Ddc Ppr

ANNUAL PROGRAM PERFORMANCE REPORT TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
OVERVIEW:
This template incorporates new information being requested as part of the Program Performance Report
(PPR) comprehensive reporting. It includes the following sections:

Section
I.
II.
III.
IV.
V.
VI.

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Area
Identification
Comprehensive Review and Analysis (CRA)
State Plan Implementation
Progress Report
Council Financial Information
Measures of Collaboration

Revised–October 2022 - PPR Reporting Template

Note: Section numbers and minor section title changes may occur

ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
ANNUAL PROGRAM PERFORMANCE REPORT (PPR)
SECTION I: IDENTIFICATION
PURPOSE: To provide identifying information of the reporting Council

1. State/Territory:
2. Federal Fiscal Year Reporting: October 1, 20___ through September 30, 20___
3. Contact person regarding PPR information:
4. Contact person’s phone number:
5. Contact person’s e-mail address:
6. Executive Director name (if different from contact person):
7. Executive Director’s phone number:
8. Executive Director’s email address:

SECTION II: COMPREHENSIVE REVIEW AND ANALYSIS
PURPOSE : To provide an update to the Comprehensive Review and Analysis

Comprehensive Review and Analysis- Update- [Section 124(C)(3)]
The DD Act requires the following annual descriptions:
• adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in
Intermediate Care Facilities (ICF) receive;

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
•

adequacy of health care and other services, supports, and assistance that individuals with developmental disabilities served
through home and community-based waivers receive;
AIDD interprets this as annual updates to:
• adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in
Intermediate Care Facilities receive; (ICF updates)
• adequacy of health care and other services, supports, and assistance that individuals with developmental disabilities served
through home and community-based waivers (HCBW) receive; (HCBW updates)
• And other sections that apply (e.g.: state information, portrait of state services, analysis of state issues and challenges, rational
for goal selection, collaboration).
• Federal and state initiatives impacting people with DD and their families in the State/Territory
Note: (*)- Adequacy may be described in terms of quality and/or populations served versus need.

SECTION III: STATE PLAN IMPLEMENTATION
PURPOSE: To provide the context of what will be reported in the PPR. Section III is comprised of 3 reporting areas: (A) Introduction; (B) evaluation
of state plan implementation; (C) Input on National Priorities

A. Introduction
In this section provide an executive summary with cohesive information that provides an overview of the report including, but
not limited to the following: (1) targeted areas of emphasis, (2) strategies used to implement activities; (3) significant
accomplishments and/or barriers to state plan implementation; (4) needs requiring state plan amendments

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
Note: detailed information will be provided below in Section IV
Cultural Diversity
Describe the Council’s overall efforts to address the needs of individuals with developmental disabilities and their families of a
diverse culture through its state plan supported activities.

B. Evaluation of State Plan Implementation [Section 125(c) (5) and (c)(7)]
In this section report on the evaluation activities conducted and results. The report should include:
B1. Evaluation Activities
Describe the evaluation activities undertaken during the fiscal year being reported, including evaluation activities
conducted to strategically assess the overall progress and direction of the state plan implementation
B2. Evaluation Results
Report the broad results of the evaluation activities described above (B1), including a broad assessment of the overall
progress of Council supported activities.

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
B3. Lessons Learned and Future work of the Council
Report on how the Council will use lessons learned from state plan implementation and the data gathered from the
evaluation activities to move forward the work of the Council?
C. Input on National Priorities

SECTION IV: STATE PLAN IMPLEMENTATION PROGRESS REPORT
Section IV.A. Detailed Progress Report on Goals

Goal #1: Goal statement would be taken directly from State Plan
Area(s) of Emphasis:
Area of Emphasis

Planned for this goal
Taken directly from State Plan;
areas checked off

Areas addressed
To be completed annually; Council
checks off Areas

Quality Assurance
Education and Early Intervention
Child Care
Health

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Employment
Housing
Transportation
Recreation
Formal and Informal Community Supports

Strategies:
**Strategies
** As identified in Section 125 (c)(5)(A-L) of the
Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (PL 106-402)

Planned for this goal
Taken directly from State
Plan; strategies checked off

Strategies Used
To be completed annually;
Council checks off Strategies
Used

Outreach
Training
Technical Assistance
Supporting and Educating Communities
Interagency Collaboration and Coordination
Coordination with Related Councils,
Committees and Programs
Barrier Elimination
Systems Design and Redesign
Coalition Development and Citizen
Participation

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES

Collaborators
Definition of collaborator: someone who works
with another person or group in order to achieve
or do something

Planned for this goal
Taken directly from State Plan;
Collaborators checked off as
planned

Actual
To be completed annually; Council
checks off planned Collaborators
who actually participated or adds
collaborators not previously
planned.

State Protection and Advocacy System
University Center(s)
State DD agency
Other:
Other:
Other:
Informing Policymakers
Demonstration of New Approaches to Services
and Supports
Demonstration of projects and activities
Other Activities
Intermediaries/Collaborators:

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
1.
2.
3.

Goal # 1:
State Plan Objective 1:
Check the appropriate box for each of the questions below:
This Objective is:

☐ Individual & Family Advocacy ☐ System Change ☐ Capacity Building
4.

This Objective is:

☐ New ☐
5.

Ongoing

☐ Completed

This Objective is:
a. Fulfilling the Self-Advocacy DD Act Requirement

☐ Yes ☐ No

☐ Yes ☐ No
DD Network Collaboration ☐ Yes ☐ No

b. Targeted Disparity
c.

d. A demonstration project of New Approaches to Services and Supports
original start date for this effort: name of project; mm/yy
e. A demonstration of projects or activities ☐ Yes
effort: name of project/ mm/yy
6.

☐ Yes ☐ No , If Yes, Indicate project name and

☐ No, If Yes, indicate project or activity name and original start date for this

Stage of Implementation for systems change activities:

☐ planning

☐ implementation ☐ outcome/fully integrated

Background/Context
7.
Provide an overall description of this objective:
The description should at a minimum provide background information on the objective to establish a context for the activities.
Goal # 1:

Objective # 1:

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
8.

Expected Outputs
List expected outputs from annual work plan

1.
2.
3.

10.
•
•
•
•

11.

9.
1.
2.
3.

Outputs Achieved
List outputs achieved

Progress Report
The report should include the following:
A narrative progress report that cohesively describes the activities that were implemented toward achieving the objective, including how
the identified strategy was used, how the activity was implemented, challenges to achieving the objective and unexpected benefits.
For system change activities, include a description of the stage of implementation (planning, initiation, implementation, outcome/fully
integrated) of the system change initiative.
All narratives must describe what numbers make up the performance measures number for the activities being reported in the narrative.
A summary of evaluation activities to monitor progress and impact of council supported activities for the objective; data collected during the
year, data sources, and data collection methods; (logic model and evaluation plan may be attached to the report).
Expected Outcomes (matches the expected outcomes
from the annual work plan as it relates to the objective)
List the expected outcomes for the activities described for the
objective from the annual work plan

12.

Outcomes achieved

13.
Progress towards achieving outcomes for overall objective :
The annual report should include an assessment as to the extent to which progress was made on the intended outcomes for the objective.
14.
Additionally, include stories of culturally diverse people with developmental disabilities whose lives are better because of Council work on
this activity (e.g., became better advocates for themselves and others, became more connected to the community). Stories of policy or
legislative changes that happened as a result of Council individual advocacy work that are likely to positively impact the lives of people with
developmental disabilities or that will prevent a potential negative impact (e.g., created deleted, refined programs and/or legislation,
reallocated use of funds, organizational systems change as a result of evidence based practices).

Repeat this page for each goal and objectives as necessary for the individual Council’s 5 year state plan

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
2. Goal # Narrative
In this section, for each goal reported for this reporting period, provide an overall cohesive description of:
•
•
•
•

the extent to which progress is being made in achieving the intended outcomes of the Goal for the
reporting year;
the extent to which each goal was or was not achieved for the reporting year;
where applicable, factors that impeded goal achievement for the reporting year
needs that require substantive state plan amendment (goal only)

4 Year Overview (FY 2020)
A description of how the Council will use and build from knowledge gained and progress made to move forward in the next
state plan cycle (FY 2022-2026).
5 Year Overview (FY2021)
For the final PPR (FY2021) of this state plan cycle, provide an overall analysis of the outcomes achieved during the five year
state plan cycle. The description should include the extent to which diverse stakeholders are satisfied with council activities
that promote self-determination and community participation for individuals with disabilities and families, results of other
types of information gathering such as focus groups, surveys, or other feedback or input methods with individuals with
developmental disabilities and families and major accomplishments and factors impeding goal achievement (if applicable)

Section IV.B. Individual & Family Advocacy Performance Measure (By GOAL)
Individual Responses (individuals with DD and Family members only)
Demographic Data **
**This is an aggregated number from all individual responses collected for the reporting FFY

Race/Ethnicity
White, alone
Black or African American alone

#

%

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
American Indian and Alaska Native
alone
Hispanic/Latino
Asian alone
Native Hawaiian & Other Pacific
Islander alone
Two or more races
Race unknown

Sexual Orientation:

Which of the following best
represents how you think of
yourself? [Select ONE]:
□ Lesbian or gay
□ Straight, that is, not gay or
lesbian
□ Bisexual
□ [If respondent is AIAN:] TwoSpirit*
□ I use a different term [freetext]**
□ (Don’t know)
□ (Prefer not to answer)

#

%

Gender Identity:

Q1: What sex were you assigned
at birth, on your original birth
certificate?

#

%

□ Female
□ Male
□ (Don’t know)
□ (Prefer not to answer)

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Q2: What is your current
gender? [Select ONE]
□ Female
□ Male
□ Transgender
□ [If respondent is AIAN:] TwoSpirit*
□ I use a different term: [free
text]**
□ (Don’t know)
□ (Prefer not to answer)

#

%

Category

#

Individual with DD

This is IFA1.1

Family Member

This is IFA 1.2

%

Geographical
Urban
Rural

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
I.

Output Measures

Objective #

Performance Measure

Performance Measure

IFA 1.1
The number of people with developmental
disabilities who participated in Council
supported activities designed to increase
their knowledge of how to take part in
decisions that affect their lives, the lives of
others, and/or systems

IFA 1.2
The number of family members who
participated in Council supported in
activities designed to increase their
knowledge of how to take part in decisions
that affect the family, the lives of others,
and/or systems

1. Specify Objective #
2. Specify Objective #
3. Specify Objective #
4. Add additional lines as
needed
Denominator:
TOTAL # of Output Respondents
(this is the total number of people
responding to a survey):

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
II.
Outcome Measures
Performance Measures
IFA 2.1
After participation in Council supported activities, the percent of people with developmental
disabilities who report increasing their advocacy as a result of Council work.

Percent (%)

IFA 2.2
After participation in Council supported activities, the percent of families who report
increasing their advocacy as a result of Council work.
Sub- Outcome Measures

The number (#) of people who are better able to say
what they want/say what is important to them

Projects

#
People with
developmental
disabilities

#
Family
Members

1. Specify Objective #

#

#

2. Specify Objective #

#

#

#
#

#
#

Total sub-outcome # /
IFA 1.1 total # of
output respondents =
X%

Total suboutcome # / IFA
1.2 total of
output
respondents =
X%

3. Add additional lines as needed
Total # of Sub-Outcome Respondents:
IFA 2.3
The percent of people who are better able to say what they want or say what services and supports
they want or say what is important to them

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
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Sub- Outcome Measures

The number (#) of people who are participating in
advocacy activities

Projects

#
People with
developmental
disabilities

1. Specify Objective #

#

#

2. Specify Objective #

#

#

#
#
Total sub-outcome # /
IFA 1.1 total number
of output respondents
= X%

#
#

3. Add additional lines as needed
Total # of Sub-Outcome Respondents:
IFA 2.4
The percentage (%) of people who are participating now in advocacy activities

Sub- Outcome Measures

The number (#) of people who are on cross disability
coalitions, policy boards, advisory boards, governing
bodies and/or serving in leadership positions.

#
Family
Members

#
People with
developmental
disabilities

Projects

1. Specify Objective #

2. Specify Objective #
3. Add additional lines as needed
Total # of Sub-Outcome Respondents:
IFA 2.5
The percent of people who are on cross disability coalitions, policy boards, advisory boards, governing
bodies and/or serving in leadership position

Total suboutcome # / IFA
1.2 total number
of output
respondents = X%

#
Family Members

#

#

#
#
#

#
#
#

Total sub-outcome # / IFA
1.1 total number of output
respondents = X%

Total sub-outcome # /
IFA 1.2 total number
of output respondents
= X%

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IFA 3 The percent of people satisfied with a project activity

Divide the # of
positive responses
by PWDD to this
question by the
number of surveys
received (IFA 1.1.
denominator)

IFA 3.1 The percentage (%) of people with developmental disabilities who are satisfied with a
project activity

Divide the # of
positive responses
by PWDD to this
question by the
number of surveys
received (IFA 1.1.
denominator)

IFA 3.2 The percentage (%) of family members satisfied with a project activity

Divide the # of
positive responses
by PWDD to this
question by the
number of surveys
received (IFA 1.1.
denominator)

Divide the # of
positive responses
by family
members to this
question by the
number of surveys
received (IFA 1.2
denominator)
Divide the # of
positive responses
by family
members to this
question by the
number of surveys
received (IFA 1.2
denominator)
Divide the # of
positive responses
by family
members to this
question by the
number of surveys
received (IFA 1.2
denominator)

Section IV.C. System Change Performance Measures (By Goal)
SC 1: Output Measures

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
The number of Council efforts to transform fragmented approaches into a coordinated and effective system that assures
individuals with developmental disabilities and their families participate in the design of and have access to needed
community services, individualized supports, and other forms of assistance that promote self-determination, independence,
productivity, and integration and inclusion in all facets of community life.
Objective
1. Specify Objective #
2. Specify Objective #
3. Specify Objective #
4. Specify Objective #

SC 1.1 The number of policy and/or procedure created or changed

Objective
1, Specify Objective #
2. Specify Objective #
3. Specify Objective #
4. Specify Objective #

SC 1.2 The number of statute and/or regulations created or changed

Objective

SC 1.3 The number of promising and/or best practices created and/or supported
SC 1.3.1 The number
of promising
practices created

1.
2.
3.
4.

SC 1.3.2 The number
of promising
practices supported
through Council
activities

SC 1.3.3. The
number of best
practices created

SC 1.3.4 The number
of best practices
supported through
Council activities

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
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Objective
1.
2.
3.
4.

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

Objective
1.
2.
3.
4.

SC 1.4 The number of people trained or educated through Council systemic change
initiatives

SC 1.5 The number of Council supported systems change activities with organizations
actively involved

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

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Systems Change SC 2: Outcome Measures
Outcome Measures
SC 2.1
The number of Council efforts that led to the creation or improvement of best or promising practices,
policies, procedures, statute or regulation changes. (sub-measures 2.1.1; 2.1.3)

Number (#)

SC 2.2
The number of Council efforts that were implemented to transform fragmented approaches into a
coordinated and effective system that assures individuals with developmental disabilities and their
families participate in the design of and have access to needed community services, individualized
supports, and other forms of assistance that promote self-determination, independence, productivity, and
integration and inclusion in all facets of community life. (sub-measures 2.1.2; 2.14)

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
III. Sub-Outcome Measures
Objective

1.
2.
3.
4.

SC 2.1.1
# of policy, procedure, statute
or regulation changes improved
as a result of systems change.

SC 2.1.2
# Policy, procedure, statute or
regulation changes implemented.

SC 2.1.3
# of promising and/or best
practices improved as a result
of systems change activities.

SC 2.1.4
# of promising and/or best practices
implemented

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

Objective

1.
2.
3.
4.

SC 2: Sub outcome measures

Specify Objective #
Specify Objective #
Specify Objective #
Specify Objective #

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Additional goal/objective reporting fields would be created
based on the individual Council’s 5-year state plan.
SECTION V: COUNCIL Financial Information [Section 124(c)(5)(B) and 125(c)(8)]
Council is its own DSA: ____Yes

____No

Fiscal Information for Programmatic Purposes ONLY
Purpose: In this section, Councils are to identify the obligation and liquidation status for the 3 FFY of funds
1.
2.
3.
4.
5.
6.
7.
8.

Fiscal Year
Reporting Period
Total Federal Fiscal Award for Reporting Year
State Funds Contributing to Council State Plan Activities
Additional Council Funds Used for Other Activities
Federal Share of Expenditures
Federal Share of Unliquidated Obligations
Unliquidated Balance of Federal Funds (=Total Federal Fiscal Year Award –
Federal Share of expenditures – Federal Share of unliquidated obligations
9. Match Required
10. Match Met
11. Match Unmet

YR
MM/DD/YR - MM/DD/YR
$
$
$
$
$
$
$
$
$

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1.
2.
3.
4.
5.
6.
7.
8.

