Beneficiary Report - Beneficiaries

---

Overview

PRA Statement
Instructions
Cover Page
Child Characteristics
Caregiver Information
Family Characteristics
Outcomes

---

Sheet 1: PRA Statement

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 4 hour per
response, including the time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information.
OMB Approval Number: 0970-0642
Expiration Date: 04/30/2028
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.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.

---

Sheet 2: Instructions

---

Sheet 3: Cover Page

Name of Grant Recipient
Grant Number	90EDA____
Reporting Period

---

Sheet 4: Child Characteristics

Item	Description	Number of Children Newly Enrolled During This Reporting Period	Notes
CT	Total Number of Children Receiving Diapers:
Item	Age at Enrollment for Children Receiving Diapers	Number of Children Newly Enrolled During This Reporting Period	Notes
CA1	Not yet born
CA2	Newborn - 3 months
CA3	4 - 6 months
CA4	7 - 9 months
CA5	10 - 12 months
CA6	13 - 15 months
CA7	16 - 18 months
CA8	19 - 23 months
CA9	2 years
CA10	3 years
CA11	4 years
CA12	5 - 7 years
CA13	8 - 11 years
CA14	12 - 14 years
CA15	15+ years
CAU	Unknown
CAT	TOTAL (automatically sums)	0
Item	Race or Ethnicity for Children Receiving Diapers	Number of Children Newly Enrolled During This Reporting Period	Notes
CR1	American Indian or Alaskan Native
CR2	Asian
CR3	Black or African American
CR4	Hispanic or Latino
CR5	Middle Eastern or North African
CR6	Native Hawaiian or Other Pacific Islander
CR7	White
CRU	Unknown
CRT	TOTAL KNOWN (cell does not autosum because caregivers can select multiple race and ethnicity options.)
Item	DDDRP Children Enrolled in Early Head Start or Head Start	Number of Children Newly Enrolled During This Reporting Period	Notes
CE1	Yes
CE2	No
CEU	Unknown
CET	TOTAL (automatically sums)	0
Item	Children Under-Age for Kindergarten Receiving Diapers that Attend Childcare	Number of Children Newly Enrolled During This Reporting Period	Notes
CC1	Yes
CC2	No
CC3	Other
CCU	Unknown
CCT	TOTAL (automatically sums)	0

---

Sheet 5: Caregiver Information

Item

Description

Number of Caregivers Newly Enrolled During This Reporting Period

Notes

GT

Total Number of Caregivers:

Item

Age

Number of Caregivers Newly Enrolled During This Reporting Period

Notes

GA1

Under 18

GA2

18 - 24

GA3

25 - 34

GA4

35 - 44

GA6

45 - 64

GA7

65 +

GAU

Unknown

GAT

TOTAL (automatically sums)

0

Item

Sex

Number of Caregivers Newly Enrolled During This Reporting Period

Notes

GG1

Female

GG2

Male

GGU

Unknown

GGT

TOTAL (automatically sums)

0

Item

Race or Ethnicity

Number of Caregivers Newly Enrolled During This Reporting Period

Notes

GR1

American Indian or Alaskan Native

GR2

Asian

GR3

Black or African American

GR4

Hispanic or Latino

GR5

Middle Eastern or North African

GR6

Native Hawaiian or Other Pacific Islander

GR7

White

GRU

Unknown

GRT

TOTAL KNOWN (cell does not autosum because caregivers can select multiple race and ethnicity options.)

Item

Education Levels

Number of Caregivers Newly Enrolled During This Reporting Period

Notes

GE1

Grades 0-8

GE2

Grades 9-12 or Non-Graduate

GE3

High School Graduate, GED, or Equivalency Diploma

GE4

12th Grade + Some Post-Secondary

GE5

2 or 4 Years College Graduate

GE6

Graduate or Other Post-Secondary School

GEU

Unknown

GET

TOTAL (automatically sums)

0

---

Sheet 6: Family Characteristics

Item

Description

Number of Families Newly Enrolled During This Reporting Period

Notes

FT

Total Number of Families:

Item

Number of Adults in Family Household

Number of Families Newly Enrolled During This Reporting Period

Notes

FA1

0

FA2

1

FA3

2

FA4

3

FA5

4+

FAU

Unknown

FAT

TOTAL (automatically sums)

0

Item

Number of Children Under 18 in Family Household

Number of Families Newly Enrolled During This Reporting Period

Notes

FC1

0

FC2

1

FC3

2

FC4

3

FC5

4

FC6

5

FC7

6+

FCU

Unknown

FCT

TOTAL (automatically sums)

0

Item

Household Size

Number of Families Newly Enrolled During This Reporting Period

Notes

FH1

1

FH2

2

FH3

3

FH4

4

FH5

5

FH6

6+

FHU

Unknown

FHT

TOTAL (automatically sums)

0

Item

Federal Poverty level

Number of Families Newly Enrolled During This Reporting Period

Notes

FP1

Up to 50%

FP2

51% - 75%

FP3

76% - 100%

FP4

101% - 125%

FP5

126% - 150%

FP6

151% - 175%

FP7

176% - 200%

FP8

201% - 250%

FP9

251% and over

FPU

Unknown

FPT

TOTAL (automatically sums)

0

---

Sheet 7: Outcomes

Item	Total Enrollment Indicators	Number of Families Eligible for Outcomes Reporting During This Reporting Period	Notes
OT1	Total Families Reporting Diaper Need at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Family Diaper Need	Number of Families This Reporting Period	Notes
ON1	Number of families with diaper need at baseline who do not have diaper need during the outcomes reporting period
ON2	Number of families with diaper need at baseline who continue to have diaper need during the outcomes reporting period
ONT	TOTAL	0
Item	Total Enrollment Indicators	Number of Caregivers Eligible for Outcomes Reporting This Reporting Period	Notes
OT2	Total Caregivers With Employment Needs at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Caregiver Education, Training and Employment Activities	Number of Caregivers This Reporting Period	Notes
OE1	Number of caregivers with employment needs at baseline preparing for employment or training activities this reporting period
OE2	Number of caregivers with employment needs at baseline enrolling in education or training activities this reporting period
OE3	Number of caregivers with employment needs at baseline obtaining employment this reporting period
OE4	Number of caregivers with employment needs at baseline who have not prepared for employment or training, enrolled in education or training, or obtained employment this reporting period
OET	TOTAL	0
Item	Total Enrollment Indicators	Number of Children Eligible for Outcomes Reporting This Reporting Period	Notes
OT3	Total Children with Diaper Health Issues at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Child Diaper Health Issues	Number of Children This Reporting Period	Notes
OH1	Number of children with diaper health issues at baseline who did not have diaper health issues at follow up
OH2	Number of children with diaper health issues at baseline who had diaper health issues at follow up
OHT	TOTAL	0
Item	Total Enrollment Indicators	Number of Families Eligible for Outcomes Reporting This Reporting Period	Notes
OT4	Total Families with Childcare Needs at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Childcare Access	Number of Families This Reporting Period	Notes
OC1	Total families with childcare need at baseline who have obtained childcare
OC2	Total families with childcare need at baseline who have not obtained childcare
OCT	Total	0