Mediation Grant Data Collection Form {NHJB-2752-F}

NHJB-2752-F - MEDIATION GRANT DATA COLLECTION FORM. This form gathers optional, non-identifying information from parties whose mediation fees were covered by a DHHS grant. Parties indicate role (petitioner/respondent; father/mother), current relationship status, number of shared children, parenting time (including whether time increased through mediation), and basic demographics and income range. A brief mediator section notes whether resource referrals were provided, if a temporary or permanent parenting plan was created, and whether child support was discussed. Responses are aggregated and reported to DHHS to help improve services; individual identities are not used. www.FormsWorkflow.com