# Instructions

> OMB Control Number: 1820-0606
>
> Expiration Date: July 31, 2011

**UniTed States Department of Education**

###### Office of Special Education and Rehabilitative Services

**Rehabilitation Services Administration**

**Section 704**

**annual performance report**

####### **For**

####### **STATE INDEPENDENT LIVING SERVICES PROGRAM**

**(Title VII, Chapter 1, Part B of the Rehabilitation Act of 1973, as
amended)**

**Part I**

**INSTRUCTIONS**

**(To be completed by Designated State Units**

######### And Statewide Independent Living Councils)

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 1820-0606. The time required
to complete this information collection is estimated to average 35 hours
per response, including the time to review instruction, 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(s) or suggestions for improving this form, please
write to: U.S. Department of Education, Washington, D.C. 20202-4651. If
you have comments or concerns regarding the status of your individual
submission of this form, write directly to: Thomas Kelley, IL Unit
Supervisor, Rehabilitation Service Administration, U.S. Department of
Education, 400 Maryland Ave, SW, Washington, DC 20202-2800.

Chapter 1, Title VII of the Rehabilitation Act

TABLE OF CONTENTS

+--------------------------------------------+------------+------------+
| **Topic**                                  | **Page     | **Page     |
|                                            | \#**       | \#**       |
|                                            |            |            |
|                                            | **in the   | **in the   |
|                                            | In         | Inst       |
|                                            | strument** | ructions** |
+============================================+============+============+
| Annual Performance Report (704) Revision:  | \--        | 4          |
|                                            |            |            |
| *What's New?*                              |            |            |
+--------------------------------------------+------------+------------+
| Frequently Asked Questions                 | \--        | 8          |
+--------------------------------------------+------------+------------+
| Glossary of Terms                          | \--        | 12         |
+--------------------------------------------+------------+------------+
| General Instructions                       | \--        | 15         |
+--------------------------------------------+------------+------------+
| **Subpart I -- Administrative Data**       | 2          | 15         |
+--------------------------------------------+------------+------------+
| Section A -- Sources and Amount of Funds   | 2          | 15         |
| and Resources                              |            |            |
+--------------------------------------------+------------+------------+
| Section B -- Distribution of Title VII,    | 4          | 16         |
| Chapter 1,\                                |            |            |
| Part B Funds                               |            |            |
+--------------------------------------------+------------+------------+
| Section C -- Grants or Contracts Used to   | 5          | 16         |
| Distribute Title VII, Chapter 1, Part B    |            |            |
| Funds                                      |            |            |
+--------------------------------------------+------------+------------+
| Section D -- Grants or Contracts for       | 6          | 16         |
| Purposes Other Than Providing IL Services  |            |            |
| or for the General Operation of CILs       |            |            |
+--------------------------------------------+------------+------------+
| Section E -- Monitoring Title VII, Chapter | 6          | 16         |
| 1, Part B Funds                            |            |            |
+--------------------------------------------+------------+------------+
| Section F -- Administrative Support        | 6          | 17         |
| Services and Staffing                      |            |            |
+--------------------------------------------+------------+------------+
| Section G -- For Section 723 States ONLY   | 6          | 17         |
+--------------------------------------------+------------+------------+
| **Subpart II -- Number and Types of        | 8          | 18         |
| Individuals with Significant Disabilities  |            |            |
| Receiving Services**                       |            |            |
+--------------------------------------------+------------+------------+
| Section A -- Number of Consumers Served    | 8          | 18         |
| During the Reporting Year                  |            |            |
+--------------------------------------------+------------+------------+
| Section B -- Number of CSRs Closed by      | 8          | 18         |
| September 30 of the Reporting Year         |            |            |
+--------------------------------------------+------------+------------+
| Section C -- Number of CSRs Active on      | 9          | 19         |
| September 30 of the Reporting Year         |            |            |
+--------------------------------------------+------------+------------+
| Section D -- IL Plans and Waivers          | 9          | 19         |
+--------------------------------------------+------------+------------+
| Section E -- Age                           | 9          | 19         |
+--------------------------------------------+------------+------------+
| Section F -- Sex                           | 10         | 19         |
+--------------------------------------------+------------+------------+
| Section G - Ethnicity                      | 10         | 20         |
+--------------------------------------------+------------+------------+
| Section H - Race                           | 10         | 20         |
+--------------------------------------------+------------+------------+
| Section I - Disability                     | 11         | 20         |
+--------------------------------------------+------------+------------+
| **Subpart III -- Individual Services and   | 12         | 21         |
| Achievements Funded Through Title VII,     |            |            |
| Chapter 1, Part B Funds**                  |            |            |
+--------------------------------------------+------------+------------+
| Section A -- Individual Services and       | 12         | 23         |
| Achievements                               |            |            |
+--------------------------------------------+------------+------------+
| Section B -- Increased Independence and    | 13         | 25         |
| Community Integration                      |            |            |
+--------------------------------------------+------------+------------+
| Section C -- Additional Information        | 15         | 27         |
| Concerning Individual Services or          |            |            |
| Achievement                                |            |            |
+--------------------------------------------+------------+------------+
| **Subpart IV -- Community Activities and   | 16         | 28         |
| Coordination**                             |            |            |
+--------------------------------------------+------------+------------+
| Section A -- Community Activities          | 16         | 28         |
+--------------------------------------------+------------+------------+
| Section B -- Working Relationships Among   | 16         | 31         |
| Various Entities                           |            |            |
+--------------------------------------------+------------+------------+
| **Subpart V -- Statewide Independent       | 17         | 31         |
| Living Council (SILC)**                    |            |            |
+--------------------------------------------+------------+------------+
| Section A -- Composition and Appointment   | 17         | 31         |
+--------------------------------------------+------------+------------+
| Section B -- SILC Membership               | 18         | 31         |
| Qualifications                             |            |            |
+--------------------------------------------+------------+------------+
| Section C -- SILC Staffing and Support     | 19         | 32         |
+--------------------------------------------+------------+------------+
| Section D -- SILC Duties                   | 19         | 32         |
+--------------------------------------------+------------+------------+
| Section E -- Training and Technical        | 20         | 33         |
| Assistance Needs                           |            |            |
+--------------------------------------------+------------+------------+
| **Subpart VI -- SPIL Comparison and        | 23         | 34         |
| Updates, Other Accomplishments And         |            |            |
| Challenges**                               |            |            |
+--------------------------------------------+------------+------------+
| Section A -- Comparison of Reporting Year  | 24         | 34         |
| Activities with the SPIL                   |            |            |
+--------------------------------------------+------------+------------+
| Section B -- Significant Activities and    | 24         | 34         |
| Accomplishments                            |            |            |
+--------------------------------------------+------------+------------+
| Section C -- Substantial Challenges        | 24         | 34         |
+--------------------------------------------+------------+------------+
| Section D -- Additional Information        | 24         | 34         |
+--------------------------------------------+------------+------------+
| **Subpart VII -- Signatures**              | 25         | 34         |
+--------------------------------------------+------------+------------+

**ANNUAL PERFORMANCE REPORT (704) REVISION:**

***WHAT'S NEW*?**

The 704 Report has been revised to reflect the "Final Guidance on
Maintaining, Collecting, and Reporting Racial and Ethnic Data to the
U.S. Department of Education," issued on October 19, 2007. This
guidance, which became effective on December 3, 2007, requires
educational institutions and other recipients to collect racial and
ethnic data using a two-part question on the educational institution's
or other recipient's survey instrument.

The first question is whether or not the respondent is Hispanic/Latino.
Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican, South
or Central American, or other Spanish culture or origin, regardless of
race. The term ''Spanish origin'' can be used in addition to
''Hispanic/Latino or Latino.'' The second question asks the respondent
to select one or more races from the following five racial groups: (1)
American Indian or Alaska Native, (2) Asian, (3) Black or African
American, (4) Native Hawaiian or Other Pacific Islander, and (5) White.

Educational institutions and other recipients will be required to report
aggregated racial and ethnic data in seven categories: (1)
Hispanic/Latino of any race; and, for individuals who are
non-Hispanic/Latino only, (2) American Indian or Alaska Native, (3)
Asian, (4) Black or African American, (5) Native Hawaiian or Other
Pacific Islander, (6) White, and (7) Two or more races.

In addition, Rehabilitation Services Administration (RSA) grantees are
permitted to use the "Race Unknown" category when reporting data to the
Department, although the use of this category is not permitted in
elementary and secondary programs.

The final guidance text is accessible at:
<http://www.ed.gov/legislation/FedRegister/other/2007-4/101907c.pdf>.

**FREQUENTLY ASKED QUESTIONS**

**Question:** What is the Purpose of the Annual Performance Report, or
704 Report?

**Answer:** The purpose of Part I of the 704 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 Statewide
    Independent Living Councils (SILCs) as required by Section 721(b)(3)
    of the Rehabilitation Act of 1973, as amended (Act).

C)  Collect information on the administration of the Part C program by
    states who administer that program under section 723 of the Act.

D)  Collect information necessary for issuance of continuation awards
    for the State Independent Living Services (SILS) program.

E)  Collect the data required by Section 13, 706, and 721 of the Act for
    the SILS program.

F)  Serve as the basis for on-site reviews of the SILS program.

G)  Obtain a report on SILC and designated state units (DSU) activities.

H)  Establish a uniform reporting system to compile an accurate national
    report on independent living.

I)  Serve as the state's official request for continued funding under
    Part B or Part C of Chapter 1 of Title VII of the Act.

J)  Collect information on the distribution of title VII, chapter 1,
    Part B funds within the state and the monitoring of the use of those
    funds by grantees and contractors of the state.

K)  Enable each state to access information on all funds expended for
    independent living in the state, including individuals served,
    services provided and outcomes achieved, and to enable RSA to
    compare the performance among states. (Authority: Section 13,
    704(m)(4)(D); 705 (c)(5); 706(d); 721; 723; of the Act; 34 CFR Parts
    364, 365, and 366).

