Form 0920-24BG Evaluation Work Plan Template

OMB Approval Number: 0920-XXXX CCC Program Name: __________________________

Expiration Date: XX/XX/XXXX

[Title]

[Program Year Evaluation Plan]

Remove guidance in the brackets once the template is completed.

Introduction

Program history

[Insert narrative describing the program history, who are key contributors to the work, what are plan priorities, how was this work implemented over time]

Lessons learned

[Insert any key findings and lessons learned from previous evaluations]

Purpose of the evaluation

[Insert purpose of the current evaluation]

Evaluation Stakeholders and Primary Intended Users

[Insert narrative describing the evaluation stakeholders, engagement strategies, and their contribution to the program and evaluation; ensure that tables below are identified and described in great detail]

[I. Evaluation Stakeholders & Primary Intended Users- List key individuals (by title, not by name) or groups who 1) have a stake in the evaluation and 2) who will use evaluation results. Identify and document each stakeholder’s evaluation interests.]

Table 1. Evaluation Stakeholder Perspective

Evaluation Stakeholders	What Stakeholders Want to Know

[II. Engaging Stakeholders- For each stakeholder listed above, note how and when you might engage them in your program evaluation. Be sure to consider stakeholders’ areas of expertise, interests, and availability.]

Table 2. Stakeholder Engagement Strategy

Evaluation Stakeholders	How to Engage Stakeholders	When to Engage Stakeholders

Program Background & Description

[Insert narrative describing the program, ensure that figures and tables below are identified and described in great detail]

[I. Key CCC Program Components- Insert a copy of your program’s logic model] activities, and the anticipated outputs and outcomes of program activities. ]

Figure 1. Program Logic Model

[II. Stage of Development- Briefly describe your program’s stage of development. Also include: Which major activities have been completed, what are you currently working on, what work has yet to begin?]

[III. Program Context- Briefly describe any unique program context that may affect the success of your comprehensive cancer control efforts. Also include information regarding what historical, political, program or organization, and community factors have affected CCC efforts, and how?]

Focus areas

[Insert narrative describing how an assessment of your program’s partnership, cancer control plan, and program interventions will be conducted during this program year.]

Evaluation Design & Methods

[Insert narrative regarding the chosen evaluation design, evaluation questions, and chosen methods using to address evaluation questions. Refer to the table below and describe how the matrix below will drive the data collection and analysis of the evaluation.]

Table 3. Evaluation Planning Matrix

Focus	Evaluation Questions	Indicator(s)	Data collection			Data Analysis
			Source	Method	Timing
The CCC component you will evaluate.	What you want to know.	The type of data you will need to address the evaluation question.	Where you will get the data.	How you will get the data.	When you will collect the data.	How you will organize and interpret the data.

Dissemination and Utilization of Findings

[Insert narrative describing how the evaluation findings will be disseminated, include any and all strategies necessary for the design and distribution of dissemination materials that will articulate evaluation findings to key stakeholders. Also include information regarding how the findings will be used to inform the program in the upcoming program year. Ensure that the table below is identified and described in great detail in this narrative.]

Table 4. Dissemination Strategy Matrix

Audience	Format & Channel for Sharing Findings	Timeline	Responsible Person

Public reporting burden of this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74 Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX)