Download:
pdf |
pdfOMB Control Number: 0970-0467
Expiration Date: 11/30/2018
Trafficking Victim Assistance Program Grantee
Partnership Development and Expansion: Enrollment Form
Grantee:
Reporting Period Start Date
Reporting Period End Date
Report Type
Name of Partner Organization/Agency
City
Enrollment Date
State/Territory
Type of Partner Organization/Agency
Number of Service Sites
Goal of Partnership
Partner Type
Increase Grantee's Capacity to Identify/Serve Victims
Referral Partnership
Increase Clients' Access to a Range of Services
Information Sharing Partnership
Increase Awareness of the Issue of Human Trafficking
Joint Service Programming
Partnership
Increase Sharing of Professional Expertise
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .25 hours 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.
Services Provided by Subrecipient (in-house)
Basic Necessities
Child Care
Dental Health Services
Education Assistance
Employment Assistance
Family Reunification
Financial Assistance
Housing/Shelter Services
Interpreter/Translator
Legal Advocacy and Services
Life Skills
Mental/Behavioral Health Services
Medical Services
Safety Planning Services
Substance Use Assessment/Treatment
Transportation
Victim Advocacy
None
Other
Services Provided Through Referral
Basic Necessities
Child Care
Dental Health Services
Education Assistance
Employment Assistance
Family Reunification
Financial Assistance
Housing/Shelter Services
Interpreter/Translator
Legal Advocacy and Services
Life Skills
Mental/Behavioral Health Services
Medical Services
Safety Planning Services
Substance Use Assessment/Treatment
Transportation
Victim Advocacy
None
Other
| File Type | application/pdf |
| File Modified | 2019-10-01 |
| File Created | 2019-10-01 |