Category 1 Measures (4 Measures)

Pregnancy Assistance Fund (PAF) Performance Measures Collection

0990-0416_Renewal_Attachement C Forms_Category1 Grantees_PAF PM Renewal_0990_0416

Category 1 Measures (4 Measures)

OMB: 0990-0416

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OMB #: 0990-0416

Exp Date: xx/xx/xxxx


Attachment C: Form for Grantees implementing Programs in Category 1


Category 1 Grantee Programs Only: (Grantees Working with Institutions of Higher Education (IHEs)).


1.0 How many eligible participants received at least one activity? Indicate the total number in each category below. (REVISED, formerly measure 0.01)


a) Expectant female teens (19 years and younger)

b) Expectant male teens (19 years and younger)

c) Parenting teen mothers (19 years and younger )

d) Parenting teen fathers (19 years and younger )

e) Expectant women (20 years and older)

f) Expectant men (20 years and older )

g) Parenting women (20 years and older)

h) Parenting men (20 years and older )

i) Children (of expectant or parenting participants [reported in a to h] above)

1.1 How many expectant and parenting IHE student participants does the program serve?

Indicate the number for each category below.

a) Vocational/Technical School (Nursing certification, computer certification, etc.)

b) Community College

c) 4 year College or University

d) Other

1.2 How many expectant and parenting IHE student participants graduated from the IHE?

Indicate the number for each category below.

a) Vocational/Technical School (Nursing certification, computer certification, etc.)

b) Community College

c) 4 year College or University

d) Other


1.3 How many expectant and parenting IHE student participants are enrolled in the next semester or quarter of classes?

Indicate the number for each category below.

a) Vocational/Technical School (Nursing certification, computer certification, etc.)

b) Community College

c) 4 year College or University

d) Other

1.4 How many parenting IHE student participants 19 years and younger reported a new pregnancy during the program year?

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0416. The time required to complete this information collection is estimated to average 6 hours per respondent, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

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AuthorTara Rice
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File Created2021-01-22

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