2023 Version – Semi-Annual Quantitative Report MANDATORY

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Overview

PRA Statement
Direct Services
Referrals
Housing Community
Partners
Characteristics

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Sheet 1: PRA Statement

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Sheet 2: Direct Services

Direct Services
Provide service delivery data on the services funded directly by AHSSD this reporting period. These services may be provided directly by the CAA or by partners receiving funding for the provision of AHSSD services.
One-on-One Intensive Services
Please report the number of individuals who receive one-on-one intensive services, which are individualized, ongoing services to address the distinct needs of the indiviual or family.
Service Type	# of unduplicated individuals receiving service from AHSSD	# of sessions held	Description of service activities for service type (i.e., length of typical session, remote or in-person, etc.)	Please describe the primary focus of the services (e.g., general case management to address self-sufficiency needs, family coaching, financial counseling, housing counseling, career counseling, education coaching)
General case management or service coordination for individuals
Health and Support Services
Service Type	# of unduplicated individuals receiving service from AHSSD	# of appointments, treatments, sessions, or enrollments provided	Description of types of service activities for service type (i.e., preventative or specialist, in-person or remote, group event or one-on-one)
Physical health services
Mental health services
Substance abuse services
Disability services
Older adult care services
Health insurance enrollment
Other (please specify)
Training Services
Service Type	# of unduplicated individuals receiving service from AHSSD	# of trainings held	Description of service activities for service type (i.e., length of typical training, remote or in-person, etc.)
Financial literacy training
Health and wellness education
Parenting and family skills
Other training (please specify)
Resources for Individuals
Resource Type	# of unduplicated individuals receiving service from AHSSD grant recipient	# of resources distributed this reporting period	Description of resources provided
Transportation assistance
Funds to support basic needs
Funds to reduce barriers to self-sufficiency
Other (please specify)
Resources for the Community
Resource Type	Estimated # of individuals using the resources	Estimated # of times resource used by residents	Description of resources provided and how it benefits residents
Community garden
Computers or other technology
Vehicles
Other resources available to the community (please specify)
Occasional or Short-Term Services
Service Type	# of unduplicated individuals receiving service from AHSSD	# of times service provided to individuals	Description of service activities for service type (i.e., days and hours provided)
Drop-in childcare
Other occasional or short-term services (please specify)
Community-Building Services
Service Type	# of unduplicated individuals receiving service from AHSSD	# of events, meetings, or elections	Description of service activities for service type
Community events to build relationships between neighbors
Community board/tenant council participation
Elections for community board/tenant council
Other (please specify)

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Sheet 3: Referrals

Referrals to Wraparound Services
Use this form to report the number of referrals to services that are not directly funded by the AHSSD grant this reporting period. These services may be provided by an external organization or a different department of your organization that is not funded by the AHSSD grant.
For each service, enter the number of unduplicated individuals who were referred to the service type, the number of individuals for whom your organization tracked access to that service type, and the number of individuals for whom your organization has confirmed access to that service type. If you did not track the number of individuals who were able to access the service, you should enter "0" for the second two columns.
Summary of Referrals by Service Type
Referral to service type	# of unduplicated individuals referred	# of unduplicated individuals tracked for accesssing service	# of unduplicated individuals accessing the service	Notes
Food assistance
Utilities assistance
Housing assistance
Child care services
Youth supports and programs, including afterschool and other youth programs
Older adult care services
Services for individuals with disabilities
Employment and training services
Educational services for adults
Clothes, uniforms, tools
Domestic violence support and assistance
Family relationships services
Financial counseling
VITA and other tax advice or assistance
Legal advice, record expungement
Immigration assistance
Physical health treatment
Mental health treatment
Substance abuse treatment
Stable housing support services
Stress reduction services
Transportation services
Tuition assistance
Other (please specify)				Please specify service type for other referrals:
Total Number of Individuals Receiving at Least One Referral
	# of unduplicated individuals referred for any service	# of unduplicated individuals tracked for accesssing any service	# of unduplicated individuals accessing any service	Notes
Received at least one referral

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Sheet 4: Housing Community

Housing Community Indicators
Please provide the requested information for the housing communities supported by the AHSSD program for the quarters covered by this reporting period.
Indicator	Q4 2023	Q1 2024	Q2 2024	Q3 2024	Q4 2024	Q1 2025
	10/1/23 - 12/31/23	1/1/2024 - 3/31/2024	4/1/2024 - 6/30/2024	7/1/2024 - 9/30/2024	10/1/2024 - 12/31/2024	1/1/2025 - 3/31/2025
Total # of units occupied for some portion of time this quarter
Total unduplicated # of individuals residing in housing community for some portion of time this quarter
# of units current on paying rent for all months this quarter (if applicable)
# of households moving out of community this quarter
# of household moving into community this quarter
# of households evicted this quarter

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Sheet 5: Partners

Partnerships for AHSSD Grant Program
Use this form to report information about partnerships supporting services to residents in AHSSD communities. For the first reporting period, please list all partners that will support the grant activities. For subsequent reports, please list only new partnerships that will support the grant activities.
Partner name	Partnership Start Date (MM/YYYY)	Types of Services Partner Will Provide to AHSSD Residents [Select all that apply: employment, education, financial, housing, health and social, civic engagement, support services, other (please describe in "Other Notes" section)]	Description of Services Partner Will Provide to AHSSD Participants	Will partner receive AHSSD funding for provision of these services?	Location of Service Delivery for AHSSD Residents	Other Notes

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Sheet 6: Characteristics

Characteristics Data entry for individuals served by AHSSD this reporting period.

Use this form to report the characteristics of individuals who have received services or referrals through the AHSSD grant project this reporting period. At the top of the form, you will provide the total number of unduplicated individuals and the households of those individuals who have received any services from the project. In the "Individual-Level Characteristics" section, you will provide the number of all individuals in the left-hand column and the number receiving intensive services in the right-hand column. In the "Household-Level Characteristics" section, you will report on the number of all households of individuals served in the left-hand column and the number of receiving intensive services in the right hand column.

Total unduplicated number of INDIVIDUALS who received services through the AHSSD grant this reporting period:

Total unduplicated number of all HOUSEHOLDS who received services from the AHSSD grant this reporting period:

INDIVIDUAL-LEVEL CHARACTERISTICS

HOUSEHOLD-LEVEL CHARACTERISTICS

1. Gender

Number of Individuals

Number Receiving Intensive Services

5. Households with Children

Number of Households

Number Receiving Intensive Services

a.

Male

a.

No children in household

b.

Female

b.

Children reside in household

c.

Other

c

TOTAL

0

0

d.

Unknown

e.

TOTAL

0

0

6. Household Size

Number of Households

Number Receiving Intensive Services

a.

Single Person

2. Age

Number of Individuals

Number Receiving Intensive Services

b.

Two

a.

0-5

c.

Three

b.

6-13

d.

Four

c.

14-17

e.

Five

d.

18-24

f.

Six or more

e.

25-44

g.

Unknown

f.

45-54

h.

TOTAL

0

0

g.

55-59

h.

60-64

7. Level of Household Income

Number of Households

Number Receiving Intensive Services

i.

65-74

(% of HHS Guideline)

j.

75+

a.

Up to 50%

k.

Unknown

b.

51% to 75%

l.

TOTAL

0

0

c.

76% to 100%

d.

101% to 125%

3. Education Levels

Number of Individuals

Number Receiving Intensive Services

e.

126% to 150%

a.

Grades 0-8

f.

151% to 175%

b.

Grades 9-12/Non-Graduate

g.

176% to 200%

c.

High School Graduate

h.

201% to 250%

d.

GED/Equivalency Diploma

i.

251% and over

e.

Some college

j.

Unknown

f.

College Graduate

k.

TOTAL

0

0

g.

Graduate of other post-secondary school

h.

Unknown

i.

TOTAL

0

0

4. Ethnicity/Race

Number of Individuals

Number Receiving Intensive Services

a. Ethnicity

a.1. Hispanic, Latino or Spanish Origins

a.2. Not Hispanic, Latino or Spanish Origins

a.3. Unknown

a.4. TOTAL

0

0

b. Race

b.1. American Indian or Alaska Native

b.2. Asian

b.3. Black or African American

b.4. Native Hawaiian and Other Pacific Islander

b.5. White

b.6. Other

b.7. Multi-race (two or more of the above)

b.8. Unknown

b.9. TOTAL

0

0