APPENDICES FOR OMB PART A
Appendix A.1: Grantee and Subrecipient/Service Recipient Surveys
Process Evaluation of the Social Innovation Fund
Pay for Success Program
(SIF PFS Program)
Grantee Survey
INSTRUCTIONS AND GUIDANCE TO COMPLETE THE ONLINE SURVEY Please keep the following in mind as you complete the survey:
If you have questions about the study, or need help in accessing the survey or navigating the screens, please email CNCS_PFS_STUDY@abtassoc.com or call 617-520-3899. |
Organizational Background and Staffing
Please complete the table below indicating the number of staff members (either part-time or full-time) that fall into each of the following categories:
[Online version will contain hover-above note stating that columns B-E should include administrative as well as programmatic staff.]
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Number of staff members (either part- or full-time) currently employed by your organization… |
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across all locations? |
that currently work on any PFS activities? |
that currently work on SIF PFS program activities? |
that currently work only on SIF PFS program activities? |
that were hired to work on PFS activities after your organization received the award from the SIF PFS program? |
# of staff members (either part-time or full-time) |
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Experience and Involvement with Pay For Success (PFS)
Approximately when did your organization first begin exploring, planning, implementing, or evaluating PFS projects?
_____________
[Month/Year] *online survey will have dropdown to enter Month/Year
Prior to receiving the SIF PFS grant from CNCS, was your organization directly involved in assessing the feasibility of, planning for, or implementing a specific PFS project?
___ No (SKIP TO QII.3)
___ Yes
[IF YES] What was the primary role of
your organization in this (these) project(s)? [SELECT ONE]
__
Government agency planning/implementing project
__ Technical assistance provider
__ Direct service provider
__ Evaluator
__ Intermediary
__ Payor
__ Investor/funder
__ Other (Please describe): ______________________
Prior to receiving the SIF PFS grant, how many of your staff members had direct experience with any activities related to the planning or implementation of a PFS initiative? ________________
After receiving the SIF PFS grant, how many of your staff members had direct experience with any activities related to the planning or implementation of a PFS initiative? ________________
Prior to receiving your award from the SIF PFS program, did your organization receive any external funding for PFS activities?
__ No (SKIP TO QII.6)
__ Yes
[IF YES] What were the source(s) of these external funds? [SELECT ALL THAT APPLY]
Source of Funds
__ Federal
government
__ State government
__ Local government
__ Philanthropies/foundations
__ Individual donors
__ Commercial bank/thrift/credit union/savings and loan
__ Investment bank
__ College/university
__ Other
research organization
__ Community development financial institution (CDFI)
__ Non-profit organization not otherwise
listed here
__ Non-forgivable loans from any source
__ Other (Please describe):__________________
__ Other (Please describe):__________________
After receiving your award from the SIF PFS program, has your organization obtained any additional external funding for PFS activities over and above any matching funds required by the SIF PFS program?
___ No (SKIP TO QII.7)
___ Yes
[IF YES] What were the source(s) of these external funds? [SELECT ALL THAT APPLY]
Source of Funds
__ Federal
government
__ State government
__ Local government
__ Philanthropies/foundations
__ Individual donors
__ Commercial bank/thrift/credit union/savings and loan
__ Investment bank
__ College/university
__ Other
research organization
__ Community development financial institution (CDFI)
__ Non-profit organization not otherwise
listed here
__ Non-forgivable loans from any source
__ Other (Please describe):__________________
__ Other (Please describe):__________________
SIF PFS Program
Which of the following best describes your organization’s approach in working with subs? [SELECT ONE]?
___ Address a specific social policy or programmatic area through the PFS model
___ Promote the PFS model regardless of issue area
___ Other (Please describe): _____________________________
_____________________________________________________
Subrecipient/Service Recipient Selection
For each Request for Proposal (RFP) or other similar solicitation for subs released since July 1, 2015 [OR AUTO-FILL DATE OF LAST DATA COLLECTION], what was the approximate time elapsed (in weeks) from RFP release date to final selection of your subs?
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# of Weeks from RFP Release to Final Selection |
First RFP (post-July 1, 2015 [OR AUTO-FILL DATE OF LAST DATA COLLECTION]) |
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Second RFP (post-July 1, 2015[OR AUTO-FILL DATE OF LAST DATA COLLECTION]) |
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Third RFP (post-July 1, 2015[OR AUTO-FILL DATE OF LAST DATA COLLECTION]) |
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* online survey will include rows for additional RFPs
What methods were used to publicize your organization’s SIF PFS program RFP competition(s)? [SELECT ALL THAT APPLY]
___ Organization’s website
___ Webinars
___ Social media
___ Listservs or email contact lists
___ Conversations with prospective applicants
___ Presentations at conferences or meetings
___ Other (Please describe): _______________________________________
Did your organization specify one or more focus areas in your selection of subs?
___ No (SKIP TO QIV.4)
___ Yes
[IF YES] Was consideration limited to applications within the specified focus areas, or was focus area only one part of the review process?
__ Applicants had to address the specified focus area(s)
__ Applicants did not have to address the specified focus area(s), but those that did received preference in the review process
Did your RFPs target a specific type of organization as subrecipients/service recipients?
___ No (SKIP TO QIV.5)
___ Yes
[IF YES] Which type of organizations did your RFP(s) target? [CHECK ALL THAT APPLY]
__State governments
__Local governments
__Service providers
__Collaborative/partnerships (multiple organizations)
__Other (Please describe):_______________________________
__Other (Please describe):_______________________________
__Other (Please describe):_______________________________
Did your organization have a matching requirement for your subs?
___ No (SKIP TO QIV.6)
___ Yes
[IF YES] What type of match was required? (SELECT ONE)
___ In-kind match required
___ Cash match required
___ Either cash or in-kind match required
[IF YES] Was a dollar amount or a percentage required for the match?
[DROP DOWN SELECTION OF DOLLAR AMOUNT OR PERCENTAGE]
[IF DOLLAR AMOUNT] What was the estimated amount of the required match? $ ________
[IF PERCENTAGE] What was the required percentage of the match? __________%
Are you providing any “pass-through” funding to subs?
___ No
___ Yes
Feasibility Assessment/Capacity Building Assistance or Transaction Structuring Approach
[FEASIBILITY ASSESSMENT/CAPACITY BUILDING GRANTEES ONLY] Which of the following statements best describes your organization’s approach to providing feasibility assessment/capacity building assistance to PFS subs? (SELECT ONE)
___ Responsibility for coordinating initial planning and feasibility assessment activities lies primarily with your organization as the SIF PFS grantee (consulting model)
___ Responsibility for coordinating initial planning and feasibility assessment activities lies primarily with the subs and your organization acts as a facilitator (coaching model)
___ Combination of the two above approaches
___ Other (Please explain): ______________________________
____________________________________________________
How many of your subs will be assigned a designated staff member from your organization to coordinate assistance? (SELECT ONE)
[Add hover-above text box defining “designated staff member” as: “For example, a site liaison, project manager, lead contact, grants manager, etc.]
___ None of our subs will be assigned a designated staff member from our organization (SKIP TO QV.4)
___ At least one but not all of our subs will be assigned a designated staff member from our organization
___ All of our subs will be assigned a designated staff member from our organization
___All assistance is monetary or administrative; no programmatic assistance will be provided
Will/does your organization embed a grantee staff person within the sub organization (i.e., co-locate a “fellow” in the sub organization)?
___ No
___ Yes
Will/does your organization fund a staff person hired by the sub organization?
___ No
___ Yes
Do you have a planned length of time that you intend to work with each sub?
___ No, will depend on the individual needs of sub (SKIP
TO QV.6)
___ Yes
[IF YES] Approximately how long do you anticipate working with each
sub?__________ (months)
[FEASIBILITY ASSESSMENT/CAPACITY BUILDING GRANTEES ONLY] Please fill out the grid below documenting the activities that your organization has either completed, is currently engaged in, or is planning to engage in with your subs as part of the SIF PFS program. Please indicate the number of subs that fall into each category.
Activities |
# of Subs Completed Activity |
# of Subs Currently Engaged in Activity |
# of Subs Planning to Engage in Activity |
No Plans to Engage in Activity/ N/A |
Work plan design |
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Identify or select evidence-based intervention |
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Needs assessment |
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Target population analysis |
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Risk assessment |
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Logic model development |
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Cost-benefit analysis |
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Service provider capacity assessment |
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Potential investor assessment (funding streams) |
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Evaluation model development |
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Stakeholder engagement |
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Assist with federal funding requirements |
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Other (Please describe): |
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Other (Please describe): |
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Other (Please describe): |
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Please fill out the grid below documenting how your organization has interacted with your subs to date as part of the SIF PFS program.
Interaction |
Number Completed to Date |
Estimated Number Planned (Not Yet Completed) |
Webinars or online training with multiple subs |
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In-person group events or conferences for multiple subs |
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Individual site visits or in-person meetings with subs |
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Other (Please describe): |
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Other (Please describe): |
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Other (Please describe): |
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Please fill out the grid below documenting whether and when you developed or plan to develop the following types of PFS products or materials as part of the SIF PFS program.
Types of Products or Materials |
Developed Prior to Receiving SIF PFS Grant (Yes/No) |
Developed Since Receiving SIF PFS Grant (Yes/No) |
Plan to Develop (Yes/No) |
Templates for feasibility assessment |
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Templates for contracts |
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Templates for evaluation designs |
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Printed materials and toolkits |
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Toolkits or timelines specifically for project management |
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Templates for federal funding requirements |
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Other (Please describe): |
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Other (Please describe): |
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Other (Please describe): |
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How often do you currently (or expect) to have contact with your subs? (SELECT ONE)
__Weekly or more frequently
__Twice a month
__Monthly
__Less frequently than monthly, but on a regular basis
__As needed
To date, what are the primary areas of focus of the feasibility assessment/capacity building assistance or transaction structuring assistance that you are providing to your subs? (SELECT UP TO THREE)
Focus Areas of Assistance
____ Providing general education on PFS concepts and operations
____ Offering general management/organizational assistance
____ Identifying social problem or policy area suitable for PFS project
____ Developing logic models of PFS project
____ Identifying/selecting intervention
____ Identifying/selecting intermediary
____ Identifying/selecting service provider
____ Recruiting investors
____ Developing investment structure/outcomes pricing
____ Identifying/selecting evaluator or designing evaluation
____ Developing or finalizing contract(s)
____ Conducting data analysis
____ Providing cash grants
____ Cohort learning/knowledge sharing
____ Other (Please describe):________________________________
Looking forward to the next 3-6 months, what are the primary areas that you anticipate focusing on in the feasibility assessment/capacity building assistance or transaction structuring assistance that you are providing to your subs? (SELECT UP TO THREE)
Focus Areas of Assistance
____ Providing general education on PFS concepts and operations
____ Offering general management/organizational assistance
____ Identifying social problem or policy area suitable for PFS project
____ Developing logic models of PFS project
____ Identifying/selecting intervention
____ Identifying/selecting intermediary
____ Identifying/selecting service provider
____ Recruiting investors
____ Developing investment structure/outcomes pricing
____ Identifying/selecting evaluator or designing evaluation
____ Developing or finalizing contract(s)
____ Conducting data analysis
____ Providing cash grants
____ Cohort learning/knowledge sharing
____ Other (Please describe):________________________________
[FEASIBILITY ASSESSMENT/CAPACITY BUILDING GRANTEES ONLY] Feasibility Assessment
Who has the primary responsibility for conducting PFS feasibility assessments as part of your SIF PFS program? (SELECT ONE)
___ Your organization as the SIF PFS grantee
___ Individual subs (with help from your organization as needed)
___ Other (Please describe):____________________________
What are the three most important considerations for your organization when assessing the feasibility of a PFS project?
[PLEASE SELECT UP TO THREE (3) CONSIDERATIONS WHERE 1 IS THE MOST IMPORTANT, 2 IS THE SECOND MOST IMPORTANT AND 3 IS THE THIRD MOST IMPORTANT CONSIDERATION]
__ Commitment or leadership of sub organization
__ Political will/support from local/state/federal government
__ Able to identify suitable social problem or policy area
__ Able to identify or select evidence-based intervention(s)
__ Able to identify or retain services of proven service provider(s)
__ Able to take project to necessary scale
__ Have support from funder/investors
__ Have support from governments/payors
__ Have data and are able to identify or agree upon measurable outcomes
__ Able to conduct experimental or quasi-experimental evaluation
__ Able to determine an agreed-upon price per successful outcome
__ Other (Please describe):_____________________________
__ Other (Please describe):_____________________________
__ Other (Please describe):_____________________________
Considering all of your organization’s subs that were selected as part of the SIF PFS program, please indicate the number from each round (if multiple rounds) and the status of your feasibility assessment efforts.
RFP Round |
# projects assessing feasibility |
# projects with feasibility assessments completed |
[IF FEASIBILITY ASSESSMENT WAS COMPLETED] How many projects were determined feasible? |
Round 1 |
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Round 2 |
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Round 3 |
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* online survey will include rows for additional RFPs
[IF (SUM OF COLUMN D)<(SUM OF COLUMN C), AUTO-FILL TABLE BELOW WITH CORRECT NUMBER OF COLUMNS (SUM OF COLUMN D)-(SUM OF COLUMN C)] For each project found not feasible, please place a “√” in the table below for up to three primary reasons that the project was found not feasible. (SELECT UP TO THREE REASONS FOR EACH PROJECT)
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Project #1 |
Project #2 (if applicable) |
Lack of commitment or leadership of sub organization |
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Lack of political will/support from local/state/federal government |
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Unable to identify suitable social problem or policy area |
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Unable to identify or select evidence-based intervention |
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Unable to identify or retain services of proven service provider(s) |
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Unable to take project to necessary scale |
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Insufficient demand for services |
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Failure to obtain support from funder/investors |
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Failure to obtain support from governments/payors |
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Lack of data or unable to identify or agree upon measurable outcomes |
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Unable to conduct experimental or quasi-experimental evaluation |
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Unable to determine an agreed-upon price per successful outcome |
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Other (Please describe):_____________________________ |
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Other (Please describe):_____________________________ |
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Other (Please describe):_____________________________ |
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* online survey will include additional columns as needed
Have any of your subs’ PFS projects been discontinued for reasons other than they were found not feasible?
__ No (SKIP TO QVIII.1)
__ Yes
[IF YES] How many projects? _________
[IF YES] Please briefly describe why each project was discontinued: _______________________________
__________________________________________
[TRANSACTION STRUCTURING GRANTEES ONLY] Transaction Structuring Progress
Considering all of your subs that were selected as part of the SIF PFS program, please indicate the number of subs that have completed, are currently engaged in, are planning to engage in, or have no plans to engage in each activity listed in the table below.
Activities |
# of Subs Completed Activity |
# of Subs Currently Engaged in Activity |
# of Subs Planning to Engage in Activity |
No Plans to Engage Subs in this Activity |
Development of project monitoring plan |
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Identification and commitment of key partners (service provider, intermediary/project manager, back-end payor, evaluator, etc.) |
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Recruitment of and commitment from investors |
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Development of PFS financial model |
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Finalization of evaluation plan |
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Finalization and signing of contract |
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Full implementation of PFS project |
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Development of data sharing agreements |
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Other (Please describe):___ _______________________ |
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Other (Please describe):___ _______________________ |
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2. Were any subs unable to complete transaction structuring activities?
__ No (SKIP TO QVIII.1)
__ Yes
[IF YES] How many projects? _________
[IF YES, AUTO-FILL TABLE BELOW WITH CORRECT NUMBER OF COLUMNS (QVII.2a)] For each project listed below, what was the primary reason that a PFS structure was determined to be infeasible? (CHECK (√) ONE REASON FOR EACH COLUMN)
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Project #1 |
Project #2 (if applicable) |
Lack of interested investors |
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Inability to raise enough capital from investors |
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Unable to reach agreement on the financial structure of the transaction (e.g., payout structure, capital requirements) |
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Lack of back-end payor |
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Inability to reach mutually agreeable outcome benchmarks with investors and/or back-end payor |
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Other (Please describe):_______________________________ |
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Other (Please describe):_______________________________ |
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Other (Please describe):_______________________________ |
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* online survey will include additional columns as needed
Reflection on the SIF PFS Program
Please list up to three of your organization’s most important considerations in determining whether or not you have been successful in building capacity among your subs. For each consideration, please indicate your organization’s progress towards meeting your goals using a three-point scale where 1=Excellent Progress, 2=Average/In-Progress, and 3=Fair/No Progress.
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Progress toward achieving success |
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Success Considerations |
Excellent Progress |
Average/In-Progress |
Fair/No Progress |
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1 |
2 |
3 |
1)
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2)
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3)
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Please rate how your organization’s capacity for providing PFS assistance has changed since the time of your SIF PFS program award, [OR since (AUTO-FILL DATE OF LAST DATA COLLECTION] FOR RETURNING SURVEY RESPONDENTS)], both overall and in each of the following areas. For each factor in which you indicated a change, please indicate if you think that the change was a result of your organization’s participation in the SIF PFS program.
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Capacity Change |
Was change a result of participation in the SIF PFS program? |
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Substantially Lower |
Somewhat Lower |
About the Same |
Somewhat Higher |
Substantially Higher |
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1 |
2 |
3 |
4 |
5 |
Yes/Yes, Partially/No |
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Overall capacity to provide PFS assistance |
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Organizational infrastructure |
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Staff expertise with PFS |
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Expertise in management of subs |
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Expertise in operating open competitions/RFPs |
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Provision of technical support to assist subs’ capacity building |
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Provision of technical support to assist subs’ feasibility assessment |
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Other (Please describe):
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Other (Please describe):
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Other (Please describe):
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Please describe up to three important lessons your organization has learned related to your participation in the SIF PFS program since (receiving your SIF PFS award/INSERT DATE OF LAST DATA COLLECTION).
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Is there anything your organization currently needs, but does not have, to effectively engage in the SIF PFS program? Please explain. __________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Perception of SIF PFS Program
Using a four-point scale where 1 = Very Satisfied and 4 = Very Dissatisfied, please rate your satisfaction or dissatisfaction with the each of the following factors affecting implementation of your SIF PFS award.
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Very Satisfied |
Satisfied |
Dissatisfied |
Very Dissatisfied |
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1 |
2 |
3 |
4 |
Amount of content training received from CNCS |
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Amount of grant management training received from CNCS |
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Type of training received from CNCS |
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Opportunity for knowledge-sharing among grantees |
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Guidance provided for sub selection from CNCS |
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Reporting requirements for SIF PFS program |
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Other (Please describe):
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Other (Please describe):
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Other (Please describe):
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Thank you very much for your participation!
CNCS Process Evaluation of the Social Innovation Fund
Pay for Success Program
(SIF PFS Program)
Subrecipient/Service Recipient Survey
INSTRUCTIONS AND GUIDANCE TO COMPLETE THE ONLINE SURVEY Please keep the following in mind as you complete the survey:
If you have questions about the study, or need help in accessing the survey or navigating the screens, please email CNCS_PFS_STUDY@abtassoc.com or call 617-520-3899. |
Organization Background and Staffing
What type of organization is [SUB NAME]? [SELECT ALL THAT APPLY]
___ Non-profit — multi-state
___ Non-profit — state-wide
___ Non-profit – local
___ Higher education organization — public
___ Higher education organization — private
___ Foundation/philanthropic
___ Research organization
___ Private financial institution (such
as a CDFI)
___ State government agency
___ County
government agency
___ City government agency
___ School
district
___ Private business
___ Other (Please
describe):______________________________
In which U.S. city and state or territory is your organization headquartered?
________________________
[City, State or Territory) *online survey will have dropdown menu of states and territories
How long ago was your organization founded (if applicable)? [SELECT ONE]
__ Less than 2 Years
__ 2-5 Years
__ 6-10 Years
__ 11-20 Years
__ More than 20 Years
Please complete the table below indicating the number of staff members (either part-time or full-time) that fall into each of the following categories:
[Online survey will include a hover-above stating that “Number of staff members” should include administrative as well as programmatic staff.]
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Number of staff members (either part- or full-time) currently employed by your organization… |
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across all locations? |
that currently work on any PFS activities? |
that currently work on SIF PFS program activities? |
that currently work only on SIF PFS program activities? |
that were hired to work on PFS activities after your organization was selected as a SIF PFS sub? |
# of staff members (either part-time or full-time) |
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Experience and Involvement with Pay For Success (PFS)
Approximately when did your organization first begin exploring, planning, implementing, or evaluating PFS projects?
_____________
[Month/Year] *online survey will have dropdown to enter Month/Year
Prior to being selected as a sub in the SIF PFS program, was your organization directly involved in assessing the feasibility of, planning for, or implementing a specific PFS project?
___ No (SKIP TO QII.3)
___ Yes
[IF YES] What was the primary role of your organization in this (these)
project(s)? [SELECT ONE]
__Government agency planning/implementing project
__Technical assistance provider
__ Direct service provider
__ Evaluator
__ Intermediary
__ Payor
__ Investor/ funder
__ Other (Please describe): ______________________
Prior to being selected as a sub in the SIF PFS program, how many of your staff members had direct experience with any activities related to the planning or implementation of a PFS initiative? ________________
After being selected as a sub in the SIF PFS program, how many of your staff members had direct experience with any activities related to the planning or implementation of a PFS initiative? ________________
Prior to being selected as a sub in the SIF PFS program, did your organization receive any external funding for PFS activities?
__ No (SKIP TO QII.6)
__ Yes
[IF YES] What was (were) the source(s) of these external funds? [SELECT ALL THAT APPLY]
Source of Funds
__ Federal
government
__ State government
__ Local government
__
Philanthropies/foundations
__ Individual donors
__
Commercial bank/thrift/credit union/savings and loan
__ Investment bank
__ College/university
__ Other
research organization
__ Community development financial institution (CDFI)
__ Non-profit organization not otherwise
listed here
__ Non-forgivable loans from any source
__
Other (Please describe):_________________________
__ Other (Please
describe):_________________________
After being selected as a sub in the SIF PFS program, has your organization obtained any additional external funding for PFS activities (not including any matching funds required by the SIF PFS program)?
___ No (SKIP TO QIII.1)
___ Yes
[IF YES] What was (were) the source(s) of these external funds? [SELECT ALL THAT APPLY]
Source of Funds
__ Federal
government
__ State government
__ Local government
__
Philanthropies/foundations
__ Individual donors
__
Commercial bank/thrift/credit union/savings and loan
__ Investment bank
__ College/university
__ Other
research organization
__ Community development financial institution (CDFI)
__ Non-profit organization not otherwise
listed here
__ Non-forgivable loans from any source
__
Other (Please describe):__________________
__ Other (Please
describe):__________________
SIF PFS Program Application and Selection
What was the primary way that your organization learned about the opportunity to become a sub in the SIF PFS program? [SELECT ONE]
__ CNCS website
__ CNCS announcement or marketing materials (e.g., listserv, hard copies of materials)
__ SIF PFS grantor website
__ SIF PFS grantor announcement or marketing materials (e.g., listserv, hard copies of materials)
__ SIF PFS grantor presentation at a meeting or convening
__ Direct outreach from SIF PFS grantor to you or your organization
__ Current or previous SIF PFS sub
__ Personal/professional contact or word of mouth
__ Other (please describe):____________________________
We are interested in knowing how many applications your organization has submitted in response to requests for proposals (RFPs) or similar solicitations issued by grantors in the SIF PFS program [OR since (AUTO-FILL DATE OF LAST DATA COLLECTION FOR RETURNING SURVEY RESPONDENTS)]. Please fill in the table below for each application submitted in response to an RFP issued under the SIF PFS program:
To which SIF PFS RFP competition did your organization submit an application?
Was your organization selected as a sub by the grantor during that RFP process?
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Application |
Selection |
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SIF PFS Grantor Name and RFP Release Date [DROPDOWN]* |
Selected as a Sub? [Yes/No/Don’t Know Yet] |
Application #1 |
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Application #2 |
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Application #3 |
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* DROPDOWN OPTIONS WILL INCLUDE: Corporation for Supportive Housing (CSH) December 2014, Green & Healthy Homes Initiative (GHHI) December 2014, Green & Healthy Homes Initiative (GHHI) March 2015, Harvard Kennedy School Social Impact Bond Lab (Harvard SIB Lab) October 2014, Institute For Child Success, Inc. (ICS) December 2014, National Council on Crime and Delinquency (NCCD) December 2014, Nonprofit Finance Fund (NFF) January 2015, Third Sector Capital Partners November 2014, University of Utah Policy Innovation Lab (Utah PIL) January 2015, and University of Utah Policy Innovation Lab (Utah PIL) April 2015. [NOTE: This list will be updated as new grantees are selected and grantees release new RFPs]. Additional rows will be added to online survey if needed.
Has your organization received any funding or pass-through funding as of today’s date from one or more SIF PFS grantor(s)? (SELECT ONE)
__ No, do not expect to receive funding or pass-through funding from one or more SIF PFS grantors (SKIP TO QIV.1)
__ No but expect to receive funding or pass-through funding from one or more SIF PFS grantors (SKIP TO QIV.1)
__ Yes
[IF YES] How many grantors will you receive funding from? ______
[AUTO-FILL TABLE WITH NUMBER OF ROWS BASED ON QIII.3a] Please fill in the table below with the following information for each SIF PFS grantor from which your organization received funds:
From which SIF PFS grantor(s) did your organization receive funds?
What month and year did your organization first receive these funds?
What is the approximate amount received to date from each SIF PFS grantor?
What is the total amount of funds your organization expects to receive from each SIF PFS grantor?
|
SIF PFS Grantor Name [DROPDOWN] |
Month/Year Funds First Received |
Approximate Amount Received To Date |
Total Amount of Funds Expected |
SIF PFS Grantor #1 |
|
|
$_ _ _, _ _, _ _ _ |
$_ _ _, _ _, _ _ _ |
SIF PFS Grantor #2 |
|
|
$_ _ _, _ _, _ _ _ |
$_ _ _, _ _, _ _ _ |
SIF PFS Grantor #3 |
|
|
$_ _ _, _ _, _ _ _ |
$_ _ _, _ _, _ _ _ |
*DROPDOWN OPRIONS WILL INCLUDE: Corporation for Supportive Housing (CSH), Green & Healthy Homes Initiative (GHHI), Harvard Kennedy School Social Impact Bond Lab (Harvard SIB Lab), Institute For Child Success, Inc. (ICS), National Council on Crime and Delinquency (NCCD), Nonprofit Finance Fund (NFF), Third Sector Capital Partners, and University of Utah Policy Innovation Lab (Utah PIL). Additional rows will be added to online survey if needed.
