Form 3 Core VIPP Funded SHD: SOTS Financial Module

Evaluation of Core Violence and Injury Prevention Program

Attachment E-1 - PDF

Core VIPP Funded SHD: SOTS Financial Module

OMB: 0920-0916

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2011 SOTS Finance & Personnel Survey
Background

 

Thank you for agreeing to complete the Safe States Alliance 2011 State of the States (SOTS) Finance & Personnel
Survey. The SOTS survey is administered to each U.S. state health department injury and violence prevention (IVP) 
program to develop a comprehensive picture of the status of these programs over time. 
 
As of this year, Safe States will split the SOTS survey into two components:
1. Survey #1 (Late Summer 2011) will assess state IVP program finances and personnel; and 
2. Survey #2 (Early Winter 2012) will assess other core components related to infrastructure, data, programs, 
training, and policy. 
The SOTS Finance & Personnel Survey is intended to help us better understand how states finance their injury and 
violence prevention programs and strengthen our ability to advocate, such as improving our ability to quickly quantify the 
potential impact of losses in particular sources of funding. The information collected through this survey will:
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Be used to generate an annual report on the state of injury and violence prevention programs in the U.S.; 
Provide the fourth year of data for measuring changes in these injury and violence prevention programs over time; 
Inform partners at the federal, national, state and local levels about the activities in the states or nation; 
Be used by Safe States to share indepth information with state directors about possible program funding sources; 
and 
Help Safe States develop future programs and services to support our members. 

We know your time is valuable. In designing and testing this survey, Safe States has made every effort to limit the 
questions to those most essential in developing a profile of state IVP programs. Depending on the size and breadth of 
your program, it will take approximately X hours to gather the needed information and complete this questionnaire. 
 
PLEASE COMPLETE AND SUBMIT YOUR SURVEY BY MONDAY, AUGUST 29, 2011. 
 
Most data collected will be presented in aggregate. If you have any questions about the questionnaire, please contact 
Jamila Porter at 7706909000 or [email protected]. 
 
Thank you for your contribution to this important and exciting project!  

 

2011 SOTS Finance & Personnel Survey
Instructions & Deadline (MONDAY, AUGUST 29, 2011)

 

The 2011 State of the States (SOTS) Finance & Personnel Survey asks for information about several aspects of your 
state's injury and violence prevention program funding sources and personnel. 
 
Please answer the questions based on the status of your program during Federal Fiscal Year 2011 (October 1, 2010  
September 30, 2011). 
 
You may find it helpful to first review the hard copy of the survey (emailed to your State Representative) in order to gather 
all necessary information before beginning the survey. You also may find it helpful to coordinate completion of the survey 
among your staff by distributing hard copies of the staffing section and other portions of the survey to appropriate staff 
members who are most knowledgeable about the specific topics addressed. 
 
There are several ways to complete the survey:
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Complete the entire survey online through Survey Monkey;
Complete the survey in hard copy first, then enter all responses online through Survey Monkey; OR
Complete the entire survey in hard copy and fax (7706908996) or email it ([email protected]) to Safe
States for data entry. 

If you cannot use one of these methods to complete the survey, please contact Jamila Porter at Safe States (770690
9000) to identify an alternative arrangement. 
 
PLEASE COMPLETE AND SUBMIT YOUR SURVEY BY MONDAY, AUGUST 29, 2011. 
 
PLEASE NOTE: If you choose to complete the survey online, you will be able to save your responses to allow you to 
complete the survey over several days or weeks. Your responses are saved when you click on the "next" button at the 
bottom of each page of the survey. You can access the survey to continue or edit your previous responses by using the 
same computer each time. When you reaccess the survey, you will begin on the last completed page (not the beginning 
of the survey). If you try to complete the remainder of the survey using a different computer, you will not see any 
of your previous data. 
 
Additional notes about the survey:
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Other 

Throughout the questionnaire, the acronym IVP is used to indicate "injury and violence prevention." 
The intent of this survey is to assess the program within the state health department that is considered the 
PRIMARY or CENTRAL FOCUS of IVP activities. In completing the questionnaire, please focus your responses on 
the one program that is considered the PRIMARY or CENTRAL IVP program  whether the focus is on 
unintentional injury, intentional injury (violence), or both. In some states, however, there simply is no central IVP 
program. Perhaps there is no funding or personnel, or prevention activities may be spread among programs and 
units with no coordinating program or staff. Regardless of how your program is defined, the individual or program 
charged with program planning, strategic planning and/or policy development for IVP should answer the questions 
to the best of their ability based on what is considered to be the PRIMARY or CENTRAL FOCUS of your state’s 
IVP activities. 

If you have any questions or concerns about how to define the boundaries of your state's program, please contact Jamila 
Porter at 7706909000 [email protected] to discuss. Clarification before completing the questionnaire will 
help ensure that the data collected are comparable across states.  

 

2011 SOTS Finance & Personnel Survey
Contact Information

 

*1. In which state is your injury and/or violence prevention program (IVPP) located?
j AL
k
l
m
n

 

j AK
k
l
m
n
j AZ
k
l
m
n

 

 

j AR
k
l
m
n
j CA
k
l
m
n

 
 

j CO
k
l
m
n
j CT
k
l
m
n
j DE
k
l
m
n
j FL
k
l
m
n

 
 

 

j GA
k
l
m
n
j HI
k
l
m
n
j ID
k
l
m
n
j IL
k
l
m
n

 

 

 
 

 

j IN
k
l
m
n
j IA
k
l
m
n

 
 

j KS
k
l
m
n
j KY
k
l
m
n
j LA
k
l
m
n

 
 

 

j ME
k
l
m
n
j MD
k
l
m
n
j MA
k
l
m
n
j MI
k
l
m
n

 
 
 

 

j MN
k
l
m
n
j MS
k
l
m
n

 
 

j MO
k
l
m
n
j MT
k
l
m
n
j NE
k
l
m
n
j NV
k
l
m
n

 

 
 
 

j NH
k
l
m
n

 

j NJ
k
l
m
n

 

2011 SOTS Finance & Personnel Survey
j NM
k
l
m
n
j NY
k
l
m
n

 

 
 

j NC
k
l
m
n

 

j ND
k
l
m
n

j OH
k
l
m
n
j OK
k
l
m
n
j OR
k
l
m
n
j PA
k
l
m
n
j RI
k
l
m
n

 
 
 

 

 

j SC
k
l
m
n
j SD
k
l
m
n

 
 
