Cooking survey

Name of female head of household

Age

Educational level

• No schooling
• Grade 1-5
• Grade 6-8
• Grade 9-10
• Grade 11-12

Total # of household members

Mobile number

Do you or your immediate family have a gas connection in your name anywhere?

• Yes - here
• Yes - in village
• No

What fuel do you mainly use to cook?

• Gas
• Wood
• Kerosene
• Electric Heater

What type of gas connection do you have?

• Normal connection
• Ujjwala Yojna connection
• Using someone else's connection
• Black gas

If using a connection & refill system, how long does a 14kg cylinder normally last? (months)

If using black gas, how many kg do you use per week normally?