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Process Monitoring Template 6 -Form Fill

Village Information
Q01

State Name
Q02

State Code
Q03

District Name
Q04

District Code
Q05

Block Name
Q06

Block Code
Q07

Gram Panchayat Name
Q08

Gram Panchayat Code
Q09

Village Name
Q10

Village Code
Q11

Village Unique ID
Survey Information
A01

Name of the respondents
A02

Respondent identification code
A03

FIRST VISIT

A03_1

Interviewer name
A03_2

Interviewed code
A03_3

Date of the interview
A03_4

Result of the interview
A03_5

Record time when you start the interview
A03_6

Record time when you end the interview
A04

SECOND VISIT

A04_1

Interviewer name
A04_2

Interviewed code
A04_3

Date of the interview
A04_4

Result of the interview
A04_5

Record time when you start the interview
A04_6

Record time when you end the interview
A05

THIRD VISIT

A05_1

Interviewer name
A05_2

Interviewed code
A05_3

Date of the interview
A05_4

Result of the interview
A05_5

Record time when you start the interview
A05_6

Record time when you end the interview
Basic Information of the member & group
B01

Name of the SHG
B02

What is your age? (in completed years)
B03

What is your highest educational qualification?
B04

What is your marital status?

B05

Do you hold any key position in the village?
B06

What is your main economic activity?
B07

When was your SHG formed?
B08

Is your SHG formed under the SRLM?
B09

Which organization helped in the formation of this SHG?
B10

How many members are there in your SHG for 2021-22?
B11

Please tell us the caste composition of your SHG in the current period 2021-22?
B12

How many members in your SHG in the current period 2021-22 belong to Particularly Vulnerable Tribal Groups (PVTGs)?
B13

How many members have dropped off in the last year?
B14

Are SHG members aware of what producer groups are?
B15

Are there any SHG members who are part of the producer group?
B16

Are there any SHG members who are part of any producer enterprise/Farmer Producer Company (FPC)?
B17

What is the average age of the members of this SHG?
B18

Are the SHG meetings held weekly?
B19

If not, how frequently are the meetings of the SHGs conducted?
B20

On average, what was the expected attendance record in the meetings that happened in the last three months?

B20_1

Month 1
B20_2

Month 2
B20_3

Month 3
B21

On average, what is the attendance record in the meetings that happened in the last three months?

B21_1

Month 1
B21_2

Month 2
B21_3

Month 3
B22

How often has the group leadership been rotated?
B23

Has this SHG/ representative of this SHG attended the meetings at the VO level?
B24

Pre-Covid, how frequently were the VO meetings attended by the SHG members/representatives?
B25

During Covid, how frequently were the SHG members/representatives attending VO meetings?
B26

During the last month, how much time was spent by SHG members/representatives attending the VO meetings?

B27

Pre-Covid, on average, how much time was spent by SHG members/representatives attending the VO meetings?

B28

Has this SHG/ representative of this SHG attended the meetings at the CLF level?
B29

Pre-Covid, how frequently were the VO meetings attended by the SHG members/representatives?
B30

During the last month, how much time was spent by SHG members/representatives attending the CLF meetings?

B31

What is your opinion on the time spent on the meetings at both VO and CLF levels?
B32

What areas do the group feel the SHGs are helpful for women?
B33

According to the group, the ongoing pandemic affected the activities of SHGs
B34

According to the group, what are the key barriers to becoming members of SHG?
B35

What can be done to mitigate these challenges?
B36

Has this SHG ever received any help and support from the VO linked with the SHG?
B37

How did the VO help and/or support your SHG?
B38

How frequently has this SHG been helped or supported by the VO?
B39

How important is the VO to your SHG, considering the activities that the VO has performed?
B40

Has your SHG ever received any help and support from the CLF linked with the SHG?
B41

How did the CLF help and/or support your SHG?
B42

How frequently have your SHG been helped or supported by the CLF?
B43

How important is the CLF to your SHG, considering the activities that the CLF has performed?
B44

Are you aware of Lakhpati Mahila Kisan initiative?
B45

Has this SHG identified members for Lakhpati Mahila Kisan initiative?
B46

How many members of your SHG have been identified for the Lakhpati Mahila Kisan Initiative?
B47

Which are the activities promoted by the SHG under Lakpathi Mahila Kisan Initiative?
B48

How many SHG members are engaged in

B48_1

One livelihood activity
B48_2

Two livelihood activities
B48_3

More than two livelihood activities
B49

How did the CLF help SHG for the Lakhpati Mahila Kisan Initiative?
B50

How did the VO help SHG for the Lakhpati Mahila Kisan Initiative?
Financial Performance
C01

What is the total fund that was available with the SHG in the last three months (from 1st Apr 2022)?
C02

How much money has been disbursed by the SHG in the last three months (from 1st Apr 2022)?
C03

Does the SHG have a bank account?
C04

If not, what are the reasons for not having a bank account?
C05

Has the group designated any member who will be operating the account?
C06

If yes, please specify the designation of the SHG member
C07

Can you briefly tell us about the formalities your SHG had to fulfill to open an account?
C08

Has the SHG taken any loan from the bank?
C09

How many bank loans have been taken by this SHG after its formation (ongoing and closed)?
C09_1

How many bank loans availed by this SHG after its formation are collateral-free loans?
C09_2

What was the total amount of collateral-free loans demanded by the SHG?
C09_3

What was the total amount of other (with submission of collateral) bank loans amount demanded by the SHG?
C10

What was the total sanctioned loan amount (Collateral free loans), including interest?

C10_1

What is the average interest rate of the collateral-free bank loans availed by this SHG?
C10_2

What was the total sanctioned loan amount for other loans (with collateral submission), including interest?
C10_3

What is the average interest rate of bank loans with collateral availed by this SHG?
C11

What has been the total repayment of the bank loan (collateral free) till June 2022?

C11A

Principal
C11B

Interest
C12

What has been the total repayment of the bank loan (with collateral) till June 2022?

C12A

Principal
C12B

Interest
C13

How much time, on average, does it take for the bank loan to be approved?
C14

Does the SHG have a micro-credit plan (MCP) in place?
C15

As per the norms of the SHG, what minimum weekly savings should each SHG member contribute?
C16

Autogenerate expected savings from 1st Apr 2022 to 30th June 2022
C17

What has been the total savings of the group from 1st Apr 2022 to 30th June 2022
C18

Record reasons if the gap between 516-515 is more than 20%
C19

What is the total fund that was available with the SHG in the last three months (from 1st Apr 2022)?
C20

How much money has been disbursed by the SHG in the last three months (from 1st Apr 2022)?
C21

What has been the total borrowing of the group from 1st Apr 2022 to 30th June 2022?
C22

How many members asked for a loan in the last three months?

C23

How many members have sanctioned the loan in the last 3 months?
C24

Has the SHG funded any interest-free loans to its members in the last three months?
C25

How many members have accessed interest-free loans from your SHG in the last three months?
C26

Do you think providing interest-free loans has helped improve the penetration of funds within the SHG?
C27

How did the SHG members utilize the interest-free loans they availed in the last 3 months?
C28

Can you categorize the individual loans by their amount in the last three months?

C28_1

Less than 1000: ___
C28_2

1000-2500:____
C28_3

2500-5000:____
C28_4

5000-10000:___
C28_5

10000-20000: ___
C28_6

20000+: ______
C29

How long (in terms of days) does it take for a member to receive the loan within SHG after they apply?
C30

Do the members of this SHG follow on-time repayment of the loans they availed?
C31

What was the expected total repayment, including interest, from 1st April 2022 to 30th June 2022?
C32

What have been the loan's total repayments, including interest from 1st April 2022 to 30th June 2022?
C33

Did the SHG receive any revolving funds?
C34

What has been the total amount of Revolving fund that the SHG received in 2021-22?
C35

