2 2026 Performance Reporting System Data Entry Form

INSTRUMENT 3

Sexual Risk Avoidance Education (SRAE)

performance reporting system data entry form

November 2025

The 190 estimated grant recipients will continue to report measures on participant demographics, behaviors, intentions, perceived effects, and program experiences; attendance, reach, and dosage; implementation challenges and needs for technical assistance; and structure, cost, and support for program implementation. The contractor (Mathematica) and subcontractor (Public Strategies) have developed this tool for grant recipients to use to collect data originating from subrecipient providers and to organize all of the grant-, provider-, and program-level performance measures data elements for submission into the SRAE Performance Measures Portal. The contractor developed separate tools to support grant recipients in their submission of the data originating from the entry and exit surveys (Instruments #1 and #2). However, these tools are considered voluntary and are to be used at the discretion of the grant recipients. Grant recipients may elect to use alternative means to collect the data that will be submitted. The only requirement will continue to be that all grant recipients enter the required measures into the Portal systematically. For that they will (1) use an online form that contains all of the items in this instrument and (2) upload data files containing the items in Instruments #1 and #2.

THE PAPERWORK REDUCTION ACT OF 1995

Public reporting burden for this collection of information is estimated to average 16 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD		[reporting period]
Grant recipient:		Enter grant recipient name
Funding
Of the total amount of SRAE grant funding obligated during [reporting period], percentage obligated for:
Percent of funding obligated	Direct service provision (youth programming)		%
	Training, technical assistance, and monitoring conducted at the grant level		%
	Evaluation and/or research		%
	Administrative purposes at the grant level		%
Grant Recipient Staffing			Count
Number of grant recipient staff involved in overseeing SRAE1			#
Number of grant recipient FTEs involved in overseeing SRAE			#

Grant Recipient Observation, Training and Technical Assistance		Y/N
Grant recipient or its designee observed program delivery to monitor quality and fidelity to program models
Type of organization that conducted observations:		Y/N
Type of Organization – Observations	Grant recipient
	Developer
	Training or technical assistance partner
	Evaluation partner
	Program provider
Grant recipient or its designee provided technical assistance to support program implementation
Type of organization that provided technical assistance:		Y/N
Type of Organization – TA	Grant recipient
	Developer
	Training or technical assistance partner
	Evaluation partner
	Program provider
Grant recipient or its designee conducted training of facilitators who deliver the program (or of other staff who might train facilitators)
Type of organization that conducted program facilitator training:		Y/N
Type of Organization – Training	Grant recipient
	Developer
	Training or technical assistance partner
	Evaluation partner
	Program provider
Number of providers		Count
Number of providers funded
Number of new providers

Target number of youth to be served by the grant (in the original application, State Plan, State Letter of Intent, Non-competing Continuation Application, or Approved Change in Scope)	Count
Target number of youth

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grant recipient:	Enter grant recipient name
Provider:	Enter provider name

Provider Staff in SRAE Administration	Count
Number of provider staff involved in administering SRAE programs2
Number of provider FTEs involved in administering SRAE programs
Provider Status	Y/N
Is provider new for the [reporting year]?
Did provider serve youth during the [reporting year]?
Facilitators	Count
Number of SRAE facilitators working for provider
Facilitator Training and Observation	Count
Number of SRAE facilitators trained in delivering core curriculum
Number of SRAE facilitators observed at least once

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grant recipient:	Enter grant recipient name
Provider:	Enter provider name

Implementation Challenges: Use the scale below to indicate how the provider assessed each implementation challenge listed

Needs for Technical Assistance: Use the scale below to indicate if the provider has expressed interest in receiving technical assistance for each implementation factor listed

Not a Problem

Somewhat a problem

A serious problem

Not Interested, Because Already Received

Not Interested

Somewhat Interested

Very Interested

Implementation Challenges/ Needs for Technical Assistance

Recruiting youth

Keeping youth engaged

Getting youth to attend regularly

Recruiting qualified staff

Ensuring facilitators understand content/training facilitators

Covering program content

Staff turnover/retaining staff

Negative peer reactions

Youth behavioral problems

Natural disasters

Program facilities

Obtaining buy-in or support from key stakeholders

Evaluation (e.g., how to select or manage an evaluator, data collection, data analysis, and report writing)

Parent support or engagement

Other

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grant recipient:	Enter grant recipient name
Provider:	Enter provider name
Program:	Enter program name

Program Delivery
Core curriculum
Indicate which SRAE topics3 are addressed by this core curriculum:		Y/N
SRAE topics covered through core curriculum	Advantage of refraining from nonmarital sexual activity (B)
	Self-regulation and goal setting (A)
	Success sequence for poverty prevention4 (C)
	Healthy relationships (D)
	Resisting sexual coercion and dating violence (F)
	Other youth risk behaviors, such as alcohol, tobacco, and other drug use (E)
Other program elements that address SRAE topics	Are there any other program elements – such as supplemental curricula, guest speakers, or other program activities that are not part of the core curriculum – that address SRAE topics?	Y/N
Indicate which SRAE topics3 are addressed through supplemental program elements:		Y/N
SRAE topics covered through supplemental program elements	Advantage of refraining from nonmarital sexual activity (B)
	Self-regulation and goal setting (A)
	Success sequence for poverty prevention4 (C)
	Healthy relationships (D)
	Resisting sexual coercion and dating violence (F)
	Other youth risk behaviors, such as alcohol, tobacco, and other drug use (E)

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grant recipient:	Enter grant recipient name
Provider:	Enter provider name
Program:	Enter program name

Indicate which, if any, of the following youth groups are target populations for the provider’s program		Y/N
Target Population	Youth in high-need geographic areas
	Youth in foster care
	Homeless or runaway youth
	Youth living with HIV/AIDS
	Pregnant or parenting youth
	Hispanic/Latino youth
	African American youth
	Native American youth
	Youth in adjudication systems
	Male youth
	Youth who stopped attending school without completing a high school credential
	Youth in residential treatment for mental health issues
	Trafficked youth

Measures of Attendance, Reach, and Dosage

REPORT PERIOD	[reporting period]
Grant recipient:	Enter grant recipient name
Provider:	Enter provider name
Program:	Enter program name

	Enter the number of youth during the reporting period who:	Enter Count
Reach	Attended at least one program session
	Number of middle school age participants
	Number of high school age or older participants
Program Setting	Attended a session in school during school
	Attended a session in school after school
	Attended a session in a community-based organization
	Attended a session in a foster care setting
	Attended a session in a juvenile detention center
	Attended a virtual sessiona
	Attended a session in another setting (Specify any other setting: ________________________________)
Attendance/Dosage	Completed at least 75 percent of the scheduled program hours
aVirtual includes any programming that is facilitated virtually rather than by an in-person facilitator, regardless of the physical setting where participants are located.
	Enter the appropriate count below	Enter Count
Parent Involvement	Number of youth’s parents and other caring adults who attended at least one program session during the reporting period

	Enter the appropriate number of hours below5	Enter Number
Programming hours intended and delivered	Intended number of hours of programming per participant (including your core curriculum plus other lessons or activities that may be integrated with the core curriculum to meet SRAE objectives)
	Average number of hours of programming actually delivered to each group of participants (including your core curriculum plus other lessons or activities that may be integrated with the core curriculum to meet SRAE objectives)

Measures Related to Collection of Participant Entry Surveys

REPORT PERIOD	[reporting period]
Grant recipient:	Enter grant recipient name
Provider:	Enter provider name
Program:	Enter program name

	Enter Count			Enter Count
Total Entry Surveys Completed (Middle School):			Total Entry Surveys Completed (High School or Older):

Did the program receive an approved waiver letter from their Federal Project Officer for any entry survey items?

Y/N

Measures Related to Collection of Participant Exit Surveys

REPORT PERIOD							[reporting period]
Grant recipient:							Enter grant recipient name
Provider:							Enter provider name
Program:							Enter program name
			Enter Count					Enter Count
Total Exit Surveys Completed (Middle school):					Total Exit Surveys Completed (High school and older):

Did the program receive an approved waiver letter from their Federal Project Officer for any exit survey items?						Y/N

1 The Portal will include the following hover-over text: “This measure should include grant recipient staff, such as SRAE program directors and program coordinators, who were directly responsible for administering, managing, and overseeing the SRAE program. Do not include grant recipient staff who provide programming directly to youth but do not oversee SRAE in this measure. Those staff should be counted in the measure of facilitators on the program provider data page. If staff play both roles, they should be included in both measures.”

2 The Portal will include the following hover-over text: “This measure should include provider staff, such as SRAE program directors and program coordinators, who were directly responsible for administering, managing, and overseeing the SRAE program for the provider. Do not include staff who provide programming directly to youth in this measure. Those staff should be counted in the measure of facilitators later in this section. If staff play both roles, they should be included in both measures.”

3 The letter in parentheses after each of these measures indicates which of the A-F topics in the Title V, Section 510 legislation it aligns with:

1. The holistic individual and societal benefits associated with personal responsibility, self-regulation, goal setting, healthy decision-making, and a focus on the future.

2. The advantage of refraining from non-marital sexual activity in order to improve the future prospects, and physical and emotional health of youth.

3. The increased likelihood of avoiding poverty when youth attain self-sufficiency and emotional maturity before engaging in sexual activity.

4. The foundational components of healthy relationships and their impact on the formation of healthy marriages and safe and stable families.

5. How other youth risk behaviors, such as drug and alcohol usage, increase the risk for teen sex.

6. How to resist and avoid, and receive help regarding sexual coercion and dating violence, recognizing that even with consent teen sex remains a youth risk behavior.

4 Success sequence for poverty prevention – The three steps that young adults should take to improve the likelihood of successful economic outcomes when reaching adulthood. The steps include, but are not limited to, graduating from high school, working a full time job, and waiting until age 21 or later to get married and have children (SRAE 2019 Funding Opportunity Announcement).

5 The data submission portal will include a pop-up warning if a user enters a value above 40 for either measure of hours.