IND-GEN - SetupTo begin providing individual-level data for students who received a BHW-funded financial award during the current reporting period or to provide updates for students previously reported on IND-GEN, click "Yes" to the initial setup question. Clicking "Yes" will activate the embedded Excel® form that will allow you to begin data entry.
Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period? | Yes (complete IND-GEN) No (click Save and Validate button to proceed to the next form) |
Figure 1. IND-GEN - Setup Do you have either a) new trainees OR b) updates to provide for trainees from a previous reporting period?:
Warning If you have used the INDGEN form before, this answer is pre-selected ‘Yes’ for you. You do not need to answer this question again. Please move ahead to the INDGEN form by using the form list located on the left side of your screen. Warning If you are unable to enter data into the INDGEN form, edit prior records, or see drop-down menus despite the question above being answered ‘Yes’, you have a browser compatibility problem. Please refer to the Getting Started-Browser Settings page at the beginning of this manual. Warning Gray fields in prior records cannot be edited.
Warning Prior records cannot be deleted. Note You must complete an INDGEN record for every individual who: - Received direct financial support (e.g., scholarships, stipends, loans, loan repayment) from the HRSA-funded grant
- Participated in a course or training activity that was developed, enhanced, or implemented as part of the grant (whether the individual received direct financial support or not)
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IND-GEN - Excel Upload (optional)Warning Do not modify the format. For example: renaming the columns, deleting columns, or renaming worksheets. Users must download and use the file from EHB. The system will not upload/process a different format.
Warning The ‘Type of Training Program’ (Column 1) and ‘Trainee Unique ID’ are key columns. These columns must be complete for the row to be uploaded and processed into EHB. If one or both of these columns are not complete, then the row of data will not be processed in EHB.
Warning If you edit your INDGEN data in EHB, you must click the “Generate Template with most recent INDGEN data’ button before downloading the template. If you fail to do so, your Excel template will not reflect the changes you made and may cause issues when you upload/process your data. You can generate and download the Excel template to enter the trainee information on the INDGEN form. Use of the Excel template is optional. If you plan to use it, please read the instructions carefully. - You can generate the Excel template by clicking the ‘Generate Template with most recent INDGEN data’ button.
- You can download the Excel template by clicking the ‘Download Template’ button.
- After downloading the file, save the INDGEN template on your local computer. To save in a particular location, click the arrow next to the Save button and select the Save As option.
- Then you can enter the data in the Excel Template file. After completing the file, click the Browse button to locate your completed INDGEN form on the computer. If applicable, add a description in the textbox field. Click the Upload button to attach the completed INDGEN form.
- Click on the ‘Process Data’ button to view the INDGEN data on your screen.
- You can add or modify the data within EHB once it is uploaded. Note that the system will check for errors and prompt you to fix them before you can save and validate the form.
Types of Data Fields: - Data Entry fields – For these fields, users can copy/paste allowable values and/or enter valid data in the cell or in the formula bar (if required) – e.g., Trainee Unique ID.
- Single-Select dropdown fields – For these fields, users can copy/paste allowable values (note they must match the selection option exactly), select an option from the list of pre-set choices in the dropdown box, and/or enter the valid selection in the cell or in the formula bar – e.g., Select Individual’s Training or Awardee Category.
- Multi-Select dropdown fields – For these fields, users can copy/paste allowable values (note they must match the selection options exactly) and/or select one or more options from the list of pre-set choices in the dropdown box – e.g., Select Individual’s Race. Please do not try to enter data into the cell or the formula bar for this type of field, as it may cause errors.
General Instructions: - Previously reported training programs (i.e., prior records) will be auto-populated and displayed at the top of the page. Gray cells are not editable. If new rows are added in the IND-GEN form, the Record Status, City, and State columns remain non-editable and empty (see below for additional details).
- To enter a new record, users should start on the next blank row, select the ‘Type of Training Program’, and enter the ‘Trainee Unique ID’. While the Record Status will be new, that column is not editable and will remain empty. Once the template is uploaded and processed, the ‘New Record’ status will be displayed in EHB.
- Training programs with at least one active Fellowship Program, Major Participating Site/Rotation Site, or Residency Program will be populated in the ‘Type of Training Program’ dropdown list in the IND-GEN. The list is derived from the Training Program – Setup form.
- The City and State columns are not editable and will remain empty even if the user enters the Zip Code. Once the template is uploaded and processed, as long as a valid Zip Code is provided, the City and State will be populated in EHB.
Copying and Pasting Data: - Users can copy and paste data from another source/file into Data Entry, Single-Select Dropdown, and Multi-Select Dropdown fields.
- The values provided for Single-Select or Multi-Select fields must exactly match the values that exist in the system. This includes having the same spelling, spacing, and punctuation (hyphens, etc.). Capitalization does not matter. Values for Multi-Select fields must be separated by a comma and a space.
Multi-Selecting and Unselecting Pre-Set Options: - For the multi-select fields, users can select one or more pre-set options in the dropdown list. Users will have to select the options one at a time. However, the pre-set options will be concatenated in the field.
- To unselect one or more pre-set options, users can click on the pre-set option(s) a second time. This will remove the option from the field.
Validations: - Validations are embedded within the Excel template.
- Validations will fire:
- When a required field is missing,
- When there is a conditional validation on two or more columns,
- When a pre-set selection option cannot be combined with other pre-set options (specifically for multi-select fields), and
- When the value of the cell is changed (i.e., a different selection value is selected, the data is deleted, or the text field does not match the data type).
- When a validation fires, the user can correct the field or leave it as is. Users can still upload the template into EHB and fix any remaining validation errors in EHB as long as data has been selected/entered in Column 1 and Column 2.
Uploading the Excel File in EHB: - Once you have completed the Excel file:
- Log into HRSA EHB,
- Access the Annual Performance Report,
- Navigate to the INDGEN form,
- Click the "Attach File" button,
- Select the completed INDGEN template,
- Upload your Excel file
- Click the ‘Process Data’ button, and
- Confirm that the data transferred successfully, enter missing fields, and fix validation errors.
Note Once the excel template has been processed in EHBs, the row numbers in EHBs will not match the row numbers in the excel template. |
IND-GEN - Selecting Type of Training Program Figure 2. IND-GEN - Selecting Type of Training Program Type of Training Program: Select each individual's training program by clicking on the drop-down menu under the Column 1 and choosing one of the available options. The options available in this menu will prepopulate with active programs entered and saved in the Training Program Setup Form.
Warning The training program option "OTHER" does not apply to the CHWTP and should not be selected for trainees. |
IND-GEN - Entering Trainee Unique ID Figure 3. IND-GEN - Entering Trainee Unique ID Trainee Unique ID: Enter a seven (7) character alphanumeric unique identifier for each individual in the textbox in Column 2 (Block 1).
Warning It is the responsibility of each grantee to generate each unique ID and keep a log of all unique IDs used, as these will be required to provide annual updates and 1-year follow-up data for each individual. Note This Block will prepopulate for prior records with data submitted in previous reporting periods. |
IND-GEN - Selecting Individual's Training or Awardee Category Figure 4. IND-GEN - Selecting Individual's Training or Awardee Category Select Individual's Training or Awardee Category: Select each individual’s awardee category by clicking on the drop-down menu in Column 3 (Block 2) and choosing one of the following options: Note Expansion- Select type of trainee based on NO prior experience as a CHW/HSW and becoming a NEW CHW/HSW through this program. Options for this track begin with the prefix, "Certificate Student- " Note Extension- or "Upskilling" - Select type of trainee based on PRIOR experience as a CHW/HSW and gaining NEW SKILLS through this program. Options for this track begin with the prefix, "Certificate Student- ". |
IND-GEN - Selecting Individual's Enrollment/Employment Status Figure 5. IND-GEN - Selecting Individual's Enrollment/Employment Status Select Individual's Enrollment / Employment Status: Select each individual’s current enrollment status by clicking on the drop-down menu in Column 4 (Block 3) and choosing one of the following options: - Full-time
- Part-time
- On leave of absence
Note For trainees, select enrollment status based on the individual's participation in their degree or certificate program. |
IND-GEN - Selecting Individuals Gender Figure 6. IND-GEN - Selecting Individuals Gender Select Individual's Gender(s): Select the gender option(s) that apply to each individual by clicking on the drop-down menu under column 5a and choosing all that apply: - Female
- Male
- Transgender or non-binary or another gender
- Not reported
Warning The 'Not Reported' option may not be selected for prior records.
