Form 1 DD Council PPR

ANNUAL PROGRAM PERFORMANCE REPORT TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
OVERVIEW:
This template incorporates new information being requested as part of the Program Performance Report
(PPR) comprehensive reporting. It includes the following sections:

Section
I.
II.
III.
IV.
V.
VI.

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Area
Identification
Comprehensive Review and Analysis (CRA)
State Plan Implementation
Progress Report
Council Financial Information
Measures of Collaboration

DRAFT –June 2016 - PPR Reporting Template

Note: Section numbers and minor section title changes may occur

ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
ANNUAL PROGRAM PERFORMANCE REPORT (PPR)
SECTION I: IDENTIFICATION
PURPOSE: To provide identifying information of the reporting Council

1. State/Territory:
2. Federal Fiscal Year Reporting: October 1, 20___ through September 30, 20___
3. Contact person regarding PPR information:
4. Contact person’s phone number:
5. Contact person’s e-mail address:
6. Executive Director name (if different from contact person):
7. Executive Director’s phone number:
8. Executive Director’s email address:

SECTION II: COMPREHENSIVE REVIEW AND ANALYSIS

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
PURPOSE : To provide an update to the Comprehensive Review and Analysis

Comprehensive Review and Analysis- Update- [Section 124(C)(3)]
The DD Act requires the following annual descriptions:
 adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in
Intermediate Care Facilities (ICF) receive;
 adequacy of health care and other services, supports, and assistance that individuals with developmental disabilities served
through home and community-based waivers receive;
AIDD interprets this as annual updates to:
 adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in
Intermediate Care Facilities receive; (ICF updates)
 adequacy of health care and other services, supports, and assistance that individuals with developmental disabilities served
through home and community-based waivers (HCBW) receive; (HCBW updates)
 And other sections that apply (e.g.: state information, portrait of state services, analysis of state issues and challenges, rational for
goal selection, collaboration).
 Federal and state initiatives impacting people with DD and their families in the State/Territory
Note: (*)- Adequacy may be described in terms of quality and/or populations served versus need.

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
SECTION III: STATE PLAN IMPLEMENTATION
PURPOSE: To provide the context of what will be reported in the PPR. Section III is comprised of 3 reporting areas: (A) Introduction; (B) evaluation
of state plan implementation; (C) Input on National Priorities

A. Introduction
In this section provide an executive summary with cohesive information that provides an overview of the report including, but
not limited to the following: (1) targeted areas of emphasis, (2) strategies used to implement activities; (3) significant
accomplishments and/or barriers to state plan implementation; (4) needs requiring state plan amendments
Note: detailed information will be provided below in Section IV
Cultural Diversity
Describe the Council’s overall efforts to address the needs of individuals with developmental disabilities and their families of a
diverse culture through its state plan supported activities.

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
B. Evaluation of State Plan Implementation [Section 125(c) (5) and (c)(7)]
In this section report on the evaluation activities conducted and results. The report should include:
B1. Evaluation Activities
Describe the evaluation activities undertaken during the fiscal year being reported, including evaluation activities conducted
to strategically assess the overall progress and direction of the state plan implementation
B2. Evaluation Results
Report the broad results of the evaluation activities described above (B1), including a broad assessment of the overall
progress of Council supported activities.
B3. Lessons Learned and Future work of the Council
Report on how the Council will use lessons learned from state plan implementation and the data gathered from the evaluation
activities to move forward the work of the Council?
C. Input on National Priorities

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
SECTION IV: STATE PLAN IMPLEMENTATION PROGRESS REPORT
Section IV.A. Detailed Progress Report on Goals
Goal #1: Goal statement would be taken directly from State Plan
Area(s) of Emphasis:
Area of Emphasis

Planned for this goal
Taken directly from State Plan;
areas checked off

Areas addressed
To be completed annually; Council
checks off Areas

Quality Assurance
Education and Early Intervention
Child Care
Health
Employment
Housing
Transportation
Recreation
Formal and Informal Community Supports

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES

Strategies:
**Strategies
** As identified in Section 125 (c)(5)(A-L) of the
Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (PL 106-402)

Planned for this goal
Taken directly from State
Plan; strategies checked off

Strategies Used
To be completed annually;
Council checks off Strategies
Used

Outreach
Training
Technical Assistance
Supporting and Educating Communities
Interagency Collaboration and Coordination
Coordination with Related Councils,
Committees and Programs
Barrier Elimination
Systems Design and Redesign
Coalition Development and Citizen
Participation
Informing Policymakers
Demonstration of New Approaches to Services
and Supports
Demonstration of projects and activities
Other Activities

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
Intermediaries/Collaborators:
Collaborators
Definition of collaborator: someone who works
with another person or group in order to achieve
or do something

Planned for this goal
Taken directly from State Plan;
Collaborators checked off as
planned

Actual
To be completed annually; Council
checks off planned Collaborators
who actually participated or adds
collaborators not previously
planned.

State Protection and Advocacy System
University Center(s)
State DD agency
Other:
Other:
Other:

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
1.
2.
3.

Goal # 1:
State Plan Objective 1:
Check the appropriate box for each of the questions below:
This Objective is:
Individual & Family Advocacy

4.

Capacity Building

This Objective is:
New

5.

System Change

Ongoing

Completed

This Objective is:
a. Fulfilling the Self-Advocacy DD Act Requirement
b. Targeted Disparity

Yes

c. DD Network Collaboration

Yes

No

No
Yes

No

d. A demonstration project of New Approaches to Services and Supports
original start date for this effort: name of project; mm/yy
e. A demonstration of projects or activities
effort: name of project/ mm/yy
6.

Yes

Yes

No , If Yes, Indicate project name and

No, If Yes, indicate project or activity name and original start date for this

Stage of Implementation for systems change activities :
planning

implementation

outcome/fully integrated

Background/Context
7.
Provide an overall description of this objective:
The description should at a minimum provide background information on the objective to establish a context for the activities.

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
Goal # 1
8.

Objective # 1 :

Expected Outputs
List expected outputs from annual work plan

1.
2.
3.

9.

Outputs Achieved
List outputs achieved

1.
2.
3.
Progress Report
10.





The report should include the following:
A narrative progress report that cohesively describes the activities that were implemented toward achieving the objective, including how
the identified strategy was used, how the activity was implemented, challenges to achieving the objective and unexpected benefits.
For system change activities, include a description of the stage of implementation (planning, initiation, implementation, outcome/fully
integrated) of the system change initiative.
All narratives must describe what numbers make up the performance measures number for the activities being reported in the narrative.
A summary of evaluation activities to monitor progress and impact of council supported activities for the objective; data collected during
the year, data sources, and data collection methods; (logic model and evaluation plan may be attached to the report).

11.

Expected Outcomes (matches the expected outcomes
12.
Outcomes achieved
from the annual work plan as it relates to the objective)
List the expected outcomes for the activities described for the
objective from the annual work plan
13.
Progress towards achieving outcomes for overall objective :
The annual report should include an assessment as to the extent to which progress was made on the intended outcomes for the objective.
14.
Additionally, include stories of culturally diverse people with developmental disabilities whose lives are better because of Council work on
this activity (e.g., became better advocates for themselves and others, became more connected to the community). Stories of policy or
legislative changes that happened as a result of Council individual advocacy work that are likely to positively impact the lives of people with
developmental disabilities or that will prevent a potential negative impact (e.g., created deleted, refined programs and/or legislation,
reallocated use of funds, organizational systems change as a result of evidence based practices).

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
Repeat this page for each goal and objectives as necessary for the individual Council’s 5 year state plan
2. Goal # Narrative
In this section, for each goal reported for this reporting period, provide an overall cohesive description of:
•
•
•
•

the extent to which progress is being made in achieving the intended outcomes of the Goal for the reporting
year;
the extent to which each goal was or was not achieved for the reporting year;
where applicable, factors that impeded goal achievement for the reporting year
needs that require substantive state plan amendment (goal only)

4 Year Overview (FY 2020)
A description of how the Council will use and build from knowledge gained and progress made to move forward in the next
state plan cycle (FY 2022-2026).
5 Year Overview (FY2021)
For the final PPR (FY2021) of this state plan cycle, provide an overall analysis of the outcomes achieved during the five year
state plan cycle. The description should include the extent to which diverse stakeholders are satisfied with council activities
that promote self-determination and community participation for individuals with disabilities and families, results of other
types of information gathering such as focus groups, surveys, or other feedback or input methods with individuals with
developmental disabilities and families and major accomplishments and factors impeding goal achievement (if applicable)

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
Section IV.B. Individual & Family Advocacy Performance Measure (By GOAL)
Individual Responses (individuals with DD and Family members only)
Demographic Data **
**This is an aggregated number from all individual responses collected for the reporting FFY

Race/Ethnicity
White, alone
Black or African American alone
American Indian and Alaska Native
alone
Hispanic/Latino
Asian alone
Native Hawaiian & Other Pacific
Islander alone
Two or more races
Race unknown

#

%

Gender
Female
Male
Other

Category

#

Individual with DD

This is IFA1.1

Family Member

This is IFA 1.2

#

%

%

Geographical
Urban
Rural

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
I.

Output Measures

Objective #

Performance Measure

Performance Measure

IFA 1.1
The number of people with developmental
disabilities who participated in Council
supported activities designed to increase
their knowledge of how to take part in
decisions that affect their lives, the lives of
others, and/or systems

IFA 1.2
The number of family members who
participated in Council supported in
activities designed to increase their
knowledge of how to take part in decisions
that affect the family, the lives of others,
and/or systems

1. Specify Objective #
2. Specify Objective #
3. Specify Objective #
4. Add additional lines as
needed
Denominator:
TOTAL # of Output Respondents:

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
II.
Outcome Measures
Performance Measures
IFA 2.1
After participation in Council supported activities, the percent of people with developmental
disabilities who report increasing their advocacy as a result of Council work.

Percent (%)

IFA 2.2
After participation in Council supported activities, the percent of families who report
increasing their advocacy as a result of Council work.
Sub- Outcome Measures

The number (#) of people who are better able to say
what they want/say what is important to them

Projects

1. Specify Objective #
2. Specify Objective #
3. Add additional lines as needed
Total # of Sub-Outcome Respondents:

IFA 2.3
The percent of people who are better able to say what they want or say what services and supports
they want or say what is important to them

#
People with
developmental
disabilities

#
Family
Members

#
#

#
#

#
#
Total sub-outcome # /
IFA 1.1 total = X%

#
#
Total suboutcome # / IFA
1.2 total = X%

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES

Sub- Outcome Measures

The number (#) of people who are participating in
advocacy activities

Projects

#
People with
developmental
disabilities

1. Specify Objective #
2. Specify Objective #
3. Add additional lines as needed
Total # of Sub-Outcome Respondents:

IFA 2.4
The percentage (%) of people who are participating now in advocacy activities

Sub- Outcome Measures

The number (#) of people who are on cross disability
coalitions, policy boards, advisory boards, governing
bodies and/or serving in leadership positions.

#
#

#
#

#
#
Total sub-outcome # /
IFA 1.1 total = X%

#
#
Total suboutcome # / IFA
1.2 total = X%

Projects

#
People with
developmental
disabilities

1. Specify Objective #
2. Specify Objective #
3. Add additional lines as needed
Total # of Sub-Outcome Respondents:

IFA 2.5
The percent of people who are on cross disability coalitions, policy boards, advisory boards, governing
bodies and/or serving in leadership positions.

#
Family
Members

#
Family Members

#
#
#
#

#
#
#
#

Total sub-outcome #
/ IFA 1.1 total = X%

Total sub-outcome
# / IFA 1.2 total =
X%

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
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IFA 3 The percent of people satisfied with a project activity
IFA 3.1 The percentage (%) of people with developmental disabilities who are satisfied with a
project activity
IFA 3.2 The percentage (%) of family members satisfied with a project activity

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
Section IV.C. System Change Performance Measures (By Goal)
SC 1: Output Measures
The number of Council efforts to transform fragmented approaches into a coordinated and effective system that assures
individuals with developmental disabilities and their families participate in the design of and have access to needed
community services, individualized supports, and other forms of assistance that promote self-determination, independence,
productivity, and integration and inclusion in all facets of community life.
Objective
1. Specify Objective #
2. Specify Objective #
3. Specify Objective #
4. Specify Objective #

SC 1.1 The number of policy and/or procedure created or changed

Objective
1, Specify Objective #
2. Specify Objective #
3. Specify Objective #
4. Specify Objective #

SC 1.2 The number of statute and/or regulations created or changed

Objective

SC 1.3 The number of promising and/or best practices created and/or supported
SC 1.3.1 The number of promising practices created
SC 1.3.2 The number of promising practices supported through Council activities

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
SC 1.3.3. The number of best practices created
SC 1.3.4 The number of best practices supported through Council activities
1.
2.
3.
4.

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

Objective
1.
2.
3.
4.

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

Objective
1.
2.
3.
4.

SC 1.4 The number of people trained or educated through Council systemic change
initiatives

SC 1.5 The number of Council supported systems change activities with organizations
actively involved

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

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FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
Systems Change SC 2: Outcome Measures
Outcome Measures
SC 2.1
The number of Council efforts that led to the creation or improvement of best or promising practices,
policies, procedures, statute or regulation changes. (sub-measures 2.1.1; 2.1.3)

Number (#)

SC 2.2
The number of Council efforts that were implemented to transform fragmented approaches into a
coordinated and effective system that assures individuals with developmental disabilities and their
families participate in the design of and have access to needed community services, individualized
supports, and other forms of assistance that promote self-determination, independence, productivity, and
integration and inclusion in all facets of community life. (sub-measures 2.1.2; 2.14)

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
III. Sub-Outcome Measures
Objective

1.
2.
3.
4.

