Questionnaire Text

Burkina Faso 2014 Congo (Democratic Republic) 2021 India 2020 Nigeria 2015a
Burkina Faso 2015 Congo (Democratic Republic) 2021 India 2021 Nigeria 2015b
Burkina Faso 2016a Cote d'Ivoire 2017 Indonesia 2015 Nigeria 2016
Burkina Faso 2016b Cote d'Ivoire 2018 Indonesia 2016 Nigeria 2017a
Burkina Faso 2017 Cote d'Ivoire 2020 Kenya 2014a Nigeria 2017b
Burkina Faso 2018 Cote d'Ivoire 2021 Kenya 2014b Nigeria 2018
Burkina Faso 2020 Ethiopia 2014a Kenya 2015a Nigeria 2019a
Burkina Faso 2021 Ethiopia 2014b Kenya 2015b Nigeria 2019b
Burkina Faso 2022 Ethiopia 2015 Kenya 2016 Nigeria 2020a
Congo (Democratic Republic) 2014 Ethiopia 2016 Kenya 2017 Nigeria 2020b
Congo (Democratic Republic) 2015a Ethiopia 2017 Kenya 2018 Nigeria 2021a
Congo (Democratic Republic) 2015b Ethiopia 2018 Kenya 2019 Nigeria 2021b
Congo (Democratic Republic) 2015c Ethiopia 2019 Kenya 2020 Uganda 2014
Congo (Democratic Republic) 2016a Ghana 2013 Kenya 2021 Uganda 2015a
Congo (Democratic Republic) 2016b Ghana 2014a Niger 2015 Uganda 2015b
Congo (Democratic Republic) 2017a Ghana 2014b Niger 2016a Uganda 2016
Congo (Democratic Republic) 2017b Ghana 2015 Niger 2016b Uganda 2017
Congo (Democratic Republic) 2018a Ghana 2016 Niger 2017 Uganda 2018
Congo (Democratic Republic) 2018b Ghana 2017 Niger 2018 Uganda 2019
Congo (Democratic Republic) 2019a India 2016 Niger 2020 Uganda 2020
Congo (Democratic Republic) 2019b India 2017a Niger 2022 Uganda 2021
Congo (Democratic Republic) 2020 India 2017b Nigeria 2014a
Congo (Democratic Republic) 2020 India 2018 Nigeria 2014b
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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
[] No

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
[] No

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
[] No

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
[] No

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
[] No

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


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Burkina Faso 2018
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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____

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Burkina Faso 2020
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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


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Burkina Faso 2021
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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


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Burkina Faso 2022
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E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ 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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002b. 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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002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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Congo (Democratic Republic) 2018a
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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____

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Congo (Democratic Republic) 2018b
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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____

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Congo (Democratic Republic) 2019a
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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


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Congo (Democratic Republic) 2019b
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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


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Congo (Democratic Republic) 2020
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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


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Congo (Democratic Republic) 2020
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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


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Congo (Democratic Republic) 2021
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E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ Minutes____ AM/PM

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Congo (Democratic Republic) 2021
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E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ Minutes____ AM/PM

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Cote d'Ivoire 2017
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C. Current date and time: Is this date and time correct?
[ODK will display on screen]

[] Yes
[] No

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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____

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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____

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Cote d'Ivoire 2021
Questionnaire form view entire document:  text 
Record the correct date and time.

Day____
Month____
Year____
Hours____
Min____
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
[] No

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
[] No

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
[] No

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
[] No

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
[] No

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


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Ethiopia 2019
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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


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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
[] No

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


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India 2016
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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


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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


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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
[] No

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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India 2020
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002b. Record the correct date and time

Date
Month____
Day____
Year____
Time
Hour____
Minutes____
AM/PM____

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India 2021
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Record the correct date and time.

Day____
Month____
Year____
Hours____
Min____
AM/PM____

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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


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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
[] No

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
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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Kenya 2017
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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Kenya 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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Kenya 2019
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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 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.


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Kenya 2021
Questionnaire form view entire document:  text 
Record the correct date and time.

Day____
Month____
Year____
Hours____
Min____
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
[] No

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
[] No

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
[] No

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
[] No

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


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Niger 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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Niger 2020
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002a. Current date and time.

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Niger 2022
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E. Record the correct date and time.
Date
Month____ Day____ Year____
Time
Hours____ 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
[] No

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


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Nigeria 2014b
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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


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Nigeria 2015a
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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


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Nigeria 2015b
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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


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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
[] No

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
[] No

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
[] No

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
[] No

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


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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


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Nigeria 2019b
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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


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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


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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


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Nigeria 2021a
Questionnaire form view entire document:  text 
Record the correct date and time.

Day____
Month____
Year____
Hours____
Min____
AM/PM____

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Nigeria 2021b
Questionnaire form view entire document:  text 
Record the correct date and time.

Day____
Month____
Year____
Hours____
Min____
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
[] No

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
[] No

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
[] No

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
[] No

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
[] No

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
[] No

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


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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


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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


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Uganda 2021
Questionnaire form view entire document:  text 
Record the correct date and time.

Day____
Month____
Year____
Hours____
Min____
AM/PM____