RSA PAAT Assurances Form

OMB Control No. 1820-0658

Exp. Date:

REHABILITATION SERVICES ADMINISTRATION ASSURANCES FOR THE PROTECTION AND ADVOCACY FOR ASSISTIVE TECHNOLOGY (PAAT) PROGRAM
Yes	An eligible system
	(1) has in effect a system to provide protection and advocacy services for the purposes of assisting in the acquisition, utilization, or maintenance of assistive technology or assistive technology services for individuals with disabilities;
	(2) shall annually prepare and submit to the secretary a report that contains such information as the secretary may require, including documentation of the progress of the entity in-- (A) conducting consumer-responsive activities, including activities that will lead to increased access, for individuals with disabilities, to funding for assistive technology devices and assistive technology services; (B) engaging in informal advocacy to assist in securing assistive technology and assistive technology services for individuals with disabilities; (C) engaging in formal representation for individuals with disabilities to secure systems change, and in advocacy activities to secure assistive technology and assistive technology services for individuals with disabilities; (D) developing and implementing strategies to enhance the long-term abilities of individuals with disabilities and their family members, guardians, advocates, and authorized representatives to advocate the provision of assistive technology devices and assistive technology services to which the individuals with disabilities are entitled under law other than the Assistive Technology Act of 1998 (AT Act); and (E) coordinating activities with protection and advocacy services funded through sources other than this title, and coordinating activities with the capacity building and advocacy activities carried out by the State agency funded pursuant to section 101 of the AT Act;
	(3) shall prepare and submit to the state agency funded pursuant to section 101 of the AT Act, the report described in (2) above, and quarterly updates regarding those activities;
	(4) shall comply with all relevant provisions of the Education Department General Administrative Regulations (EDGAR).
As a duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above assurances. Name of Applicant:
Printed name and title of authorized representative:
Signature: Date:

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 1820-0658. The time required to complete this information collection is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. If you have any comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Rehabilitation Services Administration, 400 Maryland Avenue, S.W., PCP Room 5030, Washington, DC 20202-2800.