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Expiration Date: XX/XX/XXXX
Domestic Victims of Human Trafficking Grantee
Partnership Development and Expansion: Enrollment Form
Grantee:
Reporting Period Start Date
Reporting Period End Date
Report Type
Name of Partner Organization/Agency
City
Enrollment Date
State/Territory
Type of Partner Organization/Agency
Number of Service Sites
Goal of Partnership
Partner Type
Increase Grantee's Capacity to Identify/Serve Victims
Referral Partnership
Increase Clients' Access to a Range of Services
Information Sharing Partnership
Increase Awareness of the Issue of Human Trafficking
Joint Service Programming
Partnership
Increase Sharing of Professional Expertise
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN:
Through this information collection, ACF is gathering data on the grant program to assess program performance, inform evaluation, tailor technical
assistance, report to stakeholders, and inform policy and program development. Public reporting burden for this collection of information is estimated to
average .25 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of
information. This collection of information is required to retain a benefit (22 USC 7105, Trafficking Victims Protection Act). An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless
it displays a currently valid OMB control number. If you have any comments on this collection of information, please contact Flavia Keenan-Guerra, Office
on Trafficking in Persons, by email at Flavia.Keenan-Guerra@acf.hhs.gov.
Services Provided by Subrecipient (in-house)
Basic Necessities
Child Care
Crisis Intervention
Dental Health Services
Education Assistance
Employment Assistance
Family Reunification
Financial Assistance
Housing/Shelter Services
Interpreter/Translator
Legal Advocacy and Services
Life Skills
Mental/Behavioral Health Services
Medical Services
Safety Planning Services
Substance Use Assessment/Treatment
Traditional Healing/Cultural Practices
Transportation
Victim Advocacy
None
Other
Services Provided Through Referral
Basic Necessities
Child Care
Crisis Intervention
Dental Health Services
Education Assistance
Employment Assistance
Family Reunification
Financial Assistance
Housing/Shelter Services
Interpreter/Translator
Legal Advocacy and Services
Life Skills
Mental/Behavioral Health Services
Medical Services
Safety Planning Services
Substance Use Assessment/Treatment
Traditional Healing/Cultural Practices
Transportation
Victim Advocacy
None
Other
| File Type | application/pdf |
| File Modified | 2020-01-21 |
| File Created | 2020-01-21 |