American Indian and Alaska Native (AIAN) Facility Survey

American Indian and Alaska Native (AIAN) Facility Condition, Location, and Ownership Survey

This survey collects the information necessary to meet congressional reporting requirements on the condition, location, and ownership of facilities used by AIAN agencies. (Sec. 650(b) of the Head Start Act.)

Definition

Facility – the building or structure where children receive Head Start or Early Head Start services, regardless of ownership. This does not include outdoor space or outdoor equipment (e.g., buses).

Survey

Q1: This survey is for the following facility: [Facility name and ID]

Q2: What best describes the ownership of this facility? Select only one.

• Owned by grantee

• Lease-to-own or rent-to-own agreement for facility

• Leased or rented

• Donated for grantee use

• Other __________

Q2: What is the condition of this facility? Select only one.

• Excellent – a like-new facility; very few buildings fit this description.

• Good – a facility that is fully operational with a regular maintenance schedule. No need for renovations.

• Average – a facility that is fully operational with a regular maintenance schedule. It could use a few minor renovations.

• Fair – a facility with multiple areas needing major or minor renovation. The facility might be nearing its full use lifecycle.

• Poor – a facility in need of major renovation across most areas and could potentially be decommissioned.

Q3: [if respondent selects “Fair” or “Poor”, display the following] You indicated Fair/Poor in the prior question. Please describe the facility issues and specify if any issues may pose health and safety risks to children served in the facility, and whether there are funds awarded or available through your organization to address these needs:

Q4: [if respondent selects “Fair” or “Poor”, display the following] Please upload an image(s) of the facility issues described in Q3, particularly of areas needing major renovation or areas that may pose health and safety risks to children served in the facility.

[Grantee completes this survey for each facility they operate]

OMB Control #: 0970-####, Expires: #/#/####, The Paperwork Reduction Act of 1995 (Pub. L. 104-13), Public reporting burden for this collection of information is estimated to average six minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.