ang LTIA Form 1 (Page 2) ay ang gamit na form sa pag evaluate ng Lupon.

ang mga nasa page

3 hanggang 20 ay ang inyong guide para maihanda ang mga kinakailangang documento na
isubmit sa amin para sa evaluation. isubmit po ang kopya ng mga documento na kailangan
sa aming opisina hanggang february 8, 2024.

ang mga dokumento po para sa taong 2023 ang kinakailangan

 CY 2023LUPONG TAGAPAMAYAPA INCENTIVES AWARDS
(LTIA)
LTIA FORM 01-PERFORMANCE EVALUATION FORM

A. IDENTIFYING INFORMATION
Lupong Tagapamayapa ______________________________
City/Municipality ______________________________
Region ______________________________
Category ______________________________

B. EVALUATION CRITERIA

CRITERIA ASSIGNED RATING

POINT SCORE
I. EFFICIENCY IN OPERATION 42
A. Observance of Settlement Procedure and Settlement 20
Deadlines
B. Systematic Maintenance of Records 5
C. Timely Submissions to the Court and the DILG 7
D. Conduct of monthly meetings for administration of the 10
Katarungang Pambarangay (KP)
II. EFFECTIVENESS IN SECURING THE SETTLEMENT 20
OF INTERPERSONAL DISPUTE OBJECTIVE OF
THE KATARUNGANG PAMBARANGAY
A. Quantity of settled cases against filed 10
B. Quality of Settlement of Cases 2
C. At least 80% compliance with the terms of settlement or 8
award after the cases have been settled
III. CREATIVITY AND RESOURCEFULNESS OF THE 30
LUPONG TAGAPAMAYAPA
A. Settlement Technique utilized by the Lupon 10
B. Coordination with Concerned Agencies relating to 5
disputes filed (PNP, DSWD, DILG, DAR, DENR, Office of
the Prosecutor, Court, DOJ, CHR, etc.)
C. Sustained information drive to promote Katarungang 5
Pambarangay

D. KP Training or seminar within the assessment period 10

IV. AREA OR FACILITY FOR KP ACTIVITIES 5

● Building structure or space 5

V. FINANCIAL OR NON-FINANCIAL SUPPORT 3

TOTAL 100

C. WE CERTIFY TO THE CORRECTNESS OF THE ABOVE INFORMATION.

_____________________________

1 | LTIA FORM 01-PERFORMANCE EVALUATION FORM

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 06-SUMMARY OF CASES

CATEGORY: ____________________________

FINALIST LUPONG TAGAPAMAYAPA : POPULATION :

PUNONG BARANGAY: LAND AREA :
CITY/MUNICIPALITY : TOTAL NO. OF CASES:
MAYOR: NUMBER OF LUPONS:
PROVINCE: MALE :
REGION: FEMALE :

General Instruction: Please read the Technical Notes at the back before accomplishing this form. Supply only the number.

NATURE OF CASES ACTION TAKEN

(1) SETTLED NOT SETTLED
(2) (3)
OUTSIDE
DROP TOTA BUDGE
CERTIF THE
PEN - L T
CRI MED CONC ARBI REPU IED TO JURISDICT
CI - DIS- PED/ (case ALLO-
MI- OTHE TOT IA- I- T- TOT - FILE TOT ION OF
VIL DIN MISS WITH s CATED
NAL RS AL TIO LIATI RATI AL DIAT ACTIO AL THE
(1b G ED -- filed) (6)
(1a (1c) (1D) N ON ON (2D) ED N IN (3F) BARANGAY
) (3a (3b) DRA (5)
) (2a) (2b) (2c) (3c) COURT
) WN
(3d)
(3e)

***Total Number of Lupons excluding Lupon Chairman and Lupon Secretary

13 | LTIA FORM 06-SUMMARY OF CASES
 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 06-SUMMARY OF CASES

***Please attached Form 07-A “LIST OF CASES”

14 | LTIA FORM 06-SUMMARY OF CASES

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

Category
Name of the Lupong Tagapamayapa
Punong Barangay
City/Municipality
Mayor
Province Barangay
Region Logo Here
IRA
Land Area
Population
LTIA Awards Received (all levels)
GENERAL INSTRUCTION: Kindly fill-out this form by following the instructions stated per sub-criteria.

CRITERIA

I. EFFICIENCY IN OPERATIONS
A). Observance of Settlement
Procedure and Settlement
Deadlines
●
1 a) Proper Recording
of every dispute/
complaint ● Kindly attached MOvs after the description.

NOTE: Record Book entries should contain docket number, names of the parties, date and time filed, nature of
the case and disposition.

15 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

MOVs: Two (2) photos with caption of the Record Book and sample entries in the record book

1 b) Sending of Notices ● mons to the respondent

and Summons with
complete and accurate ● Kindly attached the MOVs after the description.
information to the
parties within the
prescribed period MOVs: At least 10 samples of Notices to the Complainant/s and Summons to the respondent/s with Officer’s Return
(within the next and Minutes of the Proceedings
working day upon
receipt of complaint) KP Form No. 7 – Complaint’s Form
KP Form No. 8 – Notice of Hearing
KP Form No. 9 – Summon with Officer’s Return

16 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

17 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

1) Settlement and Award ●

Period

● - -
●

● Kindly attached the MOVs after the desc

SETTLEMENT AND AWARD PERIOD

LEGEND: M- A- C w/ EP-Conciliation C46+ -Conciliation
C-Conciliation
Mediation Arbitration with Extendible Period beyond 46 days
CASE CASE TITLE COMP NATURE DATE DATE OF ACTION DATE OF
NO. LAINT FILED INITIAL TAKEN SETTLEMENT
TITLE CONFRON (M, C, C w/
TATION EP,
OF A and C46+)
PARTIES
2022-01 Juan Dela Collecti January January M January 28,
Cruz vs. on of Civil 22, 2022 25, 2022 2022
Juana Sum of
Change Money

18 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

MOVs: At least 10 samples of the Minutes of the Settlement Proceedings

Four photos with caption of on-going procedure (mediation, conciliation or arbitration)

B. Systematic Maintenance of Describe how the Lupon Secretary manages and keeps the KP records systematically
Records
MOVs:
● Two (2) photos with caption of Record Books in reference to the assessment year
● For cities, two (2) photos with caption of the computer database with searchable case information and for
municipalities, one (1) photo each, with caption of the manual and digital file
● Two (2) photos with caption of compilation of the Notices of Meetings, Minutes of Lupon Meetings with
Attendance Sheets
● Two (2) photos with caption of Compilation of Copies of Reports submitted to the Court and to the DILG
● Two (2) photos with caption of the filing cabinet

D. Timely Submissions to ● -
the Court and the DILG -

Presented/Submitted
TIMELY SUBMISSION OF REPORTS
copies of settlement
DATE OF SUBMISSION REPORT/S SUBMITTED AGENCY
agreement to the Court
April 4, 2022 KP Quarterly Consolidated Reports DILG
from the lapse of the
Monthly Transmittal of Final Reports MTC
ten-day period

19 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

repudiating the
mediation/ conciliation
settlement agreement,
or within five (5)
calendar days from the MOVs:
date of the arbitration ● Transmittal Memo or Letters and copies of settlement agreements submitted to the Court from the lapse of
award the ten-day period repudiating the mediation/conciliation settlement agreement, or within five (5) calendar
days from the date of the arbitration award
● Submitted reports to the DILG with date and time stamped of receipt
● KP Form No. 16 Amicable Settlement or
● KP Form No. 14 Agreement for Arbitration

20 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

A. Conduct of Monthly ● Please provide the information needed in the table below and attach the following: (Please see sample in
Meetings Exclusively on
the first line)
Katarungang
Pambarangay (KP) Matters
SUMMARY OF LUPON MEETINGS
DATE OF NOTICE OF DATE OF THE MEETING AGENDA
MEETING MEETING
February 1, 2022 February 6, 2022 ● Number of cases on January 2022.
● On-going cases.

MOVs:
● Copies of Notices of Meetings with Name and date and time stamped receipt of each Lupon Members
● Copies of Minutes of Meetings with Attendance Sheets
● Three (3) photos of on-going meeting with caption

21 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

2 EFFECTIVENESS IN SECURING THE SETTLEMENT OF

INTERPERSONAL DISPUTE OBJECTIVE OF THE KATARUNGANG PAMBARANGAY
A. Quantity of Settled cases Please provide brief explanation and the computation based on the definition provided.
against filed
Formula:
Total number of settled cases filed X 100%
No. of cases received by the Lupon + Referred by other agencies

Please attach Form 7-A, List of Cases

Note: withdrawn cases, dismissed cases due to non-appearance of the complainant or both parties, referred to
other agencies and cases outside the jurisdiction of KP should be deducted to the total number of cases filed.

B. Quality of Settlement of
Cases Please supply the necessary information and briefly explain how the Lupong Tagapamayapa achieved such quality
of settlement of cases.

Out of the (Total number of Settled Cases), there is only (Percentage of repudiated case/s).
i.e. Out of the 200 settled cases, there is only 2% of repudiated cases.

22 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

Out of the (total number of settled cases), there is only (Percentage of non-recurrence) of cases settled by the
Lupon.
i.e. Out of the 200 settled cases there is no recurrence of cases settled by the Lupon.

C. At least 80% compliance ● Please supply the necessary information and briefly explain how the Lupong Tagapamayapa achieved such
with the terms of quality of settlement of cases.
settlement or award after
the case have been settled
For (validation year), Barangay (name of Barangay), achieved (Percentage) compliance with the terms of
settlement or award after the case have been settled.
i.e. For 2022, Barangay Putingkahoy, achieved 90% compliance with the terms of settlement or award after
the case have been settled.
MONITORING OF COMPLIANCE TO SETTLEMENT or AWARD
LEGEND: M- C- A- C w/ EP-Conciliation with C46+ -Conciliation
Mediation Conciliation Arbitration Extendible Period beyond 46 days
ACTIO SETTLEMENT OR
STATU
CASE TITLE N AWARD
S OF
(COMPLAIN TAKEN DATE DATE MAIN
COMP
CASE ANT COMPLAI (M, C, AGREED OF POINT OF
LIANC REMARKS
NO. VS. NT TITLE Cw/EP EXECU AGREEMEN
E
RESPONDE ,A TION T
(C or
NT) and
NC)
C46+)
2022- Juan Dela Collection M January 28, Februa Respondent C Respondent
01 Cruz vs. of Sum of 2022 ry 5, agreed to paid
Juana Money 2022 pay Complainant
Change Complainant the amount

23 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

PhP 500.00 of PhP

per month 500.00 on:
starting February 5,
February to March 6,
pay for the April 7 and
total debt May 5, 2022.
amount of
PhP
2,000.00.

MOV: At least 10 samples of proof of compliance (e.g. Acknowledgement receipts, ledgers, certifications, etc.)
KP Form No. 16 Amicable Settlement or
KP Form No. 14 Agreement for Arbitration
3 CREATIVITY AND RESOURCEFULNESS OF THE LUPONG TAGAPAMAYAPA
A. Settlement Technique Describe the settlement technique used by the Lupong Tagapamayapa and explain briefly how each settlement
technique helps in the speedy settlement of disputes

Note: Technique utilized should be within the KP process and procedures.

MOVs: Two (2) photos with caption of each Settlement Techniques utilized by the Lupon within the assessment
period

B. Coordination with
● Please fill out the table provided with the information needed.
Concerned Agencies
24 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS
 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

relating to disputes filed ●

(PNP, DSWD, DILG, DAR,
DENR, Office of the
Prosecutor, Court/s, DOJ,
COORDINATION WITH AGENCIES
CHR, volunteer
groups/organizations, NGOs, Date of Coordination Agency Coordinated Subject Matter Proof of
CSOs, Barangay Justice Coordinated Coordination
Advocates) June 15, 2022 MSWDO Case involving a child (Please attached here
proof of Coordination)

MOVs:
● Certified true copy of any proof of coordination (Certificate of Appearance, letters or other written
documents)
● Two (2) photos each, with caption for each coordination activity with concerned agencies relating to disputes
file

C. Sustained information ● Briefly explain each information drive strategies practiced by the Lupong Tagapamayapa to create greater
drive to promote awareness to the community in promoting Katarungang Pambarangay (KP)
Katarungang
Pambarangay
MOVs:
● Two (2) photos with caption of the information drive conducted by the LT in the promotion of KP in their
community

25 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

● Copies of pamphlets, leaflets, tarpaulins and other IEC materials produced by the Lupons
● Two (2) photos of Innovative Campaign Strategy utilized by the Lupon

