DFC-008 Development Outcomes Survey

DEVELOPMENT OUTCOMES SURVEY (DFC-008)

OMB [ 3015-0015 ]

Expiration Date: [ ]

United States International Development Finance Corporation

1100 New York Avenue, NW Washington, DC 20527-0001

An Agency of the United States Government

Responses to questions which call for estimates or projections should take the form of good faith statements made to the best of the Project officer’s knowledge and belief. Statements of fact provided to DFC in this document must be accurate as of the date of submission. Anyone who knowingly makes a false statement with the intent to influence DFC’s guarantees, loans, or other investments may be criminally prosecuted. Such false statements are also grounds for DFC to terminate a commitment or declare a contract default.  These rights are in addition to any other rights or remedies available to United States government. Neither submission nor acceptance of this application implies that the proposed transaction is eligible for support or that support will be provided.

Paperwork Reduction Act Notice: This information is required to retain benefits. Federal agencies may not collect information unless a valid OMB Control Number with an expiration date that has not expired is displayed. The public reporting burden for this collection of information is estimated to average 2.0 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to Agency Clearance Officer, Records Management, United States International Development Finance Corporation 1100 New York Ave., NW, Washington, DC 20527 and to the DFC Desk Officer at the Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.

I have read and agree to the terms and conditions listed above.

1. PROJECT DESCRIPTION AND OWNERSHIP PROFILE

The questions in this section will ask for background and descriptive information about the Project and the company managing the Project (i.e., the DFC client company). For the purposes of the DOS, Project generally refers to a specific project or portion of a client's business that is supported by DFC. More specifically:

For project finance, "Project" refers to a specific project supported by DFC. This definition includes standalone greenfield or brownfield projects (e.g., wind turbine farm) as well as projects undertaken by operating enterprises (e.g. expansion of manufacturing facilities).

For corporate finance, “Project” refers to an enterprise that received DFC support to grow and/or sustain its business activities (e.g., working capital, refinancing, etc.).

For enterprises engaged in the provision of financial services, "Project" refers to the portfolio of financial product(s) (e.g., loans, equity investments, leasing contracts, insurance contracts, etc.) supported by DFC.

If you are not sure about what to consider as the Project for this survey, please contact dos@dfc.gov

Q101 Project Name (PRE-FILLED)

Q102 In what country (or countries) does this Project operate? (SELECT ONE OR MORE FROM COUNTRY LIST)

Q103 Please provide a brief description of the key Project activities during the Reporting Period. (OPEN-ENDED)

Q104 How much did the Project invest (spend) during the Reporting Period in each country? Please include all countries in which the Project invested or spent funds. (SELECT ONE OR MORE COUNTRY FROM COUNTRY LIST; then FILL IN amount in U.S. Dollars)

Q105 Did the Project provide financial services (i.e. loans, equity investments, insurance, leasing, etc.) during the Reporting Period? (SELECT ONE: Yes/No)

Q106 Does this Project operate or invest in any of the following sectors? (Please check all that apply)

1. Agriculture

2. Education

3. Energy

4. Healthcare

5. Housing

6. Information and Communications Technology

7. Transportation

8. Waste, Water, and Sanitation

9. Other

Q107 What is the percentage of local ownership of the Project (i.e. ownership by individuals who are nationals of the Project’s country or countries of operations)? If there is no local ownership, enter ‘0’. If not applicable, please leave blank. (PERCENTAGE)

Q108 What percentage of ownership of the company managing the Project (i.e. the DFC client company), in terms of shares or other ownership portions, is held by women? If not applicable, please leave blank. (PERCENTAGE)

Q109 How many full-time Senior Managers were employed by the Project at the end of the Reporting Period? (NUMBER)

• [IF Q109>0, ASK] Q109A Of these full-time Senior Managers, how many are women? (NUMBER)

Q110 Is the company managing the Project (i.e. the client company), or the Project itself, overseen by a Board of Directors? (SELECT ONE: Yes / No)

• [IF Q110=YES, ASK] Q110A What is the total number of Board of Directors members? (NUMBER)

• [IF Q110=YES, ASK] Q110B How many Board of Directors members are women? (NUMBER)

Q111 Has the project become operational? (SELECT ONE: Yes / No)

• [IF Q111=YES, ASK] Q111A Please enter the date when the project became operational? (DATE)

Q112 Please specify the Project’s most recently completed fiscal year (representing 12 months of data) and use data from this year to complete the rest of this form.

Reporting Period Start Date: (DATE: Month/Year)

Reporting Period End Date: (DATE: Month/Year)

Q113 If applicable, what is the Project’s target population? (Please check all that apply)

• Women-owned/women-led enterprises

• Small and Medium Enterprises (SMEs)

• Microenterprises

• Women

• Young adults (15-24 years old)

• Rural populations

• Smallholder farmers

• Low-income populations

• Other Disadvantaged Group (not included above) (Write-in)

2. PROJECT ENVIRONMENTAL AND SOCIAL CHARACTERISTICS

The questions in this section will ask about environmental and social characteristics for the project.

Q201 Is the Project currently in compliance with all conditions in the DFC contract or consent with respect to environment, social impacts, health and safety? (SELECT ONE: Yes / No/ Do not know)

• [IF Q201=NO, ASK] Q201A Please describe the reason for non-compliance: (OPEN-ENDED)

Q202 Did the design or scope of the Project change in any significant or material way during the Reporting Period? (SELECT ONE: Yes/No)

• [IF Q202=YES, ASK] Q202A Please describe: (OPEN-ENDED)

Q203 Did the Project’s environmental and social organizational structure or staff management structure change in any significant or material way during the Reporting Period?

• IF Q203=YES, ASK] Q203A Please describe: (OPEN-ENDED)

Q204 Did the Project’s Environmental and Social Management System (policies and procedures related to environmental health and safety, human resources, etc.) change, in any significant or material way during the Reporting Period?

• IF Q204=YES, ASK] Q204A Please describe: (OPEN-ENDED)

To the best of your knowledge, has the Project experienced any of the following during the Reporting Period? This can be self-diagnosed, or as a result of official inspections or other audits.

Q205 Strikes or other labor disputes in the last 3 years. (SELECT ONE: Yes / No)

Q206 Ongoing or unresolved disputes with a trade union. (SELECT ONE: Yes / No)

Q207 Community strike, protest, or opposition. (SELECT ONE: Yes/No)

Q208 Incidents or investigations of gender-based violence or sexual harassment. (SELECT ONE: Yes / No)

Q209 Has the Project been cited or fined, or been the subject of any investigation or litigation, for any violation of local or host country environmental, human rights, labor, health or safety laws during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q209=YES, ASK] Q209A Please explain: (OPEN-ENDED)

Q210 Has the Project submitted all DFC-required deliverables on social, environmental, health and safety during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q210=NO, ASK] 210A Please note the required deliverables for the Reporting Period that were not submitted, and list the deliverables that were submitted including due date and date of transmission: (OPEN-ENDED)

Q211 Have there been any changes in the design or capacity of the Project that resulted in increased hazards to workers, local populations, or the environment during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q211=YES, ASK] Q211A Please describe: (OPEN-ENDED)

Q212 Have any accidents occurred that resulted in loss of human life, serious injuries (e.g. Lost Time Injuries, and/or near misses) or material impacts on the environment during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q212=YES, ASK] Q212A Please describe: (OPEN-ENDED)

Q213 Has the Project engaged with communities impacted by the Project (including disadvantaged and vulnerable groups) during the Reporting Period? (SELECT ONE: Yes / No)

Q214 Has the Project been involved in a formal, third-party dispute resolution process during the Reporting Period, including an Independent Accountability Mechanism of an International Financial Institution and/or OECD National Contact Point? (SELECT ONE: Yes / No)

• [IF Q214=YES, ASK] Q214A Please describe the dispute or complaint and list steps being taken to resolve it: (OPEN-ENDED)

Q215 Did the Project involve any land acquisition during the Reporting Period? (SELECT ONE: Yes / No)

• [IF 215=YES, ASK] Q215A How many households were physically displaced and resettled during the Reporting Period? (NUMBER)

• [IF 215=YES, ASK] Q215B How many households were economically displaced (disruption of loss of livelihood, jobs or income) during the Reporting Period? (NUMBER)

Q216 Has the Project’s impacts been monitored or audited by any government regulatory agencies during the Reporting Period? (SELECT ONE: Yes / No)

• [IF 216=YES, ASK] Q216A What agency performed this audit? (OPEN-ENDED)

• [IF 216=YES, ASK] Q216B Describe how they monitored or audited the Project. (OPEN-ENDED)

3. PROJECT HUMAN RESOURCES MANAGEMENT AND JOB QUALITY

The questions in this section will ask about human resource policies, labor standards, and employee benefits.

Q301 Does the Project or the company managing the Project have a written human resources policy consistent with the law of the country or countries of operations? (SELECT ONE: Yes / No)

Q302 During the Reporting Period, did the Project or company managing the Project offer employees any of the following family friendly benefits that go beyond what is legally required by the country or countries of operations? Please select all that apply.

1. Flexible work schedules

2. Extended paid maternity leave

3. Paid paternity leave

4. Access to on-site childcare or childcare stipends

5. Family healthcare

6. Other (Please describe)

• [IF Q302=ANY OPTIONS SELECTED, ASK] Q302A Please describe how the selected option goes beyond legal requirements in the country or countries of operations. (OPEN-ENDED)

Q303 Did the Project include any initiatives to advance women in the workforce beyond what is legally required by the country or countries of operations during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q303=YES, ASK] Q303A Please describe these initiatives and how they go beyond what is legally required: (OPEN-ENDED)

Q304 Has the Project experienced worker layoffs during the Reporting Period? Please only include layoffs that were part of workforce reductions for business reasons, rather than workers let go for performance reasons. (SELECT ONE: Yes / No)

• [IF Q304=YES, ASK] Q304A How many workers were laid off? (NUMBER)

Q305 Does the Project expect any significant changes to the workforce in the next year (i.e., layoffs/demobilization, increase in contracted workers, re-organization)? (SELECT ONE: Yes / No)

4. PROJECT BENEFITS TO THE ENVIRONMENT AND THE COMMUNITY

This section will ask about the Project’s efforts to help the environment and local communities.

