1 Print Copy of LOCAL AV SURVEY
Grants to States for Access and Visitation
Feb 26 Print Copy of Local AV Survey Spreadsheet.xls
Grants to States for Access and Visitation (Local Service Providers)
OMB: 0970-0204
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0204 can be found here:
Document [xlsx]
Download: xlsx | pdf
DO NOT ENTER
State Form
Overview
Provider FormDO NOT ENTER
State Form
Sheet 1: Provider Form
Sheet 2: DO NOT ENTER
| Alabama | Y | 1 | |||
| Alaska | N | 2 | |||
| Arizonia | 3 | ||||
| Arkansas | GP Father | 4 | |||
| California | GP Mother | 5 | |||
| Colorado | 6 | ||||
| Connecticut | Am. Indian | Asian AM | Y | 7 | |
| Delaware | Alaskan Nat | Pacfic Isd. | N | 8 | |
| District of Columbia | 9 | ||||
| Florida | X | 10 | |||
| Georgia | |||||
| Guam | |||||
| Hawaii | |||||
| Idaho | |||||
| Illinois | |||||
| Indiana | |||||
| Iowa | |||||
| Kansas | |||||
| Kentucky | |||||
| Louisiana | |||||
| Maine | |||||
| Maryland | |||||
| Massachusetts | |||||
| Michigan | |||||
| Minnesota | |||||
| Mississippi | |||||
| Missouri | |||||
| Montana | |||||
| Nebraska | |||||
| Neveda | |||||
| New Hampshire | |||||
| New Jersey | |||||
| New Mexico | |||||
| New York | |||||
| North Carolina | |||||
| North Dakota | |||||
| Ohio | |||||
| Oklahoma | |||||
| Oregon | |||||
| Pennsylvania | |||||
| Puerto Rico | |||||
| Rhode Island | |||||
| South Carolina | |||||
| South Dakota | |||||
| Tennessee | |||||
| Texas | |||||
| Utah | |||||
| Vermont | |||||
| Virgin Island | |||||
| Washington State | |||||
| West Virginia | |||||
| Wisconsin | |||||
| Wisconsin | |||||
| Wyoming |
Sheet 3: State Form
| Name/Address of Local Service Provider | |||||||||||||||||||||||||||||||||||||
| D. | Local Service Provider Spreadsheet | FY 2009 | |||||||||||||||||||||||||||||||||||
| State | |||||||||||||||||||||||||||||||||||||
| Ohio | |||||||||||||||||||||||||||||||||||||
| Client Referral Source | Client Information | Marital Status | Race/Ethnicity | Income in Thousands | Client Participation by Services Provided | Outcome | Outcome | ||||||||||||||||||||||||||||||
| Upon Entry Into Program | |||||||||||||||||||||||||||||||||||||
| Required | Required | ||||||||||||||||||||||||||||||||||||
| Case/Reference ID Number | Self | Court | Child Support Agency | Domestic Violence Agency | Child Protection Agency | Other | Father (custodial) | Father (noncustodial) | Mother (custodial) | Mother (noncustodial) | Grandparents/Legal Guardians | Number of Children in Common | Never Married to Each Other | Married to Each Other | Separated from Each Other | Divorced from Each Other | American Indian or Alaska Native | Asian | Black or African-American | Hispanic or Latino | Native Hawaiian or Other Pacific Islander | White | Multi-Ethnic | Less than $10,000 | $10,000 to $19,999 | $20,000 to $29,999 | $30,000 to $39,999 | $40,000 & Above | Mediation | Development of Parenting Plan | Counseling | Parent Education | Visitation Compliance Monitoring | Supervised Visitation | Neutral Drop-Off/Pick-Up | Noncustodial Fathers with Increased Parenting Time | Noncustodial Mothers with Increased Parenting Time |
| Total | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| File Type | application/vnd.ms-excel |
| Author | John Jolley |
| Last Modified By | USER |
| File Modified | 2008-02-29 |
| File Created | 2003-07-08 |
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