Form 1122-0016 Semi-Annual Progress Report for Transitional Housing Gra

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U.S. Department of Justice
Office on Violence Against Women
SEMI-ANNUAL PROGRESS REPORT FOR
Transitional Housing Assistance
Grant Program
Brief Instructions: This form must be completed for each Transitional Housing Assistance Grant Program
(Transitional Housing Program) grant received. The grant administrator or coordinator must ensure that the
form is fully completed. Grant partners, however, may complete sections relevant to their portion of the grant.
Grant administrators and coordinators are responsible for compiling and submitting a single report that reflects all information collected from grant partners.
All grantees should read each section to determine which questions they must answer, based on the activities supported under this grant during the current reporting period. Sections B and E of this form must be
completed by all grantees. Subsections A1 and C1 must be answered by all grantees. In section D, and subsections A2, A3, C2, and C3, grantees must answer an initial question about whether they supported certain
activities during the current reporting period. If the response is yes, then the grantee must complete that
section or subsection. If the response is no, the rest of that section or subsection is skipped.
For example, 1) if you are an organization using Transitional Housing Program funds to provide services
through grant-funded staff, you would complete A, B, C1, D, and E (and answer ‘no’ in C2 and C3); or 2) if you
are an organization using Transitional Housing Program funds solely for staff to participate in your local continuum of care, you would complete A, B, C1, and E (and answer ‘no’ in C2, C3, and D).
The activities of volunteers or interns may be reported if they are coordinated or supervised by Transitional
Housing Program-funded staff or if Transitional Housing Program funds substantially support their activities.
For further information on filling out this form, refer to the separate set of instructions, which contains detailed definitions and examples illustrating how questions should be answered.
SECTION
Section A:
A1:
A2:
A3:
Section B:
Section C:
C1:
C2:
C3:
Section D:
Section E:

General Information
Grant Information
Program Description
Staff Information
Program Areas
Function Areas
Coordinated Community Response
Accessibilty and Security
Policies
Services
Narrative

Page Number
1
1
3
4
5
6
6
8
9
11
23

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A1

GENERAL INFORMATION
Grant Information

All grantees must complete this subsection.

1.

Date of report

2.

Current reporting period

3.

Grantee name

4.

Grant number

5.

Type of funded organization
(Check all that apply to describe the organization receiving the Transitional Housing Program grant.)
Domestic violence program
Sexual assault program
State government agency (e.g., Department of Health and Human Services, state housing authority)
Tribal government
Unit of local government
Other non-profit community-based organization
Other (specify):

January 1-June 30

July 1-December 31

(Year)

5A. Is this a faith-based organization?
Yes
6.

No

Point of contact
(person responsible for the day-to-day coordination of the grant)
First name

MI

Last name

Agency/organization name
Address
City

State

Telephone

Zip code
Facsimile

E-mail
7.

Does this grant specifically address tribal populations?
(Check yes if your Transitional Housing Program grant focuses on tribal populations and indicate which
tribes or nations you serve or intend to serve.)
Yes

No

If yes, which tribes/nations:

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8.

What percentage of your Transitional Housing Program grant was directed to each of these areas?
(Report the area[s] addressed by your Transitional Housing Program grant during the current reporting
period and estimate the approximate percentages of funds [or resources] used to address each area
[consider training, victim services, etc.]. The grantee may choose how to make this determination.)
Throughout this form, the term sexual assault includes both assaults committed by offenders who are
strangers to the victim/survivor and assaults committed by offenders who are known to, related by
blood or marriage to, or in a dating relationship with the victim/survivor. The term domestic violence/
dating violence applies to any pattern of coercive behavior that is used by one person to gain power
and control over a current or former intimate partner or dating partner. Stalking is defined as a course
of conduct directed at a specific person that would cause a reasonable person to fear for his or her
safety or the safety of others, or suffer substantial emotional distress. (See separate instructions for
more complete definitions.)
Percentage of grant funds
Sexual assault
Domestic violence/dating violence
Stalking
TOTAL

100%

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A2

Program Description

Were Transitional Housing Program funds used to support housing units?
Check yes if Transitional Housing Program funds were used to support housing units. Housing units refer to program-owned units, program-rented units, and units paid for with voucher or rental assistance.
Yes—answer questions 9-10
No—skip to A3
9.

