Download:
pdf |
pdfTHIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Grants to Indian Tribal Governments Program
Brief Instructions: This form must be completed for each Grants to Indian Tribal Governments (Tribal Governments Program) grant received. The grant administrator or coordinator must ensure that the form is
completed fully with regard to all grant activities. Grant partners, however, may complete sections relevant to
their portion of the grant. Grant administrators or coordinators are responsible for compiling and submitting
a single report that reflects all information collected from grant partners.
All grantees should read each section to determine which questions they must answer based on the activities supported under this grant during the current reporting period. Sections B, F, and subsections A1 and
C3 of this form must be completed by all grantees. In sections D, E, and subsections A2, C1, C2, C4, C5, C6,
and C7, grantees must answer an initial question about whether they supported certain activities during the
current reporting period. If the response is yes, then the grantee must complete that section or subsection.
If the response is no, the rest of that section or subsection is skipped.
For example, 1) if you are a victim services agency providing training and victim services with staff funded
under this grant, you would complete A1, A2, B, C1, C3, D, and F (and answer ‘no’ in C2, C4, C5, C6, C7, and
E1-E5); or, 2) if you are a law enforcement agency receiving funds to pay for staff who provide training to
other law enforcement officers, you would complete A1, A2, B, C1, C3, and F (and answer ‘no’ in C2, C4, C5,
C6, C7, D, and E1-E5).
The activities of volunteers or interns should be reported if they were coordinated or supervised by Tribal
Governments Program-funded staff or if Tribal Governments Program funds substantially supported their
activities.
For further information on filling out this form, refer to the separate set of instructions, which contains detailed definitions and examples, illustrating how questions should be answered.
SECTION
Section A: General Information
A1 Grant Information
A2 Staff Information
Section B: Purpose Areas
Section C: Function Areas
C1 Training
C2 Community Education
C3 Coordinated Community Response
C4 Policies
C5 Products and Codes
C6 Data Collection and Communication Systems
C7 System Improvement
Section D: Services to Victims/Survivors and Families
D1 Victim Services/Transitional Housing/Legal Services
D2 Supervised Visitation
Section E: Criminal Justice System
E1 Tribal Law Enforcement
E2 Tribal Prosecution
E3 Tribal Courts
E4 Tribal Probation/Offender Monitoring
E5 Batterer Intervention Program (BIP)
Section F: Narrative
Page Number
1
1
2
3
4
4
8
10
12
16
18
19
20
20
30
34
34
37
41
44
47
49
Tribal Governments Program Semi-annual Progress Report • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
A1
GENERAL INFORMATION
Grant Information
All grantees must complete this subsection.
1.
Date of report
2.
Current reporting period
3.
Grantee name
4.
Grant number
(The federal grant number assigned to your Tribal Governments Program grant)
5.
Point of contact
(person responsible for the day-to-day coordination of the grant)
First
name
(format date with 6 digits - 01/31/07)
✔
January 1-June 30
MI
✔
July 1-December 31
(Year)
Last
name
Address
City
State
Telephone
Zip code
Facsimile
E-mail
6.
What tribal population(s) is(are) served by this grant?
7.
What percentage of your Tribal Government Program funds was directed to each of these areas?
(Report the area[s] addressed by your Tribal Governments Program grant during the current reporting
period and estimate the approximate percentage of funds [or resources] used to address each area
[consider education, training, victim services, etc.]. The grantee may choose how to make this determination.)
Throughout this form, the term sexual assault includes both assaults committed by offenders who are
strangers to the victim/survivor and assaults committed by offenders who are known to, related by
blood or marriage to, or in a dating relationship with the victim/survivor. The term domestic violence/
dating violence applies to any pattern of coercive behavior that is used by one person to gain power
and control over a current or former intimate partner or dating partner. Stalking is defined as engaging
in a course of conduct directed at a specific person that would cause a reasonable person to fear for his
or her safety or the safety of others, or suffer substantial emotional distress.
(See separate instructions for more complete definitions.)
Percentage of grant funds
Sexual assault
Domestic violence/dating violence
Stalking
0%
TOTAL (must equal 100%)
Tribal Governments Program Semi-annual Progress Report • 1 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
A2
Staff Information
Were Tribal Governments Program funds used to fund staff positions during the current reporting period?
Check yes if Tribal Governments Program funds were used to pay staff, including part-time staff and contractors.
Yes—answer question 8
No—skip to section B
8.
Staff
(Report the total number of full-time equivalent (FTE) staff funded by the Tribal Governments Program
grant during the current reporting period. Report staff by function(s) performed, not by title or location.
Include employees who are part-time and/or only partially funded with these grant funds, as well as
consultants/contractors. Report grant-funded overtime. If an employee or contractor was employed
or utilized for only a portion of the reporting period, prorate appropriately. For example, if you hired a
full-time administrator in October who was 100% funded with Tribal Governments Program funds, you
would report that as .5 FTEs. Report all FTEs in decimals, not percentages. One FTE is equal to 1,040
hours—40 hours per week multiplied by 26 weeks. See separate instructions for examples of how to
calculate FTEs.)
Staff
FTE(s)
Administrator (fiscal manager, executive director, shelter manager)
Attorney (does not include prosecutor)
Batterer intervention program staff
Case manager
Child care worker
Counselor
Court personnel
Information technology staff
Judge
Law enforcement officer
Legal advocate (does not include attorney or paralegal)
Outreach staff
Paralegal
Probation officer/offender monitor
Program coordinator (CCR coordinator, training coordinator, victim services coordinator, transitional housing coordinator, visitation services coordinator)
Prosecutor
Sexual assault forensic examiner/sexual assault nurse examiner (SAFE/SANE)
Security staff
Supervised visitation/exchange staff (visitation and exchange center)
Support staff (administrative assistant, bookkeeper, accountant )
Trainer/educator
Tribal cultural specialist
Victim advocate
Victim-witness specialist/coordinator
Other (specify): ________________________________________________________
TOTAL
0.00
Tribal Governments Program Semi-annual Progress Report • 2 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
9.
B
PURPOSE AREAS
All grantees must complete this section.
Statutory purpose areas
(Check all purpose areas that apply to activities supported with Tribal Governments Program funds during the current reporting period.)
Check ALL
that apply
Purpose areas
Develop and enhance effective governmental strategies to curtail violent crimes
against and increase the safety of Indian women consistent with tribal law and custom.
Increase tribal capacity to respond to domestic violence/dating violence, sexual assault, and stalking crimes against Indian women.
Strengthen tribal justice interventions including tribal law enforcement, prosecution,
courts, probation, and correctional facilities.
Enhance services to Indian women victimized by domestic violence/dating violence,
sexual assault, and stalking.
Work in cooperation with the community to develop education and prevention strategies directed toward issues of domestic violence/dating violence and stalking programs and to address the needs of children exposed to domestic violence.
Provide programs for supervised visitation and safe visitation exchange of children in
situations involving domestic violence/dating violence, sexual assault, or stalking committed by one parent against the other with appropriate security measures, policies,
and procedures to protect the safety of victims and their children.
Provide transitional housing for victims of domestic violence/dating violence, sexual
assault, or stalking, including rental or utilities payments assistance and assistance
with related expenses such as security deposits and other costs incidental to relocation to transitional housing, and support services to enable a victim of domestic
violence/dating violence, sexual assault, or stalking to locate and secure permanent
housing and integrate into a community.
Provide legal assistance necessary to provide effective aid to victims of domestic
violence/dating violence, stalking, or sexual assault who are seeking relief in legal
matters arising as a consequence of that abuse or violence, at minimal or no cost to
victims.
Tribal Governments Program Semi-annual Progress Report • 3 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
C1
FUNCTION AREAS
Training
Were your Tribal Governments Program funds used for training during the current reporting period?
Check yes if Tribal Governments Program-funded staff provided training or if Tribal Governments Program
funds were used to directly support training.
Yes—answer questions 10-13
No—skip to subsection C2
For purposes of this reporting form, training means providing information on sexual assault, domestic
violence, dating violence, and stalking that enables professionals to improve their response to victims/
survivors as it relates to their role in the system. Education means providing general information that
will increase public awareness of sexual assault, domestic violence, dating violence, and stalking. In
this subsection, report information on training activities. Education should be reported in subsection
C2.
10. Training events
(Report the total number of training events provided during the current reporting period that were either provided by Tribal Governments Program-funded staff or directly supported by Tribal Governments
Program funds. Training provided to Tribal Governments Program-funded staff should not be counted.)
Total number of training events provided
Tribal Governments Program Semi-annual Progress Report • 4 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
11. Number of people trained
(Report the number of people trained during the current reporting period by Tribal Governments Program-funded staff or training supported by Tribal Governments Program funds by type of agency. Use
the category that is most descriptive of the people who attended the training event. Tribal Governments
Program-funded staff attending training events should not be counted. If you do not know how many
people to report in specific categories, you may report the overall number in “Multidisciplinary” but this
category should be used only as a last resort. Students, community members, and victims should not
be reported as people trained, since they are not professionals responding to victims.)
People trained
Attorneys/law students (does not include prosecutors)
Batterer intervention/offender accountability program staff
Correction personnel (probation, parole, and correctional facility staff)
Court personnel (judges, clerks)
Disability organization staff (non-governmental)
Educational/child care staff (teachers, administrators, etc.)
Elder organization staff (non-governmental)
Faith-based organization staff
Federal law enforcement officers
Government agency staff (vocational rehabilitation, food stamps, TANF)
Health professionals (doctors, nurses-- does not include SAFE/SANE)
Law enforcement officers
Legal services staff (does not include attorneys)
Mental health professionals
Military command staff
Multidisciplinary (various disciplines at same training)
Prosecutors
Sexual assault forensic examiners/sexual assault nurse examiner
(SAFE/SANE)
Social service organization staff (non-governmental-- food bank, homeless shelter)
Spiritual leaders
Substance abuse treatment staff
Supervised visitation and exchange center staff
Tribal council members
Tribal elders
Tribal government/Tribal government agency staff
Victim advocates (includes sexual assault, domestic violence, and dual)
Victim-witness specialists/coordinators
Volunteers
Women’s Advisory Committee members
Other (specify): __________________________
TOTAL
Tribal
Non-tribal
0
Tribal Governments Program Semi-annual Progress Report • 5 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
12. Training content areas
(Indicate all topics covered in training events provided with your Tribal Governments Program funds during the current reporting period. Check all that apply.)
Sexual assault, domestic violence, dating viollence, and stalking
Advocacy for American Indian and/or Alaska
Native women
Child witnesses
Confidentiality
Cultural issues specific to American Indians
and/or Alaska Natives
Dating violence overview, dynamics,
and services
Domestic violence overview, dynamics,
and services
Dynamics and history of violence against
American Indian and/or Alaska Native women
Historical trauma
Indian Child Welfare Act
Mandatory reporting requirements
Response to victims who are incarcerated
Safety planning for victims
Sexual assault overview, dynamics, and
services
Stalking overview, dynamics, and services
Supervised visitation and exchange
Tribal strategies to address sexual assault, domestic violence/dating violence, or stalking
Other (specify):
Other underserved populations
Issues specific to American Indian or Alaska Native
victims/survivors who:
are elderly
are geographically isolated
are homeless or living in poverty
are lesbian, gay, bisexual, transgender,
or intersex
have disabilities
have mental health issues
have substance abuse issues
live in rural areas
live in urban areas
Other (specify):
Justice system
Civil court procedures
Criminal court procedures
Dispatcher response
Firearms and domestic violence/dating violence
Identification and arrest of predominant
aggressor
Judicial response
Jurisdictional issues (local, tribal, federal,
state)
Law enforcement response
Offender accountability programs/BIP
Pro-arrest policies
Probation response
Prosecution response
Protection orders (including full faith
and credit)
Sexual assault statutes/codes
Sexual assault forensic examinations
Stalking statutes/codes
Tribal jurisdiction and Public Law 280
Other (specify):
Community response
Community response to sexual assault
Coordinated community response
Response teams (DART, DVRT, SART)
Technology
Volunteer training
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 6 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
13. (Optional) Additional information
(Use the space below to discuss the effectiveness of training activities funded or supported by your
Tribal Governments Program grant and to provide further explanation on how these activities increase
the safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 7 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
C2
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Community Education
Were your Tribal Governments Program funds used for community education activities during the current
reporting period?
Check yes if any Tribal Governments Program-funded staff engaged in community education activities or if
Tribal Governments Program funds directly supported community education.
Yes—answer questions 14-16
No—skip to subsection C3
For purposes of this reporting form, education means providing general information that will increase
public awareness of sexual assault, domestic violence, dating violence, and stalking. Training means
providing information on sexual assault, domestic violence, dating violence, and stalking that enables
professionals to improve their response to victims/survivors as it relates to their role in the system. In
this subsection, report information on community education activities. Training should be reported in
subsection C1.
14. People educated with Tribal Governments Program funds
(Report the number of people attending community education events during the current reporting period. Use the category that is most descriptive of the people who attended the event.)
People attending event
Number
Child care providers
Community businesses (casinos, retail stores)
Community groups (service or social groups)
Community members
Educators (teachers, administrators, etc.)
Faith-based groups
Men’s groups
Parents/guardians
Students
Tribal elders
Victims/survivors
Women’s groups
Other (specify):
0
TOTAL
Tribal Governments Program Semi-annual Progress Report • 8 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
15. Topics of education events provided with Tribal Governments Program funds
(Indicate all topics covered in education events provided with your Tribal Governments Program funds
during the current reporting period. Check all that apply.)
Domestic violence, dating violence, and stalking
How to help American Indian or Alaska Native
Child witness overview, dynamics and services victims/survivors who:
are elderly
Dating violence overview, dynamics and services
are geographically isolated
Domestic violence/dating violence prevention
program
are homeless or living in poverty
Domestic violence overview, dynamics and serare isolated or institutionalized
vices
are lesbian, gay, bisexual, transgender, or
Healthy relationships/domestic violence/dating
intersex
violence prevention (6-12th grade)
have disabilities
Healthy relationships/domestic violence/dating
have mental health issues
violence prevention (university)
have substance abuse issues
Healthy relationships/domestic violence/dating
live in rural areas
violence prevention (community)
live in urban areas
Indigenous prevention programs
Other (specify):
Mandated reporting of child victimization
Response to victims who are incarcerated
Safety planning
Sexual assault overview, dynamics, and services
Stalking overview, dynamics, and services
Youth awareness of sexual assault, domestic violence/dating violence, and stalking
Workplace violence
Other (specify):
16. Outreach activities
(Indicate the number of outreach activities supported with Tribal Governments Program funds during
the current reporting period.)
Activities
Community organizing/community events (rallies, speak outs, Take Back the Night,
vigils)
Educational exhibits (Clothesline Project, silent witness, information tables)
Media campaigns (press conferences, public service announcements, articles)
Productions for public awareness (video series, theater productions)
Other (specify):
TOTAL events
Number
Tribal Governments Program Semi-annual Progress Report • 9 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
C3
Coordinated Community Response
All grantees must complete this subsection.
Are you an Indian victim services provider organization?
Yes
No
Are you a Tribal Coalition?
Yes
No
17. Coordinated community response activities
(Check the appropriate boxes to indicate the agencies or organizations that you: provided victim/survivor
referrals to, received victim/survivor referrals from, engaged in consultation with, provided technical assistance to, and/or attended meetings with, during the current reporting period, according to the usual frequency of the interactions. If the interactions were not part of a regular schedule, you will need to estimate
the frequency with which these interactions occurred during the current reporting period. In the last column, indicate the agencies or organizations with which you have a mandatory collaboration for purposes of
your Tribal Governments Program grant. If Tribal Governments Program-funded staff participated in a task
force or work group, indicate that under “Meetings” by checking the frequency of the meetings and the types
of organizations participating.)
Meetings
Collaborative
Agencies or groups
Victim/survivor referpartners
rals, consultations,
technical assistance
Daily Weekly Monthly Weekly Monthly Quarterly
Non-profit, non-governmental Indian
victim services program
Non-profit, tribal domestic violence/
dating violence or sexual assault
coalition
Women’s advisory committee
Batterer intervention/offender monitoring program
Community advocacy organization
Corrections (probation, parole and
correctional facility staff)
Court (federal)
Court (local or state)
Court (tribal)
Educational institutions/youth programs
Faith-based organization
Health/mental health organization
Law enforcement (federal)
Law enforcement (local or state)
Law enforcement (tribal)
Legal organization (legal services,
bar association, law school)
Prosecutor (federal)
Prosecutor (local or state)
Prosecutor (tribal)
Social service organization
Tribal council
Tribal elders
Tribal government agency
Tribal housing authority
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 10 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
18. (Optional) Additional information
(Use the space below to discuss the effectiveness of coordinated community response activities funded
or supported by your Tribal Governments Program grant and to provide further explanation on how
these activities increase the safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 11 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
C4
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Policies
Were your Tribal Governments Program funds used to develop, substantially revise, or implement policies or
protocols during the current reporting period?
