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Clf Template 4 -Form Fill
Identification Information
Q01
District Name
Q02
District Code
Q03
Block Name
Q04
Block Code
Q05
Name of the CLF
Q06
UID
Survey Information
A01
Name of the respondents
A02
Designation of the respondent
President
Vice-President
Secretary
Others (Specify)
A03
Respondent identification code
A04
Interviewer name
A05
Interviewer code
A06
Date of the interview
A07
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)
CLF Information
B01
What is the date of formation of this CLF?
B02
Is this (building/location) office owned/rented by the CLF?
Yes
No
B03
Is this CLF registered under Society Registration Act 1860?
Yes
No
B04
What is the date of registration of this CLF?
B05
What is the registration number of this CLF?
B06
How many VOs are there in this CLF?
B07
In the last one year, has the accounts of this CLF been audited by an external agency (chartered accountant)
Yes
No
Not Applicable
B08
Is the Audit report submitted to CLF?
Yes
No
B09
Is the audit report written in Hindi?
Yes
No
B10
Is the Audit report explained to CLF EC members?
Yes
No
B11
Has the CLF received PAN No.?
Yes
No
B12
If PAN is not issued earlier, did the CLF apply for PAN?
Yes
No
B13
Does this CLF file their annual ITR?
Yes
No
Governance
C01
Does the CLF have a vision statement/mission statement?
Yes
No
C02
Are these statements posted openly in the office or somewhere so that members can see?
Displayed in the CLF office
Printed on CLF records
Not displayed anywhere
Others (specify)
C03
When was the last time CLF reviewed its vision/mission statement?
C04
Was the vision building training organized for CLF?
Yes
No
C05
Who organized the vision building training for the CLF?
IPRP
DRP
SRP
NRP
Others (specify)
C06
Does this CLF have vision documents developed
Yes
No
C07
Does the CLF have an annual action plan?
Yes
No
C08
What are the key priorities of the annual action plan?
Leadership
D01
Name of the office bearer
D02
Social category of this office bearer
SC
ST
OBC
General
Others
D03
Position currently held by this office bearer
President
Vice president
Secretary
Treasurer
Deputy Secretary
D04
How many times has the position rotated since the formation of CLF?
D05
In which year did the last rotation in position take place?
D06
Is the current position a paid position?
Yes
No
Don’t know
D07
Education level of this office bearer
Primary
Middle
Secondary
Senior secondary
Certificate/ Diploma course
Graduate
Postgraduate
Others, specify
Never attended school
D08
Is the office bearer differently abled?
Yes
No
D09
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
Others (specify)
Governing Body/ Executive Committee (EC)
E01
When was the present Executive Committee (EC) of the CLF constituted?
E02
What is the norm for conducting EC meeting of this CLF?
Fortnightly
Monthly
Quarterly
Other (specify)
E03
How many EC meetings were held in the last 12 months?
E04
Can you please tell me if the last two meetings were conducted?
E04A
Meeting 1
Yes
No
E04B
Meeting 2
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)
Others (specify)
E06
How many EC members were absent in each of the last four two consecutive meetings?
E07
What was the penalty levied if any of the EC member did not attend the EC meeting?
E08
Were the following issues discussed during the last 2 EC meetings?
E08_1
Health and nutrition related issues – importance of balance diet, child and maternal health, health services in the village
Yes but not recorded in register
Yes and recorded in register
No
E08_2
Sanitation related issues- importance of cleanliness, sanitation practices, availability of clean drinking water, construction of toilets etc
Yes but not recorded in register
Yes and recorded in register
No
E08_3
Education in the village- school enrolment, availability of the teaching staff etc.
Yes but not recorded in register
Yes and recorded in register
No
E08_4
Involvement in Panchayati Raj Institutions – Participation in Gram Sabha (General)
Yes but not recorded in register
Yes and recorded in register
No
E08_5
Active Participation in Government Schemes- by facilitating members to access Govt. Welfare/ Development Schemes/Programs (e.g. MGNREGS, PDS, etc.
Yes but not recorded in register
Yes and recorded in register
No
E08_6
Discussion on Household Livelihoods (e.g., Livestock, Animal husbandry, farming etc.)
Yes but not recorded in register
Yes and recorded in register
No
E08_7
Self-employment schemes
Yes but not recorded in register
Yes and recorded in register
No
E08_8
Discussion around ways to prevent CORONA (COVID-19) infection, social distancing, handwashing, use of mask etc.
Yes but not recorded in register
Yes and recorded in register
No
E08_9
Others (Specify)
Yes but not recorded in register
Yes and recorded in register
No
Sub-committees of the CLF
F01
Has the CLF has formed different sub-committees for managing various roles and responsibilities of the CLF?
Yes
No
F02
COMMITTEE TYPE
Social Action Committee
Bank linkage/CBRM committee
Livelihoods committee
procurement committee
Monitoring committee
Others(specify)
F03
When was this committee formed?
F04
How many members are there in the committee currently?
F05
How many times did this committee meet in the last 12 months?
F06
Do ASHA/ANM/AWW attend the EC meetings?
Yes
ASHA/ANM/AWW is EC member
No
F07
On which occasions do ASHA/ANM/AWW attend EC meetings?
Every EC meeting
Whenever needed
When EC meeting has health and nutrition agenda
Others (Specify)
F08
What do the ASHA/ANM/AWW discuss during meetings?
