Example SOAR Demonstration Grant Program Reporting Workbook 3.15.23.xlsx

SOAR Demonstration Grant Program Data

Example SOAR Demonstration Grant Program Reporting Workbook 3.15.23.xlsx

OMB: 0970-0609

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Overview

Q. Provider Capacity Building
Q. Client Demographics
Q. HTRP
Q. Network Providers
Q. Training Feedback Form
FY.Categories of Assistance


Sheet 1: Q. Provider Capacity Building






Training Reporting Summary Q1 Q2 Q3 Q4

















Grant Recipient Name:


Total HT 101 Trainings 0 0 0 0

















Grant Number:


Total Trauma Informed Care Trainings 0 0 0 0

















Report Type:


Total Partnership Building Trainings 0 0 0 0

















Report Period:


*Do not edit data in the table above. Counts will automatically update. Total Trainings Delivered:

0






















Total Providers Trained:

0

















OMB Control Number: 0970-NEW
Expiration Date: XX/XX/XXXX



























Training Reporting

















As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.


number number number number




















Q1 Q2 Q3 Q4


















Human Trafficking 101: Definition, Types, Laws, and Indicators Federal definition of severe forms of trafficking in persons






















State and tribal anti-trafficking laws and legal considerations for a specific geographic area






















Information about human trafficking, including types of human trafficking and recruitment and/or
retention tactics used by traffickers; indicators that a person may be experiencing human trafficking























Case studies of individuals who have experienced human trafficking 






















Approaches, Strategies, and Special Considerations for Working with Victims (e.g. Trauma Informed Care) Safety protocols for those in direct contact with individuals potentially experiencing human trafficking





















Please reference the Reporting Reference Guide (p.X-XX) to populate this table.
Services and benefits available for individuals who have experienced human trafficking






















Special considerations for both domestic and foreign national minors experiencing human trafficking, which may
include relevant legal and social welfare systems, such as juvenile justice, immigration, and child welfare 























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






















How to deliver person-centered, trauma-informed services and assistance to individuals who have experienced human trafficking 


























Housing and employment needs of individuals who have experienced human trafficking 


























Intersectionality between race and human trafficking 


























Intersectionality between sexual orientation, gender identity, and human trafficking  


























Intersectionality between individuals with disabilities and human trafficking  


























Intersectionality between human trafficking and forced criminality  


























Building a Community Referral Network and Partnership Building Referral protocols within a continuum of care for aftercare and ongoing service needs 


























Information about local continuums of care or multidisciplinary anti-trafficking task forces 


























Processes by which organizational partnerships are developed and maintained 


























Post-identification reporting and referral protocols 


























Provider Type Individuals Trained by Prime Recipient Providers


























Individuals Trained by Subrecipient Providers


























Individuals Trained by Partner Organization Providers













































































































Sheet 2: Q. Client Demographics
































Client Demographics

















Grant Recipient Name:



Q1 Q2 Q3 Q4

















Grant Number:



number number number number

















Report Period:

Client Demographics
(All Providers)
Number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client age


















Adult



















OMB Control Number: 0970-NEW
Expiration Date: XX/XX/XXXX

Minor





















Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client race/ethnicity 















As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 1 hour per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.
American Indian or Alaska Native (AIAN) 




















Asian  






















Black or African American 






















Native Hawaiian or Other Pacific Islander 






















White  






















Hispanic or Latino 






















Other  


























Not Reported 


























Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client current gender identity
NOTE: Award recipients will be required to obtain this information from clients/patients utilizing NASEM’s recommended two-step question and to report information to OTIP in the aggregate. Write-In responses to “I use a different term: [free text]” will not be provided to OTIP. Rather, the recipients will report the total number of individuals who elected to write in an option. “Not Reported” will reflect the count of clients/patients who selected “Prefer not to answer". See Reporting Reference Guide for additional operational guidance.











Female  
















Male 
















Transgender 











Please reference the Reporting Reference Guide (p.X-XX) to populate this table.
Two-Spirit 












Different term 












Don’t know












Not Reported
















Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client sexual orientation 






















Lesbian or gay 




NOTE: Award recipients will be required to obtain this information from clients/patients utilizing NASEM’s recommended question and to report information to OTIP in the aggregate. Write-In responses to “I use a different term: [free text]” will not be provided to OTIP. Rather, the recipients will report the total number of individuals who elected to write in an option. “Not Reported” will reflect the count of clients/patients who selected “Prefer not to answer". See Reporting Reference Guide for additional operational guidance.











Straight, that is, not gay or lesbian 
















Bisexual 
















Two-Spirit 
















Different term 
















(Don’t know) 
















Not Reported 
















Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client disability status






















Ambulatory Difficulty


























Cognitive Difficulty


























Hearing Difficulty


























Independent Living Difficulty


























Self-Care Difficulty


























Vision Difficulty


























Not Reported 


























Total number of clients enrolled in services by providers within the recipient’s multidisciplinary network by client preferred language






















Prefer to be served in English 


























Prefer to be served in a language other than English 






















Sheet 3: Q. HTRP
































Human Trafficking Response Protocol (HTRP)

















Grant Recipient Name:



Q1 Q2 Q3 Q4

















Grant Number:



number number number number

















Report Period:

Implementation Summary Total number of providers coordinating care within the recipient's multidisciplinary network





















Number of clients screened by providers within multidisciplinary network





















Number of clients identified as potential victims of HT based on screening conducted by
providers within recipient’s multidisciplinary network by type of trafficking experienced






















Sex



















As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 2.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.
Labor




















Sex and Labor






















Not Reported






















Number of clients enrolled in services by providers within recipient’s multidisciplinary network
by type of trafficking experienced























Sex






















Labor






















Sex and Labor


























Not Reported


























Total number of clients referred to providers within the recipient’s multidisciplinary network


























Total number of clients referred to providers external to the recipient’s multidisciplinary network

























































Check all that apply
























Q1 Q2 Q3 Q4






















Barriers to Service Delivery and Implementation Client/Patient Constraints 


























Affordability 


























Accommodation 






















Availability 






















Accessibility 






















Acceptability 






















Not Specified 






















Safety Concerns 






















Feelings of No Support and Isolation 






















Excluded from key decision-making opportunities 


























Experiences of bias or discrimination as it pertains to [insert leadership, practice, policy]
(e.g., gender, race, ethnicity, sexual orientation) 























Feeling undervalued or not perceived as a leader in my organization 


























Lack of authority to use new skills in current position 






















Ineffective Coordination with Agencies and Providers 






















Difficulty coordinating with benefits-issuing agencies 


























Difficulty establishing/maintaining multidisciplinary team (MDT)  






















Lack of data sharing among organizations 






















Lack of shared responsibility across organizational collaborators 






















Need for partnership building with other orgs 






















Variation in mission/regulatory frameworks when partnering with other organizations






















Lack of Adequate Funding 






















Lack of Adequate Resources 






















Competing priorities 


























Frequent staff turnover 






















Lack of senior leadership support  






















Lack of support/accountability from frontline staff 






















Lack of time to implement changes 






















Lack of urgency 






















Shortage of key personnel (including clinician shortage issues) 






















Lack of Adequate Training 






















Lack of accessible research/information 






















Lack of training for staff on how to implement change 






















Lack of Formal Rules and Regulations 






















Lack of Procedures 






















Lack of Knowledge of Victims’ Rights 






















Public Health Concerns 











































Sheet 4: Q. Network Providers


















Grant Recipient Name:



Please reference the Reporting Reference Guide (p.X-XX) to populate this table.




