OMB Control No: 0970-NEW
Expiration date: xx/xx/201x
Program Performance
Trafficking Victim Assistance Program grantees must provide data or information to ACF on the following items on a monthly, quarterly, or annual basis, as directed by the Project Officer, in an Excel spreadsheet:
Participant Demographics
Adult or minor
Male or female
Country of origin
Type of Trafficking
Sex, labor, or both
Immigration Status
Continued Presence, T nonimmigrant status or both
Services Provided or Referred
Types of health screening provided or referred
Types of medical services provided or referred
Names of the entities providing medical services
Amount of money expended on each type of medical service provided, by entity
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .25 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Sample Instrument |
| Author | Windows User |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |