One PPR Template

OMB Control Number 0985-0063
Expiration 04/30/2022

ONE PPR
Annual Program Performance Report (PPR)
Annual Statement of Goals and Priorities (SGP)

PADD
PAAT
PATBI
PAVA
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reporting burden for this collection of information is estimated to average hours per response,
including time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of inf ormation. The
obligation to respond to this collection is required to obtain or retain benefit (P.L. 105-220
Section 410 Workforce Investment Act).

1

OMB Control Number 0985-0063
Expiration 04/30/2022

Part 1: Demographics
Interventions on behalf of Individuals
The following subsections include demographic information for the seven intervention strategy
types listed in Part I.F.

A. Individuals Served
What to Count
1. Individuals served as of October 1 (Carried over from previous
FY).
2. Additional individuals served during the year.
3. Total individuals served during the year (Add lines A1 and A2).
4. Individuals with more than one (1) intervention opened/closed
FY.
5. Individuals served as of September 30 (Carry over to next FY; ≤
A3).

PADD

PAAT

PATBI

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

PADD

PAAT

PATBI

PAVA

X

X

X

B. Problem Areas/Complaints of Individuals
Served
Problem Area/Complaint
1. Abuse (total)
a) 1. Inappropriate Use of Restraint & Seclusion
b) 2. Involuntary Treatment
c) 3. Physical, Verbal, & Sexual Assault
d) 4. Excessive Medication
e) 5. Financial Exploitation
f) 6. Other
2. Access to Administrative or Judicial Processes
3. Access to Records
4. Advance Directives
5. Architectural Accessibility
6. Assistive Technology Device Procurement
a) 1. Augmentative Communication Devices
2

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X
X

X

X

X

X

OMB Control Number 0985-0063
Expiration 04/30/2022
X

b) 2. Durable Medical Equipment

X

c) 3. Vehicle Modification/Transportation

X

d) 4. Other Device

X

X
X

X
X

X
X

7. Aversives (including ECT)

X

X

8. Civil Commitment
9. Criminal Justice
10. Custody/Parental Rights
11. Education (total)

X

X

X

X

X

X

X

a) 1. FAPE: IEP/IFSP Planning/Development/Implementation
b) 2. FAPE: Discipline/Procedural Safeguards

X
X

X

X
X

X

X

X
X

c) 3. FAPE: Eligibility

X

d) 4. FAPE: Least Restrictive Environment

X

e) 5. FAPE: Multi-disciplinary Evaluation/Assessments

X

X
X

X
X

X
X

f) 6. FAPE: Transition Services

X

X
X

g) 7. Other

X

12. Employment Discrimination (total)

X

a) 1. Benefits

X
X
X

X

X
X

X

b) 2. Hiring/Termination

X

X
X

c) 3. Reasonable Accommodations

X

d) 4. Service Provider Issues

X

X
X

X
X

e) 5. Supported Employment

X

X
X

f) 6. Wage and Hour Issues

X

g) 7. Other

X

X
X

13. Employment Preparation
14. Financial Benefits (total)
a) 1. SSDI Work Incentives
b) 2. SSI Eligibility
c) 3. SSI Work Incentives
d) 4. Social Security Benefits Cessation

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X
3

X

X

OMB Control Number 0985-0063
Expiration 04/30/2022

e) 5. Work Related Overpayments
6. Welfare Reform
7. Other Financial Entitlements
15. Forensic Commitment
16. Government Benefits/Services
17. Guardianship/Conservatorship/Substitute Decision Maker
18. Home & Community Based Services including Discharge
Planning Transition Follow-up
19. Healthcare (total)
a) 1. General Healthcare
b) 2. Medicaid
c) 3. Medicare
d) 4. Private Medical Insurance
e) 5. Other
20. Housing (total)

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X
X

X
X

X
X

X

X

X

X

X

X

X

X

X

X

X
X

X

a) 1. Accommodations

X

b) 2. Architectural Barriers

X

X
X

X
X

c) 3. Landlord/Tenant

X

X
X

d) 4. Modifications

X

X
X

e) 5. Rental Denial/Termination

X

f) 6. Sales/Contracts/Ownership

X

X
X

X
X

g) 7. Subsidized Housing/Section 8

X

X
X

h) 8. Zoning/Restrictive Covenants

X

i) 9. Other

X

X
X

21. Immigration
22. Juvenile Justice
23. Neglect (total)
a) 1. Failure to Provide Necessary or Appropriate Medical
Treatment
b) 2. Failure to Provide Necessary or Appropriate Mental
Health Treatment
c) 3. Failure to Provide Necessary or Appropriate Personal
Care & Safety
4

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

OMB Control Number 0985-0063
Expiration 04/30/2022

d). Other
24. Post-Secondary Education
25. Non-Medical Insurance
26. Privacy Rights
27. Public Accommodations
28. Rehabilitation Services (total)

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X
X

X

a) 1. Communications Problems (Individuals/Counselor)

X

b) 2. Conflict About Services To Be Provided

X

c) 3. Individual Request Information

X

X
X

X
X

X
X

d) 4. Non-Rehabilitation Act

X

X
X

e) 5. Private Providers

X

f) 6. Related to Application/Eligibility Process

X

g) 7. Related to IPE Development/Implementation

X

X
X

X
X

X
X

h) 8. Related to Title I of ADA

X

i) 9. Other Rehabilitation Act-related problems
29. Suspicious Death
30. Transportation (total)

X
X

X

X

X
X

X
X

X

X

X

X

X

X

X

X

X

X

X

a) 1. Air Carrier

X

b) 2. Paratransit

X

c) 3. Public Transportation

X

X
X
X

d) 4. Other

X

31. Unnecessary Institutionalization including identification and
assessment
32. Voting (total)
a) 1. Accessible Polling Place/Equipment
b) 2. Registration to Vote
c) 3. Casting a Ballot
d) 4. Voter Eligibility/Competency Issues
e) 5. Other Voting Issues
33. Other

5

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

OMB Control Number 0985-0063
Expiration 04/30/2022

C. Gender of Individuals Served
PADD

PAAT

PATBI

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

PADD

PAAT

PATBI

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

6. Foster Care
7. Nursing Homes, Including Skilled Nursing Facilities (SNF)
8. Intermediate Care Facilities (Icf)
9. Public And Private General Hospitals including Emergency
Rooms

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

10. Public Institutional Living Arrangement
11. Private Institutional Living Arrangement
12. Psychiatric Wards (Public Or Private)
13. Jail
14. State Prison
15. Federal Detention Center
16. Federal Prison
17. Veterans Administration Hospital/Clinic
18. Other Federal Facility
19. Homeless
20. Unknown
TOTAL

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

Gender
1. Female
2. Male
TOTAL

D. Living Arrangements of Individuals Served
Living Arrangement
1.
2.
3.
4.

Independent
Parental r Other Family Home
Community Residential Home for Children/Youth (0-18 Yrs.)
Community Residential Home for Adults

5. Non-Medical Community Based Residential Facility for
Children and Youth

E. Reasons for Closing Individual Intervention
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OMB Control Number 0985-0063
Expiration 04/30/2022

Files
Reasons for Closing Individual Advocacy Case File

PADD

PAAT

PATBI

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

PAAT
X

PATBI
X

PAVA

1. Number of Closed Cases in which Client’s Objective Was Partially or Fully
Met
2. Some Issues Resolved in Client’s Favor

3. Other Representation Found
4. Individual Withdrew Complaint
5. Services Were Not Needed Due To Client’s Death or
Relocation
6. P&A Withdrew Because Individual or Client Would Not
Cooperate
7. Individual’s Case Lacked Merit
8. Individual’s Issue Not Favorably Resolved
9. Appeal(s) Unsuccessful

Reason for Closing Individual Investigation File

PADD

1. Complaint was Withdrawn

X

2. Other Appropriate Entity Investigating

X

X

X

X

X

X

X

X

X

X

X

PADD
X

PAAT
X

PATBI
X

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

5. Mediation/Alternative Dispute Resolution

X

X

X

X

6. Litigation
TOTAL (1-6)

X

X

X

X

X

X

3. P&A withdrew because Individual or Client Would Not
Cooperate

X

4. Investigation completed
TOTAL

Individual Advocacy Service
1.
2.
3.
4.

Self-Advocacy Assistance
Limited Advocacy
Administrative Remedies
Negotiation

Individual Investigation Service
7

X

OMB Control Number 0985-0063
Expiration 04/30/2022

7. Individual Investigation
TOTAL (1-7)

X

x

X

X

X

X

PADD

PAAT

PATBI

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

PADD
X

PAAT
X

PATBI

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

9. Cancer

X

X

X

10. Cerebral Palsy

X

X

X

11.
12.
13.
14.
15.
16.

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

G. Age Range of Individuals Served
Range
1. 0 – 2
2. 3 – 5
3. 6 – 10
4. 11 – 22
5. 23 – 64
6. 65 & Over
TOTAL

PAVA

H. Primary Disability of Individuals Served
Primary Disability
1. Absence of Extremities
2. Acquired Brain Injury
3. ADD/ADHD
4. AIDS/HIV Positive
5. All Other Disabilities
6. Autism
7. Auto-immune (non-AIDS/HIV)
8. Blindness (Both Eyes)

Deafness
Deaf-Blind
Diabetes
Digestive Disorders
Epilepsy
Genitourinary Conditions
8

X

OMB Control Number 0985-0063
Expiration 04/30/2022

17. Hearing Impaired (Not Deaf)/Hard of Hearing
18. Heart & Other Circulatory Conditions
19. Intellectual Disability
20. Mental Illness
21. Multiple Sclerosis
22. Muscular Dystrophy
23. Muscular/Skeletal Impairment
24. Orthopedic Impairments
25. Other Emotional/Behavioral
26. Other Visual Impairments (not blind)
27. Neurological Disorders/Impairments
28. Respiratory Disorders/Impairments
29. Skin Conditions
30. Specific Learning Disabilities (SLD)
31. Speech Impairments
32. Spina Bifida
33. Substance Use (Alcohol or Drugs)
34. Tourette Syndrome
35. Traumatic Brain Injury (TBI)
TOTAL

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X
X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

PADD

PAAT

PATBI

X

X

X

X

PADD

PAAT

PATBI

PAVA
X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

I. Racial and Ethnic Diversity of
Individuals Served
State
%

Race/Ethnicity
1. Hispanic/Latino (of any race)

State
%

(NOT Hispanic/Latino)
2. American Indian/Alaskan Native

PAVA

X

3. Asian

X

4. Black/African American

X

5. Native Hawaiian/Other Pacific Islander

X

6. White
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OMB Control Number 0985-0063
Expiration 04/30/2022
X

7. Two or more races
8. Race/Ethnicity Unknown

10

X

X

X

X

X

X

X

OMB Control Number 0985-0063
Expiration 04/30/2022

Intervention Benefitting
Groups
J. Groups Served
PADD
X

PAAT
X

PATBI
X

PAVA
X

X

X

X

X

X

X

X

X

4. Total group cases/projects as of September 30.
(Carry over to next FY)

X

X

X

X

5. Group cases/projects targeted at serving
racial/ethnic minority(ies).
6. Total # of individuals potentially impacted by the
line I.J.3 projects/cases.

X

X

X

X

X

X

X

X

PADD
X
X

PAAT
X
X

PATBI
X
X

PAVA

X
X

X
X

X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X

X
X

X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

1. Group cases/projects still open at October 1.
(Carried over from prior FY(s))
2. New group cases/projects opened during the
year.
3. Total group cases/projects worked on during the
year. (Add lines I1 and I2)

K. Problem Areas
Problem Area/Complaint
1. Abuse
2. Access to Administrative or Judicial Processes
3. Access to Records
4. Advance Directives
5. Architectural Accessibility
6. Assistive Technology
7. Aversives (including ECT)
8. Civil Commitment
9. Custody/Parental Rights
10. Education
11. Employment Discrimination
12. Employment Preparation
13. Financial Benefits
a) SSDI Work Incentives
b) SSI work Incentive
14. Forensic Commitment
15. Government Benefits/Services
16. Guardianship/Conservatorship/Substitute
11

X

X
X

X

OMB Control Number 0985-0063
Expiration 04/30/2022
Decision Maker
17. Home & Community Based Services including
Discharge Planning Transition Follow-up
18. Healthcare
a)Medicaid
b)Medicare
c)Private Medical Insurance
d)Other
19. Housing
20. Immigration
21. Neglect
22. Post-Secondary Education
23. Non-Medical Insurance
24. Privacy Rights (same question from individual)
25. Rehabilitation Services
26. Suspicious Death
27. Transportation
28. Unnecessary Institutionalization including
Identification and Assessment
29. Voting

