Sample Census Format Household (HH) Socio-Economic Census Form Name of Asset Owner: Name of Village: Map Location: GPS Asset Affected: (add description i.e. 2has of Coordinates ___ rainfed agriculture) Household Composition Name of HH Member Sex Age Relation to HH Primary Secondary Occupation Highest of Illness or Disability Head Occupation Education Example 1 Male 34 Head of Household Farmer Seasonal Work Secondary School None Example 2 Female 25 Wife Trader None Primary School None Example 3 Female 7 Daughter Student None None None Example 4 Male 5 Son Student None None None Productive Assets Owned (all assets owned, not just those lost to transmission line) Rainfed Land Tenure Irrigated Land Tenure Status Number of fruit Number of trees Commercial Other structures (ha’s) status (ha’s) trees structures owned and owned operated 3has Owner 0.5ha Owner 20 2 None 1 Stable Overall Annual Source of Income (Percentage HH Revenue 100,000 AMD Rainfed Agr Irrigated Ag Remittances Livestock Trade Seasonal Woodlots 40% 20% 10% 5% 10% 10% 5% Sample Inventory of Losses Format ID Name Land Family affected Buildings affected Trees Businesses affected Resettled Vulnerable Severe members/ affected PAP Impact Employees allowance Allowance
Sample Census Format Household (HH) Socio-Economic Census Form Name of Asset Owner: Name of Village: Map Location: GPS Coordinates ___ Asset Affected: (add description i.e. 2has of rainfed agriculture) Household Composition Name of HH Member Sex Age Relation to HH Head Primary Occupation Secondary Occupation Highest of Education Illness or Disability Example 1 Male 34 Head of Household Farmer Seasonal Work Secondary School None Example 2 Female 25 Wife Trader None Primary School None Example 3 Female 7 Daughter Student None None None Example 4 Male 5 Son Student None None None Productive Assets Owned (all assets owned, not just those lost to transmission line) Rainfed Land (ha’s) Tenure status Irrigated Land (ha’s) Tenure Status Number of fruit trees Number of trees Commercial structures owned and operated Other structures owned 3has Owner 0.5ha Owner 20 2 None 1 Stable Overall Annual HH Revenue Source of Income (Percentage 100,000 AMD Rainfed Agr Irrigated Ag Remittances Livestock Trade Seasonal Woodlots 40% 20% 10% 5% 10% 10% 5% Sample Inventory of Losses Format ID Name Family members/ Employees Land affected Buildings affected Trees affected Businesses affected Resettled Vulnerable PAP allowance Severe Impact Allowance
RP10980V10REVI0Box385390B00PUBLIC0.docx