Ucedd Ppr

ACL/CDC supplemental funding to Expand COVID-19 Vaccine Access for People with Disabilities
Public Burden Statement:
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 (OMB 0985-0030). Public reporting burden for this collection of information is estimated to average 1556 hours per response,
including time for gathering and maintaining the data needed and completing and reviewing the collection of information. The obligation to respond to this
collection is required to retain or maintain benefits.

Instructions for performance reporting for ACL/CDC supplemental funding to Expand COVID-19 Vaccine Access for People with Disabilities
Complete the tables of quantitative and qualitative data for service activities conducted between April 1, 2021 and September 30, 2022.
[question for ACL: how should UCEDDs respond/report on activities not yet conducted at the time this report will be due?
The report will be submitted July 30 and this funding period ends September 30. We'd like to ensure instructions reflect this.]
• Enter data for the full project period 4/1/21 through 9/30/22.
• Ensure that the information you enter is complete and correct.
• Enter the information in the column as specified in both Quantitative and Qualitative worksheets.
• If a list of valid values is provided, select only from these values. Do not add or change any values.
• Do not add or delete any columns in the worksheets.
•Do not change the sequence of the columns.
• Do not delete worksheets.
• In the Quantitative worksheet, enter digits only (no letters, punctuation, or symbols).
• In the Qualitative worksheet, enter up to 2,500 characters to describe your narrative, successes, and challenges for the service activities
completed. Completion of all service activities was not required. For service activities not completed, enter N/A.
• In the Qualitative worksheet, enter up to 2,500 characters to describe collaborations with ACL partners, collaborations with other
community-based organizations, lessons learned, and recommendations for future activities. These fields are not optional.
• In addition to completing this spreadsheet, include a project with related activities and products in NIRS to reflect this effort and
its associated leveraged funds.
• Direct any questions related to the completion of this spreadsheet to Dawn Rudolph at drudolph@aucd.org.
• Upload completed data sheets as an attachment in the annual UCEDD PPR due July 30, 2022.

Project Title
Center Name (select option)
Project Timeline
Service Activity
Education about the importance of
receiving a vaccine

Expand COVID-19 Vaccine Access for People with Disabilities

April 1, 2021 - September 30, 2022
Number of People Served
Number of people with disabilities
reached by your education activities
Number of all other people (including
family members, direct support
providers/workers, personal care
attendants, and other support providers)
reached by your education activities
Identifying people unable to independing Number of people unable to
independently travel to a site
travel to a vaccination site
Providing technical assistance (TA) to local Number of local health departments or
other entities assisted with TA on vaccine
health departments or other entities on
appointments
vaccine accessibility
Number of people helped in scheduling
Helping with scheduling a vaccine
appointment
vaccine appointments
Arranging or providing accessible
Number of people assisted with
accessible transportation to a vaccination
transportation
site
Number of people assisted with
Providing companion/personal support
companion/personal support to receive
vaccines
Number of people who needed and
Reminding people of their second
received a reminder of their second
vaccination appointment if needed
vaccination appointment
Overall outcome: Number of people vaccinated as a result of implementing one or more of the service activities
Number of people with disabilities vaccinated as a result of implementing one or
more of the service activities
Total number of all other people vaccinated as a result of implementing one or more
of the service activities

Project Title

Expand COVID-19 Vaccine Access for People with Disabilities

Center Name (select option)

Project Timeline

April 1, 2021 - September 30, 2022

Service Activity
Narrative
Education about the importance
of receiving a vaccine
Describe the type of education activities conducted (e.g., one on one assistance,
brochures/pamphlets/fliers, social media postings, social stories)

Successes

Challenges

Describe the most successful/effective education activities
implemented

Describe Challenges that limited your ability to
educate others about the importance of the vaccine

Identifying people unable to
independing travel to a
vaccination site

Describe the strategy to identify people unable
to independently travel to a vaccination site

Describe the most commonly cited
reasons for why they couldn't travel to the
site

Providing technical assistance
(TA) to local health departments Describe the type of strategies/TA activities to assist local health departments or other
entities on vaccine accessibility
or other entities on vaccine
accessibility

Describe successes achieved as a result of identifying people
Describe challenges that limited your ability to
unable to independently travel to a site (e.g., were such individuals identify people unable to independently travel to a
able to get vaccinated at an alternative site)
site

Describe successes achieved as a result of TA activities provided to
local health departments

provide technical assistance to local health
departments or other entities on vaccine
accessibility

Helping with scheduling a
vaccine appointment

Arranging or providing
accessible transportation

Providing companion/personal
support

Describe the type of activities used to assist people in scheduling vaccines

Describe successes achieved as a result of assistance provided to
help schedule vaccine appointments

Describe challenges that limited your ability to help
with scheduling a vaccine appointment

Describe the type of activities used to assist people with accessible transportation to a
vaccination site

Describe successes achieved as a result of accessible
transportation activities

Describe challenges that limited your ability to
arrange or provide accessible transportation

