Disability Instructions

OMB Clearance # 1122-0012
Expiration Date 03/31/2011

U.S. DEPARTMENT OF JUSTICE
OFFICE ON VIOLENCE AGAINST WOMEN
INSTRUCTIONS FOR SEMI-ANNUAL PROGRESS REPORT FOR
EDUCATION, TRAINING, AND ENHANCED SERVICES TO END VIOLENCE
AGAINST AND ABUSE OF WOMEN WITH DISABILITIES

The Violence Against Women Act of 2000 (VAWA 2000) requires grantees to report on the effectiveness of
activities carried out with grant funds, including the number of persons served and number of persons
seeking services who could not be served. To meet this Congressional reporting requirement and the
requirements of the Government Performance and Results Act, the Office on Violence Against Women
(OVW) requires all grantees to complete this Semi-Annual Progress Report.
A grant administrator or coordinator must ensure that the form is completed fully with regard to all grant
activities. Grant administrators and coordinators are responsible for compiling and submitting a single
report that reflects all information collected from grant partners. Grant partners, however, may complete
sections relevant to their portion of the grant.
This form is to be used for reporting progress semi-annually for the periods January 1 to June 30 and July 1
to December 31. All grantees should read each section to determine which questions they must answer
based on the activities supported under this grant during the current reporting period. Sections B and
E and subsection A1 of this form must be completed by all grantees. In section D and subsections A2 and
C1-C7, grantees must answer an initial question about whether they engaged in certain activities during the
current reporting period. If the response is yes, then the grantee must complete the rest of that section or
subsection. If the response is no, the rest of that section or subsection is skipped.
This form must be submitted to OVW within 30 days from the end of the current reporting period (i.e., by
July 30 or January 30). OVW recognizes that some of the information requested in this form will not be
available for many projects until they have had sufficient time to implement record-keeping procedures to
track the information requested. In the meantime, provide the most accurate and complete information
possible with the data you have available.
If you have any questions about this form or if you need assistance completing the form, call the VAWA
Measuring Effectiveness Initiative at the Muskie School of Public Service, 1-800-922-VAWA (8292).
Frequently asked questions and other information on the Semi-Annual Progress Report can be found at
http://muskie.usm.maine.edu/vawamei/. If you have questions about your grant, please contact your OVW
program specialist at 1-202-307-6026 (TTY: 202-307-2277).

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Office of Violence Against Women

OMB Clearance # 1122-0012
Expiration Date 03/31/2011

INSTRUCTIONS
Please note: It may be helpful to have the Education, Training, and Enhanced Services to End Violence
Against and Abuse of Women with Disabilities (Disability Program) Application Guideline and your grant
proposal(s) available at the time you complete this form. The application guideline is available on the OVW
website (www.ovw.usdoj.gov).
A. General Information
A1. Grant information
All grantees must complete this subsection.
1. Date of report
Enter the date on which you complete this form.
2. Current reporting period
This information will be pre-populated by the GMS system. You must download a new
reporting form for each reporting period.
3. Grantee name
This information will be pre-populated by the GMS system.
4. Grant number
This information will be pre-populated by the GMS system.
5., 5a., 5b. Type of funded organization
Choose the box that best describes the type of agency/organization receiving the Disability Program
Grant.
In question 5a, indicate whether the grantee is a faith-based organization.
In question 5b, check whether your grant was in the planning and development phase and/or the
implementation phase during the current reporting period.
6. Point of contact
Provide the name, agency/organization name if different from grantee, mailing address, telephone
number, facsimile number, and e-mail address for the person responsible for the day-to-day coordination
or administration of the grant.
7. Tribal populations
Check yes if your grant specifically focuses on American Indians and indicate which tribes or nations
you serve or intend to serve.
Indian tribe: A tribe, band, pueblo, nation, or other organized group or community of Indians, including
any Alaska Native village or regional or village corporation (as defined in, or established pursuant to,
the Alaska Native Claims Settlement Act [43 U.S.C. 1601 et seq.]) that is recognized as eligible for the
special programs and services provided by the United States to Indians because of their status as Indians.

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8. Percentage of Disability Program funds directed to each statutory purpose
Provide appropriate percentages to reflect the time and/or resources you have devoted to each of these
areas during the current reporting period. The total of all percentages should be 100%.
Sexual assault is a continuum of behaviors defined in VAWA to include both sexual assaults committed
by offenders who are strangers to the victim and sexual assaults committed by offenders who are known
to, related by blood or marriage to, or in a dating relationship with the victim. VAWA defines sexual
assault as any conduct proscribed as sexual abuse by federal statute. Such proscribed behavior includes
knowingly causing another person to engage in a sexual act by using force against that other person or
by threatening or placing that other person in fear. It also includes engaging in a sexual act with another
person after knowingly rendering that person unconscious, or administering to another person by force
or threat of force, or without the knowledge or permission of that person, a drug, intoxicant, or other
similar substance and thereby substantially impairing the ability of that other person to appraise or
control sexual conduct. Sexual assault also includes knowingly engaging in a sexual act with another
person if that other person is incapable of appraising the nature of the conduct or is physically incapable
of declining participation in or communicating unwillingness to engage in that sexual act. Sexual
assault also includes knowingly engaging in sexual contact with another person without the other
person’s permission. Finally, the statute proscribes any attempts to commit any of these acts.
The Violence Against Women Act defines domestic violence to include felony or misdemeanor crimes
of violence (including threats or attempts) committed by a current or former spouse of the
victim/survivor, by a person with whom the victim/survivor shares a child in common, by a person who
is cohabiting with or has cohabited with the victim/survivor as a spouse, by a person similarly situated to
a spouse of the victim/survivor under the domestic or family violence laws of the jurisdiction receiving
grant monies, or by any other person against an adult or youth victim/survivor who is protected from
that person’s acts under the domestic or family violence laws of the jurisdiction receiving grant monies.
It should be understood that domestic violence applies to any pattern of coercive behavior that is used by
one person to gain power and control over a current or former intimate partner. This pattern of behavior
may include physical or sexual violence, emotional and psychological intimidation, threats, verbal
abuse, dating violence, stalking, isolation, and economic control. In compiling domestic violence
figures, grantees should include grant funds directed at dating violence. The Violence Against Women
Act defines dating violence as violence committed by a person who is or has been in a social
relationship of a romantic or intimate nature with the victim. The existence of such a relationship is
determined by the length of the relationship, the type of relationship, and the frequency of interaction
between the persons involved in the relationship.
Stalking is defined as a course of conduct directed at a specific person that would cause a reasonable
person to fear for his or her safety or the safety of others or suffer substantial emotional distress.
Individuals with disabilities refers to all individuals covered under the definition contained in the
Americans with Disabilities Act (ADA) (42 U.S.C. § 12102 (2)). According to the ADA, disability
means a physical or mental impairment that substantially limits one or more of the major life activities
of an individual.
EXAMPLE: Your project trains the staff of disabilities agencies on recognizing domestic violence and
sexual assault against people with disabilities, and you train equally on sexual abuse, domestic violence
and stalking. You would report that 34% of your grant money goes to sexual assault, 33% to domestic
violence, and 33% to stalking.

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OMB Clearance # 1122-0012
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A2. Staff information
If your Disability Program funds were used to fund staff positions during the current reporting
period, check yes and answer question 9. If not, check no and skip to Section B.
9. Staff
Report the total number of full-time equivalent (FTE) staff funded under this grant during the current
reporting period. Include employees who are part-time and/or partially funded with these grant funds, as
well as consultants/contractors. Report staff by function(s) performed, not by title or location. Report
all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours—40 hours per week multiplied
by 26 weeks. If an employee or contractor was employed or utilized for only a portion of the reporting
period, prorate appropriately. If staff members fall into two or more categories of job descriptions,
divide their time as appropriate.
EXAMPLE 1: One employee, whose salary is 100% funded with Disability Program funds, spends
approximately 20 hours a week training sexual assault programs, and 20 hours providing administrative
support, report .50 under trainer and .50 under support staff.
EXAMPLE 2: One employee’s salary was funded full-time with Disability Program funds for the first
three months of the reporting period but had no time on the Disability Program Grant during the last
three months of the reporting period. Report that staff person as .50 FTE.
EXAMPLE 3: One employee works ½ time (20 hours per week) on the Disability Program Grant. Half
of her time is dedicated to training, and the other half to program coordination. Count her time as .25
for trainer and .25 as program coordinator.
EXAMPLE 4: A social work intern is paid a small stipend ($500) with Disability Program funds for a
nine-month internship. Since the amount is nominal, you do not need to report her as staff. However, if
the intern is supervised by Disability Program-funded staff, any services the intern provides to
victims/survivors during the reporting period should be reported. If the intern’s services are reported
but the intern is not reported in the staff question, it would be helpful to discuss the intern in Narrative
question 44.
EXAMPLE 5: A trainer is paid a $500 fee to provide a keynote address at your annual training
conference. You do not need to report this person under staff, since the time and payment are so small,
but you may count the training event and the number of people attending in section C2 (Training).
B. Priority Areas
All grantees must complete this section.
10. Priority areas
Check all priority areas that apply to activities supported with Disability Program funds during the
current reporting period.

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C. Function Areas
C1. Planning and Development
If you have Disability Program funds and you are in the planning and development phase, check yes
and answer questions 11-15. If not, check no and skip to C2. NOTE: This section applies only to
grantees who are in the planning and development phase of their grant.
11. Planning and development meeting attendance
Report the total number of people attending planning and development meetings during the current
reporting period.
12. Planning and development activities conducted
Check all activities that were conducted in the planning and development phase supported by your
Disability Program during the current reporting period.
13. Mandatory planning and development activities
Report the total number of planning and development meetings and check the appropriate boxes to
indicate if the agencies or organizations are memorandum of understanding [MOU] partners and/or pilot
sites.
14. Technical assistance received during planning and development
Report the number of site visits and consultations received from OVW TA provider.
Technical assistance: A wide variety of activities designed to facilitate individual or agency change in
some systematic manner by providing expertise to solve a problem.
Site visit: A visit made to the grantee for the purpose of providing technical assistance. This includes
weekly, bi-weekly, or monthly site visits from the OVW TA provider.
Consultation: Technical assistance consultations conducted by telephonic, electronic, videoconference,
TTY/TDD, or other types of technology. This includes quarterly tele/video conference calls and all
mandatory OVW-sponsored meetings. Count each contact or meeting as one consultation.
15. (Optional) Additional information
Use the space provided to discuss the effectiveness of planning and development activities that were
funded or supported by your Disability Program grant. You may provide examples, data, or any other
information about your planning and development activities that you have not already provided.
C2. Training
If your Disability Program funds were used to provide training during the current reporting period,
check yes and answer questions 16-19. If not, check no and skip to C3.
NOTE: This section applies only to grantees who are in the implementation phase of their grant.
16. Training events provided
Training, for the purposes of this reporting form, means providing information on sexual assault, domestic
violence, dating violence, and stalking that enables a person to improve her/his response to
victims/survivors with disabilities as it relates to her/his role in the system. Education means providing
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general information that will increase awareness and knowledge about sexual assault, domestic violence,
dating violence, or stalking against people with disabilities. Report on training events in this subsection.
Report the total number of training events provided during the current reporting period that were either
provided by Disability Program-funded staff or directly supported with Disability Program funds. Also
report the number of training events in which interpretive services were provided.
Interpretive services: At a training event, services provided to ensure effective communication with
people with disabilities. This may include sign language interpreters, transliterators, captionists, or other
means of conveying information. Do not count an event as having interpretive services if only products
such as large type materials, or materials in Braille, were provided. These materials will be counted
under subsection C7 (Products).
If non-grant-funded staff were sent to training with Disability Program funds, count the training as one
event. Include workshops, conferences, meetings, Internet-based training, teleconferences,
videoconferences, and cross-training. Training provided to Disability Program-funded staff should not
be counted.
EXAMPLE: You send five judges for training at the same judicial institute. Count this as one training
event.
EXAMPLE: You hold a statewide conference and provide American Sign Language interpreters at the
conference. Count this as one training event, and as one training event in which interpretive services
were provided.
17. Number of people trained
Report the number of people trained with Disability Program funds during the current reporting period.
Use the category that is most descriptive of people attending the training event. Count each attendee
only once for each training event they attended. These should be people trained by Disabilities
Program-funded staff or people attending training events that were directly supported with Disabilities
Program funds during the current reporting period. Disabilities Program-funded staff attending training
should not be counted.
EXAMPLE: Eight domestic violence victim advocates attended a two-day training event; two of the
advocates were funded under your Disabilities Program grant. You would enter six in the category
“Domestic violence program staff.”
18. Training topics
Check the topics addressed in training events reported in question 16. Check all that apply. Do not use
the “Other” category to report the name of the group that received the training, the title of the training
event, or the name of the conference that was attended.
19. (Optional) Additional information
Use this space to discuss the effectiveness of training activities funded or supported by your Disability
Program grant. You may provide examples, data, or any other information about your training activities
that you have not already provided.

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OMB Clearance # 1122-0012
Expiration Date 03/31/2011

C3. Education
If your Disability Program funds were used to provide education during the current reporting period,
check yes and answer questions 20-23. If not, check no and skip to C4.
NOTE: This section applies only to grantees who are in the implementation phase of their grant.
20. Number of education events
Education, for the purposes of this reporting form, means providing general information that will increase
awareness and knowledge about sexual assault, domestic violence, or stalking against people with
disabilities. Training means providing information on sexual assault, domestic violence, and stalking that
enables a person to improve her/his response to victims/survivors with disabilities as it relates to her/his role
in the system. Report on education events in this subsection
Report the total number of education events provided during the current reporting period that were either
provided by Disability Program-funded staff or directly supported by Disability Program funds. Also
report the number of education events in which interpretive services were provided.
Interpretive services: At an educational event, services provided to ensure effective communication
with people with disabilities. This may include sign language interpreters, transliterators, captionists, or
other means of conveying information. Do not count an event as having interpretive services if only
products such as large type materials, or materials in Braille, were provided. These materials will be
counted under subsection C7 (Products).
EXAMPLE: During Sexual Assault Awareness Month, you host three educational workshops on
violence against women with disabilities. American Sign Language interpreters translated at all three
events. Report this as three educational events and as three educational events in which interpretive
services were provided.
21. Number of people educated
Report the number of people educated with Disability Program funds during the current reporting
period. Use the category that is most descriptive of people attending the education event. Count each
attendee only once for each event they attended.
22. Education topics
Check all topics that were covered in education events provided by your Disability Program grant during
the current reporting period.
23. (Optional) Additional information
Use this space to discuss the effectiveness of education activities funded or supported by your Disability
Program grant. You may provide examples, data, or any other information about your education
activities that you have not already provided.

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Expiration Date 03/31/2011

C4. Policies
If Disability Program-funded staff developed, substantially revised, and/or implemented polices or
protocols or if Disability Program funds were used to develop, substantially revise, and/or implement
policies or protocols during the current reporting period, check yes and answer questions 24 and 25.
If not, check no and skip to C5.
NOTE: This section applies only to grantees who are in the implementation phase of their grant.
24. Policies developed, substantially revised, or implemented
Check all the types of policies or protocols developed, substantially revised, and/or implemented during
the current reporting period. These activities should be completed by Disability Program-funded staff or
directly supported by Disability Program funds. Check all that apply. If the protocol/policy is still in the
development or revision phase, it should not be reported until it is actually finished.
Develop: To create a new policy or protocol.
Substantially revise: To make a significant amendment to an existing policy or protocol.
Implement: To carry out a new or revised policy or protocol as standard practice.
EXAMPLE 1: (Developed) Your agency did not have a policy concerning accessibility. During the
current reporting period, grant-funded staff developed a policy and outlined protocols for accessibility.
You report this activity during the current reporting period because the development of the policy was
completed.
EXAMPLE 2: (Substantially revised) Your agency had a policy and protocol concerning accessibility,
but it only referred to accessibility to physical locations. During the current reporting period, grantfunded staff amended the policy to include accessible communications. You report this activity during
the current reporting period because the amendments were completed.
EXAMPLE 3: (Implemented) Your agency amended its policy concerning accessibility to include
protocols for accessible communications. During the current reporting period, the new protocols were
distributed and became standard practice within the agency. You would report this activity during the
current reporting period because the protocol became standard practice. You would not continue to
report this same activity in future reporting periods.
25. (Optional) Additional information
Use the space provided to discuss the effectiveness of the policies you have developed, revised, or
implemented that were funded or supported by your Disability Program grant. You may provide
examples, data, or any other information about your policy activities that you have not already provided.
C5. Technical Assistance
If Disability Program-funded staff provided technical assistance, or if grant funds were used to
support technical assistance during the current reporting period, check yes and answer questions 2629. If not, check no and skip to C6.
NOTE: This section applies only to grantees who are in the implementation phase of their grant.

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26. Technical assistance
Technical assistance: a wide variety of activities designed to facilitate individual or agency change in
some systematic manner by providing expertise to solve a problem. Examples of technical assistance
activities include clarifying legislative and policy implementation and/or standards of service,
technology consultations, and assistance with problem-solving.
Report the total number of technical assistance activities provided to programs during the current
reporting period, indicating whether they were accessibility assessment site visits or other types of
consultations. Consultations may include in-person, telephonic, electronic, or other types of contact.
Each contact should count as one consultation.
Accessibility assessment site visit: A visit made to agencies for the purpose of providing technical
assistance consultation about the accessibility of their programs and agency.
Other technical assistance consultation: Technical assistance consultations conducted by telephone,
electronic, or other types of contact other than site visits. Each contact should count as one activity.
EXAMPLE: You provide technical assistance to a sexual assault program about creating appropriate
services for women with disabilities. You conduct three teleconferences to discuss the challenges they
have encountered while creating the program. You would report this as follows: In the “Sexual assault
program staff” row, enter three under “Number of other technical assistance consultations.”
27. Topics of technical assistance
Check all topics that apply to technical assistance you provided during the current reporting period. The
technical assistance provided may be categorized by more than one topic. Grantees should make this
determination. Check all that apply.
EXAMPLE: You provide an accessibility assessment consultation to a domestic violence program about
cost-effective strategies for compliance with ADA. You would report this as follows: check
“Accessibility assessment (physical, programmatic, attitudinal)” and “Cost-effective compliance with
ADA.”
28. Organizational policies and technical assistance
Indicate the number of organizations that developed, revised, and/or implemented polices regarding
accessibility and/or services for women with disabilities as a result of technical assistance during the
current reporting period.
29. (Optional) Additional information
Use the space provided to discuss the effectiveness of technical assistance activities that were funded or
supported by your Disability Program grant. You may provide examples, data, or any other information
about your technical assistance activities that you have not already provided.
C6. Coordinated Community Response
If you have Disability Program funds and you are in the implementation phase, check yes and answer
question 30. If not, check no and skip to C7.
NOTE: This section applies only to grantees who are in the implementation phase of their grant.

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30. Coordinated community response activities
Check the appropriate boxes to indicate the agencies or organizations, even if they are not memorandum
of understanding (MOU) partners, that you engaged in development, revision, or implementation of
training and/or education with; and/or collaborated with during the current reporting period. In the last
column, indicate the agencies or organizations with which you have an MOU for purposes of your
Disability Program Grant.
Development, revision, or implementation of training and/or education: Training or educational
curricula, materials, and/or events with which Disability Program-funded staff worked with other
agencies to develop, revise, or implement.
Collaboration: Working with other organizations to achieve common objectives, such as improved and
coordinated services, more effective response by individual agencies, and systems-level change. In the
Disabilities Program, collaboration may include working as a team to develop policies or products
and/or participating in meetings to affect systems change.
31. (Optional) Additional information
Use this space to discuss the effectiveness of CCR activities funded or supported by your Disability
Program grant. You may provide examples, data, or any other information about your CCR activities
that you have not already provided.
C7. Product Development
If Disability Program funds were used to develop, substantially revise, and/or distribute products
during the current reporting period, check yes and answer question 32. If not, check no and skip to
section D.
NOTE: This section applies only to grantees who are in the implementation phase of their grant.
32. Use of Disability Program funds for product development, substantial revision, and/or distribution
Report the number of products developed, substantially revised, and/or distributed with Disability
Program funds during the current reporting period. Report the number of new products developed
and/or substantially revised during the current reporting period; the title/topic, and intended audience for
each product developed, revised, and/or distributed; and the number of products used and/or distributed.
If a product was created in or translated into an alternative format, indicate the format. Report on
products that were newly developed and/or substantially revised during the current reporting period
whether or not they were used or distributed, and on products that were previously developed or revised
and were used or distributed during the current reporting period.
EXAMPLE 1: You used Disability Program funds to create and distribute 1,000 brochures on victim
services for sexual assault victim/survivors with disabilities.
For this example, you would report as follows: In the “Brochures” row, enter “1” in the “Number and
developed or revised” column; write “Victim services for women with disabilities” in the “Title/topic”
column; and write “Victims/survivors with disabilities” in the “Intended audience” column.
EXAMPLE 2: You used Disability Program funds to distribute 200 copies of a brochure for rape survivors
that was developed during a previous reporting period.
For this example, you would report as follows: In the “Brochures” row, write “What to do if you are
raped” in the “Title/topic” column; write “Victims/survivors” in the “Intended audience column”; and
enter “200” in the “Number used and/or distributed.”
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EXAMPLE 3: You developed a new brochure in Braille for victims/survivors who are blind, although no
copies were distributed during the current reporting period.
For this example, you would report as follows: in the “Brochures” row, enter “1” in the “Number
developed or revised” column; write “Violence against women: A guide for women who are blind or
visually impaired” in the “Title/topic column”; write “Victims/survivors who are blind” in the “Intended
audience” column; and write “Braille” in the “Alternative format” column.
D. Victim Services
If Disability Program-funded staff provided victim services, or if grant funds were used to support
victim services during the current reporting period, check yes and answer questions 33-39. If your
Disability Program funds were not used for victim services, skip to section E.
NOTE: This section applies only to grantees who are in the implementation phase of their grant.
33. Number of primary victims/survivors served, partially served, and victims/survivors seeking services
who were not served
Only provide information in this section that represents victims/survivors served and services
provided with Disability Program funding during the current reporting period. Report all victim
services provided, whether by legal services, a victim services agency, or by staff providing victim
services within law enforcement, prosecution, or the court system, in this section.
Report the following, to the best of your ability, as an unduplicated count for each category during the
current reporting period. This means that each victim/survivor who was seeking or who received
services during the current reporting period should be counted only once in that reporting period. You
can report victims/survivors in each reporting period that they request services.
Victims/survivors are those against whom the sexual assault, domestic violence, dating violence, or
stalking was directed. Some victims/survivors may have experienced more than one type of
victimization, such as sexual assault and domestic violence, or domestic violence and stalking. These
victims/survivors should be counted only once under the primary victimization. (See Example 1 below
on primary victimization, and refer to definitions of sexual assault, domestic violence, dating violence,
and stalking in question 8 of these instructions.) Do not report secondary victims.
EXAMPLE (unduplicated count): A victim/survivor requested services three different times during the
current reporting period; you will report this person only once in question 33.
EXAMPLE (unduplicated count): A victim requested counseling at the beginning of the reporting period
and then the same victim came back at the end of the reporting period and requested civil legal
advocacy. Although this victim came two times and requested two different services, you will only
count that victim once in question 33. You will count the victim once for each type of service
received in question 37A.
A. Victims/survivors served are those who received the service(s) they requested, if those services were
provided under your Disability Program grant.
B. Victims/survivors partially served are those who received some of the service(s), but not all of the
services they requested, if those services were provided under your Disability Program grant.
C. Victims/survivors seeking services who were not served are those who sought services but did not
receive the service(s) they were seeking, if those services were provided under your Disability
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Program grant.
Note: If you receive a call or request for service from someone who is NOT a victim/survivor, or if the
person is a victim/survivor but is requesting a service you do NOT provide under your Disability Program
grant, that person should NOT BE COUNTED in any category. If you contact victims/survivors to offer
services, and they do not want services or you can not locate them, do not count them in this question. (See
instructions for question 37D, Victim-witness notification/outreach to victims.)
EXAMPLE 1: (Primary victimization) A victim/survivor comes to your program looking for help with a
protection order. Her estranged intimate partner, who had a history of very controlling behavior with some
physical abuse, came to her apartment and sexually assaulted her. You could report her under either
domestic violence/dating violence or sexual assault, but you must choose only one. In this instance, sexual
assault may be more appropriate, because it was the sexual assault that prompted her to seek services.
EXAMPLE 2: (Served) A domestic violence victim/survivor calls your program looking for assistance
obtaining a protection order. You assist her with the paperwork and with the filing and service of the
emergency protection order, and accompany her to the protection order hearing three weeks later. Since
this victim/survivor received the services she requested that were provided under your Disability Program
grant, she should be counted as “served” in the domestic violence/dating violence column.
EXAMPLE 3: (Partially served) A victim/survivor whose ex-husband has been charged with stalking comes
into the prosecutor’s office to get information about the criminal process. Your advocate explains the
process to her, what she can expect, the different hearings that will take place, etc. She asks the advocate to
attend the arraignment with her, but the advocate already is scheduled to be in another courtroom on the
date. This victim/survivor received information from your advocate, but not the other service she requested
that you normally provide under your Disability Program grant. She should be counted as “partially
served” in the stalking column.
EXAMPLE 4: (Not served) A woman is sexually assaulted by the person with whom she was living. A
police officer who responded to the call has called your program’s hotline on behalf of the victim asking if
an advocate will accompany the victim to the hospital during her examination. There is no advocate
available to do this, and it is a service your program is funded to do under your Disability Program grant.
You are unable to provide the requested service, therefore she should be counted as “not served” in the
sexual assault column.
EXAMPLE 5: (Not counted) You receive police reports on all domestic violence incidents responded to by
police. During the reporting period, you sent out letters to 500 victims/survivors based on these police
reports, informing victims/survivors of services you provide; twenty-five letters are returned as
undeliverable. Only victims/survivors who contact you after receiving the letter and who request a service
that you are funded to provide with Disability Program funds would be counted in question 33; none of the
other victims/survivors to whom you mailed letters would be counted at all in this question. (You would,
however, count the letters sent to victims/survivors in question 37D, if this activity was funded by your
Disability Program grant.)
(Examples 6A, 6B, and 6C use the same scenario to illustrate how the three categories of “served,”
“partially served,” and “not served” should be applied to the varying responses the victim/survivor
received.)

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EXAMPLE 6
A. A sexual assault victim/survivor calls your program looking for crisis intervention and group support.
You provide crisis intervention and she attends a support group for sexual assault victims/survivors. This
victim/survivor has received the services she requested that you are funded to provide under your Disability
Program grant and should be counted as “served.”
B. A sexual assault victim/survivor calls your program looking for crisis intervention and group support.
You provide crisis intervention. However, your group support services are full and you can not provide this
service. This victim/survivor has received some, but not all, of the services she requested that you are
funded to provide under your Disability Program grant and should be counted as “partially served.”
C. A sexual assault victim/survivor calls your program looking for crisis intervention and group support.
You have a waiting list for all services and cannot provide her any services at this time. When your services
become available, you cannot locate her. This victim/survivor has not received any of the services she
requested that you are funded to provide under your Disability Program grant and should be counted as
“not served.”
The partially served and not served categories generally have to do with issues within your program that
keep you from providing grant-funded services to a victim/survivor who requests those services. If a
victim/survivor chooses to discontinue services once they have begun receiving them, then the
victim/survivor should be reported as “served.” The same is true if a victim/survivor moves, even if they
do not inform you, and they are unable to complete the services. When determining whether a
victim/survivor is served, partially served, or not served, do not consider services the victim/survivor
declined, unless the victim/survivor requested a service but found the program rules unacceptable.
34. Reasons that victims/survivors seeking services were not served or were partially served
Indicate the reasons that victims/survivors seeking services were not served or were partially served by
checking all that apply. OVW acknowledges that funded programs may not be able to serve all
victims/survivors who request services. This information is being collected to identify unmet needs and
barriers to service.
Conflict of interest: The program cannot serve the victim/survivor because current or previous
relationships with that victim/survivor or other parties related to that victim/survivor would interfere
with the ability of the program to serve that victim/survivor. For example, the program is currently
serving a victim/survivor. Her partner, identifying as your client’s victim, requests to join the same
support group as the person you are already serving.
Did not meet statutory requirements: Victim/survivor does not meet requirements of statute. For
example, a victim/survivor requests help with a divorce, but has not met statutory residency
requirements to file for a divorce in the jurisdiction.
Hours of operation: Hours during which the program provides services are not compatible with the
hours the victim/survivor is available to receive requested services.
Lack of child care: Victim/survivor is unable to receive requested services due to the lack of available
child care.
Program reached capacity: Program is operating at full capacity. Victims/survivors may be placed on
a waiting list.
Program rules not acceptable to victim/survivor: Although eligible for services under the grant, a
victim/survivor is not willing to comply with rules of the program. For example, a program requires
eight individual counseling sessions and the victim/survivor does not want to attend individual
counseling.
Program unable to provide service due to limited resources/priority setting: Program has set priorities
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(e.g., that they will only represent victims/survivors in protection order hearings who are in
imminent danger, or who have complex legal issues related to their protection orders) and is unable
to serve victims/survivors who do not meet the priority criteria because of limited resources.
Services inappropriate or inadequate for victims/survivors who are D/deaf or hard of hearing: Staff are
not able, for any reason, to provide appropriate or adequate services for victims/survivors who are
D/deaf or hard of hearing.
Services inappropriate or inadequate for victims/survivors who have disabilities: Staff are not able, for
any reason, to provide appropriate or adequate services for victims/survivors who have disabilities.
For example, the two wheelchair accessible rooms in your shelter are currently occupied by
victims/survivors.
Services inappropriate or inadequate for people with mental health issues: Staff are not able, for any
reason, to provide appropriate or adequate services for victims/survivors with mental health
problems. For example, the program does not have overnight staff and the victim/survivor cannot be
left alone overnight.
Services inappropriate or inadequate for people with substance abuse issues: Staff are not able, for any
reason, to provide appropriate or adequate services for victims/survivors with substance abuse
problems.
Services not available for victims/survivors accompanied by male adolescent: Although shelter services
are provided under the grant, your shelter has rules prohibiting adolescent males from residing in the
shelter, and the victim/survivor refuses to go to the shelter without the child. Therefore, the
victim/survivor is denied shelter services.
Services not appropriate for victim/survivor: For any reason, the services available under the grant are
not appropriate for a victim/survivor. For example, although support groups are offered under the
grant for survivors of sexual assault, a victim/survivor requesting support group services is not
served because it is clinically determined that the victim/survivor is not appropriate for the group.
Transportation: Victim/survivor is unable to arrange for transportation to receive services or to attend
court hearings. This includes situations in which public transportation is not available or, if
available, cannot be paid for.
Below are examples of responses in the “other” category that indicate the victim/survivor should have
been reported in a different category or should not have been reported at all in answer to this question.
EXAMPLE 1: In the “Other” category, you report “Victim refused services.”
If your program offers services, usually through outreach, and the victim/survivor refuses the services or
does not contact your program to accept services, you would not count this person at all in this section.
EXAMPLE 2: In the “Other” category, you report “Service was not provided by our program.”
Only consider services supported with grant funds. For example, your Disability Program funds only
crisis intervention services but a victim/survivor contacts your program seeking crisis intervention and a
support group. You only consider your program’s ability to provide the crisis intervention when
determining if the victim/survivor should be counted as served, partially served, or not served, since
your program is not funded to provide support group services under your Disability Program grant.
EXAMPLE 3: In the “Other” category, you report “Could not locate victim.”
If your program began to provide the requested services, this person would be counted as served.
However, if this person was placed on a waiting list, and when your program was able to provide the
service you were not able to locate the victim/survivor, you would then count this victim/survivor as not
served. You would indicate “program reached capacity” in question 34 because your program was not
able to provide the service when it was requested.
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35. Demographics of victims/survivors served or partially served
Based on the victims/survivors reported in 33A and 33B, report the total numbers for all that apply.
Because victims/survivors may identify as more than one race or ethnicity and with more than one of the
“other demographics” options, the totals for these two categories may exceed the total number of
victims/survivors reported in 33A and 33B. However, the total number of victim/survivors reported in
the “gender” and “age” categories should equal the total number of victims/survivors reported in 33A
and 33B. The demographic categories listed under race/ethnicity are mandated by the federal Office of
Management and Budget.
Race/ethnicity: Report the race or ethnicity with which the victim/survivor identifies. You may count
victims/survivors in more than one of the race/ethnicity categories.
Gender: Report the gender of each victim/survivor, or if the gender is unknown, report it as unknown.
This is an unduplicated count, and the total number for gender should equal the sum of 33A and
33B.
Age: Report the number of victims/survivors served in the applicable age category, or if the age is
unknown, report it as unknown. This is an unduplicated count, and the total number for age should
equal the sum of 33A and 33B.
People with disabilities: Count victims/survivors with a significant limitation in activities of daily living
as people with disabilities. This may include people who are blind or who have low vision, people
with developmental disabilities, and people with mental health issues or who have mental illness, or
people with a chronic, debilitating illness.
People who are D/deaf or hard of hearing: Report the number of victims/survivors who identify with
and participate in the language, culture, and community of Deaf people based on the use of sign
language (Deaf); victims/survivors who identify within the audiological definition of severe to
profound hearing loss and who don’t have a cultural affiliation (deaf); and/or victims/survivors who
identify with any degree of hearing loss from mild to profound and are committed to participate in
society through the use of their residual hearing plus hearing aids, speechreading, and assistive
technology to aid communication (hard of hearing).
People with limited English proficiency: Report the number of victims/survivors served who have
limited English proficiency. Individuals who do not speak English as their primary language and
who have limited ability to read, write, speak, or understand English can be counted as having
limited English proficiency.
People who are immigrants/refugees/asylum seekers: Where possible, report the number of
victims/survivors who were immigrants/refugees/asylum seekers. This is not a question about
immigration or legal status.
People who live in rural areas: Report the number of victims/survivors who live in a rural area or
community. (If you do not know if an area is rural, you may use any of the following definitions:
any area or community, respectively, no part of which is within an area designated as a standard
metropolitan statistical area by the Office of Management and Budget, consistent with the U.S.
Census; or any area or community, respectively, that is within an area designated as a metropolitan
statistical area or considered as a part of a metropolitan statistical area and is located in a rural
census tract.)
EXAMPLE: You served a 20-year-old woman who is a victim/survivor of sexual assault, who identifies
as American Indian and Latina, who does not read or write English, and whose primary language is
Lakota. Count this victim/survivor under Race/Ethnicity (American Indian and Hispanic or Latino),
Gender (Female), Age (18-24), and as a person with limited English proficiency.

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36. Victims/survivors' relationship to offender
For those victims/survivors reported as served and partially served in items 33A and 33B, report the
relationship of the victim/survivor to the offender by type of victimization. Victims/survivors are those
against whom the sexual assault, domestic violence, dating violence, or stalking was directed. If a
victim/survivor experienced more than one type of victimization and/or was victimized by more than
one perpetrator, count the victim/survivor in all categories that apply. The total number of relationships
in the sexual assault column must be at least the sum of the number of sexual assault victims/survivors
reported in 33A and 33B; the total number in the domestic violence/dating violence column must be at
least the sum of the number of domestic violence/dating violence victims/survivors reported in 33A and
33B; and the total number in the stalking column must be at least the sum of the number of stalking
victims/survivors reported in 33A and 33B. The total number of victims/survivors reported here all
together may total more than the sum of all victims/survivors reported in 33A and 33B. Do not report
relationships to offenders for secondary victims.
Current or former spouse or intimate partner: The victim/survivor (1) is currently or formerly married
to the offender, (2) shares a child in common with the offender, (3) is cohabitating with or has
cohabitated with the offender as a spouse, or (4) is a person similarly situated to a spouse of the
offender under the domestic or family violence laws of the jurisdiction receiving grant monies.
Other family member or household member: The victim/survivor is related to the offender by blood,
kinship, or similar relationships. Family is defined to include both traditional and non-traditional
family structures, including foster parents, grandparents and other relatives, single parents, gay or
lesbian parents, extended family, clans, etc. This includes victims/survivors who shared a household
or have/had a roommate relationship with the offender.
Dating relationship: The victim/survivor is, or has been, in a social relationship of a romantic or
intimate nature with the offender. The existence of such a relationship is determined by the
following factors: 1) length of the relationship; 2) type of relationship; and 3) frequency of the
interaction between the persons involved.
Acquaintance: The victim/survivor is known to the offender. For example, the victim/survivor is a
neighbor, employee, co-worker, friend, fellow schoolmate, student, etc., of the offender.
Stranger: The victim/survivor and the offender are not known to each other.
Recipient of personal care service: The victim/survivor is or was receiving personal care services from
the offender. Does not include victims/survivors who are receiving personal care service from
family members, spouses, or intimate partners, or from friends—those victim relationships would be
reported in the appropriate categories above.
EXAMPLE 1: For a victim/survivor who was being stalked by her former intimate partner and was
sexually assaulted by the person with whom she is currently in a dating relationship, the victim
relationships would be reported as follows: In the “Current or former spouse or intimate partner” row,
report one in the “Stalking” column; in the “Dating relationship” row, report one in the “Sexual
assault” column.
EXAMPLE 2: For a victim/survivor who was sexually assaulted by a personal care attendant, the
victim relationship would be reported as follows: In the “Recipient of personal care service” row,
report one in the “Sexual assault” column.
37A. Victim services
Based on the victims/survivors reported in 33A and 33B, report the number of primary
victims/survivors who received Disability Program-funded services during the current reporting
period. Count each victim/survivor only once for each type of service that victim/survivor received
during the current reporting period; do not report the number of times that service was provided to the
victim. Do not report secondary victims receiving services in this question.
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Case management: A collaborative process of assessment, planning, facilitation, and advocacy for
options and services to meet a victim/survivor’s needs through communication and available
resources to promote desired outcomes.
Civil legal advocacy/court accompaniment: Assisting a victim/survivor with civil legal issues, including
preparing paperwork for protection orders; accompanying a victim/survivor to a protection order
hearing, or other civil proceeding; and all other advocacy within the civil justice system. This also
includes accompanying a victim/survivor to an administrative hearing, such as unemployment,
Social Security, TANF, or food stamp hearing.
Civil legal assistance: Civil legal services provided by an attorney and/or paralegal.
Counseling services/support group: Individual or group counseling or support provided by a volunteer,
peer, or professional.
Criminal justice advocacy/court accompaniment: Assisting a victim/survivor with criminal legal issues
including notifying the victim/survivor of case status, hearing dates, plea agreements, and sentencing
terms; preparing paperwork such as victim impact statements; accompanying a victim/survivor to a
criminal court proceeding or law enforcement interview; and all other advocacy within the criminal
justice system.
Crisis intervention: Process by which a person identifies, assesses, and intervenes with an individual in
crisis so as to restore balance and reduce the effects of the crisis in her/his life. In this category,
report crisis intervention that occurs in person and/or over the telephone.
Employment: Job training, coaching, supported or sheltered employment.
Forensic exam: A medical examination to collect and document evidence, evaluate and treat STDs and
pregnancy, and refer victims/survivors to follow-up or medical care or counseling. Does not include
accompanying the victim/survivor to a hospital, clinic, or medical office.
Hospital/clinic/medical response: Accompanying a victim/survivor to, or meeting a victim/survivor at,
a hospital, clinic, or medical office.
Language services: Translation, interpretation, and other services provided to ensure effective
communication with victims/survivors with disabilities and to assist those victims/survivors to
participate in or access services.
Long-term care: Assistance to meet a victim/survivor’s needs for an extended period of time.
Typically, this is assistance with daily needs (eating, dressing, bathing, etc.).
Peer support services: Services provided by self-advocates.
Personal planning: Assisting the victim/survivor with the process of planning for both their immediate
and future needs, including establishing goals and developing plans for meeting those goals.
Respite: Short-term care offered in the home, through an adult day center, or at a residential care facility
that offers primary caregivers relief, thus enabling a family to care for a victim/survivor with a
disability in their own home.
Transportation: Provision of transportation, either directly or through bus passes, taxi fares, or other
means of transportation.
Victim/survivor advocacy: Actions designed to help the victim/survivor obtain needed resources or
services including employment, housing, shelter services, health care, victim’s compensation, etc.
37B. Shelter services
Report the total number of victims/survivors and accompanying family members who received
emergency shelter or transitional housing. This should be an unduplicated count of both
victims/survivors and family members. This means that each victim/survivor and each family member
who received shelter services during the current reporting period should be counted only once. Report
the total number of bed nights provided in emergency shelter or transitional housing to
victims/survivors and family members. The number of bed nights is computed by multiplying the
number of victims and family members by the number of nights they stayed in the shelter. The number
of bed nights will typically be significantly higher than the number of victims and family members.
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EXAMPLE: If 10 victims/survivors stayed in the emergency shelter for 5 days each and each victim
survivor was accompanied by 3 family members who also stayed for 5 nights each, this would be
reported as follows: In the “Emergency shelter” row, report 10 in the “Number of victims/survivors”
column, 30 in the “Number of family members” column, and 200 in the “Number of bed nights”
column.
Emergency shelter: Victim/survivor is housed in a safe, sometimes confidential place that provides 24hour access to living quarters for a limited amount of time. Emergency shelter can also be safehomes (generally private homes allowing a victim/survivor who is in immediate danger to stay for a
short period of time on an emergency basis) and hotel accommodations.
Transitional housing: Victim/survivor is housed either in an apartment or single-family unit. This
housing often includes a case management component that would include a work plan for what the
client will accomplish while staying at the facility. Victims/survivors and their children are offered
the array of direct services that the victim service agency offers other clients, such as court advocacy
and assistance in getting TANF, WIC, job training, child care, legal assistance, permanent housing,
vouchers, support and educational groups, and other services.
37C. Hotline calls
Report the number of crisis or information and referral calls received on phone lines paid for with
Disability Program funds or answered by Disability Program-funded staff during the current reporting
period. Calls reported here should not be reported as victims/survivors served in question 33 unless
they also received at least one of the services listed in question 37A Victim Services or question 37B
Shelter Services. All calls, whether or not from victims/survivors, should be included in Total number
of calls.
EXAMPLE 1: A victim/survivor calls the grant-funded hotline and is in crisis. The advocate spends 30
minutes on the call assisting the victim/survivor. In this case, the call would be counted in this
question under “Number of calls from primary victims” and under “Total number of calls.” The
victim/survivor would also be counted in question 33 as a victim served, in question 37A under “Crisis
intervention,” and demographics would need to be collected on this caller in questions 35 and 36.
EXAMPLE 2: A mother of a victim/survivor calls the grant-funded hotline and requests information
about available services for her daughter. Your program provides her with the information. In this
case, she would be counted in this question under “Total number of calls”- she would not be reported
in any other questions, and demographics would not be collected for this caller.
37D. Victim-witness notification/outreach to victims
Report the number of unsolicited letters, phone calls, or visits to victims/survivors of specific incidents
of sexual assault, domestic violence, dating violence, and stalking identified in police reports or court
documents, informing them of services and/or providing information about the criminal justice system.
Victims/survivors who are the recipients of these notification/outreach activities should not be
reported as victims/survivors served in question 33 unless they also received at least one of the
services reported in question 37A Victims Services or question 37B Shelter Services.
EXAMPLE 1: Your agency works closely with local law enforcement and they provide you with copies
of the police reports. Your agency sends out 75 letters during the current reporting period and five
victims/survivors call and request grant-funded services. In this case, you would report 75 in question
37D and the 5 victims/survivors requesting grant-funded services would also be counted in question
37A by the type of grant-funded service they requested. These 5 victims/survivors would be reported in
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question 33 and, if they were reported as served or partially served, demographics would also need to
be reported in questions 35 and 36. However, if no victims/survivors requested services, you would
only report in question 37D.
EXAMPLE 2: Your agency conducts outreach activities in the community during the current reporting
period. Your grant-funded outreach worker conducts outreach by visiting the homes of 10
victims/survivors during the current reporting period. Each victim/survivor refuses services. In this
case, you would only report those 10 outreach activities in question 37D. The victims/survivors visited
by the outreach worker would not be reported at all in question 33 and no other demographics would
need to be reported.
38. Protection orders
Report the total number of temporary and/or final protection orders requested and granted for which
Disability Program-funded victim services staff assisted victims/survivors during the current reporting
period. This should include all orders having the force of law that are designed to protect the
victim/survivor from contact with the offender during the pendency of the order. They may be referred
to as protection from abuse, protection from harassment or anti-harassment orders, restraining orders, or
no-contact or stay-away orders in your jurisdiction, and they may be criminal or civil. Temporary orders
are generally issued ex parte, meaning without a court hearing, for a short period of time (e.g., 30 days),
and final orders are issued after a court hearing for a longer period of time (e.g., two years). For all
instances in which victim services staff assisted the victim/survivor in obtaining such an order, the
number of those orders requested and granted, and whether they were for victims/survivors of domestic
violence/ dating violence, sexual assault, or stalking, should be reported here.
39. (Optional) Additional information
Use the space provided to discuss the effectiveness of victim services activities funded or supported by
your Disability Program grant. You may provide examples, data, or any other information about your
victim services activities that you have not already provided.

E. Narrative
All grantees must answer question 40.
Please limit your responses to the space provided.
40. Report on the status of the goals and objectives for this grant.
Report on the status of the goals and objectives for your Disability Program Grant as of the end of the
current reporting period, as identified in your grant proposal or as they have been added or revised. Indicate
whether the activities related to your objectives for the current reporting period have been completed, are in
progress, are delayed, or have been revised. Comment on your successes and challenges, and provide any
additional explanation you feel is necessary for us to understand what you have or have not accomplished
relative to your goals and objectives. If you have not accomplished objectives that should have been
accomplished during the current reporting period, you must provide an explanation.
EXAMPLE:
Objective:

Train all victim services agencies on responding to sexual assault victims/survivors
with disabilities

Activity:

Develop training curricula and conduct five regional trainings

Status:

Ongoing

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Comments:

Although we developed training curricula and conducted five regional trainings, only
half of the victim services agency staff were trained. We will conduct five more
regional trainings during the next six months in an attempt to train all victim services
staff.

All grantees must answer questions 41 and 42 on an annual basis. Submit this information on the
January to June reporting form only.
Please limit your response to the space provided. (8,000 characters)
41. What do you see as the most significant areas of remaining need, with regard to obstacles faced by
individuals with disabilities?
Describe the remaining areas of need in the communities served by your Disability Program Grant. This
may be based on practice experience, research, feedback from others, etc. Consider challenges and
barriers unique to your service area.
EXAMPLE: Disability organization staff are from a large, diverse group of disciplines and serve
individuals with a wide range of disabilities. Therefore, it has been a challenge to develop and provide
training to meet the needs of these service providers. We have also had some challenges forging
relationships with state facilities, such as the state psychiatric facility, to educate both consumers and
staff. Finally, we know that there are a number of service providers from many disciplines that we have
not been able to reach during this reporting period.
42. What has Disability Program funding allowed you to do that you could not do prior to receiving this
funding?
Report on activities you are able to engage in, collaborations you have been able to build, or work that
you have been able to continue, because of the Disability Program Grant.
EXAMPLE: Prior to receiving Disability Program funds we could not provide adequate training or
education on serving victims/survivors with disabilities, nor was any other organization providing this
training or education. Through this grant, we were able to hire a person to conduct training for all
victim service agencies in our city about serving victims/survivors with disabilities.
EXAMPLE: After training all victim service agencies in the state on how to use TTYs, requests for
services from victims/survivors who are deaf or hard of hearing increased from 100 per year to 300 per
year.
Question 43 and 44 are optional.
Please limit your response to the space provided. (8,000 characters)
43. Provide any additional information regarding the effectiveness of your grant-funded activities.
If you have other data or information regarding the effectiveness of your Disability Program-funded
activities or information that would more fully or accurately reflect your grant activities than the data
you have been asked to provide on this form, answer this question.
EXAMPLE: Prior to this grant, we did not have collaborative relationships with any sexual assault or
domestic violence programs. Now, we meet with these groups on a monthly basis.

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44. Provide any additional information that you would like us to know about the data submitted.
If you have any information that could be helpful in understanding the data you have submitted in this
report, please answer this question. For example, if you submitted two different progress reports for the
same reporting period, you may explain how the data was apportioned to each report; or if you funded
staff—e.g., trainer, victim advocates, etc.—but did not report any corresponding training or victim
services activities, you may explain why; or if you did not use program funds to support either staff or
activities during the reporting period, please explain how program funds were used, if you have not
already done so.

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