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Program Indicators SF-PPR-B
ICR 202610-0970-005 · OMB 0970-0599 · Object 174272500.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Program Indicators SF-PPR-B |
| Author | USER |
| Last Modified By | Writer |
| File Modified | 2026-02-20 |
| File Created | 2026-10-29 |
| Conversion State | complete |
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ACF Office of Refugee Resettlement: Services for Survivors of Torture
Program Data Points Form
Agency: Administration for Children and Families (ACF)/Office of Refugee Resettlement (ORR)
Form: Survivors of Torture – Program Data Points (SOT-PDP)
Grantee Name:
Grant Number:
Point of Contact:
Reporting Period
From:
MM/DD/YYYY
To:
MM/DD/YYYY
Reporting: Submit annual program data with the second semi-annual report each year of the project period. Please use the narrative report to explain or highlight key program indicators and illustrate changes in outcome indicators. See the Program Data Points User Guide for more information: https://healtorture.org/content/office-refugee-resettlement
PROGRAM INDICATORS1
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
01a
Active Caseload:
Client count during reporting period
New primary
New secondary
Continuing primary
Continuing secondary
TOTAL ACTIVE CLIENT COUNT
_____
_____
_____
_____
_____
Please double check your math when adding up all new and continuing clients in the line indicating the total active client count.
01b
Closed Caseload:
Client count during reporting period
New primary
New secondary
Continuing primary
Continuing secondary
TOTAL CLOSED CASE COUNT
_____
_____
_____
_____
_____
Please double check your math when adding up all new and continuing clients in the line indicating the total closed case count.
01c
Length of Service for Active Caseload
0 to 3 years
4 to 6 years
7 to 9 years
10 or more years
TOTAL COUNT
_____
_____
_____
_______
____
Please double check that the total count for this data point matches the total active caseload count in data point 01a.
02
Age when first subjected to torture
(Primary survivors only)
Under 5 years
5 – 17 years
18 – 44 years
45 – 64 years
65 years and over
TOTAL
_____
_____
_____
_____
_____
_____
Add the number of new primary and continuing primary clients from DP01a to get the total number of active primary survivors:
01a. New primary: ______ + 01a. Continuing primary: ______ = _______
The total number of active primary survivors should be less than or equal to the total ages reported to the left. If this is not the case, please check your entries for DP02.
Total number of active primary survivors = ______
Total reported for DP02 = ______
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
03
Type of torture suffered
(Primary survivors only)
Asphyxiation
Beating
Burning
Deprivation
Electrical
Forced postures
Sex-based violence
Kidnapping and disappearances
Rape and sexual torture
Sensory stress
Severe humiliation
Threats and psychological torture
Witnessing torture of others
Wounding/maiming
Other:
Please specify_________________
TOTAL
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
Compare the total number of active primary survivors to the total number of types of torture reported to the left:
Total active primary survivors = ______
Total types of torture from DP03 = ______
The total number of types of torture from DP03 can be less than, equal to, or greater than to the total number of active primary survivors. If this is not the case, please go back and check your entries for DP03.
04
Reason for torture
(Primary survivors only)
Breakdown of authority/terror by non- state actors
Ethnicity
Nationality
Religion
Social group
Clan/Tribe
Sex
Other Social group
Sociopolitical activism
Other:
Please specify_________________
TOTAL
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
____
Compare the total number of active primary survivors to the total number of reasons for torture reported to the left:
Total active primary survivors = ______
Total reasons for torture from DP04 = ______
The total number of reasons for torture from DP04 can less than, equal to or greater than or equal to the total number of active primary survivors. If this is not the case, please go back and check your entries for DP04.
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
05
Country where torture occurred
(Primary survivors only)
Country 1:
Country 2:
Country 3:
Country 4: …
Unknown
(Report all countries)
TOTAL
_____
_____
_____
_____
_____
_____
Compare the total number of active primary survivors to the total number of countries reported to the left:
Total active primary survivors = ______
Total countries from DP05 = ______
The total number of countries from DP05 can be less than, equal to, or greater than or equal to the total number of active primary survivors.
06
Client goal(s) at intake
Behavioral
Housing
Interpersonal/Social
Legal
Occupational/Educational
Physical/Medical
TOTAL
_____
_____
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) from DP01a to the total number of goals reported to the left:
Total active clients from DP01a = ______
Total goals from DP06 = ______
The total number of goals from DP06 should be greater than or equal to the total number of active clients (primary and secondary). If this is not the case, please go back and check your entries for DP06.
07
Sex
Female
Male
TOTAL
_____
_____
_____
_____
The total from DP07 does not need to be equal to the total number of active clients.
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
08
Immigration category/status
at intake
Afghan Humanitarian Parolee
Asylee (include derivatives)
Asylum Applicant
Refugee (include derivatives)
Special Immigrant Juvenile (SIJ)
Special Immigrant Visa Holder (SIV)
Lawful Permanent Resident (LPR)
U.S. Citizen
Ukrainian Humanitarian Parolee
Other at intake:
Please specify___________________
TOTAL
_____
_____
_____
_____
_____
_____
_____
_____
_____
_____
____
____
__
Compare the total number of active clients (primary and secondary) from DP01a to the total number of categories/statuses reported to the left:
Total active clients from DP01a = ______
Total categories/statuses from DP08 = ______
The total number of categories/statuses from DP08 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP08.
09
Age at intake
Under 5 years
5 – 17 years
18 – 44 years
45 – 64 years
65 years and over
TOTAL
_____
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) served from DP01a to the total number of ages reported to the left:
Total active clients from DP01a = ______
Total ages from DP09 = ______
The total number of ages from DP09 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for D09.
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
10
Education prior to arrival
(For clients > 18 years of age at intake)
Less than 1 year
1-4 years
5-8 years
9-12 years
13-16 years
More than 16 years
TOTAL
_____
_____
_____
_____
_____
_____
____
Add the following age categories together from DP09:
18 – 44 years = ______
45 – 64 years = ______
65 years and over = ______
This gives you the total number of clients ≥ 18 years at intake = ______
Compare the total number of clients ≥ 18 years of age at intake to the total from DP10 to the left.
Total number of clients ≥ 18 years at intake = ______
Total education from DP10 = ______
The total reported in DP10 should be equal to or less than the total number of clients 18 years or older at intake. If this is not the case, please go back and check your entries for D10.
11
Employment in the U.S. at intake
(For clients > 18 years of age at intake)
Employed (PT/FT)
Unemployed and not seeking employment (e.g., students, elderly, disabled, and primary caregivers)
Unemployed and seeking employment
TOTAL
_____
_____
_____
_____
_____
Compare the total number of clients ≥ 18 years of age at intake calculated above to the total number of employment categories reported to the left:
Total clients ≥ 18 years of age at intake = ______
Total employment categories from DP11 = ______
The total number employment categories from DP11 should be equal to or less than the total number of clients ≥ 18 years of age at intake. If this is not the case, please go back and check your entries for DP11.
12
Length of time in the U.S. at intake
Less than one year
1-5 years
More than 5 years
Unknown
TOTAL
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) served from DP01a to the total number of categories reported to the left:
Total active clients from DP01a = ______
Total length of time in the U.S. at intake from DP12 = ______
The total number of categories from DP12 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP12.
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
13
Country of origin
Country 1:
Country 2:
Country 3:
Country 4: …
(Report all countries)
TOTAL
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) from DP01a to the total number of countries reported to the left:
Total active clients from DP01a = ______
Total countries from DP13 = ______
The total number of countries from DP13 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP13.
14
Ethnicity
Ethnicity 1:
Ethnicity 2:
Ethnicity 3:
Ethnicity 4: ….
Unknown
(Report all ethnicities)
TOTAL
_____
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) from DP01a to the total number of ethnicities reported to the left:
Total active clients from DP01a = ______
Total ethnicities from DP14 = ______
The total number of ethnicities from DP14 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP14.
15
Religion
Buddhism
Christianity
Hinduism
Islam
Judaism
None
Unknown
Other:
Please specify______________________
TOTAL
_____
_____
_____
_____
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) from DP01a to the total number of religions reported to the left:
Total active clients from DP01a = ______
Total religions from DP15 = ______
The total number of religions from DP15 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP15.
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
16
Languages used
Language 1:
Language 2:
Language 3:
Language 4: …
(Report all languages used)
TOTAL
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) from DP01a to the total number of languages reported to the left:
Total active clients from DP01a = ______
Total languages from DP16 = ______
The total number of languages from DP16 should be equal to the total number of active clients. If this is not the case, please go back and check your entries for DP16.
17
Clients served by service category
Behavioral
Housing
Interpersonal/Social
Legal
Occupational/Educational
Physical/Medical
TOTAL
_____
_____
_____
_____
_____
_____
_____
Compare the total number of active clients (primary and secondary) from DP01a to the total number of service categories reported to the left:
Total active clients from DP01a = ______
Total service categories from DP17 = ______
The total number of service categories from DP17 should be greater than or equal to the total number of active clients. If this is not the case, please go back and check your entries for DP17.
18
Professionals/community members trained under SOT
Community
Education
Interpretation/translation
Law Enforcement
Legal
Medical
Mental health
Social work
Other:
Please specify:___________________
_____
_____
_____
_____
_____
_____
_____
_____
_____
There are no data validation checks for this data point.
Data Point
Description
Indicators
No. of Clients Served
Data Validation Checks
19
Pro bono professional service hours donated to SOT program
Administrative, managerial, and other professional services
Accounting, development, and grant writing
Information technology and research
Interpretation/Translation
Legal
Medical services
Mental health services
Social services
Other:
Please specify:______________________
Number of hours
_____
_____
_____
_____
_____
_____
_____
_____
_____
There are no data validation checks for this data point.
OUTCOME INDICATORS2
• Indicate the tool from which you have derived the client-level data you are reporting here in the aggregate:
SOT-PWI-S Our Program Tool Case File Review Other: Please specify
• Complete all the boxes for each data point below to show aggregate changes in the level of need.
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
20.a
New Clients
Legal (Immigration)
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
20.b
Continuing Clients
Legal (Immigration)
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
21.a
New Clients
Housing
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
21.b
Continuing Clients
Housing
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
22.a
New Clients
Employment
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
22.b
Continuing Clients
Employment
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
23.a
New Clients
Physical
Health
S
T
A
R
T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
23.b
Continuing Clients
Physical
Health
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
24.a
New Clients
Mental
Health
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
24.b
Continuing Clients
Mental
Health
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
25.a
New Clients
Access to community resources
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
25.b
Continuing Clients
Access to community resources
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
Data Point
Description
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
26.a
New Clients
U.S.-Based
Support Systems
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
26.b
Continuing Clients
U.S.-Based
Support Systems
Level of Need
END
1
In Crisis
2
Vulnerable
3
Stable
4
Safe
S T A R T
1
In Crisis
N=
2
Vulnerable
N=
3
Stable
N=
4
Safe
N=
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
The purpose of this information collection is to collect demographic, programmatic, and outcome data in order to learn more about the population being served, the types of services they receive, and the effectiveness of those services. Public reporting burden for this collection of information is estimated to average 4.2 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Funding Announcement: HHS-2022-ACF-ORR-ZT-0051). This collection of information is required to retain a benefit (Torture Victims Relief Act of 1998, Pub. L. 105-320). If you have any comments on this collection of information, please contact the Administration for Children and Families, Office of Refugee Resettlement, Division of Refugee Health, 330 C Street, SW, 5th Floor, Washington, DC 20201 or email [email protected]. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number and expiration date for this collection are OMB #: 0970-0599`, Exp: XX/XX/XXXX.