Form 1 Performance Report

PERFORMANCE PROGRESS REPORT

Strengthening Communities Fund, Government Capacity Building Program

Administration for Children and Families, Office of Community Services

U.S. Department of Health and Human Services

Page 2

of 15 Pages

1.Federal Agency and Organization Element to Which Report is Submitted OCS/ACF/DHHS		2. Federal Grant or Other Identifying Number Assigned by Federal Agency      			3a. DUNS Number        3b. EIN      
4. Recipient Organization (Name and complete address including zip code)      					5. Recipient Identifying Number or Account Number      
6. Project/Grant Period			7. Reporting Period End Date		8. Final Report? Yes No
Start Date: (Month, Day, Year)      	End Date: (Month, Day, Year)      		(Month, Day, Year)      		9. Report Frequency
					annual semi-annual quarterly other (If other, describe: __________ ________________________)
10. Performance Narrative      
11. Other Attachments
12. Certification: I certify to the best of my knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
12a. Typed or Printed Name and Title of Authorized Certifying Official      ,      				12c. Telephone (area code, number and extension)      
				12d. Email Address      
12b. Signature of Authorized Certifying Official				12e. Date Report Submitted (Month, Day, Year)      
				13. Agency use only

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

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Cover Page Instructions

Federal Agency and Organization Element to Which Report is Submitted: This form has been populated with the acronyms of the following Federal agency and organizational elements: the Office of Community Services (OCS), Administration for Children and Families (ACF), Department of Health and Human Services (DHHS). You may not change this field.

Federal Grant or Other Identifying Number Assigned by Federal Agency: Enter the grant/award number contained in the award document. This number is found in box 3 of ACF’s “Federal Financial Assistance Award” form.

DUNS: Enter the recipient organization’s Data Universal Numbering System (DUNS) number. This unique identifier is assigned by Dun & Bradstreet and was required for your grant application. You can search for your DUNS number at this website: http://fedgov.dnb.com/webform/displayHomePage.do.

EIN: Enter your Employer Identification Number as assigned by the Internal Revenue Service.

Recipient Organization: Enter the complete legal name and address (including zip code) of the recipient organization.

Recipient Identifying Number or Account Number: Enter the account number or any other identifying number assigned by the recipient to the award. This number is for the recipient's use only and is not required.

Project/Grant Period: Indicate the project period established in the award document during which Federal sponsorship begins and ends. See box 9 of the Financial Assistance Award for this grant.

Reporting Period End Date: Enter the ending date of the reporting period. For quarterly progress reports, the following calendar quarter reporting period end dates shall be used: 3/31, 6/30, 9/30, and 12/31. For final PPRs, the reporting period end date shall be the end date of the project period.

Final Report?: Select Yes or No. Note: The final report is due 90 days after the end of the entire project/grant period. In some cases, the final report may simply finalize information provided in the previous quarterly report.

Report Frequency: The Strengthening Communities Fund requires reporting on a quarterly basis, so the box “quarterly” has already been completed on this form.

Performance Narrative: Provide any significant stories or findings concerning the impact of your project on benefiting organizations, including outcomes where the level of achievement was beyond what was expected. If the narrative exceeds 1500 characters, attach additional pages.

Other Attachments:

Budget Progress - Provide a report on the progress of spending in each budget category from your most recent Financial Assistance Award (FAA). This attachment supplements, but does not replace, the SF-269 Financial Status Report, also due quarterly. See additional instructions under “Budget Progress Attachment” below.

Training and Technical Assistance - Attach information about technical assistance and/or training engagements lasting an hour or longer during the reporting period. See additional instructions under “Training and Technical Assistance Attachment” below.

Certification: The signature of the Authorizing Official is required to certify the accuracy of the performance reports. The Authorizing Official is listed beneath the organization address in box 11 of the Financial Assistance Award letter.

1.Federal Agency and Organization Element to Which Report is Submitted OCS/ACF/DHHS		2. Federal Grant or Other Identifying Number Assigned by Federal Agency		3a. DUNS Number       3b. EIN	4. Reporting Period End Date (Month, Day, Year)
A. Additional Grantee Information
(1) Label	(2) Additional Information on Grantee or Grant Project		(3) Provide Grantee or Grant Project Information Requested:
Grantee	Contact Person, Email Address, & Telephone		a) Name:             b) Email address:       c) Telephone:      
Grantee	Organization Profile		a) Organization type: b) Number of paid full-time equivalents:       c) Annual operating budget: d) Previous Federal funding history:
Grant Project	Social Service Priorities		Comment:      
Grant Project	Geographic Scope		      State:       Comment:      
Grant Project	Relationship to Other Federal Initiatives		Weed and Seed: TANF: VISTA: Other: Description of relationship:      

This section of the form collects standard information about your organization and project.

