1.

Household Survey
Data Collector
Data Collection Date
Name
Governorate District Sub-district Village/Camp
Locations

Introduction and Consent:

My name is __________ and I am collecting data for …… as an external evaluator for the MPCA
project that provided support to you and your community.
The purpose of this interview is to learn about your experience as a beneficiary of this project.
We expect that the interview will last approximately 30-45 minutes. Your answers and opinions
will remain anonymous. Anything you say will not have any impact whatsoever on your inclusion
or exclusion of any programs that are currently being implemented or will be implemented in
the future.

Participation is completely voluntary, and you have the freedom to leave the discussion at any
time or not answer one or more questions, without consequence. In case you do not want to
participate, it will not involve any loss of benefits or penalty. You will not receive any
compensation or payment for participating in this discussion.

We will treat everything you say today with respect and want you to feel comfortable sharing
your observations and opinions. There are no wrong answers. Keep in mind that we're just as
interested in negative comments as positive comments, and at times negative comments are
most helpful.

Do you have any questions?

Do you wish to be interviewed?

Interviewee’s Consent:

Yes: ____________ No: ___________

1.1 Demographic- and Socio-economic Characteristics:

Respondent’s name1 Text

 Yes
Are you the recipient of the MPCA?
 No
If no, thanks the respondents and move to another
one.
 Yes
Are you the head of household?
 No

1
Although it could be a sensitive information, it would help ….. to have a better identification for the case if
any red flag arose.

1
If yes, respondent age Integer
 Male
If yes, respondent gender
 Female
 Male
If no, what is the gender of the household head?
 Female
 Brother
 Sister
 Father
If no, what is your relation to the head of the
 Mother
household?
 Son
 Daughter
 Wife
What is your household size including yourself?
Hint: household means a group of individuals living under
one roof with joint household habits (common shopping, Integer
eating), even when they are not relatives, and their number
is large.
 Adult with disability/chronically ill
 Children with disability/chronically ill
Does your household have any of those categories
 Pregnant and Lactating Women
among its members?
 One or more children under 5-year-old in
the household
 Old IDP (more than 3 months)
 New IDP (less than 3 months)
What is the status of the household?  Returnee
 Resident household
 Resident household hosting new IDPs
Please define other Text
 Cash and Cash Equivalents (Includes
currency, bank accounts)
 Real Estate: (Property ownership,
including homes, land, etc.)
 Personal Property: (Vehicles, furniture,
electronics, and other personal
What are your assets?
belongings)
Select-Multiple
 Investments
 Business Ownership: Shops, enterprises
 Other
 None
 Prefer not to say.
 Other
Please define other Text
What were your household’s primary income sources  Regular employment in private sector
of the last 30 days (do not read out loud from list)?  Regular employment in public sector
Select-Multiple  Temporary or daily wage-earning
employment
 Own business

2
  Remittances
 Retirement fund or pension
 Selling household assets
 Selling the assistance received
 Cash assistance.
 Support from the community, friends and
family (including borrowing money)
 NGO or charity assistance
 Social services (disability allowance)
 Other
Please specify other Text
 More than 2 million
 Between 1,4 to 2 million
What is your household monthly income?
 Less than 1,4 million
 I don’t know

1.2 Accountability:
This section will be asked at the end of the PDM survey.

 Very aware
How aware are you of the Feedback and Complaint  Somewhat aware
Mechanism (FCM) available to you?  Not very aware
 Not aware at all
Have you ever used the FCM to provide feedback or  Yes
lodge a complaint?  No
 Lack of awareness about the existence of
the FCM.
 Perceived complexity in using the FCM
process.
 Doubts about confidentiality
 Uncertainty about the effectiveness
If no, why?
 Previous negative experiences
 Cultural or personal reasons
 Fear of retaliation
 Belief that the issue is too minor
 Assumption that nothing will change
 Other
Please define other Text
 Very satisfactory
 Satisfactory
If yes, how would you rate your overall experience?  Neutral
 Unsatisfactory
 Very unsatisfactory
If yes, how easy was it to access the FCM?  Very easy
 Easy
 Neutral

3
  Difficult
 Very difficult
 Yes, within the expected time frame
Did you receive a timely response after providing
 Yes, but later than expected
feedback or lodging a complaint?
 No, I did not receive a response
 Very satisfied
 Satisfied
How satisfied are you with the resolution or outcome
 Neutral
provided?
 Dissatisfied
 Very dissatisfied
 Organization’s Hotline
 In person to organization’s staff
 Complaints box
Which feedback and complaints mechanism do you  Local authorities
prefer?  WhatsApp number
 Email
 Help desk during distribution
 Other, please specify

1.3 Assistance Received:

 One time
 Two times
How many times did you receive the CASH?
 Three times
 More than 3 times
What was the amount of money you received? (in USD) Integer
 Face-to-face
Which delivery mechanism was used to deliver your  From exchange company
cash assistance?  Through agents
 Other
Please define other Text
Did anyone ask you for payment at any point in the  Yes
process (from registration to collection of assistance  No
even after collection of the assistance)?  Prefer not to say
If yes, please provide details regarding the amount of
payment, the name of the person, his/her gender, the Text
position and the organization if applicable.

1.4 Selection Criteria:

How did you learn about the Multi-Purpose Cash  Through family or friends
Assistance program??  Via a community meeting
 Through local NGOs or aid organizations
 Via social media or other online
platforms
 Through health workers
 Other (please specify)
 I was not aware about the MPCA before

4
 receiving it
Please define other Text
If the answer for the previous question wasn’t (I was
 Yes, all the information I needed
not aware about the MPCA before receiving it)
 Yes, but not enough
Did you receive enough information about the project
 Very limited information
during the whole process?
 Child at risk
 Unaccompanied/Separated Children
 Women at risk
 Older person at risk
 Single parents (With dependents of age
below 18)
 Survivor of Sexual and Gender Based
Violence
Do you know why you received the MPCA?
 Survivor of Torture
 Serious medical condition
 Eligible based on my household’s
vulnerability assessment
 As a part of a marginalized group that
was prioritized for assistance
 I don’t know
 Other
Please define other Text
 Yes, very clearly
Did you feel that the criteria for eligibility were clearly  Somewhat clear
communicated to you?  Not very clear
 Not clear at all

1.5 Market access and functionality:

 Yes, all of them
Were the items you needed available in your local  Yes, but only some of them
market?  Yes, but they were too expensive
 Items were not available
 No difficulty
 Distance/time taken to travel
Did you experience any difficulties travelling/going to
 Insecurity
the market?
 Lack of transport
(select-multiple)
 Difficulty due to disability
 Other
Please define other Text

1.6 Household expenditure:

What did you spend the cash assistance on?  Food
(select-multiple)  Water
 Hygiene items

5
  Health costs
 Medicines
 Rent
 Shelter repair
 Shelter maintenance
 Shelter NFI
 Clothes/shoes
 Utilities and bills
 Assets for a livelihood activity
 Children's Education
 Transport
 Communication
 Electricity
 Debt repayment
 Saved some money
 Gave some to other family
members/relatives /friends
 Legal assistance/documents
 Other
Please define other  Text
 Food
 Water
 Hygiene items
 Health costs
 Medicines
 Rent
 Shelter repair
 Shelter maintenance
 Shelter NFI
 Clothes/shoes
Please select the most three stuff you spent the MPCA  Utilities and bills
on?  Assets for a livelihood activity
 Children's Education
 Transport
 Communication
 Electricity
 Debt repayment
 Saved some money
 Gave some to other family
members/relatives /friends
 Legal assistance/documents
 Other
How long did the cash last before it was all spent?
Integer
(Number of days)

6
 1.7 HH and community dynamics because of MPCA
 Male spouse
 Female spouse
Who in the household decides how to spend the cash  Jointly
received?  All members
 Parents
 Other
Please define other Text
 Yes
Did receiving cash cause any conflict within the
 No
household?
 Prefer not to answer
 No conflict
 Beneficiary selection
 Distribution process
 Way the cash was spent or given away by
Are you aware of any conflict, tension or disagreement beneficiaries
that arose in your community as a result of the cash  Impact of the distribution on the local
distribution? livelihoods
 Impact of the distribution on the local
markets
 I don’t know
 Other
Please define other Text

1.8 Satisfaction
 Very satisfied, nothing could have been
better
To what extent were you satisfied with the process of  Satisfied
receiving your cash assistance (from registration to  Somewhat satisfied, but could have been
cashing out)? better
 Not satisfied
 Very unsatisfied
 The registration process was too
complicated and time-consuming.
 There was a lack of clear communication
about the steps involved.
 I experienced delays at multiple stages,
from registration to cashing out.
If somewhat, not satisfied or very unsatisfied, why?  The staff were not helpful or lacked the
necessary information.
 The locations for cashing out were too far
or inconvenient.
 My revived money was torn, making
buying difficult.
 Other
Please define other Text

7
  Cash
 Voucher
What is your preferred assistance method?  In-kind
 Vocational training
 Other (Identify)
 Very satisfied, nothing could have been
better
 Satisfied
Are you satisfied with the amount of cash you received?  Somewhat satisfied, but could have been
better
 Not satisfied
 Very unsatisfied
 The amount is insufficient to cover basic
needs like food, rent, and utilities.
 The cost of living has increased, making
the cash assistance less impactful.
 I have a large family, and the per capita
If somewhat, not satisfied or very unsatisfied, why? assistance doesn’t account for that.
 There have been delays in receiving the
payments, causing financial strain.
 The amount hasn’t been adjusted for
inflation or local economic changes.
 Other
Please define other Text

