### FORM RSA - 113 OMB Approval No.: 1820 - 0013 Expiration Date: **[Pending] QUARTERLY CUMULATIVE CASELOAD REPORT**  Rehabilitation Services Administration OSERS/US DEPARTMENT OF ED UCATION 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, Be fore 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 Individu als 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 Indivi duals 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 Exitin g 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

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**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 numb er. 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 reviewin g 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 informatio n, 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 18 20 - 0013 to this address.