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Community Institution -Form Fill
Identification Information
Q01
District Name
Q02
District Code
Q03
Block Name
Q04
Block Code
Q05
Cluster Level Federation Name
Q06
Cluster Level Federation Unique ID
Survey Information
A01
Name of the respondents
A02
Designation of the respondent
President
Vice-President
Secretary
Treasurer
Bookkeeper
If 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
A04_6
Record time when you end 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
A05_6
Record time when you end 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
A06_6
Record time when you end the interview
CLF Formation, Training, and Capacity Building
B01
What is the name of this CLF?
B02
What is the date of formation of this CLF?
B03
How many VOs are a member of this CLF?
B04
How many VOs had joined CLF after its formation?
B05
How many Vos had left the CLF after the formation?
B06
Is this CLF registered?
Yes
No
B07
What is the date of registration of this CLF?
B08
In the last year, has the accounts of this CLF been audited by an external agency (Chartered Accountant)?
Yes
No
B09
How many auditors were appointed last year?
B10
If Auditors had raised audit objection last year?
Yes
No
B11
How many audit objections were raised last year?
B12
How many audit compliances have been submitted by CLF?
B13
Has the office of CLF been established?
Yes
No
B14
Date of establishment of the office
B15
Is the office of CLF functional?
Yes
No
B16
Is Master Bookkeeper appointed for this CLF?
Yes
No
B17
What is the date of appointment of Master Bookkeeper?
B18
Does the master bookkeeper receive training?
Yes
No
B19
Is Cluster Facilitator appointed for this CLF?
Yes
No
B20
What is the date of appointment of the Cluster Facilitator?
B21
Does Cluster Facilitator receive training?
Yes
No
B22
What is the status of training?
B22_1
Exposure Visit of functional CLF
Yes
No
B22_2
CLF Concept and Functioning
Yes
No
B22_3
CLF Books Keeping
Yes
No
B22_4
Refresher
Yes
No
B22_5
Roles of CLF Sub-Committee
Yes
No
B22_6
Procurement Sub-Committee
Yes
No
B22_7
Fund management
Yes
No
B22_8
MCP/MIP Preparation/Facilitation and Appraisal
Yes
No
B22_9
Leadership/Group management
Yes
No
B22_10
Grading of VO
Yes
No
B22_11
Livelihood and Income Generation
Yes
No
B22_12
Cadre Review
Yes
No
B22_13
Convergence
Yes
No
B23
Number of times training has been conducted
B23_1
Exposure Visit of functional CLF
B23_2
CLF Concept and Functioning
B23_3
CLF Books Keeping
B23_4
Refresher
B23_5
Roles of CLF Sub-Committee
B23_6
Procurement Sub-Committee
B23_7
Fund management
B23_8
MCP/MIP Preparation/Facilitation and Appraisal
B23_9
Leadership/Group management
B23_10
Grading of VO
B23_11
Livelihood and Income Generation
B23_12
Cadre Review
B23_13
Convergence
B24
Last Training Date
B24_1
Exposure Visit of functional CLF
B24_2
CLF Concept and Functioning
B24_3
CLF Books Keeping
B24_4
Refresher
B24_5
Roles of CLF Sub-Committee
B24_6
Procurement Sub-Committee
B24_7
Fund management
B24_8
MCP/MIP Preparation/Facilitation and Appraisal
B24_9
Leadership/Group management
B24_10
Grading of VO
B24_11
Livelihood and Income Generation
B24_12
Cadre Review
B24_13
Convergence
B25
Duration (In Days)
B25_1
Exposure Visit of functional CLF
B25_2
CLF Concept and Functioning
B25_3
CLF Books Keeping
B25_4
Refresher
B25_5
Roles of CLF Sub-Committee
B25_6
Procurement Sub-Committee
B25_7
Fund management
B25_8
MCP/MIP Preparation/Facilitation and Appraisal
B25_9
Leadership/Group management
B25_10
Grading of VO
B25_11
Livelihood and Income Generation
B25_12
Cadre Review
B25_13
Convergence
B26
Who facilitated the training?
B26_1
Exposure Visit of functional CLF
BRLPS team
External Trainer
Others
B26_2
CLF Concept and Functioning
BRLPS team
External Trainer
Others
B26_3
CLF Books Keeping
BRLPS team
External Trainer
Others
B26_4
Refresher
BRLPS team
External Trainer
Others
B26_5
Roles of CLF Sub-Committee
BRLPS team
External Trainer
Others
B26_6
Procurement Sub-Committee
BRLPS team
External Trainer
Others
B26_7
Fund management
BRLPS team
External Trainer
Others
B26_8
MCP/MIP Preparation/Facilitation and Appraisal
BRLPS team
External Trainer
Others
B26_9
Leadership/Group management
BRLPS team
External Trainer
Others
B26_10
Grading of VO
BRLPS team
External Trainer
Others
B26_11
Livelihood and Income Generation
BRLPS team
External Trainer
Others
B26_12
Cadre Review
BRLPS team
External Trainer
Others
B26_13
Convergence
BRLPS team
External Trainer
Others
B27
Where was training conducted?
B27_1
Exposure Visit of functional CLF
At CLF office
At Cluster office
At Block office
Any Other
B27_2
CLF Concept and Functioning
At CLF office
At Cluster office
At Block office
Any Other
B27_3
CLF Books Keeping
At CLF office
At Cluster office
At Block office
Any Other
B27_4
Refresher
At CLF office
At Cluster office
At Block office
Any Other
B27_5
Roles of CLF Sub-Committee
At CLF office
At Cluster office
At Block office
Any Other
B27_6
Procurement Sub-Committee
At CLF office
At Cluster office
At Block office
Any Other
B27_7
Fund management
At CLF office
At Cluster office
At Block office
Any Other
B27_8
MCP/MIP Preparation/Facilitation and Appraisal
At CLF office
At Cluster office
At Block office
Any Other
B27_9
Leadership/Group management
At CLF office
At Cluster office
At Block office
Any Other
B27_10
Grading of VO
At CLF office
At Cluster office
At Block office
Any Other
B27_11
Livelihood and Income Generation
At CLF office
At Cluster office
At Block office
Any Other
B27_12
Cadre Review
At CLF office
At Cluster office
At Block office
Any Other
B27_13
Convergence
At CLF office
At Cluster office
At Block office
Any Other
B28
Was training material provided?
B28_1
Exposure Visit of functional CLF
Yes
No
B28_2
CLF Concept and Functioning
Yes
No
B28_3
CLF Books Keeping
Yes
No
B28_4
Refresher
Yes
No
B28_5
Roles of CLF Sub-Committee
Yes
No
B28_6
Procurement Sub-Committee
Yes
No
B28_7
Fund management
Yes
No
B28_8
MCP/MIP Preparation/Facilitation and Appraisal
Yes
No
B28_9
Leadership/Group management
Yes
No
B28_10
Grading of VO
Yes
No
B28_11
Livelihood and Income Generation
Yes
No
B28_12
Cadre Review
Yes
No
B28_13
Convergence
Yes
No
B29
To whom was the training imparted?
To Office-bearers
BOD members
To all members
To few members and group leaders
Bookkeeper
Representative General Body members
Cluster Facilitator
Any other, please specify
B30
Was the training useful and content relevant?
Very much
Somewhat
Not much
B31
Do you recall the training content?
Able to recall well
Able to recall partly
Not able to recall
B32
Is the training session noted in the book of records?
Yes
No
Operational Guidelines of CLF
C01
Does this CLF have operational guidelines?
Yes
No
C02
Do these operational guidelines clearly define the roles and responsibilities of the office bearer of your CLF and their subcommittees?
Yes
No
C03
Are these guidelines available in the public domain?
Displayed in the CLF office
Printed on CLF records
Not displayed anywhere
If others (specify____)
C04
Does the CLF review its operational guidelines?
Yes
No
C05
When was the last time your CLF had reviewed its operational guidelines?
C06
Does your CLF prepare an annual action plan?
Yes
No
C07
Who prepares the annual action plan of CLF?
BOD
Master bookkeeper
Office Bearers of CLF
Any member of CLF
Area Coordinator
Cluster Facilitator
If others, Please specify(____)
Leadership
D01
Name of the office bearer
D02
Age of this Office bearer
D03
Religion of this office-bearer
Hinduism
Islam
Christianity
Jainism
Sikh
Buddhism
If other (Specify___)
D04
Social category of this office bearer
SC
ST
OBC
General
If other (Specify___)
D05
Position currently held by this office bearer
President
Vice President
Secretary
Treasurer
D06
How many times has the position rotated since the formation of CLF?
D07
In which year did the last rotation in position take place?
D08
Is the current position a paid position?
Yes
No
D09
Education level of this office-bearer
Primary
Middle
Secondary
Senior secondary
Certificate/Diploma course
Graduate
Postgraduate
If others(specify)
Never attended school
D10
What type of ration card does the member’s household have?
APL (Blue card)
BPL (Red Card)
Annapurna
Antyodaya Anna Yojana (AAY)
Single Card
Coupon
Do not have any ration card
Do not know
If Other, please specify
D11
Is the office bearer disabled?
Yes
No
D12
What are the trainings received by the office-bearer?
CLF concept and Management
leadership training
CLF visioning
Business plan development
Training on CLF Books of Accounts
Financial Management of CLF
Development of Annual Action Plan
Cadre Selection and Management
Convergence
livelihood training
No training received
If others (specify______)
Governing Body/ Executive Committee (EC)
E01
When was the present Board of Directors (BOD)/ Executive Committee (EC) of the CLF constituted?
