CDD A-01: Form

MUNICIPAL ACTIVITY ATTENDANCE SHEET

Province: _______________________________________ Date/Duration: __________________________________________
Municipality: _______________________________________ Program/Project (e.g. NCDDP, KC-MCC, etc): __________________
Venue: _______________________________________ Cycle: __________________________________________
Title: _________________________________________________________________________________________________________________________
P CDD Committee
Sex
a Membership
n
S M/BLGU Sector
t I Barangay/ Committee
Last Name First Name M.I. L Age Official? (farmer, Signature

Member
a P Community Name

Chair
P M F (Y/N) women, etc.)
w (BRT, PPT,
i etc.)
d

Sub-total

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 CDD A-02: Form

MUNICIPAL ACTIVITY MINUTES FORM

Region: ___________________________
Province: ___________________________
Municipality: ___________________________
Total Number of Brgys: ___________________________
Venue: ___________________________
Date: ___________________________

1. Activity Profile
Program/Project (e.g. NCDDP, KC-MCC, etc):________________________
Cycle: ____________________________
Activity Name: ____________________________
Facilitators: ____________________________
Documenter/Secretary: ____________________________

2. Attendance
Male attendees: _______
Female attendees: _______
Male IP attendees: _______
Female IP attendees: _______
Male Attendees 60 years old and above: _______
Female Attendees 60 years old and above: _______
Barangay/s represented: ________________________________________

3. Agenda/Objectives
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

4. Highlights of the activity including details of facilitation process and quality of participation of men and
women during the activity. (Attach the LGU prescribed minutes)

5. PINCOs and Grievances

Who raised the Concern and PINCOs and Grievances Resolution/Next Steps/Agreements
Profile of the Person
Ex. Juan, IP member

Prepared by: Approved by:

______________________________ _________________________________
Signature over Printed Name Signature over Printed Name

______________________________ _________________________________
Position Position

Attachments (not limited to the following depending on the activity):

1. Attendance Sheet
2. Resolutions
3. Results/Outputs of the Activity (Copy of Plans)

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 CDD A-03: Form

BARANGAY/COMMUNITY ASSEMBLY ATTENDANCE SHEET

Province: Sarangani Province Date/Duration: _________________________________
Municipality: Malungon Program/Project (e.g. NCDDP, KC-MCC, etc):_________
Barangay/Community: _______________________________________ Cycle: ____________________
Purok/Sitio: _______________________________________ Venue: ____________________
Purpose of BA: _______________________________________
NAME IP B/LGU Position Sex
IP Group Age Signature
Last Name First Name M.I. Leader? (Captain, Kagawad, etc.) Male Female

Sub-Total

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 CDD A-04: Form

BARANGAY/COMMUNITY ASSEMBLY HOUSEHOLD PARTICIPATION

Province: _______________________________________ Date/Duration: __________________________________________
Municipality: _______________________________________ Program/Project (e.g. NCDDP, KC-MCC, etc): __________________
Barangay/Community: _______________________________________ Cycle: __________________________________________
Venue: _______________________________________
Purpose of BA: ___________________________________________________________________________________________________________________
Household Head Name Total Families Present
Pantawid
No. of Non-IP/ No. No. of No. Sector/s
Sitio/Purok IP? Pamilya Remarks
Last Name First Name M.I. Pantawid of Pan- of Represented
Beneficiary?
Pamilya/SLP IP tawid SLP

Sub-Total
4
 CDD A-05: Form

BARANGAY/COMMUNITY ACTIVITY MINUTES FORM

Region: XII
Province: SARANGANI
Municipality: MALUNGON Total HH in the Barangay 343
Barangay/Community: BLAAN Total IP HH in the Barangay 343
Venue: TRIBAL HALL Total Pantawid Pamilya HH in the Barangay 293
Date: DECEMBER 13, 2018

1. Activity Profile
Program/Project (e.g. NCDDP, KC-MCC, etc): KC-PAMANA IP CDD
Cycle: PAMANA-1
Activity Name/Purpose: ICC MEETING
Facilitator/s: JAMAL D. MARIGA
Documenter/Secretary: BAE LITA B. CORANTE

