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{"sheet":"Instructions","index":0,"n_rows":50,"n_cols":4,"rows_kept":50}
["FLASH-V Eligibility Assessment Form Instructions"]
[]
["Thank you for taking the time to complete the FLASH-V Eligibility Assessment Form. "]
["This form will take approximately 30 minutes to complete.  "]
["Your participation in this study is voluntary and information will be kept private to the degree permitted by the technology used."]
["The goal of this form is to identify MIECHV funded local implementing agencies (LIAs) and centralized intake agencies in your state that may be eligible to participate in FLASH-V."]
["The FLASH-V project aims to understand how LIAs are making decisions regarding which families will be offered services."]
[]
["Instructions for completing both tabs of the FLASH-V Eligibility Assessment Form:"]
["* Select \"Enable Content\" in the yellow bar at the top of the spreadsheet in order to complete this form."]
["(1) Local Implementing Agencies"]
[null,"Columns A and B are prepopulated with information about your state's MIECHV funded LIAs"]
[null,"For each LIA, please enter the applicable information into columns C-H. "]
[null,null,"If you select \"No\" in column C, automated \"Not applicable\" text will appear in columns D-G because we will not be reaching out to these LIAs for participation in FLASH-V. "]
[null,null,"For all LIAs, column H can be used to provide any notes about the LIA that are pertinent to the FLASH-V project. "]
[null,"If an LIA is listed incorrectly on this form, or is no longer being funded by MIEVHV, please feel free to make corrections and/or strikethrough the row. If an LIA is missing, please feel free to add them to the bottom of the spreadsheet."]
[]
["(2) Centralized Intake Agencies"]
[null,"Columns A and B are prepopulated with information about your state's MIECHV funded LIAs"]
[null,"For each LIA, please enter the applicable information into columns C-F. "]
[null,null,"If you select \"No\" in column C, automated \"Not applicable\" text will appear in columns D and E because we will not be reaching out to these centralized intake agencies for participation in FLASH-V. "]
[null,null,"For all LIAs, column F can be used to provide any notes about the LIA's centralized intake agency that are pertinent to the FLASH-V project. "]
[]
[]
[]
[]
[]
[]
["FLASH-V Eligibility Assessment Form Definitions"]
[]
["LIAs that are eligible to participate in FLASH-V = "]
[null,"LIAs that typically have a higher number of families interested in services than they have the capacity to serve"]
[]
[null,"Examples of LIAs that would be eligible for the study:"]
[null,null,"(1) An LIA that typically has only 3-5 open slots, but receives about 10 new eligible referrals every month."]
[null,null,"(2) An LIA that has no open slots, but maintains a waitlist of eligible families."]
[null,null,"(3) An LIA that has no open slots, but receives eligible referrals to fill an open slot in the near future."]
[null,null,"(4) An LIA that has very little turnover in families, but continues to receive eligible referrals."]
[]
[null,"Examples of LIAs that would NOT be eligible for the study:"]
[null,null,"(1) An LIA that typically can serve all eligible families that are referred to its home visiting program. (Note: This may include an LIA that experiences a one-time staff "]
[{"$nulls":3},"shortage, leaving the program with no open slots at that point-in-time.)"]
[null,null,"(2) An LIA that stops accepting incoming referrals from referral partners when it has no open slots"]
[]
["Centralized Intake Definition ="]
[null,"Centralized intake, also referred to as “coordinated intake,” “common intake,” or “central intake,” provides a single entry point through which families are referred "]
[null,null,"to or can request home visiting services and potentially other services in the community"]
[]
[]
["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. The OMB number for this information collection is 0970-0356 and the expiration date is 03/31/2018."]

{"sheet":"(1) Local Implementing Agencies","index":1,"n_rows":99,"n_cols":8,"rows_kept":99}
["FLASH-V Eligibility Assessment Form - Local Implementing Agency Information"]
[]
["Name of local implementing agency (LIA)","Model(s) implemented by LIA","Does the LIA typically have a higher number of families interested in services than it has the capacity to serve? (See Instructions tab for definitions.)","Name of primary contact person at LIA","Email address of primary contact at LIA","Phone number of primary contact at LIA, if readily available","Role of primary contact at LIA, if readily available","Please include any notes about this LIA that may be pertinent to this project, including any concerns about the study team reaching out to this LIA for participation in FLASH-V at this time"]
["LIA 1","HFA, NFP","Yes","Jane Smith","smith@lia1.org","555-555-5555","Program Manager"]
["LIA 2","HIPPY","Yes","Mary Johnson","johnson@lia2.edu","444-444-4444","Intake Coordinator","LIA is working on a grant application that is due at the end of July. They are currently very busy with this."]
["LIA 3","PAT","No","Not applicable","Not applicable","Not applicable","Not applicable"]
["LIA 4","EHS, HFA","Unknown","Paul Jones","jones@lia4.gov","333-333-3333","Program Manager","LIA has expressed interest in research projects in the past."]
["LIA 5","NFP","Yes","Linda Williams","williams@lia5.org","222-222-2222","Nurse Supervisor"]
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{"sheet":"(2) Centralized Intake Agencies","index":2,"n_rows":8,"n_cols":6,"rows_kept":8}
["FLASH-V Eligibility Assessment Form - Centralized Intake Agency Information"]
[]
["Name of local implementing agency (LIA)","Model(s) implemented by LIA","Is this LIA part of a centralized intake agency? (See instructions tab for definitions.)","Name of primary contact person at centralized intake agency","Email address of primary contact person at centralized intake agency","Please include any notes about this centralized intake agency that may be pertinent to this project, including any concerns about the study team reaching out to this agency for participation in FLASH-V at this time"]
["LIA 1","HFA, NFP","Yes","Susan Brown","brown@ci1.org","Centralized intake agency is going through a change in leadership. They just recently hired a new Executive Director."]
["LIA 2","HIPPY","No","Not applicable","Not applicable"]
["LIA 3","PAT","Yes","John Jackson","jackson@ci2.edu"]
["LIA 4","EHS, HFA","Yes","Maria Thomas","thomas@ci3.gov","Centralized intake agency is swamped with referrals during the summer, so they may not have time to participate."]
["LIA 5","NFP, PAT","No","Not applicable","Not applicable"]

{"sheet":"(3) General CI Information","index":3,"n_rows":12,"n_cols":5,"rows_kept":12,"merged":[[8,0,9,0],[8,1,9,1],[8,2,9,2],[8,3,8,4]]}
["FLASH-V Eligibility Assessment Form - Centralized Intake Agency Information"]
[]
["Are any of your state's MIECHV funded LIAs participating in a centralized intake agency (also referred to as “coordinated intake,” "]
["“common intake,” or “central intake.” A centralized intake agency provides a single entry point through which families are referred"]
[" to or can request home visiting services and potentially other services in the community)?"]
[]
["If yes, please provide the following information on each centralized intake agency in your state that refers families to MIECHV funded LIAs."]
[]
["Name of primary contact person at centralized intake agency","Email address of primary contact person at centralized intake agency","Please include any notes about this centralized intake agency that may be pertinent to this project, including any concerns about the study team reaching out to this agency for participation in FLASH-V at this time","If available, please provide the following information:"]
[{"$nulls":3},"Name of LIA(s) participating in centralized intake agency","Model(s) implemented by LIA(s) participating in centralized intake agency"]
["Susan Brown","brown@ci1.org","Centralized intake agency is going through a change in leadership. They just recently hired a new Executive Director.","LIA 1, LIA 2, LIA 3","HFA, NFP, EHS"]
["John Jackson","jackson@ci2.edu","Centralized intake agency is swamped with referrals during the summer, so they may not have time to participate.","LIA 4, LIA 5","PAT, HFA"]

{"sheet":"Sheet2","index":4,"n_rows":4,"n_cols":1,"rows_kept":4,"hidden":true}
["Yes"]
["No"]
["Unknown"]
[" "]