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APPENDIX A

QUESTIONNAIRE
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On-line Survey of 

State Vocational Rehabilitation (VR) Agencies 

on the Delivery of Services through the VR Grants Program

To enter the Survey of State VR Agencies on the Delivery of Services through the VR Grants 

Program, please type your Login and Password in the boxes below, then click Login. The 

next page will be the first page of the survey you are requested to complete.

User Login:

Password:

US Department of Education

Rehabilitation Services Administration

OMB # 1820-xxxx

Expiration Date: xx-xx-xxxx

This survey is designed to be completed by the person(s) most knowledgeable about 

the delivery of state VR services, including knowledge of your agency’s policies and 

practices in providing VR services to individuals with disabilities. 

Public Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collec tion 

of information unless such collection displays a valid OMB control number. Public reporting burden for 

this collection of information is estimated to average 90 hours per response, including time for 

reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and 

completing and reviewing the collection of information. The obligation to respond to this collection is 

voluntary (Section 14(a) of the Rehabilitation Act (P.L. 93-112; P.L. 105-220). Send comments 

regarding the burden estimate or any other aspect of this collection of information, including suggestions 

for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, 

DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820-XXXX. 

Note: Please do not return the completed Study of the Delivery of Services under the State Vocational 

Rehabilitation Grants Program to this address. 
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On-line Survey of State VR Agencies on the Delivery of Services 

through the VR Grants Program

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Instructions

The frame of reference for the survey is October 2011 through September 2012, Federal Fiscal Year 

(FFY) 2012. When asked to provide numbers, amounts, or percentages, please provide values as of 

September 30, 2012, unless otherwise specified. 

VR Agency: _______________________________________________ Date: _____ / _____ / _______

(DD/MM/YYYY)

Completed by:__________________________________ Title: __________________________

Completed by:__________________________________ Title: __________________________

Completed by:__________________________________ Title: __________________________

I. AGENCY STRUCTURE AND STAFF

1. Please indicate the number of local VR offices operated by the VR agency on 

September 30, 2012 through which you delivered services: 

_______

2. On September 30, 2012, how many of your agencies counselors had a general 

caseload, a specialized caseload, or a mixed caseload of general and specialized 

cases? What was the average caseload size for each type of caseload? Please use the 

table below to provide your response.

Type of caseload Number of 

counselors

Average 

caseload

General caseload

Specialty caseload

Mixed caseload of general and specialty

3. How much money was available in FFY 2012 per counselor to serve any client and/or 

purchase any service?

$_______

_______ Agency does not designate amounts per counselor
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4. Is the VR agency currently facing any of the following limitations on its operations?

 Yes [CHECK ALL THAT APPLY]

 State-level hiring freeze

 State unable to provide matching funding

 Budget cuts to other agencies reduce ability to obtain match 

through agreements

 Implementation of legislation to merge agency

 Implementation of legislation to split combined agency

 Designated state agency (DSA) making changes that weaken 

designated state unit (DSU)

 Other (specify)

 No

5. What, if any, particular actions has the agency taken in the past year to address 

recruitment and retention of VR agency staff? (CHECK ALL THAT APPLY)

 Strengthened relationship with University programs

 Increased amount of staff training

 Revised CSPD standards and/or goals

 Expanded authority and autonomy of field staff

 Revised pay scales 

 Other (specify)

Comprehensive Residential Rehabilitation Center 

6. Did the VR agency operate a comprehensive residential rehabilitation center (i.e., a 

residential facility that provides a wide array of rehabilitation services to individuals with 

all types of disabilities) in FFY 2012?

 Yes

 No [SKIP TO ITEM 7]

6a. Please indicate the number of FTE staff positions at the center on September 

30, 2012:

_______

6b. Please indicate the total amount of funds used to support the center in FFY 

2012:

$_______
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6c. Please indicate the total number of individuals who completed services at 

comprehensive residential rehabilitation center in FFY 2012:

_______

Orientation and Training Centers

7. Did the VR agency operate any orientation and training centers (OTCs) for blind

persons in FFY 2012?

 Yes

 No [SKIP TO ITEM 8]

7a. Please indicate the number of OTCs the VR agency operated on September 30, 

2012:

_______

7b. Please indicate the number of FTE staff positions at the OTCs on September 

30, 2012:

_______

7c. Please indicate the total amount of funds used to support the OTCs in FFY 

2012:

$_______

7d. Please indicate the total number of individuals who completed services at OTCs 

for blind persons in FFY 2012?

_______

Centers for Deaf or Hard of Hearing

8. Did the VR agency operate any specialized (or state run) centers for services for 

individuals who are deaf or hard of hearing in FFY 2012?

 Yes

 No [SKIP TO ITEM 9]
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8a. Please indicate the number of centers for the deaf or hard of hearing the VR 

agency operated on September 30, 2012:

_______

8b. Please indicate the number of FTE staff positions at the center(s) for the deaf 

and hard of hearing on September 30, 2012:

_______

8c. Please indicate the total amount of funds used to support the center(s) for the 

deaf and hard of hearing in FFY 2012:

$_______

8d. Please indicate the total number of individuals who completed services at 

centers for individuals who are deaf or hard of hearing in FFY 2012?

_______

Other Centers 

9. Did the VR agency operate any other centers through which it delivered centralized 

services (e.g., vocational evaluation, assistive technology) in FFY 2012?

 Yes

 No [SKIP TO ITEM 10]

9a. Please indicate the number of other service centers the VR agency operated on 

September 30, 2012 and the type(s) of centralized service(s) they delivered:

# _______

Type(s) of service(s)

9b. Please indicate the number of FTE staff positions at these other service centers 

on September 30, 2012:

_______
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9c. Please indicate the total amount of funds used to support these other service 

centers in FFY 2012:

$_______

9d. Please indicate the total number of individuals who completed services at these 

other centers in FFY 2012?

_______

Order of Selection

10. Is the VR agency currently operating under an order of selection (OOS) regardless of 

having wait list categories open or closed?

 Not operating under OOS [SKIP TO ITEM 11]

 Yes

10a. What factors does the VR agency consider in opening a wait listed category? 

[CHECK ALL THAT APPLY]

 Sufficient number of staff

 Federal funding

 State matching funds

 Forecasts of the number of individuals to be served

 Current caseload size

 Other (specify)

Vendors in General (All Providers of Purchased Services)

11. Approximately how many vendors did business with the VR agency in FFY 2012? 

_______ (number of vendors)

12. How would you characterize the supply of VR vendors in the state in FFY 2012 with 

regard to types of services they provide?

 Adequate to meet the needs of individuals for all types of services

 Adequate to meet the needs of individuals for most types of services

 Adequate to meet the needs of individuals for only a few types of 

services

 Inadequate to meet the needs of individuals for any types of services
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13. How would you characterize the supply of vendors in the state in FFY 2012 

geographically?

 Adequate to meet the needs of individuals in all areas of the state

 Adequate to meet the needs of individuals in only high population density 

areas of the state

 Inadequate to meet the needs of individuals in any areas of the state

14. How did the VR agency ensure reasonable costs for purchased services in FFY 2012? 

[CHECK ALL THAT APPLY]

 Agency did not purchase services [SKIP TO ITEM 20]

 Use competitive bid process

 Use performance-based contracting

 Monitor service providers

 Require certification (e.g., CARF)

 Establish service cost list

 Other (specify)

15. To what extent did the VR agency use performance-based contracts for client services 

in FFY 2012 in which vendors are paid only after individuals achieve certain 

milestones?

 VR agency did not use performance-based contracts at all

 VR agency used performance-based contracts only with vendors of 

specific services (specify services)

 VR agency used performance-based contracts with all vendors

16. What were the VR agency’s sources of information in FFY 2012 on the costs and 

performance of specific vendors? [CHECK ALL THAT APPLY]

 Formal on-site monitoring on an annual or more frequent basis

 Formal on-site monitoring less often than annually

 Written reports from agency vendors

 Vendor invoices

 Counselor assessment

 Purchasing technician assessment

 Client assessment/satisfaction

 Other (specify)

17. Did the VR agency’s data system provide counselors with access to information on the 

quality and performance of specific vendors in FFY 2012?

 Yes

 No
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18. Did the VR agency’s data system provide counselors with access to information on the 

costs of specific services of vendors in FFY 2012?

 Yes

 No

19. What is the greatest challenge to improving the quality and availability of vendors?

II. SERVICE DELIVERY APPROACHES

20. Which of the following best characterizes the VR agency’s overall approach to 

delivering services in FFY 2012?

