1



## Title III **Al ternativ** **e Financing Program Data Collection**

**Instrument and Instructions**2 **U.S. Department of Education Rehabilitation Services A** **dministration**

**An nual Report**  **for Al**  **ternative Financing Programs Public Reporting Burden**  OMB # 1820 - 0662 Expires: Paperwork Burden Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 27 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 obliga tion to respond to this collection is required under Title III of the Assistive Technology Act of 1998 to retain benefit of the Alternative Financing Program. 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, W ashington, DC 20210 -4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820 - 0662. No te: Please do not return the completed Title III Alternative Financing Program Data Collection Instrument and Instructions application to this address.3

Instructions for completion of this form and relevant definitions are contained in this document **.** Throughout the reporting form, terms for which a definition is available are indicated with an asterisk (*).4 

### Table of Contents A. General Information

................................ ................................ ................................ ... 5 B. Background, General Instructions, and Definitions

................................ .................... 7 1. Reporting Period

................................ ................................ ................................ ........ 7 2. Aggregate Data

................................ ................................ ................................ .......... 7 3. Loan Activities That Occur Across More than One Reporting Period

......................... 7 4. Definitions

................................ ................................ ................................ .................. 8 C. AFP Required Data Elements

................................ ................................ .................... 9 1. Number, Result, and Geographic Distribution of Loan Applications

.......................... 9 2. Information about Loans Made

................................ ................................ ................ 12 3. Type of Device Financed through the Program

................................ ....................... 15 4. Defaults and Net Losses

................................ ................................ .......................... 18 5. Classification of Consumers Receiving Assistance

................................ .................. 19 D. Anecdote

................................ ................................ ................................ .................. 22 E. Notes

................................ ................................ ................................ ....................... 22 F. Classification of Devices

................................ ................................ .......................... 23 1. Vision

................................ ................................ ................................ ....................... 23 2. Hearing

................................ ................................ ................................ .................... 24 3. Speech Communication

................................ ................................ ........................... 25 4. Learning, Cognition, and Developmental

................................ ................................ . 26 5. Mobility, Seating, and Positioning

................................ ................................ ............ 26 6. Daily Living

................................ ................................ ................................ .............. 28 7. Environmental Adaptations and Home Modifications

................................ ............... 29 8. Vehicle Modification and Transportation

................................ ................................ .. 30 9. Computers and Related

................................ ................................ ........................... 30 10. Recreation, Sports, and Leisure Equipment

................................ ............................ 315



### A. **General Information General Information**  **: Al**  **ternative Financing Program (A FP)**  1. State and Name of AFP **Lead A gency**  1. Agency Name 2. Agency Contact 3. Mailing Address 4. M ailing Address (continued) 5. City 6. State 7. Zip Code 8. Phone 9. Fax 10. Program URL 11. Program E - mail 12. Program Toll -free Number 13. Program TTY Number **Community -**  **Based Organization (CBO)** 1. Name of Community- Based Organization 2. Name of AFP Director/Loan Fund Ma nager 3. Mailing Address 4. Mailing Address (continued) 5. City 6. State 7. Zip Code 8. Phone 9. Fax 10. Program URL 11. Program E - mail 12. Program Toll -free Number 13. Program TTY Number **Lending Institution** (see option below to add additional lending institution partn ers) 1. Name of Lending Institution 2. Contact at Lending Institution 3. Mailing Address 4. Mailing Address (continued) 5. City 6. State 7. Zip Code 8. Phone 9. Fax 10. Program URL6

**Report Submission** 1. Some or all of the data reported in this information collection i nstrument is also used as part of data on State Financing Activities in the Annual Report for State Grant for Assistive Technology Programs. **□** Yes **□** No

2. To the best of my knowledge and belief, by submitting this report we are attesting that all data in this performance report are true and correct and the report fully discloses all known weaknesses concerning accuracy, reliability, and completeness of the data. 3. Date Form Submitted (mm/dd/yy) 4. Name of Lead Agency Representative Submitting Report 5. Mail ing Address 6. City 7. State 8. Zip Code 9. Phone 10. Fax 11. Email 

### □ If the AFP has more than one lending institution as a partner check the box to display additional forms to record the contact/general information for additional lending institutions/partners. You can add up to a total of 5 lending institutions/partners

.7



### B. Background, General Instructions, and Definitions This document contains information needed for completing the AFP Annual Report required by the Rehabilitation Services Administration (RSA) under title III of the Assistive Technology Act of 1998 as in effect prior to the amendments of 2004 (AT Act of 1998). This annual report is designed to provide RSA with the data necessary for program planning and reporting to Congress, the Secretary of Education and other entities. Information from individual s tates will be available to the public once the information is completed by the state and submitted to and approved by RSA. Questions regarding potential uses of the information submitted by individual states should be directed to Robert Groenendaal, Manag ement and Program Analyst , RSA, U.S. Department of Education, 400 Maryland Avenue, SW , P CP Room 5025 , Wa shington, DC 20202 - 2800, Robert.Groenendaal@ed.gov, 202 - 245 - 7393. Many individuals and organizations contributed to the development of this data collection system, including a workgroup representing AFPs and Statewide Assistive Technology Programs, and the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). The workgroup’s discussions and input framed issues, developed solutions, provided perspective on implementation and refined this document. 

### 1. **Reporting Period** The reporting period is the federal fiscal year, which begins on October 1 of each year and ends on the following September 30. 

### 2. **Ag gregate Data**  You do not prov ide data on individual loans. Individual loan data and records should be retained at the program level and will not be requested by RSA for the purposes of this data collection. All data is provided in the aggregate and represents the total for the reporting period. 

### 3. **Loan A ctivities That Occur A** **cross More than One Reporting Period** It is possible for an AFP to receive a loan application during one reporting period, but not process that application to a conclusion until the following reporting period. Do not split your data across reporting periods. If an application is received during reporting period “A” but the decision about that application is not made until the following reporting period “B,” report **all** data related to that application during report ing period “B” only. The same logic should be applied to data on any activities that can cross two reporting periods.8

**4. Definitions**  On subsequent pages, many terms with meanings specific to this instrument are used. Definitions for these terms are provid ed throughout these instructions. Once defined in this document, the term retains the same meaning throughout. Key terms to know before proceeding are: **a. Partnership loan:**  A loan administered by and using dollars from a source other than the AFP, usually a financial entity, for which the AFP has an investment through interest or principal buy- down, loan guarantee (see next definition), agreement with a financial institution based on an investment deposit, or other financial/administrative role. **b. Loan guar** 

**antee or insurance:** The AFP uses its funds to guarantee all or a portion of loans for AT. A guaranteed loan is a partnership loan in which the AFP guarantees that the loan to a consumer is secure and will be repaid in the event of a default, thus increasi ng the lender’s willingness to loan funds.

**c. Revolving loan fund (or revolving loan):**  A loan fund that directly uses funds from the “permanent separate account” ( title III funds plus match dollars plus interest paid/accrued) for loans. The AFP directly provides the funds that are to be loaned out and retains full control over to whom and at what terms the funds are loaned. As loans are repaid, the money is lent out again to other AT consumers

— that is, the same money “revolves” out to other borrowers as e arlier borrowers return it to the program.9



### C **. A FP Required Data Elements**  All AFPs are required to provide the data requested in C items 1 - 8 and E. See General Instructions in Section B for information on reporting on activities that cross over reportin g periods. **1. Number, Result, and Geographic Distribution of Loan A**  **pplications Number and Result of Loan A**  **pplication of Loan A pplications**  Here you will provide data on the number of applications you received, what resulted from those applications and the ge ographic distribution of the applicants. In this section, report on all loan applications that were processed to one of the three decisions shown in the table below (i.e., approved

— loan made, approved

— loan not made, or loan application rejected) during th is reporting period. **“** Approved - loan not made” includes loan applications that were approved but not accepted by the consumer and loans that were withdrawn by the consumer after review. “Loan application rejected” does not mean that the AFP did not proce ss and review the application; it means that the application was fully processed and reviewed but a loan was denied to the consumer. Report on all loan applications including (1) revolving loans* that are made directly by the AFP; and (2) partnership loa ns* that use dollars from another source, usually a financial institution, in which the AFP has an investment through loan guarantee, agreement with a financial institution based on an investment deposit, interest or principal buy- down, or other financial or administrative role

. Do not include loans in which the AFP had no financial or administrative role, such as loans for which you simply made a referral to another funding or lending source. Do not include applications that were not reviewed because the y were not complete, were withdrawn before a final decision was made, or were still pending at the end of the reporting period. As explained in the general instructions, report on applications even if the application was received prior to the start of the reporting period, but was processed to a decision or approved during this reporting period. **Geographic Distribution of Loan A pplications**  In this section, report on geographic distribution of the applicant for a loan during the reporting period. Report only one applicant per loan. Choose the primary applicant in the event of multiple applicants for a loan. States have various methods for classifying an applicant by the area of the state where he or she resides. For the purposes of national data collection, a single method for designating the area where an applicant resides must be used by all grantees. This data collection will classify applicants by Rural Urban Continuum Codes (RUCCs). To use RUCCs, you must ascertain the county of residence of the a pplicant. Once you know the county where the applicant resides, you can determine the RUCC for10

that county. The 2003 RUCCs form a classification scheme that distinguishes metropolitan counties by size and non - metropolitan counties by degree of urbanizatio n and proximity to metro areas. 1 The standard Office of Management and Budget (OMB) metro and non - metro categories have been subdivided into three metro and six non - metro categories, resulting in a nine - part county codification as follows: 1 - Counties i n metro areas of one million population or more 2 - Counties in metro areas of 250,000 to one million population 3 - Counties in metro areas of fewer than 250,000 population 4 - Urban population of 20,000 or more, adjacent to a metro area 5 - Urban populat ion of 20,000 or more, not adjacent to a metro area 6 - Urban population of 2,500 to 19,999, adjacent to a metro area 7 - Urban population of 2,500 to 19,999, not adjacent to a metro area 8 - Completely rural or less than 2,500 urban population, adjacent to a metro area 9 - Completely rural or less than 2,500 urban population, not adjacent to a metro area For purposes of this data collection, these nine codes are combined into two levels:

