Example SOAR Demonstration Grant Program Reporting Workbook 3.15.23.xlsx

SOAR Demonstration Grant Program Data

Example SOAR Demonstration Grant Program Reporting Workbook 3.15.23.xlsx

OMB: 0970-0609

Document [xlsx]

Download: xlsx | pdf

Overview

Q. Provider Capacity Building
Q. Client Demographics
Q. HTRP
Q. Network Providers
Q. Training Feedback Form
FY.Categories of Assistance

Sheet 1: Q. Provider Capacity Building

Training Reporting Summary

Grant Recipient Name:

Total HT 101 Trainings

Grant Number:

Total Trauma Informed Care Trainings

Report Type:

Total Partnership Building Trainings

Report Period:

*Do not edit data in the table above. Counts will automatically update.

Total Trainings Delivered:

Total Providers Trained:

OMB Control Number: 0970-NEW
Expiration Date: XX/XX/XXXX

Training Reporting

As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.

number

Human Trafficking 101: Definition, Types, Laws, and Indicators

Federal definition of severe forms of trafficking in persons

State and tribal anti-trafficking laws and legal considerations for a specific geographic area

Information about human trafficking, including types of human trafficking and recruitment and/or
retention tactics used by traffickers; indicators that a person may be experiencing human trafficking

Case studies of individuals who have experienced human trafficking

Approaches, Strategies, and Special Considerations for Working with Victims (e.g. Trauma Informed Care)

Safety protocols for those in direct contact with individuals potentially experiencing human trafficking

Please reference the Reporting Reference Guide (p.X-XX) to populate this table.

Services and benefits available for individuals who have experienced human trafficking

Special considerations for both domestic and foreign national minors experiencing human trafficking, which may
include relevant legal and social welfare systems, such as juvenile justice, immigration, and child welfare

Human Trafficking 101: Definition, Types, Laws, and Indicators

How to deliver person-centered, trauma-informed services and assistance to individuals who have experienced human trafficking

Housing and employment needs of individuals who have experienced human trafficking

Intersectionality between race and human trafficking

Intersectionality between sexual orientation, gender identity, and human trafficking

Intersectionality between individuals with disabilities and human trafficking

Intersectionality between human trafficking and forced criminality

Building a Community Referral Network and Partnership Building

Referral protocols within a continuum of care for aftercare and ongoing service needs

Information about local continuums of care or multidisciplinary anti-trafficking task forces

Processes by which organizational partnerships are developed and maintained

Post-identification reporting and referral protocols

Provider Type

Individuals Trained by Prime Recipient Providers

Individuals Trained by Subrecipient Providers

Individuals Trained by Partner Organization Providers

Sheet 2: Q. Client Demographics

Client Demographics

Grant Recipient Name:

Grant Number:

number

Report Period:

Client Demographics
(All Providers)

Number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client age

Adult

OMB Control Number: 0970-NEW
Expiration Date: XX/XX/XXXX

Minor

Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client race/ethnicity

American Indian or Alaska Native (AIAN)

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Hispanic or Latino

Other

Not Reported

Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client current gender identity

NOTE: Award recipients will be required to obtain this information from clients/patients utilizing NASEM’s recommended two-step question and to report information to OTIP in the aggregate. Write-In responses to “I use a different term: [free text]” will not be provided to OTIP. Rather, the recipients will report the total number of individuals who elected to write in an option. “Not Reported” will reflect the count of clients/patients who selected “Prefer not to answer". See Reporting Reference Guide for additional operational guidance.

Female

Male

Transgender

Please reference the Reporting Reference Guide (p.X-XX) to populate this table.

Two-Spirit

Different term

Don’t know

Not Reported

Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client sexual orientation

Lesbian or gay

NOTE: Award recipients will be required to obtain this information from clients/patients utilizing NASEM’s recommended question and to report information to OTIP in the aggregate. Write-In responses to “I use a different term: [free text]” will not be provided to OTIP. Rather, the recipients will report the total number of individuals who elected to write in an option. “Not Reported” will reflect the count of clients/patients who selected “Prefer not to answer". See Reporting Reference Guide for additional operational guidance.

Straight, that is, not gay or lesbian

Bisexual

Two-Spirit

Different term

(Don’t know)

Not Reported

Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client disability status

Ambulatory Difficulty

Cognitive Difficulty

Hearing Difficulty

Independent Living Difficulty

Self-Care Difficulty

Vision Difficulty

Not Reported

Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client preferred language

Prefer to be served in English

Prefer to be served in a language other than English

Sheet 3: Q. HTRP

Human Trafficking Response Protocol (HTRP)

Grant Recipient Name:

Grant Number:

number

Report Period:

Implementation Summary

Total number of providers coordinating care within the recipient's multidisciplinary network

Number of clients screened by providers within multidisciplinary network

Number of clients identified as potential victims of HT based on screening conducted by
providers within recipient’s multidisciplinary network by type of trafficking experienced

Sex

As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 2.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.

Labor

Sex and Labor

Not Reported

Number of clients enrolled in services by providers within recipient’s multidisciplinary network
by type of trafficking experienced

Sex

Labor

Sex and Labor

Not Reported

Total number of clients referred to providers within the recipient’s multidisciplinary network

Total number of clients referred to providers external to the recipient’s multidisciplinary network

Check all that apply

Barriers to Service Delivery and Implementation

Client/Patient Constraints

Affordability

Accommodation

Availability

Accessibility

Acceptability

Not Specified

Safety Concerns

Feelings of No Support and Isolation

Excluded from key decision-making opportunities

Experiences of bias or discrimination as it pertains to [insert leadership, practice, policy]
(e.g., gender, race, ethnicity, sexual orientation)

Feeling undervalued or not perceived as a leader in my organization

Lack of authority to use new skills in current position

Ineffective Coordination with Agencies and Providers

Difficulty coordinating with benefits-issuing agencies

Difficulty establishing/maintaining multidisciplinary team (MDT)

Lack of data sharing among organizations

Lack of shared responsibility across organizational collaborators

Need for partnership building with other orgs

Variation in mission/regulatory frameworks when partnering with other organizations

Lack of Adequate Funding

Lack of Adequate Resources

Competing priorities

Frequent staff turnover

Lack of senior leadership support

Lack of support/accountability from frontline staff

Lack of time to implement changes

Lack of urgency

Shortage of key personnel (including clinician shortage issues)

Lack of Adequate Training

Lack of accessible research/information

Lack of training for staff on how to implement change

Lack of Formal Rules and Regulations

Lack of Procedures

Lack of Knowledge of Victims’ Rights

Public Health Concerns

Sheet 4: Q. Network Providers

Grant Recipient Name:

Please reference the Reporting Reference Guide (p.X-XX) to populate this table.

Grant Number:

Report Type:

Report Period:

OMB Control Number: 0970-NEW
Expiration Date: XX/XX/XXXX

As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 0.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.

Multidisciplinary Network Providers

open text

Y/N

open text

Kiefer, Vera J.: Advocacy Behavioral Health Child Welfare Community Member Education Employment Faith Based Government Health Care Housing Law Enforcement Legal Other Criminal Justice Private Sector Public Health School (K-12) Service Provider Other (specify) open text, refer to field value options

open text

number

Kiefer, Vera J.: Basic Necessities Child Care Dental Health Services Education Assistance Employment Assistance Family Reunification Financial Assistance Housing/Shelter Services Interpreter/Translator Legal Advocacy and Services Life Skills Training Mental/Behavioral Health Services Medical Services Safety Planning Services Substance Use Assessment/Treatment Transportation Victim Advocacy Other Services (specify) None open text, refer to field value options

open text

mm/dd/yyyy

Name of Partnering Organization

Is the partner organization a subrecipient?

Location of Organization
(City)

Location of Organization
(State)

Type of Partner Organization

If Type of Organization 'Other', Specify

Number of Partner Organization Service Sites

Services Provided by Partner Organization

If Services Provided by Partner Organization 'Other', Specify

Enrollment Date

Exit Date

SampleOrg

Washington

Advocacy

Legal Advocacy and Services

Immigration Relief

9/29/2020

Sheet 5: Q. Training Feedback Form

Separate PDF based form; obtained through SOAR/NHTTAC implementation

See TAB F: SOAR Demonstration Grant Participant Training Feedback Form

Average Burden Hours per Response: 0.75 hours

Sheet 6: FY.Categories of Assistance

SOAR Demonstration Grant Program Data
Grant Recipient: (Name of Organization)
As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 2.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.
Case Management Categories of Assistance	OTIP: Record the number of clients who received each type of service during the reporting period. Number of Clients	OTIP: Record the amount of grant funds spent on each type of service (e.g. spending on rent for clients, purchasing groceries for clients, funds spent on client's medical expenses, etc.) Total Funds Spent	% of Project Budget
Basic Necessities		$-	#DIV/0!
Case Management		$-	#DIV/0!
Child Care		$-	#DIV/0!
Coordination with Benefit Issuing Agencies		$-	#DIV/0!
Coordination with Child Welfare/Child Protective Services		$-	#DIV/0!
Coordination with Migrant Health Programs		$-	#DIV/0!
Crisis Intervention		$-	#DIV/0!
Education Assistance		$-	#DIV/0!
Employment Assistance		$-	#DIV/0!
Family Reunification		$-	#DIV/0!
Financial Assistance		$-	#DIV/0!
Healthcare		$-	#DIV/0!
Housing/Shelter Services		$-	#DIV/0!
Interpreter/Translator		$-	#DIV/0!
Legal Advocacy and Services		$-	#DIV/0!
Life Skills		$-	#DIV/0!
Mental/Behavioral Health Services		$-	#DIV/0!
Other Services (specify)		$-	#DIV/0!
Peer-to-Peer Support/Mentoring		$-	#DIV/0!
Safety Planning Services		$-	#DIV/0!
Substance Use Assessment/Treatment		$-	#DIV/0!
Transportation		$-	#DIV/0!
Victim Advocacy		$-	#DIV/0!
Total Direct Services Spending		$-
Khaila Montgomery: Record the amount of grant funds spent on direct services staff administering each type of service (e.g. salary and benefits of case management staff, office space for direct services staff, travel reimbursement for direct services staff, etc.) Total Case Management Spending		$-
Khaila Montgomery: Program administration spending includes funds allocated to administering the grant (e.g., cost of site visits, travel, salaries for administrative staff, etc.). This category excludes funds spent on case management or direct services. Total Program Administration Spending		$-
Khaila Montgomery: The total amount grantee was awarded by OTIP to fund project activities during the fiscal year Total Grant Recipient Budget		$-

File Type	application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified	0000-00-00
File Created	0000-00-00