Modified Reporting Template for CDC OT21-2103 Performanc

The Performance Measures Project: Improving Performance Measurement and Monitoring by CDC Programs

App B_1 Modified Reporting Template CDC OT21-2103_Performance Measures V2 Report

OMB: 0920-1282

Document [pdf]

Download: pdf | pdf

Form approved:
OMB Control Number: 0920-1282
Expiration date: 01/31/2023
This document is provided as an EXAMPLE of the reporting fields in REDCap for the report due October 31, 2022.
Recipients must enter data in REDCap to be compliant with reporting requirements. To enter data, go to rdcp.cdc.gov.

OT21-2103 Quarterly Performance Measures Report
Collaboration Tool – Updated for October 2022
This tool provides a preview of the instructions and data fields in the Quarterly Performance
Measures Report form in REDCap. This tool can be used to collaborate with partners and
coordinate data entry prior to submitting data in REDCap. All data entry must be submitted in
REDCap.
Information and instructions provided below this line are a preview of the content in REDCap.
Automatic calculations, notifications, submission buttons are included for awareness only and
are not functional in this tool.
CDC estimates the average public reporting burden for this collection of information as 140 hours annually per response from each recipient,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed,
and completing 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. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to
CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1282)

This document is provided as an EXAMPLE of the reporting fields in REDCap for the report due October 31, 2022.
Recipients must enter data in REDCap to be compliant with reporting requirements. To enter data, go to rdcp.cdc.gov.

The form in REDCap will be used to capture performance measurement for the OT21-2103. The
performance measures associated with this grant are intended to be used by CDC and recipients to 1)
monitor implementation and progress toward achieving intended outcomes; 2) demonstrate
accountability to interested parties (e.g., funders, public) by showing how funds are being allocated; and
3) maximize learning opportunities associated with the implementation and impacts of this grant.
Reminders:
•
•
•
•
•

Only report on the measures for the strategy areas you are working in. Note - There are no
performance measures specific to Strategy 5: Other.
CDC will review your report and work with your PO if there are any questions or concerns.
Additional guidance can be found in the "File Repository" within REDCap.
For questions on REDCap, reach out to [email protected] and cc your project officer.
If you have questions related to these performance measures, contact
[email protected].

Instructions:
1. Report only on the measures that align with your selected strategies. Note - all recipients who
engage partners to support any of the strategies will report on measure 4.1.
2. Entering counts for calculations:
o Aggregate counts for the current quarter(s) they are completed or realized within.
o Enter whole numbers (e.g. integer) only; Example: 0, 1, 4.
o Fractions, dollar signs, decimals, and other special characters are not allowed.
o Some fields automatically calculate totals and the text will be red.
3. Select "Yes" to the final question, "Would you like to submit your report to the CDC 2103
Performance Measurement Team?" to notify CDC that your report is complete.
4. Select "Complete" from the "From Status" drop down menu; Click Save.
Next Steps? - Here's What You Can Expect:
•
•
•

Reporting Forms Release: TBD
Recipient Office Hour (s): TBD
Quarterly Reports Due: 11:59PM ET, Monday, October 31, 2022

If you have questions related to these performance measures, contact [email protected]. For
questions on REDCap, reach out to [email protected] and cc your project officer.

Str at egy 1. E xpand e xistin g and/o r de ve lop new mit igat ion and p re vent ion
r esour ces and se rvice s t o redu ce COV ID -1 9 related d isparit ies amon g
po pulations at highe r risk and th at are und erse rved .
Are you reporting on Measure 1.1? Number (#) of COVID-19 mitigation & prevention resources and
services delivered in support of populations that are underserved and disproportionately affected by
type. (Select yes to respond)
___ Yes
___ No

Do you have an approved justification to update the target for Measure 1.1?
___Yes
___ No
(note: the two fields below will only appear and only apply if you have an approved justification
to update the target for Measure 1.1.)
Measure 1.1 Updated Target – October 1, 2022:

Measure 1.1 Approved Justification – October 1, 2022:

Measure 1.1 Quarterly Progress: Report counts of resources and services delivered if they are
completed or acted upon in the reporting quarter.
Measure 1.1 Describe challenges or other information related to measure 1.1. If none, enter N/A.
(1000-character limit):

Type of Resource / Service:

Count (If none, enter 0)

Vaccination and vaccine support
Testing
Contact tracing
Case investigation
Quarantine and isolation
Preventive care and disease management
Personal protective equipment (PPE)
Wrap-around services related to COVID-19
Evidence-based policies, systems, and environmental strategies
Other navigation and support services to address COVID-19 risk factors
and mitigation/prevention
Communications about COVID-19 risk factors and
mitigation/prevention
Plans for countermeasures and adaption services
Other COVID-19 mitigation and prevention resource
Total Number of Resources / Services:

(automatically calculated
in REDCap)

Are you reporting on Measure 1.2 (optional)? Number (#) of COVID-19/SARS-CoV-2 tests completed
by test type, results, and ethnicity? (Select yes to respond)
___ Yes
___ No
Do you have an approved justification to update the target for Measure 1.2? NOTE: For the October
reporting cycle, recipients do not need to provide or update targets for measures 1.2 and 1.3, only.
Recipients who are reporting on measures 1.2 and 1.3 are still expected to provide updated counts.
___Yes
___ No
(note: the two fields below will only appear and only apply if you have an approved justification
to update the target for Measure 1.2.)
Measure 1.2 Updated Target – October 1, 2022:

Measure 1.2 Approved Justification – October 1, 2022:

Measure 1.2 Quarterly Progress: Report tests completed in the reporting quarter.
Measure 1.2 Describe challenges or other information related to measure 1.2. If none, enter N/A.
(1000-character limit):

•

This measure and guidance align with ELC Enhancing Detection Measure E.2. If you are an ELC
recipient, you October report the same data for OT21-2103, including racial and ethnic
population data.
If exact numbers are difficult to obtain, please indicate numbers for which race and ethnicity are
unknown.

Measure 1.2 Geographic Level:
Choose an item.

Measure 1.2 Name/description of geographic level:

Note About Geography - If you have the capacity to report the number and type of resource/service at
the county, parish, tribal land, census track, or metropolitan statistical area (MSA) level, please provide
that information to the lowest geographical level possible.
Test Conducted
Number of COVID-19/SARS-CoV-2 molecular tests conducted:

Counts (If none, enter "0")
(automatically calculated in
REDCap)

(automatically calculated in
REDCap)

Alaska Native, non-Hispanic
American Indian, non-Hispanic
Asian, Non-Hispanic
Black or African American, non-Hispanic
Hispanic, Latino or Latinx
Native Hawaiian and Pacific Islanders, non-Hispanic
White, non-Hispanic
Multiple race, non-Hispanic
Unknown
Number of COVID-19/SARS-CoV-2 molecular tests that were positive:
Alaska Native, non-Hispanic
American Indian, non-Hispanic
Asian, Non-Hispanic
Black or African American, non-Hispanic
Hispanic, Latino or Latinx
Native Hawaiian and Pacific Islanders, non-Hispanic
White, non-Hispanic
Multiple race, non-Hispanic
Unknown

(automatically calculated in
REDCap)

Are you reporting on Measure 1.3 (optional)? Caseload, number of cases per case investigator and
number of contacts per contact tracer during the data collection period? (Select yes to respond)
___ Yes
___ No
Do you have an approved justification to update the target for Measure 1.3? NOTE: For the October
reporting cycle, recipients do not need to provide or update targets for measures 1.2 and 1.3, only.
Recipients who are reporting on measures 1.2 and 1.3 are still expected to provide updated counts.
___ Yes
___ No
(note: the two fields below will only appear and only apply if you have an approved justification
to update the target for Measure 1.3.)
Measure 1.3 Updated Target – October 1, 2022:

Measure 1.3 Approved Justification – October 1, 2022:

Measure 1.3 Quarterly Progress: Report caseload, number of cases per case investigator and number
of contacts per contact tracer in the reporting quarter.
Measure 1.3 Describe challenges or other information related to measure 1.3. If none, enter N/A.
(1000-character limit):

•

If exact numbers are difficult to obtain, please indicate numbers for which race and ethnicity are
unknown.

Measure 1.3 Geographic Level:
Choose an item.

Measure 1.3 Name/description of geographic level:

Counts (If none, enter "0")

Number of cases reported to the health department (confirmed and,
if possible, probable)

(automatically calculated in
REDCap)

Alaska Native, non-Hispanic
American Indian, non-Hispanic
Asian, Non-Hispanic
Black or African American, non-Hispanic
Hispanic, Latino or Latinx
Native Hawaiian and Pacific Islanders, non-Hispanic
White, non-Hispanic
Multiple race, non-Hispanic
Unknown
Number of cases sent to the case investigation team
Number of case investigators
Number of contacts identified through case investigations
Alaska Native, non-Hispanic
American Indian, non-Hispanic
Asian, Non-Hispanic
Black or African American, non-Hispanic
Hispanic, Latino or Latinx
Native Hawaiian and Pacific Islanders, non-Hispanic
White, non-Hispanic
Multiple race, non-Hispanic
Unknown
Number of contact tracers

Are you reporting on Measure 1.4? Delivery and access to testing resources and services in support of
populations that are underserved and disproportionately affected. (Select yes to respond)
Yes
No
Measure 1.4 Quarterly Progress: Delivery and access to testing resources and services in support of
populations that are underserved and disproportionately affected.
• If exact numbers are difficult to obtain, please indicate numbers for which race and ethnicity are
unknown.
Measure 1.4 Describe challenges or other information related to measure 1.4. If none, enter N/A.
(1000-character limit):

1. Number of testing resources and services delivered in support of populations that are
underserved and disproportionately affected. Note – This count is pulled from Measure 1.1
Total.
2. Did you deliver testing resources and services to the following populations of focus? If yes,
provide the following:

Alaska Native, non-Hispanic

o
o

Yes
No

American Indian, non-Hispanic

o
o

Yes
No

Asian, Non-Hispanic

o
o

Yes
No

Black or African American, non-Hispanic

o
o

Yes
No

Hispanic, Latino or Latinx

o
o

Yes
No

Native Hawaiian and Pacific Islanders, non-Hispanic

o
o

Yes
No

White, non-Hispanic

o
o

Yes
No

Multiple race, non-Hispanic

Yes

People living in rural areas

o
o

Yes
No

Unknown

o
o

Yes
No

Recipients also have the option to report by other populations of focus that are supported through
testing services. Reporting by the populations below is optional - only racial and ethnic populations
and rural populations above are required.
People experiencing poverty
o Yes
o No
People experiencing homelessness
o Yes
o No
Non-US-born persons
o Yes
o No
People with disabilities
o Yes
o No
Adults aged 65+
o Yes
o No
People with substance use disorders
o Yes
o No
LGBTQ+ persons
o Yes
o No
People living in other congregate housing
o Yes
o No
People who are incarcerated
o Yes
o No
Youth and young adults
o Yes
o No
People experiencing mental illness
o Yes
o No
People in religious minority groups
o Yes
o No

Alaska Native: (Sample population of focus, copy this section for each selected population of focus)
I. Number of testing resources and services delivered to this
population:
II. Settings where testing resources and services were delivered to this
population:

Childcare center/school

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Community-based organization

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Correctional facility or institution

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Faith-based organization (e.g., place of worship)

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Home

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Local health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Medical or clinical site (e.g., hospital)

o
o
o

0%
1-25%
26-50%

o
o
o

51-75%
76-99%
100%

Recreational facility

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Senior residence or long-term care facility

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Shelter/group home

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

State health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Tribal nation or area

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

University or college

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Worksite

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Governmental organizations focused on non-health services

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Community

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Other—please specify:

III. How were testing resources and services delivered to this
population:

At-home test kits

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Testing sites

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Mobile testing

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Partner events

o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%

100%

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Academic Institutions

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Asian American and Pacific Islander-Serving Institution

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Community-based and civic organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Correctional facilities and institutions organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Faith Based Organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Healthcare providers

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Other—please specify:

IV. Partners mobilized to deliver testing resources and services to this
population:

Health-related organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Local governmental agencies and community leaders

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Nongovernmental organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Rural health clinics and critical access hospitals governmental
organizations focused on non-health services

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Schools / School Districts

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Social services providers and organizations, including those that address
social determinants of health

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

State offices of rural health or equivalent, state rural health associations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Tribes, tribal organizations

o
o
o
o

0%
1-25%
26-50%
51-75%

o
o

76-99%
100%

State Health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Local health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Council, community group, coalition or other working group

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Mental or behavioral health

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Federal agency (other than CDC)

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Corporation, industry, or private sector

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Are you reporting on Measure 1.5? Delivery and access to vaccination resources and services in
support of populations that are underserved and disproportionately affected. (Select yes to respond)
Yes
No
Measure 1.5 Quarterly Progress: Delivery and access to vaccination resources and services in support
of populations that are underserved and disproportionately affected.
• If exact numbers are difficult to obtain, please indicate numbers for which race and ethnicity are
unknown.
Measure 1.5 Describe challenges or other information related to measure 1.5. If none, enter N/A.
(1000-character limit):

1. Number of vaccination resources and services delivered in support of populations that are
underserved and disproportionately affected. Note – This count is pulled from Measure 1.1
Total.
2. Did you deliver vaccination resources and services to the following populations of focus? If yes,
provide the following:

Alaska Native, non-Hispanic

o
o

Yes
No

American Indian, non-Hispanic

o
o

Yes
No

Asian, Non-Hispanic

o
o

Yes
No

Black or African American, non-Hispanic

o
o

Yes
No

Hispanic, Latino or Latinx

o
o

Yes
No

Native Hawaiian and Pacific Islanders, non-Hispanic

o
o

Yes
No

White, non-Hispanic

o
o

Yes
No

Multiple race, non-Hispanic

Yes

People living in rural areas

o
o

Yes
No

Unknown

o
o

Yes
No

Recipients also have the option to report by other populations of focus that are supported through
vaccination services. Reporting by the populations below is optional - only racial and ethnic
populations and rural populations above are required.
People experiencing poverty
o Yes
o No
People experiencing homelessness
o Yes
o No
Non-US-born persons
o Yes
o No
People with disabilities
o Yes
o No
Adults aged 65+
o Yes
o No
People with substance use disorders
o Yes
o No
LGBTQ+ persons
o Yes
o No
People living in other congregate housing
o Yes
o No
People who are incarcerated
o Yes
o No
Youth and young adults
o Yes
o No
People experiencing mental illness
o Yes
o No
People in religious minority groups
o Yes
o No

Alaska Native: (Sample population of focus, copy this section for each selected population of focus)
I. Number of vaccination resources and services delivered to this
population:
II. Settings where vaccination resources and services were delivered to
this population:

Childcare center/school

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Community-based organization

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Correctional facility or institution

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Faith-based organization (e.g., place of worship)

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Home

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Local health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Medical or clinical site (e.g., hospital)

o
o
o

0%
1-25%
26-50%

o
o
o

51-75%
76-99%
100%

Recreational facility

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Senior residence or long-term care facility

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Shelter/group home

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

State health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Tribal nation or area

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

University or college

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Worksite

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Governmental organizations focused on non-health services

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Community

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Other—please specify:

III. How were vaccination resources and services delivered to this
population:

Vaccination education and outreach

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Vaccination clinic support

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

At-home vaccination support

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Partner events

o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%

100%

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Academic Institutions

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Asian American and Pacific Islander-Serving Institution

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Community-based and civic organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Correctional facilities and institutions organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Faith Based Organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Healthcare providers

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Other—please specify:

IV. Partners mobilized to deliver vaccination resources and services to
this population:

Health-related organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Local governmental agencies and community leaders

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Nongovernmental organizations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Rural health clinics and critical access hospitals governmental
organizations focused on non-health services

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Schools / School Districts

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Social services providers and organizations, including those that address
social determinants of health

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

State offices of rural health or equivalent, state rural health associations

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Tribes, tribal organizations

o
o
o
o

0%
1-25%
26-50%
51-75%

o
o

76-99%
100%

State Health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Local health department

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Council, community group, coalition or other working group

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Mental or behavioral health

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Federal agency (other than CDC)

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

Corporation, industry, or private sector

o
o
o
o
o
o

0%
1-25%
26-50%
51-75%
76-99%
100%

S tr a teg y 2 . I ncr ea se/ im pro v e d at a co ll ect io n an d re po r ti n g fo r po pu l atio n s
ex pe r ie nc in g a di s pro p o r tio na te b ur de n o f C OV ID -1 9 in fe ctio n , sev e re i ll ne ss , a n d
d ea th to g ui de t he res po nse to th e C OV ID -1 9 p an dem ic .
Are you reporting on Measure 2.1? Number of improvements to data collection, quality, and reporting
capacity for recipients, partners, and agencies related to COVID-19 health disparities and inequities
(Select yes to respond)
___ Yes
___ No
Do you have an approved justification to update the target for Measure 2.1?
___Yes
___ No
(note: the two fields below will only appear and only apply if you have an approved justification
to update the target for Measure 2.1.)
Measure 2.1 Updated Target – October 1, 2022:

Measure 2.1 Approved Justification – October 1, 2022:

Measure 2.1 Quarterly Progress: Report counts of improvements only in the quarter they are
completed or realized.
•

Please report all data systems and staffing related to data infrastructure improvements under
this measure and not under measure 2.1
Measure 2.1 Describe challenges or other information related to measure 2.1. If none, enter N/A.
(1000-character limit):

Data Collection and Reporting

Counts (if none, enter “0”)

Count of improvements to data collection and reporting within
recipient organization

(automatically calculated in
REDCap)

Established plans for collecting and reporting data
Established, enhanced, or maintained data systems
Workforce support for data collection and reporting
Developed key data principles and resources
Implemented improvements to testing and contact tracing data
Developed monitoring and evaluation plans
Other
Count of improvements to data collection and reporting across partner (automatically calculated in
or agency organizations
REDCap)
Established plans for collecting and reporting data
Established, enhanced, or maintained data systems
Workforce support for data collection and reporting
Developed key data principles and resources
Implemented improvements to testing and contact tracing data
Developed monitoring and evaluation plans
Other
Total count of improvements to data collection and reporting

(automatically calculated in
REDCap)

Data Quality
Count of improvements to data quality within recipient organization
Implemented health equity data education efforts
Developed plans for data quality assurance and improvement
Data coordination within or across departments and systems
Other

(automatically calculated in
REDCap)

Count of improvements to data quality across partner or agency
organizations

(automatically calculated in
REDCap)

Implemented health equity data education efforts
Developed plans for data quality assurance and improvement
Data coordination within or across departments and systems
Other
(automatically calculated in
REDCap)
Total count of improvements (Data Collection & Reporting + Data Quality Improvements)
Total count of improvements to data quality

(automatically calculated)

S tr a teg y 3 . Bu i ld , lev e ra ge , a n d e xp a nd i n fr as tr uc tu re s up po rt fo r C OV ID -1 9
p rev en tio n a nd co ntro l am o n g po p u lat io ns th at ar e a t hi g he r ri sk a n d un de rse rv e d .
Are you reporting on Measure 3.1? Number of improvements to infrastructure to address COVID-19
health disparities and inequities (Select yes to respond)
___ Yes
___ No
Do you have an approved justification to update the target for Measure 3.1?
___Yes
___ No
(note: the two fields below will only appear and only apply if you have an approved justification
to update the target for Measure 3.1.)
Measure 3.1 Updated Target – October 1, 2022:

Measure 3.1 Approved Justification – October 1, 2022:

Measure 3.1 Quarterly Progress: Report counts of improvements only in the quarter they are
completed or realized. This measure October count staff who are retained because of OT21-2103
funds and activities.
Measure 3.1 Describe challenges or other information related to measure 3.1. If none, enter N/A.
(1000-character limit):

•

Note - this measure excludes infrastructure improvements to data systems and data related
workforce support (e.g., IT specialist, data coordinators, and analysts).

Data Collection and Reporting

Counts (if none, enter “0”)

Count of improvements to infrastructure within recipient
organization

(automatically calculated in
REDCap)

Expanded or enhanced workforce
Training or education delivered within recipient organization
Developed or updated health equity plans
Established health equity offices
Expanded contact tracing and testing infrastructure
Other
Count of improvements to infrastructure across partner or agency
organizations
Training or education delivered within community or partner
organizations
Convened multisector coalitions or advisory groups
Improved cross-sector coordination and systems
Other
Total number of improvements to infrastructure
(automatically calculated)

(automatically calculated in
REDCap)

S tr a teg y 4 . Bu i ld , lev e ra ge , a n d e xp a nd i n fr as tr uc tu re s up po rt fo r C OV ID -1 9
p rev en tio n a nd co ntro l am o n g po p u lat io ns th at ar e a t hi g he r ri sk a n d un de rse rv e d .
Are you reporting on Measure 4.1? Number and proportion of new, expanded, or existing
partnerships mobilized to address COVID-19 health disparities and inequities? (Note - All recipients
are asked to report on measure 4.1)
___ Yes
Do you have an approved justification to update the target for Measure 4.1?
___Yes
___ No
(note: the two fields below will only appear and only apply if you have an approved justification
to update the target for Measure 3.1.)
Measure 4.1 Updated Target – October 1, 2022:

Measure 4.1 Approved Justification – October 1, 2022:

Measure 4.1 Quarterly Progress: Report counts of partnerships in the quarter they are initiated. To
avoid double counting, only count each partnership once even if partnerships evolve over the period
of performance. Provide updates of how partnerships evolve in progress reports (Arm 1).
Measure 4.1 Describe challenges or other information related to measure 4.1. If none, enter N/A.
(1000-character limit):

•
•
•

All OT21-2103 recipients will calculate and report on measure 4.1.
Both funded and unfunded partnerships should be included when calculating and reporting this
measure.
Do not include plans, staffing, or materials in support of partnerships when reporting this
measure.

Counts (if none, enter “0”)
Count of NEW partnerships mobilized

(automatically calculated)

Academic Institutions
Asian American and Pacific Islander-Serving Institution
Community-based and civic organizations
Correctional facilities and institutions organizations
Faith Based Organizations
Healthcare providers
Health-related organizations
Local governmental agencies and community leaders
Nongovernmental organizations
Rural health clinics and critical access hospitals governmental
organizations focused on non-health services
Schools / School Districts
Social services providers and organizations, including those that
address social determinants of health
State offices of rural health or equivalent, state rural health
associations
Tribes, tribal organizations
State Health department
Local health department
Council, community group, coalition or other working group
Mental or behavioral health
Federal agency (other than CDC)
Corporation, industry or private sector

Count of EXPANDED partnerships mobilized
Academic Institutions
Asian American and Pacific Islander-Serving Institution
Community-based and civic organizations
Correctional facilities and institutions organizations
Faith Based Organizations
Healthcare providers
Health-related organizations
Local governmental agencies and community leaders

(automatically calculated)

Nongovernmental organizations
Rural health clinics and critical access hospitals governmental
organizations focused on non-health services
Schools / School Districts
Social services providers and organizations, including those that
address social determinants of health
State offices of rural health or equivalent, state rural health
associations
Tribes, tribal organizations
State Health department
Local health department
Council, community group, coalition or other working group
Mental or behavioral health
Federal agency (other than CDC)
Corporation, industry or private sector
Individual community members
Other
Count of EXISTING partnerships mobilized
Academic Institutions
Asian American and Pacific Islander-Serving Institution
Community-based and civic organizations
Correctional facilities and institutions organizations
Faith Based Organizations
Healthcare providers
Health-related organizations
Local governmental agencies and community leaders
Nongovernmental organizations
Rural health clinics and critical access hospitals governmental
organizations focused on non-health services
Schools / School Districts
Social services providers and organizations, including those that
address social determinants of health/
State offices of rural health or equivalent, state rural health
associations
Tribes, tribal organizations
State Health department
Local health department

(automatically calculated)

Council, community group, coalition or other working group
Mental or behavioral health
Federal agency (other than CDC)
Corporation, industry or private sector
Individual community members
Other
Partnership Summary Table
Total number of partnerships mobilized

(automatically calculated in
REDCap)

Proportion of new partnerships mobilized

(automatically calculated in
REDCap)

Proportion of expanded partnerships mobilized

(automatically calculated in
REDCap in REDCap)

Proportion of existing partnerships mobilized

(automatically calculated in
REDCap)

Would you like to submit your report to CDC? Selecting YES will automatically send a notification
to CDC when you mark the form as complete and save the form.

___ Yes
___ No
Form Status
Complete?

Choose an item.

File Type	application/pdf
Author	Monique Martin
File Modified	2022-08-22
File Created	2022-07-01