E02
How frequently do the BOD/ Executive Committee of this CLF meet?
Fortnightly
Monthly
Quarterly
If others (specify___)
E03
How many were BOD/ EC meetings held in the last 12 months?
E04
Can you please tell me if the last four meetings were conducted?
E04_1
Meeting 1
Yes
No
E04_2
Meeting 2
Yes
No
E04_3
Meeting 3
Yes
No
E04_4
Meeting 4
Yes
No
E05
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)
If others (specify___)
E06
How many were BOD/EC members present in each of the last four consecutive meetings?
E06_1
Meeting 1
E06_2
Meeting 2
E06_3
Meeting 3
E06_4
Meeting 4
E07
Was any penalty levied on any of the EC members who did not attend the EC meeting?
Yes
No
E08
What topics were discussed in the last 4 meetings of the EC
E08_1
Meeting 1
Issues related to savings & loan
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Grading of VO and SHG
Promotion/ Status of PG
Promotion/ Status of RRM
Promotion/ Status DKR
Issues related to VHSND
Issues related to Community Cadre
Quality of services provided by ASHA/AWW
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
If others (Specify___)
E08_2
Meeting 2
Issues related to savings & loan
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Grading of VO and SHG
Promotion/ Status of PG
Promotion/ Status of RRM
Promotion/ Status DKR
Issues related to VHSND
Issues related to Community Cadre
Quality of services provided by ASHA/AWW
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
If others (Specify___)
E08_3
Meeting 3
Issues related to savings & loan
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Grading of VO and SHG
Promotion/ Status of PG
Promotion/ Status of RRM
Promotion/ Status DKR
Issues related to VHSND
Issues related to Community Cadre
Quality of services provided by ASHA/AWW
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
If others (Specify___)
E08_4
Meeting 4
Issues related to savings & loan
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Grading of VO and SHG
Promotion/ Status of PG
Promotion/ Status of RRM
Promotion/ Status DKR
Issues related to VHSND
Issues related to Community Cadre
Quality of services provided by ASHA/AWW
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
If others (Specify___)
Sub-Committees
F01
Has the CLF formed different sub-committees for managing various roles and responsibilities of the CLF?
Yes
No
F02
When was this committee formed?
F02_1
Social Action Committee
F02_2
Social Audit and Property Evaluation Committee
F02_3
Monitoring & capacity building Committee
F02_4
Bank Linkage and Microinsurance Committee
F02_5
Community Procurement & Marketing Committee
F03
How many members are there on the committee currently?
F03_1
Social Action Committee
F03_2
Social Audit and Property Evaluation Committee
F03_3
Monitoring & capacity building Committee
F03_4
Bank Linkage and Microinsurance Committee
F03_5
Community Procurement & Marketing Committee
F04
How many times did this committee meet in the last 12 months?
F04_1
Social Action Committee
F04_2
Social Audit and Property Evaluation Committee
F04_3
Monitoring & capacity building Committee
F04_4
Bank Linkage and Microinsurance Committee
F04_5
Community Procurement & Marketing Committee
F05
Key roles and responsibilities
F05_1
Social Action Committee
F05_2
Social Audit and Property Evaluation Committee
F05_3
Monitoring & capacity building Committee
F05_4
Bank Linkage and Microinsurance Committee
F05_5
Community Procurement & Marketing Committee
F06
What are the trainings received by this committee to perform its duties?
F06_1
Social Action Committee
Need for the formation of sub-committees and review process
Training on health and nutrition practices
training on livelihood and procurement
training on monitoring and reviewing VO work
None
If others (specify___)
F06_2
Social Audit and Property Evaluation Committee
Need for the formation of sub-committees and review process
Training on health and nutrition practices
training on livelihood and procurement
training on monitoring and reviewing VO work
None
If others (specify___)
F06_3
Monitoring & capacity building Committee
Need for the formation of sub-committees and review process
Training on health and nutrition practices
training on livelihood and procurement
training on monitoring and reviewing VO work
None
If others (specify___)
F06_4
Bank Linkage and Microinsurance Committee
Need for the formation of sub-committees and review process
Training on health and nutrition practices
training on livelihood and procurement
training on monitoring and reviewing VO work
None
If others (specify___)
F06_5
Community Procurement & Marketing Committee
Need for the formation of sub-committees and review process
Training on health and nutrition practices
training on livelihood and procurement
training on monitoring and reviewing VO work
None
If others (specify___)
F07
How would you rate the effectiveness of this committee?
F07_1
Social Action Committee
very effective
effective
not effective
no response
F07_2
Social Audit and Property Evaluation Committee
very effective
effective
not effective
no response
F07_3
Monitoring & capacity building Committee
very effective
effective
not effective
no response
F07_4
Bank Linkage and Microinsurance Committee
very effective
effective
not effective
no response
F07_5
Community Procurement & Marketing Committee
very effective
effective
not effective
no response
F08
Does this CLF conduct review meetings for sub-committees?
Yes
No
F09
How frequently are review meetings conducted?
Monthly
Bimonthly
Quarterly
Bi- Annually
Annually
F10
How many review meetings were conducted in the past 12 months?
F11
Does any legal issues raised in the meeting?
Yes
No
F12
If yes, how many legal issues had been raised in the last three months?
F13
How many of these compliances had been resolved?
Review and Monitoring
G01
What is the target number of households to form SHG under this CLF?
G02
How many households have already formed SHG?
G03
How many SHGs have are under this CLF?
G04
Out of the total SHGs, How many of them are currently functional?
G05
How many SHGs have less than 10 members?
G06
How many SHGs do not have OB members selected?
G07
How many office bearers of SHGs have received training?
G08
How many records of SHG members updated in the MIS?
G09
How many SHGs update their records in the MIS?
G10
How many SHGs received Community Investment Money (CIM)?
G11
How many SHGs have a saving bank account opened?
G12
How many SHGs received Modular Trainings?
G13
Do all the SHGs have Community Mobiliser (CM) appointed under this CLF?
Yes
No
G14
Does the Community Mobiliser (CM) of all SHGs receive training?
Yes
No
G15
How many SHGs’ members Aadhar seeding have completed so far?
G16
How many SHGs maintain the book of records?
G17
How many SHGs have received the Revolving Fund (RF)?
G18
How many SHGs have received the Initial Capitalization Fund (ICF)?
G19
How many SHGs have their loan account?
G20
How many SHGs have received bank loans?
G21
Is there a possibility to form more VOs under this CLF?
Yes
No
G22
Does all VOs are mapped under this CLF?
Yes
No
G23
How many VOs update their records on MIS?
G24
How many VOs have their saving bank account opened?
G25
Does BOD for all the VOs has been selected?
Yes
No
G26
How many VOs are yet to select their BOD members?
G27
Does OB for all the VOs has been selected?
Yes
No
G28
How many VOs are yet to select their OB members?
G29
Does BOD/ OB of VOs under this CLF has received training?
Yes
No
G30
How many VOs have bookkeepers appointed under this CLF?
G31
How many of the Bookkeepers of VOs have received training?
G32
Do all VOs under this CLF have received Modular training?
Yes
No
G33
How many VOs under this CLF have sub-committees formed?
G34
Did the members of sub-committees of VOs received training?
Yes
No
G35
How many VOs under this CLF received HRF?
G36
How many VOs under this CLF received FSF?
G37
How many VOs update the records of the transactions performed in the MIS?
G38
How frequently are the VOs updating MIS?
Weekly
Fortnightly
Monthly
Once in two months
No predetermined frequency
G39
How many VOs maintain the book of records under this CLF?
G40
How many VOs books of records were audited in the last 6 months?
G41
How many VOs are yet to purchase items through Community Investment Money (CIM)?
G42
How often does the CLF review the activities of the member VOs?
Weekly
Fortnightly
Monthly
Once in two months
No predetermined frequency
Never reviewed
If others (Specify__)
G43
What VO activities are reviewed by the CLF?
Books of records /Quality of bookkeeping
Micro credit plan
Utilization of the CIF
Democratic financial transaction in VO
Financial transaction between VO and CLF
Social Issues
VO Bank-Linkage
Promotion of livelihood activities by VO
If others (Specify__)
G44
What kind of support does this CLF provide to the member VOs?
Providing handholding support in maintenance of records
Providing support in maintaining financial discipline
Providing support in identification of livelihood activities
Providing information on flagship government schemes
Facilitating market linkages
If others (Specify__)
G45
How many trainings were provided in the last month?
G46
How many member VOs attended training?
G47
Does this CLF prepare a Mashik Prativedan?
Yes
No
G48
Who prepares the Mashik Prativedan for this CLF?
Master Bookkeeper
Office Bearers of CLF
Area Coordinator
CLF Facilitator
CLF Manager
Do Not Know
If others, Please Specify()
G49
What major points are covered in the Mashik Prativedan?
Progress of CLF level financial and Non-Financial transaction
CLF level report of VOs prepared and used for review of the groups
Progress of convergence and other activities at the CLF level
Progress of Farm / Non-Farm livelihood activities
If others, Please Specify (_____)
G50
Is the Mashik Prativedan submitted to BPIU?
Yes
No
G51
Please provide us the detail of the last 4 Mashik Prativedan submitted to BPIU
G51_1
Mashik Prativedan 1
G51_2
Mashik Prativedan 2
G51_3
Mashik Prativedan 3
G51_4
Mashik Prativedan 4
G52
Does this CLF prepare annual budgets?