[AUTO-FILL NUMBER OF COLUMNS BASED ON QIII.3a] Approximately what percent of these funds provided by each grantor is being used or is designated for each of the following costs? [INDICATE PERCENT USED FOR EACH ITEM]
|
SIF PFS Grantor #1 [AUTO-FILL NAME] |
SIF PFS Grantor #2 [AUTO-FILL NAME] |
SIF PFS Grantor #3 [AUTO-FILL NAME] |
% Salaries of own organization’s staff working on PFS project activities |
|
|
|
% Outside intermediary |
|
|
|
% Outside evaluator or data analyst |
|
|
|
% Transaction coordinator costs |
|
|
|
% Legal services |
|
|
|
% Other (Please describe):______________ |
|
|
|
% Other (Please describe):______________ |
|
|
|
*Total of each column should equal 100% |
100% |
100% |
100% |
Note: additional columns will be added to online survey if needed.
SIF PFS Activities
[AUTO-FILL TABLE WITH GRANTOR ROWS FROM QIII.2a if QIII.2b=YES ] Is your organization required to obtain any matching funds or in-kind contributions under your agreement with your SIF PFS grantor(s)?
|
Matching funds required [Yes/No] |
In-kind contributions required [Yes/No] |
SIF PFS Grantor #1 [AUTO-FILL NAME] |
|
|
SIF PFS Grantor #2 [AUTO-FILL NAME] |
|
|
SIF PFS Grantor #3 [AUTO-FILL NAME] |
|
|
Note: online survey will include additional rows if needed.
[IF ANY QIV.1 MATCHING FUNDS=YES, AUTO-FILL TABLE WITH NUMBER OF COLUMNS FROM QIV.1. WITH “MATCHING FUNDS”=YES] Please specify the type of organization that provided the matching funds and the estimated amount of matching funds provided by each organization. [SKIP IF MATCHING FUNDS=NO FOR ALL ROWS OF QIV.1]
|
Estimated Amount of Matching Funds |
||
Type of Organization |
SIF PFS Grantor #1 [AUTO-FILL NAME] |
SIF PFS Grantor #2 [AUTO-FILL NAME] |
SIF PFS Grantor #3 [AUTO-FILL NAME] |
Federal government |
|
|
|
State government |
|
|
|
Local government |
|
|
|
Philanthropies/foundations |
|
|
|
Individual donors |
|
|
|
Commercial bank/thrift/credit union/savings and loan |
|
|
|
Investment bank |
|
|
|
College/university |
|
|
|
Other research organization |
|
|
|
Community development financial institution (CDFI) |
|
|
|
Non-profit organization not otherwise listed |
|
|
|
Non-forgivable loans from any source |
|
|
|
Matching funds not yet obtained |
|
|
|
Other (Please describe): |
|
|
|
Other (Please describe): |
|
|
|
Note: online survey will include additional columns if needed.
How many PFS projects does your organization hope to explore or develop as part of the SIF PFS program? ______
[TABLE AUTO-FILLED WITH NUMBER OF ROWS FROM QIV.2] To clarify information about each project, please choose a one- or two-word name for each of the PFS projects your organization hopes to explore or develop. This information will be auto-filled into subsequent survey questions so it is clear which project you are providing information about.
One or two-word project NAME: |
One or two-word project NAME: |
One or two-word project NAME: |
Note: online survey will include additional rows if needed.
[SUBS OF FEASIBILITY ASSESSMENT/CAPACITY BUILDING GRANTORS] Please describe how far along your organization’s SIF PFS projects are in the feasibility assessment process:
Project |
Begun feasibility assessment [Month/Year, Check box if not begun] |
Completed feasibility assessment [Month/Year, Check box if not complete] |
If completed, was the project determined to be feasible? [YES/NO] |
Project #1 [AUTO-FILL NAME FROM ABOVE] |
|
|
|
Project #2 [AUTO-FILL NAME FROM ABOVE] |
|
|
|
Project #3 [AUTO-FILL NAME FROM ABOVE] |
|
|
|
Note: online survey will include additional rows if needed
(AUTO-SKIP TO QV.4 IF NO PROJECTS WERE DETERMINED INFEASIBLE)
[AUTO-FILL TABLE BELOW WITH CORRECT NUMBER OF COLUMNS] For each project found not feasible, please place a “√” in the table below for up to three primary reasons that the project was found not to be feasible. (SELECT UP TO THREE REASONS FOR EACH PROJECT)
|
Project #1 |
Project #2 |
Lack of commitment or leadership of own organization |
|
|
Lack of political will/support from local/state/federal government |
|
|
Unable to identify suitable social problem or policy area |
|
|
Unable to identify or select evidence-based intervention |
|
|
Unable to identify or retain services of proven service provider(s) |
|
|
Unable to take project to necessary scale |
|
|
Insufficient demand for services |
|
|
Failure to obtain support from funder/investors |
|
|
Failure to obtain support from governments/payors |
|
|
Lack of data or unable to identify or agree upon measurable outcomes |
|
|
Unable to conduct experimental or quasi-experimental evaluation |
|
|
Unable to determine an agreed-upon price per successful outcome |
|
|
Other (Please describe):_____________________________ |
|
|
Other (Please describe):_____________________________ |
|
|
Other (Please describe):_____________________________ |
|
|
* online survey will include additional columns if needed
Will you continue to work with the SIF PFS program? (SELECT ONE)
__ No
__ Yes, for some projects
__ Yes, for all projects
Will you continue to search for a suitable PFS project? (SELECT ONE)
__ No
__ Yes, for some projects
__ Yes, for all projects
Will you continue to search for alternative (non-PFS) financing arrangements? (SELECT ONE)
__ No
__ Yes, for some projects
__ Yes, for all projects
Have any of your SIF PFS projects been discontinued for reasons other than they were found not feasible?
__ No (SKIP TO QV.1)
__ Yes
[IF YES] How many projects were discontinued? ______
[IF YES] Please explain why each project was discontinued:
Reason that Project #1 was discontinued: _____________________________________________________
Reason that Project #2 was discontinued:
_____________________________________________________
*online survey will include additional project #s as needed
SIF PFS Subrecipient/Service Recipient Project Progress
[THE FOLLOWING QUESTIONS WILL BE REPEATED FOR EACH PROJECT.
[IF ONE OR MORE PFS PROJECT(S)] We will now ask a series of questions about the progress of each of your SIF PFS project(s). Please consider each project separately when answering these questions.[START OF LOOP- WILL BE REPEATED FOR EACH PFS PROJECT IDENTIFIED BY SUB IN SURVEY QUESTION QIV.2]
Has your SIF PFS project [AUTO-FILL PROJECT NAME FROM QIV.2 ABOVE] selected an intermediary?
__ No
__ Yes, selected prior to involvement in SIF PFS program
__ Yes, selected after involvement in SIF PFS program
__ Not applicable (my organization is the intermediary)
Has your SIF PFS project [AUTO-FILL IN PROJECT NAME FROM QIV.2 ABOVE] selected a service provider?
__ No
__ Yes, selected prior to involvement in SIF PFS program
__ Yes, selected after involvement in SIF PFS program
__ Not applicable (my organization is the service provider)
Has your SIF PFS project [AUTO-FILL IN PROJECT NAME FROM QIV.2 ABOVE] secured a commitment of funds from any potential investors?
__ No (SKIP TO QV.4)
__ Yes, secured commitment of funds prior to involvement in SIF PFS program
__ Yes, secured commitment of funds after involvement in SIF PFS program
[IF YES] Please fill in the table below with the following information for each investor from which your organization has secured a funding commitment:
What type of investor(s) did you secure a commitment of funds from?
When (month/year) did the investor commit their support?
What was the estimated amount committed by the investor (if known)?
|
Type of Investor [DROPDOWN] |
Approximate Month/Year Investor Committed Support |
Estimated Amount Committed or Indicate if Don’t Know |
Investor #1 |
|
|
$_ _ _, _ __, _ _ _ ___ Don’t Know |
Investor #2 |
|
|
$_ _ _, _ __, _ _ _ ___ Don’t Know |
Investor #3 |
|
|
$_ _ _, _ __, _ _ _ ___ Don’t Know |
Note: online survey will include a minimum of 12 additional rows
TYPE OF INVESTOR DROPDOWN MENU WILL INCLUDE: State government, Local government, Local philanthropy/foundation, National philanthropy/foundation, Individual donor, Commercial bank/thrift/credit union/savings and loan, Investment bank, College/University, Other research organization, Community development financial institution (CDFI), Non-profit organization not otherwise listed here, Non-forgivable loans from any source, Other (Please describe).
Have outcome measures for your SIF PFS project [AUTO-FILL IN PROJECT NAME FROM QIV.2 ABOVE] been identified?
__ No (SKIP TO QV.5)
__Yes, identified prior to involvement in SIF PFS program
__Yes, identified after involvement in SIF PFS program
[IF YES] When were outcome measures identified? ____________
[Month/Year]
[IF YES] Have outcome measures been tied to payback amounts for investors?
__ No (SKIP TO QV.5)
__ Yes
[IF YES] When was this process completed? ____________
[Month/Year]
Has your SIF PFS project [AUTO-FILL NAME FROM QIV.2 ABOVE] drafted an evaluation plan?
__ No (SKIP TO QV.6)
__ Yes, drafted prior to involvement in SIF PFS program
__ Yes, drafted after involvement in SIF PFS program
[IF YES] Will the evaluation be conducted by an outside evaluator?
__ No (SKIP TO QV.6)
__ Yes
[IF YES] Has an outside evaluator been hired or contracted?
__ No (SKIP TO QV.6)
__ Yes, hired or contracted prior to involvement in SIF PFS program
__ Yes, hired or contracted after involvement in SIF PFS program
Has your organization finalized the PFS project contract(s) for [AUTO-FILL NAME FROM QIV.2]?
__ No (SKIP TO QVI.1)
__ Yes,
finalized prior to involvement in SIF PFS program
__ Yes,
finalized after involvement in SIF PFS program
[END OF LOOP- REPEAT SECTION V FOR EACH REMAINING PFS PROJECT IDENTIFIED BY SUB IN SURVEY QUESTION QIV.2]
Assistance or Support Provided by your SIF PFS Grantor
Does your SIF PFS grantor(s) provide your organization with a designated individual from the grantor organization to provide assistance or support in SIF PFS project activities?
[Add hover-above text box defining “designated individual” as: For example, site liaison, project manager, lead contact, etc.]
