FORM RSA-113 OMB Approval No.: 1820-0013
Expiration Date:
QUARTERLY CUMULATIVE CASELOAD REPORT
Rehabilitation Services Administration
OSERS/US DEPARTMENT OF EDUCATION
Fiscal Year
Period Covered
[ ] Blind [ ] Oct-Dec [ ] Oct-Jun
State [ ] General/Combined [ ] Oct-Mar [ ] Oct-Sep
Operated Under Order Of Selection During Period? [ ] Yes [ ] No
CASELOAD ITEMS |
TOTAL NUMBER |
NUMBER WITH SIGNFICANT DISABILITY |
A. APPLICATIONS AND ELIGIBILITY |
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Applicants |
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1 Applicants On Hand October 1 |
|
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2 Applicants, New This FY |
|
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3 Applicants At End Of Period (A1+A2-A5-A8-A12-D7) |
|
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4 Applicants In Trial Work/EE On Hand, October 1 |
|
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5 Applicants In Trial Work/EE Referred This FY |
|
|
6 Applicants In Trial Work/EE At End Of Period (A4+A5-A9-A13-D6) |
|
|
Eligible Individuals On Order Of Selection (OOS) Waiting List |
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7 Individuals On OOS Waiting List On Hand October 1 |
|
|
8 Individuals On OOS Waiting List, New This FY From Application |
|
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9 Individuals On OOS Waiting List, New This FY From Trial Work/EE |
|
|
10 Individuals On OOS Waiting List At End Of Period (A7+A8+A9-A14-D5) |
|
|
Individuals Determined Eligible, Before Signed IPE |
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11 Eligible Individuals Before Signed IPE On Hand, October 1 |
|
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12 Eligible Individuals Before Signed IPE, New This FY From Application |
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13 Eligible Individuals Before Signed IPE, New This FY From Trial Work/EE |
|
|
14 Eligible Individuals Before Signed IPE, New This FY From OOS Waiting List |
|
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15 Eligible Individuals Before Signed IPE At End Of Period (A11+A12+A13+A14-B2-D3) |
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B. DEVELOPMENT OF INDIVIDUALIZED PLAN FOR EMPLOYMENT (IPE) |
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1 Individuals With Signed IPE, Before Receiving Services, On Hand October 1 |
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2 Individuals With Signed IPE, Before Receiving Services, This FY |
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3 Individuals With Signed IPE, Before Receiving Services, At End Of Period (B1+B2-C2-D4) |
|
|
C. SERVICE IMPLEMENTATION |
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1 Individuals Receiving Services, On Hand October 1 |
|
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2 Individuals Receiving Services, Beginning This FY |
|
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3 Individuals Receiving Services At End Of Period (C1+C2-D1-D2) |
|
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D. OUTCOMES FOR INDIVIDUALS EXITING THE PROGRAM |
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1 Individuals Exiting With Employment Outcomes |
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2 Individuals Exiting Without Employment, After Receiving Services |
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3 Individuals Exiting Without Employment, After Eligibility, Before Signed IPE |
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4 Individuals Exiting Without Employment, After Signed IPE, Before Receiving Services |
|
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5 Individuals Exiting From OOS Waiting List |
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6 Individuals Exiting From Trial Work/EE |
|
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7 Individuals Exiting As Applicants |
|
|
8 Total Number Of Individuals Exiting The Program (D1+D2+D3+D4+D5+D6+D7) |
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Contact Person (Please Print) Phone Number _______
E-mail address ____________
Date Authorized Signature
| File Type | application/msword |
| File Title | FORM RSA-113 OMB Approval No |
| Author | DoED User |
| Last Modified By | Sheila.Carey |
| File Modified | 2008-12-23 |
| File Created | 2008-12-23 |