goa migration study: appendix v questionnaire

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


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


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?


27. Was the quality of food offered passable?


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


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


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


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


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


STATE OF GOA- INDIA

GOVERNMENT OF GOA


THIRUVANATHAPURAM

MIGRATION AND WOMEN

(Only to those women whose husbands are currently emigrants)

25

SCHEDULE III. Women Left Behind


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


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


STATE OF GOA- INDIA

GOVERNMENT OF GOA


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


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


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

goa migration study: appendix v questionnaire

Documents