1820-0664

Expires xx/xx/xxxx

State Grants for Assistive Technology Program

State Plan for Assistive Technology

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection 

of information unless such collection displays a valid OMB control number. Public reporting burden for 

this collection of information is estimated to average 74 hours per response, including time for 

reviewing instructions, searching existing data sources, gathering and maintaining the data needed, 

and completing and reviewing the collection of information. The obligation to respond to this 

collection is required to obtain or retain benefits (Assistive Technology Act of 1998, as amended,

Sec. 4, Pub. L. 108-364; 34 CFR 76.102). Send comments regarding the burden estimate or any 

other aspect of this collection of information, including suggestions for reducing this burden, to the 

U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email 

ICDocketMgr@ed.gov and reference the OMB Control Number 1820-0664. Note: Please do not return 

the completed State Plan for Assistive Technology form to this address.
1820-0664

Expires xx/xx/xxxx

2

Instructions

Section 4 of the Assistive Technology Act of 1998, as amended (AT Act) establishes grants to 

states to support comprehensive statewide programs (Statewide AT Programs) that conduct 

activities that improve access to and acquisition of AT devices and services for individuals with 

disabilities across the human lifespan and across a wide array of disabilities, and their family 

members, guardians, advocates, and authorized representatives. 

Section 4(d)(1) of the AT Act requires that states submit an application to the Rehabilitation 

Services Administration (RSA) to receive a grant. RSA calls the application a State Plan for 

Assistive Technology (State Plan for AT or State Plan). This document provides the 

instructions for completing the State Plan that covers the activities of Statewide AT Programs 

for Federal fiscal years 2012 (October 1, 2011 to September 30, 2012), 2013 (October 1, 2012 

to September 30, 2013), and 2014 (October 1, 2013 to September 30, 2014).

The State Plan for AT must be developed, prepared, and submitted with the advice of the state’s 

Advisory Council by the Lead Agency designated by the Governor to carry out the Statewide 

AT Program. If an Implementing Entity carries out the Statewide AT Program rather than the 

Lead Agency, the State Plan for AT can be jointly developed and prepared by the Lead Agency

and Implementing Entity with the advice of the state’s Advisory Council, though the State Plan 

must be submitted by the Lead Agency. The Certifying Representative for the Lead Agency

must sign the plan.1 

 

The State Plan describes how the state will conduct its Statewide AT Program during the period 

covered by the plan. The plan is reviewed by RSA to ensure that it conforms with the 

instructions in this document and the requirements of the AT Act. RSA may work with the 

state to adjust the State Plan in order to make the plan approvable. 

If RSA determines that the State Plan for AT is not approvable, RSA will attempt to resolve the 

disputed issues after providing the appropriate technical assistance to the state. If no resolution 

has been reached after reasonable efforts, RSA will provide an opportunity for a hearing in 

accordance with 34 CFR part 76.202 before the State Plan for AT is disapproved.

The State Plan for AT must be amended during the three-year period of the plan if RSA 

determines that an amendment is essential, such as in the case of a material change in state law, 

organization, policy or agency operations affecting the information, assurances, or 

administration of the plan. The state must change or update its plan as needed to ensure the 

information contained in it accurately reflects the state’s activities. States should note that the 

content of the State Plan directly correlates to requirements for reporting annual data to RSA. 

The instructions contain frequent reminders that “. . . you are required to provide annual data 

for any activity claimed in this State Plan.” This is a reference to the annual data submitted in 

 

1

The Certifying Representative will sign the plan via electronic signature. A paper follow-up will not be required. 
1820-0664

Expires xx/xx/xxxx

3

the “Annual Report for State Grant for Assistive Technology Programs,” OMB #1820-0572. 

For State-level Activities (as explained below), this includes the performance measures featured 

in Section H of this State Plan.

When RSA reviews your annual report, it will use the most recent version of your State Plan for 

AT as a reference. Therefore, it is recommended that the state periodically review its State Plan 

to determine whether changes are necessary. The need for changes must be communicated to 

RSA and RSA will approve changes in the same manner it approves the initial submission of 

the Plan. 

Paper submissions of the State Plan for AT are neither required nor accepted. States will 

submit plans using RSA’s Management Information System (MIS). RSA plans to host training 

on use of the MIS and will send information about this training to all Statewide AT Programs 

via e-mail. Visit the following website to access the MIS: http://rsa.ed.gov. 

 

Only individuals with user identification (ID) and passwords can enter data into the MIS. Visit 

the website address above and select the “Info for New Users” link on the left side of the screen 

to obtain a user ID and password. Follow the instructions provided on the “Info for New 

Users” page. RSA recommends that states initiate the process for obtaining user IDs and 

passwords well in advance of the need to enter data into the MIS. 

Once you have received a user ID and password and log into the system, select “Data Entry.” 

Then select your state from the drop-down menu and scroll down the table to the row labeled 

“SGAT.” In that row, you will check the box next to “SPAT.” Then scroll to the bottom of the 

page and select “View Information.”

On the next screen, information about your state should appear, with two buttons on the right 

side of the screen: “View” and “Add/Update.” Select “Add/Update” to open your State Plan. 

The State Plan is completed by entering information into text boxes, making selections from 

drop-down menus, and use of “check boxes.” The format cannot account for every variable in 

how states conduct their programs. Therefore, a state should select its answers based on the 

responses that are the most accurate and best describe how the Statewide AT Program operates, 

even if the description is not exact. In almost all cases, there is an opportunity to clarify using 

an open-ended text box. A state need not provide information related to activities it does not 

conduct, but must respond to every item for activities it does conduct.2

The instructions in this document mirror the screens presented in the MIS. The MIS does not 

contain instructions, however, so states will need this document when completing the State Plan 

online.

 

2 Responding is at the discretion of the state when given the opportunity to provide “additional information,” 

however. 
1820-0664

Expires xx/xx/xxxx

4

For assistance with completing a plan, contact Robert Groenendaal at (202) 245-7393 or 

Robert.Groenendaal@ed.gov. For technical support on use of the MIS, contact Ken 

Schellenberg at (202) 245-6589 or Ken.Schellenberg@ed.gov. 
1820-0664

Expires xx/xx/xxxx

5

Assistive Technology State Grant 

Program 

State Plan for FY 2009-2011

Table of Contents

Screen 1 A Identification and Description of Lead Agency and Implementing Entity;

Change in Lead Agency or Implementing Entity

Screen 2 B Advisory Council, Budget Allocations, and Identification of Activities

Conducted

C State Financing Activities

Screen 3 Financial loan program 

Screen 4 Access to telework loan fund

Screen 5 Cooperative buying program 

Screen 6 Financing for home modifications program 

Screen 7 Telecommunications distribution program 

Screen 8 Last resort program 

Screen 9 Other program

D Device Reutilization Activities

Screen 10 Device exchange 

Screen 11 Device reassignment

Screen 12 E Device Loan Activity

Screen 13 F Device Demonstration Activity

G State Leadership Activities

Screen 14 Training Activities

Screen 15 Technical Assistance Activities

Screen 16 Public Awareness Activities

Screen 17 Information and Assistance Activities

Screen 18 H Assurances, Measurable Goals and Signatures
1820-0664

Expires xx/xx/xxxx

6

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section A. Identification and Description of

Lead Agency and Implementing Entity; 

Change in Lead Agency or Implementing 

Entity

Section 4(d)(2) of the AT Act requires that the State Plan contain information identifying and 

describing the Lead Agency and Implementing Entity (if applicable) designated by the state’s 

governor. If there is an Implementing Entity, section 4(d)(4)(B) requires that the State Plan 

include a description of the mechanisms established to ensure coordination of activities and 

collaboration between the Implementing Entity and the Lead Agency. If the governor chooses 

to re-designate the Lead Agency or Implementing Entity, section 4(c)(1)(C) requires that good 

cause for this change be shown in the State Plan, including why that previously designated 

agency or entity no longer should serve. If the Lead Agency or Implementing Entity is 

changing, the information provided in this State Plan should pertain to how the new agency or 

entity will conduct the Statewide AT Program. The following items are intended to satisfy the 

requirements just described. 

1. Name Given to Statewide AT Program. [Text box]

Instructions: Most Statewide AT Programs have a name for common usage and easy

recognition within the state. For example, the Statewide AT Program may be designated as 

the “Consumer Access to Technology” or CAT program. Provide this title in the text box, 

as well as the preferred acronym in parentheses if an acronym is used. 

2. Website dedicated to Statewide AT Program. [Text box]

Instructions: Provide in the text box the link that allows direct access to the website 

dedicated to your Statewide AT Program, not the general website of the Lead Agency or 

Implementing Entity (unless the Implementing entity exists solely to serve as the Statewide 

AT Program). Enter N/A if there is no website dedicated to your Statewide AT Program.

3. Name and Address of Lead Agency. [Text box]

Instructions: In the text box, provide complete contact information for the Lead Agency. 

This information will be used to print address labels for correspondence sent to your 

program, so enter the mailing address to which you want correspondence sent, not the 
1820-0664

Expires xx/xx/xxxx

7

physical address (if different). Separate address items such as building names, street names, 

and box numbers, as applicable. The state can be an abbreviation, but include a 9-digit zip 

code. 

Follow the organizational chart for the Lead Agency from its highest level to the division of 

the agency directly responsible for implementation of the Statewide AT Program. Enter the 

full name of the agency and its divisions as they would be referred to in formal 

communication, without abbreviations. For example, if the Governor has designated the 

Department of Disabilities as the Lead Agency, within which there is an Office of 

Employment and Community Living, within which there is a Bureau of Vocational 

Rehabilitation that administers the Statewide AT Program:

Department of Disabilities

Office of Employment and Community Living

Bureau of Vocational Rehabilitation

Administration Building

200 Government Way

Suite 1951, Box 22

Anywhere, WU 77666-5544

4. Name, Title, and Contact Information for Lead Agency Certifying Representative. [Text 

box]

Instructions: Every grant recipient must appoint a certifying representative that is 

authorized to be responsible for Federal funds. In the text box, provide the name and title of 

the Certifying Representative for the Statewide AT Program as it should appear on official 

correspondence. If the Certifying Representative’s title is of a general nature, please 

provide full information (e.g., if his/her title is “Director,” indicate what he/she is Director 

of). Contact information for the Certifying representative includes mailing address, phone 

number, and e-mail. When providing the address, follow the instructions given for the 

address of the Lead Agency. If the Certifying Representative’s address is the same as the 

Lead Agency, you must repeat the information. Example:

Dr. John Doe, Bureau Chief

Department of Disabilities

Office of Employment and Community Living

Bureau of Vocational Rehabilitation

Administration Building

200 Government Way

Suite 1951, Box 22

Anywhere, WU 77666-5544

(123) 456-7891

john.doe@bvr.wu.gov
1820-0664

Expires xx/xx/xxxx

8

5. Information about Program Director at Lead Agency. [Text box]

Instructions: Your Program Director is the individual officially responsible for overseeing 

the implementation of the grant, though occasionally this individual does not operate the 

program on a day-to-day basis. Your Lead Agency may use different terminology for this 

position (e.g., Principal Investigator). This may or may not be the same individual as your 

Certifying Representative. If your Program Director is the same as your Certifying 

Representative, you still must provide all of the information required in this item.

In the text box, provide the following information about the Program Director:

 His/her name and title - Include his/her title as it relates to the Statewide AT 

Program. For example, an employee of the Bureau of Vocational Rehabilitation 

might be called a Program Specialist within the agency, but he or she is considered 

the Program Director for the Statewide AT Program. His/her title should be entered 

as “Program Director,” because this is the role the individual plays in relationship to 

the Statewide AT Program. 

 Address - Follow the same instructions for previous address-related items. 

 Phone number.

 E-mail.

 % full-time equivalent (FTE) dedicated to the Statewide AT Program - Enter the 

number followed by the percent sign. 100% FTE indicates that the individual 

exclusively works on the Statewide AT Program (100% = 40 hours per week). 

While the FTE may fluctuate for those who are not 100%, enter the FTE that has 

been formally identified in the individual’s job description.

6. Information about Program Contact(s) at Lead Agency. [Text box]

Instructions: Many Lead Agencies have a number of individuals who are responsible for 

the Statewide AT Program in some capacity. For example, the Governor has designated the 

Department of Disabilities as the Lead Agency, within which there is an Office of 

Employment and Community Living, within which there is a Bureau of Vocational 

Rehabilitation that administers the Statewide AT Program. The Bureau of Vocational 

Rehabilitation has a Branch Chief designated as responsible for AT programs throughout 

the bureau. This person supervises a Program Specialist, who oversees a Contract Liaison 

that works directly with the subcontractors conducting the activities of the Statewide AT 

Program. All of these individuals would be considered Program Contacts and all should be 

identified in this section if not previously identified as the Certifying Representative or 

Program Director. However, this does not mean that every person involved in the Statewide 

AT Program should be named. Name only those who have oversight, who are paid using 

grant funds, and to whom RSA and others should correspond about the program. If an 

individual is not paid using grant funds but performs duties and functions that make them a 

Program Contact, he or she should also be included here. Provide the same information 

about each program contact that you provided for the Program Director.
1820-0664

Expires xx/xx/xxxx

9

7. Telephone at Lead Agency for Public. [Text box]

Instructions: The contact information provided for RSA’s use may be different from the 

contact information for the public. Statewide AT Programs often have 1-800 numbers to 

which inquiries about the program from the public are routed to information and referral 

specialists or others. Provide this information in the text box. If this information has been 

provided previously, repeat it here.

8. E-mail at Lead Agency for Public. [Text box]

Instructions: The contact information provided for RSA’s use may be different from the 

contact information for the public. Statewide AT Programs often have general e-mail 

addresses for inquiries about the program from the public. Provide this information in the 

text box. If this information has been provided previously, repeat it here.

9. Select the most appropriate descriptor of the agency/division/bureau directly 

responsible for the Statewide AT Program within the Lead Agency. [Drop-down menu]

Instructions: The drop-down menu offers the following choices (select one):

o General or Combined Vocational Rehabilitation Agency

o Vocational Rehabilitation for the Blind Agency

o State Education Agency

o University

o Health and Human Services Agency

o Aging and Disability (or similar) Agency

o Other

Though the name of the Lead Agency, or division of that Lead Agency, responsible for 

implementing the Statewide AT Program may be self-explanatory, sometimes it is not clear 

the “type” of state agency it is. To complete this item, select the type of entity with which 

the Statewide AT Program considers itself most affiliated. This may not necessarily be the 

highest level of the Lead Agency. For example, the Statewide AT Program may be housed 

in a State Education Agency, but is directly implemented by a General Vocational 

Rehabilitation Agency that is housed within that State Education Agency. If the Statewide 

AT Program is more closely affiliated with the General Vocational Rehabilitation Agency

than the State Education Agency as a whole, select General or Combined Vocational 

Rehabilitation Agency.

10. If Other was selected for question 9, identify and describe the agency. [Text box]

Instructions: “Other” should be selected only when none of the available choices can 

reasonably be applied to the type of Lead Agency. The description should be brief and 

explain that agency’s function in a manner that makes it clear why none of the other 

choices apply.

 
1820-0664

Expires xx/xx/xxxx

10

11. Does your Lead Agency contract with an Implementing Entity to carry out the 

Statewide AT Program on its behalf? [Drop-down menu]

Instructions: The drop-down box above allows you to select “yes” or “no.” A state either 

has a Lead Agency alone or has both a Lead Agency and an Implementing Entity. The 

Implementing Entity is a subcontractor separate from the Lead Agency. The Lead Agency

does not also name itself as the Implementing Entity. If you answer “yes” to this question, 

you must complete the information about the Implementing Entity that follows. If you 

answer “no,” you do not complete items related to an Implementing Entity.

If you answered no to question 11, you may skip ahead to the items on 

change in Lead Agency or Implementing Entity. Otherwise, you must 

answer the following questions.

12. Name and Address of Implementing Entity. [Text box]

Instructions: Follow the same instructions for item 3.

13. Information about Program Director at the Implementing Entity. [Text box]

Instructions: Follow the same instructions for item 5.

14. Information about Program Contact(s) at Implementing Entity. [Text box]

Instructions: Follow the same instructions for item 6.

15. Telephone at Implementing Entity for Public. [Text box]

 Instructions: Follow the same instructions for item 7.

16. E-mail at Implementing Entity for Public. [Text box]

Instructions: Follow the same instructions for item 8.

17. Select the most appropriate descriptor of the type of organization that is the 

Implementing Entity. [Drop-down menu]

Instructions: The drop-down box offers the following choices (you may select only one):

o AgrAbility Program

o Alliance for Technology Access Center

o Bank or other financial institution

o Easter Seals

o Independent Living Center

o Institution of Higher Education

o Non-categorical disability organization

o Organization that primarily serves individuals who are blind or visually impaired

o Organization that primarily serves individuals who are deaf or hard of hearing

o Organization that primarily serves individuals with developmental disabilities

o Organization that primarily serves individuals with physical disabilities
1820-0664

Expires xx/xx/xxxx

11

o Organization focused specifically on providing AT

o Protection and Advocacy organization

o UCP

o Other

It may not be clear what type of Implementing Entity it is based on the title alone. To 

complete this item, select the type of entity with which the Implementing Entity considers 

itself most affiliated. Many organizations could be categorized using a number of the 

descriptors provided. Use the following rules when deciding how to indicate the type of 

organization:

 If applicable, the national affiliation of an entity should be selected before other 

descriptors (e.g., if an organization is an Alliance for Technology Access Center, choose 

this national affiliation rather than “organization focused specifically on providing 

AT”). These include:

 AgrAbility Program

 Alliance for Technology Access Center

 Easter Seals

 Independent Living Center

 Protection and Advocacy organization

 UCP

 If a private entity has no national affiliation, use the following more general descriptors. 

 Bank or other financial institution – Self-explanatory.

 Non-categorical disability organization – This is an organization 

that serves individuals with disabilities without a particular focus 

by age or disability type, and, while it may provide AT services, 

is not exclusively dedicated to providing AT services. Also 

select this if the entity serves two or more of the types of 

disabilities in the bullets below.

