Form 4 Barriers to Service Delivery and Monitoring Form

OMB Control Number: 0970-0467
Expiration Date: 11/30/2018

Trafficking Victim Assistance Program Grantee
Barriers to Service Delivery and Monitoring Form
Grantee
Reporting Period Start Date

Reporting Period End Date

Report Type

Select all barriers to service delivery encountered during the reporting period.
Barriers to Service Delivery Encountered (Check all that apply)
Lack of Adequate Resources

Lack of Adequate Funding

Lack of Adequate Training

Ineffective Coordination with Federal Agencies

Ineffective Coordination with Local Agencies

Language Concerns

Safety Concerns

Lack of Knowledge of Victims' Rights

Lack of Formal Rules and Regulations

Lack of Cooperation of Client

Victims' Legal Status

Feelings of No Support and Isolation

Lack of In-House Procedures

None

Number of Monitoring Visits Conducted

Number of Desk Audits Conducted

Number of Subrecipients that Provided Services

Number of Clients who Received Remote Case
Management

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