i----------------------------------------------------------------------------------------------------------j

:I Respondent No: I I RegIon: I

1-------------------------------­ I ,:
!
I

GPS Reading: Iv (Northing) I IX (Easting) I Elevation: 1

~:::::::_~--:::_~~-::_~~~~------------------------------------------------------------------------------------~
: Interview Status
: (Encircle appropriate code) Ecosystems Research and Development Bureau
I
I Deparbnent of Environment and Natural Resources (DENR)
1 Completed Interview

2 Refusal

3 Deferred
SOCIO-ECONOMJC13ASELINE FOR THE NATIONAL GREENING PROGRAM
4 Housing unit Is

temporarily closedf not at INTERVIEW S C H E D U L E

home I On vacation

5 Vacant housing unit

Part I. Demographic Characteristics
6 HOUSingldls

demolished, destroyed by
I fire, typhoon, etc.
I
I 7 OtherB, specify _ A. Infonnation about the Head of the Family
I

I
-----------------------
-----------------------~ 1. Name of Household Head _
: Name of Interviewer.
I
I
I
I
2. Age '_.L-...J 3. Gender 1- Male 2-Female

: Date of Intervlew: _ _
I 4. Highest Educational Attainment 1- No Formal Education 2- Elementary
I
3- High School 4--CoIIege
: Name of Reviewer:
I 5- Vocational I Technical 6- Postgraduate
I
I
J
I
: Date of Review:_
5. Number of Years in SchOOf' 1---1
~----------------------- 6. Civil Status 1- Single 2-'MaTTied 3- Widow 4- Widower 5- Separated 6- Uveln
Types of Organization

CooperatIve
7. Religion 1- Roman Catholic 2- Protestant 3- Islam 4- Iglesia ni Cristo
Guinomsn Inleglllled MIMI· 5- Seventh Day Adventist 6- Mormons 7- Bom Again
P\II1lOll8 CoopenIIive 8- Jehovah's Witnesses 9- Others, please specify _
MlcrollnallC9
Center fof Agricullure end
Rul'lll Development (CARD) 8. Mobility Pattern 1- Bom-resident I native 2- Migrant
Tuley .. Pag-tlnlad
Inc.(TSPI)
If Migrant;
Ahon . . HnIP Inc. (ASHI)
ASA PhIlIppl_ FDUndlIIiOll Place of Origin: --;:==:::;- _ i

,---'-­
Inc

"-OpIe'. Organlullon Length of stay in the area: i

......
,. VUlaconSusio T~ Plant. . ~
,
I
AaaclBllOIl

I RelIgious 0IgInIDtI0n
Reason for migration: D
I· Singles fof Christ (SFC) I-Dccupotlanal/ worlc-re/ated 2 - Marriage! Matrimonial reason
I - Couples fof Christ (CFC) 3·lmprovemem ofsecurity 4 - Availability ofland for cultivation
I El Sh8ddIl ~ Evictedfrom land 6- Disp/oced due to natural calamities
I KnIghIa r:I Columbus
Christi... group
7· Availment ofGovernment Program 8 - Others, specify
Buk88 Loob .. Diyos (BLC)

Government Orgsnlatlon

~Mlg KIIb81a8n

9. Occupation: ~......
, L---L_..L..-~_
(SK)
Brgy. Council (re!er to 2012 Philippine Stondard Octupational Classification (PSOC})
81nngay H8lIIlh WOIkers
(BtM')
B. .ngey Nutrition SCholar
(BNS)
B. Affiliation of Household Head to Organizationl Associations in the Community
IocIo-ClYk:I8oclo PolItIcal

Magdala group
Are you • mambar vi tills Role
PhilIppines GulUdlsn,
0rganizatI0nI~ . orgsnizlIUon? Name vi OrpnIDllon (1-rn8lllber
Brotherhood Inc. (POOl)
(1·Y",D-No) 2-off1cer)

T~ Cooperative
Opsratorl and Orivelll
AIIOCi8IIon (ODA) Microfinance
PiIlon
~Mad. People's Organization
Fedeillllowl r:I Jeepney
0peIwI0ra 8nd 0Ii.....
AISDCiIIIion r:I the ReligioUS Organization
~(FEJODAP)
Government Organization
Labor lIfOUP
AnakpIIwl. I Socio-CiviclSocio-PoIitical
Trade Union Conglal r:I I
the PNIippines (TUCP) I
1· Federallon r:I F~ Work8I1l I
Transportation
I (FFW) I labor group
I. ....
W_'s .
....snlutlon II
I . Gabllele I senior Citizen
:. Women', Club I
.... 1
Women's Organization

