This document contains a questionnaire used in a comparative study of quality of life between urban and rural households. The questionnaire contains several sections assessing various aspects of quality of life, including physical well-being, family life, economic life, personal life, self-perception, social support, and financial resources. Respondents are asked to rate their level of satisfaction with various statements in these areas on a 5-point scale from strongly dissatisfied to strongly satisfied. The questionnaire also collects demographic information such as age, gender, income, education level, and whether the respondent lives in a rural or urban area.