Fillable Fsa External Program Form (Federal Bureau of Prisons)

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Fsa External Program Form (Federal Bureau of Prisons)

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1 | P a g e J a n u a r y 10, 2 0 2 0
FSA EXTERNAL PROGRAM SUBMISSION FORM
GENERAL INFORMATION
A. Enter the name of the program
Enter the complete name of the program and acronym, if applicable:
Provide a link to program webpage, if applicable:
B. Enter your name
Last name:
First name:
C. Enter your contact information
Email:
Telephone number:
Group (e.g., business/vendor, organization, university/college), if applicable:
Please describe or identify the group:
D. Are you the point of contact for
this program submission?
Yes: (If yes, please skip to G) No: (If no, please answer E and F)
E. Enter the name of the point of
contact
Last name:
First name:
F. Enter the point of contact’s
information
Email:
Telephone number:
Group (e.g., business/vendor, organization, university/college), if applicable:
Please identify or describe the group:
2 | P a g e J a n u a r y 10, 2 0 2 0
G. What is your or your group’s
(e.g., business/vendor,
organization, university/college)
relation to the program?
If you selected Other, please describe:
H. Enter the name of the developer
(or author, researcher,
publisher, vendor) of the
program
(May be same as the contact above.)
Last name:
First name:
Select
3 | P a g e J a n u a r y 10, 2 0 2 0
PROGRAM (DETAILS/INFORMATION)
I. What is the target population
for the program (i.e., who is the
program designed for or used
with)?
Federal offenders/inmates
Sub-populations of federal offenders/inmates (e.g., women inmates, violent offenders)
Other population/sub-populations with needs similar to federal offenders/inmates (e.g., those
in need of drug treatment)
Other population
Please further describe, if applicable, the selected target population:
J. What is the primary
criminogenic or critical need the
program meets/addresses?
Select the best answer:
If you selected Other, please describe:
Select
4 | P a g e J a n u a r y 10, 2 0 2 0
K. Answer each of the following
questions about the program
K1. Is the program implemented with a group or an individual?
Individual: Group:
If you selected Group, please enter maximum number of group members:
K2. What is the staff-to-inmate ratio for program delivery/implementation?
If you selected Other, please explain:
Select
5 | P a g e J a n u a r y 10, 2 0 2 0
If you selected Other, please explain:
K4. What is the length/duration of the entire program?
K5. How often are program sessions held?
K3. What is the length/duration of each program session?
Select
Select
6 | P a g e J a n u a r y 10, 2 0 2 0
If you selected Other, please explain:
K6. Are information technology (IT) equipment or access required (e.g., computer)?
No: Yes:
If yes, please describe the required technology:
K7. Is there a manual and/or documentation that details the requirements or specifications for
delivery/implementation/use?
Yes: No: Not applicable:
K5. How do you know that an inmate’s need has been met (i.e., they no longer need the program
to meet their need)?
If you selected Other, please explain:
Other
7 | P a g e J a n u a r y 10, 2 0 2 0
No: Yes:
If yes, please describe expertise/qualifications required:
K9. What is the time required to train staff to implement the program?
If other, please enter the required time for training:
K10. Provide any additional relevant information about the program for the BOP
K8. Does the program require staff training and/or qualifications to implement?
Select
8 | P a g e J a n u a r y 10, 2 0 2 0
L. Answer each of the following
questions about the cost of the
program
L1. Is the program available in the public domain at no cost?
Yes: No:
L2. Is there a license fee required to use the program (i.e., terms and conditions of use)?
No: Yes:
If yes, please enter the cost of the license:
L3. Is there a cost for required staff training (not including staff hours listed in K9 above)?
No: Yes:
If yes, please enter the per person cost:
L4. Is there a cost for any supporting materials (i.e., manuals, assignments) required to implement
the program?
No: Yes:
If yes, please describe additional resources and cost, if applicable:
L5. Provide any additional relevant information about the program costs for the BOP:
STUDY OF PROGRAM (DETAILS/INFORMATION)
M. Are you providing one, two, or
three studies of the program?
One study: Two studies: Three studies:
9 | P a g e J a n u a r y 10, 2 0 2 0
N. Is the first study published?*
*SOURCES INCLUDE: journal articles,
other publications, evaluation reports,
systematic reviews, meta-analyses, or
other research study sources
No:
Yes:
If yes, please include where the study was published and supply a web address for the publication, if
applicable:
O. What is the research design of
the first study?*
*CAUTION: Programs ultimately
considered to be evidence-based,
specifically EBRR programs, will have at
least one study using study designs 1-3.
Study designs rated 4 will not be
considered for evidence review because
they are not study designs that can
provide evidence.
Experimental: Well-designed randomized field trial
Quasi-experimental A: Uses a credible comparison group, with extensive information provided
on pre-treatment equivalence of groups (includes time series comparison group design, etc.)
Quasi-experimental B: Uses a comparison group but lacks comparability on important
preexisting variables or lacks information on pre-treatment equivalence of groups (includes
time series single group design, etc.)
Non-experimental: Includes one group pretest-posttest, one- and two-group posttest only,
case studies, or other
If non-experimental was selected, please describe:
P. Who was the first study
conducted with (i.e., what
population was included in the
study)?
Federal offenders/inmates
Sub-populations of federal offenders/inmates (e.g., women inmates, violent offenders)
Other population/sub-populations with needs similar to federal offenders/inmates (e.g., those
with in need of drug treatment)
Select the best answer:
Select the best answer:
Other population
10 | P a g e J a n u a r y 10, 2 0 2 0
Q. What is the sample size of the
first study (i.e., number of
people)?
100 and above:
More than 25, but fewer than 100:
25 and under:
R. What year was the first study
completed
(published/available)?
2010 to 2020:
2000 to 2009:
Before 2000:
S. Is the second study published?*
*SOURCES INCLUDE: journal articles,
other publications, evaluation reports,
systematic reviews, meta-analyses, or
other research study sources
No:
Yes:
If yes, please include where the study was published and supply a web address for the publication, if
applicable:
T. What is the research design of
the second study?*
Experimental: Well-designed randomized field trial
Select the best answer:
Please describe the actual population used in the study:
11 | P a g e J a n u a r y 10, 2 0 2 0
*CAUTION: Programs ultimately
considered to be evidence-based,
specifically EBRR programs, will have at
least one study using study designs 1-3.
Study designs rated 4 will not be
considered for evidence review because
they are not study designs that can
provide evidence.
Quasi-experimental A: Uses a credible comparison group, with extensive information provided
on pre-treatment equivalence of groups (includes time series comparison group design, etc.)
Quasi-experimental B: Uses a comparison group but lacks comparability on important
preexisting variables or lacks information on pre-treatment equivalence of groups (includes
time series single group design, etc.)
Non-experimental: Includes one group pretest-posttest, one- and two-group posttest only,
case studies, or other
If non-experimental was selected, please describe:
U. Who was the second study
conducted with (i.e., what
population was included in the
study)?
Federal offenders/inmates
Sub-populations of federal offenders/inmates (e.g., women inmates, violent offenders)
Other population/sub-populations with needs similar to federal offenders/inmates (e.g., those
with in need of drug treatment)
Other population
Please describe the actual population used in the study:
V. What is the sample size of the
second study (i.e., number of
people)?
100 and above:
More than 25, but fewer than 100:
25 and under:
W. What year was the second study
completed
(published/available)?
2010 to 2020:
2000 to 2009:
Select the best answer:
12 | P a g e J a n u a r y 10, 2 0 2 0
Before 2000:
X. Is the third study published?*
*SOURCES INCLUDE: journal articles,
other publications, evaluation reports,
systematic reviews, meta-analyses, or
other research study sources
No:
Yes:
If yes, please include where the study was published and supply a web address for the publication, if
applicable:
Y. What is the research design of
the third study?*
*CAUTION: Programs ultimately
considered to be evidence-based,
specifically EBRR programs, will have at
least one study using study designs 1-3.
Study designs rated 4 will not be
considered for evidence review because
they are not study designs that can
provide evidence.
Experimental: Well-designed randomized field trial
Quasi-experimental A: Uses a credible comparison group, with extensive information provided
on pre-treatment equivalence of groups (includes time series comparison group design, etc.)
Quasi-experimental B: Uses a comparison group but lacks comparability on important
preexisting variables or lacks information on pre-treatment equivalence of groups (includes
time series single group design, etc.)
Non-experimental: Includes one group pretest-posttest, one- and two-group posttest only,
case studies, or other
If non-experimental was selected, please describe:
Select the best answer:
13 | P a g e J a n u a r y 10, 2 0 2 0
Z. Who was the third study
conducted with (i.e., what
population was included in the
study)?
Federal offenders/inmates
Sub-populations of federal offenders/inmates (e.g., women inmates, violent offenders)
Other population/sub-populations with needs similar to federal offenders/inmates (e.g., those
with in need of drug treatment)
Other population
Please describe the actual population used in the study:
AA. What is the sample size of the
third study (i.e., number of
people)?
100 and above:
More than 25, but fewer than 100:
25 and under:
BB. What year was the third study
completed
(published/available)?
2010 to 2020:
2000 to 2009:
Before 2000:
Select the best answer:
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Fsa External Program Form (Federal Bureau of Prisons)

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Completed 19 July 2020

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