NAMRS Agency Component

OMB Control Number 0985-0054
Expiration Date: 03/31/202X

AGENCY COMPONENT DATA
March 31, 2023

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.

The Agency Component data will be entered directly onto an online form on the NAMRS website. Once entered, the state
can update information annually. The reporting period is the federal fiscal year (October–September).
Table 1–General Information
Element No.
Agency 1.1
Agency 1.2
Agency 2.1

Element Name
Agency Name 1
Agency Name 2
Street 1

Agency 2.2

Street 2

Agency 2.3
Agency 2.4

City
State

Agency 2.5
Agency 3.1

ZIP
Street 1

Agency 3.2

Street 2

Agency 3.3
Agency 3.4

City
State

Agency 3.5
Agency4.1

ZIP
Name

Agency 4.2
Agency 4.3

Title
E-mail

Agency 4.4
Agency 4.5

Phone
Contact’s role in
agency

Element Description
Department or agency name
Branch or unit name
First line street address of agency physical
address
Second line street address of agency
physical address
City of agency physical address
State of agency physical address

Required
Yes
No
Yes

Field Entry Format
Text - 100 characters
Text - 100 characters
Text - 100 characters

No

Text - 100 characters

Yes
Yes

ZIP of agency physical address
First line street address of agency mailing
address
Second line street address of agency
physical address
City of agency physical address
State of agency physical address

Yes
Yes

Text - 100 characters
Select from list of
states/territories
##### or #####-####
Text - 100 characters

No

Text - 100 characters

Yes
Yes

ZIP of agency physical address
Enter at least two contacts for the NAMRS
submission, such as the program
administrator and the NAMRS lead.
Contact name
Contact title
Contact e-mail

Yes
Yes

Text - 100 characters
Select from list of
states/territories
##### or #####-####
Text - 100 characters

Contact telephone
Contact’s role in agency

Yes
No

Yes
Yes

Text - 100 characters
E-mail address
format
Text - 50 characters
Select one from list

Selection List:
• Case manager
• Data coordinator/manager
• Field coordinator
• Intake manager/supervisor
• Investigator
• IT/data specialist
• Manager/director/supervisor
• Policy specialist
• Regional supervisor
• Social worker
• Training coordinator/specialist

A-1

Table 2–Agency Profile
Element No.
Agency 5

Element Name
Data Sources

Agency 5.1

Comment

Agency 6

Population
Served: Age

Element Description
The sources of information used to submit
data this year to NAMRS.
Selection List:
• APS agency only
• APS and other agencies
Provide names of other agencies that
provided data and a brief description of the
population served. Please indicate if adults
includes "emancipated minors".
Select which of the following population
groups are served by the APS programs
submitting data. Vulnerability includes
criteria such as disability or impairment.

Required
No

Field Entry Format
Select one from list

No

Text – 5,000
characters

No

Select one or more
from list

No

Text – 5,000
characters

No

Select one or more
from list

Selection List:
• Emancipated minor
• 18 - 59 with a vulnerability
• 18 – 64 with vulnerability
• 18+ with a vulnerability
• 60+ with a vulnerability
• 60+
• 65+ with a vulnerability
• 65+
• Other
Agency 6.1

Comment

Agency 6.2

Population
served: setting

Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. If reporting for
multiple agencies, indicate which agency
serves which population group.
Indicate the types of settings in which APS
is responsible for investigating allegations of
maltreatment involving facility staff or
operations in addition to allegations

involving visitors or resident on resident
maltreatment.
Selection List:
• Own residence or relative or
caregiver
• Residential care community (nonspecific)
• Licensed residential care
community
• Non-licensed residential care
community
• Nursing home (non-specific)
• Licensed nursing home
• Non-licensed nursing home
A-2

•

Agency 7

Investigator FTEs
filled

Agency 7.1

Supervisor FTEs
filled

Agency 7.2

Comment

Agency 8

Intake

Agency 8.1

Comment

Agency 9

Agency 9.2

Reports
Accepted for
Investigation
Reports Not
Accepted, or
Resolved
Through
I&R/I&RA
Comment