**Question:** What is the Structure of the 704 Report?

**Answer:** The 704 Report is composed of Part I and Part II

> Part I reports on the SILC and DSU's activities for the reporting
> year. It also contains data from consumer service records from the
> DSUs, DSU contractors and grantees and any center for independent
> living (CIL) receiving Part B funds from the DSU (not including CILs
> that also receive Part C funds and that file the 704 Report, Part II).
>
> Part II 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 consumer service records maintained by
> the CIL.

The structure of the 704 Report Part I is as follows:

> [Subpart I -- Administrative Data]{.underline}: This subpart contains
> information reflecting the duties of the DSU (including section 723
> states) outlined in section 704(c) of the Act, including the sources
> and expenditures of funds during the reporting year as well as the
> DSU's administrative support services, staffing and monitoring
> activities involving grantees and contractors.
>
> [Subpart II -- Numbers and Types of Individuals with Significant
> Disabilities Receiving Services]{.underline}: This subpart asks for
> information from CSRs on the numbers and types of consumers receiving
> IL services.
>
> [Subpart III -- Individual Services and Achievements]{.underline}:
> This subpart asks for information on the individual IL services
> provided and received, goals set and met, and outcomes achieved.
>
> [Subpart IV -- Community Activities and Coordination]{.underline}:
> This subpart asks for a report on the community activities involving
> the DSU, SILC and DSU contractors and grantees and the outcomes of
> such activities.
>
> [Subpart V -- Statewide Independent Living Council]{.underline}: This
> subpart asks for a report on the composition, qualifications and
> activities of the Statewide Independent Living Council (including
> technical assistance and training needs for next fiscal year).

[Subpart VI -- SPIL Comparison and Updates, Other Accomplishments and
Challenges]{.underline}: This subpart asks for program accomplishments
and goal achievements, updates to the SPIL, substantial problems or
difficulties and any additional information.

[Subpart VII -- Signatures]{.underline}: Signatures, printed names,
titles and phone numbers of DSU director(s) and SILC chair.

**Question:** Who Must Complete Part I of the 704 Report?

> **Answer:**
>
> Each DSU and SILC will jointly complete Part I. The SILC and the DSU
> must be given the freedom to independently prepare the portions of the
> report for which they are responsible. Subpart VI is designed to be a
> cooperative venture of both the DSU and SILC. In this manner, a
> complete report of activities that is jointly developed and shared
> within the state is assured.
>
> Only a single Part I report, with data aggregated from the state's
> reporting entities, will be accepted by RSA.
>
> Subparts II and III report information obtained from CSRs maintained
> by the DSU and grantees/contractors receiving Part B funds (other than
> CILs who receive Part C funds and who complete Part II of the 704
> Report). This is also true for section 723 states.

**Question:** Where must the 704 Report bE Submitted?

**Answer:**

[Section 722 states]{.underline}**:**

> The DSU and SILC will jointly submit the 704 Report both
> electronically and in an original, signed hard copy. For the FY 2008
> reporting year, states may submit the 704 Report via email to RSA and
> the Independent Living Research Utilization Project (ILRU) or they may
> choose to complete and submit the 704 Report directly through the RSA
> Management Information System (MIS). The signed hard copy of the 704
> Report is to be mailed to RSA only.
>
> Detailed instructions for the electronic and hard copy submittals will
> be provided when RSA officially transmits the 704 Report.

[Section 723 states]{.underline}:

> The 723 states forward their Part I 704 Report, along with the Part II
> reports of the Part C funded CILs, to RSA both electronically and in
> an original, signed hard copy. For the FY 2008 reporting year, states
> may submit the 704 Report via email to RSA and the Independent Living
> Research Utilization Project (ILRU) or they may choose to complete and
> submit the 704 Report directly through the RSA Management Information
> System (MIS). The signed hard copy of the 704 Report is to be mailed
> to RSA only. [The 723 states are no longer responsible for aggregating
> Part II report data into their Part I report.]{.underline} (They still
> may want to summarize applicable Part II information in their Part I
> report, as appropriate).

Detailed instructions for the electronic and hard copy submittals will
be provided to DSUs and SILCs when RSA officially transmits the 704
Report.

**Question:** When Must the DSU and SILC Submit the 704 Part I Report to
RSA?

> **Answer:** The date will vary depending on whether the state is a
> section 722 or section 723 state.

Section 722 states must submit the 704 Report, Part I to RSA postmarked
by December 31, 2006, for the preceding federal fiscal year (10/1/2005
-- 9/30/2006).

Section 723 states must submit the 704 Report, Part I to RSA postmarked
by January 31, 2007, for the preceding federal fiscal year (10/1/2005 --
9/30/2006).

**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. (Authority: 34 CFR
> 74.53)

**GLOSSARY OF TERMS**

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 These living arrangements include apartments,
>
> Living 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 under 34 CFR 364.40(a) 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); and, individual and
> systems advocacy.
>
> CSR A Consumer Service Record maintained for an eligible consumer
> receiving IL services and meeting the requirements of 34 CFR 364.53.
> 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.
>
> DSU The designated state unit, or units, identified under section
> 101(a)(2)(B) 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. The term
> includes a state agency solely designated under state law to provide
> IL services to individuals who are blind. In such states, the state
> agency for the blind may administer the provisions in the state plan
> related to services for individuals who are blind. In a 723 state, the
> DSU receiving, accounting for, and disbursing the funds for the CIL
> program is always the general agency.

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
>
> 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.
>
> 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 PAS funds).
>
> Reporting Year The most recently completed federal fiscal project year
> starting October 1 and ending September 30.
>
> RSA The Rehabilitation Services Administration at the United States
> Department of Education, Office of Special Education and
> Rehabilitative Services.
>
> Section 722 State A state in which RSA issues grants under Part C
> directly to eligible agencies for the planning, establishment, and
> operation of CILs.
>
> Section 723 State A state where the DSU 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 DSU 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 DSU.
>
> 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 of Independent Living jointly developed and signed
> by the director of the designated state unit(s) and the chairperson of
> the Statewide Independent Living Council, acting on behalf of and at
> the direction of the Council. 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 Include, but are not limited to, groups or
>
> Underserved populations of individuals with significant
>
> Populations disabilities who:

(1) have cognitive and sensory impairments;

(2) are members of racial and ethnic minority groups;

(3) live in rural areas; or

(4) have been identified by the eligible agency as unserved or
    underserved with a center's project area.

##### Instructions: 704 Report, Part I

**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 state, a "NOT
APPLICABLE" response is appropriate.

2\) When a subpart requests data or a numerical response but does not
apply to your state, enter zero, "0".

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

# SubPart I -- Administrative Data

## **Section A -- Sources and Amounts of Funds and Resources**

Sections 704(m)(3) and (4) of the Act; 34 CFR 364.35 and 364.36

List the amounts of all resources received by the state 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 DSU on behalf of consumers,
that are subsequently passed on to consumers, e.g., personal assistance
services, representative payee funds, or Medicaid funds. In item 3(H),
"other resources" may include, for example, foundations, corporations or
trust grants, donations from individuals or investment or endowment
income.

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 DSU 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.

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(H) to get the amount of Total Income
received by the state. 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 state. Enter this amount
> in Item 6.

## **Section B -- Distribution of Title VII, Chapter 1, Part B Funds**

Section 713 of the Act; 34 CFR 364.22, 365.1, 365.20, and 365.21

Complete the table by providing in items (1) through (8) the amount of
Part B funds expended by the state directly or through grant or contract
in each category in the appropriate column. If funds were not used for a
purpose listed, please indicate by placing \$0 in the appropriate
column.

## **Section C -- Grants or Contracts Used to Distribute Title VII, Chapter 1, Part B Funds** 

Sections 704(f) and 713 of the Act; 34 CFR 364.43, and 34 CFR 365
Subpart C

Review your answers to Section B and enter the requested information for
all grants or contracts funded at least in part by Part B funds, in the
table. Include Part C funded centers if they also received Part B funds.
Add more rows as necessary. A contractor or grantee that receives Part B
funds for more than one activity (e.g., to provide IL services, as well
as to conduct IL philosophy training), must be listed for as many
different activities it performs. If a column is not applicable to a
particular grant or contract, such as the consumer eligibility or CSR
columns intended only for service providers, enter "N/A." If there were
no non-Part B funds (e.g. title VII, Chapter 2 funds, other federal
funds or state funds) provided to this grantee or contractor for the
purpose listed, enter "\$0" in that column.

## **Section D -- Grants or Contracts for Purposes Other Than Providing IL Services or For the General Operation of Centers**

Section 713 of the Act; 34 CFR 365.1 and 34 CFR 365.20

For Part B funds awarded as grants or contracts ***for purposes other
than to provide IL services or for the general operation of centers***,
provide a brief narrative description of the objectives for each
agreement, what activities were conducted during the year, and what
results were achieved (e.g. funding for data collection, outreach
programs to minorities, surveys).

### Section E -- Monitoring Part B Funds

34 CFR 80.40(a)

Provide a summary of the program or fiscal review, evaluation, and
monitoring activities conducted by the state during the reporting year
for any of the grantees/contractors receiving Part B funds. Examples of
review, evaluation and monitoring activities include review of 704
Reports or other program reports, on-site reviews by DSU and/or SILC,
fiscal audits of expenditures of Part B funds, summaries of corrective
action plans, etc.

## **Section F -- Administrative Support Services and Staffing**

Section 704(m)(2) and (4) of the Act; 34 CFR 364.31

**Item 1 -- Administrative Support Services**

Section 704(c)(2); 34 CFR 364.22(a)(2)

Describe any administrative support services, including staffing,
provided by the DSU to the Part B program.

**Item 2 -- Staffing**

Report the total number Full Time Equivalents (FTEs) employed in the
SILS program administered by the DSU(s) and by service providers other
than CILs reporting in 704 Report, Part II. Report the total decision
making and other staff and the number of FTEs filled by individuals with
disabilities.

-   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 2080 (approximate number of hours worked by an FTE), the
    subsequent total is the equivalent fraction of the FTEs.

## **Section G -- For Section 723 States ONLY**

Section 723 of the Act, 34 CFR Part 366, Subpart D

### Item 1 -- Distribution of Part C Funds to Centers

In the table provided, please respond with the following information:

A)  the name of each center within your state that received Part C
    funding during the reporting year;

B)  the amount of Part C funding each center received;

C)  whether the Part C funding included a cost-of-living increase, with
    a yes or no response;

D)  whether the Part C funding included any excess funds remaining after
    cost-of-living increases were provided, with a yes or no response;

E)  whether any of the centers received its Part C funding pursuant to a
    competition for a new center in the state, with a yes or no
    response; and

F)  whether the center was the subject of an on-site compliance review
    conducted by the DSU during the reporting year, with a yes or no
    response.

Add additional rows as necessary.

**Item 2 -- Administrative Support Services**

Section 704(c)(2); 34 CFR 364.22(a)(2)

Describe the administrative support services used by the DSU to
administer the Part C program.

### Item 3 -- Monitoring and On-site Compliance Reviews

Section 723(g), (h), and (i); 34 CFR 366.38, 366.40-46

Provide a summary of the monitoring activities involving Part C centers
conducted by the state during the current reporting year, including the
on-site reviews of at least 15% of centers receiving Part C funds under
section 723. The summary should include, at least, the following:

A)  the center's level of compliance with the standards and assurances
    in section 725 of the Act;

B)  any adverse actions taken against centers;

C)  any corrective action plans entered into with centers; and

D)  exemplary, replicable or model practices of centers.

### Item 4 -- Updates or Issues

Provide any updates to the administration of the Part C program by the
DSU, including any significant changes in the amount of earmarked funds
or any changes in the order of priorities in the distribution of Part C
funds. Provide a description of any issues of concern addressed by the
DSU in its administration of the Part C program.

**SUBPART II -- NUMBER AND TYPES OF INDIVIDUALS WITH SIGNIFICANT
DISABILITIES RECEIVING SERVICES**

Section 704(m)(4) of the Act; 34 CFR 364.53

In this section, provide data from all service providers (DSU, grantees,
contractors) who received Part B funds and who were listed in subpart I,
section C of this report, [except centers for independent living that
receive Part C funds]{.underline}. (Part C centers will provide this
data themselves on their annual 704 Reports, Part II.)

## **Section A -- Number of Consumers Served During the Reporting Year**

Include Consumer Service Records (CSRs) for ALL consumers served during
the reporting year.

> \(1\) Enter the number of [active]{.underline} 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 opened 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 (e.g.
> unable to locate consumer).
>
> \(2\) Withdrawn - The consumer has stated he or she is 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 the 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 get the number of CRSs
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 table in Section C.

## **Section D -- IL Plans 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 IL plan was unnecessary.

\(2\) Enter the total number 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). 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 704 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.

(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 704 Report, 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.

# SubPart III -- Individual Services and Achievements Funded Through Title VII, Chapter 1, part B funds 

Sections 13, 704(m)(4) of the Act; 34 CFR 364.53; 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]{.underline} - 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]{.underline} contributing to the consumers' expected [outcomes]{.underline}, that is, greater independence and community integration. 

[Section B- Independence And Community Integration]{.underline} -
Quantifies the independent living program's [outcomes]{.underline},
expressed in terms of the diverse goals that consumers have achieved
through the provision of IL services ([outputs]{.underline}), including
the four core services. Section B consists of two related tables:

[Item 1]{.underline} (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 achievements 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]{.underline} (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 RSA'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, and individual
advocacy. \[Systems advocacy is addressed in subpart IV.\] For example,
a service provider may facilitate a consumer's [access to previously
unavailable transportation]{.underline} 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]{.underline} may be enhanced through information
and referral services, such as the provision of directories of local
medical facilities with available interpreters or 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]{.underline} may be expanded
through information and referral to public and private 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]{.underline} *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.

*[Detailed instructions for completing subpart III follow
below]{.underline}:*

## 

## **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. Include all consumers who were provided
services during the reporting year through Part B funds, either directly
by DSU staff or via grants or contracts with other providers. Do not
include consumers who were served by any centers that received Part C
funds during the reporting year.

Note: The total number of individual services provided is
[not]{.underline} expected to equal the number of active CSRs during the
reporting year, because one consumer may receive multiple services
during the reporting year. Also, individuals who receive information and
referral (I&R) services would not necessarily have an CSRs.

A)  [Advocacy/Legal Services]{.underline} -- Assistance and /or
    representation in obtaining access to benefits, services, and
    programs to which a consumer may be entitled.

B)  [Assistive Technology]{.underline} -- 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]{.underline} -- The provision of specific IL
    services designed to serve individuals with significant disabilities
    under the age of 14.

D)  [Communication Services]{.underline} -- 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]{.underline} -- These include
    information sharing, psychological services of a non-psychiatric,
    non-therapeutic nature, parent-to-parent services, and related
    services.

F)  [Family Services]{.underline} -- 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]{.underline} --
    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]{.underline}: 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]{.underline} --
    These may include instruction to develop independent living skills
    in areas such as personal care, coping, financial 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]{.underline} -- Identify all
    individuals who requested this type of assistance. This is the only
    service (other then 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]{.underline} -- Psychiatric restoration
    services including maintenance on psychotropic medication,
    psychological services, and treatment management for substance
    abuse.

K)  [Mobility Training Services]{.underline} -- A variety of services
    involving assisting consumers to get around their homes and
    communities.

L)  [Peer Counseling Services]{.underline} -- Counseling, teaching,
    information sharing, and similar kinds of contact provided to
    consumers by other people with disabilities.

M)  [Personal Assistance Services]{.underline} -- 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]{.underline} -- Restoration services
    including medical services, health maintenance, eyeglasses, and
    visual services.

O)  [Preventive Services]{.underline} -- Services intended to prevent
    additional disabilities, or to prevent an increase in the severity
    of an existing disability.

P)  [Prostheses, Orthotics, and Other Appliances]{.underline} --
    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]{.underline} -- 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]{.underline} -- Any service that
    assists an individual with a disability in the selection,
    acquisition or use of applied technologies, engineering
    methodologies or scientific principles to meet the needs of the
    individual and address the barriers confronted by individuals with
    significant disabilities with respect to education, rehabilitation,
    employment, transportation, IL and/or recreation.

Note: Rehabilitation technology services may include assistive
technology devices and services. However, for the purpose of this
report, include the provision of assistive technology devices and
services under item B, above.

S)  [Therapeutic Treatment]{.underline} -- Services provided by
    registered occupational, physical, recreational, hearing, language,
    or speech therapists.

T)  [Transportation Services]{.underline} -- Provision of, or
    arrangements for, transportation.

U)  [Youth/Transition Services]{.underline} -- Any service that develops
    skills specifically designed for youth with significant disabilities
    between the ages 14 and 24 to promote self-awareness and esteem,
    develop advocacy and self-empowerment skills and career exploration,
    including the transition from school to post school activities such
    as postsecondary education, vocational training, employment,
    continuing and adult education, adult services, independent living
    or community participation.

V)  [Vocational Services]{.underline} -- Any services designed to
    achieve or maintain employment.

W)  [Other Services]{.underline} -- Any IL services not listed above in
    A-V.

**Section B -- Increased Independence And Community Integration**

**Item 1** **-- Goals Related to Increased Independence in a Significant
Life Area**

For each of the significant life areas below, indicate the number of
consumers who set goals, the number who achieved their goals, and the
number whose goals were in progress at the end of the reporting year.
Goal achievement is to be determined through self-reporting by the
consumer and recorded in the individual's CSR.

(A) [Self-Advocacy/Self-Empowerment]{.underline} -- 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/her own activities to achieve desired objectives.

(B) [Communication]{.underline} -- 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]{.underline} -- 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]{.underline} -- 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]{.underline} -- 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]{.underline} -- Goals related to obtaining, maintaining,
    or advancing in employment.

(G) [Self-Care]{.underline} -- Goals to improve/maintain a consumer's
    autonomy with respect to activities of daily living such as personal
    grooming and hygiene, meal preparation and nutrition, shopping,
    eating, and other aspects of personal health and safety.

(H) [Information Access/Technolog]{.underline}y -- 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]{.underline} -- 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]{.underline}-- 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]{.underline} -- 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]{.underline} -- 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)]{.underline} -- Indicate the
number of 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 (as the consumer's
    advisor).

> [Column 2 (Consumers Achieving Access)]{.underline} -- 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)]{.underline} --
> Indicate the number of consumers who, at the end of the reporting
> year, were in the process of attaining access to previously
> 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:]{.underline} 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 RSA 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 -- Community Activities AND coordination 

Section 704(i), (l), and (m)(4) of the Act; 34 CFR 364.26, 364.27,
364.32

## **Section A -- Community Activities** 

### Item 1 -- Community Activities Table

In the table provided, give a summary of the community activities
involving the DSU staff, SILC members/staff and CIL board members or
staff during the reporting year. **Include in this count only CILs in
the statewide network of centers that do not receive Part C funds.** Add
more rows as needed.

#### 

#### Including information about the community activities of non-Part C centers in the statewide network, in addition to DSU and SILC community activities, will help provide a more complete picture of the independent living program's impact on the lives of individuals with disabilities. 

#### 

#### For each activity, complete the following columns:

> [Column 1 (Issue Area)]{.underline} -- 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

RSA 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)]{.underline} -- Indicate which of the
> following activity types best describes the activity by placing it in
> column 2:

-   [Community/Systems Advocacy]{.underline} -- Includes efforts to
    implement local and state policy changes to make facilities,
    services, and opportunities available and accessible to individuals
    with disabilities.

-   [Technical Assistance]{.underline} -- 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]{.underline} --
    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 brochures, ADA information) and
    databases/directories for personal assistants, recreation
    opportunities, accessible transportation, accessible housing, and
    other available services.

-   [Outreach Efforts]{.underline} -- Entails the location of, and
    encouragement to use services for unserved/underserved populations,
    including minority groups and urban and rural populations.

-   [Collaboration/Networking]{.underline} -- 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.

> RSA 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 activities related
> to the disability issue areas identified in column 1. **A sample table
> is provided below.**
>
> [Column 3 (Entity]{.underline}) -- Specify whether the DSU, the SILC
> and/or a center was the [primary]{.underline} entity involved in the
> activity. More than one primary entity may be specified, if
> appropriate. (Entities with a secondary or supportive role may be
> included in Subpart IV, Section A, item 2) **A sample table is
> provided below.**
>
> [Column 4 (Number of Hours]{.underline}) -- Report the number of hours
> spent by DSU staff, SILC members/staff or 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 5 (Objectives)]{.underline} -- 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 6 (Outcomes)]{.underline} -- Provide a brief narrative
> describing the primary outcome(s) of the DSU, SILC or CIL activity
> including, wherever possible, the number of people who actually
> benefited from the activity. **A sample table is provided below.**

###### SAMPLE TABLE

  ---------------- --------------- ----------- --------- --------------------- ----------------------
  **Issue Area**   **Activity      **Primary   **Hours   **Objective(s)**      **Outcome(s)**
                   Type**          Entity**    Spent**                         

  Health care      Community       CILs        50        To develop an         Distributed copies of
                   education /                           accessibility guide   the accessibility
                   Outreach                              listing service area  guide to 5,000
                                                         physicians,           individuals with
                                                         specialists and       disabilities through
                                                         facilities offering   partner organizations,
                                                         accessibility and     including in
                                                         reasonable            underserved areas.
                                                         accommodations. The   Received feedback from
                                                         guide will also       50 consumers reporting
                                                         identify accessible   that the guides helped
                                                         medical providers     them to achieve access
                                                         offering services in  to previously
                                                         Spanish.              unavailable health
                                                                               care.

  Transportation   Advocacy        CILs        30        To secure the county  The county council
                                                         council's commitment  voted to conduct an
                                                         to repairing and/or   assessment of the
                                                         replacing aging and   wheelchair lifts in
                                                         failing para-transit  its entire 50-vehicle
                                                         wheelchair lifts.     fleet of para-transit
                                                                               buses, and to make the
                                                                               required
                                                                               repairs/replacements
                                                                               within two years.

  Assistive        Collaboration   DSU, SILC,  60        To establish a        Held the first monthly
  technology                       CILs                  consortium of         meeting of the
                                                         universities,         consortium, with the
                                                         businesses, service   participation of 6
                                                         providers, disability partner organizations.
                                                         advocacy groups,      
                                                         mental health         
                                                         organizations and     
                                                         state/local           
                                                         government agencies   
                                                         to identify ways to   
                                                         expand the            
                                                         availability of       
                                                         assistive technology  
                                                         for individuals with  
                                                         significant           
                                                         disabilities.         

  Housing          Technical       SILC, CILs  20        To provide            Completed a legal
                   assistance                            information about     resource guide and
                                                         applicable laws       compiled a list of 20
                                                         related to housing    initial target
                                                         accessibility and     companies and owners.
                                                         accommodations to     
                                                         approximately 20      
                                                         apartment owners and  
                                                         management companies  
                                                         accounting for 20% of 
                                                         all rental housing    
                                                         units in the city.    
  ---------------- --------------- ----------- --------- --------------------- ----------------------

# Item 2 -- Description of Community Activities

For the community activities mentioned above, provide any additional
details such as the role of the DSU, SILC, CIL, and/or consumers, names
of any partner organizations and further descriptions of the specific
activities and services performed and benefits conferred.

### Section B -- Working Relationships Among Various Entities

Describe DSU and SILC activities to maximize the cooperation,
coordination, and working relationships among the independent living
program, the SILC, and CILs; and the DSU, other state agencies
represented on the SILC, other councils that address the needs of
specific disability populations and issues, and other public and private
entities. Describe the expected or actual outcomes of these activities.

**Part V -- Statewide Independent Living Council (SILC)**

Section 705 of the Act; 34 CFR 364.21

## **Section A - Composition and Appointment**

### Item 1 -- Current SILC Composition

Provide the requested information for each SILC member in the table.
Employment data is requested in order to ascertain whether the SILC
member is employed by a center, a state agency, or neither. The category
in which the member was appointed can be described, for example, as
ex-officio state agency representative, other state agency
representative, center representative, person with a disability not
employed by a center or state agency, section 121 funded project
director, parent of person with a disability, community advocate, other
service provider, etc.). Include current vacancies, along with the
corresponding appointment category for each. Add more rows as necessary.

### Item 2 -- SILC Composition Requirements

Provide the number of SILC members requested in each category. Include
any current vacancies in a particular appointment category.

## **Section B -- SILC Membership Qualifications**

Section 705(b)(4) of the Act; 34 CFR 364.21(c)

### Item 1 -- Statewide Representation

Describe how the SILC is composed of members who provide statewide
representation. For example, you may list the service areas currently
represented in the SILC by center representatives or section 121
representatives. You may also describe the policies and practices
adopted by the SILC to ensure continued statewide representation on the
SILC.

