ANNUAL PROGRAM PERFORMANCE REPORT TEMPLATE

FOR STATE COUNCILS ON DEVELOPMENTAL DISABILITIES

 

Page | 1 Revised–October 2020 - 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: 

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

3. Contact person regarding PPR information: 

4. Contact person’s phone number: 

5. Contact person’s e-mail address:

6. Executive Director name (if different from contact person):

7. Executive Director’s phone number:

8. Executive Director’s email address:

SECTION II: COMPREHENSIVE REVIEW AND ANALYSIS 
ANNUAL PROGRAM PERFORMANCE REPORT (PPR) TEMPLATE

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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 Planned for this goal

Taken directly from State Plan; 

areas checked off

Areas addressed

To be completed annually; Council 

checks off Areas 

Quality Assurance

Education and Early Intervention

Child Care

Health

Employment

Housing

Transportation

Recreation

Formal and Informal Community Supports
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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)

Planned for this goal

Taken directly from State 

Plan; strategies checked off

Strategies Used

To be completed annually; 

Council checks off Strategies 

Used

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
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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 Yes No , If Yes, Indicate project name and 

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

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 # % Gender # %

White, alone Female

Black or African American alone Male

American Indian and Alaska Native 

alone

Other

Hispanic/Latino

Asian alone

Native Hawaiian & Other Pacific 

Islander alone

Two or more races

Race unknown

Category # %

Individual with DD This is IFA1.1

Family Member This is IFA 1.2

Geographical

Urban

Rural
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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

(this is the total number of people 

responding to a survey): 
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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 # of 

output respondents = 

X% 

Total suboutcome # / IFA 

1.2 total of 

output 

respondents = 

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 # # #

2. Specify Objective # # #

3. Add additional lines as needed # #

Total # of Sub-Outcome Respondents: # #

IFA 2.4

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

Total sub-outcome # / 

IFA 1.1 total number 

of output respondents

= X% 

Total suboutcome # / IFA 

1.2 total number 

of output 

respondents = X% 

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 position

Total sub-outcome # / 

IFA 1.1 total number of 

output respondents = X% 

Total sub-outcome # / 

IFA 1.2 total number of 

output respondents = 

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

positive responses 

by PWDD to this 

question by the 

number of surveys 

received (IFA 1.1. 

denominator)

Divide the # of 

positive responses 

by family 

members to this 

question by the 

number of surveys 

received (IFA 1.2 

denominator)

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

project activity

Divide the # of 

positive responses 

by PWDD to this 

question by the 

number of surveys 

received (IFA 1.1. 

denominator)

Divide the # of 

positive responses 

by family 

members to this 

question by the 

number of surveys 

received (IFA 1.2 

denominator)

IFA 3.2 The percentage (%) of family members satisfied with a project activity Divide the # of 

positive responses 

by PWDD to this 

question by the 

number of surveys 

received (IFA 1.1. 

denominator)

Divide the # of 

positive responses 

by family 

members to this 

question by the 

number of surveys 

received (IFA 1.2 

denominator)
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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 #

2. Specify Objective #

3. Specify Objective #

4. Specify Objective #

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

1, Specify Objective #

2. Specify Objective #

3. Specify Objective #

4. Specify Objective #
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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

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 #

2. Specify Objective #

3. Specify Objective #

4. Specify Objective #

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

initiatives

1. Specify Objective #

2. Specify Objective #

3. Specify Objective #

4. Specify Objective #

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

actively involved

1. Specify Objective #

2. Specify Objective #

3. Specify Objective #

4. Specify Objective #
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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 #

2. Specify Objective #

3. Specify Objective #

4. Specify Objective #

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 #

2. Specify Objective #

3. Specify Objective #

4. Specify Objective #
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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 YR

2. Reporting Period MM/DD/YR - MM/DD/YR

3. Total Federal Fiscal Award for Reporting Year $

4. State Funds Contributing to Council State Plan Activities $

5. Additional Council Funds Used for Other Activities $

6. Federal Share of Expenditures $

7. Federal Share of Unliquidated Obligations $

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

Federal Share of expenditures – Federal Share of unliquidated obligations

$

9. Match Required $

10. Match Met $

11. Match Unmet $
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1. Fiscal Year YR

2. Reporting Period MM/DD/YR - MM/DD/YR

3. Total Federal Fiscal Award for Reporting Year $

4. State Funds Contributing to Council State Plan Activities $

5. Additional Council Funds Used for Other Activities $

6. Federal Share of Expenditures $

7. Federal Share of Unliquidated Obligations $

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

Federal Share of expenditures – Federal Share of unliquidated obligations)

$

9. Match Required $

10. Match Met $

11. Match Unmet $

Fiscal Year YR

1. Reporting Period MM/DD/YR - MM/DD/YR

2. Total Federal Fiscal Award for Reporting Year $

3. State Funds Contributing to Council State Plan Activities $

4. Additional Council Funds Used for Other Activities $

5. Federal Share of Expenditures $

6. Federal Share of Unliquidated Obligations $

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

Federal Share of expenditures – Federal Share of unliquidated obligations)

$

8. Match Required

9. Match Met

10. Match Unmet

Dollars leveraged for the reporting year being reported: $
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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

1. 1. Quality Assurance 1. Quality of Life

2. 2. Education and Early Intervention 2. Other- Assistive Technology

3. 3. Child Care 3. Other- Cultural Diversity

4. 4. Health 4. Other- Leadership

5. 5. Employment 5. Other- please specify 

6. 6. Housing 14. Other- please specify 

1. 7. Transportation 15. Other- please specify 
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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.
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Reporting Requirements for CDC Funding

Guidance for Administration on Disabilities Grantees 

The Administration for Community Living (ACL), with funding and partnership support from the Centers for Disease Control and Prevention (CDC), 

awarded grants to disability networks to provide critical services to help communities combat COVID-19. A leading priority of this joint effort is to 

ensure vaccines are equally accessible to individuals with the disabilities. As part of the agreement with CDC, ACL is required to collect annual 

progress reports from the Protection and Advocacy Agencies (P&As), Centers for Independent Living (CILs), State Councils on Developmental 

Disabilities (DDCs), and University Centers for Excellence in Developmental Disabilities (UCEDDs) on the activities conducted, challenges, successes, 

and lessons learned. ACL is providing guidance on reporting requirements for the Administration on Disabilities grant programs that received CDC 

funding.

Guidance:

Grantees will report on any of the service activities listed in the chart below that were implemented using the CDC funding from April 1, 2021 up 

through September 30, 2022. All narrative sections (narrative, successes, challenges, and the questions 1 - 12) are limited to 500 words each. 

AoD is developing the specific mechanisms you will use to submit your report on the CDC funded activities. More information will be provided when 

we have it available. Until then, you should begin tracking now the activities being carried out through CDC funding using the guidance below as a 

framework. Specific methods for reporting that data will be shared as soon as possible.

Service Activity a. Number of People Served b. Narrative c. Successes d. Challenges

1. Education about the 

importance of 

receiving a vaccine

Provide the following:

• Number of people with 

disabilities reached by 

your education activities

Describe the type of 

education activities 

conducted (e.g., one on one 

assistance, 

brochures/pamphlets/ fliers, 

Describe the most 

successful/effective 

education activities 

implemented 

Describe challenges that 

limited your ability to 

educate others about the 

importance of the vaccine
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• Number of all other 

people1reached by your 

education activities

social media postings, social 

stories)

2. Identifying people 

unable to 

independently travel 

to a vaccination site

List the number of people 

unable to independently 

travel to a site

Describe:

• The strategy to identify 

people unable to 

independently travel to a 

vaccination site

• The most commonly 

cited reasons for why 

they couldn’t travel to 

the site

Describe successes achieved 

as a result of identifying 

people unable to 

independently travel to a 

site (e.g., were such 

individuals able to get 

vaccinated at an alternative 

site)

Describe challenges that 

limited your ability to 

identify people unable to 

independently travel to a 

site

3. Providing technical 

assistance (TA) to 

local health 

departments or other 

entities on vaccine 

accessibility

List the number of local 

health departments or other 

entities assisted with TA on 

vaccine accessibility 

Describe the type of 

strategies/TA activities to 

assist local health 

departments or other 

entities on vaccine 

accessibility 

Describe successes achieved 

as a result of TA activities 

provided to local health 

departments 

Describe challenges that 

limited your ability to 

provide technical assistance 

to local health departments 

or other entities on vaccine 

accessibility

4. Helping with 

scheduling a vaccine 

appointment

List the number of people 

helped in scheduling vaccine 

appointments

Describe the type of 

activities used to assist 

people in scheduling 

vaccines 

Describe successes achieved 

as a result of assistance 

provided to help schedule 

vaccine appointments 

Describe challenges that 

limited your ability to help 

with scheduling a vaccine 

appointment

5. Arranging or 

providing accessible 

transportation

List the number of people 

assisted with accessible 

Describe the type of 

activities used to assist 

people with accessible 

Describe successes achieved 

as a result of accessible 

transportation activities 

Describe challenges that 

limited your ability to 

1 Other people include family members, direct support providers/workers, personal care attendants, and other support providers.
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transportation to a 

vaccination site

transportation to a 

vaccination site

arrange or provide accessible 

transportation

6. Providing 

companion/personal 

support

List the number of people 

assisted with 

companion/personal support 

to receive vaccines

Describe the type of 

activities to provide 

companion/personal support 

services for people to receive 

vaccines

Describe successes achieved 

as a result of providing 

companion/personal support 

services for people to receive 

vaccines

Describe challenges that 

limited your ability to 

provide companion/personal 

support 

7. Reminding people of 

their second 

vaccination 

appointment if 

needed

List the number of people 

who needed and received a 

reminder of their second 

vaccination appointment 

Describe the type of 

activities to provide people 

with reminders on their 

second vaccination 

appointment

Describe successes achieved 

as a result of providing 

reminders to people on their 

second vaccination 

appointment

Describe challenges that 

limited your ability to 

provide people reminders on 

their second vaccination

appointment
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8. Overall outcome: Number of people vaccinated as a result of implementing one or more of the service activities (number): 

Provide:

a. The number of people with disabilities vaccinated as a result of implementing one or more of the service activities

b. The total number of all other people vaccinated as a result of implementing one or more of the service activities

9. Collaboration with ACL partners (ADRCs, AAA, CIL, DDC, P&A, UCEDD) (narrative):

Describe the nature of collaboration and joint activities with ACL partners, including successes and challenges in your collaboration efforts

10. Collaboration with other community-based organizations (narrative): 

Describe the collaboration and joint activities with other community-based organizations, including successes and challenges in your collaboration 

efforts 

11. Overall lessons learned (narrative): 

Describe the leading key lessons learned, as a result of, your overall implementation activities

12. Recommendations for future activities (narrative): 

Provide recommendations for ACL to consider that will maximize the impact of future responses to disasters or pandemics. 
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PHWF- Data reporting requirements

Award recipients will be required to submit annual progress reports in the form of a :

• written summary on the number of full-time equivalents (FTEs)

• type of public health professional(s) hired

• the activities they are engaged in to advance public health