Check yes if Tribal Governments Program-funded staff developed, substantially revised, or implemented policies
or protocols, or if Tribal Governments Program funds directly supported the development, revision, or implementation of policies, protocols.
Yes—answer questions 19-20
No—skip to subsection C5
19.
Types of policies or protocols developed, revised, or implemented during the current reporting period.
(Check all that apply.)
Victim services
Appropriate response to victims/survivors with substance abuse issues and/or mental health diagnoses
Appropriate services for victims/survivors who are American Indian or Alaska Native
Appropriate services for victims/survivors who are elderly or have disabilities
Confidentiality
Mandatory training standards for staff and volunteers
Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault
Victims/survivors informed about Crime Victim’s Compensation and Victim Impact Statements
Other (specify):
Health care
Advocate response to emergency room
Appropriate response to victims/survivors to avoid or eliminate re-traumatization
Appropriate services for victims/survivors who are American Indian or Alaska Native
Appropriate services for victims/survivors are who are elderly or have disabilities
Forensic exams not billed to victims/survivors
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
Routine screening and referrals for sexual assault, domestic violence/dating violence, and/or stalking
Other (specify):
Law enforcement
Appropriate response to other underserved populations
Appropriate response to victims/survivors who are American Indian or Alaska Native
Appropriate response to victims/survivors who are elderly or have disabilities
Identifying primary aggressor/discouraging dual arrest
Immediate access to protection order information
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
No charge to sexual assault victims/survivors for any cost associated with forensic exam
No charge to victims/survivors for any costs related to the investigation of sexual assault, domestic violence/dating violence, and/or stalking offenses
No charge to victims/survivors for service of protection orders, warrants, or subpoenas
No victims/survivors polygraphed
Procedures for anonymous, confidential, or Jane Doe reporting of sexual assault
Protection order enforcement (including full faith and credit)
Providing information to victims/survivors about victim services
Report writing and investigation guidelines
Sexual assault response and protocols
Stalking response and protocols
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 12 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Prosecution
Appropriate response to other underserved populations
Appropriate response to victims/survivors who are American Indian or Alaska Native
Appropriate response to victims/survivors who are elderly or have disabilities
Child witness strategies
Evidence-based prosecution
Protection order enforcement (including full faith and credit)
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
No charge to victims/survivors for any costs related to the prosecution of sexual assault, domestic
violence/dating violence, and/or stalking
No victims/survivors polygraphed
Sexual assault response and protocols
Stalking response and protocols
Victim witness notification
Other (specify):
Court
Accelerated trial schedules
Appropriate response to other underserved populations
Appropriate response to victims/survivors who are American Indian or Alaska Native
Appropriate response to victims/survivors who are elderly or have disabilities
Full faith and credit for protection orders
Judicial monitoring of sexual assault, domestic violence/dating violence, and/or stalking offenders
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
No charge to victims/survivors for any costs related to the prosecution of sexual assault, domestic
violence/dating violence, and/or stalking
Policy against mediation
Policy against mutual restraining orders
Procedures for courtroom security
Other (specify):
Probation and parole
Appropriate response to victims/survivors who are American Indian or Alaska Native
Appropriate response to victims/survivors from other underserved populations
Appropriate response to victims/survivors who are elderly or have disabilities
Mandatory training on sexual assault, domestic violence/dating violence, and/or stalking
Strategies to assist and protect victims/survivors during probation and parole
Victim/survivor notification
Other (specify):
CCR
Interagency response
Tribal Governments Program Semi-annual Progress Report • 13 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Supervised visitation and exchange policies
Center operations
Confidentiality
Flexible hours of operation
Income-based fees (sliding scale)
Program does not charge fees
Protocol between advocacy organization and supervised visitation program
Recordkeeping and report writing
Other (specify):
Service provision
Appropriate response to underserved populations
Child-friendly (toys, games, appropriate décor)
Court feedback procedures
Courtesy monitoring
Document exchange procedures
Mandatory training on domestic violence/dating violence, sexual assault, child abuse, and
stalking
Out-of-jurisdiction referrals
Supervised exchange procedures
Other (specify):
Security and safety
Different entrances for parties
Escort for children and custodial parent
Metal detectors
Panic button(s)
Private, secure drop-off locations for children
Private, secure entrances for children and custodial parent
Security guards
Security measures in place (cameras, staff, etc.)
Security staff observations
Staggered arrival/departure times
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 14 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
20. (Optional) Additional information
(Use the space below to discuss the effectiveness of policies funded or supported by your Tribal Governments Program grant that you have developed or implemented and to provide further explanation
on how these policies increase the safety of American Indian/Alaska Native women.) (Maximum 2,000
characters)
Tribal Governments Program Semi-annual Progress Report • 15 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
C5
Products and Codes
Were your Tribal Governments Program funds used to develop, substantially revise, or distribute products
or codes during the current reporting period?
Check yes if Tribal Governments Program-funded staff developed, revised, and/or distributed products or
codes or if Tribal Governments Program funds directly supported the development, revision, or distribution of
products or codes.
Yes—answer question 21
No—skip to subsection C6
21. Use of Tribal Governments Program funds for product or code development, substantial revision, or
distribution
(Report the number of products or codes developed, substantially revised, or distributed with Tribal
Governments Program funds during the current reporting period. Report the number of new products or codes developed or substantially revised during the current reporting period; the title/topic;
the intended audience for each product or code developed, revised, or distributed; and the number of
products or codes used or distributed. If a product or code was created in or translated into a language
other than English, including Braille, indicate the language. Report on products or codes that were
newly developed during the current reporting period whether or not they were used or distributed, and
on products or codes that were previously developed or revised but were used or distributed during the
current reporting period. Do not report the number of products printed or copied; only report the number developed or revised—in most cases that number will be one for each product described—and/or
the number used or distributed. See separate instructions for examples of how to report under “developed or revised” and “used or distributed.”)
Products
Number
developed
or revised
Title/topic
Intended
audience
Number
Other
used or
languages
distributed
Brochures
Manuals
Training
curricula
Tribal Governments Program Semi-annual Progress Report • 16 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
21. Use of Tribal Governments Program funds for product or code development, substantial revision, or
distribution (cont.)
Products
Number
developed
or revised
Title/topic
Intended
audience
Number
Other
used or
languages
distributed
Training
materials
Tribal
codes
Other
(specify):
Tribal Governments Program Semi-annual Progress Report • 17 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
C6
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Data Collection and Communication Systems
Were your Tribal Governments Program funds used for data collection systems or communication systems or for the purchase of hardware or other equipment during the current reporting period?
Check yes if Tribal Governments Program funds or Tribal Governments Program-funded staff were used to
develop, install, or expand data collection and/or communication systems.
Yes—answer questions 22-23
No—skip to subsection C7
22.
Use of Tribal Governments Program funds for data collection and/or communication systems
(Check all that apply.)
Develop new data collection/communication systems
Install data collection/communication systems
Expand existing data collection/communication systems
Link existing data collection/communication systems
Share information with other community partners
Manage data collection and communication
Purchase computers and other equipment
23. Purpose of data collection and/or communication systems
(Indicate all types of information being identified or tracked with this technology by checking all that apply.)
Arrests/charges
Bail/bond orders
Calls to police
Case management
Compliance with court-ordered sanctions
Convictions
Court docket management
Evaluation/outcome measures
Incident reports
Information sharing
Probation conditions/violations
Prosecutions
Protection orders
Recidivism
Sentencing
Sex offender registration
Stalking and harassment orders
Victim/survivor notification
Victim/survivor service availability
Violations of protection orders
Warrants
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 18 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
C7
System Improvement
Were your Tribal Governments Program funds used for system improvement during the current reporting
period?
Check yes if any Tribal Governments Program-funded staff engaged in system improvement activities or if
Tribal Governments Program funds directly supported system improvements (e.g., safety audits, security).
Yes—answer question 24
No—skip to section D
24. Use of Tribal Governments Program funds for system improvement
(Check all that apply for the current reporting period.)
Victim
services
Law
enforcement
Prosecution
Court
Probation or
parole/offender
monitoring
Meetings between tribal and nontribal entities
Safety and accountability audits
Security personnel or equipment
Translation of forms and documents
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 19 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
D1
SERVICES TO VICTIMS/SURVIVORS
AND FAMILIES
Victim Services/Transitional Housing Services/Legal Services
Were your Tribal Governments Program funds used to provide victim services, transitional housing services, and/or legal services to victims/survivors during the current reporting period?
Check yes if Tribal Governments Program-funded staff provided any of these victim services or if Tribal Governments Program funds were used to support any of these victim services during the current reporting
period. Report all victims/survivors served, and services provided with Tribal Governments Program funds,
whether by a victim services agency, a legal services organization, or by staff providing victim services within
law enforcement, prosecution, or the court system in subsection D1. Report supervised visitation and exchange services in subsection D2 only. Report criminal justice activities, such as 911 calls, cases investigated, and cases prosecuted in section E only.
Yes—answer questions 25-37 (as relevant), and 44
No—skip to D2
25. Number of victims/survivors served, partially served, and victims/survivors seeking services who
were not served
Please do not answer this question without referring to the separate instructions for further explanation and examples of how to distinguish among these categories. (Report the following, to the best of
your ability, as an unduplicated count for each category during the current reporting period. This means
that each victim/survivor who was seeking or who received services during the current reporting period
should be counted only once in that reporting period. For purposes of this question, victims/survivors
are those against whom the sexual assault, domestic violence, dating violence, and/or stalking was
directed. If the victim/survivor experienced more than one victimization, that person should be counted
only once under the primary victimization. Do not report secondary victims here.)
Number of victims/survivors
Domestic vioSexual
lence/dating Stalking Total
assualt
violence
A.
Served: Victims/survivors who received the grantfunded service(s) they requested, if those services were
funded by your Tribal Governments Program grant.
B. Partially served: Victims/survivors who received some
grant-funded service(s), but not all of the grant-funded
services they requested, if those services were funded by
your Tribal Governments Program grant.
TOTAL SERVED and PARTIALLY SERVED (25A + 25B)
C. Victims/survivors seeking services who were not
served: Victims/survivors who sought grant-funded
services and did not receive the grant-funded service(s)
they were seeking, if those services were funded by your
Tribal Governments Program grant.
0
0
0
0
0
Tribal Governments Program Semi-annual Progress Report • 20 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
0
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
26. Reasons that victims/survivors seeking services were not served or were partially served
(Check all that apply.)
Reasons not served or partially served
Conflict of interest
Did not meet statutory requirements
Hours of operation
Insufficient or lack of culturally appropriate services
Insufficient or lack of language capacity (including sign language)
Insufficient or lack of services for people with disabilities
Lack of child care
Program reached capacity
Program rules not acceptable to victim/survivor
Program unable to provide service due to limited resources/priority-setting
Services inappropriate or inadequate for victims/survivors with mental health issues
Services inappropriate or inadequate for victims/survivors with substance abuse issues
Services not appropriate for victim/survivor
Services not available for victim/survivor accompanied by male adolescents
Transportation
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 21 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
27. Demographics of victims/survivors served or partially served
(Based on the victims/survivors reported in questions 25A and 25B, report the total numbers for all demographic categories that apply. Because victims/survivors may identify in more than one category of
race/ethnicity, the total for “Race/ethnicity” may exceed the total number of victims/survivors reported
in questions 25A and 25B. However, the total number of victims/survivors reported under “Race/
ethnicity” should not be less than the total number of victims/survivors reported in questions 25A and
25B. The total number of victims/survivors reported under “Gender” and the total number reported
under “Age” should equal the total number of victims/survivors reported in questions 25A and 25B.
Those victims for whom gender, age, and/or race/ethnicity is not known should be reported in the “Unknown” category. Do not report demographics for children.)
Race/ethnicity (Victims/survivors should be counted once in each category
of race/ethnicity that applies. Victims/survivors should not be counted more
Victims/survivors
than once in either the category “American Indian and Alaska Native” or in the
category “Native Hawaiian and other Pacific Islander.”)
American Indian and/or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian and other Pacific Islander
White
Unknown
TOTAL RACE/ETHNICITY (should not be less than sum of25A and 25B)
Gender
0
Victims/survivors
Female
Male
Unknown
TOTAL GENDER (should equal sum of 25A and 25B)
Age
0
Victims/survivors
0-12
13-17
18-24
25-59
60 +
Unknown
TOTAL AGE (should equal sum of 25A and 25B)
Other demographics
0
Victims/survivors
People with disabilities
People with limited English proficiency
People who live in rural areas
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
28. Victims/survivors’ relationships to offenders by victimization
(For those victims/survivors reported as served and partially served in Questions 25A and 25B, report
the victim/survivor’s relationship to the offender by type of victimization. If a victim/survivor experienced more than one type of victimization and/or was victimized by more than one perpetrator, count
the victim/survivor in all categories that apply. The total number of relationships in the sexual assault
column must be at least the sum of sexual assault victims reported in Questions 25A and 25B; the
total number in the domestic violence/dating violence column must be at least the sum of domestic
violence victims reported in Questions 25A and 25B; and the total number in the stalking column
must be at least the sum of stalking victims in Questions 25A and 25B. Do not report relationships
to offender for children.)
Victim/survivor’s relationship to
offender
Number of victim/survivor relationships by victimization
Domestic violence/
Sexual assault
Stalking
dating violence
Current or former spouse or intimate
partner
Other family or household member
Dating relationship
Acquaintance (neighbor, employee, coworker, student, schoolmate, etc.)
Stranger
Relationship unknown
TOTAL
0
0
0
29. Number of services provided to children of victims
(Report the number of children of victims/survivors reported as served or partially served in questions
25A and 25B who also received services and the number of times the services were provided during
the current reporting period. Do not report demographic information in question 27 for the children
served.)
Number of children
Number of times service
was provided
Children’s services (refers to services provided to
children of victims/survivors, including child care,
transportation, counseling, etc.)
Tribal Governments Program Semi-annual Progress Report • 23 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
30A. Victim services
(Report the number of victims/survivors from questions 25A and 25B who received Tribal Governments
Program-funded services during the current reporting period. Count each victim/survivor only once for
each type of service that victim/survivor received during the current reporting period in the column for
the number of victims/survivors and report the number of times that service was provided to the victim/survivor. The total for each type of service should not be higher in the number of victims/survivors
column than the total of questions 25A and 25B [0
]. Transitional housing and shelter services
should be reported in questions 32-34. Do not report children receiving services in this question.)
Type of service
Number of
victims/
survivors
Number of
times service
was provided
Civil legal advocacy/court accompaniment (Assisting a victim/survivor
with civil legal issues, including preparing paperwork for protection
orders; accompanying a victim/survivor to a protection order hearing, administrative hearing, or other civil proceeding; and all other
advocacy within the civil justice system. Does not include services
provided by an attorney or paralegal.)
Counseling services/support group (Individual or group counseling or
support provided by a volunteer, peer, or professional.)
Criminal justice advocacy/court accompaniment (Assisting a victim/
survivor with criminal legal issues including notifying the victim/survivor of case status, hearing dates, plea agreements, and sentencing
terms; preparing paperwork such as victim/survivor impact statements; accompanying a victim/survivor to a criminal court proceeding or law enforcement interview; and all other advocacy within the
criminal justice system.)
Crisis intervention (A process by which a person identifies, assesses,
and intervenes with an individual in crisis so as to restore balance
and reduce the effects of the crisis in her/his life. In this category,
report crisis intervention that occurs in person and/or over the telephone.)
Cultural advocacy (Activities such as sweat lodge, talking circles, wellness gatherings, cultural ceremonies, etc.)
Forensic exam
Hospital/clinic/medical response (Accompanying a victim/survivor to
or meeting a victim/survivor at the hospital, clinic, or medical office.)
Transportation
Victim/survivor advocacy (Actions designed to assist the victim/survivor in obtaining support, resources, or services including employment, housing, shelter services, health care, victim’s compensation,
etc.)
Tribal Governments Program Semi-annual Progress Report • 24 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
30B. Hotline calls
(Report the total number of hotline calls received on phone lines paid for with Tribal Governments
Program funds or answered by Tribal Governments Program-funded staff, during the current reporting
period. Primary victims whose calls are reported here should not be reported as victims served in
Question 25 unless they also received at least one of the services listed in Question 30A Victim
Services. Victims/survivors who receive services such as crisis intervention or victim advocacy over
the telephone, in addition to basic hotline information and/or referrals, should also be reported in
Question 30A. Hotline calls that include victim advocacy or crisis intervention services are those that
require more time than the average call and involve a more intensive focus on the immediate needs
and situation of the victim. For examples of when to report only the hotline call and when to report
both the hotline call and a service or services in Question 30A, see separate instructions.)
Total number of calls
Hotline calls (Crisis or information and referral calls received by an agency’s
hotline or office telephone)
30C. Victim witness notification/outreach to victims/survivors
(Report the number of unsolicited letters, phone calls, or visits to victims/survivors of specific incidents
of sexual assault, domestic violence, dating violence, and stalking incidents identified in police reports
or court documents, informing them of services and/or providing information about the criminal justice
system. Victims/survivors who are the recipients of these notification/outreach activities should not be
reported as victims/survivors served in question 25 unless they also received at least one of the services reported in question 30A Victim Services or questions 32-34, Shelter Services/Transitional Housing
Assistance.)
