Survey Text
Afghanistan 2015
No questionnaire text is available for this sample.
Angola 2015
Survey form
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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____
Bangladesh 1994
No questionnaire text is available for this sample.
Bangladesh 1997
Survey form
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TOTAL NUMBER OF VISITS
TOTAL IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE MEN
Bangladesh 2000
Survey form
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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:
Bangladesh 2004
Survey form
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TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
LINE NO. OF RESP. TO HOUSEHOLD QUEST. ___
Bangladesh 2007
Survey form
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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____
Bangladesh 2011
No questionnaire text is available for this sample.
Bangladesh 2014
Survey form
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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 __ __
Benin 1996
No questionnaire text is available for this sample.
Benin 2001
No questionnaire text is available for this sample.
Benin 2006
No questionnaire text is available for this sample.
Benin 2011
No questionnaire text is available for this sample.
Benin 2017
Survey form
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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 __ __
Burkina Faso 1993
No questionnaire text is available for this sample.
Burkina Faso 1998
No questionnaire text is available for this sample.
Burkina Faso 2003
No questionnaire text is available for this sample.
Burkina Faso 2010
No questionnaire text is available for this sample.
Burundi 1987
Survey form
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110) What is your nationality?
RWANDAN 1
ZAIREAN 2
TANZANIAN 3
OTHER AFRICAN 4
OTHER (SPECIFY) ______ 5
Burundi 2010
Survey form
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TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
Burundi 2016
Survey form
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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:
Cameroon 1991
No questionnaire text is available for this sample.
Cameroon 1998
No questionnaire text is available for this sample.
Cameroon 2004
No questionnaire text is available for this sample.
Cameroon 2011
Survey form
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1. LINE NUMBER
LINE NO. ____
Central African Republic 1995
Survey form
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TOTAL IN HOUSEHOLD____
TOTAL ELIGIBLE WOMEN____
TOTAL ELIGIBLE MEN____
Chad 1996
Survey form
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TOTAL IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE ____
Chad 2004
Survey form
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TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
LINE NO. OF RESP. TO HOUSEHOLD QUEST. ___
Chad 2014
Survey form
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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
__ __
Congo (Democratic Republic) 2007
No questionnaire text is available for this sample.
Congo (Democratic Republic) 2013
No questionnaire text is available for this sample.
Congo Brazzaville 2005
No questionnaire text is available for this sample.
Congo Brazzaville 2011
No questionnaire text is available for this sample.
Cote d'Ivoire 1994
No questionnaire text is available for this sample.
Cote d'Ivoire 1998
No questionnaire text is available for this sample.
Cote d'Ivoire 2011
No questionnaire text is available for this sample.
Egypt 1988
No questionnaire text is available for this sample.
Egypt 1992
No questionnaire text is available for this sample.
Egypt 1995
No questionnaire text is available for this sample.
Egypt 2000
No questionnaire text is available for this sample.
Egypt 2003
Survey form
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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.
Egypt 2005
No questionnaire text is available for this sample.
Egypt 2008
No questionnaire text is available for this sample.
Egypt 2014
No questionnaire text is available for this sample.
Eswatini (Swaziland) 2006
Survey form
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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 _____
Ethiopia 2000
No questionnaire text is available for this sample.
Ethiopia 2005
No questionnaire text is available for this sample.
Ethiopia 2011
No questionnaire text is available for this sample.
Ethiopia 2016
Survey form
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TOTAL PERSONS IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL ELIGIBLE MEN
LINE NUMBER OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE
Ghana 1988
No questionnaire text is available for this sample.
Ghana 1993
No questionnaire text is available for this sample.
Ghana 1998
No questionnaire text is available for this sample.
Ghana 2003
No questionnaire text is available for this sample.
Ghana 2008
No questionnaire text is available for this sample.
Ghana 2014
Survey form
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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 ____
Ghana 2016
Survey form
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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.
Guinea 1999
No questionnaire text is available for this sample.
Guinea 2005
No questionnaire text is available for this sample.
Guinea 2012
No questionnaire text is available for this sample.
Guinea 2018
Survey form
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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
India 1992
No questionnaire text is available for this sample.
India 1998
No questionnaire text is available for this sample.
