2024 Version – Semi-Annual Quantitative Report OPTIONAL

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Overview

PRA statement
Instructions
Events
Outcomes

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Sheet 1: PRA statement

PAPERWORK REDUCTION ACT OF 1995 (Public Law 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF 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 3 hours per grant recipient, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. 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 0970-0628 and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact .

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Sheet 2: Instructions

Instructions

Events Tab

Use this form to report information about events your organization has held this for residents of communities supported by AHSSD funds.

Outcomes Tab

Use this form to report outcomes for this reporting period that you are tracking for residents of communities served by AHSSD funds. We have included example outcome metrics, but feel free to add other outcome measures that you are tracking. You can do so by inserting a new row in the relevant category underneath the example outcome measures. Please do not report outcomes derived from the self-sufficiency matrix for which you submit individual-level data to the evaluation team. The evaluation team will supply the aggregate totals for those outcomes for the report.

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Sheet 3: Events

Event Date (MM/DD/YYYY)

Length of Event (in hours and minutes)

Title of Event

Topic [Select all that apply: employment and training; childcare; youth supports; adult education and skills development; income and asset building; housing; health and nutrition; civic engagement and involvement; transportation; legal, tax, and immigration support; family relationships; other (please describe in "Other Notes" section)]

Description

# of Attendees

Is this event part of a series?

Other Notes

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Sheet 4: Outcomes

Employment Outcomes	# unduplicated achieving outcome	# unduplicated receiving services to support this outcome for whom the outcome was tracked	How was this measured?
The number of unemployed youth who increased skills to obtain employment.
The number of unemployed adults who increased skills to obtain employment.
The number of employed individuals who increased income from employment through a wage or salary amount.
The number of youth who obtained employment.
The number of adults who obtained employment.
Other (please specify)
Education and Youth Development Outcomes	# unduplicated achieving outcome	# unduplicated receiving services to support this outcome for whom the outcome was tracked	How was this measured?
The number of young children (0-5) with increased access to childcare or early childhood education services.
The number of youth with increased access to education and skills development programs.
The number of individuals who increased their education by obtaining a high school diploma and/or obtained an equivalency certificate or diploma.
The number of individuals who increased their education by obtaining a recognized credential, certificate, or degree relating to the achievement of educational or vocational skills.
The number of individuals who increased their education through enrollment in a post-secondary degree program (e.g., associates, bachelors, etc.)
The number of individuals who obtained a post-secondary degree.
Other (please specify)
Income and Asset Building Outcomes	# unduplicated achieving outcome	# unduplicated receiving services to support this outcome for whom the outcome was tracked	How was this measured?
The number of individuals completing income and asset building training.
The number of individuals who opened a savings account or IDA.
The number of individuals who purchased a home.
Other (please specify)
Housing Outcomes	# unduplicated achieving outcome	# unduplicated receiving services to support this outcome for whom the outcome was tracked	How was this measured?
The number of individuals experiencing homelessness who obtained safe temporary shelter.
The number of individuals with increased access to safe and affordable housing.
The number of individuals who avoided eviction.
The number of individuals who experienced improved health and safety due to improvements within their home (e.g. reduction or elimination of lead, radon, carbon monoxide and/or fire hazards or electrical issues, etc.).
The number of individuals with increased access to energy assistance or energy efficiency in their homes.
The number of individuals who obtained improved water safety in their homes.
Other (please specify)
Health and Nutrition Outcomes	# unduplicated achieving outcome	# unduplicated receiving services to support this outcome for whom the outcome was tracked	How was this measured?
The number of individuals served who then improved their health and wellbeing through preventative measures.
The number of individuals with increased access to health coverage.
The number of individuals whose health issue was treated by receiving health services.
The number of individuals whose reproductive health issue was treated.
The number of individuals with increased access to wellness services.
The number of older adults (age 65+) with increased access to home visiting services.
The number of individuals served who then improved their mental health, behavioral health and well-being.
The number of adults with increased access to preventative oral health services.
The number of children with increased access to preventative oral health services.
The number of individuals receiving access to healthy food options.
Other (please specify)
Civic Engagement and Community Involvement Outcomes	# unduplicated achieving outcome	# unduplicated receiving services to support this outcome for whom the outcome was tracked	How was this measured?
The number of individuals who increased skills, knowledge, and abilities to help improve conditions in their community.
Other (please specify)
Family and Relationship Outcomes	# unduplicated achieving outcome	# unduplicated receiving services to support this outcome for whom the outcome was tracked	How was this measured?
Number of individuals reporting increased nurturing and attachment between caregiver and child
Number of individuals reporting increased parenting knowledge
Number of individuals reporting improved conflict resolution skills
Number of individuals reporting increased caregiver/parental resilience
Number of individuals reporting increased social and emotional well-being of their children
Number of individuals reporting increased social connections
Other (please specify)