2. Attendance
Male attendees 38 Female attendees 81
Male IP attendees 38 Female IP attendees 81
Male attendees 60 years old and above 1 Female attendees 60 years old and above 2
Total HH represented 119
No. of IP HH represented 119 No. of IP Families represented 3
No. of SLP HH represented 17 No. of SLP Families represented 17
No. of Pantawid HH represented 50 No. of Pantawid Families represented 50
Purok/Sitios represented 8
Sectors represented 2

3. Agenda/Objectives
1. ICC Meeting
 Introduction to PAMANA IP CDD Program,
 The identification of the project along with its implementation and prioritization,
 Brief summary of the tribal resolution format and its formulation,
 And others concerns for PAMANA IP CDD Program.

4. Highlights of the activity including details of facilitation process and quality of participation of men and women during
the activity.
The activity started with the prayer lead by FULONG ORTEGA A. PANDAYAN, member of the tribal council. Then come up
with the opening remarks lead by FULONG JOEL C. CORANTE, tribal chieftain and also the IPMR (Indigenous People Mandatory
Representatives) of the tribal council in barangay BLAAN. And then followed by the facilitator JAMAL D. MARIGA, introducing the
PAMANA IP CDD program, along with the information through the process of identification of the project prioritization and its
implementation through their active participation of the tribal council as well as the indigenous people in the barangay. And brief
summary of the tribal resolution format and its formulation. Series of question were identified and discussed by the facilitator with the
support of the tribal chieftain. The meeting was adjourned by the motion of FULONG JOEL C. CORANTE, followed with closing
prayer lead by FULONG ORTEGA A. PANDAYAN.
5. PINCOs and Grievances
Who raised the Concern and Profile
PINCOs and Grievances Resolution/Next Steps/Agreements
of the Person
Instead of Road Concreting, Construction of Foot
Suggested Road Concreting to Sitio Bridge/Hanging Bridge will be prioritized and it
FULONG ELAY B. MAGPON
Samlang, Magbok, Bago, and Lutay was been decided among its member of the
Member of the Tribal Council
council along with the IP’s in the barangay
BLAAN.

Prepared by: Approved by:

_________________________________ _________________________________
Signature over Printed Name Signature over Printed Name

_________________________________ _________________________________
Position Position

5
 CDD A-05: Form

BARANGAY/COMMUNITY ACTIVITY MINUTES FORM

Region: XII
Province: SARANGANI
Municipality: MALUNGON Total HH in the Barangay 707
Barangay/Community: DATAL BATONG Total IP HH in the Barangay 584
Venue: BARANGAY HALL Total Pantawid Pamilya HH in the Barangay 259
Date: DECEMBER 14, 2018

6. Activity Profile
Program/Project (e.g. NCDDP, KC-MCC, etc): KC-PAMANA IP CDD
Cycle: PAMANA-1
Activity Name/Purpose: ICC MEETING
Facilitator/s: JAMAL D. MARIGA
Documenter/Secretary: EMERALD O. DALAMA

7. Attendance
Male attendees 24 Female attendees 17
Male IP attendees 24 Female IP attendees 17
Male attendees 60 years old and above 0 Female attendees 60 years old and above 0
Total HH represented 41
No. of IP HH represented 41 No. of IP Families represented 41
No. of SLP HH represented 0 No. of SLP Families represented 0
No. of Pantawid HH represented 13 No. of Pantawid Families represented 13
Purok/Sitios represented 7
Sectors represented 2

8. Agenda/Objectives
1. ICC Meeting
 Introduction to PAMANA IP CDD Program,
 The identification of the project along with its implementation and prioritization,
 Brief summary of the tribal resolution format and its formulation,
 And others concerns for PAMANA IP CDD Program.

9. Highlights of the activity including details of facilitation process and quality of participation of men and women during the activity.
The activity started with the prayer lead by EMERALD O. DALAMA, member of the tribal council. Then come up with the opening remarks
lead by DATU MONTOS M. MANGGOY, tribal chieftain and also the IPMR (Indigenous People Mandatory Representatives) of the tribal council in
barangay DATAL BATONG. And then followed by the facilitator JAMAL D. MARIGA, introducing the PAMANA IP CDD program, along with the
information through the process of identification of the project prioritization and its implementation through their active participation of the tribal
council as well as the indigenous people in the barangay. And brief summary of the tribal resolution format and its formulation. Series of question
were identified and discussed by the facilitator with the support of the tribal chieftain. The meeting was adjourned by the motion of DATU
MONTOS M. MANGGOY, followed with closing prayer lead by BAE LILIAN LEOCASIO, a tribal treasurer of the barangay DATAL BATONG.

10. PINCOs and Grievances

Who raised the Concern and Profile of
the Person
DATU MONTOS M. MANGGOY
Tribal Chieftain/IPMR
PINCOs and Grievances Resolution/Next Steps/Agreements
Instead of Animal Dispersing and Solar Drier with
Corn Sheller, they been discussed it thoroughly that
the major problem among Sitios/Purok is having a
flooded area in road section which has the most
Suggested Livelihood Project such as
common problem in every Sitios/Purok. Hon. Ronel
Animal Dispersing and Solar Drier with
Zorilla suggested it among the tribal council that
Corn Sheller
drainage canal was the key solution to address the
problem, it was been decided among the majority of
the council as well as Datu Montos that the drainage
canal will be prioritized for 1st cycle of PAMANA IP
CDD program.

Prepared by: Approved by:

_________________________________ _________________________________
Signature over Printed Name Signature over Printed Name

_________________________________ _________________________________
Position Position

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 CDD A-06: Form

COMMUNITY VOLUNTEER’S PROFILE

Province: Cotabato Municipality: Carmen
Barangay: ___________________
Program: KC-NCDDP Cycle: NCDDP-4
Name: ____________________________, ___________________________________________ _____
Last Name First Name M.I.
Birth date (month/day/year): ___________________________
Sex (Male or Female): _________________ Civil Status: _________________
No. of Children: ___________
Highest Educational Attainment: ___________________________
Occupation: ___________________________
Sector Represented: ___________________________
Current Position in Barangay LGU: ___________________________
Contact Number: ___________________________
Address: Barangay Tupig, Cotabato
I.P.?: _______ I.P. Leader?: _______
Pantawid Pamilyang Pilipino Program Beneficiary? _______ Parent Leader? _______
Sustainable Livelihood Program Beneficiary? _______ SLP Officer? _______
Date of Volunteer’s Identification/Appointment: ___________________________
BSPMC Chair?: _______ Date Started: _______________ Date Ended: _______________

Committee Membership in KC
Date
Name of Committee Position
Start End
Volunteer

Previous Trainings Attended (Non-KC)

Title of Training Training Provider Year Attended

Membership in Other Organization (Non-KC)

Organization Position

_________________________ EBRAHIM M. MOHAMMAD, JR.

Signature of Volunteer Signature over Printed Name
Community Empowerment Facilitator

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 CDD A-07: Form

BARANGAY/COMMUNITY MEETING/TRAINING ATTENDANCE SHEET

Province: Cotabato Date/Duration: __________________________________________
Municipality: Carmen Program/Project (e.g. NCDDP, KC-MCC, etc): KC-NCDDP
Barangay/Community: Tupig Cycle: NCDDP-4
Venue: Barangay Multi-Purpose Hall
Title: Procurement Preparation Meeting
P CDD Committee
Sex
a Membership
n
S Sector
t I M/BLGU
Last Name First Name M.I. L Age Sitio/Purok Committee (farmer, Signature

Member
a P Official?

Chair
P M F Name (BRT, women, etc.)
w
PPT, etc.)
i
d

Sub-total

8
 CDD A-08: Tool

SUB-PROJECT’S HOUSEHOLD BENEFICIARIES

Target? (SP Concept Form Attachment) Actual? (SP Completion Report Attachment)
Municipality: Carmen Program/Project: KC-NCDDP
Barangay/Community: Tupig-Tonganon Cycle: NCDDP-2 Date: Dec. 16, 2016
Sub-Project Name: Const. Of 3 Barrel RCBC at Tonganolan Creek and 3 Barrel RCPC Overflow at Maitum Creek
Sub-Project Type: ___________________________________________________________________________
# of SP Beneficiaries within # of Families within the HH
Sitio / Household Head Name the HH (Beneficiaries of SP only)
Purok (HH Beneficiary of SP) Total Total
Male Female IP Pantawid SLP
Individuals Families
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Sub-
Total
Note: This is an optional form. It can be replaced by other documents available at the community which capture information on Households and
Families including the Pantawid Pamilya Beneficiaries, IP and SLP benefitting from the sub-project.

9
 CDD A-09: Form

OVERSIGHT AND COORDINATING COMMITTEES CHECKLIST

Region: _____________________________
Date accomplished: ____________________

Provincial
Municipal
Date

Regional
Oversight/ Coordinating # of Male # of Female Regular Meetings Conducted
Organized Name of Province / Municipality
Committee Name Members Members (frequency of meetings)
(mm/dd/yy)

Prepared by:

____________________________________
Name of Regional M&E / Area Coordinator
10
 CDD A-10: Form

CDD SUB-PROJECT WORKERS’ BASIC PROFILE

For the Period of (Month/Day/Year) From: ________________ To: ____________________
Municipality: ________________________________________ Cycle: ____________________ Sub-Project Name: ______________________________________________
Covered Barangays by SP: ____________________________ □ Hauling □ Pakyaw □ CFA Sub-Project ID: ___________________________________
Nature of Work Beneficiaries
Birthday
Last Name First Name Middle Name (e.g. laborer, Sex Barangay Name IP
(mm/dd/yy) Pantawid SLP
Carpenter, etc.)

Prepared by: Noted by:

_______________________________ ______________________________
Community Empowerment Facilitator Head, Project Implementation Team
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 CDD A-11: Form

PTA INTEGRATION PLANS CHECKLIST

Region: ________________ Province: ___________________________ Municipality: ___________________________
Program/Project (KC-NCDDP, KC-PAMANA, etc): ___________ Cycle: _______ Date MOA was signed: ______________ Date SIA was signed: _______________
Requirements If complied, provide the following data:
ACCOUNTABILITY
1. Legislation/Resolution/Ordinances passed in support of CDD and Participatory Governance
1.1 Institutionalization of People’s PTA in LGU development, planning and poverty reduction Resolution No.: Date of Approval:
programs, plans, and activities
1.2 Convergence of NGA poverty reduction PPAs in the Municipality Resolution No.: Date of Approval:
Formation of MIAC (Executive Order/Resolution issued) Executive Order/Resolution No.: Date of Approval:
Formation of MCT (Executive Order/Resolution issued) Executive Order/Resolution No.: Date of Approval:
NGO and PO Accreditation Guidelines Resolution No.: Date of Approval:
1.5 Support to BDP Formulation and BDP-MDP implementation including GAD plans Resolution No.: Date of Approval:
2. Municipal resolution expanding MDC membership to include CDD volunteers/representative Resolution No.: Date of Approval:
No. of CDD Volunteers as members of MDC:
Male: _______ Female _______
3. Support to KC-NCDDP Implementation
Allocation of LCC SB Resolution No.: Date of Approval:
Opening of Municipal Trust Fund Account No.: Date Opened:
Provision of KC Municipal Office and Equipment KC Municipal Office Address:
Equipment provided for KC?:
If yes, attach list of equipment provided with information on:
1. Equipment/Item Name/Type
2. Quantity
3. Date Provided
4. End-user
5. Functionality
Provision of personnel (including MCT, Municipal Database Encoder and GAD Focal Person) No. of LGU paid Staff provided for KC:
(attach list of Staff with designation)
Assist community volunteers in KC-NCDDP procurement and fiduciary processes No. of TAs provided:
(attach list of Activities with dates)

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 TRANSPARENCY
1. Available Information on the State of Municipality
Income and Expenditure Location of Posting: Date Posted:
Budget and data used for formulating the budget Location of Posting: Date Posted:
LGU Plans and Activities Location of Posting: Date Posted:
PARTICIPATION
1. NGO-PO engaged and represented in MDC and LSB No. of NGO/PO accredited:
Total No. of NGO/PO representatives in MDC:
Male _____ Female _____
Total No. of NGO/PO representatives in LSB:
Male _____ Female _____
(with Percentage vis-à-vis total composition)
2. Representation of highly marginalized/vulnerable groups in MDC and BDC Pantawid representative:Male ____ Female ____
3. (Pantawid, IPs, Women, Youth, Elderly, PWD) IPs representative: Male ____ Female ____
Women representative: Male ____ Female ____
Youth representative: Male ____ Female ____
Elderly representative: Male ____ Female ____
PWD representative: Male ____ Female ____
(attached list of representative)
4. Regular LGU-CSO consultation and dialogue No. of consultations conducted:
(include dates conducted)
5. Conduct of participatory review and assessment of the gender responsiveness of GAD Plans and No. of reviews/assessments conducted:
GAD-funded projects (include dates conducted)
6. NGO participation in project implementation and monitoring No. of NGOs involved in activities:
(include dates conducted)

Prepared by: Noted by:

__________________________________ __________________________________
Signature over Printed Name Signature over Printed Name
Area Coordinator Municipal Area Coordinator

13
 CDD A-12: Form
GRIEVANCE REDRESS SYSTEM (GRS) INTAKE FORM
Date Received : ___________ Date Resolved: ______________________________

GRS Form : PINCOs Filed Grievance

Intake Level : Central Region Municipal

Grievance Location : Region : ________Province:_________Municipality: ________ Barangay:_________________

Mode of Filing :

Mail/Letter Walk-in/verbal narration Phone/Fax BA Reports (specify) _________

E-mail Text Message Suggestion Box Media Others (specify) _________

I. Complainant/Sender’s Information
Name (optional) : __________________ IP Group:________________________

Sex : Male Female Unknown Group/Organization/Institution (specify): ____________

Designation/Position

MLGU Official/Staff BLGU Official/Staff DSWD/KC-NCDDP Personnel Volunteer Ordinary Resident

Contractor Service provider/Supplier Other Participating Agencies (specify): ______________

Others(specify)___________

Contact Information (Address/Tel/Fax/Cel./Email):___________________________________________________________

II. Details of the Issue/Concern

Nature of Issue/Concern:

Type A: Queries, Comments and Suggestions (non-contentious)

Type B: Compliance with project processes, MOA and other KC-NCDDP implementation arrangements (non-performance of obligations)

Type C: Conformance with KC-NCDDP/government procurement and finance guidelines (violation of law)

Subject of Complaint:

MLGU Official/Staff BLGU Official/Staff DSWD/KC-NCDDP Personnel Volunteer Ordinary Resident Contractor
Service provider/Supplier Other Participating Agencies (specify): ______________ Others(specify)_____________

Category of Concerns

Administrative CEAC Schedule/Timeline Community Participation Delivery of LCC Delivery of Materials

Financial Mgmt Gender Concerns Graft and Corruption KC-NCDDP Process/Design/Guidelines

LGU Participation O&M/Sustainability Positive Comments Procurement

Quality and Operations of SP RFR Processing Salary and allowances Social and Envt’l Safeguards

SP Imple. TA/support, information dissem. and capability building Other concerns specify)____________

14
.Details of Concern (if PINCOs, indicate if Community and/or Operation and Management Concern):

Details/Narrative Summary Actions Taken/Resolution of the FOR PINCOs ONLY

(Use additional sheet if table is not enough.) Issue Recommendations
(Action needed from RPMO/NPMO/Other
agencies)