Issues related to VHSND
Government welfare programs on health and nutrition and entitlements
Discussing initiatives of social action committee on health and nutrition
Others (specify)
Organizational Structure
G01
How many VOs are member of this CLF?
G02
What is the membership fee paid by member VOs?
G03
What is the name of the VO?
G04
When did this VO join the CLF?
G05
In which gram panchayat is the VO located?
G06
In the past 12 months, has the VO repaid the agreed CIF installments on time?
Yes, every time
Yes mostly, except few installments
Not paid most of the installments on time
Not Applicable
G07
How many members SHG are there in the in this CLF?
G08
How often does the CLF review the activities of the member VOs?
Weekly
Fortnightly
Monthly
Once in two months
No predetermined frequency
Never reviewed
Not Applicable
Others (specify)
G09
What VO activities are reviewed by the CLF?
Books of records
Micro credit plan
Utilization of the CIF
Annual action plan
Implementation of Health and Nutrition module in SHG
Action taken on the key issues emerged during Health and Nutrition meetings
Implementation of training plan
Work on social security and gender related issues
Role of Village Organization in Panchayat and Village Development
Bank linkage and bank loan withdrawal
Others (specify)
G10
What kind of support does this CLF provide to the member VOs?
Capacity building trainings
Helping establish credit linkages with banks, MFIs etc.
Providing handholding support in maintenance of records
Providing support for rolling out Health and Nutrition module in the SHG
Providing information on flagship government schemes
Helping in establishing group-level livelihood activity
Facilitating market linkages
Others (specify)
G11
What kind of support does this CLF provide to the VOs for rolling out Health and Nutrition module?
Providing training on Health and Nutrition module to cadre working with VO
Providing training and support for developing VO’s annual plan
Others (specify)
Not giving any support
Cadre Management
H01
Community cadre engaged with the CLF
ICRP
ICRP-FNHW
Samuh Sakhi
Bookkeeper
Bank Sakhi
VO accountant / assistant
Pashu Sakhi
Krishi Sakhi
Banking Correspondent
Ajeevika Sakhi
Vidyut Sakhi
Rojgar Sakhi
Others (specify)
H02
Name of this community cadre?
H03
Gender of this community cadre?
Male
Female
H04
Age in years completed
H05
Social category of this community cadre?
General
SC
ST
OBC
Minority
Others
H06
Religion of the community cadre?
Hinduism
Islam
Christianity
Jainism
Sikhism
Buddhism
Others
H07
Education level of this community cadre?
Primary
Middle
Secondary
Senior secondary
Certificate/ Diploma course
Graduate
Postgraduate
Never attended school
Others (specify)
H08
Since when the community cadre is working?
Maintenance of Records
I01
Whether the record is introduced in the CLF?
I01_1
Minutes Book
Yes
No
I01_2
CLF passbook
Yes
No
I01_3
General Ledger
Yes
No
I01_4
Cash Book
Yes
No
I01_5
Loan Register/Ledger
Yes
No
I01_6
Receipt Book/Voucher
Yes
No
I01_7
Payment Voucher Book
Yes
No
I01_8
CLF Passbook
Yes
No
I01_9
Cheque Issue Register
Yes
No
I01_10
DCB
Yes
No
I02
Please record date last updated
I02_1
Minutes Book
I02_2
CLF passbook
I02_3
General Ledger
I02_4
Cash Book
I02_5
Loan Register/Ledger
I02_6
Receipt Book/Voucher
I02_7
Payment Voucher Book
I02_8
CLF Passbook
I02_9
Cheque Issue Register
I02_10
DCB
Financial Management
J01
Did this CLF receive Community Investment Fund (CIF)?
Yes
No
not applicable
J02
When did this CLF receive CIF ?
J03
Total amount of CIF received by this CLF till now
J04
What action was taken by the CLF against loan defaulter Vos?
Financial penalty
Taking over VO savings
Refusal of provision of new loans until the old one is repaid
Others (Specify)
J05
Did this CLF receive any bank loan?
Yes
No
J06
When was the first time this CLF received a bank loan?
J07
How many times has this CLF received a bank loan ?
J08
Total amount of bank loan received by the CLF till date
J09
Total amount of bank loan repaid by the CLF
Collective Business Activity
K01
Has the CLF undertaken any collective business activity where at least some members of this CLF jointly invest some money or time, and share surplus/ profits?
Yes
No
CLF has started a business but it did not sustain
K02
What type of activity has the CLF taken up?
Collective Farming (including crops, vegetables, fruits, flowers)
Collective Animal Husbandry (including cattle, goatery, poultry, piggery)
Collective Non-Farm Activities (like textiles, handicrafts, petty business, fishing, etc
Service Provided to Village facilities (such as PDS outlet, angandwadi, School, etc.)
Others (specify)
K03
Is the CLF involved in this activity currently?
Yes
No
K04
What was the date of start of this activity?
K05
How many member VOs are part of the activity?
K06
What was the amount invested?
K07
What is the total expenditure incurred in past 1 years?
K08
What is the total revenue form the enterprise in past 3 years?
K09
What is the profit from the enterprise in past 3 years?
K10
How did you distribute profit?
Equally among member VOs
Among member VOs as per time- spent on activity
Others (specify)
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