Semi-Annual Report on Complaints

Purpose, Dates of Submission, and Submission Process

The purpose of the Semi-Annual Report on Complaints is to provide the accrediting entity with information on complaints received by the agency/person during the preceding six-month period. The report below is designed to collectinformation needed to show substantial compliance with 22 CFR 96.41 (b), (f), (g), and (h).

Agency/Person Semi-Annual Report on Complaints are due to IAAME within ten (10) days of April 1st and October 1st of each calendar year.

Agencies/Persons must complete the Semi-Annual Report on Complaints, accompanying summary, data reports, and other documentation and upload this information into their IAAME online account.

Report on Complaints

Agency/Person Name:

Address:

Phone Number:Email Address:

Dates Covered by Report: to

Total Number of Complaints Received: (if none, enter 0)

Number of Agency/Person Sites, Including the Main Office:

The agency/person utilizes domestic supervised providers? Yes No

  • If yes, number of domestic supervised providers
  • If yes, the agency/person must report in the summary the number of complaintsfor each domestic supervised provider and the agency/person’s analysis of this complaint data as outlined in the summary information below.

The agency/person utilizes foreignsupervised providers? Yes No

  • If yes, number of foreign supervised providers
  • If yes, the agency/person must report in the summary the number of complaints for each foreign supervised provider and the agency/person’s analysis of this complaint data as outlined in the summary information below.

Summary Information

In keeping with the standards set forth in 22 CFR 96.41 (b), (f), (g), and (h) the agency/person must complete the Semi-Annual Report on Complaints which includes a summary of complaints. The summary must:

  • Include information related to the agency/person’s total number of complaints regarding any of the services or activities of the agency/person (including complaints against utilizeddomestic and foreign supervised providers) which are related to compliance with the Convention, the IAA, the UAA or the regulations implementing the IAA, or UAA.
  • Describe the number of complaints for the agency/person and for each domestic and foreign supervised provider utilized and how each compliant was resolved.
  • Include the agency/person’s findings and subsequent quality improvement activities resulting from the review of complaint data and information.
  • Quality improvement data and information must include the agency/person’s review of the complaint information, analysis of the information, including any discernable patterns in complaints received,and information regarding what systemic changes, if any, were made or are planned by the agency/person in response to such patterns.

The agency/person has attached the summary of complaintswhich includes all information as required in96.41 (b), (f), (g) and (h).

The agency/person did not receive any complaints during the reporting timeframe and is s not required to provide a summary of complaints.

Signature

By signing this document, I attest that the above and attached summary information is correct and is an accurate reflection of all complaints received by the agency/person during the reporting period.

CEO/President Printed/Typed NameDate of Signature

CEO/President Signature

1 | Page

IAAME Semi-Annual Report on Complaints form 204(03/08/2018)