Community Based Organizations- Business Not for Profit
An Assessment of the Roles and Effectiveness of Community-Based Organizations in the Supplemental Nutrition Assistance Program
CPI - Appendix E - Data Collection Spreadsheet.xlsx
Community Based Organizations- Business Not for Profit
OMB: 0584-0578
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Program Access
Eligibility Decision
Error Rates
Timeliness
Client Satisfaction Survey
Staffing
Project Costs
Overview
Performance Data Q3 & Q4 FY15Program Access
Eligibility Decision
Error Rates
Timeliness
Client Satisfaction Survey
Staffing
Project Costs
Sheet 1: Performance Data Q3 & Q4 FY15
| COMMUNITY PARTNER INTERVIEW DEMONSTRATION | |||||
| PERFORMANCE DATE | |||||
| Name of State: | |||||
| REPORTING PERIOD | |||||
| DATA ELEMENTS | 05/1/2015 to 7/31/2015 | 8/01/2015 to 10/31/2015 | |||
| Applications Completed | Number of regular application completed. | ||||
| Number of expedited application completed. | |||||
| Total number of applications completed. | |||||
| Applications Submitted | Number of regular applications submitted. | ||||
| Number of expedited application submitted. | |||||
| Total number of applications submitted. | |||||
| Applications Approced | Number of regular applications approved. | ||||
| Number of expedited applications approved. | |||||
| Total number of applications approved. | |||||
| Application Processing Time | Number of regular applications processed within 30 days. | ||||
| Number of expedited aplications processed within 7 days. | |||||
| Case Errors | Number of active case errors for regular cases. | ||||
| Number of active cases for expedited cases. | |||||
| Number of negative case errors for regular cases. | |||||
| Number of negative cases errors for expedited cases | |||||
| Will ad reasons for denial | |||||
Sheet 2: Program Access
| Program Access | State Name: | ||||||||||||||||||||
| Enter values for each site seperately for the given time period. Data should represent total counts for each site. | |||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
| Name of Site: | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Customer Service | Total customers served | ||||||||||||||||||||
| Number of customers who received SNAP application assistance | |||||||||||||||||||||
| Number of customers who recieved SNAP application interviews | |||||||||||||||||||||
| Applications Submitted | Number of regular applications submitted | ||||||||||||||||||||
| Number of expedited applications submitted | |||||||||||||||||||||
| Total number of applications submitted | |||||||||||||||||||||
| Recertifications Submitted | Total number of recertifications submitted | ||||||||||||||||||||
Sheet 3: Eligibility Decision
| Eligibility Decision | State Name: | ||||||||||||||||||||
| Values below should be the total for all sites for the given time period. Data should represent total counts for each site. | |||||||||||||||||||||
| DATA ELEMENTS | FY 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | FY 2020 | |||||||||||||||
| 05/01/15 to 06/30/15 | 7/1/15 to 9/30/15 | 10/01/15 to 12/31/15 | 01/01/26 to 03/31/16 | 04/01/16 to 06/30/16 | 07/01/16 to 09/30/16 | 10/01/16 to 12/31/16 | 01/01/17 to 03/31/17 | 04/01/17 to 06/30/17 | 07/01/17 to 09/30/17 | 10/01/17 to 12/31/17 | 01/01/18 to 03/31/18 | 04/01/18 to 06/30/18 | 07/01/18 to 09/30/18 | 10/01/18 to 12/31/18 | 01/01/19 to 03/31/19 | 04/01/19 to 06/30/19 | 07/01/19 to 09/30/19 | 10/01/19 to 12/31/19 | 01/01/20 to 03/31/20 | ||
| Applications Approved | Number of regular applications approved | ||||||||||||||||||||
| Number of expedited applications approved | |||||||||||||||||||||
| Total number of applications approved | |||||||||||||||||||||
| Applications Denied | Number of days to eligibility decision | ||||||||||||||||||||
| Number of days to eligibility decision | Regular Apps - Average number of days between app date and approval date | ||||||||||||||||||||
| Expedited Apps - Average number of days between app date and approval date | |||||||||||||||||||||
Sheet 4: Error Rates
| Error Rates | State Name: | ||||||||||||||
| Bases values on the errors found in the random sample of applications from all sites. | |||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | Instructions: Review a sample of applications from the community sites (see demonstration Terms and Conditions for details on size of sample). The State agency should re-verify items for which State agency policy requires independent verification at certification. FNS expects that the State agency’s certification policy for verification conforms to FNS regulations and follows procedures specified in the Quality Control 310 Handbook. If, for any reason, one or more application items were not independently verified at certification as per FNS policy, those items must be verified using independent sources of information as part of the review. These reviews should focus primarily on errors related to income, deductions, and household composition. The State agency may conduct these reviews via telephone. The State agency should report on all errors by case. |
||||||||
| Case Errors | Number of sampled cases for payment accuracy | ||||||||||||||
| Number of sampled cases with positive (active) errors | |||||||||||||||
| Number of denied/terminated sampled cases | |||||||||||||||
| Number of sampled cases with negative errors* | |||||||||||||||
| Causes of Errors | |||||||||||||||
| Record causes of errors for the given time period. | |||||||||||||||
| May 1, 2015 - September 30, 2015 | |||||||||||||||
| FY 2016 | |||||||||||||||
| FY 2017 | |||||||||||||||
| FY 2018 | |||||||||||||||
| FY 2019 | |||||||||||||||
| October 1, 2019 - April 30, 2020 | |||||||||||||||
Sheet 5: Timeliness
| Timeliness | State Name: | |||||||||
| Bases values on the timeliness of of all applications submitted by all sites in the give time period. | ||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | Instructions: The State agency should report the percent of all applications submitted by the community partners that were processed within current timeliness standards. The State agency should differentiate between expedited and regular 30-day applications. The State agency should identify the causes of any cases that do not meet the timeliness requirements, as measured in accordance with the quality control methods. | |||
| Application Processing Timeliness | Number of sampled cases | |||||||||
| Regular Apps - Percent of regular cases processed within 30 days | ||||||||||
| Expedited Apps - Percent of expedited cases processed within 7 days | ||||||||||
| Causes of Errors | ||||||||||
| Record causes of untimely cases for the given time period. | ||||||||||
| May 1, 2015 - September 30, 2015 | ||||||||||
| FY 2016 | ||||||||||
| FY 2017 | ||||||||||
| FY 2018 | ||||||||||
| FY 2019 | ||||||||||
| October 1, 2019 - April 30, 2020 | ||||||||||
Sheet 6: Client Satisfaction Survey
| CLIENT SATISFACTION SURVEY | State Name: | |||||||||
| Record responses from the customer satisfaction survey administered to a sample of applicants from all sites. | ||||||||||
| May 1, 2015 - September 30, 2015 | ||||||||||
| Survey Questions | Responses | |||||||||
| A | B | C | D | E | F | G | H | I | ||
| 1 | Why did you choose this location? [Select all that apply.] | |||||||||
| 2 | When you first went to (FILL NAME FROM 1), how long after you arrived did you have to wait to speak with someone who could provide you with the assistance you needed? | |||||||||
| 3 | Have you ever applied for SNAP before? | |||||||||
| 4 | [If yes to 3]: Was the application process easier or harder this time around? | |||||||||
| 5 | Thinking about all the interactions you have had with [FILL NAME FROM 1], how satisfied are you overall with the SNAP-related services or assistance they offered you? | |||||||||
| 6 | The staff at [FILL NAME FROM 1] were very knowledgeable about SNAP, SNAP eligibility and the application procedures. | |||||||||
| 7 | It was difficult to find someone at [FILL NAME FROM 1] who was available to help me apply for SNAP. | |||||||||
| 8 | The people at [FILL NAME FROM 1] seemed confused about what information or documents I needed to have with me during the interview. | |||||||||
| 9 | The location where I was interviewed for SNAP benefits did not have amenities that I needed to complete my application. | |||||||||
| 10 | My interview for SNAP benefits was conducted in an area that offered enough privacy. | |||||||||
| FY 2016 | ||||||||||
| Survey Questions | Responses | |||||||||
| A | B | C | D | E | F | G | H | I | ||
| 1 | Why did you choose this location? [Select all that apply.] | |||||||||
| 2 | When you first went to (FILL NAME FROM 1), how long after you arrived did you have to wait to speak with someone who could provide you with the assistance you needed? | |||||||||
| 3 | Have you ever applied for SNAP before? | |||||||||
| 4 | [If yes to 3]: Was the application process easier or harder this time around? | |||||||||
| 5 | Thinking about all the interactions you have had with [FILL NAME FROM 1], how satisfied are you overall with the SNAP-related services or assistance they offered you? | |||||||||
| 6 | The staff at [FILL NAME FROM 1] were very knowledgeable about SNAP, SNAP eligibility and the application procedures. | |||||||||
| 7 | It was difficult to find someone at [FILL NAME FROM 1] who was available to help me apply for SNAP. | |||||||||
| 8 | The people at [FILL NAME FROM 1] seemed confused about what information or documents I needed to have with me during the interview. | |||||||||
| 9 | The location where I was interviewed for SNAP benefits did not have amenities that I needed to complete my application. | |||||||||
| 10 | My interview for SNAP benefits was conducted in an area that offered enough privacy. | |||||||||
| FY 2017 | ||||||||||
| Survey Questions | Responses | |||||||||
| A | B | C | D | E | F | G | H | I | ||
| 1 | Why did you choose this location? [Select all that apply.] | |||||||||
| 2 | When you first went to (FILL NAME FROM 1), how long after you arrived did you have to wait to speak with someone who could provide you with the assistance you needed? | |||||||||
| 3 | Have you ever applied for SNAP before? | |||||||||
| 4 | [If yes to 3]: Was the application process easier or harder this time around? | |||||||||
| 5 | Thinking about all the interactions you have had with [FILL NAME FROM 1], how satisfied are you overall with the SNAP-related services or assistance they offered you? | |||||||||
| 6 | The staff at [FILL NAME FROM 1] were very knowledgeable about SNAP, SNAP eligibility and the application procedures. | |||||||||
| 7 | It was difficult to find someone at [FILL NAME FROM 1] who was available to help me apply for SNAP. | |||||||||
| 8 | The people at [FILL NAME FROM 1] seemed confused about what information or documents I needed to have with me during the interview. | |||||||||
| 9 | The location where I was interviewed for SNAP benefits did not have amenities that I needed to complete my application. | |||||||||
| 10 | My interview for SNAP benefits was conducted in an area that offered enough privacy. | |||||||||
| FY 2018 | ||||||||||
| Survey Questions | Responses | |||||||||
| A | B | C | D | E | F | G | H | I | ||
| 1 | Why did you choose this location? [Select all that apply.] | |||||||||
| 2 | When you first went to (FILL NAME FROM 1), how long after you arrived did you have to wait to speak with someone who could provide you with the assistance you needed? | |||||||||
| 3 | Have you ever applied for SNAP before? | |||||||||
| 4 | [If yes to 3]: Was the application process easier or harder this time around? | |||||||||
| 5 | Thinking about all the interactions you have had with [FILL NAME FROM 1], how satisfied are you overall with the SNAP-related services or assistance they offered you? | |||||||||
| 6 | The staff at [FILL NAME FROM 1] were very knowledgeable about SNAP, SNAP eligibility and the application procedures. | |||||||||
| 7 | It was difficult to find someone at [FILL NAME FROM 1] who was available to help me apply for SNAP. | |||||||||
| 8 | The people at [FILL NAME FROM 1] seemed confused about what information or documents I needed to have with me during the interview. | |||||||||
| 9 | The location where I was interviewed for SNAP benefits did not have amenities that I needed to complete my application. | |||||||||
| 10 | My interview for SNAP benefits was conducted in an area that offered enough privacy. | |||||||||
| FY 2019 | ||||||||||
| Survey Questions | Responses | |||||||||
| A | B | C | D | E | F | G | H | I | ||
| 1 | Why did you choose this location? [Select all that apply.] | |||||||||
| 2 | When you first went to (FILL NAME FROM 1), how long after you arrived did you have to wait to speak with someone who could provide you with the assistance you needed? | |||||||||
| 3 | Have you ever applied for SNAP before? | |||||||||
| 4 | [If yes to 3]: Was the application process easier or harder this time around? | |||||||||
| 5 | Thinking about all the interactions you have had with [FILL NAME FROM 1], how satisfied are you overall with the SNAP-related services or assistance they offered you? | |||||||||
| 6 | The staff at [FILL NAME FROM 1] were very knowledgeable about SNAP, SNAP eligibility and the application procedures. | |||||||||
| 7 | It was difficult to find someone at [FILL NAME FROM 1] who was available to help me apply for SNAP. | |||||||||
| 8 | The people at [FILL NAME FROM 1] seemed confused about what information or documents I needed to have with me during the interview. | |||||||||
| 9 | The location where I was interviewed for SNAP benefits did not have amenities that I needed to complete my application. | |||||||||
| 10 | My interview for SNAP benefits was conducted in an area that offered enough privacy. | |||||||||
| October 1, 2019 - April 30, 2020 | ||||||||||
| Survey Questions | Responses | |||||||||
| A | B | C | D | E | F | G | H | I | ||
| 1 | Why did you choose this location? [Select all that apply.] | |||||||||
| 2 | When you first went to (FILL NAME FROM 1), how long after you arrived did you have to wait to speak with someone who could provide you with the assistance you needed? | |||||||||
| 3 | Have you ever applied for SNAP before? | |||||||||
| 4 | [If yes to 3]: Was the application process easier or harder this time around? | |||||||||
| 5 | Thinking about all the interactions you have had with [FILL NAME FROM 1], how satisfied are you overall with the SNAP-related services or assistance they offered you? | |||||||||
| 6 | The staff at [FILL NAME FROM 1] were very knowledgeable about SNAP, SNAP eligibility and the application procedures. | |||||||||
| 7 | It was difficult to find someone at [FILL NAME FROM 1] who was available to help me apply for SNAP. | |||||||||
| 8 | The people at [FILL NAME FROM 1] seemed confused about what information or documents I needed to have with me during the interview. | |||||||||
| 9 | The location where I was interviewed for SNAP benefits did not have amenities that I needed to complete my application. | |||||||||
| 10 | My interview for SNAP benefits was conducted in an area that offered enough privacy. | |||||||||
Sheet 7: Staffing
| Staffing | State Name: | |||||||||||||
| Enter values for each site seperately for the given time period. | ||||||||||||||
| Name of Site: | Number of State merit personnel performing SNAP interviews - Give average number of State merit personnel performing SNAP interviews in the specified pilot area for the given time period. Include personnel who perform SNAP interviews as part of combined State applications for multiple benefit programs. Only include merit personnel. | |||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Average number of State merit personnel performing SNAP interviews in the geographic area served by the CBO. | ||||||||||||||
| Total number of community partner staff hours to conduct SNAP interviews for given time period. | ||||||||||||||
| If community partner hours are from a time study, indicate date of time study . | Number of community partner staff hours to conduct SNAP interviews - Give TOTAL number of hours spent by community partner staff conducting project activities in the specified pilot area for the given time period. Include hours spent by full time and part time staff. If an employee conducts the interview for a SNAP applicant, count all hours that employee spends assisting that SNAP applicant obtain benefits (e.g. answering questions, helping with verifications, follow-up calls to the State agency etc.). | |||||||||||||
| Name of Site: | ||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Average number of State merit personnel performing SNAP interviews in the geographic area served by the CBO. | Time Study - To ease data collection burdens, community partners may conduct a time study to assess total number of project hours. The time study should be conducted independently in each site at least once a year. | |||||||||||||
| Total number of community partner staff hours to conduct SNAP interviews for given time period. | ||||||||||||||
| If community partner hours are from a time study, indicate date of time study . | ||||||||||||||
| Name of Site: | ||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Average number of State merit personnel performing SNAP interviews in the geographic area served by the CBO. | ||||||||||||||
| Total number of community partner staff hours to conduct SNAP interviews for given time period. | ||||||||||||||
| If community partner hours are from a time study, indicate date of time study . | ||||||||||||||
| Name of Site: | ||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Average number of State merit personnel performing SNAP interviews in the geographic area served by the CBO. | ||||||||||||||
| Total number of community partner staff hours to conduct SNAP interviews for given time period. | ||||||||||||||
| If community partner hours are from a time study, indicate date of time study . | ||||||||||||||
| Name of Site: | ||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Average number of State merit personnel performing SNAP interviews in the geographic area served by the CBO. | ||||||||||||||
| Total number of community partner staff hours to conduct SNAP interviews for given time period. | ||||||||||||||
| If community partner hours are from a time study, indicate date of time study . | ||||||||||||||
| Name of Site: | ||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Average number of State merit personnel performing SNAP interviews in the geographic area served by the CBO. | ||||||||||||||
| Total number of community partner staff hours to conduct SNAP interviews for given time period. | ||||||||||||||
| If community partner hours are from a time study, indicate date of time study . | ||||||||||||||
| Name of Site: | ||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Average number of State merit personnel performing SNAP interviews in the geographic area served by the CBO. | ||||||||||||||
| Total number of community partner staff hours to conduct SNAP interviews for given time period. | ||||||||||||||
| If community partner hours are from a time study, indicate date of time study . | ||||||||||||||
Sheet 8: Project Costs
| Demonstration Project Costs | State Name: | 
|
||||||||||||
| Values below should refelct total costs for all project sites in the given time period. | ||||||||||||||
| DATA ELEMENTS | May 1, 2015 - September 30, 2015 | FY 2016 | FY 2017 | FY 2018 | FY 2019 | October 1, 2019 - April 30, 2020 | ||||||||
| Total Cost | Total Cost to community partners to conduct projects. Give dollar amount. | |||||||||||||
| State/Federal Share | Share of project costs provided by the State agency including any dollars that pass through the State agency to the community partner. Give total dollar amount of State share here and provide breakdown in dollars by source of funds below. | |||||||||||||
| SNAP Administrative Funds | ||||||||||||||
| SNAP Outreach funds | ||||||||||||||
| Other Federal funds (please specify) | ||||||||||||||
| State funds | ||||||||||||||
| Other funds (please specify) | ||||||||||||||
| Community Partner Share | Share of project costs provided by community partners. Give dollar amount. | |||||||||||||
| Compensation Narrative | ||||||||||||||
| Describe below any agreements between the State agency and one or more of the community partners to provide compensation to the community pertners for their project services. Include agreements to provide SNAP administrative match, SNAP outreach funding, or any non-SNAP related local, State, or Federal dollars. Use as much space as needed. | ||||||||||||||
| May 1, 2015 - September 30, 2015 | ||||||||||||||
| FY 2016 | ||||||||||||||
| FY 2017 | ||||||||||||||
| FY 2018 | ||||||||||||||
| FY 2019 | ||||||||||||||
| October 1, 2019 - April 30, 2020 | ||||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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