Questionnaire
Topic – assessment of socio-economic status of Kullu district in Himachal Pradesh
Demographic data
Respondent’s Name _____________________________________________
Location (village name) _____________________________________________
Age _____________________________________________
Gender / Sex _____________________________________________
Religion _____________________________________________
Name of tribal community (if Tribal) _______________________________________
Marital status
Single Married Divorced Widow / widower
Educational status
Primary Secondary Senior Graduation Post Prefer not
(0-5) (6-10) secondary Graduation More to say
(11-12)
Number of family members _______________________________________
Number of members earning (in family) _______________________________________
Occupation _______________________________________
Type of worker
Permanent wage Seasonal wage Daily wage worker Prefer not to say
worker worker
If seasonal wage worker, what else occupation are you indulges in off-season?
___________________________________________________________________________
Annual family income
Less than 50,000 – 2 Lakh – 3.5 Lakh – 5 Lakh – More
50,000 2 Lakh 3.5 Lakh 5 Lakh 6.5 Lakh
Are you a migrant? ( YES / NO )
(If YES)
Migrated ( along with FAMILY / INDIVIDUAL )
What is your place of origin? _____________________________________________
How many times have you migrated from one place to another? __________________
What is the reason for your migration? _______________________________________
How many years are you staying here? _______________________________________
Qualitative Data
[Link] of house you live in?
Paccka house
Kachha house
[Link] is your Residential status?
Permanent (own)
Permanent (inherited)
Rental
Prefer not to say
[Link] there electricity connection in your house?
___________________________________________________________________________
[Link] you have a borewell in your house? Or a personal well?
___________________________________________________________________________
[Link] you have any motor vehicle of your own?
No
Yes
If yes, how many? __________
[Link] you receive any food security from government? (राशन facility)
Yes
No
Yes, but do not utilize
[Link] fuel do you use for cooking?
Wood
LPG
Bio-fuel (dung cakes)
Coal
Others : _______________________________________________
[Link] you use online banking methods?
___________________________________________________________________________
[Link] is the quality of drinking water available to you?
___________________________________________________________________________
[Link] government policy you are getting advantage of?
___________________________________________________________________________
[Link] is road connectivity in your area?
Very Bad Bad Average Good Very good Excellent Don’t
Know
Reason : ___________________________________________________________________
[Link] long do you need to travel to get any public transport from your house?
___________________________________________________________________________
[Link] many government schools are there in your locality?
___________________________________________________________________________
[Link] indulged in agriculture, what type?
Owner of agricultural land and employer of labors for work
Owner of agricultural land and work in your own
Rental agricultural land
Agricultural labor
Seasonal Migrant agricultural labor
[Link] there any family member who has migrated for higher studies? If yes, then how many?
And where?
___________________________________________________________________________
___________________________________________________________________________
[Link] you aware of the government policies and schemes in your area?
Yes
No
Don’t know (recently migrated)
[Link] is your opinion on developments made by government in your society? (what type
of development and how is its impact)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
[Link] you associated with any political organization?
Yes
No
Prefer not to say
If yes, which type of organization ____________________________________________
[Link] you ever faced any natural calamity here like flood / draught / land slide / cloud
burst / water scarcity? If yes, how did you tackled it? Was there any government help during
that time?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
[Link] care facilities in your area
Facility PHC’s Private Government Local clinics Other
name (Primary hospitals hospitals
Health Care
Centre)
Number of
outlets