Form 1 Head Start Collab-PPR

OMB Control No: 0970-0490
Expiration date: 1/31/2020

Head Start Collaboration Office
[YEAR] Annual Report Questionnaire
ABOUT THIS REPORT
This annual report will support the work completed by your Head Start Collaboration Office (HSCO). The
annual report will allow the Office of Head Start (OHS) to capture and promote your collaboration office
accomplishments that are both quantitative and qualitative. The categories were determined by
information that was submitted in past reports along with current priorities and therefore is intended to
build on past work as we move forward. While we structure a number of questions to focus on current
priorities, we also allow for work outside of the priorities to be reported at the end of each section.
INSTRUCTIONS
Please only report on work completed during the [YEAR] calendar year. When necessary, you may
include some background information prior to [YEAR] to understand the work being reported. If no work
has been completed in an area during [YEAR], there is no need to enter any information.
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 3 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.

Head Start Collaboration Office [YEAR] Annual Report Questionnaire

A. DEMOGRAPHIC INFORMATION
Please fill out the following demographic information.
* indicates a required question
† indicates a question that will be used to populate your collaboration profile webpage on Early Childhood
Learning & Knowledge Center (ECLKC)
1. * Name
2. * Title
3. *† Select the state of the Head Start Collaboration Office (HSCO)
4. *† What region is the collaboration office located in?
5. When did you begin in this position?
6. *† Select the Department that best represents the location of the HSCO
Department of Education
Department of Human or Social Services
Workforce Department
Governor’s Office
Combined Education and Human Services Department
Other
7. *† Where is the HSCO actually housed (e.g. specify the division within the department)

8. *† Is this position appointed by the Governor or their Designee
Yes
No
9. † Please provide the Vision and Mission of the department in the State where the HSCO is located. You
may include the Purpose/Mission of the HSCO if applicable.

10. How many staff positions are there in the HSCO?
Director

Full-time employees (FTE)

Coordinator

FTE
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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
Assistant/Admin

FTE

Other

FTE

(Please indicate position)

11. † Does your state or region have an identified State Advisory Council? If so, provide the name of the
council and the involvement of the HSCO.
Yes
No
Regional Advisory Council
12. † List up to ten major partnerships/collaborations that are in place between the HSCO and other
entities

13. † List the major goals for your HSCO

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire

B. PROFESSIONAL DEVELOPMENT
† Reponses to sections B-G will be used to populate the results on your ECLKC collaboration office profile
webpage and can be used in completing your mid and annual reports.
1. Please indicate if the collaboration office has been involved in any education for legislative actions
around Professional Development in the following areas
educational requirements for Early Childhood Education (ECE)
system development
other (please specify)
2. Please indicate the area(s) of higher education where the collaboration office was involved
development or revision of a state credential/certificate
infant toddler
preschool
mental health
early childhood special education
development or revision of a degree
Associate degree in ECE with a focus on infant and toddler development
Baccalaureate degree in ECE with a focus on infant and toddler development
Master degree in ECE with a focus on infant and toddler development
development or revision of online coursework or degree
infant toddler
preschool
enhancement of coursework
infant toddler
social emotional
brain development
support for articulation
facilitated partnerships

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
other (please specify)
3. Please indicate the area(s) where the collaboration office has been involved in the development or
implementation of Early Learning Guidelines/Standards (ELG/ELS)
alignment with the Head Start Early Learning Outcomes Framework: Ages Birth to Five (ELOF)
dual language in developing ELG/ELS
initial development or revisions to
infant toddler
preschool
birth to 5 continuum
other (please specify)
4. Please indicate the area(s) where the collaboration office has been a part of development or revision of
core knowledge and competencies for practitioners/professionals
infant toddler
birth to five continuum
drafting documents
other (please specify)
5. Please indicate the area(s) where the collaboration office has been involved in facilitating conference
or training activities
statewide in collaboration with State Head Start Association
regional in collaboration with Regional Head Start Association
in partnership with National Head Start Association (NHSA)
in partnership with other organization (please specify)
other (please specify)
6. Please indicate the area(s) where the collaboration office has been involved in the development or
enhancement of Professional Development Registry activities
statewide system
Early Childhood professional tracking
trainer requirements and tracking
meeting of Head Start professional development requirements
other (please specify)

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
7. Please provide a narrative description of your work in professional development indicated above and if
applicable, measurable results. If no work in professional development indicated above, then leave
blank.

8. If there are any other professional development activities the collaboration office has been involved in
that have not been reported in this section, please provide a narrative description of your work and if
applicable, measurable results

C. SCHOOL READINESS and PRE-K
Include a description and some measurable results where possible.
1. Please indicate the area(s) where the collaboration office has been involved in the promotion of school
readiness efforts
importance of relationships and trust
continuity of care
transition planning
pre-literacy and literacy efforts
early math and science and/or STEM efforts
Kindergarten Entry Assessment (KEA)
summits or conferences
Memorandum of Understandings (MOUs)
public engagement and marketing tool
other (please specify)
2. If you indicate that the collaboration office has been involved in transition planning in Question 1,
please indicate if the collaboration office has met with one of the following:

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
SEAs
LEAs
Superintendents
Principals
Bureau of Indian Affairs (BIA)
Tribal Schools
Charter Schools
Other

3. Please indicate if the collaboration office has been involved in or supported involvement with pre-K
partnerships
funding (please be as specific as possible in the narrative)
other (please specify)
4. Please provide a narrative description of your work in school readiness and pre-K indicated above and
if applicable, measurable results. If no work in school readiness and pre-K indicated above, then leave
blank.

5. If there are any other school readiness or pre-K activities the collaboration office has been involved in
that are not reported in this section, please provide a narrative description of your work and if
applicable, measurable results

D. DATA and STATE FUNDING RELATED WORK
Include a description and some measurable results where possible.
1. Please indicate if the collaboration office has worked on setting up unique identifiers that include Head
Start children in your state or region.

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
Yes
No
2. Please indicate if the collaboration office has developed or updated any profiles regarding data for your
state or for certain populations
Fact Sheets or Profiles – please include the geographic level in the description (such as county/city
etc.)
economic impact studies
mapping studies
other (please specify)
3. Please indicate if the collaboration office has contributed to the development of a state data system or
other data system in your region.
been a part of task force or coalitions for planning and developing the state’s or region’s data system
including early childhood
developed or been a part of an MOU to share data
deliberate integration of Head Start data into the state data system
work on common definitions within the state
other (please specify)
4. Please provide a narrative description of your work in data or state/region funding indicated above
and if applicable, measurable results. If no work in data or state/region funding indicated above, then
leave blank.

5. If there are any other data or state/region funding related activities the collaboration office has been
involved in that are not reported in this section, please provide a narrative description of your work
and if applicable, measurable results

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire

E. PARENT/FAMILY and DIVERSITY RELATED
Include a description and some measurable results where possible.
1. Please indicate if the collaboration office has used the Parent Family Community Engagement
Framework to guide work with other systems or projects within the state or region
Yes
No
2. Please indicate if the collaboration office has been engaged in work around home visiting such as
MIECHV and Early Head Start work
coordination and/or systems work within your state or region
development or support of pilots around home visiting
other (please specify)
3. Please indicate what work the collaboration office has been engaged in that supports dual language
learners and/or cultural responsiveness
MOUs or work with the Office of Refugee Resettlement
development of any early English language development standards
other (please specify)
4. Please indicate if the collaboration office has been involved in the development of MOUs with child
welfare
Yes
No
5. Please indicate if the collaboration office has been involved in developing materials or conferences /
meetings to support parent/family/community engagement
conferences or meetings
materials
other (please specify)
6. Please indicate if the collaboration office has worked on issues relating to the specific topic areas
below
fatherhood
parent advisory groups
parent data

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
financial capability
homelessness
domestic violence
incarcerated parents
Strengthening Families work
other (please specify)
6. Please provide a narrative description of your work in parent/family or diversity related indicated
above and if applicable, measurable results. If no work in parent/family or diversity related indicated
above, then leave blank.

7. If there are any other parent/family or diversity related activities the collaboration office has been
involved in that are not reported in this section, please provide a narrative description of your work
and if applicable, measurable results

F. QUALITY RATING AND IMPROVEMENT SYSTEM (QRIS)
Include a description and some measurable results where possible.
1. Please indicate any work the collaboration office has been intentionally involved in regarding Head
Start in QRIS
piloting efforts
alignment issues
active participation in development of QRIS
reducing barriers to Head Start involvement to increase number of grantees who are a part of QRIS
provided support in the adoption of ”Caring for Our Children Basics,” proposed Health and Safety
Model Standards
other (please specify)
If any selected, please provide a narrative description of your work and if applicable, measurable results

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
2. If there are any QRIS activities that the collaboration office has been involved in that are not reported
in this section, please provide a narrative description of your work and if applicable, measurable results

G. EARLY EDUCATION SYSTEM OUTSIDE OF QRIS
Include a description and some measurable results where possible.
1. Please indicate if the collaboration office has been involved in or supported efforts to expand access to
quality infant and toddler spaces within your state or region
within Early Head Start
within Early Head Start – Child Care Partnerships
within early care and education
other (please specify)
2. Please indicate if the collaboration office has regular meetings or communications with other early care
and education professional
child care
state data system staff
pre-K
QRIS
higher education
K-12
other (please specify)
3. Please indicate if the collaboration office has worked on a cross walk between state child care licensing
and Head Start Program Performance Standards
in discussion
started the process
completed (please e-mail a copy to Karen.Heying@acf.hhs.gov or include a link to the crosswalk in
the description in Question 6 of this section)
other (please specify)

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
4. Please indicate if the collaboration office has worked on Family Child Care issues in your state or region
licensing issues for partnering with Head Start/Early Head Start
piloting efforts
increasing quality in general for family child care
other (please specify)
5. Please indicate if the collaboration office has worked on general early care and education systems work
in your state or region around the following areas
State Advisory Council (SAC)/Interagency work
Planning and developing frameworks
MOU/Interagency agreements
General alignment across systems
state funding
materials/public awareness
work with the child care subsidy office
other (please specify)

6. Please provide a narrative description of your work in early childhood system outside of QRIS indicated
above and if applicable, measurable results. If no work in early childhood system outside of QRIS
indicated above, then leave blank.

7. If there are any other early childhood system outside of QRIS related activities the collaboration office
has been in involved in and are not reported in this section, please provide a narrative description of
your work and if applicable, measurable results

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire

H. HEALTH RELATED
Include a description and some measurable results where possible.
1. Please indicate if the collaboration office has been involved in activities around support of a medical or
dental home
medical
dental
2. Please indicate if the collaboration office has been involved in intentional activity to support Early and
Periodic Screening, Diagnostic and Treatment (EPSDT) screenings
lead toxicity screening
hearing screening
vision screening
dental screening
other (please specify)
3. Please indicate if the collaboration office has been involved in intentional activities around oral health
initiatives
coordination for increased access
conference coordination
partnerships
funding
other (please specify)
4. Please indicate if the collaboration office has been involved in support or development of Health
Networks in your state or region
Yes
No
5. Please indicate what level of involvement the collaboration office had in your state or region around
early childhood and disabilities
development of state or regional MOUs
public awareness campaigns
support materials
other (please specify)

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire
6. Please indicate what areas of involvement the collaboration office had around mental health and social
emotional issues in your state or region
specific involvement in infant and toddlers
materials development
coordination of conferences
support for the development of coaching and mentoring groups
interagency coordination
other (please specify)
7. Please indicate what areas of involvement the collaboration office had around nutrition issues in your
state or region
WIC
CACFP
obesity prevention
other (please specify)

9. Please provide a narrative description of your work in early childhood system outside of QRIS indicated
above and if applicable, measurable results. If no work in early childhood system outside of QRIS
indicated above, then leave blank.

10. If there are any other health related activities that the collaboration office has been involved in that
are not reported in this section, please provide a narrative description of your work and if applicable,
measurable results

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Head Start Collaboration Office [YEAR] Annual Report Questionnaire

I. OTHER REGIONAL PRIORITIES THAT ARE NOT INCLUDED IN ANY OF THE
SECTIONS
Include a description and some measurable results where possible.
List and describe up to three other collaboration office regional priorities not reported in any of the previous
sections (if there are no regional priorities identified, this may be left blank)

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