Center for Independent Living (CIL) Program Performance Report (PPR)

INSTRUCTIONS
OMB Control Number: 0985-0061
Expiration Date: January 31, 2022

UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES
ADMINISTRATION FOR COMMUNITY LIVING
INDEPENDENT LIVING ADMINISTRATION

SECTION 704
ANNUAL PERFORMANCE REPORT
for

CENTERS FOR INDEPENDENT LIVING PROGRAM
(Title VII, Chapter 1, Part C of the Rehabilitation Act of 1973, as amended)

Program Performance Report
INSTRUCTIONS
(To be completed by Centers for Independent Living)

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 (0985-0061). Public reporting
burden for this collection of information is estimated to average 35 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
required to obtain or retain benefits (P.L. 105-220 Section 410 Workforce Investment Act).

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TABLE OF CONTENTS
Topic

Page #
in the
Instrument
--

Page #
in the
Instructions
4

Glossary of Terms

--

8

General Instructions

--

11

Subpart I – Administrative Data

2

12

Section A – Sources and Amount of Funds and Resources

2

12

Subpart II – Number and Types of Individuals with
Significant Disabilities Receiving Services
Section A – Number of Consumers Served During the
Reporting Year
Section B – Number of Consumer Service Records (CSRs)
Closed by September 30 of the Reporting Year
Section C – Number of CSRs Active on September 30 of
the Reporting Year
Section D – IL Plans and Waivers

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13

4

13

4

13

4

13

5

14

Section E – Age

5

14

Section F – Sex

5

14

Section G –Ethnicity

6

14

Section H – Race

6

15

Section I – Disability

6

15

Section J – Individuals Served by County During the
Reporting Year

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15

Page #
in the
Instrument
8

Page #
in the
Instructions
16

Section A – Individual Services

8

18

Section B – Increased Independence and Community
Integration

9

20

Frequently Asked Questions

Topic
Subpart III – Individual Services and Achievements

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Section C – Additional Information Concerning Individual
Services or Achievement
Subpart IV – Extent of CIL Compliance with the Six
Evaluation Standards
Section A – Compliance Indicator 1: Philosophy

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22

11

22

11

22

Section B – Compliance Indicator 2 – Provision of
Services on a Cross-Disability Basis
Section C – Compliance Indicator 3 – Independent Living
Goals
Section D – Compliance Indicator 4 – Community Options
and Community Capacity
Section E – Compliance Indicator 5 – IL Core Services and
Other IL Services
Section F – Compliance Indicator 6 – Resource
Development Activities
Subpart V – Annual Program and Financial Planning
Objectives
Section A –Work Plan for the Reporting Year

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24

13

24

13

25

14

29

14

29

15

29

15

29

Section B – Work Plan for the Year Following the
Reporting Year
Subpart VI – Training and Technical Assistance Needs

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30

16

30

Subpart VII – Additional Information

19

30

Section A – Other Accomplishments, Activities and
Challenges

19

30

19

30

20

30

Section B – Additional Information
Subpart VIII – Signatures

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FREQUENTLY ASKED QUESTIONS
Question: WHAT IS THE PURPOSE OF CENTERS FOR INDEPENDENT LIVING
PROGRAM PERFORMANCE REPORT?
Answer: The purpose of this report is to:
A) Serve as a performance activity measuring instrument of independent living (IL)
programs including both quantitative and qualitative information.
B) Determine the training and technical assistance needs of Centers for Independent Living
(CILs) as required by Section 721(b)(3) of the Rehabilitation Act of 1973, as amended
(Act).
C) Assure CIL compliance with the standards, assurances and compliance indicators in
section 725(b) and (c) of the Act and 45 CFR 1329.5.
D) Collect information necessary for issuance of continuation awards for qualified CILs
under Title VII, Chapter 1, Part C.
E) Collect the data required by Section 13, 706, 721, and 725 of the Act for the CIL
program.
F) Serve as the basis for on-site reviews of the CILs funded under Part C.
G) Establish a uniform reporting system to compile an accurate national report on
independent living.
H) Enable each state to access information on all funds expended for IL in the state,
including individuals served, services provided, and outcomes achieved, and to enable
ILA to compare the performance of among states. (Authority: Section 13, 704(m)(4)(D);
705 (c)(5); 706(d); 721; 723; of the Act; 45 CFR 1329.6(a))

