| Ethnic Commnity Self-Help (ECSH) Program Data Indicators |
OMB Control Number: 0970-0490
Expiration Date: 3/31/2026
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| 1. Recipient Name: |
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| 2. Grant Number: |
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| 3. Reporting Period End Date: |
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| DIRECT SERVICES |
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| Program Activities |
First Reporting Period |
Second Reporting Period |
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| 4. Number of New Enrollments |
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| 5. Number of Clients Served |
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| 6. Number of Clients Served According to Gender |
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| 6a. Female |
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| 6b. Male |
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| 6c. X (Other/Unspecified) |
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| 7. Number of Clients Served According to Status |
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| 7a. Refugee |
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| 7b. Asylee |
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| 7c. Cuban/Haitian Entrants |
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| 7d. Special Immigrants Visa Holders |
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| 7e. Afghan Humanitarian Parolees |
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| 7f. Amerasians |
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| 7g. Victims of Human Trafficking |
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| 7h. Ukraine Humanitarian Parolees |
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| 8. Types of Services Provided |
First Reporting Period |
Second Reporting Period |
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| 8a. Navigation Services |
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| 8b. Cultural/community orientation |
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| 8c. Health-related services |
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| 8d. Home management services |
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| 8e. Transportation |
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| 8f. Translation and interpretation services |
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| 8g. Case management services |
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| 8h. English language training |
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| 8i. Employability services |
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| 8j. Academic enrichment/college preparation |
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| 8k. Emotional wellness services |
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| 8l. Referral services |
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| 8m. Citizenship preparation/civic engagement |
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| 8n. Other (list): |
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| ORGANIZATIONAL DEVELOPMENT |
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| Program Activities |
First Reporting Period |
Second Reporting Period |
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| 9. Number of New Partnerships Developed |
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| 10. Type of New Partnerships Developed |
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| 10a. Educational organization |
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| 10b. Local/state government entity |
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| 10c. Medical service provider |
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| 10d. Legal service provider |
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| 10e. Faith-based group |
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| 10f. Other (list) |
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| 11. Types of Training Provided to Staff |
First Reporting Period |
Second Reporting Period |
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| 11a. Case management |
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| 11b. Case documentation |
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| 11c. Interpretation |
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| 11d. Cultural sensitivity and awareness |
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| 11e. Self-care |
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| 11f. Cultural orientation provision |
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| 11g. Public benefits |
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| 11h. Health services and systems |
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| 11i. Non-profit management |
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| 11j. Other (list) |
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| CIVIC ENGAGEMENT |
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| 12. Types of Community Engagement Activities Conducted (list) |
First Reporting Period |
Second Reporting Period |
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| LOGIC MODEL OUTPUTS & OUTCOMES |
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| 13. Logic Model Outputs Progress |
Semi-Annual Results |
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| First Reporting Period |
Second Reporting Period |
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| Please list all planned Outputs from the Logic Model in the following spaces. Add more spaces as necessary. |
Identify progress towards each Output for Months 1-6 |
Identify progress towards each Output for Months 7-12. |
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| 14. Logic Model Outcomes Progress |
Semi-Annual Results |
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First Reporting Period |
Second Reporting Period |
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| Please list all planned Outcomes from the Logic Model in the following spaces. Add more spaces as necessary. |
Identify progress towards each Outcomes for Months 1-6 |
Identify progress towards each Outcomes for Months 7-12. |
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| PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, the Office of Refugee Resettlement (ORR) is gathering data on your grant program to understand the design and effectiveness of the program and to inform technical assistance needs. Public reporting burden for this collection of information is estimated to average 2 hours per recipient, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is required to retain a benefit (Pub. L. 105-285, section 680(b) as amended). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB# is 0970-0490 and the expiration date is 03/31/2026. If you have any comments on this collection of information, please contact Zahra Cheema, ACF/ORR, by email at [email protected]. |
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