Contact Person, Email Address, & Telephone: There are four fields in this box: You must enter:

a) the first and last name of someone that can be contacted about your report.

b) the contact person’s email address, and

c) the contact person’s area code and phone number.

Organization Profile: There are four fields in this box. You must enter:

a) your organization’s type (by selecting an organization type from the list),

b) your organization’s number of paid full-time staff equivalents (FTEs),

c) your organization’s annual operating budget (by selecting a budget range from the list), and

d) whether or not your organization has previously received Federal funding (by selecting from the list).

Social Service Priorities: Enter the primary focus of the project consistent with the approved work plan by selecting from the list. If there are other priorities, describe them in the Comments field.

Geographic Scope: You can use the text box to enter a brief description of the geographic area served by the project, usually the name of a county, city, or town. Select the state from the list. The geographic scope must be consistent with the approved work plan, but you may write comments regarding any issues with the approved scope.

Relationship to Other Federal Initiatives: Select the checkboxes that correspond to other Federal initiatives your project may be involved with. You may describe your project’s relationship to the other initiatives in the Description field.

1.Federal Agency and Organization Element to Which Report is Submitted OCS/ACF/DHHS			2. Federal Grant or Other Identifying Number Assigned by Federal Agency				3a. DUNS Number       3b. EIN			4. Reporting Period End Date (Month, Day, Year)
B. Capacity-Building Services Provided
(1) Label	(2) Objective/Goal Description	(3) Measure		(4) Base line	(5) Target Year	(6) Project Target		(7) Actual To Date	(8) Explanation
Output Measure	Provide outreach & information	Estimated number of organizations reached		N/A	2011	     		     	            since last report
Output Measure	Provide technical assistance	Number of hours provided		N/A	2011	     		     	            since last report
Output Measure	Provide technical assistance	Number of organizations assisted		N/A	2011	     		     	            since last report
Output Measure	Provide training	Number of hours provided		N/A	2011	     		     	            since last report
Output Measure	Provide training	Number of organizations assisted		N/A	2011	     		     	            since last report

This section of the form collects information about the capacity-building services provided through the end of the reporting period. These services may be:

• Outreach and information: Services aimed at increasing the involvement of nonprofit organizations in economic recovery. Outreach can be done through face-to-face meetings, group education, use of website, email, mass media, print material, or other methods.

• Technical assistance: One-on-one consultation specifically customized or tailored to needs of its recipients and aimed at building the capacity of nonprofit organizations to address the broad economic recovery issues present in their communities.

• Training: Group-based adult education or skill-building activities (such as workshops) aimed at building the capacity of nonprofit organizations to address the broad economic recovery issues present in their communities.

Provide outreach & information (Estimated number of organizations reached)

Project Target: Enter the estimated number of organizations that will be reached by the end of the project according to the approved work plan.

Actual To Date: Enter the estimated number of organizations reached through the end of the reporting period.

Provide technical assistance (Number of hours provided)

Project Target: Enter the number of hours of technical assistance to be provided by the end of the project according to the approved work plan.

Actual To Date: Enter the total number of hours of technical assistance provided through the end of the reporting period.

Provide technical assistance (Number of organizations assisted)

Project Target: Enter the number of organizations to be assisted by the end of the project according to the approved work plan.

Actual To Date: Enter the total number of organizations that the project has assisted through the end of the reporting period. Count each organization only once.

Provide training (Number of hours provided)

Project Target: Enter the number of hours of training to be provided by the end of the project according to the approved work plan.

Actual To Date: Enter the total number of hours of training that the project has supported through the end of the reporting period. Do not multiply the length of a training event by the number of attendees.

Provide training (Number of organizations assisted)

Project Target: Enter the number of organizations to be trained by the end of the project according to the approved work plan.

Actual To Date: Enter the total number of organizations trained through the end of the reporting period. Count each organization only once.