D. Katarungang Kindly fill-out the information needed in the table below. Provide brief explanation about the training and
Pambarangay Training or attached two (2) photos with caption of each training conducted and attended. First line is filled-out as guide.
Seminar participated KP TRAINING or SEMINAR
within the Assessment
DATE TITLE OF THE TRAINING or VENUE SPONSOR/S PARTICIPANTS
Period
SEMINAR
Organized skills training April 14-15, Training on Gender-Responsive, 8th Floor DILG-RO Lupon Chairman,
participated by the Lupong 2022 Child-Friendly and Indigenous Robredo Hall, Lupon Secretary and
Tagapamayapa Peoples-Relevant Katarungang Quezon City at least 2 Lupong
Pambarangay Tagapamayapa
members of all
Barangays in
Quezon City

MOVs:

● Two (2) photos with caption of training on general/basic orientation or review of KP system
● Two (2) photos with caption of skills training on the conduct of KP proceedings
● Two (2) photos with caption of advance knowledge on laws, policies and standards in relation to KP system
● Certified true copies of any proof of trainings such as Certificates of Completion and/or Participation,
Attendance Sheets, among others.

26 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

4 AREA OR FACILITY FOR KATARUNGANG PAMBARANGAY ACTIVITIES

● Building structure
or space

For cities – the office ● Please describe briefly the building structure or space provided by the Barangay exclusively for KP and
or space should be Lupong Tagapamayapa concerns
exclusive for KP
matters MOV: Three (3) photos with caption of the building or space used exclusively for KP and LT concerns, furniture,
fixtures and equipment used in the operation of the KP Office.
For municipalities –
KP office or space may
be shared or used for
other Barangay
matters.
5 FINANCIAL OR NON-FINANCIAL SUPPORT

27 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-PERFORMANCE HIGHLIGHTS

1. City, Municipal or ● Kindly fill-out the information needed in the table below. Explain briefly how the Lupong Tagapamayapa
Provincial Government was able to acquire such grant from those provided in the criteria.
and NGAs FINANCIAL OR NON-FINANCIAL SUPPORT
SUPPORT
2. People’s Organization,
NGOs or Private Sector FINANCIAL NON-FINANCIAL
DATE
and others (Please DONOR/SPONSOR
GRANTED/GIVEN
provide the
amount)
PhP 15,000.oo March 25, 2022 Gerry Roxas Foundation, Inc.
1 Desktop set February 12, 2022 Quezon City Government

MOVs: from C/M/P or NGAs - Certified true copies of any proof of support such as Deed of Donation, MOA,
Resolution, Appropriations Ordinance, Acknowledgment Receipts, Vouchers and etc.

From People's Organizations, NGOs or Private Sector - Certified true copies of any proof of support such as Deed
of Donation, MOA, Acknowledgment Receipts, Vouchers and etc.

28 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 202 Juan Dele Collection Civil Januar January M January 28, February 5, Respondent Complete Respondent
2-01 Cruz vs. of Sum of y 22, 25, 2022 2022 2022 agreed to paid
Juana Money 2022 pay Complainant
Change Complainant the amount of
PhP 500.00 PhP 500.00
per month on: February
starting 5, March 6,
February to April 7 and
pay for the May 5, 2022.
total debt
amount of

29 | LTIA FORM 07-PERFORMANCE HIGHLIGHTS

 CY LUPONG TAGAPAMAYAPA INCENTIVES AWARDS (LTIA)
LTIA FORM 07-A : LIST OF CASES

Name of the Lupong Tagapamayapa

Punong Barangay
City/Municipality Barangay Logo
Here
Province
Region

LIST OF CASES
DATE OF STATUS OF
DATE OF DATE OF
EXECUTION MAIN POINT COMPLIANCE
CAS CASE COMPLAI DATE INITIAL ACTION SETTLEMEN
NATURE OF OF ON THE REMARKS
E TITLE NT TITLE FILED CONFRON TAKEN T OR
SETTLEMENT AGREEMENT SETTLEMENT
NO. -TATION AWARD
OR AWARD OR AWARD
PhP
2,000.00.

Prepared by: Approved by:

Lupon Secretary Lupon Chairman

Signature over printed name Signature over printed name
Date: ______________ Date: ______________