Type and number of housing units funded
(Report the number and type of housing units supported with Transitional Housing Program funds. See
the separate set of instructions for definitions.)
Number of units/vouchers
Type of housing units
Vouchers/
Program-owned
Program-rented
rent subsidies
units
units
Scattered
Clustered
Co-located with domestic violence
emergency shelter
Co-located with homeless
emergency shelter
Other (specify)
TOTAL

10. Number of units that are accessible to people with disabilities
(Report the number and type of housing units supported with grant funds that are accessible to people
with disabilities. See the separate set of instructions for definitions.)
Type of housing units

Number of units accessible
to people with disabilities

Scattered
Clustered
Co-located with domestic violence emergency shelter
Co-located with homeless emergency shelter
Other (specify)
TOTAL

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A3

Staff Information

Were Transitional Housing Program grant funds used to fund staff positions during the current reporting
period?
Check yes if Transitional Housing Program funds were used to pay staff, including part-time staff and
contractors.
Yes—answer question 11
No—skip to Section B
11. Staff
(Report the total number of full-time equivalent [FTE] staff funded by the Transitional Housing Program
grant during the current reporting period. Report staff by functions performed, not by title or location.
Include employees who are part-time and/or only partially funded with these grant funds as well as
consultants/contractors. If an employee or contractor was employed or utilized for only a portion of
the reporting period, prorate appropriately. For example, if you hired a full-time administrator in Ocober
who was 100% funded with Transitional Housing Program funds, you would report that as .5 FTE.
Report all FTEs in decimals, not percentages. One FTE is equal to 1,040 hours – 40 hours per week x
26 weeks. See separate instructions for examples of how to calculate FTEs.)

Staff

FTE(s)

Administrator (fiscal manager, executive director)
Attorney
Case manager
Child advocate/counselor
Child care worker
Counselor (mental health, substance abuse)
Driver/transportation provider
Facilities/operations staff (property manager, janitorial, maintenance)
Housing advocate
Information technology staff
Legal advocate (does not include attorney)
Program coordinator (volunteer coordinator, transitional housing
manager)
Security staff
Support staff (administrative assistant, bookkeeper, accountant)
Transitional services advocate (e.g., job training, financial counselor,
life skills)
Translator/interpreter
Victim advocate (non-governmental, includes domestic violence,
sexual assault, and dual)
Other (specify):
TOTAL

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B

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PROGRAM AREAS

All grantees must complete this section.

12. Program Purpose Areas
(Check all the program areas that apply to activities supported with Transitional Housing Program funds
during the current reporting period.)
Check ALL
that apply

Purpose Area
Provide transitional housing, including funding for the operating expenses of newly developed or existing transitional housing.
Provide short-term housing assistance, including rental or utilities payments assistance
and assistance with related expenses such as payment of security deposits and other
costs incidental to relocation to transitional housing.
Provide support services designed to enable individuals who are fleeing domestic
violence, dating violence, sexual assault, or stalking to locate and secure permanent
housing and integrate into a community by providing those individuals with services
such as transportation, counseling, child care services, case management, employment
counseling, and other assistance.

13. Areas of Special Interest
(In addition to the program areas identified above, the Transitional Housing Program Grant Application
and Program Guidelines identified several areas of special interest. If your program addressed any of
these special interest areas during the current reporting period, list them below.)

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C1

FUNCTION AREAS
Coordinated Community Response
All grantees must complete this subsection.

14. Coordinated community response activities during the current reporting period
(Check the appropriate boxes to indicate the agencies or organizations, even if the are not memorandum of understanding [MOU] partners, that you provided victim/survivor referrals to, received victim/
survivor referrals from, engaged in consultation with, provided technical assistance to, and/or attended
meetings with, during the current reporting period, according to the usual frequency of the interactions.
If the interactions were not part of a regular schedule, you will need to estimate the frequency with
which these interactions occurred during the current reporting period. Do not report “task force” in
the “Other” category. If Transitional Housing Program-funded staff participated in a task force or work
group, indicate that under “Meetings” by checking the frequency of the meetings and the types of organizations participating. In the last column, indicate the agencies or organizations with which you have
a Memorandum of Understanding for the purposes of the Transitional Housing Program grant.)
Agency/organization

Victim/survivor referrals,
MOU
Meetings
consultations, technical assistance
Partner
Daily
Weekly
Monthly Weekly Monthly Quarterly

Advocacy organization (Tenants
rights, NAMI)
Arts organization/association
Banks/finance institutions
Batterer intervention program
Child care provider
Corrections (probation, parole and
correctional facility staff)
Court
Domestic violence organization
Educational institution/organization
Faith-based organization
Government agency (HUD, DHS)
Health/mental health organization
Homelessness/housing organization
Job training office
Law enforcement
Legal organization (legal services,
bar association, law school)
Prosecutor’s office
Public housing providers (local PHAs)
Private housing providers/developers
Real estate agents
Sexual assault organization
Sex offender management/sex offender treatment provider
Social service organization (nongovernmental)
Tribal government/Tribal government
agency
Unit of local government
Youth organization
Other (specify):
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14A. Number of communities with improved CCR capacity
(Provide the number of communities that have improved their capacity to respond to domestic violence,
dating violence, sexual assault, and stalking as a result of the coordinated community response activities described above. For purposes of this question, a community may be defined as a city or town that
you serve, but in larger metropolitan areas a “community” may be a neighborhood or borough.)
Number of communities
15. (Optional) Additional information
(Use the space below to discuss the effectiveness of your CCR activities and to provide any additional
information you would like to share about your CCR activities beyond what you have provided in the
data above. An example might include an improved process for survivors to be considered for Section 8
housing in your community as a result of meetings between advocates and the Public Housing Office.)

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C2

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Accessibility and Security

Were your Transitional Housing Program funds used for accessibility and/or security during the current
reporting period?
Check yes if Transitional Housing Program funds directly supported the enhancement of program accessibility and/or security (interpreters, security equipment).
Yes—answer question 16
No—skip to C3
16. Use of Transitional Housing Program funds for accessibility and security
(Check all that apply.)
Victim services
TDD/TTY
Cell phones
Interpreters
Language lines
Translation of forms and documents
Secured or monitored entrances
Metal detectors
Security systems (alarms)
Security personnel/guards
Security cameras
Other

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Housing

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C3

Policies

Were your Transitional Housing Program funds used to develop, substantially revise, or implement policies or protocols during the current reporting period?
Check yes if Transitional Housing Program-funded staff developed, substantially revised or implemented
polices or protocols, or if Transitional Housing Program funds were used to directly support the development, revision or implementation of policies or protocols.
Yes—answer questions 17-19
No—skip to Section D
17. Types of protocols and/or policies developed, substantially revised, or implemented during the current reporting period
(Check all that apply.)
Victim Services
Appropriate response to underserved populations
Appropriate response to victims/survivors who are elderly or have disabilities
Confidentiality
Mandatory training standards for staff and volunteers
Staff, board, and/or volunteers represent the diversity of your service area
Victim safety
Other (specify):
Transitional Housing Rules
Confidentiality
Eligibility requirements (victim/survivor in need of housing as a result of domestic violence/dating
violence)
Escrow accounts
Length of stay
Rent & utility payment structure
Resident rules (visitors, child supervision)
Other (specify):
Security and Safety
Disaster response
Emergency incident response
Facility security
Technology security
Other (specify):
Capacity Building
Coordinated community response
Program advisory committees
Resident leadership/advisory committees
Technology
Victim/survivor input into service delivery and policies
Other (specify):
18. Have you received technical assistance in the development of these policies?
Yes
No
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19. (Optional) Additional information
(Use the space below to discuss the effectiveness of policies you have developed or implemented and
to provide any additional information you would like to share about your activities relating to the developing, revising, or implementing of policies beyond what you have provided in the data above. An
example might include a change in policy establishing mandatory training for all volunteers resulting in
consistency of approach to all clients.)

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D

SERVICES

Were your Transitional Housing Program funds used to provide services to victims/survivors, children
and other dependents?
Check yes if Transitional Housing Program-funded staff provided services or if Transitional Housing Program funds were used to support services during the current reporting period. Report all victims/survivors, children and other dependents served, partially served, and not served, and services provided
with Transitional Housing Program funds. See the separate set of instructions for the definitions of Children and Other Dependents.
Yes—answer questions 20-38
No—skip to Section E
20. Number of victims/survivors, children and other dependents served, partially served, and those
seeking services who were not served
Please do not answer this question without referring to the separate set of instructions for further explanation and examples of how to distinguish among these categories.
(Report the following, to the best of your ability, as an unduplicated count for each category during the
current reporting period. This means, for example, that each victim/survivor who sought or received
services during the current reporting period should be counted only once during the current reporting
period. For purposes of this question, victims/survivors are those against whom the domestic violence,
dating violence, sexual assault, or stalking is directed.)
Victims/
Other
Children
survivors
dependents
A. Served: People who received the service(s) they requested,
if those services were provided under your Transitional Housing
Program grant
B. Partially served: People who received some service(s), but
not all of the services they requested, if those services were
provided under your Transitional Housing Program grant
TOTAL SERVED AND PARTIALLY SERVED (20A + 20B)
C. Not served: People who sought services and did not receive
the service(s) they needed, if those services were provided under your Transitional Housing Program grant
21. Number of victims/survivors, children and other dependents not served or partially served solely
due to lack of available housing: (This question should only be completed by grantees who are using
funds to provide housing units as described in question 9.)
(Of the victims/survivors, children and other dependents that were reported in 20B and 20C, report
those that were partially served or not served due solely to a lack of available housing. The total reported for the three categories should not exceed the total of 20B and 20C.)
Number partially served or not served due solely to lack of available housing
Victims/survivors
Children
Other dependents
TOTAL

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22. Other reasons those victims/survivors, children and other dependents seeking services were not
served or were partially served
(For those people reported in 20B and 20C, indicate the reasons, other than lack of available housing,
they were partially served or not served. Check all that apply.)
Other reasons not served or partially served
Program reached capacity
Did not meet statutory requirements (local or state statutes or program rules; this does
not refer to OVW requirements)
Program rules not acceptable to party(ies)
Services not appropriate for party(ies)
Transportation problems
Conflict of interest
Safety/security risk (due to offender’s behavior)
Services inappropriate or inadequate for people with substance abuse issues
Services inappropriate or inadequate for people with mental health issues
Services not available for party(ies) based on family composition
Inadequate language capacity (including sign language)
Insufficient/lack of culturally appropriate services
Insufficient/lack of services for people with disabilities
Hours of operation
Other (specify):

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23. Demographics of victims/survivors, children and other dependents served or partially served
(For those people reported in 20A and 20B, report on the demographics of victims/survivors, children, and other dependents. Provide the total numbers for all that apply. Because victims/survivors,
children and other dependents may identify in more than one category of race/ethnicity, the total for
“Race/ethnicity” may exceed the total number of victims/survivors, children and other dependents reported in 20A and 20B. However, the total number of victims/survivors, children and other dependents
reported under race/ethnicity should not be less than the total number of victims/survivors, children
and other dependents reported in 20A and 20B. Those victims/survivors, children and other dependents for whom gender, age, and/or race/ethnicity are not known should be reported in the “Unknown”
category.)
Race/ethnicity (individuals should not be
counted more than once in either the category
“American Indian and Alaska Native” or in the
category “Native Hawaiian and Other Pacific
Islander”)

Victims/survivors

Children

Other dependents

Victims/survivors

Children

Other dependents

Victims/survivors

Children

Other dependents

Victims/survivors

Children

Other dependents

Black or African American
American Indian and Alaska Native
Asian
Native Hawaiian and other Pacific Islander
Hispanic or Latino
White
Unknown
Gender
Female
Male
Unknown
TOTAL GENDER
(should equal sum of 20A and 20B)
Age
0-6
7-12
13-17
18-24
25-59
60+
Unknown
TOTAL AGE
(should equal sum of 20A and 20B)
Other demographics
People with disabilities
People with limited English proficiency
People who are immigrants/refugees/
asylum seekers
People who live in rural areas
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24. Victims/survivors’ relationship to offender
(For those victims/survivors reported in 20A and 20B, report the relationship of the victim/survivor to
the offender by type of victimization. Count the relationship to each offender for victims/survivors who
were victimized by more than one perpetrator. The number of victims/survivors reported here may total
more than the sum of 20A and 20B.)
Relationship to offender
Number of victims/survivors
Current or former spouse or intimate partner
Other family or household member (in-law, sibling,
grandparent, roommate, etc.)
Dating relationship
Relationship unknown
TOTAL
25. Transitional housing days of shelter
(For those victims/survivors, children, and other dependents reported in 20A and 20B, report the
number who received housing services provided with Transitional Housing Program funds during the
current reporting period. Do not count those victims/survivors, children, and other dependents who
received housing through a voucher or other rental assistance. This should be an unduplicated count
for victims/survivors, children, and for other dependents; each victim/survivor, each child, and each
dependent who received transitional housing services during the current reporting period should be
counted only once. Report the total number of bed nights provided in transitional housing to victims/
survivors, children, and other dependents. Bed nights are determined by multiplying the total number
of nights that each victim/survivor, child, and dependent stays in the housing unit by the number of victims/survivors, children, and dependents served. See separate set of instructions for examples on how
to calculate bed nights.)
Transitional Housing

Victims/ survivors

Children

Other dependents

Number of people
Number of bed nights
26. Housing Assistance
(For those victims/survivors reported in 20A and 20B, report the number provided with each of type of
financial housing assistance during the current reporting period. Each person may be counted once for
each type of housing assistance they received during the current reporting period. See separate set of
instructions for examples.)
Type of service

Total cost

Number of
victims/
survivors

Household furnishings (purchased with grant funds)
Rent subsidy/voucher
Relocation expenses
Rental unit fees (security deposit, application fees, credit
report fees)
Utilities (including electricity, heat, telephone)
Other (specify):
TOTAL

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Total number
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27. (Optional) Additional information
(Use the space below to discuss the effectiveness of housing assistance. An example might include
a housing assistance package given to victims/survivors as they move into a new rental unit which includes a voucher for the first month’s rent, and all-inclusive up-front coverage of rental unit fees including the security deposit and credit report fee, resulting in a significantly larger number of victims living
independently.)

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28. Support services
(For those victims/survivors, children and other dependents reported in 20A and 20B, report the
number who received each of these support services during the current reporting period, excluding
those who received these services via vouchers. Each person may be counted more than once, if they
received more than one type of support service during the current reporting period. However, each
person should only be counted once within each type of service received during the current reporting
period. See separate set of instructions for examples.)
Type of service

