1820-0508

Expires xx/xx/xxxx

Reporting Manual for the

CASE SERVICE RECORD REPORT

(RSA-911)

STATE-FEDERAL PROGRAM FOR

VOCATIONAL REHABILITATION

Public Burden Statement

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 81.25 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 necessary to 

obtain or retain benefits as required by the Rehabilitation Act of 1973, as amended. 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 

20202-4536 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820-0508. Note: 

Please do not return the completed RSA-911 to this address. 
i

Reporting Manual for the Case Service Record Report (RSA-911)

Contents

 Page

GENERAL INSTRUCTIONS................................................................................................. v

COMPARISON OF THE NEW RSA-911 TO THE PREVIOUS RSA-911 CASE 

SERVICE REPORT................................................................................................................ vii

INSTRUCTIONS FOR PREPARATION OF ELECTRONIC TRANSMITTAL............... xii

ELEMENT-BY-ELEMENT INSTRUCTIONS...................................................................... 1

1. Agency Code.......................................................................................................... 2

2. Social Security Number.......................................................................................... 3

3. Closure Order......................................................................................................... 3

4. Previous Closure..................................................................................................... 3

5. Date of Application................................................................................................ 4

6. Date of Birth........................................................................................................... 4

7. Gender.................................................................................................................... 4

Race

8. White.................................................................................................... 5

9. Black or African American.................................................................. 5

10. American Indian or Alaska Native....................................................... 5

11. Asian..................................................................................................... 5

12. Native Hawaiian or Other Pacific Islander........................................... 5

13. Ethnicity.................................................................................................................. 5

14. Veteran Status......................................................................................................... 5

15. Zip Code................................................................................................................. 6

16. County.................................................................................................................... 6

17. Source of Referral................................................................................................... 6

18. Involvement with Other Agencies and Services at Application............................ 7

19. Level of Education Attained at Application........................................................... 8

20. Student with Disability in Secondary Education at Application............................ 8

21. Living Arrangement at Application........................................................................ 9

22. Sensory/Communicative Impairment Type............................................................ 9

Primary and Secondary Disabilities

23. Primary Disability - ICD-10 Code ........................................................... 10

24. Primary Disability - DSM-5 Code........................................................ 10

25. Secondary Disability - ICD-10 Code....................................................... 10

26. Secondary Disability - DSM-5 Code ...................................................... 10

27. Significance of Disability....................................................................................... 10

28. Employment Status at Application......................................................................... 11

29. Weekly Earnings at Application............................................................................. 12
ii

30. Hours Worked in a Week at Application................................................................ 13

Monthly Public Support Amount at Application

31. Social Security Disability Insurance (SSDI)........................................ 14

32. Supplemental Security Income (SSI) for the Aged, Blind or Disabled 14

33. Temporary Assistance for Needy Families (TANF)............................ 14

34. General Assistance (State or local government)................................... 14

35. Veterans' Disability Benefits................................................................ 14

36. Workers' Compensation........................................................................ 14

37. All Other Public Support...................................................................... 14

38. Primary Source of Support at Application............................................................. 14

Medical Insurance Coverage at Application

39. Medicaid............................................................................................... 15

40. Medicare............................................................................................... 15

41. Public Insurance from Other Sources................................................... 15

42. Private Insurance through Own Employer........................................... 15

43. Not Yet Eligible for Private Insurance through Current Employer, 

But Will Be Eligible for Private Insurance after a Certain Period of 

Employment.......................................................................................... 15

44. Private Insurance through Other Means............................................... 15

Dates of Trial Work Experience/Extended Evaluation (EE)

45. Start Date of Trial Work Experience.................................................... 16

46. End Date of Trial Work Experience..................................................... 16

47. Start Date of Extended Evaluation....................................................... 16

48. End Date of Extended Evaluation........................................................ 16

49. Date of Eligibility Determination........................................................................... 16

Dates of Order of Selection (OOS) Waiting List

50. Date of Placement on Order of Selection (OOS) Waiting List............ 16

51. Date of Exit from OOS Waiting List.................................................... 16

52. Date of Individualized Plan for Employment (IPE)............................................... 17

53. Supported Employment Goal................................................................................. 17

Services Provided and Costs for Purchased Services

NOTE: Each Service Category has the following five data elements.

(1) Services Purchased and/or Provided by VR Agency

(2) Primary Purchased VR Service Provider Type

(3) State Vocational Rehabilitation Grant (Title I) Funds Used to 

Purchase Services

(4) Supported Employment State Grant (Title VI. Part B) Funds Used 

to Purchase Services

(5) Comparable Services and Benefits Providers
iii

Service Categories

54-58. Assessment................................................................................................ 20

59-63. Diagnosis and Treatment of Impairments................................................ 21

64-68. Vocational Rehabilitation Counseling and Guidance.............................. 22

69-73. Graduate College or University Training............................... .................. 22

74-78. Four-Year College or University Training............................................... 22

79-82. Junior or Community College Training................................................... 22

83-88. Occupational or Vocational Training....................................................... 23

89-93. On-the-job Training.................................................................................. 23

94-98. Apprendice Training................................................................................. 23

99-103. Basic Academic Remedial or Literacy Training...................................... 23

104-108. Job Readiness Training.............................................................................. 23

109-113. Disability-Related Skills Training............................................................. 24

114-118. Miscellaneous Training............................................................................. 24

119-123. Job Search Assistance............................................................................... 24

124-128. Job Placement Assistance.......................................................................... 24

129-133. On-the-job Supports - Short Term............................................................ 24

134-138. On-the-job Supports - Supported Employment........................................ 24

139-143. Transportation........................................................................................ 25

144-148. Maintenance ......................................................................................... 25

149-153. Rehabilitation Technology ....................................................................... 26

154-158. Reader Services..................................................................................... 27

159-163. Interpreter Services................................................................................ 27

164-168. Personal Attendant Services...................................................................... 27

169-173. Technical Assistance Services................................................................... 28

174-178. Information and Referral Services............................................................ 28

179-183. Beneftis Counseling................................................................................... 28

184-188. Customized Employment Services............................................................ 28

189-193. Other Services....................................................................................... 29

194. Level of Education Attained At Closure................................................................ 29

195. Student with Disability in Secondary Education at Closure................................... 29

196. Number of Jobs/Occupations at Closure................................................................ 30

197. Primary Occupation at Closure............................................................................... 30

198. Start Date of Employment in Primary Occupation At Closure.............................. 31

199. Employment Status at Closure................................................................................ 31

200. Weekly Earnings at Closure................................................................................... 32

201. Hours Worked in a Week at Closure...................................................................... 33

Monthly Public Support Amount at Closure

202. SSDI..................................................................................................... 33

203. SSI for the Aged, Blind or Disabled..................................................... 33

204. TANF.................................................................................................... 33
iv

205. General Assistance (State or local government)................................... 34

206. Veterans' Disability Benefits................................................................ 34

207. Workers' Compensation........................................................................ 34

208. All Other Public Support...................................................................... 34

209. Primary Source of Support at Closure.................................................................... 34

Medical Insurance Coverage at Closure

210. Medicaid............................................................................................... 35

211. Medicare............................................................................................... 35

212. Public Insurance from Other sources.................................................... 35

213. Private Insurance Through Own Employer.......................................... 35

214. Not Yet Eligible for Private Insurance Through Current Employer, 

But Will Be Eligible for Private Insurance After a Certain Period of 

Employment.......................................................................................... 35

215. Private Insurance Through Other Means.............................................. 35

216. