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An appendex to the report on Goa Migration, put out by the NRI Commission of Goa.
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1
Schedule Number
GOA MIGRATION SURVEY 2008
STATE OF GOA- INDIA
GOVERNMENT OF GOA
AND CENTRE FOR DEVELOPMENT STUDIES (CDS),
THIRUVANATHAPURAM
MIGRATION STATUS
1. Return migrants from outside India
2. Emigrants living outside India
3. Return migrants from other states in India
4. Out-migrants living in other states in India
5. None of these
FSU
2
M I G R A T I O N S U R V E Y
Schedule 1
BLOCK - 1
Identification Particulars
District…………………………Taluk ………………………………………
City/Panchayat………………… Ward………………Locality (rural-1, urban-2)…………………
Number…………………………………House No. /House Name ………………………………..
Name of Informant ………………………………………………………………….………………
Details about visits to the household
1
2
Date (s) of Interview
Name of Investigator
Name of the supervisor
Time Taken
Notes: The respondent should be the Head of the household. If the head of the household is not
present, the information should be collected from the immediate responsible person
3
Blo
ck -
2 H
OU
SE
HO
LD
DE
TA
ILS
1
2
3
4
5
6
7
8
9
Ser
ial
No.
Nam
e of
mem
ber
s of
House
hold
(H
ead o
f th
e H
H
firs
t)
Rel
atio
n w
ith
the
Hea
d
(Code)
Sex
Mal
e – 1
Fem
ale
– 2
Dat
e of
Bir
th
(Month
and
Yea
r)
Gener
al
Educa
tional
Sta
tus
(See
code)
Act
ivit
y s
tatu
s
(See
code)
Mar
ital
Sta
tus
(See
code)
Code
Mar
ried
wom
en w
hose
hu
sban
d r
esid
ing
outs
ide
India
- 1
01
02
03
04
05
06
07
08
Colu
mn
– 0
8
Un
mar
ried
1
Mar
ried
2
Wid
ow
/ W
idow
er
3
Div
orc
ed
4
Sep
arat
ed
5
Colu
mn
– 0
6
Illi
tera
te
1
Lit
erat
e w
ithou
t sc
hoo
l E
duca
tio
n
2
Pri
mar
y n
ot
com
ple
ted
3
Pri
mar
y
4
Upp
er P
rim
ary u
p t
o S
eco
nd
ary
5
Sec
on
dar
y p
asse
d b
ut
hav
e no
Deg
ree
6
Deg
ree
ho
lder
s
7
Oth
ers
(spec
ify)…
……
8
Colu
mn
- 0
7
Em
plo
yed
in
Sta
te /C
entr
al G
ovt.
1
Em
plo
yed
in S
emi G
ovt. A
ided
sc
hool/co
lleg
e, c
o-op
erat
ive
/ lo
cal ad
min
istr
ativ
e bodie
s. e
tc
2
Em
plo
yed
in
Pri
vate
sec
tor
3
S
elf
emplo
ym
ent
4
Unpai
d f
amil
y w
ork
5
A
gri
cultura
l la
bou
r
6
L
aboure
rs in n
on-a
gri
c. S
ecto
r
7
Job s
eeker
s
8
Job n
ot re
quir
ed
9
Stu
den
ts
10
House
hold
wor
ks
11
Pen
sioner
s, too o
ld t
o w
ork
12
Oth
ers(
spec
ify)…
……
……
..
13
Cod
es:
Colu
mn
- 0
3
Hea
d o
f th
e H
H
1
Hu
sban
d/W
ife
2
Un
mar
ried
ch
ild
ren
3
Mar
ried
ch
ild
ren
4
So
n i
n l
aw/D
augh
ter
in l
aw
5
Gra
nd
ch
ild
6
Fat
her
/Mo
ther
/Mo
ther
in
law
7
Ser
van
t
8
Oth
ers
9
4
Blo
ck –
3 M
IGR
AT
ION
ST
AT
US
01
10
11
12
13
14
15
16
17
Mig
rati
on S
tatu
s of
per
son r
efer
red i
n
colu
mn 2
For
per
son
s li
sted i
n c
olu
mn 1
0 o
r 11
Mon
th a
nd y
ear
in
whic
h t
he
per
son f
irst
stayed o
uts
ide
Goa
Ser
ial
No.
Ever
liv
ed o
uts
ide
Goa
for
a per
iod o
f
one
year
or
more
?
(Wri
te t
he
nam
e)
Ever
liv
ed o
uts
ide
Goa
for
less
than a
year
for
work
/
lookin
g f
or
work
/
for
stu
die
s
(Wri
te t
he
nam
e)
Wit
hin
India
Outs
ide
India
Cou
ntr
y /
Sta
te
wher
e th
e
per
son f
irst
stayed o
uts
ide
Goa
Act
ivit
y s
tatu
s
of
the
per
son
bef
ore
lea
vin
g
Goa
(Code
of
colu
mn 7
)
Wher
e w
as
the
per
son l
ivin
g b
efore
retu
rnin
g t
o G
oa
(Sta
te/C
ou
ntr
y)
Res
iden
ce
code
Wit
hin
In
dia
– 1
Outs
ide
India
- 2
When d
id t
he
per
son
com
e bac
k t
o G
oa
Month
and y
ear
5
Country /state codes 13 &15 Country Code State / Union territory Code
Argentina 1 Andaman Nicobar 43
Australia 2 Andhra Pradesh 44
Bahrain 3 Arunanchal Pradesh 45
Bangladesh 4 Assam 46
Canada 5 Bihar 47
Caribbean Islands 6 Chandigarh 48
China 7 Chattisgarh 49
France 8 Dadar & Nagar Haveli 50
Germany 9 Daman & Diu 51
Hong Kong 10 Goa 52
Hungary 11 Gujarat 53
Indonesia 12 Haryana 54
Iran 13 Himachal Pradesh 55
Iraq 14 Jammu & Kashmir 56
Ireland 15 Jharkhand 57
Italy 16 Karnataka 58
Japan 17 Kerala 59
Kenya 18 Lakshwdeep 60
Kuwait 19 Madhya Pradesh 61
Latin America 20 Maharashtra 62
Malaysia 21 Manipur 63
Mascot 22 Meghalaya 64
Myanmar 23 Mizoram 65
Nepal 24 Nagaland 66
Netherlands 25 New Delhi 67
New Zealand 26 Orissa 68
Oman 27 Pondicherry 69
Pakistan 28 Punjab 70
Philippines 29 Rajasthan 71
Qatar 30 Sikkim 72
Saudi Arabia 31 Tamil Nadu 73
Singapore 32 Tripura 74
South Africa 33 Uttar Pradesh 75
Sri Lanka 34 Uttaranchal 76
Switzerland 35 West Bengal 77
Taiwan 36
Thailand 37
United Arab Emirates 38
United Kingdom 39
United States of America 40
West Indies 41
Others (specify)…………………………… 42
6
Blo
ck –
4 I
NT
ER
ST
AT
E A
ND
IN
TE
RN
AT
ION
AL
MIG
RA
TIO
N
01
18
19
20
21
22
23
24
25
26
27
28
Ser
ia
l N
o.
Nam
e of
per
sons
(incl
udin
g
wom
en a
nd
chil
dre
n)
wh
o
wer
e m
ember
s of
this
Hou
se h
old
now
liv
ing
outs
ide
Goa
(in
India
or
abro
ad)
Rel
atio
n o
f th
e
per
son t
o t
he
hea
d o
f th
e
Hou
seh
old
(C
ode
of c
olum
n 3)
Sex
Mal
e – 1
Fem
ale
- 2
Nam
e of
the
Sta
te/C
ou
ntr
y w
her
e th
e
per
son i
s
curr
entl
y
resi
din
g
(code
13,1
5)
Code
of
the
Cou
ntr
y
curr
entl
y
resi
din
g
Wit
hin
Ind
ia
– 1
Outs
ide
India
- 2
When d
id
the
per
son
go o
uts
ide
Goa
for
the
firs
t
tim
e?
Mon
th
and Y
ear
Age
at
whic
h
the
per
son
firs
t
wen
t
outs
ide
Goa
Educa
tion
al s
tatu
s at
tim
e of
emig
rati
o
n /
out-
mig
rati
on
(Code
of
colu
mn 6
)
Mar
ital
stat
us
at t
he
tim
e of
emig
rati
on
/ou
t -
mig
rati
on
(Code
of
colu
mn 8
)
Act
ivit
y
stat
us
at
the
tim
e
of
emig
rati
o
n/
out
-
mig
rati
on
(Code
of
colu
mn 7
)
Act
ivit
y a
t
pre
sent
(Code
of
Colu
mn 7
)
7
Block –5 Household
29. Is your house electrified?
Yes-1 No-2
30. What type of fuel is used for cooking?
Wood-1 Kerosene-3 Others-5 (specify)
Electricity-2 L.P. Gas-4
31. Type of house which the household is now occupying
Luxurious-1
Very Good (2 bed rooms with attached bathrooms, concrete roof, Mosaic
floor)-2
Good (1 bed room, brick and cement walls, concrete or tile roof)-3
Poor (Brick walls, cement floor, tin or asbestos roof)-4
Kutcha (Mud walls, Mud floor & Thatched roof)-5
32. Does any member of this household own a house here or anywhere else
Yes-1 No-2
33.Does the household own any of the following
1. Motor car Yes No
2. Taxi / Truck / Lorry Yes No
3. Motor Cycle /Scooter Yes No
4. Telephone (land phone) Yes No
5. Mobile Phone Yes No
6. Television Yes No
7. MP3/DVD/VCD Yes No
8. Refrigerator Yes No
9. Electric Cooking Oven Yes No
10. Microwave Oven Yes No
11. Baking Oven Yes No
12. Computer/Laptops Yes No
34. What is your religion?
(Hindu – 1, Christian – 2, Muslim – 3, Sikhs-4, Others –5)
35. Which category of community you belong to
Forward-1, SC/ST-2, Backward-3, OBC-4, Others-5
(specify)……………………
8
Block –6 Questions to the members of the Household
36.Did anyone in your family receive money or goods or gifts other than cash from persons
residing abroad during the last 12-month period?
Yes-1 (If Yes, go to Q.37) No-2 (If No, go to Q.40)
37.If Yes, total amount of money received last year Rs. ………………………………
38. If any goods/gifts received, specify by �mark
(1) Clothes
(2) Gold ornaments
(3) Small electrical equipments
(4) MP3/VCD/DVD
(5) Others (Specify)
Total value Rs. …………………………….
39. In what ways did you use the money? (Tick the appropriate)
(1) For day-to-day household expenses
(2) Education of children
(3) To repay debts
(4) To purchase land
(5) Dowry payment of relatives
(6) To build/purchase new house/renovation of old house
(7) To embark new business/enlarging the existing one
(8) To Maintain agricultural land
(9) Deposited in bank
(10) Others (Specify)………………………………………….
40. Did anyone in your family residing abroad bring money to build house / to purchase land
during last one year?
Yes-1 No-2
If Yes, how much? Rs. ………………………….
41. Did anyone in your family bring money last one year for any purpose, which is not included
above?
Item Amount in Rs.
To buy a Car /. Scooter / Taxi etc
To invest in share / Bonds / mutual funds etc
To start a small enterprise
Others (Dowry payments, education, medical
expenses, payment of debts etc) (specify)
………………………………………………….
9
Block –7 Expenses Incurred for Emigration
(For those who had gone abroad)
On the basis of block 3 and 4
Q.42 Return migrants from abroad and Emigrants
Serial No.
a. Payment to recruitment
agencies
b. Payment to other
Intermediaries
c. Passport
d. Visa
e. Air ticket
f. Emigration Clearance
g. Loss due to fraud (Rs.)
Total
Block –8 Sources of financing for going abroad (�the relevant items)
Q. 43 1 2 3 4
a. From other members of family
b. Personal Savings
c. Parents Savings
d. Borrowing from friends / relatives
e. Loans from moneylenders
f. Loans from Bank
g. Sale / mortgage of landed
Property
h. Sale / pledging of financial assets
i. Sale / pledging of ornaments or
j. Jewellery
k. Government assistance
l. Other sources (specify)…………..
10
Block – 9 Information on Emigrants and Out-Migrants
Q.44 Out Migrants living in other states in India
1 2 3 4
Sl No. From Block 4
Name
Q.45 Emigrants living out side India
1 2 3 4
Sl No. From Block 4
Name
Block –10 Information on Returnees
Q.46 Return migrants from other states in India
1 2 3 4
Sl No. from Block 2
Name from Block 2
Q.47 Return migrants from out side India
1 2 3 4
Sl No. from Block 2
Name from Block 2
11
Blo
ck -
11 E
du
cati
on
(P
art
icula
rs o
f H
ouse
hold
mem
bers
)
48
49
50
51
52
53
54
55
56
57
58
59
60
If y
es, i
n c
olu
mn
48
Ser
ial
No.
in
Blo
ck
2
Do
you
(…..)
curr
ently
atte
nd a
n
educa
tion
al
inst
itut
ion?
Yes
– 1
No
– 2
Whic
h is
the
cours
e
you (
…..)
curr
ently
atte
nd?
(cod
e)
If ther
e is
a
school
studen
t in the
HH
, what
syllab
us
do
they
fol
low
(cod
e)
If H
ighe
r
seco
ndar
y an
d
enro
lled
in
Entr
ance
coac
hin
g
clas
ses,
the
amou
nt of
Fee
pai
d
duri
ng
the
year
Typ
e of
educa
tion
al
inst
itution
(Cod
e)
Pay
men
t
for
regi
stra
tion
/ en
rolm
ent
/ don
atio
n,
etc
(Rs.
)
Tuitio
n f
ee
pai
d fo
r
the
mon
th
(Rs.
)
Pri
vate
tuitio
n
fee
pai
d
for
the
mon
th
(Rs.
)
Cos
t of
Uni
form
,
shoe
etc
.
duri
ng
the
year
(Rs.
)
Cos
t of
book
s,
school
supplies
etc
duri
ng
the
year
(Rs.
)
Cos
t of
Tra
nsp
orta
tion
for
the
mon
th
(Rs.
)
Tot
al
cost
(per
mon
th)
Sch
olar
ship
s /
aid / a
ssis
tanc
e
rece
ived
duri
ng
the
year
(Rs.
