NAME OF LOCALITY ______
NAME OF HEAD OF HOUSEHOLD ______
CLUSTER NUMBER ______
CONCESSION NUMBER ______
HOUSEHOLD NUMBER ______
ADMINISTRATIVE REGION ______
ENVIRONMENT (URBAN = 1, RURAL = 2) ______
DETAILED ENVIRONMENT (BAMAKO = 1, OTHER CITY = 2, RURAL = 3) ______

WOMAN'S QUESTIONNAIRE

IDENTIFICATION
PLACE NAME
NAME OF HEAD OF HOUSEHOLD
PLOT NUMBER
CLUSTER NUMBER
HOUSEHOLD NUMBER
NAME AND LINE NUMBER OF WOMAN

INSTRUCTIONS

As part of the MIS ("EIP"), we are collecting information on all fieldworkers for the Mali 2021 MIS. Please answer the questions below. The information you provide will be part of the database of the survey; however, your name will be removed and will not be part of the database. Thank you for providing the necessary information.

102. What REGION do you live in?