**GUIDEBOOK TO THE**

**RESPONSIBLE FATHERHOOD PROJECT PARTICIPANT MANAGEMENT**

**INFORMATION SYSTEM**

**\[RFMIS 2003\]**

*Prepared Under HHS Contract No. 100-96-0011 for:*

**The Department of Health and Human Services**

**The Office of the Assistant Secretary for Planning and Evaluation
and**

**The Office of Child Support Enforcement**

Project Officers: Linda Mellgren and David Arnaudo

*Prepared by:*

**THE LEWIN GROUP, INC.**

*Guidebook Authors:*

John Trutko, Capital Research Corporation

Burt S. Barnow, Johns Hopkins University

Erica Chan, The Lewin Group

**June 2003**

**INTRODUCTION**

The U.S. Department of Health and Human Services (DHHS) contracted with
The Lewin Group to develop a management information system to help eight
DHHS-sponsored Responsible Fatherhood Projects with tracking and
reporting on program participants. The system -- referred to as the
Responsible Fatherhood Management Information System (RFMIS) \-- was
developed also to be more widely applicable to other responsible
fatherhood (or parenting programs serving non-custodial parents) that
have emerged in recent years across the nation. From this Internet site
-- originally established in 1999 and revised in June 2003 -- interested
organizations and individuals can download an automated data system for
tracking individuals involved in local responsible fatherhood projects
and full documentation on how to install and use this system. *\[Note:
Organizations or individuals who previously downloaded and were using
the original RFMIS prior to January 2003 (when the revised RFMIS became
available) may contact John Trutko or Burt Barnow (see below for contact
information) for information on how to update the original RFMIS to this
revised version without losing records already entered into the system.
This new version of the RFMIS adds a follow-up survey that was not
available in the earlier system.\]*

This technical assistance project was originally designed to assist each
Responsible Fatherhood Project site with the development of data forms
and a working automated data system to track participant
characteristics, services received, outcomes, and costs. The RFMIS,
originally designed to operate using Microsoft Access 97, has been
updated to operate using Microsoft Access 2000. A follow-up survey has
also been added to the system, which enables users to collect follow-up
data on participants at a future time (i.e., six months or a year after
the individual enters the program) to facilitate analysis of project
outcomes. The revised RFMIS is designed so that users can -- if desired
-- use the programming capabilities within Access 2000 to tailor system
components to local program operations and adapt the system over time to
meet future program needs (i.e., it is possible for sites to add new
fields, change form views, and create new report formats).

The data system that is the focus of this manual was developed based on
an assessment of needs and capacities of local program sites involved in
the DHHS-sponsored demonstration effort. Among the data collection
activities involved in developing the system and this guidebook were the
following:

-   telephone and in-person interviews with DHHS' Administration on
    Children and Families (ACF) Responsible Fatherhood Projects located
    in eight states: Colorado, Massachusetts, New Hampshire, California,
    Wisconsin, Missouri, Maryland, and Washington;

-   telephone and in-person interviews with local and national
    evaluators of Responsible Fatherhood Projects;

-   two conferences that brought together representatives of Responsible
    Fatherhood Projects, local evaluators of Responsible Fatherhood
    Projects, the national evaluation contractors (Policy Studies, Inc.
    and the Center for Policy Research), the management information
    system contractor for the Responsible Fatherhood initiative (The
    Lewin Group), the management information system contractor for the
    Ford Foundation's Fragile Family Initiative (Metis Associates,
    Inc.), and representatives of the Department of Health and Human
    Services' Office of Child Support Enforcement (OCSE/DHHS) and the
    Office of the Assistant Secretary for Planning and Evaluation
    (ASPE/DHHS);

-   review of the management information system and forms developed for
    the Parents' Fair Share demonstration (including a site visit to a
    Parents' Fair Share project); and

-   review of existing materials and documents on tracking participant
    characteristics, participant outcomes, program services, and program
    costs in Responsible Fatherhood Projects.

We would particularly like to acknowledge the role of Policy Studies,
Inc. and the Center for Policy Research, which were instrumental in the
development of the forms and follow-up survey for the system. In
addition, Linda Mellgren and David Arnaudo (of DHHS) provided many
helpful suggestions and guidance on the development of the RFMIS.

The purpose of this guidebook is to provide written documentation on how
to complete the data forms and operate the RFMIS. Sections 1-3 of this
guidebook are primarily intended for program staff (e.g., intake and
case managers) responsible for interviewing participants and completing
forms. These sections include the following:

-   **SECTION 1: PARTICIPANT DATA FORMS.** This section provides copies
    of data forms for use in collecting data from responsible fatherhood
    participants.

-   **SECTION 2: EXAMPLE OF A COMPLETED SET OF PARTICIPANT DATA ENTRY
    FORMS.** This section provides an example of a completed set of data
    forms for a sample participant.

-   **SECTION 3: INSTRUCTIONS FOR COMPLETING PARTICIPANT DATA FORMS.**
    This section provides detailed instructions on how to complete data
    items on each of the data forms.

The next sections of the guidebook are aimed primarily at project staff
responsible for managing and operating the RFMIS. It includes
instructions on how to install the system, enter new data records, find
and edit existing data records, and generate reports. These sections
include the following:

-   **SECTION 4: GUIDE TO USING THE RESPONSIBLE FATHERHOOD MANAGEMENT
    INFORMATION SYSTEM.** The revised RFMIS was developed to operate on
    Microsoft Access 2000. This section provides an overview of how to
    get started using the data system. It provides step-by-step
    instructions for getting into and exiting the system, entering data,
    locating records, and backing up data files. Users may also want to
    refer to the Microsoft Access 2000 manual for more detailed
    instruction on how to operate the software (especially with respect
    to creating and generating new report formats).

-   **SECTION 5: SAMPLE DATA ENTRY SCREENS.** This section provides a
    set of completed sample data entry screens.

-   **SECTION 6: LIST OF RFMIS DATA FIELDS.** This section identifies
    the data field names for each data item on the RFMIS data forms.

-   **SECTION 7: GUIDE TO GENERATING SAMPLE REPORTS AND DESIGNING NEW
    REPORTS.** This section provides instructions for generating a
    series of sample reports on participant characteristics, services
    received, and outcomes. Microsoft Access 2000 has a highly flexible
    reporting capability that permits system users to develop their own
    reports and print out data on any data item in the data system. This
    section includes instructions on (a) how to print out pre-formatted
    reports, (b) some basic guidance on how to create new reports,
    and (c) examples of reports printed out using sample data.

If you should have questions concerning the data forms, system
installation, system design or system operations, please contact:

-   John Trutko (Consultant to the Lewin Group)

> Capital Research Corporation
>
> 1910 N. Stafford Street
>
> Arlington, VA 22207
>
> Telephone - (703) 522-6270
>
> FAX - (703) 522-0885
>
> E-mail - jtrutko@aol.com

-   Burt Barnow (Consultant to the Lewin Group)

> Institute for Policy Research

Johns Hopkins University

Wyman Building

> Baltimore, MD 21218
>
> Telephone - (410) 516-5388

FAX - (410) 516-8233

> E-mail - barnow@jhu.edu

**SECTION 1:**

**PARTICIPANT DATA FORMS**

**SECTION 2:**

**EXAMPLE OF A COMPLETED**

**SET OF PARTICIPANT DATA FORMS**

**SECTION 3:**

**INSTRUCTIONS FOR COMPLETING**

**PARTICIPANT DATA FORMS**

**SECTION 3:**

**INSTRUCTIONS FOR COMPLETING**

**PARTICIPANT DATA FORMS**

The revised RFMIS has been developed with six basic forms: (1) Form 1,
Intake Form; (2) Form 2, Assessment Form; (3) Form 3, Participant
Service Needs Form; (4) Form 4, Monthly Tracking Form; and (5) Form 5,
Change in Service Needs, Change of Address, and Case Closing Form, and
(6) a Follow-up Interview survey. The final of these six forms (the
Follow-up Interview) has been added to the original RFMIS. The sections
that follow describe the basic procedures to be used by project staff in
completing each participant form. See Section 2 (earlier) for examples
of completed participant forms.

**A. INSTRUCTIONS FOR COMPLETING FORM 1, INTAKE FORM**

The Intake Form should be completed by site intake staff or case
managers at the time of the initial intake interview with a prospective
participant. Prospective participants do [not]{.underline} need to
subsequently enroll in the program for the Intake Form to be completed.
This form may be completed either prior to the completion of Form 2
(Assessment Form) or at the same time. Specific instructions for
completing this form follow.

+-------------------------+--------------------------------------------+
| **QUESTION ON FORM 1**  | **INSTRUCTIONS FOR COMPLETING THE          |
|                         | QUESTION**                                 |
+=========================+============================================+
| A1. Name                | Enter participant's (i.e.,                 |
|                         | client/customer/individual) last name,     |
|                         | first name, and middle initial (e.g.,      |
|                         | Smith, John H.)                            |
+-------------------------+--------------------------------------------+
| A2. Address, City,      | Enter participant's street address (e.g.,  |
| State, Zip              | 123 Main Street, Apt. #5); city (e.g.,     |
|                         | Cleveland); appropriate 2-letter           |
|                         | abbreviation for the state (e.g., OH); and |
|                         | 5-digit zip code (e.g., 44107). If         |
|                         | participant is living with a               |
|                         | relative/friend, in a transitional housing |
|                         | facility, or in an emergency shelter at    |
|                         | the time of intake, use the address of the |
|                         | relative/friend or facility. If the        |
|                         | individual is living on the street, out of |
|                         | his/her car, or otherwise has no fixed     |
|                         | addressed, write in "no fixed address."    |
+-------------------------+--------------------------------------------+
| A3. Home Phone          | Enter participant's home telephone number  |
|                         | \[e.g., (216) 987-6543\]. Write in "None"  |
|                         | if the individual has no home phone.       |
+-------------------------+--------------------------------------------+
| A4. Work Phone          | Enter participant's work telephone number  |
|                         | \[e.g., (216) 987-1234\]. Write in "None"  |
|                         | if the individual has no work phone.       |
+-------------------------+--------------------------------------------+
| A5. Pager Number        | Enter participant's pager/cellular phone   |
|                         | number \[e.g., (216) 987-5433\]. Write in  |
|                         | "None" if the individual has no            |
|                         | pager/cellular phone.                      |
+-------------------------+--------------------------------------------+
| A6. E-Mail Address      | Enter participant's Internet E-mail        |
|                         | address (e.g., jsmith@mlbcleve.com). Write |
|                         | in "None" if the individual has no E-mail  |
|                         | address.                                   |
+-------------------------+--------------------------------------------+
| A7. Social Security     | Enter participant's 9-digit Social         |
| Number                  | Security Number (123-44-5678).             |
+-------------------------+--------------------------------------------+
| A8. Where did you hear  | Check the source or sources by which the   |
| about the program?      | participant heard about the program.       |
| **\[Check all that      |                                            |
| apply.\]**              |                                            |
+-------------------------+--------------------------------------------+
| A9. Are you required to | Check "Yes" or "No" to indicate if the     |
| attend this program?    | participant was required to attend the     |
|                         | program (e.g., as a condition for          |
|                         | continued receipt of welfare payments, to  |
|                         | avoid imprisonment, or to meet parole      |
|                         | requirements).                             |
+-------------------------+--------------------------------------------+
| A10. Date of Birth      | Enter the numeric month, day, and year the |
| (MM/DD/YY):             | participant was born (e.g., 05/27/67).     |
+-------------------------+--------------------------------------------+
| A11. Gender:            | Check the appropriate box indicating       |
|                         | participant's gender (i.e., male or        |
|                         | female).                                   |
+-------------------------+--------------------------------------------+
| A12. What is your       | Check the category that best describes the |
| current marital status? | participant's current legal marital        |
|                         | status.                                    |
+-------------------------+--------------------------------------------+
| A13. Do you consider    | Check the category that best describes the |
| yourself:               | participant's race/ethnicity. If no        |
|                         | category sufficiently describes the        |
|                         | participant's race/ethnicity, then check   |
|                         | "Other" and write in the other             |
|                         | race/ethnicity.                            |
+-------------------------+--------------------------------------------+
| A14. Are you currently  | Check "Yes" or "No" to indicate whether    |
| enrolled in school?     | the participant is currently enrolled in   |
|                         | high school, junior college/community      |
|                         | college, college/university, Adult Basic   |
|                         | Education (ABE) or General Equivalency     |
|                         | Diploma (GED) program.                     |
+-------------------------+--------------------------------------------+
| A15. What is the        | Enter the highest educational level that   |
| highest grade in school | the participant completed. If for example, |
| you have completed?     | the participant entered the ninth grade,   |
|                         | but did not finish the school year, then   |
|                         | "8" would be the correct response. Use 1   |
|                         | through 12 to indicate the highest grade   |
|                         | completed through high school graduation.  |
|                         | For participants who advance beyond high   |
|                         | school, enter the following:               |
|                         |                                            |
|                         | > 13 = Completed 1 year of                 |
|                         | > college/university or community college  |
|                         | >                                          |
|                         | > 14 = Completed 2 years of                |
|                         | > college/university or community college  |
|                         | >                                          |
|                         | > 15 = Completed 3 years of                |
|                         | > college/university                       |
|                         | >                                          |
|                         | > 16 = Completed 4 years of                |
|                         | > college/university                       |
|                         | >                                          |
|                         | > 18 = Completed a Master's, Doctoral      |
|                         | > (Ph.D.), or professional degree          |
+-------------------------+--------------------------------------------+
| A16. What is the        | Check the appropriate category to indicate |
| highest degree you have | the highest educational degree the         |
| earned?                 | participant has earned. GED stands for     |
|                         | General Equivalency Diploma; Technical/AA  |
|                         | degree stands for a technical degree,      |
|                         | certification, or 2-year associate degree  |
|                         | (for example through a community college). |
+-------------------------+--------------------------------------------+
| A17. In addition to     | Check all of the types of individuals who  |
| you, who do you         | normally live with the participant.        |
| normally live with?     | Someone "normally" living with the         |
| **\[Check all that      | participant would live (e.g., eat, sleep,  |
| apply.\]**              | etc.) in the same living quarters (e.g.,   |
|                         | house or apartment) at least half of the   |
|                         | days of a typical month. If the individual |
|                         | lives in a halfway house or emergency      |
|                         | shelter, check response item 10.           |
+-------------------------+--------------------------------------------+
| A18. Do you have any    | Check "Yes" or "No" to indicate whether    |
| children under the age  | the participant has any children (under    |
| of 18 who do            | the age of 18) who currently live (e.g.,   |
| [not]{.underline} live  | eat, sleep, etc.) with the participant at  |
| with you?               | least half of the days of a typical month. |
+-------------------------+--------------------------------------------+
| A19. Are you or is your | Check "Yes" or "No" to indicate whether    |
| girlfriend/partner      | the participant or the participant's       |
| pregnant?               | girlfriend/partner is currently pregnant.  |
+-------------------------+--------------------------------------------+
| A20. Do you think you   | Check all of the types of                  |
| might want help with    | services/assistance the participant        |
| any of the following?   | indicates he/she needs. \[Note: Form 3,    |
| **\[Check all that      | Service Plan, provides the case            |
| apply.\]**              | manager/counselor with an opportunity to   |
|                         | indicate his/her assessment of the         |
|                         | participant's service needs; this data     |
|                         | item on Form 1 should indicate the         |
|                         | participant's perception of service        |
|                         | needs.\]                                   |
+-------------------------+--------------------------------------------+
| **\*\*\*FOR OFFICE USE  | Project staff/counselor should indicated   |
| ONLY\*\*\***            | whether individual is appropriate for      |
|                         | enrollment in the responsible fatherhood   |
| A21. Is this person     | program. This would include determination  |
| appropriate for the     | of whether the individual is eligible for  |
| program?                | services (under site rules) and is in need |
|                         | of and would benefit from available        |
|                         | program services.                          |
+-------------------------+--------------------------------------------+
| A22. Project Staff:     | Enter the last name and first initial of   |
|                         | the project staff person (Johnson, K.) who |
|                         | completed the form. Alternatively, a staff |
|                         | person code number/name may be used by     |
|                         | sites in place of the staff person's name. |
+-------------------------+--------------------------------------------+
| A22. Date:              | Enter the numeric month, day, and year the |
|                         | form was completed (e.g., 06/25/99)        |
+-------------------------+--------------------------------------------+
| A23. Participant ID     | This data item should be left blank at the |
| Number:                 | time the form is completed by project      |
|                         | staff. The Participant ID Number will be   |
|                         | assigned automatically by the automated    |
|                         | management information system at the time  |
|                         | the form is initially entered into the     |
|                         | system. This number should be written onto |
|                         | the form by the data entry staff person    |
|                         | when the form has been entered into the    |
|                         | RFMIS. This number should be entered onto  |
|                         | subsequent forms as they are completed by  |
|                         | project staff (i.e., the Assessment Form,  |
|                         | the Participant Service Needs Form, and    |
|                         | the Monthly Tracking Form).                |
+-------------------------+--------------------------------------------+
| A24. Case Notes:        | Enter any case notes or narrative about    |
|                         | the participant, which might include       |
|                         | information relevant for determining       |
|                         | appropriateness for program participation, |
|                         | special family circumstances, information  |
|                         | helpful in determining services needed by  |
|                         | the individual, additional contact         |
|                         | information, etc. If additional room is    |
|                         | needed, notes can be continued on the back |
|                         | of the form.                               |
+-------------------------+--------------------------------------------+

**B. INSTRUCTIONS FOR COMPLETING FORM 2, ASSESSMENT FORM**

Form 2 (Assessment Form) is intended to capture background information
about the responsible fatherhood project participant, including contact
information, employment history, and potential barriers to employment
and effective parenting, as well as data on each of the participant's
children. Form 2 should be completed by a site case manager or
counselor. This form can be completed at the same time as Form 1 (the
Intake Form) during the intake interview or, more likely, over the span
of several interviews during the assessment process with the
participant. This form should only be completed on individuals who are
enrolled as program participants.

The first two pages of the form collect data on the participant, while
the last two pages of the form collect information on each child of the
participant. Note that Pages 3 and 4 of the Assessment Form should be
completed on each child \-- thus, if the participant has three children
(under the age of 18), the case manager would complete separate Pages 3
and 4 on each child. Also, note on Question D12 that if the particular
child is currently living with the participant, the case manager does
not complete Questions D13-D26.

Specific instructions for completing this form follow.

+-------------------------+--------------------------------------------+
| **QUESTION ON FORM 2**  | **INSTRUCTIONS FOR COMPLETING THE          |
|                         | QUESTION**                                 |
+=========================+============================================+
| Name                    | Enter participant's last name, first name, |
|                         | and middle initial (e.g., Smith, John H.). |
+-------------------------+--------------------------------------------+
| Participant ID Number   | Enter the unique Participant ID Number     |
|                         | assigned to the participant. \[Note: This  |
|                         | number will be assigned automatically by   |
|                         | the automated management information       |
|                         | system (MIS) when the form is entered into |
|                         | the RFMIS. The number that is generated by |
|                         | the RFMIS should be entered onto the form  |
|                         | at the time of data entry by project staff |
|                         | in data item "A23. Participant ID Number"  |
|                         | on Form 1.\]                               |
+-------------------------+--------------------------------------------+
| **A. CONTACTS**         |                                            |
+-------------------------+--------------------------------------------+
| A1. Name (of the First  | Enter the last name, first name, and       |
| Contact)                | middle initial of an individual (not       |
|                         | living with the participant) who will know |
|                         | how to contact the participant if the      |
|                         | program loses contact with the individual  |
|                         | (e.g., Smith, Beverly S.).                 |
+-------------------------+--------------------------------------------+
| A1. Address, City,      | Enter first contact person's street        |
| State, Zip              | address (e.g., 1367 Elm St., Apt. #3);     |
|                         | city (e.g., Cleveland Hts.); appropriate   |
|                         | 2-letter abbreviation for the state (e.g., |
|                         | OH); and 5-digit zip code (e.g., 44109).   |
+-------------------------+--------------------------------------------+
| A1. Home Phone          | Enter first contact person's home          |
|                         | telephone number \[e.g., (216) 444-3621\]. |
|                         | Write in "None" if the individual has no   |
|                         | home phone.                                |
+-------------------------+--------------------------------------------+
| A1. Work Phone          | Enter first contact person's work          |
|                         | telephone number \[e.g., (216) 436-4324\]. |
|                         | Write in "None" if the individual has no   |
|                         | work phone.                                |
+-------------------------+--------------------------------------------+
| A1. Pager Number        | Enter first contact person's               |
|                         | pager/cellular phone number \[e.g., (216)  |
|                         | 422-4136\]. Write in "None" if the         |
|                         | individual has no pager or cellular phone. |
+-------------------------+--------------------------------------------+
| A1. Relationship        | Enter first contact person's relationship  |
|                         | with the participant \[e.g., mother,       |
|                         | father, sister, brother, friend, relative, |
|                         | etc.\].                                    |
+-------------------------+--------------------------------------------+
| A2. Name (of the Second | Enter the last name, first name, and       |
| Contact)                | middle initial of a second individual (not |
|                         | living with the participant) who will know |
|                         | how to contact the participant if the      |
|                         | program loses contact with the individual  |
|                         | (Williamson, Ron D.).                      |
+-------------------------+--------------------------------------------+
| A2. Address, City,      | Enter second contact person's street       |
| State, Zip              | address (e.g., 4327 W. Euclid St.); city   |
|                         | (e.g., Cleveland); appropriate 2-letter    |
|                         | abbreviation for the state (e.g., OH); and |
|                         | 5-digit zip code (e.g., 44111).            |
+-------------------------+--------------------------------------------+
| A2. Home Phone          | Enter second contact person's home         |
|                         | telephone number \[e.g., (216) 432-5825\]. |
|                         | Write in "None" if the individual has no   |
|                         | home phone.                                |
+-------------------------+--------------------------------------------+
| A2. Work Phone          | Enter second contact person's work         |
|                         | telephone number \[e.g., (216) 232-4875\]. |
|                         | Write in "None" if the individual has no   |
|                         | work phone.                                |
+-------------------------+--------------------------------------------+
| A2. Pager Number        | Enter second contact person's              |
|                         | pager/cellular phone number \[e.g., (216)  |
|                         | 444-2893\]. Write in "None" if the         |
|                         | individual has no pager/cellular phone.    |
+-------------------------+--------------------------------------------+
| A2. Relationship        | Enter second contact person's relationship |
|                         | with the participant \[e.g., mother,       |
|                         | father, sister, brother, friend, relative, |
|                         | etc.\].                                    |
+-------------------------+--------------------------------------------+
| **B. EMPLOYMENT         |                                            |
| HISTORY**               |                                            |
+-------------------------+--------------------------------------------+
| B1.During the past 12   | Check any of the different types of        |
| months, did you         | program assistance or payments that an     |
| receive: **\[Check all  | individual had received during the         |
| that apply.\]**         | previous year.                             |
+-------------------------+--------------------------------------------+
| B2. Have you ever been  | If the participant has been employed       |
| employed?               | (including self-employment) in a           |
|                         | subsidized or unsubsidized job (i.e.,      |
|                         | worked for pay), check "Yes;" if the       |
|                         | participant has never been employed, check |
|                         | "No." If "No," then skip to Question C1.   |
+-------------------------+--------------------------------------------+
| B3. Have you ever been  | If the participant has ever been employed  |
| employed full-time?     | full-time (i.e., 30 or more hours per      |
|                         | week) in a subsidized or unsubsidized job  |
|                         | (i.e., worked for pay), check "Yes"; if    |
|                         | the participant has never been employed    |
|                         | full-time, check "No".                     |
+-------------------------+--------------------------------------------+
| B4. What is the longest | Enter the longest number of years and      |
| you ever worked for any | months that the participant worked for pay |
| one employer full-time? | full-time for any one employer (e.g., 2    |
|                         | years and 3 months). Note that months      |
|                         | should not exceed 11 (i.e., convert months |
|                         | in excess of 11 to years).                 |
+-------------------------+--------------------------------------------+
| B5. Which best          | Check the appropriate box indicating       |
| describes your          | employment status of participant over the  |
| employment in the past  | previous 12 months. Full-time employment   |
| 12 months?              | is defined as working for pay at a         |
|                         | subsidized or unsubsidized job for 30 or   |
|                         | more hours per week.                       |
+-------------------------+--------------------------------------------+
| B6. During the past 12  | Enter the number of months over the past   |
| months, about how many  | 12 months that the participant has worked  |
| months did you work     | for pay at a subsidized or unsubsidized    |
| full-time?              | job full-time (i.e., for 30 or more hours  |
|                         | per week). Round to the nearest month. Use |
|                         | "0" if the individual has not worked       |
|                         | full-time for an employer during the past  |
|                         | 12 month or worked full-time less than ½   |
|                         | month.                                     |
+-------------------------+--------------------------------------------+
| B7. Are you currently   | Check appropriate box indicating           |
| employed?               | participant's current employment status.   |
|                         | If "No," please indicate the month and     |
|                         | year that the participant left his/her     |
|                         | last job (e.g., 11/97) and skip to         |
|                         | Question B11.                              |
+-------------------------+--------------------------------------------+
| B8. Is this employment  | Check "Full-time" if the participant is    |
| full-time or part-time? | currently employed 30 or more hours per    |
|                         | week; check "Part-time" if the participant |
|                         | is currently employed less than 30 hours   |
|                         | per week.                                  |
+-------------------------+--------------------------------------------+
| B9. Is the job expected | Check "Yes" or "No" to indicate if the     |
| to end within the next  | participant's current job is expected to   |
| 6 months?               | end within next 6 months.                  |
+-------------------------+--------------------------------------------+
| B10. Do you have more   | Check "Yes" or "No" to indicate if the     |
| than one job?           | participant has more than one job.         |
+-------------------------+--------------------------------------------+
| B11. Are you currently  | Check "Yes" or "No" to indicate if the     |
| looking for another     | participant is currently searching for     |
| job?                    | another job (regardless of whether he/she  |
|                         | is or is not currently employed). Looking  |
|                         | for another job would include activities   |
|                         | such as regularly (at least weekly)        |
|                         | looking at job openings in newspapers, on  |
|                         | the Internet, or at a public/private       |
|                         | employment agency; submitting job          |
|                         | applications or resumes to employers; or   |
|                         | interviewing for job openings.             |
+-------------------------+--------------------------------------------+
| B12. When did you start | Enter numeric month and year (e.g., 04/99) |
| working for your        | when the participant started working for   |
| current/most recent     | his/her current or most recent employer.   |
| employer?               | If the participant has more than one job,  |
|                         | provide information on the primary job     |
|                         | (i.e., the job at which the individual     |
|                         | spends the most hours per week working).   |
+-------------------------+--------------------------------------------+
| B13. Are/were you       | Check "Yes" or "No" to indicate if the     |
| self-employed?          | participant is (or was) self-employed in   |
|                         | his/her current or most recent job.        |
+-------------------------+--------------------------------------------+
| B14. What kind of work  | Indicate the participant's occupation in   |
| do/did you do?          | his/her current or most recent job (e.g.,  |
|                         | machinist, nurse, cook).                   |
+-------------------------+--------------------------------------------+
| B15. How many hours     | Indicate the number of hours each week the |
| each week do/did you    | participant usually works (or worked) in   |
| usually work at this    | his/her current or most recent job. If     |
| job?                    | there is considerable week-to-week         |
|                         | fluctuation, average the number of hours   |
|                         | worked over the four preceding weeks.      |
+-------------------------+--------------------------------------------+
| B16. What is/was your   | Enter the participant's usual gross wages  |
| usual wage before       | (i.e., before taxes) in his/her current or |
| taxes/deductions?       | most recent job, then check the period for |
|                         | which the wages apply (e.g., \$8.50 per    |
| > \$\_\_\_\_\_\_\_\_    | hour; \$320 per two weeks).                |
| > per**:**              |                                            |
+-------------------------+--------------------------------------------+
| B17. How well does/did  | Enter participant's assessment of how well |
| this salary cover your  | the salary from the current or most recent |
| financial needs?        | job covers his/her financial needs.        |
+-------------------------+--------------------------------------------+
| B18. Does/did this job  | Check all of the types of fringe benefits  |
| provide you             | provided through the participant's current |
| with\...**\[Check all   | or most recent job. Medical coverage is    |
| that apply.\]**         | defined as health insurance that is made   |
|                         | available to the participant through the   |
|                         | employer and paid either in part or full   |
|                         | by the employer. If none of the three      |
|                         | types of benefits is/was provided, then    |
|                         | check "None of the above."                 |
+-------------------------+--------------------------------------------+
| **C.                    |                                            |
| EMPLOYMENT/PARENTING    |                                            |
| ISSUES**                |                                            |
+-------------------------+--------------------------------------------+
| C1. Do you have\...     | Check appropriate responses (Yes or No) to |
|                         | indicate whether the participant has: a    |
|                         | valid driver's license; a photo ID; a      |
|                         | Social Security Number; a birth            |
|                         | certificate; access to reliable            |
|                         | transportation; or a permanent place to    |
|                         | live. "Access to Reliable Transportation"  |
|                         | means that the participant has regular     |
|                         | access to a car, bus transportation, or    |
|                         | other transportation services (e.g., car   |
|                         | pool, agency operated van; transportation  |
|                         | tokens through a provider) to get to and   |
|                         | from work.                                 |
+-------------------------+--------------------------------------------+
| C2. Do the following    | Check appropriate responses (Yes or No) to |
| make it hard to find or | indicate whether any of the following      |
| keep a job\...          | problems make it hard for the participant  |
|                         | to find or keep a job: health problems or  |
|                         | disabilities; problems with alcohol/drugs; |
|                         | trouble reading or writing; problems       |
|                         | speaking English; lack of a green card; or |
|                         | lack of child care. A "green card" is only |
|                         | applicable to immigrants to the United     |
|                         | States (enabling immigrants to lawfully    |
|                         | work). If the participant has another type |
|                         | of barrier to finding or keeping a job     |
|                         | check "Yes" on Item 7 ("Other") and write  |
|                         | in the "other" factor on the space         |
|                         | provided.                                  |
+-------------------------+--------------------------------------------+
| C3. Have you ever       | Check appropriate responses (Yes or No) to |
| been\...                | indicate whether the participant has ever  |
|                         | been: convicted of a misdemeanor;          |
|                         | convicted of a felony; convicted of a      |
|                         | violent crime; convicted of spousal or     |
|                         | child abuse; or involved in an             |
|                         | alcohol/drug abuse treatment program; or   |
|                         | arrested for driving under the influence   |
|                         | (DUI) or driving while intoxicated (DWI).  |
+-------------------------+--------------------------------------------+
| C4. Have you ever been  | Check appropriate response (Yes or No) to  |
| incarcerated in prison  | indicate whether participant has been      |
| or jail for committing  | incarcerated in prison or jail for a       |
| a non-child support     | non-child support related offense. If he   |
| related offense?        | or she has been in prison or jail,         |
|                         | indicated the most recent month, day, and  |
|                         | year of release (e.g., 02/20/99).          |
+-------------------------+--------------------------------------------+
| C5. Are you currently   | Check appropriate response (Yes or No) to  |
| on\...                  | indicate whether the participant is        |
|                         | currently on probation or parole.          |
+-------------------------+--------------------------------------------+
| C6. Do you have any     | Check appropriate response (Yes or No) to  |
| current charges         | indicate whether the participant has any   |
| pending?                | current criminal charges pending. If the   |
|                         | individual has criminal charges pending,   |
|                         | indicate the type of charges pending       |
|                         | (e.g., burglary).                          |
+-------------------------+--------------------------------------------+
| C7. During the past six | Check appropriate response (Yes or No) to  |
| months, have you at any | indicate whether the participant has been  |
| time been homeless or   | homeless or lived in an emergency shelter  |
| lived in an emergency   | during the six month period prior to       |
| shelter?                | intake.                                    |
+-------------------------+--------------------------------------------+
| C8. During the past six | Check appropriate response (Yes or No) to  |
| months, have you at any | indicate whether the participant has lived |
| time lived in a halfway | in a halfway house during the six-month    |
| house?                  | period prior to intake..                   |
+-------------------------+--------------------------------------------+
| C9. How many people     | Identify the number of people (including   |
| normally live in your   | the participant) who normally live with    |
| household?              | the participant. Someone normally living |
|                         | in the same household would live (e.g.,    |
|                         | eat, sleep, etc.) in the same living       |
|                         | quarters (e.g., house or apartment) at     |
|                         | least half of the days of a typical month. |
|                         | Enter 1 if the individual lives alone or   |
|                         | by themselves in a homeless shelter,       |
|                         | halfway house, or other group living       |
|                         | arrangement.                               |
+-------------------------+--------------------------------------------+
| C10. How many children  | Identify the total number of children      |
| under age 18 do you     | (under age 18) the participant has at the  |
| have?                   | time of enrollment in the program.         |
+-------------------------+--------------------------------------------+
| C11. With how many      | Identify the total number of women/men     |
| different women/men     | with which the participant has had these   |
| have you had these      | children.                                  |
| children?               |                                            |
+-------------------------+--------------------------------------------+
| C12. How many of these  | Identify the total number of children that |
| children live with you  | live with the participant most of the      |
| most of the time?       | time. A child living in the same household |
|                         | most of the time would live (e.g., eat,    |
|                         | sleep, etc.) in the same living quarters   |
|                         | (e.g., house or apartment) at least half   |
|                         | of the days of a typical month.            |
+-------------------------+--------------------------------------------+
| C13. Do you have an     | Check the appropriate response (Yes or     |
| order through the court | No). If the participant has an order       |
| or the child support    | through the court or the child support     |
| agency that says you    | agency that says he/she is supposed to pay |
| are supposed to pay     | child support for some or all of his/her   |
| child support for some  | children, indicate the number of child     |
| or all of your          | support orders covering the children. If   |
| children?               | the response is "No," skip to Question     |
|                         | C17. The most reliable source of data      |
|                         | should be used to answer this question     |
|                         | (i.e., if possible, child support records  |
|                         | or other administrative data). Check the   |
|                         | box (below the question) if child support  |
|                         | or other administrative data are used to   |
|                         | verify data entered onto this form.        |
+-------------------------+--------------------------------------------+
| C14. How much are you   | At the time of enrollment in the program,  |
| supposed to pay each    | indicate the dollar amount the participant |
| month in child support? | is supposed to pay each month in child     |
|                         | support payments (e.g., \$350.40). If the  |
|                         | participant has more than one child        |
|                         | support order, add together amounts across |
|                         | all orders. The first column on the table  |
|                         | should be used to record the participant's |
|                         | understanding of his/her monthly payment   |
|                         | amount; the second column should be used   |
|                         | to record the monthly payment amount       |
|                         | according to Child Support records. If     |
|                         | possible, record amounts for both columns. |
+-------------------------+--------------------------------------------+
| C15. During the past 6  | Indicate an estimate of the percentage of  |
| months, about what      | child support paid as a percentage of what |
| percentage of the child | the individual was supposed to pay across  |
| support you were        | all child support orders over the past six |
| supposed to pay, did    | months (e.g., 40%). The first column on    |
| you actually pay?       | the table should be used to record the     |
|                         | participant's understanding of his/her     |
|                         | percentage paid; the second column should  |
|                         | be used to record the percentage paid      |
|                         | according to Child Support records. If     |
|                         | possible, record amounts for both columns. |
+-------------------------+--------------------------------------------+
| C16. How much do you    | At the time of enrollment in the program,  |
| owe in back due child   | enter the total amount (\$6500.42) of      |
| support payments?       | child support the participant owes (i.e.,  |
|                         | his/her child support arrearage). The      |
|                         | first column on the table should be used   |
|                         | to record the participant's understanding  |
|                         | of his/her back due child support payment  |
|                         | amount; the second column should be used   |
|                         | to record the back due child support       |
|                         | payment amount according to Child Support  |
|                         | records. If possible, record amounts for   |
|                         | both columns.                              |
+-------------------------+--------------------------------------------+
| C17. During the past 6  | Check all of the types of additional types |
| months, have you        | of assistance/support the participant has  |
| provided any of these   | provided over the previous six months for  |
| types of support for    | children not living with the participant.  |
| children of yours who   | If some other type of assistance was       |
| do not live with you?   | provided not covered on the list, check    |
| **\[Check all that      | data item #7 ("Anything Else") and then    |
| apply.\]**              | write in the type of assistance. If no     |
|                         | additional types of informal assistance    |
|                         | were provided, check Item 8 ("None of the  |
|                         | above").                                   |
+-------------------------+--------------------------------------------+
| C18. Project Staff:     | Enter the last name and first initial of   |
|                         | the project staff person (Johnson, K.) who |
|                         | completed or assisted the participant with |
|                         | completion of the form. Alternatively, a   |
|                         | staff person code number/name may be used  |
|                         | by sites in place of the staff person's    |
|                         | name.                                      |
+-------------------------+--------------------------------------------+
| C18.                    | Enter the numeric month, day, and year     |
| Da                      | that the form was completed (e.g.,         |
| te:\_\_\_/\_\_\_/\_\_\_ | 09/24/99).                                 |
+-------------------------+--------------------------------------------+
| C19. Case Notes         | Enter any case notes or narrative about    |
|                         | the participant, which might include       |
|                         | information relevant for determining       |
|                         | appropriateness for program participation, |
|                         | special family circumstances, information  |
|                         | helpful in determining services needed by  |
|                         | the individual, additional contact         |
|                         | information, etc. If additional room is    |
|                         | needed, notes can be continued on the back |
|                         | of the form.                               |
+-------------------------+--------------------------------------------+
| **D. INFORMATION ABOUT  |                                            |
| EACH CHILD \[COMPLETE   |                                            |
| THIS FORM FOR           |                                            |
| [EACH]{.underline}      |                                            |
| CHILD \--This form is   |                                            |
| for Child \_\_\_ of     |                                            |
| \_\_\_.\]** Indicate in |                                            |
| space provided which    |                                            |
| child this form is      |                                            |
| being completed on of   |                                            |
| the total number of     |                                            |
| children (e.g., Child   |                                            |
| [1]{.underline} of      |                                            |
| [3]{.underline}, Child  |                                            |
| [2]{.underline} of      |                                            |
| [3]{.underline}, etc.). |                                            |
| **\*\*Note: Pages 3 and |                                            |
| 4 of the Assessment     |                                            |
| Form should be          |                                            |
| completed on each child |                                            |
| of the                  |                                            |
| participant.\*\***      |                                            |
+-------------------------+--------------------------------------------+
| D1. Child's Name        | Enter child's last name, first name, and   |
|                         | middle initial (e.g., Barnes, Gale M.).    |
+-------------------------+--------------------------------------------+
| D2. Child's Social      | Enter child's 9-digit Social Security      |
| Security Number         | Number (421-43-8777)                       |
+-------------------------+--------------------------------------------+
| D3. Name of Child's     | Enter the last name, first name, and       |
| Mother/Father           | middle initial of the other parent (e.g.,  |
|                         | Barnes, Jane M.)                           |
+-------------------------+--------------------------------------------+
| D4. Child's Date of     | Enter numeric month, day, and year of the  |
| Birth                   | child's birth (e.g., 11/23/89).            |
+-------------------------+--------------------------------------------+
| D5. Child's Gender      | Indicate the child's gender.               |
+-------------------------+--------------------------------------------+
| D6. Do you live with    | Check appropriate category to indicate how |
| this child's            | often the participant is living this the   |
| mother/father?          | other parent. Someone should be considered |
|                         | living "most of the time" in the same      |
|                         | household if they live (e.g., eat, sleep,  |
|                         | etc.) in the same living quarters (e.g.,   |
|                         | house or apartment) at least half of the   |
|                         | days of the month leading up to program    |
|                         | enrollment.                                |
+-------------------------+--------------------------------------------+
| D7. Are you, or were    | Check "Yes" or "No" to indicate if the     |
| you in the past, ever   | participant was previous married to the    |
| married to this child's | child's other parent.                      |
| mother/father?          |                                            |
+-------------------------+--------------------------------------------+
| D8. Has legal custody   | If legal custody for this child was        |
| for this child ever     | decided by the court, check "Yes." If      |
| been decided by the     | "Yes," proceed to the next question.       |
| court? **\[If no, Skip  | Otherwise, check "No" or "Don't Know," and |
| to Question D10\]**     | skip to Question D10.                      |
+-------------------------+--------------------------------------------+
| D9. If yes, what is the | If the answer to Question D8 was "Yes,"    |
| custody arrangement:    | then indicate the current custody          |
|                         | arrangement for the child. (Note: Check    |
|                         | only one response.)                        |
+-------------------------+--------------------------------------------+
| D10. Is your name on    | Check "Yes," "No," or "Don't Know" to      |
| the birth certificate   | indicate whether the participant is either |
| as the legal parent or  | named on the child's birth certificate or  |
| has paternity been      | has had paternity established for the      |
| established for this    | child. Check the box (below the question)  |
| child?                  | if child support or other administrative   |
|                         | data are used to verify data entered onto  |
|                         | this form.                                 |
+-------------------------+--------------------------------------------+
| D11. Is this child      | Check "Yes," "No," or "Don't Know" to      |
| covered by a child      | indicate whether the child is covered by a |
| support order?          | child support order.                       |
+-------------------------+--------------------------------------------+
| D12. With whom does the | Indicate with whom the child usually       |
| child usually live?     | lives. (Note: Check only one response.) A  |
|                         | child "usually" living in the same         |
|                         | household would live (e.g., eat, sleep,    |
|                         | etc.) in the same living quarters (e.g.,   |
|                         | house or apartment) at least half of the   |
|                         | days of a typical month.                   |
|                         |                                            |
|                         | If the child lives with the participant    |
|                         | (i.e., Item 1, With you, is checked), stop |
|                         | completing the form here and move on to    |
|                         | complete additional Pages 3 and 4 of Form  |
|                         | 2 on the participant's other children. If  |
|                         | the child does not live with the           |
|                         | participant, continue on to Question D13.  |
+-------------------------+--------------------------------------------+
| D13. Do you have a      | Check "Yes" or "No" to indicate whether    |
| court order saying you  | the participant has received a court order |
| can spend time with     | that allows him/her to spend time with the |
| this child?             | child.                                     |
+-------------------------+--------------------------------------------+
| D14. Has the court      | Check "Yes" or "No" to indicate whether    |
| placed any restrictions | the court has placed restrictions on the   |
| on your contact with    | participant's contact with the child. If   |
| this child?             | No, skip to Question D16.                  |
+-------------------------+--------------------------------------------+
| D15. If yes, what kind  | If participant responded "Yes" to the      |
| of restrictions?        | Question D14, check the appropriate        |
|                         | response to indicate the type of           |
|                         | restriction imposed on the participant's   |
|                         | contact with the child. (Note: Check only  |
|                         | one response.)                             |
+-------------------------+--------------------------------------------+
| D16. Do you have a      | Enter appropriate response ("Yes -         |
| temporary or permanent  | Temporary or ex-parte order;" "Yes -       |
| restraining order       | Permanent or ex-parte order;" or "No") to  |
| against the other       | indicate whether the participant has       |
| parent of this child?   | placed a temporary or permanent            |
|                         | restraining order against the other parent |
|                         | of this child.                             |
+-------------------------+--------------------------------------------+
| D17. Does the other     | Enter appropriate response ("Yes -         |
| parent of this child    | Temporary or ex-parte order;" "Yes -       |
| have a temporary or     | Permanent or ex-parte order;" or "No") to  |
| permanent restraining   | indicate whether this child's other parent |
| order against you?      | has placed a temporary or permanent        |
|                         | restraining order against the participant. |
+-------------------------+--------------------------------------------+
| D18. How many miles do  | Enter an estimate of the number of miles   |
| you live from this      | the participant lives from the child       |
| child?                  | (e.g., 40 miles).                          |
+-------------------------+--------------------------------------------+
| D19. How long has it    | Enter an estimate of the amount of time    |
| been since you last saw | (in months, weeks, and/or days) since the  |
| this child?             | participant last visited with the child    |
|                         | (e.g., 3 weeks; 2 days). Weeks should be   |
|                         | converted to months if in excess of 4      |
|                         | weeks and days converted to weeks if in    |
|                         | excess of 6 days.                          |
+-------------------------+--------------------------------------------+
| D20. During the past 12 | Check the response that best describes the |
| months, about how often | frequency with which the participant       |
| did you see this child? | visited this child over the past year: not |
|                         | at all; about once a year; several times a |
|                         | year; one to three times a month; about    |
|                         | once a week; or several times a week.      |
|                         | (Note: Check only one response.)           |
+-------------------------+--------------------------------------------+
| D21. Overall, how       | Indicate the participant's level of        |
| satisfied are you with  | satisfaction with the amount of time spent |
| the amount of time you  | with this child (i.e., very satisfied;     |
| spend with this child?  | somewhat satisfied; somewhat dissatisfied; |
|                         | or very dissatisfied).                     |
+-------------------------+--------------------------------------------+
| D22. During the past 12 | Indicate the participant's assessment of   |
| months, how much        | his or her influence over major decisions  |
| influence have you had  | in this child's life (i.e., a great deal,  |
| in making major         | some, or none).                            |
| decisions about such    |                                            |
| things as this child's  |                                            |
| education, religion,    |                                            |
| and health?             |                                            |
+-------------------------+--------------------------------------------+
| D23. Overall, how would | Indicate the participant's assessment of   |
| you describe your       | his or her relationship with this child's  |
| relationship with this  | other parent.                              |
| child's other parent?   |                                            |
+-------------------------+--------------------------------------------+
| D24. Do you think the   | Indicate the participant's assessment of   |
| other parent wants you  | whether he/her thinks the other parent     |
| to have a positive and  | want the participant to have a positive    |
| close relationship with | and close relationship with this child.    |
| this child?             |                                            |
+-------------------------+--------------------------------------------+
| D25. Over the past 12   | Indicate the participant's assessment the  |
| months, how much        | level of conflict with the other parent on |
| conflict have you and   | each item listed. Circle one response for  |
| the other parent had on | each item listed (i.e., circle 1 \[Great   |
| the following:          | Deal\], 2 \[Some\] or 3 \[None\]),         |
|                         | according to the participant's response).  |
+-------------------------+--------------------------------------------+
| D26. When you and the   | Indicate the participant's assessment on   |
| other parent of this    | each item of what happens when serious     |
| child have a serious    | disagreements arise. Indicated how often   |
| disagreement, how often | (i.e., circle 1 \[Often\], 2               |
| do you:                 | \[Occasionally\], or 3 \[Never\]) each     |
|                         | type of behavior occurs, according to the  |
|                         | participant's response.                    |
+-------------------------+--------------------------------------------+
| **Note: The form is now |                                            |
| complete on this        |                                            |
| particular child;       |                                            |
| complete additional     |                                            |
| Pages 3 and 4 of this   |                                            |
| form on each additional |                                            |
| child.**                |                                            |
+-------------------------+--------------------------------------------+

**C. INSTRUCTIONS FOR COMPLETING FORM 3, PARTCIPANT SERVICE NEEDS**

Form 3 (Participant Service Needs) is intended to capture the project
staff (or case manager's) assessment of the types of assistance or
services needed by the participant at the time of enrollment into the
program. Form 3 should be completed by the case manager at the end of
the assessment process and identify the specific services a participant
needs. Similar to Forms 1 and 2, this form should be completed on the
participant only once \-- and in the early stages of program involvement
(i.e., at the end of the assessment). It should be completed at the same
time as Form 2 or shortly after Form 2 is completed. If a problem such
as alcohol or drug use is identified later, the form can be updated to
reflect such a service need, though the form should reflect the service
needs of the participant at the time of enrollment into the program.

  ------------------------------------------------------------------------
  **QUESTION ON FORM 3**          **INSTRUCTIONS FOR COMPLETING THE
                                  QUESTION**
  ------------------------------- ----------------------------------------
  Participant Name                Enter participant's (i.e.,
                                  client/customer/individual) last name,
                                  first name, and middle initial (e.g.,
                                  Doe, Jr., John H.).

  Participant ID Number           Enter the Participant ID Number assigned
                                  to the participant. Enter the unique
                                  Participant ID Number assigned to the
                                  participant. \[Note: This number will be
                                  assigned automatically by the automated
                                  management information system (MIS) and
                                  should have been entered as one of the
                                  last data items on Form 1.\]

  **A. Education/Training/Job     
  Placement Needs**               

  A1. Primary Education/Basic     Check box if the participant needs
  Skills/pre-GED                  primary education, basic skills
                                  instruction, or pre-GED preparation.
                                  Primary education refers to education in
                                  grades 1-8 (i.e., before high school).
                                  Pre-GED (General Equivalency Diploma)
                                  preparation involves instruction to
                                  enhance basic reading or math skills
                                  (i.e., basic literacy) so that an
                                  individual can begin study for the GED
                                  test. Participants in need of primary
                                  education or pre-GED would typically
                                  have serious basic skills deficits
                                  (e.g., poor reading/math skills).

  A2. Secondary Education/GED     Check box if the participant is in need
  Preparation                     of secondary education or GED
                                  preparation. Secondary education refers
                                  to instruction in grades 9-12 (i.e.,
                                  before high school graduation). General
                                  Equivalency Diploma (GED) preparation
                                  involves instruction to enhancing basic
                                  reading or math skills so that an
                                  individual can pass the GED test.
                                  Participants in need of primary or
                                  secondary education or a GED would
                                  typically have some type of basic skills
                                  deficit (e.g., poor reading/math skills)
                                  and may lack a high school diploma.

  A3. Post-Secondary Education    Check box if the participant is in need
                                  of some form of post-secondary
                                  education. Post-secondary education
                                  refers to formal education after high
                                  school leading toward a post-secondary
                                  degree (e.g., an associate or B.A.) or
                                  certification, such as classroom
                                  training at a community college,
                                  college/university, or proprietary
                                  school.

  A4. English as a Second         Check box if the participant is in need
  Language (ESL)                  of English as a Second Language
                                  instruction. ESL refers to instruction
                                  in the English language for non-English
                                  speaking participants.

  A5. Job Club/Job Search         Check box if the participant is in need
                                  of and appropriate for job club or job
                                  search assistance to either secure a job
                                  or upgrade his/her current job. Job club
                                  is a group session in which participants
                                  gather regularly (e.g., daily, several
                                  times a week, or weekly) to help
                                  structure ongoing job search activity.
                                  Job search assistance refers to help
                                  with job leads or strategies to find a
                                  job provided by an agency counselor
                                  either on an individual basis or as part
                                  of a group workshop.

  A6. Job Referrals               Check box if the participant is in need
                                  of job leads to find a new job or move
                                  to a better job.

  A7.                             Check box if the participant is in need
  OJT/Apprenticeship/Subsidized   of and appropriate for placement in an
  Job                             on-the-job training (OJT) slot with an
                                  employer, an accredited apprenticeship
                                  program, or a subsidized job. OJT refers
                                  to on-the-job training, which is
                                  training provided by an employer as part
                                  of the job. Typically, a portion of the
                                  wage will be paid by the agency to the
                                  employer and the employer will provide
                                  the worker with formal or informal
                                  training to upgrade skills. A portion of
                                  the job training may be provided at the
                                  work site, while additional training may
                                  or may not be provided in a classroom
                                  setting. Apprenticeship is a rigorous
                                  training program (e.g., to become an
                                  electrician, plumber, welder, or other
                                  skilled tradesperson), which is
                                  certified by the state or U.S.
                                  Department of Labor. Typically,
                                  apprenticeship programs last for 2 to 4
                                  years; involve a combination of
                                  on-the-job training and classroom
                                  instruction; have a formal curriculum;
                                  and offer apprenticeship credentialing
                                  at the conclusion of training. A
                                  subsidized job refers to a job placement
                                  in which the employer receives a payment
                                  to cover all or part of the wages of the
                                  worker (e.g..,  of hourly wages, for up
                                  to 35 hours per month, for a six-month
                                  period). There may or may not be a
                                  commitment to hire after the subsidized
                                  work is concluded.

  A8. Job Skills                  Check box if the participant is in need
  Training/Vocational Education   of and appropriate for job skills
                                  training or vocational education. Job
                                  skills training or vocational education
                                  may be short or longer-term training
                                  provided in a classroom setting (e.g.,
                                  at a proprietary school, community
                                  college, or college/university) or
                                  on-the-job. Training is generally aimed
                                  at upgrading skills within a specific
                                  occupation and is applicable to a
                                  specific job. Training may or may not
                                  lead to certification or a degree.

  A9. Job Readiness/Life          Check box if the participant is in need
  Skills/Pre-Employment           of and appropriate for job readiness,
                                  life skills, or pre-employment
                                  assistance. Job readiness, life skills,
                                  and pre-employment services are often
                                  provided as part of a group workshop
                                  over several days, a week, or longer.
                                  Such sessions are designed to prepare
                                  participants to conduct effective job
                                  searches and for what can be expected
                                  once employed. For example, such
                                  workshops may provide help with
                                  effective job search strategies,
                                  completing a resume, how to interview,
                                  how to dress, anger management,
                                  budgeting, and a range of other
                                  instruction oriented to finding and
                                  keeping a job.

  A10. Job Retention Services     Check box if the participant is in need
                                  of job retention services. To receive
                                  such services a participant must already
                                  be employed. Job retention services are
                                  intended to help participants keep jobs.
                                  Such help might come through individual
                                  or group counseling, mentoring,
                                  mediation of conflicts with employers or
                                  co-workers, or other services aimed at
                                  reducing chances that participant will
                                  lose his/her job.

  A11. Other (specify):           Check box and write in any other type of
                                  education, training, or job placement
                                  service needed by the participant.

  **B. CHILD                      
  SUPPORT/PARENTING/VISITATION    
  NEEDS**                         

  B1. Help with Paternity         Check box if the participant is in need
  Establishment                   of help with establishing paternity for
                                  one or more of his/her children.

  B2. Help with Establishing a    Check box if the participant needs help
  Child Support Order             establishing a child support order for
                                  one or more children.

  B3. Help with Modifying a Child Check box if the participant needs help
  Support Order                   with modifying conditions or amounts to
                                  be paid under an existing child support
                                  order for one or more children.

  B4. Help with Child Support     Check box if the participant needs help
  Arrearage                       negotiating repayment of child support
                                  arrearage (e.g., temporary relief from
                                  repayment of past due amounts or a
                                  change in terms of regular repayment
                                  under a child support order for one or
                                  more children).

  B5. Help Establishing/Modifying Check box if the participant needs
  Visitation Order                assistance with establishing/modifying a
                                  visitation order for one or more
                                  children.

  B6. Help Establishing/Modifying Check box if the participant needs help
  Custody Order                   with establishing/modifying a custody
                                  order for one or more children.

