Created
October 17, 2024 19:41
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| { | |
| "title": "Annual Monitoring Form", | |
| "name": "annualMonitoringForm", | |
| "type": "form", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "collapsible": false, | |
| "type": "panel", | |
| "title": "Page 1", | |
| "components": [ | |
| null, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "wx6b3d42", | |
| "size": "medium", | |
| "type": "textfield", | |
| "label": "Agency or Company", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "2z0j5s9h", | |
| "size": "medium", | |
| "type": "textfield", | |
| "label": "Role ", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "inputMask": "999-999-9999", | |
| "validateOn": "blur", | |
| "key": "y7fn4368", | |
| "type": "phoneNumber", | |
| "label": "Contact Phone Number", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| null, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "5pfxmg0u", | |
| "size": "medium", | |
| "type": "textfield", | |
| "label": "Name of Sponsor/Agency", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "1e1c2m1t", | |
| "size": "medium", | |
| "type": "textfield", | |
| "label": "Name of Property Management Company", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "x22czo68", | |
| "size": "medium", | |
| "type": "textfield", | |
| "label": "Name of Service Provider (if applicable)", | |
| "validate": { | |
| "required": true | |
| } | |
| } | |
| ], | |
| "key": "page1" | |
| }, | |
| null, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "collapsible": false, | |
| "type": "panel", | |
| "title": "Page 2", | |
| "components": [ | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "5sabxj45", | |
| "label": "Services in senior-restricted buildings<br><br>Please report on (7) service areas provided at the senior-restricted Buildings. The areas are as follows: 1) Annual resident assessments; 2) Non-housing basic needs; 3) Community-building activities; 4) Training and skill development; 5) Service coordination and linkages; 6) Other services; and 7) Program learnings.\n\nEligible supportive services, categories and examples are provided. \n\nThe reporting period covers January 1 - December 31, 2023.", | |
| "components": [ | |
| null | |
| ] | |
| }, | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "vl9say8m", | |
| "label": "Annual Resident Assessments<br><br>Annual assessments include need assessments and resident satisfaction survey.", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "baiq5h4q", | |
| "type": "radio", | |
| "label": "Needs assessments are distributed at this site.", | |
| "conditions": [], | |
| "description": "", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| null, | |
| null, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "delimiter": false, | |
| "requireDecimal": false, | |
| "inputFormat": "plain", | |
| "truncateMultipleSpaces": false, | |
| "validateOn": "blur", | |
| "key": "qrtrzi7t", | |
| "type": "number", | |
| "label": "# of resident surveys collected", | |
| "conditions": [ | |
| { | |
| "value": "Yes", | |
| "action": "show", | |
| "method": "eq", | |
| "response_field_id": "baiq5h4q" | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "qw5kioxh", | |
| "type": "radio", | |
| "label": "Residents satisfaction surveys are distributed at this site. ", | |
| "conditions": [], | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| null, | |
| null, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "delimiter": false, | |
| "requireDecimal": false, | |
| "inputFormat": "plain", | |
| "truncateMultipleSpaces": false, | |
| "validateOn": "blur", | |
| "key": "r159fyke", | |
| "type": "number", | |
| "label": "# of resident surveys collected ", | |
| "conditions": [ | |
| { | |
| "value": "Yes", | |
| "action": "show", | |
| "method": "eq", | |
| "response_field_id": "qw5kioxh" | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| } | |
| ] | |
| } | |
| ], | |
| "key": "page2" | |
| }, | |
| null, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "collapsible": false, | |
| "type": "panel", | |
| "title": "Page 3", | |
| "components": [ | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "87l41md1", | |
| "label": "Non-Housing Basic Needs<br><br>Non-housing basic needs includes but not limited to food pantry, transportation support, utility financial assistance.", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "k636k9a7", | |
| "type": "radio", | |
| "label": "Access to food, such as food pantry or meal deliveries are offered on-site.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "lfsxlh2a", | |
| "label": "Food access service provided.", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. food pantry, world kitchen delivery)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGFoodPantry" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (E.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity ", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "k636k9a7", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "d6ftyp3t", | |
| "type": "radio", | |
| "label": "Utility financial assistance is offered on-site.", | |
| "description": "E.g. Utility deposit", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "xspgiw1f", | |
| "label": "Utility financial assistance service provided.", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. Utility deposit, on-going assistance)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGUtilityDeposit" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (E.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly1" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity1" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting1" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter utility provider", | |
| "type": "textfield", | |
| "key": "enterUtilityProvider" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "d6ftyp3t", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "ozj2r1oj", | |
| "type": "radio", | |
| "label": "Transportation support services are offered on-site.", | |
| "description": "E.g. Transportation, discounted tokens ", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "5s84f1qj", | |
| "label": "Transportation support services provided.", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. GoGoGranparent, Lyft coordination) ", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGGoGoGranparent" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (E.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly2" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity2" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting2" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "ozj2r1oj", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "4a5hlsko", | |
| "type": "radio", | |
| "label": "Other services offered to meet Non-housing basic needs.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "6hkq25wq", | |
| "label": "Service provided", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter Other Service(s)", | |
| "type": "textfield", | |
| "key": "enterOtherServiceS" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly3" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity3" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting3" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "4a5hlsko", | |
| "eq": true | |
| } | |
| } | |
| ] | |
| }, | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "u9n4x53v", | |
| "label": "Community Building", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "vnlgjp7y", | |
| "type": "radio", | |
| "label": "Social events and gatherings are offered on-site.", | |
| "description": "E.g. Movie night, outings, seasonal or cultural gatherings", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "uzhrmp09", | |
| "label": "Social Events", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (E.g. Coffee Korner, Spring Gathering)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGCoffeeKorner" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (E.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly4" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity4" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting4" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "vnlgjp7y", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "ophd43zb", | |
| "type": "radio", | |
| "label": "Group excercise classes are offered on-site.", | |
| "description": "E.g. Chair yoga, Zumba", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "alfeodkh", | |
| "label": "Group Class Excercises (CD2)", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. Zumba, Chair yoga)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGZumbaChairYoga" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly5" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity5" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting5" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "ophd43zb", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "xumq00yk", | |
| "type": "radio", | |
| "label": "Enrichment classes are offered on-site.", | |
| "description": "E.g. Art and crafting classes", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "1dgb0ffv", | |
| "label": "Enrichment Classes ", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. Knitting Korner, Paint and Tea)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGKnittingKorner" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly6" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity6" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting6" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "xumq00yk", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "o9lhtp1i", | |
| "type": "radio", | |
| "label": "Other community building services are offered.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "gebe1esl", | |
| "label": "Community building, Other services provided.", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter Other Service(s)", | |
| "type": "textfield", | |
| "key": "enterOtherServiceS1" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly7" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity7" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting7" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "o9lhtp1i", | |
| "eq": true | |
| } | |
| } | |
| ] | |
| }, | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "cdms0of7", | |
| "label": "Training and Skill Development", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "hnjr29mt", | |
| "type": "radio", | |
| "label": "Educational services are offered on-site.", | |
| "description": "E.g. GED, ESL classes", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "pghbair6", | |
| "label": "Education Services", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. GED classes, ESL classes)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGGEDClasses" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly8" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity8" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting8" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "hnjr29mt", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "agitpqtd", | |
| "type": "radio", | |
| "label": "Life skills trainings are offered on-site.", | |
| "description": "E.g. Computer and/or Internet classes ", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "81muljde", | |
| "label": "Life skills trainings", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. Internet classes)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGInternet" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly9" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity9" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting9" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "agitpqtd", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "3d1008yi", | |
| "type": "radio", | |
| "label": "Employment assistance and job trainings are offered on-site.", | |
| "description": "E.g. Resume writing, Jobs search", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "z92ksnsm", | |
| "label": "Employment assistance and job trainings. ", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. Resume writing, Jobs for Retirees)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGResumeWriting" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly10" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity10" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting10" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "3d1008yi", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "lu9ttmpi", | |
| "type": "radio", | |
| "label": "Other training and skill development classes are offered on-site.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "dsz3nhxh", | |
| "label": "Other training and skill development service provided", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter Other Service(s)", | |
| "type": "textfield", | |
| "key": "enterOtherServiceS2" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly11" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity11" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting11" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "lu9ttmpi", | |
| "eq": true | |
| } | |
| } | |
| ] | |
| }, | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "129v88f8", | |
| "label": "Service Coordination and Linkages", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "5ewk0dvj", | |
| "type": "radio", | |
| "label": "Individual case management is offered on-site.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "f1f3p31s", | |
| "label": "Individual case management services", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (E.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly12" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity12" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting12" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "5ewk0dvj", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "yx4i6o0h", | |
| "type": "radio", | |
| "label": "Mental health services are offered on-site.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "xvodfbth", | |
| "label": "Mental health services", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. Elder group, Individual Counseling)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGElderGroup" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly13" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity13" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting13" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "yx4i6o0h", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "g6h9h4ou", | |
| "type": "radio", | |
| "label": "Outpatient services are offered on-site.", | |
| "description": "e.g Prevention and Screening", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "t0fahetw", | |
| "label": "Outpatient services", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter service name (e.g. Prevention and Screening)", | |
| "type": "textfield", | |
| "key": "enterServiceNameEGPreventionAnd" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (e.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly14" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity14" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting14" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "g6h9h4ou", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "4lp5y3qj", | |
| "type": "radio", | |
| "label": "Substance abuse treatment services are offered on-site.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "ggyqt2i4", | |
| "label": "Substance abuse treatment services.", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (E.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly15" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity15" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting15" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "4lp5y3qj", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "dcmsjcp7", | |
| "type": "radio", | |
| "label": "Other coordination or linkage services are offered", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "vxkasjy5", | |
| "label": "Other service coordination and linkages provided ", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter Other Service(s)", | |
| "type": "textfield", | |
| "key": "enterOtherServiceS3" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Frequency (Enter: Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "frequencyEnterDailyWeeklyMonthly" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity16" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting16" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "dcmsjcp7", | |
| "eq": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "autoExpand": true, | |
| "key": "d53fx5r6", | |
| "size": "medium", | |
| "type": "textarea", | |
| "label": "List top 3 internal referrals: ", | |
| "description": "Internal service coordination referrals include services hosted by either sponsor or building service provider. Services can be on-site or at another location (e.g. food bank, seasonal gatherings). ", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "autoExpand": true, | |
| "key": "mmxx8pgx", | |
| "size": "medium", | |
| "type": "textarea", | |
| "label": "List top 3 external referrals: ", | |
| "description": "External service coordination referrals include services that are through another organization. Services can be on-site or at another location (e.g. medical care, flu shots, psycho-educational groups).", | |
| "validate": { | |
| "required": true | |
| } | |
| } | |
| ] | |
| }, | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "rywn0mtg", | |
| "label": "Other services", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "key": "pbkv04ja", | |
| "type": "radio", | |
| "label": "Other services, not mentioned above, are offered on-site.", | |
| "values": [ | |
| { | |
| "label": "Yes", | |
| "value": true | |
| }, | |
| { | |
| "label": "No", | |
| "value": false | |
| } | |
| ], | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "type": "datagrid", | |
| "reorder": false, | |
| "addAnotherPosition": "bottom", | |
| "layoutFixed": true, | |
| "enableRowGroups": false, | |
| "initEmpty": false, | |
| "tableView": false, | |
| "input": true, | |
| "defaultValue": [ | |
| {} | |
| ], | |
| "key": "oom06gia", | |
| "label": "Other senior-restricted building services provided.", | |
| "required": true, | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter Other Service(s)", | |
| "type": "textfield", | |
| "key": "enterOtherServiceS4" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "Enter frequency (E.g. Daily, Weekly, Monthly, Annually, As Needed)", | |
| "type": "textfield", | |
| "key": "enterFrequencyEGDailyWeekly16" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of hours per activity", | |
| "type": "textfield", | |
| "key": "OfHoursPerActivity17" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "label": "# of total served during reporting period", | |
| "type": "textfield", | |
| "key": "OfTotalServedDuringReporting17" | |
| } | |
| ], | |
| "conditional": { | |
| "show": true, | |
| "when": "pbkv04ja", | |
| "eq": true | |
| } | |
| } | |
| ] | |
| } | |
| ], | |
| "key": "page3" | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "collapsible": false, | |
| "type": "panel", | |
| "title": "Page 4", | |
| "components": [ | |
| { | |
| "tableView": false, | |
| "input": false, | |
| "type": "fieldSet", | |
| "key": "4a5c30tl", | |
| "label": "Program Learnings", | |
| "components": [ | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "autoExpand": true, | |
| "key": "kblop742", | |
| "size": "medium", | |
| "type": "textarea", | |
| "label": "What are the program’s top three (3) strengths?", | |
| "description": "", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "autoExpand": true, | |
| "key": "ppb5enrw", | |
| "size": "medium", | |
| "type": "textarea", | |
| "label": "What are the program’s top three (3) challenges or areas for improvement?", | |
| "description": "", | |
| "validate": { | |
| "required": true | |
| } | |
| }, | |
| { | |
| "tableView": true, | |
| "input": true, | |
| "autoExpand": true, | |
| "key": "mgg0ezzs", | |
| "size": "medium", | |
| "type": "textarea", | |
| "label": "What are the opportunities for the program?", | |
| "description": "", | |
| "validate": { | |
| "required": true | |
| } | |
| } | |
| ] | |
| } | |
| ], | |
| "key": "page4" | |
| }, | |
| null | |
| ], | |
| "metadata": {} | |
| } |
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