Form 1122-0012 the Semi-Annual Performance Report questions for the Tra

U.S. Department of Justice Office on Violence Against Women
Semi-Annual Performance Report for
Training and Services to End Violence and Abuse Against Individuals
with Disabilities and Deaf People Program
Brief Instructions
This reporting tool details the Semi-Annual Performance Report questions for the Training and
Services to End Violence and Abuse Against Individuals with Disabilities and Deaf People
Program (Disability Program). A report must be completed for each grant received. Grant
partners may complete sections relevant to their portion of the grant. Grant administrators and
coordinators are responsible for compiling and submitting a single report that reflects all
information collected from grant partners.
All grantees must complete the required sections. Required questions are marked with an
asterisk (*). For all other sections, grantees must answer an initial question about whether they
used Disability Program funds to support certain activities during the current reporting period. If
the response is yes, then the grantee must complete that section. If the response is no, the rest
of that section is skipped.
The activities of volunteers or interns should be reported if they were coordinated or supervised
by Disability Program-funded staff or if Disability Program funds substantially supported their
activities.
For further information on filling out this report, refer to the separate instructions, which contain
detailed definitions and examples.

Public Reporting Burden
Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required
to respond to a collection of information unless it displays a currently valid OMB control number.
We try to create forms and instructions that are accurate, can be easily understood, and which
impose the least possible burden on you to provide us with information. The estimated average
time to complete and file this form is 60 minutes per form. If you have comments regarding the
accuracy of this estimate, or suggestions for making this form simpler, you can write to the
Office on Violence Against Women, U.S. Department of Justice, 145 N Street NE, Washington,
DC 20530.

Disability Program Semi-Annual Performance Report - Office on Violence Against Women 1
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General Information

All grantees must complete the General Information section.
1. Date of report
2. Current reporting period
3. Grantee name
4. Grant number
The federal grant number assigned to your Disability Program grant.
5. Type of performance report
•
•

Final
Regular

6. Point of contact
Provide information for the person responsible for the day-to-day coordination of the
grant.
•
•
•
•
•
•
•
•
•

First name
Last name
Agency/organization name
Address
City
State
Zip code
Telephone
Email

7. Is this a faith-based organization?
•
•

Yes
No

8. Is this a culturally-specific community-based organization?
•
•

Yes
No

9. Does this grant specifically address and focus on tribal populations?
•
•

Yes
o
No

If yes, which tribes/nations?

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10. Does your grant support the creation of products in languages other than English
or provide services in languages other than English?
•
•

Yes
o
No

If yes, what languages?

11. What percentage of your Disability Program grant was directed to each of these
areas?
Estimate the approximate percentage of funds (or resources) used to address each area
with your Disability Program grant during the current reporting period. The grantee may
choose how to make the determination of how to calculate this. Grantees should
consider training, staff time, victims services, etc. when making this determination.
Throughout this form, the term sexual assault means any nonconsensual sexual act
proscribed by Federal, tribal, or State law, including when the victim lacks the capacity to
consent. The term domestic violence/dating violence applies to any pattern of abusive
behavior that is used by one person to gain power and control over a current or former
intimate partner or dating partner. Stalking is defined as engaging in a course of
conduct directed at a specific person that would cause a reasonable person to fear for
his or her safety, or the safety of others, or suffer substantial emotional distress. See
separate instructions for additional victimizations and more complete definitions.
Percentage of grant funds
Sexual assault
Domestic violence/dating violence
Stalking
Total (must equal 100%)

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Staff Information
1. Were Disability Program funds used to fund staff time (at your agency, at a partner
agency, contractors, or stipends) during the current reporting period?
•
•

Yes
No

2. Staff
Report the total number of full-time equivalent (FTE) staff funded by the Disability
Program grant during the current reporting period.
 Reporting 1.00 FTEs means a staff person worked full-time and was 100%
funded by the grant for the entire reporting period. Typically, one FTE is equal to
1,040 hours (40 hours per week multiplied by 26 weeks).
 FTEs should be prorated to reflect when a staff person did not work-full time
and/or when was not 100% funded by the Disability Program grant for the entire
reporting period.
 Report staff by the function(s) they performed, not by title.
 Round and report FTEs to the second decimal place. For example, if you
calculate an FTE to be 0.66667, then rounding to the second decimal would
mean this FTE would be reported as 0.67 FTE.

