Annapurna Yojana Portal

A Family Identity

Instructions: Mark ☑ if true. Fill all fields — they are mandatory.

* 1. Name of Head of Family (HOF)

* 2. Date of Birth of HOF (As per Aadhaar/official ID)

* 3. Gender of Head of Family (HOF)

M F Other

* 4. Aadhaar of HOF

5. Household ID of Digital Ration Card (if any)

* 6. No. of family members

* 8. Contact No. (Preferably Aadhaar-linked mobile of HOF)

* 7. Address (Permanent Address)

9. Family Member Details (Name, DOB, Gender, Relation with HOF, Aadhaar)

For children below 5 years, 'NA' may be written where Aadhaar is not available.

Head of Family (HOF)

Name

DOB

Gender

Relation with HOF

Aadhaar No.

☑ Applying for Annapurna Yojana

10. Bank Accounts (Aadhaar-linked for DBT credit)

11. EPIC (Voter ID) – HOF & all adult members

* 12. Category (Necessary certificates as applicable)

UR UR-EWS SC ST OBC PVTG

B Ration Card / Food Subsidy

* 1. Do you have a Digital Ration Card?

Yes No

2. If Yes, indicate type of card:

AAY PHH SPHH RKSY1 RKSY2 Non-subsidized

* 3. Whether family is lifting monthly ration from the Ration Shop?

Yes No

C Assets

(Mark ☑ if true)

* 1. House size: Does your house have ≥3 pucca rooms?

Yes No

* 2. Whether your family owns any land?

Yes No

3. Size of total landholding (in decimals)

* 4. Vehicles: Do any member own a motorized non-commercial 4-wheeler?

Yes No

If yes, No. of vehicles:

Model:

Vehicle Registration No.:

5. Status of Health Insurance Coverage (Family Member-wise)

D Income / Profession

* 1. Does any member pay Income Tax or Professional Tax?

Yes No

2. PAN Card of Family Members (If available)

3. Nature of Employment

(Choose most appropriate box; can tick multiple options)

4. Literacy Status

No. of literate adult members:

No. of illiterate adult members:

* 5. Is any member a former/current holder of constitutional posts (Ministers, MPs, MLAs, etc.)?

Yes No

If yes, Member No. & Position:

* 6. Is any member a government pensioner?

Yes No

If yes, Member no.:

* 7. Is any member registered under GST?

Yes No

If yes, GSTIN:

* 8. Total annual family income (INR):

E Other Identity Documents

1. CAA Application Status (if any)

2. Others (KCC, KCC ARD, Artisan Credit Card, MJCC, Student CC, etc.)

3. If Deleted in SIR 2026 – whether case pending in Tribunal

F Social Status and Dependents

1. Details of all children attending school (up to 4 children)

2. Children's Vaccination Status

G Benefits under Government Schemes

(Specify name of scheme if Yes. For opting out, mark checkbox.)

2. If excluded, reasons (to be filled by officer):

H Declaration & Consent

I hereby declare that the above information is true to the best of my knowledge and I have provided all the supporting documents where applicable and HAVE NOT missed any criteria as mentioned above. I understand that my social protection benefits will be stopped if any information provided by me turns out to be false.

☑ Agree

------------------------------------------------------- (Signature)

Note: 'Family' is defined as a group of persons who normally live together and take their meals from a common kitchen.

📋 For Official Use

Enquiry Report on Family Level Data Collection Form for Annapurna Yojana

I have verified the application submitted by ……………………… s/o/d/o, …………………, Village/Town……., GP…………., Block ……………/ Municipality……………. …….., District………………………….

Findings:

Recommendation:

Date:

Place:

Signature:

Name:

Designation:

A Family Identity

9. Family Member Details (Name, DOB, Gender, Relation with HOF, Aadhaar)

10. Bank Accounts (Aadhaar-linked for DBT credit)

11. EPIC (Voter ID) – HOF & all adult members

B Ration Card / Food Subsidy

C Assets

5. Status of Health Insurance Coverage (Family Member-wise)

D Income / Profession

2. PAN Card of Family Members (If available)

3. Nature of Employment

4. Literacy Status

E Other Identity Documents

1. CAA Application Status (if any)

2. Others (KCC, KCC ARD, Artisan Credit Card, MJCC, Student CC, etc.)

3. If Deleted in SIR 2026 – whether case pending in Tribunal

F Social Status and Dependents

1. Details of all children attending school (up to 4 children)

2. Children's Vaccination Status

G Benefits under Government Schemes

H Declaration & Consent

📋 For Official Use

Registration Successful!

🔍 Application Status