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

**Instructions**

1. **Heading Fiscal Year:**  Enter the fiscal y ear covered by this report. **Agency Information:** Enter the name, address, telephone and fax numbers (including area codes), and e

- mai l 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/ty pe the name and phone number of the person RSA can contact if an y 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 an y individual with disabilities in the State or to Rehabilitation Act clients or client applicants who have not been defined as " **indi viduals served**  " (see defini tion 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 identify ing 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 service s according to Section 112(a) of the Act; 2) CAP has opened a case file/service record b y including at least the name, address, age, race, disability , signed release of information form (if2 appropriate), concern or complaint, and action taken in the servic e 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 te lephone call to the client when the time between telephone calls was used to obtain additional information about appropriate programs; or d) the provision of an y al lowable service bey ond information and referral (as defined above).

c. **Case file/service record:**  This is the compilation of personal identify ing 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. In formation/referral services : I nclude 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 Dis

abilities Act (ADA) of 1990; 2) the rights and responsibilities of persons apply ing for or rece iving 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. In formation/referral services also include responses to individuals at meet ings, 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, brochure s 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 b y C AP. Summarize these activities in the narrative sec tion of this report.3 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 b y C AP staff, or extended contact with the individual. Do not include in this section an y information/referral services provided to individuals that meet the definition of "individuals served." Services provided to those individuals are recorded in a later s ection 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). **Li ne 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 , as sistive 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 b y CAP during the fiscal ye ar. **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 t ype of intervention (even if it is only brief) w ith a program, project or communit y 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 y ear, regardless of how many

case files/service records were open ed/closed for that individual during the y ear. 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 mee t the definition of "individuals served." Information/referral services provided to those individuals are recorded in an earlier section of this report.4 **Line B1:** Enter the number of individuals who had open case files/service records on hand at the be ginning of the fiscal year, which were carried over from the prior fiscal ye ar. **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 ye ar. Remember, no individual may be counted more than once in a fiscal ye ar. **Line B4:** Of the number of individuals accounted for on L ine 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 ye ar. She raises se veral 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 ye ar. CAP opens a new case file/service record. This individual would be counted on Li ne 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 indivi dual 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 tha t 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 b e counted on L ine B4. If none of the "individuals served" seems to match the criteria for having multiple cases during the same y ear, CAP should put a "0" on Line B4. C. Individuals still being served as of September 30 : Enter here the number of indivi duals 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 y ear (carry over) in order to resolve the problems/issues raised this fiscal y ear. This n umber may not exceed the total of5 individuals served listed on L ine 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 y ear's annual report. D. Reasons for clos ing 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/ser vice record (defined above). Do not itemize a reason for resolving each issue. This item asks y ou 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 issu es/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 L ine I.B4, when an individual had mul tiple case files/service records closed during the fiscal ye ar. Estimated counts are not acceptable. CAPs should maintain records to respond accuratel y to this item. **Line D1:** Enter the number of case files closed because all of the issues requiring CA P 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 onl y if the indiv idual 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 A ct 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 c omplaint 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. I n these situations, the individual wanted to "forget it". **Line D7:** Enter the number of case files closed because the individual had exhausted all available/app ropriate 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 the6 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 f ile/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 th is listing. This response should be reserved for rare instances. Be sure to attach a separate explanation of the circumstances for the case closure if yo u use this response. E. Results achieved for individuals : "Results Achieved for Individuals" shoul d 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 ou tcomes, 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 b y 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 (L ine 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 accuratel y to this item.7 Enter the number of case files/service records closed in w hich 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 app ropriate 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 bey ond the scope of CAP's authorit y. 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 com pleted/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 close d 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 co mmunity rehabilitation program, or an emplo yer (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:** E nter 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 basicall y re solved 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 attempt ed to list all of the possible outcomes CAP could cite as having achieved. However, we realize there may be8 others not encompassed in this listing. This response should be reserved for rare instances. Be sure to attach a separate explanation of the outc omes achieved if yo u 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 y ear. Estimated counts are not acceptable for these items. All CAPs should maintain records to answer these items accuratel y. A. Age : Enter the number of individuals served in each of the age categories listed. Record the individual's age a s of the beginning of the fiscal y ear. 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 L ine II.B3 must equal the total recorded on L ine I.B3. C. Race/ethnicit y : 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/ethnicit y unknown.” Only indiv iduals 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 indi vidual’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.9 **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 rarel y be used. D. Primary

disabling condition of individuals served : Enter the number of ind ividuals served according to the individual's primary /major disabling condition. This is the phy sical or mental condition, impairment or disease most responsible for the individual's work or activity limitations. Consult the case file/service record or t he VR counselor to determine the major disabling condition. Persons with multiple disabili ties 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 s ys tem. An individual may not be counted more than once during a fiscal year. The total on Line II.D22 must equal the total on L ine I.B3. **Line D1:** Enter the number of individuals served who are blind in both ey es. These indiv iduals qualify as legally blind in both ey es. **Line D2:** Enter the number of individuals served who are blind in only one ey e or who have other visual impairments that do not result in blindness in both ey es. **Line D3:** Enter the number of individuals se rved 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, paraly sis or other functional impairments (except amputations) involving the limbs, digits, trunk, back or spine.10 **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 addic tions. **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 d isabilities. **Line D12:** Enter the number of individuals served who have epileps y or other disorders of the nervous sy stem, not elsewhere classified. **Line D13:** Enter the number of individuals served who are disabled from respiratory

s ys tem conditions i ncluding tuberculosis, emphy sema and chronic bronchitis. **Line D14:** Enter the number of individuals served who are disabled from cardiac and other circulatory

s ys tem conditions. **Line D15:** Enter the number of individuals served who are disabled from digestive s ys tem 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 indi viduals served with speech impairments, such as cleft palate and harelip with speech imperfections, stam mering and stuttering, lary ngectomies, and aphasia resulting from strokes. **Line D18:** Enter the number of individuals served who are infected with th e human immunodeficiency virus (HIV), whether symptomatic or as ym ptomatic. **Line D19:** Enter the number of individuals served whose disabling condition or functional limitation is caused b y traumatic brain injuries (TBI). **Line D20:** Enter the number o f individuals served who have other impairments or disabling diseases and conditions not mentioned above.11 **Line D21:** Enter the number of individuals served whose major disabling condition could not be determined. This line should be marked in onl y rare circumstances. **Line D22:** Add L ines D1 through D21 and enter the total here. This sum also must equal the total recorded on L ine I.B3.

E. Ty

pes of individuals served : Enter the number of individuals served according to their relationships with th e 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 (PAI R) program. An individual may

be c ounted more than once during a fiscal y ear. However, the total on any

line cannot exceed the total on L ine I. B3. **Line E1:** Enter the number of individuals served who have applied for or who have attempted to appl y for services from the State VR agency a nd 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. I t does not matter whether the individual's I PE has been developed or implemented. I n addition, be sure to include here any individual with severe disabilities who has supported emplo yment identified as his/her rehabilitation objective (i.e., recipients of supported employ ment services). I t does not matter whether the supported emplo ym ent activity is funded from Title I or Title VI, Part C of the Act. **Line E3:** Enter the number of i ndividuals served who have either applied for or are receiving Independent L iving 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 I ndustry , migratory farm workers, Supported Employ

ment projects, VR projects for American Indians, Recreation, and Interpreter Services). F. Source of person's concern :12 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 L ine I.B3. **Line F1:** Enter the number of individuals served who are onl y 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 th at 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 othe r 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 employ ers 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 serv ed more than once during a fiscal year. The amount on any line may not exceed the total on L ine I.B3. **Line G1:** Enter the number of individuals served who requested information about an y 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 mem ber after the former staff member has left the agency

.13 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 L ine II.G3. **Line G3:** Enter the number of individuals served who had a conflict with their VR counselor or an y staff member of one of the programs authorized unde r the Act. In a sense, client

- staff conflict problems/concerns might be regarded as the underly ing cause of most other problem areas for individuals. Client/counselor conflicts can occur when the client: a) dis agrees with the deci sion/action of t he staff member; b) desires a change of a counselor or staff member; or c) has a personalit y conflict with the staff member. Also include on this line the number of individuals served who request CAP assistance in resolving problems that involve th e quantity , qualit y, and/or expediency

of the services received under the Act. However, if the basic cause of such delay s or denials is a problem of the individual's eligibility , this problem should be recorded on line II.G4. Individuals served who had c onflicts related to employ ment goals or informed choice should be included on L ine II.G5. **Line G4:** Enter the number of individuals served who have concerns involving such issues as the application process, ineligibility determinations, delay s in eligibi lity 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 emplo ym ent 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 appropriatel y 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 i n one of the other problem areas above. The issues related to this problem area are bey ond the immediate domain of services provided under the Act. However, sometimes these issues affect the individual's relationship with the rehabilitation program or pr oject. **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 merel y asked for information about their rights14 under Title I of the ADA. Those individuals served should be accounted for on line II.G1 above. H. Ty

pes 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 t han one t ype 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 ope n. 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 ye ar. However, no line may exceed the total on L ine I.B3. Estimated counts are not acceptable. CAPs should maintain records to respond to this item accuratel y. **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 in dividual 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 ye ar. During the course of working with the individual in the first ca se 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 advoca cy services provid ed to more than one individual (sy stemic advocacy ) should be provid ed 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 highest

level CAP service provided to the individ ual served was information/referral (I&R) services. This category of services must be in addition to another service; therefore, this response will be rarel y marked. I&R services can include a15 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 t he 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 cour ses 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 problem s 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 negotia tion in order to effect a settlement or compromise with a representative of a program, project or facility funded under the Act or with an employ er to reconcile differences. **Line H4:** Enter the number of case files/service records closed in which the hig hest 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 merel y 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 t he 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 emplo ye r. ADR can in clude 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 part y mutually agreed to b y the parties in the dispute, or a CAP employ ee 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 instruction s. **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 proceedin gs conducted by impartial hearing officers and State Directors/Fair Hearing Boards. Do not include any legal services provided on this line.16 **Line H7:** Enter the number of case files/service records closed in which the highest level of CAP services provi ded to the individual served was that CAP assisted the individual in pursuing legal recourse in the judicial sy stem 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 separat e 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 an y other information, not otherwise collected on this reporting form that would be helpful in describing the extent of CAP activities this fiscal ye ar. Please limit the narrative report, including attachments, to 20 pages or less.

a. **Type of agency used to administer CAP:**  Id entify the t yp e of agency

used to administer the CAP and ty pe of agency

operating the CAP, if different. Ty pes of agencies used to administer the CAP include, but are not limited to: 1) external

-- P&A; 2) exter nal

-- other pub lic 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 servic es to CAP

- eligible individuals according to the source of funding. Provide this information even if the agency 's onl y source of funding is the Federal formula grant. The following chart is recommended: Source of funding Total expenditures spent on indivi duals 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 is17 hoped that CAP agencies will collect this information separatel y if appropriate.

c. **Budget for current and following fiscal years:** Be sure to outline the budget for the current and subsequent fiscal ye ars. 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 followi ng 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/I

nsurance Equipment Rental/P urchase 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 repor t. If a position was filled throughout the ye ar, it counts as one person - ye ar. Positions filled for an y fraction of the fiscal ye ar should be expressed in "full

- time equivalents.” Person

- ye ars should be reported for all CAP personnel whose salaries are paid totally or partially

by Section 112 funds. Identify

the number of person

- ye ars 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: Ty pe of position Full

- time

equivalent % of year

position filled Person

- years
Professional18 Full

- time Part

- time Vacant Clerical Full

- time Part

- time Vacant

e. **Summary of pres entations made:**  Summarize the ty pes 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 way s 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 yo ur outreach efforts have benefited individuals who traditionally have been uns erved or underserved. h. **Alternative dispute resolutions:** The Act clearl y mandates CAPs to engage in mediation (or other forms of alternative dispute resolutions) prior to seeking a formal or legal remed y on behalf of the individual served. Part II

H5 of the Form RSA

- 227 asks y ou to identify the number of times y our CAP agency engaged in ADR. I n addition to that numerical data, be sure to describe, in the Narrative portion of y our report, your efforts at engaging in ADR procedures, including how succes sful (or not successful) y our attempts have been and an explanation of wh y CAP did not engage in ADR prior to seeking a formal or legal remed y. i. **Systemic advocacy:** Describe the s ys temic advocacy undertaken. Indicate the problems that have been ident ified 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 remed y the problems. Outline the State VR agency's response s to those activities and explain the status of the problems at the close of the fiscal y ear. As appropriate, provide CAP's plans for continuing to address the problems during the next fiscal y ear.19 j. **Interesting cases:** Describe a few of the more interes ting or unique cases that CAP worked on during the fiscal ye ar. 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 s ys temic or poli cy making 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. I nclude information about the number of "hits" y our on - line site received.

5. **End of form: Transmittal:**  The RSA

- 227 reports should be sent within 90 day s of the end of the fiscal ye ar covered. Please submit report to RSA using one of the methods set forth below.

A. Electronic M ail addresses via INTERNET

-- Specific instructions for key entry /on

- line editing of data directly into the RSA MI S can be obtained b y contacting RSA, or b y going to t he following URL for information and the forms needed to access the RSA MI S: http://rsami s.ed.gov/choose.cfm. The RSA E

- mail address for the RSA

- 227 is: Jim.Doy le@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 Doy le Rehabilitation Services Administration 550 12 th St , SW, PCP Room 5096 Washington, D.C. 20202

- 2800
**Signature and title of CAP program director:** T he 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.20