9 Technical Assistance Form

OMB Control Number: 0970-0467
Expiration Date: 11/30/2018

Trafficking Victim Assistance Program Grantee Technical Assistance Reporting Form
Complete each section of the form on technical assistance activities conducted during the reporting period.
Grantee:

Reporting Period Start Date

Reporting Period End Date

Report Type

Grant Management Topics of Technical Assistance
Fill in the number of occasions of technical assistance provided by grantee during the reporting period.
Building a Community Referral Network
and Partnership Building

Data Collection, Management,
and Reporting

Introduction to Grant Program and
Onboarding

NGO Case Consultations
(OTIP)

Outreach Strategies

Program Policy, Protocol, and
Administration

Service Delivery and Access Topics of Technical Assistance
Fill in the number of occasions of technical assistance provided by grantee during the reporting period.
Approaches, Strategies, and Special
Considerations for Working with Victims

Available Services/Benefits and
Strategies for Self Sufficiency

Case Consultation

HHS Certification, Eligibility,
and Other HHS Resources

Human Trafficking 101: Definition,
Types, Laws, and Indicators

How to Access Legal Services
and Remedies

Other
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .5 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.

Technical Assistance Audience
Record the number of individuals provided technical assistance by the grantee during the reporting period.
Behavioral Health

Child Welfare

Community Member

Education

Faith-Based

Government

Health Care

Housing

Law Enforcement

Legal

Private Sector

Public Health

Social Services

Survivors/Victims

Tribal

Other

Type of Relationship Between Grantee and Recipient
Record the number of technical assistance occasions provided by type of relationship between the grantee
and the recipient of the technical assistance.
Intra-Agency

Formal Partner

Informal Partner

Other (No Partnership)