OMB Control Number: 1820-0508

Expires 

Reporting Manual for the

CASE SERVICE RECORD REPORT

(RSA-911)

State-Federal Program for

Vocational Rehabilitation
i

Contents

GENERAL	INSTRUCTIONS ...............................................................................................................VIII

INSTRUCTIONS	FOR	PREPARATION	OF	ELECTRONIC	TRANSMITTAL............................XIII

COMPARISON	OF	THE	NEW	RSA-911	CASE	SERVICE	REPORT	TO	THE	

PREVIOUS	RSA-911	CASE	SERVICE	REPORT	AS	A	RESULT	OF THE	

WORKFORCE	INNOVATION AND	OPPORTUNITY	ACT	(WIOA)	SIGNED	

INTO	LAW	ON	JULY	22, 2014........................................................................................................XV

ELEMENT-BY-ELEMENT	INSTRUCTIONS:	CASE	SERVICE	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

RACE................................................................................................................................................................ 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
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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. Limited 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 AMOUNT AT APPLICATION ................................................................. 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

MEDICAL INSURANCE COVERAGE AT APPLICATION ........................................................................ 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

EDUCATION .................................................................................................................................................. 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 special 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 postsecondary 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 AND COSTS FOR PURCHASED SERVICES ................................................... 32

1) Services Provided..................................................................................................................................... 32

2) Primary 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 CATEGORIES FOR PRE-EMPLOYMENT TRANSITION 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 CATEGORIES FOR VR APPLICANTS AND ELIGIBLE INDIVIDUALS ................................ 37

 Assessment....................................................................................................................................................38

 Diagnosis and Treatment of Impairments.....................................................................................................38

 Vocational Rehabilitation Counseling and Guidance ....................................................................................39

TRAINING....................................................................................................................................................... 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-Related Skills Training....................................................................................................................41

 Miscellaneous Training..................................................................................................................................41
vi

 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.............................................................................................................................43

PERSONAL ASSISTANCE 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 AMOUNT AT EXIT .................................................................................. 51

274. Social Security Disability Insurance (SSDI)................................................................................................ 51

275. Supplemental Security Income (SSI) for the Aged, Blind or Disabled........................................................ 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

MEDICAL INSURANCE COVERAGE AT EXIT.......................................................................................... 53

282. Medicaid.................................................................................................................................................. 53
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283. Medicare ................................................................................................................................................. 53

284. Public Insurance from Other Sources (Workers' Compensation, Children's Health 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 Official ............................................................................................. 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 Authorized Certifying Official........................................................................................ 58

303. Signed by Authorized Certifying Official................................................................................................... 58

304. Date Report Submitted............................................................................................................................ 58

RSA-911	RECORD	LAYOUT...............................................................................................................59
viii

GENERAL INSTRUCTIONS

Reported case service records pertain to all individuals 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 data 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.

Duplicate 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 PreEmployment 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. This means that records with the same Agency Code, 

Social Security Number, Date of Birth, and Application Date and/or Start Date of PreEmployment 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 Preemployment Transition Services of the second service record.

With 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 tables 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

14 Ethnicity

15 Veteran Status at Application

16 Source of Referral at Application

17 Living Arrangement at Application

18 Indicators of Poor Work History at Application
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Data Element 

Number

Data Element

19 Lack of Work Experience at Application

20 Lack of Educational or Occupational Skills Attainment at 

Application

21 Dislocation from High-Wage and High-Benefit Employment 

at Application

22 Limited English, Low Literacy, Cultural Barriers at 

Application

23 Homelessness at Application

24 Offender Status at Application

25 Welfare Dependency at Application

26 Single Parent at Application

27 Basic Skills Deficient at Application

28 Foster Care Youth Status at Application

29 Displaced Homemaker at Application

30 Low Income at Application

31 Migrant and Seasonal Farmworker Status at Application

32 Dislocated Worker at Application

33 Long-Term Unemployed Status at Application

34 Date of Last Paid Employment at Application

35 Exhausted Part A Title IV of Social Security Within 2 Years

36 & 270 Employment Status at Application & Exit

37 & 268 Primary Occupation at Application & Exit

38 & 271 Hourly Wage at Application & Exit

39 & 273 Hours Worked in a Week at Application & Exit

40-46 & 274-280 Monthly Public Support Amount at Application & Exit

47 & 281 Primary Source of Support at Application & Exit

48-54 & 282-288 Medical Insurance Coverage at Application & Exit

55 Date of Eligibility Determination

56 Date of Placement on Order of Selection Waiting List

57 Date of Exit on Order of Selection Waiting List

100 Start Date of Initial VR Service

267 Number of Jobs at Exit

269 Start Date of Employment in Primary Occupation at Exit

272 Competitive Integrated Employment at Exit

289 Type of Exit

290 Reason for Exit

291 Date of Exit

297 Case Service Record Archive Date
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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

60 FIPS Code

61 Organizations Referred To:

62 Involvement with Other Agencies and Services

63-91 Education

92 Student with Disabilities

93 State Definition for Age of Students with Disabilities

94 Primary Disability

95 Secondary Disability

96 Significance of Disability

97 Start Date of Trial Work Experience

98 End Date of Trial Work Experience

99 Date of Most Recent or Amended Individualized Plan for 

Employment (IPE)

101 Supported Employment Goal on Current IPE

102-126 Service Categories for Pre-Employment Transition Students

127-266 Service Categories for VR Applicants and Eligible Individuals

292 Adult Education

293 Vocational Rehabilitation

294 Wegner-Peyser Act

295 Unemployment Insurance Quarterly Earnings

296 Employer Identification Number (EIN)

298 Last Name of Authorized Certifying Official

299 First Name of Authorized Certifying Official

300 Title of Authorized Certifying Official

301 Telephone of Authorized Certifying Official

302 Email of Authorized Certifying Official

303 Signed by Authorized Certifying Official

304 Date Report Submitted

It is important to note that three data elements are new and are reported after the Date 

of Exit (data element 291). These three new data elements are the Case Service 

Record Archive Date (data element 297), the Unemployment Insurance Quarterly 

Earnings (data element 295), and the Employer Identification Number (data element 

296). The Case Service Record Archive Date is not collected until the individual exits 
xi

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.

