Download:
pdf |
pdfTHIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Legal Assistance to Victims Grant Program
Brief Instructions: This form must be completed for each Legal Assistance for Victims Program (LAV Program)
grant received. The grant administrator or coordinator must ensure that the form is completed fully with regard to
all grant-funded activities. Grant partners, however, may complete sections relevant to their portion of the grant.
Grant administrators and coordinators are responsible for compiling and submitting a single report that reflects all
information collected from grant partners.
All grantees should read each section to determine which questions they must answer based on the activities engaged in under this grant during the current reporting period. Sections B and E must be completed by all grantees.
In section A, subsection A1 must be answered. In section C, subsection C2 must be answered. In Section D and
subsections A2, C1, C3, C4, and C5, grantees must answer an initial question about whether they engaged in
certain activities during the current reporting period. If the response is yes, then the grantee must complete that
section/subsection. If the response is no, the rest of that section/subsection is skipped.
For example, 1) if you are a legal services organization providing legal services with staff funded under this grant,
you would complete sections A, B, D, E, and subsection C2 (and answer “no” in C1, C3, C4 and C5); or 2) if you
receive funds for staff to provide training and technical assistance and funds for data collection, you would complete sections A, B, and E, and subsections C1, C2, C4, and C5 (and answer “no” in C3).
The activities of volunteers or interns may be reported if they are coordinated or supervised by LAV Programfunded staff or if LAV Program grant funds substantially support their activities.
For further information on filling out this form, refer to the separate set of instructions, which contains detailed
definitions and examples, illustrating how questions should be answered.
SECTION
Page Number
Section A: General Information
Section B: Purpose Areas
Section C: Function Areas
C1: Training
C2: Community Collaboration
C3: Products
C4: Technical Assistance
C5: Data Collection
Section D: Victim Services/Legal Services
Section E: Narrative
Appendix A: Status of Goals and Objectives Table
1
4
5
5
7
8
9
10
11
17
18
LAV Semi-annual Progress Report • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
OMB Clearance # 1121-0276
Expiration 02/28/2007
A
GENERAL INFORMATION
All grantees must complete this section.
(format date with 6 digits, like - 01/31/04)
1.
Date of report
2.
Current reporting period
3.
Grantee name University of Southern Maine
4.
Grant number 1999-WL-VX-0068
5.
Type of grantee organization
/
/
January 1-June 30
✔
July 1-December 31
2 0 0 3 (Year)
(the federal grant number assigned to your LAV Program grant)
(Check the one answer that best describes the organization receiving the LAV Program funds.)
Bar association
Bar foundation/IOLTA administrator
Law school
Legal aid/assistance (non-Legal Services Corporation)
Legal services organization (Legal Services Corporation funded)
State coalition
Tribal government/organization
Victim services (domestic violence)
Victim services (dual—domestic violence/sexual assault)
Victim services (sexual assault)
Other (specify):
6. Point of contact (person responsible for the day-to-day coordination or administration of the grant)
Name
Agency/organization name
(if different from grantee name)
Address
Telephone
Facsimile
E-mail
7. Does this grant specifically address tribal populations?
(Check yes if your LAV Program grant focuses on tribal populations, and indicate which tribes or nations
you serve or intend to serve.)
Yes
No
If yes, which tribes/nations:
LAV Semi-annual Progress Report • 1 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
8.
What percentages of your LAV Program grant funds were directed to each of these areas?
(Report the area[s] addressed by your LAV Program grant during the current reporting period and estimate
the approximate percentage of funds [or resources] used to address each area [consider education, training,
victim services, etc.]. The grantee may choose how to make this determination.)
Throughout this form, the term sexual assault includes both assaults committed by offenders who are
strangers to the victim/survivor and assaults committed by offenders who are known or related by blood or
marriage to the victim/survivor. The term domestic violence applies to any pattern of coercive behavior that
is used by one person to gain power and control over a current or former intimate partner. Stalking is defined
as a course of conduct directed at a specific person that places that person in reasonable fear of the death
of, or serious bodily injury to, herself or himself, a member of her/his immediate family, or her/his spouse or
intimate partner.
Percentage of grant funds
Sexual assault
Domestic violence
Stalking
TOTAL
(validated at submit time)
100%
0.00%
LAV Semi-annual Progress Report • 2 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
A2
SECTION
Staff Information
OMB Clearance # 1121-0276
Expiration 02/28/2007
Were LAV Program funds used to fund staff positions during the current reporting period?