Number of notification/outreach activities to
victims/survivors
Victim witness notification/outreach to victims/
survivors (unsolicited letters, phone calls or visits)
31. Protection orders
(Report the total number of temporary and/or final protection orders requested and granted for which
Tribal Governments Program-funded victim services staff provided assistance to victims/survivors
during the current reporting period. These orders may also be referred to as protection from abuse,
protection from harassment, or anti-harassment orders, restraining orders, or no-contact or stay-away
orders.)
Temporary protection orders Final protection orders
Number of protection orders requested
Number of protection orders granted
Tribal Governments Program Semi-annual Progress Report • 25 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Shelter/Transitional Housing Assistance
Were your Tribal Governments Program funds used to provide shelter and/or transitional housing assistance to victims/survivors during the current reporting period?
Check yes if Tribal Governments Program-funded staff provided any of these services or if Tribal Governments Program funds were used to support any of these services during the current reporting period.
Yes--answer questions 32-34
No--skip to Legal Services section
32. Shelter and transitional housing services
(Report the total number of victims/survivors and accompanying family members who received emergency shelter or transitional housing provided with Tribal Governments Program funds during the current reporting period. This should be an unduplicated count for both victims/survivors and for family
members. This means that each victim/survivor and each family member who received shelter services during the current reporting period should be counted only once. Report the total number of bed
nights provided in emergency shelter or transitional housing to victims/survivors and family members.
Emergency shelter can be safe houses or hotel/motel accommodations. The number of bed nights is
determined by multiplying the number of victims and family members by the number of nights they
stayed in the shelter. The number of bed nights will typically be significantly higher than the number of
victims and family members. For example, one victim and her three children all stayed in the shelter
for 10 nights. The number of bed nights would be 4 multiplied by 10, or 40.)
Number of victims/
survivors
Shelter service
Number of family
members
Number of bed nights
Emergency shelter
Transitional housing
33. Type and number of housing units
(Report the number and type of housing units supported with grant funds. Section B, number of units,
should be an unduplicated count of the units available. See the separate set of instructions for definitions.)
A. Number of units/subsidies
B. Number of single/family units
Type of housing
Available to
Tribal/program- Program-rented
Vouchers/
Available to
units
single victims/
owned units
units
rent subsidies
families
survivors
Scattered
Clustered
Co-located with
domestic violence/dating violence emergency
shelter
Co-located with
homeless emergency shelter
Other (specify):
TOTAL
0
0
0
0
Tribal Governments Program Semi-annual Progress Report • 26 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
34. Housing assistance
(For those victims/survivors reported in questions 25A and 25B, report the number provided with each
type of housing assistance during the current reporting period. Each person may be counted once
for each type of housing assistance they received during the current reporting period. See separate set
of instructions for examples.)
Number of victims/ Total number of
Type of service
Total cost
survivors
months
Childcare
Clothing
Food
Household furnishings (purchased with
grant funds)
Rent subsidy
Relocation expenses
Rental unit fees (security deposit, application fees, credit report fees)
Transportation
Utilities (including electricity, heat and
telephone)
Other (specify):
TOTAL
0.00
0
Tribal Governments Program Semi-annual Progress Report • 27 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0.00
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Legal Services
Were your Tribal Governments Program funds used to provide legal services to victims/survivors during
the current reporting period?
Check yes if Tribal Governments Program-funded staff provided any of these services or if Tribal Governments Program funds were used to support any of these services during the current reporting period.
Yes--answer questions 35-37.
No--skip to subsection D2
Answer questions 35-37 only if your Tribal Governments Program funds supported lawyers, paralegals, or
specially appointed advocates who provided legal services to victims/survivors during the current reporting
period.
35. Legal issues
(Report the total number of new and pending matters in which the following legal issues were addressed by Tribal Governments Program-funded lawyers, paralegals, or specially appointed advocates
during the current reporting period. Count a victim/survivor once for each category of legal issue for
which they received assistance. A pending matter is one that was open as of the first day of the current reporting period; a new matter is one that was opened during the current reporting period.)
Legal issues
Number of victims/survivors
Pending
New
A. Protection orders (temporary and final, enforcement
of existing PO)
B. Family law matters
Divorce
Custody/visitation
Establishment of paternity
Child/spousal support
Other family law matters
C. Consumer/finance (credit, debt, bankruptcy, tax, etc.)
D. Employment
E. Income maintenance (TANF, disability, food stamps,
unemployment)
F. Housing
G. Victims’/suvivors’ rights within the criminal justice
system (Does not include defending victims accused
of criminal activities.)
H. Other (specify):
Tribal Governments Program Semi-annual Progress Report • 28 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
35A. Number of victims/survivors who received assistance with legal issues in question 35
(Report an unduplicated count for the number of victims/survivors who received assistance with at
least one legal issue in question 35. If they received assistance with more than one legal issue, count
them only once in this question and report them below in question 36.)
Total number of victims/survivors who received assistance with legal issues
36. Number of victims/survivors who received assistance with multiple legal issues
(Report the number of victims/survivors who received Tribal Governments Program-funded services in
more than one of the categories [A-H] listed in question 35 during the current reporting period. Consider all family law matters as one category.)
Total number of victims/survivors who received assistance with multiple legal issues
37.
Legal outcomes
(For all cases closed or issues resolved during the current reporting period for which services were
provided by Tribal Governments Program-funded lawyers, paralegals, or lay legal advocates, report the
number and type of outcome for each issue addressed and resolved. Include all outcomes in all matters.)
Negotiated resolution
Information/
AdminVictim/
Brief
Court
Other
Legal issue
referral/
istrative
survivor
Filed
No
fi
led
services
decision
result
advice only
decision
withdrew
action
action
Protection orders
(temporary and final, enforcement
of existing PO)
Divorce
Custody/visitation
Establishment of
paternity
Child/spousal
support
Other family law
matters
Consumer/
finance (credit,
debt, bankruptcy,
tax, etc.)
Employment
Income maintenance (TANF,
disability, food
stamps, unemployment)
Housing
Victims’/suvivors’
rights in criminal
justice system
(Does not include
defending victims
accused of criminal activities.)
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 29 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
D2
Supervised Visitation
Were your Tribal Governments Program funds used to provide supervised visitation and/or exchange
services to families during the current reporting period?
Check yes if Tribal Governments Program-funded staff provided supervised visitation and/or exchange services during the current reporting period.
Yes--answer questions 38-44 Provide information only on families served with Tribal
Governments Program grant funds.
No--skip to section E or Question 44
38. Number of families served, partially served, and families seeking services who were not served
Please do not attempt to answer this question without referring to the separate set of instructions for
further explanation and examples of how to distinguish among these categories. (Report the following, to the best of your ability, as an unduplicated count for each category during the current reporting
period. This means that each family who were seeking or who received services during the current reporting period should be counted only once in that reporting period.)
Number of families
A. Served: Families who received the grant-funded service(s) they requested, if those services were funded by your Tribal Governments
Program grant.
B. Partially served: Families who received some grant-funded service(s),
but not all of the grant-funded services they requested, if those services were funded by your Tribal Governments Program grant.
TOTAL SERVED AND PARTIALLY SERVED (38A + 38B)
C.
Families seeking services who were not served: Families who sought
grant-funded services and did not receive the grant-funded service(s)
they requested, if those services were funded by your Tribal Governments Program grant.
39. Reasons families seeking services were not served or were partially served
(Check all that apply.)
Reasons not served or partially served
Hours of operation
Insufficient or lack of language capacity (including sign language)
Insufficient/lack of culturally appropriate services
Insufficient/lack of services for people with disabilities
Party(ies) not accepted into program
Program reached capacity
Program rules not acceptable to party(ies)
Services inappropriate or inadequate for people with mental health issues
Services inappropriate or inadequate for people with substance abuse issues
Services not appropriate for party(ies)
Transportation
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 30 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
39A. Number of families not accepted into program and reasons
(Report the total number of families who were not accepted into the program during the current reporting period
by the reason they were not accepted.)
Reason
Number of families declined
Too dangerous
Conflict of interest
Client unwilling to agree with program rules
Other (specify):
TOTAL
0
40. Demographics of family members served or partially served
(Based on the families reported in 38A and 38B, report the total numbers for all demographic categories that
apply. Report the numbers of parents and children served and partially-served. These numbers should be based
on the individuals in the families counted in question 38A and 38B. This should be an unduplicated count for
“gender” and “age”. Parents and children may identify in more than one category for race/ethnicity, however,
they may not be counted more than once in each individual category of race/ethnicity. Those victims/survivors
for whom gender, age, and/or race/ethnicity is not known should be reported in the “unknown” category.)
Race/ethnicity (Individuals may be counted for each ethnicity that applies. Individuals should not be counted more than once in either the
Custodial Non-custodial
Children
category “American Indian and Alaska Native” or in the category “Naparents
parents
tive Hawaiian and other Pacific Islander.”)
American Indian and Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian and other Pacific Islander
White
Unknown
TOTAL RACE/ETHNICITY (should not be less than sum of 38A and 38B)
0
Custodial
parents
Gender
0
Non-custodial
parents
0
Children
Female
Male
Unknown
TOTAL GENDER
(should equal sum of 38A and 38B)
0
Custodial
parents
Age
0
Non-custodial
parents
0
Children
0 to 6
7 to 12
13 to 17
18 to 24
25 to 59
60+
Unknown
TOTAL AGE
(should equal sum of 38A and 38B)
Other demographics
0
Custodial
parents
0
Non-custodial
parents
People with disabilities
People with limited English proficiency
People who live in rural areas
Tribal Governments Program Semi-annual Progress Report • 31 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
Children
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
41. Number of families by primary victimization and referral source
(Report the number of families by primary type of victimization and referral source. This is an unduplicated count and each family should only be counted once. This should equal the sum of questions 38A
and 38B. Refer to the separate set of instructions for further explanation and examples.)
Referral Source
Total number of
families
Sexual assault
Domestic violence/dating
violence
Stalking
Criminal court order
Family court order
Juvenile court order
Protection order
Other civil court order
Other (specify):
TOTAL
0
0
0
0
42. Services provided with Tribal Governments Program funds
(Report the number of families receiving each of these services and the number of times the services
were provided during the current reporting period.)
Type of service
Number of families
Number of times services provided
Group supervision
One-to-one supervision
Supervised exchange
Telephone monitoring
Other (specify):
43. Services terminated or completed
(Report the number of families whose services were terminated or completed during the current reporting period. Check the primary reason.)
Reason terminated or completed
Number of families
Cessation of threats/use of violence
Change in court order
Child refuses to participate
Deceased
Habitual non-compliance with program rules
Habitual no-shows or cancellations
Incarcerated
Moved/relocated
Mutual agreement of both parties
Parent completed treatment program
Supervisor's discretion
Unknown
Other (specify):
TOTAL
0
Tribal Governments Program Semi-annual Progress Report • 32 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
44. (Optional) Additional information
(Use the space below to discuss the effectiveness of victim services, shelter/transitional housing, legal
services, and supervised visitation activities funded or supported by your Tribal Governments Program
grant and to provide further explanation on how these activities increase the safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 33 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
E1
CRIMINAL JUSTICE SYSTEM
Tribal Law Enforcement
Were your Tribal Governments Program funds used for Tribal law enforcement activities during the current reporting period?
Check yes if Tribal Governments Program funded law enforcement activities. If Tribal Governments Program
funds supported only a victim-witness assistant or victim advocate located in a law enforcement agency,
then only subsection D1 Victim Services should be completed.
Yes--answer questions 45-48 Provide information only for Tribal Governments Program-funded
law enforcement activities engaged in during the current reporting period.
No--skip to subsection E2
45. Activities
(Report the number of Tribal Governments Program-funded activities on sexual assault, domestic violence, dating violence, and stalking cases/incidents for the current reporting period. If an activity relates to a case/incident involving more than one type of crime, the activity should be counted only once
under the primary victimization. See instructions for more complete definitions of cases/incidents.)
Domestic
Sexual
violence/
Activity
Stalking
assault
dating
violence
Calls for assistance (All 911 and other calls made to law
enforcement.)
Incident reports (All responses to an incident as reported on
an incident report.)
Cases/incidents investigated (All cases in which evidence
was collected/witnesses interviewed relating to an incident.)
Forensic medical evidence (All cases in which rape kits were
processed.)
Arrests (All arrests made by law enforcement, except dual
arrests.)
Dual arrests (Responses by law enforcement in which the
two parties involved in the incident are arrested.)
Protection/ex parte/temporary restraining orders served
(All instances in which these types of orders were served on
offenders.)
Arrests for violation of bail bond (All instances in which arrests were made of offenders who violated conditions set
out in their bail bonds.)
Enforcement of warrants (All Instances in which warrants
relating to these incidents were enforced.)
Arrests for violation of protection order
Protection orders issued (All orders directly issued by law
enforcement, in jurisdictions where law enforcement officers are so authorized.)
Cases referred to tribal prosecutors
Cases referred to local or state law enforcement or prosecutors
Cases referred to federal law enforcement or prosecutors
(Not including federal firearms charges.)
Referrals of federal firearms charges to federal prosecutor
Tribal Governments Program Semi-annual Progress Report • 34 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
46. Victim/survivor referrals to victim services
(Report the total number of victim/survivor referrals to victim services by Tribal Governments Programfunded staff during the current reporting period. Victim services refer to services provided by agencies
that serve victims/survivors of sexual assault, domestic violence, dating violence, and/or stalking.)
Tribal victim services
Non-tribal victim services
Number of victim/survivor referrals
47. Protection orders
(Report the total number of temporary and/or final protection orders requested and granted for which
Tribal Governments Program-funded law enforcement staff provided assistance to victims/survivors
during the current reporting period. These orders may also be referred to as protection from abuse,
protection from harassment or anti-harassment orders, restraining orders, or no-contact or stay-away
orders.)
Temporary protection orders
Final protection orders
Number of protection orders
requested
Number of protection orders
granted
Tribal Governments Program Semi-annual Progress Report • 35 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
48. (Optional) Additional information
(Use the space below to discuss the effectiveness of law enforcement activities funded or supported
by your Tribal Governments Program grant and to provide further explanation on how these activities
increase the safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 36 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
E2
Tribal Prosecution
Were your Tribal Governments Program grant funds used for tribal prosecution during the current reporting period?
Check yes if Tribal Governments Program funded prosecution activities. If Tribal Governments funds supported only a victim-witness assistant/specialist or victim advocate located in a prosecution office, then only
subsection D1 Victim Services should be completed.
Yes--answer questions 49-54 Provide the information only for Tribal Governments Program-funded
prosecution activities engaged in during the current reporting period.
No--skip to subsection E3
49. Number of cases received, accepted for prosecution, or declined
(Report the number of domestic violence, dating violence, sexual assault, or stalking-related case referrals received--including cases already charged before reaching the prosecutor’s office—and of those
cases referred, report the number that were accepted and the number that were declined for prosecution during the current reporting period. A case should be characterized by the most serious offense
and may include numerous charges or counts. In most instances, a case will refer to one victim, one
offender, and one incident. It is strongly suggested that you refer to the separate instructions for examples of how to count and characterize cases.)
Domestic violence cases may include any assaults, battery, vandalism, or other offenses that occurred in a domestic violence incident. Your tribal code does not have to name an offense ‘‘domestic
violence’’ for a case addressing that offense to be counted here. Similarly, cases addressing sexual
assault, dating violence and stalking offenses should be counted, even if your tribal code uses other
names for these types of offenses, such as ‘‘sexual battery’’ or ‘‘harassment.’’
Domestic violence/
Received/accepted/declined
Sexual assault
Stalking
dating violence
a. Number of case referrals received
b. Number of cases accepted for prosecution
c. Number of cases declined
d. Number of cases declined due to jurisdictional limitations
d1. Cases referred to local, state, or federal
entity for prosecution
d2. Cases not referred to local, state, or
federal entity for prosecution
49A. Reasons for declining cases
(Of those cases reported in question 49c as declined and question 49d2 as not referred, report only
the primary reason for the decision to decline or not refer for prosecution. Please see separate instructions for further explanation of the reasons and for examples of how to apply them.)
Domestic violence/
Reason for declining
Sexual assault
Stalking
dating violence
Insufficient evidence (returned for further investigation)
Insufficient evidence or victim/survior unavailable
Request of victim/survivor or victim/survivor
safety
Other (specify):
Tribal Governments Program Semi-annual Progress Report • 37 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
50. Disposition of cases
(Report the dispositions of all cases resolved during the current reporting period.)