)
Co
des
:
Qu
esti
on
49
P
re-s
choo
l
1
Pri
mar
y s
cho
ol
(cla
ss 1
-5)
2
Sec
ond
ary s
choo
l (c
lass
6-1
0)
3
Hig
her
sec
on
dar
y s
choo
l (c
lass
11
-12
)
4
Vo
cati
on
al t
rain
ing
5
Deg
ree
6
P
ost
gra
duat
ion
7
Pro
fess
ion
al C
ours
es
8
Oth
ers
(sp
ecif
y _
__
___
__)
9
Qu
esti
on
50
1.s
tate
2. I
CS
E
3.C
BS
E
4. o
ther
s (s
peci
fy)…
……
……
……
……
Qu
esti
on
52
Gove
rnm
ent
1
Pri
vat
e ai
ded
2
Pri
vat
e unai
ded
/ S
elf
finan
cing
3
12
Blo
ck -
12 H
ealt
h (
Par
ticu
lars
of
all
the m
ember
s of
house
ho
ld)
61
62
63
64
65
66
67
68
69
Ser
ial
No.
in
Blo
ck 2
Was
ther
e an
y a
ilm
ent
/
acci
den
t/ i
nju
ry/a
ches
etc
duri
ng t
he
pre
vio
us
month
Y
es
– 1
No –
2
(if
no, sk
ip t
o q
ues
tion
68)
Who w
as
consu
lted
for
the
ailm
ent
duri
ng
the
pre
vio
us
month
?
(code)
Pla
ce o
f
con
sult
atio
n
(code)
Consu
ltat
ion
fee
pai
d
duri
ng t
he
month
(Rs.
)
Cost
of
med
icin
e /
dia
gn
ost
ic t
ests
etc.
incu
rred
duri
ng t
he
month
(Rs.
)
Tra
nsp
ort
atio
n
cost
in
curr
ed
for
hea
lth c
are
duri
ng t
he
month
(Rs.
)
Hosp
ital
izat
ion
char
ges
incu
rred
las
t
year
(Rs.
)
Do a
ny
mem
ber
of
this
HH
suff
er
from
an
y
illn
ess
whic
h
nee
ds
conti
nu
ous
trea
tment?
If y
es,
(Code)
Expense
s
incu
rred
per
month
for
trea
tment
(Rs.
)
C
od
es:
Qu
esti
on
62
No C
on
sult
atio
n
0
Doct
or/
Den
tist
/Gynae
colo
gis
t/P
sycholo
gis
t 1
Nurs
e/nurs
e as
sist
ant
2
Hea
lth w
ork
er/h
ealt
h a
ssis
tant
3
Tra
dit
ional
docto
r
4
Phar
mac
ist
5
Fam
ily/m
em
ber
s of
the
hou
sehold
6
Oth
ers
(spec
ify…
……
…)
7
Qu
esti
on
63
Gover
nm
ent
hosp
ital
1
Pri
vat
e H
osp
ital
s/N
urs
ing H
om
e/cl
inic
2
Publi
c H
ealt
h C
ente
r /
Sub c
entr
e
3
Dis
pen
sary
(P
ubli
c or
Pri
vat
e)
4
Phar
mac
y
5
Quac
ks
6
Par
amed
ical
Per
sons
7
Oth
ers
(spec
ify…
……
….)
8
Qu
esti
on
68
Dia
bet
es
1
Hea
rt P
rob
lem
2
Art
hri
tis
3
Chole
ster
ol
4
Blo
od
Pre
ssure
5
Ast
hm
a
6
Can
cer
7
Kid
ney d
isea
ses
8
Oth
ers
(Spec
ify…
……
…)
9
13
Blo
ck -
13 H
ealt
h (
For
marri
ed
wom
en
)
70
71
72
73
74
75
76
Peri
od
ic
con
sult
ati
on
Res
ult
of
Pre
gnan
cy
Ch
ild
del
iver
y
Ser
ial
No.
in
Blo
ck 2
Duri
ng t
he
last
12
month
s, h
ave
you
or
an
y o
ther
mem
ber
of
the
HH
bee
n p
regnan
t?
Yes
– 1
No –
2
Cos
t of co
nsu
ltat
ions
/
med
icin
es/o
ther
med
ical
rem
edie
s, e
tc d
urin
g pa
st y
ear
(Rs.
)
Pre
gnan
cy
Conti
nuin
g –
1
Ab
ort
ion –
2
Del
iver
y –
3
Type
of
chil
d b
irth
Norm
al
– 1
Pre
mat
ure
– 2
Typ
e of
Del
iver
y
Norm
al
– 1
Ind
uce
d– 2
Cae
sari
an –
3
Pla
ce o
f
Del
iver
y /
Chil
d
Bir
th
(Code)
Expense
s on c
hil
d
bir
th /
del
iver
y
(Rs.
)
(Ple
ase
indi
cate
the
num
ber
0 if
you d
id
not m
ake
any
paym
ent)
14
Block 14- Household Consumer Expenditure
Value of consumption
(Rs 0.00)during
Sl. No.
Item group last 30
days
last 365
days
14.1 Cereals (include rice, wheat, jowar, maize, barley, ragi, etc)
14.2 Cereal substitutes ( include atta, suji, maida, muri, chira etc)
14.3 Pulses (include arhar, urad, moong, gram, kesar etc)
14.4 Pulse products ( include gram flour, bason, soya bean power etc)
14.5 Milk ( include all types of milk)
14.6 Milk products (include curd, butter milk, butter, ghee, condensed milk, milk powder,
baby food etc)
14.7 Edible oils and vanaspati (include coconut oil, gingely oil, ground nut oil, palm oil,
soya bean oil, sunflower oil, mustard oil etc)
14.8 Vegetables (include all kinds of root, leafy and other kinds of vegetables, ginger,
green chillies, coconut etc)
14.9 Fruits (include banana, apple, guava, mango etc)
14.10 Egg, Fish and Meat
14.11 Sugar (all types of sugar including candy)
14.12 Salt (include all kinds of salt)
14.13 Condiments and spices (include dry chilies, coriander, jeera, pepper, cardamom,
turmeric, curry powder, masala powder etc)
14.14 Tea, Coffee, Bournvita, Complan, Horlicks etc
14.15 Other food items (include bakery products, biscuits, cake, noodles, processed food
items such as pickles, sauce, fruit juices, juice powders like Rasna, Tang etc)
14.16 Ready to eat food items (items procured from eateries, hotels and restaurants)
14.17 Food Items (Total of items 2.1 to 2.16)
14.18 Pan, tobacco, cigarettes, bidi etc
14.19 Intoxicants (include liquor, country liquor, arrack, fenny, beer, rum and similar
products)
14.20 Personal care and toilet articles (include tooth paste, brush, powder, soap, hair oil,
shampoo, deodorants etc)
14.21 Consumer services ( include domestic servant , grinding charges, tailoring charges,
ironing services and other similar expenses
14.22 Entertainment (include cinema, picnic, sports, video, cable charges etc)
14.23 Sundry items (include spectacles, umbrella, torch, lighter etc)
14.24 Travel and conveyance (include train / bus fare, petrol / diesel expenses, taxi / auto
hiring charges etc)
Not
required
14.25 News paper, books and periodicals
14.26 Fuel (firewood, charcoal, gas, kerosene etc)
14.27 Light (electricity, kerosene etc)
14.28 Rent and taxes (house rent, telephone rent, consumer services, taxes, water charges,
mobile prepaid / post paid coupons, property tax etc)
14.29 Medical expenses (include cost of medicines, doctors fee, diagnostic tests,
hospitalization expenses etc)
14.30 Education expenses( include tuition fee, books, school bags, private tuition, hostel
fees and all other related expenses)
14.31 Clothing and foot wear
14.32 Consumer durables( include expenses for purchase of utensils, fan, mixie, cooker,
furniture items and similar household durables)
Not
required
14.33 Other non food expenses (pocket money, internet browsing charges, prepaid charges
etc)
14.34 Proportionate expenses on items 14.26 to 14.32
14.35 All non food expenses (Total of items 14.18 to 14.25 and 14.33 and 14.34)
14.36 Total consumer expenditure (Items 14.17 + 14.35)
Not
required
15
Enquiry on Household Consumer Expenditure
Block 15- Household savings
Savings (Rs 0.00) during Sl.
No.
Particulars Last month Last year
15.1 Savings account in Bank
15.2 Fixed deposits
15.3 Recurring deposits
15.4 Chitty, Kuris and similar instruments
15.5 PF installment, LIC premium etc
15.6
15.7
15.8 All savings (Total of 15.1 to15.7)
Block 16. Investments during last year
Sl.
No.
Particulars Investment during (Rs 0.00)
last year
16.1. Land
16.2. Buildings
16.3 Other constructions
16.4 Business enterprises
16.5 Shares, debentures etc
16.6 Mutual funds
16.7 Human Capital (Education and training)
16.8 Bonds and Similar financial instruments
16.9
16.10
16.11
16.12 All Investments (Total of 16.1 to 16.11)
Block 17. Remarks of the filed Investigator
Date of interview
Signature of the investigator
16
FSU Number Questionnaire Number
GOA MIGRATION SURVEY 2008
STATE OF GOA- INDIA
GOVERNMENT OF GOA
AND
CENTRE FOR DEVELOPMENT STUDIES (CDS), THIRUVANANTHAPURAM
RETURN EMIGRATION SURVEY, 2008
17
SCHEDULE II. RETURN EMIGRANTS
BLOCK 1: IDENTIFICATION PARTICULARS
1.1 FSU Number 1.2 Schedule Serial Number
1.3. Serial Number of the main
module
1.4. Tabulation Serial
Number of the main
module
1.5. Serial number of the return
emigrant (from Schedule 1,
block 2)
1.6. Name (from Schedule 1,
block 2)
BLOCK 2: STATUS AS ON THE EVE OF EMIGRATION
1. Activity status on the eve of first emigration (Code: Use the same code as
used in column 7 of Block 2 of the main schedule)
2. Income status on the eve of first emigration (annual income in Rs) – Report
‘0’ if code 8 to 13 against item 1.
3. Reasons for the first emigration: Identify three most important reasons in the order of their
importance. (Code: Get employment –1, Accumulate savings –2, Meet household
expenditure –3, Marriage of siblings/children –4, Construction/purchase of house –5,
Purchase of vehicle –6, Repay debts –7, Experience pleasure of travel – 8, Others –9)
3.1 First priority
3.2 Second priority
3.3 Third priority
Report the status on the following for the first and last
episodes of emigration
First Episode Last episode
4. Sources of information on emigration opportunity:
Report the main reason for the emigration. (Code:
News paper advertisement – 1, Advertisement in
other mass media –2, Friends and relatives –3,
Recruitment agencies – 4, Emigrants – 5, Foreign
employment agents – 6, Individual agents – 7,
Others – 8)
5. Year of emigration (yyyy)
6. Status in the household (Code: Head –1, Earning
dependent –2, Non earning dependent –3)
7. Marital status on the eve of emigration
(Code: Never married – 1, Currently married –2,
Widowed –3, Divorced – 4, Separated - 5)
8.
Channel through which the emigration took place
(Code: Direct application –1, Govt. agencies –2,
Licensed Recruiting Agencies - 3, Unlicensed
Recruiting Agencies – 4, Relatives – 5, Friends – 6,
Individual agents – 7, Others –8)
9. Name of the Country to which emigrated
10. Country Code
18
BLOCK 2: STATUS AS ON THE EVE OF EMIGRATION (contd.)
First Episode Last episode
11. Did you get pre emigration counseling (Code: Yes –1,
No –2)
12. Type of visa obtained (Code: Employment visa –1,
Visit Visa -2, Tourist visa –3, Pilgrimage visa – 4,
Others –5)
13. Did you sign an employment contract before
emigration?
(Code: Yes –1, No – 2)
14. If yes to item 12 in which language the contract was
prepared? (Code: English –1, Arabic –2, English
and Arabic – 3, Other languages – 4, Don’t know –
5)
BLOCK 3: EMIGRATION EXPERIENCE
15 Migration
episode
Country to which
emigrated (Use country
code)
Period
of stay
(years)
Activity status
(Use the code of column 7
of block 2 of the main
schedule)
Annual
Income (Rs)
Reasons for
return
(Code) *
15.1 1
15.2 2
15.3 3
15.4 4
15.5 5
* (Code: Expiry of contract –1, Compulsory expatriation –2, Low wages –3, Ill health –4, Problems at
home – 5, Poor working conditions – 6, Harsh behavior of employer – 7, Hostile climate –8, Others –9)
16. Cost of Emigration (Rs) First episode Last episode
16.1 Payment to recruiting agencies
16.2 Payment to other intermediaries
16.3 Passport
16.4 Visa expenses
16.5 Air ticket
16.6 Emigration clearance
16.7 Medical Test
16.8 Loss due to fraud
16.9 Others (specify)
16.10 Total
17. Sources of Financing emigration (Code: Yes –1, No –2)
17.1. Personal savings
17.2. Parents savings
17.3. Other members of the family
17.4. Borrowing from friends and relatives
17.5. Loan from money lenders
19
17.6. Loan from Bank
17.7. Sale / mortgage of landed property
17.8 Sale / pledging of financial assets
17.9 Sale / pledging of ornaments / Jewellery etc
17.10 Govt. assistance
17.11 Other sources (specify)
BLOCK 4. WORKING AND LIVING CONDITIONS ABROAD
WORKING CONDITIONS First episode Last episode
18. Problems faced at the time of arrival at the destination
(Code: Yes –1, No – 2)
18.1 With regard to passport
18.2 With regard to visa
18.3 With regard to work permit
18.4 With regard to employment contract
18.5 Others (specify)
19. Whom did you contact on arrival? (Code: Employer /
employer’s representative – 1, Friends – 2, Relatives – 3,
Indian embassy officials – 4, Others – 5, none – 6)
20. Was the job received the same as the one promised at the
time of recruitment? (Code: Yes – 1, No – 2)
21. Were you required to sign a new contract at the time of
arrival? (Code: Yes – 1, No – 2)
22. Were you allowed to keep the passport and other
documents with you? ? (Code: Yes – 1, No – 2)
23. Were the conditions of work agreeable to you?
(Code: Yes – 1, No – 2)
24. Did the employer provide free accommodation and food?
(Code: Accommodation only –1, Food only – 2,
Accommodation and food – 3, None – 4)
25. Were you required to share accommodation with others?
(Code: Yes –1, No – 2, Not applicable - 3)
26. Was your accommodation satisfactory?
(Code: Yes –1, No – 2, Not applicable - 3)
27. Was the quality of food offered passable?
(Code: Yes –1, No – 2, Not applicable - 3)
28. How was the food given to you by the employer (Code: Free – 1, Subsidized – 2, Normally priced –3,
Exorbitantly priced – 4, No food provided –5)
29. Medical facilities provided by the employer (Code: Good –1, Satisfactory – 2, Poor – 3, Not provided – 4)
30. Were religious practices permitted in the place where you
lived? (Code: Yes – 1, No – 2)
31. Were facilities available in the place you lived to observe
religious practices? (Code: Yes – 1, No – 2)
32. Did your spouse accompany you?
(Code: Yes – 1, No – 2, Not applicable – 3)
33. If yes to item 32 was your spouse employed at the
destination? (Code: Yes –1, No – 2)
20
BLOCK 4. WORKING AND LIVING CONDITIONS ABROAD (contd.)
