ICRC Indicators Data Collection
Progress Report for Injury Control Research Centers (ICRC)
Att 3a. ICRC Indicators Data Collectionm
ICRC Indicators Data Collection
OMB: 0920-1216
Injury Control Research Centers (ICRC) Indicators Data Collection 20XX
Form Approved
OMB No.: 0920-xxxx
Expiration Date: XX/XX/XXXX
Public Reporting burden of this collection of information is estimated at 10 hour 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 NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-XXXX).
Awardee
FOA Number
Instructions
Please refer to the companion ICRC indicator template guidance document for instructions on completing this template.
Navigation
3. Completed and Ongoing Studies
5. Academic Training, Mentoring, and Leadership
7. Research Tools Developed and Disseminated
8. Practice Tools Developed and Disseminated
1. ICRC Affiliated Personnel
Personnel supported with ICRC funding or ICRC affiliated personnel actively involved with the ICRC who worked on at least one ICRC project over the previous funding years.
See Excel attachment to complete Personnel information.
Number of ICRC Affiliated personnel receiving at least 50% support from non-ICRC sources (1000 Character Limit)
What example can you provide to best illustrate how the diversity of disciplines and departmental appointments of ICRC-affiliated personnel is a strength to the ICRC? (There is no character limit for this response)
What additional information do you want to provide about personnel (e.g., rationale for why a particular individual was considered to be ICRC-affiliated)? (There is no character limit for this response)
2. Funding from all Sources
Funding Amounts should be the total amount (direct and indirect) awarded from all sources, but only for the funding year.
Funding Source 1
Funding Amount per Source Source (255 Character Limit)
Funding Source 2
Funding Amount per Source Source (255 Character Limit)
Funding Source 3
Funding Amount per Source Source (255 Character Limit)
Funding Source 4
Funding Amount per Source Source (255 Character Limit)
Funding Source 5
Funding Amount per Source Source (255 Character Limit)
Funding Source 6
Funding Amount per Source Source (255 Character Limit)
Funding Source 7
Funding Amount per Source Source (255 Character Limit)
Funding Source 8
Funding Amount per Source Source (255 Character Limit)
Funding Source 9
Funding Amount per Source Source (255 Character Limit)
Funding Source 10
Funding Amount per Source Source (255 Character Limit)
Funding Source 11
Funding Amount per Source Source (255 Character Limit)
Funding Source 12
Funding Amount per Source Source (255 Character Limit)
Funding Source 13
Funding Amount per Source Source (255 Character Limit)
Funding Source 14
Funding Amount per Source Source (255 Character Limit)
Funding Source 15
Funding Amount per Source Source (255 Character Limit)
What example can you provide to best illustrate how CDC funding is leveraged to acquire additional funds? (1000 Character Limit)
What additional information do you want to provide (e.g., explanation of how a grant was stimulated by the ICRC)? (1000 Character Limit)
What percent of ICRC funding support comes from the CDC ICRC grant?
Select all types of funding support your ICRC receives (select all that apply):
Local Government
State Government
Other Federal Government
Foundation/Community Based Organization
Other Private Non-Profit Organization
Other Private for Profit Organization
University
Other
If "Other" please describe (500 Character Limit)
3. Completed and Ongoing Studies
Studies supported with ICRC funding
Study 1 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 2 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 3 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 4 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 5 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 6 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 7 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 8 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 9 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 10 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 11 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 12 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 13 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 14 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
Study 15 : CDC ICRC Funded Research Project
Study Title (500 Character Limit)
ICRC Personnel Involved (500 Character Limit)
Principal Investigator (255 Character Limit)
Partners Involved in Study (1000 Character Limit)
Project Start Date
Project End Date
Injury Topic Area: Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Brief Summary/Results (1000 Character Limit)
Year to Date Status, including milestones (1000 Character Limit)
Findings/Accomplishments (1000 Character Limit)
Significance of Findings/Accomplishments (1000 Character Limit)
Project Milestones for upcoming Budget year (1000 Character Limit)
Other Significant Information
Implications of Findings for Practice:
Plans for Use/Outreach of Study Findings
Please indicate if this study is an original approved study or a pilot (exploratory) study:
Type of Research or Evaluation (Select all that apply)
Surveillance
Basic Epidemiology
Risk/Protective Factor Research
Intervention Research
Translational Research
Implementation Research
Policy Research or Evaluation
Economic/Cost-Effectiveness Evaluation
Other
If "Other" please describe (500 Character Limit)
Level of Prevention
What additional information do you want to provide about completed and ongoing studies (e.g., cross-disciplinary nature of studies, innovative studies, how a study impacted the field, how studies related to your previous studies or planned future studies, etc.)? (There is no character limit for this response)
Other Significant Information
Describe any other proposed research-related objectives and activities for the budget year and any significant programmatic changes.
4. Publications
Note: Please ensure you do not report the DOI #
See Excel attachment to complete Publication information.
What information do you want to provide about publications authored by ICRC-affiliated personnel (e.g., cross-disciplinary nature of published work, an article that describes innovative work, how an article that impacted the field)? (There is no character limit for this response)
5. Academic Training, Mentoring, and Leadership
Completed during the reporting period
Number of injury courses offered with enrollment (Enter the number only)
Number of training grants (if any) obtained (Enter the number only)
Number of Bachelors level students (Enter the number only)
Number of Masters level students (Enter the number only)
Number of Doctoral students (Enter the number only)
Number of Post-doc fellows (Enter the number only)
Number of junior faculty mentored (Enter the number only)
Number of student research assistants supported through the center:
Bachelors (Enter the number only)
Masters (Enter the number only)
Doctoral (Enter the number only)
Student/fellow injury related research projects:
Number of projects (Enter the number only)
Total dollars provided (Enter the number only)
Injury-related faculty development awards:
Number of awards (Enter the number only)
Total dollars provided (Enter the number only)
What example(s) can you provide of ICRC-mentored students who went on to impact the field after leaving the institution?
Other Significant Information
Training and Education Core Milestone status and brief summary of progress to date
Project milestones for the upcoming year
Significant Programmatic changes
6. Outreach
Give the best 10 for which impact can be described
Outreach Activity 1
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 2
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 3
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 4
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 5
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 6
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 7
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 8
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 9
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
Outreach Activity 10
Type of outreach activity conducted (See outreach guidance for explanation of each category)
Partners Involved in Outreach Activity (1000 Character Limit):
Outreach Description/Impact (1000 Character Limit)
Injury topic addressed Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Intended audience (500 Character Limit)
Number of People Reached (Enter the number only)
What additional information do you want to provide about how these outreach activities relate to your ICRC's previous body of work and planned future endeavors? (1000 Character Limit)
Other Significant Information
Outreach Core Milestone status and brief summary of progress to date
Project milestones for the upcoming year
Significant Programmatic changes
7. Research Tools Developed and Disseminated
Research Tool 1
Tool Name (500 Character Limit)
Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)
Focus Area (e.g., topic area, category, etc.) (500 Character Limit)
Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Tool Description/Impact (1000 Character Limit)
Research Tool 2
Tool Name (500 Character Limit)
Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)
Focus Area (e.g., topic area, category, etc.) (500 Character Limit)
Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Tool Description/Impact (1000 Character Limit)
Research Tool 3
Tool Name (500 Character Limit)
Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)
Focus Area (e.g., topic area, category, etc.) (500 Character Limit)
Primary: Secondary: Tertiary:
If "Other" please describe (500 Character Limit)
Tool Description/Impact (1000 Character Limit)
What additional information do you want to provide about how these tools relate to your ICRC's previous body of work and planned future endeavors? (1000 Character Limit)
8. Practice Tools Developed and Disseminated
Practice Tool 1
Tool Name (500 Character Limit)
Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)
Focus Area (e.g., topic area, category, etc.) (500 Character Limit)
Tool Description/Impact (1000 Character Limit)
Practice Tool 2
Tool Name (500 Character Limit)
Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)
Focus Area (e.g., topic area, category, etc.) (500 Character Limit)
Tool Description/Impact (1000 Character Limit)
Practice Tool 3
Tool Name (500 Character Limit)
Partners Involved in Research Tool Development and Dissemination (1000 Character Limit)
Focus Area (e.g., topic area, category, etc.) (500 Character Limit)
Tool Description/Impact (1000 Character Limit)
What additional information do you want to provide about how these tools relate to your ICRC's previous body of work and planned future endeavors? (1000 Character Limit)
9. Narrative Story of Innovation and Impact
Provide a narrative description of the success and impact of your ICRC over the previous funding year. Give first consideration to CDC ICRC-funded activities or activities that support CDC Injury Focus Areas in this section
Additional PGO Requirements
Administrative Core milestone status and brief summary of progress to date
Administrative Core milestones for the upcoming year
Significant Programmatic changes
Please provide the following PGO requirements as noted in NOA terms and conditions if not addressed earlier:
1. A comparison of actual accomplishments to the goals established for the period;
2. Reasons for failure, if established goals were not met;
3. Other pertinent information including, when appropriate, analysis and explanation of performance costs are significantly higher than expected; and
4. Any additional information on the Administrative Core not addressed in previous sections.
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