Yes
No
G53
When was the last time when this budget was prepared by CLF?
G54
Who is responsible for preparing annual budgets for this CLF?
Master Bookkeeper
Office Bearers of CLF
Area Coordinator
CLF Facilitator
CLF Manager
BOD
Do Not Know
If others, Please Specify()
G55
Does this CLF conduct grading of VO?
Yes
No
G56
How many VOs have been graded till the last month by this CLF?
G57
Who conducts the grading process of VO?
Master Bookkeeper
CLF Facilitator
Office bearer of CLF
External agency
BRLPS staff
Do not know
If others, Please specify (____)
G58
Does this CLF conduct Annual General Meeting (AGM)?
Yes
No
G59
When was the last Annual General Meeting (AGM) conducted?
G60
How many members were present at the last AGM?
G61
What were the issues raised/ discussed in the AGM?
Issues related to savings & loan
maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Grading of VO and SHG
Promotion/ Status of PG/ PC
Promotion/ Status of RRM
Promotion/ Status DKR
Issues related to VHSND
Issues related to Community Cadre
Quality of services provided by ASHA/AWW
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA (COVID-19)
Future Plans of CLF
If others (Specify___)
G62
Meeting Regularity and Attendance in Last three Months/Meetings
G63
Date of Meeting
G64
Number of VOs as member
G65
Number of VOs present
G66
Presence of BRLPS Staff
Yes
No
G67
Presence of Master Bookkeeper
Yes
No
G68
Cadre
Yes
No
G69
Livelihood Specialist
Yes
No
Maintenance of Record
H01
Check if the following book of records is available or not?
H01_1
Membership Register
Yes
No
H01_2
Meetings Register
Yes
No
H01_3
Minutes Book
Yes
No
H01_4
Savings Register
Yes
No
H01_5
General Ledger
Yes
No
H01_6
Daily Expenses Register
Yes
No
H01_7
Cash Book
Yes
No
H01_8
Loan Register
Yes
No
H01_9
Receipt Book
Yes
No
H01_10
Voucher Book
Yes
No
H01_11
Stock register
Yes
No
H01_12
Financial statements
Yes
No
H01_13
CLF Passbook
Yes
No
H01_14
Cheque Issue Register
Yes
No
H02
Check if the book of records is updated or not?
H02_1
Membership Register
Updated till last meeting
Partly updated
Incomplete
H02_2
Meetings Register
Updated till last meeting
Partly updated
Incomplete
H02_3
Minutes Book
Updated till last meeting
Partly updated
Incomplete
H02_4
Savings Register
Updated till last meeting
Partly updated
Incomplete
H02_5
General Ledger
Updated till last meeting
Partly updated
Incomplete
H02_6
Daily Expenses Register
Updated till last meeting
Partly updated
Incomplete
H02_7
Cash Book
Updated till last meeting
Partly updated
Incomplete
H02_8
Loan Register
Updated till last meeting
Partly updated
Incomplete
H02_9
Receipt Book
Updated till last meeting
Partly updated
Incomplete
H02_10
Voucher Book
Updated till last meeting
Partly updated
Incomplete
H02_11
Stock register
Updated till last meeting
Partly updated
Incomplete
H02_12
Financial statements
Updated till last meeting
Partly updated
Incomplete
H02_13
CLF Passbook
Updated till last meeting
Partly updated
Incomplete
H02_14
Cheque Issue Register
Updated till last meeting
Partly updated
Incomplete
H03
Please record the date last updated
H03_1
Membership Register
H03_2
Meetings Register
H03_3
Minutes Book
H03_4
Savings Register
H03_5
General Ledger
H03_6
Daily Expenses Register
H03_7
Cash Book
H03_8
Loan Register
H03_9
Receipt Book
H03_10
Voucher Book
H03_11
Stock register
H03_12
Financial statements
H03_13
CLF Passbook
H03_14
Cheque Issue Register
H04
Please specify the reason for not updating the book of records
H04_1
Membership Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_2
Meetings Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_3
Minutes Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_4
Savings Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_5
General Ledger
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_6
Daily Expenses Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_7
Cash Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_8
Loan Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_9
Receipt Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_10
Voucher Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_11
Stock register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_12
Financial statements
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_13
CLF Passbook
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
H04_14
Cheque Issue Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to CLF
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
Financial Management
I01
Opening of CLF Bank Account
I01_1
Is the bank account of CLF opened?
Yes
No
I01_2
When was the bank account opened for this CLF?
I01_3
Whether the signature of the CLF President, Secretary, and Treasurer are taken for opening the bank account?
Yes
No
I01_4
Type of CLF bank account
Savings
Current
I01_5
How many bank accounts are opened and linked with your CLF?
I02
Authorization for operating the CLF Bank Account
I02_1
Do all three signatories, viz. the CLF President, Secretary, and Treasurer, mandatorily authorize all bank transactions?
Yes
No
I02_2
Are all deposit and withdrawal slips, NEFT, RTGS receipts, etc., mandatorily signed by all three signatories?
Yes
No
I03
Custody of cheques and their transactions
I03_1
Are all cheques kept in a safe lock (with two keys) in the CLF office only?
Yes
No
I03_2
Is one key for the safe lock kept with the CLF secretary and the other with the CLF treasurer/ manager?
Yes
No
I03_3
Are any cheques kept in the personal custody of the CLF president, secretary, treasurer, master bookkeeper, manager, or member?
Yes
No
I03_4
If “Yes” in I03_3, was a criminal case filed against the person?
Yes
No
I03_5
Are all cheque transactions recorded in the appropriate book of records that are maintained in the CLF office?
Yes
No
I03_6
Do CLF President, Secretary, and Treasurer sign the advance or blank cheques?
Yes
No
I04
Office expense
I04_1
Are all office expenses carried out according to rules and regulations set by the Mission guidelines?
Yes
No
I05
Guidelines for funds received from various sources
I05_1
From how many sources have your CLF received funds since the formation, Start-up-Cost, etc.?
I05_2
Does this CLF receive any fund in the name of NRETP?
Yes
No
I05_3
Whether this fund is managed and utilized according to the set guidelines of BRLPS (JEEViKA)?
Yes
No
I05_4
Are discrepancies in Management and utilization of this fund resolved through filing a criminal case against those involved?
Yes
No
I05_5
What are the lending norms set by CLFs for onward lending VO/ SHG/ PG/ PC?
I05_6
Is there a timely flow of funds among CBOs, i.e., from higher federations (CLFs) to lower (VOs/ SHGs/ PG/ PE)?
Yes
No
I05_7
How many days does it take to transfer the required fund since the day request has been received from VO/ SHG/ PG/PC?
I05_8
Is there any cash transaction that happens between CLF -VO- SHG?
Yes
No
I05_9
If yes, then what are the ways to reduce the cash transaction amongst CLF-VO-SHG-Member and vice-versa?
I05_10
Is the promotion of digital transactions a good alternative to cash transactions?
Yes
No
I06
Settlement of bills
I06_1
Are all bills scrutinized thoroughly for CLF name, date of transaction, item name, quantity, rate, total amount, signature, and authorization of the vendor who raised the bill?
Yes
No
I06_2
Does the authorized person of CLF deny settlement of cash memo, proforma bills, etc.?
Yes
No
I06_3
Does your CLF raise vouchers for the bills that are to be settled?
Yes
No
I06_4
Are the vouchers placed for approval from authorized persons of the CLF?
Yes
No
I06_5
Are the bills settled only on the final approval of vouchers from CLF authorized persons?
Yes
No
I07
Method for settlement of bills
I07_1
Are all bills settled through either RTGS or NEFT or Crossed Cheques only?
Yes
No
I07_2
While transacting through the crossed check, is it ensured that the authorized persons of CLF check the name of the party, details of the amount entered in both figures and words, apply transparent cello tape on the entered amount, cross the cheque, or use ‘accounts payee only’ stamp to mark, all authorized signatories have signed the cheque in CLF office only, noted the details of cheques in chequebook and book of records and then issued the cheque?
Yes
No
I07_3
After clearance of the cheque in the bank, is it ensured that the vendor sign on the receipt register?
Yes
No
I07_4
In case of the transaction through RTGS/ NEFT, is it ensured that the authorized persons of CLF note all the details in the RTGS/ NEFT registers available in the CLF office?
Yes
No
I08
Maintaining the Books of Records in CLF office
I08_1
Are all transactions which are entered in books of records/ registers signed by the President, Secretary, and Treasurer?
Yes
No
I08_2
In every CLF meeting, are the members of CLF allowed to access and scrutinize the books of records?
Yes
No
I09
Bank reconciliation
I09_1
Does CLF Master Bookkeeper carry out the task of Bank Reconciliation every month?
Yes
No
I09_2
Is the Bank Reconciliation file prepared and presented to CLF President, Secretary, and treasurer every month?
Yes
No
I09_3
Is the file signed by CLF Master Bookkeeper, Manager, CLF President, Secretary, and treasurer?
Yes
No
I09_4
Is the bank statement for every month attached to Month Wise Bank Statement File?
Yes
No
I09_5
Are the deposits and withdrawals noted in the bank statements scrutinized regularly on a weekly or monthly basis?
Yes
No
I10
Guidelines for issuing an advance amount
I10_1
How much amount the CLF Master Bookkeeper/ Manager is eligible to receive for office expense?
I10_2
Under which head of office expense is this amount utilized?
Expense on meetings
Expense on housekeeping
Expense on stationary
If others, please specify
I10_3
To receive the new advance, what proportion of the existing advance amount must be utilized?
I10_4
Before issuing the advance amount, are all approvals according to the set guidelines of CLF taken?
Yes
No
I10_5
Is there any instance when both the CLF Master Bookkeeper and manager have received the advance amount at the same time?
Yes
No
I10_6
Is the advance amount utilized within a month?
Yes
No
I10_7
If “No” in I10_5, is the interest amount at the pre-defined rate levied on the person who holds the amount?
Yes
No
I10_8
Is there any instance when the CLF President, Secretary, and Treasurer have received the advance amount?
Yes
No
I11
Cash Transaction
I11_1
Are cash transactions allowed under your CLF?
Yes
No
I11_2
Are you aware that the occurrence of cash transactions, if any, will be considered as serious financial lapses, and necessary actions will follow?
Yes
No
I12
Statutory Audit
I12_1
Are statutory audits for CLF done?
Yes
No
I12_2
If “Yes” in I12_1, are audit reports available?
Yes
No
I12_3
Are there any objections reported in the audit reports?
Yes
No
I12_4
If yes, are the objections raised were of low, moderate, or high risks?
Low risk
Moderate risk
High risk
I12_5
Is the annual audit report prepared?
Yes
No
I12_6
When was the last audit report was prepared
I12_7
Is this audit report being available to all CLF members?
Yes
No
I13
Community Investment Fund
I13_1
Does this CLF receive Community Investment Fund?
Yes
No
I13_2
After how many months of formation does the CLF receive the CIF?
I13_3
What is the date of receiving CIF?
I13_4
How much amount has been received under CIF?
I14
What is expenditure incurred by the CLF under the following heads:
I14_1
Payment of staff (cadre)
I14_2
Training expenses
I14_3
Purchase of fixed assets (ag. Purchase/ Construction of CLF office, furniture, almirah, etc.)
I14_4
Miscellaneous expenses (e.g., Printing of brochures, purchase of stationery, etc.)
I15
What is the amount received by the CLF under the following heads:
I15_1
Membership fees (subscription fee) deposited by VOs
I15_2
Interest received on loans
I15_3
Earnings from other sources
I16
Total profit/surplus accumulated by the CLF
I17
Opening balance
I18
Closing balance
I19
Is monthly financial statement is prepared by the CLF
Yes
No
I20
If Yes, when was the last financial statement was prepared?
Cadre Management
J01
Community cadre engaged with the CLF
CM
ICRP-FNHW
Master Bookkeeper
Bank Sakhi
Pashu Sakhi
Krishi Sakhi
Business Correspondent
Area Coordinator
If other (Specify___)
J02
Name of this community cadre?
J03
Gender of this community cadre?
Male
Female
J04
Age in years completed
J05
The social category of this community cadre?
General
SC
ST
OBC
If other (Specify___)
J06
The religion of the community cadre?
Hinduism
Islam
Christianity
Jainism
Sikhism
Buddhism
If other (Specify___)
J07
Education level Of this community cadre?
Primary
Middle
Secondary
Senior secondary
Certificate/ Diploma course
Graduate
Postgraduate
Never attended school
If other (Specify___)
J08
Since when the community cadre is working?
J09
What are the trainings received by the cadre?
CLF concept and Management
training on CLF Books of Record
training on Banking Procedures (including the opening of a bank account, deposit, withdrawal)
training on group formation
training on Health and Nutrition Modules
If other (Specify___)
Social Action and Convergence
K01
Did the cluster face any problem regarding ISSUE?
K01_1
Non-repayment of loans to CLF
Yes
No
K01_2
Conflict within SHG/VO members
Yes
No
K01_3
Identification and mobilization of left-out poor
Yes
No
K01_4
Issues related to bank linkage, bank loan, and CIF repayment
Yes
No
K01_5
Promotion of new SHGs/VO
Yes
No
K01_6
Training identification for Livelihood Promotion /Institution strengthening
Yes
No
K01_7
Poor service by health providers (AWW /ASHA/ ANM)
Yes
No
K01_8
Lack of services/ supplies at PHC/HSC/ Aganwadi
Yes
No
K01_9
Irregularity in VHSND
Yes
No
K01_10
Lack of services/supplies at VHSND
Yes
No
K01_11
Domestic Violence
Yes
No
K01_12
Alcoholism
Yes
No
K01_13
Dowry Issues
Yes
No
K01_14
Child labor
Yes
No
K01_15
Child marriage
Yes
No
K01_16
Discrimination against girl child
Yes
No
K01_17
Discrimination against disadvantaged
Yes
No
K01_18
MGNREGS cards
Yes
No
K01_19
Ration cards/ PDS shop
Yes
No
K01_20
Pensions
Yes
No
K01_21
Housing subsidy
Yes
No
K01_22
Swachh Bharat Mission
Yes
No
K01_23
Illegal liquor business/shop
Yes
No
K01_24
Janani Suraksha Yojana
Yes
No
K01_25
Pradhan Mantri Matru Vandana
Yes
No
K01_26
Nikshay Yojna
Yes
No
K02
Did this CLF take any action against ISSUE?
Yes
No
K03
Action/ Collective Action taken up
Counseled the Perpetrator
Initiated police action against the perpetrator
Arranged for temporary stay for the victim
Counseled family members
Arranged for Rehabilitation
Provided financial assistance for rehabilitation
Mobilizing women to take collective actions
If other (Specify___)
K04
Did this CLF collaborate with or seek help from other institutions for this activity?
Yes
No
K05
If yes, which institutions did this CLF collaborate or seek help from?
Gram Panchayat
Police
Banks
Block office of BRLPS
NGOs
Member VOs
If others (specify__)
K06
Result
Problem was completely resolved
Problem was partially resolved
Problem was not resolved
Role of CLF in Promoting Livelihoods
L01
Does your CLF promote livelihood activities?
Yes
No
L02
Which livelihood activities does your CLF promote among its members?
Farm based livelihood
Bee Keeping
Rural Retail Mart
Didi Ki Rasoi
Tailoring
Art & Craft
Milk production
Goatry
Poultry
If other (Specify___)
L03
How many members of households associated with your CLF are involved in these livelihood activities?
L04
What kind of support CLF provides to its member household?
Create awareness
Capacity building through trainings
Reviewing microcredit plan
Providing funds to start a business
Helping in terms of providing technical assistance
Continuous monitoring of their performance
Providing bank linkage through VOs
Provide with market linkage opportunity
If other (Specify___)
L05
How does CLF decide on which livelihood activity a member household will work?
Based on the requirement by BRLPS (JEEViKA)
Discussion in SHG meeting
Assessing the skill set of members
Based on funds and resource available
If other (Specify___)
L06
Do your CLF conducted trainings to build the capacity of member households for livelihood activities?
Yes
No
L07
How many household members received training till the last month?
L08
Does your CLF provide financial assistance for taking up livelihood activity?
Yes
No
L09
Does CLF provide VGF to member VO and SHGs to carry livelihood activities?
Yes
No
L10
What are the criteria for the distribution of VGF to member SHGs?
Based on the demand raised
Based on the Micro Plan submitted
Based on the discussion/ assessment done by the CLF members
No specific criteria
If others, please specify(____)
L11
Does this CLF engage CRPs in farm livelihood activities?
Yes
No
L12
Does this CLF provide an Honorarium to the CRPs for the service provided by them?
Yes
No
L13
Does CLF review the work done by the CRPs?
Yes
No
L14
How frequently are these review meetings conducted?
Monthly
Quarterly
Bi-annually
Annually
L15
What are the activities of CRPs reviewed in these meetings?
Meetings with the key person of the village
Conduct meeting with SHGs
Forming groups of leftover groups
Providing farm trainings to SHGs
Enable SHGs for maintaining records
If others, please specify(______)
L16
How many households practice multiple livelihood options under this CLF?
L17
How many PG/ PC is created by CLF till the last month?
L18
How many PG/ PC is planned for this year as per the annual action plan?
L19
How much investment was made to generate livelihood opportunities?
L20
How much revenue was generated from these livelihood activities?
L21
Any Livelihood activity closed after Fund support had been stopped?
Yes
No
L22
If yes, Please specify the livelihood activity which was closed due to lack of financial support?
Farm based livelihood
Bee Keeping
RRM
DKR
Tailoring
Art & Craft
Milk production
Goatry
Poultry
If other (Specify___)
L23
What were all facilities accessible to member households in farm livelihoods?
Farm inputs
Machineries
Technology
If other (Specify___)
L24
Were unemployed youth identified through VO?
Yes
No
L25
If Yes, how many Youths were identified for training?
L26
How many training sessions under DDUGKY/ RSETI were conducted for unemployed youths in the last 6 months?
L27
How many youths were trained till last month?
L28
Was placement provided to these trained youths?
Yes
No
L29
If yes, how many youths were placed in the last 6 months?
Village Organization Identification Information
M01
District Name
M02
District Code
M03
Block Name
M04
Block Code
M05
Village Name
M06
Village Code
M07
VO Name
M08
VO Code
Village Organization Survey Information
N01
Name of the respondent
N02
Designation of the respondent
President
Vice-President
Secretary
Treasurer
Bookkeeper
If others (specify____)
N03
Respondent identification code
N04
FIRST VISIT
N04_1
Interviewer name
N04_2
Interviewed code
N04_3
Date of the interview
N04_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)
N04_5
Record time when you start the interview
N04_6
Record time when you end the interview
N05
SECOND VISIT
N05_1
Interviewer name
N05_2
Interviewed code
N05_3
Date of the interview
N05_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)
N05_5
Record time when you start the interview
N05_6
Record time when you end the interview
N06
THIRD VISIT
N06_1
Interviewer name
N06_2
Interviewed code
N06_3
Date of the interview
N06_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)
N06_5
Record time when you start the interview
N06_6
Record time when you end the interview
VO Information
O01
What is the name of this VO?
O02
What is the date of the formation of this VO?
O03
Is this VO registered under the BISCO act?
Yes
No
O04
How many SHGs are members of this VO?
O05
How many SHGs are at least six months old?
O06
How many numbers of households covered by VO?
O07
How many new SHGs are eligible to join the VO?
O08
What is the membership fee paid by member SHGs?
O09
What is the yearly membership renewal fee paid by member SHGs?
O10
How many SHGs not submitted membership/renewal fees?
O11
Does this VO map with CLF?
Yes
No
O12
Please provide the name of CLF under which VO function.
O13
Does CLF review the performance of VO?
Yes
No
O14
What is the frequency of reviewing VO by CLF?
Monthly
Quarterly
Bi-Annually
Annually
If other, Please specify()
O15
Please provide us the detail of the review conducted by CLF
O15_1
Review 1
O15_2
Review 2
O15_3
Review 3
O15_4
Review 4
O16
Does this VO update record on the MIS?
Yes
No
O17
How frequently are records on MIS being updated?
Weekly
Fortnightly
Monthly
Once in two months
Quarterly
No fixed time period
O18
Does the information of transactions done by the VO updated in the MIS?
Yes
No
O19
Is a Bookkeeper appointed for this VO?
Yes
No
O20
Please provide the date of appointment of the Bookkeeper
O21
Does Bookkeeper receive training?
Yes
No
O22
Did the VO purchase items through Community Investment Money (CIM)?
Yes
No
Governance
P01
Name of the office bearer
P02
Age of this office bearer
P03
The religion of this office bearer
Hinduism
Islam
Christianity
Jainism
Sikhism
Buddhism
Other
P04
The social category of this office bearer
SC
ST
OBC
General
Others
P05
Position currently held by this office bearer
President
Vice president
Secretary
Treasurer
P06
How many times has the position rotated since the formation of VO?
P07
In which year did the last rotation in a position take place?
P08
Is the current position a paid position?
Yes
No
P09
Education level of this office bearer
Primary
Middle
Secondary
Senior secondary
Certificate/ Diploma course
Graduate
Postgraduate
Others specify
Never attended school
P10
Type of ration card the office bearer has
APL (Blue card)
BPL (Red Card)
Annapurna
Antyodaya Anna Yojana (AAY)
Single Card
Coupon
Do not have any ration card
Do not know
If Other, please specify
P11
Is the office bearer disabled?
Yes
No
P12
What are the training 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)
P13
When was the last General Body constituted?
P14
What is the norm for conducting the General Body meeting of this VO?
Biannually
Annually
P15
Can you please tell me if the last three meetings were conducted?
P15_1
Meeting 1
Yes
No
P15_2
Meeting 2
Yes
No
P15_3
Meeting 3
Yes
No
P16
How many SHGs had not participated in each of the last two GBM?
P17
When was the present Executive Committee (EC) of the VO constituted?
P18
What is the norm for conducting EC meetings of this VO?
Fortnightly
Monthly
Quarterly
P19
How many EC members are currently elected?
P20
How many EC meetings were held in the last 12 months?
P21
Can you please tell me if the last four meetings were conducted?
P21_1
Meeting 1
Yes
No
P21_2
Meeting 2
Yes
No
P21_3
Meeting 3
Yes
No
P21_4
Meeting 4
Yes
No
P21A
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)
P22
How many were EC members absent in each of the last four consecutive meetings?
P22_1
Meeting 1
P22_2
Meeting 2
P22_3
Meeting 3
P22_4
Meeting 4
P23
What was the penalty levied if any of the EC members did not attend the EC meeting?
P24
How many meetings did Community Mobilizer had attended in the last three months?
P25
How many meetings are attended by BRLPS staff in the last three months?
P26
Were the following issues discussed during the last four EC meetings?
P26_1
Financial status of VO and Repayment from SHGs
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_2
Monthly Progress Report and Grading of the SHGs
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_3
Status and Promotion of PGs
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_4
Identification of Defaulter SHG or SHG at risk of default
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_5
Action plan for loan recovery
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_6
Identification of most poor families in the village
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_7
Identification of training and financial help to sustain/promote livelihood activities
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_8
Performance of Community cadre, ie. CM, Bookkeeper, BS/BC, etc
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_9
Health and nutrition-related issues – the importance of balanced 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
P26_10
Sanitation related issues- the 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
P26_11
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
P26_12
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
P26_13
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
P26_14
Discussion on last month meeting minutes
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_15
Discussion on Household Livelihoods
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P26_16
Role of Business correspondent agent and accessing alternate banking services through Customer Service Points
Yes but not recorded in minutes of meeting register
Yes and recorded in minutes of meeting register
No
P27
Has the VO formed different sub-committees for managing various roles and responsibilities of the VO?
Yes
No
P28
When was this committee formed?
P28_1
Social Audit Committee
P28_2
Loan Repayment committee
P28_3
Bank Linkage committee
P28_4
social Action committee
P28_5
Purchase and Sell Committee
P29
How many members are there on the committee currently?
P29_1
Social Audit Committee
P29_2
Loan Repayment committee
P29_3
Bank Linkage committee
P29_4
social Action committee
P29_5
Purchase and Sell Committee
P30
How many times did this committee meet in the last 3 months?
P30_1
Social Audit Committee
P30_2
Loan Repayment committee
P30_3
Bank Linkage committee
P30_4
social Action committee
P30_5
Purchase and Sell Committee
P31
Key roles and responsibilities of the committee
P32
What are the trainings received by this committee to perform its duties?
Need for the 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, microcredit, loan need identification, fund management, bookkeeping, bank linkage and operations, grading of SHGs, Exposure visit, conflict management
Others (specify)
P33
How would you rate the effectiveness of this committee?
very effective
effective
not effective
no response
Organizational Management
R01
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)
R02
What are SHG activities reviewed by the VO?
Books of records
Micro credit plan
Utilization of the CIF
Mashik Prativedan
Implementation of Social Activites
Grivances between SHGs / VO members
Complaint / Grivance against community cadre
Others (specify)
R03
How many SHGs submitted Mashik Prativedan in the last month?
R04
How many SHGs defaulted in submitting Mashik Prativedan in the last month?
R05
How many SHGs have defaulted once or multiple times in submitting Mashik Prativedan in the last quarter?
R06
How many SHGs defaulted in the repayment parameter?
R07
How many SHGs submitted Utilization certificates (UC) to VO in the last month?
R08
What kind of support does this VO provide to the member SHGs?
Providing handholding support in maintenance of records
Providing loan against the demand
Providing information on flagship government schemes
Helping in establishing group-level livelihood activity
Facilitating market linkage
Promotion of village-level producer groups
Training support to SHG members to start new livelihood exercises
Others (specify)
R09
How many new SHGs are promoted by VO in the last three months?
R10
Does CLF review the performance of VO?
Yes
No
R11
What is the frequency of reviewing VO by CLF?
Monthly
Quarterly
Bi-Annually
Annually
If other, Please specify(____)
R12
Please provide us the detail of the review conducted by CLF
R12_1
Review 1
R12_2
Review 2
R12_3
Review 3
R12_4
Review 4
R13
Which activities of VO are reviewed by the CLF?
Books of records
Micro credit plan
Loans and repayment
Mashik Prativedan
Implementation of Social Activities
Implementation of Livelihood activities
Grievances between SHGs / VO members
Complaint / Grievance against community cadre
Others (specify)
R14
What is the frequency of submitting Mashik Prativedan of this VO to CLF?
Monthly
Once in two months
Bi-Annually
Annually
No predetermined frequency
Never submitted
Others (specify)
R15
Who prepares the Mashik prativedan of this VO?
OB members
Bookkeeper
BRLPS Staff
Any member of VO
If other, Please specify (_____)
R16
What kind of support does VO receive from CLF?
Handholding support in maintenance of records
loan against the demand
information on flagship government schemes
Helping in establishing group-level livelihood activity
Facilitating market linkage
Promotion of Producer Groups/ Producer Company
Training support to SHG/ VO members to start new livelihood exercises
Others (specify)
R17
At what frequency does the VO is graded?
Monthly
Once in two months
Bi-Annually
Annually
No predetermined frequency
Never graded
Others (specify)
R18
Who conducts the grading process?
OB members of CLF
Master Bookkeeper
BRLPS staff
Members of another VO
If others, Please specify (___)
R19
Please provide the details of the last three grading processes conducted for this VO?
R19_1
Grading 1
R19_2
Grading 2
R19_3
Grading 3
R20
At what frequency CLF conducts the Audit for this VO?
Monthly
Once in two months
Bi-Annually
Annually
No predetermined frequency
Never submitted
Others (specify)
R21
When was the last Audit conducted for this VO?
R22
Who conducts the Audit of VOs?
External Agency
Members from CLF
Master Bookkeeper
BRLPS staff
If other, Please Specify (___)
R23
Meeting Regularity and Attendance in Last three Months/Meetings
R23_1
Date of Meeting
R23_2
Number of SHGs as member
R23_3
Number of SHGs present
R23_4
Presence of BRLPS Staff
Yes
No
R23_5
Presence of VO Bookkeeper
Yes
No
R23_6
Community Mobiliser
Yes
No
R23_7
Community Resource Person
Yes
No
R24
Check if the following book of records is available or not?
R24_1
Membership Register
Yes
No
R24_2
Meetings Register
Yes
No
R24_3
Minutes Book
Yes
No
R24_4
Savings Register
Yes
No
R24_5
General Ledger
Yes
No
R24_6
Daily Expenses Register
Yes
No
R24_7
Cash Book
Yes
No
R24_8
Loan Register
Yes
No
R24_9
Receipt Book
Yes
No
R24_10
Voucher Book
Yes
No
R24_11
Stock register
Yes
No
R24_12
Financial statements
Yes
No
R24_13
VO Passbook
Yes
No
R24_14
Cheque Issue Register
Yes
No
R24_15
VO DCB Register
Yes
No
R25
Check if the book of records is updated or not?
R26
Please record the date last updated
R26_1
Membership Register
R26_2
Meetings Register
R26_3
Minutes Book
R26_4
Savings Register
R26_5
General Ledger
R26_6
Daily Expenses Register
R26_7
Cash Book
R26_8
Loan Register
R26_9
Receipt Book
R26_10
Voucher Book
R26_11
Stock register
R26_12
Financial statements
R26_13
VO Passbook
R26_14
Cheque Issue Register
R26_15
VO DCB Register
R27
Please specify the reason for not updating the book of records
R27_1
Membership Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_2
Meetings Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_3
Minutes Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_4
Savings Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_5
General Ledger
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_6
Daily Expenses Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_7
Cash Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_8
Loan Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_9
Receipt Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_10
Voucher Book
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_11
Stock register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_12
Financial statements
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_13
VO Passbook
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_14
Cheque Issue Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
R27_15
VO DCB Register
Bookkeeper is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
Book of Records were given late to VO
Book format has changed, and training is yet to be given
BookKeeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
Training and Capacity Building
S01
What is the status of training?
S01_1
Exposure visits of functional VO
Yes
No
S01_2
VO concept and functioning
Yes
No
S01_3
VO Books Keeping
Yes
No
S01_4
Refresher
Yes
No
S01_5
Roles of VO Sub-Committee
Yes
No
S01_6
Procurement Sub-Committee
Yes
No
S01_7
Fund management
Yes
No
S01_8
MCP/MIP Preparation/Facilitation and Appraisal
Yes
No
S01_9
Leadership/Group management
Yes
No
S01_10
Grading of SHG
Yes
No
S01_11
Livelihood and Income Generation
Yes
No
S01_12
Cadre Review
Yes
No
S01_13
Convergence
Yes
No
S02
Training Date
S02_1
Exposure visits of functional VO
S02_2
VO concept and functioning
S02_3
VO Books Keeping
S02_4
Refresher
S02_5
Roles of VO Sub-Committee
S02_6
Procurement Sub-Committee
S02_7
Fund management
S02_8
MCP/MIP Preparation/Facilitation and Appraisal
S02_9
Leadership/Group management
S02_10
Grading of SHG
S02_11
Livelihood and Income Generation
S02_12
Cadre Review
S02_13
Convergence
S03
Duration (In Days)
S03_1
Exposure visits of functional VO
S03_2
VO concept and functioning
S03_3
VO Books Keeping
S03_4
Refresher
S03_5
Roles of VO Sub-Committee
S03_6
Procurement Sub-Committee
S03_7
Fund management
S03_8
MCP/MIP Preparation/Facilitation and Appraisal
S03_9
Leadership/Group management
S03_10
Grading of SHG
S03_11
Livelihood and Income Generation
S03_12
Cadre Review
S03_13
Convergence
S04
Who facilitated the training?
S04_1
Exposure visits of functional VO
BRLPS team
External Trainer
Others
S04_2
VO concept and functioning
BRLPS team
External Trainer
Others
S04_3
VO Books Keeping
BRLPS team
External Trainer
Others
S04_4
Refresher
BRLPS team
External Trainer
Others
S04_5
Roles of VO Sub-Committee
BRLPS team
External Trainer
Others
S04_6
Procurement Sub-Committee
BRLPS team
External Trainer
Others
S04_7
Fund management
BRLPS team
External Trainer
Others
S04_8
MCP/MIP Preparation/Facilitation and Appraisal
BRLPS team
External Trainer
Others
S04_9
Leadership/Group management
BRLPS team
External Trainer
Others
S04_10
Grading of SHG
BRLPS team
External Trainer
Others
S04_11
Livelihood and Income Generation
BRLPS team
External Trainer
Others
S04_12
Cadre Review
BRLPS team
External Trainer
Others
S04_13
Convergence
BRLPS team
External Trainer
Others
S05
Where was training conducted?
S05_1
Exposure visits of functional VO
At CLF office
At Cluster office
At Block office
Any Other
S05_2
VO concept and functioning
At CLF office
At Cluster office
At Block office
Any Other
S05_3
VO Books Keeping
At CLF office
At Cluster office
At Block office
Any Other
S05_4
Refresher
At CLF office
At Cluster office
At Block office
Any Other
S05_5
Roles of VO Sub-Committee
At CLF office
At Cluster office
At Block office
Any Other
S05_6
Procurement Sub-Committee
At CLF office
At Cluster office
At Block office
Any Other
S05_7
Fund management
At CLF office
At Cluster office
At Block office
Any Other
S05_8
MCP/MIP Preparation/Facilitation and Appraisal
At CLF office
At Cluster office
At Block office
Any Other
S05_9
Leadership/Group management
At CLF office
At Cluster office
At Block office
Any Other
S05_10
Grading of SHG
At CLF office
At Cluster office
At Block office
Any Other
S05_11
Livelihood and Income Generation
At CLF office
At Cluster office
At Block office
Any Other
S05_12
Cadre Review
At CLF office
At Cluster office
At Block office
Any Other
S05_13
Convergence
At CLF office
At Cluster office
At Block office
Any Other
S06
Was training material provided?
S06_1
Exposure visits of functional VO
Yes
No
S06_2
VO concept and functioning
Yes
No
S06_3
VO Books Keeping
Yes
No
S06_4
Refresher
Yes
No
S06_5
Roles of VO Sub-Committee
Yes
No
S06_6
Procurement Sub-Committee
Yes
No
S06_7
Fund management
Yes
No
S06_8
MCP/MIP Preparation/Facilitation and Appraisal
Yes
No
S06_9
Leadership/Group management
Yes
No
S06_10
Grading of SHG
Yes
No
S06_11
Livelihood and Income Generation
Yes
No
S06_12
Cadre Review
Yes
No
S06_13
Convergence
Yes
No
S07
To whom was the training imparted?
S07_1
Exposure visits of functional VO
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_2
VO concept and functioning
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_3
VO Books Keeping
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_4
Refresher
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_5
Roles of VO Sub-Committee
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_6
Procurement Sub-Committee
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_7
Fund management
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_8
MCP/MIP Preparation/Facilitation and Appraisal
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_9
Leadership/Group management
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_10
Grading of SHG
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_11
Livelihood and Income Generation
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_12
Cadre Review
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S07_13
Convergence
To Office Bearers
To all members
Executive Committee
Book Keeper
Any other, please specify
S08
Was the training useful and content relevant?
S08_1
Exposure visits of functional VO
Very much
Somewhat
Not much
S08_2
VO concept and functioning
Very much
Somewhat
Not much
S08_3
VO Books Keeping
Very much
Somewhat
Not much
S08_4
Refresher
Very much
Somewhat
Not much
S08_5
Roles of VO Sub-Committee
Very much
Somewhat
Not much
S08_6
Procurement Sub-Committee
Very much
Somewhat
Not much
S08_7
Fund management
Very much
Somewhat
Not much
S08_8
MCP/MIP Preparation/Facilitation and Appraisal
Very much
Somewhat
Not much
S08_9
Leadership/Group management
Very much
Somewhat
Not much
S08_10
Grading of SHG
Very much
Somewhat
Not much
S08_11
Livelihood and Income Generation
Very much
Somewhat
Not much
S08_12
Cadre Review
Very much
Somewhat
Not much
S08_13
Convergence
Very much
Somewhat
Not much
S09
Do you recall the training content?
S09_1
Exposure visits of functional VO
Able to recall well
Able to recall partly
Not able to recall
S09_2
VO concept and functioning
Able to recall well
Able to recall partly
Not able to recall
S09_3
VO Books Keeping
Able to recall well
Able to recall partly
Not able to recall
S09_4
Refresher
Able to recall well
Able to recall partly
Not able to recall
S09_5
Roles of VO Sub-Committee
Able to recall well
Able to recall partly
Not able to recall
S09_6
Procurement Sub-Committee
Able to recall well
Able to recall partly
Not able to recall
S09_7
Fund management
Able to recall well
Able to recall partly
Not able to recall
S09_8
MCP/MIP Preparation/Facilitation and Appraisal
Able to recall well
Able to recall partly
Not able to recall
S09_9
Leadership/Group management
Able to recall well
Able to recall partly
Not able to recall
S09_10
Grading of SHG
Able to recall well
Able to recall partly
Not able to recall
S09_11
Livelihood and Income Generation
Able to recall well
Able to recall partly
Not able to recall
S09_12
Cadre Review
Able to recall well
Able to recall partly
Not able to recall
S09_13
Convergence
Able to recall well
Able to recall partly
Not able to recall
S10
Is the training session noted in the book of records?
S10_1
Exposure visits of functional VO
Yes
No
S10_2
VO concept and functioning
Yes
No
S10_3
VO Books Keeping
Yes
No
S10_4
Refresher
Yes
No
S10_5
Roles of VO Sub-Committee
Yes
No
S10_6
Procurement Sub-Committee
Yes
No
S10_7
Fund management
Yes
No
S10_8
MCP/MIP Preparation/Facilitation and Appraisal
Yes
No
S10_9
Leadership/Group management
Yes
No
S10_10
Grading of SHG
Yes
No
S10_11
Livelihood and Income Generation
Yes
No
S10_12
Cadre Review
Yes
No
S10_13
Convergence
Yes
No
S11
Does VO had conducted training for SHGs in the last month?
Yes
No
S12
What training did VO had provided in the last month to SHGs? Please specify the number of SHGs received trainings on the following subjects:
S12_1
Panchsutra
S12_2
Micro Credit
S12_3
Bookkeeping
S12_4
Concept of VO
S12_5
Conflict Management
S12_6
Livelihood Promotion
S13
Who conducted the trainings for the SHG members in the last month?
Village Resource Person
Community Resource Person
Master Trainer
BRLPS Staff
External Agency
Bookkeeper
If other, Please Specify (___)
Revolving/ Initial Capitalization Fund (RF/ ICF), Food Security Fund(FSF), and Health Risk Fund(HRF)
T01
Did this VO receive a Revolving fund (RF)?
Yes
No
T02
When did this VO receive RF?
T03
Total amount of RF received by this VO till last month
T04
Total amount of RF disbursed to the member SHGs till last month
T05
Total amount of RF repaid by member SHGs to the VO till last month
T06
Did this VO receive Initial Capitalization Fund (ICF)?
Yes
No
T07
When did this VO receive ICF?
T08
Total amount of ICF received by this VO till last month
T09
Total amount of ICF disbursed to the member SHGs till last month
T10
Total amount of ICF repaid by member SHGs to the VO till last month
T11
Does VO provide support in repayment of loans from defaulter SHG?
Yes
No
T12
How does VO provide support to the SHGs to ensure regular repayment?
Form a sub-committee to counsel SHG members
Provide loans to encourage repayment
provide handholding support/ training to ensure repayment
If others, Please specify (____)
T13
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
If others (Specify____)
T14
Does this VO have a savings bank account?
Yes
No
T15
When was the savings bank account opened for this VO?
T16
After how many months of formation of VO, does the bank account opened?
T17
Did this VO receive any bank loan?
Yes
No
T18
When was the first time this VO received a bank loan?
T19
How many times has this VO received a bank loan?
T20
Total amount of bank loan received by the VO till the last month
T21
Total amount of bank loan repaid by the VO till the last month
T22
Total amount in the bank account of VO
T23
Did this VO received Food security Fund (FSF)?
Yes
No
T24
When did VO receive Food Security Fund (FSF)?
T25
Distribution of FSF (calculate from) latest cycle
T25A
Date of distribution
T25A_1
Cycle 1
T25A_2
Cycle 2
T25A_3
Cycle 3
T25B
No of SHG participated
T25B_1
Cycle 1
T25B_2
Cycle 2
T25B_3
Cycle 3
T25C
No of Beneficiaries
T25C_1
Cycle 1
T25C_2
Cycle 2
T25C_3
Cycle 3
T25D
Cost of the purchased item
T25D_1
Cycle 1
T25D_2
Cycle 2
T25D_3
Cycle 3
T26
Did this VO receive Health Risk Fund?
Yes
No
T27
When did VO receive HRF?
T28
Number of SHGs depositing Health Risk Fund (HRF)
T29
Number of SHGs who had received benefit through HRF fund in last three years
T30
Number of loan Demands accepted by VO for last three months
T31
Total loan of demand raised by VO to CLF in last three months (Amount in INR)
T31_1
Month 1
T31_2
Month 2
T31_3
Month 3
T32
Total loan received by VO in last three months (Amount in INR)
T32_1
Month 1
T32_2
Month 2
T32_3
Month 3
T33
What is the expenditure incurred by the VO under the following heads?
T33_1
Payment of staff (cadre)
T33_2
Training expenses
T33_3
Purchase of fixed assets (ag. Purchase/ Construction of VO office - furniture, almirah, etc.)
T33_4
Miscellaneous expenses (e.g., Printing of brochures, purchase of stationery, etc.)
T34
What is the amount received by the VO under the following heads?
T34_1
Membership fees (subscription fee) deposited by SHGs
T34_2
Interest received on loans
T34_3
Earnings from other sources (specify)
T35
Total profit/surplus accumulated by the VO
T36
Opening balance
T37
Closing balance
Micro-Credit Plans of SHGs
U01
How many SHG under this VO involve in Micro-credit planning?
U02
What type of micro plans are approved by this VO?
Income generation
Health
Education
Consumption
Housing
Social needs
If others (Specify____)
U03
How frequently are these micro plans prepared?
U04
How much time does it take to approve a micro-credit plan?
A week
15 days
One Month
More than a month
U05
How much time does it require to transfer micro-credit funds to beneficiary accounts?
A week
15 days
One Month
More than a month
U06
What is the mode of fund transfer?
Cash
Bank account transfer
If others (Specify____)
U07
Do SHGs under this VO use online/ mobile banking?
Yes
No
U08
How many SHGs use online/ mobile banking services?
U09
How regularly are micro-credit books of records maintained?
Weekly
Monthly
Bi-Monthly
Within 6 months
If others (Specify____)
U10
How many micro-credit trainings for SHG members are conducted in the last year?
U11
How many SHG members generally attend these micro-credit trainings?
U12
How many micro credit plans of SHG households have been approved in the last 6 months?
U13
How frequently have SHGs been graded since inception?
3 months
6 months
9 months
If others (Specify____)
Self Help Group Identification Information
V01
District Name
V02
District Code
V03
Block Name
V04
Block Code
V05
Village Name
V06
Village Code
V07
SHG Name
V08
SHG Code
Self Help Group Survey Information
W01
Name of the respondent
W02
Designation of the respondent
President
Secretary
Treasurer
Member
Others (specify)
W03
Respondent identification code
W04
FIRST VISIT
W04_1
Interviewer name
W04_2
Interviewed code
W04_3
Date of the interview
W04_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)
W04_5
Record time when you start the interview.
W04_6
Record time when you end the interview
W05
SECOND VISIT
W05_1
Interviewer name
W05_2
Interviewed code
W05_3
Date of the interview
W05_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)
W05_5
Record time when you start the interview.
W05_6
Record time when you end the interview
W06
THIRD VISIT
W06_1
Interviewer name
W06_2
Interviewed code
W06_3
Date of the interview
W06_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)
W06_5
Record time when you start the interview.
W06_6
Record time when you end the interview
SHG Information
X01
What is the name of this SHG?
X02
What is the date of the formation of this SHG?
X03
How Many Members are there in this SHG?
X04
Was there any meeting conducted in the village before the formation of the group?
Yes
No
X05
How many meetings were conducted before the formation of the group?
X06
How many households are still left out to form SHG?
X07
Who can join this Self Help Group?
Women identified in PRA
Selected by CM
Anyone interested
Don’t know
Other
X08
Is this SHG is member of the Village Organization(VO)?
Yes
No
X09
If Yes, what is the name of VO?
X10
Did you pay a membership fee to VO?
Yes
No
X11
If Yes, please specify?
X12
If the SHG savings bank account is open?
Yes
No
X13
When was the SHG savings bank account opened?
X14
Do all members of SHG have a bank account?
Yes
No
X15
If No, How many members do not have a bank account?
X16
Does SHG have a loan account opened?
Yes
No
X17
When was the SHG loan bank account opened?
X18
Is the VO (of which this SHG is a member) member of a Cluster Level Federation(CLF)?
Yes
No
X19
If yes, what is the name of the CLF?
X20
Do the details of all SHG members entered in MIS?
Yes
No
X21
Does the SHG receive Community Investment Money to procure necessary items for conducting SHG functions?
Yes
No
X22
Does this SHG a Community Mobiliser appointed?
Yes
No
X23
Please specify the date of appointment of Community Mobiliser
SHG Member Roster – Socio-Demographic Details
Y01
Name of the current SHG member
Y02
Whether included in household survey?
Yes
No
Y03
When did the member join the SHG?
Y04
In which hamlet/Mohalla does the member live?
Y05
What is the religion of the member?
Hindu
Muslim
Christian
Jain
Sikh
Buddhist
Others (Specify)
Y06
What is the social Category of the member?
General
SC
ST
OBC
Others (Specify)
Y07
What is the age of the member?
Y08
What is the primary occupation of the member?
Agriculture on own land
Animal husbandry
Agriculture labor
MGNREGS labor
Own business / shop
Salaried government
Salaried private job
Not working/unemployed
Senior citizen
Others (Specify)
Don’t know
Y09
What is the educational qualification of member?
Illiterate
No Schooling (But knows to read/ write)
Primary
Secondary
High Secondary
Diploma/ ITI
Graduation
Post Graduation
If other, please specify
Y10
What type of ration card does the member’s household have?
APL (Blue card)
BPL (Red Card)
Annapurna
Antyodaya Anna Yojana (AAY)
Single Card
Coupon
Do not have any ration card
Do not know
If Other, please specify
Y11
Is the member currently holding any of the following position with the VO?
VO accountant/ assistant
Community Mobiliser
Bookkeeper
ICRP
ICRP-FNHW
Bank Sakhi
KrishiSakhi
PashuSakhi
Others (specify)
Not holding any position
Y12
Is the member currently holding any of the following position in the SHG?
President
Vice president
Treasurer
Secretary
Community Mobiliser
Others (Specify)
Not holding any position
Y13
Does aadhar Seeding Of the member is completed?
Yes
No
Y14
When was the last SHG meeting conducted?
Y15
What is the norm for conducting the meeting of this SHG?
Weekly
Fortnightly
Monthly
No Fixed Period
If other, please specify
Y16
Who sets the agenda for the meetings?
President
Secretary
Treasurer
Community Mobiliser
Other
Y17
How many meetings were supposed to be conducted in the last three months?
Y18
How many meetings were actually conducted in the last three months?
Y19
In how many meetings as Community Mobiliser was present in the last three months?
Y20
Where are meetings generally conducted?
President house
Any member house as decided by members
A common Place/ community place
Treasurer house
Secretary House
If other, please specify()
Y21
In how many meetings BRLPS staff were present in the last month?
Y22
Please verify the attendance of members in the last 4 meetings from records?
Y22_1
Meeting 1
Y22_2
Meeting 2
Y22_3
Meeting 3
Y22_4
Meeting 4
Y23
What is the reason for the absence of SHG members?
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)
Y24
What was the penalty levied if any of the members did not attend the SHG meeting?
Y25
How many meetings did Community Mobilizer had attended in the last three months?
Y26
How many meetings were attended by BRLPS staff in the last three months?
Y27
Does the members of SHG also the member of VO Executive committee?
Yes
No
Y28
Does members of this SHG also the members of VO Sub Committees?
Yes
No
Y29
Does the representatives of this SHG attend VO meetings?
Yes
No
Y30
What is the frequency of attending the VO meetings?
Monthly
Once in two months
Quarterly
Once in six months
Annually
Saving, Credit & LoanC
Z01
Does this SHG save regularly?
Yes
No
Z02
What is the periodicity of savings?
Weekly
Fortnightly
Monthly
No fixed schedule
Z03
How much amount does your SHG save monthly?
Z04
Please provide the details of savings done by SHG members
Z04_1
Member ID
Z04_2
Saving Amount
Z04_3
Number of Cycle
Z04_4
Total Saving
Z04_5
Total Group Saving
Z04_6
Any fine for doing default in saving Y/N
Yes
No
Z04_7
Is the record of savings updated for the group? Y/N
Yes
No
Z04_8
Do the Records show the updated saving of Members Y/N
Yes
No
Z04_9
Are Members Saving Accounts are updated? Y/N
Yes
No
Z04_10
Are members aware of their savings? Y/N
Yes
No
Z05
How many members defaulted in saving in the last month?
Z06
How many members have defaulted saving multiple times in the last quarter?
Z07
How many SHGs defaulted in the repayment parameter?
Z08
Does this SHG receive Revolving Fund?
Yes
No
Z09
What is the date of receiving the revolving fund?
Z10
How much amount has it received as a Revolving fund?
Z11
Does this SHG receive an Initial Capitalization Fund (ICF)?
Yes
No
Z12
What is the date of receiving ICF?
Z13
How much amount has it received as ICF?
Z14
Do all members of your SHG regularly pay back their loans?
Yes
No
Z15
How many members have paid loans on time?
Less than 5 members
5 to 10 members
11 to 15 members
15 to 20 members
Z16
What are the different sources of loan/funds SHG can access?
Z16A
Common Loan from VO
Z16A_1
Date of receiving
Z16A_2
Amount
Z16A_3
To be repaid Y/N
Yes
No
Z16A_4
Status of repayment till date
Z16B
CIF
Z16B_1
Date of receiving
Z16B_2
Amount
Z16B_3
To be repaid Y/N
Yes
No
Z16B_4
Status of repayment till date
Z16C
Bank Loan
Z16C_1
Date of receiving
Z16C_2
Amount
Z16C_3
To be repaid Y/N
Yes
No
Z16C_4
Status of repayment till date
Z17
What is the maximum amount of loan any member can take?
Z18
Does SHG allow a member who had not repaid the loan can get access to another loan?
Yes
No
Z19
Does the SHG allow for early repayment of the loan?
Yes
No
Z20
Does SHG cross verify the utilization of loan amount?
Yes
No
Book of Records
AA01
Check if following book of records is available or not?
AA01_1
Membership Register
Yes
No
AA01_2
Meetings Register
Yes
No
AA01_3
Minutes Book
Yes
No
AA01_4
Savings Register
Yes
No
AA01_5
General Ledger
Yes
No
AA01_6
Cash Book
Yes
No
AA01_7
Loan Register
Yes
No
AA01_8
Financial statements
Yes
No
AA01_9
SHG Passbook
Yes
No
AA01_10
Cheque Issue Register
Yes
No
AA02
Check if book of records is updated or not?
AA02_1
Membership Register
Updated till last meeting
Partly updated
Incomplete
AA02_2
Meetings Register
Updated till last meeting
Partly updated
Incomplete
AA02_3
Minutes Book
Updated till last meeting
Partly updated
Incomplete
AA02_4
Savings Register
Updated till last meeting
Partly updated
Incomplete
AA02_5
General Ledger
Updated till last meeting
Partly updated
Incomplete
AA02_6
Cash Book
Updated till last meeting
Partly updated
Incomplete
AA02_7
Loan Register
Updated till last meeting
Partly updated
Incomplete
AA02_8
Financial statements
Updated till last meeting
Partly updated
Incomplete
AA02_9
SHG Passbook
Updated till last meeting
Partly updated
Incomplete
AA02_10
Cheque Issue Register
Updated till last meeting
Partly updated
Incomplete
AA03
Please record date last updated
AA03_1
Membership Register
AA03_2
Meetings Register
AA03_3
Minutes Book
AA03_4
Savings Register
AA03_5
General Ledger
AA03_6
Cash Book
AA03_7
Loan Register
AA03_8
Financial statements
AA03_9
SHG Passbook
AA03_10
Cheque Issue Register
AA04
Please specify reason for not updating book of records
AA04_1
Membership Register
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_2
Meetings Register
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_3
Minutes Book
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_4
Savings Register
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_5
General Ledger
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_6
Cash Book
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_7
Loan Register
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_8
Financial statements
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_9
SHG Passbook
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
AA04_10
Cheque Issue Register
Member/CM is not skilled to write the book despite training
Skilled but not getting time to fill
Book Keeping has stopped after unresolved issues of record or other matter
Feels updating is not necessary
Not trained - has not received any training
Needs new books of record (the existing record are filled)
other
Training and Building Capacity
BB01
What is the status of training?
BB01_1
Module 1
Yes
No
BB01_2
Module 2
Yes
No
BB01_3
Module 3
Yes
No
BB01_4
Module 4
Yes
No
BB02
Training Date
BB02_1
Module 1
BB02_2
Module 2
BB02_3
Module 3
BB02_4
Module 4
BB03
Duration(In Days)
BB03_1
Module 1
BB03_2
Module 2
BB03_3
Module 3
BB03_4
Module 4
BB04
Who facilitated the training?
BRLPS team
External Trainer
Community Mobiliser
Others
BB05
Where was training conducted?
At CLF office
At Cluster office
At Block office
Training and learning center
Any Other, please specify
BB06
Was training material provided?
Yes
No
BB07
To whom was the training imparted?
To office Bearers
To all members
To few members and group leaders
Any other, please specify.
BB08
Was the training useful and content relevant?
Very much
Somewhat
Not much
BB09
Do you recall the training content?
Able to recall well
Able to recall partly
Not able to recall
BB10
Is the training session noted in the book of records?
Yes
No
Food Security Fund (FSF) & Health Risk Fund (HRF)
CC01
Does this SHG receive Food Security Fund (FSF)?
Yes
No
CC02
When did this SHG receive FSF?
CC03
Total amount of FSF received by VO till last month
CC04
Total amount of FSF disbursed to the member SHGs till last month
CC05
What is the reason for not getting access to FSF?
Repayment
Self sufficient
High price
quality concern
Other
CC06
Does the SHG member save under HRF?
Yes
No
CC07
From when does this group saving under HRF?
CC08
How many members are saving under HRF?
CC09
What are the reasons due to which members are not saving for HRF?
Financial Constraint
Unaware about the benefits of HRF
Conscious decision taken by the member
If other, please specify()
CC10
Does this SHG default in saving under HRF last year?
Yes
No
CC11
What is the reason for irregular HRF saving?
CC12
When was the last application sent to VO to raise demand for HRF?
CC13
Date of Application
CC13_1
Member 1
CC13_2
Member 2
CC13_3
Member 3
CC13_4
Member 4
CC13_5
Member 5
CC13A
Date of HRF received from VO
CC13A_1
Member 1
CC13A_2
Member 2
CC13A_3
Member 3
CC13A_4
Member 4
CC13A_5
Member 5
CC13B
Date HRF has given to the member
CC13B_1
Member 1
CC13B_2
Member 2
CC13B_3
Member 3
CC13B_4
Member 4
CC13B_5
Member 5
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