| Grantee and/or Sub-Grantee Agency Profile | Summary of State AV Program Data | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Grantee and/or Sub-Grantee Information OMB Control No: 0970 - 0204 Expiration date: 10/31/2018 |
Service Provided &Client Participation (Values M (Mandatory), V (Voluntary) B (Both) | U, R, B | Client Referral Source | Client Information | Child Support Cases (Required) | Marital Status | Race/Ethnicity | Annual Income | Services Provided | Frequency of Service ( Hours) (Optional) | Outcome#1-Parenting Time (Required) | Outcome#2 - Knowledge of Effective Co-Parenting Strategies (Optional) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Name of Grantee and/or Sub-Grantee | Title of AV Program | Contact Name | Address Line 1 | City | State | Zip | Grant Amount | Grant Period From Date | Grant Period To Date | Mediation | Development of Parenting Plan | Counseling | Parent Education | Neutral Drop-off/Pick-up | Supervised Visitation | Visitation Enforcement | Geographic Area Served | Self | Court | Child Support Agency | Domestic Violence Agency | Child Protection Agency | Other | Data Not Reported | NCP Father | CP Father | NCP Mother | CP Mother | Grandparent/Legal Guardian | Number of Children in Common | NCP Father | CP Father | NCP Mother | CP Mother | Grandparent/Legal Guardian | Never Married to Each Other | Married to Each Other | Separated From Each Other | Divorced From Each Other | Data Not Reported | American Indian or Alaska Native | Asian | Black or African American | Hispanic or Latino | Native Hawaiian or Other Pacific Islander | White | Two or More Races | Data Not Reported | Other | Less than $10,000 | $10,000 to $19,999 | $20,000 to $29,999 | $30,000 to $39,999 | $40,000 & Above | Data Not Reported | Mediation | Development of Parenting Plan | Counseling | Parent Education | Neutral Drop-off/Pick-up | Supervised Visitation | Visitation Enforcement | Mediation | Development of Parenting Plan | Counseling | Parent Education | Neutral Drop-Off/Pick-Up | Supervised Visitation | Visitation Enforcement | NCP Fathers | NCP Mothers | NCP Fathers | CP Fathers | NCP Mothers | CP Mothers |
| GRANTEE NUMBER 1 | TITLE of AV Program 1 | Mike | 123 Easy Street | CITY NAME ONE | SS | 12345 | 300000 | 1/20/1999 | 2/13/2015 | B | M | M | B | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| GRANTEE NUMBER 2 | SPACES | Bhargav | 123 Slow and Annoying street | CITY NAME TWO | SS | 98765 | 456789.5 | 2/13/1998 | 3/15/2020 | V | V | R | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Totals | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| File Type | application/vnd.ms-excel |
| File Modified | 2018-05-14 |
| File Created | 2006-09-16 |