NAIVS Baseline 2010 – Listing Survey
A. HOUSEHOLD LOCATION
Region Name/Code:
District Name/Code:
Ward Name/Code:
Village/EA Name/Code:
Hamlet Name:
GPS Coordinates of household:
Household Identifier:
☐☐°☐☐.☐☐☐'S
☐☐☐°☐☐.☐☐☐'E
☐☐
☐
1 = Random from Hamlet
2 = Selected from
Beneficiary/Eligibility List
Sample Type:
B. HOUSEHOLD DEMOGRAPHICS
1.
Name of Household Head:
2.
Sex of Household Head:
3.
Marital status of household head:
4.
Primary Occupation:
5.
Total Number of Household Members:
[Adult = 18 yrs or older, Child = under 18
yrs]
What vernacular language do you speak at
home?
ENUMERATOR OBSERVATION:
The main construction material of outside
walls of the main dwelling is:
6.
7.
8.
ENUMERATOR OBSERVATION:
The roof of the main dwelling is
predominantly made of what materials:
9.
ENUMERATOR OBSERVATION:
The floor of the main dwelling is
predominantly made of what materials:
Male…1 Female…2
a. Adult Male
Married
Divorced.......4
(monogamous)...1
Separated......5
Married
Widowed........6
(polygamous)...2
Never Married..7
Informal Union..3
A PAID EMPLOYEE....1
ON YOUR OWN
SELF EMPLOYED (NON-AG): FARM...6
WITH EMPLOYEES.....2
STUDENT...................7
W/OUT EMPLOYEES…3
RETIRED...................8
UNPAID FAMILY HELPER:
DISABLED..................9
NON-AGRIC.......4
OTHER (SPECIFY).....10
AGRICULTURE....5
b. Adult Female
c. Child Male
d. Child Female
WRITE NAME OF LANGUAGE
Mud…………..….1
Unburnt/raw bricks…2
Stone…………....3
Burnt Bricks…....4
Cement / concrete….5
Mud/Mud Bricks……1
Thatch (grass or
straw).....2
Wood/Bamboo……..3
Corrugated Iron
sheets….4
Earth/Mud..1
Wood/Tile...2
Plank……...3
Wood / bamboo......6
Iron Sheets……..7
Cardboard…..….8
Other (specify)…9
Cement/Concrete….5
Roofing Tiles……….6
Asbestos……………7
Other (specify)….….8
Concrete….4
Dirt/Straw…5
Other (specify)...6
1
NAIVS Baseline 2010 – Listing Survey
10.
Do you own the following items?
Yes…1
No….2
a. Radio
e. Electric/Gas Stove
b. Mobile phone
f. Bicycle
c. Refrigerator/Freezer
g. Motorbike
d. Video/DVD
h. Motor vehicle
C. NETWORKS
POSITION
11.
Do you know the person
who holds the following
[POSITION]?
Yes…1
No…2 ►NEXT
Self…3 ►NEXT
12.
Are you related to
[POSITION]?
13.
Do you have regular
social interaction with
[POSITION]?
Yes…1
No…2
Yes…1
No…2
a. HAMLET CHAIRPERSON
b. VILLAGE EXECUTIVE OFFICER
c. VVC MEMBER (any of 6)
D. NAIVS SELECTION CRITERIA
14. Do you reside in this village full-time?
Yes…1
No….2
ACRES
15. What is the total area of land that you own?
16. How much cultivable land do you own?
17. On how many acres of land did you cultivate maize during the long rains in: (a)
2008/09, (b) 2009/10, and (c) 2010/11?
ACRES
a.
b.
ACRES
c.
18. On how many acres of land did you cultivate paddy during the long rains in: (a)
2008/09, (b) 2009/10, and (c) 2010/11?
a.
b.
ACRES
c.
19. Did you use improved seeds for maize or rice during the long rains in: (a)
2008/09, (b) 2009/10, and (c) 2010/11?
a.
b.