X

X

X

X

X

X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X

X
X

X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

X
X
X

X

X

X

X

a) Accessible polling Place/Equipment

X

X

X

X

b)Registration

X

X

X

X

e)Other Voting Issue

X

X

X

x

c)Casting a Ballot

X

X

x

x

d)Voter Eligibility/Competency

x

X

x

x

30. Other (PADD/PAAT/PATBI PAVA) Issue

X

X

X

X

PADD
X

PAAT
X

PATBI
X

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

L. Group Cases by Living
Arrangement
Living Arrangement
1. Independent
2. Parental or Other Family Home
3. Community Residential Home for Children/youth
(0-18 yrs.)
4. Community Residential Home for Adults

12

X

OMB Control Number 0985-0063
Expiration 04/30/2022
5. Non-medical Community Based Residential
Facility for Children and Youth
6. Foster care

X

X

X

X

X

X

X

X

7. Nursing Homes, including Skilled Nursing
Facilities (SNF)
8. Intermediate Care Facilities (ICF)

X

X

X

X

X

X

X

X

9. Public and Private General Hospitals including
Emergency Rooms
10. Public Institutional Living Arrangement

X

X

X

X

X

X

X

X

11. Private Institutional Living Arrangement

X

X

X

X

12. Psychiatric Wards (Public Or Private)

X

X

X

X

13. Jail

X

X

X

X

14. State Prison

X

X

X

X

15. Federal Detention Center

X

X

X

X

16. Federal Prison

X

X

X

X

17. Veterans Administration Hospital

X

X

X

X

18. Other Federal Facility

X

X

X

X

19. Homeless

X

X

X

X

20. Not Applicable – Intervention not Focused on a
Particular Living Arrangement
TOTAL

X

X

X

X

X

X

X

X

PADD

PAAT

PATBI

PAVA

X

X

X

X

2. Concluded Unsuccessfully

X

X

X

X

3. Other

X

X

X

X

X

X

X

X

M. Reasons for Closing Group
Cases/Projects
Reason
1. Concluded Successfully

TOTAL

N. Intervention Strategies Used in Group
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OMB Control Number 0985-0063
Expiration 04/30/2022

Cases/Projects
PADD
X
X
X

PAAT
X
X
X

PATBI
X
X
X

PAVA

4. Issuance of Public Report

X

X

X

X

4. Other Systemic Advocacy

X

X

X

X

TOTAL

X

X

X

X

PATBI
X

PAVA

Intervention Strategy
1. Abuse and Neglect Investigation
2. Systemic Litigation
3. Educating Policymakers

X

O. Group Advocacy by Age Focus
Focus
PADD PAAT
1. Group Cases/Projects Focused on Children
X
X
Approximately 0-2 yrs. old
2. Group Cases/Projects Focused on Children
X
X
Approximately 3-5 yrs. old
X
X
3. Group Cases/Projects Focused on Young People
Approximately 6-10 yrs. old
X
X
4. Group Cases/Projects Focused on Young People
Approximately 11-22 yrs. old
X
X
3. Group Cases/Projects Focused on Adults
Approximately 23—64 yrs. old
X
X
4. Group Cases/Projects Focused on Seniors
Approximately 65 yrs. & older
5. Not Applicable – Intervention Not Focused on Any
X
X
Particular Age Range Grouping

X
X
X

X

X

X

X

X

X

X

X

X

X

X

PADD
X

PAAT
X

PATBI
X

PAVA
X

2. American Indian/ Alaskan Native

X

X

X

X

3. Asian

X

X

X

X

4. Black/African American

X

X

X

X

TOTAL

P. Race/Ethnicity of Groups Served
Race/Ethnicity
1. Hispanic/Latino (of any race)

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OMB Control Number 0985-0063
Expiration 04/30/2022
5. Native Hawaiian/Other Pacific Islander

X

X

X

X

6. White

X

X

X

X

7. Two or more races

X

X

X

X

8. Unknown

X

X

X

X

Part 2: Statement of Goals and Priorities
A. Report on FY 20__ (Previous Year) Statement of Goals and
Priorities (SGP)
1. Goal Number:
Goal Statement:

___PADD

___PAAT

___PATBI

___PAVA

2. Priorities (Add rows below if needed)
#

Priority

1
___PADD

___PAAT

___PATBI

___PAVA

___PADD

___PAAT

___PATBI

___PAVA

___PADD

___PAAT

___PATBI

___PAVA

2

3

15

OMB Control Number 0985-0063
Expiration 04/30/2022
3. Strategies Used to Implement Goal and Address Priorities (Check all that apply below)
□ Collaboration

□ Systemic Litigation1

dd□ Rights-Based Individual Advocacy Services

□ Educating Policy Makers

□ Investigations of Abuse and Neglect

□ Other Systemic Advocacy

□ Monitoring

□ Training/Outreach

□ Issuance of Public Report
4. Extent to Which Goal was Achieved (Check one below)
□ Not Achieved

□ Partially Achieved

□ Achieved

□ No Results This Year

5. Stage of Implementation (Check one below)
□ Planning

□ Initiation

□ Implementation

□ Outcome/Fully Integrated

6. Results Narratives of P&A Activities and Accomplishments Related to Above Goal 2
List goal and priority #(s) addressed in the activity described in the narrative below.

Goal #(s): 1
___PADD

Priority #(s):
___PAAT

___PATBI

___PAVA

Collaborator(s):
Underserved/Unserved/Minorities Targeted? ☐ Yes ☐ No (If yes, describe in narrative).

1

2

This selection does not apply to PAVA.
A results narrative is a story which presents relevant information pertinent to each goal and its priorities about

an individual or group case/project which is being pursued or was pursued with the intent of achieving a
result/outcome. A grantee may submit multiple narratives.

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Choose performance measures from Part III here for activity described above in this Results Narrative
Performance measurement

Other Qualitative Narrative Related to the Above Goal
Significant activity for which there were no quantifiable results goes here.

Describe any other significant activity related to this goal

17

Number

OMB Control Number 0985-0063
Expiration 04/30/2022

B. Priority Setting Process3
Complete this section by providing a thorough description of how the P&A conducts priority setting
process (e.g., methods) used to develop the goals and priorities for the fiscal years covered in your
multiyear plan. Revise based on public input on an annual basis with the idea that major changes will be
made when it is time for a new multiyear plan.

1. Means by which the P&A conducted data-driven strategic planning, including formal public input
(Check all that apply below)
Public
Hearing

Public
Comment

☐

☐

Experience

Focus
Groups

☐

Advisory
Council(s)

Monitoring
Visits

☐

☐

Research/Data

☐

☐

Narrative (describe how the P&A conducted data driven strategic planning):

3

The P&A will submit periodically a thorough description of the methods used for the priority setting process, and
then annually indicate whether they have changed the methods used for the priority setting process. If it has
changed, they would need to include a full description of the changes.

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2. Number of days for public comment:
3. A copy of the proposed SGP for comment was provided to the: 4
State Council on Developmental Disabilities: Yes/No
The University Centers for Excellence in Developmental Disabilities Education, Research and
Service: Yes/No

4. Describe efforts to assure diversity (disability, geographic, racial, etc.) in the data-driven strategic
planning process

5. Summary of Findings

6. Summary of How Data was used to Develop P&A Goals and Priorities (include how priority input
used, including input from the DDC and UCEDD)5

4
5

This question is only required for PADD.
This question is only required for PADD.

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5. List of topic areas of additional priorities that would be listed but are not due to lack of resources.

C. FY _ _ _ _ (Current Year) Statement of Goals and Priorities (SGP)
This section allows you to edit your goals and priorities for the next fiscal year. Check the box to indicate
if there are changes or no changes to the SGP from prior year. If there are changes from the prior year,
the system will give you the prompts below. There may be multiple goals for each grantee.
☐ There are no changes to the SGP from prior year. ☐ There are changes to the SGP (see below below).

1. Goal Number: 1 Goal Statement:

___PADD

___PAAT

___PATBI

___PAVA

2. Priorities (Add rows below if needed)
#

Priority

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3. Strategies to Be Used to Implement Goal and Address Priorities (Check all that apply below)
□ Collaboration

□ Systemic Litigation

□ Rights-Based Individual Advocacy Services

□ Educating Policy Makers

□ Investigations of abuse and neglect

□ Other Systemic Advocacy

□ Monitoring

□ Training/Outreach

□ Issuance of Public Report
4. Rationale for Adding/Changing Goal

5. Rationale for Adding/Changing Priorities

D. Description of P&A Operations6
1. Provide a description of how the P&A operates. Include information on how the P&A coordinates
the PADD program with other Protection and Advocacy programs administered by the State
Protection and Advocacy System. This description must include the System’s processes for intake,
internal and external referrals, and streamlining of advocacy services.

2. Will the System will be requesting or requiring fees or donations from clients as part of the intake
process?
a. Yes
b. No

3. Collaboration and Coordination:
a. Describe how the P&A is collaborating with others in the State, including the DDC and
UCEDD.

6

This section is only required for PADD.

6

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b. Describe how the P&A is reducing duplication and overlap of services and sharing of
information on service needs.

Part III: Results of P&A Activity7
A. End Outcomes of P&A Activity
PADD

End Outcome

PAAT

PATBI

PAVA

1. People with disabilities who are provided with
appropriate community based services or AT devices
and services resulting in community integration and
independence.
2. People with disabilities who accessed benefits or
services.
3. People with disabilities who live in a healthier, safer
or otherwise improved environment.
4. People with disabilities who were able to stay in
their own home.

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

5. People with disabilities who work in safer and more
humane conditions.
6. People with disabilities who go to school in safer and
more humane conditions.
7. Students with disabilities who stayed in school.

X

X

X

X

X

X

X

X

X

X

X

X

8. Children with disabilities receiving appropriate services in
most integrated settings.
9. People with disabilities who had their other rights
enforced, retained, restored and/or expanded.

X

X

X

X

X

X

X

X

10. Public and private places/services made more
accessible.
11. People with disabilities are better able to participate
fully in the electoral process.

X

X

X

X

X

X

X

X

7

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By Intervention Type8
End
Outcome

Technical Individual
Assistance
Advocacy9

Abuse &
Neglect

Systemic

Educating

Litigation

Policy
Makers

Advocacy

Investigations

Other
Systemic

On row below insert

Line

Line

Line

Line

Line

Line

# from line to right

1.I.2

1.A.3

1.N.1

1.N.2

1.N.3

1.N.4

T.A.’s/Cases/Projects
1

N/A

2

N/A

3
4

N/A

5
6
7

N/A

8

N/A

9

N/A

Total
1010

N/A

8

There will be one table for each program.
Individual advocacy includes self-advocacy assistance, limited advocacy, administrative remedies, negotiation,
mediation/alternative dispute resolution and litigation.
10 End Outcome 10 is separated because it does not count people and therefore cannot be included in the total.
9

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B. Overview of How Many People with Disabilities Served
PADD

Performance Measurement
1. People with disabilities receiving individual
advocacy services to exercise their civil, human
and legal rights.
2. Abuse and neglect investigations to protect
people with disabilities from abuse and neglect.
3. People with disabilities receiving information,
technical assistance and referral services.
4. People with disabilities trained to become active
participants in making decisions that affect their
lives.
5. People whose rights were advanced through
class and/or systemic impact litigation.
6. People with disabilities whose rights were
enforced, protected or restored as a result of
non-litigation group advocacy.
7. People with disabilities who received a lower
level of services due to lack of P&A resources.
8. People with disabilities impacted by one or
more provision(s) in law modified or prevented.

PAAT

PATBI

PAVA

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

PAAT

PATBI

PAVA

X

X

X

X

X

X

X

X

X

C. Rights-Based Individual Advocacy Services
PADD

Performance Measurement
X
1. People with disabilities who had their
rights enforced and/or restored.
2. People with disabilities who were assisted X
in obtaining access to administrative or
judicial processes.
3. Closed cases in which client objective was X
met or partially met.

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D. Investigations of Abuse and Neglect
PADD

Performance Measurement

PATBI

PAAT

1. Investigations (not death related).

X

X

X

2. Investigations of abuse and neglect completed with
a finding or determination (not including death
investigations).
3. Death investigations.

X

X

X

X

X

4. Death investigations completed with a finding or
determination.
5. People with disabilities who benefitted from the
findings of investigations of abuse and neglect.
6. Provisions in policy added or prevented.

X

X

X

X

X

X

X

X

Other Qualitative Narrative
Report additional information related to investigations not already reported in Part II.

E. Monitoring [PADD/PATBI/PAAT]

Facilities/Programs Monitored
Unique Facility

Facility Type

Facility

Location

Capacity

(By County)

# of
Visits

Court Ordered
Monitoring?
Yes/No

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Total Number of Unique Facilities:

Performance Measurement

1. People with disabilities whose living, working
and/or other circumstances were monitored by
P&A.
2. Cases opened for health and safety issue
investigation.
3. Health and/or safety violations validated by the
P&A.
4. Rights violations (not health or safety and
including quality of life) identified and addressed
as a result of P&A monitoring.
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PADD

PATBI

PAAT

X

X

X

X

X

X

X

X

X

X

X

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5. Complaints referred to regulatory agencies or
investigative organizations.
6. Times P&A access was denied during a
monitoring/access attempt.
7. Times denial of P&A access was successfully
resolved.

X

X

X

X

X

X

X

X

X

Other Qualitative Narrative
Describe P&A’s overall approach and strategy for monitoring activities

F. Systemic Litigation

Performance Measurement

PADD

PAAT

PATBI

1. Systemic or class action lawsuits handled for the benefit of
people with disabilities.
2. Provisions in policy modified or prevented.

X

X

X

X

X

X

3. Provisions in regulation modified or prevented.

X

X

X

4. Provisions in law modified or prevented.

X

X

X

5. Lawsuits addressing systemic issues resolved by settlement.

X

X

X

6. Lawsuits addressing systemic issues resolved by judgment.

X

X

X

7. Amicus briefs signed onto or filed.

X

X

X

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8. People with disabilities whose rights were advanced as a result
of amicus participation.

X

X

X

G. Educating Policymakers11

Performance Measurement

PADD

PAAT

PATBI

PAVA

1. Communications to people with disabilities
explaining a policy initiative.
2. People with disabilities supported in expressing
their own viewpoint on a policy related matter.
3. Times written comments were submitted
regarding proposed legislation or regulations.
4. Times testimony was provided at a legislative
hearing.
5. Provisions in regulation added, modified or
prevented.
6. People with disabilities impacted by the
regulation provision(s) modified or prevented.
7. Provisions in law added, modified or prevented.

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

8. People with disabilities impacted by one or more
provision(s) in law modified or prevented.
9. Provisions in ordinances modified or prevented.

X

X

X

X

X

X

X

X

PAAT

PATBI

PAVA

H. Other Systemic Advocacy
Performance Measurement

PADD

1.

Changes in practices made or prevented.

X

X

X

X

2.

Provisions in policy modified or prevented.

X

X

X

X

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PROGRAM SPECIFIC MEASURES

PAAT PROGRAM
Performance Measurement

PAAT

1. People receiving one or more AT devices as a result of P&A
advocacy
2. Type and/or Use of Device

X

a. Devices for communication

X

a. Devices for mobility

X

b. Devices for hearing and seeing

X

c. Devices for reading and writing

X

d. Devices for assisting with household chores

X

e. Devices to aid with school/learning

X

f.

X

Devices to assist with participation in play or recreation

X

g. Devices to assist with personal care

X

h. Devices to aid in therapy or medical treatment

X

i.

X

Devices to assist with the use of public/private transportation

j. Devices to assist with employment

X

k.

X

Other

X

DEVICE TOTAL

3. People receiving one or more AT service as a result of P&A
advocacy
4. Type of Service

X
X

a.

AT evaluation

X

b.

Training in use of AT

X

c.

AT repair

X

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d.

Other (including acquisition and customizing of AT device)

X
X

Total number of services: (fill in the number)

PAVA PROGRAM
Performance Measurement

PAVA

1. Education and training of election officials, volunteers and poll
workers regarding rights of people with disabilities and best
practices.
2. Education and training of people with disabilities on their voting
rights.
3. Registering people with disabilities to vote.

X

4. Monitoring

X

5. Non- partisan candidate forums

X

6. Operating a voter assistance hotline

X

7. Issuance of public reports

X

X
X

Combined Report for ACL P&A Programs
This is the place to report information common to the four P&A programs (PADD, PAVA, PAAT
and PATBI) under the oversight of the Administration for Community Living (ACL). Information
is entered once here and applies to all programs.

Part 1 - Public Relations and Outreach

Performance Measure
1. Press releases issued.
2. Times a P&A representative was interviewed or featured on TV or Radio
related to activity funded by this program.
3. Articles about this P&A program or its work in external mass media such as
newspapers, radio, podcasts, blogs or television.
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4. Social media followers.
5. Absolute unique visitors to blogs/web pages where information about the P&A
is posted.
6. Circulation of the P&A’s newsletter, reportsand/or listserv updates.
7. Articles by the P&A about disability rights issues published in newspapers,
books, journals or magazines.
8. Links to other disability rights related information sources published on the
P&A website.

Performance Measure

Number

Exhibitions and Presentations

PADD PAAT

PATBI

PAVA

1. Times the P&A exhibited at conferences, community fairs, etc.
2. Presentations made to community groups.

Part 2 - Collaboration
The purpose for this section is to streamline the reporting of major collaborative efforts and
avoid duplication in the reporting of activity. Step 1 is to enter the name and description of all
major collaborations. Then when writing Results Narratives as a part of reporting on priority
implementation in any of the ACL P&A PPRs, it will only be necessary to select name of the
collaboration from a dropdown menu when work it contributed to is being described.
Required collaborations include the client assistance program (unless housed within the P&A),
long term care ombudsman (unless housed within the P&A), developmental disabilities council,
center(s) for excellence (university affiliated program) and any parent training centers. Listing
other collaborations is optional but can be very useful in demonstrating the extent and
effectiveness of collaborative efforts.

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Check one or more of the following boxes if the P&A houses any of these programs.
☐ Client Assistance Program12

☐ Long Term Care Ombudsman14

☐ Parent Training Center 15

☐ State Grants for Assistive
Technology Program13

Multiple collaborations may be entered.
Name of Collaboration
Which funding sources may benefit from this collaboration: □ PADD □ PATBI □ PAAT □ PAVA

Description of collaboration

Role of P&A within the collaboration

Part 3 – Board, Staff, and Advisory Council Demographics
A. Advisory Council
Does your P&A have a governing board?
□ Yes

□ No

Does your P&A have an advisory council(s) ?
□ General

□ PADD □ PATBI □ PAAT □ PAVA

If yes, describe the role of the council(s)

12

Applies only to PADD program.
Applies only to PAAT program.
14 Applies only to PADD program.
15 Applies only to PADD program.
13

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B. Board, staff and advisory council race and ethnicity
Race/Ethnicity

Board

Employees

Advisory
Council16

1) Hispanic/Latino (of any race)

Race/Ethnicity
(NOT Latino/Hispanic)
2) American Indian/ Alaskan
Native
3) Asian
4) Black/African American
5) Native Hawaiian/
Other Pacific Islander
6) White
7) Two or more races
8) Race/Ethnicity Unknown
TOTAL

C. Consumer involvement in P&A governance
(Please report the total number of board members for your Board and/or Advisory Council. Then report
how many members fall into each consumer group. Members can be counted as more than one type of
consumer)

Board

Advisory Council17

Applicable only if the P&A has an advisory council that is funded in part or entirely by the PADD, PAAT,
PATBI and/or PAVA program. The PAIMI Advisory Council is not applicable.
16

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If applicable

If Applicable

TOTAL Numbers of Members
(nonduplicative)
PADD Eligible Primary Consumers
PADD Eligible Secondary Consumers
PATBI Eligible Primary Consumers
PATBI Eligible Secondary Consumers
AT Users
PAIMI or PAIR or PABSS Eligible Primary
Consumers
PAIMI or PAIR or PABSS Other Eligible
Secondary Consumers
Other Members

Does the P&A Board meet the requirements of section 144 of the DD Act? 18
□ Yes □ No

Applicable only if the P&A has an advisory council that is funded in part or entirely by the PADD, PAAT,
PATBI and/or PAVA program. The PAIMI Advisory Council is not applicable.
17

18 42 U.S.C. 15044

(B) a majority of the members of the board shall be—
(i) individuals with disabilities, including individuals with developmental disabilities, who are eligible for services, or
have received or are receiving services through the system; or
(ii) parents, family members, guardians, advocates, or authorized representatives of individuals referred to in
clause (i);

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Part 4 – General Information
A. P&A Identification
Name of state, territory or jurisdiction
Name of P&A system

B. Main Office (or Office of Record)
Mailing Address & Phone Number of Main Office

C. Additional Offices (If any) (Add rows if needed)
Name, Mailing Address

D. CEO Contact Information
Name, phone number, and email address of P&A CEO

E. PPR Preparer Contact Information
PADD PPR Preparer
Name, title, phone number, and email address of
P&A Preparer
PAVA PPR Preparer
Name, title, phone number, and email address of
P&A Preparer
PATBI PPR Preparer
Name, title, phone number, and email address of
P&A Preparer
PAAT PPR Preparer
Name, title, phone number, and email address of
P&A Preparer
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