Muhammad Abdullah

 BENEFICIARY ASSESSMENT FORM Field team Need to consider the below guidelines before data collection: Read selection criteria before using this form Before you proceed for selection of project beneficiary, please check that the respondent (TDP) has met the following criteria for selection Please don’t proceed for data collection if responded with ‘‘No’’to Pre-Assessment Questions, however the non-registration may not be sole reason for exclusion Vulnerability data is part of the total family number; this may not be addition to family size. Don’t ask direct question in case beneficiriy or their family have any kind of disability Pre-Assessment Questions 1 Are you migrated from North Waziristan? Yes No 2 Are you registered TDP? Yes No 3 Do you have valid CNIC/Registration form? Yes No 4 Are you currently living in UC Hawid? Yes No General information : Beneficiary profile Name of Respondent:   Sex of Respondent  Women  Men NIC: Age of respondent:   Disability: Marital status:   Family Registration Number /Unique ID Relation of the respondent to the head of household?  Head of HH Spouse  Son  Relative  Daughter Other Family Size Above 60-80 years age Above 18-59 Years age Above 5-18 Year Below 5 years Grand Total Male Female Total Male Female Total Male Female Total Male Female Total Type of impairment : 1 Guidelines: Plz mention number e.g # under gender heading (impairment Type as mentioned in footnote.)….. Example Vulnerability assessment (TDP family only)  Women headed HH  Minority class HH  Vulnerable minority class HH  Widow with no earning source  Pregnant / Lactating Women  Vulnerable Women dependent on others  Elderly headed (60+) HH  Chronically ill or HIV and AIDS + in HH  Child headed HH  People with disabilities  HH with significant no of under aged children Shelter Status: 1 Did you receive tent / shelter assistance earlier (from any other source)  Yes  No 2 If yes, what type of assistance you received? Tent Transitional shelter Material for shelter House rent Any other_____________________ 3 What is your current living status? a) Living with relative free of cost b) Living in rented house c) Living in open land in tent d) Living in camp e) Living in Shared rooms with Host or Other TDPs f) Any other _____________________ 4 If provided with tent / shelter, is it liveable? Yes No Somehow 5 If not liveable, so how you cope with the situation ……………………………………………………… ……………………………………………………… 6 In case of rented house how many room do you have? 1 2 3 and above Specific/Technical Criteria: 1 H.H have any place for new shelter Yes No 2 Is it protected in context of women and children (it might not be vulnerable to hazards and might be socially protected? Yes No 3 Is it sufficient for shelter (Engineer will fill this sections) Yes No 4 Are you willing to Sign MOU with Host Community for land and MF? Yes No 5 Are you willing to provide unskilled labour during erection of T-Shelters? Yes No Due to above mentioned information Benefeciary is recommended for providing him support in unskilled labor during eraction 0f T shelter? Yes No 6 If “No” to the question 5, what is the main reason(s) ……………………………………………………… ……………………………………………………… Team Remarks …………………………………………………………………………………………………………………………………………………………… Recommended for Type Support: In case of rejection, pls write down the reason / justification for exclusion: ……………………………………………………………………………………………………………………………………………………………. Data Collector Checked By&Verified By Name & Signature: _________________ _________________ _________________ Signature:_________________ _________________ _________________ Date:_________________ _________________ _________________