 Codes 1 - 3 are considered “metro”  Codes 4 - 9 are considered “non - metro” Wh en required by this instrument, AFPs will categorize individuals into one of these two groups based on the RUCC for their county. Finding the RUCC for any county is done in the following manner: 1. Go to the following web site s : US Department of Agri culture, Economic Research Service Site : http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/2003/ This site allows you to view all the counties in your state, at the same time, in a table format. In addition, the USDA provides a link to a downloadable version of the county codes in excel format which will enable you to pull the information and manipulate it for your use. http://www.ers.usda.gov/data/RuralUrbanContinuumCodes/ Scroll down to the Data Files Section and click on the option “ Download the 2003 codes in an Excel file ” 2. Select the appropriate state from the map or listing of states that appears below the map.

1 For complete information about Rural Urban Continuum Codes, visit t he following W eb site: http://www.ers.usda.gov/briefing/Rurality/RuralUrbCon/11 3. A list of all counties in the selected state will appear. The 2003 RUCC is the fourth column from the left. AFPs are responsible for tallying how many direct users fall into each grouping of RUCC and providing the final number in the appropriate area of the data collection instrument. **E xample**  : For the program that had six loan applications during the reporting period:  Person A lives in a county with a RUCC of 2

 Person B lives in a county with a RUCC of 4  Person C lives in a county with a RUCC of 8  Person D lives in a county with a RUCC of 6  Person E lives in a county with a RUCC of 9  Person F lives in a county with a RUCC of 3 The Geographic Distribution totals for the six loan applications depicted in the example result in the following example:

**Number of Ap**  **plications Ar** **ea of Residence Total**  **Metro RUCC 1**  **- 3**  In the example, persons A & F would be included in this RUCC **Non -**  **Metro RUCC 4**  **- 9**  In the example, persons B,C,D, & E would be included in this RUCC Approved

— loan made 1 (person A) 2 (persons B and C) System generated Approved

— loan not made* (i.e., the app lication was withdrawn after the loan was approved, or the loan was approved but not accepted by the consumer) 0 1 (person D) System generated

Rejected 1 (person F) 1 (person E) System generated Total System -generated System generated System generated12



### Number, Result, and Geographic Distribution of Loan A **pplications Number of**  **Ap plications**  **Ar ea of Residence**  **Total Metro**  **RUCC 1 -**  **3 Non**  **- Metro** 

**RUCC 4 -** **9** A. Approved

— loan made System generated B. Approved

— loan not made* (i.e., the application was withdrawn after the loan was approved, or the loan was approved but not accepted by the consumer) System generated

C. Rejected System generated D. Total System -generated System generated System generated **2. Information about Loans Made**  Nationally, many diffe rent kinds of alternative financing mechanisms are available because AFPs offer different types of loans to consumers; some individual AFPs may offer several types of loans. Here you will provide data on the types of loans you offer and the number of loan s of each type you provided during this reporting period. The difference between partnership loans and revolving loans was previously explained. W ithin partnership loans and revolving loans, other types of loans include: **Loan guarantee or insurance:** A partnership loan in which the AFP uses its funds to guarantee all or a portion of a loan for AT. A guaranteed loan is a partnership loan in which the AFP guarantees that the loan to a consumer is secure and will be repaid in the event of a default, thus in creasing the lender’s willingness to loan funds. **Low -** **interest loans:** In a low- interest loan, the AFP establishes an agreement with a lending institution to provide loans for AT at “preferred” interest rates. Preferred interest rates are highly variable a nd context - specific, depending upon such factors as the prime lending rate, the borrower’s credit rating, and whether the loan is secured. The mechanism or mechanisms by which AFPs arrange for lending institutions to provide low- interest loans for AT are variable, but typically include a requirement that the AFP deposit its funds with the lending institution. The interest that the AFP’s funds would normally generate is then used by the lending institution to supplement the interest it charges consumers on loans for13

AT, thus resulting in lower interest rates paid by the consumers. The reporting form collects data on two types of low- interest loans: (a) low- interest loans at or below prime rate and (b) preferred interest loans. For both loan types, use the prime rate at the time the loan was provided. Both loans are defined as follows: **a. Low -**  **interest loan (at or below prime rate*):** A loan at interest rates that are at or below the prime rate. See below for a definition of prime rate. **b. Preferred inter** **est loan:** A loan offered at an interest rate that is lower than the consumer would normally pay, but not as low as the prime rate*. See below for a definition of prime rate. **Interest buy**

**- down loan:**  A partnership loan in which AFP funds are used to buy down the interest rate of a loan. The AFP uses funds to reduce the interest rate that lending institutions offer to consumers for loans to purchase AT. The AFP pays the lending institution for a portion of the interest on the loan, resulting in lower interest payments for the consumer over the term of the loan. **Prime Rate:** The prime rate is the average majority prime rate charged by banks on short - term loans to business, quoted on an investment basis. The Federal Reserve defines a bank prime loan as foll ows: “Rate posted by a majority of top 25 (by assets in domestic offices) insured U.S. - chartered commercial banks. Prime is one of several base rates used by banks to price short - term business loans." To determine whether a loan was made above, at, or b elow prime rate, check the U.S. prime rate at the following website for the date on which the loan was closed: http://www.federalreserve.gov/releases/h15/update/ **a. Ty**  **pe of Loans, Number, an d Percentage**  Enter the number of loans made in this reporting period, by loan type. The system will calculate the percentage of loans that fall into each category. The total number of loans must match the number of applications “approved

– loan made” in the previous table, so report each loan in only one category.

