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pdfOMB Control No: 0970‐0379
Expiration date: 08/31/2016
Project Outcome Assessment Survey
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104‐13) Public reporting burden for this collection of
information is estimated to average 6 hours per response, including the time for reviewing instructions, gathering
and maintaining the data needed, and reviewing the collection of information.
Identifying Information (Pre‐Filled by Federal Staff)
Evaluator’s Name (First), (Last):
Other ANA Staff/Contractors Present at the Site Visit:
Evaluation Region: [DROP DOWN] East, West, Pacific, Alaska
State: [DROP DOWN] AK, AL, AR, AS, AZ,
CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MP, MS, MT, NC,
ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Date of Evaluation:
Grantee Information (Pre‐Filled by Federal Staff)
Grantee Name:
Grant Number:
Updated Grantee Contact Info (if Grantee Contact Info is not Correct in GrantSolutions):
Geo Designation:
Number of Program Specialists during Project Period:
Grant Category: [DROP DOWN MENU] Social Development, Economic Development, Governance,
Strengthening Families, Environmental Regulatory Enhancement, Language Preservation, Esther
Martinez, AFI (partnership), ADD (partnership)
Grant Sub‐Category:
Original Project Duration:
Total Federal Funding Amount:
Grant History (Pre‐Filled by Federal Staff)
Received TA:
Yes o
No o
Comments?
Received Supplements:
Yes o
No o
Comments?
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
Received Carryovers:
Yes o
No o
Comments?
Received an LCE:
Yes o
No o
Comments?
Received an NCE:
Yes o
No o
Comments?
Pre‐Visit Information (Pre‐Filled by Federal Staff)
Background Information/General Comments
1. Objective Work Plan (Pre‐Filled by Federal Staff)
1.1 Objective 1
Relevant Year(s); o Yr1 o Yr2 o Yr3 o Yr4 o Yr5
Objective
Results (Outputs)/Benefits (Outcomes) Expected:
Criteria for Evaluating Results and Benefits Expected:
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
Deliverables:
Product
Documentation Reviewed/Comments
Comments
1.2 If you could share some best practices from your project with other ANA grantees, what would they
be?
2. Results (Outputs) and Benefits (Outcomes)
2.1 Is the Three‐Year End of Project Target still achievable and realistic?
If not, how would you revise?
2.2 Your project was designed to serve ___ community or ___ number of people. To what extent did you
serve this population? (Pre‐Filled by Federal Staff from application and confirm on‐site)
3. Partnerships
3.1 Identify the top three partners who contributed the most to the success of the project.
Partnership:
Contributions: [DROP DOWN MENU] Technical expertise/capacity building; Education; Market./media
svc; Training (for proj. staff/beneficiaries; Volunteer services; Data collect./resch; Office/classroom
space provision; Food/catering service; Mgmt or legal serv; Financial assistance/leveraging resources;
Community outreach; Client referral; Other
Comments
4. Beneficiaries
(Evaluator: use this section to capture information collected during interaction with
beneficiaries/community members/partners including indirectly. If necessary ask grantee to identify
beneficiaries and discuss impact.)
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
Beneficiary
4.1 Do you expect that the results of this project will affect your and/or your family's life?
Yes o
No o
If yes, please describe.
4.2 What did you learn about your community by participating in this project?
Yes o
No o
4.3 Do you think your life will change or that of your family when this project ends?
Yes o
No o
4.4 Did you expect to gain or achieve something by participating in the project that didn’t materialize? If
so, what would have made a difference?
Yes o
No o
4.5 Has this project helped connect you and your family with traditional practices, cultural strengths, or
spiritual practices that were helpful to you and/or your child? If yes, please describe.
Yes o
No o
5. Project Benefits
5.1 Did this project support native‐owned business? Yes o
No o
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
5.2 How many?
5.3 Of the Native‐owned businesses the project supported, what were the top 3 businesses by dollar
amount?
5.4 Income Generated by business:
5.4.1 Did this project generate income?
5.4.1 List the income generated by this project:
5.5 What project outcomes would you like to sustain after ANA funds end, and what is needed to sustain
such outcomes?
5.6 What obstacles are foreseen to project sustainability over the next 5 years?
5.7 Did the services provided appear to have beneficial effects on the project participants?
5.8 Do you think the positive results for these individuals can be traced to the project itself? What other
factors could have contributed?
6. Project Development
6.1 How was the project developed? Please describe how the community was involved in the
development process.
6.2 Was the project’s target population involved during project planning prior to the grant award?
6.3 Is there anything you would have done differently in planning your project?
6.4 What marketing or outreach methods did you use to bring attention to your project? (Check any that
apply.)
o Brochures and Pamphlets
o Email
o Festivals and Community Events
o Networking (with Other Tribes, Agencies, Organizations, Businesses)
o Newspaper Advertisements
o Newspaper Coverage
o Onsite Community Outreach (knock on doors)
o Phone Calls
o Posting Information in Public Spaces
o Radio (includes PSAs and other programming)
o Regular Mail
o Social Media (such as Facebook, Twitter, Youtube, etc.);
o Tribal/Community Meetings
o Tribal/Organizational Publications or Newsletters
o TV (includes PSAs and other programming)
o Website
o Word of Mouth
6.5 In terms of marketing/outreach, what would you have done differently?
6.6 Did any members of the community and/or general public express opposition to the project?
7. Project Challenges
7.1 Did you have any challenges that affected your ability to implement the project?
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
Rank
Challenge
Ability to
Overcome
Challenge?
Staff turnover
Late start due to ANA notification
Late start due to hiring delays
Scope too ambitious
Geographic isolation/travel issues
Lack of expertise
Challenges with ANA processes
Challenges with OGM processes
Underestimated project cost
Underestimated personnel needs
Partnership fell through
Lack of community support (planning)
Lack of community support (implementation)
Other
Comments
7. Staffing
7.1 How many Project Directors/Principal Investigators served on this project?
7.2 Post Award Training
7.2.1 Did the Project Director/Principal Investigator receive post‐award training?
Yes o
No o
Why not?
7.2.2 Did the financial staff member receive post‐award training?
Yes o
No o
Why not?
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
8. Program Specific
LANGUAGE
8.1L How did you determine the figures listed as increasing proficiency and/or fluency? (note to
evaluator: see ADR #s 6‐9)
8.2L Status of language prior to the project (evaluator: pre‐fill from application)
8.2.1L Describe the current status of the language.
ENVIRONMENTAL
8.1ERE What was the main focus of your project?(Check all that apply)
(Evaluator: Pre‐fill and verify during visit)
Data collection to establish baseline
Data collection to monitor condition or trend
Develop/implement management systems (GIS, enforcement)
Develop regulations
Develop Tribal Environmental Protection Act (TEPA)
Environmental education
Staff training/development
Obtain funding from the Environmental Protection Agency
Other
8.2ERE Did you use EPA or other federal funds to meet your non‐federal share for this grant?
Yes – EPA
Yes – Other federal agency (please specify)
No
Was not aware this is allowed
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
8.3ERE Does your Tribe/organization receive funding from EPA, US Forest Service, or US Fish and
Wildlife?
EPA
US Forest Service
US Fish and Wildlife
No
Unknown
8.3.1ERE If yes, what is it used for? How does your ANA ERE grant fit in with this funding?
SUSTAINABLE EMPLOYMENT AND ECONOMIC DEVELOPMENT STRATEGIES
8.1SEEDS E Does the project track financial behavior of its beneficiaries?
Yes o
No o
Comments:
8.1.1 Does the project have a partnership with or access to public assistance services? If so, who are the
partners?
Yes o
No o
Comments:
8.1.2SEEDS E (if so) Has there been a change in project participants use of public assistance programs
since the beginning of the project? If so, which ones?
Yes o
No o
Comments:
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
8.1.3SEEDS E Do you track information on secondary beneficiaries? If yes, how many secondary
beneficiaries are you aware of?
Yes o
No o
Comments:
What information do you track on secondary beneficiaries?
Comments:
Please allow two secondary beneficiaries to describe the benefits they received as a result of this
project.
Comments:
8.1.4SEEDS E Local median income (evaluator prefill from census data, and confirm on‐site)
8.2 SEEDS E Did anyone obtain other employment as a result of this project?
Yes o
No o
Comments:
8.3 SEEDS E (beneficiaries) Has this project been able to improve economic resiliency? If yes, how so?
Yes o
No o
Comments:
8.4 SEEDS E If training was an aspect of this project, how many of the trainees are employed?
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
8.4.1 SEEDS E Of those employed, how many are in positions in the industry as a result of their training?
8.4.2 SEEDS E Are trainings going to continue and if not how will you sustain the benefits of training?
Yes o
No o
Comments:
8.4.3 SEEDS E As a result of training, did individuals receive certifications in that industry? If so, how
many?
Yes o
No o
Comments:
8.4.4 SEEDS E If individuals received a certification, did that enable them to increase their wages and job
security?
Comments:
8.5 SEEDS E Employment Information
8.5.1Number of men employed?
Number of women employed?
Number of employed ages 16‐24?
Number of employed ages 25+?
Number temporary or seasonal?
8.1SEEDS B Business Ownership
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
8.1.1SEEDS B Are any businesses created women owned? If so, how many?
8.1.2SEEDS B Are any businesses created veteran owned? If so, how many?
8.2SEEDS B Business Expansion (evaluator prefill nature of expansion)
8.2.1SEEDS B
Met
Did not meet
Exceeded
Comments:
8.3 Revenue/profit generated annually
Revenue
Profit
Year 1
Year 2
Year 3
Year 4
Year 5
8.4SEEDS B Which of these organizations exist in your local community?
o Local chamber of commerce
o Small Business Association
o Tribal incorporation
o Bank
o Credit Union
o Community Development Financial Institution
Comments:
8.5SEEDS Of the businesses created, were any a member of those organizations?
o Local chamber of commerce
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
o Small Business Association
o Tribal incorporation
o Bank
o Credit Union
o Community Development Financial Institution
Comments:
8.6 SEEDS B Have jobs been created as a result of this business creation/expansion? If so, how many?
Yes o
No o
Comments:
8.7 SEEDS B Other investment
8.7.2 Are there other governmental funding contributing to business creation/development? If so, which
ones?
Yes o
No o
Comments:
NATIVE ASSET BUILDING INITIATIVE
8.1 NABI How was the experience managing a project that consists of two separate awards across two
program areas?
Comments:
8.2 NABI Tell us about your experience with ANA’s TTA providers. Tell us about your experience with
OCS’s TTA providers.
8.2.1 NABI Which experience did you find most helpful and why?
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
Comments:
8.3 NABI How was the experience of managing two budgets?
Comments:
8.4 NABI How did you adapt to community and cultural needs throughout the program?
Comments:
[LIST TOOLS FROM OTHER REPORTS/OPEN ENDED LIST]
8.5 NABI How did you monitor for quality and effectiveness of financial education trainings? How did
you monitor the relevance to participants and assess what they learned?
Comments:
8.6 NABI Has this project affected your organization or community’s ability to offer financial services?
Yes o
No o
If yes, how so?
8.7 NABI Has documenting earned income changed participants’ financial behavior?
Yes o
No o
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
If yes, how so?
8.8 NABI Were there limitations on infrastructure in the local community that affected the participants’
abilities to purchase an asset?
Yes o
No o
If yes, please describe.
8.9 NABI What are the most common reasons why individuals choose to not enroll in the program or
finish the program?
Comments:
8.10 NABI Of the individuals who attended trainings and did not go on to further participate, what were
the reasons?
Comments:
8.11 NABI What model of training and frequency was the most successful?
Comments:
8.12 NABI Do you intend to continue to offer IDAs? If yes, where will you obtain funding to continue?
Yes o
No o
If yes, how so?
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
8.13 NABI Did this NABI program prepare you to apply for other IDA funding?
Yes o
No o
If so, how did you find your partners?
8.14 NABI How many participants were successful in obtaining their initial goal? Please allow two
beneficiaries to answer this question.
Comments:
8.15 NABI How did you encourage participants to follow through with the process? Were there external
factors that also helped?
Comments:
8.16 NABI Were multigenerational interactions encouraged?
Yes o
No o
What were the outcomes?
8.17 NABI If youth were involved?
Yes o
No o
What were the outcomes?
8.15 NABI Participant Information
Number of men participating?
OMB Control No: 0970‐0379
Expiration date: 08/31/2016
Number of women participating?
Number of participating ages 16‐24?
Number of participating ages 25+?
9. Project Specific
Question for Grantee (Evaluator: Include any project‐specific questions for the grantee and community
members here. These should be developed before the site visit and based upon your review of the grant
file).
Question
Answer
File Type | application/pdf |
File Title | Microsoft Word - 2016 Tool Revisions - OMB Clearance030916.docx |
Author | Amy.Sagalkin |
File Modified | 2016-03-10 |
File Created | 2016-03-10 |