| Grantee and/or Sub-Grantee Agency Profile | Summary of State AV Program Data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Grantee and/or Sub-Grantee Information OMB Control No: 0970 - 0204 Expiration date: 06/30/2027 “A Federal agency may not conduct or sponsor, and no individual or entity is required to respond to, nor shall an individual or entity be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless that collection of information displays a currently valid OMB Control Number” |
Service Provided &Client Participation (Values M (Mandatory), V (Voluntary) B (Both) | U, R, B | Client Referral Source | Client Information | Child Support Cases (Required) | Marital Status | Race/Ethnicity | Annual Income | Services Provided | Frequency of Service ( Hours) (Optional) | Outcome#1-Parenting Time (Required) | Outcome#2 - Knowledge of Effective Co-Parenting Strategies (Optional) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Name of Grantee and/or Sub-Grantee | Title of AV Program | Contact Name | Address Line 1 | City | State | Zip | Grant Amount | Grant Period From Date | Grant Period To Date | Mediation | Development of Parenting Plan | Counseling | Parent Education | Neutral Drop-off/Pick-up | Supervised Visitation | Visitation Enforcement | Geographic Area Served | Self | Court | Child Support Agency | Domestic Violence Agency | Child Protection Agency | Other | Data Not Reported | NCP Father | CP Father | NCP Mother | CP Mother | Grandparent/Legal Guardian | Number of Children in Common | NCP Father | CP Father | NCP Mother | CP Mother | Grandparent/Legal Guardian | Never Married to Each Other | Married to Each Other | Separated From Each Other | Divorced From Each Other | Data Not Reported | American Indian or Alaska Native | Asian | Black or African American | Hispanic or Latino | Middle Eastern or North African | Native Hawaiian or Pacific Islander | White | Two or More Races | Data Not Reported | Less than $10,000 | $10,000 to $19,999 | $20,000 to $29,999 | $30,000 to $39,999 | $40,000 & Above | Data Not Reported | Mediation | Development of Parenting Plan | Counseling | Parent Education | Neutral Drop-off/Pick-up | Supervised Visitation | Visitation Enforcement | Mediation | Development of Parenting Plan | Counseling | Parent Education | Neutral Drop-Off/Pick-Up | Supervised Visitation | Visitation Enforcement | NCP Fathers | NCP Mothers | NCP Fathers | CP Fathers | NCP Mothers | CP Mothers |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |