CSBG Annual Report Module 3

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Option 1: Module 3, Section A: Community Level Initiative Report
CSBG Eligible Entities will use this form to report on initiatives intended to achieve community level outcomes . The
information reported on this status page will provide valuable information about community initiatives in the current reporting
period. This form also allows CSBG Eligible Entities to note initiatives that ended or were completed in the current reporting
period, report on NPIs achieved, and provide comments and explanations. CSBG Eligible Entities will update the initiative's
progress in future reporting periods.

1. Name of CSBG Eligible Entity Reporting:
2. Initiative Name:
3. Initiative Year: (use dropdown menu to select one of the following options: 1-7+ years)
4. Provide a narrative on the scope of the problem.

5. Provide a narrative describing the agenda and goals for this initiative.

add clarity on the
to select more tha
domain

6. Use the provided dropdown menu to select one of the following options to identify the initiatives relevant domain:
Employment, Education and Cognitive Development, Income, Infrastructure, and Asset Building, Housing, Health and
Social/Behavioral Development, or Civic Engagement and Community Involvement.
7. Please identify the ultimate expected outcome using the provided Community NPI Forms.
8. Identify the specific community for this initiative by selecting one of the following options: Neighborhood, City, School
District, County, Service Area, State, Region, or Other.
9. Provide the expected duration for this initiative using the provided dropdown menu to select one of the following
options: 0-1 years, 1-2 years, 2-3 years, 3-4 years, 4-5 years, 5-6 years, or 7+ years.
define multiple-partner

10. Report partnerships by selecting one of the following options: Independent CAA Initiative, CAA is the core organizer of
multi-partner Initiative, or CAA is one of multiple active investors and partners.
11. Provide a narrative describing any collaboration efforts with the initiative's top 1-3 partners.

initiative-- your agency
and one other partner

change to CSBG eligible
entity

12. Select strategies that were implemented from the provided Community Level Strategies list.
13. Using the Community NPI forms please report any progress on all relevant outcomes/Indicators. This can include any
progress on interim outcomes and/or final outcomes. Please provide additional information on the scope of the impact of
these outcomes. (e.g. If an initiative created a health clinic, please describe how many individuals and families are expected to
be impacted.)
14. Final Status - use dropdown menu to select one of the following options: Initiative Active, Initiative Ended Early, Initiative
Ended as Planned, Completed Still Delivering Value.
15. Provide a narrative on any lessons learned during this reporting period.

October 2016

Option 1
Module 3, Section A

Page 1 of 18

Instructional Notes
Module 3 - Community Level
Module 3, Section A: Community Initiative Status Form

Section A: Community Initiatve Status Form is where CSBG Eligible Entities identify initiatives intended to
achieve community level outcomes. This form provides a central place to report valuable information about a
single community initiative that started, continued, or ended during the current reporting period. The
information reported on the status form will be selected via a dropdown menu or written as a narrative.

Module 3, Section B: Community National Performance Indicators (NPIs) - Data Entry Form

Section B: Community NPIs Data Entry Form provides an opportunity for CSBG Eligible Entities to enter data for
the community level outcomes reported in Section A, Line 14. Entities may select from the indicators outlined in
this section, or create their own indicator if none of the provided indicators captures what the CSBG Eligible
Entity is trying to achieve. To facilitate the reporting, use, and learning from Community NPIs the Annual Report
provides two types of indicators (Counts of Change and Rates of Change).

The first way to report impact is the Counts of Change indicators. These are basic measures that provide the
number of units being measured, e.g. jobs, houses, resources, etc. that have been added (created) or subtracted
(eliminated), and in some cases maintained, in the community the CSBG Eligible Entity has targeted.
The second way to report impact is the Rates of Change indicators. While requiring a bit more information,
these indicators tell the full story of the magnitude of the impacta community initiative (usually involving
multiple organizations) has had in a community.

Module 3, Section C: Community Strategies List
Section C: Community Strategies List provides a basic identification of strategies, arranged by Domain and by
topic area. The list cannot be all-inclusive; as such, an “other” category is included. This standardized list will
aid in local and state analysis of the relationship between community-level strategies and outcomes.

August 2017

Module 3, Instructional Notes

Module 3, Section A: Community Transformation Status Form
Name of CSBG Eligible Entity
Reporting:
State:

DUNS:

Does this include CSBG funds?
Does this include CSBG CARES
Supplemental funds?
Does this include CSBG Disaster
Supplemental funds?
Reporting Status:

Yes or No
Yes or No
Yes or No
New, Previously Submitted
Use the dropdown menu to select the response where appropriate.

1. Transformation Name
2. Transformation Year
3. Problem Identification

1-7+ years
Narrative
(Provide a narrative on the scope of the problem)

4. Goal/Agenda

Narrative
(Provide a narrative on the goal/agenda)

5. Issue/CSBG Community
Domains
6. Ultimate Expected Outcome
7. Identified Community
8. Expected Duration
9. Partnership Type
10. Partners
11. Strategy(ies)
12. Progress on
Outcomes/Indicators
13. Impact of Outcomes

14. Outcomes/Indicators to
Report
15. Final Status
16. Lessons Learned

August 2017

Employment; Education and Cognitive Development; Income, Infrastructure,
and Asset Building; Housing; Health and Social/Behavioral Development; or
Civic Engagement and Community Involvement
Community Level National Performance Indicators (NPIs)
(Reference the Community NPIs listed in Section B)
Neighborhood, City, School District, County, Service Area, State, Region, or
Other
Narrative
(Provide the range in years, e.g. 1-3 years)
Independent CAA Initiative, CAA is the core organizer of multi-partner Initiative,
or CAA is one of multiple active investors and partners
Narrative
(Provide a narrative on the key 1-3 partners)
Select from the Community Level Strategies listed in Section C
No Outcomes to Report, Interim Outcomes, Final Outcomes
Narrative
(Provide additional information on the scope of the impact of these outcomes.
e.g. If an initiative created a health clinic, please describe how many individuals
and families are expected to be impacted.)
Community Level National Performance Indicators (NPIs)
(Reference the Community NPIs listed in Section B)
Initiative Active, Initiative Ended Early, Initiative Ended as Planned, Completed
Still Delivering Value
Narrative

Module 3, Section A: Community Initiative Status Form

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Employment Indicators
Name of CSBG Eligible Entity Reporting:
State:

DUNS:
I.) Identified
Community
(auto-populated)

Counts of Change for Employment Indicators (CNPI 1)
CNPI 1a Number of jobs created to increase opportunities for people with low incomes in the identified
Counts
community.
of
CNPI
1b Number of job opportunities maintained in the identified community.
Change
CNPI 1c Number of “living wage ” jobs created in the identified community*.
CNPI 1d Number of “living wage” jobs maintained in the identified community*.
CNPI 1e Number of jobs created in the identified community with a benefit package.

II.) Target
(#)

III.) Actual
Results
(#)

IV.) Performance
target accuracy
(% auto calculated)
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*When reporting on indicators related to living wage, agencies can provide their own definition or select from national or locally-defined models. Please indicate the living wage definition used in the General Comment box.

I.) Identified
Community

Other Counts of Change for Employment Indicators (CNPI 1z) - Please specify below.
Other
Counts of CNPI 1z.1 Other
Change CNPI 1z.2 Other

(auto-populated)

II.) Target
(#)

III.) Actual
Results

IV.) Performance
target accuracy

(#)

(% auto calculated)

#DIV/0!
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CNPI 1z.3 Other
I.) Identified
Community

Rates of Change for Employment Indicators (CNPI 1)
Rates of
Change

(auto-populated)

CNPI 1f Percent decrease of the unemployment rate.
CNPI 1g Percent decrease of the youth unemployment rate.
CNPI 1h Percent decrease of the underemployment rate.
Other Rates of Change for Employment Indicators (CNPI 1z)

Other
Rates of
Change CNPI 1z.4 Other

- Please specify below.

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

(Target % auto
calculated)

#DIV/0!
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#DIV/0!

I.) Identified
Community
(auto-populated)

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

(% auto
calculated)

#DIV/0!
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IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

VII.) Performance
target accuracy
(% auto calculated)

#DIV/0!
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VII.) Performance
target accuracy
(% auto calculated)

(Target % auto
calculated)

CNPI 1z.5 Other

#DIV/0!
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(% auto
calculated)

#DIV/0!
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CNPI 1z.6 Other

#DIV/0!

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General comments:

August 2017

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

Module 3, Section B: Community NPIs - Employment

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Education and Cognitive Development Indicators
Name of CSBG Eligible Entity Reporting:
State:

DUNS:
Counts of Change for Education and Cognitive Development Indicators (CNPI 2)
CNPI 2a Number of accessible and affordable early childhood or pre-school education assets or resources added
to the identified community.
CNPI 2b Number of accredited or licensed affordable child care facilities added in the identified community.

I.) Identified
Community

II.) Target
(#)

(auto-populated)

III.) Actual
Results

IV.) Performance
target accuracy

(#)

(% auto calculated)

#DIV/0!
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CNPI 2c Number of new Early Childhood Screenings offered to children (ages 0-5) of families with low-incomes in
Counts the identified community.
of
CNPI 2d Number of accessible and affordable education assets or resources added for school age children in the
Change identified community. (e.g., academic, enrichment activities, before/after school care, summer programs)

#DIV/0!

#DIV/0!

CNPI 2e Number of accessible and affordable post secondary education assets or resources added for newly
graduating youth in the identified community. (e.g. college tuition, scholarships, vocational training, etc.)

#DIV/0!

CNPI 2f Number of accessible and affordable basic or secondary education assets or resources added for adults in
the identified community. (e.g. literacy, ESL, ABE/GED, etc.)

#DIV/0!

Other Counts of Change for Education and Cognitive Development Indicators (CNPI 2z) - Please specify below.

Other
Counts of CNPI 2z.1 Other
Change CNPI 2z.2 Other

I.) Identified
Community
(auto-populated)

CNPI 2z.3 Other

August 2017

Module 3, Section B: Community NPIs - Education and Cognitive Development

II.) Target
(#)

III.) Actual
Results

IV.) Performance
target accuracy

(#)

(% auto calculated)

#DIV/0!
#DIV/0!
#DIV/0!

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Education and Cognitive Development Indicators
Rates of Change for Education and Cognitive Development
Indicators (CNPI 2)

I.) Identified
Community
(auto-populated)

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

(% auto calculated)

(Target % auto
calculated)

(% auto
calculated)

#DIV/0!

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CNPI 2h Percent increase of children in the identified community
at (or above) the basic reading level.

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CNPI 2i Percent increase of children in the identified community
at (or above) the basic math level.

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CNPI 2l Percent increase of the rate of youth in the identified
community who graduate from post-secondary education.

#DIV/0!

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CNPI 2m Percent increase of adults in the identified community
who attend post-secondary education.

#DIV/0!

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CNPI 2g Percent increase of children in the identified community
who are kindergarten ready.

CNPI 2j Percent increase in high school (or high school
Rates of equivalency) graduation rate in the identified community.
Change
CNPI 2k Percent increase of the rate of youth in the identified
community who attend post-secondary education.

CNPI 2n Percent increase of adults in the identified community
who graduate from post-secondary education.
CNPI 2o Percent increase in the adult literacy rate in the
identified community .
Other Rates of Change for Education and Cognitive
Development Indicators (CNPI 2z)

Other
Rates of
Change CNPI 2z.4 Other
CNPI 2z.5 Other
CNPI 2z.6 Other

- Please specify below.

I.) Identified
Community
(auto populated)

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline
(Target % auto
calculated)

#DIV/0!
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General comments:

August 2017

VII.) Performance
target accuracy

Module 3, Section B: Community NPIs - Education and Cognitive Development

(% auto
calculated)

#DIV/0!
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VII.) Performance
target accuracy
(% auto calculated)

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Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Infrastructure and Asset Building Indicators
Name of CSBG Eligible Entity Reporting:
State:

DUNS:
Counts of Change for Infrastructure and Asset Building
Indicators (CNPI 3)

I.) Identified
Community

II.) Target
(#)

(auto-populated)

III.) Actual
Results
(#)

CNPI 3a Number of new accessible assets/resources created in the identified community:
CNPI 3a.1 Commercial
CNPI 3a.2 Financial
CNPI 3a.3 Technological/ Communications (e.g.
broadband)
CNPI
3a.4
Transportation
Counts
CNPI
3a.5
Recreational (e.g. parks, gardens, libraries)
of
CNPI 3a.6 Other Public Assets/Physical Improvements
Change
CNPI 3b Number of existing assets/resources made accessible to the identified community:
CNPI 3b.1 Commercial
CNPI 3b.2 Financial
CNPI 3b.3 Technological/ Communications (e.g.
broadband)
CNPI 3b.4 Transportation
CNPI 3b.5 Recreational (e.g. parks, gardens, libraries)
CNPI 3b.6 Other Public Assets/Physical Improvements
Other Counts of Change for Infrastructure and Asset
Building Indicators (CNPI 3z) - Please specify below.

Other
Counts of CNPI 3z.1 Other
Change

I.) Identified
Community

(auto populated)

II.) Target
(#)

(% auto calculated)

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III.) Actual
Results
(#)

IV.) Performance
target accuracy
(% auto calculated)

#DIV/0!
#DIV/0!
#DIV/0!

CNPI 3z.2 Other
CNPI 3z.3 Other

August 2017

IV.) Performance
target accuracy

Module 3, Section B: Community NPIs - Infrastructure and Asset Building

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Infrastructure and Asset Building Indicators
I.) Identified
Community

Rates of Change for Infrastructure and Asset Building
Indicators (CNPI 3)

(auto-populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

(Target % auto
calculated)

CNPI 3c Percent decrease of abandoned or neglected
buildings in the identified community.
CNPI 3d Percent decrease in emergency response time
Rates of measured in minutes in the identified community. (EMT,
Change Police, Fire, etc.).
CNPI 3e Percent decrease of predatory lenders and/or
lending practices in the identified community.
CNPI 3f Percent decrease of environmental threats to
households (toxic soil, radon, lead, air quality, quality of
drinking water, etc.) in the identified community.
CNPI 3g Percent increase of transportation services in the
identified community.

I.) Identified
Community

Other
Rates of
Change

August 2017

Other Rates of Change for Infrastructure and Asset Building (auto-populated)
Indicators (CNPI 3z)
- Please specify below.

II.) Baseline

existing starting
point used for
comparisons
(%)

IV.) Expected %
change from
baseline

III.) Target
(%)

VII.)
Performance
target
accuracy
(% auto
calculated)

#DIV/0!

#REF!

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#REF!

IV.) Expected %
change from
baseline

VII.)
Performance
target
accuracy

(Target % auto
calculated)

(% auto
calculated)

CNPI 3z.4 Other

#DIV/0!

#REF!

CNPI 3z.5 Other

#DIV/0!

#REF!

Module 3, Section B: Community NPIs - Infrastructure and Asset Building

Other
Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Rates
of
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Change

Infrastructure and Asset Building Indicators

#DIV/0!

CNPI 3z.6 Other

General comments:

August 2017

Module 3, Section B: Community NPIs - Infrastructure and Asset Building

#REF!

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Housing Indicators
Name of CSBG Eligible Entity Reporting:
State:

DUNS:
Counts of Change for Housing Indicators (CNPI 4)

I.) Identified
Community

II.) Target
(#)

(auto-populated)

III.) Actual
Results
(#)

CNPI 4a Number of safe and affordable housing units developed in the identified community (e.g. built or set aside
Counts units for people with low incomes).
CNPI 4b Number of safe and affordable housing units maintained and/or improved through WAP or other
of
Change rehabilitation efforts in the identified community.

(% auto calculated)

#DIV/0!
#DIV/0!

CNPI 4c Number of shelter beds created in the identified community.

#DIV/0!

CNPI 4d Number of shelter beds maintained in the identified community.

#DIV/0!

Other
Counts of CNPI 4z.1 Other
Change

August 2017

IV.) Performance
target accuracy

Other Counts of Change for Housing Indicators (CNPI 4z) - Please specify below.

I.) Identified
Community

(auto-populated)

II.) Target
(#)

III.) Actual
Results
(#)

IV.) Performance
target accuracy
(% auto calculated)

#DIV/0!

CNPI 4z.2 Other

#DIV/0!

CNPI 4z.3 Other

#DIV/0!

Module 3, Section B: Community NPIs - Housing

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Housing Indicators
I.) Identified
Community

(auto-populated)

Rates of Change for Housing Indicators (CNPI 4)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

CNPI 4e Percent decrease in the rate of homelessness in the
Rates of identified community.
Change CNPI 4f Percent decrease in the foreclosure rate in the identified
community.
CNPI 4g Percent increase in the rate of home ownership of
people with low incomes in the identified community.
CNPI 4h Percent increase of affordable housing in the identified
community.
CNPI 4i Percent increase of shelter beds in the identified
community.
I.) Identified
Community

Other Rates of Change for Housing Indicators (CNPI 4z)

Other
Rates of
Change

- Please specify below.

(auto populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

CNPI 4z.4 Other
CNPI 4z.5 Other
CNPI 4z.6 Other

General comments:

August 2017

Module 3, Section B: Community NPIs - Housing

IV.) Expected % V.) Actual Results VI.) Actual % VII.) Performance
(%)
change from
change from
target accuracy
(% auto calculated)
baseline
baseline
(Target % auto
calculated)

(% auto
calculated)

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IV.) Expected % V.) Actual Results VI.) Actual % VII.) Performance
(%)
change from
change from
target accuracy
(% auto calculated)
baseline
baseline
(Target % auto
calculated)

(% auto
calculated)

#DIV/0!
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Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Health and Social/Behavioral Indicators
Name of CSBG Eligible Entity Reporting:
State:

DUNS:
I.) Identified
Community

Counts of Change for Health and Social/Behavioral Indicators (CNPI 5)

II.) Target
(#)

(auto-populated)

III.) Actual
Results

IV.) Performance
target accuracy

(#)

(% auto calculated)

#DIV/0!

CNPI 5a Number of accessible and affordable physical health assets or resources created in the identified community.

Counts CNPI 5b Number of accessible and affordable behavioral and mental health assets or resources created in the identified
of
community.
Change

#DIV/0!

CNPI 5c Number of public safety assets and resources created in the identified community.

#DIV/0!

CNPI 5d Number of accessible and affordable healthy food resources created in the identified community.

#DIV/0!

CNPI 5e Number of activities designed to improve police and community relations within the identified community.

#DIV/0!

Other Counts of Change for Health and Social/Behavioral Indicators (CNPI 5z) - Please specify below.
Other
Counts of
Change CNPI 5z.1 Other

I.) Identified
Community
(auto-populated)

II.) Target
(#)

III.) Actual
Results

IV.) Performance
target accuracy

(#)

(% auto calculated)

#DIV/0!
#DIV/0!
#DIV/0!

CNPI 5z.2 Other
CNPI 5z.3 Other

Rates of Change for Physical Health, Wellbeing, and
Development Indicators (CNPI 5)
CNPI 5f Percent decrease in infant mortality rate in the identified
community.
Rates of CNPI 5g Percent decrease in childhood obesity rate in the identified
Change community.
CNPI 5h Percent decrease in adult obesity rate in the identified
community.
CNPI 5i Percent increase in child immunization rate in the identified
community.
CNPI 5j Percent decrease in uninsured families in the identified
community.

August 2017

I.) Identified
Community
(auto-populated)

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

VII.) Performance
target accuracy
(% auto calculated)

(Target % auto
calculated)

(% auto
calculated)

#DIV/0!

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Module 3, Section B: Community NPIs - Health and Social/Behavioral

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Health and Social/Behavioral Indicators
Rates of Change for Behavioral and Mental health, Emotional
Wellbeing, and Development Indicators (CNPI 5)

I.) Identified
Community
(auto-populated)

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

CNPI 5k Percent decrease in the teen pregnancy rate in the identified
community.
CNPI 5l Percent decrease in unplanned pregnancies in the identified
community.
CNPI 5m Percent decrease in substance abuse rate in the identified
Rates of community.(e.g. cigarettes, prescription drugs, narcotics, alcohol).
Change CNPI 5n Percent decrease in domestic violence rate in the identified
community.
CNPI 5o Percent decrease in the child abuse rate in the identified
community.
CNPI 5p Percent decrease in the child neglect rate in the identified
community.
CNPI 5q Percent decrease in the elder abuse rate in the identified
community.
CNPI 5r Percent decrease in the elder neglect rate in the identified
community.
I.) Identified
Community

Rates of Change for Public Safety Indicators (CNPI 5)

(auto populated)

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

Rates of CNPI 5s Percent decrease in recidivism rate in the identified
Change community.

CNPI 5t Percent decrease in non-violent crime rate in the identified
community.
CNPI 5u Percent decrease in violent crime rate in the identified
community.
CNPI 5v Percent decrease in teens involved with the juvenile court
system in the identified community.

Other
Rates of
Change

Other Rates of Change for Health and Social/Behavioral
Indicators (CNPI 5z)

CNPI 5z.4 Other
CNPI 5z.5 Other
CNPI 5z.6 Other
General comments:

August 2017

- Please specify below.

I.) Identified
Community
(auto populated)

II.) Baseline

III.) Target

existing starting
point used for
comparisons
(%)

(%)

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

VII.) Performance
target accuracy
(% auto calculated)

(Target % auto
calculated)

(% auto
calculated)

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IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

VII.) Performance
target accuracy
(% auto calculated)

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calculated)

(% auto
calculated)

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IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline
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Module 3, Section B: Community NPIs - Health and Social/Behavioral

VII.) Performance
target accuracy
(% auto calculated)

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Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 2: Communities where people with low incomes live are healthy and offer economic opportunity.
Civic Engagement and Community Involvement Indicators

Name of CSBG Eligible Entity Reporting:
State:

DUNS:
Rates of Change for Civic Engagement and Community
Involvement Indicators - Goal 2 (CNPI 6)

I.) Identified
Community

(auto-populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

CNPI 6 G2a Percent increase of donated time to support the CSBG
Eligible Entity's delivery of services and/or implementation of strategies
to address conditions of poverty in the identified community.

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

VII.) Performance
target accuracy
(% auto calculated)

(Target % auto
calculated)

(% auto
calculated)

#DIV/0!

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Rates of
Change CNPI 6 G2b Percent increase of donated resources to support the CSBG

Eligible Entity's delivery of services and/or implementation of strategies
to address conditions of poverty in the identified community.
CNPI 6 G2c Percent increase of people participating in public hearings,
policy forums, community planning, or other advisory boards related to
the CSBG Eligible Entity's delivery of service and/or implementation of
strategies to address conditions of poverty in the identified community.

Other Rates of Change for Civic Engagement and Community
Involvement Indicators - Goal 2 (CNPI 6 G2z)

Other
Rates of
Change CNPI 6 G2z.4 Other

- Please specify below.

I.) Identified
Community

(auto-populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

(Target % auto
calculated)

#DIV/0!
#DIV/0!
#DIV/0!

CNPI 6 G2z.5 Other
CNPI 6 G2z.6 Other

Other
Counts of
Change

August 2017

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

Other Counts of Change for Civic Engagement and Community
Involvement Indicators - Goal 2 (CNPI 6 G2z)
- Please specify below.

I.) Identified
Community

(auto-populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

(% auto
calculated)

#DIV/0!
#DIV/0!
#DIV/0!

