UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

REHABILITATION SERVICES ADMINISTRATION

WASHINGTON, D.C. 20202

> POLICY DIRECTIVE
>
> RSA-PD-
>
> DATE: XXXXXXXX

ADDRESSEES: STATE VOCATIONAL REHABILITATION AGENCIES

> CLIENT ASSISTANCE PROGRAMS
>
> PROTECTION & ADVOCACY OF INDIVIDUAL RIGHTS PROGRAMS
>
> STATE REHABILITATION COUNCILS
>
> AMERICAN INDIAN VOCATIONAL REHABILITATION SERVICE PROGRAMS
>
> CONSUMER ADVOCACY ORGANIZATIONS

SUBJECT: Announcement of OMB Approval for Report Form RSA-227, Annual
Client Assistance Program (CAP) Report.

POLICY

STATEMENT: The Office of Management and Budget (OMB) has approved an
extension of Form RSA-227, Annual Client Assistance Program (CAP)
Report, as a data collection instrument, through August 31, 2009. The
OMB number is 1820-0528.

> RSA uses this form to meet specific data collection requirements of
> Section 112 of the Rehabilitation Act of 1973, as amended, and its
> implementing federal regulations at 34 CFR Part 370. The CAPs must
> report annually using Form RSA-227 (copy and instructions attached),
> which is due on or before December 30 each year. Information on
> transmittal of the form, including electronic transmission, is found
> on pages 19 and 20 of the reporting instructions. However, grantees
> are reminded that they can enter data directly into RSA's Management
> Information System (MIS) via the Internet.
>
> The attached version of Form RSA-227 has been approved through August
> 31, 2009 for the purpose of collecting data and information concerning
> CAP activities carried out during fiscal year 2008. RSA currently is
> revising this information collection instrument in order to collect
> data that better describes the important work of CAP grantees. CAP
> programs will be required to use the revised form to submit data and
> information for fiscal year 2009 and subsequent years.

CITATIONS

IN LAW: Section 112 of the Rehabilitation Act of 1973, as amended, and
Paperwork Reduction Act of 1995.

CITATIONS IN

REGULATIONS: 34 CFR Part 370

EFFECTIVE

DATE: Immediately upon issuance

EXPIRATION

DATE: August 31, 2009

INQUIRIES: Please direct any questions concerning this Policy Directive
to the Chief, Vocational Rehabilitation Unit, Rehabilitation Services
Administration, 400 Maryland Avenue, SW, Washington, DC 20202-2800, by
telephone (202) 245-7325.

> Edward Anthony, PhD
>
> Delegated the authority
>
> To perform the functions of
>
> Commissioner for Rehabilitation
>
> Services Administration

ATTACHMENTS

cc: Council of State Administrators of Vocational Rehabilitation

National Council of State Agencies for the Blind

National Disability Rights Network

FORM RSA-227 OMB NO. 1820- 0528 EXPIRES: August 31, 2009

## ANNUAL CLIENT ASSISTANCE PROGRAM (CAP) REPORT

**[Fiscal Year]{.underline}**

+-----------------------------------+---+------------------+----------+
| **DESIGNATED AGENCY               |   |                  |          |
| IDENTIFICATION**                  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Name:                             |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Address:                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
|                                   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| E-mail Address (if applicable):   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Website Address (if applicable):  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Phone: ( )                        | T |                  |          |
|                                   | T |                  |          |
|                                   | Y |                  |          |
|                                   | : |                  |          |
|                                   | ( |                  |          |
|                                   | ) |                  |          |
+-----------------------------------+---+------------------+----------+
| Toll-free Phone: ( )              | T |                  |          |
|                                   | o |                  |          |
|                                   | l |                  |          |
|                                   | l |                  |          |
|                                   | - |                  |          |
|                                   | f |                  |          |
|                                   | r |                  |          |
|                                   | e |                  |          |
|                                   | e |                  |          |
|                                   | T |                  |          |
|                                   | T |                  |          |
|                                   | Y |                  |          |
|                                   | : |                  |          |
|                                   | ( |                  |          |
|                                   | ) |                  |          |
+-----------------------------------+---+------------------+----------+
| Fax: ( )                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **OPERATING AGENCY (IF DIFERENT   |   |                  |          |
| FROM DESIGNATED AGENCY)**         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Name:                             |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Address:                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
|                                   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| E-mail Address (if applicable):   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Website Address (if applicable):  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Phone: ( )                        | T |                  |          |
|                                   | T |                  |          |
|                                   | Y |                  |          |
|                                   | : |                  |          |
|                                   | ( |                  |          |
|                                   | ) |                  |          |
+-----------------------------------+---+------------------+----------+
| Toll-free Phone: ( )              | T |                  |          |
|                                   | o |                  |          |
|                                   | l |                  |          |
|                                   | l |                  |          |
|                                   | - |                  |          |
|                                   | f |                  |          |
|                                   | r |                  |          |
|                                   | e |                  |          |
|                                   | e |                  |          |
|                                   | T |                  |          |
|                                   | T |                  |          |
|                                   | Y |                  |          |
|                                   | : |                  |          |
|                                   | ( |                  |          |
|                                   | ) |                  |          |
+-----------------------------------+---+------------------+----------+
| Fax: ( )                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Name of CAP Director/Coordinator: |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Person to contact regarding       |   |                  |          |
| report:                           |   |                  |          |
+-----------------------------------+---+------------------+----------+
| Contact Person\'s phone: ( )      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **PART I. AGENCY WORKLOAD DATA**  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **A. Information and Referral     |   |                  |          |
| Services (I&R):** (Multiple       |   |                  |          |
| responses are not permitted.)     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Information regarding the   |   |                  |          |
| > Rehabilitation Act              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Information regarding Title |   |                  |          |
| > I of the ADA                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Other information provided  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Total I&R services provided |   |                  |          |
| > (Lines A1+A2+A3)                |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 5\. Individuals attending       |   |                  |          |
| > trainings by CAP staff          |   |                  |          |
| > (approximate)                   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **B. Individuals served** (An     |   |                  |          |
| individual is counted only once   |   |                  |          |
| during a fiscal year. Multiple    |   |                  |          |
| counts are not permitted for      |   |                  |          |
| Lines B1-B3.)                     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Individuals who are still   |   |                  |          |
| > being served as of October 1    |   |                  |          |
| > (carryover from prior year)     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Additional individuals who  |   |                  |          |
| > were served during the year     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Total individuals served    |   |                  |          |
| > (Lines B1+B2)                   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Individuals (from Line B3)  |   |                  |          |
| > who had multiple case files     |   |                  |          |
| > opened/closed this year. (In    |   |                  |          |
| > unusual situations, an          |   |                  |          |
| > individual may have more than   |   |                  |          |
| > one case file opened/closed     |   |                  |          |
| > during a fiscal year. This      |   |                  |          |
| > number is not added to the      |   |                  |          |
| > total in Line B3 above.)        |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **PART I. AGENCY WORKLOAD DATA    |   |                  |          |
| (continued)**                     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **C. Individual still being       |   |                  |          |
| served as of September 30**       |   |                  |          |
| (Carryover to next year) (This    |   |                  |          |
| total may not exceed Line I.B3.)  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **D. Reasons for closing          |   |                  |          |
| individuals' case files** (Choose |   |                  |          |
| one primary reason for closing    |   |                  |          |
| each case file. There may be more |   |                  |          |
| case files than the total number  |   |                  |          |
| of individuals served to account  |   |                  |          |
| for those unusual situations,     |   |                  |          |
| referred to in Line I.B4, when an |   |                  |          |
| individual had multiple case      |   |                  |          |
| files closed during the year.)    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. All issues resolved in      |   |                  |          |
| > individual's favor              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Some issues resolved in     |   |                  |          |
| > individual's favor (when there  |   |                  |          |
| > are multiple issues)            |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. CAP determines VR agency    |   |                  |          |
| > position/decision was           |   |                  |          |
| > appropriate for the individual  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Individual's case lacks     |   |                  |          |
| > legal merit; (inappropriate for |   |                  |          |
| > CAP intervention)               |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 5\. Individual chose            |   |                  |          |
| > alternative representation      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 6\. Individual decided not to   |   |                  |          |
| > pursue resolution               |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 7\. Appeals were unsuccessful   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 8\. CAP services not needed due |   |                  |          |
| > to individual's death,          |   |                  |          |
| > relocation, etc.                |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 9\. Individual refused to       |   |                  |          |
| > cooperate with CAP              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 10\. CAP unable to take case    |   |                  |          |
| > due to lack of resources        |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 11\. Other (Please explain on   |   |                  |          |
| > separate sheet)                 |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **E. Results achieved for         |   |                  |          |
| individuals** (Choose one primary |   |                  |          |
| outcome for each closed case      |   |                  |          |
| file. As stated in Section D,     |   |                  |          |
| there may be more case files than |   |                  |          |
| the total number of individuals   |   |                  |          |
| served.)                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Controlling law/policy      |   |                  |          |
| > explained to individual         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Application for services    |   |                  |          |
| > complet­ed                       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 3\. Eligibility determination     |   |                  |          |
| expedited                         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 4\. Individual participated in    |   |                  |          |
| evaluation                        |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 5\. IPE developed/implemented     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 6\. Communication re-established  |   |                  |          |
| between individual and other      |   |                  |          |
| party                             |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 7\. Individual assigned to new    |   |                  |          |
| counselor/office                  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 8\. Alternative resources         |   |                  |          |
| identified for individual         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 9\. ADA/504/EEO/OCR complaint     |   |                  |          |
| made                              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 10\. Other (Please explain on     |   |                  |          |
| separate sheet)                   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **PART II. PROGRAM DATA**         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **A. Age** (As of the beginning   |   |                  |          |
| of the fiscal year.) (Multiple    |   |                  |          |
| responses not permitted.)         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. 21 and under                |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. 22 -- 40                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. 41 -- 64                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. 65 and over                 |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 5\. Total (Sum of Lines A1      |   |                  |          |
| > through A4. Total must equal    |   |                  |          |
| > Line I. B3.)                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **B. Gender** (Multiple responses |   |                  |          |
| not permitted.)                   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Females                     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Males                       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Total (Lines B1+B2. Total   |   |                  |          |
| > must equal Line I.B3.)          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **PART II. Program Data           |   |                  |          |
| (continued)**                     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **C. Race/ethnicity** (Multiple   |   |                  |          |
| responses are permitted.)         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. American Indian or Alaskan  |   |                  |          |
| > Native                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 2\. Asian                         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 3\. Native Hawaiian or Other      |   |                  |          |
| Pacific Islander                  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Black or African American   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 5\. Hispanic or Latino          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 6\. White                       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 7\. Race/ethnicity unknown      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| # D. Primary disabling c          |   |                  |          |
| ondition of individuals served (M |   |                  |          |
| ultiple responses not permitted.) |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Blindness (both eyes)       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Other visual impairments    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Deafness                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Hard of hearing             |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 5\. Deaf-blind                  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 6\. Orthopedic impairments      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 7\. Absence of extremities      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 8\. Mental illness              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 9\. Substance abuse (alcohol or |   |                  |          |
| > drugs)                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 10\. Mental retardation         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 11\. Specific learning          |   |                  |          |
| > disabilities (SLD)              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 12\. Neurological disorders     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 13\. Respiratory disorders      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 14\. Heart and other            |   |                  |          |
| > circulatory conditions          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 15\. Digestive disorders        |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 16\. Genitourinary conditions   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 17\. Speech impairments         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 18\. AIDS/HIV positive          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 19\. Traumatic brain injury     |   |                  |          |
| > (TBI)                           |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 20\. All other disabilities     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 21\. Disabilities not known     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 22\. Total (Sum of Lines D1     |   |                  |          |
| > through D21. Total must equal   |   |                  |          |
| > Line I. B3.)                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **E. Types of individuals         |   |                  |          |
| served** (Multiple responses      |   |                  |          |
| permitted.)                       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Applicants of VR Program    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Clients of VR Program       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Applicants or clients of IL |   |                  |          |
| > Program                         |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Applicants or clients of    |   |                  |          |
| > other programs and projects     |   |                  |          |
| > funded under the Act            |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **F. Source of individual's       |   |                  |          |
| concern** (Multiple responses     |   |                  |          |
| permitted.)                       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. VR agency only              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Other Rehabilitation Act    |   |                  |          |
| > sources only                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Both VR agency and other    |   |                  |          |
| > Rehabilitation Act sources      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Employer                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **PART II. PROGRAM DATA           |   |                  |          |
| (continued)**                     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **G. Problem areas** (Multiple    |   |                  |          |
| responses permitted.)             |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Individual requests         |   |                  |          |
| > information                     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Communication problems      |   |                  |          |
| > between individual and          |   |                  |          |
| > counselor                       |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Conflict about services to  |   |                  |          |
| > be provided                     |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Related to                  |   |                  |          |
| > application/eligibility process |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 5\. Related to IPE              |   |                  |          |
| > development/implementation      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 6\. Other Rehabilitation        |   |                  |          |
| > Act-related problems            |   |                  |          |
+-----------------------------------+---+------------------+----------+
| 7\. Non-Rehabilitation Act        |   |                  |          |
| related                           |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 8\. Related to Title I of the   |   |                  |          |
| > ADA                             |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **H. Types of CAP services        |   |                  |          |
| provided** (Choose one primary    |   |                  |          |
| service CAP provided for each     |   |                  |          |
| closed case file. As stated       |   |                  |          |
| above, there may be more case     |   |                  |          |
| files than actual individuals     |   |                  |          |
| served.)                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 1\. Information/referral        |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 2\. Advisory/interpretational   |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 3\. Negotiation                 |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 4\. Administrative/informal     |   |                  |          |
| > review                          |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 5\. Alternative dispute         |   |                  |          |
| > resolution                      |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 6\. Formal appeal/fair hearing  |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 7\. Legal remedy                |   |                  |          |
+-----------------------------------+---+------------------+----------+
| > 8\. Transportation              |   |                  |          |
+-----------------------------------+---+------------------+----------+
| **PART III. NARRATIVE (Attach     |   |                  |          |
| separate sheet(s).)** Refer to    |   |                  |          |
| pages 16-19 of the instructions   |   |                  |          |
| for guidelines on the contents of |   |                  |          |
| the narrative.                    |   |                  |          |
+-----------------------------------+---+------------------+----------+
|                                   |   |                  |          |
+-----------------------------------+---+------------------+----------+

Reports are to be submitted to RSA within 90 days after the end of the
fiscal year covered by this report. Please be reminded that you can
enter data directly into RSA's Management Information System (MIS) via
the Internet. Information on transmittal of the form, including
electronic transmission, is found on pages 19 and 20 of the reporting
instructions.

Signature and title of designated agency official Date

**[Paperwork Burden Statement:]{.underline} According to the Paperwork
Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid OMB
control number. The valid OMB control number for this information
collection is 1820-0528. The time required to complete this information
collection is estimated to average 16 hours per response, including the
time to review instructions, search existing data resources, gather the
data needed, and complete and review the information collection. If you
have any comments concerning the accuracy of the time estimate or
suggestions for improving this form, please write to: U.S. Department of
Education, Washington, DC 20202-2703. If you have comments or concerns
regarding the status of your individual submission of this form, write
directly to: OSERS/RSA, U.S. Department of Education, 400 Maryland
Avenue S.W, Washington, DC 20202-2800.**