APPENDIX F
REQUEST TO STATE VR AGENCIES
RSA Letter to Agency Administrator Requesting Contact Information
DATE
<Name>
<Title>
<Agency>
<Street Address>
<City, State, ZIP >
Reference: Post-Vocational Rehabilitation Experiences Study (PVRES)
Dear <Agency Administrator Salutation and Last Name>:
The Rehabilitation Services Administration (RSA) is undertaking a longitudinal study of former consumers of the State Vocational Rehabilitation Services program as authorized under Section 14(a) of the Rehabilitation Act. RSA has contracted with Westat of Rockville, Maryland to conduct the study as RSA’s agent.
Westat has selected a sample from the 2006 RSA 911 file to be part of the longitudinal study; including <Number> former consumers from <NAME OF AGENCY>. In order to conduct the study we need the state VR agencies to provide identifying information and information we can use to locate the sampled consumers. Westat has provided a list of what is needed to [you/your designated liaison, NAME,] under separate cover.
RSA is authorizing state agencies to provide the requested information directly to Westat. Westat’s information security protocols have been evaluated by RSA and deemed to meet or exceed requirements. However, RSA understands that some states have legislation that precludes providing names and other personally identifiable information to an agent. Should this be the case in your state, RSA is prepared to receive the information directly.
[You/Your designated liaison] will be contacted shortly by a representative of Westat to discuss procedures for secure transfer of confidential information. You are encouraged to respond promptly so that data collection can begin on schedule.
PVRES promises to provide valuable information for all of us concerned with the State-Federal Vocational Rehabilitation program. We look forward to your full support in helping us locate and monitor the outcomes of your agency’s sampled former consumers.
Sincerely,
<Designated RSA Official>
Westat request to designated liaison for contact and locating information
DATE <Name> <Agency> <Street
Address> <City,
State, ZIP > Dear
<VR Agency Liaison>: As
indicated in our earlier correspondence and as we have discussed
over the telephone, persons who received vocational rehabilitation
services from your agency in FY 2006 have been selected to
participate in the Post-Vocational Rehabilitation Experiences Study
(PVRES). This national study will follow a sample of 8,000 former
consumers of vocational rehabilitation services over a 3-year period
to learn about their employment experiences, earnings, benefits,
additional services, and integration into the community. The study
is being conducted by Westat of Rockville, Maryland, for the
Rehabilitation Services Administration of the U.S. Department of
Education.
We
are contacting you at this time to request the information necessary
to locate <Number>
recipients of your program’s services so that we can invite
them to participate in the study. Be assured that the
confidentiality of participants will be maintained to the extent
required by law. Information that could identify individuals will
not be disclosed to persons outside of the research team. No states,
agencies, or individuals will be identified in any reports. An
informational copy of the consent form that sampled individuals will
receive is included.
Enclosed
with this letter is a description of the information we need you to
provide for each individual. The list of sampled individuals,
identified by the Social Security Number you reported on the RSA 911
Case Service Report submitted for 2006, can be accessed at <<insert
address of secure web site>>.
<Recruiter>,
of the study team, will call you shortly to answer any questions you
may have, discuss use of the web site and the best approach for our
obtaining the information we need. <Recruiter>
will then send you a User ID and Password to access your agency’s
list. In
the meantime, should you have any questions, please contact me at
1-888-519-9481 or email me at [email protected]. Sincerely, Frank
Bennici, Ph.D. Project
Director Enclosure
Description of contact and locating information to be requested of state agencies
Information needed for
former consumers sampled to participate in the Post-Vocational
Rehabilitation Experiences Study
Social Security Number (as
reported in RSA 911 for 2006)
Date of birth (for quality
control matching)
Primary impairment (as
reported in RSA 911 for 2006) (for quality control matching)
Respondent’s full name
(First name, MI, Last name)
Respondent’s salutation
or title (Mr., Ms., Mrs., Dr.)
Respondent’s current or
most recent street address (Street address, City, State, ZIP)
Respondent’s current or
most recent mailing address—if different (PO box, City, State,
ZIP)
Respondent’s current or
most recent phone number(s) including area code (home number, other,
please indicate)
Respondent’s email
address
Guardian’s full name
(if applicable) - (First name, MI, Last name)
Guardian’s salutation
or title (Mr., Ms., Mrs., Dr.)
Guardian’s relationship
to respondent
Type of guardianship (e.g.,
legal, financial)
Guardian’s current or
most recent address (Street address, PO Box, City, State, ZIP)
Guardian’s current or
most recent phone number(s) (home, work, other, please indicate)
Guardian’s email
address
Other reference for
respondent full name (First name, MI, Last name)
Other reference for
respondent’s current or most recent address (Street address,
PO Box, City, State, ZIP)
Other reference for
respondent’s current or most recent phone number(s) (home,
work, other, please indicate)
Other reference’s email
address
Local agency
Local agency’s address
and phone number
Respondent’s VR
counselor (current or at closure, please indicate)
VR counselor’s phone
number
Counselor’s email
address
Primary language (English,
Spanish, ASL, other)
According
to the Paperwork Reduction Act of 1995, no persons are required to
respond to a collection of information unless such collection
displays a valid OMB control number. The valid OMB control number
for this information collection is xxxx-xxxx. The time required to
complete this information collection is estimated to average 26
minutes per response, including the time to review the instructions,
search existing data resources, gather the data needed, and complete
and review the information collection. If
you have any comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to:
U.S. Department of Education, Washington, DC 20202-4651. If you have
comments or concerns regarding the status of your individual
submission of this form, write directly to: Steve
Zwillinger, Rehabilitation Services Administration, U.S. Department
of Education, 550 12th
Street, SW, Washington, DC 20202.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 49 minutes per response, including the time to review the instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Steve Zwillinger, Rehabilitation Services Administration, U.S. Department of Education, 550 12th Street, SW, Washington, DC 20202.
File Type | application/msword |
File Title | APPENDIX D |
Author | Linda LeBlanc |
Last Modified By | DoED User |
File Modified | 2007-05-23 |
File Created | 2007-05-23 |