Exhibit_I_-_Social_Services_Block_Grant_Report.docx
DOCX document 2 MB Posted
- Attached to
- Master Agreement AZ|CTR075550
- Contract number
- CTR075550
- Issued by
- Arizona
About this file
This document is a Social Services Block Grant (SSBG) Report template from the Arizona Department of Economic Security's Child and Community Services Division (CCSD). The report is designed for contracted agencies to provide aggregated data about services rendered, which will be compiled into an annual report submitted to the federal Department of Health and Human Services.
The report focuses on tracking unduplicated client service data, specifically for case management and direct services like transportation. Agencies are required to report the number of unique adult and child clients served during the contract fiscal year, with specific counting guidelines. Each month starting in July, new individuals receiving services for the first time will be counted, creating a cumulative year-to-date total. The completed report must accompany the June invoice and provides a mechanism for the state to track and analyze social service delivery across different contracted providers.
View the file
Other files
Show all 19
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .