| Trafficking Victim Assistance Program Data |
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| Grantee: (Name of Organization) |
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THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .75 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. |
| Case Management-Categories of Assistance |
OTIP:
Record the number of clients who received each type of service during the reporting period.
Number of Clients |
OTIP:
Record the amount of grant funds spent on direct services staff administering each type of service (e.g. salary and benefits of case management staff, office space for direct services staff, travel reimbursement for direct services staff, etc.)
Funds Spent: Staff |
OTIP:
Record the amount of grant funds spent on each type of service (e.g. spending on rent for clients, purchasing groceries for clients, funds spent on client's medical expenses, etc.)
Funds Spent: Non-Staff |
OTIP:
Record the amount of grant funds spent on all costs associated with providing direct services to clients (i.e. subrecipient reimbursement)
Total Funds Spent |
% of Project Budget |
| Advocacy |
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$- |
#DIV/0! |
| Crisis Intervention |
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$- |
#DIV/0! |
| Interpreter/Translator |
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$- |
#DIV/0! |
| Safety Planning |
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$- |
#DIV/0! |
| Clothing |
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$- |
#DIV/0! |
| Food |
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$- |
#DIV/0! |
| Personal Care Items |
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$- |
#DIV/0! |
| Child Care |
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$- |
#DIV/0! |
| Education |
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$- |
#DIV/0! |
| Employment and Job Skills |
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$- |
#DIV/0! |
| Family Reunification |
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$- |
#DIV/0! |
| Housing/Shelter |
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$- |
#DIV/0! |
| Legal |
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$- |
#DIV/0! |
| Life Skills |
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$- |
#DIV/0! |
| Transportation |
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$- |
#DIV/0! |
| Dental Health |
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$- |
#DIV/0! |
| Mental/Behavioral Health |
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$- |
#DIV/0! |
| Medical Care/Physical Health |
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$- |
#DIV/0! |
| Substance Use Assessment/Treatment |
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$- |
#DIV/0! |
| Vision Care |
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$- |
#DIV/0! |
| Other |
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$- |
#DIV/0! |
| Total Direct Services Spending |
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$- |
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| Total Program Administration Spending |
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| Total Grantee Budget |
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| Type of Client |
OTIP:
Record the number of clients who received served during the reporting period by their enrollment type.
Number of Clients |
Total Funds Spent |
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| Individuals Enrolled Only as Pre-Certified |
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| Households Enrolled Only as Pre-Certified |
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| Individuals Enrolled Only as Certified |
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| Households Enrolled Only as Certified |
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| Individuals Enrolled as Both Pre- & Certified |
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| Households Enrolled as Both Pre- & Certified |
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| Trafficking Victim Assistance Program Data |
|
| Grantee: (Name of Organization) |
|
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .75 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. |
| Type of Medical Service (e.g. behavioral health, physical health, or dental) |
Type of Entity Providing Service (Federally Qualified Health Centers, Private Physician, Indian Health Services; Urgent Care/Emergency Room/Hospital) |
Number of Victims Accessing Entity |
Amount of Project Funds Expended on Service |