Project Staff Roster

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Overview

Instructions
Definitions
Data requested

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Sheet 1: Instructions

Pathways to Partnerships Project Staff Roster

Instructions

Please fill out the "Data requested" tab with one row for each individual involved in the Pathways to Partnerships project as of [DATE]. These may include staff who:

- Interact directly with youth as well as those involved in the oversight, planning, development, or implementation of services or training for youth, parents, or youth service professionals under the Pathways to Partnerships project.
- Work at the state or local education agency, vocational rehabilitation agency, Centers for Independent Living, or other entities.
- Are employed by your agency or by partnering contractors and subgrantees involved in your project whose salaries are or are not paid with project funds.

Refer to the "Definitions" tab if you have questions about the data elements requested.

Privacy Statement

The personally identifiable information (PII) requested on this form is collected as authorized by Consolidated Appropriations Act, 2022, P.L. 117-103 Rehabilitation Services, March 15, 2022. The researchers conducting this study follow the confidentiality and data protection requirements, as required by law. All your responses will be kept private and used only for research purposes. Your responses will be combined with the responses of other respondents and no individual names will be reported. While there are no direct benefits to participants and participation is voluntary, your participation will help us learn how states can better provide services to youth with disabilities. While your information will not be disclosed outside of the Department, there may be circumstances where information may be shared with a third party, such as a Freedom of Information Act request, court orders or subpoena, or if a breach or security incident affects the data management system.

Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1820-NEW. Public reporting burden for this collection of information is estimated to average 3 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is voluntary. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this individual collection, or if you have comments or concerns regarding the status of your individual form, application, or survey, please contact Diandrea Bailey, PhD, U.S. Department of Education, Office of Special Education and Rehabilitative Services, Rehabilitation Services Administration, 400 Maryland Avenue SW, Washington, DC 20202 directly.

Questions?

Please contact the Mathematica study team at XXX-XXX-XXXX or [email protected].

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Sheet 2: Definitions

Pathways to Partnerships Project Staff Roster
Data element	Definition and purpose
Staff name	Report the name of each individual involved in overseeing, planning, developing, or implementing services or training for youth, parents, or youth service professionals under the Pathways to Partnerships project as of the reporting date. These might include staff of your agency as well as staff of partnering contractors and subgrantees whose salaries are or are not paid using Pathways to Partnerships grant funds. Include one row per staff member. The purpose of collecting this information is to be able contact staff involved in your state's Pathways to Parnterships project for surveys in project years 2 and 4.
Job title	Report the job title of the staff. If they have multiple job titles, include the title relevant to the Pathways to Partnerships project. If they have multiple titles relevant to the Pathways to Partnerships project, include them all.
Organization/employer	Report the name of the employer. The purpose of collecting this information is to understand whether staff delivering services are employed by state or local education agencies, a vocational rehabilitation agency, Centers for Independent Living, or other entity.
Staff email	Report the best email address for the staff. The purpose of collecting this information is to be able contact staff for surveys in projects year 2 and 4.
Staff phone number	Report the best phone number for the staff. The purpose of collecting this information is to be able contact staff for surveys in projects year 2 and 4.
Staff service location	Report the city where the staff member works or provides services to youth, parents, or youth service professionals. If the staff member provides services statewide, please put "statewide." The purpose of collecting this information is to be able to select staff in multiple service areas to complete a survey in projects year 2 and 4.

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Sheet 3: Data requested

Pathways to Partnerships Project Staff Roster
Staff name	Job title	Organization/employer	Staff email	Staff phone number	Staff service location (city, state or statewide)