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Question: WHAT IS THE STRUCTURE OF THE PPR?
Answer: CIL PPR contains a CIL’s evidence of compliance with the requirements of
Section 725 of the Act, a comparison of the CIL’s activities during the reporting year
with its work plan for that year, work plans for the next year, and data from CSRs
maintained by the CIL.
The structure of CIL PPR is as follows:
Subpart I – Administrative Data: A report on resources received and expended during the
reporting year.
Subpart II – Numbers and Types of Individuals with Significant Disabilities Receiving
Services: This subpart asks for information from CSRs on the numbers and types of
consumers receiving IL services.
Subpart III – Individual Services and Achievements: This subpart asks for information on
the individual IL services provided and received, goals set and met, and outcomes
achieved.
Subpart IV – Extent of CIL Compliance with the Six Evaluation Standards: This subpart
asks for evidence of compliance with the CIL’s six evaluation standards, including
community options and capacity-building activities. Data is provided in tables and
through narrative description.
Subpart V – Annual Program and Financial Planning Objectives: This subpart describes
the CIL’s progress in achieving its work plan goals and objectives, a comparison between
the CIL’s reporting year and prior years’ activities, and a description of the work plan for
the year following the reporting year.
Subpart VI – Training and Technical Assistance Needs: This subpart asks the CIL to
identify its priority training and technical assistance needs.
Subpart VII – Additional Information: This subpart offers CILs the opportunity to
describe any accomplishments, activities, challenges and comments not included
elsewhere in the report.
Subpart VIII – Signatures: Signatures, printed names, titles and phone numbers of the
CIL director and board chairperson.
Question: WHO MUST COMPLETE THE CIL PPR?
Answer: Only CILs receiving Title VII, Part C funding must complete the Centers for
Independent Living Program Performance Report. Each Title VII, Part C grant funds a
separate center. The following applies in the case of two centers who share the same
governing board: If the two centers are separate and complete CILs, and each receives its
own Part C grant, then both centers must complete individual PPRs.
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Question: WHERE MUST THE PPR BE SUBMITTED?
Answer:
Section 722 states:
The CILs will submit the PPR electronically via ACLReporting.
CILs must also forward a copy of the CIL PPR to their SILC. Please contact the SILC in
your state for the preferred format.
Section 723 states:
Part C funded CILs will submit their Program Performance Reports to the DSE and the
SILC. The Section 723 states will forward one electronic (Word) copy of the CILs’ PPRs
to ILA (along with the states’ ILS PPR) and one electronic (Word) copy to Independent
Living Research Utilization (ILRU). (Section 723 states are no longer responsible for
aggregating the CIL PPR data into their ILS PPR.)
Question: WHEN MUST THE CILS SUBMIT THE CENTERS FOR INDEPENDENT
LIVING PROGRAM PERFORMANCE REPORT TO ILA?
Answer: The date will vary depending on whether the state is a Section 722 or 723 state.
Part C funded CILs in section 722 states must submit the CIL PPR to OILP by December
31, for the preceding federal fiscal year.
Part C funded CILs in section 723 states must submit the CIL PPR to the DSE in the state
with sufficient time for the DSE to review the report and submit it, along with its ILS
PPR, to ILA by January 31, for the preceding federal fiscal year.
Question: HOW LONG MUST RECORDS BE RETAINED?
Answer:
Three Years. Information provided in this report by federal grantees is subject to
confirmation at an on-site review; therefore, financial records, statistical records, and all
supporting documents and other records pertinent to the grant award, adequate to
document the accuracy of the information and statements in the 704 Annual Performance
Report, must be kept for three years.

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GLOSSARY OF TERMS
ACL

Administration for Community Living

Act

The Rehabilitation Act of 1973, as amended.

CIL

A Center for Independent Living meeting the definition in Section
702 of the Act, the standards in Section 725 of the Act, and
included in the state’s network of centers.

CIL Program

The Centers for Independent Living Program funded under Part C,
Chapter 1 of Title VII of the Act.

Community-based
Living

These living arrangements include apartments, privately owned
housing, self-directed assisted living, or self-directed living with
family or friends.

Consumer

Any individual with a significant disability who is eligible for IL
services and is currently receiving or has been provided with any
IL service(s) under the program, other than information and
referral.

Core Services

IL services defined in Section 7(17) of the Act means: information
and referral services; IL skills training; peer counseling (including
cross-disability peer counseling); individual and systems advocacy;
and diversion and transition.

CSR

A Consumer Service Record maintained for an eligible consumer
receiving IL services. In cases where IL services are provided to
the parent or guardian of a consumer, the CSR is established for
the consumer and the services provided are reflected in that CSR.

DSE

The designated state entity, identified under section 704(c) of the
Act, authorized to jointly develop and sign, with the Statewide
Independent Living Council (SILC), the State Plan for Independent
Living (SPIL) under Section 704 of the Act.

Earmarked Funds

Funds appropriated by the state and expressly or clearly identified
as state expenditures in the relevant fiscal year for the sole purpose
of funding the general operation of CILs meeting the requirements
of Sections 702 and 725 of the Act.

FTE

The equivalent of one person working full-time for one year.

IL

Independent Living

ILA

The federal entity (also known as OILP) within the United States
Department of Health and Human Services, Administration for
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Community Living, that administers the IL Services and CIL
programs.
ILP

An Independent Living Plan for the provision of IL services
mutually agreed upon by an appropriate staff member of a service
provider and an individual with significant disabilities.

Minority

Alaskan Natives, American Indians, Asian Americans, Blacks
(African Americans), Hispanic Americans, Native Hawaiians, and
Pacific Islanders.

OILP

The federal entity (also known as ILA) within the United States
Department of Health and Human Services, Administration for
Community Living, that administers the IL Services and CIL
programs.

Pass Through

Funds that a provider receives on behalf of a consumer that are
subsequently issued by the provider directly to the consumer (e.g.,
representative payee funds, Medicaid or state personal assistance
services [PAS] funds).

Reporting Year

The most recently completed federal fiscal project year starting
October 1 and ending September 30.

Section 722 State

A state in which ILA issues grants under Part C directly to eligible
agencies for the planning, establishment, and operation of CILs.

Section 723 State

A state where the DSE issues grants or assistance contracts under
Part C to eligible entities for the planning, establishment, and
operation of CILs.

Service Provider

Can mean: 1) A DSE that directly provides IL services to
consumers; 2) A CIL; or 3) An entity that provides IL services
under a grant or contract from the DSE.

SILC

The Statewide Independent Living Council established in each
State as required by Section 705 of the Act.

SILS

A State Independent Living Services program funded under Part B,
Chapter 1 of Title VII of the Act.

