Form 1 ECSH Program Data Indicators

Generic Performance Progress Reports

CLEAN ECSH Data Indicators_2022 Update.xlsx

Ethnic Community Self-Help (ECSH) Program Data Indicators

OMB: 0970-0490

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Ethnic Commnity Self-Help (ECSH) Program Data Indicators OMB Control Number: 0970-0490
Expiration Date: 1/31/2023
1. Recipient Name:

2. Grant Number:

3. Reporting Period End Date:

DIRECT SERVICES
Program Activities First Reporting Period Second Reporting Period

4. Number of New Enrollments



5. Number of Clients Served



6. Number of Clients Served According to Gender


6a. Women




6b. Men




6c. Other/Unspecified




7. Number of Clients Served According to Status

7a. Refugee



7b. Asylee



7c. Cuban/Haitian Entrants




7d. Special Immigrants Visa Holders




7e. Afghan Humanitarian Parolees




7f. Amerasians




7g. Victims of Human Trafficking




7h. Ukraine Humanitarian Parolees




8. Types of Services Provided First Reporting Period Second Reporting Period

8a. Navigation Services


8b. Cultural/community orientation


8c. Health-related services


8d. Home management services


8e. Transportation


8f. Translation and interpretation services


8g. Case management services


8h. English language training


8i. Employability services


8j. Academic enrichment/college preparation


8k. Emotional wellness services


8l. Referral services


8m. Citizenship preparation/civic engagement


8n. Other (list):








ORGANIZATIONAL DEVELOPMENT
Program Activities First Reporting Period Second Reporting Period

9. Number of New Partnerships Developed



10. Type of New Partnerships Developed

10a. Educational organization



10b. Local/state government entity



10c. Medical service provider



10d. Legal service provider



10e. Faith-based group



10f. Other (list)




11. Types of Training Provided to Staff First Reporting Period Second Reporting Period

11a. Case management


11b. Case documentation


11c. Interpretation


11d. Cultural sensitivity and awareness


11e. Self-care


11f. Cultural orientation provision


11g. Public benefits


11h. Health services and systems


11i. Non-profit management


11j. Other (list)


CIVIC ENGAGEMENT
12. Types of Community Engagement Activities Conducted (list) First Reporting Period Second Reporting Period




LOGIC MODEL OUTPUTS & OUTCOMES
13. Logic Model Outputs Progress Semi-Annual Results
First Reporting Period Second Reporting Period
Please list all planned Outputs from the Logic Model in the following spaces. Add more spaces as necessary. Identify progress towards each Output for Months 1-6 Identify progress towards each Output for Months 7-12.








































14. Logic Model Outcomes Progress Semi-Annual Results

First Reporting Period Second Reporting Period
Please list all planned Outcomes from the Logic Model in the following spaces. Add more spaces as necessary. Identify progress towards each Outcomes for Months 1-6 Identify progress towards each Outcomes for Months 7-12.














































PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, the Office of Refugee Resettlement (ORR) is gathering data on your grant program to understand the design and effectiveness of the program and to inform technical assistance needs. Public reporting burden for this collection of information is estimated to average 2 hours per recipient, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is required to retain a benefit (Pub. L. 105-285, section 680(b) as amended). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB# is 0970-0490 and the expiration date is 01/31/2023. If you have any comments on this collection of information, please contact Zahra Cheema, ACF/ORR, by email at [email protected].
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