 

j TN
k
l
m
n
j TX
k
l
m
n
j UT
k
l
m
n
j VT
k
l
m
n
j VA
k
l
m
n

 
 
 
 
 

j WA
k
l
m
n

 

j WV
k
l
m
n
 

j WI
k
l
m
n

 

j WY
k
l
m
n

*2. Please provide the contact information for the person responsible for completing this

survey.
Name:

Title/Position:
Organization Name:
Email Address:

 

2011 SOTS Finance & Personnel Survey
Total Program Staff

 

*1. For the Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), what is the

TOTAL NUMBER OF STAFF POSITIONS in your IVP program (including currently vacant
positions)?
NOTE: Please include parttime positions using the formula found at 
http://www.hr.tcu.edu/3163.htm (i.e., if you have two (2) fulltime staff and one (1) 0.5 FTE, 
your response would be "2.5")
 

 

2011 SOTS Finance & Personnel Survey
Staff Detail

 

*1. You have indicated that you had [Q3] staff in Federal Fiscal Year 2011. Please indicate

how many staff members were part of the IVPP in each of the following status categories.
Your total answer should not exceed [Q3].
Paid staff member (Full
time)
Paid staff member (Part
time)
Paid intern
Unpaid intern
Fellow
Other

2011 SOTS Finance & Personnel Survey

*2. Please indicate how many of your [Q3] total staff members in the IVPP have the

following degrees.

PLEASE NOTE: Choose ALL degrees attained by each IVPP employee, not just the
highest degree the employee has obtained. For example, an employee with a MPH should 
also be counted in the high school diploma and Bachelor's degree rows.
Include all paid employees, regardless of the percent time they work in the IVPP.
High School Diploma/GED
AA
AS
BA
BS
RN
MS
MA
MBA
MPA
MPH
MSW
MD
PhD
DrPH
JD
Other

*3. Please indicate how many of your [Q3] total staff members in the IVPP have been

working for the state IVPP program for the various periods of time listed.

Note: Include all paid employees regardless of percent time they work in the IVPP (your 
total should not exceed [Q3]).
Less than 1 year
1 year to less than 4 years
4 years to less than 7 years
7 years to less than 10 years
10 years or more

2011 SOTS Finance & Personnel Survey

*4. Please indicate how many of your [Q3] total staff members in the IVPP have been

working in the field of injury and violence prevention for the various periods of time listed.
Note: Include all paid employees regardless of percent time they work in the IVPP (your 
total should not exceed [Q3]).
Less than 1 year
1 year to less than 4 years
4 years to less than 7 years
7 years to less than 10 years
10 years or more

*5. Please indicate how many of your [Q3] total staff members in the IVPP have been

working in the field of public health for the various time periods listed.

Note: Include all paid employees regardless of percent time they work in the IVPP (your 
total should not exceed [Q3]).
Less than 1 year
1 year to less than 4 years
4 years to less than 7 years
7 years to less than 10 years
10 years or more

 

2011 SOTS Finance & Personnel Survey
 

List of Potential Funding Sources

*1. Please select ALL FUNDING SOURCES the state IVPP received funding from during

Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011).
c State General Revenue
d
e
f
g

 

c Dedicated State Funding Stream (e.g., fines and fees)
d
e
f
g

 

c State Highway Safety Office (e.g., Safe Routes to School)
d
e
f
g

 

c CDC/NCIPC  Integrated Core Injury Prevention and Control Program (Core State Injury and Violence Prevention Program Grant Part A)
d
e
f
g

 

c CDC/NCIPC  Traumatic Brain Injury Extended Surveillance Program (Core State Injury and Violence Prevention Program Grant Part B)
d
e
f
g

 

c CDC/NCIPC  Traumatic Brain Injury Emergency Department Surveillance Program (Core State Injury and Violence Prevention Program 
d
e
f
g
Grant Part C) 

c CDC/NCIPC  Traumatic Brain Injury Service Linkage Program (Core State Injury and Violence Prevention Program Grant Part D)
d
e
f
g
c CDC/NCIPC  Older Adult Falls Program (Core II)
d
e
f
g

 

c CDC/NCIPC  Child Injury Prevention Program (Core II)
d
e
f
g
c CDC/NCIPC  Teen Dating Violence Initiative (Core II)
d
e
f
g

 

 

c CDC/NCIPC  Core VIPP Base Integration Component (BIC)
d
e
f
g
c CDC/NCIPC  Core VIPP Regional Network Leader (RNL)
d
e
f
g

 

 

c CDC/NCIPC  Core VIPP Surveillance Quality Improvement (SQI)
d
e
f
g
c CDC/NCIPC  Core VIPP Motor Vehicle Injury Prevention
d
e
f
g
c CDC/NCIPC  Core VIPP Falls Among Older Adults
d
e
f
g

 

 

 

c CDC/NCIPC  National Violent Death Reporting System (NVDRS)
d
e
f
g
c CDC/NCIPC – Rape Prevention and Education (RPE)
d
e
f
g

 

 

c CDC/NCIPC  Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA)
d
e
f
g
c CDC/NCIPC  Residential Firerelated Injury Prevention
d
e
f
g

 

c CDC – Preventive Health and Health Services (PHHS) Block Grant
d
e
f
g
c CDC – Communities Putting Prevention to Work
d
e
f
g
c Consumer Product Safety Commission (CPSC)
d
e
f
g

 

 

 

c Federal Emergency Management Agency (FEMA)
d
e
f
g
c HRSA/MCHB – Title V Block Grant
d
e
f
g

 

 

 

c HRSA/MCHB – Emergency Medical Services for Children (EMSC)
d
e
f
g

 

c National Highway Traffic Safety Administration (NHTSA)  CODES
d
e
f
g
c National Highway Traffic Safety Administration (NHTSA)  Other
d
e
f
g

 

 

c Substance Abuse and Mental Health Services Administration (SAMHSA)  Campus Suicide Prevention Grants
d
e
f
g

 
 

 

2011 SOTS Finance & Personnel Survey
c Substance Abuse and Mental Health Services Administration (SAMHSA)  State and Tribal Youth Suicide Prevention Grants
d
e
f
g
c U.S. Department of Justice
d
e
f
g

 

c U.S. Department of Transportation (Federal, not through the state DOT or State Highway Safety Office)
d
e
f
g
c Corporate/Private
d
e
f
g
c Foundation
d
e
f
g

 

 

c Nonprofit Organizations (i.e., Safe Kids, Public Health Institutes, etc)
d
e
f
g
c Universities
d
e
f
g

 

 

c Other (please specify)
d
e
f
g

 
 

 

 

 

2011 SOTS Finance & Personnel Survey
State General Revenue Fund

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from your State's General Revenue Fund?
j YES, I received funding from my State's General Revenue Fund.
k
l
m
n

 

j NO, I did NOT receive funding from my State's General Revenue Fund.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  State General Revenue Fund Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from your State General Revenue Fund.
j State General Revenue Fund
k
l
m
n

 

*2. Please describe the source of the state general fund dollars (i.e., general state budget,

speeding ticket fines, tobacco taxes, vanity license plate fees, etc.).
5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  State General Revenue Fund: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q10]?

 

*2. Approximately what percentage of funding from the [Q10] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q10] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q10] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  State General Revenue Fund: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q10]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  State General Revenue Fund: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q17] position(s) are funded by the

[Q10]. Please identify the PRIMARY ROLE for each staff person funded by the [Q10]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q17].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  State General Revenue Fund: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q10]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q10] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
Dedicated State Funding Stream

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from your Dedicated State Funding Stream (e.g., fines and fees)?
j YES, I received funding from the Dedicated State Funding Stream.
k
l
m
n

 

j NO, I did NOT receive funding the Dedicated State Funding Stream.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  Dedicated State Funding Stream Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from your Dedicated State Funding Stream.
j Dedicated State Funding Stream
k
l
m
n

 

*2. Please describe the source of the dedicated state funding stream dollars (i.e.,

speeding ticket fines, tobacco taxes, vanity license plate fees, etc.).
5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  Dedicated State Funding Stream: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q21]?

 

*2. Approximately what percentage of funding from the [Q21] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q21] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q21] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  Dedicated State Funding Stream: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q21]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  Dedicated State Funding Stream: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q27] position(s) are funded by the

[Q21]. Please identify the PRIMARY ROLE for each staff person funded by the [Q21]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q27].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  Dedicated State Funding Stream: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q21]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q21] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
State Highway Safety Office

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from your State Highway Safety Office (e.g., Safe Routes to School)?
j YES, I received funding from the State Highway Safety Office.
k
l
m
n

 

j NO, I did NOT receive funding the State Highway Safety Office.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  State Highway Safety Office Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from your State Highway Safety Office.
j State Highway Safety Office
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  State Highway Safety Office: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q31]?

 

*2. Approximately what percentage of funding from the [Q31] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q31] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q31] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  State Highway Safety Office: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q31]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  State Highway Safety Office: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q36] position(s) are funded by the

[Q31]. Please identify the PRIMARY ROLE for each staff person funded by the [Q31]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q36].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  State Highway Safety Office: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q31]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q31] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Integrated Core Injury Prevention Program (Core State IVP
Program...

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Integrated Core Injury Prevention and Control Program
(Core State Injury and Violence Prevention Program Grant Part A)?
j YES, I received funding from the CDC/NCIPC Integrated Core Injury Prevention and Control Program.
k
l
m
n

 

j NO, I did NOT receive funding from CDC/NCIPC Integrated Core Injury Prevention and Control Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Integrated Core Injury Prevention and Control Program

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Integrated Core Injury
Prevention and Control Program (Core State IVP Program Grant Part A).
j CDC/NCIPC Integrated Core Injury Prevention and Control Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Integrated Core Injury Prevention and Control Program: ...

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q40]?

 

*2. Approximately what percentage of funding from the [Q40] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q40] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q40] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Integrated Core Injury Prevention and Control Program: ...

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q40]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Integrated Core Injury Prevention and Control Program: ...

 

*1. Out of your [Q3] total staff, you have indicated that [Q45] position(s) are funded by the

[Q40]. Please identify the PRIMARY ROLE for each staff person funded by the [Q40]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q45].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Integrated Core Injury Prevention and Control Program: ...

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q40]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q40] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program (Core
State ...

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program (Core
State IVP Program Grant Part B)?
j YES, I received funding from CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program.
k
l
m
n

 

j NO, I did NOT receive funding from CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program Co...

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Traumatic Brain Injury
Extended Surveillance Program (Core State IVP Program Grant Part B).
j CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program
k
l
m
n

 

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program: ...

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q49]?

 

*2. Approximately what percentage of funding from the [Q49] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q49] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q49] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program: ...

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q49]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program: S...

*1. Out of your [Q3] total staff, you have indicated that [Q54] position(s) are funded by the

[Q49]. Please identify the PRIMARY ROLE for each staff person funded by the [Q49]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q54].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Traumatic Brain Injury Extended Surveillance Program: ...

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q49]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q49] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Traumatic Brain Injury ED Surveillance Program (Core State IVP Pr...

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Traumatic Brain Injury Emergency Department Surveillance
Program (Core State IVP Program Grant Part C)?
j YES, I received funding from CDC/NCIPC Traumatic Brain Injury Emergency Department Surveillance Program.
k
l
m
n

 

j NO, I did NOT receive funding from CDC/NCIPC Traumatic Brain Injury Emergency Department Surveillance Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Traumatic Brain Injury ED Surveillance Program Confirma...

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Traumatic Brain Injury
Emergency Department Surveillance Program.
j CDC/NCIPC Traumatic Brain Injury Emergency Department Surveillance Program
k
l
m
n

 

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Traumatic Brain Injury ED Surveillance Program: Fundin...

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q58]?

 

*2. Approximately what percentage of funding from the [Q58] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q58] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q58] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Traumatic Brain Injury ED Surveillance Program: Number...

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q58]?
 

 

 

2011 SOTS Finance & Personnel Survey

 

5 of 6  CDC/NCIPC Traumatic Brain Injury ED Surveillance Program: Staff R...

*1. Out of your [Q3] total staff, you have indicated that [Q63] position(s) are funded by the

[Q58]. Please identify the PRIMARY ROLE for each staff person funded by the [Q58]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q63].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Traumatic Brain Injury ED Surveillance Program: IVP Pr...

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q58]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q58] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Traumatic Brain Injury Service Linkage Program

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Traumatic Brain Injury Service Linkage Program (Core State
IVP Program Grant Part D)?
j YES, I received funding from the CDC/NCIPC Traumatic Brain Injury Service Linkage Program.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Traumatic Brain Injury Service Linkage Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Traumatic Brain Injury Service Linkage Program Confirma...

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Traumatic Brain Injury Service
Linkage Program.
j CDC/NCIPC Traumatic Brain Injury Service Linkage Program
k
l
m
n

 

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Traumatic Brain Injury Service Linkage Program: Fundin...

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q67]?

 

*2. Approximately what percentage of funding from the [Q67] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q67] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q67] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Traumatic Brain Injury Service Linkage Program: Number...

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q67]?
 

 

 

2011 SOTS Finance & Personnel Survey

 

5 of 6  CDC/NCIPC Traumatic Brain Injury Service Linkage Program: Staff R...

*1. Out of your [Q3] total staff, you have indicated that [Q72] position(s) are funded by the

[Q67]. Please identify the PRIMARY ROLE for each staff person funded by the [Q67]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q72].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Traumatic Brain Injury Service Linkage Program: IVP Pr...

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q67]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q67] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Older Adult Falls Program (Core II)

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Older Adult Falls Program (Core II)?
j YES, I received funding from the CDC/NCIPC Older Adult Falls Program (Core II).
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Older Adult Falls Program (Core II).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Older Adult Falls Program Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Older Adult Falls Program.
j CDC/NCIPC Older Adult Falls Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Older Adult Falls Program: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q76]?

 

*2. Approximately what percentage of funding from the [Q76] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q76] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q76] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Older Adult Falls Program: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q76]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Older Adult Falls Program: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q81] position(s) are funded by the

[Q76]. Please identify the PRIMARY ROLE for each staff person funded by the [Q76]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q81].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Older Adult Falls Program: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q76]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q76] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Child Injury Prevention Program (Core II)

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Child Injury Prevention Program (Core II)?
j YES, I received funding from the CDC/NCIPC Child Injury Prevention Program (Core II).
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Child Injury Prevention Program (Core II).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Child Injury Prevention Program Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Child Injury Prevention
Program.
j CDC/NCIPC Child Injury Prevention Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Child Injury Prevention Program: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q85]?

 

*2. Approximately what percentage of funding from the [Q85] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q85] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q85] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Child Injury Prevention Program: Number of Staff Funde...

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q85]?
 

 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Child Injury Prevention Program: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q90] position(s) are funded by the

[Q85]. Please identify the PRIMARY ROLE for each staff person funded by the [Q85]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q90].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Child Injury Prevention Program: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q85]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q85] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Teen Dating Violence Initiative (Core II)

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Teen Dating Violence Initiative (Core II)?
j YES, I received funding from the CDC/NCIPC Teen Dating Violence Initiative (Core II).
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Teen Dating Violence Initiative (Core II).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Teen Dating Violence Initiative Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Teen Dating Violence Initiative.
j CDC/NCIPC Teen Dating Violence Initiative
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Teen Dating Violence Initiative: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q94]?

 

*2. Approximately what percentage of funding from the [Q94] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q94] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q94] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Teen Dating Violence Initiative: Number of Staff Funde...

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q94]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Teen Dating Violence Initiative: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q99] position(s) are funded by the

[Q94]. Please identify the PRIMARY ROLE for each staff person funded by the [Q94]. If no
staff were funded by this funding source place a zero (0) next to N/A.

PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q99].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Teen Dating Violence Initiative: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q94]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q94] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey

 

CDC/NCIPC Core VIPP Base Integration Component (BIC)

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Core VIPP Base Integration Component (BIC)?
j YES, I received funding from the CDC/NCIPC Core VIPP Base Integration Component (BIC).
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Core VIPP Base Integration Component (BIC).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Core VIPP Base Integration Component Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Core VIPP Base Integration
Component (BIC).
j CDC/NCIPC Core VIPP Base Integration Component
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Core VIPP Base Integration Component: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q103]?

 

*2. Approximately what percentage of funding from the [Q103] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q103] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q103] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Core VIPP Base Integration Component: Number of Staff ...

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q103]?
 

 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Core VIPP Base Integration Component: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q108] position(s) are funded by

the [Q103]. Please identify the PRIMARY ROLE for each staff person funded by the [Q103].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q108].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Core VIPP Base Integration Component: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q103]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q103] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey

 

CDC/NCIPC Core VIPP Regional Network Leader (RNL)

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding to be a CDC/NCIPC Core VIPP Regional Network Leader (RNL)?
j YES, I received funding to be a CDC/NCIPC Core VIPP Regional Network Leader (RNL).
k
l
m
n

 

j NO, I did NOT receive funding to be a CDC/NCIPC Core VIPP Regional Network Leader (RNL).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Core VIPP Regional Network Leader Program Confirmation

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Core VIPP Regional Network
Leader (RNL) Program.
j Core VIPP Regional Network Leader Program
k
l
m
n

 

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Core VIPP Regional Network Leader Program: Funding
Amo...

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q112]?

 

*2. Approximately what percentage of funding from the [Q112] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q112] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q112] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Core VIPP Regional Network Leader Program: Number of
S...

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q112]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Core VIPP Regional Network Leader Program: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q117] position(s) are funded by

the [Q112]. Please identify the PRIMARY ROLE for each staff person funded by the [Q112].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q117].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Core VIPP Regional Network Leader Program: IVP Priorit...

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q112]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q112] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Core VIPP Surveillance Quality Improvement (SQI) Program

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Core VIPP Surveillance Quality Improvement (SQI) Program?
j YES, I received funding from the CDC/NCIPC Core VIPP Surveillance Quality Improvement (SQI) Program.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Core VIPP Surveillance Quality Improvement (SQI) Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Core VIPP SQI Program Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Core VIPP Surveillance Quality
Improvement (SQI) Program.
j Core VIPP Surveillance Quality Improvement Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Core VIPP SQI Program: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q121]?

 

*2. Approximately what percentage of funding from the [Q121] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q121] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q121] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Core VIPP SQI Program: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q121]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Core VIPP SQI Program: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q126] position(s) are funded by

the [Q121]. Please identify the PRIMARY ROLE for each staff person funded by the [Q121].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q126].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Core VIPP SQI Program: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q121]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q121] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey

 

CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention Program

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention (MVP) Program?
j YES, I received funding from the CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention (MVP) Program.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention (MVP) Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

2 of 6  CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention Program Confi...

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Core VIPP Motor Vehicle Injury
Prevention Program.
j Core VIPP Motor Vehicle Injury Prevention Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention Program: Fun...

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q130]?

 

*2. Approximately what percentage of funding from the [Q130] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q130] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q130] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

4 of 6  CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention Program: Num...

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q130]?
 

 

2011 SOTS Finance & Personnel Survey

 

5 of 6  CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention Program: Staf...

*1. Out of your [Q3] total staff, you have indicated that [Q135] position(s) are funded by

the [Q130]. Please identify the PRIMARY ROLE for each staff person funded by the [Q130].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q135].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Core VIPP Motor Vehicle Injury Prevention Program: IVP...

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q130]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q130] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Core VIPP Falls Among Older Adults Program

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Core VIPP Falls Among Older Adults Program?
j YES, I received funding from the CDC/NCIPC Core VIPP Falls Among Older Adults Program.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Core VIPP Falls Among Older Adults Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Core VIPP Falls Among Older Adults Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Core VIPP Falls Among Older
Adults Program.
j Core VIPP Falls Among Older Adults Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC/NCIPC Core VIPP Falls Among Older Adults: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q139]?

 

*2. Approximately what percentage of funding from the [Q139] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q139] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q139] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Core VIPP Falls Among Older Adults: Number of Staff Fu...

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q139]?
 

 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Core VIPP Falls Among Older Adults: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q144] position(s) are funded by

the [Q139]. Please identify the PRIMARY ROLE for each staff person funded by the [Q139].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q144].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Core VIPP Falls Among Older Adults: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q139]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q139] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC National Violent Death Reporting System (NVDRS)

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC National Violent Death Reporting System (NVDRS)?
j YES, I received funding from the CDC/NCIPC National Violent Death Reporting System (NVDRS).
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC National Violent Death Reporting System (NVDRS).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC NVDRS Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC National Violent Death
Reporting System (NVDRS).
j National Violent Death Reporting System (NVDRS)
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

3 of 6  CDC/NCIPC NVDRS: Funding Amounts

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q148]?

 

*2. Approximately what percentage of funding from the [Q148] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q148] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q148] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC NVDRS: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q148]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC NVDRS: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q153] position(s) are funded by

the [Q148]. Please identify the PRIMARY ROLE for each staff person funded by the [Q148].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q153].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC NVDRS: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q148]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q148] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Rape Prevention and Education (RPE) Program

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Rape Prevention and Education (RPE) Program?
j YES, I received funding from the CDC/NCIPC Rape Prevention and Education (RPE) Program.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Rape Prevention and Education (RPE) Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC RPE Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Rape Prevention and
Education (RPE) Program.
j Rape Prevention and Education (RPE) Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

3 of 6  CDC/NCIPC RPE: Funding Amounts

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q157]?

 

*2. Approximately what percentage of funding from the [Q157] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q157] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q157] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC RPE: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q157]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC RPE: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q162] position(s) are funded by

the [Q157]. Please identify the PRIMARY ROLE for each staff person funded by the [Q157].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q162].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC RPE: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q157]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q157] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Domestic Violence Prevention Enhancement and Leadership
Through A...

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Domestic Violence Prevention Enhancement and
Leadership Through Alliances (DELTA) Program?

j YES, I received funding from the CDC/NCIPC Domestic Violence Prevention Enhancement and Leadership Through Alliances (DELTA) 
k
l
m
n
Program. 

j NO, I did NOT receive funding from CDC/NCIPC Domestic Violence Prevention Enhancement and Leadership Through Alliances 
k
l
m
n
(DELTA) Program. 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC DELTA Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Domestic Violence Prevention
Enhancement and Leadership Through Alliances (DELTA) Program.
j DELTA Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

3 of 6  CDC/NCIPC DELTA: Funding Amounts

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q166]?

 

*2. Approximately what percentage of funding from the [Q166] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q166] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q166] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC DELTA: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q166]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC DELTA: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q171] position(s) are funded by

the [Q166]. Please identify the PRIMARY ROLE for each staff person funded by the [Q166].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q171].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC DELTA: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q166]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q166] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC/NCIPC Residential Firerelated Injury Prevention Program

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC/NCIPC Residential Firerelated Injury Prevention Program?
j YES, I received funding from the CDC/NCIPC Residential Firerelated Injury Prevention Program.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC/NCIPC Residential Firerelated Injury Prevention Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC/NCIPC Residential Firerelated Injury Prevention Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC/NCIPC Residential Firerelated Injury
Prevention Program.
j Residential Firerelated Injury Prevention Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

3 of 6  CDC/NCIPC Residential Firerelated Injury Prevention: Funding Am...

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q175]?

 

*2. Approximately what percentage of funding from the [Q175] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q175] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q175] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC/NCIPC Residential Firerelated Injury Prevention: Number of ...

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q175]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC/NCIPC Residential Firerelated Injury Prevention: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q180] position(s) are funded by

the [Q175]. Please identify the PRIMARY ROLE for each staff person funded by the [Q175].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q180].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC/NCIPC Residential Firerelated Injury Prevention: IVP Priori...

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q175]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q175] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC Preventive Health and Health Services (PHHS) Block Grant

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC Preventive Health and Health Services (PHHS) Block Grant?
j YES, I received funding from the CDC Preventive Health and Health Services (PHHS) Block Grant.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC Preventive Health and Health Services (PHHS) Block Grant.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC PHHS Block Grant Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC Preventive Health and Health Services
(PHHS) Block Grant.
j Preventive Health and Health Services (PHHS) Block Grant
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CDC PHHS Block Grant: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q184]?

 

*2. Approximately what percentage of funding from the [Q184] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q184] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q184] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC PHHS Block Grant: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q184]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC PHHS Block Grant: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q189] position(s) are funded by

the [Q184]. Please identify the PRIMARY ROLE for each staff person funded by the [Q184].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q189].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC PHHS Block Grant: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q184]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q184] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
CDC Communities Putting Prevention to Work (CPPW) Program

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the CDC Communities Putting Prevention to Work (CPPW) Program?
j YES, I received funding from the CDC Communities Putting Prevention to Work (CPPW) Program.
k
l
m
n

 

j NO, I did NOT receive funding from the CDC Communities Putting Prevention to Work (CPPW) Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CDC CPPW Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the CDC Communities Putting Prevention to
Work (CPPW) Program.
j Communities Putting Prevention to Work (CPPW) Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
 

3 of 6  CDC CPPW: Funding Amounts

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q193]?

 

*2. Approximately what percentage of funding from the [Q193] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q193] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 
 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

*4. Do you anticipate receiving funding from the [Q193] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CDC CPPW: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q193]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CDC CPPW: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q198] position(s) are funded by

the [Q193]. Please identify the PRIMARY ROLE for each staff person funded by the [Q193].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q198].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CDC CPPW: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q193]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q193] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
Consumer Product Safety Commission

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the Consumer Product Safety Commission (CPSC)?
j YES, I received funding from the Consumer Product Safety Commission (CPSC).
k
l
m
n

 

j NO, I did NOT receive funding from the Consumer Product Safety Commission (CPSC).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  CPSC Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the Consumer Product Safety Commission
(CPSC).
j Consumer Product Safety Commission (CPSC)
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  CPSC: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q202]?

 

*2. Approximately what percentage of funding from the [Q202] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q202] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q202] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  CPSC: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q202]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  CPSC: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q207] position(s) are funded by

the [Q202]. Please identify the PRIMARY ROLE for each staff person funded by the [Q202].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q207].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  CPSC: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q202]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q202] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey

 

Federal Emergency Management Agency (FEMA)

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the Federal Emergency Management Agency (FEMA)?
j YES, I received funding from the Federal Emergency Management Agency (FEMA).
k
l
m
n

 

j NO, I did NOT receive funding from the Federal Emergency Management Agency (FEMA).
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  FEMA Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the Federal Emergency Management Agency
(FEMA).
j Federal Emergency Management Agency (FEMA)
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  FEMA: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q211]?

 

*2. Approximately what percentage of funding from the [Q211] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q211] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q211] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  FEMA: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q211]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  FEMA: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q216] position(s) are funded by

the [Q211]. Please identify the PRIMARY ROLE for each staff person funded by the [Q211].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q216].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  FEMA: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q211]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q211] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
HRSA/MCHB Title V Block Grant

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the HRSA/MCHB Title V Block Grant?
j YES, I received funding from the HRSA/MCHB Title V Block Grant.
k
l
m
n

 

j NO, I did NOT receive funding from the HRSA/MCHB Title V Block Grant.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  HRSA/MCHB Title V Block Grant Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the HRSA/MCHB Title V Block Grant.
j HRSA/MCHB Title V Block Grant
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  HRSA/MCHB Title V Block Grant: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q220]?

 

*2. Approximately what percentage of funding from the [Q220] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q220] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q220] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  HRSA/MCHB Title V Block Grant: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q220]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  HRSA/MCHB Title V Block Grant: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q225] position(s) are funded by

the [Q220]. Please identify the PRIMARY ROLE for each staff person funded by the [Q220].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q225].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  HRSA/MCHB Title V Block Grant: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q220]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q220] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
HRSA/MCHB Emergency Medical Services for Children (EMSC) Program

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the HRSA/MCHB Emergency Medical Services for Children (EMSC)
Program?
j YES, I received funding from the HRSA/MCHB Emergency Medical Services for Children (EMSC) Program.
k
l
m
n

 

j NO, I did NOT receive funding from the HRSA/MCHB Emergency Medical Services for Children (EMSC) Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  HRSA/MCHB EMSC Program Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the HRSA/MCHB Emergency Medical Services
for Children Program.
j HRSA/MCHB EMSC Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  HRSA/MCHB EMSC Program: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q229]?

 

*2. Approximately what percentage of funding from the [Q229] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q229] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q229] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  HRSA/MCHB EMSC Program: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q229]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  HRSA/MCHB EMSC Program: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q234] position(s) are funded by

the [Q229]. Please identify the PRIMARY ROLE for each staff person funded by the [Q229].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q234].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  HRSA/MCHB EMSC Program: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q229]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q229] in Federal Fiscal Year
2011.

Not a Focus of this 

Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
National Highway Traffic Safety Administration (NHTSA)  CODES

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the National Highway Traffic Safety Administration (NHTSA) for the CODES
Program?
j YES, I received funding from NHTSA for the CODES Program.
k
l
m
n

 

j NO, I did NOT receive funding from NHTSA for the CODES Program.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  NHTSA CODES Program Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the NHTSA CODES Program.
j NHTSA CODES Program
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  NHTSA CODES Program: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q238]?

 

*2. Approximately what percentage of funding from the [Q238] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q238] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q238] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  NHTSA CODES Program: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q238]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  NHTSA CODES Program: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q243] position(s) are funded by

the [Q238]. Please identify the PRIMARY ROLE for each staff person funded by the [Q238].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q243].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  NHTSA CODES Program: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q238]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q238] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
National Highway Traffic Safety Administration (NHTSA)  Other

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the National Highway Traffic Safety Administration (NHTSA) for any other
programs?
NOTE: Only include any other funding received directly from NHTSA. Do not include 
funding from CODES or from your state DOT or State Highway Safety Office.
j YES, I received funding from NHTSA for other programs.
k
l
m
n

 

j NO, I did NOT receive funding from NHTSA for other programs.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  Other NHTSA Programs: Names

 

*1. Please provide the name(s) of the other NHTSA program(s) for which you have

received funding.

5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  Other NHTSA Programs: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q247]?

 

*2. Approximately what percentage of funding from the [Q247] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q247] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q247] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  Other NHTSA Programs: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q247]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  Other NHTSA Programs: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q252] position(s) are funded by

the [Q247]. Please identify the PRIMARY ROLE for each staff person funded by the [Q247].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q252].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  Other NHTSA Programs: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q247]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q247] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey

 

SAMHSA Campus Suicide Prevention Grants

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from SAMHSA Campus Suicide Prevention Grants?
j YES, I received funding from SAMHSA Campus Suicide Prevention Grants.
k
l
m
n

 

j NO, I did NOT receive funding from SAMHSA Campus Suicide Prevention Grants.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  SAMHSA Campus Suicide Prevention Grants Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from SAMHSA Campus Suicide Prevention Grants.
j SAMHSA Campus Suicide Prevention Grants
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  SAMHSA Campus Suicide Prevention Grants: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q256]?

 

*2. Approximately what percentage of funding from the [Q256] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q256] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q256] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  SAMHSA Campus Suicide Prevention Grants: Number of Staff Funded

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q256]?
 

 

 

2011 SOTS Finance & Personnel Survey
5 of 6  SAMHSA Campus Suicide Prevention Grants: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q261] position(s) are funded by

the [Q256]. Please identify the PRIMARY ROLE for each staff person funded by the [Q256].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q261].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  SAMHSA Campus Suicide Prevention Grants: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q256]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q256] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
SAMHSA State and Tribal Youth Suicide Prevention Grants

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from SAMHSA State and Tribal Youth Suicide Prevention Grants?
j YES, I received funding from SAMHSA State and Tribal Youth Suicide Prevention Grants.
k
l
m
n

 

j NO, I did NOT receive funding from SAMHSA State and Tribal Youth Suicide Prevention Grants.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

2 of 6  SAMHSA State and Tribal Youth Suicide Prevention Grants Confirmat...

