VILLAGE GRAM PANCHAYAT

(NAME) (Name)
TALUK/ TEHSIL CD BLOCK DISTRICT
(Name) (Name) (Name)

Please do not fill this in the field/village. It has to be

populated in a sequential order, as indicated below

Village Code :
Panchayat Code :
 STATE
Village Code Panchyat Code
(Name)

the field/village. It has to be entered only after all the student groups have returned to IRMA and must be
al order, as indicated below :

001 to 088
001 to 088
 Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Village Code Panchyat Code

 1(A) : SAMPLE VILLAGE

a b c d

Name of the Village Census location code Census location code C. D. Block
(as per 2001) (as per 2011) (Name)
 Section-1 : Identification of the Village

E VILLAGE 1(B) DEMOGRAPHIC PARTIC

1(a)
e f g
Census (2011)
Taluk/Tehsil District State Population
(Name) (Name) (Name)
tion of the Village

1(B) DEMOGRAPHIC PARTICULARS 1(C) LOCATION AN

1(b) 2(a) 2(b) 1 2
Census (2011) Census (2019)
Sl.
Particulars
Households Population Households No.

1 District Headquarters

2 Tehsil/Taluk HQ

3 Block Headquarters

4 Nearest Bus Stand

5 Nearest Railway Station

6 Nearest Post Office

7 Nearest Telephone facility

8 Nearest Town

9 Nearest Pucca road

10 Nearest Fair Price store

11 Nearest store for agricultural inputs

12 Nearest wholesaler market for

agricultural products

13 Nearest police station

14 Nearest Secondary school

15 Nearest Hospital

16 Nearest PHC/CHC/Sub-centre

17 Nearest Traditional Healer

18 Nearest Alcohol Store

19 Nearest ATM (Bank & PO)

 Section-1 : Identi

1(C) LOCATION AND COMMUNICATION 1(D) DETAILS

3 4 5 6 1
Distance from Village Travel time
Location (km) Sl.
(name of the place) [If distance is ‘0’, then Hours minutes No.
write ‘9999’]

9
 Section-1 : Identification of the Village

1(D) DETAILS OF OTHER FACILITIES AT PANCHAYAT LEVEL

2 3

Particulars Response

No. of internet connections at Panchayat Bhawan

No. of Waste Management Systems

No. of cyber cafes (Public internet cafe)

No. of Common Service Centers (CSC)/Kiosks

No. of non-formal training centers (run by NGOs/CSOs)

No. of registered agents who facilitate cross-country migration

No. of registered people from the village who have migrated abroad for work

No. of farmer field schools conducted by local authorities per year

No. of certified seed banks, grain banks and training centers

 Village Identification
[to be copied correctly from Introduction/Cover Sheet]
Sl. No.

Village Code Panchyat Code 1(a)

1(b)

(i)

(ii)

(iii)

(iv)

(v)

(vi)

(vii)

2
3. Details of episodes of In-mi

3a

Sl. No.
(i)
(ii)
(iii)
(iv)
3b
(i)
(ii)
(iii)
(iv)
3b(iv)a
3b(iv)b
3b(iv)c
4. Details of episodes of Out-m
4a
Sl. No.
(i)
(ii)
(iii)
(iv)
4b
(i)
(ii)
(iii)
(iv)
(v)
5a
5b

6a
(i)
(ii)
(iii)
(iv)
(v)
6b
6c
6d
6e

7
 Section-2 : Settlement Patterns

2(A) : History of Village

Particulars Response

When was the village formed (Year)?

How was the village formed? (Put ‘1’ in appropriate box) : *************

Bequest (and grants) by a local King

Bequest (and grants) by the British

Purchased by a rich landlord

Migration due to war and conflicts

Settled by a religious group

Local economic activity (such as road building, dam construction)

Others (Specify)

How many original inhabitants at the time of formation?

3. Details of episodes of In-migration

Episodes of in migration in the distant past (identify years) :

Particulars No. of times

Last 100 years
Last 50 years
Last 10 years
Last 5 years
Reasons for in-migration (Put ‘1’ in appropriate box) : *************
Employment
Diseases
Flood
Local Economic activity such as : *************
Road construction
Dam construction
Agricultural Employment
4. Details of episodes of Out-migration
Episodes of Out-migration in the distant past (identify years) :
Particulars No. of times
Last 100 years
Last 50 years
Last 10 years
Last 5 years
Reasons for Out-migration (Put ‘1’ in appropriate box) : *************
Lack of employment
Diseases
Flood
Loss of crops
Lack of local jobs (Severe seasonal unemployment)
Are there any historical places nearly? (Yes-1, No-2)
If yes, then identify how far (kms)

Is this village known specially for one or more of the following?

*************
(Put ‘1’ in appropriate box) :
Agriculture in general YES NO
Rice cultivation
Wheat cultivation
Dry-land crops
Sugarcane
Groundnut
Pilgrimage
Textiles
Trade Centre
Historical Place

Is the cultivated land owned by the residents of the village within the
boundary of this village?
 Village Identification
[to be copied correctly from Introduction/Cover Sheet]
1

Village Code Panchyat Code

Street
ID

1
2
3
4
5
6
7
8
9
10
 Section-3 : STREET-WISE FACILITIES

3(A) : Availability of Facilities in Each Street/Habitations (Now

2 3 4 5

Pucca Road since

No. of Households what year/ Number of Brick
Street/Basti Name in Each Street (enter 0 of Houses
no pucca road)
ET-WISE FACILITIES

n Each Street/Habitations (Now)

6 7 8 9 10

Street lighting

Number of No. of multi-storied No. of Households

Number of Huts Mud Houses Houses that cultivate only Street Light
by leasing-in land (Yes=1/
No=2)
 Section-3 : STREET-WISE

3(A) : Availability of Facilities in Each Stre

11 12 13 14

Street lighting

Avg. No. of hours that No. of households

No. of Households with
the street received using solar panel for
If Yes Legal Electric
electricity supply in a electricity connections
[Functional=1; Connection
day for lighting
Non-functional=2]
 Section-3 : STREET-WISE FACILITIES

3(A) : Availability of Facilities in Each Street/Habitations (Now)

15 16 17 18

Sanitation

No. of households Public Toilet No. of Households with Does the Street Possess
owning solar lanterns (Yes=1/No=2) Private Toilets a Proper Sewage
System
(Yes=1, No=2)
 19 20 21 22

Sanitation

No. of drain cleaning &

fumigation processes
Does the Street Possess Does the Street Possess No. of water treatment undertaken in an
a Proper Garbage a Community Sanitary plants average year (of all
Disposal System Complex? drains)
(Yes=1, No=2) (Yes=1, No=2)
 Section-3 : STREET-WISE FACILITIES

3(A) : Availability of Facilities in Each Street/Habitations (Now)

23 24 25 26

PDS Store
(Location Code :
Inside the Street-1, No. of Wells for
In the Neighboring Irrigation Is the Village Post Office Does the Post Master
Street-2, Located on this Street? Reside in this Street?
Outside the Village-3) (Yes=1, No=2) (Yes=1, No=2)
FACILITIES

t/Habitations (Now) 3(A)

27 28 29 30 31

Communication

No. of
Does the Postman Does this Street have a No. of Households No. of Households Households
Reside in this Street? PCO? having a proper having a Cell Phone? Having Access to
(Yes=1, No=2) (Yes=1, No=2) Telephone Connection? view Television
Programs?
 Section-3 : STREET-WISE FACILITIES

3(A) : Availability of Facilities in Each Street/Habitations (Now)

32 33 34 35 36 37 38 39 40

Education Facilities

No. of Households Children Children Children Children Persons Persons No. of

Possessing an attending attending attending attending attending attending No. of Drinking
Internet Primary Post-
Middle Secondary secondary College/ Technical Public Water
Taps
Connection School School School School University Education Wells
 Section-3 : STREET-WISE FAC

3(A) : Availability of Facilities in Each Street/Ha

41 42 43 44

Drinking Water

No. of Ponds for No. of Public Hand- No. of Households No. of Households
Drinking Water pumps having Tap Connection having Hand-pumps
Purposes inside the House within the House
 Section-3 : STREET-WISE FACILITIES

) : Availability of Facilities in Each Street/Habitations (Now)

45 46 47 48

Drinking Water

No. of Households Is there an Overhead Smell of Drinking Water Colour of

having Private Wells for Tank Available in this (Odorless=1, Slightly Drinking Water
Drinking Water Street? Abnormal Odor=2, (Clear & colorless=1,
(Yes,=1 Highly Repulsive Slightly muddy=2,
Purposes No=2) Odor=3) Extremely dirty color=3)
 Section-3 : ST

3(A) : Availability of Facili

49 50 51 52 53 54

Irrigation

No. of Persons Afflicted No. of % of Households % of Households (in % of Households (in % of Households
Col. 49)
(in
with Water-borne Household (in Col. 49) that Col. 49) that have Col. 49) that have that are
Diseases s owning have Access to own Access to Govt. Access to both own dependent on
Bore-wells & Govt.
(Past 1 year) Land Bore-wells Canals only Canals Ponds for
irrigation
 Section-3 : STREET-WISE FACILITIES

3(A) : Availability of Facilities in Each Street/Habitations (Now)

55 56 57 58 59

Ownership of Assets

No. of Functional
Water recharge
artificial structures No. of households Total number of No. of Households No. of Households
(underground well, using solar pumps Households owning owning Poultry only owning Cows &
rain water for irrigation Livestock Buffalos only
harvesting
structures)
 Section-3 : STREET-WISE

3(A) : Availability of Facilities in Each Str

60 61 62 63 64

Ownership of Assets Owne

No. of HH using
No. of Households No. of Households clean energy for No. of Households
owning Goats & owning other form cooking (LPG/Bio having a mix of all Bicycle
Sheep only of cattle Animals
gas)
 Section-3 : STREET-WISE FACILITIES

3(A) : Availability of Facilities in Each Street/Habitations (Now)

65 66 67 68 69

Ownership of Other Assets [NO. of households owning the following ---]

2-Wheelers Autorickshaws/ Mini-Vans/

(scooter/moped/ Cars/Jeeps Tempo Lorries/Vans Pick-up Vehicles
motorcycle)
 Section-3 : STREET-WISE FACILITIES

3(A) : Availability of Facilities in Each Street/Habitations (Now)

70 71 72 73 74 75

owing ---] A

No. of HH having
Soil Health Card
Availability of If Yes (in Col. 73), Availability of
School in the then location of the Anganwadi Centre
Buses Trucks Street? school (Private
Space=1, Public (AWC) in the Street?
(Yes=1, No=2) Space=2) (Yes=1, No=2)
WISE FACILITIES Section-3 : STREET-WISE FAC

ch Street/Habitations (Now) 3(A) : Availability of Facilities in Each Street/H

76 77 78 79 80

Availability & Location of Major Institutions

If Yes (in Col. 75), Availability of Public If Yes (in Col. 77), Availability of Sub- If Yes (in Col. 79),
then location of the Health Centre (PHC) then location of the Centre (SC) in the then location of the
AWC (Private in the Street? PHC Street? SC
Space=1, Public (Private Space=1, (Private Space=1,
Space=2) (Yes=1, No=2) Public Space=2) (Yes=1, No=2) Public Space=2)
Section-3 : STREET-WISE FACILITIES

Availability of Facilities in Each Street/Habitations (Now)

81 82 83 84

If Yes (in Col. 81), No. of Deaths

No. of Live of Children <
Availability of PDS then location of the Births 6 Years of
Store in the Street? PDS Store (Private (in the Last Age
(Yes=1, No=2) Space=1, Public
Space=2) Year) (in the Last
Year)
 Village Identification
[to be copied correctly from Introduction/Cover Sheet]
1

Village Code Panchyat Code

Street
ID

1
2
3
4
5
6
7
8
9
10
 Section-3 : STREET-WISE FA

3(B) : Street Level Outcomes – Detail of Works Done in Diffe

2 3 4

BPL Card/Antyodaya/Other Ration Cards

Street/Basti Name

No. of BPL Cards Issued No. of other

Cards Issued
ection-3 : STREET-WISE FACILITIES (Contd. ……)

comes – Detail of Works Done in Different Streets/Habitations in the Current Panchayat

5 6 7 8

d/Antyodaya/Other Ration Cards Drinking Water Supply

No. of other No. of Hand pumps No. of Bore-wells

Ration Card (Above No. of Persons Benefited Installed/Repaired for Installed/Repaired For
Poverty Line) Issued Under Antyodaya Drinking Water Drinking Water
 3(

9 10 11 12

Drinking Water Supply Sanitation

No. of Taps No. of Overhead Tanks No. of Community No. of Households Where
Installed/Repaired Built/Renovated Toilets Installed Toilet were Installed
 Section-3 : STREET-WISE FACILITIES

3(B) : Street Level Outcomes – Detail of Works Done in Different Streets/Habitations in the Current Pan

13 14 15 16

tion Healthcare

Construction of Sewage &

Drainage No. of Deliveries at No. of Children Immunized No. of Pregnant
(Yes-1, No-2) Hospital/Clinics Mothers Immunized
CILITIES

ets/Habitations in the Current Panchayat

17 18 19 20

care Rural Roads

Construction/Repair of Construction/Repair of
No. of Children Vaccinated Anganwadi Centre New Road Built/Repaired School Building
for Polio (Yes-1, No-2) (Yes-1, No-2) (Yes-1, No-2)
 Section

3(B) : Street Level Outcomes – Detail of

21 22 23 24

Education & Schooling

No. of SC/ST/OBC No. of Other Households

Construction/Repair of
Toilet(s) in School Households Benefited by Benefited by Affirmative No. of Primary/Secondary
(Yes-1, No-2) Affirmative Action Action regarding Children Enrolled
Regarding Scholarship scholarship
 Section-3 : STREET-WISE FACILITIES

Street Level Outcomes – Detail of Works Done in Different Streets/Habitations in the Current Panchayat

25 26 27 28

Business Support
Rural Housing Schemes Employment Generation Sch
Programs

Total No. of Households Total No. of Males

No. of Houses No. of Enterprises Benefited through Benefited through
Built/Repaired Started/Re-stared MGNREGS MGNREGS
yat

29 30 31

Employment Generation Schemes

Total No. of Females No. of Ground Water No. of Ground Water

Benefited through Harvesting Pits Harvesting Ponds
MGNREGS Constructed/Repaired Dug/Renovated
 Se
Village Identification 1. Name of Respondent :
[to be copied correctly from Introduction/Cover Sheet] 2. Name of Respondent :

Village Code Panchyat Code

1A. (i). Name of Local Unit in which

1A. (ii). 1 Acre (Local Units) =

Sl. No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16a
16b
16c
 Section-4 : VILLAGE AGRICULTURE AND LIVESTOCK
1. Name of Respondent : Designation :
2. Name of Respondent : Designation :

2 3 4

1. Land Utilization

1A. (i). Name of Local Unit in which area is measured (Write local name clearly) :

1A. (ii). 1 Acre (Local Units) =

2019
Particulars
Area Area
(Local Unit) (in Acres)

Net Cultivated Area

Gross Cultivated Area
Area Irrigated by Govt. Canal
Area Irrigated by Other Streams
Area Irrigated by Tanks
Total Area Under Cultivation (i.e. irrigated)
Area Under Orchards & Plantations
Area Under Plantations
Area Under Forest
Extent Of Pasture And Grazing Ground
Seasonal Fallow
Permanent Fallow
Area Under Inhabitation
Public Land (Panchayat/Community land)
Other Land
Area Irrigated By Open Wells
Area Irrigated By Bore Wells (Mechanical Pumping of Water)
Area Irrigated by Wells (16a + 16b)
OCK

2019

Area
(in Acres)
 Section-4 :

Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Sl.
No.

Village Code Panchyat Code

1
2
3
4
 Section-4 : VILLAGE AGRICULTURE AND LIVESTOCK Section

4b. Availability of Facilities (Veterinary Hospitals, Dairies & Co-o

Major Modes of Transp

One Way
Year of (Cycle Rickshaw-1, Au
Type Location Distance
Establishment Rickshaw-2, Taxi/tempo
(in kms.)
Bus-4, Bullock Cart-5
Bicycle-6, On foot-7)

2 3 4 5 6

Govt. Veterinary Service

Private Veterinary Service
Private Dairies
Dairy Co-operative Society
 Section-4 : VILLAGE AGRICULTURE AND LIVESTOCK

Hospitals, Dairies & Co-operative Societies)

Major Modes of Transport Services Provided

(Use Multiple codes)
Travel Time (in min.)
(Cycle Rickshaw-1, Auto
(Time corresponding to
Rickshaw-2, Taxi/tempo-3, (Treatment of Disease-1, Vaccination-2,
Each Mode
Bus-4, Bullock Cart-5, Artificial Insemination-3, Stud Cattle-4, Milk
Bicycle-6, On foot-7) Processing-5, Marketing-6)

7 8 9 10 11 12 13 14 15
 Section-4 : V

4C
Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Are Any Residents of this V

Cooperative or a Poultry Co

Village Code Panchyat Code

 Section-4 : VILLAGE AGRICULTURE AND LIVESTOCK

4C 4(D). Services

Are Any Residents of this Village member of a Milk Sl.

Type
Cooperative or a Poultry Cooperative? (Yes-1, No-2) No.

