National Organizations
Prevention and Wellness-Leveraging National Organizations
0990-Attachment_B_-_National_Organizations_Outcome_Measure_Template(1).xls
National Organizations
OMB: 0990-0373
Document [xlsx]
Download: xlsx | pdf
Example
Matched Community 1
Matched Community 2
Matched Community 3
Matched Community 4
Matched Community 5
Overview
InstructionsExample
Matched Community 1
Matched Community 2
Matched Community 3
Matched Community 4
Matched Community 5
Sheet 1: Instructions
| Definitions and Instructions for Completion Date: Input effective date of plan. Site Name: Input the name of the funded site Funded Category: Use the drop-down menu to select the appropriate category (Tobacco or Obesity) Grantee Number: Input the grantee number as indicated on the Notice of Award. Targeted Populations: Input any populations specifically targeted by this outcome objective. Outcome Objective: Input this text from the CAP: An Outcome Objective is a measureable change in supportive policy, systems, or environment that affects healthy behavior. Objective must be SMART. Objective should include a reference to any high-burden populations or communities being specifically targeted. If objective targets the general population of the Jurisdiction or the site is unable to specify in the objective, circle Yes or No in the box to the right of “Objective Targets High-Risk Group”. MAPPS Strategy: Input all appropriate MAPPS Strategies being addressed by this objective. MAPPS Strategies are one of an identified set of evidence-based actions that can be used to drive a policy, system, or environmental change objective. Current Outcome Objective Status: Use the drop-down menu to select the most appropriate status for the objective during that month. These status levels mirror the Status levels in the CPPW MIS. Reportable Milestone Activities: Input ALL APPROVED Milestone Activities associated with this objective. This is an agreed upon list of key events or actions between the Project Officer and the site that will be implemented. Key events, if possible, should be specific, measurable and sufficient in quantity such that their completion should lead to the accomplishment of the outcome objective Milestone Implementation schedule: Use drop-down menu for Coding: X = Scheduled this Quarter; A = Adjusted Timeline from existing CAP (an “A” would be included in a box that was previously empty); C= Canceled Activity (a “C” would replace the “X” to reflect the time period that the CAP work was canceled for). Milestone Implementation Status: Use drop-down menu for coding: Complete: Activity is Completed; IP-OS: Activity is In Process – On Schedule; IP-BS: In Process – Behind Schedule; Past Due: Activity is Not Complete and work is no longer planned Milestone Implementation Quarters: Q3: April – June 2010; Q4: July – Sept 2010; Q5: Oct – Dec 2010; Q6: Jan-March 2011; Q7: April – June 2011; Q8: July – Sept 2011; Q9: Oct – Dec 2011; Q10: Jan – March 2012 Quarterly Milestone Summary Rating: This figure is automatically calculated based upon a combination of work scheduled and completion status. Current Rating reflects the Green(70%+)/Yellow (50-69%)/Red (<50%) status of the current quarter and the Cumulative rating represents the same information over the entire term of the award to date. This information will automatically update as the project Officers enters new information pertaining to schedule of work or status. PO Alternative Rating and Justification: If for a specific reason the Project Officer feels that an automatically calculated Summary Rating for Milestones does not truly reflect the status of the objective, the PO may enter a specific percent and provide a detailed justification. This justification must be reviewed by the Team Lead and agreed with. Barriers: Input a running list of all barriers being experienced by the community for the quarter that have been discussed on monthly calls or during monthly communications. TA Provided: Input a running list of all technical assistance delivered to the community for the quarter that has been discussed on monthly calls or during monthly communications. Additional Comments: Health Equity: Input a running list of any specific examples of work to highlight or address issues related to Health Equity by the community for the quarter that have been discussed on monthly calls or during monthly communications. Additional Comments: General: Input a running list of any specific comments not captured in other areas of the reference sheet of work by the community for the quarter that have been discussed on monthly calls or during monthly communications. Definitions and Instructions for Completion Date: Input effective date of plan. Site Name: Input the name of the funded site Funded Category: Use the drop-down menu to select the appropriate category (Tobacco or Obesity) Grantee Number: Input the grantee number as indicated on the Notice of Award. Targeted Populations: Input any populations specifically targeted by this outcome objective. Outcome Objective: Input this text from the CAP: An Outcome Objective is a measureable change in supportive policy, systems, or environment that affects healthy behavior. Objective must be SMART. Objective should include a reference to any high-burden populations or communities being specifically targeted. If objective targets the general population of the Jurisdiction or the site is unable to specify in the objective, circle Yes or No in the box to the right of “Objective Targets High-Risk Group”. MAPPS Strategy: Input all appropriate MAPPS Strategies being addressed by this objective. MAPPS Strategies are one of an identified set of evidence-based actions that can be used to drive a policy, system, or environmental change objective. Current Outcome Objective Status: Use the drop-down menu to select the most appropriate status for the objective during that month. These status levels mirror the Status levels in the CPPW MIS. Reportable Milestone Activities: Input ALL APPROVED Milestone Activities associated with this objective. This is an agreed upon list of key events or actions between the Project Officer and the site that will be implemented. Key events, if possible, should be specific, measurable and sufficient in quantity such that their completion should lead to the accomplishment of the outcome objective Milestone Implementation schedule: Use drop-down menu for Coding: X = Scheduled this Quarter; A = Adjusted Timeline from existing CAP (an “A” would be included in a box that was previously empty); C= Canceled Activity (a “C” would replace the “X” to reflect the time period that the CAP work was canceled for). Milestone Implementation Status: Use drop-down menu for coding: Complete: Activity is Completed; IP-OS: Activity is In Process – On Schedule; IP-BS: In Process – Behind Schedule; Past Due: Activity is Not Complete and work is no longer planned Milestone Implementation Quarters: Q3: April – June 2010; Q4: July – Sept 2010; Q5: Oct – Dec 2010; Q6: Jan-March 2011; Q7: April – June 2011; Q8: July – Sept 2011; Q9: Oct – Dec 2011; Q10: Jan – March 2012 Quarterly Milestone Summary Rating: This figure is automatically calculated based upon a combination of work scheduled and completion status. Current Rating reflects the Green(70%+)/Yellow (50-69%)/Red (<50%) status of the current quarter and the Cumulative rating represents the same information over the entire term of the award to date. This information will automatically update as the project Officers enters new information pertaining to schedule of work or status. PO Alternative Rating and Justification: If for a specific reason the Project Officer feels that an automatically calculated Summary Rating for Milestones does not truly reflect the status of the objective, the PO may enter a specific percent and provide a detailed justification. This justification must be reviewed by the Team Lead and agreed with. Barriers: Input a running list of all barriers being experienced by the community for the quarter that have been discussed on monthly calls or during monthly communications. TA Provided: Input a running list of all technical assistance delivered to the community for the quarter that has been discussed on monthly calls or during monthly communications. Additional Comments: Health Equity: Input a running list of any specific examples of work to highlight or address issues related to Health Equity by the community for the quarter that have been discussed on monthly calls or during monthly communications. Additional Comments: General: Input a running list of any specific comments not captured in other areas of the reference sheet of work by the community for the quarter that have been discussed on monthly calls or during monthly communications. |
