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 house
10) 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 village
18) 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)
Comple
ted
educati
onal
qualific
ations
*
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- 2
nd
class, 3-3
rd
class, 4-4
th
class,
11-Inter 1
st
year, 12-Inter 2
nd
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./1
st
Class
class, 5-5
th
class, 6-6
th
class, 7-7
th
Class, 8-8
th
Class,
year, 13-Degree 1
st
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, 1-1
st
class,
Class, 9-9
th
class 10-10
th
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