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National Population Census 2011 -- Nepal

Schedule 1

Questions in this schedule should be asked to the household head or to a household (HH) member who is able to answer. Answers should be marked by circling the number corresponding to the appropriate answer.

Contact telephone no. ____
Total page _ of _

____ District
____ V.D.C/Municipality
____ Ward No.
____ Enumeration Area no.
____ Village/Settlement/Tole

____ House no.
____ Household no.

____ First and last name of household head

Sex of household head:

[] 1 Male
[] 2 Female

Household members:
Usually live:

____ Total
____ Male
____ Female

Absent [within country]:

____ Total
____ Male
____ Female

Absent [abroad]:

____ Total
____ Male
____ Female

Household Information

1. What is the type of the house occupied by the household?

[] 1 Own
[] 2 Rented
[] 3 Institutional
[] 4 Others ____

[2] What is the structure of the house?

[2.1] Foundation

[] 1 Mud bonded bricks/stone
[] 2 Cement bonded bricks/stone
[] 3 Concrete with pillar
[] 4 Wooden pillar
[] 5 Other ____

[2.2] Outer wall

[] 1 Mud bonded bricks/stone
[] 2 Cement bonded bricks/stone
[] 3 Wood/planks
[] 4 Bamboo
[] 5 Unbaked bricks
[] 6 Other ____

[2.3] Roof

[] 1 Straw/thatch
[] 2 Galvanized iron
[] 3 Tile/slate
[] 4 Concrete/cement
[] 5 Wood/planks
[] 6 Earth/mud
[] 7 Other ____

[2.4] No. of floor ____

[2.5] How old is the house? ____

[3] What is the main source of drinking water in your household?

[] 1 Tap / pipe
[] 2 Tube well / hand pump
[] 3 Covered well / kuwa
[] 4 Uncovered well / kuwa
[] 5 Spout water
[] 6 River / stream
[] 7 Other ____

[4] What is the usual type of fuel used for cooking in your household?

[] 1 Wood
[] 2 Kerosene
[] 3 LP gas
[] 4 Cow dung
[] 5 Biogas
[] 6 Electricity
[] 7 Other ____

[5] What is the usual source of lighting in your household?

[] 1 Electricity
[] 2 Kerosene
[] 3 Biogas
[] 4 Solar
[] 5 Other ____

[6] What type of toilet facility are you using in your household?

[] 1 Flush [public sewerage]
[] 2 Flush [septic tank]
[] 3 Ordinary
[] 4 No toilet

[7] Do you have the following facilities in your household?

[Multiple responses is possible]

[] 1 Radio
[] 2 TV
[] 3 Cable TV
[] 4 Computer
[] 5 Internet
[] 6 Telephone
[] 7 Mobile phone
[] 8 Motor
[] 9 Motorcycle
[] 10 Bicycle
[] 11 Other type of vehicle
[] 12 Refrigerator
[] 13 None

[8] Does any female member of the HH own house in any part of Nepal?

[] 1 Yes
[] 2 No [If no, go to number 11]

[9] Does any female member of the HH own land in any part of Nepal?

[] 1 Yes
[] 2 No [If no, go to number 11]

[10] Please tell us the area of land owned by the female member

Unit: Bigha
Area: ____

Unit: Katha
Area: ____

Unit: Dhur
Area: ____

Unit: Ropani
Area: ____

Unit: Anna
Area: ____

Unit: Paisa
Area: ____

[11] Were there any deaths occurred during the last 12 months in your household?

[] 1 Yes
Number: ____
[] 2 No [If no, go to number 13]

[12] Please give us the description of these deceased persons.

Sex:
[] 1 Male
[] 2 Female
Cause of death: ____
Age at death: ____ [year]

Condition at the time of death:

If deceased woman was 15-49 years of age

[] 1 Pregnant
[] 2 Delivery
[] 3 Deaths during 6 weeks from delivery

[13] Are any persons absent from the household living in other countries?

[] 1 Yes
[] 2 No [If no, go to personal information]
[] 3 Don't know [if no, go to personal information]

[14] Give description of persons absent and living in other countries

Sex:
[] 1 Male
[] 2 Female

Age at leaving ____

Passed level of education ____
Code for passed level of education [5 years and above only]: passed level but illiterate, SLC, Intermediate, Diploma, PhD, should be given proper code.

Absent duration ____

Absent reason/purpose
[] 1 Business
[] 2 Personal service
[] 3 Institutional service
[] 4 Study
[] 5 Conflict
[] 6 Dependent
[] 7 Other
[] 8 Don't know

Destination country ____

Personal Information

[2] Please give the first, middle and last name of the persons who usually live in your household [starting from the head of the household]

____ First name
____ Last name

[3] What is the relationship of household head to [the respondent]?

[] 1 Household head
[] 2 Spouse
[] 3 Son/daughter-in-law
[] 4 Daughter/son-in-law
[] 5 Parent
[] 6 Father/mother-in-law
[] 7 Brother/sister
[] 8 Grandson/granddaughter
[] 9 HH worker
[] 10 Other ____

[4] What is the sex of [the respondent]?

[] 1 Male
[] 2 Female

[5] What is the age of [the respondent]?

[Write down completed years, enter "00" if less than one year]

Years ____

[6] What is the caste/ethnicity for [the respondent]? ____

[7] What is the marital status of [the respondent]?

For persons 10 years and above

[] 1 Never married [Go to 9]
[] 2 Once married
[] 3 Multiple spouse
[] 4 Re-married
[] 5 Widow/widower
[] 6 Divorced
[] 7 Separated

[8] What was the age at first marriage of [the respondent]?

Only for married persons

Year ____

[9] What is the religion of [the respondent]? ____

[10] What is the mother tongue and second language of [the respondent]?

[] 1 Mother tongue ____
[] 2 Second language ____

[11] Which country's citizen is [the respondent]?

[] 1 Nepal
[] 2 India
[] 3 China
[] 4 Other ____

[12] What is the physical and mental disability of [the respondent]?

[] 1 No disability
[] 2 Physical disability
[] 3 Blind and low vision
[] 4 Deaf and hard of hearing
[] 5 Deaf-blind
[] 6 Speech problem
[] 7 Mental illness
[] 8 Intellectual disability
[] 9 Multiple disabilities

For person 5 years and above
[Question 13 to 15 asked of persons 5 years and above.]

[13] Can [the respondent] read and write?

[] 1 Read and write
[] 2 Read only
[] 3 Can't read and write

[14] Is [the respondent] currently attending school/college?

[] 1 Yes
[] 2 No

[15] What is the level of education of [the respondent]?

[] 1 Pass level ____
[] 2 Major subject [above SLC] ____

Schedule 2

Questions in this schedule should be asked to the household head or to a household [HH] member who is able to answer. Answers should be marked by circling the number corresponding to the appropriate answer.

[Pg. 2]

For questions 1,2,4,5,7 please write down these information from Form 1
[Information from questions 1,2,4,5, and 7 are repeated on the second page of the personal information form.]

Personal Information

[16] Where is the birthplace of [the respondent]?

Code must be encircled, if the place of birth is other district or other country the name must be specified.

[] 1 Same district [go to 19]
[] 2 Other district ____
[] 1 V.D.C
[] 2 Municipality
[] 3 Other country ____

[17] How long [the respondent] has been staying here?

Only for code 2 and 3 in Question 16. [For respondents who have moved to this district at some point in their lives.]

[Write down completed year; enter "00" if less than one year]

Year ____

[18] What is the main reason for staying in this district of [the respondent]?

[For respondents who have moved to this district at some point in their lives.]

[] 1 Agriculture
[] 2 Business
[] 3 Service
[] 4 Study
[] 5 Marriage
[] 6 Dependent
[] 7 Conflict
[] 8 Others ____

[19] Where was [the respondent] lived 5 years ago?

For persons 5 years and above

[] 1 Same district
[] 2 Other district ____
[] 3 V.D.C
[] 4 Municipality
[] 5 Other country ____

[20] How many children were ever born to [the respondent]?

Only for married women [15-49 years of age]

State all children born alive, by sex.

[] 1 Yes
[] 2 No [If No, go to 22]

If Yes,

Description
[Indicate number of sons and daughters for each category]

1 Living together
_ Son
_ Daughter

2 Living separately
_ Son
_ Daughter

3 Dead
_ Son
_ Daughter

4 Total
_ Son
_ Daughter

[21] Have [the respondent] had any live births during the last 12 months?

Only for married women [15-49 years of age]

[] 1 Yes
[] 2 No [If No, go to 22]

If Yes,

Sex:
[] 1 Son
[] 2 Daughter
Year ____
Month ____

Questions are asked to persons 10 years of age and above
[Questions 22 to 26 were asked of persons 10 years or older.]

[22] What work [the respondent] usually did during the last 12 months?

[] 1 Agriculture
____ months

[] 2 Salary / wage
____ months

[] 3 Own economic entrepreneur
____ months

[] 4 Extended economic
____ months

[] 5 Seeking work
____ months

[] 6 Household work
____ months

[] 7 Study [student]
____ months

[] 8 No work
____ months

For questions 23, 24 and 25, Q 22: [1+2+3+4] greater than 0
[Questions 23 to 25 were asked of those who answered they did agricultural (1), salary/wage (2), own economic enterprise (3), or extended economic (4) work for a total of months greater than zero.]

[23] What work [the respondent] usually has done? [Occupation] ____

[Describe the actual work done. eg. Teaching, high school teacher]

[24] Where did [the respondent] work? [Industry] ____

[Name the establishment or the organization where worked. eg. own land, paddy production]

[25] What was the status of employment of [the respondent]?

[] 1 Employer
[] 2 Employee
[] 3 Own account worker
[] 4 Unpaid family worker

[26] What was the reason for usually not working during the last 12 months by [the respondent]?

For question 26, Q 22: [1+2+3+4+5] less than 6.
[Question 26 was answered by people who indicated less than a total of 6 months within responses agricultural (1), salary/wage (2), own economic enterprise (3), extended economic (4) or are seeking work in question 22.]

[] 1 Student
[] 2 House work
[] 3 Aged
[] 4 Pension
[] 5 Physically and mentally handicapped
[] 6 Sickness or chronic illness
[] 7 Others ____

[27] What is the living arrangement of [the respondent]?

Only for children below 16 years of age. [Encircle one of the appropriate codes for children less than 16 years]

[] 1 Mother / father
[] 2 Mother
[] 3 Father
[] 4 Father and stepmother
[] 5 Mother and stepfather
[] 6 Other relative
[] 7 Employer
[] 8 Other relative ____

[Pg. 3]

House/ household listing form

[1] Serial no of house _
[2] Serial no of household _

Question 3, 4, 5 for household head's only
[3] First and middle name ____
[4] Last name ____
[5] Caste / ethnicity ____

Question 6, 7, 8, 9 for total number of usually living household members
[6] Total _
[7] Male _
[8] Female _
[9] Third sex _

[10] Does your household operate any land for agriculture purpose?

[] 1 Yes
[] 2 No [If No, go to 17]

The total area of the agricultural land

Only for code 1 in question 10

[For each of the units, indicate area.]

[11] Bigha _
[12] Katha _
[13] Dhur _
[14] Ropa _
[15] Ana _
[16] Paisa _

[17] Does your household raise livestock/poultry for agriculture purpose?

[] 1 Yes
[] 2 No [If No, go to 29]

Livestock

The total number of livestock/poultry in the household for agriculture purpose
Only for code 1 in question 17. [For each of the livestock, indicate number.]

[18] Cow/ox _
[19] Buffalo _
[20] Yak/nak/chauri _
[21] Horse/mule/ass _
[22] Sheep _
[23] Goat _
[24] Pig/pork _
[25] Other _

Poultry

The total number of livestock/poultry in the household for agriculture purpose
Only for code 1 in question 17. [For each of the livestock, indicate number.]

[26] Chicken _
[27] Duck _
[28] Other _

[29] Does your HH engage in small-scale domestic economic activities [e.g. not registered]?

[] 1 Yes
[] 2 No [If No, go to the end of the questionnaire]

[30] What is the main activity related to?

[] 1 Industry
[] 2 Business
[] 3 Transportation
[] 4 Service
[] 5 Other ____