Core Services

OMB No. 0990-0460

Exp. Date XX/XX/20XX

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0460. The time required to complete this information collection is estimated to average 9 hours per response, including the time to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

Core Services Programs Provided to PAF Program Participants (Revised)

Grantees will be expected to report on the total number of the priority population receiving services through the PAF program (either provided directly by the PAF program staff or through referrals made by PAF program staff) during the grant year. Grantees should collect these numbers from all program sites; the grantee will report aggregate numbers to OAH annually.

1. How many expectant and parenting teens, students, and their families were assisted in locating the each of the services below?

Assistance with finding student health care that covers the cost of maternity and newborn care _____

Family housing _____

Child care _____

Flexible or alternative academic scheduling _____

Education to improve parenting skills _____

Education to strengthen marriages _____

Material needs of expectant and parenting teens and students (such as maternity and baby clothing, baby food, baby furniture) _____

Post-partum counseling _____

2. How many expectant or parenting teens or students received referrals for each of the services below?

Prenatal care and delivery _____

Infant or foster care _____

Adoption ___