Form B-1

Republic of the Philippines

Department of the Interior and Local Government
2022 RBME of LGU Infrastructure Projects
RBME of LGU Infrastructure Projects (RLIP) – DATA CAPTURE FORM
Form B-1. Forms Review – Enrollment

INSTRUCTIONS | PLEASE READ

(1) The form shall be completed by the DILG Municipal (for municipal LGUs) / City (for city LGUs) / Provincial (for provincial
LGUs) Offices; (2) Please refer to RLIP Form B Guidance Notes for instructions on how to accomplish RLIP Form B; (3) Please
accomplish the Certification Page. (4) Upload PDF of this Form through the designated folder on https://tinyurl.com/RLIP-2022-
FoldersDocs.

I. Local Government Unit Name and Location

☐ City / ☐ Municipality of : ________________________________________
☐ Province of : ________________________________________
Region : ________________________________________

II. Project Details

Please supply the requested information below:

Project Name / Title _____________________________________________________________________________

_____________________________________________________________________________

Type of Project ☐ ☐ ☐ ☐
Roads and Water Evacuation Others
Bridges Supply and Center /
Sanitation MP Hall
Facilities

Provide details if Others: _________________________________________________

Project Fund _____________________________________________________________________________
With LGU Counterpart Fund ☐
Amount of LGU Counterpart Fund _______________________________

Fund Source ☐ ☐ ☐ ☐ ☐
Development NTA Loans / Other Internally-
Fund (DF) (except DF) Borrowings Externally- Sourced
Sourced Income
Income
Provide details if not DF: _________________________________________________

Exact Project Location _____________________________________________________________________________

Start Date (Date on _____________________________________________________________________________

Notice to Proceed)

End Date (Projected _____________________________________________________________________________

Completion Date per S-
Curve or equivalent)
 III. Documents Submitted
Please indicate which conditions apply relative to the enrolled project:

Not
Submitted
Submitted
Project Brief ☐ ☐
Form 1 ☐ ☐
Logical Framework ☐ ☐

IV. Logical Framework (LogFrame) Form

Please provide the relevant Sectoral Goal, as stated in the latest Comprehensive Development Plan
(CDP) / Provincial Development and Physical Framework Plan (PDPFP):

Type the relevant CDP / PDPFP – Sectoral Goal here. For example: In the next six years, the
Municipality of [] will strive to improve economic situation in the community by developing the
production capability of farmers and fisherfolks, and improve access to livelihood opportunities,
resource management and application of appropriate technologies.

Please tick all conditions that apply:

Status of CDP / PDPFP

Approved ☐
Draft ☐
Period of Effectivity (latest
YYYY – YYYY
approved CDP / PDPFP)
Enrolled Project is present in
☐
CDP / PDPFP List of PPAs

Impact Outcome Output

Objectives
Clearly states objectives ☐ ☐ ☐
Provides statements related to lower-
☐ ☐
level objectives
Provides objectives stated as long-
term results, consistent with the
relevant Sectorial Goal on CDP / ☐
PDPFP covering CY 2022 (see typed
Sectoral Goal above)
Provides objectives stated as
immediate-term development
☐
objective, logically resulting from the
accomplishment of the Output
Provides objectives stated as ☐
deliverables arising from activities
carried out using the project
resources, and accomplished at the
 end of project implementation
Indicators
Provides specific performance target
☐ ☐ ☐
rates
Provides clearly stated timeline for
achievement of performance target ☐ ☐ ☐
measures
Provides specific target beneficiaries
(if unspecified, DO NOT TICK. Assumed ☐ ☐ ☐
that whole LGU population is covered)
Relates to corresponding objectives ☐ ☐ ☐
Means of Verification
Provides specific, publicly available, ☐ ☐ ☐
standard reports/documents
Relates to corresponding indicators ☐ ☐ ☐

V. Form 1
Initial Project Report Form
Please indicate which conditions apply to the elements required for Form 1:

Elements Present Not present

Name of project ☐ ☐
Funding source ☐ ☐
Location ☐ ☐
Total project cost ☐ ☐
Project schedule ☐ ☐
Mode of implementation ☐ ☐
Physical and financial targets for the year ☐ ☐
 Republic of the Philippines
Department of the Interior and Local Government
2022 RBME of LGU Infrastructure Projects P/HUC/ICC Certification

RBME of LGU Infrastructure Projects (RLIP)

CERTIFICATION
for Form B. Forms Review
Provinces (P) / Highly-Urbanized Cities (HUC) / Independent Component Cities (ICC)

We, the undersigned, certify that the project information and data, assessments, and
related items, contained in the RLIP Form B: Forms Review are accurate, based on
local records and submitted documents from the Local Government Unit (LGU).

Local Government Unit Name and Location

☐ City / ☐ Municipality of : ________________________________________
☐ Province of : ________________________________________
Region : ________________________________________

Local Infrastructure Project Details

Name of Project : ________________________________________
Location of Project : ________________________________________
Type of Project : ________________________________________

SIGNATORIES

Prepared by:

_____Name & Signature of Preparing Officer_____

Designated Officer from DILG Provincial/HUC/ ICC Office

Reviewed by:

_____Name & Signature of Reviewing Officer_____

DILG Provincial / City Director

Approved by:

____Name & Signature of Approving Officer____

DILG Regional Office Director
 Republic of the Philippines
Department of the Interior and Local Government
2022 RBME of LGU Infrastructure Projects CC/M Certification

RBME of LGU Infrastructure Projects (RLIP)

CERTIFICATION
for Form B. Forms Review
Component Cities (CC) & Municipalities (M)

We, the undersigned, certify that the project information and data, assessments, and
related items, contained in the RLIP Form B: Forms Review are accurate, based on
local records and submitted documents from the Local Government Unit (LGU).

Local Government Unit Name and Location

☐ City / ☐ Municipality of : ________________________________________
☐ Province of : ________________________________________
Region : ________________________________________

Local Infrastructure Project Details

Name of Project : ________________________________________
Location of Project : ________________________________________
Type of Project : ________________________________________

SIGNATORIES
 Prepared by:

_____Name & Signature of Preparing Officer_____

DILG City / Municipal Government Operations Office

Reviewed by:

_____Name & Signature of Reviewing Officer_____

DILG Cluster Leader

Approved by:

____Name & Signature of Approving Officer____

DILG Provincial Director