Rape Prevention and Education Work Plan Tool - Word

Att._3a_Work_Plan_Tool_041416.docx

Monitoring and Reporting System for Rape Prevention and Education (RPE) Program Awardees

Rape Prevention and Education Work Plan Tool - Word

OMB: 0920-1130

Document [docx]
Download: docx | pdf

Attachment 3a— Work Plan Tool Word Version


Home Page

*denotes required field

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Public reporting burden of this collection of information is estimated to average 10 hours for the initial population of the tool and 3 hours for annual reporting 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).




Rape Prevention and Education (RPE)

Work Plan Tool


Select a state or territory.* [Drop Down Menu]

Alabama

Hawaii

Massachusetts

New Mexico

South Dakota

District of Columbia

Alaska

Idaho

Michigan

New York

Tennessee

Guam

Arizona

Illinois

Minnesota

North Carolina

Texas

Marianna Island

Arkansas

Indiana

Mississippi

North Dakota

Utah

Puerto Rico

California

Iowa

Missouri

Ohio

Vermont

Virgin Islands

Colorado

Kansas

Montana

Oklahoma

Virginia


Connecticut

Kentucky

Nebraska

Oregon

Washington


Delaware

Louisiana

Nevada

Pennsylvania

West Virginia


Florida

Maine

New Hampshire

Rhode Island

Wisconsin


Georgia

Maryland

New Jersey

South Carolina

Wyoming



Before You Begin

The goals of the RPE cooperative agreement (14-1401) are to improve the ability of RPE-funded organizations to use the public health approach and effective prevention principles to implement and evaluate sexual violence prevention strategies. The Work Plan Tool will capture key information on your goals, objectives and activities relating to the implementation and evaluation of sexual violence prevention strategies.


Instructions: Please use this Tool to prepare a work plan for the Rape Prevention and Education Program. For instructions on completing this Tool, please refer to the reporting guidance.


Submission: In addition to uploading it onto grants.gov for your continuation application, please submit the completed Tool with your Annual Performance Report to your Project Officer and {email address}


Technical Tips: You may navigate this Tool by clicking on the navigation menu (shown below) located at the top of each spreadsheet.


Shape1


Please enter information into the yellow fields. If you enter an invalid character in any field that is not open text, an error message box will pop up.


Questions and Support: If you have any content-related questions or need assistance, please contact your Project Officer. If you need technical support at any time, please send an email with a detailed description of your need to the following address: [email protected].


Component 1: Implementation and Program Evaluation of Sexual Violence (SV) Strategies Using a Public Health Approach

Awardees are able to add as objectives as needed. There will be fields for 5 goals listed under this component.


Goal #

[Open Text Field]


Annual Objective Number #.#

[Open Text Field]

What is the status of this objective?

[Status Drop Down Menu]

  • Not Yet Started

  • Scheduled

  • Ongoing

  • Complete

Activity Description

Responsible Party

Estimated Completion

Activity Progress Measure(s)

Status

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]


[Button: Add Objective] [Dynamic button that allows adding as many of objectives table with automatic numbering]


Please describe potential challenges and needed support for completing the activities within this goal. [Open Text Field]


  1. How are funds allocated to evaluate your prevention strategies?* [Closed options]

  • Evaluation is being implemented at the state level. Funds are allocated through the state-level budget. [Answer Q1a]

  • Evaluation is being implemented at the implementer (sub-awardee) level. Funds are allocated through the implementer’s budget. [Skip to Component 2]

  • Evaluation is being implemented at the prevention strategy level. Funds are allocated through the prevention strategy budget. [Skip to Component 2]

  • Not applicable, please explain: __________ [Open Text Field] [Skip to Component 2]


    1. How much funding is allocated through the state-level budget to evaluate your prevention strategies? Provide information in dollar amounts. [Open numeric field with two decimals]

$_____.___


Component 2: Provision of Training and TA to RPE-funded Organizations on the Implementation of SV Prevention

Awardees are able to add as objectives as needed. There will be fields for 5 goals listed under this component.


Goal 1



Annual Objective Number #.#

[Open Text Field]

What is the status of this objective?

[Status Drop Down Menu]

  • Not Yet Started

  • Scheduled

  • Ongoing

  • Complete

Activity Description

Responsible Party

Estimated Completion

Activity Progress Measure(s)

Status

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]

[Open Text Field]

[Open Text Field]

[Drop down menu]

[Month Year]

Optional field

[Status Drop Down Menu]


[Button: Add Objective] [Dynamic button that allows adding as many of objectives table with automatic numbering]


Please describe potential challenges and needed support for completing the activities within this goal. [Open Text Field]



Component 2: Participation in RPE Program Support Activities


Which of the following CDC-Sponsored program support activities will you participate in this year? (mark "x" or "as needed" for all that apply)

Program Support Activity

Select all that apply

Description of participation (Optional)

Annual RPE Leadership Training

[Drop Down Menu]

  • X

  • As Needed

[Open Text Field]

CDC site visit or reverse site visit

[Drop Down Menu]

[Open Text Field]

E-Learning Collaborative (Peer Learning Forums) on SV prevention and/or evaluation (facilitated by PreventConnect)

[Drop Down Menu]

[Open Text Field]

State-specific training or TA from NSVRC

[Drop Down Menu]

[Open Text Field]


[Button: Add Objective] [Dynamic button that allows adding as many of rows as necessary


Attachment 3a— Work Plan Tool: Word Version 5

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorLinda Vo-Green;Pari Chowdhary
File Modified0000-00-00
File Created2021-01-22

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