ED(RSA)-7-OB Form - Instructions

OMB No. 1820-0608

Expiration Date: May 31, 2011

**UNITED STATES DEPARTMENT OF EDUCATION**

OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES

REHABILITATION SERVICES ADMINISTRATION

Washington D.C. 20202

FISCAL YEAR

INDEPENDENT LIVING SERVICES FOR

OLDER INDIVIDUALS WHO ARE BLIND

ANNUAL REPORT INSTRUCTIONS

**Title VII Chapter 2, of the Rehabilitation Act, as amended**

**Section 752(I)(2)(A) of the Rehabilitation Act, as amended**

> 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 1820-0608. The time required
> to complete this information collection is estimated to average 8
> hours (or minutes) 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:** Thomas Kelley, U.S. Department of
> Education, 400 Maryland Ave, S.W., PCP Room 5031, Washington, D.C.
> 20202-2800.

**TABLE OF CONTENTS**

[INTRODUCTION](#__RefHeading___Toc203536259) III

[SUBMITTAL INSTRUCTIONS IV](#__RefHeading___Toc203536260)

[PART I: FUNDING SOURCES FOR EXPENDITURES AND ENCUMBRANCES --
INSTRUCTIONS 1](#__RefHeading___Toc203536261)

[PART II: STAFFING -- INSTRUCTIONS 2](#__RefHeading___Toc203536262)

[PART III: DATA ON INDIVIDUALS SERVED -- INSTRUCTIONS
4](#__RefHeading___Toc203536263)

[PART IV: TYPES OF SERVICES PROVIDED AND RESOURCES ALLOCATED --
INSTRUCTIONS 9](#__RefHeading___Toc203536264)

[PART V: COMPARISON OF PRIOR YEAR ACTIVITIES TO CURRENT REPORTED YEAR --
INSTRUCTIONS 12](#__RefHeading___Toc203536265)

[PART VI: PROGRAM OUTCOMES/PERFORMANCE MEASURES -- INSTRUCTIONS
13](#__RefHeading___Toc203536266)

[]{#__RefHeading___Toc203536259 .anchor}Introduction

The revised ED RSA-7-OB form incorporates four newly established
performance measures for the Independent Living Services for Older
Individuals who are Blind (IL-OIB) program. These measures aim to better
reflect the program's impact on individual consumers and the community.

Added to capture information that may be required to meet GPRA
guidelines, the new performance measures can be found under Part VI:
Program Outcomes/Performance Measures as follows:

Measure 1.1

Of individuals who received orientation and mobility (O & M) services,
the percentage who experienced functional gains or maintained their
ability to travel safely and independently in their home and/or
community environment.

Measure 1.2

Of individuals who received services or training in alternative
non-visual or low vision techniques, the percentage that experienced
functional gains or were able to successfully restore and maintain their
functional ability to engage in their customary life activities within
their home environment and community.

Measure 1.3

Of individuals who received AT (assistive technology) services and
training, the percentage who regained or improved functional abilities
previously lost as a result of vision loss.

Measure 1.4

Of the total individuals served, the percentage that reported that they
are in greater control and are more confident in their ability to
maintain their current living situation as a result of services.

The revised ED RSA-7-OB form has been streamlined to optimize the
usefulness of information collected. This information will assist RSA in
reporting results and outcomes related to the IL-OIB program.

In consultation with the Office of Management and Budget, the Department
of Education established performance goals and indicators as a way to
express the independent living program's purpose in terms of desired
outcomes or results that can be quantified and measured. The performance
indicators addressed by the revised ED RSA-7-OB form through the four
newly added performance measures represent a sampling of the range of
ways in which the IL-OIB program promotes the independence, empowerment,
and community integration of older individuals who are blind.

Since not all states will be able to make all the necessary reporting
system adjustments, RSA understands that the FY 2008 data collection may
not be as accurate or comprehensive as will be possible in the future.
RSA asks states to make their best efforts in completing the FY 2008 ED
RSA-7-OB form. Also, RSA invites states to report on their data
collection efforts in the ED RSA-7OB narrative section.