Check yes if LAV Program grant funds were used to pay staff, including part-time staff and contractors.
Yes—answer question 9
No—skip to Section B
9.
Staff
(Report the total number of full-time equivalent [FTE] staff funded by the LAV Program grant during the
current reporting period. Include employees who are part-time and/or only partially funded with these grant
funds as well as contractors. If an employee or contractor was not employed or utilized over the entire
reporting period, report the average. Round to the second decimal. Click the help button for examples of
how to calculate FTE's for part-time staff and contractors.)
Staff
Grant-funded staff
Administrator (fiscal manager, executive director)
Civil attorney
Counselor
Information technology specialist
Law student/intern
Legal Adovocate
Paralegal
Program coordinator(training coordinator,victim services coordinator)
Support staff (secretary, administrative assistant)
Trainer
Victim advocate
Other (specify):
TOTAL
0.00
LAV Semi-annual Progress Report • 3 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
SECTION
B
PURPOSE AREAS
All grantees must complete this section.
10. Statutory purpose areas
(Check all purpose areas that apply to activities supported by LAV Program grant funds during
the current reporting period.)
Check ALL
that apply
Purpose areas
Cooperative efforts and projects between domestic violence and sexual assault victim
services organizations and legal assistance providers to provide legal assistance for
victims of domestic violence, stalking, and sexual assault.
Efforts and projects to provide legal assistance for victims of domestic violence,
stalking, and sexual assault by organizations with a demonstrated history of
providing direct legal or advocacy services on behalf of these victims.
Training, technical assistance and data collection to improve the capacity of grantees
and other entities to offer legal assistance to victims of domestic violence, stalking,
and sexual assault.
11. Program priorities addressed by your grant
(In addition to the purpose areas identified above, the LAV Program Grant Application and Program Guidelines
may have identified several special interest categories or program priorities that would receive priority consideration. If your program addressed any of these special interest categories or priorities during the current
reporting period, list them below.)
LAV Semi-annual Progress Report • 4 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
C1
SECTION
FUNCTION AREAS
Training
Were your LAV Program funds used for training during the current reporting period?
Check yes if LAV Program-funded staff provided training or if grant funds directly supported the training.
Yes—answer questions 12-14
No—skip to subsection C2
12. Training provided
(Report the total number of training events during the current reporting period that were either provided by
LAV Program-funded staff or directly supported by LAV Program funds. Staff development training provided to
LAV Program-funded staff should not be counted.)
Total number of training events provided
13. Number of people trained
(Report the number of people trained during the current reporting period by LAV Program-funded staff or training supported by LAV Program funds. Use the category that is most descriptive of the people who attended
the training event. LAV Program-funded staff attending staff development training should not be counted.)
People trained
Number
People trained
Attorneys
Law students
Bar association/volunteer lawyer
program staff
Mental health professionals
Batterer Intervention Program staff
Child welfare workers/advocates
Courts (judges and court personnel)
Community advocacy organization
staff (NAACP, Gray Panthers)
Disability organization staff (nongovernmental)
Elder organization staff (nongovernmental)
Faith-based organization staff
Government agency staff (Vocational
Rehabilitation, food stamps, TANF)
Number
Multidisciplinary group
Prosecutors
Social service organization staff
State or tribal domestic violence
coalition staff
Supervised visitation and exchange
center staff
Tribal government/tribal government
agency staff
Victim advocates (domestic violence)
Victim advocates (sexual assault)
Health professionals (doctors, nurses)
Victim advocates (dual-sexual assault
and domestic violence)
Immigrant organization staff
Volunteers
Law enforcement officers
Other (specify):
Legal Services Staff
TOTAL
LAV Semi-annual Progress Report • 5 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
14. Training content areas
(Indicate all topics covered in training events provided or directly supported with your LAV Program funds
during the current reporting period. Check all that apply.)
Confidentiality
Consumer/finance (credit, debt,
bankruptcy, tax, etc.)
Divorce/custody/visitation/child
support
Domestic violence laws
Domestic violence overview,
dynamics and services
Housing
Identifying legal issues
Immigration
Protection orders (including full
faith and credit)
Public benefits (TANF, disability,
food stamps, unemployment)
Relocation
Safety planning
Serving underserved/unserved
populations
Sexual assault laws
Sexual assault overview, dynamics and services
Stalking laws
Stalking overview, dynamics and
services
Other (specify):
Issues specific to victims/survivors who:
live in rural areas
are American Indian or Alaska Native
are Asian
are black or African American
are disabled
are elderly
are Hispanic or Latino
are homeless or living in poverty
are immigrants, refugees, or asylum
seekers
are lesbian, gay, bisexual,
transgender, or intersex
are Native Hawaiian or other Pacific
Islander
have mental health problems
have substance abuse problems
Other (specify):
LAV Semi-annual Progress Report • 6 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
C2
SECTION
Community Collaboration
All grantees must answer this subsection.
15. Community collaboration
(Check the appropriate boxes to indicate the agencies or organizations, even if they are not partners
with which you have a memorandum of understanding [MOU], that you provided victim/survivor
referrals to, received victim/survivor referrals from, engaged in consultation regarding victims/survivors
with, provided technical assistance regarding victims/survivors to, and/or attended meetings with,
during the current reporting period, according to the usual frequency of the interactions. If the
interactions were not part of a regular schedule, you will need to estimate the frequency with which
these interactions occurred during the current reporting period. In the last column, indicate the
agencies or organizations with which you have a MOU for purposes of the LAV Program grant.)
Agency/organization
Community advocacy
organization (NAACP,
Gray Panthers)
Victim/survivor referrals,
consultations, technical assistance
Daily
Weekly
Monthly
Meetings
Weekly
MOU
Partner
Monthly Quarterly
Corrections (probation,
parole, and correctional
facility)
Court
Domestic violence
program
Faith-based organization
Government agency
(INS, Social Security,TANF)
Health/mental health
organization
Law enforcement
Legal services organization (legal services, bar
association, law school)
Prosecutor's office
Sexual Assault Program
Social service
organization
Tribal government/Tribal
government agency
Other (specify):
LAV Semi-annual Progress Report • 7 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
C3
SECTION
Products
OMB Clearance # 1121-0276
Expiration 02/28/2007
Were your LAV Program funds used to develop, substantially revise, or distribute products during
the current reporting period?
Check yes if LAV Program-funded staff developed products, or if LAV Program funds directly supported the
development, revision, or distribution of products.
Yes—answer question 16
No—skip to subsection C4
16. Use of LAV Program funds for product development, substantial revision, or distribution
(Report the number of products developed, substantially revised, or distributed with LAV Program grant
funds during the current reporting period. Report the number of new products developed or substantially
revised during the current reporting period; the title/topic; and intended audience of each product
developed, revised, or distributed; and, the number of products used or distributed. If a product was created
in or translated into a language other than English, including Braille, indicate the language. Report on
products that were newly developed during the current reporting period whether or not they were used or
distributed, and on products that were previously developed or revised but were used or distributed during
the current reporting period.)
Number
Number
Products
Intended
Other
Products
developed
used or
Title/topic
audience
languages
or revised
distributed
Brochures
Client
Education
Materials
Manuals
Training
curricula
Training
materials
Other (specify):
LAV Semi-annual Progress Report • 8 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
C4
SECTION
Technical Assistance
Were your LAV Program funds used to provide technical assistance during the current reporting
period?
Check yes if grant-funded staff provided technical assistance or if grant funds directly supported the
provision of technical assistance.
Yes—answer question 17
No—skip to subsection C5
17. Technical assistance provided
(Indicate the area[s] of technical assistance addressed and the type of recipient. Check all that apply.)
Sexual assault Domestic violence Stalking
Attorneys
Friends of the Court/mediators/Guardians ad Litem
Judges
Legal services staff
Prosecutors
Victim advocates
Other (specify):
LAV Semi-annual Progress Report • 9 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
C5
SECTION
Data Collection
Were your LAV Program funds used to develop, install, expand, or coordinate data collection
systems during the current reporting period?
Check yes if grant funds or grant-funded staff were used to develop, install, expand, or coordinate data
collection systems.
Yes—answer question 18
No—skip to Section D
18. Use of LAV Program funds for data collection systems
(Check all that apply.)
Develop new data collection system
Install data collection systems
Expand existing data collection system
Coordinate existing data collection
Purchase computers and other equipment
LAV Semi-annual Progress Report • 10 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
OMB Clearance # 1121-0276
Expiration 02/28/2007
D
VICTIM SERVICES/LEGAL SERVICES
Were your LAV Program funds used to provide victim services and/or legal services to victims/
survivors during the current reporting period?
Check yes if LAV Program grant-funded staff provided services to victims/survivors, or if grant funds were
used to directly support victim services.
Yes—answer questions 19-22 and 23-28 as appropriate. Provide information only on victims/
survivors served with LAV Program funds. If your LAV Program funds were used to work with
pro bono attorneys and/or law students, also answer questions 29-30.
No—skip to Section E
19. Number of victims/survivors served, partially served, and victims/survivors seeking services
who were not served
Please do not answer this question without referring to the help button for further explanation and
examples of how to distinguish among these categories.
(Report the following, to the best of your ability, as an unduplicated count for each category during the current reporting period. This means that each victim/survivor who sought or received services during the current reporting period should be counted only once and in only one of the listed categories. For the purposes
of this question, victims/survivors are those against whom the sexual assault, domestic violence or stalking
was directed. If the victim/survivor presented with more than one victimization, that person should be
counted only once under the primary victimization.)
Sexual
assault
Domestic
violence
Stalking
A. Served: victims/survivors who received the service(s) they needed,
if those services were funded under your LAV Program grant
B. Partially served: victims/survivors who received some service(s),
but not all of the services they needed, if those services were
funded under your LAV Program grant
C. Victims/survivors seeking services who were not served: victims/
survivors who sought service and did not receive service(s) they
needed, if those services were funded under your LAV Program grant
20. Reasons victims/survivors seeking services were not served or were partially served
(Check all that apply.)
Reasons not served or partially served
Program reached capacity
Need not documented
Did not meet eligibility or statutory requirements
Program unable to provide service due to limited resources/priority-setting
Services not appropriate for victim/survivor
Transportation problems
Conflict of interest
Services inappropriate or inadequate for victims/survivors with substance abuse problems
Services inappropriate or inadequate for victims/survivors with mental health problems
Services not available for victims/survivors accompanied by male adolescents
Inadequate language capacity (including sign language)
Geographic or other isolation of victim/survivor
Other (specify):
LAV Semi-annual Progress Report • 11 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
21. Demographics of victims/survivors served or partially served
(Based on the victims/survivors reported in 19A and 19B, report the total numbers for all that apply.
This should be an unduplicated count for “gender” and “age.”)
Race/Ethnicity (victims/survivors may be counted
for each race/ethnicity that applies)
Number of victims/survivors
Black or African American
American Indian and Alaska Native
Asian
Native Hawaiian and other Pacific Islander
Hispanic or Latino
White
Unknown
Number of victims/survivors
Gender
Female
Male
Unknown
TOTAL
0
Number of victims/survivors
Age
0-17
18-24
25-59
60+
Unknown
TOTAL
0
Other demographics
Number of victims/survivors
People with disabilities
People with limited English proficiency
People who are immigrants/refugees/asylum seekers
People who live in rural areas
LAV Semi-annual Progress Report • 12 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
22. Victims/survivors’ relationship to offender
(For those victims/survivors reported in questions 19A and 19B, report the relationship of the victim/survivor to the offender by type of victimization. If a victim/survivor experienced more than one type of victimization and/or was victimized by more than one perpetrator, count the victim/survivor in all categories that
apply. The number of victims/survivors reported here may total more than the sum of 19A and 19B.)
Relationships to offender
Number of victims/survivors
Sexual
assault
Domestic
violence
Stalking
0
0
Current or former spouse or intimate partner
Other family or household member (sibling, grandparent, etc.)
Dating relationship
Acquaintance (friend, neighbor, co-worker, schoolmate, etc.)
Stranger
Relationship unknown
Other (specify):
TOTAL
0
23. Victim services provided by lawyers
(Report the total number of victims/survivors from 19A and 19B who received the following services from
LAV Program-funded lawyers during the current reporting period by type of service. Count a victim/survivor
once for each type of service received during the current reporting period. This may total more than the sum
of 19A and 19B. Note that question 25 below addresses the provision of legal services to victims/survivors.)
Victim services provided by lawyers
Number of victims/survivors
Safety planning
Support services (assisting the victim/survivor to obtain resources or
services including employment, health care, child care, etc.)
Pro se clinics/group services
24. Victim services provided by other staff
(Report the total number of victims/survivors from 19A and 19B who received the following services from
other LAV Program-funded staff [e.g., paralegals, advocates, case managers, etc.] during the current reporting period by type of service. Count a victim/survivor once for each type of service received during the current reporting period. The number of victims/survivors reported here may total more than the sum of 19A
and 19B.)
Victim services provided by other staff
Number of victims/survivors
Safety planning
Support services (assisting the victim/survivor to obtain resources or
services including employment, health care, child care, etc.)
