OMB Control Number: 1820 - 0508 Expires 

# Reporting Manual for the CASE SERVICE RECORD REPORT

(RSA- 911) State - Federal Program for Vocational Rehabilitationi



### Contents **GENERAL	INSTRUCTIONS ................................**  **................................ ................................**  **............... VIII**  **INSTRUCTIONS	FOR	PRE PARATION	OF	ELECTR** **ONIC	TRANSMITTAL ............................**  **XIII COMPARISON	OF	THE	NE** **W	RSA -**  **911	CASE	SERVICE	REP ORT	TO	THE**  **PREVIOUS	RSA -**  **911	CASE	SERVICE	REP ORT	AS	A	RESULT	OF**  **THE WORKFORCE	INNOVATION**  **AND	OPPORTUNITY	ACT (WIOA)	SIGNED**  **INTO	LAW	ON	JULY	22, 2014**  **................................ ................................**  **................................ ........**  **XV ELEMENT**  **- BY** **- ELEMENT	INSTRUCTIONS**  **:	CASE	SE RVICE	RECORD**  **REPORT	(RSA -**  **911) ................................**  **................................ ................................**  **............................. 2**  **1. Agency Code**  **................................ ................................**  **................................ ................................**  **.............. 3**  **2. Social Security Number**  **................................ ................................**  **................................ ..............................**  **4 3.**  **Calendar Year ................................**  **................................ ................................**  **................................ ............**  **5 4.**  **Calendar Quarter**  **................................ ................................**  **................................ ................................**  **....... 5**  **5. Start Date of Pre**  **- Employment Transition Services**  **................................ ................................**  **..................... 5**  **6. Date of Application**  **................................ ................................**  **................................ ................................**  **.... 6**  **7. Date of Birth**  **................................ ................................**  **................................ ................................**  **.............. 6**  **8. Gender**  **................................ ................................**  **................................ ................................**  **....................... 6**  **RA CE**  **................................ ................................**  **................................ ................................**  **................................ 6**  **9. White**  **................................ ................................**  **................................ ................................**  **......................... 7**  **10. Black or African American**  **................................ ................................**  **................................ ..........................**  **7 11.**  **American Indian or Alaska Native ................................**  **................................ ................................**  **.............. 7**  **12. Asian**  **................................ ................................**  **................................ ................................**  **.......................... 7**  **13. Native Hawaiian or Other Pacific Islander**  **................................ ................................**  **................................ ..**  **7 14.**  **Ethnicity -**  **Hispanic or Latino ................................**  **................................ ................................**  **..................... 7**  **15. Veteran Status at**  **Application ................................**  **................................ ................................**  **.................... 8**  **16. Source of Referral at Application**  **................................ ................................**  **................................ ...............**  **9**ii

**17. Living Arrangement at Application**  **................................ ................................**  **................................ ...........**  **10 18.**  **Indicators of Poor Work History at Application**  **................................ ................................**  **........................ 10**  **19. Lack of Work Experience at Application**  **................................ ................................**  **................................ ...**  **10 20.**  **Lack of Educational or Occupational Skills Attainment at Application ................................**  **...................... 10**  **21. Dislocation from High**  **- Wage and High**  **- Benefit Employment at Application**  **................................ .............**  **10 22.**  **Limi ted English, Low Literacy, Cultural Barriers at Application**  **................................ ................................**  **. 10**  **23. Homelessness at Application**  **................................ ................................**  **................................ ...................**  **11 24.**  **Offender Status at Application ................................**  **................................ ................................**  **................. 11**  **25. Welfare Dependency at Application**  **................................ ................................**  **................................ ........**  **11 26.**  **Single Parent at Application ................................**  **................................ ................................**  **..................... 12**  **27. Basic Skills Deficient at Application**  **................................ ................................**  **................................ ..........**  **12 28.**  **Foster Care Youth Status at Application ................................**  **................................ ................................**  **... 12**  **29. Displaced Homemaker at Application**  **................................ ................................**  **................................ ......**  **12 30.**  **Low Income at Application ................................**  **................................ ................................**  **...................... 13**  **31. Migrant and Seasonal Farmworker Status at Application**  **................................ ................................**  **........ 13**  **32. Dislocated Worker at Application**  **................................ ................................**  **................................ ............**  **14 33.**  **Long -** **Term Unemployed Status at Application ................................**  **................................ .........................**  **14 34.**  **Date of Last Paid Employment at Application ................................**  **................................ ..........................**  **15 35.**  **Exhausted Part A Title IV of Social Security within 2 Years**  **................................ ................................**  **....... 15**  **36. Employment Status at Application**  **................................ ................................**  **................................ ...........**  **15 37.**  **Primary Occupation at Application ................................**  **................................ ................................**  **.......... 17**  **38. Hourly Wage at Application**  **................................ ................................**  **................................ .....................**  **17 39.**  **Hours Worked in a Week at Application ................................**  **................................ ................................**  **.. 18**  **MONTHLY PUBLIC SUPPORT A MOUNT A**  **T A PPLICA** 

**TION ................................**  **................................ .**  **18 40.**  **Social Security Disability Insurance (SSDI) ................................**  **................................ ................................**  **19 41.**  **Supplemental Security Income (SSI) for the Aged, Blind or Disabled**  **................................ ........................**  **19 42.**  **Temporary Assistance for Needy Families (TANF) ................................**  **................................ ....................**  **19**iii

**43. General Assistance (State or local government)**  **................................ ................................**  **....................... 19**  **44. Veterans' Disability Benefits**  **................................ ................................**  **................................ ....................**  **19 45.**  **Workers' Compensation ................................**  **................................ ................................**  **.......................... 20**  **46. All Other Public Support**  **................................ ................................**  **................................ ..........................**  **20 47.**  **Primary Source of Support at Application**  **................................ ................................**  **................................ 20**  **ME DICA** **L INSURA NCE COVERA** **GE A T A** **PPLICA**

**TION ................................**  **................................ ........**  **20 48.**  **Medicaid ................................**  **................................ ................................**  **................................ ..................**  **20 49.**  **Medicare ................................**  **................................ ................................**  **................................ .................**  **20 50.**  **Public Insurance from Other Sources (Workers' Compensation, Children's Health Insurance Program, etc)**  **................................ ................................**  **................................ ................................**  **........... 21**  **51. Private Insurance Through Own Employer**  **................................ ................................**  **............................... 21**  **52. Not Yet Eligible for Private Insurance through Current Employer, But Will Be Eligible for Private**  **Insurance after a Certain Period of Employment ................................**  **................................ .....................**  **21 53.**  **Private Insurance through Other Means ................................**  **................................ ................................**  **.. 21**  **54. State or Federal Affordable Care Act Exchange**  **................................ ................................**  **........................ 21**  **55. Date of Eligibility Determination**  **................................ ................................**  **................................ ..............**  **21 56.**  **Date of Placement on Order of Selection (OOS) Waiting List ................................**  **................................ ...**  **21 57.**  **Date of Exit from OOS Waiting List ................................**  **................................ ................................**  **.......... 21**  **58. Zip Code**  **................................ ................................**  **................................ ................................**  **................... 22**  **59. County Name**  **................................ ................................**  **................................ ................................**  **........... 22**  **60. FIPS Code**  **................................ ................................**  **................................ ................................**  **................. 22**  **61. Organizations Referred To:**  **................................ ................................**  **................................ ......................**  **22 62.**  **Involvement with Other Agencies and Services ................................**  **................................ .......................**  **24 EDUC**  **AT ION**  **................................ ................................**  **................................ ................................**  **.................. 25**  **63. No formal schooling**  **................................ ................................**  **................................ ................................**  **. 25**  **64. Enrolled in elementary education**  **in grades 1 -** **8 ................................**  **................................ .......................**  **25 65.**  **Completed elementary education (grades 1 -** **8) ................................**  **................................ ........................**  **25 66.**  **Enrolled in secondary education in grade 9 ................................**  **................................ .............................**  **26**iv

**67. Completed**  **secondary education through grade 9 ................................**  **................................ ...................**  **26 68.**  **Enrolled in secondary education in grade 10 ................................**  **................................ ............................**  **26 69.**  **Completed secondary education through grade 10 ................................**  **................................ ..................**  **26 70.**  **Enrolled in secondary education in grade 11 ................................**  **................................ ............................**  **26 71.**  **Completed secondary education through grade 11 ................................**  **................................ ..................**  **26 72.**  **Enrolled in secondary education in grade 12 ................................**  **................................ ............................**  **26 73.**  **Completed secondary education through grade 12, no high school diploma ................................**  **........... 26**  **74. Enrolled in a state adult high school at the high ASE level**  **................................ ................................**  **....... 26**  **75. Attained high school diploma or equivalency certificate (GED)**  **................................ ................................**  **26 76.**  **Completed some speci al education, no certificate of completion/diploma**  **................................ .............**  **26 77.**  **Enrolled in special education ................................**  **................................ ................................**  **................... 26**  **78. Attained special education certificate of completion/diploma**  **................................ ................................**  **26 79.**  **Completed some postsecondary education, no degree or certificate ................................**  **....................... 26**  **80. Enrolled in postsecondary education**  **- 1st academic year**  **................................ ................................**  **........ 26**  **81. Enrolled in postsecond**  **ary education -**  **2nd academic year ................................**  **................................ .......**  **26 82.**  **Attained Associate degree ................................**  **................................ ................................**  **....................... 27**  **83. Enrolled in postsecondary education**  **- 3rd academic year**  **................................ ................................**  **....... 27**  **84. Enrolled in postsecondary education**  **- 4th academic year**  **................................ ................................**  **....... 27**  **85. Attained Bachelor's degree**  **................................ ................................**  **................................ ......................**  **27 86.**  **Attained Master’s degree ................................**  **................................ ................................**  **........................ 27**  **87. Attained degree above a Master's**  **- e.g. Ph.D., Ed.D., J.D., M.D.**  **................................ ..............................**  **27 88.**  **Enrolled in a career or technical training program that does not lead to a recognized postsecondary credential**  **................................ ................................**  **................................ .........................**  **27 89.**  **Enrolled in a career or technical training program that leads to a recognized postsecondary credential**  **................................ ................................**  **................................ ................................**  **................ 27**  **90. Attained Vocational/Technical Certificate**  **................................ ................................**  **............................... 27**  **91 .**  **Attained Vocational/Technical License ................................**  **................................ ................................**  **.... 27**  **92. Student with Disabilities**  **................................ ................................**  **................................ ..........................**  **27**v

**93. State Definition for Age of Students with Disabilities**  **................................ ................................**  **.............. 28**  **94. Primary Disability**  **................................ ................................**  **................................ ................................**  **.... 28**  **95. Secondary Disability**  **................................ ................................**  **................................ ................................**  **28 96.**  **Significance of Disability ................................**  **................................ ................................**  **.......................... 30**  **97. Start Date**  **of Trial Work Experience ................................**  **................................ ................................**  **......... 31**  **98. End Date of Trial Work Experience**  **................................ ................................**  **................................ ...........**  **31 99.**  **Date of Most Recent or Amended Individualized Plan for Employment (IPE) ................................**  **........... 31**  **100. Start Date of Initial VR Service**  **................................ ................................**  **................................ .................**  **31 101.**  **Supported Employment Goal on Current IPE ................................**  **................................ ...........................**  **32 SERVICES PROVIDED A** **ND COSTS FOR PURCHA SED SERVICES**  **................................ ...................**  **32 1)**  **Services Provided ................................**  **................................ ................................**  **................................ .....**  **32 2)**  **Prima ry Purchased VR Service Provider Type**  **................................ ................................**  **........................... 34**  **3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services**  **................................ .....**  **35 4)**  **Supported Employment State Grant (Title VI) Funds Used to Purchase Services ................................**  **...... 35**  **5) Comparable Services and Benefits Provider**  **................................ ................................**  **............................. 35**  **SERVICE CA**

**TE GORIES FOR PRE**  **- EM**  **PLOYMENT TRA NSITION STUDENTS**  **................................ ...**  **37**  Job Exploration Counseling
................................ ................................ ................................ ........................... 37  Work

- Based Learning Experiences
................................ ................................ ................................ ................ 37  Counseling on Enrollment Opportunities
................................ ................................ ................................ ...... 37  Workplace Readiness Training
................................ ................................ ................................ ...................... 37  Instruction in Self

- advocacy
................................ ................................ ................................ .......................... 37 **SERVICE CA**

**TE GORIES FOR VR A** **PPLICA NTS A** **ND ELIGIBLE INDIVIDUA LS**  **................................ 37**   Assessment ................................ ................................ ................................ ................................ .................... 38  Diagnosis and Treatment of Impairments
................................ ................................ ................................ ..... 38  Vocational Rehabilitation Counseling and Guidance
................................ ................................ .................... 39 **TRA INING**  **................................ ................................**  **................................ ................................**  **....................... 39**   Graduate College or University Training
................................ ................................ ................................ ....... 40  Four
-Year College or University Training
................................ ................................ ................................ ....... 40  Junior or Community College Training
................................ ................................ ................................ .......... 40  Occupational or Vocational Training
................................ ................................ ................................ ............. 40  On
-the

-job Training
................................ ................................ ................................ ................................ ....... 40  Registered Apprenticeship Training
................................ ................................ ................................ .............. 40  Basic Academic Remedial or Literacy Training
................................ ................................ .............................. 41  Job Readiness Training
................................ ................................ ................................ ................................ .. 41  Disability

- Relat ed Skills Training
................................ ................................ ................................ .................... 41  Miscellaneous Training
................................ ................................ ................................ ................................ .. 41vi

 Job Search Assistance
................................ ................................ ................................ ................................ .... 41  Job Placement Assistance
................................ ................................ ................................ .............................. 42  On
-the

-job Supports

- Short term
................................ ................................ ................................ ................. 42  On
-the

-job Supports
– Supported Employment
................................ ................................ ........................... 42  Transportation ................................ ................................ ................................ ................................ ............... 42  Maintenance ................................ ................................ ................................ ................................ ................. 43  Rehabilitation Technology
................................ ................................ ................................ ............................. 4 3 **PERSONA L A** **SSIST AN**  **CE SERVICES ................................**  **................................ ................................**  **...... 44**   Reader Services
................................ ................................ ................................ ................................ ............. 45  Interpreter Services ................................ ................................ ................................ ................................ ....... 45  Personal Attendant Services
................................ ................................ ................................ ......................... 45  Technical Assistance Services
................................ ................................ ................................ ........................ 45  Information and Referral Services
................................ ................................ ................................ ................. 45  Benefits Counseling
................................ ................................ ................................ ................................ ....... 46  Customized Employment Services
................................ ................................ ................................ ................ 46  Other Services
................................ ................................ ................................ ................................ ............... 46 **267. Number of Jobs at Exit**  **................................ ................................**  **................................ .............................**  **46 268.**  **Primary Occupation at Exit ................................**  **................................ ................................**  **...................... 47**  **269. Start Date of Employment in Primary Occupation at Exit**  **................................ ................................**  **......... 47**  **270. Employment Status at Exit**  **................................ ................................**  **................................ .......................**  **48 271.**  **Hourly Wage at Exit ................................**  **................................ ................................**  **................................ .**  **49 272.**  **Competitive Integrated Employment at Exit ................................**  **................................ ............................**  **50 273.**  **Hours Worked in a Week at Exit ................................**  **................................ ................................**  **.............. 51**  **MONTHLY PUBLIC SUPPORT A MOUNT A**  **T EXIT ................................**  **................................ ..................**  **51 274.**  **Social Security Disability Insurance (SSDI) ................................**  **................................ ................................**  **51 275.**  **Supplemental Security Income (SSI) for the Aged, Blind or Disab led**  **................................ ........................**  **52 276.**  **Temporary Assistance for Needy Families (TANF) ................................**  **................................ ....................**  **52 277.**  **General Assistance (State or local government) ................................**  **................................ .......................**  **52 278.**  **Veterans' Disability Benefits ................................**  **................................ ................................**  **.................... 52**  **279. Workers' Compensation**  **................................ ................................**  **................................ ..........................**  **52 280.**  **All Other Public Support ................................**  **................................ ................................**  **.......................... 52**  **281. Primary Source of Support at Exit**  **................................ ................................**  **................................ ............**  **52 ME**  **DICA L INSURA** **NCE COVERA** **GE A T EXIT**  **................................ ................................**  **.......................... 53**  **282. Medicaid**  **................................ ................................**  **................................ ................................**  **.................. 53** vii

**283. Medicare**  **................................ ................................**  **................................ ................................**  **................. 53**  **284. Public Insurance from Other Sources (Workers' Compensation, Children's He**  **alth Insurance Program, etc)**  **................................ ................................**  **................................ ................................**  **........... 53**  **285. Private Insurance Through Own Employer**  **................................ ................................**  **............................... 53**  **286. Not Yet Eligible for Private Insurance Through Current Employer, But Will Be Eligible for Private**  **Insurance After a Certain Period of Employment ................................**  **................................ .....................**  **53 287.**  **Private Insurance Through Other Means ................................**  **................................ ................................**  **. 53**  **288. State or Federal Affordable Care Act Exchange**  **................................ ................................**  **........................ 54**  **289. Type of Exit**  **................................ ................................**  **................................ ................................**  **.............. 54**  **290. Reason for Exit**  **................................ ................................**  **................................ ................................**  **......... 54**  **291. Date of Exit**  **................................ ................................**  **................................ ................................**  **.............. 56**  **292. Adult**  **Education ................................**  **................................ ................................**  **................................ .......**  **56 293.**  **Vocational Rehabilitation ................................**  **................................ ................................**  **........................ 56**  **294. Wagner** **- Peyser Act**  **................................ ................................**  **................................ ................................**  **.. 57**  **295. Unemployment Insurance Quarterly Earnings**  **................................ ................................**  **......................... 57**  **296. Employer Identification Number (EIN)**  **................................ ................................**  **................................ .....**  **57 297.**  **Case Service Record Archive Date ................................**  **................................ ................................**  **............ 57**  **298. Last Name of Authorized Certifying Of** **ficial ................................**  **................................ .............................**  **58 299.**  **First Name of Authorized Certifying Official ................................**  **................................ .............................**  **58 300.**  **Title of Authorized Certifying Official ................................**  **................................ ................................**  **....... 58**  **301. Telephone of Authorized Certifying Official (Area code, number and extension)**  **................................ .....**  **58 302.**  **Email Address of Author ized Certifying Official**  **................................ ................................**  **........................ 58**  **303. Signed by Authorized Certifying Official**  **................................ ................................**  **................................ ...**  **58 304.**  **Date Report Submitted ................................**  **................................ ................................**  **............................ 58**  **RSA -**  **911	RECORD	LAYOUT ................................**  **................................ ................................**  **............... 59** viii **GENERA L**  **INSTRUCTIONS** Reported case service records pertain to all individual s with open or closed service records during the life of the case service record , as well as information collected for students with disabilities receiving pre -employment transition services. RSA- 911 data will be collected quarterly , with the quarters covering the following periods : October 1 through December 31, January 1 through March 31, April 1 through June 30, and July 1 through September 30. The quarterly RSA- 911 reports must be submitted 45 days after the end of each quarter as follows: February 15 , May 15 , August 15 , and November 15

. All records submitted for the same reporting period must be unique i.e. , non -duplicative of other service records

. The following d ata elements determine the "uniqueness" of a given case service record: 1 . Agency Code ; 2 . Social Security Number; 7 . Date of Birth ; and 6

. Application Date and/or 5

. Start Date of Pre - Employment Transition Services

. D uplicate records will be rejected. For example, records with an Agency Code, Social Security Number, Date of Birth and Application Date and/or Start Date of P re Employment Transition Services that are identical to those in another record during the same reporting period will be considered to be a duplicate and will be rejected. If an individual has multiple exits within the same reporting period , each exit must be reported and cannot overlap. T h i s means t hat records with the same Agency Code, Social Security Number , Date of Birth , and Application Date an d/or Start Date of Pre Employment Transition Services must be staggered in time such that the Date of Exit for the first service record must be before the Application Date and/or Start Date of P re employment Transition Services of the second service record

. Wi th the requirement of submitting open and closed case data quarterly, it is important to note that some data elements are not modified or updated during the life of the case due to the nature of those data elements, while others are updated and reported on a quarterly basis. See table s below. **Data elements that are not modified or updated , due to the nature of those data**  **elements, during the life of the case**  **are: Data Element**  **Number Data Element** 

1 Agency

Code 2 Social Security

Number 5 Start Date of Pre

-Employment Transition Services 6 Date of Application 7 Date of Birth 9
- 13 Race 1 4 Ethnicity 1 5 Veteran Status at Application 1 6 Source of Referral at Application 1 7 Living Arrangement at Application 18 Indicators of P oor Work History at Applicationix

**Data Element Number**  **Data Element**

19 Lack of Work Experience at Application 20 Lack of Educational or O ccupational Skills Attainment at Application 2 1 Dislocation from High

-Wage and High

-B enefit Employ ment at Application 22 Limited English, Low Literacy, Cultural Barriers at Application 2 3 Homelessness at Application 24 Offender Status at Application 2 5 Welfare Dependency at Application 2 6 Single Parent at Application 2 7 Basic Skills Deficient at Application 28 Foster Care Youth Status at Application 29 Displaced Homemaker at Application 3 0 Low Income at Application 3 1 Migrant and Seasonal Farmworker Status at Application 3 2 Dislocated Worker at Application 3 3 Long
-Term Unemployed Status at Application 3 4 Date of Last Paid Employ ment at Application 35 Exhausted Part A Title IV of Social Security Within 2 Years 36 & 270 Employ

ment Status at Application & Exit 3 7 & 2 68 Primary

Occupation at Application & Exit 38 & 27 1 Hourly

Wage at Application & Exit 39 & 27 3 Hours Worked in a Week at Application & Exit 4 0
-4 6 & 274
-28 0 Monthly Public Support Amount at Application & Exit 4 7 & 28 1 Primary

Source of Support at Application & Exit 48
- 5 4 & 28 2
-2 88 Medical Insurance Coverage at Application & Exit

5 5 Date of Eligibility

Determination 5 6 Date of Placement on Order of Selection Waiting List 5 7 Date of Exit on Order of Selection Waiting List 10 0 Start Date of Initial VR Service 26 7 Number of Jobs at Exit 2 69 Start Date of Employment in Primary Occupation at Exit 272 Competitive Integrated Employ ment at Exit 2 89 Ty pe of Exit 29 0 Reason for Exit 29 1 Date of Exit 29 7 Case Service Record Archive Datex

**Data elements that could change**  **, due to the nature of those data elements, quarterly** 

**are: Data**  **Element Number**  **Data Element**

3 Calendar Year 4 Calendar Quarter 8 Gender 58 Zip Code 59 County

Name 6 0 FIPS Code 6 1 Organizations Referred To : 62 Involvement with Other Agencies and Services 6 3
- 9 1 Education 92 Student with Disabilities 9 3 State Definition for Age of Students with Disabilities 94 Primary

Disability 9 5 Secondary

Disability 9 6 Significance of Disability 9 7 Start Date of Trial Work Experience 98 End Date of Trial Work Experience 99 Date of Most Recent or Amended Individualized Plan for Employ ment (IPE) 10 1 Supported Employ

ment Goal on Current IPE 102
- 12 6 Service Categories for Pre
-Employ ment Transition Students 12 7
-26 6 Service Categories for VR Applicants and Eligible Individuals 292 Adult Education 29 3 Vocational Rehabilitation 294 Wegner
-Peyser Act 29 5 Unemploy

ment Insurance Quarterly Earnings 29 6 Employer Identification Number (EIN) 298 Last Name of Authorized Certifying Official 299 First Name of Authorized Certifying Official 30 0 Title of Authorized Certifying Official 30 1 Telephone of Authorized Certifying Official 302 Email of Authorized Certifying Official 30 3 Signed by Authorized Certifying Official 304 Date Report Submitted I t is important to note that three data elements are new and are reported after the Date of Exit (data element 29 1 )

. These three new data elements are the Case Service Record Archive Date (data element 29 7 ) , the Unemployment Insurance Quarterly Earnings (data element 29 5 ) , and the Employer Identification Number (data element 29 6 )

. The Case Service Record Archive Date is not collected until the individual exitsxi

the program. The Unemployment Insurance Quarterly Earnings and the Employer Identification Number are collected and updated quarterly until all of the individual’s services are complete and the case service record is archived (Case Service Record Archive Date), usually after the fourth quarter following the Date of Exit or later if the individual is receiving extended services. The file format is a comma -delimited text file. Each data element is accompanied by data type information that will serve as a guide for submitting valid values

. **DA TA**  **TYPE DESCRIPTION**  VARCHAR (n) This data type can hold any character(s) with a

maximum length defined by the number within the parentheses. All variable character (VARCHAR) data elements within the RSA- 911 hold numeric characters with the exception of County data element which can be alphanumeric

. DATE 112 (YYYYMMDD) This data type holds dates in the eight-digit format of

year, month, and day. All dates reported on the RSA911 must be in the format of YYYYMMDD, where YYYY is Year, MM is Month and DD is Day. For Year: Record the year using all four digits of the year. For Month: Record the months using two digits

. For example, use 01 for January, 02 for February, etc. For Day of the month: Record the day of the month using a "0" prefix for single digit date of days. For example, 01, 02, 03, etc. Decimal (n,x) This data type can hold a decimal number with a total

of number of n digits, of which x can be after the decimal point. LONG INT( n) This data type can hold any integer (whole number)

with a maximum length of integers as defined by the number within the parentheses. Number of hours worked and dollar amounts for monthly a mounts of public support, funds expended, and Quarterly earnings must be reported as positive integers

.xii

Agencies should leave blank those data elements that are incomplete because case s were closed with Type of Exit equal to “ 0 ” ( exited as an applicant) or where the case service record has not yet been closed. In addition, the data elements in the table below are the only ones that are required to be completed if an individual has not applied for VR services and is only receiving pre -employment transition services

. **Required data elements for individuals who are only receiving pre**  **- employ** **ment transition services:**  **Data Element Number**  **Data Element**

1 Agency Code 2 Social Security Number 3 Calendar Year 4 Calendar Quarter 5 Start Date of Pre - Employment Transition Services 63 - 91 Education 92 Students with Disabilities 102 - 126 Service Categories for Pre - Employment Transition

Students Data element numbers are in the order of the record layout for text file submission

. Also refer to the Record Layout listing on page 6 0

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**INSTRUCTIONS FOR PREPA RA** **TION OF ELECTRONIC TRA NSMITTA** **L** In order to upload your RSA- 911 data file to the RSA SFTP server, you will need to download a free SFTP program onto your computer. Below is a li st of a few free SFTP software packages and links to their websites. Follow the downloading instructions to install SFTP software on your system. Wi nSCP FileZilla Core FTP LE Once you have completed downloading the software, you will need to establish a connection to RSA’s SFTP server

. The name of the server to which you will be uploading the RSA- 911 data file is: edsecureftp .ed.gov Your user- id is “ rsa - ba -g ” , where " ba " is the official postal abbreviation for your state/territory and "g" is the type of agency, that is "g"=general, "c"=combined and "b"=blind

. Likewise, the naming convention for the RSA- 911 data fil e is " BAgXCYNN Q ", where "BA" is the official postal abbreviation for your state/territory, "g" is the type of agency, that is "g"=general, "c"=combined and "b"=blind, "X" is the number of the submission, that is, "1"=first, "2"=second, etc. "NN" is the last two digits of the calendar year. "Q" is the designation for the calendar quarter. As an example, since the Oklahoma Department of Rehabilitation Services is a combined agency, the user ID would be: rsa -ok-c and the name of the file submitted for calendar year 2014, second quarter would be OKc1 CY14 2

. Passwords will be distributed by RSA to VR agency staff responsible for submitting RSA- 911 data files

. Passwords will be managed and maintained by Vernita Washington at vernita.washington@ed.gov or 202 -245 -7479 or Yann -Yann Shieh at yann yann. shieh @ed.gov or 202 -245 - 7 247

. After the submission of the RSA- 911 files to the SFTP server has been completed, an email must be sent to Vernita Washington and Yann -Yann Shieh inform ing them that the data have been submitted and certifying who is responsible for the submission. If agencies are unable to submit data to the SFTP server, data are to be sent on electronic media via overnight services with signed receipt with an external label identifying the contents as "RSA- 911 Data for BAgXCYNN Q " following the naming convention as described above. Certification as described above must be included with the e lectronic media

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If by private carrier, the electronic media must be sent to : US Department of Education State Monitoring and Program Improvement Division Data Collection and Analysis Unit ATTN: Vernita W ashington 550 12th Street, S. W. , PCP 5047 Washington, DC 20202 -2800 If by USPS , the electronic media must be sent to : US Department of Education State Monitoring and Program Improvement Division Data Collection and Analysis Unit ATTN: Vernita W ashington, PCP 5047 LBJ Basement Level 1 400 Maryland Avenu e, SW Washington, DC 20202 -2800 If you need additional information, contact either Vernita Washington at vernita.washington@ed.gov or 202 -245 - 7479 , or Yann -Yann Shieh at yann yann.shieh@ed.gov or 202 -245 - 7 247

.xv

**COMPA RISON OF THE NEW RSA** **- 911**  **CA SE SERVICE REPORT**  **TO THE PREVI**  **OUS RSA -** **911 CA SE SERVICE REPORT**  **AS A**  **RESULT OF THE WORKFORCE INNOVA** **TION A ND OPPORTUNITY**  **ACT (WIO A) SIGNED INTO**  **LA W ON JULY 22, 2014**  **New Data**  **Element Number**  **Previous**

**Data Element**  **Number Data Element Description**  **Change, if any , from**  **previous RS A** **- 911**  1 1 Agency Code No change 2 2 Social Security Number No change 3 None Calendar Year New data element 4 Calendar Quarter New data element 5 None Start Date of Pre - Employment

Transition Services New data element 6 5 Date of Application No change 7 6 Date of Birth No change 8 7 Gender Added one coding option: "Does not wish to self- identify" 9 - 1 3 8 - 12 Race No change 1 4 13 Ethnicity No change 15 14 Veteran Status at Application Data element na me changed from "Veteran Status " to "Veteran Status at Application

. " Coding options added to align with W IOA. 16 17 Source of Referral at

Application Data element name changed from "Source of Referral" to "Source of Referral at Application

. " 17 21 Living Arrangement at

Application No change 18 None Indicators of P oor W ork H istory

at Application New data element 19 None Lack of W ork Experience at

Application New data element 2 0 None Lack of E ducational or

O ccupational S kills Attainment at Application New data element 2 1 None Dislocation from H igh -W age

and H igh - B enefit E mployment at Application New data element 2 2 None Limited English, Low Literacy,

Cultural Barriers at Application New data element 2 3 None Homelessness at Application New data elementxvi

**New Data**  **Element Number**  **Previous**

**Data Element**  **Number Data Element Description**  **Change, if any , from**  **previous RS A** **- 911**  2 4 None Offender Status at Application New data element 2 5 None We lfare Dependency at

Application New data element 2 6 None Single Parent at Application New data element 2 7 None Basic Skills Deficient at

Application New data element 28 None Foster Care Youth Status at

Application New data element 29 None Displaced Homemaker at

Application New data element 3 0 None Low Income at Application New data element 3 1 None Migrant and Seasonal

Farmworker Status at Application New data element 3 2 None Dislocated Wo rker at

Application New data element 3 3 None Long -Term Unemployed Status

at Application New data element 34 None Date of Last Paid Employment

at Application New data element 3 5 None Exhausted Part A Title IV of

Social Security within 2 Years New data element 3 6 25 Employment Status at

Application The coding option 1 ("Employment without Supports in Integrated Setting") has changed to "Competitive Integrated Employment." Coding options 5 and 6 ("Homemaker" and "Unpaid Family W orker") have been eliminated. Coding option 7 ("Employment with Supports in Integrated Setting") has been changed to ”Competitive Integrated Employment with Supports." Added coding option "Employed but eithe r (a) has received a notice of termination of employment or the employer has issued a Wo rker Adjustment andxvii

**New Data**  **Element Number**  **Previous**

**Data Element**  **Number Data Element Description**  **Change, if any , from**  **previous RS A** **- 911**  Retraining Notification (WARN) or other notice that the facility or enterprise will close, or (b) is a transitioning service member." 3 7 None Primary Occupation at

Application New data element 38 & 27 1 26 &197 Hourly W age at Application &

Exit "W eekly Earnings" have been changed to "Hourly Wage." 39 & 27 3 27 & 198 Hours W orked in a Week at

Application & Exit No change 4 0 -4 6 & 274 -28 0 28 - 34 &

199 -205 Monthly Public Support Amount

at Application & Exit No change 4 7 & 28 1 35 & 206 Primary Source of Support at

Application & Exit No change 48 - 54 & 28 2 -2 88 36 -41&

207 -212 Medical Insurance Coverage at

Application & Exit Data elements 54 and 288 are new elements and capture "State or Federal Affordable Care Exchange." 5 5 46 Date of Eligibility Determination No change 5 6 47 Date of Placement on Order of

Selection W aiting List No change 5 7 48 Date of Exit on Order of

Selection W aiting List No change 58 15 Zip Code Data element name changed from "Zip Code at Application" to "Zip Code

. " 59 16 County Name Data element name changed from "County Name at Application" to "County Name

. " 6 0 None FIPS Code New data element 6 1 None Organizations Referred To New data element 6 2 18 Involvement with Other

Agencies and Services Coding options added 6 3 - 9 1 19 & 191 Education "Level of Education Attained at Application/Closure" has changed from one data element with 13 coding options to 29 discrete data elements used to reportxviii

**New Data**  **Element Number**  **Previous**

**Data Element**  **Number Data Element Description**  **Change, if any , from**  **previous RS A** **- 911**  Wo rkforce Innovation and Opportunity Act (WI OA) performance indicators. 9 2 20 & 192 Student with Di sabilities "Student with Disability in Secondary Education at Application/Closure" changed to one data element entitled " Student with Disabilities." Wh ile coding options are largely the same, the description of the data element has been modified to align with W IOA. 9 3 None State Definition for Age of

Students with Disabilities New data element 94 22 Primary Disability No change 9 5 23 Secondary Disability No change 9 6 24 Significance of Disability Clarification made to the description

. 9 7 42 Start Date of Trial W ork

Experience No change 98 43 End Date of Trial W ork

Experience No change 99 49 Date of Individualized Plan for

Employment (IPE) Date of most recent IPE is reported quarterly to capture the signing dates of multiple IPEs amendments over the life of the case. 10 0 None Start Date of Initial VR Service New data element 10 1 50 Supported Employment Goal on

Current IPE Data element name changed from "Supported Employment Goal" to "Supported Employment Goal on Current IPE" and is reported quarterly to capture if the individual has a supported employment goal on their current IPE. Description of the data element has been updated to reflect changes in definition of supported employment due to WI OA.xix

**New Data**  **Element Number**  **Previous**

**Data Element**  **Number Data Element Description**  **Change, if any , from**  **previous RS A** **- 911**  10 2 - 12 6 None Service Categories for Pre Employment Transition Students New data element 12 7 -26 6 51 - 190 Service Categories for VR

Applicants and Eligible Individuals  Data element 4) Supported Employment State Grant "(Title VI, Part B)" changed to "(Title VI)."  New coding options have been ad ded to data element 5) Comparable Services and Benefits Provider.  Service category "On -the Job Su pports - Supported Employment" - description changed from "not to exceed18 months" to "not to exceed 24 months."  Service category "Customized Employment"

- description has been updated due to W IOA. 26 7 193 Number of Jobs at Exit No change 2 68 194 Primary Occupation at Exit M ay now add up to two positions. “ Homemaker” and “ Unpaid Family W orker” codes are eliminated. Changed from six- to eightdigit O*Net SOC codes. 2 69 195 Start Date of Employment in

Primary Occupation at Exit Description has been clarified. 27 0 196 Employment Status at Exit The coding option 1 ("Employment without Supports in Integrated Setting") has changed to "Competitive Integrated Employment." Coding option 2 ("Extended Employment") has been eliminated. Coding options 5 and 6 ("Homemaker" and "Unpaid Family W orker") have beenxx

**New Data**  **Element Number**  **Previous**

**Data Element**  **Number Data Element Description**  **Change, if any , from**  **previous RS A** **- 911**  eliminated. Coding option 7 ("Employment with Supports in Integrated Setting") has been changed to “ Competitive Integrated Employment with Supports." 27 1 None Competitive Integrated

Employment at Exit New data element 2 8 9 213 Type of Exit C oding options are reordered and contain the new definition for employment outcomes. 2 90 214 Reason for Exit  Reason 2 - "Disability too significant to benefit from VR services" has been changed from "cannot benefit" to "cannot benefit or continue to benefit."  Reasons have been added and renumbered. 29 1 215 Date of Exit No change 29 2 None Adult Education New data element 29 3 None Vocational Rehabilitation New data element 294 None Wagner- Peyser Act New data element 29 5 None Unemployment Insurance

Quarterly Earnings New data element 29 6 None Employer Identification Number New data element 29 7 None Case Service Record Archive

Date New data element 298 None Last Name of Authorized

Certifying Official New data element 299 None First Name of Authorized

Certifying Official New data element 30 0 None Title of Authorized Certifying

Official New data element 30 1 None Telephone of Authorized

Certifying Official New data element 30 2 None Email of Authorized Certifying

Official New data element 30 3 None Signed by Authorized Certifying

Official New data element 304 None Date Report Submitted New data element

3 Closure Order Eliminatedxxi

**New Data**  **Element Number**  **Previous**

**Data Element**  **Number Data Element Description**  **Change, if any , from**  **previous RS A** **- 911**  4 Previous Closure Eliminated 44 Start Date of Extended Evaluation Eliminated 45 End Date of Extended Evaluation Eliminated2

**Element -**  **by -**  **Element Instructions: CA** **SE SERVICE RECORD REPORT (RSA** **- 911)** 

**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 infor**  **mation is estimated to average 13 1.25 hours per**  **response, including time for reviewing instructions, searching existing data sources, gathering and maintain** **ing the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is mandatory as required by the Rehabilitation Act of 1973,**  **as amended**

**, and the WIOA,**  **signed into law on July 22, 2014** **. Send comme nts 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 ICDocket Mg** **r@ed.gov and r eference the OMB Control Number 1820** **- 0508.**  **Note: Please do not return the completed RSA -** **911 to this address.**3

1. Agency Code Data type: VARCHAR (3) Enter the three -digit code assigned to each State VR a gency from the following list. Please note that codes have been pre -assigned to nonexistent agencies for individuals who are blind or visually impaired in the event that the se agencies are established in the future. This data element is required. No modifications after initial entry.

