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| ![](media/image    | > **NORTHWEST POWER**                           |
| 1.jpeg){width="1.0 | >                                               |
| 770833333333334in" | > **     NORTHWEST VALUES**                     |
| height="0.87       |                                                 |
| 77777777777778in"} |                                                 |
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**Job Title/Series/Grade: Contract Specialist, GS-1102-9/11/12**

**Job Announcement Number: 005975-09-DE**

**Duty Location: Portland, OR**

**Position Information: This is a permanent position with a full-time
work schedule.**

**Anticipated Number of Positions To Be Filled: More than one position
will be filled.**

**Opening Date: 12/08/08**

**Closing Date: 01/07/09**

**Salary range: GS-9: \$47,245 - \$61,423**

**GS-11: \$57,161 - \$74,310**

**GS-12: \$68,512 - \$89,070**

**Organization**: **Internal Business Services, Supply Chain Services,
Sourcing Services, Sourcing Services, Professional & Services
Purchasing-NSSP**

**Who May Be Considered:**

Applications will be accepted from United States citizens.

**Job Summary:**

The Bonneville Power Administration, headquartered in Portland, Oregon,
is a federal agency under the U.S. Department of Energy. BPA serves the
Pacific Northwest through operating an extensive electricity
transmission system and marketing wholesale electrical power at cost
from federal dams, one non-federal nuclear plant and other nonfederal
hydroelectric and wind energy generation facilities. BPA aims to be a
national leader in providing high reliability, low rates consistent with
sound business principles, responsible environmental stewardship and
accountability to the region.

For information on BPA's Mission, Vision and Core Values, please click
on the following link: [About BPA]{.underline}

**Key Requirements:**

• Pre-Appointment Background Investigation is Required.

• Confidential Financial Disclosure

• College Transcripts

**Notes:**

This is a permanent position.

The full performance level of this position is GS-12.

This position may be filled at the GS-9, GS-11 or GS-12 level. You must
indicate on your application the grade level(s) for which you are
applying. Candidates hired at less than full-performance level may be
promoted without further competition when assigned higher-level duties
and meeting all qualification requirements.

**Confidential Financial Disclosure:** Selectee will be required to
complete the Office of Government Ethics Standard Confidential Financial
Disclosure Report (OGE450e) within 30 days of employment and annually.

**Current permanent Federal employees with status may also apply under
Merit Promotion procedures to vacancy announcement 005974-09.  Merit
Promotion announcements can be viewed at
[www.jobs.bpa.gov. ](../www.jobs.bpa.gov. %20) You must submit separate
and complete application packages for each announcement for which you
would like to be considered.**

**Major Duties:**

This position serves as one of several contract specialists responsible
for the full range of contract administration for preaward and postaward
functions, including price/cost analysis, negotiation, and
administration for services, materials, equipment and/or construction
within a major spend category, organizational component, or in a
geographical area associated with operating and maintaining a
high-voltage electric utility industry. The incumbent reports directly
to the Supervisory Contract Specialist and may receive daily assignments
and technical guidance from the assigned Contract Administrator (Spend
Manager).

**Requirements typically involve the following:**

**(1) Equipment:** Highly specialized instruments and testing devices,
such as electro/mechanical testing equipment; or newly developed items,
major components, or items which require special testing, approval,
tooling, and Government-furnished property; or automatic data processing
systems; or similar equipment of special design to required
specifications not available as standard off-the-shelf items; and/or,
high-voltage or substation equipment and materials, towers, structures
and cable and lines and communication equipment for control of
substations. MRO (materials, maintenance, repair and operation)
equipment and construction and building materials for projects for the
transmission services organizations, IT (information technology)
equipment, hardware and software and contracting needs for IT
consultants and contractors.

**(2) Services:** Professional or technical services, such as scientific
studies involving waste and transportation systems; or broadly based
land and resources inventories; or evaluation of industrial processes
and emission sources, and state-of-the-art control technology for
various specialized communication control equipment; or natural
resources and impact statements on wildlife and forestry uses, or air
and water pollution; or architect and engineering services in support of
construction and maintenance projects, large buildings, or other complex
projects; or design services for modifying specialized equipment, e.g.
electronic or electrical systems; and/or fish hatchery or the
construction of various facilities or improvements to facilities to meet
needed fish mitigation projects.

