Draft

CAMBODIAN REHABILITATION AND DEVELOPMENT BOARD
COUNCIL FOR THE DEVELOPMENT OF CAMBODIA

QUESTIONNAIRE ON EXTERNAL ASSISTANCE TO CAMBODIA

Reporting Year:  2006

Donor___________________________________              Date questionnaire completed:______________
Currency used throughout questionnaire:  _______________

I.  Program/Project Information
1.   Donor Program/Project Number:_________________                     PIP No: ____________________
2.   Official Title:________________________________________________________________________
3.   Program/Project Objectives: ___________________________________________________________
      ___________________________________________________________________________________
      ___________________________________________________________________________________
      ___________________________________________________________________________________
      ___________________________________________________________________________________
4.   Was a Program/Project Document or an equivalent document signed with Government ministry(ies) and/or
      agency(ies):
                                £ YES                               £ NO go to Q8
5.   Is the implementing agency for the Program/Project a government institution?
                                £ YES                               £ NO go to Q8
6.   If yes, then please specify the name of the Government institution(s) with whom the agreement was signed:....
      …………………………………………………………………………………………………………………………………………………………
7.    Please specify the name of the Government institution(s) responsible for implementing the Program/project:....
      ………………………………………………………………………………………………………………………………………….….. ........
8.    If the answer to Q4 and/or Q5 is NO, then please specify the name(s) of the non-government or
       international development cooperation agency that is the implementing institution(s): .................................
9.    Is this Program/Project part of a broad Sector/Thematic Program?
                                £ YES                               £ NO go to Q11
10.  If yes, please specify the Sector/Thematic Program:  .....………………………………………………………………….…
11.   Program/Project Approval Date                                 Start Date                           Completion Date
              _________________                                   ________________                  ________________ 
                     (dd/mm/yy)                                              (dd/mm/yy)                              (dd/mm/yy)
 

II.  Program/Project Budget
12.  Total Program/Project Budget:          _______________ 

• RGC Contribution ________________________

• External Assistance ______________________

13.  Terms of Assistance
          £ Grant                                Amount:  ____________
          £ Concessional Loan:            Amount:  ____________   Interest Rate:_______  £ Fixed   £ Variable
                                                     Grace Period:_________________     Amortization Period:____________
          £ Non-concessional Loan:      Amount:  ____________

14.  Planned budget allocation/expenditure for each year of the Program/Project duration.

III.  Source of Funds

15. Is this Program/Project funded by more than one development partner:

                                £ YES                               £ NO go to Q #18

16. If answer to Q #15 is YES: Was this Program/Project is delivered through a multilateral institution:

                                £ YES                               £ NO go to Q #17

To minimize double counting errors -- that can arise if both the reporting multi-lateral institution and the contributing bilateral or multilateral institution(s) also include these funds in their reported disbursements -- the reporting multi-lateral institution for this Program/Project is requested to report disbursements from their "own resources" and "resources mobilized from in-country bilateral or other multilateral sources". The reporting multilateral institution's "own resources" include: (i) institution's core resources; and (ii) any donor funds received by reporting multilateral institution's headquarters' that are provided to Cambodia but would not be reported by the contributing donor's country office in Cambodia. The "resources mobilized from in-country bilateral or multilateral sources" include any funds provided by the country office(s) of bilateral donor(s) or another multilateral institution(s) to the reporting multilateral institution's program or project that would also be reported by the contributing bilateral or multilateral donor(s) in their responses to this survey.

To be completed by multilateral institution delivering the Program/Project

 

Source of Funds	Amount	Currency
1.   Own Resources 2.   Resources mobilized from in-country bilateral or other       multilateral sources, please list:      i.      ii.      iii.      iv.

To be completed by development partner who has contributed to a Program/Project that is delivered through a multilateral institution:

-     Multilateral Institution delivering the Program/Project: ____________________________
-     What is your contribution :                                        ____________________________

17. If answer to Q #16 is NO: Was this Program/Project is delivered through a delegated cooperation arrangement:   

                                £ YES                               £ NO go to Q #18

-     Multilateral Institution delivering the Program/Project: ____________________________
-     What is your contribution :                                        ____________________________

IV.  Disbursements

18. Please report the following data in the currency listed on Page 1. In the case of project/program funded by more than one development partner, the agency who manages the fund should also complete the column "other resources" on behalf of other development partners.

V.  Sector(s) of Program/Project Activities

19. Please identify the sector of the Program/Project Activities by putting an “x” in the appropriate box. In the case of multi-sector Program/Project, please identify the sectors by putting an “x” in the appropriate boxes and entering the amount disbursed and the percent of total expenditure in 2005 & 2006 by each sector.

VI.  Target Geographic Location (s) of Program/Project Activities

20. Please check each province or municipality where Program/Project activities are being delivered. If the Program/Project is being delivered in more than one area, please indicate the percentage of resource disbursed in 2006 to each region in the space provided. If the activities of a Program/Project are or were delivered in only one province or municipality then the percentage would be 100 %.