Questionnaire
1. Who is the head of the family and how many members in the family?
2. Since when are you living here? (Duration in the city in ranges e.g. 0-5 year etc.)
3. Whether you lived in an own or a rented place?
a) Option A(own) – Duration, kind of ownership document (ownership, lease, no eviction
notice, electricity bill on their name), where they have bought the house from( allotted
by govt., inherited, by land owner/developer), price, are they paying any loan?, .
b) Option B (Rented) – Owner of the house, for how long they are living, rent of the house,
Owner rent agreement.
4. How many married family?
5. How many vehicles do you have? ( mode of transport)
6. Housing typologies?
7. Tentative dimension of their area?
8. No of rooms and building age?
9. Land prices ? ( through people, developer, online medium)
10. Any loan has been taken for the house? If they’ve taken the loan then from where and the
amount?
11. Down payment they have made? EMI of the house?
12. Housing conditions( good/bad/poor)
Infrastructure
13. Water source? ( through govt. connection/ through public tab or handpump/ private
borewell/ private handpump/ private connection/ well) Hour of the water connection and its
duration? Frequency of services? Quality of water(if bad then reason) ? If their is water
cutoff then what do they do?
14. Availability of toilet? (Individual/shared/ community(distance from their house)/ public/
open).
15. Sewage disposal mechanism? ( govt./septic tank/soak pit/ open drain) frequency of
disposal?
16. Electricity? (yes/no). if there is a cut then duration (in ranges)? Whether cut is daily weekly
or occasionally?
17. How do the cook food? (gas cylinder/ pipe system/ kerosene/ wood fire/)
18. Do they have access to community center? (Common plot/ nearby gathering ground/
community center/ religious or institutional place (distance?) Any Park or playground
nearby?
19. Education – How many member go for the education? (school/college), (private/ govt.)
20. Health facilities- Hospital (private/govt/other)
21. Expenditure on household activities? Household income?(working member in the family,
income, type of work)
22. Issues faced and need ?
23. Rashan provided by govt.?
24. Road in their locality ? (developed/ undeveloped), width?
25. How far is their work area and medium of transport? how much time does it takes to reach?
26. Whether any kind of scheme has been proposed or nay project?
27.