Family Home Visiting Program Evaluation

Data Collection Forms Archive

2011 Data Collection Forms

Reporting Period: January - December 2011 (Due in PPMRS March 31, 2012)

Data collection forms are listed below.

Individual Data Collection Forms

The FHV 2011 data collection forms require further clarification and two fields in the individual forms have minor errors. Clarifying and corrective edits have been made to aggregate and individual forms and the data dictionary. These edits do not result in additional data collection and/or changes in current data collection methods.

The following document is a Summary of edits to the January-December 2011 FHV Evaluation Data Collection Forms:

Data Dictionary

2011 Evaluation Aggregate Data Collection Form WebEx Training
This resource provides an in-depth training on the 2011 data collection and reporting period. The training expands on the information provided in the Data Dictionary and includes changes made for the 2011 reporting period.

2010 Data Collection Forms

Reporting Period: January - December 2010 (Due in PPMRS March 31, 2011)

Data collection forms are listed below.

Individual Data Collection Forms

Aggregate Data Collection Form

Data Dictionary: This resource provides detailed information on which populations to include in each question as well as when to report and collect the data.

2009 Data Collection Forms

For the reporting period of July – December 2009, the forms highlighted in red are modified versions. Local public health can choose to use either the original version or the modified version.

A summary of the modifications made to the forms is available here:

Summary of Changes July –December 2009 (PDF: 28KB/1 page)

Reporting Period: July-December 2009
Due date: March 31, 2010

Data collection forms are listed below including crosswalks, which detail how to transfer data from the Aggregate Data Collection Form (in Excel format) to the PPMRS forms.

Individual Data Collection (IDC) Forms

Aggregate Data Collection Form

Data entry Excel file for individual family home visiting data collection forms (MS Excel: 35KB)
Data entry Excel file for individual family home visiting data collection forms (MS Excel: 41KB) ** MODIFIED

Crosswalks (these documents show how data should be transferred from the Aggregate Data Collection Form to the PPMRS forms)

For more information
For technical assistance on the FHV evaluation, data collection and reporting, contact Joni Geppert at 651-201-3632 or joni.geppert@state.mn.us.

Tribal Governments should contact Sharon T. Smith for their Tribal Grant reporting requirements under the LPH Act. Ms. Smith can be reached at 651-201-5820 or Sharon.T.Smith@.state.mn.us.