Form 1 State Program Performance Report Requirements

OMB Control Number: XXXX-XXXX

Expiration Date: XX/XX/XXXX

UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING (ACL)

ADMINISTRATION ON AGING (AOA)

STATE PROGRAM PERFORMANCE REPORT

For

STATE UNITS ON AGING

(Older Americans Act Titles III and VII (Chapters 3 and 4)¹

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 33.5 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (P.L. 114-144 Older Americans Act of 1965 (OAA), Section 307 (a) (6)). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Administration for Community Living (ACL), Attention: Jennifer Klocinski, Social Science Analyst, Room 1234A, U.S. Department of Health & Human Services, 330 C Street SW, Washington, DC 20201 or email SPRredesign.comments@acl.hhs.gov.

1. Overview of Older Americans Act (AoA) Titles III and VII State Program Performance Report (SPR) Requirements

Purpose:

The purpose of this data collection is to fulfill requirements of the Older Americans Act (OAA) and the Government Performance and Results Modernization Act (GPRA Modernization Act) of 2010 and related program performance activities. Section 202(a)(16) of the OAA requires the collection of statistical data regarding the programs and activities carried out with funds provided under the OAA and Section 207(a) directs the Assistant Secretary on Aging to prepare and submit a report to the President and Congress based on those data. Section 202(f) directs the Assistant Secretary to develop a set of performance outcome measures for planning, managing, and evaluating activities performed and services provided under the OAA. Requirements pertaining to the measurement and evaluation of the impact of all programs authorized by the OAA are described in section 206(a). The State Performance Report is one source of data used to develop and report performance outcome measures and measure program effectiveness in achieving the stated goals of the OAA.

Revision:

These reporting requirements are a revision of those currently in effect (2016-2019). The factors that influenced the revision of the SPR, include: 1) the need to modernize the data structure to allow for more efficient reporting and the ability to use current technology for reporting and analysis; 2) the interest in aligning data elements within and across data collections; 3) the need to consider alternative data elements that reflect the current Aging Network and long-term care services and supports; and 4) the need to reduce reporting burden while enhancing data quality. The revised SPR reduces the number of data elements reported by 70% compared to the 2016-2019 SPR.

Data structure and Content:

This document summarizes the requirements for the State Performance Report for Titles III and VII (Chapters 3 and 4) for federal fiscal year 2019 (FFY 2019) starting 10/01/2018 and subsequent years by all State Units on Aging. The proposed data collection is aggregate data at the state-level which is consistent with the current data collection. The data collection structure is based on components and sub-components that are reflected in the Data Model found on page 3. SPR data are multi-dimensional, that is, data regarding the number of people served, the characteristics of those people served, amount of service and expenditures are reported by service and groups of services. The Service Lists by Demographic Data Requirements (see pages 4 and 5) are representations of services to be reported by program and population (older adults (Title III-B, C, and D); caregivers of older adults (Title III-E); and older relative caregivers of children and adults under age 60 with disabilities (Title III-E). Many consumer demographic and characteristic categories cross to form data elements (e.g. age and poverty status). The Data Element Categories and Intersections tables (see pages 6-9) represent which data categories intersect to form data elements. The Data Elements tables display the data to be collected and the data attributes (e.g. data codes and values). The table displays all data elements along with their attributes by component and sub-component. Full data definitions are provided in the accompanying document Data Element Definitions. The tables are for presentation purposes only. ACL/AoA will continue to require electronic transmission of the annual State Performance Report (SPR) data.

Document Layout:

Section 1: Data Model

Section 2: Service Lists by Demographic Data Requirements

Section 3: Data Element Categories and Intersections

Section 4: Data Elements

Section 1: Data Model

The Data Model below is a representation of the two main components (Aging Network and Service) within the proposed revised SPR and the corresponding sub-components.

D ata Model

Section 2: Service Lists by Demographic Data Requirement

The Service Lists by Demographic Data Requirement on the following pages are representations of services for older adults, caregivers of older adults, and older relative caregivers of children and adults under age 60 with disabilities. The goal of the diagram is to display services to be reported and which require submission of aggregate demographic information. Areas of note include: (1) Legal assistance is a restricted service for which demographic information is reported in aggregate, but no PII is associated; (2) Health promotion includes two service categories – evidence based and non-evidence based; (3) Caregiver program services counseling, support groups and training are reported separately; (4) Caregiver program service respite is reported in total and by four subcategories of respite service (in-home day; out-of-home day; out-of-home overnight; and type other); and (5) Caregiver program service assistance includes two service categories - case management and information and assistance.

Service List by Demographic Data Requirement – Title III B/C/D

Services for Older Adults (Title III B/C/D)
Registered Services, Demographic Data Required	Non-Registered, No Demographic Data Required
1. Personal Care	10. Transportation
2. Homemaker	11. Nutrition Education
3. Chore	12. Information and Assistance
4. Home Delivered Nutrition	13. Health Promotion: Evidence-Based
5. Adult Day Care/Health	14. Health Promotion: Non Evidence-Based
6. Case Management
7. Assisted Transportation
8. Congregate Nutrition	Restricted Service: Aggregated, de-identified demographic Data Required
9. Nutrition Counseling	16. Legal Assistance

• Demographic data are required for services 1-9 and 16.

• Data on Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) are required for services 1-6.

• Nutrition Risk Scores are required for services 4, 8, and 9.

Service List by Demographic Data Requirement - Title III-E

Services for Caregivers of Older Adults and Older Relative Caregivers (caring for Children and Adults with Disabilities (age under 60) (Title III-E)
Demographic Data Required	No Demographic Data Required
1. Counseling	6. Support Groups
2. Training	7. Assistance: Information and Assistance
3. Respite (all types)	8. Information Services (public)
3a. In-Home Respite
3b. Out-of-Home Respite (day)
3c. Out-of-Home Respite (overnight)
3d. Other Respite
4. Supplemental services
5. Assistance: Case Management

• Aggregated unduplicated demographic data are required for services 1-5 combined. Note that respite services are broken down by type for reporting of people served, units of service and expenditures.

Section 3: Data Element Intersections

Many SPR demographic categories cross to form data elements (e.g. age and poverty status). The Data Element Intersections tables represent which data categories intersect to form data elements. The revised SPR limits those intersections thereby greatly reducing the total data elements for older adult services by 74%. The revised SPR for caregiver services reduces the total demographic data elements by 20%. Table 3.1 provides details of the data sub-categories for older adult services (Title III B, C, and D) and intersections between data elements. Table 3.2 provides details of the data sub-categories for all caregiver services (Title III-E) and intersections between data elements.

Table 3.1 Detail Data Element Intersections for Older Adults Services, Title III (B/C/D)

Consumer Characteristic: Older Adult Services (Title - B, C, and D)	Total	At or Below Poverty	ADL 3+	IADL 3+
Age
Age: <60	X	X	X	X
Age: 60 -64	X	X	X	X
Age: 65-74	X	X	X	X
Age: 75 - 84	X	X	X	X
Age: 85+	X	X	X	X
Age Missing	X	X	X	X
Gender
Female	X	X	X	X
Male	X	X	X	X
Other	X	X	X	X
Gender Missing	X	X	X	X
Geographic Distribution
Rural	X	X	X	X
Non-Rural	X	X	X	X
Geographic Distribution Missing	X	X	X	X
Poverty Status
At or Below Poverty	X		X	X
Above Poverty	X		X	X
Poverty Status Missing	X		X	X
Household Status
Lives Alone	X	X	X	X
Lives with Others	X	X	X	X
Lives in Long Term Care (LTC) Facility2	X	X	X	x
Household Status Missing	X	X	X	X
Ethnicity
Hispanic or Latino	X	X	X	X
Not Hispanic or Latino	X	X	X	X
Ethnicity Missing	X	X	X	X
Race
American Indian or Alaska Native	X	X	X	X
Asian	X	X	X	X
Black or African American	X	X	X	X
Native Hawaiian or Pacific Islander	X	X	X	X
White	X	X	X	X
Race Missing	X	X	X	X
Minority Status
Minority	X	X	X	X
Not Minority	X	X	X	X
Minority Status Missing	X	X	X	X
ADL Limitations
0-1	X	X
2	X	X
3+	X	X
ADL Limitations Missing	X	X
IADL Limitations
0-1	X	X
2	X	X
3+	X	X
IADL Limitations Missing	X	X
Nutrition Risk Score (nutrition services only)
0-5	X	X	X	X
6+	X	X	X	X
Score Missing	X	X	X	X

Table 3.2 represents the data intersection with poverty status (at or below poverty) for both populations of caregivers (caregivers of older adults and older relative caregivers caring for children and adults age 18-59 with disabilities).

Table 3.2 Detail Data Element Intersections for Caregiver Services, Title III (E)

Consumer Characteristic: Caregiver Services (Title III-E)	Total - Caregiver of Older Adults	At or Below Poverty	Total - Older Relative Caregivers	At or Below Poverty
Total	X	X	X	X
Age
Age: 18-49	X	X
Age: 50-59	X	X
Age: 55 -59			X	X
Age: 60-64	X	X	X	X
Age: 65-74	X	X	X	X
Age: 75-84	X	X	X	X
Age: 85+	X	X	X	X
Age: Missing	X	X	X	X
Gender
Female	X	X	X	X
Male	X	X	X	X
Other	X	X	X	X
Gender Missing	X	X	X	X
Geographic Distribution
Rural	X	X	X	X
Non-Rural	X	X	X	X
Geographic Distribution Missing	X	X	X	X
Poverty Status
At or Below Poverty	X		X
Above Poverty	X		X
Poverty Status Missing	X		X
Ethnicity
Hispanic or Latino	X	X	X	X
Not Hispanic or Latino	X	X	X	X
Ethnicity Missing	X	X	X	X
Race
American Indian or Alaska Native	X	X	X	X
Asian	X	X	X	X
Black or African American	X	X	X	X
Native Hawaiian or Pacific Islander	X	X	X	X
White	X	X	X	X
Race Missing	X	X	X	X
Minority Status
Minority	X	X	X	X
Not Minority	X	X	X	X
Minority Status Missing	X	X	X	X
Relationship
Husband	X	X
Wife	X	X
Domestic Partner, including civil union	X	X
Son/Son-in-Law	X	X
Daughter/Daughter-in-law	X	X
Sister	X	X
Brother	X	X
Grandparents			X	X
Parents			X	X
Other Relative	X	X	X	X
Non-Relative	X	X	X	X
Relationship Missing	X	X	X	X
Total Children Receiving Care			X
Total Adults with Disabilities Receiving Care			X

Section 4: Data Element Tables

The Data Element Tables display the data to be collected and the data attributes (e.g. data codes and values). The goal of the table is to display all data elements along with their attributes by component and sub-component. Full data definitions are provided in the accompanying document Data Element Definitions.

Each data element can be described by a series of eight metadata attributes which are listed below. If the data attribute is the same for all data elements within a component or subcomponent, it will be noted at the beginning of the component table. The attribute column will not be included as to provide additional space for other attribute descriptions.

The Data Attributes are as follows:

1. MD – Metadata

2. Data Element – Data element is a name, title, or short descriptor for a specific data element.

3. Element Description – Briefly summarizes a data element and its purpose.

4. Required – Indicates whether reporting of the data element by states is mandatory

5. Quantifier – Identifies whether there can be just one value reported for a data element, or if more than one value can be provided.

6. Services – Identifies that the data element is collected for specific services or combination of services. For example, the Nutritional Risk Scores are collected for Home Delivered Nutrition, Congregate Nutrition, and Nutrition Counseling services only. Services attribute does not apply to all sub-components.

7. Type – Indicates the data type for a given data element, e.g., whether it corresponds to a date, a coded value, or a string.

8. Codes & Values – For data elements with coded values, specifies the specific codes used and their associated values.

9. Business Rules & Notes – Details specific business rules, such as how many characters may be included in a string element, or the format of a date.

Each data element is identified by a unique combination of element number and data component abbreviation.

Element Number: The element number provides a way to refer to data elements. Element numbers are sequential within a data component/sub-component.

Data Component: Each taxonomic component or subcomponent is prefixed as follows to facilitate grouping and categorization:

NC – Network Component

• SV – Staff/Volunteers subcomponent

• SP – Service Providers subcomponent

• SF – Senior Centers/Focal Points subcomponent

• SD – Self-Directed (Title III B/E) subcomponent

• RV – Respite Vouchers (Title III-E) subcomponent

SC-Service Component

• CD – Consumer Demographics/Characteristics for Select Services (Title III B/C/D) subcomponent

• CG – Caregiver of Older Adults Demographics/Characteristics for Select Services

(Title III-E) subcomponent

• OR – Older Relative Caregivers (of Children and Adults with Disabilities) Demographics/Characteristics for Select Services (Title III-E) subcomponent

• SU – Service Units (Title III B/C/D/E) subcomponent

• EX – Expenditures (Title III B/C/D/E) subcomponent

• VII – Title VII Expenditures (Chapters 3 & 4) subcomponent

• LA – Legal Assistance (Title III B) subcomponent

• OS – Other Services (Title III B/C/D) subcomponent

• SCG – Supplemental Services (Title III-E) subcomponent for caregivers of older adults

• SOR - Supplemental Services (Title III-E) subcomponent for older relative caregivers of children and adults under age 60 with disabilities

• NS – Nutrition Services Incentive Program (NSIP) subcomponent

2. Transmission Metadata Component

States will submit elements identifying and contextualizing their reported data.

Element Number	Data Element	Element Description	Required	Quantifier	Type	Codes and Values	Business Rules/Notes
MD1	State ID	Geographical location of the data submission by State, DC and/or US Territory	Yes	Single	String	ANSI INCITS 38:2009 standard 2-letter state codes
MD2	Reporting Period	Federal Fiscal Year 10/01/20XX-09/30/20XX	Yes	Single	Date	Date range for Federal Fiscal Year of the report MM/DD/YYY - MM/DD/YYY
MD3	Dataset ID	Unique identifier for the data included in a data transmission	Yes	Single	String	N/A (not a coded element)	• Must include component or subcomponent identification

3. Network Component

The Network component includes data regarding the state network.

Element Number	Data Element	Element Description	Required	Quantifier	Type	Codes and Values	Business Rules/Notes
NC1	Single PSA	State is a single Planning and Service Area.	Yes	Single	Boolean	01=Yes 02=No
NC2	Other Federal Funds	Indication of other federal funds used for OAA services. (multiple selection)	Yes	Multiple	Boolean (multiple select)	01=Medicaid 02=Medicaid Waiver 03=SSBG 04=CSBG 05=USDA 06=DOT 98=Other 99=None	• If 99=None is selected; other codes are not available.
NC3	Other Federal Funds Comments	Comments on Other Federal Funds, if appropriate.	No	Single	String	N/A (not a coded element)	• Maximum length of 700 characters with spaces.

1. Network Staff and Volunteers Subcomponent

The Network subcomponent includes data regarding staffing and volunteers and the state and Area Agency on Aging level of the network.

• All data elements are single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Required	Business Rules/Notes
SV1	SUA Staff (paid)-Full-time	Number of paid full-time (average 35+ hours a week) at SUA as of September 30 of reporting year. Ombudsman staff are not included in count.	Yes
SV2	SUA Staff (paid)-Part-time	Number of paid part-time (average less than 35 hours a week) at SUA as of September 30 of reporting year. Ombudsman staff are not included in count.	Yes
SV3	AAA Staff (paid)-Full-time	Number of paid full-time (average 35+ hours a week) at AAA as of September 30 of reporting year. Ombudsman staff are not included in count.	Yes (conditional)	• Not required if single PSA
SV4	AAA Staff (paid)-Part-time	Number of paid part-time (average less than 35 hours a week) at AAA as of September 30 of reporting year. Ombudsman staff are not included in count.	Yes (conditional)	• Not required if single PSA
SV5	SCSEP Beneficiaries Hired	Number of staff working within the Aging Network (SUA, AAA…) from the OAA Title V SCSEP (Senior Community Service Employment Program). SCSEP staff are not staff managing or overseeing the SCSEP program but SCSEP beneficiaries hired by the SUA or AAA. If those individuals are full time paid staff they would be captured within SV1 and if part time SV2.	Yes
SV6	AAA Volunteers – Persons	Number of volunteers (unduplicated) at all AAAs.	Yes
SV7	AAA Volunteers - Total hours	Number of volunteer hours provided to all AAAs. Rounded to nearest integer.	Yes

2. Network Service Providers Subcomponent

The Network subcomponent includes data regarding local service providers in the state network.

• All data elements are required and single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Business Rules/Notes
SP1	Providers (all services)	Total number of service providers for any and all Title III services (Parts B/C/D/E) (unduplicated).
SP2	Providers (Title III-B/C/D only)	Total number of service providers for Title III-B/C/D services only (unduplicated).	• Value cannot be larger than Providers (all services) - element # SP1
SP3	Providers (Title III-E only)	Total number of service providers for Title III-E only (unduplicated).	• Value cannot be larger than Providers (all services) - element # SP1
SP4	Providers (Home Delivered Meals)	Total number of service providers for only Home Delivered Nutrition (unduplicated). This does not include providers of nutrition education or counseling	• Value cannot be larger than Providers (all services) - element # SP1
SP5	Providers (Congregate Meals)	Total number of service providers for only Congregate Nutrition (unduplicated). This does not include providers of nutrition education or counseling	• Value cannot be larger than Providers (all services) - element # SP1
SP6	Providers (Home-Delivered and Congregate Meals)	Total number of service providers for both Home-Delivered and Congregate Nutrition (unduplicated). This does not include providers of nutrition education or counseling	• Value cannot be larger than Providers (all services) - element # SP1
SP7	Providers (Information and Assistance)	Total number of service providers for Information and Assistance (unduplicated).	• Value cannot be larger than Providers (all services) - element # SP1

3. Network Senior Centers and Focal Points Subcomponent

The Network subcomponent includes data regarding senior centers and focal points in the state network.

• All data elements are required and single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Business Rules/Notes
SF1	Senior Centers	Total Number of Senior Centers in the State regardless of funding.
SF2	Senior Centers- OAA Funds	Total Number of Senior Centers in the State that received OAA Funds.	• Value must be equal to or smaller than element #SF1.
SF3	Total Number of Focal Points	Total number of focal points designated Under Section 306(a)(3) of the Act in Operation in the Past Year.
SF4	Total Number of Focal Points that are Senior Centers	Total number of focal points designated Under Section 306(a)(3) of the Act in Operation in the Past Year that are Senior Centers.	• Value must be equal to or smaller than element #SF3.

4. Self-Direction (Title III B/E) Subcomponent

The Network subcomponent includes data regarding the number of older adult consumers and caregivers that used the Self-Directed approach for services delivery. Self-Direction is an approach to service delivery. Actual service information will be collected within the appropriate service area.

• All data elements are required and single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Type	Business Rules/Notes
SD1	Persons Served - Older Adult	Total Unduplicated Count of Older Adults who use self-direction to obtain services funded in whole or part by Title III B of the OAA.	Numeric (integer)	• Value must be equal to or less than element #SC1: Older Adults served Title III B/C/D
SD2	Title III Expenditure - Older Adults	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide Title III B services through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD3	Other - State Expenditure - Older Adults	Outlays/payments made by the SUA and/or AAA’s using state funds to provide Title III B services through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD4	Other - Non-State Expenditure - Older Adults	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide Title III B services through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD5	Program Income Expended - Older Adults	Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period.	Numeric dollar amount (2 decimal)
SD6	Persons Served - Caregivers Older Adult	Total Unduplicated Count of Caregivers of Older Adults who use self-direction to obtain services funded in whole or part by Title III-E of the OAA	Numeric (integer)	• Value must be equal to or less than element #SC4: Caregivers of Older Adults (Title III-E registered services)
SD7	Title III Expenditure - Caregivers Older Adult	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide Title III-E services for Caregivers of Older Adults through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD8	Other - State Expenditure -Caregivers Older Adult	Outlays/payments made by the SUA and/or AAA’s using state funds to provide Title III-E services for Caregivers of Older Adults through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD9	Other - Non-State Expenditure - Caregivers Older Adult	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide Title III-E services for Caregivers of Older Adults through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD10	Program Income Expended -Caregivers Older Adult	Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period.	Numeric dollar amount (2 decimal)
SD11	Persons Served - Older Relative Caregivers	Total Unduplicated Count of Older Relative Caregivers (caring for children and adults under age 60 with disabilities) who use self-direction to obtain services funded in whole or part by Title III-E of the OAA.	Numeric (integer)	• Value must be equal to or less than element #SC7: Older Relative Caregivers (Title III-E registered services)
SD12	Title III Expenditure - Older Relative Caregivers	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide Title III-E services for Caregivers of Children and Disabled Adults through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD13	Other - State Expenditure - Older Relative Caregivers	Outlays/payments made by the SUA and/or AAA’s using state funds to provide Title III-E services for Older Relative Caregivers through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD14	Other - Non-State Expenditure - Older Relative Caregivers	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide Title III-E services for Caregivers of Children and Disabled Adults through Self-Directed Care.	Numeric dollar amount (2 decimal)
SD15	Program Income Expended - Older Relative Caregivers	Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period.	Numeric dollar amount (2 decimal)

5. Respite Voucher (Title III-E) Subcomponent

The Network subcomponent includes data regarding caregivers that used Respite Vouchers to receive respite services. The use of vouchers is an approach to service delivery. Actual respite service information will be collected within the appropriate respite service area.

• All data elements are required and single quantifier.

Element Number	Data Element	Element Description	Type	Business Rules/Notes
RV1	Persons Served -Caregivers Older Adult	Total Unduplicated Count of Caregivers of Older Adults who use vouchers to obtain respite services funded in whole or in part by Title III-E of the OAA.	Numeric (integer)	• Value must be less than or equal to element #CG1 (total persons served respite).
RV2	Title III Expenditure - Caregivers Older Adult	Were outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide respite services for Caregivers of Older Adults through vouchers?	Check box (Yes/No)
RV3	Other - State Expenditure - Caregivers Older Adult	Were outlays/payments made by the SUA and/or AAA’s using state funds (e.g., general revenue, Medicaid) to provide respite services for Caregivers of Older Adults through vouchers?	Check box (Yes/No)
RV4	Other - Non-State Expenditure - Caregivers Older Adult	Were outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide respite services for Caregivers of Older Adults through vouchers?	Check box (Yes/No)
RV5	Program Income Expended - Caregivers Older Adult	Was any gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period?	Check box (Yes/No)
RV6	Persons Served - Older Relative Caregivers	Total Unduplicated Count of Older Relative Caregivers who use vouchers to obtain respite services funded in whole or in part by Title III-E of the OAA.	Numeric (integer)	• Value must be equal to or less than element # OR1 (persons served respite).
RV7	Title III Expenditure - Older Relative Caregivers	Were outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide respite services for Older Relative Caregivers through vouchers?	Check box (Yes/No)
RV8	Other - State Expenditure - Older Relative Caregivers	Were outlays/payments made by the SUA and/or AAA’s using state funds to provide respite services for Older Relative Caregivers through vouchers?	Check box (Yes/No)
RV9	Other - Non-State Expenditure - Older Relative Caregivers	Were outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide respite services for Older Relative Caregivers through vouchers?	Check box (Yes/No)
RV10	Program Income expended - Older Relative Caregivers	Was any gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period?	Check box (Yes/No)

4. Service Component

The Service component includes data regarding unduplicated consumers across all services.

• All data elements are required and single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Business Rules/Notes
SC1	Older Adult Consumers Served for registered cluster 1 and 2 services supported by the OAA Title III B/C/D	Unduplicated Count of Consumers Served For Registered Services Supported by the OAA Title III B/C/D. Excluding Legal Assistance.	• Number does not include caregivers served
SC2	Unduplicated count of consumers served for registered cluster 1 services supported by the OAA Title III B/C/D	Unduplicated Count of Consumers Served For Registered Services Supported by the OAA Title III B/C/D. Excluding Legal Assistance.	Number does not include caregivers served
SC3	Older Adult Consumers Served Unregistered supported by the OAA Title III B/C/D	Estimated Unduplicated Count of Consumers Served For Unregistered Services Supported by the OAA Title III B/C/D.	• Number does not include caregivers served
SC4	Total Older Adult Consumers Served	Total Estimated Unduplicated Count of Consumers Served Through Services Supported by OAA Title III B/C/D	• Number does not include caregivers served
SC5	Caregivers of Older Adults Served Registered	Unduplicated Count of Caregivers of Older Adults Served For Registered Services Supported by the OAA Title III-E
SC6	Caregivers Older Adults Served Unregistered	Estimated Unduplicated Count of Caregivers of Older Adults Served For Unregistered Services Supported by the OAA Title III-E
SC7	Total Caregivers of Older Adults Served	Total Estimated Unduplicated Count of Caregivers of Older Adults Served Through Services Supported by OAA Title III-E
SC8	Older Relative Caregivers Served Registered	Unduplicated Count of Older Relative Caregivers Served For Registered Services Supported by the OAA Title III-E
SC9	Older Relative Caregivers Served Unregistered	Estimated Unduplicated Count of Older Relative Caregivers Served For Unregistered Services Supported by the OAA Title III-E
SC10	Total Older Relative Caregivers Served	Total Estimated Unduplicated Count of Older Relative Caregivers Served Through Services Supported by OAA Title III-E

1. Consumer Demographics/Characteristics for Select Services (Title III B/C/D) Subcomponent

The Service subcomponent includes data regarding specific demographics and characteristics of older adult consumers. Data elements are submitted for each service and combination of services identified in the “services” column.

• All data elements are single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Required	Services
CD1	Total Consumers - Total	Total Count of Consumers that received a specific service.	Yes	• Registered services w/ ADLs and IADLs - unduplicated (note: data element SC1 captures total registered consumers) • Each Registered service separately • Restricted service: Legal Assistance • Nutrition Education (non-registered service; estimated audience size) • Health Promotion – Evidence Based • Health Promotion – Non-Evidence Based • Other services – unduplicated count (note details are reported in the subcomponent – “other services”)
CD2	Age - Total • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Total Count of Consumers by age group that received service.	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD3	Gender Identity - Total • Female • Male • Other • Gender Missing	Total Count of Consumers by gender identity that received service.	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD4	Geographic Distribution - Total • Rural • Non-rural • Geographic Distribution Missing	Total Count of Consumers by geographic distribution (e.g. rural, non-rural) that received service.	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD5	Poverty Status - Total • At or Below Poverty • Above Poverty • Poverty Status Missing	Total Count of Consumers by poverty status that received service.	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD6	Household Status - Total • Lives Alone • Lives with Others Lives in Long Term Care (LTC) Facility • Household Status Missing	Total Count of Consumers by household status that received service.	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD7	Ethnicity - Total • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Total Count of Consumers by ethnicity that received service.	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD8	Race - Total • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Total Count of Consumers by race that received service. Race is duplicated person count -- NOT unduplicated. Multi-racial Consumers are counted for each racial identity.	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD9	Minority Status - Total • Minority • Not Minority • Minority Status Missing	Total Count of Consumers by minority status that received service. Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. (CDC)	Yes	• All registered services – unduplicated • Registered services w/ ADLs and IADLs - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD10	ADL Score - Total • 0-1 • 2 • 3+ • ADL Missing	Total Count of Consumers by ADL score that received service.	Yes	• Registered services with ADL/IADL - unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt)
CD11	IADL Score - Total • 0-1 • 2 • 3+ • IADL Missing	Total Count of Consumers by IADL score that received service.	Yes	• Registered services with ADL/IADL - unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt)
CD12	Nutrition Risk Score - Total • 0-5 • 6+ • Score Missing	Total Count of Consumers by Nutrition Risk Score that received service.	Yes	• Registered services with Nutrition Risk Score - unduplicated Each registered service separately that requires Risk Score (Home-delivered nutrition, congregate nutrition, nutrition counseling)
CD13	Age - At or Below Poverty • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Count of Consumers at or below poverty by age group that received service.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD14	Gender Identity - At or Below Poverty • Female • Male • Other • Gender Missing	Total Count of Consumers by gender identity that received service.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD15	Geographic Distribution - At or Below Poverty • Rural • Non-rural • Geographic Distribution Missing	Count of Consumers at or below poverty by geographic distribution that received service.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD16	Household Status - At or Below Poverty • Lives Alone • Lives with Others Lives in Long Term Care (LTC) Facility • Household Status Missing	Count of Consumers at or below poverty by household status that received service.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD17	Ethnicity - At or Below Poverty • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Count of Consumers at or below poverty by ethnicity that received service.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD18	Race - At or Below Poverty • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Count of Consumers at or below poverty by race that received service. Race is duplicated person count -- NOT unduplicated. Multi-racial Consumers are counted in each race indicated.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately Restricted service: Legal Assistance
CD19	Minority Status - At or Below Poverty • Minority • Not Minority • Minority Status Missing	Count of Consumers at or below poverty by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately • Restricted service: Legal Assistance
CD20	ADL Score - At or Below Poverty • 0-1 • 2 • 3+ • ADL Missing	Count of Consumers at or below poverty by ADL score that received service.	Yes	• Registered services with ADL/IADL - unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt)
CD21	IADL Score - At or Below Poverty • 0-1 • 2 • 3+ • IADL Missing	Count of minority Consumers by poverty status that received service.	Yes	• Registered services with ADL/IADL - unduplicated Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt)
CD22	Nutrition Risk Score - At or Below Poverty • 0-5 • 6+ • Score Missing	Count of Consumers at or below poverty by Nutrition Risk Score that received service.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately that requires Risk Score (Home-delivered nutrition, congregate nutrition, nutrition counseling)
CD23	Age - ADL 3+ • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Count of Consumers ADL score of 3 and above by age group that received service.	Yes	• Registered services with ADL/IADL - unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD24	Gender Identity -ADL 3+ • Female • Male • Other • Gender Missing	Total Count of Consumers with ADL score 3 and above by gender identity that received service.	Yes	• All registered services - unduplicated • Registered services with ADL/IADL - unduplicated • Each registered service separately • Excluding Legal Assistance
CD25	Geographic Distribution - ADL 3+ • Rural • Non-rural • Geographic Status Missing	Count of Consumers ADL score of 3 and above by geographic distribution that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD26	Poverty Status - ADL 3+ • At or Below Poverty • Above Poverty • Poverty Status Missing	Count of Consumers ADL score of 3 and above by poverty status that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD27	Household Status - ADL 3+ • Lives Alone • Lives with Others • Household Status Missing	Count of Consumers ADL score of 3 and above by household status that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD28	Ethnicity - ADL 3+ • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Count of Consumers ADL score of 3 and above by ethnicity that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD29	Race - ADL 3+ • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Count of Consumers ADL score of 3 and above by race that received service. Race is duplicated person count -- NOT unduplicated. Multi-racial Consumers are counted in each race indicated.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD30	Minority Status - ADL 3+ • Minority • Not Minority • Minority Status Missing	Count of Consumers ADL score of 3 and above by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD31	Nutrition Risk Score - ADL 3+ • 0-5 • 6+ • Score Missing	Count of Consumers ADL score of 3 and above by Nutrition Risk Score that received service.	Yes	• Home Delivered Meals
CD32	Age - IADL 3+ • <60 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Count of Consumers IADL score of 3 and above by age group that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD33	Gender Identity - IADL 3+ • Female • Male • Other • Gender Missing	Total Count of Consumers with IADL score 3 and above by gender identity that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD34	Geographic Distribution - IADL 3+ • Rural • Non-rural • Geographic Distribution Missing	Count of Consumers IADL score of 3 and above by geographic distribution that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD35	Poverty Status - IADL 3+ • At or Below Poverty • Above Poverty • Poverty Status Missing	Count of Consumers IADL score of 3 and above by poverty status that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt Excluding Legal Assistance)
CD36	Household Status- IADL 3+ • Lives Alone • Lives with Others • Household Status Missing	Count of Consumers IADL score of 3 and above by household status that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD37	Ethnicity - IADL 3+ • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Count of Consumers IADL score of 3 and above by ethnicity that received service.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD38	Race - IADL 3+ • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Count of Consumers IADL score of 3 and above by race that received service. Race is duplicated person count -- NOT unduplicated. Multi-racial Consumers are counted in each race indicated.	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD39	Minority Status - IADL 3+ • Minority • Not Minority • Minority Status Missing	Count of Consumers IADL score of 3 and above by minority status that received service. Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native. (CDC)	Yes	• Registered services with ADL/IADL – unduplicated • Each registered service separately for which this is required (Personal Care, Homemaker, Chore, Home-delivered Nutrition, Adult Day Care, Case Mgmt) Excluding Legal Assistance
CD40	Nutrition Risk Score - IADL 3+ • 0-5 • 6+ • Score Missing	Count of Consumers IADL score of 3 and above by Nutrition Risk Score that received service.	Yes	• Home Delivered Meals

2. Caregiver of Older Adults for Select Services (Title III-E) Subcomponent

The Service subcomponent includes data regarding specific demographics and characteristics of caregivers of older adults.

• All data elements are single quantifier. Note some variables are not required for the first 3-years of data collection

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Required	Services
CG1	Total Caregiver of Older Adults - Total	Total Count of Caregivers of Older Adults that received service.	Yes	• Each registered service separately (including supplemental services and respite - see below) • Unduplicated for Total Respite • Unduplicated count by respite service type: (in-home, out of home day, out of home overnight, and Other Respite). • Assistance – Information & Assistance (non-registered service; estimated unduplicated) • Information Services (non-registered service; estimated audience size) (Note: Registered services – unduplicated is not included as SC4 captures this data)
CG2	Age - Total • 18-49 • 50-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Total Count of Caregivers of Older Adults by age that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG3	Gender Identity - Total • Female • Male • Other • Gender Missing	Total Count of Caregivers of Older Adults by gender identity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG4	Geographic Distribution - Total • Rural • Non-rural • Geographic Distribution Missing	Total Count of Caregivers of Older Adults by geographic distribution that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG5	Poverty Status - Total • At or Below Poverty • Above Poverty • Poverty Status Missing	Total Caregivers of Older Adults by poverty status that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG6	Ethnicity - Total • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Total Caregivers of Older Adults by ethnicity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG7	Race - Total • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Total Caregivers of Older Adults by race that received service. Race is duplicated caregiver count -- NOT unduplicated. Multi-racial caregivers are counted in each race indicated.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG8	Minority Status - Total • Minority • Not Minority • Minority Status Missing	Total Caregivers of Older Adults by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG9	Relationship • Husband • Wife • Domestic partner, including civil union • Son/Son-in-Law • Daughter/Daughter-in-Law • Sister • Brother • Other Relative • Non-Relative • Relationship Missing	Total Caregivers of Older Adults by relationship that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG10	Age - At or Below Poverty • 18-49 • 50-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Count of Caregivers of Older Adults at or below poverty by age group that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG11	Gender Identity - At or Below Poverty • Female • Male • Other • Gender Missing	Count of Caregivers of Older Adults at or below poverty by gender identity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG12	Geographic Distribution - At or Below Poverty • Rural • Non-rural • Geographic Distribution Missing	Count of Caregivers of Older Adults at or below poverty by geographic distribution that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG13	Ethnicity - At or Below Poverty • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Count of Caregivers of Older Adults at or below poverty by ethnicity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG14	Race - At or Below Poverty • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Count of Caregivers of Older Adults at or below poverty by race that received service. Race is duplicated caregiver count -- NOT unduplicated. Multi-racial caregivers are counted in each race indicated.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG15	Minority Status - At or Below Poverty • Minority • Not Minority • Minority Status Missing	Count of Caregivers of Older Adults at or below poverty by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
CG16	Relationship - At or Below Poverty • Husband • Wife • Domestic partner, including civil union • Son/Son-in-Law • Daughter/ Daughter-in-Law • Sister • Brother • Other Relative • Non-Relative • Relationship Missing	Count of Caregivers of Older Adults at or below poverty by relationship that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)

3. Older Relative Caregivers of Children and Adults with Disabilities for Select Services (Title III-E) Subcomponent

The Service subcomponent includes data regarding specific demographics and characteristics of older relative caregivers (caring for children or adults under age 60 with disabilities).

• All data elements are single quantifier. Note some variables are not required for the first 3-years of data collection

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Required	Services
OR1	Total Older Relative Caregivers - Total	Total Count of Older Relative Caregivers that received service.	Yes	• Registered services - unduplicated • Each registered service separately (including supplemental services and respite - see below) • Unduplicated for Total Respite • Unduplicated count by respite service type: (in-home, out of home day, out of home overnight, and other respite). • Assistance – Information & Assistance (non-registered service; estimated unduplicated) • Information Services (non-registered service; estimated audience size)
OR2	Age - Total • 55-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Total Count of Older Relative Caregivers by age that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR3	Gender Identity -Total • Female • Male • Other • Gender Missing	Count of Older Relative Caregivers at or below poverty by gender identity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR4	Geographic Distribution Status - Total • Rural • Non-rural • Geographic Distribution Missing	Total Count of Older Relative Caregivers by geographic distribution that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR5	Poverty Status - Total • At or Below Poverty • Above Poverty • Poverty Status Missing	Total Older Relative Caregivers by poverty status that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR6	Ethnicity - Total • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Total Older Relative Caregivers by ethnicity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR7	Race - Total • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Total Older Relative Caregivers by race that received service. Race is duplicated caregiver count -- NOT unduplicated. Multi-racial caregivers are counted in each race indicated.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR8	Minority Status - Total • Minority • Not Minority • Minority Status Missing	Total Older Relative Caregivers by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR9	Relationship - Total • Grandparents • Parents • Other Older Relative • Older Non-Relative • Relationship Missing	Total Older Relative Caregivers by relationship that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR10	Age - At or Below Poverty • 55-59 • 60-64 • 65-74 • 75-84 • 85+ • Age Missing	Count of Older Relative Caregivers at or below poverty by age group that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR11	Gender Identity -At or Below Poverty • Female • Male • Other • Gender Missing	Count of Older Relative Caregivers at or below poverty by gender identity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR12	Geographic Distribution - At or Below Poverty • Rural • Non-rural • Geographic Distribution Missing	Count of Older Relative Caregivers at or below poverty by geographic distribution that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR13	Ethnicity - At or Below Poverty • Hispanic or Latino • Not Hispanic or Latino • Ethnicity Missing	Count of Older Relative Caregivers at or below poverty by ethnicity that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR14	Race - At or Below Poverty • American Indian or Alaska Native • Asian or Asian American • Black or African American • Native Hawaiian or Pacific Islander • White • Race Missing	Count of Older Relative Caregivers at or below poverty by race that received service. Race is duplicated caregiver count -- NOT unduplicated. Multi-racial caregivers are counted in each race indicated.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR15	Minority Status - At or Below Poverty • Minority • Not Minority • Minority Status Missing	Count of Older Relative Caregivers at or below poverty by minority status that received service. CDC Source: Racial and ethnic minority populations are defined as: Asian American, Black or African American, Hispanic or Latino, Native Hawaiian and Pacific Islander, American Indian and Alaska Native.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR16	Relationship - At or Below Poverty • Grandparents • Parents • Other Older Relative • Older Non-Relative • Relationship Missing	Count of at Older Relative Caregivers at or below poverty by relationship that received service.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR17	Total Children Receiving Care	Count of children under the age of 18 receiving care.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)
OR18	Total Adults with Disabilities Receiving Care	Count of adults age 18-59 with disabilities receiving care.	Yes	• Registered services – unduplicated (i.e. counseling, training, total respite, access assistance – case management, supplemental services)

4. Service Units (Title III B/C/D/E) Subcomponent

The Service subcomponent includes the number of service units provided for each service.

• All data elements are required and single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Services
SU1	Service Units	Total service units provided for an allowable service. See Service Definitions and Attributes for unit type for each service.	Every Title III B/C/D/E service separately, except: Health Promotions-Evidence Based, Health Promotions-Non-Evidence Based, Other Services, Supplemental Services Note that Title III-E Respite Services are reported in total and by 3 types of respite plus "other". The types are in-home respite, out-of-home respite (day), out-of-home (overnight). Other services and supplemental services are reported in detail under their respective subcomponents. Note that all caregiver services are reported twice: once for caregivers of older adults and a second time for older relative caregivers.

5. Expenditures (Title III B/C/D/E) Subcomponent

The Service subcomponent includes data regarding service expenditures (federal and non-federal) for all OAA Title III services.

• All data elements are required and single quantifier.

• All data elements are numeric dollar amount (2 decimal) and not a coded element.

Element Number	Data Element	Element Description	Services
EX1	Title III Expenditure	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide an allowable service.	• Every Title III B/C/D/E service separately • Note that Respite services are reported in total and by type of service (in-home respite, out-of-home day respite, out-of-home overnight, and other respite) • Note that the caregiver services are repeated - once for caregivers of older adults and once for older relative caregivers.
EX2	Part B Expenditure	Part B portion of total outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide an allowable service.	• Health Promotion: Evidence-Based Services
EX3	Part D Expenditure	Part D portion of total outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide an allowable service.	• Health Promotion: Evidence-Based Services
EX4	Other - State Expenditure	Outlays/payments made by the SUA and/or AAA’s using state funds to provide an allowable service.	• Every Title III B/C/D/E service separately Note that Title III-E Respite Services are report in total and by 3 types of respite plus "other". The types are in-home respite, out-of-home respite (day), out-of-home (overnight). • Note that the caregiver services are repeated - once for caregivers of older adults and once for older relative caregivers.
EX5	Other - Non-State Expenditure	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide an allowable service. Could include local and other federal funds, e.g. Medicaid Waiver.	• Every Title III B/C/D/E service separately Note that Title III-E Respite Services are report in total and by 3 types of respite plus "other". The types are in-home respite, out-of-home respite (day), out-of-home (overnight). • Note that the caregiver services are repeated - once for caregivers of older adults and once for older relative caregivers.
EX6	NSIP Expenditure	Total outlays/payments made by the SUA and/or AAA’s using Title III-A funding for meals.	• Home Delivered Meals • Congregate Meals
EX7	Program Income Expended	Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period.	• Every Title III B/C/D/E service separately Note that Title III-E Respite Services are report in total and by 3 types of respite plus "other". The types are in-home respite, out-of-home respite (day), out-of-home (overnight). • Note that the caregiver services are repeated - once for caregivers of older adults and once for older relative caregivers.

6. Title VII Expenditures (Chapters 3 & 4) Subcomponent

The Service subcomponent includes data regarding expenditures (federal and non-federal) on Title VII Chapter 3 – Elder Abuse Prevention and Chapter 4 – Legal Assistance Development.

• All data elements are single quantifier.

• All data elements are numeric dollar amount (2 decimal) and not a coded element.

Element Number	Data Element	Element Description	Required	Business Rules/Notes
VII1	Title VII-3 Expenditure	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds for Elder Abuse Prevention (Title VII Chapter 3).	Yes
VII2	Title VII Ch 3 Funds expended by SUA	Total funds retain and expended by the SUA for Elder Abuse Prevention (Title VII Chapter 3)	Yes
VII3	Title VII Ch 3 funds expended by AAA	Total funds distributed to and expended by AAAs for Elder Abuse Prevention (Title VII Chapter 3)	Yes (conditional)	• Does not apply to Single PSA states
VII4	Title VII Ch 3 funds expended by APS	Total funds distributed to and expended by APS for Elder Abuse Prevention (Title VII Chapter 3)	Yes
VII5	Title VII Ch 3 funds expended by other Entities	Total funds distributed to and expended by Other Entities for Elder Abuse Prevention (Title VII Chapter 3)	Yes
VII6	Title VII-3 Other - State Expenditure	Outlays/payments made by the SUA and/or AAA’s using state funds to provide for Elder Abuse Prevention (Title VII Chapter 3).	Yes
VII7	Title VII-3 Other - Non-State Expenditure	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to for Elder Abuse Prevention (Title VII Chapter 3).	Yes
VII8	Title VII-4 Total Expenditure	Total outlays/payments made by the SUA and/or AAA’s for Legal Assistance Development (Title VII Chapter 4), regardless of funding source.	Yes

7. Legal Assistance (Title III B) Subcomponent

The Service subcomponent includes data regarding the state’s provision of legal assistance services by level of service and case type.

• All data elements are a single quantifier.

• All data elements are numeric (integer) and not a coded element.

Element Number	Data Element	Element Description	Required	Business Rules/Notes
LA1	Total Number of Open Cases	Total Number of cases that were open at any time during the reporting period. A consumer may have multiple open cases.	Yes
LA2	Total Number of Closed Cases	Total Number of cases that were closed during the reporting period. A consumer may have multiple closed cases.	Yes
LA3	Number of Closed Cases – Advice	Total Number of closed cases by level of service equal to advice.	Yes
LA4	Number of Closed Cases – Limited Representation	Total Number of closed cases by level of service equal to limited representation	Yes
LA5	Number of Closed Cases - Representation	Total Number of closed cases by level of service equal to representation	Yes
LA6	Number case - Income	Total Number of cases that were closed during the reporting period with type of Income.	Yes
LA7	Number case – Health Care	Total Number of cases that were closed during the reporting period with type of Health Care.	Yes
LA8	Number case - Long-term Care	Total Number of cases that were closed during the reporting period with type of Long-term Care.	Yes
LA9	Number case-Nutrition	Total Number of cases that were closed during the reporting period with type of Nutrition.	Yes
LA10	Number case - Housing	Total Number of cases that were closed during the reporting period with type of Housing.	Yes
LA11	Number case-Utilities	Total Number of cases that were closed during the reporting period with type of Utilities.	Yes
LA12	Number case-Abuse/Neglect	Total Number of cases that were closed during the reporting period with type of Abuse/Neglect.	Yes
LA13	Number case - Defense of Guardianship or Protective Services	Total Number of cases that were closed during the reporting period with type of Defense of Guardianship or protective services.	Yes
LA14	Number case – Age Discrimination	Total Number of cases that were closed during the reporting period with type of age discrimination.	Yes
LA15	Number case – Other/Miscellaneous	Total Number of cases that were closed during the reporting period with type that is not represented in the previously defined types.	Yes

8. Other Services (Title III-B) Subcomponent

The Service subcomponent includes data regarding state’s provision of a service for older adults using OAA funds (Title III-B) that are not included the defined service categories.

• All data elements are required and single quantifier.

