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									              NATIONAL AGING PROGRAM INFORMATION SYSTEM - AREA AGENCY ON AGING (NAPIS-AAA)
                              FOR TITLES III AND VII OF THE OLDER AMERICANS ACT
                           FOR THE PERIOD 10/01/2009 - 09/30/2010 : AAA-PSA SUMMARY
                            Question 1 & 2 details can be retrieved from AIM Report #VA01
                        or PeerPlace Demographics Analysis Report (excluding "Local AAA")
Area Agency:                                                                        PSA #:
Contact Person:                                                                    Phone #:


UNDUPLICATED COUNTS OF PERSONS SERVED
1. Total Unduplicated Count of Persons Served in ALL Title III Funded Services
2. Of the Total in #1, how many were:
   Racial Detail:
   a. White - Non-Hispanic
   b. White - Hispanic
   c. American Indian/Native Alaskan
   d. Asian
   e. Black or African American
   f. Native Hawaiian/Pacific Islander
   g. Persons Reporting Some Other Race
   h. Persons Reporting 2 or More Races
   i. Race Missing or Undetermined
   Note: The sum of a. - i. totals should equal #1


   Ethnicity Detail:
   j. Hispanic or Latino
   k. Not Hispanic or Latino
   l. Ethnicity Missing or Undetermined
   Note: The sum of j. - l. totals should equal #1


   Rural Status Detail:
   m. Rural
   n. Not Rural (Urban)
   o. Rural Status Unknown
  Note: The sum of m. - o. totals should equal #1


  Poverty Status Detail (Income Level)
   p. Caregivers that are not Clients - Poverty Ignored
   q. Individuals with Poverty Unanswered or Undetermined
   r. Individuals Poverty Unanswered and Congregate Vol. (not used in PeerPlace)
   s. Individuals in Poverty
   t. Minority Individuals in Poverty
   u. Non-Minority Individuals in Poverty
   v. Individuals Not in Poverty
  Note: The sum of p. + q. + s. + v. should equal #1


COMMUNITY FOCAL POINTS AND SENIOR CENTERS
3. Total number of community focal points designated under
   Section 306(a)(3) of the OAA in operation during the period?
4. Of the total in #3 how many were senior centers?
  Note: #4 must be equal to or less than #3
5. How many senior centers were operating in your PSA during the period?
  Note: #5 must be equal to or greater than #4
6. Of the total in #5, how many were funded by Title III during the period?
  Note: #6 must be equal to or less than #5
    9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls               Sheet 1                       Printed 1/6/2011
         NATIONAL AGING PROGRAM INFORMATION SYSTEM - AREA AGENCY ON AGING (NAPIS-AAA)
                                    FOR TITLES III AND VII OF THE OLDER AMERICANS ACT
                                FOR THE PERIOD 10/01/2009 - 09/30/2010 : AAA-PSA SUMMARY


Area Agency:

STAFFING PROFILE
                                                                      On September 30
                                                                        of the reported
                                                                       fiscal year, how                          How many of the
                                                                        many full time     How many of the       FTEs were paid
                                                                     equivalents (FTEs)   FTEs were filled by     in full or part
                                                                        did the agency         minority            using OAA
                         Staffing Categories                            have on staff?       individuals?             funds?


1. Agency Executive & Management Staff
    (Includes director, deputy directors, division directors and
    other positions which provide overall leadership and
    direction,)
2. Planning
    (Includes responsibilities such as needs assessment, plan
    development, budgeting/resource analysis, inventory,
    standards development and policy analysis.)
3. Development
    (Includes responsibilities such as public education, resource
    development, training and education, research and
    development and legislative activities.)
4. Administration
    (Includes responsibilities such as bidding, contract
    negotiation, reporting, reimbursement, accounting, finance,
    auditing, monitoring and quality assurance.)
5. Service Delivery - Program Staff
    (Includes activities associated with the direct provision of a
    service which meets the needs of an individual older person
    and/or caregiver.)
6. Access/Care Coordination

    (Includes responsibilities such as outreach, screening,
    assessment, case management and information & referral.)
7. Clerical/Support Staff
    (Paid staff that provide support to the management and
    professional staff.)

8. Total Paid Staff     (Sum of 1 - 7)



9. Volunteers (FTEs)
    (Note: compute volunteer FTEs by dividing the number
    of volunteer hours by 2,080)


10. Total Area Agency Staff      (Sum of 8 & 9)




                                                                     Sheet 2
  9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls                                                                      Printed 1/6/2011
                                    NATIONAL AGING PROGRAM INFORMATION SYSTEM - AREA AGENCY ON AGING (NAPIS-AAA)
                                                     FOR TITLES III AND VII OF THE OLDER AMERICANS ACT
                                                   FOR THE PERIOD 10/01/2009 - 09/30/2010 : AAA-PSA SUMMARY


Area Agency:                                                                                               0
Service
                                                                               Persons
Title III (Excluding Title III-E)                           Units           (Unduplicated)
Adult Day Care                                                                                    Retrieve
                                                                                                 data from
Assisted Transportation
                                                                                                 AIM VA95
Care Coordination - Title III                                                                    Report or
Checking                                                                                         PeerPlace
                                                                                                Service and
Chore
                                                                                               Units Summary
Congregate Nutrition            (NSIP Certified)                                                   Report
Disease Prevention/Health Promotion
Elder Abuse (Protect Elder Rights)
Emergency
Employment
Health Education/Screening
Home Delivered Nutrition        (NSIP Certified)
Home Delivered Meals - Fee for Service
Home Health
Homemaker
Identification/Discount
Information and Referral\ Assistance
Legal Assistance
Medication Management
Money Management
Personal Care
Public Information/Education (PIE / NAPIS Outreach)
Residential Repair and Renovation
Socialization/Recreation
Transportation
Volunteer Programs
Total Duplicated Count                                               0.00                  0
Total Unduplicated Count (AIM users - optional)
                                                                               Persons
Respite Care Initiative Program                              Units          (Unduplicated)
Adult Day Care License                                                                            Retrieve
                                                                                                 data from
Companion
                                                                                                 AIM VA95
Home Health                                                                                      Report or
Homemaker                                                                                        PeerPlace
                                                                                                Service and
Hospice
                                                                                               Units Summary
Personal Care                                                                                      Report
Other
Care Coordination for Elderly Virginians (CCEVP)
Guardianship
S.O.S. Referrals
S.O.S. Service Implementations
Total Duplicated Count                                               0.00                  0
Total Unduplicated Count (AIM users - optional)




     9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls                                    Sheet 3                           Printed 1/6/2011
                              NATIONAL AGING PROGRAM INFORMATION SYSTEM - AREA AGENCY ON AGING (NAPIS-AAA)
                                                   FOR TITLES III AND VII OF THE OLDER AMERICANS ACT
                                                 FOR THE PERIOD 10/01/2009 - 09/30/2010 : AAA-PSA SUMMARY


Area Agency:                                                                                             0
                                                                                           Clients Served
                                                                          Clients Served       without     Caregivers Caregivers
Title III-E                                                Units          with Caregiver      Caregiver     Served    Benefited Individuals
Adult Day Care - Respite                                                                                                                        Retrieve
                                                                                                                                               data from
Assisted Transportation
                                                                                                                                               AIM VA36
Care Coordination                                                                                                                              Report or
Caregiver Training                                                                                                                             PeerPlace
                                                                                                                                               Title III-E
Chore
                                                                                                                                               Detail and
Congregate Meals              (NSIP Certified)                                                                                                 Summary
Direct Payment - Respite                                                                                                                        Report
Direct Payment - Supplemental Svcs
Home Delivered Meals       (NSIP Certified)
Homemaker - Respite
Individual Counseling
Information and Referral/Assistance
Institutional Respite
Other Respite
Other Supplemental Services
Personal Care - Respite
Public Information/Education (PIE / NAPIS Outreach)
Support Groups
Transportation
Total Duplicated Count                                             0.00             0.00             0.00       0.00        0.00       0.00
Total Unduplicated Count (AIM users - optional)




     9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls                                  Sheet 3                                                  Printed 1/6/2011
        NATIONAL AGING PROGRAM INFORMATION SYSTEM - AREA AGENCY ON AGING (NAPIS-AAA)
                        FOR TITLES III AND VII OF THE OLDER AMERICANS ACT
                     FOR THE PERIOD 10/01/2009 - 09/30/2010 : AAA-PSA SUMMARY

Area Agency:                                                                                                                                   0
                                   PROVIDERS EXCEPT TITLE III-E (see page 5 for Title III-E)
UTILIZATION and
EXPENDITURE PROFILE                          TOTAL PROVIDERS:
                                           Enter the total number of               MINORITY                  RURAL
                                        providers for each service that          PROVIDERS:               PROVIDERS:
                                          were paid in whole or part           How many of the          How many of the
                                         using Title III funds. Include         providers in the        providers in the      Enter 1 here if the
                                          the AAA if the service was           "Total Providers"       "Total Providers"      AAA was included
                                           provided directly. If the              column are              column are            in the provider
                                         provider delivers more than               "minority"          "rural" providers?     count in the "Total
                                        one service, count them under          providers? (See           (See definition          Providers"
                                          each service they provide.           definition below.)            below.)                column.



Services


Personal Care
Homemaker
Chore
Home Delivered Meals / NSIP
Adult Day Care
Case Management
Congregate Meals / NSIP
Transportation
Legal Assistance
Information and Assistance
Public Information/Education
Assisted Transportation


For the services listed above,
how many unduplicated
providers did the agency
have during the period?


Definition of Minority Provider:
  1) a not for profit organization whose controlling board is comprised of at least 51% minority individuals, or
  2) a business concern that is at least 51% owned by one or more persons who are either African American, Hispanic origin,
    American Indian/Native Hawaiian, Asian American/Pacific Islander, or any combination thereof (including White Hispanic persons).
  3) 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.


Definition of "Rural" Provider:        See Rural Status classification for all cities and counties on pages 7 & 8.
If provider's business location is in a city or county classified as "rural", count the provider as a "rural" provider.




                                                                    Sheet 4
9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls                                                                                    Printed 1/6/2011
      NATIONAL AGING PROGRAM INFORMATION SYSTEM - AREA AGENCY ON AGING (NAPIS-AAA)
                         FOR TITLE III-E OF THE OLDER AMERICANS ACT
                   FOR THE PERIOD 10/01/2009 - 09/30/2010 : AAA-PSA SUMMARY

    Area Agency:                                                                                      0
                                        PROVIDERS - TITLE III-E ONLY
    UTILIZATION and
    EXPENDITURE PROFILE                                                     TOTAL PROVIDERS:
                                                                          Enter the total number of
                                                                       providers for each service that
                                                                         were paid in whole or part
                                                                       using Title III-E funds. Include
                                                                         the AAA if the service was
                                                                          provided directly. If the
                                                                        provider delivers more than
                                                                       one service, count them under
                                                                         each service they provide.



    Services

    Counseling/Support Groups/Caregiver Training
    Respite Care
    Supplemental Services
    Access Assistance
    Information Services


    For the services listed above, how many unduplicated providers
    did the agency have during the period?




                                                   Sheet 5
9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls                                             Printed 1/6/2011
     NATIONAL AGING PROGRAM INFORMATION SYSTEM - AREA AGENCY ON AGING (NAPIS-AAA)
                     FOR TITLES III AND VII OF THE OLDER AMERICANS ACT
                  FOR THE PERIOD 10/01/2009 - 09/30/2010 : AAA-PSA SUMMARY


Area Agency:                                                                                                          0




                                                   Certification
I have reviewed this agency’s submission of the NAPIS-AAA report as required by the “CONTRACT FOR
TITLES III AND VII, OLDER AMERICANS ACT CARE COORDINATION FOR ELDERLY VIRGINIANS RESPITE
CARE PROGRAM”. The data presented in this report accurately reflects the services provided as authorized by
the Contract.



I certify, that to the best of my knowledge and belief, this information is true, correct, and a complete statement
prepared from the books and records of the agency in accordance with applicable instructions, except as noted.
All exceptions to the books and records of the agency are detailed in clear written form in attachments.

This report includes the final meal count of Certified NSIP (Nutrition Services Incentive Program) Eligible Meals
Served. No other meal count for Certified NSIP Eligible Meals will be requested. This count will be used to
determine my agency's NSIP reimbursement for the fiscal year after next.



                                                                                         _____________________
Executive Director Signature                                                                              Date




9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls              Sheet 6                                       Printed 1/6/2011
                                Rural Status Classification for Virginia Cities and Counties by AAA-PSA



                                PSA Jurisdiction          Rural Status?   PSA Jurisdiction                Rural Status?
                                  1    LEE CO                  Yes          3     BRISTOL CITY                 No
                                  1    NORTON CITY             Yes          3     WASHINGTON CO                No
                                  1    SCOTT CO                Yes          4     MONTGOMERY CO                No
                                  1    WISE CO                 Yes          4     PULASKI CO                   No
                                  2    BUCHANAN CO             Yes          4     RADFORD CITY                 No
                                  2    DICKENSON CO            Yes          5     BOTETOURT CO                 No
                                  2    RUSSELL CO              Yes          5     ROANOKE CITY                 No
                                  2    TAZEWELL CO             Yes          5     ROANOKE CO                   No
                                  3    BLAND CO                Yes          5     SALEM CITY                   No
                                  3    CARROLL CO              Yes          6     HARRISONBURG                 No
                                  3    GALAX CITY              Yes          6     ROCKINGHAM CO                No
                                  3    GRAYSON CO              Yes          7     CLARKE CO                    No
                                  3    SMYTH CO                Yes          7     FREDERICK CO                 No
                                  3    WYTHE CO                Yes          7     WARREN CO                    No
                                  4    FLOYD CO                Yes          7     WINCHESTER CITY              No
                                  4    GILES CO                Yes         08A ALEXANDRIA CITY                 No
                                  5    ALLEGHANY CO            Yes         08B ARLINGTON CO                    No
                                  5    COVINGTON CITY          Yes         08C FAIRFAX CO                      No
                                  5    CRAIG CO                Yes         08C FAIRFAX CITY                    No
                                  6    AUGUSTA CO              Yes         08C FALLS CHURCH                    No
                                  6    BATH CO                 Yes         08D LOUDOUN CO                      No
                                  6    BUENA VISTA CITY        Yes         08E MANASSAS CITY                   No
                                  6    HIGHLAND CO             Yes         08E MANASSAS PARK CO                No
                                  6    LEXINGTON CITY          Yes         08E PRINCE WILLIAM                  No
                                  6    ROCKBRIDGE CO           Yes          9     FAUQUIER CO                  No
                                  6    STAUNTON CITY           Yes          10    ALBEMARLE CO                 No
                                  6    WAYNESBORO CITY         Yes          10    CHARLOTTESVILLE              No
                                  7    PAGE CO                 Yes          10    FLUVANNA CO                  No
                                  7    SHENANDOAH CO           Yes          10    GREENE CO                    No
                                  9    CULPEPER CO             Yes          10    LOUISA CO                    No
                                  9    MADISON CO              Yes          11    AMHERST CO                   No
                                  9    ORANGE CO               Yes          11    BEDFORD CITY                 No
                                  9    RAPPAHANNOCK CO         Yes          11    BEDFORD CO                   No
                                  10   NELSON CO               Yes          11    CAMPBELL CO                  No
                                  11   APPOMATTOX CO           Yes          11    LYNCHBURG CITY               No
                                  12   HENRY CO                Yes          12    DANVILLE CITY                No
                                  12   MARTINSVILLE CO         Yes          12    FRANKLIN CO                  No
                                  12   PATRICK CO              Yes          12    PITTSYLVANIA                 No
                                  13   BRUNSWICK CO            Yes          15    CHESTERFIELDCO               No
                                  13   HALIFAX CO              Yes          15    GOOCHLAND CO                 No
                                  13   MECKLENBURG CO          Yes          15    HANOVER CO                   No
                                  14   AMELIA CO               Yes          15    HENRICO CO                   No
                                  14   BUCKINGHAM CO           Yes          15    NEW KENT CO                  No
                                  14   CHARLOTTE CO            Yes          15    POWHATAN CO                  No
                                  14   CUMBERLAND CO           Yes          15    RICHMOND CITY                No
                                  14   LUNENBURG CO            Yes          16    FREDERICKSBURG CITY          No
                                  14   NOTTOWAY CO             Yes          16    SPOTSYLVANIA CO              No
                                  14   PRINCE EDWARD CO        Yes          16    STAFFORD CO                  No
                                  15   CHARLES CITY CO         Yes        17/18 GLOUCESTER CO                  No
                                  16   CAROLINE CO             Yes        17/18 MATHEWS CO                     No
                                  16   KING GEORGE CO          Yes          19    COLONIAL HEIGHTS CITY        No
                                 17/18 ESSEX CO                Yes          19    HOPEWELL CITY                No
                                 17/18 KING & QUEEN CO         Yes          19    PETERSBURG CITY              No
                                 17/18 KING WILLIAM CO         Yes          19    PRINCE GEORGE                No
                                 17/18 LANCASTER CO            Yes          20    CHESAPEAKE CITY              No
                                 17/18 MIDDLESEX CO            Yes          20    ISLE OF WIGHT                No
                                 17/18 NORTHUMBERLAND          Yes          20    NORFOLK CITY                 No
                                 17/18 RICHMOND CO             Yes          20    PORTSMOUTH CITY              No
                                 17/18 WESTMORELAND CO         Yes          20    SUFFOLK CITY                 No
                                  19   DINWIDDIE CO            Yes          20    VA BEACH CITY                No
                                  19   EMPORIA CITY            Yes          21    HAMPTON CITY                 No
                                  19   GREENSVILLE CO          Yes          21    JAMES CITY CO                No
                                  19   SURRY CO                Yes          21    NEWPORT NEWS CITY            No
                                  19   SUSSEX CO               Yes          21    POQUOSON CITY                No
                                  20   FRANKLIN CITY           Yes          21    WILLIAMSBURG CITY            No
                                  20   SOUTHAMPTON CO          Yes          21    YORK CO                      No
                                  22   ACCOMACK CO             Yes
                                  22   NORTHAMPTON CO          Yes




9f2536d0-b9c6-4f32-a703-147cfd0c9f9e.xls                   Rural_Classification                                           Printed: 1/6/2011

								
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