Socio Economic Survey of MG Locality

Questionnaire Household-
level

1. Name (Head of the Family)

2. a. Have you migrated from rural/semi-urban/Urban areas? Yes/ No
b. If your answer is ‘Yes’ then how long ?
1. Demographic Features:
No. of family members Male Female Total
1 No. of children (Below 5 Yrs.)
2 No. of children (5-18 Yrs.)
3 No. of adults (18-60 Yrs.)
4 No. of adults (Above 60 Yrs.)
Total

No. of working members(full time/part time works) Male Female Total

Adult

Education level Male Female Total

Chil Adult Chil Adul Chil Adul
d d t d t
NIL
Upto Primary level
Upto Sec. level
Upto HS level
Upto Undergraduate level
Graduate level

Occupational Structure
Occupations of Agricultural Industrial Activities Service Activities
Activities
Adults No. (Male)

(Female)

Income & Assets:

Household Assets Yes No
Own House
Rented House
TV
Radio
Mobile Phone
Bicycle/Van Rickshaw
LPG connection
Sewing Machine
Gold/Silver ornaments
Any other (specify)
 Socio Economic Survey of MG Locality
Please Put Tick mark
Monthly Income( ) Less 501- 1001- 2001- 4001- 6001-
than 1000 2000 4000 6000 above
500
Adults a. Male
b. Female

Expenditure Pattern
Expenditure on Monthly Expense Yearly Expense
Food Items
Fuel
Electricity
Housing
Clothing & Footwear
Medical Expenses
Child Education
Conveyance
Telephone/Mobile Charges
Social Functions/Obligations
Enjoying Cinema
Sightseeing/Tour
Purchase Ornaments
Any other

Saving/Borrowing Pattern
Saving/Borrowing Response of the Household
Do you have any savings account with post Yes No
office/ bank
What is your average monthly saving?
Have you borrowed money during the last Yes No
5 years
Mention the source of your borrowing Individual/ Bank/
relatives. Co-operatives/post
office

Amount borrowed
Interest payment
Amount outstanding