| Federal Fiscal Quarter Report Period (MMM-MMM, YYYY) Oct 1 - Dec 31; Jan 1 - Mar 31; April 1 - Jun 30; Jul 1 - Sept 30 | Grant Number | Organization Name | Project Name | Grant Program Name | One-on-one Patient TA: What is the total number of encounters with patients, clients, customers, their families or other individuals who participated in Individualized/one-on-one education; Training; TA; Mentoring; Counseling; Consultation; Case-management sessions? | One-on-one Patient TA (PARTNERS): What is the total number of encounters with patients, clients, customers, their families or other individuals who participated in Individualized/one-on-one education; Training; TA; Mentoring; Counseling; Consultation; Case-management sessions provided by your project PARTNERS? | One-on-one Provider TA: What is the total number of encounters with health care providers, other service providers, or other professionals who participated in: Individualized/one-on-one education; Training; TA; Mentoring; Counseling; Consultation; Case-management sessions? |
One-on-one Provider TA (PARTNERS): What is the total number of encounters with health care providers, other service providers, or other professionals who participated in: Individualized/one-on-one education; Training; TA; Mentoring; Counseling; Consultation; Case-management sessions provided by your project PARTNERS? |
Group patients TA: What is the total number of encounters with patients, clients, customers, their families or other individuals who participated in: Group education; Training; TA; Mentoring; Counseling; Consultation; Case-management sessions ? | Group patients TA (PARTNERS): What is the total number of encounters with patients, clients, customers, their families or other individuals who participated in: Group education; Training; TA; Mentoring; Counseling; Consultation; Case-management sessions provided by your project PARTNERS? | Group provider TA: What is the total number of individuals that attended who participated in each of the group education, training, TA, mentoring, counseling, consultation or case-management sessions for health care providers, other service providers, or other professionals? | Group provider TA (PARTNER): What is the total number of individuals that attended who participated in each of the group education, training, TA, mentoring, counseling, consultation or case-management sessions for health care providers, other service providers, or other professionals provided by your project PARTNERS? | Language Interpretation:What is the total number of encounters with individuals during which the individuals received language interpretation and/or other verbal language assistance? | Language Interpretation (PARTNERS):What is the total number of encounters with individuals during which the individuals received language interpretation and/or other verbal language assistance provided by your project PARTNERS? | Non-English materials: What is the total number of encounters with individuals during which any printed or written instructional/educational materials, forms, and other documents translated into languages other than English were received by individuals served by your program? | Non-English materials (PARTNERS): What is the total number of encounters with individuals during which any printed or written instructional/educational materials, forms, and other documents translated into languages other than English were received by individuals served by your project PARTNERS? | Community Screenings: What is the total number of community-based health screenings (e.g., screening for high blood pressure, high cholesterol, diabetes, or HIV/AIDS) received by individuals provided by your OMH-funded project during this reporting period? | Community Screenings (PARTNERS): What is the total number of community-based health screenings (e.g., screening for high blood pressure, high cholesterol, diabetes, or HIV/AIDS) received by individuals provided by your OMH-funded project PARTNERS during this reporting period? | Health Fairs: What is the total number of encounters with individuals at OMH-funded project community-based health fairs, expositions, and other similar public events that you sponsored, led or managed? | Health Fairs (PARTNERS): What is the total number of encounters with individuals at OMH-funded project community-based health fairs, expositions, and other similar public events that your project PARTNERS sponsored, led or managed? | Booths at other events: What is the total number of encounters with individuals at any OMH-funded project exhibit booths at broader community-based health fairs, expositions, and other public events? | Booths at other events (PARTNERS): What is the total number of encounters with individuals at any OMH-funded project PARTNERS exhibit booths at broader community-based health fairs, expositions, and other public events? | Public meetings: What is the total number of encounters with individuals at the conferences or other large scale meetings you planned, managed and/or conducted as part of your OMH-funded project? | Public meetings (PARTNERS): What is the total number of encounters with individuals at the conferences or other large scale meetings your PARTNERS planned, managed and/or conducted as part of your OMH-funded project? | Language Access Services (LAS). What is the total number of encounters of individuals served under your LAS? Comprehensive LAS includes all of the following: audio interpretation, non-English materials, effective communication, sight translation, and in-language communication. | Language Access Services (LAS) (PARTNERS). What is the total number of encounters of individuals served under LAS provided by your PARTNERS? Comprehensive LAS includes all of the following: audio interpretation, non-English materials, effective communication, sight translation, and in-language communication. | Total De-Duplicated Program Participants (Quarter): What is the total number of individuals participating in your OMH-funded project? Include only individuals who are participating in your project this quarter. | Total De-Duplicated Program Participants (Annual): What is the total number of individuals participating in your OMH-funded project during this year ? | Comments (Optional) |
| **INSERT GRANT NUMBER** | **INSERT ORGANIZATION NAME** | **INSERT PROJECT NAME** | **INSERT GRANT PROGRAM NAME** | ||||||||||||||||||||||||||
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| 1. Please only include 1 quarter of data per file in your submission. | |||||||||||||||||||||||||||||
| 2. Performance data are reported by Federal fiscal quarter. Please use the following reporting periods (Oct 1-Dec 31; Jan 1-Mar 31; Apr 1-Jun 30; Jul 1-Sept 30). | |||||||||||||||||||||||||||||
| 3. Submit your Performance Data Report as an Excel Document through GrantSolutions. | |||||||||||||||||||||||||||||
| 4. Do not rename, reorder, or transpose any rows or columns. | |||||||||||||||||||||||||||||
| 5. Ensure a number is in every light yellow cell (columns F to AC). | |||||||||||||||||||||||||||||
| 6. Do not enter "N/A" or leave any cells blank, instead enter 0. | |||||||||||||||||||||||||||||
| 7. If an explanation is needed, add a comment to column AD (no text in columns F through AC allowed). | |||||||||||||||||||||||||||||
| 8. To save your file, “Save As” and name it as follows: 1) Grant Program, 2) Grantee Name 3) “_Performance Report_” 4) Submission date; i.e. "NWDP_NORC_Performance Report_07.31.19.xlsx" | |||||||||||||||||||||||||||||
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| Quarters |
| Apr 1 – Jun 30, 2020 |
| Jul 1 - Sep 30, 2020 |
| Oct 1 – Dec 31, 2020 |
| Jan 1 – Mar 30, 2021 |
| Apr 1 – Jun 30, 2021 |
| Jul 1 – Sep 30, 2021 |
| Oct 1 – Dec 31, 2021 |
| Jan 1 – Mar 30, 2022 |
| Apr 1 – Jun 30, 2022 |
| Jul 1 – Sep 30, 2022 |
| Oct 1 – Dec 31, 2022 |
| Jan 1 – Mar 30, 2023 |
| Apr 1 – Jun 30, 2023 |
| Jul 1 – Sep 30, 2023 |
| Oct 1 – Dec 31, 2023 |
| Jan 1 – Mar 30, 2024 |
| Apr 1 – Jun 30, 2024 |
| Jul 1 - Sep 30, 2024 |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |