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| You should decide whether researchers should code in the field (see the final page for an example) or have the coding done after returning to the office. | | You should decide whether researchers should code in the field (see the final page for an example) or have the coding done after returning to the office. |
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| '''Religion‚ Ethnicity‚..‚Head of Household ‚s/o(w/o)‚'''
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| '''SECTION A'''
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| {| class="prettytable"
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| | = NAME =
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| | '''Sex'''
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| | '''Age '''
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| | '''Marital'''
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| '''status'''
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| | '''Relation '''
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| '''to # 1'''
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| | '''Education status'''
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| | '''Class completed'''
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| | '''Work status'''
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| | '''Current work/school details'''
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| |-
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| | 1.
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| | 2.
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| | 3.
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| | 4.
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| | 5.
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| |-
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| | 6.
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| | 7.
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| | 8.
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| |}
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| '''SECTION B'''
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| {| class="prettytable"
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| | '''NON-RESIDENTS (out-married, labour migrants):'''
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| | '''Relation '''
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| '''To HH'''
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| | '''Age'''
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| | '''Marital status'''
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| | '''Class completed'''
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| | '''Work status'''
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| | '''Current work/school details'''
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| | '''Destination'''
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| | '''Since when?'''
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| | '''Why? '''
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| |}
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| '''SECTION C'''
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| {| class="prettytable"
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| | = MARRIED WOMEN =
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| | '''Birthplace'''
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| | '''Distance'''
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| | '''Marriage date'''
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| | '''prior relationship, if any'''
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| |}
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| '''SECTION D'''
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| '''1. HOUSING, ASSETS AND FACILITIES'''
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| {| class="prettytable"
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| | All brick/concrete
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| | No. of rooms
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| | Bicycle
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| | Radio/tape
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| | Flush toilet
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| | Some brick/concrete
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| | Air cooler
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| | Scooter/
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| motorcycle
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| | TV
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| | Cooking medium
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| | Not brick/concrete
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| | Fridge
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| | Car
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| | Mobile
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| | Electricity
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| | Pumpset
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| | Tractor
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| | Telephone
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| |}
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| '''2. Land and Livestock'''
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| {| class="prettytable"
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| | Local units
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| | <center>Owned</center>
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| | <center>Cultivated</center>
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| | Livestock
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| | <center>Cows </center>
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| | <center>Buffaloes/ox</center>
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| | <center>Sheep/goat</center>
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| | Shared ownership
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| | Number shared
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| | Sole ownership
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| | Number sole
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| |}
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| '''SECTION E'''
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| '''OTHER INFORMATION (in each case enter information separately for each person, giving his/her number in the list on the front page of this form)'''
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| 1. Disability
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| {| class="prettytable"
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| | Type of Impairment:
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| | <center>Seeing</center>
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| | <center>Hearing</center>
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| | <center>Speaking</center>
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| | <center>Walking</center>
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| | <center>Learning</center>
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| | <center>Personal care</center>
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| | Person numbers
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| |}
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| 2. Any individual who is or was a member of the following?
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| {| class="prettytable"
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| | <center>Elected Panchayat</center>
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| | <center>Caste Panchayat</center>
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| | <center>SHG</center>
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| | <center>CHC (Asha etc)</center>
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| | <center>VEC</center>
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| | <center>PTA/MTA</center>
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| | Person numbers
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| |}
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| 3. Has any individual attended any of the following?''' '''
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| {| class="prettytable"
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| | '''Training'''
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| | <center>ITI</center>
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| | <center>polytechnic</center>
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| | <center>Other govt. training</center>
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| | <center>Private training</center>
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| | <center>NGO training</center>
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| | <center>Apprenticeship at garage/crafts</center>
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| | Person numbers
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| |}
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| '''COMMENTS'''
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| <center>'''Coding manual'''</center>
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| '''Section A'''
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| {| class="prettytable"
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| | Sex
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| | 1. Male
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| 2. Female
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| |-
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| | Age
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| | In completed years
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| | Marital status
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| | 1. Unmarried
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| 2. Married, not yet living together
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| 3. Married
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| 4. Separated/divorced
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| 5. Widow/widower
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| 6. Any other
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| | Relation to head
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| | Use simple codes, and add more, if required. Make a note of it
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| 1. Self
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| H: husband; W: wife
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| HB: Husband's father, HM: Husband's Mother; WF, WM
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| HB: Husband's brother, HZ: husband's sister; WB, WZ
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| S: Son, D: daughter; SW: Son's wife, DH: Daughter's husband
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| SS: son's son, SD: son's daughter, DS: daughter's son, DD: Daughter's daughter
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| |-
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| | Education status
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| | 1. currently enrolled
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| 2. never enrolled
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| 3. dropouts
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| | Class completed
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| | 0 for those who have not completed class 1 (includes never enrolled and those studying in preschool)
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| Add number of years successfully completed in college to 12, for those who have been to college
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| |-
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| | Work status
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| | 1. working full time
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| 2. working part time
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| 3. working seasonally
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| 4. not working
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| |-
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| | School/Work details
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| | Fill in all that appears relevant for our sampling purposes
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| |}
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| '''Section B - other codes are same as section A'''
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| {| class="prettytable"
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| | Destination
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| | Give the name of town/village, district and state
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| |-
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| | Since when?
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| | Give the month (if possible) and year.
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| |-
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| | Why?
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| | Note all the reasons (if more than one)
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| |}
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| '''Section C'''
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| {| class="prettytable"
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| | Birthplace
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| | Give the name of town/village, district and state
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| |-
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| | Distance
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| | In Kms
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| | Marriage date
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| | Give the month (if possible) and year.
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| | Prior relationship
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| | Note their response
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| |}
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| '''Section D'''
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| Tick options which are applicable, and a "dash" when not. Put in numbers where applicable
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| {| class="prettytable"
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| | Cooking medium
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| | 1: Gas; 2: kerosene/coal/wood (purchased); 3: collected (free of cost)
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| |-
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| | Electricity
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| | 1: permanent connection, 2: temporary/illegal connection, 3: None
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| |}
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| '''Section E''': Give numbers in appropriate boxes. "0" when there are none
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| Comments: Note down whatever additional details you have heard or observed during the interview. It is very important.
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| <noinclude>{{RECOUP_footer|Community_scoping/Handout_on_Sample_Household_Census_Form/handout}}</noinclude><noinclude>[[Category:RECOUP]]</noinclude> | | <noinclude>{{RECOUP_footer|Community_scoping/Handout_on_Sample_Household_Census_Form/handout}}</noinclude><noinclude>[[Category:RECOUP]]</noinclude> |