India 2005
No questionnaire text is available for this sample.
India 2015
No questionnaire text is available for this sample.
Jordan 1990
Survey form
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text
TOTAL IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _______
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __________
Jordan 1997
Survey form
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text
TOTAL IN HOUSEHOLD
TOTAL ELIGIBLE WOMEN
TOTAL NUMBER OF RESPONDENT TO HOUSEHOLD SCHEDULE
Jordan 2002
Survey form
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text
3. RELATIONSHIP TO HEAD OF HOUSEHOLD: What is the relationship of (NAME) to the head of the household?
________
Jordan 2007
Survey form
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SUPERVISOR
NAME_______
DATE ________
FIELD EDITOR
NAME________
DATE________
OFFICE EDITOR ___
KEYED BY____
Jordan 2009
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN___
TOTAL ELIGIBLE MEN___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONAIRE
Jordan 2012
Survey form
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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 __________
Jordan 2017
No questionnaire text is available for this sample.
Kenya 1989
No questionnaire text is available for this sample.
Kenya 1993
No questionnaire text is available for this sample.
Kenya 1998
No questionnaire text is available for this sample.
Kenya 2003
No questionnaire text is available for this sample.
Kenya 2008
No questionnaire text is available for this sample.
Kenya 2014
No questionnaire text is available for this sample.
Lesotho 2004
Survey form
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TOTAL PERSONS IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____
Lesotho 2009
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN _____
Lesotho 2014
Survey form
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TOTAL PERSONS IN HOUSEHOLD____
TOTAL ELIGIBLE WOMEN____
TOTAL ELIGIBLE MEN____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___
Liberia 1986
No questionnaire text is available for this sample.
Liberia 2007
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _______
TOTAL ELIGIBLE MEN ________
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __________
Liberia 2013
Survey form
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TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
Madagascar 1992
No questionnaire text is available for this sample.
Madagascar 1997
No questionnaire text is available for this sample.
Madagascar 2003
No questionnaire text is available for this sample.
Madagascar 2008
No questionnaire text is available for this sample.
Malawi 1992
No questionnaire text is available for this sample.
Malawi 2000
No questionnaire text is available for this sample.
Malawi 2004
No questionnaire text is available for this sample.
Malawi 2010
No questionnaire text is available for this sample.
Malawi 2016
No questionnaire text is available for this sample.
Mali 1987
No questionnaire text is available for this sample.
Mali 1995
No questionnaire text is available for this sample.
Mali 2001
No questionnaire text is available for this sample.
Mali 2006
No questionnaire text is available for this sample.
Mali 2012
No questionnaire text is available for this sample.
Mali 2018
No questionnaire text is available for this sample.
Morocco 1987
Survey form
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text
3. RESIDENCE: Does (NAME) usually live here?
YES 1
NO 2
Morocco 1992
No questionnaire text is available for this sample.
Morocco 2003
No questionnaire text is available for this sample.
Mozambique 1997
No questionnaire text is available for this sample.
Mozambique 2003
No questionnaire text is available for this sample.
Mozambique 2011
No questionnaire text is available for this sample.
Myanmar 2015
No questionnaire text is available for this sample.
Namibia 1992
Survey form
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Namibia 2000
Survey form
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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)
___
Namibia 2006
Survey form
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TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _______
TOTAL ELIGIBLE MEN ________
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE __________
Namibia 2013
No questionnaire text is available for this sample.
Nepal 1996
No questionnaire text is available for this sample.
Nepal 2001
Survey form
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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 __
Nepal 2006
No questionnaire text is available for this sample.
Nepal 2011
Survey form
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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 __________
Nepal 2016
No questionnaire text is available for this sample.
Niger 1992
No questionnaire text is available for this sample.
Niger 1998
No questionnaire text is available for this sample.
Niger 2006
No questionnaire text is available for this sample.
Niger 2012
No questionnaire text is available for this sample.
Nigeria 1990
No questionnaire text is available for this sample.
Nigeria 1999
No questionnaire text is available for this sample.
Nigeria 2003
No questionnaire text is available for this sample.
Nigeria 2008
No questionnaire text is available for this sample.
Nigeria 2013
No questionnaire text is available for this sample.
Nigeria 2018
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
Pakistan 1991
No questionnaire text is available for this sample.
Pakistan 2006
Survey form
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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
Pakistan 2012
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
Pakistan 2017
Survey form
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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 _______
Rwanda 1992
No questionnaire text is available for this sample.
Rwanda 2000
No questionnaire text is available for this sample.
Rwanda 2005
No questionnaire text is available for this sample.
Rwanda 2008
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD ______
TOTAL ELIGIBLE WOMEN _________
TOTAL ELIGIBLE MEN __________
LINE NO. OF RESP. TO HOUSEHOLD QUEST. ___________
Rwanda 2010
No questionnaire text is available for this sample.
Rwanda 2014
Survey form
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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 __ __
Senegal 1986
No questionnaire text is available for this sample.
Senegal 1992
No questionnaire text is available for this sample.
Senegal 1997
Survey form
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text
TOTAL IN THE HOUSEHOLD_____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____
Senegal 2005
Survey form
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text
TOTAL IN THE HOUSEHOLD_____
TOTAL ELIGIBLE WOMEN_____
TOTAL ELIGIBLE MEN_____
Senegal 2010
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
Senegal 2012
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
Senegal 2014
Survey form
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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 __ __
Senegal 2015
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD _____
TOTAL ELIGIBLE WOMEN _____
TOTAL ELIGIBLE MEN ______
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE _________
SUPERVISOR _____
NAME ______
DATE ______
Senegal 2016
Survey form
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text
TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ___
TOTAL ELIGIBLE MEN ___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___
Senegal 2017
Survey form
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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
South Africa 1998
No questionnaire text is available for this sample.
South Africa 2016
Survey form
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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 ____
Sri Lanka 1987
Survey form
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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____
Sudan 1989
No questionnaire text is available for this sample.
Tanzania 1991
No questionnaire text is available for this sample.
Tanzania 1996
No questionnaire text is available for this sample.
Tanzania 1999
No questionnaire text is available for this sample.
Tanzania 2004
No questionnaire text is available for this sample.
Tanzania 2010
No questionnaire text is available for this sample.
Tanzania 2015
Survey form
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9. ELIGIBILITY
CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49
Togo 1988
Survey form
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101. RECORD THE NUMBER OF PEOPLE LISTED IN THE HOUSEHOLD SCHEDULE.
NUMBER OF PEOPLE______
Togo 1998
Survey form
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TOTAL IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
LINE NO. OF RESP. TO HOUSEHOLD SCHEDULE ____
Togo 2013
Survey form
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TOTAL PERSONS IN HOUSEHOLD ____
TOTAL ELIGIBLE WOMEN ____
TOTAL ELIGIBLE MEN ____
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ____
Tunisia 1988
No questionnaire text is available for this sample.
Uganda 1988
No questionnaire text is available for this sample.
Uganda 1995
No questionnaire text is available for this sample.
Uganda 2001
No questionnaire text is available for this sample.
Uganda 2006
No questionnaire text is available for this sample.
Uganda 2011
No questionnaire text is available for this sample.
Uganda 2016
Survey form
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TOTAL PERSONS IN HOUSEHOLD ___
TOTAL ELIGIBLE WOMEN ___
TOTAL ELIGIBLE MEN ___
LINE NO. OF RESPONDENT TO HOUSEHOLD QUESTIONNAIRE ___
Yemen 1991
Survey form
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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____
Yemen 2013
Survey form
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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____
Zambia 1992
No questionnaire text is available for this sample.
Zambia 1996
No questionnaire text is available for this sample.
Zambia 2001
No questionnaire text is available for this sample.
Zambia 2007
No questionnaire text is available for this sample.
Zambia 2013
No questionnaire text is available for this sample.
Zambia 2018
Survey form
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HOUSEHOLD SCHEDULE
(1) LINE NO.
LINE NUMBER _____
Zimbabwe 1988
No questionnaire text is available for this sample.
Zimbabwe 1994
No questionnaire text is available for this sample.
Zimbabwe 1999
No questionnaire text is available for this sample.
Zimbabwe 2005
No questionnaire text is available for this sample.
Zimbabwe 2010
No questionnaire text is available for this sample.
Zimbabwe 2015
No questionnaire text is available for this sample.