[]{#__RefHeading___Toc203536260 .anchor}Submittal Instructions

Through the completed ED RSA-7-OB form, each state is required to submit
**two (2) copies** of the annual 7-OB Report in the following manner:

**One (1) electronic copy** **in Microsoft Word (preferred), RTF, or
Text** and **one (1) hard copy** **with signatures**. The signed hard
copy serves as the official copy of the 7-OB Report.

Each state is required to send the signed hard copy to:

> United States Department of Education
>
> Office of Special Education and Rehabilitative Services
>
> Attention: Veronica Hogan
>
> 400 Maryland Avenue, S.W., PCP Room 5044
>
> Washington, D.C. 20202-2800

The electronic copy is to be sent to:

<elizabeth.akinola@ed.gov> with cc to: <veronica.hogan@ed.gov>.

PART I: FUNDING SOURCES FOR EXPENDITURES AND ENCUMBRANCES --
INSTRUCTIONS

Please note: Total expenditures and encumbrances for direct program
services in Part I (C) must equal the total funds spent on services in
Part IV. Part I C must equal the sum of Part IV A1+B1+C1+D1.

# 

# Title VII-Chapter 2 federal GRANT award for reportED fiscal year 

Enter the total amount of your Title VII-Chapter 2 Grant Award for the
reported Federal Fiscal Year (FY).

# Title VII-Chapter 2 carryover from previous year

Enter any federal grant carryover amount from the previous FY that was
expended or encumbered in the reported FY.

A.  [Funding SourceS for Expenditures and encumbrances in]{.underline}

[reported fy]{.underline}

A1. Enter the total amount of Title VII-Chapter 2 funds *expended or
encumbered* during the reported FY. Include expenditures or encumbrances
made from both carryover funds from the previous FY and from the
reported FY grant funds.

A2. Enter the total of any other federal funds *expended or encumbered*
in the Title VII-Chapter 2 program during the reported FY. Designate the
funding sources and amounts in (a) through (e).

A3. Enter the total amount of state funds *expended or encumbered* in
the Title VII - Chapter 2 program. Do not include in-kind contributions
(e.g., documented value of services, materials, equipment, buildings or
office space, or land).

A4. Enter the total amount of third party contributions including local
and community funding, non-profit or for-profit agency funding, etc. Do
not include in-kind contributions (e.g., documented value of services,
materials, equipment, buildings or office space, or land).

A5. Enter the total amount of in-kind contributions from non-federal
sources. Include value of property or services that benefit the Title
VII-Chapter 2 program (e.g. the fairly evaluated documented value of
services, materials, equipment, buildings or office space or land).

A6. Enter the total matching funds (A3 + A4 + A5). *Reminder:* The
required non-federal match for the Title VII-Chapter 2 program is not
less than \$1 for each \$9 of federal funds provided in the Title
VII-Chapter 2 grant. Funds derived from or provided by the federal
government, or services assisted or subsidized to any significant extent
by the federal government, may not be included in determining the amount
of non-federal contributions.

A7. Enter the total amount of all funds expended and encumbered (A1 +
A2 + A6) during the reported fiscal year.

B. [Total expenditures and encumbrances allocated to administrative,
support staff, and general overhead costs]{.underline}

> Enter the total amount of expenditures and encumbrances allocated to
> administrative, support staff, and general overhead costs. Do not
> include costs for direct services provided by agency staff or the
> costs of contract or sub-grantee staff that provide direct services
> under contracts or sub-grants. If an administrator spends a portion of
> his or her time providing administrative services and the remainder
> providing direct services, include only the expenditures for
> administrative services.

C. [Total expenditures and encumbrances for direct program
services]{.underline}

> Enter the total amount of expenditures and encumbrances for direct
> program services by subtracting line B from line A7.

[]{#__RefHeading___Toc203536262 .anchor}PART II: STAFFING --
INSTRUCTIONS

Base all FTE calculations upon a full-time 40-hour workweek or 2080
hours per year. Record all FTE assigned to the Title VII-Chapter 2
program irrespective of whether salary is paid with Title VII-Chapter 2
funds.

A. [Full-time Equivalent (FTE) Program Staff]{.underline}

A1. Under the "Administrative & Support" column (A1a), enter the
full-time equivalent (FTE) of all administrative and support staff (e.g.
management, program directors, supervisors, readers, drivers for staff,
etc.) assigned to the Title VII-Chapter 2 program from the State agency.
(For example, if 20% or 8 hours per week of a staff person's time were
spent on administrative and support functions related to this program,
the FTE for that staff person would be .2). Under the "Direct Services"
column (A1b), enter the FTE of all direct service staff (e.g.
rehabilitation teacher, IL specialist, orientation and mobility
specialist, social worker, drivers for individuals receiving services,
etc.) assigned to the Title VII-Chapter 2 program from the State agency.
If administrative or support staff of the State agency also provide
direct services, report the FTE devoted to direct services in the
"Direct Services" column (A1b). (For example, if 80% of a staff person's
time were spent in providing direct services, the FTE for that person
would be 8). Finally, add across the "Administrative & Support" FTE
(A1a) and "Direct Service" FTE (A1b) to enter the total State agency FTE
in the TOTAL (A1c) column.

A2. Under the "Administrative & Support" column (A2a), enter the
full-time equivalent (FTE) of all administrative and support staff (e.g.
management, program directors, supervisors, readers, drivers for staff,
etc.) assigned to the Title VII-Chapter 2 program from contractors or
sub-grantees. Under the "Direct Services" column (A2b), enter the FTE of
all direct service staff (e.g. rehabilitation teacher, IL specialist,
orientation and mobility specialist, social worker, driver for
individuals receiving services, etc.) assigned to the Title VII-Chapter
2 program from contractors and sub-grantees. If administrative staff of
the contractors or sub-grantees also provides direct services, report
the FTE devoted to direct services in the "Direct Services" column
(A2b). Finally, add across the "Administrative & Support" FTE (A2a) and
"Direct Service" FTE (A2b) to enter the total contractor or sub-grantee
FTE in the TOTAL (A2c) column.

A3. Add each column for A1 and A2 and record totals on line A3.

B. [Employed or advanced in employment]{.underline}

B1. Enter the total number of employees (agency and
contractor/sub-grantee staff) with disabilities, including blindness or
visual impairment, in B1a. Enter the FTE of employees with disabilities
in B1b. (To calculate B1b, add the total number of hours worked by all
employees with disabilities and divide by 2080 to arrive at the FTE)

B2. Enter the total number of employees (agency and
contractor/sub-grantee staff) who are blind or visually impaired *and*
age 55 and older in B2a. Enter the FTE of employees who are blind or
visually impaired *and* age 55 or older in B2b. (To calculate B2b, add
the total number of hours worked by employees who are blind or visually
impaired *and* age 55 and older and divide by 2080 to arrive at the FTE)

B3. Enter the total number of employees (agency and
contractor/sub-grantee staff) who are members of racial/ethnic
minorities in B3a. Enter the FTE of employees who are members of
racial/ethnic minorities in B3b. (To calculate B3b, add the total number
of hours worked by employees who are members of racial/ethnic minorities
and divide by 2080 to arrive at the FTE)

B4. Enter the total number of employees (agency and
contractor/sub-grantee staff) who are women in B4a. Enter the FTE of
employees who are women in B4b. (To calculate B4b, add the total number
of hours worked by women and divide by 2080 to arrive at the FTE)

B5. Enter the total number of employees (agency and
contractor/sub-grantee staff) who are ages 55 and older, but not blind
or visually impaired, in B5a. Enter the FTE of employees who are ages 55
and older, but not blind or visually impaired, in B5b. (To calculate
B5b, add the total number of hours worked by employees who are ages 55
and older, but not blind or visually impaired, and divide by 2080 to
arrive at the FTE)

PART III: DATA ON INDIVIDUALS SERVED -- INSTRUCTIONS

Provide data in all categories on program participants who received one
or more services during the fiscal year being reported.

A. [Individuals Served]{.underline}

A1. Enter the number of program participants carried over from the
previous federal fiscal year who received services in this reported FY
(e.g. someone received services in September (or any other month) of the
previous FY and continued to receive additional services in the reported
FY).

A2. Enter the number of program participants who began receiving
services during the reported fiscal year irrespective of whether they
have completed all services.

A3. Enter the total number served during the reported fiscal year (A1 +
A2).

B. [Age]{.underline}

B1-B10. Enter the total number of program participants served in each
respective age category.

B11. Enter the sum of B1 through B10. This must agree with A3.

C. [Gender]{.underline}

C1. Enter the total number of females receiving services.

C2. Enter the total number of males receiving services.

C3. Enter the sum of C1 and C2. This must agree with A3.

####### D. [RACE/ETHNICITY]{.underline} 

Hispanic or Latino means a person of Cuban, Mexican, Puerto Rican, South
or Central American, or other Spanish culture or origin, regardless of
race.

D1. Enter the number of individuals served who are Hispanic/Latino of
any race or Hispanic/Latino only. Hispanic/Latino means a person of
Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.

D2. Enter the number of individuals served who are 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.

D3. Enter the number of individuals served who are Asian. 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.

D4. Enter the number of individuals served who are Black or African
American. 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.

D5. Enter the number of individuals served who are Native Hawaiian or
Other Pacific Islander. 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.

D6. Enter the number of individuals served who are White or Caucasian.
White means a person having origins in any of the original peoples of
Europe, the Middle East, or North Africa.

D7. Enter the number of individuals served who report two or more races
but who are not Hispanic/Latino of any race.

D8. Enter "race and ethnicity unknown" only if the consumer refuses to
identify race and ethnicity.

D9. Enter the total of D1 through D8. This number must agree with A3.

E. [Degree of Visual Impairment]{.underline}

E1. Enter the number of individuals served who are totally blind (e.g.
have light perception only or no light perception).

E2. Enter the number of individuals served who are legally blind
(excluding those recorded in E1).

E3. Enter the number of individuals served who have severe visual
impairment.

E4. Add E1 + E2 + E3 and enter the total. This number must agree with
A3.

F. [Major Cause of Visual Impairment]{.underline}

> (Please note that the primary site for the definitions of diseases is
> <http://www.nia.nih.gov/AboutNIA/StrategicPlan/ResearchGoalA/Subgoal1.htm>.)

Enter only one major cause of visual impairment for each individual
served.

F1. Enter the number of individuals served who have macular degeneration
as the major cause of visual impairment. Age-related macular
degeneration (AMD) is a progressive disease of the retina wherein the
light-sensing cells in the central area of vision (the macula) stop
working and eventually die. The cause of the disease is thought to be a
combination of genetic and environmental factors, and

> It is most common in people who are age 60 and over. AMD is the
> leading cause of legal blindness in senior citizens.

F2. Enter the number of individuals served who have diabetic retinopathy
as the major cause of visual impairment. Diabetic retinopathy is the
leading cause of new cases of legal blindness among working-age
Americans and is caused by damage to the small blood vessels in the
retina. It is believed that poorly controlled blood sugar levels are
related to its progression. Most persons with diabetes have
non-insulin-dependent diabetes mellitus (NIDDM) or what is commonly
called "adult-onset" or Type II diabetes, and control their blood sugar
with oral medications or diet alone. Others have insulin-dependent
diabetes mellitus (IDDM), also called \"younger or juvenile-onset\" or
Type I diabetes, and must use insulin injections daily to regulate their
blood sugar levels.

F3. Enter the number of individuals served who have glaucoma as the
major cause of visual impairment. Glaucoma is a group of eye diseases
causing optic nerve damage that involves mechanical compression or
decreased blood flow. It is permanent and is a leading cause of
blindness in the world, especially in older people.

F4. Enter the number of individuals served who have cataracts as the
major cause of visual impairment. A cataract is a clouding of the
natural lens of the eye resulting in blurred vision, sensitivity to
light and glare, distortion, and dimming of colors. Cataracts are
usually a natural aging process in the eye (although they may be
congenital) and may be caused or accelerated by other diseases such as
glaucoma and diabetes.

F5. Enter the number of individuals served who have any other major
cause of visual impairment.

F6. Enter the sum of F1 through F5. This number must agree with A3.

G. [OTHER AGE-RELATED IMPAIRMENTS]{.underline}

Enter the total number of individuals served in each category.
Individuals may report one or more non-visual impairments/conditions.
The National Institute on Aging (NIA) Strategic Plan identifies
age-related diseases, disorders, and disability including the following
categories.

G1. Hearing Impairment: Presbycusis is the gradual hearing loss that
occurs with aging. An estimated one-third of Americans over 60 and
one-half of those over 85 have some degree of hearing loss. Hearing
impairment occurs when there is a problem with or damage to one or more
parts of the ear, and may be a conductive hearing loss (outer or middle
ear) or a sensorineural hearing loss (inner ear) or a combination. The
degree of hearing impairment can vary widely from person to person. Some
people have partial hearing loss, meaning that the

> Ear can pick up some sounds; others have complete hearing loss,
> meaning that the ear cannot hear at all. One or both ears may be
> affected, and the impairment may be worse in one ear than in the
> other.

G2. Diabetes: Diabetes is a disease in which the body does not produce
or properly use insulin, a hormone that is needed to convert sugar,
starches and other food into energy needed for daily life. Type 2
diabetes, which results from insulin resistance and abnormal insulin
action, is most prevalent in the older population. Diabetes
complications, such as heart disease and loss of sight, increase
dramatically when blood sugar is poorly controlled and often develop
before diabetes is diagnosed.

G3. Cardiovascular Disease and Strokes: Diseases of the heart and blood
vessels are the leading cause of hospitalization and death in older
Americans. Congestive heart failure is the most common diagnosis in
hospitalized patients aged 65 and older.

G4. Cancer: The second leading cause of death among the elderly is
cancer, with individuals age 65 and over accounting for 70 percent of
cancer mortality in the United States. Breast, prostate, and colon
cancers, are common in older people.

### **G5.** **Bone, Muscle, Skin, Joint, and Movement Disorders: Osteoporosis (loss of mass and quality of bones), osteoarthritis (inflammation and deterioration of joints), and sarcopenia (age-related loss of skeletal muscle mass and strength) contribute to frailty and injury in millions of older people. Also contributing to loss of mobility and independence are changes in the central nervous system that control movement. Cells may die or become dysfunctional with age, as in Parkinson\'s disease. Therefore, older people may have difficulty with gross motor behavior, such as moving around in the environment, or with fine motor skills, such as writing.**

**G**6. Alzheimer's Disease/Cognitive Impairment: Alzheimer's disease is
the most common type of dementia (a brain disorder that significantly
affects an individual's ability to carry out daily life activities) in
older people. It and other cognitive impairments impact parts of the
brain that control thought, memory, and language.

G7. Depression is widespread, often undiagnosed, and often under-treated
in the elderly. It is believed to affect more than 6.5 million of the 35
million Americans who are 65 or older. Depression is closely associated
with dependency and disability. Symptoms may include: loss of interest
in normally pleasurable activities, persistent, vague or unexplained
somatic complaints, memory complaints, change in weight, sleeping
disorder, irritability or demanding behavior, lack of attention to
personal care, difficulty with concentration, social withdrawal, change
in appetite, confusion, delusions or hallucinations, feeling of
worthlessness or hopelessness, and thought about suicide.

G8. Other Major Geriatric Concerns: Several conditions can compromise
independence and quality of life in older persons including weakness and
falls, urinary incontinence, benign prostatic hyperplasia, and co
morbidity (co morbidity describes the effect of all other diseases an
individual might have on the primary disease).

H. [TYPE OF LIVING ARRANGEMENT]{.underline}

H1. Enter the number of individuals served who live alone.

H2. Enter the number of Individuals served who live with someone else,
such as a spouse, family member, friend, caregiver, nursing attendent,
etc.

H3. Enter the sum of H1 and H2. This number must agree with A3.

I. [TYPE OF RESIDENCE]{.underline}

I1. Enter the number of individuals served who live in a private
residence such as a house or apartment unrelated to senior living.

I2. Enter the number of individuals served who live in a senior living
or retirement community (e.g. housing designed for those age 55 and
older).

I3. Enter the number of individuals served who live in an assisted
living community or facility (e.g. housing that provides personal care
and services which meet needs beyond basic provision of food, shelter
and laundry).

I4. Enter the number of individuals served who live in a nursing home or
long-term care facility (e.g. any facility that provides care to one or
more persons who require nursing care and related medical services of
such complexity to require professional nursing care under the direction
of a physician on a 24 hour a day basis).

I5. Enter the sum total of I1 -- I4. This number must agree with A3.

J. [SOURCE OF REFERRAL]{.underline}

J1. Enter the number of individuals served referred by an
ophthalmologist or optometrist.

J2. Enter the number of individuals served referred by a medical
provider other than an ophthalmologist or optometrist.

J3. Enter the number of individuals served referred by a state
vocational rehabilitation agency.

J4. Enter the number of individuals served referred by a government or
social services agency defined as a public or private agency which
provides assistance to consumers related to eligibility and securing
entitlements and benefits, counseling, elder law services, assistance
with housing, etc.

J5. Enter the number of individuals served referred by a senior program
defined as a community-based educational, recreational, or socialization
program operated by a senior center, nutrition site, or senior club.

J6. Enter the number of individuals served referred by a faith-based
(religious affiliated) organization.

J7. Enter the number of individuals served referred by an independent
living center (ILC) defined as a consumer-controlled, community-based,
cross-disability, nonresidential private nonprofit agency that is
designed and operated within a local community by individuals with
disabilities, and provides an array of independent living services.

J8. Enter the number of individuals served referred by a family member
or friend.

J9. Enter the number of individuals who were self-referred.

J10. Enter the number of individuals served referred by the Veterans
Administration

J11. Enter the number of individuals referred from all other sources
aside from those listed above.

J11. Enter the total sum total of J1 through J10. The number must agree
with A3.

PART IV: TYPES OF SERVICES PROVIDED AND RESOURCES ALLOCATED --
INSTRUCTIONS

Please note: Total expenditures and encumbrances for direct program
services in Part I C must equal the total funds spent on services in
Part IV. Part I C must equal the sum of Part IV A1+B1+C1+D1.

In addition, salary or costs associated with direct service staff or
contractors providing

direct services should be included in the cost of services provided in
A, B, C, and D.

A. [CLINICAL / FUNCTIONAL VISION ASSESSMENTS AND SERVICES]{.underline}

A1. Enter the total cost from Title VII-Chapter 2 federal grant funds
(A1a) and the total cost from all other sources of program funding (A1b)
for clinical and/or functional vision assessments and services, whether
purchased or provided directly.

A2. Enter the total number of program participants who received clinical
vision screening or vision examinations from qualified or certified
professionals such as ophthalmologists or optometrists, and who received
functional vision assessments or low vision evaluations to identify
strategies for enhancing visual performance both without and with
optical and low vision devices and equipment. Assessment areas may
include functional visual acuity and fields, efficiency of vision in the
performance of everyday tasks, and evaluation for low vision aids or
equipment. These assessments are typically provided by skilled
professionals or those who are certified or have a master's degree in
low vision rehabilitation. Do not include evaluations for orientation
and mobility. These should be included in C3.

A3. Enter the total number of program participants who received surgical
or therapeutic treatment to prevent, correct, or modify disabling eye
conditions; and, hospitalizations related to such services. Include
*prescription* optics in this service category. Nonprescription optics
should be reported in B2.

B. [ASSISTIVE TECHNOLOGY DEVICES AND SERVICES]{.underline}

B1. Enter the total cost from Title VII-Chapter 2 federal grant funds
(B1a) and the total cost from all other sources of program funding (B1b)
for the provision of assistive technology devices and services.

B2. Enter the total number of program participants who received one or
more assistive technology devices. As defined in Section 3(4) of the
Assistive Technology Act of 2004 (P.L. 108-364), "assistive technology
device means any item, piece of equipment, or product system whether
acquired commercially, modified, or customized that is used to increase,
maintain, or improve functional capabilities of individuals with
disabilities." Assistive technology devices may include such items as
canes, slates, insulin gauges, CCTVs, computers, adaptive software,
magnifiers, adaptive cooking items, adaptive recreational items,
handwriting guides, Braillers, large button telephones, etc.

B3. Enter the total number of program participants who received one or
more assistive technology services. As defined in Section 3(5) of the
Assistive Technology Act of 2004 (PL 108-364), "assistive technology
service means any service that directly assists an individual with a
disability in the selection, acquisition, or use of an assistive
technology device." Services may include the evaluation of assistive
technology needs of an individual, services related to acquisition of
technology, costs of loan programs, maintenance and repair of assistive
technology, training or technical assistance for the individual or
professionals related to the use of assistive technology, programs to
expand the availability of assistive technology, low vision therapy
services related to the use of optical aids and devices, and other
services related to the selection, acquisition, or use of an assistive
technology device.

C. [INDEPENDENT LIVING]{.underline} [AND]{.underline} [ADJUSTMENT
TRAINING AND SERVICES]{.underline}

C1. Enter the total cost from Title VII-Chapter 2 federal grant funds
(C1a) and the total cost from all other sources of program funding (C1b)
for the provision of services and adjustment training leading to
independent living. Evaluation and assessment services (excluding those
included in A2 or B3) leading to the planning and implementation of
services and training should be included in these costs.

C2. Enter the unduplicated number of individuals who received one or
more of the services or training in C3, C4 or C5. For example, if an
individual received services in both C3 and C4, they would only be
counted once in the total for C2.

C3. Enter the total number of individuals who received orientation and
mobility (O & M) services or travel training (i.e. learning to access
public or private transportation, and to travel safely and as
independently as possible in the home and community with or without the
use of mobility aids and devices).

C4. Enter the total number of individuals who received communication
skills training (e.g. reading and writing Braille, keyboarding and
computer literacy, using the telephone, handwriting guides, telling
time, using readers, use of audio and tactile technologies for home,
recreational or educational use; etc.). Training in the use of newspaper
reading services and radio services should be included.

C5. Enter the total number of individuals who received personal
management and daily living skills training (e.g. training in the use of
adaptive aids and assistive technology devices for personal management
and daily living, blindness and low vision alternative techniques for
food preparation, grooming and dress, household chores, medical
management, shopping, recreational activities, etc.)

C6. Enter the total number of individuals who received supportive
services (e.g. reader services, transportation, personal attendant
services, support service providers, interpreters, etc.) while actively
participating in the program or attaining independent living goals.

C7. Enter the total number of program participants who participated in
advocacy training or support network activities such as consumer
organization meetings, peer support groups, etc.

C8. Enter the total number of individuals who received counseling (peer,
individual or group) to assist them in adjusting to visual impairment
and blindness.

C9. Enter the total number of program participants that received
information and referral to other service providers, programs, and
agencies (e.g. senior programs, public and private social service
programs, faith-based organizations, consumer groups, etc.) to enhance
adjustment, independent living, and integration into the community. Do
not include individuals who received *only* information and referral and
for whom no other services were provided.

C10. Enter the total number of individuals served who were provided any
other service not listed above.

D. [COMMUNITY AWARENESS ACTIVITIES / INFORMATION AND
REFERRAL]{.underline}

D1. Enter the total cost from Title VII-Chapter 2 federal grant funds
(D1a) and the total cost from all other sources of program funding (D1b)
for providing information and referral services and community awareness
activities/events to individuals for whom this was the only service
provided (i.e. training for other professionals, telephone inquiries,
general inquiries, etc.).

D2. Enter the number of individuals receiving information and referral
services for whom this is the only service provided. (optional)

D3. Enter the number of community awareness events/activities in which
the Chapter 2 program participated during the reported year (D3a) and
the number or estimated number of individuals who benefited from these
activities (D3b).

PART V: COMPARISON OF PRIOR YEAR ACTIVITIES TO CURRENT REPORTED YEAR --
INSTRUCTIONS

A1. [Program]{.underline} [Expenditures and Encumbrances]{.underline}
[(all sources)]{.underline} Enter the total cost of the program for the
prior fiscal year (A1a), and the fiscal year being reported (A1b). The
total cost of the program can be found in Part I A7. Calculate the
change (plus or minus) from the prior year to the reported year (A1c).

A2. [Number of]{.underline} [Individuals Served]{.underline} Enter the
total number of eligible individuals served in the prior year (A2a), and
in the current reported year (A2b). The total number of individuals
served can be found in Part III A3. Calculate the change (plus or minus)
in the numbers served from the prior year to the reported year (A2c).

A3. [Number of]{.underline} [Minority Individuals]{.underline}
[Served]{.underline} Enter the total number of minority individuals
served in the prior year (A3a), and in the fiscal year currently being
reported (A3b). The total number of minority individuals served is the
total of Part III D1+D2+D3+D4+D6+D7. Calculate the change (plus or
minus) in the numbers served from the prior year to the reported year
(A3c).

A4. [Number]{.underline} [of]{.underline} [Community Awareness
Activities]{.underline} Enter the number of community awareness
activities or events in which the Chapter 2 program participated during
the prior year (A4a), and in the fiscal year currently being reported
(A4b). The number of community awareness activities is found in Part IV
D3a. Calculate the change (plus or minus) in the number of events from
the prior year to the year being reported (A4c).

A5. [Number]{.underline} [of]{.underline} [Collaborating Agencies
and]{.underline} [Organizations]{.underline} Enter the number of
collaborating organizations or agencies (formal agreements or informal
activity) other than Chapter 2 paid sub-grantees or contractors in the
prior year (A5a), and in the fiscal year currently being reported (A5b).
Calculate the change (plus or minus) from the prior year to the year
being reported (A5c).

[]{.mark}

A6. [Number]{.underline} [of]{.underline}
[Sub-grantees/Contractors]{.underline} If you provide services through
sub-grantee agencies or contract, enter the number of sub-grantees or
contracts in the prior year (A6a), and in the fiscal year currently
being reported (A6b). Calculate the change (plus or minus) from the
prior year to the year being reported (A6c). If you do not use
sub-grantees, enter 0 in A6a, A6b, and A6c.

PART VI: PROGRAM OUTCOMES/PERFORMANCE MEASURES -- INSTRUCTIONS

A. Enter the number from Part IV C3 in A1. From available program data
and evaluations, enter the number of individuals who experienced
functional gains or maintained their ability to travel safely and
independently in their residence and/or community environment as a
result of services in A2.

> In A3, from available program data and evaluations, enter the number
> of individuals for whom functional gains have not yet been determined
> at the close of the reporting period. (This number would not include
> those individuals who are no longer receiving services and who either
> did not make functional gains or maintain functional ability.)

B. Enter the number from Part IV C2 in B1. From available program data
and evaluations, enter the number of individuals that experienced
functional gains or successfully restored or maintained their functional
ability to engage in their customary life activities as a result of
services or training in alternative non-visual or low vision techniques
in B2.

> In B3, from available program data and evaluations, enter the number
> of individuals for whom functional gains have not yet been determined
> at the close of the reporting period. (This number would not include
> those individuals who are no longer receiving services and who either
> did not make functional gains or maintain functional ability.)

C. Enter the number from Part IV B2 in C1. From available program data
and evaluations, enter the number of individuals receiving AT (assistive
technology) services and training who regained or improved functional
abilities that were previously lost or diminished as a result of vision
loss in C2.

> In C3, from available program data and evaluations, enter the number
> of individuals for whom functional gains have not yet been determined
> at the close of the reporting period. (This number would not include
> those individuals who are no longer receiving services and who either
> did not make functional gains or maintain functional ability.)

D.  From available program data and evaluations, in D1 enter the number
    of individuals served who reported feeling that they are in greater
    control and are more confident in their ability to maintain their
    current living situation as a result of services they received; in
    D2 enter the number of individuals served who reported feeling that
    they have less control and confidence in their ability to maintain
    their current living situation as a result of services they
    received; and in D3 enter the number of individuals served who
    reported no change in their feelings of control and confidence in
    their ability to maintain their current living situation as a result
    of services they received.

> In D4, of those who report no gains in feelings of confidence and
> control, enter the number of individuals served who experienced
> changes in lifestyle for reasons unrelated to vision loss (e.g.,
> decline in health, decline in cognitive ability, or death of a
> spouse).