Afghanistan. BASELINE DISPLACEMENT LOCATION (Settlement, Village) PROFILE. 1. RET Population IN Flow : Returns to the Village B2F

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1 Afghanistan BASELINE DISPLACEMENT LOCATION (Settlement, Village) PROFILE FORM QUESTIONNAIRE Version: Displacement Tracking Matrix (DTM) International Organization for Migration (IOM) New Village, never before assessed Round Number What is the base population (do not include returnees and IDPs: Type of Date of Assessment d d - m m - y y y y interview Male DFP Name Sex of DFP Female Re-assessment in the same round Face-to-f ace interview Phone call Both Team Leader The location is:. Village from the master list. New village neighboring a village in master list Province Settlement (village/neighborhood) Name Returnees/IDPs Exact Location Name District If Key informant agrees, please provide name. Contact will be used for follow-up assessment on populations, conditions and needs. Use the below table # 5 6 For Column C. Type use:. Local CDC Representative;. Humanitarian/Social Organization;. Community / tribal representative;. Representation of displaced groups; 5. Other representation from district authorities office; 6. Representatives of education facilities 7. Representatives of Health facilities 8. Other, please specify in contact column. NAME if informant agrees, if not mark XX and state the type and sex only Type Sex M/F. RET Population IN Flow : Returns to the Village Contact Details (Phone or Address) BF IN flow WHO & FROM Where? 0/ Returnees from Abroad Yes No Yes No Yes No Yes No Yes No Returnees from Abroad. - Neighboring Countries Pakistan (PAK) Undocumented Documented Iran (IRN) Undocumented Documented individuals IOM Afghanistan Page of 5

2 Returnees from Abroad. Non-Neighboring Countries Europe including Turkey Middle East Rest of Asia Other How are, the returnees from abroad, currently accommodated in this village? (enter the percentage for each the total must add up to 00%) OWN HOUSE HOST FAMILY TENT OPEN AIR RENTED HOUSE TOTAL % % % % % %. RET Population IN Flow : Returns to the Village (IDPs) IN flow WHO & FROM Where? 0/ Returnees from Internal Displacement Yes No Yes No Yes No Yes No Yes No Returnees, from internal displacement from Internal Displacement District : District : Other Province Other Province All others 0/5 06. IDP Population IN Flow : IDPs in to the District IN flow WHO & FROM Where? 0/ Internally Displaced (from Afghanistan) Yes No Yes No Yes No Yes No Yes No Arrivals of Internally Displaced Persons All IDPs FROM District : District : FROM Other Province FROM Other Province FROM All others 0/ IOM Afghanistan Page of 5

3 . How are, Arrival IDPs present in the village, currently accommodated in this village? (enter the percentage for each the total must add up to 00%) OWN HOUSE HOST FAMILY TENT OPEN AIR RENTED HOUSE Total % % % % % %. What is the reason for the majority of IDP inflow into the village, since 06 to date?. Conflict. Natural Disaster. For each reason for displacement selected in., provide the percentage of each? (enter the percentage for each the total must add up to 00%) Conflict Natural Disaster % %. Moved OUT of the District Population OUT Flow: Moved out of Village OUT Flow WHO & TO Where? 0/ Moved Abroad Yes No Yes No Yes No Yes No Yes No Moved Abroad To Neighboring Countries To Pakistan (PAK) Iran (IRN) Moved Abroad To Non Neighboring Countries Europe including Turkey Middle East Rest of Asia Other.. What is the reason for majority of Migrants outflow from the village, since 06 to date? (select all that apply). Conflict. Natural Disaster. Economic/Job/Labour. Health 5. Education. For each reason for displacement selected in., provide the percentage of each? (enter the percentage for each the total must add up to 00%) Conflict Natural Disaster Economic/Job/Labour Health Education % % % % % IOM Afghanistan Page of 5

4 5. Moved OUT of the District Population OUT Flow: Moved out of District (Fled IDPs) OUT Flow WHO & TO Where? 0/ Fled IN Internal Displacement Yes No Yes No Yes No Yes No Yes No Fled in Internal Displacement All fled as IDPs IN District : District : IN to Other Province IN to Other Province IN to All other provinces 5.. What is the reason for majority of IDP outflow from the village, since 06 to date? (select all that apply). Conflict. Natural Disaster 5.. For each reason for displacement selected in 5., provide the percentage of each? (enter the percentage for each the total must add up to 00%) Conflict 6. Informal Settlements Natural Disaster % % 6. Are there informal settlements in the village?. Yes. No Settlement Name 7. Other Population Groups 7.. Are there any nomads (Kuchi) present in the village throughout the year?. Yes. No Season 7.. Are there any cross border tribal groups present in the village throughout the year?. Yes. No Season 7.. Are there any Refugees resident in the village?. Yes. No Country IOM Afghanistan Page of 5

5 8. Access to Services Are there any of below Services in the village? Clinic Hospital Market Safe Drinking Water Source School. Yes. No. Yes. No. Yes. No. Yes. No. Yes. No If No, what is the distance to the nearest location of service (km)? Distance: km Total Students: (% Boys: % Girls: %) If No, what is the time to reach to the nearest location of service (min) and specify mode of transport? Time Transport Mode Mode of Transport:. Foot;. Animals;. Taxi / Car;. Mini Bus; 5. Truck; 6. Boat; 7. Bicycle; 8. Motorbike; 9. Three-wheel; 0. Train;. Airplane;. Other (specify) 9. CDC Coverage A: Village has ONE CDC. Yes (move to B). No (then move to option C) CDC Name CDC Chairman Name Contact Number Remark B: The village is part of CDC that covers more than one village.. Yes (list the villages). No If Yes, how many villages are registered under this CDC? Number: Village Name Village Elder Name Contact Number Is the village on the master list?.yes.no.yes.no.yes.no.yes.no C: How many CDCs are established in this village? Number: CDC Name CDC Chairman Name Contact Number Remark Please make CROKI (Sketch) map (on Blank page) with settlements not on the list and baseline map. Use google earth printout or simple sketch. CDC Representative: Position: Signature: IOM Afghanistan Page 5 of 5