SPIL

A State Plan for Independent Living jointly developed by the
chairperson of the Statewide Independent Living Council, and the
directors of the centers for independent living in the state, after
receiving input from individuals with disabilities through the State;
and signed by the chairperson of the Statewide Independent Living
Council, acting on behalf of and at the direction of the Council; the
director of the designated state entity; and not less than 51% of the
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directors of the centers for independent living in the State. The
plan addresses the provision of state IL services, the development
and support of a statewide network of centers for independent
living and the working relationships among programs providing IL
services, CILs, the state VR program, and other programs
providing services for individuals with disabilities.
State

The term state includes, in addition to each of the several states of
the United States, the District of Columbia, the Commonwealth of
Puerto Rico, the United States Virgin Islands, Guam, American
Samoa, and the Commonwealth of the Northern Mariana Islands,
except where otherwise noted.

Unserved and
Underserved
Populations

Include, but are not limited to, groups or populations of individuals
with significant disabilities who:
(1)
(2)
(3)
(4)

have cognitive and sensory impairments;
are members of racial and ethnic minority groups;
live in rural areas; or
have been identified by the eligible agency as unserved or
underserved within a center’s project area

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Instructions: CIL PPR

General Instructions: Please respond to each subpart of this preprint.
1) When a question/section requests a description, list, or other non-data information but does
not apply to your CIL (or center), a “not applicable” response is appropriate.
2) When a subpart requests data or a numerical response but does not apply to your CIL, enter
zero, “0”.

Specific Instructions: please carefully read the instructions below and provide the
requested details and/or data.

COVER PAGE:
Please complete the following sections on the instrument cover page:
1) Fiscal Year: Enter the federal reporting year covered by the report.
2) Grant #: Enter the pr/award (grant) number for the grantee as listed in block #5 on the grant
award notification form.
3) Name of Center: Enter the official name of the grantee as it appears on the grant award
notification.
4) Acronym for Center: Enter the acronym for the center, if applicable.
5) State: Enter the state in which the center provides services.
6) Counties Served: Enter the counties served by the center.

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SUBPART I – ADMINISTRATIVE DATA
Section A – Sources and Amounts of Funds and Resources
Section 725(c)(8)(d) of the Act
List the amounts of all resources received by the CIL from items 1 through 3 during the federal
fiscal reporting year. In item 2 include “pass-through” funds received from state or local
governments. “Pass-through” funds are funds, received by the CIL on behalf of consumers, that
are subsequently passed on to consumers, e.g., personal assistance services (PAS), representative
payee funds, or Medicaid funds. Round off to the nearest dollar amount any funds ending with
cents. Example: $4,240,010.87 →$4,240,011)
(1) Add lines 1(a) through 3(l) to get the amount of total income received by the CIL.
Record this amount in item 4.
(2) Enter the total amount of “pass-through” funds received in item 5.
(3) Subtract the amount in item 5 from the amount in item 4 to get the total of net
operating resources for the CIL. Enter this amount in item 6.
Note: If the State receives funding dedicated or restricted to a particular purpose, that
funding should be included in the appropriate source category. For example, if the CIL
receives funding from another Federal agency for specified transportation services for
people with significant disabilities under the IL program, that funding should be included
in the “Other Federal Funds” category.

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SUBPART II – NUMBER AND TYPES OF INDIVIDUALS WITH
SIGNIFICANT DISABILITIES RECEIVING SERVICES
Section 725(c)(8)(B) of the Act

Section A – Number of Consumers Served During the Reporting Year
Include CSRs for ALL consumers served during the reporting year.
(1) Enter the number of active CSRs carried over from September 30 of the year
preceding the reporting year. Active CSRs are those corresponding to consumers who
were actually served during the reporting year.
(2) Enter the number of new CSRs opened since October 1 of the reporting year.
(3) To get the number of consumers served during the reporting year, add the number of
active CSRs carried over from the preceding year to the number of new CSRs open ed for
the reporting year. Enter this number in line a(3). A(1) + a(2) = a(3).

Section B – Number of CSRs Closed by September 30 of the Reporting Year
In the appropriate category, enter the number of CSRs that have been closed out of the active
CSR files during the reporting year because the consumer has:
(1) Moved - the consumer has moved out of the service provider’s service area and/or has
moved and left no forwarding address (example: unable to locate consumer).
(2) Withdrawn - the consumer has stated they are no longer interested in receiving
services at this time.
(3) Died.
(4) Completed all goals set - the consumer has completed all goals and objectives,
whether or not listed in an independent living plan (ILP), and does not need/is not
interested in receiving additional services at this time.
(5) Other - the CSR has been closed for any other reason than those listed above.
Total the number of CSRs for each category to calculate the number of CSRs closed for the
reporting year. Example: Line B(1) + B(2) + B(3) + B(4) + B(5) = B(6).

Section C – Number of CSRs Active on September 30 of the Reporting Year
To get the number of CSRs active on September 30 of the Reporting Year subtract the total
number of CSRs closed by September 30 (line B(6)) from the total number of consumers served
during the reporting year (line A(3)). Enter this number in the chart in Section C.

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Section D – ILPs and Waivers
(1) Enter the total number of consumers with active CSRs during the reporting year who have
knowingly and voluntarily signed a waiver stating an ILP was unnecessary.
(2) Enter the total number of consumers with active CSRs during the reporting year with whom
an ILP was developed.
(3) Add the total number of consumers who signed a waiver to the total number of consumers
who developed ILPs. Enter this figure in line D(3). D(1) + D(2) = D(3).
Note: This is the total number of consumers served during the reporting year and MUST
equal the “number of consumers served” in Section A, line 3 above.

Section E – Age
(1) through (6) - Enter the number of consumers served during the reporting year in each age
category as self reported by each consumer.

Section F – Sex
(1) and (2) – Enter the number of male and female consumers served during the reporting year as
self reported by each consumer.

Section G – Race and Ethnicity
(1) through (8) - Enter the number of consumers served during the reporting year in each
category, as self-reported by each consumer. Each consumer may be counted under ONLY
ONE of the following categories in the Program Performance Report, even if the consumer
reported more than one race and/or Hispanic/Latino ethnicity.
(1) American Indian or Alaska Native. American Indian or Alaska Native means a person
having origins in any of the original peoples of North and South America (including
Central America), and who maintains tribal affiliation or community attachment.
(2) Asian means a person 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.
(3) Black or African American means a person having origins in any of the black racial
groups of Africa. Terms such as “Haitian” may be used.
(4) Native Hawaiian or Other Pacific Islander means a person having origins in any of the
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
(5) White means a person having origins in any of the original peoples of Europe, the Middle
East or North Africa.
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(6) Hispanic/Latino of any race or Hispanic/ Latino only. Hispanic or Latino means a person
of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or
origin, regardless of race. Any consumer who reports Hispanic/Latino ethnicity can
only be counted as “Hispanic/Latino,” even if the consumer also reported one or
more race categories.
(7) Two or more races. If a consumer self-reports more than one race, that consumer must
counted once in the PPR, that is, as “Two or More Races.”
(8) “Race and ethnicity unknown” – A consumer is counted as Race/Ethnicity Unknown if
the consumer does not reports any race or ethnicity.
Note: The total of G1 through G8 must agree with subpart II, A3.

Section H – Disability
(1) through (7) – Enter the total number of consumers served in each category during the current
reporting year as self reported by each consumer. These categories are meant to describe the
functional limitations involved with a consumer’s disability rather than a grouping of specific
diagnoses of disabilities.

Section I – Individuals Served by County During the Reporting Year
Section 704(m)(4)(D) of the Act
List each county within the CIL’s service area, as indicated in the CIL’s application for Part C
funds and the approved State Plan for Independent Living (SPIL). Add additional rows as
necessary. For each county, indicate how many individuals residing in that county were served
by the CIL during the reporting year. Place a “0” in the column if no individuals residing in that
county received IL services during the reporting year.

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SUBPART III – INDIVIDUAL SERVICES AND ACHIEVEMENTS
Section 13, 725(c)(8)(C) of the Act; Government Performance Results Act (GPRA) Performance
Measures
Subpart III features three related tables designed to measure how IL core services and other IL
services help maximize the leadership, empowerment, independence, and productivity of
individuals with disabilities, and the integration and full inclusion of individuals with disabilities
into the mainstream of American society. Each table is described below.
Section A – Individual Services - Quantifies the IL services requested by, and provided to,
consumers during the reporting year. These services can be considered as the independent living
program’s outputs contributing to the consumers’ expected outcomes, that is, greater
independence and community integration.
Section B – Independence And Community Integration - Quantifies the independent living
program’s outcomes, expressed in terms of the diverse goals that consumers have achieved
through the provision of IL services (outputs), including the four core services. Section B
consists of two related tables:
Item 1 (Goals Related to Increased Independence in a Significant Life Area). This table
tracks the number of consumers who achieved independence in at least one significant
life area. The term significant life area (SLA) is a way to classify the multiplicity of
possible consumer goals into a few categories representing the range of life ac hievements
made possible through IL services. SLAs represent the varying ways in which diverse
consumers with disabilities can realize their particular potential – ranging from
competence in self-care to relocation from a nursing home/institution to fulfillment of
educational and vocational aspirations.
Item 2 (Improved Access to Transportation, Health Care and Assistive Technology). The
lack of access to essential opportunities such as transportation, appropriate health care
services, or assistive technology may prevent an individual from achieving independence
in one or more significant life areas. This table measures how the independent living
program enables consumers to overcome barriers to their independence by helping them
to access previously unavailable transportation, health care services, and assistive
technology. These are certainly not the only barriers faced by individuals with
disabilities. However, data provided in these areas will enhance ILA’s ability to
document the impact of the independent living program on individuals in these areas.
Individuals with disabilities can overcome barriers to accessing transportation, health
care services, or assistive technology through a combination of the IL services listed in
the table under section A, including the four core services -- information and referral
services, independent living skills training, peer counseling, individual advocacy.
[Systems advocacy is addressed in subpart IV]. For example, a service provider may
facilitate a consumer’s access to previously unavailable transportation through mobility
training, assistive devices, prosthesis or personal attendant care assistance; or
independent living skills training to help consumers avail themselves of existing
community transportation services. Access to appropriate health care services may be
enhanced through information and referral services, such as the provision of directories
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of local medical facilities with available interpreters or Telecommunication Device for
the Deaf (TDD) phone numbers; individual advocacy efforts resulting in accessible
ramps or examining tables at doctors’ offices; peer counseling services to improve
consumers’ self-advocacy abilities; or the arrangement of assistive technology services
for consumers to better communicate with their doctors. Access to assistive technology
may be expanded through information and referral to public and priv ate sector sources of
funding or equipment, independent living skills training on the use of assistive
technology, and peer counseling and individual advocacy to help consumers advocate for
the services and equipment for which they are eligible.
Note: The term “assistive technology” (as defined in subpart III, section A) encompasses
a broad range of independent living resources such as daily living, mobility, cognitive
and communications aids as well as information technology.
The subpart III tables (section A, section B, item 1 and section B, item 2) are closely related.
Transportation and assistive technology, for example, appear in each table. There are important
differences, however, as the following examples illustrate:
•

•

A consumer whose goal is Mobility/Transportation (section B, item 1) may receive
Transportation Services such as information and referral to the community’s para-transit
system (section A). Yet it may be that the consumer cannot achieve the
Mobility/Transportation goal until he or she gains the necessary confidence to utilize the
para-transit system through IL skills training and peer counseling services. In this
example, the Mobility/Transportation goal (section B, item 1) involves more than just
Transportation Services (section A).
A consumer whose goal is Community-Based Living (section B, item 1) may be impeded
from reaching that goal because he/she lacks Access to Transportation (section B, item
2). Access to transportation is not the consumer’s goal, but simply the means to the
consumer’s goal, community-based living.

Consumers may appear in more than one of the subpart III tables:
•

•

In the first example, the successful consumer would appear in section A (under
Transportation Services, Peer Counseling and IL Skills Training); in section B, item 1
(under the Mobility/Transportation goal); and in section B, item 2 (under Access to
Transportation).
In the second example, the consumer would also appear in the three tables, except that
he/she would appear under the Community-Based Living goal instead of the
Mobility/Transportation goal in section B, item 1.

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Detailed instructions for completing subpart III follow below:
Section A – Individual Services
List the number of consumers requesting and the number of consumers receiving each of the
following services during the reporting year, including the IL core services. The total of these
numbers is not expected to equal the number of active CSRs during the reporting year, as a
consumer may receive multiple services during the reporting year. Also, individuals who receive
information and referral (I&R) services only may not have a CSR.
A) Advocacy/Legal Services – Assistance and /or representation in obtaining access to
benefits, services, and programs to which a consumer may be entitled.
B) Assistive Technology – Any assistive technology device, that is, any item, piece of
equipment or product system that is used to increase, maintain or improve functional
capabilities of individuals with disabilities and any assistive technology service that
assists an individual with a disability in the selection, acquisition or use of an assistive
technology device.
C) Children’s Services – The provision of specific IL services designed to serve individuals
with significant disabilities under the age of 14.
D) Communication Services – Services directed to enable consumers to better communicate,
such as interpreter services, training in communication equipment use, Braille instruction,
and reading services.
E) Counseling and Related Services – These include information sharing, psychological
services of a non-psychiatric, non-therapeutic nature, parent-to-parent services, and
related services.
F) Family Services – Services provided to the family members of an individual with a
significant disability when necessary for improving the individual’s ability to live and
function more independently, or ability to engage or continue in employment. Such
services may include respite care. Record the service in the consumer’s CSR on behalf of
whom services were provided to the family.
G) Housing, Home Modifications, and Shelter Services – These services are related to
securing housing or shelter, adaptive housing services (including appropriate
accommodations to and modifications of any space used to serve, or occupied by
individuals with significant disabilities).
•

Note: A CIL may not provide housing or shelter as an IL service on either a
temporary or long term basis unless the housing or shelter is incidental to the
overall operation of the CIL and is provided to any individual for a period not to
exceed eight weeks during any six-month period.

H) IL Skills Training and Life Skill Training Services – These may include instruction to
develop independent living skills in areas such as personal care, coping, financial
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management, social skills, and household management. This may also include education
and training necessary for living in the community and participating in community
activities.
I) Information and Referral Services – Identify all individuals who requested this type of
assistance. This is the only service (other than services to family members) that may be
provided to all individuals, whether or not the individual has a disability. Some entities
record this service using strokes on an answering pad without opening a CSR, others
create a CSR or other such file for future contact and outreach.
J) Mental Restoration Services – Psychiatric restoration services including maintenance on
psychotropic medication, psychological services, and treatment management for
substance abuse.
K) Mobility Training Services – A variety of services involving assisting consumers to get
around their homes and communities.
L) Peer Counseling Services – Counseling, teaching, information sharing, and similar kinds
of contact provided to consumers by other people with disabilities.
M) Personal Assistance Services – These include, but are not limited to, assistance with
personal bodily functions; communicative, household, mobility, work, emotional,
cognitive, personal, and financial affairs; community participation; parenting; leisure; and
other related needs.
N) Physical Restoration Services – Restoration services including medical services, health
maintenance, eyeglasses, and visual services.
O) Preventive Services – Services intended to prevent additional disabilities, or to prevent an
increase in the severity of an existing disability.
P) Prostheses, Orthotics, and Other Appliances – Provision of, or assistance in obtaining
through other sources, an adaptive device or appliance to substitute for one or more parts
of the human body.
Q) Recreational Services – Provision or identification of opportunities for the involvement
of consumers in meaningful leisure time activities. These may include such things as
participation in community affairs and other recreation activities that may be competitive,
active, or quiet.
R) Rehabilitation Technology Services – Provision of, or assistance to obtain through other
sources, adaptive modifications, such as wheelchairs and lifts, which address the barriers
confronted by individuals with significant disabilities with respect to education,
rehabilitation, employment, transportation, IL and/or recreation.
S) Therapeutic Treatment – Services provided by registered occupational, physical,
recreational, hearing, language, or speech therapists.
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T) Transportation Services – Provision of, or arrangements for, transportation.
U) Youth/Transition Services – Any service that develops skills specifically designed for
youth with significant disabilities between the ages of 14 and 24 to promote selfawareness and esteem, develop advocacy and self -empowerment skills, and the
exploration of career options, including the transition from school to post scho ol
activities such as postsecondary education, vocational training, employment, continuing
and adult education, adult services, independent living, or community participation.
V) Vocational Services – Any services designed to achieve or maintain employment.
W) Other Services – Any IL services not listed above in A–V.

