Form 1 Grantee Characteristics Form

GRANT INFORMATION

Grant Snapshot

• Grant #

• Grant Type

  • FatherhoodFIRE

  • FRAMEWorks

  • READY4Life

• Funded Organization Name

• Annual Funding Level

  • $350,000-$699,999

  • $700,000-$999,999

  • $1,00,000-$2,000,000

• Annual Funding Amount

• Funded Evaluation Type

  • Local Impact (LI)

  • Local Descriptive (LD)

  • Focus on Performance (FP)

  • Strengthening the Implementation of Marriage and Relationship Programs (SIMR)

  • Strengthening the Implementation of Responsible Fatherhood Programs (SIRF)

• ACF Region

  • Region 1 (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont)

  • Region 2 (New Jersey, New York, Puerto Rico and the U.S. Virgin Islands)

  • Region 3 (Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia)

  • Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee)

  • Region 5 (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin)

  • Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas)

  • Region 7 (Iowa, Kansas, Missouri, and Nebraska)

  • Region 8 (Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming)

  • Region 9 (Arizona, California, Hawaii, Nevada, American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Republic of Palau, and Commonwealth of the Northern Mariana Islands)

  • Region 10 (Alaska, Idaho, Oregon, and Washington)

• HMRF Funding History: First time OFA HMRF Grantee

  • Yes

  • No

• Prior HMRF OFA Cohort and Grant Type

  • Cohort One - HMRE

  • Cohort One - HMRE Resource Center Cooperative Agreement

  • Cohort One - RF

  • Cohort One - RF Cooperative Agreement

  • Cohort Two - HMRE

  • Cohort Two - RF

  • Cohort Three - HMRE

  • Cohort Three - Fatherhood

  • Cohort Three – ReFORM

• Prior Funding Level

  • $350,000-$699,999

  • $700,000-$999,999

  • $1,00,000-$2,000,000

• Other Federal Funding Source(s)

  • CDC - HHS

  • Child Support - ACF

  • Children's Bureau - ACF

  • Department of Labor - Re-Entry

  • Department of Labor - Youth

  • Department of Labor - Other

  • Department of Labor - Adults

  • Family and Youth Services Bureau - ACF/FYSB

  • Office of Adolescent Health (OAH) - HHS/OAH

  • Office of Family Assistance (non-HMRF) - ACF

  • Office of Juvenile Justice - Justice

  • Other

Leadership Team

• Active Program Director Name

  • Organization Title

  • Start Date

  • % of Time Allocated to HMRF Grant

    • 51% or more

    • 50% or less

  • Actual Time Allocated to the HMRF Grant

  • # Years HMRF Experience Prior to this Grant

  • Program Director Phone

  • Program Director Email

  • Program Director Status

    • Permanent Program Director

    • Interim Program Director

• Authorizing Official Name

  • Phone

  • Email

• Active Program Manager

  • Organization Title

  • Program Title

  • Start Date

  • % of Time Allocated to HMRF Grant

  • Phone Email

• Data Manager Name

  • Organization Title

  • Phone

  • Email

• Financial Officer Name

  • Organization Title

  • Phone

  • Email

• Other Key Decision Maker Name

  • Title

  • Phone

  • Email

Organization Information

• Organization Type

  • Public Institutions of Higher Education - Non-Profit

  • Private Institutions of Higher Education - Non-Profit

  • Public Non-Profit Community Entity

  • Private Non-Profit Community Entity

  • University

  • Cooperative Extension

  • Government Entity (State, County, Municipality)

  • Tribal Organization

  • Religious Organization

  • Other

• Organization Focus

  • Positive Youth Development

  • HMRF

  • Child Support

  • Mental Health

  • Education

  • Child Welfare

  • ReEntry

  • Pregnancy Prevention

  • Social Services

  • Workforce

  • Family Resource Center

  • Home Visitation Program

  • Prison

  • Jail

  • Community Action Council

  • Other

• Organization Size

  • 0-10

  • 11--50

  • 51-100

  • 101-200

  • >200

• Is the HMRF grant program operating within a department or division of a broader organization?

  • Yes

  • No

  • If yes, what is the department/division?

• Approximately how many staff are working on the HMRF grant program?

