ANNUAL PROGRAM PERFORMANCE REPORT TEMPLATE 

FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES 

 

Page | 1 DRAFT –June 2016 - PPR Reporting Template 

Note: Section numbers and minor section title changes may occur 

OVERVIEW: 

This template incorporates new information being requested as part of the Program Performance Report 

(PPR) comprehensive reporting. It includes the following sections: 

Section Area

I. Identification

II. Comprehensive Review and Analysis (CRA)

III. State Plan Implementation

IV. Progress Report

V. Council Financial Information 

VI. Measures of Collaboration
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ANNUAL PROGRAM PERFORMANCE REPORT (PPR) 

SECTION I: IDENTIFICATION 

PURPOSE: To provide identifying information of the reporting Council 

1. State/Territory: 

Federal Fiscal Year Reporting: October 1, 20___ through September 30, 20___ 

Contact person regarding PPR information: 

Contact person’s phone number: 

Contact person’s e-mail address: 

Executive Director name (if different from contact person): 

Executive Director’s phone number:

Executive Director’s email address: 

2.

3.

4.

5.

6.

7.

8.

SECTION II: COMPREHENSIVE REVIEW AND ANALYSIS 
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PURPOSE : To provide an update to the Comprehensive Review and Analysis

Comprehensive Review and Analysis- Update- [Section 124(C)(3)] 

The DD Act requires the following annual descriptions: 

 adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in 

Intermediate Care Facilities (ICF) receive; 

 adequacy of health care and other services, supports, and assistance that individuals with developmental disabilities served 

through home and community-based waivers receive; 

AIDD interprets this as annual updates to: 

 adequacy of health care and other services, supports and assistance that individuals with developmental disabilities in 

Intermediate Care Facilities receive; (ICF updates) 

adequacy of health care and other services, supports, and assistance that individuals with developmental disabilities served 

through home and community-based waivers (HCBW) receive; (HCBW updates) 

And other sections that apply (e.g.: state information, portrait of state services, analysis of state issues and challenges, rational for 

goal selection, collaboration). 

Federal and state initiatives impacting people with DD and their families in the State/Territory 







Note: (*)- Adequacy may be described in terms of quality and/or populations served versus need. 
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SECTION III: STATE PLAN IMPLEMENTATION 

PURPOSE: To provide the context of what will be reported in the PPR. Section III is comprised of 3 reporting areas: (A) Introduction; (B) evaluation 

of state plan implementation; (C) Input on National Priorities 

A. Introduction 

In this section provide an executive summary with cohesive information that provides an overview of the report including, but 

not limited to the following: (1) targeted areas of emphasis, (2) strategies used to implement activities; (3) significant 

accomplishments and/or barriers to state plan implementation; (4) needs requiring state plan amendments 

Note: detailed information will be provided below in Section IV

Cultural Diversity 

Describe the Council’s overall efforts to address the needs of individuals with developmental disabilities and their families of a 

diverse culture through its state plan supported activities. 
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B. Evaluation of State Plan Implementation [Section 125(c) (5) and (c)(7)] 

In this section report on the evaluation activities conducted and results. The report should include: 

B1. Evaluation Activities 

Describe the evaluation activities undertaken during the fiscal year being reported, including evaluation activities conducted 

to strategically assess the overall progress and direction of the state plan implementation 

B2. Evaluation Results 

Report the broad results of the evaluation activities described above (B1), including a broad assessment of the overall 

progress of Council supported activities. 

B3. Lessons Learned and Future work of the Council 

Report on how the Council will use lessons learned from state plan implementation and the data gathered from the evaluation 

activities to move forward the work of the Council? 

C. Input on National Priorities 
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SECTION IV: STATE PLAN IMPLEMENTATION PROGRESS REPORT 

Section IV.A. Detailed Progress Report on Goals 

Goal #1: Goal statement would be taken directly from State Plan

Area(s) of Emphasis: 

Area of Emphasis 

Quality Assurance 

Education and Early Intervention 

Child Care 

Health 

Employment 

Housing 

Transportation 

Recreation 

Formal and Informal Community Supports

Planned for this goal 

Taken directly from State Plan; 

areas checked off

Areas addressed 

To be completed annually; Council 

checks off Areas 
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Strategies: 

**Strategies 

** As identified in Section 125 (c)(5)(A-L) of the 

Developmental Disabilities Assistance and Bill of 

Rights Act of 2000 (PL 106-402) 

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 

Demonstration of projects and activities 

Other Activities 

Planned for this goal 

Taken directly from State 

Plan; strategies checked off

Strategies Used 

To be completed annually; 

Council checks off Strategies

Used
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Intermediaries/Collaborators: 

Collaborators 

Definition of collaborator: someone who works 

with another person or group in order to achieve 

or do something

Planned for this goal 

Taken directly from State Plan; 

Collaborators checked off as 

planned

Actual 

To be completed annually; Council 

checks off planned Collaborators 

who actually participated or adds 

collaborators not previously 

planned.

State Protection and Advocacy System 

University Center(s) 

State DD agency 

Other: 

Other: 

Other: 
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1. Goal # 1: 

2. State Plan Objective 1: 

 Check the appropriate box for each of the questions below: 

3. This Objective is: 

Individual & Family Advocacy System Change Capacity Building 

4. This Objective is: 

New Ongoing Completed 

5. This Objective is: 

a. Fulfilling the Self-Advocacy DD Act Requirement Yes No

b. Targeted Disparity Yes No

c. DD Network Collaboration Yes No 

d. A demonstration project of New Approaches to Services and Supports

original start date for this effort: name of project; mm/yy 

Yes No , If Yes, Indicate project name and 

e. A demonstration of projects or activities Yes No, If Yes, indicate project or activity name and original start date for this 

effort: name of project/ mm/yy 

6. Stage of Implementation for systems change activities : 

 planning implementation outcome/fully integrated 

Background/Context

7. Provide an overall description of this objective: 

The description should at a minimum provide background information on the objective to establish a context for the activities. 
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Goal # 1 Objective # 1 : 

8. Expected Outputs 

 List expected outputs from annual work plan 

1.

2.

3.

9. Outputs Achieved 

 List outputs achieved 

1.

2.

3.

Progress Report 

10. The report should include the following: 

 A narrative progress report that cohesively describes the activities that were implemented toward achieving the objective, including how

the identified strategy was used, how the activity was implemented, challenges to achieving the objective and unexpected benefits. 

For system change activities, include a description of the stage of implementation (planning, initiation, implementation, outcome/fully 

integrated) of the system change initiative. 

All narratives must describe what numbers make up the performance measures number for the activities being reported in the narrative. 

A summary of evaluation activities to monitor progress and impact of council supported activities for the objective; data collected during 

the year, data sources, and data collection methods; (logic model and evaluation plan may be attached to the report). 







11. Expected Outcomes (matches the expected outcomes 

from the annual work plan as it relates to the objective) 

List the expected outcomes for the activities described for the 

objective from the annual work plan

12. Outcomes achieved 

13. Progress towards achieving outcomes for overall objective : 

The annual report should include an assessment as to the extent to which progress was made on the intended outcomes for the objective. 

14. Additionally, include stories of culturally diverse people with developmental disabilities whose lives are better because of Council work on 

this activity (e.g., became better advocates for themselves and others, became more connected to the community). Stories of policy or 

legislative changes that happened as a result of Council individual advocacy work that are likely to positively impact the lives of people with 

developmental disabilities or that will prevent a potential negative impact (e.g., created deleted, refined programs and/or legislation, 

reallocated use of funds, organizational systems change as a result of evidence based practices).
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Repeat this page for each goal and objectives as necessary for the individual Council’s 5 year state plan 

2. Goal # Narrative

In this section, for each goal reported for this reporting period, provide an overall cohesive description of: 

• the extent to which progress is being made in achieving the intended outcomes of the Goal for the reporting

year;

the extent to which each goal was or was not achieved for the reporting year;

where applicable, factors that impeded goal achievement for the reporting year

needs that require substantive state plan amendment (goal only)

•

•

•

4 Year Overview (FY 2020) 

A description of how the Council will use and build from knowledge gained and progress made to move forward in the next 

state plan cycle (FY 2022-2026). 

5 Year Overview (FY2021) 

For the final PPR (FY2021) of this state plan cycle, provide an overall analysis of the outcomes achieved during the five year 

state plan cycle. The description should include the extent to which diverse stakeholders are satisfied with council activities 

that promote self-determination and community participation for individuals with disabilities and families, results of other 

types of information gathering such as focus groups, surveys, or other feedback or input methods with individuals with 

developmental disabilities and families and major accomplishments and factors impeding goal achievement (if applicable) 
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Section IV.B. Individual & Family Advocacy Performance Measure (By GOAL) 

 Individual Responses (individuals with DD and Family members only) 

Demographic Data ** 

**This is an aggregated number from all individual responses collected for the reporting FFY 

Race/Ethnicity 

White, alone

Black or African American alone

American Indian and Alaska Native 

alone

Hispanic/Latino

Asian alone

Native Hawaiian & Other Pacific 

Islander alone

Two or more races 

Race unknown 

# % Gender 

Female 

Male 

Other 

# % 

Category # % 

Individual with DD 

Family Member 

Geographical 

Urban 

Rural 

This is IFA1.1 

This is IFA 1.2 
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I. Output Measures

Objective # Performance Measure Performance Measure 

IFA 1.1 

The number of people with developmental

disabilities who participated in Council 

supported activities designed to increase 

their knowledge of how to take part in 

decisions that affect their lives, the lives of 

others, and/or systems

IFA 1.2 

The number of family members who 

participated in Council supported in 

activities designed to increase their 

knowledge of how to take part in decisions 

that affect the family, the lives of others, 

and/or systems

1. Specify Objective #

2. Specify Objective #

3. Specify Objective #

4. Add additional lines as

needed

Denominator: 

TOTAL # of Output Respondents: 
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II. Outcome Measures 

Performance Measures Percent (%) 

IFA 2.1 

After participation in Council supported activities, the percent of people with developmental 

disabilities who report increasing their advocacy as a result of Council work. 

IFA 2.2 

After participation in Council supported activities, the percent of families who report 

increasing their advocacy as a result of Council work. 

Sub- Outcome Measures Projects # 

People with 

developmental 

disabilities 

# 

Family 

Members 

The number (#) of people who are better able to say 

what they want/say what is important to them 

1. Specify Objective # # 

# 

# 

# 

# 

# 

# 

# 

2. Specify Objective #

3. Add additional lines as needed 

Total # of Sub-Outcome Respondents: 

IFA 2.3 

The percent of people who are better able to say what they want or say what services and supports 

they want or say what is important to them 

Total sub-outcome # / 

IFA 1.1 total = X% 

Total suboutcome # / IFA 

1.2 total = X% 
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Sub- Outcome Measures Projects # 

People with 

developmental 

disabilities 

# 

Family 

Members 

The number (#) of people who are participating in 

advocacy activities 

1. Specify Objective # 

Specify Objective # 

Add additional lines as needed 

# 

# 

# 

# 

Total sub-outcome # / 

IFA 1.1 total = X% 

# 

# 

# 

# 

Total suboutcome # / IFA 

1.2 total = X% 

2.

3.

Total # of Sub-Outcome Respondents: 

IFA 2.4 

The percentage (%) of people who are participating now in advocacy activities 

Sub- Outcome Measures Projects # 

People with 

developmental 

disabilities 

# 

Family Members 

The number (#) of people who are on cross disability 

coalitions, policy boards, advisory boards, governing 

bodies and/or serving in leadership positions. 

1. Specify Objective # # 

# 

# 

# 

# 

2. Specify Objective # # 

# 

# 

3. Add additional lines as needed 

Total # of Sub-Outcome Respondents: 

IFA 2.5 

The percent of people who are on cross disability coalitions, policy boards, advisory boards, governing 

bodies and/or serving in leadership positions. 

Total sub-outcome # 

/ IFA 1.1 total = X% 

Total sub-outcome 

# / IFA 1.2 total = 

X% 
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IFA 3 The percent of people satisfied with a project activity 

IFA 3.1 The percentage (%) of people with developmental disabilities who are satisfied with a 

project activity 

IFA 3.2 The percentage (%) of family members satisfied with a project activity 
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Section IV.C. System Change Performance Measures (By Goal) 

SC 1: Output Measures

The number of Council efforts to transform fragmented approaches into a coordinated and effective system that assures 

individuals with developmental disabilities and their families participate in the design of and have access to needed 

community services, individualized supports, and other forms of assistance that promote self-determination, independence, 

productivity, and integration and inclusion in all facets of community life. 

Objective SC 1.1 The number of policy and/or procedure created or changed 

1. Specify Objective # 

Specify Objective # 

Specify Objective # 

Specify Objective # 

2.

3.

4.

Objective SC 1.2 The number of statute and/or regulations created or changed 

1, Specify Objective # 

Specify Objective # 

Specify Objective # 

Specify Objective # 

2.

3.

4.

Objective SC 1.3 The number of promising and/or best practices created and/or supported 

SC 1.3.1 The number of promising practices created 

SC 1.3.2 The number of promising practices supported through Council activities 
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SC 1.3.3. The number of best practices created 

SC 1.3.4 The number of best practices supported through Council activities 

1. Specify Objective # 

Specify Objective # 

Specify Objective # 

Specify Objective # 

2.

3.

4.

Objective SC 1.4 The number of people trained or educated through Council systemic change 

initiatives 

1. Specify Objective # 

Specify Objective # 

Specify Objective # 

Specify Objective # 

2.

3.

4.

Objective SC 1.5 The number of Council supported systems change activities with organizations 

actively involved 

1. Specify Objective # 

Specify Objective # 

Specify Objective # 

Specify Objective # 

2.

3.

4.
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Systems Change SC 2: Outcome Measures 

Outcome Measures Number (#) 

SC 2.1 

The number of Council efforts that led to the creation or improvement of best or promising practices, 

policies, procedures, statute or regulation changes. (sub-measures 2.1.1; 2.1.3)

SC 2.2 

The number of Council efforts that were implemented to transform fragmented approaches into a 

coordinated and effective system that assures individuals with developmental disabilities and their 

families participate in the design of and have access to needed community services, individualized 

supports, and other forms of assistance that promote self-determination, independence, productivity, and 

integration and inclusion in all facets of community life. (sub-measures 2.1.2; 2.14)
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III. Sub-Outcome Measures 

Objective SC 2: Sub outcome measures 

SC 2.1.1 

# of policy, procedure, statute 

or regulation changes improved 

as a result of systems change. 

SC 2.1.2 

# Policy, procedure, statute or 

regulation changes implemented. 

1. Specify Objective # 

Specify Objective # 

Specify Objective # 

Specify Objective # 

2.

3.

4.

Objective SC 2.1.3 

# of promising and/or best 

practices improved as a result 

of systems change activities. 

SC 2.1.4 

# of promising and/or best practices 

implemented 

1. Specify Objective # 

Specify Objective # 

Specify Objective # 

Specify Objective # 

2.

3.

4.
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Additional goal/objective reporting fields would be created 

based on the individual Council’s 5-year state plan.
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SECTION V: COUNCIL Financial Information [Section 124(c)(5)(B) and 125(c)(8)] 

Council is its own DSA: ____Yes ____No 

Fiscal Information for Programmatic Purposes ONLY 

Purpose: In this section, Councils are to identify the obligation and liquidation status for the 3 FFY of funds 

1. Fiscal Year 

Reporting Period 

Total Federal Fiscal Award for Reporting Year 

State Funds Contributing to Council State Plan Activities 

Additional Council Funds Used for Other Activities 

Federal Share of Expenditures 

Federal Share of Unliquidated Obligations 

Unliquidated Balance of Federal Funds (=Total Federal Fiscal Year Award –

Federal Share of expenditures – Federal Share of unliquidated obligations 

Match Required 

Match Met 

Match Unmet 

YR

MM/DD/YR - MM/DD/YR 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.
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Dollars leveraged for the reporting year being reported: $ 

1. Fiscal Year 

Reporting Period 

Total Federal Fiscal Award for Reporting Year 

State Funds Contributing to Council State Plan Activities 

Additional Council Funds Used for Other Activities 

Federal Share of Expenditures 

Federal Share of Unliquidated Obligations 

Unobligated Balance of Federal Funds (=Total Federal Fiscal Year Award –

Federal Share of expenditures – Federal Share of unliquidated obligations) 

Match Required 

Match Unmet 

YR

MM/DD/YR - MM/DD/YR 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

2.

3.

4.

5.

6.

7.

8.

9.

10. Match Met 

11.

Fiscal Year 

1. Reporting Period 

Total Federal Fiscal Award for Reporting Year 

State Funds Contributing to Council State Plan Activities 

Additional Council Funds Used for Other Activities 

Federal Share of Expenditures 

Federal Share of Unliquidated Obligations 

Unobligated Balance of Federal Funds (=Total Federal Fiscal Year Award –

Federal Share of expenditures – Federal Share of unliquidated obligations) 

Match Required 

Match Met 

Match Unmet 

2.

3.

4.

5.

6.

7.

8.

9.

10.

YR

MM/DD/YR - MM/DD/YR 

$ 

$ 

$ 

$ 

$ 

$ 
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 SECTION VI: MEASURES OF COLLABORATION 

Purpose: In this section, Councils are to discuss collaborative efforts with specific DD Network partners and other collaborators separate 

from the planned DD Network Collaboration goal/objective. 

 

1. Identify the critical issues/barriers affecting individuals with developmental disabilities and their families in your State that the 

Council and the P&A, the Council and the UCEDD, the Council and other collaborators may have worked on during the reporting 

period 

2. Identify the Area of Emphasis collaboratively addressed by the DD Council and Collaborators 

Area of Emphasis [Check Applicable area(s) ] 8. Recreation 

Quality of Life 

Other- Assistive Technology 

Other- Cultural Diversity 

Other- Leadership 

Other- please specify 

Other- please specify 

1. 1. Quality Assurance 

Education and Early Intervention 

Child Care 

Health 

Employment 

Housing 

1.

2. 2. 2.

3. 3. 3.

4. 4. 4.

5. 5. 5.

6. 6. 14. 
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1. 7. Transportation 15. Other- please specify 

The report should include a narrative progress report that cohesively describes the activities that were implemented by the Council 

and the P&A, the Council and the UCEDD, the Council and other collaborators.DD Network. For at least one of the issues/barriers 

identified above describe: 

(a) the issue/barrier; 

(b) collaborative strategies to address issue/barrier and expected outcome(s); 

(c) the DDC’s specific role and responsibilities in this collaborative effort. Include any technical assistance expertise DD Council staff 

can provide to other States in this area; 

(d) briefly identify problems encountered as a result of this collaboration, and technical assistance, if any, desired; and 

(e) any unexpected benefits of this collaborative effort.