii. How did they overcome these crises?

Seasonality of crops/ crop calendar:

Predominant livelihood options for different communities in the village :

Working Under EGS (MGNREGS) : Yes ⃝ No ⃝ Wages : _____________________

Number of employment days : ___________________________________

Selling mechanism of the produce(s) – individual/collectivization:_______________________________________________________

Presence of a market/shandy/haats in the vicinity of the village:______________________________________________________________________________________

PACS, Co-operative, APMC – availability, role in buying & selling the produce
 Gender roles in employment

Underemployment (vis. a vis. the education status, willingness to work?)

Description of six important but diverse livelihoods from the stage of initiating production till the produce/commodity/service is marketed or

Supply chain of the produce(s) , different stakeholders involved in the supply chain (farmers, agents, middlemen, traders)

Migration analysis: Migration patterns and flow of remittances

i. Who migrates?

ii. Places to which migrated

iii. Type and duration of migration

iv. Work at the place of migration

v. How do they send remittances?

consumed – local value chain analysis

Health Opinion
a. Any disease:_______________________________________________
b. Do you feel healthy:_________________________________________
 c. Do you feel open defecation causing health issues: ___________________________________________________________________________
d. Do children consume health supplement like Bournvita, Boost, Complan:_____________________________
e. Any infant or maternal mortality in recent past:____________________________________ Cause:____________________________
f. Do you know any disabled (divyang / apang) in the village:_________________________
g. From where you seek remedy: PHC ⃝ Local doctor (RMP) ⃝ Home remedies ⃝ spiritual healing ⃝
preference of persons to access these health facilities
h. Proximity of the health facilities/ medicine shops/ PHCs: _________________________________________________________________________
i. The experiences of people visiting PHC (doctors/ nurses being present, PHC being closed
etc.):_______________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________

j. Experiences of the doctors/nurses and/or any other person from which people seek remedy:
__________________________________________________________________________________________________________________________
k. The trust in traditional medicines vis. a vis. allopathic drugs: ______________________________________________________________________________________
l. Proportion of income being spent on health issues:______________________________________________________________________________________________
m. Issues related to sanitation (OD), clean water, garbage, sewage, etc. :
__________________________________________________________________________________________________
Credit Sources/ Insurance
a. Do you have bank account, post office account:__________________________________________________________________________________________
b. Is there any MFI like SHG, money lender present in the village:_____________________________________________________________
c. If not then how do you save your money:______________________________________________________________________________
d. How do you take loan:_______________________________________ What are the terms of the loan:_____________________________________
________________________________________________________________________________________________________________________________
e. What do you do at times of financial emergencies:__________________________________________________________________________________
_______________________________________________________________________________________________________________________________
f. What happens when you are unable to repay: _______________________________________________________________________________________
g. Any insurance like LIC or any mutual fund: __________________________________________________________________________________________
h. Any preferred source of credit: ___________________________________ The reason behind it : ____________________________________________
________________________________________________________________________________________________________________________________
i. Rates of interest being charged by the moneylender/MFI/Bank/Post Office: ______________________________________________________________

Entitlements Opinion
a. Impact of NREGA on migration, daily wage, if any.___________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
b. Access to those entitlements (esp. by the poor). People eligible but still left out (Reasons?)
 ______________________________________________________________________________________________________________________________
c. Entitlements being offered in the village (NREGA, pension, IAY, Shadi Mubarak etc.):_________________________________________________________
_____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
d. Your experience with these entitlements : ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________

Infrastructure Opinion
a. How are the CC roads in your opinion : _______________________________________________________________________________________________
b. Do you think the village is well connected to the city/town by road:____________ Why:_________________________________________________________
_________________________________________________________________________________________________________________________________
c. Status of PHC, School (ZPHC) etc. ______________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
d. Electricity & street lights : ____________________________________________________________________________________________________________
e. Water supply : _____________________________________________________________________________________________________________________
f. Sanitation, Swach Bharat Mission : _____________________________________________________________________________________________________
g. Community infrastructure like meeting halls, play grounds, library, etc. : ________________________________________________________________________
___________________________________________________________________________________________________________________________________
h. Role of different stakeholders in maintenance of infrastructure : ______________________________________________________________________________
___________________________________________________________________________________________________________________________________

Top Problems, Gaps and Opportunities in the villages:

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