NHTH Grantee Reporting Data Collection Workbook

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Overview

Instructions
Definitions
Operational Guidance
Monthly Summary Report
Semi-Annual Summary Report
Annual Summary Report

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Sheet 1: Instructions

National Human Trafficking Hotline Background		How to Use This Workbook
In 2005, the U.S. Department of Health and Human Services (HHS) began funding a 24/7, national, toll-free Trafficking Information and Referral Hotline to receive calls about potential human trafficking in the United States as authorized by Section 107(b)(1)(B)(ii) of the Trafficking Victims Protection Act of 2000 (TVPA), as amended, codified at 22 U.S.C. 7105(b)(1)(B)(ii). The National Human Trafficking Hotline (NHTH) provides 24/7, yearlong, timely, person-centered, trauma-informed, culturally responsive, and linguistically appropriate emergency assistance and information to potential domestic and foreign victims of sex and labor trafficking. Recipients of NHTH funding must conduct the following activities throughout the project period: 1. Operate the NHTH, a 24/7 U.S. national hotline that receives signals through telephone, text, chat, and website; 2. Promote NHTH services to increase the identification and protection of victims of severe forms of human trafficking; 3. Provide information and service referrals to victims of trafficking using a trauma-informed, person-centered, culturally responsive, and linguistically appropriate approach, and in a timely manner; and 4. Notify law enforcement agencies of potential cases of human trafficking, as well as instances when a trafficking victim is in imminent danger, and document emerging trafficking schemes to assist in the detection and investigation of trafficking cases. To carry out the objectives of the NHTH, the successful applicant must maintain the following five program requirements throughout the project period: 1. Respond to and track calls and texts in a timely manner 2. Operate website and respond to online signals 3. Maintain national coverage to serve the U.S. and all U.S. territories 4. Develop and maintain a referral database 5. Raise awareness about NHTH and resources		The National Human Trafficking Hotline (NHTH) prime recipient is responsible for compiling performance indicator data into detailed monthly, fiscal year, and ad hoc reports as directed by OTIP to monitor the prime recipient’s progress toward accomplishing the objectives and requirements of the project and improving funded activities. In addition, the prime recipient must submit ad hoc reports detailing notable data trends regarding human trafficking and the efforts of the NHTH. The NHTH grantee is expected to submit client program entry, delivery barriers and monitoring, client case closure, training, technical assistance, and partnership development data to OTIP on a quarterly basis and client service use and costs of services data on an annual basis. The name of each quarterly submission tab will start with a 'Q.' The name of each annual submission tab will start with 'FY.' Over the course of the reporting period, the NHTH grantee aggregate and submit performance indicator data to OTIP via this Excel-based data collection workbook and through GrantSolutions.gov to fulfill post-award performance reporting requirements. Several of the OMB-approved data elements have a predetermined list of values. Unfortunately, in order to adhere to HHS' Policy for Software Development Secure Coding Practices, we are unable to add macros that would allow for multi-select data validation. This means that, for some data elements/columns, you will need to type the relevant information. The grey cells above each of the data elements describe the format of the data that should be entered into the column and a pop-up comment box in the cell provides the field value options. The yellow example row of data also has a drop down box that contains all field options. See screenshots below. If you are adding more than one value to these "multi-select" open text cells, please separate the values with a comma delimiter. For example, under the Services Requested/Needed column, you might type out, "Basic Necessities, Child Care". You can find term definitions on the 'Definitions' tab and operational guidance, including response options for each data element in the workbook on the 'Operational Guidance' tab.
OMB Control Number: 0970-0467
Expiration Date: 01/31/2023
As required by the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. §§ 3501-3521, please see each form/tab for the estimated public reporting burden 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: 0970-0467, expiration date is 01/31/2023. 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.

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Sheet 2: Definitions

National Human Trafficking Hotline
Terms and Definitions
Term	Definition
	Ambulatory Difficulty	Having serious difficulty walking or climbing stairs (DPHY).
	Basic Necessities	Encounters between a client and service provider in which a client is provided directly with items needed for daily living or with funds to purchase said items. This includes providing clients with personal care items such as shampoo, conditioner, soap, lotion, clothing, feminine hygiene products, and food.
	Case Management	An encounter between a case management provider and a client during which services are provided that assist clients in the management of their health and social needs, including client needs assessments, the establishment of service plans, and the maintenance of referral, tracking, and follow-up systems. This also includes assisting clients in understanding their rights and advocating on their behalf with referral partners.
	Certification Letters	Indicate a victim’s eligibility for federally funded benefits and services. It contains a Certification date; eligibility for benefits and services begins on the date of Certification. Certification letters do not expire, but many benefits and services are time sensitive. Derivatives and Certification Derivatives (family members of a victim) do not receive Certification Letters; however, Derivative T visa holders are eligible for benefits and services to the same extent as a refugee. For an individual who is already present in the United States on the date the DHS issues the Derivative T status, the period of eligibility begins on the date that DHS grants T status, as indicated on the Notice Date on the I-797, the Notice of Action of approval of the individual’s Derivative T status. For the individual who enters the United States on the basis of a Derivative T visa, the period of eligibility begins on the date that the individual is admitted to the United States, as indicated by the date stamped on the individual’s passport or I-94 Arrival Record.
	Certified Foreign National	A victim of human trafficking who is not a United States citizen and has received a letter of HHS Certification or Eligibility.
	Clients	Those individuals enrolled in OTIP funded programs such as the Trafficking Victim Assistance Program or Domestic Victims of Human Trafficking Program.
	Cognitive Difficulty	Having difficulty remembering, concentrating, or making decisions because of a physical, mental, or emotional problem (DREM).
	Crisis Intervention	Includes encounters in which a client or potential client in crisis receives interventions and services. This includes assistance or referrals provided for client emergencies as well as the provision of intervention techniques by a service provider aimed at alleviating emotional distress.
	Culturally responsive	The ability to learn from and relate respectfully with people of diverse cultures in order to effectively, equitably, and respectfully provide services that are responsive to diverse cultural beliefs and practices of the community being served.
	Disability	The product of interactions among individuals’ bodies; their physical, emotional, and mental health; and the physical and social environment in which they live, work, or play. Disability exists where this interaction results in limitations of activities and restrictions to full participation at school, at work, at home, or in the community (Institute of Medicine and International Classification of Functioning, Disability, and Health).
	Domestic Victim	Refers to a U.S. citizen or lawfully admitted permanent resident.
	Education Services	Encounters in which a client accesses educational courses in an informal, traditional, or online setting. This includes English as a Second Language (ESL) courses, General Education courses, GED test preparation, and enrollment in higher education. These courses can be directly provided by the grantee or through a referral.
	Emergency Housing	Any facility whose primary purpose is to provide temporary or transitional shelter for the homeless in general or for specific populations of the homeless (e.g. domestic violence shelters, human trafficking shelters, etc.); also referred to as Short-Term or Temporary Housing.
	Employment Assistance	Encounters between a client and service provider in which they receive assistance in finding and securing employment. This may include interview preparation, assistance in job hunting or resume building, or engagement in job placement programs. This can be directly provided by the grantee or through a referral.
	Enrollment	Occurs when a victim of human trafficking is entered into the program to receive comprehensive case management services. This includes occasions when a victim reconnects to the program after a period of absence, often referred to as re-enrollment.
	Exit	Or disenrollment occurs when a client separates from the program and is no longer receiving comprehensive case management services. This may occur as a result of the client completing the program or for a variety of other reasons.
	Family Reunification	Encounters between a client and service provider or on behalf of a client (with their consent) in which efforts are made to reunify the client with their family members in the United States. This may include making phone calls to arrange family reunification, holding meetings to prepare for family reunification, and assisting clients in obtaining and completing any necessary reunification paperwork.
	Feelings of No Support and Isolation	Indicate the organization’s lack of knowledge of which service providers understand human trafficking and serve victims of trafficking or difficulties in collaborating within a local network of service providers.
	Financial Planning Services	Encounters between a client and service provider to assist the client in managing their available and future financial resources. This may include creating budgets, repaying debts or applying for debt relief, saving money in Escrow, and other forms of financial counseling.
	Foreign National Victim	Refers to persons who are not U.S. citizens or lawful permanent residents.
	Formal Partnerships	Those relationships between the grantee and an agency or organization in which there is a formal agreement, like a letter of support or Memorandum of Understanding (MOU) documenting the partnership.
	Hearing Difficulty	Being deaf or having serious difficulty hearing (DEAR).
	Housing/Shelter Services	Encounters between a client and service provider to assist the client in securing and maintaining housing. This may include full or partial payment of a client's rent or utilities, enrollment in housing programs or housing units, completion of housing related paperwork, and assistance with the client's housing search.
	Identified Victims	Those individuals who have been identified by law enforcement as having been subjected to a severe form of trafficking in persons or have been screened by victim assistance providers trained on human trafficking and found to be a victim of trafficking.
	Independent Living Difficulty	Having difficulty doing errands alone such as visiting a doctor’s office or shopping because of a physical, mental, or emotional problem (DOUT).
	Ineffective Coordination with Federal Agencies	Indicates that the organization needs training at all levels including on confidentiality, outreach methods, cultural/religious competency, methods to identify victims, etc.
	Ineffective Coordination with Local Agencies	Indicates a need to share information, poor reporting and prosecution, delays in certification, and a lack of specialized units/agencies for victims of human trafficking.
	Informal Partnerships	Those relationships between the grantee and an agency or organization with which the grantee works regularly without a formal agreement or MOU documenting the partnership.
	Information Sharing Partnerships	A type of relationship between at least two organizations in which one organization, or more, has agreed to serve clients from another organization.
	Institutional Housing	Any facility whose primary purpose is to provide 24-hour care, treatment, and/or supervision. This includes psychiatric treatment facilities, juvenile detention centers, jails, prisons, foster care home settings, substance abuse treatment facilities, detox centers, long-term care facilities, and nursing homes.
	Joint Service Programming Partnerships	A type of relationship between at least two organizations in which one organization, or more, has agreed to share its financial resources to conduct a program with another organization (e.g. subrecipients).
	Lack of Adequate Funding	Indicates the organization needs sources of funding, especially during a foreign-national client’s pre-certification period.
	Lack of Adequate Resources	Indicates that the organization needs housing/shelter, staff, transportation for victims, contacts in home countries, and infrastructure designated for the population being served.
	Lack of Cooperation of Client	Indicates the victim’s lack of interest in receiving services or inability to comply with the case coordination plan.
	Lack of Formal Rules and Regulations	Include inadequate rules, need for legislative advocacy, inadequate victim assistance laws, or restrictive eligibility requirements.
	Lack of In-House Procedures	Indicates the organization does not have effective protocols or has an inadequate data management system.
	Lack of Knowledge of Victims' Rights	Include a lack of knowledge or understanding of the relevant trafficking legislation or the issue in general.
	Language Concerns	Include the inability to readily provide interpreters for all languages/dialects.
	Language Services	Encounters between a translator or interpreter and client to assess service needs and/or to provide services to a client. This includes the use of language lines for interpretation services.
	Legal Services	Generally encounters between a client and an attorney or paralegal to discuss the client's rights and legal options or to follow through on legal remedies. This may include expunging criminal records as a result of the trafficking experience or assistance with civil or family court issues. This may also include using program funds to provide 'know your rights' presentations to facilitate legal representation by private attorneys willing to act on behalf of clients pro bono. However, program funding cannot be used for criminal defense attorney services.
	Life Skills	Encounters between a client and service provider to develop skills necessary for full participation in everyday life. This includes assisting clients in learning how to do laundry, navigate public transportation, maintain personal hygiene, develop healthy relationships, enact conflict resolution, and cook healthy and balanced meals.
	Linguistically Appropriate	Refers to the provision of services that are responsive to diverse preferred languages, literacy, and other communication needs.
	Medicaid	Health insurance available to low-income individuals and families.
	Medical/Dental Services	Encounters between a client and a physician, physician assistant, nurse practitioner, physician assistant, or nurse for the purpose of assessing or treating a medical problem. This includes encounters between a dentist or dental hygienist and a patient for the purpose of prevention, assessment, or treatment of a dental problem, including restoration.
	Mental Health Services	Encounters between a licensed mental health provider (psychiatrist, psychologist, LCSW, and certain other Masters Prepared mental health providers licensed by specific states,) or an unlicensed mental health provider credentialed by the center, and a client, during which mental health services (i.e., services of a psychiatric, psychological, psychosocial, or crisis intervention nature) are provided. Clinicians and Hospitals use diagnostic codes from the DSM-5 for insurance purposes.
	Other Services	Encounters between a provider, other than those listed above, and a client during which other forms of services are provided.
	Partner	An individual or organization that enters into a relationshipw with the prime recipient for the purpose of referral, joint service programming, and information sharing.
	Partnership Development	The process by which individuals or organizations identify and recruit representatives of communities or organizations to enter into referral, information sharing, or joint service programming partnerships for the purposes of: increasing their capacity to identify and/or serve victims, increasing their clients' access to a range of services, increasing awareness of the issue of human trafficking, and/or increasing the sharing of professional expertise. This includes efforts to develop relationships with representatives that culminate in formal or informal partnerships that may be one-way or reciprocal in nature.
	Permanent Housing	Community-based housing with no time limit on how long an individual can reside in the housing or receive housing assistance, living as independently as possible. This includes Permanent Supportive Housing as well as housing owned or rented by the client.
	Person-Centered Approach	Promotes the safety and well-being of victims and minimizes potential re-traumatization associated with criminal justice and other intervening processes. For the anti-trafficking response system, this can include providing support through victim advocates and service providers, empowering survivors as engaged participants, and providing survivors an opportunity to play a role in seeing their traffickers brought to justice. The person-centered approach plays a critical role in supporting a victim’s rights, dignity, autonomy, and self-determination, while simultaneously advancing the government’s and society’s interest in prosecuting traffickers and protecting and assisting clients.
	Potential Victim of Human Trafficking	Any individual who is reported or suspected as being a victim of trafficking as defined in the Trafficking Victims Protection Act.
	Pre-Certified Foreign National	A victim of human trafficking who is not a United States citizen and has not received a letter of HHS Certification or Eligibility.
	Public Awareness	Information provided to the general public to increase knowledge or understanding of human trafficking.
	Referral Partnerships	A type of relationship between at least two organizations in which one organization, or more, has agreed to serve clients from another organization.
	Remote Case Management	Occurs when the grantee or subrecipient is providing case management or care coordination services for a client who does not live in the service area of the provider.
	Safety Concerns	Indicate a lack of safety for victims and staff from abusers.
	Safety Planning	Encounter between a client and service provider in which they develop a practical plan to avoid and react to dangerous situations. This plan should be based on the specific needs of each client.
	Section 8	The Housing Choice Voucher Program which assists low-income families, the elderly, and the disabled to afford safe housing in the private market.
	Self-Care Difficulty	Having difficulty bathing or dressing (DDRS).
	SNAP	The Supplemental Nutrition Assistance Program, formerly known as SNAP, which provides food-purchasing assistance to individuals and families.
	SSDI	Social Security Disability Insurance, a type of financial assistance provided to workers who become disabled before reaching retirement age.
	SSI	Supplemental Security Income, a type of financial assistance provided to low-income people who are aged 65 or older, blind, or disabled.
	Substance Use Assessment/Treatment Services	Encounters between a substance abuse provider (e.g., credentialed substance abuse counselor, rehabilitation therapist, psychologist) and a client during which alcohol or drug abuse services (i.e., assessment and diagnosis, treatment, aftercare) are provided.
	Survivor Engagement	Provides a pathway to incorporate survivors’ experiences into inception, development, and execution of all forms of anti-trafficking responses. Engagement of survivors allows organizations to better serve clients, create programs, identify challenges and opportunities, and achieve agency missions and mandates. As a primary stakeholder in the anti-trafficking field, survivor leaders offer invaluable insight and expertise, and can validate other survivor's experiences and reactions to traumatic events resulting from a trafficking experience.
	TANF	Temporary Assistance to Needy Families program, formerly known as welfare, which provides financial assistance to pregnant women and families with one or more dependent children.
	Technical Assistance	The process of providing coordinated, innovative, and results-driven support to build the capacity of professionals to address a diverse range of needs, develop a sustainable response; may be delivered in person or virtually to a single organization or to a multidisciplinary group of service providers.
	Training	The planning, development, delivery and evaluation of activities designed to achieve specific learning objectives for participants. The learning objectives may be achieved using a variety of instructional strategies such as lecture, group discussion, demonstration role play, and other methods of group and individual integration. Training may include onsite instruction, classroom training, webinars, online or virtual training, self-directed learning, and workshops.
	Transitional Housing	Designed to provide homeless individuals and families with the interim stability and support to successfully move to and maintain permanent housing. Transitional housing is time limited with clients staying up to 24 months in the housing, typically with accompanying supportive services. Individuals must have a lease (or sublease) or occupancy agreement in place when residing in transitional housing.
	Transportation Services	Encounters in which a service provider provides a client with the necessary resources to access transportation which enables clients to access services. This includes providing clients with bus/rail passes, cabs/cab vouchers, or gas assistance. This may occur with the service provider purchasing transportation on behalf of the client, providing clients with gifts cards to the same purpose, or providing clients with cash to purchase transportation themselves.
	Trauma-Informed Approach	An understanding of the physical, social, and emotional impact of trauma on individuals, as well as on the professionals who help them. A trauma-informed approach includes person-centered practices. A program, organization, or system that is trauma-informed realizes the widespread impact of traumatic events experienced by the survivor; recognizes the signs and symptoms of trauma in staff, survivors, and others involved in the anti-trafficking response system; identifies paths for support and healing; and responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings. Like a person-centered approach, a trauma-informed approach prioritizes the safety and security of clients, including safeguarding against policies and practices that may inadvertently re-traumatize clients.
	Victim Advocacy	An an encounter between a client and service provider in which the client is provided information and support to help them understand and exercise their rights as a victim of crime within the criminal justice process.
	Victims' Legal Status	A barrier in which status renders the victim ineligible for social services funding (e.g. pre-certification period issues, prior criminal histories, etc.).
	Vision Difficulty	Being blind or having serious difficulty seeing, even when wearing glasses (DEYE).
	WIC	Special Supplemental Nutrition Program for Women, Infants, and Children, which provides nutrition assistance to low-income pregnant women, breastfeeding women, infants, and children under the age of five.
	Client Trafficking Experience Definitions
	Type of Trafficking	Describes the type of trafficking a client experienced according to the Trafficking Victims Protection Act (TVPA) of 2000, as amended1, US Federal law (22 USC § § 7102), and the Justice for Victims of Trafficking Act (JVTA) (P.L. 114-22).
	Labor	Recruited, harbored, transported, provided, or obtained for labor or services, through the use of force, fraud, or coercion, for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery (22 U.S.C.§ 7102 (9)).
	Sex	Recruited, harbored, transported, provided, obtained, patronized, or solicited for the purpose of a commercial sex act (22 U.S.C. § 7102 (9)) (P.L. 114-22).
	Sex and Labor	Recruited, harbored, transported, provided, obtained, “patronized, or solicited” (P.L. 114-22) for the purpose of a commercial sex act AND for labor or services, through the use of force, fraud, or coercion, for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery (22 U.S.C. § 7102 (9)).
	Unknown Type of Trafficking	Purpose for which the client was recruited, harbored, transported, provided, or obtained is not known (22 U.S.C. § 7102 (9)).
	Trafficking Exploitation Industry	Describes the industry through which, or venue where, a trafficked client was exploited to provide commercial sex acts or labor/services. The industry or venue can be formally recognized or family-owned.