Warning 'Not Reported' cannot be selected in combination with any other options under column 5a. |
IND-GEN - Entering Year of Birth Figure 7. IND-GEN - Entering Year of Birth Enter Year of Birth: Enter each individual’s year of birth at the end of the current reporting period (i.e., as of June 30, 2024) in the textbox under Column 6a. - 1933
- 1934
- 1935
- 1936
- 1937
- 1938
- 1939
- 1940
- 1941
- 1942
- 1943
- 1944
- 1945
- 1946
- 1947
- 1948
- 1949
- 1950
- 1951
- 1952
- 1953
- 1954
- 1955
- 1956
- 1957
- 1958
- 1959
- 1960
- 1961
- 1962
- 1963
- 1964
- 1965
- 1966
- 1967
- 1968
- 1969
- 1970
- 1971
- 1972
- 1973
- 1974
- 1975
- 1976
- 1977
- 1978
- 1979
- 1980
- 1981
- 1982
- 1983
- 1984
- 1985
- 1986
- 1987
- 1988
- 1989
- 1990
- 1991
- 1992
- 1993
- 1994
- 1995
- 1996
- 1997
- 1998
- 1999
- 2000
- 2001
- 2002
- 2003
- 2004
- 2005
- 2006
- 2007
- 2008
- 2009
- 2010
- 2011
- 2012
- 2013
- 2014
- 2015
- 2016
- 2017
- Not Reported
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IND-GEN - Selecting Individual's Ethnicity Figure 8. IND-GEN - Selecting Individual's Ethnicity Select Individual's Ethnicity: Select each individual’s ethnicity by clicking on the drop-down menu in Column 7 (Block 6) and choosing one of the following options: - Hispanic/Latino
- Non-Hispanic/Non-Latino
- Not Reported
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IND-GEN - Selecting Individual's Race Figure 9. IND-GEN - Selecting Individual's Race Select Individual's Race: Select each individual’s race by clicking on the drop-down menu in Column 8 (Block 7) and choosing all that apply from the following options. You may select more than one (1) option for individuals of multiple races: - American Indian or Alaska Native
- Asian
- Black or African-American
- Native Hawaiian or Other Pacific Islander
- White
- Not Reported
Warning You may not select "Not Reported" in combination with any other option. |
IND-GEN - Selecting if Individual is from a Rural Residential Background Figure 10. IND-GEN - Selecting if Individual is from a Rural Residential Background Select Whether Individual is from a Rural Residential Background: Select whether each individual is from a rural residential background by clicking on the drop-down menu in Column 9 (Block 8) and choosing one of the following options: Reference Refer to the glossary for a definition of rural setting. |
IND-GEN - Selecting if Individual is from a Disadvantaged Background Figure 11. IND-GEN - Selecting if Individual is from a Disadvantaged Background Select Whether Individual is from a Disadvantaged Background: Select whether each individual is from a disadvantaged background by clicking on the drop-down menu in Column 10 (Block 9) and choosing one of the following options: Reference Refer to the glossary for a definition of disadvantaged background. |
IND-GEN - Selecting Individual's Veteran Status Figure 12. IND-GEN - Selecting Individual's Veteran Status Select Individual's Veteran Status: Select each individual's current veteran status by clicking on the drop-down menu in Column 11 (Block 10) and choosing one of the following options: - Active Duty Military
- Individual is not a Veteran
- National Guard
- Reservist
- Veteran - Prior Service
- Veteran - Retired
- Not Reported
Reference Refer to the glossary for a definition of the various types of veteran statuses. |
IND-GEN - Entering BHW-Funded Financial Award Information Figure 13. IND-GEN - Entering BHW-Funded Financial Award Information Select Whether Individual Received BHW Financial Award?: Select whether each individual received a BHW-funded financial award during the current reporting period by clicking on the drop-down menu in Column 12 (Block 11) and choosing one of the following options: Enter Individual's Financial Award Amount (BHW funds only): Stipend: Enter Individual's Financial Award Amount (BHW funds only): Tuition, Fees, and Supplies: Enter Individual's Financial Award Amount (BHW funds only): Academic Year Total: |
IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding Figure 14. IND-GEN - Entering # of Academic Years the Individual has Received BHW Funding Enter # of Academic Years the Individual has Received BHW Funding: Select the cumulative number of academic years that each student has received a BHW-funded financial award by clicking on the drop-down menu under Column 22 and choosing one of the following options: Note The number of academic years receiving BHW-funded financial awards does not need to be consecutive; rather, the cumulative total number of years should be reported.
Note If an individual has received money for ½ an academic year, please round up. For example, if a resident or dentist has received a financial award for 1 ½ years, please enter 2.
Note If an individual received a BHW-funded financial award for the first time during the annual reporting period, select "1" under Block 12. |
IND-GEN - Selecting Individual's Academic or Training Year Figure 15. IND-GEN - Selecting Individual's Academic or Training Year Select Individual's Academic or Training Year: Select each student's current training year by clicking on the drop-down menu under Block 15 and choosing one of the following options: - Apprentice Year 1
- Apprentice Year 2
- Training Year 1
- Training Year 2
- Training Year 3 or more
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IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training Figure 16. IND-GEN - Selecting any HHS Priority Topic Area on which an Individual Received Training Select any HHS Priority Topic Area on which an Individual Received Training: Use the dropdown menu in Column 26b to select all that apply from the list of topic areas on which the individual was trained. - Individual received provider resilience training
- Individual received training in Health Equity
- Individual received training in medications for opioid use disorder (MOUD)
- Individual received training in substance use treatment
- Individual received training on integrated behavioral health in primary care
- Individual received training related to maternal health
- None of the above
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IND-GEN - Selecting Profession and Discipline/Specialty Figure 17. IND-GEN - Selecting Profession and Discipline/Specialty Select Individual's Profession: Select the individual’s profession by clicking on the drop-down menu in Column 26c and selecting one of the available options.- Allied Health - Student
- Other - Student
- Paraprofessional - Student
- Public Health - Student
Select Individual's Primary Discipline/Specialty: Select the individual’s discipline/specialty by clicking on the drop-down menu in Column 26d and choosing from one of the available options. Please note that you must select a discipline/specialty that is associated with the profession you selected in Column 26c. The disciplines/specialties are organized by profession in the drop-down; please scroll to find the correct option.- ALLIED HEALTH OPTIONS (please select)
- Community Health Worker
- Home Health Aide
- OTHER OPTIONS (please select)
- Doula
- PARAPROFESSIONAL OPTIONS (please select)
- Peer Paraprofessional
- Recovery Coach
- Social Services Aide
- PUBLIC HEALTH OPTIONS (please select)
- Health Education
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IND-GEN - Entering Telehealth Training Information Figure 18. IND-GEN - Entering Telehealth Training Information Training in Telehealth: Select Whether Individual Received Training: Select whether each individual received clinical or experiential training in telehealth during the current reporting period by clicking on the drop-down menu in Column 27d and choosing one of the following options:Training in Telehealth: Enter # of Contact Hours: - If the individual received clinical or experiential training in Telehealth, enter the total number of hours spent offering telehealth services and/or participating in training about how to offer telehealth services during the current reporting period in the textbox in Column 27e.
- If the individual did not receive clinical or experiential training in Telehealth, leave the textbox in Column 27e blank.
Training in Telehealth: Enter # of Patient Encounters: - If the individual received clinical or experiential training in Telehealth, enter the number of telehealth patient encounters in this setting during the current reporting period in Column 27f.
- If the individual did not receive clinical or experiential training in Telehealth, leave the textbox in Column 27f blank.
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IND-GEN - Entering Training Information in a Primary Care Setting Figure 19. IND-GEN - Entering Training Information in a Primary Care Setting Training in a Primary Care Setting: Select Whether Individual Received Training: Select whether each student received clinical or experiential training in a primary care setting during the current reporting period by clicking on the drop-down menu in Column 28 (Block 17) and choosing one of the following options: Training in a Primary Care Setting: Enter # of Contact Hours: -
If the individual received clinical or experiential training in primary care, enter the total number of hours spent in this type of setting during the current reporting period in the textbox. -
If the individual did not receive clinical or experiential training in primary care, leave the textbox blank. Training in a Primary Care Setting: Enter # of Patient Encounters: |
IND-GEN - Entering Training Information in a Medically Underserved CommunityWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 20. IND-GEN - Entering Training Information in a Medically Underserved Community Training in a Medically Underserved Community: Select Whether Individual Received Training: Select whether each individual received clinical or experiential training in a medically underserved community during the current reporting period by clicking on the drop-down menu in Column 31 and choosing one of the following options: Training in a Medically Underserved Community: Enter # of Contact Hours: -
If the individual received clinical or experiential training in a MUC, enter the total number of hours spent in this type of setting during the current reporting period in the textbox in Column 32. -
If the individual did not receive clinical or experiential training in a MUC, leave the textbox blank. Training in a Medically Underserved Community: Enter # of Patient Encounters : |
IND-GEN - Entering Training Information in a Rural AreaWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 21. IND-GEN - Entering Training Information in a Rural Area Training in a Rural Area: Select Whether Individual Received Training: Select whether each individual received clinical or experiential training in a rural area during the current reporting period by clicking on the drop-down menu in Column 33 (Block 19) and choosing one of the following options: Training in a Rural Area: Enter # of Contact Hours: - If the individual received clinical or experiential training in a rural area, enter the total number of hours spent in this type of setting during the current reporting period in the textbox.
- If the individual did not receive clinical or experiential training in a rural area, leave the textbox blank.
Training in a Rural Area: Enter # of Patient Encounters: |
IND-GEN - Entering Total # of Patient Encounters Across All Settings Including Inpatients Figure 22. IND-GEN - Entering Total # of Patient Encounters Across All Settings Including Inpatients Enter Total # of Patient Encounters Across All Settings Including Inpatients: For each individual, enter the number of patient encounters across all settings, including inpatients, during the current reporting period in Column 34ab.
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IND-GEN - Entering Total # of Contact Hours Across All Settings Including Inpatients Figure 23. IND-GEN - Entering Total # of Contact Hours Across All Settings Including Inpatients Enter Total # of Contact Hours Across All Settings Including Inpatients:
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IND-GEN - Selecting Any Key Services Provided by Individual Figure 24. IND-GEN - Selecting Any Key Services Provided by Individual Select Any Key Services Provided by Individual: - Advocacy
- Education
- Emergency response and recovery
- Health services
- Navigation
- Outreach and enrollment
- Social-emotional support
- None of the Above
Note Select all that apply. |
IND-GEN - Selecting Whether Individual Left the Program Before Completion Figure 25. IND-GEN - Selecting Whether Individual Left the Program Before Completion Select Whether Individual Left the Program Before Completion: Select whether each individual permanently left their training program before completion during the current reporting period by clicking on the drop-down menu in Column 36 (Block 21) and choosing one of the following options: |
IND-GEN - Selecting Reason for Attrition or Inactive Status Figure 26. IND-GEN - Selecting Reason for Attrition or Inactive Status Select Reason for Attrition or Inactive Status: Select the primary reason each individual discontinued participation by clicking on the drop-down menu under Column 36a and choosing one of the following options: - Administrative Error
- Dissatisfaction with training program/certification
- Emotional/physical/mental exhaustion (burnout)
- Family obligations
- Financial obligations
- Medical leave of absence
- Military/Active duty
- Pursuing different career path
- Pursuing on the job training instead
- Transportation difficulties
- Other
- N/A
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IND-GEN - Entering Graduation/Completion Information Figure 27. IND-GEN - Entering Graduation/Completion Information Select Whether Individual Graduated/Completed the Program: Select whether each student completed their training program during the current reporting period by clicking on the drop-down menu in Column 37 (Block 22) and choosing one of the following options: Select Degree Earned: - If an individual did complete their training program during the current reporting period, select “Yes” in Column 37 (Block 22) and select the degree earned by clicking on the drop-down menu in Column 38 (Block 22a) and choosing all that apply from the below listed options.
- If an individual did not complete their training program during the current reporting period select “No” in Column 37 (Block 22) and select “N/A” in Column 38 (Block 22a).
- Certificate - Behavioral Health Technician/Aide
- Certificate - Community Health Worker/Promotora
- Certificate - Mental Health Worker
- Certificate - Other
- Certificate - Outreach Worker
- Certificate - Peer Paraprofessional
- Certificate - Social Services Aide
- Certificate - Substance Use/ Addictions Worker
- Certificate - Youth Worker
- N/A
Select Individual's Post-Graduation/Completion Intentions: - If an individual did complete their training program during the current reporting period, select “Yes” in Column 37 (Block 22) and select the individual’s training or employment intentions at the time of completion by clicking on the drop-down menu in Column 39 (Block 22b) and choosing all that apply from the below listed options.
- If an individual did not complete their training program during the current reporting period select “No” in Column 37 (Block 22) and select “N/A” in Column 39 (Block 22b).
