**OMB Control No. 0985-0029**

**Exp. Date 01/31/2020**

**Annual State Plan Work Plan**

# State Plan Yr.(e.g.: 1, 2, 3, 4, 5); FFY(Specify fiscal year)

**SECTION IV: State Plan GOALS**[Section 124(4); Section 125(c)(5)]

# Goal #:

· Identify State Plan Goal

· Expected 5-year outcomes

# Area(s) of Emphasis:

For each goal, check **all**the area(s) of emphasis that relate to the goal statement. See Appendix A for definitions of the area(s) of emphasis.

Quality Assurance

Education and Early Intervention Child Care

Health Employment Housing Transportation Recreation

Formal and Informal Community Supports **Activities to be used in achieving each goal:**Check **all**that apply.

Outreach Training

Technical Assistance

Supporting and Educating Communities Interagency Collaboration and Coordination

Coordination with Related Councils, Committees and Programs Barrier Elimination

Systems Design and Redesign

Coalition Development and Citizen Participation Informing Policymakers

Demonstration of New Approaches to Services and Supports

Other demonstration projects or activities (indicate start date mm/d/yr Other Activities

2

****-**If “Demonstration of New Approaches to Services and Supports” has been checked, provide a justification including but not limited to the following: (1) description of the approach to be demonstrated; (2) estimated length of the activity; (3) strategies to locate on-going funding from other sources after 5 years

# This Goal addresses

(Check each box that applies)

Individual/Family Advocacy

System Change

Self-Advocacy Requirement

Targeted Disparity

DD Network Collaboration

Capacity Building

**Collaborators Planned for this goal (if known):**Identify all organizations/agencies the Council plans to work with and/or has commitments from in addressing the goal.

State Protection and Advocacy System University Center(s)

State DD agency Other:

Other: Other:

# Objectives/Guidance

· For each goal that will be addressed the first two years of the state plan cycle (FFY’17 and FFY ‘18) and annually each year, identify if the efforts for the goal is Individual Advocacy, System Change, or both.  For each goal, outline a plan of action that describes the key activities to accomplish the Council goals by listing for each objective, key activities, the expected outputs, outcomes and targeted performance measures

o	The objectives should be more detailed, specific projections of how the Council will implement the goals. The objectives may include quantitative projections of the work to be accomplished (e.g., the number of people to be trained; the number of outreach activities) or they may provide qualitative projections of the work to be accomplished (convening coalitions; researching state service models).

· The key activities should identify the major activities the Council will use to implement the objectives.

· The expected outputs and outcomes should identify the outputs and outcomes the key activities intend to achieve.

o	The goals, objectives and outcomes can be updated annually through the State Plan Amendment process.

# Project the performance measure(s) that will be targeted for each objective

**Individual & Family Advocacy (IFA)**

**System Change (SC)**

***SC 2.1 = 2.1.1 +2.1.3**
**SC Code**

**Targeted #**

**SC 1.1.1**

**SC 1.2.1**

**SC 1.3.1**

**SC 1.3.2**

**SC 1.3.3**

**SC 1.3.4**

**SC 1.4.1**

**SC 1.5.1**

**SC 2.1.1**

**SC 2.1.2**

**SC 2.1.3**

**SC 2.1.4**

**IFA Code**

**Targeted #**

**IFA 1.1**

**IFA 1.2**

**IFA 2.1**

**IFA 2.2**

**IFA 2.2.1**

**IFA 2.2.2**

**IFA 2.2.3**

**IFA 3.1**

**IFA 3.2**

***SC 2.2 = 2.1.2 +2.1.4**
**SC 2.1***

**SC 2.2***

**Note: add additional sheets to accommodate the number of objectives for a given goal.**

Public Burden Statement: 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number (OMB 0985-0029).  Public reporting burden for this collection of information averages 367 hours per State response, including time for gathering, maintaining data and reviewing the collection of information.  The obligation to respond to this collection is required to retain or maintain benefits under the statutory authority Section 124(a) [42 U.S.C. 15024(a)].