  B7. Help Dealing with Child     Check box if the participant needs help
  Abuse or Neglect                coping with child abuse or neglect
                                  either by the participant, the other
                                  parent, or another household member.

  B8. Help Establishing a         Check box if the participant needs help
  Parenting Plan                  establishing a parenting plan, which
                                  identifies goals and effective
                                  strategies for parenting.

  B9. Help Getting to Visit       Check box if the participant needs help
  Children                        getting to visit his/her children, which
                                  may include establishing visitation
                                  arrangements, mediation, or other
                                  related services.

  B10. Mediation                  Check box if the participant needs help
                                  with mediation, which involves
                                  assistance with negotiating an agreement
                                  between the participant and the other
                                  parent of one or more children. Such
                                  mediation is generally intended to avoid
                                  court action.

  B11. Parenting Education        Check box if parent education is needed
                                  by the participant. Parenting education
                                  is generally conducted as part of group
                                  workshops (though may involve one-on-one
                                  counseling) and is designed around a
                                  curriculum. Instruction is intended to
                                  enhance parenting skills of
                                  participants.

  B12. Other (specify):           Check box and write in any other type of
                                  child support, parenting, or visitation
                                  service needed by the participant.

  **C. OTHER SERVICES**           

  C1. Peer Support                Check box if peer support is needed by
                                  the participant. Peer support involves
                                  group sessions or workshops (e.g., rap
                                  sessions) in which participants (usually
                                  with the help of a facilitator) discuss
                                  parenting, employment, and other issues.

  C2. Transportation Assistance   Check box if transportation assistance
                                  is needed by the participant.
                                  Transportation assistance may include
                                  bus tokens, reimbursement for gas or
                                  mileage, reimbursement for car repair,
                                  taxi fare, help with purchasing a car,
                                  or other types of assistance to help
                                  participants overcome transportation
                                  problems.

  C3. Child Care Assistance       Check box if the participant needs help
                                  with childcare for one or more children.
                                  This type of assistance includes help in
                                  finding a childcare provider, direct
                                  provision of childcare, and full/partial
                                  payment of childcare for a child of the
                                  participant.

  C4. Medical/Dental/Vision Exams Check box if the participant needs help
  and Treatment                   with overcoming a medical, dental, or
                                  vision problem(s) that is a barrier to
                                  employment or becoming a better parent.

  C5. Substance Abuse Treatment/  Check box if the participant is in need
  Counseling                      of alcohol or substance abuse treatment
                                  or counseling.

  C6. Mental Health               Check box if the participant needs
  Treatment/Counseling            counseling or treatment for a mental
                                  health problem that is a barrier to
                                  employment or becoming a better parent.

  C7. Vocational Rehabilitation   Check box if the participant needs
                                  vocational rehabilitation services. Such
                                  services are typically provided by a
                                  state rehabilitation agency or other
                                  contracted service provider to help a
                                  participant overcome an injury or other
                                  health problem in order to be able to
                                  work.

  C8. Services Related to Anger   Check box if the participant needs
  Management                      counseling or other types of assistance
                                  on how to control anger.

  C9. Service Related to Partner  Check box if the participant needs
  Abuse                           counseling or assistance related to
                                  partner abuse.

  C10. Housing                    Check box if the participant needs
  Placement/Assistance            assistance in securing emergency,
                                  transitional, or permanent housing or
                                  other types of housing assistance (e.g.,
                                  help with paying a security deposit,
                                  help avoiding eviction, help with
                                  housing repairs, help applying for
                                  public housing units or other types of
                                  subsidized housing, etc.).

  C11. Money Management/Budgeting Check box if the participant is in need
                                  of help with money management or
                                  budgeting. Such services may be provided
                                  as part of a workshop (e.g., parenting
                                  or job readiness workshop) or by
                                  individual counseling.

  C12. Other Legal Assistance     Check box if the participant is in need
                                  of legal assistance, other than related
                                  to child support, visitation, or
                                  custody.

  C13. Clothing/Work Equipment    Check box if the participant is in need
                                  of work clothing, tools, or other
                                  equipment.

  C14. Help Obtaining an ID Card  Check box if participant needs help with
                                  obtaining an ID card (e.g., Social
                                  Security Card, driver's license, or
                                  other form of valid identification).

  C15. Case Management            Check box if the participant needs
                                  ongoing case management. This would
                                  include ongoing counseling, help with
                                  planning/arranging services, and
                                  monitoring of participant progress.

  C16. Other Advocacy/Referral    Check box if participant needs other
  Service                         types of advocacy (besides legal
                                  services) or referral to other types of
                                  services not listed.

  C17. Other (specify):           Check box and write in any other type of
                                  support services needed by the
                                  participant.

  **D. POST-ASSESSMENT CASE       
  STATUS**                        

  D1. Were any of the services    Check "Yes," "No," or "Don't Know" any
  court-ordered, required as part of the services to be provided are
  of a child neglect or abuse     court-ordered, required as part of a
  case, or required as a          child neglect or abuse case, or required
  condition of parole or          as a condition of parole or probation.
  probation?                      

  D2. Enrollment Status:          Check appropriate box to indicated if
                                  the individual is enrolled as a
                                  participant in the responsible
                                  fatherhood program. If enrolled in the
                                  responsible fatherhood program, indicate
                                  the month, day, and year of enrollment
                                  (e.g., 09/23/99).

  D3. Project Staff:              Enter the last name and first initial of
                                  the project staff person (Johnson, K.)
                                  who completed or assisted the
                                  participant with completion of the form.
                                  Alternatively, a staff person code
                                  number/name may be used by sites in
                                  place of the staff person's name.

  D3. Date:                       Enter the numeric month, day, and year
                                  that the form was completed (09/24/99).

  D4. Case Notes:                 Enter any case notes or narrative about
                                  the participant, particularly relating
                                  to obstacles to employment or parenting,
                                  and planned service strategies.
  ------------------------------------------------------------------------

**D. INSTRUCTIONS FOR COMPLETING FORM 4, MONTHLY TRACKING FORM**

Form 4 (Monthly Tracking Form) is intended to capture the services that
each participant receives on a monthly basis from the time of enrollment
in the responsible fatherhood project through termination from the
program. This form should be completed by the case manager at the end of
each month on each program participant (up until and including the month
of termination from the program) to identify the types of services
actually received during the reporting month, employment status during
the month, outcomes/milestones achieved, and, if terminated during the
reporting month, case closing information. A Form 4 should be completed
on each participant for each month the individual is enrolled in the
program (e.g., if an individual was enrolled in the program 15 months,
there should be a total of 15 Form 4s on the individual).

Specific instructions for completing this form follow.

  -------------------------------------------------------------------------
  **QUESTION ON FORM 4**           **INSTRUCTIONS FOR COMPLETING THE
                                   QUESTION**
  -------------------------------- ----------------------------------------
  Participant Name:                Enter participant's last name, first
                                   name, and middle initial (e.g., Doe,
                                   Jr., John H.).

  Participant ID Number:           Enter the unique Participant ID Number
                                   assigned to the participant. \[Note:
                                   This number will be assigned
                                   automatically by the automated
                                   management information system (MIS) and
                                   should have been entered at the bottom
                                   of Form 1.\]

  A1. Reporting Period             Indicate the numeric month and year of
  (Month/Year):                    the reporting period (e.g., 11/99).

  A2. Check here if program did    Check the box if the program had no
  [not]{.underline} have contact   contact (e.g., in-person, by telephone)
  with participant during the      during the reporting period with the
  month:                           participant. If this box is checked it
                                   is still possible that a participant may
                                   have received services, attained one or
                                   more outcomes/milestones, experienced a
                                   change of address, etc.

  A3. Check here if individual did Check the box if the participant did
  [not]{.underline} participate in [not]{.underline} participate in any
  any activity during the month:   services/activity during the month. If
                                   this box is checked, no services should
                                   be checked in Sections B-D. It is
                                   possible, however, that other parts of
                                   the form could be completed, including
                                   information about employment status,
                                   outcomes/ milestones, address change, or
                                   case closing.

  **B. EDUCATION/TRAINING/JOB      
  PLACEMENT**                      

  **\*\*Check All Services         Place a check mark in the box next to
  Received During Month\*\***      each of the activities listed that the
                                   participant attended or received during
                                   the reporting month. The
                                   assistance/services could be provided by
                                   the grantee (using grant funds),
                                   provided under subcontract (using grant
                                   funds) by another agency, or provided
                                   under referral by another agency (using
                                   or not using grant funds).

  B1. Primary Education, Basic     Primary education refers to education in
  Skills, Pre-GED                  grades 1-8 (i.e., before high school);
                                   basic skills instruction and pre-GED
                                   involves instruction to enhance basic
                                   reading and math skills generally in
                                   anticipation of receiving other types of
                                   instruction or to enter GED preparation.

  B2. Secondary Education/GED      Secondary education refers to education
  Preparation                      in grades 9-12 (i.e., before high school
                                   graduation). General Equivalency Diploma
                                   (GED) preparation involves instruction
                                   to enhance basic reading and math skills
                                   so that an individual can pass the GED
                                   test.

  B3. Post-Secondary Education     Post-secondary education refers to
                                   formal education after high school
                                   leading toward a post-secondary degree
                                   (e.g., an associate or B.A.) or
                                   certification, such as classroom
                                   training at a community college,
                                   college/university, or proprietary
                                   school.

  B4. English as a Second Language ESL refers to instruction in the English
  (ESL)                            language for non-English speaking
                                   participants.

  B5. Job Club/Job Search          Job club is a group session in which
                                   participants gather regularly (i.e.,
                                   daily, several times a week, or weekly)
                                   to help structure ongoing job search
                                   activity. Job search assistance refers
                                   to help with job leads or strategies to
                                   find a job provided by an agency
                                   counselor either on an individual basis
                                   or as part of a group workshop.

  B6. Job Referrals                Job referrals typically involve
                                   counselor or case manager referrals to
                                   job openings.

  B7.                              OJT refers to on-the-job training, which
  OJT/Apprenticeship/Subsidized    is training provided by an employer as
  Work                             part of the job. Typically, a portion of
                                   the wage will be paid by the agency to
                                   the employer and the employer will
                                   provide the worker with formal or
                                   informal training to upgrade skills. A
                                   portion of the job training may be
                                   provided at the work site, while
                                   additional training may or may not be
                                   provided in a classroom setting.
                                   Apprenticeship is a rigorous training
                                   program (e.g., to become an electrician,
                                   plumber, welder, or other skilled
                                   tradesperson), which is certified by the
                                   state or U.S. Department of Labor.
                                   Typically, apprenticeship programs last
                                   for 2 to 4 years; involve a combination
                                   of on-the-job training and classroom
                                   instruction; have a formal curriculum;
                                   and offer apprenticeship credentialing
                                   at the conclusion of training. A
                                   subsidized job refers to a job placement
                                   in which the employer receives a payment
                                   to cover all or part of the wages of the
                                   worker (e.g..,  of hourly wages, for up
                                   to 35 hours per month, for a six-month
                                   period). There may or may not be a
                                   commitment to hire after the subsidized
                                   work is concluded.

  B8. Job Skills                   Job skills training or vocational
  Training/Vocational Education    education may be short or longer-term
                                   training provided in a classroom setting
                                   (e.g., at a proprietary school,
                                   community college, or
                                   college/university) or on-the-job.
                                   Training is generally aimed at upgrading
                                   skills within a specific occupation and
                                   is applicable to a specific job.
                                   Training may lead to certification or a
                                   degree.

  B9. Job Readiness/Life Skills    Job readiness, life skills, and
  Training/ Pre-Employment         pre-employment services are often
                                   provided as part of a group workshop
                                   over several days, a week, or longer.
                                   Such sessions are designed to prepare
                                   participants to conduct effective job
                                   searches and for what can be expected
                                   once employed. For example, such
                                   workshops may provide help with how to
                                   search for a job, how to complete a
                                   resume, how to interview, how to dress,
                                   anger management, budgeting, and a range
                                   of other instruction oriented to finding
                                   and keeping a job.

  B10. Job Retention Services      Job retention services involve a range
                                   of services to help keep participants in
                                   jobs once they have them, including
                                   mentoring on the job, help dealing with
                                   conflicts with other workers, and
                                   mentoring.

  B11. Other:                      This space is available to write in
                                   other types of education, employment, or
                                   training services in which the
                                   participant was involved during the
                                   reporting month (not covered elsewhere
                                   on the form).

  **C. CHILD                       
  SUPPORT/PARENTING/VISITATION**   

  **\*\*Check All Services         Place a check mark in the box next to
  Received During Month\*\***      each of the activities listed that the
                                   participant attended or received during
                                   the reporting month. The
                                   assistance/services could be provided by
                                   the grantee (using grant funds),
                                   provided under subcontract (using grant
                                   funds) by another agency, or provided
                                   under referral by another agency (using
                                   or not using grant funds).

  C1. Help with Paternity          Help with establishing paternity for one
  Establishment                    or more of the participant's children.

  C2. Help with Establishing a     Help establishing a child support order
  Child Support Order              for one or more of the participant's
                                   children.

  C3. Help with Modifying a Child  Help with modifying conditions or
  Support Order                    amounts to be paid under an existing
                                   child support order for one or more of
                                   the participant's children.

  C4. Help with Child Support      Help negotiating repayment of child
  Arrearage                        support arrearages (i.e., temporary
                                   relief from repayment of past due
                                   amounts or a change in terms of regular
                                   repayment under a child support order
                                   for one or more children).

  C5. Help Establishing/Modifying  Assistance with establishing/modifying a
  Visitation Order                 visitation order for one or more of the
                                   participant's children.

  C6. Help Establishing/Modifying  Help with establishing/modifying a
  Custody Order                    custody order for one or more of the
                                   participant's children.

  C7. Help Dealing with Child      Help with responding to problems of
  Abuse or Neglect                 child abuse or neglect for one or more
                                   of the participant's child.

  C8. Help Establishing a          Help with identifying goals and
  Parenting Plan                   effective strategies for parenting and
                                   incorporating them into an overall plan
                                   for parenting.

  C9. Help Getting to Visit        Help with gaining access to one or more
  Children                         children.

  C10. Mediation                   Assistance with negotiating an agreement
                                   between the participant and the other
                                   parent of one or more of the
                                   participant's children. Such mediation
                                   is generally intended to avoid court
                                   action.

  C11. Parenting Education         Group workshops (though may involve
                                   one-on-one counseling) usually designed
                                   around a curriculum and providing
                                   instruction to enhance parenting skills
                                   of participants. If such
                                   sessions/workshops have been attended
                                   during the month, indicate the number of
                                   days the participant attended the
                                   workshops during the reporting month.

  C12. Other:                      Write in any other type of child
                                   support, parenting, or visitation
                                   services received by the participant
                                   during the reporting period.

  **D. OTHER SERVICES**            

  **\*\*Check All Services         Place a check mark in the box next to
  Received During Month\*\***      each of the activities listed that the
                                   participant attended or received during
                                   the reporting month. The
                                   assistance/services could be provided by
                                   the grantee (using grant funds),
                                   provided under subcontract (using grant
                                   funds) by another agency, or provided
                                   under referral by another agency (using
                                   or not using grant funds).

  D1. Peer Support                 Sessions or workshops (usually involving
                                   other program participants) designed to
                                   discuss parenting, relationships,
                                   employment, and a range of other
                                   personal issues. If such
                                   sessions/workshops have been attended
                                   during the month, indicate the number of
                                   days the participant attended the
                                   workshops during the reporting month.

  D2. Transportation Assistance    Includes bus tokens, reimbursement for
                                   gas or mileage, reimbursement for car
                                   repair, taxi fare, help with purchasing
                                   a car, or other types of assistance to
                                   help participants overcome
                                   transportation problems.

  D3. Child Care Assistance        Includes help in finding a childcare
                                   provider, direct provision of childcare,
                                   and full/partial payment of childcare
                                   expenses for a child of the participant.

  D4. Medical/Dental/Vision Exams  Treatment or other assistance provided
  and Treatment                    to help participants with medical,
                                   dental, or vision problems.

  D5. Substance Abuse Treatment/   Treatment or counseling to overcome an
  Counseling                       alcohol or drug abuse problem, including
                                   inpatient or outpatient care.

  D6. Mental Health                Treatment or counseling for a mental
  Treatment/Counseling             health problem that is a barrier to
                                   employment or becoming a better parent.

  D7. Vocational Rehabilitation    Such services are typically provided by
                                   a state rehabilitation agency or other
                                   contracted service provider to help a
                                   participant overcome an injury or other
                                   health problem in order to be able to
                                   work.

  D8. Services Related to Anger    Counseling or other types of services to
  Management                       help the participant control anger.

  D9. Service Related to Partner   Counseling or other assistance related
  Abuse                            to eliminating partner abuse.

  D10. Housing                     Assistance in securing emergency,
  Placement/Assistance             transitional, or permanent housing and
                                   other types of housing assistance (e.g.,
                                   help with paying a security deposit,
                                   help avoiding eviction, help with
                                   housing repairs, or help applying for
                                   public housing units or other types of
                                   subsidized housing).

  D11. Money Management/Budgeting  Workshop sessions (e.g., parenting or
                                   job readiness workshop) or individual
                                   counseling to improve the participant's
                                   money management and budgeting skills.

  D12. Other Legal Assistance      Provision of legal assistance/services,
                                   other than related to child support,
                                   visitation, or custody.

  D13. Clothing/Work Equipment     Help with purchasing or provision of
                                   clothing, tools, or other equipment for
                                   the workplace.

  D14. Help Obtaining an ID Card   Help with obtaining an ID card (e.g.,
                                   Social Security Card, driver's license,
                                   or other form of valid identification).

  D15. Case Management             Counseling and other one-on-one
                                   assistance provided by project staff on
                                   an ongoing basis to help keep the
                                   participant on track, to help
                                   troubleshoot emerging problems, and to
                                   monitor progress. Typically, a
                                   participant would be assigned to a
                                   project staff person.

  D16. Other Advocacy/Referral     Help with other types of advocacy
  Services                         (besides legal services) or referral to
                                   other types of referral services not
                                   listed.

  D17. Other:                      Write in any other type of support
                                   services received by the participant
                                   during the reporting period (not covered
                                   above).

  **E. EMPLOYMENT STATUS**         

  E1. Was the participant employed Based on discussion with the
  at any time during the reporting participant, employer, or other reliable
  month?                           sources, indicate whether the
                                   participant was employed at any time
                                   during the reporting month.

