0920-1369 Att D2_ PerformMonitorFields

0920-1369 Att D2_ PerformMonitorFields.docx

[NCIPC] Performance Monitoring of CDC’s Core State Injury Prevention Program

0920-1369 Att D2_ PerformMonitorFields

OMB: 0920-1369

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Annual Performance Monitoring Fields

Core State Injury Prevention Program – CE21-2101


NCIPC Core SIPP Partners’ Portal – Annual Performance Monitoring Fields

Program-specific prepopulated fields in “Task Details” and “Overview” tabs.

Activity”

Activity Description”

Topic Area (checklist entry)

  • ACEs

  • Transportation Safety

  • TBI

  • Optional Flex Topic

  • All Topic Areas

If more than one topic area is selected above, please explain how you anticipate this activity will affect the multiple topics you selected (free text)

Alignment with Logic Model Activities (checklist entry)

Population(s) of Interest” (free text)

Short or intermediate outcome(s) that align with your indicator” (free text)

Indicator Name” (free text)

Is this indicator quantitative or qualitative” (radio button)

  • Quantitative

  • Qualitative

Are you still tracking this indicator” (radio button)

  • Yes

  • No

If no, please explain why you are no longer tracking this indicator (free text)

Indicator Description” (free text)

Type of Indicator” (dropdown menu)

  • Process

  • Short-term

  • Intermediate

Data Source” (free text)

Unit” (dropdown menu)

  • Count

  • Percent

  • Proportion

  • Rate

Values” (numeric entry)

Anticipated Directionality” (dropdown menu)

  • Increase

  • Decrease

  • Keep Stable

Notes” (free text)

Success Stories”

  • Suggested Title [free text]

  • The Problem: Describe the problem identified [free text]

  • The Narrative: How was Core SIPP funding used to address the problem? [free text]

  • Outcomes and Impact: What outcomes (short-, intermediate- or long-term) resulted from your actions? [free text]

  • Lessons Learned (optional): What lesson(s) was learned that can help others with similar problems in the future? [free text]

  • Check if any of the following are being submitted to complement your story. Please upload your additional documents in the Document upload tab. 

    • Press Release

    • Project Photos

    • Promotional Materials

    • Publication (e.g., news story, journal article)

    • Quote from Partner/Participant

    • Sample of Materials Produced

    • Testimonials

    • Video/Audio Clip

    • Website URL

    • Other: Explain [write-in option, 200-character max]

Assistance and Barriers”

  • Please include any technical assistance currently necessary to complete your Core SIPP activities”[free text]

  • Please add any barriers and/or challenges you have encountered” [free text]

Sub-Activity Name” (free text)

Sub-Activity Description” (free text)

Responsible Parties”

Frequency of Sub-Activity” (checklist)

  • Year 1

  • Year 2

  • Year 3

  • Year 4

  • Year 5

  • Annual

Status” (dropdown menu choices)

  • Not yet started - still planned, but not yet started 

  • New - added since initial work plan submitted 

  • Revised - revised since initial work plan submitted 

  • Initiated - current timeframe for completion unknown 

  • On track - on track to complete by due date 

  • Completed - completed on time 

  • Discontinued - no longer being addressed

Progress” (free text)



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMullins, Khiya J. (CDC/NCIPC/DIP)
File Modified0000-00-00
File Created2025-07-24

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