Number of
victims/
survivors

Number of
children

Case management
Child care
Children’s activities
Civil legal advocacy/court accompaniment (Assisting a
victim/survivor with legal issues including preparing paperwork for protection orders, accompanying a victim/survivor
to a protection order hearing or other civil proceeding, and
all other advocacy within the civil justice system)
Civil legal assistance (Civil legal services provided by an
attorney)
Counseling/support group (Individual or group counseling
or support provided by a volunteer, peer, or professional)
Criminal justice advocacy/court accompaniment (Assisting a victim/survivor with criminal legal issues including
preparing paperwork such as victim impact statements, accompanying a victim/survivor to a criminal court proceeding
or law enforcement interview, and all other advocacy within
the criminal justice system)
Crisis intervention (Crisis intervention is a process by
which a person identifies, assesses, and intervenes with an
individual in crisis so as to restore balance and reduce the
effects of the crisis in her/his life. In this category, report
crisis intervention that occurs in person and/or over the
telephone.)
Education (GED, primary, secondary)
Employment counseling
Financial counseling
Housing advocacy
Job training
Leadership development opportunities (peer mentorship,
resident advisory board)
Material assistance (including clothing, food, and personal
items)
Translation and interpretation
Transportation (Direct provision of transportation, including
vehicle maintenance)
Other victim/survivor advocacy (Actions designed to help
the victim/survivor obtain other resources or services including health care, social services, etc.)
Other (specify):
TOTAL
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Number of
other
dependents

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29. (Optional) Additional information
(Use the space below to discuss the effectiveness of support services and to provide any additional
information you would like to share about your activities related to support services beyond what you
have provided in the data above. An example might include the implementation of a peer mentoring
program resulting in an increased participation by residents in project activities.)

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30. Vouchers for support services
(Please indicate the types of service for which you provide vouchers. The term voucher refers to a coupon or other means whereby a client can receive the designated service or specific item [i.e. food bank
voucher, child care voucher, and voucher for clothes]. The key factor as to whether something qualifies
as a voucher is the client’s ability to independently choose the service/item. Support services provided
directly to victims/survivors by Transitional Housing Program funded staff should be reported in question 28. See separate set of instructions for examples.)
Child care
Clothing
Counseling/support group
Food
Household furnishings
Telephone (phone cards)
Transportation (including gas vouchers or cards, subway/bus cards)
Other (do not include housing vouchers here) Specify:
31. Transitional housing and destination upon exit (questions 31-37 should only be completed by those
grantees who are using funds to support housing units as described in question 9)
(For those victims/survivors reported in 20A and 20B, report the number of victims/survivors in each
destination category upon their exit from your transitional housing program during the current reporting period. Only report victims/survivors who exited because they either reached the maximum time
allowed in the program or the program services were no longer required or desired. This should be an
unduplicated count.)
Destination upon exit
Domestic violence emergency shelter
Health care facility/substance abuse treatment program (physical or
mental health treatment)
Homeless emergency shelter
Hotel or motel
Incarceration/jail
Permanent housing of choice (e.g., Section 8, return to home, rent, or
purchase housing)
Temporary housing with family or friends
Transitional housing (other than your grant-funded program)
Unknown
Other (specify)
TOTAL

Number of victims/survivors

32. Victim/survivor perception of risk of violence upon exit
(Report the number of victims/survivors who indicated each of the following perceptions about their
risk of future violence from their batterer, at the time the victim/survivor exited the program. Indicate
whether the victim/survivor felt she/he was at equal risk of violence, less risk of violence, or greater
risk of violence compared to the risk of violence when she/he first sought services. The total responses to this question should equal the total number of victims/survivors reported in 20A and 20B.)
Greater risk of
violence

Equal risk of
violence

Lower risk of
violence

Does not know

Unknown (e.g., did not
ask victim/survivor)

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33. Length of stay/exited
(For victims/survivors, children, and other dependents who exited your grant-funded transitional program during this reporting period, report the number of months each person stayed in your housing
program. This should be an unduplicated count. See the separate set of instructions for examples.)
Number of
months

Victims/
survivors

Children

Other
dependents

1
2
3
4
5
6
7
8
9
10
11
12

Number of
months
13
14
15
16
17
18
19
20
21
22
23
24

Victims/
survivors

Children

Other
dependents

34. Reason for termination and destination upon termination
(For those victims/survivors reported in 20A and 20B, report the number of victims/survivors who
identified their destinations upon their termination from your transitional housing program during the
current reporting period. Only report victims/survivors who were terminated before they reached maximum time allowed in your program and who still required or desired program services. This should be
an unduplicated count. Non-compliance with program rules is applicable only to program-managed
housing; violation of lease agreement is applicable only to non-program managed housing. See separate set of instructions for definitions and examples.)

