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Process Monitoring Template 4 -Form Fill

Identification Information
Q01

District Name

Q02

District Code

Q03

Block Name
Q04

Block Code
Q05

Model Cluster Level Federation Name
Q06

Model Cluster Level Federation Unique ID
Survey Information
A01

Name of the respondents
A02

Designation of the respondent
A03

FIRST VISIT

A03_1

Interviewer name
A03_2

Interviewed code
A03_3

Date of the interview
A03_4

Result of the interview
A03_5

Record time when you start the interview
A03_6

Record time when you end the interview
A04

SECOND VISIT

A04_1

Interviewer name
A04_2

Interviewed code
A04_3

Date of the interview
A04_4

Result of the interview
A04_5

Record time when you start the interview
A04_6

Record time when you end the interview
A05

THIRD VISIT

A05_1

Interviewer name
A05_2

Interviewed code
A05_3

Date of the interview
A05_4

Result of the interview
A05_5

Record time when you start the interview
A05_6

Record time when you end the interview
M-CLF Formation, Training, and Capacity Building
B01

What is the name of this M-CLF?
B02

What is the date of formation of this M-CLF?

B03

How many VOs are a member of this M-CLF?
B04

How many VOs had left the M-CLF since formation?
B05

Is this M-CLF registered?
B06

What is the reason for delay in the registration process of M-CLF?
B07

What is the date of registration of this M-CLF?
B08

Does this M-CLF receive the registration certificate?
B09

Does this M-CLF display the registration certificate in their office premises?
B10

Has the office of M-CLF been established?
B11

Date of establishment of the office?
B12

Why the office M-CLF not established yet?
B13

Is the office of M-CLF functional?
B14

Why the office of M-CLF not functional?

Operational Guidelines of M-CLF
C01

Does this M-CLF have operational guidelines?
C02

Do these operational guidelines clearly define the roles and responsibilities of the office bearer of your M-CLF and their subcommittees?

C03

Are these guidelines available in the public domain?
C04

Does the M-CLF review its operational guidelines?
C05

When was the last time your M-CLF had reviewed its operational guidelines?
C06

Does your M-CLF prepare an annual action plan between April 2022 to March 2023?
C07

When was the last time this M-CLF prepared annual action plan?
C08

Who prepares the annual action plan of M-CLF?
C09

What all information do you include in the annual action plan?
C10

What is the reason for not preparing the Annual Action Plans?
C11

Does this M-CLF prepare annual budgets? (April 2022 to March 2023)
C12

What is the reason for not preparing the Annual budgets?
C13

When was the last time when this budget was prepared by M-CLF?
C14

Who is responsible for preparing annual budgets for this M-CLF?
Leadership
D01

Position currently held by this office bearer
D02

Name of the office bearer
D03

Age of this Office bearer
D04

Religion of this office-bearer
D05

Social category of this office bearer
D06

In which year were you appointed for this position?
D07

Is your appointment fresh or repeated?
D08

Do you receive any honorarium for this position?
D09

Education level of this office-bearer
D10

What type of ration card?
D11

Is the office bearer disabled?
BOD/ RGB/ General Body
E01

When was the present Board of Directors (BOD) of the M-CLF constituted?
E02

How frequently do the BOD of this M-CLF meet?

E03

How many were BOD meetings held in the last 12 months? (From April 2022 to March 2023)
E03A

How many BOD have consecutively not attended last three meetings?
E04

Can you please tell me if the last four RGB meetings were conducted?

E04_1

Meeting 1
E04_2

Meeting 2
E04_3

Meeting 3
E04_4

Meeting 4
E05

Why were the meetings not held?
E06

How many members VO were part of this M-CLF in the following months?

E06_1

march, 2023
E06_2

February, 2023
E06_3

January, 2023
E06_4

December, 2022
E07

How many VO (RGB) members were absent continuously from last four meetings?
E08

What topics were discussed in the last 4 meetings of the RGB
E09

Does this M-CLF conduct Annual General Meeting (AGM)?

E10

When was the last Annual General Meeting (AGM) conducted?
E11

How many members were present at the last AGM?
E12

What were the issues raised/ discussed in the AGM?
Sub-Committees
F01

Has the M-CLF formed different sub-committees for managing various roles and responsibilities of the M-CLF?
F01A

What are the reasons for not forming any sub-committee in the M-CLF?
F02

COMMITTEE TYPE
F03

When was this committee formed?
F04

How many members are there on the committee currently?
F05

How many times did this committee meet in the last 12 months?
F06

Were orientation of sub-committee members was done?
F07

Does sub-committee members aware about their key roles and responsibilities of the committee?
F08

How would you rate the effectiveness of this committee?
F09

Does this M-CLF conduct review meetings for sub-committees?
F09A

What is the reason for not conducting review meeting of sub-committees?
F10

How frequently are review meetings conducted?
F11

How many review meetings were conducted in the past 12 months?
Review and Monitoring
G01

What is the target number of households to form SHG under this M-CLF?
G02

How many households are already part of SHGs?
G03

How many SHGs are linked this M-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

Please provide the number of SHG whose office bearers have received training on M-CLF concept.
G08

How many SHGs profile linked to this M-CLF is updated on MIS (SHG Profile entry)?
G09

How many members of SHGs records linked to this M-CLF is updated on MIS?
G10

How many SHGs received Community Investment Money (CIM/ Dari Baksa)?
G11

How many SHGs have a saving bank account opened?
G12

How many SHGs do not have a saving bank account opened?
G13

How many SHGs received all Modular Trainings?
G14

Do all the SHGs have Community Mobiliser (CM) appointed under this M-CLF?
G15

How many SHGs are left to get a Community Mobiliser (CM)?
G16

Does the Community Mobiliser (CM) of all SHGs received training?
G17

How have many SHGs’ members Aadhar seeding completed so far?

G18

How many SHGs maintain the book of records?

G19

How many SHGs have received the Revolving Fund (RF)?
G20

How many SHGs have availed the Initial Capitalization Fund (ICF) from VO?
G21

How many SHGs have their loan account/ Cash Credit Linkage (1st Bank linkage)?
G22

How many SHGs have received bank loans?
G23

Is there a possibility to form more VOs under this M-CLF?
G24

Does all VOs are mapped under this M-CLF?
G25

How many VOs records are updated on MIS?
G26

How many VOs have their saving bank account opened?
G27

Does BOD for all the VOs has been selected?
G28

How many VOs are yet to select their BOD members?
G29

Does OB for all the VOs has been selected?
G30

How many VOs are yet to select their OB members?
G31

Does BOD/ OB of VOs under this M-CLF has received training?
G32

How many VOs have bookkeepers appointed under this M-CLF?
G33

How many of the Bookkeepers of VOs have received training?
G34

Do all VOs under this M-CLF have received Modular training?
G35

How many VOs under this M-CLF have sub-committees formed?
G36

Did the members of sub-committees of VOs were oriented?
G37

How many VOs under this M-CLF received HRF?
G38

How many VOs under this M-CLF received FSF?
G39

How many VOs update the records of the transactions performed in the MIS?
G40

How frequently are the VOs updating MIS?
G41

How many VOs maintain the book of records under this M-CLF?
G42

How many VOs books of records were audited in the financial year 2022-2023?
G43

How many VOs are yet to purchase items through Community Investment Money (CIM/ dari baksa fund)?
G44

How often does the M-CLF review the activities of the member VOs?
G45

What are all the activities of VO reviewed by the M-CLF?
G46

What kind of support does this M-CLF provide to the member VOs?
G47

Does this M-CLF prepare and submit Mashik Prativedan to BPIU?
G48

What is the reason for not preparing mashik Prativedan?
G49

What is the grade of M-CLF awarded by BPIU?
G50

Who prepares the Mashik Prativedan for this M-CLF?
G51

In which month last Mashik Prativedan was Submitted?
G52

Please provide us the status of the last 4 Mashik Prativedan submitted to BPIU

G52_1

44986
G52_2

44958
G52_3

44927
G52_4

44896
G53

Does this M-CLF conduct grading of VO?
G54

How many VOs of this M-CLF are under following grades?

G54_1

Grade A
G54_2

Grade B
G54_3

Grade C
G55

Who conducts the grading process of VO in M-M-CLF?

Maintenance of Book of Records under M-CLFs
H01

Check if the following book of records is available or not?

H01_1

Cash Book
H01_2

General Ledger
H01_3

Minutes Book
H01_4

Loan Register
H01_5

Stock register
H01_6

Cheque Issue Register
H01_7

Membership Register
H01_8

Receipt Book
H01_9

Voucher Book
H01_10

Cadre Selection Register
H01_11

Savings Register
H01_12

Daily Expenses Register
H02

Check if the book of records is updated or not?

H02_1

Cash Book
H02_2

General Ledger
H02_3

Minutes Book
H02_4

Loan Register
H02_5

Stock register
H02_6

Cheque Issue Register
H02_7

Membership Register
H02_8

Receipt Book
H02_9

Voucher Book
H02_10

Cadre Selection Register
H02_11

Savings Register
H02_12

Daily Expenses Register
H03

Please record the date last updated

H03_1

Cash Book
H03_2

General Ledger
H03_3

Minutes Book
H03_4

Loan Register
H03_5

Stock register
H03_6

Cheque Issue Register
H03_7

Membership Register
H03_8

Receipt Book
H03_9

Voucher Book
H03_10

Cadre Selection Register
H03_11

Savings Register
H03_12

Daily Expenses Register
H04

Please specify the reason for not updating the book of records

H04_1

Cash Book
H04_2

General Ledger
H04_3

Minutes Book
H04_4

Loan Register
H04_5

Stock register
H04_6

Cheque Issue Register
H04_7

Membership Register
H04_8

Receipt Book
H04_9

Voucher Book
H04_10

Cadre Selection Register
H04_11

Savings Register
H04_12

Daily Expenses Register
H05

Is financial statement of previous financial year available in the M-CLF office?
H06

Is Passbook of M-CLF bank account available in the M-CLF office?
H07

Is passbook updated for all the transactions conducted till the date of survey?
H08

What is the reason for not updating the passbook frequently?
H09

Does this M-CLF maintain Cadre Payment register?

Financial Management
I01

Opening of M-CLF Bank Account

I01_1

Is the bank account of M-CLF opened?
I01_2

How many bank accounts are opened and linked with your M-CLF?
I01_3

Type of M-CLF bank account
I01_4

When was the bank account opened for this M-CLF?
I01_5

Whether the signature of the M-CLF President, Secretary, and Treasurer are taken for opening the bank account?

I02

Authorization for operating the M-CLF Bank Account

I02_1

Does two or three signatories, viz. the M-CLF President, Secretary, and Treasurer, mandatorily authorize all bank transactions?

I02_2

Does all deposit and withdrawal slips, NEFT, RTGS receipts, etc., mandatorily signed by two or three signatories?

I03

Custody of cheques and their transactions

I03_1

Are all cheques kept in a safe lock (with two keys) in the M-CLF office only?

I03_2

Is one key for the safe lock kept with the M-CLF secretary and the other with the M-CLF treasurer/ manager?
I03_3

Are any cheques kept in the personal custody of the M-CLF president, secretary, treasurer, master bookkeeper, manager, or member?

I03_4

If “Yes”, was a criminal case filed against the person?

I03_5

Are all cheque transactions recorded in the appropriate book of records that are maintained in the M-CLF office?

I03_6

Do M-CLF President, Secretary, and Treasurer sign the advance or blank cheques?
I04

Office expense

I04_1

Are all office expenses carried out according to rules and regulations set by the Mission guidelines?
I05

Guidelines for funds received from various sources

I05_1

Does this M-CLF receive any fund in the name of NRETP/ BTDP?
I05_2

Whether this fund is managed and utilized according to the set guidelines of BRLPS (JEEViKA)?

I05_3

Are discrepancies in Management and utilization of this fund resolved through filing a criminal case against those involved?

I05_4

What are the lending norms set by M-CLFs for onward lending VO/ SHG/ PG/ PC?

I05_5

Is there a timely flow of funds among CBOs, i.e., from higher federations (M-CLFs) to lower (VOs/ SHGs/ PG/ PC)?
I05_6

How many days does it take to transfer the required fund since the day request has been received from VO/ SHG/ PG/PC?
I06

Cash transactions and Promotion of Digital/ Cashless transactions

I06_1

What is the mode of transaction that happens between M-CLF/ VO/ SHG?
I06_2

Are cash transactions allowed under your M-CLF?
I06_3

Are you aware that the occurrence of cash transactions, if any, will be considered as serious financial lapses, and necessary actions will follow?

I06_4

What type of transactions are done through account transfer/ online transfer/ digital transactions?
I06_5

Can you suggest some ways to reduce the cash transaction amongst M-CLF/ VO/ SHG-Member and vice-versa?
I06_6

Is the promotion of digital transactions a good alternative to cash transactions?
I06_7

What are the reason according you that make digital transactions more beneficial?
I07

Settlement of bills

I07_1

Are all bills scrutinized thoroughly for M-CLF name, date of transaction, item name, quantity, rate, total amount, signature, and authorization of the vendor who raised the bill?
I07_2

Does your M-CLF raise vouchers for the bills that are to be settled?

I07_3

Are the vouchers placed for approval from authorized persons of the M-CLF?
I07_4

Are the bills settled only on the final approval of vouchers from M-CLF authorized persons?
I08

Method for settlement of bills

I08_1

Are all bills settled through either RTGS or NEFT or Crossed Cheques only?
I08_2

While transacting through the crossed check, is it ensured that the authorized persons of M-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 M-CLF office only, noted the details of cheques in chequebook and book of records and then issued the cheque?

I08_3

After clearance of the cheque in the bank, is it ensured that the vendor sign on the receipt register?
I08_4

In case of the transaction through RTGS/ NEFT, is it ensured that the authorized persons of M-CLF note all the details in the RTGS/ NEFT registers available in the M-CLF office?
I09

Maintaining the Books of Records in M-CLF office

I09_1

Are all transactions which are entered in books of records/ registers signed by the President, Secretary, and Treasurer?
I09_2

In every M-CLF meeting, are the members of M-CLF allowed to access and scrutinize the books of records?
I10

Bank reconciliation

I10_1

Does M-CLF Master Bookkeeper carry out the task of Bank Reconciliation every month?
I10_2

Is the Bank Reconciliation file prepared and presented to M-CLF President, Secretary, and treasurer every month?
I10_3

Is the file signed by M-CLF Master Bookkeeper, Manager, M-CLF President, Secretary, and treasurer?

I10_4

Is the bank statement for every month attached to Month Wise Bank Statement File?
I10_5

Are the deposits and withdrawals noted in the bank statements scrutinized regularly on a weekly or monthly basis?
I11

Guidelines for issuing an advance amount

I11_1

How much amount the M-CLF Master Bookkeeper/ Manager is eligible to receive for office expense?
I11_2

Under which head of office expense is this amount utilized?
I11_3

To receive the new advance, what proportion of the existing advance amount must be utilized?
I11_4

Before issuing the advance amount, are all approvals according to the set guidelines of M-CLF taken?

I11_5

Is there any instance when both the M-CLF Master Bookkeeper and manager have received the advance amount at the same time?
I11_6

Is the advance amount utilized completely within a month?
I11_7

Is there any instance when the M-CLF President, Secretary, and Treasurer have received the advance amount?
I12

Statutory Audit

I12_1

Are statutory audits for M-CLF done?
I12_2

Are audit reports available?
I12_3

Are there any objections reported in the audit reports?
I12_4

If yes, are the objections raised were of low, moderate, or high risks?
I12_5

When was the last audit report was prepared?
I12_6

Is this audit report being available to all M-CLF members?
i13

Now I will ask you a few questions about the type of funds received

I13A

Did you receive the following funds?

I13A_1

Startup fund/ Establishment fund
I13A_2

ICF
I13A_3

Bank Loan

I13A_4

Viability Gap Funding (VGF)
I13A_5

Livelihoods Funds/ Funds for PG
I13B

What is the amount of [fund] received by this M-CLF?

I13B_1

Startup fund/ Establishment fund
I13B_2

ICF
I13B_3

Bank Loan

I13B_4

Viability Gap Funding (VGF)
I13B_5

Livelihoods Funds/ Funds for PG
I13C

What is the date of receiving the following funds?

I13C_1

Startup fund/ Establishment fund
I13C_2

ICF
I13C_3

Bank Loan

I13C_4

Viability Gap Funding (VGF)
I13C_5

Livelihoods Funds/ Funds for PG
I14

Cash in hand
I15

Opening Balance (Cash in Bank)
I16

Closing balance

I17

Total amount Received from following sources:

I17_1

Interest received from repayment received from VOs
I17_2

Interest received from bank
I17_3

How much amount received under membership fees from VOs?
I18

Total expenditure of M-CLF on the following:

I18_1

Payment of staff (cadre) through M-CLF

I18_2

Payment of staff (cadre) project
I18_3

Purchase of fixed assets (ag. Purchase/ Construction of M-CLF office, furniture, almirah, etc.)
I18_4

Rent and Maintenance
I18_5

Miscellaneous expenses (e.g., Printing of brochures, purchase of stationery, etc.)
I18_6

Other expenses (specify)
I19

Please give us the detail of On-time repayment (for December 2022- March 2023)

I19A

Expected Principal

I19A_1

44986
I19A_2

44958
I19A_3

44927
I19A_4

44896
I19B

Expected Interest

I19B_1

44986
I19B_2

44958
I19B_3

44927
I19B_4

44896
I19C

Actual Principal

I19C_1

44986
I19C_2

44958
I19C_3

44927
I19C_4

44896
I19D

Actual Interest

I19D_1

44986
I19D_2

44958
I19D_3

44927
I19D_4

44896
Cadre Management
J01

Is this cadre appointed through this M-CLF?

J01_1

Bookkeeper
J01_2

Master Bookkeeper
J01_3

HNS-MRP
J01_4

SJY- MRP
J01_5

JRP
J01_6

Bank Mitra
J01_7

Cluster Facilitator (CF)
J01_8

CM through VOs
J01_9

MIS Operator
J02

How many persons are appointed in this position?

J02_1

Bookkeeper
J02_2

Master Bookkeeper
J02_3

HNS-MRP
J02_4

SJY- MRP
J02_5

JRP
J02_6

Bank Mitra
J02_7

Cluster Facilitator (CF)
J02_8

CM through VOs
J02_9

MIS Operator
J03

Is this cadre received training?

J03_1

Bookkeeper
J03_2

Master Bookkeeper
J03_3

HNS-MRP
J03_4

SJY- MRP
J03_5

JRP
J03_6

Bank Mitra
J03_7

Cluster Facilitator (CF)
J03_8

CM through VOs
J03_9

MIS Operator
J04

What is the reason for not receiving training?

J04_1

Bookkeeper
J04_2

Master Bookkeeper
J04_3

HNS-MRP
J04_4

SJY- MRP
J04_5

JRP
J04_6

Bank Mitra
J04_7

Cluster Facilitator (CF)
J04_8

CM through VOs
J04_9

MIS Operator
J05

How does the M-CLF pay honorarium amount to the cadre?

J05_1

Bookkeeper
J05_2

Master Bookkeeper
J05_3

HNS-MRP
J05_4

SJY- MRP
J05_5

JRP
J05_6

Bank Mitra
J05_7

Cluster Facilitator (CF)
J05_8

CM through VOs
J05_9

MIS Operator
Role of M-CLF in Promoting Livelihoods
K01

Does your M-CLF engaged in income generating livelihood activities?
K02

Which livelihood activities does your M-CLF promote among its members?

K02_1

Farm based livelihood

K02_2

Bee Keeping
K02_3

Rural Retail Mart
K02_4

Didi Ki Rasoi
K02_5

Tailoring / Mask making
K02_6

Art & Craft
K02_7

Milk production/ Dairy
K02_8

Goatry
K02_9

Poultry Murgi Palan
K02_10

Painting
K02_11

Aggarbatti making
K03

Is there any PG formed for following Livelihood activity?

K03_1

Farm based livelihood

K03_2

Bee Keeping
K03_3

Rural Retail Mart
K03_4

Didi Ki Rasoi
K03_5

Tailoring / Mask making
K03_6

Art & Craft
K03_7

Milk production/ Dairy
K03_8

Goatry
K03_9

Poultry Murgi Palan
K03_10

Painting
K03_11

Aggarbatti making
K04

Amount Invested

K04_1

Farm based livelihood

K04_2

Bee Keeping
K04_3

Rural Retail Mart
K04_4

Didi Ki Rasoi
K04_5

Tailoring / Mask making
K04_6

Art & Craft
K04_7

Milk production/ Dairy
K04_8

Goatry
K04_9

Poultry Murgi Palan
K04_10

Painting
K04_11

Aggarbatti making
K05

Profit generated

K05_1

Farm based livelihood

K05_2

Bee Keeping
K05_3

Rural Retail Mart
K05_4

Didi Ki Rasoi
K05_5

Tailoring / Mask making
K05_6

Art & Craft
K05_7

Milk production/ Dairy
K05_8

Goatry
K05_9

Poultry Murgi Palan
K05_10

Painting
K05_11

Aggarbatti making
K06

How many members of households associated with your M-CLF are involved in these livelihood activities?
K07

What were all facilities accessible to member households in farm livelihoods?
K08

Any Livelihood activity closed after Fund support had been stopped?
K09

If yes, Please specify the livelihood activity which was closed due to lack of financial support?

K10

How does M-CLF decide on which livelihood activity a member household will work?
K11

Do your M-CLF facilitate trainings to build the capacity of member households for livelihood activities?
K12

Does your M-CLF provide financial assistance for taking up livelihood activity?
K13

Does this M-CLF engage CRPs/ cadres in promoting livelihood activities?
K14

Does this M-CLF provide an Honorarium to the CRPs/ cadres for the service provided by them?
K15

How many PG/ PC is created by M-CLF till March 2023 (Last month) ?
K16

How many PG/ PC are functional under this M-CLF till March 2023 (Last month) ?
K17

How many PG/ PC is planned for this year (2023-2024) as per the annual action plan?
K18

Is there any JRP working under the catchment of this M-CLF?
K19

Does unemployed youths were identified in the catchment of M-CLF through JRP?
K20

If yes, how many Youths were identified for training in last Financial year (1st April 2022 to 31st March 2023)?
K21

How many training sessions under DDUGKY/ RSETI were conducted for unemployed youths in last financial year (1st April 2022 to 31st March 2023)?
K22

How many youths were trained in last financial year (1st April 2022 to 31st March 2023)?
K23

Was placement provided to these trained youths in last financial year (1st April 2022 to 31st March 2023)?

K24

If yes, how many youths were placed in the last Financial year (1st April 2022 to 31st March 2023) ?
Expectations, Challenges and Way forward
L01

Overall, what changes have you observed in the functioning of this M-CLF in the last 12 months?
L02

What have been the changes in the linkages with VOs and SHGs by the M-CLF in the last 12 months?
L03

What have been the activities done by this M-CLF to promote livelihood activities in the last 12 months?
L04

Have they observed any changes in the repayment of loan availed by the VOs in the last 12 months? If yes, then explain?
L05

What have been the challenges and issues faced by this M-CLF in the last 12 months?
L06

What are the aspirations that were met after forming the M-CLF?
L07

What are the expectations from the M-CLF for future?
L08

Do you have any suggestions for improving the functioning of M-CLF? If yes, what are the suggestions?
L09

Please add your observation (to enumerators)