Lifespan Respite Grantee PPR

Federal Lifespan Respite Program:
Data Elements
version August 19, 2022
Section A: Federal Lifespan Respite Program – Care Services Delivered
Item 1 – Federal Lifespan Respite Care delivered
Indicate the cumulative number over the course of the project period. Enter “0” for none.
Cumulative total
Hours of respite care delivered to date, in increments of 0.25
Expenditures to date on respite care delivered

$

Does your state deliver Federal Lifespan Respite Care via vouchers? If yes, please complete
Item 2:
Item 2 – Federal Lifespan Respite Care delivered via voucher
Indicate the cumulative number over the course of the project period. Enter “0” for none.
Note: For grants that provide respite care ONLY through vouchers, numbers in Item 2 will
match those in Item 1 above.
Cumulative total
Hours of respite care delivered to date via redeemed vouchers
Expenditures to date on respite care via redeemed vouchers

$

Item 3 – Sources of match for the Lifespan Respite Care Program
Indicate all sources of match funding received over the course of the project period.
Check all that apply
State government funds
Local/community government funds
Foundation funds
In-kind sources
Other funding source(s)

1

Item 4 – Location of Federal Lifespan Respite Care
Indicate the number of unique caregivers served in each location over the course of the project
period. Caregivers who receive respite care in more than one location should be counted once for
each applicable category.
Cumulative Number of
Caregivers Receiving Each
Type of Respite

In-home respite (day)
In-home respite (overnight)
Out-of-Home respite (day)
Out-of-Home respite (overnight)
Emergency respite
Respite care location missing
Item 5 – Total people served by the Federal Lifespan Respite Program Funds
Indicate the number of unique individuals in each category over the course of the project period.
Cumulative,
Unduplicated Total
Total caregivers served through Federal Lifespan Respite
Program Services
Caregivers who received respite care
Caregivers who received training
Total care recipients (children and adults for whom Federal
Lifespan Respite Program caregivers provided care)

Section B: Federal Lifespan Respite Program – Caregiver Demographics
Indicate the cumulative number over the course of the project period. Enter “0” for none. Ensure
that totals for each item add up to the same number reported in Section A, Item 5, line 1.
Item 1 – Caregiver Age
Cumulative,
Unduplicated Total
18-24 years
25-39
40-64 years
65 years and over
Age missing
2

Item 2 – Caregiver Gender Identity
Cumulative,
Unduplicated Total
Woman
Man
Non-binary/non-conforming
Other gender identity
Gender missing
Item 3 – Caregiver Transgender
Cumulative,
Unduplicated Total
Transgender
Not transgender
Transgender missing
Item 4 – Caregiver Sexual Orientation
Cumulative,
Unduplicated Total
Lesbian or gay
Straight, that is, not gay or lesbian
Bisexual
Other sexual orientation
Sexual orientation not known by participant
Sexual orientation missing
Item 5 – Caregiver Geographic Location
Cumulative,
Unduplicated Total
Urban
Suburban
Rural
Frontier
Geographic location missing

3

Item 6 – Caregiver Ethnicity
Cumulative,
Unduplicated Total
Hispanic or Latino
Not Hispanic or Latino
Ethnicity Missing
Item 7 – Caregiver Race
Respondents may select more than one category, so the total may be greater than the total in
Section A, Item 5, line 1.
Cumulative Total
American Indian or Alaskan Native
Asian or Asian American
Black or African American
Native Hawaiian or other Pacific Islander
White
Race missing
Item 8 – Caregiver Relationship to Care Recipient
Cumulative,
Unduplicated Total
Adult child of the care recipient
Parent of the care recipient
Spouse or partner of the care recipient
Grandparent of the care recipient
Other kin caregiver (e.g., aunt, sibling)
Other relationship
Relationship missing

4

Section C: Federal Lifespan Respite Program - Care Recipient Demographics
Indicate the cumulative number over the course of the project period. Enter “0” for none. Ensure
that totals for each item add up to the same number reported in Section A, Item 5, line 5.
Item 1 – Care Recipient Age
Cumulative,
Unduplicated Total
Under 18
18-24 years
25-39 years
40-64 years
65 years and over
Age missing
Item 2 – Care Recipient Gender Identity
Cumulative,
Unduplicated Total
Woman/girl
Man/boy
Non-binary/non-conforming
Other gender identity
Gender missing
Item 3 – Care Recipient Transgender for Care Recipients age 18 and older
Cumulative,
Unduplicated Total
Transgender
Not transgender
Transgender missing

5

Item 4 – Care Recipient Sexual Orientation for Care Recipients age 18 and older
Cumulative,
Unduplicated Total
Lesbian or gay
Straight, that is, not gay or lesbian
Bisexual
Other sexual orientation
Sexual orientation not known by participant
Sexual orientation missing
Item 5 – Care Recipient Geographic Location
Cumulative,
Unduplicated Total
Urban
Suburban
Rural
Frontier
Geographic location missing
Item 6 – Care Recipient Ethnicity
Cumulative,
Unduplicated Total
Hispanic or Latino
Not Hispanic or Latino
Ethnicity Missing
Item 7 – Care Recipient Race
Respondents may select more than one category, so the total may be greater than the total in
Section A, Item 5, line 5.
Cumulative Total
American Indian or Alaskan Native
Asian or Asian American
Black or African American
Native Hawaiian or other Pacific Islander
White
Race missing
6

Section D: Federal Lifespan Respite Program - Respite Training
Item 1 – Hours of Respite Training Provided through the Federal Lifespan Respite
Program grant
Indicate the cumulative number of training hours over the course of the project period. Enter “0”
for none.
Cumulative total
Hours of respite training provided to paid and volunteer respite
providers, in increments of 0.25
Hours of respite training provided to caregivers, in increments of
0.25

Section E: Awareness
Item 1 – Respite Program Website and Registry for your State
Enter “yes” or “no” to indicate the current existence of a website or registry.
Yes/No
Does your state have a respite program website or webpage?
If yes – does the website or webpage use the title or
description “Lifespan Respite”?
Does your state have a registry of respite providers?
If yes – is your respite registry available online?
Item 2 – Access to/Awareness of Respite Program Website and Registry for Your State
Indicate the cumulative number of unique visitors over the course of the project period. Enter “0”
for none or “n/a” if your state does not have a website or registry available to caregivers.
Cumulative,
unduplicated total
Total respite program website visitors
Total respite registry webpage visitors

7

Item 3 – Outreach Activities to Build Respite Program Awareness Across the Lifespan
Indicate the outreach activities your project has engaged in over the course of the project period.
Yes/No
Hosted respite conference(s)
Community presentations
Social media posts
Radio advertisements
TV advertisements
Newspaper advertisements
PSAs
e-Newsletters
Item 4 – Number of e-newsletter subscribers
Indicate the total number of e-newsletter subscribers as of the final date of the project period. If
your project does not distribute an e-newsletter enter “n/a.”
Current number
Subscribers

Section F: Lifespan Respite Program System and Providers
Item 1 – Lifespan Respite Program Coalition Meetings
Indicate the cumulative number of meetings over the course of the project period.
Cumulative Number
How many meetings has your state Lifespan Respite Program
coalition or organization convened over the course of the project
period?
Item 2 – Lifespan Respite Program Coalition Members
Indicate the current number as of the final date of the reporting period.
Current Number
How many individuals are currently members of your Lifespan
Respite coalition?
How many organizations are currently members of your Lifespan
Respite coalition?

8

Item 3 – Lifespan Respite Providers
Indicate the current number of respite providers as of the final date of the reporting period.
Current number
Number of respite provider organizations

9