**Ty pe of Loan**  **Number of Loans**  **Percentage**

**of Loans Revolving Loan** * Revolving Loan: Low Interest (prime or less) System generated Revolving Loan: Preferred Interest (greater than prime) Sys tem generated **Total Revolving Loans** System generated System generated **Partnership Loan*** **Low Interest (prime or less)** * Wi thout interest buy- down* or loan System -14 guarantee* generated Wi th interest buy- down* only System generated W ith loan guarantee* only System generated Wi th both interest buy- down* and loan guarantee* System generated **Preferred Interest (greater than prime)** * Wi thout interest buy- down* or loan guarantee* System generated Wi th interest buy- down* only System generated Wi th loan guarantee* only System generated Wi th both interest buy- down* and loan guarantee* System generated **Total Partnership Loans** System generated System generated **Total A ll Loans**  System generated System generated **b. Ty**  **pe of Loans and A m**  **ount Financed** Enter the dollar value of both Revolving Loans* and Partnership Loans*. **Ty pe of Loan**  **Number of Loans Dollar Value of Loans**  Revolving Loans* System -generated Partnership Loans* System -generated Total System -generated System -generated **c. R** **ange of Dollar A mounts of Loans Provided**  In the table below, enter how many loans were made within the range of dollar amounts shown below. This is the dollar amount of the entire loan, not the dollar amount divided among different devices if more than o ne device was purchased. The total number of loans must match the number of loans in the “Total” row of the preceding table. The system will calculate the percentage of the amount of the loans made to individuals.15

**d. Highest and Lowest Loan A**  **mounts** Unlike the data you may have reported under the option section at the beginning of this instrument, these are the actual highest and lowest loan amounts provided for the reporting period, not a description of your policies. Enter the highest and lowest dollar amounts of loans provided during this reporting period: High est $_________ Lowest $ _________ **e. Highest and Lowest Interest Rates**  Enter the lowest and highest interest rates among all loans made, including both revolving* and partnership loans.* For interest buy- downs,* report the interest rate to which you bought the loan down: Lowest: ______________% Highest: ______________% **3. Ty**  **pe of Device Financed through the Program** Loans are provided for many different kinds of AT devices. Here you will report on how many devices were funded by your loans during the reporti ng period, what categories of devices were funded, and how much funding was provided for devices in those categories. There are a total of 1 0 categories for classifying devices:

 Vision  Hearing  Speech communication  Learning, cognition, and developmental  M obility, seating, and positioning **Number and Percentage of Loans Made t**  **o A pplicants in the A** **mount of $1,000**  **or Less**  **$1,001**

**to $5,000**  **$5,001**

**to $10,000**  **$10,001**

**to $15,000**  **$15,001**

**to $20,000**  **$20,001**

**to $25,000**  **$25,001**

**to $50,000**  **$50,001**

**or More Total**  **Number of loans**  System generat ed **Percent of**  **Loan s**  System generat ed System generat ed System generat ed System generat ed System generat ed System generat ed System generat ed System generat ed System generat ed16

 Daily living  Environmental adaptations  Vehicle modification and transportation  Computers and related  Recreation, sports, and leisure Definitions for each of the Categories of AT can be found in Section G: Classification of Devices. The Classification of Devices includes a description, decision rules, and examples that will assist you in deciding whether a device should go into a particular category. Many devices can fit into more than one category depending on how they are used by a consumer. You must choose one category where a device belongs in each instance you are reporting and may not count a device more than once. For example, your AFP may provide one loan to one consumer for one computer. Though this computer may be classified in many of the ten categories, it must be counted only once and placed in one category in this circumstance. This does not mean a computer must always go into the same category every time a loan for a computer is provided, however. W hen it is not immediately obvious in which category you should classify a device, you should classify it based on the functional need that is served by the “assistive” aspect of the device. For example, while telephones are used for communication, not all telep hones are immediately categorized in speech communication. A telephone could be classified in different categories, depending on the functional needs of the user. W hen the primary challenge is seeing the dial, a large button phone would be classified und er Vision. Wh en the primary challenge is hearing another person on the phone, an amplified phone would be classified under Hearing. W hen the primary challenge is having one’s speech understood on the phone, an adapted phone would be classified under Spee ch Communication. Wh en the primary challenge involves another function (or multiple functions) the phone would be classified under Daily Living. A component of a larger system should be classified according to the function or primary use of the larger system. For example, a mouth stick that is used to provide access to a communication system such as Pathfinder would be classified under Speech Communication. A mouth stick that is used to type papers would be classified under Computer Access. A mouth stic k that is used generically as an aid to daily living would be classified as Daily Living. Services are classified according to the AT category associated with the service. For example, an audiological evaluation would be classified under Hearing.17

**a. Ty**  **pes and Dollar A** **mounts of A T Financed**  Use the table below to provide information on the types of devices or services financed and the **dollar value of loans made for each ty pe of device or**  **service**

. Because a single loan may pay for more than one device or se rvice, the number of devices and services reported in this table may exceed the number of loans. The total number of devices financed may be different than the total number of direct users of AT as reported in the Tables on Age, Gender and Underrepresented

. Wh en multiple devices fall into different categories of Type of AT Device or Service are acquired with a single loan, the number of devices or services should be reflected in the appropriate “Number of Devices Financed” Category and an approximation of the loan amount used to acquire that Device or Service should be recorded in the associated category for “Dollar Value of Loans.” For large building access projects, the numbers reported should reflect a logical access grouping (e.g., a bathroom modificat ion or exterior ramping of a house would each be one Environmental Adaptation/Home Modification). Wh ere an AT service (such as an evaluation or training) was part of a financial loan, include that dollar amount in the appropriate AT category associated wi th the service (e.g., an audiological evaluation would go in the “hearing” category). **Ty pe of**  **AT Dev**  **ice/Service Number of**  **Devices Financed**  **Dollar Value**

**of Loans** Vision* Hearing* Speech communication* Learning, cognition, and developmental* Mobility, seating and positioning* Daily living* Environmental adaptations and home modifications* Vehicle modification and transportation* Computers and related* Recreation, sports, and leisure* **Total** System generated System generated18

**4. Defaults and Net Losses**  Most AFPs have their own policies for when they declare a loan to be in default. For the purposes of national data collection, one definition of default must be applied to all programs. An AFP can continue to use its own definit ion of default for its own purposes, but under the AFP data collection instrument, a default is defined as follows: **Default :**  A loan is in default, on or before 120 days in which the borrower has not made the scheduled payment for the balance still owed; o r at which time the organization administering the loan paid the lending institution the remaining agreed upon balance of loan. Do not count any payments that may have been made by the loan administering organization on behalf of the borrower during that 120 - day period. All loans that meet the above definition must be reported in this data collection. Here you will report on your default rate and net dollar losses for the reporting period. To do so, you must include your active loans, which are defined as follows: **Ac tiv** **e loan:** A loan for which a borrower owes money and is still actively making payments (i.e., the loan has not been paid in full by the borrower or otherwise “closed” due to default) no matter when they originated. For the purposes of pro viding data on defaults and net losses, active loans are only those loans in which the AFP or their designated affiliate/partner could incur direct losses, such as revolving loans or guaranteed loans. Do not count loans in which the AFP or their designated affiliate/partner does not have a financial responsibility to pay the bank in case of default, such as loan balances for low interest loans, preferred interest loans, or buy- down interest rate loans that are not guaranteed. The default rate* in the follo wing tables is reported only for revolving and guaranty loans, those for which the organization administering the loan can incur a financial loss in the case of default. **a. Number of Loans in Default and Default Rate**  In the table below, enter the number of loans that were in default* during this reporting period. In the second column, enter the number of active loans* as of the last day of this reporting period. The system will calculate the percentage of loans in default for your program, which is your default rate. **Number of Loans in Default**  **Number of A ctiv** **e Loans**  **Default Rate**

System -generated19

Wh en a loan defaults, there often (but not always) is a net dollar loss. For this data collection, a net dollar loss is defined as: **a. Net Dollar Loss**  **:** The amo unt lost as a result of default during this reporting period after subtracting any funds that were recovered. It includes the amount that is unpaid on any loans in default and any loan guarantee payout amounts minus the amount of collateral recovered. To tal dollar value of active loans means the unpaid amount of guaranty or revolving loan balance the loan administering organization is responsible for paying in case of a default at the end of the reporting period of all active loans, no matter when they or iginated. **b. Net Dollar Loss on Defaulted Loans**  In the table below, enter the net dollar loss on loans that were in default during this reporting period. Net dollar loss on loans means the amount lost as a result of default* during this reporting period af ter subtracting any funds that were recovered. It includes the amount that is unpaid on any loans in default* and any loan guarantee payout amounts minus the amount of collateral recovered. Total dollar value of active loans means the unpaid amount of gu aranty or revolving loan balance the organization administering the loan is responsible for paying in case of a default at the end of the reporting period of all active loans*, no matter when they originated. The system will calculate the net loss rate* for your program. **Net Dollar Loss on Loans**  **Total Dollar Value of Ac**  **tiv e Loans**  **Net Loss Rate** System -generated **5. Classification of Consumers Receiving**  **As sistance**  Here you will provide data about the consumers who received loans from your AFP during this reporting period. The data should be provided only for the direct user of the AT, not the individual to whom the loan was provided (in some cases these are the same person, but often they are not). **Direct User:** A direct user is an individual that uses a n AT Device or Service that provides a direct benefit or impact to the individual. A secondary user or beneficiary is a person who benefits from the user having an AT Device or Service. For example, if a family acquired a modified van for two children that are wheelchair users, both children would be considered direct users, but the parents of the children would be considered the secondary users or beneficiaries. Although a secondary user or beneficiary may benefit from the direct user having an AT device or service, for the data below, you must report on the direct user only.20

**a. Gender**  Enter the total number of direct users* of AT benef iting from a loan for a device or service by gender - female or male. If multiple persons are direct users* of the AT provi ded by a single loan, the gender for each direct user* should be reported. **Gender of Direct User(s)** * **Number** Female Male Total System -generated **c. Ag**  **e** Enter the total number of direct users* of AT benefiting from a loan for a device or service by the age range distribution. If multiple persons are direct users* of the AT provided by a single loan, the age for each direct user* should be reported. Programs should report the actual age of the direct user(s) at the time the loan was made. **Ag e of**  **Direct U**

**sers** *** of A T**  **Number** 0 - 9 10 - 17 18 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80+ Total System -generated* **d. Ty**  **pe of Disability** In this section, report on which of the AT user’s abilities will be affected by the AT they are purchasing during this reporting period. An AT user may be affected in more than one area, therefore the data reported for each user may reflect multiple areas or “Type of Abilities” affected. **Ty pe of**  **Disa bility**  **Number** Seeing Hearing Talking/communicating Getting around /mobility Handling objects, reaching Learning new information Remembering21

Interacting with others/socializing **Total** System -generated *The total number of areas affected may exceed the total number of loans and the totals reported for age, gende r, and geographic distribution/underrepresented population.22



### D. **Anecdote** Provide at least one anecdote about a direct user or secondary user or beneficiary who benefited f rom a n AFP loan. Please make these entries as specific as possible and include the fol lowing information:

 Wh at AT devic e or service did the user need?  How did your AFP help the user obtain that device or service?  Wh at barrier(s) did your AFP help the user overcome?  If applicable, how did your AFP collaborate with other entities in providin g this help?  How did obtaining that device or service improve that user’s life ? Other instructions to follow in providing anecdotes:

 Limit each anecdote to 500 words or less.  Include examples that are understandable to an uninformed audience.  Do not iden tify any users by name or use other details that would allow a user to be identified. Be sure that the example clearly fits within the appropriate activities supported by the AFP. (Narrative item)



### E. **Notes** Describe any unique issues that may affect your data during this reporting period (e.g., if you are unable to provide data due to circumstances beyond the control of the entity submitting the data, you must explain). Limit notes to 500 words or less. (Narrative item)23



### F. **Classification of Devices 1.**  **Visi on**  **Definition:** Products designed to assist with vision. **Decision rules :**  Products intended to facilitate access and participation for people who are blind or visually impaired are classified in this category, even if they are used for activities of dail y living, computer access, reading/learning, way finding/travel, recreation, etc. Products in this category characteristically provide output of information through large print/display, synthetic speech or Braille/tactile. If the adaptation is for an ind ividual who is both visually impaired and hearing impaired, categorize according to the primary functionality of the device. Reading systems to accommodate vision are classified here while similar systems to accommodate learning are classified accordingl y. A TTY with Braille output is classified as hearing. A telephone with both a large print keypad and amplification for listening may be classified in either vision or hearing. **Examples** :

 Magnifiers including CCTV systems;  Talking scales, blood pressure gauge, glucometer etc.;  Screen readers, screen magnifiers and Braille displays;  Daisy or Victor Readers;  PDA’s with large print, speech or Braille output;  Talking or Braille GPS, white canes, talking or tactile compass, etc.;  OCR reading systems; talking t hermostats, household appliances etc.24



### 2. **Hearing Definition:**  Products designed to assist with hearing. **Decision rules:** Products intended to facilitate access and participation for people who are deaf or hard of hearing are classified in this category, ev en if they are used for activities of daily living or could have another application for people with other disabilities or for other functions. Products intended to facilitate telephone usage for individuals with hearing disabilities are categorized here, rather than as aids to daily living. If the telephone adaptation is for an individual who is both visually impaired and hearing impaired, categorize under either vision or hearing. Products that amplify voice are classified here if the purpose is to enh ance the volume of speech produced by an individual without a disability, in order for his/her speech to be heard by persons who are deaf or hard of hearing. This category also includes systems that provide for text communication, both via telecommunicati on (text messaging; TTY) and face to face (Interpretype). Peripherals designed to facilitate access or otherwise support the use of a device for hearing (e.g. neck loop induction coils; TeleLink phone couplers; conference microphone; telephone signalers) are counted in this category. **Examples:**

 Personal amplification systems (hearing aids, PocketTalker Pro, etc.)  Assistive Listening Systems (FM; loop; infrared, sound -field, large area, personal)  Wi reless headphones to enhance TV listening (e.g. DirectEar; TV Listener)  Daily living aids that use visual or tactile rather than audible signals (e.g. vibrating alarm clock; smoke alarm with strobe light; doorbell with flashing signal; etc.)  Instant messaging devices (used as portable TTY)  Daily living aids with enhanced audible signals (Sonic Boom Alarm Clock)  Amplified Telephones, in - line amplifiers for telephones, cell phone amplifiers  Text telephones (TTYs), Voice carryover (including CapTel) and Hearing carryover telephones and Signaling devices (visual and/o r tactile alerting to incoming phone calls)  Classroom Captioning System  iCommunicator (Voice to text system)  AudioSee (enhanced view of speaker for speech reading, in addition to FM capabilities)  InterpreType dual keyboard system25