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Sheet 2: Example
| Date Last Updated | 9/1/2010 | ||||||||||||||||||||||||||||||
| Organization Name | Organization X | ||||||||||||||||||||||||||||||
| Funded Category | Tobacco-B | ||||||||||||||||||||||||||||||
| Grantee Number | 123456789 | ||||||||||||||||||||||||||||||
| Targeted Populations | Youth | ||||||||||||||||||||||||||||||
| Outcome Objective | Tobacco: February 2012, Jefferson County Department of Health will support the passage of a tobacco excise tax by the Alabama state legislature through educating the public about the health effects of smoking and disclosing the evidence base that links the tax to health impact. | ||||||||||||||||||||||||||||||
| MAPPS Strategies | Tobacco: Media - Media and advertising restrictions consistent with federal law ** Tobacco: Price - Use evidence-based pricing strategies to discourage tobacco use | ||||||||||||||||||||||||||||||
| Community Name | Community Y | ||||||||||||||||||||||||||||||
| Reportable Milestone Activities | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | |||||||||||||||||||||||
| Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | ||||||||||||||||
| Milestone Activity 1 | X | IP-OS | |||||||||||||||||||||||||||||
| Milestone Activity 2 | X | IP-BS | X | Yes | Green | IP-OS | Under Development | Obesity-A | |||||||||||||||||||||||
| Milestone Activity 3 | X | IP-OS | O | No | Yellow | IP-BS | Under Consideration-Some | Tobacco-B | |||||||||||||||||||||||
| Milestone Activity 4 | X | IP-OS | A | IP | Red | Past Due | Under Consideration-All | ||||||||||||||||||||||||
| Milestone Activity 5 | X | IP-OS | X | IP-OS | X | Complete | I | Complete | Approved-Some | ||||||||||||||||||||||
| Approved-All | |||||||||||||||||||||||||||||||
| X | |||||||||||||||||||||||||||||||
| Quarterly Milestone Summary Rating | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | |||||||||||||||
| NA | 83% | NA | 100% | NA | 100% | NA | NA | NA | NA | NA | NA | NA | NA | NA | 0% | ||||||||||||||||
| Alternative Rating | |||||||||||||||||||||||||||||||
| Justification for Alternative Rating | |||||||||||||||||||||||||||||||
| Barriers | |||||||||||||||||||||||||||||||
| TA Provided | |||||||||||||||||||||||||||||||
| Additional Comments: General | |||||||||||||||||||||||||||||||
| Milestone Counts | 6 | 5 | 4 | 4 | 4 | 4 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
| Cumulative Counts | 6 | 5 | 10 | 9 | 14 | 13 | 14 | 13 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
Sheet 3: Matched Community 1
| Date Last Updated | |||||||||||||||||||||||||||||||
| Organization Name | |||||||||||||||||||||||||||||||
| Funded Category | |||||||||||||||||||||||||||||||
| Grantee Number | |||||||||||||||||||||||||||||||
| Targeted Populations | |||||||||||||||||||||||||||||||
| Outcome Objective | |||||||||||||||||||||||||||||||
| MAPPS Strategies | |||||||||||||||||||||||||||||||
| Community Name | |||||||||||||||||||||||||||||||
| Reportable Milestone Activities | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | |||||||||||||||||||||||
| Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | ||||||||||||||||
| Milestone Activity 1 | |||||||||||||||||||||||||||||||
| Milestone Activity 2 | X | Yes | Green | IP-OS | Under Development | Obesity-A | |||||||||||||||||||||||||
| Milestone Activity 3 | O | No | Yellow | IP-BS | Under Consideration-Some | Tobacco-B | |||||||||||||||||||||||||
| Milestone Activity 4 | A | IP | Red | Past Due | Under Consideration-All | ||||||||||||||||||||||||||
| Milestone Activity 5 | I | Complete | Approved-Some | ||||||||||||||||||||||||||||
