One PPR Template

AIDD PROPOSED VERSION 06.29.2018

ONE PPR

Annual Program Performance Report (PPR)

Annual Statement of Goals and Priorities (SGP)

PADD

PAAT

PATBI

PAVA

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 128 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (P.L. 105-220 Section 410 Workforce Investment Act). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Administration for Community Living, U.S. Department of Health and Human Services, 330 C Street, SW, Washington, DC 20201-0008, Attention Ophelia McLain, or email [email protected] and reference the OMB Control Numbers for the four annual reports, i.e., (1) Developmental Disabilities Protection and Advocacy Systems Program Performance Report (0985-0027), (2) Protection and Advocacy for Assistive Technology (PAAT) Program Performance Report (0985-0046); (3) Protection and Advocacy Voting Access Annual Report (Help America Vote Act (HAVA) (0985-0028); Protection and Advocacy Systems (P&A) Annual Narrative Report (0970-0326) and (4) Protection and Advocacy for Traumatic Brain Injury (PATBI) Program Performance Report (0985-0058). Note: Please do not return the completed Program Performance Report to this address.

Part 1: Demographics

Interventions on behalf of Individuals

The following subsections include demographic information for the seven intervention strategy types listed in Part I.F.

A. Individuals Served
What to Count					PADD		PAAT		PATBI		PAVA
1. Individuals served as of October 1 (Carried over from previous FY).					X		X		X		X
2. Additional individuals served during the year.					X		X		X		X
3. Total individuals served during the year (Add lines A1 and A2).					X		X		X		X
4. Individuals with more than one (1) intervention opened/closed FY.					X		X		X		X
5. Individuals served as of September 30 (Carry over to next FY; ≤ A3).					X		X		X		X
B. Problem Areas/Complaints of Individuals Served
Problem Area/Complaint					PADD		PAAT		PATBI		PAVA
1. Abuse (total)					X		X		X
1. Inappropriate Use of Restraint & Seclusion					X				X
2. Involuntary Treatment					X				X
3. Physical, Verbal, & Sexual Assault					X				X
4. Excessive Medication					X				X
5. Financial Exploitation					X				X
6. Other					X				X
2. Access to Administrative or Judicial Processes					X		X		X		X
3. Access to Records					X				X
4. Advance Directives					X				X
5. Architectural Accessibility					X		X		X
6. Assistive Technology Device Procurement					X		X		X
1. Augmentative Communication Devices					X		X		X
2. Durable Medical Equipment					X		X		X
3. Vehicle Modification/Transportation					X		X		X
4. Other Device					X		X		X
7. Aversives (including ECT)					X		X		X
8. Civil Commitment					X				X
9. Criminal Justice					X				X
10. Custody/Parental Rights					X				X
11. Education (total)					X		X		X
1. FAPE: IEP/IFSP Planning/Development/Implementation					X		X		X
2. FAPE: Discipline/Procedural Safeguards					X		X		X
3. FAPE: Eligibility					X		X		X
4. FAPE: Least Restrictive Environment					X		X		X
5. FAPE: Multi-disciplinary Evaluation/Assessments					X		X		X
6. FAPE: Transition Services					X		X		X
7. Other					X		X		X
12. Employment Discrimination (total)					X		X		X
1. Benefits					X		X		X
2. Hiring/Termination					X		X		X
3. Reasonable Accommodations					X		X		X
4. Service Provider Issues					X		X		X
5. Supported Employment					X		X		X
6. Wage and Hour Issues					X		X		X
7. Other					X		X		X
13. Employment Preparation					X		X		X
14. Financial Benefits (total)					X		X		X
1. SSDI Work Incentives					X		X		X
2. SSI Eligibility					X		X		X
3. SSI Work Incentives					X		X		X
4. Social Security Benefits Cessation					X				X
5. Work Related Overpayments					X		X		X
6. Welfare Reform					X		X		X
7. Other Financial Entitlements					X		X		X
15. Forensic Commitment					X				X
16. Government Benefits/Services					X		X		X
17. Guardianship/Conservatorship/Substitute Decision Maker					X		X		X		X
18. Home & Community Based Services including Discharge Planning Transition Follow-up					X		X		X
19. Healthcare (total)					X		X		X
1. General Healthcare					X		X		X
2. Medicaid					X		X		X
3. Medicare					X		X		X
4. Private Medical Insurance					X		X		X
5. Other					X		X		X
20. Housing (total)					X		X		X
1. Accommodations					X		X		X
2. Architectural Barriers					X		X		X
3. Landlord/Tenant					X		X		X
4. Modifications					X		X		X
5. Rental Denial/Termination					X		X		X
6. Sales/Contracts/Ownership					X		X		X
7. Subsidized Housing/Section 8					X		X		X
8. Zoning/Restrictive Covenants					X		X		X
9. Other					X		X		X
21. Immigration					X		X		X
22. Juvenile Justice					X		X		X
23. Neglect (total)					X		X		X
1. Failure to Provide Necessary or Appropriate Medical Treatment					X		X		X
2. Failure to Provide Necessary or Appropriate Mental Health Treatment					X		X		X
3. Failure to Provide Necessary or Appropriate Personal Care & Safety					X		X		X
d). Other					X		X		X
24. Post-Secondary Education					X		X		X
25. Non-Medical Insurance					X		X		X
26. Privacy Rights					X		X		X
27. Public Accommodations					X		X		X
28. Rehabilitation Services (total)					X		X		X
1. Communications Problems (Individuals/Counselor)					X		X		X
2. Conflict About Services To Be Provided					X		X		X
3. Individual Request Information					X		X		X
4. Non-Rehabilitation Act					X		X		X
5. Private Providers					X		X		X
6. Related to Application/Eligibility Process					X		X		X
7. Related to IPE Development/Implementation					X		X		X
8. Related to Title I of ADA					X		X		X
9. Other Rehabilitation Act-related problems					X		X		X
29. Suspicious Death					X				X
30. Transportation (total)					X		X		X		X
1. Air Carrier					X		X		X		X
2. Paratransit					X		X		X		X
3. Public Transportation					X		X		X		X
4. Other					X		X		X		X
31. Unnecessary Institutionalization including identification and assessment					X		X		X
32. Voting (total)					X		X		X		X
1. Accessible Polling Place/Equipment					X		X		X		X
2. Registration to Vote					X		X		X		X
3. Casting a Ballot					X		X		X		X
4. Voter Eligibility/Competency Issues					X		X		X		X
5. Other Voting Issues					X		X		X		X
33. Other					X		X		X		X
C. Gender of Individuals Served
Gender					PADD		PAAT		PATBI		PAVA
1. Female					X		X		X		X
2. Male					X		X		X		X
TOTAL					X		X		X		X
D. Living Arrangements of Individuals Served
Living Arrangement					PADD		PAAT		PATBI		PAVA
1. Independent					X		X		X		X
2. Parental r Other Family Home					X		X		X		X
3. Community Residential Home for Children/Youth (0-18 Yrs.)					X		X		X		X
4. Community Residential Home for Adults					X		X		X		X
5. Non-Medical Community Based Residential Facility for Children and Youth					X		X		X		X
6. Foster Care					X		X		X		X
7. Nursing Homes, Including Skilled Nursing Facilities (SNF)					X		X		X		X
8. Intermediate Care Facilities (Icf)					X		X		X		X
9. Public And Private General Hospitals including Emergency Rooms					X		X		X		X
10. Public Institutional Living Arrangement					X		X		X		X
11. Private Institutional Living Arrangement					X		X		X		X
12. Psychiatric Wards (Public Or Private)					X		X		X		X
13. Jail					X		X		X		X
14. State Prison					X		X		X		X
15. Federal Detention Center					X		X		X		X
16. Federal Prison					X		X		X		X
17. Veterans Administration Hospital/Clinic					X		X		X		X
18. Other Federal Facility					X		X		X		X
19. Homeless					X		X		X		X
20. Unknown					X		X		X		X
TOTAL					X		X		X		X
E. Reasons for Closing Individual Intervention Files
Reasons for Closing Individual Advocacy Case File					PADD		PAAT		PATBI		PAVA
1. Number of Closed Cases in which Client’s Objective Was Partially or Fully Met					X		X		X		X
2. Some Issues Resolved in Client’s Favor					X		X		X		X
3. Other Representation Found					X		X		X		X
4. Individual Withdrew Complaint					X		X		X		X
5. Services Were Not Needed Due To Client’s Death or Relocation					X		X		X		X
6. P&A Withdrew Because Individual or Client Would Not Cooperate					X		X		X		X
7. Individual’s Case Lacked Merit					X		X		X		X
8. Individual’s Issue Not Favorably Resolved					X		X		X		X
9. Appeal(s) Unsuccessful							X		X		X
Reason for Closing Individual Investigation File					PADD		PAAT		PATBI		PAVA
1.      Complaint was Withdrawn					X		X		X
2.      Other Appropriate Entity Investigating					X		X		X
3.      P&A withdrew because Individual or Client Would Not Cooperate					X		X		X
4.      Investigation completed					X		X		X
TOTAL					X		X		X
Individual Advocacy Service					PADD	PAAT		PATBI		PAVA
1. Self-Advocacy Assistance					X	X		X		X
2. Limited Advocacy					X	X		X		X
3. Administrative Remedies					X	X		X		X
4. Negotiation					X	X		X		X
5. Mediation/Alternative Dispute Resolution					X	X		X		X
6. Litigation					X	X		X
TOTAL (1-6)					X	X		X
Individual Investigation Service
7. Individual Investigation					X	x		X
TOTAL (1-7)					X	X		X
G. Age Range of Individuals Served
Range					PADD	PAAT		PATBI		PAVA
1. 0 – 2					X	X		X
2. 3 – 5					X	X		X
3. 6 – 10					X	X		X
4. 11 – 22					X	X		X		X
5. 23 – 64					X	X		X		X
6. 65 & Over					X	X		X		X
TOTAL					X	X		X		X
H. Primary Disability of Individuals Served
Primary Disability					PADD	PAAT		PATBI		PAVA
1.      Absence of Extremities					X	X				X
2.      Acquired Brain Injury					X	X				X
3.      ADD/ADHD					X	X				X
4.      AIDS/HIV Positive					X	X				X
5.      All Other Disabilities					X	X				X
6.      Autism					X	X				X
7.      Auto-immune (non-AIDS/HIV)					X	X				X
8.      Blindness (Both Eyes)					X	X				X
9.      Cancer					X	X				X
10.  Cerebral Palsy					X	X				X
11.  Deafness					X	X				X
12.  Deaf-Blind					X	X				X
13.  Diabetes					X	X				X
14.  Digestive Disorders					X	X				X
15.  Epilepsy					X	X				X
16.  Genitourinary Conditions					X	X				X
17.  Hearing Impaired (Not Deaf)/Hard of Hearing					X	X				X
18.  Heart & Other Circulatory Conditions					X	X				X
19.  Intellectual Disability					X	X				X
20. Mental Illness					X	X				X
21.  Multiple Sclerosis					X	X				X
22.  Muscular Dystrophy					X	X				X
23.  Muscular/Skeletal Impairment					X	X				X
24.  Orthopedic Impairments					X	X				X
25.  Other Emotional/Behavioral					X	X				X
26.  Other Visual Impairments (not blind)					X	X				X
27.  Neurological Disorders/Impairments					X	X				X
28.  Respiratory Disorders/Impairments					X	X				X
29.  Skin Conditions					X	X				X
30.  Specific Learning Disabilities (SLD)					X	X				X
31.  Speech Impairments					X	X				X
32.  Spina Bifida					X	X				X
33.  Substance Use (Alcohol or Drugs)					X	X				X
34.  Tourette Syndrome					X	X				X
35.  Traumatic Brain Injury (TBI)					X	X		X		X
TOTAL					X	X		X		X

I. Racial and Ethnic Diversity of Individuals Served
Race/Ethnicity	State %
		PADD	PAAT	PATBI	PAVA
1. Hispanic/Latino (of any race)		X	X	X	X
(NOT Hispanic/Latino)	State %	PADD	PAAT	PATBI	PAVA
2. American Indian/Alaskan Native		X	X	X	X
3. Asian		X	X	X	X
4. Black/African American		X	X	X	X
5. Native Hawaiian/Other Pacific Islander		X	X	X	X
6. White		X	X	X	X
7. Two or more races		X	X	X	X
8. Race/Ethnicity Unknown		X	X	X	X

Intervention Benefitting Groups

J. Groups Served

PADD

PAAT

PATBI

PAVA

1. Group cases/projects still open at October 1. (Carried over from prior FY(s))

X

X

X

X

2. New group cases/projects opened during the year.

X

X

X

X

3. Total group cases/projects worked on during the year. (Add lines I1 and I2)

X

X

X

X

4. Total group cases/projects as of September 30. (Carry over to next FY)

X

X

X

X

5. Group cases/projects targeted at serving racial/ethnic minority(ies).

X

X

X

X

6. Total # of individuals potentially impacted by the line I.J.3 projects/cases.

X

X

X

X

K. Problem Areas

Problem Area/Complaint

PADD

PAAT

PATBI

PAVA

1. Abuse

X

X

X

2. Access to Administrative or Judicial Processes

X

X

X

X

3. Access to Records

X

X

X

4. Advance Directives

X

X

X

5. Architectural Accessibility

X

X

X

X

6. Assistive Technology

X

X

X

X

7. Aversives (including ECT)

X

X

X

8. Civil Commitment

X

X

X

9. Custody/Parental Rights

X

X

X

10. Education

X

X

X

11. Employment Discrimination

X

X

X

12. Employment Preparation

X

X

X

13. Financial Benefits

X

X

X

a) SSDI Work Incentives

X

X

X

b) SSI work Incentive

X

X

X

14. Forensic Commitment

X

X

X

15. Government Benefits/Services

X

X

X

16. Guardianship/Conservatorship/Substitute Decision Maker

X

X

X

X

17. Home & Community Based Services including Discharge Planning Transition Follow-up

X

X

X

18. Healthcare

X

X

X

a)Medicaid

X

X

X

b)Medicare

X

X

X

c)Private Medical Insurance

X

X

X

d)Other

X

X

X

19. Housing

X

X

X

20. Immigration

X

X

X

21. Neglect

X

X

X

22. Post-Secondary Education

X

X

X

23. Non-Medical Insurance

X

X

X

24. Privacy Rights (same question from individual)

X

X

X

x

25. Rehabilitation Services

X

X

X

26. Suspicious Death

X

X

X

27. Transportation

X

X

X

28. Unnecessary Institutionalization including Identification and Assessment

X

X

X

29. Voting

X

X

X

X

a) Accessible polling Place/Equipment

X

X

X

X

b)Registration

X

X

X

X

e)Other Voting Issue

X

X

X

c)Casting a Ballot

X

X

x

x

d)Voter Eligibility/Competency

x

X

x

x

30. Other (PADD/PAAT/PATBI PAVA) Issue

X

X

X

X

L. Group Cases by Living Arrangement

Living Arrangement

PADD

PAAT

PATBI

PAVA

1. Independent

X

X

X

X

2. Parental or Other Family Home

X

X

X

X

3. Community Residential Home for Children/youth (0-18 yrs.)

X

X

X

X

4. Community Residential Home for Adults

X

X

X

X

5. Non-medical Community Based Residential Facility for Children and Youth

X

X

X

X

6. Foster care

X

X

X

X

7. Nursing Homes, including Skilled Nursing Facilities (SNF)

X

X

X

X

8. Intermediate Care Facilities (ICF)

X

X

X

X

9. Public and Private General Hospitals including Emergency Rooms

X

X

X

X

10. Public Institutional Living Arrangement

X

X

X

X

11. Private Institutional Living Arrangement

X

X

X

X

12. Psychiatric Wards (Public Or Private)

X

X

X

X

13. Jail

X

X

X

X

14. State Prison

X

X

X

X

15. Federal Detention Center

X

X

X

X

16. Federal Prison

X

X

X

X

17. Veterans Administration Hospital

X

X

X

X

18. Other Federal Facility

X

X

X

X

19. Homeless

X

X

X

X

20. Not Applicable – Intervention not Focused on a Particular Living Arrangement

X

X

X

X

TOTAL

X

X

X

X

M. Reasons for Closing Group Cases/Projects

Reason

PADD

PAAT

PATBI

PAVA

1. Concluded Successfully

X

X

X

X

2. Concluded Unsuccessfully

X

X

X

X

3. Other

X

X

X

X

TOTAL

X

X

X

X

N. Intervention Strategies Used in Group Cases/Projects

Intervention Strategy

PADD

PAAT

PATBI

PAVA

1. Abuse and Neglect Investigation

X

X

X

2. Systemic Litigation

X

X

X

3. Educating Policymakers

X

X

X

X

4. Issuance of Public Report

X

X

X

X

4. Other Systemic Advocacy

X

X

X

X

TOTAL

X

X

X

X

O. Group Advocacy by Age Focus

Focus

PADD

PAAT

PATBI

PAVA

1. Group Cases/Projects Focused on Children Approximately 0-2 yrs. old

X

X

X

2. Group Cases/Projects Focused on Children Approximately 3-5 yrs. old

X

X

X

3. Group Cases/Projects Focused on Young People Approximately 6-10 yrs. old

X

X

X

4. Group Cases/Projects Focused on Young People Approximately 11-22 yrs. old

X

X

X

X

3. Group Cases/Projects Focused on Adults Approximately 23—64 yrs. old

X

X

X

X

4. Group Cases/Projects Focused on Seniors Approximately 65 yrs. & older

X

X

X

X

5. Not Applicable – Intervention Not Focused on Any Particular Age Range Grouping

X

X

X

X

TOTAL

X

X

X

X

P. Race/Ethnicity of Groups Served

Race/Ethnicity

PADD

PAAT

PATBI

PAVA

1. Hispanic/Latino (of any race)

X

X

X

X

2.  American Indian/ Alaskan Native

X

X

X

X

3.  Asian

X

X

X

X

4.  Black/African American

X

X

X

X

5.  Native Hawaiian/Other Pacific Islander

X

X

X

X

6.  White

X

X

X

X

7.  Two or more races

X

X

X

X

8.  Unknown

X

X

X

X

Part 2: Statement of Goals and Priorities

A. Report on FY 20__ (Previous Year) Statement of Goals and Priorities (SGP)

1. Goal Number:

Goal Statement:

___PADD ___PAAT ___PATBI ___PAVA

2. Priorities (Add rows below if needed)
#	Priority
1
	___PADD ___PAAT ___PATBI ___PAVA
2
	___PADD ___PAAT ___PATBI ___PAVA
3
	___PADD ___PAAT ___PATBI ___PAVA
3. Strategies Used to Implement Goal and Address Priorities (Check all that apply below)
□ Collaboration				□ Systemic Litigation1
dd□ Rights-Based Individual Advocacy Services				□ Educating Policy Makers
□ Investigations of Abuse and Neglect				□ Other Systemic Advocacy
□ Monitoring				□ Training/Outreach
□ Issuance of Public Report
4. Extent to Which Goal was Achieved (Check one below)
□ Not Achieved		□ Partially Achieved	□ Achieved		□ No Results This Year

5. Stage of Implementation (Check one below)
□ Planning	□ Initiation	□ Implementation	□ Outcome/Fully Integrated

6. Results Narratives of P&A Activities and Accomplishments Related to Above Goal²

List goal and priority #(s) addressed in the activity described in the narrative below.

Goal #(s): 1	Priority #(s):
___PADD ___PAAT ___PATBI ___PAVA
Collaborator(s):
Underserved/Unserved/Minorities Targeted? ☐ Yes ☐ No (If yes, describe in narrative).
<Narrative Headline> <Story/Narrative> Choose performance measures from Part III here for activity described above in this Results Narrative
Performance measurement		Number

Other Qualitative Narrative Related to the Above Goal

Significant activity for which there were no quantifiable results goes here.

Describe any other significant activity related to this goal

B. Priority Setting Process³

Complete this section by providing a thorough description of how the P&A conducts priority setting process (e.g., methods) used to develop the goals and priorities for the fiscal years covered in your multiyear plan. Revise based on public input on an annual basis with the idea that major changes will be made when it is time for a new multiyear plan.

1. Means by which the P&A conducted data-driven strategic planning, including formal public input (Check all that apply below)

Public Hearing ☐	Public Comment ☐	Experience ☐	Focus Groups ☐	Advisory Council(s) ☐	Monitoring Visits ☐	Research/Data ☐
Narrative (describe how the P&A conducted data driven strategic planning):

2. Number of days for public comment:

3. A copy of the proposed SGP for comment was provided to the:⁴

State Council on Developmental Disabilities: Yes/No

The University Centers for Excellence in Developmental Disabilities Education, Research and Service: Yes/No

4. Describe efforts to assure diversity (disability, geographic, racial, etc.) in the data-driven strategic planning process

5. Summary of Findings

6. Summary of How Data was used to Develop P&A Goals and Priorities (include how priority input used, including input from the DDC and UCEDD)⁵

5. List of topic areas of additional priorities that would be listed but are not due to lack of resources.

C. FY _ _ _ _ (Current Year) Statement of Goals and Priorities (SGP)

This section allows you to edit your goals and priorities for the next fiscal year. Check the box to indicate if there are changes or no changes to the SGP from prior year. If there are changes from the prior year, the system will give you the prompts below. There may be multiple goals for each grantee.

☐ There are no changes to the SGP from prior year. ☐ There are changes to the SGP (see below below).

1. Goal Number: 1 Goal Statement:

___PADD ___PAAT ___PATBI ___PAVA
2. Priorities (Add rows below if needed)
#	Priority
3. Strategies to Be Used to Implement Goal and Address Priorities (Check all that apply below)
□ Collaboration		□ Systemic Litigation
□ Rights-Based Individual Advocacy Services		□ Educating Policy Makers
□ Investigations of abuse and neglect		□ Other Systemic Advocacy
□ Monitoring		□ Training/Outreach

□ Issuance of Public Report
	4. Rationale for Adding/Changing Goal
	5. Rationale for Adding/Changing Priorities

D. Description of P&A Operations⁶

1. Provide a description of how the P&A operates. Include information on how the P&A coordinates the PADD program with other Protection and Advocacy programs administered by the State Protection and Advocacy System. This description must include the System’s processes for intake, internal and external referrals, and streamlining of advocacy services.

2. Will the System will be requesting or requiring fees or donations from clients as part of the intake process?

   1. Yes

   2. No

3. Collaboration and Coordination:

   1. Describe how the P&A is collaborating with others in the State, including the DDC and UCEDD.

2. Describe how the P&A is reducing duplication and overlap of services and sharing of information on service needs.

Part III: Results of P&A Activity⁷

A. End Outcomes of P&A Activity

End Outcome	PADD	PAAT	PATBI	PAVA
People with disabilities who are provided with appropriate community based services or AT devices and services resulting in community integration and independence.	X	X	X	X
People with disabilities who accessed benefits or services.	X	X	X	X
People with disabilities who live in a healthier, safer or otherwise improved environment.	X	X	X	X
People with disabilities who were able to stay in their own home.	X	X	X	X
People with disabilities who work in safer and more humane conditions.	X	X	X	X
People with disabilities who go to school in safer and more humane conditions.	X	X	X	X
Students with disabilities who stayed in school.	X	X	X	X
Children with disabilities receiving appropriate services in most integrated settings.	X	X	X	X
People with disabilities who had their other rights enforced, retained, restored and/or expanded.	X	X	X	X
Public and private places/services made more accessible.	X	X	X	X
People with disabilities are better able to participate fully in the electoral process.	X	X	X	X

By Intervention Type⁸

End Outcome	Technical Assistance	Individual Advocacy9	Abuse & Neglect Investigations	Systemic Litigation	Educating Policy Makers	Other Systemic Advocacy
On row below insert # from line to right	Line 1.I.2	Line 1.A.3	Line 1.N.1	Line 1.N.2	Line 1.N.3	Line 1.N.4
T.A.’s/Cases/Projects
1			N/A
2			N/A
3
4			N/A
5
6
7			N/A
8			N/A
9			N/A
Total
1010			N/A

B. Overview of How Many People with Disabilities Served

Performance Measurement	PADD	PAAT	PATBI	PAVA
1.      People with disabilities receiving individual advocacy services to exercise their civil, human and legal rights.	X	X	X	X
2.      Abuse and neglect investigations to protect people with disabilities from abuse and neglect.	X	X	X	X
3.      People with disabilities receiving information, technical assistance and referral services.	X	X	X	X
4.      People with disabilities trained to become active participants in making decisions that affect their lives.	X	X	X	X
5.      People whose rights were advanced through class and/or systemic impact litigation.	X	X	X	X
6.      People with disabilities whose rights were enforced, protected or restored as a result of non-litigation group advocacy.	X	X	X	X
7.      People with disabilities who received a lower level of services due to lack of P&A resources.	X	X	X	X
8.      People with disabilities impacted by one or more provision(s) in law modified or prevented.	X	X	X	X

C. Rights-Based Individual Advocacy Services

Performance Measurement	PADD	PAAT	PATBI	PAVA
People with disabilities who had their rights enforced and/or restored.	X	X	X	X
People with disabilities who were assisted in obtaining access to administrative or judicial processes.	X	X	X	X
Closed cases in which client objective was met or partially met.	X	X	X	X

D. Investigations of Abuse and Neglect

Performance Measurement	PADD	PATBI	PAAT
Investigations (not death related).	X	X	X
Investigations of abuse and neglect completed with a finding or determination (not including death investigations).	X	X	X
Death investigations.	X	X
Death investigations completed with a finding or determination.	X	X
People with disabilities who benefitted from the findings of investigations of abuse and neglect.	X	X	X
Provisions in policy added or prevented.	X	X	X

Other Qualitative Narrative

Report additional information related to investigations not already reported in Part II.

E. Monitoring [PADD/PATBI/PAAT]

Facilities/Programs Monitored

Unique Facility	Facility Type	Facility Capacity	Location (By County)	# of Visits	Court Ordered Monitoring? Yes/No

Total Number of Unique Facilities:

Performance Measurement	PADD	PATBI	PAAT
People with disabilities whose living, working and/or other circumstances were monitored by P&A.	X	X	X
Cases opened for health and safety issue investigation.	X	X	X
Health and/or safety violations validated by the P&A.	X	X	X
Rights violations (not health or safety and including quality of life) identified and addressed as a result of P&A monitoring.	X	X	X
Complaints referred to regulatory agencies or investigative organizations.	X	X	X
Times P&A access was denied during a monitoring/access attempt.	X	X	X
Times denial of P&A access was successfully resolved.	X	X	X

Other Qualitative Narrative

Describe P&A’s overall approach and strategy for monitoring activities

F. Systemic Litigation

Performance Measurement	PADD	PAAT	PATBI
Systemic or class action lawsuits handled for the benefit of people with disabilities.	X	X	X
Provisions in policy modified or prevented.	X	X	X
Provisions in regulation modified or prevented.	X	X	X
Provisions in law modified or prevented.	X	X	X
Lawsuits addressing systemic issues resolved by settlement.	X	X	X
Lawsuits addressing systemic issues resolved by judgment.	X	X	X
Amicus briefs signed onto or filed.	X	X	X
People with disabilities whose rights were advanced as a result of amicus participation.	X	X	X

G. Educating Policymakers¹¹

Performance Measurement	PADD	PAAT	PATBI	PAVA
Communications to people with disabilities explaining a policy initiative.	X	X	X	X
People with disabilities supported in expressing their own viewpoint on a policy related matter.	X	X	X	X
Times written comments were submitted regarding proposed legislation or regulations.	X	X	X	X
Times testimony was provided at a legislative hearing.	X	X	X	X
Provisions in regulation added, modified or prevented.	X	X	X	X
People with disabilities impacted by the regulation provision(s) modified or prevented.	X	X	X	X
Provisions in law added, modified or prevented.	X	X	X	X
People with disabilities impacted by one or more provision(s) in law modified or prevented.	X	X	X	X
Provisions in ordinances modified or prevented.	X	X	X	X

H. Other Systemic Advocacy

Performance Measurement	PADD	PAAT	PATBI	PAVA
Changes in practices made or prevented.	X	X	X	X
Provisions in policy modified or prevented.	X	X	X	X

PROGRAM SPECIFIC MEASURES

PAAT PROGRAM

Performance Measurement	PAAT
People receiving one or more AT devices as a result of P&A advocacy	X
Type and/or Use of Device	X
Devices for communication	X
Devices for mobility	X
Devices for hearing and seeing	X
Devices for reading and writing	X
Devices for assisting with household chores	X
Devices to aid with school/learning	X
Devices to assist with participation in play or recreation	X
Devices to assist with personal care	X
Devices to aid in therapy or medical treatment	X
Devices to assist with the use of public/private transportation	X
Devices to assist with employment	X
Other	X
DEVICE TOTAL	X
People receiving one or more AT service as a result of P&A advocacy	X
Type of Service	X
a. AT evaluation	X
b. Training in use of AT	X
c. AT repair	X
d. Other (including acquisition and customizing of AT device)	X
Total number of services: (fill in the number)	X

PAVA PROGRAM

Performance Measurement	PAVA
Education and training of election officials, volunteers and poll workers regarding rights of people with disabilities and best practices.	X
Education and training of people with disabilities on their voting rights.	X
Registering people with disabilities to vote.	X
Monitoring	X
Non- partisan candidate forums	X
Operating a voter assistance hotline	X
Issuance of public reports	X

Combined Report for ACL P&A Programs

This is the place to report information common to the four P&A programs (PADD, PAVA, PAAT and PATBI) under the oversight of the Administration for Community Living (ACL). Information is entered once here and applies to all programs.

Part 1 - Public Relations and Outreach

Performance Measure	Number
Press releases issued.
Times a P&A representative was interviewed or featured on TV or Radio related to activity funded by this program.
Articles about this P&A program or its work in external mass media such as newspapers, radio, podcasts, blogs or television.
Social media followers.
Absolute unique visitors to blogs/web pages where information about the P&A is posted.
Circulation of the P&A’s newsletter, reportsand/or listserv updates.
Articles by the P&A about disability rights issues published in newspapers, books, journals or magazines.
Links to other disability rights related information sources published on the P&A website.

Performance Measure	Number
Exhibitions and Presentations	PADD	PAAT	PATBI	PAVA
1. Times the P&A exhibited at conferences, community fairs, etc.
2. Presentations made to community groups.

Part 2 - Collaboration

The purpose for this section is to streamline the reporting of major collaborative efforts and avoid duplication in the reporting of activity. Step 1 is to enter the name and description of all major collaborations. Then when writing Results Narratives as a part of reporting on priority implementation in any of the ACL P&A PPRs, it will only be necessary to select name of the collaboration from a dropdown menu when work it contributed to is being described.

Required collaborations include the client assistance program (unless housed within the P&A), long term care ombudsman (unless housed within the P&A), developmental disabilities council, center(s) for excellence (university affiliated program) and any parent training centers. Listing other collaborations is optional but can be very useful in demonstrating the extent and effectiveness of collaborative efforts.

Check one or more of the following boxes if the P&A houses any of these programs.

☐ Client Assistance Program12 ☐ State Grants for Assistive Technology Program13

☐ Long Term Care Ombudsman14

☐ Parent Training Center15

Multiple collaborations may be entered.

Name of Collaboration
Which funding sources may benefit from this collaboration: □ PADD □ PATBI □ PAAT □ PAVA
Description of collaboration Role of P&A within the collaboration

Part 3 – Board, Staff, and Advisory Council Demographics

A. Advisory Council

Does your P&A have a governing board?

□ Yes □ No

Does your P&A have an advisory council(s) ?

□ General □ PADD □ PATBI □ PAAT □ PAVA

If yes, describe the role of the council(s)

B. Board, staff and advisory council race and ethnicity

Race/Ethnicity	Board	Employees	Advisory Council16
1) Hispanic/Latino (of any race)

Race/Ethnicity (NOT Latino/Hispanic)
2) American Indian/ Alaskan Native
3) Asian
4) Black/African American
5) Native Hawaiian/ Other Pacific Islander
6) White
7) Two or more races
8) Race/Ethnicity Unknown
TOTAL

C. Consumer involvement in P&A governance

(Please report the total number of board members for your Board and/or Advisory Council. Then report how many members fall into each consumer group. Members can be counted as more than one type of consumer)

	Board If applicable	Advisory Council17 If Applicable
TOTAL Numbers of Members (nonduplicative)
PADD Eligible Primary Consumers
PADD Eligible Secondary Consumers
PATBI Eligible Primary Consumers
PATBI Eligible Secondary Consumers
AT Users
PAIMI or PAIR or PABSS Eligible Primary Consumers
PAIMI or PAIR or PABSS Other Eligible Secondary Consumers
Other Members

Does the P&A Board meet the requirements of section 144 of the DD Act? ¹⁸

□ Yes □ No

Part 4 – General Information

A. P&A Identification

Name of state, territory or jurisdiction
Name of P&A system

B. Main Office (or Office of Record)

Mailing Address & Phone Number of Main Office

C. Additional Offices (If any) (Add rows if needed)

Name, Mailing Address

D. CEO Contact Information

Name, phone number, and email address of P&A CEO

E. PPR Preparer Contact Information

PADD PPR Preparer

Name, title, phone number, and email address of P&A Preparer

PAVA PPR Preparer

Name, title, phone number, and email address of P&A Preparer

PATBI PPR Preparer

Name, title, phone number, and email address of P&A Preparer

PAAT PPR Preparer

Name, title, phone number, and email address of P&A Preparer

1 This selection does not apply to PAVA.

2 A results narrative is a story which presents relevant information pertinent to each goal and its priorities about an individual or group case/project which is being pursued or was pursued with the intent of achieving a result/outcome. A grantee may submit multiple narratives.

3 The P&A will submit periodically a thorough description of the methods used for the priority setting process, and then annually indicate whether they have changed the methods used for the priority setting process. If it has changed, they would need to include a full description of the changes.

4 This question is only required for PADD.

5 This question is only required for PADD.

6 This section is only required for PADD.

7 Only those measures and subsections with data will be displayed when the report is submitted.

8 There will be one table for each program.

9 Individual advocacy includes self-advocacy assistance, limited advocacy, administrative remedies, negotiation, mediation/alternative dispute resolution and litigation.

10 End Outcome 10 is separated because it does not count people and therefore cannot be included in the total.

11

12 Applies only to PADD program.

13 Applies only to PAAT program.

14 Applies only to PADD program.

15 Applies only to PADD program.

16 Applicable only if the P&A has an advisory council that is funded in part or entirely by the PADD, PAAT, PATBI and/or PAVA program. The PAIMI Advisory Council is not applicable.

17 Applicable only if the P&A has an advisory council that is funded in part or entirely by the PADD, PAAT, PATBI and/or PAVA program. The PAIMI Advisory Council is not applicable.

18 42 U.S.C. 15044

(B) a majority of the members of the board shall be—

(i) individuals with disabilities, including individuals with developmental disabilities, who are eligible for services, or have received or are receiving services through the system; or

(ii) parents, family members, guardians, advocates, or authorized representatives of individuals referred to in clause (i);

39