Fiscal Year
Reporting Period
Total Federal Fiscal Award for Reporting Year
State Funds Contributing to Council State Plan Activities
Additional Council Funds Used for Other Activities
Federal Share of Expenditures
Federal Share of Unliquidated Obligations
Unobligated Balance of Federal Funds (=Total Federal Fiscal Year Award –
Federal Share of expenditures – Federal Share of unliquidated obligations)
9. Match Required
10. Match Met
11. Match Unmet

YR
MM/DD/YR - MM/DD/YR
$
$
$
$
$
$

Fiscal Year
1. Reporting Period
2. Total Federal Fiscal Award for Reporting Year
3. State Funds Contributing to Council State Plan Activities
4. Additional Council Funds Used for Other Activities
5. Federal Share of Expenditures
6. Federal Share of Unliquidated Obligations
7. Unobligated Balance of Federal Funds (=Total Federal Fiscal Year Award –
Federal Share of expenditures – Federal Share of unliquidated obligations)
8. Match Required
9. Match Met
10. Match Unmet

YR
MM/DD/YR - MM/DD/YR
$
$
$
$
$
$

$
$
$

Dollars leveraged for the reporting year being reported: $

SECTION VI: MEASURES OF COLLABORATION
Purpose: In this section, Councils are to discuss collaborative efforts with specific DD Network partners and other collaborators separate
from the planned DD Network Collaboration goal/objective.

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1. Identify the critical issues/barriers affecting individuals with developmental disabilities and their families in your State that the
Council and the P&A, the Council and the UCEDD, the Council and other collaborators may have worked on during the reporting
period

2.

Identify the Area of Emphasis collaboratively addressed by the DD Council and Collaborators

1.
2.
3.
4.
5.
6.
1.

Area of Emphasis [Check Applicable
area(s)]
1. Quality Assurance
2. Education and Early Intervention
3. Child Care
4. Health
5. Employment
6. Housing
7. Transportation

8. Recreation
1. Quality of Life
2. Other- Assistive Technology
3. Other- Cultural Diversity
4. Other- Leadership
5. Other- please specify
14. Other- please specify
15. Other- please specify

The report should include a narrative progress report that cohesively describes the activities that were implemented by the Council
and the P&A, the Council and the UCEDD, the Council and other collaborators.DD Network. For at least one of the issues/barriers
identified above describe:
(a) the issue/barrier;
(b) collaborative strategies to address issue/barrier and expected outcome(s);
(c) the DDC’s specific role and responsibilities in this collaborative effort. Include any technical assistance expertise DD Council staff
can provide to other States in this area;

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(d) briefly identify problems encountered as a result of this collaboration, and technical assistance, if any, desired; and
(e) any unexpected benefits of this collaborative effort.

Reporting Requirements for CDC Funding
Guidance for Administration on Disabilities Grantees
The Administration for Community Living (ACL), with funding and partnership support from the Centers for Disease Control and Prevention (CDC),
awarded grants to disability networks to provide critical services to help communities combat COVID-19. A leading priority of this joint effort is to
ensure vaccines are equally accessible to individuals with the disabilities. As part of the agreement with CDC, ACL is required to collect annual
progress reports from the Protection and Advocacy Agencies (P&As), Centers for Independent Living (CILs), State Councils on Developmental
Disabilities (DDCs), and University Centers for Excellence in Developmental Disabilities (UCEDDs) on the activities conducted, challenges, successes,
and lessons learned. ACL is providing guidance on reporting requirements for the Administration on Disabilities grant programs that received CDC
funding.

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Guidance:
Grantees will report on any of the service activities listed in the chart below that were implemented using the CDC funding from April 1, 2021 up
through September 30, 2022. All narrative sections (narrative, successes, challenges, and the questions 1 - 12) are limited to 500 words each.
AoD is developing the specific mechanisms you will use to submit your report on the CDC funded activities. More information will be provided when
we have it available. Until then, you should begin tracking now the activities being carried out through CDC funding using the guidance below as a
framework. Specific methods for reporting that data will be shared as soon as possible.
Service Activity
1. Education about the
importance of
receiving a vaccine

2.

Identifying people
unable to
independently travel
to a vaccination site

3.

Providing technical
assistance (TA) to
local health
departments or other

1

a. Number of People Served
Provide the following:
• Number of people with
disabilities reached by
your education activities
• Number of all other
people1 reached by your
education activities
List the number of people
unable to independently
travel to a site

List the number of local
health departments or other
entities assisted with TA on
vaccine accessibility

b. Narrative
Describe the type of
education activities
conducted (e.g., one on one
assistance,
brochures/pamphlets/ fliers,
social media postings, social
stories)
Describe:
• The strategy to identify
people unable to
independently travel to a
vaccination site
• The most commonly
cited reasons for why
they couldn’t travel to
the site
Describe the type of
strategies/TA activities to
assist local health
departments or other

c. Successes
Describe the most
successful/effective
education activities
implemented

d. Challenges
Describe challenges that
limited your ability to
educate others about the
importance of the vaccine

Describe successes achieved
as a result of identifying
people unable to
independently travel to a
site (e.g., were such
individuals able to get
vaccinated at an alternative
site)

Describe challenges that
limited your ability to
identify people unable to
independently travel to a
site

Describe successes achieved
as a result of TA activities
provided to local health
departments

Describe challenges that
limited your ability to
provide technical assistance
to local health departments

Other people include family members, direct support providers/workers, personal care attendants, and other support providers.

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
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entities on vaccine
accessibility
4. Helping with
scheduling a vaccine
appointment

List the number of people
helped in scheduling vaccine
appointments

5. Arranging or
providing accessible
transportation

List the number of people
assisted with accessible
transportation to a
vaccination site

6. Providing
companion/personal
support

List the number of people
assisted with
companion/personal support
to receive vaccines

7. Reminding people of
their second
vaccination
appointment if
needed

List the number of people
who needed and received a
reminder of their second
vaccination appointment

entities on vaccine
accessibility
Describe the type of
activities used to assist
people in scheduling
vaccines
Describe the type of
activities used to assist
people with accessible
transportation to a
vaccination site
Describe the type of
activities to provide
companion/personal support
services for people to receive
vaccines
Describe the type of
activities to provide people
with reminders on their
second vaccination
appointment

Describe successes achieved
as a result of assistance
provided to help schedule
vaccine appointments
Describe successes achieved
as a result of accessible
transportation activities

Describe successes achieved
as a result of providing
companion/personal support
services for people to receive
vaccines
Describe successes achieved
as a result of providing
reminders to people on their
second vaccination
appointment

or other entities on vaccine
accessibility
Describe challenges that
limited your ability to help
with scheduling a vaccine
appointment
Describe challenges that
limited your ability to
arrange or provide accessible
transportation
Describe challenges that
limited your ability to
provide companion/personal
support
Describe challenges that
limited your ability to
provide people reminders on
their second vaccination
appointment

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
8. Overall outcome: Number of people vaccinated as a result of implementing one or more of the service activities (number):
Provide:
a. The number of people with disabilities vaccinated as a result of implementing one or more of the service activities
b. The total number of all other people vaccinated as a result of implementing one or more of the service activities
9. Collaboration with ACL partners (ADRCs, AAA, CIL, DDC, P&A, UCEDD) (narrative):
Describe the nature of collaboration and joint activities with ACL partners, including successes and challenges in your collaboration efforts
10. Collaboration with other community-based organizations (narrative):
Describe the collaboration and joint activities with other community-based organizations, including successes and challenges in your collaboration
efforts
11. Overall lessons learned (narrative):
Describe the leading key lessons learned, as a result of, your overall implementation activities
12. Recommendations for future activities (narrative):
Provide recommendations for ACL to consider that will maximize the impact of future responses to disasters or pandemics.

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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE
FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES
PHWF- Data reporting requirements
Award recipients will be required to submit annual progress reports in the form of a :
• written summary on the number of full-time equivalents (FTEs)
• type of public health professional(s) hired
• the activities they are engaged in to advance public health

Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
such collection displays a valid OMB control number (OMB 0985-0033). Public reporting burden for this collection of
information is estimated to average 266 hours per response, including time for gathering and maintaining the data needed and
completing and reviewing the collection of information. The obligation to respond to this collection is required to retain or
maintain benefits.

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Revised – Oct. 2022 Program Performance Report Template