Staff Function

FTE(s)

Administrator
Attorney (does not include prosecutor)
Counselor
Information technology staff
Legal advocate (does not include attorney or paralegal)
Outreach worker
Paralegal
Program coordinator
Support staff
Trainer
Translator/interpreter
Victim advocate (non-governmental)
Victim Assistant
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Staff Function

FTE(s)

Other (specify):
Total

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Training
1. Were Disability Program funds used to support training activities during the
current reporting period?
Select yes if Disability Program-funded staff provided training or if Disability Program
funds directly supported the training.
Training means providing information on sexual assault, domestic violence, dating
violence, stalking, and/or any additional victimizations funded under the OVW grant that
provides professionals (or volunteers acting in the role of professionals) with a tool, skill,
or resource that better allows them to support victims/survivors.
•
•

Yes
No

2. Live training events
Report the total number of live training events that were provided by Disability Programfunded staff or directly supported by Disability Program funds during the current
reporting period. Include both virtual and in-person live events. Do not include training
provided to Disability Program-funded staff.
3. Total number of people trained at live training events
Report the total number of people trained at both virtual and in-person live training
events that were supported with Disability Program funds during the current reporting
period. Disability Program-funded staff who attended training events should not be
counted as people trained.
4. Most frequently trained
Report the top three types of professionals trained at the Disability Program-funded live
training events. Select the type of professional from the dropdowns.
Dropdown options:
o Adult protective services
o Advocacy organization staff
o Attorneys/law students (does not include prosecutors)
o Abuser intervention program staff
o Child care staff
o Child protective services
o Corrections personnel (probation, parole, and correctional facilities staff)
o Court personnel (judges, clerks)
o Disability organization staff (non-governmental)
o Educators (teachers, administrators, etc.)
o Elder organization staff (non-governmental)
o Faith-based organization staff
o Government agency staff (vocational rehabilitation, food stamps, TANF)
o Health professionals (doctors, nurses, does not include SANEs or SAFEs)
o Immigrant organization staff (non-governmental)
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o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Law enforcement officers
Legal services staff (does not include attorneys)
Mental health professionals
Prosecutors
Sex offender treatment providers
Sexual assault nurse examiners/sexual assault forensic examiners
Social service organization staff (non-governmental)
Substance abuse organization staff
Supervised visitation and exchange center staff
Translators/interpreters
Tribal government/Tribal government agency staff
Victim advocates (non-governmental)
Victim assistants (governmental, includes victim-witness specialists/
coordinators)
Volunteers
Other (specify)

5. Describe the content of the Disability Program-funded live training events.
6. Were Disability Program funds used to develop, create, and/or launch prerecorded trainings during the current reporting period?
•
•

Yes
No

7. Number of pre-recorded trainings
Report the number of pre-recorded trainings developed, created, and/or launched with
Disability Program funds during current reporting period.
8. Describe the target audience and content of the pre-recorded trainings supported
with Disability Program funds during the current reporting period.
9. Discuss the effectiveness of training activities funded or supported by your
Disability Program grant and provide any information you would like to share
about your training activities beyond what you have provided in the data above.
Examples might include an improved system response to victims/survivors with
disabilities following a multidisciplinary training provided to advocates, law enforcement,
and prosecution agencies on issues specific to victims/survivors with disabilities.

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Community Education/Public Awareness
1. Were Disability Program funds used for community education/public awareness
activities during the current reporting period?
Select yes if Disability Program-funded staff engaged in community education or public
awareness activities or if Disability Program funds directly supported community
education or public awareness activities during the current reporting period.
Activities may include presentations or public service announcements to nonprofessional peoples, such as the general public, victim/survivors, or parents, for the
purpose of increasing awareness of sexual assault, domestic violence, stalking and/or
any additional victimizations funded under the OVW grant.
•
•

Yes
No

2. Live education events
Report the total number of live education events (including exhibits/tabling events) that
were supported with Disability Program funds during the current reporting period. Include
both virtual and in-person events.
3. Groups educated with Disability Program funds
Identify the groups of people that attended the live education events during the current
reporting period. Check all that apply.
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Child care providers
Community advocacy groups
Community businesses
Community groups
Community members
Educators
Elementary school students
Faith-based groups
Men’s groups
Middle and high school students
Parents or guardians
Tribal elders
University or college students
Victims/survivors
Women’s groups
Other (specify)

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4. Were Disability Program funds used to develop and post/share public service
announcements (PSAs) or social media content during the current reporting
period?
•
•

Yes
No

5. Target audiences for PSAs or social media posts
Identify the target audiences for the Disability Program-funded PSAs or social media
posts during the current reporting period. Check all that apply.
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Child care providers
Community advocacy groups
Community businesses
Community groups
Community members
Educators
Elementary school students
Faith-based groups
Men’s groups
Middle and high school students
Parents or guardians
Tribal elders
University or college students
Victims/survivors
Women’s groups
Other (specify)

6. Describe the content of the education and public awareness activities funded with
your Disability Program funds during the current reporting period.

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Technical Assistance
1. Were Disability Program funds used to provide technical assistance during the
current reporting period?
Select yes if Disability Program-funded staff provided technical assistance or if Disability
Program funds directly supported the provision of technical assistance.

2. Number of technical assistance activities

Report the total number of technical assistance activities provided to programs during
the current reporting period, indicating whether they were site visits or other types of
consultations. Consultations may include in-person, telephonic, electronic, or other types
of contact. Each contact should be counted as one activity.
Number of site visits
Total

Number of other technical
assistance consultations

3. Discuss the technical assistance activities funded or supported by Disability
Program funds, including the topics of the technical assistance activities. Provide
any additional information you would like to share about your technical
assistance activities.

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Coordinated Community Response
1. Coordinated community response activities
This question is required. Select all agencies/organizations that you provided referrals
to/received referrals from, met with, or engaged in consultation with during the current
reporting period. Also indicate if the agency/organization is an MOU partner. If Disability
Program-funded staff participated in a task force or work group, check all attendees.
Agency/organization

Provided referrals to/received
referrals from, met with, or
engaged in consultation with

MOU
Partner

Advocacy organization
Abuser intervention program
Corrections (probation, parole,
and correctional facility staff)
Court
Domestic violence organization
Educational
institutions/organizations
Faith-based organization
Governmental agency
Health/mental health organization
Law enforcement
Legal organization
Prosecutor’s office
Sex offender management/sex
offender treatment provider
Sexual assault organization
Social service organization (nongovernmental)
Tribal government/Tribal
governmental agency
Other (specify): __________

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2. Discuss the effectiveness of CCR activities funded or supported by your Disability
Program grant and provide any additional information you would like to share
about your CCR activities.

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Policies and Legislation
1. Were Disability Program funds used to develop, substantially revise, or implement
policies or protocols or to develop or promote State, local, or tribal legislation and
policies during the current reporting period?
•
•

Yes
No

2. Type of organizations/agencies in which policies or protocols were developed,
substantially revised, or implemented
Indicate the organizations/agencies in which policies or protocols were developed,
substantially revised, or implemented using Disability Program funds during the current
reporting period.
o
o
o

o
o

o
o
o

o
o

Courts
Healthcare
Law enforcement
Legal services
Probation, parole, or another correctional agency
Prosecution
Supervised visitation
Transitional housing
Victim services
Other (specify)

3. Describe the protocols and/or policies developed, substantially revised, or
implemented with Disability Program funds during the current reporting period.
4. Describe the development or promotion of State, local, or tribal legislation and
policies with Disability Program funds during the current reporting period.
Use the space below to discuss the development or promotion of State, local, or tribal
legislation and policies that were supported with Disability Program funds.

