Form 1 SSAPC PPR

OMB Approval Number: 0970-0490

Expiration Date: 03/31/2026

Administration for Children and Families (ACF) PERFORMANCE PROGRESS REPORT (PPR)

ACF−Specialized Services for Abused Parents and Their Children (SSAPC)−OFVPS

COVER PAGE INSTRUCTIONS

Office of Family Violence Prevention and Services (OFVPS)

Family Violence Prevention and Services (FVPSA) Program

Administration for Children and Families

U.S. Department of Health and Human Services

Number	Data Element	Instructions
1.	Awarding Federal Agency & Organizational Element to Which Report is Submitted	Enter the name of the awarding federal agency and organizational element identified in the award document or as otherwise instructed by the agency. The organizational element is the sub-agency within an awarding federal agency
2.	Federal Grant/Other Identifying Number Assigned by Awarding Federal Agency	Enter the grant number/award referenced in the award document.
3. (a-b)	Data Universal Numbering System Employer (DUNS) and Identification Number (EIN)	Enter the recipient organization's Data Universal Numbering System (DUNS) number or Central Contract Registry extended DUNS number and EIN provided by the Internal Revenue Services (IRS).
4.	Recipient Organization	Enter the name and complete address, including zip code.
5.	Recipient Identifying Number/Account Number	Enter the account number or any other identifying number assigned by the recipient to the award. This number is strictly for the recipient’s use only and is not required by the awarding federal agency.
6.	Project Reporting Period	Check the correct reporting period, either April 1 – September 30 or October 1 – March 31.
7.	Final Report	Mark appropriate box. Check “Yes” only if this is the final report for the project/grant period in Box 6.
8. (a-e)	Certification	Fill in the appropriate information to certify the report, including name, signature, telephone number, email address and date.

Specialized Services for Abused Parents and Their Children (SSAPC) Discretionary Grant

PERFORMANCE PROGRESS REPORT (PPR)

ACF-SSAPC-OFVPS PPR COVER PAGE

Office of Family Violence Prevention and Services

Family Violence Prevention and Services Act (FVPSA)Program

Administration for Children and Families

U.S. Department of Health and Human Services

1. Federal Agency and Organization Element to Which Report is Submitted ACF-SSAPC-OFVPS	2. Federal Grant or Other Identifying Number Assigned by Federal Agency [Enter text here]		3a. DUNS Number [Enter text here]
			3b. EIN [Enter text here]
4. Recipient Organization (Name and Complete Address Including Zip Code) [Enter text here]			5. Recipient Identifying Number or Account Number [Enter text here]
6. Project Reporting Period [ ] April 1 – September 30 [ ] October 1 – March 31			7. Final Report Yes [ ] No [ ]
8. Certification: I certify to the best of my knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
8a. Typed or Printed Name and Title of Authorized Certifying Official [Enter text here]		8c. Telephone (Area Code, Number and Extension) [Enter text here]
		8d. Email Address [Enter text here]
8b. Signature of Authorized Certifying Official [Enter text here]		8e. Date Report Submitted (Month, Day, Year) [Enter text here]

General Instructions for Quantitative Data Tables

Complete the tables in Sections 1–5 below with data from the relevant reporting period.

Quantitative data sections include:

1. Allowable Services Provided to Parents Who Are Abused and Their Children

2. Demographics

3. Workforce Information

4. Other Services Provided

5. Survivor Outcomes

If you would like to provide additional context on the services your organization provided in Sections 1–5, please refer to Section 6: Narrative Descriptions toward the end of the PPR.

Section 1. Allowable Services Provided to Parents Who Are Abused and Their Children

Table 1.1 Outcomes: Quantifiable Expected Goals versus Completed Goals

Please complete the chart below to indicate the progress your organization has made toward at least one or more expected goals and provide a brief description of the associated outcome. Please note that these goals should align to the goals your organization created in your grant application.

When completing this table, enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. In addition, please use the mandatory narrative section “Significant and impactful outcomes” at the end of this document to describe the activities that resulted in the most significant and impactful outcomes for the individuals you serve. The narrative section is specifically appropriate for organizational goals that are not quantifiable or require additional context. You will also outline future activities planned in the narrative section “Activities planned for next reporting period” at the end of this document.

Expected Goal Description	Goal	Progress this Period	Remaining	Outcome Description
Example 1: 50 survivors referred to therapy via behavioral health screening	50	15	35	Of 30 survivors engaged in behavioral health screening, 15 were referred to therapy and 8 successfully enrolled
Example 2: All 20 project partners demonstrate increased knowledge of culturally specific dynamics of family violence	20	10	10	Of 20 total project partners, 10 participated in culturally specific dynamics learning activities and of those who participated, 100% demonstrated increased knowledge based on pre- and post-activity knowledge checks
Expected Goal Description
Expected Goal Description
Expected Goal Description
Expected Goal Description
Expected Goal Description

Table 1.2 Services Provided to Parents Who Are Abused and Their Children

Please complete the table below to indicate which of the services your organization provided to adult, children, and youth survivors and indicate the number of individuals who were provided the service. Definitions of the service categories in this table are available for reference in the Section 6: Terms and Definitions table. Please note that the age cutoff for children/youth is 17 years of age.

Note that adult, children, and youth survivors can be counted across multiple services. For example, if child/youth A received children/youth crisis intervention and children/youth legal advocacy, count them in both areas. However, please ensure that counts for children/youth and adults served together are not also counted under the children/youth or adult section. However, if a child/youth or adult receives both services separately and services together, each instance should be counted. Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the service was not provided, enter “0.”

Service Provided	Total # of Individuals Provided with Service
Children/Youth receiving:
Art-based approaches to healing (e.g., A Window Between Worlds, dance, photography, etc.)
Childcare/Early Childhood Development Services and Head Start services
Crisis intervention
Disability Support Services/Accessibility Services
Individual or group counseling/support group
Legal advocacy/services
Medical advocacy
Mental health services
Mobile Advocacy/Offsite Services
Prevention programs and outreach
Safety planning
Shelter services
Transportation services
Victim advocacy services
Youth/Teen Support Services
Additional services such as educational support, respite care, supervised visitation, etc.
Other service(s) not listed: (Provide other service(s) type and count)
Adults receiving:
Art-based approaches to healing (e.g., A Window Between Worlds, dance, photography, etc.)
Child Care/Early Childhood Development Services and Head Start Services
Crisis intervention
Disability Support Services/Accessibility Services
Individual or group counseling/support group
Legal advocacy/services
Medical advocacy
Mental health services
Mobile Advocacy Services/Offsite Services
Parenting programs/classes
Prevention programs and outreach
Safety planning
Shelter services
Social Services/Public Benefits (i.e. TANF, WIC, Low Income Home Energy Assistance Program [LIHEAP], Child Support)
Transportation services
Victim advocacy services
Youth/Teen Support Services
Additional services such as educational support, respite care, supervised visitation, etc.
Other service(s) not listed: (Provide other service(s) type and count)
Children/Youth and Adults Together receiving:
Art-based approaches to healing (e.g., A Window Between Worlds, dance, photography, etc.)
Child Care/Early Childhood Development Services and Head Start Services
Crisis intervention
Disability Support Services/Accessibility Services
Individual or group counseling/support group
Legal advocacy/services
Medical advocacy
Mental health services
Mobile Advocacy Services/Offsite Services
Prevention programs and outreach
Safety planning
Shelter services
Services to the abusive parent and child within their respective service system to restore the parent-child bond
Social Services/Public Benefits (i.e. TANF, WIC, Low Income Home Energy Assistance Program [LIHEAP], Child Support)
Transportation services
Victim advocacy services
Youth/Teen Support Services
Additional services such as educational support, respite care, supervised visitation, etc.
Other service(s) not listed: (Provide other service(s) type and count)

Table 1.3 Service Referrals

Please complete the table below to indicate the number of incoming and outgoing service referrals for adult, children, and youth survivors. Note that adult, children, and youth survivors can be counted across multiple referral areas if they received multiple referrals. Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the referral was not provided, enter “0.”

Services Referred
Children/Youth	# Referred In		# Referred Out
Art-based approaches to healing (e.g., A Window Between Worlds, dance, photography, etc.)
Childcare/Early Childhood Development Services and Head Start services
Crisis intervention
Disability Support Services/Accessibility Services
Individual or group counseling/support group
Legal advocacy/services
Medical advocacy
Mental health services
Mobile Advocacy/Offsite Services
Prevention programs and outreach
Safety planning
Shelter services
Social Services/Public Benefits (i.e. TANF, WIC, Low Income Home Energy Assistance Program [LIHEAP], Child Support)
Transportation services
Victim advocacy services
Youth/Teen support services
LGBTQIA2S+ specific services
Additional services such as educational support, respite care, supervised visitation, etc.
Other referred service(s) not listed: (Provide other service(s) type and count)
Adults	# Referred In		# Referred Out
Art-based approaches to healing (e.g., A Window Between Worlds, dance, photography, etc.)
Child Care/Early Childhood Development Services and Head Start Services
Crisis intervention
Disability support services/Accessibility services
Individual or group counseling/support group
Legal advocacy/services
Medical advocacy
Mental health services
Mobile advocacy services/Offsite services
Parenting programs/classes
Prevention programs and outreach
Safety planning
Shelter services
Social services/Public benefits (i.e. TANF, WIC, LIHEAP, Child Support)
Transportation services
Victim advocacy services
Youth/Teen support services
LGBTQIA2S+ specific services
Additional services such as educational support, respite care, supervised visitation, etc.
Other referred service(s) not listed: (Provide other service(s) type and count)
Children/Youth and Adults Together	# Referred In		# Referred Out
Art-based approaches to healing (e.g., A Window Between Worlds, dance, photography, etc.)
Child Care/Early Childhood Development Services and Head Start Services
Crisis intervention
Disability Support Services/Accessibility Services
Individual or group counseling/support group
Legal advocacy/services
Medical advocacy
Mental health services
Mobile Advocacy Services/Offsite Services
Prevention programs and outreach
Safety planning
Shelter services
Services to the abusive parent and child within their respective service system to restore the parent-child bond
Social Services/Public Benefits (i.e. TANF, WIC, Low Income Home Energy Assistance Program [LIHEAP], Child Support)
Transportation services
Victim advocacy services
Youth/Teen Support Services
LGBTQIA2S+ specific services
Additional services such as educational support, respite care, supervised visitation, etc.
Other referred service(s) not listed: (Provide other service(s) type and count)

Section 2: Demographics

Table 2.1 Race/Ethnicity

Please report the total number of adult, children and youth survivors who were supported by Family Violence Prevention and Services Act (FVPSA) grant funding by race/ethnicity. Clients may self-identify in more than one broader level category, (e.g., White and Hispanic) and should be represented as “multiracial”.

Please note: All the main Race and Ethnicity categories (Asian, for example) should add up to equal the total number of individuals served. However, the subcategories (Chinese, Asian Indian, Filipino, for example) may total a higher number than the individuals in that category, due to multiple sub-categories chosen by one individual of a single race.

Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the racial or ethnic group was not represented, enter “0.” Definitions for the categories in this table are available for reference in the Section 6: Terms and Definitions table.

Defining race and ethnicity. In accordance with the Office of Management and Budget (OMB) Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (SPD 15), the race and ethnicity categories set forth are sociopolitical constructs and are not an attempt to define race and ethnicity biologically or genetically.  The SPD 15 race and ethnicity categories are intended to result in more accurate and useful race and ethnicity data across the Federal government.

Adults, Children, and Youth Served Who Are:	Total Number
American Indian or Alaska Native (AIAN)
For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.
Asian
Chinese
Asian Indian
Filipino
Vietnamese
Korean
Japanese
Enter, for example, Pakistani, Hmong, Afghan, etc.
Black or African American
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somali
Enter, for example, Trinidadian and Tobagonian, Ghanaian, Congolese, etc.
Hispanic or Latino
Mexican
Puerto Rican
Salvadoran
Cuban
Dominican
Guatemalan
Enter, for example, Colombian, Honduran, Spaniard, etc.
Middle Eastern or North African
Lebanese
Iranian
Egyptian
Syrian
Iraqi
Israeli
Enter, for example, Moroccan, Yemeni, Kurdish, Palestinian, etc.
Native Hawaiian or Pacific Islander
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Enter, for example, Chuukese, Palauan, Tahitian, etc.
White
English
German
Irish
Italian
Polish
Scottish
Enter, for example, French, Swedish, Norwegian, etc.
Multi-Racial (Individuals who identify as more than one race and/or ethnicity)

Table 2.2 Age (In Years)

Please report the total number of adult, children, and youth survivors who were supported by FVPSA grant funding by age range. Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the age group was not represented, enter “0.”

Age (In Years)	Total Number
0–12
13–17
Unknown Child Age
18–24
25–59
60 +
Unknown Adult Age
Not Collected (Organization did not collect this data)

Table 2.3 (a-d) Sex, Gender Identity, and Sexual Orientation

In tables 2.3a-d, please report the total number of adult, children, and youth survivors who were supported by FVPSA grant funding by their 1) sex (assigned at birth), 2) gender identity, and 3) sexual orientation.

In tables 2.3e-h, please report the total number of adults, children, and youth survivors in LGBTQI2S+ populations for both services received and service referrals.

Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the listed gender identity group was not represented, enter “0.”

Table 2.3a Sex (Assigned at Birth)

Sex (Assigned at Birth)	Total Number
Female
Male
Intersex
Preferred not to say
Client identity not listed (provide identity examples):
Information not provided

Table 2.3b Gender Identity

Gender Identity	Total Number
Woman
Man
Gender Non-Binary/Gender Fluid/Genderqueer
Two-Spirit
Preferred not to say
Client identity not listed (provide identity examples):
Information not provided

Table 2.3c Cisgender/Transgender-Specific Identity

Cisgender/Transgender Identity	Total Number
Cisgender
Transgender

Table 2.3d Sexual Orientation

Sexual Orientation	Total Number
Lesbian
Gay
Bisexual
Asexual
Queer
Heterosexual/Straight
Pansexual
Questioning
Preferred not to say
Client identity not listed (provide identity examples):
Information not provided

Table 2.3e Services Provided that are Tailored for Trans, Intersex, Non-Binary and/or Two-Spirit People

Services Provided that are Tailored for Trans, Intersex, Non-Binary, and /or Two-Spirit People	Total # of Individuals Provided with Service
Children/Youth receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Adults receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Children/Youth and Adults together receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services

Table 2.3f Services Referred that are Tailored for Trans, Intersex, Non-Binary, and/or Two-Spirit People

Services Referred that are Tailored for Trans, Intersex, Non-Binary, and /or Two-Spirit People	# Referred In	# Referred Out
Children/Youth receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Adults receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Children/Youth and Adults together receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services

Table 2.3g Services Provided that are Tailored for Lesbian, Gay, Bisexual and/or Queer People

Services Provided that are Tailored for Lesbian, Gay, Bisexual and/or Queer People	Total # of Individuals Provided with Service
Children/Youth receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Adults receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Children/Youth and Adults together receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services

Table 2.3h Services Referred that are Tailored for Lesbian, Gay, Bisexual and/or Queer People

Services Referred that are Tailored for Lesbian, Gay, Bisexual and/or Queer People	# Referred In	# Referred Out
Children/Youth receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Adults receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services
Children/Youth and Adults together receiving:
Support Services
Individual or Group Counseling/Support Group
Legal Advocacy
Medical Advocacy
Shelter Services

Table 2.4 Additional Populations

Please report the total number of adult, children, and youth survivors who were supported by FVPSA grant funding who belong to any of the below categories. Note that adult, children, and youth survivors can be counted across multiple categories. For example, if a survivor reports they need language access services and has a history of substance use, they would be counted in both categories. Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the “other” populations group was not represented, enter “0.”

Category	Total Number
People experiencing homelessness/housing instability
People who were formerly incarcerated
People who are currently incarcerated
People who are elders
People with physical disabilities (includes those who are deaf or hard of hearing)
People with cognitive disabilities
People who need language access services (please provide information in Table 2.5)
People who are immigrants
People who are refugees or asylum seekers
People who are undocumented
People who are experiencing substance misuse issues
People who are experiencing mental health issues
People who do not have health insurance
People who are migratory/seasonal agricultural workers
People who are Veterans/military spouses/active duty
People who live in rural communities
People who are victims of trafficking
People who need social services (TANF, WIC, Child Support, Low Income Home Energy Assistance Program [LIHEAP] LIHEAP)
People who need economic education or support services (credit repair, matched savings, or arears/debt relief)
Other not listed (provide examples and count):

Table 2.5 Languages Spoken by Survivors Who Require Language Services

Please report the number of adult, children, and youth survivors needing language services, based on their primary language(s) spoken. If an adult, children, and youth survivor needs support for more than one language, please include them in counts for each language they speak. If adult, children, and youth survivors speak other languages not listed here, please indicate the language(s) and the total number in the “Other” row. Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the language group was not represented, enter “0.”

NOTE: If adult, children, and youth survivors spoke another language other than English but did not need language access services, do not count them in the table.

Language	Total # of Individuals Needing Language Services
African Languages
Arabic
Chinese
French
German
Hindi
Korean
Native North American Languages (Includes American Indian and Alaska Native languages)
Russian
Spanish
Tagalog
Vietnamese
Other not listed (Please specify languages and count)

Section 3: Workforce Information

Table 3.1 Breakdown of Full-Time Equivalents (FTE) Across Grant Categories

Please use the chart below to indicate the total staff full-time equivalents (FTE) paid using FVPSA funding. One FTE is equal to the number of hours a full-time employee works for an organization. FTE Planned refers to planned/expected staff, while FTE Staffed refers to actual staff hired. Each full-time paid staff member should equal 1 and each part-time paid staff member should equal 0.5. For employees paid across categories, use decimals (e.g., 0.25, 0.50, etc.) to refer to the amount of time spent across grant categories. For example, if you have one employee dedicated 0.5 FTE to work on the SSAPC grant and their time is split equally performing both Outreach and Finance, they would be counted in both categories. In this case, write 0.25 in the Total FTE column for Outreach and 0.25 for Finance. Enter only numerical values; ranges (e.g., 30–45), text values (e.g., thirty to forty-five), and percentages (50%) will not be accepted.

If your organization had staff working across additional categories, please indicate the specific type of service and the total number of staff in the “Other” row.

NOTE: If no grant funds were allocated toward FTEs, please enter zeroes in each category.

Category	Total FTE Planned	Total FTE Staffed
Direct Services
Evaluator Services
Finance
Grant funds were not allocated toward FTEs
Outreach
Program/Project Management
Other not listed: (Please specify category or categories here and the total count planned and staffed)
Total FTE

Table 3.2 Workforce Capacity Building Implemented with SSAPC Grant Funds

Please indicate which of the below capacity building activities were implemented with FVPSA funding. If your organization implemented additional capacity building activities through use of FVPSA funding, please indicate the capacity building activity in the “Other” row.

Workforce Capacity Building Activity Type	Activity Provided (mark with an X if provided)	Provide # of Staff FTE Impacted (if available)
Conferences and seminars funded (national conferences on DV/SA, etc.)
Culturally specific trainings and workshops (trauma-informed care, crisis intervention, advocacy training, etc.)
Hazard pay
Hired additional FVPSA-funded staff
Hired bilingual/culturally sensitive staff
Hired data collection staff/consultant
Hired program evaluators
Hiring bonus
Housing/rental assistance
Paid interns
Professional development (e.g., certification programs, online learning)
Provided health/wellness services (e.g., health insurance, prescriptions, chiropractic care, vision, dental, etc.)
Staff retention activities (e.g., pay increase, childcare assistance, commuting/transportation assistance)
Other not listed: (Please specify activity or activities here and the total count of staff impacted)

Section 4: Other Services Provided

Table 4.1 Training/Technical Assistance

Please indicate areas in which you have provided training/technical assistance by including the total number of individuals (adult, children, and youth survivors or individuals at organizations/service providers) trained in that area in the right column of the table. If your organization provided other forms of training/technical assistance, please indicate the type as well as the total number of individuals trained in the “Other” row. Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the training area was not provided, enter “0.”

For example: If there were 10 total individuals (adult, children, and youth survivors or individuals at organizations/service providers) trained on adolescent/teen relationship abuse, but there were not any individuals trained on program evaluation, enter a “10” for adolescent/teen relationship abuse and a “0” for program evaluation. Note that one individual can be trained across multiple areas and therefore would be entered multiple times.

Training Area	# individuals trained
Adolescent/teen relationship abuse
Child custody issues
Child welfare
Civil legal issues (includes family court response, civil legal assistance)
Data collection and evaluation
Dating violence
Disabilities (includes those who are deaf/hard of hearing)
Domestic violence
Economic empowerment
Evidence- and practice-based interventions/trauma-informed practice
LGBTQIA2S+ services
Parenting programs
Primary prevention
Program development
Program evaluation
Public benefits (TANF, SNAP, WIC, etc.)
Refugees/immigrants survivor response
Runaway/homeless youth
Rural communities (includes those living in remote areas)
Safety planning
Sexual assault
Substance abuse
Trafficking
Training for people who use violence
Tribal justice issues
Other not listed: (Please specify training area(s) here and the total count)

Table 4.2 Partnership/Community Outreach

Please indicate which organizations, agencies, etc. you have completed partnership/outreach activities with by indicating the total number of partnerships/activities completed during the grant period in the right column of the table. Note that prevention services to culturally specific communities that increase access to sexual assault and domestic violence services are also considered partnership/community outreach activities.

If your organization provided other forms of partnership/outreach, please indicate the type as well as the total number of activities in the “Other” row. Enter only full numerical values. Ranges (e.g., 30–45) or text values (e.g., thirty to forty-five) will not be accepted. If the organization was not represented, enter “0.”

In addition, if you have developed a Memorandum of Understanding (MOU) or Letter of Agreement with any of these types of organizations, please also indicate that in the final column with an X.

Organizations & Communities	# of Partnership/ Outreach Activities	Check [X] if MOU/Letter of Agreement Developed
Childcare centers
Community-based activists, sexual assault and domestic violence service providers and survivors, rape crisis centers/sexual assault programs
Culturally specific populations and community-based organizations (CBOs)
Domestic violence programs
Domestic violence shelters
Faith-based organizations (churches, mosques, temples, etc.)
General public
Homeless shelters
Hospitals and health clinics
Housing programs
Human trafficking organizations
Immigration services
Jails and prisons
Legal aid organizations
LGBTQIA2S+ organizations
Local and state public health authorities/departments
Local businesses/corporate partners
Local departments of social services
Local law enforcement agencies
Local schools and colleges/universities
Media outlets
Mental health/behavioral health organizations
Organizations that support refugees and immigrants
Other local and state government agencies
Sex trafficking/sex worker advocacy organizations
Social service non-profit organizations
Substance abuse rehabilitation centers
Tribes
Tribal organizations
Urban Indian organizations
Youth-serving organizations
Other not listed: (Please specify other types of organization(s) here and the total count of activities and MOU details to the right)

Table 4.3 Subrecipients

Please use the chart below to list your organization’s subrecipients*, if applicable. Please also be sure to list the number of domestic violence/sexual assault survivors who were referred to each subrecipient, as well as the number of those survivors who were served.

Sub-recipient Name	City, State, Zip	Website	OFVPS Funding Amount	Population	Number of Referrals	Number of Individuals Served

*“Subrecipient means a non-Federal entity that receives a subaward from a pass-through entity to carry out part of a Federal program; but does not include an individual that is a beneficiary of such program. A subrecipient may also be a recipient of other Federal awards directly from a Federal awarding agency.” (45 CFR § 75.2).

Section 5: Survivor Outcomes

Table 5.1 Survivor Outcomes

Please complete the table below to indicate the percentage of survivors receiving FVPSA funded services that reported the below outcomes. Please note that survivor percentages are counted separately across the two outcomes. If the outcome was not reported, enter “NA”.

Survivor-Centered Outcome Metrics	Total Percentage
For this reporting period, please provide the percentage of survivors receiving FVPSA-funded services that reported increased knowledge of safety planning
For this reporting period, please provide the percentage of survivors receiving FVPSA-funded services that reported increased knowledge of community resources

Section 6: Narrative Descriptions

In this section you will provide additional narrative information regarding how your organization designed, implemented, and sustained activities that add value to the SSAPC program’s intended outcomes. Note that the first five narrative descriptions are required and the last is optional. Please type your questions directly into the space provided, avoid restating the question in your responses and avoid uploading narrative descriptions as attachments. Please limit your responses to 500 words, if possible.

Required Narrative Descriptions

Survivor Stories: Provide examples of the experiences of survivors you served based on the services you provided for them, and their associated impact. You may include stories and/or anecdotes to contextualize your work.

Significant and Impactful Outcomes: Describe a significant or impactful outcome or accomplishment this reporting period you would like the Office of Family Violence Prevention and Services to know about. This could include but is not limited to additional information on survivor-centered outcomes not already addressed in your report, reduction in trauma symptoms, less violence, more confidence in being able to support children, reunification numbers, reduction in parenting stress, parent/child relationship changes, skill development for providers, etc.

Barriers and Challenges Faced During this Reporting Period: Briefly describe any barriers and/or challenges your organization faced this reporting period. Please describe how you overcame those barriers and challenges, including any pivots in your approach. Please write directly in the space provided and avoid using a table.

Activities Planned for Next Reporting Period: Briefly describe any activities planned for the next reporting period that align with the terms of the cooperative agreement as outlined in the Award Letter. Please list planned activities directly in the space provided and avoid using a table.

Progress on Equity and Accessibility Plans: Briefly describe your progress this reporting period on your organization’s Equity Plan. Include details that demonstrate the processes and policies the organization has put in place to ensure the proactive identification of systemic barriers to opportunities and benefits for people of color and other underserved populations. You may also use this section to discuss racial and gender equity work and any time spent toward policy or systems-level change.

Support for LGBTQIA2S+ Communities: Briefly describe efforts to meet the needs of survivors who are part of Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual and Two-Spirit communities.

Optional Narrative Description

Context on Data Tables: Please provide any context you feel is necessary as it relates to the completed quantitative data tables throughout Sections 1–4 of the PPR. If providing additional context, please include the section of the PPR (Allowable Services, Demographics, etc.)

to which the additional context refers. Please limit your response to 500 words.

Section 7: Terms and Definitions

Please refer to the definitions below when completing the relevant data tables.

SSAPC PPR Allowable Activity Terms

Term	Definition and/or Example
Criminal/Civil Legal Advocacy	“Assisting a client with civil legal issues, including preparing paperwork for protection orders; accompanying a client to a protection order hearing, or other civil proceeding; and all other advocacy within the civil justice system. This also includes accompanying a client to an administrative hearing, such as unemployment, Social Security, TANF, or food stamp hearing. Assisting a client with criminal legal issues, including notifying the client of case status, hearing dates, plea agreements, and sentencing terms; preparing paperwork such as victim impact statements; accompanying a client to a criminal court proceeding or law enforcement interview; and all other advocacy within the criminal justice system.” (State and Tribal FVPSA Grantees PPR)
Crisis Intervention	“Process by which a person identifies, assesses, and intervenes with an individual in crisis so as to restore balance and reduce the effects of the crisis in their life. In this category, report crisis intervention that occurs in person and/or over the telephone with an established client. This is typically short-term to intervene in a crisis.” (State and Tribal FVPSA Grantees PPR)
Individual/Group Counseling	“Individual or group counseling or support provided by a volunteer, staff, or advocate.” (State and Tribal FVPSA Grantees PPR)
LGBTQIA2S+ Individuals, Communities, and Services	PLACEHOLDER FOR DESCRIPTION OF SERVICES LGBTQIA2S+ stands for lesbian, gay, bisexual, transgender, queer and questioning, intersex, asexual or agender, and two-spirit. LGBTQIA2S+ specific services refer to services that are tailored to best address the unique context of LGBTQIA2S+ individuals and communities. The adaptation of services may focus on, but is not limited to, the delivery approach or the incorporation of community context. LGBTQIA2S+ specific services also include services as defined by the needs and lived realities of LGBTQIA2S+individuals and communities rather than an adaptation of “mainstream” services.
Medical Advocacy	“Includes accompanying a domestic violence victim to, or meeting a victim at, a hospital, clinic, or medical office.” (State and Tribal FVPSA Grantees PPR)
Transportation Services	“Provision of transportation, either directly or through bus passes, taxi fares, or other means of transportation.” (State and Tribal FVPSA Grantees PPR)
Victim Advocacy Services	“Actions designed to help the victim/survivor obtain needed resources or services, including employment, housing, shelter services, health care, victim’s compensation, etc.” (State and Tribal FVPSA Grantees PPR)

Additional PPR Terms
Term	Definition and/or Example
Culturally specific services	“Culturally specific services mean community-based services that include culturally relevant and linguistically specific services and resources to culturally specific communities, which are primarily directed toward racial and ethnic minority groups (American Indian/Alaska Native, Native Hawaiians/Other Pacific Islander, Black, Hispanic, etc.).   This underserved populations definition also includes other population categories determined by the Secretary [of Health and Human Services] or the Secretary’s designee to be underserved.” (House.gov)
Domestic violence	“Felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws or jurisdiction receiving grant monies; or by any other person against an adult or youth victim who is protected from that person’s acts under the domestic or family violence laws of the jurisdiction.” (House.gov)
Evidence based	“Evidence-based practices in policymaking include identifying existing solutions, scaling up practices that are working, and designing solutions with regular input of the individuals and communities to be served.” (House.gov)
Family violence	“Any act or threatened act of violence, including any forceful detention of an individual, which: (a) results in or threatens to result in physical injury, and (b) is committed by a person against another individual (including an elderly person) to whom such person is, or was, related by blood or marriage, or otherwise legally related, or with whom such person is, or was, lawfully residing.” (Legal Information Institute)
Housing assistance	“The term [“housing assistance”] means, with respect to federally assisted housing, the grant, contribution, capital advance, loan, mortgage insurance, or other assistance provided for the housing under the provisions of law referred to in paragraph (2). The term also includes any related assistance provided for the housing by the Secretary, including any rental assistance for low-income occupants.” (Legal Information Institute)
Medical advocacy	“Includes accompanying a domestic violence victim to, or meeting a victim at, a hospital, clinic, or medical office.” (State and Tribal FVPSA Grantees PPR)
Sexual assault	“For the purposes of this announcement, [“sexual assault”] means any nonconsensual sexual act proscribed by federal, tribal, or state law, including when the victim lacks capacity to consent.” (Office on Violence Against Women)
Supportive services	“For the purposes of this announcement, [“supportive services”] is defined as services for adult and youth victims of family violence, domestic violence, dating violence, and sexual assault and their dependents that are designed to meet the needs of such victims and their dependents for short-term, transitional, or long-term safety and recovery.   Supportive services include, but are not limited to, the following: direct and/or provide referral-based advocacy on behalf of victims and their dependents, counseling, case management, employment services, referrals, transportation services, legal advocacy or assistance, childcare services, health, behavioral health and preventive health services, culturally and linguistically appropriate services, and other services that assist victims and their dependents in recovering from the effects of the violence.” (Code of Federal Regulations)
Trauma	“Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” SAHMSA
Trauma-Informed	“Trauma-informed care acknowledges the need to understand a patient’s life experiences in order to deliver effective care and has the potential to improve patient engagement, treatment adherence, health outcomes, and provider and staff wellness.” SAHMSA
Underserved population	“Underserved populations mean populations who face barriers in accessing and using victim services, and includes populations underserved because of geographic location, religion, sexual orientation, gender identity, underserved racial and ethnic populations, and populations underserved because of special needs, including language barriers, disabilities, immigration status, and age.   Individuals with criminal histories due to victimization and individuals with substance use disorders and mental health issues are also included in this definition.   The reference to racial and ethnic populations is primarily directed toward racial and ethnic minority groups (American Indian/Alaska Native, Native Hawaiians/Other Pacific Islander, Black, Hispanic, etc.).” (Family and Youth Services Bureau, 2021)

Race and Ethnicity Terms

Term	Definitions and/or Examples
American Indian or Alaska Native	“Individuals with origins in any of the original peoples of North, Central, and South America, including, for example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, and Maya.” (Census.gov)
Asian	“Individuals with origins in any of the original peoples of Central or East Asia, Southeast Asia, or South Asia, including, for example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, and Japanese.” (Census.gov)
Black or African American	“Individuals with origins in any of the Black racial groups of Africa, including, for example, African American, Jamaican, Haitian, Nigerian, Ethiopian, and Somali.” (Census.gov) Note from OFVPS: This refers to the original peoples of black racial groups of Africa.
Hispanic or Latino	“Includes individuals of Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, and other Central or South American or Spanish culture or origin.” (Census.gov)
Middle Eastern or North African (MENA)	“Individuals with origins in any of the original peoples of the Middle East or North Africa, including, for example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, and Israeli.” (Census.gov)
Native Hawaiian or Pacific Islander	“Individuals with origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands, including, for example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, and Marshallese.” (Census.gov)
White	“Individuals with origins in any of the original peoples of Europe, including, for example, English, German, Irish, Italian, Polish, and Scottish.” (Census.gov)
Multiracial and/or Multiethnic	“This term is used when presenting data for individuals who identify with multiple race/ethnicity minimum reporting categories (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Middle Eastern or North African, Native Hawaiian or Pacific Islander, and White).” (Census, 2024) (U.S. Census Bureau, n.d. ; Marks et al., 2024)

PAPERWORK REDUCTION ACT (PRA) OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to implement a Specialized Services for Abused Parents and Children (SSAPC) demonstration projects PPR, the OFVPS seeks to ensure that the complexity and nuance of the SSAPC’s work is reflected through metrics or narrative information collected through an updated PPR while also reporting on challenges or barriers to meeting the SSAPC’s performance metrics. Public reporting burden for this collection of information is estimated to average 10 hours per grantee, 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 related to and funded by the Family Violence Prevention and Services Act (FVPSA), 42 U.S.C. 10401 et seq., which authorizes the U.S. Department of Health and Human Services to award grants to the National Domestic Violence Hotline and National, Special Issue, and Culturally Specific Resource Centers. 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 PRA of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact Holi Dahl [[email protected]].