Annexure V
Part - B (Annexure - V)
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
|
PHYSICAL PERFORMANCE |
|||||||||||||
|
S.
No |
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, No. of women
opting Institutional Deliveries |
Total
No. of Beneficiaries upto the Quarter |
Out
of 13, No. of beneficiaries assisted by an accredited worker (ASHA etc) (000) |
|||||||||||
|
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 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Name and Signature of the nodal officer with rubber
stamp
Date
:
Annexure V
Part - A (Annexure - V)
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
|
FINANCIAL
PERFORMANCE |
||||||||||
|
S. No. |
Opening Balance as on 1st
April (in lakhs) |
Amount Allocated under
RCH_flexipool (in lakhs) |
Amount Released so far
during the year |
Total amount available
with the State (in lakhs) (2+4) |
Total Expenditure under Janani Suraksha Yojana during the Quarter
(In lakhs) |
Total Expnd. Upto the
Quarter (In lakhs) |
||||
|
To mothers |
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 |
|
|
|
|
|
|
|
|
|
|
Name and Signature of the nodal officer with rubber
stamp
Date
:
Annexure I V
Part - A (Annexure - IV)
JANANI SURAKSHA YOJANA
ANNUAL STATEMENT OF ACTUAL EXPENDITURE FOR THE YEAR ___________________
(To be sent to the Maternal Health Division, Ministry
of Health and Family Welfare, GOI by the
beginning of the following year)
Name
of the State
Name of the Nodal Officer
Telephone/Fax No
Amount
Allocated under RCH Flexipool: (In lakhs)_________________________________________
Amount
Released so far During the Year (In lakhs) _________________________________________
|
S. No. |
Name of the District |
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 Expnd. Upto the
Quarter |
||||
|
To mothers |
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 |
|
|
|
|
|
|
|
|
|
|
Name and Signature of the nodal officer with rubber
stamp
Date
:
Annexure IV
Part - B (Annexure - IV)
JANANI SURAKSHA YOJANA
ANNUAL STATEMENT OF ACTUAL EXPENDITURE FOR THE YEAR ___________________
(To be sent to the Maternal Health Division, Ministry
of Health and Family Welfare, GOI by the beginning of the following year)
Name
of the State
Name of the Nodal Officer
Telephone/Fax No
|
PHYSICAL PERFORMANCE |
||||||||||||||
|
S.
No |
Name of the District |
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, No. of women
opting Institutional Deliveries |
Total
No. of Beneficiaries upto the Quarter |
Out
of 13, No. of beneficiaries assisted by an accredited worker (ASHA etc) (000) |
||||||||||||
|
Name of the District |
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 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Name and Signature of the nodal officer with rubber
stamp
Date
: