DATA CAPTURE FORM

BARANGAY: ___________
Year Under Review (Preceding Year) ___________

GENERAL INFORMATION

Region: ___________
Province: ___________
Congressional District: ___________
City/Municipality: ___________

Legal Basis of Creation: ___________ Date of Ratification/Plebiscite: ___________

Land Area (in hectares): ___________

Barangay Category and Characteristic:

URBAN Agricultural Coastal Upland Lowland Land Locked
RURAL Agricultural Coastal Upland Lowland Land Locked

Number of: Total Female Male

Population: (if NSO Data is not available, ___________ ___________ ___________
use RBI)
Labor Force: ___________ ___________ ___________
Unemployed: ___________ ___________ ___________
Registered Voters: ___________ ___________ ___________
Families: ___________
Households: ___________
Precincts: ___________

Total Income: P______________

Internal Revenue Allotment: P______________
Local Source: P______________
Others (pls. specify): _________________

Basic Utilities/Services:
Power Supply: Electric Cooperative Others: ______________
No. of Families with access to electricity _________

Water Supply: (pls. indicate level) First Second Third

Means of Transportation: ________________________
Means of Communication: (telephone, cellphone, etc., indicate name of provider) ________________________

Awards/Recognition Received (specify title)

National Level: _______________________________________________________________

Regional Level: _______________________________________________________________

Local Level: _______________________________________________________________

 2.1.1.2 Created BDC Executive Committee Yes No
2.1.1.3 Conducted Meetings Yes No

2.1. Formulated Current Year Annual Investment Plan Yes No

2
2.1. Developed Program for Differently-Abled Persons Yes No
3
2.1. Implemented the Informal Settler/Mendicants Monitoring Program Yes No
4
2.1. Developed/Updated the following Database System:
5 2.1.5.1 Registry of Barangay Inhabitants Yes No
2.1.5.2 Socio-Economis Profile Yes No
2.1.5.3 Others, please specify Yes No

Service Area 2.2 Revenue Generation

2.2. Enacted Tax Ordinance Yes No

1
2.2. Conducted Fund Raising Activity Yes No
2
2.2. Generated Income from Barangay Economic Enterprise Yes No
3
2.2. Developed Financial Management System Yes No
4
2.2. Formulated Barangay Revenue Code Yes No
5

Service Area 2.3 Revenue Allocation and Utilization

2.3. Appropriated/Expended Fund for the following: Yes No

1
Actual Amount
Appropriation Expenditure %Ceiling
- Personal Services ______________ ______________ ______________
- Development Fund ______________ ______________ ______________
- Calamity Fund ______________ ______________ ______________
- Sangguniang Kabataan ______________ ______________ ______________
- Gender & Development ______________ ______________ ______________
- Others, pls specify ______________ ______________ ______________

Service Area 2.4 Fiscal Accountability

2.4. Prepared Certified Statement of Actual Income & Expenditures Yes No

1
2.4. Functional Bids and Awards Committee Yes No
2 - Number of BAC Meetings Conducted: _________
2.4. Formulated Annual Procurement plan using NGAS Yes No
3
2.4. Prepared Annual Inventory of Barangay Assets using NGAS Yes No
4
2.4. Prepared/Submitted Barangay Financial Report using NGAS Yes No
5
2.4. Prepared/Submitted Barangay Disbursement Report Yes No
5

Service 2.5 Facilities and Services

2.5. Prescence of Barangay Hall Yes No

1