Form 1122-0003 STOP State Administrator Form

Annual Progress Report for Grantees from the STOP Formula Grant Program

STOPAdminFormGMSSample

Annual Progress Report for Grantees from the STOP Formula Grant Program

OMB: 1122-0003

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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.
OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

U.S. Department of Justice
Office on Violence Against Women
ANNUAL STOP ADMINISTRATORS REPORT
STOP Violence Against Women
Formula Grant Program
1.

Date of report

(format date with 6 digits - 01/31/09)

Current reporting period: January 1- December 31

STOP administrator (person responsible for administering STOP Program funds)
First name

Agency

Address

(Year)

Last name

City

State

Telephone

Zip code

Facsimile

6A. STOP Program funds awarded to subgrantees and amount of funds returned during current reporting period
(For all federal fiscal years from which you made awards to subgrantees or from which unused funds were returned by
subgrantees during the current reporting period, provide the following: the federal grant number, the amount of funds
that were returned unused by subgrantees during the current reporting period if applicable, the amount awarded to subgrantees during the current reporting period, and the percentage of the total amount awarded that was returned. Provide
this information for all awards made during the current reporting period, whether those awards were made from the current FFY allocation, from unobligated funds from another FFY, or from funds returned unused by subgrantees. Do not
report on funds awarded or returned unused during previous reporting periods.)
.

Federal grant #

Amount of grant funds
returned unused by
subgrantees

Amount awarded to
subgrantees during
current reporting
period

Percentage of total
returned

FFY

TOTAL

STOP Program Annual Administrators Report • 1 • Office on Violence Against Women
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Expiration Date: 3/31/2012

6B. STOP Program funds returned by subgrantees

(If any of the FFY allocation was returned unused by subgrantees during the current reporting period, provide the
category(ies)—e.g., victim services, law enforcement, prosecution, etc.—from which those funds were returned and the
amount returned from each category for the corresponding FFY.)

Area

FFY

FFY
Amount

Amount

Courts

Law enforcement

Prosecution

Victim services

Discretionary

TOTAL

Allocation categories

(For every federal fiscal year from which awards were made during the current reporting period, indicate the number
of awards made to subgrantees, and the amounts awarded, to each of the allocation categories. Also indicate the
amount(s) allocated for administrative costs during the current reporting period. For discretionary awards, report the
number of awards and the allocation categories to which the awards were made. The percentages of total amounts
awarded will be automatically calculated. Only use the discretionary category to report on awards that cannot be assigned to the other categories.)

FFY
Area

FFY

Number

Courts

Amount
$

% Total amount
awarded
0.00 %

Number

% Total amount
awarded
0.00 %

Amount
$

Law enforcement

Prosecution

0.00 %
0.00 %

Victim services

0.00

Discretionary

0.00

Administrative
costs

0.00

TOTAL

FFY
Area

0.00

FFY

Number

Amount

% Total amount
awarded
0.00 %

Number

% Total amount
awarded
0.00 %

Amount

Courts

Law enforcement

0.00

Prosecution

0.00

Victim services

0.00

Discretionary

0.00

Administrative
costs

0.00

TOTAL

STOP Program Annual Administrators Report • 2 • Office on Violence Against Women
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OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

FFY
Area

FFY

Number

Amount

% Total amount
awarded
0.00 %

Number

Amount

% Total amount
awarded
%

Courts

Law enforcement

0.00

Prosecution

0.00

Victim services

0.00

Discretionary

0.00

Administrative
costs

0.00

TOTAL

7A. Use of discretionary funds

(For any discretionary awards that you did not assign to the existing categories of courts, law enforcement, prosecution, or
victim services, describe below how those funds were used. Please include award amounts. Maximum 2,000 characters.)

STOP Program Annual Administrators Report • 3 • Office on Violence Against Women
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7B. Use of administrative funds

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

(If you reported administrative costs in question 7, please provide a detailed description of the amount and description of
administrative costs. Please include all personnel costs, membership dues, association fees, training, travel costs for subgrantee monitoring, etc. Maximum 2,000 characters.)

STOP Program Annual Administrators Report • 4 • Office on Violence Against Women
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OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

8A. Culturally specific victim services awards

(Of the awards you reported in question 7 for victim services, indicate, for those awards that represent the 10 percent setaside for culturally specific community-based organizations, the numbers of awards, and the total amount awarded. The
percentage of victim services allocations will be automatically calculated. Also, indicate on your list of active subgrants
which of the victim services awards were made to these organizations.)

Culturally specific victim services awards
Number of subgrants
Total amount awarded
awarded

Percentage of victim
service allocation
0.00 %

FFY

0.00

FFY

0.00

FFY

0.00

FFY

0.00

8B. Culturally specific victim services awards less than 10%

(If your culturally specific victim service awards do not represent 10% of your victim service allocation, please explain why
and detail what efforts are being made to increase representation of culturally specific victim service providers in your
subgrantee population. Maximum 2,000 characters.)

STOP Program Annual Administrators Report • 5 • Office on Violence Against Women
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Expiration Date: 3/31/2012

Percentage of allocations by type of victimization

(Based on total money awarded during the current reporting period, provide your best estimate of the percentage of funding awarded to each of the following types of victimizations. The total should equal 100%.)

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. 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 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.

Type of victimization

% STOP funds

Sexual assault

Domestic violence/dating violence

Stalking

TOTAL (must equal 100%)

10. Listing of active subgrants

(In a separate attachment to this report, please provide the following information on all subgrants that were active during
the current reporting period: subgrant #; date of award; amount of award; name of subgrantee agency; contact person,
address, telephone number; and subgrant period [beginning and ending dates]. Provide the amount of each subgrant
by allocation category[ies]—e.g., victim services, law enforcement, courts—for those grants awarded during the current
reporting period. If a subgrant addressed more than one allocation category, indicate this by reporting the appropriate
portion of the total award focused on each category. Indicate if a victim services subgrant was made to a culturally specific community-based organization. If you wish, you may use Appendix A and Appendix B as guides for presenting this
information.)

STOP Program Annual Administrators Report • 6 • Office on Violence Against Women
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NARRATIVE

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

All STOP administrators must answer questions 11-13.
Please limit your response to the space provided (20,000 characters).
11. Report on the status of your STOP implementation plan(s), as of the end of the current reporting period.
(Using the implementation plan(s) you submitted to your program specialist as a reference point, report on the
distribution of funds across law enforcement, prosecution, courts, and victims services; the extent to which you
were able to support the type of programs identified in your plan(s); whether you achieved equitable distribution of your funds in terms of geographic diversity and the availability of victim services. Describe your successes and challenges and provide any additional explanation you feel is necessary to understand what you
have or have not accomplished relative to your implementation plan(s). If you have not accomplished objectives that should have been accomplished during the current reporting period, please provide an explanation.)
Page 8.

Please limit your response to the space provided (8,000 characters).

12. Report on your state or territory’s efforts to recognize and address the needs of underserved populations
during the current reporting period. Include information regarding culturally specific victim services if not
already provided in your response to question 8B.
(Underserved populations are those groups underserved because of geographic location (such as rural isolation), race or ethnicity, or special needs (such as language barriers, disabilities, immigration status, or age),
and any other population determined to be underserved by the planning process in consultation with the U.S.
Page 13.
Attorney General.)
13. What do you see as the most significant areas of remaining need in your state or territory, with regard to
increasing victim/survivor safety and offender accountability?
(Consider geographic regions, underserved populations, service delivery systems, types of victimization, and
challenges and barriers unique to your state or territory. Please include any areas where you might wish to receive OVW-funded technical assistance.)
Page 15.
Questions 14-17 are optional
Please limit your response to the space provided (8,000 characters).
14. Describe any problems or barriers your state or territory has had in its efforts to allocate the required
percentages of funds to the categories of victim services, law enforcement, prosecution, or the courts.
(If appropriate, describe any such barriers, what you have done to address these barriers, and any technical assistance needs you have in this area.)
Page 17.
15. What has STOP program funding allowed your state or territory to do that it could not do without this
funding?
(Describe changes that occurred because of STOP Program funding. Consider expansion of services; coordination and collaboration between agencies; development of technology tracking systems; specialized units; etc.)
Page 19.

16. Provide information regarding STOP-funded model projects and/or promising practices that are examples
of what has been accomplished with STOP funding in your state or territory.
(Describe and identify the funded projects and the reasons you believe they are exemplary.)
Page 21.

17. Provide any additional information that you would like us to know about your use of STOP program funds
and/or the effectiveness of that funding.
(If you have not already done so elsewhere on this form, feel free to discuss any of the following: institutionalization of staff positions, policies, and/or protocols; systems-level changes; community and statewide collaboration; the removal or reduction of barriers and challenges for victims/survivors; promising practices; and
positive or negative unintended consequences.)
Page 23.
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 sixty 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.
STOP Program Annual Administrators Report • 7 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Report on the status of your STOP implementation plan(s), as of the end of the current reporting period.
Question #11

STOP Program Annual Administrators Report • 8 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Report on the status of your STOP implementation plan(s), as of the end of the current reporting period.
Question #11 (cont.)

