Article 1The structured survey on end recipients referred to in Article 17(4) of Regulation (EU) No 223/2014 shall be carried out in accordance with the template set out in the Annex.

Article 2This Regulation shall enter into force on the twentieth day following that of its publication in the Official Journal of the European Union.

This Regulation shall be binding in its entirety and directly applicable in all Member States.Done at Brussels, 18 April 2016.For the CommissionThe PresidentJean-Claude JunckerANNEXFEAD STRUCTURED SURVEY — QUESTIONSName of the interviewer[full name of the interviewer. If several people carry out the interview, all of them should be noted here]Place[address where the survey is carried out]Organisation[name of the partner organisation from which the end recipient received assistance]Date[date of the survey in format dd/mm/yyyy]Time[time of the survey in format hh:mm]A.QUESTIONS ON THE SCOPE OF ASSISTANCE PROVIDED TO END RECIPIENTS BY THE PARTNER ORGANISATIONQuestions concern assistance provided at distribution point where interviews take place.

A1.What type of FEAD assistance is distributed to end recipients and how often is it distributed?The definition of what is to be understood as a food package can be provided at the level of the partner organisation/operation/managing authority. Packages do not need to be standardised in size or content.

	Daily	Weekly	Monthly	Other
Food packages				(specify)
Meals				(specify)
Goods distributed to children				(specify)
Goods distributed to the homeless				(specify)
Other (to be specified)	[specify type]	[specify type]	[specify type]	[specify type and period]

A2.What are the types of accompanying measures offered to end recipients when they receive FEAD assistance?

Advice on food preparation and storage, cooking workshops, educational activities to promote healthy nutrition, or advice on how to reduce food waste
Personal cleanliness advice
Redirection to competent services (e.g. social/administrative)
Individual coaching and workshops
Psychological and therapeutic support
Advice on managing a household budget
Other (to be specified)	[Text box to be filled in]
None

A3.Does the partner organisation also provide material assistance to end recipients that is not co-financed by the FEAD?

Yes	No

A3a.If yes, which kind of assistance does the partner organisation provide beyond the FEAD?

Food packages
Meals
Goods distributed to children
Goods distributed to the homeless
Other goods	[specify type]

B.QUESTIONS FOR THE END RECIPIENT

B1.Are you male or female?

Male	Female

B2.Could you please tell me how old you are?

15 or less	16-24	25-49	50-64	65 or above	Does not wish to answer	Does not know or does not understand the question

B3.Could you please tell me whether you are a single parent?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B4.Could you please tell me what type of assistance you received just now (or you will receive now)?

	Yes	No	Does not wish to answer	Does not know or does not understand the question
Food packages
Meals
Layette (baby essentials)
School bags
Stationery, exercise books, pens, painting equipment and other equipment required in school (non-clothes)
Sports equipment (sport shoes, leotard, swimsuit, etc.)
Clothes (winter coat, footwear, school uniform, etc.)
Sleeping bags/blankets
Kitchen equipment (pots, pans, cutlery, etc.)
Household linen (towels, bedclothes)
Hygiene articles (first aid kit, soap, toothbrush, disposable razor, etc.)
Other categories of goods	[Text box to be filled in]

B5.Could you please tell me who is receiving this assistance?

Yourself	Other people in your household	Does not wish to answer	Does not know or does not understand the question

If the answer to question B5 is "Yourself" only, skip question B6.

B6.Could you please tell me whether other people will also benefit from this assistance? And if so, could you say how many (not including yourself), and what is their age and their gender?

	Male	Female
5 or less
6-15
16-24
25-49
50-64
65 or above
Does not wish to answer
Does not know or does not understand the question

B7.Could you please tell me whether this is the first time that you have come to get this assistance?

Yes	No	Does not wish to answer	Does not know or does not understand the question

If the answer to question B7 is "Yes", "Does not wish to answer" or "Does not know or does not understand the question", then go directly to question B9.

B8.Could you please tell me how often you come to get this assistance?

Daily	Weekly	Monthly	Other	Does not wish to answer	Does not know or does not understand the question

B9.Do you know when you will need the same assistance again?

Tomorrow	Within next week	Within next month	Other	Does not wish to answer	Does not know or does not understand the question

B10.Could you please tell me whether you faced any difficulties in getting this assistance?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B10a.If yes, please tell me which kind of difficulties you faced?

Need to get some papers from some national, regional or local office
Need to travel a long distance
Psychological hurdles
Other (to be specified)	[Text box to be filled in]
Does not wish to answer
Does not know or does not understand the question

B11.Could you tell me whether the assistance provided by the FEAD has made a difference to you or to the members of your household?

Yes	Partially	No	Does not wish to answer	Does not know or does not understand the question

B11a.If "No" or "Partially", could you please tell me why?

Insufficient quantity of food/goods
Insufficient frequency of food/goods distribution
Insufficient quality of food/goods
Other type of assistance required (to be specified)	[Text box to be filled in]
Does not wish to answer
Does not know or does not understand the question

B12.A year ago, could you or your household afford to purchase the food/goods you just received?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B13.Could you please tell me whether you and/or other members of your household are receiving assistance from other organisations?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B13a.If yes, could you please tell me what type of assistance you receive from other organisations?

	Yes	Does not wish to answer	Does not know or does not understand the question
Food packages
Meals
Layette (baby essentials)
School bags
Stationery, exercise books, pens, painting equipment and other equipment required in school (non-clothes);
Sports equipment (sport shoes, leotard, swimsuit, etc.)
Clothes (winter coat, footwear, school uniform, etc.)
Sleeping bags/blankets
Kitchen equipment (pots, pans, cutlery, etc.)
Household linen (towels, bedclothes)
Hygiene articles (first aid kit, soap, toothbrush, disposable razor, etc.)
Other	[Text box to be filled in]

B14.If you have received (now or in the past) advice or guidance through this organisation, please could you tell me what it was about?

Advice on food preparation and storage, cooking workshops, educational activities to promote healthy nutrition, or advice on how to reduce food waste
Personal cleanliness advice
Redirection to competent services (e.g. social/administrative)
Individual coaching and workshops
Psychological and therapeutic support
Advice on managing a household budget
Other (to be specified)	[Text box to be filled in]
Does not wish to answer
Does not know or does not understand the question

B15.Could you please tell me whether you found this advice or guidance useful or not?

Very useful	Somewhat useful	Not very useful	Not useful at all	Does not wish to answer	Does not know or does not understand the question

B16.Could you please tell me whether you have any income from work?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B17.Could you please tell me whether you get any other income or benefits?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B18.Could you please tell me whether any members of your household have any income from work?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B19.Could you please tell me whether any members of your household get any other income or benefit?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B20.Could you please tell me whether you have the nationality of this country?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B21.If no, could you please tell me whether you have the nationality of another EU country?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B22.Could you please tell me if you are an asylum seeker or a refugee?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B23.Could you please tell me whether you have a place to live?

Yes	No	Does not wish to answer	Does not know or does not understand the question

B23a.If you do have a place to live, could you please tell me what type of place this is?

Owned or rented dwelling or house, either alone or with the family
Shared dwelling with friends and other people
Institutional long-term home (home for elderly, single mothers, asylum seekers)
Sheltered housing
Ruined house or slum
Mobile home/caravan
Refugee camp
Other (to be specified)	[Text box to be filled in]
Does not wish to answer
Does not know or does not understand the question