5 Progress Report Supplement

AmeriCorps Seniors Grant Applications, Progress Reporting, Independent Living and Respite Surveys

Proposed PRS_9.2023

OMB: 3045-0035

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Revised PRS


Volunteers Demographics

Age Group

  • 55 to 59

  • 60 to 69

  • 70 to 79

  • 80 to 84

  • 85 and over


Gender

  • Female

  • Male

  • Gender Fluid/Does Not Identify as Male or Female


Ethnicity

  • Hispanic or Latino

  • Non-Hispanic or Latino


Racial Group

  • African American/Black

  • Asian/Asian American

  • Native American or Alaska Native

  • Native Hawaiian or Other Pacific Islander

  • White/Caucasian

  • Two or More Races


LGBTQIA+

  • Identify as a member of the member of the LGBTQ community

  • Does not identify as a member of the LGBTQ community

  • Unknown


Income

  • Report total counts of volunteers within each income bracket. This represents the total combined income for the volunteer and their spouse/partner (if living in the same residence) during the past 12 months. This includes income from any source, like wages, Social Security and other benefits, pension/retirement savings plans, or regular support from other family members. 

    • $24,999 or less   

    • $25,000 to $39,999   

    • $40,000 to $59,999   

    • $60,000 to $74,999   

    • $75,000 to $99,999   

    • $100,000 to $149,999   

    • 150,000 or more   

    • Don’t know   

  • [ALTERNATE QUESTION] Report total counts of volunteers within each income bracket. This represents the total combined income for the volunteer and all individuals living in their household (if living in the same residence) during the past 12 months. This includes income from any source, like wages, Social Security and other benefits, pension/retirement savings plans, or regular support from other family members.  

    • $24,999 or less    

    • $25,000 to $39,999    

    • $40,000 to $59,999    

    • $60,000 to $74,999    

    • $75,000 to $99,999    

    • $100,000 to $149,999    

    • 150,000 or more    

    • Don’t know    

  • Report total counts of volunteers who live in a house, apartment, or mobile home that is: 

    • Owned by the volunteer or someone in their household with a mortgage or loan

    • Owned by the volunteer or someone in the household free and clear without a mortgage or loan

    • Rented

    • Occupied without payment or rent

    • Don’t know 


Service Information

Volunteers

  • Total number of volunteers

  • Total counts of volunteers who are below 200% of the state poverty line

  • Number of volunteers identifying as a member of the Disability community

  • Number of veterans serving as volunteers

  • Total number of hours served


For Stipend Programs Only

  • Total number of volunteers federally funded

  • Total number of volunteers non-federally funded

  • Total number of Non-Stipend volunteers


Client Information

Clients Served

  • Total number of veterans served

  • Total number of US Armed Forces Service members served

  • Total number of family members of US Armed Forces service members served

  • Total number of caregivers provided with respite care

  • Total number of seniors receiving independent living services

  • Total number of children/youth served

  • Total number of children mentored

  • Total number of direct project beneficiaries. Direct beneficiaries are unique persons who have received services or benefits directly attributable to a program and for whom counts are measurable given data collected. 

  • Total number of direct project beneficiaries in poverty. Direct beneficiary refers to unique persons who have received services or benefits from a program and for whom counts are measurable given data collected. Please utilize the Census Bureau measurement of poverty, which can be found here. 

  • Report the percentage of total direct project beneficiaries for whom poverty level is known. 


Station Information

  • Total number of volunteer stations

  • Total number of volunteer stations that collect data to count the number of direct beneficiaries

  • Total number of volunteers stations that do not collect data to count the number of direct beneficiaries in poverty 


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorWhite, Colin
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File Created2023-09-18

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