RV2 Title III Expenditure - Were outlays/payments made by the SUA Check box (Yes/No) Caregivers Older Adult and/or AAA’s using OAA federal funds to provide respite services for Caregivers of Older Adults through vouchers? RV3 Other - State Expenditure - Were outlays/payments made by the SUA Check box (Yes/No) Caregivers Older Adult and/or AAA’s using state funds (e.g., general revenue, Medicaid) to provide respite services for Caregivers of Older Adults through vouchers? RV4 Other - Non-State Were outlays/payments made by the SUA Check box (Yes/No) Expenditure - Caregivers and/or AAA’s not using OAA or state funds to Older Adult provide respite services for Caregivers of Older Adults through vouchers? RV5 Program Income Expended Was any gross income received and Check box (Yes/No) - Caregivers Older Adult expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period? RV6 Persons Served - Older Total Unduplicated Count of Older Relative Numeric (integer) Value must be equal to or • Relative Caregivers Caregivers who use vouchers to obtain less than element # OR1 respite services funded in whole or in part by (persons served respite). Title III-E of the OAA. RV7 Title III Expenditure - Older Were outlays/payments made by the SUA Check box (Yes/No) Relative Caregivers and/or AAA’s using OAA federal funds to provide respite services for Older Relative Caregivers through vouchers? RV8 Other - State Expenditure - Were outlays/payments made by the SUA box (Yes/No) Older Relative Caregivers and/or AAA’s using state funds to provide respite services for Older Relative Caregivers through vouchers?
RV2 Title III Expenditure - Caregivers Older Adult Were outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide respite services for Caregivers of Older Adults through vouchers? Check box (Yes/No) RV3 Other - State Expenditure - Caregivers Older Adult Were outlays/payments made by the SUA and/or AAA’s using state funds (e.g., general revenue, Medicaid) to provide respite services for Caregivers of Older Adults through vouchers? Check box (Yes/No) RV4 Other - Non-State Expenditure - Caregivers Older Adult Were outlays/payments made by the SUA and/or AAA’s not using OAA or state funds to provide respite services for Caregivers of Older Adults through vouchers? Check box (Yes/No) RV5 Program Income Expended - Caregivers Older Adult Was any gross income received and expended by the grantee and all sub grantees such as voluntary contributions or income earned only as a result of the grant project during the grant period? Check box (Yes/No) RV6 Persons Served - Older Relative Caregivers Total Unduplicated Count of Older Relative Caregivers who use vouchers to obtain respite services funded in whole or in part by Title III-E of the OAA. Numeric (integer) • Value must be equal to or less than element # OR1 (persons served respite). RV7 Title III Expenditure - Older Relative Caregivers Were outlays/payments made by the SUA and/or AAA’s using OAA federal funds to provide respite services for Older Relative Caregivers through vouchers? Check box (Yes/No) RV8 Other - State Expenditure - Older Relative Caregivers Were outlays/payments made by the SUA and/or AAA’s using state funds to provide respite services for Older Relative Caregivers through vouchers? box (Yes/No)
State%20Program%20Performance%20Report%20_OMB0985-0008_0.docx