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FVPSA ARP Survey All Questions

ICR 202405-0970-006 · OMB 0970-0531 · Object 142703501.

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FVPSA ARP Survey All Questions
Qualtrics
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2023-07-14
2026-09-02
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American Rescue Plan Act 
Culturally Specific Domestic Violence and Sexual Assault Supplemental Funding Survey 

Specific Special Issue Resource Centers (CSSIRCs), Alaska Native Tribal Resource Center (ANTRC), and National Indian Resource Center Addressing Domestic Violence (NIRC)

Office of Family Violence Prevention and Services
Administration for Children and Families

Thank you for your participation.  In an effort to assess implementation of the ARP Act supplemental funding, we would like to request your participation in this survey. The information provided will be used to improve the Office of Family Violence Prevention and Services (OFVPS) training and technical assistance provided to you as a grantee.  Please note your participation in this feedback survey is required, and the information provided will be kept private.  

Paperwork Reduction Act of 1995 (Pub. L. 104-13) Public reporting burden for this collection of information is estimated to average one hour per response, including the time for reviewing instructions.  

Please only include information that is funded through the ARP supplemental funding and do not include information that is funded exclusively with FVPSA core annual funding.  You may find you have not provided services using ARP funding, so the answer “No” or “O” is acceptable for those questions or categories. 

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB # is 0970-0531 and the expiration date is 09/30/2025.  If you have any comments on this collection of information, please contact Sabrina Peña at [email protected] and Holi Dahl at [email protected].  

Organizational and Program Information

Name of Organization: _________________________________________________________

Staff Name Completing Survey and Title: ___________________________________________

Contact Phone: ____________________ Contact Email: ______________________________


Workforce Support and Capacity Building 

Total number of staff paid using ARP Act supplemental funding: 
Instructional Note:  Each full-time paid staff member should equal 1.  If an employee is part-time, please use the numeric value of 0.5.


Total
Total number of staff paid using ARP supplemental funding 



Please share the type and total number of staff paid using FVPSA ARP supplemental funding:

Instructional Note:  Each full-time paid staff member should equal 1.  If an employee is being paid from more than one category, use fractions to denote the allotted time in each (i.e., 0.5 or 0.33).  Please enter 0 in in fields that do not apply.


Total
ARP DV Services Funding 

ARP COVID-19 Testing, Vaccines, Mobile Health Units  Funding 

ARP Sexual Assault Services Funding 

Total
[Auto Sum]


Types of workforce capacity building and supports being implemented with ARP supplemental funding. 


Please indicate if your ARP grant funds are supporting this support [Yes/No]

Please indicate the number of staff impacted 

Hired more FVPSA funded staff 


Trained staff on COVID-19 mitigation activities: implementation of mobile advocacy services; or virtual/remote services implementation


Hired bi-lingual staff 


Hired data collection staff/consultant


Paid Interns


Hired COVID-19 mitigation staff/consultant 


Hiring bonuses 


Retention payments 


Childcare 


Transportation subsidies 


Wellness services (employee assistance programs, onsite fitness center, yoga classes, smoking prevention, nap space, etc.)


Health services (health insurance, prescriptions, chiropractic care, vision, dental, etc.)


Contracted with an employment agency 


Other 

[Open Text ]

Sub-recipients and Services 

Number of sub-recipients by program type:

Total
Culturally Specific Domestic Violence Program 

Culturally Specific Sexual Assault Program 

Total
[Auto Sum]

Sub-recipients List
Sub-recipients Name
City
State
Zip
Website
FVPSA Funding Amount
Type of Sub-recipient SA or DV
Underserved or culturally- and linguistically specific population1-
Classification of urban, rural, suburban or frontier2



























Client Demographics

Total number of clients reached by program type: 
Instructional Note: Report on all ARP participants that are served with this funding.


Program Type
Total
Domestic Violence Program Only

Sexual Assault Program Only

Both Domestic Violence and Sexual Assault Programs

Domestic Violence Program Only
[Auto Sum]


Total number of clients reached by ethnicity:

Race/Ethnicity
Total
Black or African American 

American Indian / Alaskan Native 

Native Hawaiian / Other Pacific Islander

Asian/Asian American

Caucasian or White 

Hispanic or Latino

Unknown Race / Ethnicity 

Other (Please Specify)

Total
[Auto Sum]


Total number of clients reached by underserved type:

Clients reached by underserved type
Total
Person with a Disability 

Formerly Incarcerated

Immigrant or Refugee 

Limited English Proficiency (LEP) 

Clients needing Language Translation Services 

LGBTQ/Two Spirited 

Faith-Based 

Rural Geographically Isolated

Youth ages 13-17 receiving services due to being a victim of dating violence

Youth ages 13-17 receiving services due to being a victim of sexual assault



Total number of clients reached by age:

Age
Total
0-12 

13-17 

18-24 

25-59 

60 + 

Unknown Age

Total
[Auto Sum]
Remote/Virtual Supportive Services

Total number of clients reached through remote/virtual services:



What challenges do survivors face in utilizing remote/virtual services for urban or rural clients? (check all that apply)


Urban
Rural
None 


Lack of available internet connection 


Lack of a high-speed internet account 


Lack of a phone/data plan to talk on phone 


Lack of a device with camera and microphone 


Lack of digital proficiency 


Cognitive impairment 


Language/translation needs 


Hearing impairment 


Lack of private quiet place that is safe 


Distrust of technology 


Other (comment box, "Please specify") 





Rental Assistance and Hotel/Motel Vouchers
Total number of technical assistance contacts provided for shelter, temporary refuge: rental assistance and hotel/motel vouches 


Total
TA 
Contacts 
Shelter alternatives 

Rental assistance 

Hotel/motel vouchers 

Other 



Rental Assistance and Hotel/Motel Partnerships
Please tell us more about the partnerships that your organization/agency has related to rental assistance and temporary refuge to increase housing supports for survivors. Total number of partnerships related to temporary refuge: shelter alternatives, rental assistance, and hotel/motel vouches. 


Total
Number of Partners 
Public housing agency 

Rental company

Hotels/motels 

Private landlords 

Faith-based organization providing housing  

Tribal program providing housing 

Culturally specific organization providing housing 

Homeless services provider

Housing agency

Other 


COVID-19 Supportive Services

For each type of allowable supportive service, or items provided: 


Total
Mobile advocacy client sessions conducted 

PPE items provided 

Client vaccinations assistance 

Testing assistance 



For the COVID-19 medical emergency, total number of telehealth clients provided support by program type: 


Domestic Violence Total
Sexual Assault Total
Telehealth Clients



Training and Technical Assistance

Training and technical assistance topics support needed: (check all that apply)


Training Needed
Technical Assistance Needed
Assessing, planning, adapting workforce capacity 


Assessing, planning, adapting organizational programs/processes 


Assessing, planning, adapting supportive services 


Assessing, planning, adapting client risks 


Supporting underserved populations 


Supporting culturally specific populations 


Providing mobile advocacy 


Providing remote/virtual services 


Providing sexual assault supportive services 


Providing mobile health unit services including contracted 


Providing linguistically appropriate services, referrals, and staff 


Providing culturally specific services, referrals, and staff 


COVID-19 testing activities 


Provisioning virus testing supplies 


COVID-19 contact tracing 


COVID-19 education 


COVID-19 vaccine promotion or confidence building 


Support services for acute virus infection symptoms 


Providing telehealth direct crisis intervention services 


Innovating new service pilots 


Improving current processes and/or best practices 


Removing barriers 


Improving collaboration with established partners 


Developing new partnerships 


Flexible funding 


None 


Other (comment box, "Please specify") [Open Text]






Total number of training and technical assistance resources topics developed and/or distributed:


Developed Total
Distributed Total
Assessing, planning, adapting workforce capacity 


Assessing, planning, adapting organizational programs/processes 


Assessing, planning, adapting supportive services 


Assessing, planning, adapting client risks 


Supporting underserved populations 


Supporting culturally specific populations 


Providing mobile advocacy 


Providing remote/virtual services 


Providing sexual assault supportive services 


Providing mobile health unit services including contracted 


Providing linguistically appropriate services, referrals, and staff 


Providing culturally specific services, referrals, and staff 


COVID-19 testing activities 


Provisioning virus testing supplies 


COVID-19 contact tracing 


COVID-19 education 


COVID-19 vaccine promotion or confidence building 


Support services for acute virus infection symptoms 


Providing telehealth direct crisis intervention services 


Innovating new service pilots 


Improving current processes and/or best practices 


Removing barriers 


Improving collaboration with established partners 


Developing new partnerships 


Flexible funding 


None 


Other (comment box, "Please specify") [Open Text]







Accomplishment Highlights: 

Share an accomplishment that demonstrates how implementation of this funding is support survivors. Please do NOT share personally identifiable information.

Title of Accomplishment:  

Accomplishment Category:

Type
Please check box for the innovation  
Survivor engagement, services, or support impact 

Health and domestic violence impact 

Health and sexual assault impact 

Mental health impact 

Substance use impact  

Mobile services impact  

Virtual services impact  

Culturally specific communities impact  

LGBTQ communities impact  

American Indian and Alaska Native services impact   

Youth services impact  

COVID mitigation impact  

Other [Open Text]




Story Link:  Please provide the story website link or resource link if one is available.  


Story Narrative: 

Spending Challenges

What challenges do you experience spending ARP Act supplemental funds? (check all that apply)


Implementation

Difficulty finding appropriate/sufficient shelter

Difficulty finding appropriate/sufficient sub-awardees

Difficulty implementing remote/virtual services

Difficulty finding ARP activity authorized supplies

Difficulty implementing mobile advocacy services

Difficulty implementing telehealth or mobile health services

Difficulty implementing innovative services

Difficulty finding appropriate/sufficient workforce


Funding

Having sufficient other funds to expend prior to ARP funds

 Difficulty identifying appropriate ARP and COVID-19 risk mitigating activities

Complications of tracking and allocating funds from multiple grants simultaneously

Difficulty drawing down funds through the Payment Management System


Regulatory or Policy limitations

Having to use other to use funds that expire before using ARP funds

Local regulations limiting spending flexibility

State regulations limiting spending flexibility

Federal regulations limiting spending flexibility

            Tribal government/Tribal Council approval is pending, delayed, or was denied. 


NONE

Other (Please Specify)