2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No.

1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Identifying Information

Region : _______________________________
Barangay : _______________________________
City/Municipality : _______________________________
Province : _______________________________

CORE AREA 1: SAFETY, PEACE AND ORDER

INDICATORS DATA DATA HOW TO ASSIGN PASSIN SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE ED G OBTAIN SUBMITTED
SCORE SCORE ED BY
SCORE
THE
BARANG
AY
1. Functionality of the  Functionality of Barangay If the result is: 8 4
Barangay Anti-Drug BADAC based Secretary
● High = 8
Abuse Council on DILG-DDB
(BADAC) JMC No. 2018- ● Moderate = 4
01 DILG
● Low = 2
 Form 5 of DILG City/Municipal
MC No. 2018- Office ● No data = 0
135

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

2. Functionality of the BPOC Monitoring DILG If the result is: 5 4

Barangay Peace and Form No. 2 based City/Municipal
● High = 5
Order Committee on DILG MC No. Office
(BPOC) 2020-047 ● Moderate = 4
● Low = 3
● Non functional =
1
● No BPOC= 0
● No data = 0
3. Performance Rate in LTIA Form 003 DILG If the result is: 4 2
the Lupong based on DILG MC City/Municipal
● 85-100 = 4
Tagapamayapa No. 2016-58 Office
Incentives Awards ● 80-84 = 3
(LTIA)
● 75-79 = 2
● Below 75 = 1
● No data = 0
4. Maintenance of RBI form A of DILG Barangay ● With RBI = 1 1 1
Record of Barangay MC No. 2008-144 Secretary
● Without RBI = 0
Inhabitants (RBI) validated by the
Punong Barangay

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Certification from
the Punong
Barangay

Date of last update:

_______

5. Professionalizing EO or similar Barangay With EO or similar 1 1

the Barangay Tanod issuance on the Secretary issuance:
based on DILG MC organization of the
Yes = 1
No. 2003-42 Barangay Tanod
No = 0

Training attended With trainings 1 1

for CY 2022 attended:
Yes = 1
No = 0
TOTAL 20 13

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

CORE AREA 2: FINANCIAL ADMINISTRATION AND SUSTAINABILITY

INDICATORS DATA REQUIREMENTS DATA HOW TO PERFECT PASSING SCORE DOCUMENT

SOURCE DETERMINE SCORE SCORE OBTAINED SUBMITTED
THE SCORE BY THE
BARANGAY
1. Compliance  BFDP Monitoring Form DILG Presence of 2 2
with the City/Municipal
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Barangay Full 1 , Form 2 and Form 3 Office BFDP Board

Disclosure pursuant to DILG MC
● Yes = 2
Policy (BFDP) No. 2014-81
● No = 0
Onsite Compliance to 3 3
 Barangay Full
Inspection the design
Disclosure Board in
pursuant to
compliance to the
Annex 7 of the
requirements set in,
DILG MC No.
with photo
2014-81:
documentation
● Yes = 3
● No = 0
CY 2022, 4th Qtr
compliance: If the result of CY 8 6
2019, 4th Qtr
______________________
compliance is:
● Full
Location of the BFDP Compliance -
Board: 8 financial
documents
______________________
(refer to
technical
notes) = 8
● Partial
Compliance:

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

o 7 financial
documents
posted = 7
o 5-6 financial
documents
posted = 6
o 3-4 financial
documents
posted = 4
o 1-2 financial
documents
posted = 2
● Non-
compliance =
0
● No data = 0
2. Percentage Barangay Budget Barangay With increase? 3 3
Increase in Preparation Form No. 2: Treasurer
● Yes = 3
local Actual Income and
resources Expenditure ● No = 0

Total amount collected

from fees and charges: City/Municipal

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Accountant
CY 2021 PhP ________
CY 2022 PhP ________

Difference : PhP
_________
Percentage increase:
_____
3. Conduct of Monitor report on the Barangay Conducted 4 4
Barangay compliance of the Secretary Barangay
Assembly for barangays to conduct Assembly:
the first and barangay assembly to be
1st Semester = 2
second submitted thru shared
semester of google drive 2nd Semester = 2
CY 2019
No data = 0
TOTAL 20 18

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

CORE AREA 3: DISASTER PREPAREDNESS

INDICATORS DATA DATA HOW TO ASSIGN PASSIN SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE ED G OBTAINE SUBMITTED
SCORE SCORE D BY THE
SCORE
BARANG
AY
1. Functionality of the 5% BDRRM Fund in Barangay With at least 5% 2 2
Barangay Disaster the Barangay : PhP Secretary/ BDRRM Fund
Risk Reduction and __________ Barangay allocation
Management Treasurer
● Yes = 2
Committee
(BDRRMC) To compute % ● No = 0
allocation for Local Disaster
LDRRMF: Risk Reduction
and
(BDRRMF Allocated Management
/ Estimated Total Officer
Revenue from (LDRRMO)
Regular Sources) x
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

100

EO or similar Organization of the 1

issuance creating BDRRMC
the BDRRMC
● Yes = 1
● No = 0
● No data = 0
Approved Barangay With Approved 2
Disaster Risk BDRRM Plan
Reduction and
● Yes, using the
Management
prescribed
(BDRRM) Plan
template = 2 1
under NDRRMC
Memorandum ● No = 0
Circular No. 01,
Series of 2018

Minutes of the Conduct of quarterly 2

quarterly meeting meeting
● 4 out of 4 = 2 2
● 2 or 3 out of 4 =
1

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
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● 1 out of 4 = 0
● No = 0
● No data = 0
Utilization Rate of Utilization of the 1
the 70% component 70% BDRRM Fund
of the BDRRM Fund
● 50% and above
=1
To compute for % ● Less than 50% =
utilization: 0.5

% utilization of the ● No = 0 1
70% BDRRMF = ● No data = 0
(Total Amount
Utilized / Total
Amount Allocated) x
100

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
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● Accomplishment Barangay Accomplishment 3 2

Report Secretary Rate of the
Activities/Projects
Reflected in the
How to compute? Local Disaster Barangay Disaster
Risk Reduction Risk Reduction And
Accomplishment Management Plan
and
A
rate = x 100 Management (BDRRMP)
B
Officer
● 60% and above
(LDRRMO)
=3
o A = Total number
● 40 – 59% = 2
of
activities/projects ● 20 – 39% = 1
accomplished in
● 19% and Below
the BDRRM plan
=0
● No BDRRM Plan
o B= Total number =0
of
activities/projects
in the BDRRM

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Plan
2. Extent of risk Date of drill/s Barangay With Post-Activity 1 1
assessment and conducted: Secretary Report:
Early Warning
________________ ● Yes = 1
System (EWS)
Local Disaster ● No = 0
Risk Reduction
Drills conducted Conducted drills 1 1
and
(Earthquake, fire,
Management ● Earthquake/Fire/
etc.)
Officer Others = 1
(LDRRMO)
● No = 0
Local risk map Presence of Local 1 1
risk map
● Yes = 1
● No = 0
Early Warning Presence of Early 1 1
System (EWS) Warning System
location:
● Yes = 1
________________
● No = 0

3. Extent of EO or similar Barangay With EO or similar 1 1

preparedness for issuance creating Secretary issuance creating
effective response Barangay the Barangay
Emergency Search Emergency Search
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

and recovery and Rescue Team/s Local Disaster and Rescue Team/s
Risk Reduction
● Yes = 1
and
Total number of Management ● No = 0
Emergency Search Officer
and Rescue (LDRRMO)
Team/s: _________ Provision of training 1 1
to the Emergency
Search and Rescue
Team/s:
● Trained in the
past 12 months
(CY 2019) = 1
No training in the
past 12 months (CY
2019) = 0
Designated/ Presence of 1 1
Evacuation Center Evacuation
location : Center/Designated
________________ Evacuation Center
____________
● Yes = 1
● No = 0
Disaster equipment: Disaster equipment 2 1
● 2-way radio / ● 2-way radio /

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

mobile phone mobile phone =

0.5
● Rescue
vehicle/Baranga ● Rescue
y patrol vehicle/Baranga
y patrol = 0.5
● Generator set
● Generator set =
● First aid kit
0.5
● Flashlight with
● First aid kit /
batteries
Flashlight with
batteries = 0.5

TOTAL 20 17

ESSENTIAL AREA 1: SOCIAL PROTECTION AND SENSITIVITY

INDICATORS DATA REQUIREMENTS DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

SOURCE DETERMINE SCORE OBTAINED SUBMITTED
SCORE
THE SCORE BY THE

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

BARANGAY
1. Functionality of Functionality of the Barangay If the result is: 1 1
the Violence Violence Against Secretary
● Ideal = 1
Against Women Women (VAW) Desk
(VAW) Desk based on VAW Desk ● Mature = 0.5
Form 2 of MC No. 2017- Local Social
114 dated 30 August ● Basic -
Welfare and
2017 Progressive =
Development
0.25
Officer
● No
Functionality
=0
VAWC Cases Quarterly Submission of 2 1
Reports Quarterly
Reports on
● 1st Qtr submitted:
VAWC Cases
__________
● 1st Qtr report
● 2nd Qtr submitted:
submission =
_________
0.5
● 3rd Qtr submitted:
● 2nd Qtr report
__________
submission =
● 4th Qtr submitted: 0.5
__________
● 3rd Qtr report
submission =
0.5

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

● 4th Qtr report

submission =
0.5
Certificate of VAW Desk 1 1
Attendance/Participation Person is trained
and Date of
● Yes = 1
Training/Seminar
____________ ● No = 0

2. Access to EO or similar issuance Barangay Presence of EO 1 1

health and on the Appointment of Secretary or similar
social welfare Barangay Health Worker issuance on the
services in the (BHW) appointment of
barangay On site BHW
inspection
● Yes = 1
● No = 0
EO or similar issuance Presence of EO 1 1
on the appointment of or similar
Barangay Nutrition issuance on the
Scholar (BNS) appointment of
BNS
● Yes = 1
● No = 0

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Barangay Health Presence of a 1 1

Station/Center (BHS/C) BHS/C
Location: ● Maintained
BHS/C = 1
____________________
● With access
BHS/C (check the
to other
corresponding answer)
BHS/C = 0.5
____ Barangay
● None = 0
owned/maintained
Availability of 2 1
____ With access to
services in the
other BHS/C
BHS/C
● Expanded
Program on
Immunization
(EPI) = 0.5
● Maternal
Care = 0.5
● Nutrition Care
= 0.5
● Other
Services =
0.5
● None = 0

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

3. Functionality of DILG-MC No. 2019-69 Punong If the result is: 1 1

the Barangay Barangay
DILG MC No. 2019-112 ● High - Ideal =
Development
1
Council (BDC) ● Annex 3 (C/MAT
Audit Form) Barangay ● Moderate =
Secretary 0.5
● Annex 4 (C/M
Consolidated Results ● Low = 0.25
Form)
● Non-
Functional =
0.15
● None = 0
● No data = 0
2019 Barangay Bonus Point
Development Plan
With 2019
(BDP)
Barangay
Note: For 2019 assessment, Development
the BDP shall be crafted in Plan:
FY 2018 and shall cover the
period of 2018-2020. Also the Yes = 1
BDP in any format or
template shall be considered No = 0
and accepted.

5. Representation Ordinance or similar Barangay With EO or 1 1

of CSOs in the issuance organizing Secretary similar issuance
Barangay each of the following: organizing the

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Based 1. BDC BBIs (with CSO

Institutions representative
2. BADAC
(BBIs) that is accredited
3. BDRRMC by the
a. BDC
Sangguniang
4. BPOC Barangay):
b. BADAC
5. BESWMC ● 4 to 7 BBIs =
c. BDRRMC
6. BCPC 1
d. BPOC
7. Barangay GAD ● 1-3 out of 7
e. BESWMC BBIs = 0.5
Focal Point System
f. BCPC ● No EO or
g. Barangay similar
GAD Focal issuance = 0
Point
System
6. Registration of DILG MC No. 2013-061 Barangay With established 2 2
Kasambahay Secretary kasambahay
● KR Form 5 –
and desk:
Barangay
Establishment
Consolidated Yes = 1
of Kasambahay Public
Kasambahay Report
Desk Employment No = 0
Note: If the barangay Service
conducted the Office
registration but no Maintained and
kasambahay registered, updated
indicate the information kasambahay
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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in KR Form 5. masterlist KR
Form 5:
Yes = 1
No kasambahay
registered = 1
No = 0
7. Functionality of DILG MC No. 2008-126 Barangay If the result is: 1 1
the Barangay Secretary
● LCPC Form 1-A ● Ideal = 1
Council for the
Protection of ● Mature = 0.5
Children
(BCPC) ● Basic -
Progressive =
0.25
● No
Functionality
=0
8. Allocation for PCW, DILG, DBM and Barangay With approved 1 1
the Annual NEDA JMC No. 2016-01 Secretary Barangay Annual
Gender and Plan and Budget:
● Annex D-1
Development
Yes = 1
(GAD) Plan and
Budget No = 0
TOTAL 15 13

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

ESSENTIAL AREA 2: BUSINESS-FRIENDLINESS AND COMPETITIVENESS

INDICATORS DATA DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE SCORE OBTAINED SUBMITTED
SCORE
SCORE BY THE
BARANGAY
1. Enactment of Barangay Tax Barangay Presence of 3 3
Barangay Tax Ordinance Secretary Barangay
Ordinance Ordinance:
● Presence of
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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Barangay Barangay Tax

Treasurer Ordinance = 3
● No Barangay
Tax Ordinance
=0
2. Enactment of an Barangay Ordinance Barangay Presence of 3 3
ordinance Secretary Barangay
relative to Ordinance:
Barangay
● Presence of
Clearance fees Barangay
Barangay
on business Treasurer
Ordinance = 3
permit and
locational ● No Barangay
clearance for Tax Ordinance
building permit =0
3. Approval of a Barangay Barangay Presence of 2 2
resolution Resolution Secretary Barangay
authorizing the Resolution:
City/Municipal
● Presence of
Treasurer to Barangay
Barangay
collect fees for Treasurer
Resolution = 2
Barangay
Clearance for ● No approved
Business permit Barangay
and locational Resolution = 0
clearance

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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purposes
4. Issuance of Logbook/record Barangay Timeliness of 7 5
Barangay book Treasurer issuance of
1
Clearance within barangay
seven (7) working clearance
days (for
● 90%-100% of
businesses
applications
which do not
met = 7
require
occupancy ● 80%-89% of
permits). For applications
locational met = 5
clearance,
issuance of ● 70%-79% of
Barangay applications
Clearance in not met = 3
more than three ● 60%-69% of
(3) working days applications
from application met = 2
at the
city/municipality ● 50%-59% of
applications
met = 1
● 49% and below
of applications
1
Item 5.1 of DILG MC No. 2019-177 dated October 17, 2019 – Barangay Clearance refers to any and all documents issued by the barangays with or without
corresponding fees as defined in their ordinances relative to or in relation to the issuance of business permit and locational clearance by the city/municipality
or any other permit as may be required.
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
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met = 0
TOTAL 15 13

ESSENTIAL AREA 3: ENVIRONMENTAL MANAGEMENT

INDICATORS DATA DATA HOW TO ASSIGNED PASSING SCORE DOCUMENT

REQUIREMENTS SOURCE DETERMINE THE SCORE OBTAINED SUBMITTED
SCORE
SCORE BY THE
BARANGA

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
Assessment Period: CY 2022
Revised Data Capture Form
As of

Y
1. Presence of a ● MRF (check the Onsite Presence of MRF: 2 1
Materials corresponding inspection
● Yes = 2
Recovery answer)
Facility (MRF) ● None but with
____ Barangay
pursuant to other materials
owned
R.A. 9003 recovery
____ Clustered scheme = 1
Brgys
● None = 0

● Location of MRF
● MOA
● Certification from
the
City/Municipal
Environment and
Natural
Resources Office
(C/MENRO) on
the existence of
the MRF
2. Presence of a  Ordinance or Barangay Presence of 2 2
Collection similar issuance Secretary Ordinance on
System to on segregation of segregation of
Ensure
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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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Segregation of wastes at-source wastes-at-source

Wastes at-
● Yes = 2
Source
● No = 0

3. Functionality of EO or similar Barangay If the result is: 2 2

Barangay issuance on the Secretary
EO organizing the
Ecological Solid organization of the
BESWMC
Waste BESWMC
Management ● Yes = 2
Committee
(BESWMC) ● No = 0
Approved Solid Approved 1 1
Waste Management BESWMC
Program/Plan Program/Plan
(Any template or ● Yes = 1
annotated)
● No = 0
Allocation of With fund 1 1
barangay funds, allocation:
approved by the
● Yes =1
sangguniang
barangay ● No = 0

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 2021 SEAL OF GOOD LOCAL GOVERNANCE FOR BARANGAY SGLGB Form No. 1
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Conduct of capacity- Capacity-building 2 2

building for activity conducted:
BESWMC
Yes = 2
No = 0
TOTAL 10 9

We certify to the correctness of the above information.

City/Municipal Assessment Team:

____________________________________
Chairperson

____________________________________
Vice-Chairperson

____________________________________
Member

____________________________________
Member
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Revised Data Capture Form
As of

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