CTR075530_Exhibit_F_Monthly_Navigation_Report.pdf

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Attached to
Master Agreement AZ|CTR075530
Contract number
CTR075530
Issued by
Arizona

About this file

This document is an Exhibit F PBI (Performance-Based Indicator) Reporting Template, which appears to be a standardized reporting form for social service agencies. The template is designed to track various methods of contact, service requests, and assistance types across multiple program categories including LIHEAP, LIHWAP, ERAP, SSBG, TANF, and other social support programs. While no specific agency or state is filled in on this template, it is a blank form ready for data entry.

The reporting template captures detailed metrics across several dimensions, including contact methods (in-person, phone, email/text, kiosk/tablet), service request types (households in crisis, utility assistance, housing assistance, special needs, food, transportation, case management), and additional categories like weatherization, energy education, and energy advocacy. The form allows for tracking approved, denied, unserved, and self-served interactions, providing a comprehensive overview of social service program interactions and outcomes. The template appears designed to help agencies systematically record and potentially report on their service delivery performance across multiple social support programs.

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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 .