34. If no to item 32 what was the main reason?
(Code: Unwillingness of spouse –1, Spouse employed in
India – 2, Responsibilities at home – 3, Permission not
granted by India – 4, Desire to maximize savings – 5,
Lack of accommodation –6, Inadequate income
abroad –7, Others – 8)
35. Did you report your arrival at the Indian Embassy in the
destination country? (Code: Yes –1, No –2)
36. Did you approach the Indian Embassy with any problem /
complaint? (Code: Yes –1, No –2)
37. If yes to item 36 nature of the problem (Code Yes –1, No – 2)
37.1. Grievances against employer
37.2. Problems of pay
37.3. Problems of communication
37.4. Harassment from local police/public
37.5 Other (specify)
38. If yes to 37.1 to 37.4, did you receive positive response
from the Indian embassy officials? (Code Yes –1, No – 2)
39. Your average monthly income (Rs)
40. Your average monthly living expenses (Rs)
41.. Your average monthly home remittances (Rs)
42. Your average monthly savings (Rs)
43. Who was managing household affairs during your
employment abroad? (Code: Spouse – 1, Parents – 2,
Siblings – 3, Children –4, In laws –5, Other (specify) – 6)
44. To whom did you use to send regular remittances?
(Code: Spouse – 1, Parents – 2, Children – 3, In laws – 4,
Other (specify) – 5)
45. How did you send money home? (Code: Mail transfer –1,
Bank deposits – 2, Friends / relatives – 3, During home
visits – 4, Hawala – 5 Other means (specify) – 6)
46 Did your household face the following problems during your absence? (Code Yes –1, No – 2)
46.1 Prolonged Illness
46.2 Death of family members
46.3 Loss of assets
46.4 Threats to personal safety
46.5 Litigation
46.5 Poverty / Deprivation
46.6 Children’s behavioral issues
46.7 Others (specify)
21
BLOCK 5. POST RETURN PHASE
47. Year of return from your last emigration episode (yyyy)
48.
Reasons for return (Code: Expiry of contract –1, Compulsory expatriation –2, Low
wages –3, Ill health –4, Problems at home – 5, Poor working conditions – 6, Harsh
behavior of employer – 7, Hostile climate –8, Others –9)
49. Were skills acquired from work abroad? (Code: Yes –1, No –2)
49.1 Technical skill
49.2 Managerial / Supervisory
49.3 Accounting
49.4 Housekeeping
49.5 Marketing / trading skills
49.6 Navigation skills (driving, sailing etc)
49.7 Leadership/organizational skills
49.8 Financial management skills
49.9 Others (specify)
50. Identify the forms in which you kept your savings? (Code: Yes –1, No –2)
50.1 Bank deposits
50.2 Shares/ debentures
50.3 Gold/Jewellery
50.4 Mutual funds
50.5 Invested with private financiers
50.6 Invested with money lenders
50.7 Others (specify)
51. Have you invested / spent your earnings in the following forms? (Code: Yes –1, No –2)
51.1 Agricultural land
51.2 Real estate
51.3 Residential / Non residential buildings
51.4 Transport vehicles
51.5 Education of children
51.6 Medical treatment of family members
51.7 Marriage of sisters / daughters etc
51.8 Business enterprises
51.9. Repayment of debts
51.10. Others (specify)
52. Activity status (use the same code as in column 7 of block 2 of the main schedule)
If working (code 1 to 8 against item 52 report data against items 53 and 54
53. Nature of employment (Code: Regular –1, Temporary – 2, Casual –3)
54.
Sector in which engaged (Code: Agriculture / Animal husbandry / Fishing /
mining –1, Manufacturing –2, Construction –3, Transport – 4, Trade – 5, Hotels
and restaurant – 6, Communication – 7, Personal services – 8, Other services –
9)
55. If self-employed (Code 4 against item 52), nature of self-employment
(Code: Own account worker –1, Employer –2, Both -3
If code 2 against item 55 report data for items 56 to 62.
56. Year of starting the enterprise (yyyy)
22
BLOCK 5. POST RETURN PHASE (contd.)
57. Number of persons working in the enterprise
57.1 Unpaid household workers
57.2 Apprentices
57.3 Paid employees
58. Nature of activity of the enterprise (Code: Processing of agricultural produce –1,
Repair workshop –2, Production of handicraft / pottery etc. –3, Transport /
Communication services – 4, Trading establishment – 5, Hotel / restaurant – 6,
Personal services – 7, Others – 8)
59. Identify the motive for starting the enterprise (Code: Yes –1, No –2)
59.1 Desire to be financially independent
59.2 Find jobs for members of the family
59.3 Perpetuation of the family business
59.4 Access to raw materials
59.5 Access to markets for the outputs
59.6 Experience /expertise gained abroad
59.7 Incentives from government
59.8 Others (specify) Performance of the Enterprise
60 Particulars At the beginning At present
60.1 Number of workers
60.2 Size of the unit in terms of capital (Code: Rs < 1 lakh – 1,
1 to 5 lakhs – 2, 5 – 10 lakhs – 3, More than 10 lakhs-4)
60.3 Annual turn over (Rs)
60.4 Annual net profit (Rs)
61. Did you get public support in starting your enterprise? (Code: Yes –1, No –2)
62. If code 1 to item 60 report the type of support received
If unemployed at present (code 9 against item 52) report data for items 63 and 64.
63. Have you pursued an economic activity at any time in the past?
(Code: Yes –1, No –2)
64.
If yes how did that activity terminate?
(Code: Employer terminated job –1, Employer closed / shifted business – 2,
Left the job on account of low remuneration –3, Left due to ill-health - 4,
Old age – 5, Decided to start own business – 6, Others – 7)
23
BLOCK 6: FUTURE PLANS
65. Future plans? (Report response in terms of code: Yes –1, No – 2)
65.1 Start a new business
65.2 Take up employment
65.3 Re-emigrate
65.4 Retire from work
65.5 Others (specify)
66. Do you think that the government has to pay more attention to the
rehabilitation of return emigrants? (Code: Yes –1, No –2)
67. If yes to item 66 what are the areas
BLOCK 7. REMARKS OF THE INVESTIGATOR
Name of the Investigator Date of Interview
24
FSU Number Questionnaire Number
GOA MIGRATION SURVEY 2008
STATE OF GOA- INDIA
GOVERNMENT OF GOA
AND CENTRE FOR DEVELOPMENT STUDIES (CDS),
THIRUVANATHAPURAM
MIGRATION AND WOMEN
(Only to those women whose husbands are currently emigrants)
25
SCHEDULE III. Women Left Behind
BLOCK 1: IDENTIFICATION PARTICULARS
1.1 FSU Number 1.2 Schedule Serial
Number
1.3. Serial Number of the
main module
1.4. Tabulation Serial
Number of the main
module
1.5. Serial number of the
woman left behind (from
Schedule 1, block 2)
1.6. Name (from
Schedule 1, block 2)
BLOCK 2: GENERAL INFORMATION 1.Name of the husband
2.Husband’s date of birth: Month………Year………
3.Date of Marriage: Month Year
4.Duration of marital life (in completed years)
5.Activity status of husband at the time of marriage (use codes)
6.Husband’s Educational Status (use codes)
7. Activity status of husband at present (use codes)
8.During the time of marriage, where was husband living?
(In Goa - 1, Outside Goa but within India - 2, Outside India - 3)
9. If the answer is ‘Outside India’, specify the country (use codes)
10.If code 3 for item 8, was it one of the reasons for your getting
married to him? (Yes - 1, No - 2)
11. When did he go from Goa in search of job, for the first time?
Month Year
12. When did he go for taking up job, after marriage?
Month Year
13. After marriage, how many times has he visited you on leave from
abroad? (report ‘0’ if he has not visited)
14. After your marriage how many times your husband visited and duration of his stay at
home with you? (last six visits)
Visit Year of arrival Duration of stay
Month Days
First
Second
Third
Fourth
Fifth
Sixth
26
BLOCK 2: GENERAL INFORMATION (continued)
15. How many times you have visited husband’s working place
overseas? (report ‘0’ if you have not visited, Code: Yes – 1, No - 2)
16. How long did you stay with him at his work place during the last
visit? (One week - 1, 8 days to 1 month - 2, 1 – 3 months - 3, 4
months to 1 year – 4 , More than one year - 5)
17.Do you keep in touch with your husband while he is abroad?
(Yes -1 , No -2)
If ‘Yes’ to item 17 : answer 18, 19 , 20.
18. What are the means of communication used?
(Code :Letters - 1, Telephone/ mobile - 2, E-mail - 3,Web cam - 4,
More than one mode – 5, Others (specify) – 6)
19.Frequency of receiving letters/e-mails/telephone calls from your
husband (Code:Daily - 1, At least once in a week - 2, 3- at least once
in 2 weeks - 3, at least once month - 4, Occasionally - 5 )
20. Frequency of your sending letters/mails/telephones to your
husband (Daily - 1, At least once in a week - 2, 3- at least once in 2
weeks - 3, at least once month - 4, Occasionally - 5 )
BLOCK 3: REMITTANCES AND AUTONOMY
21. In whose name your husband sends money? (Code: My name -1, His
parent’s name -2, His brothers name -3, My parent’s name -4, Others -5)
22. Do you have control over the money sent by your husband?
(Full control -1, Partial control -2 , No control -3)
23. If code 3 to items 22 how does you meet your daily expenses?
(Code: Income from property - 1, Earnings from Work-2, My parents take
care 3, Husband’s parents take care -4, , Others - 5 (specify) )
24.What is the mode of transfer of money?
(Code: Through bank -1, Through Cheques/drafts -2, Through other
financial institutions -3, Through relatives/ friends coming on leave -4,
Others - 5 (specify) )
25. During the past 12 months, how much money was received as
remittance ? (in Rs)
25.1.To you
25.2.To others
27
BLOCK 3: REMITTANCES AND AUTONOMY(continued)
26. Do you posses any landed property or any other property, in your
name? (Code: yes in my name -1, yes jointly with my husband -2, yes
jointly with other members of household -3, no property -4)
27. If yes to item 26, what is the type of property owned?
(Code: Land -1, House -2, Others - 3 (specify))
28. Sources of income (Code: No independent source -1, Agriculture /
dairying -2, Enterprise -3, Salary / Wage - 4, Rent – 5, Interest / dividend
etc – 6, Remittance – 7, Other sources – 8, More than one source -9)
29. Control on income (Code: Myself -1, My parents -2, My in laws -3,
My children -4, Others -5)
30. How do you spend your income? (Code: Savings -1, Emergencies -2,
Day to day household expenses – 3, Purchase of durables – 4, Purchase of
ornaments -5, Others -6)
31. Do you keep money without knowledge of husband/other family
members? (code : Yes -1, No – 2)
32. Do you have a savings account in Bank/ Post Office?
(Code: Yes -1, No – 2)
33. Do you subscribe to any Chitties / Kuries? ? (Code: Yes -1, No – 2)
34.Some women manage household affairs on their own while others depend on parents /
fathers-in-law / mothers-in-law / others for such matters. Answer the following questions to
show the category to which you belong. (Code: own decision – 1, directions from husband -2,
directions from parents -3, directions from in laws – 4, directions from others -5)
34.1 Day to day household expenses
34.2 Purchase of apparel (sari, chappel etc)
34.3 Purchase of clothes for children
34.4 Taking children for treatment
34.5 Going out for social visits
35. Do you have a circle of friends around? (Code: yes –1, No –2)
36. How many children do you have? (Indicate ‘0’ if you have no child)
Sex ( male –1,
female –2)
Age
Class in
which
studying
37. If you have children give their particulars
38. Do you feel that your children will fare better in their studies if your
husband is around? (Code: Yes –1, No –2, Not applicable -3)
28
BLOCK 4: PROBLEMS AND PROSPECTS 39. In the absence of your husband do you feel any problems of
(Code: Yes –1, No –2)
40. If yes to item 42, nature of the problems (Code: Yes –1, No –2) 40.1 Loneliness
40.2 Added responsibility
40.3 Insecurity
40.4 Health of parents / in-laws
40.5 Bringing up children
40.6 Financial adjustments
40.7 Others
41. What is the nature of relationship with your in laws?
(Code: Excellent –1, Normal –2, Strained –3)
42. If code 3 to item 41 what is the main reason?
(Code: Financial issues –1, Disciplining children –2, Typical in law
problems –3, Basic misunderstandings – 4, Others –5,)
43. In case somebody in the family has to be taken to hospital
urgently, who does it? (Code: Myself –1, My parents –2, My father
in law – 3,Other members – 4)
44. In the absence of your husband, do you face problems in bringing up
your children? (Code: Yes –1, No –2, Not applicable –3)
45. If yes to item 44 nature of problems
( Code: yes –1, No –2)
45.1 Disobedience
45.2 Misbehavior
45.3 Stubbornness
45.4 Lack of interest in studies
45.5 Money mishandling
45.6 Others (specify)
29
BLOCK 4: PROBLEMS AND PROSPECTS (continued)
46. During your husband’s absence, you might have had both good and bad
experiences in your Life. Please specify 3 good experiences & 3 bad
experiences. Indicate your choice by circling the entries.