Plead
to
lesser
Plead
as
charged
Guilty of
lesser
Number
dismissed
Number convicted
Guilty
as
charged
Type of
case
Number of
deferred
adjudications
Sexual
assault
Domestic
violence/
dating
violence
Stalking
Violation
of
protection
order
Violation
of bail
Violation
of
probation
Violation
of other
court
order
Other
(specify):
Tribal Governments Program Semi-annual Progress Report • 38 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
Number
acquitted
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
51. (Optional) Other issues present in cases that reached disposition
(If possible, use the space below to discuss the extent to which cases that were characterized as domestic violence, dating violence, sexual assault, and/or stalking also included additional charges or
elements of domestic violence, dating violence, sexual assault, and/or stalking beyond that case characterization. For example, cases reported above as domestic violence cases may also have included
counts of sexual assault, and cases reported as sexual assaults may also have included stalking charges. The purpose of this question is to gather information on how often multiple crimes were present in
the cases reported. If detailed information is not available, feel free to provide estimates based on your
experience.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 39 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
52. Victim/survivor referrals to victim services
(Report the total number of victim/survivor referrals to victim services by Tribal Governments Program-funded staff during the current reporting period. Victim services refer to services provided by agencies that serve
victims/suvivors of sexual assault, domestic violence, dating violence, and/or stalking.)
Tribal victim services
Non-tribal victim services
Number of victim/survivor referrals
53. Protection orders
(Report the total number of temporary and/or final protection orders requested and granted for which Tribal
Governments Program-funded tribal prosecutors provided assistance to victims/survivors during the current
reporting period. These orders may also be referred to as protection from abuse, protection from harassment or anti-harassment orders, restraining orders, or no-contact or stay-away orders.)
Temporary protection orders
Final protection orders
Number of protection orders requested
Number of protection orders granted
54. (Optional) Additional information
(Use the space below to discuss the effectiveness of prosecution activities funded or supported by your
Tribal Governments Program grant and to provide further explanation on how these activities increase the
safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 40 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
E3
Tribal Courts
Were your Tribal Governments Program funds used for tribal courts during the current reporting period?
Check yes if Tribal Governments Program funds directly supported court activities. If Tribal Governments
funds supported only a victim advocate located in a court, then only section D Victim Services would be completed.
Yes--answer questions 55-62 Provide the information only for Tribal Governments Program-funded
court activities engaged in during the current reporting period.
No--skip to subsection E4
55. Number of criminal cases
(Report the total number of new sexual assault, domestic violence, dating violence and stalking-related
cases filed during the current reporting period.)
Your tribal code or state law does not have to name the offense “sexual assault”, “domestic violence or
dating violence,” or “stalking” for it to be counted here. Your code may use other names for these types
of offenses, such as sexual battery or harassment. Similarly, domestic violence or dating violence offenses include any assaults, battery, vandalism, or other offenses that occurred in a domestic violence
or dating violence incident.
Type of case
New cases filed during the current reporting period
Sexual assault
Domestic violence/dating violence
Stalking
Violation of protection order
Violation of bail
Violation of probation
Violation of other court order
TOTAL
0
56. Disposition of criminal cases
(Report the disposition of sexual assault, domestic violence, dating violence, and/or stalking cases resolved during the current reporting period.)
Number of deferred
Type of case
Number dismissed
Number convicted Number acquitted
adjudications
Sexual assault
Domestic violence/
dating violence
Stalking
Violation of protection
order
Violations of bail
Violation of probation
Violation of other court
order
TOTAL number of
dispositions
0
0
0
Tribal Governments Program Semi-annual Progress Report • 41 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
0
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
57. Judicial monitoring
(Report the number of sexual assault, domestic violence, dating violence, and stalking offenders whose
cases were reviewed by the court for compliance with conditions of probation or other court-ordered
conditions, or for violations of those conditions. Also, report the total number of review hearings conducted. The number of review hearings is the number of individual hearings held for each offender, even
when that offender is reviewed during the same monitoring sessions as other offenders. For example,
if 10 offenders were reviewed at the same three sessions during the reporting period, the number of
offenders reviewed would be 10 and the number of review hearings conducted would be 10 multiplied
by 3, or 30.)
Number of offenders reviewed
Number of review hearings conducted
TOTAL
58. Dispositions of violations
(Report the number of sexual assault, domestic violence, dating violence, and stalking cases in which
there were dispositions of violations during the current reporting period. The violation does not have
to have occurred during this reporting period, only the disposition. A case may be counted more than
once if there were multiple violations.)
Partial reProbation
No action Verbal/writConditions
Violation
Fine
vocation of revoked/intaken
ten warning
added
probation carcerated
Protection order
New criminal behavior
Failure to attend mandated batterers intervention program (BIP)
Failure to attend mandated offender treatment (does not include
BIP)
Other condition of
probation
TOTAL
0
0
0
0
0
0
59. Victim/survivor referrals to victim services
(Report the total number of victim/survivor referrals to victim services by Tribal Governments Programfunded staff during the current reporting period. Victim services refer to services provided by agencies
that serve victims/survivors of sexual assault, domestic violence, dating violence, and/or stalking.)
Tribal victim services
Non-tribal victim services
Number of victim/survivor referrals
60. Civil protection orders
(Report the total number of temporary and/or final civil protection orders requested and granted for
domestic violence, dating violence, sexual assault, or stalking, by the court during the current reporting
period. These orders may be referred to as protection from abuse or protection from harassment or
anti-harassment, or restraining orders. Include only civil orders.)
Domestic violence/dating violence
Temporary protection orders Final protection orders
Number of protection orders requested
Number of protection orders granted
Tribal Governments Program Semi-annual Progress Report • 42 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
61. Criminal protection orders
(Report the total number of criminal protection orders requested and the total number granted by the
court to victims/survivors of domestic violence, dating violence, sexual assault, or stalking during the
current reporting period. These orders may be referred to as no-contact or stay-away orders.)
Requested
Granted
Number of protection orders
62. (Optional) Additional information
(Use the space below to discuss the effectiveness of court activities funded or supported by your Tribal
Governments Program grant and to provide further explanation on how these activities increase the
safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 43 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
E4
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Tribal Probation/Offender Monitoring
Were your Tribal Governments Program funds used for probation during the current reporting period?
Check yes if Tribal Governments Program funds directly supported probation activities.
Yes--answer questions 63-67 Provide the information only for Tribal Governments Programfunded probation/offender monitoring activities engaged in during the current reporting period.
No--skip to E5
63. Number of offenders
(Report the total number of continuing and new offenders charged with sexual assault, domestic violence, dating violence, and/or stalking. This is an unduplicated count. If you have not previously filed
a semi-annual report, include all pending offenders at the beginning of the current reporting period as
“Number of continuing offenders.”)
Misdemeanor and felony domestic violence and/or dating violence offenses include any assaults, battery, vandalism, or other offenses that occurred in a domestic violence, dating violence incident. Your
tribal law does not have to name the offense "domestic violence or dating violence" for it to be counted
here. Similarly, sexual assault and stalking offenses should be counted, even if your tribal law uses another name for these types of offenses, such as "sexual battery" or "harassment."
Number who completed probation
Number of
Number of new
continuing offenders
offenders
Without violations With violations
Total unduplicated count
of sexual assault offenders
Total unduplicated count
of domestic violence/
dating violence offenders
Total unduplicated count
of stalking offenders
TOTAL
0
0
0
0
64. Monitoring activities
(For new and continuing offenders reported in question 63, report the number of monitoring activities
engaged in during the current reporting period. Report only those offenders who were monitored using
the specific activity under “number of offenders.” Report the total number of contacts for all offenders for the specific activity under “total contacts.” For example, out of a total caseload of 50, a probation officer/offender monitor has face-to-face contact 5 times each with 20 of those offenders during
the reporting period. Multiplying those offenders by the number of face-to-face meetings an officer/
monitor had with each offender, the total contacts amounts to 100. The number of offenders reported
as having face-to-face meetings would be 20, and the number of total face-to-face contacts would be
100.)
Activity
Face-to-face meeting with offender
Number of offenders
Total contacts
Number of victims/survivors
Total contacts
Telephone contact with offender
Unscheduled surveillance of offender
Activity
Outreach to victims/survivors
Tribal Governments Program Semi-annual Progress Report • 44 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
65.
Disposition of probation violations
(Report the total number of sexual assault, domestic violence, dating violence, and/or stalking cases in
which there were dispositions of violations during the current reporting period. The violation does not
have to have occurred during this reporting period, only the disposition. A case may be counted more
than once if there were multiple violations.)
Verbal/
written
warning
No action
taken
Violation
Conditions
added
Fine
Partial
revocation
Probation
revoked/
incarcerated
Protection order
New criminal
behavior
Failure to attend
mandated batterer intervention
program (BIP)
Failure to attended offender
treatment program (does not
include BIP)
Other condition
of probation
TOTAL
0
0
0
0
0
0
66. Victim/survivor referrals to victim services
(Report the total number of victim/survivor referrals to victim services by Tribal Governments Programfunded staff during the current reporting period. Victim services refer to services provided by agencies
that serve victims of sexual assault, domestic violence, dating violence, and/or stalking.)