**(3) Construction:** Facilities for the production of high-voltage
electrical substations or subsystems where a substantial amount of
special and collateral equipment is to be procured and installed; or
special purpose buildings and structures.

**Preaward**

• Reviews requests for the procurement of complex equipment, services,
and/or construction. Analyzes the requirement, recommends revisions to
the statement of work or specifications as necessary, and decides on the
type of contract, milestones, and procurement plan. Reviews
justifications for sole source and other required clearances, and
prepares documentation.

• Prepares solicitation documents incorporating provisions, such as cost
price analysis standards, requirements for technical proposals with
appropriate weighing factors, testing procedures, cost escalation
factors, cost data requirements, and socioeconomic programs. Solicits
proposals from prospective contractors.

• Analyzes proposals for conformance with the solicitation. Performs
cost or price analysis, including review of cost breakdowns to determine
reasonableness. Coordinates the establishment of a technical evaluation
committee to determine acceptability of technical proposals. Obtains
required preaward surveys to establish contractor responsibility, and
obtains audits and pricing reports to develop negotiation strategy.

• Negotiates with potential contractors. Awards contracts within
delegated contracting officer authority, or recommends award to higher
level contracting officer on contracts outside delegated authority.

**Postaward**

• Assists contract administration offices in the administration of
contracts, including performance of termination actions, until final
delivery and payments are completed and the contract is closed and
retired; or personally monitors contractor\'s performance through work
with selected COTR's , telephone conversations, correspondence, reports,
vouchers, and visits for status of contract performance, scheduling,
problems that have arisen and proposed solutions, verification of
deliveries, and similar activities. Interprets contract provisions for
contractors and for officials of the agency, and provides appropriate
advice and guidance. Negotiates contract modifications.

• Prepares initial agency position on protests from unsuccessful bidders
and renders or recommends a decision on claims arising under the
contract.

• Closes out the contract or issues termination notices and reviews
settlement proposals.

**Qualifications:**

**Basic Education Requirements:**

A. A 4-year course of study leading to a bachelor\'s degree with a major
in any field;

OR

B. At least 24 semester hours in any combination of the following
fields: accounting, business, finance, law, contracts, purchasing,
economics, industrial management, marketing, quantitative methods, or
organization and management.

C. Exceptions: Employees in GS-1102 positions will be considered to have
met the standard for positions they occupy on January 1, 2000. Employees
who occupy GS-1102 positions at grades 5 through 12 will be considered
to meet the basic requirements for other GS-1102 positions up to and
including those classified at GS-12. This includes positions at other
agencies and promotions up through grade 12. However, employees must
meet specialized experience requirements when seeking another position.

**You must provide a copy of all relevant college transcripts with your
application (Photocopies are sufficient), with your qualifying courses
highlighted. Failure to provide transcripts will result in a rating of
not qualified.**

**In addition to meeting the basic requirements above, you must also
meet the following QUALIFICATION REQUIREMENTS:**

You must have one year of specialized experience at a level close to the
work of this job that has given you the particular knowledge, skills,
and abilities required to successfully perform. Typically we would find
this experience in work within this field or a field that is closely
related.

**Note:** In order to be rated as qualified for the position, we must be
able to determine that you meet the specialized experience requirement -
please be sure to include this information in your application. To be
creditable, specialized experience must have been equivalent to the next
lower grade of the position to be filled. Applicants who have qualifying
experience performed on less than a full-time basis must specify the
percentage and length of time spent in performance of such duties.

**Specialized Experience (GS-9):** Experience gained in pre-award and
post-award contract administration, the acquisition of supplies or
services using commercial contract terms and conditions, or in
negotiating IT terms and conditions or IT Software Licensing or End User
IT Licensing Agreements.

**Specialized Experience (GS-11):** Experience gained as a contract
specialist that included completing all pre-award and post-award
activities for commercial (including Uniform Commercial Code (UCC)) and
non-commercial contracts that required preparation of contracts in an
electric utility or government agency. (multiple pages).

**Specialized Experience (GS-12):** Experience gained as a contract
specialist with full responsibility for administering contracts that
included completing all pre-award and post-award activities for
non-commercial contracts that required preparation of complex contracts
in an electric utility or government agency. (multiple pages).

**Substitution of education for specialized experience:**

**GS-9:** 2 years of progressively higher-level graduate education
leading to a master's degree or master's or equivalent graduate degree.

**GS-11:** 3 years of progressively higher-level graduate education
leading to a PhD degree or PhD or equivalent doctoral degree.

Degree or graduate education must meet the basic education requirements
listed above. You must submit a copy of college transcripts with your
application.

**Education obtained outside the United States:** If your education has
been obtained outside then you must submit proof with your application
that your transcripts have been evaluated by a private organization that
specializes in interpretation of foreign educational credentials and
have been deemed at least equivalent to that gained in conventional
education institutions.

**VETERANS PREFERENCE:** Five-point preference is given to those
honorably separated veterans (this means an honorable or general
discharge) who served on active duty (not active duty for training) in
the Armed Forces: during any war (this means a war declared by Congress,
the last of which was World War II); during the period April 28, 1952,
through July 1, 1955; for more than 180 consecutive days, any part of
which occurred after January 31, 1955, and before October 15, 1976;
during the Gulf War period beginning August 2, 1990, and ending January
2, 1992; or for more than 180 consecutive days, any part of which
occurred during the period beginning September 11, 2001, and ending on
the date prescribed by Presidential proclamation or by law as the last
day of Operation Iraqi Freedom; or in a campaign or expedition for which
a campaign medal has been authorized, such as El Salvador, Lebanon,
Granada, Panama, Southwest Asia, Somalia, and Haiti. You must submit a
copy of your DD-214 (Member 4 copy of your discharge papers) with your
application. You may be entitled to a 10-point veteran\'s preference if
you are a disabled veteran or Purple Heart recipient or you are the
widow, widower, or mother of a deceased veteran. You must submit a
Standard Form 15 (SF-15) and documented proof of your claim to receive
10 pt. preference.

**CAREER TRANSITION ASSISTANCE PROGRAM/INTERAGENCY CAREER TRANSITION
ASSISTANCE PROGRAM (CTAP/ICTAP):** Individuals who have special priority
selection rights under the Agency Career Transition Assistance Program
(CTAP) or the Interagency Career Transition Assistance Program (ICTAP)
must be well qualified for the position to receive consideration for
special priority selection. See Basis for Rating for definition of
\"well qualified\". Federal employees seeking CTAP/ICTAP eligibility
must submit proof that they meet the requirements of 5 CFR 330.605 (a)
for CTAP and 5 CFR 330.704 for ICTAP. This includes a copy of the agency
notice, a copy of their most recent Performance Rating and a copy of
their most recent SF-50 noting current position, grade level, and duty
location. Please annotate your application to reflect that you are
applying as a CTAP or ICTAP eligible. NOTE: For CTAP/ICTAP, well
qualified for non-status applicants means an applicant who scores 85
points or higher prior to the addition of veteran\'s preference, if
applicable. For additional information please refer to
[http://www.opm.gov/]{.underline}.

How Will You Be Evaluated:

You will be evaluated to determine if you meet the minimum
qualifications required; and on the extent to which your application
shows that you possess the knowledges, skills, and abilities associated
with this position as defined below. When describing your knowledges,
skills, and abilities, please be sure to give examples and explain how
often you used these skills, the complexity of the knowledge you
possessed, the level of the people you interacted with, the sensitivity
of the issues you handled, etc. Failure to submit narrative responses to
the KSAs may negatively affect your eligibility and/or rating.

**1. Knowledge of contract pre-award through contract award procedures
and activities sufficient to solicit, evaluate and award complex
contracts for materials/equipment, construction and/or services.**
*(Describe and provide examples of your experience implementing
pre-award through contract award procedures to plan and conduct award
and administer the procurement of a variety of materials/equipment,
services and supplies. Address the variety, level of responsibility, and
complexity of contract functions in which you were engaged. Describe the
materials/equipment, services or supplies you procured. Identify the
environment in which you performed the work (e.g., Federal, state, or
local government sector; public or private utility company; other
organization).*

**2. Knowledge of contract administration laws, regulations, principles,
concepts and methodologies.** *(Describe your experience applying
government, agency, or local contract law and procurement regulations
especially in the areas of contract formation, negotiation, and
administration. Delineate the types (i.e., fixed price, cost
reimbursement, time and materials, etc.) and complexity of the contracts
for which you were responsible.)*

**3. Ability to negotiate the terms and conditions of contracts using
sound business principles.** *\[Describe your experience analyzing
various types of contracts (i.e., fixed price, cost reimbursement, time
and materials, etc.). Describe the scope of your analysis and complexity
of the contract, as well as your role and responsibility involved with
the contract.\]*

**4. Skill in written and oral communication within peer groups,
management, BPA clients and the business community. Experience
negotiating critical or contentions positions.** *\[Discuss your ability
to communicate effectively, both orally and in writing, with others in a
clear, concise, tactful, and diplomatic manner. Describe the audience
levels you have dealt with (i.e. peers, subordinates, management,
clients, etc,) include the scope and frequency, complexity of topics
addressed, and the type of communication used (orally or in writing). Be
sure to provide different examples of oral and written communication
demonstrating where you gained your experience.\]*

**Benefits:**

You may participate in the Federal Employees Health Benefits program,
with costs shared with your employer. More info:
[http://www.usajobs.gov/jobextrainfo.asp#FEHB]{.underline}.

Life insurance coverage is provided. More info:
<http://www.usajobs.gov/jobextrainfo.asp#life>

Long-Term Care Insurance is offered and carries into your retirement.
More info: <http://www.usajobs.gov/jobextrainfo.asp#ltci>

New employees are automatically covered by the Federal Employees
Retirement System (FERS). If you are transferring from another agency
and covered by CSRS, you may continue in this program. More info:
<http://www.usajobs.gov/jobextrainfo.asp#retr>

You will earn annual vacation leave. More info:
<http://www.usajobs.gov/jobextrainfo.asp#VACA>

You will earn sick leave. More info:
<http://www.usajobs.gov/jobextrainfo.asp#SKLV>

You will be paid for federal holidays that fall within your regularly
scheduled tour of duty. More info:
[http://www.usajobs.gov/jobextrainfo.asp#HOLI]{.underline}

**Other Information:**

You must submit all required information by the closing date. If
materials are not received, your application will be evaluated solely on
the information available and you may not receive full consideration or
may not be considered eligible.

**You must provide a copy of all relevant college transcripts with your
application (Photocopies are sufficient), with your qualifying courses
highlighted. Failure to provide transcripts will result in a rating of
not qualified.**

# APPLICATION INFORMATION:

There is no specific required application form. There is specific
information that you are required to submit. For further information on
completing your application, please refer to the statement below
"Required Information on Resumes."

-   Applicants may, at their choice, submit a resume, the Optional
    Application for Federal Employment (OF 612), a copy of the obsolete
    Application for Federal Employment (SF 171), or any other written
    application format.

-   All applications must contain sufficient information to determine
    eligibility for the position.

-   **Applicants will not be contacted for missing information. Material
    received after the closing date will not be accepted.**

**[HOW TO APPLY:]{.underline}**

Submit your application with supplemental information. It must be
received with the application. Your application package should include
the following:

1.  Your resume, or other application, that fully describes your
    education and experience.

2.  Narrative responses to Knowledges, Skills, and Abilities

3.  College transcripts (**REQUIRED** - Copies are acceptable).
    **Failure to submit a copy of college transcripts will result in a
    rating of disqualification.**

4.  If you are applying for consideration with 5-point veteran's
    preference, you must provide a copy of your DD-214 (Member 4).

5.  If you are applying for consideration with 10-point veteran's
    preference, you must provide a copy of your DD-214 (Member 4),
    Standard Form 15 (Application for 10-Point Veteran Preference), and
    documented proof of claim as specified on SF-15. ([SF-15
    form](http://www.opm.gov/forms/pdf_fill/SF15.pdf)).

6.  All applicants are encouraged to complete and submit **BPA Form
    F3330-11e,** Applicant Disability, Race/National Origin and Gender
    Identification form (attached).

**[REQUIRED INFORMATION ON RESUME\*:]{.underline}**

**Please do not include Social Security Numbers or birth dates on any
documents submitted.**

1.  Announcement number, title, and grade of the position for which you
    are applying.

2.  Your full name, mailing address, and day and evening telephone
    number.

3.  Your e-mail address (please provide if available -- failure to
    provide will not effect the processing of your application.)

4.  Country of citizenship.

5.  High school attended which includes name of high school, location
    (city/state), and date of diploma or GED.

6.  Work experience (Paid and non-paid experience related to the job for
    which you are applying. Include job title ((**YOU MUST INCLUDE
    SERIES AND GRADE IF FEDERAL JOB)**, duties and accomplishments,
    employer\'s name and address, supervisor\'s name and phone number,
    starting and ending dates **(including month and year),** salary,
    hours worked per week, salary).

7.  Indicate if we may contact your current supervisor.

8.  A list of other job related training, skills (for example,
    languages, tools, machinery, typing speed, etc.), certificates and
    licenses, honor societies, awards, professional membership,
    publications, leadership activities, performance awards, etc.

**\*\*Please note that if your resume or application does not provide
all the information requested in the vacancy announcement, you may lose
consideration.**

**[Forms Availability:]{.underline}** All application materials may be
obtained from all Bonneville Power Administration Human Resources
offices at 905 NE 11^th^ Avenue, Portland, OR 97232, or by calling
503-230-3810, or 1-877-975-4272 . You may also download a copy of this
announcement, including all forms from our website at
<http://www.jobs.bpa.gov./>

If you have questions, you may call the Employment Center at
503-230-3810, or 1-877-975-4272.

**Applicants should retain a copy of their application as BPA does not
return applications or provide copies.**

**[WHERE TO APPLY:]{.underline}**

If **mailing** your application, please send to the following address:
Bonneville Power Administration, ATTN: Human Resources, Employment
Center -- NHR-1, PO Box 3621, Portland, OR, 97208-3621. If applications
are delivered in person, they can be delivered to: Bonneville Power
Administration, Human Resources, Employment Center, NHR-1, 905 NE 11^th^
Avenue, Portland, OR 97232**. Please note that if you do not currently
have a building access pass, and are hand delivering your application,
you will not be able to gain access into the building after 6 p.m.**

# RECEIPT OF APPLICATION:

Your complete application must be received no later than 11:59 pm
Pacific Time (PT) of the closing date to be accepted. Applications
submitted by fax or e-mail must be time/date stamped or electronically
postmarked at point of origin no later than 11:59 pm PT.

Applicants will be notified of receipt of their application package.

# Fax Applications:

Faxed applications should be sent to 503-230-3149. Applicants are
responsible for ensuring that application materials transmit
successfully.

**[Email Applications:]{.underline}**

Applications should be sent as email attachments to: <jobs@bpa.gov>. The
Announcement Number must be included in the subject line of the email.
Required forms may be sent as email attachments, may be faxed, or sent
as hard copy. Application materials provided by different means must be
cross--referenced so they may be combined at BPA. Applicants who apply
by email will receive an email confirmation. Applicants are responsible
for ensuring that application materials are formatted in a manner that
will transmit successfully.

**Contact Information:**

Human Resources - NHR-1

Phone: 1-877-975-4272

Fax: 503-230-3149

Or Write:

Bonneville Power Administration

P.O. Box 3621

Portland OR 97208-3621

**What to Expect Next:**

You will receive notification that we have received your application.
This notification will also explain our process in more detail. You may
check the status of closed vacancy announcements on our website at:
[http://www.jobs.bpa.gov/Job_Search/index.aspx]{.underline}

[EEO Policy Statement]{.underline}

The United States Government does not discriminate in employment on the
basis of race, color, religion, sex, national origin, political
affiliation, sexual orientation, marital status, disability, age,
membership in an employee organization, or other non-merit factor.

[Reasonable Accommodation]{.underline}

Federal agencies must provide reasonable accommodation to applicants
with disabilities where appropriate. Applicants requiring reasonable
accommodation for any part of the application and hiring process should
contact the hiring agency directly. Determinations on requests for
reasonable accommodation will be made on a case-by-case basis.

[Veterans Information]{.underline}

Veterans who served on active duty in the U.S. Armed Forces and were
separated under honorable conditions may be eligible for veterans'
preference. For service beginning after October 15, 1976, the veteran
must have served the required length of time and have a Campaign Badge,
Expeditionary Medal, a service-connected disability, or have served in
the Gulf War between August 2, 1990, and January 2, 1992.

The Veterans Employment Opportunity Act (VEOA) gives veterans access to
job vacancies that might otherwise be closed to them. The law allows
eligible veterans to compete for vacancies advertised under agency's
promotion procedures when the agency is seeking applications from
outside of its own workforce.

To claim veterans' preference, veterans should be ready to provide a
copy of their DD-214, Certificate of Release or Discharge from Active
Duty, or other proof. Veterans with service connected disability and
others claiming 10 point preference will need to submit Form SF-15,
Application for 10-point Veterans' Preference.

For more specifics on all veterans employment issues such as Veterans
preference or special appointing authorities see the VetGuide.

[Legal and Regulatory Guidance]{.underline}

Privacy Act - Privacy Act Notice (PL 93-579): The information requested
here is used to determine qualifications for employment and is
authorized under Title 5 U.S.C. 3302 and 3361.

Signature - Before you are hired, you will be required to sign and
certify the accuracy of the information in your application.

False Statements - If you make a false statement in any part of your
application, you may not be hired; you may be fired after you begin
work; or you may be subject to fine, imprisonment, or other disciplinary
action.

Selective Service - If you are a male applicant born after December 31,
1959, you must certify that you have registered with the Selective
Service System, or are exempt from having to do so under the Selective
Service Law.

**BPA Form F3330-11e**

**10/06**

**APPLICANT DISABILITY, RACE/NATIONAL ORIGIN AND GENDER IDENTIFICATION**

**(Please read the instructions and Privacy Act Statement before
completing this form)**

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 7%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 8%" />
<col style="width: 3%" />
<col style="width: 46%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="15"><p><strong><u>PRIVACY ACT STATEMENT</u></strong></p>
<p>This data is being collected to plan and evaluate the agency’s
recruitment of persons with disabilities, minorities and women, and to
help ensure that agency personnel practices meet the requirements of
Federal law and regulation. The data you supply will be used for
statistical analysis only. <strong>SUBMISSION OF THIS INFORMATION IS
VOLUNTARY</strong>. Failure to provide this information will have no
effect on the processing of your application for Federal employment.
Individual personnel selections are not made based on this
information.</p>
<p><u>Authority:</u> Sections 1302, 3301, 3302, 3304 and 7201 of Title 5
of the U.S. Code, Section 2000e of Title 42 of the U.S. Code; and
Section 791 of Title 29 of the U.S. Code.</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="13">1. Vacancy Announcement Number</td>
<td colspan="2">2. Position Title, Series, Grade</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="13">3. Name <em>(Last, First, Middle Initial)</em></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="13"><strong>     </strong></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">5. Gender</td>
<td></td>
<td colspan="2">Male</td>
<td></td>
<td colspan="9">Female</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="8"><strong>6. SECTION A. DISABILITY STATUS</strong></td>
<td colspan="4"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p>A person is disabled if he or she has a physical or
mental impairment, which substantially limits one or more major life
activities. Please read the disability descriptions below and then write
the two-digit numeric code in the box above which best describes your
disability, if any. If you have more than one disability, choose the one
which results in the most substantial limitation.</p>
<p><strong>01</strong>. I do not wish to identify my handicap
status.</p>
<p><strong>05</strong>. I do not have a disability</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><p><strong><u>SPEECH/HEARING/VISION
IMPAIRMENTS</u></strong></p>
<p><strong>13</strong>. Severe speech malfunction or inability to speak;
hearing is normal (Examples: defects of articulation [unclear
language</p>
<blockquote>
<p>sounds]; stuttering; aphasia [impaired language function];
laryngectomy [removal of the “voice box”]).</p>
</blockquote>
<p><strong>15</strong>. Hard of hearing (Total deafness in one ear or
inability to hear ordinary conversation, correctable with a hearing
aid).</p>
<p><strong>16</strong>. Total deafness in both ears, with understandable
speech.</p>
<p><strong>17</strong>. Total deafness in both ears, and unable to speak
clearly.</p>
<p><strong>22</strong>. Ability to read ordinary size print with
glasses, but with loss of peripheral (side) vision (Restriction of the
visual field to the</p>
<blockquote>
<p>extent that mobility is affected – “Tunnel vision”).</p>
</blockquote>
<p><strong>23</strong>. Inability to read ordinary size print, not
correctable by glasses (can read oversize print or use assisting devices
such as</p>
<blockquote>
<p>glass or projector modifier).</p>
</blockquote>
<p><strong>24</strong>. Blind in one eye</p>
<p><strong>25</strong>. Blind in both eyes (no usable vision, may have
some light perception)</p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong><u>MISSING EXTREMITIES</u></strong></p>
<p><strong>27</strong>. One hand <strong>28</strong>. One arm
<strong>29</strong>. One foot <strong>32</strong>. One leg</p>
<p><strong>33</strong>. Both hands or arms <strong>34</strong>. Both
feet or legs</p>
<p><strong>35</strong>. One hand or arm <em><u>and</u></em> one foot or
leg <strong>36</strong>. One hand or arm <em><u>and</u></em> both feet
or legs</p>
<p><strong>37</strong>. Both hands or arms <em><u>and</u></em> one foot
or leg <strong>38</strong>. Missing both hands or arms
<em><u>and</u></em> both feet or legs.</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><p><strong><u>NONPARALYTIC ORTHOPEDIC
IMPAIRMENTS</u></strong> <em>(Because of chronic pain, stillness, or
weakness in bones or joints, there is some loss of ability to move or
use a part or parts of the body.)</em></p>
<p><strong>44</strong>. One or both hands <strong>45</strong>. One or
both feet <strong>46</strong>. One or both arms <strong>47</strong>. one
or both legs</p>
<p><strong>48</strong>. Hip or pelvis <strong>49</strong>. Back
<strong>57</strong>. Any combination of two or more parts of the
body</p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong><u>PARTIAL PARALYSIS</u></strong>
<em>(Because of a brain, nerve, or muscle problem, including palsy and
cerebral palsy, there is some loss of ability to move or use a part of
the body, including legs, arms, and/or trunk.)</em></p>
<p><strong>61</strong>. One hand <strong>62</strong>. One arm, any part
<strong>63</strong>. One leg, any part <strong>64</strong>. Both
hands</p>
<p><strong>65</strong>. Both legs, any part <strong>66</strong>. Both
arms, any part</p>
<p><strong>67</strong>. One side of the body, including one arm and one
leg. <strong>68</strong>. Three or more major parts of the body (arms
and legs)</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>7. <u>COMPLETE PARALYSIS</u></strong>
<em>(Because of a brain, nerve, or muscle problem, including palsy and
cerebral palsy, there is complete loss of ability to move or use a part
of the body, including legs, arms, and/or trunk.)</em></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>70</strong>. One hand <strong>71</strong>.
Both hands <strong>72</strong>. One arm <strong>73</strong>. Both
arms</p>
<p><strong>74</strong>. One leg <strong>75</strong>. Both legs
<strong>76</strong>. Lower half of body, including legs</p>
<p><strong>77</strong>. One side of body, including one arm and one
leg</p>
<p><strong>78</strong>. Three or more major parts of body (arms and
legs)</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong><u>OTHER IMPAIRMENTS</u></strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>80</strong>. Heart disease with no
restriction or limitation of activity <em>(History of heart problems
with complete recovery.)</em></p>
<p><strong>81</strong>. Heart disease with restriction or limitation of
activity</p>
<p><strong>82</strong>. Convulsive disorder <em>(e.g. epilepsy)</em></p>
<p><strong>83</strong>. Blood disease <em>(e.g. sickle cell anemia,
leukemia, hemophilia)</em></p>
<p><strong>84</strong>. Diabetes</p>
<p><strong>86</strong>. Pulmonary or respiratory disorders <em>(e.g.
tuberculosis, emphysema, asthma)</em></p>
<p><strong>87</strong>. Kidney dysfunction <em>(e.g. if dialysis [Use of
an artificial kidney machine is required])</em></p>
<p><strong>88</strong>. Cancer (<em>a history of cancer with complete
recovery)</em></p>
<p><strong>82</strong>. Cancer <em>(undergoing surgical and/or medical
treatment)</em></p>
<p><strong>90</strong>. Mental retardation <em>(Chronic and lifelong
condition involving a limited ability to learn, to be educated, and to
be trained for</em></p>
<blockquote>
<p><em>useful productive employment as certified by a State Vocational
Rehabilitation agency under section 213.3102(t)</em></p>
<p><em>of Schedule A.)</em></p>
</blockquote>
<p><strong>91</strong>. Mental or emotional illness <em>(A history of
treatment for mental or emotional problems.)</em></p>
<p><strong>92</strong>. Severe distortion of limbs and/or spine
<em>(e.g. dwarfism, severe distortion of the back)</em></p>
<p><strong>93</strong>. Disfigurement of face, hands, or feet (e.g.
distortion of features on skin, such as those caused by burns, gunshot
injuries,</p>
<blockquote>
<p>and birth defects [gross facial birthmarks, club feet, etc.])</p>
</blockquote>
<p><strong>94</strong>. Learning disability <em>(A disorder in one or
more of the processes involved in understanding, perceiving, or using
language</em></p>
<p><em>Or concepts [spoken or written]; e.g. dyslexia.)</em></p>
<p><strong>06</strong>. I have a disability, but it is not listed above:
Describe below:</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>     </strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>SECTION B. ETHNICITY AND RACE IDENTIFICATION:
Specific Instructions:</strong> The two questions below are designed to
identify your ethnicity and race. <strong>Regardless of your answer to
question 1, go to question 2.</strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Question 1. Are you Hispanic or
Latino?</strong> <em>(A person of Cuban, Mexican, Puerto Rican, South or
Central American, or other Spanish culture or origin, regardless of
race.)</em></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="3">Yes</td>
<td colspan="3"></td>
<td colspan="5">No</td>
<td></td>
</tr>
<tr class="even">
<td colspan="15"><strong>Question 2.</strong> Please select the racial
category or categories with which you most closely identify by placing
an “X” in the appropriate box(s). Check as many as apply.</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="9"><p><strong>RACIAL CATEGORY</strong></p>
<p><em><strong>(Check as many as apply)</strong></em></p></td>
<td colspan="2"></td>
<td colspan="5"><strong>DEFINITION OF CATEGORY</strong></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">American Indian or Alaska Native</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the original peoples
of North and South America <em>(including Central America)</em>, and who
maintains tribal affiliation or community attachment.</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Asian</td>
<td colspan="2"></td>
<td colspan="5">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.</td>
</tr>
<tr class="odd">
<td colspan="11"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Black or African American</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the black racial
groups of Africa</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="8"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Native Hawaiian or Other Pacific Islander</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the original peoples
of Hawaii, Guam, Samoa, or other Pacific Islands.</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="8"></td>
<td colspan="2"></td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">White</td>
<td colspan="2"></td>
<td colspan="5">A person having origins in any of the original peoples
of Europe, the Middle East, or North Africa.</td>
</tr>
</tbody>
</table>