**State or Territory Ab**  **brev iations**  **General/ Combined**  **Blind** Alabama AL 001 057 Alaska AK 002 058 American Samoa AM 003 059 Arizona AZ 004 060 Arkansas AR 005 061 California CA 006 062 Colorado CO 007 063 Connecticut CT 008 064 Delaware DE 009 065 District of Columbia DC 010 066 Florida FL 011 067 Georgia GA 012 068 Guam GU 013 069 Hawaii HI 014 070 Idaho ID 015 071 Illinois IL 016 072 Indiana IN 017 073 Iowa IA 018 074 Kansas KS 019 075 Kentucky KY 020 076 Louisiana LA 021 077 Maine ME 022 078 Maryland MD 023 079 Massachusetts MA 024 080 Michigan MI 025 081 Minnesota MN 026 082 Mississippi MS 027 083 Missouri MO 028 084 Montana MT 029 0854 **State or Territory Ab**  **brev iations**  **General/ Combined**  **Blind** Nebraska NE 030 086 Nevada NV 031 087 New Hampshire NH 032 088 New Jersey NJ 033 089 New Mexico NM 034 090 New York NY 035 091 North Carolina NC 036 092 North Dakota ND 037 093 Northern Marianas MP 038 094 Ohio OH 039 095 Oklahoma OK 040 096 Oregon OR 041 097 Pennsylvania PA 042 098 Puerto Rico PR 043 099 Rhode Island RI 044 100 South Carolina SC 045 101 South Dakota SD 046 102 Tennessee TN 047 103 Texas TX 048 104 Utah UT 049 105 Vermont VT 050 106 Virginia VA 051 107 Virgin Islands VI 052 108 Washington WA 053 109 West Virginia WV 054 110 Wi sconsin WI 055 111 Wyoming WY 056 112 2. Social Security Number Data type: VARCHAR (9 ) Enter the individual ’s nine -digit Social Security number (SSN). W hen a SSN is not available or if the individual prefers not to provide his/her SSN, assign a unique nine digit number that :5

a) does not duplicate a genuine SSN , and b) does not duplicate any other substitute number assigned in place of a SSN

. Starting the nine -digit number with the digits "99" will avoid duplicating a genuine SSN. Only numeric characters between “0” and “9” are permitted in the Social Security Number field. Wh en assigning a unique nine -digit number to an individual, ensure that the same unique nine -digit number is used in subsequent years for the same individual if cases are opened for the individual in the future. This data elem ent is required. No modifications after initial entry. Note: If no SSN is available or provided, wage information will not be able to be verified through unemployment insurance data for the individual. 3. Calendar Year Data type: VARCHAR (4) Enter the cal endar year that represents this data collection. Th ese data are required and updated quarterly

. 4. Calendar Quarter Data type: VARCHAR (1) Enter the calendar quarter to indicate which quarter this data collection represents. T h ese data are required and up dated quarterly. 1 January 1 through March 31 2 April 1 through June 30 3 July 1 through September 30 4 October 1 through December 31 5. Start Date of Pre - Employment Transition Services Data type: DATE 112 (YYYYMMDD) Record the date (year, month, and day) that the student with a disability started receiving pre -employment transition services

. Students with disabilities receiving pre employment transition s ervices are not required to be applicants or determined eligible for VR services. Pre - Employment Transition Services can only include the following services: (1) job exploration counseling; (2) work- based learning experiences, which may include in -school or after school opportunities, or experience outside the traditio nal school setting (including internships), provided in an integrated environment to the maximum extent possible; (3) counseling on opportunities for enrollment in comprehensive transition or postsecondary educational programs at i nstitutions of higher edu cation; (4) workplace readiness training to develop social skills and independent living; an d (5) instruction in self-advocacy, which may include peer mentoring. No modifications after initial entry.6

6. Date of Application Data type: DATE 112 (YYYYMMDD) Record the date (year, month, and day) that the agency received a completed and signed application form from the applicant. The date shoul d be verifiable by date stamp. This data element may be left blank if a date is entered in data element 5 . Start Date of Pre - Employment Transition Services. No modifications after initial entry. 7. Date of Birth Data type: DATE 112 (YYYYMMDD) Record the individual ’s date (year, month, and day) of birth

. This data element is required. No modifications after initial entry. 8. Gender Data type: VARCHAR (1) Code the individual ’s gender

. Modifications can be made after initial entry. 1 Male 2 Female 3 Does not wish to self- identify RACE Race information should be recorded for all individual s whose service records were opened in the calendar quarter being reported

. For each race category below, use the following codes to record the individual ’s race: 0 if the individual is not of that race 1 if the individual is of that race RSA continues to require self- identification to the greate st extent possible. It is generally expected that the information recorded will reflect the individual ’s own identification of race from the categories provided. However, if a n individual refuses to identify his/her race, the counselor should, at a minimum , notify the individual that if he/s he fail s to selfidentify, an observer- identification method will be used. The counselor or interviewer would then provide the best assessment of the individual 's race. This guidance follows OMB standards for collecting race data. OMB prefers self- identification methods, but allows for observer- identification methods when necessary. At least one of the race categories must be coded as 1

. Remaining categories should have codes of 0 (not this race). M ore than one race vari abl e can contain a code of 1 for a n individual

.7

Agencies may leave the element blank only if the information is not available due to circumstances beyond the agency’s control for Type of Exit coded to " 1 " (exited as an applicant)

. Such service record s will be few in number. As an example, if a n individual applies for services via an application form or letter and exits the agency without being seen by agency personnel, this individual's race would not be known and could not be observed and therefore a ll race options would be left blank

. No modifications after initial entry. 9. Wh ite Data type: VARCHAR (1) An individual having origins in any of the original peoples of Europe, the Middle East or North Africa. 10. Black or African American Data type: VARCHAR (1) An individual having origins in any of the Black racial groups of Africa. 11. American Indian or Alaska Native Data type: VARCHAR (1) An individual having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment. 12. Asian Data type: VARCHAR (1) An individual having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including for example, Cambodi a, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. 13. Native Hawaiian or Other Pacific Islander Data type: VARCHAR (1) An individual having origins in any of the original peoples of Hawaii, Guam, Samoa, or oth er Pacific Islands. 14. E thnicity - Hispanic or Latino Data type: VARCHAR (1) An individual of Cuban, Mexican, Puerto Rican, South o r C entral American, or other Spanish culture or origin, regardless of race.8

This data element should be recorded for all individuals who se service record s were opened in the calendar quarter being reported. Use the following codes to record the individual’s Hispanic or Latino ethnicity: 0 if the individual is not of Hispanic/Latino ethnicity 1 if the individual is of Hispanic/L atino ethnicity If the individual self- identifies as Hispanic, but refuses or is unable to identify one or more race categories in addition, then code th e individual as Hispanic for ethnicity and follow the observer- identification method as described above for the race categories. Notify the individual that if he/she fails to identify, then an observer- identification method will be used. Individuals who identify as Hispanic may belong to any race group. No modifications after initial entry. 15. Veteran Status at Application Data type: VARCHAR (1) Enter a one -digit code to indicate the individual 's veteran status at application No modifications after initial entry. 0 Not a veteran 1 Served in the active U.S. military, naval, or air service for a period of less th an or equal to 180 days, and who was discharged or released from such service under conditions other than dishonorable. 2 Served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge ; or was discharged or released because of a service connected disability ; or as a member of a reserve component under an order to active duty pursuant to section 167(a), (d), or (g), 673 (a) of Title 10, U.S.C., served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge. 3 Is a (a) spouse of any person who died on active duty or of a service connected disability, (b) spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S.C 101 and the regulations issued there under, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days: (i) missing in action ; (ii) captured in the line of duty by a hostile force ; or (iii) forcibly detained or interned in the line of duty by a foreign government or power ; or (c) the spouse of any person who has a total disability permanent in nature resulting from a service connected disability or the spouse of a veteran who died while a disability so evaluated was in existence. 4 Individual does not wish to disclose veteran status.9

16. Source of Referral at Application Data type: VARCHAR (2) Indicate the individual, agency, or other entity that first referred the individual to the State VR agency by using one of the following codes. If the individual approached the VR agency on his/her own, use Code 19 (self - referral). No modifications after initial entry. 1 14(c) Certificate Holders 2 Adult Education and Literacy Programs 3 American Indian VR Services Program 4 Centers for Independent Living 5 Child Protective Services 6 Community Rehabilitation Programs 7 Consumer Organizations or Advocacy Groups 8 DOL Employment and Training Service Programs for Adults, Dislocated Wo rkers, and Youth 9 Educational Institutions (elementary/secondary) 10 Educational Institutions ( postsecondary) 11 Employers 12 Extended Employment Providers 13 Faith B ased Organizations 14 Family/Friends 15 Intellectual and Developmental Disabilities Providers 16 Medical Health Provider (Public or Private) 17 Mental Health Provider (Public or Private) 18 Public Housing Authority 19 Self- referral 20 Social Security Administration (Disability Determination Service or District office) 21 State Department of Correction/Juvenile Justice 22 Veteran's Benefits Administration (which includes VA Vocational Rehabilitation) 23 Veteran's Health Administration (the VA hospital system, as well as the VA transition al living, transitional employment, and compensated work therapy programs) 24 Wagner- Peyser Employment Service Program 25 We lfare Agency (State or local government) 26 Wo rker's Compensation 27 Other One -stop Partner 28 Other Sources 29 Other State Agencies 30 Other VR State Ag encies 31 Other WI OA-funded Programs including Job Corps, YouthBuild, Indian and Native Americans, and Migrant and Seasonal Farmworker Programs10

17. Living Arrangement at Application Data type: VARCHAR (2) Indicate the living arrangements of the individual, eith er temporarily or permanently, on the date of application to the State VR agency using the following codes

. No modifications after initial entry. 1 Private Residence (independent, or with family or other person) 2 Community Residential/Group Home 3 Rehabilitati on Facility 4 Mental Health Facility 5 N ursing Home 6 Adult Correctional Facility 7 Halfway House 8 Substance Abuse Treatment Center 9 Homeless/Shelter 10 Other 18. Indicators of Poor W ork H istory at Application Data type: VARCHAR (1) 0 Does not have a poor work history 1 Has a poor work history 19. Lack of W ork Experience at Application Data type: VARCHAR (1) 0 Does not lack work experience 1 Lacks work experience 20. Lack of E ducational or O ccupational S kills Attainment at Application

Data type: VARCHAR (1) 0 Does not lack educational or occupational skills attainment 1 Lacks educational or occupational skills attainment 21. Dislocation from H igh -W age and H igh - B enefit E mployment at Application

Data type: VARCHAR (1) 0 Has not been dislocated from high -wage and high - benefit employment 1 Has been dislocated from high -wa ge and high - benefit employment 22. L imited English, L ow Literacy, Cultural Barriers at Application

Data type: VARCHAR (1)11

The individual is a person who : (1) has limited ability in speaking, reading, writing or understanding the English language and (a) whose native language is a language other than English, or (b) who lives in a family or community environment where a language other than English is the dominant language ; or (2) computes or solves problems, reads , writes, or speaks English at or below the 8th grade level or is unable to compute or solve problems, read, write, or speak English at a level necessary to function on the job, in the individual's family, or in society. 0 Does not have limited English, low literacy, or cultural barriers 1 Has limited English, low literacy, or cultural barriers 23. Homeless ness at Application

Data type: VARCHAR (1) An individual is homeless if he or she lacks a fixed, regular, adequate night time residence. This definition includes any individual who has a primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated for or ordinarily used as a regular sleeping accommodation for human beings; or a person under 18 years of age who absents himself or herself from home or place of l egal residence without the permission of his or her family (i.e., runaway youth). This definition does not include an individual imprisoned or detained under an Act of Congress or State law. An individual who may be sleeping in a temporary accommodation while away from home should not, as a result of that alone, be recorded as homeless. 0 Is not currently homeless 1 Is c urrently homeless 24. Offender Status at Application

Data type: VARCHAR (1) The individual is a person who either (a) is or has been subject to any stage of the criminal justice process for committing a status offense or delinquent act, or (b) requires assistance in overcoming barriers to employment resulting from a record of arrest or convicti on for committing delinquent acts, such as crimes against persons, crimes against property, status offenses, or other crimes. 0 Is not currently an offender 1 Is c urrently or has been an offender 25. We lfare D ependency at Application

Data type: VARCHAR (1) 0 Is not currently welfare dependent 1 Is c urrently welfare dependent12

26. Single P arent at Application

Data type: VARCHAR (1) The individual is single, separated, divorced or a widowed individual (including pregnant women) who has primary responsibility for one or more dependent children under age 18. 0 Is not currently a single parent 1 Is currently a single parent 27. Basic Skills Deficient at Application

Data type: VARCHAR (1) The individual computes or solves problems, reads, writes, or speaks English at or below the 8th grade level or is unable to compute or solve problems, read, write, or speak English at a level necessary to function on the job, in the individual's family, or in society. In addition, states and grantees have the option of establishing the ir own definition, which must include the above language. In cases where states or grantees establish such a definition, that definition will be used for basic literacy skills determination. 0 Is not currently basic skills deficient 1 Is currently basic skil ls deficient 28. Foster Care Youth Status at Application

Data type: VARCHAR (1) The individual is currently in foster care or has been in the foster care system at any point during his/her lifetime. 0 Is not curren t ly a foster care youth 1 Is currently or has been a foster care youth 29. Displaced H omemaker at Application

Data type: VARCHAR (1) The individual who has been providing unpaid services to family members in the home and who

— (A) (i) has been dependent on the income of another family member but is no longer supported by that income; or (ii) is the dependent spouse of a member of the Armed Forces on active duty (as defined in section 101(d)(1) of title 10, United States Code) and whose family income is significantly reduced because of a deployment (as defined in section 991(b) of title 10, United States Code, or pursuant to13 paragraph (4) of such section), a call or order to active duty pursuant to a provision of law referred to in section 101(a)(13)(B) of title 10, United States Code, a permanent change of station, or the service -connected (as defined in section 101(16) of title 38, United States Code) death or disability of the member; and (B) is unemployed or underemployed and is experiencing difficulty in obtaining or upgrading employment. 0 Is not currently a displace d homemaker 1 Is currently a displaced homemaker 30. Low I ncome at Application

Data type: VARCHAR (1) The individual (A) receives, or is a member of a family which receives, cash payments under a federal, state or local income - based public assistance program, or (B) received an income, or is a member of a family that received a total family income, for the six- month period prior to program participation (exclusive of unemployment compensation, child support payments, payments described in subparagraph A and old -age and survivors insurance benefits received under section 202 of the Social Security Act (42 U.S.C 402)) that , in relation to family size does not exceed the higher of (i) the poverty line, for an equivalent period, or (ii) 70 percent of the lower living standard income level, for an equivalent period; or (C) is a member of a household that receives (or has been determined within the 6 - month period prior to program participation) Food Stamps under the Food Stamp Act of 1977 (7 U.S.C. 2011 et seq.) update to SNAP; or ( D) qualifies as a homeless individual, as defined in subsections (a) and (c) of section 103 of t he Stewart B. McKinney Homeless Assistance Act (42 U.S.C. 11302); or (E) is a foster child on behalf of whom State or local government payments are made; or (F) is an individual with a disability whose own income meets the income criteria established in WI OA section 101(25)(A) or (B), but is a member of a family whose income does not meet the established criteria. 0 Is not curren t ly low income 1 Is currently low income 31. Migrant and Seasonal Farmworker S tatus at Application

Data type: VARCHAR (1) 0 The indiv idual does not meet any of the conditions described below. 1 The individual who, during the last 12 months, received at least 50 percent of his or her total earned income from qualifying farmwork, worked at least an14

aggregate of 25 or more days or parts of d ays in qualifying farmwork, and was not employed in farmwork year round by the same employer. 2 The indivi dual had to travel to a job site that is far enough away from his or her permanent residence that they cannot return to their residence within the same day. Full -time students traveling in organized groups, rather than with their families, are excluded. 3 The individual meets 1 and 2 above. 32. Dislocated Wo rker at Application

Data type: VARCHAR (1) A dislocated worker is an individual who

—

(A) (i) has been terminated or laid off, or who has received a notice of termination or layoff, from employment; (ii) (I) is eligible for or has exhausted entitlement to

unemployment compensation; or (II) has been employed for a duration sufficient to demon strate, to the appropriate entity at a one -stop center referred to in section 121(e), attachment to the workforce, but is not eligible for unemployment compensation due to insufficient earnings or having performed services for an employer that were not covered under a State unemployment compensation law; and (iii) is unlikely to return to a previous industry or occupation; (B) (i) has been terminated or laid off, or has received a notice of termination or layoff, from employment as a result of any permanent closure of, or any substantial layoff at, a plant, facility, or enterprise; (ii) is employed at a facility at which the employer has made a general announcement that such facility will close within 180 days; or (iii) for purposes of eligibility to receive services other than training services described in section 134(c)(3), career services described in section 134(c)(2)(A)(xii), or supportive services, is employed at a facility at which the employer has made a general announcement that such facility will close; (C) was self-employed (including employment as a farmer, a rancher, or a fisherman) but is unemployed as a result of general economic conditions in the community in which the individual resides or because of natural disasters. 0 Is not currently a dislocated worker 1 Is currently a dislocated worker 33. Long -Term Unemployed Status at Application15

Data type VARCHAR (1 ) 0 Individual has been unemployed for more than 26 weeks. 1 Condition above has not been met. 34. Date of Last Paid Employment at Application