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline
(Target % auto
calculated)

Module 3, Section B: Goal 2 Community NPIs - Civic Engagement Community Involvement

(% auto
calculated)

VII.) Performance
target accuracy
(% auto calculated)

#DIV/0!
#DIV/0!
#DIV/0!
VII.) Performance
target accuracy
(% auto calculated)

Module 3, Section B: Community National Performance Indicators (CNPIs) - Data Entry Form
Goal 3: People with low-incomes are engaged and active in building opportunities in communities.
Civic Engagement and Community Involvement Indicators
Name of CSBG Eligible Entity Reporting:
State:

DUNS:
I.) Identified
Community

Rates of Change for Civic Engagement and Community
Involvement Indicators - Goal 3 (CNPI 6)

(auto-populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

Rates of
Change CNPI 6 G3a Percent increase of people with low incomes who support

the CSBG Eligible Entity's delivery of service and/or implementation of
strategies to address conditions of poverty in the identified community.
CNPI 6 G3b Percent increase of people with low incomes who acquire
and maintain leadership roles with the CSBG Eligible Entity or other
organizations within the identified community.

Other Rates of Change for Civic Engagement and Community
Involvement Indicators - Goal 3 (CNPI 6 G3z)

Other
Rates of
Change CNPI 6 G3z.4 Other

- Please specify below.

I.) Identified
Community

(auto-populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

August 2017

- Please specify below.

I.) Identified
Community

(auto-populated)

II.) Baseline

existing starting
point used for
comparisons
(%)

III.) Target
(%)

(% auto calculated)

(% auto
calculated)

#DIV/0!

#DIV/0!

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#DIV/0!

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline
#DIV/0!
#DIV/0!
#DIV/0!

Other Counts of Change for Civic Engagement and Community
Involvement Indicators - Goal 3 (CNPI 6 G3z)

VII.) Performance
target accuracy

(Target % auto
calculated)

(Target % auto
calculated)

CNPI 6 G3z.5 Other
CNPI 6 G3z.6 Other

Other
Counts of
Change

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline

(% auto
calculated)

#DIV/0!
#DIV/0!
#DIV/0!

IV.) Expected % V.) Actual Results VI.) Actual %
(%)
change from
change from
baseline
baseline
(Target % auto
calculated)

Module 3, Section B: Goal 3 Community NPIs - Civic Engagement Community Involvement

(% auto
calculated)

VII.) Performance
target accuracy
(% auto calculated)

#DIV/0!
#DIV/0!
#DIV/0!
VII.) Performance
target accuracy
(% auto calculated)

Module 3, Section C: Community Strategies List
Name of CSBG Eligible Entity Reporting:
State:
DUNS:
Employment Strategies (STR 1)
STR 1a
STR 1b
STR 1c
STR 1d
STR 1e
STR 1f
STR 1g
STR 1h
STR 1i

Minimum/Living Wage Campaign
Job Creation/Employment Generation
Job Fairs
Earned Income Tax Credit (EITC) Promotion
Commercial Space Development
Employer Education
Employment Policy Changes
Employment Legislative Changes
Other Employment Strategy: (please specify)

STR 2a
STR 2b
STR 2c
STR 2d
STR 2e
STR 2f
STR 2g
STR 2h
STR 2i
STR 2j
STR 2k
STR 2l

Education and Cognitive Development Strategies (STR 2)
Preschool for All Campaign
Charter School Development
After School Enrichment Activities Promotion
Pre K-College/Community College Support
Children’s Trust Fund Creation
Scholarship Creation
Child Tax Credit (CTC) Promotion
Adoption Child Care Quality Rating
Adult Education Establishment
Education and Cognitive Development Policy Changes
Education and Cognitive Development Legislative Changes
Other Education and Cognitive Development Strategy: (please specify)

STR 3a
STR 3b
STR 3c
STR 3d
STR 3e
STR 3f
STR 3g
STR 3h
STR 3i
STR 3j
STR 3k
STR 3l
STR 3m
STR 3n
STR 3o
STR 3p
STR 3q
STR 3r
STR 3s

Infrastructure and Asset Building Strategies (STR 3)
Cultural Asset Creation
Police/Community Relations Campaign
Neighborhood Safety Watch Programs
Anti-Predatory Lending Campaign
Asset Building and Savings Promotion
Develop/Build/Rehab Spaces
Maintain or Host Income Tax Preparation Sites
Community-Wide Data Collection Systems Development
Local 211 or Resource/Referral System Development
Water/Sewer System Development
Community Financial Institution Creation
Infrastructure Planning Coalition
Park or Recreation Creation and Maintenance
Rehabilitation/Weatherization of Housing Stock
Community Center/Community Facility Establishment
Asset Limit Barriers for Benefits Policy Changes
Infrastructure and Asset Building Policy Changes
Infrastructure and Asset Building Legislative Changes
Other Infrastructure and Asset Building Strategy: (please specify)

August 2017

Module 3, Section C: Community Strategies List

Module 3, Section C: Community Strategies List
Housing Strategies (STR 4)
STR 4a
STR 4b

End Chronic Homelessness Campaign
New Affordable Single Unit Housing Creation

STR 4c
STR 4d
STR 4e
STR 4f
STR 4g
STR 4h
STR 4i
STR 4j

New Affordable Multi- Unit Housing Creation (Single Resident Occupancy (SRO), temporary housing, transitional housing)
Tenants’ Rights Campaign
New Shelters Creation (including day shelters and domestic violence shelters)
Housing or Land Trust Creation
Building Codes Campaign
Housing Policy Changes
Housing Legislative Changes
Other Housing Strategy: (please specify)

STR 5a
STR 5b
STR 5c
STR 5d
STR 5e
STR 5f
STR 5g
STR 5h
STR 5i
STR 5j
STR 5k
STR 5l
STR 5m
STR 5n

Health and Social/Behavioral Development Strategies (STR 5)
Health Specific Campaign
Farmers Market or Community Garden Development
Grocery Store Development
Gun Safety/Control Campaign
Healthy Food Campaign
Nutrition Education Collaborative
Food Bank Development
Domestic Violence Court Development
Drug Court Development
Alternative Energy Source Development
Develop or Maintain a Health Clinic
Health and Social/Behavioral Development Policy Changes
Health and Social/Behavioral Development Legislative Changes
Other Health and Social/Behavioral Development Strategy: (please specify)

August 2017

Module 3, Section C: Community Strategies List

Module 3, Section C: Community Strategies List
STR 6 G2a
STR 6 G2b
STR 6 G2c
STR 6 G2d
STR 6 G2e
STR 6 G2f
STR 6 G2g
STR 6 G2h
STR 6 G2i
STR 6 G2j
STR 6 G2k

Civic Engagement and Community Involvement Strategies - Goal 2 (STR 6 G2)
Development of Health and Social Service Provider Partnerships
Recruiting and Coordinating Community Volunteers
Poverty Simulations
Attract Capital Investments
Build/Support Increased Equity
Equity Awareness Campaign
Coordinated Community-wide Needs Assessment
Civic Engagement and Community Involvement in Advocacy Efforts
Civic Engagement Policy Changes
Civic Engagement Legislative Changes
Other Civic Engagement and Community Involvement Strategy: (please specify)

STR 6 G3a
STR 6 G3b
STR 6 G3c
STR 6 G3d
STR 6 G3e
STR 6 G3f
STR 6 G3g

Civic Engagement and Community Involvement Strategies - Goal 3 (STR 6 G3)
Empowerment of Individuals/Families with Low-Incomes
Campaign to Ensure Individuals with Low-Incomes are Represented on Local Governing Bodies
Social Capital Building Campaign for Individuals/Families with Low-Incomes
Campaign for Volunteer Placement and Coordination
Civic Engagement Policy Changes
Civic Engagement Legislative Changes
Other Civic Engagement and Community Involvement Strategy: (please specify)

August 2017

Module 3, Section C: Community Strategies List