**UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES**

**ADMINISTRATION FOR COMMUNITY LIVING (ACL)**

**ADMINISTRATION ON DISABILITIES**

**ANNUAL PROGRAM PERFORMANCE REPORT**

**For**

**CENTERS FOR INDEPENDENT LIVING**

**(Title VII, Chapter 1, Part C of the Rehabilitation Act of 1973, as amended)**

**REPORTING INSTRUMENT**

**(To be completed by Centers for Independent Living)**

**Proposed CIL PPR Redesign**

OMB Control Number:  XXXX-XXXX	FY YYY			Expiration Date:  MM DD YYYY 

**Fiscal Year: ____________________________________**

**Grant #: _______________________________________**

**Name of Center: ________________________________**

**Acronym for Center (if applicable): ________________**

**State: _________________________________________**

**Executive Director**

**Name: ____________________________________________**

**Email Address: ____________________________________**

**Phone Number: ____________________________________**

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. Public reporting burden for this collection of information is estimated to average 36 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (P.L. 113-128 Workforce Innovation and Opportunity Act (WIOA). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Administration For Community Living (ACL), Administration on Disabilities, Attention: Corinna Stiles, Supervisory Program Specialist Room 1123, U.S. Department of Health and Human Services, 330 C Street SW, Washington, DC 20201 or email Corinna.Stiles@acl.hhs.gov and reference the OMB Control Number 0985-0043.

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**Overview of Centers for Independent Living Annual Program Performance Report Requirements**

The purpose of this report is to:  (a) assess grantees’ compliance with title VII of the Act, with section 1329 of the Code of Federal Regulations and with applicable provisions of the HHS regulations at 45 CFR Part 75.  (b) serve as the primary basis for ACL’s monitoring activities in fulfillment of its responsibilities under sections 706 and 722 of the Act.  (c) enable ACL to collect qualitative and quantitative data to track performance outcomes and efficiency measures of the CILs programs with respect to the annual and long-term performance targets established in compliance with the Government Performance and Results Act (GPRA).  And (d) to be used to design CIL training and technical assistance programs authorized by section 721 of the Act.  

**Outline of Centers for Independent Living Annual Program Performance Report (CIL PPR)**

**Section I.  FISCAL COMPONENT**

**Total Expenditures**

A. Federal Funds

B. Other Government Funds 

C. Non-Government Funds 

D. Amount of other government funds received on behalf of consumers, that are subsequently passed on to consumers 

**Section II.  BOARD AND STAFF**

A. Agency Executive / Management Staff

B. Functional Responsibilities

**Section III.  NETWORK & SERVICE RECORDS**

CSRs Records

CIL Counties with Part C Funds 

**Section IV. DEMOGRAPHICS**

**Section V. SERVICES, ACHIEVEMENTS, and COORDINATION**

A. Services 

B. Achievements/Goals Achieved In Significant Life Areas

C. Consumer Satisfaction

D. Community Collaborations/ Activities and Events

E. Supports, Modifications, and Accommodations

**Section VI. ANNUAL PROGRAM PERFORMANCE**

A. Goals/Objectives 

B. Target Population

C. Work Plan

D. State Plan For Independent Living

E. Achievements

F. Use of Part C Funds

G. Training and Technical Assistance

**Glossary of Terms & Sections**

The following pages show the Centers for Independent Living 	Annual Program Performance Report format through a series of data tables corresponding with the sections of the outline above. The tables are for presentation purposes only. ACL will continue to require electronic transmittal of the CIL PPR. 

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**Section I.  FISCAL COMPONENT**

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**Section II.  BOARD AND STAFF**

**Section III.  Network & Service Records**

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**3.1 CIL Counties with Part C Funds**

**Rural Populations**: The Office of Management and Budget (OMB) designates counties as Metropolitan, Micropolitan, or Neither. A Metro area contains a core urban area of 50,000 or more population, and a Micro area contains an urban core of at least 10,000 (but less than 50,000) population. All counties that are not part of a Metropolitan Statistical Area (MSA) are considered rural.  Micropolitan counties are considered non-Metropolitan or rural along with all counties that are not classified as either Metro or Micro. For more information on rural populations, see: https://www.ers.usda.gov/topics/rural-economy-population.aspx

**Section IV. Demographics**

**Section IV. Demographics (*continued*)**

**Section V. Services, Achievements, and Coordination**

**5.1 Services**

**5.2 Achievements**

**INSERT CIL REQUESTED ACHIEVEMENTS**

**Please note on your feedback template topics of achievements you would like to add to this area.**

**5.3 Achievements:****Consumer Satisfaction**

Please enter the total number of consumers who selected the categories below... 

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**5.4 Coordination**

5.5 **Coordination**

Please check alternative supports, modifications, and accommodations your center provides to assist individuals with disabilities in accessing and services supports.

**Physical Access**

☐  Signage

*Accessible*

☐  Doors and Doorways

☐  Bathrooms 

☐  Parking Lots

**Alternative Formats**

☐  Braille 

☐  Large Print 

☐  Electronic/Digital Formats

☐  Audiotape

**Other**

☐  Equipment and Devices

**Communications Access**

☐  Sign Language Interpreters 

☐  Personal Attendants

☐  Readers 

☐  Teletypewriters (TTYs) 

☐  Telecommunications Devices for the Deaf (TDDs) 

☐  Text Telephones (TTs)

☐  Videophones 

☐  Picture Boards 

**Program Access**

☐  No-fragrance policy 

☐  “Green” cleaners 

*(for individuals with environmental illness or chemical sensitivities)*

**Section VI. Annual Program Performance**

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**Glossary of Terms & Sections**