Section B – Increased Independence and Community Integration
Item 1 – Goals Related to Increased Independence in an SLA
Please complete the columns as follows:
A) Self-Advocacy/Self-Empowerment – Goals involving improvement in a consumer’s
ability to represent himself/herself with public and/or private entities, the ability to make
key decisions involving himself/herself, or the ability to organize and manage his/he r
own activities to achieve desired objectives.
B) Communication – Goals involving either improvement in a consumer’s ability to
understand communication by others (receptive skills), and/or improvement in a
consumer’s ability to share communication with others (expressive skills).
C) Mobility/Transportation – Goals to improve a consumer’s access to her/his life space,
environment, and community. This may occur by improving the consumer’s ability to
move, travel, transport himself/herself, or use public transportation.
D) Community-Based Living – Goals that provide for a change in living situations with
increased autonomy for the consumer. This may involve a consumer’s goals related to
obtaining/modifying an apartment or house. Community-based living arrangements may
include apartments, privately owned housing, self -directed assisted living, or self-directed
living with family/friends.
E) Educational – Academic or training goals that are expected to improve the consumer’s
knowledge or ability to perform certain skills that would expand his/her independence,
productivity or income-generating potential.
F) Vocational – Goals related to obtaining, maintaining, or advancing in employment.
G) Self-Care – Goals to improve/maintain a consumer’s autonomy with respect to activ ities
of daily living such as personal grooming and hygiene, meal preparation and nutrition,
shopping, eating, and other aspects of personal health and safety.
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H) Information Access/Technology – Goals related to a consumer obtaining and/or using
information necessary for the consumer’s independence and community integration.
These may include use of a computer or other assistive technology, devices, or
equipment, as well as developing information technology skills, such as using computer
screen-reading software.
I) Personal Resource Management – Goals related to a consumer learning to establish and
maintain a personal/family budget, managing a checkbook, and/or obtaining knowledge
of available direct and indirect resources related to income, housing, food, medical,
and/or other benefits.
J) Relocation from a Nursing Home or Institution – Goals related to relocation from nursing
homes or other institutions to community-based living arrangements. This significant life
area specifically pertains to consumers who live in a nursing home or institution, unlike
the Community-Based Living life area, above, which includes any consumer regardless of
his/her living situation prior to receiving IL services.
K) Community/Social Participation – Goals related to full participation in the mainstream of
American society, including the ability to participate in community events such as
community fairs and government functions, attend worship services and access
recreational activities and facilities.
L) Other – IL goals not included in the above categories.
Item 2 – Improved Access to Transportation, Health Care Services and Assistive
Technology
(A) Table:
Please complete the columns in the Access Table found at (A) as follows:
Column 1 (Consumers Requiring Access) – Indicate the number of CIL consumers – whether
or not they originally requested the assistance – who required access to previously unavailable
transportation, assistive technology or health care services in order to reach one or more of their
IL goals listed in Item 1.
•

The lack of transportation, health care services or assistive technology as barriers to
independence may be identified by the consumer and/or by the service provider’s staff
(serving as the consumer’s advisor).

Column 2 (Consumers Achieving Access) – Of the consumers counted in column 1, indicate
the number who gained access to previously unavailable transportation, assistive technology
or health care services as a result of the provision of IL services. Include all consumers whose
access in these areas was facilitated through the IL services provided – whether or not such
access had been the consumers’ originally stated goal.
Column 3 (Consumers Whose Access Is In Progress) – Indicate the number of consumers
who, at the end of the reporting year, were in the process of attaining access to previously
20

unavailable transportation, assistive technology or health care services through the provision
of IL services.
•

Any consumer counted in column 2 or 3 must also be counted in column 1. In the case
of a consumer who achieves access as a result of I&R services, for example, that
consumer should be counted under “consumers requiring access” (column 1) as well as
under “consumers achieving access” (column 2).

Note: For most IL services, a consumer’s access to previously unavailable transportation, health
care and assistive technology is documented through his or her CSR. In some instances,
consumers may achieve an outcome solely through information and referral services. In order to
report these instances as successful outcomes, providers are not required to create CSRs for these
consumers but must be able to document that follow-up contacts with these consumers showed
access to previously unavailable transportation, health care and assistive technology.
(B) Information and Referral Information:
To inform ILA how many service providers engaged in I&R follow-up contacts regarding access
to transportation, health care services or assistive technology, please respond to the
corresponding question in the instrument.

Section C – Additional Information Concerning Individual Services or
Achievements
Please provide any additional description or explanation concerning individual services or
achievements reported in subpart III, including outstanding success stories and/or major
obstacles encountered.

SUBPART IV – EXTENT OF CIL COMPLIANCE WITH THE SIX
EVALUATION STANDARDS
Section 725(b) and Section 725(c)(8)(A) of the Act; 45 CFR 1329.23(a)

Section A – Compliance Indicator 1: Philosophy
Item 1 - Consumer Control
(A) Board Member Composition
In the chart provided, report the total number of CIL board members and the number of board
members with significant disabilities.
(B) Staff Composition
In the first column of the chart, report the total Full Time Equivalents (FTEs) for the employees
who are in the staff and decision-making positions of the CIL. In the second column, report the
total FTEs for the staff and decision-making positions filled by individuals with disabilities, and
21

in the third column, report the total FTEs for the staff and decision-making positions filled by
individuals from minority populations.
•

In calculating FTEs, a CIL may exclude personal assistants, readers, drivers, and
interpreters employed by the center from its FTE calculations. To compute FTEs,
determine the number of hours (excluding overtime) for which all employees were
actually paid during the last six months of the reporting year. Multiply the hours worked
by 2 (two), divide by 2,080 (approximate number of hours worked by an FTE), the
subsequent total is the equivalent fraction of the FTEs.

Item 2 - Self-Help and Self-Advocacy
Briefly describe how the CIL has promoted self-help and self-advocacy among individuals with
significant disabilities during the reporting year (e.g. by conducting activities to train individuals
with significant disabilities in self-advocacy).
Item 3 - Peer Relationships and Peer Role Models
Briefly describe how, during the reporting year, the CIL has promoted the development of peer
relationships and peer role models among individuals with significant disabilities (e.g., by using
individuals with significant disabilities who have achieved IL goals as instructors in its training
programs or as peer counselors).
Item 4 - Equal Access
(A) Equal Access Regardless of Type of Disability
Briefly describe how, during the reporting year, the CIL has ensured eq ual access of individuals
with significant disabilities, including communication and physical access, to the center's
services, programs, activities, resources, and facilities, whether publicly or privately funded.
•

Equal access, for the purposes of this indicator, means that the same access is provided to
any individual with a significant disability regardless of the individual’s type of
significant disability.

(B) Equal Access for Individuals with Disabilities
Briefly describe how, during the reporting year, the CIL has advocated for and conducted
activities that promote the equal access to all services, programs, activities, resources, and
facilities in society, whether public or private, and regardless of funding source, for individuals
with significant disabilities.
•

Equal access, for the purposes of this indicator, means that the same access provided to
individuals without disabilities is provided in the center’s service area to individuals with
significant disabilities.

Item 5 – Alternative Formats
22

Briefly describe how, during the reporting year, the CIL has ensured the availability in
alternative formats of all of its written policies and materials and IL services, as appropriate.

Section B – Compliance Indicator 2: Provision of Services on a CrossDisability Basis
Section 725(b)(2) of the Act
In your answer to this question, briefly address the following three categories when you describe
how, during the reporting year, the CIL has met this compliance indicator. For example, you
may describe CIL policies, practices, by-laws, manuals, staff training initiatives, etc.
•

•
•

IL services are provided to eligible individuals or groups of individuals without
restrictions based on the particular type or types of significant disability of an individual
or groups of individuals, unless the restricted IL service (other than the IL core services)
is unique to the significant disability of the individuals to be served;
IL services are provided to individuals with a diversity of significant disabilities and to
individuals who are members of populations that are unserved or underserved; and
IL core services are provided to individuals with significant disabilities in a manner that
is neither targeted nor limited to a particular type of significant disability.

Section C – Compliance Indicator 3: Independent Living Goals
Section 725(b)(3) of the Act
Item 1 – Consumer Information
In your answer to this question, briefly address the following four categories when you describe
how, during the reporting year, the CIL has met this compliance indicator. For example, you
may describe CIL policies, practices, by-laws, manuals, staff training initiatives, etc.
•
•
•
•

a CSR that contains all the required information is maintained for each consumer;
the development and achievement of IL goals selected by individuals with significant
disabilities who request assistance from the center are facilitated;
opportunities are provided for consumers to express satisfaction with the center’s services
and policies and any consumer satisfaction results are provided to the governing board
and the SILC; and
consumers are notified of their right to develop or waive an ILP.

In reference to the consumer satisfaction requirements, CILs may show compliance by providing
a brief summary of the methods used to assess consumers’ satisfaction (e.g., focus groups,
written survey, telephone survey, public meeting, etc.) and discussing any major findings from
the most recent consumer satisfaction assessment. If applicable, you may describe the CIL’s
action plan to address specific areas for improvement identified through the consumer
satisfaction assessment.
Item 2 – Consumer Service Record Requirements

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In your answer to this question regarding the composition of CSRs, briefly address the following
three categories of required contents of CSRs when you describe how, during the reporting year,
the CIL has met this compliance indicator. For example, you may describe CIL policies,
practices, by-laws, manuals, staff training initiatives, etc.
•
•
•

IL goals that consumers receiving services at the center believe they have achieved;
Number of ILPs developed by consumers; and
Number of waivers signed by consumers.

Section D – Compliance Indicator 4: Community Options and Community
Capacity
Section 725(b)(4) and (6) of the Act
Item 1 – Community Activities Table
In the table provided give a summary of the community activities involving the CIL board
members or staff during the reporting year. Add more rows as needed. For each activity,
complete the following columns:
Column 1 (Issue Area) – indicate which of the following disability issue areas is most
closely related to the purpose of the activity by placing it in column 1:
•
•
•
•

increasing accessibility to transportation
increasing access to appropriate health care
increasing the availability /access to assistive technology
increasing opportunities for affordable, accessible housing units

ILA has chosen to highlight the four issue areas listed above. However, respondents are
expected to include all community activities in which they participated during the reporting
year. Therefore, respondents should identify any other disability issue areas and include
them in column 1. A sample table is provided below.
Column 2 (Activity Type) – indicate which of the following activity types best describes
the activity by placing it in column 2:
•

Community/Systems Advocacy – includes efforts to implement local and state policy
changes to make facilities, services, and opportunities available and accessible to
individuals with disabilities.

•

Technical Assistance – assistance to the community on making services, programs,
activities, resources, and facilities in society accessible to individuals with significant
disabilities.

•

Community Education and Public Information – activities and information programs
to enhance the community’s awareness of disabilities and disability issues, e.g., local
TV, radio, or newspaper campaigns. This type of services may include the creation
and distribution of publications (such as accessibility guides, disability awareness
24

brochures, ADA information) and databases/directories for personal assistants,
recreation opportunities, accessible transportation, accessible housing, and other
available services.
•

Outreach Efforts – entails the location of, and encouragement to use services for
unserved/underserved populations, including minority groups and urban and rural
populations.

