Survey Text

Afghanistan 2015 Ethiopia 2000 Malawi 2010 Senegal 1992
Angola 2015 Ethiopia 2005 Malawi 2016 Senegal 1997
Bangladesh 1994 Ethiopia 2011 Mali 1987 Senegal 2005
Bangladesh 1997 Ethiopia 2016 Mali 1995 Senegal 2010
Bangladesh 2000 Ghana 1988 Mali 2001 Senegal 2012
Bangladesh 2004 Ghana 1993 Mali 2006 Senegal 2014
Bangladesh 2007 Ghana 1998 Mali 2012 Senegal 2015
Bangladesh 2011 Ghana 2003 Mali 2018 Senegal 2016
Bangladesh 2014 Ghana 2008 Morocco 1987 Senegal 2017
Benin 1996 Ghana 2014 Morocco 1992 South Africa 1998
Benin 2001 Ghana 2016 Morocco 2003 South Africa 2016
Benin 2006 Guinea 1999 Mozambique 1997 Sri Lanka 1987
Benin 2011 Guinea 2005 Mozambique 2003 Sudan 1989
Benin 2017 Guinea 2012 Mozambique 2011 Tanzania 1991
Burkina Faso 1993 Guinea 2018 Myanmar 2015 Tanzania 1996
Burkina Faso 1998 India 1992 Namibia 1992 Tanzania 1999
Burkina Faso 2003 India 1998 Namibia 2000 Tanzania 2004
Burkina Faso 2010 India 2005 Namibia 2006 Tanzania 2010
Burundi 1987 India 2015 Namibia 2013 Tanzania 2015
Burundi 2010 Jordan 1990 Nepal 1996 Togo 1988
Burundi 2016 Jordan 1997 Nepal 2001 Togo 1998
Cameroon 1991 Jordan 2002 Nepal 2006 Togo 2013
Cameroon 1998 Jordan 2007 Nepal 2011 Tunisia 1988
Cameroon 2004 Jordan 2009 Nepal 2016 Uganda 1988
Cameroon 2011 Jordan 2012 Niger 1992 Uganda 1995
Central African Republic 1995 Jordan 2017 Niger 1998 Uganda 2001
Chad 1996 Kenya 1989 Niger 2006 Uganda 2006
Chad 2004 Kenya 1993 Niger 2012 Uganda 2011
Chad 2014 Kenya 1998 Nigeria 1990 Uganda 2016
Congo (Democratic Republic) 2007 Kenya 2003 Nigeria 1999 Yemen 1991
Congo (Democratic Republic) 2013 Kenya 2008 Nigeria 2003 Yemen 2013
Congo Brazzaville 2005 Kenya 2014 Nigeria 2008 Zambia 1992
Congo Brazzaville 2011 Lesotho 2004 Nigeria 2013 Zambia 1996
Cote d'Ivoire 1994 Lesotho 2009 Nigeria 2018 Zambia 2001
Cote d'Ivoire 1998 Lesotho 2014 Pakistan 1991 Zambia 2007
Cote d'Ivoire 2011 Liberia 1986 Pakistan 2006 Zambia 2013
Egypt 1988 Liberia 2007 Pakistan 2012 Zambia 2018
Egypt 1992 Liberia 2013 Pakistan 2017 Zimbabwe 1988
Egypt 1995 Madagascar 1992 Rwanda 1992 Zimbabwe 1994
Egypt 2000 Madagascar 1997 Rwanda 2000 Zimbabwe 1999
Egypt 2003 Madagascar 2003 Rwanda 2005 Zimbabwe 2005
Egypt 2005 Madagascar 2008 Rwanda 2008 Zimbabwe 2010
Egypt 2008 Malawi 1992 Rwanda 2010 Zimbabwe 2015
Egypt 2014 Malawi 2000 Rwanda 2014
Eswatini (Swaziland) 2006 Malawi 2004 Senegal 1986
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Afghanistan 2015

No questionnaire text is available for this sample.


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Angola 2015
Survey form view entire document:  text 
SECTION 1: LIST AND BASIC CHARACTERISTICS OF MEMBERS OF HOUSEHOLD

1) LINE NUMBER____

2) USUAL RESIDENTS AND VISITORS
Please give the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.
AFTER FILLING OUT THE NAMES, RELATIONS AND SEX OF EACH PERSON, ASK QUESTIONS 2A-2C, TO BE SURE THAT THE LISTING IS COMPLETE.
THEN ASK QUESTIONS FROM COLUMNS 5-20 TO EACH PERSON.

NAME____

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Bangladesh 1994

No questionnaire text is available for this sample.


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Bangladesh 1997
Survey form view entire document:  text 
TOTAL NUMBER OF VISITS
TOTAL IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE MEN

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Bangladesh 2000
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE
INTERVIEWER'S NAME
RESULT*

1 COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)

NEXT VISIT
DATE
TIME

FINAL VISIT
DAY
MONTH
YEAR
INTERVIEWER'S CODE
RESULT*

TOTAL NUMBER OF VISITS:

TOTAL PERSONS IN HOUSEHOLD:
TOTAL ELIGIBLE WOMEN:
TOTAL ELIGIBLE MEN:
LINE NUMBER OF RESPONDENT TO HOUSEHOLD SCHEDULE:


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Bangladesh 2004
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
LINE NO. OF RESP. TO HOUSEHOLD QUEST. ___

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Bangladesh 2007
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

1) LINE NUMBER____

2) USUAL RESIDENTS AND VISITORS
Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A TO 2C TO BE SURE THAT THE LISTING IS THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5 THROUGH 15 FOR EACH PERSON.

NAME____

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Bangladesh 2011

No questionnaire text is available for this sample.


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Bangladesh 2014
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

SECOND VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

THIRD VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

NEXT VISIT:

DATE_____________
TIME______________

FINAL VISIT

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __
RESULT*___

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD __ __
TOTAL ELIGIBLE WOMEN __ __
TOTAL ELIGIBLE MEN __ __
LINE NO. RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __ __

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Benin 1996

No questionnaire text is available for this sample.


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Benin 2001

No questionnaire text is available for this sample.


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Benin 2006

No questionnaire text is available for this sample.


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Benin 2011

No questionnaire text is available for this sample.


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Benin 2017
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

SECOND VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

THIRD VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

NEXT VISIT:

DATE_____________
TIME______________

FINAL VISIT

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __
RESULT*___

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD __ __
TOTAL ELIGIBLE WOMEN __ __
TOTAL ELIGIBLE MEN __ __
LINE NO. RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __ __

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Burkina Faso 1993

No questionnaire text is available for this sample.


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Burkina Faso 1998

No questionnaire text is available for this sample.


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Burkina Faso 2003

No questionnaire text is available for this sample.


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Burkina Faso 2010

No questionnaire text is available for this sample.


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Burundi 1987
Survey form view entire document:  text 
110) What is your nationality?

RWANDAN 1
ZAIREAN 2
TANZANIAN 3
OTHER AFRICAN 4
OTHER (SPECIFY) ______ 5

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Burundi 2010
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____

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Burundi 2016
Survey form view entire document:  text 
2) USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.

Just to make sure that I have a complete listing:


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Cameroon 1991

No questionnaire text is available for this sample.


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Cameroon 1998

No questionnaire text is available for this sample.


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Cameroon 2004

No questionnaire text is available for this sample.


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Cameroon 2011
Survey form view entire document:  text 
1. LINE NUMBER

LINE NO. ____

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Central African Republic 1995
Survey form view entire document:  text 
TOTAL IN HOUSEHOLD____
TOTAL ELIGIBLE WOMEN____
TOTAL ELIGIBLE MEN____

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Chad 1996
Survey form view entire document:  text 
TOTAL IN HOUSEHOLD ____

TOTAL ELIGIBLE WOMEN ____

LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE ____


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Chad 2004
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
LINE NO. OF RESP. TO HOUSEHOLD QUEST. ___

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Chad 2014
Survey form view entire document:  text 
TOTAL NO. OF VISITS

*RESULT CODES:

1COMPLETED
2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT
3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME
4 POSTPONED
5 REFUSED
6 DWELLING VACANT OR ADDRESS NOT A DWELLING
7 DWELLING DESTROYED
8 DWELLING NOT FOUND
9 OTHER (SPECIFY)

TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE MEN
LINE NO. OF RESP. TO HOUSEHOLD QUEST.

SUPERVISOR
NAME_______
DATE____

FIELD EDITOR
NAME__________
DATE____

OFFICE EDITOR

__ __

KEYED BY

__ __

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Congo (Democratic Republic) 2007

No questionnaire text is available for this sample.


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Congo (Democratic Republic) 2013

No questionnaire text is available for this sample.


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Congo Brazzaville 2005

No questionnaire text is available for this sample.


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Congo Brazzaville 2011

No questionnaire text is available for this sample.


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Cote d'Ivoire 1994

No questionnaire text is available for this sample.


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Cote d'Ivoire 1998

No questionnaire text is available for this sample.


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Cote d'Ivoire 2011

No questionnaire text is available for this sample.


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Egypt 1988

No questionnaire text is available for this sample.


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Egypt 1992

No questionnaire text is available for this sample.


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Egypt 1995

No questionnaire text is available for this sample.


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Egypt 2000

No questionnaire text is available for this sample.


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Egypt 2003
Survey form view entire document:  text 
002. USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.

AFTER LISTING NAMES, ASK QUESTIONS 003-005 TO BE SURE THAT THE LISTING IS COMPLETE. THEN GO ON TO QUESTION 006.


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Egypt 2005

No questionnaire text is available for this sample.


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Egypt 2008

No questionnaire text is available for this sample.


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Egypt 2014

No questionnaire text is available for this sample.


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Eswatini (Swaziland) 2006
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD______
TOTAL WOMEN 15-49______
TOTAL MEN 15-49_______
TOTAL AGE 12-14_____
TOTAL CHILDREN 0-5______
TOTAL AGE 50+______
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE _____

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Ethiopia 2000

No questionnaire text is available for this sample.


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Ethiopia 2005

No questionnaire text is available for this sample.


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Ethiopia 2011

No questionnaire text is available for this sample.


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Ethiopia 2016
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD

TOTAL ELIGIBLE WOMEN

TOTAL ELIGIBLE MEN

LINE NUMBER OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE


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Ghana 1988

No questionnaire text is available for this sample.


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Ghana 1993

No questionnaire text is available for this sample.


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Ghana 1998

No questionnaire text is available for this sample.


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Ghana 2003

No questionnaire text is available for this sample.


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Ghana 2008

No questionnaire text is available for this sample.


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Ghana 2014
Survey form view entire document:  text 
2. USUAL RESIDENTS AND VISITORS: Please give me the names of the persons who usually live in your household and guests of the household who stayed here last night, starting with the head of the household.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 (QUESTIONS 5-20) FOR EACH PERSON.

NAME ____

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Ghana 2016
Survey form view entire document:  text 
INSTRUCTIONS

We are collecting information on the 2016 GMIS field staff. Please fill in the information below. The information will be part of the survey data files. Your name will not be in the data files; your information will remain anonymous. If there is any question you do not want to answer you may skip it and go to the next question.


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Guinea 1999

No questionnaire text is available for this sample.


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Guinea 2005

No questionnaire text is available for this sample.


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Guinea 2012

No questionnaire text is available for this sample.


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Guinea 2018
Survey form view entire document:  text 
TOTAL NO. OF VISITS

TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE MEN
TOTAL ELIGIBLE CHILDREN
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE


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India 1992

No questionnaire text is available for this sample.


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India 1998

No questionnaire text is available for this sample.


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India 2005

No questionnaire text is available for this sample.


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India 2015

No questionnaire text is available for this sample.


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Jordan 1990
Survey form view entire document:  text 
TOTAL IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _______
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __________

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Jordan 1997
Survey form view entire document:  text 
TOTAL IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL NUMBER OF RESPONDENT TO HOUSEHOLD SCHEDULE

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Jordan 2002
Survey form view entire document:  text 
3. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?

________

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Jordan 2007
Survey form view entire document:  text 
SUPERVISOR
NAME_______
DATE ________

FIELD EDITOR
NAME________
DATE________

OFFICE EDITOR ___

KEYED BY____


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Jordan 2009
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN___
TOTAL ELIGIBLE MEN___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONAIRE

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Jordan 2012
Survey form view entire document:  text 
2. USUAL RESIDENT AND VISITORS: Please give me the names of the persons who usually live in your household who stayed here last night, starting with the head of the household.

AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE. THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-20 FOR EACH PERSON.

NAME __________

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Jordan 2017

No questionnaire text is available for this sample.


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Kenya 1989

No questionnaire text is available for this sample.


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Kenya 1993

No questionnaire text is available for this sample.


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Kenya 1998

No questionnaire text is available for this sample.


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Kenya 2003

No questionnaire text is available for this sample.


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Kenya 2008

No questionnaire text is available for this sample.


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Kenya 2014

No questionnaire text is available for this sample.


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Lesotho 2004
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____

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Lesotho 2009
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____

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Lesotho 2014
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD____

TOTAL ELIGIBLE WOMEN____

TOTAL ELIGIBLE MEN____

LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___


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Liberia 1986

No questionnaire text is available for this sample.


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Liberia 2007
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _______
TOTAL ELIGIBLE MEN ________
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __________

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Liberia 2013
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____

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Madagascar 1992

No questionnaire text is available for this sample.


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Madagascar 1997

No questionnaire text is available for this sample.


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Madagascar 2003

No questionnaire text is available for this sample.


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Madagascar 2008

No questionnaire text is available for this sample.


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Malawi 1992

No questionnaire text is available for this sample.


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Malawi 2000

No questionnaire text is available for this sample.


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Malawi 2004

No questionnaire text is available for this sample.


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Malawi 2010

No questionnaire text is available for this sample.


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Malawi 2016

No questionnaire text is available for this sample.


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Mali 1987

No questionnaire text is available for this sample.


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Mali 1995

No questionnaire text is available for this sample.


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Mali 2001

No questionnaire text is available for this sample.


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Mali 2006

No questionnaire text is available for this sample.


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Mali 2012

No questionnaire text is available for this sample.


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Mali 2018

No questionnaire text is available for this sample.


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Morocco 1987
Survey form view entire document:  text 
3. RESIDENCE: Does (NAME) usually live here?

YES 1
NO 2

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Morocco 1992

No questionnaire text is available for this sample.


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Morocco 2003

No questionnaire text is available for this sample.


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Mozambique 1997

No questionnaire text is available for this sample.


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Mozambique 2003

No questionnaire text is available for this sample.


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Mozambique 2011

No questionnaire text is available for this sample.


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Myanmar 2015

No questionnaire text is available for this sample.


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Namibia 1992
Survey form view entire document:  text 
1) LINE NO.

_____

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Namibia 2000
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household or who are staying with you now.

1) LINE NO. (THE NUMBER OF PERSONS LISTEN BY THE RESPONDENT)

___

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Namibia 2006
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _______
TOTAL ELIGIBLE MEN ________
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __________

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Namibia 2013

No questionnaire text is available for this sample.


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Nepal 1996

No questionnaire text is available for this sample.


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Nepal 2001
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)

DAY __
MONTH __
YEAR ____

INTERVIEWER'S NAME __________
INT. CODE __

RESULT

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ____________ 9

TOTAL PERSONS IN HOUSEHOLD __

TOTAL WOMEN ELIGIBLE __

TOTAL ELIGIBLE MEN __

LINE NO. OF RESP. TO HOUSEHOLD QUEST.

SUPERVISOR

NAME ______
DATE _______

FIELD EDITOR

NAME _______
DATE ________

OFFICE EDITOR __

KEYED BY __


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Nepal 2006

No questionnaire text is available for this sample.


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Nepal 2011
Survey form view entire document:  text 
INTERVIEWER VISITS

VISIT 1

DATE __________
INTERVIEWER'S NAME _____________
RESULT ___________

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ________________ 9

NEXT VISIT:
DATE _________
TIME _________

VISIT 2

DATE __________
INTERVIEWER'S NAME _____________
RESULT ___________

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ________________ 9

NEXT VISIT:
DATE _________
TIME _________

VISIT 3

DATE __________
INTERVIEWER'S NAME _____________
RESULT ___________

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ________________ 9

NEXT VISIT:
DATE _________
TIME _________

FINAL VISIT

DAY ___________
MONTH __________
YEAR __________
INT. NUMBER __________
RESULT _________

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) ________________ 9

TOTAL NUMBER OF VISITS __________

TOTAL PERSONS IN HOUSEHOLD _________

TOTAL ELIGIBLE WOMEN ________

TOTAL ELIGIBLE MEN ________

LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ________

SUPERVISOR

NAME __________

DATE __________

OFFICE EDITOR __________

KEYED BY __________


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Nepal 2016

No questionnaire text is available for this sample.


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Niger 1992

No questionnaire text is available for this sample.


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Niger 1998

No questionnaire text is available for this sample.


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Niger 2006

No questionnaire text is available for this sample.


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Niger 2012

No questionnaire text is available for this sample.


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Nigeria 1990

No questionnaire text is available for this sample.


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Nigeria 1999

No questionnaire text is available for this sample.


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Nigeria 2003

No questionnaire text is available for this sample.


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Nigeria 2008

No questionnaire text is available for this sample.


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Nigeria 2013

No questionnaire text is available for this sample.


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Nigeria 2018
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____

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Pakistan 1991

No questionnaire text is available for this sample.


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Pakistan 2006
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD __

DEATHS UNDER 5/SBs FROM Q. 38 __

FEMALE DEATHS AGE 12-49 FROM Q. 39 __

LINE NO. OF RESPONDENT __

LANGUAGE OF QUESTIONNAIRE: URDU


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Pakistan 2012
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____

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Pakistan 2017
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT* ______

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) __________ 9

NEXT VISIT DATE _____
TIME ______

SECOND VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT* ______

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) __________ 9

NEXT VISIT DATE _____
TIME ______

THIRD VISIT
DATE _______
INTERVIWER'S NAME _______
RESULT* ______

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) __________ 9

NEXT VISIT DATE _____
TIME ______

FINAL VISIT
DAY _____
MONTH ______
YEAR _____
INT. NO. _______
RESULT* _______

COMPLETED 1
NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 2
ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 3
POSTPONED 4
REFUSED 5
DWELLING VACANT OR ADDRESS NOT A DWELLING 6
DWELLING DESTROYED 7
DWELLING NOT FOUND 8
OTHER (SPECIFY) __________ 9

TOTAL NUMBER OF VISITS _________

TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN ______
TOTAL ELIGIBLE MEN _______
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE _______


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Rwanda 1992

No questionnaire text is available for this sample.


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Rwanda 2000

No questionnaire text is available for this sample.


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Rwanda 2005

No questionnaire text is available for this sample.


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Rwanda 2008
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN _________
TOTAL ELIGIBLE MEN __________
LINE NO. OF RESP. TO HOUSEHOLD QUEST. ___________

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Rwanda 2010

No questionnaire text is available for this sample.


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Rwanda 2014
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

SECOND VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

THIRD VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

NEXT VISIT:

DATE_____________
TIME______________

FINAL VISIT

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __
RESULT*___

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD __ __
TOTAL ELIGIBLE WOMEN __ __
TOTAL ELIGIBLE MEN __ __
LINE NO. RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __ __

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Senegal 1986

No questionnaire text is available for this sample.


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Senegal 1992

No questionnaire text is available for this sample.


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Senegal 1997
Survey form view entire document:  text 
TOTAL IN THE HOUSEHOLD_____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____

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Senegal 2005
Survey form view entire document:  text 
TOTAL IN THE HOUSEHOLD_____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____

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Senegal 2010
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____

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Senegal 2012
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____

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Senegal 2014
Survey form view entire document:  text 
INTERVIEWER VISITS

FIRST VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

SECOND VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

THIRD VISIT

DATE_______________
INTERVIEWER'S NAME_____________________
RESULT*________________

NEXT VISIT:

DATE_____________
TIME______________

FINAL VISIT

DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __
RESULT*___

TOTAL NUMBER OF VISITS

TOTAL PERSONS IN HOUSEHOLD __ __
TOTAL ELIGIBLE WOMEN __ __
TOTAL ELIGIBLE MEN __ __
LINE NO. RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __ __

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Senegal 2015
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN ______
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE _________

SUPERVISOR _____

NAME ______
DATE ______

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Senegal 2016
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ___
TOTAL ELIGIBLE MEN ___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___

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Senegal 2017
Survey form view entire document:  text 
Just to make sure that I have a complete listing:

2A) Are there any other persons such as small children or infants that we have not listed?
YES (ADD EACH IN TABLE)
NO
2B) In addition, are there any other people who many not be members of your family, such as domestic servants, lodgers or friends who usually live here?
YES (ADD EACH IN TABLE)
NO
2C) Are there any guests or temporary visitors staying here, or anyone else who stayed here last night, who have not been listed?
YES (ADD EACH IN TABLE)
NO

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South Africa 1998

No questionnaire text is available for this sample.


