Survey-Soil health CardReference PeriodSchedule No:Enumerator's NameDateStateDistrictTalukGram PanchayatVillageRespondents DetailsName of Family Head/RespondentGenderMaleFemaleFarming Experience (in years)Contact numberCategory (SC/ST/OBC/GEN)SCSTOBCGENAre you a member of any local bodyCo-operativeSelf-Help GroupFarmer Producer Organisation (FPO)Gram PanchayatYuvaka MandalaWorker’s AssociationOtherFamily income per Annumland holding detailsown farmland irrigated in acresown farmland dry land in acresown farmland total land in acresleased in irrigated land in acresleased in dry land in acresleased in total land in acresleased out irrigated land in acresleased out dry land in acresleased out total land in acresoperational irrigated land in acresoperational dry land in acresoperational total land in acresAwarenessAre you aware of soil health schemeYesNoAre you aware of Model Village Program (MVP)YesNospecify aboveDo you know the reasons for soil testing?YesNospecify aboveExtension ParticipationHave you attended the MVP Demonstration in your villageYesNospecifyif yes when (date/month/year)How many MVP demonstrations have you attended?How many farmers visited your field for seeing demonstrationHave you attended any Farmer Trainings related to soil health card or fertilizer application?YesNoif yes when, dateHow many such training programmes have you attended till date?Did the training program is helped you?YesNospecifyDid you receive any information related to Soil fertility/status frequently? if yes mention sourceYesNoHow frequently you receive information?once in a weekonce a monthhalf yearlyyearlyneverspecify aboveMode of informationsmstelecalldirect contactOther:Benefitshave you received SHC?YesNospecifyWhen did you received SHC?specifyDid you received SHC after sowing of crops?YesNospecifyif yes, mention number of days delayeddistance of soil testing centre from your home in kmsAre you a Demonstration (demo) farmer in the MVP?YesNoif yes, how many acres of your land have you allotted as the demonstration plot (acres)if yes, what is the benefits you received as Demo farmer in kgdid you continue this input combination from the demo in the next crop seasonYesNoSkill development and adoptionDo you know the procedure for soil samplingYesNoSpecifyAre you aware of soil testing centres/lab?YesNoif yes mention and specifyAre you able to read and understand the information in SHC?YesNospecifyIf No, did anyone explained the information of SHC?RSKKVKATMFELLOW FARMERSspecifyAre you aware of your soil nutrient status?YesNospecifyFor how many crops recommendation is given in your SHCspecifyDid you grow recommended crop in the SHC?YesNospecifyIf Yes, have you followed the recommended doses of fertilisers and nutrients?YesNoif yes mentionfullypartiallyDid you receive any information related to Soil fertility/status frequently?YesNoif yes mention the sourceAssessmentDue to SHC, the total fertilizer usage has increased or decreased?increaseddecreasedif increased, % or amountif decreased, % or amountDo you feel due to SHC the cost of cultivation decreased?YesNomention percentage/amountDo you feel due to SHC there is an increase in soil fertility?YesNoDo you feel due to SHC there is an increase in crop yield?YesNomention percentage/amountConstraints and suggestionsmajor constraints in receiving SHC (list the reasons)Major constraints in adoption of SHC recommendationsSuggestion for improving SHC schemeOverall Rating of the Performance of SHC schemeOverall Rating of the Performance of SHC schemeExcellentGoodSatisfactorySomewhatPoorVery PoorStakeholder – Implementing AgenciesName of the officerdept. nameDistrictTalukaContact details:DesignationBudget details (Rs.) allocatedBudget details (Rs.) releasedBudget details (Rs.) utilizationsReasons for variations:TargetsAchievedBalanceSoil nutrient status in you region before (N:P:K)Soil nutrient status in you region after (N:P:K)Quantity of work done in related to SHC schemeNo. of soil samples collectedNo. of soil samples testedNo. of SHC printedNo. of SHC distributedNo. of demonstration plots identifiedNo. of demonstration givenNo. of farmers attended demonstrationNo. of training programs conductedNo. of farmers attended training programsQuantity of fertilizer and micro-nutrient distributed under SHC scheme (micro-nutrient)Quantity of fertilizer and micro-nutrient distributed under SHC scheme (bio-fertilizer)Quantity of fertilizer and micro-nutrient distributed under SHC scheme (Manure)Number of village coveredNumber of village covered in %How much total area of cultivation of your region was soil tested: Area (in Ha.)How much total area of cultivation of your region was soil tested in %Feedback and constraintsMentions the major feedbacks obtained from the farmersMentions the major constraints in collection of soil sampleMentions the major constraints in soil testingMentions the major constraints in card distributionMentions the major Constraints in conducting training program / demonstration/ identification of Model village:Overall Rating of the Performance of SHC scheme (tick the appropriate):ExcellentGoodSatisfactorySomewhatPoorVery Poor