1.9 Accessing basic needs

 All
How much of your Basic Needs (Rent, Food, Hygiene
 Most
Items, Electricity, Water, Transportation and
 Some
Communication, etc..) were you able to meet?
 None
Which of your household’s basic needs can you not  Food
afford?  Water
 Hygiene items
 Health care
 Medicines
 Rent
 Shelter repair
 Shelter maintenance
 Shelter NFI
 Clothes/shoes
 Utilities and bills
 Children's Education
 Transport
 Communication
 Electricity
 Debt repayment

8
  Legal assistance/documents
 None
 Other
Please define other Text
 The amount received was not enough to
cover all essential expenses.
 Unexpected medical emergencies or
health-related costs arose.
 Increase in rent or utility bills that
exceeded the budget.
 Educational expenses for children, such
as school fees or supplies.
If the answer isn’t “None”, Why?
 Debt repayment obligations that had to
be prioritized.
 Food prices increased significantly,
reducing the purchasing power of the
cash assistance.
 Transportation costs for work or school
were higher than anticipated.
 Other
Please define other Text

1.10 Negative Coping Strategies

 Selling household property
 Spending savings
 Buying food on credit or through
borrowed money from relatives and
friends
 Selling means of transport
 Children dropout from school
 Reducing expenditure on non-food items
During the past 30 days, did anyone in your household (health, education)
have to do one of the following things because there  Changing place of residence and
was not enough food or money to buy it? accommodation to reduce expenses.
 Children under 18 work to provide
resources.
 Anyone in family migrating
 Attending banquets held on religious and
social events to have food
 Child marriage
 Forced marriage (for adults)
 Other
Please define other Text
During the last 7 days, how many times, in days, did  Shifting towards cheaper and less quality
your household have to employ one of the following food items
strategies to cope with a lack of food or money to buy  Borrowing food or asking assistance from

9
 relatives and friends
 Reducing the number of daily meals
it?  Consume less food during meals.
 Curbing the adults’ need to ensure food
needs of children


1.11 Food Consumption Score

How many days in the past 7 days did your
household consume Cereals, grains, roots
Integer
and tubers (rice, pasta, bread, potato)? (0-7
days)
How many days in the past 7 days did your
household consume Legumes/nuts (beans,
Integer
peanuts, lentils, nut, soy and/or other nuts?
(0-7 days)
How many days in the past 7 days did your
household consume ) Milk and other dairy
products (fresh milk, yogurt, cheese, other
Integer
dairy products, excluding margarine/butter
or small amounts of milk for tea/coffee)? (0-7
days)
How many days in the past 7 days did your
household consume Meat, fish and eggs
Integer
(goat, beef, chicken, fish including canned
tuna and/or other seafood, eggs)? (0-7 days)
How many days in the past 7 days did your
household consume vegetables and leaves
(spinach, onion, tomatoes, carrots, peppers,
green beans, lettuce, cabbages, eggplant)?
(0-7 days)
How many days in the past 7 days did your
household consume Fruits (banana, apple,
lemon, mango, watermelon, apricot, peach, Integer
pineapple, passion, orange, avocado, wild
fruits, etc.)? (0-7 days)
How many days in the past 7 days did your
household consume Oils, fats and butter
Integer
(vegetable oil, palm oil, margarine, other
fats)? (0-7 days)
How many days in the past 7 days did your
household consume Sugar or sweets (honey,
Integer
jam, cakes, candy, cookies, pastries, cakes
and other sweets)? (0-7 days)
How many days in the past 7 days did your Integer
household consume Condiments and spices
(tea, coffee, cocoa, salt, garlic, spices, yeast,
10
 tomato)? (0-7 days)

1.12 Household Hunger Scale

Q1: In the past [4 weeks/30 days], was there ever

 No (Skip to Q2)
no food to eat of any kind in your house because
 Yes
of lack of resources to get food?
 Rarely (1–2 times)
Q1a: How often did this happen in the past [4
 Sometimes (3–10 times)
weeks/30 days]?
 Often (more than 10 times)
Q2: In the past [4 weeks/30 days], did you or any
 No (Skip to Q3)
household member go to sleep at night hungry
 Yes
because there was not enough food?
 Rarely (1–2 times)
Q2a: How often did this happen in the past [4
 Sometimes (3–10 times) Often
weeks/30 days]?
(more than 10 times)
Q3: In the past [4 weeks/30 days], did you or any
household member go a whole day and night  No (Skip to the next section)
without eating anything at all because there was  Yes
not enough food?
 Rarely (1–2 times)
Q3a: How often did this happen in the past [4
 Sometimes (3–10 times)
weeks/30 days]?
 Often (more than 10 times)

1.13 Priority needs

What are your family’s top (4) priority needs?  Food
 Water
 Hygiene items
 Health care
 Medicines
 Rent
 Shelter repair
 Shelter maintenance
 Shelter NFI
 Clothes/shoes
 Utilities and bills
 Children's Education
 Transport
 Communication
 Debt repayment
 Legal assistance/documents

11
  Productive assets
 Employment
 Cash
 Other
Please define other Text

1.14 Impact of MPCA to HH

 To pay debts
 To pay rent
 To meet basic needs
 To purchase household items
 To help others by giving them some
How did this cash assistance help you? money to invest in a small business.
(Select-Multiple)  To help to build / rehabilitate my house.
 To feel better to improve my health
condition.
 Other
 It did not help my current situation.
 Other
Please define other Text
Do you think these impacts will continue into the coming  Yes
month?  No
 I have made budget adjustments that
should alleviate the financial strain.
 I am due to receive other forms of
assistance that will help meet our needs.
If yes, why?  The prices of essential goods are
expected to decrease soon.
 I have found more affordable alternatives
for some of our expenses.
 Other
Please define other Text
 Because the cost of living is constantly
rising, and the assistance doesn’t match
it.
 There are no signs of my financial
situation improving in the near future.
 Because the assistance is periodic and
If no, why? the gaps between payments are
challenging.
 The economic conditions in the area are
deteriorating, not improving.
 Because the underlying issues causing
financial strain have not been addressed
 Other
Please define other Text

12
  Assistance amount not enough
If the answer for the previous question was “It did not help
 Assistance ran out too quickly
my current situation”
 Wrong type of assistance
To what extent did the assistance not help improve your
 Assistance only provides short-term relief
overall situation?
 Other
Please define other Text

1.15 MPCA Receiving Process (Distribution process)

 Yes
Did you receive the cash from the distribution points or
 No
location?
 If no don’t ask the following questions
 Through community meetings
 Via SMS or phone call
How were you informed about the MPCA distribution
 Through local authorities or NGOs
schedule and location?
 I was not informed.
 Other
Please define other Text
 Very convenient
How convenient was the location of the cash distribution  Somewhat convenient
point for you?  Not convenient
 I did not attend the distribution
 The distribution point was too far from
my home, requiring long travel.
 I had no access to reliable transportation
to reach the distribution site.
 The area was not safe, making it risky to
travel to and from the location.
 The distribution point was always
overcrowded, leading to long waiting
If not convenient why?
times.
 The location was not accessible for
people with disabilities or the elderly.
 There were no facilities like restrooms or
seating areas at the distribution point.
 The timing of the distribution clashed
with my work or other responsibilities
 Other
Please define other Text
- 15 mins
If the answer was “The distribution point was too far from -30 mins
my home, requiring long travel”, How far was the -45 mins
distribution location from your place? -1 hour
-More than one hour
Did you feel safe during the cash distribution process?  Yes, completely safe
 Somewhat safe
 Not safe

13
  I did not attend the distribution
 There was a lack of security personnel at
the distribution site.
 The area around the distribution point
was known for high crime rates.
 There were instances of theft or
harassment reported during previous
distributions.
 The crowd management was poor,
If not somewhat safe or not safe, why?
leading to chaotic and unsafe conditions.
 I heard about safety incidents from other
beneficiaries that made me feel uneasy.
 The distribution took place in an isolated
area with no nearby assistance.
 There was tension among beneficiaries,
creating a hostile environment.
 Oher
Please define other Text

 Very well organized

How would you rate the organization and management of  Somewhat organized
the distribution site?  Poorly organized
 I did not attend the distribution
 Very helpful and respectful
 Somewhat helpful and respectful
Were the staff at the distribution site helpful and respectful?
 Not helpful and respectful
 I did not interact with the staff
 The staff were rude and did not listen to
our concerns.
 They treated us with impatience and
seemed annoyed by questions.
 Some staff members were discriminatory
or biased in their behavior.
 The staff did not provide clear
instructions and ignored those who
needed help.
If not helpful and respectful, why?
 There was a lack of empathy for our
situation and no respect for our dignity.
 Staff members were unprofessional,
engaging in personal conversations
instead of assisting us.
 They did not maintain privacy and
confidentiality when handling our
personal information.
 Other
Please define other Text
How long did you have to wait to receive the cash  Less than an hour

14
  1-2 hours
assistance?  More than 2 hours
 I did not attend the distribution

15