OMB Control Number 0985-0054

Expiration Date: 02/29/2020

AGENCY COMPONENT DATA

PRA 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 0985-0054). Public 

reporting burden for this collection of information is estimated to average per response as follows for each 

component of the collection: Agency Component – 7 hours; Key Indicator Component – 32 hours; Case 

Component – 125 hours. These estimates include the time for gathering and maintaining the data needed and 

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

voluntary. 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, 

U.S. Department of Health and Human Services, 330 C Street, SW, Washington, DC 20201-0008, Attention: 

Stephanie Whittier Eliason, at 202.795.7467 and Stephanie.WhittierEliason@acl.hhs.gov
The Agency Component data will be entered directly onto an online form on the NAMRS website. Once entered, 

the state can update information annually. The reporting period is the federal fiscal year (October–September).

Table 1–General Information

Element No. Element Name Element Description Required Field Entry Format

Agency 1.1 Agency Name 1 Department or agency name Yes Text - 100 characters

Agency 1.2 Agency Name 2 Branch or unit name No Text - 100 characters

Agency 2.1 Street 1 First line street address of agency physical address Yes Text - 100 characters

Agency 2.2 Street 2 Second line street address of agency physical

address

No Text - 100 characters

Agency 2.3 City City of agency physical address Yes Text - 100 characters

Agency 2.4 State State of agency physical address Yes Select from list of

states/territories

Agency 2.5 ZIP ZIP of agency physical address Yes ##### or #####-####

Agency 3.1 Street 1 First line street address of agency mailing address Yes Text - 100 characters

Agency 3.2 Street 2 Second line street address of agency physical

address

No Text - 100 characters

Agency 3.3 City City of agency physical address Yes Text - 100 characters

Agency 3.4 State State of agency physical address Yes Select from list of

states/territories

Agency 3.5 ZIP ZIP of agency physical address Yes ##### or #####-####

Multiple contact names and associated information can be entered.

Agency4.1 Name Contact name Yes Text - 100 characters

Agency 4.2 Title Contact title Yes Text - 100 characters

Agency 4.3 E-mail Contact e-mail Yes E-mail address format

Agency 4.4 Phone Contact telephone Yes Text - 50 characters

Agency 4.5 Contact’s role in

agency

Contact’s role in agency

Selection List:

• Case manager

• Data coordinator/manager

• Field coordinator

• Intake manager/supervisor

• Investigator

• IT/data specialist

• Manager/director/supervisor

• Policy specialist

• Regional supervisor

• Social worker

• Training coordinator/specialist

No Select one from list

A-1
A-2

Table 2–Agency Profile

Element No. Element Name Element Description Required Field Entry Format

Agency 5 Data Sources The sources of information used to submit data this

year to NAMRS.

Selection List:

• APS agency only

• APS and other agencies

No Select one from list

Agency 5.1 Comment Provide names of other agencies that provided data. No Text – 5,000 characters

Agency 6 Population Served Provide the citation in state statute or regulation, or

agency policy, regarding the population your APS

agency is mandated to serve.

No Text – 5,000 characters

Agency 6.1 Population served:

setting

If your agency investigates allegations in residential

care communities and/or nursing homes, please 

indicate whether or not your agency would conduct an 

investigation if the allegation does not pertain to a 

specific resident, but rather to the residents in

general.

No Text – 5,000 characters

Agency 7 Investigator FTEs

filled

Number of filled APS FTEs responsible for the hotline

and/or conducting investigations.

No Numeric – 10 integers

Agency 7.1 Supervisor FTEs

filled

Number of filled APS FTEs responsible for

supervision.

No Numeric – 10 integers

Agency 7.2 Comment Provide additional information as to whether the

numbers in 7 and 7.1 were the annual total or total for 

a given day.

No Text – 5,000 characters

Agency 8 Intake Centralized or localized intake of APS reports.

Selection List:

• Centralized at a statewide hotline or call in 

number

• Combination of both statewide and local hotlines 

or call in numbers

• Local at county or regional hotlines or call in 

numbers

• Other

No Select one from list

Agency 8.1 Comment Provide additional information on your state’s

definition of intake.

No Text – 5,000 characters

Agency 9 Reports Accepted for

Investigation

Number of reports accepted for investigation during

the reporting period.

No Numeric – 10 integers

Agency 9.1 Reports Not

Accepted, or 

Resolved Through 

I&R/I&RA

Number of reports that were either not accepted by

APS for investigation, or were resolved through 

Information & Referral (I&R)/Information & Referral 

Assistance (I&RA).

No Numeric – 10 integers

Agency 9.2 Comment Please confirm that the sum of 9 and 9.1 is the total

number of investigations received during the reporting 

period. Please provide additional information

regarding policy for accepting reports and not 

accepting reports, or resolving through I&R/I&RA.

No Text – 5,000 characters

Agency 10 Response Time The length of time (hours) from receipt of call or

notice of alleged maltreatment to face-to-face contact 

with the client by the APS worker, based on the 

standard set by policy or practice.

No Numeric – 3 integers
A-3

Element No. Element Name Element Description Required Field Entry Format

Agency 10.1 Comment Provide additional information on the definition of

response time to allegations of maltreatment. If 

different types of allegations are given different 

priorities in terms of response time, please provide 

additional information.

No Text – 5,000 characters

Agency 11 Investigation

Completion Time

The length of time (days) from investigation start to

investigation completion, based on the standard set 

by policy or practice.

No Numeric – 3 integers

Agency 11.1 Comment Provide additional information on the definition of start

of investigation and completion of an investigation.

No Text – 5,000 characters

Agency 12 Types of

Maltreatment

Indicate which types of maltreatment are investigated 

by APS.

Selection List:

• Abandonment

• Emotional abuse

• Exploitation (non-specific)

• Financial exploitation

• Other exploitation

• Neglect

• Physical abuse

• Sexual abuse

• Suspicious death

• Self-neglect

• Other

No Select one or more from list

Agency 12.1 Comment Provide citation or URL in state law, regulations, or

program guidance for maltreatment types investigated 

by APS.

No Text – 5,000 characters

Agency 13 Standard of Evidence Standard used for substantiating an allegation of 

maltreatment.

Selection List:

• Clear and convincing

• Credible, reasonable, or probable cause

• Different standards based on type of perpetrator

• No state standard

• Preponderance

• Other

No Select one from list

Agency 13.1 Comment Provide citation or URL of state law, regulations, or

program guidance. Include discussion of definitions of 

perpetrator if relevant.

No Text – 5,000 characters

Agency14 Assessment Tools Indicate whether APS personnel use standard

assessment tools throughout the state, such as client 

safety, at risk factors, or behavioral conditions.

Selection List:

• No, assessment instruments are determined by 

each county or left to the worker’s discretion

• Yes, use common instrument or tool throughout 

the state

No Select one from list

Agency 14.1 Comment Provide the name and reference (i.e., URL) for each

standardized tool that is used.

No Text – 5,000 characters
A-4

Element No. Element Name Element Description Required Field Entry Format

Agency 15 Service Gaps Indicate which services are not available or

accessible in the state.

Selection List:

• Care/Case Management Services

• Caregiver Support Services

• Community Day Services

• Education, Employment, and Training Services

• Emergency Assistance and Material Aid Services

• Financial Planning Services

• Housing and Relocation Services

• In-home Assistance Services

• Legal Services

• Medical and Dental Services

• Medical Rehabilitation Services

• Mental Health Services

• Nutrition

• Public Assistance Benefits

• Substance Use Services

• Transportation

• Victim Services

• Other Services

No Select one or more from list

Agency 15.1 Comment Provide additional information on how gaps in 

services were identified, if possible.

No Text – 5,000 characters

Agency 16 Perpetrators Does APS collect person-specific data on persons

found to be perpetrators of substantiated 

maltreatment? Does your information system collect 

unique IDs and demographic characteristics of such 

persons? If there is specific state statute or regulation, 

or agency policy on such data, please provide the 

citation.

No Text – 5,000 characters