Home > Laws & Policies > Policy/Program Issuances > Program Instructions > PI-01-08

TITLE IV-E WAIVER DEMONSTRATIONS

Form C
Progress Report Outline
After Submission of Initial Design and Implementation Plan
(Submitted quarterly prior to implementation, then semi-annually)

1. Overview

   If there are any changes to the demonstration or evaluation plan, please update the previously provided summary.

2. Activities and Schedule Necessary to Implement Demonstration (Complete Section II only if implementation is not complete)

   Please update the Implementation Plan previously submitted. Note the following:

   • Completed activities;
   • Activities scheduled for completion but not completed - identify any problems encountered and steps to overcome them, and submit revised schedule; and
   • Remaining activities and revisions to the schedule, if necessary.
   
   
   

3. Status of the Demonstration

   Please update the Work Plan if needed.

   Please describe the following:

   1. Services Provided
   2. Population Served to Date
   3. Barriers Encountered (if any)
   4. Innovative or Promising Practices (if any)
   
   
   

4. Evaluation Status

   1. Number of Children and Families Assigned to Experimental and Control Groups.

      Note if sample sizes are different from those anticipated.

   2. Activities Completed.

      Note the status of evaluation activities (e.g., interviews, process analysis, database development). Discuss any barriers or revisions needed to the design or schedule.

   3. Interim Findings (Optional).

      If any preliminary findings from either the process or outcome studies are available and can be disseminated to other waiver states, please describe.

   
   
   

OMB No. 0980-0272
Expiration Date: 6/30/2003

This information is being collected by the Administration on Children, Youth and Families for States to report on their evaluations of Child Welfare Demonstration Projects. Information collection will be used to provide data on groups of individuals. The average burden hours per response for this collection of information are estimated not to exceed a total of 24 hours for quarterly responses and 80 hours for semi-annual responses. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to: Patricia Campiglia, Children's Bureau, ACYF, 330 C Street, SW., Washington, D.C. 20447 and to: Office of Management and Budget, Paperwork Reduction Project, OMB Control No. 0980-0272, Washington, D.C. 20503

Attachments

Form A - Initial Design and Implementation Plan Outline
Form B - Evaluation Plan Outline
Form D - Interim and Final Report Outline