### Item 2 -- Broad Range of Individuals with Disabilities from Diverse Backgrounds

Describe how the SILC members represent a board range of individuals
with disabilities from diverse backgrounds. For example, you may list
the different disability groups and minority, urban and rural
populations represented. You may also describe the policies and
practices adopted by the SILC to ensure continued diversity on the SILC.

######## Item 3 -- Knowledgeable about IL

Describe how SILC members are knowledgeable about centers for
independent living and independent living services. For example, you may
describe in general terms the SILC members' IL background or expertise
or efforts made to train members on IL philosophy, laws, or best
practices. You may also describe the policies and practices adopted by
the SILC to ensure continued IL knowledge possessed by members of the
SILC.

**Section C -- SILC Staffing and Support**

**Item 1 -- SILC Staff**

Please provide the name and contact information for the SILC executive
director. Indicate the number and titles of any other SILC staff, if
applicable. Also indicate whether any SILC staff is also a state agency
employee.

**Item 2 -- SILC Support**

Describe the administrative support services for the SILC provided by
the DSU, if any.

## **Section D -- SILC Duties**

Section 705(c); 34 CFR 364.21(g)

### Item 1 -- SILC Duties

Provide a summary of SILC activities conducted during the reporting year
related to the SILC's duties outlined in section 705(c) of the Act:

**(A) State Plan Development**

Describe any activities related to the joint development of the state
plan. Include any activities in preparation for developing the state
plan, such as needs assessments, evaluations of consumer satisfaction,
or hearings and forums.

**(B) Monitor, Review and Evaluate the Implementation of the State
Plan**

Describe any activities related to the monitoring, review and evaluation
of the implementation of the state plan. Examples of discussion issues
may include review of 704 Reports, SILC participation on site reviews
conducted by RSA, the DSU, and/or other relevant federal or state
agencies, comments from persons with disabilities, surveys conducted,
etc.

**(C) Coordination With Other Disability Councils**

Describe the SILC's coordination of activities with the State
Rehabilitation Council (SRC) established under section 105, if the state
has such a Council, or the commission described in section
101(a)(21)(A), if the state has such a commission, and councils that
address the needs of specific disability populations and issues under
other federal law. Please state whether the SILC has at least one
representative serving as a member of the SRC and whether the SILC has
any members serving on other councils, boards or commissions in the
state.

**(D) Public Meeting Requirements**

Describe how the SILC has ensured that all regularly scheduled meetings
and other public hearings and forums hosted by the SILC are open to the
public and sufficient advance notice is provided. This summary may
include, for example, how meetings were publicized, methods used to
ensure that individuals across the state had access to meetings,
outreach to special populations, state notification requirements, etc.

**Item 2 -- Other Activities**

Describe any other SILC activities funded by non-Part B funds. Please
note that the SILC may use Part B funds only to conduct the activities
outlined in section 705 of the Act. Any activities that do not fall into
the SILC's federal duties may only be conducted with non-federal funds.

## **Section E -- Training and Technical Assistance Needs** 

Section 721(b)(3) of the Act

Please choose up to 10 priority needs that reflect the technical
assistance and training needs of the SILC. Using the column on the
right, indicate the SILC'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 VI -- SPIL Comparison and Updates, Other Accomplishments and Challenges

Section 704(m)(4) of the Act; 34 CFR 76.140

## **Section A -- Comparison of Reporting Year Activities with the SPIL**

## **Item 1 -- Comparison with SPIL goals and objectives**

## Describe progress made in achieving the objectives and goals outlined in the most recently approved SPIL. Discuss goals achieved and/or in progress as well as barriers encountered. 

## **Item 2 -- Updates to SPIL Information** 

Provide any changes to the information contained in the currently
approved SPIL. In particular, discuss any changes that may have occurred
to the DSU administration of the SILS program, SILC placement, legal
status, membership or autonomy, SILC budget, or the statewide network of
centers.

Note: An amendment to the SPIL is required, in addition to this update,
if there has been a significant and relevant change in the information
or assurances in the plan, the administration or operation of the plan;
or the organization, policies, or operations of the DSU (if the change
materially affects the information or assurances in the plan).

## **Section B -- Significant Activities and Accomplishments**

Describe any significant activities and accomplishments achieved by the
DSU and SILC during the reporting year and not included elsewhere in the
report, e.g. brief summaries of innovative practices, improved service
delivery to consumers, etc.

## **Section C -- Substantial Challenges**

Describe any substantial problems encountered by the DSU and SILC not
included elsewhere in this report and discuss resolutions/attempted
resolutions. Examples include difficulty in outreach efforts,
disagreements between the SILC and the DSU, complications recruiting
SILC members, complications working with other State agencies or
organizations within the State.

## **Section D -- Additional Information**

Provide any other information, comments or explanations of the reporting
year activities and data that were not previously included in other
sections of the report. Please include any suggestions that may be
helpful to other state agencies, SILCs, CILs and RSA.

# SUBPART VII - SIGNATURES

Provide signatures, printed names, titles and phone numbers of DSU
director(s) and SILC chair.