Estimated Persons to Be Served Instructions

ESTIMATED PERSONS TO BE SERVED INSTRUCTIONS

The purpose of this form is to provide an overview of the anticipated persons to be served. Note that all numbers should reflect unduplicated persons served. Only Title III-C eligible clients should be included.

1.  Line 1: for both congregate and home delivered meals, place total estimated number of person to be served.

2.  Line 2: for both congregate and home delivered meals, place total estimated number of persons to be served that will be frail/disabled (persons with a physical or mental disability that restricts their ability to perform normal daily tasks or which threatens their capacity to live independently).

3.  Line 2a: place total estimated number of persons to be served congregate meals who will score Moderate to High on the Nutrition Risk Assessment completed on the NAPIS Registration form and calculated in the AIM database.

4.  Line 2b: place total estimated number of persons to be served home delivered meals who will score High on the Nutrition Risk Assessment completed on the NAPIS Registration form and calculated in the AIM database.

5.  Line 2c: place total estimated number of persons to be served home delivered meals who will have 2+ Activities of Daily Living (ADL) Limitations.

6.  Line 3: for both congregate and home delivered meals, place total estimated number of persons to be served that will be residents of a rural area (See Appendix E for definition of rural).

7.  Line 4: for both congregate and home delivered meals, place total estimated number of persons to be served that will be White, not Hispanic. Of that number, enter number that will be below poverty.

8.  Line 5: for both congregate and home delivered meals, place total estimated number of persons to be served that will be of minority status. Of that number, enter number that will be below poverty.

9.  Lines 6 – 9: for both congregate and home delivered meals, break down the total number of minorities included on Line 5, by specific minority classifications. (Total of Lines 6 – 9 must equal Line 5.) Of the numbers on Lines 6 – 9, enter number that will be below poverty.

10.  Line 10: for both congregate and home delivered meals enter total of Lines 4 and 5.

11.  Under Line 11: for both congregate and home delivered meals, break down the number on Line 10 by individual county. Include estimated number of persons who will be below poverty.

12.  Line 12a: for both congregate and home delivered meals, enter total estimated number of persons that will volunteer.

13.  Line 12b: of the total number of volunteers, for both congregate and home delivered meals, enter the number who will be age 60 and over.

14.  Line 12c: for both congregate and home delivered meals, enter the number of hours that will contributed by volunteers.