Youth Organization
Persons With Disabilities
(PWD)
 2

C. Household Composition

1. Total household size I I

(including extended family members and non-family members who stay in the same abode)

Age bracket No. of household members

Total
No. of Male(s) No. of Female(s)
Under 1
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
4044
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80 andover
Total

2. Number of school-age children attending school

3. Number of out-of-school children I I

Reason(sJ for not attending school

1- cannot afford school fees and other requirements/financial constraints

2- children do not want to go to school
3- disability or illness
4- school is inaccessible or too far
5- others, please specify, ..,.-- _

4. Number of married children S~~ing with the family D

5. Number of non-family members staying with the family 0
6. Number of earning family members including the head who are staying with the family 0
7. Number of unemployed members of the family D
Reason(sJ for unemployment

1- Lack of education

2- Lack of vacancies! No available jobs .

3- Lack of experience or qualifICations

4- Age qualifICations!overage

5- Physically-unfit for work! health reasons

6- Unwillinglunable to relocate to the place of work

7- Lack ofinterest to worle

8- House caretaker/ housekeeper

9- others, pis. specify _

 3

Part II. Economic Infonnation

A. Household Income

Household's income in the last 12 months

Salary and Wages from regular employment (agricultural)

Salary and Wages from regular employment (non-agricultural)

Salary and Wages from seasonal or occasional employment (agricultural)

Salary and Wages from seasonal or occasional employment (non-agricultural)

Net income from crops, fruits and vegetable garoeningl farming

Net income from livestock and poultry raising

Net income from fishing

Net income from forestry activities (tree planting, charcoal making, gathering of
forest products)
Net income from whole sale and retail (market vending, sidewalk vending and
~Ii ~

Net income from manufacturing (mat weaving, tailoring, dressmaking, bagoong

making, fish drying)
Net income from community, social, recreational and personal services
(services such as medical and dental practice, operation of school, restaurants
and hotels etc.
Net income from transportation, storage and communication services (operation
of jeepneys or taxis, warehouse and storage, tour and travel agencies etc.)
Net income from mining and quarrying (salt mining, gravel and sand quarrying)
Net income from construction
contract services for the construction or re ir of a house or an

Government Assistance (4Ps, cash for work)

Pension, Retirement benefits, Social Security benefits,

Remittance from abroad

Local remittance

Cash gift from abroad

Interest from bank deposits
Interest from loans extended to other families
Rentals received from agricultural! non-agriculturallands, bUildings, spaces and
other rties .­
Dividends from investment

Sale of personal property

Loans from other families

Loans from business firmsl govemment institutions/ microfinancel cooperative

Net winnings from gambling, sweepstake and raffle

Seedling production! selling of planting stock

Hired labor
"adapted from Family Income and Expenditure Survey (NSO)

. . . . .

f;,·······f·.··········.
'-':4QnUal .flCQIQ
. · · ·.
[ 0• .

How do you assess your overall current economic status/situation?

1- Very poor 2- Poor 3- Average 4- Well-off 5- Rich

 4

r----------------I B. Property Ownership and Housing Amenities

Type of Building ....rIals I

Roof , B.1 Do you own the residential lot where you are staying at present? 1- Yes
I
I " YES, proceecJ to B. 1. a H NOT, proceecJ to B.1.b
0- No D
1. Mahaw I
2. Bamboo I
3. Brick I B.1.a Residential lot: LOt Si%e(sq m)
I
4. CementlConcrete I Lot 1
5. Cogan I
6. Galvanized Iron I I Lot 2
aluminum I
7.
8.
Nlpa
Plywood
,
I
B.1.b House status:
Lot 3

9. Salvaged materials I
10.
11.
Sawall
Tiles
I
I
I
Floor Area: IL.-.. . . . . . . . _I square meters (sq.m.)

12.
13.
Wood
Mixed but
predominantly made
I
I
I
Structure (1-Single 2- (2-storey)) : D No. of Rooms: IL....-L­
of galvanized iron or I
I If OWNED, value of the house PhP _

aluminum I
14. others. pis. specify I
If RENTED, rental fee per month PhP ~~

I If NOT OWNED NOR RENTED, what is the tenurial status?

I 1- Caretaker 2- Informal settler 3- Recipient of housing project

Wall I
I
1. Anahaw B.2 Housing materials
2. Asbestos
3. Bamboo 1. Type of bUilding materials
4. Brick < , ..

5. Cement
blocks/Concrete Roof Wan Windows Floor
6. Cogan
7. Galvanized Iron or
aluminlnl
8. Glass
9. Make8hiftlSalvagecll
Improvised materials
10. Mixed but
2. Vehicle, fann machi'1erieslequipment, furniture and appliances:
predominantly made
of galvanized iron or Does your family own the
Number of
aluminum Goods following items?
11. Nipa Units
(1-Yes O-No)
12. Plywood Farm machlnerlesleauloment
13. Sawall
14. Tiles Bulldozer! roPer
15. Wood Cart
16. No walls Plouah
17. Othenl, pis. specify Rice mill
Threshina machine
WIndows
Hand tractor! tractor
WateroumD
1. Mahaw Vehicle
2. Bamboo Bicvcle
3. Cogon Boat (machine)
4. Galvanized Boat (oaddled)
Iron/aluminium
5. Glaas Car! Van! Pick-UD .'
6. Nlpa Jeeo
7. Plywood Motorcvcle .
8. salvaged materials Tricvcle
9. sawall Truck
10. Wood
11. Othenl, pis. specify Durable Goods
Fumiture
CabinetiADarador
Floor Dininaset
Sala set
1. Cement
Bed
2. Parquatlpollshed
woods
3. Marble/Polished APPliances
atones Air conditioner (not referring to
4. VInyl electric fan)
5. CeramiC tiles DVDNCD
6. Wooden pianka
7. Bamboo strips
Electric fan
8. DIrt lIoor Flat iron
9. Othenl, pis. specify Generator
Hot water boiler! heater
L... _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Microwave oven
Radio
RefriaBratorl freezer
Rice cooker
Satellite dish (OlV)
Stereo set! $ina-alona system
Stove! Cookina ranae
Television set (lV)
Vacuum cleaner
Washina machine
 5

Does your family own the

Number of
Goods following items?
Units
(1-Yes O-No)
Electronic gadgets
Camera
Computerllaptoo/netbook
Landline telephone
Mobile/cell ohone
Tablet

C. Family Expenditures and savings

Amount! Amount!
Item of Expenditure
month (Php) Year (Php)
a. Farm related
. Crops/Agriculture
- Livestock/poultry
- TImber and non-timber
- Marketing and transport cost
b. Household
- Food
- Education
- Clothing & Personal Care
- Transportation
- Communication expenses
- Health services
- Electricity
- Water
- Fuel used in cooking
- House rentall repair and
maintenance
- Special occasions (Fiesta,
wedding, birthday. etc.)
- Recreation
- Tobacco and alcohol products
- Others (acquisition of furniture
and aooliancesl
c. Payment of debt /credit /Loan in
year
d. Insurance
e. Taxes
TOTAL

1. Does your family have loans right now?

..
D 1 - Yes 0 - No

Reason(s) for borrowing:

1- Pay educational expenses

2- Pay health expenses
3- Pay rent or house mortgage
4- Buy food and basic needs
5- Buy construction materials for house repair and construction
6- Buy livestock or poultry
7- Purchase farming inputs (fertilizers, pesticides. seeds etc.)
8- Buy farm equipment. machineries and tools
9- Buy land
1O-Capital for business
11-Pay special occasion expenses
12-Pay other loans
13-others. please specify _

2. How much savings do you have right now? PhP (amount)

_ _ If none, please check
 6

Part III. Health, Sanitation and Support Services

A. Food Security B. Common illnesses

1. Food intake (per day) What are the common illnesses in your family?
(in the past six (6) months)
1 - (3 meals + 2 snacks)
2 - (3 meals + 1 snad<) Does your family
3 - (3 meals (no snacks» suffer from these
4-(2 meals) chronic illnesses?
5 - (1 meal) (1-Yes D-No)
Allergies
2. During which months of the year do you
Arthritis
usually experience problem on
acquiring food for the household? Asthma
Birth complications
1 - This month (women)
Month
o- Not aDDlicable
~ronchitis
January
February Cancer
March
Chicken pox
April
May Cholera
",
June Cough/colds
July
Dengue
August
September Diabetes
October
Diarrhea
November
December Disability
Disease related to eye
3. Reason(s) for food shortage of the (cataract, glaucoma)
household:
Fever/flu
1 - Disaster/ Drought! Calamities
HeadacheIMigraine
2 - Enrollment of Children
3 - Civil unrest/Peace and order situation Heart disease!
4 - Low Agricultural Production cardiovascular disease
5 - Employment Problems
Hepatitis
6 -Increasing number of family members
7 - others, pis. specify _.,.--_--'-__ Hypertension! High
blood
4. What do you normally do to address Infections of the ear,
food shortages? throat or nose
Kidney problems!
1 - Borrow from neighbors or relatives .­ disease
2 - Borrow from microfinancel
L,eprosy
cooperativeslbanks

3 - Backyard gardening
Malaria
4 - Look for extra work

5 - others, pis. specify _ Measles

Physical trauma

Pneumonia

Rheumatism
~exually transmitted
disease
Skin infection / disease
Stomach
diseaselillness
lulcer aastritis)
Tuberculosis (TB)

Typhoid fever
Urinary Tract Infection
(UTI)
Others, please specify
 7

C. Support services

1. What is the family's main source of water 7. Do you have access to the following health
supply for domestic use? facilitiesl services in the community?

1- Own use, faucet, local water system

2- Shared, faucet, local water system Do you have access
3- Own use, tubed I piped well to the following health
4- Shared, tubed I piped well Health facilitiesl services in your community?
(1-1 have access
5- Own use, jetmatic (hand pump)
6- Shared, jetmatic (hand pump) o- I do not have
access)
7- Deep weill Dug well (balon)
B- Stream! spring Botika ng barangay
9- Rainwater Rural health unit! Health
center
2. What is the family's main source of drinking Public hoscital
water? Private clinic
Local hilot I herbolaryo
1- Own use, faucet, local water system Day carelcenter
2- Shared, faucet, focal water system Emergency medical kit in
3- Own use, tubedlpiped well the baranaav
4- Shared, tubed/piped well Others, cis soecifv
5- Own use, jetmatic (hand pump)
6- Shared, jetmatic (hand pump)
7- Deep well / Dug well (balon) 8. Do you have access to any of the following financial
8- stream! spring
9- Rainwater institutions in your community?
10-BoWed water /refilling station
(1- available (1- I have access

3. What is the family's main source of lighting o-not o- I do not halle

available) access)
facility? Cooperative
Bank
1-Kerosene
2- Solar Private lender
3- Electricity
4- Gas-operated (LPG)
Bombay/5-6
5- Battery
6- Candle
7- Generetor Relatives
B- Others, please specify _ Mierofinance
Others, pis. specify
4. What is the family's main source of

cooking fuel?

9. Environmental issues
1- Kerosene
Select the top three (3)
2- Fuelwood Check the
issues. Write 1 for the
3- Charcoal environmental
Environmental most prevalent, 2 for
issues that you
4- Gas-opereted (LPG) issues observe in your
the second most
5- Electricity prevalent and 3 for the
community
third most prevalent
6-Biofuel Destruction of natural
7- Others, pis. specify _ habitats
Air pollution
5. What kind of toilet facility does the family
have in the house? Soil pollution

Water pollution
1-0pen-pit, Used &cluslvely by the
Household Forest disturbance
2-0pen-pit, ShafBd with other Households Encroachment and
3- Closed-pit! Antipolo-type, Used hunting of wild
&clusively by the Household animals
4-Closed-pifl Antipolo-type, ShafBd with Forest fire
other Households
5- Water-sealed, Used &cluslvely by the Kaingin/ slash and
bum
Household
6- Water-sealed, ShafBd with other I Illegal cutting/
Households timber poaching
7-0thers, pIs. specify _
Illegal collection of
wildlife species and
6. What kind of waste disposal does the
forest products
family practice?
Introduction of
exotic species
1- Thrown anywhere
Mining
2- Burning
3- segregation!recycling Quarrying
4- Composting
5- CollectecJI Picked-Up by garbage Natural disasters
truck Oil spill
6- Burying
7-0pen-pit Overfishing
B- Others, pis. specify _
Waste disposal
Water shortage
 8

Part IV. Physical Capital

A. Farming System

1. Farm lot: (OWNED)

No. of Area allotted I used for (in percentage)

Parcel
Area Fruit I Timber and Mixed Livestock Aqua­ Left idle TOTAL
(hectare) agricultural non-timber timber, fruit culture
crops trees and
other
agricultural
crops
1 100%
2 100%

2. Farm lot: (NOT OWNED) What is your tenurial instrument?

1- ISF 2-CSC 3-5IFMA 4- PACBRMA 5-others, please specify _

Lot Area allotted I used for (in percentage)

No.
Area Fruit I Timber and Mixed Livestock Aqua­ Left idle TOTAL
(hectare) agricultural non-timber timber, fruit culture
crops trees and
other
agricultural
croos
1 100%
2 100%

B. Crop Production
Crop production Revenue (PhP)/ Market* Markel
Year
1- at the community/village 10 small farmers
a. Fruit 2- at the community/village to wholesaler agent
3- local rnarkeI
b. Agriculture 4- large maJltet
c. Animal/Livestock 5- neighboring town(s)

d. Timber
e. Non-Timber
r----------------~----------------r------------------------
I Crop Production (PI_ check the I: I
, cropa being produced) 'I I
I I I
I Fruit ,I Agrtculture •• I Animal/ Uvestock
I II I
I [1 Rambutan (I [1 Palay/Rice I [ lPoWIJy
I [I Lanzonea II [I Com I ( ) Swine
I [IDurian (I [IColfee 1 [ 1Goal
( lMango I' [ICacao I [ 1Horse
[ 1Pomelo ,I (I Coconut I [ 1CallIe/Carabao
[ I Guyllbano IJ [I Abaca I [ lBangus
[ I MlII'8l1g II [I Sugarcane I [ 1Tilapia
[ I Pill II [I Cessava , [ ) PI'IIWI1
[ I JeckfNIt I [1 AmplUya I [ ) others, pis. specify _
[ 1CiWI I [I SwlIel Potato I
[ I Chico I [I GlIbi I
[ I Avoc:ado [ I Ube I 11nlblll'
[ I M8t8ng [ 1Sitao
[ I Mengosteen [ ) Eggplant I [ ) Mahogany [ I Malave
[ 1Santol [ ) Pineepple I ' [ 1Mangium [ lApitong
[ 1Banana [ 1SqUSlh I I [ 1NaIT8 [ ) Makaasim
[ 1Pepaya [ 1Ginger II [ lAuri . ( ) White lauan
[ 1othe~, pis. spedfy [ ) Pechay , [ lGmelina [ ) Red lauan I
L [ 1TIg8I" grass
[)~ II [ I Falcata [ I Lanite I
[ ) Bagras [ 1Dalipapak I
[ 1Cucumber I [ ) Nato [ IBatino I

~
[ I Bell pepper
J
,
I [ I Kalantas [ ) others, pis. specify _ I
I
I
Non-Timber I
I
[ IBamboo I
I
[ I Rattan I
[ ) Honey
I
[ I Medicinal plants I
[ 1Wildfood plants I
[ ) Vines
I
[ I others, pis. I
specify--­ I
I
~------------------------
 9

Part V. Awareness and Involvement in the NGP Activities

1. Are you aware of the NGP? 1- Yes 0- No

If YES, how did you know about it? [J Newspaper [ J Radio [J Television (TV)
[ J Flyers / leaflets / posters [J thru barangay/ LGU [J thru NGO
[ J thru NGP implementors [J others, pIs. specify _ _
2. What do you know about NGP?
a. Implementing agency : _
b. Objectives: _

3. Are you or any member of your household involved in NGP Activities? 1- Yes 0- No
(If NO, politely end the interview)

4. If YES, in what year were you or your household member(s) involved in NGP? _

5. What were the NGP activity(ies) that you or your household member(s) were involved in?
(Please answer the matrix below.)

Please indicate the income derived in a (vear) of NGP activitv<ies) involvement:

Responsible Person(Please check) Type of
Income
involvement No. of
NGP Activities Children I Youth derived
Man Wo~an (laborer, days
(in pesos)
Male Female supplier, etc.)
1. Survey, Mapping and
Planning
2. Site DreDaration
3. Seedlina Production
4. Plantation Establishment
and Maintenance
5. Others soecifv
GRAND TOTAL

6. Other forms of benefits derived from NGP (financial assistance; community development; other, specify):

7. Problems Encountered and Suggested Solutions

Problems related to implementation of NGP Suggested Solutions/Measure(s) Done

..

. . . . . . . . . . . . . . . . . . $~ ~()t(..l .

.
I
------------------------------------------------------------------------------------------------~
I
I
I Name of Respondent
I
I
I Relationship with 1-head 2-wife 3-husband 4-partner 5-son
,
I
Household Head 6-daughter 7-others, pIs. specifY.

Address

Remarks

Statement of Confidentiality

This survey is being conducted to establish baseline information for the Mure conduct of the impact evaluation of the

NGP Project.

The information collected in this survey will be strictly confidential.

~~-----------------------------------------------------------------------------------------------