1 2

1 Government Milk Cooperatives

2 Private Milk Cooperatives
3 Government Poultry Cooperatives
4 Private Poultry Cooperatives
 Section-4 : VILLAGE AGRICULTURE AND LIVESTOCK

4(D). Services offered by Co-operatives

Services Offered
One (Multiple Codes Possible)
Year of Way Distance (Rank in Order of Importance Starting with Col. 5)
Establishment
(in kms.) {Codes : Collection of Output-1, Marketing-2, Storage-3,
Transportation of Output-4, Credit Facility-5)}

3 4 5 6 7
 ESTOCK Section-4 : VILLAGE AGRICULTURE AND LIVESTOCK

4(E). Availability of Livestock & Poultry Schemes

(From Co-Operatives or other Sources) to Villagers

Livestock
(Yes-1, No-2)
ble)
rting with Col. 5) Sl.
Scheme
keting-2, Storage-3, No.
edit Facility-5)} Cooperative Other Sources

8 1 2 3 4

1 Obtaining Credit
2 Obtaining Subsidies
3 Supplies of Livestock
4 Supplies of Feed
5 Technical Advice
6 Other Help (specify)
URE AND LIVESTOCK

Poultry Schemes
urces) to Villagers

Poultry
(Yes-1, No-2)

Cooperative
Other Sources

5 6
 S
Village Identification 1. Name of Respondent :
[to be copied correctly from Introduction/Cover Sheet] 2. Name of Respondent :

Village Code Panchyat Code

Sl.
No.

1
PERIOD -1 (Rabi Dec. 18 – Apr

1
2
3
4
5
PERIOD -2 (Kharif Jul. 18 – Nov
6
7
8
9
10
PERIOD -3 (Zaid May 19 – June
11
12
13
14
15
 Section-5 : LAND TENURE SYSTEM
1. Name of Respondent : Designation :
2. Name of Respondent : Designation :

(A) Land Ownership Patterns & Land Prices

1. Patterns of Cultivation in this Village

No. of No. of
No. of Households With Households
Type Households Head Migrating With Other
Members
Out Migrating Out

2 3 4 5
PERIOD -1 (Rabi Dec. 18 – Apr. 19)
Marginal (0-2 acres)
Small (2-4 acres)
Medium (4-10 acres)
Large (>10 acres)
Landless
PERIOD -2 (Kharif Jul. 18 – Nov. 18)
Marginal (0-2 acres)
Small (2-4 acres)
Medium (4-10 acres)
Large (>10 acres)
Landless
PERIOD -3 (Zaid May 19 – June 19)
Marginal (0-2 acres)
Small (2-4 acres)
Medium (4-10 acres)
Large (>10 acres)
Landless
 Section-5 : LAND TENURE SYSTEM

(A) Land Ownership Patterns & Land Prices

1. Patterns of Cultivation in this Village

No. of No. of No. of No. of No. of No. of

Households Households
Households Households Cultivating Own Households Cultivating on Households
Cultivating Cultivating Own & Share Leasing/Share Leased/Share Leasing/Share
Owned Land & Leased-in Cropping-out all Cropping-out
Only Land Cropped-in Land Cropped-in Land Partial Land
Land Only

6 7 8 9 10 11
 Section-5 : LAND TENURE SYSTEM

(A) Land Ownership Patterns & Land Prices

2. Land Prices [Market Prices (Rs./acre) (Average p

Main Crops Grown

(Rice-1, Wheat-2,
Potato-3, Sugarcane-4, Sl.
No. Land Type
Cotton-5,
Other cash crops-6,
Groundnut-7,
Other food-8)

12
1 2

1 Irrigated by canal only

2 Un-irrigated (entirely rainfed)
3 Irrigated by the multiple sources bore-wells, wells, etc.
4 Irrigated through bore-wells only (filter point)
5 Irrigated through open wells only
6 Other land used for construction of house
7 Waste land
8 Irrigated Land
9 Non-irrigated Land
ction-5 : LAND TENURE SYSTEM

p Patterns & Land Prices

Prices [Market Prices (Rs./acre) (Average price)]

Rental Price (Rs./acre)

Sale Price (Rs./acre) {Convert In-kind Payment to
Cash Equivalence if In-kind Payment is Involved}

[Current Unit Current

(Seasonal-1,
Price] Annual-2) Price

3 4 5
 1. Name of Respondent :
2. Name of Respondent :
1(a) ). Do Cultivators Get
Village Identification 1(b) If Yes, From Where D
[to be copied correctly from Introduction/Cover Sheet]

Sl.
No.

Village Code Panchyat Code

Traditional Crop Varieties

1
2
3
4
Modern Crop Varieties
5
6
7
8
Animal Husbandry
9
10
11
 Section-6 : EXTENSION SERVICES
1. Name of Respondent :
2. Name of Respondent :
1(a) ). Do Cultivators Get Information Pertaining to Prices, Movement of Traders, etc.? (Yes-1, No-2)
1(b) If Yes, From Where Do these Cultivators Get the Information? -----

Where/are the Main Sources of Information about

Items in Col.-2 for Persons from Your Village?
Items
(Public Extension Services-1, Input Dealers/Manufacturers-2, Traders-3, NGO-4,
Other Farmers-5, Radio or TV-6, Internet Kiosk-7, NRLM-8, Others-9)

2 3 4

Traditional Crop Varieties

Seeds/Varieties
Fertilizer/Pesticides
Crop Care
Market Information
Modern Crop Varieties
Seeds/Varieties
Fertilizer/Pesticides
Crop Care
Market Information
Animal Husbandry
Husbandry/Production
Health
Land Records
N SERVICES
Designation :
Designation :
? (Yes-1, No-2) 3. Type of Extension W
3(a). Public Wo

How Easy is/was it to Get

of Information about Access to Information About Sl.
rom Your Village? Items in Col.-2 for Persons from No.
Your Village?
Manufacturers-2, Traders-3, NGO-4,
et Kiosk-7, NRLM-8, Others-9) (Very Easy-1, Easy-2,
Not Easy-3)

5 6 1

1
2
3
4
 Section-7 : EXTENSION S

3. Type of Extension Worker Present

3(a). Public Worker

Designation

Name (Agriculture Extension Worker [e.g. How frequently do

Kisan Mitra, Kisan Sewak, etc.)-1, they visit? (Numbers) Sl.
Bharat Nirman Volunteers (BNVs)-2, No.
ASHA-3, ANM-4]

2 3 4 1

1
2
3
4
on-7 : EXTENSION SERVICES

3. Type of Extension Worker Present

3(b). Private Worker

Does this Person If No, Where Does One-way Distance

Live
He/She Live? From this Village
Designation In this Village? (Name of the Place) (in kms.)
(Yes-1, No-2)

2 3 4 5

1
2
3
4
 Section-7 : EXTENSION SERVICES

4. Agricultural Extension Service (AES) Centre – Organization of V

Programs by AES Centre to Educate Villagers

Organized in this Was the Program

Village? Organized in a
How Often Does (Always-1, Frequency per Year Nearby Village?
He/She Visit the Sl. Sometimes-2,
Village in a Year? No. Programme Rarely-3, (Yes-1, No-2)
Never-4)

(Always-1, Year Nearby Village?

6 1 2 3 4 5

1 Demonstrations 1
2 Exhibition 2
3 Lectures 3
4 Film Shows 4
NSION SERVICES

S) Centre – Organization of Various

e to Educate Villagers

If Yes in Col. 5

One-way Distance Frequency

Name of Village From this Village Per
(Km.) Year

6 7 8

1
2
3
4
 Section-7 : EXTENSION SERVICES

5. Other Agencies

Question Response

Does any AGENCY other than the AES Centre

organize such programs? (Yes-1, No-2)

1 2
-7 : EXTENSION SERVICES

6. Agro-Forestry/Social Forestry

Question Response

No. of land owners participating in Agro-forestry and

Social forestry activity.

1 2
 1. Name of Respondent :
2. Name of Respondent :

Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Sl.
No.

Village Code Panchayat Code

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
 Section-7 : EMPLOYMENT & BUSINESS STRUCTURE
1. Name of Respondent :
2. Name of Respondent :
1(a) In this Village

No. of Main Activity of this Enterprise

Establishment Establishments in
this Village {Use Code}

2 3 4

Factory
Grain Furnace
Rice Huller
Flour Mill
Gur Making Unit
Khandsari Making Unit
Oil Extraction Units
Bakery
Lime Kiln
Brick Kiln (for baked bricks)
Bicycle Repair Shop
Tractor/vehicle Electronic Repair Shop
Tea Shops
Eating Houses
Tailors
Blacksmith
Masons
Carpenters
Weavers
Cobblers
Potters
Handcrafts
Washer Man
Barber
Cinema House
Vegetable shops
Grocery shops
Dairy farm
Poultry farm
Piggery farm
PCO
BUSINESS STRUCTURE Section-7 : E
Designation :
Designation :
illage

Does this No. of Workers in the Establishment

Establishm
Type of Power Used ent offer
Does this Establishment Get Jobs in
(Mechanical=1; Non- Govt. Subsidy? (Yes=1, No=2) Lean
Mechanical=2) Season? Total No. No. of
(Yes=1, Workers No. of
of
No=2) Workers from this Women
Village

5 6 7 8 9 10
 Section-7 : EMPLOYMENT & BUSINESS STRUCTURE

1(a) In this Village

orkers in the Establishment (No.) Wage Rate (Rs./day)

Permanent Casual
No. of No. of No. of Worker Worker
Salaried Casual Piece-rate
Workers Workers Workers
Male Female Child* Male Female Child*

11 12 13 14 15 16 17 18 19
 Piece
Rate
(typical day)

20
 1. Name of Respondent :
2. Name of Respondent :

Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Sl.
No.

Village Code Panchayat Code

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
 Section-7 : EMPLOYMENT & BUSINESS STRUCTURE
1. Name of Respondent :
2. Name of Respondent :
1(b) Outside this Village

No. of Main Activity of this Enterprise

Establishment Establishments in
this Village {Use Code}

2 3 4

Factory
Grain Furnace
Rice Huller
Flour Mill
Gur Making Unit
Khandsari Making Unit
Oil Extraction Units
Bakery
Lime Kiln
Brick Kiln (for baked bricks)
Bicycle Repair Shop
Tractor/vehicle Electronic Repair Shop
Tea Shops
Eating Houses
Tailors
Blacksmith
Masons
Carpenters
Weavers
Cobblers
Potters
Handcrafts
Washer Man
Barber
Cinema House
Vegetable shops
Grocery shops
Dairy farm
Poultry farm
Piggery farm
PCO
BUSINESS STRUCTURE Section-7 : E
Designation :
Designation :
s Village

Does this No. of Workers in the Establishment

Establishm
Type of Power Used ent offer
Does this Establishment Get Jobs in
(Mechanical=1; Non- Govt. Subsidy? (Yes=1, No=2) Lean
Mechanical=2) Season? Total No. No. of
(Yes=1, Workers No. of
of
No=2) Workers from this Women
Village

5 6 7 8 9 10
 Section-7 : EMPLOYMENT & BUSINESS STRUCTURE

1(b) Outside this Village

orkers in the Establishment (No.) Wage Rate (Rs./day)

Permanent Casual
No. of No. of No. of Worker Worker
Salaried Casual Piece-rate
Workers Workers Workers
Male Female Child Male Female Child

11 12 13 14 15 16 17 18 19
 Piece
Rate
(typical day)

20
 Section-7 : EMP

2(a) Have Non-residen

Last 5 Years? (Yes-1, N
Village Identification
[to be copied correctly from Introduction/Cover Sheet] 2(b) If Yes, For What T

Sl.
No.

Village Code Panchayat Code

1
2
3
4
5
6
 Section-7 : EMPLOYMENT & BUSINESS STRUCTURE Section-

2(a) Have Non-residents Come to this Village for Work in the

Last 5 Years? (Yes-1, No-2)

3(a) Normal Daily Wage-rate in

2(b) If Yes, For What Type of Work? -----

Now Sl.
Type of Work (Yes-1, No-2) No.

2 3 1

Casual Labour for Agriculture Cultivation

Casual Labour for Non-agriculture 1
Casual Labour for Harvesting 2
Road Construction 3
Canal Deepening 4
Well Digging 5
Harvesting
6
Post-Harvesting
7
8
9
 Section-7 : EMPLOYMENT & BUSINESS STRUCTURE

3(a) Normal Daily Wage-rate in the Village for Casual Agricultural Laborers for Various Operations (Exclude
Harvesting)

This Village (Rs./day) Nearby Village (Rs./day)

Operation

Male Female Child Male Female

2 3 4 5 6 7

Cultivation
Ploughing
Sowing
Transplanting
Irrigation
Weeding
Harvesting
Harvesting
Post-Harvesting
Hoeing
Threshing
Winnowing
 Section-8 : EMPLOYMENT & BUSI

Operations (Exclude 3(b) Daily Crop-wise Wage Rate for Harvesting

by Village (Rs./day) This Village (Rs./day) Nearby Village (Rs./day)

Sl.
No. Operation

Child Male Female Child Male Female

8 1 2 3 4 5 6 7

1 Paddy
2 Wheat
3 Sugarcane
4 Vegetables
5 Cotton
6 Oil seeds (til)
7 Coconut
8 Other (specify)
OYMENT & BUSINESS STRUCTURE

Particulars Response

by Village (Rs./day)
3(c) Average Wage Rate Under MGNREGS (Rs./day)

Child

8
 1. Name of Respondent :
2. Name of Respondent :

(A) ). Does Your Village Have a

Village Identification (B) If No (in A above), then Nam
[to be copied correctly from Introduction/Cover Sheet] (C) Details of All Associated Vil

Village
ID

Village Code Panchyat Code

1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
 Section-08 : LOCAL GOVERNANCE
1. Name of Respondent :
2. Name of Respondent :
Question
(A) ). Does Your Village Have a Panchayat? (Yes-1, No-2)
(B) If No (in A above), then Name of the Panchayat With Which Your Village is Associated
(C) Details of All Associated Villages -----

One way
Village Code
Distance
Name of Associated Village From
(From
(Revenue Villages) the Village
Election
(Write the Name of the Village Headquarter/ Having
Commission’s
Panchayat First) Panchayat
Records)
Headquarter
(in kms.)

2 3 4
: LOCAL GOVERNANCE
Designation :
Designation :
Response

Was Village Part of this Panchayat?

Population of the Associated Villages
(Yes-1, No-2)

Previous
Census
Current Now Panchayat
2011*

5 6 7 8
 Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Sl.
No.

Village Code Panchyat Code

1
2
 Section-08 : LOCAL GOVERNANCE

(D) Details of Elected Panchayats : Elections

When were the

Elections Held?
No. of
Panchayat Term Elected Members
Month of this Panchayat?
Year
(Use Code)

2 3 4 5

Current Panchayat
Previous Panchayat
 Section-08 : LOCAL GOVERNANCE

(D) Details of Elected Panchayats : Elections

Reservations for Pradhan?

Total (1-Yes; 2-No)
Population
Represented by
this Panchayat? Women SC ST

6 7 8 9
CAL GOVERNANCE Section-08 : LOCAL GOVERNANC

(E) Details of Elected Panchayats : Political Structure

Is district seat reserved for?

(1-Yes; 2-No)
Sl.
No. Panchayat Term
OBC Women SC ST OBC

10 1 2 3 4 5 6

1 Current Panchayat
2 Previous Panchayat
08 : LOCAL GOVERNANCE

ats : Political Structure

Is Block seat reserved for?

(1-Yes; 2-No)

Women SC ST OBC

7 8 9 10
 Village Identification (1). Organizations & No
[to be copied correctly from Introduction/Cover Sheet]

Sl.
No.

Village Code Panchyat Code

1
2
3
4
5
6
7
8
9
10

11

12
13
14
 Section-08 : LOCAL GOVERNANCE

(1). Organizations & Non-panchayat Government Officials in the Village (2). Decision-M

Now Sl.
Particulars (Number) No.

2 3 1

Self Help Groups 1

Other Community Groups 2
NGO Workers 3
Government Officials Working Outside Village 4
VDO 5
BDO 6
ANM 7
LHV 8
Mukhya Sevika/Supervisor (ICDS) 9
Other ICDS Functionaries (CDPO/DPO) 10
Functionaries of Water Works/Jal Nigam (such as – Junior
Engineer, Executive Engineer) 11

District Inspector of Schools (DIOS) 12

Others 13
Banking Correspondents 14
LOCAL GOVERNANCE

(2). Decision-Making at the Village Level

Who Makes Main

Local Public Goods Decisions?
(Use Code)

2 3

Drinking Water Supply (hand-pumps and piped water supply)

Sanitation and Sewage
Rural Roads
Irrigation Facilities (canals, ponds and wells)
Transportation (bus stops)
Electrification
Street lighting
Credit & Input Subsidies For Farmers
Communication Facilities
School & Education

Health and Nutrition Facilities

Natural Resource Management

Seasonal Unemployment
Employment Schemes
 1. Name of Respondent :
2. Name of Respondent :

Village Identification (A) Agency of Credi

[to be copied correctly from Introduction/Cover Sheet]

Sl. No.

Village Code Panchyat Code

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
 Section-09 : FINANCIAL INSTITUTIONS
1. Name of Respondent : Designation :
2. Name of Respondent : Designation :
(A) Agency of Credit - Where do the People in the Village Generally Obtain Credit and put Deposits?

In this If Not, Take

Distance from
Agency Village Village Deposits
(Yes-1, No-2) (in kms.) (Yes-1, No-2)

2 3 4 5

Formal Bank
Cooperative
Private Money Lenders
Employer
Private Bank
Non-Banking Financial Institutions
Grameen Bank
Insurance
Post Office
Multipurpose Co-operative
Agricultural Credit Societies
Agricultural Non-credit Societies
Marketing Co-operative
Consumer Co-operative
Micro-Finance Institutions (MFIs)
 Section-09 : FINANCIAL INSTITUTIONS

and put Deposits?

If yes,
If yes, Give Rate of
Purpose
% Rate Paid Loan Interest (Use Multiple Codes if Necessary)
on Deposit (Yes-1, No-2) Charged
(%)

6 7 8 9 10
NSTITUTIONS

Purpose
Multiple Codes if Necessary)

11 12
 1. Name of Respondent :
2. Name of Respondent :
Village Identification
[to be copied correctly from Introduction/Cover Sheet]

School
ID

Village Code Panchyat Code

1
2
3
4
5
6
7
 Section-10 : SCHOOLS
1. Name of Respondent : Designation :
2. Name of Respondent : Designation :
(A) Details of Schools in the Panchayat

Location Type
(If in the sample (Govt.-1,
If Outside Village,
village, enter Street One Panchayat-2,
School Name Way Distance Non-profit Private-
ID and If outside (km) 3, For Profit,
village: 0)
Private-4)

2 3 4 5
 Section-10 : SC

(A) Details of Schools in

No. of Studen
Grades Taught
Medium of Teaching (Primary-1,
(Use Code) Middle-2, Now
Secondary-3,
(Multiple Codes) Higher Secondary-4)
Total
No.

6a 6b 6c 7 8
 Section-10 : SCHOOLS S

(A) Details of Schools in the Panchayat (A) Det

No. of Students

% %
Now 5 yrs. Ago of Students Getting of Students Getting
Half Fee Concession Full Fee Concession

% of Female in total Total % of Female in total

No.

9 10 11 12 13
 Section-10 : SCHOOLS

(A) Details of Schools in the Panchayat

Composition of Te
Total Number of Teachers (Now)

Year
of Gender
Establishment
Now 5 yrs. Ago
Male Female

14 15 16 17 18
 Section-10 : SCHOOLS

(A) Details of Schools in the Panchayat

Composition of Teachers
(Now)

Qualification No. of
Classrooms
Under Graduate Graduate Post Graduate Specialized Courses
(High school, (B.A., B.Sc. (M.A., M.Sc., (B.Ed, M.Ed,
diploma, etc.) B.Com, etc.) M.Com, etc.) TET, LT, etc.)

19 20 21 22 23
 Section-10 : SCHOOLS

(A) Details of Schools in the Panchayat

Electricity
(Yes-1, No-2)

Smart Classes Library Furniture for Furniture for

Teachers Students

24 25 26 27 28
OOLS Section-10 : SCHOOLS

he Panchayat (A) Details of Schools in the Panchayat

Facilities (Nos.)

Black-board Chalk-duster Laboratory Playground Computers

29 30 31 32 33
ction-10 : SCHOOLS Section-10 : SCHOOL

s of Schools in the Panchayat (A) Details of Schools in the Pan

Additional Information

No. of Classrooms
No. of Students that are Divided
Internet Connection TV/VCR Eligible for Free No. of Contractual to Accommodate
Teachers
Books More than One
Section

34 35 36 37 38
 Section-10 : SCHOOLS

A) Details of Schools in the Panchayat

Additional Information

Do all the
Classrooms have
No. of Classrooms Type of Roofing of Adequate No. of
with Ceiling Fans School Building*
Windows/Proper
Ventilation?**

39 40 41
 Village Identification
[to be copied correctly from Introduction/Cover Sheet]

School
ID

Village Code Panchyat Code

1
2
3
4
5
6
7
 Section-10 : SCHOOLS
(B). Performance of Schools
Incidence of Absence of What Fraction of Students of this School What Fraction of Students of this School
Teachers in the School have passed out 10th grade have Passed out 12th grade
(No. of times)

Now 5 years ago Now 5 years ago Now

2 3 4 5 6
 Section-10 : SCHOOLS
(B). Performance of Schools
action of Students of this School What Fraction of Students from this
ave Passed out 12th grade School Have Enrolled in College/
University in the Immediate Past Year?

No. of students
admitted No. of Students who
under RTE Dropped-outs School
ID
5 years ago Now 5 years ago (Total of (Total of last 5 yrs.)
last 5 yrs.)

7 8 9 10 11 1

1
2
3
4
5
6
7
 Section-10 : SCHOOLS
(C) Drinking Water & Sanitation Facilities In Schools
No. of Functional Units

Does the School Have a

Is Toilet Facility Available Separate Toilet Facility for
in School? Boys and Girls?
(Yes-1, (Yes-1, No-2,
No-2) If Not a Sanitary Toilets Urinals
Co-ed School-3)

2 3 4 5
 Section
In Schools (C) Drinking Water &

Any Evidence of Open

Was Any Toilet (s) Found
Locked & Not Available for If Yes in Col. 6, then Whether Toilets are Defecation/ Urination
Use at the Time of Visit to Reasons for the Same Properly Cleaned and seen around the Toilet
the School? (Not Functional-1, Not Maintained? Block in the School?
(Yes-1, Clean-2, Only for
No-2) Teacher’s Use-3, Other (Yes-1, (Yes-1,
Reasons-4) No-2) # No-2) #

6 7 8 9
 Section-10 : SCHOOLS
(C) Drinking Water & Sanitation Facilities In Schools
Status of D
Is a Functional Water Whether the School has a
Supply Facility Available Whether Hygiene
Education is Imparted to Proper Facility for Potable
for All the Toilets? Children in the School? Drinking Water? If Yes in Col. 12, then Type
(Yes for All-1, For only a of Facility
(Yes-1, (Yes Available &
Few-2, Not available at all- Functional-1, Yes (Handpump-1, Water
No-2) Fountain-2, Open/ Closed
3) # Available but Not Well-3, Others-4)
Functional-2, Not
Available-3)

10 11 12 13
 Section-10 : SCHOOLS
(C) Drinking Water & Sanitation Facilities In Schools
Status of Drinking Water Facilities

General Cleanliness
Around the Drinking
Water Facility in the How is the Water Is there a Provision of
How is the Water Being Separate Utensil for Each
School Usually Stored? (Use Code) Normally Drawn-out from of the Children to Draw
(Clean-1, Average-2, the Vessel? (Use Code)
Dirty-3) the Water? (Use Code)

14 15 16 17
 (D). Statu
Village Identification
[to be copied correctly from Introduction/Cover Sheet]

School
ID

Village Code Panchyat Code

1
2
3
4
5
6
7
 Section-10 : SCHOOLS
(D). Status of Mid-Day Meal (MDM) Facilities In Schools

Does the Pradhan Is the Food under

Is the MDM Scheme Since when is the have a say in the the Scheme being Amount of Food per
Operational in the Child being Served
School? MDM functional in MDM distributed to all under the Scheme
the School? (Year) Management? the Students?
(Yes-1, No-2) (Yes-1, No-2) (Yes-1, No-2) (Use Code)

2 3 4 5 6
 Section-10 : SCHOOLS
(D). Status of Mid-Day Meal (MDM) Facilities In Schools

Person Responsible
Type of Menu Being Place where the
for Cooking the Children Frequency of Where is Ration
are usually Receiving the Ration
Served Food under the Served the Food under the Scheme Usually Stored
(Use Code) Scheme (Use Code)
(Use Code) (Use Code) (Use Code)

7 8 9 10 11
 Section-10 : SCHOOLS
hools (D). Status of Mid-Day Meal (MDM) Facilities In School

Is there
an
Established
Mechanism
Status of the Status of Serving How are Leftovers How are the of
Plates under the Serving Plates
Cooking Area Scheme Being Utilized? Cleaned? Monitoring the
(Use Code) (Use Code) MDM
(Use Code) (Use Code) Scheme?

(Yes-1, No-2)

12 13 14 15 16
n-10 : SCHOOLS
y Meal (MDM) Facilities In Schools
If Yes in Col. 16, then No. of Visits Made by the Following in the last
12 Months

Officials of the Officials From Other

Education Department
Departments
(including BRCs/CRCs/ Dy. Block Officials (such as, Health
Inspector/Sub-Inspector/ Dept.)
Inspector of Schools, etc.)

17 18 19
 1. Name of Respondent :
Village Identification 2. Name of Respondent :
[to be copied correctly from Introduction/Cover Sheet]

Sl. No.

Village Code Panchyat Code

3
4
5
6
7
8

10
 Section-11 : HEALTH SERVICES AND HOSPITALS
1. Name of Respondent : Designation :
2. Name of Respondent : Designation :
(A) Health Care Centres
Nearest
Available
(one way Year of Number of Patients
Particulars distance Establishment Treated/ day
from
this village)
(in kms)

2 3 4 5

Health Sub-centre
Subsidiary Health Centre (with maternity and child
health care and laboratory)
Primary Health Centre
Govt. Hospital
Family Planning Clinic
Anganwadi
Private Clinic – Allopathic
Private Hospital – Allopathic
Private Clinic – Alternate Medicine
(unani/homeopathic/ayurvedic/traditional)
Private Hospital – Alternate Medicine
(unani/homeopathic/ayurvedic/traditional)
TALS Section-11 : HEALTH SERVICES AND

(B) Availability of Health Faciliti

How Many days in a No. of hrs. Open Sl.

Week it is Open? Per Day No. Particulars

6 7 1 2

1 Health Sub-centre
Subsidiary Health Centre (with maternity and child
2 health care and laboratory)
3 Primary Health Centre
4 Govt. Hospital
5 Family Planning Clinic
6 Anganwadi
7 Private Clinic – Allopathic
8 Private Hospital – Allopathic
Private Clinic – Alternate Medicine
9 (unani/homeopathic/ayurvedic/traditional)
Private Hospital – Alternate Medicine
10 (unani/homeopathic/ayurvedic/traditional)
1 : HEALTH SERVICES AND HOSPITALS

(B) Availability of Health Facilities

Male Doctor in Place Female Doctor in Place Beds Available for Availability of Medicin
Delivery & Treatment (Yes-1, No-2)

Yes-1, No. Yes-1, No. Yes-1, No. Malaria Diphtheria

No-2 No-2 No-2

3 4 5 6 7 8 9 10
 Section-11 : HEALTH SERVICES AND HOSPITALS

(B) Availability of Health Facilities

Availability of Medicine Availability of following Tests at the F
(Yes-1, No-2) (Yes-1, No-2)
Sl.
No. Particulars
Dengue Hepatitis Rehydratio Blood Urine
n salt

11 12 13 1 2 3 4

1 Health Sub-centre
Subsidiary Health Centre (with maternity
2 and child health care and laboratory)
3 Primary Health Centre
4 Govt. Hospital
5 Family Planning Clinic
ability of following Tests at the Facilities
(Yes-1, No-2)

Stool Malaria Others

5 6 7
 Section-11 : HEALT

(C)
Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Sl. No.

Village Code Panchyat Code

4
Section-11 : HEALTH SERVICES AND HOSPITALS

(C) Health Workers

Yes-1,
Health Workers No-2

2 3

Trained Dai

Health Guide

Trained Male Health Worker

Trained Female Health Worker

 Section-11 : HEALTH SERVICES AND HOSPITALS

(D). Mobile Health Clinics and Vans (E). Other Relevant Information

No. of deaths of married women

No. of Mobile Health Clinics and Vans due to complications during
operating in the Village pregnancy
(past 1 year)

1 1
ERVICES AND HOSPITALS

(E). Other Relevant Information

No. of deaths of children in the No. of live births within the

age group 0-5 years due to illness village
(past 1 year) (past 1 year)

2 3
 Section-11 : HEALT
Village Identification
[to be copied correctly from Introduction/Cover Sheet]

Sl. No.
Village Code Panchyat Code

10

11

12

13

14
Section-11 : HEALTH SERVICES AND HOSPITALS

(F) Visit of Government Workers to the Village for the Following Services
Frequency of Visits (Use Code)

Services
Health Workers

2 3

Chlorinate Wells

Malaria Eradication - Spraying

Malaria Eradication - Blood slides

Malaria Eradication - Quinine Pills

Blindness Prevention & Cure

Immunization of Children

Help Pregnant Women - Iron & Vitamin Pills

Help Pregnant Women - Deliver babies

Food Supplements - For Breast Feeding Women

Food Supplements - For Children

General Health Education

Family Planning Education

Contraceptive Distribution

HIV-AIDS Awareness
 Section-11 : HEALTH SERVICES AND HOSPITALS

Workers to the Village for the Following Services

Frequency of Visits (Use Code)

Doctors Govt. Officials

4 5
RVICES AND HOSPITALS

(G). Polio Eradication Program

Total Number of Children in How Many of these Children

Village (below 6 years) were Given Pulse Polio?

1 2