  E2. What was participant's       Based on discussion with the
  employment status at the end of  participant, employer, or other reliable
  the reporting month (or at last  sources, indicate the participant's
  contact)?                        employment status as of the end of the
                                   reporting period or at the time when the
                                   participant was last contacted during
                                   the month.

  E3. On average (during the       If the participant worked, indicate in
  month), how many hours did the   the space provided the number of hours
  participant work per week?       (on average) per week he/she worked
  \_\_\_\_\_                       during the reporting period.

  E4. What was the hourly wage     Indicate in the space provided the gross
  before taxes/deductions?         hourly rate the participant was paid. If
  \$\_\_\_\_\_hour                 the rate changed during the month, use
                                   the last rate the individual was paid
                                   during the month. If the hourly rate is
                                   not available, it may be necessary to
                                   calculate the hourly rate based on
                                   annual, monthly, or weekly salary. For
                                   example, if the individual is paid an
                                   annual salary, find out how many hours
                                   the individual works per week and take
                                   these hours times 52; then divide the
                                   gross annual salary by the estimate of
                                   the number of hours worked per year.

  E5. What kind of work did        Indicate the participant's occupation in
  participant do?                  his/her job (e.g., machinist, nurse,
                                   cook).

  E6. Did the participant change   Indicate if the participant changed or
  or lose a job at any time during lost a job during the reporting period.
  the reporting period?            

  E7. If participant changed or    If the individual did change or lose a
  lost a job, why? **\[Check all   job, check the reason(s) for the job
  that apply.\]**                  change or loss.

  **F. OUTCOMES/MILESTONES**       

  F1. Did participant complete or  Based on discussions with the
  meet any of the following        participant, other project staff,
  outcomes/milestones during       project staff at other agencies, and
  month: **\[Check all that        other available records, please check
  apply.\]**                       all of the outcomes/milestones achieved
                                   by the participant during the reporting
                                   month.

  F2. Project Staff:               Enter the last name and first initial of
                                   the project staff person (Johnson, K.)
                                   who completed the form. Alternatively, a
                                   staff person code number/name may be
                                   used by sites in place of the staff
                                   person's name.

  F2. Date:                        Enter the numeric month, day, and year
                                   that the form was completed (09/24/99).

  F3. Case Notes                   Enter any case notes or narrative about
                                   the participant, particularly relating
                                   to receipt of services or
                                   outcomes/milestones achieved.
  -------------------------------------------------------------------------

Number range CHAPTER**E. INSTRUCTIONS FOR COMPLETING FORM 5, CHANGE IN
SERVICE NEEDS, CHANGE OF ADDRESS, AND CASE CLOSING FORM**

Form 5 (Change in Service Needs, Change of Address, and Case Closing
Form) is intended to capture changes in service needs and address of
participants and contact persons, as well as case closing information.
This form should be completed by the case manager on an as-needed basis
to record changes in the participant's service needs or address; or to
close the participant's case. It is anticipated that each participant
will have several change forms completed on them as they proceed through
the program. Specific instructions for completing this form follow.

+-----------------------------+----------------------------------------+
| **QUESTION ON FORM 5**      | **INSTRUCTIONS FOR COMPLETING THE      |
|                             | QUESTION**                             |
+=============================+========================================+
| Participant Name:           | Enter participant's last name, first   |
|                             | name, and middle initial (e.g., Doe,   |
|                             | Jr., John H.).                         |
+-----------------------------+----------------------------------------+
| Participant ID Number:      | Enter the unique Participant ID Number |
|                             | assigned to the participant. \[Note:   |
|                             | This number will be assigned           |
|                             | automatically by the automated         |
|                             | management information system (MIS)    |
|                             | and should have been entered at the    |
|                             | bottom of Form 1.\]                    |
+-----------------------------+----------------------------------------+
| Type of Action:             | Check the appropriate box or boxes to  |
|                             | indicate the type of change being      |
| >  1. Change in Service    | recorded on the form.                  |
| > Needs                     |                                        |
| >                           |                                        |
| >  2. Address Changes      |                                        |
| >                           |                                        |
| >  3. Case Closing         |                                        |
+-----------------------------+----------------------------------------+
| > **A.                      |                                        |
| > Education/Training/Job    |                                        |
| > Placement Needs:**        |                                        |
+-----------------------------+----------------------------------------+
| **CHANGE IN SERVICE NEEDS   | Place a "N" (New) as appropriate to    |
| (\*\*Note: Use "N" to       | indicate a new service need that has   |
| Indicate [New]{.underline}  | emerged for a participant or "D"       |
| Service Need and "D" to     | (Dropped) as appropriate to indicate a |
| Indicate                    | service (previously needed by the      |
| [Dropped]{.underline}       | participant) that is no longer needed  |
| Service Need)**             | by the participant.                    |
+-----------------------------+----------------------------------------+
| A1. Primary Education,      | Primary education refers to education  |
| Basic Skills, Pre-GED       | in grades 1-8 (i.e., before high       |
|                             | school); basic skills instruction and  |
|                             | pre-GED involves instruction to        |
|                             | enhance basic reading and math skills  |
|                             | generally in anticipation of receiving |
|                             | other types of instruction or to enter |
|                             | GED preparation.                       |
+-----------------------------+----------------------------------------+
| A2. Secondary Education/GED | Secondary education refers to          |
| Preparation                 | education in grades 9-12 (i.e., before |
|                             | high school graduation). General       |
|                             | Equivalency Diploma (GED) preparation  |
|                             | involves instruction to enhancing      |
|                             | basic reading and math skills so that  |
|                             | an individual can pass the GED test.   |
+-----------------------------+----------------------------------------+
| A3. Post-Secondary          | Post-secondary education refers to     |
| Education                   | formal education after high school     |
|                             | leading toward a post-secondary degree |
|                             | (e.g., an associate or B.A.) or        |
|                             | certification, such as classroom       |
|                             | training at a community college,       |
|                             | college/university, or proprietary     |
|                             | school.                                |
+-----------------------------+----------------------------------------+
| A4. English as a Second     | ESL refers to instruction in the       |
| Language (ESL)              | English language for non-English       |
|                             | speaking participants.                 |
+-----------------------------+----------------------------------------+
| A5. Job Club/Job Search     | Job club is a group session in which   |
|                             | participants gather regularly (i.e.,   |
|                             | daily, several times a week, or        |
|                             | weekly) to help structure ongoing job  |
|                             | search activity. Job search assistance |
|                             | refers to help with job leads or       |
|                             | strategies to find a job provided by   |
|                             | an agency counselor either on an       |
|                             | individual basis or as part of a group |
|                             | workshop.                              |
+-----------------------------+----------------------------------------+
| A6. Job Referrals           | Job referrals typically involve        |
|                             | counselor or case manager referrals to |
|                             | job openings.                          |
+-----------------------------+----------------------------------------+
| A7.                         | OJT refers to on-the-job training,     |
| OJ                          | which is training provided by an       |
| T/Apprenticeship/Subsidized | employer as part of the job.           |
| Work                        | Typically, a portion of the wage will  |
|                             | be paid by the agency to the employer  |
|                             | and the employer will provide the      |
|                             | worker with formal or informal         |
|                             | training to upgrade skills. A portion  |
|                             | of the job training may be provided at |
|                             | the work site, while additional        |
|                             | training may or may not be provided in |
|                             | a classroom setting. Apprenticeship is |
|                             | a rigorous training program (e.g., to  |
|                             | become an electrician, plumber,        |
|                             | welder, or other skilled               |
|                             | tradesperson), which is certified by   |
|                             | the state or U.S. Department of Labor. |
|                             | Typically, apprenticeship programs     |
|                             | last for 2 to 4 years; involve a       |
|                             | combination of on-the-job training and |
|                             | classroom instruction; have a formal   |
|                             | curriculum; and offer apprenticeship   |
|                             | credentialing at the conclusion of     |
|                             | training. A subsidized job refers to a |
|                             | job placement in which the employer    |
|                             | receives a payment to cover all or     |
|                             | part of the wages of the worker        |
|                             | (e.g.., ½ of hourly wages, for up to   |
|                             | 35 hours per month, for a six-month    |
|                             | period). There may or may not be a     |
|                             | commitment to hire after the           |
|                             | subsidized work is concluded.          |
+-----------------------------+----------------------------------------+
| A8. Job Skills              | Job skills training or vocational      |
| Training/Vocational         | education may be short or longer-term  |
| Education                   | training provided in a classroom       |
|                             | setting (e.g., at a proprietary        |
|                             | school, community college, or          |
|                             | college/university) or on-the-job.     |
|                             | Training is generally aimed at         |
|                             | upgrading skills within a specific     |
|                             | occupation and is applicable to a      |
|                             | specific job. Training may lead to     |
|                             | certification or a degree.             |
+-----------------------------+----------------------------------------+
| A9. Job Readiness/Life      | Job readiness, life skills, and        |
| Skills Training/            | pre-employment services are often      |
| Pre-Employment              | provided as part of a group workshop   |
|                             | over several days, a week, or longer.  |
|                             | Such sessions are designed to prepare  |
|                             | participants to conduct effective job  |
|                             | searches and for what can be expected  |
|                             | once employed. For example, such       |
|                             | workshops may provide help with how to |
|                             | search for a job, how to complete a    |
|                             | resume, how to interview, how to       |
|                             | dress, anger management, budgeting,    |
|                             | and a range of other instruction       |
|                             | oriented to finding and keeping a job. |
+-----------------------------+----------------------------------------+
| A10. Job Retention Services | Job retention services involve a range |
|                             | of services to help keep participants  |
|                             | in jobs once they have them, including |
|                             | mentoring on the job, help dealing     |
|                             | with conflicts with other workers, and |
|                             | mentoring.                             |
+-----------------------------+----------------------------------------+
| A11. Other:                 | This space is available to write in    |
|                             | other types of education, employment,  |
|                             | or training services in which the      |
|                             | participant was involved during the    |
|                             | reporting month (not covered elsewhere |
|                             | on the form).                          |
+-----------------------------+----------------------------------------+
| **B. Child                  |                                        |
| S                           |                                        |
| upport/Parenting/Visitation |                                        |
| Needs:**                    |                                        |
+-----------------------------+----------------------------------------+
| **CHANGE IN SERVICE NEEDS   | Place a "N" (New) as appropriate to    |
| (\*\*Note: Use "N" to       | indicate a new service need that has   |
| Indicate [New]{.underline}  | emerged for a participant or "D"       |
| Service Need and "D" to     | (Dropped) as appropriate to indicate a |
| Indicate                    | service (previously needed by the      |
| 1[Dropped]{.underline}      | participant) that is no longer needed  |
| Service Need)**             | by the participant.                    |
+-----------------------------+----------------------------------------+
| B1. Help with Paternity     | Help with establishing paternity for   |
| Establishment               | one or more of the participant's       |
|                             | children.                              |
+-----------------------------+----------------------------------------+
| B2. Help with Establishing  | Help establishing a child support      |
| a Child Support Order       | order for one or more of the           |
|                             | participant's children.                |
+-----------------------------+----------------------------------------+
| B3. Help with Modifying a   | Help with modifying conditions or      |
| Child Support Order         | amounts to be paid under an existing   |
|                             | child support order for one or more of |
|                             | the participant's children.            |
+-----------------------------+----------------------------------------+
| B4. Help with Child Support | Help negotiating repayment of child    |
| Arrearage                   | support arrearages (i.e., temporary    |
|                             | relief from repayment of past due      |
|                             | amounts or a change in terms of        |
|                             | regular repayment under a child        |
|                             | support order for one or more          |
|                             | children).                             |
+-----------------------------+----------------------------------------+
| B5. Help                    | Assistance with establishing/modifying |
| Establishing/Modifying      | a visitation order for one or more of  |
| Visitation Order            | the participant's children.            |
+-----------------------------+----------------------------------------+
| B6. Help                    | Help with establishing/modifying a     |
| Establishing/Modifying      | custody order for one or more of the   |
| Custody Order               | participant's children.                |
+-----------------------------+----------------------------------------+
| B7. Help Dealing with Child | Help with responding to problems of    |
| Abuse or Neglect            | child abuse or neglect for one or more |
|                             | of the participant's child.            |
+-----------------------------+----------------------------------------+
| B8. Help Establishing a     | Help with identifying goals and        |
| Parenting Plan              | effective strategies for parenting and |
|                             | incorporating them into an overall     |
|                             | plan for parenting.                    |
+-----------------------------+----------------------------------------+
| B9. Help Getting to Visit   | Help with gaining access to one or     |
| Children                    | more children.                         |
+-----------------------------+----------------------------------------+
| B10. Mediation              | Assistance with negotiating an         |
|                             | agreement between the participant and  |
|                             | the other parent of one or more of the |
|                             | participant's children. Such mediation |
|                             | is generally intended to avoid court   |
|                             | action.                                |
+-----------------------------+----------------------------------------+
| B11. Parenting Education    | Group workshops (though may involve    |
|                             | one-on-one counseling) usually         |
|                             | designed around a curriculum and       |
|                             | providing instruction to enhance       |
|                             | parenting skills of participants.      |
+-----------------------------+----------------------------------------+
| B12. Other:                 | Write in any other type of child       |
|                             | support, parenting, or visitation      |
|                             | services received by the participant   |
|                             | during the reporting period.           |
+-----------------------------+----------------------------------------+
| **C. Other Service Needs:** |                                        |
+-----------------------------+----------------------------------------+
| **CHANGE IN SERVICE NEEDS   | Place a "N" (New) as appropriate to    |
| (\*\*Note: Use "N" to       | indicate a new service need that has   |
| Indicate [New]{.underline}  | emerged for a participant or "D"       |
| Service Need and "D" to     | (Dropped) as appropriate to indicate a |
| Indicate                    | service (previously needed by the      |
| [Dropped]{.underline}       | participant) that is no longer needed  |
| Service Need)**             | by the participant.                    |
+-----------------------------+----------------------------------------+
| C1. Peer Support            | Sessions or workshops (usually         |
|                             | involving other program participants)  |
|                             | designed to discuss parenting,         |
|                             | relationships, employment, and a range |
|                             | of other personal issues.              |
+-----------------------------+----------------------------------------+
| C2. Transportation          | Includes bus tokens, reimbursement for |
| Assistance                  | gas or mileage, reimbursement for car  |
|                             | repair, taxi fare, help with           |
|                             | purchasing a car, or other types of    |
|                             | assistance to help participants        |
|                             | overcome transportation problems.      |
+-----------------------------+----------------------------------------+
| C3. Child Care Assistance   | Includes help in finding a childcare   |
|                             | provider, direct provision of          |
|                             | childcare, and full/partial payment of |
|                             | childcare expenses for a child of the  |
|                             | participant.                           |
+-----------------------------+----------------------------------------+
| C4. Medical/Dental/Vision   | Treatment or other assistance provided |
| Exams and Treatment         | to help participants with medical,     |
|                             | dental, or vision problems.            |
+-----------------------------+----------------------------------------+
| C5. Substance Abuse         | Treatment or counseling to overcome an |
| Treatment/ Counseling       | alcohol or drug abuse problem,         |
|                             | including inpatient or outpatient      |
|                             | care.                                  |
+-----------------------------+----------------------------------------+
| C6. Mental Health           | Treatment or counseling for a mental   |
| Treatment/Counseling        | health problem that is a barrier to    |
|                             | employment or becoming a better        |
|                             | parent.                                |
+-----------------------------+----------------------------------------+
| C7. Vocational              | Such services are typically provided   |
| Rehabilitation              | by a state rehabilitation agency or    |
|                             | other contracted service provider to   |
|                             | help a participant overcome an injury  |
|                             | or other health problem in order to be |
|                             | able to work.                          |
+-----------------------------+----------------------------------------+
| C8. Services Related to     | Counseling or other types of services  |
| Anger Management            | to help the participant control anger. |
+-----------------------------+----------------------------------------+
| C9. Service Related to      | Counseling or other assistance related |
| Partner Abuse               | to eliminating partner abuse.          |
+-----------------------------+----------------------------------------+
| C10. Housing                | Assistance in securing emergency,      |
| Placement/Assistance        | transitional, or permanent housing and |
|                             | other types of housing assistance      |
|                             | (e.g., help with paying a security     |
|                             | deposit, help avoiding eviction, help  |
|                             | with housing repairs, or help applying |
|                             | for public housing units or other      |
|                             | types of subsidized housing).          |
+-----------------------------+----------------------------------------+
| C11. Money                  | Workshop sessions (e.g., parenting or  |
| Management/Budgeting        | job readiness workshop) or individual  |
|                             | counseling to improve the              |
|                             | participant's money management and     |
|                             | budgeting skills.                      |
+-----------------------------+----------------------------------------+
| C12. Other Legal Assistance | Provision of legal                     |
|                             | assistance/services, other than        |
|                             | related to child support, visitation,  |
|                             | or custody.                            |
+-----------------------------+----------------------------------------+
| C13. Clothing/Work          | Help with purchasing or provision of   |
| Equipment                   | clothing, tools, or other equipment    |
|                             | for the workplace.                     |
+-----------------------------+----------------------------------------+
| C14. Help Obtaining an ID   | Help with obtaining an ID card (e.g.,  |
| Card                        | Social Security Card, driver's         |
|                             | license, or other form of valid        |
|                             | identification).                       |
+-----------------------------+----------------------------------------+
| C15. Case Management        | Counseling and other one-on-one        |
|                             | assistance provided by project staff   |
|                             | on an ongoing basis to help keep the   |
|                             | participant on track, to help          |
|                             | troubleshoot emerging problems, and to |
|                             | monitor progress. Typically, a         |
|                             | participant would be assigned to a     |
|                             | project staff person.                  |
+-----------------------------+----------------------------------------+
| C16. Other                  | Help with other types of advocacy      |
| Advocacy/Referral Services  | (besides legal services) or referral   |
|                             | to other types of referral services    |
|                             | not listed.                            |
+-----------------------------+----------------------------------------+
| C17. Other:                 | Write in any other type of support     |
|                             | services received by the participant   |
|                             | during the reporting period (not       |
|                             | covered above).                        |
+-----------------------------+----------------------------------------+
| # D. ADDRESS CHANGE         |                                        |
+-----------------------------+----------------------------------------+
| D1. Address Change -        | If the participant changed his/her     |
| Participant                 | address or telephone numbers, enter    |
|                             | the new address and/or telephone       |
| New                         | numbers.                               |
| Address:\_\_\_\_\_\_\       |                                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                        |
|                             |                                        |
| City:\_\_\_\_\_\_\_\_\_\_\_ |                                        |
| State:\_\_\_\_ Zip:\_\_\_\_ |                                        |
|                             |                                        |
| Home Phone:                 |                                        |
| (\_\_\_\_                   |                                        |
| \_\_)\_\_\_\_\_\_\_\_\_\_\_ |                                        |
|                             |                                        |
| Pager Number:               |                                        |
| (\_\_\_\_                   |                                        |
| \_\_)\_\_\_\_\_\_\_\_\_\_\_ |                                        |
|                             |                                        |
| Work Phone:                 |                                        |
| (\_\_\_\_                   |                                        |
| \_\_)\_\_\_\_\_\_\_\_\_\_\_ |                                        |
+-----------------------------+----------------------------------------+
| D2. Address Change -        | If the participant's contact person    |
| Contact Person              | changed or if the contact person's     |
|                             | address or telephone numbers changed   |
| Name:\_\_\_\_\_\_\_\        | enter changes in the space provided.   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ | Indicate whether the change is for one |
|                             | of the two existing contact persons    |
| Address:\_\_\_\_\_\_\       | indicated either on an earlier Form 2  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ | or Form 5; or whether this is a new    |
|                             | contact person to replace one of the   |
| City:\_\_\_\_\_\_           | two contact persons indicated on an    |
| State:\_\_\_\_ Zip:\_\_\_\_ | earlier Form 2 or Form 5.              |
|                             |                                        |
| Home Phone:                 |                                        |
| (\_\_\_\_\_\_)\_\_\_\_\_\_  |                                        |
|                             |                                        |
| Work Phone:                 |                                        |
| (\_\_\_\_\_\_)\_\_\_\_\_\_  |                                        |
|                             |                                        |
| Pager Number:               |                                        |
| (\_\_\_\_\_\_)\_\_\_\_\_\_  |                                        |
|                             |                                        |
| Relationship:\_\_\          |                                        |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_ |                                        |
|                             |                                        |
|  New Contact -             |                                        |
|                             |                                        |
| Replace Contact: #1 #2    |                                        |
|                             |                                        |
|  Change in Data on         |                                        |
| Existing Contact            |                                        |
+-----------------------------+----------------------------------------+
| > **E. CASE CLOSING**       |                                        |
+-----------------------------+----------------------------------------+
| E1. Date Case Closed:       | If the participant was terminated from |
| \_\_\_/\_\_\_/\_\_\_        | the program during the reporting       |
|                             | period, enter the numeric month, day,  |
|                             | and year (e.g., 02/24/00).             |
+-----------------------------+----------------------------------------+
| E2. Reason for Termination: | Check the appropriate category (select |
|                             | only one category) to indicate why the |
|                             | participant was terminated from the    |
|                             | program. If none of the categories     |
|                             | sufficiently describes the reason for  |
|                             | termination, check Item 6 ("Other")    |
|                             | and write in the termination reason in |
|                             | the space provided.                    |
+-----------------------------+----------------------------------------+
| **F. PROJECT STAFF/CASE     |                                        |
| NOTES**                     |                                        |
+-----------------------------+----------------------------------------+
| F1. Project Staff:          | Enter the last name and first initial  |
|                             | of the project staff person (Johnson,  |
|                             | K.) who completed the form.            |
|                             | Alternatively, a staff person code     |
|                             | number/name may be used by sites in    |
|                             | place of the staff person's name.      |
+-----------------------------+----------------------------------------+
| F1. Date:                   | Enter the numeric month, day, and year |
|                             | that the form was completed            |
|                             | (09/24/99).                            |
+-----------------------------+----------------------------------------+
| F2. Case Notes:             | Enter any case notes or narrative      |
|                             | about the participant, particularly    |
|                             | relating to changes in service needs,  |
|                             | changes in address, or case closing.   |
+-----------------------------+----------------------------------------+

