#1. Semi-annual HPOG Program Performance Report

Health Profession Opportunity Grants (HPOG) program

#1. Semi-annual HPOG Program Performance Report

#1. Semi-annual HPOG Program Performance Report

OMB: 0970-0394

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Semi-annual HPOG Program Performance Report

HPOG Grantee Performance Indicators

The following indicators will be used to track grantee performance. All data required to calculate the measures will be programmed into the HPOG Performance Reporting System and submitted to ACF by grantees with their semi-annual Performance Progress Report (SF-PPR). All information in the SF-PPR (Cover Page, Narrative, and Performance Measures) will be programmed into the Performance Reporting System and the report will be electronically produced, with narrative entries, verification, and submission to ACF done by grantees. See Instrument A.1 HPOG Performance Reporting System at the end of this document.

HPOG Program Participation

Indicator #1 Number of enrollees (number of persons served)



HPOG Program Early Results

Indicator #2 Number and percentage who complete the training program

Indicator #3 Number and percentage who receive credentials (certificates/degrees)

Indicator #4 Number and percentage of exiters: a) employed at exit; b) average wage; c) average weekly hours

Indicator #5 Number and percentage of exiters: employed in health occupations; average wage; average weekly hours



HPOG Program Later Results



Indicator #6 Number and percentage of exiters: (a) employed six months after exit; (b) average wage; (c) average weekly hours

Indicator #7 Number and percentage of exiters: (a) employed in health occupations; (b) average wage; (c) average weekly hours

Indicator #8 Number and percentage of exiters: (a) employed in health occupations who increased wages at six months; (b) employed in health occupation who had advanced in position at six months.



Health Profession Opportunity Grant (HPOG)

Program Performance Reporting System

Overview & “Common Core” Participant Data Elements



The Health Profession Opportunity Grant (HPOG) Program Performance Reporting System is being developed for the U.S. Department of Health and Human Services, Administration for Children and Families and will be used for both program performance management and evaluation. Major features of the system are summarized below. See Instrument A.1 HPOG Performance Reporting System at the end of this document for a full list of data elements.

Purposes of the System

  • Program Performance Reporting. The system will include all data needed to track and manage grantee performance. The quantitative sections of grantees’ required semi-annual Performance Progress Reports (PPR) to USDHHS/ACF will be produced from the participant-level information in the HPOG data system. Grantees will also be able to insert the narrative portions of the semi-annual PPR and thus submit the entire report directly from the data system sections.

  • Program Evaluation. The system will include data necessary for future analyses and evaluations of HPOG. Data items will enable a range of analyses at the participant, program, and grantee levels.

Key System Features

  • Internet-Based Application. The HPOG data system will be on a secure HPOG website maintained by The Urban Institute. Staff at the grantee or subgrantee level who are granted authorization to access the system will receive a secure password and will be able to enter and/or view data on their participants (but not those in programs operated by other grantees). HPOG evaluators will be able to view data from participants across all grantees, but private information (such as participant name and Social Security number) will be accessible only by those identified in informed consent forms signed by the participant.

  • Efficient and Secure Data Entry Format. The data system is structured to reduce the burden on grantees and programs while ensuring adequate detail and accuracy. A data streaming capability is built into the secure web-based system, allowing authorized grantees and programs to program their existing information systems to interface with and stream data to the HPOG Performance Reporting System. The interface will allow HPOG participant data on existing grantee or provider systems to be uploaded directly into the HPOG Performance Reporting System. Populating the HPOG system as fully as possible with existing electronic data reduces data entry burden and minimizes data entry errors. Data items that cannot be uploaded will be entered directly by program staff into the HPOG data system. Data items that include private information (e.g., Social Security number) will be automatically encrypted at data entry.

  • Full Case Management Capability. The HPOG Performance Reporting System is being developed to allow programs to use it for case management and performance management purposes. Data on individual participants can be entered at intake as part of the initial interaction between the participant and grantee staff. Participant training experience and use of services may be recorded at any time in the individual record. Narrative case notes can also be added as text. The system will generate automatic periodic management and performance reports. This includes the capability to generate the federally required semi-annual Performance Progress Report.

  • Multi-level Data Structure. The multi-level structure of the HPOG Performance Reporting System is designed to serve both program management purposes and future evaluation purposes. For example, activities and outcomes can be tracked by participant, by site or program unit, and by grantee. The multi-level variables can also be used in future analyses that might include hierarchical statistical modeling of program features, inputs, outputs, and outcomes.

Participant-Level Data Items

  • Data to be Collected and Entered into the HPOG System throughout Each Participant’s Involvement in HPOG. As shown in the exhibit below, detailed and systematic participant-level information will be collected and recorded into the HPOG Performance Reporting System for all HPOG participants at every grantee and program (subgrantee location) beginning with program intake/enrollment and continuing through exit and follow-up.

    • Participant characteristics data will be collected at intake, including a range of demographic characteristics, employment and educational background, and receipt of public assistance and supportive services.

    • Ongoing services and activities in which the participant engages in HPOG (pre-training components, remedial education, occupational training and type of training, support services, and employment-related services) will be entered into the HPOG Performance Reporting System throughout each participant’s involvement in the program. To determine the extent of the service or activity (i.e., “dosage”), staff will also record dates of service and, and for some activities, hours of participation or program funds expended on the service.

    • Results/outcomes of HPOG activities will be recorded in the HPOG Performance Reporting System at exit and six months after exit, including: completion of education or training, receipt of credential, degree or license, entry into employment, and employment in a health care industry. For those who enter employment, occupation, hourly wage, and hours worked per week will be recorded. Programs will also follow up with participants six months after exit to update employment and education status. These program-recorded data on results will complement quarterly earnings data compiled from the National Directory of New Hires, which will also be merged into the HPOG Performance Reporting System.

Program-Level Data Items

  • Categories of information that characterize each program (at either grantee or subgrantee level depending on grant details):

    • Organizational information (e.g., name, location, institutional type)

    • All key components (e.g., services, education, training programs, employment components)

    • Role in HPOG (e.g., grantee, subgrantee, vendor, non-financial service provider)

  • Key characteristics of each training program

    • Name and location of program

    • Occupational focus (e.g., CNA, EMT)

    • Duration/length (weeks)

    • Objective (e.g., credential/degree, credit/non-credit)

    • Service delivery or instructional model if appropriate (e.g., I-BEST, Cooperative Education internship, Registered Apprenticeship)

Grantee Level Data Items

  • Key Grantee Programmatic and implementation

    • Primary HPOG model (e.g., occupation(s) or occupational clusters targeted, career pathway focus, theoretical or cultural foundation)

    • Presence of a dominant delivery model (e.g., contextual instruction, cooperative education, registered apprenticeship)

    • HPOG inter-organizational network characteristics (e.g., partnerships/collaborations, vendors)

    • HPOG employer or industry groups

  • Grantee Program Performance Report (PPR)

    • Cover Page (grantee information, narrative, certification/electronic signature)

    • Performance Narrative (summary, accomplishments, changes, technical assistance, dissemination, findings/events, evaluation)

    • Administrative Milestones

    • Project Outputs

    • Intermediate and End Outcomes

    • Performance Indicators

    • Performance Indicators for Next Year

  • Contextual and environmental information about each grantee and program

    • Economic condition (e.g., employment and unemployment rates, industry mix, over time)

    • Socio-demographic characteristics (e.g., poverty rate, population-density, ethnic/demographic mix)

    • Geographic catchment area of the grantee and each program (e.g., counties, cities/towns)

Timeline

  • The HPOG Program Performance Data System will be operational on September 30, 2011, following a six-month development and testing period. It will remain operational for grantees and programs through September 30, 2015, when the HPOG funding ends.



INSTRUMENT A.1: HPOG PERFORMANCE REPORTING SYSTEM


Participant-Level Data Items



A. Enrollment


Basic Demographic Data

The following group of demographic and socio-economic characteristics will be entered for each participant at the point of HPOG enrollment.


Data Item / Question

Response Fields to be Completed for Each Data Item

Data Source

Performance Managt., Evaluation, Both

WIASRD

ISIS Form

Participant Program Enrollment

E1. HPOG Enrollment Date

MM-DD-YYYY

Grantee Records

Both

Date of Program Participation


E2. HPOG Participant ID

Numeric value generated by system upon approval confirmation

System Defined

Both



E3. Grantee number

Programmed static identifier

Evaluator coding

Performance Management



E4. Subgrantee number

Programmed static identifier

Evaluator coding

Performance Management



Individual Characteristics at Enrollment*

(*The Solicitation for Grant Application notes eligible populations. Participants must be US citizens or individuals who meet the immigrant eligibility requirements for Federal Public Benefits. They can either be TANF participants, participants in other public assistance programs, or low-income individuals. Special populations under the low-income category may include high-school dropouts, low-income non-custodial and other single parents, individuals with disabilities, veterans, victims of domestic violence, youth transitioning out of foster care, individuals with a family history of intergenerational dependency, and individuals with limited English proficiency.)

D1. Last Name

Open field (Narrative value)

Enrollment Information

Evaluation



D2. First Name

Open field (Narrative value)

Enrollment Information

Evaluation



D3. Date of birth

MM-DD-YYYY

Enrollment Information

Both

Age and Date of Birth

Age and Date of Birth

D4. Social Security Number

SSS-SS-SSSS

Enrollment Information

Evaluation



D5. Citizenship

1 = Yes, born in the United States

2 = Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or Northern Marianas

3 = Yes, born abroad of American parent or parents

4 = Yes, a U.S. citizen by naturalization

5 = No, not a citizen of the United States

0 = Does not self-identify

Enrollment Information

Evaluation



D6. Refugee Status

1 = Yes

2 = No

0 = Does not self-identify

Enrollment Information

Evaluation







D7. Sex

1 = Male

2 = Female

0 = Does not self-identify

Enrollment Information

Both

Gender

Sex

D8. Ethnicity – Hispanic/Latino

1 = Person is of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture in origin, regardless of race.

2 = Does not meet any of these conditions

Enrollment Information

Both

Ethnicity (Hispanic)

Hispanic Origin

D9. Race

1 = American Indian or Alaska Native

2 = Asian

3 = Black or African American

4 = Native Hawaiian or other Pacific Islander

5 = White

Enrollment Information

Both

Race categories

Race/Ethnicity

D10. If D9 = 1 (American Indian or Alaskan Native):

D10a. Tribal member

1 = Yes

2 = No

Enrollment Information

Both







D10b. Tribal affiliation

Select tribal group from federal listing

Enrollment Information

Both



D10c. Lives on or off reservation

1 = Lives on reservation

2 = Lives off reservation

Enrollment Information

Performance Management





D11. Marital status

1 = Now married

2 = Widowed

3 = Divorced

4 = Separated

5 = Never married

0 = Does not self-identify marital status

Enrollment Information

Both







Marital Status

D12. If D11 = 1 (Now married):

D13a. Spouse of tribal member

1 = Yes

2 = No

Enrollment Information

Performance Management





D13. Head of household

1 = Yes

2 = No

Enrollment Information

Both





D14. Annual household earned income

1 = $0 - $10,000

2 = $10,001 - $25,000

3 = $25,001 - $50,000

4 = $50,001 - $75,000

5 = $75,001 and greater

0 = Does not self-identify earned income

Enrollment Information

Both













D15. Number living in household

Open field (numeric value)

Enrollment Information

Both



D16. Number dependent children for which you are responsible

Open field (numeric value)

Enrollment Information

Both


Children under 18 who live with person being interviewed

D17. Age of youngest child

Open field (numeric value)

Enrollment Information

Both



D18. Number children for which you are the non-custodial parent

Open field (numeric value)

Enrollment Information

Both

Single Parent


D19. Pregnant or expectant parent

1 = Yes

2 = No

Enrollment Information

Both





D20. Highest level of education completed

0 = No education

1-12 = Number of elementary/secondary grades (enter corresponding value)

13-15 = Years of college/full-time technical/vocational school (enter corresponding value)

16 = Bachelor’s degree or equivalent

17 = Education beyond bachelor’s degree

(single category selection allowed)

Enrollment Information

Both

Highest School Grade Completed

Highest degree/level of school completed

D22. Degrees or Certificates received

0 = No degree or certificate

87 = Attained High-School Diploma

88 = Attained GED or equivalent

90 = Attained other post-secondary degree or certification

91 = Attained Associates Diploma or Degree (AA / AS)

92 = Baccalaureate degree (4-year)

93 = Occupational Skills Licensure, Certificate, Credential

(multiple category selection as appropriate)

Enrollment Information

Both



How HS diploma earned

D23. First generation college student

1 = Yes

2 = No

Enrollment Information

Both





D24. School status at program enrollment

1 = Currently in school

2 = Currently not in school

Enrollment Information

Both





D25. Ever trained for a health profession / occupation

1 = Yes

2 = No

Enrollment Information

Both





D26. Veteran status

1 = Yes

2 = No

Enrollment Information

Both

Eligible Veteran Status, Campaign Veteran, Disabled Veteran, Recently Separated Veteran



D27. Disability status

1 = Yes

2 = No

0 = Does not wish to disclose disability status

Enrollment Information

Both

Individual with a Disability




D28. Current or former foster care youth

1 = Individual is in or has been in the foster care system

2 = Individual is NOT in or has been in the foster care system

Enrollment Information

Both

Foster Care Youth


D29. Limited English proficiency

1 = Yes

2 = No


[Definition: Person who has limited ability in speaking, reading, writing or understanding the English language and (a) whose native language is a language other than English, or (b) who lives in a family or community environment where a language other than English is the dominant language.]

Enrollment Information

Both

Limited English Language Proficiency


D30. Unemployment Insurance recipient status

1 = UI claimant

2 = UI exhaustee

3 = Not a UI claimant or exhaustee

Enrollment Information

Both

UC Eligible Status at Participation




D31. Homeless and/or runaway youth

1 = Yes

2 = No

Enrollment Information

Both

Homeless Individual and/or Runaway Youth



D32. Ex-offender

1 = Yes

2 = No


[Definition: Person (a) is or has been subject to any stage of criminal justice process for committing a status offense or delinquent act or (b) requires assistance overcoming barriers to employment resulting from a record of arrest or conviction for committing delinquent acts such as crimes against persons, property or other crimes]

Enrollment Information

Both

Offender


D33. Ever worked for pay

1 = Yes

2 = No

Enrollment Information

Both





D34. Ever worked in a health care profession/occupation

1 = Yes

2 = No

Enrollment Information

Both





D35. If D33 = 1 (Yes), specify profession/occupation:

Select corresponding profession from SOC listing

Enrollment Information

Both



D36. Currently employed (at the time of HPOG enrollment)

1 = Currently employed

2 = Not currently employed but has been employed

3 = Never employed

Enrollment Information

Both

Employment Status at Participation

Are you currently working in a job for pay? Date started? Hours/wk? Work schedule? Current wage? Benefits? More than one job? Wants more hours? # months worked in last 3 years?

D37. If D36 = 1 (Currently employed), individual is:

  1. = working for a health care employer

  2. = working for a non-health care employer

  3. = self-employed

  4. = does not self-identify

Enrollment Information

Both



D38. Hourly wage in last full week

$XX.XX

Enrollment Information

Both



D39. Number of hours worked in last full week

Open field (numeric value of 0 to 40)

Enrollment Information

Both



D40. If D36 = 1 (Yes, currently employed) or 2 (Not currently employed but has been employed), AND D9 = 1 (American Indian or Alaska Native), employee of tribal organization

1 = Yes, employee of tribal organization

2 = Not employee of tribal organization

Enrollment Information

Both





D41. Ever worked or trained in health profession prior to participation

  1. = Yes

2 = No

Enrollment Information

Both





D42. If D36 = 2 (Not currently employed but has been employed), for most recent last full week of employment:

D42a. Hourly wage in last full week

$XX.XX

Enrollment Information

Both



D42b. Number of hours worked in last full week

Open field (numeric value of 0 to 40)

Enrollment Information

Both



D43. At the time of HPOG enrollment, participant receives:


D43a. TANF




1 = Yes

2 = No




Enrollment Information




Both




TANF, Other Public Assistance Recipient

Income sources past 12 months: public assistance, welfare or WIC; Food stamps/SNAP; free or reduced lunch; unemployment insurance, worker’s compensation, disability or social security benefits; family/friends; grants/loans for school; other

D43b. General Assistance (GA)

1 = Yes

2 = No

Enrollment Information

Both





D43c. SNAP/Food Stamps

1 = Yes

2 = No

Enrollment Information

Both





D43d. SSI

1 = Yes

2 = No

Enrollment Information

Both





D43e. SSDI

1 = Yes

2 = No

Enrollment Information

Both





D43f. Refugee Cash Assistance (RCA)

1 = Yes

2 = No

Enrollment Information

Both





D43g. Medicaid

1 = Yes

2 = No

Enrollment Information

Both





D43h. Subsidized child care / voucher

1 = Yes

2 = No

Enrollment Information

Both





D43i. Section 8 / public housing

1 = Yes

2 = No

Enrollment Information

Both





D43j. LIHEAP

1 = Yes

2 = No

Enrollment Information

Both





D43k. Other public assistance, specify

1 = Yes

2 = No

3 = Other, specify

Enrollment Information

Both






Assessment/Work Readiness (at/about enrollment)
(*Expect all grantees to have basic literacy/numeracy testing but not all may conduct work readiness and occupational interest testing.)

A1. Literacy test level (from TABE or other test)

1 = The individual reads, writes, or speaks English at or below the 8th grade level or is unable to read, write or speak English at a level necessary to function on the job, in the individual’s family or in society.

2 = the individual does not meet the conditions described above

Grantee Records (from TABE or other test)

Both

Basic Literacy Skills Deficiency (above/below 8th grade level)


A2. Numeracy test level (from TABE or other test)

1 = The individual computes or solves problems at or below the 8th grade level or is unable to compute or solve problems at a level necessary to function on the job, in the individual’s family or in society

2 = the individual does not meet the conditions described above

Grantee Records (from OWRA, ETS, or other test)

Both



C1. Participant Contact Information


C1a. Street Address



Open field (Narrative value)



Enrollment Information



Evaluation





C1b. City

Open field (Narrative value)

Enrollment Information

Evaluation



C1c. State

Open field (Narrative value)

Enrollment Information

Evaluation



C1d. Zip code

Open field (Numeric value)

Enrollment Information

Evaluation



C1e. Home phone

Open field (Numeric value)

Enrollment Information

Evaluation



C1f. Work phone

Open field (Numeric value)

Enrollment Information

Evaluation



C1g. Cell phone

Open field (Numeric value)

Enrollment Information

Evaluation



C2. Alternative Contact Information

(Up to 3 contacts may be identified)

C2a. Alternative contact name





Open field (Narrative value)




Enrollment Information





Evaluation



C2b. Alternative contact address

Open field (Narrative value)

Enrollment Information

Evaluation



C2c. Alternative contact relationship

1 = Parent

2 = Sibling

3 = Extended biological family member

  1. = Partner

5 = Friend / social support network member

6 = Other, specify

Enrollment Information

Evaluation



C2d. Alternative contact phone number

Open field (Numeric value)

Enrollment Information

Evaluation





B. Services

Services Received

Data Item / Question

Response Fields to be Completed for Each Data Item

Data Source

Performance Managt., Evaluation, Both

WIASRD

ISIS Form

S1. Education/ Training Activities

S1a. Remedial / Pre-training Activities

(Select as many as appropriate from pick list: each activity can be selected multiple times)

  1. General Equivalency Degree (GED) classes

  2. Pre-GED classes

  3. English as a Second Language (ESL) instruction

  4. Adult basic education

  5. Other remedial or basic skills training

  6. Orientation or introduction to health care careers or occupations

  7. College skills training

  8. Prerequisite subject courses needed prior to entering into an occupational program (e.g. math, biology)

  9. Other, specify

For each activity (1-9 completed):


  1. Begin date: MM-YYYY



Grantee Case File / MIS




Both



Date Entered Training, Date Completed or Withdrew from Training, Pell Grant Recipient, Received Pre-Vocational Activities, Type of Training Service (#1-2)


Type of Recognized Credential

High School Diploma/GED










  1. End date: MM-YYYY

Grantee Case File / MIS

Both

  1. Successfully Complete?

Grantee Case File / MIS

Both

  1. Training vendor (pick list selection)

Grantee Case File / MIS

Both

  1. Education degree or certification received (pick list selection)

Grantee Case File / MIS

Both








S1. Education/ Training Activities

S1b. Health Occupation / Vocational Training Activities

  1. For each health occupation / profession of the training program select BLS SOC code from pick list


(Select as many as appropriate from pick list: each activity can be selected multiple times)

For each activity (1-5 completed):


  1. Occupation (SOC) (pick list selection)



Grantee Case File / MIS



Both


Date Entered Training, Date Completed or Withdrew from Training, Pell Grant Recipient, Received Pre-Vocational Activities, Type of Training Service (#1-2)


Type of Recognized Credential

AA or AS Diploma/Degree, BA or BS Diploma/ Degree, Occupational Skills Licensure, Occupational Skills Certificate/ Credential, or Other Recognized Educational or Occupational Skills Certificate









  1. Begin date: MM-YYYY

Grantee Case File / MIS

Both

  1. End date: MM-YYYY

Grantee Case File / MIS

Both

  1. Successfully complete?

Grantee Case File / MIS

Both

  1. Training Vendor (pick list selection)

Grantee Case File / MIS

Both

  1. Education degree or certificate received (pick list selection)

Grantee Case File / MIS

Both

  1. Regulatory license or certification received (pick list selection)

Grantee Case File / MIS

Both

  1. Title of course required for program completion

(note: identify and enter the title of each course completed. Courses will be stored in a sub-table associated with each program completed by a participant)