Grant Number:








Report Type:








Report Period:






































OMB Control Number: 0970-NEW
Expiration Date: XX/XX/XXXX




























As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 0.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.
Multidisciplinary Network Providers










open text Y/N open text open text Kiefer, Vera J.: Advocacy Behavioral Health Child Welfare Community Member Education Employment Faith Based Government Health Care Housing Law Enforcement Legal Other Criminal Justice Private Sector Public Health School (K-12) Service Provider Other (specify) open text, refer to field value options open text number Kiefer, Vera J.: 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 Training Mental/Behavioral Health Services Medical Services Safety Planning Services Substance Use Assessment/Treatment Transportation Victim Advocacy Other Services (specify) None open text, refer to field value options open text mm/dd/yyyy mm/dd/yyyy

Name of Partnering Organization Is the partner organization a subrecipient? Location of Organization
(City)
Location of Organization
(State)
Type of Partner Organization If Type of Organization 'Other', Specify Number of Partner Organization Service Sites Services Provided by Partner Organization If Services Provided by Partner Organization 'Other', Specify Enrollment Date Exit Date

SampleOrg Y Washington DC Advocacy
3 Legal Advocacy and Services Immigration Relief 9/29/2020































































































































































































































































































































































































































































































































































































































































0




Sheet 5: Q. Training Feedback Form

Separate PDF based form; obtained through SOAR/NHTTAC implementation











See TAB F: SOAR Demonstration Grant Participant Training Feedback Form











Average Burden Hours per Response: 0.75 hours













Sheet 6: FY.Categories of Assistance

SOAR Demonstration Grant Program Data
Grant Recipient: (Name of Organization)
As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. § 3501-3521, the public reporting burden for the following performance indicators is estimated to average 2.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This form is approved under the Office of Management and Budget (OMB) control number OMB No: 0970-XXXX, expiration date is XX/XX/XXXX. 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.
Case Management Categories of Assistance OTIP: Record the number of clients who received each type of service during the reporting period. Number of Clients OTIP: Record the amount of grant funds spent on each type of service (e.g. spending on rent for clients, purchasing groceries for clients, funds spent on client's medical expenses, etc.) Total Funds Spent % of Project Budget
Basic Necessities 
$- #DIV/0!
Case Management 
$- #DIV/0!
Child Care 
$- #DIV/0!
Coordination with Benefit Issuing Agencies 
$- #DIV/0!
Coordination with Child Welfare/Child Protective Services 
$- #DIV/0!
Coordination with Migrant Health Programs 
$- #DIV/0!
Crisis Intervention 
$- #DIV/0!
Education Assistance 
$- #DIV/0!
Employment Assistance 
$- #DIV/0!
Family Reunification 
$- #DIV/0!
Financial Assistance 
$- #DIV/0!
Healthcare 
$- #DIV/0!
Housing/Shelter Services 
$- #DIV/0!
Interpreter/Translator 
$- #DIV/0!
Legal Advocacy and Services 
$- #DIV/0!
Life Skills 
$- #DIV/0!
Mental/Behavioral Health Services 
$- #DIV/0!
Other Services (specify) 
$- #DIV/0!
Peer-to-Peer Support/Mentoring 
$- #DIV/0!
Safety Planning Services 
$- #DIV/0!
Substance Use Assessment/Treatment 
$- #DIV/0!
Transportation 
$- #DIV/0!
Victim Advocacy 
$- #DIV/0!
Total Direct Services Spending
$-
Khaila Montgomery: Record the amount of grant funds spent on direct services staff administering each type of service (e.g. salary and benefits of case management staff, office space for direct services staff, travel reimbursement for direct services staff, etc.) Total Case Management Spending
$-
Khaila Montgomery: Program administration spending includes funds allocated to administering the grant (e.g., cost of site visits, travel, salaries for administrative staff, etc.). This category excludes funds spent on case management or direct services. Total Program Administration Spending
$-
Khaila Montgomery: The total amount grantee was awarded by OTIP to fund project activities during the fiscal year Total Grant Recipient Budget
$-
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