Questionnaire for Citizens not using Gyandoot Services

I.  Respondent’s Profile:

Name: Village:

Sex: Age

Community: Caste: Sub-Caste:

Literacy Level:

Occupation: Daily Earning (Rs.):

II. Family Profile:

Number of Members: Male Female Children

Assets owned by family: Land Livestock: Vehicles:

Economic Level of the Family:

Two years back Current

Income (pa)

Source of Income

Govt Schemes availed

NGO Schemes availed

II.  Visits to Government Offices / Service Centers:

Office / Frequency / Purpose / Total time spent (days) / Cost incurred
Gram Panchayat
Taluka / Block
Collector’s Office
District Court
Taluka Court
Civil Supplies
RTO
Bank
Gyandoot Kiosk

III.  Usage details of Services (last one year):

Office / Freq / Helped by
Self / sw / Total / Result
Time / Cost
1. Mandi Information
2. Income Certificate.
3. Domicile Certificate
4. Caste Certificate.
5. Landholder's passbook
6. Rural Hindi e-mail.
7. Grievance Redressal
8. Forms of Govt schemes
9. BPL Family List.
10. Employment news.
11. Rural matrimonial
12. Rural Market
13. Rural News Paper
14. Advisory module
15. E-education.
16. Driving License.
17. Khasra Nakal Avedan.
18. Varmi Compost Khad
Others Govt related services

IV.  Rank services in the order of requirement:

Service / Your Importance
1. Mandi Information
2. Income Certificate.
3. Domicile Certificate
4. Caste Certificate.
5. Landholder's passbook
6. Rural Hindi e-mail.
7. Grievance Redressal
8. Forms of Govt schemes
9. BPL Family List.
10. Employment news.
11. Rural matrimonial
12. Rural Market
13. Rural News Paper
14. Advisory module
15. E-education.
16. Driving License.
17. Khasra Nakal Avedan.
18. Varmi Compost Khad
Other Govt Related Services

V.  Perception of Service Level of Government Agencies:

Benefit Ratings (1: Poor; 5: Excellent, NA: Not Availed)

Service / Time / Cost / Reliability / Accssblty / Conv / Sugg. Impr
1. Mandi Information
2. Income Certificate.
3. Domicile Certificate
4. Caste Certificate.
5. Landholder's passbook
6. Rural Hindi e-mail.
7. Grievance Redressal
8. Forms of Govt schemes
9. BPL Family List.
10. Employment news.
11. Rural matrimonial
12. Rural Market
13. Rural News Paper
14. Advisory module
15. E-education.
16. Driving License.
17. Khasra Nakal Avedan.
18. Varmi Compost Khad
Others

VI.  Gyandoot Awareness and Use

Reasons / Not Visited / Visited - Not Used / Used - Discontinued
1. Need not felt
2. Wanted services unavailable*
3. Perceived to be Expensive
4. Kiosk too distant
5. Fear of High Tech
6. Class/Caste Inhibitions
7. Gender Inhibitions
8. Adverse feedback from users
9. Service timings not suitable

* Specify such wanted services in the column

1