Supportive Services for Tier 1 Grantees

OMB# 0990-0438

Expiration Date: xx/xx/xxxx

TPP Performance Measures for

FY2020

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 0990-0XXX. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review 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

Referrals and Linkages to Supportive Services (FY2020 Tier 1 Only)

In the reporting period, how many TPP program participants were referred by grant project staff to supportive services providers of the following services (Collect # of each): Reproductive Health Care ------------

Mental Health Services ________

Substance Abuse Prevention/Treatment Services _---------------

Primary Health Care -----------

Educational Services ------------

Vocational Education/Workforce Development ---------------

Violence Prevention ___________