OMB Control Number: 1820-0508
Expires
Reporting Manual for the
CASE SERVICE RECORD REPORT
State-Federal Program for
Vocational Rehabilitation
INSTRUCTIONS FOR PREPARATION OF ELECTRONIC TRANSMITTAL xi
COMPARISON OF THE NEW RSA-911 TO THE PREVIOUS RSA-911 CASE SERVICE REPORT xiii
Element-by-Element Instructions: CASE SERVICE RECORD REPORT (RSA-911) 2
1. Agency Code 3
2. Social Security Number 4
3. Calendar Year 5
4. Calendar Quarter 5
5. Closure Order 5
6. Previous Closure 6
7. Start Date of Pre-Employment Transition Services 6
8. Date of Application 6
9. Date of Birth 7
10. Gender 7
11. White 8
12. Black or African American 8
13. American Indian or Alaska Native 8
14. Asian 8
15. Native Hawaiian or Other Pacific Islander 8
16. Ethnicity - Hispanic or Latino 8
17. Veteran Status at Application 9
18. Source of Referral at Application 9
19. Living Arrangement at Application 10
20. Employment Status at Application 10
21. Primary Occupation at Application 12
22. Hourly Wage at Application 13
23. Hours Worked in a Week at Application 13
MONTHLY PUBLIC SUPPORT AMOUNT AT APPLICATION 14
24. Social Security Disability Insurance (SSDI) 14
25. Supplemental Security Income (SSI) for the Aged, Blind or Disabled 14
26. Temporary Assistance for Needy Families (TANF) 14
27. General Assistance (State or local government) 14
28. Veterans' Disability Benefits 15
29. Workers' Compensation 15
30. All Other Public Support 15
31. Primary Source of Support at Application 15
MEDICAL INSURANCE COVERAGE AT APPLICATION 15
32. Medicaid 15
33. Medicare 16
34. Public Insurance from Other Sources (Workers' Compensation, Children's Health Insurance Program, etc) 16
35. Private Insurance Through Own Employer 16
36. Not Yet Eligible for Private Insurance through Current Employer, But Will Be Eligible for Private Insurance after a Certain Period of Employment 16
37. Private Insurance through Other Means 16
38. State or Federal Affordable Care Act Exchange 16
39. Date of Eligibility Determination 16
40. Date of Placement on Order of Selection (OOS) Waiting List 16
41. Date of Exit from OOS Waiting List 16
42. Zip Code 17
43. County Name 17
44. Organizations Referred To: 17
45. Involvement with Other Agencies and Services 18
46. No formal schooling 20
47. Completed some elementary education (grades 1-8) 20
48. Enrolled in elementary education (grades 1-8) 20
49. Completed secondary education (grade 9) 20
50. Enrolled in secondary education (grade 9) 20
51. Completed secondary education (grade 10) 20
52. Enrolled in secondary education (grade 10) 20
53. Completed secondary education (grade 11) 20
54. Enrolled in secondary education (grade 11) 20
55. Completed secondary education (grade 12) , no high school diploma 20
56. Enrolled in secondary education (grade 12) 21
57. Enrolled in a state adult high school at the high ASE level 21
58. Attained high school diploma or equivalency certificate (GED) 21
59. Completed some special education, no certificate of completion/diploma 21
60. Enrolled in special education 21
61. Attained special education certificate of completion/diploma 21
62. Completed some post-secondary education, no degree or certificate 21
63. Enrolled in post-secondary education - 1st academic year 21
64. Enrolled in post-secondary education - 2nd academic year 21
65. Attained Associate degree 21
66. Enrolled in post-secondary education - 3rd academic year 21
67. Enrolled in post-secondary education - 4th academic year 21
68. Attained Bachelor's degree 21
69. Attained Master’s degree 21
70. Attained degree above a Master's - e.g. Ph.D., Ed.D., J.D., M.D. 21
71. Enrolled in a career or technical training program that does not lead to a recognized postsecondary credential 22
72. Enrolled in a career or technical training program that leads to a recognized postsecondary credential 22
73. Attained Vocational/Technical Certificate 22
74. Attained Vocational/Technical License 22
75. Youth with Disabilities 22
76. State Definition for Age of Students with Disabilities 22
77. Primary Disability 22
78. Secondary Disability 23
79. Significance of Disability 25
80. Start Date of Trial Work Experience 25
81. End Date of Trial Work Experience 26
82. Date of Individualized Plan for Employment (IPE) 26
83. Supported Employment Goal on Current IPE 26
SERVICES PROVIDED AND COSTS FOR PURCHASED SERVICES 26
1) Services Provided 27
2) Primary Purchased VR Service Provider Type 28
3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services 29
4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services 29
5) Comparable Services and Benefits Provider 30
SERVICE CATEGORIES FOR PRE-EMPLOYMENT TRANSITION STUDENTS 31
Job Exploration Counseling 31
Work-Based Learning Experiences 31
Counseling on Enrollment Opportunities 31
Workplace Readiness Training 31
Instruction in Self-advocacy 32
SERVICE CATEGORIES FOR PARTICIPANTS OF THE VR PROGRAM 32
Diagnosis and Treatment of Impairments 32
Vocational Rehabilitation Counseling and Guidance 34
Graduate College or University Training 34
Four-Year College or University Training 34
Junior or Community College Training 34
Occupational or Vocational Training 34
Basic Academic Remedial or Literacy Training 35
Disability-Related Skills Training 35
On-the-job Supports - Short term 36
On-the-job Supports – Supported Employment 36
Rehabilitation Technology 38
PERSONAL ASSISTANCE SERVICES 39
Personal Attendant Services 39
Technical Assistance Services 40
Information and Referral Services 40
Customized Employment Services 40
249. Number of Jobs at Exit 41
250. Primary Occupation at Exit 41
251. Start Date of Employment in Primary Occupation at Exit 42
252. Employment Status at Exit 42
253. Hourly Wage at Exit 43
254. Hours Worked in a Week at Exit 44
MONTHLY PUBLIC SUPPORT AMOUNT AT EXIT 44
255. Social Security Disability Insurance (SSDI) 45
256. Supplemental Security Income (SSI) for the Aged, Blind or Disabled 45
257. Temporary Assistance for Needy Families (TANF) 45
258. General Assistance (State or local government) 45
259. Veterans' Disability Benefits 45
260. Workers' Compensation 45
261. All Other Public Support 45
262. Primary Source of Support at Exit 45
MEDICAL INSURANCE COVERAGE AT EXIT 46
263. Medicaid 46
264. Medicare 46
265. Public Insurance from Other Sources (Workers' Compensation, Children's Health Insurance Program, etc) 46
266. Private Insurance Through Own Employer 46
267. Not Yet Eligible for Private Insurance Through Current Employer, But Will Be Eligible for Private Insurance After a Certain Period of Employment 46
268. Private Insurance Through Other Means 46
269. State or Federal Affordable Care Act Exchange 47
270. Type of Exit 47
271. Reason for Exit 47
272. Date of Exit 49
273. Unemployment Insurance Quarterly Earnings 49
274. Employer Identification Number (EIN) 49
275. Case Service Record Archive Date 50
Reported case service records pertain to all individuals with open or closed service records during the life of the case service record, as well as information collected for students receiving pre-employment transition services. RSA-911 data will be collected quarterly for the periods of October 1 through December 31, January 1 through March 31, April 1 through June 30, and July 1 through September 30. The due dates for RSA-911 submittals are the last day of the month 60 days past the end of a quarter (February 28, May 31, August 31, and November 30.
All records submitted must be unique. Data elements 1. Agency Code, 2. Social Security Number, 9. Date of Birth, and 8. Application Date and/or 7. Start Date of Pre-Employment Transition Services determine the "uniqueness" of a given case service record. Duplicate records will be rejected. For example, records with an Agency Code, Social Security Number, Date of Birth and Application Date and/or Start Date of Pre-Employment Transition Services that are identical to those in another record during the same reporting period, will be considered to be a duplicate and will be rejected. If an individual has multiple exits within the same reporting period, each exit must be reported and cannot overlap. That is, records with the same Agency Code, Social Security Number, Date of Birth, and Application Date and/or Start Date of Pre-Employment Transition Services must be staggered in time such that the Date of Exit for the first service record must be before the Application Date and/or Start Date of Pre-employment Transition Services of the second service record. Case service records with a Date of Exit before the date of adoption of this form should continue to use data element 5. Closure Order to indicate how many closures have taken place for an individual in the same Federal fiscal year.
With the requirement of submitting open and closed case data quarterly, it is important to note that some data elements are not modified or updated during the life of the case while others are updated and reported on a quarterly basis. See tables below.
Data elements that are not modified or updated during the life of the case are:
Data Element Number |
Data Element |
1 |
Agency Code |
2 |
Social Security Number |
7 |
Start Date of Pre-Employment Transition Services |
8 |
Date of Application |
9 |
Date of Birth |
10 |
Gender |
11-15 |
Race |
16 |
Ethnicity |
17 |
Veteran Status at Application |
18 |
Source of Referral at Application |
19 |
Living Arrangement at Application |
20 & 252 |
Employment Status at Application & Exit |
21 & 250 |
Primary Occupation at Application & Exit |
22 & 253 |
Hourly Wage at Application & Exit |
23 & 254 |
Hours Worked in a Week at Application & Exit |
24-30 & 255-261 |
Monthly Public Support Amount at Application & Exit |
31 & 262 |
Primary Source of Support at Application & Exit |
32-38 & 263-269 |
Medical Insurance Coverage at Application & Exit |
39 |
Date of Eligibility Determination |
40 |
Date of Placement on Order of Selection Waiting List |
41 |
Date of Exit on Order of Selection Waiting List |
249 |
Number of Jobs at Exit |
251 |
Start Date of Employment in Primary Occupation at Exit |
270 |
Type of Exit |
271 |
Reason for Exit |
272 |
Date of Exit |
275 |
Case Service Record Archive Date |
Data elements that are updated and reported quarterly are:
Data Element Number |
Data Element |
3 |
Calendar Year |
4 |
Calendar Quarter |
42 |
Zip Code |
43 |
County Name |
44 |
Organizations Referred To |
45 |
Involvement with Other Agencies and Services |
46-74 |
Education |
75 |
Youth with Disabilities |
76 |
State Definition for Age of Students with Disabilities |
77 |
Primary Disability |
78 |
Secondary Disability |
79 |
Significance of Disability |
80 |
Start Date of Trial Work Experience |
81 |
End Date of Trial Work Experience |
82 |
Date of Individualized Plan for Employment (IPE) |
83 |
Supported Employment Goal on Current IPE |
84-108 |
Services Provided and Costs for Purchased Services for Pre-Employment Transition Students |
109-248 |
Services Provided and Costs for Purchased Services for Participants of the VR Program |
273 |
Unemployment Insurance Quarterly Earnings |
274 |
Employer Identification Number (EIN) |
It is important to note that two data elements, Closure Order (data element 5) and Previous Closure (data element 6) are collected for service records opened at the time of the form adoption. They will no longer be collected for case service records opened on or after the adoption of the form.
Additionally, It is important to note that three data elements are new and are reported after the Date of Exit (data element 270). These three data elements are the Case Service Record Archive Date (data element 275), the Unemployment Insurance Quarterly Earnings (data element 273), and the Employer Identification Number (data element 274). The Case Service Record Archive Date is not collected until the individual drops out of the program or until all of the individual’s services are complete. The Unemployment Insurance Quarterly Earnings and the Employer Identification Number that are updated and reported quarterly are collected until all of the individual’s services are complete and the case service record is archived (Case Service Record Archive Date), usually after the fourth quarter following the Date of Exit or more if the individual is receiving extended services.
The file format is a comma-delimited text file. Each data element is accompanied by data type information that will serve as a guide for submitting valid values.
DATA TYPE |
DESCRIPTION |
VARCHAR (n) |
This data type can hold any character(s) with a maximum length defined by the number within the parentheses. All variable character (VARCHAR) data elements within the RSA-911 hold numeric characters with the exception of County data element which can be alphanumeric. |
DATE 112 (YYYYMMDD) |
This data type holds dates in the eight-digit format of year, month, and day. All dates reported on the RSA-911 must be in the format of YYYYMMDD, where YYYY is Year, MM is Month and DD is Day.
For Year: Record the year using all four digits of the year.
For Month: Record the months using two digits. For example, use 01 for January, 02 for February, etc.
For Day of the month: Record the day of the month using a "0" prefix for single digit date of days. For example, 01, 02, 03, etc. |
Decimal (n,x)
|
This data type can hold a decimal number with a total of number of n digits, of which x can be after the decimal point. |
LONG INT(n) |
This data type can hold any integer (whole number) with a maximum length of integers as defined by the number within the parentheses. Number of hours worked and dollar amounts for monthly amounts of public support, funds expended, and Quarterly earnings must be reported as positive integers. |
Agencies should leave blank those data elements that are incomplete because cases were closed with Type of Exit equal to “1” (exited as an applicant) or where the case service record has not yet been closed. In addition, the data elements in the table below are the only ones that are required to be completed if an individual has not applied for VR services and is only receiving pre-employment transition services.
Data Element Number |
Data Element |
1 |
Agency Code |
2 |
Social Security Number |
3 |
Calendar Year |
4 |
Calendar Quarter |
7 |
Start Date of Pre-Employment Transition Services |
44 - 72 |
Education |
73 |
Youth with Disabilities |
84 - 108 |
Services Provided and Costs for Purchased Services for Pre-Employment Transition Students |
Data element numbers are in the order of the record layout for text file submission. Also refer to the Record Layout listing on page 51.
In order to upload your RSA-911 data file to the RSA SFTP server, you will need to download a free SFTP program onto your computer. Below is a list of a few free SFTP software packages and links to their websites. Follow the downloading instructions to install SFTP software on your system.
Once you have completed downloading the software, you will need to establish a connection to RSA’s SFTP server. The name of the server that you will be uploading the RSA-911data file to is:
edsecureftp.ed.gov
Your user-id is “rsa-ba-g”, where "ba" is the official postal abbreviation for your state/territory and "g" is the type of agency, that is "g"=general, "c"=combined and "b"=blind. Likewise, the naming convention for the RSA-911 data file is "BAgXCYNNQ", where "BA" is the official postal abbreviation for your state/territory, "g" is the type of agency, that is "g"=general, "c"=combined and "b"=blind, "X" is the number of the submission, that is, "1"=first, "2"=second, etc."NN" is the last two digits of the calendar year. "Q" is the designation for the calendar quarter.
As an example, since the Oklahoma Department of Rehabilitation Services is a combined agency, the user ID would be: rsa-ok-c and the name of the file submitted for calendar year 2014, second quarter would be OKc1CY142.
Passwords will be distributed by RSA to VR agency staff responsible for submitting RSA-911 data files. Passwords will be managed and maintained by Vernita Washington at [email protected] or 202-245-7479 or Yann-Yann Shieh at y[email protected] or 202-245-7247.
After the submission of the RSA-911 files to the SFTP server has been completed, an email must be sent to Vernita Washington and Yann-Yann Shieh to inform them that the data have been submitted and certifying who is responsible for the file submission and when it is submitted.
If agencies are unable to submit data to the SFTP server, data are to be sent on a compact disc via overnight services with an external label identifying the contents as "RSA-911 Data for BAgXCYNNQ" following the naming convention as described above and must be signed for by the recipient. Certification as described above must be included with the CD.
If by private carrier:
State Monitoring and Program Improvement Division
Data Collection and Analysis Unit
ATTN: Vernita Washington
550 12th Street, S.W., PCP 5047
Washington, DC 20202-2800
If by USPS:
State Monitoring and Program Improvement Division
Data Collection and Analysis Unit
ATTN: Vernita Washington, PCP 5047
LBJ Basement Level 1
400 Maryland Avenue, SW
Washington, DC 20202-2800
If you need additional information, contact either Vernita Washington at [email protected] or 202-245-7479; or Yann-Yann Shieh at [email protected] or 202-245-7247.
New Data Element Number |
Previous Data Element Number |
Data Element Description |
Change, if any, from previous RSA-911 |
1 |
1 |
Agency Code |
No change |
2 |
2 |
Social Security Number |
No change |
3 |
|
Calendar Year |
New data element |
4 |
|
Calendar Quarter |
New data element |
5 |
3 |
Closure Order |
Used only for service records opened prior to the date of form adoption, i.e., not collected for service records opened after form adoption. |
6 |
4 |
Previous Closure |
Used only for service records opened prior to the date of form adoption, i.e., not collected for service records opened after form adoption. |
7 |
|
Start Date of Pre-Employment Transition Services |
New data element |
8 |
5 |
Date of Application |
No change |
9 |
6 |
Date of Birth |
No change |
10 |
7 |
Gender |
No change |
11-15 |
8-12 |
Race |
No change |
16 |
13 |
Ethnicity |
No change |
17 |
14 |
Veteran Status at Application |
Data element name changed from "Veteran Status" to "Veteran Status at Application." |
18 |
17 |
Source of Referral at Application |
Data element name changed from "Source of Referral" to "Source of Referral at Application." |
19 |
21 |
Living Arrangement at Application |
No change |
20 |
25 |
Employment Status at Application |
The coding option 1 ("Employment without Supports in Integrated Setting") has changed to "Competitive Integrated Employment." Coding options 5 and 6 ("Homemaker" and "Unpaid Family Worker") have been eliminated. Coding option 7 ("Employment with Supports in Integrated Setting") has been changed to ”Competitive Integrated Employment with Supports." |
21 |
|
Primary Occupation at Application |
New data element |
22 & 253 |
26 &197 |
Hourly Wage at Application & Exit |
"Weekly Earnings" have been changed to "Hourly Wage." |
23 & 254 |
27 & 198 |
Hours Worked in a Week at Application & Exit |
No change |
24-30 & 255-261 |
28-34 & 199-205 |
Monthly Public Support Amount at Application & Exit |
No change |
31 & 262 |
35 & 206 |
Primary Source of Support at Application & Exit |
No change |
32-38 & 263-269 |
36-41& 207-212 |
Medical Insurance Coverage at Application & Exit |
Data elements 38 and 269 are new elements and capture "State or Federal Affordable Care Exchange." |
39 |
46 |
Date of Eligibility Determination |
No change |
40 |
47 |
Date of Placement on Order of Selection Waiting List |
No change |
41 |
48 |
Date of Exit on Order of Selection Waiting List |
No change |
42 |
15 |
Zip Code |
Data element name changed from "Zip Code at Application" to "Zip Code." |
43 |
16 |
County Name |
Data element name changed from "County Name at Application" to "County Name." |
44 |
|
Organizations Referred To |
New data element |
45 |
18 |
Involvement with Other Agencies and Services |
Coding options added |
46-74 |
19 & 191 |
Education |
"Level of Education Attained at Application/Closure" has changed from one data element with 13 coding options to 29 discrete data elements used to report Workforce Innovation and Opportunity Act (WIOA) performance indicators. |
75 |
20 & 192 |
Youth with Disabilities |
"Student with Disability in Secondary Education at Application/Closure" changed to one data element entitled "Youth with Disabilities." While coding options are largely the same, the description of the data element has been modified to align with WIOA. |
76 |
|
State Definition for Age of Students with Disabilities |
New data element |
77 |
22 |
Primary Disability |
No change |
78 |
23 |
Secondary Disability |
No change |
79 |
24 |
Significance of Disability |
Clarification made to the description. |
80 |
42 |
Start Date of Trial Work Experience |
No change |
81 |
43 |
End Date of Trial Work Experience |
No change |
82 |
49 |
Date of Individualized Plan for Employment (IPE) |
No change |
83 |
50 |
Supported Employment Goal on Current IPE |
Data element name changed from "Supported Employment Goal" to "Supported Employment Goal on Current IPE" and is reported quarterly to capture if the individual has a support employment goal on their current IPE. Description of the data element has been updated to reflect changes in definition of supported employment due to WIOA. |
84-108 |
|
Services Provided and Costs for Purchased Services for Pre-Employment Transition Students |
New data element |
109-248 |
51-190 |
Services Provided and Costs for Purchased Services for Participants of the VR Program |
|
249 |
193 |
Number of Jobs at Exit |
No change |
251 |
195 |
Start Date of Employment in Primary Occupation at Exit |
Description has been clarified. |
250 |
194
|
Primary Occupation at Exit |
May now add up to two positions. “Homemaker” and “Unpaid Family Worker” codes are eliminated. |
252 |
196 |
Employment Status at Exit |
The coding option 1 ("Employment without Supports in Integrated Setting") has changed to "Competitive Integrated Employment." Coding option 2 ("Extended Employment") has been eliminated. Coding options 5 and 6 ("Homemaker" and "Unpaid Family Worker") have been eliminated. Coding option 7 ("Employment with Supports in Integrated Setting") has been changed to “Competitive Integrated Employment with Supports." |
270 |
213 |
Type of Exit |
Coding options are reordered and contain the new definition for employment outcomes. |
271 |
214 |
Reason for Exit |
|
272 |
215 |
Date of Exit |
No change |
273 |
|
Unemployment Insurance Quarterly Earnings |
New data element |
274 |
|
Employer Identification Number |
New data element |
275 |
|
Case Service Record Archive Date |
New data element |
|
44 |
Start Date of Extended Evaluation |
Eliminated |
|
45 |
End Date of Extended Evaluation |
Eliminated |
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. Public reporting burden for this collection of information is estimated to average 131.25 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is mandatory as required by the Rehabilitation Act of 1973, as amended and the Workforce Innovation and Opportunity Act (WIOA), enacted July 22, 2014. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email [email protected] and reference the OMB Control Number 1820-0508. Note: Please do not return the completed RSA-911 to this address.
Data type: VARCHAR (3)
Enter the three-digit code assigned to each State vocational rehabilitation (VR) agency from the following list. Please note that codes have been pre-assigned to nonexistent agencies for individuals who are blind or visually impaired in the event that they are established in the future. This data element is required. No modifications after initial entry.
State or Territory |
Abbreviations |
General/ Combined |
Blind |
Alabama |
AL |
001 |
057 |
Alaska |
AK |
002 |
058 |
American Samoa |
AM |
003 |
059 |
Arizona |
AZ |
004 |
060 |
Arkansas |
AR |
005 |
061 |
California |
CA |
006 |
062 |
Colorado |
CO |
007 |
063 |
Connecticut |
CT |
008 |
064 |
Delaware |
DE |
009 |
065 |
District of Columbia |
DC |
010 |
066 |
Florida |
FL |
011 |
067 |
Georgia |
GA |
012 |
068 |
Guam |
GU |
013 |
069 |
Hawaii |
HI |
014 |
070 |
Idaho |
ID |
015 |
071 |
Illinois |
IL |
016 |
072 |
Indiana |
IN |
017 |
073 |
Iowa |
IA |
018 |
074 |
Kansas |
KS |
019 |
075 |
Kentucky |
KY |
020 |
076 |
Louisiana |
LA |
021 |
077 |
Maine |
ME |
022 |
078 |
Maryland |
MD |
023 |
079 |
Massachusetts |
MA |
024 |
080 |
Michigan |
MI |
025 |
081 |
Minnesota |
MN |
026 |
082 |
Mississippi |
MS |
027 |
083 |
Missouri |
MO |
028 |
084 |
Montana |
MT |
029 |
085 |
Nebraska |
NE |
030 |
086 |
Nevada |
NV |
031 |
087 |
New Hampshire |
NH |
032 |
088 |
New Jersey |
NJ |
033 |
089 |
New Mexico |
NM |
034 |
090 |
New York |
NY |
035 |
091 |
North Carolina |
NC |
036 |
092 |
North Dakota |
ND |
037 |
093 |
Northern Marianas |
CNMI |
038 |
094 |
Ohio |
OH |
039 |
095 |
Oklahoma |
OK |
040 |
096 |
Oregon |
OR |
041 |
097 |
Pennsylvania |
PA |
042 |
098 |
Puerto Rico |
PR |
043 |
099 |
Rhode Island |
RI |
044 |
100 |
South Carolina |
SC |
045 |
101 |
South Dakota |
SD |
046 |
102 |
Tennessee |
TN |
047 |
103 |
Texas |
TX |
048 |
104 |
Utah |
UT |
049 |
105 |
Vermont |
VT |
050 |
106 |
Virginia |
VA |
051 |
107 |
Virgin Islands |
VI |
052 |
108 |
Washington |
WA |
053 |
109 |
West Virginia |
WV |
054 |
110 |
Wisconsin |
WI |
055 |
111 |
Wyoming |
WY |
056 |
112 |
Data type: VARCHAR (9)
Enter the individual’s nine-digit Social Security number (SSN). When a SSN is not available or if the individual prefers not to provide his/her SSN, assign a unique nine-digit number that:
a) does not duplicate a genuine SSN, and
b) does not duplicate any other substitute number assigned in place of a SSN.
Starting the nine-digit number with the digits "99" will avoid duplicating a genuine SSN. Only numeric characters between “0” and “9” are permitted in the Social Security Number field. When assigning a unique nine-digit number to an individual, ensure that the same unique nine-digit number is used in subsequent years for the same individual if cases are opened for the individual in the future. This data element is required. No modifications after initial entry.
Note: If no SSN is available or provided, wage information will not be able to be verified through unemployment insurance data for the individual.
Data type: VARCHAR (4)
Enter the calendar year that represents this data collection. These data are required and updated quarterly.
Data type: VARCHAR (1)
Enter the calendar quarter to indicate which quarter this data collection represents. These data are required and updated quarterly.
