2-Enhanced Component -Annual Progress Report

Form Approved
OMB No. 0920-XXXX
Exp. Date xx/xx/20xx

Attachment C2

CE 11-1101 Core Violence and Injury Prevention Program (Core VIPP)
Annual Progress Report: RNL Year 4

Awardee:
Award Number:

Instructions: Using the template provided below, verify start and end dates, select progress status, and describe progress during Year 4 toward objectives and
activities submitted in your Year 4 continuation application. You may choose to modify activities for standardized objectives or your state objectives based on
the information you provided in your Year 4 Continuation Application and more current information to better reflect Year 4 activities. Indicate any changes
made to progress report objectives and activities in the related “Progress Description” field and provide a brief justification for the change(s).
Definitions:
• Objective = Specific statements about how to achieve a goal
• Measurement = Description of how all activities specific to the objective will be monitored
• Activity = Specific steps/tasks needed to accomplish objectives
• Start date = Date an activity will begin
• End date = Projected completion date for an activity
• Progress status:
o Not started = Activity is not yet started
o Redirected = Activity redirected to next funding year
o Planning = Planning the implementation and evaluation of the activity
o Ongoing/Implementation = Activity is ongoing and/or being implemented and evaluated
o Complete = Completed implementation and evaluation of the activity
o n/a = Not applicable
Public reporting burden of this collection of information is estimated to average 73 hours for the initial population of the tool, and 58 hours for annual reporting for awardees
funded for 1 enhanced component. For respondents funded for 2 enhanced components the average is estimated at 146 hours for the initial population of the tool, and 116
hours for annual reporting. The response includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it
displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

•

Description of Progress = Brief but sufficient description of the level of progress achieved for the activity during the reporting period must be entered
(do not just refer to attachments). Please include activity successes for all activities and barriers to progress for activities “not started” or “redirected.”

Regional Network Leader (RNL)
Goal 1: Provide structured assistance to states within the designated regions to build capacity, share best practices, and increase state injury and violence
prevention capacity across the network.
Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Progress Description
(1000 character limit)

Objective 1.3: Annually hold regular meetings with regional network states.
Measurement:
Activity 1.3.1:

Start:

Select One

End:
Activity 1.3.2:

Start:

Select One

End:
Activity 1.3.3:

Start:

Select One

End:
Activity 1.3.4:

Start:

Select One

End:
Activity 1.3.5:

Start:

Select One

End:
Activity 1.3.6:

Start:

Select One

End:
Activity 1.3.7:

Start:

Select One

End:
Objective 1.4: Annually facilitate appropriate technical assistance venues for supporting and enhancing injury and violence prevention activities throughout the
regional network (i.e. hosted webinars, facilitated peer to peer mentoring etc.).
Measurement:
Activity 1.4.1:

Start:
End:

Select One

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Activity 1.4.2:

Start:

Select One

Progress Description
(1000 character limit)

End:
Activity 1.4.3:

Start:

Select One

End:
Activity 1.4.4:

Start:

Select One

End:
Activity 1.4.5:

Start:

Select One

End:
Activity 1.4.6:

Start:

Select One

End:
Activity 1.4.7:

Start:

Select One

End:
Objective 1.5: Annually participate in and report results of the annual state consumer satisfaction and impact survey, with representation from states in each
regional network.
Measurement:
Activity 1.5.1:

Start:

Select One

End:
Activity 1.5.2:

Start:

Select One

End:
Activity 1.5.3:

Start:

Select One

End:
Activity 1.5.4:

Start:

Select One

End:
Activity 1.5.5:

Start:

Select One

End:
Activity 1.5.6:

Start:

Select One

End:
Activity 1.5.7:

Start:

Select One

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Progress Description
(1000 character limit)

End:
Objective 1.6: Annually participate in all CDC initiated/sponsored activities related to Core VIPP, including but not limited to, regional networks, annual Core
VIPP Grantees meeting, webinars, regular phone calls, evaluation, and technical assistance.
Measurement:
Activity 1.6.1:

Start:

Select One

End:
Activity 1.6.2:

Start:

Select One

End:
Activity 1.6.3:

Start:

Select One

End:
Activity 1.6.4:

Start:

Select One

End:
Activity 1.6.5:

Start:

Select One

End:
Activity 1.6.6:

Start:

Select One

End:
Activity 1.6.7:

Start:

Select One

End:
Objective 1.A:
Measurement:
Activity 1.A.1:

Start:

Select One

End:
Activity 1.A.2:

Start:

Select One

End:
Activity 1.A.3:

Start:

Select One

End:
Activity 1.A.4:

Start:
End:

Select One

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Activity 1.A.5:

Start:

Select One

End:
Activity 1.A.6:

Start:

Select One

End:
Activity 1.A.7:

Start:

Select One

End:
Objective 1.B:
Measurement:
Activity 1.B.1:

Start:

Select One

End:
Activity 1.B.2:

Start:

Select One

End:
Activity 1.B.3:

Start:

Select One

End:
Activity 1.B.4:

Start:

Select One

End:
Activity 1.B.5:

Start:

Select One

End:
Activity 1.B.6:

Start:

Select One

End:
Activity 1.B.7:

Start:
End:

Select One

Progress Description
(1000 character limit)

Form Approved
OMB No. 0920-XXXX

Exp. Date xx/xx/20xx
CE 11-1101 Core Violence and Injury Prevention Program (Core VIPP)
Annual Progress Report: SQI Year 4
Awardee:
Award Number:
Instructions: Using the template provided below, enter start and end dates, select progress status, and describe progress during Year 4 toward objectives and
activities submitted in the Year 4 continuation application. Note that any state-provided objectives and associated activities can be included under each Goal
and are listed as 1.A and B; 2.A and B.
Definitions:
• Objective = Specific statements about how to achieve a goal
• Measurement = Description of how all activities specific to the objective will be monitored
• Activity = Specific steps/tasks needed to accomplish objectives
• Start date = Date an activity will begin
• End date = Projected completion date for an activity
• Progress status:
o Not started = Activity is not yet started
o Redirected = Activity redirected to next funding year
o Planning = Planning the implementation and evaluation of the activity
o Ongoing/Implementation = Activity is ongoing and/or being implemented and evaluated
o Complete = Completed implementation and evaluation of the activity
o n/a = Not applicable
• Progress description = Brief description of the level of progress achieved for the activity during the reporting period. Please include activity successes for
all activities and barriers to progress for activities “not started” or “redirected.” Do not leave blank and include sufficient information to describe
progress.
Public reporting burden of this collection of information is estimated to average 58 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta,
Georgia 30333; ATTN: PRA (0920-XXXX).

Surveillance Quality Improvement (SQI)
Goal 1: To conduct injury and data investigations through state-based projects supportive of promoting and advancing uniform injury case definitions,
improving data quality, and advancing methodology.
Year 4 State-Based Project Description: (2000 character limit)

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Progress Description
(1000 character limit)

Objective 1.1: Annually collect, analyze and interpret data for the purposes of a state-based injury surveillance evaluation project
Measurement:
Activity 1.1.1:

Start:

Select One

End:
Activity 1.1.2:

Start:

Select One

End:
Activity 1.1.3:

Start:

Select One

End:
Activity 1.1.4:

Start:

Select One

End:
Activity 1.1.5:

Start:

Select One

End:
Activity 1.1.6:

Start:

Select One

End:
Activity 1.1.7:

Start:

Select One

End:
Objective 1.2: Annually prepare reports on state-based injury surveillance project findings suitable for dissemination.
Measurement:
Activity 1.2.1:

Start:
End:

Select One

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Activity 1.2.2:

Start:

Select One

End:
Activity 1.2.3:

Start:

Select One

End:
Activity 1.2.4:

Start:

Select One

End:
Activity 1.2.5:

Start:

Select One

End:
Activity 1.2.6:

Start:

Select One

End:
Activity 1.2.7:

Start:

Select One

End:
Objective 1.A:
Measurement:
Activity 1.A.1:

Start:

Select One

End:
Activity 1.A.2:

Start:

Select One

End:
Activity 1.A.3:

Start:

Select One

End:
Activity 1.A.4:

Start:

Select One

End:
Activity 1.A.5:

Start:

Select One

End:
Activity 1.A.6:

Start:

Select One

End:
Activity 1.A.7:

Start:
End:

Select One

Progress Description
(1000 character limit)

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Start:

Select One

Progress Description
(1000 character limit)

Objective 1.B:
Measurement:
Activity 1.B.1:

End:
Activity 1.B.2:

Start:

Select One

End:
Activity 1.B.3:

Start:

Select One

End:
Activity 1.B.4:

Start:

Select One

End:
Activity 1.B.5:

Start:

Select One

End:
Activity 1.B.6:

Start:

Select One

End:
Activity 1.B.7:

Start:

Select One

End:
Goal 2: To conduct injury and data investigations through group consensus projects supportive of promoting and advancing uniform injury case definitions,
improving data quality, and advancing methodology.
Year 4 Group Project Description: (2000 character limit)

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Progress Description
(1000 character limit)

Objective 2.1: Annually participate in a study consensus process to select topics, design and develop injury surveillance products.
Measurement:

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Activity 2.1.1:

Start:

Select One

Progress Description
(1000 character limit)

End:
Activity 2.1.2:

Start:

Select One

End:
Activity 2.1.3:

Start:

Select One

End:
Activity 2.1.4:

Start:

Select One

End:
Activity 2.1.5:

Start:

Select One

End:
Activity 2.1.6:

Start:

Select One

End:
Activity 2.1.7:

Start:

Select One

End:
Objective 2.2: Annually collect, analyze and interpret data and prepare reports suitable for dissemination.
Measurement:
Activity 2.2.1:

Start:

Select One

End:
Activity 2.2.2:

Start:

Select One

End:
Activity 2.2.3:

Start:

Select One

End:
Activity 2.2.4:

Start:

Select One

End:
Activity 2.2.5:

Start:

Select One

End:
Activity 2.2.6:

Start:
End:

Select One

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

Activity 2.2.7:

Start:

Select One

Progress Description
(1000 character limit)

End:
Objective 2.3: Annually make contributions and submit mutually agreed upon analyses and participate in report generation.
Measurement:
Activity 2.3.1:

Start:

Select One

End:
Activity 2.3.2:

Start:

Select One

End:
Activity 2.3.3:

Start:

Select One

End:
Activity 2.3.4:

Start:

Select One

End:
Activity 2.3.5:

Start:

Select One

End:
Activity 2.3.6:

Start:

Select One

End:
Activity 2.3.7:

Start:

Select One

End:
Objective 2.4: Annually participate in all CDC initiated/sponsored activities related to Core VIPP, including but not limited to, regional networks, annual joint
CDC/Safe States meeting, webinars, regular phone calls, evaluation, and technical assistance.
Measurement:
Activity 2.4.1:

Start:

Select One

End:
Activity 2.4.2:

Start:

Select One

End:
Activity 2.4.3:

Start:

Select One

End:
Activity 2.4.4:

Start:

Select One

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

End:
Activity 2.4.5:

Start:

Select One

End:
Activity 2.4.6:

Start:

Select One

End:
Activity 2.4.7:

Start:

Select One

End:
Objective 2.A:
Measurement:
Activity 2.A.1:

Start:

Select One

End:
Activity 2.A.2:

Start:

Select One

End:
Activity 2.A.3:

Start:

Select One

End:
Activity 2.A.4:

Start:

Select One

End:
Activity 2.A.5:

Start:

Select One

End:
Activity 2.A.6:

Start:

Select One

End:
Activity 2.A.7:

Start:

Select One

End:
Objective 2.B:
Measurement:
Activity 2.B.1:

Start:

Select One

End:
Activity 2.B.2:

Start:

Select One

Progress Description
(1000 character limit)

Activity

(500 character limit)

Start and End
Date (mm/dd/yy)

Progress Status

End:
Activity 2.B.3:

Start:

Select One

End:
Activity 2.B.4:

Start:

Select One

End:
Activity 2.B.5:

Start:

Select One

End:
Activity 2.B.6:

Start:

Select One

End:
Activity 2.B.7:

Start:
End:

Select One

Progress Description
(1000 character limit)