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from SAMHSA State and Tribal Youth Suicide
Prevention Grants.
j SAMHSA State and Tribal Youth Suicide Prevention Grants
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  SAMHSA State and Tribal Youth Suicide Prevention Grants: Funding...

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q265]?

 

*2. Approximately what percentage of funding from the [Q265] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q265] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q265] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey

 

4 of 6  SAMHSA State and Tribal Youth Suicide Prevention Grants: Number ...

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q265]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  SAMHSA State and Tribal Youth Suicide Prevention Grants: Staff Ro...

*1. Out of your [Q3] total staff, you have indicated that [Q270] position(s) are funded by

the [Q265]. Please identify the PRIMARY ROLE for each staff person funded by the [Q265].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q270].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

 

2011 SOTS Finance & Personnel Survey
6 of 6  SAMHSA State and Tribal Youth Suicide Prevention Grants: IVP Pri...

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q265]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q265] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
U.S. Department of Justice

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the U.S. Department of Justice?
j YES, I received funding from the U.S. Department of Justice.
k
l
m
n

 

j NO, I did NOT receive funding from the U.S. Department of Justice.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  U.S. Department of Justice Confirmation

 

*1. If you answered "YES" in the previous question, please click the circle below

confirming that you received funding from the U.S. Department of Justice.
j U.S. Department of Justice
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
3 of 6  U.S. Department of Justice: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q274]?

 

*2. Approximately what percentage of funding from the [Q274] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q274] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q274] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  U.S. Department of Justice: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q274]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  U.S. Department of Justice: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q279] position(s) are funded by

the [Q274]. Please identify the PRIMARY ROLE for each staff person funded by the [Q274].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q279].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  U.S. Department of Justice: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q274]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q274] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
U.S. Department of Transportation

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from the U.S. Department of Transportation?

NOTE: Do not include funding from NHTSA, from your state DOT, or State Highway Safety 
Office.
j YES, I received funding from the U.S. Department of Transportation.
k
l
m
n

 

j NO, I did NOT receive funding from the U.S. Department of Transportation.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  U.S. Department of Transportation Confirmation

 

*1. Please provide the name(s) of the U.S. Department of Transportation program(s) for

which you have received funding.

5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  U.S. Department of Transportation: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q283]?

 

*2. Approximately what percentage of funding from the [Q283] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q283] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q283] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  U.S. Department of Transportation: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q283]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  U.S. Department of Transportation: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q288] position(s) are funded by

the [Q283]. Please identify the PRIMARY ROLE for each staff person funded by the [Q283].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q288].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  U.S. Department of Transportation: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q283]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q283] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
Corporations

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from any corporations?
j YES, I received funding from corporations.
k
l
m
n

 

j NO, I did NOT receive funding from corporations.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  Corporations: Names

 

*1. Please provide the name(s) of the corporation(s) from which you have received

funding. NOTE: Please use commas to separate each name.
5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  Corporations: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q292]?

 

*2. Approximately what percentage of funding from the [Q292] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q292] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q292] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  Corporations: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q292]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  Corporations: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q297] position(s) are funded by

the [Q292]. Please identify the PRIMARY ROLE for each staff person funded by the [Q292].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q297].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  Corporations: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q292]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q292] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
Foundations

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from any foundations?
j YES, I received funding from foundations.
k
l
m
n

 

j NO, I did NOT receive funding from foundations.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  Foundations: Names

 

*1. Please provide the name(s) of the foundation(s) from which you have received

funding. NOTE: Please use commas to separate each name.
5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  Foundations: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q301]?

 

*2. Approximately what percentage of funding from the [Q301] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q301] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q301] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  Foundations: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q301]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  Foundations: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q306] position(s) are funded by

the [Q301]. Please identify the PRIMARY ROLE for each staff person funded by the [Q301].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q306].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  Foundations: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q301]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q301] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
NonProfit Organizations

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from any nonprofit organizations (e.g., Safe Kids, Public Health Institutes, etc.)?
j YES, I received funding from nonprofit organizations.
k
l
m
n

 

j NO, I did NOT receive funding from nonprofit organizations.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  NonProfit Organizations: Names

 

*1. Please provide the name(s) of the nonprofit organization(s) from which you have

received funding. NOTE: Please use commas to separate each name.
5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  NonProfit Organizations: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q310]?

 

*2. Approximately what percentage of funding from the [Q310] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q310] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q310] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  NonProfit Organizations: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q310]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  NonProfit Organizations: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q315] position(s) are funded by

the [Q310]. Please identify the PRIMARY ROLE for each staff person funded by the [Q310].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q315].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  NonProfit Organizations: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q310]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q310] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
 

Universities and Academic Institutions

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from a university or academic institution?
j YES, I received funding from a university or academic institution.
k
l
m
n

 

j NO, I did NOT receive funding from a university or academic institution.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  University & Academic Institutions: Names

 

*1. Please provide the name(s) of the academic institution(s) from which you have

received funding. NOTE: Please use commas to separate each name.
5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  University & Academic Institutions: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q319]?

 

*2. Approximately what percentage of funding from the [Q319] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q319] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q319] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  University & Academic Institutions: Number of Staff Funded
Other 

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q319]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  University & Academic Institutions: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q324] position(s) are funded by

the [Q319]. Please identify the PRIMARY ROLE for each staff person funded by the [Q319].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q324].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Other 
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  University & Academic Institutions: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q319]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q319] in Federal Fiscal Year
Yes 
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
Other Funding Sources

 

*1. In Federal Fiscal Year 2011 (October 1, 2010  September 30, 2011), did you receive

funding from any additional funding source(s) that have not been listed previously?
j YES, I received funding from additional funding source(s) that were not listed previously.
k
l
m
n
j NO, I did NOT receive funding from any additional funding sources.
k
l
m
n

 

 

 

2011 SOTS Finance & Personnel Survey
2 of 6  Other Funding Sources: Names

 

*1. Please provide the name(s) of the additional funding source(s) from which you have

received funding. NOTE: Please use commas to separate each name.
5
6  

 

2011 SOTS Finance & Personnel Survey
3 of 6  Other Funding Sources: Funding Amounts

 

*1. Between October 1, 2010  September 30, 2011, what is the total amount of funding

you will receive from the [Q328]?

