Submission Time

start_time

end_time

Please assign a unique household ID.

What is today's date?

What state are you in?

Is this area rural, urban, peri-urban, or other?

What is your position in the household?

How many people live in this household most of the time?

How many of the people who live here are adults (age 18 or over)?

How many boys under age 18 live here?

How many girls under age 18 live here?

If you're comfortable, is there any way we can get in touch with you?

The roof of this house is made of:

The walls of the house are made of:

The floor of the house is made of:

Does the house appear to have access to improved toilet facilities?

What is the main source of light in the house?

Compared to other houses in the community, how would you say this one compares?