Q401 Did the Project track its greenhouse gas (GHG) emissions during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q401=YES, ASK] Q401A What is the total amount of GHG emissions generated as a result of the Project’s activities during the Reporting Period? Please report in metric tons of CO2e (carbon dioxide equivalent) per year. (NUMBER)

• [If Q401=YES, ASK] Q401B Please provide an explanation of how the reported figure was calculated. (OPEN-ENDED)

Q402 Did the Project track the amount of sequestered greenhouse gas (GHG) emissions during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q402=YES, ASK] Q402A What is the total amount of GHG emissions sequestered by the Project during the Reporting Period? Please report in metric tons of CO2e (carbon dioxide equivalent) per year. (NUMBER)

• [IF 402=YES, ASK] Q402B Please provide an explanation of how the reported figure was calculated. (OPEN-ENDED)

Q403 Did the Project track the amount of avoided greenhouse gas (GHG) emissions by, for example the use of renewable energy, during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q403=YES, ASK] Q403A What is the total amount of GHG emissions avoided by the Project during the Reporting Period? Please report in metric tons of CO2e (carbon dioxide equivalent) per year. (NUMBER)

• [IF 403=YES, ASK] Q403B Please provide an explanation of how the reported figure was calculated. (OPEN-ENDED)

Q404 Did the Project or the company managing the Project (I.e. the client company) take any actions to conserve, preserve, and/or restore terrestrial or aquatic ecosystems through sustainable resource management practices? (SELECT ONE: Yes/No)

• [IF Q404=YES, ASK] Q404A Area of land directly controlled or supported by the Project under sustainable cultivation or stewardship during the Reporting Period. Please report in hectares of land sustainable managed. (NUMBER)

• [IF Q404=YES, ASK] Q404B Area of ocean or other marine habitat directly controlled or supported by the Project under sustainable cultivation or stewardship during the Reporting Period. Please report in square kilometers. (NUMBER)

Q405 Has the Project (including the company managing the Project, i.e. the client company), its suppliers, or its investees met and received any third party internationally-recognized environmental or social standards or certifications during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q405=YES, ASK] Q405A Please list the environmental or social standards or certifications the Project or the company managing the Project (i.e. the Client Company), or Project suppliers or investees, met and received. (OPEN-ENDED)

• [IF Q405=YES, ASK] Q405B How many suppliers or investees have met and received any environmental or social standards or certifications from an internationally recognized third party? If you do not know, enter "0". (NUMBER)

Q406 Did the Project or the company managing the Project (i.e. the DFC client company) support any charitable activities to benefit the local community in which the Project operates during the Reporting Period? (Do NOT include the goods and/services the Project will produce for customers in the local community.) (SELECT ONE: Yes / No)

• [IF Q406=YES, ASK] Q406A How much money (in U.S. Dollars) was spent on these charitable activities during the Reporting Period? (DOLLARS)

5. BUSINESS INNOVATION AND TECHNICAL ASSISTANCE

The information in this section will ask about the Project's support for innovation and provision of technical assistance.

For investment funds answering the following questions, please think about investments into portfolio companies you expect the fund will make and the impacts of those investments.

Q501 During the Reporting Period, how has the Project incorporated the needs and preferences of target populations in the design and delivery of products and services? [Multi-select]

• The Project has added new product or service offerings to meet its target populations’ needs and preferences.

• The Project adjusted existing product or service offerings to meet its target populations’ needs and preferences.

• The Project designed its pricing models according to its target populations’ ability to pay.

• The Project adjusted our operational and/or expansion strategy to better reach our target populations.

• The Project has not yet adapted the design of its products and services according to its target populations needs and preferences.

• We have not yet adapted the design of our products and services according to our target populations needs and preferences.

• Other (write-in).

• [IF Q501=YES, ASK] Q501A Please provide additional detail about how the Project has incorporated the needs and preferences of target populations in the design and delivery of products and services, including who the target population is for the products and services in question. (OPEN-ENDED)

Q502 Did the Project introduce or disseminate an innovative product or service (including innovative financial services and financing structures) during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q502=YES, ASK] Q502A please describe the innovative product or service (OPEN-ENDED)

• [IFQ502=YES, ASK] Q502B Please select from the following benefits provided by the innovation:

Reducing prices to consumers

IF CHECKED: What was the average percentage savings premium to customers accessing the innovative product or service during the Reporting Period? (PERCENTAGE)

Increasing prices paid to producers

IF CHECKED: What was the average percentage premium paid to producers due to the product or service innovation during the Reporting Period? (PERCENTAGE)

Other

IF CHECKED Please Describe (OPEN-ENDED)

Q503 Did the Project provide advisory services (such as training or advice designed to improve business performance; this is also known as technical assistance) to customers, suppliers, or investees during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q503=YES, ASK] Q503A How many customers, suppliers, or investees did the Project provide advisory services to during the Reporting Period? For investees, please include those for whom a Project representative had an active role on the investee Board. (NUMBER)

• [IF Q503=YES, ASK] Q503B How much money (U.S. Dollars) was spent on advisory services for customers, suppliers, or investees during the Reporting Period? (DOLLARS)

• [If Q503=YES, ASK] Q503C Were these activities supported by a DFC Technical Assistance grant? (Yes / No)

Q504 During the Reporting Period, did the Project carry out Technical Assistance activities funded by a DFC grant? (Yes/No)

• [If Q504=YES, ASK] Q504A Pease describe the TA activities undertaken during the Reporting Period. (OPEN-ENDED)

• [If Q504=YES, ASK] Q504B Please describe how this TA impacted the project’s operations, products, or services. (OPEN-ENDED)

• [IF Q504=YES, ASK] Q504C Please describe any challenges encountered undertaking and operationalizing the TA during the Reporting Period. (OPEN-ENDED)

6. PROJECT OPERATIONAL EMPLOYMENT

The questions in this section will ask about local Project employees at the end of the Reporting Period, including full-time, part-time, seasonal, and contract employees. We will ask several detailed questions about the staff you currently employ so you may need to refer to your employment records to answer questions in this section.