Non-attorney legal advocacy (assisting the victim/survivor in preparing legal
paperwork, accompanying her to court or administrative proceedings, etc.)
Pro se clinics/group services
LAV Semi-annual Progress Report • 13 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
25. Legal issues
(Report the total number of new and pending matters in which the following legal issues were addressed
during the current reporting period. Count a victim/survivor once for each legal issue for which they received
assistance. A pending matter is one that was open as of the first day of the current reporting period; a new
matter is one that was opened during the current reporting period. The number of victims/survivors reported
here may total more than the sum of 19A and 19B.)
Legal issues
Number of victims/survivors
Pending
New
A. Protection orders (temporary and final, enforcement of existing PO)
B. Family law matters
Divorce
Custody/visitation
Establishment of paternity
Child/spousal support
Other family law matters
C. Consumer/finance (credit, debt, bankruptcy, tax, etc.)
D. Employment
E. Income maintenance (TANF, disability, food stamps, unemployment)
F. Housing
G. Immigration
H. Other (specify):
26. Number of victims/survivors who received assistance with multiple legal issues
(Report the number of victims/survivors who received LAV Program-funded services in more than one of the
categories [A-G] listed in question 25 during the current reporting period. Consider all family law matters as
one category.)
27. Comprehensive services
(If victims/survivors received other needed legal services for matters such as those listed in question 25
from other sources [i.e., from your organization but with non-LAV funds, or from another source, such as pro
bono attorneys], describe those sources. You may provide data to demonstrate that those additional needs
of victims/survivors were met.)
LAV Semi-annual Progress Report • 14 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
28. Legal outcomes
(For all cases closed during the current reporting period in which services were provided by LAV Programfunded lawyers, report the number and disposition of those cases by legal issue. Include all outcomes in all
matters.)
Legal issue
Protection orders
(temporary and
final, enforcement of existing
PO)
Information/ Brief
Administrative Court Negotiated resolution Victim/ Other
survivor result
referral/
services
decision
decision
Filed
No filed
withdrew
advice only
action
action
Divorce
Custody/
visitation
Establishment
of paternity
Child/spousal
support
Other family
law matters
Consumer/
finance (credit,
debt, bankruptcy,
tax, etc.)
Employment
Income maintenance (TANF,
disability, food
stamps, unemployment)
Housing
Immigration
Other (specify):
LAV Semi-annual Progress Report • 15 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
29. a. Pro bono attorneys
(Report the total number of pro bono attorneys recruited, trained, mentored or coordinated during the current
reporting period.)
Recruited
Trained
Mentored
Coordinated
b. Cases accepted
(Report the number of cases accepted by pro bono attorneys during the current reporting period.)
c. Cases completed
(Report the number of cases completed by pro bono attorneys during the current reporting period.)
30. a. Volunteer law students
(Report the total number of law students recruited, trained, mentored, or coordinated during the current
reporting period.)
Recruited
Trained
Mentored
Coordinated
b. Cases worked on
(Report the number of cases worked on by law students during the current reporting period.)
LAV Semi-annual Progress Report • 16 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
E
NARRATIVE
All grantees must answer question 31.
PLEASE LIMIT YOUR RESPONSE TO FOUR PAGES FOR THIS QUESTION. To answer this question go to Page 19.
31. Report on the status of your LAV Program grant goals and objectives as of the end of the current
reporting period.
(Using Appendix A as a guide, report on the status of the goals and objectives for your grant as of the end of
the current reporting period, as they were identified in your grant proposal or as they have been added or revised. Indicate whether the activities related to your objectives for the current reporting period have been
completed, are in progress, are delayed or have been revised. Comment on your successes and challenges,
and provide any additional explanation you feel is necessary for us to understand what you have or have not
accomplished relative to your goals and objectives. If you have not accomplished objectives that should have
been accomplished during the current reporting period, you must provide an explanation.)
All grantees providing direct legal services must answer question 32.
PLEASE LIMIT YOUR RESPONSE TO TWO PAGES FOR THIS QUESTION. To answer this question, go to Page 22.
32. Describe the nature of the outcomes achieved for victims/survivors during the current reporting
period.
Discuss the reasons for those outcomes and, if appropriate, any systemic patterns or practices that you
believe were contributing factors to the outcomes of specific cases or to cases in general involving victims/
survivors.
All grantees must answer questions 33 and 34 on an annual basis. Submit responses on January to
June reporting form only.
PLEASE LIMIT YOUR RESPONSE TO TWO PAGES FOR EACH QUESTION. To answer question #33 go to Page 24.
To answer question #34 go to Page 26.
33. What do you see as the most significant areas of remaining need, with regard to meeting the
civil legal needs of victims/survivors of sexual assault, domestic violence, and stalking?
(Consider geographic regions, underserved populations, service delivery systems, types of legal problems,
and challenges and barriers unique to your state or service area.)
34. What has LAV Program funding allowed you to do that you could not do prior to receiving this
funding?
(e.g., expanding service areas and populations served, expanding range of services offered to victims/
survivors)
Question 35 is optional.
PLEASE LIMIT YOUR RESPONSE TO TWO PAGES FOR THIS QUESTION. To answer this question go to Page 28.
35. Provide any additional information that you would like us to know about your LAV Program grant
and/or the effectiveness of your grant.
(If you have other data or information regarding your program that would more fully or accurately reflect the
effectiveness of your LAV Program grant than the data you have been asked to provide on this form, answer
this question. Feel free to discuss any of the following: systems-level changes, community collaboration, the
removal or reduction of barriers and challenges for victims/survivors, promising practices, positive or negative unintended consequences.)
Public Reporting Burden
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection
of information unless it displays a currently valid OMB control number. We try to create forms and instructions that are
accurate, can be easily understood, and which impose the least possible burden on you to provide us with information.
The estimated average time to complete and file this form is 60 minutes per form. If you have comments regarding the
accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against
Women, U.S. Department of Justice, 810 7th Street, NW, Washington, DC 20531.
LAV Semi-annual Progress Report • 17 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
APPENDIX A
Describe your goals and objectives, as outlined in your grant proposal, or as revised) - Question #31
Back to Instructions
Status
Back to Instructions
Status
Goals/Objectives
Key Activities
Comments
Goals/Objectives
Key Activities
Comments
LAV Semi-annual Progress Report • 18 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
APPENDIX A
Describe your goals and objectives, as outlined in your grant proposal, or as revised) - Question #31 (cont. 1)
Back to Instructions
Status
Back to Instructions
Status
Goals/Objectives
Key Activities
Comments
Goals/Objectives
Key Activities
Comments
LAV Semi-annual Progress Report • 19 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
APPENDIX A
Describe your goals and objectives, as outlined in your grant proposal, or as revised) - Question #31
Back to Instructions
Status
Back to Instructions
Status
(cont. 2)
Goals/Objectives
Key Activities
Comments
Goals/Objectives
Key Activities
Comments
LAV Semi-annual Progress Report • 20 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Describe the nature of the outcomes achieved for victims/survivors during the current reporting period
Expiration 02/28/2007
- Question #32
LAV Semi-annual Progress Report • 21 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Describe the nature of the outcomes achieved for victims/survivors during the current reporting period
Expiration 02/28/2007
- Question #32 (cont.)
LAV Semi-annual Progress Report • 22 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
What do you see as the most significant areas of remaining need, with regard to meeting the civil legal needs
Expiration 02/28/2007
of victims/survivors of sexual assault, domestic violence, and stalking - Question #33
LAV Semi-annual Progress Report • 23 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
What do you see as the most significant areas of remaining need, with regard to meeting the civil legal needs
Expiration 02/28/2007
of victims/survivors of sexual assault, domestic violence, and stalking - Question #33 (cont.)
LAV Semi-annual Progress Report • 24 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
What has LAV Program funding allowed you to do that you could not do prior to receiving this funding
Expiration 02/28/2007
- Question #34
LAV Semi-annual Progress Report • 25 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
What has LAV Program funding allowed you to do that you could not do prior to receiving this funding
Expiration 02/28/2007
- Question #34 (cont.)
LAV Semi-annual Progress Report • 26 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Provide any additional information that you would like us to know about your LAV Program grant and/or the
Expiration 02/28/2007
effectiveness of your grant - Question #35
LAV Semi-annual Progress Report • 27 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Provide any additional information that you would like us to know about your LAV Program grant and/or the
Expiration 02/28/2007
effectiveness of your grant - Question #35 (cont.)
LAV Semi-annual Progress Report • 28 • Office on Violence Against Women
Back to Instructions
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1121-0276
Expiration 02/28/2007
Click Go to Validate and Upload Form
Go
LAV Semi-annual Progress Report • 29 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
File Type | application/pdf |
File Title | LAV_FORM |
File Modified | 2007-02-26 |
File Created | 2004-02-19 |