Form 0990-0221 FPAR Forms and Instructions

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0221. The time required to complete this information collection is estimated to average 36 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OIRM/PRA, 200 Independence Ave., S.W., Suite 336–E, Washington, DC 20201, Attention: PRA Reports Clearance Officer.

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Introduction

This annual reporting requirement is for family planning services delivery projects authorized and funded under the Population Research and Voluntary Family Planning Programs (Section 1001 of Title X of the Public Health Service Act, 42 United States Code [USC] 300).¹ The Office of Population Affairs (OPA) administers the Title X Family Planning Program.

Annual submission of the Family Planning Annual Report (FPAR) is required of all Title X family planning services grantees for purposes of monitoring and reporting program performance (45 Code of Federal Regulations [CFR] Part 75²). FPAR data are presented in summary form to protect the confidentiality of individuals who receive Title X-funded services (42 CFR Part 59).³

The FPAR is the only source of annual, uniform reporting by all Title X family planning services grantees. It provides consistent, national-level data on the Title X Family Planning Program and its users. Information from the FPAR is important to OPA for several reasons. First, OPA uses FPAR data to monitor compliance with statutory requirements, regulations, and operational guidance set forth in the Title X Family Planning Program Guidelines,⁴ which include the following:

monitoring compliance with legislative mandates, such as giving priority in the provision of services to low-income persons [42 USC 300 §1006(c)]¹

ensuring that Title X grantees and their subcontractors provide a broad range of family planning methods and services [42 USC 300 §1001(a)]¹

Second, OPA uses FPAR data to comply with accountability and federal performance requirements for Title X family planning funds as required by the Government Performance and Results Modernization Act of 2010. Current performance measures focus on increasing access to family planning services and serving individuals and families from underserved, vulnerable, and low-income populations. Objectives for the Title X Family Planning program include increasing the number of unintended pregnancies averted by providing Title X family planning services, with priority for services to low-income individuals; increasing the proportion of women using highly or moderately effective methods of contraception; reducing invasive cervical cancer through cervical cancer screening; and reducing infertility through chlamydia screening.

Finally, OPA relies on FPAR data to guide strategic and financial planning, to monitor performance, and to respond to inquiries from policymakers and Congress about the program. The FPAR allows OPA to assemble comparable and relevant program data to answer questions about the characteristics of the population served by Title X projects, use of family planning and related preventive health services offered, the amount and composition of revenues, and program impact. FPAR data are the basis for objective grant reviews, program evaluation, and assessment of program technical needs.

This version (October 2016) of the FPAR consists of 15 tables, including a Grantee Profile Cover Sheet and 14 data tables. The data collected include demographic, social, and economic characteristics of family planning users; use of family planning and related preventive health services; use of health personnel; and project revenues. Minor corrections or clarifications to this version of the FPAR Forms and Instructions include the following:

Updated references throughout the document
Updated the “General Instructions” for FPAR submission and revision to account for grantees’ use of the Web-based FPAR Data System
Updated the first question in the “Questions About” section for all FPAR tables
Made minor wording changes to the Clinical Services Provider definition to account for the reference to the “Program Guidelines” (see footnote 2)
Updated instructions for Table 9, including Exhibit 1, to reflect the 2014 Bethesda System update

General Instructions

This section provides general instructions for completing the FPAR. Grantees should use the general instructions in conjunction with the table-specific instructions; they are cross-referenced where appropriate. If you need additional information or guidance, please refer to the Title X Program Guidelines (http://www.hhs.gov/opa/guidelines/program-guidelines/index.html) and Program Policy Notices (http://www.hhs.gov/opa/title-x-family-planning/about-title-x-grants/program-policy-notices/index.html) on the OPA Website.

Who Submits an FPAR

Grantees funded under Section 1001 of the Title X Public Health Service Act (42 USC 300) are required to submit the FPAR. The family planning services grantee is the direct recipient of the Title X grant. Subrecipients (delegates or subcontractors) to the grantee receive Title X funds via the grantee. Subrecipients should not submit an FPAR report; instead, subrecipients should follow grantee instructions for data collection and reporting.

Scope of Activities Reported in the FPAR

The purpose of the FPAR is to provide a comprehensive view of the family planning activities within the scope of the grantee’s Title X-funded project, as defined in the approved grant application. Family planning services grantees should report the total, unduplicated number of users, encounters, and other outputs from activities that are within the scope of a grantee’s Title X-funded project. If you have questions about whether to include certain data in this report, contact your Regional Project Officers (RPOs). A current list of RPOs and their contact information is on the OPA Website at http://www.hhs.gov/opa/about-opa-and-initiatives/regional-contacts/index.html.

FPAR Submission Due Date

Grantees should prepare and submit the FPAR no later than February 15 after the end of the reporting period. If February 15 is a weekend day, the FPAR is due on the following Monday or next business day.

Submitting the FPAR

OPA encourages grantees to submit the FPAR electronically using the Web-based FPAR Data System, which is located at https://fpar.opa.hhs.gov/. You must have an authorized user account to submit and manage your FPAR using the system. Contact your RPO (http://www.hhs.gov/opa/about-opa-and-initiatives/regional-contacts/index.html) to request a user account. Once OPA authorizes your account, you will receive an automated e-mail confirming your registration and providing a link to the FPAR Data System website, your user name, and a temporary password that you will be required to change at first login.

Visit the FPAR Data System Training page at https://fpar.opa.hhs.gov/Public/Training to learn about and view on-demand training videos and to access Section 508-compliant slides and handouts for each course. An FPAR Data System User Guide, accessed from the Support page, provides step-by-step instructions for using the system to submit and manage your FPAR.

If you are unable to submit the FPAR using the FPAR Data System, contact your RPO (http://www.hhs.gov/opa/about-opa-and-initiatives/regional-contacts/index.html) to determine the best way (e.g., e-mail or fax) to send them an electronic or hardcopy version of the completed FPAR tables. Once the RPO receives the completed tables, they will record the date of receipt and enter the FPAR data into the FPAR Data System. Once the FPAR data have been entered into the FPAR Data System, all subsequent actions related to your FPAR will be performed using the FPAR Data System.

FPAR Data Validation

FPAR data undergo rigorous electronic and manual validations prior to tabulation. For FPARs submitted through the FPAR Data System, the system automatically validates the data as you complete each table to ensure consistency within and across tables. Each validation procedure is based on a validation rule that defines which table cells to compare and what condition or validation test to apply (e.g., =, , , , or ). The values reported in FPAR Table 1, Row 10, indicated by the double-letter identifiers (AA, BB, and CC), serve as important checkpoint references to ensure consistency across multiple FPAR tables. The automated validation procedures include cross-table comparisons to these three FPAR checkpoints, as well as comparisons between other table cells. The system will flag blank cells; if the value for a cell is zero, enter “0.”

After a grantee submits an FPAR, it goes through two levels of review by HHS staff. First, an RPO reviews the FPAR and either accepts it or returns it to the grantee for correction or clarification. Once the RPO accepts the FPAR, the FPAR Data Coordinator performs a second and final review, either accepting the FPAR or returning it to the RPO and grantee for correction or clarification. When the FPAR Data Coordinator has accepted all FPARs, the FPAR data contractor performs additional electronic validations (“post-submission validations”) to identify reporting errors and highlight reporting issues (e.g., missing or out-of-range values). The contractor also performs a manual review of all “Note” field comments.

Request for FPAR Revision

During the HHS review of the FPAR or after the FPAR contractor has completed post-submission validations, HHS staff may ask you to correct or provide additional information about the reported data. If the RPO requests a revision, the FPAR contact for your agency will receive an automated e-mail from the FPAR Data System that includes revision instructions. If the FPAR Data Coordinator requests a revision, the RPO will receive the automated e-mail and will contact the FPAR contact for your agency to determine who (RPO or grantee) will enter the correction or clarification using the FPAR Data System.

If you are unable to revise the FPAR using the FPAR Data System, contact your RPO (http://www.hhs.gov/opa/about-opa-and-initiatives/regional-contacts/index.html) to request assistance. Grantees should consult with their RPO regarding any requirements or deadlines for submitting revised FPAR tables.

FPAR Note Field

OPA encourages grantees to include information about the data reported in the FPAR tables, including grantee observations and information about trends or any issues affecting the quality or completeness of the reported data. Please use the table-specific “Note” field to enter a comment and reference the cell or cells to which each comment applies. For estimated figures, describe the rationale and method for generating the estimate. In the FPAR Data System, the “Note” field appears under every FPAR table. The system also includes a “Note” field under the FPAR Preparation Checklist where grantees may enter comments about issues affecting data in all FPAR tables.

FPAR Identification

Each FPAR table includes a header with key identifying information. For grantees that use the FPAR Data System to submit the FPAR, these fields will populate automatically. For grantees that submit a hardcopy FPAR by fax or e-mail, you must enter this information on the Grantee Profile Cover Sheet and on all 14 reporting tables. The identifying information includes the following:

FPAR Number – Enter the unique, four-digit number assigned to your agency by the RPO. This number is different from your HHS grant number.

Date Submitted – Enter the report submission date.

Reporting Period – Enter the reporting period covered by your FPAR report. In most cases, the reporting period is the 12-month calendar year (i.e., January 1 through December 31). Title X grantees that begin operating after January 1, stop operating before December 31, or are reporting data for a different 12-month period (e.g., December to November) should enter the date range for the period during which their Title X project was active and for which they are reporting data. For grantees that submit the FPAR using the FPAR Data System, please consult the FPAR Data System User Guide for instructions about editing the reporting period on the FPAR Preparation Checklist.

Initial Submission or Revision – Check the appropriate box in the header of each table to indicate whether the table is an initial or revised submission. For grantees that submit the FPAR using the FPAR Data System, the system will automatically update the submission status (initial or revised) of each table.

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Terms and Definitions

OPA provides definitions for key FPAR terms to ensure uniform reporting by Title X grantees. The terms describe the individuals receiving family planning and related preventive health services at Title X-funded service sites, the range and scope of the services provided, and the family planning providers who deliver care.

Family Planning User

A family planning user is an individual who has at least one family planning encounter at a Title X service site during the reporting period. The same individual may be counted as a family planning user only once during a reporting period. Grantees should follow the table-specific instructions to identify applicable users.

Family Planning Provider

A family planning provider is the individual who assumes primary responsibility for assessing a client and documenting services in the client record. Providers include those agency staff that exercise independent judgment as to the services rendered to the client during an encounter. Two general types of providers deliver Title X family planning services: Clinical Services Providers and Other Services Providers.

Clinical Services Providers – Include physicians (family and general practitioners, specialists), physician assistants, nurse practitioners, certified nurse midwives, and registered nurses with an expanded scope of practice who are trained and permitted by state-specific regulations to perform all aspects of the user (male and female) physical assessments recommended for contraceptive, related preventive health, and basic infertility care. Clinical Services Providers are able to offer client education, counseling, referral, followup, and clinical services (physical assessment, treatment, and management) relating to a client’s proposed or adopted method of contraception, general reproductive health, or infertility treatment, in accordance with the Program Guidelines.

Other Services Providers – Include other agency staff (e.g., registered nurses, public health nurses, licensed vocational or licensed practical nurses, certified nurse assistants, health educators, social workers, or clinic aides) that offer client education, counseling, referral, or followup services relating to the client’s proposed or adopted method of contraception, general reproductive health, or infertility treatment, as described in the Program Guidelines. Other Services Providers may also perform or obtain samples for routine laboratory tests (e.g., urine, pregnancy, STD, and cholesterol and lipid analysis), give contraceptive injections (e.g., Depo-Provera), and perform routine clinical procedures that may include some aspects of the user physical assessment (e.g., blood pressure evaluation), in accordance with the Program Guidelines.

Family Planning Encounter

A family planning encounter is a documented, face-to-face contact between an individual and a family planning provider that takes place in a Title X service site. The purpose of a family planning encounter is to provide family planning and related preventive health services to female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies. To be counted for purposes of the FPAR, a written record of the services provided during the family planning encounter must be documented in the client record.

There are two types of family planning encounters at Title X service sites: (1) family planning encounters with a Clinical Services Provider and (2) family planning encounters with an Other Services Provider. The type of family planning provider who renders the care, regardless of the services rendered, determines the type of family planning encounter. Although a client may meet with both Clinical and Other Services Providers during an encounter, the provider with the highest level of training who takes ultimate responsibility for the client’s clinical or non-clinical assessment and care during the visit is credited with the encounter.

Family Planning Encounter with a Clinical Services Provider – A face-to-face, documented encounter between a family planning client and a Clinical Services Provider that takes place in a Title X service site.

Family Planning Encounter with an Other Services Provider – A face-to-face, documented encounter between a family planning client and an Other Services Provider that takes place in a Title X service site.

Laboratory tests and related counseling and education, in and of themselves, do not constitute a family planning encounter unless there is face-to-face contact between the client and provider, the provider documents the encounter in the client’s record, and the tests are accompanied by family planning counseling or education.

Family Planning Service Site

A family planning service site refers to an established unit where grantee or subrecipient agency staff provide Title X services (clinical, counseling, educational, or referral) that comply with the Program Guidelines, and where at least some of the encounters between the family planning providers and the individuals served meet the requirements of a family planning encounter. Established units include clinics, hospital outpatient departments, homeless shelters, detention and correctional facilities, and other locations where Title X agency staff provide these family planning services. Service sites may also include equipped mobile vans or schools.

Client Records

Title X projects must establish a medical record for every client who obtains clinical services or other screening or laboratory services (e.g., blood pressure check, urine-based pregnancy or STD test). The medical record contains personal data; a medical history; physical exam data; laboratory test orders, results, and followup; treatment and special instructions; scheduled revisits; informed consent forms; documentation of refusal of services; and information on allergies and untoward reactions to identified drugs. The medical record also contains clinical findings; diagnostic and therapeutic orders; and documentation of continuing care, referral, and followup. The medical record allows for entries by counseling and social service staff. The medical record is a confidential record, accessible only to authorized staff and secured by lock when not in use. The client medical record must contain sufficient information to identify the client, indicate where and how the client can be contacted, justify the clinical impression or diagnosis, and warrant the treatment and end results.

If a family planning user receives no clinical services, the provider still must establish a client record that enables the site to complete the required FPAR data reporting. Like a medical record, this client record must contain sufficient information to identify the client, indicate where and how the client can be contacted, and fully document the encounter. This record is confidential, accessible only to authorized staff, and secured by lock when not in use.

Questions about FPAR Terms and Definitions

Question – Are the definitions for any of the FPAR terms different from their definition in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA made a minor wording change to the Clinical Services Provider definition to account for the reference to the “Program Guidelines” (see footnote 2). This wording change does not represent a change in the types of providers that grantees should report in this category.

Question – Can a client have more than one family planning encounter during a single family planning visit?

Answer – A client may have only one family planning encounter per visit. In the family planning services setting, the term “encounter” is synonymous with “visit.” Although a client may meet with both Clinical and Other Services Providers during an encounter, the encounter is credited to the provider with the highest level of training who takes ultimate responsibility for the client’s clinical or non-clinical assessment and care during the visit.

Question – If an individual receives gynecological or related preventive health services (e.g., pelvic exam, Pap test, pregnancy test, STD screening) at a Title X-funded service site, but does not receive counseling, education, or clinical services aimed at avoiding unintended pregnancy or achieving intended pregnancy, is the encounter a family planning encounter? Is the client a family planning user?

Answer – If a client is an ongoing family planning user who visits the service site to obtain any type of family planning or related preventive health services, the encounter is considered a family planning encounter and the client is considered a family planning user.

If a client of reproductive age is sterilized under the service site’s Title X-funded project, or is an ongoing Title X user who was sterilized elsewhere but continues to receive gynecological or related preventive health services from the site, the encounter is considered a family planning encounter and the agency may continue to count the client as a family planning user.

If a post-menopausal client obtains gynecological or related preventive health services, the encounter is not a family planning encounter and the client is not a family planning user.

If a client is not an ongoing family planning user and obtains a service that does not include counseling, education, or clinical services related to achieving intended pregnancy or avoiding unintended pregnancy, the encounter is not a family planning encounter and the client is not a family planning user.

Example: A new client who receives STD services, but no counseling, education, or clinical services aimed at avoiding an unintended pregnancy or achieving an intended pregnancy, is not a family planning user, and the encounter is not a family planning encounter. If, in addition to STD testing, this same client receives condoms or counseling about using condoms to prevent STD transmission, but does not receive counseling, education, or clinical services aimed at avoiding an unintended pregnancy, the client is not a family planning user and the encounter is not a family planning encounter.

Question – If a clinic aide or nurse is trained and authorized to give contraceptive injections (e.g., Depo-Provera), should an agency report the encounter as an encounter with a Clinical Services Provider?

Answer – No. For purposes of reporting on the FPAR, a clinic aide is classified as an Other Services Provider even though he or she may be trained and authorized to give contraceptive injections. Only physicians, physician assistants, advanced practice nurses (certified nurse midwife or nurse practitioner), or registered nurses with an expanded scope of practice who are trained and permitted by state-specific regulations to perform all aspects of the user (male and female) physical assessments recommended for contraceptive, related preventive health, and basic infertility care may be reported as Clinical Services Providers. Report full-time equivalents (FTEs) for each type of Clinical Services Provider in Table 13, Rows 1a to 1c, and the number of encounters with Clinical Services Providers in Table 13, Row 1. Report the number of encounters with Other Services Providers in Table 13, Row 2.

Grantee Profile Cover Sheet

The Grantee Profile Cover Sheet provides important identifying and contact information for the grantee and the grantee’s FPAR contact. The Cover Sheet also provides information about the network of service providers supported by the Title X grant.

Instructions

If you are submitting the FPAR using the FPAR Data System, the system will automatically populate the following fields: grantee legal name; address of grantee administrative offices; and name, title, and contact information for the Title X Project Director. If there is an error in the pre-populated fields, enter the corrected information in the Grantee Profile Cover Sheet “Note” field and notify the RPO that key grant information has changed. Grantees can modify all other fields. For grantees submitting a hardcopy FPAR by e-mail or fax, follow these instructions:

Grantee Legal Name – Enter the name of the legal recipient of the Title X family planning services grant.

Address of Grantee Administrative Offices – Enter the grantee’s complete address, including nine-digit ZIP code.

Title X Project Director – Enter the name, title, mailing address, phone and fax numbers, and e‑mail address for the agency representative responsible for directing the grantee’s Title X project.

Grantee Contact Person (Person completing FPAR) – Enter the name, title, mailing address, phone and fax numbers, and e-mail address for the agency representative with primary responsibility for preparing the FPAR.

Number of Subrecipients (Delegates or Subcontractors) Supported by the Title X Grant – Report the number of subrecipients (delegates or subcontractors) that receive funding through the grantee’s Title X service grant.

Number of Family Planning Service Sites Supported by the Title X Grant – Report the total number of family planning service sites supported by the Title X grant and represented in the FPAR data. If the number of service sites supported by the Title X grant is different from the number provided in the grant application, check the box and explain the reason for this difference in the Grantee Profile Cover Sheet “Note” field.

Questions about the Grantee Profile

Question – Is the Grantee Profile Cover Sheet different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA has made no changes to the Grantee Profile Cover Sheet in the October 2016 version of the Title X FPAR Forms and Instructions.

Question – If Title X services are provided at a clinic and two non-clinic service sites, should the grantee report one or three sites as the total number of service sites supported by the Title X grant?

Answer – For purposes of FPAR reporting, the grantee should count and report any established unit, clinic, or non-clinic site where staff provide Title X services and where at least some of the encounters between the family planning providers and the individuals served meet the requirements of a family planning encounter. Refer to the definition of a “Family Planning Service Site” on page 8. OPA assumes that each of the sites reported in the Grantee Profile contributes data to the grantee’s FPAR. If all three sites in this example contribute data to the FPAR, the grantee should include these three service sites in the total number of sites reported on the Grantee Profile Cover Sheet.

Grantee Profile Cover Sheet

Grantee Legal Name	Name
Address of Grantee Administrative Offices	Street
	City
	State		ZIP + 4	–
Title X Project Director	Name
	Title
	Street
	City
	State		ZIP + 4	–
	Phone
	Fax
	E-Mail
Grantee Contact (Person completing FPAR)	Name
	Title
	Street
	City
	State		ZIP + 4	–
	Phone
	Fax
	E-Mail
Number of Subrecipients (Delegates or Subcontractors) Supported by the Title X Grant
Number of Family Planning Service Sites Supported by the Title X Grant		Check if total number of sites is different from application

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Family Planning User Demographic Profile

Data reported in Tables 1 through 3 allow program administrators to monitor access to and use of Title X services among the diverse population these projects aim to serve. These FPAR tables describe the demographic characteristics of family planning users, including the distribution of users by age group, sex, ethnicity, and race.

The numbers reported in Table 1, Row 10, serve as consistency checkpoints in subsequent FPAR tables. The values in these tables are identified with unique, double-letter identifiers (AA, BB, and CC).

Instructions

Table 1 – Report the unduplicated number of family planning users by age group and sex.

Table 2 – Report the unduplicated number of female family planning users by race and ethnicity.

Table 3 – Report the unduplicated number of male family planning users by race and ethnicity.

Terms and Definitions

Age Group – Categorize family planning users based on their age as of June 30 of the reporting period.

Race and Ethnicity – The categories for reporting ethnicity and race in the FPAR conform to the Office of Management and Budget (OMB) 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity⁵ and are used by other HHS programs and compilers of such national data sets as the National Survey of Family Growth. If an agency wants to collect data for ethnicity or race subcategories, the agency must be able to aggregate the data reported into the OMB minimum standard set of ethnicity and race categories.

OMB encourages self-identification of race. When respondents are allowed to self-identify or self-report their race, agencies should adopt a method that allows respondents to mark or select more than one of the five minimum race categories. Appendix A to this form provides general guidance and a list of resources regarding collection of multi-race responses.

The two minimum OMB categories for reporting ethnicity are as follows:

Hispanic or Latino (All Races) – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

Not Hispanic or Latino (All Races) – A person not of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

The five minimum categories for reporting race are as follows:

American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American – A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific islands.

White – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Questions about Tables 1 through 3

Question – Is Table 1, Table 2, or Table 3 different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)

Answer – OPA has made no changes to Table 1, Table 2, or Table 3 in the October 2016 version of the Title X FPAR Forms and Instructions.

Question – What if a client self-identifies as Hispanic or Latino, but was born in the United States?

Answer – Report as Hispanic or Latino family planning users of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, including those Hispanic or Latino users who were born in the United States.

Question – Should clients from Brazil or Haiti or who are of Brazilian or Haitian descent be classified as Hispanic or Latino?

Answer – All clients who self-identify as Hispanic or Latino should be classified as Hispanic or Latino regardless of country of origin. Clients who identify solely as Brazilian or Haitian should not be classified as Hispanic or Latino.

Question – What if a client does not self-identify with any of the OMB minimum standard race categories?

Answer – According to the 1997 OMB guidance, all races are represented in Tables 2 and 3, and technically every client should be included in one of these categories. Nevertheless, a client may not self-identify with any of the OMB race categories or may refuse to report his or her race. Providers must respect a client’s right to refuse to report his or her race or to self-identify with any of the race categories. Providers may wish to include the definition of each race category on their intake forms (if space and formatting permit) and to familiarize themselves with the OMB definitions for each race category so they can assist clients who have questions. Grantees should report the number of users with missing or unknown race information in the “unknown/not reported” race category.

Hispanic or Latino clients account for a high proportion of family planning users for whom race data are unknown or not reported. The structure of Tables 2 and 3 allows OPA to identify the numbers of female and male Hispanic or Latino clients that do not self-identify with any of the OMB race categories.

Question – What if a client self-identifies with more than one of the five minimum OMB race categories?

Answer – According to the 1997 OMB guidance, when self-identification is used, the data collection method should allow clients to self-report more than one race. A single “multiracial” category should not appear as an option on the intake form. At a minimum, the client intake form should list the five OMB race categories, and clients should be instructed to check or select “one or more” or “all that apply.” Report clients who self-identify with two or more races in Row 6 of Table 2 (female users) or Table 3 (male users).

Appendix A to this form provides general guidelines and a sample question for collecting multi-race responses. Please note that the information in Appendix A is not comprehensive and serves only to highlight important considerations and ideas for handling multi-race response. Grantees interested in issues surrounding collection of race data should consult the resource list in Appendix A.

Table 1
Unduplicated Number of Family Planning Users by Age Group and Sex

Age Group (Years)		Female Users (A)	Male Users (B)	Total Users (Sum Cols A + B) (C)
1	Under 15
2	15 to 17
3	18 to 19
4	20 to 24
5	25 to 29
6	30 to 34
7	35 to 39
8	40 to 44
9	Over 44
10	Total Users (sum rows 1 to 9)
		Checkpoint Reference AA	Checkpoint Reference BB	Checkpoint Reference CC

Table 2
Unduplicated Number of Female Family Planning Users by Race and Ethnicity

Race		Hispanic or Latino (A)	Not Hispanic or Latino (B)	Unknown/ Not Reported (C)	Total Female Users (Sum Cols A to C) (D)
1	American Indian or Alaska Native
2	Asian
3	Black or African American
4	Native Hawaiian or Other Pacific Islander
5	White
6	More than one race
7	Unknown/not reported
8	Total Female Users (sum rows 1 to 7)
					Checkpoint Reference AA

Table 3
Unduplicated Number of Male Family Planning Users by Race and Ethnicity

Race		Hispanic or Latino (A)	Not Hispanic or Latino (B)	Unknown/ Not Reported (C)	Total Male Users (Sum Cols A to C) (D)
1	American Indian or Alaska Native
2	Asian
3	Black or African American
4	Native Hawaiian or Other Pacific Islander
5	White
6	More than one race
7	Unknown/not reported
8	Total Male Users (sum rows 1 to 7)
					Checkpoint Reference BB

Family Planning User Economic and Social Profile

The data reported in Tables 4 through 6 provide OPA with information on key social and economic characteristics of individuals who receive family planning and related preventive health care in Title X-funded service sites. OPA uses these data to monitor the program’s role in supporting the health care safety net for individuals who confront financial or sociocultural barriers to care due to low income, lack of health insurance, or limited English proficiency (LEP). In addition, OPA uses these data to assess the program’s compliance with legislative or regulatory mandates, including priority care to individuals who are low-income and ensuring meaningful access to clients with LEP.⁶

Instructions

Table 4 – Report the unduplicated number of family planning users by income level.

Table 5 – Report the unduplicated number of family planning users by their principal health insurance coverage status.

Table 6 – Report the unduplicated number of family planning users with LEP.

Terms and Definitions

Income Level as a Percentage of the HHS Poverty Guidelines – Grantees are required to collect family income data from all users in order to determine charges based on the schedule of discounts.³ In determining a user’s family income, agencies should refer to the poverty guidelines updated periodically in the Federal Register by HHS under the authority of 42 USC 9902(2).⁷ Report the unduplicated number of users by income level, using the most current income information available. For additional guidance, see the Program Requirements for Title X Funded Family Planning Projects.⁸

Principal Health Insurance covering Primary Medical Care – Refers to public and private health insurance plans that provide a broad set of primary medical care benefits to enrolled individuals. Report the most current health insurance coverage information available for the client even though he or she may not have used this health insurance to pay for family planning services received during his or her last encounter. For individuals who have coverage under more than one health plan, principal insurance is defined as the insurance plan that the agency would bill first (i.e., primary) if a claim were to be filed. Categories of health insurance covering primary medical care include public and private sources of coverage.

Public Health Insurance Covering Primary Medical Care – Refers to federal, state, or local government health insurance programs that provide a broad set of primary medical care benefits for eligible individuals. Examples of such programs include Medicaid (both regular and managed care), Medicare, the Children’s Health Insurance Program (CHIP), and other state or local government programs that provide a broad set of benefits. Also included are public-paid or public-subsidized private insurance programs.

Private Health Insurance Covering Primary Medical Care – Refers to health insurance coverage through an employer, union, or direct purchase that provides a broad set of primary medical care benefits for the enrolled individual (beneficiary or dependent). Private insurance includes insurance purchased for public employees or retirees or military personnel and their dependents (e.g., TRICARE or CHAMPVA).

Uninsured – Refers to clients who do not have a public or private health insurance plan that covers broad, primary medical care benefits. Clients whose services are subsidized through state or local indigent care programs, or clients insured through the Indian Health Service who obtain care in a non-participating facility, are considered uninsured.

Limited English Proficient (LEP) Users – Refers to family planning users who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English.⁶ Because of their limited English proficiency, LEP users derive little benefit from Title X services and information provided in English. In Table 6, report the unduplicated number of family planning users who required language assistance services (interpretation or translation) to optimize their use of Title X services. Include as LEP any user who received Title X services from bilingual staff in the user’s preferred non-English language, who was assisted by a competent agency or contracted interpreter, or who opted to use a family member or friend as an interpreter after refusing the provider’s offer of free language assistance services. Service providers should consult the Revised HHS LEP Guidance⁶ for further information about identifying LEP individuals and complying with language assistance requirements. Unless they are also LEP, do not include users who are visually or hearing impaired or have other disabilities.

Questions about Tables 4 through 6

Question – Is Table 4, Table 5, or Table 6 different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA has made no changes to Table 4, Table 5, or Table 6 in the October 2016 version of the Title X FPAR Forms and Instructions.

Question – If a client has health insurance that covers a broad set of primary medical care benefits, including some or all family planning services, but he or she chooses not to use his or her health insurance plan to pay for some or all of the cost of services, how should an agency classify this client for purposes of Table 5 reporting?

Answer – Although an insured client may elect not to use his or her health insurance to pay for services, he or she is considered insured and should be reported in either Row 1 or Row 2 of the table according to the type of health insurance coverage (public or private) that he or she has.

Question – Are Title X agencies required to verify client health insurance status?

Answer – No. The information required to complete Table 5 is based on clients’ self-reported insurance coverage. However, as stipulated in the program regulations (see 42 CFR Part 59.5(a)(9)),³ service providers are required to bill all third parties authorized or legally obligated to pay for services and to make reasonable efforts to collect charges without jeopardizing client confidentiality.

Question – How do I classify a client who has coverage for a specific type of care or health condition—for example, dental services or expanded Medicaid coverage under the Breast and Cervical Cancer Prevention and Treatment Act of 2000—but has no health insurance that provides a broad set of primary medical care benefits?

Answer – Users who do not have a health insurance plan that provides a broad set of primary medical care benefits, even though they may have coverage for a specific condition, are considered uninsured.

Question – If a client’s services are paid by a state’s Medicaid family planning expansion program (i.e., waiver demonstration project or State Plan Amendment [SPA]), is he or she considered insured for purposes of Table 5?

Answer – A client whose services are paid by a Medicaid family planning expansion is considered uninsured if he or she has no coverage under another public or private insurance plan that covers a broad set of primary medical care benefits. A Medicaid family planning expansion program that covers only family planning services does not cover a “broad set of primary medical care benefits.”

A client whose services are paid by a Medicaid family planning expansion is considered insured if he or she has a public or private insurance plan that covers a broad set of primary medical care benefits.

Question – In Table 6, should a user be reported as LEP if he or she receives care from a bilingual provider in his or her preferred, non-English language or if he or she receives language assistance from a trained (agency, contracted, or telephonic) or informal (friend or family member) interpreter?

Answer – In Table 6, report the number of users who are best served in a language other than English, including clients who received care from bilingual providers in their preferred, non-English language or received language assistance from trained or informal interpreters.

Confidentiality, privacy, conflicts of interest, and competence as medical services interpreters are several limitations of using family members or friends as interpreters in the Title X clinic setting. While in some cases an LEP client may feel more comfortable when a trusted family member or friend acts as an interpreter, the family member or friend may not be competent to provide quality and accurate interpretations, particularly if the service provided is complex or not of a routine nature. If a client opts to provide his or her own interpreter, and the service provider determines at any point during the service that the client’s interpreter is not competent in this role, the service provider should obtain the services of a competent interpreter.⁶

Table 4
Unduplicated Number of Family Planning Users by Income Level

Income Level as a Percentage of the HHS Poverty Guidelines		Number of Users (A)
1	100% and below
2	101% to 150%
3	151% to 200%
4	201% to 250%
5	Over 250%
6	Unknown/not reported
7	Total Users (sum rows 1 to 6)
		Checkpoint Reference CC

Table 5
Unduplicated Number of Family Planning Users by Principal Health Insurance Coverage Status

Principal Health Insurance Covering Primary Medical Care		Number of Users (A)
1	Public health insurance covering primary medical care
2	Private health insurance covering primary medical care
3	Uninsured (no public or private health insurance)
4	Unknown/not reported
5	Total Users (sum rows 1 to 4)
		Checkpoint Reference CC

Table 6
Unduplicated Number of Family Planning Users with Limited English Proficiency (LEP)

		Number of Users (A)
1	LEP users
2	Not LEP users
3	Unknown/not reported
4	Total Users (sum rows 1 to 3)
		Checkpoint Reference CC

Family Planning Method Use

Title X projects are required to provide a broad range of acceptable and effective, medically approved family planning methods and services.³ Tables 7 and 8 provide sex- and age-specific information on the types of family planning methods that female and male clients use to prevent unintended pregnancy. In addition, the tables provide information on the numbers of female and male clients who reported using no method, including the reason for nonuse.

Information on method use by age group for female (Table 7) and male (Table 8) users allows OPA to track patterns in method use over time at the state, regional, and national levels. In addition, these data allow OPA to examine the extent to which Title X providers contribute to increased access to and use of a broad range of acceptable and effective contraceptive methods, to monitor performance on contraceptive care measures,⁹ and to assess the program’s contribution to national health objectives (i.e., Healthy People) for family planning and disease prevention. These data also permit OPA to compare the data from Title X clinics with other sources of information, including the National Survey of Family Growth.

Instructions

Table 7 – Report the unduplicated number of female family planning users by primary method and age group.

Table 8 – Report the unduplicated number of male family planning users by primary method and age group.

Terms and Definitions

Age Group – Use the client’s age as of June 30 of the reporting period.

Primary Method of Family Planning – The primary method of family planning is the user’s method—adopted or continued—at the time of exit from his or her last encounter in the reporting period. If the user reports that he or she is using more than one family planning method, report the most effective one as the primary method. Family planning methods include the following:

Female Sterilization – In Table 7, report the number of female users who rely on female sterilization as their primary family planning method. Female sterilization refers to a contraceptive surgical (tubal ligation) or non-surgical (implant) procedure performed on a female user in the current or any previous reporting period.

Intrauterine Device or System (IUD/IUS) – In Table 7, report the number of female users who use a long-term hormonal or other type of intrauterine device (IUD) or system (IUS) as their primary family planning method.

Hormonal Implant – In Table 7, report the number of female users who use a long-term, subdermal hormonal implant as their primary family planning method.

1-Month Hormonal Injection – In Table 7, report the number of female users who use 1-month injectable hormonal contraception as their primary family planning method.

3-Month Hormonal Injection – In Table 7, report the number of female users who use 3-month injectable hormonal contraception as their primary family planning method.

Oral Contraceptive – In Table 7, report the number of female users who use any oral contraceptive, including combination and progestin-only (“mini-pills”) formulations, as their primary family planning method.

Contraceptive Patch – In Table 7, report the number of female users who use a transdermal contraceptive patch as their primary family planning method.

Vaginal Ring – In Table 7, report the number of female users who use a hormonal vaginal ring as their primary family planning method.

Cervical Cap or Diaphragm – In Table 7, report the number of female users who use a cervical cap or diaphragm (with or without spermicidal jelly or cream) as their primary family planning method.

Contraceptive Sponge – In Table 7, report the number of female users who use a contraceptive sponge as their primary family planning method.

Female condom – In Table 7, report the number of female users who use female condoms (with or without spermicidal foam or film) as their primary family planning method.

Spermicide (used alone) – In Table 7, report the number of female users who use only spermicidal jelly, cream, foam, or film (i.e., not in conjunction with another method of contraception) as their primary family planning method.

Fertility Awareness Method (FAM) or Lactational Amenorrhea Method (LAM) – Fertility awareness methods (FAMs) refer to family planning methods that rely on identifying the fertile days in each menstrual cycle when intercourse is most likely to result in a pregnancy. FAMs include Standard Days, Calendar Rhythm, TwoDay, Billings Ovulation, and SymptoThermal methods. The Lactational Amenorrhea Method (LAM) is the proactive application of exclusive breastfeeding during lactational amenorrhea for the first 6 months after delivery. To be effective, LAM requires full (i.e., no other liquid or solid given to infant) or nearly full (i.e., infrequent supplementation in small amounts, but not by bottle) breastfeeding.¹⁰ In Table 7, report the number of female users who use one or a combination of the FAMs listed above or who rely on LAM as their primary family planning method. In Table 8, Row 3, report male users who rely on a FAM as their primary method. Report male users who rely on LAM as their primary method in Table 8, Row 6, “Rely on female method(s).”

Abstinence – In Tables 7 and 8, report the number of female and male users, respectively, who rely on abstinence as their primary family planning method or who are not currently sexually active and therefore not using contraception. For purposes of FPAR reporting, abstinence is defined as refraining from oral, vaginal, and anal intercourse.¹¹

Withdrawal and Other Methods – In Tables 7 and 8, report the number of female and male users, respectively, who use withdrawal or other methods not listed in the tables as their primary family planning method.

Method Unknown or Not Reported – In Tables 7 and 8, report the number of female and male users, respectively, for whom the primary family planning method at exit from the last family planning encounter is unknown or not reported.

No Method–[Partner] Pregnant or Seeking Pregnancy – In Tables 7 and 8, report the number of female and male users, respectively, who are not using any family planning method because they (Table 7) or their partners (Table 8) are pregnant or seeking pregnancy.

No Method–Other Reason – In Tables 7 and 8, report the number of female and male users, respectively, who are not using any family planning method to avoid pregnancy due to reasons other than pregnancy or seeking pregnancy, including if either partner is sterile without having been sterilized surgically, if either partner has had a non-contraceptive surgical procedure that has rendered him or her unable to conceive or impregnate, or if the user has a sexual partner of the same sex.

Vasectomy – Refers to conventional incisional or no-scalpel vasectomy performed on a male user, or the male partner of a female user, in the current or any previous reporting period. In Table 7, report the number of female users who rely on vasectomy as their (partner’s) primary family planning method. In Table 8, report the number of male users on whom a vasectomy was performed in the current or any previous reporting period.

Male condom – In Table 7, report the number of female users who rely on their sexual partner to use male condoms (with or without spermicidal foam or film) as their primary family planning method. In Table 8, report the number of male users who use male condoms (with or without spermicidal foam or film) as their primary family planning method.

Rely on Female Method(s) – In Table 8, report the number of male family planning users who rely on their female partners’ family planning methods as their primary methods. “Female” contraceptive methods include female sterilization, IUD/IUS, hormonal implants, 1- and 3-month hormonal injections, oral contraceptives, the contraceptive patch, the vaginal ring, cervical cap or diaphragm, the contraceptive sponge, female condoms, LAM, and spermicides.

Questions about Tables 7 and 8

Question – Is Table 7 or Table 8 different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA has made no changes to Table 7 or Table 8 in the October 2016 version of the Title X FPAR Forms and Instructions.

Question – If family planning users, male or female, rely on their partners’ family planning method for pregnancy prevention, how should the grantee report this information in Table 7 or 8?

Answer – If a female family planning user relies on a male family planning method (e.g., vasectomy or male condoms) for pregnancy prevention, report this user in Table 7, Row 16 or 17. If the female user relies on withdrawal, report this user in Table 7, Row 15 (“Withdrawal or other method”).

If a male family planning user relies on a “female” family planning method for pregnancy prevention (i.e., female sterilization, IUD, hormonal implant, 1- or 3-month hormonal injection, oral contraceptives, contraceptive patch, vaginal ring, cervical cap or diaphragm, contraceptive sponge, female condoms, LAM, or spermicides), report this user in Table 8, Row 6.

If a male client and his female sexual partner rely on pills (for pregnancy prevention) and condoms (for STD or pregnancy prevention), record the method that is most effective in terms of pregnancy prevention (i.e., pills). In this example, the male user’s family planning method would be “Rely on female method(s)” (Table 8, Row 6). If this same male client were to report that he relies on condoms for pregnancy prevention because of his partner’s inconsistent pill use, report male condoms (Table 8, Row 2) as this client’s primary contraceptive method.

Question – How should a grantee report a user who exits the encounter with no method because he or she, or his or her sexual partner, has had a non-contraceptive surgical procedure that has rendered one of the two sexual partners unable to conceive or impregnate?

Answer – Report female users in Table 7, Row 19 (“No method–Other reason”) and male users in Table 8, Row 8 (“No method–Other reason”).

Table 7
Unduplicated Number of Female Family Planning Users by Primary Method and Age Group

Primary Method	Under 15 (A)	15 to 17 (B)	18 to 19 (C)	20 to 24 (D)	25 to 29 (E)	30 to 34 (F)	35 to 39 (G)	40 to 44 (H)	Over 44 (I)	Total Female Users (Sum Cols A to I) (J)
1 Female sterilization
2 IUD or IUS
3 Hormonal implant
4 1-Month hormonal injection
5 3-Month hormonal injection
6 Oral contraceptive
7 Contraceptive patch
8 Vaginal ring
9 Cervical cap or diaphragm
10 Contraceptive sponge
11 Female condom
12 Spermicide (used alone)
13 FAM or LAM
14 Abstinence
15 Withdrawal or other method
Rely on Male Method 16 Vasectomy
17 Male condom
No Method 18 Pregnant/seeking pregnancy
19 Other reason
Unknown/Not Reported 20 Unknown/not reported
21 Total Female Users (sum rows 1 to 20)
Note: IUD=Intrauterine Device. IUS=Intrauterine System. FAM=Fertility Awareness Method. LAM=Lactational Amenorrhea Method.										See Checkpoint Reference AA

Table 8
Unduplicated Number of Male Family Planning Users by Primary Method and Age Group

Primary Method	Under 15 (A)	15 to 17 (B)	18 to 19 (C)	20 to 24 (D)	25 to 29 (E)	30 to 34 (F)	35 to 39 (G)	40 to 44 (H)	Over 44 (I)		Total Male Users (Sum Cols A to I) (j)
1 Vasectomy
2 Male condom
3 FAM
4 Abstinence
5 Withdrawal or other method
Rely on Female Method 6 Rely on female method(s)
No Method 7 Partner pregnant/seeking pregnancy
8 Other reason
Unknown/Not Reported 9 Unknown/not reported
10 Total Male Users (sum rows 1 to 9)
Note: FAM=Fertility Awareness Method.										See Checkpoint Reference BB

Cervical and Breast Cancer Screening

Tables 9 and 10 provide information on the cervical and breast cancer screening activities that are performed within the scope of a grantee’s approved Title X project. Data from these tables permit OPA to monitor achievement of program performance objectives and adoption of cervical and breast cancer screening recommendations established by federal agencies and professional medical organizations. In addition, OPA uses these data to assess the number of abnormal results that require further followup and to assess the program’s contribution to national health objectives (i.e., Healthy People) related to early cancer detection and health promotion.

Instructions

Table 9 – Report the following information on cervical cancer screening activities. Refer to the chart in Exhibit 1 for reporting information on Pap test results:

Unduplicated number of female users who obtained a Pap test
Number of Pap tests performed
Number of Pap tests with an ASC or higher result according to the 2014 Bethesda System¹² (see Exhibit 1). ASC or higher results include ASC-US; ASC-H; LSIL; HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; endocervical AIS; adenocarcinoma; or other malignant neoplasms
Number of Pap tests with an HSIL or higher result according to the 2014 Bethesda System¹² (see Exhibit 1). HSIL or higher results include HSIL; squamous cell carcinoma; AGC; AGC, favor neoplastic; endocervical AIS; adenocarcinoma; or other malignant neoplasms

Table 10 – Report the following information on breast cancer screening and referral activities:

Unduplicated number of female users receiving a clinical breast exam (CBE)
Unduplicated number of female users referred for further evaluation based on CBE results

Terms and Definitions

Tests – Report Pap tests and CBEs performed during the reporting period that are provided within the scope of the grantee’s Title X project.

Squamous Cell Abnormalities – The 2014 Bethesda System¹² (see Exhibit 1) classifies squamous cell abnormalities into the following categories:

Atypical squamous cells of undetermined significance (ASC-US) or atypical squamous cells, cannot exclude HSIL (ASC-H) – ASC is a finding of abnormal squamous cells in the tissue lining the outer part of the cervix. ASC-US is the most common abnormal finding in a Pap test. An ASC-US result may be caused by a human papillomavirus (HPV), a benign growth (e.g., cyst or polyp), or low hormone levels in menopausal women. ASC-H may be a sign of a high-grade squamous intraepithelial lesion (HSIL), which may become cervical cancer if untreated.¹³
Low-grade squamous intraepithelial lesion (LSIL) is a finding of slightly abnormal cells on the surface of the cervix caused by certain types of HPV. LSIL is a common abnormal finding on a Pap test. Mild dysplasia and cervical intraepithelial neoplasia (CIN) 1 are other terms for referring to LSILs.¹³
High-grade squamous intraepithelial lesion (HSIL) is a growth on the surface of the cervix with moderately or severely abnormal cells. HSILs are usually caused by certain types of HPV. If not treated, these abnormal cells may become cancer and spread to normal tissue. HSIL encompasses moderate dysplasia (CIN 2) or severe dysplasia and carcinoma in situ (CIN 3).¹³
Squamous cell carcinoma is a finding of cancer in the squamous cells of the cervix.¹³

Glandular Cell abnormalities – The 2014 Bethesda System¹²(see Exhibit 1) classifies glandular cell abnormalities into the following categories:

Atypical glandular cells (AGCs) is a finding of abnormal cells that come from glands in the walls of the cervix. The presence of these abnormal cells may be a sign of more serious lesions or cancer.¹³ The 2014 Bethesda System¹² (see Exhibit 1) subdivides AGCs into two categories:

AGC—endocervical, endometrial, or glandular cells—not otherwise specified
AGC—endocervical or glandular cells—favor neoplastic.

Endocervical adenocarcinoma in situ (AIS) is a finding of abnormal cells found in the glandular tissue lining the endocervical canal. AIS may become cancer and spread to nearby normal tissue.¹³
Adenocarcinoma is a finding of cancer in endocervical, endometrial, extrauterine, or not otherwise specified glandular tissue.¹³

Questions about Tables 9 and 10

Question – Is Table 9 or Table 10 different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA has made no changes to Table 9 or Table 10 in the October 2016 version of the Title X FPAR Forms and Instructions. OPA has updated the abnormal result descriptions and Exhibit 1 to reflect the 2014 Bethesda System.

Question – How should grantees count and report a CBE that is part of a “bundled” billing or service code (e.g., as part of a comprehensive exam)?

Answer – Grantees who do not have a count of the actual number of CBEs performed because of the structure of the “bundled” billing or service code should report the estimated number of CBEs performed in Table 10, Row 1, and provide a brief explanation about the estimated figure in the Table 10 “Note” field.

Question – In Table 9, does the total number of Pap tests reported in Row 3 include tests reported in Row 4?

Answer – Yes. Table 9, Row 3, will include the tests reported in Row 4 because tests with a result of HSIL or higher are also tests with a result of ASC or higher.

Exhibit 1. The 2014 Bethesda System

SPECIMEN TYPE:

Indicate conventional smear (Pap smear) vs. liquid-based preparation vs. other

SPECIMEN ADEQUACY

Satisfactory for evaluation (describe presence or absence of endocervical/transformation zone component and any other quality indicators, e.g., partially obscuring blood, inflammation, etc.)
Unsatisfactory for evaluation (specify reason)
Specimen rejected/not processed (specify reason)
Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality because of (specify reason)

GENERAL CATEGORIZATION (optional)

Negative for Intraepithelial Lesion or Malignancy
Other: See Interpretation/Result (e.g., endometrial cells in a woman ≥45 years of age)
Epithelial Cell Abnormality: See Interpretation/Result (specify ‘squamous’ or ‘glandular’ as appropriate)

INTERPRETATION/RESULT

NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY

(When there is no cellular evidence of neoplasia, state this in the General Categorization above and/or in the Interpretation/Result section of the report--whether or not there are organisms or other non-neoplastic findings)

Non-Neoplastic Findings (optional to report)

Non-neoplastic cellular variations

Squamous metaplasia
Keratotic changes
Tubal metaplasia
Atrophy
Pregnancy-associated changes

Reactive cellular changes associated with:

Inflammation (includes typical repair)

Lymphocytic (follicular) cervicitis

Radiation
Intrauterine contraceptive device (IUD)

Glandular cells status post hysterectomy

Organisms

Trichomonas vaginalis
Fungal organisms morphologically consistent with Candida spp.
Shift in flora suggestive of bacterial vaginosis
Bacteria morphologically consistent with Actinomyces spp.
Cellular changes consistent with herpes simplex virus
Cellular changes consistent with cytomegalovirus

OTHER

Endometrial cells (in a woman ≥45 years of age) (Specify if “negative for squamous intraepithelial lesion”)

Shape2 Shape1 EPITHELIAL CELL ABNORMALITIES

SQUAMOUS CELL

Atypical squamous cells

of undetermined significance (ASC-US)
cannot exclude HSIL (ASC-H)

Low-grade squamous intraepithelial lesion (LSIL) (encompassing: HPV/mild dysplasia/CIN 1)
High-grade squamous intraepithelial lesion (HSIL) (encompassing: moderate and
severe dysplasia, CIS; CIN 2 and CIN 3)

with features suspicious for invasion (if invasion is suspected)

Report in Table 9 Row 3

Squamous cell carcinoma

GLANDULAR CELL

Atypical

Report in Table 9 Row 4

endocervical cells (NOS or specify in comments)
endometrial cells (NOS or specify in comments)
glandular cells (NOS or specify in comments)

Atypical

endocervical cells, favor neoplastic
glandular cells, favor neoplastic

Endocervical adenocarcinoma in situ
Adenocarcinoma

endocervical
endometrial
extrauterine
not otherwise specified (NOS)

Shape7 OTHER MALIGNANT NEOPLASMS: (specify)

ADJUNCTIVE TESTING

Provide a brief description of the test method(s) and report the result so that it is easily understood by the clinician.

COMPUTER-ASSISTED INTERPRETATION OF CERVICAL CYTOLOGY

If case examined by an automated device, specify device and result.

EDUCATIONAL NOTES AND COMMENTS APPENDED TO CYTOLOGY REPORTS (optional)

Suggestions should be concise and consistent with clinical follow-up guidelines published by professional organizations (references to relevant publications may be included).

Source: Nayar, R., & Wilbur, D. C. (2015). The Pap test and Bethesda 2014. Acta Cytologica 2015 (59)121-132 (DOI:10.1159/000381842) (Copyright 2015, S. Karger AG. All rights reserved. Reprinted with permission.)

Table 9
Cervical Cancer Screening Activities

Screening Activity		Number of Female Users or Number of Tests (A)
1	Unduplicated number of female users who obtained a Pap test
2	Number of Pap tests performed
3	Number of Pap tests with an ASC or higher result
4	Number of Pap tests with an HSIL or higher result

Table 10
Clinical Breast Exams and Referrals

Screening Activity		Number of Female Users (A)
1	Unduplicated number of female users who received a clinical breast exam (CBE)
2	Unduplicated number of female users referred for further evaluation based on their CBE

Sexually Transmitted Disease (STD) Screening

Tables 11 and 12 provide information on STD testing activities that are performed within the scope of a grantee’s approved Title X project. Data from these tables permit OPA to monitor compliance with legislative mandate, achievement of program performance objectives, and adoption of STD and HIV screening recommendations established by federal agencies and professional medical organizations. In addition, OPA uses these data to assess the program’s contribution to national health objectives (i.e., Healthy People) for disease prevention (e.g., STDs and HIV) and health promotion.

Instructions

Table 11 – Report the unduplicated number of family planning users tested for chlamydia, by age group (under 15, 15–17, 18–19, 20–24, and 25 and over) and sex.

Table 12 – Report the following STD testing information:

Number of gonorrhea tests performed, by sex
Number of syphilis tests performed, by sex
Number of confidential HIV tests performed, by sex
Number of confidential HIV tests with a positive result
Number of anonymous HIV tests performed

Terms and Definitions

Age Group – Use the client’s age as of June 30 of the reporting period.

Tests – Report STD (chlamydia, gonorrhea, and syphilis) and HIV (confidential and anonymous) tests performed during the reporting period that are provided within the scope of the grantee’s Title X project. Do not report tests performed in an STD clinic operated by the Title X-funded agency, unless the activities of the STD clinic are within the defined scope of the agency’s Title X project.

Questions about Tables 11 and 12

Question – Is Table 11 or Table 12 different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA has made no changes to Table 11 or Table 12 in the October 2016 version of the Title X FPAR Forms and Instructions.

Question – How should grantees that fund agencies operating co-located Title X and STD clinics report STD tests?

Answer – Do not report tests performed in an STD clinic operated by the Title X-funded agency or co-located with the Title X-funded service site unless (1) the activities of the STD clinic are within the defined scope of the grantee’s Title X project and (2) the STD tests are provided to clients who meet the FPAR user and encounter definitions (see pages 7 and 8). A client seeking STD services, who refuses family planning counseling, information, or services that are offered, should not be reported as a family planning user.

Question – In Table 12, Row 3, should grantees count and report confirmatory HIV tests separately from initial HIV tests (i.e., one versus two tests)?

Answer – To the extent possible, a grantee should report all HIV tests—initial and confirmatory—performed within the scope of their Title X projects, including HIV tests performed on site and tests for which a specimen is collected on site and analyzed off site (e.g., laboratory). If an offsite laboratory performs a confirmatory test using the same specimen obtained for the initial test, grantees should not count the confirmatory test unless (1) the provider has billing or other transaction records to document that the laboratory performed a second/confirmatory test and (2) compiling and reporting confirmatory test counts do not pose an undue burden. Grantees should use the Table 12 “Note” field to explain if HIV test counts exclude confirmatory tests.

Question – Should grantees include preliminary positive rapid HIV tests in the total number of positive HIV test results reported in Table 12, Row 4?

Answer – No. The total number of confidential positive HIV tests should include only the number of standard (i.e., not rapid) HIV tests with a positive result and the number of preliminary positive rapid HIV tests confirmed to be positive.

Table 11
Unduplicated Number of Family Planning Users Tested for Chlamydia by Age Group and Sex

Age Group (Years)	Female Users (A)	Male Users (B)
1 Under 15
2 15 to 17
3 18 to 19
4 20 to 24
5 25 and over
6 Total Users (sum rows 1 to 5)

Table 12
Number of Tests for Gonorrhea, Syphilis, and HIV and Number of Positive Confidential HIV Tests

Test Type	Female Tests (A)	Male Tests (B)	Total Tests (Sum Cols A and B) (C)
1 Gonorrhea
2 Syphilis
3 HIV – All confidential tests
4 HIV – Positive confidential tests
5 HIV – Anonymous tests

Substance Use Disorder Screening

Tables 12b and 12c provide information on substance use disorder (SUD) screening activities that are performed within the scope of a grantee’s approved Title X project. Data from these tables allow OPA to measure the extent to which Title X family planning users receive routine screening for SUD, as recommended by several federal agencies and professional medical organizations. Data from these tables also provide OPA with information on the types of screening or assessment tools or instruments that providers are using to screen clients. The provision of tools to support SUD screening in Title X-funded family planning services is a key program issue. Finally, OPA uses these SUD screening data to assess the program’s contribution to national health objectives (i.e., Healthy People) to reduce alcohol and drug misuse and related SUDs.

Instructions

Table 12b – Report the unduplicated number of female family planning users by SUD screening status and age group.

Table 12c – Report the unduplicated number of male family planning users by SUD screening status and age group.

Terms and Definitions

age group – Categorize female and male family planning users based on their age as of June 30 of the reporting period.

substance – A psychoactive compound with the potential to cause health and social problems, including substance use disorders (and their most severe manifestation, addiction).¹⁴

substance use – The use—even one time—of any substance.¹

substance misuse – The use of any substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them. For some substances or individuals, any use would constitute misuse (e.g., underage drinking, injection drug use). Substances that are commonly misused can be categorized into three groups: alcohol, illicit drugs (includes prescription drugs used nonmedically), and over-the-counter (OTC) drugs.¹

Examples of commonly misused substances are shown in the chart below:

Commonly Misused Substances

Substance	Representative examples
Alcohol	Beer, wine, malt liquor, and distilled spirits
Illicit Drugs	Cannabinoids (marijuana, hashish, synthetic cannabinoids) Club drugs (3,4-methylenedioxy-methamphetamine [MDMA or ecstasy], flunitrazepam [Rohypnol], gamma-hydroxybutyrate [GHB], synthetic cathinones [bath salts]) Dissociative drugs (ketamine, phencyclidine [PCP] and analogs, Salvia divinorum [salvia], dextromethorphan [DXM]) Hallucinogens (lysergic acid diethylamide [LSD or acid], N,N-dimethyltryptamine [DMT], mescaline, psilocybin) Illicit opioids (heroin, opium, Mitragyna speciosa [kratom], illicitly manufactured fentanyl [IMF]) Stimulants (cocaine, amphetamine, Catha edulis [khat], methamphetamine) Prescription opioid pain relievers Prescription sedatives (barbiturates, benzodiazepines, sleep medications) Prescription stimulants
OTC or Other	Cough and cold medicines (DXM or dextromethorphan) Inhalants (includes amyl nitrite, cleaning fluids, gasoline and lighter gases, anesthetics, solvents, spray paint, nitrous oxide) Tobacco (includes cigarettes, smokeless tobacco, cigars, and pipe tobacco)

substance use disorder – A medical illness caused by repeated misuse of a substance or substances.¹ Substance use disorder occurs when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.¹⁵

substance use disorder screening – SUD screening is a process for evaluating the possible presence of a problem; it involves asking questions carefully designed to determine whether a more thorough evaluation is warranted.¹⁶ Various agencies within the U.S. Department of Health and Human Services (e.g., Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration [SAMHSA], and the National Institute on Drug Abuse) and professional organizations (e.g., American Society of Addiction Medicine, American College of Obstetricians and Gynecologists, and American Academy of Pediatrics) recommend routine screening in primary and other health care settings to identify patients who may have or be at risk of developing a SUD. The goal of routine SUD screening is early identification that leads to early and proper intervention and care. To avoid bias and reduce missed opportunities, routine screening should be provided equally to all people, regardless of age, sex, race, ethnicity, or socioeconomic status.¹⁷ Providers who screen for SUD should be familiar or have established referral arrangements with SUD resources in their community where they can refer clients for whom assessment and care beyond a brief intervention is required.¹⁸ For FPAR reporting purposes, Title X providers must document that SUD screening was performed.

substance use disorder screening tool – OPA encourages Title X providers to use validated SUD screening tools that screen for commonly misused substances, are designed for use in the primary care setting, and are appropriate for the population (e.g., adult or adolescent) being screened. Other considerations in the choice of a screening tool include the cost and ease of administering it and its acceptance by patients.³ A validated screening tool is an instrument that has been psychometrically tested for reliability (the ability to produce consistent results), validity (the ability to measure what is intended), and sensitivity (the probability of correctly identifying a patient who has or is at risk for developing a SUD).^¹⁹ Various federal and other authoritative websites offer information and links to validated screening and assessment tools, including:

National Institute on Drug Abuse:
https://www.drugabuse.gov/nidamed-medical-health-professionals/screening-tools-resources/chart-screening-tools
SAMHSA-Health Resources and Services Administration, Center for Integrated Health Solutions: https://www.integration.samhsa.gov/clinical-practice/screening-tools#drugs
American Society of Addiction Medicine: https://www.asam.org/education/live-online-cme/fundamentals-program/additional-resources/screening-assessment-for-substance-use-disorders/screening-assessment-tools
Society for Adolescent Health and Medicine: https://www.adolescenthealth.org/Topics-in-Adolescent-Health/Substance-Use/Clinical-Care-Guidelines/Screening-Tools.aspx

Questions about Tables 12b and 12c

Question – Are Tables 12b and 12c different from the previous FPAR?

Answer – Yes, these two tables are new to the FPAR and have been added to the October 2019 version of the Title X FPAR Forms and Instructions.

Question – If a family planning client is screened for use of alcohol or tobacco but not for other commonly misused or abused substances (e.g., misuse of prescription drugs), how should this user be reported in Tables 12b and 12c?

Answer – Clients who are screened for use or misuse of alcohol or tobacco but not for use of any illicit drugs (see chart) should be reported according to their age group in Column C, “Not Screened.”

Table 12b
Unduplicated Number of Female Family Planning Users
Screened for a Substance Use Disorder by Age Group

Age Group		Screened Using Validated^a Tool (A)	Screened Using Other Tool (B)	Not Screened (C)	Screening Status Unknown/Not Reported (D)	Total Female Users (Sum Cols A through D) (E)
1	Under 20
2	20 to 29
3	30 to 39
4	40 or older
5	Total Female Users (sum rows 1 through 4)
^aA validated SUD screening tool is one that has been psychometrically tested for reliability (produces consistent results when repeated), validity (measures what is intended), and sensitivity (the probability of correctly identifying a patient who has or is at risk for developing a SUD).						Checkpoint Reference AA

Table 12c
Unduplicated Number of Male Family Planning Users
Screened for a Substance Use Disorder by Age Group

Age Group		Screened Using Validated^a Tool (A)	Screened Using Other Tool (B)	Not Screened (C)	Screening Status Unknown/Not Reported (D)	Total Male Users (Sum Cols A through D) (E)
1	Under 20
2	20 to 29
3	30 to 39
4	40 or older
5	Total Male Users (sum rows 1 through 4)
^aA validated SUD screening tool is one that has been psychometrically tested for reliability (produces consistent results when repeated), validity (measures what is intended), and sensitivity (the probability of correctly identifying a patient who has or is at risk for developing a SUD).						Checkpoint Reference BB

Family Planning Encounters and Clinical Services Provider Staffing

Table 13 provides OPA with information on the number and type of family planning encounters, and the use of Clinical Services Providers to deliver Title X-funded family planning and related preventive health services.

Instructions

Table 13 – Report the following provider staffing and encounter data:

Number of full-time equivalent (FTE) family planning Clinical Services Providers, by type of provider
Number of family planning encounters with Clinical Services Providers
Number of family planning encounters with Other Services Providers

Terms and Definitions

Family Planning Provider – A family planning provider is the individual who assumes primary responsibility for assessing a client and documenting services in the client record. Providers include those agency staff that exercise independent judgment as to the services rendered to the client during an encounter. Two general types of providers deliver Title X family planning services: Clinical Services Providers and Other Services Providers.

Clinical Services Providers – Include physicians (family and general practitioners, specialists), physician assistants, nurse practitioners, certified nurse midwives, and registered nurses with an expanded scope of practice who are trained and permitted by state- specific regulations to perform all aspects of the user (male and female) physical assessments recommended for contraceptive, related preventive health, and basic infertility care. Clinical Services Providers are able to offer client education, counseling, referral, followup, and clinical services (physical assessment, treatment, and management) relating to a client’s proposed or adopted method of contraception, general reproductive health, or infertility treatment, in accordance with the Program Guidelines.

Family Planning Encounter – A family planning encounter is a documented, face-to-face contact between an individual and a family planning provider that takes place in a Title X service site. The purpose of a family planning encounter—whether clinical or non-clinical—is to provide family planning and related preventive health services to female and male clients who want to avoid unintended pregnancies or achieve intended pregnancies. To be counted for purposes of the FPAR, a written record of the services provided during the family planning encounter must be documented in the client record.

Full-Time Equivalent (FTE) – For each type of Clinical Services Provider, report the time in FTEs that these providers are involved in the direct provision of Title X-funded services (i.e., engaged in a family planning encounter). A full-time equivalent (FTE) of 1.0 describes staff who, individually or as a group, work the equivalent of full time for 1 year. Each agency defines the number of hours for “full-time” work and may define it differently for different positions. For example, a physician hired as a full-time employee (i.e., 1.0 FTE) may be required to work only 36 hours per week. FTEs for positions with different time expectations, especially clinicians, should be calculated based on the organization’s established base for that position. In addition, FTEs are adjusted for part-time work or for part-year employment. In an organization that has a 40-hour workweek (2,080 hours/year), a person who works 20 hours per week (i.e., 50% time) is reported as “0.5 FTE.” Thus, a physician working 36 hours per week would be considered 1.0 FTE, and a physician working 18 hours per week would be considered 0.5 FTE, regardless of whether other employees work 40-hour weeks. FTE is also based on the part of the year that the employee works. An employee who works full time for 4 months out of the year would be reported as “0.33 FTE” (i.e., 4 months divided by 12 months).

Questions about Table 13

Question – Is Table 13 different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA has made no changes to Table 13 in the October 2016 version of the Title X FPAR Forms and Instructions. OPA made a minor wording change to the Clinical Services Provider definition. This wording change has no impact on the types of providers that grantees should report in this category.

Question – Can a client have more than one family planning encounter during a single family planning visit?

Answer – As noted in the “Terms and Definitions” section of the report, a client may have only one family planning encounter per visit. In the family planning services setting, the term “encounter” is synonymous with “visit.” Although a client may meet with both Clinical and Other Services Providers during an encounter, only one provider is credited with the encounter. The provider with the highest level of training who takes ultimate responsibility for the client’s clinical or non-clinical assessment and care during the visit is credited with the encounter.

Question – If a nurse provides a contraceptive injection (e.g., Depo-Provera), should the grantee report the encounter as an encounter with a Clinical Services Provider?

Answer – If the nurse providing the injection is a registered nurse with an expanded scope of practice who is trained and permitted by state-specific regulations to perform all aspects of the user (male and female) physical assessment as described in the Program Guidelines, then the encounter is an encounter with a Clinical Services Provider and should be reported in Table 13, Row 1.

However, if the nurse providing the injection is a registered nurse who does not have an expanded scope of practice or is another type of nurse (e.g., LPN, LVN, or public health nurse), then the encounter should be reported as an encounter with an Other Services Provider in Table 13, Row 2.

Question – If an individual receives gynecological or related preventive health services (e.g., pelvic exam, Pap test, pregnancy test, STD screening) at a Title X-funded service site, but does not receive counseling, education, or clinical services aimed at avoiding unintended pregnancy or achieving intended pregnancy, is the encounter a family planning encounter? Is the client a family planning user?

If a post-menopausal client obtains gynecological or related preventive health services, the encounter is not a family planning encounter and the client is not a family planning user.

Example: A new client who receives STD services—but no counseling, education, or clinical services aimed at avoiding an unintended pregnancy or achieving an intended pregnancy—is not a family planning user and the encounter is not a family planning encounter. If, in addition to STD testing, this same client receives condoms or counseling about using condoms to prevent STD transmission but does not receive counseling, education, or clinical services aimed at avoiding an unintended pregnancy, the client is not a family planning user and the encounter is not a family planning encounter.

Table 13
Number of Full-Time Equivalent Clinical Services Providers and
Family Planning Encounters by Type of Provider

Provider Type	Number of FTEs (A)	Number of Family Planning Encounters (B)
1 Clinical Services Providers
1a Physicians
1b Physician assistants/nurse practitioners/ certified nurse midwives
1c Registered nurses with an expanded scope of practice who are trained and permitted by state-specific regulations to perform all aspects of the user physical assessment
2 Other Services Providers
3 Total Family Planning Encounters (sum rows 1 + 2)

Revenue Report

Title X Section 1001 grantees are required to maintain a financial management system that meets the standards for grant administration and to document and keep records of all income and expenditures.² Table 14 identifies the sources and amounts of financial support received during the reporting period that support activities within the scope of the grantee’s Title X family planning services project (“Title X project”).

Instructions

Table 14 – Report the revenues (i.e., actual cash receipts or drawdown amounts) received during the reporting period from each funding source to support activities within the scope of the grantee’s Title X services grant (Section 1001), even if the funds were not expended during the reporting period. Include (1) all receipts from the Title X services grant; (2) collections from patients and reimbursements from third parties for services rendered; and (3) receipts from other sources, including block grants, state and local governments, and other sources. If the value for a cell is zero, enter “0.” The agency must retain for audit purposes all worksheets that document how the agency derived the reported amounts.² Do not report the monetary value of in-kind contributions as revenue in Table 14.

Terms and Definitions

Title X Grant – Refers to funds received from the Title X Section 1001 family planning services grant. Report the amount received (cash receipts or drawdown amounts) during the reporting period from the Title X services grant. Include base Title X grant funding and other Title X funding for special initiatives (e.g., HIV integration and male involvement). Do not report the amount of grant funds awarded unless this figure is the same as the actual cash receipts or drawdown amounts.

Payment for Services – Refers to funds collected directly from clients and revenues received from public and private third party payers (capitated or fee-for-service) for services provided within the scope of the grantee’s Title X project.

Total Client Collections/Self-Pay – Report the amount collected directly from clients during the reporting period for services provided within the scope of the grantee’s Title X project.

Third-Party Payers – For each third-party source listed, report the amount received (i.e., reimbursed) during the reporting period for services provided within the scope of the grantee’s Title X project. Only revenue from pre-paid (capitated) managed care arrangements (e.g., capitated Medicare, Medicaid, and private managed care contracts) should be reported as prepaid. Revenues received after the date of service, even under managed care arrangements, should be reported as not prepaid.

Medicaid/Title XIX – Report the amount received from Medicaid (federal and state shares) during the reporting period for services provided within the scope of the grantee’s Title X project, regardless of whether the reimbursement was paid directly by Medicaid or through a fiscal intermediary or a health maintenance organization (HMO). For example, in states with a capitated Medicaid program (i.e., the grantee has a contract with a private plan like Blue Cross), the payer is Medicaid, even though the actual payment may come from Blue Cross. Include revenue from family planning waivers (both federal and state shares) in Row 3a, Column B. If the amount reported in Row 3a, Column B includes family planning waiver revenue, indicate this in the Table 14 “Note” field.

Medicare/Title XVIII – Report the amount received from Medicare during the reporting period for services provided within the scope of the grantee’s Title X project, regardless of whether the reimbursement was paid directly by Medicare or through a fiscal intermediary or an HMO. For clients enrolled in a capitated Medicare program (i.e., where the grantee has a contract with a private plan like Blue Cross), the payer is Medicare, even though the actual payment may come from Blue Cross.

Children’s Health Insurance Program (SCHIP) – Report the amount of funds received during the reporting period from CHIP for services provided within the scope of the grantee’s Title X project. If the grantee is unable to report CHIP revenue separately from Medicaid (Row 3a), indicate this in the Table 14 “Note” field.

Other Public Health Insurance – Report the amount reimbursed by other federal, state, or local government health insurance programs during the reporting period for services provided within the scope of the grantee’s Title X project. Other public health insurance programs include state or local government programs that provide a broad set of benefits and public-paid or public-subsidized private insurance programs.

Private Health Insurance – Report the amount of funds received from private third-party health insurance plans during the reporting period for services provided within the scope of the grantee’s Title X project. Private health insurance include plans obtained through an employer, union, or direct purchase, including insurance purchased for public employees or retirees or military personnel and their dependents (e.g., TRICARE or CHAMPVA) that provide a broad set of primary medical care benefits for the enrolled individual (beneficiary or dependent).

Other Revenue – Refers to revenue received from other sources during the reporting period that supported services provided within the scope of the grantee’s Title X project. Other revenue sources include block grants, TANF, state and local governments (e.g., contracts, state and local indigent care programs), the Bureau of Primary Health Care, private and client donations, or other public or private revenues.

Maternal and Child Health (MCH) Block Grant/Title V – Report the amount of Title V funds received during the reporting period that supported services provided within the scope of the grantee’s Title X project.

Social Services Block Grant/Title XX – Report the amount of Title XX funds received in the reporting period that supported services provided within the scope of the grantee’s Title X project.

Temporary Assistance for Needy Families (TANF) – Report the amount of TANF funds received in the reporting period that supported services provided within the scope of the grantee’s Title X project.

Local Government Revenue – Report the amount of funds from local government sources (including county and city grants or contracts) that were received during the reporting period and that supported services provided within the scope of the grantee’s Title X project.

State Government Revenue – Report the amount of funds from state government sources (including grants or contracts) that were received during the reporting period and that supported services provided within the scope of the grantee’s Title X project. Do not report as “state government revenue” funding from sources like the Centers for Disease Control and Prevention (CDC) or block grant funds that are awarded to and distributed by the state. Report these revenues as “Other revenue” and specify their sources.

Bureau of Primary Health Care (BPHC) – Report the amount of revenue received from BPHC grants (e.g., Section 330) during the reporting period that supported services provided within the scope of the grantee’s Title X project.

Other Revenue – Report the amount and specify the source of funds received during the reporting period from other sources that supported services provided within the scope of the grantee’s Title X project. This may include revenue from such sources as the CDC (infertility, STD, or HIV prevention; breast and cervical cancer detection), private grants and donations, fundraising, interest income, or other sources.

Questions about Table 14

Question – Is Table 14 different from the previous version of the table in the Title X FPAR Forms and Instructions (Reissued October 2013)?

Answer – OPA has made no changes to Table 14 in the October 2016 version of the Title X FPAR Forms and Instructions. OPA updated the definition for Other Public Health by removing the listed examples. This wording change has no impact on reporting revenue for this category.

Question – Can a grantee report an estimate of the monetary value of in-kind donations of goods, services, or other noncash contributions as revenue in Table 14?

Answer – No. In Table 14, revenues include actual cash receipts or drawdown amounts only. Do not report the monetary value of in-kind contributions as revenue in Table 14.

Table 14
Revenue Report

Revenue Source		Amount
Title X
1	Title X grant (Section 1001: family planning services)
Payment for Services
2	Total client collections/self-pay
3	Third-party payers	Amount Prepaid (A)	Amount Not Pre-paid (B)
3a	Medicaid (Title XIX)
3b	Medicare (Title XVIII)
3c	Children’s Health Insurance Program (CHIP)
3d	Other public health insurance
3e	Private health insurance
4	Total – Third-Party Payers (sum rows 3a to 3e)
5	Total – Payment for Services (sum row 2 + cell 4a + cell 4b)
Other Revenue
6	Title V (MCH Block Grant)
7	Title XX (Social Services Block Grant)
8	Temporary Assistance for Needy Families (TANF)
9	Local government revenue
10	State government revenue
11	Bureau of Primary Health Care (BPHC)
12	Other (Specify:__________________ )
13	Other (Specify:__________________ )
14	Other (Specify:__________________ )
15	Other (Specify:__________________ )
16	Other (Specify:__________________ )
17	Total– Other Revenue (sum rows 6 to 16)
18	Total Revenue (sum rows 1 + 5 + 17)

Notes

Notes (Continued)

Abbreviations and Acronyms

AGC atypical glandular cells

AIS adenocarcinoma in situ

ASC atypical squamous cells

ASC-H atypical squamous cells, cannot exclude HSIL

ASC-US atypical squamous cells of undetermined significance

BPHC Bureau of Primary Health Care

CBE clinical breast exam

CDC Centers for Disease Control and Prevention

CFR Code of Federal Regulations

CHAMPVA Civilian Health and Medical Program of the Department of Veterans Affairs

CHIP Children’s Health Insurance Program

CIN cervical intraepithelial neoplasia

DHHS Department of Health and Human Services

FAM fertility awareness method

FPAR Family Planning Annual Report

FTE full-time equivalent

HHS Department of Health and Human Services

HIV human immunodeficiency virus

HMO health maintenance organization

HSIL high-grade squamous intraepithelial lesion

IUD intrauterine device

IUS intrauterine system

LAM Lactational Amenorrhea Method

LEP limited English proficiency, limited English proficient

LPN licensed practical nurse

LSIL low-grade squamous intraepithelial lesion

LVN licensed vocational nurse

MCH maternal and child health

OIRM Office of Information Resource Management

OMB Office of Management and Budget

OPA Office of Population Affairs

OS Office of the Secretary

PRA Paperwork Reduction Act

QFP Report: Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs

RPO Regional Project Officer

SCHIP Children’s Health Insurance Program

SPA State Plan Amendment

STD sexually transmitted disease

TANF Temporary Assistance for Needy Families

USC United States Code

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Appendix A:
Collecting and Tabulating Multi-Race Responses

Background. On October 24, 1997, the Department of Health and Human Services (HHS) issued a Policy Statement on Inclusion of Race and Ethnicity in DHHS Data Collection Activities.²⁰ This policy requires the inclusion of racial and ethnic categories in HHS-funded and -sponsored data collection and reporting systems. Implementation of this policy is intended to help to identify major health conditions of minority populations, monitor progress in meeting their needs, and ensure nondiscrimination in access to and provision of appropriate HHS services for various racial and ethnic groups. Although programs that are directed to minority racial or ethnic populations have exemptions, these programs are encouraged to collect and report data on subgroups within their target populations.

The HHS inclusion policy refers to the Office of Management and Budget (OMB) 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity,²¹ and any subsequent revisions, as the standard for racial and ethnic reporting categories in HHS-funded programs. The FPAR race and ethnicity categories comply with the 1997 OMB revised minimum standards.

Reporting more than one race. According to the 1997 OMB revised standards, self-identification is the preferred means of obtaining information about an individual’s race and ethnicity. When self-identification is used, Title X-funded agencies should adopt a method that allows users to mark or select more than one of the five minimum OMB race categories. The OMB guidance includes the following recommendations for collecting data from individuals who self-identify with more than one race:

The method for respondents to report more than one race should take the form of multiple responses to a single question and not a single “multiracial” category.
When a list of races is provided to respondents, the list should not contain a “multiracial” category.
Two recommended forms for the instruction accompanying the multiple-response question are “Mark one or more…” and “Select one or more….”
If the criteria for data quality and confidentiality are met, provision should be made to report, at a minimum, the number of individuals identifying with more than one race. Data producers are encouraged to provide greater detail about the distribution of multiple responses as long as the detail can be aggregated to the minimum standard set of race and ethnicity categories.

Agencies should consult with their Regional Project Officer (RPO) if they have questions about collecting multiple responses to a single race question. On the following page is a sample question, designed to be self-administered, for collecting race data. A list of resources on this topic is also included.

What is your race? Select one or more.

American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American: A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Resource List

Office of Management and Budget. (2000, March 9). Guidance on aggregation and allocation of data on race for use in civil rights monitoring and enforcement. OMB Bulletin No. 00-02. Retrieved from http://www.whitehouse.gov/omb/bulletins/b00-02.html

Office of Management and Budget. (2000). Provisional guidance on the implementation of the 1997 standards for federal data on race and ethnicity. Retrieved from http://www.whitehouse.gov/sites/default/files/omb/assets/information_and_regulatory_affairs/re_guidance2000update.pdf

Office of Management and Budget. (1997, October 30). Revisions to the standards for the classification of federal data on race and ethnicity, Federal Register notice. Retrieved from http://www.whitehouse.gov/omb/fedreg_1997standards

U.S. Census Bureau. (2012). The two or more races population: 2010. 2010 Census Briefs No. C2010BR–13. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-13.pdf

U.S. Department of Health and Human Services. (2011, October). U.S. Department of Health and Human Services implementation guidance on data collection standards for race, ethnicity, sex, primary language, and disability status. Retrieved from https://aspe.hhs.gov/sites/default/files/pdf/76331/index.pdf

U.S. Department of Health and Human Services. (1997, October 24). Policy statement on inclusion of race and ethnicity in DHHS data collection activities. Retrieved from http://aspe.hhs.gov/datacncl/inclusn.htm

1 42 United States Code (USC) 300. Population research and voluntary family planning programs, section 1001 of Title X of the Public Health Service Act. Retrieved from http://www.hhs.gov/opa/sites/default/files/title-x-statute-attachment-a.pdf

2 45 Code of Federal Regulations (CFR) Part 75. Uniform administrative requirements, cost principles, and audit requirements for HHS awards. Retrieved from http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=88c2f29440664f74c9444e7ff44bab5a&mc=true&n=pt45.1.75&r=PART&ty=HTML

3 42 CFR Part 59. Project grants for family planning services. Retrieved from http://www.ecfr.gov/cgi-bin/text-idx?SID=beacfd044d5a71d9fdb2a76300994972&mc=true&node=sp42.1.59.a&rgn=div6http://www.hhs.gov/opa/pdfs/42-cfr-59-b.pdf

4 The Title X Family Planning Program Guidelines consist of two documents: (1) Program requirements for Title X funded family planning projects (“Program Requirements”) and clinical recommendations as outlined in Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs (“QFP”). Retrieved from http://www.hhs.gov/opa/guidelines/program-guidelines/index.html

5Office of Management and Budget. (1997, October 30). Revisions to the standards for the classification of federal data on race and ethnicity, Federal Register notice. Retrieved from http://www.whitehouse.gov/omb/fedreg_1997standards

6 U.S. Department of Health and Human Services. (2003, August 8). Guidance to federal financial assistance recipients regarding Title VI prohibition against national origin discrimination affecting limited English proficient persons (“Revised HHS LEP guidance”). Federal Register, 68(153), 47311-47323. Retrieved from http://www.hhs.gov/civil-rights/for-individuals/special-topics/limited-english-proficiency/guidance-federal-financial-assistance-recipients-title-VI/

7 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, (2015). Poverty guidelines, research, and measurement. Retrieved from http://aspe.hhs.gov/poverty/index.shtml

8 Office of Population Affairs. (2014, April). Program requirements for Title X funded family planning projects. Retrieved from https://www.hhs.gov/opa/sites/default/files/ogc-cleared-final-april.pdf

9 Office of Population Affairs. (2016). Performance measures: Contraceptive care measures. Retrieved October 31, 2016, from http://www.hhs.gov/opa/performance-measures/index.html

10 Kennedy, K. I., & Trussell, J. (2011). Postpartum contraception and lactation. In R. A. Hatcher, J. Trussell, A. L. Nelson, W. Cates, D. Kowal, & M. S. Policar (Eds.), Contraceptive technology (20th ed., pp. 483–511). New York, NY: Ardent Media.

11 Centers for Disease Control and Prevention. (2016). How you can prevent sexually transmitted diseases. Retrieved from http://www.cdc.gov/std/prevention/default.htm

12 Nayar, R. and D.C. Wilbur. (2015). The Pap test and Bethesda 2014. Acta Cytologica 2015, 29-121-132.

13 National Cancer Institute. (2016). NCI Dictionary of Cancer Terms. Retrieved from https://www.cancer.gov/publications/dictionaries

14 U.S. Department of Health and Human Services, Office of the Surgeon General. (2016, November). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, pp. I-6.

15 Substance Abuse and Mental Health Services Administration. (2019, July 1). Mental Health and Substance Use Disorders. Accessed from https://www.samhsa.gov/find-help/disorders

16 Substance Abuse and Mental Health Services Administration. (2009). Substance Abuse Treatment: Addressing the Specific Needs of Women. Screening and Assessment. Treatment Improvement Protocol (TIP) Series, No. 51. Accessed from https://www.ncbi.nlm.nih.gov/books/NBK83253/

17 Substance Abuse and Mental Health Services Administration. (1997). A Guide to Substance Abuse Services for Primary Care Clinicians. Screening for substance use disorders. Treatment Improvement Protocol (TIP) Series, No. 24. Accessed from https://www.ncbi.nlm.nih.gov/books/NBK64820/

18 The American College of Obstetricians and Gynecologists, Committee on Ethics. (2015, June). Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice (Committee Opinion No. 633). Accessed from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Ethics/co633.pdf?dmc=1

19The Joint Commission. (No date). Definition of Validated and Non-validated Screening Tool for Substance Use. Accessed from https://manual.jointcommission.org/Manual/Questions/UserQuestionId03Sub0015

20 U.S. Department of Health and Human Services. (1997, October 24). Policy statement on inclusion of race and ethnicity in DHHS data collection activities. Retrieved from http://aspe.hhs.gov/datacncl/inclusn.htm

21Office of Management and Budget. (1997, October 30). Revisions to the standards for the classification of federal data on race and ethnicity, Federal Register notice. Retrieved from http://www.whitehouse.gov/omb/fedreg_1997standards

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Title X Familiy Planning Annual Report
Author	Fowler, Christina
File Modified	0000-00-00
File Created	2021-01-15

Form 0990-0221 FPAR Forms and Instructions

Family Planning Annual Report: Forms and Instructions

FPAR_Reissued_Oct2019_ToOPA

Family Planning Annual Report: Forms and Instructions

OMB: 0990-0221

Introduction

General Instructions

Who Submits an FPAR

Scope of Activities Reported in the FPAR

FPAR Submission Due Date

Submitting the FPAR

FPAR Data Validation

Request for FPAR Revision

FPAR Note Field

FPAR Identification

Terms and Definitions

Family Planning User

Family Planning Provider

Family Planning Encounter

Family Planning Service Site

Client Records

Questions about FPAR Terms and Definitions

Grantee Profile Cover Sheet

Instructions

Questions about the Grantee Profile

Grantee Legal Name

Address of Grantee Administrative Offices

Title X Project Director

Grantee Contact (Person completing FPAR)

Number of Subrecipients (Delegates or Subcontractors) Supported by the Title X Grant

Number of Family Planning Service Sites Supported by the Title X Grant

Family Planning User Demographic Profile

Instructions

Terms and Definitions

Questions about Tables 1 through 3

Total Users (sum rows 1 to 9)

Checkpoint Reference AA

Checkpoint Reference BB

Checkpoint Reference CC

Total Female Users (sum rows 1 to 7)

Checkpoint Reference AA

Total Male Users (sum rows 1 to 7)

Checkpoint Reference BB

Family Planning User Economic and Social Profile

Instructions

Terms and Definitions

Questions about Tables 4 through 6

Total Users (sum rows 1 to 6)

Checkpoint Reference CC

Total Users (sum rows 1 to 4)

Checkpoint Reference CC

Family Planning Method Use

Instructions

Terms and Definitions

Questions about Tables 7 and 8

See Checkpoint Reference AA

Cervical and Breast Cancer Screening

Instructions

Terms and Definitions

Questions about Tables 9 and 10

Sexually Transmitted Disease (STD) Screening

Instructions

Terms and Definitions

Questions about Tables 11 and 12

Substance Use Disorder Screening

Instructions

Terms and Definitions

Questions about Tables 12b and 12c

Checkpoint Reference AA

Checkpoint Reference BB

Family Planning Encounters and Clinical Services Provider Staffing

Instructions

Terms and Definitions

Questions about Table 13

Revenue Report

Instructions

Terms and Definitions

Questions about Table 14

Total – Third-Party Payers (sum rows 3a to 3e)

Total – Payment for Services (sum row 2 + cell 4a + cell 4b)

Address of Grantee
Administrative Offices

Grantee Contact
(Person completing FPAR)

Number of Subrecipients
(Delegates or Subcontractors)
Supported by the Title X Grant

Total Users
(sum rows 1 to 9)

Checkpoint
Reference
AA

Checkpoint
Reference
BB

Checkpoint
Reference
CC

Total Female Users
(sum rows 1 to 7)

Checkpoint
Reference
AA

Total Male Users
(sum rows 1 to 7)

Checkpoint
Reference
BB

Checkpoint
Reference
CC

Checkpoint
Reference
CC

See Checkpoint
Reference
AA

Checkpoint
Reference
AA

Checkpoint
Reference
BB

Total – Third-Party Payers
(sum rows 3a to 3e)

Total – Payment for Services
(sum row 2 + cell 4a + cell 4b)

Total– Other Revenue
(sum rows 6 to 16)

Total Revenue
(sum rows 1 + 5 + 17)

Appendix A:
Collecting and Tabulating Multi-Race Responses