Data type DATE 112 (YYYYMMDD) Enter the date of the individual’s last paid employment. 35. Exhausted Part A Title IV of Social Security within 2 Years

Data type: VARCHAR (1) 0 Did not exhaust Part A Title IV of Social Security within 2 years **1** Exhausted Part A Title IV of Social Security within 2 years 36. Employment Status at Application

Data type: VARCHAR (2) Enter the code which best describes the employment status of the individual at application from the following codes. The first six codes are considered "employment" for purposes of this item. Individuals not meeting the definitions for coding options 1 through 6 below would be classified as "not employed" (coding options 7 through 10 ) at the time of application for services

. Wh en an individual’s work acti vity overlaps into two different employment statuses, select the coding option that is more descriptive of the individual's employment activity at application. No modifications after initial entry. 1 Competitive Integrated Employment refers to work that is performed on a full time or part-time basis (including self-employment)

— (A) for which an individual

— (i) is compensated at a rate that

— (I) (aa) shall be not less than the higher of

the rate specified in section 6(a)(1) of the Fair Labor Standards Act of 1938 (29 U.S.C. 206(a)(1)) or the rate specified in the applicable State or local minimum wage law; and (bb) is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities, and who are similarly situated in similar occupations by the same employer and who have similar training, experience, and skills; or16 (II) in the case of an individual who is self-employed, yields an income that is comparable to the incom e received by other individuals who are not individuals with disabilities, and who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and (ii) is eligible for the level of benefits provided to other employees; (B) that is at a location where the employee interacts with other persons who are not individuals with disabilities (not including supervisory personnel or individuals who are providing services to such employee) to the same extent that individuals who are not individuals with disabilities and who are in comparable positions interact with other persons; and (C) that, as appropriate, presents opportunities for advancement that are similar to those for other employees who are not individu als with disabilities and who have similar positions

. 2 Extended Employment means work in a non - integrated or sheltered setting for a public or private nonprofit agency or organization that provides compensation in accordance with the Fair Labor Standards Act

. 3 Self-employment (except BEP) refers to work for profit or fees including operating one's own business, farm, shop, or office. "Self-employment" includes sharecroppers, but not wage earners on farms. 4 State Agency- managed Business Enterprise Program (B E P) refers to Randolph - Sheppard vending facilities and other small businesses operated by individuals with significant disabilities under the management and supervision of a State VR agency. Include home industry where the work is done under the management and supervision of a State VR agency in the individual's own home or residence for wages, salary, or on a piece - rate. Individuals capable of activity outside the home, as well as homebound individuals, may engage in such employment. 5 Competitive Integrate d Employment with Supports refers to competitive integrated employment as defined above with ongoing support services for individuals with significant disabilities (supported employment). 6 Employed but either (a) has received a notice of termination of employment or the employer has issued a W orker Adjustment and Retraining Notification (WARN) or other notice that the facility or enterprise will close, or (b) is a transitioning service member. 7 Not employed: Student in Secondary Education including GED classes and special education classes with the goal of obtaining a high school diploma or GED.17

8 Not employed: All other Students are persons attending school full or parttime other than students in secondary education (for example, students in postsecond ary education, adult education, or vocational training). 9 Not employed: Trainee, Intern or Volunteer refers to persons engaging in unpaid work experiences, internships or volunteer work for purposes of increasing their employability. Such individuals may receive a stipend to defray the cost of transportation or other incidental expenses. 10 Not employed: Other refers to persons not in any of the other categories (e.g., persons just out of school who are not yet employed; persons unable to retain or obtain work; and persons who have recently left specialized medical facilities). 37. Primary Occupation at Application

Data type VARCHAR (6) For an individual who is employed at application , enter the eight-digit O*Net Version 4.0 (or later version) Standard Occupational Classification ( SOC ) code to describe the individual’s occupation from which he/she derives the majority of their hourly earnings. If the individual is not employed at application, leave blank. No modifications after initial entry. For the employme nt situations unique to the VR program, use the special codes indicated below. **Special Codes**  **Special Code Descriptions** 899999 99 Randolph - Sheppard vending facility clerk use this category for persons

employed as clerks, sales persons, or helpers in a vending facility operated under the Randolph - Sheppard Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility operators (999999), or individuals employed in vending facilities outside the Vending Facility Program (use their occupation code). 999999 99 Randolph - Sheppard vending facility operator use this category for

individuals employed as operators or managers of vending facilities operated under the Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility clerks (899999), o r individuals employed as vending facility operators outside the Randolph - Sheppard Vending Facility Program (use their occupation code). 38. Hourly W age at Application

Data type: Decimal ( 5 , 2 )18

Enter the hourly wage (to the nearest cent ) earned at the time of application. This data element captures cash earnings of the applicant at time of application expressed as an hourly wage and includes all wages, salaries, tips, and commissions received as income . These earnings are before payrol l deductions of Federal, State and local income taxes and Social Security payroll tax are taken

. Hourly wages (e arnings ) also include profits derived from self-employed individuals. Wages for salespersons, consultants, self-employed individuals, and other similar occupations are based on the adjusted gross income. Adjusted gross income is gross income minus unreimbursed business expenses. Do not include estimates of payments in - kind, such as meals and lodging. Estimate profits of farmers, if necessary. Wh ere wages are based on commissions that are irregular (e.g., real estate, automobile sales, etc.) , they should be calculated as a n hourly wage average over a representative period of t ime such as one month or longer to obtain a meaningful figure. Commissions are generally not paid when earned, but rather are paid periodically, such as weekly, biweekly, or even monthly. To bring standardization to this item, wages should be based on the actu al receipt of the payment and not on amounts accruing until the next commission payout. If there are significant amounts of irregular unreimbursed business expenses (e.g., car lease payments due the first week of every month), the expenses should be avera ged over a representative period of time such as one month or longer to obtain a meaningful figure for a n hourly wage

. If the individual had no earnings, enter "0". No modifications after initial entry. 39. Hours W orked in a Week at Application

Data type IN T ( 3) Enter the number of hours an individual worked for earnings in a typical week at the time of application. Earnings may have been in the form of wages, salaries, tips, commissions, profits from self-employment, adjusted gross income for salespersons, etc. If the individual was unemployed and/or generated no earnings, enter "0". No modifications after initial e ntry. MONTHLY PUBLIC SUPPORT AMOUNT AT APPLICATION Enter the monthly amount (to the nearest dollar) of public support received by the individual at application from each of the following sources. If the individual did not receive any monthly public suppo rt, enter "0" for each type of public support. Agencies may leave these data elements blank for Type of Exit cod ing option 0 (exited as an applicant)

. No modifications after initial entry.19

Public support means cash payments made by Federal, State and/or l ocal governments for any reason, including an individual’s disability, age, or economic status. Include payments to a family unit precipitated by the individual’s disability or when the individual’s presence is taken into account in the computation of the family benefit. Also include any payments that are sent directly to the individual in an institution or to dependents on his/her behalf. Exclude any non -cash support payments such as Medicaid, Medicare, food stamps and rental subsidies. NOTE: For Social Security Disability Insurance and Supplemental Security Income for the Aged, Blind or Disabled include monthly payments made within the 30 days prior to the Date of Application (data element 6 ). Categories of public support are as follows: 40. Social Security Disability Insurance (SSDI)

Data Type INT ( 5) E nter the monthly amount of SSDI received by the individual. This figure can be verified through the Social Security Administration (SSA) or from a copy of the individual’s benefit notification lette r. 41. Supplemental Security Income (SSI) for the Aged, Blind or Disabled

Data Type INT ( 5) Enter the monthly payment to the individual under the Federal program of SSI for the aged, blind, and disabled. Only the individual’s portion of the payment should be recorded here. This figure can be verified through the SSA or from a copy of the individual’s benefit notification letter. 42. Temporary Assistance for Needy Families (TANF)

Data Type INT ( 5) Enter the monthly amount of cash public assistance payments made through the federally funded TANF program. If the TANF payment is made to the family unit, use the local disbursing agency's procedure to estimate the individual’s portion of the payment. 43. General Assistance (State or local government)

Data Type INT ( 5) 44. Veterans' Disability Benefits

Data Type INT ( 5) Veterans' Disability Benefits are payments made by the Department of Veterans Affairs for partial or total disability.20

45. Wo rkers' Compensation

Data Type INT ( 5) 46. All Other Public Support

Data Type INT ( 5) Enter the monthly amount of public support received from all other sources of public support not listed. Other Public Support payments are cash payments to individuals beyond those otherwise listed. Include payments made by Federal, State and loca l governments for retirement or survivor benefits to the individual as well as unemployment insurance benefits and other temporary payments. 47. Primary Source of Support at Application

Data Type VARCHAR (1) Enter a cod ing option from the list below to indicate the individual’s largest single source of economic support at application, even if it accounts for less than one - half of the individual’s total support. No modifications after initial entry. Note: If an individual is supported by the earnings of a sp ouse, or by the spouse's unemployment insurance checks, identify coding option 2 as the Primary Source of Support (family and friends) and not coding option 1 (personal income). If an individual is primarily supported by a governmental entity with no cash support
– for example, incarcerated individuals

– use coding option 3 (public support) as the primary source of support only if the individual applicant is the recipient of the support

. If the family receives public support, use cod ing option 2 (family and friends). 1 Personal Income (employment earnings, interest, dividends, rent, retirement including social security) 2 Family and Friends 3 Public Support (SSI, SSDI, TANF, etc.) 4 All other sources (e.g., private disability insurance and private charities) MEDICAL INSURANCE COVERAGE AT APPLICATION Record whether an individual had medical insurance coverage at the time of application. Enter a “1” in each of the following data elements if the individual had this type of medical insurance coverage at applicati on, otherwise leave blank

. No modifications after initial entry. 48. Medicaid

Data Type: VARCHAR (1) 49. Medicare

Data Type: VARCHAR (1)21

50. Public Insurance from Other Sources (Wo rkers' Compensation, Children's Health

Insurance Program, etc) Data Type: VARCHAR (1 ) 51. Private Insurance Through Own Employer

Data Type: VARCHAR (1) 52. Not Yet Eligible for Private Insurance through Current Employer, But W ill Be

Eligible for Private Insurance after a Certain Period of Employment Data Type: VARCHAR (1) 53. Private Insurance through Other Means

Data Type: VARCHAR (1) Refers to individuals receiving benefits through their parent/family members’ insurance plan

. 54. State or Federal Affordable Care Act Exchange

Data Type: VARCHAR (1) Refers to individuals receiving benefits through their enrollment in an Affordable Care Act Exchange. 55. Date of Eligibility Determination

Data type: DATE 112 (YYYYMMDD) Enter the date that an eligibility determination was made regardless of whether the individual was determined ineligible later in the VR process because of changed circumstances. No modifications after initial entry. 56. Date of Placement on Order of Selectio n ( OOS ) Wa iting List

Data type: DATE 112 (YYYYMMDD) Enter the date that the individual was placed on an OOS waiting list , if applicable . This date must be equal to or later than both the Date of Application and the Date of Eligibility Determination. No modifications after initial entry. 57. Date of Exit from OOS W aiting List

Data type: DATE 112 (YYYYMMDD)22

Enter the date , if applicable, that the individual exited from an OOS waiting list. This date, if entered, must be after the Date of Placement on OOS Wa it ing List (Data Element 5 6 ) . This data element must be left blank if the individual was not placed on an OOS wait list. If the individual exited the VR program from the OOS waiting list, this data element must contain a valid date and be equal to the Date of Exit (data element 29 1 ) and Type of Exit (data element 2 89 ) , must be coded 2 )

. No modifications after initial entry. 58. Zip Code

Data type VARCHAR (5) Enter the five -d igit numeric US Postal Service Z ip C ode corresponding to the location of the individual ’s residence at the beginning of the quarter. 59. County Name

Data type: VARCHAR (40) Enter the name of the county corresponding to the location of the individual’s residence at the beginning of the quarter

. 60. FIPS Code

Data type: VARCHAR (2 ) Enter the 2 - letter Federal Information Processing Standard ( FIPS ) alpha code of the state or US territory corresponding to the location of the individual’s residence at the beginning of the quarter. For example, the State of Alabama would be represented as "AL." F or persons on active military duty, states should record the two - letter Air/Army Post Office (APO) or Fleet Post Office (FPO) as defined by the Military Postal Service Agency. AE (ZIPs 09xxx) for Armed Forces Europe which includes Canada, Middle East, and Africa AP (ZIPs 962xx - 966xx) for Armed Forces Pacific AA (ZIPs 340xx) for Armed Forces (Central and South) Americas 61. Organizations Referred To:

Data type: VARCHAR ( 6 ) E nter up to three codes that best describe the individual, agency, or other entity to which the State VR agency referred the individual at the beginning of the quarter. Make sure to enter the leading zero e s if necessary and do not use commas or spaces between any of the codes

. For example, if the individual was referred to Adult Education and Literacy programs, Centers for Independent Living, and Educational Institutions (elementary/secondary) , e nter “0 20410 ”

. If the individual received comparable services23

or benefits from a Community Rehabilitation Program and a D evelopmental D isability Provider, enter “ 0619 ”. If an individual received comparable services or benefits from only an elementary or secondary educational institut ion, enter “10 ”. If no comparable services or benefits were provided, leave blank. 01 14(c) Certificate Holders 02 Adult Education and Literacy Programs 03 American Indian VR Services Program 04 Centers for Independent Living 05 Child Protective Services 06 Community Rehabilitation Programs 07 Consumer Organizations or Advocacy Groups 08 Day care provider programs 09 DOL Employment and Training Service Programs for Adults, Dislocated Wo rkers, and Youth 10 Educational Institutions (elementary/secondary) 11 Educational Institutions ( postsecondary) 12 Employers 13 Employment Programs 14 Energy Assistance Programs 15 Extended Employment Providers 16 Faith Based Organizat ions 17 Family/Friends 18 Housing Programs 19 Intellectual and Developmental Disabilities Providers 20 Medical Health Provider (Public or Private) 21 Mental Health Provider (Public or Private) 22 Programs for Older Individuals who are Blind 23 Public Housing Authority 24 Self- referral 25 Social Security Administration (Disability Determination Service or District office) 26 State Department of Correction/Juvenile Justice 27 TANF Program and Food Stamp Programs 28 Transportation Programs 29 Veteran's Benefits Administration (which includes VA Vocational Rehabilitation) 30 Veteran's Health Administration (the VA hospital system, as well as the VA transitional living, transitional employment, and compensated work therapy programs) 31 Wagner- Peyser Employment Service Program 32 We lfare Agency (State or local government) 33 Wo rker's Compensation 34 Other One -stop Partner 35 Other Sources 36 Other State Agencies24

37 Other VR State Agencies 38 Other WI OA-funded Programs including Job Corps, YouthBuild, Indian and Native Americans, and Migrant and Seasonal Farmworker Programs 62. Involvement with Other Agencies and Services

Data type: VARCHAR ( 6 ) E nter up to three codes that best describe the service providers or funding sources listed below to which the individual was provided funding or services at the beginning of the quarter

. Make sure to enter the leading zero e s if necessary and do not use commas or spaces between any of the codes. For example, if the individual received comparable services or benefits from an employer, the Veteran’s Benefits Administration, and other source s, enter “ 102 1 26 ”. If the individual received comparable services or benefits from a Community Rehabilitation Program and a One - Stop Operator, enter “0 616 ”. If an individual received comparable services or benefits from only an elementary or secondary educational institution, enter “0 8 ”. If no comparable services or benefits were provided, leave blank. 01 Adult education and Literacy program administered by the Department of Education 02 Adult, Dislocated W orker and Youth formula program administered by Departm ent of Labor (DOL) 03 American Indian VR Services Program 04 C enters for Independent Living 05 Child Protective Services 06 Community Rehabilitation Programs 07 Consumer Organizations or Advocacy Groups 08 Educational Institutions (elementary/secondary) 09 Educational Institut ions ( postsecondary) 10 Employers 11 Employment Networks (not otherwise listed) 12 Federal Student Aid (such as, Pell grants, SEOG (Supplemental Educational Opportunity Grant), work study, etc. 13 Intellectual and Developmental Disabilities Agencies 14 Medical Health Provider (Public or Private) 15 Mental Health Provider (Public or Private) 16 One -stop Operators 17 Public Housing Authority 18 Social Security Administration (Disability Determination Service or District office) 19 State Department of Correction/Juvenile Justice 20 State Employment Service Agency 21 Veteran's Benefits Administration (which includes VA Vocational Rehabilitation)25

22 Veteran's Health Administration (the VA hospital system, as well as the VA transitional living, transitional employment, and compensated work therapy programs) 23 Wagner- Peyser Employment Service P rogram 24 Wo rker's Compensation 25 Other DOL programs authorized under WI OA (Job Corps, YouthBuild, Indian and Native American programs, Migrant and Seasonal Farmworker programs, and evaluation and multistate projects 26 Other Sources 27 Other State Agencies 28 Other VR State Agencies 29 Other We lfare Agencies (State or local government) EDUCATION Enter a "1" for each of the data elements below to indicate the highest level of enrollment or attainment level at the begin n ing of the current quarter

. NOTE: Certification: A credential awarded by a certification body based on an individual demonstrating through an examination process that he or she has acquired the designated knowledge, skills, and abilities to perform a specific job. The examination can be either written, oral, or performance - based. Certification is a time - limited credential that is renewed through a recertification process. License: A credential awarded by a licensing agency based on pre -determined criteria. Th e criteria may include some combination of degree attainment, certifications, certificates, assessment, apprenticeship programs, or work experience. Licenses are time - limited and must be renewed periodically. Educational certificate: A credential awarde d by an educational institution based on completion of all requirements for a program of study, including coursework and test or other performance evaluations. Certificates are typically awarded for life (like a degree). Certificates of attendance or parti cipation in a short-term training (e.g., 1 day) are not in the definitional scope for educational certificates. 63. No formal schooling

Data type: VARCHAR ( 1 ) 64. Enrolled in elementary education in grades 1 - 8

Data type: VARCHAR ( 1 ) 65. Completed elementary educati on (grades 1 - 8)

Data type: VARCHAR ( 1 )26

66. Enrolled in secondary education in grade 9

Data type: VARCHAR (1) 67. Completed secondary education through grade 9

Data type: VARCHAR (1) 68. Enrolled in secondary education in grade 10

Data type: VARCHAR (1) 69. Completed secondary education through grade 10

Data type: VARCHAR (1) 70. Enrolled in secondary education in grade 11

Data type: VARCHAR (1) 71. Completed secondary education through grade 11

Data type: VARCHAR (1) 72. Enrolled in secondary education in grade 12

Data type: VARCHAR (1) 73. Completed secondary education through grade 12, no high school diploma

Data type: VARCHAR (1) 74. Enrolled in a state adult high school at the high ASE level

Data type: VARCHAR ( 1 ) 75. Attained high school diploma or equivalency certificate (GED)

Data type: VARCHAR ( 1 ) 76. Completed some special education, no certificate of completion/diploma

Data type: VARCHAR ( 1 ) 77. Enrolled in special education

Data type: VARCHAR ( 1 ) 78. Attained special education certificate of completion/diploma

Data type: VARCHAR ( 1 ) 79. Completed some postsecondary education, no degree or certificate

Data type: VARCHAR ( 1 ) 80. Enrolled in postsecondary education - 1st academic year

Data type: VARCHAR ( 1 ) 81. Enrolled in postsecondary education - 2nd academic year27

Data type: VARCHA R ( 1 ) 82. Attained Associate degree

Data type: VARCHAR ( 1 ) 83. Enrolled in postsecondary education - 3rd academic year

Data type: VARCHAR ( 1 ) 84. Enrolled in postsecondary education - 4th academic year

Data type: VARCHAR ( 1 ) 85. Attained Bachelor's degree

Data type: VARCHAR ( 1 ) 86. Attained Master’s degree

Data type: VARCHAR ( 1 ) 87. Attained degree above a Master's - e.g. Ph.D., Ed.D., J.D., M.D.

Data type: VARCHAR ( 1 ) 88. Enrolled in a career or technical training program that does not lead to a

recognized postsecondary crede ntial Data type: VARCHAR ( 1 ) 89. Enrolled in a career or technical training program that leads to a recognized

postsecondary credential Data type: VARCHAR ( 1 ) 90. Attained Vocational/Technical Certificate

Data type: VARCHAR ( 1 ) 91. Attained Vocational/Technical License

Data type: VARCHAR ( 1 ) 92. Student with Disabilit ies

Data type: VARCHAR (1) A student with a disability is defined to be a person who is (1) at least 16 years of age, unless a State elects to provide pre -employment transition services at a younger age, and no older than 21 years of age, unless the State provides transition services under the Individuals with Disabilities Education Act (IDEA) at an older age; and ( 2) is receiving transition services pursuant to IDEA, or is considered to have a disability for the purposes of section 504 of the Rehabilitation Act (29 U.S.C. 794). This element captures the status of youth with disabilities at the beginning of the current quarter

. 0 This individual is not in secondary education

.28

1 This individual is a student with a disability and who has a Section 504 accommodation plan. 2 This individual is a student with a disability and is receiving transition servi ces under an IEP. 3 This individual is a student with a disability who does not have a Section 504 accommodation plan and is not receiving services under an IEP. 93. State Definition for Age of Students with Dis abilit ies

Data type: VARCHAR (4 ) I f the state defines age of students with disabilities at the beginning of the reporting quarter to be other than ages 16 to 21 , enter the two -digit lower limit for the age of the students with disabilities followed by the two -digit upper limit for the age of the students with disabilities . For example, if the state defines the ages of students with disabilities to be 14 to 24 instead of 16 to 21, enter "1424." If the state defines the ages of students with disabilities to be 16 to 24, enter "1624." If state defines th e ages of students with disabilities to be 16 to 21, leave blank. 94. Primary Disability

Data type: VARCHAR (4 ) At the beginning of the quarter, e nter the four-digit code that best describes the individual's primary physical or mental impairment that causes or results in a substantial impediment to employment

. The number reported is a combination of the impairment code and cause/source code

. The first two digits designate the impairment (sensory, physical or mental), and the last two digits indicate the cause or source of the impairment. Make sure to enter the leading zeros if necessary and do not use commas or spaces between the impairment code and the cause/source code. If the person is found not to have a disability, this item should be coded 0000

. Leave bl ank if the information is not available for Type of Exit coded "1" (exited as an applicant)

. This data element is required. 95. Secondary Disability

Data type: VARCHAR (4 ) At the beginning of the quarter, e nter the four-digit code that best describes the secondary disability

. This is the physical or mental impairment that contributes to, but is not the primary basis of, the impediment to employment

. The number reported is a combination of the impairment code and cause/source code

. Make sure to enter the leadi ng zero e s if necessary and do not use commas or spaces between the impairment code and the cause/source code. If the person is found not to have a secondary disability, this item should be coded 0000

. Leave blank if the information is not available for Typ e of Exit code d " 1 " (exited as an applicant)

. This data element is required.29

CODES FOR IMPAIRMENTS 00 No impairment S ensory/Communicative Impairments : 01 Blindness 02 Other Visual Impairments 03 Deafness, Primary Communication Visual 04 Deafness, Primary Communication Auditory 05 Hearing Loss, Primary Communication Visual 06 Hearing Loss, Primary Communication Auditory 07 Other Hearing Impairments (Tinnitus, Meniere's Disease, hyperacusis, etc.) 08 Deaf

- Blindness 09 Communicative Impairments (expressive/receptive) P hysical Impairmen ts : 10 Mobility Orthopedic/Neurological Impairments 11 Manipulation/Dexterity Orthopedic/Neurological Impairments 12 Both mobility and Manipulation/Dexterity Orth opedic/Neurological Impairments 13 Other Orthopedic Impairments (e.g., limited range of motion) 14 Respirator

y Impairments 15 General Physical Debilitation (fatigue, weakness, pain, etc.) 16 Other Physical Impairments (not listed above) M ental Impairments : 17 Cognitive Impairments (impairments involving learning, thinking, processing information and concentration) 18 Psychosocial Impairments (interpersonal and behavioral impairments, difficulty coping) 19 Other Mental Impairments CODES FOR CAUSES/SOURCES OF IMPAIRMENTS 00 Cause unknown 01 Accident/Injury (other than TBI or SCI) 02 Alcohol Abuse or Dependence 03 Amputations 04 Anxiety Disorders 05 Arthritis and Rheumatism 06 Asthma and other Allergies 07 Attention - Deficit Hyperactivity Disorder (ADHD) 08 Autism 09 Blood Disorders 10 Cancer 11 Cardiac and other Conditions of the Circulatory System 12 Cerebral Palsy30

13 Congenital Condition or Birth Injury 14 Cystic Fi brosis 15 Depressive and other Mood Disorders 16 Diabetes Mellitus 17 Digestive 18 Drug Abuse or Dependence (other than alcohol) 19 Eating Disorders (e.g., anorexia, bulimia, or compulsive overeating) 20 End -Stage Renal Disease and other Genitourinary System Disorders 21 Epilepsy 22 HIV and AIDS 23 Immune Deficiencies excluding HIV/AIDS 24 Mental Illness (not listed elsewhere) 25 Intellectual/Developmental Conditions 26 Multiple Sclerosis 27 Muscular Dystrophy 28 Parkinson's Disease and other Neurological Disorders 29 Personality Disorders 30 Physical Disorders/Conditions (not listed elsewhere) 31 Polio 32 Respiratory Disorders other than Cystic Fibrosis or Asthma 33 Schizophrenia and other Psychotic Disorders 34 Specific Learning Disabilities 35 Spinal Cord Injury (SCI) 36 Stroke 37 Tr aumatic Brain Injury (TBI) 96. Significan ce of Disability

Data type: VARCHAR (1) Select a coding option below to indicate whether the individual was considered a person with a significant disability or a most s ignificant disability at the beginning of the quarter

. If an individual is receiving Social Security benefits at application or exit due to their own disabling condition , he/she is presumed eligible and significantly disabled

. Individuals are to be coded as most significantly disabled if they meet the definiti on of significantly disabled and have additional functional limitations as defined by the agency. An individual with a significant disability is an individual: a) who has a physical or mental impairment that seriously limits one or more functional capacitie s (such as mobility, communication, self-care, self-direction, interpersonal skills, work tolerance, or work skills) in terms of an employment outcome; b) whose VR can be expected to require multiple VR services over an extended period of time; and c) who has on e or more physical or mental disabilities resulting from amputation, arthritis, autism, blindness, burn injury, cancer, cerebral palsy, cystic fibrosis,31

deafness, head injury, heart disease, hemiplegia, hemophilia, respiratory or pulmonary dysfunction, intellectual disability, mental illness, multiple sclerosis, muscular dystrophy, musculo -skeletal disorders, neurological disorders (including stroke and epilepsy), spinal cord conditions (including paraplegia and quadriplegia), sickle cell anemia, specific l earning disability, end -stage renal disease, or another disability or combination of disabilities determined on the basis of an assessment for determining eligibility and VR needs to cause comparable substantial functional limitation. 0 No Significant Disab ility 1 Significant Disability 2 Most Significant Disability 97. Start Date of Trial W ork Experience

Data type: DATE 112 (YYYYMMDD) This data element captures the start of pre - and possibly post-eligibility assessment activities that are part of the VR experience for many severely disabled individuals for whom an employment outcome might be in doubt. Enter the date that the individual’s t rial work experience began. If the individual has been place d in more than one trial work experience, the first occurrence of trial work must have an End Date of Trial Wo rk Experience (Data Element 98 ) before another Start Date of Trial W ork Experience can be entered. Th ese data are reported quarterly. 98. End Date of Trial W ork Experience

Data type: DATE 112 (YYYYMMDD) Enter the date that the individual’s t rial work experience ended. These data are reported quarterly. 99. Date of Most Recent or Amended Individualized Plan for Employment (IPE)

Data type: DATE 112 (YYYYMMDD) Record the date on which the most recent IPE for the individual became effective. For purposes of this data element, assume that the IPE is effective on the date on which both the agency and individual reach agreement. If the two signatures bear two different dates, the later date should govern. If t he IPE is amended more than once during the same reporting quarter, enter the most recent date. If the IPE is amended later in the individual's VR program, enter the subsequent date in the reporting quarter in which the IPE was amended. Th ese data are repo rted quarterly. 100. Start Date of In itial VR Service

Data type: DATE 112 (YYYYMMDD)32

Record the date on which the initial VR service began after the IPE for the individual became effective. No modifications after initial entry. 101. Supported Employment Goal on C urrent IPE

Data type: VARCHAR (1) If the individual has an employment goal of supported employment in their current IPE during the reporting quarter, enter "1" to indicate that the individual has a supported employm ent goal on his/her current IPE. These data are reported quarterly. N ote : The term “supported employment” means competitive integrated employment, including customized employment, or employment in an integrated work setting in which individuals are working on a short-term basis toward competitive integrated e mployment, that is i ndividualized and customized consistent with the strengths, abilities, interests, and informed choice of the individuals involved, for individuals with the most significant disabilities for whom competitive integrated employment has not historically occurred; or for whom competitive integrated employment has been interrupted or intermittent as a result of a significant disability; and who, because of the nature and severity of their disability, need intensive supported employment services and extended servi ces after the transition described in paragraph (13)(C), in order to perform the work involved. **SERVICES PROVIDED A ND COSTS FOR PURCHA** **SED SERVICES** There are five data elements for each of the service categories. The first data element indicates whether s ervice has been provided

. If purchase d by the VR agency, the second data element identifies the primary purchase VR service provider type

. The third data element is used to report state VR Title I funds used to purchase services . F or pre -employment transi tion services, the source of funds for this data element would be state VR Title I grant funds , reserved in accordance with 110 (D ) . For participants of the VR program, the source of funds for this data element would be state VR Title I grant funds . The fourth data element is used to report supported employment state grant (Title VI ) funds used to purchase services

. The fifth data element is used to capture up to three comparable services and benefits providers

. 1) Services Provided Data Type VARCHAR (1) For each of the service categories, this data element provides information on whether services in the category were purchased and/or provided by the VR agency and/or provided by comparable services and benefits providers for the individual. Include all ser vices furnished over the life of the service record for the individual. The following codes are used to capture this information for all services within the service category. 0 not provided33

1 provided by the VR agency (in - house/by VR staff) 2 purchased by th e VR agency 3 provided by comparable services and benefits providers 4 provided by the VR agency (in - house/by VR staff) and/or purchased by the VR agency and/or provided by comparable services and benefits providers Note: For each service category, select code 0 if the service was not provided to the individual at all. Each of the other data elements, (2) Primary Purchase VR Service Provider Type, (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services, and (4) Supported Employme nt State Grant (Title VI) Funds Used to Purchase Services should be left blank. For each service category, select code 1 if the service was provided ONLY by the State VR agency through its own staff. Each of the other data elements, (2) Primary Purchase VR Service Provider Type, (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services, and (4) Supported Employment State Grant (Title VI ) Funds Used to Purchase Services should be left blank. For each service category, select code 2 if the service was provided ONLY through purchase by the VR agency. Data elements (2) Primary Purchased VR Service Provider Type and an amount should be entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI ) Funds Used to Purchase Services. For each service category, select code 3 if the service was provided by a combination of coding options, 1 provided by the VR agency (in - house/by VR staff) and 2 purchase d by the VR agency. If the service was provided by the VR agency (in - house/by VR staff) and purchased by the VR agency, a coding option should be selected for data element (2) Primary Purchased VR Service Provider Type and an amount should be entered in ( 3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI ) Funds Used to Purchase Services. For each service category, select code 4 if the service was provided by any combinat ion of coding options, 1 provided by the VR agency (in - house/by VR staff), 2 purchased by the VR agency, and/or 3 provided by comparable services and benefits providers (see coding details below)

.
 If the service was provided by the VR agency (in - house/by VR staff) and purchased by the VR agency, a coding option should be selected for data element (2) Primary Purchased VR Service Provider Type and an amount should be entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI ) Funds Used to Purchase Services. Data element (5) Comparable Services and Benefits Providers should be left blank.34

 If the service was provided by the VR agency (in - house/by VR staff) and also p rovided by comparable services and benefits providers, data elements, (2) Primary Purchase VR Service Provider Type, (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services, and (4) Supported Employment State Grant (Title VI ) Fu nds Used to Purchase Services should be left blank. Data element (5) Comparable Services and Benefits Providers should be entered with up to three comparable services and benefits providers.

 If the service was purchased by the VR agency and also provided by comparable services and benefits providers, a coding option should be entered in data element (2) Primary Purchased VR Service Provider Type with an amount entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services an d/or (4) Supported Employment State Grant (Title VI ) Funds Used to Purchase Services. Data element (5) Comparable Services and Benefits Providers should also be entered with up to three comparable services and benefits providers.

 If the service was provided by the VR agency (in - house/by VR staff) and purchased by the VR agency and also provided by comparable services and benefits providers, data should be entered in data element (2) Primary Purchased VR Service Provider Type with a n amount entered in (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant (Title VI ) Funds Used to Purchase Services. Data element (5) Comparable Services and Benefits Providers sho uld also be entered with up to three comparable services and benefits providers. 2) Primary Purchased VR Service Provider Type Data Type VARCHAR (1) For each of the service categories, this data element provides information on what type of service provider provided the purchased services. The following codes are used to capture this information. For each service category, select the code that best describes from which service provider type the majority of the purchased services provided to the individual ori ginated over the life of the service record. The majority of purchased services were provided directly by: 1 Public Community Rehabilitation Programs (CRPs)

– public CRPs are programs that are operated by a state, county, municipal or other local government

. 2 Private CRPs

– private CRPs are programs that are operated as not-forprofit organizations.35

3 Other public service providers

– public service providers are organizations or agencies of State, county, municipal or other local government and third party coop erative arrangements. 4 Other private service providers

– private service providers include private not-for- profit organizations, such as VR providers (other than CRPs), as well as proprietary businesses, such as private hospitals and mental health clinics a s well as contracted service delivery staff. 3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services Data type INT ( 6) For pre -employment transition services, t his data element captures the costs (amounts) per quarter of purchase d services using the VR grant (Title I) funds reserved in accordance with 110 (D). For participants of the VR program, t his data element captures the costs (amounts) per quarter of purchased services using the VR grant (Title I) funds including state and other sources of matching funds as well as program income. Do not include costs incurred for program administration and for salaries of counselors and other staff. Also exclude costs for services provided by rehabilitation programs owned and operated by the State VR agency that are not directly billed on an indivi dual basis. 4) Supported Employment State Grant (Title VI ) Funds Used to Purchase Services Data type INT ( 6) This data element records all expenditures (amounts) per quarter within this service category for services purchased for the most significantly di sabled individual with the supported employment grant program (Title VI ) funds

. Recipients of these funds should have a supported employment goal in their IPE

. Individuals with a supported employment goal stated in their IPEs may receive any category of se rvices depending on their particular needs

. Therefore, to identify the use of these funds, each service category includes this data element. Include all Title VI expenditures made to public and/or private service providers, individuals or an organization

. Include Title VI expenditures for all types of purchased services including, but not limited to assessment, training, medical services, job development, placement and/or coaching services, maintenance, transportation, tuition for higher education, rehabil itation technology services, personal assistance, or any other rehabilitation services

. Exclude costs incurred for program administration and for salaries of counselors and other staff. Also exclude costs for services provided by rehabilitation programs owned and operated by the State VR agency that are not directly billed on an individual basis. 5) Comparable Services and Benefits Provider36

Data Type VARCHAR (6) For each of the service categories, enter up to three codes that best describe the service provid ers who provided the individual with a comparable service or benefit

. Make sure to enter the leading zero e s if necessary and do not use commas or spaces between any of the codes

. For example, if the individual received comparable services or benefits from an employer, the Veteran’s Benefits Administration, and other sources, enter “ 102129 ”

. If the individual received comparable services or benefits from a Community Rehabilitation Program and a developmental disability agency, enter “0 613 ”

. If an individual received comparable services or benefits from only a n elementary or secondary educational institution , enter “0 8 ”. If no comparable services or benefits were provided, leave blank. 01 Adult education and Literacy program administered by the Department of Education 02 Adult, Dislocated W orker and Youth formula program administered by Department of Labor (DOL) 03 American Indian VR Services Program 04 Centers for Independent Living 05 Child Protective Services 06 Community Rehabilitation Programs 07 Consumer Organizations or Advocacy Groups 08 Educational Institutions (elementary/secondary) 09 Educational Institutions ( postsecondary) 10 Employers 11 Employment Networks (not otherwise listed) 12 Federal Student Aid (such as, Pell grants, SEOG (Supplemental Educational Opportunity Grant), work study, etc. 13 Intellectual and Developmental Disabilities Agencies 14 Medical Health Provider (Public or Private) 15 Mental Health Provider (Public or Private) 16 One -stop Operators 17 Public Housing Authority 18 Social Security Administration (Disability Determination Se rvice or District office) 19 State Department of Correction/Juvenile Justice 20 State Employment Service Agency 21 Veteran's Benefits Administration (which includes VA Vocational Rehabilitation) 22 Veteran's Health Administration (the VA hospital system, as well as th e VA transitional living, transitional employment, and compensated work therapy programs) 23 Wagner- Peyser Employment Service Program 24 We lfare Agency (State or local government) 25 Wo rker's Compensation37

26 Other DOL programs authorized under WI OA (Job Corps, YouthB uild, Indian and Native American programs, Migrant and Seasonal Farmworker programs, and evaluation and multi state projects 27 Other VR State Agencies 28 Other State Agencies 29 Other Sources SERVICE CATEGORIES FOR PRE - EMPLOYMENT TRANSITION STUDENTS Pre -employment transition services may be provided to all students with disabilities.  Job Exploration Counseling Data Elements 10 2 - 10 6  Wo rk- Based Learning Experiences Data Elements 10 7 - 11 1 Use this category for in -school or after school opportunities, o r experience outside the traditional school setting (including internships), that is provided in an integrated environment to the maximum extent possible.  Counseling on Enrollment Opportunities Data Elements 11 2 - 11 6 Use this category for counseling on op portunities for enrollment in comprehensive transition or postsecondary educational programs at institutions of higher education.  Wo rkplace Readiness Training Data Elements 11 7 - 12 1 Use this category for workplace readiness training to develop social skil ls and independent living.  Instruction in Self-advocacy Data Elements 12 2 - 12 6 Use this category for instruction in self-advocacy (including instruction in person centered planning), which may include peer mentoring (including peer mentoring from individuals with disabilities working in competitive integrated employment). SERVICE CATEGORIES FOR VR APPLICANTS AND ELIGIBLE INDIVIDUALS The purpose of the service categories listed below is to capture all services provided to individuals during the life of their service record whether provided by the VR agency or others as comparable services or benefits

. Except for certain services such as38

assessment that can be provided to determine eligibility prior to an IPE or to assign an individual to a priori ty category, the services provided should be those identified on the IPE , not services merely authorized, but actually provided

.  Assessment Data Elements 12 7 - 13 1 Assessment means services provided and activ ities performed to determine an individual ’s el igibility for VR services, to assign an individual to a priority category of a State VR agency that operates under an order of selection, and/or to determine the nature and scope of VR services to be included in the IPE

. Include here trial work experiences and extended evaluation

. Assessments to determine eligibility, assignment of a priority category or the nature or scope of services to be included on the IPE include, but are not limited to psychological assessments, audio logical evaluations, dental and medical exams and other assessments of personality, interests, interpersonal skills, intelligence and related functional capacities, educational achievements, work experience, vocational aptitudes, personal and social adjustments, and employment opportunities of the individual and the medical, psychiatric, psychological, and other pertinent vocational, educational, cultural, social, recreational, and environmental factors that affect the employment and rehabilitation needs of the individual

. See a lso 34 CFR 361.5(b)(6) and 34 CFR 361.48.  Diagnosis and Treatment of Impairments Data Elements 13 2 - 13 6 Diagnosis and treatment of impairments means: a) Corrective surgery or therapeutic treatment that is likely, within a reasonable period of time, to correct or modify substantially a physical or mental impairment that constitutes a substantial impediment to employment including the medical and surgical procedures required for implantation of n europrosthetic devices , such as cochlear implants, v isual prosthetics, and motor prosthetic devices ; b) Diagnosis and treatment for mental and emotional disorders by qualified personnel who meet State licensure laws; c) Dentistry; d) Nursing services; e) Necessary hospitalization (either inpatient or outpatient care) in co nnection with surgery or treatment; f) Drugs and supplies;39

g) Prescription of p rosthetics and/or orthotics related to the individual’s diagnosed disability and is necessary for the achievement of the employment outcome; h) Prescription of eyeglasses and visual services, including visual training, related to the individual’s diagnosed disability and necessary for the achievement of the employment outcome; i) Podiatry; j) Physical therapy; k) Occupational therapy; l) Speech or hearing therapy; m) Mental health services; n) Treatment of either acute or chronic medical complications and emergencies that are associated with or arise out of the provision of physical and mental restoration services or that are inherent in the condition under treatment; o) Special services for the t reatment of individuals with end -stage renal disease, including transplantation, dialysis, artificial kidneys, and supplies; p) Other medical or medically related rehabilitation services ; and q) Medical care for acute conditions arising during rehabilitation and constituting a barrier to the achievement of an employment outcome is also included in this category.  Vocational Rehabilitation Counseling and Guidance Data Elements 13 7 - 14 1 Vocational rehabilitation counseling and guidance includes information and support services to assist an individual in exercising informed choice and is distinct from the case management relationship that exists between the counselor and the individual during the VR process . TRAINING Training services are design ed to help the individual improve educationally or vocationally or to adjust to the functional limitations of his or her impairment

. If the individual receives more than one type of training, each type should be recorded

. For those individuals not seeking a degree or certificate and attending a course in a college or university, code this type of training under Miscellaneous Training.40  Graduate College or University Training Data Elements 14 2 - 14 6 Full -time or part-time academic training leading to a degree recognized as beyond a baccalaureate degree, such as a Master of Science, Arts (M.S. or M.A.) or Doctor of Philosophy (Ph.D.) or Doctor of Jurisprudence (J.D.)

. Such training would be provided by a college or university

.  Four-Year College or University Training Data Elements 14 7 - 15 1 Full -time or part-time academic training leading to a baccalaureate degree, a certificate , or other recognized educational credential

. Such training may be provided by a four-year college or university or technical college.  Junior or Community College Training Data Elements 15 2 - 15 6 Full -time or part-time academic training above the high school level leading to an associate degree, a certificate , or other recognized educational credential

. Such training may be provided by a community college, junior college, or technical college.  O ccupational or Vocational Training Data Elements 15 7 - 16 1 O ccupational, vocational, or job skill training provided by a community college and/or business, vocational/trade or technical school to prepare students for gainful employment in a recognized occupation, not leading to an academic degree

. This would include selected courses or programs of study at a community college, four-year college , university , technical college or proprietary schools or programs .  On -the -

job Training Data Elements 16 2 - 16 6 Training in specific job skills by a prospective employer

. Generally the trainee is paid during this training and will remain in the same or a similar job upon successful completion.  Registered App renticeship Training Data Elements 16 7 - 17 141 A registered apprenticeship program is a work- based employment and training program that combines hands -on, on -the - job work experience in a skilled occupation with related classroom instruction

. Structured apprenticeship programs generally have minimum requirements for the duration of on -the job work experience and classroom instruction, and/or could utilize competency- based elements but should have mechanisms in place to ensure quality and consistency of sk ills acquisition

. Other elements that distinguish apprenticeship programs from other work- based efforts including co -op education, on -the - job training, and internships are the following: includes supervision and structured mentoring; provides for wage inc reases as an apprentice's skills increase; is based on an employer-employee relationship; and provides an i ndustry recognized certificate of completion of the program

.  Basic Academic Remedial or Literacy Training Data Elements 17 2 - 17 6 Literacy training or training provided to remediate basic academic skills that are needed to function on the job in the competitive labor market.  Job Readiness Training Data Elements 17 7 - 18 1 Training provided to prepare an individual for the world of work (e.g., appropri ate work behaviors, getting to work on time, appropriate dress and grooming, increasing productivity).  Disability- Related Skills Training Data Elements 18 2 - 18 6 Disability- related augmentative skills training includes but is not limited to: orientation and mobility; rehabilitation teaching; training in the use of low vision aids; Braille; speech reading; sign language; and cognitive training/retraining.  Miscellaneous Training Data Elements 18 7 - 19 1 Any training not recorded in one of the other categorie s listed, including GED or high school training leading to a diploma , or courses taken at four-year, junior or community college s not leading to a certificate or diploma

.  Job Search Assistance Data Elements 19 2 - 19 642

Job search activities support and assist an individual in searching for an appropriate job. Job search assistance may include help in resume preparation, identifying appropriate job opportunities, developing interview skills, and making contacts with compa nies on behalf of the consumer.  Job Placement Assistance Data Elements 19 7 -20 1 Job placement assistance is a referral to a specific job resulting in an interview, whether or not the individual obtained the job.  On -the -

job Supports - Short term Data Elements 20 2 -20 6 Support services provided to an individual who has been placed in employment in order to stabilize the placement and enhance job retention. Such services include short-term job coaching for persons who do not have a supported employment g oal consistent with the employment goal on the IPE

.  On -the -

job Supports

– S upported E mployment Data Elements 20 7 -21 1 On -going support services and other appropriate services needed to support and maintain an individual with a most significant disability in supported employment for a period of time generally not to exceed 24 months

. S e rvices, such as job coaching , are for individuals who have supported employment and long -term supports identified on the IPEs

. On -the -

job support services with a supported employment goal are funded using Title VI and Title I funds.  Transportation Data Elements 21 2 -21 6 Transportatio n, including adequate training in the use of public transportation vehicles and systems, means travel and related expenses that are necessary to enable an applicant or eligible individual to participate in a VR service

. Examples of transportation services/expenses include, but are not limited to: a) Travel and related expenses for a personal care attendant or aide if the services of that person are necessary to enable the individual to travel to participate in any VR service; b) Relocation expenses incurred by the individual in connection with a job placement that is a significant distance from the individual's current residence;43

c) The purchase and repair of vehicles, including vans

. This specifically excludes the modification of vehicles, which is to be reported in rehabilitation technology; d) Training in the use of public transportation vehicles and systems.  Maintenance Data Elements 21 7 -22 1 Maintenance means monetary support provided for those expenses such as food, shelter and clothing that are in excess of the normal expenses of the individual , and that are necessitated by the individual ’s participation in an assessment for determining elig ibility and VR needs or while receiving services under an IPE. Examples of maintenance expenses include, but are not limited to: a) cost of uniforms or other suitable clothing required for an individual's job placement or job seeking activities; b) cost of sho rt-term expenses, such as food and shelter, that is required in order for a n individual to participate in assessment or vocational training at a site that is not within commuting distance of an individual's home; c) initial one -time costs, such as security deposits or charges for the initiation of utilities, that are required in order for an individual to relocate for a job placement; and  Rehabilitation Technology Data Elements 22 2 -22 6 Rehabilitation technology means the systematic application of technolog ies, engineering methodologies, or scientific principles to meet the needs of, and address the barriers confronted by, individuals with disabilities in areas that include education, rehabilitation, employment, transportation, independent living, recreation , home and vehicular modification, other assistive devices including, but not limited to hearing aids, low vision aids and wheelchairs

. This includes the hardware portion of n europrosthetic devices, such as cochlear implants, v isual prostheti cs, and motor prosthetic devices, but does not include medical and surgical procedures required for implantation of n europrosthetic devices which should be coded as diagnosis and treatment of impairments. Rehabilitation technology includes rehabilitation engineering, a ssistive technology devices, and assistive technology services

. See also 34 CFR 361.5(b)(45)

. The term includes the following: a) Rehabilitation Engineering Services are the systematic application of engineering sciences to design, develop, test, evaluate, a pply, and distribute technological solutions to problems confronted by VR individuals in functional areas such as mobility, communications, hearing, vision, and cognition, and in44 activities associated with employment, independent living, education, and integration into the community. b) Assistive Technology Devices are any items, piece of equipment, or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain, or improve the functional capabilities of a VR customer. c) Assistive Technology Services are any services that directly assist an individual with a disability in the selection, acquisition, or use of an assistive technology device. Services may include: 1. the evaluation of the needs of an individual, including a functional evaluation of the individual in his/her customary environment; 2. purchasing, leasing, or otherwise providing for the acquisition by an individual of an assistive technology device; 3. selecting, designing, fitting, customizing , adapting, applying, maintaining, repairing, or replacing assistive technology devices; 4. coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitati on plans and programs; 5. training or providing technical assistance for an individual or, if appropriate, the family members, guardians, advocates, or authorized representatives of the individual; and 6. training or providing technical assistance for profession als (including individuals providing education and rehabilitation services), employers, or others who provide services to, employ, or are otherwise substantially involved in the major life functions of VR individuals to the extent that training or technica l assistance is necessary for individuals to achieve an employment outcome. P ERSONAL ASSISTANCE SERVICES Personal Assistance Services are a range of services provided by one or more persons designed to assist a n individual to perform daily living activities on or off the job that the individual would typically perform without assistance if he or she did not have a disability

. The services must be designed to increase the individual ’s control in life and ability to perform everyday activities on or off the job

. The services must be necessary to the achievement of an employment outcome and may be provided only while the individual is receiving other VR services

. The services may include training in managing, supervising, and di recting personal assistance services. Three distinct services that are considered personal assistance services are reader services, interpreter services, and personal attendant services. Further information on recording each of these services follows

. Record only whether and which of these45

services were provided to the individual (e.g., if the same person provided both reader service and personal attendant service to an individual, indicate both services).

 Reader Services Data Elements 22 7 -23 1 Reader services are for individual s who cannot read print because of blindness or other disability

. Reader services include, in addition to reading aloud, transcription of printed information into Braille or sound recordings if the individual requests such transcription

. Reader services are generally for individuals who are blind or deaf- blind, but may also include individuals unable to read because of serious neurological disorders, specific learning disabilities, or other physical or mental impairments.  Interpreter Services Data Elements 23 2 -23 6 Interpreter services are sign language or oral interpretation services for individual s who are deaf or hard of hearing and tactile interpretation services for individuals who are deaf- blind

. Specially trained ind ividuals perform sign language or oral interpretation

. Also include here real -time captioning services for persons who are deaf or hard of hearing

. Do not include language interpretation in this category, but in "other services".  Personal Attendant Services Data Elements 23 7 -24 1 Personal attendant services are those personal services th at an attendant performs for a n individual with a disability including, but not limited to bathing, feeding, dressing, providing mobility and transportation, etc in multipl e settings to include home, work and training facilities/school

.  Technical Assistance Services Data Elements 24 2 -24 6 Technical assistance and other consultation services provided to conduct market analyses, to develop business plans, and to provide resou rces to individual s in the pursuit of self-employment, telecommuting and small business operation outcomes.  Information and Referral Services Data Elements 24 7 -25 1 Information and referral services are provided to individual s who need services from other agencies ( e.g., cooperative agreements) not available through the VR program.46

 Benefits Counseling Data Elements 25 2 -25 6 Assistance provided to a n individual who is interested in becoming employed , but is uncertain of th e imp act work income will have on any disability benefits and entitlements being received , and/or is not aware of benefits, such as access to healthca re, that might be available to support any work attempt. This typica lly involves an analysis of an individual’ s current benefits, such as SSDI and SSI, the individual’s financial situation, and the effect differen t income levels from work will have on the individual’s future financial situation

. This assistance is intended to provide the individual an opportunity to make an informed c hoice regarding the pursuit of employment

. Ongoing assistance may also be provided as the individual decides on employment goals, searches for jobs, and becomes employed.  Customized Employment Services D ata Elements 25 7 -26 1 Customized employment means competitive integrated employment for an individual with a significant disability, that is based on an individualized determination of the strengths, needs, and interests of the individual with a significan t disability, that is designed to meet the specific abilities of the individual with a significant disability and the business needs of the employer, and that is carried out through flexible strategies

. Flexible strategies include job exploration by the i ndividual or working with an employer to facilitate placement, including : a) customizing a job description based on current employer needs or on previously unidentified and unmet employer needs ; b) developing a set of job duties, a work schedule and job arrangement, and specifics of supervision (including performance evaluation and review), and determining a job location; c) representation by a professional chosen by the individual, or selfrepresentation of the individual, in working with an employer to fa cilitate placement; and d) providing services and supports at the job location.  Other Services Data Elements 26 2 -26 6 Use this category for all other VR services that cannot be recorded elsewhere

. Included here are occupational licenses, tools and equipment, initial stocks and supplies

. 267. Number of Jobs at Exit47

Data type VARCHAR (1) This data element captures the number of separate positions consistent with the employment goal on an individual's IPE and primary employment goal SOC codes that the individual held at the time of exit . For those exiting with only one source of employment, enter the number ‘1’. For those exiting the VR program with 2 sources of employment or position s , enter a ‘2’, and so on for each additional position

. For those individuals exiting without employment, leave blank

. 268. Primary Occupation at Exit

Data type VARCHAR ( 16 ) For a n individual who achieved an employment outcome, enter up to two eight-digit O*Net Version 4.0 (or later version) SOC code s to describe the individual ’s occupation (s) consistent with the employment goal on an individual's IPE from which the exiting individual derives the majority of their hourly earnings

. Make sure to enter the leading zero e s if necessary and do not use commas or spaces between any of the codes

. For example, if the individual ’s first position was SOC code 436012 01 and their second position was SOC code 434051 01 , enter “436012 01 434051 01 .” If th e individual has only one position with the SOC code 292041 01 , enter “202041 01 .” For individuals who did not achieve an employment outcome, leave blank. For the employment situations unique to the VR program, use the special codes indicated below. **Special Codes**  **Special Code Descriptions** 899999 99 Randolph - Sheppard vending facility clerk use this category for persons

employed as clerks, sales persons, or helpers in a vending facility operated under the Randolph - Sheppard Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility operators (999999), or individuals employed in vending facilities outside the Vending Facility Program (use their occupation code). 999999 99 Randolph - Sheppard vending facility operator use this category for

individuals employed as operators or man agers of vending facilities operated under the Vending Facility Program. Use this special code even though these occupations are classifiable. Do not include vending facility clerks (899999), or individuals employed as vending facility operators outside th e Randolph - Sheppard Vending Facility Program (use their occupation code).Randolph - Sheppard vending facility operator. 269. Start Date of Employment in Primary Occupation at Exit

Data type: DATE 112 (YYYYMMDD)48

For an individual who achieved an employment outcome, record the earliest date of suitable employment after the provision of substantial services when the individual began the job (s) coded in data element 2 68 as the primary occupation. 270. Employment Status at Exit

Data type VARCHAR (1) For a n individual who achieved an employment outcome, enter the applicable one -digit code that describes the employment outcome of the individual at exit

. If classifying the individual into two different employment statuses from Codes 1 -4 is possible, select a code designating the principal status. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry

. 1 Competitive Integrated Employment refers to work that is performed on a full time or part-time basis (including self-employment)

— (A) for which an individual

— (i) is compensated at a rate that

— (I) (aa) shall be not less than the higher of

the rate specified in section 6(a)(1) of the Fair Labor Standards Act of 1938 (29 U.S.C. 2 06(a)(1)) or the rate specified in the applicable State or local minimum wage law; and (bb) is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individuals with disabilities, and who are similarly situated in similar occupations by the same employer and who have similar training, experience, and skills; or (II) in the case of an individual who is self-employed, yields an income that is comparable to the income received by other individuals who are not individuals with disabilities, and who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and (ii) is eligible for the level of b enefits provided to other employees; (B) that is at a location where the employee interacts with other persons who are not individuals with disabilities (not including supervisory personnel or individuals who are providing services to such employee) to th e same extent that individuals who are not individuals with disabilities and who are in comparable positions interact with other persons; and49 (C) that, as appropriate, presents opportunities for advancement that are similar to those for other employees who are not individuals with disabilities and who have similar positions