• All data elements are repeated for each unique service provided by the state.

Element Number	Data Element	Element Description	Type	Codes and Values
OS1	Service Name	Name of a service provided using OAA funds, in whole or in part, that do not fall into the defined service categories for Title III B/C/D.	Alphanumeric String (30 characters)
OS2	Service Unit Name	Service Unit type. e.g. Activity, hours, session	Alphanumeric String (15 characters)
OS3	Service Domain	Category of service provided.	Numeric Code	01=Assistive Technology/ Durable Equipment/ Emergency Response 02=Consumable supplies 03=Home Modifications/ Repairs 04=Elder abuse prevention/ Elder Rights 05=Health 06=Outreach 07=Public Education 08= Socialization 09=Access not reported elsewhere 10=Other
OS4	Estimated Persons Served	Total Estimated Unduplicated Person served	Numeric (integer)
OS5	Estimated Service Unit	Total estimated service units provided.	Numeric (integer)
OS6	Title III Expenditure	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide the service.	Numeric dollar amount (2 decimal)
OS7	Other - State Expenditure	Outlays/payments made by the SUA and/or AAA’s using state funds to provide the service.	Numeric dollar amount (2 decimal)
OS8	Other - Non-State Expenditure	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide the service.	Numeric dollar amount (2 decimal)
OS9	Program Income Expended	Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period.	Numeric dollar amount (2 decimal)

9. Supplemental Services (Title III-E) for Caregivers of Older Adults Subcomponent

The Service subcomponent includes data regarding State’s provision of a supplemental service for caregivers of older adults using OAA funds (Title III-E). Supplemental services are services not included in the defined service categories which are provided on a limited basis, to complement the care provided by caregivers.

• All data elements are required and single quantifier.

Element Number	Data Element	Element Description	Type	Codes and Values
SCG1	Service Name	Name of a service provided using OAA funds, in whole or in part, that do not fall into the defined service categories for Title III-E	Alphanumeric String (30 characters)
SCG2	Service Unit Name	Service Unit type. e.g. Activity, hours, session	Alphanumeric String (15 characters)
SCG3	Service Domain	Category of service provided.	Numeric Code	01=Assistive Technology/ Durable Equipment/ Emergency Response 02=Consumable supplies 03=Home Modifications/ Repairs 04=Legal and/or Financial Consultation 05=Homemaker/chore/personal care 06=Transportation 07 = Nutrition services 08=Other
SCG4	Estimated Persons Served	Total Estimated Unduplicated Person served	Numeric (integer)
SCG5	Estimated Service Unit	Total estimated service units provided.	Numeric (integer)
SCG6	Title III Expenditure	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds, in whole or in part, to provide the service.	Numeric dollar amount (2 decimal)
SCG7	Other - State Expenditure	Outlays/payments made by the SUA and/or AAA’s using state funds to provide the service.	Numeric dollar amount (2 decimal)
SCG8	Other - Non-State Expenditure	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide the service.	Numeric dollar amount (2 decimal)
SCG9	Program Income Expended	Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period.	Numeric dollar amount (2 decimal)

10. Supplemental Services (Title III-E) for Older Relative Caregivers of Children and Adults under age 60 with Disabilities Subcomponent

The Service subcomponent includes data regarding State’s provision of a supplemental service for older relative caregivers of children and adults under age 60 with disabilities using OAA funds (Title III-E). Supplemental services are services not included in the defined service categories which are provided on a limited basis, to complement the care provided by caregivers.

• All data elements are required and single quantifier.

Element Number	Data Element	Element Description	Type	Codes and Values
SOR1	Service Name	Name of a service provided using OAA funds, in whole or in part, that do not fall into the defined service categories for Title III-E	Alphanumeric String (30 characters)
SOR2	Service Unit Name	Service Unit type. e.g. Activity, hours, session	Alphanumeric String (15 characters)
SOR3	Service Domain	Category of service provided.	Numeric Code	01=Assistive Technology/ Durable Equipment/ Emergency Response 02=Consumable supplies 03=Home Modifications/ Repairs 04=Legal and/or Financial Consultation 05=Homemaker/chore/personal care 06=Transportation 07 = Nutrition services 08=Other
SOR4	Estimated Persons Served	Total Estimated Unduplicated Person served	Numeric (integer)
SOR5	Estimated Service Unit	Total estimated service units provided.	Numeric (integer)
SOR6	Title III Expenditure	Total outlays/payments made by the SUA and/or AAA’s using OAA federal funds, in whole or in part, to provide the service.	Numeric dollar amount (2 decimal)
SOR7	Other - State Expenditure	Outlays/payments made by the SUA and/or AAA’s using state funds to provide the service.	Numeric dollar amount (2 decimal)
SOR8	Other - Non-State Expenditure	Outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide the service.	Numeric dollar amount (2 decimal)
SOR9	Program Income Expended	Gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period.	Numeric dollar amount (2 decimal)

11. Nutrition Services Incentive Program (NSIP) Subcomponent

The Service subcomponent includes data regarding the number of meals served by states that were Nutrition Services Incentive Program (NSIP) compliant (meet all criteria for a meal to be supported with Title III-C funding). These data are used to calculate the Title III-A NSIP grant award allocation to states and tribal grantees.

• All data elements are required and single quantifier.

• All data elements are numeric (integer) type and not a coded element.

Element Number	Data Element3	Element Description	Business Rules/Notes
NS1	NISP qualified home-delivered meals served under Title III-C	Number of meals provided with in programs (home-delivered nutrition and Title III-E supplemental services) that were NSIP compliant under Title III-C	Note that these data will have a separate workflow. These data will be reviewed and locked, separate from the other SPR data.
NS2	NISP qualified home-delivered meals served under Title III-E	Number of meals provided with in programs (home-delivered nutrition and Title III-E supplemental services) that were NSIP compliant under Title III-E	Note that these data will have a separate workflow. These data will be reviewed and locked, separate from the other SPR data.
NS3	NISP qualified congregate meals served under Title III-C	Number of meals provided with in programs (congregate nutrition and Title III-E supplemental services) that were NSIP compliant under Title III-C	Note that these data will have a separate workflow. These data will be reviewed and locked, separate from the other SPR data.
NS4	NISP qualified congregate meals served under Title III-E	Number of meals provided with in programs (congregate nutrition and Title III-E supplemental services) that were NSIP compliant under Title III-E	Note that these data will have a separate workflow. These data will be reviewed and locked, separate from the other SPR data.

1 Note: OAA Title VII, Chapter 2, Ombudsman expenditures are reported separately in the National Ombudsman Reporting System (NORS).

2 Only applies to Legal Assistance services.

3 Note that total NSIP qualified meals and total NSIP qualified meals for home-delivered nutrition and congregate nutrition will be calculated by the reporting system and are not included as data elements for submission.

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