[FOR ALL PROJECTS THAT DO NOT PROVIDE FINANCIAL SERVICES] Please complete the table below for all local employees (i.e. nationals of the country or countries of operations) of the Project at end of the Reporting Period. Please do NOT include employment facilitated through an online or other matchmaking/peer-to-peer platform in this table. If the Project does not yet have any employees, or no longer has employees, please enter “0”.

Q601

	Full-Time Local Employees (non-construction)	Part-Time Local Employees (non-construction)	Temporary/Seasonal Local Workers (non-construction)	Temporary/Seasonal Local Workers (construction)
Total
Women
Young adults (15-24 years old)
Other disadvantaged groups (not included in Women or Young adults)

[IF any fields for “Part-Time Local Employees (non-construction)” >0, ASK] Q601A Approximately what proportion of a typical work week, on average, do the part-time local employees (non-construction) work (expressed as a percentage)? (PERCENTAGE)

[IF any fields for “Temporary/Seasonal Local Workers (non-construction)” > 0, ASK] Q601B Approximately how many months, on average, did the temporary/seasonal local workers (non-construction) work during the Reporting Period? (MONTHS)

[IF any fields for “Temporary Seasonal Local Workers (construction)” > 0, ASK] Q601C Approximately how many months, on average, did the temporary/seasonal local workers (construction) work during the Reporting Period? (MONTHS)

Q602 Did the Project employ any disabled people from the country or countries of operation at the end of the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q602=YES, ASK] Q602A How many disabled employees from the country or countries of operations did the Project employ at the end of the Reporting Period? (NUMBER)

Q603 Did the Project facilitate employment through an online or other matchmaking/peer-to-peer platform (sometimes referred to as “gig economy”) during the Reporting Period? (SELECT ONE: Yes/No)

• [f Q603=YES, ASK] Q603A If yes, how many of these jobs were facilitated during the Reporting Period?

Q604 Please provide the total amount, in U.S. Dollars, paid during the Reporting Period to Project employees in the country or countries of operations (total annual local payroll in U.S. Dollars). Do not include foreign nationals working on the Project. (DOLLARS)

7. PROCUREMENT AND TAXES

This section will ask about different ways that the Project and the company managing the project (i.e. the DFC client company) have an impact on the economy.

NOTE: Projects providing financial services (as selected in Section 1) will NOT fill out this section.

Q701 Please enter the total dollar amount (in U.S. Dollars) spent by the Project on goods and services procured from the United States during the Reporting Period. (DOLLARS)

Q702 Please enter the total dollar amount (in U.S. Dollars) spent by the Project on goods and services procured in the country or countries of operations during the Reporting Period. (DOLLARS) (If number is greater than 0, answer below questions).

• [IF Q702>0, ASK] Q703 How many local suppliers did you purchase goods and services from during the Reporting Period? (NUMBER)

• [IF Q702>0, ASK] Q704 How many of these local suppliers are a women-owned or women-led enterprises? (NUMBER)

• [IF Q702>0, ASK] Q705 How many of these local suppliers were microenterprises? (NUMBER)

• [IF Q702>0, ASK] Q706 How many of these local suppliers are SMEs? (NUMBER)

• [IF Q702>0, ASK] Q707 How many local suppliers are smallholder farmers? (NUMBER)

• [IF Q702>0, ASK] Q708 How many local suppliers are owned or led by disadvantaged populations not included in above categories? (NUMBER)

  • If >0, Please describe the disadvantaged population not included in above categories.

Q709 Please enter the total dollar amount (in U.S. Dollars) spent by the Project on goods and services procured from any other countries (i.e. not the United States, and not the country or countries of operations) during the Reporting Period. (DOLLARS)

Q710 Please enter the total dollar amount (in U.S. Dollars) paid by the Project to the government of the country or countries of operations in taxes, royalties, concessions, or other fees during the Reporting Period. (DOLLARS)

8. REVENUE AND EXPORTS

This section will ask a few questions about the revenue and exports of the Project during the Reporting Period.

NOTE: Projects providing financial services (as selected in Section 1) will NOT fill out this section.

