Questionnaire Text

Burkina Faso 2014 Ethiopia 2014a India 2018 Nigeria 2014b
Burkina Faso 2015 Ethiopia 2014b Indonesia 2015 Nigeria 2015a
Burkina Faso 2016a Ethiopia 2015 Indonesia 2016 Nigeria 2015b
Burkina Faso 2016b Ethiopia 2016 Kenya 2014a Nigeria 2016
Burkina Faso 2017 Ethiopia 2017 Kenya 2014b Nigeria 2017a
Congo (Democratic Republic) 2014 Ethiopia 2018 Kenya 2015a Nigeria 2017b
Congo (Democratic Republic) 2015a Ghana 2013 Kenya 2015b Nigeria 2018
Congo (Democratic Republic) 2015b Ghana 2014a Kenya 2016 Uganda 2014
Congo (Democratic Republic) 2015c Ghana 2014b Kenya 2017 Uganda 2015a
Congo (Democratic Republic) 2016a Ghana 2015 Niger 2015 Uganda 2015b
Congo (Democratic Republic) 2016b Ghana 2016 Niger 2016a Uganda 2016
Congo (Democratic Republic) 2017a Ghana 2017 Niger 2016b Uganda 2017
Congo (Democratic Republic) 2017b India 2016 Niger 2017 Uganda 2018
Cote d'Ivoire 2017 India 2017a Niger 2018
Cote d'Ivoire 2018 India 2017b Nigeria 2014a
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Burkina Faso 2014
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Burkina Faso 2015
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Burkina Faso 2016a
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Burkina Faso 2016b
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Burkina Faso 2017
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Congo (Democratic Republic) 2014
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Congo (Democratic Republic) 2015a
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Congo (Democratic Republic) 2015b
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Congo (Democratic Republic) 2015c
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Congo (Democratic Republic) 2016a
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Congo (Democratic Republic) 2016b
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Congo (Democratic Republic) 2017a
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Congo (Democratic Republic) 2017b
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Cote d'Ivoire 2017

No questionnaire text is available for this sample.


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Cote d'Ivoire 2018
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002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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Ethiopia 2014a
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Ethiopia 2014b
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Ethiopia 2015
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Ethiopia 2016
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Ethiopia 2017
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Ethiopia 2018
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Ghana 2013
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Ghana 2014a
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Ghana 2014b
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Ghana 2015
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Ghana 2016
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Ghana 2017
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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India 2017a
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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India 2017b
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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India 2018
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002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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Indonesia 2015
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Indonesia 2016
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Kenya 2014a
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Kenya 2014b
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Kenya 2015a
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Kenya 2015b
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D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM

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Kenya 2016
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002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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Kenya 2017
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002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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Niger 2018
Questionnaire form view entire document:  text 

002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM


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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 1
[] No 0

D. Record the correct date and time.
Date:
Month____ Day____ Year____
Time: Hour____ Minutes____ AM/PM