REPORTING INSTRUMENT

OMB Control Number: 0985-0043

Expiration Date: March 31, 2024

UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADMINISTRATION FOR COMMUNITY LIVING

ADMINISTRATION ON DISABILITIES

OFFICE OF INDEPENDENT LIVING PROGRAMS

SECTION 704

ANNUAL PERFORMANCE 

REPORT

for

STATE INDEPENDENT LIVING 

SERVICES PROGRAM

(Title VII, Chapter 1, Part B of the Rehabilitation Act of 1973, as amended)

INSTRUMENT

(To be completed by Designated State Entities

and Statewide Independent Living Councils)

Reporting Fiscal Year: _____________________________

State: ___________________________________________

Contents

Reporting Instrument ...................................................................................................................... 1

STATE INDEPENDENT LIVING SERVICES PROGRAM................................................ 1

SubPart I – Administrative Data ..................................................................................................... 4

Section A – Sources and Amounts of Funds and Resources...................................................... 4

Item 1 - All Federal Funds Received ...................................................................................... 4

Item 2 - Other Government Funds.......................................................................................... 4

Item 3 - Private Resources...................................................................................................... 4

Item 4 - Total Income ............................................................................................................. 4

Item 5 – Pass-Through Funds................................................................................................. 4
2

Item 6 - Net Operating Resources........................................................................................... 4

Section B – Distribution of Title VII, Chapter 1, Part B Funds.................................................. 6

Section C – Grants or Contracts Used to Distribute Title VII, Chapter 1, Part B Funds............ 7

Section D - Grants or Contracts for Purposes Other than Providing IL Services or for the 

General Operation of Centers ..................................................................................................... 8

Section E – Monitoring Title VII, Chapter 1, Part B Funds................................................... 8

Section F – Administrative Support Services and Staffing ........................................................ 8

Section G – For Section 723 States ONLY ................................................................................ 8

Item 1 – Distribution of Part C Funds to Centers ................................................................... 8

Item 3 – Monitoring and Onsite Compliance Reviews........................................................... 9

Item 4 – Updates or Issues...................................................................................................... 9

SubPart II – Number and Types of Individuals with significant disabilities receiving services.. 11

Section A – Number of Consumers Served During the Reporting Year.................................. 11

Section B –Number of CSRs Closed by September 30 of the Reporting Year........................ 11

Section C –Number of CSRs Active on September 30 of the Reporting Year......................... 12

Section D – IL Plans and Waivers............................................................................................ 12

Section E – Age ........................................................................................................................ 12

Section F – Sex ......................................................................................................................... 12

Section G – Race and Ethnicity ................................................................................................ 13

Section H – Disability............................................................................................................... 14

SubPart III – Individual Services and Achievements funded through Title VII, Chapter 1, PART 

B funds.......................................................................................................................................... 15

Section A – Individual Services and Achievements................................................................. 15

Services................................................................................................................................. 15

Section B – Increased Independence and Community Integration........................................... 16

subpart Iv – community Activities AND Coordination................................................................ 20

Section A – Community Activities....................................................................................... 20

Item 2 – Description of Community Activities..................................................................... 20

SUBPart V – Statewide Independent Living Council (SILC) ...................................................... 21

Section A - Composition and Appointment.............................................................................. 21

Item 1 – Current SILC Composition..................................................................................... 21

Item 2 – SILC Composition Requirements............................Error! Bookmark not defined.

SILC Composition .................................................................Error! Bookmark not defined.

Section B – SILC Membership Qualifications ......................................................................... 22

Item 1 – Statewide Representation ....................................................................................... 22

Item 2 – Broad Range of Individuals with Disabilities from Diverse Backgrounds............ 22

Section D – SILC Duties........................................................................................................... 23

Item 1 – SILC Duties............................................................................................................ 23

Section E – Training and Technical Assistance Needs............................................................. 24

Applicable Laws ........................................................................................................................... 24

SubPart VI – State plan for independent living (SPIL) Comparison and updates, Other 

Accomplishments and Challenges of the Reporting Year............................................................ 28

Section A – Comparison of Reporting Year Activities with the SPIL ..................................... 28

Item 1 – Progress in Achieving Objectives and Goals ......................................................... 28

Item 2 – SPIL Information Updates...................................................................................... 28

Section B– Significant Activities and Accomplishments......................................................... 28
3

Section C – Substantial Challenges .......................................................................................... 28

Section D – Additional Information ......................................................................................... 28

SubPART VII - signatures............................................................................................................ 29
4

SUBPART I – ADMINISTRATIVE DATA

Section A – Sources and Amounts of Funds and Resources

Sections 704(c) and 704(m)(3)(4) 

Indicate amount received by the DSE as per each funding source. Enter “0” for none.

Item 1 - All Federal Funds Received

(A) Title VII, Ch. 1, Part B $

(B) Title VII, Ch. 1, Part C – For Section 723 states Only $

(C) Title VII, Ch. 2 $ 

(D) Other Federal Funds $

Item 2 - Other Government Funds 

(E) State Government Funds $

(F) Local Government Funds $

Item 3 - Private Resources

(G) Fees for Service (program income, etc.) $

(H) Other resources $

Item 4 - Total Income 

Total income = (A)+(B)+(C)+(D)+(E)+(F)+(G)+(H) $

Item 5 – Pass-Through Funds

Amount of other government funds received as pass-through funds to 

consumers (include funds received on behalf of consumers that are 

subsequently passed on to consumers, e.g., personal assistance services, 

representative payee funds, Medicaid funds, etc.) $

Item 6 - Net Operating Resources

[Total Income (Section 4) <minus> amount paid out to Consumers 

(Section 5) = Net Operating Resources $
5

Item 7 –Total State Funds Allotted to Support CIL Operations (Excluding Title VII, Ch. 1 Part B

Funding)

Item 8 – Total Section 110 (I&E Funds) allotted, consistent with the SILC Resource Plan

(Section 101(a)(18)
6

Section B – Distribution of Title VII, Chapter 1, Part B Funds

Section 713 of the Act; 45 CFR 1329.10

What Activities were 

Conducted with Part B Funds?

Expenditures of 

Part B Funds for 

Services by DSE 

Staff

Expenditures for 

Services 

Rendered by

Grant or 

Contract

(1) Provided resources to the SILC to carry out its 

functions $ $

(2) Provided IL services to individuals with 

significant disabilities $ $

(3) Demonstrated ways to expand and improve IL 

services $ $

(4) Supported the general operation of CILs that

are in compliance with the standards and 

assurances set forth in subsections (b) and (c)

of section 725 of the Act $ $

(5) Supported activities to increase capacity to 

develop approaches or systems for providing 

IL services $ $

(6) Conducted studies and analyses, gathered 

information, developed model policies, and 

presented findings in order to enhance IL 

services $ $

(7) Provided training regarding the IL philosophy $ $

(8) Provided outreach to unserved or underserved

populations, including minority groups and 

urban and rural populations $ $

(9) Performance of DSE services, as outlined 

in Section 704c(1-4), (cannot be more than 

5%)
7

Section C – Grants or Contracts Used to Distribute Title VII, Chapter 1, Part B Funds 

Sections 704(f) and 713 of the Act 

Enter the requested information for all DSE grants or contracts, funded at least in part by Part B funds, in the chart below. If a column 

is not applicable to a particular grant or contract, enter “N/A.” If there were no non-Part B funds provided to this grantee or contractor 

for the purpose listed, enter “$0” in that column Add more rows as necessary. 

Name of Grantee or 

Contractor

Use of Funds

(based on the activities listed in 

Subpart I, Section B)

Amount of 

Part B 

Funds 

Amount of

Non-Part B 

Funds Counties Served 

Designated in 

SPIL as 

Underserved/U

nserved Area? 

(Yes/No)

Total Amount of Grants 

and Contracts $ $
8

Section D - Grants or Contracts for Purposes Other than Providing IL 

Services or for the General Operation of Centers

Section 713 of the Act

Describe the objectives, activities and results for each Part B grant or contract awarded for 

purposes other than IL services or the general operation of centers. 

Section E – Monitoring Title VII, Chapter 1, Part B Funds

45 CFR 1329.12

Provide a summary of the program and / or fiscal review, evaluation and monitoring conducted 

by the state of any of the grantees/contractors receiving Part B funds during the reporting year. 

For CILs that only receive part B money, describe how it is confirmed that they meet the 

definition of a CIL, as described in Section 702(2). See instructions for the definition. 

Section F – Administrative Support Services and Staffing 

Section 704(c)(2) and 704 (m)(2) and (4) of the Act

Item 1 – Administrative Support Services

Describe any administrative support services, including staffing, provided by the DSE to the Part 

B Program.

Item 2 - Staffing

Enter requested staff information for the DSE and service providers listed in Section C, above 

(excluding Part C funded CILs):

Type of Staff

Total Number

of FTEs

FTEs filled by 

Individuals with 

Disabilities

Decision-Making Staff

Other Staff

Section G – For Section 723 States ONLY

Section 723 of the Act, 45 CFR 1329.12

Item 1 – Distribution of Part C Funds to Centers

In the chart below, please provide the following information: 
9

A) name of each center within your state that received Part C funding during the reporting

year; 

B) amount of Part C funding each center received; 

C) whether the Part C funding included a cost-of-living increase; 

D) whether the Part C funding included any excess funds remaining after cost-of-living 

increases were provided; 

E) whether any of the centers received its Part C funding pursuant to a competition for a new 

center in the state; and 

F) whether the center was the subject of an onsite compliance review conducted by the DSE 

during the reporting year. 

Name of CIL 

Amount of 

Subchapter C 

Funding 

Received 

Cost of 

Living 

Increase? 

(Yes/No)

Excess 

Funds 

After Cost 

of Living 

Increase? 

(Yes/No)

New 

Center? 

(Yes/No)

Onsite 

Compliance 

Review of 

Center?

(Yes/No)

Add additional rows as necessary.

Item 2 – Administrative Support Services

Section 704(c)(2) of the Act

Describe the administrative support services used by the DSE to administer the Part C program.

Item 3 – Monitoring and Onsite Compliance Reviews

Section 723(g), (h), and (i)

Provide a summary of the monitoring activities involving Part C centers conducted by the state 

during the current reporting year, including the onsite reviews of at least 15% of centers 

receiving Part C funds under section 723. The summary should include, at least, the following:

A) centers’ level of compliance with the standards and assurances in Section 725 of the Act; 

B) any adverse actions taken against centers;

C) any corrective action plans entered into with centers; and

D) exemplary, replicable or model practices for centers.

Item 4 – Updates or Issues

Provide any updates to the administration of the Part C program by the DSE, if any, including 

any significant changes in the amount of earmarked funds or any changes in the order of
10

priorities in the distribution of Part C funds. Provide a description of any issues of concern 

addressed by the DSE in its administration of the Part C program. 
11

SUBPART II – NUMBER AND TYPES OF INDIVIDUALS WITH 

SIGNIFICANT DISABILITIES RECEIVING SERVICES

Section 704(m)(4) of the Act; 45 CFR 1329.12(a)(3–4)

In this section, provide data from all service providers (DSE, grantees, contractors) who received 

Part B funds and who were listed in Subpart I, Section C of this report, except for the centers that 

receive Part C funds. Part C centers will provide this data themselves on their annual CIL PPRs.

Section A – Number of Consumers Served During the Reporting Year

Include Consumer Service Records (CSRs) for all consumers served during the year.

# of CSRs

(1) Enter the number of active CSRs carried over from September 30 of 

the preceding reporting year

(2) Enter the number of CSRs started since October 1 of the reporting 

year

(3) Add lines (1) and (2) to get the total number of consumers served

Section B –Number of CSRs Closed by September 30 of the Reporting Year

Include the number of consumer records closed out of the active CSR files during the reporting

year because the individual has:

# of CSRs

(1) Moved

(2) Withdrawn

(3) Died

(4) Completed all goals set

(5) Other

(6) Add lines (1) + (2) + (3) + (4) +(5) to get total CSRs closed
12

Section C –Number of CSRs Active on September 30 of the Reporting Year

Indicate the number of CSRs active on September 30th of the reporting year.

# of CSRs

Section A(3) <minus> Section (B)(6) = Section C

Section D – IL Plans and Waivers

Indicate the number of consumers in each category below.

# of Consumers

(1) Number of consumers who signed a waiver

(2) Number of consumers with whom an ILP was developed

(3) Total number of consumers served during the reporting year

Section E – Age

Indicate the number of consumers in each category below.

# of Consumers

(1) Under 5 years old 

(2) Ages 5 – 19 

(3) Ages 20 – 24

(4) Ages 25 – 59

(5) Age 60 and Older

(6) Age unavailable

Section F – Sexual Orientation & Gender Identity

Which of the following best represents how you self-identify? [Select ONE]:
13

# of Consumers

(1) Number of individuals served who identify as female

(2) Number of individuals served who identify as male 

(3) Number of individuals served who identify as non-binary 

(4) Number of individuals served who identify as two-spirit 

(5) Number of individuals served who identify as neither male nor 

female nor non-binary nor two-spirit

(6) Number of individuals served who identify as transgender

Which of the following best represents how you self-identify? [Select ONE]

# of Consumers

(7) Number of individuals served who identify as lesbian or gay

(8) Number of individuals served who identify as straight, that is, not gay 

or lesbian

(9) Number of individuals served who identify as bisexual

(10) Number of individuals served who identify as two-spirit (among 

AIAN)

(11) Number of individuals served who use a different term [free-text]

(12) Number of individuals served who don’t know

(13) Number of individuals served who prefer not to answer

Section G – Race and Ethnicity

Indicate the number of consumers served in each category below. Each consumer may be 

counted under ONLY ONE of the following categories in the Program Performance Report, 

even if the consumer reported more than one race and/or Hispanic/Latino ethnicity).

This section reflects a new OMB directive. 

Please refer to the Instructions before completing.

# of Consumers

(1) American Indian or Alaska Native
14

(2) Asian 

(3) Black or African American

(4) Native Hawaiian or Other Pacific Islander

(5) White

(6) Hispanic/Latino of any race or Hispanic/ Latino only

(Other (Text Field)

(8) Race and ethnicity unknown

Section H – Disability

Indicate the number of consumers in each category below.

# of Consumers

(2) Mental/Emotional

(3) Physical

(4) Hearing

(5) Vision

(6) Multiple Disabilities

(7) Other

(1) Cognitive
15

SUBPART III – INDIVIDUAL SERVICES AND 

ACHIEVEMENTS FUNDED THROUGH TITLE VII, CHAPTER

1, PART B FUNDS

Sections 13 and 704(m)(4); 45 CFR 1329.12(a)(3–4); Government Performance Results Act 

(GPRA) Performance Measures

Subpart III contains new data requests. Please refer to the Instructions before completing.

Section A – Individual Services and Achievements

For the reporting year, indicate in the chart below how many consumers requested and received

each of the following IL services. Include all consumers who were provided services during the 

reporting year through Part B funds, either directly by DSE staff or via grants or contracts with 

other providers. Do not include consumers who were served by any centers that received Part

C funds during the reporting year.

Services

Consumers 

Requesting

Services

Consumers 

Receiving

Services

(A) Advocacy/Legal Services

(B) Assistive Technology 

(C) Children’s Services

(D) Communication Services

(E) Counseling and Related Services

(F) Family Services

(G) Housing, Home Modifications, and Shelter Services

(H) IL Skills Training and Life Skills Training 

(I) Information and Referral Services

(J) Mental Restoration Services

(K) Mobility Training 

(L) Peer Counseling Services

(M) Personal Assistance Services

(N) Physical Restoration Services

(O) Preventive Services
16

Services

Consumers 

Requesting

Services

Consumers 

Receiving

Services

(P) Prostheses, Orthotics, and Other Appliances

(Q) Recreational Services

(R) Rehabilitation Technology Services

(S) Therapeutic Treatment

(T) Transportation Services

(U) Youth/Transition Services

(V) Vocational Services

(W) Other Services

Section B – Increased Independence and Community Integration

Item 1 – Goals Related to Increased Independence in a Significant Life Area

Indicate the number of consumers who set goals related to the following significant life areas, the 

number whose goals are still in progress, and the number who achieved their goals as a result of 

the provision of IL services.

Significant Life Area Goals Set

Goals 

Achieved

In 

Progress

(A) Self-Advocacy/Self-Empowerment

(B) Communication

(C) Mobility/Transportation 

(D) Community-Based Living

(E) Educational

(F) Vocational

(G) Self-care

(H) Information Access/Technology

(I) Personal Resource Management
17

Significant Life Area Goals Set

Goals 

Achieved

In 

Progress

(J) Relocation from a Nursing Home or Institution 

to Community-Based Living

(K) Community/Social Participation

(L) Other (text field ‘Please describe)

Item 2 – Improved Access to Transportation, Health Care and Assistive Technology

(A) Table

In column one, indicate the number of consumers who required access to previously unavailable 

transportation, health care services, or assistive technology during the reporting year. Of the 

consumers listed in column one, indicate in column two, the number of consumers who, as a 

result of the provision of IL services (including the core services), achieved access to previously 

unavailable transportation, health care services, or assistive technology during the reporting year. 

In column three, list the number of consumers whose access to transportation, health care 

services or assistive technology is still in progress at the end of the reporting year. 

Areas

# of Consumers 

Requiring Access

# of Consumers 

Achieving Access

# of Consumers 

Whose Access is 

in Progress

(A) Transportation

(B) Health Care Services

(C) Assistive Technology

Note: For most IL services, a consumer’s access to previously unavailable transportation, health

care and assistive technology is documented through his or her CSR. In some instances, 

consumers may achieve an outcome solely through information and referral (I&R) services. To 

document these instances as successful outcomes, providers are not required to create CSRs for 

these consumers but must be able to document that follow-up contacts with these consumers 

showed access to previously unavailable transportation, health care and assistive technology.

(B) I&R Information

To inform ACL how many service providers engage in I&R follow-up contacts regarding access 

to transportation, health care services or assistive technology, please indicate the following:

The service provider did ___ / did not ___ engage in follow-up contacts with I & R 

recipients to document access gained to previously unavailable transportation, health care 

or assistive technology.
18
19

Section C – Additional Information Concerning Individual Services or 

Achievements

Please provide any additional description or explanation concerning individual services or 

achievements reported in subpart III, including outstanding success stories and/or major 

obstacles encountered.
20

SUBPART IV – OUTREACH AND COORDINATION

Section 704(i), (l), and (m)(4) of the Act; 45 CFR 1329.17(c)

Section A – Community Outreach

Item 1 – Outreach to Unserved or Underserved Table

In the table below, with respect to services and centers funded with Part B & C funds and 

included in the SPIL, summarize the community outreach activities to populations that are 

unserved or underserved during the reporting year. 

For each activity, identify the primary disability issue(s) addressed as well as the type of activity 

conducted. Indicate the entity(ies) primarily involved and the unserved/underserved group

identified in the activity. Describe the primary objective(s) and outcome(s) for each activity. 

Add more rows as necessary but aggregate where possible. 

Issue 

Area

Activity 

Type

Primary 

Entity

Targeted 

Unserved/Underserved 

Group Objective(s) Outcomes(s)

Item 2 – Description of Community Outreach Activities

For the community outreach activities mentioned above, provide any additional details such as

the role of the DSE, SILC, CIL, and/ornames of any partner organizations and further 

descriptions of the specific activities, services and benefits to unserved or underserved 

populations.

Section B – Working Relationships among Various Entities

Describe DSE and SILC activities to maximize the cooperation, coordination, and working

relationships among the independent living program, the SILC, and CILs; and the DSE, other 

state agencies represented on the SILC, other councils that address the needs of specific 

disability populations and unserved or underserved populations, and other public and private 

entities. Describe the expected or actual outcomes of these outreach activities.
21

SUBPART V – STATEWIDE INDEPENDENT LIVING COUNCIL 

(SILC)

Section 705 of the Act; 45 CFR Part 1329.14–16 

Section A - Composition and Appointment

Item 1 – Current SILC Composition

In the chart below, provide the requested information for each SILC member. The category in 

which the member was appointed can be described, for example, as ex-officio state agency 

representative, other state agency representative, center representative, person with a disability 

not employed by a center or state agency, section 121 funded project director, parent of person 

with a disability, community advocate, other service provider, etc. Include current vacancies, 

along with the corresponding appointment category for each. Add more rows as necessary.

Name of SILC

member

Individual 

with a 

Disability? 

(Yes/No)

Employed by CIL, 

State Agency or

Neither

Appointment 

Category 

Voting or 

Non-Voting

Term Start

Date

Term End 

Date
22

Section B – SILC Membership Qualifications

Section 705(b)(4) of the Act; 45 CFR 1329.14(a)

Item 1 – Statewide Representation

Describe how the SILC is composed of members who provide statewide representation.

Item 2 – Broad Range of Individuals with Disabilities from Diverse Backgrounds

Describe how the SILC members represent a board range of individuals with disabilities from

diverse backgrounds. 

Item 3 – Knowledgeable about IL

Describe how SILC members are knowledgeable about centers for independent living and 

independent living services.
23

Section C – SILC Staffing and Support

Item 1 – SILC Staff

Please provide the name and contact information for the SILC executive director. Indicate the 

number and titles of any other SILC staff, if applicable. Also indicate whether any SILC staff is 

also a state agency employee.

Item 2 – SILC Support

Describe the administrative support services provided by the DSE, if any.

Section D – SILC Duties

Section 705(c); 45 CFR 1329.15

Item 1 – SILC Duties

Provide a summary of SILC activities conducted during the reporting year related to the SILC’s 

duties listed below:

(A) State Plan Development or Amendment

Describe any activities related to the joint development or amendment of the state plan. Include 

any activities in preparation for developing/modifying the state plan, such as needs assessments, 

evaluations of consumer satisfaction, hearings and forums. 

(B) Monitor, Review and Evaluate the Implementation of the State Plan

Describe any activities related to the monitoring, review and evaluation of the implementation of 

the state plan. 

(C) Coordination with Other Disability Councils

Describe the SILC’s coordination of activities with the State Rehabilitation Council (SRC) 

established under section 105, if the state has such a Council, or the commission described in 

section 101(a)(21)(A), if the state has such a commission, and councils that address the needs of 

specific disability populations and issues under other Federal law. Please state whether the SILC 

has at least one representative serving as a member of the SRC and whether the SILC has any 

members serving on other councils, boards or commissions in the state.
24

(D) Public Meeting Requirements

Describe how the SILC has ensured that all regularly scheduled board and committee meetings 

and other public hearings and forums hosted by the SILC are open and accessible to the public 

and sufficient advance notice is provided.

Item 2 – Other Activities

Describe any other SILC activities funded by non-Part B funds. For example, DSE and or SILC 

staff may be providing I&R in the form of referrals. Please explain how I&R is provided by DSE 

or SILC, if applicable. Include numbers if available.

Section E – Training and Technical Assistance Needs

Section 721(b)(3) of the Act 

Please identify the SILC’s training and technical assistance needs. The needs identified in this

chart will guide the priorities set by ACL for the training and technical assistance provided to 

CILs and SILCs. 