___ No
___ Yes
Will/does your SIF PFS grantor embed a grantor staff person within your organization (i.e., co-locate a “fellow” with your staff)?
___ No
___ Yes
Will/does your grantor fund a staff person hired by your organization?
___ No
___ Yes
We are interested in the types of activities provided by the SIF PFS grantor(s) to assist your organization with your SIF PFS project activities. Please use the table below to indicate the types of activities provided by your grantor(s) and the usefulness of that activity.
Types of Activities |
Provided by Grantor(s) [DROPDOWN OPTIONS: 1. Offered and used 2. Offered but not used 3. Not offered but wanted 4. Not offered and not wanted or not applicable |
If Activity was Provided, How Useful Was It? |
||
Very Useful |
Somewhat Useful |
Not Very Useful |
||
Work plan design and management |
|
|
|
|
Review of the evidence base for intervention(s) |
|
|
|
|
Needs assessment |
|
|
|
|
Target population analysis |
|
|
|
|
Risk assessment |
|
|
|
|
Logic model development |
|
|
|
|
Cost-benefit analysis |
|
|
|
|
Service provider capacity assessment |
|
|
|
|
Potential investor assessment (funding streams) |
|
|
|
|
Evaluation model development |
|
|
|
|
Stakeholder engagement |
|
|
|
|
Assist with federal funding requirements |
|
|
|
|
Other (Please describe): |
|
|
|
|
Other (Please describe): |
|
|
|
|
Other (Please describe): |
|
|
|
|
We are interested in the types of interactions engaged in by the SIF PFS grantor(s) to assist your organization with your SIF PFS project activities. Please use the table below to indicate the types of interactions engaged in by your grantor(s) and the usefulness of that interaction.
Types of Interactions |
Provided by Grantor(s) [DROPDOWN OPTIONS: 1. Offered and used 2. Offered but not used 3. Not offered but wanted 4. Not offered and not wanted or not applicable |
If Interaction was Provided, How Useful Was It? |
||
Very Useful |
Somewhat Useful |
Not Very Useful |
||
Webinars or online training with multiple subs |
|
|
|
|
In-person group events or conferences for multiple subs |
|
|
|
|
Individual site visits to your organization or in-person meetings with staff from your organization |
|
|
|
|
Periodic or regular telephone calls with staff from your organization |
|
|
|
|
Resources such as templates, guides, reports, etc. |
|
|
|
|
Other (Please describe):
|
|
|
|
|
Other (Please describe):
|
|
|
|
|
Other (Please describe):
|
|
|
|
|
We are also interested in the types of products or materials provided by the SIF PFS grantor(s) to assist your organization with your SIF PFS project activities. Please use the table below to indicate the types of products or materials provided by your grantor(s) and the usefulness of those products or materials.
Types of Products or Materials |
Provided by Grantor(s) [DROPDOWN OPTIONS: 1. Offered and used 2. Offered but not used 3. Not offered but wanted 4. Not offered and not wanted or not applicable] |
If Product or Material was Provided, How Useful Was It? |
||
Very Useful |
Somewhat Useful |
Not Very Useful |
||
Templates for feasibility assessment |
|
|
|
|
Templates for contracts |
|
|
|
|
Templates for evaluation designs |
|
|
|
|
Printed materials and toolkits |
|
|
|
|
Toolkits or timelines specifically for project management |
|
|
|
|
Templates for federal funding requirements |
|
|
|
|
Other (Please describe):
|
|
|
|
|
Other (Please describe):
|
|
|
|
|
Other (Please describe):
|
|
|
|
|
Please rate how your capacity has changed since being selected as a SIF PFS sub, [OR since (AUTO-FILL DATE OF LAST DATA COLLECTION FOR RETURNING SURVEY RESPONDENTS)] both overall and in each of the areas listed below. For each factor in which you indicated a change, please indicate if you think that the change was a result of your organization’s participation in the SIF PFS program.
|
Capacity Change |
Was change as a result of participation the SIF PFS program? [YES/YES, PARTIALLY/ NO] |
||||
|
Substantially Lower |
Somewhat Lower |
About the Same |
Somewhat Higher |
Substantially Higher |
|
Overall capacity |
|
|
|
|
|
|
Grant management |
|
|
|
|
|
|
Project management |
|
|
|
|
|
|
Assessing project feasibility |
|
|
|
|
|
|
Ability to support and scale projects |
|
|
|
|
|
|
Identification/selection of evidence-based interventions |
|
|
|
|
|
|
Ability to conduct or identify rigorous evaluation methods |
|
|
|
|
|
|
Ability to collect data |
|
|
|
|
|
|
Ability to support effective program development |
|
|
|
|
|
|
Other (Please describe):
|
|
|
|
|
|
|
Other (Please describe):
|
|
|
|
|
|
|
Other (Please describe):
|
|
|
|
|
|
|
Please describe up to three important lessons your organization has learned related to your participation in the SIF PFS program since being selected as a SIF PFS subrecipient/service recipient.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Is there anything your organization currently needs, but does not have, to effectively engage in the SIF PFS program? Please explain. ____________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Overall, how useful has the assistance and support from your SIF PFS grantor been to your organization for increasing knowledge and understanding of PFS?
___ Very useful
___ Somewhat useful
___ Not very useful
Thank you very much for your participation!
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Liana Fox |
File Modified | 0000-00-00 |
File Created | 2021-01-24 |