## E. INSTRUCTIONS FOR COMPLETING FORM 6, FOLLOW-UP INTERVIEW

Form 6 (Follow-up Interview) is designed to collect follow-up data
(primarily related to outcomes) on each program participant. This survey
could be administered either via telephone or in-person. The RFMIS has
been set up so that only one follow-up form can be entered on each
participant. It is recommended that sites using the follow-up survey
conduct the survey at six months or one year after the date of
enrollment of each participant in the program -- though sites can elect
to complete the survey at other times (e.g., at case closure, six months
after closure). While the RFMIS will not permit more than one follow-up
survey to be entered into the system on each participant, if sites
wanted to complete and enter more than one follow-up survey per
participant, they could make programming changes in the RFMIS so that
the system will accept more than one survey per participant (note: such
programming changes, however, would require ACCESS programming
expertise). Specific instructions for completing this form follow.

+-----------------------------+----------------------------------------+
| **QUESTION ON FORM 6**      | **INSTRUCTIONS FOR COMPLETING THE      |
|                             | QUESTION**                             |
+=============================+========================================+
| Name:                       | Enter participant's last name, first   |
|                             | name, and middle initial (e.g., Doe,   |
|                             | Jr., John H.).                         |
+-----------------------------+----------------------------------------+
| Site:                       | Enter the name of the responsible      |
|                             | fatherhood program site.               |
+-----------------------------+----------------------------------------+
| SSN:                        | Enter participant's Social Security    |
|                             | Number (this optional and may not be   |
|                             | necessary because this identifier is   |
|                             | included in the RFMIS).                |
+-----------------------------+----------------------------------------+
| Participant ID Number:      | Enter the unique Participant ID Number |
|                             | assigned to the participant. \[Note:   |
|                             | This number should have already been   |
|                             | assigned automatically by the RFMIS    |
|                             | and should have been entered at the    |
|                             | bottom of Form 1.\]                    |
+-----------------------------+----------------------------------------+
| Today's Date:               | Enter the numeric month, day, and year |
|                             | that the form (survey) was completed   |
|                             | with the participant (09/24/99).       |
+-----------------------------+----------------------------------------+
| **A. Services**             |                                        |
+-----------------------------+----------------------------------------+
| I want to ask you some      |                                        |
| questions about the types   |                                        |
| of services you may have    |                                        |
| received through this       |                                        |
| project \--                 |                                        |
+-----------------------------+----------------------------------------+
| A1. Help so you could see   | For each question --                   |
| your children...            |                                        |
|                             | Check off in the first column "yes" or |
| ...through...               | "no" to indicate whether the           |
|                             | participant wanted help with this      |
| A5. Other kinds of help,    | particular service.                    |
| like...                     |                                        |
|                             | Check off in the second column "yes"   |
|                             | or "no" to indicate whether the        |
|                             | participant got help with this         |
|                             | particular service.                    |
|                             |                                        |
|                             | -   If the participant did get help    |
|                             |     ("yes" checked in column 2), then  |
|                             |     for each subcategory of types of   |
|                             |     help (e.g., A1.a. through A1.d),   |
|                             |     move to column 3 and check off the |
|                             |     appropriate response (very         |
|                             |     helpful, somewhat helpful, not     |
|                             |     helpful) to indicate whether the   |
|                             |     specific type of service received  |
|                             |     was helpful.                       |
|                             |                                        |
|                             | -   If the participant did not get     |
|                             |     help, move to column four and      |
|                             |     check off or write in the reason   |
|                             |     help was not received (i.e., check |
|                             |     off dropped or write in other      |
|                             |     reason that help was not           |
|                             |     received).                         |
+-----------------------------+----------------------------------------+
| # B. Children and Families  |                                        |
+-----------------------------+----------------------------------------+
| B1. In the past six months  | Check off appropriate answer -- "Yes,  |
| have you had a new baby or  | had new baby," "Yes, currently         |
| are you currently           | expecting," or "No."                   |
| expecting?                  |                                        |
+-----------------------------+----------------------------------------+
| B2. If yes, are you married | Check off "yes" or "no."               |
| to this baby's              |                                        |
| mother/father?              |                                        |
+-----------------------------+----------------------------------------+
| B3. How many children age   | Indicate the total number of children  |
| 18 or younger do you have?  | the participant has. \[Note: B3 should |
|                             | equal the sum of B4 through B7.\]      |
+-----------------------------+----------------------------------------+
| B4. How many of your        | Indicate the total number of children  |
| children live with you now? | the participant lives with. **\[If all |
|                             | children live with the participant     |
|                             | (i.e., B3=B4), skip to section C.\]**  |
+-----------------------------+----------------------------------------+
| B5. How many of your        | Indicate the total number of children  |
| children live with the      | the participant has that live with the |
| other parent?               | other parent.                          |
+-----------------------------+----------------------------------------+
| B6. How many of your        | Indicate the total number of children  |
| children live with a        | the participant has that live with a   |
| relative?                   | relative.                              |
+-----------------------------+----------------------------------------+
| B7. How many of your        | Indicate the total number of children  |
| children live with someone  | the participant has that live with     |
| else?                       | someone else (i.e., than the parent,   |
|                             | other parent, or relative).            |
+-----------------------------+----------------------------------------+
| B8. How many of your        | Indicate the total number of children  |
| children began living with  | that have started living with the      |
| you since you started the   | participant since they entered the     |
| Program?                    | responsible fatherhood program.        |
+-----------------------------+----------------------------------------+
| B9. How many of your        | Indicate the total number of children  |
| children stopped living     | that have stopped living with the      |
| with you since you started  | participant since they entered the     |
| the Program?                | responsible fatherhood program.        |
+-----------------------------+----------------------------------------+
| **Now let's talk about a    | Select either a focal child or         |
| focal child (ages 18 and    | complete separate forms on each of the |
| younger) who does not live  | child being tracked -- then complete   |
| with you.** \[Note: The     | questions B10-B30.                     |
| program has the alternative |                                        |
| of (1) identifying a single | Identify the particular child being    |
| child as the focal child    | tracked by either the child's name or  |
| for this assessment (e.g.,  | ID number.                             |
| youngest, oldest, child     |                                        |
| that was focus of the       |                                        |
| original referral), or (2)  |                                        |
| completing separate forms   |                                        |
| (Questions B10 - B30) on    |                                        |
| all children not living     |                                        |
| with the participant.\]     |                                        |
|                             |                                        |
| Child's Name or ID Number:  |                                        |
| \_\_\_\_\_\_\_\_            |                                        |
+-----------------------------+----------------------------------------+
| B10. Do any of the          | Check "Yes" or "No" under each of the  |
| following make it difficult | factors (B10a. through B10f.).         |
| for you to see this child?  |                                        |
+-----------------------------+----------------------------------------+
| B11. Compared to six months | Check the appropriate response -- if   |
| ago, do you see this child  | "1-See more often" go to Question      |
| (who does not live with     | B12a; if "2-See less often" go to      |
| you) MORE often, LESS       | Question B13a; and if "3-See about the |
| often, or ABOUT THE SAME?   | same" go to Question B14.              |
+-----------------------------+----------------------------------------+
| **If respondent sees the    | Under Questions B12a and B12b, check   |
| child "MORE OFTEN" ask:**   | the appropriate response; under        |
| Think about                 | Question B12c., check as many          |
| \_\_\_\_\_\_\_\_\_ (focal   | responses as appropriate.              |
| child) -- how often do you  |                                        |
| see the child NOW and how   |                                        |
| often did you see the child |                                        |
| six months ago?             |                                        |
|                             |                                        |
| B12a. NOW ... B12c. Why are |                                        |
| you...                      |                                        |
+-----------------------------+----------------------------------------+
| **If respondent sees the    | Under Questions B13a and B13b, check   |
| child "LESS OFTEN" ask:**   | the appropriate response; under        |
| Think about                 | Question B13c., check as many          |
| \_\_\_\_\_\_\_\_\_ (focal   | responses as appropriate.              |
| child) -- how often do you  |                                        |
| see the child NOW and how   |                                        |
| often did you see the child |                                        |
| six months ago?             |                                        |
|                             |                                        |
| B13a. NOW...B13c. Why are   |                                        |
| you...                      |                                        |
+-----------------------------+----------------------------------------+
| **If respondent sees the    | Check the appropriate response.        |
| child ABOUT THE SAME,       |                                        |
| ask:**                      |                                        |
|                             |                                        |
| B14. You said you see this  |                                        |
| child about as often as you |                                        |
| did six months ago. How     |                                        |
| often is that?              |                                        |
+-----------------------------+----------------------------------------+
| B15. Overall, how satisfied | Check the appropriate response.        |
| are you with the amount of  |                                        |
| time you spend with this    |                                        |
| child?                      |                                        |
+-----------------------------+----------------------------------------+
| B16. Compared to six months | Check the appropriate response.        |
| ago, are you more or less   |                                        |
| satisfied with the amount   |                                        |
| of time you spend with this |                                        |
| child?                      |                                        |
+-----------------------------+----------------------------------------+
| B17. Compared to six months | Check the appropriate response.        |
| ago, how much say do you    |                                        |
| think you have in making    |                                        |
| major decisions about this  |                                        |
| child (decisions about      |                                        |
| things like education,      |                                        |
| health religion)? Do you    |                                        |
| think you have more say,    |                                        |
| less say, or about the      |                                        |
| same?                       |                                        |
+-----------------------------+----------------------------------------+
| B18. Compared to six months | Check the appropriate response.        |
| ago, how well do you get    |                                        |
| along with the other parent |                                        |
| of this child?              |                                        |
+-----------------------------+----------------------------------------+
| B19. In the past six        | Check the appropriate response.        |
| months, has paternity been  |                                        |
| established for this child  |                                        |
| (i.e. has your name/the     |                                        |
| father's name been added to |                                        |
| the birth certificate\]?    |                                        |
+-----------------------------+----------------------------------------+
| B21. Do you have an order   | Check the appropriate response. If the |
| from the court or the child | answer is "No" skip to Question B27.   |
| support agency that says    |                                        |
| you are supposed to pay     |                                        |
| child support for this      |                                        |
| child?                      |                                        |
+-----------------------------+----------------------------------------+
| B22. Does this order apply  | Check the appropriate response. If     |
| to other children?          | "Yes," indicate the number of children |
|                             | to which the order applies.            |
+-----------------------------+----------------------------------------+
| B23. How much are you       | Enter dollar amount participant is     |
| supposed to pay each month  | supposed to pay each month under the   |
| in child support (total)    | particular order.                      |
| under this order?           |                                        |
| \$\_\_\_\_\_\_\_\_\_\_\_    |                                        |
+-----------------------------+----------------------------------------+
| B24. During the past few    | Enter percentage amount of order paid  |
| months, about what          | over past few months. If 100% of order |
| percentage of the child     | has been paid, skip to Question B27.   |
| support you were SUPPOSED   |                                        |
| to pay, did you ACTUALLY    |                                        |
| pay (under this order)?     |                                        |
| \_\_\_\_\_% **(IF 100% go   |                                        |
| to B27)**                   |                                        |
+-----------------------------+----------------------------------------+
| B25. There are lots of      | Check either "Yes" or "No" for each    |
| reasons why someone may not | reason participant did not pay all of  |
| pay child support. I'm      | the child support owed.                |
| going to mention a few.     |                                        |
| Tell me if this was a       |                                        |
| reason why you did not pay  |                                        |
| all your child support      |                                        |
| under this order during the |                                        |
| past few months.            |                                        |
+-----------------------------+----------------------------------------+
| B26. How much do you        | Enter dollar amount owed.              |
| estimate you owe in past    |                                        |
| due child support under     |                                        |
| this order?                 |                                        |
| \$\_\_\_\_\_\_\_\_\_\_\_    |                                        |
+-----------------------------+----------------------------------------+
| B27. In the past 6 months   | Check the appropriate response. If     |
| have you or your case       | "Yes," go to Question B28; if "No,"    |
| manager talked with anyone  | skip to Question B29.                  |
| at the child support agency |                                        |
| about your child support    |                                        |
| situation?                  |                                        |
+-----------------------------+----------------------------------------+
| B28. If yes, How helpful    | Check the appropriate response.        |
| was this?                   |                                        |
+-----------------------------+----------------------------------------+
| B29. During the past few    | Check all of the ways in which the     |
| months have you given this  | participant may have helped; if        |
| child, or his/her other     | "Anything else" is checked, indicate   |
| parent, assistance by:      | the type of assistance provided.       |
+-----------------------------+----------------------------------------+
| B30. Do you have a child    | Check the appropriate response.        |
| support order covering any  |                                        |
| other children?             |                                        |
+-----------------------------+----------------------------------------+
| # C. EMPLOYMENT             |                                        |
+-----------------------------+----------------------------------------+
| C1. Which best describes    | Check the appropriate box indicating   |
| your current employment     | current employment status of           |
| situation?                  | participant. Full-time employment is   |
|                             | defined as working for pay at a        |
|                             | subsidized or unsubsidized job for 30  |
|                             | or more hours per week.                |
+-----------------------------+----------------------------------------+
| C2. In the past 6 months,   | Enter the number of months over the    |
| how many months did you     | past 6 months that the participant has |
| work full-time?             | worked for pay at a subsidized or      |
| \_\_\_\_\_\_\_ months       | unsubsidized job full-time (i.e., for  |
|                             | 30 or more hours per week). Round to   |
|                             | the nearest month. Use "0\" if the     |
|                             | individual has not worked full-time    |
|                             | for an employer during the past 6      |
|                             | month or worked full-time less than ½  |
|                             | month.                                 |
+-----------------------------+----------------------------------------+
| C3. In the past 6 months,   | Enter number of jobs the individual    |
| about how many different    | has had over the past 6 months. If     |
| jobs have you               | none, go to Question C4; if one or     |
| had?\_\_\_\_\_\_\_\_ **(If  | more skip to Question C6.              |
| 0, go to C4; if 1 or more,  |                                        |
| go to C6)**                 |                                        |
+-----------------------------+----------------------------------------+
| C4. If you haven't worked   | Check appropriate response. If "Yes,"  |
| in the past 6 months, have  | go to Question C5a; if "No," go to     |
| you been looking for work?  | Question C5B.                          |
+-----------------------------+----------------------------------------+
| C5a. Why do you think you   | Check all appropriate responses.       |
| haven't found a job?        |                                        |
+-----------------------------+----------------------------------------+
| C5b. Why haven't you looked | Check all appropriate responses.       |
| for a job?                  |                                        |
+-----------------------------+----------------------------------------+
| **Now I have a few          | Enter numeric month and year (e.g.,    |
| questions about your        | 04/99) when the participant started    |
| [current or most            | working at the job he/she spends the   |
| recent]{.underline} job. If | most time working at a week.           |
| you have more than one job, |                                        |
| let's talk about the job    |                                        |
| you spend the most hours    |                                        |
| on.**                       |                                        |
|                             |                                        |
| C6. When did you start      |                                        |
| working at this job         |                                        |
| (month/year)?               |                                        |
| \_                          |                                        |
| \_\_\_\_\_\_/\_\_\_\_\_\_\_ |                                        |
+-----------------------------+----------------------------------------+
| C7a. **If NOT CURRENTLY     | Enter numeric month and year (e.g.,    |
| EMPLOYED**, when did you    | 04/99) when the participant stopped    |
| stop working at this last   | working at his/her last job (note:     |
| job?                        | leave blank if the individual is       |
| \_\_\_\_\_\_\_/\_\_\_\_\_   | currently working).                    |
+-----------------------------+----------------------------------------+
| C7b. **If CURRENTLY         | Check all appropriate responses (note: |
| EMPLOYED**, how likely is   | leave blank if the individual is       |
| it that you will still be   | currently not employed).               |
| with the same company in    |                                        |
| another two years?          |                                        |
+-----------------------------+----------------------------------------+
| C8. Did you have this job   | Check appropriate response. If "Yes,"  |
| before you entered the      | go to Question C10; if "No," go to     |
| Program?                    | Question C9.                           |
+-----------------------------+----------------------------------------+
| C9. If no, do you think you | Check all appropriate responses (note: |
| would have found this job   | leave blank if the individual had job  |
| without the help of the     | before entry into the program).        |
| program?                    |                                        |
+-----------------------------+----------------------------------------+
| C10. Are/were you           | Check appropriate response.            |
| self-employed?              |                                        |
+-----------------------------+----------------------------------------+
| C11. What kind of work      | Indicate the participant's occupation  |
| do/did you do?              | in his/her current or most recent job  |
|                             | (e.g., machinist, nurse, cook).        |
+-----------------------------+----------------------------------------+
| C12. Did you get any        | Check appropriate response.            |
| services or training        |                                        |
| through the Program that    |                                        |
| has helped you on the job?  |                                        |
+-----------------------------+----------------------------------------+
| C13. How many hours each    | Indicate the number of hours each week |
| week do/did you usually     | the participant usually works (or      |
| work at this job?           | worked) in his/her current or most     |
| \_\_\_\_\_\_hrs.            | recent job. If there is considerable   |
|                             | week-to-week fluctuation, average the  |
|                             | number of hours worked over the four   |
|                             | preceding weeks.                       |
+-----------------------------+----------------------------------------+
| C14. Does/did this job      | Check all of the types of fringe       |
| provide you with (check all | benefits provided through the          |
| that apply):                | participant's current or most recent   |
|                             | job. Medical coverage is defined as    |
|                             | health insurance that is made          |
|                             | available to the participant through   |
|                             | the employer and paid either in part   |
|                             | or full by the employer. If none of    |
|                             | the types of benefits is/was provided, |
|                             | then check "None of the above."        |
+-----------------------------+----------------------------------------+
| C15. What is/was your usual | Enter the participant's usual gross    |
| wage before taxes and       | wages (i.e., before taxes) in his/her  |
| deductions?                 | current or most recent job, then check |
|                             | the period for which the wages apply   |
|                             | (e.g., \$8.50 per hour; \$320 per two  |
|                             | weeks).                                |
+-----------------------------+----------------------------------------+
| C16. How well does/did this | Enter participant's assessment of how  |
| salary cover your financial | well the salary from the current or    |
| needs?                      | most recent job covers his/her         |
|                             | financial needs. If "Very Well" is     |
|                             | checked, skip to Section D.            |
+-----------------------------+----------------------------------------+
| C17. Have you tried to find | Check appropriate response. If "1-Yes, |
| a better paying in the past | and I found one," skip to Section D;   |
| 6 months?                   | if "2-Yes, but I haven't found one, go |
|                             | to Question C17a; and if "3-No, I      |
|                             | haven't tried," go to Question C17b.   |
+-----------------------------+----------------------------------------+
| **If C17 = "Yes, but I      | Check all appropriate responses, then  |
| haven't found one," ask:**  | skip to Section D.                     |
| C17a. Why do you think you  |                                        |
| haven't found a better      |                                        |
| paying job?                 |                                        |
+-----------------------------+----------------------------------------+
| **If C17 = No, ask:** C17b. | Check all appropriate responses, then  |
| Why haven't you looked for  | skip to Section D.                     |
| a better paying job?        |                                        |
+-----------------------------+----------------------------------------+
| ### D. Wrap Up              |                                        |
+-----------------------------+----------------------------------------+
| D1. Compared to 6 months    | Check the most appropriate response.   |
| ago, would you say your     |                                        |
| life today is:              |                                        |
+-----------------------------+----------------------------------------+
| D2. In the past six months  | Check "Yes" or "No" on each            |
| did you\...                 | outcome/milestone.                     |
+-----------------------------+----------------------------------------+
| D3. I'm going to read a few | Circle the appropriate response for    |
| statements about how things | each of the statements (1=Better;      |
| might have changed for you  | 2=Same; 3=Worse; and 4=Not             |
| in the past few months.     | Applicable).                           |
| Please tell me if the       |                                        |
| following things are        |                                        |
| better, worse, or about the |                                        |
| same as six months ago      |                                        |
| (Circle Response).          |                                        |
+-----------------------------+----------------------------------------+
| D4. How would you rate the  | Circle the appropriate response for    |
| program on the following    | each of the statements (1=Excellent;   |
| (Circle Response):          | 2=Good; 3=Fair; 4=Poor; 5=Not an issue |
|                             | for me; and 6=Not in program long      |
|                             | enough).                               |
+-----------------------------+----------------------------------------+
| D5. Overall, how would you  | Check the most appropriate response.   |
| rate the program?           |                                        |
+-----------------------------+----------------------------------------+
| D6. What else would you     | Write down participant's               |
| like us to know about your  | response/comment.                      |
| experiences with the        |                                        |
| Program?                    |                                        |
+-----------------------------+----------------------------------------+
| D7. Any changes you can     | Write down participant's               |
| recommend to improve the    | recommendations.                       |
| Program?                    |                                        |
+-----------------------------+----------------------------------------+

**SECTION 4:**

**GUIDE TO USING**

**THE RESPONSIBLE FATHERHOOD**

**MANAGEMENT INFORMATION SYSTEM**

**GUIDE TO USING THE RESPONSIBLE FATHERHOOD**

**MANAGEMENT INFORMATION SYSTEM**

This portion of the manual is intended to provide an overview of how to
get started on the Responsible Fatherhood Management Information System
(RFMIS). It provides basic instructions on how to:

-   Install the RFMIS

-   Start up the RFMIS

-   Exit from the RFMIS

-   Add new records to the system

-   Locate existing records in the system

-   Edit existing records

-   Delete existing records

-   Regularly back-up the data system

The revised RFMIS has been developed using Microsoft Access 2000. It is
intended for use on an IBM-compatible PC. Users of this system will
typically load Microsoft Access 2000 and conduct all operations on the
system (e.g., adding new records, editing existing records, deleting
records, printing reports) from within Microsoft Access. Once
participant records are entered into the system, data may be transferred
to other applications (such as SPSS and Excel) for analysis purposes.

The instructions in this portion of the guidebook are intended to
provide an introduction to using the revised RFMIS and its most
important functions. These instructions are not meant to be exhaustive.
For more detailed instruction on how to conduct specific functions
within the Access environment, it is recommended that project staff
consult a basic manual on Access 2000. If project staff have questions
or encounter problems with any aspect of installing or operating the
RFMIS, they should contact John Trutko, at (703) 522-0885 or Burt
Barnow, at (410) 516-5388.

**A. How to Install the RFMIS**

The installation of the automated system should take no more than about
10 minutes. Installation procedure will create a directory (i.e., also
referred to as a folder in Microsoft Windows) on your computer and then
copy one file (i.e., an Access data file) onto the specified directory.
Installation and operation of the system will require the following:

-   an IBM-compatible system (preferably a Pentium-class PC), with at
    least 10 mg of available space; and

-   Microsoft Access 2000 installed on the system.

Step-by-step instructions on installation are provided separately from
this manual (along with the installation diskette). If sites need
additional help with installation or run into difficulty with
installation, they should contact John Trutko, at (703) 522-0885.

**B. How to Start Up the RFMIS**

**Step 1:** Start up your computer.

**Step 2:** Start up Microsoft Access 2000 \[Note: This can be done from
the Microsoft Windows Desktop (i.e., at the Main Menu) that appears once
your system is fully booted. Using the mouse, click once on the "Start"
key in the lower left-hand corner of the Desktop. Use the mouse to move
up the menu and highlight "Programs." A list of software programs will
appear. Using the mouse, highlight "Microsoft Access" and click the
mouse once. This will take you into Microsoft Access.\]

**Step 3:** Once you are within Microsoft Access, a screen will appear
which will allow you to create a new database or open an existing
database (see Exhibit 4-1). Using your mouse click on "Open an Existing
Data Base" (if this is not already selected), then click on the OK box.

**Step 4:** This will bring you to a screen with "Open" in the upper
right hand corner (see Exhibit 4-2). \[Note: If you have used the RFMIS
before, it is possible that it will appear in the list of files and you
can simply highlight the file using the mouse and click the mouse to
select the file\]. On this screen you will select the appropriate
directory and file. For example, if the RFMIS was in a directory called
"RFFOLDER" on your C\> drive, you would follow these steps:

> \- Use the mouse to click on the gray downward pointing arrow near
> where it says "Look in."
>
> \- Use the mouse to highlight and click on ("C").
>
> \- Use the mouse to highlight and double click on "RFFOLDER."
>
> \- Use the mouse to highlight and double click on "RFMIS2003" (as
> shown in Exhibit 4-3).
>
> \- The RFMIS Main Menu will appear on your computer screen (as shown
> in Exhibit 4-4).

![](media/image1.png){width="6.0in" height="4.5in"}

EXHIBIT 4-1: Opening Access Database Screen #1

![](media/image2.png){width="6.0in" height="4.5in"}

Exhibit 4-2: Opening Access Database Screen #2

![](media/image3.png){width="6.0in" height="4.5in"}

Exhibit 4-3: Opening Access Database Screen #3

![](media/image4.png){width="5.991666666666666in" height="4.49375in"}

Exhibit 4-4: RFMIS Main Menu

**C. How to Exit from the RFMIS**

If you are at the RFMIS Main Menu (see Exhibit 4-4), there are two main
ways to exit from the system.

-   You can take the mouse and click on the box with the "X" located in
    the very upper right hand corner of the screen and this will
    automatically exit you from Microsoft Access. \[When you do this
    Microsoft will automatically save the entries that you have made in
    the RFMIS.\]

-   You can take the mouse and click on the word "File" on the menu at
    the top of the RFMIS Main Menu, slide the mouse down and click on
    "Exit." This will automatically exit you from Microsoft Access.

If you are within a RFMIS data form, you can either (1) move to the
final screen on the particular form you are working on, and using the
mouse, click on "Save Record" or (2) using the mouse click on the box in
the right hand corner of the form window. Either method will result in
saving of the record to the file and will return you to the RFMIS Main
Menu.

**D. Adding New Records**

The basic procedures for adding new records are the same for each of the
forms that are included in the RFMIS (i.e., the Intake Form, Assessment
Form, Participant Service Needs Form, Monthly Tracking Form, and Change
in Service Needs Form; see Section 1 for a copy of the forms). There is,
however, one key distinction that exists between Form 1 and the other
four forms in the RFMIS:

-   When you first enter a Form 1 (the Intake Form) for a new
    participant, the RFMIS will automatically enter a Participant ID
    Number onto the screen. The Participant ID field is what is termed
    in Microsoft Access an "AutoNumber" field, which means that the
    system automatically assigns a unique number to each participant
    entered into the database. The Participant ID numbers start at 1 and
    sequentially increases by one (i.e., 2, 3, 4 and so on) as each new
    participant is added to the RFMIS. It is this Participant ID that is
    used to link information entered on to the initial Intake Form to
    subsequent forms entered into the RFMIS for each participant.

-   When you enter data on Form 2 (Assessment Form), Form 3 (Participant
    Service Needs Form), Form 4 (Monthly Tracking Form), Form 5 (Change
    in Service Needs, Change of Address, and Case Closing Form), or Form
    6 (Follow-up Interview) it will be necessary to (a) indicate that
    you are entering a new form into the system, and (2) find and select
    from an alphabetized listing of the participants already in the
    RFMIS the specific participant whose form you are entering.

While the process of entering data into the system is not complicated,
it will be important to follow the steps outlined in this guidebook. It
also may be useful to practice entering forms on a few participants into
the system (perhaps using dummy data) before entering "real" participant
data. If desired, the system can be installed first into a test
directory (e.g., a folder called RFTEST) and sample data entered; then
the RFMIS can be copied into a folder (e.g., RFFOLDER) and used to enter
data on actual participants.

Below, we first illustrate the basic procedures for entering a Form 1,
and then, we highlight the key difference in entering subsequent forms.

> **1. Adding a Form 1 (Intake Form) for a New Participant to the
> RFMIS**

A new, completed Form 1 (Intake Form) should be entered using the
following procedures (note: all questions on the form should be
complete, with the exception of the Participant ID which is generated
automatically by the RFMIS):

**Step 1:** At the RFMIS Main Menu, use the mouse to click on "Form 1:
Intake Form." You will automatically be brought into the first
(existing) participant record in the Form 1 data base (see Exhibit 4-5,
for an example). \[Note: If it is the first record that you are entering
into the system you will come into a blank record\]. Notice that near
the bottom of screen will be a line that starts with the word "Record"
followed by two arrows, a record number, several more arrows, an
indication of the total number of records in the data system (note: for
this particular form). These arrows are to help navigate through the
various records in the system:

> \|\< If clicked, this box will move you to the first record in the
> database;
>
> \< If clicked, this box will move you to the previous record in the
> database, from the record you are currently working on;
>
> \> If clicked, this box will move you to the next record in the
> database, from the record you are currently working on;
>
> \>\| If clicked, this box will move you to the last existing record in
> the database;
>
> \>\* If clicked, this box will bring up a new (blank) record that can
> be used to enter a new participant.
>
> The two numbers at the bottom of the screen are important \-- the
> first one (in the white rectangular box) indicates the current record
> that you are on; the second number (which is preceded by "of")
> indicates the total number of records in the database (note: for this
> particular form).

**Step 2:** ***This step is very important*** when entering a new record
into the system \[note: if this is the very first record being entered
into the system form, it will not be necessary to hit the \>\* box
because you will automatically be brought into a blank record\]. Using
the mouse, you will click onto the \>\* box at the bottom of the screen.
This will bring up a new (blank) form onto which data can be entered
(see Exhibit 4-6 for an example). You will also notice that the number
of total number of records in the system increases by one and that a new
record number will come up in the rectangular box at the bottom of the
page.

**Step 3:** The cursor will automatically move to the first data item on
the form \-- A1. Name: Last. At this point, you can begin to enter data.
For example, in the attached example, we would type *Smith* in the
available space. From here you can move to the next field on the form
(i.e., "First") by either (a) using the mouse and clicking on the field,
or (b) hitting the "Tab" key on your keyboard (which will advance the
cursor to the next data field). Once on the available space next to
"First," you simply type in the participant's first name (in our
example, *John*). You will notice that as you complete the participant's
name, it will also appear in the top right hand corner along with the
record number. The Participant ID number and name will appear on every
screen that you are working on within the RFMIS so that you can keep
track of who you are entering data on. You would then simply move on
from field to field using either the mouse to click on the next field or
by hitting the Tab key.

![](media/image5.png){width="6.0in" height="4.5in"}

Exhibit 4-5: Sample Completed Form 1 Record

![](media/image6.png){width="6.0in" height="4.5in"}

Exhibit 4-6: Sample Blank Form 1 Record (for Entry of a New Record)

**Step 4:** Form 1 is broken down into three screens \-- 1-Identifiers,
2-Characteristics 1, and 3-Characteristics 2 \-- each of which is noted
by a folder tab at the top of the screen. You can move between the
folders either by (a) using your mouse to click on the tab folder for
the particular screen you want to move to, or (b) by hitting the Tab key
on your keyboard when you are on the final field on a screen (e.g., on
the "1-Identifiers" screen, after you enter data into field A9. \[Are
you required to attend this program?\] and hit the Tab key on your
keyboard, you will automatically move to the next field \[A10. Date of
Birth\] on the "2-Characteristics 1" screen.

**Step 5:** When you complete the final field on the last screen of a
form \-- on Form 1, it will be field A24. Comments, on the
"3-Characteristics 2" screen \-- you will see a "Save Record" box. Using
the mouse, click on the "Save Record" box \-- this will return you to
the RFMIS Main Menu. \[Note: Microsoft Access enters data to the data
file as soon as you begin entering data onto a record. Hence, if you
were to hit either of the boxes (with the x) in the far right hand
corner of the screen, you would exit the form and also save the record
to the database.\]

You will find several types of data fields on the screens. The main
types of data fields that are included are the following: (a) text
fields, in which you will enter text using your keyboard, such as a
participant's name and address; (b) check boxes, in which you will
simply click on the box (or alternatively you can use your Tab key and
hit a SPACE bar on your keyboard) to leave a check mark in the box; (c)
date fields, which will only allow you to enter valid dates (in the
month/day/year format); and (d) "list" (or drop-down) boxes, which when
clicked on with your mouse will show you all of the choices available on
a particular field. The list boxes work as follows: if you click on the
gray down arrow next to a particular field (e.g., the field "A11.
Gender" on Form 1), you will be provided with valid choices for the
field (e.g., A11. offers two choices, "1-Male" or "2-Female") \-- simply
click with your mouse on the correct entry for the participant and it
will be the value entered into the data base.

Where possible, internal edits have been built into the system to reduce
the possibility of incorrect data being entered. Limits have been placed
on the greatest number that can be entered into some fields. For
example, 12 is the highest number permitted on Form 2, B6. "During the
past 12 months, about how many months did you work full-time." If you
were to enter a value 13 or higher, the system will beep and warn you
that the number is in error. You can simply go back into the field and
enter the appropriate number.

If you enter an incorrect value into a particular field, you can go back
at any time while entering a particular form or at a later date (after
the record has been saved) and correct the entry on the field. To
correct an incorrect entry in a field, bring up the particular form,
find the participant (see the instructions in the next section on how to
locate specific individuals), and simply go to the field with the errant
entry, enter the correct value, and save the record as discussed
earlier.

If data are missing for a particular field, you can enter the rest of
the data on the form and come back later when the data becomes available
and enter the missing data.

Finally, note that as you land on each data entry field, there are brief
instructions at the bottom of the screen. For example, if you cursor
onto "A10. Date of Birth," the following data entry instruction will
appear on the bottom of the screen, "Enter the participant's month, day,
year of birth (e.g., 09/23/75)."

> **2. Entering Forms 2, 3, 4, 5 and 6**

The basic procedures for entering the other five forms (Forms 2-6) are
basically the same as Form 1, with one important exception: When you
enter data on Forms 2 through 6, it will be necessary to find and select
from an alphabetized list of the participants already in the RFMIS, the
specific participant whose form you are entering. These forms can only
be entered if a Form 1 (Intake Form) has already been entered into the
system. Without a Form 1, there will not be a Participant ID number to
link all subsequent forms for a particular participant. Using Form 2
(Assessment Form) to illustrate, follow these procedures to enter a new
Form 2 through 5.

**Step 1:** At the RFMIS Main Menu, use the mouse to click on "Form 2:
Assessment Form (Part A)." You will automatically be brought into the
first (existing) Form 2 participant record in the data base (see Exhibit
4-7 for an example).

**Step 2:** Using the mouse, you will click onto the \>\* box at the
bottom of the screen \[note: if this is the very first record being
entered into the system form, it will not be necessary to hit the \>\*
box because you will automatically be brought into a blank record\].
This will bring up a new (blank) form onto which data can be entered
(see Exhibit 4-8 for an example). You will also notice that the number
of Form 2 records in the system increases by one and that a new record
number will come up in the rectangular box at the bottom of the page.

**Step 3:** The cursor will automatically move to the first data item on
Form 2, 3, 4, 5 or 6. Using your mouse, you will need to click on the
gray "Participant Name/ID" list box, which will provide an alphabetized
listing of all participants in the RFMIS (for whom Form 1s have been
completed). You can run down the listing of participants using your
mouse and click on the specific participant in the listing that
corresponds to the participant on the Form 2, 3, 4, 5 or 6. Once you
click on the participant's name on the listing, you will notice that the
participant's ID number and name will appear in the upper right hand
corner of the screen. You are then ready to enter data using basically
the same procedures as you used on Form 1. \[Note: If someone does not
appear on the participant listing, it means that a Form 1 was not
originally entered into the system or has been deleted from the system.
A Form 2, 3, 4, 5, or 6 cannot be entered into the system unless a
corresponding Form 1 has previously been entered

![](media/image7.png){width="6.0in" height="4.5in"}

Exhibit 4-7: Sample Completed Form 2 Record

![](media/image8.png){width="6.0in" height="4.5in"}

Exhibit 4-8: Sample Blank Form 2 Record (for Entry of a New Record)

> into the RFMIS. The data entry person should check with project staff
> responsible for case managing the participant to obtain a copy of a
> Form 1 for the particular participant.\]

When entering Forms 2, 3, 4, 5, or 6, there are several other important
items to note:

-   Because of its length, Form 2 (Assessment Form) is spread across
    three automated forms on the RFMIS. Within each of these forms,
    there are several screens that will need to be completed.

-   When a participant has more than one child, it will be necessary to
    enter multiple Child Forms into the RFMIS for each participant. The
    RFMIS will permit multiple Child Form records to be linked to a
    Participant ID Number.

-   It is anticipated that most participants will have multiple Form 4s
    (the Monthly Tracking Form). This form will be completed at the end
    of each month on each participant whose case has not been
    terminated. The RFMIS will permit multiple Monthly Tracking Form
    records to be linked to a participant number.

-   Data entry staff may want to consult a Microsoft Access 2000 manual
    for additional instructions on data entry.

**E. Locating and Editing Existing Records**

If you need to update information within the RFMIS there are a number of
ways in which a record can be located. If there are a relatively small
number of participants in the database, you can use the arrow keys at
the bottom of the data entry forms to move from record to record (see
Exhibit 4-9). The participant name and Participant ID will appear at the
upper right hand corner of the form as you move through the database.

> \|\< If clicked, this box will move you to the first record in the
> database;
>
> \< If clicked, this box will move you to the previous record in the
> database, from the record you are currently working on;
>
> \> If clicked, this box will move you to the next record in the
> database, from the record you are currently working on;
>
> \>\| If clicked, this box will move you to the last existing record in
> the database;

A second method for locating records is to use the Find feature in
Microsoft Access. Follow these steps:

**Step 1:** At the RFMIS Main Menu, use the mouse to click on a
particular form (e.g., "Form 1: Intake Form"). You will automatically be
brought into the first (existing) participant record on that form.

**Step 2:** Place the cursor on any field that you want to search to
find a particular record. For example, on Form 1, you might want to
place the cursor on the data entry box for "A1. Name \"Last" if you were
interested in searching the database for a specific individual (e.g.,
"Anderson").

**Step 3:** Using your mouse, click on "Edit" on the upper left-hand
corner of the Microsoft Access tool bar. Run down the menu that appears
and click on "Find." A box will appear which will ask "Find What?" Into
the space provided, enter the specific value that you are interested in
finding (e.g., you would enter "Anderson" if you were interested in
finding a participant named Anderson). Once you have entered the value
that you want to search on, you can then click on the "Find First" box
and the first record meeting the criteria will be shown. When you then
click on the "Close" box, you will be on that particular matching
record.

A third method for locating records is to use the Datasheet View. To use
the Datasheet View you must be in a specific form (e.g., Form 1). Below,
we illustrate using the Datasheet View to find a record in Form 1:

**Step 1:** At the RFMIS Main Menu, use the mouse to click on "Form 1:
Intake Form." You will automatically be brought into the first
(existing) participant record in the Form 1 database.

![](media/image9.png){width="6.0in" height="4.5in"}

Exhibit 4-9: Sample Form 1 Record

**Step 2:** Using your mouse, click on "View" on the upper left-hand
corner of the Microsoft Access tool bar.

**Step 3:** Using the mouse, run down the menu that appears and click on
"Datasheet View." A list of participants will appear in a spreadsheet
format (see Exhibit 4-10). At this point there are several options
available:

> \- If you see the record you are looking for in the listing, you can
> simply click on the record with your mouse.
>
> \- You can sort the data that appears in the spreadsheet on any field
> in ascending or descending order. To do this, using your mouse click
> on the particular field name at the top of a column that you want to
> sort. This will highlight (i.e., darken) the entire column. Then,
> using your mouse, click on "AZ downward arrow" on the Access tool bar.
> For example, on Form 1 you could sort the participant database in
> alphabetical order by clicking and holding down the mouse on "A1.
> Name" and sweeping across the column headed "First" and "MI" and then
> releasing the mouse. This will highlight (i.e., darken) the three
> columns under these field names. Then, click with your mouse on "AZ
> downward arrow" on the Access tool bar. \[Note: To return the database
> to numeric order by Participant ID, click on "A1. Name" and sweep
> across "Participant ID," then click on the "AZ downward arrow" on the
> Access tool bar.\]
>
> \- You can move across the Datasheet View spreadsheet with your mouse,
> the Tab key (to move horizontally), or by using the four arrow keys on
> your keyboard.

**Step 4:** To return to the Form View from the Datasheet View, use your
mouse to click on "View" on the upper left-hand corner of the Microsoft
Access tool bar. Using the mouse, run down the menu that appears and
click on "Form View." You will return to the Form you were working on
(e.g., Form 1).

There are several other more advanced ways to search for records \-- for
example, using queries and reports. Consult your Microsoft Access 2000
manual for details on how to do this.

Once you have located a particular record in the database, to edit
existing data in a record, you can simply overwrite that data with new
data (e.g., if the last name of the participant was misspelled, you can
go into the particular field and correct the misspelling). Access will
automatically update the record as soon as you leave the field.

![](media/image10.png){width="6.0in" height="4.5in"}

Exhibit 4-10: Microsoft Access Datasheet View

**F. Deleting Records from the RFMIS**

Great care should be taken in deleting records from the RFMIS. In the
rare circumstances that a record needs to be deleted from the system,
follow these steps:

**Step 1:** From the RFMIS Main Menu, click with your mouse on the box
that says "Delete a Participant Record."

**Step 2:** A screen will appear that says "Please select the
participant record that you would like to delete" (See Exhibit 4-11).
Click on the gray downward arrow in the box, which will provide a
listing of all participants in the data system. Use your mouse to slide
down the list of records in the list. Click on the particular record
that you would like to delete.

**Step 3:** The Participant ID of the participant that you have selected
to delete will appear in a box. If this is the correct participant
number, then click your mouse on the "Delete Record" box. You will be
asked if you want to delete all data for this participant. (Note: The
delete function will delete all forms \-- that is all Forms 1, 2, 3, 4,
5 and 6 \-- for the particular participant.) Using your mouse, click on
the "Yes" box to delete the participant from the data system. You will
be given a last warning that you will delete a row of records. Click on
the "Yes" box if you still want to delete the record. This warning will
repeat for each individual form that you delete until all forms for the
individual are eliminated from the system.

Although great care should be taken, it is also possible to delete a
single form for a participant (without deleting all forms for a
participant) by using the Datasheet View. Users should consult the
Microsoft Access manual for instructions on how to do this. \[Please
note that such deletions should be approached with caution, because it
can result in incomplete sets of forms for users in the system, e.g.,
you may end up with a Form 1, 3 but not a Form 2 for a participant.\]

![](media/image11.png){width="6.0in" height="4.5in"}

Exhibit 4-11: Screen for Deleting a Record

**H. Making Back-Up Copies of the RFMIS**

At a minimum, sites should back up the RFMIS at the end of each month.
The data can be backed-up onto a floppy diskette, CD-ROM, or onto a tape
backup unit. Because of its size (in excess of several mg) it will need
to be compressed or zipped up to be backed-up onto a 3.5 floppy
diskette. This can be done using a data compression software such as
WinZip or PKZIP. The database can be directly copied down to either a
CD-ROM diskette or data tape. If you have questions on how to back up
your system, please contact: John Trutko, at (703) 522-0885, or Burt
Barnow, at (410) 516-5388.

**SECTION 5:**

**SAMPLE DATA ENTRY SCREENS**

![](media/image12.png){width="5.833333333333333in"
height="4.375in"}![](media/image13.png){width="5.833333333333333in"
height="4.375in"}

![](media/image14.png){width="5.841666666666667in"
height="4.38125in"}![](media/image15.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image16.png){width="5.841666666666667in"
height="4.38125in"}![](media/image17.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image18.png){width="5.841666666666667in"
height="4.38125in"}![](media/image19.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image20.png){width="5.841666666666667in"
height="4.38125in"}![](media/image21.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image22.png){width="5.841666666666667in"
height="4.38125in"}![](media/image23.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image24.png){width="5.841666666666667in"
height="4.38125in"}![](media/image25.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image26.png){width="5.841666666666667in"
height="4.38125in"}![](media/image27.png){width="5.841666666666667in"
height="4.38125in"}![](media/image28.png){width="5.841666666666667in"
height="4.38125in"}![](media/image29.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image30.png){width="5.841666666666667in"
height="4.38125in"}![](media/image31.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image32.png){width="5.841666666666667in"
height="4.38125in"}![](media/image33.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image34.png){width="5.841666666666667in"
height="4.38125in"}![](media/image35.png){width="5.841666666666667in"
height="4.38125in"}

![](media/image36.png){width="5.841666666666667in"
height="4.38125in"}![](media/image37.png){width="5.833333333333333in"
height="4.375in"}

![](media/image38.png){width="5.833333333333333in"
height="4.375in"}![](media/image39.png){width="5.833333333333333in"
height="4.375in"}![](media/image40.png){width="5.833333333333333in"
height="4.375in"}![](media/image41.png){width="5.833333333333333in"
height="4.375in"}![](media/image42.png){width="5.833333333333333in"
height="4.375in"}![](media/image43.png){width="5.833333333333333in"
height="4.375in"}![](media/image44.png){width="5.833333333333333in"
height="4.375in"}![](media/image45.png){width="5.833333333333333in"
height="4.375in"}![](media/image46.png){width="5.833333333333333in"
height="4.375in"}![](media/image47.png){width="5.833333333333333in"
height="4.375in"}![](media/image48.png){width="5.833333333333333in"
height="4.375in"}![](media/image49.png){width="5.833333333333333in"
height="4.375in"}![](media/image50.png){width="5.833333333333333in"
height="4.375in"}![](media/image51.png){width="5.833333333333333in"
height="4.375in"}

**SECTION 6:**

**LIST OF RFMIS DATA FIELDS**

**SECTION 7:**

**GUIDE TO GENERATING SAMPLE REPORTS**

**AND DESIGNING NEW REPORTS**

**SECTION 7: GUIDE TO GENERATING SAMPLE REPORTS**

**AND DESIGNING NEW REPORTS**

Microsoft Access 2000 contains a powerful and flexible report generating
capability. This capability will allow sites to use data within the
RFMIS to assist with ongoing case management and to conduct in-depth
statistical analysis of participant characteristics, services received,
and outcomes. Access has the ability to link up all data fields within
the system (see "queries") and to allow the user to print all data items
within the system on reports. Data included on reports can be sorted on
any variable or combination of variables (e.g., alphabetically by
participant name). In addition, reports can select out and print data on
only a select group of participants (e.g., for males, for a certain case
manager, for individuals with substance abuse problems). While generally
sites will print out reports that include listings of participant
characteristics, it is also possible to generate more summary reports
(e.g., tabulations calculating the percentage of participants in
specified age ranges; pie charts and other graphs; or crosstabulations).
In addition, it is possible to transfer data to other statistical
applications for more sophisticated statistical analyses, such as SAS
and SPSS.

In designing the RFMIS, we have included a series of pre-formatted
reports that sites can use as appropriate and will provide examples of
the types of reports that can be generated by the system. Sites are
encouraged to experiment with both reports and queries to generate their
own reports tailored to specific site case management and analysis
needs. Below, we provide instructions on how to generate pre-formatted
reports, some basic instructions on how to begin creating new reports,
and some examples of the pre-formatted reports (with sample data).

**A. Printing Pre-Formatted Reports**

The steps involved in printing a pre-formatted report are relatively
simple. At the RFMIS Main Menu, click on the menu item "Print Out an
Existing Report." This will bring up a submenu, with a list of
pre-formatted reports (see Exhibit 7-1). Using your mouse, click on the
report that you would like to print. This report will first be previewed
on your monitor (with data). To print the report, click on the print
icon on the Access Toolbar. The report should be sent to your printer.
You can then print another report or simply hit the "X" in the right
hand corner of the screen to return to the RFMIS Main Menu.

**B. Creating a New Report**

Creating new reports in Microsoft Access takes some patience and
practice, but the procedures are relatively simple once mastered. Once
some proficiency in report design has been developed, it should be
possible to produce new reports in less than an hour (unless they are
very

![](media/image52.png){width="6.0in" height="4.5in"}

Exhibit 7-1: Pre-Formatted Reports Submenu

complicated). Below, we provide a brief set of steps for beginning to
create a new report. Please consult your Access help menu or manual for
additional instruction on creating new reports.

If you are new to creating reports, there are several "wizards" that can
help you with beginning to lay out reports. As you progress, you can
develop reports using a custom layout you design. You will probably want
to use the "report wizard" to create your first few report. Use these
basic steps:

-   **Step 1.** At the RFMIS Main Menu, use your mouse to click on the
    "Database Window" icon on the Access Toolbar. This will present you
    with a list of folders (i.e., Table, Queries, Forms, Reports, etc.).

-   **Step 2.** Click on the tab that says "Reports" \-- this will
    provide a list of all existing reports (as shown in Exhibit 7-2). To
    begin the steps involved in creating a new report, click on the
    "New" box with your mouse. This will provide you with six ways to
    create report in Access: (1) Design Report, (2) Report Wizard, (3)
    Columnar AutoReport, (4) Tabular AutoReport, (5) Chart Wizard,
    and (6) Label Wizard.

-   **Step 3.** You could move forward with any of these six choices. If
    you have not worked with reports before, you will probably want to
    use the "report wizard." If you select report wizard, then you will
    be led through a series of choices that will select fields to
    include in the report and determine the basic structure of the
    report. Among the basic steps that you will follow under the report
    wizard will be the following (note: after each step, click the
    "next" box with your mouse:

```{=html}
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```
-   First, you will select a table or query to use (e.g., the
    "Participant" table), which will define the basic group of fields
    that you can select from in defining your report.

-   Next, you will select the specific fields that you want to include
    in your report.

-   Next, you will select if and how you want to group records on your
    report (e.g., by case manager).

-   Next, you will select how you want the records to sort on your
    report (e.g., alphabetically, by last name, first name, and middle
    initial of the participant).

-   Next, you will determine how the report will look \-- three basic
    forms are provided: columnar, tabular, or justified). You will
    probably want your initial reports to be tabular, though may want to
    experiment with the other two formats. Under this menu item, you
    also determine whether the report will be printed out in "portrait"
    or "landscape" on the paper (note: landscape will enable you to fit
    more fields of data across the page).

![](media/image53.png){width="6.0in" height="4.5in"}

Exhibit 7-2: Access Screen for Creating New Reports

-   Next you will be able to select among several different styles
    (e.g., corporate), which will determine the font size and appearance
    of the report.

-   Finally, you will give a title to the report.

In creating reports, you will use what are termed "controls." Controls
are the objects on a report that perform actions, decorate the document,
or line the report and its data source. For example, use controls to
display data from fields on the report. To create a report, you use the
Access toolbox to add controls. Frequently used report controls include
text boxes, check boxes, labels, and decorative lines and borders.
"Control properties" determine the structure, appearance, and behavior
of a control, as well as the characteristics of the text or data that it
contains. Properties vary depending on the object (for example, there
are nearly 20 possible properties for a picture that is placed in a
report, including name, alignment, size, relative location, background
color, border color, and border width).

Consulting a Microsoft Access manual, using the tutorials that come with
Access database, and "hands-on" practice in creating reports will enable
you to master the basics of creating new reports and move toward more
sophisticated report creation.

**C. Sample Pre-Formatted Reports**

Examples of pre-formatted reports are attached in the pages that follow.