### Annual Client **Assistance Program (CAP) Report (Form RSA**  **- 227)**  **Instructions 1.**  **Heading Fiscal Year:**  Enter the fiscal y ear covered by this report. **Agency Contact Information:** Enter the name, address, fax and telephone numbers (including area codes), and e mail address of the agency designated to administer the CAP. Be sure to include the same information for the operating CAP agency, if different from the designated agency . Also include the name of the CAP Director/Coordinator. **Person to contact about this form:**  Print/ty pe 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 an y individual with disabilities in the State or to Rehabilitation Act clients or client applicants who have not been defined as " individual s 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 identifying information about the individuals who ask for and rec eive 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 b y 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 ; and3) 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 an y al lowable 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 leas t 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 exi sting case file/service record. **3. PART I**  **. Non -**  **Case Services A**  **. Information/referral Services:**  In clude 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 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. In formation/refe rral 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 giv en b y C AP. Summarize these activitiesin 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 b y CAP 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 section of this report. **Line A1:** Enter the number of requests CAP respond ed 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 a bout 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 b y CAP during the fiscal ye ar. **B. Training Activities**  **:** A training session can take many forms, including in

- person sessions and distance learning sessions (i.e., tel econference 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

c onference. In answering questions B1 and B2, please count each discrete session as one training sessi on.

 **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 c onference. F ollowing a full

- morning plenary

s ession 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 b y staff.**Line B2** : Enter number of individuals who attended training sessio ns (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 o utreach**  Id entify 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 ho w 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 yo ur ag ency

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 b y agency staff. **Line D2** . Enter number of articles about CAP featured in newspaper/magazine/journal s . **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 an y 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 a gency by**  **external m edia**  **c overage**  **:** 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 y ear. This narrative information should be included under the category

that is most appropriate. If there is no information to report, ty pe 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 ser ved" 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 i ntervention (even if it is only brief) with 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 opened/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 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 f iles/service records on hand at the beginning of the fiscal ye ar, 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+A 2 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 4:** Of the number of individuals accounted for on L ine A 3, 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/serv ice 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 in dividual would be counted on L ine A 4 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 A 4.**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 opene d for this individual to address these new issues. This individual would not be counted on L ine A 4. 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 A 4. **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 L ine A 3. This number will equal the "number of individuals with open case files/service records on hand as of October 1" (Line A 1) on next fiscal y ear'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 L ine A3

. **Line B1:** 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 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 whe n 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 in cludedon L ine B 3. **Line B3:** 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 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 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 the quantity , qualit y, and/or expediency

of the services received under the Act. Howeve r, if the basic cause of such delay s or denials is a problem of the individual's eligibility , this problem should be recorded on Li ne B4 . Individuals served who had conflicts related to employ ment goals or informed choice should be included on L ine B5

. **L ine B4:**  Enter the number of individuals served who have concerns involving such issues as the application process, ineligibility determinations, delay s 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 emplo ym ent 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 appropriatel y 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 merel y asked for information about their rights under Title I of the ADA. Those individuals served should be accounted for on line.**C .**  **Intervention S trategies 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 t ype of service during the course of the CAP/client relationship. However, cho ose **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 w as 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/servi ce 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 A 4, when an individual had multiple case files/service records closed during the fis cal ye ar. However, no line may exceed the total on L ine A 3 . 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 individual shoul d 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 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 p roceeding. 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 C1:** Enter the number case files/service records closed in which the highest

level CAP service provided to the individual served was sho rt 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 in dividuals 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 asrights provided under Title Iof the ADA, or resulted in a referral to another source for servi ces. **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

- advoca cy . 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 eng aged 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 employ er 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 emplo ye r. 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 part y mutual ly 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. **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 progr am 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 C 1 above. **Line C6:** Enter the number of case files/service records clos ed 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 b y impartial hearing officers and State Directors/Fai r 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 sy stem to resolvethe 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 a ppropriate) 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 h as 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 unusua l situations, referred to in Line B 4 , when an individual had multiple 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 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 onl y 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 individu al'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. F or 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 se rved did not prevail at the formal administrative hearingand 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 unavai lable for continued representation by

CAP. **Line D9:** Enter the number of case files closed because the individual is non

responsive or uncooperative , CAP is unable to continue effective representation. Some of the reasons might have been that the individ ual 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 yo u use this response. **E .**  **Results achieved for individ uals:**  "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 indi vidual 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 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 ( Part II, Line A 3) in order to account for tho se unusual situations, referred to in Part II, Line A 4, when an individual had multiple case files/service records closed during the fiscal ye ar. Estimated counts are not acceptable. CAPs shouldmaintain records to respond accuratel y 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 le gal 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 whe re 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 employ

ment 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 empl oy er (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 basicall y resolved most of the individual's issues/prob lems. **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 co uld 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 onl y once during a fiscal ye ar. 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 as of the beginning of the fiscal y ear. No individual can be counted mor e than once. The total recorded on Part III, Line A6 must equal the total recorded on Part II, Line A 3. **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, Li ne A 3. **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/ethnicit y 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 individual s 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 lin e should rarel y be used. **D. Primary Disabling Condition of Individuals served:**  **Guidelines:** Report information about the primary d isability

o f the individuals served by the agency

under CAP. The primary disability , for purposes of this report, is the ind ividual's disability that is directly

r elated 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 ye ar. **Example 1:**  An individual is deaf and also has an orthopedi c impairment that requires the use of a wheelchair. T he individual came to the agency b ecause the local VR is inaccessible for wheelchair

- users. T he agency s hould 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

c omplaining that the count y hosp ital 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 orthope dic 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 hy

peractivity

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

v irus (HIV), regardless of whether the individual is sy mptomatic or as ymptomatic.**D .4**  **:** Enter the number of individuals served who are lacking an extremity o r 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 :**  Ent er 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 ey eglasses), are legall y blind in both ey es. **D. 10**  **:** Enter the number of individuals served with visual impairments other than blindness in both ey es (E6). **D .**  **11 :**  Enter the number of individuals served who have cancer. **D.1 2**  **:** Enter the number of individuals served who have cerebral pals y. **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. T hese 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 ser ved who have digestive disorders (e.g. Irritable Bowel S yndrome). **D.18 :**  Enter the number of individuals served who have epileps y. **D.19 :**  Enter the number of individuals served who have a cardiac or other circulatory

s ys tem impairment or condition

. **D .**  **2 0**  **:** E nter 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 specificall y covered by another category. **D .2**  **2 :**  Enter the number of individuals served who have multiple sclerosis.**D.23 :**  Enter the number of individuals served who have muscular dys trophy

. **D.24 :**  Enter the number of individuals served with any f orm of muscular or skeletal impairment not specificall y covered b y another category

. **D .2**  **5 :**  Enter the number of individuals served with any f orm of neurological disorder or impairment not specificall y covered by another category
. T his total should include individuals affected b y strokes and Acquired Brain Injury (ABI). **D.26 :**  Enter the number of individuals served who have an orthopedic impairment. T hese individuals may b e paral yzed, or may

h ave 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 di sorder

. **D .2**  **8 :**  Enter the number of individuals served who have a respiratory s ys tem 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, lary ngectomies, stuttering, etc. **D.32 :**  Enter the number of individuals served with spina bifida. **D.3 3**  **:** 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 oth er 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 Act ivities**  **: Line 1**  : Provide the number of non

- litigation sy stemic 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 ye ar. **Line 2:** Describe each non - litigation sy stemic activity completed during the fiscal year
. In clude information describing (a) the activity undertaken, (b) the policy or practice that changed as a result of your agency’s non

- litigation sy stemicactivity , and ( c ) the manner in which this change benefited individuals with disabilities. **B. Systemic**  **Litigation Activities**  **: Line 1**  : Provide the t otal number of CAP cases requiring litigation with the potential for sy stemic change during the fiscal year . **Line 1.a** : Provide the number of cases that required litigation filed during the current fiscal ye ar. **Line 1.b** : Provide the number of cases requiring litigation that were pending at start of fiscal ye ar (carryover from prior y ear)

. **Line 1.c** : Provide the number of cases closed during reporting fiscal ye ar requiring litigation. **Line 2** : Describe the agency ’s on

- going and completed sy stemic 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 negativel y affected, and (c) the potential benefit to individuals with disabilities. If pos sible, (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**  : I dentify

the t ype of agency designate d as the CAP. Choose only one option from L ine 1.a through Line 1.e. **Line 2** : I dentify

the name of the designated agency for CAP. **Line 3** : I dentify

whether the designated agency for CAP is contracting the operation of CAP services (y es or no). **Line 4** : I f “y es” was selected in L ine A.3, identify the agency operating the CAP. **B. Number of person**  **- years**  **:** Id entify the number of person

- years staffing CAP this reporting fiscal ye ar. "Person

- ye ars" refer to the actual time that positions (both professional and c lerical) were filled during the period covered b y this annual report. If a position was filled throughout the y ear, it counts as one person

- ye ar. 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 paidtotally 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

- ti me 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 ye ar. Summarize the facts of the case and the activities that CAP undertook or is undertaking to res olve the issues raised by the individual served. Explain whether the case raised s ys temic 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 day s of the end of the fiscal ye ar 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 followi ng e - mail ad dress Jim.Doyle@ed.gov or at 202

- 245

- 6630.