Grantee Case File / MIS

Both

  1. Date course completed: MM-YYYY

(note: identify and enter the completion date of each course. Courses will be stored in a sub-table associated with each program completed by a participant)

Grantee Case File / MIS

Both

S2. Employment

S2a. Employment Development Activities

Possible employment activities options:

(Select as many as appropriate from pick list: each activity can be selected multiple times)

  1. On-the-job training

  2. Job readiness workshops

  3. Work experience (subsidized or not), not part of any occupational education or training program

  4. Transitional job or subsidized employment

  5. Soft skills / life skills / work readiness training

  6. Other, specify

For each activity (1-6 completed):


  1. Begin date: MM-YYYY



Grantee Case File / MIS



Both



Core and intensive service records







  1. End date: MM-YYYY

Grantee Case File / MIS

Both

  1. Actual hours completed: Open field (Numeric value)

Grantee Case File / MIS

Both

S2. Employment

S2b. Employment Activities

Possible employment activity options:


  1. Job shadowing

  2. Pre-employment screening services

  3. Career counseling / job coach / navigator

  4. Job search / placement assistance

  5. Job retention services

For each activity (1-5 completed):


Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)



Grantee Case File / MIS



Both



Core and intensive service records







Counseling options

  1. Academic counseling / advising

  2. Assessment

  3. Mentoring / peer support

  4. Tutoring

  5. Other, specify

For each activity (1-5 completed):


Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)



Grantee Case File / MIS



Both

Received Supportive Services (except needs-related payments)




S3. Social and Family Services

S3a. Case Management

Case management (may also be identified as mentor, career advisor, navigator)

Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)

Grantee Case File / MIS

Both

Received Supportive Services (except needs-related payments)






S3. Social and Family Services

S3b. Cultural Programming

Cultural programming

Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)

Grantee Case File / MIS

Both

Received Supportive Services (except needs-related payments)






S3. Social and Family Services

S3c. Emergency Discretionary Payment Support

Possible emergency discretionary payment support options:

  1. Home heating assistance

  2. Car repair

  3. Car insurance

  4. Food and shelter

  5. Utilities assistance

  6. Other emergency assistance, specify

For each service (1-6 received):


Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)



Grantee Case File / MIS



Both
















S3. Social and Family Services

S3d. Housing Support

Possible housing support options:

  1. Security deposit

  2. First month’s rent

  3. Funds to participate in housing program

  4. Short-term / temporary housing payment

  5. Other (does not include emergency payments), specify

For each service (1-5 received):


Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)



Grantee Case File / MIS



Both













S3. Social and Family Services

S3e. Social Supportive / Other Benefits

Possible social supportive / other benefits options:

  1. Child / dependent care assistance

  2. Transportation assistance

  3. Driver’s license assistance

  4. Food assistance (other than SNAP)

  5. Addiction and substance abuse services

  6. Family preservation services

  7. Family engagement services

  8. Legal assistance

  9. Primary / medical care

  10. Other, specify

For each service (1-10 received):


Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)



Grantee Case File / MIS



Both

Received Supportive Services (except needs-related payments)










S3. Social and Family Services

S3f. Other (other than emergency payments)


  1. Other, specify

For this service:


Received in 6 month period:

check box to affirm received (statically displayed for 6 month periods)

Grantee Case File / MIS

Both

Received Supportive Services (except needs-related payments)







Describe

Grantee Case File / MIS

Both



C. Exit

Outputs and “Intermediate” Outcome Information

Data Item / Question

Response Fields to be Completed for Each Data Item

Data Source

Performance Managt., Evaluation, Both

WIASRD

ISIS Form

O1. HPOG exit date

MM-DD-YYYY

Grantee Case File / MIS

Both

Date of Exit


O2. Date of program Re-entry (if greater than 3 months past program exit)

MM-DD-YYYY

Grantee Case File / MIS

Both



O3. HPOG training program completed at exit date

1 = Yes

2 = No

Grantee Case File / MIS

Both



O4. Reason for early HPOG program exit (prior to expected completion)

  1. = Got a job

  2. = Moved out of program area

  3. = Found out that the health care occupations were ”not for me”

  4. = Did not like the program

  5. = Participant dropped out / Unable to locate

  6. = Institutionalized

  7. = Health/Medical

  8. = Deceased

  9. = Family Care

  10. = Reserve Forces Called to Active Duty

  11. = Relocated to Mandated Residential Program

  12. = Other reason

  1. = No choice identified

Grantee Case File / MIS

Both

Reason for Exit


O5. Employed at exit

1 = Yes

2 = No

Grantee Case File / MIS

Both

Employed in 1st Quarter After Exit Quarter


O6. If O3 = 1 (Yes), employed:

O6a. Starting hourly wage

$XX.XX

Grantee Case File / MIS

Both



O6b. Hours worked in last full week

Open field (Numeric value) possible entry 0 to 40 hours

Grantee Case File / MIS

Both



O7. If O3 = 1 (Yes), employed in health care occupation

  1. = Yes

  2. = No

Grantee Case File / MIS

Both



O8. If O5 = 1 (Yes), enter occupational BLS SOC code

Pick list value selection

Grantee Case File / MIS

Both

Occupational Code (if Yes, Employed); Entered Training Related Employment


O9. If O5 = 1 (Yes), individual is:

  1. = working for a health care employer

  2. = working for a non-health care employer

  3. = self-employed

  4. = does not self-identify

Grantee Case File / MIS

Both



O10. If O5 = 1 (Yes) and D9 = 1 (American Indian or Alaska Native), individual is an employee of a tribal organization

  1. = Yes

  2. = No

Grantee Case File / MIS

Both



O11. If O5 = 1 (Yes), individual is provided access to health insurance through employer

  1. = Yes

  2. = No

Grantee Case File / MIS

Both



O12. For education and training activities received by a participant, were any of the following funding sources utilized?

  1. = Tuition assistance from HPOG funds

  2. = Tuition assistance from Pell grant

  3. = Tuition assistance from employer

  4. = ITA

  5. = Tuition assistance – other

Grantee Case File / MIS

Evaluation



“End” Outcome Information

(*We currently anticipate that grantees would conduct six-month follow-up surveys of program exiters to obtain these data. The follow-up survey would ask five questions: 1) Are you currently employed? 2) If yes, are you employed in a health care occupation?; 3) What was your hourly wage during the last full week?; 4) how many hours did you work in the last full week?; and 5) have you received a promotion or moved to a higher level position since first becoming employed?)

E1. Employed in any occupation 6 months after program exit?

  1. = Yes

  2. = No

Program staff and regular follow up

Both



E2. If E1 = 1 (Yes), employed:

E2a. Current hourly wage in last full week


$XX.XX

Program staff and regular follow up

Both



E2b. Hours worked in last full week

Open field (Numeric value) possible entry 0 to 40 hours

Program staff and regular follow up

Both



E3. If E1 = 1 (Yes), employed in health care occupation:

  1. = Yes

  2. = No

Program staff and regular follow up

Both

Wages 2nd Quarter After Exit Quarter


E4. If E1 = 1 (Yes), enter occupational BLS SOC code

Pick list value selection

Program staff and regular follow up

Both



E5. If E1 = 1 (Yes), individual is:

  1. = working for a health care employer

  2. = working for a non-health care employer

  3. = self-employed

  4. = does not self-identify

Program staff and regular follow up

Both



E6. If E1 = 1 (Yes), participant has been promoted (i.e. higher pay and/or title) since HPOG program exit

  1. = Yes

  2. = No

Program staff and regular follow up

Both



E7. If E1 = 1 (Yes), individual is provided access to health insurance through employer

  1. = Yes

  2. = No

Program staff and regular follow up

Both



E8. Currently enrolled in non-HPOG funded education program

  1. = Yes

  2. = No

Program staff and regular follow up

Both



E9. If E1 = 1 (Yes) and D9 = 1 (American Indian or Alaska Native), individual is an employee of a tribal organization

  1. = Yes

2 = No

Program staff and regular follow up

Both




Grantee-Level Data Items


A. Basic Grant Data

The following group of characteristics will be entered for each grantee and remain constant over the grant period.


Data Item / Question

Response Fields to be Completed for Each Data Item

Data Source

Performance Managt., Evaluation, Both

WIASRD

ISIS Form

A1. Grantee organization identification

A1a. Grantee organization name



Programmed static identifier



Evaluator coding


Performance Management



A1b. Grantee number

Programmed static identifier

Evaluator coding

Performance Management



A1c. Sub-grantee name

Open Field Text Entry

(may be entered for multiple sub-grantees)

Grantee entry

Performance Management



A1d. Sub-grantee number

Programmed static identifier (may be generated for multiple sub-grantees)

Evaluator coding

Performance Management



A1e. Federal grant number

Programmed static identifier

Evaluator coding

Performance Management



A1f. DUNS number

Programmed static identifier

Evaluator coding

Performance Management



A1g. EIN number

Programmed static identifier

Evaluator coding

Performance Management



A1h. Grant amount

Programmed static identifier

Evaluator coding

Performance Management



A1i. Grant project title

Programmed static identifier

Evaluator coding

Performance Management



A1j. HPOG Grantee Project Director Last Name

Open Field Text Entry

Grantee entry

Performance Management



A1k. HPOG Grantee Project Director First Name

Open Field Text Entry

Grantee entry

Performance Management



A1l. HPOG Grantee Director telephone

Open Field Numeric Entry

Grantee entry

Performance Management



A1m. HPOG Grantee Project Director email

Open Field Text Entry

Grantee entry

Performance Management



A1n. HPOG PPR Contact Last Name

Open Field Text Entry

Grantee entry

Performance Management



A1o. HPOG PPR Contact First Name

Open Field Text Entry

Grantee entry

Performance Management



A1p. HPOG PPR Contact telephone

Open Field Numeric Entry

Grantee entry

Performance Management



A1q. HPOG PPR Contact email

Open Field Text Entry

Grantee entry

Performance Management



A1r. Grantee street address

Open Field Text Entry

Grantee entry

Performance Management



A1s. Grantee city

Open Field Text Entry

Grantee entry

Performance Management



A1t. Grantee state

Open Field Text Entry

Grantee entry

Performance Management



A1u. Grantee zip code

Open Field Text Entry

Grantee entry

Performance Management





B. PPR Report

The following group of characteristics will be entered for each PPR during the grant period. The database will allow for as many semi-annual reports the grantee submits to ACF.

B1a. Reporting period end date

MM-DD-YYYY

Grantee entry

Performance Management



B1b. Year of grant support

Open Field Numeric Entry

Grantee entry

Performance Management



B1c. Total years of grant support

Open Field Numeric Entry

Grantee entry

Performance Management



B1d. Report period begin date

MM-DD-YYYY

Grantee entry

Performance Management



B1e. Report period end date

MM-DD-YYYY

Grantee entry

Performance Management



B1f. Performance Narrative: Introduction

Open Field Text Entry

Grantee entry

Performance Management



B1g. Performance Narrative: Obstacles

Open Field Text Entry

Grantee entry

Performance Management



B1h. Performance Narrative: Proposed Changes

Open Field Text Entry

Grantee entry

Performance Management



B1i. Performance Narrative: Technical Assistance

Open Field Text Entry

Grantee entry

Performance Management



B1j. Performance Narrative: Dissemination Activities

Open Field Text Entry

Grantee entry

Performance Management



B1k. Performance Narrative: Significant Findings and Events

Open Field Text Entry

Grantee entry

Performance Management



B1l. Performance Narrative: Evaluation

Open Field Text Entry

Grantee entry

Performance Management




C. Education and Training Program Catalog

HPOG grantees will enter the following data elements on each training and education program offered to any HPOG participant. These characteristics may be expanded over the grant period and will be a unique catalog group for each grantee.

C1a. Occupation (SOC)

Programmed static identifier from pick list

SOC

Both



C1b. Training vendor

Open Field Narrative Entry

Grantee entry

Both



C1c. Education degree or certificate resulting from training completion

Open Field Narrative Entry

Grantee entry

Both



C1d. Regulatory license or certification possible post training completion

Open Field Narrative Entry

Grantee entry

Both



C1e. Types of training activities within program

(may select more multiple responses)

  1. = classroom instruction

  2. = OJT/work experience

  3. = internship

  4. = clinical experience

  5. = other

Grantee entry

Both



C1f. Estimated number of total program hours

Open Field Numeric Entry

Grantee entry

Both



D. Remedial / Pre-training Program Catalog

HPOG grantees will enter the following data elements on each remedial / pre-training program offered to any HPOG participant. These characteristics may be expanded over the grant period and will be a unique catalog group for each grantee.

D1a. Training vendor

Open Field Narrative Entry

Grantee entry

Both



D1b. Education degree or certificate resulting from training completion

Open Field Narrative Entry

Grantee entry

Both



D1c. Estimated number of total program hours

Open Field Numeric Entry

Grantee entry

Both




File Typeapplication/msword
AuthorMcDonald, Erin
Last Modified Bybbarker
File Modified2011-08-29
File Created2011-08-29
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