Exhibit_H_-_Social_Services_Block_Grant_Report.docx
DOCX document 2 MB Posted
- Attached to
- Master Agreement AZ|CTR075530
- Contract number
- CTR075530
- Issued by
- Arizona
About this file
The document is a Social Services Block Grant (SSBG) Report template from the Arizona Department of Economic Security's Child and Community Services Division (CCSD). It is an internal reporting form designed to track and aggregate service delivery data for federal reporting purposes to the Department of Health and Human Services.
The report focuses on capturing unduplicated client service data for CCSD contracted services, specifically case management and direct services like transportation. The reporting methodology requires agencies to track and report the number of unique adult and child clients served throughout the contract fiscal year, with all clients in July considered new and subsequent months only counting newly added individuals. The report must be submitted with the June invoice and serves as a comprehensive annual summary of service provision under the Social Services Block Grant.
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Text version
Arizona Department of Economic Security Child and Community Services Division (CCSD) Social Services Block Grant Report
Reporting Agency Completes the Following Information
AGENCY:
| SUBMITTED BY: |
| CCSD CONTRACT NUMBER(S): |
| PHONE NUMBER: |
| Contract (SFY)Year: |
Purpose Data from this report is aggregated by the Department of Economic Security and used to compile the annual Social Services Block Grant (SSBG) report that is submitted to the federal Department of Health and Human Services.
Instructions
1. Column 1. This column is to be populated with the CCSD contracted service(s) supported with SSBG. Respond with the year-to-date data for each CCSD Contracted Service.
2. Column 2. Enter the total number of unduplicated adults served in the service regardless of fund source when the Primary Client is the Adult otherwise leave this column blank. The number should be unduplicated for the entire contract fiscal year. All individuals receiving services(s) in July will be considered new and counted as unduplicated individuals. Each month thereafter only NEW individuals receiving services for the first time that month will be counted. The final number of unduplicated individuals for the year will be a cumulative, year-to-date number.
3. Column 3. Enter the total number of unduplicated children served in the service regardless of fund source when the Primary Client is the Child otherwise leave this column blank. The number should be unduplicated for the entire contract fiscal year. All individuals receiving services(s) in July will be considered new and counted as unduplicated individuals. Each month thereafter only NEW individuals receiving services for the first time that month will be counted. The final number of unduplicated individuals for the year will be a cumulative, year-to-date number.
4. This report must accompany the June Invoice.
CLIENTS SERVED
| 1. CCSD Contracted Service |
| 2. Number of Unduplicated |
Adults
3. Number of Unduplicated Children
Case Management
[Direct Service (e.g., Transportation)]
Updated: 12/2024
File details come from the government source that posted it. Updated .