Consumer Confidence Survey Interview Start Time Hour ( hours) Minute
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For Official Use: Gender Language of Interview Overall Behavior Survey Status Urdu Other Complete Male Please use check mark () one of the two above In case of Urdu please check mark () Female Please mention the Language in which Interview was conducted Positive Negative Can t Assess Please use check mark () one of the three above Partially Completed- Incomplete Refused to answer remaining questions Please use check mark () one of the four above Partially Completed-Any other reason (Please mention the reason) Interview End Time Hour ( hours) Minute Name of Enumerator Entered by: Data Entry: Reviewed by: Date Day Month Year