Form 4 Barriers to Service Delivery and Monitoring Form

Trafficking Victim Assistance Program (TVAP) Data

FY24 TVAP Performance Indicators_Clean

Barriers to Service Delivery and Monitoring Form

OMB: 0970-0467

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Trafficking Victims Assistance Program (TVAP) Performance Indicators

The Trafficking Victim Assistance Program (TVAP) is inclusive of four distinct programs: the Trafficking Victim Assistance Program (TVAP), Aspire: Child Trafficking Victim Assistance Demonstration Program, Victims of Human Trafficking Services and Outreach Program – Pacific Region Demonstration Program (VHT-SO Pacific Program), and Lighthouse: Services, Outreach, and Awareness for Labor Trafficking (Lighthouse) Demonstration Program. The performance indicators described below are applicable to all four TVAP programs. TVAP award recipients must provide the following program performance indicator data to OTIP on a quarterly and annual basis, as indicated. Award recipients will be provided with the following information when requesting data:

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gather data on the grant program to assess program performance, inform evaluation efforts, tailor technical assistance for recipients, respond to inquiries from stakeholders, and inform policy and program development. Public reporting burden for this collection of information is estimated to average XX hours per grant recipient, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is required to retain a benefit (22 U.S.C. 7105, Trafficking Victims Protection Act). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0467 and the expiration date is 2/28/2026. If you have any comments on this collection of information, please contact Vera Soto, Office on Trafficking in Persons, by email at Vera.Soto@acf.hhs.gov.

Quarterly Reports

Victim Assistance – Client Characteristics and Program Entry (Public reporting burden for this collection of information is estimated to average 0.75 hours per grant recipient)

  • Intake Date

  • Referral Date

  • Referral Source

    • Child Protective Services/Child Welfare [Aspire only]

    • Court

    • District Attorney/State's Attorney/Victim Assistance

    • Defense Attorney/Public Defender/Legal Aid

    • Domestic Violence Agency/Shelter

    • Educator/Teacher/School

    • Employer

    • Family Member/Guardian

    • Friend/Peer/Acquaintance

    • Health Care Provider

    • Housing Assistance Agency/Shelter

    • Juvenile Justice [Aspire only]

    • Law Enforcement

    • National Human Trafficking Hotline (NHTH)

    • Other National Hotline

    • Psychiatric Treatment Facility

    • State/Local Hotline

    • Religious Organization

    • Self

    • Other (specify)

  • Type of Trafficking

    • Sex

    • Labor

    • Sex and Labor

    • Unknown

  • Does the client have family members receiving services from grant recipient?

    • Yes

    • No

  • Grant Eligibility Status

    • Pre-Certified Foreign National

    • Certified Foreign National

    • U.S. Citizen/Lawful Permanent Resident

  • Country of Origin

  • Age

  • Gender Identity

    • Male

    • Female

    • Transgender

    • Client uses a different term (specify)

    • Unknown

    • Prefer not to answer

  • Sexual Orientation

    • Straight or heterosexual

    • Gay

    • Lesbian

    • Bisexual

    • Client uses a different term (specify)

    • Unknown

    • Prefer not to answer

  • Does the client have a disability?

    • Ambulatory Difficulty

    • Cognitive Difficulty

    • Hearing Difficulty

    • Self-Care Difficulty

    • Vision Difficulty

  • Race/Ethnicity

    • American Indian or Alaska Native

    • Asian

    • Black or African American

    • Native Hawaiian or Other Pacific Islander

    • White

    • Hispanic or Latino

    • Other (specify)

    • Unknown

  • Living Situation at Intake

    • Emergency Housing

    • Institutional Housing

    • No Housing/Place not meant for habitation

    • Permanent Housing

    • Transitional Housing

    • Unknown

  • If client is a minor, are they enrolled in school? [Aspire only]

    • Yes

    • No

  • Location of Services

    • State/Territory

    • Remote

  • Location of Trafficking

    • State/Territory

    • Country

  • Exploitation Industry/Venue

    • Agriculture/Field Labor

    • Auto-Mechanic/Auto-Shop/Car Repair

    • Arts/Entertainment

    • Bar/Cantina/Nightclub

    • Begging/Peddling

    • Carnival

    • Carpentry/Woodworking

    • Cobbling

    • Commercial Cleaning

    • Commercial Sex

    • Construction

    • Domestic Work

    • Elder Care

    • Escort Services

    • Factories/Manufacturing

    • Fishing

    • Forced Criminal Activities

    • Forestry/Logging

    • Garment/Textiles

    • Herding/Livestock

    • Health/Beauty

    • Health Care

    • Herding Livestock/Animal Husbandry

    • Hotel/Hospitality

    • Illicit Massage/Health

    • Landscaping

    • Mining/Quarrying

    • Other (specify)

    • Personal Sexual Servitude

    • Production of Child Sexual Abuse Material (CSAM)

    • Recreation/Sports

    • Religious Institution

    • Restaurant/Food Service

    • Retail Sales

    • Stripping/Dancing

    • Transportation

    • Traveling Sales Crew

    • Waste Management/Recycling

    • Not Reported

  • Commercial Sex Venue

    • Commercial Space-Based

    • Institution-Based

    • Technology-Based

    • Outdoor/Street-Based

    • Residence-Based

    • Not Reported

Victim Assistance – Barriers to Service Delivery and Monitoring (Public reporting burden for this collection of information is estimated to average 0.167 hours per grant recipient)

  • Feelings of No Support and Isolation

  • Ineffective Coordination with Federal Agencies

  • Ineffective Coordination with Local Agencies

  • Lack of Adequate Funding

  • Lack of Adequate Resources

  • Lack of Adequate Training

  • Lack of Cooperation of Client

  • Lack of Formal Rules and Regulations

  • Lack of In-House Procedures

  • Lack of Knowledge of Victims’ Rights

  • Language Concerns

  • Public Health Concerns

  • Safety Concerns

  • Victims’ Legal Status

  • Other Services (specify)

  • None

Victim Assistance – Client Case Closure (Public reporting burden for this collection of information is estimated to average 0.167 hours per grant recipient)

  • Case Closure Date

  • Reason for Case Closure

    • Client relocated

    • Client unable to meet program expectations

    • Determined not eligible

    • Incarcerated and out of contact with program

    • Lost contact

    • No longer in need of services

    • Time limitations of the program

    • Transfer to another service program

    • Other (specify)

  • Living Situation Upon Case Closing

    • Emergency Housing

    • Institutional Housing

    • No Housing/Place not meant for habitation

    • Permanent Housing

    • Transitional Housing

    • Unknown

  • Did the client obtain Continued Presence or a T Visa?

    • Continued Presence

    • Bona Fide T Visa

    • T Visa

    • Unknown

  • Did the client obtain HHS Certification or Eligibility?

    • Yes

    • No

  • Did the client receive a referral for continued case management services?

    • Yes

    • No

Victim Outreach (Public reporting burden for this collection of information is estimated to average 0.3 hours per grant recipient)

  • Number of public awareness activities conducted

  • Number of outreach activities conducted

  • Outreach Settings

    • Agricultural Settings

    • Casinos

    • Commercial Establishments

    • Consulates

    • Court-Based Settings

    • Day Labor Settings

    • Detention Settings

    • Digital: Social Media

    • Digital: Other

    • Education Settings

    • Factories

    • Health Care Settings

    • Homeless Encampments

    • Hotel/Hospitality Settings

    • Massage Parlors

    • Shelter Settings

    • Street Settings

    • Strip Clubs

    • Youth Care Settings

    • Other (specify)

  • Target Population(s)

    • 2SLGBTQIA+ Populations

    • Alaska Native/Indigenous Populations

    • Asian American/Pacific Islander Populations

    • Black Populations

    • Boys and Men

    • Direct Care Workers

    • Hispanic or Latino Populations

    • People with Disabilities

    • People who Live in Rural Communities

    • Religious Minority Populations

    • Runaway Homeless Youth Populations

  • Number of Victims Identified

Subrecipient Enrollment (Public reporting burden for this collection of information is estimated to average 0.167 hours per grant recipient)

  • Name of Subrecipient Organization

  • Location of Subrecipient Organization

    • City

    • State

  • Type of Subrecipient Organization

    • Advocacy

    • Behavioral Health

    • Child Welfare

    • 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)

  • Number of Subrecipient Service Sites

  • Services Provided by Subrecipient

    • Basic Necessities

    • Case Management

    • Child Care

    • Crisis Intervention

    • Education Assistance

    • Employment Assistance

    • Family Reunification

    • Financial Assistance

    • Healthcare

    • Housing/Shelter Services

    • Interpreter/Translator

    • Legal Advocacy and Services

    • Life Skills

    • Mental/Behavioral Health Services

    • Medical Services

    • Peer-to-Peer Support/Mentoring

    • Safety Planning Services

    • Substance Use Assessment/Treatment

    • Traditional Healing/Cultural Practices

    • Transportation

    • Victim Advocacy

    • Other Services (specify)

    • None

    • Unknown

  • Enrollment Date

  • Exit Date



Annual Performance Indicator Report

Victim Assistance – Client Service Use and Delivery (Public reporting burden for this collection of information is estimated to average 0.25 hours per grant recipient)

  • Services Received

    • Basic Necessities

    • Case Management

    • Child Care

    • Crisis Intervention

    • Education Assistance

    • Employment Assistance

    • Family Reunification

    • Financial Assistance

    • Healthcare

    • Housing/Shelter Services

    • Interpreter/Translator Services

    • Legal Advocacy and Services

    • Life Skills

    • Mental/Behavioral Health Services

    • Peer-to-Peer Support/Mentoring

    • Safety Planning Services

    • Substance Use Assessment/Treatment

    • Traditional Healing/Cultural Practices

    • Transportation

    • Victim Advocacy

    • Other Services (specify)

    • None

    • Unknown

  • Benefits Received

    • Child Care Subsidy

    • General Assistance

    • Medicaid

    • ORR Match Grant

    • ORR Targeted Assistance Grant (TAG)

    • ORR Unaccompanied Children (UC) Program

    • ORR Unaccompanied Refugee Minors (URM) Program

    • ORR Wilson/Fish Program

    • Refugee Cash Assistance

    • Refugee Medical Assistance

    • Refugee Social Services

    • Section 8/Permanent Housing Assistance

    • SNAP (Food Stamps)

    • State-specific Health Benefits

    • Social Security Disability (SSI or SSDI)

    • Temporary Assistance for Needy Families

    • Unemployment Insurance

    • WIC

    • Other (specify)

    • None

    • Unknown

Categories of Assistance (Public reporting burden for this collection of information is estimated to average 0.5 hours per grant recipient)

  • Total number of clients who received services under each category of assistance

  • Total dollars spent on each category of assistance

  • Percentage of recipient’s budget spent on each category of assistance

  • Total grant recipient budget for project

  • Categories of Assistance

    • Basic Necessities

    • Case Management

    • Childcare

    • Crisis Intervention

    • Education Assistance

    • Employment Assistance

    • Family Reunification

    • Financial Assistance

    • Healthcare

    • Housing/Shelter Services

    • Interpreter/Translator

    • Legal Advocacy and Services

    • Life Skills

    • Mental/Behavioral Health Services

    • Peer-to-Peer Support and Mentoring

    • Safety Planning Services

    • Substance Use Assessment/Treatment

    • Traditional Healing/Cultural Practices

    • Transportation

    • Victim Advocacy

    • Other Services

    • None




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKimberly Casey
File Modified0000-00-00
File Created2023-10-29

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