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Vo Template 1 -Form Fill
Identification Information
Q01
District Name
Q02
District Code
Q03
Block Name
Q04
Block Code
Q05
Name of the VO
Q06
UID
Q07
Type of Area
Comparison
Project
Survey Information
A01
Name of the respondents
A02
Designation of the respondent
President
Vice-President
Secretary
Treasurer
Bookkeeper
Others (specify)
A03
Respondent identification code
A04
FIRST VISIT
A04_1
Interviewer name
A04_2
Interviewed code
A04_3
Date of the interview
A04_4
Result of the interview
Interview complete
Visit rescheduled
Interview incomplete
Refused
Respondent is out of station for extended period
Respondent is temporarily away
Other (specify)
A04_5
Record time when you start the interview
A05
SECOND VISIT
A05_1
Interviewer name
A05_2
Interviewed code
A05_3
Date of the interview
A05_4
Result of the interview
Interview complete
Visit rescheduled
Interview incomplete
Refused
Respondent is out of station for extended period
Respondent is temporarily away
Other (specify)
A05_5
Record time when you start the interview
A06
THIRD VISIT
A06_1
Interviewer name
A06_2
Interviewed code
A06_3
Date of the interview
A06_4
Result of the interview
Interview complete
Visit rescheduled
Interview incomplete
Refused
Respondent is out of station for extended period
Respondent is temporarily away
Other (specify)
A06_5
Record time when you start the interview
VO Information
B01
What is the name of this VO?
B02
What is the date of formation of this VO?
B03
How many SHGs are member of this VO?
B04
What is the membership fee paid by member SHGs?
B05
What is the yearly membership renewal fee paid by member SHGs?
B06
In the last 12 months, have the accounts of this VO been reviewed by the CLF?
Yes
No
Not applicable
B07
Have the accounts of this VO been reviewed during the CORONA lockdown?
Yes
No
Not applicable
Leadership
C01
Name of the office bearer
C02
Age of this office bearer
C03
Religion of this office bearer
Hinduism
Islam
Christianity
Jainism
Sikhism
Buddhism
Other
C04
Social category of this office bearer
SC
ST
OBC
General
Others
C05
Position currently held by this office bearer
President
Vice president
Secretary
Treasurer
C06
How many times has the position rotated since the formation of VO?
C07
In which year did the last rotation in position take place?
C08
Is the current position a paid position
Yes
No
C09
Education level of this office bearer
Primary
Middle
Secondary
Senior secondary
Certificate/ Diploma course
Graduate
Postgraduate
Others, specify
Never attended school
C10
Type of ration card the office bearer have?
PHH
AYY
Do not have ration card
C11
Is the office bearer disabled
Yes
No
C12
What are the trainings received by the office bearer?
VO concept and Management
leadership training
Training on VO Books of Accounts
Financial Management of VO
Cadre Selection and Management
Convergence
livelihood training
No training received
Others (specify)
Governing Body/ Executive Committee (EC)
D01
When was the present Executive Committee (EC) of the VO constituted ?
D02
What is the norm for conducting EC meeting of this VO?
Fortnightly
Monthly
Quarterly
D03
How many EC meetings were held in the last 12 months?
D03A
EC meetings held before CORONA (COVID-19) lockdown
D03B
EC meetings held during CORONA (COVID-19) lockdown
D03C
EC meetings held after CORONA (COVID-19) lockdown
D04
Can you please tell me if the last four meetings were conducted?
D04_1
Meeting 1
Yes
No
D04_2
Meeting 2
Yes
No
D04_3
Meeting 3
Yes
No
D04_4
Meeting 4
Yes
No
D05
Why were the meetings not held?
Office bearers were not available
There was a function (marriage, festival etc.) in the village
Meetings were suspended due to CORONA (COVID-19)
Others (specify)
D06
How many EC members were absent in each of the last four consecutive meetings
D06_1
Meeting 1
D06_2
Meeting 2
D06_3
Meeting 3
D06_4
Meeting 4
D07
What was the penalty levied if any of the EC member did not attend the EC meeting
D07A
Was penalty levied even during the lockdown period?
Yes
No
D08
What topics were discussed in the last 4 meetings of the EC
D08_1
Meeting 1
Issues related to savings & loans
Maintenance of records
disbursement of CIF
Schedule and loan repayment terms
issues related to VHSND
quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
Others (Specify)
D08_2
Meeting 2
Issues related to savings & loans
Maintenance of records
disbursement of CIF
Schedule and loan repayment terms
issues related to VHSND
quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
Others (Specify)
D08_3
Meeting 3
Issues related to savings & loans
Maintenance of records
disbursement of CIF
Schedule and loan repayment terms
issues related to VHSND
quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
Others (Specify)
D08_4
Meeting 4
Issues related to savings & loans
Maintenance of records
disbursement of CIF
Schedule and loan repayment terms
issues related to VHSND
quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
Others (Specify)
D09
Has the VO formed different sub-committees for managing various roles and responsibilities of the VO?
Yes
No
D10
COMMITTEE TYPE
Social Action Committee
Livelihoods committee
Education committee
Monitoring committee
Others(specify)
D11
When was this committee formed?
D12
How many members are there in the committee currently?
D13
How many times did this committee meet in the last 12 months?
D14
Key roles and responsibilities of the committee
D15
What are the trainings received by this committee to perform its duties?
Need for formation of sub-committees and review process
Training on health and nutrition practices
training on livelihood and procurement
training on monitoring and reviewing SHG work
Others (specify)
D16
How would you rate the effectiveness of this committee?
very effective
effective
not effective
no response
D17
Were the following issues discussed during the last four EC meetings ?
D17_1
Health and nutrition related issues – importance of balance diet, child and maternal health, health services in the village
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_2
Sanitation related issues- importance of cleanliness, sanitation practices, availability of clean drinking water, construction of toilets etc
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_3
Education in the village- school enrolment, availability of the teaching staff etc.
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_4
Involvement in Panchayati Raj Institutions – Participation in Gram Sabha (General)
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_5
Active Participation in Government Schemes- by facilitating members to access Govt. Welfare/ Development Schemes/Programs (e.g. MGNREGS, PDS, etc.
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_6
Discussion on Household Livelihoods
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_7
Self-employment schemes
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_8
Discussion around ways to prevent CORONA (COVID-19) infection, social distancing, handwashing, use of mask etc.
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D17_9
Others (Specify)
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
D18
Health and nutrition related issues discussed in the last four EC meetings
D18A
Issue discussed
D18A_1
Meeting 1
D18A_2
Meeting 2
D18A_3
Meeting 3
D18A_4
Meeting 4
D18B
Amount of time spend on discussion
D18B_1
Meeting 1
D18B_2
Meeting 2
D18B_3
Meeting 3
D18B_4
Meeting 4
D19
Do you think it is the responsibility of the VO to create awareness on Health and Nutrition issues?
Yes
No
don't know
D20
If no, why?
Creating awareness on Health and Nutrition is the responsibility of health department
It would interfere with the core business of VO (lending, monitoring and reviewing activities of member SHGs etc.)
Others (specify)
D20A
What is the annual target set by your social action committee?
D20B
Does this committee review the monthly progress of the annual target ?
Yes
No
Review on need basis
D21
What are the roles and responsibilities of your committe in facilitating access to public health in your village?
Review of Health and Nutrition related issues of SHGs
Review of work done by ICRP-FNHW
Enagaging with ASHA/ANM/AWW for facilitating access to public health
Making efforts to increase the community participation in VHSND
Monitoring and providing feedback on service delivery at VHSND
Occassional visits to PHC to monitor the quality of health services provided
Not applicable
Others (specify)
D22
Do ASHA/ANM/AWW attend the EC meetings?
Yes
ASHA/ANM/AWW is EC member
No
D23
On which occasions do ASHA/ANM/AWW attend EC meetings?
Every EC meeting
Whenever needed
When EC meeting has health and nutrition agenda
Others (Specify)
D24
What do the ASHA/ANM/AWW discuss during meetings?
Issues related to VHSND
Government welfare programs on health and nutrition and entitlements
Discussing initiatives of social action committee on health and nutrition
Others (specify)
D25A
Did ASHA/ANM/AWW reachout to VO during CORONA lockdown?
Yes
No
D25B
Has your committee facilitated its plan and annual target at SHG level ?
Yes
No
Not applicable
D26
Does social action committe tracks discussion on Health and Nutrition in the SHG meetings?
Yes
No
D27
How does the social action committee tracks discussion on Health and Nutrition in the SHG meetings?
by taking monthly reporting of SHG and reviewing ‘SHG Masik Prativedan’ (Masik prativedan reports health activities like training planned and conducted, data on pregnant women, data on new borns etc.)
social action committee participates in such SHG meetings where discussion on health and nutrition happens
social action committee regularly takes update from ICRP-FNHW and provides feedback
Others (specify)
D28
Is there any provision for individual counselling of the vulnerable SHG households (households where there is a case of complicated pregnancy or lactating mother and child are vulnerable) by Samuh Sakhi or any other cadre (that VO has assigned for overseeing the Health and Nutrition activities in SHG)?
Yes
No
D28A
What is the provision?
D28B
How did the lockdown affect this provision?
As cadre was engaged in providing support on CORONA crisis no individual counselling happened during lockdown
Individual couselling happened as usual
Others (specify)
D29
Has your VO received any information/directives on CORONA (COVID-19)
Yes
No
D30
Who has provided the information/directives ?
UPSRLM officials
ASHA/ANM
AWW
Gram Pradhan/sarpanch
Other(specify)
D31
What are the directives/infromation your VO has received?
Suspend all the VO and SHG meetings until the next notice
Information on symptoms of CORONA (COVID-19)
Information on preventive measures for CORONA (COVID-19)
Instructions on how to carry out the VO financial activities during the lockdown
Others (specify)
D32
What are the initiatives that your VO took to fight against CORONA (COVID-19) in your village?
Provide information on symptoms and prevention from CORONA (COVID-19) to the SHG members through mobile messaging
VO members helped ASHA/ ANM/ AWW in distribution of face masks and sanitizers
Others (specify)
No initiative taken
D33
What are the preventive measures VO members are adopting while helping with the CORONA situation at community level?
Wash hands frequently
Wash hands frequently with soap
Clean hands with sanitizer
Cover nose and mouth with handkerchief/ tissue/elbow while coughing or sneezing
Don't touch eyes, nose, or mouth
Don't be in close physical contact with anyone
Avoid crowded places
Be at least 1 meter away from everyone
Don't spit in public
Wear a mask if sick
Avoid physical contact with infected individuals
Avoid touching common surfaces, items or sharing plates/utensils
Avoid touching what sick persons have touched such as surfaces, items, plates/utensils
Keep cleaning common surfaces
Don't shake hands with others
Others (specify)
Don't Know
Review and Monitoring
E01
Does VO have its own plan and annual target ?
Yes
No
E02
What is the annual target of this VO?
E03
How often does the VO review its plan and target achievement?
Monthly
Once in two months
No predetermined frequency
Never reviewed
Not Applicable
Others (specify)
E04
How often does the VO review the activities of the member SHGs?
Weekly
Fortnightly
Monthly
Once in two months
No predetermined frequency
Never reviewed
Others (specify)
E05
What SHG activities are reviewed by the VO?
Books of records
Micro credit plan
Utilization of the CIF
Implementation of Health and Nutrition module in SHG
Action taken on the key issues emerged during Health and Nutrition meetings
Others (specify)
E06
What kind of support does this VO provide to the member SHGs?
Providing handholding support in maintenance of records
Providing support for rolling out Health and Nutrition module in the SHG
Providing information on flagship government schemes
Helping in establishing group-level livelihood activity
Facilitating market linkages
Others (specify)
Maintenance of Records
F01
Whether the record is introduced in the VO?
F01_1
Membership Register
Yes
No
F01_2
Meetings Register
Yes
No
F01_3
Minutes Book
Yes
No
F01_4
Savings Register
Yes
No
F01_5
General Ledger
Yes
No
F01_6
Daily Expenses Register
Yes
No
F01_7
Cash Book
Yes
No
F01_8
Loan Register
Yes
No
F01_9
Receipt Book
Yes
No
F01_10
Voucher Book
Yes
No
F01_11
Stock register
Yes
No
F01_12
Financial statements
Yes
No
F01_13
VO Passbook
Yes
No
F01_14
Cheque Issue Register
Yes
No
F01_15
VO DCB Register
Yes
No
F01_16
Others (specify)
Yes
No
F02
Please record date last updated
F02_1
Membership Register
F02_2
Meetings Register
F02_3
Minutes Book
F02_4
Savings Register
F02_5
General Ledger
F02_6
Daily Expenses Register
F02_7
Cash Book
F02_8
Loan Register
F02_9
Receipt Book
F02_10
Voucher Book
F02_11
Stock register
F02_12
Financial statements
F02_13
VO Passbook
F02_14
Cheque Issue Register
F02_15
VO DCB Register
F02_16
Others (specify)
Financial Management
G01
Did this VO receive Community Investment Fund (CIF)?
Yes
No
Not Applicable (if fund was directly disbursed to SHG)
G02
When did this VO receive CIF ?
G03
Total amount of CIF received by this VO till now
G04
Total amount of CIF disbursed to the member SHGs
G05
Total amount of CIF repaid by member SHGs to the VO till date
G05A
Amount of CIF repaid by SHGs during CORONA lockdown
G05B
Amount of CIF repaid by SHGs after CORONA lockdown
G06
What action was taken by the VO against loan defaulter SHGs ?
Financial penalty
Taking over SHG savings
Refusal of provision of new loans until the old one is repaid
Others (Specify)
G07
Did this VO receive any bank loan?
Yes
No
G08
When was the first time this VO received a bank loan?
G09
How many times has this VO received a bank loan ?
G10
Total amount of bank loan received by the VO till date
G11
Total amount of bank loan repaid by the VO till
G11A
Amount of bank loan repaid by the VO during CORONA lockdown
G11B
Amount of bank loan repaid by the VO after CORONA lockdown
G12
What is the expenditure incurred by the VO under the following heads
G12A
Payment of staff (cadre)
G12A_1
Payment terms
Per month
Per meeting
Others (specify)
G12A_2
Total Amount paid by VO in the last FY
G12A1
What was the payment status for cadre during lockdown?
Cadre were paid as per agreed terms
No payment made during the lockdown period
Others (specify)
G12B
Training expenses
G12C
Purchase of fixed assets (ag. Purchase/ Construction of VO office, furnitures, almirah etc.)
G12D
Miscellaneous expenses (eg. Printing of brochures, purchase of stationary etc.)
G12E
Other expenses (specify)
G13
What is the amount received by the VO under the following heads:
G13_1
Membership fees (subscription fee) deposited by SHGs
G13_2
Interest received on loans
G13_3
Earnings from other sources (specify)
G14
Total profit/surplus accumulated by the VO
G15
Opening balance
G16
Closing balance
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