What was the amount of Revolving Fund repaid by this SHG in 2021-22?
C36

What has been the total amount of Community Investment Fund that the SHG received in 2021-22?
C37

What was the amount of Community Investment Fund repaid by this SHG in 2021-22?
C38

How did the SHG/SHG members utilize the Community Investment Fund they received in 2021-22?
C39

What has been the total Vulnerability Reduction Fund the SHG has received?
C40

What was the amount of the Vulnerability Reduction Fund repaid by this SHG in 2021-22?
C41

What has the total amount of Livelihoods/Layering Fund the SHG has received?
C42

What amount of Livelihood/Layering funds will be repaid by this SHG in 2021-22?
C43

Has the SHG taken any loan from the VOs in 2021-22? (other than VRF, CIF, Livelihood/layering funds)
C44

What is the amount of the loan (besides VRF, CIF, and Livelihood/layering funds) taken by the SHG from the VO in 2021-22?
C45

What is the average annual interest charged by VO on loans to your SHG?
C46

What have been the expected total repayments of the loan from the SHGs to the VO during 2021-22?
C47

What have been the total repayments of the loan from the SHGs to the VO’s during 2021-22?
C48

Has the SHG received any loans from the CLFs in 2021-22? (other than VRF, CIF, Livelihood/layering funds)
C49

If yes, in the last year, what is the total amount of loan received from the CLF in 2021-22?
C50

What is the average annual interest charged by CLF on loans to your SHG?
C51

What have been the expected total repayments of the loan from the SHGs to the CLF during 2021-22?
C52

What have been the total repayments of the loan from the SHGs to the CLF during 2021-22?
C53

What percentage of SHG members are dependent on other informal sources for credit?
C54

What has been the total amount of funds received from the mission as a vulnerability reduction fund during 2020-2021?
C55

What has been the total amount of funds received from the mission in the form of Livelihoods/Layering Fund during 2020-2021?
C56

Who all helped the SHG in getting through the bank formalities?
C57

Has any of the SHG members made any investments in the last year?
C58

Has there been an impact of the ongoing pandemic on the group’s ability to save?
C59

Has there been an impact of the ongoing pandemic on your group’s ability to invest?
C60

How influential are your family's female members in the decision-making process related to savings, investments, and loans?
C61

What are the top purposes for which these members usually take these loans?
C62

Now I will ask about the loan disbursement and repayment in the last 3 months

C62A

As on 31st May 2022

C62A_1

Total loan amount demanded (in INR)
C62A_2

Total loan amount disbursed (in INR)
C62A_3

Total loan outstanding (in INR)
C62A_4

Expected payment of Principal amount (in INR)
C62A_5

Expected payment of Interest amount (in INR)
C62A_6

Actual collection of Principal amount (in INR)
C62A_7

Actual collection of Interest amount (in INR)
C62A_8

Closing Balance (Cash in Hand) (in Rs)
C62A_9

Closing Balance (Cash in Bank) (in Rs)
C62A_10

Total Amount overdue for more than 30 days (only principal)
C62A_11

Total Amount overdue for more than 90 days (only principal)
C62B

As on 30th June 2022

C62B_1

Total loan amount demanded (in INR)
C62B_2

Total loan amount disbursed (in INR)
C62B_3

Total loan outstanding (in INR)
C62B_4

Expected payment of Principal amount (in INR)
C62B_5

Expected payment of Interest amount (in INR)
C62B_6

Actual collection of Principal amount (in INR)
C62B_7

Actual collection of Interest amount (in INR)
C62B_8

Closing Balance (Cash in Hand) (in Rs)
C62B_9

Closing Balance (Cash in Bank) (in Rs)
C62B_10

Total Amount overdue for more than 30 days (only principal)
C62B_11

Total Amount overdue for more than 90 days (only principal)
C62C

As on 31st July 2022

C62C_1

Total loan amount demanded (in INR)
C62C_2

Total loan amount disbursed (in INR)
C62C_3

Total loan outstanding (in INR)
C62C_4

Expected payment of Principal amount (in INR)
C62C_5

Expected payment of Interest amount (in INR)
C62C_6

Actual collection of Principal amount (in INR)
C62C_7

Actual collection of Interest amount (in INR)
C62C_8

Closing Balance (Cash in Hand) (in Rs)
C62C_9

Closing Balance (Cash in Bank) (in Rs)
C62C_10

Total Amount overdue for more than 30 days (only principal)
C62C_11

Total Amount overdue for more than 90 days (only principal)
C63

Income and expenditure of SHGs

C63_1

Expenditure of SHG (INR): Remuneration of cadres
C63_2

Expenditure of SHG (INR): Penalty paid to higher level federations
C63_3

Expenditure of SHG (INR): Travel expenses
C63_4

Expenditure of SHG (INR): Marketing of produce
C63_5

Expenditure of SHG (INR): other miscellaneous expenses
C63_6

Income of the SHG (INR): Grants from SRLM
C63_7

Income of the SHG (INR): Grants from VO and CLF
C63_8

Income of the SHG (INR): Interest income from the loan to members
C63_9

Income of the SHG (INR): Interest income from the funds in the bank
C63_10

Income of the SHG (INR): Fines and penalties from SHG members
C63_11

Income of the SHG (INR): Other income
Insurance
D01

Are the members of your group aware of any available insurance products?
D01A

Which of the following schemes are the members aware of?
D01B

How many members in your group are aware of insurance schemes?
D02

What are the main sources from which you got awareness about various Insurance?
D03

Have you provided awareness about insurance products to other members of your village?
D04

How many members in your group have insurance?
D05

Can you tell us briefly about the process they followed to get insured?

D06

Who had informed them about the various insurance products?
D07

Can you tell us the top two forms of insurance that most of the group has availed of?
D08

Can you tell us how most members pay the premium amount?
D09

What is the average amount paid by the group as the premium for the insurance they have taken?
D10

Did any group members claim under the insurance schemes in the last year?
D11

Did the group member receive the claimed amount?

D12

What is the average time usually taken to avail claim benefits for insurance policies by any group member?
D13

What was the claim amount that was received?
D14

If they haven’t received any claim, what were the reasons for not getting the claim amount?
D15

Can you tell us for how long, on average, the group members had this insurance?
D16

According to the group, what are the major facilitators and challenges for people to buy insurance?
D17

What steps do you think can be taken to mitigate the challenges?
D18

Is the SHG aware of what is an insurance settlement process?
D19

Who informed the group about the processes of insurance settlement?
D20

What are the reasons that the group members have not taken insurance?
D21

How influential are the female members of the family in the process of buying insurance?
Pension
E01

Are you and other group members aware of pension schemes?
E02

How many members in your group are aware of pension schemes?
E03

What mediums did you and other group members use to learn about the pension schemes?
E04

Have you provided awareness to other women regarding the various pension scheme?
E05

According to you, what are the various pension products available in your district?
E06

How many members of your group are eligible for pension products?
E07

Have you or other group members purchased/subscribed to any pension scheme?
E08

How many office bearers of the SHG are enrolled in the contributory pension scheme?

E09

How many SHG members are enrolled in the contributory pension scheme at present?

E10

What are most of these members' contributions towards the pension scheme?
E11

How many office bearers of this SHG have taken a pension scheme (exclude contributory pension scheme)?
E12

How many members of this SHG have taken a pension scheme (exclude contributory pension scheme)?
E13

What are the top two kinds of pension schemes that have been bought?
E14

What is the kind in which the eligible beneficiaries receive the payment?
E15

What factors led you or the other group members to subscribe to a pension scheme?
E16

Can you briefly tell us about the understanding of the people who have taken the pension and their purpose for taking the pension scheme?
E17

What are the reasons that some members may not have bought any pension plan?
E18

According to the group, what promotes more people in the nearby neighborhood to buy pension plans?
E19

According to SHG, what challenges restrict more people in your neighborhood from buying pension plans?
E20

What steps can be taken to mitigate these challenges?
SHG Transactions through BC Sakhi
F01

How do you conduct financial transactions within your group? (Multiple Choice)
F02

Have you heard about the BC Sakhi intervention?
F03

Is there a BC Sakhi operating in your area?
F04

Are you aware that you could conduct SHG transactions through the BC point?
F05

How did you learn about conducting SHG transactions through the BC point?
F06

Has the SHG ever conducted transactions through the BC point?
F07

What sort of transactions were carried out? (Multiple Choice)
F08

Is there a policy for transacting through the BC point?
F09

How many transactions did your SHG conduct through the BC point in the last 3 months?

F10

Why did you not conduct more transactions through the BC point
F11

What do you think are the advantages of conducting transactions through BC Sakhi? (open-ended)
F12

What are the disadvantages? (open-ended)
F13

Why didn’t you conduct SHG transactions through the BC point?

Agri-Nutri Gardens
G01

Are you aware about agri nutri-gardens?
G02

How did you come to know about the agri-nutri gardens?

G03

Have you, other SHG women/community members set up an agri-nutri garden?
G04

How many women are there in your SHG
G05

Amongst these, how many SHG women have set up an agri-nutri garden
G06

How many non-SHG women from the village have set up agri-nutri garden?
G07

How many women in your SHG are beneficiaries of the Integrated Child Development Scheme (ICDS)?
G08

What are the reasons women do not choose to set up an agri-nutri garden?
G09

What is the total land area under cultivation for agri-nutri graden for all the beneficiaries (both SHG and non-SHG members)?
G09A

Unit
G10

What is the total land are under cultivation for the agri-nutri garden for your SHG members?
G10A

Unit
G11

Did anyone assist you in setting up the agri-nutri garden?
G12

What help does the CRP offer to SHG members in setting up agri-nutri-gardens?
G13

What all does your agri-nutri garden have?
G14

Do you receive an all year round supply of agriculture seedlings?
G15

Are these seeds HYV seeds/ GM Seeds?
G16

Who supplied the seedlings?
G17

Do you receive an all year round supply of fingerlings?
G18

Who supplied the fingerlings?
G19

Do you receive an all year round supply of chicks?
G20

Who supplied the chicks?
G21

Did you receive help from MGNREGS to set up the Agri-Nutri Garden?
G22

In what ways does MGNREGS support you in setting up agri-nutri gardens
G23

How do women typically fund their agri-nutrition gardens?
G24

How many SHG members have taken loans from this SHG for setting up of agri-nutri garden?
G25

What is the total amount of loan taken by this SHG members from this SHG for the agri-nutri garden?
G26

How many SHG members have repaid the loans taken from this SHG for setting up of agri-nutri garden?
G27

What is the total amount of loan repaid by the SHG members who have taken loan for agri-nutri garden?
G28

Did the CRP(s) assist you in setting up agri-nutri gardens?
G29

Did you receive any training for setting up the agri nutria garden?
G30

What all subjects are covered in your training?
G31

Were exposure visits a part of your training?
G32

What is the frequency of trainings in a year?
G33

Does the cadres visit your field for monitoring the cultivation practices in the agri-nutri garden?
G34

On a scale of 1-5, please rate the existing trainings offered to you
G35

How can the trainings be improved to help you better assist mahila kisans in setting up nutri-gardens?
G36

How do agri-nutri gardens help you/ SHG women?
G37

How has the agri-nutri garden impacted your daily consumption of food and expenditure on food?
G38

What kind of additional support do you require to run agri-nutri gardens successfully?
G39

Do you/other SHG members sell the harvest from the agri-nutri garden in the market?
G40

Approximately, what proportion of the harvest from agri-nutri garden in the last season have been sold in the market?

G41

What are the reasons for the sale crops produced in the agri nutri garden in the market?