Annual Client Assistance Program (CAP) Report 

(Form RSA-227) Instructions

1. Heading

Fiscal Year:

Enter the fiscal year covered by this report.

Agency Contact Information:

Enter the name, address, fax and telephone numbers (including area codes), and email 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 telephone number 

of the person RSA can contact regarding this form.

2. Definitions

Definitional Guidelines for completing this form:

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

(Rehabilitation 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 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.

3. PART I. Non-Case Services

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.

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.

B. Training Activities:

A training session can take many forms, including in-person sessions and distance 

learning sessions (i.e., teleconference training or web-based training). It could 

include a very short presentation of 30 minutes or less, or might involve a full-day 

or multi-day conference. In answering questions B1 and B2, please count each 

discrete session as one training session.

 First Example: The CAP presents a daylong program on self advocacy. 

Three different funding sources are covered, but this is all one coordinated 

session. Under B1, this counts as one training session; under B2, the 

participants are also counted once.

 Second Example: The CAP delivers a two-day conference. Following a 

full-morning plenary session for all 150-conference attendees, the 

remainder of the conference is divided into four concurrent tracks or 

breakout sessions, allowing for 20 additional sessions over the remainder 

of the conference. Despite the much larger scope of this second event, the 

full conference should count as one training session under B1 and 150 

should be entered once under B2. NOTE: The CAP can explain the larger 

scope of this second event as a narrative example under B3.

Line B1: Enter the number of training sessions presented by staff.
Line B2: Enter number of individuals who attended training sessions (e.g., 

orientation sessions, self-advocacy training, etc.) conducted by CAP staff. 

Line B3: Describe the training events presented by the staff. Include; (a) topics 

covered, (b) the purpose of the training, and (c) a description of the attendees.

C. Agency outreach

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. 

D. Information disseminated to the public by your agency: 

For each method of dissemination, enter the total number of each method used by 

your agency during the reporting period to distribute information to the public. 

For publications/booklets/brochures (item 4), enter the total number of documents 

produced. 

Line D1. Enter number of radio and TV appearances by agency staff.

Line D2. Enter number of articles about CAP featured in 

newspaper/magazine/journals.

Line D3. Enter number of PSAs / videos aired by the agency.

Line D4. Enter number of publications/booklets/brochures disseminated by the 

agency.

Line D5. Enter the number of times CAP staff exhibited at a conference, 

community fair or similar public event. 

Line D6. Enter any other types of information dissemination not mention above 

that the agency has been involved in. Please note: Website hits are not to be 

considered under this category. 

E. Information disseminated about your agency by external media coverage:

The activities of a CAP program or the services available through the CAP 

program often are reported by the radio, TV, or print media, for example, with or 

without the encouragement of the CAP. Where it is available, enter narrative 

information regarding any external media that provided coverage of the agency’s 

activities during the fiscal year. This narrative information should be included

under the category that is most appropriate. If there is no information to report, 

type in ‘N/A’ or ‘not applicable’.
4. PART II. Individual Case Services

A. 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. 

Line 1: 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 2: Enter the number of individuals who had new case files/service records 

opened during this fiscal year.

Line 3: Add lines A1+A2 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 4: Of the number of individuals accounted for on Line A3, 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: 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 A4 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 A4.
Example B: 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 A4. 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 A4.

Line 5: 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 

individuals served listed on Line A3. This number will equal the "number of 

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

A1) on next fiscal year's annual report.

B. 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 A3.

Line B1: 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 B2: 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.

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 B3.

Line B3: 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 B4. Individuals served who had conflicts related to 

employment goals or informed choice should be included on Line B5.

Line B4: 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 B5: 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 B6: 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 B7: Enter the number of individuals served who had problems or concerns 

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

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 B8: 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 

under Title I of the ADA. Those individuals served should be accounted for on 

line.
C. Intervention Strategies for Closed Cases:

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 A3). In order to account for those unusual situations, referred to in 

Line A4, when an individual had multiple case files/service records closed during 

the fiscal year. However, no line may exceed the total on Line A3. 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 C1: Enter the number case files/service records closed in which the highestlevel CAP service provided to the individual served was short term technical

assistance beyond what is defined as information/referral (I&R) services in Part I, 

Section A. Short term technical assistance services can include a 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 that would assist the individual in self-advocacy, as well as 
rights provided under Title I of the ADA, or resulted in a referral to another 

source for services.

Line C2: Enter the number of case files/service records closed in which the 

highest level of CAP services provided to the individual served fits into 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 C3: 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 C4: 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 that 

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.

Line C5: 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 C1 above.

Line C6: 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.

Line C7: 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 C8: Enter the total number here

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 A3) in order to account for those unusual 

situations, referred to in Line 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 request the complaint be withdrawn or refused further CAP services.

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 

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 is nonresponsive or uncooperative, CAP is unable 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. Provide additional 

information below.

Line D11: Enter the number of cases closed because of a conflict of interest. 

Provide further details below.

Line D12: 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 

(Part II, Line A3) in order to account for those unusual situations, referred to in 

Part II, Line A4, 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.

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. This would 

include resolution or implementation of services identified under an IPE or the 

individual’s employment goal.

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 

others not encompassed in this listing. This response should be reserved for rare 

instances. Be sure to provide an explanation of the outcomes achieved if you use 

this response.

5. PART III. Program Data

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 Part III, Line A6 must equal the 

total recorded on Part II, Line A3.

B. Gender:

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

an individual more than once. The total recorded on Part III, Line B3 must equal 

the total recorded on Part II, Line A3.

C. Race and Ethnicity of Individuals Served:

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.
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:

Guidelines: Report information about the primary disability of the individuals 

served by the agency under CAP. The primary disability, for purposes of this 

report, is the individual's disability that is directly related to the issues or 

complaints raised by the primary complaint of the individual served. Do not count 

an individual more than once during a fiscal year.

Example 1: An individual is deaf and also has an orthopedic impairment that 

requires the use of a wheelchair. The individual came to the agency because the 

local VR is inaccessible for wheelchair-users. The agency should report this 

individual under orthopedic impairment (D.25) because the issue raised focuses 

on building accessibility problems. The fact that the individual also is deaf (D.11) 

is not relevant to this particular complaint.

Example 2: If an individual with the same disabilities described above came to 

the agency complaining that the county hospital refused to provide an interpreter 

to explain the diagnostic testing she was to undergo, the agency should report this 

individual under deafness (D.11) because the issue dealt with interpreter services. 

The fact that the individual also has an orthopedic impairment is not relevant to 

this particular complaint.

D.1: Enter the number of individuals served who was diagnosed with an acquired 

brain injury.

D.2: Enter the number of individuals served who have Attention Deficit Disorder 

with or without hyperactivity.

D.3: Enter the number of individuals served who are infected with the human 

immunodeficiency virus (HIV), regardless of whether the individual is 

symptomatic or asymptomatic.
D.4: Enter the number of individuals served who are lacking an extremity or 

multiple extremities.

D.5: Enter the number of individuals served who are afflicted with arthritis or 

rheumatism.

D.6: Enter the number of individuals served who have been diagnosed with a 

specified or nonspecific anxiety disorder.

D.7: Enter the number of individuals served who have autism or autism spectrum 

disorder.

D.8: Enter the number of individuals served who are afflicted with an

autoimmune disorder or immune deficiency (e.g. Crohn’s Disease).

D.9: Enter the numbers of individuals served who, with best correction (i.e., with 

eyeglasses), are legally blind in both eyes.

D.10: Enter the number of individuals served with visual impairments other than 

blindness in both eyes (E6).

D.11: Enter the number of individuals served who have cancer.

D.12: Enter the number of individuals served who have cerebral palsy.

D.13: Enter the number of individuals served who are deaf.

D.14: Enter the number of individuals served who are hard-of-hearing or hearing 

impaired but are not deaf (E.10).

D.15: Enter the number of individuals served who are deaf-blind. These 

individuals meet the criteria for both deafness (E.10) and blindness (E.6).

D.16: Enter the number of individuals served who have diabetes.

D.17: Enter the number of individuals served who have digestive disorders (e.g. 

Irritable Bowel Syndrome).

D.18: Enter the number of individuals served who have epilepsy.