### 3. **Speech Communication Def**  **inition:** Products designed to assist with speaking and face - to -face communication for individuals with speech disabilities. **Decision rules:** Products intended to facilitate computer access and usage for written communications are classified under Compute rs. Products intended to facilitate telephone usage for individuals with speech disabilities will be classified under activities of daily living, EXCEPT when the adaptation is for an individual who is deaf or hard of hearing in which case it is classified under hearing. Products that amplify voice are classified here if the purpose is to enhance the volume of speech produced by an individual with a disability, in order for his/her speech to be audible by persons without disabilities. If the purpose of th e amplifier is to enhance the volume of speech produced by an individual without a disability, in order for his/her speech to be heard by persons who are deaf or hard of hearing, the device is classified under hearing. Peripherals designed to facilitate a ccess or otherwise support the use of a device for speech communication (e.g. mounting systems; carrying cases, switch or mouth stick used for access) are counted in this category. **Examples:**

 Speech generating devices such as BIGMack; DV4; ChatPC; DynaW ri te; Pathfinder; talking photo album  Communication boards/books  Software with speech output e.g. Speaking Dynamically Pro  Software that provides symbol sets for use in developing “low tech” communication boards/books or “high tech” overlays e.g. BoardMaker; Picture This!  Artificial larynx  Devices that produce text but not voice output for face - to -face communication (e.g. Crespeaker)  Voice clarifiers (e.g. Speech Enhancer)  Voice amplifiers (e.g. Falck amplifier)  Stuttering aids26

**4. Learning, Cognition, and Devel**  **opmental Definition:**  Products to provide people with disabilities with access to educational materials and instruction in academic or other environments; products that assist with learning and cognition. **Common subcategories:** Cognitive aids Early inter

vention aids Instructional materials Memory Aids General Personal Organization Tools Sensory/Developmental Stimulation Products **Decision rules:** Products intended to mitigate, compensate, or address learning or cognitive limitations should be classified h ere along with products used to facilitate computer access for individuals with learning/cognitive limitations. Products designed to assist people who are blind or visually impaired with reading, organization, learning, computer access, etc. are classifie d under vision. **Examples:**

 Calculators and measurement tools  Clocks/Timers/W ake - up Systems  Electronic Reference Tools and Money Management Tools  Memory Aids  Electronic Notetakers, Portable W ord Processers, and Recording Devices  Electronic Organizers/Perso nal Digital Assistants  Scientific Equipment  Educational/Instructional Software ( computer based instructional applications used to teach cause and effect, reading, language, spelling, math, writing, science, history, etc)  Cognitive/Perceptual Training So ftware  Tape or other audio players (except as related to vision)  Text - to - speech systems (WY NN, Read and W rite Gold, etc.

– not related to vision)  FM systems (to support auditory processing - not related to hearing loss) **5. Mobility, Seating, and Positionin**  **g Definition:**  Products whose main focus is on augmenting or replacing the functional limitations of an individual’s mobility.27

**Decision rules:** Wh eelchair restraints associated with seating & positioning (shoulder or safety belts) are classified in this category. W heelchair restraints (tie downs: 4 - belt & docking or lock downs: trailer- hitch) associated van locks, which allow a power chair user to drive and/or be transported safely is classified under “Vehicle Modification and Transportation.” **Examples:**

 Ambulatory aids: low tech aids such as canes, walkers or crutches

 O rthotics & prosthetics

 Wh eelchairs: dependent (such as strollers & transport chairs) & independent manual mobility (4 - wh eels propelled independently)

 Scooters and power chairs: Functional ly matched motorized independent power mobility bases

 Seating and positioning

– considerations based on postural control & deformity management, pressure & postural management, and/or comfort & postural accommodation. (such as pelvic guides, contoured seat ing systems, head supports)28

**6. Daily**  **Liv ing**  **Definition:** Devices that enhance the capacity of people with disabilities to live independently, especially AT that assists with Instrumental and other Activities of Daily Living, (ADLs, IADLs) such as dressing, personal hygiene, bathing, home maintenance, cooking, eating, sleeping, breathing, shopping and managing money. **Common Subcategories:**

 Personal hygiene, care and toileting  Dressing and apparel, and aids to dressing  Housekeeping, cleaning, maintenance  Cook ing and eating  Handling, reaching, manipulating  Alerting and signaling  Household management, bill paying (not cognitive, vision, or hearing AT)  Telephony equipment **Decision rules:** Architectural/home adaptations or modifications are classified under Environmental adaptations. Life safety and life support devices and systems that do not involve home modifications are categorized here including medical and respiratory equipment . Devices intended to accommodate specific disabilities, such as hearing or vision , are assigned to those categories. Devices that assist with personal organization are classified as Learning, Cognition and Developmental AT. Devices used to accommodate multiple disabilities are categorized here. Devices that assist persons with motor im pairments not categorized elsewhere are included here. EADLs that also function as environmental controls are classified according to their primary use. Telephony equipment not intended to accommodate other categories of disabilities is listed here. Switc hes controlling daily living aids or unknown devices are reported here. Otherwise switches are reported with the category of devices controlled. **Examples:**  Writing guides, adapted writing implements  Modified or large - handled tools and utensils  Eating/feed ing equipment, spiked cutting board, jar opener  Zipper pulls, button hooks, needle threader  Personal pager, multi - sensing/multi - sensory alerting devices  Wh eelchair desks/trays  Reacher  Wh eelchair/walker bag  Switch - adapted food processor or other appliance  L arge - button telephone (not for vision or cognitive accommodation).29

**7. Environmental**  **Ad aptations and Home Modifications**  **Definition:** Environmental and structural adaptations to the built environment that remove or reduce barriers and promote access to and wi thin the built home, employment and community facilities for individuals with disabilities. Environmental adaptations usually involve building construction, engineering, and architecture, but also include environmental controls and switches that can control a large portion of or an entire living environment. Environmental adaptations are typically permanent or semi permanent structures, modifications or additions. **Decision rules:** Adaptations or modifications to vehicles are classified under Vehicle modi fications. Adaptations to furniture such as chairs, couches, beds, etc., would generally be classified under Mobility, Seating, and Positioning. Those i tems or structures that are portable or temporary rather than permanent or semi permanent would genera lly be classified in another category related to the functional limitation addressed. For example, shower chairs, commodes, raised toilet seats and similar portable items should be classified in the daily living category where as a roll in shower, wall or floor mounted grab bars, installed ramps, etc. would be classified here because they become part of the building structure. **Examples:**

 Accessible HVAC controls, accessible plumbing fixtures and controls  Adapted playground equipment and structures  Alarm a nd Security Systems  Cabinetry and Storage equipment  Door/Gate Openers including farm and ranch gates/latches  Environmental controls and switches (i.e., electronic systems that enable people to control various appliances, lights, telephones, security system s etc.)  Flooring and Surface materials/Detectable warning surfaces  General Environmental Access Products  Lifts  Lighting/lighting controls  Ramps  Signage/signaling products  Wo rkstations/Desks/Tables, Home -workplace adaptations  Adapted farm equipment that is not reported as Vehicle Modification and Transportation such as sprayers, seeding systems, augers, etc.)30

**8. Vehicle Modification and Transportation**  **Definition:** Products that give people with disabilities independence and enhance safety in transportation through adaptation of vehicles. **Decision rules :**  Vehicle ramps are classified in this category. Versatile/portable ramps (temporary adaptation) and wheelchair lifts (permanently installed in buildings) are classified under Environmental adaptations. **Exam ples:**   Adaptive shoulder and seat safety belts  Tie downs and lock downs that secure the wheelchair to the vehicle floor  Hand controls  Extended directional mirrors.  Vehicles and vans modified with lifts, ramps, raised roofs, etc.  Adapted farm vehicles such a s tractors and other self- propelled vehicles modified with hand controls, GPS, lifts and ramp systems. **9. Computers and Related**  **Definition:** Hardware and software products that enable people with disabilities to access, interact with, and use computers at h ome, work, or school. Includes modified or alternate keyboards, switches activated by pressure, touch screens, special software, voice to text software. **Decision rules:** Classify standard computers and computer- related devices (those that will be used wit hout any adaptations) in this category, along with input adaptations used to mitigate, compensate or address motor limitations. Do not include computer adaptations used to address vision or learning, cognitive or developmental limitations. **Examples:**

 Stan dard software  Standard hardware  Computer accessories  Alternative keyboards and pointing devices  Switches and scanning software used for computer access  Touchscreens  Voice recognition systems31

**10. Recreation, Sports, and Leisure Equipment**  **Definition:** Products not already classified in other categories that help persons with disabilities to participate in sport, health, physical education, recreation, leisure, and dance events. **Common subcategories:**

 Toys and games  Sports equipment  Fitness equipment  Specialize d wheelchairs and recreational mobility equipment  Musical instruments and related devices  Arts, crafts and photography equipment  Gardening and horticultural equipment  Hunting, fishing, shooting equipment  Camping, hiking and other outdoor recreational equip ment  Audio and video entertainment equipment **Decision rules:** Devices intended to accommodate specific disabilities, such as hearing or vision, are assigned to those categories. Specialized products designed specifically for recreational, leisure or athle tic pursuits are categorized here. Certain d evices that may have other uses, but are selected as AT such as those devices used for a recreational setting, should be categorized here. Devices for environmental control that also serve as entertainment syste m controls (e.g. television remote) are classified according to their primary use. **Examples:**

 T oys and games (includes toys used for developmental purposes such as teaching cause and effect.) ;  Tennis wheelchairs; beach wheelchairs  Skiing equipment; sled/sledge hockey equipment  Gardening tools and equipment;  Playing card shuffler;  Adapted camera and other photography equipment;  Adaptive exercise equipment (not used in a rehabilitation setting);  Adaptive equipment for fishing, huntin g, and camping;  Adaptive musical instruments and accessories (not used in a school setting);  Entertainment system remote control not used for lights, heat or other environmental control.