Form 1 O&E Progress Report

Outreach and Enrollment O/E Quarterly Progress Report Mock Up DRAFT 1/28/2021

DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration OUTREACH AND ENROLLMENT SUPPLEMENTAL	FOR HRSA USE ONLY
	Application Tracking Number	Grant Number

Grantee Information
Grantee Name, City, State:	Application Tracking Number:

Progress toward O/E Projection
Number of O/E workers who completed HHS training in previous quarter	Number of unique individuals assisted* by O/E workers in previous quarter	Cumulative total # of individuals assisted with O/E	Budget period projection of individuals to be assisted with O/E
Whole numbers only	Whole numbers only	Auto-calculate from past submissions.	Prepopulate with projection in application.

*Assisted …

2. Coordination of Efforts

How have you coordinated your O/E efforts with other health centers and with other state or local efforts?

1500 characters (1/2 page)

3. Barriers

Describe any major O/E barriers you have encountered.

1500 characters (1/2 page)

4. Key Strategies and Lessons Learned

Describe key strategies and lessons learned that have contributed to the success of your O/E efforts.

1500 characters (1/2 page)