Destination upon termination

Reason for termination
Chronic non- Non-compliance
Violation
payment of with program rules of lease
rent
(excluding nonagreement
payment of rent)

Domestic violence emergency shelter
Health care facility/substance abuse treatment program (physical or mental health
treatment)
Homeless emergency shelter
Hotel or motel
Incarceration/jail
Permanent housing of choice (Section 8,
return to home, rent, or purchase housing)
Temporary housing with family or friends
Transitional housing (other than your
grant-funded program)
Unknown
Other (specify)

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Other

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35. Length of stay/terminated
(For victims/survivors, children, and other dependents who were terminated from your grant-funded
transitional program during this reporting period, report the number of months each person stayed in
your housing program. This should be an unduplicated count. See the separate set of instructions for
examples.) Reminder: A waiver is required for housing beyond 18 months.
Number of
months
1
2
3
4
5
6
7
8
9
10
11
12

Victims/
survivors

Children

Other
dependents

Number of
months

Victims/
survivors

Children

Other
dependents

13
14
15
16
17
18
19
20
21
22
23
24

36. Follow-up services
(If your grant-funded program provides follow-up services to victims/survivors, children and other dependents that exited or completed the program, check yes and indicate the number of months followup services may be provided. If you check yes, answer question 37.)
Yes Number of months:
No

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37. Follow-up support services
(For those victims/survivors, children and other dependents who exited, completed or were terminated
from the residential component of the program, report the number who received each of these followup support services during the current reporting period. Each person may be counted more than once,
if they received more than one type of support service during the current reporting period. However,
each person should only be counted once within each type of service received during the current reporting period. See separate set of instructions for examples.)
Type of service

Number of
victims/
survivors

Number of
children

Case management
Child care
Children’s activities
Civil legal advocacy/court accompaniment (Assisting a
victim/survivor with legal issues including preparing paperwork for protection orders, accompanying a victim/survivor to a protection order hearing or other civil proceeding; and all other advocacy within the civil justice system)
Civil legal assistance (Civil legal services provided by an
attorney)
Counseling/support group (Individual or group counseling
or support provided by a volunteer, peer, or professional.)
Criminal justice advocacy/court accompaniment (Assisting a victim/survivor with criminal legal issues including
preparing paperwork such as victim impact statements,
accompanying a victim/survivor to a criminal court proceeding or law enforcement interview; and all other advocacy within the criminal justice system)
Crisis intervention (Crisis intervention is a process by
which a person identifies, assesses, and intervenes with
an individual in crisis so as to restore balance and reduce
the effects of the crisis in her/his life. In this category,
report crisis intervention that occurs in person and/or over
the telephone.)
Education (GED, primary, secondary)
Employment counseling
Financial counseling
Housing advocacy
Job training
Leadership development opportunities (e.g., peer mentorship)
Material assistance (including clothing, food, and personal items)
Translation and interpretation
Transportation (Direct provision of transportation, including vehicle maintenance)
Other Victim/survivor advocacy (Actions designed to help
the victim/survivor obtain other resources or services
including social services, etc.)
Other (specify):
TOTAL

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Number of
other
dependents

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38. (Optional) Additional information
(Use the space below to discuss the effectiveness of your follow-up services and to provide any additional information you would like to share about your activities beyond what you have provided in the
data above. An example might include that your agency, as a result of Transitional Housing Program
funding, was able to provide employment support groups and one-on-one employment counseling. This
resulted in a significant rise in victims/survivors obtaining jobs within six months of exiting the program.)

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SECTION

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E

NARRATIVE

All grantees must answer question 39.
39. Report on the status of your Transitional Housing Program grant goals and objectives as of the end
of the current reporting period.
(Report on the status of the goals and objectives for your grant as of the end of the current reporting
period, as they were identified in your grant proposal or as they have been added or revised. Indicate
whether the activities related to your objectives for the current reporting period have been completed,
are in progress, are delayed, or have been revised. Comment on your successes and challenges, and
provide any additional explanation you feel is necessary for us to understand what you have or have
not accomplished relative to your goals and objectives. If you have not accomplished objectives that
should have been accomplished during the current reporting period, you must provide an explanation.)
All grantees must answer questions 40 and 41 on an annual basis. Submit responses on the January to
June reporting form only.
Please limit your response to 8,000 characters (approximately two pages of continuous single-spaced
text in times new roman 12 pt. font, one-inch margins). See separate instructions regarding formatting
of text and cutting and pasting into this form.
40. What do you see as the most significant areas of remaining need, with regard to improving services
to victims/survivors, increasing victim/survivor safety, access to permanent housing of choice, and
economic self-sufficiency?
(Consider geographic regions, availability of safe, affordable housing and/or employment opportunities, underserved populations, service delivery systems, and challenges and barriers.)
41. What has the Transitional Housing Program funding allowed you to do that you could not do prior to
receiving this funding?
(provide housing, expand coordination and collaboration with housing developers, develop best practice service delivery policies, etc.)
Questions 42 and 43 are optional.
Please limit your response to 8,000 characters (approximately two pages of continuous single-spaced
text in times new roman 12 pt. font, one-inch margins). See separate instructions regarding formatting
of text and cutting and pasting into this form.
42. Provide any additional information that you would like us to know about your Transitional Housing
Program grant and/or the effectiveness of your grant.
(If you have not already done so elsewhere on this form, feel free to discuss any of the following:
change in the development/availability of housing units; community collaboration; the removal or reduction of barriers and challenges for victims/survivors; evaluation of program services and policies
through customer satisfaction surveys and exit interviews; and, positive or negative unintended consequences.)
43. Provide any additional information that you would like us to know about the data submitted.
(If you have any information that could be helpful in understanding the data you have submitted in this
report, please answer this question. For example, if you submitted two different progress reports for the
same reporting period, you may explain how the data was apportioned to each report; or if you funded
staff-- but did not report any corresponding activities, you may explain why; or if you did not use program funds to support either staff or activities during the reporting period, please explain how program
funds were used, if you have not already done so.)
Public Reporting Burden
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate,
can be easily understood, and which impose the least possible burden on you to provide us with information. The estimated
average time to complete and file this form is 60 minutes per form. If you have comments regarding the accuracy of this estimate, or suggestions for making this form simpler, you can write to the Office on Violence Against Women, U.S. Department of
Justice, 810 7th Street, NW, Washington, DC 20531.
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Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #39

Goals/Objectives (1,750 characters)

Status
(100 characters)

Key Activities (1,750 characters)

Comments (500 characters)

Goals/Objectives

Status

Key Activities

Comments

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Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #39 (cont. 1)

Status
Goals/Objectives

Key Activities

Comments

Goals/Objectives

Status

Key Activities

Comments

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Describe your goals and objectives, as outlined in your grant proposal, or as revised - Question #39 (cont. 2)

Status
Goals/Objectives

Key Activities

Comments

Goals/Objectives

Status

Key Activities

Comments

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What do you see as the most significant areas of remaining need, with regard to increasing victim/survivor
safety, access to permanent housing of choice, and economic self-sufficiency? - Question #40

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What do you see as the most significant areas of remaining need, with regard to increasing victim/survivor
safety, access to permanent housing of choice, and economic self-sufficiency? - Question #40 (cont.)

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What has the Transitional Housing Program funding allowed you to do that you could not do prior to receiving
this funding? - Question #41

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What has the Transitional Housing Program funding allowed you to do that you could not do prior to receiving
this funding? - Question #41 (cont.)

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Provide additional information that you would like us to know about your Transitional Housing Program grant
and/or the effectiveness of your grant? - Question #42

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Provide additional information that you would like us to know about your Transitional Housing Program grant
and/or the effectiveness of your grant? - Question #42 (cont.)

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Provide any additional information that you would like us to know about the data submitted - Question #43

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Provide any additional information that you would like us to know about the data submitted - Question #43
(cont.)

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