SC 2.1.1
# of policy, procedure, statute
or regulation changes improved
as a result of systems change.

SC 2.1.2
# Policy, procedure, statute or
regulation changes implemented.

SC 2.1.3
# of promising and/or best
practices improved as a result
of systems change activities.

SC 2.1.4
# of promising and/or best practices
implemented

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

Objective

1.
2.
3.
4.

SC 2: Sub outcome measures

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES

Additional goal/objective reporting fields would be created
based on the individual Council’s 5-year state plan.

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
SECTION V: COUNCIL Financial Information [Section 124(c)(5)(B) and 125(c)(8)]
Council is its own DSA: ____Yes

____No

Fiscal Information for Programmatic Purposes ONLY
Purpose: In this section, Councils are to identify the obligation and liquidation status for the 3 FFY of funds
1.
2.
3.
4.
5.
6.
7.
8.

Fiscal Year
Reporting Period
Total Federal Fiscal Award for Reporting Year
State Funds Contributing to Council State Plan Activities
Additional Council Funds Used for Other Activities
Federal Share of Expenditures
Federal Share of Unliquidated Obligations
Unliquidated Balance of Federal Funds (=Total Federal Fiscal Year Award –
Federal Share of expenditures – Federal Share of unliquidated obligations
9. Match Required
10. Match Met
11. Match Unmet

YR
MM/DD/YR - MM/DD/YR
$
$
$
$
$
$
$
$
$

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
1.
2.
3.
4.
5.
6.
7.
8.

Fiscal Year
Reporting Period
Total Federal Fiscal Award for Reporting Year
State Funds Contributing to Council State Plan Activities
Additional Council Funds Used for Other Activities
Federal Share of Expenditures
Federal Share of Unliquidated Obligations
Unobligated Balance of Federal Funds (=Total Federal Fiscal Year Award –
Federal Share of expenditures – Federal Share of unliquidated obligations)
9. Match Required
10. Match Met
11. Match Unmet

YR
MM/DD/YR - MM/DD/YR
$
$
$
$
$
$

Fiscal Year
1. Reporting Period
2. Total Federal Fiscal Award for Reporting Year
3. State Funds Contributing to Council State Plan Activities
4. Additional Council Funds Used for Other Activities
5. Federal Share of Expenditures
6. Federal Share of Unliquidated Obligations
7. Unobligated Balance of Federal Funds (=Total Federal Fiscal Year Award –
Federal Share of expenditures – Federal Share of unliquidated obligations)
8. Match Required
9. Match Met
10. Match Unmet

YR
MM/DD/YR - MM/DD/YR
$
$
$
$
$
$

$
$
$

Dollars leveraged for the reporting year being reported: $

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FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
SECTION VI: MEASURES OF COLLABORATION
Purpose: In this section, Councils are to discuss collaborative efforts with specific DD Network partners and other collaborators separate
from the planned DD Network Collaboration goal/objective.
1. Identify the critical issues/barriers affecting individuals with developmental disabilities and their families in your State that the
Council and the P&A, the Council and the UCEDD, the Council and other collaborators may have worked on during the reporting
period

2.

Identify the Area of Emphasis collaboratively addressed by the DD Council and Collaborators
Area of Emphasis [Check Applicable area(s) ]
1. 1. Quality Assurance
2. 2. Education and Early Intervention
3. 3. Child Care
4. 4. Health
5. 5. Employment
6. 6. Housing

8. Recreation
1. Quality of Life
2. Other- Assistive Technology
3. Other- Cultural Diversity
4. Other- Leadership
5. Other- please specify
14. Other- please specify

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1.

7. Transportation

15. Other- please specify

The report should include a narrative progress report that cohesively describes the activities that were implemented by the Council
and the P&A, the Council and the UCEDD, the Council and other collaborators.DD Network. For at least one of the issues/barriers
identified above describe:
(a) the issue/barrier;
(b) collaborative strategies to address issue/barrier and expected outcome(s);
(c) the DDC’s specific role and responsibilities in this collaborative effort. Include any technical assistance expertise DD Council staff
can provide to other States in this area;
(d) briefly identify problems encountered as a result of this collaboration, and technical assistance, if any, desired; and
(e) any unexpected benefits of this collaborative effort.

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