1 

 OMB Control Number: 0985-0066 

Expiration Date: XX/XX/XXXX

Administration for Community Living (ACL)

Traumatic Brain Injury State Partnership Grants

Performance Progress Reporting (PPR)

Cover Sheet

1. ACL Grant Award #: 

2. Grantee State: 

3. Grantee Name: 

4. Date for Total Project Period: 

5. Reporting Period: 

February 1, 2023-July 31, 2023

August 1, 2023 – January 31, 2024

February 1, 2024 – July 31, 2024

August 1, 2024 – January 31, 2025

February 1, 2025 – July 31, 2025 

August 1, 2025 – January 31, 2026 

February 1, 2026 – July 31, 2026 

6. Date of Report Submission: 

7. ACL Project Officer: 

Note: This cover page will need to be completed only for a paper submission, which is not expected to 

occur- all of this information is available from administrative data in the online submission. 
2 

ACL Traumatic Brain Injury State Partnership Grants

Performance Progress Reporting (PPR) TABLE OF CONTENTS

A. Grant Activities (all grantees respond) ................................................................................................. 3

B. Partnership Activities (all grantees respond)........................................................................................ 6

C. Planning and Infrastructure (all grantees respond).............................................................................. 8

D. Information and Referral and Assistance (I&R/A) (if applicable to grant activities) ..........................11

E. Screenings (if applicable to grant activities).......................................................................................13

F. Resource Facilitation (all grantees respond) ......................................................................................15

G. Trainings, Outreach and Awareness (if applicable to grant activities) ...............................................17

H. Other (if applicable to grant activities)...............................................................................................21

I. Narrative Responses (all grantees respond).......................................................................................22

NOTE TO REVIEWERS: The Performance Progress Reporting (PPR) will be programmed into an online 

reporting system. Some guidance and instructions are presented in this document. More detailed 

guidance is provided in the PPR Guidance Document. For future submissions of the PPR in the online 

reporting system, some of the responses will be prepopulated from previous reports. Grantees will be 

able to edit or delete the information previously entered, as applicable. 

PURPOSE AND GENERAL INSTRUCTIONS: ACL designed this report to provide opportunities for 

Traumatic Brain Injury State Partnership Program grantees to submit information about the activities 

they carry out using program funds. ACL will use these data to measure the aggregate performance of all 

grantees. ACL’s primary purpose for requesting this information is to understand how grantees use TBI 

State Partnership Program funds and the impact it has across all participating states. Please review the 

PPR Guidance Document prior to and as you complete the PPR, as guidance/instructions are provided on 

how to respond to each question.

The questions included in this report are questions ACL would like all grantees to be able to answer in 

the future, to the extent they are applicable to grantees’ work. However, ACL understands that grantees 

have different reporting capacities. We encourage grantees to report as comprehensively as they can 

and use the notes fields to describe the data they report as needed so ACL can interpret it correctly.

Grantees should focus on reporting activities funded with program funds only. Program funds are 

defined as those funds awarded to the grantee by ACL plus any funds or other resources (e.g., facilities, 

staff time) used as the required match for the grant award. Grantees should not report activities that 

program funds do not support – even if they are related to other program-funded activities. If a mixture 

of program funds and funds from other sources are used to carry out an activity, grantees should report 

on that activity in the most appropriate way they can. For example, if program funds and other funds 

are blended together and the people being reached with these funds include a mix of people with TBI 

and others, grantees may report about these activities in different ways. Noted below are two scenarios: 
3 

Scenario 1: One grantee may be able to access data from all funded partners and report the total 

number of people with a TBI reached or served with program funds. 

Scenario 2: Another grantee may only have data about the total number of people served including 

people with TBI and others, by one funded partner only, and cannot distinguish between those 

reached with program funds and those reached with other funds. 

Both grantees should report the data they have about the people reached and use the notes field to 

describe the parameters and limitations of their data as appropriate.

A. Grant Activities (all grantees respond) 

1. Which activities did you carry out as part of your ACL project using program funds during this 

reporting period? (Check all that apply) 

[To relieve burden, the responses will be prepopulated in the online reporting system for future 

reporting periods but can be edited as needed.]

a. Partnership Activities - identifying and reaching out to new partners, coordinating and 

aligning activities, information exchange, collaboration on grant activities, collaboration on 

activities related to the grant

b. Planning and Infrastructure - state planning, policy and procedures development, state 

councils, needs assessment, surveillance, registry, IT systems

c. Information and Referral and Assistance (I&R/A) - bringing people and services 

together, answering questions from individuals and families about human service 

resources, helping people get connected to public benefits, sharing information about 

available services like home care and adaptive equipment. Note: I&R/A is about bringing 

people and services together. Individuals may reach out once or many times, but I&R/A

typically does not involve ongoing engagement of individuals like Resource Facilitation. For 

I&R/A there is not typically a “case” established and the support in considered a one-anddone interaction; though as previously noted, individuals may make use of the support

more than once. If the description provided here does not align with how your program 

defines this activity, please provide your definition here: 

d. Screenings - using a standardized procedure, structured interview, or tool to elicit 

the lifetime history of TBI for an individual. Screening can be used for clinical, research, 

programmatic, eligibility determination, service delivery or treatment purposes. If the 

description provided here does not align with how your program defines this activity, 

please provide your definition here: 

e. Resource Facilitation – this category of activity could include development of 

resources such as databases, resource directories, and communications tools to improve 

service delivery. It could also mean providing assistance through an accessible, holistic, 

and person-centered process that engages individuals in decision making about their 

options, preferences, values, and financial resources and helps connect them with 

programming, services and supports they choose. In some states this may be called service 
4 

coordination, service navigation, case management, options counseling, or personcentered counseling. Resource facilitation could be of short term or long-term duration. If 

the description provided here does not align with how your program defines this activity, 

please provide your definition here: 

 

f. Trainings, Outreach and Awareness - continuing education for professionals who may 

work with or provide services for people who have experienced a TBI, training for 

individuals who have experienced a TBI, public education and awareness, training for 

caregivers, on-the-job training for agency staff, cross-training with partnering agencies. If 

the description provided here does not align with how your program defines this activity, 

please provide your definition here:

g. Other 1 (Describe): 

h. Other 2 (Describe): 

i. Other 3 (Describe): 

2. Did you target some or all your grant activities to support people in a particular setting or

population during this reporting period? 

a. Yes (Go to Q3)

b. No (Go to Q4) 

3. Please select the populations or settings that were targeted by your grant activities during this 

reporting period. (Check all that apply)

a. Athletes

b. Children and youth (younger than 22)

c. Adults (22-59)

d. Older adults (60 or over)

e. People who are homeless

f. People who are hospitalized

g. People who are incarcerated or formerly incarcerated

h. Medicaid home and community-based services patients

i. Native Americans

j. Other ethnic, racial, or linguistic minorities

k. Residents of nursing facilities, rehab facilities or ICFs-MR

l. Rural populations

m. People who experience unhealthy substance use or a substance use disorder

n. Students

o. Veterans or current service members

p. People who are victims of crime, domestic violence, or intimate partner violence

q. Other 1 (describe):

r. Other 2 (describe): 

s. Other 3 (describe): 
5 

4. Number and percent of your state’s counties (parishes or boroughs) targeted and reached 

through your grant’s activities during this reporting period. The percent of counties targeted 

and reached will be auto generated in the on-line reporting system. 

[To relieve burden, the responses will be prepopulated in the on-line reporting system for future 

reporting periods but can be edited as needed.]

Counties Questions Number Percent

a. Total number of counties in state

b. Number of counties targeted for this project

c. Number of counties reached this reporting 

period

5. Did your project promote the use of evidence-based practices, interventions, or programs as 

part of your grant activities during this reporting period? 

a. Yes (Go to Q6) 

b. No (Go to Q7) 

6. What evidence-based practices, interventions, or programs did your project promote as part 

of your grant activities during this reporting period? Please describe. 
6 

7. Is there anything else you would like to let ACL know about your grant activities during this 

reporting period? This question is not mandatory.

B. Partnership Activities (all grantees respond) 

 

8. Which organization in your state received funding through the ACL State Partnership Program to 

carry out and/or support grant activities (primary awardee) in this reporting period? 

[To relieve burden, the information for a and b will be prepopulated from previous reports 

and/or based on existing information from Notice of Award. Grantees will be able to edit if it is 

incorrect.] 

a. Lead Grantee Agency Name: 

b. Type of organization (Check all that apply): 

a. State Medicaid Agency

b. State Vocational Rehabilitation Agency, 

c. State Department of Education

d. State Department of Criminal Justice/Corrections 

e. State Unit on Aging

f. State Department for Developmental Disabilities

g. State Behavioral and/or Mental Health Agency 

h. State Department of Public Health

i. Tribal Council

j. Other State Agency 

k. University Center on Excellence for Developmental Disabilities

l. University

m. Other (describe)

9. Which types of organizations are program partners and support program activities and received 

program funds (sub-awarded partners) during this reporting period? (Check all that apply)

a. State Medicaid Agency

b. State Vocational Rehabilitation Agency 

c. State Department of Education

d. State Department of Criminal Justice/Corrections 

e. State Unit on Aging

f. State Department for Developmental Disabilities

g. State Behavioral and/or Mental Health Agency

h. State Department of Public Health

i. Tribal Council/Organization

j. Other State Agency 

k. University Center on Excellence for Developmental Disabilities 

l. University

m. State Independent Living Council

n. State I/DD Council

o. Affiliate of National Brain Injury Organization

p. County or Local Government Entity, 
7 

q. Community-Based Services Organization (e.g., CAA, ADRC, AAA, CIL) 

r. Public Health Department or Clinic

s. Recovery or Substance Abuse Treatment Center

t. VA Medical Center

u. Other Health Care Provider

v. Private Business/Employer

w. Other 1 (describe):

x. Other 2 (describe):

y. Other 3 (describe):

10. Which types of organizations are program partners and support program activities but did not 

receive program funds during this reporting period? (Check all that apply) 

a. State Medicaid Agency

b. State Vocational Rehabilitation Agency 

c. State Department of Education

d. State Department of Criminal Justice/Corrections 

e. State Unit on Aging

f. State Department for Developmental Disabilities

g. State Behavioral and/or Mental Health Agency

h. State Department of Public Health

i. Tribal Council/Organization

j. Other State Agency 

k. University Center on Excellence for Developmental Disabilities 

l. University

m. State Independent Living Council

n. State I/DD Council

o. Affiliate of National Brain Injury Organization

p. County or Local Government Entity, 

q. Community-Based Services Organization (e.g., CAA, ADRC, AAA, CIL) 

r. Public Health Department or Clinic

s. Recovery or Substance Abuse Treatment Center

t. VA Medical Center

u. Other Health Care Provider

v. Private Business/Employer

w. Other 1 (describe):

x. Other 2 (describe):

y. Other 3 (describe):

11. Is there anything else you would like to let ACL know about your Partnership activities during this 

reporting period? This question is not mandatory. 

 

 

 
8 

C. Planning and Infrastructure (all grantees respond) 

12. Please identify the characteristics that apply to your advisory board/council: (Check all that 

apply)

[To relieve burden, the responses to this question will be prepopulated for future reporting 

periods but can be edited as needed.]

a. It is designated by statute 

b. It was established by executive order or the governor 

c. Seats must be approved by governor or another executive authority

d. It is located within the State’s Lead Agency

e. It is located within the Executive Branch

f. It is located within another State Branch

g. It is an independent body

h. It is appointed by the governor or lieutenant governor

i. It is appointed by a commissioner or department head 

j. It is voluntary – people self-identify 

k. Requires the involvement of specific representatives (e.g., state agency) 

l. The size of the board is limited to certain number of slots

m. Subcommittees are used to meet the people with TBI requirement

n. Other 1 (describe):

o. Other 2 (describe): 

p. Other 3 (describe): 

13. What supports are provided to people with a TBI that are involved in your advisory 

board/council? (Check all that apply)

a. Stipends for participation

b. Formal mentoring program

c. Formal on-boarding/orientation process

d. Virtual attendance of meetings allowed

e. Promote use of plain language in meetings

f. Meeting materials are shared in advance of meeting

g. Meeting materials provided in accessible or alternative formats

h. Reimbursement for travel expenses (i.e., mileage, tolls, etc.)

i. Other 1 (describe):

j. Other 2 (describe): 

k. Other 3 (describe): 
9 

14. How is the advisory board/council involved in the TBI SPP program? (Check all that that apply)

a. Not directly involved with the TBI SPP program

b. Provides oversight

c. Needs assessment activities

d. Setting priorities for the TBI State Plan 

e. Planning activities

f. Collaboration and/or coordination activities

g. Education activities

h. Advocacy activities

i. Prevention activities

j. Medical and/or rehabilitation activities or concerns

k. Engaged in peer mentoring or on-boarding of people with TBI

l. Other 1 (describe):

m. Other 2 (describe)

n. Other 3 (describe)

15. a. Describe what it means for your advisory board/council to be representative (e.g., of your 

state’s demographics, types of brain injury, severity of brain injury, etc.). 

15.b. What efforts or actions are being taken to ensure that the advisory board/council is 

representative?
10

16. Please list your advisory council members for this project period and place an ‘X” by their affiliations. Please use initials or some other 

non-identifying method (e.g., AC #1) to identify the members. You may select all that apply if a person represents two or more affiliated 

entities. The totals for each column will be auto calculated in the online reporting system.

Advisory 

Council 

Member

initials or 

some other 

nonidentifying 

method

Person with

a TBI

Family 

Member of 

person with

a TBI

Center for 

Independent 

Living/State 

Independent 

Living Council 

representative

Aging and 

Disability 

Resource 

Center 

representative

Protection & 

Advocacy 

agency 

representative

Long-term 

ombudsman 

representative

TBI Model 

Systems 

representative

Affiliate or 

National Brain 

Injury Association 

representative

State agency 

representative

Other (describe 

category and 

not title)

Totals for 

each column
11

17. What planning and infrastructure accomplishments or activities of the last six months do you 

think have been or will be most impactful? Consider how you are working toward systems change 

and what progress you are seeing.

18. Is there anything else you would like to let ACL know about your planning and infrastructure 

activities during this reporting period? These activities may be related to the needs assessments, 

state plans, evaluation, and registries. This question is not mandatory.

D. Information and Referral and Assistance (I&R/A) (if applicable to grant 

activities) 

 

19. a. How many I&R/A contacts occurred during this reporting period (across the grantee and all 

funded partners providing grant-related I&R/A)? Please enter a number or select zero or unknown. 

a. Number: 

b. Zero

c. Unknown

19.b. Notes about data provided: (e.g., unknown because none of our partners collect this 

information, data are incomplete because only some of our partners collect this information. 

Please describe.): This question is not mandatory. 
12

20. What I&R/A services were people commonly referred to during this reporting period? (Check all 

that apply) 

a. Grant-funded resource facilitation, service coordination 

b. Other type of resource facilitation, service coordination (provided by other 

unfunded partners or other organizations such as an affiliate of national brain injury 

organization, ADRC, CIL, other ABI association, or other organization)

c. Older Americans Act services (e.g., nutrition services, LTC Ombudsman)

d. Behavioral health services 

e. Brain injury support groups

f. Caregiver supports

g. Independent living services

h. Domestic violence help services

i. Employment counseling

j. Educational counseling or school disability services

k. Health insurance information or counseling (e.g., SHIP, Medicaid eligibility)

l. General medical services

m. Specialized TBI/ABI services

n. Homeless services provider

o. Housing supports

p. Medicaid waiver services 

q. Physical, occupational, recreational or speech therapy

r. Legal or advocacy services

s. Transportation services

t. Social Security

u. Veteran’s hospital or clinic 

v. Vocational rehabilitation services

w. In-home services and supports

x. Other 1 (describe):

y. Other 2 (describe): 

z. Other 3 (describe):

 

21. Is there anything else you would like to let ACL know about your I&R/A activities during this 

reporting period? This question is not mandatory.
13

E. Screenings (if applicable to grant activities) 

22. a. Please respond to the following questions about screening activities during this reporting 

period. Please enter a number or select zero or unknown.

22b. Notes about data provided: (e.g., unknown because none of our partners collect this 

information, data are incomplete because only some of our partners collect this information. 

Please describe.) This question is not mandatory.

Screening Question Number Zero Unknown

a. How many unduplicated people

were screened to identify their 

likelihood of TBI during this 

reporting period (by grantee and 

across all funded partners 

providing grant-related screening)? 

b. Of the people screened for a TBI, 

how many were positive?

c. Of the people who screened 

positive for a TBI, how many were:

1. Under the age of 22 

2. Between the ages of 22-59

3. Aged 60 or over

4. Veterans of any age
14

23. Select which standardized instruments you or your funded partners used for screening 

procedures during this reporting period. (Check yes or no for each instrument) 

Screening Instrument Yes No

a. The Ohio State University Traumatic Brain 

Injury Identification Method (OSU TBI-ID)

b. A modified version of the OSU TBI-ID

c. The Brain Injury Screening Questionnaire 

(BISQ)

d. Defense and Veterans Brain Injury Center TBI 

Screening Tool (DVBIC TBI), also called The 

Brief Traumatic Brain Injury Screen (BTBIS)

e. HELPS

f. Military Acute Concussion Evaluation (MACE)

g. Automated Neuropsychological Assessment 

Metrics (ANAM)

h. Brain Check Survey (BCS)

i. Traumatic Brain Injury Questionnaire (TBIQ)

j. Other 1 (describe)

k. Other 2 (describe)

l. Other 3 (describe)

24. Is there anything else you would like to let ACL know about your screening activities this 

reporting period? This question is not mandatory.
15

F. Resource Facilitation (all grantees respond) 

25. a. Please respond to the following questions about the resource facilitation activities during this 

reporting period. Please enter a number or select zero or unknown.

25.b. Notes about data provided: (e.g., unknown because none of our partners collect this 

information, data are incomplete because only some of our partners collect this information. 

Please describe.) This question is not mandatory.

Resource Facilitation Questions Number Zero Unknown

a. How many unduplicated people with a 

TBI were provided resource facilitation 

during this reporting period (by grantee 

and across all funded partners providing 

grant-related resource facilitation)? 

b. Of the people with a TBI provided 

resource facilitation, how many were: 

1. Under the age of 22 

2. Between the ages of 22-59

3. Aged 60 or older

4. Veterans of any age
16

26. What services were people with a TBI who were provided resource facilitation commonly 

referred to during this reporting period? (Check all that apply)

a. Grant-funded resource facilitation, service coordination 

b. Other type of resource facilitation, service coordination (provided by other 

unfunded partners or other organizations such as a Brain Injury Alliance or Association, 

ADRC, CIL, TBI association or other)

c. Older Americans Act services (e.g., nutrition services, LTC Ombudsman)

d. Behavioral health services 

e. Brain injury support groups

f. Caregiver supports

g. Independent living services

h. Domestic violence help services

i. Employment counseling

j. Educational counseling or school disability services

k. Health insurance information or counseling (e.g., SHIP, Medicaid eligibility)

l. General medical services

m. Specialized TBI services

n. Homeless services provider

o. Housing supports

p. Medicaid waiver services 

q. Physical, occupational, recreational or speech therapy

r. Legal or advocacy services

s. Transportation services

t. Social Security

u. Veteran’s hospital or clinic 

v. Vocational rehabilitation services

w. In-home services and supports

x. Other 1 (Describe): 

y. Other 2 (Describe):

z. Other 3 (Describe):

27. Is there anything else you would like to let ACL know about your resource facilitation efforts 

during this period? This question is not mandatory.
17

G. Trainings, Outreach and Awareness (if applicable to grant activities) 

28. a. What types of trainings, outreach and/or awareness activities were provided with program funds during this reporting period? For 

each activity identify the mode for providing the activity, types of people trained or reached, the topics covered in the activity, and the 

number of people trained or reached by the activity. Additional rows can be added as needed in the online reporting system and paper 

version.

a.Name of 

training, 

outreach, or 

awareness 

activity 

(e.g., Annual 

Brain Injury 

Conference)

b.Mode for 

providing 

training, 

outreach, or 

awareness 

activity 

(select one 

response)

c. Types of people trained or reached 

(select all that apply)

d. Topics covered in training, outreach, or awareness 

activity (select all that apply)

e. Number of 

people who 

attended the

training or 

reached (enter 

number or 

select 

unknown)

a. Inperson only

b. Virtual 

only

c. Both inperson and 

virtual

a. Staff providing grant-related services

b. Clinical/medical providers

c. Coaches or other athletics personnel

d. Domestic violence services staff

e. Homeless services organization staff

f. Family, friends, informal caregivers

g. Individuals who have experienced a 

TBI

h. In-home services and supports staff

i. Law enforcement personnel

j. Prison or criminal justice system staff

k. Protection and advocacy staff

l. Residential rehabilitation center staff

m. Nursing home staff

n. Universities, colleges, or school staff 

(excluding school coaches)

o. Veterans & military organization staff

p. Other 1, specify:

q. Other 2, specify:

r. Other 3, specify

a. TBI Basics

b. Aging and TBI

c. Assistive technology

d. Athletics

e. Behavioral health & TBI

f. Caregiving

g. Children & TBI

h. Concussions & mild TBI

i. Criminal justice & TBI

j. Diagnosis

k. Educational issues

l. Employment and training of people with TBI

m. Identification/screening 

n. Independent living

o. Substance use & TBI

p. Neurobehavioral aspects of TBI

q. Public policy 

r. Person centered planning/counseling

s. Community-based services and support resources

t. Treatment & therapies

u. Other 1, specify:

v. Other 2, specify:

w. Other 3, specify: 

Enter Number:

Unknown
18

a.Name of 

training, 

outreach, or 

awareness 

activity 

(e.g., Annual 

Brain Injury 

Conference)

b.Mode for 

providing 

training, 

outreach, or 

awareness 

activity 

(select one 

response)

c. Types of people trained or reached 

(select all that apply)

d. Topics covered in training, outreach, or awareness 

activity (select all that apply)

e. Number of 

people who 

attended the

training or 

reached (enter 

number or 

select 

unknown)

a. Inperson only

b. Virtual 

only

c. Both inperson and 

virtual

a. Staff providing grant-related services

b. Clinical/medical providers

c. Coaches or other athletics personnel

d. Domestic violence services staff

e. Homeless services organization staff

f. Family, friends, informal caregivers

g. Individuals who have experienced a 

TBI

h. In-home services and supports staff

i. Law enforcement personnel

j. Prison or criminal justice system staff

k. Protection and advocacy staff

l. Residential rehabilitation center staff

m. Nursing home staff

n. Universities, colleges, or school staff 

(excluding school coaches)

o. Veterans & military organization staff

p. Other 1, specify:

q. Other 2, specify:

r. Other 3, specify

a. TBI Basics

b. Aging and TBI

c. Assistive technology

d. Athletics

e. Behavioral health & TBI

f. Caregiving

g. Children & TBI

h. Concussions & mild TBI

i. Criminal justice & TBI

j. Diagnosis

k. Educational issues

l. Employment and training of people with TBI

m. Identification/screening 

n. Independent living

o. Substance use & TBI

p. Neurobehavioral aspects of TBI

q. Public policy 

r. Person centered planning/counseling

s. Community-based services and support resources

t. Treatment & therapies

u. Other 1, specify:

v. Other 2, specify:

w. Other 3, specify: 

Enter Number:

Unknown
19

a.Name of 

training, 

outreach, or 

awareness 

activity 

(e.g., Annual 

Brain Injury 

Conference)

b.Mode for 

providing 

training, 

outreach, or 

awareness 

activity 

(select one 

response)

c. Types of people trained or reached 

(select all that apply)

d. Topics covered in training, outreach, or awareness 

activity (select all that apply)

e. Number of 

people who 

attended the

training or 

reached (enter 

number or 

select 

unknown)

a. Inperson only

b. Virtual 

only

c. Both inperson and 

virtual

a. Staff providing grant-related services

b. Clinical/medical providers

c. Coaches or other athletics personnel

d. Domestic violence services staff

a. Homeless services organization staff

b. Family, friends, informal caregivers

c. Individuals who have experienced a 

TBI

d. In-home services and supports staff

e. Law enforcement personnel

f. Prison or criminal justice system staff

g. Protection and advocacy staff

h. Residential rehabilitation center staff

i. Nursing home staff

j. Universities, colleges, or school staff 

(excluding school coaches)

k. Veterans & military organization staff

l. Other 1, specify:

m. Other 2, specify:

n. Other 3, specify

a. TBI Basics

b. Aging and TBI

c. Assistive technology

d. Athletics

e. Behavioral health & TBI

f. Caregiving

g. Children & TBI

h. Concussions & mild TBI

i. Criminal justice & TBI

j. Diagnosis

k. Educational issues

l. Employment and training of people with TBI

m. Identification/screening 

n. Independent living

o. Substance use & TBI

p. Neurobehavioral aspects of TBI

q. Public policy 

r. Person centered planning/counseling

s. Community-based services and support resources

t. Treatment & therapies

u. Other 1, specify:

v. Other 2, specify:

w. Other 3, specify: 
20

b. Notes about data provided: (e.g., unknown because none of our partners collect this 

information, data are incomplete because only some of our partners collect this information. 

Please describe.) This question is not mandatory.

29. Please list and describe any training materials, outreach materials, fact sheets or other products

you produced during this reporting period.

30. Is there anything else you would like to let ACL know about your training, outreach, and 

awareness activities during this reporting period? This question is not mandatory.

 
21

H. Other (if applicable to grant activities) 

[This section can be duplicated as needed]

31. Describe what activities you undertook in this area this reporting period.

32. a. Please respond to the following questions about your other activities that you undertook 

during this reporting period. Please enter a number or select zero or unknown.

Other Grant Activity Question Number Zero Unknown

a. Total number of unduplicated people who 

have experienced a TBI who participated in 

the other grant activity noted in Q31 in this 

reporting period

b. Of the people who participated in the other 

grant activity noted in Q31, how many were:

1. Under the age of 22:

2. Between the ages of 22-59:

3. Aged 60 or older

4. Veterans of any age

32.b. Notes about data provided: (e.g., unknown because none of our partners collect this 

information, data are incomplete because only some of our partners collect this information. 

Please describe.) This question is not mandatory.
22

I. Narrative Responses (all grantees respond) 

33. Please describe how the workgroup activities you participated in added value to your program, 

the national program, and/or any other aspect of your TBI work.

34. Is there anything else you would like to let ACL know about your project or the TBI State 

Partnership Program? 

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 0985-0066). Public reporting burden for this collection of 

information is estimated to average [8] hours per response, including time for gathering and maintaining the data needed and 

completing and reviewing the collection of information. The obligation to respond to this collection is required to retain or 

maintain benefits under the statutory authority [Traumatic Brain Injury Reauthorization Act of 2018 (P.L. 115-377)].