D.19: Enter the number of individuals served who have a cardiac or other 

circulatory system impairment or condition.

D.20: Enter the number of individuals served who have an intellectual disability.

D.21: Enter the number of individuals served who have a mental illness that is 

not specifically covered by another category.

D.22: Enter the number of individuals served who have multiple sclerosis.
D.23: Enter the number of individuals served who have muscular dystrophy.

D.24: Enter the number of individuals served with any form of muscular or 

skeletal impairment not specifically covered by another category.

D.25: Enter the number of individuals served with any form of neurological 

disorder or impairment not specifically covered by another category. This total 

should include individuals affected by strokes and Acquired Brain Injury (ABI).

D.26: Enter the number of individuals served who have an orthopedic 

impairment. These individuals may be paralyzed, or may have some other 

functional impairment involving the limbs, digits, trunk, back or spine.

D.27: Enter the number of individuals served who have a diagnosed personality

disorder.

D.28: Enter the number of individuals served who have a respiratory system 

disorder or impairment.

D.29: Enter the number of individuals served who have a skin condition.

D.30: Enter the number of individuals served with a specific learning disability 

(not including mental retardation (E.19)).

D.31: Enter the number of individuals served with speech impairments, such as 

cleft palate and harelip with speech imperfections, laryngectomies, stuttering, etc.

D.32: Enter the number of individuals served with spina bifida.

D.33: Enter the number of individuals served who have substance abuse 

conditions (i.e., current or former alcohol and/or drug addictions).

D.34: Enter the number of individuals served who have other impairments or 

disabling diseases or conditions that are not covered by the above categories.

D.35: Total (Line D.1 through Line D34; must equal total from Part II, Line A3)

6. PART IV. Systemic Activities and Litigation

A. Non-litigation Systemic Activities:

Line 1: Provide the number of non-litigation systemic activities that resulted in 

the change of one or more policy or practice of an agency. This activity must be 

completed in the current fiscal year, but may have been initiated in a prior fiscal

year. 

Line 2: Describe each non-litigation systemic activity completed during the 

fiscal year. Include information describing (a) the activity undertaken, (b) the 

policy or practice that changed as a result of your agency’s non-litigation systemic 
activity, and (c) the manner in which this change benefited individuals with 

disabilities.

B. Systemic Litigation Activities:

Line 1: Provide the total number of CAP cases requiring litigation with the 

potential for systemic change during the fiscal year.

Line 1.a: Provide the number of cases that required litigation filed during 

the current fiscal year.

Line 1.b: Provide the number of cases requiring litigation that were pending 

at start of fiscal year (carryover from prior year).

Line 1.c: Provide the number of cases closed during reporting fiscal year

requiring litigation.

Line 2: Describe the agency’s on-going and completed systemic non-class action 

litigation activities requiring individual representation. Using a case example that 

demonstrates the potential impact of the agency’s non-class action activities, 

explain (a) the issue that prompted the litigation, (b) how individuals with 

disabilities were being negatively affected, and (c) the potential benefit to 

individuals with disabilities. If possible, (d) estimate the number of individuals 

potentially affected by changes resulting from the litigation and (e) the method 

used to determine this estimate.

7. PART V. Agency Information

A. Agency Type: 

Line 1: Identify the type of agency designated as the CAP. Choose only one 

option from Line 1.a through Line 1.e.

Line 2: Identify the name of the designated agency for CAP.

Line 3: Identify whether the designated agency for CAP is contracting the 

operation of CAP services (yes or no).

Line 4: If “yes” was selected in Line A.3, identify the agency operating the CAP.

B. Number of person-years:

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

"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. 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.

8. PART VI. Case Examples

A. 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 policy-making issues and CAP's plan 

to address those issues.

9. PART VII. End of Form:

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

year covered.

A. Electronic reporting:

Agencies should submit the RSA-227 report through RSA’s website: rsa.ed.gov.

A user name and password and information on entering the report through RSA’s 

website can be obtained by clicking the link “Info for new users” at the URL 

listed above.

For alternative methods to submit the RSA-227 report, please contact Jim Doyle 

at the following e-mail address Jim.Doyle@ed.gov or at 202-245-6630.