Participants reach

OMB Approval # 0990-0XXX

Expiration Date: XX/XX/2018

Questions at Program-Level

Reach Demographics

• How many youth participated in your program for at least one activity in the past program year?

  • Sex – Male, Female

  • Age – 10 or younger, 11, 12, 13, 14, 15, 16, 17, 18, 19 or older

  • Grade – 6 or less, 7, 8, 9, 10, 11, 12, GED program, Technical/vocational training/college, Ungraded, Not currently in school

  • Ethnicity – Hispanic or Latino, Not Hispanic or Latino, Unknown/unreported

  • Race (check all that apply) – American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White, Unknown/unreported

• How many parents or other clients participated in your program for at least one activity in the past program year?

The performance measures concerning youth to be reported to the agency (and to Congress) will be obtained by summing the responses to the each of the demographic characteristics (i.e., gender, age, grade, race, ethnicity questions across grantee types and tiers.

The performance measures concerning other clients served to be reported to the agency (and to congress) will be obtained by summing responses to these two questions across grantee types and tiers.

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 0990-0XXX. The time required to complete this information collection is estimated to average 2.8 hours per response, 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.