Explanation (8)

You may provide an explanation of your accomplishments, or the variance between your target and actual accomplishments for this reporting period, in this column. Other fields in this column may display information derived from previous reports, and may not be applicable.

1.Federal Agency and Organization Element to Which Report is Submitted OCS/ACF/DHHS		2. Federal Grant or Other Identifying Number Assigned by Federal Agency		3a. DUNS Number       3b. EIN		4. Reporting Period End Date (Month, Day, Year)
C. Internal Capacity Building
(1) Activity Label	(2) Activity Description & Extent of SCF support		(3) Status		(4) Explanation
     	           		     		     
     	           		     		     

This section of the form collects information about progress in improving the internal capacity of grantee organization through the end of the reporting period.

Activity Label (1)

For each planned capacity building activity, enter one of the SCF capacity-building activities from the list below, or enter “Other.” Click on “Add Row” to add additional activities.

Leadership Development

• Create a volunteer management plan

• Create a volunteer recruitment plan

• Create board policies

• Create an executive succession plan

• Engage an executive coach

• Implement a volunteer management plan

• Provide management/leadership training to staff

• Provide training/written information for board of directors

• Recruit board members

• Recruit volunteers (non-board)

Organizational Development

• Create a staff performance review process

• Create a strategic plan

• Create financial management procedures/improve internal controls

• Create job descriptions

• Create marketing materials

• Create/revise organizational identity

• Create/update an annual report

• Implement a new accounting system

• Implement a new budgeting process

• Implement a staff performance review process

• Implement new financial management procedures

• Incorporate as a legally recognized organization

• Install IT infrastructure

• Obtain 501(c)(3) status with the IRS

• Create a revenue development plan

• Identify potential funding sources

• Implement donor tracking software

• Provide revenue development training to staff

Program Development

• Obtain program-related equipment and durable supplies

• Research and develop new programs or services

• Take steps to expand current services to new geographic area

• Take steps to increase the effectiveness of existing services

• Take steps to increase the number of clients served in existing geographic area

• Take steps to increase the number or scope of services

• Take steps to reach an underserved population in existing geographic area

Collaboration and Community Engagement

• Assess effectiveness of existing collaborative efforts

• Conduct assessment of community needs

• Create a map/inventory of community assets

• Create action plan for coordinating/collaborating

• Create or update a brochure

• Create or update a website

• Create processes for collaborating with partners

• Develop new strategic partnerships

• Establish partnership agreements

• Make presentations to community groups

Evaluation of Effectiveness

• Implement systems to keep information related to client needs, referral sources, and services provided

• Implement systems to keep records on service recipient satisfaction and/or service recipient outcomes

• Collect information related to service recipient outcomes

• Collect information related to service recipient satisfaction

• Analyze outcome data/evaluate effectiveness of current services

• Create an outcome measurement plan

Activity Description & Extent of SCF Support (2)

Enter a brief description for the capacity-building activity. If the activity is partially funded with non-grant funds, explain how costs will be allocated, especially if part of the activity is not allowed under SCF guidelines or Federal regulations.

Status (3)

Indicate the status of each capacity-building activity (either complete or in progress) by making a selection from the list. Enter an end date (in the form MM/DD/YYYY) for each activity that has been completed. For an activity that is still in progress, enter the estimated amount of the activity that has been completed as a percentage (for example, 50%).

Explanation (4)

If you wish, you may provide an explanation of the status of your organization’s activities.

1.Federal Agency and Organization Element to Which Report is Submitted OCS/ACF/DHHS			2. Federal Grant or Other Identifying Number Assigned by Federal Agency		3a. DUNS Number       3b. EIN	4. Reporting Period End Date (Month, Day, Year)
D. Concerns/Problems
(1) Label	(2) Activity Description	(3) Deviation, Lesson, or Concern?		(4) Explanation
Outreach				     
Training				     
Technical Assistance				     
Grant Management				     
Use of Technology				     
Other				     

This section of the form collects information about challenges your project faced during the reporting period. Identify each challenge as a deviation, lesson, or concern.

• Deviation refers to any change from your approved project plan.

• Lesson refers to practical knowledge gained when implementing a practice that did not go well.

• Concern refers to an ongoing situation that may affect project performance.

Deviation, Lesson, or Concern (3)

For each of the activities listed in the first column, identify your concern or problem as a deviation, lesson, or concern by making a selection from the list. If there is nothing to report in this area, select “None.”

Explanation (4)

Enter a brief description for each concern or problem. For deviations, please indicate whether you have discussed the deviation with your program specialist.

1.Federal Agency and Organization Element to Which Report is Submitted OCS/ACF/DHHS		2. Federal Grant or Other Identifying Number Assigned by Federal Agency		3a. DUNS Number       3b. EIN		4. Reporting Period End Date (Month, Day, Year)
E. Promising Practices
(1) Label	(2) Activity Description		(3) Indicator		(4) Explanation
Outreach	     		     
Training	     		     
Technical Assistance	     		     
Grant Management	     		     
Use of Technology	     		     
Other	     		     

This section of the form collects information about practices used to successfully implement your project. A promising practice is a program, activity, or strategy that has worked in an organization, which has an objective basis for claiming effectiveness, as well as the potential for replication.

Activity Description (2)

For each of the categories listed in the first column, describe any practices that have worked well for your project.

Indicator (3)

Briefly describe what indicates that this practice is successful.

1.Federal Agency and Organization Element to Which Report is Submitted OCS/ACF/DHHS			2. Federal Grant or Other Identifying Number Assigned by Federal Agency			3a. DUNS Number       3b. EIN		4. Reporting Period End Date (Month, Day, Year)
F. Capacity-Building Activities Completed and Outcomes
(1) Benefiting Organization	(2) Activities Completed	(3.1) Increase in persons served		(3.2) Expansion of service	(3.3) Improved success rate		(3.4) Interagency Collaboration
     	     	     		:      	     		:      
     	     	     		:      	     		:      

This section of the form collects information on the completion of standard capacity building activities by the grantee or organizations receiving more than ten hours of technical assistance. It also collects information on the outcomes resulting from those capacity building activities.

Benefiting Organization (1)

In the first column enter the name of the grantee or another organization receiving more than ten hours of technical assistance through the project. Click the “Add Row” button to add additional rows.

Activities Completed (2)

For each benefiting organization, enter the SCF-supported capacity-building activities completed during the project period by selecting them from the list.

Leadership Development

• Create a volunteer management plan

• Create a volunteer recruitment plan

• Create board policies

• Create an executive succession plan

• Engage an executive coach

• Implement a volunteer management plan

• Provide management/leadership training to staff

• Provide training/written information for board of directors

• Recruit board members

• Recruit volunteers (non-board)

Organizational Development

• Create a staff performance review process

• Create a strategic plan

• Create financial management procedures/improve internal controls

• Create job descriptions

• Create marketing materials

• Create/revise organizational identity

• Create/update an annual report

• Implement a new accounting system

• Implement a new budgeting process

• Implement a staff performance review process

• Implement new financial management procedures

• Incorporate as a legally recognized organization

• Install IT infrastructure

• Obtain 501(c)(3) status with the IRS

• Create a revenue development plan

• Identify potential funding sources

• Implement donor tracking software

• Provide revenue development training to staff

Program Development

• Obtain program-related equipment and durable supplies

• Research and develop new programs or services

• Take steps to expand current services to new geographic area

• Take steps to increase the effectiveness of existing services

• Take steps to increase the number of clients served in existing geographic area

• Take steps to increase the number or scope of services

• Take steps to reach an underserved population in existing geographic area

Collaboration and Community Engagement

• Assess effectiveness of existing collaborative efforts

• Conduct assessment of community needs

• Create a map/inventory of community assets

• Create action plan for coordinating/collaborating

• Create or update a brochure

• Create or update a website

• Create processes for collaborating with partners

• Develop new strategic partnerships

• Establish partnership agreements

• Make presentations to community groups

Evaluation of Effectiveness

• Implement systems to keep information related to client needs, referral sources, and services provided

• Implement systems to keep records on service recipient satisfaction and/or service recipient outcomes

• Collect information related to service recipient outcomes

• Collect information related to service recipient satisfaction

• Analyze outcome data/evaluate effectiveness of current services

• Create an outcome measurement plan

Increase in persons served (3.1)

Enter the increased number of clients served by the benefiting organization. This increase may be based on an average number of clients served during a relevant period (daily, weekly, monthly, or quarterly) or on the total number served during a particular year.

Expansion of service (3.2)

If the benefiting organization has expanded its services, indicate the type of expansion by making a selection from the list. Enter a brief description (one or two sentences).

Improved success rate (3.3)

Enter a brief description (one or two sentences) of the benefiting organization’s improved success rates in achieving desired social service outcomes. If you have more information, you may include it in your Performance Narrative (entered in section 10 of the Cover Page).

Interagency Collaboration (3.4)

If the benefiting organization has contributed staff time, money, or volunteers to an inter-organizational effort, you should indicate the results of the collaboration by making a selection from the list. Enter a brief description (one or two sentences). The organization’s participation in the collaborative effort must be attributable to the SCF project, and efforts that would have occurred in the SCF project’s absence should not be reported.

Training and Technical Assistance Attachment

Grant Number:

Organization Name:

Reporting Period End Date:

Attach information about technical assistance and/or training engagements lasting one hour or longer during the reporting period. The attachment should include dates of engagements, location, the type of organization(s) served, technical assistance or training methods used, and the capacity building needs identified or addressed. It should also provide the name of the organization assisted (if technical assistance), or the number of organizations attending (if training).

Any format is allowable. Below are instructions for this template.

TTA Method (1) - List technical assistance or training methods: needs assessment, one-on-one expert coaching, or training workshop.

Date (2) - Provide the date of engagement.

Location (3) - Provide the city and state.

# of organizations (4) or name of organization assisted (5) – For training events, provide the number of organizations attending. If one-on-one assistance is provided, enter the name of organization assisted.

Type (6) - Indicate if the organization is a faith-based charity (FBO) or secular non-profit (CBO), a subrecipient or a non-subrecipient

Capacity building needs identified or addressed (7) —Identify critical area of capacity building and focus of improvements.

Sample Training and Technical Assistance Engagements Table
(1) TTA method	(2) Date	(3) Location	(4) # of orgs	(5) Name of organization assisted	(6) Type	(7) Capacity building needs identified/ addressed
needs assessment	5/12/06	Jacksonville, FL	1	READ, Inc.	FBO, sub-awardee	comprehensive assessment
grants training	6/30/06	Palm Beach, FL	50	N/A	N/A	Organizational development, Revenue development training

Budget Progress Attachment

Grant Number:

Organization Name:

Reporting Period End Date:

Federal Share - Indicate the progress of spending through the end of the reporting period in each budget category from your most recent Financial Assistance Award (FAA) letter, box 16. This approved budget may be different from the budget you submitted in your original application. Provide names of staff, contractors, and consultants where applicable.

Non-Federal Share (Cost sharing/match) - Provide the amount of spending on the total non-federal share of project budget, as documented in the grant application and subsequent continuation applications. The final progress report must substantiate the total non-federal match for the entire project. Failure to provide required match will result in the disallowance of Federal expenditures in proportion to the shortage of matching funds expended. 

NOTE: Box 17 of the FAA reflects the minimum non-federal share for all program applicants. However, the grantee is responsible for the proposed applicant share, found on the Budget Information section of the Application for Federal Assistance, SF-424A.

SF-269 - The budget progress attachment supplements the SF-269. Be sure to also submit a complete, signed SF-269 Financial Status Report form.

Sample Table - The table below is a sample; you may provide the information in a spreadsheet or other file format. Be sure to indicate the grant number, organization name and reporting period.

Sample Budget Progress Table
Budget Category	Staff/Recipient Name	Approved Budget (FAA)	Amount Spent	Under/Over Spending	Approaches to Address Variations
Personnel does not include the costs of consultants
Fringe Benefits health insurance, FICA, retirement insurance, taxes, etc.	No Data Requested
Travel costs for key staff to attend trainings or workshops	No Data Requested
Equipment nonexpendable property having a useful life of more than one year and an acquisition cost <$5,000 per unit	No Data Requested
Supplies property valued at less than $5,000 per item	No Data Requested
Contractual payments to other organizations, not individuals
Other consultants and professional services; space and equipment rental; printing and publication; local travel; training costs; administrative costs
Indirect Costs	No Data Requested
Total Federal Share

	Staff / Recipient Name	Proposed Cost Share (SF-424A)	Amount Spent	Under/Over Spending	Approaches to Address Variations
Total Non-Federal Share

SCF-GOV SF-PPR Cover Page OMB Control No. 0970-0376

Expiration: 10/31/2010