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: _______________________________________________________________