Are you using Collect or Enketo (Webform), please? At least for Collect, you cannot implement this cmplex format with numbers. In total, your design covers 3*4 = 12 questions/answers.
You can find a similar discussion in a previous posting: Need advise on how to design form layout for use with ODK Collect Android App. And also an ODK enhancement proposition: Form design: grid of text or numeric input. You may vote there.
(@LN, @yanokwa. Might be to review for the roadmap?)