1. Which scheme is the respondent a beneficiary of at present?

(Field executive to please mark a

tick mark against the appropriate scheme)

i. Indira Gandhi National Old Age Pension Scheme (IGNOAPS):

ii. Indira Gandhi National Widow Pension Scheme (IGNWPS)
iii. Indira Gandhi National Disability Pension Scheme (IGNDPS)
iv. National Family Benefit Scheme (NFBS)
v. Annapurna Scheme

2. What benefit do you receive under the scheme? (Field executive to please mark a tick mark
against the appropriate benefit and fill in the blanks)

i. I receive pension of Rs._______ per month

ii. I have received a lump sum amount of Rs.________ due to the death of the
breadwinner of the family.
iii. I receive _______Kgs. Of food grains per month

3. From which year have you received the benefit of the scheme? (Field executive to please mark a
tick mark against the appropriate choice)

i. 2014-15
ii. 2015-16
iii. 2016-17
iv. 2017-18

4. Are you aware who is providing the funds for the scheme for your benefit? ? (Field executive to
please mark a tick mark against the respondent’s choice)

i. Central Government
ii. State Government
iii. Both Central and State Government
iv. I do not know
v. I will not say
5. In what form do you receive the benefit under the scheme? ? (Field executive to please mark a
tick mark against the respondents’ choice)

i. Cash
ii. Cheque
iii. Direct Benefit Transfer (DBT) to my account
iv. Sometimes Cash and Sometimes Cheque
v. Sometimes DBT and sometimes Cash/Cheque

6. How is the benefit delivered to you? (Field executive to please mark a tick mark against the
respondent’s choice)

i. It is delivered to me physically where I stay

ii. I have to go and collect it from Panchayat office or a place near my village
iii. I have to go and collect from Block office
iv. I have to go and collect it from District headquarters
v. Direct Benefit transfer
vi. Sometimes DBT and sometimes I have to go and collect

7. How regularly do you receive the benefit? (Field executive to please mark a tick mark against the
respondent’s choice)
i. Every time I receive the benefit on time
ii. Almost all the time I receive the benefit on time
iii. Most of the times I receive the benefit on time
iv. Many times I do not receive the benefit on time
v. Most of the time I receive the benefit on time
vi. Almost all the time I do not receive the benefit on time
vii. Never do I receive the benefit on time

8. With respect to the response above, what in your case are the reasons known to you for not
receiving benefits on time: (Field executive to please mark a tick mark against the respondent’s
choices)

i. Funds not received in time by the local office

ii. Lack/shortage of staff at local office
iii. Local staff giving low priority to this work
iv. Local staff asking for bribes to release benefit
v. Any other_______

9. Please tell me about the delay you face when you go to collect your benefit. (Field executive to
please mark a tick mark against the respondent’s choice)
 i. Every time I go there is a lot of delay/wait
ii. Most of the times I go there is a lot of delay/wait
iii. Most of the time I receive the benefit without much delay/wait
iv. There never is a delay in receiving the benefit when I go to collect it

10. With respect to the response above, what in your case are the reasons known to you for
delay/wait when you go to receive the benefits: (Field executive to please mark a tick mark
against the respondent’s choices)

i. Lack/shortage of staff at local office

ii. Local staff giving low priority to this work
iii. Local staff asking for bribes to release benefit
iv. Many people called at the same time
v. Indifference of the local staff to our delay/wait
vi. Any other_______

11. Has Adhaar seeding been done in your case? (Field executive to please mark a tick mark against
the respondent’s choice)

i. Yes
ii. No
iii. Do not Know whether seeding done
iv. Do not have an Adhaar Card
v. Any other_______

12. In case you are receiving benefits under DBT, how is your experience with DBT so far? (Field
executive to please mark a tick mark against the respondent’s choices- multiple choces are
permitted)

i. I find it very convenient

ii. I find it very inconvenient ( Please mention reason for inconvenience)

iii. I do not find it any more convenient than the earlier method of cash and check
collection/delivery
iv. I find that due to DBT, I receive the correct and due amount in my account without
anyone deducting any amount from the benefit
13. Please give your suggestions to improve the working of DBT so as to deliver better benefits to
beneficiaries?

14. If your Adhaar has been seeded, how was your experience with the Adhaar Seeding process?

i. I found it very convenient

ii. I found it very inconvenient ( Please mention reasons for inconvenience)

iii. I found that due to Aadhar Seeding , I receive the correct and due amount in my account
without anyone deducting any amount from the benefit

15. If your Adhaar has been updated, how was your experience with the Adhaar Updation process?

i. I found it very convenient

ii. I found it very inconvenient ( Please mention reason for inconvenience)

iii. I found that due to Aadhar Updation , I receive the correct and due amount in
my account without anyone deducting any amount from the benefit

16. To what uses do you put the benefit (assistance/pension) amount to? (Field Executive – put rank
mark against the responses indicated by the respondent- rank 1 for most common use, rank 2
for less than that, rank 3 for next and so on..)

i. Helps me in buying regular food for myself

ii. Helps me in buying special food for myself that me/my family are not able to afford
iii. Helps me in buying gifts for my children/grandchildren
iv. Helps me in buying clothes
v. Helps me in buying personal things of daily use for myself
vi. Helps me in buying gifts for other members of the family/relatives
vii. Helps me in buying special things that I like but otherwise cannot afford
 viii. Helps me in buying tobacco products/other intoxicants
ix. Helps me in contributing to family/household expenses
x. Others (Please specify)____________________________________________

17. Is the benefit that you receive sufficient for meeting your requirements?
i. Yes
ii. No
iii. Cannot say

In case answer to previous question is ‘No’, then answer next question , else skip the next
question and go to question mentioned after that
18. What according to you should be the level of benefit that you will find sufficient ? (Field
Executive-Record Verbatim)

19. Have you ever had a grievance with the process of this scheme that we are discussing? (Field
Executive-Put a tick mark against the best choice)

i. Yes
ii. No
iii. Cannot say

In case answer to previous question is ‘Yes’, then answer next question , else skip the next
question and go to question mentioned after that

20. What did you do to resolve your grievance? (Field Executive-Put a tick mark against the best
choice)

i. Made a verbal complaint about the grievance to the dealing official

ii. Made a verbal complaint about the grievance to the superior of the dealing official
iii. Made a written complaint about the grievance to the dealing official
iv. Made a written complaint about the grievance to the superior of the dealing official
v. Took some other action (Please specify-record
verbatim)__________________________________________________________
vi. Did not do anything about it
vii. I do not want to respond to this question

In case answer to previous question is from choices i. to v, then answer next question , else
skip the next question and go to question mentioned after that

21. Were you satisfied with the way your grievance was handled (appropriateness of resolution,
time taken for resolution etc.)?
i. Yes
ii. No
iii. Cannot say
22. Does Gram Sabha have any role to play in the implementation of this scheme in your area?

i. Yes
ii. No
iii. Cannot say

In case answer to previous question is ‘ Yes’, then answer next question , else skip the next
question and go to question mentioned after that

23. What role does Gram Sabha play in implementation of this scheme in your area? (Field
Executive- Record Verbatim)

24. Has Social Audit of this scheme been carried out in your area?

i. Yes
ii. No
iii. Cannot say

In case answer to previous question is ‘ Yes’, then answer next question , else skip the next
question and go to question mentioned after that

25. What do you think is the importance of Social Audit in improving the implementation of this
scheme in your area? (Field Executive- Record Verbatim)

i. Social Audit results in improvement in implementation of the scheme

ii. Social Audit does not result in any improvement of the scheme
iii. I cannot say anything about the impact of Social Audit on improvement of the scheme

26. In case you are a woman, have you felt any discrimination based on your gender at any time
while availing the benefit of the scheme?
i. Yes, I have faced difficulty and discrimination due to my gender many times while availing
the benefit of the scheme
ii. Yes, I have faced difficulty and discrimination due to my gender a few times while availing
the benefit of the scheme
iii. No, I have never faced any difficulty and discrimination due to my gender while availing the
benefit of the scheme
iv. I do not want to respond to this question
In case answer to previous question is either i. or ii., then answer next question , else skip
the next question and go to question mentioned after that.