Free Form 02AG020E (SUOA-S-54) - Oklahoma

*02AG020E-001*
OKLAHOMA DEPARTMENT OF HUMAN SERVICES

Area Agency on Aging (AAA) Quarterly Report
Fiscal year Quarter Months AAA name AAA director

This report summarizes specific AAA activities. This report is due to the appropriate OKDHS Aging Services Division (ASD) programs field representative no later than .

Section I. ASD staff request for specific information.

Section II. AAA staff information or concerns pertinent to the Program Monitoring and Policy Development Unit.

OKDHS issued 11-1-2006

02AG020E (SUOA-S-54)

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02AG020E (SUOA-S-54)

Area Agency on Aging (AAA) Quarterly Report

Section III. Title III volunteer data for this quarter.
· · Unduplicated number of volunteers, except Senior Corps and Ombudsman: Unduplicated number of volunteer hours, except Senior Corps and Ombudsman:

Section IV. Refer to the documentation on Form 02AG021E, Area Agency on Aging (AAA) Quarterly Report ­ A, to
complete this section. Please follow the instructions below and complete the table on the next page. List each service quarter goal. identified as significantly above or below its · · · · · Column 1: List service. Columns 2 through 3: Place an X in the appropriate column. Columns 4 through 5: Place an X showing if the quarter is above or below its projected Column 6: Justification for service determined above or below the quarter goal. Column 7: Enter action plan for AAA follow-up. 1 Service category 2 UoS 3 UPS 4 +15% 5 -15% 6 Justification, be specific

quarter goal.

7 Follow-up by AAA, be specific

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OKDHS issued 11-1-2006