 Organization that primarily serves individuals who are blind or 

visually impaired – Self-explanatory.

 Organization that primarily serves individuals who are deaf or 

hard of hearing – Self-explanatory.

 Organization that primarily serves individuals with 

developmental disabilities – Self-explanatory.

 Organization that primarily serves individuals with physical 

disabilities – Self-explanatory.

 Organization focused specifically on providing AT – These 

generally are organizations exclusively dedicated to providing 

AT-related, rather than general or disability-specific, assistance 

to consumers.

 Other – See instructions for item 18.
1820-0664

Expires xx/xx/xxxx

12

18. If Other was selected, identify and describe the entity. [Text box]

Instructions: “Other” should be selected only when none of the available choices can 

reasonably be applied to the type of Implementing Entity. The description should be brief 

and explain that entity’s function in a manner that makes it clear why none of the other 

choices apply.

19. Describe the mechanisms established to ensure coordination of activities and 

collaboration between the Implementing Entity and the state. [Text box]

Instructions: According to section 4(c)(1)(B) of the AT Act of 1998, as amended, the 

Implementing Entity must carry out its responsibilities through a subcontract or other 

administrative agreement with the Lead Agency. Your description should identify the 

mechanism used and how the Lead Agency provides oversight and holds the Implementing 

Entity accountable for appropriate implementation of the Statewide AT Program.

20. Is the Lead Agency named in this State Plan a new or different Lead Agency from the 

one designated by the Governor in your previous State Plan? [Drop-down menu]

Instructions: The drop-down menu allows you to select “yes” or “no.” The “previous 

state plan” was the plan under which the Statewide AT Program operated from October 1, 

2005 until the submission of this State Plan. If a change in Lead Agency already has been 

approved by RSA under the previous State Plan, the state can select “no.” If you select 

“no,” and you use an Implementing Entity, move on to the questions about changing 

Implementing Entities. 

If you answered no to question 20, and you do not use an Implementing Entity, you 

may skip ahead to the next section. Otherwise, you must answer the following 

questions.

21. Explain why the Lead Agency previously designated by your state should not serve as 

the Lead Agency. [Text box]

Instructions: Describe all factors that led the state to consider changing from the previous 

Lead Agency or Implementing Entity, such as concerns about performance, state policies 

that require periodic competition for contracts, or restructuring of state government.

22. Explain why the Lead Agency newly designated by your state should serve as the Lead 

Agency. [Text box]

Instructions: Describe how and why the new Lead Agency was chosen to implement the 

Statewide AT Program and justify the appropriateness of the choice.

23. Is the Implementing Entity named in this State Plan a new or different Implementing 

Entity from the one designated by the Governor in your previous State Plan? [Dropdown menu]

Instructions: The drop-down box above allows you to select “yes,” “no” or “not 

applicable.” The “previous state plan” was the plan under which the Statewide AT 

Program operated from October 1, 2008 until the submission of this State Plan. If a 
1820-0664

Expires xx/xx/xxxx

13

change in Implementing Entity already has been approved by RSA under the previous 

State Plan, the state can select “no.” 

If you answered no or not applicable to question 23, you may skip ahead to the next 

section. Otherwise, you must respond to items 24 and 25.

24. Explain why the Implementing Entity previously designated by your state should not 

serve as the Implementing Entity. [Text box]

Instructions: Follow the same instructions for item 21.

25. Explain why the Implementing Entity newly designated by your state should serve as 

the Implementing Entity. [Text box]

Instructions: Follow the same instructions for item 22.
1820-0664

Expires xx/xx/xxxx

14

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section B: Advisory Council, Budget 

Allocations, and Identification of Activities 

Conducted

Section 4(c)(2) of the AT Act requires the Statewide AT Program to establish a consumermajority advisory council that provides consumer-responsive, consumer-driven advice to the 

state for planning of, implementation of, and evaluation of the activities carried out through the 

grant, including setting measurable goals. Exceptions to these requirements are allowed under 

section 4(c)(2)(E) if the requirements will affect existing state statutes, rules, or official policies 

relating to advisory bodies or require changes to existing governing bodies of incorporated 

agencies. The following items provide assurances related to and identify compliance with the 

requirements of section 4(c)(2).

1. In accordance with section 4(c)(2) of the AT Act of 1998, as amended our state has a 

consumer-majority advisory council that provides consumer-responsive, consumerdriven advice to the state for planning of, implementation of, and evaluation of the 

activities carried out through the grant, including setting measurable goals. This 

advisory council is geographically representative of the State and reflects the diversity 

of the State with respect to race, ethnicity, types of disabilities across the age span, 

and users of types of services that an individual with a disability may receive. [Dropdown menu]

Instructions: You must read and verify the statement by selecting “yes” or “no” from the 

drop-down menu (though N/A is available on the dropdown list, it cannot be selected). This 

statement assures that the advisory council is representative of the state in terms of 

geography and diversity and meets the purposes and performs the functions required under 

the AT Act. Your Certifying Representative’s signature on the state plan attests to the 

statement being true as of the date of submission of the State Plan for AT.

2. The advisory council includes a representative of the designated State agency, as 

defined in section 7 of the Rehabilitation Act of 1973 (29 U.S.C. 705). [Drop-down 

menu]

3. The advisory council includes a representative of the State agency for individuals who 

are blind (within the meaning of section 101 of that Act (29 U.S.C. 721)). [Drop-down 

menu]

4. The advisory council includes a representative of a State center for independent living 

described in part C of title VII of the Rehabilitation Act of 1973 (29 U.S.C. 796f et 

seq.). [Drop-down menu]
1820-0664

Expires xx/xx/xxxx

15

5. The advisory council includes a representative of the State workforce investment board 

established under section 111 of the Workforce Investment Act of 1998 (29 U.S.C. 

2821). [Drop-down menu]

6. The advisory council includes a representative of the State educational agency, as 

defined in section 9101 of the Elementary and Secondary Education Act of 1965. [Dropdown menu]

Instructions: For items 2-6 above, verify that your council has each of the members listed 

by selecting “yes” or “no” or “not applicable” from the drop-down menus. In order to 

select “yes,” you must have an official representative of the applicable agency on record as

named and appointed to the council at the time of submitting this plan. In order to select 

“not applicable,” you must either not have a separate agency for individuals who are blind 

or not be required to have a member because existing statutes, rules or policies related to 

advisory bodies or governing bodies of Statewide AT Programs would be affected.

7. The advisory council includes other representatives (list below). [Text box]

Instructions: Many advisory councils include agency or other organization representatives 

beyond those required under the AT Act. In the text box, identify those members and the 

entities they represent here, though you need not provide personal names. Do not list 

consumer representatives here.

8. The advisory council includes the following number of individuals with disabilities that 

use assistive technology or their family members or guardians: [Number field]

Instructions: Section 4(c)(2)(B)(ii) of the AT Act requires that a majority, not less than 51 

percent, of the members of the advisory council be individuals with disabilities that use 

assistive technology or their family members or guardians. Enter the number of these 

individuals that are current members of your council. In order to include an individual, he 

or she must be on record as named and appointed to the council at the time of submitting 

this plan. This total cannot include agency representatives from the previous lists.

9. If the Statewide AT Program does not have the composition and representation 

required under section 4(c)(2)(B), explain here. [Text box]

Instructions: Provide the reasons that you do not have representatives of the required 

agencies or do not have a consumer-majority on your council and where you are in the 

process of filling vacant positions. If the composition of your council is different from the 

requirements of 4(c)(2)(B) because existing statutes, rules or policies related to advisory

bodies or governing bodies of Statewide AT Programs would be affected, explain here. 

You do not need to explain if you selected “not applicable” because you do not have a 

separate agency for individuals who are blind in your state.
1820-0664

Expires xx/xx/xxxx

16

10. Proposed Budget Allocations.

State-level Activities

Proposed Budget Allocation for 

Entire Annual Award

State Financing Activities Drop-down menu

Device Reutilization Activities Drop-down menu

Device Loan Activities Drop-down menu

Device Demonstration Activities Drop-down menu

State Leadership Activities Drop-down menu

Instructions: Each of the drop-down menus offers the following selections (choose one):

o Not performed due to comparability

o Not performed due to flexibility

o 1 to 10,000;

o 10,001 to 20,000;

o 20,001 to 30,000;

o 30,001 to 40,000;

o 40,001 to 50,000;

o 50,001 to 60,000;

o 60,001 to 70,000;

o 70,001 to 80,000;

o 80,001 to 90,000;

o 90,001 to 100,000;

o More than 100,000.

During the course of this State Plan, you will receive at least three annual awards. The 

amount to report here is not the amount you plan to spend on a particular activity over the 

course of three years. It is the amount you plan to spend from each annual award. This 

means you may have to update this information on an annual basis if (a) the amount of 

your award increases or decreases significantly or (b) you choose to change the amount of 

funds dedicated to an activity or activities.

To answer the above items, select the amount of funds closest to the amount you plan to 

spend on the activity from your annual AT Act award only – not funds you may spend on 

this activity from other sources. You will report financial support received from other 

sources in a later item.

Annual awards can be spent over a two-year period. If your program requires the two-year 

period to expend your total award you should report the total amount spent from the 

annual award, not the amount you plan to spend every calendar year (e.g., if your annual 

award generally is for $400,000 indicate the total amount of that $400,000 that you plan to 

dedicate to this activity). 
1820-0664

Expires xx/xx/xxxx

17

If RSA has not provided your annual award by the time you are required to complete or 

update your state plan, you should assume relatively level funding (based on the amount 

you received for FY 2011) for each annual award provided during the period of the State 

Plan.

If you will not spend any funds on an activity, it is assumed you are not conducting it 

because either (a) comparable financial support for that activity is provided from state or 

other non-Federal sources in accordance with section 4(e)(1)(B) of the AT Act or (b) you 

are exercising flexibility under section 4(e)(6) of the AT Act. However, you must enter a 

funding level for State Leadership activities, as the AT Act does not allow comparability 

or flexibility for State Leadership.

“Spending” funds on an activity is not limited to purchasing equipment, providing 

subcontracts to other entities, conference costs, etc. It can include administration of an 

activity. Funds are considered to be spent when staff being paid under your annual award 

dedicate their time to the specific activity. The time spent by staff should be a 

program/personnel cost that can be translated into a dollar figure.

However, simply serving on an advisory board or providing technical assistance to an 

organization engaged in an activity is not considered administering an activity (the cost of 

providing TA would be reflected under your State Leadership allocation, for example). 

Promoting an activity during speaking engagements or distributing brochures about an 

activity is not considered administering an activity. To count the expenditure of staff time 

on an activity, the level of involvement must be such that the activity could not be carried 

out without the Statewide AT Program’s personnel.

11. For every activity for which you selected “claiming comparability” in item 10, describe 

the comparable activity: [text box]

Instructions: In the text box, explain in the simplest terms possible what the comparable 

activity is, who conducts the activity, who supports the activity, and what makes it 

comparable both in terms of resources supporting the activity and how the activity is 

related to the purposes of the AT Act. 

12. Describe your planned procedures for tracking expenditures for State-level and State 

Leadership activities: [text box]

Instructions: In the text box, explain in the simplest terms possible what processes and 

procedures are in place to ensure the program is funds in accordance with the AT Act (i.e., 

how your program knows it is spending no more than 40% of its funds on State Leadership 

Activities and at least 5% of that 40% on transition-related activities). 
1820-0664

Expires xx/xx/xxxx

18

13. State Financing Activities Performed.

State Financing Activities

Activities 

Performed

(select all that 

apply)

Financial loan program Check box

Cooperative buying program Check box

Financing for home modifications program Check box

Telecommunications distribution program Check box

Last resort program Check box

Other program Check box

Instructions: Using the above, identify all types of state financing activities conducted by 

your Statewide AT Program. The answers you provide here will determine the format of 

the remainder of the State Plan (i.e., for every activity you check, a screen with questions 

about that activity will appear in the State Plan). The information you provide here should 

be consistent with the information you provided related to proposed budget allocations. If 

you indicated that you will allocate funds for state financing, it is expected that at least one 

activity will be indicated here; if you indicated that you are claiming comparability or 

exercising flexibility, it is expected that you will answer zero to all activities. Note that 

you are required to provide annual data for any activity claimed in this State Plan.

Other Activities Performed.

Device Reutilization, Device Loan, and Device Demonstration 

Activities

Number of 

Activities 

Performed

How many device exchange programs do you support?

Number field

How many device reassignment programs do you support?

Number field

How many device loan programs do you support?

Number field

How many device demonstration programs do you support?

Number field

Instructions: Using the above table, identify the number of device exchange, device 

reassignment, device loan, and device demonstration activities conducted by your 

Statewide AT Program. A “zero” indicates that you do not conduct the activity, whereas 

any number above zero indicates that you conduct the activity. Enter a number above 

“one” only if you conduct two or more separate and distinct forms of the activity (e.g., you 
1820-0664

Expires xx/xx/xxxx

19

operate two device reassignment programs – one that reassigns computers only and a 

different one that reassigns AT such as durable medical equipment). 

The number of programs you support is not equivalent to the number of sites at which you 

conduct the activity. A state may have several sites at which device loans are provided, 

but these sites still constitute a single, comprehensive device loan program because they all 

serve the same function. In this case, the state would report one device loan program. 

Alternately, a state may have one site with two separate and distinct device loan programs. 

The same building may house a device loan program that can be accessed by anyone and a 

separate device loan program that can be accessed by only school personnel. In this case, 

the state would report two device loan programs. 

The answers you provide here will determine the format of the remainder of the State Plan. 

If you enter “zero” for any activity, you will not provide information related to it. If you 

enter “one” for any activity, you will provide information about it. If you enter a number 

above “one,” you will provide information about each activity separately (e.g., if you 

operate two reassignment activities as given in the previous example, you will provide one 

set of information about your computer reassignment and one set of information about 

your AT reassignment). 

The information you provide here should be consistent with the information you provided 

related to proposed budget allocations. If you indicated that you will allocate funds for an 

activity, it is expected that at least one activity will be indicated here; if you indicated that 

you are claiming comparability or exercising flexibility, it is expected that you will answer 

zero. Note that you are required to provide annual data for any activity claimed in this 

State Plan.

14. What is the baseline year for measurable goals for this State Plan? [Number field]

Instructions: Data on your measurable goals for this State Plan will be provided under 

“Assurances, Measurable Goals and Signatures.” To format that page correctly, enter 

2007 in this number field. 
1820-0664

Expires xx/xx/xxxx

20

Instructions for Items that Appear for Every 

State-level and State Leadership Activity

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. For the 

purposes of the following portions of the State Plan, there is no distinction between a Lead 

Agency or Implementing Entity in terms of implementation. If an Implementing Entity is used, 

the State Plan reports on how that entity is implementing the Act.

Section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. 

Sections C-G of this State Plan contain items intended to meet these requirements. Each 

section may request unique information about specific activities, but there is a core set of 

information that is required for every activity. The items and instructions shown below apply to 

every State-level and State Leadership activity, with two exceptions: 

 information about the year when the program began conducting the activity is not 

required of State Leadership activities; and

 the option to provide additional information does not appear when there is a text box for 

describing the activity, as it is assumed that all pertinent information will be provided in 

that description.

Use the below as your reference throughout the State Plan, as the instructions will not be 

repeated in each section.

Enter the year when the program began conducting this activity. [Number field]

Instructions: Enter the year that the Statewide AT Program began conducting this activity, to 

the best of your knowledge, in the number field. The year can be any year since the passage of 

the first version of the AT Act in 1988 and even may pre-date the AT Act. You may estimate 

the year if you have justification for the estimate. If the Statewide AT Program conducted this 

activity, then stopped the activity, then restarted it, enter the year in which it restarted, not the 

original year.
1820-0664

Expires xx/xx/xxxx

21

Who conducts this activity? Check all that apply.

The Statewide AT Program. [Check-box to indicate “yes”]

Other entities (e.g., contractors). [Check-box to indicate “yes”]

Instructions: Lead Agencies/Implementing Entities implement their activities in many ways. 

Some implement their activities directly using their own staff and resources, others use 

subcontractors, and others use combinations of both. Remember, the Implementing Entity is 

considered the Statewide AT Program, not an “other entity.” 

Indicate how your program conducts this activity using the following rules: 

Select “yes” for “The Statewide AT Program” and do not select “Other entities” if this activity

is carried out exclusively by employees of the Lead Agency/Implementing Entity working 

directly with consumers using Lead Agency/Implementing Entity facilities and resources. 

Regional sites that are staffed by employees of the Lead Agency/Implementing Entity are 

considered part of the Statewide AT Program. 

Select “yes” for BOTH “The Statewide AT Program” and “Other entities” if the Lead 

Agency/Implementing Entity carries out the activity using its employees and facilities to work 

directly with consumers and ALSO uses some subcontracts or other agreements with external 

organizations whose own employees, facilities, and resources are used to work directly with 

consumers. 

Select ONLY “Other entities” if the Lead Agency/Implementing Entity does not work directly 

with consumers using Lead Agency/Implementing Entity facilities and resources and instead 

uses external organizations only. 

DO NOT indicate that “other entities” are conducting the activity if you mean that the activity 

is conducted in “coordination and collaboration” with other entities. You will use the following 

item to indicate whether you coordinate and collaborate. 

The Statewide AT Program provides and/or receives the following support (choose all that 

apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. [Check-box to indicate “yes”]

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program. [Check-box to indicate “yes”]

Receives financial support from the state. [Check-box to indicate “yes”]

Receives in-kind support from the state. [Check-box to indicate “yes”]

Receives financial support from private entities. [Check-box to indicate “yes”]

Receives in-kind support from private entities. [Check-box to indicate “yes”]

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service. [Check-box to indicate “yes”]

Coordinates and collaborates with other entities for the purpose of expanding an existing 

program or service. [Check-box to indicate “yes”]

Coordinates and collaborates with other entities for the purpose of reducing duplication of 

programs or services. [Check-box to indicate “yes”]
1820-0664

Expires xx/xx/xxxx

22

Instructions: Identify all types of support provided and received under this activity, as well as 

whether you conduct it in coordination and collaboration with other entities, by selecting “yes” 

as appropriate. Do not confuse these options with the use of an Implementing Entity (for 

purpose of these questions, the Implementing Entity is the Statewide AT Program). 

Provides financial support to other entities via an agreement or Provides in-kind support to 

other entities via an agreement - Select either or both of these if you subsidize an external 

entity to conduct this activity on your behalf either in part or in whole. What you answer here 

should be consistent with what you answered for “Who conducts this activity?” (i.e., if you said 

yes to “Other entities” you must indicate the provision of either financial or in-kind support to 

other entities). If you select either financial or in-kind support (and you may select both if 

appropriate), it is assumed that an agreement of some kind exists between the Lead 

Agency/Implementing Entity and AT Act resources are supporting that agreement. It also is 

assumed that the organization is providing you with data on its activities. If no AT Act 

resources are being used to support this activity and you do not have data on it, you should 

reconsider whether it is appropriate to claim it in your State Plan. Use the following (for this 

item and all other items) to determine whether the support is financial or in-kind:

 Select “financial support” only when funds are being provided to the organization 

by the Lead Agency/Implementing Entity. 

 Select “in-kind support” only if a tangible resource that could be assigned a value 

is donated to the organization. Examples of in-kind contributions could be 

providing storage space at no charge, creating and distributing promotional 

materials at no charge, transporting items at no charge. In rare cases, personnel 

support could be considered in-kind support. If Lead Agency/Implementing 

Entity personnel are using their time to support the organization, the involvement 

and donation of time must be substantive and more than routine oversight of a 

subcontract or other administrative/clerical functions. Do not include service on 

an advisory board or other similar activity and do not include verbal promotion 

during public awareness activities. An example of providing personnel support 

would be assisting with screening applications (e.g., loan applications, requests 

for used devices) on a regular basis or providing ongoing training and technical 

assistance to an organization free of charge. Forgoing indirect costs is not 

considered providing in-kind support.

Receives financial support from the state or Receives in-kind support from the state - Select 

either or both of these (as appropriate to the circumstance) if the Statewide AT Program 

receives support from a state agency to conduct the activity. This does not mean the state 

agency has to designate support directly for the activity, but if a state agency provides general 

support for the Statewide AT Program as a whole, the program must have apportioned some of 

that support specifically for the activity. This does not include typical administrative and 

logistical support that the Lead Agency would provide to any program under its purview. It 

must be support above and beyond that provided for a typical program.

Receives financial support from private entities or Receives in-kind support from private 

entities – Select either one of these (as appropriate to the circumstance) if the Statewide AT 
1820-0664

Expires xx/xx/xxxx

23

Program receives support from a private entity (such as a non-profit organization) to conduct 

the activity. This does not mean the private entity has to designate support directly for the 

activity, but if the private entity provides general support for the Statewide AT Program as a 

whole, the program must have apportioned some of that support specifically for the activity.

Coordinates and collaborates with other entities for the purpose of establishing a new program 

or service or expanding an existing program or service or reducing duplication of programs or 

services – Select as many of these as is applicable. Providing a subcontract to another entity

does not automatically mean you are conducting an activity in coordination and collaboration. 

Use the following description of coordination and collaboration to determine whether you 

coordinate or collaborate in carrying out this activity: 

 Coordination and collaboration involves working with other entities to improve 

access to AT devices and services. Coordination and collaboration may include 

improving how the Statewide AT Program implements state-level or state 

leadership activities or how the Statewide AT Program assists other entities to 

provide similar activities on their own. Further, the Statewide AT Program and 

other entities must be working together for a specific purpose:

 to establish a service that did not exist previously; 

 to enable expansion of an activity geographically or to groups not 

previously served; or 

 to eliminate duplicative services. 

 For example, a Statewide AT Program could work with a local organization to 

establish a monthly pick-up and drop off schedule for used/recycled AT devices 

in a part of the state previously un-served. 

 However, not all activities in which a Statewide AT Program participates with 

other entities are considered coordination and collaboration. If the coordination 

and collaboration is intended to result in a change in policies, procedures or 

funding for AT beyond improving the delivery of state-level and state leadership 

activities, the activity might be better described as technical assistance. In 

addition, if the Statewide AT Program has a contract with an entity to provide a 

specific service, that interaction would not typically be reported under 

coordination and collaboration.

Additionally, use of a bank or community-based organization (CBO) involved in a financial 

loan program would not be considered coordination and collaboration, and the provision of inkind or personnel support alone is not the basis for coordination and collaboration.
1820-0664

Expires xx/xx/xxxx

24

If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, identify 

the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, identify 

those entities in column (d) of the following table.

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collaborate 

with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitation-related 

agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves individuals 

who are blind or visually impaired

Organization that primarily serves individuals 

who are deaf or hard of hearing

Organization that primarily serves individuals 

with developmental disabilities

Organization that primarily serves individuals 

with physical disabilities

Organization focused specifically on providing 

AT

Protection and Advocacy Organization

Technology agency

UCP

Other

Instructions: If you indicated that you provide financial or in-kind support to other entities, 

receive financial or in-kind support from either state agencies or private entities, or conduct this 

activity in coordination and collaboration with other entities, use the table to indicate the types 

of agencies/entities from which you receive the support or with which you collaborate. The 

information provided in this table must be consistent with the information provided in the 

previous question. If in the previous question you answered “yes,” this activity receives 

financial support from the state, the above table must have at least one selection in column “b.” 

Select all organizations that apply. For example, in column “a” indicate all organizations to 

which you provide support. Selecting all that apply does not mean checking all descriptors that 
1820-0664

Expires xx/xx/xxxx

25

apply to an individual organization. Only one descriptor per organization should be selected 

(e.g., if you have one subcontract with an Easter Seals, you select only Easter Seals, not Easter 

Seals and organization that serves individuals with developmental disabilities).

Many organizations could be categorized using a number of the descriptors provided. Use the 

following rules when deciding how to indicate the type of organization:

 You can select more than one organization if more than one organization is involved in 

the activity (e.g., if you have three subcontracts to three different organizations, you 

would make three selections). However, if you have more than one different 

organization involved but the same descriptor applies to them, you can select that 

descriptor only once (e.g., if you subcontract to two different Easter Seals and one UCP, 

you select only two - Easter Seals and UCP). 

 If applicable, the national affiliation of a private entity should be selected before other 

descriptors (e.g., if an organization is an Alliance for Technology Access Center, choose 

this national affiliation rather than “organization focused specifically on providing 

AT”). These include:

 AgrAbility Program

 Alliance for Technology Access Center

 Easter Seals

 Independent Living Center

 Protection and Advocacy organization

 UCP

If a private entity has no national affiliation, use the following more general descriptors. 

Do not use these descriptors when categorizing a state agency (e.g., your state 

vocational rehabilitation for the blind agency should be an employment-related agency

instead of organization that primarily serves individuals who are blind or visually

impaired). These include:

 Bank or other financial institution – Self-explanatory.

 Non-categorical disability organization – This is an organization that 

serves individuals with disabilities without a particular focus by age or 

disability type, and, while it may provide AT services, is not exclusively

dedicated to providing AT services. Also select this if the entity serves 

two or more of the types of disabilities in the bullets below.

 Organization that primarily serves individuals who are blind or visually 

impaired – Self-explanatory.

 Organization that primarily serves individuals who are deaf or hard of 

hearing – Self-explanatory.

 Organization that primarily serves individuals with developmental 

disabilities - Self-explanatory.

 Organization that primarily serves individuals with physical disabilities -

Self-explanatory.
1820-0664

Expires xx/xx/xxxx

26

 Organization focused specifically on providing AT - These generally are 

organizations exclusively dedicated to providing AT-related, rather than 

general or disability-specific, assistance to consumers.

 If you receive support from or collaborate with a state agency, use the following 

descriptions to determine the type of agency:

 Education-related: This category can include any type of educational entity 

such as early childhood, elementary, secondary, special education, remedial 

education, adult basic education, continuing education. It includes both 

public and private educational agencies and organizations and federal, state, 

and local governmental entities who primarily provide or regulate 

educational services (e.g. State Education Agency). It does not include 

Institutions of Higher Education, which has its own category.

 Employment-related: This category includes employment training programs, 

vocational rehabilitation programs and other programs related to 

employment. It can include providers of employment and/or training 

services, public and private agencies and organizations that provide or 

regulate employment services, such as state employment agencies, one-stop 

career centers, state vocational rehabilitation agencies, community

rehabilitation programs, vocational training programs, training providers 

approved under the Workforce Investment Act, and apprenticeship programs. 

 Health, allied health and rehabilitation-related: This includes hospitals, 

health clinics, mental health agencies and organizations, and managed care 

providers. This category can also include organizations for physicians, 

physicians’ assistants, nurses, nurse practitioners, psychologists, 

psychiatrists, occupational therapists, physical therapists, speech 

pathologists, audiologists, rehabilitation counselors, hospital discharge 

planners and other hospital employees. 

 Community Living-related: This category includes agencies providing 

services for seniors, and other related social service and community

organizations. This category can also include both public and private 

organizations and federal, state and local governmental entities who 

primarily provide or regulate community living and related services (e.g. a 

State Department of Aging, Public Utilities Commission and State Housing 

Authority.) It does not include Centers for Independent Living, which has its 

own category.

 Technology-related: This includes entities whose primary purpose is delivery

of technology devices or services. This category can include technology

experts such as computer programmers, web and application developers, 

information technology professionals and procurement officials along with 

manufacturers and vendors of information technology, telecommunications 

products, and assistive technology devices. 
1820-0664

Expires xx/xx/xxxx

27

 An Institution of Higher Education can be considered either a state agency or private 

entity depending on the type of college or university. In either case, institution of higher 

education should be selected rather than education-related agency. 

 Use “Other” only when the entity cannot reasonably be categorized in any of the ways 

provided. “Other” should be used rarely.

Select the option that best describes from where this activity is conducted. [Drop-down 

menu]

Instructions: The drop down menu offers the following selections (choose only one):

o One central location 

o Regional sites 

o A combination of a central location and regional sites

Use the following guidance to select the choice that best or most closely describes the location 

from which you conduct this activity. 

One central location – Select this if your state conducts this activity from a single site that 

houses all employees and resources engaged in the activity. It may be the case that employees 

or resources travel from this site to other places, but they are based at a single site, and the other 

places are not established/permanent sites. Sites that simply serve as referral sources or provide 

minimal assistance to a central location are not considered regional sites. Remember that this is 

tied to the activity itself, so two different activities could take place at two different central 

locations. Also, if in previous items you indicated that you use subcontractors, it does not 

automatically mean you use regional sites. For example, your Statewide AT Program may have 

a building on a university campus that houses the staff and devices for a device loan program. 

The university campus is the central location for that program. You also may contract with a 

CBO in another part of the state to operate an AFP as your state financing activity. If the 

employees and resources for operating the AFP are housed at the CBO, the CBO is considered 

the central location for state financing and not a regional site. 

Regional sites – Select this only if you conduct this activity from at least two sites that operate 

relatively independently without any of them being considered the main site or headquarters (if 

one of them is considered the headquarters you would choose a combination of central location 

and regional sites instead). Regional sites can be directly managed by the Lead 

Agency/Implementing Entity or can be subcontractors. For example, the Lead Agency may

employ three part-time staff people at three different one-stop centers in the state. Those onestop centers have their own small inventory of devices purchased by the Lead Agency and the 

part-time staff use those devices to provide device demonstrations on a regular basis. These 

could be considered regional sites. Sites that simply serve as referral sources or provide 

minimal assistance to a central location are not considered regional sites. For example, if all of 

the devices for your loan program are located at a central site along with those responsible for 

operating the program, but independent living centers provide referrals and you often send 

devices to independent living centers for pick-up by consumers, the independent living centers 

are not considered regional sites. 
1820-0664

Expires xx/xx/xxxx

28

A combination of central location and regional sites – Select this only if you have a site that is 

considered the main site or headquarters that houses the majority of employees and resources 

and regional sites that also have their own employees and resources. For example, if the 

majority of the devices for your loan program are located in a central inventory along with 

those responsible for operating the loan program, but independent living centers under 

subcontract house their own, smaller inventories and have staff assigned to do loans, you would 

have both a central location and regional sites. 

If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

Instructions: When entering the number of regional sites, do not include the central location if 

you answered “a combination of central location and regional sites.” 

This activity is available (choose all that apply). [Check boxes]

By website

By phone

By e-mail

By mail

In person

Instructions: Consumers may be able to access this activity to in a number of ways. Identify all 

the ways that a consumer can access this activity.

By website – Select this if consumers can access the activity by visiting a website. Usually this 

means being able to do more than get general information about the activity. Rather, 

consumers can engage in the activity via website (e.g., request a loan or demonstration). This is 

different from sending an e-mail, which is its own option.

By phone – Select this if consumers can call your program to access this activity.

By e-mail – Usually this means being able to do more than get general information about the 

activity sent by e-mail. Rather, consumers can engage in the activity via e-mail (e.g., request a 

loan or demonstration). 

By mail – Select this if material for this activity is sent out, like want-ads in a newsletter or 

some other hard copy format, or if the consumer can request assistance by sending a letter.

In person – Select this if there is a location or locations to which a consumer can go to make an 

initial contact to receive assistance.

Provide any additional information about this activity you wish to share. [Text 

box]

Instructions: Use the text box to provide any important information about this activity that is 

essential to understanding it in context, that you feel is not appropriately captured by the items 

already included, or that you believe makes this activity unique. 
1820-0664

Expires xx/xx/xxxx

29

The following two items are not requested for every State-level or State Leadership Activity, 

but they do appear in many of the activities. Use the following instructions every time these 

items appear. Note, similar items appear in the section on Device Exchange, but the options are 

different from those featured below. That section contains its own instructions.

Select the option that best describes the policy of the program for charging individuals 

with disabilities for a device or loan or demonstration or training or technical assistance. 

[Drop-down menu]

Select the option that best describes the policy of the program for charging professionals 

for a device or loan or demonstration or training or technical assistance. [Drop-down 

menu]

Instructions: The drop-down menu offers the following options (choose one):

o Nothing

o A flat fee

o A fee on a variable or sliding scale

o A fee is assigned based on the device

o A financial donation is requested

o A donation of time or other non-financial commitment is 

requested

o An annual fee or similar regular payment arrangement

o The fee is based on the length/complexity/value/type

o The fee is based on the purpose

o Multiple subcontractors are used and they set their own 

policies

o Other

Many programs support their activities by charging some kind of fee. Here you will identify

whether you charge a fee and if so what that fee is based upon. Even though exceptions may be 

made in particular cases, choose the answer that is closest to your policy. When selecting the 

answer, if you use a hierarchy to determine the fee, indicate which option begins the hierarchy. 

Example: If it is your policy to charge a flat fee, but when a consumer indicates that he or she 

cannot pay the fee you then would charge on a sliding scale, select “flat fee” because it is your 

policy default. Use the following to assist you in determining which selection to make:

It also is possible that you have different policies under different circumstances. For example, 

some organizations pay an annual fee while others do not. If this is the case, select the answer 

that applies in the majority of cases.

Nothing – Self-explanatory.

Flat fee – You charge a set amount for participation in the activity. 

Fee on a variable or sliding scale – You charge differing amounts based on the recipient’s 

ability to pay.
1820-0664

Expires xx/xx/xxxx

30

Fee is assigned based on the value/type/length/complexity – The amount of the fee depends on 

the quality or type of device (e.g., the higher quality or better or more expensive the device, the 

more the recipient is charged); or how long the device is needed (e.g., the longer the loan the 

more is charged); or how complex the demonstration is (e.g. the more devices that need 

demonstrating or the greater the expertise needed for the demonstration, the more expensive).

Financial donation is requested – There is no set charge, but you do request that individuals 

pay what they can or believe is appropriate.

Donation of time or other non-financial commitment is requested – You do not request money

from recipients, but ask that they repay your program through some form of service, either to 

the program itself or to the community.

An annual fee or similar regular payment arrangement - An individual or entity pays 

membership dues or a subscription fee to use the program and does not pay for each individual 

device/loan/demonstration.

The fee is based on the purpose – You may or may not charge depending on what the device 

will be used for. Perhaps you do not charge for a device loan if a consumer is using it for 

decision-making or to fill a gap, but you do charge if a professional uses a device for an 

evaluation or to provide training at a conference. 

Multiple subcontractors are used and they set their own policies – If the charging of fees is at 

the discretion of subcontractors and those subcontractors set their own policies, there is an 

option to indicate this. If you use subcontractors but your subcontracts stipulate if/how fees are 

to be charged for all subcontractors, do not select this and instead reflect the policy you apply to 

all. If you use only one subcontractor, do not select this and respond to the item based on that 

one subcontractor’s policy.

Other – This should be selected only if the fees charged cannot reasonably be described using 

one of the other options. 
1820-0664

Expires xx/xx/xxxx

31

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section C: State Financing Activities

The AT Act describes state financing activities as activities that increase:

“access to, and funding for, assistive technology devices and assistive technology services 

(which shall not include direct payment for such a device or service for an individual with a 

disability but may include support and administration of a program to provide such payment), 

including development of systems to provide and pay for such devices and services, for targeted 

individuals and entities described in section 3(16)(A), including—

(i) support for the development of systems for the purchase, lease, or other acquisition of, or 

payment for, assistive technology devices and assistive technology services; or

(ii) support for the development of State-financed or privately financed alternative financing 

systems of subsidies (which may include conducting an initial 1-year feasibility study of, 

improving, administering, operating, providing capital for, or collaborating with an entity with 

respect to, such a system) for the provision of assistive technology devices, such as—

(I) a low-interest loan fund;

(II) an interest buy-down program;

(III) a revolving loan fund;

(IV) a loan guarantee or insurance program;

(V) a program providing for the purchase, lease, or other acquisition of assistive technology

devices or assistive technology services; or

(VI) another mechanism that is approved by the Secretary.”

For the purposes of this State Plan, state financing activities include financial loan programs, 

home modification programs, telecommunications distribution programs, last resort funds, and 

other activities. Each of these activities is defined in the corresponding section of this State 

Plan.

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are intended to meet these requirements for State 

Financing Activities. Respond only to the items that correspond with the State Financing 

Activities you selected in Section B of this Plan. 
1820-0664

Expires xx/xx/xxxx

32

Financial loan program

A financial loan program provides financial loans for purchase of AT devices and services. A 

financial loan program may make loans directly (revolving loans) or may make partnership 

loans using dollars from another source, usually a financial institution.

1. Enter the year when the program began conducting this activity. [Number field]

2. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

3. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

4. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency
1820-0664

Expires xx/xx/xxxx

33

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental 

disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

5. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

6. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

7. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

8. Enter the total endowment of the activity. [Number field]

Instructions: Your total endowment is the full amount of funding you would have 

available for loans if all of your funds were in a bank account and you had no outstanding 

loans. Your total endowment begins with the initial investment made to establish your 

financial loan program. For example, if a title III AFP received $300,000 in Federal funds 

and provided $100,000 in matching funds, you began with $400,000. Your financial loan 

program may have gained interest over the years, so your current endowment may be 

greater than $400,000; likewise, you may have had a number of defaults that reduced your 

program’s endowment below the $400,000. Whatever this amount is, do not deduct 

outstanding loans or administrative costs before reporting it. Another way of looking at 

this number is how much money you have in the bank plus how much money you have 

out in existing loans. You may provide approximate, or rounded, totals rather than exact.
1820-0664

Expires xx/xx/xxxx

34

9. Select the option that best describes the primary source of capital used to begin the 

activity. [Drop-down menu]

Instructions: The drop-down menu offers the following selections (choose one):

o Section 4 of the AT Act of 1998, as amended

o Title III of the AT Act of 1998

o Title I of the AT Act of 1998

o Another federal source

o A state source

o A private source 

Choose only one answer, as this item asks for the primary source of initial capital that 

started the program, meaning the source that provided the largest contribution to get the 

loan program off the ground. If your financial loan program is a title III AFP funded when 

the match was 1 to 1, select title III of the AT Act of 1998 as the primary source even 

though the state contribution was equal.

10. Select the option that best describes the primary source of support for ongoing 

operation of the activity. [Drop-down menu]

Instructions: The drop down menu offers the following selections (choose one):

o Section 4 of the AT Act of 1998, as amended

o Interest and investments from the original source of capital

o Another federal source

o A state source

o A private source

Choose only one answer, as this asks for the primary source of funds that maintain the 

financial loan program, meaning the source that provides the largest contribution to 

maintenance of the program. 

11. Even if they are not the primary source of support, do you support this program using 

section 4 funds? [Check box for “yes”]

Instructions: Even if funds provided under the AT Act are not the primary source of funds 

supporting the program, a Statewide AT Program still may be dedicating resources to a 

financial loan program. To answer yes, the funds must either be provided to the financial 

loan program or must be used to support the program directly in some way. Staff time 

used to serve on advisory boards or for normal program oversight are not included as 

resources.
1820-0664

Expires xx/xx/xxxx

35

12. This activity offers the following types of assistance (select all that apply). [Check 

boxes]

Revolving loans

Loan guarantees 

Low interest loans

Interest buy-downs

Preferred interest loans

Instructions: Identify all types of loans your program offers, regardless of whether any 

loans of that type are currently outstanding. The types of loan products are defined as 

follows:

Interest buy-down loan: A loan in which AT program funds are used to buy down the 

interest rate of a loan. The AT program uses funds to reduce the interest rate that lending 

institutions offer to consumers for loans to purchase AT. The AT program pays the lending 

institution for a portion of the interest on the loan, resulting in lower interest payments for 

the consumer over the long term.

Loan guarantee or insurance program: The grantee uses its funds to guarantee all or a 

portion of loans for AT. A guaranteed loan is a loan in which the Statewide AT Program 

guarantees that the loan to a consumer is secure and will be repaid, thus increasing the 

lender’s willingness to loan funds. 

Low-interest loan: In a low-interest loan, a Statewide AT Program establishes an 

agreement with a lending institution to provide loans for AT at “preferred” interest rates. 

Preferred interest rates are highly variable and context-specific, depending upon such 

factors as the prime lending rate, the borrower’s credit rating, and whether the loan is 

secured. The mechanism or mechanisms by which states arrange for lending institutions to 

provide low-interest loans for AT are variable, but typically include a requirement that the 

Statewide AT Program deposit its funds with the lending institution. The interest that the 

Statewide AT Program’s funds would normally generate is then used by the lending 

institution to supplement the interest it charges consumers on loans for AT, thus resulting 

in lower interest rates paid by the consumers. There are two types of low-interest loans:

a. Low-interest loan (at or below prime rate*): A loan at interest rates that are at or 

below the prime rate. See below for a definition of prime rate.

b. Preferred interest loan: A loan offered at an interest rate that is lower than the 

consumer would normally pay, but not as low as the prime rate*. See below for a 

definition of prime rate.

Revolving loan: A loan that uses Statewide AT Program funds for loans. The AT 

program directly provides the funds that are to be loaned out and retains full control over 

to whom and at what terms the funds are loaned. As loans are repaid, the money is lent out 

again to other AT consumers — that is, the same money “revolves” out to other borrowers 

as earlier borrowers return it to the program.
1820-0664

Expires xx/xx/xxxx

36

Prime Rate: The prime rate is the average majority prime rate charged by banks on shortterm loans to business, quoted on an investment basis. The Federal Reserve notes that the 

"Rate posted by a majority of top 25 (by assets in domestic offices) insured U.S.-chartered 

commercial banks. Prime is one of several base rates used by banks to price short-term 

business loans." To determine whether a loan was made above, at, or below prime rate, 

check the national prime rate at the following website for the date on which the loan was 

closed: 

http://www.federalreserve.gov/Releases/H15/data/Daily/H15_PRIME_NA.txt

13. The lowest loan amount provided as established by the policies of the activity (leave 

blank if N/A). [Number field]

Instructions: The response to this item must be based on your established, written 

policies. This is not the lowest actually provided in a given year, but the lowest given 

your policies. Leave it blank if your policies do not specify a lowest.

14. The highest loan amount provided as established by the policies of the activity (leave 

blank if N/A). [Number field]

Instructions: The response to this item must be based on your established, written 

policies. This is not the highest actually provided in a given year, but the highest given 

your policies. Leave it blank if your policies do not specify a highest.

15. Provide any additional information about this activity you wish to share. [text box]
1820-0664

Expires xx/xx/xxxx

37

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section C: State Financing Activities

Cooperative buying program

Cooperative buying programs purchase AT in bulk at a discount from AT suppliers and then 

pass the savings on to consumers.

1. Enter the year when the program began conducting this activity. [Number field]

2. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

3. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

4. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

38

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental 

disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

5. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

6. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

7. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person
1820-0664

Expires xx/xx/xxxx

39

8. Describe the activity. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. This explanation should make it clear how this activity

is related to the purposes of the AT Act. It also should describe who the activity is intended 

to serve, specifically if only particular populations of individuals are served by the activity

or if there are qualifications for participation in the activity. The role of the Statewide AT 

Program in carrying out the activity should be explained clearly. The example provided 

below is for a Last Resort Fund, but a similar concept should be applied here. 

Example: Our Statewide AT Program supports a Last Resort Fund (LRF). The state 

Department of Community Living placed $500,000 in an interest-bearing account in 2006. 

The interest generated from this account is used to purchase AT devices for individuals with 

disabilities in need who apply to the LRF. The LRF can be accessed by an individual of 

any age with any disability. However, only individuals with disabilities who can clearly 

establish a need for AT but who do not qualify for AT through other systems such as 

Medicaid, VR, or special education, and cannot pay for a device on their own can receive a 

device paid for through this fund. Once an individual is determined qualified to receive a 

device through the LRF, he or she generally is referred to our device loan or device

demonstration program or to other qualified parties for assistance in determining the 

appropriate AT. The LRF also checks with reuse programs to see if the device is available 

used before making a new purchase. Once the AT has been selected, the LRF works with 

the vendor of that AT and the funds are paid directly to that vendor, who then provides the 

device to the consumer. While no AT Act funds are used to purchase devices (all purchases 

are paid for with interest from the account started by the community living agency), the 

Statewide AT Program incurs all costs of administering the LRF. Staff time is dedicated to 

reviewing applications, working with the vendors who provide the AT, processing all of the 

funds, and following-up with the recipient once a device is obtained. Additional resources 

are used to make and disseminate promotional materials about the LRF. 
1820-0664

Expires xx/xx/xxxx

40

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section C: State Financing Activities

Financing for home modifications program

A home modification program finances home modifications, including the addition of 

wheelchair ramps. States may not use AT Act dollars to provide funds or devices directly to 

individuals. AT Act dollars may be used to administer a home modification program 

comprising non-AT Act dollars.

1. Enter the year when the program began conducting this activity.

2. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

3. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

4. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

41

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

5. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

6. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

7. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person
1820-0664

Expires xx/xx/xxxx

42

8. Describe the activity. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. This explanation should make it clear how this activity

is related to the purposes of the AT Act. It also should describe who the activity is intended 

to serve, specifically if only particular populations of individuals are served by the activity

or if there are qualifications for participation in the activity. The role of the Statewide AT 

Program in carrying out the activity should be explained clearly. The example provided 

below is for a Last Resort Fund, but a similar concept should be applied here. 

Example: Our Statewide AT Program supports a Last Resort Fund (LRF). The state 

Department of Community Living placed $500,000 in an interest-bearing account in 2006. 

The interest generated from this account is used to purchase AT devices for individuals with 

disabilities in need who apply to the LRF. The LRF can be accessed by an individual of 

any age with any disability. However, only individuals with disabilities who can clearly 

establish a need for AT but who do not qualify for AT through other systems such as 

Medicaid, VR, or special education, and cannot pay for a device on their own can receive a 

device paid for through this fund. Once an individual is determined qualified to receive a 

device through the LRF, he or she generally is referred to our device loan or device 

demonstration program or to other qualified parties for assistance in determining the 

appropriate AT. The LRF also checks with reuse programs to see if the device is available 

used before making a new purchase. Once the AT has been selected, the LRF works with 

the vendor of that AT and the funds are paid directly to that vendor, who then provides the 

device to the consumer. While no AT Act funds are used to purchase devices (all purchases 

are paid for with interest from the account started by the community living agency), the 

Statewide AT Program incurs all costs of administering the LRF. Staff time is dedicated to 

reviewing applications, working with the vendors who provide the AT, processing all of the 

funds, and following-up with the recipient once a device is obtained. Additional resources 

are used to make and disseminate promotional materials about the LRF. 
1820-0664

Expires xx/xx/xxxx

43

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section C: State Financing Activities

Telecommunications distribution program

This is a program to distribute telecommunications equipment that serves the needs of people 

with disabilities, including safety needs during emergencies. States may not use AT Act dollars 

to provide funds or devices directly to individuals. AT Act dollars may be used to administer a 

telecommunications distribution program comprising non-AT Act dollars.

1. Enter the year when the program began conducting this activity.

2. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

3. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

4. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

44

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

5. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

6. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

7. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person
1820-0664

Expires xx/xx/xxxx

45

8. Describe the activity. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. This explanation should make it clear how this activity

is related to the purposes of the AT Act. It also should describe who the activity is intended 

to serve, specifically if only particular populations of individuals are served by the activity

or if there are qualifications for participation in the activity. The role of the Statewide AT 

Program in carrying out the activity should be explained clearly. The example provided 

below is for a Last Resort Fund, but a similar concept should be applied here. 

Example: Our Statewide AT Program supports a Last Resort Fund (LRF). The state 

Department of Community Living placed $500,000 in an interest-bearing account in 2006. 

The interest generated from this account is used to purchase AT devices for individuals with 

disabilities in need who apply to the LRF. The LRF can be accessed by an individual of 

any age with any disability. However, only individuals with disabilities who can clearly 

establish a need for AT but who do not qualify for AT through other systems such as 

Medicaid, VR, or special education, and cannot pay for a device on their own can receive a 

device paid for through this fund. Once an individual is determined qualified to receive a 

device through the LRF, he or she generally is referred to our device loan or device 

demonstration program or to other qualified parties for assistance in determining the 

appropriate AT. The LRF also checks with reuse programs to see if the device is available 

used before making a new purchase. Once the AT has been selected, the LRF works with 

the vendor of that AT and the funds are paid directly to that vendor, who then provides the 

device to the consumer. While no AT Act funds are used to purchase devices (all purchases 

are paid for with interest from the account started by the community living agency), the 

Statewide AT Program incurs all costs of administering the LRF. Staff time is dedicated to 

reviewing applications, working with the vendors who provide the AT, processing all of the 

funds, and following-up with the recipient once a device is obtained. Additional resources 

are used to make and disseminate promotional materials about the LRF. 
1820-0664

Expires xx/xx/xxxx

46

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section C: State Financing Activities

Last resort program

These programs provide AT, or funds to purchase AT, to consumers when all other options 

have been exhausted. These may be earmarked for particular types of consumers (such as 

children) or particular types of AT (such as home modification) or they may be for any group or 

type of AT. States may not use AT Act dollars to provide funds or devices directly to 

individuals. AT Act dollars may be used to administer a last resort fund comprised of non-AT 

Act dollars. 

1. Enter the year when the program began conducting this activity.

2. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

3. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

4. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

47

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental 

disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

5. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

6. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

7. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person
1820-0664

Expires xx/xx/xxxx

48

8. Describe the activity. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. This explanation should make it clear how this activity

is related to the purposes of the AT Act. It also should describe who the activity is intended 

to serve, specifically if only particular populations of individuals are served by the activity

or if there are qualifications for participation in the activity. The role of the Statewide AT 

Program in carrying out the activity should be explained clearly. The example below is an 

example of the style with which the entry should be written, not an example of what a last 

resort fund must be.

Example: Our Statewide AT Program supports a Last Resort Fund (LRF). The state 

Department of Community Living placed $500,000 in an interest-bearing account in 2006. 

The interest generated from this account is used to purchase AT devices for individuals with 

disabilities in need who apply to the LRF. The LRF can be accessed by an individual of 

any age with any disability. However, only individuals with disabilities who can clearly 

establish a need for AT but who do not qualify for AT through other systems such as 

Medicaid, VR, or special education, and cannot pay for a device on their own can receive a 

device paid for through this fund. Once an individual is determined qualified to receive a 

device through the LRF, he or she generally is referred to our device loan or device 

demonstration program or to other qualified parties for assistance in determining the 

appropriate AT. The LRF also checks with reuse programs to see if the device is available 

used before making a new purchase. Once the AT has been selected, the LRF works with 

the vendor of that AT and the funds are paid directly to that vendor, who then provides the 

device to the consumer. While no AT Act funds are used to purchase devices (all purchases 

are paid for with interest from the account started by the community living agency), the 

Statewide AT Program incurs all costs of administering the LRF. Staff time is dedicated to 

reviewing applications, working with the vendors who provide the AT, processing all of the 

funds, and following-up with the recipient once a device is obtained. Additional resources 

are used to make and disseminate promotional materials about the LRF. 
1820-0664

Expires xx/xx/xxxx

49

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section C: State Financing Activities

Other program

This is any state financing activity not covered in a previous section of this state plan. 

Feasibility studies would be described here.

 

1. Enter the year when the program began conducting this activity.

2. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

3. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

4. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

50

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

5. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

6. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

7. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person
1820-0664

Expires xx/xx/xxxx

51

8. Describe the activity. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. This explanation should make it clear how this activity

is related to the purposes of the AT Act. It also should describe who the activity is intended 

to serve, specifically if only particular populations of individuals are served by the activity

or if there are qualifications for participation in the activity. The role of the Statewide AT 

Program in carrying out the activity should be explained clearly. The example provided 

below is for a Last Resort Fund, but a similar concept should be applied here. 

Example: Our Statewide AT Program supports a Last Resort Fund (LRF). The state 

Department of Community Living placed $500,000 in an interest-bearing account in 2006. 

The interest generated from this account is used to purchase AT devices for individuals with 

disabilities in need who apply to the LRF. The LRF can be accessed by an individual of 

any age with any disability. However, only individuals with disabilities who can clearly 

establish a need for AT but who do not qualify for AT through other systems such as 

Medicaid, VR, or special education, and cannot pay for a device on their own can receive a 

device paid for through this fund. Once an individual is determined qualified to receive a 

device through the LRF, he or she generally is referred to our device loan or device 

demonstration program or to other qualified parties for assistance in determining the 

appropriate AT. The LRF also checks with reuse programs to see if the device is available 

used before making a new purchase. Once the AT has been selected, the LRF works with 

the vendor of that AT and the funds are paid directly to that vendor, who then provides the 

device to the consumer. While no AT Act funds are used to purchase devices (all purchases 

are paid for with interest from the account started by the community living agency), the 

Statewide AT Program incurs all costs of administering the LRF. Staff time is dedicated to

reviewing applications, working with the vendors who provide the AT, processing all of the 

funds, and following-up with the recipient once a device is obtained. Additional resources 

are used to make and disseminate promotional materials about the LRF. 
1820-0664

Expires xx/xx/xxxx

52

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section D: Device Reutilization Activities

The AT Act describes the State-level activity of device reutilization as follows:

“DEVICE REUTILIZATION PROGRAMS. —The State shall directly, or in collaboration with 

public or private entities, carry out assistive technology device reutilization programs that 

provide for the exchange, repair, recycling, or other reutilization of assistive technology

devices, which may include redistribution through device sales, loans, rentals, or donations.”

For the purposes of this State Plan, device reutilization activities are categorized as either 

device exchange activities or device reassignment activities. Device exchange activities are 

those in which the Statewide AT Program facilitates the transfer of a device from a consumer 

who does not need the device to a consumer who could use the device without the organization 

taking possession of the device at any time. Devices are listed in a “want ad” or other type of 

posting and consumers can contact and arrange to obtain the device (either by purchasing it or 

obtaining it for free) from the current owner. Exchange activities do not involve warehousing 

inventory and do not include repair, sanitization or refurbishing of used devices. In some cases, 

a Statewide AT Program serves as an intermediary directly involved in making this exchange; 

in others the consumer and current owner make this exchange without the involvement of the 

Statewide AT Program.

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for device 

exchange activities. 

If you indicated that you conduct two or more device exchanges, you will repeat the items 

below once for each device exchange you indicated.
1820-0664

Expires xx/xx/xxxx

53

1. Select the option that best describes the type of exchange. [Drop-down menu]

Instructions: The drop down box offers the following selections, use the definitions below 

to determine which type of device exchange to select (choose one):

o General device exchange

o Device exchange for targeted agencies or entities

 

General device exchange – This is an exchange available to the public for use. These 

include websites, want-ads in newsletters or other formats that can be accessed by any kind 

of consumer or professional

Device exchange for targeted individuals or entities – This is an exchange that is not open 

to the public and does not directly serve consumers; instead, the exchange was created and 

is used only by a specific agency or entity. For example, a statewide AT program may have 

developed and maintains an exchange that tracks used devices in a school system and 

allows school system employees to exchange these devices online. 

2. If you indicated this is a general exchange, describe it. If this exchange is part of a 

collaborative among states, identify the states and how the collaborative works as part of 

your description.

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. The role of the Statewide AT Program in carrying out 

the activity should be explained clearly. Describe the format or formats used for the 

exchange (e.g., website, want ads), how the format works (i.e., how a consumer makes a 

device available for exchange and how a consumer can receive a used device from the 

exchange) and how you collect data. 

Some Statewide AT programs support their device exchange specifically for their own state 

(though occasionally consumers in bordering states may be served). Other Statewide AT 

Programs work together and share their exchange sites within a region or make their devices 

available nationally. Provide the names of the other states participating in the collaborative 

exchange (abbreviations can be used) and how the collaboration “works.” If it is a national 

exchange and you do not know the other states participating, indicate that it is a national 

exchange.

3. If you indicated that your device exchange serves a particular entity or agency, identify 

the entity or agency and describe the purpose of the exchange: [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing.” This explanation should make it clear how this activity is 

related to the purposes of the AT Act. It also should describe who the activity is intended to 

serve, and how it is of benefit to the given agency. The role of the Statewide AT Program 

in carrying out the activity should be explained clearly. If you support more than one such 

exchange for more than one agency, each should be counted separately when answering 
1820-0664

Expires xx/xx/xxxx

54

how many device exchanges you support and you should respond to items about each 

separately.

Example: Under subcontract, our Statewide AT Program developed an online database of 

AT that is purchased for the Big City School System. When the Big City School System 

purchases AT it is barcoded and scanned into an inventory system that tracks information 

about the equipment and the school and class in which it is being used. The AT continues 

to be tracked until the student to whom it originally was assigned no longer needs it. It then 

is flagged as available for exchange and can be sent to any other school or class in the 

system that needs it. Before purchasing new AT, staff access a password protected website 

to view the inventory of devices available for exchange within the system. If there is a 

match, they request the device online and it is sent to them via the school’s interoffice mail. 

The Statewide AT Program is responsible for ongoing maintenance, quality control, and 

training on use of this site for the Big City School system. All barcoding and other data 

entry activities are done at the school level.

4. Enter the year when the program began conducting this activity. [Number field]

5. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

6. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

7. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

55

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabo

rate 

with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

8. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

9. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

10. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

11. The online page for this activity can be found at: [Text box]

Instructions: Enter the website address for this exchange, or enter N/A if the exchange is 

not online or the website cannot be accessed by the public.
1820-0664

Expires xx/xx/xxxx

56

12. Select the option that best describes what happens when a device is exchanged. 

[Drop-down menu]

Instructions: The drop down offers the following selections (choose one):

o the transaction is direct consumer-to-consumer 

o the Statewide AT Program is involved in the 

transaction

Use the following to determine how to respond:

The transaction is direct consumer-to-consumer - The exchange is set up so that the person 

who wants the device directly contacts the person who has the device and the two of them 

work out the details of the exchange without the involvement of the Statewide AT 

Program. Occasionally, an individual may not want to post contact information on the 

exchange and requests that the Statewide AT Program be the contact. In these cases, the 

Statewide AT Program’s only responsibility is providing the contact information to those 

who ask.

The Statewide AT Program is involved in the transaction - A consumer who wants a 

device must go through the Statewide AT Program to connect with the person who has the 

device. The role of the Statewide AT Program may vary once this connection has been 

made, but the Statewide AT Program undertakes some level of control over the exchanges 

made through its program.

13. Select the option that best describes the policy of the program for charging individuals 

with disabilities for a device. [Drop-down menu]

Instructions: The drop down offers the following selections (choose one):

o Nothing

o A flat fee for posting a device on the site 

o A flat fee when a device is exchanged 

o A percentage of the price when a device is exchanged

o Combination 

o Multiple subcontractors are used and they set their own policies

o Other

Many programs support their activities by charging some kind of fee. Here you will 

identify whether you charge a fee and if so what that fee is based upon. Even though 

exceptions may be made in particular cases, choose the answer that is closest to your 

policy. When selecting the answer, if you use a hierarchy to determine the fee, indicate 

which option begins the hierarchy. Example: If it is your policy to charge a flat fee, but a 

consumer indicates that he or she cannot pay the fee and you then would charge a 

percentage when the device is exchanged, select “flat fee” because it is your policy default.

A flat fee for posting – You charge only those who are offering devices for exchange, 

regardless of whether the device actually is exchanged.
1820-0664

Expires xx/xx/xxxx

57

A flat fee when an exchange is made – You do not charge for offering a device for 

exchange, but you charge a set amount when an exchange happens. Select this whether 

you charge the person giving the device, the person receiving the device, or both.

A percentage of the price when the device is exchanged – Unlike a flat fee charged when 

an exchange takes place, you collect a percentage of the “sale price” of the device. Select 

this whether you charge the person giving the device, the person receiving the device, or 

both.

Combination – Your policy may be to charge more than once. For example, you may

charge a fee for someone to offer the device and a fee to the recipient when the exchange 

is made. 

Multiple subcontractors are used and they set their own policies - If the charging of fees is 

at the discretion of subcontractors and those subcontractors set their own policies, there is 

an option to indicate this. If you use subcontractors but your subcontracts stipulate if/how 

fees are to be charged for all subcontractors, do not select this and instead reflect the 

policy you apply to all. If you use only one subcontractor, do not select this and respond 

to the item based on that one subcontractor’s policy. 

14. Provide any additional information about this activity you wish to share [Text box].
1820-0664

Expires xx/xx/xxxx

58

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section D: Device Reutilization Activities

The AT Act describes the State-level activity of device reutilization as follows:

“DEVICE REUTILIZATION PROGRAMS. —The State shall directly, or in collaboration with 

public or private entities, carry out assistive technology device reutilization programs that 

provide for the exchange, repair, recycling, or other reutilization of assistive technology

devices, which may include redistribution through device sales, loans, rentals, or donations.”

For the purposes of this State Plan, device reutilization activities are categorized as either 

device exchange activities or device reassignment activities. Device reassignment activities are 

those in which the Statewide AT Program accepts devices from donors and stores them until 

they can be given or sold to new owners. Some programs repair, sanitize, and/or refurbish the 

devices as needed, and then offer them for sale, loan, rental, or give away to consumers. The 

proxy for device reassignment under NISAT is device recycling/refurbishment/repair activities. 

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for device 

reassignment activities. 

If you indicated that you conduct two or more device reassignment programs, you will repeat 

the items below once for each device reassignment program you indicated. 

1. Select the option that best describes the type of reassignment program. [Drop-down 

menu]

Instructions: The drop down box offers the following selections, use the definitions below 

to determine which type of device exchange to select (choose one):

o Reassigns computers only

o Reassigns general AT

o Open-ended loan program
1820-0664

Expires xx/xx/xxxx

59

Computer-only reassignment – A program that reutilizes computers exclusively and 

the only AT devices reutilized are part of the computer. 

AT reassignment – A programs that reassigns any kind of AT (including durable medical 

equipment). A program that occasionally reassigns computers if they are donated would 

be included here rather than a computer-only program. 

Open-ended loan program – A program in which the device borrower can keep the 

device for as long as it is needed but it the policy of the program to require the device be 

returned. Do not select this if the intent of the program really is as a reassignment 

program and the choice to call it an open-ended loan is for legal or administrative reasons 

only. 

2. Enter the year when the program began conducting this activity. [Number field]

3. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

4. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a new 

program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

5. If you conduct this activity by providing financial or in-kind support to other entities, 

identify the kinds of entities you support in column (a) of the following table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

60

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabo

rate 

with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

6. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

7. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

8. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

9. Select the option that best describes the policy of the program for charging individuals 

with disabilities for a reutilized device. [Drop-down menu]
1820-0664

Expires xx/xx/xxxx

61

10. Select the option that best describes the policy of the program for charging 

professionals for a reutilized device. [Drop-down menu]

11. How do you get the device to the consumer? [Drop-down menu]

Instructions: The drop-down menu offers the following options (choose one):

o The device is shipped via mail or other commercial delivery

o The device is delivered to the consumer by staff

o The consumer picks up the device at a designated site

o Other

Statewide AT Programs use many methods for getting devices (or computers) to 

consumers under their device loan and device reuse programs. Here you will indicate the 

primary method you use. Your primary method should be your preferred or most 

frequently used method. Please note that in the option “the device is delivered to the 

consumer by staff,” your program determines who is designated as staff. This could 

include subcontractors and volunteers.

12. In the following table, select by device type how the device is reassigned. Select the 

top two used by the program.

Type of device

Based on 

consumer 

choice 

and/or 

request

A professional 

recommendation 

is required

Qualified 

program 

staff 

match it 

to the 

consumer

Qualified 

consultants 

and/or 

volunteers 

match it to 

the 

consumer

The 

device is 

provided 

through 

a 

qualified 

thirdparty

Not 

applicable 

- this 

type of 

device is 

not made 

available

Vision

Hearing

Speech 

Communication

Learning, 

Cognition, and 

Developmental

Mobility, 

Seating, and 

Positioning

Daily Living

Environmental 

Adaptations

Vehicle 

Modification 

and 

Transportation

Recreation, 

Sports, and 

Leisure 

Equipment
1820-0664

Expires xx/xx/xxxx

62

Computer and 

Associated 

Equipment

Instructions: Statewide AT Programs employ different strategies to ensure that reused 

devices will meet the needs of recipients. As the policy may change depending on a 

particular device within a larger device type, provide the two strategies most used by the 

program. Your program may employ a hierarchy of strategies or use different strategies 

depending on the individual’s need. Example: You first request that a consumer bring a 

professional recommendation. If the consumer cannot provide a professional 

recommendation, you then have qualified program staff work with the consumer. These 

would be the “top two” for the program. Another option is to select the two methods most 

frequently used. For example, the category of “mobility, seating, and positioning” 

includes both wheelchairs and walkers. These may be the most frequently reassigned 

devices but you may have very different policies for them (e.g., professional 

recommendation for a wheelchair but consumer choice for walker). In this case, you 

would select the strategy the corresponds to each because they would be the strategies 

most frequently used. 

Definitions and decision rules for each type of device are consistent with NISAT and are 

included as an appendix. If the answer is the same regardless of the device type, you need 

to repeat this information. 

If your program conducts a device reassignment program for computers only, you need 

answer this question only for the category of computers and associated equipment and 

select not applicable for the rest of the categories. 

Use the following to help make your selections: 

Based on consumer choice/request – Select this if you rely on the consumer’s assessment 

of his or her own needs. 

Professional recommendation – Select this if you require that a medical, educational, 

allied health, or other professional recommend a device before you will provide it. Your 

program defines whom it considers a professional and what constitutes a 

recommendation.

Qualified program staff match it to the consumer – Select this if your staff gather 

information from the consumer and use their expertise to determine what device they

believe may best meet the consumer’s need. Your program defines what it means to be 

qualified.

Qualified consultants/volunteers match it to the consumer – Select this if others outside 

your organization assist with matching on a regular or as-needed basis. Examples 

include: a retired rehabilitation engineer who volunteers once a week or an occupational 

therapist who you pay on a case-by-case basis to consult. Your program defines what it 

means to be qualified.
1820-0664

Expires xx/xx/xxxx

63

The device is provided through a qualified third party – Select this if you provide the 

device only when a qualified individual or agency requests it on behalf of someone and 

that individual or agency has done the work of determining the appropriate match. 

Example: An independent living center requests used devices on behalf of consumers. 

Your program defines what it means to be qualified.

Not applicable – this type of device is not made available - Your program may choose not 

to accept certain categories of devices. If you do not accept certain categories, choose 

this. Choosing not to accept a category of devices is different from having never received 

a device in that category, however. If you have not received a device in a given category, 

but would accept and reassign a device in it if available, provide the response for what 

you most likely would do under the circumstances.

13. If applicable, describe how consumers demonstrate the need for devices. [Text box]

Instructions: If a consumer must in some way qualify for a device from your reassignment 

program, describe how they qualify and the qualifications. Additionally, you may want to 

describe if your program assists the consumer with accessing appropriate funding streams 

to pay for a device before using the reassignment program. Explain in the simplest terms 

possible; a person unfamiliar with the program should be able to read this explanation and 

understand what the Statewide AT Program is “doing”. If consumers do not need to 

qualify or you do not provide assistance, simply state that they do not. 

Example: To receive a device from our reuse program, a consumer must (a) attest to 

having a disability, (b) lack or be denied public payment or private insurance coverage for 

the device, and (c) prove that the household income is not sufficient to purchase or to take 

out a financial loan to purchase the device. Before providing a device we work with the 

consumer to determine their eligibility for Medicaid, VR, or other systems that cover AT. 

If they prove ineligible, we then work with our AFP to see if he or she could obtain a loan 

for the purchase. During the period of looking at funding options, we provide a used 

device on a temporary basis. If he or she does not qualify for any funding options to 

purchase a new device, he or she can keep the used device permanently. If he or she 

qualifies for other funding, he or she returns the used device once he or she has obtained 

the new one.

14. Describe any supports provided to the consumer to ensure successful use of the 

device. [Text box]

Instructions: Describe any work you do with a consumer either before or after he or 

she obtains a device in order to ensure that the device is successfully used, such as: 

training the consumer or family members in use and maintenance of the device or 

requiring that the consumer receive training elsewhere; or following up with the 

consumer after they have received the device to see how it is working out and 

answer any questions. Explain in the simplest terms possible; a person unfamiliar 

with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. If you do provide supports, simply state that you 

do not. 
1820-0664

Expires xx/xx/xxxx

64

Example: Before a consumer receives a device, we provide on-site training on how 

to use and maintain it. A family member or friend must attend with the consumer so 

there is a back-up. A month after the consumer has taken the device, we call the 

consumer to see how the device is being used in the community and provide any 

assistance or troubleshooting. If this follow-up call shows it to be necessary, we will 

visit the consumer at home or work for further training.

15. Describe the activity. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a 

person unfamiliar with the program should be able to read this explanation and understand 

what the Statewide AT Program is “doing”. Describe the process for obtaining, 

refurbishing (if applicable), and reassigning devices. If the program is for a particular 

agency or entity, identify that agency or entity and the purpose and population served.

Example: The MS society subcontracts with us to operate an open-ended loan 

program for individuals with MS in the state. We have a pool of communication 

and adaptive daily living devices set aside for this program. When the MS society

identifies an individual in need, they contact and inform us of the types of devices 

that could assist him or her. We arrange to provide the devices, and support for their 

use, to the individual. We track all devices as they come in and out of the program, 

and contact the individual with the device on a regular basis to determine if he or she 

still is benefiting from it. When the device no longer can be used by the individual, 

we collect it and take care of any necessary sanitization and maintenance of the item 

in preparation for another open-ended loan. 
1820-0664

Expires xx/xx/xxxx

65

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section E: Device Loan Activity 

The AT Act says that Statewide AT Programs are to “directly or in collaboration with public or 

private entities, carry out device loan programs that provide short-term loans of assistive 

technology devices to individuals, employers, public agencies, or others seeking to meet the 

needs of targeted individuals and entities, including others seeking to comply with IDEA, ADA 

and Section 504.”

The purpose of a device loan may be to assist in decision making, to serve as a loaner while the 

consumer is waiting for device repair or funding, to provide an accommodation on a short-term 

basis or for other purposes. “Other” purposes include: (1) self-education by a consumer for the 

purpose of later decision making (e.g., when the school year begins); (2) self-education by an 

intermediary (e.g., a teacher) whose purpose is to become familiar with the device; and (3) 

training. 

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for device 

loan activities. 

If you indicated that you conduct two or more device loan activities, you will repeat the items 

below once for each device loan activity you indicated. 

1. Select the option that best describes the type of program. [Drop-down menu]

Instructions: The drop-down menu offers the following options (choose one):

o General program 

o Program for targeted consumers 

o Program for targeted agencies or entities

o Other
1820-0664

Expires xx/xx/xxxx

66

Some Statewide AT Programs have a pool of devices available for loan to anyone for any

purpose, while others maintain several pools of devices, some for the public and some for 

specific audiences or purposes. Use the definitions below to determine the best description 

of the types of device loan activities you conduct. You will repeat these questions again if 

you have more than one type of loan activities, so select only one descriptor here. Note that 

you are required to provide annual data for any activity claimed in this State Plan.

General device loan program – Devices in the loan inventory are available to most targeted 

individuals and entities for most purposes.

Device loan program for targeted consumers - Devices in the loan inventory are reserved 

for the use of certain consumers. The type of consumer can be defined by age, disability, 

intended purpose, or other characteristic. If they are reserved for the use of particular 

professionals, you should answer that it is for targeted agencies or entities. If the type of 

consumer is linked to an agency or entity, you also would answer targeted agency or entity

(e.g., the pool is reserved for children being served by early intervention agencies is 

different from a pool reserved for infants and toddlers). 

Device loan program for targeted agencies or entities – Devices in the loan inventory are 

reserved for the use of a certain agency or entity (e.g., you have a pool of communication 

devices specifically set aside for the use of a nearby school district). This can apply to both 

consumers and professionals who receive the loan through the agency in question. 

Other – The device loan inventory is not available like a general loan inventory, but the 

exclusions are not related to a type of consumer or entity.

2. If you indicated that you have a device loan program for targeted consumers or 

devices, describe the specific types of consumers or devices for whom the loan program is 

intended and why. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. It also should describe to whom the activity is intended 

to serve, and how it is of benefit to the consumer. The role of the Statewide AT Program in 

carrying out the activity should be explained clearly. 

Example: We maintain an inventory of augmentative communication devices specifically

for children with autism. We purchased the devices in this inventory specifically with 

children with autism in mind because their needs are distinct and our program received so 

many requests for assistance from their families. There are duplicates of some of the 

devices in our general loan inventory, but if the person requesting a device identifies that it 

is for an autistic child, the device comes from this specific pool before we loan it to him or 

her from the general pool. A staff member with expertise in autism is assigned to assist all 

those who receive devices from this inventory.

3. If you indicated that you have a device loan program for targeted agencies or entities, 

identify the entity or agency and describe the purpose of the program. [Text box]
1820-0664

Expires xx/xx/xxxx

67

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. It also should describe who the activity is intended to 

serve, and how it is of benefit to the consumer. The role of the Statewide AT Program in 

carrying out the activity should be explained clearly. 

Example: We have a partnership to provide device loans to vocational rehabilitation

counselors serving students in transition. All requests for device loans for students in 

transition come to us from the VR agency and are fulfilled from a pool of devices set aside 

for this purpose. The devices were purchased using funds provided by the VR agency, but 

the Statewide AT Program provides the management of the pool and staff expertise related 

to the devices at no cost to the agency. 

4. If you selected other, describe. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. It also should describe who the activity is intended to 

serve, and how it is of benefit. The role of the Statewide AT Program in carrying out the 

activity should be explained clearly. 

5. Enter the year when the program began conducting this activity. [Number field]

6. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

7. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a 

new program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.
1820-0664

Expires xx/xx/xxxx

68

8. If you conduct this activity by providing financial or in-kind support to other 

entities, identify the kinds of entities you support in column (a) of the following 

table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following 

table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

9. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

10. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]
1820-0664

Expires xx/xx/xxxx

69

11. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

12. Select the option that best describes the policy of the program for charging 

individuals with disabilities for a loan. [Drop-down menu]

13. Select the option that best describes the policy of the program for charging 

professionals for a loan. [Text box]

14. Describe any supports provided to the consumer to ensure a successful loan. [Text 

box]

Instructions: Some loan programs provide support to consumers on multiple levels at 

multiple times to improve the loan experience. Describe the types of supports you 

provide, if any. Explain in the simplest terms possible how this activity is conducted; a 

person unfamiliar with the program should be able to read this explanation and understand 

what the Statewide AT Program is “doing”. 

Example: Every device sent out from our loan inventory comes both with the 

manufacturer’s instructions and a “cheat sheet” of basic instructions. Prior to sending the 

device, we ensure that at least one adult in the household receiving the device is able to 

read the instructions that are sent. A week after a device has been sent, we place a followup call to the recipient to ask (a) if the device has arrived and (b) if they need any

assistance with setting it up. If it has not been set up, we call back in another week. If it 

already has been set up, we ask them a series of questions to probe how 

successfully/correctly the device is being used. If it appears that the consumer is having 

difficulty, we troubleshoot the situation or offer a different device.

15. Devices in the loan pool also are made available for the following (choose all that 

apply). [Check boxes]

Device demonstrations

Evaluations and assessments

Training

Public awareness

Instructions: Indicate other purposes for which you allow your device loan devices to be 

used, whether the other use is internal to your program only or if you allow others to 

receive a loan for the given purpose. This includes if you allow a professional not 

affiliated with your program to check out a device for the purpose of evaluating a 

consumer or conducting a training.
1820-0664

Expires xx/xx/xxxx

70

16. How do you get the device to the consumer? [Drop-down menu]

Instructions: The drop-down menu offers the following options (choose one):

o The device is shipped via mail or other 

commercial delivery

o The device is delivered to the consumer by 

staff

o The consumer picks up the device at a 

designated site

o Other

Statewide AT Programs use many methods for getting devices to consumers under their 

device loan and device reuse programs. Here you will indicate the primary method you 

use. Your primary method should be your preferred or most frequently used method. 

Please note that in the option “the device is delivered to the consumer by staff,” your 

program determines who is designated as staff. This could include subcontractors and 

volunteers.

17. Provide any additional information about this activity you wish to share. [Text box]
1820-0664

Expires xx/xx/xxxx

71

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section F: Device Demonstration Activity 

The AT Act describes device demonstrations as activities to “directly, or in collaboration with 

public and private entities, such as one-stop partners, as defined in section 101 of the 

Workforce Investment Act of 1998 (29 U.S.C. 2801), demonstrate a variety of assistive 

technology devices and assistive technology services (including assisting individuals in making 

informed choices regarding, and providing experiences with, the devices and services), using 

personnel who are familiar with such devices and services and their applications.” Section 

4(e)(2)(D)

In a device demonstration for an individual, guided experience with the device(s) is provided to 

the participant with the assistance of someone who has technical expertise related to the 

device(s). This expert may be in the same location as the participant or may assist the 

participant through Internet or distance learning mechanism that provides real-time, effective 

communication to deliver the necessary device exploration. 

A demonstration is characterized by its interactive nature whereby the participant can interact 

with an expert to increase their knowledge and understanding about the details and functions of 

a device; the participant drives the demonstration and has the ability to interact and have their 

individual questions about the device addressed. If the demonstration is conducted via the 

internet or distance learning mechanism it must be a real-time, interactive demonstration that 

provides one-on-one assistance to the participant. A web-based demonstration that is archived 

or is a static presentation without interaction is considered an awareness activity, not a 

demonstration. If a demonstration is to be conducted without the participant having direct 

(hands-on) access to the devices to be demonstrated, the interaction must be structured to 

ensure the device can be adequately explored to enable decision-making. 

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for device 

demonstration activities. 
1820-0664

Expires xx/xx/xxxx

72

If you indicated that you conduct two or more device demonstration activities, you will repeat 

the items below once for each device demonstration activity you indicated. 

1. Select the option that best describes the type of program. [Drop-down menu]

Instructions: The drop-down menu offers the following options (choose one):

o General device demonstration program 

o Device demonstration program for targeted consumers 

o Device demonstration program for targeted agencies or entities

o Other

Some Statewide AT Programs have a pool of devices available to demonstration to anyone 

for any purpose, while others maintain several pools of devices, some for the public and 

some for specific audiences or purposes. Use the definitions below to determine the best 

description of the types of device demonstration activities you conduct. You will repeat 

these questions again if you have more than one type of demonstration activities, so select 

only one descriptor here. Note that you are required to provide annual data for any activity

claimed in this State Plan.

General device demonstration program – Devices in the demonstration inventory are 

available to most targeted individuals and entities for most purposes.

Device demonstration program for targeted consumers - Devices in the demonstration 

inventory are reserved for the use of certain consumers. The type of consumer can be 

defined by age, disability, intended purpose, or other characteristic. If they are reserved for 

the use of particular professionals, you should answer that it is for targeted agencies or 

entities. If the type of consumer is linked to an agency or entity, you also would answer 

targeted agency or entity (e.g., the pool is reserved for children being served by early 

intervention agencies is different from a pool reserved for infants and toddlers). 

Device demonstration program for targeted agencies or entities – Devices in the 

demonstration inventory are reserved for the use of a certain agency or entity (e.g., you have 

a pool of communication devices specifically set aside for the use of a nearby school 

district). This can apply to both consumers and professionals who receive the 

demonstration through the agency in question. 

Other – The device demonstration inventory is not available like a general demonstration 

inventory, but the exclusions are not related to a type of consumer or entity.

2. If you indicated that you have a device demonstration program for targeted consumers 

or devices, describe the specific types of consumers or devices for whom this 

demonstration program is intended and why. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. It also should describe who the activity is intended to 
1820-0664

Expires xx/xx/xxxx

73

serve, and how it is of benefit to the consumer. The role of the Statewide AT Program in 

carrying out the activity should be explained clearly. 

Example: Under an agreement with AARP, we have a special demonstration program for 

senior citizens. The inventory for this program consists of the most popular and affordable

AT for the elderly who live on their own or in nursing homes. Twice a month, all of the 

devices in this program are taken to locations such as nursing homes, senior centers, and 

hospitals. Staff spend a full day at the location providing one-on-one demonstrations to 

those being served there.

3. If you indicated that you have a device demonstration program for targeted agencies or 

entities, identify the entity or agency and describe the purpose of the program. [Text box]

Instructions: See instructions for item 2.

4. If you selected other, describe. [Text box]

Instructions: Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing”. It also should describe whom the activity is intended to 

serve, and how it is of benefit. The role of the Statewide AT Program in carrying out the 

activity should be explained clearly. 

5. Enter the year when the program began conducting this activity.

6. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

7. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a 

new program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.
1820-0664

Expires xx/xx/xxxx

74

8. If you conduct this activity by providing financial or in-kind support to other 

entities, identify the kinds of entities you support in column (a) of the following 

table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following 

table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

9. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

10. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]
1820-0664

Expires xx/xx/xxxx

75

11. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

12. Select the option that best describes the primary type of demonstrations provided by 

the program. [Drop-down menu]

Instructions: The drop-down menu offers the following selections (choose one):

o In-person demonstrations from one fixed location

o In-person demonstrations at fixed regional sites

o In-person demonstrations that move to multiple sites

o In-person demonstrations from a mobile unit(s)

o Virtual demonstrations via technology

For this item, you identify the primary method. The next item allows you to identify a 

secondary method. The primary method should be your preferred or most frequently used 

method, and secondary the next in your hierarchy. Use the following definitions when 

determining the type of method:

In-person demonstrations from one fixed location – You have a central location that 

houses all employees and resources engaged in the activity. If you have a central location 

and use other strategies described here, remember you can choose a primary and 

secondary. It is assumed that there is a correlation between your response to this item and 

your response to the general item about the use of central locations vs. regional sites. 

In-person demonstrations at fixed regional sites – You have at least two sites that operate 

relatively independently and house their own employees and separate resources. If one of 

these sites is considered the central site or “headquarters,” that site most likely should be 

identified as either your primary or secondary “one fixed location.” Regional sites can be 

directly managed by the Lead Agency/Implementing Entity or can be subcontractors. 

Sites that simply serve as referral sources or provide minimal assistance to a central 

location are not considered regional sites.

In-person demonstrations that move to multiple sites – You use community-based sites on 

a temporary basis, and staff and equipment move from site to site. For example, a staff 

member travels from independent living center to independent living center across the 

state with a vehicle full of devices. The staff member spends a week at each independent 

living center performing demonstrations. If the staff members and equipment are sent out 

from a primary site, that site most likely should be identified as either your primary or 

secondary “one fixed location.” This option is not to be confused with a mobile unit, 

wherein the vehicle transporting devices serves as a demonstration in and of itself. It also 

is not to be confused with regional sites, which are fixed locations. 
1820-0664

Expires xx/xx/xxxx

76

In-person demonstrations from a mobile unit(s) – Unlike demonstrations that move to 

multiple sites, a mobile unit is designed to be a demonstration in and of itself. This is 

different from a vehicle in which devices are transported. 

Virtual demonstrations via technology – You deliver a demonstration using the Internet or 

some other distance learning technology rather than in-person, regardless of whether the 

recipient of the demonstration has hands-on access to the device. 

Select the option that best describes the secondary type of demonstrations provided 

by the program. [Drop-down menu]

Instructions: Same instructions for primary type.

13. Select the option that best describes the policy of the program for charging individuals 

with disabilities for a demonstration. [Drop-down menu]

14. Select the option that best describes the policy of the program for charging 

professionals for a demonstration. [Drop-down menu]

 

15. Devices in the demonstration pool also are made available for the following (choose 

all that apply). [Check boxes]

Device loans

Evaluations and assessments

Training

Public awareness

Instructions: Indicate other purposes for which you allow your device demonstration 

devices to be used, whether the other use is internal to your program only or if you allow 

others to receive a loan for the given purpose. This includes if you allow a professional 

not affiliated with your program to check out a device for the purpose of evaluating a 

consumer or conducting training.

17. Select the option that best describes what is shared with the device loan program. 

[Drop-down menu]

Instructions: The drop-down menu offers the following selections:

o Staff

o Space

o Not applicable

Many Statewide AT Programs share resources between their device demonstration and 

device loan programs. Identify here the resources shared between your programs. If you 

share devices, this already should have been identified. 

18. Provide any additional information about this activity you wish to share. [Text box]
1820-0664

Expires xx/xx/xxxx

77

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section G1: State Leadership Activities

Training Activities

The AT Act describes training as follows:

“(i) TRAINING AND TECHNICAL ASSISTANCE. —

(I) IN GENERAL. —The State shall directly, or provide support to public or private entities 

with demonstrated expertise in collaborating with public or private agencies that serve 

individuals with disabilities, to develop and disseminate training materials, conduct training, 

and provide technical assistance, for individuals from local settings statewide, including 

representatives of State and local educational agencies, other State and local agencies, early 

intervention programs, adult service programs, hospitals and other health care facilities, 

institutions of higher education, and businesses.

(II) AUTHORIZED ACTIVITIES. —In carrying out activities under subclause (I), the State 

shall carry out activities that enhance the knowledge, skills, and competencies of individuals 

from local settings described in subclause (I), which may include—

(aa) general awareness training on the benefits of assistive technology and the Federal, State, 

and private funding sources available to assist targeted individuals and entities in acquiring 

assistive technology;

(bb) skills-development training in assessing the need for assistive technology devices and 

assistive technology services;

(cc) training to ensure the appropriate application and use of assistive technology devices, 

assistive technology services, and accessible technology for e-government functions;

(dd) training in the importance of multiple approaches to assessment and implementation 

necessary to meet the individualized needs of individuals with disabilities; and

(ee) technical training on integrating assistive technology into the development and 

implementation of service plans, including any education, health, discharge, Olmstead, 

employment, or other plan required under Federal or State law.”

Training activities are instructional events, usually planned in advance for a specific purpose or 

audience, that are designed to increase participants’ knowledge, skills, and competencies 

regarding AT. Such events can be delivered to large or small groups, in-person, or via 

telecommunications or other distance education mechanisms. In general, participants in training 

can be individually identified and could complete an evaluation of the training. Examples of 

training include classes, workshops, and presentations that have a goal of increasing skills, 

knowledge, and competency, as opposed to training intended only to increase general 
1820-0664

Expires xx/xx/xxxx

78

awareness of AT. Training activities have more depth and breadth than public awareness 

activities and are focused on skill building and competency development. 

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for training 

activities. 

1. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

2. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a 

new program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

3. If you conduct this activity by providing financial or in-kind support to other 

entities, identify the kinds of entities you support in column (a) of the following 

table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following 

table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

79

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental 

disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

4. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

5. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

6. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person
1820-0664

Expires xx/xx/xxxx

80

7. Select the option that best describes how training is primarily provided.

Instructions: The drop-down menu offers the following selections (choose one):

o At fixed sites supported by the Statewide AT Program.

o At sites arranged by those receiving the training.

o Via distance learning technology.

While it is likely you deliver training in many situations, you will identify the primary

method you use to deliver training. Choose the answer that is your policy or your preferred 

or most frequently used method. Use the following definitions when determining the type 

of method:

At fixed sites supported by the Statewide AT Program – Whether you have a central location 

or use regional sites, you ask that trainees come to one of your facilities to receive training.

At sites arranged by those receiving the training – When training is requested, you go to 

one of the trainee’s facilities to provide it.

Via distance learning technology - Trainings are not provided on-site. 

8. Select the option that best describes the policy of the program for charging individuals 

with disabilities for training. [Drop-down menu]

9. Select the option that best describes the policy of the program for charging 

professionals for training. [Drop-down menu]

10. Provide any additional information about this activity you wish to share
1820-0664

Expires xx/xx/xxxx

81

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section G2: State Leadership Activities

Technical Assistance Activities

The AT Act describes training as follows:

“(i) TRAINING AND TECHNICAL ASSISTANCE. —

(I) IN GENERAL. —The State shall directly, or provide support to public or private entities 

with demonstrated expertise in collaborating with public or private agencies that serve 

individuals with disabilities, to develop and disseminate training materials, conduct training, 

and provide technical assistance, for individuals from local settings statewide, including 

representatives of State and local educational agencies, other State and local agencies, early 

intervention programs, adult service programs, hospitals and other health care facilities, 

institutions of higher education, and businesses.

(II) AUTHORIZED ACTIVITIES. —In carrying out activities under subclause (I), the State 

shall carry out activities that enhance the knowledge, skills, and competencies of individuals 

from local settings described in subclause (I), which may include—

(aa) general awareness training on the benefits of assistive technology and the Federal, State, 

and private funding sources available to assist targeted individuals and entities in acquiring 

assistive technology;

(bb) skills-development training in assessing the need for assistive technology devices and 

assistive technology services;

(cc) training to ensure the appropriate application and use of assistive technology devices, 

assistive technology services, and accessible technology for e-government functions;

(dd) training in the importance of multiple approaches to assessment and implementation 

necessary to meet the individualized needs of individuals with disabilities; and

(ee) technical training on integrating assistive technology into the development and 

implementation of service plans, including any education, health, discharge, Olmstead, 

employment, or other plan required under Federal or State law.”

Technical Assistance (TA) is direct problem-solving services provided by Statewide AT 

Program staff to assist programs and agencies in improving their services, management, 

policies and/or outcomes. TA may be provided in person, by electronic media such as 

telephone, video or e-mail and by other means. The following are examples of technical 

assistance: needs assessment, program planning or development, curriculum or materials 

development, administrative or management consultation, program evaluation and site reviews 

of external organizations, and policy development.
1820-0664

Expires xx/xx/xxxx

82

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for 

technical assistance activities. 

1. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)

2. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a 

new program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

3. If you conduct this activity by providing financial or in-kind support to other 

entities, identify the kinds of entities you support in column (a) of the following 

table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following 

table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.
1820-0664

Expires xx/xx/xxxx

83

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabo

rate 

with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

4. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

5. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

6. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

7. Select the option that best describes the policy of the program for charging for 

technical assistance. [Drop-down menu]

8. Provide any additional information about this activity you wish to share [Text box].
1820-0664

Expires xx/xx/xxxx

84

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section G3: State Leadership Activities

Public Awareness Activities

The AT Act says the following about Public Awareness

“The State shall conduct public-awareness activities designed to provide information to targeted 

individuals and entities relating to the availability, benefits, appropriateness, and costs of 

assistive technology devices and assistive technology services, including—

(aa) the development of procedures for providing direct communication between providers of 

assistive technology and targeted individuals and entities, which may include partnerships with 

entities in the statewide and local workforce investment systems established under the 

Workforce Investment Act of 1998 (29 U.S.C. 2801 et seq.), State vocational rehabilitation 

centers, public and private employers, or elementary and secondary public schools;

(bb) the development and dissemination, to targeted individuals and entities, of information 

about State efforts related to assistive technology; and

(cc) the distribution of materials to appropriate public and private agencies that provide social, 

medical, educational, employment, and transportation services to individuals with disabilities.”

Public awareness activities are designed to reach large numbers of people, including activities 

such as public service announcements, radio talks shows and news reports, newspaper stories 

and columns, newsletters, brochures, and public forums. 

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for public 

awareness activities. 

1. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)
1820-0664

Expires xx/xx/xxxx

85

2. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a 

new program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

3. If you conduct this activity by providing financial or in-kind support to other 

entities, identify the kinds of entities you support in column (a) of the following 

table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following 

table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of 

hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 
1820-0664

Expires xx/xx/xxxx

86

individuals with physical disabilities

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

4. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

5. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

6. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

7. Describe the activity. [Text box]

Instructions: This should include a description of the major activities that occur on an 

ongoing basis. Explain in the simplest terms possible how this activity is conducted; a 

person unfamiliar with the program should be able to read this explanation and understand 

what the Statewide AT Program is “doing.” 

Example: Our statewide AT Program conducts 3 major public awareness activities on an 

annual basis. 

(1) We sponsor the state’s annual AT awareness day. On AT awareness day, 

stakeholders in the field of AT gather in the state capitol for a small festival 

featuring events and a device pavilion. As sponsor, we are responsible for 

arranging the facilities, logistics, and publicity for the event, though other 

agencies and organizations contribute funds.

(2) We have a booth at 3-5 conferences/expos every year, such as education 

conferences and health expos. Depending on the theme and attendees of the 

conference, the booth features various devices and staff with appropriate 

expertise. We also distribute material to promote the program and general 

information about AT.

(3) In partnership with the state chapter of AARP, we do a once-a-year mailing to 

all AARP members in the state that includes information about AT and the 

services available through our program. 
1820-0664

Expires xx/xx/xxxx

87

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section G4: State Leadership Activities

Information and Assistance Activities

The AT Act says the following about information and referral activities, which for the purpose 

of this State Plan are called information and assistance activities:

“(aa) IN GENERAL. — The State shall directly, or in collaboration with public or private (such 

as nonprofit) entities, provide for the continuation and enhancement of a statewide information 

and referral system designed to meet the needs of targeted individuals and entities.

(bb) CONTENT. — The system shall deliver information on assistive technology devices, 

assistive technology services (with specific data regarding provider availability within the 

State), and the availability of resources, including funding through public and private sources, 

to obtain assistive technology devices and assistive technology services. The system shall also 

deliver information on the benefits of assistive technology devices and assistive technology

services with respect to enhancing the capacity of individuals with disabilities of all ages to 

perform activities of daily living.” 

Section 4(d)(5) of the AT Act requires that the State Plan include a description of how the 

Statewide AT Program will implement its State-level and State Leadership activities. Further, 

section 4(d)(4) requires that the State Plan describe how various public and private entities will 

be involved in the implementation of those activities, including a description of the nature and 

extent of resources that will be committed by public and private collaborators. Section 4(d)(7) 

also requires that the State Plan include a description of the State-level and State Leadership 

Activities the state will support with state funds. Section 4(e)(3)(B)(iii) requires that states 

coordinate and collaborate their State-level and State Leadership activities among public and 

private entities. The following items are items intended to meet these requirements for 

information and assistance activities.

1. Who conducts this activity? Check all that apply.

The Statewide AT Program

Other entities (e.g. contractors)
1820-0664

Expires xx/xx/xxxx

88

2. The Statewide AT Program provides and/or receives the following support (choose all 

that apply).

Provides financial support to other entities via an agreement with the Statewide AT 

Program. 

Provides in-kind support to other entities via an agreement with the Statewide AT 

Program.

Receives financial support from the state.

Receives in-kind support from the state.

Receives financial support from private entities.

Receives in-kind support from private entities.

Coordinates and collaborates with other entities for the purpose of establishing a 

new program or service.

Coordinates and collaborates with other entities for the purpose of expanding an 

existing program or service.

Coordinates and collaborates with other entities for the purpose of reducing 

duplication of programs or services.

3. If you conduct this activity by providing financial or in-kind support to other 

entities, identify the kinds of entities you support in column (a) of the following 

table.

If you receive financial or in-kind support from the state to conduct this activity, 

identify the state entities that provide this support in column (b) of the following 

table.

If you receive financial or in-kind support from private entities, identify the private 

entities that provide this support in column (c) of the following table.

If you coordinate and collaborate with other entities in conducting this activity, 

identify those entities in column (d) of the following table.

Organization or Activity

a. You 

provide 

support

b. 

Receive 

support 

from 

the 

state

c. 

Receive 

support 

from 

these 

private 

entities

d. 

Collabor

ate with

AgrAbility Program

Alliance for Technology Access Center

Bank or other financial institution

Community Living agency

Easter Seals

Education-related agency

Employment-related agency

Health, allied health, and rehabilitationrelated agency

Independent Living Center

Institution of Higher Education

Non-categorical disability organization

Organization that primarily serves 

individuals who are blind or visually 

impaired

Organization that primarily serves 

individuals who are deaf or hard of hearing

Organization that primarily serves 

individuals with developmental disabilities

Organization that primarily serves 

individuals with physical disabilities
1820-0664

Expires xx/xx/xxxx

89

Organization focused specifically on 

providing AT

Protection and Advocacy Organization

Technology agency

UCP

Other

4. Select the option that best describes from where this activity is conducted.

One central location 

Regional sites 

A combination of a central location and regional sites

5. If you indicated the use of regional sites, from how many regional sites is the activity 

conducted? [Number field]

6. This activity is available (choose all that apply).

By website

By phone

By e-mail

By mail

In person

7. Describe the activity. [Text box]

Instructions: This should include a description of how a consumer in need of information 

and assistance can contact your program and how your program would provide assistance to 

him or her. Explain in the simplest terms possible how this activity is conducted; a person 

unfamiliar with the program should be able to read this explanation and understand what the 

Statewide AT Program is “doing.”

Example: Our Statewide AT Program has four regional sites. Each site has a half-time 

person devoted to answering information and assistance calls and e-mails and this person 

receives extensive and ongoing training. A consumer can call any of the four sites (usually 

he or she is directed to the one closest to where he or she lives) and either speak to the staff 

or leave a message via voicemail. E-mail inquiries are handled similarly, except that they

all go to a general account and then are forwarded to the appropriate staff member. Our 

policy is to respond to all inquiries within one business day. When contacting a consumer, 

the staff has a routine of questions to ask to ensure that we have all of the information 

necessary to connect the consumer with appropriate resources. The expertise of the staff 

about AT-related resources in the state is backed up by several three-ring binders full of 

topical information for quick reference. If staff is not able to respond to a request for 

assistance alone, the request is brought to the weekly staff meeting to problem-solve. 
1820-0664

Expires xx/xx/xxxx

90

Assistive Technology State Grant 

Program

State Plan for FY 2009-2011

Section H: Assurances, Measurable Goals, 

and Signature

Section 4(d) of the AT Act prescribes the duties of the Lead Agency receiving a grant under 

section 4 of the AT Act and requires the State to provide a number of assurances in its 

application for funds. 34 CFR part 76 also requires that any State Plan include certain 

assurances. Your certifying representative will attest to these assurances and other 

requirements below and will sign the State Plan, indicating that to the best of his or her 

knowledge and belief all information provided in the State Plan is true and correct and the State 

Plan fully discloses all known weaknesses concerning the accuracy, reliability, and 

completeness of the information.

1. As Certifying Representative of the Lead Agency for the State of [state name will 

automatically populate], I hereby assure the following:

2. The Lead Agency prepared and submitted this State Plan on behalf of the State of 

[state name will automatically populate].

3. The Lead Agency submitting this plan is the State agency that is eligible to submit 

this plan.

4. The State agency has authority under State law to perform the functions of the 

State under this program.

5. The State legally may carry out each provision of this plan.

6. All provisions of this plan are consistent with State law.

7. A State officer, specified by title in this certification, has authority under State law 

to receive, hold, and disburse Federal funds made available under the plan.

8. The State officer who submits this plan, specified by title in this certification, has 

authority to submit this plan.

9. The agency that submits this plan has adopted or otherwise formally approved this 

plan.

10. The plan is the basis for State operation and administration of the program.

11. The Lead Agency will maintain and evaluate the program under this State Plan.
1820-0664

Expires xx/xx/xxxx

91

12. The State will annually collect data related to the required activities implemented 

by the State under this section in order to prepare the progress reports required 

under subsection 4(f) of the Act. 

13. The Lead Agency will submit the progress report on behalf of the State. 

14. The State will prepare reports to the Secretary in such form and containing such 

information as the Secretary may require to carry out the Secretary's functions 

under this Act and keep such records and allow access to such records as the 

Secretary may require to ensure the correctness and verification of information 

provided to the Secretary.

15. The Lead Agency will control and administer the funds received through the grant. 

16. The Lead Agency will make programmatic and resource allocation decisions 

necessary to implement the State Plan.

17. Funds received through the grant will be expended in accordance with Section 4 of 

the Act, and will be used to supplement, and not supplant, funds available from 

other sources for technology-related assistance, including the provision of assistive 

technology devices and assistive technology services. 

18. The Lead Agency will ensure conformance with Federal and State accounting 

requirements.

19. The State will adopt such fiscal control and accounting procedures as may be 

necessary to ensure proper disbursement of and accounting for the funds received 

through the grant. 

20. Funds made available through a grant to a State under this Act will not be used for 

direct payment for an assistive technology device for an individual with a disability. 

21. A public agency or an individual with a disability holds title to any property 

purchased with funds received under the grant and administers that property. 

22. The physical facility of the Lead Agency and Implementing Entity, if any, meets the 

requirements of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et 

seq.) regarding accessibility for individuals with disabilities. Section 4(d)(6)(E)

23. Activities carried out in the State that are authorized under this Act, and supported 

by Federal funds received under this Act, will comply with the standards 

established by the Architectural and Transportation Barriers Compliance Board 

under section 508 of the Rehabilitation Act of 1973 (20 U.S.C. 794d). Section 

4(d)(6)(G)

24. The Lead Agency will coordinate the activities of the State Plan among public and 

private entities, including coordinating efforts related to entering into interagency 

agreements.

25. The Lead Agency will coordinate efforts related to the active, timely, and 

meaningful participation by individuals with disabilities and their family members, 

guardians, advocates, or authorized representatives, and other appropriate

individuals, with respect to activities carried out through the grant.

26. Describe how your program will conform to section 427 of General Education 

Provisions Act by describing the steps you propose to take to ensure equitable 

access to, and participation in, your program for students, teachers, and other 

program beneficiaries with special needs. [Text box]
1820-0664

Expires xx/xx/xxxx

92

To complete item 26, refer to the instructions for the “General Education Provisions Act 

(GEPA) Requirements - Section 427” form found at the following website: 

http://www.ed.gov/fund/grant/apply/appforms/appforms.html

General Instructions for Measurable Goals: 

Section 4(d)(3) of the AT Act requires that the State include information on the measurable 

goals, and a timeline for meeting those goals, that the State, with the advice of the Advisory

Council required in section 4(c)(2), has addressed the assistive technology needs of individuals 

with disabilities in the State in the domains of education, employment, community living, and 

telecommunications and information technology (IT).

 Section 4(d)(3)(A)(i) of the AT Act states that education goals include goals involving 

the provision of assistive technology to individuals who receive services under the 

Individuals with Disabilities Education Improvement Act (20 U.S.C. 1400 et seq.). This 

includes infants and toddlers receiving early intervention services under Part C.

 Education also includes the provision of assistive technology to individuals who receive 

services under section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.) and 

individuals in institutions of higher education and vocational education, including 

community colleges.

 Section 4(d)(3)(A)(ii) of the AT Act states that employment goals include goals 

involving the State vocational rehabilitation program carried out under title I of the 

Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.). 

RSA has established two types of measurable goals: access goals and acquisition 

goals. 

 Access goals relate to the activities of device loan and device demonstration. The State 

will show that it has improved access to AT by increasing the percentage of appropriate 

targeted individuals and entities who accessed device demonstration programs or device 

loan programs and made a decision about an AT device or service as a result of the 

assistance they received. 

 Acquisition goals relate to the activities of state financing and device reutilization. The 

State will show that it has improved acquisition by increasing the percentage of 

appropriate targeted individuals and entities who obtained devices or services from State 

financing activities or reutilization programs who would not have obtained that AT 

device or service. 
1820-0664

Expires xx/xx/xxxx

93

Access Goal and Table 

RSA sets one goal for improving access to assistive technology for individuals with 

disabilities in each of the domains of education, employment, community living, and 

telecommunications and IT. 3 The State will show that it has improved access by

increasing the percentage of appropriate targeted individuals and entities who 

accessed device demonstration programs and device loan programs and made a 

decision about an AT device or service as a result of the assistance they received. 

Long-term and annual short-term measurable goals are based on the combined performance 

measure data for both device demonstration and device loan activities claimed in the State Plan 

and reported in the state’s Annual Report. 

RSA sets a long-term goal (the desired percentage of appropriate targeted individuals and 

entities who accessed device demonstration programs and device loan programs that are able to 

make an informed decision about an AT device or service as a result of the assistance they

received) to be achieved by the end of the third year of the State Plan for AT. A long-term goal 

is the desired optimal level of performance at the end of three years. The Statewide AT 

Program should work with its advisory council to address this optimal level of performance 

based on its own data and knowledge of the state. 

 

RSA sets annual short-term goals that may show progress from the first year of the State Plan 

for AT toward the long-term goal. The long-term and short-term measurable goals should be 

both ambitious and attainable. Short-term goals may represent increases that lead to a longterm goal. If a program reaches its long-term goal or its first year annual data proves to be 

optimal, the goal should be maintenance of that performance. 

The long-term and short-term goals are a percentage not a number of people served. The 

calculation is the percentage of those who were served by the Statewide AT Program who also 

had a particular outcome. Example: Under the access performance measure, those who receive 

a device loan or demonstration will complete a follow-up survey (the survey and its instructions 

are included in the annual report). Those who respond to the survey will indicate whether they

were able to make a decision about an AT device or service as a result of the loan or 

demonstration. 

 

3 A State is unable to meet a goal for access if it performs neither device loans nor device demonstrations due to 

claiming comparability or flexibility. However, a goal will be set if either activity is undertaken. If both activities 

are undertaken the performance measure in your annual report is based on the combined performance measure of 

both activities. This combined performance measure is used to determine your performance status and must be 

taken into consideration as you address your long-term and short-term access goals. 
1820-0664

Expires xx/xx/xxxx

94

The table in item 27 below will be used to report the long-term goal, short-term goals, and 

actual performance. See below for detailed instructions on completing the table.

27. Access Goal Table

Access Education Employment

Community 

Living IT/Telecomm

a. Long-term 

Goal

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

b. Long-term 

Goal Status

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

c. FY 2011

Performance

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

d. FY 2012

Short-term 

goal

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

e. FY 2012

Performance

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

f. FY 2012

Status

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

g. FY 2013

Short-term 

goal

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

h. FY 2013

Performance

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

i. FY 2013

Status

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

j. FY 2014

Short-term 

goal

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

k. FY 2014

Performance

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated

l. FY 2014

Status

SystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated
1820-0664

Expires xx/xx/xxxx

95

Acquisition Goal and Table 

RSA sets one goal for improving acquisition of assistive technology for individuals 

with disabilities in each of the domains of education, employment, and community

living. 4 The State will show that it has improved acquisition by increasing the 

percentage of appropriate targeted individuals and entities who obtained devices 

and/or services from all State financing activities and reutilization programs who 

would not have obtained that AT device or service. 

Long-term and annual short-term measurable goals are based on the combined performance 

measure data for any State Financing Activities (including Financial Loan Programs; State 

financing activities that provide consumers with resources and services that result in the 

acquisition of AT devices and services; and, State financing activities that allow consumers to 

obtain AT at reduced costs) and any Reutilization activities (including Device Exchange, 

Recycling/Refurbishment/Repair and Open-ended loans) claimed in the State Plan and reported 

in the state’s Annual Report.

RSA sets a long-term goal (the desired percentage of appropriate targeted individuals and 

entities who obtained devices or services from State financing activities or reutilization 

programs who would not have obtained that AT device or service) to be achieved by the end of 

the third year of the State Plan for AT. A long-term goal is the desired optimal level of 

performance at the end of three years. The Statewide AT Program should work with its 

advisory council to address this optimal level of performance based on its own data and 

knowledge of the state. 

RSA sets annual short-term goals that may show progress from the first year of the State Plan 

toward the long-term goal. The long-term and short-term measurable goals should be both 

ambitious and attainable. Short-term goals may represent increases that lead to a long-term 

goal. If a program reaches its long-term goal or its first year annual data proves to be optimal, 

the goal should be maintenance of that performance. 

 

4 A State is unable to meet a goal for acquisition if it performs neither state financing nor device reutilization due 

to claiming comparability or flexibility. However, a goal must be set if either activity is undertaken. If both 

activities are undertaken the performance measure in your annual report is based on the combined performance 

measure of both activities. This combined performance measure is used to determine your performance status 

must be taken into consideration as you address your long-term and short-term acquisition goals. 
1820-0664

Expires xx/xx/xxxx

96

The table in item 28 below will be used to report the long-term goal, short-term goals, and 

actual performance. See below for detailed instructions on completing the table.

28. Acquisition Goal Table

Acquisition Education Employment

Community 

Living

a. Long-term 

Goal

SystemgeneratedSystemgeneratedSystemgenerated

b. Long-term 

Goal Status

SystemgeneratedSystemgeneratedSystemgenerated

c. FY 2011

Performance

SystemgeneratedSystemgeneratedSystemgenerated

d. FY 2012

Short-term 

goal

SystemgeneratedSystemgeneratedSystemgenerated

e. FY 2012

Performance

SystemgeneratedSystemgeneratedSystemgenerated

f. FY 2012

Status

SystemgeneratedSystemgeneratedSystemgenerated

g. FY 2013

Short-term 

goal

SystemgeneratedSystemgeneratedSystemgenerated

h. FY 2013

Performance

SystemgeneratedSystemgeneratedSystemgenerated

i. FY 2013

Status

SystemgeneratedSystemgeneratedSystemgenerated

j. FY 2014

Short-term 

goal

SystemgeneratedSystemgeneratedSystemgenerated

k. FY 2014

Performance

SystemgeneratedSystemgeneratedSystemgenerated

l. FY 2014

Status

SystemgeneratedSystemgeneratedSystemgenerated

Instructions: 

The two tables in items 27 and 28 correspond to the access and acquisition goals. The majority 

of the data needed to complete these tables is derived from the State’s “Annual Report for State 

Grant for Assistive Technology Programs” (OMB #1820-0572). The instructions for 

calculating the State’s progress toward measurable goals are included in the instruction manual 

accompanying the annual report. This annual report is also entered into RSA’s MIS. Once the 

State has entered its annual report data into the MIS, many items will cross-populate into tables 

27 and 28 (as indicated by use of “system-generated”). 

In row “a” (Long-Term goal) of tables 27 and 28, RSA enters the long-term goal for each 

domain as a percentage. This goal is a fixed, cumulative goal not tied to any particular year, 

but it reflects what is hoped to be achieved by the end of the third year of the approved State 

Plan for AT. Once RSA sets the long-term goal, this row of the tables is locked. The long-term 
1820-0664

Expires xx/xx/xxxx

97

goal can be modified only if an appeal is made to RSA. Such requests must be based on events 

or circumstances that have or are expected to impact a State’s ability to make progress towards 

the long-term goal, such as a natural disaster.

Row “b” (Long-term goal status) of both tables automatically will show whether you have met 

the long-term goal. The status of the long-term goal is automatically generated and progress in 

meeting the long-term goal is designated by either a “met” or “not met” designation. This 

determination will be based on the State’s performance for the fiscal year most recently entered 

(e.g., in FY 2012 the number entered into row “e” will be used, in FY 2013 the number entered 

into row “h” will be used). The data in row “b” will change accordingly when annual report 

data is entered for subsequent years.

In row “c” of both tables, your FY 2010 performance will be entered for each domain. This 

data serves as your baseline and is reflected as a percentage. 

In rows “d,” “g,” and “j” of both tables, the short-term goals may reflect incremental progress 

from this baseline toward the long-term goal, or maintenance of that level of performance if the 

State already has reached its long-term goal. RSA enters the short-term goals into rows “d,” 

“g,” and “j” in each table. 1This is the annual goal developed based upon the 2010 Performance 

data. 

In rows “e,” “h,” and “k” of both tables, the State’s actual performance on each short-term goal 

(rows “e,” “h,” and “k”) will be system generated based on the performance data entered in the 

annual report. 

In rows “f,” “i,” and “l” of each table, the actual performance data from rows e, h, and k will be 

used to determine the State’s goal status. The status determination will be based on data from 

the most recent FY and the system will automatically generate “met” goal or goal “not met.” 

For example, if in row “d” the FY 2012 goal is 87%, and in row “e” the actual performance for 

FY 2008 is 85%, row “f” will reflect that the goal was “not met”. 

RSA will provide instructions and deadlines for addressing measurable goal information on an 

annual basis. Once entered, the long-term and short-term goals only can be modified upon 

appeal to RSA.

29. Name of Certifying Representative for the Lead Agency.

30. Title of Certifying Representative for the Lead Agency.

31. Signed.

32. Date Signed.
1820-0664

Expires xx/xx/xxxx

98

Appendix

Classification of Devices

(Adapted from Annual Report Instructions)

1. Vision

Definition: Products designed to assist with vision

Decision rules: Products intended to facilitate access and participation for people who are 

blind or visually impaired are classified in this category, even if they are used for activities 

of daily living, computer access, reading/learning, way finding/travel, recreation, etc. 

Products in this category characteristically provide output of information through large 

print/display, synthetic speech or Braille/tactile. If the adaptation is for an individual who 

is both visually impaired and hearing impaired, categorize according to the primary

functionality of the device. Reading systems to accommodate vision are classified here 

while similar systems to accommodate learning are classified accordingly. A TTY with 

Braille output is classified as hearing. A telephone with both a large print keypad and 

amplification for listening may be classified in either vision or hearing. 

Examples: 

 Magnifiers including CCTV systems 

 Talking scales, blood pressure gauge, glucometer etc. 

 Screen readers, screen magnifiers and Braille displays 

 Daisy or Victor Readers 

 PDA’s with large print, speech or Braille output 

 Talking or Braille GPS, white canes, talking or tactile compass, etc. 

 OCR reading systems; talking thermostats, household appliances etc. 
1820-0664

Expires xx/xx/xxxx

99

2. Hearing

Definition: Products designed to assist with hearing

Decision rules: Products intended to facilitate access and participation for 

people who are deaf or hard of hearing are classified in this category, even 

if they are used for activities of daily living or could have another 

application for people with other disabilities or for other functions. 

Products intended to facilitate telephone usage for individuals with hearing 

disabilities are categorized here, rather than as aids to daily living. If the 

telephone adaptation is for an individual who is both visually impaired and 

hearing impaired, categorize under EITHER vision or hearing. Products 

that amplify voice are classified here if the purpose is to enhance the 

volume of speech produced by an individual without a disability, in order 

for his/her speech to be heard by persons who are deaf or hard of hearing. 

This category also includes systems that provide for text communication, 

both via telecommunication (text messaging; TTY) and face to face 

(Interpretype). Peripherals designed to facilitate access or otherwise 

support the use of a device for hearing (e.g., neck loop induction coils, 

TeleLink phone couplers, conference microphone, telephone signalers) are 

counted in this category.

Examples: 

 Personal amplification systems (hearing aids, PocketTalker Pro, etc.)

 Assistive Listening Systems (FM; loop; infrared, sound-field, large area, personal)

 Wireless headphones to enhance TV listening (e.g., DirectEar, TV Listener)

 Daily living aids that use visual or tactile rather than audible signals (e.g., vibrating 

alarm clock, smoke alarm with strobe light, door bell with flashing signal, etc.)

 Instant messaging devices (used as portable TTY)

 Daily living aids with enhanced audible signals (Sonic Boom Alarm Clock)

 Amplified Telephones, in-line amplifiers for telephones, cell phone amplifiers

 Text telephones (TTYs), Voice carryover (including CapTel) and Hearing carryover 

telephones and Signaling devices (visual and/or tactile alerting to incoming phone calls)

 Classroom Captioning System

 iCommunicator (Voice to text system)

 AudioSee (enhanced view of speaker for speech reading, in addition to FM capabilities)

 InterpreType dual keyboard system
1820-0664

Expires xx/xx/xxxx

100

3. Speech Communication

Definition: Products designed to assist with speaking and face-to-face 

communication for individuals with speech disabilities.

Decision rules: Products intended to facilitate computer access and usage 

for written communication are classified under Computers. Products 

intended to facilitate telephone usage for individuals with speech 

disabilities will be classified under activities of daily living, EXCEPT 

when the adaptation is for an individual who is deaf or hard of hearing in 

which case it is classified under hearing. Products that amplify voice are 

classified here if the purpose is to enhance the volume of speech produced 

by an individual with a disability, in order for his/her speech to be audible 

by persons without disabilities. If the purpose of the amplifier is to 

enhance the volume of speech produced by an individual without a 

disability, in order for his/her speech to be heard by persons who are deaf 

or hard of hearing, the device is classified under hearing. Peripherals 

designed to facilitate access or otherwise support the use of a device for 

speech communication (e.g., mounting systems; carrying cases, switch or 

mouth stick used for access) are counted in this category.

Examples: 

 Speech generating devices such as BIGMack, DV4, ChatPC, DynaWrite, Pathfinder, 

talking photo album

 Communication boards/books

 Software with speech output (e.g. Speaking Dynamically Pro)

 Software that provides symbol sets for use in developing “low tech” communication 

boards/books or “high tech” overlays (e.g., BoardMaker, Picture This!)

 Artificial larynx

 Devices that produce text but not voice output for face-to-face communication (e.g. 

Crespeaker)

 Voice clarifiers (e.g. Speech Enhancer)

 Voice amplifiers (e.g. Falck amplifier)

 Stuttering aids
1820-0664

Expires xx/xx/xxxx

101

4. Learning, Cognition, and Developmental 

Definition: Products to provide people with disabilities with access to 

educational materials and instruction in school or other environments; 

products that assist with learning, and cognition.

Common subcategories:

Cognitive aids

Early intervention aids

Instructional materials

Memory Aids

General Personal Organization Tools

Sensory/Developmental Stimulation Products

Decision rules: Products intended to mitigate, compensate, or address 

learning or cognitive limitations should be classified here along with 

products used to facilitate computer access for individuals with 

learning/cognitive limitations. Products designed to assist people who are 

blind or visually impaired with reading, organization, learning, computer 

access, etc. are classified under vision. 

Examples: 

 Calculators and measurement tools

 Clocks/Timers/Wake-up Systems

 Electronic Reference Tools and Money Management Tools

 Memory Aids

 Electronic Notakers, Portable Word Processers, and Recording Devices

 Electronic Organizers/Personal Digital Assistants

 Scientific Equipment

 Educational/Instructional Software (cause and effect, reading, language, spelling, math, 

writing, science, history, etc.) 

 Cognitive/Perceptual Training Software

 Tape or other audio players (except as related to vision) 

 Text-to-speech systems (WYNN, Read and Write Gold, etc. – not related to vision)

 FM systems (to support auditory processing - not related to hearing loss)
1820-0664

Expires xx/xx/xxxx

102

5. Mobility, Seating, and Positioning

Definition: Products whose main focus is on augmenting or replacing the functional 

limitations of an individual’s mobility

Decision rules: Wheelchair restraints associated with seating & 

positioning (shoulder or safety belts) are classified in this category. 

Wheelchair restraints (tie downs: 4-belt & docking or lock downs: trailerhitch) associated van locks that allow a power chair user to drive and/or be 

transported safely is classified under “Vehicle Modification and 

Transportation.”

Examples: 

 Ambulatory aids: low tech aids such as canes, walkers or crutches; also includes 

orthotics & prosthetics

 Wheelchairs: dependent (such as strollers & transport chairs) & independent 

manual mobility (4-wheels propelled independently)

 Scooters and power chairs: Functionally matched motorized independent power 

mobility bases 

 Seating and positioning – considerations based on postural control & deformity

management, pressure & postural management, and/or comfort & postural 

accommodation (such as pelvic guides, contoured seating systems, head 

supports)
1820-0664

Expires xx/xx/xxxx

103

6. Daily Living

Definition: Devices that enhance the capacity of people with disabilities to 

live independently, especially AT that assists with Instrumental and other 

Activities of Daily Living, (ADLs, IADLs) such as dressing, personal 

hygiene, bathing, home maintenance, cooking, eating, shopping and 

managing money.

Common Subcategories:

Personal hygiene, care and toileting

Dressing and apparel, and aids to dressing

Housekeeping, cleaning, maintenance

Cooking and eating

Handling, reaching, manipulating

Alerting and signaling

Household management, bill paying (not cognitive, vision, or hearing AT)

Telephony equipment

Decision rules: Architectural/home adaptations or modifications are 

classified under Environmental adaptations. Life safety devices and 

systems that do not involve home modifications are categorized here. 

Devices intended to accommodate specific disabilities, such as hearing or 

vision, are assigned to those categories. Devices that assist with personal 

organization are classified as Learning, Cognition and Developmental AT. 

Devices used to accommodate multiple disabilities are categorized here. 

Devices that assist persons with motor impairments not categorized 

elsewhere are included here. EADLs that also function as environmental 

controls are classified according to their primary use. Telephony equipment 

not intended to accommodate other categories of disabilities is listed here.

Examples: 

 Writing guides, adapted writing implements

 Modified or large-handled tools and utensils

 Eating/feeding equipment, spiked cutting board, jar opener

 Zipper pulls, button hooks, needle threader

 Personal pager, multi-sensing/multi-sensory alerting devices

 Wheelchair desks/trays 

 Reacher

 Wheelchair/walker bag 

 Switch-adapted food processor or other appliance

 Large-button telephone (not for vision or cognitive accommodation).
1820-0664

Expires xx/xx/xxxx

104

7. Environmental Adaptations 

Definition: Environmental and structural adaptations to the built 

environment that remove or reduce barriers and promote access to and 

within the built home, employment and community facilities for 

individuals with disabilities. Environmental adaptations usually involve 

building construction, engineering, and architecture, but also include 

environmental controls and switches that can control a large portion of or 

an entire living environment. Environmental adaptations are typically 

permanent or semi permanent structures, modifications or additions.

Decision rules: Adaptations or modifications to vehicles are classified 

under Vehicle modifications. Adaptations to furniture such as chairs, 

couches, beds, etc., would be generally be classified under Mobility, 

Seating, and Positioning. Items or structures that are portable or 

temporary, rather than permanent or semi-permanent, would generally be 

classified in another category related to the functional limitation address. 

For example, shower chairs, commodes, raised toilet seats and similar 

portable items should be classified in the daily living category where as a 

roll in shower, wall or floor mounted grab bars, installed ramps, etc would 

be classified here because they become part of the building structure. 

Examples: 

 Accessible HVAC controls, accessible plumbing fixtures and controls

 Adapted playground equipment and structures

 Alarm and Security Systems

 Cabinetry and Storage equipment

 Door/Gate Openers

 Environmental controls and switches (i.e., electronic systems that enable people 

to control various appliances, lights, telephones, security systems etc.) 

 Flooring and Surface materials/Detectable warning surfaces

 General Environmental Access Products

 Lifts

 Lighting/lighting controls

 Ramps

 Signage/signaling products

 Workstations/Desks/Tables, Home-workplace adaptations
1820-0664

Expires xx/xx/xxxx

105

8. Vehicle Modification and Transportation

Definition: Products that give people with disabilities independence and 

enhance safety in transportation through adaptation of vehicles.

Decision rules: Vehicle ramps are classified in this category. 

Versatile/portable ramps (temporary adaptation) and wheelchair lifts 

(permanently installed in buildings) are classified under Environmental 

adaptations. 

Examples:

 

 Adaptive shoulder and seat safety belts

 Tie downs and lock downs that secure the wheelchair to the vehicle floor

 Hand controls

 Extended directional mirrors.

 Vehicles and vans modified with lifts, ramps, raised roofs, etc. 
1820-0664

Expires xx/xx/xxxx

106

9. Computers and Related

Definition: Hardware and software products that enable people with 

disabilities to access, interact with, and use computers at home, work, or 

school. Includes modified or alternate keyboards, switches activated by

pressure, touch screens, special software, voice to text software

Common subcategories:

Decision rules: Classify standard computers and computer-related devices 

(those that will be used without any adaptations) in this category, along 

with input adaptations used to mitigate, compensate or address motor 

limitations. Do not include computer adaptations used to address vision or 

learning, cognitive or developmental limitations. 

Examples: 

 Standard software

 Standard hardware

 Computer accessories

 Alternative keyboards and pointing devices

 Switches and scanning software used for computer access

 Touchscreens

 Voice recognition systems
1820-0664

Expires xx/xx/xxxx

107

10. Recreation, Sports, and Leisure Equipment

Definition: Products not already classified in other categories that help 

persons with disabilities to participate in sport, health, physical education, 

recreation, leisure, and dance events. 

Common subcategories:

 Toys and games

 Sports equipment

 Fitness equipment

 Specialized wheelchairs and recreational mobility equipment

 Musical instruments and related devices

 Arts, crafts and photography equipment

 Gardening and horticultural equipment

 Hunting, fishing, shooting equipment

 Camping, hiking and other outdoor recreational equipment

 Audio and video entertainment equipment

Decision rules: Devices intended to accommodate specific disabilities, such as hearing or 

vision, are assigned to those categories. Specialized products designed specifically for 

recreational, leisure or athletic pursuits are categorized here. Devices that may have other 

uses, but are selected as AT for a recreational setting, should be categorized here. Devices 

for environmental control that also serve as entertainment system controls (e.g. television 

remote) are classified according to their primary use.

Examples: 

 Switch-adapted toys and games 

 Tennis wheelchairs; beach wheelchairs

 Skiing equipment; sled/sledge hockey equipment

 Gardening tools and equipment 

 Playing card shuffler 

 Adapted camera and other photography equipment 

 Adaptive exercise equipment (not used in a rehabilitation setting) 

 Adaptive equipment for fishing, hunting, and camping 

 Adaptive musical instruments and accessories (not used in a school setting) 

 Entertainment system remote control not used for lights, heat or other environmental 

control