Please Wait...
Shg Template 1 -Form Fill
Village Information
Q01
District Name
Q02
District Code
Q03
Block Name
Q04
Block Code
Q05
Gram Panchayat Name
Q06
Gram Panchayat Code
Q07
Village Name
Q08
Village Code
Q09
Village Organization Name
Q10
Village UID
Q11
Type of Area
Comparison
Project
Survey Information
A01
Name of the respondent
A02
SHG identification code
A03
Interviewer name
A04
Interviewed code
A05
Date of the interview
A06
Result of the interview
Interview complete
Visit rescheduled
Interview incomplete
Refused
SHG not located
Respondent is out of station for extended period
Respondent is temporarily away
Other (specify)
A07
Record time when you start the interview
SHG Information
B01
Who formed this SHG?
Formed under UPSRLM
Formed under AP-SERP
Formed under T-SERP
Formed under JEEVIKA
Formed under RMGVP
Formed under SRIJAN
Others (specify)
Don’t know
B02
When was the SHG brought under UPSRLM?
B03
Please describe the current status of this SHG?
SHG is functional
SHG is defunct (SHG was active at some point but group has dissolved and no activity at the time of this survey)
B04
When was this SHG formed?
B05
Who formed this SHG?
ICRP
NGO/other organization (Specify)
Self-formed
Don’t know where the mobilizers were from
B06
Has a bank account been opened in the name of the SHG?
Yes
No
B07
When was the bank account opened?
B08
What is the distance to the bank from the usual SHG meeting place office?
B09
Is the SHG a member of the village organization (VO)?
Yes
No
B10
What is the name of the VO of which this SHG is a member?
B11
When did the SHG join the VO?
B12
Has this SHG ever been graded ?
Yes
No
B13
On what parameters was the SHG graded?
Homogeneity and conflict resolution among members
Average attendance
Regularity in savings
Frequency of inter-loaning
Timely repayment of loans
Maintenance of books of records
Timely and fair elections
Frequency of Health and Nutrition meetings in the SHG
Participation of pregnant and lactating mothers in Health and Nutrition meetings
Receipt of productive loans from commercial banks
Others (Specify)
Not aware
B14
How many times has the SHG been graded till now ?
B15
When was the last time this SHG was graded?
B16
What is the latest grade awarded to the SHG?
B17
Who according to you is the most important community cadre who provides pivotal support to the daily functioning of your SHG?
Samuh Sakhi
Bookkeeper
ICRP
ICRP-FNHW
Bank Sakhi
Krishi Sakhi (only for MKSY block)
Pashu Sakhi (only for MKSY block)
Aajeevika Sakhi
None of the community cadre is engaged with the SHG
Others (Specify)
Don’t know
B18
How many women are members of the SHG currently?
B19
How many members have permanently left this SHG?
B20
What are the reasons for members leaving this SHG?
Migration
Marriage
Old age/health
Ill health
Did not agree to group norms
Multiple membership
Loan amount by SHG was too small
No bank linkage
Expelled
Husband/family members did not allow to continue
Misuse of funds
Did not see any benefit in being a member of SHG
Others (Specify)
Don’t know
SHG Member Roster – Socio-demographic details
C01
UID auto filled from SHG listing data
C02
Name of the current SHG member
C03
Whether included in household survey?
Yes
No
C04
When did the member join the SHG?
C05
In which Hamlet/ Mohalla does the member live?
C06
What is the religion of the member?
Hindu
Muslim
Christian
Jain
Sikh
Buddhist
Others (Specify)
C07
What is the social category of the member?
General
SC
ST
OBC
Others
C08
What is the age of the member?
C09
What is the primary occupation of the member?
Agriculture on own land
Animal husbandry
Agriculture labor
MGNREGS labor
own business / shop
Salaried government job
Salaried private job
Not working/unemployed
Senior citizen
Others (Specify)
Don’t know
C10
What is the completed education status of the member?
C11
What type of ration card does the member’s household have?
PHS
AYY
No ration card
C12
Is the member currently holding any of the following position with the VO?
VO accountant/ assistant
Samuh Sakhi
Bookkeeper
ICRP
ICRP-FNHW
Bank Sakhi
Krishi Sakhi (only for MKSY block)
Pashu Sakhi (only for MKSY block)
Aajeevika Sakhi
Others (specify)
Not holding any position
C13
Is the member currently holding any of the following position in the SHG?
President
Vice president
Treasurer
Secretary
Book keeper
Others (Specify)
Not holding any position
C14
What all trainings has the member received by the SHG?
SHG concept & management & leadership
SHG credit linkages
Micro credit plan training
Training on SHG books of records
Financial literacy training
Concept of VO, formation process and its functions
Livelihoods training
training on health and nutrition module
Others (Specify)
Don’t remember
C15
Who provided the training?
DRP
BRP
ICRP
ICRP-FNHW
Samuh Sakhi
Bank Sakhi
Others (Specify)
Don’t remember
SHG Finances
D01
Did this SHG receive Revolving Fund (RF)?
Yes
No
D02
When did this SHG receive RF?
D03
Investigator: Please record the amount of RF received.
D04
How was the RF distributed among SHG members?
Distributed equally among the members
Preference was given to the poorer members
Given to members who have asked for it
D05
Amount of RF repaid by the members to the SHG?
D06
Has this SHG prepared a Micro Credit Plan (MCP)?
Yes
No
D06A
Whether Micro Credit Planning (MCP) is a one-time event or it is updated every year?
Onetime event
Updated every year
Others (specify)
D07
Did this SHG receive CIF?
Yes
No
D08
When did this SHG receive CIF?
D09
Investigator: Please record the amount of CIF received.
D10
Was CIF distributed according to the Micro Credit Plan (MCP)?
Yes
No
D11
What is the total amount of the CIF repaid by the SHG to the VO till date?
D11_1
Were the financial activities of the SHG (savings, inter-loaning, repayment) continued during CORONA (COVID-19) lockdown?
Yes
No
D11_2
How were these financial activities carried out during CORONA (COVID-19) lockdown?
Through digital payment
Door to door collection of money from SHG members
Others (specify)
D11_3
Has the repayment of loan by the SHG members affected due to CORONA (COVID-19) lockdown?
Yes, there is an increase in number of defaulters
No, repayment trend remains same as before
Don’t know/ Can’t say
D11_4
Amount of CIF repaid by the SHG to the VO during CORONA lockdown
D12
Did this SHG receive any bank loan?
Yes
No
D13
How many times did this SHG receive a bank loan since its formation?
D14
What were the purposes for which bank loan was taken ?
D15
What is the total amount of bank loan received till date?
D16
What is the amount of bank loan repaid by the SHG till date?
D16_1
Was SHG able to access banking services during CORONA lockdown?
Yes
No
D16_2
Which banking services were accessible during CORONA lockdown?
Cash/cheque deposit
Cash withdrawal
Applying for loan
Repayment of loan
Others (specify)
D16_3
Why were banking services inaccessible ?
Movement outside the village was restricted
Bank was not providing any services
Others (Specify)
SHG Savings and Loans
E01
UID
E02
Name of the current SHG member
E03
Whether included in household survey?
Yes
No
E04
Number of meetings attended by the member in the last 12 months
E05
Number of times the member saved in the SHG in the last 12 months
E06
Total savings of the member till date
E07
Total number of loans received by the member till date ?
E08
What was the purpose for taking these loans?
For investing in livelihood activity
For medical expenditure
for other household expenditures
Don’t know
E09
Whether any of the loan is taken from CIF?
Yes
No
E10
Amount of CIF taken by the member
E11
Amount of CIF repaid by the member
E12
Duration taken to repay the loan (loan repaid till date)
E13
Has the member received Vulnerability Reduction Fund (VRF)?
Yes
No
Adherence to Dasasutra
F01
What is the frequency of SHG meetings?
Weekly
Fortnightly
Monthly
Irregular
F02
Number of meetings held in the past 12 months
F02A
Meetings held before CORONA (COVID-19) lockdown
F02B
Meetings held during CORONA (COVID-19) lockdown
F02C
Meetings held after CORONA (COVID-19) lockdown
F03
Can you please tell me if the last four meetings were conducted?
F03_1
Meeting 1
Yes
No
F03_2
Meeting 2
Yes
No
F03_3
Meeting 3
Yes
No
F03_4
Meeting 4
Yes
No
F03A
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)
F04
How many SHG members were absent in each of the last four consecutive meetings
F04_1
Meeting 1
F04_2
Meeting 2
F04_3
Meeting 3
F04_4
Meeting 4
F05
Does the meeting have a structured agenda?
Yes
No
F06
What was the agenda for the last four meetings conducted?
F06_1
Meeting 1
F06_2
Meeting 2
F06_3
Meeting 3
F06_4
Meeting 4
F07
Does the place for the meeting is fixed or keep rotating?
Fixed
Rotating
F08
Does the SHG own or is it a rented place for meeting?
Own
Rented
F09
What is the rent paid for this meeting place?
F10
What are the ways of choosing office bearers?
Members consent
On rotation
Self-declared
Elections
Ohers (Specify)
F11
Has the office bearer rotated since the formation of the SHG?
Yes
No
F12
Reasons for non-rotation of office bearers?
Present office bearers unwilling to step down
Other members are unwilling
Bankers not accepting for changing office bearers
All other members are illiterate
Nobody informed us
Others (Specify)
F13
What is the norm set by the group for frequency of savings?
Weekly
Fortnightly
Monthly
Not fixed
F14
What is the prescribed savings amount per member per meeting?
F15
Is there a norm in your group for penalizing a member if she misses any saving?
Yes
No
F16
What is the rate of penalty?
F16A
Was penalty levied even during the lockdown period?
Yes
No
F17
When are the savings collected?
During the meeting
Outside the meeting
Both during and outside the meeting
F18
What is usually done with the savings?
Held with the leader or bookkeeper
Remitted in the bank in one or two days
Inter-lent immediately
Others (Specify)
F19
What is the process for obtaining a loan from the SHG?
Member applies in advance for loan
Member requests for loan during meetings
Member requests and obtains loan outside the meeting
Others (Specify)
F20
Where does loaning activity usually take place?
During the meeting
Decisions in the meeting, but transactions outside the meeting
Outside the meeting in case of emergency
Sometimes during the meeting and sometimes outside the meeting
Always outside the meeting
F23
What is the rate of interest on the loan?
F23A
Was there any subsidy on rate of interest on the SHG loan during CORONA lockdown period?
Yes
No
F23B
What was the rate of interest on the loan during lockdown?
F24
What is the usual cycle of repayment?
Weekly
Fortnightly
Monthly
Others (Specify)
F25
Is the rate of interest uniform for all types of loans?
Yes
No
F26
On what basis is the differential rate of interest for loans decided?
Purpose of the loan
Past credit history with SHG of the member
Economic status of the member
Duration of the loan
Others (Specify)
F27
Is there a system of collecting penalties/fines for delayed repayment of the loan?
Yes
No
F28
What is the penalty for delayed payments?
F28A
Was the penalty levied on delayed repayment even during the CORONA lockdown period?
Yes
No
F29
What is the method of supervision over the end-use of loan?
Review in group meetings
VO/CLF sub-committee constituted to monitor
No supervision mechanism
Others (Specify)
F30
Is there an action taken on loan defaulters?
Yes
No
F31
What action is taken for loan defaulters?
Removing member from the SHG
Financial penalty
Taking over HH assets
Taking over SHG savings
Refusal of provision on loans
Others (Specify)
F32
Please request for the following books/ records and fill in the data
F32A
Name of the book
F33
Adopted
F32A_1
Minutes book
Yes
No
F32A_2
Loan ledger
Yes
No
F32A_3
General ledger
Yes
No
F32A_4
Savings ledger
Yes
No
F32A_5
Cash book
Yes
No
F32A_6
SHG bank passbook
Yes
No
F32A_7
SHG VO passbook
Yes
No
F32A_8
Individual member passbook
Yes
No
F32A_9
Others (Specify)
Yes
No
F32B
Date when last updated
F32B_1
Minutes book
F32B_2
Loan ledger
F32B_3
General ledger
F32B_4
Savings ledger
F32B_5
Cash book
F32B_6
SHG bank passbook
F32B_7
SHG VO passbook
F32B_8
Individual member passbook
F32B_9
Others (Specify)
Information on Roll out of Health and Nutrition Module
G01_1
Does your group discuss about the Health and Nutrition related issues – importance of balance diet, Newborn care and child feeding practices, child and maternal health, health services in the village ?
Yes
No
G01_2
Does your group discuss about Sanitation related issues- importance of cleanliness, sanitation practices, availability of clean drinking water, construction of toilets etc ?
Yes
No
G01_3
Does your group discuss about Education in the village- school enrolment, availability of the teaching staff etc.?
Yes
No
G01_4
Does your group discuss about Involvement in Panchayati Raj Institutions – Participation in Gram Sabha (General)?
Yes
No
G01_5
Does your group discuss about Active Participation in Government Schemes- by facilitating members to access Govt. Welfare/ Development Schemes/Programs (e.g. MGNREGS, PDS, etc. ?
Yes
No
G01_6
Does your group discuss on Household Livelihoods ?
Yes
No
G01_7
Does your group discuss about Self-employment schemes?
Yes
No
G02
Was health & nutrition discussed during SHG meetings in the last 3 months to inform currently pregnant or mother of newborn child about health and Nutrition practices?
Yes
No
G03
Health and Nutrition modules discussed in the last 3 months during SHG meetings?
G04
Do the SHG members also invite their household members, such as currently pregnant women, or mothers of newborn children, to such meetings?
Yes
No
G05
What are the topics were discussed in the past 3 months in such meetings?
G06
Who facilitate/ lead such meetings?
ICRP
ICRP- FNHW
ASHA/ANM/AWW
Others (Specify)
G07
Does this SHG plan to discuss Health and Nutrition during meetings to inform currently pregnant or mother of newborn child about health and Nutrition practices?
Yes
No
G08
What will be the average amount of time spend discussing Health and Nutrition during SHG meetings?
G09
Will the SHG members also invite their household members, such as currently pregnant women, or mothers of newborn children, to such meetings?
Yes
No
G10
What will be the topics discussed?
G11
Who will facilitate/ lead such meetings?
ICRP
ICRP- FNHW
ASHA/ANM/AWW
Others (Specify)
G12
Whether any FLW (ASHA/ANM/AWW) is a member of SHG ?
Yes
No
G13
When was the last SHG meeting on Health and Nutrition was held ?
G14
Number of SHG members who attended the meeting?
G15
Number of non-SHG members (from SHG households) who attended the meeting?
G16
Has your SHG received any information/directives on CORONA (COVID-19)
Yes
No
G17
Who has provided the information/directives ?
UPSRLM officials
ASHA/ANM
AWW
Gram Pradhan/sarpanch
VO
CLF
Other(specify)
G18
What are the directives/infromation your SHG has received?
Suspend all the SHG meetings until the next notice
Information on symptoms of CORONA (COVID-19)
Information on preventive measures for CORONA (COVID-19)
Instructions on how to carry out the SHG financial activities during the lockdown
Others (specify)
G19
What are the initiatives that your SHG took to fight against CORONA (COVID-19) in your village?
Provide information on symptoms and prevention from CORONA (COVID-19) to the villagers through mobile messaging
SHG members made face mask and sanitizers
SHG members helped ASHA/ ANM/ AWW in distribution of face masks and sanitizers
SHG had set up a community kitchen to feed poor and the vulnerable
Others (specify)
No initiative taken
G20
What are the preventive measures SHG members are adopting while helping with the CORONA situation at community level?
Wash hands frequently
Wash hands frequently with soap
Clean hands with sanitizer
Cover nose and mouth with handkerchief/ tissue/elbow while coughing or sneezing
Don't touch eyes, nose, or mouth
Don't be in close physical contact with anyone
Avoid crowded places
Be at least 1 meter away from everyone
Don't spit in public
Wear a mask if sick
Avoid physical contact with infected individuals
Avoid touching common surfaces, items or sharing plates/utensils
Avoid touching what sick persons have touched such as surfaces, items, plates/utensils
Keep cleaning common surfaces
Don't shake hands with others
Others (specify)
Dear user, please upgrade your plan to access this feature
See Plans
Please Wait