Instrument 3b_PREP Performance Reporting System Data Entry Form (2023+)

Form approved

OMB Control No: 0970-0497

Expiration Date: XX/XX/XXXX

Personal responsibility education program (PREP)

Instrument 3B

performance reporting system data entry form (2023+)

December 2022

The 98 estimated grantees will continue to report measures on participant demographics, behaviors, intentions, and perceived effects; attendance, reach, and dosage; implementation challenges and needs for technical assistance; and structure, cost, and support for program implementation. The contractor (Mathematica) will maintain tools for grantees’ use in organizing the performance measures data that they and their subrecipients collect, thereby expediting data entry into the national data submission system. However, use of the tools is not mandatory. Grantees may elect to use alternative means to collect and organize the specified data for submission. The only requirement is that grantees enter the specified measures into the national system systematically; for that, they will use an online form containing all the items in this instrument, in addition to uploading survey data files containing all items in Instruments 1 and 2.

Measures Related to Collection of Participant Entry Surveys

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

	Enter Count			Enter Count
Total Entry Surveys Completed (Middle School):			Total Entry Surveys Completed (High School or Older):

Did the program receive an approval from their Federal Project Officer to delay their survey data collection start date?	Y/N
Did the program receive an approved waiver from their Federal Project Officer for any entry survey items?	Y/N
At any point during the reporting period [DATES], was the program unable to collect Entry Survey data due to COVID-19?	Y/N
What mode(s) of data collection did the program use for participant entry surveys during the reporting period? MARK YES OR NO FOR EACH
In-person paper-and-pencil survey	Y/N
Online, web-based survey	Y/N
Telephone survey	Y/N
Mail survey	Y/N
Other (specify: )	Y/N

Measures Related to Collection of Participant Exit Surveys

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

			Enter Count				Enter Count
Total Exit Surveys Completed (Middle school):					Total Exit Surveys Completed (High school and older):

Did the program receive an approval from their Federal Project Officer to delay their survey data collection start date?	Y/N
Did the program receive an approved waiver from their Federal Project Officer for any exit survey items?	Y/N
At any point during the reporting period [DATES], was the program unable to collect Exit Survey data due to COVID-19?	Y/N
What mode(s) of data collection did the program use for participant exit surveys during the reporting period? MARK YES OR NO FOR EACH
In-person paper-and-pencil survey	Y/N
Online, web-based survey	Y/N
Telephone survey	Y/N
Mail survey	Y/N
Other (specify: )	Y/N

Measures of Attendance, Reach, and Dosage

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

		Enter Count
Reach	Enter the number of youth during the reporting period who:
	Attended at least one program session
	Number of middle school age participants
	Number of high school age or older participants
Program Setting	Attended a session in school during school
	Attended a session in school after school
	Attended a session in a community-based organization
	Attended a session in a clinic
	Attended a session in a foster care setting
	Attended a session in a juvenile detention center
	Attended a session in a residential mental health treatment facility
	Attended a virtual session1
	Attended a session in another setting
Majority population	Indicate whether more than 50 percent of youth attending the program were:
	In foster care
	Homeless or runaway
	Pregnant or parenting
	In adjudication systems
	LGBTQ youth
Attendance/dosage	Enter the appropriate count below
	The number of youth who completed at least 75 percent of scheduled program hours

Measures of Attendance, Reach, and Dosage

REPORT PERIOD				[reporting period]
Grantee:				Enter grantee name
Provider:				Enter provider name
Program:				Enter program name
	Cohort:2
	1	2	3		4	5	6	7	8	9	10
Enter a unique identifier for each cohort that ended the program during this reporting period.
How many hours of programming, overall, were delivered to the cohort?

Measures of Implementation Challenges and Needs for Technical Assistance

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name

Use the scale at the right to indicate how provider assessed the implementation challenges below.	Not a Problem	Somewhat a problem	A serious problem
Recruiting youth
Keeping youth engaged
Getting youth to attend regularly
Recruiting qualified staff
Ensuring facilitators understand content
Covering program content
Staff turnover
Negative peer reactions
Youth behavioral problems
Natural disasters
Program facilities
Obtaining buy-in or support from key stakeholders

Use the scale at the right to indicate if the provider has expressed interest in receiving technical assistance for the implementation factors below.	Not Interested Because Already Received	Not Interested	Somewhat Interested	Very Interested
Recruiting youth
Keeping youth engaged in program sessions
Getting youth to attend regularly
Recruiting qualified staff
Training facilitators
Retaining staff
Minimizing negative peer reactions
Addressing youth behavioral issues
Obtaining buy-in or support from key stakeholders
Evaluation (e.g., how to select or manage an evaluator, data collection, data analysis, and report writing)
Parent support and engagement
Other

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name

PREP Operational Status Related to COVID-19
Did the grantee experience any interruptions of PREP administrative operations during the reporting period due to COVID-19?	Y/N
Did the grantee experience any interruptions of PREP services to youth during the reporting period due to COVID-19?	Y/N

PREP Funding
Total amount of PREP grant funding obligated (including any carryover funds) during [reporting period]	$
Of that total, percentage obligated for: Direct service provision (youth programming) Training, technical assistance, and monitoring conducted at the grantee level3 Evaluation and/or research Retained for administrative purposes at the grantee level4	% % % %

Grantee Staffing	Count
Number of grantee staff involved in overseeing PREP5	#
Number of grantee FTEs involved in overseeing PREP	#

Grantee Observation, Training and Technical Assistance	Y/N
Grantee or its designee observed program delivery to monitor quality and fidelity to program models
Type of organization that conducted observations (mark all that apply):  Grantee  Developer  Training or technical assistance partner  Evaluation partner  Program provider
Grantee or its designee provided technical assistance to support program implementation
Type of organization that provided technical assistance (mark all that apply):  Grantee  Developer  Training or technical assistance partner  Evaluation partner  Program provider
Grantee or its designee conducted training of facilitators who deliver the program (or of other staff who might train facilitators)
Type of organization that conducted program facilitator training (mark all that apply):  Grantee  Developer  Training or technical assistance partner  Evaluation partner  Program provider

Provider Count	Count
Number of providers funded
Number of new providers

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name

Provider Funding	Amount
PREP award amount (for current reporting period only)	$
Amount of non-PREP funding received during current reporting period to support PREP programming	$

Provider Staff Administering PREP	Count
Number of provider staff involved in administering PREP programs6
Number of provider FTEs involved in administering PREP programs
Provider Status	Y/N
Is provider new for the [reporting period]?
Did provider serve youth during the [reporting period]?

Facilitators	Count
Number of PREP facilitators working for provider
Facilitator Training and Observation	Count
Number of PREP facilitators trained in delivering core program model
Number of PREP facilitators observed exactly once
Number of PREP facilitators observed twice or more

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

Program Delivery
Program model implemented
Number of intended program delivery hours

Indicate which, if any, of the following youth groups are target populations for the provider’s program		Y / N
Target Population	Youth in foster care
	Homeless or runaway youth
	Youth living with HIV/AIDS
	Pregnant or parenting youth
	Hispanic/Latino youth
	African American youth
	Native American youth
	LGBTQ youth
	Youth in adjudication systems
	Male youth
	Youth in high-need geographic areas
	Out of school or dropout youth
	Youth in residential treatment for mental health issues
	Trafficked youth

Indicate which of the following adulthood preparation subjects (APS) are covered by the program		Y / N
Adulthood Preparation Subjects	Healthy relationships
	Adolescent development
	Financial literacy
	Parent child communication
	Educational and career success
	Healthy life skills

For each APS selected, indicate whether content is (mark all that apply):		Y / N
Source of Adulthood Preparation Subjects Content	Included in the program’s evidence-based or evidence-informed APP curriculum
	Covered by incorporating an entire additional existing curriculum
	Covered by adding selected lessons from another existing curriculum
	Covered by original content that we or a partner organization created

1¹Virtual includes any programming that is facilitated online rather than by an in-person facilitator, regardless of the physical setting where participants are located

2 PMMS will include the following hover-over text: “A cohort, in this context, represents a group of youth that all jointly receive a defined PREP program, which could include a specific curriculum and any additional hours of programming added to meet all requirements for the PREP program, including requirements for covering select adulthood preparation subjects. If a provider is delivering a PREP program to multiple groups of youth simultaneously, but these groups meet separately, each group of youth should be considered a separate cohort. A cohort could consist of an individual, if programming is delivered one-on-one.”

3 PMMS will include the following hover-over text: “This would include funds for training or TA that is provided by the grantee or its designee for grantee staff, provider staff, or program staff. However, it would exclude funds given to subrecipient program providers and used by those providers for their own training or TA.”

4 PMMS will include the following hover-over text: “This would include funds used for grantee administrative purposes but would exclude funds given to subrecipient program providers and used by those providers for administrative purposes.”

5 PMMS will include the following hover-over text: “This measure should include grantee staff, such as PREP program directors and program coordinators, who were directly responsible for administering, managing, and overseeing the PREP program. Do not include grantee staff who provide programming directly to youth but do not oversee PREP in this measure. Those staff should be counted in the measure of facilitators on the program provider data page. If staff play both roles, they should be included in both measures.”

6 PMMS will include the following hover-over text: “This measure should include provider staff, such as PREP program directors and program coordinators, who were directly responsible for administering, managing, and overseeing the PREP program for the provider. Do not include staff who provide programming directly to youth in this measure. Those staff should be counted in the measure of facilitators later in this section. If staff play both roles, they should be included in both measures.”

THE PAPERWORK REDUCTION ACT OF 1995

Public reporting burden for this collection of information is estimated to average 14 to 18 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.