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Title III Alternative Financing Program Data Collection 

Instrument and Instructions
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U.S. Department of Education

Rehabilitation Services Administration

Annual Report for

Alternative 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 

obligation 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, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB 

Control Number 1820-0662. Note: Please do not return the completed Title III Alternative Financing Program Data 

Collection Instrument and Instructions application to this address.
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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 (*).
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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 ............................................................ 31
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A. General Information

General Information: Alternative Financing Program (AFP)

1. State and Name of AFP

Lead Agency

1. Agency Name

2. Agency Contact

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

Community-Based Organization (CBO)

1. Name of Community-Based Organization

2. Name of AFP Director/Loan Fund Manager

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 partners)

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 URL
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Report Submission

1. Some or all of the data reported in this 

information collection instrument 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. Mailing 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.
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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 states 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, Management and Program Analyst, RSA, U.S. Department of 

Education, 400 Maryland Avenue, SW, PCP Room 5025, Washington, 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. Aggregate Data

You do not provide 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 Activities That Occur Across 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 

reporting period “B” only. The same logic should be applied to data on any activities 

that can cross two reporting periods.
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4. Definitions

On subsequent pages, many terms with meanings specific to this instrument are 

used. Definitions for these terms are provided 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 guarantee 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 increasing 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 earlier borrowers return it to the program.
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C. AFP 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 reporting periods.

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

Number and Result of Loan Application of Loan Applications

Here you will provide data on the number of applications you received, what resulted 

from those applications and the geographic 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 this 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 process 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 loans* 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 they 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 Applications

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 applicant. Once 

you know the county where the applicant resides, you can determine the RUCC for 
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that county. The 2003 RUCCs form a classification scheme that distinguishes 

metropolitan counties by size and non-metropolitan counties by degree of 

urbanization 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 in 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 population 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”

When 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 sites: US Department of Agriculture, 

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 the following Web site:

http://www.ers.usda.gov/briefing/Rurality/RuralUrbCon/
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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.

Example: 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 

Applications

Area 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)

Systemgenerated

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)

0 1 (person D) Systemgenerated

Rejected 1 (person F) 1 (person E) Systemgenerated

Total System-generated Systemgenerated

Systemgenerated
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Number, Result, and Geographic Distribution of Loan Applications

Number of 

Applications

Area of Residence Total

Metro

RUCC 1-3

Non-Metro

RUCC 4-9

A. Approved—loan 

made

Systemgenerated

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)

Systemgenerated

C. Rejected Systemgenerated

D. Total System-generated Systemgenerated

Systemgenerated

2. Information about Loans Made

Nationally, many different 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 loans of each type you provided during this reporting 

period. The difference between partnership loans and revolving loans was 

previously explained. Within 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 increasing 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 and 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 for 
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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 interest 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 follows: “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 below 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. Type of Loans, Number, and 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.

Type of Loan Number

of Loans

Percentage

of Loans

Revolving Loan*

Revolving Loan: Low Interest (prime or 

less) 

Systemgenerated

Revolving Loan: Preferred Interest 

(greater than prime) 

Systemgenerated

Total Revolving Loans Systemgenerated

Systemgenerated 

Partnership Loan*

Low Interest (prime or less)*

Without interest buy-down* or loan System-
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guarantee* generated

With interest buy-down* only Systemgenerated

With loan guarantee* only Systemgenerated

With both interest buy-down* and loan 

guarantee*

Systemgenerated

Preferred Interest (greater than prime)*

Without interest buy-down* or loan 

guarantee*

Systemgenerated

With interest buy-down* only Systemgenerated

With loan guarantee* only Systemgenerated

With both interest buy-down* and loan 

guarantee*

Systemgenerated

Total Partnership Loans Systemgenerated

Systemgenerated

Total All Loans Systemgenerated

Systemgenerated

b. Type of Loans and Amount Financed

Enter the dollar value of both Revolving Loans* and Partnership Loans*.

Type of Loan Number of Loans Dollar Value of Loans

Revolving Loans* System-generated

Partnership Loans* System-generated

Total System-generated System-generated

c. Range of Dollar Amounts 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 one 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.
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d. Highest and Lowest Loan Amounts

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:

Highest $_________

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. Type 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 reporting period, what categories of 

devices were funded, and how much funding was provided for devices in those 

categories. There are a total of 10 categories for classifying devices:

 Vision

 Hearing

 Speech communication

 Learning, cognition, and developmental

 Mobility, seating, and positioning

Number and Percentage of Loans 

Made to Applicants in the Amount 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

Systemgenerat

ed

Percent 

of 

Loans

Systemgenerat

ed

Systemgenerat

ed

Systemgenerat

ed

Systemgenerat

ed

Systemgenerat

ed

Systemgenerat

ed

Systemgenerat

ed

Systemgenerat

ed

Systemgenerat

ed
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 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. When 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 telephones are 

immediately categorized in speech communication. A telephone could be classified 

in different categories, depending on the functional needs of the user. When the 

primary challenge is seeing the dial, a large button phone would be classified under 

Vision. When the primary challenge is hearing another person on the phone, an 

amplified phone would be classified under Hearing. When the primary challenge is 

having one’s speech understood on the phone, an adapted phone would be 

classified under Speech Communication. When 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 stick 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.
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a. Types and Dollar Amounts of AT 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 type of device or 

service.