- Individual intends to apply for NHSC Loan Repayment
- Individual intends to become employed in a public health/prevention setting
- Individual intends to become employed or pursue further training in a medically underserved community
- Individual intends to become employed or pursue further training in a primary care setting
- Individual intends to become employed or pursue further training in a rural setting
- Individual intends to continue employment as a CHW/HSW
- Individual intends to pursue employment as a CHW/HSW
- Individual intends to serve individuals with OUD/SUD
- None of the above
- Not Reported
- N/A
Select Competencies the Individual is Highly Ready to Perform: - Advocacy
- Communication
- Community and Individual Assessment and Monitoring
- Community Capacity-building
- Community Outreach and Engagement
- Cultural Competency
- Emergency Response
- Health Equity
- Health Insurance Basics
- Implementation - Programs / Plans / Policies / Laws
- Interprofessional Practice
- Leadership and Management
- Organizational Skills
- Policy Development and Analysis
- Promoting Healthy Lifestyles
- Public Health
- Research and Evaluation
- Service Coordination
- Teaching
- Vaccine Hesitancy
- None of the Above
- N/A
Select Factors Individual was Highly Satisfied with: - Quality of experiential training
- Quality of instruction for CHW competencies
- Quality of instruction for public health competencies
- Quality of mentoring and support services for attaining certification
- Quality of mentoring and support services for employment readiness
- Quality of mentoring and support services for job placement
- None of the Above
- N/A
Warning None of the above, Not reported, and N/A cannot be selected in combination with any other option. Note If an individual did complete their training program during the current reporting period, select the competencies the individual feels they are highly ready to perform at the time of completion and choose all that apply. If an individual did not complete their training program during the current reporting period, select 'N/A'. Note If an individual did complete their training program during the current reporting period, select the factors the individual is highly satisfied with and choosing all that apply. If an individual did not complete their training program during the current reporting period, select 'N/A'. |
IND-GEN - Entering Individual's Employment DataWarning Multiple steps are required to complete this portion of the subform. Please read instructions carefully. Figure 28. IND-GEN - Entering Individual's Employment Data Select whether Employment Data is available?: Select whether employment data are available by clicking on the drop-down menu in Column 56 and choosing one of the following options: - Yes
- Yes (outside U.S.)
- No
- N/A
Select Whether Your Organization Hired this Individual: Select Whether a Partner Organization Hired this Individual: Select Whether Program Sponsoring Employer Hired the Apprentice After the Apprenticeship: - Yes
- No - hired as a CHW elsewhere
- No - found employment as a non-CHW
- No - not employed
- N/A
Hired Hourly Wage: Enter Zip Code: - If ‘Yes’ was selected in Column 56, enter the zip code (5 digits) of the employment site.
- If ‘No’ or ‘Yes (outside U.S.)' was selected, leave Column 57 blank.
Enter City: Enter State: Select Type of Employment: - If ‘Yes’ was selected in Column 56, identify the individual’s type of employment by clicking on the drop-down menu and selecting the best option among those listed below.
- If ‘No’ or ‘Yes (outside U.S.)' was selected, select 'N/A' in Column 60.
- Academic Institution
- Academic Medical Center
- Area Health Education Center
- Certified Community Behavioral Health Center (CCBHC)
- Community Behavioral Health/Mental Health Center
- Community Health Center (CHC)
- Critical Access Hospital
- Federal Government
- FQHC or Look-Alike
- Health Department (local/state/tribal)
- Hospital (non-academic)
- Indian Health Service (IHS)/Tribal/Urban Indian Health Center
- Nursing Home
- Other Clinical Health Setting
- Other Community-Based Organization
- Other Long-term Care Facility
- Other Specialty Clinic
- Private Industry
- Private Practice
- Residential Living Facility (including independent and assisted living)
- Rural Health Clinic
- School-based Clinic
- State or Local Government
- US Armed Forces
- Veterans Affairs Healthcare (e.g. VA hospital or clinic)
- Pursuing Additional Education or Training
- Not Currently Employed
- N/A
Warning For Column 60, None of the above, not reported, and N/A cannot be selected in combination with any other option. NoteIf an individual has completed the program but is not currently employed, please select “Yes” for Column 56 (Select whether employment data is available). Leave the zip code, city, and state blank and select "N/A" for whether you or a partner organization hired the individual (Columns 56a and 56b). Then, select “Not Currently Employed” for Column 60 and N/A for Column 61.
Note Employment columns 56c and 56d are only applicable for trainees who completed an apprenticeship program. The remaining employment columns are applicable to all program completers, regardless of whether they participated in an apprenticeship program. |
IND-GEN - Selecting Individual's Employment Location Settings Figure 29. IND-GEN - Selecting Individual's Employment Location Settings Select Individual's Employment Location Settings: For each individual, use the drop-down menu in Column 61 to select all that apply from the list of employment location settings. - Medically Underserved Community
- National Health Service Corps (NHSC)-Approved Site
- Primary Care Setting
- Rural Area
- None of the Above
- N/A
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IND-GEN - Selecting Individual's Role(s) at Employment Setting Figure 30. IND-GEN - Selecting Individual's Role(s) at Employment Setting Select Individual’s Primary Role at Employment Setting: - Address social determinants of health
- Advocacy - individual and community
- Assessment - individual and community
- Capacity building - individual and community
- Case management
- Collect data and relay information to stakeholders to inform programs and policies
- Conduct outreach
- Create connections between vulnerable populations and healthcare providers
- Determine eligibility and enroll individuals in health insurance plans
- Educate healthcare providers and stakeholders about community health needs
- Ensure cultural competence among healthcare providers serving vulnerable populations
- Help patients navigate healthcare and social service systems
- Manage care and care transitions for vulnerable populations
- Participate in research and evaluation
- Provide coaching and/or informal counseling
- Provide cultural mediation among individuals / communities / health and social service systems
- Provide culturally appropriate health education
- Provide interpretation and translation services
- Provide referrals
- Provide some direct services such as first aid and blood pressure screening
- Reduce social isolation among patients
- Not employed as CHW/HSW
- N/A
Select Individual's Other Role(s) at Employment Setting: - Address social determinants of health
- Advocacy - individual and community
- Assessment - individual and community
- Capacity building - individual and community
- Case management
- Collect data and relay information to stakeholders to inform programs and policies
- Conduct outreach
- Create connections between vulnerable populations and healthcare providers
- Determine eligibility and enroll individuals in health insurance plans
- Educate healthcare providers and stakeholders about community health needs
- Ensure cultural competence among healthcare providers serving vulnerable populations
- Help patients navigate healthcare and social service systems
- Manage care and care transitions for vulnerable populations
- Participate in research and evaluation
- Provide coaching and/or informal counseling
- Provide cultural mediation among individuals / communities / health and social service systems
- Provide culturally appropriate health education
- Provide interpretation and translation services
- Provide referrals
- Provide some direct services such as first aid and blood pressure screening
- Reduce social isolation among patients
- Not employed as CHW/HSW
- N/A
Note For primary role, select one. For other roles, select all that apply. |
IND-GEN - Selecting Type(s) of Vulnerable Populations Served at Employment Setting Figure 31. IND-GEN - Selecting Type(s) of Vulnerable Populations Served at Employment Setting Select Type(s) of Vulnerable Populations Served at Employment Setting: - Children or Adolescents
- Chronically ill
- College students
- Financially underserved
- Geographically underserved
- Health Insurance Marketplace eligible Individuals
- Individuals experiencing homelessness
- Individuals with HIV/AIDS
- Individuals with mental illness or substance use disorders
- Lesbian/Gay/Bisexual/Transgender
- Low income persons/families
- Medically underserved
- Migrant workers
- Military and/or military families
- Older adults
- People with disabilities
- Pregnant women and infants
- Refugee Adults
- Socio-culturally underserved
- Transitional Age Youth (16-25 years)
- Tribal Population
- Underrepresented minorities
- Undocumented Immigrants
- Unemployed
- Uninsured/Underinsured persons/families
- Veterans
- Victims of interpersonal violence abuse or trauma
- None of the above
- N/A
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IND-GEN - Selecting Apprenticeship Program Status Figure 32. IND-GEN - Selecting Apprenticeship Program Status Select Apprenticeship Program Status: - Enrolled
- Cancelled or Withdrew
- Completed
- Not in an Apprenticeship Program
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IND-GEN - Entering Program Entry and Exit Dates for Apprenticeship Participants Figure 33. IND-GEN - Entering Program Entry and Exit Dates for Apprenticeship Participants Program Entry Date for Apprenticeship Participant: Program Exit Date for Apprenticeship Participant:
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IND-GEN - Entering Entry Information for the Apprenticeship Figure 34. IND-GEN - Entering Entry Information for the Apprenticeship Employment Status at Apprenticeship Entry: - Employed
- Employed but Received Notice of Termination of Employment or Military Separation is pending
- Not in labor force
- Unemployed
Hourly Wage At Apprenticeship Entry: |
IND-GEN - Selecting Apprentice Roles at Site Figure 35. IND-GEN - Selecting Apprentice Roles at Site Select Apprentice Role(s) at Site: - Address social determinants of health
- Advocacy - individual and community
- Assessment - individual and community
- Capacity building - individual and community
- Case management
- Collect data and relay information to stakeholders to inform programs and policies
- Conduct outreach
- Create connections between vulnerable populations and healthcare providers
- Determine eligibility and enroll individuals in health insurance plans
- Educate healthcare providers and stakeholders about community health needs
- Ensure cultural competence among healthcare providers serving vulnerable populations
- Help patients navigate healthcare and social service systems
- Manage care and care transitions for vulnerable populations
- Participate in research and evaluation
- Provide coaching and/or informal counseling
- Provide cultural mediation among individuals / communities / health and social service systems
- Provide culturally appropriate health education
- Provide interpretation and translation services
- Provide referrals
- Provide some direct services such as first aid and blood pressure screening
- Reduce social isolation among patients
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IND-GEN - Selecting Skills the Apprentice is Developing Figure 36. IND-GEN - Selecting Skills the Apprentice is Developing Select Skills the Apprentice is Developing: - Advocacy
- Communication
- Community and Individual Assessment and Monitoring
- Community Capacity-building
- Community Outreach and Engagement
- Cultural Competency
- Dental Health
- Emergency Response
- Health Equity
- Health Insurance Basics
- Implementation - Programs / Plans / Policies / Laws
- Interprofessional Practice
- Leadership and Management
- Organizational Skills
- Policy Development and Analysis
- Promoting Healthy Lifestyles
- Public Health
- Research and Evaluation
- Service Coordination
- Teaching
- Vaccine Hesitancy
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IND-GEN - Selecting Support Received During Apprenticeship Figure 37. IND-GEN - Selecting Support Received During Apprenticeship Select Support Received During Apprenticeship : - Academic/career counseling
- Assistance with certification costs
- Assistance with costs for tools equipment books supplies and/or other materials
- Basic skills or remedial/developmental training in math and/or English
- Child care
- Flexible scheduling
- In-kind or other substantive support
- Introductory information technology training
- Resiliency and safety support
- Transportation assistance
- Tuition assistance
- Tutoring
- None of the above
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IND-GEN - Entering Apprenticeship Minimum Term Length Figure 38. IND-GEN - Entering Apprenticeship Minimum Term Length Apprenticeship Minimum Term Length:
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IND-GEN - Entering Total Number of Apprenticeship Training Hours Figure 39. IND-GEN - Entering Total Number of Apprenticeship Training Hours Total Number of Apprenticeship Training Hours:
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IND-GEN - Entering Apprenticeship Address Figure 40. IND-GEN - Entering Apprenticeship Address Apprenticeship Street: Apprenticeship City: Apprenticeship State: - AK
- AL
- AR
- AS
- AZ
- CA
- CO
- CT
- DC
- DE
- FL
- FM
- GA
- GU
- HI
- IA
- ID
- IL
- IN
- KS
- KY
- LA
- MA
- MD
- ME
- MH
- MI
- MN
- MO
- MP
- MS
- MT
- NC
- ND
- NE
- NH
- NJ
- NM
- NV
- NY
- OH
- OK
- OR
- PA
- PR
- PW
- RI
- SC
- SD
- TN
- TX
- UT
- VA
- VI
- VT
- WA
- WI
- WV
- WY
Apprenticeship Zip Code: |
IND-GEN - Entering Exit Information for the Apprenticeship Figure 41. IND-GEN - Entering Exit Information for the Apprenticeship Type of Credential Attained During Or At Apprenticeship Exit: - Secondary School Diploma/or equivalency
- AA or AS Diploma/Degree
- BA or BS Diploma/Degree
- Occupational Licensure
- Occupational Certificate
- Occupational Certification
- Other Recognized Diploma Degree or Certificate
- No recognized credential
Hourly Wage At Apprenticeship Exit: To Complete the Form: Click on the "Save and Validate" button located on the bottom right corner of your screen. If no errors are found, the BPMH system will automatically route you to the next required subform. |
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