Q801 What was the gross revenue for the Project during the Reporting Period? Please express in U.S. Dollars. (DOLLARS)

Q802 What was the net profit for the Project during the Reporting Period? Please express in U.S. Dollars. (DOLLARS)

Q803 How much of the Project's revenue during the Reporting Period came from exports to the United States? Please express in U.S. Dollars. (DOLLARS)

Q804 How much of the Project's revenue during the Reporting Period came from sales in the country or countries of operations? Please express in U.S. Dollars. (DOLLARS)

Q805 How much of the Project's revenue during the Reporting Period came from exports to countries other than the United States? Please express in U.S. Dollars. (DOLLARS)

9. SECTOR-SPECIFIC METRICS

The questions in this section will ask about your results for the specific sectors on which the Project focused during the Reporting Period. For each sector, we will ask for detailed information about services provided and the number of people who benefit from these services. If a question is not relevant the Project or the Project does not track the relevant metric, please enter a response of “0”.

NOTE: Projects will only answer questions for the sectors selected in Section 1.

AGRICULTURE SECTOR [IF Q106A=YES, ASK Q901]

Please only report data for the Reporting Period.

Q901 Average annual yield from this Project during the Reporting Period, expressed in tons per hectare. (NUMBER)

EDUCATION SECTOR [IF Q106B=YES, ASK Q902-Q907]

Please only report data for the Reporting Period.

Q902 Total number of students enrolled. (NUMBER)

Q903 Number of women/girl students enrolled. (NUMBER)

Q904 Number of students from low-income households. (NUMBER)

Q905 Number of students from disadvantaged backgrounds. These are students from other disadvantaged backgrounds, other than women/girl students or students from low-income households. (NUMBER)

Q906 Percentage of students promoted to next grade/academic level. (PERCENTAGE)

Q907 Percentage of students receiving a passing score on standardized tests. (PERCENTAGE)

ENERGY SECTOR [IF Q106C=YES, ASK Q908-Q918]

Please only report data for the Reporting Period.

Q908 Amount of non-renewable energy produced, expressed in gigawatt hours (GWh). (NUMBER)

Q909 Amount of renewable energy (including solar, wind, hydro, geothermal, tidal) produced, expressed in gigawatt hours (GWh). (NUMBER)

Q910 Number of on-grid connections for households. (NUMBER)

Q911 Number of on-grid connections for businesses. (NUMBER)

Q912 Number of off-grid power systems installed for households. (NUMBER)

Q913 Number of off-grid power systems installed for enterprises/businesses/organizations. (NUMBER)

Q914 Number of micro-grid connections installed. (NUMBER)

Q915 Energy storage capacity as of the end of the Reporting Period, expressed in MWh. (NUMBER)

Q916 Length of energy transmission lines built or improved, expressed in kilometers. (NUMBER)

Q917 Frequency of power outages (reported as total number of customer interruptions / total number of customers served). (NUMBER)

Q918 Number of energy efficient lighting devices sold [e.g. solar lanterns, street lighting]. (NUMBER)

HEALTHCARE SECTOR [IF Q106D=YES, ASK Q919-Q923]

Please only report data for the Reporting Period.

Q919 Number of patient beds available as of the end of the Reporting Period. (NUMBER)

Q920 Number of patients served. (NUMBER)

Q921 Number of women or girl patients served. (NUMBER)

Q922 Number of low-income patients served (NUMBER)

Q923 Number of patients from disadvantaged backgrounds served. (These are patients from other disadvantaged backgrounds, other than women or girl patients, or low-income patients.) (NUMBER)

HOUSING SECTOR [IF Q106E=YES, ASK Q924-Q928]

Please only report data for the Reporting Period. If a unit was constructed or refurbished prior to the Reporting Period, do not include it here.

Q924 Number of new residential dwellings constructed. (NUMBER)

• [IF Q924>0, ASK] Q924A Of these new residential dwellings, how many were certified as green buildings (green buildings refer to resource-efficient buildings that are third-party certified, for example, Edge, LEED, etc.) (NUMBER)

Q925 Number of new residential dwellings for low-income homebuyers or renters constructed. (NUMBER)

Q926 Area of buildings receiving energy efficiency improvements during the Reporting Period, expressed in square meters. (NUMBER)

Q927 Number of residential dwellings refurbished (NUMBER)

• [IF Q927>0, ASK] Q927A Of these residential dwellings refurbished, how many were certified as green buildings (green buildings refer to resource-efficient buildings that are third-party certified, for example, Edge, LEED, etc.) (NUMBER)

Q928 Number of residential dwellings refurbished for low-income homebuyers/renters. (NUMBER)

INFORMATION AND COMMUNICATIONS TECHNOLOGY SECTOR [IF Q106F=YES, ASK Q929-Q937]

Please only report data for the Reporting Period.

Q929 Number of cell towers constructed. (NUMBER)

Q930 Number of mobile subscriptions as of the end of the Reporting Period. (NUMBER)

Q931 Number of mobile subscriptions with data as of the end of the Reporting Period. (NUMBER)

Q932 Number of fixed data (wired connection) subscriptions as of the end of the Reporting Period. (NUMBER)

Q933 Number of fixed voice (landline telephone) subscriptions as of the end of the Reporting Period. (NUMBER)

Q934 Number of subscribers to an affordable data plan (priced at less than 2% of local average annual income) as of the end of the Reporting Period. (NUMBER)

Q935 Median download speed of data subscriptions, expressed in megabytes per second (MBps). (NUMBER)

Q936 Number of low-income subscribers as of the end of the Reporting Period. (NUMBER)

Q937 Number of data center racks as of the end of the Reporting Period. (NUMBER)

TRANSPORTATION SECTOR [IF Q106G=YES, ASK Q938-Q944]

Please only report data for the Reporting Period. If a length of road was constructed or improved in a previous Reporting Period, do not include it here.

Q938 Length of road constructed, expressed in kilometers. (NUMBER)

Q939 Length of road improved, expressed in kilometers. (NUMBER)

Q940 Number of twenty foot-equivalent units of cargo containers transported through the road/railway/port/airport. (NUMBER)

Q941 Bulk cargo transported through the road/railway/port/airport, expressed in metric tons. (NUMBER)

Q942 Number of passengers using transportation service. (NUMBER)

Q943 Number of warehouses or storage units constructed or improved. (NUMBER)

Q944 Number of vehicles using roads daily (NUMBER)

WASTE, WATER, AND SANITATION SECTOR [IF Q106H=YES, ASK Q945-Q949]

Please only report data for the Reporting Period.

Q945 Amount of wastewater disposed, expressed in metric tons. (NUMBER)

Q946 Volume of wastewater treated, expressed in metric tons. (NUMBER)

Q947 Volume of water produced and/or delivered, expressed in metric tons. (NUMBER)

Q948 Number of households with new or improved sanitation facilities as of the end of the Reporting Period. (NUMBER)

Q949 Number of residential connections to water and wastewater services as of the end of the Reporting Period. (NUMBER)

SECTION 10 CUSTOMERS AND PRODUCTS/SERVICES FOR NON-FINANCIAL INTERMEDIARIES

The questions in this section will ask about the customers or clients reached by the Project during the Reporting Period, as well as the products or services provided by the Project during the Reporting Period.

[IF Q105=NO, ASK Section 10]

Q1001 How many enterprises/other organizational customers did the Project reach? (NUMBER)

• [IF Q1001>0, ASK] Q1001A Number of women-owned/women-led enterprises (or women-owned/women-led organizational customers of other types) reached during the Reporting Period (NUMBER)

• [IF Q1001>0, ASK] Q1001B Number of Small and Medium Enterprise (SME) customers or clients reached during the Reporting Period (NUMBER)

• [IF Q1001>0, ASK] Q1001C Number of microenterprises reached during the Reporting Period (NUMBER)

Q1002 How many individual customers (i.e. people and households) did the Project reach during the Reporting Period? (NUMBER)

• [IF Q1002>0, ASK] Q1002A Number of women customers or clients reached during the Reporting Period (NUMBER)

• [IF Q1002>0, ASK] Q1002B Number of customers or clients who are young adults, reached during the Reporting Period (NUMBER)

• [IF Q1002>0, ASK] Q1002C Number of rural customers or clients reached during the Reporting Period (NUMBER)

• [IF Q1002>0, ASK] Q1002D Number of smallholder farmer customers or clients reached during the Reporting Period. (NUMBER)

• [IF Q1002>0, ASK] Q1002E Number of low-income customers or clients reached during the Reporting Period. (NUMBER)

• [[IF Q1002>0, ASK]] Q1002F Number of customers or clients from disadvantaged populations reached during the Reporting Period (other than those included above). (NUMBER)

• [IF Q1002>0, ASK] Q1002G Number of customers receiving new access to the Project’s product or service during the Reporting Period. This should only be reported if the Project is able to track whether customers previously had access to the relevant product or service prior to accessing it from the Project. (NUMBER)

• [IF Q1002>0, ASK] Q1002H Number of customers receiving improved access to the Project’s product or service during the Reporting Period. This should only be reported if the Project is able to track the type of access customers previously had to the relevant product or service prior to accessing it from the Project. (NUMBER)

Q1003 Did DFC financing support the sale of products during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q1003=YES, ASK] Q1003A Please list and describe the DFC-supported products sold during the Reporting Period.

Description of product sold	Unit (e.g. product type)	Number of products sold

Q1004 During the Reporting Period, did the Project increase its market share? YES/NO

• [IF 1004 YES, ASK] Q1004A Please estimate the percent increase in market share gained by the Project during the Reporting Period. (PERCENTAGE)

QUESTIONS ONLY FOR PROJECTS PROVIDING FINANCIAL PRODUCTS/SERVICES (SECTION 11)

11. FINANCIAL SERVICES PORTFOLIO

This section includes information regarding the DFC Client Company’s overall portfolio of financial product(s) and the portfolio supported by the DFC project.

NOTE: This section is ONLY for projects providing financial services. [IF Q105=Yes, ASK Section 11]

Q1101 Does the DFC Client Company have an Investment Committee?

• [IF Q1101=YES, ASK] Q1101A What is the total number of Investment Committee members? (NUMBER)

• [IF Q1101=YES, ASK] Q1101B How many of the Investment Committee members are women? (NUMBER)

Q1102 Is the DFC Client Company a Client Protection Certified Institution? (SELECT ONE: Yes/No)

• [IF Q1102=YES, ASK] Q1102A What year was the certification provided? (YEAR)

• [IF Q1102=NO, ASK] Q1102B Is the DFC Client Company part of the Client Protection Pathway? (SELECT ONE: Yes/No)

  • [IF Q1102B=YES, ASK] Q1102C When did the DFC Client Company become part of the Client Protection Pathway? (YEAR)

Q1103 Is the DFC Project supporting a(n):

1. Portfolio of loans from a commercial bank, non-bank financial institution, microfinance institution (MFI), Single-Purpose Entity/Trust, etc.

2. Investment fund, loan framework, loan portfolio guarantee facility, etc.

3. Portfolio of lease or insurance contracts

4. Other (Please Specify)

[IF Q1103A IS SELECTED, ASK] Q1104 IF a portfolio of loans from a commercial bank, non-bank financial institution, microfinance institution (MFI), single-purpose entity/trust, etc.:

1. What was the value (U.S. Dollars) of the DFC Client Company’s total assets at the end of the Reporting Period? (DOLLARS)

2. Was the DFC Project intended to support the DFC Client Company’s microenterprise loan portfolio?

1. If yes, please provide information below with respect to the DFC Client Company’s microenterprise loan portfolio:

2. Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

3. Please describe how the clients and/or loans supported by the DFC Project are different from the DFC Client Company’s typical microenterprise loan portfolio. (SELECT ALL THAT APPLY)

• Lower interest rates

• Longer tenor

• Longer grace period

• Other loan structure difference

• Increased exposure to women, women-owned/women-led clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to disadvantaged group, other than those listed above

• No difference

• Other (Please describe)

3. Was the DFC Project intended to support the DFC Client Company’s small and medium enterprise (SME) loan portfolio?

1. If yes, please provide information below with respect to the DFC Client Company’s SME loan portfolio:

2. Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

3. Please describe how the clients and/or loans supported by the DFC Project are different from the DFC Client Company’s typical SME loan portfolio (SELECT ALL THAT APPLY)

• Lower interest rates

• Longer tenor

• Longer grace period

• Other loan structure difference

• Increased exposure to women, women-owned/women-led clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to disadvantaged group, other than those listed above

• No difference

• Other (Please describe)

4. Was the DFC Project intended to support the DFC Client Company’s consumer loan portfolio?

1. If yes, please provide information below with respect to the DFC Client Company’s consumer loan portfolio:

2. Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

3. Please describe how the clients and/or loans supported by the DFC Project are different from the DFC Client Company’s typical consumer loan portfolio (SELECT ALL THAT APPLY)

• Lower interest rates

• Longer tenor

• Longer grace period

• Other loan structure difference

• Increased exposure to women, women-owned/women-led clients

• Increased exposure to rural clients

• Increased exposure to low-income clients

• Increased exposure to disadvantaged group, other than those listed above

• No difference

• Other (Please describe)

5. Was the DFC Project intended to support a DFC Client Company portfolio (or portfolios) not articulated in the above sections (microenterprise, SME, consumer finance)?

1. If yes, please provide information below with respect to the DFC Client Company’s portfolio(s) and articulate what type of portfolio (or portfolios) were supported? (OPEN-ENDED)

2. Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

3. Please describe how the clients and/or loans supported by the DFC Project are different from the DFC Client Company’s typical loan portfolio that was articulated above (SELECT ALL THAT APPLY)

• Lower interest rates

• Longer tenor

• Longer grace period

• Other loan structure difference

• Increased exposure to women, women-owned/women-led clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to low-income clients

• Increased exposure to disadvantaged group, other than those listed above

• No difference

• Other (Please describe)

[IF Q1103B IS SELECTED, ASK] Q1105 IF investment fund or DFC-Supported loan framework, loan portfolio guarantee facility, etc.:

1. What were the DFC Client Company’s total assets (U.S. Dollars) at the end of the Reporting Period? (DOLLARS)

2. What portion of the DFC Client Company’s total assets (U.S. Dollars) are represented by the DFC Project (e.g., investment fund, loan framework, or loan portfolio guarantee facility)? (For example, if the intent of the DFC Project was to provide debt or equity capital to the DFC Client Company’s investment fund, the response should relate to the entirety of the DFC Client Company’s investment fund supported by DFC). (DOLLARS)

3. Please provide information below with respect to the DFC Project (e.g., investment fund, framework, or loan portfolio guarantee facility):

1. Did the DFC Project lend to or otherwise invest in microfinance institutions (MFIs)?

1. If yes, please provide the information below:

2. Of the Total Number of Clients of MFIs listed above, what is the allocation to the following sectors:

3. Of the Total Number of MFIs listed above, how many are Client Protection Certified Institutions or on the Client Protection Pathway?

C1. Client Protection Certified Institutions: [NUMBER]

C2. On the Client Protection Pathway: [NUMBER]

2. Did the DFC Project lend to or otherwise invest in financial service providers that are NOT microfinance finance institutions?

1. If yes, please provide the information below:

2. Of the Total Number of Clients of Non-MFI Financial Service Providers listed above, what is the allocation to the following sectors:

3. Did the DFC Project directly lend to or otherwise invest in microenterprises? If yes, please provide the information below:

1. If yes, please provide the information below:

2. Of the Total Number of Microenterprises listed above, what is the allocation to the following sectors:

4. Did the DFC Project lend to or otherwise invest in small and medium enterprises (SMEs)?

1. If yes, please provide the information below:

2. Of the Total Number of SMEs listed above, what is the allocation to the following sectors:

5. Did the DFC Project lend to or otherwise invest in enterprises that are NOT micro, small, and medium enterprises (MSMEs)?

1. If yes, please provide the information below:

2. Of the Total Number of Non-MSME Enterprises listed above, what is the allocation to the following sectors:

6. Did the DFC Project lend to or otherwise invest in enterprises, organizations, or projects that are NOT MFIs, Non-MFI Financial Service Providers, MSMEs, or non-MSMEs?

1. If yes, please provide the information below:

2. Of the number of other enterprises/organizations or projects listed above, what is the allocation to the following sectors:

7. Is the DFC Project different from the DFC Client Company’s typical investment fund, loan framework, and/or loan portfolio guarantee facility that it manages, sponsors, or otherwise supports? (SELECT ONE: Yes/No)

1. If yes, please provide how the DFC project is different (SELECT ALL THAT APPLY)

• Type and/or size of investee company

• Longer loan tenor and/or equity holding period for investee companies

• Number of investee companies

• Average size of investment in investee company

• Type of engagement with investee company

• Other loan/equity investment structure difference

• Increased exposure to new sector/industry

• Increased exposure to new geography

• Increased exposure to new thematic thesis (e.g., impact investing, water access, women-led enterprises, etc.)

• Increased exposure to other strategic difference

• Other (Please describe)

[IF Q1103C IS SELECTED, ASK] Q1106 IF portfolio of leasing or insurance contracts:

1. What were the DFC Client Company’s total assets (U.S. Dollars) at the end of the Reporting Period? (DOLLARS)

2. Of the value (U.S. Dollars) of the DFC Client Company’s total assets, what is the value (U.S. Dollars) of the outstanding portfolio of financial product(s) (e.g., leasing, insurance) at the end of the Reporting Period that is supported by the DFC Project? (For example, if the intent of the DFC Project was to expand the DFC Client Company’s SME leasing portfolio, the response should relate to the entirety of the DFC Client Company’s SME leasing portfolio at the end of the Reporting Period). Total Outstanding Portfolio Value of Financial Product(s): (DOLLARS)

3. Was the DFC Project intended to support the DFC Client Company’s microenterprise portfolio?

1. If yes, please provide information below with respect to the DFC Client Company’s microenterprise portfolio:

2. Of the total number of clients and outstanding contracts listed above, what is the allocation to the following sectors (if applicable):

3. Are the clients and/or contracts supported by the DFC Project different from the DFC Client Company’s typical microenterprise leasing or insurance portfolio? (SELECT ONE: Yes/No)

1. If yes, please provide how the DFC project is different (SELECT ALL THAT APPLY)

• Longer contract duration

• Other contract structural difference

• Increased exposure to women, women-owned/women-led clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to disadvantaged group, other than those listed above

• Other (Please describe)

4. Was the DFC Project intended to support the DFC Client Company’s small and medium enterprise (SME) portfolio?

1. If yes, please provide information below with respect to the DFC Client Company’s SME portfolio:

2. Of the number of total number clients and outstanding contracts listed above, what is the allocation to the following sectors (if applicable):

3. Are the clients or contracts supported by the DFC Project different from the DFC Client Company’s typical SME leasing and/or insurance portfolio? (SELECT ONE: Yes/No)

1. If yes, please provide how the DFC project is different (SELECT ALL THAT APPLY)

• Longer contract duration

• Other contract structural difference

• Increased exposure to women, women-owned/women-led clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to disadvantaged group, other than those listed above

• Other (Please describe)

5. Was the DFC Project intended to support a DFC Client Company portfolio (or portfolios) of leasing or insurance contracts to enterprises that are NOT micro, small, and medium enterprise (MSME)?

1. If yes, please provide information below with respect to the DFC Client Company’s portfolio(s) and articulate what type of portfolio (or portfolios) were supported? (OPEN-ENDED)

2. Of the number of total number clients and outstanding contracts listed above, what was the allocation to the following sectors:

3. Are the clients or contracts supported by the DFC Project different from the DFC Client Company’s the typical leasing or insurance portfolio articulated above? (SELECT ONE: Yes/No)

1. If yes, please provide how the DFC project is different (SELECT ALL THAT APPLY)

• Longer contract duration

• Other contract structural difference

• Increased exposure to women, women-owned/women-led clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to low-income clients

• Increased exposure to disadvantaged group, other than those listed above

• Other (Please describe)

[IF Q1103D IS SELECTED, ASK] Q1107 IF Other, please contact DFC at DOS@DFC.gov

12. OTHER DEVELOPMENT IMPACTS

This section is an opportunity to further describe how the Project has impacted women, rural communities, and other underserved populations during the Reporting Period. Please use this section to highlight any ways that the Project helped these populations that may not have been fully covered in previous sections.

Q1201 Please describe the ways, if any, that the Project worked to support rural businesses and communities during the Reporting Period. (OPEN-ENDED)

Q1202 Please describe the ways, if any, that the Project worked to support women and women-led businesses during the Reporting Period. (OPEN-ENDED)

Q1203 Please describe the ways, if any, that the Project worked to support other disadvantaged communities during the Reporting Period. (OPEN-ENDED)

Representative Certification

I hereby represent the information provided in this document is complete and accurate to the best of my knowledge.
Name:	Date:	Telephone:      
Title:      		Email address: