Free Form 02AG022E (SUOA-S-56-A) Instructions - Oklahoma

Cumulative Program Performance Report Purpose of Form

02AG022E (SUOA-S-56-A)

Form 02AG022E is used to annually generate program information from Older Americans Act (OAA) grantees to meet federal requirements. Instructions for Preparation of Form This form is completed by the Area Agency on Aging (AAA), and forwarded to the Aging Services Division (ASD). A. AAA staffing profile. To complete the staffing profile, categorize all paid AAA staff by the categories listed on lines 1 - 3, according to the definitions below. Develop the staffing profile based on a typical day during the fiscal year. Determine the number of fulltime equivalency (FTE) for each position category. The number of FTEs reflects current filled or staffed positions. Do not include authorized but unfilled positions. Add the FTE totals for lines 1, 2, and 3, and the volunteers reported on line 4, to create an agency total for line 5. In the same manner, in the appropriate columns report the number of FTEs who are minority staff, and the number of FTEs paid in part or in whole with OAA funds. 1. Agency executive/management staff. Includes such personnel as agency director, assistant directors, directors of key divisions, and other positions who provide overall leadership and direction for the AAA. 2. Other paid professional staff by functional responsibility. Personnel who are considered professional staff who are not responsible for overall agency management or direction setting, but carry out key responsibilities or tasks associated with the AAA. These persons are listed in the appropriate areas, as described in a ­ f. a. Planning. Includes such responsibilities as needs assessment, plan development, budgeting/resource analysis, inventory, standards development, and policy analysis. b. Development. Includes such responsibilities as public education, resource development, training and education, research and development, and legislative activities. c. Administration. Includes such responsibilities as bidding, contract negotiation, reporting, reimbursement, accounting, auditing, monitoring, and quality assurance. d. Service delivery. Includes those activities associated with the direct provision of a service that meets the needs of an older person or caregiver. e. Access/care coordination. Includes such responsibilities as outreach, screening, assessment, case management, and information and assistance. f. Other. Includes such personnel as the ombudsman. 3. Clerical/support staff. Paid personnel management and professional staff. who provide support to the

4. Volunteers. Persons who assist the AAA to carry out its responsibilities, either in direct service provision or any of its planning, development, administration, and access/care coordination roles, such as AAA advisory council, board of directors, ombudsman volunteers, or other AAA volunteers. Volunteers are included in the total AAA staff count on line 5. OKDHS revised 12-15-2003 1

02AG022E (SUOA-S-56-A)

Cumulative Program Performance Report

5. Total AAA staff and volunteers. Include volunteers in this total. B. Profile of community focal points and senior centers 6. List the total number of focal points designated by the AAA that operated during the fiscal year you are reporting. 7. Of the focal points in number 1 above, list the number within that total which are also multi-purpose senior centers. 8. List the total number of senior centers funded through any source which operated during the fiscal year you are reporting. 9. List only the total number of senior centers in operation during the fiscal year that received Title III operational funds or Title III service funds. C. Service providers. For 1 ­ 14, list only those services that are registered and funded other services. Do not list those services that are non-funded.
(a) Total number of providers. Enter a count of the number of providers who

provide each listed service in the planning and service area using OAA Title III funding, in whole or in part. Be sure to include AAA ombudsman, case management, and information and assistance services.
(b) Total number of minority providers. Of the total providers listed in the first

column, identify how many are minority organizations. A minority provider is a not-for-profit organization whose controlling board is comprised of at least 51% minority individuals or a business concern that is at least 51% owned by one or more individuals who are either African American, Hispanic origin, American Indian/Native Alaskan/Native Hawaiian, Asian American/Pacific Islander minority, or a publicly owned business having at least 51% of its stock owned by one or more minority individuals and having its management and daily business controlled by one or more minority individuals.
(c) AAA direct service providers. If the AAA provides any direct services,

indicate this on the line that corresponds with the direct service provided. For example, information and assistance, case management, and ombudsman. Total unduplicated providers in the PSA. Enter a count of the unduplicated number of providers supported with OAA funding across all 14 services, taking into account that provider organizations are likely to provide multiple services. For example, if a nutrition project also includes service components for homemaker, nutrition counseling, and assisted transportation, you will count the provider only one time in this section. Provide this information for all providers. Total unduplicated minority providers in the PSA. Provide this information for the minority providers within the total number. Routing of Form AAA submits completed form annually to ASD. A notice is sent out annually advising the due date, which is close to December 30th. 2 OKDHS revised 12-15-2003