Because a single loan may pay for more than one device or service, 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.

When 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 modification or exterior ramping of a house 

would each be one Environmental Adaptation/Home Modification). Where 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 with the service 

(e.g., an audiological evaluation would go in the “hearing” category).

Type of AT Device/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 Systemgenerated

Systemgenerated
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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 definition 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; or 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:

Active 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 providing 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 following 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 Active 

Loans

Default Rate

System-generated
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When 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 amount 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. Total 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 originated.

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 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. Total 

dollar value of active loans means the unpaid amount of guaranty 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 

Active Loans

Net Loss Rate

System-generated

5. Classification of Consumers Receiving Assistance

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 an 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.
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a. Gender

Enter the total number of direct users* of AT benefiting from a loan for a device or 

service by gender - female or male. If multiple persons are direct users* of the AT 

provided 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. Age

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.

Age of Direct Users * of AT Number 

0-9

10-17

18-29

30-39

40-49

50-59

60-69

70-79 

80+

Total System-generated*

d. Type 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.

Type of Disability Number

Seeing

Hearing

Talking/communicating

Getting around/mobility

Handling objects, reaching

Learning new information

Remembering
21

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, gender, and geographic distribution/underrepresented population.
22

D. Anecdote

Provide at least one anecdote about a direct user or secondary user or beneficiary 

who benefited from an AFP loan. Please make these entries as specific as possible

and include the following information:

 What AT device or service did the user need?

 How did your AFP help the user obtain that device or service?

 What barrier(s) did your AFP help the user overcome?

 If applicable, how did your AFP collaborate with other entities in 

providing 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 identify 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. Vision

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 daily 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 individual 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 accordingly. 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 thermostats, 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, even 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 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. This category also includes systems 

that provide for text communication, both via telecommunication (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)

 Wireless 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/or 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 system
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3. Speech Communication

Definition: 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 Computers. 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 the 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 access 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; DynaWrite; 

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 aids
26

4. Learning, Cognition, and Developmental

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 intervention 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 here 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 classified under vision.

Examples:

 Calculators and measurement tools

 Clocks/Timers/Wake-up Systems

 Electronic Reference Tools and Money Management Tools

 Memory Aids

 Electronic Notetakers, Portable Word Processers, and Recording Devices

 Electronic Organizers/Personal 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 Software

 Tape or other audio players (except as related to vision) 

 Text-to-speech systems (WYNN, Read and Write Gold, etc. – not related to 

vision)

 FM systems (to support auditory processing - not related to hearing loss)

5. Mobility, Seating, and Positioning

Definition: Products whose main focus is on augmenting or replacing the functional 

limitations of an individual’s mobility.
27

Decision rules: Wheelchair restraints associated with seating & positioning 

(shoulder or safety belts) are classified in this category. Wheelchair 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

 Orthotics & prosthetics

 Wheelchairs: dependent (such as strollers & transport chairs) & independent 

manual mobility (4-wheels propelled independently)

 Scooters and power chairs: Functionally 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 seating systems, 

head supports)
28

6. Daily Living

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

 Cooking 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 impairments 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. Switches 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/feeding equipment, spiked cutting board, jar opener

 Zipper pulls, button hooks, needle threader

 Personal pager, multi-sensing/multi-sensory alerting devices

 Wheelchair desks/trays

 Reacher

 Wheelchair/walker bag

 Switch-adapted food processor or other appliance

 Large-button telephone (not for vision or cognitive accommodation).
29

7. Environmental Adaptations and Home Modifications

Definition: Environmental and structural adaptations to the built environment that 

remove or reduce barriers and promote access to and within 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 modifications. Adaptations to furniture such as chairs, couches, beds, etc., 

would generally be classified under Mobility, Seating, and Positioning. Those items 

or structures that are portable or temporary rather than permanent or semipermanent would generally 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 and 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 systems etc.) 

 Flooring and Surface materials/Detectable warning surfaces

 General Environmental Access Products

 Lifts

 Lighting/lighting controls

 Ramps

 Signage/signaling products

 Workstations/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.

Examples:

 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 as 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 home, 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 without 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:

 Standard software

 Standard hardware

 Computer accessories

 Alternative keyboards and pointing devices

 Switches and scanning software used for computer access

 Touchscreens

 Voice recognition systems
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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

 Specialized 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 equipment

 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 athletic pursuits are categorized here. Certain 

devices 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 system controls (e.g. 

television remote) are classified according to their primary use.

Examples:

 Toys 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, hunting, 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.