46.1.Good experiences 46.2. Bad experiences
Financial benefits 1 Loneliness and isolation 1
Could construct a house 2 Heavy responsibilities 2
Bought Gold Ornaments 3 Worries about the future /
studies of children
3
Purchased land 4 Outstanding debts / disposal
of property
4
Improved status with relatives 5 Insecurity 5
Helped relatives/in-laws 6 Children’s health problems 6
Cleared debts 7 Anxiety and fear 7
Improved life style 8 Disarray in household
matters
8
Could afford better education for
children
9 Legal disputes 9
Greater exposure to outside world 10 Dependence on outside help 10
47. All things considered how satisfied or dissatisfied you are with your
life these days? (Code: Extremely satisfied –1, Very satisfied –2,
satisfied –3, neutral –4, dissatisfied –5, very dissatisfied – 6,
extremely dissatisfied – 7)
48. If you have a daughter of marriageable age, who would you like her to
get married to? (Code: A person with in Goa –1, A person outside Goa
but with in India –2, A person outside India –3)
Block 5: Remarks of the Investigator
Name Date of interview
30
FSU Number Question Number
GOA MIGRATION SURVEY 2008
STATE OF GOA- INDIA
GOVERNMENT OF GOA
AND CENTRE FOR DEVELOPMENT STUDIES (CDS),
THIRUVANATHAPURAM
MIGRATION AND ELDERLY
(Only to those who are aged 60 and above)
31
GOA MIGRATION MONITORING STUDY– 2008
MIGRATION AND THE ELDERLY SCHEDULE IV
BLOCK 1: IDENTIFICATION PARTICULARS
1.1. FSU Number 1.2. Schedule Serial Number
1.3 Serial Number of the
main module
1.4 Tabulation Serial Number of
the main module
1.5. Serial number of the
person as in block 2 of
the main schedule
1.6. Name of the person as in
Block 2 of the main schedule
BLOCK 2: GENERAL INFORMATION
1. Current marital status (Never married -1, Currently married -2, Widowed
-3, Divorced -4, Separated -5)
2. If code other than 1 for item 1, were you married more than once?
(Code : Yes -1, No -2)
3 If code no to item 2 month and year of marriage (mm – yyyy)
4. If yes to item 2 reason (Death of spouse -1, Divorce – 2, Separation – 3, Others -4)
5. If code 1 for item 2 ie. married more than once
5.1 Month and year of first marriage (mm - yyyy)
5.2 Month and year of last marriage (mm - yyyy)
6. If widowed / divorced / separated
6.1 Month and year of death / divorce / separation
6.2 Month and year of widowed / divorced / separated spouse of the first
marriage (mm – yyyy)
7. Number of living children including married daughters (all sons/ daughters may
not be members of the household and as such need not be in block 2 of the main
schedule)
7.1. Sons
7.2. Daughters
8. How many of your children are staying with you in this house?
8.1 Sons 8.2 Daughters
9. How many of your children are staying away
9.1 In Goa 9.2. Outside Goa but within India 9.3. Outside India
10. Do your children who do not stay with you visit you often?
(Code: Never -1, Yes occasionally – 2, Yes as often as they can -3 )
11. Number of persons other than spouse and children staying in the house
32
BLOCK 2: GENERAL INFORMATION (contd ……)
12. Do you get financial assistance from your children (Code: Yes -1, No -2)
13. Do your children help you financially on the following (Code: Yes -1, No -2)
13.1 Subsistence / household expenses
13.2 Medical / health related expenses
13.3 Emergencies
13.4 Other needs
14. Are any of your children readily available to take you to doctor / hospital etc?
(Code: Yes – 1, No – 2)
15. Who takes care of your household matters – the person who takes decision
about matters relating to the day-today-activities in the household?
(Code: Myself – 1, My spouse – 2, Son -3, Daughter -4, Son in law -5,
Daughter in law -6, Bother / sister – 7, Others - 9)
16. It is often said that children are the main support for the parents at old age. Do
you agree with this view? (Code: Agree -1, Do not agree -2, No comments – 3)
17. When people become old they experience several problems. Have you experienced
/ experiencing any of the problems identified below? (Code Yes – 1, No -2, Do not know –9)
17.1 Daily subsistence
17.2 Financial
17.3 Health problems
17.4 Feeling lonely
17.5 Not able to move around
17.6 Nobody to help when you are sick
17.7 Nobody to prepare food
17.8 Children away
17.9 Children don't visit often
17.10 Security problems/afraid of thieves etc
17.11 Disrespect from relatives and others
18. Whether staying with spouse? (Code Yes -1, No -2, Not applicable -3)
33
BLOCK 3: LIVING ARRANGEMENTS
19. With whom you are residing now? (Code: With spouse only – 1, With married daughters -2,
With married sons -3, With unmarried children – 4, With other relatives – 5, Alone – 6)
20. If living alone whether any close relative is living nearby?(Code: Yes -1, No -2, )
21. Possession of the house in which staying (Code: Owned by self / spouse -1,
Owned by son / daughter -2, Owned by other relatives -3, Rented – 4, Others -5)
22. If living with son / daughters / relatives do you have a separate room for yourself?
(Code: Yes -1, No -2)
23. Location of toilet / bath used by the elderly (Code: Attached to the house -1,
Close to the house – 2, Away from the house -3, No toilet / bath -4)
24. Suitability of toilet / bath for the subject (Code: Good -1, Satisfactory -2, Not satisfactory -3)
25. Suitability of sleeping arrangements (Code: Good -1, Satisfactory -2, Not satisfactory -3)
26. Suitability of accommodation (Code: Good -1, Satisfactory -2, Not satisfactory -3)
27. In your opinion, which is the best place for persons to live in old age? (Code: With spouse only – 1, With married daughters -2, With married sons -3,
With unmarried children – 4, With other relatives – 5, Alone – 6, Old age homes – 7)
28. Have you heard of OLD AGE HOMES? (Code: Yes -1, No -2)
29. If yes to item 28, have you ever visited an OLD AGE HOME?(Code Yes -1, No -2)
30. Do you consider old age homes suitable for elderly?(Code: Yes -1, No -2, No idea -3)
31. If you have the financial ability or if your children or somebody else agrees to
meet the expenses of an old age home will you be happy to move in to an
old age home? (Code Willingly – 1, Only as a last resort– 2, - Not at all - 3)
BLOCK 4: ECONOMIC AND FINANCIAL SECURITY
32. As on date do you or your spouse own / possess the following assets? (Code: Yes -1, No – 2)
32.1 Land
32.2 House / Building
32.3 Bank Deposits
32.4 Other assets
33 During the last 10 years whether you have gifted your / your spouse’s property /
assets? (Code: No assets -1, Keeping entire assets – 2, Partially gifted -3,
Fully gifted -4)
34. If owns property who manages the property? (Code: Self / Spouse -1,
Children -2, Other relatives – 3, Not applicable – 4)
35. What is your current state of economic dependence?
(Code: Fully independent – 1, Dependent on spouse – 2, Partially dependent on
others – 3, Fully dependent on others - 4)
36. What is the main source of your income? (Code: Employment – 1, Pension -2,
Interest -3, Rent -4, Property – 5, Remittances – 6, Others -7)
37. Are you currently working? (Code: Yes -1, No -2)
38. If you are working nature of employment (Code: Own account worker – 1, Employer -2,
Regular salary / wage paid employment – 3, Casual wage labor – 4, Others – 5)
34
BLOCK 4: ECONOMIC SECURITY (contd…)
39. If working type of remuneration that you get? (Code: Cash -1, Kind -2, Cash and
Kind -3, No payment -4)
40. What are your means of your subsistence? ( Code; Yes -1, No -2)
40.1 Income from own current work
40.2 Pensions arising out of own retirement/spouse pension
40.3 Income from savings, rent and property
40.4 Support from children residing in the house
40.5 Support from children residing elsewhere but within India
40.6 Remittances/support from children who work outside India
40.7 Support from other relatives
40.8 Support from NGOs, charitable organizations etc
40.9 Others
41. Do you have a bank account? (Code: Yes -1, No – 2 )
42. If yes to item 41. Type of account:
(Code: Savings account -1, Current account – 2, Others – 3)
43. Who operates your bank account?
(Code: Myself -1, Spouse -2, Children -3, Others -4)
FOR WIDOWS AND WIDOWERS ONLY
44 What happened to the assets owned by you or your spouse after his / her death?
Type of asset
Status ( I inherited -1, My
children inherited -2, Sold -3,
Others -4)
If sold who received the proceeds?
