Form 1 Refugee IDA Program Indicators

GRANTEE NAME:							REPORTING PERIOD
GRANT NUMBER:							BUDGET PERIOD
	Quarter Results				Fiscal Year Results		Project Period Results
RECRUITMENT & ENROLLMENT	Quarter 1	Quarter 2	Quarter 3	Quarter 4	Cumulative Fiscal Year	Annual Goal	Cumulative Project Period	Goal Project Period
Number of Individual Savings Plan Agreements Signed					0
Number of Individual IDAs Opened					0
Number of Household Savings Plan Agreements Signed					0
Number of Household IDAs Opened					0
Number of IDAs Opened for Vehicle Purchases					0
Total Match Funds Obligated for Vehicle IDAs					0
Number of IDAs Opened for Home Purchases					0
Total Match Funds Obligated for Home IDAs					0
Number of IDAs Opened for Microenterprise Purchases					0
Total Match Funds Obligated for Microenterprise IDAs					0
Number of IDAs Opened for Education Purchases					0
Total Match Funds Obligated for Education IDAs					0
Total Number of IDAs Opened (Single + Household)					0
Total Match Funds Obligated for All Assets (Single + Household)					0
Total number of individuals enrolled in the program identifying as Male. Exclude minor dependents.					0
Total number of individuals enrolled in the program identifying as Female. Exclude minor dependents.					0
Total number of individuals enrolled in the program identifying as "Unspecified" or another gender identity. Exclude minor dependents.					0
TRAINING & TECHNICAL ASSISTANCE	Quarter Results				Fiscal Year Results		Project Period Results
	Quarter 1	Quarter 2	Quarter 3	Quarter 4	Cumulative Fiscal Year	Annual Goal	Cumulative Project Period	Goal Project Period
Number of clients completing finanical literacy training					0
Number of hours of finanical literacy training completed					0
Number of clients completing asset-specific training					0
Number of hours of asset-specific training completed					0
Number of hours of technical assistance provided					0
ASSET PURCHASES	Quarter Results				Fiscal Year Results		Project Period Results
	Quarter 1	Quarter 2	Quarter 3	Quarter 4	Cumulative Fiscal Year	Annual Goal	Cumulative Project Period	Goal Project Period
Number of Homes Purchased					0
Total Number of Homes Purchased by individuals identifying as Male					0
Total Number of Homes Purchased by Individuals Identifying as Female					0
Total Number of Homes Purchased by Individuals Identifying as "Unspecified" or another gender identity.					0
Total Savings and Match ($) used to puchase Home assets					0
Total Value of Homes Purchased ($)					0
Number of Microenterprise Assets Purchased					0
Total Number of Microenterprise Assets Purchased by individuals identifying as Male					0
Total Number of Microenterprise Assets Purchased by Individuals Identifying as Female					0
Total Number of Microenterprise Assets Purchased by Individuals Identifying as "Unspecified" or another gender identity.					0
Total Savings and Match ($) used to puchase Home assets					0
Total Value of Homes Purchased ($)					0
Number of Education Assets Purchased					0
Total Number of Education Assets Purchased by individuals identifying as Male					0
Total Number of Education Assets Purchased by Individuals Identifying as Female					0
Total Number of Education Assets Purchased by Individuals Identifying as "Unspecified" or another gender identity.					0
Total Savings and Match ($) used to purchase Education Assets					0
Total Value of Education Assets Purchased ($)					0
Number of Vehicles Purchased					0
Total Number of Vehicles Purchased by Individuals identifying as Male					0
Total Number of Vehicles Purchased by Individuals Identifying as Female					0
Total Number of Vehicles Purchased by Individuals Identifying as "Unspecified" or another gender identity.					0
Total Savings and Match ($) used to purchase Vehicle Assets					0
Total Value of Vehicle Assets Purchased ($)					0
Total Number of All Assets Purchased	0	0	0	0	0	0	0	0
Total Number of All Assets Purchased by Males	0	0	0	0	0		0
Total Number of All Assets Purchased by Females	0	0	0	0	0		0
Total Number of All Asssets Purchased by Individuals Identifying as "X" or other than Male or Female	0	0	0	0	0		0
Total Savings and Match ($) used to pruchase All Assets	0	0	0	0	0	0	0	0
Total Value of All Assets Purchased ($)	0	0	0	0	0	0	0	0
Total Match Funds Obligated for Asset Purchases ($)					0
Total Match Funds Liquidated for Asset Purchases ($)					0
Total Match Funds Currently in Parallel Account ($)
Total Match Funds Obligated, but Unliquidated ($)					0
Total Match Funds Unobligated ($)					0
ECONONOMIC SELF-SUFFICIENCY Data for this section should be reflective of the entire 3-year project period as it becomes available.
1 - Client cannot meet needs even with financial assistance.
2 - Client can meet needs with a lot of financial assistance.
3 - Client can meet needs with some financial assistance.
4 - Client can meet all needs without financial assistance.
Based on the scale above, what is the mean assessment score for all clients' general ability to meet the self-sufficiency needs without financial assistance (e.g., SNAP, WIC, Weatherization Assistance Program, Section 8, etc.) before, and after participating in the Refugee IDA Program? For the purpose of this assessment, self-sufficiency needs can include, but are not limited to: food, housing, utilities, health care, transportation, clothing, and child care.
	Before Participation		After Participation
Number of IDA Clients Assessed
Mean Self-Sufficiency Score
Logic Model Outputs Progress	Quarter Results				Cumulative Fiscal Year	Cumulative Project Period
	Quarter 1	Quarter 2	Quarter 3	Quarter 4
Please list all planned Outputs from the Logic Model in the following spaces. Add more spaces as necessary.	Identify progress towards each Output for Quarter 1.	Identify progress towards each Output for Quarter 2.	Identify progress towards each Output for Quarter 3.	Identify progress towards each Output for Quarter 4.	Describe the cumulative progress towards Outputs for the current fiscal year.	Describe the cumulative progress towards Outputs for the project period.
Logic Model Outcomes Progress	Quarter Results				Cumulative Fiscal Year	Cumulative Project Period
	Quarter 1	Quarter 2	Quarter 3	Quarter 4
Please list all planned Outcomes from the Logic Model in the following spaces. Add more spaces as necessary.	Identify progress towards each Outcome for Quarter 1.	Identify progress towards each Outcome for Quarter 2.	Identify progress towards each Outcome for Quarter 3.	Identify progress towards each Outcome for Quarter 4.	Enter the cumulative progress towards each Outcome for the current fiscal year.	Enter the cumulative progress towards each Outcome for the project period.
OMB Control Number: 0970-0490			Expiration Date: 1/31/2023
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering data on your grant program to understand the design and effectiveness of the program and to inform technical assistance needs. Public reporting burden for this collection of information is estimated to average 6 hours per grantee, 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 (Pub. L. 105-285, section 680(b) as amended). 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 Yimeem Vu at Yimeem.Vu@acf.hhs.gov