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[Questionnaire for Households]

Household number
Name of the respondent
Sub unit of the village
Village (village)


Interviewers name:
Date:
Time interview began:
Time interview completed:
Data input by Final Check by:

1. FAMILY PROFILE

1. Number of family members (only living together in the same house)
Male adults at 20 yrs or over _____________ persons
Female adults at 20 yrs or over _____________ persons
Children less than 20 yrs old _____________ persons
Total ______________ persons


2. Number of school going children
University student ____________ persons
High school student ____________ persons
Junior high school student ____________ persons
Total ____________ persons


3. How many of your family are earning income in the village in the village?
________persons

4. How many of your family members are living in other town to work?
________persons

5. Is your household headed by male or female?
Tick ( )
Male
Female



6. How many of your family members graduated from (upper) high school?
______persons


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2. Housing
7. How many rooms does your house have?
_____rooms (including kitchen)


8. What is floor area of your house?
_______m2


3. Economic aspects
3-1. Household income

9. How much is your family earning from agriculture?
Type of
Crops
Average
amount of
production
per cropping
(kg)
Times of
cropping per
year
Average
farm gate
price (Nu.)
Approximate
Annual
earning
(Nu.)
Average
annual cost
(Nu.)
Subsistence/
Cash crop

Subsistence/Cash crop

Subsistence/Cash crop

Subsistence/Cash crop

Subsistence/Cash crop

Subsistence/Cash crop



10. What kind of income sources does your family have? Insert the amount of earning of the last month in
each category by each income earner.

Income earner
Income source
1
st
income
earner
2
nd
income
earner
3
rd
income
earner
4
th
income
earner
5
th
income
earner
Salaries/ wages
Pension
Handicraft
Other cottage Industry
Shops/ restaurant
Services (hair-dress,
car/bike garage)

Money Transfer from
outside the village

Others (specify)
Total
LIVING PLACE







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3-2. Household Expenditure

11. How much did your household spend on each item for the last month?
Nu/month
No. Item of expenditure Amount (Nu.) Remarks
1 Food Including drinks
2 Clothing Including personal good such as sandal/cosmetics
3 Housing Housing loan repayment/house rent, etc
4 Inputs for business Equipments & raw materials, if any
5 Utilities Water, gas, electricity, fuel & sanitation
6 Tax If you pay income or property tax
7 Education Including enrolment fee, books, uniforms, etc
8 Transportation Including oils for your own cars/bikes
9 Health Medical treatment, medicines
10 Others Other costs not specified in the above
Total



12. How much did your household spend on the utility except energy for the last month?
Nu/month
No. Item of expenditure Amount (nu.) Remarks
1 Potable water For cooking, drinking & washing
2 Irrigation water Agriculture use
3 Sanitation Waste water & solid waste, toilet, etc
4 Others Other costs not specified in the above
Total



13. How much did your household spend on the energy-related item for the last month?
No. Item of expenditure Amount (Nu.) Remarks
1 Electricity Distributed Electricity by lines
2 Gas Purchase cost
3 Solar Power Operation & maintenance cost for facilities
4 Kerosene Purchase cost. Do not include for car, bike &
tractor but include lamps
5 Diesel oil Purchase cost for diesel generator
6 Coal Purchase cost
7 Charcoal Purchase cost
8 Fuel wood Purchase cost
9 Dry batteries Purchase cost
10 Candles Purchase cost
11 Matches Purchase cost
12 Car battery Charging Charging cost per time
13 Others Other costs not specified in the above
Total


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14. If your village is to be electrified with this new Micro Hydro power, how much monthly charge are
you willing to pay for new electricity services?


4. Energy related property
15. Do you have following equipment for lighting and/or heating?
Kind of
equipment
Generator Kerosene Gas fired
cooking
appliances
Car battery Others
(Specify)
Number



16. What kind of electrical appliances does your household currently use?
[ ] Bulb/fluorescent light ______units
[ ] TV-set ______units
[ ] Radio & cassette recorder set ______units
[ ] Refrigerator ______units
[ ] Air conditioner ______units
[ ] Other, specify ______units


17. What kind of electrical appliances does your household currently use for productive activities?
[ ] Sawmill machine
[ ] Rice milling machine
[ ] Rice dryer
[ ] Irrigation pump
[ ] Others, specify_____________________________


5. Needs for electricity
5-1. Priority needs
18. Could you give your priority order on the followings needs?
Priority Example
Water supply 1
Education 2
Health Care 3
Sanitation (toilet, solid waste,
drainage, etc
7
Electrification 4
Irrigation 6
Road improvement 5
Others (specify)





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5-3. Purpose of using electricity
18. If you can have access to electricity, what kind of electrical appliances and how many appliances do
you want to use?
[ ] Bulb/fluorescent light ____units
[ ] TV-set ____units
[ ] Radio & cassette recorder set _____ units
[ ] Refrigerator _____units
[ ] Air conditioner _____units
[ ] Other, specify _____units

19. What facility/equipment do you want to use electricity for productive activities?
[ ] Sawmill machine
[ ] Rice milling machine
[ ] Rice dryer
[ ] Irrigation pump
[ ] Others, specify_________________________________________


20. What public facilities do you think should have access to electricity?
[ ] School
[ ] Clinic/health center
[ ] Water pump for drinking water
[ ] Others, specify________________________________________

5-4. Electrification by the organization other than Rural Electric Cooperative
21. Who/what organization do you think would be the most appropriate for the installation of the
electricity supply system?
[ ] Village Association
[ ] NGO
[ ] Private contractor
[ ] Village members (including village head)
[ ] Others, specify_____________________________________________
[ ] Dont know


22. Do you and/or your family member volunteer to participate in working for the construction without
any cash reward if the generating facility is to be installed in the village?
[ ] yes [ ] no

23. Who/what organization should be responsible for operation and maintenance of the system?
[ ] Village Association
[ ] Village Council
[ ] NGO
[ ] Private contractor
[ ] Village members (including Village head)
[ ] Others, specify____________________________________________
[ ] Dont know


24. Do you and/or your family member want to participate in working for operation and maintenance?
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[ ] yes [ ] no


36. Who/what organization should be responsible for billing and collection of charges for electricity?
[ ] Village Association
[ ] Village Council
[ ] NGO
[ ] Private contractor
[ ] Village members (including Village head)
[ ] Others, specify_______________________________________________
[ ] Dont know


37. How should the electricity tariff be decided?
[ ] Based on consultation with and consensus of the community
[ ] Free of charge
[ ] Other, specify__________________________________________________





*For Small Scale Industry (mining, Saw mill, etc)
How much did your company spend on the electric power consumption for the last month?
Ans: