Questionnaire for Socio-Economic Survey

1. State :………………………………….., District………………………………….., Block

2. Name of the Panchayat……………………..……………….Name of Village……………………….…
1. Head of the family…………………………………………………………………………………………
Mobile no……………………...Caste……………………..Religion……………………………………..
House condition……………….Toilet-Yes/No………….T.V /Dish yes/No……………………………..
2. Occupation………………………………..Monthly income……………………..
3. Vehicle…………………….. Electricity yes/ No ……………………..
4. Structure of Family
5. 8. Occupation of the respondent:
6. a) Government servant d) Wage labor
7. b) Farmer e) Self employed
8. c) Private servant f) Any other (name)

Male in no. Occupation/Qualification Female in no. Occupation /Qualification

9. Domestic cattles status

Sl.No Cattles name In numbers Milk production(in Ltrs) Domestic use Sell (in Ltrs.)
1 Cow
2 Buffalo
3 Ox
4 Goat/ Sheep
5 Horse/ Ass
6 others

10. Current Land -Small land holding less than 1 acre yes/ no………………………………………………
11. Landless/ Nill yes/ no …………………Large land holding more than 1 acre yes/ no………………….
12. Water Demand and availability in litres
1. Water Demand………………………………………………………………………………………………
2. Water availability………………………………………………………………………………………..
3. Water source for irrigation (mention)………………………………………………………………….
4. Water source for drinking purpose (mention)……………………………………………………………..
5. Water requirements for drinking in litres /day (including animals reqd.)………………………..….….
6. Water source: 1. Summer ……………………………… 2. Winter………………………………………..

Crops production Organic/ In-organic

Organic crops/ summer crop
Sl.No. Crops Production Domestic use Sell Rate

In-organic crops/ summer crop

Sl.No. Crops Production Domestic use Sell Rate

In-Organic crops/ Winter crop others indicate

Sl.No. Crops Production Domestic use Sell Rate
 In-Organic crops/ winter crops others indicate
Sl.No. Crops Production Domestic use Sell Rate

Doses/ name of fertilizer / Doses of insecticide/ cost Other costs for the Organic
cost cultivation of crops compost type /
cost

7. Use of fuel wood, foddar /Agriculture/ forest leaves/foddar /day requirements : Yes/ No. ………,
………………… …………………………………………………………………………………………..
8. i) Types of fodder__________________

ii) Fodder obtained from: a) Fields b) Forests c) Market d) Other

iii) If from forests, mention trees______________________________
iv) Amount of fodder as consumed per day (in kg):
9. Source of fodder for the cattle/Grazing in forest/pasture
lands…………………………………………………………………………………………………………
……

10. Mention the fodder fuelwood name with local name

………..………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
 11. a) What are the important services from nearby forests ?

FODDER(in kg) FIREWOOD(in kg) FRUITS (in kg) MEDICINAL PLANTS OTHERS

b) Any type of Non-wood forests product? Yes No

c) If yes, for:

i) Resin iv) Fibers vii) Sericulture

ii) Gums v) Medicinal plants viii) Lac culture

iii) Dyes vi) Apiculture ix) Any other

Interfere of wild animals in the agriculture fields : Yes No

If yes, specify name and problem: __________________________________________

Comments
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Head of the family signature/date………………………………….

Surveyor…………………………………………………………….Mobile No………………………