Questionnaire Text
Burkina Faso 2014
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Burkina Faso 2015
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Burkina Faso 2016a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Burkina Faso 2016b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Burkina Faso 2017
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Burkina Faso 2018
Questionnaire form
view entire document:
text
002a. Current date and time.
[ODK will display on screen]
Is this date and time correct?
[] Yes
[] No
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Burkina Faso 2020
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Burkina Faso 2021
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Burkina Faso 2022
Questionnaire form
view entire document:
text
E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ Minutes____ AM/PM
Congo (Democratic Republic) 2014
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2015a
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2015b
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2015c
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2016a
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2016b
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2017a
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Congo (Democratic Republic) 2017b
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Congo (Democratic Republic) 2018a
Questionnaire form
view entire document:
text
002a. Current date and time.
[ODK will display on screen]
Is this date and time correct?
[] Yes
[] No
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Congo (Democratic Republic) 2018b
Questionnaire form
view entire document:
text
002a. Current date and time.
[ODK will display on screen]
Is this date and time correct?
[] Yes
[] No
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Congo (Democratic Republic) 2019a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2019b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2020
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2020
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Congo (Democratic Republic) 2021
Questionnaire form
view entire document:
text
E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ Minutes____ AM/PM
Congo (Democratic Republic) 2021
Questionnaire form
view entire document:
text
E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ Minutes____ AM/PM
Cote d'Ivoire 2017
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
Cote d'Ivoire 2018
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Cote d'Ivoire 2020
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Cote d'Ivoire 2021
Questionnaire form
view entire document:
text
Record the correct date and time.
Day____
Month____
Year____
Hours____
Min____
AM/PM____
Ethiopia 2014a
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ethiopia 2014b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ethiopia 2015
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ethiopia 2016
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ethiopia 2017
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ethiopia 2018
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ethiopia 2019
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ghana 2013
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ghana 2014a
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ghana 2014b
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ghana 2015
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ghana 2016
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Ghana 2017
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
India 2016
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
India 2017a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
India 2017b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
India 2018
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
India 2020
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
India 2021
Questionnaire form
view entire document:
text
Record the correct date and time.
Day____
Month____
Year____
Hours____
Min____
AM/PM____
Indonesia 2015
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Indonesia 2016
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Kenya 2014a
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Kenya 2014b
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Kenya 2015a
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Kenya 2015b
Questionnaire form
view entire document:
text
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Kenya 2016
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Kenya 2017
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Kenya 2018
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Kenya 2019
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Kenya 2020
Questionnaire form
view entire document:
text
002b. Record the correct date and time.
The date must be between 2020-10-01 and 2021-10-01.
Kenya 2021
Questionnaire form
view entire document:
text
Record the correct date and time.
Day____
Month____
Year____
Hours____
Min____
AM/PM____
Niger 2015
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Niger 2016a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Niger 2016b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Niger 2017
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Niger 2018
Questionnaire form
view entire document:
text
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Niger 2020
Questionnaire form
view entire document:
text
002a. Current date and time.
Niger 2022
Questionnaire form
view entire document:
text
E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ Minutes____ AM/PM
Nigeria 2014a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2014b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2015a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2015b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2016
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2017a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2017b
Questionnaire form
view entire document:
text
002a. Current date and time.
[ODK will display on screen]
Is this date and time correct?
[] Yes
[] No
002b. Record the correct date and time
Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____
Nigeria 2018
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2019a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2019b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2020a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2020b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Nigeria 2021a
Questionnaire form
view entire document:
text
Record the correct date and time.
Day____
Month____
Year____
Hours____
Min____
AM/PM____
Nigeria 2021b
Questionnaire form
view entire document:
text
Record the correct date and time.
Day____
Month____
Year____
Hours____
Min____
AM/PM____
Uganda 2014
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2015a
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2015b
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2016
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2017
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2018
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2019
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2020
Questionnaire form
view entire document:
text
C. Current date and time: Is this date and time correct?
[ODK will display on screen]
[] Yes
[] No
D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM
Uganda 2021
Questionnaire form
view entire document:
text
Record the correct date and time.
Day____
Month____
Year____
Hours____
Min____
AM/PM____