Form Attachment A Attachment A Performance Measures

D

Attachment A: Training and TA Performance Measures

Training and TA Common Performance Measures

OMB No. 0930-0197

Expiration Date: 03/31/2014

Expiration Date: 03/31/2014

Please circle the appropriate response.

TRAINING

Domain: Utility

Measure: Individual

   The training has been useful to my prevention work.

Response Options:

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Measure: Organization

The training has been useful to my organization’s prevention work.

Response Options:

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Domain: Capacity

Measure 1: Individual

   The training I received improved my capacity to do prevention work.

Response Options:

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Measure 2: Organization

   The training I received improved my organization’s capacity to do prevention work. (GPRA)

Response Options:

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

TECHNICAL ASSISTANCE (TA)

Domain: Utility

Measure: Organization

   This technical assistance has been useful to my organization’s prevention work.

   Response Options:

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Domain: Capacity

Measure: Individual

   This technical assistance has improved my capacity to do prevention work.

Response Options:

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Measure: Organization

 This technical assistance has improved my organization’s capacity to do prevention work. (GPRA)

Response Options:

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

Public Burden Statement: 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 control number for this project is 0930-0197.  Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.