FORM RSA-113 OMB Approval No.: 1820-0013

 Expiration Date: [Pending]

QUARTERLY CUMULATIVE CASELOAD REPORT

Rehabilitation Services Administration

OSERS/US DEPARTMENT OF EDUCATION

Fiscal Year 

Period Covered

[ ] Blind [ ] Oct-Dec [ ] Oct-Jun

State [ ] General/Combined [ ] Oct-Mar [ ] Oct-Sep

Operated Under Order Of Selection During Period? [ ] Yes 

[ ] No

CASELOAD ITEMS TOTAL 

NUMBER

NUMBER WITH 

SIGNFICANT 

DISABILITY

A. APPLICATIONS AND ELIGIBILITY

Applicants

1 Applicants On Hand October 1

2 Applicants, New This FY 

3 Applicants At End Of Period (A1+A2-A5-A8-A12-D7)

4 Applicants In Trial Work/EE On Hand, October 1

5 Applicants In Trial Work/EE Referred This FY

6 Applicants In Trial Work/EE At End Of Period

 (A4+A5-A9-A13-D6)

Eligible Individuals On Order Of Selection (OOS) Waiting List

7 Individuals On OOS Waiting List On Hand October 1

8 Individuals On OOS Waiting List, New This FY From

 Application

9 Individuals On OOS Waiting List, New This FY From

 Trial Work/EE

10 Individuals On OOS Waiting List At End Of Period

 (A7+A8+A9-A14-D5)

Individuals Determined Eligible, Before Signed IPE

11 Eligible Individuals Before Signed IPE On Hand,

 October 1

12 Eligible Individuals Before Signed IPE, New This FY From 

Application

13 Eligible Individuals Before Signed IPE, New This FY From Trial 

Work/EE

14 Eligible Individuals Before Signed IPE, New This FY From OOS 

Waiting List

15 Eligible Individuals Before Signed IPE At End Of Period 

(A11+A12+A13+A14-B2-D3)
CASELOAD ITEMS TOTAL 

NUMBER

NUMBER WITH 

SIGNFICANT 

DISABILITY

B. DEVELOPMENT OF INDIVIDUALIZED PLAN FOR EMPLOYMENT (IPE)

1 Individuals With Signed IPE, Before Receiving Services, On 

Hand October 1

2 Individuals With Signed IPE, Before Receiving Services, This 

FY

3 Individuals With Signed IPE, Before Receiving Services, At End 

Of Period (B1+B2-C2-D4)

C. SERVICE IMPLEMENTATION

1 Individuals Receiving Services, On Hand October 1

2 Individuals Receiving Services, Beginning This FY

3 Individuals Receiving Services At End Of Period

(C1+C2-D1-D2)

D. OUTCOMES FOR INDIVIDUALS EXITING THE PROGRAM

1 Individuals Exiting With Employment Outcomes

2 Individuals Exiting Without Employment, After Receiving 

Services

3 Individuals Exiting Without Employment, After Eligibility, 

Before Signed IPE

4 Individuals Exiting Without Employment, After Signed IPE, 

Before Receiving Services

5 Individuals Exiting From OOS Waiting List

6 Individuals Exiting From Trial Work/EE

7 Individuals Exiting As Applicants

8 Total Number Of Individuals Exiting The Program 

(D1+D2+D3+D4+D5+D6+D7)

Contact Person (Please Print) Phone Number _______

E-mail address ____________

Date Authorized Signature 

Public Burden Statement

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. Public 

reporting burden for this collection of information is estimated to average 1.0 hour 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 required to obtain or retain benefit (Rehabilitation 

Act of 1973, as Amended). 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 20202-4536 or email ICDocketMgr@ed.gov and 

reference the OMB Control Number 1820-0013. Note: Please do not return the completed 1820-0013 to 

this address.