Part A: Identification Particulars 1) District Name

4) Ward Name

8) House Number

11) If Yes then Consumer

Account Number

Part B: Family Particulars (Tick if the door is locked)

1) Name of the head of

household

Surname

4) Religion

*

5) Social

Category*

8) Do you have Gas / LPG Connection

(1-Y, 2-N)?

11) Mobile Number

13) In case of

orphans place of

Stay *

14) Status of

Orphan / Destitute

*

15) If Nomadic Tribe / household,

16) Village Name

Part C: Housing details: 1) Status of house *

2) Type of roof *

3) No. of floors in the house

4) Usage of House*

5) Number of rooms excluding kitchen

6) House in other place (1 – Y/ 2 - N)

Details of Orphans, Destitute, Nomadic Tribes

2) Mandal Name

5) Locality: Colony

name / Lane No.

9) Number of households

living in this house

12) Whether Property Tax

assessed? (1- Y/2-N)

Part B: Family Particulars (Tick if the door is locked) Full

Name

6) Caste

9) Gas Company Name *

12)

If Nomadic Tribe / household, do they have permanent residence

Village Name 17 ) Mandal Name

in other

Y/

7) House site else where (1 – Y / 2 - N)

8) Are you beneficiary of Government Housing Scheme (1 – Y / 2 - N)

9) If govt. supported house then year of house construction

Status of house10) If in

col. 1,

answer

is 1 or

3 then

type of

house

11) If in

col. 1,

answer is

2, then

type of

house

Government of Telangana

Intensive Household Survey -2014

Nomadic Tribes

3) Circle Name

6) Street name 7)Street No.

10) Whether House Water tap

Connection is there? (1- Y, 2- N)

13) If yes, then PT Id Number

(PTIN)

2) Father / Mother

/ Husband Name

3) Number of Family

Members

7) Mother Tongue

10) Consumer Number

12) Household Income Tax payee (1-Y, 2-N)

residence at other place (1- Y, 2- N) if yes then 19)

stay in the

present village18) District Name

Status of house* 12) Latrine (1- Y/ 2- N)

13) Drinking water source*

14) Is the house electrified (1- Y/ 2- N)

15) If yes then Meter connection (1- Y/ 2- N)

) If in

col. 1,

answer is

2, then

type of

house

2014

Survey format N

Notional house No.

Census EB No.

No.

Number of Family

Members

19) Duration of

stay in the

present village*

16) If yes then meter connection number

Survey format No.

Part D: Family Member Details :(Only for those who are presently living in city – details of the students in the family who are studying/staying at hostel in or outside city shall be included)

1) S.No.

2) Name of the Family member (Head of the family first )

3) Relationship with the head of the family*

4) Sex*

5) (i) Date of Birth (DD/MM/YYYY)/ (ii) Age*

6) Marital Status*

7) Completed educational qualifications *

8)

Education Status of 6-14 years old children*

9)Bank/ post office account

(1- Y,

2- N)

10) In case of post office account then post office name

11) Post office account number

12) In case of Bank account then name of the Bank

13) Bank branch name

Part E: Persons with Disability details Part F: Chronic diseases

1) S. No

2) Name of the person with disability

3) Type of

disability *

4) Disabled Certificate (SADAREM)

(1-Y, 2- N)

5) If Yes then Disability(SADAREM) Certificate Identification number

6) Percentage of Disability (As per Disability/ SADAREM Certificate)

1) S.

No.

2) Name of the person

suffering from chronic

disease

3) Type of

Chronic

disease *

14) In case of Bank account then Bank Account number

15) Regular Employment

(1- Y, 2- N)

16) If yes then type of Employment*

17) Type of govt. employment pensioner*

18) If Social Security Pensioner, Type of pension *

19) Major Occupation*

20)SHG Membership *

(1- Y, 2- N)

21) Aadhar Card (UID) number

Part G: Movable Assets of the Household

S.No Type of Asset 1-Y

2-N Number

If column 3 is yes then write registration number (Only for S.No. 1 to 4) (If same type

of vehicle is more than 1 in number then write registration number for only 1 vehicle)

1 2 3 4 5

1 Motor Cycle / Scooter

2 Three wheeler motor vehicle /Auto

3 Car /Jeep/ / Four wheeler motor vehicle / JCB / Heavy load vehicle

4 Tractor/Tiller / Harvesting machine/ Other agriculture equipment

5 Air Conditioner

Part-H: Household land details (including of all lands in all places)

1. Does the household hold agricultural land? (1- Yes 2- Yes but land is on the name of mother/father/ grandfather /brother, 3– Land less )

2. If family holds land, give details

1) S. No 2)Type of live

stock/pets

3) Number S. No Type of live stock/pets Number

1 Buffalo/Cow/Ox 4 Poultry birds (including the birds in poultry farm )

2 Sheep/goat 5 Pet Dogs

3 Pigs 6 Others (Specify)

Declaration

I certify that the above information is true. If the above information is found to be wrong I may be declared ineligible for Government benefits/schemes and I will

be liable for any legal action. I solemnly declare the above in the name of God/Self.

Head of the family/members signature/left

thumb impression*

Name:

Enumerator Signature

Name:

Designation:

Mobile No:

Supervisor signature

Name:

Designation:

Mobile No:

S.

No

Name of the

person

holding land

Patta

/Account

No. (Khatha

No.)

Extent How

land

is

acqui

red*

If land is in different place then Extent If

Dry/Fallow

land then

reason *

Wet Land Dry Land Wet Land Dry Land

Acres Gu. Type

of

irriga

tion *

Cultivable Fallow land* Acres Gu. Type

of

irriga

tion*

Cultivable Fallow land*

Acres Gu. Type

of

irriga

tion*

Acres Gu. Acres Gu. Type

of

irrig

ation

*

Acres Gu.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Part I: Livestock and Pets details: 1. Do the household have livestock/pets? 1-Y, 2-N) 2. If yes then give details:

Intensive Household Survey 2014

Part A: Self explanatory

Part B:

Column No.4*: 1- Hindu, 2- Muslim

Column No.5*: 1- SC, 2-ST, 3-BC

Column No.9*: 1-HP. 2- Indian 3

Column No.13*: 1-Own house 2-

Column No.14*: 1- Parents expired

Column No. 19*: 1- Less than 3 months

Part C:

Column No 1*: 1-Own House

sheet roof)

Column No 2*: 1-Thatched house

Column No 4*: 1- Residential, 2-

Column No. 10*: 1- Good condition

Column No.11*: 1-Sanctioned but not

4-Construction completed but not living

7-Completely Collapsed.

Column No 13*: 1-Own well, 2

pump

Part D:

Column No.3*: 1-Himself/herself

8-Mother, 9-Father, 10-Father in law

15-Maternal Grand Mother, 16-Paternal Grand Mother

20- Sister in law, 21- Non relatives

Column No.4*: 1- Female, 2--Male

Column No.5*: If 5(i) is written 5(ii) is not required

Column No.6*: 1-Married, 2-Un Married

from wife, 7- Husband/Wife abandoned

Colum No .7*: C-Small Children

2- 2nd class, 3-3rd class, 4-4th class,

11-Inter 1st year, 12-Inter 2nd year

16- Studying PG , 17- Completed PG, 1

Engineering 21- Completed Engineering

ITI, 25- Completed ITI, 26-Studying Nursing

B.Ed, 30-Others

Column No.8*: 1- In school, 2- Out of school

Intensive Household Survey 2014 Codes Details

Muslim, 3-Christians, 4- Sikhs, 5- Jains, 6- Buddhist

BC, 4-OC

3- Bharat 4- Others

- Relatives House, 3-Open Place, 4- Dilapidated

Parents expired, 2- Abandoned by Parents, 3- Abandoned by

ess than 3 months, 2- Less than 6 months, 3-Less than 1 year

2- Government assisted house , 3- Rent, 4

Thatched house, 2- Tiles/Asbestos/Stone roof house, 3- RCC

- Non Residential, 3- Commercial, 4- Mixed

ood condition, 2- Partially Collapsed

Sanctioned but not constructed 2- Under construction

ompleted but not living, 5-Construction completed and living

2- Common well, 3-Own tap, 4-Public tap,

Himself/herself, 2-Husband, 3-Wife, 4-Son, 5-Daughter, 6-Daughter in law

Father in law, 11-Mother in law, 12- Brother, 13

Paternal Grand Mother 17-Grandson, 18-Granddaughter

Non relatives

Male, 3-Transgender

5(i) is written 5(ii) is not required

Un Married, 3-Widow, 4-Separated from husband

abandoned, 8- Small age.

Small Children, S-Studying Nursery/LKG./UKG./1st Class

class, 5-5th class, 6-6th class, 7-7th Class, 8-8th Class,

year, 13-Degree 1st year, 14- Degree second year

Completed PG, 18- Studying Polytechnic, 19- Completed Polytechnic

Completed Engineering, 22- Studying Medicine, 23- Completed Medicine,

Studying Nursing, 27- Completed Nursing, 28-Studying B.Ed

Out of school

Codes Details

uddhists, 7- Others

Dilapidated , 5- Orphanage Home

bandoned by Sons/Daughters

ess than 1 year 4- More than one year

4- Temporary Shelter (Plastic

RCC

Under construction, 3-Construction halted

living, 6- Partially collapsed,

5-Bore pump, 6-Own motor

Daughter in law, 7-Son in law,

13- Sister, 14-Grand Father,

Granddaughter, 19- Brother in law,

husband, 5-Widower, 6-Separated

Class, 0- Illiterates, 1-1st class,

Class, 9-9th class 10-10th Class,

Degree second year, 15- Degree third year,

Completed Polytechnic 20- Studying

Completed Medicine, 24-Studying

Studying B.Ed, 29- Completed

Column No.16*: 1-State govt. employee, 2- Central govt. employee, 3-PSU employee, 4-State govt. project

employee (Anganwadi worker, MEPMA, Contract employee, RVM, Home gaurd, Other out sourcing

employee.etc), 6- Private employee (monthly salaried)

Column No.17*: 1-Central govt. pension, 2- State govt. pension, 3 – PSU pension

Column No.18*: 1-Oldage pension, 2-Widow pension, 3- Weavers pension, 4-Disability pension, 5-Toddy

toppers pension, 6-Abhayahastham pension, 7-AIDS infected people pension, 8-Artists pension, 9- Freedom

fighters pension 10- Beedi workers pension

Column No.19*: 1-Agriculture labour, 2-Daily wage labour, 3-Migrated labour, 4- Own agriculture,

5-Lease agriculture, 6-Milch animals, 7-Large business, 8-Small business, 9- Working in other countries,

10-Presently working beedi workers, 11- Presently working weavers, 12 – Presently working toddy toppers,

13- Presently working fisherman, 14- Presently working goldsmith, 15- Presently working Barbour,

16- Presently working washer man, 17- Presently working pottery, 18- Presently working blacksmith,

19- Presently working carpenter, 20- Presently working tailor, 21- Cobbler, 22- Animal herder, 23- Drivers,

24- Artists, 25-Other skilled workers, 26-Housewife, 27-Student, 28-Scavenger, 29-Beggars, 30-Do nothing,

31- IT professionals 32- Other Professions 33- Shop keepers 34-Apartment Watch man 35- Private Security

gaurds, 36-Others (provide details)

Column No.20*: Applicable to Women (Above 18 and Below 60 years) and Persons with Disability

Part E:

Column No.3*: 1-Physical disability, 2-Visually impaired, 3-Deaf &Dumb, 4-Dwarf, 5 – Leprosy,

6-Mentally retarded

Part F:

Column No.3*: 1-Cancer, 2-Heart, 3- Tuberculosis (TB), 4-Leprosy, 5-paralysis, 6-AIDS 7-Asthma,

8- Fluorosis , 9- Epilepsy, 10-Filaria , 11- Others specify

Part H:

Column No..5,7,11,13*: 1- Pond, 2- Bore, 3- Project canal, 4- Well, 5- Lift, 6- Rain fed

Column No.8&14*: Not in cultivation more than 5 years

Column No.9*: 1- Purchase, 2- Hereditary, 3 Through share (even if the family member do not have land

patta on his name but he is legal heir of land) 4- Assigned, 5- Inam, 6-R.O.F.R, 7-I.K.P/SC Corporation

purchase, 8- podu

Column No.15*: 1-Not useful for cultivation, 2-Living in other places, 3-Living in foreign countries, 4-

Lack of man power in the family, 5-Lack of investment, 6- Unable to develop the land. 7- Real estate

* Before taking signature of head of the family or the member of the family declaration should

be read out