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Sheet 3: Operational Guidance

National Human Trafficking Hotline

Performance Reporting Data Elements and Operational Guidance

Scroll Right

Victim Assistance - Client Characteristics and Program Entry Data

Client Exploitation Industry (Additional Operational Guidance)

Victim Assistance - Client Service Use and Delivery Reporting

Victim Assistance - Barriers to Service Delivery and Monitoring

Victim Assistance - Client Case Closure Reporting

Training Reporting

Partnership Development Reporting

Fiscal Year Reporting

Data Element

Operational Guidance

Response Options

Workbook Tab

Industry or Venue

Operational Guidance

Data Element

Operational Guidance

Response Options

Workbook Tab

Data Element

Operational Guidance

Response Options

Workbook Tab

Data Element

Operational Guidance

Response Options

Workbook Tab

Data Element

Operational Guidance

Response Options

Workbook Tab

Data Element

Operational Guidance

Response Options

Workbook Tab

Data Element

Operational Guidance

Response Options

Workbook Tab

Client Identifier

Unique alphanumeric code generated by system to identify the client

Alphanumeric Code

Client Program Entry

Agriculture/Field Labor

This value should be selected if the client was trafficked to grow crops or cultivate soil, inclusive of farming operations that are not legally or formally recognized as businesses, such as agriculture on family-owned lands.

Client Identifier

Unique alphanumeric code generated by system to identify the client

Alphanumeric Code

Client Service Use and Delivery

Barriers to Service Delivery

Describes all barriers to service delivery that the grantee encountered or experienced during the reporting period

Lack of Adequate Resources Lack of Adequate Funding Lack of Adequate Training Ineffective Coordination with Federal Agencies Ineffective Coordination with Local Agencies Language Concerns Safety Concerns Lack of Knowledge of Victims’ Rights Lack of Formal Rules and Regulations Lack of Cooperation of Client Victims’ Legal Status Feelings of No Support and Isolation Lack of In-House Procedures Other Services (specify) None

Delivery Barriers, Monitoring

Client Identifier

Unique alphanumeric code generated by system to identify the client

Alphanumeric Code

Client Case Closure Reporting

Total Trainings

Describes the total number of trainings provided during the reporting period

Reported as a number

Training

Name of Partner Organization

Name of the partnering organization

Open Text

Partnership Dev, Expansion

Categories of Assistance Costs

House Committee on Appropriations directs the Department to provide an annual consolidated report to the House Appropriations Committee, the House Foreign Affairs Committee, and the House Energy and Commerce Committee on the percent of funds spent on food, housing, clothing, mental health screening and therapy, legal assistance, employability services, and health screening and medical services. For health screening and medical services, the Department is directed to include specific information regarding the types of services provided or referred and the names of the entities providing such medical services. For each of the entities providing medical services, the Department shall record the amount of money expended on each type of medical service provided. The Department is directed to make this information available annually and more frequently by request (House Report 114-195, page 94).

See annotated tab for additional guidance

FY. Types and Costs of Services

Intake Date

Describes the date the client enrolled in TVAP

mm/dd/yyyy

Client Program Entry

Arts/Entertainment

This value should be selected if the client was trafficked to provide recreational entertainment or art, including modeling, athletics, and the performing arts.

Services Received

Describes the services received by the client; grantee should select one or more services that the client received either directly by the organization or through a referral during the reporting period, excluding referrals that did not result in the client accessing the service

Basic Necessities Child Care Crisis Intervention Dental Health Services Education Assistance Employment Assistance Family Reunification Financial Assistance Housing/Shelter Services Interpreter/Translator Legal Advocacy and Services Life Skills Mental/Behavioral Health Services Medical Services Safety Planning Services Substance Use Assessment/Treatment Transportation Victim Advocacy Other Services (specify) None Unknown

Client Service Use and Delivery

Case Closure Date

Describes the month, day, and year that the client's case was closed

mm/dd/yyyy

Client Case Closure Reporting

Topic

Describes the number of occasions each topic was covered during the trainings provided during the reporting period If one training reasonably covers multiple topics, the training may be double-counted

Grant Management Topics: - Building a Community Referral Network and Partnership Building (#) - Data Collection, Management, and Reporting (#) - Introduction to Grant Program and Onboarding (#) - Outreach Strategies (#) - Program Policy, Protocol, and Administration (#) Service Delivery and Access Topics: - Approaches, Strategies, and Special Considerations for Working with Victims (e.g. Trauma Informed Care) (#) - Available Services/Benefits and Strategies for Self Sufficiency (#) - HHS Certification, Eligibility, and Other HHS Resources (#) - Human Trafficking 101: Definition, Types, Laws, and Indicators (#) - How to Access Legal Services and Remedies (#) - Other (#)

Training

Location of Partner Organization

Describes the location of the partner organization

City, State

Partnership Dev, Expansion

Medical Service Costs by Type of Service

Describes the amount of money expended on each type of medical service provided

See annotated tab for additional guidance

FY. Categories of Assistance

Type of Intake

Describes the type of intake most applicable to the client, where new intakes should be understood as clients who have never enrolled in TVAP and reopened cases are fiscal year-specific For example, if a client left the program but re-enrolled within the same fiscal year due to COVID-19 destabilization, they should be logged as a reopened case. Describes the kind of intake applicable to the client

New Intake Reopened

Client Program Entry

Bar/Cantina/Nightclub

This value should be selected if the client was trafficked through an establishment that serves alcohol/drinks as their primary business product.

Public Benefits Receieved

Describes the benefits received by the client; grantee should select one or more benefits that the client received either directly by the organization or through a referral during the reporting period, excluding referrals that did not result in the client accessing the benefit

Child Care Subsidy SNAP (Food Stamps) General Assistance Section 8/Permanent Housing Assistance Medicaid ORR Match Grant ORR Targeted Assistance Grant (TAG) ORR Wilson/Fish Program Refugee Cash Assistance Refugee Medical Assistance Refugee Social Services State-specific Health Benefits Social Security Disability (SSI or SSDI) Temporary Assistance for Needy Families Unaccompanied Alien Children Program Unemployment Insurance WIC Other (specify) None Unknown

Client Service Use and Delivery

Desk Audits

Describes the number of desk audits conducted by the grantee during the reporting period

Reported as a number

Delivery Barriers, Monitoring

Reason for Case Closing

Describes one or more reason(s) why the client's case was closed as known at the time of exit

No longer in need of services Lost contact Incarcerated and out of contact with program Client relocated Time limitations of the program Transfer to another service program Determined not eligible Client unable to meet program expectations Other (specify)

Client Case Closure Reporting

Audience

Describes the number of each type of professional who attended trainings offered during the reporting period Please do not double count; instead, please provide counts by the audience type that best describes the individuals For example, if a training was conducted for 30 private sector public health professionals, please record as Public Health: 30

Behavioral Health (#) Child Welfare (#) Education (#) Faith-Based (#) Government (#) Health Care (#) Housing (#) Law Enforcement (#) Legal (#) Private Sector (#) Public Health (#) Social Services (#) Students (Higher Education) (#) Tribal (#) Other (#)

Training

Type of Partner Organization

Describes the sector that best describes the type of organization entering into the partnership

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)

Partnership Dev, Expansion

Annual Service Costs by Enrollment Type

Describes the number of clients who received each service during the reporting period by their enrollment type

See annotated tab for additional guidance

FY. Types and Costs of Services

Was client matched to a service provider within 48 hours of referral?

Describes how long it took to place a client with a service provider This is intended to capture if the client has been enrolled/determined eligible to begin receiving services with a provider even if they have not yet begun receiving those services

Yes No

Client Program Entry

Begging/Peddling

This value should be selected if the client was made to beg for money or ask strangers for donations that primarily benefit the exploiters.

Did client apply for HHS Certification or Eligibility?

Describes whether the client applied for HHS Certification or Eligibility through OTIP

Yes No N/A (U.S. citizen or LPR)

Client Service Use and Delivery

Monitoring Visits

Describes the number of on-site monitoring visits conducted by the grantee during the reporting period

Reported as a number

Delivery Barriers, Monitoring

Employment Status Upon Case Closing

Describes the client's employment status at the time of exit from the program; grantee should select the option(s) that best describe the client's employment status

Employed, Full-time Employed, Part-time Employed, Seasonal/sporadic Enrolled in Job Training Unemployed, Looking for work Unemployed, Unable to work Unemployed, Not looking for work Unknown

Client Case Closure Reporting

Service Sites

Describes the total number of service site locations of the partner organization

Reported as a number

Partnership Dev, Expansion

Referral Date

Describes the date that the service agency received the referral for the client

mm/dd/yyyy

Client Program Entry

Carnival

This value should be selected if the client was trafficked to provide entertainment through traveling oddity and wonder shows and performances. This value should be selected if the client was a carnival performer or if the client supported the carnival through sale of retail goods/tickets, animal caretaking, event management tasks.

Did client receive HHS Certification or Eligibility?

Describes whether the client received HHS Certification or Eligibility through OTIP

Yes No N/A (U.S. citizen or LPR)

Client Service Use and Delivery

Active Subrecipients

Describes the total number of subrecipients that provided services during the reporting period

Reported as a number

Delivery Barriers, Monitoring

Living Situation Upon Case Closing

Describes the client's living situation at the time of exit from the program; grantee should select the option that best describes the client's living situation

Permanent Housing Transitional Housing Institutional Housing Emergency Housing No Housing/Place Not Meant For Habitation Unknown

Client Case Closure Reporting

Goal of Partnership

Describes the goals of the partnership; grantee should select all that apply

Increase Grantee's Capacity to Identify/Serve Victims Increase Clients' Access to a Range of Services Increase Awareness of the Issue of Trafficking Increase Sharing of Professional Expertise

Partnership Dev, Expansion

Referral Source

Describes the entity or individual who referred the client for services; grantee should select the option that best describes the entity or individual

Child Protective Services/Child Welfare Court DA/State's Attorney/Victim Assistance Defense Attorney/Public Defender/Legal Aid Domestic Violence Agency/Shelter Educator/Teacher/School Employer Family Member/Guardian Friend/Peer/Acquaintance Health Care Provider Homeless Agency/Shelter Juvenile Justice Law Enforcement Look Beneath the Surface Grantee Mental Hospital/Psychiatric Treatment Facility National Human Trafficking Hotline (NHTH) Other National Hotline State/Local Hotline Religious Organization Self Other (specify)

Client Program Entry

Commercial Cleaning

This value should be selected if the client was made to provide janitorial or out-call cleaning services for commercial or public properties. IMPORTANT NOTE: This industry is inclusive of business operations like Merry Maids but does not refer to housekeeping staff labor performed at a hotel (Hotel/Hospitality).

Remote Case Management

Describes the total number of clients who received remote case management services during the reporting period

Reported as a number

Delivery Barriers, Monitoring

Did the client obtain Continued Presence or a T-Visa?

Describes the type of immigration remedy the client may have received

Continued Presence T-Visa None

Client Case Closure Reporting

Type of Partnership

Describes the type of partnership; refer to DVHT definitions tab

Referral Partnerships Information Sharing Partnerships Joint Service Programming Partnerships

Partnership Dev, Expansion

Does the client have family members receiving services from grantee?

Describes whether family members of the client are also receiving services from the grantee

Yes No

Client Program Entry

Construction

This value should be selected if the client was trafficked to provide improvements to real estate or infrastructure through building, repairs, or demolition. IMPORTANT NOTE: This industry should not be confused with private household repair (Domestic Work).

Did the client obtain HHS Certification or Eligibility?

Describes whether the client received a certification or eligibility letter while enrolled in the program

Yes No

Client Case Closure Reporting

Services Provided by Subrecipient (in-house)

Describes the services that are provided to clients through the partnership in-house; grantee should select all that apply

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

Partnership Dev, Expansion

Relationship to Victim

Describes the number of each type of family member being served as part of the household

Parent (#) Sibling (#) Spouse (#) Child(ren) < 18 (#) Child(ren) 18 or older (#)

Client Program Entry

Domestic Work

This value should be selected if the client was made to provide child care, housekeeping, household repair, or other household duties to an employer or family member. IMPORTANT NOTE: Household repair includes things like providing “handyman” services or backyard gardening, but should not be confused with specialized lawn care (Landscaping) or other contracted work home improvement work (Construction).

Did the client receive a referral for continued case management services?

Describes whether the client received a referral to continue receiving services at the time of exit from the program

Yes No

Client Case Closure Reporting

Services Provided through Referral

Describes the services that are provided to clients through the partnership through referrals; grantee should select all that apply

Partnership Dev, Expansion

Service Eligibility Status

Describes the client's service eligibility

Pre-Certified Foreign National Certified Foreign National U.S. Citizen/Lawful Permanent Resident

Client Program Entry

Elder Care

This value should be selected if the client was trafficked to provide non-medical daily needs or fulfilling other caregiver duties for the elderly or otherwise vulnerable adults.

Enrollment Date

Describes the month, day, and year when entity partnered with grantee network

mm/yy/yyyy

Partnership Dev, Expansion

Date of Birth

Describes the client's date of birth

mm/dd/yyyy

Client Program Entry

Escort Services

This value should be selected if the client was supplied to buyers to provide commercial sex or romantic companionship; OR, the client primarily provided commercial sex services on an “out-call” basis, meeting clients at various locations such as hotels or private residences.

Exit Date

Describes the month, day, and year when entity ended their partnership with grantee network

mm/dd/yyyy

Partnership Dev, Expansion

Age

Describes the client's age at intake

1-99

Client Program Entry

Factories/Manufacturing

This value should be selected if the client was trafficked to produce package food or merchandise to be sold; OR, through any other type of type of industrial factory-type job.

Sex

Describes the client's sex assignment, as reported by the client

Male Female Unknown

Client Program Entry

Fishing

This value should be selected if the client was trafficked to catch/obtain fish, shellfish, or other sea life from a natural body of water (i.e. ocean, bay, gulf, etc.); OR to harvest aquatic animals or plants in controlled or selected aquatic environments.

Race/Ethnicity

Describes the client's race/ethnicity, as reported by the client

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic or Latino Other (specify) Unknown

Client Program Entry

Forced Criminal Activity

This value should be selected if the client was trafficked to provide labor or services that contributed to an illegal/illicit business operation. Includes: assault, arms smuggling/dealing, extortion, financial scams, human smuggling/foot guiding, drug cultivation/production, drug transporting/distribution, drug smuggling, look-out/scouting, robbery, and wildlife smuggling, etc.

Does the victim have a disability?

Describes whether the client has a disability, as reported by the client or diagnosed by a clinician

Hearing Difficulty Vision Difficulty Cognitive Difficulty Ambulatory Difficulty Self-Care Difficulty

Client Program Entry

Forestry/Logging

This value should be selected if the client was trafficked to create, cultivate, mange, use, and/or repair forests or trees for recreational or commercial use.

Location of Origin

Describes the client's country of origin

Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cabo Verde Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Curacao Cyprus Czechia Denmark Djibouti Dominica Dominican Republic East Timor (see Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Yemen Zambia Zimbabwe United States of America Unknown

Client Program Entry

Health/Beauty

This value should be selected if the client was trafficked to provide cosmetology-related services. Includes: acupuncture services, hair salon/barber shop services, massage services, and nail salon services.

Current Living Situation

Describes the client's current living situation; grantee should select the option that best describes the client

Permanent Housing Transitional Housing Institutional Housing Emergency Housing No Housing/Place not meant for habitation Unknown Permanent Housing Transitional Housing Institutional Housing Emergency Housing No Housing/Place not meant for habitation Unknown

Client Program Entry

Health Care

This value should be selected if the client was trafficked to provide medical care to patients. This can include, but is not limited to the provision of: doula/midwife services, CNA work, home health care services, and residential care facility services.

If client is a minor, are they enrolled in school?

Describes if the client is enrolled in school at intake if client is a minor

Yes No

Client Program Entry

Herding Livestock/Animal Husbandry

This value should be selected if the client was trafficked to care for and rear animals for their byproducts.

Services Requested/Needed

Describes the services requested or needed by the client; grantee should select one or more services as requested by the client or assessed as being a need by the service provider at intake

Basic Necessities Child Care Crisis Intervention Dental Health Services Education Assistance Employment Assistance Family Reunification Financial Assistance Housing/Shelter Services Interpreter/Translator Legal Advocacy and Services Life Skills Mental/Behavioral Health Services Medical Services Safety Planning Services Substance Use Assessment/Treatment Transportation Victim Advocacy Other Services (specify) None Unknown

Client Program Entry

Hotel/Hospitality

This value should be selected if the client was trafficking to provide lodging or other temporary accommodations. Includes: front desk/front of house work and in-house housekeeping. IMPORTANT NOTE: This venue should not be confused with Commercial Cleaning and does not refer to tourist attractions Ski Resorts/Casinos (Recreation/Sports) or Cruise Ships (Transportation).

Public Benefits Requested/Needed

Describes the public benefits requested or needed by the client; grantee should select one or more benefits as requested by the client or assessed as being a need by the service provider at intake

Child Care Subsidy SNAP (Food Stamps) General Assistance Section 8/Permanent Housing Assistance Medicaid ORR Match Grant ORR Targeted Assistance Grant (TAG) ORR Wilson/Fish Program Refugee Cash Assistance Refugee Medical Assistance Refugee Social Services State-specific Health Benefits Social Security Disability (SSI or SSDI) Temporary Assistance for Needy Families Unaccompanied Alien Children Program Unemployment Insurance WIC Other (specify) None Unknown

Client Program Entry

Illicit Massage/Health/Beauty

This value should be selected if the client was trafficked through a business that claimed to offer legitimate health/beauty/spa services, but whose true purpose is provide commercial sex services to clients. Includes: massage parlors, nail salons, acupressure shops, spas.

Location of Services

Describes the location of the organization that will be providing services to the client

County or Parish State or Territory Tribal Land or Reservation

Client Program Entry

Landscaping

This value should be selected if the client was trafficked to modify the aesthetic features of land. Includes: commercial gardening, grass cutting, hedge trimming, etc.

Type of Trafficking

Describes the type of trafficking situation the client experienced; grantee should select the type that bnest describes the potential trafficking situation

Sex Labor Sex and Labor Unknown

Client Program Entry

Mining/Quarrying

This value should be selected if the client was trafficked to harvest of coal or other minerals, oil, fuel, or gas.

Relationship to Trafficker

Describes the trafficker's relationship to the client; grantee should select the option(s) that best describes the relationship between the client and their exploiter(s), marking 'Unknown' if the relationship is unclear or not disclosed

Acquaintance/Person Briefly Known Coworker Current or Former Spouse Current or Former Intimate Partner Employer Family or Household Member Family Friend Friend Gang Member Spiritual Advisor None Other Unknown

Client Program Entry

Other

This value should be selected if the client described experiencing a trafficking situation that does not reasonably fit into any of the other Venue/Industries. This option should be used in extremely rare circumstances.

Exploitation Industry

Describes the describes the industry through which, or venue where, the client was exploited to provide commercial sex acts or labor/services. The industry or venue can be formally recognized or family-owned; grantee should select the option(s) that best describe the trafficking situation, marking 'Unknown' if the information was not clear or disclosed by the client

Agriculture/Field Labor Arts/Entertainment Bar/Cantina/Nightclub Begging/Peddling Carnival Cartel/Gang Commercial Cleaning Construction Domestic Work Elder Care Escort Services Factories/Manufacturing Fishing Forced Criminal/Illicit Activities Forestry/Logging Herding/Livestock Health/Beauty Health Care Hotel/Hospitality Illicit Massage/Health/Beauty Landscaping Mining/Quarrying Pornography/Remote Interactive Sexual Acts Prostitution/Outdoor Solicitation Prostitution/Residential Recreation/Sports Religious Institution Restaurant/Food Service Retail Sales Sexual Servitude Stripping/Exotic Dancing Traveling Sales Crew Transportation Other (specify) Unknown

Client Program Entry

Pornography/Remote Interactive Sexual Acts

This value should be selected if the client was forced to provide visual material depicting sexually explicit displays, sexual activity or sexual abuse, intended to erotically stimulate a person or through a business that produces such material or to provide or display any of the sexually explicit activites on a remote interactive platform such as webcam. This value should be selected any time a child is offered anything of value in exchange for a sex act, even if engagement sex act does not take place.

Location of Trafficking

Describes the location of the trafficking incident, if known

County or Parish State or Territory Tribal Land or Reservation

Client Program Entry

Prostitution/Outdoor Solicitation

This value should be selected if the client provided or was solicited to provide a commercial sex act outside of a formal venue or business, or along a “track,” “stroll,” “block,” or along a smuggling route. This value should be selected any time a child is offered anything of value in exchange for a sex act, even if engagement sex act does not take place.

Prostitution/Residential

This value should be selected if the client provided or was solicited to provide a commercial sex act outside in a residential setting. This value should be selected any time a child is offered anything of value in exchange for a sex act, even if engagement sex act does not take place.

Recreation/Sports

This value should be selected if the client was trafficked through a business that provides a venue for patrons to partake in amusement or leisure or through athletic leagues or teams. Includes: casinos, ski resorts, pools, amusement/theme parks, recreational camps, golf courses, race tracks, etc.

Religious Institution

This value should be selected if the client was trafficked through a spiritual or religious institution or organization.

Restaurant/Food Service

This value should be selected if the client was trafficked through a business primarily engaged in selling prepared food. Includes: fast food, sit-down restaurants, food/ice cream trucks, etc.

Retail Sales

This value should be selected if the client was trafficked through a business primarily engaged in selling merchandise. This value should also be selected for informal sales and family business street retail sales.

Sexual Servitude

Stripping/Exotic Dancing

This value should be selected if the client was trafficked to provide strip/exotic dance performances. IMPORTANT NOTE: This value should not be confused with Bar/Club/Cantina – a venue whose primary business purpose is the sale of alcoholic beverages.

Transportation

This value should be selected if the client was trafficked to facilitate the movement of passengers and cargo, the warehousing and movement of goods, scenic and sightseeing transportation, or any related support activities. Includes: cruise ships, shipping, trucking, etc.

Traveling Sales Crew

This value should be selected if the client was trafficked through a business where salespersons/potential victims travel in groups to various cities/states to sell items such as magazines or cleaning supplies. IMPORTANT NOTE: This industry should not be confused with Begging/Peddling.

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Sheet 4: Monthly Summary Report

Grantee Name:

Polaris

Grant Number:

Report Type:

Monthly

Please reference the Grantee Reporting Reference Guide (p.xx-xx) to populate this table.

Report Period:

December 2021

OMB Control Number: 0970-NEW Expiration Date: mm/dd/yyyy

Human Trafficking Emergency-Related Service Request and Referral Data

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 x 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: 0970-0467, expiration date is mm/dd/yyyy. 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.

FY21 (9/30/2021 - 9/29/2022)

Oct-21

Nov-21

Dec-21

Jan-22

Feb-22

Mar-22

Apr-22

May-22

Jun-22

Jul-22

Aug-22

Sep-22

Emergency-Related Service Requests

Emergency Shelter

Extraction

Transportation

Total Number of Emergency-Related Service Requests

Case Referrals

Total Number of Cases With At Least One Referral Provided

Total Number of Individual Referrals Provided

Total Number of New Referral Partners Added to the Referral Database

Total Number of Referral Partners in the Referral Database

Vera To-Do

Instructions tab

Human Trafficking Case-Level Data

Operational Guidance tab

FY21 (9/30/2021 - 9/29/2022)

Grantee Reporting Reference Guide

Oct-21

Nov-21

Dec-21

Jan-22

Feb-22

Mar-22

Apr-22

May-22

Jun-22

Jul-22

Aug-22

Sep-22

Type of Trafficking

Sex

Labor

Sex and Labor

Type of Potential Trafficking Not Specified

Total Number of Human Trafficking Cases Reported to the Hotline

Cases Reported to Law Enforcement

Cases Involving Adult Victims Reported to Law Enforcement

Cases Involving Minor Victims Reported to Law Enforcement

Cases Involving Both Adult/Minor Victims Reported to Law Enforcement

Cases Reported Where Victim Age Unknown Reported to Law Enforcement

Total Cases Reported to Law Enforcement

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Sheet 5: Semi-Annual Summary Report

		Grantee Name:	Polaris
		Grant Number:
		Report Type:	Semi-Annual		Please reference the Grantee Reporting Reference Guide (p.xx-xx) to populate this table.
		Report Period:	March 2021
					Signaler Data
OMB Control Number: 0970-NEW Expiration Date: mm/dd/yyyy							FY21 (9/30/2021 - 9/29/2022)
							Mid-Year	Year-End
					Type of Signaler	211/311 Operator
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 x 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: 0970-0467, expiration date is mm/dd/yyyy. 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.						Airline/Airport Personnel
						Asylee/Refugee
						Bus Industry Employee
						Business
						Child Welfare/ORR
						Community Member
						DOJ/BJA Task Force Member
						Educator/School Personnel
						Faith-based Organization/Representative
						Family Member of Potential Victim
						Family Member of Potential Victim of Trafficking
						Family/Friend of Potential Victim of Labor Exploitation
						Family/Friend of Potential Victim of Other Crime
						Family/Friend of Potential Victim of Unknown Situation
						Family/Friend/Acquaintance of Potential Controller
						Federal Law Enforcement
						Finance Industry Employee
						Foreign Government
						Friend of Potential Victim
						Friend of Potential Victim of Trafficking
						Government
						Hotel/Motel Employee
						International Law Enforcement
						Legal Professional
						Local Law Enforcement
						Medical Professional
						Mental Health Professional
						Military Personnel
						NGO – Anti-trafficking
						NGO - DV/SA
						NGO - General Social Services
						NGO - Immigrant/Refugee
						NGO - Other
						NGO – Other
						NGO - RHY
						NGO - Worker Rights
						Other
						Possible Buyer of Commercial Sex
						Potential Controller
						Potential Victim of Labor Exploitation
						Potential Victim of Other Crime
						Potential Victim of Trafficking
						Potential Victim of Unknown Situation
						Press/Media
						State Law Enforcement
						Student
						Taxi/Rideshare Driver/Employee
						Truck Stop Employee
						Trucker
						Unknown
						Visa Holder
					Signaler Location	Alabama
						Alaska
						American Samoa
						Arizona
						Arkansas
						California
						Colorado
						Connecticut
						Delaware
						District of Columbia
						Florida
						Georgia
						Guam
						Hawaii
						Idaho
						Illinois
						Indiana
						Iowa
						Kansas
						Kentucky
						Louisiana
						Maine
						Maryland
						Massachusetts
						Michigan
						Minnesota
						Mississippi
						Missouri
						Montana
						Nebraska
						Nevada
						New Hampshire
						New Jersey
						New Mexico
						New York
						North Carolina
						North Dakota
						Northern Mariana Islands
						Ohio
						Oklahoma
						Oregon
						Pennsylvania
						Puerto Rico
						Rhode Island
						South Carolina
						South Dakota
						Tennessee
						Texas
						U.S. Virgin Islands
						Utah
						Vermont
						Virginia
						Washington
						West Virginia
						Wisconsin
						Wyoming
					Signaler Language	English
						Spanish
						Amharic, Somali, or other Afro-Asiatic languages
						Arabic
						Armenian
						Bengali
						Chinese (includes Cantonese, Mandarin)
						French (includes Cajun)
						German
						Greek
						Gujarati
						Haitian
						Hebrew
						Hindi
						Ilocano, Samoan, Hawaiian, or other Austronesian languages
						Italian
						Japanese
						Khmer
						Korean
						Navajo
						Malayalam, Kannada, or other Dravidian languages
						Nepali, Marathi, or other Indic languages
						Persian (includes Farsi, Dari)
						Polish
						Portuguese
						Punjabi
						Russian
						Serbo-Croatian
						Swahili or other languages of Central, Eastern, and Southern Africa
						Tagalog (includes Filipino)
						Tamil
						Telugu
						Thai, Lao, or other Tai-Kadai languages
						Ukrainian or other Slavic languages
						Urdu
						Vietnamese
						Yiddish, Pennsylvania Dutch, or other West Germanic languages
						Other Indo-European languages
						Yoruba, Twi, Igbo, or other languages of Western Africa
						Other Languages
					Potential Victim Referral, Report, Outcome Data
							FY21 (9/30/2021 - 9/29/2022)
							Mid-Year	Year-End
					Referrals and Reports	Child Protection Services
						Domestic Violence Hotline/Services
						DVHT Program Grantee
						Law Enforcement
						Other
						Other Service Provider
						Other Trafficking Service Provider
						Runaway Safeline/Services
						SAMHSA Helpline/Services
						Sexual Assault Hotline/Services
						Suicide Prevention Lifeline/Services
						TVAP Program Grantee
					Type of Outcome Received on Cases of Potential Trafficking	Tip-Related Outcome
						Allegations unsubstantiated/unfounded
						CPS involving LE
						Insufficient evidence found to proceed with investigation
						Investigation opened
						PT(s) charged with human trafficking
						PT(s) charged with other crime
						PV(s) not willing to cooperate with investigation
						Referral-Related Outcome
						PV(s) received services from referral organization
						PV(s) ineligible for services because referral org assessed as non-trafficking
						PV(s) unable to connect with referral organization
					Potential Victim Demographic Data
							FY21 (9/30/2021 - 9/29/2022)
							Mid-Year	Year-End
					Total Number of Potential Victims Identified by Age	Minors
						Adults
						Potential Victims of Unknown Age
					Total Number of Potential Victims Identified by Gender	Males
						Females
						Transgender Males
						Transgender Females
						Potential Victims of Unknown Gender
					Total Number of Potential Victims Identified by Type of Trafficking	Total Number of Sex Trafficking Victims
						Minor Victims of Sex Trafficking
						Adult Victims of Sex Trafficking
						Total Number of Labor Trafficking Victims
						Minor Victims of Labor Trafficking
						Adult Victims of Labor Trafficking
						Total Number of Sex and Labor Trafficking Victims
						Minor Victims of Sex and Labor Trafficking
						Adult Victims of Sex and Labor Trafficking
						Total Number of Victims of Unknown Trafficking Type
						Minor Victims of Unknown Trafficking Type
						Adult Victims of Unknown Trafficking Type

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Sheet 6: Annual Summary Report

		Grantee Name:	Polaris
		Grant Number:
		Report Type:	Annual		Please reference the Grantee Reporting Reference Guide (p.xx-xx) to populate this table.
		Report Period:	FY (9/30/2021 - 9/29/2022)
OMB Control Number: 0970-NEW Expiration Date: mm/dd/yyyy
					Human Trafficking Emergency-Related Service Request and Referral Data
							FY21 (9/30/2021 - 9/29/2022)
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 x 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: 0970-0467, expiration date is mm/dd/yyyy. 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.							FY 2021 Year-End Total
					Emergency-Related Service Requests	Emergency Shelter
						Extraction
						Transportation
						Total Number of Emergency-Related Service Requests
					Case Referrals	Total Number of Cases With At Least One Referral Provided
						Total Number of Individual Referrals Provided
						Total Number of New Referral Partners Added to the Referral Database
						Total Number of Referral Partners in the Referral Database
					Human Trafficking Case-Level Data
							FY21 (9/30/2021 - 9/29/2022)
							FY 2021 Year-End Total
					Type of Trafficking	Sex
						Labor
						Sex and Labor
						Type of Potential Trafficking Not Specified
						Total Number of Human Trafficking Cases Reported to the Hotline
					Cases Reported to Law Enforcement	Cases Involving Adult Victims Reported to Law Enforcement
						Cases Involving Minor Victims Reported to Law Enforcement
						Cases Involving Both Adult/Minor Victims Reported to Law Enforcement
						Cases Reported Where Victim Age Unknown Reported to Law Enforcement
						Total Cases Reported to Law Enforcement
					Level of Trafficking Indicators	Cases with 'High' Trafficking Indicators
						Potential Victims Referenced in relation to 'High' Trafficking Indicator cases
						Cases with 'Moderate' Trafficking Indicators
						Potential Victims Referenced in relation to 'Moderate' Trafficking Indicator cases
					Signaler Proximity to Situation or Victim	Victim Self-Report
						Direct Contact with Potential Victim
						Indirect Contact with Potential Victim
						Observation of Suspicious Activity
						Proximity Unknown or Not Reported
					Potential Victim Demographic Data (Country of Origin, Exploitation Venue/Industry)
							FY21 (9/30/2021 - 9/29/2022)
							FY 2021 Year-End Total
					Total Number of Potential Victims Identified by Country of Origin	Afghanistan
						Albania
						Algeria
						Andorra
						Angola
						Antigua and Barbuda
						Argentina
						Armenia
						Aruba
						Australia
						Austria
						Azerbaijan
						Bahamas, The
						Bahrain
						Bangladesh
						Barbados
						Belarus
						Belgium
						Belize
						Benin
						Bhutan
						Bolivia
						Bosnia and Herzegovina
						Botswana
						Brazil
						Brunei
						Bulgaria
						Burkina Faso
						Burma
						Burundi
						Cabo Verde
						Cambodia
						Cameroon
						Canada
						Central African Republic
						Chad
						Chile
						China
						Colombia
						Comoros
						Congo, Democratic Republic of the
						Congo, Republic of the
						Costa Rica
						Cote d'Ivoire
						Croatia
						Cuba
						Curacao
						Cyprus
						Czechia
						Denmark
						Djibouti
						Dominica
						Dominican Republic
						East Timor (see Timor-Leste)
						Ecuador
						Egypt
						El Salvador
						Equatorial Guinea
						Eritrea
						Estonia
						Ethiopia
						Fiji
						Finland
						France
					Gabon
					Gambia, The
					Georgia
					Germany
					Ghana
					Greece
					Grenada
					Guatemala
					Guinea
					Guinea-Bissau
					Guyana
					Haiti
					Holy See
					Honduras
					Hong Kong
					Hungary
					Iceland
					India
					Indonesia
					Iran
					Iraq
					Ireland
					Israel
					Italy
					Jamaica
					Japan
					Jordan
					Kazakhstan
					Kenya
					Kiribati
					Korea, North
					Korea, South
					Kosovo
					Kuwait
					Kyrgyzstan
					Laos
					Latvia
					Lebanon
					Lesotho
					Liberia
					Libya
					Liechtenstein
					Lithuania
					Luxembourg
					Macau
					Macedonia
					Madagascar
					Malawi
					Malaysia
					Maldives
					Mali
					Malta
					Marshall Islands
					Mauritania
					Mauritius
					Mexico
					Micronesia
					Moldova
					Monaco
					Mongolia
					Montenegro
					Morocco
					Mozambique
					Namibia
					Nauru
					Nepal
					Netherlands
					New Zealand
					Nicaragua
					Niger
					Nigeria
					North Korea
					Norway
					Oman
					Pakistan
					Palau
					Palestinian Territories
					Panama
					Papua New Guinea
					Paraguay
					Peru
					Philippines
					Poland
					Portugal
					Qatar
					Romania
					Russia
					Rwanda
					Saint Kitts and Nevis
					Saint Lucia
					Saint Vincent and the Grenadines
					Samoa
					San Marino
					Sao Tome and Principe
					Saudi Arabia
					Senegal
					Serbia
					Seychelles
					Sierra Leone
					Singapore
					Sint Maarten
					Slovakia
					Slovenia
					Solomon Islands
					Somalia
					South Africa
					South Korea
					South Sudan
					Spain
					Sri Lanka
					Sudan
					Suriname
					Swaziland
					Sweden
					Switzerland
					Syria
					Taiwan
					Tajikistan
					Tanzania
					Thailand
					Timor-Leste
					Togo
					Tonga
					Trinidad and Tobago
					Tunisia
					Turkey
					Turkmenistan
					Tuvalu
					Uganda
					Ukraine
					United Arab Emirates
					United Kingdom
					United States of America
					Unknown
					Uruguay
					Uzbekistan
					Vanuatu
					Venezuela
					Vietnam
					Yemen
					Zambia
					Zimbabwe
					Total Number of Victims Identified by Exploitation Venue/Industry	Agriculture/Farms/Animal Husbandry
						Aquafarming/Fishing
						Arts/Entertainment
						Bar/Club/Cantina
						Begging Rings
						Construction
						Domestic Work
						Education
						Escort Service/Delivery Service
						Forestry/Reforestation
						Health/Beauty Services
						Health Care
						Hospitality
						Hostess/Strip Club
						Hotel/Motel-Based Commercial Sex
						Illicit Activities
						Illicit Massage/Spa Business
						Internet-Based Commercial Sex
						Janitorial/Out-Call Cleaning Services
						Landscaping Services
						Legal Brothel
						Manufacturing/Factories
						Mining, Quarrying, Oil/Gas Extraction
						Other Small Business
						Peddling Rings
						Personal Sexual Servitude
						Pornography
						Pre-school/Child Day Care Service
						Professional/Scientific/Tech Services
						Recreational Facilities
						Remote Interactive Sexual Acts
						Residence-Based Commercial Sex
						Restaurant/Food Service
						Retail
						Sex Tourism
						Street-Based Commercial Sex
						Transportation
						Traveling Carnivals
						Traveling Sales Crews
						Truck Stop
						Other
						Not Specified