Tribal victim services
Non-tribal victim services
Number of victim/survivor referrals
Tribal Governments Program Semi-annual Progress Report • 45 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
67. (Optional) Additional information
(Use the space below to discuss the effectiveness of probation activities funded or supported by your
Tribal Governments Program grant and to provide further explanation on how these activities increase
the safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 46 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1122-0018
Expiration Date: 07/31/2011
E5
Batterer Intervention Program (BIP)
Were your Tribal Governments Program funds used for BIP activities during the current reporting period?
Check yes if Tribal Governments Program-funded staff or Tribal Governments Program directly supported
funded BIP activities.
Yes--answer questions 68-71 Provide the information only for Tribal Governments Programfunded BIP activities.
No--skip to subsection F
68. Offenders in program
(Report the number of continuing and new offenders in your BIP during the current reporting period. If
you have not previously filed an semi-annual report, include all cases at the beginning of the current reporting period as “offenders continuing in BIP.”)
Number of offenders continuing in BIP
from last reporting period
Number of offenders entering BIP
during current reporting period
Offenders in program
69. Outcomes
Report the total number of domestic violence or dating violence offenders in your program who successfully completed the program, who were terminated from the program, and who returned to the program after termination during the current reporting period.)
Number of Offenders
Completed program
Terminated from program
Returned to program after termination
Other (specify):
70.
Length of BIP in weeks
(Report the number of weeks batterers are expected to remain in the program in order to complete it.
If your BIP has more than one program length and/or curriculum, provide the length for each type of
program.)
A
B
C
Number of weeks
Tribal Governments Program Semi-annual Progress Report • 47 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
71.
(Optional) Additional information
(Use the space below to discuss the effectiveness of BIP activities funded or supported by your Tribal
Governments Program grant and to provide further explanation on how these activities increase the
safety of American Indian/Alaska Native women.) (Maximum 2,000 characters)
Tribal Governments Program Semi-annual Progress Report • 48 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
SECTION
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
F
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
NARRATIVE
All grantees must answer question 72.
PLEASE LIMIT YOUR RESPONSE TO THE SPACE PROVIDED.
72. Report on the status of your Tribal Governments Program grant goals and objectives as of the end
of the current reporting period. (Report on the status of the goals and objectives for your grant as of
the end of the current reporting period, as they were identified in your grant proposal or as they have
been added or revised. Indicate whether the activities related to your objectives for the current reporting period have been completed, are in progress, are delayed, or have been revised. Comment on your
successes and challenges, and provide any additional explanation you feel is necessary for us to understand what you have or have not accomplished relative to your goals and objectives. If you have not
accomplished objectives that should have been accomplished during the current reporting period, you
Click here to answer
must provide an explanation.)
All grantees must answer questions 73 and 74 on an annual basis. Please submit this on Jan-to-June form
PLEASE LIMIT YOUR RESPONSE TO THE SPACE PROVIDED.
73. What do you see as the most significant areas of remaining need, with regard to improving services
to victims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing
victims/survivors safety, and enhancing community response (including offender accountability for
both batterers and sex offenders)? (Consider geographic regions, service delivery systems, types of
victimizations, jurisdictional issues, and challenges and barriers unique to your service area.) Click here to answer
74. What has the Tribal Governments Program funding allowed you to do that you could not do prior to
receiving this funding? (For example, expand services to victims/survivors, increase coordination between tribal and local law enforcement, etc.) Click here to answer
Questions 75, 76, and 77 are optional.
PLEASE LIMIT YOUR RESPONSE TO THE SPACE PROVIDED.
75. Non-tribal criminal justice dispositions. (If you have information about the dispositions of sexual assault, domestic violence, dating violence, and/or stalking offenses that occurred in Indian country and
were referred to local, state, or federal law enforcement or prosecutors, please report that information
here. If available, include information on whether the offenders and victims/survivors were tribal members.) Click here to answer
76. Provide additional information regarding the effectiveness of your grant-funded program. (If you
have any other data or information that you have not already reported in answer to previous questions
that demonstrate the effectiveness of your Tribal Governments Program grant, please provide it below.
Refer to separate instructions for a fuller explanation and examples.) Click here to answer
77. Provide any additional information that may provide explanation about the data submitted. (If you
have any information that could be helpful in understanding the data you have submitted in this report,
please answer this question. For example, if you submitted two different progress reports for the same
reporting period, you may explain how the data was apportioned to each report; or if you funded staff—
e.g., victim advocates, law enforcement officers, etc.-- but did not report any corresponding victim services or law enforcement activities, you may explain why; or if you did not use program funds to support
either staff or activities during the reporting period, please explain how program funds were used, if you
have not already done so.) Click here to answer
Public Reporting Burden
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond
to a collection of information unless it displays a currently valid OMB control number. We try to create forms
and instructions that are accurate, can be easily understood, and which impose the least possible burden on
you to provide us with information. The estimated average time to complete and file this form is 60 minutes
per form. If you have comments regarding the accuracy of this estimate, or suggestions for making this form
simpler, you can write to the Office on Violence Against Women, U.S. Department of Justice, 800 K Street,
NW, Washington, DC 20531.
Tribal Governments Program Semi-annual Progress Report • 49 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Report on the status of your Tribal Governments Program grant goals and objectives as of the end of the curBack to Question
rent reporting period. - Question #72
Status
Goals/Objectives
Key Activities
Comments
Status
Goals/Objectives
Key Activities
Comments
Tribal Governments Program Semi-annual Progress Report • 50 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Report on the status of your Tribal Governments Program grant goals and objectives as of the end of the curBack to Question
rent reporting period. - Question #72 (cont. 1)
Status
Goals/Objectives
Key Activities
Comments
Status
Goals/Objectives
Key Activities
Comments
Tribal Governments Program Semi-annual Progress Report • 51 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Report on the status of your Tribal Governments Program grant goals and objectives as of the end of the curBack to Question
rent reporting period. - Question #72 (cont. 2)
Status
Goals/Objectives
Key Activities
Comments
Status
Goals/Objectives
Key Activities
Comments
Tribal Governments Program Semi-annual Progress Report • 52 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
What do you see as the most significant areas of remaining need, with regard to improving services to
victims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing victims/survivors safety, and enhancing community response (including offender accountability for both batterers and
sex offenders)? - Question #73
Back to Question
Tribal Governments Program Semi-annual Progress Report • 53 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
What do you see as the most significant areas of remaining need, with regard to improving services to
victims/survivors of sexual assault, domestic violence, dating violence, and stalking, increasing victims/survivors safety, and enhancing community response (including offender accountability for both batterers and
Back to Question
sex offenders)? - Question #73 (cont.)
Tribal Governments Program Semi-annual Progress Report • 54 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1122-0018
Expiration Date: 07/31/2011
What has the Tribal Governments Program funding allowed you to do that you could not do prior to receiving
this funding? - Question #74
Back to Question
Tribal Governments Program Semi-annual Progress Report • 55 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1122-0018
Expiration Date: 07/31/2011
What has the Tribal Governments Program funding allowed you to do that you could not do prior to receiving
Back to Question
this funding? - Question #74 (cont.)
Tribal Governments Program Semi-annual Progress Report • 56 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Non-tribal criminal justice dispositions – Question #75
Back to Question
Tribal Governments Program Semi-annual Progress Report • 57 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1122-0018
Expiration Date: 07/31/2011
Non-tribal criminal justice dispositions – Question #75 (cont.)
Back to Question
Tribal Governments Program Semi-annual Progress Report • 58 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Provide additional information regarding the effectiveness of your grant-funded program. – Question #76
Back to Question
Tribal Governments Program Semi-annual Progress Report • 59• Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Provide additional information regarding the effectiveness of your grant-funded program. – Question #76
Back to Question
(cont.)
Tribal Governments Program Semi-annual Progress Report • 60 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Provide any additional information that may provide explanation about the data submitted. – Question #77
Back to Question
Tribal Governments Program Semi-annual Progress Report • 61 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Provide any additional information that may provide explanation about the data submitted. – Question #77
(cont.)
Back to Question
Tribal Governments Program Semi-annual Progress Report • 62 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance #1122-0018
Expiration Date: 07/31/2011
Validate
Tribal Governments Program Semi-annual Progress Report • 63 • Office on Violence Against Women
THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
| File Type | application/pdf |
| File Title | TribalGovtPrettyForm040908.indd |
| Author | lmichaud |
| File Modified | 2008-09-05 |
| File Created | 2008-04-28 |