CTR075436_Exhibit_F_Monthly_Navigation_Report.pdf

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Attached to
Master Agreement AZ|CTR075436
Contract number
CTR075436
Issued by
Arizona

About this file

This document is a blank PBI (Performance-Based Indicator) Reporting Template designated as Exhibit F, designed for tracking service delivery and assistance metrics across various social service programs. The template appears to be a standardized reporting form for an agency to document service interactions and outcomes, with spaces for recording contact methods, service requests, and program-specific details including LIHEAP (Low Income Home Energy Assistance Program), LIHWAP (Low Income Household Water Assistance Program), ERAP (Emergency Rental Assistance Program), SSBG (Social Services Block Grant), TANF (Temporary Assistance for Needy Families), and other social service initiatives.

The template is structured to capture comprehensive data across multiple service categories, including households in crisis, utility assistance, housing assistance, special needs, food support, transportation, and case management. Columns are provided to track different interaction modes (in-person, phone, email/text, kiosk/tablet), service request types, and outcomes such as approved, denied, unserved, and self-served interventions. Additional sections allow for recording portal navigation, external referrals, energy education, and advocacy efforts. While no specific numerical data is present, the form is designed to aggregate and report service delivery metrics for social service program performance evaluation and reporting purposes.

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Text version

Exhibit F

1. Agency Name 2. Report Month 3. Report Year

4. METHOD OF CONTACT 5. IN PERSON 6. PHONE 7. EMAIL/TEXT 8. KIOSK/TABLET TOTAL PBI Reporting Template

9. APPROVED 0

10. DENIED 0

11. UNSERVED 0

12. SELF SERVED 0

13. SERVICE REQUESTED -> 14. HOUSEHOLDS IN CRISIS 15. UTILITY ASSISTANCE 16. HOUSING ASSISTANCE 17. SPECIAL NEEDS 18. FOOD 19. IN-KIND SERVICE / INCIDENTAL 20. TRANSPORTATION 21. CASE MANAGEMENT 22. WEATHERIZATION 23. Energy Education 24. Energy Advocacy 25. Energy Kit 26.Monthly number of applications received

27.Monthly number of HH served

28. Monthly average benefit

PORTAL NAVIGATION (LIHEAP/LIHWAP/ERAP)

SSBG

STCS/TANF

NHN

CSBG

LIHEAP ASSURANCE 16

EVICTION PREVENTION

AGENCY INTERNAL RESOURCES

EXTERNAL REFERRAL

TOTALS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Eviction Prevention

NAVIGATOR REPORT TEMPLATE

Assurance 16

File details come from the government source that posted it. Updated .