| Approved-All | |||||||||||||||||||||||||||||||
| X | |||||||||||||||||||||||||||||||
| Quarterly Milestone Summary Rating | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | |||||||||||||||
| NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 0% | ||||||||||||||||
| Alternative Rating | |||||||||||||||||||||||||||||||
| Justification for Alternative Rating | |||||||||||||||||||||||||||||||
| Barriers | |||||||||||||||||||||||||||||||
| TA Provided | |||||||||||||||||||||||||||||||
| Additional Comments: General | |||||||||||||||||||||||||||||||
| Milestone Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
| Cumulative Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
Sheet 4: Matched Community 2
| Date Last Updated | |||||||||||||||||||||||||||||||
| Organization Name | |||||||||||||||||||||||||||||||
| Funded Category | |||||||||||||||||||||||||||||||
| Grantee Number | |||||||||||||||||||||||||||||||
| Targeted Populations | |||||||||||||||||||||||||||||||
| Outcome Objective | |||||||||||||||||||||||||||||||
| MAPPS Strategies | |||||||||||||||||||||||||||||||
| Community Name | |||||||||||||||||||||||||||||||
| Reportable Milestone Activities | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | |||||||||||||||||||||||
| Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | ||||||||||||||||
| Milestone Activity 1 | |||||||||||||||||||||||||||||||
| Milestone Activity 2 | X | Yes | Green | IP-OS | Under Development | Obesity-A | |||||||||||||||||||||||||
| Milestone Activity 3 | O | No | Yellow | IP-BS | Under Consideration-Some | Tobacco-B | |||||||||||||||||||||||||
| Milestone Activity 4 | A | IP | Red | Past Due | Under Consideration-All | ||||||||||||||||||||||||||
| Milestone Activity 5 | I | Complete | Approved-Some | ||||||||||||||||||||||||||||
| Approved-All | |||||||||||||||||||||||||||||||
| X | |||||||||||||||||||||||||||||||
| Quarterly Milestone Summary Rating | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | |||||||||||||||
| NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 0% | ||||||||||||||||
| Alternative Rating | |||||||||||||||||||||||||||||||
| Justification for Alternative Rating | |||||||||||||||||||||||||||||||
| Barriers | |||||||||||||||||||||||||||||||
| TA Provided | |||||||||||||||||||||||||||||||
| Additional Comments: Health Equity | |||||||||||||||||||||||||||||||
| Additional Comments: General | |||||||||||||||||||||||||||||||
| Milestone Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
| Cumulative Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
Sheet 5: Matched Community 3
| Date Last Updated | |||||||||||||||||||||||||||||||
| Organization Name | |||||||||||||||||||||||||||||||
| Funded Category | |||||||||||||||||||||||||||||||
| Grantee Number | |||||||||||||||||||||||||||||||
| Targeted Populations | |||||||||||||||||||||||||||||||
| Outcome Objective | |||||||||||||||||||||||||||||||
| MAPPS Strategies | |||||||||||||||||||||||||||||||
| Community Name | |||||||||||||||||||||||||||||||
| Reportable Milestone Activities | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | |||||||||||||||||||||||
| Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | ||||||||||||||||
| Milestone Activity 1 | |||||||||||||||||||||||||||||||
| Milestone Activity 2 | X | Yes | Green | IP-OS | Under Development | Obesity-A | |||||||||||||||||||||||||
| Milestone Activity 3 | O | No | Yellow | IP-BS | Under Consideration-Some | Tobacco-B | |||||||||||||||||||||||||
| Milestone Activity 4 | A | IP | Red | Past Due | Under Consideration-All | ||||||||||||||||||||||||||
| Milestone Activity 5 | I | Complete | Approved-Some | ||||||||||||||||||||||||||||
| Approved-All | |||||||||||||||||||||||||||||||
| X | |||||||||||||||||||||||||||||||
| Quarterly Milestone Summary Rating | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | |||||||||||||||
| NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 0% | ||||||||||||||||
| Alternative Rating | |||||||||||||||||||||||||||||||
| Justification for Alternative Rating | |||||||||||||||||||||||||||||||
| Barriers | |||||||||||||||||||||||||||||||
