Region

District

City Council

Village

Urban or Rural

Mountain

Codes for true panel

Relationship to the Household Head

Age

Sex

Marital status

Faith

Nationality

Does he/she have birth certificate?

Does he/she have ID Card?

Does he/she have health insurance?

What is the type of this insurance?

What is the type of this insurance?

Achieved education level

During last week was he/she engaged in any activity, even only for one hour?

What type of the job was it?

Why was not he/she engaged in any activity?

Did he/she lose a job during last year?

What type of the job was it?

Do you have IDP status

Does any household member have a child (ren) below 18 that live outside the household?

Where does the child live currently?

Where does the child live currently?

Where does the child live currently?

Where does the child live currently?

Have you applied to be registered at the database of socially unprotected families (database of vulnerable families)?

During the past 12 months have you or your family members received assistance to the vulnerable families (Targeted Social Assistance)?

What is your familys ranking score right now?

Has your household been ranked repeatadly for the last two month?

What is the main source of drinking water for members of your household?

What kind of toilet facility does this household use?

What is the ownership type of the households dwelling?

What is the type of the dwelling?

Available or not ? - Water supply

Available or not ? - Hot water

Available or not ?- Electricity

Available or not ? - Gas supply

Available or not ? - Sewerage

Available or not ? - Waste disposal

Available or not ? - Toilet

Available or not ? - Bathroom

Is it inside or outside the house (flat)? - Water supply

Is it inside or outside the house (flat)? - Hot water

Is it inside or outside the house (flat)? - Toilet

Is it inside or outside the house (flat)? - Bathroom

Central (common) or individual? - Water supply

Central (common) or individual?- Hot water

Central (common) or individual?- Electricity

Central (common) or individual?- Gas supply

Central (common) or individual?- Sewerage

Central (common) or individual? - Toilet

Central (common) or individual?- Bathroom

How many hours per day is the facility available? - Water supply

How many hours per day is the facility available? - Hot water

How many hours per day is the facility available? - Electricity

How many hours per day is the facility available? - Gas supply

How would you evaluate the quality of performance? - Water supply

How would you evaluate the quality of performance? - Hot water

How would you evaluate the quality of performance? - Electricity

How would you evaluate the quality of performance? - Gas supply

How would you evaluate the quality of performance? - Sewerage

How would you evaluate the quality of performance? - Waste disposal

How would you evaluate the quality of performance? - Toilet

How would you evaluate the quality of performance? - Bathroom

To what extent did you manage to heat the dwelling during the past winter?

Main heating means

Auxiliary heating means - Central heating system

Auxiliary heating means - Common heating system (for several households)

Auxiliary heating means - Individual heating system

Auxiliary heating means - Natural gas stove (Karma, Nicalaetc.)

Auxiliary heating means - Electric heater

Auxiliary heating means - Stove (burning firewood, coal, diesel oil, saw dust et

Auxiliary heating means - Fireplace

Auxiliary heating means - Open fire in the middle of the room

Auxiliary heating means - Other

Problem - The roof is very damaged and water leaks through it

Problem - The floor/walls are very damaged

Problem - There is an earth floor

Problem - The dwelling is damp

Problem - The windows are broken

Problem - The light is insufficient

Problem - It is noisy (because of transport, an enterprise or neighbors)

Problem - The dwelling is too small for our household

Problem - Other

Do you own other dwelling apart from this one?

How do you use that dwelling?

Does your household own these functioning durables_Automobile (of all types – car, truck, bus etc.)?

Does your household own these functioning durables_Tractor (of all types, combine harvester or sowing machine, mini tractor)?

Does your household own these functioning durables_Mobile phone/Landline phone?

Does your household own these functioning durables_Washing machine?

Does your household own these functioning durables_Black &White TV set?

Does your household own these functioning durables_Color TV set?

Does your household own these functioning durables_Refrigerator?

Does your household own these functioning durables_Gas stove?

Does your household own these functioning durables_Vacuum cleaner?

Does your household own these functioning durables_Iron?

Does your household own these functioning durables_Electric water heater (tank)?

Does your household own these functioning durables_Gas water heater?

Does your household own these functioning durables_Individual system of heating?

Does your household own these functioning durables_Microwave oven?

Does your household own these functioning durables_Personal computer?

Does your household own these functioning durables_Internet?

Does your household own these functioning durables_Compact disk stereo cassette record player?

Does your household own these functioning durables_Video camera or digital photo?

Does your household own these functioning durables_Video record-player or DVD player?

Does your household own these functioning durables_Electric generator?

Does your household own these functioning durables_Satellite dish?

Does your household own these functioning durables_Air conditioner?

Does your household own these functioning durables_Piano or grand piano?

Does your household own these functioning durables_Toaster?

Does your household own these functioning durables_Dishwasher?

Does your household own these functioning durables_Kitchen unit?

Do you possess productive or workable livestock and or paultry?

Do you own and/or cultivate agricultral land? I cultivate my own land

Do you own and/or cultivate agricultral land? I cultivate a rented land

Do you own and/or cultivate agricultral land? I cultivate a land owned by others

Do you own and/or cultivate agricultral land? I own agriclutural land cultivated by others

Do you own and/or cultivate agricultral land? I own agriclutural land which is not cultivated

Do you own and/or cultivate agricultral land?I dont own or cultivate any agricultiral land

In the last 12 months, has the household been in arrears, i.e. has been unable to pay on time due to financial difficualties for rent or mortgage repayment for the main dwelling?

In the last 12 months, has the household been in arrears, i.e. has been unable to pay on time due to financial difficualties for utility bills (heating, electricity, gas, water, etc.) for the main dwelling?

In the last 12 months, has the household been in arrears on hire purchase instalments or other loan payments, i.e. has been unable to pay on time due to financial difficualties?

Can your whole household afford to go for a week's annual holiday, away from home, including stays in second dwelling or with friends/relatives?

Can your household afford a meal with meat chicken, fish (or vegetarian equvalent) every second day?

Can your household afford to keep its home adequately warm?

Can your household afford unexpected required expense 250 GEL and pay through its own resources?

Did he/she attend any educational institution, visited a tutor or a circle during the last academic year?

Which educational institution did he/she attend?(multiple answers are possible)

Which educational institution did he/she attend?(multiple answers are possible)

Which educational institution did he/she attend?(multiple answers are possible)

Which educational institution did he/she attend?(multiple answers are possible)

Who financed the education?

Who financed the education?

Who financed the education?

Who financed the education?

How did s/he get to the educational institution?

How did s/he get to the educational institution?

How did s/he get to the educational institution?

How did s/he get to the educational institution?

Out of those listed in E2, which education institution would he/she like to attend but didn't attend?

Out of those listed in E2, which education institution would he/she like to attend but didn't attend?

Out of those listed in E2, which education institution would he/she like to attend but didn't attend?

Why did not he/she attend?

Why did not he/she attend?

Why did not he/she attend?

How many childrens books or books with pictures do you have for?

Read books to or looked at picture books with (name)?

Read books to or looked at picture books with (name)?

Read books to or looked at picture books with (name)?

Told stories to (name)?

Told stories to (name)?

Told stories to (name)?

Sang songs to (name) or with (name), including lullabies?

Sang songs to (name) or with (name), including lullabies?

Sang songs to (name) or with (name), including lullabies?

Took (name) outside the home, compound, yard or enclosure?

Took (name) outside the home, compound, yard or enclosure?

Took (name) outside the home, compound, yard or enclosure?

Played with (name)?

Played with (name)?

Played with (name)?

Named, counted, or drew things to or with (name)?

Named, counted, or drew things to or with (name)?

Named, counted, or drew things to or with (name)?

Can identify at least ten letters of the alphabet?

Can read at least four simple, regular words?

Does know and can recognise numbers 1 to 10?

Can pick up a small object, for example a stone or a stick from the ground with two fingers?

Does get tired from playing?

Does follow simple instructions in order to do something correctly?

When you ask to do something, can (name) do it independently?

Does get along well with other children?

Does hit or bite another child or adult?

Does easily get distructed?

Is engaged in some kind of organised learning or educational programme for children, such as private or public kindergarten or alternative kinder gartensimilar institution?

If is not engaged, what is the main reason for it?

The institution where your child goes to, is it private or public?

Who is covering the kindergarten fee?

In general, how satisfied are you with the kindergarten where your child goes to?

Are you satisfied with the nutrition at the kindergarten?

Are you satisfied with the building of the kindergarten?

Are you satisfied with the teachers at the kindergarten?

Are you able to cover the fees of different circles/sections?

Are different unofficial fees (presents, other fees) a barrier for you from financial point of view?

Is kindergarten available close to your house?

In general, can you financially afford to take child to kindergarten?

How would you evaluate your state of health?

During the past 30 days, did you apply to any health care facility for outpatient care?

To whom did you apply for medical assistance during your most recent visit for outpatient care?

How much did you pay in total for your medical consultation during your most recent visit?

Did you make any gifts (food, etc.) or provide any services to a health professional during your last visit, besides the payment? If yes, what was the value of the gift or service?

Did you have to make any other payments not already recorded, including payments for laboratory tests and x-rays, in connection with the consultation? If yes, how much was paid?

What was your opinion of the service received during your last visit?

During the past 30 days, have you purchased any medicines at a pharmacy to treat a health problem?

How much did you pay in total for medicines purchased during the past 30 days? (Except for the amount paid by insurance)

During the past 12 months, were you admitted to a health facility overnight to obtain inpatient care?

During your most recent inpatient admission, at what type of health care facility did you stay?

What was your opinion of the service received during your last inpatient stay?

Was there any time during the last 12 months when you think you should have received medical care, but did not?

What was the reason why you did not receive medical care?

What was the main source of funding for purchasing medical services?

What was the main source of funding for purchasing medicines?

Did you ask the state or any organization for social assistance during the last 12 months?

Why did not you ask?

Do you plan to ask the state or any organization for assistance?

What type of assistance will you ask for? - Cash assistance

What type of assistance will you ask for? - Health insurance

What type of assistance will you ask for? - To provide me with a flat

What type of assistance will you ask for? - Dwelling repair

What type of assistance will you ask for? - Food assistance

What type of assistance will you ask for? - To finance education

What type of assistance will you ask for? - Day Center Vaucher

What type of assistance will you ask for? - Food Vaucher

What type of assistance will you ask for? - Other

What type of assistance will you ask for? - Do not know

What type of assistance will you ask for? - Refusal

Do you hope that your request will be satisfied?

Whom did you ask for assistance? - I applied for registration in the united database of vulnerable families

Whom did you ask for assistance? - Local government

Whom did you ask for assistance? - Central authirities

Whom did you ask for assistance? - Ministry of IDP-s

Whom did you ask for assistance? - Ombudsmans Office

Whom did you ask for assistance? - Private organizations

Whom did you ask for assistance? - An NGO

Whom did you ask for assistance? - An international donor organization

Whom did you ask for assistance? - Other

Whom did you ask for assistance? - Do not know

Whom did you ask for assistance? - Refusal

What was the main content of your request? - I wanted cash assistance

What was the main content of your request? - I wanted assistance in obtaining health services

What was the main content of your request? - Food assistance

What was the main content of your request? -I wanted benefits for financing education

What was the main content of your request? - I wanted benefits for transport and other payments

What was the main content of your request? - I wanted repair of dwelling

What was the main content of your request? - I wanted to have my own dwelling

What was the main content of your request? - Others received assistance and I also wanted

What was the main content of your request? - Other

What was the main content of your request? - Do not know

What was the main content of your request? - Refusal

Was your request satisfied?

Did you or your family member receive any social assistance during the last one year?

What types of social assistance do you or your family member receive now or received during the last year?-Cash assistance from the program of vulnerable families (TSA)

What types of social assistance do you or your family member receive now or received during the last year?-Health insurance from the program of vulnerable families

What types of social assistance do you or your family member receive now or received during the last year?-Various benefits (on transport, energy, education etc.) from the program of vulnerable families

What types of social assistance do you or your family member receive now or received during the last year?-Social assistance to single pensioners

What types of social assistance do you or your family member receive now or received during the last year?-Social assistance to the blind

What types of social assistance do you or your family member receive now or received during the last year?-Social assistance to orphans having lost both parents

What types of social assistance do you or your family member receive now or received during the last year?-Social assistance to disabled children

What types of social assistance do you or your family member receive now or received during the last year?-Social assistance to multi-children single parents

What types of social assistance do you or your family member receive now or received during the last year?-Reintegration and prevention;

What types of social assistance do you or your family member receive now or received during the last year?-Food assistance

What types of social assistance do you or your family member receive now or received during the last year?-Assistance with diesel oil

What types of social assistance do you or your family member receive now or received during the last year?-Assistance with clothes

What types of social assistance do you or your family member receive now or received during the last year?-Assistance with schoolbooks

What types of social assistance do you or your family member receive now or received during the last year?-Other non-cash assistance

What types of social assistance do you or your family member receive now or received during the last year?-Other

What types of social assistance do you or your family member receive now or received during the last year?-Do not know

What types of social assistance do you or your family member receive now or received during the last year?-Refusal

Who did you receive the assistance from?

How important the social assistance was for your family?

According to your income, which category of the listed below would you attribute your household to?

Encircle all problems of the household - Hunger/malnutrition

Encircle all problems of the household - Buying medicines

Encircle all problems of the household - Unemployment of household members

Encircle all problems of the household - Medical services

Encircle all problems of the household - Buying school items

Encircle all problems of the household - Housing conditions

Encircle all problems of the household - Furniture

Encircle all problems of the household - Buying clothes

Encircle all problems of the household - Leisure, entertainment

Encircle all problems of the household - Paying debt/bank loans

Encircle all problems of the household - Paying utility charges

Encircle all problems of the household - None of the listed

Encircle the main problem of the household

Please tell me, during the last 12 months how the acuteness of this problem has changed?

How has the economic situation of your household changed during the last 12 months?

What was the main reason for worsening the economic situation of your household?-Loss of the bread-winner

What was the main reason for worsening the economic situation of your household?-Serious illness of a family member resulting in a sharp increase in expenditures

What was the main reason for worsening the economic situation of your household?-Loss of job by household member(s)

What was the main reason for worsening the economic situation of your household?-Decrease of total income of household members

What was the main reason for worsening the economic situation of your household?-Household had to leave their house