DATA 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 amounts 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 cases 

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-employment 

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 60.
xiii

INSTRUCTIONS FOR PREPARATION OF ELECTRONIC TRANSMITTAL

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 list of a few free SFTP 

software packages and links to their websites. Follow the downloading instructions to 

install SFTP software on your system.

WinSCP

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-911data 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 file is "BAgXCYNNQ", 

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 OKc1CY142.

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 yannyann.shieh@ed.gov or 202-245-7247.

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 informing 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 BAgXCYNNQ" following the naming 

convention as described above. Certification as described above must be included with 

the electronic media.
xiv

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 Washington

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 Washington, PCP 5047

LBJ Basement Level 1

400 Maryland Avenue, 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 yannyann.shieh@ed.gov or 202-245-7247.
xv

COMPARISON OF THE NEW RSA-911 CASE SERVICE REPORT TO THE 

PREVIOUS RSA-911 CASE SERVICE REPORT AS A RESULT OF THE 

WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) SIGNED INTO 

LAW ON JULY 22, 2014

New 

Data 

Element 

Number

Previous 

Data 

Element 

Number

Data Element Description Change, if any, from 

previous RSA-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"

9-13 8-12 Race No change

14 13 Ethnicity No change

15 14 Veteran Status at Application Data element name changed 

from "Veteran Status" to 

"Veteran Status at 

Application." Coding options 

added to align with WIOA.

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 Poor Work History 

at Application

New data element

19 None Lack of Work Experience at 

Application

New data element

20 None Lack of Educational or 

Occupational Skills Attainment 

at Application

New data element

21 None Dislocation from High-Wage 

and High-Benefit Employment 

at Application

New data element

22 None Limited English, Low Literacy, 

Cultural Barriers at Application

New data element

23 None Homelessness at Application New data element
xvi

New 

Data 

Element 

Number

Previous 

Data 

Element 

Number

Data Element Description Change, if any, from 

previous RSA-911

24 None Offender Status at Application New data element

25 None Welfare Dependency at 

Application

New data element

26 None Single Parent at Application New data element

27 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

30 None Low Income at Application New data element

31 None Migrant and Seasonal 

Farmworker Status at 

Application

New data element

32 None Dislocated Worker at 

Application

New data element

33 None Long-Term Unemployed Status 

at Application

New data element

34 None Date of Last Paid Employment 

at Application

New data element

35 None Exhausted Part A Title IV of 

Social Security within 2 Years

New data element

36 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 Worker") 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 either (a) has 

received a notice of 

termination of employment or 

the employer has issued a 

Worker Adjustment and 
xvii

New 

Data 

Element 

Number

Previous 

Data 

Element 

Number

Data Element Description Change, if any, from 

previous RSA-911

Retraining Notification 

(WARN) or other notice that 

the facility or enterprise will 

close, or (b) is a transitioning 

service member." 

37 None Primary Occupation at 

Application 

New data element

38 & 

271

26 &197 Hourly Wage at Application & 

Exit

"Weekly Earnings" have been 

changed to "Hourly Wage."

39 & 

273

27 & 198 Hours Worked in a Week at 

Application & Exit

No change

40-46 & 

274-280

28-34 &

199-205

Monthly Public Support Amount 

at Application & Exit

No change

47 & 

281

35 & 206 Primary Source of Support at 

Application & Exit

No change

48-54 & 

282-288

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."

55 46 Date of Eligibility Determination No change

56 47 Date of Placement on Order of 

Selection Waiting List

No change

57 48 Date of Exit on Order of 

Selection Waiting 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."

60 None FIPS Code New data element

61 None Organizations Referred To New data element

62 18 Involvement with Other 

Agencies and Services

Coding options added 

63-91 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 report 
xviii

New 

Data 

Element 

Number

Previous 

Data 

Element 

Number

Data Element Description Change, if any, from 

previous RSA-911

Workforce Innovation and 

Opportunity Act (WIOA)

performance indicators. 

92 20 & 192 Student with Disabilities "Student with Disability in 

Secondary Education at 

Application/Closure" changed 

to one data element entitled 

"Student with Disabilities." 

While coding options are 

largely the same, the 

description of the data 

element has been modified to 

align with WIOA.

93 None State Definition for Age of 

Students with Disabilities

New data element

94 22 Primary Disability No change

95 23 Secondary Disability No change

96 24 Significance of Disability Clarification made to the 

description.

97 42 Start Date of Trial Work 

Experience

No change

98 43 End Date of Trial Work 

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.

100 None Start Date of Initial VR Service New data element

101 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 

WIOA.
xix

New 

Data 

Element 

Number

Previous 

Data 

Element 

Number

Data Element Description Change, if any, from 

previous RSA-911

102-126 None Service Categories for PreEmployment Transition 

Students

New data element

127-266 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 added to data 

element 5) Comparable 

Services and Benefits 

Provider.

 Service category "On-theJob Supports - 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 WIOA.

267 193 Number of Jobs at Exit No change

268 194 Primary Occupation at Exit May now add up to two 

positions. “Homemaker” and 

“Unpaid Family Worker”

codes are eliminated.

Changed from six- to eightdigit O*Net SOC codes.

269 195 Start Date of Employment in 

Primary Occupation at Exit

Description has been clarified.

270 196 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 Worker") have been 
xx

New 

Data 

Element 

Number

Previous 

Data 

Element 

Number

Data Element Description Change, if any, from 

previous RSA-911

eliminated. Coding option 7 

("Employment with Supports 

in Integrated Setting") has 

been changed to “Competitive 

Integrated Employment with 

Supports."

271 None Competitive Integrated 

Employment at Exit

New data element

289 213 Type of Exit Coding options are reordered 

and contain the new definition 

for employment outcomes.

290 214 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.

291 215 Date of Exit No change

292 None Adult Education New data element

293 None Vocational Rehabilitation New data element

294 None Wagner-Peyser Act New data element

295 None Unemployment Insurance 

Quarterly Earnings

New data element

296 None Employer Identification Number New data element

297 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

300 None Title of Authorized Certifying 

Official

New data element

301 None Telephone of Authorized 

Certifying Official

New data element

302 None Email of Authorized Certifying 

Official

New data element

303 None Signed by Authorized Certifying 

Official

New data element

304 None Date Report Submitted New data element

3 Closure Order Eliminated 
xxi

New 

Data 

Element 

Number

Previous 

Data 

Element 

Number

Data Element Description Change, if any, from 

previous RSA-911

4 Previous Closure Eliminated 

44 Start Date of Extended 

Evaluation

Eliminated

45 End Date of Extended 

Evaluation

Eliminated
2

Element-by-Element Instructions: CASE 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 information is estimated to average 131.25 hours per 

response, including time for reviewing instructions, searching existing data sources, gathering 

and maintaining the data needed, and completing and reviewing the collection of information. The 

obligation to respond to this collection is mandatory as required by the Rehabilitation Act of 1973, 

as amended, and the WIOA, signed into law on July 22, 2014. Send comments regarding the 

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

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

DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820-0508. 

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 agency 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 these agencies are established in the 

future. This data element is required. No modifications after initial entry.

State or Territory Abbreviations

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 029 085
4

State or Territory Abbreviations

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

Wisconsin 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). When a SSN is not 

available or if the individual prefers not to provide his/her SSN, assign a unique ninedigit 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. When 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 element 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 calendar year that represents this data collection. These 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. 

These data are required and updated 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 preemployment transition services 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 traditional 

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 institutions of 

higher education; (4) workplace readiness training to develop social skills and 

independent living; and (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 should 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 individuals 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 greatest 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 an individual refuses to identify his/her 

race, the counselor should, at a minimum, notify the individual that if he/she fails 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). More than one race variable can contain a code of 1 for 

an 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 records will be few in number. As an example, if an 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 all race options would be left blank.

No modifications after initial entry.

9. White 

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, Cambodia, 

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 other Pacific Islands.

14. Ethnicity - Hispanic or Latino

Data type: VARCHAR (1)

An individual of Cuban, Mexican, Puerto Rican, South or Central American, or 

other Spanish culture or origin, regardless of race.
8

This data element should be recorded for all individuals whose service records 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/Latino ethnicity

If the individual self-identifies as Hispanic, but refuses or is unable to identify one or 

more race categories in addition, then code the 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 than 

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 

Workers, and Youth

9 Educational Institutions (elementary/secondary)

10 Educational Institutions (postsecondary)

11 Employers

12 Extended Employment Providers

13 Faith Based 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 

transitional living, transitional employment, and compensated work therapy 

programs)

24 Wagner-Peyser Employment Service Program

25 Welfare Agency (State or local government)

26 Worker's Compensation

27 Other One-stop Partner

28 Other Sources

29 Other State Agencies

30 Other VR State Agencies

31 Other WIOA-funded Programs including Job Corps, YouthBuild, Indian and 

Native Americans, and Migrant and Seasonal Farmworker Programs
10

17. Living Arrangement at Application

Data type: VARCHAR (2)

Indicate the living arrangements of the individual, either 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 Rehabilitation Facility

4 Mental Health Facility

5 Nursing Home

6 Adult Correctional Facility

7 Halfway House 

8 Substance Abuse Treatment Center

9 Homeless/Shelter

10 Other

18. Indicators of Poor Work History at Application

Data type: VARCHAR (1)

0 Does not have a poor work history

1 Has a poor work history

19. Lack of Work Experience at Application

Data type: VARCHAR (1)

0 Does not lack work experience

1 Lacks work experience

20. Lack of Educational or Occupational Skills 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 High-Wage and High-Benefit Employment at Application

Data type: VARCHAR (1)

0 Has not been dislocated from high-wage and high-benefit employment

1 Has been dislocated from high-wage and high-benefit employment

22. Limited English, Low 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. Homelessness 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 legal 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 currently 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 

conviction 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 currently or has been an offender

25. Welfare Dependency at Application

Data type: VARCHAR (1)

0 Is not currently welfare dependent

1 Is currently welfare dependent
12

26. Single Parent 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 their 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 skills 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 currently a foster care youth

1 Is currently or has been a foster care youth

29. Displaced Homemaker 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 to 
13

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 displaced homemaker

1 Is currently a displaced homemaker

30. Low Income 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 the 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 WIOA section 101(25)(A) or (B), but is a member of a family 

whose income does not meet the established criteria. 

0 Is not currently low income

1 Is currently low income

31. Migrant and Seasonal Farmworker Status at Application

Data type: VARCHAR (1)

0 The individual 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 an 
14

aggregate of 25 or more days or parts of days in qualifying farmwork, and was 

not employed in farmwork year round by the same employer.

2 The individual 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 Worker 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 

demonstrate, 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 Application
15

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. When an individual’s work activity 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 fulltime 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; or
16

(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 

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 individuals 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 (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 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 Integrated 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 Worker 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 

postsecondary 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 employment situations unique to the VR program, use the special codes 

indicated below.

Special 

Codes Special Code Descriptions

89999999 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).

99999999 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), or individuals employed as vending facility 

operators outside the Randolph-Sheppard Vending Facility Program 

(use their occupation code).

38. Hourly Wage 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 payroll deductions of Federal, State and 

local income taxes and Social Security payroll tax are taken. 

Hourly wages (earnings) 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.

Where wages are based on commissions that are irregular (e.g., real estate, automobile 

sales, etc.), they should be calculated as an hourly wage average over a representative 

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 an hourly wage. 

If the individual had no earnings, enter "0". No modifications after initial entry.

39. Hours Worked in a Week at Application

Data type INT (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 entry.

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 support, enter "0" for each type of public support. Agencies 

may leave these data elements blank for Type of Exit coding option 0 (exited as an 

applicant). No modifications after initial entry.
19

Public support means cash payments made by Federal, State and/or local 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) 

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. 

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. Workers' 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 local 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 coding 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 spouse, or by the spouse's 

unemployment insurance checks, identify coding option 2 as the Primary Source of 

Support (family and friends) and not coding option1 (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 coding 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 application, 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 (Workers' 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 Will 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 Selection (OOS) Waiting 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 Waiting 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 Waiting List (Data 

Element 56). 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 291)

and Type of Exit (data element 289), must be coded 2). No modifications after initial 

entry.

58. Zip Code

Data type VARCHAR (5)

Enter the five-digit numeric US Postal Service Zip Code 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."

For 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)

Enter 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 zeroes 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), enter “020410”. If the individual received comparable services 
23

or benefits from a Community Rehabilitation Program and a Developmental Disability 

Provider, enter “0619”. If an individual received comparable services or benefits from 

only an elementary or secondary educational institution, 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 

Workers, 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 Organizations

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 Welfare Agency (State or local government)

33 Worker's Compensation

34 Other One-stop Partner

35 Other Sources

36 Other State Agencies
24

37 Other VR State Agencies

38 Other WIOA-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)

Enter 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 zeroes 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 “102126”. If the individual received comparable services or benefits from 

a Community Rehabilitation Program and a One-Stop Operator, enter “0616”. If an 

individual received comparable services or benefits from only an elementary or 

secondary educational institution, enter “08”. 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 Worker 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 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 Program 

24 Worker's Compensation

25 Other DOL programs authorized under WIOA (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 Welfare 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 beginning 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. 

The 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 awarded 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 participation 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 education (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 year
27

Data type: VARCHAR (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 credential

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 Disabilities

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 services 

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 Disabilities

Data type: VARCHAR (4)

If 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 the 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, enter 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 blank 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, enter 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 

leading zeroes 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 Type of Exit coded "1" (exited as an applicant). This data element is required.
29

CODES FOR IMPAIRMENTS

00 No impairment

Sensory/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)

Physical Impairments:

10 Mobility Orthopedic/Neurological Impairments

11 Manipulation/Dexterity Orthopedic/Neurological Impairments

12 Both mobility and Manipulation/Dexterity Orthopedic/Neurological Impairments

13 Other Orthopedic Impairments (e.g., limited range of motion)

14 Respiratory Impairments

15 General Physical Debilitation (fatigue, weakness, pain, etc.)

16 Other Physical Impairments (not listed above)

Mental 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 Palsy
30

13 Congenital Condition or Birth Injury

14 Cystic Fibrosis

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 Traumatic Brain Injury (TBI)

96. Significance 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 significant 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 definition 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 capacities (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 one 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 learning 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 Disability

1 Significant Disability

2 Most Significant Disability

97. Start Date of Trial Work 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 trial work experience began. If the individual has 

been placed in more than one trial work experience, the first occurrence of trial 

work must have an End Date of Trial Work Experience (Data Element 98) before 

another Start Date of Trial Work Experience can be entered. These data are 

reported quarterly.

98. End Date of Trial Work Experience

Data type: DATE 112 (YYYYMMDD)

Enter the date that the individual’s trial 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 the 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. These data are reported quarterly.

100. Start Date of Initial 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 Current 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 

employment goal on his/her current IPE. These data are reported quarterly.

Note: 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 

employment, that is individualized 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 services after the transition described in paragraph (13)(C), in order to 

perform the work involved.

SERVICES PROVIDED AND COSTS FOR PURCHASED SERVICES

There are five data elements for each of the service categories. The first data element 

indicates whether service has been provided. If purchased 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. For 

pre-employment transition 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 

services 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 provided 
33

1 provided by the VR agency (in-house/by VR staff) 

2 purchased by the 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 Employment 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 purchased 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 combination 

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 

provided 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) Funds 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 and/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 an 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 should 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 originated 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 thirdparty cooperative 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 as 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, this data element captures the costs (amounts) 

per quarter of purchased services using the VR grant (Title I) funds reserved in 

accordance with 110 (D).

For participants of the VR program, this 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 individual 

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 disabled 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 services 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, rehabilitation 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 Provider
36

Data Type VARCHAR (6)

For each of the service categories, enter up to three codes that best describe the 

service providers who provided the individual with a comparable service or benefit. 

Make sure to enter the leading zeroes 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 “0613”. 

If an individual received comparable services or benefits from only an elementary or 

secondary educational institution, enter “08”. 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 Worker 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 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)

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 Program 

24 Welfare Agency (State or local government)

25 Worker's Compensation
37

26 Other DOL programs authorized under WIOA (Job Corps, YouthBuild, Indian 

and Native American programs, Migrant and Seasonal Farmworker programs, 

and evaluation and multistate 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 102-106

 Work-Based Learning Experiences

Data Elements 107-111

Use this category for in-school or after school opportunities, or 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 112-116

Use this category for counseling on opportunities for enrollment in comprehensive 

transition or postsecondary educational programs at institutions of higher education.

 Workplace Readiness Training

Data Elements 117-121

Use this category for workplace readiness training to develop social skills and 

independent living.

 Instruction in Self-advocacy

Data Elements 122-126

Use this category for instruction in self-advocacy (including instruction in personcentered 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 as 
38

assessment that can be provided to determine eligibility prior to an IPE or to assign an 

individual to a priority category, the services provided should be those identified on the 

IPE, not services merely authorized, but actually provided. 

 Assessment

Data Elements 127-131

Assessment means services provided and activities performed to determine an

individual’s eligibility 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 also 34 CFR 361.5(b)(6) and 34 CFR 361.48.

 Diagnosis and Treatment of Impairments

Data Elements 132-136

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 

neuroprosthetic devices, such as cochlear implants, visual 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 connection 

with surgery or treatment;

f) Drugs and supplies;
39

g) Prescription of prosthetics 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 treatment 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 137-141

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 designed 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 142-146

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 147-151

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 152-156

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.

 Occupational or Vocational Training

Data Elements 157-161

Occupational, 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 162-166

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 Apprenticeship Training

Data Elements 167-171
41

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 skills 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 increases as an apprentice's skills increase; is based on an 

employer-employee relationship; and provides an industry recognized 

certificate of completion of the program.

 Basic Academic Remedial or Literacy Training

Data Elements 172-176

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 177-181

Training provided to prepare an individual for the world of work (e.g., 

appropriate work behaviors, getting to work on time, appropriate dress and 

grooming, increasing productivity).

 Disability-Related Skills Training 

Data Elements 182-186

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 187-191

Any training not recorded in one of the other categories listed, including 

GED or high school training leading to a diploma, or courses taken at 

four-year, junior or community colleges not leading to a certificate or 

diploma.

 Job Search Assistance

Data Elements 192-196
42

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 companies on 

behalf of the consumer.

 Job Placement Assistance 

Data Elements 197-201

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 202-206

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 goal consistent with 

the employment goal on the IPE.

 On-the-job Supports – Supported Employment

Data Elements 207-211

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. Services, 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 212-216

Transportation, 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 217-221

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 

eligibility 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 short-term expenses, such as food and shelter, that is required in 

order for an 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 222-226

Rehabilitation technology means the systematic application of technologies, 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 neuroprosthetic devices, 

such as cochlear implants, visual prosthetics, and motor prosthetic devices, but does 

not include medical and surgical procedures required for implantation of neuroprosthetic 

devices which should be coded as diagnosis and treatment of impairments. 

Rehabilitation technology includes rehabilitation engineering, assistive 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, apply, and distribute 

technological solutions to problems confronted by VR individuals in functional 

areas such as mobility, communications, hearing, vision, and cognition, and in 
44

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 rehabilitation 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 professionals (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 technical assistance is necessary for individuals to achieve an 

employment outcome.

PERSONAL ASSISTANCE SERVICES

Personal Assistance Services are a range of services provided by one or more persons 

designed to assist an 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 directing 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 these 
45

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 227-231

Reader services are for individuals 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 232-236

Interpreter services are sign language or oral interpretation services for 

individuals who are deaf or hard of hearing and tactile interpretation 

services for individuals who are deaf-blind. Specially trained individuals 

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 237-241

Personal attendant services are those personal services that an attendant 

performs for an individual with a disability including, but not limited to

bathing, feeding, dressing, providing mobility and transportation, etc in 

multiple settings to include home, work and training facilities/school.

 Technical Assistance Services

Data Elements 242-246

Technical assistance and other consultation services provided to conduct market 

analyses, to develop business plans, and to provide resources to individuals in the 

pursuit of self-employment, telecommuting and small business operation outcomes.

 Information and Referral Services

Data Elements 247-251

Information and referral services are provided to individuals who need services from 

other agencies (e.g., cooperative agreements) not available through the VR program.
46

 Benefits Counseling

Data Elements 252-256

Assistance provided to an individual who is interested in becoming employed, but is 

uncertain of the impact work income will have on any disability benefits and entitlements 

being received, and/or is not aware of benefits, such as access to healthcare, that might 

be available to support any work attempt.

This typically involves an analysis of an individual’s current benefits, such as SSDI and 

SSI, the individual’s financial situation, and the effect different 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 choice 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

Data Elements 257-261

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 significant 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 individual 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 facilitate 

placement; and

d) providing services and supports at the job location.

 Other Services

Data Elements 262-266

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 Exit
47

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 positions, 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 an individual who achieved an employment outcome, enter up to two eight-digit 

O*Net Version 4.0 (or later version) SOC codes 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 zeroes 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 43601201 and their 

second position was SOC code 43405101, enter “4360120143405101.” If the individual 

has only one position with the SOC code 29204101, enter “20204101.” 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

89999999 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).

99999999 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), or individuals employed as vending facility 

operators outside the 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 268 as the primary occupation. 

270. Employment Status at Exit

Data type VARCHAR (1)

For an 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 fulltime 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; 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 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
49

(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 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.

4 Competitive Integrated Employment 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 Wage at Exit

Data type: Decimal (5,2)

Enter the hourly wage (to the nearest cent) the individual 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 (earnings) 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.

Where wages are based on commissions that are irregular (e.g., real estate, automobile 

sales, etc.), they should be calculated as an hourly wage average over a representative 
50

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 an 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 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; 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 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
51

(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.

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 Worked in a Week at Exit

Data type INT (3)

For an 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. Enter 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. 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.

MONTHLY 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 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. 

Categories of public support are as follows:

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 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.

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. Workers' Compensation

Data Type INT (5) 

280. 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, 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 onehalf 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.

Note: If an 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 (personal income). If an 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 other sources (e.g., private disability insurance and private charities)

MEDICAL INSURANCE COVERAGE AT EXIT

Record whether an 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 (Workers' 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 Insurance Through Current Employer, But Will 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 indicate when in the VR process an

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 eligibility, but from an order of selection waiting list

3 Exited after eligibility, but prior to a signed IPE

4 Exited after an IPE without an employment outcome

5 Exited after an IPE in noncompetitive and/or nonintegrated employment 

6 Exited after an IPE in competitive 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 records with a code of 7 in data element 

289, 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 individual 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 transferred 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 

impediment 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 - ineligible

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 Extended 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 covered above.
56

12 Extended employment

Use this code for individuals who received services and were placed in a noncompetitive integrated employment 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 facility.

15 Sub-minimum wage

16 Extended employment and sub-minimum wage

17 Homemaker

18 Unpaid Family Worker

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 WIOA 

Title II.

1 The individual received services financially assisted under WIOA Title II.

2 Unable to track enrollment in the program. 

293. Vocational Rehabilitation

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.), WIOA title IV, 

and section 121(b)(1)(B)(vi).
57

2 The individual received services financially assisted by the Vocational 

Rehabilitation and Employment (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 the WagnerPeyser Act. 

1 The individual received services financially assisted under the WagnerPeyser Act (29 USC 49 et seq.) WIOA 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 individual exits the VR program, (data element 291. Date of Exit is not null) and 

the individual has achieved an employment outcome (data element 289. Type 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 individual exits the VR program, (data element 291. Date of Exit is not null) and 

the individual has achieved an employment outcome (data element 289. 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 

individual has multiple jobs, enter the two EINs in which the individual received the 

highest quarterly earnings. If 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 291) 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 Type

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 White VARCHAR (1) 9-13. Race

10 Black or African American VARCHAR (1) 11-15. Race

11 American Indian or Alaska Native VARCHAR (1) 11-15. Race

12 Asian VARCHAR (1) 11-15. Race

13

Native Hawaiian or Other Pacific 

Islander VARCHAR (1)

11-15. Race

14 Ethnicity – Hispanic or Latino VARCHAR (1)

15 Veteran Status at Application VARCHAR (1)

16 Source of Referral at Application VARCHAR (2)

17 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)

20

Lack of educational or occupational 

skills attainment at Application VARCHAR (1)

21

Dislocation from high-wage and 

high-benefit employment at 

Application VARCHAR (1)

22

Limited English, Low Literacy, 

Cultural Barriers at Application VARCHAR (1)

23 Homelessness at Application VARCHAR (1)

24 Offender Status at Application VARCHAR (1)

25 Welfare Dependency at Application VARCHAR (1)

26 Single Parent at Application VARCHAR (1)
60

Data 

Element # Data Element Data Type

Collective Data 

Element 

27 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)

32 Dislocated Worker at Application

33

Long-Term Unemployed Status at 

Application VARCHAR (1)

34

Date of Last Paid Employment at 

Application VARCHAR (1)

35

Exhausted Part A Title IV of Social 

Security within 2 Years VARCHAR (1)

36 Employment Status at Application VARCHAR (2)

37 Primary Occupation at Application VARCHAR (6)

38 Hourly Wage at Application DECIMAL (5,2)

39

Hours Worked in a Week at 

Application INT(3)

40

Social Security Disability Insurance 

(SSDI) INT(5)

40-46. Monthly 

Public Support at 

Application

41

Supplemental Security Income 

(SSI) for the Aged, Blind or 

Disabled INT(5) 42-48. Monthly Public Support 

at Application

42

Temporary Assistance for Needy 

Families (TANF) INT(5) 42-48. Monthly Public Support 

at Application

43

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

45 Workers’ Compensation INT(5) 42-48. Monthly Public Support 

at Application

46 All Other Public Support INT(5) 42-48. Monthly Public Support 

at Application

47

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 Application
61

Data 

Element # Data Element Data Type

Collective Data 

Element 

50

Public Insurance from Other 

Sources VARCHAR (1) 50-56. Medical Insurance 

Coverage at Application

51

Private Insurance Through Own 

Employer VARCHAR (1) 50-56. Medical Insurance 

Coverage at Application

52

Not Yet Eligible for Private 

Insurance Through Current 

Employer, but Will Be Eligible for 

Private Insurance After a Certain 

Period of Employment VARCHAR (1) 50-56. Medical Insurance 

Coverage at Application

53

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

55 Date of Eligibility Determination

DATE 112 

(YYYYMMDD)

56

Date of Placement on Order of 

Selection (OOS) Waiting List

DATE 112 

(YYYYMMDD)

57 Date of Exit from OOS Waiting List

DATE 112 

(YYYYMMDD)

58 Zip Code VARCHAR (5)

59 County Name VARCHAR (40)

60 FIPS Code VARCHAR (2)

61 Organizations Referred To: VARCHAR (6)

62

Involvement with Other Agencies 

and Services VARCHAR (6)

63 No formal schooling VARCHAR (1) 63-91. Education

64

Enrolled in elementary education 

(grades 1-8) VARCHAR (1)

65

Completed elementary education 

(grades 1-8) VARCHAR (1) 65-93. Education

66

Enrolled in secondary education in

grade 9 VARCHAR (1)

67

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)

71 Completed secondary education VARCHAR (1) 65-93. Education
62

Data 

Element # Data Element Data Type

Collective Data 

Element 

through grade 11

72

Enrolled in secondary education in 

grade 12 VARCHAR (1)

73

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

75

Attained high school diploma or 

equivalency certificate (GED) VARCHAR (1) 65-93. Education

76

Completed some special education, 

no certificate of completion/diploma VARCHAR (1) 65-93. Education

77 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

80

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. Education
63

Data 

Element # Data Element Data Type

Collective Data 

Element 

90

Attained Vocational/Technical 

Certificate VARCHAR (1) 65-93. Education

91

Attained Vocational/Technical 

License VARCHAR (1) 65-93. Education

92 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 Work Experience

DATE 112 

(YYYYMMDD)

98 End Date of Trial Work 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 CATEGORIES FOR PRE-EMPLOYMENT TRANSITION 

STUDENTS

102 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)

Work-Base Learning 

Experiences

108

Primary Purchased VR Service 

Provider Type VARCHAR (1)

Work-Base Learning 

Experiences

109

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6)

Work-Base Learning 

Experiences
64

Data 

Element # Data Element Data Type

Collective Data 

Element 

110

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6)

Work-Base Learning 

Experiences

111

Comparable Services and Benefits 

Providers VARCHAR (6)

Work-Base Learning 

Experiences

112 Services Provided VARCHAR (1)

Counseling on 

Enrollment 

Opportunities

113

Primary Purchased VR Service 

Provider Type VARCHAR (1) Counseling on Enrollment 

Opportunities

114

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6) Counseling on Enrollment 

Opportunities

115

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Counseling on Enrollment 

Opportunities

116

Comparable Services and Benefits 

Providers VARCHAR (6) Counseling on Enrollment 

Opportunities

117 Services Provided VARCHAR (1)

Workplace 

Readiness Training

118

Primary Purchased VR Service 

Provider Type VARCHAR (1)

Workplace Readiness Training

119

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6)

Workplace Readiness Training

120

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6)

Workplace Readiness Training

121

Comparable Services and Benefits 

Providers VARCHAR (6)

Workplace Readiness Training

122 Services Provided VARCHAR (1)

Instruction in Selfadvocacy

123

Primary Purchased VR Service 

Provider Type VARCHAR (1)

Instruction in Selfadvocacy

124

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6)

Instruction in Selfadvocacy

125

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6)

Instruction in Selfadvocacy

126

Comparable Services and Benefits 

Providers VARCHAR (6)

Instruction in Selfadvocacy

SERVICE CATEGORIES FOR VR APPLICANTS AND ELIGIBLE 
65

Data 

Element # Data Element Data Type

Collective Data 

Element 

INDIVIDUALS

127 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

133

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 

Training
66

Data 

Element # Data Element Data Type

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 

Training
67

Data 

Element # Data Element Data Type

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

165

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

177 Services Provided VARCHAR (1)

Job Readiness 

Training

178

Primary Purchased VR Service 

Provider Type VARCHAR (1) Job Readiness Training
68

Data 

Element # Data Element Data Type

Collective Data 

Element 

179

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

188

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

192 Services Provided VARCHAR (1)

Job Search 

Assistance

193

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

195

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Job Search Assistance

196 Comparable Services and Benefits VARCHAR (6) Job Search Assistance
69

Data 

Element # Data Element Data Type

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

205

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) On-the-job Supports – Short 

Term

206

Comparable Services and Benefits 

Providers VARCHAR (6) On-the-job Supports – Short 

Term

207 Services Provided VARCHAR (1)

On-the-job Supports 

– Supported 

Employment

208

Primary Purchased VR Service 

Provider Type VARCHAR (1) On-the-job Supports –

Supported Employment

209

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6) On-the-job Supports –

Supported Employment

210

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) On-the-job Supports –

Supported Employment

211

Comparable Services and Benefits 

Providers VARCHAR (6) On-the-job Supports –

Supported Employment

212 Services Provided VARCHAR (1) Transportation

213

Primary Purchased VR Service 

Provider Type VARCHAR (1)

Transportation
70

Data 

Element # Data Element Data Type

Collective Data 

Element 

214

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6)

Transportation

215

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6)

Transportation

216

Comparable Services and Benefits 

Providers VARCHAR (6)

Transportation

217 Services Provided VARCHAR (1) Maintenance

218

Primary Purchased VR Service 

Provider Type VARCHAR (1) Maintenance

219

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6) Maintenance

220

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Maintenance

221

Comparable Services and Benefits 

Providers VARCHAR (6) Maintenance

222 Services Provided VARCHAR (1)

Rehabilitation 

Technology

223

Primary Purchased VR Service 

Provider Type VARCHAR (1)