. 2 Self-employment (except BEP) refers to work for profit or fees including operating one's own business, farm, shop, or office. "Self-employment" includes sharecroppers, but not wage earners on farms. 3 State Agency- managed Business Enterprise Program (BEP) refers to Randolph - Sheppard vending facilities and other small businesses operated by individuals with significant disabilities under the management and supervision of a State VR agency. Include home industry where the work is done under the management an d supervision of a State VR agency in the individual's own home or residence for wages, salary, or on a piece - rate. Individuals capable of activity outside the home, as well as homebound individuals, may engage in such employment. 4 Competitive Integrated E mployment with Supports refers to competitive integrated employment as defined above with ongoing support services for individuals with significant disabilities (supported employment). 5 Integrated Employment with Supports refers to integrated employment with ongoing support services for individuals with significant disabilities, that is expected to become competitive integrated employment within six months. 271. Hourly W age at Exit

Data type: Decimal ( 5 ,2) Enter the hourly wage (to the nearest cent ) the indi vidual earned after achieving an employment outcome consistent with the employment goal on an individual’s IPE, at the time the individual exited

. This data element captures cash earnings of the individual at time of exit expressed as an hourly wage and includes all wages, salaries, tips, and commissions received as income . These earnings are before payroll deductions of Federal, State and local income taxes and Social Security payroll tax are taken

. Hourly wages (e arnings ) also include profits derived from self-employed individuals. Wages for salespersons, consultants, self-employed individuals, and other similar occupations are based on the adjusted gross income. Adjusted gross income is gross income minus unreimbursed business expenses. Do not include estimates of payments in - kind, such as meals and lodging. Estimate profits of farmers, if necessary. Wh ere wages are based on commissions that are irregular (e.g., real estate, automobile sales, etc.) , they should be calculated as a n hourly wage average over a representative50

period of time such as one month or longer to obtain a meaningful figure. Commissions are generally not paid when earned, but rather are paid periodically, such as weekly, biweekly, or even monthly. To bring standardization to this item, wages should be based on the actual receipt of the payment and not on amounts accruing until the next commission payout. If there are significant amounts of irregular unreimbursed business expenses (e.g., car lease payments due the first week of every month), the expenses should be averaged over a representative period of time such as one month or longer to obtain a meaningful figure for a n hourly wage

. If the individual had no earnings or did not achieve an employment outcome, enter "0". Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry

. 272. Competitive Integrated Employment at Exit

Data type VARCHAR (1) Competitive integrated employment means work that is performed on a full -time or parttime basis (including self-employment)

— (A) for which an individual

— (i) is compensated at a rate that

— (I) (aa) shall be not less than the higher of

the rate specified in section 6(a)(1) of the Fair Labor Standa rds Act of 1938 (29 U.S.C. 206(a)(1)) or the rate specified in the applicable State or local minimum wage law; and (bb) is not less than the customary rate paid by the employer for the same or similar work performed by other employees who are not individ uals with disabilities, and who are similarly situated in similar occupations by the same employer and who have similar training, experience, and skills; or (II) in the case of an individual who is self-employed, yields an income that is comparable to the income received by other individuals who are not individuals with disabilities, and who are self-employed in similar occupations or on similar tasks and who have similar training, experience, and skills; and (ii) is eligible for the level of benefits provi ded to other employees; (B) that is at a location where the employee interacts with other persons who are not individuals with disabilities (not including supervisory personnel or individuals who are providing services to such employee) to the same extent that individuals who are not individuals with disabilities and who are in comparable positions interact with other persons; and51

(C) that, as appropriate, presents opportunities for advancement that are similar to those for other employees who are not ind ividuals with disabilities and who have similar positions

. Enter a one -digit code to indicate whether the individual achieved competitive integrated employment at the date of exit. 0 Not competitive, integrated employment 1 Competitive, integrated employment 273. Hours W orked in a Week at Exit

Data type INT ( 3) For a n individual who achieved an employment outcome, this data element collects data on the number of hours worked on all employment consistent with the employment goal on the individual’s IPE

. E nter the number of hours the individual worked for earnings in a typical week when the individual exited

. Earnings may have been in the form of wages, salaries, tips, commissions, profits from self-employment, adjusted gross income for salespersons, etc. I f the individual had no earnings or did not achieve an employment outcome, enter "0"

. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry

. M ONTHLY PUBLIC SUPPORT AMOUNT AT EXIT Enter the monthly amount (to the nearest dollar) of public support received by the individual at exit from each of the following sources

. If the individual did not receive any monthly public support, enter "0" for each type of public support

. Agencies may leave these data elements blank for exit code 1

. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after data entry. Public support refers to cash payments made by Federal, State and/or local governments for an y reason, including an individual’s disability, age, or economic status

. Include payments to a family unit precipitated by the individual’s disability or when the individual’s presence is taken into account in the computation of the family benefit

. Also in clude any payments that are sent directly to the individual in an institution or to dependents on his/her behalf

. Exclude any non -cash support payments such as Medicaid, Medicare, food stamps and rental subsidies

. Categories of public support are as foll ows: 274. Social Security Disability Insurance (SSDI)

Data Type INT ( 5)52

Enter the monthly amount of SSDI received by the individual

. This figure can be verified through the Social Security Administration (SSA) or from a copy of the individual’s benefit notification letter. 275. Supplemental Security Income (SSI) for the Aged, Blind or Disabled

Data Type INT ( 5) Enter the monthly payment to the individual under the Federal program of SSI for the aged, blind, and disabled

. Only the individual’s portion of the payment should be recorded here

. This figure can be verified through the SSA or from a copy of the individual’s benefit notification letter. 276. Temporary Assistance for Needy Families (TANF)

Data Type INT ( 5) Enter the monthly amount of cash public ass istance payments made through the federally funded TANF program

. If the TANF payment is made to the family unit, use the local disbursing agency's procedure to estimate the individual’s portion of the payment. 277. General Assistance (State or local government )

Data Type INT ( 5) 278. Veterans' Disability Benefits

Data Type INT ( 5) Veterans' Disability Benefits are payments made by the Department of Veterans Affairs for partial or total disability. 279. Wo rkers' Compensation

Data Type INT ( 5) 280. All Other Public Suppo rt

Data Type INT ( 5) Enter the monthly amount of public support received from all other sources of public support not listed

. Other Public Support payments are cash payments to individuals beyond those otherwise listed, and include payments made by Federal, State and local governments for retirement or survivor benefits to the individual as well as unemployment insurance benefits and other temporary payments. 281. Primary Source of Support at Exit

Data type VARCHAR (1)53

Enter a code from the list below to indicate the individual ’s largest single source of economic support at the time the individual exited , even if it accounts for less than one half of the individual's total support. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry

. N ote : If a n individual is supported by the earnings of a spouse, or by the spouse's unemployment insurance checks, identify Code 2 as the Primary Source of Support (family and friends) and not Code 1 (pe rsonal income)

. If a n individual is primarily supported by a governmental entity with no cash support

– for example, incarcerated individuals

– use code 3 (public support) as the primary source of support only if the individual applicant is the recipient of the support

. If the family receives public support, use Code 2 (family and friends). 1 Personal Income ( employment earnings, interest, dividends, rent, retirement including social security) 2 Family and Friends 3 Public Support (SSI, SSDI, TANF, etc.) 4 All oth er sources (e.g., private disability insurance and private charities) M EDICAL INSURANCE COVERAGE AT EXIT Record whether a n individual had medical insurance coverage at the time of exit

. Enter a “1” in each of the following data elements if the individual had this type of medical insurance coverage at exit , otherwise leave blank

. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry

. 282. Medicaid

Data Type: VARCHAR (1) 283. Medicare

Data Type: VARCHAR (1) 284. Public Insurance from Other Sources (Wo rkers' Compensation, Children's Health

Insurance Program, etc) Data Type: VARCHAR (1) 285. Private Insurance Through Own Employer

Data Type: VARCHAR (1) 286. Not Yet Eligible for Private Insu rance Through Current Employer, But W ill Be

Eligible for Private Insurance After a Certain Period of Employment Data Type: VARCHAR (1) 287. Private Insurance Through Other Means

Data Type: VARCHAR (1)54

Individuals receiving benefits through their parent/family members’ insurance plan should use this code. 288. State or Federal Affordable Care Act Exchange

Data Type: VARCHAR (1) Refers to individuals receiving benefits through their enrollment in an Affordable Care Act Exchange. 289. Type of Exit

Data type VARCHAR (1) Enter a one -digit code from the following list to in dicate when in the VR process a n individual exited the program: 0 Exited as an applicant , prior to eligibility determination or trial work 1 Exited during or after a trial work experience 2 Exited after el igibility, but from an order of selection waiting list 3 Exited after eligibility , but prior to a signed IPE 4 Exited after an IPE without a n employment outcome 5 Exited after an IPE in non competitive and/or non integrated employment 6 Exited after an IPE in com petitive and integrated employment Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry. 290. Reason for Exit

Data type VARCHAR (2) Enter the code listed below that identifies the reason for closing the service record of an individual

. The code 0 applies only to service record s with a code of 7 in data element 2 89 , Type of Exit

. Codes of 1 or higher apply to all other Types of Exit

. Data are reported in the same quarter as the Date of Exit occurs - no updates or modifications after initial data entry. 0 Achieved employment outcome (applicable only to Type of Exit type 7 ) 1 Unable to locate or contact Use this code when the individual has relocated or left the State without a forwarding address. 2 Disability too significant to benefit from VR services - ineligible Use this code to identify an individual whose mental or physical disability is so significant that the individual cannot benefit or continue to benefit from VR services in terms of employment.55

3 No longer interested in receiving services or further services Use this code for individuals who choose not to participate or continue in their VR program at this time

. Also use this code to indicate when an individual ’s actions (or non -actions) make it impossible to begin or continue a VR program. Examples would include repeated failures to keep appointments for assessment, counseling, or other services. 4 Death 5 Transferred to another agency Use this code when an indiv idual needs services that are more appropriately obtained elsewhere. Transfer to the other agency indicates that appropriate referral information is forwarded to the other agency so that agency may provide services more effectively. Include individuals tra nsferred to other State VR agencies. 6 No disabling condition - ineligible Use this code only for applicants who are not eligible for VR services because no physical or mental impairment exists, such as when the reported disability is an acute condition with no residual impairment, e.g., a broken bone that heals. 7 No impediment to employment - ineligible Use this code for applicants who are not eligible for VR services because their physical or mental impairment does not constitute a substantial impedimen t to employment. 8 Transportation not feasible or available Use this code to indicate that the individual was unable to accept or maintain employment because suitable transportation was either not feasible or not available. 9 Does not require VR services - i neligible Use this code for applicants who do not require VR services to prepare for, enter into, engage in, or retain gainful employment consistent with their strengths, resources, priorities, concerns, abilities, capabilities, and informed choice. 10 Exten ded services not available Use this code for individuals who would have benefited from the provision of supported employment services but for whom no source of extended services was available. 11 All other reasons This code is used for all reasons not covere d above.56

12 Extended employment Use this code for individuals who received services and were placed in a non competitive integrated e mployment for a public or non - profit organization

. 13 Individual in institution other than a prison or jail Use this code when an individual has entered an institution other than a prison or jail, and will be unavailable to participate in a VR program for an indefinite or considerable period of time

. This category of institution includes hospitals, nursing homes, treatment centers , etc. 14 Individual is incarcerated in a prison or jail Use this code when an individual will be unavailable to participate in a VR program for a considerable period of time because they are incarcerated in a prison, jail, or other criminal correction facil ity. 15 Sub - minimum wage 16 Extended employment and sub - minimum wage 17 Homemaker 18 Unpaid Family W orker 291. Date of Exit

Data type: DATE 112 (YYYYMMDD) Record the date when the individual exited from the VR program

. This data element must be reported in the same quarter as the Date of Exit occurs - no updates or modifications after data entry. 292. Adult Education

Data type: VARCHAR (1) 0 The individual did not receive any services financially assisted under W IOA Title II. 1 T he individual received services financially assisted under WI OA Title II. 2 Unable to track enrollment in the program

. 293. Vocational Rehabili tation

Data type: VARCHAR (1) 0 The individual did not receive any services under the condition described below. 1 The individual received services financially assisted under parts A and B of title I of the Rehabilitation Act of 1973 (29 USC 720 et seq.), W IOA title I V, and section 121(b)(1)(B)(vi)

.57

2 The individual received services financially assisted by the Vocational Rehabilitation and Emp loyment (VR&E) Program authorized by 38 USC Chapter 31. 3 The individual received services from both vocational rehabilitation programs

. 4 Unknown 294. Wagner- Peyser Act

Data type: VARCHAR (1) 0 The individual did not receive services financially assisted under th e W agnerPeyser Act. 1 The individual received services financially assisted under the W agnerPeyser Act (29 USC 49 et seq.) W IOA section 121 (b)(1)(B)(ii). 2 Unable to track enrollment in the program. 295. Unemployment Insurance Quarterly Earnings

Data type: INT (25 ) After an i ndividual exits the VR program, (data element 29 1

. Date of Exit is not null) and the individual has achieved an employment outcome (data element 2 89 . Typ e of Exit is coded " 7

– Exited after an IPE with a competitive and integrated employment ” ) , enter the quarterly earnings for the second and fourth full quarters after Date of Exit

. If the individual has multiple jobs, enter the highest quarterly earnings followed by a comma , then the second highest quarterly earnings followed by a comma , and then the sum of the remaining quarterly earnings. For example, if an individual has four jobs earning $ 350 from one employer, $400 from another employer, $ 700 from another employer, and $ 1 , 500 from another employer, enter “1500,700,750.” 296. Employer Identification Number (EIN)

Data type: INT( 30 ) After an i ndividual exits the VR program, (data element 2 9 1 . Date of Exit is not null) and the individual has achieved an employment outcome (data element 2 89 . Type of Exit is coded "7

– Exited after an IPE with a competitive and integrated employment outcome”), enter the EIN for the second and fourth full quarters after Date of Exit. If the individu al has multiple jobs, enter the two EIN s in which the individual received the highest quarterly earnings

. I f entering two EINs separate them by a comma. 297. Case Service Record Archive Date

Data type: DATE 112 (YYYYMMDD) Enter the date in which all services are complete. NOTE: All data elements are collected until all of the individual’s services are complete and the case service record is archived, usually after the fourth quarter following the Date of Exit (data element 29 1 ) or more if the individual is receiving extended services.58

CERTIFICATION By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)

. 298. Last Name of Authorized Certifying Official

Data type VARCHAR (25) 299. First Name of Authorized Certifying Official

Data type VARCHAR (25) 300. Title of Authorized Certifying Official

Data type VARCHAR ( 50 ) 301. Telephone of Authorized Certifying Official (Area code, number and extension )

Data type VARCHAR (40 ) 302. Email Address of Authorized Certifying Official

Data type VARCHAR (40 ) 303. Signed by Authorized Certifying Official

Data type VARCHAR (3) 0 No 1 Yes 304. Date Report Submitted

Data type: DATE: 112 (YYYYMMDD)59 **RSA -** **911 RECORD LAYOUT**  **Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 1 Agency Code VARCHAR(3) 2 Social Security Number VARCHAR (9) 3 Calendar Year VARCHAR (4) 4 Calendar Quarter VARCHAR (2) 5 Start Date of Pre - Employment Transition Services DATE 112 (YYYYMMDD) 6 Date of Application DATE 112 (YYYYMMDD) 7 Date of Birth DATE 112 (YYYYMMDD) 8 Gender VARCHAR (1) 9 Wh ite VARCHAR (1) 9 - 1 3 . Race 10 Black or African American VARCHAR (1) 11 - 15. Race 1 1 American Indian or Alaska Native VARCHAR (1) 11 - 15. Race 1 2 Asian VARCHAR (1) 11 - 15. Race 1 3 Native Hawaiian or Other Pacific Islander VARCHAR (1) 11 - 15. Race 1 4 Ethnicity

– Hispanic or Latino VARCHAR (1) 1 5 Veteran Status at Application VARCHAR (1) 1 6 Source of Referral at Application VARCHAR (2) 1 7 Living Arrangement at Application VARCHAR (2) 18 Indicators of poor work history at Application VARCHAR (1) 19 Lack of work experience at Application VARCHAR (1) 2 0 Lack of educational or occupational skills attainment at Application VARCHAR (1) 2 1 Dislocation from high -wage and high - benefit employment at Application VARCHAR (1) 2 2 Limited English, Low Literacy, Cultural Barriers at Application VARCHAR (1) 2 3 Homelessness at Application VARCHAR (1) 2 4 Offender Status at Application VARCHAR (1) 2 5 We lfare Dependency at Application VARCHAR (1) 2 6 Single Parent at Application VARCHAR (1)60

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 2 7 Basic Skills Deficient at Application VARCHAR (1) 28 Foster Care Youth Status at Application VARCHAR (1) 29 Displaced Homemaker at Application VARCHAR (1) 30 Low Income at Application VARCHAR (1) 31 Migrant and Seasonal Farmworker Status at Application VARCHAR (1) 3 2 Dislocated Wo rker at Application 3 3 Long -Term Unemployed Status at Application VARCHAR (1) 34 Date of Last Paid Employment at Application VARCHAR (1) 3 5 Exhausted Part A Title IV of Social Security within 2 Years VARCHAR (1) 3 6 Employment Status at Application VARCHAR (2) 3 7 Primary Occupation at Application VARCHAR (6) 38 Hourly W age at Application DECIMAL (5,2) 39 Hours W orked in a Week at Application INT(3) 4 0 Social Security Disability Insurance (SSDI) INT(5) 4 0 -4 6 . Monthly Public Support at Application 4 1 Supplemental Security Income (SSI) for the Aged, Blind or Disabled INT(5) 42 -48. Monthly Public Support at Application 4 2 Temporary Assistance for Needy Families (TANF) INT(5) 42 -48. Monthly Public Support at Application 4 3 General Assistance (state or local governments) INT(5) 42 -48. Monthly Public Support at Application 44 Veterans’ Disability Benefits INT(5) 42 -48. Monthly Public Support at Application 4 5 Wo rkers’ Compensation INT(5) 42 -48. Monthly Public Support at Application 4 6 All Other Public Support INT(5) 42 -48. Monthly Public Support at Application 4 7 Primary Source of Support at Application VARCHAR (1) 42 -48. Monthly Public Support at Application 48 Medicaid VARCHAR (1) 48 - 54 . Medical Insurance Coverage at Application 49 Medicare VARCHAR (1) 50 -56. Medical Insurance Coverage at Application61

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 5 0 Public Insurance from Other Sources VARCHAR (1) 50 -56. Medical Insurance Coverage at Application 5 1 Private Insurance Through Own Employer VARCHAR (1) 50 -56. Medical Insurance Coverage at Application

5 2 Not Yet Eligible for Private Insurance Through Current Employer, but Wi ll Be Eligible for Private Insurance After a Certain Period of Employment VARCHAR (1) 50 -56. Medical Insurance Coverage at Application 5 3 Private Insurance Through Other Means VARCHAR (1) 50 -56. Medical Insurance Coverage at Application 54 State or Federal Affordable Care Act Exchange VARCHAR (1) 50 -56. Medical Insurance Coverage at Application 5 5 Date of Eligibility Determination DATE 112 (YYYYMMDD) 5 6 Date of Placement on Order of Selection (OOS) Wa iting List DATE 112 (YYYYMMDD) 5 7 Date of Exit from OOS W aiting List DATE 112 (YYYYMMDD) 58 Zip Code VARCHAR (5) 59 County Name VARCHAR (40) 6 0 FIPS Code VARCHAR (2) 6 1 Organizations Referred To: VARCHAR (6) 6 2 Involvement with Other Agencies and Services VARCHAR (6) 6 3 No formal schooling VARCHAR (1) 6 3 - 9 1 . Education 64 Enrolled in elementary education (grades 1 - 8) VARCHAR (1) 6 5 Completed elementary education (grades 1 - 8) VARCHAR (1) 65-93. Education 6 6 Enrolled in secondary education in grade 9 VARCHAR (1) 6 7 Completed secondary education through grade 9 VARCHAR (1) 65-93. Education 68 Enrolled in secondary education in grade 10 VARCHAR (1) 69 Completed secondary education through grade 10 VARCHAR (1) 65-93. Education 70 Enrolled in secondary education in grade 11 VARCHAR (1) 7 1 Completed secondary education VARCHAR (1) 65-93. Education62

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** through grade 11 7 2 Enrolled in secondary education in grade 12 VARCHAR (1)
7 3 Completed secondary education through grade 12, no high school diploma VARCHAR (1) 65-93. Education 74 Enrolled in a state adult high school at the high ASE level VARCHAR (1) 65-93. Education 7 5 Attained high school diploma or equivalency certificate (GED) VARCHAR (1) 65-93. Education 7 6 Completed some special education, no certificate of completion/diploma VARCHAR (1) 65-93. Education 7 7 Enrolled in special education VARCHAR (1) 65-93. Education 78 Attained special education certificate of completion/diploma VARCHAR (1) 65-93. Education 79 Completed some postsecondary education, no degree or certificate VARCHAR (1) 65-93. Education 8 0 Enrolled in postsecondary education - 1st academic year VARCHAR (1) 65-93. Education 81 Enrolled in postsecondary education

– 2nd academic year VARCHAR (1) 65-93. Education 82 Attained Associate degree VARCHAR (1) 65-93. Education 83 Enrolled in postsecondary education

– 3rd academic year VARCHAR (1) 65-93. Education 84 Enrolled in postsecondary education

– 4 th academic year VARCHAR (1) 65-93. Education 85 Attained Bachelor’s degree VARCHAR (1) 65-93. Education 86 Attained Master’s degree VARCHAR (1) 65-93. Education 87 Attained degree above a Master’s

– e.g. Ph.D., Ed.D. , J.D., M.D. VARCHAR (1) 65-93. Education

88 Enrolled in a career or technical training program that does not lead to a recognized postsecondary credential VARCHAR (1) 65-93. Education

89 Enrolled in a career or technical training program that leads to a recognized postsecondary credential VARCHAR (1) 65-93. Education63

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 9 0 Attained Vocational/Technical Certificate VARCHAR (1) 65-93. Education 9 1 Attained Vocational/Technical License VARCHAR (1) 65-93. Education 9 2 Student with Disabilities VARCHAR (1) 93 State Definition for Age of Students with Disabilities VARCHAR (4) 94 Primary Disability VARCHAR (4) 95 Secondary Disability VARCHAR (4) 96 Significance of Disability VARCHAR (1) 97 Start Date of Trial W ork Experience DATE 112 (YYYYMMDD) 98 End Date of Trial W ork Experience DATE 112 (YYYYMMDD) 42 -45. Dates of Trial Work Experience/ Extended Evaluation (EE) 99 Date of Most Recent or Amended Individualized Plan for Employment (IPE) DATE 112 (YYYYMMDD) 100 Start Date of Initial VR Service 101 Supported Employment Goal on Current IPE VARCHAR (1) **SERVICE CA** 

**TEGORIES FOR PR E**  **- EMPLOYMENT TRA** **NSITION STUDENTS**  10 2 Services Provided VARCHAR (1) Job Exploration Counseling 103 Primary Purchased VR Service Provider Type VARCHAR (1) Job Exploration Counseling 104 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Job Exploration Counseling 105 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Job Exploration Counseling 106 Comparable Services and Benefits Providers VARCHAR (6) Job Exploration Counseling 107 Services Provided VARCHAR (1) Wo rk- Base Learning Experiences 108 Primary Purchased VR Service Provider Type VARCHAR (1) Wo rk- Base Learning Experiences 109 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Wo rk- Base Learning Experiences64

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 11 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Wo rk- Base Learning Experiences
11 1 Comparable Services and Benefits Providers VARCHAR (6) Wo rk- Base Learning Experiences
11 2 Services Provided VARCHAR (1) Counseling on Enrollment Opportunities 11 3 Primary Purchased VR Service Provider Type VARCHAR (1) Counseling on Enrollment Opportunities 11 4 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Counseling on Enrollment Opportunities 11 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Counseling on Enrollment Opportunities 11 6 Comparable Services and Benefits Providers VARCHAR (6) Counseling on Enrollment Opportunities 11 7 Services Provided VARCHAR (1) Wo rkplace Readiness Training 1 18 Primary Purchased VR Service Provider Type VARCHAR (1) Wo rkplace Readiness Training

1 19 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Wo rkplace Readiness Training

12 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Wo rkplace Readiness Training

12 1 Comparable Services and Benefits Providers VARCHAR (6) Wo rkplace Readiness Training
12 2 Services Provided VARCHAR (1) Instruction in Selfadvocacy 12 3 Primary Purchased VR Service Provider Type VARCHAR (1) Instruction in Selfadvocacy 12 4 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Instruction in Selfadvocacy

12 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Instruction in Selfadvocacy 12 6 Comparable Services and Benefits Providers VARCHAR (6) Instruction in Selfadvocacy **SERVICE CA** 

**TEGORIES FOR VR A PPLICANTS A** **ND ELIGIBLE**65

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element INDIVIDUA** **LS** 12 7 Services Provided VARCHAR (1) Assessment 128 Primary Purchased VR Service Provider Type VARCHAR (1) Assessment 129 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Assessment 130 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Assessment 131 Comparable Services and Benefits Providers VARCHAR (6) Assessment 132 Services Provided VARCHAR (1) Diagnosis and Treatment of Impairments 13 3 Primary Purchased VR Service Provider Type VARCHAR (1) Diagnosis and Treatment of Impairments 134 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Diagnosis and Treatment of Impairments 135 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Diagnosis and Treatment of Impairments 136 Comparable Services and Benefits Providers VARCHAR (6) Diagnosis and Treatment of Impairments

137 Services Provided VARCHAR (1) Vocational Rehabilitation Counseling and Guidance 138 Primary Purchased VR Service Provider Type VARCHAR (1) Vocational Rehabilitation Counseling and Guidance 139 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Vocational Rehabilitation Counseling and Guidance 140 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Vocational Rehabilitation Counseling and Guidance 141 Comparable Services and Benefits Providers VARCHAR (6) Vocational Rehabilitation Counseling and Guidance 142 Services Provided VARCHAR (1) Graduate College or University Training 143 Primary Purchased VR Service Provider Type VARCHAR (1) Graduate College or University Training66

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 144 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Graduate College or University Training 145 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Graduate College or University Training 146 Comparable Services and Benefits Providers VARCHAR (6) Graduate College or University Training 147 Services Provided VARCHAR (1) Four-Year College or University Training 148 Primary Purchased VR Service Provider Type VARCHAR (1) Four-Year College or University Training 149 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Four-Year College or University Training 150 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Four-Year College or University Training 151 Comparable Services and Benefits Providers VARCHAR (6) Four-Year College or University Training 152 Services Provided VARCHAR (1) Junior or Community College Training 153 Primary Purchased VR Service Provider Type VARCHAR (1) Junior or Community College Training
154 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Junior or Community College Training

155 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Junior or Community College Training
156 Comparable Services and Benefits Providers VARCHAR (6) Junior or Community College Training 157 Services Provided VARCHAR (1) Occupational or Vocational Training 158 Primary Purchased VR Service Provider Type VARCHAR (1) Occupational or Vocational Training
159 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Occupational or Vocational Training

160 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Occupational or Vocational Training 161 Comparable Services and Benefits VARCHAR (6) Occupational or Vocational Training67

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** Providers 162 Services Provided VARCHAR (1) On -the - job Training 163 Primary Purchased VR Service Provider Type VARCHAR (1) On -the - job Training 164 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) On -the - job Training 16 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) On -the - job Training 166 Comparable Services and Benefits Providers VARCHAR (6) On -the - job Training 167 Services Provided VARCHAR (1) Registered Apprenticeship Training 168 Primary Purchased VR Service Provider Type VARCHAR (1) Apprenticeship Training 169 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Apprenticeship Training 170 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Apprenticeship Training 171 Comparable Services and Benefits Providers VARCHAR (6) Apprenticeship Training 172 Services Provided VARCHAR (1) Basic Academic Remedial or Literacy Training 173 Primary Purchased VR Service Provider Type VARCHAR (1) Basic Academic Remedial or Literacy Training 174 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Basic Academic Remedial or Literacy Training 175 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Basic Academic Remedial or Literacy Training 176 Comparable Services and Benefits Providers VARCHAR (6) Basic Academic Remedial or Literacy Training 1 77 Services Provided VARCHAR (1) Job Readiness Training 178 Primary Purchased VR Service Provider Type VARCHAR (1) Job Readiness Training68

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 1 79 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Job Readiness Training 180 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Job Readiness Training 181 Comparable Services and Benefits Providers VARCHAR (6) Job Readiness Training 182 Services Provided VARCHAR (1) Disability- Related Skills Training 183 Primary Purchased VR Service Provider Type VARCHAR (1) Disability- Related Skills Training

184 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Disability- Related Skills Training

185 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Disability- Related Skills Training

186 Comparable Services and Benefits Providers VARCHAR (6) Disability- Related Skills Training 187 Services Provided VARCHAR (1) Miscellaneous Training 1 88 Primary Purchased VR Service Provider Type VARCHAR (1) Miscellaneous Training 189 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Miscellaneous Training 190 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Miscellaneous Training 191 Comparable Services and Benefits Providers VARCHAR (6) Miscellaneous Training 19 2 Services Provided VARCHAR (1) Job Search Assistance 19 3 Primary Purchased VR Service Provider Type VARCHAR (1) Job Search Assistance 194 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Job Search Assistance 19 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Job Search Assistance 19 6 Comparable Services and Benefits VARCHAR (6) Job Search Assistance69

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** Providers 197 Services Provided VARCHAR (1) Job Placement Assistance 198 Primary Purchased VR Service Provider Type VARCHAR (1) Job Placement Assistance 199 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Job Placement Assistance 200 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Job Placement Assistance 201 Comparable Services and Benefits Providers VARCHAR (6) Job Placement Assistance 202 Services Provided VARCHAR (1) On -the - job Supports

– Short Term 203 Primary Purchased VR Service Provider Type VARCHAR (1) On -the - job Supports

– Short Term 204 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) On -the - job Supports

– Short Term 20 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) On -the - job Supports

– Short Term 20 6 Comparable Services and Benefits Providers VARCHAR (6) On -the - job Supports

– Short Term 20 7 Services Provided VARCHAR (1) On -the - job Supports

– Supported Employment 2 08 Primary Purchased VR Service Provider Type VARCHAR (1) On -the - job Supports

– Supported Employment 2 09 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) On -the - job Supports

– Supported Employment 21 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) On -the - job Supports

– Supported Employment 21 1 Comparable Services and Benefits Providers VARCHAR (6) On -the - job Supports

– Supported Employment 21 2 Services Provided VARCHAR (1) Transportation 21 3 Primary Purchased VR Service Provider Type VARCHAR (1) Transportation70

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 21 4 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Transportation

21 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Transportation

21 6 Comparable Services and Benefits Providers VARCHAR (6) Transportation 21 7 Services Provided VARCHAR (1) Maintenance 2 18 Primary Purchased VR Service Provider Type VARCHAR (1) Maintenance 2 19 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Maintenance 22 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Maintenance 22 1 Comparable Services and Benefits Providers VARCHAR (6) Maintenance 22 2 Services Provided VARCHAR (1) Rehabilitation Technology 22 3 Primary Purchased VR Service Provider Type VARCHAR (1) Rehabilitation Technology 22 4 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Rehabilitation Technology 22 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Rehabilitation Technology 22 6 Comparable Services and Benefits Providers VARCHAR (6) Rehabilitation Technology 22 7 Services Provided VARCHAR (1) Reader Services 2 28 Primary Purchased VR Service Provider Type VARCHAR (1) Reader Services 2 29 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Reader Services 23 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Reader Services 23 1 Comparable Services and Benefits Providers VARCHAR (6) Reader Services71

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 23 2 Services Provided VARCHAR (1) Interpreter Services 23 3 Primary Purchased VR Service Provider Type VARCHAR (1) Interpreter Services 234 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Interpreter Services 23 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Interpreter Services 23 6 Comparable Services and Benefits Providers VARCHAR (6) Interpreter Services 23 7 Services Provided VARCHAR (1) Personal Attendant Services 2 38 Primary Purchased VR Service Provider Type VARCHAR (1) Personal Attendant Services 2 39 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Personal Attendant Services 24 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Personal Attendant Services 24 1 Comparable Services and Benefits Providers VARCHAR (6) Personal Attendant Services 24 2 Services Provided VARCHAR (1) Technical Assistance Services 24 3 Primary Purchased VR Service Provider Type VARCHAR (1) Technical Assistance Services 244 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Technical Assistance Services 24 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Technical Assistance Services 24 6 Comparable Services and Benefits Providers VARCHAR (6) Technical Assistance Services 24 7 Services Provided VARCHAR (1) Information and Referral Services 2 48 Primary Purchased VR Service Provider Type VARCHAR (1) Information and Referral Services 2 49 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Information and Referral Services72

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 25 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Information and Referral Services 25 1 Comparable Services and Benefits Providers VARCHAR (6) Information and Referral Services 25 2 Services Provided VARCHAR (1) Benefits Counseling 25 3 Primary Purchased VR Service Provider Type VARCHAR (1) Benefits Counseling 254 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Benefits Counseling 25 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Benefits Counseling 25 6 Comparable Services and Benefits Providers VARCHAR (6) Benefits Counseling 25 7 Services Provided VARCHAR (1) Customized Employment Services 2 58 Primary Purchased VR Service Provider Type VARCHAR (1) Customized Employment Services 2 59 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Customized Employment Services 26 0 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Customized Employment Services 26 1 Comparable Services and Benefits Providers VARCHAR (6) Customized Employment Services 26 2 Services Provided VARCHAR (1) Other Services 26 3 Primary Purchased VR Service Provider Type VARCHAR (1) Other Services 264 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services INT(6) Other Services 26 5 Supported Employment State Grant (Title VI) Funds Used to Purchase Services INT(6) Other Services 26 6 Comparable Services and Benefits Providers VARCHAR (6) Other Services 26 7 Number of Jobs at Exit VARCHAR (1) 2 68 Primary Occupation at Exit VARCHAR (16)73

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 2 69 Start Date of Employment in Primary Occupation at Exit DATE 112 (YYYYMMDD) 27 0 Employment Status at Exit VARCHAR (1) 27 1 Hourly Wa ge at Exit Decimal (5,2) 27 2 Competitive Integrated Employment at Exit VARCHAR (1) 27 3 Hours W orked in a Week at Exit INT(3) 274 SSDI INT(5) 274 -28 0 . Monthly Public Support Amount at Exit 27 5 SSI for the Aged, Blind or Disabled INT(5) 276 -282. Monthly Public Support Amount at Exit 27 6 TANF INT(5) 276 -282. Monthly Public Support Amount at Exit 27 7 General Assistance (State or local government) INT(5) 276 -282. Monthly Public Support Amount at Exit 2 78 Veterans’ Disability Benefits INT(5) 276 -282. Monthly Public Support Amount at Exit 2 79 Wo rkers’ Compensation INT(5) 276 -282. Monthly Public Support Amount at Exit 28 0 Other Public Support INT(5) 276 -282. Monthly Public Support Amount at Exit 28 1 Primary Source of Support at Exit VARCHAR (1) 28 2 Medicaid VARCHAR (1) 28 2 -2 88 . Medical Insurance Coverage at Exit 28 3 Medicare VARCHAR (1) 284 -290. Medical Insurance Coverage at Exit 284 Public Insurance from Other Sources VARCHAR (1) 284 -290. Medical Insurance Coverage at Exit 28 5 Private Insurance Through Own Employer VARCHAR (1) 284 -290. Medical Insurance Coverage at Exit

28 6 Not Yet Eligible for Private Insurance Through Current Employer, but Wi ll Be Eligible for Private Insurance After a Certain Period of Employment VARCHAR (1) 284 -290. Medical Insurance Coverage at Exit 28 7 Private Insurance Through Other Means VARCHAR (1) 284 -290. Medical Insurance Coverage at Exit 2 88 State or Federal Affordable Care Act Exchange VARCHAR (1) 284 -290. Medical Insurance Coverage at Exit 2 89 Type of Exit VARCHAR (1) 29 0 Reason for Exit VARCHAR (2) 29 1 Date of Exit DATE 112 (YYYYMMDD)74

**Data Element #**  **Data Element Data Ty** **pe Collective Data**  **Element** 29 2 Adult Education VARCHAR (1) 29 3 Vocational Rehabilitation VARCHAR (1) 294 Wagner- Peyser Act VARCHAR (1) 29 5 Unemployment Insurance Quarterly Earnings INT(25) 29 6 Employer Identification Number VARCHAR (30) 29 7 Case Service Record Archive Date DATE 112 (YYYYMMDD) 298 Last Name of Authorized Certifying Official VARCHAR (25) 299 First Name of Authorized Certifying Official VARCHAR (25) 30 0 Title of Authorized Certifying Official VARCHAR (50) 30 1 Telephone of Authorized Certifying Official VARCHAR (40) 30 2 Email of Authorized Certifying Official VARCHAR (40) 30 3 Signed by Authorized Certifying Official VARCHAR (1) 304 Date Report Submitted DATE 112 (YYYYMMDD)