III. Complainant’s Feedback on Resolution of Grievance

No comment Not Satisfied Satisfied Very Satisfied

Name of Intake Office

Designation

List of Categories

Concerns Cases/Examples
Administrative • Misconduct
(includes HR concerns -(recruitment, hiring, staffing, • Tardiness/absences
behavior of staff) • CF should smile more
CEAC Schedule/Timeline • Schedule of MIBF
•
Community participation (functionality of • Volunteers not attending trainings
committees, volunteers’ responsibility, etc.) • Resignation of volunteers
• Low participation in BAs
Delivery of LCC • LCC Cash commitment not yet downloaded to community account
Delivery of materials • Contractor failed to deliver gravel and sand
• Delivery of substandard materials
Financial Management • Pay roll padding
• Inconsistent signatories in vouchers
• Misuse of funds
Gender concerns • Sexual harassment
• Gender discrimination
Graft and corruption • Bribery of contractor
• Pilferage of materials
KC-NCDDP Process/design/guidelines • Collusion in MIBF
• Intervention to community decisions
• Non-inclusion in selection of volunteer
• Tedious KC-NCDDP process
• Fraudulent filing up of attendance sheet by CF
LGU Participation • Barangay Captain does not support KC-NCDDDP activities
O&M/Sustainability • Water system association not active
(includes financial management issues, functionality • No funding from barangay to maintain SP
of SPs and ODM)
Positive Comments • The community expressed appreciation to the entry of KC-NCDDP in their
barangay.
Procurement • Can shopping be conducted in lieu of bidding?
• No bidding conducted
Quality and operation of SPs • Unfinished footbridge
• POW/design of SP not followed
RFR Processing • Reason why RFR not downloaded
Salary and allowances • Delay in salary of staff
• Travel allowances not enough
Social and environmental safeguards • No deed of donation
• IP not consulted
Subproject implementation • Delays in subproject implementation due to weather
• Labor issues
TA/support, information dissemination and • Non-provision of technical assistance by LGU staff
capability building • Non-consistency of information during KC-NCDDP implementation

15
 CDD A-13: Form

GRIEVANCE REDRESS SYSTEM BARANGAY INSTALLATION CHECKLIST

Region: ______________
Province: ____________________________
Municipality: ____________________________
Barangay/Community: _______________________
Program/Project (e.g. KC-NCDDP, KC-PAMANA, etc): ____________________________
Cycle: ______________

Requirement Date Complied MOVs

1. GRS Orientation conducted BA Minutes
(1st Barangay Assembly)
2. GRS volunteers identified Volunteers’ Profile
3. Training of community members on handling Training Attendance Sheet
grievances conducted
4. Information materials available with grievance Inspection
hotline (at least one of the following: manual at
the Barangay Hall, pamphlets/brochures given to
HHs, posters)
5. Means of reporting grievances available (at least Inspection
one of the following: grievance/suggestion box,
phone numbers, office address)

_____________________________________
Signature over Printed Name
Community Empowerment Facilitator

16
 CDD A-14: Form

GRIEVANCE REDRESS SYSTEM MUNICIPAL INSTALLATION CHECKLIST

Region: ______________
Province: ____________________________
Municipality: ____________________________
Program/Project (e.g. KC-NCDDP, KC-PAMANA, etc): ____________________________
Cycle: ______________

Requirement Date Complied MOVs

1. Information dissemination on GRS MO Minutes of the Meeting
(Municipal Orientation)
2. Municipal GRS Committee identified MO Minutes of the Meeting
Resolution
3. Training of ACT /MCT on handling grievances Training Attendance Sheet
conducted
4. Information materials available with grievance Inspection
hotline (at least one of the following: manual at
the ACT Office, pamphlets/brochures, posters)
5. Means of reporting grievances available (at least Inspection
one of the following: grievance/suggestion box,
phone numbers, office address)
Grievance /Suggestion Box 

Phone Number/s Hotline:

Office Address:

_____________________________________
Signature over Printed Name
Area Coordinator

17