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Clf Template 6 -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
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?
C09
Leadership
C10
Name of the office bearer
C11
Social category of this office bearer
SC
ST
OBC
General
Others
C12
Position currently held by this office bearer
President
Vice president
Secretary
Treasurer
Deputy Secretary
C13
How many times has the position rotated since the formation of CLF?
C14
In which year did the last rotation in position take place?
C15
Is the current position a paid position?
Yes
No
C16
Education level of this office bearer
Primary
Middle
Secondary
Senior secondary
Certificate/ Diploma course
Graduate
Postgraduate
Others, specify
Never attended school
C17
Is the office bearer differently abled?
Yes
No
C18
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)
C19
Governing Body/ Executive Committee (EC)
C20
When was the present Executive Committee (EC) of the CLF constituted?
C21
What is the norm for conducting EC meeting of this CLF?
Fortnightly
Monthly
Quarterly
Other (specify)
C22
How many EC meetings were held in the last 12 months?
C23
Can you please tell me if the last four two meetings were conducted?
C23A
Meeting 1
Yes
No
C23B
Meeting 2
Yes
No
C24
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)
C25
How many EC members were absent in each of the last four two consecutive meetings?
C26
What was the penalty levied if any of the EC member did not attend the EC meeting?
C27
Were the following issues discussed during the last 2 EC meetings?
C27_1
Health and nutrition related issues – importance of balance diet, child and maternal health, health services in the village
No
Yes but not recorded in register
Yes and recorded in register
C27_2
Sanitation related issues- importance of cleanliness, sanitation practices, availability of clean drinking water, construction of toilets etc
No
Yes but not recorded in register
Yes and recorded in register
C27_3
Education in the village- school enrolment, availability of the teaching staff etc.
No
Yes but not recorded in register
Yes and recorded in register
C27_4
Involvement in Panchayati Raj Institutions – Participation in Gram Sabha (General)
No
Yes but not recorded in register
Yes and recorded in register
C27_5
Active Participation in Government Schemes- by facilitating members to access Govt. Welfare/ Development Schemes/Programs (e.g. MGNREGS, PDS, etc.
No
Yes but not recorded in register
Yes and recorded in register
C27_6
Discussion on Household Livelihoods (e.g., Livestock, Animal husbandry, farming etc.)
No
Yes but not recorded in register
Yes and recorded in register
C27_7
Self-employment schemes
No
Yes but not recorded in register
Yes and recorded in register
C27_8
Discussion around ways to prevent CORONA (COVID-19) infection, social distancing, handwashing, use of mask etc.
No
Yes but not recorded in register
Yes and recorded in register
C28
Sub-committees of the CLF
C29
Has the CLF has formed different sub-committees for managing various roles and responsibilities of the CLF?
Yes
No
C30
When was this committee formed?
C30_1
Social Action Committee
C30_2
Bank linkage/CBRM committee
C30_3
Livelihoods committee
C30_4
procurement committee
C30_5
Monitoring committee
C31
How many members are there in the committee currently?
C31_1
Social Action Committee
C31_2
Bank linkage/CBRM committee
C31_3
Livelihoods committee
C31_4
procurement committee
C31_5
Monitoring committee
C32
How many times did this committee meet in the last 12 months?
C32_1
Social Action Committee
C32_2
Bank linkage/CBRM committee
C32_3
Livelihoods committee
C32_4
procurement committee
C32_5
Monitoring committee
C33
Do ASHA/ANM/AWW attend the EC meetings?
Yes
No
C34
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)
C35
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
D01
How many VOs are member of this CLF?
D02
What is the membership fee paid by member VOs?
D03
What is the name of the VO?
D04
When did this VO join the CLF?
D05
In which gram panchayat is the VO located?
D06
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
D07
How many SHG are there in the in this CLF?
D08
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)
D09
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)
D10
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)
D11
What kind of support does this CLF provide to the VOs for rolling out Health and Nutrition module? (Multiple response)
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
E01
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)
E02
Name of this community cadre?
E03
Gender of this community cadre?
Male
Female
E04
Age in years completed
E05
Social category of this community cadre?
General
SC
ST
OBC
Minority
Others
E06
Religion of the community cadre?
Hinduism
Islam
Christianity
Jainism
Sikhism
Buddhism
Others
E07
Education level of this community cadre?
Primary
Middle
Secondary
Senior secondary
Certificate/ Diploma course
Graduate
Postgraduate
Never attended school
Others (specify)
E08
Since when the community cadre is working?
Maintenance of Records
F01
Whether the record is introduced in the CLF?
F01_1
Minutes Book
Yes
No
F01_2
CLF passbook
Yes
No
F01_3
General Ledger
Yes
No
F01_4
Cash Book
Yes
No
F01_5
Loan Register/Ledger
Yes
No
F01_6
Receipt Book/Voucher
Yes
No
F01_7
Payment Voucher Book
Yes
No
F01_8
Cheque Issue Register
Yes
No
F01_9
DCB
Yes
No
F02
Please record date last updated
F02_1
Minutes Book
F02_2
CLF passbook
F02_3
General Ledger
F02_4
Cash Book
F02_5
Loan Register/Ledger
F02_6
Receipt Book/Voucher
F02_7
Payment Voucher Book
F02_8
Cheque Issue Register
F02_9
DCB
Financial Management
G01
Did this CLF receive Community Investment Fund (CIF)?
Yes
No
G02
When did this CLF receive CIF ?
G03
Total amount of CIF received by this CLF till now
G04
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)
G05
Did this CLF receive any bank loan?
Yes
No
G06
When was the first time this CLF received a bank loan?
G07
How many times has this CLF received a bank loan ?
G08
Total amount of bank loan received by the CLF till date
G09
Total amount of bank loan repaid by the CLF
Collective Business Activity
H01
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
H02
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)
H03
Is the CLF involved in this activity currently?
Yes
No
H04
What was the date of start of this activity?
H05
How many member VOs are part of the activity?
H06
What was the amount invested?
H07
What is the total expenditure incurred in past 1 years?
H08
What is the total revenue form the enterprise in past 3 years?
H09
What is the profit from the enterprise in past 3 years?
H10
How did you distribute profit?
Equally among member VOs
Among member VOs as per time- spent on activity
Others (specify)
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