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Products
1. Were Disability Program funds used to develop or substantially revise products
during the current reporting period?
Select yes if Disability Program-funded staff developed or revised products or if Disability
Program funds directly supported the development or revision of products.
•
•

Yes
No

2. Describe the products developed or substantially revised with Disability Program
funds during the current reporting period.
Describe what type of product it was, the title/topic of the product, as well as its intended
audience. Also provide information on if the product was translated into a language other
than English (including Braille).

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Victim Services
1. Were Disability Program funds used to provide victim services (including legal
services provided by an attorney or paralegal) during the current reporting
period?
Select yes if Disability Program funds were used to support victim services during the
current reporting period. Report all victims served and victim services provided with
Disability Program funds, whether by a victim services agency or victim services within
law enforcement, prosecution, or the court system in this section. If the grantee is
funding a victim assistant or victim-witness coordinator within law enforcement,
prosecution, or the court system, they should complete the victim services section to
capture that staff’s grant-funded work.
•
•

Yes
No

2. Number of victims/survivors who were fully served, partially served, and not
served
Report the following, to the best of your ability, as an unduplicated count for each
category during the current reporting period. This means that each victim/survivor who
requested or accepted Disability Program-funded services during the current reporting
period should be counted only once in that reporting period. If the victim/survivor
experienced more than one victimization, that person should be counted only once
under the presenting victimization. Do not report secondary victims here.
Served: A victim/survivor should be reported as served if they requested and/or
accepted grant-funded services and the program was able to provide all of those
services.
Partially Served: A victim/survivor should be reported as partially served if they
accepted and/or requested grant-funded services and the program was able to provide
some, but not all, of those services.
Not Served: A victim/survivor should be reported as not served if the program could not
provide any of the grant-funded services that the victim accepted and/or requested.
Sexual
assault

Domestic
violence/
dating
violence

Stalking

Sex
trafficking

Total

Served
Partially served
Total Served
& Partially
Served
Not served
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3. Number of victims/survivors who received Disability Program-funded services for
multiple victimizations
Report an unduplicated count of victims/survivors reported in the previous question who
received Disability Program-funded support for more than one victimization.
4. Select all the additional victimization types, including specific forms of abuse, for
which these victims/survivors received Disability Program-funded services:
o
o
o
o
o
o
o
o
o
o

Sexual assault
Domestic/dating violence
Stalking
Female genital mutilation/cutting
Adult survivor of child sexual abuse
Sex trafficking
Labor trafficking
Economic abuse
Technological abuse
Forced marriage

5. Describe how Disability Program funds were used to serve victims/survivors who
received grant-funded services for multiple victimizations.
6. Select all of the reasons primary victims/survivors who requested Disability
Program-funded services were partially or not served:
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

Conflict of interest
Did not meet statutory requirements
Hours of operation
Insufficient or lack of culturally appropriate services
Insufficient or lack of agency capacity to provide language access (including sign
language or assistive communication devices)
Insufficient or lack of services for people with disabilities
Insufficient or lack of services for people who are D/deaf or hard of hearing
Lack of childcare
Program reached capacity
Program rules not acceptable to victim/survivor
Program unable to provide service due to limited resources/priority setting
Services inappropriate or inadequate for victims/survivors with mental health
issues
Services inappropriate or inadequate for victims/survivors with substance abuse
issues
Services otherwise not appropriate for victim/survivor
Transportation
Other (specify)

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7. Describe why grant-funded services were not provided, including
barriers/challenges your agency faced when providing Disability Program-funded
services, and how those barriers impacted victims/survivors.
8. Race/ethnicity
Report the demographic information for the victims/survivors reported as served and
partially served with Disability Program funds. Do not report demographics for secondary
victims.
Report victims/survivors in each category they identify as. At least one race/ethnicity
must be reported for each victim/survivor reported as fully served and partially served.
Those victims for whom the race/ethnicity is not known should be reported in the
“unknown” category.
Race/ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latino, or Spanish origin
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
People of a race or origin not listed
(specify):
Unknown
Total

Number of victims/survivors

9. Sex
Report victims/survivors in each category that applies.
Due to Presidential Executive Order 14168 and accompanying guidance from the Office
on Management and Budget, OVW amended demographic questions as follows. The
term “gender” was changed to “sex,” and the available responsive categories were
limited to “male” and “female.” Grantees should report the data that is relevant to those
categories in those categories. Grantees should not report data for victims for whom sex
is unknown. The total number of victims reported in this section must be less than or
equal to the total number of victims served and partially served. As always, victims do
not have to share their demographic information to obtain services. Please direct any
questions to OVW.Research@usdoj.gov.
Female
Male
Total

Sex

Number of victims/survivors

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10. Age
Report the age of each victim/survivor reported as fully and partially served. Exactly one
age must be reported for each victim/survivor reported as fully and partially served.
Those victims for whom the age is not known should be reported in the “unknown”
category.
11-17
18-24
25-59
60+
Unknown
Total

Age

Number of victims/survivors

11. Additional demographics
Report the number of victims/survivors who were served and partially served who
identify with these additional demographics if they were willingly disclosed/identified by
the victims/survivors. These additional demographics are not required.
Additional demographics
People with disabilities
People whose primary language is not English
People who are D/deaf or hard of hearing
People who are immigrants/refugees/asylum seekers
People who live in rural areas

Number of victims/survivors

12. Victim services
Report the Disability Program-funded services provided to the victims/survivors reported
fully and partially served victims. Do not capture legal assistance provided by grantfunded attorneys or paralegals in this question, as that information will be asked for in
future questions. Refer to the separate instructions document for service definitions.
The first column “Number of victims/survivors served” is an unduplicated count of the
number of victims/survivors who received each type of grant-funded service. No
individual service category should have a number of victims served greater than the total
number of victims served and partially served.
The second column “Number of times service was provided” is a total of the number of
times each victim in the first column received that services type during the 6-month
reporting period.

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Number of
victims/survivors
served

Type of Service

Number of times
service was
provided

Civil legal advocacy/court
accompaniment
Counseling/support group
Criminal justice advocacy/court
accompaniment
Crisis intervention
Culturally specific services
Employment counseling
Forensic exam
Hospital/clinic/other medical
response
Language services
Transportation
Victim/survivor advocacy
Other (specify): _____
13. Shelter services
Report the number of Disability Program-funded emergency shelter and/or transitional
housing services provided to victims/survivors and accompanying family members
during the current reporting period. Under the “Number of victim/survivors” and “Number
of family members,” provide an unduplicated count of the number of victims and family
members who received Disability Program-funded shelter services. Under the “Number
of bed nights,” provide a total number of nights for those victims/survivors and family
members during the 6-month reporting period.
Number of
victims/survivors

Number of
family members

Number of
bed nights

Emergency shelter
Transitional housing

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14. Hotline support, information, and referral
Report the number of hotline requests received from primary victims and the total
number of hotline requests received on phone lines, text lines, or web-based
communication paid for with Disability funds or answered by Disability-funded staff,
during the current reporting period. If grant funds are supporting a portion or percentage
of the hotline budget, prorate the total hotline requests to reflect only what percentage of
the budget is supported by the Disability grant. Hotline requests should not be reported
as victims/survivors served or partially served unless they also received at least one of
the services reported in Victim Services questions.
Number of requests from
primary victims

Total number of
requests

Hotline support, information
and referral requests

15. Victim witness notification/unsolicited outreach activities to victims
Report the number of grant-funded victim witness notification activities and unsolicited
outreach activities. Victims/survivors who are the recipients of these notification/outreach
activities should not be reported as victims/survivors served or partially served unless
they also received at least one of the services reported in Victim Services questions.
16. Victim services staff assistance with protection orders
Report the total number of temporary and/or final protection orders granted that
Disability Program-funded victim services staff helped with obtaining. These orders may
also be referred to as restraining orders, anti-harassment orders, no contact orders, or
stay-away orders.
Temporary

Final

Protection orders granted

17. Discuss the effectiveness of victim services and legal services supported by your
Disability Program grant and provide any additional information you would like to
share.

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Legal Services
1. Were Disability Program funds used to provide legal service to victims/survivors
during the current reporting period?
Select yes if Disability Program-funded staff (i.e., attorneys or paralegals) provided these
services or Disability Program funds were used to support these services during the
current reporting period. If you select yes, be sure you also fill out the Victim Services
section.
•
•

Yes
No

2. Number of victims/survivors who received assistance with legal issues
Report an unduplicated count of victims/survivors who received assistance with at least
one legal issue.
3. Number of victims who received assistance with multiple legal issues
Of the victims/survivors who received assistance with legal issues, report the number of
victims/survivors who received assistance with more than one type of legal issue during
the current reporting period.
4. Legal issues
Under “Number of victims/survivors receiving legal assistance,” report the number of
primary victims/survivors who received legal assistance from Disability Program-funded
attorneys or paralegals during the current reporting period. Count a victim/survivor once
in each legal issue category for which they received assistance with Disability Program
grant funds.
Under “Number of cases closed or issues resolved,” report each case that was closed
and each legal issue that was resolved during the current reporting period for which
services were provided by Disability Program-funded attorneys or paralegals. Do not
include cases that are pending or were not yet closed during the reporting period. It is
okay if “Number of cases closed or issues resolved” is less than “Number of
victims/survivors receiving legal assistance.”

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Legal Issues

Number of
victims/survivors receiving
legal assistance

Number of cases
closed or issues
resolved

Protection orders
Divorce
Custody/visitation
Establishment of paternity
Child/spousal support
Other family law matters
Consumer/finance
Employment
Income maintenance
Housing
VAWA self-petition
Cancellation of removal
U visa
T visa
Other immigration matters
Criminal issues
Educational issues
Other (specify):

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Narrative
1. Report on the status of your Disability Program grant goals and objectives as of
the end of the current reporting period.
This question is required. Report on the status of the goals and objectives as they were
identified in your grant proposal or as they have been added or revised.
2. What do you see as the most significant areas of remaining need, with regard to
improving services to victims/survivors, increasing victims/survivors’ safety, and
enhancing community response (including offender accountability)?
This question is required for the January-June reporting period. Consider geographic
regions, underserved populations, service delivery systems, types of victimization, and
challenges and barriers unique to your jurisdiction.
3. What has Disability funding allowed you to do that you could not do prior to
receiving this funding?
This question is required for the January-June reporting period.
4. Provide additional information regarding the effectiveness of your grant-funded
program.
If you have any other data or information that you have not already reported that
demonstrate the effectiveness of your Disability Program grant, please provide it below.
5. Provide additional information to explain the data submitted on this form.
If you have any information that could be helpful in understanding the data you have
submitted in this report, please answer this question. For example, if you submitted two
different performance reports for the same reporting period, you may explain how the
data was apportioned to each report; if you reported staff but did not report any
corresponding activities, you may explain why; or if you did not use Disability Program
funds to support either staff or activities during the reporting period, please explain how
program funds were used.

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