January 1 through March 31
April 1 through June 30
July 1 through September 30
October 1 through December 31
Data type: VARCHAR (1)
This data element is used only for service records opened prior to the date of adoption of this form. Do not enter after date of adoption of this form.
Assign the appropriate closure order code for all service records from the list below:
First closure of an individual’s service record in the FY being reported
Second closure of the same individual’s service record in the same FY
Third closure of the same individual’s service record in the same FY, and so on.
If an individual’s service record is closed more than once in the FY, the RSA-911 data system must contain a separate record for each closure. Ensure that when a record indicates a closure order code 2, there is another record with a closure order code 1 with an identical SSN for that individual, and so on for all multiple closures in the same FY.
Data type: VARCHAR (1)
This data element is used only for service records opened prior to the date of adoption of this form. Do not enter after date of adoption of this form.
Enter the appropriate code listed below to indicate whether the individual had a previous service record closed by the State VR agency within a 36-month period prior to the most recent application for services. If more than one record was closed for the individual within that 36-month period, consider the most recent previous closure. Indicate the type of the previous closure using one of the following codes:
Closed while the individual was an applicant, but before a determination of eligibility
Closed during or after a trial work experience/extended evaluation
Closed after individual received services, without an employment outcome
Closed after an individualized plan for employment (IPE) was signed, but before receiving services
Closed after a determination of eligibility, but before an IPE was signed
Data type: DATE 112 (YYYYMMDD)
Record the date (year, month, and day) that the individual started receiving pre-employment transition services. Individuals receiving pre-employment transition services, are not required to be applicants or eligible for VR services. Pre-Employment Transition Services can only include the following services: (1) job exploration counseling; (2) work-based learning experiences, which may include in-school or after school opportunities, or experience outside the traditional school setting (including internships), provided in an integrated environment to the maximum extent possible; (3) counseling on opportunities for enrollment in comprehensive transition or postsecondary educational programs at institutions of higher education; (4) workplace readiness training to develop social skills and independent living; and (5) instruction in self-advocacy, which may include peer mentoring. No modifications after initial entry.
Data type: DATE 112 (YYYYMMDD)
Record the date (year, month, and day) that the agency received a completed and signed application form from the applicant. The date should be verifiable by date stamp. This data element may be left blank if a date is entered in data element 7. Start Date of Pre-Employment Transition Services. No modifications after initial entry.
Data type: DATE 112 (YYYYMMDD)
Record the individual’s date (year, month, and day) of birth. This data element is required. No modifications after initial entry.
Data type: VARCHAR (1)
Code the individual’s gender. No modifications after initial entry.
Race information should be recorded for all individuals whose service records were opened in the calendar quarter being reported. For each race category below, use the following codes to record the individual’s race:
RSA continues to require self-identification to the greatest extent possible. It is generally expected that the information recorded will reflect the individual’s own identification of race from the categories provided. However, if an individual refuses to identify his/her race, the counselor should, at a minimum, notify the individual that if he/she fails to self-identify, an observer-identification method will be used. The counselor or interviewer would then provide the best assessment of the individual's race. This guidance follows OMB standards for collecting race data. OMB prefers self-identification methods, but allows for observer-identification methods when necessary.
At least one of the race categories must be coded as 1. Remaining categories should have codes of 0 (not this race). More than one race variable can contain a code of 1 for an individual.
Agencies may leave the element blank only if the information is not available due to circumstances beyond the agency’s control for Type of Exit coded to "1" (exited as an applicant). Such service records will be few in number. As an example, if an individual applies for services via an application form or letter and exits the agency without being seen by agency personnel, this individual's race would not be known and could not be observed and therefore all race options would be left blank.
No modifications after initial entry.
Data type: VARCHAR (1)
An individual having origins in any of the original peoples of Europe, the Middle East or North Africa.
Data type: VARCHAR (1)
An individual having origins in any of the Black racial groups of Africa.
Data type: VARCHAR (1)
An individual having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.
Data type: VARCHAR (1)
An individual having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Data type: VARCHAR (1)
An individual having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Data type: VARCHAR (1)
An individual of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
The ethnic category Hispanic or Latino should be recorded for all individuals who exit in the calendar quarter being reported. Use the following codes to record the individual’s Hispanic or Latino ethnicity:
If the individual self-identifies as Hispanic, but refuses or is unable to identify one or more race categories in addition, then code the individual as Hispanic for ethnicity and follow the observer-identification method as described above for the race categories. Notify the individual that if he/she fails to identify, then an observer-identification method will be used. Individuals who identify as Hispanic may belong to any race group. No modifications after initial entry.
Data type: VARCHAR (1)
Enter a one-digit code to indicate if the individual served in the active military, naval or air service, and was discharged or released under conditions other than dishonorable. No modifications after initial entry.
Data type: VARCHAR (2)
Indicate the individual, agency, or other entity that first referred the individual to the State VR agency by using one of the following codes. If the individual approached the VR agency on his/her own, use Code 19 (self-referral). No modifications after initial entry.
DOL Employment and Training Service Programs for Adults, Dislocated Workers, and Youth
Social Security Administration (Disability Determination Service or District office)
Veteran's Benefits Administration (which includes VA Vocational Rehabilitation)
Veteran's Health Administration (the VA hospital system, as well as the VA transitional living, transitional employment, and compensated work therapy programs)
Other WIOA-funded Programs including Job Corps, YouthBuild, Indian and Native Americans, and Migrant and Seasonal Farmworker Programs
Indicate the living arrangements of the individual, either temporarily or permanently, on the date of application to the State VR agency using the following codes. No modifications after initial entry.
Data type: VARCHAR (2)
Enter the code which best describes the employment status of the individual at application from the following codes. The first seven codes are considered "employment" for purposes of this item. Individuals not meeting the definitions for coding options 1 through 5 below would be classified as "not employed" (coding options 6 through 9) at the time of application for services. When an individual’s work activity overlaps into two different employment statuses, select the coding option that is more descriptive of the individual's employment activity at application. No modifications after initial entry.
Competitive Integrated Employment refers to work that is:
performed on a full-time or part-time basis (including self-employment); and
for which the individual is compensated at a rate that shall be not less than the higher of the federal minimum wage or the State or local minimum wage; and
is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities, or in the case of an individual who is self-employed, yields an income that is comparable to the income by other individuals who are not individuals with disabilities, and who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and
is eligible for the level of benefits provided to other employees;
that is at a location where the employee interacts with other persons who are not individuals with disabilities (not including supervisory personnel or individuals who are providing services to such employee) to the same extent that individuals who are not individuals with disabilities; and
that as appropriate, presents opportunities for advancement that are similar to those for other employees who are not individuals with disabilities and who have similar positions.
Extended Employment is to work for wages or salary in non-competitive integrated employment for a public or nonprofit organization. Such settings are variously referred to as community rehabilitation programs, or sheltered, industrial, or occupational workshops. Individuals are compensated according to the Fair Labor Standards Act and the organization provides any needed support services that enable the individual to train or prepare for competitive employment.
Self-employment (except BEP) refers to work for profit or fees including operating one's own business, farm, shop, or office. "Self-employment" includes sharecroppers, but not wage earners on farms.
State Agency-managed Business Enterprise Program (BEP) refers to Randolph-Sheppard vending facilities and other small businesses operated by individuals with significant disabilities under the management and supervision of a State VR agency. Include home industry where the work is done under the management and supervision of a State VR agency in the individual's own home or residence for wages, salary, or on a piece-rate. Individuals capable of activity outside the home, as well as homebound individuals, may engage in such employment.
Competitive Integrated Employment with Supports refers to competitive integrated employment as defined above with ongoing support services for individuals with significant disabilities (supported employment).
Not employed: Student in Secondary Education including GED classes and special education classes with the goal of obtaining a high school diploma or GED.
Not employed: All other Students are persons attending school full or part-time other than students in secondary education (for example, students in post-secondary education, adult education, or vocational training).
Not employed: Trainee, Intern or Volunteer refers to persons engaging in unpaid work experiences, internships or volunteer work for purposes of increasing their employability. Such individuals may receive a stipend to defray the cost of transportation or other incidental expenses.
Not employed: Other refers to persons not in any of the other categories (e.g., persons just out of school who are not yet employed; persons unable to retain or obtain work; and persons who have recently left specialized medical facilities).
Data type VARCHAR (6)
For an individual who is employed at application, enter the six-digit Standard Occupational Classification (SOC) System code to describe the individual’s occupation from which he/she derives the majority of their hourly earnings. If the individual is not employed at application, leave blank. No modifications after initial entry.
For the employment situations unique to the VR program, use the special codes indicated below.
Special Codes |
Special Code Descriptions |
899999 |
Randolph-Sheppard vending facility clerk use this category for persons employed as clerks, sales persons, or helpers in a vending facility operated under the Randolph-Sheppard Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility operators (999999), or individuals employed in vending facilities outside the Vending Facility Program (use their occupation code). |
999999 |
Randolph-Sheppard vending facility operator use this category for individuals employed as operators or managers of vending facilities operated under the Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility clerks (899999), or individuals employed as vending facility operators outside the Randolph-Sheppard Vending Facility Program (use their occupation code). |
Note: The 2010 Standard Occupational Classification (SOC) System code should be referenced in obtaining the six-digit code that most closely corresponds to the individual's primary occupation at application.
Data type: Decimal (5,2)
Enter the hourly wage (to the nearest cent) earned at the time of application.
This data element captures cash earnings of the applicant at time of application expressed as an hourly wage and includes all wages, salaries, tips, and commissions received as income. These earnings are before payroll deductions of Federal, State and local income taxes and Social Security payroll tax are taken.
Hourly wages (earnings) also include profits derived from self-employed individuals. Wages for salespersons, consultants, self-employed individuals, and other similar occupations are based on the adjusted gross income. Adjusted gross income is gross income minus unreimbursed business expenses. Do not include estimates of payments in-kind, such as meals and lodging. Estimate profits of farmers, if necessary.
Where wages are based on commissions that are irregular (e.g., real estate, automobile sales, etc.), they should be calculated as an hourly wage average over a representative period of time such as one month or longer. to obtain a meaningful figure. Commissions are generally not paid when earned, but rather are paid periodically, such as weekly, biweekly, or even monthly. To bring standardization to this item, wages should be based on the actual receipt of the payment and not on amounts accruing until the next commission payout.
If there are significant amounts of irregular unreimbursed business expenses (e.g., car lease payments due the first week of every month), the expenses should be averaged over a representative period of time such as one month or longer to obtain a meaningful figure for an hourly wage.
If the individual had no earnings, enter "0". No modifications after initial entry.
Data type INT(3)
Enter the number of hours an individual worked for earnings in a typical week at the time of application. Earnings may have been in the form of wages, salaries, tips, commissions, profits from self-employment, adjusted gross income for salespersons, etc. If the individual was unemployed and/or generated no earnings, enter "0". No modifications after initial entry.
MONTHLY PUBLIC SUPPORT AMOUNT AT APPLICATION
Enter the monthly amount (to the nearest dollar) of public support received by the individual at application from each of the following sources. If the individual did not receive any monthly public support, enter "0" for each type of public support. Agencies may leave these data elements blank for Type of Exit coding option 1 (exited as an applicant). No modifications after initial entry.
Public support means cash payments made by Federal, State and/or local governments for any reason, including an individual’s disability, age, or economic status. Include payments to a family unit precipitated by the individual’s disability or when the individual’s presence is taken into account in the computation of the family benefit. Also include any payments that are sent directly to the individual in an institution or to dependents on his/her behalf. Exclude any non-cash support payments such as Medicaid, Medicare, food stamps and rental subsidies.
NOTE: For Social Security Disability Insurance and Supplemental Security Income for the Aged, Blind or Disabled include monthly payments made within the 30 days prior to the Date of Application (data element 8).
Categories of public support are as follows:
Data Type INT(5)
Enter the monthly amount of SSDI received by the individual. This figure can be verified through the Social Security Administration (SSA) or from a copy of the individual’s benefit notification letter.
Data Type INT(5)
Enter the monthly payment to the individual under the Federal program of SSI for the aged, blind, and disabled. Only the individual’s portion of the payment should be recorded here. This figure can be verified through the SSA or from a copy of the individual’s benefit notification letter.
Data Type INT(5)
Enter the monthly amount of cash public assistance payments made through the federally funded TANF program. If the TANF payment is made to the family unit, use the local disbursing agency's procedure to estimate the individual’s portion of the payment.
Data Type INT(5)
Data Type INT(5)
Veterans' Disability Benefits are payments made by the Department of Veterans Affairs for partial or total disability.
Data Type INT(5)
Data Type INT(5)
Enter the monthly amount of public support received from all other sources of public support not listed. Other Public Support payments are cash payments to individuals beyond those otherwise listed. Include payments made by Federal, State and local governments for retirement or survivor benefits to the individual as well as unemployment insurance benefits and other temporary payments.
Data Type VARCHAR (1)
Enter a coding option from the list below to indicate the individual’s largest single source of economic support at application, even if it accounts for less than one-half of the individual’s total support. No modifications after initial entry.
Note: If an individual is supported by the earnings of a spouse, or by the spouse's unemployment insurance checks, identify coding option 2 as the Primary Source of Support (family and friends) and not coding option1 (personal income). If an individual is primarily supported by a governmental entity with no cash support – for example, incarcerated individuals – use coding option 3 (public support) as the primary source of support only if the individual applicant is the recipient of the support. If the family receives public support, use coding option 2 (family and friends).
Personal Income (employment earnings, interest, dividends, rent, retirement including social security)
All other sources (e.g., private disability insurance and private charities)
MEDICAL INSURANCE COVERAGE AT APPLICATION
Record whether an individual had medical insurance coverage at the time of application. Enter a “1” in each of the following data elements if the individual had this type of medical insurance coverage at application, otherwise leave blank. No modifications after initial entry.
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Refers to individuals receiving benefits through their parent/family members’ insurance plan.
Data Type: VARCHAR (1)
Refers to individuals receiving benefits through their enrollment in an Affordable Care Act Exchange.
Data type: DATE 112 (YYYYMMDD)
Enter the date that an eligibility determination was made regardless of whether the individual was determined ineligible later in the VR process because of changed circumstances. No modifications after initial entry.
Data type: DATE 112 (YYYYMMDD)
Enter the date that the individual was placed on an OOS waiting list. This date must be equal to or later than both the Date of Application and the Date of Eligibility Determination. No modifications after initial entry.
Data type: DATE 112 (YYYYMMDD)
Enter the date that the individual exited from an OOS waiting list. This date, if entered, must be after the Date of Placement on OOS Waiting List (Data Element 40). This data element must be left blank if the individual was not placed on an OOS wait list. If the individual exited the VR program from the OOS waiting list, this data element must contain a valid date and be equal to the Date of Exit (data element 272) and Type of Exit (data element 270), must be coded 3). No modifications after initial entry.
Enter the five-digit numeric US Postal Service Zip Code corresponding to the location of the individual’s residence at the beginning of the quarter.
Enter the name of the county corresponding to the location of the individual’s residence at the beginning of the quarter.
Enter up to three codes that best describe the individual, agency, or other entity to which the State VR agency referred the individual at the beginning of the quarter. Make sure to enter the leading zeroes if necessary and do not use commas or spaces between any of the codes. For example, if the individual was referred to Adult Education and Literacy programs, Centers for Independent Living, and Educational Institutions (elementary/secondary), enter “020410”. If the individual received comparable services or benefits from a Community Rehabilitation Program and a Developmental Disability Provider, enter “0619”. If an individual received comparable services or benefits from only an elementary or secondary educational institution, enter “10”. If no comparable services or benefits were provided, leave blank.
DOL Employment and Training Service Programs for Adults, Dislocated Workers, and Youth
Social Security Administration (Disability Determination Service or District office)
Veteran's Benefits Administration (which includes VA Vocational Rehabilitation)
Veteran's Health Administration (the VA hospital system, as well as the VA transitional living, transitional employment, and compensated work therapy programs)
Other WIOA-funded Programs including Job Corps, YouthBuild, Indian and Native Americans, and Migrant and Seasonal Farmworker Programs
Data type: VARCHAR (6)
Enter up to three codes that best describe the service providers or funding sources listed below to which the individual was provided funding or services at the beginning of the quarter. Make sure to enter the leading zeroes if necessary and do not use commas or spaces between any of the codes. For example, if the individual received comparable services or benefits from an employer, the Veteran’s Benefits Administration, and other sources, enter “102126”. If the individual received comparable services or benefits from a Community Rehabilitation Program and a One-Stop Operator, enter “0616”. If an individual received comparable services or benefits from only an elementary or secondary educational institution, enter “08”. If no comparable services or benefits were provided, leave blank.
Adult education and Literacy program administered by the Department of Education
Adult, Dislocated Worker and Youth formula program administered by Department of Labor (DOL)
Federal Student Aid (such as, Pell grants, SEOG (Supplemental Educational Opportunity Grant), work study, etc.
Social Security Administration (Disability Determination Service or District office)
Veteran's Benefits Administration (which includes VA Vocational Rehabilitation)
Veteran's Health Administration (the VA hospital system, as well as the VA transitional living, transitional employment, and compensated work therapy programs)
Other DOL programs authorized under WIOA (Job Corps, YouthBuild, Indian and Native American programs, Migrant and Seasonal Farmworker programs, and evaluation and mulitstate projects
Enter a "1" for each of the data elements below to indicate the highest level of enrollment or attainment level at the beginning of the current quarter.
NOTE:
Certification: A credential awarded by a certification body based on an individual demonstrating through an examination process that he or she has acquired the designated knowledge, skills, and abilities to perform a specific job. The examination can be either written, oral, or performance-based. Certification is a time-limited credential that is renewed through a recertification process.
License: A credential awarded by a licensing agency based on pre-determined criteria. The criteria may include some combination of degree attainment, certifications, certificates, assessment, apprenticeship programs, or work experience. Licenses are time-limited and must be renewed periodically.
Educational certificate: A credential awarded by an educational institution based on completion of all requirements for a program of study, including coursework and test or other performance evaluations. Certificates are typically awarded for life (like a degree). Certificates of attendance or participation in a short-term training (e.g., 1 day) are not in the definitional scope for educational certificates.
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
Data type: VARCHAR (1)
A student with a disability is defined to be a person who is (1) at least 16 years or age, unless a State elects to provide pre-employment transition services at a younger age, and no older than 21 years of age, unless the State provides transition services under the Individuals with Disabilities Education Act (IDEA) at an older age; and (2) is receiving transition services pursuant to IDEA, or is considered to have a disability for the purposes of section 504 of the Rehabilitation Act (29 U.S.C. 794). This element captures the status of youth with a disabilities at the beginning of the current quarter.
This individual is a student with a Section 504 accommodation plan.
This individual is a student and is receiving services under an IEP.
This individual is a student without a Section 504 accommodation plan and is not receiving services under an IEP.
Data type: VARCHAR (4)
If the state defines age of students with disabilities at the beginning of the reporting quarter to be other than ages 16 to 21, enter the two-digit lower limit for the age of the students with disabilities followed by the two-digit upper limit for the age of the students with disabilities. For example, if the state defines the ages of students with disabilities to be 14 to 24 instead of 16 to 21, enter "1424." If the state defines the ages of students with disabilities to be 16 to 24, enter "1624." If state defines the ages of students with disabilities to be 16 to 21, leave blank.
Data type: VARCHAR (4)
At the beginning of the quarter, enter the four-digit code that best describes the individual's primary physical or mental impairment that causes or results in a substantial impediment to employment. The number reported is a combination of the impairment code and cause/source code. The first two digits designate the impairment (sensory, physical or mental), and the last two digits indicate the cause or source of the impairment. Make sure to enter the leading zeros if necessary and do not use commas or spaces between the impairment code and the cause/source code. If the person is found not to have a disability, this item should be coded 0000. Leave blank if the information is not available for Type of Exit coded "1" (exited as an applicant). This data element is required.
Data type: VARCHAR (4)
At the beginning of the quarter, enter the four-digit code that best describes the secondary disability. This is the physical or mental impairment that contributes to, but is not the primary basis of, the impediment to employment. The number reported is a combination of the impairment code and cause/source code. Make sure to enter the leading zeroes if necessary and do not use commas or spaces between the impairment code and the cause/source code. If the person is found not to have a secondary disability, this item should be coded 0000. Leave blank if the information is not available for Type of Exit coded "1" (exited as an applicant). This data element is required.
CODES FOR IMPAIRMENTS
No impairment
Sensory/Communicative Impairments:
Blindness
Other Visual Impairments
Deafness, Primary Communication Visual
Deafness, Primary Communication Auditory
Hearing Loss, Primary Communication Visual
Hearing Loss, Primary Communication Auditory
Other Hearing Impairments (Tinnitus, Meniere's Disease, hyperacusis, etc.)
Deaf-Blindness
Communicative Impairments (expressive/receptive)
Physical Impairments:
Mobility Orthopedic/Neurological Impairments
Manipulation/Dexterity Orthopedic/Neurological Impairments
Both mobility and Manipulation/Dexterity Orthopedic/Neurological Impairments
Other Orthopedic Impairments (e.g., limited range of motion)
Respiratory Impairments
General Physical Debilitation (fatigue, weakness, pain, etc.)
Other Physical Impairments (not listed above)
Mental Impairments:
Cognitive Impairments (impairments involving learning, thinking, processing information and concentration)
Psychosocial Impairments (interpersonal and behavioral impairments, difficulty coping)
Other Mental Impairments
CODES FOR CAUSES/SOURCES OF IMPAIRMENTS
Cause unknown
Accident/Injury (other than TBI or SCI)
Alcohol Abuse or Dependence
Amputations
Anxiety Disorders
Arthritis and Rheumatism
Asthma and other Allergies
Attention-Deficit Hyperactivity Disorder (ADHD)
Autism
Blood Disorders
Cancer
Cardiac and other Conditions of the Circulatory System
Cerebral Palsy
Congenital Condition or Birth Injury
Cystic Fibrosis
Depressive and other Mood Disorders
Diabetes Mellitus
Digestive
Drug Abuse or Dependence (other than alcohol)
Eating Disorders (e.g., anorexia, bulimia, or compulsive overeating)
End-Stage Renal Disease and other Genitourinary System Disorders
Epilepsy
HIV and AIDS
Immune Deficiencies excluding HIV/AIDS
Mental Illness (not listed elsewhere)
Intellectual/Developmental Conditions
Multiple Sclerosis
Muscular Dystrophy
Parkinson's Disease and other Neurological Disorders
Personality Disorders
Physical Disorders/Conditions (not listed elsewhere)
Polio
Respiratory Disorders other than Cystic Fibrosis or Asthma
Schizophrenia and other Psychotic Disorders
Specific Learning Disabilities
Spinal Cord Injury (SCI)
Stroke
Data type: VARCHAR (1)
Select a coding option below to indicate whether the individual was considered a person with a significant disability or a most significant disability at the beginning of the quarter. If an individual is receiving Social Security benefits at application or exit due to their own disabling condition, he/she is presumed eligible and significantly disabled. Individuals are to be coded as most significantly disabled if they meet the definition of significantly disabled and have additional functional limitations as defined by the agency.
An individual with a significant disability is an individual:
who has a physical or mental impairment that seriously limits one or more functional capacities (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome;
whose VR can be expected to require multiple VR services over an extended period of time; and
who has one or more physical or mental disabilities resulting from amputation, arthritis, autism, blindness, burn injury, cancer, cerebral palsy, cystic fibrosis, deafness, head injury, heart disease, hemiplegia, hemophilia, respiratory or pulmonary dysfunction, intellectual disability, mental illness, multiple sclerosis, muscular dystrophy, musculo-skeletal disorders, neurological disorders (including stroke and epilepsy), spinal cord conditions (including paraplegia and quadriplegia), sickle cell anemia, specific learning disability, end-stage renal disease, or another disability or combination of disabilities determined on the basis of an assessment for determining eligibility and VR needs to cause comparable substantial functional limitation.
No Significant Disability
Significant Disability
Most Significant Disability
Data type: DATE 112 (YYYYMMDD)
This data element captures the start of pre- and possibly post-eligibility assessment activities that are part of the VR experience for many severely disabled individuals for whom an employment outcome might be in doubt. Enter the date that the individual’s trial work experience began. If the individual has been placed in more than one trial work experience, the first occurrence of trial work must have an End Date of Trial Work Experience (Data Element 81) before another Start Date of Trial Work Experience can be entered. These data are reported quarterly.
Data type: DATE 112 (YYYYMMDD)
Enter the date that the individual’s trial work experience ended. These data are reported quarterly.
Data type: DATE 112 (YYYYMMDD)
Record the date on which the initial IPE for the individual became effective. For purposes of this data element, assume that the IPE is effective on the date on which both the agency and individual reach agreement. If the two signatures bear two different dates, the later date should govern. If the IPE is amended more than once during the same reporting quarter, enter the most recent date. If the IPE is amended later in the individual's VR program, enter the subsequent date in the reporting quarter in which the IPE was amended. These data are reported quarterly.
Data type: VARCHAR (1)
If the individual has an employment goal of supported employment in their current IPE during the reporting quarter, enter "1" to indicate that the individual has a supported employment goal on his/her current IPE. These data are reported quarterly.
Note: The term “supported employment” means competitive integrated employment, including customized employment, or employment in an integrated work setting in which individuals are working on a short-term basis toward competitive integrated employment, that is individualized and customized consistent with the strengths, abilities, interests, and informed choice of the individuals involved, for individuals with the most significant disabilities for whom competitive integrated employment has not historically occurred; or for whom competitive integrated employment has been interrupted or intermittent as a result of a significant disability; and who, because of the nature and severity of their disability, need intensive supported employment services and extended services after the transition described in paragraph (13)(C), in order to perform the work involved.
SERVICES PROVIDED AND COSTS FOR PURCHASED SERVICES
There are five data elements for each of the service categories. The first data element indicates whether service has been provided. If purchased by the VR agency, the second data element identifies the primary purchase VR service provider type. The third data element is used to report state VR Title I funds used to purchase services. For pre-employment transition services, the source of funds for this data element would be state VR Title I grant funds, reserved in accordance with 110 (D). For participants of the VR program, the source of funds for this data element would be state VR Title I grant funds. The fourth data element is used to report supported employment state grant (Title VI) funds used to purchase services. The fifth data element is used to capture up to three comparable services and benefits providers.
Data Type VARCHAR (1)
For each of the service categories, this data element provides information on whether services in the category were purchased and/or provided by the VR agency and/or provided by comparable services and benefits providers for the individual. Include all services furnished over the life of the service record for the individual. The following codes are used to capture this information for all services within the service category.
not provided
provided by the VR agency (in-house/by VR staff)
purchased by the VR agency
provided by the VR agency (in-house/by VR staff) and/or purchased by the VR agency and/or provided by comparable services and benefits providers
Note:
For each service category, select code 0 if the service was not provided to the individual at all. Each of the other data elements, (2) Primary Purchase VR Service Provider Type, (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services, and (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services should be left blank.
For each service category, select code 1 if the service was provided ONLY by the State VR agency through its own staff. Each of the other data elements, (2) Primary Purchase VR Service Provider Type, (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services, and (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services should be left blank.
For each service category, select code 2 if the service was provided ONLY through purchase by the VR agency. Data elements (2) Primary Purchased VR Service Provider Type and an amount should be entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services.
For each service category, select code 3 if the service was provided by a combination of coding options, 1 provided by the VR agency (in-house/by VR staff) and 2 purchased by the VR agency. If the service was provided by the VR agency (in-house/by VR staff) and purchased by the VR agency, a coding option should be selected for data element (2) Primary Purchased VR Service Provider Type and an amount should be entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services.
For each service category, select code 4 if the service was provided by any combination of coding options, 1 provided by the VR agency (in-house/by VR staff), 2 purchased by the VR agency, and/or 3 provided by comparable services and benefits providers (see coding details below).
If the service was provided by the VR agency (in-house/by VR staff) and purchased by the VR agency, a coding option should be selected for data element (2) Primary Purchased VR Service Provider Type and an amount should be entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services. Data element (5) Comparable Services and Benefits Providers should be left blank.
If the service was provided by the VR agency (in-house/by VR staff) and also provided by comparable services and benefits providers, data elements, (2) Primary Purchase VR Service Provider Type, (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services, and (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services should be left blank. Data element (5) Comparable Services and Benefits Providers should be entered with up to three comparable services and benefits providers.
If the service was purchased by the VR agency and also provided by comparable services and benefits providers, a coding option should be entered in data element (2) Primary Purchased VR Service Provider Type with an amount entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services. Data element (5) Comparable Services and Benefits Providers should also be entered with up to three comparable services and benefits providers.
If the service was provided by the VR agency (in-house/by VR staff) and purchased by the VR agency and also provided by comparable services and benefits providers, data should be entered in data element (2) Primary Purchased VR Service Provider Type with an amount entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI) Funds Used to Purchase Services. Data element (5) Comparable Services and Benefits Providers should also be entered with up to three comparable services and benefits providers.
Data Type VARCHAR (1)
For each of the service categories, this data element provides information on what type of service provider provided the purchased services. The following codes are used to capture this information. For each service category, select the code that best describes from which service provider type the majority of the purchased services provided to the individual originated over the life of the service record. The majority of purchased services were provided directly by:
Public Community Rehabilitation Programs (CRPs) – public CRPs are programs that are operated by a state, county, municipal or other local government.
Private CRPs – private CRPs are programs that are operated as not-for-profit organizations.
Other public service providers – public service providers are organizations or agencies of State, county, municipal or other local government and third-party cooperative arrangements.
Other private service providers – private service providers include private not-for-profit organizations, such as VR providers (other than CRPs), as well as proprietary businesses, such as private hospitals and mental health clinics as well as contracted service delivery staff.
Data type INT(6)
For pre-employment transition services, this data element captures the costs (amounts) per quarter of purchased services using the VR grant (Title I) funds reserved in accordance with 110 (D).
For participants of the VR program, this data element captures the costs (amounts) per quarter of purchased services using the VR grant (Title I) funds including state and other sources of matching funds as well as program income.
Do not include costs incurred for program administration and for salaries of counselors and other staff. Also exclude costs for services provided by rehabilitation programs owned and operated by the State VR agency that are not directly billed on an individual basis.
Data type INT(6)
This data element records all expenditures (amounts) per quarter within this service category for services purchased for the most significantly disabled individual with the supported employment grant program (Title VI) funds. Recipients of these funds should have a supported employment goal in their IPE. Individuals with a supported employment goal stated in their IPEs may receive any category of services depending on their particular needs. Therefore, to identify the use of these funds, each service category includes this data element.
Include all Title VI expenditures made to public and/or private service providers, individuals or an organization. Include Title VI expenditures for all types of purchased services including, but not limited to assessment, training, medical services, job development, placement and/or coaching services, maintenance, transportation, tuition for higher education, rehabilitation technology services, personal assistance, or any other rehabilitation services. Exclude costs incurred for program administration and for salaries of counselors and other staff. Also exclude costs for services provided by rehabilitation programs owned and operated by the State VR agency that are not directly billed on an individual basis.
For each of the service categories, enter up to three codes that best describe the service providers who provided the individual with a comparable service or benefit. Make sure to enter the leading zeroes if necessary and do not use commas or spaces between any of the codes. For example, if the individual received comparable services or benefits from an employer, the Veteran’s Benefits Administration, and other sources, enter “102129”. If the individual received comparable services or benefits from a Community Rehabilitation Program and a developmental disability agency, enter “0613”. If an individual received comparable services or benefits from only an elementary or secondary educational institution, enter “08”. If no comparable services or benefits were provided, leave blank.
Adult education and Literacy program administered by the Department of Education
Adult, Dislocated Worker and Youth formula program administered by Department of Labor (DOL)
Federal Student Aid (such as, Pell grants, SEOG (Supplemental Educational Opportunity Grant), work study, etc.
Social Security Administration (Disability Determination Service or District office)
Veteran's Benefits Administration (which includes VA Vocational Rehabilitation)
Veteran's Health Administration (the VA hospital system, as well as the VA transitional living, transitional employment, and compensated work therapy programs)
Other DOL programs authorized under WIOA (Job Corps, YouthBuild, Indian and Native American programs, Migrant and Seasonal Farmworker programs, and evaluation and multistate projects
SERVICE CATEGORIES FOR PRE-EMPLOYMENT TRANSITION STUDENTS
Pre-employment transition services may be provided to all students with disabilities.
Data Elements 84-88
Data Elements 89-93
Use this category for in-school or after school opportunities, or experience outside the traditional school setting (including internships), that is provided in an integrated environment to the maximum extent possible.
Data Elements 94-98
Use this category for counseling on opportunities for enrollment in comprehensive transition or postsecondary educational programs at institutions of higher education.
Data Elements 99-103
Use this category for workplace readiness training to develop social skills and independent living.
Data Elements 104-108
Use this category for instruction in self-advocacy (including instruction in person-centered planning), which may include peer mentoring (including peer mentoring from individuals with disabilities working in competitive integrated employment).
SERVICE CATEGORIES FOR PARTICIPANTS OF THE VR PROGRAM
The purpose of the service categories listed below is to capture all services provided to individuals during the life of their service record whether provided by the VR agency or others as comparable services or benefits. Except for certain services such as assessment that can be provided to determine eligibility prior to an IPE or to assign an individual to a priority category, the services provided should be those identified on the IPE, not services merely authorized, but actually provided.
Data Elements 109-113
Assessment means services provided and activities performed to determine an individual’s eligibility for VR services, to assign an individual to a priority category of a State VR agency that operates under an order of selection, and/or to determine the nature and scope of VR services to be included in the IPE. Include here trial work experiences and extended evaluation. Assessments to determine eligibility, assignment of a priority category or the nature or scope of services to be included on the IPE include, but are not limited to psychological assessments, audio logical evaluations, dental and medical exams and other assessments of personality, interests, interpersonal skills, intelligence and related functional capacities, educational achievements, work experience, vocational aptitudes, personal and social adjustments, and employment opportunities of the individual and the medical, psychiatric, psychological, and other pertinent vocational, educational, cultural, social, recreational, and environmental factors that affect the employment and rehabilitation needs of the individual. See also 34 CFR 361.5(b)(6) and 34 CFR 361.48.
Data Elements 114-118
Diagnosis and treatment of impairments means:
Corrective surgery or therapeutic treatment that is likely, within a reasonable period of time, to correct or modify substantially a physical or mental impairment that constitutes a substantial impediment to employment including the medical and surgical procedures required for implantation of neuroprosthetic devices, such as cochlear implants, visual prosthetics, and motor prosthetic devices;
Diagnosis and treatment for mental and emotional disorders by qualified personnel who meet State licensure laws;
Dentistry;
Nursing services;
Necessary hospitalization (either inpatient or outpatient care) in connection with surgery or treatment;
Drugs and supplies;
Prescription of prosthetics and/or orthotics related to the individual’s diagnosed disability and is necessary for the achievement of the employment outcome;
Prescription of eyeglasses and visual services, including visual training, related to the individual’s diagnosed disability and necessary for the achievement of the employment outcome;
Podiatry;
Physical therapy;
Occupational therapy;
Speech or hearing therapy;
Mental health services;
Treatment of either acute or chronic medical complications and emergencies that are associated with or arise out of the provision of physical and mental restoration services or that are inherent in the condition under treatment;
Special services for the treatment of individuals with end-stage renal disease, including transplantation, dialysis, artificial kidneys, and supplies;
Other medical or medically related rehabilitation services; and
Medical care for acute conditions arising during rehabilitation and constituting a barrier to the achievement of an employment outcome is also included in this category.
Data Elements 119-123
Vocational rehabilitation counseling and guidance includes information and support services to assist an individual in exercising informed choice and is distinct from the case management relationship that exists between the counselor and the individual during the VR process.
Training services are designed to help the individual improve educationally or vocationally or to adjust to the functional limitations of his or her impairment. If the individual receives more than one type of training, each type should be recorded. For those individuals not seeking a degree or certificate and attending a course in a college or university, code this type of training under Miscellaneous Training.
Data Elements 124-128
Full-time or part-time academic training leading to a degree recognized as being beyond a baccalaureate degree, such as a Master of Science, Arts (M.S. or M.A.) or Doctor of Philosophy (Ph.D.) or Doctor of Jurisprudence (J.D.). Such training would be provided by a college or university.
Data Elements 129-133
Full-time or part-time academic training leading to a baccalaureate degree, a certificate, or other recognized educational credential. Such training may be provided by a four-year college or university or technical college.
Data Elements 134-138
Full-time or part-time academic training above the high school level leading to an associate degree, a certificate, or other recognized educational credential. Such training may be provided by a community college, junior college, or technical college.
Data Elements 139-143
Occupational, vocational, or job skill training provided by a community college and/or business, vocational/trade or technical school to prepare students for gainful employment in a recognized occupation, not leading to an academic degree. This would include selected courses or programs of study at a community college, four-year college, university, technical college or proprietary schools or programs.
Data Elements 144-148
Training in specific job skills by a prospective employer. Generally the trainee is paid during this training and will remain in the same or a similar job upon successful completion.
Data Elements 149-153
An apprenticeship program is a work-based employment and training program that combines hands-on, on-the-job work experience in a skilled occupation with related classroom instruction. Structured apprenticeship programs generally have minimum requirements for the duration of on-the job work experience and classroom instruction, and/or could utilize competency-based elements but should have mechanisms in place to ensure quality and consistency of skills acquisition. Other elements that distinguish apprenticeship programs from other work-based efforts including co-op education, on-the-job training, and internships are the following: includes supervision and structured mentoring; provides for wage increases as an apprentice's skills increase; is based on an employer-employee relationship; and provides an industry recognized certificate of completion of the program.
Data Elements 154-158
Literacy training or training provided to remediate basic academic skills that are needed to function on the job in the competitive labor market.
Data Elements 159-163
Training provided to prepare an individual for the world of work (e.g., appropriate work behaviors, getting to work on time, appropriate dress and grooming, increasing productivity).
Data Elements 164-168
Disability-related augmentative skills training includes but is not limited to: orientation and mobility; rehabilitation teaching; training in the use of low vision aids; Braille; speech reading; sign language; and cognitive training/retraining.
Data Elements 169-173
Any training not recorded in one of the other categories listed, including GED or high school training leading to a diploma, or courses taken at four-year, junior or community colleges not leading to a certificate or diploma.
Data Elements 174-178
Job search activities support and assist an individual in searching for an appropriate job. Job search assistance may include help in resume preparation, identifying appropriate job opportunities, developing interview skills, and making contacts with companies on behalf of the consumer.
Data Elements 179-183
Job placement assistance is a referral to a specific job resulting in an interview, whether or not the individual obtained the job.
Data Elements 184-188
Support services provided to an individual who has been placed in employment in order to stabilize the placement and enhance job retention. Such services include short-term job coaching for persons who do not have a supported employment goal consistent with the employment goal on the IPE.
Data Elements 189-193
On-going support services and other appropriate services needed to support and maintain an individual with a most significant disability in supported employment for a period of time generally not to exceed 24 months. Services, such as job coaching, are for individuals who have supported employment and long-term supports identified on the IPEs. On-the-job support services with a supported employment goal are funded using Title VI and Title I funds.
Data Elements 194-198
Transportation, including adequate training in the use of public transportation vehicles and systems, means travel and related expenses that are necessary to enable an applicant or eligible individual to participate in a VR service. Examples of transportation services/expenses include, but are not limited to:
Travel and related expenses for a personal care attendant or aide if the services of that person are necessary to enable the individual to travel to participate in any VR service;
Relocation expenses incurred by the individual in connection with a job placement that is a significant distance from the individual's current residence;
The purchase and repair of vehicles, including vans. This specifically excludes the modification of vehicles, which is to be reported in rehabilitation technology;
Training in the use of public transportation vehicles and systems.
Data Elements 199-203
Maintenance means monetary support provided for those expenses such as food, shelter and clothing that are in excess of the normal expenses of the individual, and that are necessitated by the individual’s participation in an assessment for determining eligibility and VR needs or while receiving services under an IPE. Examples of maintenance expenses include, but are not limited to:
cost of uniforms or other suitable clothing required for an individual's job placement or job seeking activities;
cost of short-term expenses, such as food and shelter, that is required in order for an individual to participate in assessment or vocational training at a site that is not within commuting distance of an individual's home;
initial one-time costs, such as security deposits or charges for the initiation of utilities, that are required in order for an individual to relocate for a job placement; and
cost of an individual’s participation in enrichment activities related to that individual's training program.
Data Elements 204-208
Rehabilitation technology means the systematic application of technologies, engineering methodologies, or scientific principles to meet the needs of, and address the barriers confronted by, individuals with disabilities in areas that include education, rehabilitation, employment, transportation, independent living, recreation, home and vehicular modification, other assistive devices including, but not limited to hearing aids, low vision aids and wheelchairs. This includes the hardware portion of neuroprosthetic devices, such as cochlear implants, visual prosthetics, and motor prosthetic devices, but does not include medical and surgical procedures required for implantation of neuroprosthetic devices which should be coded as diagnosis and treatment of impairments. Rehabilitation technology includes rehabilitation engineering, assistive technology devices, and assistive technology services. See also 34 CFR 361.5(b)(45). The term includes the following:
Rehabilitation Engineering Services are the systematic application of engineering sciences to design, develop, test, evaluate, apply, and distribute technological solutions to problems confronted by VR individuals in functional areas such as mobility, communications, hearing, vision, and cognition, and in activities associated with employment, independent living, education, and integration into the community.
Assistive Technology Devices are any items, piece of equipment, or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain, or improve the functional capabilities of a VR customer.
Assistive Technology Services are any services that directly assist an individual with a disability in the selection, acquisition, or use of an assistive technology device. Services may include:
the evaluation of the needs of an individual, including a functional evaluation of the individual in his/her customary environment;
purchasing, leasing, or otherwise providing for the acquisition by an individual of an assistive technology device;
selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;
training or providing technical assistance for an individual or, if appropriate, the family members, guardians, advocates, or authorized representatives of the individual; and
training or providing technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or others who provide services to, employ, or are otherwise substantially involved in the major life functions of VR individuals to the extent that training or technical assistance is necessary for individuals to achieve an employment outcome.
Personal Assistance Services are a range of services provided by one or more persons designed to assist an individual to perform daily living activities on or off the job that the individual would typically perform without assistance if he or she did not have a disability. The services must be designed to increase the individual’s control in life and ability to perform everyday activities on or off the job. The services must be necessary to the achievement of an employment outcome and may be provided only while the individual is receiving other VR services. The services may include training in managing, supervising, and directing personal assistance services.
Three distinct services that are considered personal assistance services are reader services, interpreter services, and personal attendant services. Further information on recording each of these services follows. Record only whether and which of these services were provided to the individual (e.g., if the same person provided both reader service and personal attendant service to an individual, indicate both services).
Data Elements 209-213
Reader services are for individuals who cannot read print because of blindness or other disability. Reader services include, in addition to reading aloud, transcription of printed information into Braille or sound recordings if the individual requests such transcription. Reader services are generally for individuals who are blind or deaf-blind, but may also include individuals unable to read because of serious neurological disorders, specific learning disabilities, or other physical or mental impairments.
Data Elements 214-218
Interpreter services are sign language or oral interpretation services for individuals who are deaf or hard of hearing and tactile interpretation services for individuals who are deaf-blind. Specially trained individuals perform sign language or oral interpretation. Also include here real-time captioning services for persons who are deaf or hard of hearing. Do not include language interpretation in this category, but in "other services".
Data Elements 219-223
Personal attendant services are those personal services that an attendant performs for an individual with a disability including, but not limited to bathing, feeding, dressing, providing mobility and transportation, etc in multiple settings to include home, work and training facilities/school.
Data Elements 224-228
Technical assistance and other consultation services provided to conduct market analyses, to develop business plans, and to provide resources to individuals in the pursuit of self-employment, telecommuting and small business operation outcomes.
Data Elements 229-233
Information and referral services are provided to individuals who need services from other agencies (e.g., cooperative agreements) not available through the VR program.
Data Elements 234-238
Assistance provided to an individual who is interested in becoming employed, but is uncertain of the impact work income will have on any disability benefits and entitlements being received, and/or is not aware of benefits, such as access to healthcare, that might be available to support any work attempt.
This typically involves an analysis of an individual’s current benefits, such as SSDI and SSI, the individual’s financial situation, and the effect different income levels from work will have on the individual’s future financial situation. This assistance is intended to provide the individual an opportunity to make an informed choice regarding the pursuit of employment. Ongoing assistance may also be provided as the individual decides on employment goals, searches for jobs, and becomes employed.
Data Elements 239-243
Customized employment means competitive integrated employment for an individual with a significant disability, that is based on an individualized determination of the strengths, needs, and interests of the individual with a significant disability, that is designed to meet the specific abilities of the individual with a significant disability and the business needs of the employer, and that is carried out through flexible strategies. Flexible strategies include job exploration by the individual or working with an employer to facilitate placement, including:
customizing a job description based on current employer needs or on previously unidentified and unmet employer needs;
developing a set of job duties, a work schedule and job arrangement, and specifics of supervision (including performance evaluation and review), and determining a job location;
representation by a professional chosen by the individual, or self-representation of the individual, in working with an employer to facilitate placement; and
providing services and supports at the job location.
Data Elements 244-248
Use this category for all other VR services that cannot be recorded elsewhere. Included here are occupational licenses, tools and equipment, initial stocks and supplies.
Data type VARCHAR (1)
This data element captures the number of separate positions consistent with the employment goal on an individual's IPE and primary employment goal SOC codes that the individual held at the time of exit. For those exiting with only one source of employment, enter the number ‘1’. For those exiting the VR program with 2 sources of employment or positions, enter a ‘2’, and so on for each additional position. For those individuals exiting without employment, leave blank.
Data type VARCHAR (12)
For an individual who achieved an employment outcome, enter up to two six-digit SOC codes to describe the individual’s occupation(s) consistent with the employment goal on an individual's IPE from which the exiting individual derives the majority of their hourly earnings. Make sure to enter the leading zeroes if necessary and do not use commas or spaces between any of the codes. For example, if the individual’s first position was SOC code 436012 and their second position was SOC code 434051, enter “436012434051.” If the individual has only one position with the SOC code 292041, enter “202041.” For individuals who did not achieve an employment outcome, leave blank.
For the employment situations unique to the VR program, use the special codes indicated below.
Special Codes |
Special Code Descriptions |
899999 |
Randolph-Sheppard vending facility clerk use this category for persons employed as clerks, sales persons, or helpers in a vending facility operated under the Randolph-Sheppard Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility operators (999999), or individuals employed in vending facilities outside the Vending Facility Program (use their occupation code). |
999999 |
Randolph-Sheppard vending facility operator use this category for individuals employed as operators or managers of vending facilities operated under the Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility clerks (899999), or individuals employed as vending facility operators outside the Randolph-Sheppard Vending Facility Program (use their occupation code).Randolph-Sheppard vending facility operator. |
Note: The 2010 Standard Occupational Classification (SOC) System code should be referenced in obtaining the six-digit code that most closely corresponds to the individual's primary occupation(s) at exit.
Data type: DATE 112 (YYYYMMDD)
For an individual who achieved an employment outcome, record the earliest date of suitable employment after the provision of substantial services when the individual began the job(s) coded in data element 250 as the primary occupation.
Data type VARCHAR (1)
For an individual who achieved an employment outcome, enter the applicable one-digit code that describes the employment outcome of the individual at exit. If classifying the individual into two different employment statuses from Codes 1 or 3-6 is possible, select a code designating the principal status. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry.
Competitive Integrated Employment refers to work that is:
performed on a full-time or part-time basis (including self-employment); and
for which the individual is compensated at a rate that shall be not less than the higher of the federal minimum wage or the State or local minimum wage; and
is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities, or in the case of an individual who is self-employed, yields an income that is comparable to the income by other individuals who are not individuals with disabilities, and who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and
is eligible for the level of benefits provided to other employees;
that is at a location where the employee interacts with other persons who are not individuals with disabilities (not including supervisory personnel or individuals who are providing services to such employee) to the same extent that individuals who are not individuals with disabilities; and
that as appropriate, presents opportunities for advancement that are similar to those for other employees who are not individuals with disabilities and who have similar positions.
Self-employment (except BEP) refers to work for profit or fees including operating one's own business, farm, shop, or office. "Self-employment" includes sharecroppers, but not wage earners on farms.
State Agency-managed Business Enterprise Program (BEP) refers to Randolph-Sheppard vending facilities and other small businesses operated by individuals with significant disabilities under the management and supervision of a State VR agency. Include home industry where the work is done under the management and supervision of a State VR agency in the individual's own home or residence for wages, salary, or on a piece-rate. Individuals capable of activity outside the home, as well as homebound individuals, may engage in such employment.
Competitive Integrated Employment with Supports refers to competitive integrated employment as defined above with ongoing support services for individuals with significant disabilities (supported employment).
Data type: Decimal (5,2)
Enter the hourly wage (to the nearest cent) the individual earned after achieving an employment outcome consistent with the employment goal on an individual’s IPE, at the time the individual exited.
This data element captures cash earnings of the individual at time of exit expressed as an hourly wage and includes all wages, salaries, tips, and commissions received as income. These earnings are before payroll deductions of Federal, State and local income taxes and Social Security payroll tax are taken.
Hourly wages (earnings) also include profits derived from self-employed individuals. Wages for salespersons, consultants, self-employed individuals, and other similar occupations are based on the adjusted gross income. Adjusted gross income is gross income minus unreimbursed business expenses. Do not include estimates of payments in-kind, such as meals and lodging. Estimate profits of farmers, if necessary.
Where wages are based on commissions that are irregular (e.g., real estate, automobile sales, etc.), they should be calculated as an hourly wage average over a representative period of time such as one month or longer. to obtain a meaningful figure. Commissions are generally not paid when earned, but rather are paid periodically, such as weekly, biweekly, or even monthly. To bring standardization to this item, wages should be based on the actual receipt of the payment and not on amounts accruing until the next commission payout.
If there are significant amounts of irregular unreimbursed business expenses (e.g., car lease payments due the first week of every month), the expenses should be averaged over a representative period of time such as one month or longer to obtain a meaningful figure for an hourly wage.
If the individual had no earnings or did not achieve an employment outcome, enter "0". Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry.
Data type INT(3)
For an individual who achieved an employment outcome, this data element collects data on the number of hours worked on all employment consistent with the employment goal on the individual’s IPE. Enter the number of hours the individual worked for earnings in a typical week when the individual exited. Earnings may have been in the form of wages, salaries, tips, commissions, profits from self-employment, adjusted gross income for salespersons, etc. If the individual had no earnings or did not achieve an employment outcome, enter "0". Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry.
MONTHLY PUBLIC SUPPORT AMOUNT AT EXIT
Enter the monthly amount (to the nearest dollar) of public support received by the individual at exit from each of the following sources. If the individual did not receive any monthly public support, enter "0" for each type of public support. Agencies may leave these data elements blank for exit code 1. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after data entry.
Public support refers to cash payments made by Federal, State and/or local governments for any reason, including an individual’s disability, age, or economic status. Include payments to a family unit precipitated by the individual’s disability or when the individual’s presence is taken into account in the computation of the family benefit. Also include any payments that are sent directly to the individual in an institution or to dependents on his/her behalf. Exclude any non-cash support payments such as Medicaid, Medicare, food stamps and rental subsidies.
Categories of public support are as follows:
Data Type INT(5)
Enter the monthly amount of SSDI received by the individual. This figure can be verified through the Social Security Administration (SSA) or from a copy of the individual’s benefit notification letter.
Data Type INT(5)
Enter the monthly payment to the individual under the Federal program of SSI for the aged, blind, and disabled. Only the individual’s portion of the payment should be recorded here. This figure can be verified through the SSA or from a copy of the individual’s benefit notification letter.
Data Type INT(5)
Enter the monthly amount of cash public assistance payments made through the federally funded TANF program. If the TANF payment is made to the family unit, use the local disbursing agency's procedure to estimate the individual’s portion of the payment.
Data Type INT(5)
Data Type INT(5)
Veterans' Disability Benefits are payments made by the Department of Veterans Affairs for partial or total disability.
Data Type INT(5)
Enter the monthly amount of public support received from all other sources of public support not listed. Other Public Support payments are cash payments to individuals beyond those otherwise listed, and include payments made by Federal, State and local governments for retirement or survivor benefits to the individual as well as unemployment insurance benefits and other temporary payments.
Enter a code from the list below to indicate the individual’s largest single source of economic support at the time the individual exited, even if it accounts for less than one-half of the individual's total support. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry.
Note: If an individual is supported by the earnings of a spouse, or by the spouse's unemployment insurance checks, identify Code 2 as the Primary Source of Support (family and friends) and not Code 1 (personal income). If an individual is primarily supported by a governmental entity with no cash support – for example, incarcerated individuals – use code 3 (public support) as the primary source of support only if the individual applicant is the recipient of the support. If the family receives public support, use Code 2 (family and friends).
Personal Income (employment earnings, interest, dividends, rent, retirement including social security)
All other sources (e.g., private disability insurance and private charities)
MEDICAL INSURANCE COVERAGE AT EXIT
Record whether an individual had medical insurance coverage at the time of exit. Enter a “1” in each of the following data elements if the individual had this type of medical insurance coverage at exit, otherwise leave blank. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry.
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Data Type: VARCHAR (1)
Individuals receiving benefits through their parent/family members’ insurance plan should use this code.
Data Type: VARCHAR (1)
Refers to individuals receiving benefits through their enrollment in an Affordable Care Act Exchange.
Data type VARCHAR (1)
Enter a one-digit code from the following list to indicate when in the VR process an individual exited the program:
Exited as an applicant, prior to eligibility determination or trial work
Exited after eligibility, but from an order of selection waiting list
Exited after an IPE in noncompetitive, integrated employment
Exited after an IPE with a competitive, integrated employment outcome
Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry.
Data type VARCHAR (2)
Enter the code listed below that identifies the reason for closing the service record of an individual. The code 0 applies only to service records with a code of 7 in data element 270, Type of Exit. Codes of 1 or higher apply to all other Types of Exit. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry.
Use this code when the individual has relocated or left the State without a forwarding address.
Use this code to identify an individual whose mental or physical disability is so significant that the individual cannot benefit or continue to benefit from VR services in terms of employment.
Use this code for individuals who choose not to participate or continue in their VR program at this time. Also use this code to indicate when an individual’s actions (or non-actions) make it impossible to begin or continue a VR program. Examples would include repeated failures to keep appointments for assessment, counseling, or other services.
Use this code when an individual needs services that are more appropriately obtained elsewhere. Transfer to the other agency indicates that appropriate referral information is forwarded to the other agency so that agency may provide services more effectively. Include individuals transferred to other State VR agencies.
Use this code only for applicants who are not eligible for VR services because no physical or mental impairment exists, such as when the reported disability is an acute condition with no residual impairment, e.g., a broken bone that heals.
Use this code for applicants who are not eligible for VR services because their physical or mental impairment does not constitute a substantial impediment to employment.
Use this code to indicate that the individual was unable to accept or maintain employment because suitable transportation was either not feasible or not available.
Use this code for applicants who do not require VR services to prepare for, enter into, engage in, or retain gainful employment consistent with their strengths, resources, priorities, concerns, abilities, capabilities, and informed choice.
Use this code for individuals who would have benefited from the provision of supported employment services but for whom no source of extended services was available.
This code is used for all reasons not covered above.
Use this code for individuals who received services and were placed in a non-competitive integrated employment for a public or non-profit organization.
Use this code when an individual has entered an institution other than a prison or jail, and will be unavailable to participate in a VR program for an indefinite or considerable period of time. This category of institution includes hospitals, nursing homes, treatment centers, etc.
Use this code when an individual will be unavailable to participate in a VR program for a considerable period of time because they are incarcerated in a prison, jail, or other criminal correction facility.
Data type: DATE 112 (YYYYMMDD)
Record the date when the individual exited from the VR program. This data element must be reported in the same quarter as the Date of Exit occurs - no updates or modifications after data entry.
After an individual exits the VR program, (data element 272. Date of Exit is not null) and the individual has achieved an employment outcome (data element 270. Type of Exit is coded "7 – Exited after an IPE with a competitive, integrated employment outcome”), enter the quarterly earnings for the second and fourth full quarters after Date of Exit. If the individual has multiple jobs, enter the highest quarterly earnings followed by a comma, then the second highest quarterly earnings followed by a comma, and then the sum of the remaining quarterly earnings. For example, if an individual has four jobs earning $350 from one employer, $400 from another employer, $700 from another employer, and $1,500 from another employer, enter “1500,700,750.”
Data type: INT(30)
After an individual exits the VR program, (data element 272. Date of Exit is not null) and the individual has achieved an employment outcome (data element 270. Type of Exit is coded "7 – Exited after an IPE with a competitive, integrated employment outcome”), enter the EIN for the second and fourth full quarters after Date of Exit. If the individual has multiple jobs, enter the two EINs in which the individual received the highest quarterly earnings. If entering two EINs separate them by a comma.
Data type: DATE 112 (YYYYMMDD)
Enter the date in which all services are complete.
NOTE: All data elements are collected until all of the individual’s services are complete and the case service record is archived, usually after the fourth quarter following the Date of Exit (data element 272) or more if the individual is receiving extended services.
Data Element # |
Data Element |
Data Type |
Collective Data Element |
1 |
Agency Code |
VARCHAR(3) |
|
2 |
Social Security Number |
VARCHAR (9) |
|
3 |
Calendar Year |
VARCHAR (4) |
|
4 |
Calendar Quarter |
VARCHAR (2) |
|
5 |
Closure Order |
VARCHAR (1) |
|
6 |
Previous Closure |
VARCHAR (1) |
|
7 |
Start Date of Pre-Employment Transition Services |
DATE 112 (YYYYMMDD) |
|
8 |
Date of Application |
DATE 112 (YYYYMMDD) |
|
9 |
Date of Birth |
DATE 112 (YYYYMMDD) |
|
10 |
Gender |
VARCHAR (1) |
|
11 |
White |
VARCHAR (1) |
11-15. Race |
12 |
Black or African American |
VARCHAR (1) |
11-15. Race |
13 |
American Indian or Alaska Native |
VARCHAR (1) |
11-15. Race |
14 |
Asian |
VARCHAR (1) |
11-15. Race |
15 |
Native Hawaiian or Other Pacific Islander |
VARCHAR (1) |
11-15. Race |
16 |
Ethnicity – Hispanic or Latino |
VARCHAR (1) |
|
17 |
Veteran Status at Application |
VARCHAR (1) |
|
18 |
Source of Referral at Application |
VARCHAR (2) |
|
19 |
Living Arrangement at Application |
VARCHAR (2) |
|
20 |
Employment Status at Application |
VARCHAR (2) |
|
21 |
Primary Occupation at Application |
VARCHAR (6) |
|
22 |
Hourly Wage at Application |
DECIMAL (5,2) |
|
23 |
Hours Worked in a Week at Application |
INT(3) |
|
24 |
Social Security Disability Insurance (SSDI) |
INT(5) |
24-30. Monthly Public Support at Application |
25 |
Supplemental Security Income (SSI) for the Aged, Blind or Disabled |
INT(5) |
24-30. Monthly Public Support at Application |
26 |
Temporary Assistance for Needy Families (TANF) |
INT(5) |
24-30. Monthly Public Support at Application |
27 |
General Assistance (state or local governments) |
INT(5) |
24-30. Monthly Public Support at Application |
28 |
Veterans’ Disability Benefits |
INT(5) |
24-30. Monthly Public Support at Application |
29 |
Workers’ Compensation |
INT(5) |
24-30. Monthly Public Support at Application |
30 |
All Other Public Support |
INT(5) |
24-30. Monthly Public Support at Application |
31 |
Primary Source of Support at Application |
VARCHAR (1) |
28-35. Monthly Public Support at Application |
32 |
Medicaid |
VARCHAR (1) |
32-38. Medical Insurance Coverage at Application |
33 |
Medicare |
VARCHAR (1) |
32-38. Medical Insurance Coverage at Application |
34 |
Public Insurance from Other Sources |
VARCHAR (1) |
32-38. Medical Insurance Coverage at Application |
35 |
Private Insurance Through Own Employer |
VARCHAR (1) |
32-38. Medical Insurance Coverage at Application |
36 |
Not Yet Eligible for Private Insurance Through Current Employer, but Will Be Eligible for Private Insurance After a Certain Period of Employment |
VARCHAR (1) |
32-38. Medical Insurance Coverage at Application |
37 |
Private Insurance Through Other Means |
VARCHAR (1) |
32-38. Medical Insurance Coverage at Application |
38 |
State or Federal Affordable Care Act Exchange |
VARCHAR (1) |
32-38. Medical Insurance Coverage at Application |
39 |
Date of Eligibility Determination |
DATE 112 (YYYYMMDD) |
|
40 |
Date of Placement on Order of Selection (OOS) Waiting List |
DATE 112 (YYYYMMDD) |
|
41 |
Date of Exit from OOS Waiting List |
DATE 112 (YYYYMMDD) |
|
42 |
Zip Code |
VARCHAR (5) |
|
43 |
County Name |
VARCHAR (40) |
|
44 |
Organizations Referred To:
|
VARCHAR (6) |
|
45 |
Involvement with Other Agencies and Services at Application |
VARCHAR (6) |
|
46 |
No formal schooling |
VARCHAR (1) |
46-74. Education |
47 |
Completed some elementary education (grades 1-8) |
VARCHAR (1) |
46-74. Education |
48 |
Enrolled in elementary education (grades 1-8) |
VARCHAR (1) |
46-74. Education |
49 |
Completed secondary education (grade 9) |
VARCHAR (1) |
46-74. Education |
50 |
Enrolled in secondary education (grade 9) |
VARCHAR (1) |
46-74. Education |
51 |
Completed secondary education (grade 10) |
VARCHAR (1) |
46-74. Education |
52 |
Enrolled in secondary education (grade 10) |
VARCHAR (1) |
46-74. Education |
53 |
Completed secondary education (grade 11) |
VARCHAR (1) |
46-74. Education |
54 |
Enrolled in secondary education (grade 11) |
VARCHAR (1) |
46-74. Education |
55 |
Completed secondary education (grade 12), no high school diploma |
VARCHAR (1) |
46-74. Education |
56 |
Enrolled in secondary education (grade 12) |
VARCHAR (1) |
46-74. Education |
57 |
Enrolled in a state adult high school at the high ASE level |
VARCHAR (1) |
46-74. Education |
58 |
Attained high school diploma or equivalency certificate (GED) |
VARCHAR (1) |
46-74. Education |
59 |
Completed some special education, no certificate of completion/diploma |
VARCHAR (1) |
46-74. Education |
60 |
Enrolled in special education |
VARCHAR (1) |
46-74. Education |
61 |
Attained special education certificate of completion/diploma |
VARCHAR (1) |
46-74. Education |
62 |
Completed some post-secondary education, no degree or certificate |
VARCHAR (1) |
46-74. Education |
63 |
Enrolled in post-secondary education - 1st academic year |
VARCHAR (1) |
46-74. Education |
64 |
Enrolled in post-secondary education – 2nd academic year |
VARCHAR (1) |
46-74. Education |
65 |
Attained Associate degree |
VARCHAR (1) |
46-74. Education |
66 |
Enrolled in post-secondary education – 3rd academic year |
VARCHAR (1) |
46-74. Education |
67 |
Enrolled in post-secondary education – 4th academic year |
VARCHAR (1) |
46-74. Education |
68 |
Attained Bachelor’s degree |
VARCHAR (1) |
46-74. Education |
69 |
Attained Master’s degree |
VARCHAR (1) |
46-74. Education |
70 |
Attained degree above a Master’s – e.g. Ph.D, Ed.D., J.D., M.D. |
VARCHAR (1) |
46-74. Education |
71 |
Enrolled in a career or technical training program that does not lead to a recognized postsecondary credential |
VARCHAR (1) |
46-74. Education |
72 |
Enrolled in a career or technical training program that leads to a recognized postsecondary credential |
VARCHAR (1) |
46-74. Education |
73 |
Attained Vocational/Technical Certificate |
VARCHAR (1) |
46-74. Education |
74 |
Attained Vocational/Technical License |
VARCHAR (1) |
46-74. Education |
75 |
Youth with Disabilities |
VARCHAR (1) |
|
76 |
State Definition for Age of Students with Disabilities |
VARCHAR (4) |
|
77 |
Primary Disability |
VARCHAR (4) |
|
78 |
Secondary Disability |
VARCHAR (4) |
|
79 |
Significance of Disability |
VARCHAR (1) |
|
80 |
Start Date of Trial Work Experience |
DATE 112 (YYYYMMDD) |
|
81 |
End Date of Trial Work Experience |
DATE 112 (YYYYMMDD) |
42-45. Dates of Trial Work Experience/ Extended Evaluation (EE) |
82 |
Date of Individualized Plan for Employment (IPE) |
DATE 112 (YYYYMMDD) |
|
83 |
Supported Employment Goal on Current IPE |
VARCHAR (1) |
|
84-108 |
SERVICES PROVIDED AND COSTS FOR PURCHAED SERVICES FOR PRE-EMPLOYMENT TRANSITION SERVICES |
||
84 |
Services Provided |
VARCHAR (1) |
Job Exploration Counseling |
85 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Job Exploration Counseling |
86 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Job Exploration Counseling |
87 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Job Exploration Counseling |
88 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Job Exploration Counseling |
89 |
Services Provided |
VARCHAR (1) |
Work-Base Learning Experiences |
90 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Work-Base Learning Experiences |
91 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Work-Base Learning Experiences |
92 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Work-Base Learning Experiences |
93 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Work-Base Learning Experiences |
94 |
Services Provided |
VARCHAR (1) |
Counseling on Enrollment Opportunities |
95 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Counseling on Enrollment Opportunities |
96 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Counseling on Enrollment Opportunities |
97 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Counseling on Enrollment Opportunities |
98 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Counseling on Enrollment Opportunities |
99 |
Services Provided |
VARCHAR (1) |
Workplace Readiness Training |
100 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Workplace Readiness Training |
101 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Workplace Readiness Training |
102 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Workplace Readiness Training |
103 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Workplace Readiness Training |
104 |
Services Provided |
VARCHAR (1) |
Instruction in Self-advocacy |
105 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Instruction in Self-advocacy |
106 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Instruction in Self-advocacy |
107 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Instruction in Self-advocacy |
108 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Instruction in Self-advocacy |
109-248 |
SERVICES PROVIDED AND COSTS FOR PURCHASED SERCICES FOR PARTICIPANTS OF THE VR PROGRAM |
||
109 |
Services Provided |
VARCHAR (1) |
Assessment |
110 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Assessment |
111 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Assessment |
112 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Assessment |
113 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Assessment |
114 |
Services Provided |
VARCHAR (1) |
Diagnosis and Treatment of Impairments |
115 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Diagnosis and Treatment of Impairments |
116 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Diagnosis and Treatment of Impairments |
117 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Diagnosis and Treatment of Impairments |
118 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Diagnosis and Treatment of Impairments |
119 |
Services Provided |
VARCHAR (1) |
Vocational Rehabilitation Counseling and Guidance |
120 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Vocational Rehabilitation Counseling and Guidance |
121 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Vocational Rehabilitation Counseling and Guidance |
122 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Vocational Rehabilitation Counseling and Guidance |
123 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Vocational Rehabilitation Counseling and Guidance |
124 |
Services Provided |
VARCHAR (1) |
Graduate College or University Training |
125 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Graduate College or University Training |
126 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Graduate College or University Training |
127 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Graduate College or University Training |
128 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Graduate College or University Training |
129 |
Services Provided |
VARCHAR (1) |
Four-Year College or University Training |
130 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Four-Year College or University Training |
131 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Four-Year College or University Training |
132 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Four-Year College or University Training |
133 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Four-Year College or University Training |
134 |
Services Provided |
VARCHAR (1) |
Junior or Community College Training |
135 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Junior or Community College Training |
136 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Junior or Community College Training |
137 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Junior or Community College Training |
138 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Junior or Community College Training |
139 |
Services Provided |
VARCHAR (1) |
Occupational or Vocational Training |
140 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Occupational or Vocational Training |
141 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Occupational or Vocational Training |
142 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Occupational or Vocational Training |
143 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Occupational or Vocational Training |
144 |
Services Provided |
VARCHAR (1) |
On-the-job Training |
145 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
On-the-job Training |
146 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
On-the-job Training |
147 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
On-the-job Training |
148 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
On-the-job Training |
149 |
Services Provided |
VARCHAR (1) |
Apprenticeship Training |
150 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Apprenticeship Training |
151 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Apprenticeship Training |
152 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Apprenticeship Training |
153 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Apprenticeship Training |
154 |
Services Provided |
VARCHAR (1) |
Basic Academic Remedial or Literacy Training |
155 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Basic Academic Remedial or Literacy Training |
156 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Basic Academic Remedial or Literacy Training |
157 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Basic Academic Remedial or Literacy Training |
158 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Basic Academic Remedial or Literacy Training |
159 |
Services Provided |
VARCHAR (1) |
Job Readiness Training |
160 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Job Readiness Training |
161 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Job Readiness Training |
162 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Job Readiness Training |
163 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Job Readiness Training |
164 |
Services Provided |
VARCHAR (1) |
Disability-Related Skills Training |
165 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Disability-Related Skills Training |
166 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Disability-Related Skills Training |
167 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Disability-Related Skills Training |
168 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Disability-Related Skills Training |
169 |
Services Provided |
VARCHAR (1) |
Miscellaneous Training |
170 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Miscellaneous Training |
171 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Miscellaneous Training |
172 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Miscellaneous Training |
173 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Miscellaneous Training |
174 |
Services Provided |
VARCHAR (1) |
Job Search Assistance |
175 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Job Search Assistance |
176 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Job Search Assistance |
177 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Job Search Assistance |
178 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Job Search Assistance |
179 |
Services Provided |
VARCHAR (1) |
Job Placement Assistance |
180 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Job Placement Assistance |
181 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Job Placement Assistance |
182 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Job Placement Assistance |
183 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Job Placement Assistance |
184 |
Services Provided |
VARCHAR (1) |
On-the-job Supports – Short Term |
185 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
On-the-job Supports – Short Term |
186 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
On-the-job Supports – Short Term |
187 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
On-the-job Supports – Short Term |
188 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
On-the-job Supports – Short Term |
189 |
Services Provided |
VARCHAR (1) |
On-the-job Supports – Supported Employment |
190 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
On-the-job Supports – Supported Employment |
191 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
On-the-job Supports – Supported Employment |
192 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
On-the-job Supports – Supported Employment |
193 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
On-the-job Supports – Supported Employment |
194 |
Services Provided |
VARCHAR (1) |
Transportation |
195 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Transportation |
196 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Transportation |
197 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Transportation |
198 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Transportation |
199 |
Services Provided |
VARCHAR (1) |
Maintenance |
200 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Maintenance |
201 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Maintenance |
202 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Maintenance |
203 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Maintenance |
204 |
Services Provided |
VARCHAR (1) |
Rehabilitation Technology |
205 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Rehabilitation Technology |
206 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Rehabilitation Technology |
207 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Rehabilitation Technology |
208 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Rehabilitation Technology |
209 |
Services Provided |
VARCHAR (1) |
Reader Services |
210 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Reader Services |
211 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Reader Services |
212 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Reader Services |
213 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Reader Services |
214 |
Services Provided |
VARCHAR (1) |
Interpreter Services |
215 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Interpreter Services |
216 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Interpreter Services |
217 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Interpreter Services |
218 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Interpreter Services |
219 |
Services Provided |
VARCHAR (1) |
Personal Attendant Services |
220 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Personal Attendant Services |
221 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Personal Attendant Services |
222 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Personal Attendant Services |
223 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Personal Attendant Services |
224 |
Services Provided |
VARCHAR (1) |
Technical Assistance Services |
225 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Technical Assistance Services |
226 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Technical Assistance Services |
227 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Technical Assistance Services |
228 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Technical Assistance Services |
229 |
Services Provided |
VARCHAR (1) |
Information and Referral Services |
230 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Information and Referral Services |
231 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Information and Referral Services |
232 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Information and Referral Services |
233 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Information and Referral Services |
234 |
Services Provided |
VARCHAR (1) |
Benefits Counseling |
235 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Benefits Counseling |
236 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Benefits Counseling |
237 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Benefits Counseling |
238 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Benefits Counseling |
239 |
Services Provided |
VARCHAR (1) |
Customized Employment Services |
240 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Customized Employment Services |
241 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Customized Employment Services |
242 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Customized Employment Services |
243 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Customized Employment Services |
244 |
Services Provided |
VARCHAR (1) |
Other Services |
245 |
Primary Purchased VR Service Provider Type |
VARCHAR (1) |
Other Services |
246 |
State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services |
INT(6) |
Other Services |
247 |
Supported Employment State Grant (Title VI) Funds Used to Purchase Services |
INT(6) |
Other Services |
248 |
Comparable Services and Benefits Providers |
VARCHAR (6) |
Other Services |
249 |
Number of Jobs at Exit |
VARCHAR (1) |
|
250 |
Primary Occupation at Exit |
VARCHAR (12) |
|
251 |
Start Date of Employment in Primary Occupation at Exit |
DATE 112 (YYYYMMDD) |
|
252 |
Employment Status at Exit |
VARCHAR (1) |
|
253 |
Hourly Wage at Exit |
Decimal (5,2) |
|
254 |
Hours Worked in a Week at Exit |
INT(3) |
|
255 |
SSDI |
INT(5) |
255-261. Monthly Public Support Amount at Exit |
256 |
SSI for the Aged, Blind or Disabled |
INT(5) |
255-261. Monthly Public Support Amount at Exit |
257 |
TANF |
INT(5) |
255-261. Monthly Public Support Amount at Exit |
258 |
General Assistance (State or local government) |
INT(5) |
255-261. Monthly Public Support Amount at Exit |
259 |
Veterans’ Disability Benefits |
INT(5) |
255-261. Monthly Public Support Amount at Exit |
260 |
Workers’ Compensation |
INT(5) |
255-261. Monthly Public Support Amount at Exit |
261 |
Other Public Support |
INT(5) |
255-261. Monthly Public Support Amount at Exit |
262 |
Primary Source of Support at Exit |
VARCHAR (1) |
|
263 |
Medicaid |
VARCHAR (1) |
263-269. Medical Insurance Coverage at Exit |
264 |
Medicare |
VARCHAR (1) |
263-269. Medical Insurance Coverage at Exit |
265 |
Public Insurance from Other Sources |
VARCHAR (1) |
263-269. Medical Insurance Coverage at Exit |
266 |
Private Insurance Through Own Employer |
VARCHAR (1) |
263-269. Medical Insurance Coverage at Exit |
267 |
Not Yet Eligible for Private Insurance Through Current Employer, but Will Be Eligible for Private Insurance After a Certain Period of Employment |
VARCHAR (1) |
263-269. Medical Insurance Coverage at Exit |
268 |
Private Insurance Through Other Means |
VARCHAR (1) |
263-269. Medical Insurance Coverage at Exit |
269 |
State or Federal Affordable Care Act Exchange |
VARCHAR (1) |
263-269. Medical Insurance Coverage at Exit |
270 |
Type of Exit |
VARCHAR (1) |
|
271 |
Reason for Exit |
VARCHAR (2) |
|
272 |
Date of Exit |
DATE 112 (YYYYMMDD) |
|
273 |
Unemployment Insurance Quarterly Earnings |
INT(25)
|
|
274 |
Employer Identification Number |
VARCHAR (30) |
|
275 |
Case Service Record Archive Date |
DATE 112 (YYYYMMDD) |
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | PD-13-05 - Revision of the Vocational Rehabilitation Program Case Service Report RSA-911 (MS Word) |
| Subject | RSA-911 - Case Service Report |
| Author | eric.rauch |
| File Modified | 0000-00-00 |
| File Created | 2021-01-25 |