•

Collaboration/Networking – activities related to building coalitions or collaborative
partnerships designed to expand the participation of individuals with significant
disabilities in services, programs, activities, resources and facilities.

OILP has chosen to highlight the five activity types listed above. However, respondents
are expected to include all community activities in which they participated during the
reporting year. Therefore, respondents should identify any additional types of activ ities
related to the disability issue areas identified in column 1. A sample table is provided
below.
•

Note: CILs must demonstrate at least one activity in each of the five categories
listed above.

Column 3 (Number of Hours) – report the number of hours spent by CIL board members
or staff on each activity. Please round to nearest whole hour. A sample table is
provided below.
•

The number of hours of community activities must be reported, not the number of
hours times the number of participants. For example: if one CIL staff member gives
a one-hour presentation to an audience of 50 people, one hour of community service
would be counted, not 50 hours. Conversely, if three CIL staff persons each gave a
one-hour presentation at the same event, three hours of community service would be
counted.

Column 4 (Objectives) – provide a brief narrative describing the primary objective(s) of
the activity. Include, wherever possible, quantifiable data such as the number of people
the activity is expected to benefit. A sample table is provided below.
Column 5 (Outcomes) – provide a brief narrative describing the primary outcome(s) of
the CIL activity including, wherever possible, the number of people who actually
benefited from the activity. A sample table is provided below.

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SAMPLE TABLE
Issue Area

Activity Type

Health care

Community
education /
Outreach

Hours
Spent
50

Transportation Advocacy

30

Assistive
technology

Collaboration

60

Housing

Technical
assistance

20

Objective(s)

Outcome(s)

To develop an accessibility guide listing
service area physicians, specialists and
facilities offering accessibility and
reasonable accommodations. The guide
will also identify accessible medical
providers offering services in Spanish.

Distributed copies of the accessibility
guide to 5,000 individuals with
disabilities through partner organizations,
including in underserved areas. Received
feedback from 50 consumers reporting
that the guides helped them to achieve
access to previously unavailable health
care.
To secure the county council’s
The county council voted to conduct an
commitment to repairing and/or replacing assessment of the wheelchair lifts in its
aging and failing para-transit wheelchair entire 50-vehicle fleet of para-transit
lifts.
buses, and to make the required
repairs/replacements within two years.
To establish a consortium of universities, Held the first monthly meeting of the
businesses, service providers, disability
consortium, with the participation of 6
advocacy groups, mental health
partner organizations.
organizations and state/local government
agencies to identify ways to expand the
availability of assistive technology for
individuals with significant disabilities.
To provide information about applicable Completed a legal resource guide and
laws related to housing accessibility and compiled a list of 20 initial target
accommodations to approximately 20
companies and owners.
apartment owners and management
companies accounting for 20% of all
rental housing units in the city.

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Item 2 – Description of Community Activities
For the community activities mentioned above, provide additional details such as the role
of the CIL staff board members and/or consumers, names of any partner organizations,
and further descriptions of the specific activities, services and benefits.

Section E – Compliance Indicator 5: IL Core Services and other IL
Services
Section 725(b)(5) of the Act
In addition to the data provided in subpart III, briefly describe how information and
referral services and the other IL core and other IL services are provided to those who
request such services in formats accessible to the individual requesting the services.
Describe any innovative practices (not mentioned elsewhere in this report) to enhance the
availability and effectiveness of IL services.

Section F - Compliance Indicator 6: Resource Development Activities
Section 725(b)(7) of the Act
Briefly describe the CIL’s resource development activities conducted during the reporting
year to expand funding from sources other than chapter 1 of Title VII of the Act.

SUBPART V – ANNUAL PROGRAM AND FINANCIAL PLANNING
OBJECTIVES
Section 725(c)(4) of the Act

Section A –Work Plan for The Reporting Year
Item 1 – Achievements
Discuss the work plan’s proposed goals and objectives and the progress made in
achieving them during the reporting year.
Item 2 – Challenges
Describe any substantial challenges or problems encountered by the CIL and the
resolutions/attempted resolutions.
Item 3 – Comparison with Prior Reporting Year
As appropriate, compare the CIL’s activities in the reporting year with its activities in
prior years, e.g., recent trends.

27

Section B – Work Plan for the Year Following the Reporting Year
Item 1 – Annual Work Plan
List the CIL’s annual work plan goals, objectives and action steps planned for the year
following the reporting year.
Item 2 – SPIL Consistency
Explain how these work plan goals, objectives, and action steps are consistent with the
approved SPIL.

SUBPART VI - TRAINING AND TECHNICAL ASSISTANCE NEEDS
Section 721(b)(3) of the Act
Choose up to 10 priority needs that reflect the technical assistance and training needs of
the CIL. Using the column on the right, indicate the CIL’s top priorities rating items 1
through 10, with 1 being the top priority. Report any comments or clarifications using
the blank space at the end of the subpart. The needs identified will be used to design CIL
and SILC training opportunities offered through the training and technical assistance
program. Please provide any additional comments in the write-in space provided.

SUBPART VII – ADDITIONAL INFORMATION
Section 704(m)(4)(D) of the Act

Section A – Other Accomplishments, Activities and Challenges
Describe any additional significant accomplishments, activities and/or challenges, e.g.
brief summaries of innovative practices, improved service delivery to consumers, etc.
Please do not include information mentioned elsewhere in this report.

Section B – Additional Information
Provide any additional information, comments or explanations, including suggestions that
may be helpful to other CILs, SILCs, state agencies, or OILP. Please do not include
information mentioned elsewhere in this report.

SUBPART VIII - SIGNATURES
Please provide signatures, printed names, titles and telephone numbers of the CIL
director and board chairperson.

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