| TA Provided | |||||||||||||||||||||||||||||||
| Additional Comments: Health Equity | |||||||||||||||||||||||||||||||
| Additional Comments: General | |||||||||||||||||||||||||||||||
| Milestone Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
| Cumulative Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | |||||||||||||||
Sheet 6: Matched Community 4
| Date Last Updated | |||||||||||||||||||||||||||||||
| Organization Name | |||||||||||||||||||||||||||||||
| Funded Category | |||||||||||||||||||||||||||||||
| Grantee Number | |||||||||||||||||||||||||||||||
| Targeted Populations | |||||||||||||||||||||||||||||||
| Outcome Objective | |||||||||||||||||||||||||||||||
| MAPPS Strategies | |||||||||||||||||||||||||||||||
| Community Name | |||||||||||||||||||||||||||||||
| Reportable Milestone Activities | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | |||||||||||||||||||||||
| Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | ||||||||||||||||
| Milestone Activity 1 | |||||||||||||||||||||||||||||||
| Milestone Activity 2 | X | Yes | Green | IP-OS | Under Development | Obesity-A | |||||||||||||||||||||||||
| Milestone Activity 3 | O | No | Yellow | IP-BS | Under Consideration-Some | Tobacco-B | |||||||||||||||||||||||||
| Milestone Activity 4 | A | IP | Red | Past Due | Under Consideration-All | ||||||||||||||||||||||||||
| Milestone Activity 5 | I | Complete | Approved-Some | ||||||||||||||||||||||||||||
| Approved-All | |||||||||||||||||||||||||||||||
| Quarterly Milestone Summary Rating | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | |||||||||||||||
| NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||
| Alternative Rating | |||||||||||||||||||||||||||||||
| Justification for Alternative Rating | |||||||||||||||||||||||||||||||
| Barriers | |||||||||||||||||||||||||||||||
| TA Provided | |||||||||||||||||||||||||||||||
| Additional Comments: General | |||||||||||||||||||||||||||||||
| Milestone Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||||||||||||
| Cumulative Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||||||||||||
Sheet 7: Matched Community 5
| Date Last Updated | |||||||||||||||||||||||||||||||
| Organization Name | |||||||||||||||||||||||||||||||
| Funded Category | |||||||||||||||||||||||||||||||
| Grantee Number | |||||||||||||||||||||||||||||||
| Targeted Populations | |||||||||||||||||||||||||||||||
| Outcome Objective | |||||||||||||||||||||||||||||||
| MAPPS Strategies | |||||||||||||||||||||||||||||||
| Community Name | |||||||||||||||||||||||||||||||
| Reportable Milestone Activities | Q1 | Q2 | Q3 | Q4 | Q5 | Q6 | Q7 | Q8 | |||||||||||||||||||||||
| Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | Scheduled | Status | ||||||||||||||||
| Milestone Activity 1 | |||||||||||||||||||||||||||||||
| Milestone Activity 2 | X | Yes | Green | IP-OS | Under Development | Obesity-A | |||||||||||||||||||||||||
| Milestone Activity 3 | O | No | Yellow | IP-BS | Under Consideration-Some | Tobacco-B | |||||||||||||||||||||||||
| Milestone Activity 4 | A | IP | Red | Past Due | Under Consideration-All | ||||||||||||||||||||||||||
| Milestone Activity 5 | I | Complete | Approved-Some | ||||||||||||||||||||||||||||
| Approved-All | |||||||||||||||||||||||||||||||
| Quarterly Milestone Summary Rating | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | Current | Cumulative | |||||||||||||||
| NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | ||||||||||||||||
| Alternative Rating | |||||||||||||||||||||||||||||||
| Justification for Alternative Rating | |||||||||||||||||||||||||||||||
| Barriers | |||||||||||||||||||||||||||||||
| TA Provided | |||||||||||||||||||||||||||||||
| Additional Comments: General | |||||||||||||||||||||||||||||||
| Milestone Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||||||||||||
| Cumulative Counts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||||||||||||
| File Type | application/vnd.ms-excel |
| Author | rcg8 |
| Last Modified By | Calvin |
| File Modified | 2010-11-15 |
| File Created | 2010-04-12 |
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