 

*2. Approximately what percentage of funding from the [Q328] is used for the following

categories?

PLEASE NOTE: The sum total of all five categories should equal 100%. 
 
Personnel (Salary & Fringe)
Safety Equipment
Grants/MiniGrants/Contracts
Overhead Expenses (Indirect 
Costs)
Other (e.g., travel, meetings, 
educational materials, 
surveillance systems, etc.)

*3. Did you receive funding from the [Q328] in Federal Fiscal Year 2010 (October 1, 2009 

September 30, 2010)?

j YES, the same level of funding from this source as Federal Fiscal Year 2011.
k
l
m
n
j YES, but LESS funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

 

j YES, but MORE funding from this source in Federal Fiscal Year 2011.
k
l
m
n

 

j NO, I did not receive funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

j I don't know if I received funding from this source in Federal Fiscal Year 2010.
k
l
m
n

 

*4. Do you anticipate receiving funding from the [Q328] in Federal Fiscal Year 2012

(October 1, 2011  September 30, 2012)?

j YES, it is confirmed and funding will be at the same level.
k
l
m
n

 

j YES, it is confirmed and funding will be MORE than Federal Fiscal Year 2011.
k
l
m
n
j YES, it is confirmed and funding will be LESS than Federal Fiscal Year 2011.
k
l
m
n
j It is likely, but not confirmed.
k
l
m
n

 

 

 

j It is unknown if funding will be available.
k
l
m
n

 

j NO, no funding from this source is anticipated for Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
4 of 6  Other Funding Sources: Number of Staff Funded

 

*1. You have indicated that you have a total staff of [Q3]. During Federal Fiscal Year 2011,

how many of these staff positions were funded by the [Q328]?
 

 

2011 SOTS Finance & Personnel Survey
5 of 6  Other Funding Sources: Staff Roles

 

*1. Out of your [Q3] total staff, you have indicated that [Q333] position(s) are funded by

the [Q328]. Please identify the PRIMARY ROLE for each staff person funded by the [Q328].
If no staff were funded by this funding source place a zero (0) next to N/A.
PLEASE NOTE: You should assign only ONE primary role per staff member (Use the FTE 
calculation for parttime staff). If more than one staff member has the same primary role, 
please select the number of staff with that role. All of the roles you assign should not 
exceed a total of [Q333].
Coalition Building & 
Coordination
Data Collection & Analysis
Evaluation
Intervention & Program 
Coordination
Management
Public Policy & Advocacy
Support Staff/Administrative
Technical Assistance & 
Training
N/A

 

2011 SOTS Finance & Personnel Survey
6 of 6  Other Funding Sources: IVP Priorities

 

*1. Please indicate the IVP program topic areas that are addressed using funding from

the [Q328]. Please indicate whether the focus on the IVP program topic was primary,
secondary, minimal, or not a focus using funding from the [Q328] in Federal Fiscal Year
2011.
Primary Area of Focus Secondary Area of Focus Minimal Area of Focus

Not a Focus of this 
Funding Source

All Terrain Vehicles (ATV) Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Bullying

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Abuse/Neglect

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Child Passenger Safety

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Domestic/Intimate Partner Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Elder Abuse

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fall Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Fire and Burn Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Firearm Injuries

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Homicide

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Mass Trauma/Disasterrelated

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motor Vehicle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Motorcycle/Motorized Scooter Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Occupational Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Pedestrian and Bicycle Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Poisoning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Rural/Agricultural Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Schoolbased Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Sexual Assault/Rape

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Smart Growth & Community Design

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Spinal Cord Injury (SCI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Submersion Injuries/Drowning

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide/SelfInflicted Injury

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Suicide Attempts

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Teen Dating Violence

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Traumatic Brain Injury (TBI)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Other (Please specify below)

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

Name of Other Area of Focus 

 

2011 SOTS Finance & Personnel Survey
Budget/Economic Issues

 

*1. Comparing the budget period for Federal Fiscal Year 2011 to Federal Fiscal Year 2010,

which of the following did you experience?
j I experienced budget cuts.
k
l
m
n

 

j I had level funding. (No changes in funding)
k
l
m
n
j I had budget increases.
k
l
m
n

 

 

 

2011 SOTS Finance & Personnel Survey
 

Budget/Economic Issues

*1. What has been the impact of budget cuts that you experienced since October 1,

2010? (Choose all the apply.)
c Staff layoffs
d
e
f
g

 

c Staff furloughs
d
e
f
g

 

c Loss of staff through attrition
d
e
f
g

 

c Elimination of entire program(s)
d
e
f
g

 

c Reduction in surveillance efforts
d
e
f
g
c Reduction in services
d
e
f
g

 

 

c Reduction in support to partners
d
e
f
g

 

c Reduction in support to local health departments
d
e
f
g
c Other (please specify)
d
e
f
g

 

 
 

 

2011 SOTS Finance & Personnel Survey
Federal Fiscal Year 2012

 

1. In Federal Fiscal Year 2012, which of the following scenarios do you expect to
experience?
j I expect more budget cuts.
k
l
m
n
j I expect level funding.
k
l
m
n

 

 

j I expect budget increases.
k
l
m
n

 

j I'm not sure what to expect with regard to funding in Federal Fiscal Year 2012.
k
l
m
n

 

 

2011 SOTS Finance & Personnel Survey
Miscellaneous Financial and Budgetary Issues

 

*1. In general, which of the date ranges below most accurately defines your State's Fiscal

Year 2011?

j January 1, 2011  December 31, 2011
k
l
m
n
j July 1, 2010  June 30, 2011
k
l
m
n

 

 

j October 1, 2010  September 30, 2011
k
l
m
n
j Other (please specify)
k
l
m
n

 

 
 

*2. In your view, what is the minimum amount of funding your state needs to maintain an

effective injury and violence prevention presence within the state health department?
What funding sources would this include?
5
6  

*3. Do you have any documented examples of how injury and violence prevention has
saved your state money?
j No
k
l
m
n

 

j Yes (please specify)
k
l
m
n

 

5
6  

 

2011 SOTS Finance & Personnel Survey
Thank You

 

You have completed the 2011 State of the States Finance & Personnel Survey. Thank you for your time and participation. 
 
 
Please contact Jamila Porter at 7706909000 or [email protected] if you have any questions about the 
survey.
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File Modified	2011-10-07
File Created	2011-10-07