Instrument 2 – Beneficiary Report (CLEAN Version)

Instrument 2 – Beneficiary Report

Tab 1: PRA Statement

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average 4 hour per
response, including the time for reviewing instructions, gathering and maintaining the data
needed, and reviewing the collection of information.
OMB Approval Number: 0970-XXXX
Expiration Date: XX/XX/XXXX
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.

Tab 2: Instructions

Instructions

The DDDRP Beneficiary Report is a semi-annual supplement to the quarterly PPR. This is a cumulative report of beneficiary characteristics and outcomes. The child, caregiver, and family characteristics tab should include unduplicated counts of beneficiaries who have enrolled since the start of the program. The outcomes tab should include unduplicated counts of beneficiaries for whom outcomes have been measured at six months after program enrollment.

Cover Page

Please enter your grant recipient name, grant number, and project period start date as identified in your Notice of Award. Please enter the final day of the reporting period for this report.

Child Characteristics Tab

This tab only includes information on children receiving diapers through DDDRP. Please do not include characteristics of other children in the household. Please enter the number of children receiving diapers in cell B4. Next, please enter the number of children receiving diapers that fall into each category. The totals for each category, except race and ethnicity, will automatically calculate and should match the total number entered at the top of the sheet. For the race and ethnicity item, your data collection instruments should permit participants to select all races and ethnicities that apply. Because each individual may select multiple races and ethnicities, the total does not automatically sum for this question, and we ask you to confirm the number of individuals who provided this information in the total row. For more information on structuring race and ethnicity questions for your collection of information from participants, please see https://spd15revision.gov/content/spd15revision/en/2024-spd15/question-format.html.

Caregiver Characteristics Tab

Please enter the number of caregivers in the child’s household for the enrolled children in cell B4. Next, please enter the number of caregivers that fall into each category. The totals for each category, except the race and ethnicity category, will automatically calculate and should match the total number entered at the top of the sheet. For the race and ethnicity item, your data collection instruments should permit participants to select all races and ethnicities that apply. Because each individual may select multiple races and ethnicities, the total does not automatically sum for this question, and we ask you to confirm the number of individuals who provided this information in the total row. For more information on structuring race and ethnicity questions for your collection of information from participants, please see https://spd15revision.gov/content/spd15revision/en/2024-spd15/question-format.html.

Family Characteristics Tab

Please enter the number of families receiving diapers in cell B4. Next, please enter the number of families that fall into each category. The totals for each category will automatically calculate and should match the total number entered at the top of the sheet.

Outcomes Tab

Please fill out each section and appropriately enter the number of children, caregivers, or families that fall into each category. Please note that each section asks for different units, so pay attention to this. The outcomes tab should record outcomes at 6 months for enrolled families. Outcomes should be unduplicated and only recorded once for a family, caregiver, or child during the course of the program.

Tab 3: Cover Page

Name of Grant Recipient
Grant Number	90EDA____
Reporting Period	[SELECT 1] April 1, 2025 – September 30, 2025 October 1, 2025 – March 31, 2026 April 1, 2026 – September 30, 2026 October 1, 2026 – March 31, 2027 April 1, 2027 – September 30, 2027

Tab 4: Child Characteristics

Item	Description	Number of Children Newly Enrolled During This Reporting Period [Populate reporting period from pulldown on coversheet]	Notes
CT	Total Number of Children Receiving Diapers:
Item	Age at Enrollment for Children Receiving Diapers	Number of Children Newly Enrolled During This Reporting Period	Notes
CA1	Not yet born
CA2	Newborn - 3 months
CA3	4 - 6 months
CA4	7 - 9 months
CA5	10 - 12 months
CA6	13 - 15 months
CA7	16 - 18 months
CA8	19 - 23 months
CA9	2 years
CA10	3 years
CA11	4 years
CA12	5 - 7 years
CA13	8 - 11 years
CA14	12 - 14 years
CA15	15+ years
CAU	Unknown
CAT	TOTAL (automatically sums)
Item	Race or Ethnicity for Children Receiving Diapers	Number of Children Newly Enrolled During This Reporting Period	Notes
CR1	American Indian or Alaskan Native
CR2	Asian
CR3	Black or African American
CR4	Hispanic or Latino
CR5	Middle Eastern or North African
CR6	Native Hawaiian or Other Pacific Islander
CR7	White
CRU	Unknown
CRT	TOTAL KNOWN (cell does not autosum because caregivers can select multiple race and ethnicity options.)
Item	DDDRP Children Enrolled in Early Head Start or Head Start	Number of Children Newly Enrolled During This Reporting Period	Notes
CE1	Yes
CE2	No
CEU	Unknown
CET	TOTAL (automatically sums)
Item	Children Under-Age for Kindergarten Receiving Diapers that Attend Childcare	Number of Children Newly Enrolled During This Reporting Period	Notes
CC1	Yes
CC2	No
CC3	Other
CCU	Unknown
CCT	TOTAL (automatically sums)

Tab 5: Caregiver Information

Item	Description	Number of Caregivers Newly Enrolled During This Reporting Period [Populate reporting period from pulldown on coversheet]	Notes
GT	Total Number of Caregivers:
Item	Age	Number of Caregivers Newly Enrolled During This Reporting Period	Notes
GA1	Under 18
GA2	18 - 24
GA3	25 - 34
GA4	35 - 44
GA6	45 - 64
GA7	65 +
GAU	Unknown
GAT	TOTAL (automatically sums)
Item	Sex	Number of Caregivers Newly Enrolled During This Reporting Period	Notes
GG1	Female
GG2	Male
GGU	Unknown
GGT	TOTAL (automatically sums)
Item	Race or Ethnicity	Number of Caregivers Newly Enrolled During This Reporting Period	Notes
GR1	American Indian or Alaskan Native
GR2	Asian
GR3	Black or African American
GR4	Hispanic or Latino
GR5	Middle Eastern or North African
GR6	Native Hawaiian or Other Pacific Islander
GR7	White
GRU	Unknown
GRT	TOTAL KNOWN (cell does not autosum because caregivers can select multiple race and ethnicity options.)
Item	Education Levels	Number of Caregivers Newly Enrolled During This Reporting Period	Notes
GE1	Grades 0-8
GE2	Grades 9-12 or Non-Graduate
GE3	High School Graduate, GED, or Equivalency Diploma
GE4	12th Grade + Some Post-Secondary
GE5	2 or 4 Years College Graduate
GE6	Graduate or Other Post-Secondary School
GEU	Unknown
GET	TOTAL (automatically sums)

Tab 6: Family Characteristics

Item	Description	Number of Families Newly Enrolled During This Reporting Period [Populate reporting period from pulldown on coversheet]	Notes
FT	Total Number of Families:
Item	Number of Adults in Family Household	Number of Families Newly Enrolled During This Reporting Period	Notes
FA1	0
FA2	1
FA3	2
FA4	3
FA5	4+
FAU	Unknown
FAT	TOTAL (automatically sums)
Item	Number of Children Under 18 in Family Household	Number of Families Newly Enrolled During This Reporting Period	Notes
FC1	0
FC2	1
FC3	2
FC4	3
FC5	4
FC6	5
FC7	6+
FCU	Unknown
FCT	TOTAL (automatically sums)
Item	Household Size	Number of Families Newly Enrolled During This Reporting Period	Notes
FH1	1
FH2	2
FH3	3
FH4	4
FH5	5
FH6	6+
FHU	Unknown
FHT	TOTAL (automatically sums)
Item	Federal Poverty level	Number of Families Newly Enrolled During This Reporting Period	Notes
FP1	Up to 50%
FP2	51% - 75%
FP3	76% - 100%
FP4	101% - 125%
FP5	126% - 150%
FP6	151% - 175%
FP7	176% - 200%
FP8	201% - 250%
FP9	251% and over
FPU	Unknown
FPT	TOTAL (automatically sums)

Tab 7: Outcomes

Item	Total Enrollment Indicators	Number of Families Eligible for Outcomes Reporting During This Reporting Period [Populate reporting period from pulldown]	Notes
OT1	Total Families Reporting Diaper Need at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Family Diaper Need	Number of Families This Reporting Period	Notes
ON1	Number of families with diaper need at baseline who do not have diaper need during the outcomes reporting period
ON2	Number of families with diaper need at baseline who continue to have diaper need during the outcomes reporting period
ONT	TOTAL
Item	Total Enrollment Indicators	Number of Caregivers Eligible for Outcomes Reporting This Reporting Period	Notes
OT2	Total Caregivers With Employment Needs at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Caregiver Education, Training and Employment Activities	Number of Caregivers This Reporting Period	Notes
OE1	Number of caregivers with employment needs at baseline preparing for employment or training activities this reporting period
OE2	Number of caregivers with employment needs at baseline enrolling in education or training activities this reporting period
OE3	Number of caregivers with employment needs at baseline obtaining employment this reporting period
OE4	Number of caregivers with employment needs at baseline who have not prepared for employment or training, enrolled in education or training, or obtained employment this reporting period
OET	TOTAL
Item	Total Enrollment Indicators	Number of Children Eligible for Outcomes Reporting This Reporting Period	Notes
OT3	Total Children with Diaper Health Issues at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Child Diaper Health Issues	Number of Children This Reporting Period	Notes
OH1	Number of children with diaper health issues at baseline who did not have diaper health issues at follow up
OH2	Number of children with diaper health issues at baseline who had diaper health issues at follow up
OHT	TOTAL
Item	Total Enrollment Indicators	Number of Families Eligible for Outcomes Reporting This Reporting Period	Notes
OT4	Total Families with Childcare Needs at Baseline Reaching 6-Month Enrollment Milestone This Reporting Period
Item	Childcare Access	Number of Families This Reporting Period	Notes
OC1	Total families with childcare need at baseline who have obtained childcare
OC2	Total families with childcare need at baseline who have not obtained childcare
OCT	Total