Describe the type of activites to provide companion/personal support services for people to
receive vaccines

Describe successes achieved as result of providing
companion/personal support services for people to receive
vaccines

Describe challenges that limited your ability to
provide companion/personal support

Reminding people of their
second vaccination appointment Describe the type of activities to provide people with reminders on their second vaccination Describe successes achieved as a result of providing reminders to
people on their second vaccination appointment
appointment
if needed

Describe challenges that limited your ability to
provide people reminders on their second
vaccination appointment

Collaboration with ACL partners (ADRCs, AAA, CIL, DDC, P&A, UCEDD)

Describe the nature of collaboration and joint activities with ACL partners, including successes and challenges in your collaboration efforts

Collaboration with other community-based organizations

Describe the collaboration and joint activities with other community-based organizations, including successes and challenges in your collaboration efforts

Overall lessons learned

Describe the leading key lessons learned, as a result of, your overall implementation activities

Recommendations for future activities

Provide recommendations for ACL to consider that will maximize the impact of future responses to disasters or pandemics

Demographic Data
Sexual Orientation:

Which of the following best
represents how you think of
yourself? [Select ONE]:
□ Lesbian or gay
□ Straight, that is, not gay or
lesbian
□ Bisexual
□ [If respondent is AIAN:] TwoSpirit*
□ I use a different term [freetext]**
□ (Don’t know)
□ (Prefer not to answer)

#

%

#

%

#

%

Gender Identity:

Q1: What sex were you assigned
at birth, on your original birth
certificate?
□ Female
□ Male
□ (Don’t know)
□ (Prefer not to answer)
Q2: What is your current
gender? [Select ONE]
□ Female
□ Male
□ Transgender
□ [If respondent is AIAN:] TwoSpirit*
□ I use a different term: [free
text]**
□ (Don’t know)
□ (Prefer not to answer)

UCEDD
AL - Civitan International Research Center & Sparks Clinics
AK - Center for Human Development
AR - Partners for Inclusive Communities
AZ - Institute for Human Development
AZ - Sonoran UCEDD
CA - Center for Excellence in Developmental Disabilities at the UC Davis MIND Institute
CA - Tarjan Center at UCLA
CA - USC UCEDD at the Children's Hospital Los Angeles
CO - JFK Partners School of Medicine
CT - A.J. Pappanikou Center for Excellence in Developmental Disabilities
DC - Georgetown UCEDD Center for Child and Human Development
DE - Center for Disabilities Studies
FL - Florida Center for Inclusive Communities
FL - Mailman Center for Child Development
GA - Center for Leadership in Disability
GA - Institute on Human Development and Disability
GU - Guam CEDDERS
HI - Center on Disability Studies
IA - Iowa's University Center for Excellence on Disabilities
ID - Idaho Center on Disabilities and Human Development
IL - Institute on Disability and Human Development
IN - Indiana Institute on Disability and Community
KS - Kansas University Center on Developmental Disabilities
KY – Human Development Institute
LA - Louisiana UCEDDERS
MA - Eunice Kennedy Shriver Center
MA - Institute for Community Inclusion
MD - Maryland Center for Developmental Disabilities
ME – Center for Community Inclusion and Disability Studies
MI - Michigan Developmental Disabilities Institute
MN - Institute on Community Integration
MS - Institute for Disability Studies
MO - UMKC Institute for Human Development
MT - The Rural Institute for Inclusive Communities
NC - Carolina Institute for Developmental Disabilities
ND - North Dakota Center for Persons with Disabilities
NE - Nebraska UCEDD
NH - Institute on Disability
NJ - The Boggs Center on Developmental Disabilities
NM - Center for Development and Disability
NV - Nevada Center for Excellence in Disabilities
NY - Rose F. Kennedy University Center for Excellence in Developmental Disabilities
NY - Strong Center for Developmental Disabilities
NY – Westchester Institute for Human Development

OH - Nisonger Center
OH - University of Cincinnati University Center for Excellence in Developmental Disabilities
OK - Center for Interdisciplinary Learning and Leadership
OR - Institute on Development & Disability
OR - University of Oregon UCEDD
PA - Institute on Disabilities
PB - Pacific Basin UCEDD
PR - Puerto Rico University Center for Excellence on Developmental Disabilities
RI - Paul V. Sherlock Center on Disabilities
SC - Center for Disability Resources
SD - Center for Disabilities
TN - Center on Developmental Disabilities
TN - Vanderbilt Kennedy Center for Excellence in Developmental Disabilities
TX - Center for Disability Studies
TX - Center on Disability and Development
UT - Institute for Disability Research, Policy, & Practice
VA - Partnership for People with Disabilities
VI - Virgin Islands University Center for Excellence in Developmental Disabilities
VT - Center on Disability and Community Inclusion
WA - Center on Human Development and Disabilities
WV - Center for Excellence in Disabilities
WI - Waisman Center
WY - Wyoming Institute for Disabilities (WIND)