PHAP_CDRL_A001.pdf
PDF 337 KB Posted
- Attached to
- Psychological Health Advocacy Program Services
- Solicitation number
- FA664319RA003
About this file
CDRL A001
View the file
Other files
| File | Type | Posted |
|---|---|---|
| WD_2015-5621.pdf | ||
| Solicitation_Amendment_FA664319RA0030001_SF_30.pdf | ||
| WD_2015-4497.pdf | ||
| WD_2015-4819.pdf | ||
| PHAP_CDRL_A006.pdf | ||
| PHAP_CDRL_A004.pdf | ||
| PHAP_CDRL_A002.pdf | ||
| Solicitation_-_FA664319RA003.pdf | ||
| PHAP_CDRL_A005.pdf | ||
| PHAP_CDRL_A003.pdf | ||
| Final__PHAP_PWS__30_Jul_19.pdf |
Show all 11
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
DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
FY 2019 PHAP COMBINED REGION MONTHLY STATISTICS
ALL REGIONS
OCTOBER
NOVEMBER
DECEMBER
JA
NUARY
FE
BRUARY
MARCH
APRIL
MAY
JU
NE
JU
LY
AUGUST
SEPTEMBER
OUTREACH SERVICES
Number of Requests (New Cases ) for PHAP Services 5 10 13 28 21 68 Number of Persons briefed regarding PHAP Services 117 864 1067 1119 1279 1214 Number of YRRP and AFRC Events Attended 11 6 5 6 13 9 Numer of Calls on the Message Line 1 1 0 0 0 0 *Number of Outreach Support (New) 79 78 38 50 79 84
CASE STATISTICS
Number of ACTIVE Open PHAP Cases, for FY2019 104 93 86 111 92 113
Number of ACTIVE Open PHAP Cases, from FY2018 113 105 117 120 126 161 140 125 106 120 116 121 Number of Closed PHAP Cases 22 28 21 20 35 31 High Profile/Interest Cases 0 0 0 0 0 0
Deployment Concerns (Pre or Post) 20 10 13 14 9 30
Mental Health Issues (PTSD, depression, other) 37 31 25 36 46 38 Substance Abuse 1 0 0 0 1 2
MEDICAL CASES
Benefits Inquiries (Tricare/Insurance) 4 5 2 2 2 6
Medical Issues 4 5 3 4 3 7
NON-MEDICAL CASES
Job /Employment Related Services 5 5 3 3 3 6
Family Support (Parenting/Child Resources/Relationship Guidance) 23 21 30 43 20 64
Financial Hardship or Credit Counseling 19 31 21 27 39 75 Legal 3 1 1 0 0 1 Counseling 15 12 13 17 22 28 Other 6 0 1 17 37 38
PERSON MAKING REQUEST (for new cases) Reservist 15 6 10 23 5 33
Family member 48 1 3 6 0 2
DPH 6 3 1 2 3 8
First Shirt 2 0 0 0 0 0 Reserve Medical Unit (RMU) 0 0 0 0 0 0 Commander 0 0 0 0 0 0
# of Mental Health Cases 37 31 25 36 46 38
# of Medical Cases 4 5 3 4 3 7
TYPE OF REQUESTS RECEIVED (for new cases)
ACTIVE CASE ANALYSIS
1 2 3 4 TOTAL 1 2 3 4 TOTAL 1 2 3 4 TOTAL
Total Number of Calls on the Message Line 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 Number of Emergency Calls on the Message Line 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Number of Non-Emergency Calls on the Message Line 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0
Total Number of Referrals made on the Message Line 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number of Referrals specifically to the Crisis Line 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number of Calls Requesting Assistance 1 1 1 0 3 0 0 0 0 0 2 0 0 1 3
Number of E-Mails Sent to Reservist/Familiy Members 0 0 0 0 0 0 0 0 0 0 5 9 14 3 31
Number of E-Mails Received Requesting Assistance 0 0 0 0 0 0 0 0 0 0 2 2 0 1 5
Number of Walk-Ins needing Assistance 0 0 1 0 1 0 0 0 0 0 0 1 0 4 5
Number of New Cases Opened 1 2 8 0 11 0 0 0 0 0 0 0 0 9 9
Number of Cases Opened for Deployment Morale Contacts 1 1 6 0 8 0 0 0 0 0 0 0 0 5 5
CASELOAD
Total Number of Open Cases 52 52 60 56 56 37 37 33 33 33 32 30 35 37 37
Number of Case Calls Made 36 32 32 31 131 17 11 15 7 50 4 4 5 9 22
Numbe of Case E-Mails Sent 12 9 12 8 41 0 0 0 0 0 6 9 8 7 30
Number of Contacts 25 22 18 13 78 14 8 11 5 38 2 3 3 3 11 Number of High Interest Matters 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number of Cases Closed & Forwarded during the Month (NLT 20th) 0 1 0 4 5 0 0 4 0 4 0 3 0 2 5
PERSON MAKING THE REFERRAL
Reservists 1 1 6 0 8 0 0 0 0 0 0 0 0 5 5
Family Members 0 0 2 0 2 0 0 0 0 0 0 0 0 4 4
DPH 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
First Shirt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
RMUs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Friend/Wingman 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0
Commanders 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2
Other (Please Specify) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
YELLOW RIBBON EVENTS
Number and Location of Events 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1
Number Briefed (General Session & Courage to Care) 0 0 0 0 0 0 0 0 0 0 0 0 924 0 924
Total # Significant Personal Contacts (1 per interaction) - Include each follow 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number of PHAP Brochures/Call ing Cards Handed Out 0 0 0 0 0 0 0 0 0 0 0 0 50 0 50
Number of Contact Sheets Fil led Out 0 0 0 0 0 0 0 0 0 0 0 0 34 0 34
SITE VISITS (Wing, Group, Org, etc.)
Number and Location (Details in Comment Section Below) 1 0 0 0 1 0 0 0 0 0 0 1 1 1 3
Number of People Briefed 56 0 0 0 56 4 2 0 3 9 0 125 21 38 184
Significant Events 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1
Number of Contact Sheets Fil led Out 0 0 0 0 0 0 0 0 0 0 0 0 16 0 16
OUTREACH SUPPORT
Number of Contacts with RMU (ARTs) 0 7 2 1 10 3 0 1 2 6 1 0 8 6 15
Number of Contacts with WIng Leadership 3 3 3 1 10 0 0 0 0 0 0 0 1 0 1
Number of CAIB/IDS Meetings Attended 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1
REASON FOR CONTACT/REFERRAL
Number: Services for Children 1 0 3 0 4 3 1 2 2 8 3 1 3 3 10
Number: Suicide Prevention 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number: Substance Abuse Awareness 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number: Mental Health Awareness 0 1 0 0 1 1 1 1 1 4 1 0 8 5 14
Number: Financial Management 0 0 1 0 1 2 1 1 2 6 2 0 1 1 4
Number: Marital/Relationship Concerns 0 0 3 0 3 3 1 2 0 6 2 0 7 5 14
Number: Anger Management 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1
Number: Domestic Violence Awareness & Prevention 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number: Employment Assistance 0 0 0 0 0 2 1 1 2 6 1 2 2 1 6
Number: Deployment Related Issues 0 1 7 0 8 2 1 0 0 3 2 1 2 5 10
Number: Benefits Issues 0 0 0 0 0 0 0 1 2 3 1 0 0 0 1
Number: Medical Questions 0 0 0 0 0 1 0 1 1 3 0 0 0 0 0
Number: Legal Matters 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Number: Counseling 0 1 0 1 2 1 1 0 0 2 0 0 2 5 7
Number: Financial Management Awareness 0 0 1 0 1 2 1 1 2 6 1 0 1 1 3
Number: Other Issues (Please Specify) 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0
PSYCHOLOGICAL HEALTH ADVOCACY PROGRAM (PHAP) Mission:
Support and Referrals for Solution-Focused Resources in order to
NORTH REGION
Brittney Snider, RN
SOUTH REGION
Lawana Morales, RN
WEST REGION
Karen Orcutt, RN
REQUEST FOR PHAP SERVICES
WEEK NUMBER WEEK NUMBER WEEK NUMER
REFERRAL MADE TO AGENCY/TYPE OF SERVICE
AD Medical Treatment Facil ities (MTF) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Veterans Administration (VA) 0 0 0 0 0 1 1 2 1 5 0 0 0 0 0 Vet Centers 0 0 0 0 0 1 0 0 0 1 1 0 1 1 3
MFLC 0 0 0 0 0 0 1 0 0 1 2 0 1 2 5
Chaplain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 AFRC Directors of Psychological Health (DPH) 0 0 1 0 1 1 0 0 0 1 0 0 1 1 2 Military OneSource 1 0 0 0 1 0 0 1 1 2 2 2 0 1 5
TRICARE 0 0 0 0 0 1 1 2 2 6 0 0 0 0 0
Community Mental Health Centers 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 Private Practitioners 0 1 1 0 2 0 0 0 0 0 0 0 0 0 0 Civil ian Hospitals 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Other Medical Facil ities 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Local Resources (Shelters, Churches, Non-Profits, NGO, etc.) 0 0 1 1 2 1 0 0 0 1 0 0 0 0 0
ADDITIONAL INFORMATION
Amount spent on Travel 0 0 0 0 0 0 Amount spent on office supplies 0 0 0 0 0 0
COMMENTS
Week 1 (Challenges, Successes, Significant Events)
Week 2 (Challenges, Successes, Significant Events)
Week 3 (Challenges, Successes, Significant Events)
Week 4 (Challenges, Successes, Significant Events)
| PHAP Reporting Tool - FY19 Week 2 (8-14 Apr) (002).pdf |
| August 2019 |
| Roll Up - Year to Date - FY19 |
| 1_DATA_ITEM_NO: A001 |
| 2_TITLE_OF_DATA_ITEM: Activity Reports |
CONTRACTOR’S PROGRESS AND STATUS REPORT
| 3_SUBTITLE: Weekly/Monthly Activity Reports |
| 4_AUTHORITY_Data_Acquisit: DI-MGMT-81928 |
| 5_CONTRACT_REFERENCE: PWS 1.4.2.1, 1.4.7.4, 1.4.12 - 1.4.12.1 |
| 6_REQUIRING_OFFICE: AFRC/A1R Yellow Ribbon |
| 7_DID_250_REQ: |
| 8_APP_CODE: |
| DIST_STATEMENT: A |
| 10_FREQUENCY: Weekly |
| 11_AS_OF_DATE: |
| 12_DATE_OF_FIRST_SUBMISSI: Last day of first week |
| 13_DATE_OF_SUBSEQUENT_SUB: Last day of each week |
| addressee1: CO |
| draft1: 1 |
| reg1: 1 |
| repro1: |
| addressee2: COR |
| draft2: 1 |
| reg2: 1 |
| repro2: |
| addressee3: |
| draft3: |
| reg3: |
| repro3: |
| addressee4: |
| draft4: |
| reg4: |
| repro4: |
| addressee5: |
| draft5: |
| reg5: |
| repro5: |
| addressee6: |
| draft6: |
| reg6: |
| repro6: |
| addressee7: |
| draft7: |
| reg7: |
| repro7: |
| addressee8: |
| draft8: |
| reg8: |
| repro8: |
| addressee9: |
| draft9: |
| reg9: |
| repro9: |
| addressee10: |
| draft10: |
| reg10: |
| repro10: |
| addressee11: |
| draft11: |
| reg11: |
| repro11: |
| addressee12: |
| draft12: |
| reg12: |
| repro12: |
| addressee13: |
| draft13: |
| reg13: |
| repro13: |
| addressee14: |
| draft14: |
| reg14: |
| repro14: |
| addressee15: |
| draft15: |
| reg15: |
| repro15: |
| addressee16: |
| draft16: |
| reg16: |
| repro16: |
| addressee17: |
| draft17: |
| reg17: |
| repro17: |
| addressee18: |
| draft18: |
| reg18: |
| repro18: |
| addressee19: |
| draft19: |
| reg19: |
| repro19: |
| addressee20: |
| draft20: |
| reg20: |
| repro20: |
| addressee21: |
| draft21: |
| reg21: |
| repro21: |
| addressee22: |
| draft22: |
| reg22: |
| repro22: |
| addressee23: |
| draft23: |
| reg23: |
| repro23: |
| addressee24: |
| draft24: |
| reg24: |
| repro24: |
| addressee25: |
| draft25: |
| reg25: |
| repro25: |
| addressee26: |
| draft26: |
| reg26: |
| repro26: |
| addressee27: |
| draft27: |
| reg27: |
| repro27: |
| addressee28: |
| draft28: |
| reg28: |
| repro28: |
| addressee29: |
| draft29: |
| reg29: |
| repro29: |
| addressee30: |
| draft30: |
| reg30: |
| repro30: |
| addressee31: |
| draft31: |
| reg31: |
| repro31: |
| addressee32: |
| draft32: |
| reg32: |
| repro32: |
| addressee33: |
| draft33: |
| reg33: |
| repro33: |
| addressee34: |
| draft34: |
| reg34: |
| repro34: |
| addressee35: |
| draft35: |
| reg35: |
| repro35: |
| addressee36: |
| draft36: |
| reg36: |
| repro36: |
| addressee37: |
| draft37: |
| reg37: |
| repro37: |
| addressee38: |
| draft38: |
| reg38x: |
| repro38: |
| total_draft: 2 |
| total_repro: 0 |
| 16_REMARKS: For details on Weekly and Monthly Activity Reporting. |
The Contractor shall provide an activity report; broken down to weekly stats for each region (i.e. North: Week one, two, three, and four) The report should include the following for each:
Total Number of Calls on the Message Line Number of Emergency Calls on the Message Line Number of Non-Emergency Calls on the Message Line Total Number of Referrals made on the Message Line Number of Referrals specifically to the Crisis Line Number of Calls Requesting Assistance Number of E-Mails Sent to Reservist/Family Members Number of E-Mails Received Requesting Assistance Number of Walk-Ins needing Assistance Number of New Cases Opened Number of Cases Opened for Deployment Morale Contacts
CASELOAD
Total Number of Open Cases Number of Case Calls Made Number of Case E-Mails Sent Number of Contacts Number of High Interest Matters Number of Cases Closed & Forwarded during the Month (NLT 20th)
PERSON MAKING THE REFERRAL
Reservists Family Members
DPH
First Shirt RMUs Friend/Wingman Commanders Other (Please Specify)
YELLOW RIBBON EVENTS
Number and Location of Events
Closed files will include all intake forms, progress notes, emails, text messages, referral sources, case closure forms,and Customer Satisfaction Survey
| 17_PRICE_GROUP: | |
| ESTIMATED_TOTAL_PRICE: | |
| G_PREPARED_BY: | |
| H_DATE: 06 June 19 | |
| 1_APPROVED_BY: | |
| J_DATE: 06 June 19 | |
| Page: 1 | |
| reg38t: 2 | |
| A_CONTRACT_LINE_ITEM_NO: 0001 | |
| B_EXHIBIT: NA | |
| TDP: | |
| TM: | |
| OTHER: NA | |
| DSYSTEMITEM: HQ AFRC/A1R Yellow Ribbon | |
| E_CONTRACTPR_NO: F5BFDP9155AW01 | |
| FCONTRACTOR: Goldbelt Glacier Health Services | |
| of_pages: 4 | |
| Reset: | |
| 2019-06-06T11:15:18-0400 | |
| HARRIS.DANTHONY.TEON.1286867770 |
| 2019-06-06T14:55:49-0400 | |
| HILL.MARY.Z.1068819560 |
File details come from the government source that posted it.