Agency 10

Response Time

Agency 9.1

Medicaid Home and Community
Services Waiver Provider
• Other
Number of filled APS FTEs responsible for
the hotline and/or conducting investigations.
If APS staff work in other programs such as
CPS, make an estimate of FTEs devoted
only to APS work.
Number of filled APS FTEs responsible for
supervision. If APS staff work in other
programs such as CPS, make an estimate
of FTEs devoted only to APS work.
Provide additional information as to whether
the numbers in 7 and 7.1 were the annual
total or total for a given day.
Centralized or localized intake of APS
reports.
Selection List:
• Centralized at a statewide hotline or call
in number
• Combination of both statewide and local
hotlines or call in numbers
• Local at county or regional hotlines or
call in numbers
• Other
Provide additional information on your
state’s definition of intake.
Number of reports accepted for
investigation during the reporting period.
Number of reports that were either not
accepted by APS for investigation, or were
resolved through Information & Referral
(I&R)/Information & Referral Assistance
(I&RA).
Please confirm that the sum of 9 and 9.1 is
the total number of investigations received
during the reporting period. Please provide
additional information regarding policy for
accepting reports and not accepting reports,
or resolving through I&R/I&RA.
The length of time (hours), by priority level,
from receipt of call or notice of alleged
maltreatment to face-to-face contact with
the client by the APS worker. Enter the
number of hours for each priority level as
set by policy or practice.

No

Numeric – 10 integers

No

Numeric – 10 integers

No

Text – 5,000
characters

No

Select one from list

No
No

Text – 5,000
characters
Numeric – 10 integers

No

Numeric – 10 integers

No

Text – 5,000
characters

No

Numeric – 3 integers

Selection List:
• Priority 1 length
• Priority 2 length
• Priority 3 length
• Priority 4 length
A-3

Agency 10.1

Comment

Agency 11

Investigation
Completion Time

Agency 11.1

Comment

Agency 12

Types of
Maltreatment

Agency 12.1

Comment

Agency 13

Standard of
Evidence

Agency 13.1

Comment

Agency14

Assessment
Tools

Provide additional information on the
definition of each priority level, including.
citation or URL of state law, regulations, or
program guidance and/or upload documents
in the Agency Component attachments.
The length of time (days) from investigation
start to investigation completion, based on
the standard set by policy or practice.
Provide additional information on the
definition of start of investigation and
completion of an investigation, including
citation or URL of state law, regulations, or
program guidance and/or upload documents
in the Agency Component attachments.
Indicate which types of maltreatment are
investigated by APS.
Selection List:
• Abandonment
• Emotional abuse
• Exploitation (non-specific)
• Financial exploitation
• Other exploitation
• Neglect
• Physical abuse
• Sexual abuse
• Suspicious death
• Self-neglect
• Other
Provide citation or URL in state law,
regulations, or program guidance for
maltreatment types investigated by APS
and/or upload documents in the Agency
Component attachments.
Standard used for substantiating an
allegation of maltreatment.
Selection List:
• Clear and convincing
• Credible, reasonable, or probable cause
• Different standards based on type of
perpetrator
• No state standard
• Preponderance
• Other
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents the Agency Component
attachments. Include discussion of
definitions of perpetrator if relevant.
Indicate whether APS personnel use
standard assessment tools throughout the
state, such as client safety, at risk factors,
or behavioral conditions.

No

Text – 5,000
characters

No

Numeric – 3 integers

No

Text – 5,000
characters

No

Select one or more
from list

No

Text – 5,000
characters

No

Select one from list

No

Text – 5,000
characters

No

Select one from list

Selection List:
A-4

•

Agency 14.1

Comment

Agency 15

Service Gaps

Agency 15.1

Comment

Agency 16

Perpetrators

Agency 16.1

Perpetrators

No, assessment instruments are
determined by each county or left to the
worker’s discretion
• Yes, use common instrument or tool
throughout the state
Provide the name and reference (i.e., URL)
for each standardized tool that is used.
Indicate which services are not available or
accessible in the state.
Selection List:
• Care/Case Management Services
• Caregiver Support Services
• Community Day Services
• Education, Employment, and Training
Services
• Emergency Assistance and Material Aid
Services
• Financial Planning Services
• Housing and Relocation Services
• In-home Assistance Services
• Legal Services
• Medical and Dental Services
• Medical Rehabilitation Services
• Mental Health Services
• Nutrition
• Public Assistance Benefits
• Substance Use Services
• Transportation
• Victim Services
• Other Services
Provide additional information on how gaps
in services were identified, if possible.
Does APS collect person-specific data on
persons found to be perpetrators of
substantiated maltreatment?

No
No

No
No

Selection List:
• Yes
• No .
Does your information system collect unique
IDs and demographic characteristics of
perpetrators?

Text – 5,000
characters
Select one or more
from list

Text – 5,000
characters
Select one from list.

Select one from list

Selection List:

Agency 16.2

Comment

Agency 17

Policy Change

• Yes
• No
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments.
Have there been changes in law, policy, or
practice that explains changes in the data
from the previous year?

No

Text – 5,000
characters

No

Select one from list

A-5

Selection List:
•
•
Agency 17.1

Comment

Agency 18

Perpetrator
Registries

Agency 18.1

Comment

Agency 19

Multidisciplinary
Teams

Yes
No

Describe the change in law, policy, or
practice. Provide citation or URL of state
law, regulations, or program guidance
and/or upload documents in the Agency
Component attachments.
Indicate if APS refers substantiated
perpetrators to a perpetrator registry. A
perpetrator registry is a system for
maintaining the identity of individuals who
are found to have maltreated adults in the
community or facilities and meet the
requirements for referral. This information is
made available to individuals, agencies, or
employers authorized to receive the
information who use it to exclude the
perpetrator from employment.
Selection List:
• There is no perpetrator registry
• There is a perpetrator registry, but APS
does not refer to it
• APS refers all substantiated
perpetrators to a perpetrator registry
• APS refers substantiated perpetrators
that meet selected criteria to the
perpetrator registry
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. Include
description of any additional criteria for
referral to the registry (e.g., types of
maltreatment, types of perpetrators).
Indicate APS program participation in
Multidisciplinary Teams (MDTs). An MDT is
a group of people, from three or more
disciplines, who work collaboratively, bound
by a common purpose, and characterized
by shared decision-making, partnership,
interdependency, balanced power, and
process. MDTs work to ensure victims
receive the services they need to recover
from maltreatment and improve the system
of services.

No

Text – 5,000
characters

No

Select one for list.

No

Text – 5,000
characters

No

Select one from the
list

Selection List:
• MDTs do not exist in the state
• APS does not participate in existing
MDTs
• Law, rule, or policy requires APS
participate in multidisciplinary teams
A-6

•

Agency 19.1

Comment

Agency 20

Confidentiality

Agency 20.1

Comment

Agency 21.

Ethical Principles

APS participates in multidisciplinary
teams voluntarily without state
requirement
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. Include discussion
of the criteria for participation including state
requirements and the types of cases.
Indicate if information collected in an APS
investigation information is shared.
Selection List:
• Information is never shared
• There are no restrictions on sharing
information
• Information is shared in circumstances
defined in law, regulation, or policy
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. Describe the
circumstances in which information can be
shared.
Indicate the source of APS program-specific
ethical principles or core values that guide
the program.

No

Text – 5,000
characters

No

Select one from the
list

No

Text – 5,000
characters

No

Select one from the
list

No

Text – 5,000
characters

No

Select one from the
list

No

Text – 5,000
characters

Selection List:
• Created by program staff from internal
sources and processes
• Adapted from National Adult Protective
Services Association Guiding
Principles
• Adapted from other APS program(s)
• Based on principles or values from
agency APS is located in or values
from other state agencies
• Other
Agency 21.1

Comment

Agency 22

Mandatory
Reporting

Agency 22.1

Comment

Provide citation or URL and/or upload
documents in the Agency Component
attachments that describe the key
principles/core values.
Indicate if state law requires mandatory
reporting to APS.
Selection List:
• Yes, universal
• Yes, targeted groups
• No
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency

A-7

Agency 23

Reporter Identity

Agency 23.1

Comment

Agency 24

Refuse
Investigation
With Decisionmaking Ability

Component attachments. If targeted groups,
list who they are.
Indicate the protection state law or policy
provides for the identity of reporters.
Selection List:
• Protected in all cases without
exceptions
• General protection but with exceptions
defined by law, rule, or policy (e.g., law
enforcement or by court order)
• Reporter identity is not protected
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. Describe the
exceptions to reporter identity.
Indicate the response by APS if a client
refuses to cooperate with an investigation
and they appear to have ability to make
decisions.

No

Select one from the
list

No

Text – 5,000
characters

No

Select one or more
from the list

No

Select one or more
from the list

No

Text – 5,000
characters

No

Select one from the
list

Selection List:
•
•
•

Agency 24.1

Refuse
Investigation
Without Decisionmaking Ability

APS does not continue the
investigation
APS continues the investigation
APS weighs circumstances and
makes appropriate decision about
continuing the investigation

Indicate the response by APS if a client
refuses to cooperate with an investigation
and they do not appear to have ability to
make decisions.
Selection List:
•
•
•

Agency 24.2

Comment

Agency 25

Refuse Services
with Decisionmaking Ability

APS does not continue the
investigation
APS continues the investigation
APS weighs circumstances and
makes appropriate decision about
continuing the investigation

Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments
Indicate the response by APS if a client
refuses services and they appear to have
ability to make decisions.
Selection List:

A-8

•
•
•
•
•

Agency 25.1

Refuse Services
without Decisionmaking Ability

APS does not provide services
through any mechanism
APS does not provide purchased
services
APS does not make a referral for
services
APS takes appropriate steps to
attempt to provide services
APS weighs circumstances and
makes appropriate decision about
continuing the investigation

Indicate the response by APS if a client
refuses services and they do not appear to
have ability to make decisions.

No

Select one from the
list

No

Text – 5,000
characters

No

Select one from the
list

Selection List:
•
•
•
•
•

Agency 25.2

Comment

Agency 26

Involuntary
Interventions

APS does not provide services
through any mechanism
APS does not provide purchased
services
APS does not make a referral for
services
APS takes appropriate steps to
attempt to provide services
APS weighs circumstances and
makes appropriate decision about
continuing the investigation

Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments.
Indicate if APS has the authority to seek
involuntary interventions - such as
emergency protective orders, emergency
placements, or mental health commitment”
- for at-risk APS clients,
Selection List:
• APS does not have the authority to
seek involuntary interventions in any
circumstances
• APS has the authority to seek
involuntary interventions regardless of
client’s decision-making
• APS has authority to seek involuntary
interventions only if the client appears
to lack decision-making ability
• APS does not have authority to seek
involuntary interventions if the client
appears to have decision-making ability

A-9

Agency 26.1

Comment

Agency 27

Services

Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. List and define
types of interventions.
To address maltreatment, indicate who APS
has authority to provide or arrange services
for.

No

Text – 5,000
characters

No

Select one or more
from the list

No

Text – 5,000
characters

No

Select one or more
from the list

No

Text – 5,000
characters

No

Select one from the
list

No

Text – 5,000
characters

No

Select one or more
from the list

Selection List:
• Substantiated clients (victims)
• Unsubstantiated (alleged) clients
• Family members of clients
• Substantiated perpetrators
• Unsubstantiated perpetrators
Agency 27.1

Comment

Agency 28

Governing
Principles

Agency 28.1

Comment

Agency 29

Purchase of
Services

Agency 29.1

Comment

Agency 30

Case Closure

Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments.
Indicate the mechanisms that APS uses to
ensure person-centered approaches to
services (e.g., services in least restrictive
environment, trauma-informed).
Selection List:
• Contained in Guiding Principles or
Core Values
• Included in training
• Required by statute or policy
• Included in service plan requirements
• Reviewed in performance measures
• Reviewed in quality assurance
process
• Reviewed by external review teams
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. List any additional
principles.
Indicate if APS directly purchases goods
and services for clients and/or victims.
Selection List:
• Yes
• No
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. List and define
types of interventions.
Indicate how APS cases are reviewed
before case closure to ensure their quality.

A-10

Agency 30.1

Comment

Agency 31

Quality
Assurance

Agency 31.1

Comment

Agency 32.1

Information
System

Agency 32.2

Comment

Selection List:
• Caseworker review and judgment only
• Supervisor review
• Peer review
• Review team review
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments.
Indicate the different levels of quality
assurance mechanisms used to improve
casework.
Selection List:
• Documentation: Law, rule, or policy
requires standardized case
documentation
• Supervisor review: Law, rule, or policy
requires supervisor review of all or a
subset of case documentation
• Peer review: Program practice uses
peer review of closed cases (e.g.,
“case review staffing”)
• Independent Review QA Teams:
Program practice uses review of a
subset/sample of cases by
independent case reviewers
Provide citation or URL of state law,
regulations, or program guidance and/or
upload documents in the Agency
Component attachments. Describe the
quality assurance activities.
Select which of the following describes the
automated system your state uses to
document case information:
• Statewide system developed by the
state
• Statewide system developed by an
outside vendor. (Please use the
comment field to identify the vendor,
the name of the system, and when
you obtained it.)
• Separate systems for different
geographic areas of the state
• Do not have an automated system.
If your state has multiple APS programs,
please provide response to the above
question for each program. If your state
used a statewide system developed by an
outside vendor, please use the comment
field to identify the vendor, the name of the
system, and when you obtained it.

No

Text – 5,000
characters

No

Select one or more
from the list

No

Text – 5,000
characters

No

Select one from the
list

No

Text – 5,000
characters

A-11

A-12