Rehabilitation 

Technology

224

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6)

Rehabilitation 

Technology

225

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6)

Rehabilitation 

Technology

226

Comparable Services and Benefits 

Providers VARCHAR (6)

Rehabilitation 

Technology

227 Services Provided VARCHAR (1) Reader Services

228

Primary Purchased VR Service 

Provider Type VARCHAR (1) Reader Services

229

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6) Reader Services

230

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Reader Services

231

Comparable Services and Benefits 

Providers VARCHAR (6) Reader Services
71

Data 

Element # Data Element Data Type

Collective Data 

Element 

232 Services Provided VARCHAR (1) Interpreter Services

233

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

235

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Interpreter Services

236

Comparable Services and Benefits 

Providers VARCHAR (6) Interpreter Services

237 Services Provided VARCHAR (1)

Personal Attendant 

Services

238

Primary Purchased VR Service 

Provider Type VARCHAR (1)

Personal Attendant 

Services

239

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6)

Personal Attendant 

Services

240

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6)

Personal Attendant 

Services

241

Comparable Services and Benefits 

Providers VARCHAR (6)

Personal Attendant 

Services

242 Services Provided VARCHAR (1)

Technical Assistance 

Services

243

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

245

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Technical Assistance Services

246

Comparable Services and Benefits 

Providers VARCHAR (6) Technical Assistance Services

247 Services Provided VARCHAR (1)

Information and 

Referral Services

248

Primary Purchased VR Service 

Provider Type VARCHAR (1)

Information and 

Referral Services

249

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6)

Information and 

Referral Services
72

Data 

Element # Data Element Data Type

Collective Data 

Element 

250

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6)

Information and 

Referral Services

251

Comparable Services and Benefits 

Providers VARCHAR (6)

Information and 

Referral Services

252 Services Provided VARCHAR (1) Benefits Counseling

253

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

255

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Benefits Counseling

256

Comparable Services and Benefits 

Providers VARCHAR (6) Benefits Counseling

257 Services Provided VARCHAR (1)

Customized 

Employment 

Services

258

Primary Purchased VR Service 

Provider Type VARCHAR (1) Customized Employment 

Services

259

State Vocational Rehabilitation 

Grant (Title I) Funds Used to 

Purchase Services INT(6) Customized Employment 

Services

260

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Customized Employment 

Services

261

Comparable Services and Benefits 

Providers VARCHAR (6) Customized Employment 

Services

262 Services Provided VARCHAR (1) Other Services

263

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

265

Supported Employment State Grant 

(Title VI) Funds Used to Purchase 

Services INT(6) Other Services

266

Comparable Services and Benefits 

Providers VARCHAR (6) Other Services

267 Number of Jobs at Exit VARCHAR (1)

268 Primary Occupation at Exit VARCHAR (16)
73

Data 

Element # Data Element Data Type

Collective Data 

Element 

269

Start Date of Employment in 

Primary Occupation at Exit

DATE 112 

(YYYYMMDD)

270 Employment Status at Exit VARCHAR (1)

271 Hourly Wage at Exit Decimal (5,2)

272

Competitive Integrated Employment

at Exit VARCHAR (1)

273 Hours Worked in a Week at Exit INT(3)

274 SSDI INT(5)

274-280. Monthly 

Public Support 

Amount at Exit

275 SSI for the Aged, Blind or Disabled INT(5) 276-282. Monthly Public 

Support Amount at Exit

276 TANF INT(5) 276-282. Monthly Public 

Support Amount at Exit

277

General Assistance (State or local 

government) INT(5) 276-282. Monthly Public 

Support Amount at Exit

278 Veterans’ Disability Benefits INT(5) 276-282. Monthly Public 

Support Amount at Exit

279 Workers’ Compensation INT(5) 276-282. Monthly Public 

Support Amount at Exit

280 Other Public Support INT(5) 276-282. Monthly Public 

Support Amount at Exit

281 Primary Source of Support at Exit VARCHAR (1)

282 Medicaid VARCHAR (1)

282-288. Medical 

Insurance Coverage 

at Exit

283 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

285

Private Insurance Through Own 

Employer VARCHAR (1) 284-290. Medical Insurance 

Coverage at Exit

286

Not Yet Eligible for Private 

Insurance Through Current 

Employer, but Will Be Eligible for 

Private Insurance After a Certain 

Period of Employment VARCHAR (1) 284-290. Medical Insurance 

Coverage at Exit

287

Private Insurance Through Other 

Means VARCHAR (1) 284-290. Medical Insurance 

Coverage at Exit

288

State or Federal Affordable Care 

Act Exchange VARCHAR (1) 284-290. Medical Insurance 

Coverage at Exit

289 Type of Exit VARCHAR (1)

290 Reason for Exit VARCHAR (2)

291 Date of Exit

DATE 112 

(YYYYMMDD)
74

Data 

Element # Data Element Data Type

Collective Data 

Element 

292 Adult Education VARCHAR (1)

293 Vocational Rehabilitation VARCHAR (1)

294 Wagner-Peyser Act VARCHAR (1)

295

Unemployment Insurance Quarterly 

Earnings INT(25)

296 Employer Identification Number VARCHAR (30)

297 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)

300 Title of Authorized Certifying Official VARCHAR (50)

301

Telephone of Authorized Certifying 

Official VARCHAR (40)

302

Email of Authorized Certifying 

Official VARCHAR (40)

303

Signed by Authorized Certifying 

Official VARCHAR (1)

304 Date Report Submitted

DATE 112 

(YYYYMMDD)