2023 AFCSP Fiscal Report, F-21343G (02/2024)

Please respond to each question, using your agency's 2023 Alzheimer's Family Caregiver Support Program (AFCSP) budget and expenses as a guide for completing this report.

This is a required report. Failure to submit a fiscal report will result in the agency's future allocations being withheld.

You will not be able to start, stop and then resume data entry into this report. You may want to print this report so that you can gather the necessary information before doing the data entry.

The report is due on or before March 15, 2024.

1. Name of county, counties, or tribe:

2. Name of designated lead agency:

3. Your name:

4. Your email address:

5. Your phone number (include area code):

6. 2023 allocation in dollars: This question requires a valid number format.

7. Number of households enrolled and served in 2023: This question requires a valid number format.

SUMMARY OF PROGRAM EXPENDITURES

8. Dollars spent for staff training (new category): This question requires a valid currency format.

9. Dollars spent to provide respite services (minimum 40% of allocation; tribes are exempt from the 40% requirement): This question requires a valid number format.

10. Dollars spent to provide each type of respite:

Adult day services
Caregiver self-care
Homemaker/chores
In-home general respite
In-home personal care
Overnight facility respite
Other respite

11. Percent spent on all respite services (minimum 40% of allocation; tribes are exempt from the 40% requirement): This question requires a valid percent format.

12. Dollars spent purchasing other goods and services: This question requires a valid number format.

13. Dollars spent for the development of new or expanded services: This question requires a valid number format.

14. Dollars spent for outreach activities and public awareness: This question requires a valid number format.

15. Dollars spent for support group development or assistance: This question requires a valid number format.

16. Dollars spent on case management: This question requires a valid number format.

17. Dollars spent for program administration (maximum 10% of allocation): This question requires a valid number format.

18. Percent spent for program administration (maximum 10% of allocation): This question requires a valid percent format.

19. Total 2023 expenditures in dollars: This question requires a valid number format.

20. Amount in dollars that went unspent: This question requires a valid number format.

21. If you filled in an amount greater than zero in question 20, please explain why funds went unspent.

22. Describe the results of any new programs or expanded services, see definitions under Wis. Admin. Code §§ DHS 68.02(8) and (13). Indicate if this is year one, two, or three of the new program development or expansion.

23. Describe outreach and marketing techniques that your program, aging unit, or ADRC used to reach and enroll families. Include techniques for reaching individuals already living with dementia and those newly diagnosed in 2023.