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South Africa 2016
Survey form view entire document:  text 
2) USUAL RESIDENTS AND VISITORS:

Please give me the names of the persons who live in your household and guests of the household who stayed here last night, starting with the head of the household.
AFTER LISTING THE NAMES AND RECORDING THE RELATIONSHIP AND SEX FOR EACH PERSON, ASK QUESTIONS 2A-2C TO BE SURE THAT THE LISTING IS COMPLETE.
THEN ASK APPROPRIATE QUESTIONS IN COLUMNS 5-28 FOR EACH PERSON.

NAME ____

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Sri Lanka 1987
Survey form view entire document:  text 
Now we would like some information about the people who usually live in your household, or who are staying with you now.

1) NAMES: Please give me the names of the persons who usually live in your household or who are staying with you now. (RECORD NAME OF HEAD OF HOUSEHOLD FIRST)

NAME____

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Sudan 1989

No questionnaire text is available for this sample.


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Tanzania 1991

No questionnaire text is available for this sample.


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Tanzania 1996

No questionnaire text is available for this sample.


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Tanzania 1999

No questionnaire text is available for this sample.


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Tanzania 2004

No questionnaire text is available for this sample.


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Tanzania 2010

No questionnaire text is available for this sample.


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Tanzania 2015
Survey form view entire document:  text 
9. ELIGIBILITY

CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49

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Togo 1988
Survey form view entire document:  text 
101. RECORD THE NUMBER OF PEOPLE LISTED IN THE HOUSEHOLD SCHEDULE.

NUMBER OF PEOPLE______

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Togo 1998
Survey form view entire document:  text 
TOTAL IN HOUSEHOLD ____

TOTAL ELIGIBLE WOMEN ____

LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE ____


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Togo 2013
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____

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Tunisia 1988

No questionnaire text is available for this sample.


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Uganda 1988

No questionnaire text is available for this sample.


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Uganda 1995

No questionnaire text is available for this sample.


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Uganda 2001

No questionnaire text is available for this sample.


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Uganda 2006

No questionnaire text is available for this sample.


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Uganda 2011

No questionnaire text is available for this sample.


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Uganda 2016
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
TOTAL ELIGIBLE MEN ___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___

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Yemen 1991
Survey form view entire document:  text 
203) IF 201 IS 1 TO 4: What is (was) his/her main occupation?

OCCUPATION____

TOTAL NUMBER OF ELIGIBLE WOMEN____
TOTAL NUMBER OF ELIGIBLE CHILDREN____
TOTAL NUMBER OF ELIGIBLE CHILDREN WHOSE MOTHER LIVE IN THE HOUSEHOLD____
IF CONTINUATION SHEET USED, TICK HERE____


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Yemen 2013
Survey form view entire document:  text 
TOTAL PERSONS IN HOUSEHOLD____
TOTAL ELIGIBLE EVER MARRIED WOMEN IN AGE 15-49____
TOTAL ELIGIBLE NEVER MARRIED WOMEN IN AGE 15-49____
TOTAL CHILDREN 0-5____
LINE NUMBER OF RESPONDENT IN HH____

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Zambia 1992

No questionnaire text is available for this sample.


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Zambia 1996

No questionnaire text is available for this sample.


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Zambia 2001

No questionnaire text is available for this sample.


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Zambia 2007

No questionnaire text is available for this sample.


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Zambia 2013

No questionnaire text is available for this sample.


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Zambia 2018
Survey form view entire document:  text 
HOUSEHOLD SCHEDULE

(1) LINE NO.

LINE NUMBER _____

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Zimbabwe 1988

No questionnaire text is available for this sample.


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Zimbabwe 1994

No questionnaire text is available for this sample.


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Zimbabwe 1999

No questionnaire text is available for this sample.


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Zimbabwe 2005

No questionnaire text is available for this sample.


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Zimbabwe 2010

No questionnaire text is available for this sample.


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Zimbabwe 2015

No questionnaire text is available for this sample.