UNITED STATES DEPARTMENT OF EDUCATION

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

REHABILITATION SERVICES ADMINISTRATION

WASHINGTON, D.C. 20202

## [POLICY DIRECTIVE]{.underline}

> RSA-PD-03-02
>
> DATE: February 11, 2003

TO: STATE VOCATIONAL REHABILITATION AGENCIES (GENERAL)

> STATE VOCATIONAL REHABILITATION AGENCIES (BLIND)

SUBJECT: RSA 2 - Annual Vocational Rehabilitation Program/Cost Report

POLICY

STATEMENT: This is to inform you that the Office of Management and
Budget (OMB) has approved the continued use of the Annual Vocational
Rehabilitation Program/Cost Report (RSA 2) through February 28, 2006.
The approval permits the use of this report form to collect data through
Fiscal Year 2005. The OMB control number for this data collection
remains the same: 1820-0017.

> All State Vocational Rehabilitation Agencies responsible for
> administering the Title I Vocational Rehabilitation Services Program,
> including the Title VI, Part B Supported Employment Services Program,
> are required to submit a completed RSA-2 to the Rehabilitation
> Services Administration (RSA). Each agency covered by this reporting
> requirement must forward one copy of the completed report to the RSA
> Regional Office serving its State by no later than January 31
> following the close of each fiscal year.
>
> Since the attached RSA 2 report form and instructions reflect some
> clarifying changes from the earlier set issued with RSA-PD-00-09 (June
> 1, 2000), each covered agency must use the new form starting with its
> submission for FY 2003, which will be due on January 31, 2004.

CITATIONS

#### IN LAW: Sections 3(b), 13, 14(a), 101 and 103 of the Rehabilitation Act of 1973, as amended.

CITATIONS IN

REGULATIONS: 34 CFR Part 361.40

EFFECTIVE

DATE OF

POLICY: Date of this issuance.

#### AFFECTED

POLICIES: None

EXPIRATION

#### DATE: February 28, 2006

INQUIRIES: Inquiries should be addressed to John Chapman, Chief, Data
Management Unit, Financial Management and Information Systems Staff at
202-205-9290, or on the Internet at [john w.
chapman@ed.gov]{.underline}.

> Joanne Wilson
>
> Commissioner

Attachments

cc: American Indian Vocational Rehabilitation Programs

Client Assistance Programs

Council of State Administrators of Vocational Rehabilitation

National Association of Protection and Advocacy Systems

National Council for Independent Living

National Rehabilitation Facilities Coalition

Protection and Advocacy of Individuals Rights Program

Regional Rehabilitation Continuing Education Programs

RSA Senior Management Team

**Instructions**

**Annual Vocational Rehabilitation**

**Program/Cost Report (RSA-2)**

**(Revised February 2003, Ver. 1.1)**

Each State Vocational Rehabilitation (VR) Agency that has expended funds
in providing VR services to individuals with disabilities under the
Section 110 and Title VI-B programs of the Rehabilit­ation Act (hereafter
referred to as the Act) of 1973, as amended, must submit an Annual
Vocational Rehabili­tation Pro­gram/Cost Report (RSA‑2) for each Federal
fiscal year (October 1 - September 30).

The RSA‑2 report must be submitted to the RSA Regional Office by
[January 31]{.underline} following the close of the Federal fiscal year
(FY). Mail or FAX the completed form to the Regional Office, or see page
15 for electronic transmission options.

The RSA‑2 report must reflect all expen­ditures made from obligations
incurred during the Federal fiscal year covered by the report from all
Federal, State and other rehabilitation funds, including Section 110
Federal funds, Title VI-B Federal funds and program income funds that
were carried over from the previous fiscal year in accordance with
Section 19 of the Act. For the purpose of this report, **­expenditures
include obligations** that were incurred during the report period but
not yet liquidated (paid) as of the close of the period. The RSA‑2
report consists of five schedules:

**[Schedule]{.underline}** **[Title]{.underline}**

> Schedule I Total Expenditures
>
> Schedule II Number of Individuals Served and Expenditures by Service
> Category
>
> Schedule III Person Years
>
> Schedule IV Expenditures from Title VI-B Funds and Other
> Rehabilitation Funds.

##### Schedule V Carryover Funds

**Definitions**

Unless otherwise defined in this document, the terms used in these
instructions are defined in the Act or program regulations at 34 CFR
Part 361 or 363, or in the Education Department General Administrative
Regulations (EDGAR) at 34 CFR Part 80. All of the requirements ­in 34 CFR
Part 80 apply to the Section 110 Program, except for the provision
concerning third-party in-kind contributions for matching purposes.
Third-party in-kind contributions are not allowable for matching
purposes under the Section 110 Program. 34 CFR Part 80 also applies to
the Title VI-B Program.

For the purpose of these instructions, the following definitions also
apply:

[Section 110 Funds]{.underline} -

> Except where indicated otherwise in these instructions, the term
> "Section 110 funds" means the Section 110 Federal funds, the State
> matching funds including certified public funds under cooperative
> arrangements, the State funds used to meet the Maintenance of Effort
> (MOE) requirement, and the eligible State funds in excess of those
> required for matching the Federal funds or meeting the MOE
> requirement.
>
> [Title VI-B Funds]{.underline} -
>
> These are the Federal funds awarded under the Title VI-B Supported
> Employment Program.
>
> [Other Rehabilitation Funds]{.underline} -
>
> These are funds \-- other than Section 110 and Title VI-B funds \--
> that are under the control of the State VR agency and that are not
> eligible to match the Section 110 Federal funds. Included in this
> category are funds from program income.
>
> Program income means gross income received by the State VR agency that
> is directly generated by an activity supported under the Section 110
> or Title VI-B program. Examples of sources of program income include:
> reimbursement payments from the Social Security Administration for
> rehabilitating Social Security disability beneficiaries; payments
> received from insurance carriers; payments received from workers'
> compensation funds; fees for services to defray part or all of the
> costs of services provided to individuals with disabilities; and
> income generated by State VR agency operated community rehabilitation
> programs.
>
> This category also includes other sources of funds such as
> Welfare-to-Work, Temporary Assistance for Needy Families, etc., but
> does [not]{.underline} include any funds under the control of others
> (e.g. comparable benefits).

PLEASE NOTE: ALL AMOUNTS SHOULD BE REPORTED IN WHOLE DOLLARS ONLY

**[Schedule I - Total Expenditures]{.underline}**

The purpose of Schedule I is to provide the means for State VR agencies
to report the total amount of expenditures in providing VR services
under the Rehabilitation Act of 1973, as amended. The amounts entered on
this schedule include expenditures from Section 110 funds, Title VI-B
funds, and other rehabilitation funds. These would also include
expenditures made from the Section 110 Federal funds, Title VI-B Federal
funds or program income funds that were carried over from the previous
fiscal year in accordance with Section 19 of the Act.

**Line 1 - Administration**

Enter the total amount expended on administrative costs under the
vocational rehabilitation program, including those expenditures reported
on line 1a, Administrative Costs Paid with Title VI-B funds and line 1b,
Indirect Costs. The salaries and fringe benefits of all staff whose
person-years of effort are recorded on Schedule III, line 1,
Administrative Staff, are to be included here as well as all other State
VR agency expenses incident to carrying out its administrative
functions. These other expenses would include staff travel, rent,
utilities, supplies, etc. All administrative costs claimed by the State
VR agency for the fiscal year pursuant to an approved Indirect Cost
Agreement or Cost Allocation Plan are also to be included here.

\[Note: The total on line 1 may not equal the sum of the amounts
reported on lines 1a and 1b.\]

**Line 1a - Administrative Costs Paid with Title VI-B Funds**

Enter the total amount of Title VI-B funds expended on administrative
costs, including any administrative costs claimed through an approved
Indirect Cost Agreement or Cost Allocation Plan. This amount cannot
exceed 5% of the total amount of the Title VI B grant.

**Line 1b - Indirect Costs**

Enter the total amount of funds expended for administrative costs
claimed through an approved Indirect Cost (I/C) Agreement or Cost
Allocation Plan. This amount also includes such costs claimed under the
Title VI-B program and reflected on line 1a.

**2 - Services to Individuals with Disabilities**

The amounts to be entered in this part of the report are the
expenditures made by the State VR agency for the provision of VR
services to individuals with disabilities.

**2A -- Services Provided by State VR Agency Personnel**

Reported in this category are expenditures made by the State VR agency
for services provided directly by its personnel. The expenditures are to
be broken down based on where the personnel are employed. If the agency
operates its own community rehabilitation programs, all of the line
items in this category are to be completed; otherwise, only line items
2.A.2.(a) and (b) need to be completed.

# **Lines 2.A.1.a and 2.A.2.a** -- Assessment, Counseling, Guidance and Placement

Enter the total amount expended for Assessment, Counseling, Guidance and
Placement services provided directly by State VR agency personnel.

Included in this category are expenditures for trial work experiences,
the development of individualized plans for employment, any services
formerly categorized as extended evaluation services, and the collection
and retrieval of information, e.g., medical records, school transcripts,
etc. This category also includes expenditures made in providing periodic
reviews and re-evaluations of individuals with disabilities who were
determined to be ineligible for vocational rehabilitation services or
have been placed in extended employment in community rehabilitation
programs to determine the feasibility of their employment or their
training for future employment in the competitive labor market.

The total expenditures reported in this category include salaries and
fringe benefits of all personnel providing assessment, counseling,
guidance or placement services or supervising their provision or
providing consultation in their provision, as well as other State VR
agency expenses incident to the provision of these services. Other
expenses could include all of district or field offices' costs if they
deal with no other function other than to provide assessment,
counseling, guidance and placement services. These expenses could
include rent, utilities, supplies and other costs, which might be
considered administrative. The determining factor is the function they
support \-- administrative or assessment, counseling, guidance and
placement services.

Personnel included in this category are counselors, interviewers, case
aides, etc. Also included are clerical personnel whose duties support
these activities as well as supervisory personnel and consultants whose
responsibilities cover these activities. When personnel employed in
these activities devote part of their time to administrative functions,
that portion of their salaries, fringe benefits and other agency
expenses attributable to those functions should be included on line 1,
Administration.

**Lines 2.A.1.b and 2.A.2.b -- Other Services**

Enter the total amount expended for services provided directly by State
VR agency personnel other than Assessment, Counseling, Guidance and
Placement services. The amount reported for this category includes the
salaries, fringe benefits of all staff who provide these services as
well as other agency expenses incident to the provision of these
services such as rent, utilities, supplies, etc. Also included are the
salaries and fringe benefits of clerical and supervisory personnel
including the costs of consultants whose duties support the provision of
these other services.

Examples of services that would be classified under this category
include orientation and mobility training, rehabilitation teaching, and
job coaching. Do not include in this category the salaries of staff and
support personnel, and other agency expenses for the provision of
management and supervision and other services under the Business
Enterprise Program; those expenditures should be reported on line 3c.

**2B -- Services Purchased by State VR Agency**

Reported in this category are the expenditures made for services
purchased by the State VR agency broken down by the type of vendor.

**Line 2.B.1 -- Services Purchased from Public Community Rehabilitation
Programs**

Enter the total amount expended for services purchased from public
community rehabilitation programs. Public community rehabilitation
programs are those programs operated by a State, county, municipal, or
other local government. For State VR agency operated community
rehabilitation programs, all expenditures made for the provision of VR
services including salaries, wages and other expenses are
[not]{.underline} to be reported here but on lines 2.A.1.a and 2.A.1.b.

**Line 2.B.2 -- Services Purchased from Private Community Rehabilitation
Programs**

Enter the total amount expended for services purchased from private
community rehabilitation programs.

**Lines 2.B.3 and 2.B.4 -- Services Purchased from Other Public/Private
Vendors**

Enter on the appropriate line, by type of vendor, the total amount
expended for services purchased from sources other than community
rehabilitation programs. The amounts reported on these two lines are
expenditures for services purchased from vendors (doctors, schools,
etc.).

Public vendors are organizations or agencies of State, county, municipal
or other local government. Private vendors are all others, including
private not-for-profit organizations, such as VR providers (other than
community rehabilitation programs), as well as proprietary businesses,
such as hospitals and mental health clinics.

**3 - Services for Groups of Individuals with Disabilities**

The amounts to be entered in this part of the report are the
expenditures made by the State VR agency for the provision of VR
services for the benefit of groups of individuals with disabilities.

# **Line 3a - Establishment, Development or Improvement of Community Rehabilitation Programs**

Enter the total amount expended for the establishment, development or
improvement of a public or nonprofit community rehabilitation program.

**Line 3b - Construction of Facilities for Community Rehabilitation
Programs**

Enter the total amount expended for the construction of facilities for
public or nonprofit Community Rehabilitation Programs. The Federal share
of the cost of constructing a facility for a community rehabilitation
program may not be more than 50% of the total cost of the project.

**Line 3c - Business Enterprise Program**

Enter the total amount expended for the Business Enterprise Program
(e.g., Randolph-Sheppard). The Business Enterprise Program is the
program in which individuals with significant disabilities operate
vending facilities or other small businesses under the management and
supervision of the State VR agency. Include in this total the
expenditures for management services and supervision, initial stock and
supplies, and other goods and services, as well as the operational costs
of a small business enterprise during its initial establishment period,
not to exceed six months.

# **Line 3d - Other**

Enter on this line the total amount expended for services for groups of
individuals with disabilities that was not reported elsewhere on lines
3a through 3c.

Examples of the types of services that would be included in this
category are:

-   Telecommunications systems, including telephone, television,
    satellite, radio, and similar systems, that have the potential for
    substantially improving service delivery methods of activities
    described in the State plan, and developing appropriate programming
    to meet the particular needs of individuals with disabilities.

-   Special services to provide nonvisual access to information for
    individuals who are blind, including the use of telecommunications,
    Braille, sound recording, or other appropriate media;

-   Captioned television, films, or video cassettes for individuals who
    are deaf or hard of hearing; tactile materials for individuals who
    are deaf-blind; and other special services that provide information
    through tactile, vibratory, auditory, and visual media.

-   Technical assistance and support services to businesses that are not
    subject to Title I of the Americans with Disabilities Act of 1990
    and that are seeking to employ individuals with disabilities.

-   Consultative and technical assistance services to assist educational
    agencies in planning for the transition of students with
    disabilities from school to post-school activities, including
    employment.

-   Other services that promise to contribute substantially to the
    rehabilitation of a group of individuals but that are not related
    directly to the individualized plan for employment of any one
    individual with a disability.

**Line 4 - Total Expenditures**

Enter on this line the sum of the amounts recorded on lines 1, 2.A.1.a.
through 2.B.4, and 3a. through 3d.

**Line 5 - Innovation and Expansion Activities**

Of the total expenditures reported on line 4, enter the amount that was
expended for innovation and expansion activities that were identified in
the State plan. The 1998 Amendments to the Act require that the State
reserve and use a portion of its Section 110 allotment for such
purposes.

**[Schedule II - Number of Individuals Served & Expenditures by Service
Category]{.underline}**

The purpose of this schedule is to provide information on the number of
individuals with disabilities receiving services and on the funds
expended on their behalf by the State VR agency for each major type of
VR service. Except where indicated otherwise below, the expenditures
reported on each line are the expenditures made by the State VR agency
in directly providing or purchasing the service. The dollar amounts to
be reflected on this schedule are those reported in item 2 on Schedule I
except lines 2.A.1.a and 2.A.2.a.

For reporting data on lines 2 through 9 and 11 through 13: In the column
"No. of Individuals," enter the number of individuals who had
expenditures made on their behalf by the State VR agency for the
respective type of VR service furnished. If an individual received a
service, but the cost of that service was covered through "comparable
benefits," that individual should not be included in the category of the
service received. If an individual received a service under one of the
categories more than one time, count that individual only once for that
service category. For the lines in the columns titled "Amount," enter
the amount of expenditures made by the State VR agency for the
respective VR service categories.

For reporting data on line 1 and lines 10, 14 and 15: See the
instructions below for those line items.

\[Note: In the "No. of Individuals" column, no individual may be counted
more than once in a single category, but the same individual may be
included in more than one category. However, if during the fiscal year
covered by this report an individual had his or her record of services
closed and that person later reapplied for services by September 30^th^
of that fiscal year, count that individual as two separate individuals
for the purposes of reporting the number of individuals on Schedule
II.\]

# **Line 1 -- Assessment, Counseling, Guidance and Placement** 

# (Provided by State VR Agency Personnel)

Enter the number of individuals who did not receive any purchased
services and who also did not receive any of the other services provided
directly by State VR agency personnel.

The figure entered on this line would include those individuals who,
during the report period, received all of their services through the use
of comparable benefits only, resulting in no cost to the State VR
agency.

Purchased services are those services for which expenditures were
recorded on lines 2.B.1 through 2.B.4 on Schedule I. Other services
provided directly by the State VR agency personnel are those services
for which expenditures were recorded on lines 2.A.1.b and 2.A.2.b on
Schedule I.

**Line 2 -- Assessment (Purchased Only)**

Enter the number of individuals receiving assessment services for
determining eligibility and vocational rehabilitation needs that were
[purchased]{.underline} by the State VR agency. In the amount column,
enter the amount of expenditures made by the State VR agency in
[purchasing]{.underline} these services.

# **Line 3 -- Diagnosis and Treatment of Physical and Mental Impairments**

Enter the number of individuals receiving diagnostic or treatment
services for their physical or mental impairments, whether purchased or
provided directly by the State VR agency. In the amount column, enter
the amount of expenditures made on their behalf by the State VR agency
in purchasing or directly providing these services. If any individuals
received purchased diagnostic services that were for assessment
purposes, report those individuals and the associated expenditures not
on this line, but on line 2, above. If any individuals received
diagnostic services for assessment purposes which were furnished by
State VR agency personnel and those were the only services received,
report the number of individuals not on this line, but on line 1, above.

**Line 4 - Training**

This category includes training provided at schools, colleges or
universities, community or junior colleges, at community rehabilitation
programs, by tutor or correspondence or apprentice­ship or in an
organized on-the-job training situation or trade school or by some other
organized training program.

It also includes books, tools, and other training materials needed to
meet the rehabilitation needs of the individuals being served.

**Line 4a -- Postsecondary Institutions of Higher Education**

Enter the number of individuals receiving academic training from a
postsecondary institution of higher education, whether purchased or
provided directly by the State VR agency. In the amount column, enter
the amount of expenditures made on their behalf by the State VR agency
in purchasing or directly providing this service.

**Line 4b -- Job Readiness and Augmentative Skills Training**

Enter the number of individuals receiving job readiness and/or
disability related augmentative skills training services, whether
purchased or provided directly by the State VR agency. In the amount
column, enter the amount of expenditures made on their behalf by the
State VR agency in purchasing or directly providing these services. This
category includes (1) individuals receiving job readiness training to
prepare for the world of work (e.g., appropriate work behaviors, getting
to work on time, appropriate dress and grooming, increasing
productivity) and (2) individuals receiving disability related
augmentative skills training such as orientation and mobility,
rehabilitation teaching, training in the use of low vision aids,
Braille, speech reading, sign language and cognitive
training/retraining.

###### Line 4c -- Vocational and Occupational Skills Training

Enter the number of individuals receiving occupational, vocational, or
job skills training provided by a community college and/or business,
vocational/trade or technical school to prepare students for gainful
employment in a recognized occupation, not leading to an academic
degree, whether purchased or provided directly by the State VR agency.
In the amount column, enter the amount of expenditures made on their
behalf by the State VR agency in purchasing or directly providing this
service.

**Line 4d -- All Other**

Enter the number of individuals receiving training not falling into any
of the above categories, whether purchased or provided directly by the
State VR agency. This category includes courses leading to a GED, basic
academic remedial or literacy training, on-the-job training, job
coaching, or any other training that cannot be classified above. In the
amount column, enter the amount of expenditures made on their behalf by
the State VR agency in purchasing or directly providing this service.

**Line 4e -- Total Training**

Enter the number of individuals (this number will not necessarily equal
the sum of lines 4a through 4d) receiving one or more training services
and in the amount column, enter the total amount of expenditures (the
sum of lines 4a through 4d) made for training of any kind.

**Line 5 - Maintenance**

Enter the number of individuals receiving maintenance, whether purchased
or provided directly by the State VR agency. In the amount column, enter
the amount of expenditures made on their behalf by the State VR agency
in purchasing or directly providing this service.

**Line 6 - Transportation**

Enter the number of individuals receiving transportation services,
whether purchased or provided directly by the State VR agency. In the
amount column, enter the amount of expenditures made on their behalf by
the State VR agency in purchasing or directly providing this service.

**Line 7 - Personal Assistance Services**

Enter the number of individuals receiving personal assistance services,
whether purchased or provided directly by the State VR agency. In the
amount column, enter the amount of expenditures made on their behalf by
the State VR agency in purchasing or directly providing this service.
Personal assistance services include reader services, interpreter
services, and personal attendant services.

**Line 8 -- Placement (Purchased Only)**

Enter the number of individuals receiving placement services that were
[purchased]{.underline} by the State VR agency. In the amount column,
enter the amount of expenditures made on their behalf by the State VR
agency in [purchasing]{.underline} this service.

**Line 9 - All Other**

Enter the number of individuals receiving services, whether purchased or
provided directly by the State VR agency that do not fall into any of
the above service categories. In the amount column, enter the amount of
expenditures made on their behalf by the State VR agency in purchasing
or directly providing these services. Examples of the types of the
services that would be included in this category are:

-   job related services, including job search, job retention services,
    follow-up services, and follow-along services;

-   transition services for students with disabilities, that facilitate
    the achievement of the employment outcome identified in the
    individualized plan for employment;

-   services to the family of an individual with a disability necessary
    to assist the individual to achieve an employment outcome; and

-   occupational licenses, tools, equipment and initial stocks and
    supplies.

**Line 10 - Total Number of Individuals and Expenditures**

Enter the number of individuals (unduplicated count) receiving any of
the services listed above. This number will almost always be less, but
never greater, than the sum of the entries on lines 1 through 3 plus 4e
through 9.

In the amount column, enter the sum of the amounts on lines 2, 3, 4e and
5 through 9. The amount entered on this line should also equal the sum
of all of the amounts entered for item 2 on Schedule I except lines
2.A.1.a and 2.A.2.a.

**Line 11 - Post-Employment Services**

Of the total number of individuals reported on line 10, enter on line 11
the number of individuals receiving post-employment services.

Of the total expenditures reported on line 10, enter in the amount
column of line 11, the amount of expenditures made on behalf of these
individuals for post-employment services

**Line 12 - Rehabilitation Technology Services**

Of the total number of individuals reported on line 10, enter on line 12
the number of individuals receiving rehabilitation technology services.

Of the total expenditures reported on line 10, enter in the amount
column of line 12, the amount of expenditures made on behalf of these
individuals for rehabilitation technology services. The term
"rehabilitation technology services" includes rehabilitation
engineering, assistive technology devices, and assistive technology
services.

**Line 13 -- Small Business Enterprises**

Of the total number of individuals reported on line 10, enter on line 13
the number of individuals receiving services supporting small business
enterprises.

Of the total expenditures reported on line 10, enter in the amount
column of line 13, the amount of expenditures made for the provision of
services supporting small business enterprises. These services would
include technical assistance and other consultation services to conduct
market analyses, develop business plans, and otherwise provide
resources, to the extent such resources are authorized to be provided
through the statewide workforce investment system, to eligible
individuals who are pursuing self-employment or telecommuting or
establishing a small business operation as an employment outcome.

# **Line 14 -- Total Section 110 Funds Expended on Services**

Of the total expenditures reported on line 10, enter on line 14 the
amount that was expended from Section 110 funds (as defined on page 2 of
these instructions).

**Line 15 - Total Title VI-B Funds Expended on Services**

Of the total expenditures reported on line 10, enter on line 15 the
amount that was expended from Title VI- B funds.

\[Note: The difference, if any, between (a) the amount reported on line
10 and (b) the sum of the amounts on lines 14 and 15 represents the
amount of other rehabilitation funds (Schedule IV, line 2) that was
expended to provide services to individuals.\]

**[Schedule III - Person-Years]{.underline}**

Person-years means the actual time that vocational rehabilitation jobs
were filled during the period covered by this report. If a job is filled
throughout a fiscal year, it counts as one person-year; two jobs each
filled half a year would count as one person-year, etc. Except as noted
below, person-years, [in full year increments]{.underline}, must be
reported in column 1 for all State agency personnel whose salaries are
charged in whole or in part to Section 110 funds (as defined on page 2
of these instructions), Title VI-B, or other rehabilitation funds. The
total number of person years of all personnel supported by the Section
110 funds (as defined on page 2 of these instructions) and/or the Title
VI-B funds will be entered on line 5 in columns 2 and 3, respectively.

\[Note: The figure reported in column 1, line 5 may be greater than the
sum of the entries in columns 2 and 3. The difference, if any, between
(a) the total reported in column 1, line 5 and (b) the sum of the
entries in columns 2 and 3 would represent the total number of
person-years of staff supported with other rehabilitation funds
(Schedule IV, line 2).\]

**Line 1 - Administrative Staff**

Record the person-years for the number of personnel that perform
administrative functions. Included in this category are program
evaluators, program planners, budgeting and fiscal personnel, and staff
development. Clerical personnel who support the above administrative
staff functions are to be included here. However, do not include in this
category the person-years of administrative staff whose salaries are
subject to distribution pursuant to an Indirect Cost Agreement or Cost
Allocation Plan unless those staff are part of the designated State VR
Unit and under the control of its Director.

**Line 2 - Counselor Staff**

Record the person-years for the number of personnel that are involved in
direct provision of service to individuals with disabilities. Included
in this category are counselors, counselor aides, supervisors and
rehabilitation teachers who carry a caseload. Do not include
person-years for clerical personnel supporting the staff defined in this
category. Clerical support should be included on line 3 - Staff
Supporting Counselor Activities.

**Line 3 - Staff Supporting Counselor Activities**

Record the person-years for the number of personnel, other than those
included as Counselor Staff above, who directly or indirectly support
Counselor Staff in providing services to individuals with disabilities.
Included in this category are clerical personnel (other than those
included on line 1 - Administrative Staff, above), medical consultants,
interviewers, placement officers, and specialists, district and local
supervisors (except that portion of their time assigned to a caseload),
non-caseload carrying rehabilitation teachers, psychologists, social
workers, and other professional personnel who do not have a caseload
carrying responsibility.

**Line 4 - Other Staff**

Record the person-years for the number of personnel that are not
recorded in any of the above categories. Included in this category are
staff providing management and supervision services under the Business
Enterprise Program (e.g., Randolph-Sheppard Program), State Coordinators
for the Deaf and the Deaf/Blind, etc.

**Line 5 - Total**

Record the total person years under each column. For column 1, this is
the sum of lines 1 -- 4; for columns 2 and 3, see the instructions
immediately under the heading "Schedule III -- Person -- Years."

### Schedule IV - Expenditures From Title VI-B Funds and Other Rehabilitation Funds

# **Line 1 - Expenditures From Title VI-B Funds**

Of the total expenditures reported on line 4, Schedule I, enter on this
line the amount that was expended from Title VI-B funds.

**Line 2 - Expenditures From Other Rehabilitation Funds**

Of the total expenditures reported on line 4, Schedule I, enter on this
line the amount that was expended from the State VR agency's other
rehabilitation funds.

**[Schedule V - Carryover Funds]{.underline}**

**Line 1 - Amount of Current Fiscal Year Section 110 Allotment Carried
Over to the Next FY**

Enter the amount of the Section 110 Federal funds allotted for the
fiscal year covered by this report that was, in accordance with Section
19 of the Act, carried over to the following fiscal year for obligation
and expenditure. As prescribed by Section 19 of the Act, such carryover
funds remain available for obligation in the following fiscal year to
the extent that the non-Federal matching requirement for those funds was
met in the fiscal year for which the grant funds were appropriated.

Line 2 - Amount of Previous Fiscal Year Section 110 Allotment Carried
Over and Expended this FY

Enter the amount of the Section 110 Federal funds that was, in
accordance with Section 19 of the Act, carried over from the previous
fiscal year and expended in the fiscal year covered by this report.

Line 3 - Amount of Current Fiscal Year Title VI-B Allotment Carried Over
to the Next FY

Enter the amount of the Title VI-B Federal funds allotted for the fiscal
year covered by this report that was, in accordance with Section 19 of
the Act, carried over to the following fiscal year for obligation and
expenditure.

Line 4 - Amount of Previous Fiscal Year Title VI-B Allotment Carried
Over and Expended this FY

Enter the amount of the Title VI-B Federal funds that was, in accordance
with Section 19 of the Act, carried over from the previous fiscal year
and expended in the fiscal year covered by this report.

Line 5 - Amount of Current Fiscal Year Program Income Carried Over to
the Next FY

Enter the amount of Program Income funds received during the fiscal year
covered by this report that was, in accordance with Section 19 of the
Act, carried over to the following fiscal year for obligation and
expenditure.

Line 6 - Amount of Previous Fiscal Year Program Income Carried Over and
Expended this FY

Enter the amount of Program Income funds received during the previous
fiscal year that was, in accordance with Section 19 of the Act, carried
over and expended in the fiscal year covered by this report.

**[ELECTRONIC TRANSMISSION OPTION:]{.underline}**

-By electronic mail via the Internet as follows:

> [Regional Office]{.underline} [Individual]{.underline}

####### I allen.kropp@ed.gov

> II allen.kropp@ed.gov
>
> III ralph.pacinelli@ed.gov
>
> IV ralph.pacinelli@ed.gov
>
> V joe.cordova@ed.gov
>
> VI loerance.deaver@ed.gov
>
> VII joe.cordova@ed.gov
>
> VIII loerance.deaver@ed.gov
>
> IX ralph.pacinelli@ed.gov
>
> X loerance.deaver@ed.gov

**Form RSA‑2 OMB Number: 1820-0017**

**Revised FY 2000 Expires: 02/28/2006**

**Ver. 1.1**

**DEPARTMENT OF EDUCATION**

######### OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

**REHABILITATION SERVICES ADMINISTRATION**

**WASHINGTON, D.C. 20202**

######### ANNUAL VOCATIONAL REHABILITATION PROGRAM/COST REPORT

## State & Agency:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ( ) General/Combined

## Fiscal Year:\_\_\_\_\_\_\_\_\_\_\_\_ ( ) Blind 

**SCHEDULE I - [TOTAL EXPENDITURES]{.underline}** [AMOUNT]{.underline}

1\. **Administration** \$\_\_\_\_\_\_\_\_\_\_\_\_

> a\. Admin. Costs Paid with Title VI B funds \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\. Indirect Costs \$\_\_\_\_\_\_\_\_\_\_\_\_

2\. **Services to Individuals with Disabilities**

######## A. Services Provided by State VR Agency Personnel

> 1\. Employed at Agency Operated Community Rehabilitation Programs
>
> a\) Assessment, Counseling, Guidance, and Placement
> \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\) Other Services \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> 2\. Employed Elsewhere
>
> a\) Assessment, Counseling, Guidance, and Placement
> \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\) Other Services \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> B. Services Purchased by State VR Agency From:
>
> 1\. Public Community Rehabilitation Programs
> \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> 2\. Private Community Rehabilitation Programs
> \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> 3\. Other Public Vendors \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> 4 Other Private Vendors \$\_\_\_\_\_\_\_\_\_\_\_\_

3\. **Services for Groups of Individuals with Disabilities**

> a\. Establishment, Development or Improvement of Community
> Rehabilitation Programs \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\. Construction of Facilities for Community Rehabilitation Programs
> \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> c\. Business Enterprise Program \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> d\. Other \$\_\_\_\_\_\_\_\_\_\_\_\_

4\. Total Expenditures \$\_\_\_\_\_\_\_\_\_\_\_\_

5\. Innovation & Expansion Activities \$\_\_\_\_\_\_\_\_\_\_\_\_

**SCHEDULE II - [NUMBER OF INDIVIDUALS SERVED AND EXPENDITURES BY
SERVICE CATEGORY]{.underline}**

**[TYPE OF SERVICE]{.underline} [NO. OF INDIVIDUALS]{.underline}
[AMOUNT]{.underline}**

1\. Assessment, Counseling, Guidance and Placement
\_\_\_\_\_\_\_\_\_\_\_\_

(Provided by State VR Agency Personnel)

2\. Assessment (Purchased only) \_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_\_\_\_

3\. Diagnosis & Treatment of Physical and

##  Mental Impairments \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_

4\. Training:

> a\. Postsecondary Institution\
> of Higher Education \_\_\_\_\_\_\_\_\_\_\_\_
> \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\. Job Readiness and Augmentative\
> Skills Training \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> c\. Vocational and Occupational\
> Skills Training \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> d\. All Other \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_
>
> e\. **Total** \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_

5\. Maintenance \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_

6\. Transportation \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_

7\. Personal Assistance Services \_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_\_\_\_

> 8\. Placement (Purchased only) \_\_\_\_\_\_\_\_\_\_\_\_
> \$\_\_\_\_\_\_\_\_\_\_\_\_

9\. All Other \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_

10\. **Total Number of Individuals\
and Expenditures** \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_\_\_

11\. Post-Employment Services \_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_\_\_\_

12\. Rehabilitation Technology Services \_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_\_\_\_

13\. Small Business Enterprises \_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_\_\_\_

14\. **Total Section 110 Funds Expended on Services**
\$\_\_\_\_\_\_\_\_\_\_\_\_

15\. **Total Title VI-B Funds Expended on Services**
\$\_\_\_\_\_\_\_\_\_\_\_\_

**SCHEDULE III - [PERSON YEARS ]{.underline}** \-- Report Whole Years
Only

+-------------------------+--------------+--------------+--------------+
|                         | (1)**\       | (2)**\       | (3)**\       |
|                         | NO. OF       | 110 ONLY**   | TITLE VI B** |
|                         | YEARS**      |              |              |
+-------------------------+--------------+--------------+--------------+
| 1.  Administrative      |              | XXXXX        | XXXXX        |
|     Staff               |              |              |              |
+-------------------------+--------------+--------------+--------------+
| 2.  Counselor Staff     |              | XXXXX        | XXXXX        |
+-------------------------+--------------+--------------+--------------+
| 3.  Staff Supporting    |              | XXXXX        | XXXXX        |
|     Counselor           |              |              |              |
|     Activities          |              |              |              |
+-------------------------+--------------+--------------+--------------+
| 4.  Other Staff         |              | XXXXX        | XXXXX        |
+-------------------------+--------------+--------------+--------------+
| 5.  **Total**           |              |              |              |
+-------------------------+--------------+--------------+--------------+

**SCHEDULE IV - [EXPENDITURES FROM TITLE VI-B FUNDS AND OTHER
REHABILITATION FUNDS]{.underline}**

1\. Expenditures From Title VI-B Funds \$\_\_\_\_\_\_\_\_\_\_\_\_

2\. Expenditures From Other Rehabilitation Funds
\_\_\_\_\_\_\_\_\_\_\_\_

**SCHEDULE V - [CARRYOVER FUNDS]{.underline}**

1\. Amount of current Fiscal Year Section 110 Allotment carried over to
next FY \$\_\_\_\_\_\_\_\_\_\_\_\_

2\. Amount of previous Fiscal Year Section 110 Allotment carried over
and expended this FY \$\_\_\_\_\_\_\_\_\_\_\_\_

3\. Amount of current Fiscal Year Title VI-B Allotment carried over to
next FY \$\_\_\_\_\_\_\_\_\_\_\_\_

4\. Amount of previous Fiscal Year Title VI-B Allotment carried over and
expended this FY \$\_\_\_\_\_\_\_\_\_\_\_\_

5\. Amount of current Fiscal Year Program Income carried over to the
next FY \$\_\_\_\_\_\_\_\_\_\_\_\_

6\. Amount of previous Fiscal Year Program Income carried over and
expended this FY \$\_\_\_\_\_\_\_\_\_\_\_\_

**CERTIFICATION**

This Report is Complete and Correct: Signed:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

E-Mail Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Agency Point of Contact for this Report: Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

#  Phone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

E-Mail Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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 [1820-0017]{.underline}. The
time required to complete this information collection is estimated to
average [4.7]{.underline} 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(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: Director, Financial Management and Information Systems
Staff, Rehabilitation Services Administration, Room 3030-MES, 400
Maryland Avenue, SW, Washington, D.C. 20202-2551.