PDS SURVEY, AUGUST 2001

PART II: HOUSEHOLD QUESTIONNAIRE

Investigator: Find out who are the poorest households in the village, and visit three of these poorest households. Help them to fill the form below (one form for each household). Please remember also to get a photocopy of each household's card (this is important to enable us to produce the evidence in court).

1. My name is: …………………………s/o (or d/o) …………………………
2. During the months of May, June, and July, I have bought the following amounts of wheat from the ration shop, at the following prices:
   • May:………. kgs at Rs……./kg
   • June:………. kgs at Rs……./kg
   • July:……….. kgs at Rs……./kg
3. Since 1 August 2001, I have bought the following amount of wheat from the ration shop, at the following price:
   …………….. kgs at Rs……../kg
4. The main reason why I have not bought more wheat from the ration shop since 1 August is the following (mark one answer):
   1. More wheat was not available.
   2. More wheat was available, but I did not have enough money to buy more.
   3. More wheat was available, but I was not interested in buying more for the following reason…………………………………………………………………...
5. 5. Signature and date: