Formative Data Collections for American Rescue Plan (ARP) Act Culturally Specific Domestic Violence and Sexual Assault Supplemental Funding Survey

American Rescue Plan Act

Culturally Specific Domestic Violence and Sexual Assault Supplemental Funding Survey

Specific Special Issue Resource Centers (CSSIRCs), Alaska Native Tribal Resource Center (ANTRC), and National Indian Resource Center Addressing Domestic Violence (NIRC)

Office of Family Violence Prevention and Services

Administration for Children and Families

Thank you for your participation. In an effort to assess implementation of the ARP Act supplemental funding, we would like to request your participation in this survey. The information provided will be used to improve the Office of Family Violence Prevention and Services (OFVPS) training and technical assistance provided to you as a grantee. Please note your participation in this feedback survey is required, and the information provided will be kept private.

Paperwork Reduction Act of 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average one hour per response, including the time for reviewing instructions.

Please only include information that is funded through the ARP supplemental funding and do not include information that is funded exclusively with FVPSA core annual funding. You may find you have not provided services using ARP funding, so the answer “No” or “O” is acceptable for those questions or categories.

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. The OMB # is 0970-0531 and the expiration date is 09/30/2025. If you have any comments on this collection of information, please contact Sabrina Peña at sabrina.pena@acf.hhs.gov and Holi Dahl at Holi.Dahl@acf.hhs.gov.

Organizational and Program Information

Name of Organization: _________________________________________________________

Staff Name Completing Survey and Title: ___________________________________________

Contact Phone: ____________________ Contact Email: ______________________________

Workforce Support and Capacity Building

Total number of staff paid using ARP Act supplemental funding:

Instructional Note: Each full-time paid staff member should equal 1. If an employee is part-time, please use the numeric value of 0.5.

	Total
Total number of staff paid using ARP supplemental funding

Please share the type and total number of staff paid using FVPSA ARP supplemental funding:

Instructional Note: Each full-time paid staff member should equal 1. If an employee is being paid from more than one category, use fractions to denote the allotted time in each (i.e., 0.5 or 0.33). Please enter 0 in in fields that do not apply.

	Total
ARP DV Services Funding
ARP COVID-19 Testing, Vaccines, Mobile Health Units Funding
ARP Sexual Assault Services Funding
Total	[Auto Sum]

Types of workforce capacity building and supports being implemented with ARP supplemental funding.

	Please indicate if your ARP grant funds are supporting this support [Yes/No]	Please indicate the number of staff impacted
Hired more FVPSA funded staff
Trained staff on COVID-19 mitigation activities: implementation of mobile advocacy services; or virtual/remote services implementation
Hired bi-lingual staff
Hired data collection staff/consultant
Paid Interns
Hired COVID-19 mitigation staff/consultant
Hiring bonuses
Retention payments
Childcare
Transportation subsidies
Wellness services (employee assistance programs, onsite fitness center, yoga classes, smoking prevention, nap space, etc.)
Health services (health insurance, prescriptions, chiropractic care, vision, dental, etc.)
Contracted with an employment agency
Other		[Open Text ]

Sub-recipients and Services

Number of sub-recipients by program type:

	Total
Culturally Specific Domestic Violence Program
Culturally Specific Sexual Assault Program
Total	[Auto Sum]

Sub-recipients List

Sub-recipients Name	City	State	Zip	Website	FVPSA Funding Amount	Type of Sub-recipient SA or DV	Underserved or culturally- and linguistically specific population1-	Classification of urban, rural, suburban or frontier2

Client Demographics

Total number of clients reached by program type:

Instructional Note: Report on all ARP participants that are served with this funding.

Program Type	Total
Domestic Violence Program Only
Sexual Assault Program Only
Both Domestic Violence and Sexual Assault Programs
Domestic Violence Program Only	[Auto Sum]

Total number of clients reached by ethnicity:

Race/Ethnicity	Total
Black or African American
American Indian / Alaskan Native
Native Hawaiian / Other Pacific Islander
Asian/Asian American
Caucasian or White
Hispanic or Latino
Unknown Race / Ethnicity
Other (Please Specify)
Total	[Auto Sum]

Total number of clients reached by underserved type:

Clients reached by underserved type	Total
Person with a Disability
Formerly Incarcerated
Immigrant or Refugee
Limited English Proficiency (LEP)
Clients needing Language Translation Services
LGBTQ/Two Spirited
Faith-Based
Rural Geographically Isolated
Youth ages 13-17 receiving services due to being a victim of dating violence
Youth ages 13-17 receiving services due to being a victim of sexual assault

Total number of clients reached by age:

Age	Total
0-12
13-17
18-24
25-59
60 +
Unknown Age
Total	[Auto Sum]

Remote/Virtual Supportive Services

Total number of clients reached through remote/virtual services:

What challenges do survivors face in utilizing remote/virtual services for urban or rural clients? (check all that apply)

	Urban	Rural
None
Lack of available internet connection
Lack of a high-speed internet account
Lack of a phone/data plan to talk on phone
Lack of a device with camera and microphone
Lack of digital proficiency
Cognitive impairment
Language/translation needs
Hearing impairment
Lack of private quiet place that is safe
Distrust of technology
Other (comment box, "Please specify")

Rental Assistance and Hotel/Motel Vouchers

Total number of technical assistance contacts provided for shelter, temporary refuge: rental assistance and hotel/motel vouches

	Total TA Contacts
Shelter alternatives
Rental assistance
Hotel/motel vouchers
Other

Rental Assistance and Hotel/Motel Partnerships

Please tell us more about the partnerships that your organization/agency has related to rental assistance and temporary refuge to increase housing supports for survivors. Total number of partnerships related to temporary refuge: shelter alternatives, rental assistance, and hotel/motel vouches.

	Total Number of Partners
Public housing agency
Rental company
Hotels/motels
Private landlords
Faith-based organization providing housing
Tribal program providing housing
Culturally specific organization providing housing
Homeless services provider
Housing agency
Other

COVID-19 Supportive Services

For each type of allowable supportive service, or items provided:

	Total
Mobile advocacy client sessions conducted
PPE items provided
Client vaccinations assistance
Testing assistance

For the COVID-19 medical emergency, total number of telehealth clients provided support by program type:

	Domestic Violence Total	Sexual Assault Total
Telehealth Clients

Training and Technical Assistance

Training and technical assistance topics support needed: (check all that apply)

	Training Needed	Technical Assistance Needed
Assessing, planning, adapting workforce capacity
Assessing, planning, adapting organizational programs/processes
Assessing, planning, adapting supportive services
Assessing, planning, adapting client risks
Supporting underserved populations
Supporting culturally specific populations
Providing mobile advocacy
Providing remote/virtual services
Providing sexual assault supportive services
Providing mobile health unit services including contracted
Providing linguistically appropriate services, referrals, and staff
Providing culturally specific services, referrals, and staff
COVID-19 testing activities
Provisioning virus testing supplies
COVID-19 contact tracing
COVID-19 education
COVID-19 vaccine promotion or confidence building
Support services for acute virus infection symptoms
Providing telehealth direct crisis intervention services
Innovating new service pilots
Improving current processes and/or best practices
Removing barriers
Improving collaboration with established partners
Developing new partnerships
Flexible funding
None
Other (comment box, "Please specify") [Open Text]

Total number of training and technical assistance resources topics developed and/or distributed:

	Developed Total	Distributed Total
Assessing, planning, adapting workforce capacity
Assessing, planning, adapting organizational programs/processes
Assessing, planning, adapting supportive services
Assessing, planning, adapting client risks
Supporting underserved populations
Supporting culturally specific populations
Providing mobile advocacy
Providing remote/virtual services
Providing sexual assault supportive services
Providing mobile health unit services including contracted
Providing linguistically appropriate services, referrals, and staff
Providing culturally specific services, referrals, and staff
COVID-19 testing activities
Provisioning virus testing supplies
COVID-19 contact tracing
COVID-19 education
COVID-19 vaccine promotion or confidence building
Support services for acute virus infection symptoms
Providing telehealth direct crisis intervention services
Innovating new service pilots
Improving current processes and/or best practices
Removing barriers
Improving collaboration with established partners
Developing new partnerships
Flexible funding
None
Other (comment box, "Please specify") [Open Text]

Accomplishment Highlights:

Share an accomplishment that demonstrates how implementation of this funding is support survivors. Please do NOT share personally identifiable information.

Title of Accomplishment:

Accomplishment Category:

	Type Please check box for the innovation
Survivor engagement, services, or support impact
Health and domestic violence impact
Health and sexual assault impact
Mental health impact
Substance use impact
Mobile services impact
Virtual services impact
Culturally specific communities impact
LGBTQ communities impact
American Indian and Alaska Native services impact
Youth services impact
COVID mitigation impact
Other [Open Text]

Story Link: Please provide the story website link or resource link if one is available.

Story Narrative:

Spending Challenges

What challenges do you experience spending ARP Act supplemental funds? (check all that apply)

	Implementation
	Difficulty finding appropriate/sufficient shelter
	Difficulty finding appropriate/sufficient sub-awardees
	Difficulty implementing remote/virtual services
	Difficulty finding ARP activity authorized supplies
	Difficulty implementing mobile advocacy services
	Difficulty implementing telehealth or mobile health services
	Difficulty implementing innovative services
	Difficulty finding appropriate/sufficient workforce

	Funding
	Having sufficient other funds to expend prior to ARP funds
	Difficulty identifying appropriate ARP and COVID-19 risk mitigating activities
	Complications of tracking and allocating funds from multiple grants simultaneously
	Difficulty drawing down funds through the Payment Management System

	Regulatory or Policy limitations
	Having to use other to use funds that expire before using ARP funds
	Local regulations limiting spending flexibility
	State regulations limiting spending flexibility
	Federal regulations limiting spending flexibility
	Tribal government/Tribal Council approval is pending, delayed, or was denied.

	NONE
	Other (Please Specify)

1 Please select in which population the subawardee primarily serves.  Culturally and linguistically specific services refers to community-based services that offer full linguistic access and culturally specific services and resources, including outreach, collaboration and support mechanisms primarily directed toward culturally specific communities.  Underserved populations means populations who face barriers in accessing and using victim services, and includes populations underserved because of geographic location, religion, sexual orientation, gender identity, underserved racial and ethnic populations, and populations underserved because of special needs including language barriers, disabilities, immigration status, and age. Individuals with criminal histories due to victimization and individuals with substance use disorders and mental health issues are also included in this definition (45 CFR § 1370.2). ]   

2 ² To determine if a program is designated as frontier, go to www.ruralhealthinfo.org.  Click on the Am I Rural? Tool.  Run a report based on the program address.  If the program receives a Frontier and Remote Area Code, then you may select frontier.] 

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