| Family size | Number: Male ( ) Female ( ) |
| Primary source of income in priority order (a = most important, b = important, c = least important) |
Agriculture: Business: Labor: Remittance: Service: Forest: Others: |
| Food sufficiency for | No of months: |
| Total land (Khet/bari) | …….. Ropani |
| Distance to the forest from the house (or time to reach forest) | (Estimation)……………. |
| Frequency of going to the forest | 1 = frequently (several times in a month) 2 = occasionally (sometimes in a month) 3 = rarely (sometimes in a few months) 4 = never (no dependency on forest) |
| Purpose of going to the forest (a = most important, b = important, c = least important) |
Fuel wood: Fodder: Timber: NTFP collections: others (specify): |
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