STOP Program Annual Administrators Report • 9 • Office on Violence Against Women
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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Report on the status of your STOP implementation plan(s), as of the end of the current reporting period.
Question #11 (cont.)

STOP Program Annual Administrators Report • 10 • Office on Violence Against Women
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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Report on the status of your STOP implementation plan(s), as of the end of the current reporting period.
Question #11 (cont.)

STOP Program Annual Administrators Report • 11 • Office on Violence Against Women
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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Report on the status of your STOP implementation plan(s), as of the end of the current reporting period.
Question #11 (cont.)

STOP Program Annual Administrators Report • 12 • Office on Violence Against Women
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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Report on your state or territory’s efforts to recognize and address the needs of underserved populations
during the current reporting period. Include information regarding culturally specific victim services if not
already provided in your response to question 8B.
Question #12

STOP Program Annual Administrators Report • 13 • Office on Violence Against Women
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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

STOP Program Annual Administrators Report • 14 • Office on Violence Against Women
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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

What do you see as the most significant areas of remaining need in your state or territory, with regard to increasing
victim/survivor safety and offender accountability?
Question #13

STOP Program Annual Administrators Report • 15 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

What do you see as the most significant areas of remaining need in your state or territory, with regard to increasing
victim/survivor safety and offender accountability?
Question #13 (cont.)

STOP Program Annual Administrators Report • 16 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Describe any problems or barriers your state or territory has had in its efforts to allocate the required percentages
of funds to the categories of victim services, law enforcement, prosecution, or the courts.
Question #14

STOP Program Annual Administrators Report • 17 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

STOP Program Annual Administrators Report • 18 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

What has STOP program funding allowed your state or territory to do that it could not do without this funding?
Question #15

STOP Program Annual Administrators Report • 19 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

What has STOP program funding allowed your state or territory to do that it could not do without this funding?
Question #15 (cont.)

STOP Program Annual Administrators Report • 20 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Provide information regarding STOP-funded model projects and/or promising practices that are examples of what
has been accomplished with STOP funding in your state or territory.
Question #16

STOP Program Annual Administrators Report • 21 • Office on Violence Against Women
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THIS IS A SAMPLE GMS FORM. DO NOT USE THIS FORM TO SUBMIT YOUR FINAL DATA TO OVW.

Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Provide information regarding STOP-funded model projects and/or promising practices that are examples of what
has been accomplished with STOP funding in your state or territory.
Question #16 (cont.)

STOP Program Annual Administrators Report • 22 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Provide any additional information that you would like us to know about your use of STOP program funds and/or
the effectiveness of that funding.
Question #17

STOP Program Annual Administrators Report • 23 • Office on Violence Against Women
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Back to Instructions

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Provide any additional information that you would like us to know about your use of STOP program funds and/or
the effectiveness of that funding.
Question #17 (cont.)

STOP Program Annual Administrators Report • 24 • Office on Violence Against Women
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OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

APPENDIX A

Information on subgrants awarded during current reporting period
(List the subgrant numbers, award dates, award amounts by allocation category(ies), agency names and contact
information, subgrant periods [beginning and ending dates], and indicate if the agency is a culturally specific community agency receiving a victim services subgrant.)

STOP award amount by allocation category(ies)
Subgrant #

Date of
award

Victim
Law
Prosecution
services enforcement

Courts Other

Culturally
specific
comName of agency
munity
(include contact Subgrant
agency
person, address, period
receiving
phone)
a victim
services
subgrant

STOP Program Annual Administrators Report • 25 • Office on Violence Against Women
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APPENDIX B

OMB Clearance # 1122-0003
Expiration Date: 3/31/2012

Information on active subgrants awarded prior to the current reporting period
(For all subgrants awarded prior to the current reporting period that were active during the current reporting period,
list the subgrant numbers, award dates, award amounts, agency names and contact information, and subgrant
periods [i.e., beginning and ending dates].)

Subgrant
#

Date of
award

STOP
award
amount

Name of agency (include contact person, address,
phone)

Culturally
specific
community
Subgrant
agency
period
receiving
a victim
services
subgrant

STOP Program Annual Administrators Report • 26 • Office on Violence Against Women
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Validate

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File Type	application/pdf
File Title	STOP_ADMINFORM_DRAFT_02-27-09.indd
Author	lmichaud
File Modified	2010-02-16
File Created	2009-02-27