 VR agency delivered a greater number of services directly through 

agency-employed staff

 VR agency purchased most services

 An equal amount of services were delivered directly through VR agencyemployed staff and purchased

21. In the last five years, has the VR agency changed (i.e., increased or decreased) the 

number of services delivered directly through agency-employed staff?

 Yes, VR agency has increased the number of services provided directly 

through agency-employed staff

 Yes, VR agency has decreased the number of services provided directly 

through agency employed staff

 No, VR agency has not changed the number of services provided directly 

through agency-employed staff [SKIP TO ITEM 24]

22. Why did the VR agency implement this change in the way it delivers services? 

[SELECT THE MOST IMPORTANT REASON]

 To improve consumer outcomes 

 To obtain more control over cost of services

 To reduce costs

 To mitigate agency staffing issues (i.e., recruitment and retention of 

qualified staff)

 To improve availability of vendors

 To ensure quality of service delivery

 To improve access to services in rural areas

 Other (specify)
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23. To what extent has this change(s) in the way the VR agency delivers services met the 

intended purpose of the VR agency?

 Great extent

 Some extent

 Not at all

 Too early to know

24. Among the factors listed below, and recognizing that they include consumer, funding, 

or organizational challenges, please rank the three greatest challenges to improving 

the delivery of VR services, with 1 being the greatest challenge.

Rank

a. Inadequate funding generally

b. Inability to secure full state matching funds

c. Impact of Maintenance of Effort (MOE) on the willingness of the 

state to match reallotment dollars

d. Lack of transportation

e. Insufficient number of vendors

f. Staff vacancies and/or turnover

g. Order of selection status

h. Lack of extended services funding for individuals in supported 

employment (SE)

i. State procurement regulations

j. Insufficient interagency coordination at state level

k. Insufficient interagency coordination at local level

l. Limited control over key administrative decisions

m. Other (specify)

25. Please describe what steps, if any, the agency is taking to address these challenges.

VR Counseling Services

26. Did the VR agency operate with specifically assigned “VR Service Delivery Teams” 

(teams of internal, or internal and external, members for delivery of specific services) in 

FFY 2012?

 Yes (please describe the composition of those teams and the populations 

they serve)

 No
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27. Did the VR agency contract with any private entities for counseling services (i.e., 

persons who perform delegable VR functions) in FFY 2012?

 Yes (specify number of private counselors under contract during FFY 

2012): _____

 No

28. Has the VR agency changed its approach to delivering counseling services in the last 

five years (e.g., focusing previously generalized counselors, switching to a team 

approach, or making policy changes, including regarding an order of selection)?

 Yes (please describe):

 No [SKIP TO ITEM 31]

29. Why did the VR agency implement this change in its approach to delivering counseling 

services? [SELECT THE MOST IMPORTANT REASON]

 To improve consumer outcomes 

 To obtain more control over costs

 To reduce costs

 To ensure quality of service delivery 

 To mitigate agency staffing issues (i.e., recruitment and retention of 

qualified staff)

 To improve information support system for counselors

 To improve access to services in rural areas

 Other (specify)

30. To what extent has this change in the VR agency’s approach to delivering counseling 

services met the intended purpose?

 Great extent 

 Some extent

 Not at all

 Too early to know

31. What is the greatest challenge to improving counseling services?
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Other Services

Job Placement

32. How did the VR agency deliver job placement services in FFY 2012? [CHECK ALL 

THAT APPLY]

 VR agency purchased job placement services

 VR agency provided job placement services directly through specialists

 VR agency provided job placement services directly through VR 

counselors

 Other (specify)

33. How did the VR agency deliver the majority of job placement services in FFY 2012? 

[CHECK ONLY ONE]

 VR agency purchased job placement services

 VR agency provided job placement services directly through specialists

 VR agency provided job placement services directly through VR 

counselors

 Other (specify)

34. What is the greatest challenge to improving job placement services?

Vocational Evaluation

35. How did the VR agency deliver vocational evaluation services in FFY 2012? [CHECK 

ALL THAT APPLY]

 VR agency purchased vocational evaluation services

 Another state agency provided vocational evaluation services

 VR agency provided vocational evaluation services directly through 

vocational evaluators

 VR agency provided vocational evaluation services directly through 

counselor(s) with vocational evaluation skills

 VR agency both purchased vocational evaluation services and directly 

provided the services

 Other (specify)

36. What is the greatest challenge to improving vocational evaluation services?
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Assistive Technology

37. How did the VR agency deliver assistive technology services in FFY 2012? [CHECK 

ALL THAT APPLY]

 VR agency purchased assistive technology services

 VR agency provided assistive technology services directly through 

specialists

 VR agency provided assistive technology services as a comparable 

benefit from another state or local agency/entity

 Other (specify)

38. What is the greatest challenge to improving assistive technology services?

III. TARGET POPULATIONS AND PARTNERSHIPS

Coordination With Education Agencies – Transitional Youth

39. Did any of the VR counselors with general caseloads serve transitional youth in FFY 

2012?

 Yes

 No [SKIP TO ITEM 40]

39a. Approximately what percentage of transitional youth served by the VR agency 

was served by VR counselors with general caseloads on September 30, 2012? 

_______ %
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40. Did the VR agency co-locate any VR counselors at secondary or postsecondary 

schools in FFY 2012?

 Yes ____ Number of counselors co-located at schools in FFY 2012

 No 

41. Did the VR agency employ any individuals at the state level with responsibility for 

coordinating or managing services to transitional youth in FFY 2012?

 Yes _____ Number of FTEs

 No [SKIP TO ITEM 43]

42. Please indicate the responsibilities of state-level staff dedicated to coordinating or 

managing services to transitional youth. [CHECK ALL THAT APPLY]

 Training and technical assistance

 Consultation with VR counselors

 Participation in interagency committees focused on transition

 Development of curricula

 Outreach to school and other community organizations

 Initiating VR IPE services to students while in high school

 Other (specify)

43. Is the VR agency considering implementing any changes in the delivery of VR services 

to transitional youth?

 Yes (briefly describe changes the agency is considering):

 No

44. What is the greatest challenge to improving services and outcomes for transitional 

youth?
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Coordination With Intellectual and Developmental Disabilities Agencies

45. Did the VR agency have a cooperative agreement or memorandum of understanding 

(MOU) with the state intellectual or developmental disabilities (IDD) agency in FFY 

2012?

 Yes

 No [SKIP TO ITEM 47]

46. What was the focus of the agreement and/or MOU? [CHECK ALL THAT APPLY]

 Cooperation and coordination in referral for VR services

 Cooperation and coordination for provision of VR services

 Funding and delivery of supported employment services

 Funding of extended support services

 Other (specify)

47. Is the VR agency considering implementing any changes in the way the agency 

delivers VR services to individuals with intellectual or developmental disabilities?

 Yes (briefly describe changes the agency is considering):

 No

48. What is the greatest challenge to improving services and outcomes for individuals with 

intellectual or developmental disabilities?

Coordination With State and Local Mental Health Agencies

49. Did the VR agency have a cooperative agreement or memorandum of understanding 

(MOU) with the state agency that administers mental health (MH) services in FFY 

2012?

 Yes

 No [SKIP TO ITEM 51]
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50. What was the focus of the agreement or MOU? [CHECK ALL THAT APPLY]

 Cooperation and coordination in referral for VR services

 Cooperation and coordination for provision of VR services

 Funding and delivery of supported employment services

 Funding of extended support services

 Other (specify)

51. Is the VR agency considering implementing any changes in the way the agency 

delivers VR services to individuals with mental illness?

 Yes (briefly describe changes the agency is considering):

 No

52. What is the greatest challenge to improving services and outcomes for individuals with 

mental illness?

Coordination With Social Security Administration – SSI/SSDI Recipients

53. Did the VR agency have cooperative agreements or memoranda of understanding 

(MOUs) with state, regional or local offices of the Social Security Administration (SSA) 

Employment Networks (ENs) in FFY 2012? 

 Yes (specify the number of such agreements or MOUs): _______

 No [SKIP TO ITEM 55]

54. What was the focus of the agreements or MOUs? [CHECK ALL THAT APPLY]

 To expedite eligibility determination

 To improve the employment rate of SSI/SSDI recipients

 To improve the use of work incentives for Social Security disability 

beneficiaries

 Other (specify)
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55. Was the VR agency designated as an EN under the SSA’s Ticket to Work program in 

FFY 2012?

 Yes

 No

56. How did the VR agency provide benefits counseling services in FFY 2012 to individuals 

who receive Supplemental Security Income (SSI) or Social Security Disability 

Insurance (SSDI)?

 VR agency did not provide benefits counseling services [SKIP TO ITEM 

86]

 VR agency provided benefits counseling services directly through 

agency-employed benefits counselors

 VR agency provided benefits counseling services as a comparable 

benefit through SSA funded WIPA program

 VR agency provided benefits counseling services as a comparable 

benefit through Centers for Independent Living

 VR agency purchased benefits counseling services from Community 

Rehabilitation Programs or individuals

57. In the last five years, has the VR agency changed the manner through which it provides 

benefits counseling services?

 Yes (briefly describe):

 No [SKIP TO ITEM 59]

58. To what extent has this change in the manner through which the VR agency provides 

benefits counseling services led to improved quality of employment outcomes for SSA 

beneficiaries served by your agency (e.g., competitive employment; working above 

Substantial Gainful Activity level)?

 Great extent

 Some extent

 Not at all

 Too early to know

59. Were benefits counseling services sufficiently available in the state to meet the needs 

of individuals served by the VR agency in FFY 2012?

 Yes

 No
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60. Is the VR agency considering implementing any changes in the way the agency 

delivers VR services to individuals receiving SSA benefits?

 Yes (briefly describe changes the agency is considering):

 No

61. What is the greatest challenge to improving services and outcomes for individuals who 

are SSI/SSDI recipients?

Coordination With One-Stop Career Centers

62. Did the VR agency have a cooperative agreement or memorandum of understanding 

(MOU) with the state agency that administers one-stop career centers under the 

Workforce Investment Act (WIA) in FFY 2012? 

 Yes

 No

63. Did the VR agency have cost sharing agreements in place with the state agency that 

administers the one-stop career centers in FFY 2012?

 Yes

 No

64. Did the VR agency co-locate any VR counselors at one-stop career centers in FFY 

2012?

 Yes

 No [SKIP TO ITEM 65]

64a. Please indicate the number of VR counselors who were co-located at one-stop 

career centers on a full-time basis on September 30, 2012:

_______

64b. Please indicate the number of VR counselors who were co-located at one-stop 

career centers on a part-time basis on September 30, 2012:

_______
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64c. Please indicate the advantages to the VR agency of co-locating VR counselors 

at one-stop career centers. [CHECK ALL THAT APPLY]

 No advantages

 Increased number of referrals to VR

 Increased employer awareness of VR

 Ready access to labor market information

 Other (specify)

64d. Please indicate the disadvantages to the VR agency, if any, of co-locating VR 

counselors at one-stop career centers. [CHECK ALL THAT APPLY]

 No disadvantages

 Concerns of client confidentiality 

 Costs

 Other (specify)

65. What is the greatest challenge to improving service coordination with the state’s onestop career centers?
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Other Collaborations

66. With which, if any, of the following other agencies/organizations did the VR agency

have formal written agreements or memoranda of understanding (MOUs) to collaborate 

in serving individuals with disabilities in FFY 2012? For each agency, please briefly 

describe the focus of the collaboration.

 State Office for Department of Veterans Affairs (describe):

 Public Housing Authority (describe):

 State Department of Corrections/Juvenile Justice (describe):

 Temporary Assistance for Needy Families (TANF) (describe):

 Child Protective Services (describe):

 American Indian VR Services Program (Section 121 program) (describe):

 American Indian Tribe or Nation (describe):

 State Employment Service Agency (describe):

 State council or foundation on head and/or spinal injury (describe):

 Independent Living Center:

 Other agency (please specify):

67. What is the greatest challenge to improving collaboration with other state and local 

agencies?
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IV. FISCAL AND PROGRAM PLANNING

68. How often does VR agency program staff meet with agency fiscal staff for financial 

planning purposes? (CHECK ONLY ONE)

___ at least weekly

___ at least monthly

___ at least quarterly

___ at least semi-annually

___ at least annually

___ Not Applicable

69. How often does VR agency program staff meet with agency fiscal staff for reconciling 

VR program reporting and VR fiscal reporting? (CHECK ONLY ONE)

___ at least weekly

___ at least monthly

___ at least quarterly

___ at least semi-annually

___ at least annually

___ Not Applicable

70. Is the VR agency’s case management system used to track costs?

Cost per client ___ Yes ___ No

Cost per service category ___ Yes ___ No

Vendor costs ___ Yes ___ No

END OF SURVEY

Thank you for participation and completion of the survey.