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Annual Client Assistance Program (CAP) Report (Form RSA-227)

Instructions

1. Heading

Fiscal Year:

Enter the fiscal year covered by this report.

Agency Information:

Enter the name, address, telephone and fax numbers (including area codes), and e-mail 

address of the agency designated to administer the CAP. Be sure to include the same 

information for the operating CAP agency, if different from the designated agency. Also 

include the name of the CAP Director/Coordinator.

Person to contact about this form: Print/type the name and phone number of the 

person RSA can contact if any problems with the form arise.

2. PART I. AGENCY WORKLOAD DATA

Definitional Guidelines for Completing this form:

a. Information/referral service: The Rehabilitation Act of 1973, as 

amended (Act), and its implementing regulations authorize CAP to 

provide information and referral services to any individual with 

disabilities in the State or to Rehabilitation Act clients or client applicants 

who have not been defined as "individuals served" (see definition below) 

or to such individuals' representatives. Information/referral services 

include responses to individuals at meetings, one-time telephone 

discussions, and follow-up mailings of letters, brochures and/or pamphlets 

per an individual's request. These individuals do not have case files (see 

definition below). These services generally take less than one hour of 

service time. CAP usually does not have personal identifying information 

about the individuals who ask for and receive these services, except for 

perhaps the name, address and phone number.

b. Individuals served: An individual is considered an "individual served" or 

a "client" of CAP if he/she meets three criteria:

1) the individual is eligible for CAP services according to Section 112(a) 

of the Act;

2) CAP has opened a case file/service record by including at least the 

name, address, age, race, disability, signed release of information form (if 
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appropriate), concern or complaint, and action taken in the service record; 

and

3) CAP provided at least one "significant service," such as:

a) at least one hour of case service time;

b) a supervised referral that allows follow-up to assure that the referral 

was appropriate and completed;

c) the completion of a second telephone call to the client when the time 

between telephone calls was used to obtain additional information about 

appropriate programs; or 

d) the provision of any allowable service beyond information and referral 

(as defined above).

c. Case file/service record: This is the compilation of personal identifying 

information about the individual, documents, letters, complaints/issues 

raised, advocate's notes, etc., used in working with an "individual served" 

(as defined above). It may contain many issues at any one time. In fact, 

most individuals served will present several issues to CAP during the 

course of the CAP/client relationship. The case file/service record is 

opened at the time CAP determines that it will provide at least one 

"significant service" (as defined above) for the individual. New issues 

may arise while still working with the individual. These new issues, if 

appropriate for CAP intervention, should be added to the existing case 

file/service record. 

A. Information/referral services:

Include in this category the number of times that CAP provided information 

about: 

1) services available under the Act and Title I of the Americans with Disabilities Act (ADA) of 1990;

2) the rights and responsibilities of persons applying for or receiving 

services under the Act; 

3) the routine activities of programs, projects and community

rehabilitation programs funded under the Act; and

4) services available from CAP.

Information/referral services also include responses to individuals at meetings, 

one-time telephone discussions, and follow-up mailings of letters, brochures or 

pamphlets. With regard to follow-up mailings, be sure to count only the number 

of individuals who actually requested the information, not the number of letters, 

brochures or pamphlets sent. Do not include the number of brochures, pamphlets 

or newsletters that are routinely distributed en masse or the number of individuals 

who attend workshops or presentations given by CAP. Summarize these activities 

in the narrative section of this report.
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Estimated counts are not acceptable for this section. All CAPs should maintain 

logs to respond accurately to this item. Such routine requests should not require 

maintenance of client confidential information, extensive research by CAP staff, 

or extended contact with the individual. Do not include in this section any 

information/referral services provided to individuals that meet the definition of 

"individuals served." Services provided to those individuals are recorded in a 

later section of this report.

Line A1: Enter the number of requests CAP responded to regarding information 

about services and benefits available under the Act (e.g., address of the State 

vocational rehabilitation (VR) agency or the scope of VR services).

Line A2: Enter the number of requests CAP responded to regarding information 

about rights under Title I of the ADA.

Line A3: Enter the number of requests CAP responded to regarding information 

on other issues (e.g., Medicaid/Medicare, Social Security, assistive technology, 

etc.).

Line A4: Add lines A1+A2+A3 and enter the total number here. This should 

reflect the total number of information/referral services provided by CAP during 

the fiscal year.

Line A5 (optional): Enter the number of individuals who attended training 

sessions (e.g., orientation sessions, self-advocacy training, etc.) conducted by

CAP staff. 

B. Individuals served:

As stated in the definitional guidelines section above, an "individual served" is 

someone who is eligible for CAP services under the Act; who has a case 

file/service record with CAP; and who receives one or more significant services 

from CAP. All concerns noted in the case file/service record should have 

required some type of intervention (even if it is only brief) with a program, 

project or community rehabilitation program funded under the Act from CAP 

staff in the resolution of the problem.

An "individual served" is counted only once during a fiscal year, regardless of 

how many case files/service records were opened/closed for that individual during 

the year. Estimated counts are not acceptable. All CAPs should maintain logs to 

respond accurately to this item. Do not include in this section any

information/referral services provided to individuals who do not meet the 

definition of "individuals served." Information/referral services provided to those 

individuals are recorded in an earlier section of this report. 
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Line B1: Enter the number of individuals who had open case files/service 

records on hand at the beginning of the fiscal year, which were carried over from 

the prior fiscal year.

Line B2: Enter the number of individuals who had new case files/service records 

opened during this fiscal year.

Line B3: Add lines B1+B2 and enter the total number here. This is the total 

number of individuals served this fiscal year. Remember, no individual may be 

counted more than once in a fiscal year.

Line B4: Of the number of individuals accounted for on Line B3, enter here the 

number of those individuals who had more than one case file/service record 

opened/closed during the fiscal year. Please refer to the definitional guidelines 

above in answering this item.

Example A: An individual requests CAP assistance at the beginning of 

the fiscal year. She raises several issues concerning her VR program. 

CAP opens a case file/service record for her immediately. Three months 

later, CAP has resolved all of the issues and there are no more foreseeable 

problems. CAP closes the case file/service record. Near the end of the 

fiscal year, the individual returns to CAP with new problems. The issues 

she raises now may or may not be related to the issues CAP assisted her 

with earlier in the year. CAP opens a new case file/service record. This 

individual would be counted on Line B4 as having had multiple case 

files/service records this year. If this were the only individual who met 

this criteria, CAP should put a "1" on Line B4.

Example B: An individual requests CAP assistance sometime during the 

fiscal year. The individual has raised several issues regarding her VR 

program. CAP opens a case file/service record for this individual. While 

CAP is working on resolving these initial issues and the case file/service 

record is still open, the individual raises new issues that are appropriate for 

CAP intervention. These new issues should be added to those being 

worked on in the existing case file/service record. A new case file should 

not be opened for this individual to address these new issues. This 

individual would not be counted on Line B4. If none of the "individuals 

served" seems to match the criteria for having multiple cases during the 

same year, CAP should put a "0" on Line B4.

C. Individuals still being served as of September 30:

Enter here the number of individuals who still had open case files/service records 

with CAP as of September 30. These are the individuals who need CAP 

intervention to continue into the next fiscal year (carryover) in order to resolve the 

problems/issues raised this fiscal year. This number may not exceed the total of 
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individuals served listed on Line I.B3. This number will equal the "number of 

individuals with open case files/service records on hand as of October 1" (Line 

I.B1) on next fiscal year's annual report.

D. Reasons for closing individuals’ case files/service records:

Following is a list of the various reasons CAP might give for closing the case 

file/service record of an "individual served". Please choose one primary (most 

appropriate) reason for closing each case file/service record (defined above). Do 

not itemize a reason for resolving each issue. This item asks you to choose one 

overall reason for closing the entire case file/service record after CAP has done all 

it can for the individual in terms of resolving the issues/problems raised. The 

number of case files/service records may, in some situations, be greater than the 

total number of individuals served (Line I.B3) in order to account for those 

unusual situations, referred to in Line I.B4, when an individual had multiple case 

files/service records closed during the fiscal year. Estimated counts are not 

acceptable. CAPs should maintain records to respond accurately to this item.

Line D1: Enter the number of case files closed because all of the issues requiring 

CAP intervention were resolved in favor of the individual.

Line D2: Enter the number of case files closed which demonstrate that at least 

some of the issues were resolved in the individual's favor. This reason for closure 

is appropriate only if the individual has raised multiple issues requiring CAP 

intervention during the time the case file/service record was opened.

Line D3: Enter the number of case files closed because CAP determined that the 

VR agency's decision or action is appropriate under the Act and regulations and 

that there is nothing CAP can do at this time.

Line D4: Enter the number of case files closed because CAP determined, after 

exploring the facts and law, that the individual's complaint lacked legal merit or 

that the individual's complaint was outside the scope of CAP's authority.

Line D5: Enter the number of case files closed because the individual decided 

not to pursue CAP representation, but instead obtained representation elsewhere.

Line D6: Enter the number of case files closed because the individual decided 

not to pursue resolution of the problem at this time. In these situations, the 

individual wanted to "forget it".

Line D7: Enter the number of case files closed because the individual had 

exhausted all available/appropriate appeal procedures and did not prevail. The 

appeal procedures relevant to this item include formal administrative hearings and 

legal remedies. For example, CAP may choose to close a case for this reason if 

the individual served did not prevail at the formal administrative hearing and the 
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case lacks merit for judicial review. CAP may also choose to close a case for this 

reason if the individual served did not prevail at the formal administrative hearing 

and judicial review is not allowed under the State's Administrative Procedure's 

Act (APA). If a case file is closed at the informal administrative review stage 

when the individual did not prevail, one of the reasons given on Lines D2-6, 8-10 

would be a more appropriate reason for closing the case file/service record. 

Line D8: Enter the number of case files closed because the individual has died, 

or moved out of state, or for some reason is unavailable for continued 

representation by CAP.

Line D9: Enter the number of case files closed because the individual has made 

it impossible for CAP to continue effective representation. Some of the reasons 

might have been that the individual refused to:

a. give CAP access to necessary information in the individual's VR case 

file or past history;

 b. follow or accept CAP advice; or

c. follow through with the individual's obligations.

Line D10: Enter the number of case files closed because CAP was unable to 

represent the individual due to lack of CAP resources or staff.

Line D11: Enter the number of case files closed for a reason not listed above. 

RSA has attempted to list all of the possible reasons CAP could cite for closing a 

case file/service record. However, we realize there may be some unusual 

circumstances not encompassed in this listing. This response should be reserved 

for rare instances. Be sure to attach a separate explanation of the circumstances 

for the case closure if you use this response.

E. Results achieved for individuals:

"Results Achieved for Individuals" should be recorded for each case file/service 

record closed during the year. These are the outcomes that resulted from CAP 

intervention on behalf of the individual served. Although services rendered on 

behalf of an individual might have resulted in several outcomes, choose one

primary or most appropriate outcome for each case file closed during the year (not

for each issue addressed). Choose the outcome that reflects most of the services 

rendered by CAP on behalf of the individual while the case file/service record 

was opened. As stated in section D above, the number of case files/service records 

may, in some situations, be greater than the total number of individuals served 

(Line I.B3) in order to account for those unusual situations, referred to in Line 

I.B4, when an individual had multiple case files/service records closed during the 

fiscal year. Estimated counts are not acceptable. CAPs should maintain records 

to respond accurately to this item.
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Enter the number of case files/service records closed in which the following 

results were achieved during the fiscal year:

Line E1: Enter the number of case files closed where the primary outcome was 

that CAP explained the controlling law and/or policy to the individual. For 

example, this outcome could be appropriate for those case files closed because 

CAP determined that the VR agency's decision/position was appropriate for the 

individual, or for those cases closed because the individual's complaint lacked 

legal merit or was beyond the scope of CAP's authority. This outcome also could 

be appropriate for those times when the primary CAP service provided was advice 

about the individual's rights under the ADA.

Line E2: Enter the number of case files closed where the primary outcome was 

that the individual completed/submitted his application for VR services.

Line E3: Enter the number of case files closed where the primary outcome was 

that the eligibility determination process was expedited for the individual.

Line E4: Enter the number of case files closed where the primary outcome was 

that the individual was allowed to participate in an extended evaluation process or 

other evaluation process.

Line E5: Enter the number of case files closed where the primary outcome was 

the development or implementation of the IPE for the individual.

Line E6: Enter the number of case files closed where the primary outcome was 

that communication was re-established between the individual and the other party. 

The other party could be, among others, a VR agency, other community

rehabilitation program, or an employer (for an issue under Title I of the ADA). 

This item could include those times when the re-establishment of communication 

enabled the individual to exercise his/her right to make informed choices.

Line E7: Enter the number of case files closed where the primary outcome was 

that the individual was assigned to a new counselor, office, or program at the 

individual's request. This outcome would be most appropriate for a case when the 

transfer itself basically resolved most of the individual's issues/problems. 

Line E8: Enter the number of case files closed where the primary outcome was 

that CAP identified alternative resources for the individual in order to resolve 

some or all of the issues raised.

Line E9: Enter the number of case files closed where the primary outcome was 

that the individual filed an ADA/504/EEO/OCR complaint.

Line E10: Enter the number of case files closed where the primary outcome was 

something other than listed above. RSA has attempted to list all of the possible 

outcomes CAP could cite as having achieved. However, we realize there may be 
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others not encompassed in this listing. This response should be reserved for rare 

instances. Be sure to attach a separate explanation of the outcomes achieved if 

you use this response.

3. PART II. PROGRAM DATA

IMPORTANT NOTE: The following items are based on statistical information about 

the "individuals served" (defined earlier in this report). Each individual may be counted 

only once during a fiscal year. Estimated counts are not acceptable for these items. All 

CAPs should maintain records to answer these items accurately.

A. Age:

Enter the number of individuals served in each of the age categories listed. Record 

the individual's age as of the beginning of the fiscal year. No individual can be 

counted more than once. The total recorded on Line II.A5 must equal the total 

recorded on Line I.B3.

B. Gender:

Enter the number of individuals served according to their gender. Do not count

an individual more than once. The total recorded on Line II.B3 must equal the 

total recorded on Line I.B3.

C. Race/ethnicity:

Enter the number of individuals served according to their stated racial or ethnic 

origin. All Hispanic self identifiers are reported as “Hispanic” whether the 

individual chooses or does not choose a race. Non-Hispanics are identified as 

their single race or as “two or more races.” If they do not identify themselves as 

“Hispanic” and do not identify a race, the non-identifier is recorded as 

“race/ethnicity unknown.” Only individuals who are non-Hispanic/Latino should 

enter a race in lines C2 through C8.

Line C1: Enter the number of individuals served who consider themselves to be 

Latino or Hispanic, regardless of the individual’s race.

Line C2: Enter the number of individuals served who consider themselves to be 

an American Indian or Alaskan Native.

Line C3: Enter the number of individuals served who consider themselves to be 

Asian. These individuals have origins in the Far East, Southeast Asia, or the 

Indian subcontinent.
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Line C4: Enter the number of individuals served who consider themselves to be 

Black or African American. These individuals may be African-American, 

African, Jamaican, etc.

Line C5: Enter the number of individuals served who consider themselves to be 

a Native Hawaiian or other Pacific Islander.

Line C6: Enter the number of individuals served who consider themselves to be 

White or Caucasian.

Line C7: Enter the number of individuals served who consider themselves to be 

of two or more races.

Line C8: Enter the number of individuals served whose race or ethnicity is 

unknown. This line should rarely be used. 

D. Primary disabling condition of individuals served:

Enter the number of individuals served according to the individual's 

primary/major disabling condition. This is the physical or mental condition, 

impairment or disease most responsible for the individual's work or activity 

limitations. Consult the case file/service record or the VR counselor to determine 

the major disabling condition. Persons with multiple disabilities should be 

counted in the category that is determined to be the primary disabling condition. 

Listed below is a summary of the disabling conditions used by RSA in the VR 

classification system. An individual may not be counted more than once during a 

fiscal year. The total on Line II.D22 must equal the total on Line I.B3.

Line D1: Enter the number of individuals served who are blind in both eyes. 

These individuals qualify as legally blind in both eyes.

Line D2: Enter the number of individuals served who are blind in only one eye 

or who have other visual impairments that do not result in blindness in both eyes.

Line D3: Enter the number of individuals served who are deaf, i.e., depend 

primarily on visual or tactile means to communicate. 

Line D4: Enter the number of individuals served who are not deaf but who are 

hard-of-hearing. 

Line D5: Enter the number of individuals served who are deaf-blind. These 

individuals meet the criteria for both blindness and deafness.

Line D6: Enter the number of individuals served who have orthopedic 

deformities, paralysis or other functional impairments (except amputations) 

involving the limbs, digits, trunk, back or spine.
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Line D7: Enter the number of individuals served who are missing major or minor 

extremities.

Line D8: Enter the number of individuals served with mental illness.

Line D9: Enter the number of individuals served with alcohol or drug addictions. 

Line D10: Enter the number of individuals served with all degrees of mental 

retardation (mild, moderate and severe/profound).

Line D11: Enter the number of individuals served with any specific 

developmental disorders that result in learning disabilities.

Line D12: Enter the number of individuals served who have epilepsy or other 

disorders of the nervous system, not elsewhere classified.

Line D13: Enter the number of individuals served who are disabled from 

respiratory system conditions including tuberculosis, emphysema and chronic 

bronchitis. 

Line D14: Enter the number of individuals served who are disabled from cardiac 

and other circulatory system conditions. 

Line D15: Enter the number of individuals served who are disabled from 

digestive system conditions of the teeth and supporting structures, ulcers, hernias 

and colostomies. 

Line D16: Enter the number of individuals served with end-stage renal failure or 

other genitourinary conditions. 

Line D17: Enter the number of individuals served with speech impairments, such 

as cleft palate and harelip with speech imperfections, stammering and stuttering, 

laryngectomies, and aphasia resulting from strokes.

Line D18: Enter the number of individuals served who are infected with the 

human immunodeficiency virus (HIV), whether symptomatic or asymptomatic. 

Line D19: Enter the number of individuals served whose disabling condition or 

functional limitation is caused by traumatic brain injuries (TBI). 

Line D20: Enter the number of individuals served who have other impairments 

or disabling diseases and conditions not mentioned above.
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Line D21: Enter the number of individuals served whose major disabling 

condition could not be determined. This line should be marked in only rare 

circumstances. 

Line D22: Add Lines D1 through D21 and enter the total here. This sum also 

must equal the total recorded on Line I.B3.

E. Types of individuals served:

Enter the number of individuals served according to their relationships with the 

various programs or projects providing them with services under the Act. For 

purposes of CAP, "services under the Act" does not include activities carried out 

under the Protection and Advocacy of Individual Rights (PAIR) program. An 

individual may be counted more than once during a fiscal year. However, the 

total on any line cannot exceed the total on Line I.B3.

Line E1: Enter the number of individuals served who have applied for or who 

have attempted to apply for services from the State VR agency and one of the 

following situations has occurred:

a) the application was not processed;

b) no final determination of eligibility has been made; or

c) the individual has been determined ineligible to receive services.

Line E2: Enter the number of individuals served who have been determined 

eligible for VR services. It does not matter whether the individual's IPE has been 

developed or implemented. In addition, be sure to include here any individual 

with severe disabilities who has supported employment identified as his/her 

rehabilitation objective (i.e., recipients of supported employment services). It 

does not matter whether the supported employment activity is funded from Title I

or Title VI, Part C of the Act.

Line E3: Enter the number of individuals served who have either applied for or 

are receiving Independent Living services under Title VII of the Act.

Line E4: Enter the number of individuals served who have either applied for or 

are receiving services from other programs funded under the Act (e.g., community

rehabilitation programs, Projects with Industry, migratory farm workers, 

Supported Employment projects, VR projects for American Indians, Recreation, 

and Interpreter Services).

F. Source of person's concern:
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Enter the number of individuals served according to the source of the individual's 

problems or concerns. Although multiple responses are permitted, a problem area 

cannot be attributed to a particular individual served more than once during a 

fiscal year. No line may exceed the total on Line I.B3. 

Line F1: Enter the number of individuals served who are only experiencing 

problems with the State VR agency. It does not matter whether the individual is 

receiving Title I or Title VI, Part C services. All that matters is that the 

individual's complaint only involves the State VR agency.

Line F2: Enter the number of individuals served who are experiencing problems 

only with programs and projects, other than the State VR agency, that provide 

services under the Act. In other words, the individual's complaint is not with the 

State VR program, but instead is with another project or program funded under 

the Act.

Line F3: Enter the number of individuals served who are having problems with 

both the State VR agency and another program or project that provides services 

under the Act.

Line F4: Enter the number of individuals served who had problems with their 

employers regarding their rights under Title I of the ADA.

G. Problem areas:

Enter the number of individuals served according to the problem area identified 

by the individual. An individual may have issues that fall into more than one 

problem area; therefore, multiple responses are permitted. However, a problem 

area cannot be attributed to a particular individual served more than once during a 

fiscal year. The amount on any line may not exceed the total on Line I.B3.

Line G1: Enter the number of individuals served who requested information 

about any of the services, programs, and projects authorized under the Act or 

about rights under Title I of the ADA.

Line G2: Enter the number of individuals served who need help in resolving a 

communication problem. For example, the individual may ask CAP to:

a) clarify the individual's rights and obligations under the Act;

b) clarify the policy/procedures of programs under the Act; or

c) help re-establish contact with the VR agency following an inadvertent 

breakdown in the communication process. An inadvertent breakdown 

in the communication process can occur when the staff member cannot 

locate the individual because he or she has moved or when the 

individual is not assigned to a new staff member after the former staff 

member has left the agency.
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Do not include on this line communication problems that are due to a conflict 

between the individual and the agency staff member. These should be included 

on Line II.G3.

Line G3: Enter the number of individuals served who had a conflict with their 

VR counselor or any staff member of one of the programs authorized under the 

Act. In a sense, client-staff conflict problems/concerns might be regarded as the 

underlying cause of most other problem areas for individuals. Client/counselor 

conflicts can occur when the client:

a) disagrees with the decision/action of the staff member;

b) desires a change of a counselor or staff member; or

c) has a personality conflict with the staff member.

Also include on this line the number of individuals served who request CAP 

assistance in resolving problems that involve the quantity, quality, and/or 

expediency of the services received under the Act. However, if the basic cause of 

such delays or denials is a problem of the individual's eligibility, this problem 

should be recorded on line II.G4. Individuals served who had conflicts related to 

employment goals or informed choice should be included on Line II.G5.

Line G4: Enter the number of individuals served who have concerns involving 

such issues as the application process, ineligibility determinations, delays in 

eligibility determinations, or reapplication procedures.

Line G5: Enter the number of individuals served who have concerns involving 

the development or implementation of their IPE. Include on this line those 

individuals who had problems related to employment goals or informed choice 

issues.

Line G6: Enter the number of individuals served who have problems or concerns 

with a program or project funded under the Act but that cannot be included 

appropriately in one of the preceding categories.

Line G7: Enter the number of individuals served who had problems or concerns 

with issues that are not related to their rehabilitation program, such as AFDC, 

SSI/SSDI, or housing. An individual served may be recorded here only if the 

individual served also is recorded in one of the other problem areas above. The 

issues related to this problem area are beyond the immediate domain of services 

provided under the Act. However, sometimes these issues affect the individual's 

relationship with the rehabilitation program or project.

Line G8: Enter the number of individuals served who had problems or concerns 

related to their rights under Title I of the ADA. Do not include on this line the 

number of individuals served who merely asked for information about their rights 
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under Title I of the ADA. Those individuals served should be accounted for on 

line II.G1 above.

H. Types of services:

Following is a listing of the categories of services CAP can provide an individual 

served. It is expected that CAP often will provide more than one type of service 

during the course of the CAP/client relationship. However, choose one primary

CAP service provided to the individual before the case file/service record was 

closed. Choose the CAP service provided that best reflects the assistance and 

representation CAP provided to the individual while the case file/service record 

was open. Generally, this will mean that CAP should mark the highest level of 

service CAP provided on behalf of the individual while the case file/service 

record was open.

As stated in earlier sections of these instructions, the number of case files/service 

records may, in some situations, be greater than the total number of individuals 

served (Line I.B3) in order to account for those unusual situations, referred to in 

Line I.B4, when an individual had multiple case files/service records closed 

during the fiscal year. However, no line may exceed the total on Line I.B3. 

Estimated counts are not acceptable. CAPs should maintain records to respond to 

this item accurately.

Example 1: An individual may have benefited from CAP's negotiation 

assistance and been represented at an informal review and a fair hearing. 

CAP provided the individual all of these services during the course of one 

case file/service record. This individual should be counted in the category

for formal appeal procedures. 

Example 2: An individual may have had two case files/service records 

opened/closed during the same fiscal year. During the course of working 

with the individual in the first case file/service record, CAP provided 

information and negotiation assistance. During the course of working 

with the individual in the second case file/service record, CAP provided 

information and negotiation assistance and represented the individual at an 

informal review proceeding. CAP should account for this individual in the 

negotiation (first case file) and the informal review proceeding (second 

case file) categories.

A description of advocacy services provided to more than one individual 

(systemic advocacy) should be provided in the narrative section of this report. 

See the instructions for completing the narrative section.

Line H1: Enter the number case files/service records closed in which the highestlevel CAP service provided to the individual served was information/referral 

(I&R) services. This category of services must be in addition to another service; 

therefore, this response will be rarely marked. I&R services can include a 
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telephone conversation, letter, or face-to-face contact that provided information to 

individuals served about rights and benefits available under the Act and how to 

obtain such benefits, as well as rights provided under Title I of the ADA, or 

resulted in a referral to another source for services.

Line H2: Enter the number of case files/service records closed in which the 

highest level of CAP services provided to the individual served fits into one of the 

following categories: reviewed the problem or concern expressed; consulted with 

the individual on various courses of action; researched possible solutions; 

developed strategies; and provided advice. Also, include here the number of 

closed case files/service records for individuals served that reflects CAP's 

coaching and assistance with self-advocacy. The problems identified by these 

individuals could fall under the Act or Title I of the ADA.

Line H3: Enter the number of case files/service records closed in which the 

highest level of CAP services provided to the individual served was that CAP 

engaged in negotiation in order to effect a settlement or compromise with a 

representative of a program, project or facility funded under the Act or with an 

employer to reconcile differences.

Line H4: Enter the number of case files/service records closed in which the 

highest level of CAP services provided to the individual served was that CAP 

assisted the individual in requesting, preparing for, or participating in an informal 

review with the rehabilitation program or project funded under the Act. This 

assistance is more than merely advising the individual of the administrative 

review process; that kind of activity should be recorded on Line H1 above.

Line H5: Enter the number of case files/service records closed in which the 

highest level of CAP services provided to the individual served was that CAP 

engaged in alternative dispute resolution (ADR) procedures to resolve the dispute 

between the individual and the rehabilitation program or project funded under the 

Act or between the individual and an employer. ADR can include mediation 

which involves a mediator, intermediary, or conciliator to settle disputes between 

parties. Mediation may involve the use of a professional mediator, other 

independent third party mutually agreed to by the parties in the dispute, or a CAP 

employee who: 1) is not involved with representing or assigned to represent the 

individual; and 2) has not previously represented or been involved with 

representing the individual. See related section later in the "narrative" portion of 

these instructions.

Line H6: Enter the number of case files/service records closed in which the 

highest level of CAP services provided to the individual served was that CAP 

assisted the individual in requesting, preparing for, or participating in formal 

review proceedings conducted by impartial hearing officers and State 

Directors/Fair Hearing Boards. Do not include any legal services provided on this 

line.
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Line H7: Enter the number of case files/service records closed in which the 

highest level of CAP services provided to the individual served was that CAP 

assisted the individual in pursuing legal recourse in the judicial system to resolve 

the individual's problem or concern.

Line H8: Enter the number of case files/service records closed in which CAP 

provided the individual served with transportation services in connection with 

other CAP services. An individual also is deemed to have received transportation 

services if his/her attendant was transported on his/her behalf. 

4. PART III. NARRATIVE (Attach separate sheets.)

According to Education Department General Administrative Regulations 

(EDGAR) at 34 CFR Part 80, each CAP agency shall submit a written 

performance report that includes, but is not limited to, the following information. 

Be sure to include any other information, not otherwise collected on this reporting 

form that would be helpful in describing the extent of CAP activities this fiscal 

year. Please limit the narrative report, including attachments, to 20 pages or less.

a. Type of agency used to administer CAP: Identify the type of agency used 

to administer the CAP and type of agency operating the CAP, if different. 

Types of agencies used to administer the CAP include, but are not limited to:

1) external -- P&A;

2) external -- other public agency;

3) external -- nonprofit agency;

4) internal to State VR agency (not sub-contracted); and

5) internal to State VR agency (sub-contracted).

b. Sources of funds expended: Specify the total expenditure of funds used in 

providing services to CAP-eligible individuals according to the source of 

funding. Provide this information even if the agency's only source of funding 

is the Federal formula grant. The following chart is recommended:

Source of funding Total expenditures spent on individuals

Federal funds

State funds

All other funds

Total from all sources

The "all other" category is broad and includes funds from local governments, 

earned income (e.g., legal fees), charitable contributions, and other grants or 

contracts. This category does not include in-kind donations. However, it is 
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hoped that CAP agencies will collect this information separately if 

appropriate.

c. Budget for current and following fiscal years: Be sure to outline the budget 

for the current and subsequent fiscal years. This item should include a 

breakdown of dollars expended/allotted for administrative costs (e.g., salaries 

for personnel, equipment, etc.); and services to individuals and other expenses 

(e.g., training of staff, travel, etc.). The following chart is recommended:

Category Current Fiscal Year Next Fiscal Year

Wages & Salaries

Fringe Benefits (FICA, unemployment, etc.)

Materials/Supplies

Postage

Telephone

Rent

Travel

Copying

Bonding/Insurance

Equipment Rental/Purchase

Legal Services

Indirect Costs

Miscellaneous

Total Budget

d. Number of person-years: "Person-years" refer to the actual time that 

positions (both professional and clerical) were filled during the period covered 

by this annual report. If a position was filled throughout the year, it counts as 

one person-year. Positions filled for any fraction of the fiscal year should be 

expressed in "full-time equivalents.” Person-years should be reported for all 

CAP personnel whose salaries are paid totally or partially by Section 112 

funds. Identify the number of person-years staffing CAP this fiscal year. Be 

sure to include an explanation of the number of full-time, part-time, and 

vacant positions. Enter the full-time equivalent for all part-time positions. 

The following chart is recommended:

Type of position Full-time 

equivalent

% of year 

position filled

Person-years

Professional
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Full-time

Part-time

Vacant

Clerical

Full-time

Part-time

Vacant

e. Summary of presentations made: Summarize the types of presentations

made about CAP and other rehabilitation programs and projects. Include in 

the summary an estimate of the number of persons attending the presentations. 

f. Involvement with advisory boards: Identify in what ways CAP is involved 

with advisory boards (e.g., State Rehabilitation Advisory Council, Statewide 

Independent Living Council, etc.).

g. Outreach to unserved/underserved populations: Identify the strategies 

used to conduct outreach to and to serve individuals previously unserved or 

underserved and/or individuals who are members of minority groups. 

Describe the impact of your outreach efforts, especially in terms of how your 

outreach efforts have benefited individuals who traditionally have been 

unserved or underserved.

h. Alternative dispute resolutions: The Act clearly mandates CAPs to engage 

in mediation (or other forms of alternative dispute resolutions) prior to 

seeking a formal or legal remedy on behalf of the individual served. Part IIH5 of the Form RSA-227 asks you to identify the number of times your CAP 

agency engaged in ADR. In addition to that numerical data, be sure to 

describe, in the Narrative portion of your report, your efforts at engaging in 

ADR procedures, including how successful (or not successful) your attempts 

have been and an explanation of why CAP did not engage in ADR prior to 

seeking a formal or legal remedy. 

i. Systemic advocacy: Describe the systemic advocacy undertaken. Indicate 

the problems that have been identified in the delivery of VR and independent 

living services. To the extent possible, detail evidence/documentation that 

substantiates the problems. Summarize the activities CAP has undertaken to 

remedy the problems. Outline the State VR agency's responses to those 

activities and explain the status of the problems at the close of the fiscal year. 

As appropriate, provide CAP's plans for continuing to address the problems 

during the next fiscal year. 
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j. Interesting cases: Describe a few of the more interesting or unique cases that 

CAP worked on during the fiscal year. Summarize the facts of the case and 

the activities that CAP undertook or is undertaking to resolve the issues raised 

by the individual served. Explain whether the case raised systemic or policymaking issues and CAP's plan to address those issues.

k. On-line information/outreach: Describe efforts CAP may have put forth to 

create a web page or some other on-line means of providing information to the 

public. Include information about the number of "hits" your on-line site 

received.

5. End of form:

Transmittal: The RSA-227 reports should be sent within 90 days of the end of the fiscal 

year covered. Please submit report to RSA using one of the methods set forth below. 

A. Electronic Mail addresses via INTERNET--

Specific instructions for key entry/on-line editing of data directly into the RSA MIS can 

be obtained by contacting RSA, or by going to the following URL for information and 

the forms needed to access the RSA MIS: http://rsamis.ed.gov/choose.cfm.

The RSA E-mail address for the RSA-227 is: Jim.Doyle@ed.gov. 

For information about completion of the RSA-227, please use the same Internet E-mail 

address.

B. US Mail and Facsimile--

The RSA fax # is (202) 245-7592; and the US postal address is:

U.S. Department of Education

ATTN: Jim Doyle

Rehabilitation Services Administration

550 12th St, SW, PCP Room 5096

Washington, D.C. 20202-2800

Signature and title of CAP program director: The director of the CAP agency should sign 

the form to certify that it is complete and correct. 

Date: Enter the month, day and year in which the form is sent to RSA.
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