(Code: Myself -1, My children -2,
Others -3)
44.1 Land
44.2 House / Building
44.3 Bank Deposits
44.4 Other assets
45. Do you contribute to the household expenditure? ( Code: Yes -1, No -2)
46 If yes to item 45 what percentage?
BLOCK 5: HEALTH STATUS
47. How do you rate your current state of health?
(Code: Excellent –1, Very good - 2, Good - 3, Fair –4, Poor – 5)
48. How is your current state of health compared to that in the previous year
(Code: Much better – 1, Some what better – 2, Same – 3, Worse – 4)
49. Are you physically mobile? (Can move around by self -1, Can move around only
with help -2, Cannot move around – 3)
50. Can you do your daily routines without assistance? (Yes – 1, No – 2)
51. Can you travel by auto, bus, train etc without assistance? (Yes – 1, No – 2)
52. Can you read newspaper? (Yes without specks -1, Yes with specks only -2, Cannot
read even with specks -3)
35
BLOCK 5: HEALTH STATUS (cond…)
53. Chronic ailments
Suffering (Code:
Yes -1,
No - 2)
Since when
diagnosed by
health professional:
yyyy)
Type of treatment (Code:
Allopathic -1, Ayurveda -2,
Homeopathy -3, Other
systems -4, No treatment -5)
Monthly
expenditure
53.1 Arthritis
53.2 Bronchitis Asthma
53.3 Alzheimer’s disease
53.4 Blood pressure
53.5 Cataract/Glaucoma
53.6 Diabetes
53.7 Heart Disease
53.8 Hearing loss
53.9 High cholesterol
53.11 Kidney problems
53.12 Prostrate problems
53.13 Renal/urinary infection
53.14 Epilepsy
53.15 Thyroid
53.16 Migrant headache
53.17 Tuberculosis
53.18 Stomach Ulcer
53.19 Cancer
53.20 Others
54. Do you suffer from any disability (Code: Yes -1, No -2)
54.1 If yes type of disability (Code: Visual – 1, Speech - 2, Hearing – 3, Loco motor -4,
Other types – 5)
54.2 Since when you are disabled (report the year of onset of disability: yyyy)
Did you suffer from any ailment / injury / accident during last one month (Yes -1, No -2) 55.
If yes provide details
55.1 Type of ailment
55.2 Did you go undertake any treatment? (Yes -1, No -2)
55.3 If yes to item 55.2 place of treatment (Govt. hospital -1, Private hospital -2, PHC /
PHSC – 3, Govt. Doctor -4, Private doctor -5, Others -6)
55.4 Type of treatment (Code: Allopathic -1, Ayurveda -2, Homeopathy -3, Others –4)
Cost of treatment
55.5 Doctors fee / Consultation charges
55.6 Cost of diagnostic tests
55.7 Cost of medicines
55.8 Travel cost
55.9 Other costs
55.10 Total cost
36
BLOCK 5: HEALTH STATUS (cond…)
56. Were you hospitalized as an inpatient during last one year? (Code: Yes -1, No -2)
If yes to item 56 Provide details for items 57.1 to 57.5
57. Hospitalization
spell
Type of
hospital
(Govt. – 1,
Private -2)
Duration
in days
Who stayed with
you in the hospital
(Code: Spouse -1,
Children -2,
Other relatives -3,
Others -4)
Nature of treatment
(Code: Medicine -
1, Surgery -2,
Physiotherapy -3,
Others –4)
Cost of
treatment
(Rs)
Source of
financing
the cost *
57.1
57.2
57.3
57.4
57.5
*(Code: Own savings -1, Sons and daughters -2, Other family members -3, Borrowings -4, Other sources -5)
58. Details of cost of last spell of hospitalization
58.1 Doctors fee / consultation charges
58.2 Diagnostic tests
58.3 Medicines
58.4 Room rent, food etc
58.5 Travel cost
58.6 Other costs
58.7 Total cost
BLOCK 6. GENERAL FEATURES
59. Who are the normal resident members of the household? (Code: Spouse only -1, Spouse
and children -2, Children only -3, Grand children only -4, Other relatives only – 5, Non
relatives only -6)
60. Do you feel lonely or left out by your children, relatives and friends? (Yes -1, No -2)
61. Do you visit your friends? (Regularly –1, Occasionally –2, Never –3)
62. Do your friends visit you? (Regularly –1, Occasionally –2, Never –3)
63. Are you engaged in any community / voluntary work? (Code Yes – 1, No – 2)
64. Are you a member of any social or religious groups, which meet regularly?
(Code: Yes – 1, No – 2)
65. Do you participate regularly in activities related religious organizations such as church /
temple/ mosque etc? (Code: Yes – 1, No – 2)
37
BLOCK 6. GENERAL FEATURES(contd….)
66. Do you use any of the following aids on a regular basis (Code: Yes –1, No –2)
67. If yes to item 66 report for items 67.1 to 67.5
Type of aid
Since when (report
the age from which
stated using)
Cost of the
aid currently
in use (Rs)
Source of financing
(Code: Own money –1, help from
Children –2, Help from relatives –3,
Help from NGOs – 4, Others –5)
67.1 Spectacles
67.2 Walking stick
67.3 Denture
67.4 Hearing aid
67.5 Any other aid
68. Ever smoked cigarette / cigar etc (Yes –1, No –2)
69. If yes to item 68report for items 69.1 and 69.2
69.1 At what age you started smoking
69.2 Do you smoke now? (No stopped on doctors advice –1, No stopped on my own –2,
Yes occasionally – 3, Yes regularly – 4, Yes many times a day – 5)
70. Ever drink alcohol / intoxicant drinks? (Yes –1, No –2)
71. If yes to item 70 report for items 71.1 and 71.2
71.1 At what age you started drinking
71.2 Do you drink now? (No stopped on doctors advice –1, No stopped on my own –2,
Yes occasionally – 3, Yes regularly – 4, Yes every day – 5)
BLOCK 7 FOOD AND NUTRITION
72. How often do you take your meals per day?
73. How many times did you take meals yesterday?
74. Are you generally satisfied with the food you have taken? (Code: Yes – 1, No – 2)
75. Do you experience any problem in taking your food (Code: Yes -1, No – 2)
76. If yes to item 75 is it on account of the following (Code: Yes -1, No -2)
76.1 Cannot chew on account of teeth problems
76.2 Cannot digest on account of stomach problems
76.3 Others (specify)
38
BLOCK 7 FOOD AND NUTRITION
77 Does your food include the following (Code: Every day -1, Once in a week -2,
Once in a fortnight -3, Once in a month -4, Never – 5)
77.1 Milk
77.2 Fruit juices
77.3 Fruits
77.4 Green salad
77.5 Raw vegetables like cucumber, carrot etc
78. Do you feel that you are getting nutritious food (Code: Yes -1, No -2)
79. What is your height (cms)
80. What is your weight (kgs)
81. What do you think about your weight? (Code: Normal – 1, Under weight –2, Over
weight –3)
82. Do you receive any old age pension provided by the Government of Goa/India on
account of poverty, old age or widowhood? (code : Yes -1, No -2
83. If yes, how long (years)
84. How much? Rs.
85. Are you satisfied by the pension amount provided by the Government? 1 Yes 2 No
86. Did you heard about the National Policy for Older Persons? 1 Yes 2 No
BLOCK 8 REMARKS OF THE INVESTIGATOR
Date Signature