Training and Technical Assistance Needs

Choose up to 10 

Priority Needs —

Rate items 1–10 

with 1 being most 

important

Advocacy/Leadership Development

General Overview

Community/Grassroots Organizing

Individual Empowerment

Systems Advocacy

Legislative Process

Applicable Laws

General overview and promulgation of various disability laws

Americans with Disabilities Act

Air-Carrier’s Access Act

Fair Housing Act

Individuals with Disabilities Education Improvement Act

Medicaid/Medicare/PAS/waivers/long-term care

Rehabilitation Act of 1973, as amended

Social Security Act

Workforce Investment Act of 1998
25

Training and Technical Assistance Needs

Choose up to 10 

Priority Needs —

Rate items 1–10 

with 1 being most 

important

Ticket to Work and Work Incentives Improvement Act of 1999

Government Performance Results Act of 1993

Assistive Technologies

General Overview

Data Collecting and Reporting 

General Overview

704 Reports

Performance Measures contained in Program Performance Report

Dual Reporting Requirements

Case Service Record Documentation

Disability Awareness and Information

Specific Issues

Evaluation

General Overview

CIL Standards and Indicators

Community Needs Assessment

Consumer Satisfaction Surveys

Focus Groups

Outcome Measures

Financial: Grant Management

General Overview 

Federal Regulations

Budgeting

Fund Accounting

Financial: Resource Development

General Overview 

Diversification of Funding Base

Fee-for-Service Approaches

For Profit Subsidiaries

Fund-Raising Events of Statewide Campaigns

Grant Writing
26

Training and Technical Assistance Needs

Choose up to 10 

Priority Needs —

Rate items 1–10 

with 1 being most 

important

Independent Living Philosophy

General Overview

Innovative Programs

Best Practices

Specific Examples

Management Information Systems

Computer Skills

Software

Marketing and Public Relations

General Overview

Presentation/Workshop Skills

Community Awareness

Networking Strategies

General Overview

Electronic

Among CILs & SILCs

Community Partners

Program Planning

General Overview of Program Management and Staff Development

CIL Executive Directorship Skills Building

Conflict Management and Alternative Dispute Resolution

First-Line CIL Supervisor Skills Building

IL Skills Modules

Peer Mentoring

Program Design

Time Management

Team Building
27

Training and Technical Assistance Needs

Choose up to 10 

Priority Needs —

Rate items 1–10 

with 1 being most 

important

Outreach to Unserved/Underserved Populations

General Overview

Disability 

Minority 

Institutionalized Potential Consumers

Rural 

Urban 

SILC Roles/Relationship to CILs

General Overview

Development of State Plan for Independent Living

Implementation (monitor & review) of SPIL

Public Meetings

Role and Responsibilities of Executive Board

Role and Responsibilities of General Members

Collaborations with In-State Stakeholders

CIL Board of Directors

General Overview

Roles and Responsibilities

Policy Development

Recruiting/Increasing Involvement

Volunteer Programs

General Overview

Optional Areas and/or Comments (write-in)
28

SUBPART VI – STATE PLAN FOR INDEPENDENT LIVING 

(SPIL) COMPARISON AND UPDATES, OTHER 

ACCOMPLISHMENTS AND CHALLENGES OF THE 

REPORTING YEAR

Section 704(n) of the Act

Section A – Comparison of Reporting Year Activities with the SPIL

Item 1 – Progress in Achieving Objectives and Goals

Describe progress made in achieving the objectives and goals outlined in the most recently

approved SPIL. Discuss goals achieved and/or in progress as well as barriers encountered.

Item 2 – SPIL Information Updates

If applicable, describe any changes to the information contained in the SPIL that occurred during

the reporting year, including the placement, legal status, membership or autonomy of the SILC; 

the SILC resource plan, the design of the statewide network of centers; and the DSE 

administration of the ILS program.

Section B– Significant Activities and Accomplishments

If applicable, describe any significant activities and accomplishments achieved by the DSE and 

SILC not included elsewhere in the report, e.g. brief summaries of innovative practices,

improved service delivery to consumers, etc.

Section C – Substantial Challenges

If applicable, describe any substantial problems encountered by the DSE and SILC, not included 

elsewhere in this report, and discuss resolutions/attempted resolutions, e.g., difficulty in outreach 

efforts; disagreements between the SILC and the DSE; complications recruiting SILC members; 

complications working with other state agencies or organizations within the state.

Section D – Additional Information

Include any additional information, suggestions, comments or explanations not included 

elsewhere in the report.
29

SUBPART VII - SIGNATURES

Please sign and print the names, titles and telephone numbers of the DSE directors(s) and SILC

chairperson.

SIGNATURE OF SILC CHAIRPERSON DATE

NAME AND TITLE OF SILC CHAIRPERSON PHONE NUMBER

SIGNATURE OF DSE DIRECTOR DATE

NAME AND TITLE OF DSE DIRECTOR PHONE NUMBER