Yes…1
No….2
c.
20. Did you ever use improved seeds on maize or rice before 2008?
Yes…1
No….2►22
21. When did you start using improved seeds?
WRITE YEAR
22. Did you use chemical fertilizer on maize or rice during the long rains in: (a)
2008/09, (b) 2009/10, and (c) 2010/11?
a.
b.
Yes…1
No….2
c.
23. Did you ever use chemical fertilizer on maize or rice before 2008?
Yes…1
No….2►25
24. When did you start using chemical fertilizer?
25. If you ever used improved seeds or chemical
fertilizer in the past but did not use them last
season, why not?
WRITE YEAR
Did not start/stop…1
No production effect…2
Not profitable…3
Could no longer
afford…4
Other (specify)…5
2
NAIVS Baseline 2010 – Listing Survey
26. Have you heard of a program that provides eligible farmers with vouchers to
buy seeds and fertilizer?
27.
If you were offered to buy a pack of planting and top-dressing fertilizers and
improved seeds that would cover 1 acre of land for approximately 55,000 Tsh,
would you have been able to afford it during the long rains in: (a) 2008/09, (b)
2009/10, and (c) 2010/11?
28. Would you have been able to afford the voucher top-up if you were offered
vouchers in (a) 2008/09, (b) 2009/10, and (c) 2010/11? [Estimate 55,000 Tsh)
a.
Yes…1►28
No….2
Yes…1
No….2
b.
c.
a.
b.
►34
Yes…1
No….2
c.
29. Were you eligible to receive vouchers during the long rains in: (a) 2008/09, (b)
2009/10, and (c) 2010/11?
IF ALL ANSWERS “NO” ►34
b.
Yes…1
No….2
Don’t know…99
c.
30. Were you offered vouchers during the long rains in: (a) 2008/09, (b) 2009/10,
and (c) 2010/11?
IF ALL ANSWERS “NO” ►34
a.
b.
Yes…1
No….2
c.
31. Did you accept the vouchers during the long rains in: (a) 2008/09, (b) 2009/10,
and (c) 2010/11?
IF ALL ANSWERS “NO” ►34
a.
b.
Yes…1
No….2
c.
32. Did you physically receive the vouchers during the long rains in: (a) 2008/09,
(b) 2009/10, and (c) 2010/11?
IF ALL ANSWERS “NO” ►34
33.
a.
a.
b.
Yes…1
No….2
c.
How many of each of the following types of vouchers did your household receive during the long rains in: (a)
2008/09, (b) 2009/10, and (c) 2010/11? WRITE NUMBER.
DAP
MRP
Urea
Maize Hybrid
Maize OPV Seed Paddy Seed
Seed
a. 2008/09
b. 2009/10
c. 2010/11
34.
35.
36.
37.
38.
How much Maize did you (a) cultivate
and (b) produce last year (2009/10)
with vouchers?
How much Maize did you a) cultivate
and (b) produce last year (2009/10)
without vouchers?
How much Rice did you (a) cultivate
and (b) produce last year (2009/10)
with vouchers?
How much Rice did you a) cultivate and
(b) produce last year (2009/10)
without vouchers?
Which political party
do you support?
a. Acres
b. KGs
a. Acres
b. KGs
a. Acres
b. KGs
a. Acres
b. KGs
CCM...1
Chadema...2
CUF...3
TLP...4
WRITE ZERO IF NONE.
CULTIVATION IN ACRES AND
PRODUCTION IN KILOGRAMS.
WRITE ZERO IF NONE.
CULTIVATION IN ACRES AND
PRODUCTION IN KILOGRAMS.
WRITE ZERO IF NONE.
CULTIVATION IN ACRES AND
PRODUCTION IN KILOGRAMS.
WRITE ZERO IF NONE.
CULTIVATION IN ACRES AND
PRODUCTION IN KILOGRAMS.
NCCR
Refused to answer…6
Mageuzi....5
Other (specify).....7
3