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Program Operations Survey FaMLE
ICR 202608-0970-008 · OMB 0970-0566 · Object 171900500.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Program Operations Survey FaMLE |
| Subject | TEMPLATE |
| Author | MATHEMATICA |
| Last Modified By | Writer |
| File Modified | 2026-08-21 |
| File Created | 2026-08-22 |
| Conversion State | complete |
Extracted Text
OMB No.: 0970-0566
Expiration Date: 07/31/2029
Program Operations Survey
Healthy Marriage and Responsible Fatherhood Programs
Thank you for helping with this important study. This survey includes questions about your Healthy Marriage or Responsible Fatherhood Program. We want you to know that:
1. Your participation in this survey is voluntary.
2. We hope that you will answer all the questions, but you may skip any questions you do not wish to answer.
3. The answers you give will be kept private to the extent permitted by law
A. Mass Marketing, Outreach, and Recruitment
A1. Which three types of advertising did your Healthy Marriage (HM) or Responsible Fatherhood (RF) grant program most frequently use in the current reporting period (whether purchased, earned, donated, or conducted)?
SELECT Three only
1 □ Newspaper ads or publicity
2 □ TV spots
3 □ Billboards, including those on public transportation or at bus stops (that is, bench ads)
4 □ Radio ads or announcements
5 □ Internet ads
6 □ Social media
7 □ Flyers
8 □ Presentations to external organizations
9 □ Word-of-mouth campaign/outreach by program graduates
10 □ Other
A2. Which three recruitment methods did your program most frequently use in the current reporting period?
SELECT three only
1 □ Phone, mail, or email
2 □ Social media
3 □ Street outreach (recruiting people in person in their neighborhoods or places they frequent)
4 □ Referrals from inside your organization
5 □ Referrals from external organizations
6 □ On-site recruitment at external agencies or events
7 □ Other
A3. Which five types of organizations or other sources provided the most referrals to your program in the current reporting period?
SELECT five only
Health, education, employment, and faith-based
1 □ Hospitals, maternity clinics, or doctors’ offices
2 □ Schools
3 □ Head Start
4 □ Healthy Start
5 □ Employment assistance centers or one-stops
6 □ Community support agencies or community centers
7 □ Places of worship
Child support and public assistance
8 □ Child support agencies (voluntary enrollment)
9 □ Child support agencies (court ordered to enroll in a program like this)
10 □ Temporary Assistance for Needy Families (TANF) offices
11 □ Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies
Child welfare
12 □ Child protective services (voluntary enrollment)
13 □ Child protective services (court ordered to enroll in a program like this)
14 □ Other child welfare agencies (voluntary enrollment)
15 □ Other child welfare agencies (court ordered to enroll in a program like this)
Criminal justice
16 □ Probation and parole
17 □ Correctional facilities
Other
18 □ Self-referrals
19 □ Other
NA The program did not receive referrals in the current reporting period
A4. In the table, please report the number of individuals who (1) worked in a staff position for your grant program on the first day of the current reporting period, (2) began working in a staff position for your grant program (such as new hires and promotions) during the current reporting period, and (3) ended their work in a staff position for your grant program (such as through promotions or leaving the organization) during the current reporting period.
Notes:
• Please include all staff who are funded in whole or in part by this grant, including those at partner sites.
• Full time = 35 or more hours per week; part time = fewer than 35 hours per week.
• If a person performs multiple roles for the grant, report them in each relevant position, even if the staff person works full time for the grant.
• If your program does not have one of the listed staff positions, if no staff currently fill that position, or if no staff were added to or left that position, enter 0 in the applicable column(s) in the table.
STAFF POSITION
(1) STAFF ON FIRST DAY OF REPORTING PERIOD
(2) STAFF ADDED TO THE POSITION DURING REPORTING PERIOD
(3) STAFF WHO LEFT THE POSITION DURING REPORTING PERIOD
(4) STAFF AT END OF REPORTING PERIOD
(COLUMNS 1+2-3)
FULL TIME
PART TIME
FULL TIME
PART TIME
FULL TIME
PART TIME
FULL TIME
PART TIME
a. Project director
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b. Project manager
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c. Facilitators
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d. Case managers
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e. Employment specialists
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f. Recruitment specialists
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g. Data managers
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h. Other staff
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i. Total
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A5. [If A4f Column 1 (FT+PT) + Column 2 (FT+PT) = 0, no recruitment specialists during the reporting period]
How many of your program’s staff conducted recruitment as part of their job responsibilities during the current reporting period?
| | | | STAFF
B. QUALITY ASSURANCE AND MONITORING
B1. In the current reporting period, how many staff received initial training on the program curriculum(a)?
| | | | STAFF
B2. In the current reporting period, how many staff received follow-up or refresher training on the program curriculum(a)?
| | | | STAFF
B3. In the current reporting period, how many staff received training other than on the program curriculum(a)?
| | | | STAFF
B4. For the two types of facilitators shown below, how many were observed by a supervisor or another experienced facilitator in the reporting period?
TOTALS
a. Facilitators hired in this reporting period
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b. Experienced facilitators
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B5. In the current reporting period, on average, how often did the following staff meet with their supervisors one-on-one?
MARK ONE RESPONSE PER ROW
STAFF POSITION
TWO OR MORE TIMES PER MONTH
ONCE A MONTH OR LESS
NOT IN REPORTING PERIOD
a. Project manager
1
2
3
b. Facilitators
1
2
3
c. Case managers
1
2
3
d. Employment specialists
1
2
3
e. Recruitment specialists
1
2
3
f. Data managers
1
2
3
g. Other staff
1
2
3
B6. In the current reporting period, on average, how often were meetings held that focused on continuous quality improvement?
select ONE ONLY
1 Two or more times per month
2 Once a month or less
3 Not in reporting period
C. IMPLEMENTATION CHALLENGES
C1. Please indicate if each of the following has been a challenge in the current reporting period.
YES
NO
Client recruitment and participation
a. Obtaining referrals from external organizations
1
2
b. Recruiting clients
1
2
c. Enrolling the intended population
1
2
d. Getting clients to start participating in services
1
2
e. Keeping clients engaged during sessions
1
2
f. Getting clients to complete the program
1
2
Staffing
g. Hiring qualified staff
1
2
h. Maintaining staff performance
1
2
i. Retaining staff
1
2
Services
j. Covering all program content in the time allotted
1
2
k. Implementing curriculum with fidelity
1
2
l. Working with service delivery partners
1
2
m. Providing case management services
1
2
Data collection and reporting
n. Getting clients to complete entrance or exit surveys
1
2
o. Entering and reporting data
1
2
Other
p. Having adequate program facilities
1
2
q. Experiencing extreme weather or natural disasters
1
2
Thank you for completing this survey!