• Affiliated with National or Regional Organization

  • Yes

  • No

  • If yes, National or Regional Organization Name

• Funding Sources for the Organization – check all that apply

  • Federal Funding

  • State Funding

  • Local Government Funding

  • Private Donations

  • Private Grants

  • Contracts

  • Fees/Fees for Service

  • Earned Revenue

  • Other

• Organization Address

  • Address Line 2

  • City

  • State

  • Zip

• Organization Facebook

• Organization Twitter

• Organization Phone

• Organization Website/Other Info

• Program Address

  • Address Line 2

  • City

  • State

  • Zip

• Program Main Phone

• Program Facebook

• Program Twitter

• Program Website/Other info

• Requested Number of nFORM Accounts

Evaluation

• Previous Federal Research

  • Building Strong Families (BSF)

  • Community Healthy Marriages (CHMI)

  • Hispanic Healthy Marriage Initiative (HHMI)

  • Parents & Children Together (PACT)

  • Supporting Healthy Marriages (SHM)

  • Youth Education & Relationship Status (YEARS)

  • Other

  • N/A

• Applied for Local Evaluation but Not Approved (checkbox)

• Local Impact Design (if eval type = LI)

  • Total Sample Size

  • Program Sample

  • Control Sample

  • % Ratio

  • Additional Local Evaluation Information

    • Efficacy Study

    • Implementation Study

    • No Treatment Control Group

  • Lead Local Evaluator Name

    • Phone

    • Email

    • Organization Name

  • Research Questions

• Local Descriptive Design (if eval type = LD)

  • Total Sample Size

  • Lead Local Evaluator Name

    • Phone

    • Email

    • Organization Name

  • Research Questions

• Focus on Performance (if eval type = FP)

  • Started as Focus on Performance

    • Yes

    • No

PROGRAM STRUCTURE

Target Population

• Populations Served

  • Adult Couples

  • Adult Individuals

  • Youth in High School (grades 9-12)

  • High-School Aged Youth (14-17)

  • Youth in Late Adolescence to Early Adulthood (18-24)

  • Community Fathers

  • Incarcerated Fathers

• Proposed Service Numbers

• Additional Details of Adults (over 18)

  • N/A (Youth Only)

  • Active-duty military and veteran fathers

  • Active-duty military and veteran individuals and couples

  • Any Adult

  • Couples - Expectant/Pregnant

  • Couples-Adoptive/Foster Parents

  • Couples-General

  • Expectant Mothers

  • Father Figures With Children 24 & Under

  • Fathers (expectant, adoptive, stepfathers) With Children 24 & Under

  • Fathers participating in Head Start or Healthy Start programs

  • Fathers receiving TANF assistance, as well as those who have previously received or are eligible to receive TANF assistance;

  • Homeless

  • Immigrants/Refugees

  • Individuals- Disabilities

  • Individuals-Incarcerated/ReEntry

  • Individuals-TANF Eligible/Recipients

  • Low-income fathers

  • Low-income, at-risk individuals

  • Non-custodial and custodial single fathers

  • Non-custodial and custodial single parents

  • Unserved/Underserved Population

  • Young adults (18-24)

  • Other

• Additional Details of Youth (ages 14-18) - check all that apply

  • N/A (Adult Only)

  • Any Youth

  • At-Risk and Low-Income Youth

  • Criminal Justice Involved

  • Homeless/Runaway Youth

  • In Alternative School (Title I or Traditional)

  • In High School

  • In or Aging Out of Foster Care

  • Pregnant/Parenting Teens

  • Other

Service Overview

• Service Delivery Settings (check all that apply)

  • In-house only

  • In Community

  • Virtual/Online

• Delivery Setting(s) Details (check all that apply)

  • College/University

  • Combination of Service Delivery Settings

  • Community

  • Cooperative Extension

  • Faith Based Facility

  • Family Resource Centers

  • Government Offices

  • Grantee Organization

  • Health/Mental Health Facility

  • High School or Other Schools

  • Military Base

  • Prison/Jails/Detention

  • Shelter/Residential Facility

  • Workforce Center

  • Other

• Youth Service Setting(s)

  • In-school

  • Out of school

  • Combination of both

• High School involvement

  • N/A

  • Schools as Referral Partners Only

  • Services Delivered in Alternative Schools

  • Services Delivered in High School as Ancillary Activity (lunch hour, before or after school)

  • Services Delivered in High School Classrooms by HMRF Educators (guest educators)

  • Services Delivered in High School Classrooms by Teachers (integrated into classroom curriculum)

• # of School Partners

• Service Components

  • HMRE/RF Workshops

  • Case Management

  • Parenting

  • Employment Services

  • Financial Education

  • Intake

  • IPV

  • Other

• Language for Service Delivery

  • English

  • Spanish

  • Other

• Primary Workshop Hours

• Curriculum(a) [dropdown] (if grant type = HM or youth)

• Critical Components of the Curriculum (first four are required) (if grant type = HM or youth)

  • Communication skills (including expression, discussion, and negotiation skills)

  • Conflict resolution, management, and problem-solving skills

  • Knowledge of the benefits of marriage

  • Stress and anger management

  • Affection and intimacy

  • Expression and discussion of negotiation skills

  • Financial literacy, such as budgeting, financial planning, and management

  • Parenting skills (as applicable)

  • Trauma and its effects on forming healthy relationships (as applicable)

• Grantee is doing the following to meet TRI-service requirements: (if grant type = RF)

  • Responsible Parenting

    • Curriculum(a) [dropdown]

    • Approach

      • Full workshop

      • Integrated workshop content

      • Other approach

  • Economic Stability

    • Curriculum(a) [dropdown]

    • Approach

      • Full workshop

      • Integrated workshop content

      • Other approach

  • Promote or Sustain Healthy Marriage

    • Curriculum(a) [dropdown]

    • Approach

      • Full workshop

      • Integrated workshop content

      • Other approach

Partners

• Responsible for Delivering HMRF Workshops

  • Grantee

  • Partner/Subawardee

  • Both Partner and Grantee Organization

• Partner Service Responsibilities

  • All Aspects of Program Delivery

  • Intake

  • Financial Education

  • HMRF Workshops

  • Employment

  • Case Management

  • Parenting

  • Unknown

  • Other

• Location of Partner-Led Services

  • At Partner Facility

  • At Grantee Facility

  • In Community

  • Other

• Grantee has MOU Agreements/Contracts with Service Delivery Partners

  • Yes

  • No

• Key Service Delivery Partners

• Key Strategic Partner Type(s) - check all that apply

  • American Job Centers, WIBs, and other Workforce Innovation and Opportunity Act funded employment training programs

  • Child welfare agencies and organizations

  • Criminal justice agencies (including prisons, jails, pre-release centers, courts, probation, parole)

  • Domestic violence organizations

  • Head Start programs

  • Healthy Start programs

  • High school systems

  • Housing

  • Legal aid and community action agencies

  • Local child support agency

  • Local substance and mental health agencies

  • Public health services, including health insurance navigators and enrollment specialists.

  • State, local, and tribal child support agencies

  • State, local, and tribal Temporary Assistance for Needy Families (TANF) agencies

  • Other

Employment

• Types of services

  • No Employment Services

  • Coaching

  • Job Readiness - Integrated Service

  • Job Readiness - Stand-Alone Service

  • Job Search

  • One-Stop Partnership

  • Resource Room

  • Full-scale EWD Program with Certificate Trainings

  • Subsidized Employment

  • Apprenticeships

• Employment Provider

  • Grantee

  • Partner Organization - employment services are an integrated component of the program - typically through contract or MOU

  • Both Partner and Grantee Organization

  • Referral Only - participants are referred to organizations in the community with expertise in employment

• Grantee has MOU Agreements/Contracts with Employment Provider

  • Yes

  • No

• Key Employment Providers

Incentive Structure

• Incentive Use by Purpose (check all that apply)

  • Recruitment

  • Intake

  • Participation

  • Research

• Total Amount(s) of Incentives Per Person

• Incentive Structure Approved by OFA (checkbox)

Case Management

• Cast Management Structure includes at least 8 individual service contacts per client throughout the course of the program? (checkbox)

• Types of Case Management

  • Intensive

  • Moderate

  • Light-Touch

  • Other

• Case Management Recipients

  • All Participants

  • All Participants but at Varied Levels Based on Need and Interest

  • Some Participants Based on Assessment of Needs

  • Some Participants Based on Request

  • None

  • Other

• Foundations of Case Management

  • Barrier Removal (Workshop)

  • Barrier Removal (Life Challenge)

  • Curriculum Reinforcement

  • Life Coaching

  • Employment Coaching

  • Other

• Format of Case Management

  • One-on-One Sessions

  • Group Format

  • Phone Coaching

  • Other

• Duration

  • None

  • 1 session

  • 1 month

  • 1-3 months

  • 3-6 months

  • 6-9 months

  • 1 year

  • At Participants Request

• Frequency

  • 1x

  • 1x per week

  • 1x per month

  • 1x per quarter

  • Leveling system with decreasing contact over time (for grantees with services longer than 3 months)

  • At Participants Request

  • Other

• Case Management Structure Approved by OFA (checkbox)

DV/IPV

• DV/IPV Approach

  • Screening for Services

  • Screening Out of the Program

  • No Screening

  • Assessment for IPV

  • Uncertain of Practice

• Does the grantee have a DV/IPV Protocol

  • Yes

  • No

  • Uncertain

• DV Partners

• DV Training (include information by who, frequency, curriculum if any)

CQI PROCESS

Implementation Team

• Team Members

• Meeting Frequency

• Grantee has a written CQI plan in place

  • Yes

  • No

• Grantee is receiving/has received CQI TTA from MPR?

  • Yes

  • No

• Responsible party for CQI

  • Program Director

  • Program CQI Lead

  • Organizational CQI

  • Outside Contractor