Annexure – V

                                                                                                                     Part - A

JANANI SURAKSHA YOJANA

QUARTERLY STATEMENT OF PHYSICAL PROGRESS FOR THE QUARTER ENDING ________ FOR THE YEAR____________

(To be sent to the Maternal Health Division, Ministry of Health and Family Welfare, GOI in the following month)

 

Name of the State ………………………                 Name of the Nodal Officer………………                 Telephone/Fax No……………………

 

NUMBER OF JSY REGISTERED DURING THE QUARTER

Total Number of JSY Beneficiaries upto the Quarter

Rural

Urban

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

1

2

3

4

5

6

7

8

9

(1+5)

10

(2+6)

12

(3+7)

13

(4+8)

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OUT OF 13, NUMBER OF WOMEN OPTING INSTITUTIONAL DELIVERIES

Total No. of Institutional deliveries under JSY upto the Quarter

Out of 13, Number of beneficiaries assisted by an accredited worker (ASHA)#   

Rural

Urban

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

14

15

16

17

18

19

20

21

22

(14+18)

23

(15+19)

24

(16+20)

25

(17+21)

26

27

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Signature of the nodal officer with rubber stamp

Date:

# Wherever applicable

Annexure – V

Part - B

JANANI SURAKSHA YOJANA

QUARTERLY STATEMENT OF ACTUAL EXPENDITURE FOR THE QUARTER ENDING ________________ FOR THE YEAR_________

(To be sent to the Maternal Health Division, Ministry of Health and Family Welfare, GOI in the following month)

 

 

Name of the State ………………………                 Name of the Nodal Officer………………                           Telephone/Fax No……………………

 

 

Opening Balance as on 1st April of FY

(In Rs. lakhs)

Amount Allocated under RCH-flexi pool in the current year

 (In Rs. lakhs)

Amount Released by GOI so far during the year

Total amount available with the State

(In Rs. lakhs) (2+3)

Total Expenditure under Janani Suraksha Yojana during the Quarter (In Rs. lakhs)

 

Total Exp. Upto the Quarter

(In lakhs)

To mothers

To Accredited worker ASHA#

Amount spent on hiring of specialists

Administrative Expenditure made

 if any

Total Exp. during the quarter

(5+6+7+8)

1

2

3

4

5

6

7

8

9

10

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name and Signature of the nodal officer with rubber stamp

Date:

 
# Wherever applicable

Annexure – IV

Part - A

JANANI SURAKSHA YOJANA

 

DISTRICTWISE ANNUAL STATEMENT OF PHYSICAL PROGRESS FOR THE YEAR ___________________

(To be sent to the Maternal Health Division, Ministry of Health and Family Welfare, GOI by April of    following year)

 

Name of the State ………………………                 Name of the Nodal Officer………………             Telephone/Fax No……………………

 

PHYSICAL PERFORMANCE

S. No

Name of the Districts

No. of JSY Registered During the Quarter

Total No. of Beneficiaries upto the Quarter

Rural

Urban

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

1

2

 

3

4

5

6

7

8

9

10

11

12

13

14

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S. No.

OUT OF 14, NUMBER  OF WOMEN OPTING INSTITUTIONAL DELIVERIES

Total No. of Beneficiaries upto the Quarter

Out of 13, No. of beneficiaries assisted by an accredited worker (ASHA)# 

Name of the Districts

Rural

Urban

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

SC

ST

GEN

Total

1

15

 

16

17

18

19

20

21

22

23

24

25

26

27

28

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

# Wherever applicable

Name and Signature of the nodal officer with rubber stamp

Date:

 

 

Annexure –I V
Part - B

JANANI SURAKSHA YOJANA

DISTRICTWISE ANNUAL STATEMENT OF ACTUAL EXPENDITURE FOR THE YEAR ___________________

(To be sent to the Maternal Health Division, Ministry of Health and Family Welfare, GOI by April of    following year)

 

 

Name of the State ………………………                 Name of the Nodal Officer………………             Telephone/Fax No……………………

 

Amount Allocated under RCH Flexipool: (In Rs.lakhs)________________

 

Amount Released so far During the Year (In Rs.lakhs) ________________

 

 

S. No.

Name of the Districts

Opening Balance as on 1st April (in ‘000)

Total Amount Released by the State during the year

(Rs. in '000)

Total amount available with the district

(Rs. in '000)  (3 + 4)

Total Expenditure under Janani Suraksha Yojana during the Quarter (In ‘000)

 

Total Exp. Upto the Quarter

To mother’s

Accredited worker ASHA#

Amount spent on hiring of expert for C - Section

Administrative Expenditure.  if any

Total  (6+7+8+9)

1

2

3

4

5

6

7

8

9

10

11

:

 

 

 

 

 

 

 

 

 

 

 

:

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

# Wherever applicable

 

Name and Signature of the nodal officer with rubber stamp

Date: