Form 1 Implementation Project T/TA Activity

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IP T/TA Case Number: IPTA2213

Implementation Project T/TA Activity Form

Definition: T/TA Activity form tracks “Substantial T/TA”--T/TA that requires substantial efforts from the T/TA provider and is tailored to the specific
needs of the State/Tribe. Substantial T/TA is either on-site T/TA (of any duration) or other direct consultation (in-person or remote
communication) totaling at least one hour in a single business day.
IP Title

Prefilled: Able to edit
Added States/Tribes/Territories

Select States/Tribes/Territories

State/Tribe/Territory participating
in T/TA Activity

AL
AK
AR
CA
CO

Prefilled – able to edit

Click to ADD >>
<< Click to REMOVE

If other than the State/Tribal child welfare agency, specify the primary participant(s) in the IP (e.g., county or local jurisdiction, court, private
agencies operation on behalf of the state, etc.)
Prefilled – able to edit
Members of the T/TA Network involved in T/TA Activity
Lead T/TA Provider

Prefilled w/Lead Contact Info

Select other network members as needed

Nat Res Ctr Org Improvement
Nat Res Ctr Protective Services
Nat Res Ctr Legal & Judical Issues
Nat Res Ctr Welfare Data for Adoption
Nat Res Ctr for Youth Development

Added other network members

NOTE

Click to ADD >>

These tabs are
comprised of all
providers for one
event. If there are
separate events,
there will be
separate forms.

<< Click to REMOVE

Save List

IC1

TTA1

TTA2

TTA3

Start

Type of Entry

mm/dd/yyyy

days (recorded by ½ day)

If multi-day, # of on-site days:
Day 1

End

mm/dd/yyyy

Date(s) of T/TA Activity

Day 2

Day 3

Day 4

Day 5

Hours of contact

Add More Days

(recorded by ½ hour)

Hours of contact delivered in collaboration with Network members
Round to nearest ½ hour
Mode(s) of contact*

Type of T/TA*

(choose all that apply)

(choose all that apply)

select one

To which mode was the most time devoted?*

Which type of T/TA was most important to this primary mode of delivery?*
T/TA Direct Recipient*

Step in Change Process*

(choose all that apply)

Practice Area(s)*

Prefilled: Able to Edit

(choose all that apply)

NRC/IC Optional Category

select one

Select one

Organizational/Systemic Area(s)*
(choose all that apply)

NRC/IC Optional Category #2

Did any peers (e.g., other States, Tribes, local jurisdictions) participate as providers in this activity?*

Prefilled: Able to Edit

Select all that apply
Yes

No

Peer T/TA Providers

Narrative Description
of Activity
State/Tribal Contact*
Contact Person at T/TA Provider*
Optional Field

IC IP TA Activity

Prefilled: Able to Edit

Email*

Phone*

Prefilled: Able to Edit

Email*

Phone*

Optional Field

Cancel

Save

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