1

Access to Telework Programs

Data Collection Instrument and Instructions
2

Rehabilitation Services Administration

Annual Report for

Access to Telework Programs (Telework)

Public Reporting Burden

OMB # 

Expires: __________

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. The valid OMB control number for this information 

collection is XXXX-XXXX. The time required to complete this form is estimated to average 12.5 hours per response, 

including the time to review instructions, search existing data resources, gather the data needed, and complete and review 

the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for 

improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have 

comments or concerns regarding the status of your individual submission of this form, write directly to: Office of the Chief 

Financial Officer, U.S. Department of Education, 600 Independence Avenue, SW, Washington, D.C. 20202-4248.

This document was prepared by the National Assistive Technology Technical Assistance 

Partnership (NATTAP) under a supplement to a grant from the U.S. Department of Education

Grant No. H224B050003
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Instructions for completion of this form and relevant definitions are contained in 

this document. Throughout the reporting form, terms for which a definition is 

available are indicated with an asterisk (*). 
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Table of Contents

Table of Contents __________________________________________________________________________4

A. General Information_____________________________________________________________________5

B. Background, General Instructions, and Definitions ___________________________________________7

1. Reporting Period ______________________________________________________________________7

2. Aggregate Data________________________________________________________________________7

3. Loan Activities That Occur Across More than One Reporting Period ____________________________ 8

4. Missing Data _________________________________________________________________________8

5. Definitions ___________________________________________________________________________8

C. Telework Program Optional Data Elements _________________________________________________9

1. Types of Telework Program Financing Options: ____________________________________________9

2. Interest Rates - Lowest and Highest Interest Rates ___________________________________________9

3. Loan Amounts ______________________________________________________________________10

4. Repayment Terms ____________________________________________________________________11

5. Loan Guarantee Requirement __________________________________________________________12

D. Telework Program Required Data Elements ________________________________________________13

1. Number and Result of Loan Applications _________________________________________________13

2. Type of Financing Mechanism __________________________________________________________14

3. Categories of Equipment Financed through the Program_____________________________________17

4. Defaults and Net Losses________________________________________________________________19

5. Classification of Direct Users Receiving Assistance__________________________________________21

6. One-Year Follow-up of Direct Users _____________________________________________________ 24

E. Anecdote _____________________________________________________________________________26

F. Notes _________________________________________________________________________________27

G. Classification of Devices_________________________________________________________________28

1. Communication Equipment_____________________________________________________________28

2. Computer Equipment and Related Software________________________________________________28

3. Home/Office Modifications ____________________________________________________________28

4. Office Furniture and Equipment_________________________________________________________29

5. Tools of the Trade ____________________________________________________________________29

6. Vehicles ____________________________________________________________________________29
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A. General Information

General Information: Telework Program

1. State and Name of Telework Program

Lead Agency

1. Agency Name

2. Agency Contact

3. Mailing Address 

4. Mailing Address (continued)

5. City

6. State

7. Zip Code

8. Phone

9. Fax

10. Program URL

11. Program E-mail

12. Program Toll-free number

13. Program TTY number

Community-Based Organization (CBO)

1. Name of Community-Based Organization

2. Name of Telework Program Director/Manager

3. Mailing Address

4. Mailing Address (continued)

5. City

6. State

7. Zip Code

8. Phone

9. Fax

10. Program URL

11. Program E-mail

12. Program Toll-free Number

13. Program TTY Number

Lending Institution (See option below to add additional lending institution partners)

1. Name of Lending Institution 

2. Contact at Lending Institution

3. Mailing Address

4. Mailing Address (continued)

5. City

6. State

7. Zip Code

8. Phone

9. Fax

10. Program URL

Report Submission

1. Some or all of the data being reported in this data □ Yes 
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collection instrument is also used as part of data on 

State Financing Activities in the Annual Report for 

State Grant for Assistive Technology Programs.

□ No 

2. To the best of my knowledge and belief, by 

submitting this report we are attesting that all data in 

this performance report are true and correct and the 

report fully discloses all known weaknesses 

concerning accuracy, reliability, and completeness of 

the data.

3. Date form Submitted (mm/dd/yy)

4. Name of Lead Agency Representative Submitting 

Report

5. Mailing Address

6. City

7. State

8. Zip Code

9. Phone 

10. Fax

11. Email

□ If the Telework Program has more than one lending institution as a partner click here to display additional forms to record the 

contact/general information for additional lending institutions/partners. You can add up to a total of 5 lending 

institutions/partners.
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B. Background, General Instructions, and Definitions 

This document contains information needed for completing the Telework Program Annual 

Report required by the Rehabilitation Services Administration (RSA) under the Rehabilitation 

Act. This annual report is designed so that grantees can fulfill their annual reporting 

requirements under the Education Department Administrative Regulations part 75. 

Information from individual Telework Programs will be available to the public once the 

information is completed by the Telework Program and submitted to and approved by RSA. 

Questions regarding potential uses of the information submitted by individual states should be 

directed to Robert Groenendaal, Program Specialist, RSA, U.S. Department of Education, 400 

Maryland Avenue, SW, PCP Room 5025, Washington, DC 20202-2800, 

Robert.Groenendaal@ed.gov, 202-245-7393. 

Many individuals and organizations contributed to the development of this data collection 

system, including a workgroup representing Telework Loan Programs and Alternative Financing 

Programs. The workgroup’s discussions and input framed issues, developed solutions, provided 

perspective on implementation and refined this document. Working with RSA, the National 

Assistive Technology Technical Assistance Partnership (NATTAP) developed this Telework 

Loan Program data collection instrument under a supplement to Grant No. H224B050003. 

1. Reporting Period

The reporting period is the federal fiscal year, which begins on October 1 of each year and 

ends on the following September 30. 

There is one exception to this reporting period for the first year of data collection using this 

instrument. If this instrument is not approved prior to October 1, 2008, the first reporting 

period extends from approval of this instrument through September 30, 2009. For example, 

if this instrument is approved for use as of November 1, 2008, the first reporting period will 

be for 11 months from November 1, 2008 until September 30, 2009. All subsequent 

reporting periods will be 12 months, beginning October 1, 2009.

2. Aggregate Data

You do not provide data on individual loans. Individual loan data and records should be 

retained at the program level and will not be requested by RSA for the purposes of this data 

collection. All data is provided in the aggregate and represents the total for the reporting 

period. 
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3. Loan Activities That Occur Across More than One Reporting Period

It is possible for a Telework Program to receive a loan application during one reporting 

period, but not process that application to a conclusion until the following reporting period. 

Do not split your data across reporting periods. If an application is received during reporting 

period “A” but the decision about that application is not made until the following reporting 

period “B,” report all data related to that application during reporting period “B” only. The 

same logic should be applied to data on any activities that can cross two reporting periods.

4. Missing Data

For any data you are unable to provide due to circumstances beyond the control of the entity

submitting the data, leave the field blank. You should leave it blank only in rare 

circumstances. You must explain any missing data under “Notes” in section F.

5. Definitions 

On subsequent pages, many terms with meanings specific to this instrument are used. 

Definitions for these terms are provided throughout these instructions. Once defined in this 

document, the term retains the same meaning throughout. Key terms to know before 

proceeding are: 

a. Partnership loan: A loan that uses dollars from a source other than the Telework 

Program, usually a financial entity, for which the Telework Program has an 

investment through interest or principal buy-down, loan guarantee (see next 

definition), agreement with a financial institution based on an investment deposit, or 

other financial/administrative role.

b. Loan guarantee or insurance: The Telework Program uses its funds to 

guarantee all or a portion of loans. A guaranteed loan is a partnership loan in which 

the Telework Program guarantees that the loan to a borrower is secure and will be 

repaid in the event of a default, thus increasing the lender’s willingness to loan funds. 

c. Revolving loan fund (or revolving loan): A loan fund that directly uses 

Telework Program funds for loans. The Telework 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 

borrowers — that is, the same money “revolves” out to other borrowers as earlier 

borrowers return it to the program.
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C. Telework Program Optional Data Elements 

The questions in this section are optional. No Telework Program is required to 

complete these items. These items are intended only to inform RSA and the public about 

the features, differences, and similarities of Telework Programs. However, if you choose 

to complete any of these items, you must first complete item 1 as it determines the data 

you will provide. If you choose to complete these items, answer the questions based on 

your established, written policies. 

1. Types of Telework Program Financing Offered

The Telework Program offers (check all that apply): 

Revolving Loans___ Partnership Loans____

Note: Based on the response to C (1) the applicable questions 2-5 below will display in the 

online system. Responses to these questions are not required and respondents can choose to 

answer some, but not all of the questions.

2. Interest Rates - Lowest and Highest Interest Rates

Enter the lowest and highest interest rates that your policies allow to be applied to an 

individual loan (this is not the lowest or highest interest rate actually provided in a given 

year, but the highest and lowest possible given your policies). Report these separately for 

revolving* and partnership loans*. The lowest possible in any case is zero. You may select 

only one of the three options given (i.e., you cannot report an interest rate in the first row and 

also select that interest rates are determined on a case-by-case basis). 

Partnership Loans Interest Rates

Lowest Interest Rate established by policy. ____%

Established policy does not specify Lowest Interest Rate, but directs 

Telework Program to determine Lowest Interest Rate for Partnership Loan on 

a case-by-case basis.

□

Revolving Loans Interest Rates

Lowest Interest Rate established by policy. ____%

Established policy does not specify Lowest Interest Rate, but directs 

Telework Program to determine Lowest Interest Rate for Revolving Loan on 

a case-by-case basis. 

□

No established policy for a Lowest Interest Rate. Lowest Interest Rates for 

Revolving Loans are determined on a case-by-case basis. □

Highest Interest Rate established by policy. ____%

Established policy does not specify Highest Interest Rate, but directs 

Telework Program to determine Highest Interest Rate for Revolving Loan on 

a case-by-case basis.

□

No established policy for a Highest Interest Rate. Highest Interest Rates for 

Revolving Loans are determined on a case-by-case basis. □
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No established policy for a Lowest Interest Rate. Lowest Interest Rates for 

Partnership Loans are determined on a case-by-case basis. □

Highest Interest Rate established by policy. ____%

Established policy does not specify Highest Interest Rate, but directs 

Telework Loan Program to determine Highest Interest Rate for Partnership 

Loan on a case-by-case basis.

□

No established policy for a Highest Interest Rate. Highest Interest Rates for 

Partnership Loans are determined on a case-by-case basis. □

3. Loan Amounts 

Enter the Lowest and Highest loan amount your policies allow to be provided for an 

individual loan (this is not the lowest or highest actually provided in a given year, but the 

lowest or highest possible given your policies). Report these separately for revolving* and 

partnership loans*. You may select only one of the three options given (i.e., you cannot 

report a loan amount in the first row and also select that loan amounts are determined on a 

case-by-case basis). 

Revolving Loans & Loan Amounts

Lowest Loan Amount Offered as established by policy. $_____

Established policy does not specify Lowest Loan Amount, but directs 

Telework Loan Program to determine Lowest Loan Amount for Revolving 

Loan on a case-by-case basis.

□

No established policy for a Lowest Loan Amount. Lowest Loan amounts for 

Revolving Loans are determined on a case-by-case basis. □

Highest Loan Amount Offered as established by policy. $_____

Established policy does not specify Highest Loan Amount, but directs 

Telework Loan Program to determine Highest Loan Amount for Revolving 

Loan on a case-by-case basis.

□

No established policy for a Highest Loan Amount. Highest Loan amounts 

for Revolving Loans are determined on a case-by-case basis. □

Partnership Loans & Loan Amounts

Lowest Loan Amount Offered as established by policy. $____

Established policy does not specify Lowest Loan Amount, but directs 

Telework Loan Program to determine Lowest Loan Amount for Partnership 

Loan on a case-by-case basis.

□

No established policy for a Lowest Loan Amount. Lowest Loan amounts for 

Partnership Loans are determined on a case-by-case basis. □

Highest Loan Amount Offered as established by policy. $____

Established policy does not specify Highest Loan Amount, but directs 

Telework Loan Program to determine Highest Loan Amount for Partnership 

Loan on a case-by-case basis.

□
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No established policy for a Highest Loan Amount. Highest Loan amounts 

for Partnership Loans are determined on a case-by-case basis. □

4. Repayment Terms

Enter the Shortest and Longest repayment terms that your policies allow to be provided for 

an individual loan (this is not the shortest or longest actually provided in a given year, but the 

shortest or longest possible given your policies). Repayment terms should be reported in 

calendar days. Report these separately for revolving* and partnership loans*. You may 

select only one of the three options given (i.e., you cannot report a term in the first row and 

also select that the terms are determined on a case-by-case basis).

Revolving Loans & Repayment Terms

Shortest Loan Repayment Terms as established by policy. (Report in 

Calendar Days)

____ 

(Calendar 

Days)

Established policy does not specify Shortest Loan Repayment Terms, but 

directs Telework Program to determine Shortest Repayment Terms for 

Revolving Loan on a case-by-case basis.

□

No established policy for Shortest Loan Repayment Terms. Shortest Loan 

Repayment Terms for Revolving Loans are determined on a case-by-case 

basis.

□

Longest Loan Repayment Terms as established by policy. (Report in 

Calendar Days)

____ 

(Calendar 

Days)

Established policy does not specify Longest Loan Repayment Terms, but 

directs Telework Program to determine Longest Repayment Terms for 

Revolving Loan on a case-by-case basis.

□

No established policy for Longest Loan Repayment Terms. Longest Loan 

Repayment Terms for Revolving Loans are determined on a case-by-case 

basis.

□

Partnership Loans & Repayment Terms

Shortest Loan Repayment Terms as established by policy. (Report in 

Calendar Days)

____ 

(Calendar 

Days)

Established policy does not specify Shortest Loan Repayment Terms, but 

directs Telework Program to determine Shortest Repayment Terms for 

Partnership Loan on a case-by-case basis.

□

No established policy for Shortest Loan Repayment Terms. Shortest 

Repayment Terms for Partnership Loans are determined on a case-by-case 

basis.

□

Longest Loan Repayment Terms as established by policy. (Report in 

Calendar Days)

____ 

(Calendar 

Days)
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Established policy does not specify Longest Loan Repayment Terms, but 

directs Telework Program to determine Longest Repayment Terms for 

Partnership Loan on a case-by-case basis.

□

No established policy for Longest Loan Repayment Terms. Longest Loan 

Repayment Terms for Partnership Loans are determined on a case-by-case 

basis.

□

5. Loan Guarantee Requirement

Loan guarantee requirement is the guarantee percentage required by the lender to guarantee a 

loan. For example, if a loan guarantee requirement states that $0.50 be repaid for every

$1.00 approved in guaranteed loans by the lender, then the loan guarantee requirement is 

50%. If $1.00 must be reserved for every $1.00 approved in loans by the lender, then the 

loan guarantee requirement is 100%. You may select only one of the three options given 

(i.e., you cannot report a loan guarantee in the first row and also select that the guarantee is 

determined on a case-by-case basis). 

a. Specify the Loan Guarantee Percentage (%) of the loan that must be repaid by the 

Telework Program to the lender in case of default as established by the agreement with 

your lender. ___%

b. Loan Guarantee Requirements are determined on a case-by-case basis. □

c. The program does not have Guaranteed Partnership Loans. □
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D. Telework Program Required Data Elements

All Telework Programs are required to provide the data requested in D items 1-6 

and E. See General Instructions in Section B for information on reporting on 

activities that cross over reporting periods or how to handle missing data.

1. Number and Result of Loan Applications

Here you will provide data on the number of applications you received and what resulted 

from those applications. 

In this section, report on all loan applications that were processed to one of the three 

decisions shown in the table below (i.e., approved—loan made, approved—loan not made, or 

loan application rejected) during this reporting period. “Approved—loan not made” includes 

loan applications that were approved but not accepted by the borrower and loans that were 

withdrawn by the applicant after review. “Loan application rejected” does not mean that the 

Telework Programs did not process and review the application; it means that the application 

was fully processed and reviewed but a loan was denied to the applicant. 

Do not include applications that were not reviewed because they were not complete, were 

withdrawn before a final decision was made, or were still pending at the end of the reporting 

period. As explained in the general instructions, report on applications even if the 

application was received prior to the start of the reporting period, but was processed to a 

decision or approved during this reporting period. Do not include loans in which the 

Telework Program had no financial or administrative role, such as loans for which you 

simply made a referral to another funding or lending source.

Number of Applications

Total

A. Approved—loan made

B. Approved—loan not made* (i.e., the application was 

withdrawn after the loan was approved, or the loan was 

approved but not accepted by the consumer)

C. Rejected 

D. Total System-generated
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2. Type of Financing Mechanism

Nationally, many different kinds of financing mechanisms are available because Telework 

Programs offer different types of loans to borrowers; some individual Telework Programs

may offer several types of loans. Here you will provide data on the types of loans you offer 

and the number of loans you provided during this reporting period. The difference between 

partnership loans and revolving loans was previously explained. Within partnership loans 

and revolving loans, other types of loans include:

Loan guarantee or insurance: A partnership loan in which the Telework Program 

uses its funds to guarantee all or a portion of a loan. A guaranteed loan is a partnership 

loan in which the Telework Program guarantees that the loan to a borrower is secure and 

will be repaid in the event of a default, thus increasing the lender’s willingness to loan 

funds. 

Low-interest loans: In a low-interest loan, the Telework Program establishes an 

agreement with a lending institution to provide loans 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 Telework Programs arrange for 

lending institutions to provide low-interest loans are variable, but typically include a 

requirement that the Telework Program deposit its funds with the lending institution. The 

interest that the Telework Program’s funds would normally generate is then used by the 

lending institution to supplement the interest it charges borrowers, thus resulting in lower 

interest rates paid by the borrower. The reporting form collects data on two types of lowinterest loans. For both types of loans, use the prime rate at the time the loan was 

provided. Both loans are defined as follows:

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. 

Interest buy-down loan: A partnership loan in which Telework Program funds are 

used to buy-down the interest rate of a loan. The Telework Program uses funds to reduce 

the interest rate that lending institutions offer to borrowers. The Telework Program pays 

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

payments for the consumer over the term of the loan.

Other: A loan that does not meet the criteria or description of loans listed previously 

described. 
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Prime Rate: The prime rate is the average majority prime rate charged by banks on 

short-term loans to business, quoted on an investment basis. The Federal Reserve defines 

a bank prime loan as follows: “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 U.S. prime rate at the following website 

for the date on which the loan was closed: 

http://www.federalreserve.gov/releases/h15/update/

a) Type of Loans, Number, and Percentage

Enter the number of loans made in this reporting period, by loan type. If you did not 

offer a particular type of loan or did not provide this type of loan, enter zero in the 

appropriate box. The system will calculate the percentage of loans that fall into each 

category. The total number of loans must match the number of approved loans made in 

the previous table, so report each loan in only one category. If you select Other* you 

must specify how the loan differs from Revolving Loans and Partnership Loans. The 

description should not exceed 100 words. 

Type of Loan Number

of Loans

Percentage

of Loans

Revolving Loan* 

Revolving Loan: Low Interest (prime or 

less) 

System-generated

Revolving Loan: Preferred Interest 

(greater than prime) System-generated

Total Revolving Loans System-generated System-generated 

Partnership Loan* 

Low Interest (prime or less)*

Without interest buy-down* or loan 

guarantee*

System-generated

With interest buy-down* only System-generated

With loan guarantee* only System-generated

With both interest buy-down* and loan 

guarantee*

System-generated

Preferred Interest (greater than prime)*

Without interest buy-down* or loan 

guarantee*

System-generated

With interest buy-down* only System-generated

With loan guarantee* only System-generated

With both interest buy-down* and loan 

guarantee*

System-generated

Total Partnership Loans System-generated System-generated

Other* (specify below) System-generated

Total All Loans System-generated System-generated
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If Other was used in the above table, briefly describe.

b) Type of Loans and Amount Financed

Enter the dollar value of both Revolving Loans* and Partnership Loans*. 

Type of Loan Number of Loans Dollar Value of Loans

Revolving Loans* System-generated

Partnership Loans* System-generated

Other* System-generated

Total System-generated System-generated

c) Range of Dollar Amounts of Loans Provided

In the table below, enter how many loans were made within the range of dollar amounts 

shown below. This is the dollar amount of the entire loan, not the dollar amount divided 

among different pieces of equipment if more than one category was purchased. The total 

number of loans must match the number of applications approved in row A of item 1 

above. If you did not provide a loan for the specified dollar amount, enter zero in the 

appropriate box. The system will calculate the percentage of the amount of the loans 

made to individuals.

d) Highest and Lowest Loan Amounts 

Unlike the data you may have reported under the optional section at the beginning of this 

instrument, these are the actual highest and lowest amounts provided for the reporting 

period, not a description of your policies.

Number and Percentage of Loans 

Made to Applicants in the Amount of

 $1,000 

or 

Less

$1,001 

to 

$5,000

$5,001 

to 

$10,000

$10,001 

to 

$15,000

$15,001 

to 

$20,000

$20,001 

to 

$25,000

$25,001 

to 

$50,000

$50,001 

or More

Total

Number 

of loans

Systemgenerated

Percent 

of 

Loans

SystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated
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Enter the highest and lowest dollar amounts of loans provided during this reporting 

period (enter zeroes for both highest and lowest if no loans closed during the reporting 

period and the dollar amount of the loan provided for both if only one loan closed):

Highest $_________

Lowest $ _________

e) Types of Additional Funding Sources

For both Revolving Loans and Partnership Loans, in which borrowers received additional 

funding, such as matching or combined funding, to reach their employment goal, enter the 

number of loans associated with each additional funding source. A loan may have several 

additional funding sources, so the number of loans entered into the second column may be 

larger than your total number of loans (e.g., one loan may receive additional funding from 

both VR and PASS, so that loan would be entered once in each corresponding row).

Additional Funding Source Number of Loans

State Department of 

Rehabilitation/Vocational 

Rehabilitation

Plan to Achieve Self Support 

(PASS)

Other Financial Loans (e.g., 

bank, AFP, SBA, microlender)

Borrower/Consumer 

contribution (e.g., down 

payment, trade-in)

Medicaid Waivers

Individual Development 

Accounts

Non-profit/other agencies 

(e.g., foundations, church 

groups, disability

organizations)

Other

None

3. Categories of Equipment Financed through the Program

Loans are provided for many different kinds of business equipment. Here you will report on 

how many categories of equipment were funded by your loans during the reporting period.

There are a total of 6 categories for classifying equipment:
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 Communication Equipment

 Computer Equipment and Related Software

 Home/Office Modifications

 Office Furniture and Equipment

 Tools of the Trade

 Vehicles

Definitions for each of the Categories of Business Equipment can be found in Section G: 

Classification of Equipment. The Classification of Equipment includes a description, 

decision rules, and examples that will assist you in deciding whether a specific piece of 

equipment should go into a particular category. 

Many pieces of equipment can fit into more than one category depending on how they are 

used by a consumer. Generally a piece of equipment should be categorized according to its 

use. For example, if a piece of software, such as Microsoft Word is purchased with a 

Telework program loan, that piece of software would be categorized under “Computer 

Equipment and Related Equipment” because it is a general software with many uses. 

However, if a loan is used to purchase TurboTax software as part of a borrower’s tax 

preparation business, then that loan would be classified under “Tools of the Trade” as the 

software related directly to the business of the borrower. 

Also, loans associated with training to use a piece of equipment should be associated with the 

category of equipment. For example, if the loan will purchase training on how to operate 

medical transcription equipment, that loan amount should be categorized under the “Tools of 

the Trade” category.

Because a single loan may pay for more than one category of equipment, indicate all 

categories of equipment paid for by a loan. For example if the loan purchased a computer 

and a paper cutter, then indicate one for the “Computer Equipment and Related Software” 

category and one for the “Office Furniture and Equipment” category. 

Do not count the number of individual pieces of equipment within a category. For example, 

if the loan purchased a computer and three pieces of software, then indicated one in the 

“Computer Equipment and Related Software.” However, if the pieces of equipment are not 

in the same category, then indicate all the categories that apply. For example, if the loan 

purchased a computer and three pieces of software as well as a fax machine, then indicate 

one for the “Office Furniture and Equipment” category and one for the “Computer 

Equipment and Related Software” category. The total number of categories of equipment 

may exceed the total number of loans reported previously.

a) Types of Equipment Financed

Use the table below to provide information on the types of equipment financed. 
19

Type of Equipment Number of Pieces of Equipment 

Financed

Computer Equipment and Related Software*

Communication Equipment*

Home/Office Modifications*

Office Furniture and Equipment*

Tools of the Trade*

Vehicles*

Total System-generated

4. Defaults and Net Losses 

Most Telework Programs have their own policies for when they declare a loan to be in 

default. For the purposes of national data collection, one definition of default must be 

applied to all programs. A Telework Program can continue to use its own definition of 

default for its own purposes, but under this system, a default is defined as follows:

Default: A loan is in default, on or before 120 days in which the borrower has not made 

the scheduled payment for the balance still owed; or at which time the organization 

administering the loan paid the lending institution the remaining agreed upon balance of 

loan. Do not count any payments that may have been made by the loan administering 

organization on behalf of the borrower during that 120-day period.

All loans that meet the above definition must be reported in this data collection. Here you 

will report on your defaults and net dollar losses for the reporting period. To do so, you must 

include information on your active loans, which are defined as follows:

Active loan: A loan for which a borrower owes money and is still actively making 

payments (i.e., the loan has not been paid in full by the borrower or otherwise “closed” 

due to default) no matter when they originated. For the purposes of providing data on 

defaults and net losses, active loans are only those loans in which the Telework Loan 

Program or their designated affiliate/partner could incur direct losses, such as revolving 

loans or guaranteed loans. Do not count loans in which the Telework Loan Program or 

their designated affiliate/partner does not have a financial responsibility to pay the bank 

in case of default, such as loan balances for low interest loans, preferred interest loans, or 

buy-down interest rate loans that are not guaranteed. 

The default rate* in the following tables is calculated only for revolving and guarantee loans, 

those for which the organization administering the loan can incur a financial loss in the case 

of default.
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a) Number of Loans in Default and Default Rate

In the table below, enter the number of loans that were in default* during this reporting 

period. In the second column, enter the number of active loans* as of the last day of this 

reporting period. The system will calculate the percentage of loans in default for your 

program, which is your default rate. 

Number of Loans 

in Default

Number of

Active Loans Default Rate

System-generated

When a loan defaults, there often (but not always) is a net dollar loss. For this data 

collection, a net dollar loss is defined as:

Net Dollar Loss: The amount lost as a result of default during this reporting period 

after subtracting any funds that were recovered. It includes the amount that is unpaid on 

any loans in default and any loan guarantee payout amounts minus the amount of 

collateral recovered. Total dollar value of active loans means the unpaid amount of 

guaranty or revolving loan balance the loan administering organization is responsible for 

paying in case of a default at the end of the reporting period of all active loans, no matter 

when they originated.

Here you will report on your net dollar losses for the reporting period.

b) Net Dollar Loss on Defaulted Loans 

In the table below, enter the net dollar loss on loans that were in default during this 

reporting period. Net dollar loss on loans means the amount lost as a result of default* 

during this reporting period after subtracting any funds that were recovered. It includes 

the amount that is unpaid on any loans in default* and any loan guarantee payout 

amounts minus the amount of collateral recovered. Total dollar value of active loans

means the unpaid amount of guaranty or revolving loan balance the organization 

administering the loan is responsible for paying in case of a default at the end of the 

reporting period of all active loans*, no matter when they originated.

The system will calculate the net loss rate* for your program. For example, if the 

Telework Program has a net dollar loss of $10,000 and active guarantee loan balance of 

$300,000, the net loss rate would be 3%.

 Net Dollar Loss on Loans

Total Dollar Value of

Active Loans* Net Loss Rate %

System-generated
21

5. Classification of Direct Users of Equipment Receiving Assistance

Borrowers of a telework loan may include an individual with a disability, a family member or 

representative of a person with a disability, or an employer. In this section you will provide 

data about the people with disabilities who receive equipment purchased with funds from 

loans from your Telework Program during this reporting period. In this instrument, they are 

called "direct users." Direct Users* are defined as people with disabilities who are the direct 

users of the equipment purchased through the loans. In this instrument, Direct Users do not 

include all applicants, only those connected with closed loans.

a) Geographic Distribution 

In this section, report on geographic distribution of the Direct Users who received loans 

during this reporting period. States have various methods for classifying direct users by

the area of the state from which they come. For the purposes of a national data 

collection, a single method for designating the area from which a Direct User comes must 

be used by all grantees. This data collection will classify Direct Users by Rural Urban 

Continuum Codes (RUCCs).

To use RUCCs, you must ascertain the county of residence of a direct user. Since these 

loans may involve teleworking from a distance, the county of residence of the person 

taking out the loan may be different from the county of residence of the direct user. For 

this section, use the county of residence of the direct user of the equipment. Once you 

know the county where the direct user resides, you can determine the RUCC for that 

county. The 2003 RUCCs form a classification scheme that distinguishes metropolitan 

counties by size and non-metropolitan counties by degree of urbanization and proximity

to metro areas.1

The standard Office of Management and Budget (OMB) metro and non-metro categories 

have been subdivided into three metro and six non-metro categories, resulting in a ninepart county codification as follows:

 1 - Counties in metro areas of one million population or more 

 2 - Counties in metro areas of 250,000 to one million population 

 3 - Counties in metro areas of fewer than 250,000 population 

 4 - Urban population of 20,000 or more, adjacent to a metro area 

 5 - Urban population of 20,000 or more, not adjacent to a metro area 

 6 - Urban population of 2,500 to 19,999, adjacent to a metro area 

 7 - Urban population of 2,500 to 19,999, not adjacent to a metro area 

 8 - Completely rural or less than 2,500 urban population, adjacent to a metro 

area 

 9 - Completely rural or less than 2,500 urban population, not adjacent to a 

metro area 

 

 

1

For complete information about Rural Urban Continuum Codes, visit the following Web site:

http://www.ers.usda.gov/briefing/Rurality/RuralUrbCon/
22

For purposes of this data collection, these nine codes are combined into two levels:

 Codes 1-3 are considered “metro”

 Codes 4-9 are considered “non-metro”

When required by this instrument, Telework Loan Programs will categorize direct users 

into one of these two groups based on the RUCC for their county. Finding the RUCC for 

any county is done in the following manner:

1) Go to the following Web site: US Department of Agriculture, Economic 

Research Service Site:

http://www.ers.usda.gov/Data/RuralUrbanContinuumCodes/2003/

This site allows you to view all the counties in your state, at the same 

time, in a table format. In addition, the USDA provides a link to a 

downloadable version of the county codes in excel format which will 

enable you to pull the information and manipulate it for your use.

 http://www.ers.usda.gov/data/RuralUrbanContinuumCodes/ 

Scroll down to the Data Files Section and click on the option “Download 

the 2003 codes in an Excel file”

2) Select the appropriate state from the map or listing of states that appears 

below the map.

3) A list of all counties in the selected state will appear. The 2003 RUCC is the 

fifth column from the left. 

Telework Programs are responsible for tallying how many direct users fall into each 

grouping of RUCC and providing the final number in the appropriate area of the data 

collection instrument.

EXAMPLE: The Telework Program provided six loans during the reporting period:

 Person A lives in a county with a RUCC of 2

 Person B lives in a county with a RUCC of 4

 Person C lives in a county with a RUCC of 8

 Person D lives in a county with a RUCC of 6

 Person E lives in a county with a RUCC of 9

 Person F lives in a county with a RUCC of 3

The Geographic Distribution totals for the six loans depicted in the example result in the 

following:

Geographic Area of Residence Number of Direct Users

Geographic Area of Residence Metro 

(RUCC 1-3)

In this example, persons A & F would be included in this RUCC 2 

Geographic Area of Residence Non- Metro

(RUCC 4-9)

In this example, persons B,C,D & E would be included in this 

RUCC 4 

Total System-generated
23

Report information in the table below on approved loan applications made by the Rural 

Urban Continuum Code (RUCC) of the Direct User's county of residence. Do not include 

applications that were: approved but not made, not reviewed because they were

incomplete, withdrawn before a final decision was made, still pending at the end of the 

reporting period, or rejected.

b) Type of Disability

In this section, report on the primary disability of the Direct Users who received loans during 

this reporting period (one primary disability per Direct User).

Type of Disability of Direct User Number of Direct Users

Physical disability (e.g., mobility, orthopedic, 

neurological, cardiovascular, respiratory)

Sensory disability (e.g., blindness, visual 

impairment, hearing loss)

Communication disability (e.g., nonverbal, 

aphasia)

Cognitive disability (e.g., intellectual 

disability, traumatic brain injury)

Psychiatric disability

Multiple (e.g., several disabilities)

Total System-generated

c) Employment Status of Direct User of Equipment at Time of Application

In this section, report on the employment status of the Direct Users* at the time of application 

for Telework loans that have closed. Each Direct User should be entered in one category only. 

The status indicated should be that of the Direct Users when they first submitted their 

applications, not their status at the time the loans closed, as some may have already started 

businesses or become employed by the time the loans close.

*Employed includes work for which the person receives wages. It can also mean employment 

that provides commissions. 

*Self-employed includes independent and/or contractor work. 

*Employed and Self-employed indicates a Direct User has two jobs: one job for an employer 

and one where they work for themselves.

Geographic Area of Residence Number of Direct Users

Geographic Area of Residence Metro RUCC 1-3

Geographic Area of Residence Non-Metro RUCC 4-9

Total System-generated
24

Employment Status at Time of Application Number of Direct Users

Unemployed

Employed*

Self-employed* 

Employed and Self-employed*

6. One Year Follow-up of Direct Users

In this section, you will report on Direct Users one year after their loans close. To do this you 

will need to collect information from your applicants about their employment goal at the time 

that they apply for a loan. Each Telework Program can determine its own method for 

collecting the information at the time of loan closing, but will need to ask the following 

question: 

What is the Direct User’s primary employment goal at time of application (choose one)? 

____ Become newly employed in telework for an employer (Do not have a job now but 

want to get one)

____ Become newly self-employed (Do not have a job but want to work for self) 

____ Change to teleworking job for an employer (Have a job but want to change job/kind 

of work.)

____ Change to self-employment job (Have a job but want to work for self)

____ Expand existing business

____ Other: Provide brief description:

At the one-year anniversary of the loan, use the additional survey form to ask follow-up 

questions to the Direct Users who have had their loan for one year. The survey will allow you 

to report on whether Direct Users’ primary employment goals at the time of loan closings were 

achieved one year later as a result of a Telework loan. 

Telework Programs may collect this follow-up data in a manner that best meets their needs. 

The data from the Direct Users may be collected in person, via phone, via mail, or online. 

Regardless of the method of data collection, programs should collect the data from the Direct 

User as near as possible to the 12-month anniversary of the loan closing. To produce valid 

data, you should try to obtain as high a response rate as possible. 

a) Number of Direct Users Surveyed

In this section, indicate the number of Direct Users that have had their loan for one year by the 

end of the reporting period and how many of those direct users responded to the follow-up 

survey. 

For the first reporting period only there will be an exception to following-up with Direct Users 

whose loans closed a year ago. Data for the first reporting period will be collected for all 

Direct Users who have active loans that are one year old or older.
25

Enter number of Direct Users who have had their loans for one year: __________

Enter number of respondents for whom you have follow-up data: __________

Response Rate: System generated

b) Achievement of Primary Employment Goal of Direct Users at One-Year Follow-up

In this section, based on the results of the follow-up survey you conducted, report on whether 

Direct Users have achieved their primary employment goal in relation to the Telework Loan 

one year after they received their loans. Indicate one result per Direct User and each Direct 

User should be entered in only one category. 

You will need to determine the number of Direct Users in each category by comparing their 

responses to the survey given at the time of application closing to their answers to the survey

administered a year later. 

Employment Goal Number of Direct Users

Achieved primary employment goal:

Became newly employed in telework for an 

employer

Became newly self-employed

Changed to a teleworking job for an employer

Changed to a self-employment job

Expanded existing business

Other goal

Changed employment goal and achieved it

Did not achieve employment goal

c) Data on Employment Status at One-Year Follow-up

Record the number of Direct Users who achieved their primary goal and answered yes to the 

additional questions about their employment.

Data on Employment Status Number of Direct Users Percentage of those who 

achieved their employment 

goal

Increased wages/salary System-generated

Maintained employment System-generated
26

E. Anecdote 

Provide at least one anecdote about a Direct User who received a Telework Program loan*. 

Please make these entries as specific as possible, and include the following information:

 What equipment was purchased with the loan?

 How did your Telework Program assist the Direct User obtain that 

equipment?

 What barrier(s) to employment was overcome by the equipment purchase of 

the Direct User?

 If applicable, how did your Telework Program combine or match funding with 

another source of funding to assist the Direct User with his/her employment 

goal?

 How did obtaining that equipment allow that Direct User to reach his/her 

employment goal?

Other instructions to follow in providing anecdotes:

 Limit each anecdote to 500 words or less.

 Include examples that are understandable to an uninformed audience. 

 Do not identify any people by name or use other details that would allow a 

person to be identified.

Be sure that the example clearly fits within the appropriate activities supported by the 

Telework Program.

(Narrative item)
27

F. Notes

Describe any unique issues that may affect your data during this reporting period (e.g., if you 

are unable to provide data due to circumstances beyond the control of the entity submitting 

the data, you must explain). Limit notes to 500 words or less.

(Narrative item)
28

G. Classification of Business Equipment

1. Communication Equipment

Definition: Electronic devices and services that allow a worker to communicate, such as a 

telephone, or adaptive communication devices.

Decision Rules: If the device is used to communicate, it would be included in this category. If 

the device is used as a memory aid or for some other purpose, then it would go in another 

category. For example, a personal digital assistant (PDA) that is used as a memory aid would be 

categorized as “Computer and Related Equipment.” If the PDA were used as a phone it would 

be in the “Communication Equipment” category.

Examples: Cell phones, phone equipment, T1 Line, DSL line, telephone service for a year, 

videoconferencing equipment, text telephones (TTYs) and signaling devices (visual and/or 

tactile alerting to incoming calls), amplified telephones, iCommunicator, speech generating 

devices, assistive listening systems, InterpreType, dual keyboard systems.

2. Computer Equipment and Related Software

Definition: Hardware and software products that enable people to work.

Decision Rules: Products includes computers and laptops and related software, as well as 

adapted computer hardware and software. Does not include printers; these should be categorized 

as “Office Furniture and Equipment” category. Specialized software for a particular trade should 

be categorized under the “Tools of the Trade” category.

Examples: Standard software, standard hardware, laptop computers, computer accessories, and 

keyboards, adaptive hardware and software such as screen readers, touchscreens, alternative 

keyboards, voice recognition systems.

3. Home/Office Modifications

Definition: Structural adaptations to the built environment to make telework possible.

Decision Rules: If the equipment is a permanent (built-in) or semi-permanent structural change, 

include it under this category. Include cabinets that are built-in in this category. Filing cabinets 

that are stand along units should be put in the “Office Furniture and Equipment” category.

Examples: Cabinetry and storage equipment, door and gate openers, ramps (both built-in or 

portable), signage, flooring, remodeled office, remodeled bathroom.
29

4. Office Furniture and Equipment

Definition: Equipment that traditionally is found in an office to enable work or adaptive 

furniture and equipment assisting a person with a disability to work.

Decision Rules: Includes furniture, such as desks, filing cabinets as well as printers and copiers. 

Also includes adaptive furniture and equipment needed by a person with a disability to work. 

Does not include computers.

Examples: Workstation furniture, printers, copiers, audio-visual equipment, fax machine. Also 

includes adaptive furniture and adapted office equipment such as accessible workstations/ 

desks/tables/magnifiers including CCTV systems, talking calculators, talking or Braille GPS, 

Daisy or Victor readers, environmental controls and switches.

5. Tools of the Trade

Definition: Specialized equipment needed to conduct business.

Decision Rules: Use this category if the equipment is unique to the business, such as cameras 

and photographic equipment for a photography business or a loom for a weaving business. Also 

includes adaptive equipment that is unique to the business. Use “Computers and Related 

Equipment” or “Office Equipment” if the equipment fits those categories. This should not be a 

catchall category.

Examples: Equipment for a home-based catering business, such as refrigerator, food slicer; 

equipment for a photography business, such as a camera and photo-creation system, camcorder, 

tripod; farm equipment such as grapple fork, skid steer, saw, tractor; equipment for a pet 

grooming business; leather working tools; stain glass tools; taxidermy tools; loom for weaving; 

sewing machine; medical transcription equipment.

6. Vehicles

Definition: Vehicles used for transportation, such as cars and vans, either modified or 

unmodified and other types of vehicles used for the business. Include all terrain vehicles used 

for transport.

Decision rules: If the vehicle is used for transportation, it should be included in this category. If 

the vehicle is used for work unique to the “trade,” then it should be considered in the “Tools of 

the Trade” category. For example, a pick up truck that hauls a hot dog cart to a location would 

be a classified as a “Vehicle” but an ice cream truck that travels in neighborhood selling frozen 

desserts would be considered a “Tools of the Trade.”

Examples: Modified van, unmodified automobile, trucks and all terrain vehicles.