ICRC Indicators Data Collection

Progress Report for Injury Control Research Centers (ICRC)

Att 3a. ICRC Indicators Data Collectionm

ICRC Indicators Data Collection

OMB: 0920-1216

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Injury Control Research Centers (ICRC) Indicators Data Collection 20XX



Form Approved

OMB No.: 0920-xxxx

Expiration Date: XX/XX/XXXX


Public Reporting burden of this collection of information is estimated at 10 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing 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.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA  30333; Attn:  PRA (0920-XXXX).



Awardee      

FOA Number      

Instructions

Please refer to the companion ICRC indicator template guidance document for instructions on completing this template.

Utilize this spell check button in order to spell check the document.



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1. ICRC Affiliated Personnel

Personnel supported with ICRC funding or ICRC affiliated personnel actively involved with the ICRC who worked on at least one ICRC project over the previous funding years.



See Excel attachment to complete Personnel information.



Number of ICRC Affiliated personnel receiving at least 50% support from non-ICRC sources (1000 Character Limit)

     



What example can you provide to best illustrate how the diversity of disciplines and departmental appointments of ICRC-affiliated personnel is a strength to the ICRC? (There is no character limit for this response)

     



What additional information do you want to provide about personnel (e.g., rationale for why a particular individual was considered to be ICRC-affiliated)? (There is no character limit for this response)

     



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2. Funding from all Sources

Funding Amounts should be the total amount (direct and indirect) awarded from all sources, but only for the funding year.



Funding Source 1

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 2

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 3

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 4

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 5

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 6

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 7

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 8

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 9

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 10

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 11

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 12

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 13

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 14

Funding Amount per Source       Source (255 Character Limit)      

Funding Source 15

Funding Amount per Source       Source (255 Character Limit)      



What example can you provide to best illustrate how CDC funding is leveraged to acquire additional funds? (1000 Character Limit)

     



What additional information do you want to provide (e.g., explanation of how a grant was stimulated by the ICRC)? (1000 Character Limit)

     



What percent of ICRC funding support comes from the CDC ICRC grant?      



Select all types of funding support your ICRC receives (select all that apply):

Local Government

State Government

Other Federal Government

Foundation/Community Based Organization

Other Private Non-Profit Organization

Other Private for Profit Organization

University

Other

If "Other" please describe (500 Character Limit)      



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3. Completed and Ongoing Studies

Studies supported with ICRC funding

Study 1 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      

Please indicate if this study is an original approved study or a pilot (exploratory) study:



Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 2 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:





Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 3 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:



Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 4 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:



Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 5 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 6 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      

Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 7 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 8 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 9 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 10 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      

Please indicate if this study is an original approved study or a pilot (exploratory) study:



Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 11 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      

Please indicate if this study is an original approved study or a pilot (exploratory) study:



Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 12 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:



Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 13 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 14 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      

Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



Study 15 : CDC ICRC Funded Research Project

Study Title (500 Character Limit)      

ICRC Personnel Involved (500 Character Limit)      

Principal Investigator (255 Character Limit)      

Partners Involved in Study (1000 Character Limit)      

Project Start Date      

Project End Date      

Injury Topic Area: Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Brief Summary/Results (1000 Character Limit)      

Year to Date Status, including milestones (1000 Character Limit)      

Findings/Accomplishments (1000 Character Limit)      

Significance of Findings/Accomplishments (1000 Character Limit)      

Project Milestones for upcoming Budget year (1000 Character Limit)      

Other Significant Information      

Implications of Findings for Practice:      

Plans for Use/Outreach of Study Findings      



Please indicate if this study is an original approved study or a pilot (exploratory) study:

Type of Research or Evaluation (Select all that apply)

Surveillance

Basic Epidemiology

Risk/Protective Factor Research

Intervention Research

Translational Research

Implementation Research

Policy Research or Evaluation

Economic/Cost-Effectiveness Evaluation

Other

If "Other" please describe (500 Character Limit)      



Level of Prevention



What additional information do you want to provide about completed and ongoing studies (e.g., cross-disciplinary nature of studies, innovative studies, how a study impacted the field, how studies related to your previous studies or planned future studies, etc.)? (There is no character limit for this response)

     



Other Significant Information

Describe any other proposed research-related objectives and activities for the budget year and any significant programmatic changes.

     



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4. Publications

Note: Please ensure you do not report the DOI #



See Excel attachment to complete Publication information.



What information do you want to provide about publications authored by ICRC-affiliated personnel (e.g., cross-disciplinary nature of published work, an article that describes innovative work, how an article that impacted the field)? (There is no character limit for this response)

     



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5. Academic Training, Mentoring, and Leadership

Completed during the reporting period



Number of injury courses offered with enrollment (Enter the number only)      

Number of training grants (if any) obtained (Enter the number only)      

Number of Bachelors level students (Enter the number only)      

Number of Masters level students (Enter the number only)      

Number of Doctoral students (Enter the number only)      

Number of Post-doc fellows (Enter the number only)      

Number of junior faculty mentored (Enter the number only)      

Number of student research assistants supported through the center:

Bachelors (Enter the number only)      

Masters (Enter the number only)      

Doctoral (Enter the number only)      

Student/fellow injury related research projects:

Number of projects (Enter the number only)      

Total dollars provided (Enter the number only)      

Injury-related faculty development awards:

Number of awards (Enter the number only)      

Total dollars provided (Enter the number only)      



What example(s) can you provide of ICRC-mentored students who went on to impact the field after leaving the institution?

     



Other Significant Information

Training and Education Core Milestone status and brief summary of progress to date

     



Project milestones for the upcoming year

     



Significant Programmatic changes

     



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6. Outreach

Give the best 10 for which impact can be described

Outreach Activity 1

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 2

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 3

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 4

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 5

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 6

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 7

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 8

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 9

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      

Outreach Activity 10

Type of outreach activity conducted (See outreach guidance for explanation of each category)

Partners Involved in Outreach Activity (1000 Character Limit):      

Outreach Description/Impact (1000 Character Limit)      

Injury topic addressed Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Intended audience (500 Character Limit)      

Number of People Reached (Enter the number only)      



What additional information do you want to provide about how these outreach activities relate to your ICRC's previous body of work and planned future endeavors? (1000 Character Limit)

     



Other Significant Information

Outreach Core Milestone status and brief summary of progress to date

     



Project milestones for the upcoming year

     



Significant Programmatic changes 

     



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7. Research Tools Developed and Disseminated

Research Tool 1

Tool Name (500 Character Limit)      

Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)      

Focus Area (e.g., topic area, category, etc.) (500 Character Limit)      

Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Tool Description/Impact (1000 Character Limit)      

Research Tool 2

Tool Name (500 Character Limit)      

Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)      

Focus Area (e.g., topic area, category, etc.) (500 Character Limit)      

Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Tool Description/Impact (1000 Character Limit)      

Research Tool 3

Tool Name (500 Character Limit)      

Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)      

Focus Area (e.g., topic area, category, etc.) (500 Character Limit)      

Primary: Secondary: Tertiary:

If "Other" please describe (500 Character Limit)      

Tool Description/Impact (1000 Character Limit)      



What additional information do you want to provide about how these tools relate to your ICRC's previous body of work and planned future endeavors? (1000 Character Limit)

     



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8. Practice Tools Developed and Disseminated

Practice Tool 1

Tool Name (500 Character Limit)      

Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)      

Focus Area (e.g., topic area, category, etc.) (500 Character Limit)      

Tool Description/Impact (1000 Character Limit)      

Practice Tool 2

Tool Name (500 Character Limit)      

Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)      

Focus Area (e.g., topic area, category, etc.) (500 Character Limit)      

Tool Description/Impact (1000 Character Limit)      

Practice Tool 3

Tool Name (500 Character Limit)      

Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)      

Focus Area (e.g., topic area, category, etc.) (500 Character Limit)      

Tool Description/Impact (1000 Character Limit)      



What additional information do you want to provide about how these tools relate to your ICRC's previous body of work and planned future endeavors? (1000 Character Limit)

     



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9. Narrative Story of Innovation and Impact

Provide a narrative description of the success and impact of your ICRC over the previous funding year.  Give first consideration to CDC ICRC-funded activities or activities that support CDC Injury Focus Areas in this section

     



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Additional PGO Requirements

Administrative Core milestone status and brief summary of progress to date      



Administrative Core milestones for the upcoming year      



Significant Programmatic changes      



Please provide the following PGO requirements as noted in NOA terms and conditions if not addressed earlier:



1. A comparison of actual accomplishments to the goals established for the period;

2. Reasons for failure, if established goals were not met;

3. Other pertinent information including, when appropriate, analysis and explanation of performance costs are significantly higher than expected; and

4. Any additional information on the Administrative Core not addressed in previous sections.



     



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