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Village Organisation (Vo) Office Bearer -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 Unique ID
Survey Information
101
Name of the respondents
103
Respondent identification code
104
FIRST VISIT
104_1
Interviewer name
104_2
Interviewed code
104_3
Date of the interview
104_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)
104_5
Record time when you start the interview
105
SECOND VISIT
105_1
Interviewer name
105_2
Interviewed code
105_3
Date of the interview
105_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)
105_5
Record time when you start the interview
106
THIRD VISIT
106_1
Interviewer name
106_2
Interviewed code
106_3
Date of the interview
106_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)
106_5
Record time when you start the interview
VOFormation, Training and Capacity Building
A01
What is the name of this VO?
A02
What is the date of formation of this VO?
A03
How many SHGs are member of this VO?
A04
What is the membership fee paid by member SHGs?
A05
What is the renewal fee (yearly membership) paid by member SHGs?
A06
In the last one year, has the accounts of this VO been reviewed by the CLF?
Yes
No
A07
Training Type
Exposure Visit of functional VO
VO Concept and Functioning (VM)
VO Books Keeping (VBKM1)
Refresher VBKM1
Roles of VO Sub-Committee
Procurement Sub-Committee
Fund management
MCP/MIP Preparation/Facilitation and Appraisal
Leadership/Group management
Grading of SHG
Livelihood and Income Generation
Cadre Review
Convergence
Other
A08
What is the status of training?
No
Yes
A09
Date
A10
Duration (In Days)
A11
Who facilitated the training?
MSRLM team
External Trainer
ICRP/ECRP
CTC/Sanghatika
A12
Where was training conducted?
At VO office
At Cluster office
At Block office
Any Other
A13
Was training material provided?
No
Yes
A14
To whom the training was imparted?
To Group Leaders
To all members
To few members and group leaders
Book Keeper
Any other, please specify
A15
Was the training useful and content relevant?
Very much
Somewhat
Not much
A16
Do you recall the training content?
Able to recall well
Able to recall partly
Not able to recall
A17
Is the training session noted in book of records?
No
Yes
Leadership
B01
Name of the office bearer
B02
Age of this office bearer
B03
Religion of this office bearer
Hinduism
Islam
Christianity
Sikhism
Buddhism
If other (Specify___)
B04
Social category of this office bearer
SC
ST
OBC
General
If other (Specify___)
B05
Position currently held by this office bearer
President
Vice President
Secretary
Treasurer
B06
How many times has the position rotated since the formation of VO?
B07
In which year did the last rotation in position take place?
B08
Is the current position a paid position?
Yes
No
B09
Education level of this bearer
Primary
Middle
Secondary
Senior secondary
Certificate/Diploma course
Graduate
Postgraduate
If others(specify)
B10
What type of ration card does the member's household have ?
Orange (APL)
Yellow (BPL)
White (Annual Income > Rs 1 Lakh)
Annapurna (Age above 65 years)
Antodaya Anna Yojana (AAY)
Priority Household (PHH)
Do not have any ration card
Do not know
If Other, please specify
B11
Is the office bearer disabled ?
Yes
No
B12
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)
Governing Body/ Executive Committee (EC)
C01
When was the present Executive Committee (EC) of the VO constituted?
C02
How frequently do the Governing Body/ Executive Committee of this VO meet?
Fortnightly
Monthly
Quarterly
If others (specify___)
C03
How many EC meetings were held in the last 12 months?
C04
Can you please tell me if the last four meetings were conducted?
Yes
No
C04A
Meeting 1
Yes
No
C04B
Meeting 2
Yes
No
C04C
Meeting 3
Yes
No
C04D
Meeting 4
Yes
No
C05
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___)
C06
How many EC members were absent in each of the last four consecutive meetings?
C06A
Members
C06B
Members
C06C
Members
C06D
Members
C07
Was any penalty levied on any of the EC member who did not attend the EC meeting?
Yes
No
C08
What topics were discussed in the last 4 meetings of the EC
Issues related to savings & loans
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Issues related to VHSND
Quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA
If others (Specify___)
C08A
Meeting 1
Issues related to savings & loans
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Issues related to VHSND
Quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA
If others (Specify___)
C08B
Meeting 2
Issues related to savings & loans
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Issues related to VHSND
Quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA
If others (Specify___)
C08C
Meeting 3
Issues related to savings & loans
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Issues related to VHSND
Quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA
If others (Specify___)
C08D
Meeting 4
Issues related to savings & loans
Maintenance of records
Disbursement of CIF
Schedule and loan repayment terms
Issues related to VHSND
Quality of services provided by ASHA/AWW/ANM
Sanitation issues
Convergence with welfare schemes
Gender issues
Symptoms and preventive measures for CORONA
If others (Specify___)
Sub-Committees
D01
Has the VO formed different sub-committees for managing various roles and responsibilities of the VO?
Yes
No
D02
COMMITTEE TYPE
Social Action Committee
MIP Approval/ Livelihoods Committee
Education Committee
SHG Monitoring Committee
Bank Linkage and Repayment Committee
Procurement Committee
If others(specify____)
D03
When was this committee formed?
D04
How many members are there in the committee currently?
D05
How many times did this committee meet in the last 12 months?
D06
Key roles and responsibilities of the committee
D07
What are the trainings received by this committee to perform its duties?
Need for formation of sub-committees and review process
Training on health and nutrition practices
training on livelihood and procurement
training on monitoring and reviewing SHG work
If others (specify___)
D08
How would you rate the effectiveness of this committee?
very effective
effective
not effective
no response
D09
Has the Sub-committee formation and the name of members in the sub-committee been documented in the Minutes Book?
Yes
No
Review and Monitoring
E01
How often does the VO review the activities of the member SHGs?
Weekly
Fortnightly
Monthly
Once in two months
No predetermined frequency
Never reviewed
Ifothers (Specify__)
E02
What SHG activities are reviewed by the VO?
Books of records /Quality of bookkeeping
Micro credit plan
Utilization of the CIF
Democractic and financial transaction in SHG
Financial transaction between VO nad SHG
Social Issues
SHG Bank-Linkage
If others (Specify__)
E03
What kind of support does this VO provide to the member SHGs?
Providing handholding support in maintenance of records
Providing support for rolling out Health and Nutrition module in the SHG
Providing information on flagship government schemes
Helping in establishing group-level livelihood activity
Facilitating market linkages
If others (Specify__)
E04
Does this VO submit monthly progress report (maasiknivedika) to CLF?
Yes
No
E05
What major points are covered in monthly progress report?
Progress of VO level financial and Non-Financial transaction
VO level report of SHGs prepared and used for review of the groups
Progress of convergence and other activities at the VO level
E06
Does this VO generate action plans?
Yes
No
E07
When was the last time when this report submitted to CLF?
E08
Does this VO conduct grading of SHG?
Yes
No
E09
How many SHGs have been graded till now by this VO?
E10
How many meetings VO conduct for reviewing adoption of Dashsutri by SHG?
One
Two
Three
Four
More than four
E11
What kind of services does VO provide to member SHGs?
Mentor and Strenghten the capacity of member SHGs
Improve quality of SHGs through encouraging them to follow Dashsutra
Increase participation opf SHG members in Gram Sabha
Establish linkages with PRI and government schemes at village/panchayat level
Audit services
Resolve conflicts among SHGs
If others (Specify__)
E12
How frequently General Body Meetings (GBMs) are conducted?
Fortnightly
Monthly
Quaterly
Bi- Annually
Annualy
E13
When was the last Annual General Meeting (AGM) conducted?
Meeting Regularity and Attendance in Last Six Months/Meetings
F01
S. No.
F02
Date of Meeting
F03
Number of SHGs as member
F04
Number of SHGs present
F05
Presence of Umed Staff
Yes
No
F06
Presence of VO Accountant
Yes
No
F07
PRP
Yes
No
F08
Sanghatika/ ICRP
Yes
No
Maintenance of Records
G01
Books of Records
Membership Register
Meetings Register
Minutes Book
Savings Register
General Ledger
Daily Expenses Register
Cash Book
Loan Register
Receipt Book
Voucher Book
Stock register
Financial statements
VO Passbook
Cheque Issue Register
VO DCB Register
Others (specify)
G02
Check if following book of records is available or not?
Yes
No
G03
Check if book of records is updated or not?
Updated till last meeting
Partly updated
Incomplete
G04
Please record date last updated
G05
Please specify reason for not updating book of records
Book keeper 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 SHG
Book format has changed and training is yet to be given
Book Keeper has not been appointed
Book Keeper appointed but not interested/irregular
Any other
Revolving/ Community Investment Fund (RF/ CIF)
H01
Did this VO receive Revolving/ Community Investment Fund (RF/ CIF)?
Yes
No
H02
When did this VO receive RF/ CIF?
H03
Total amount of RF/ CIF received by this VO till now
H04
Total amount of RF/ CIF disbursed to the member SHGs
H05
Total amount of RF/ CIF repaid by member SHGs to the VO till date
H06
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____)
H07
Did this VO receive any bank loan?
Yes
No
H08
When was the first time this VO received a bank loan?
H09
How many times has this VO received a bank loan?
H10
Total amount of bank loan received by the VO till date
H11
Total amount of bank loan repaid by the VO till
Micro Credit Plans of SHGs
I01
How many SHG under this VO involve in Micro credit planning?
I02
What type of micro plans are approved by this VO?
Income generation
Health
Education
Consumption
Housing
Social needs
If others (Specify____)
I03
How frequently these micro plans are prepared?
I04
How much time does it takes to approve a micro credit plan?
A week
15 days
One Month
More than a month
I05
How much time does it require to transfer micro credit funds to beneficiary accounts?
A week
15 days
One Month
More than a month
I06
What is the mode of fund transfer?
Cash
Bank account transfer
If others (Specify____)
I07
How regularly micro credit book of records are maintained?
Weekly
Monthly
Bi-Monthly
Within 6 months
If others (Specify____)
I08
How many micro credit trainings for SHG members are conducted in lastone year?
I09
How many SHG members generally attend these micro credit trainings?
I10
How many micro credit plans of SHG households have been approved in last 6 months?
I11
How frequently SHGs have been graded since inception?
3 months
6 months
9 months
If others (Specify____)
Revolving/ Community Investment Fund (RF/ CIF) and Bank Loan Details
J01
Number of SHGs in VO
J02
Number of SHGs received RF/CIF
J02A
RF
J02B
CIF
J03
Number of SHGs received RF via VO
J04
Number of SHGS received RF directly
J05
Number of SHGs received CIF via VO
J06
Number of SHGs received CIF directly
J07
Name of SHG
J08
Revolving Fund Details (if disbursed via VO)
J08A
Date Proposed
J08B
Date Sanctioned
J08C
Amount of RF Received
J09
VO General Loan Details
J09A
Total Amount Sanctioned
J09B
Number of Member
J09C
Total Amount Outstanding
J09D
Regular Repayment
J10
Name of SHG
J11
CIF Details
J11A
Date Proposed
J11B
Date Sanctioned
J11C
Amount of CIF Received
J11D
Has it started Returning CIF
Yes
No
J11E
Is Repayment Schedule
Fixed
Flexible
J11F
Amount Outstanding
J11G
MCP/MIP Followed
Yes
No
J12
Name of SHG
J13
SHG Bank Linkage Details
J13A
Bank Loan Disbursement Date
J13B
Bank Loan Amount Proposed
J13C
Bank LoanAmount Disbursed
J13D
Bank LoanAmount Outstanding
J13E
Date of Last Repayment to Bank
J13F
MCP/MIP Followed
Yes
No
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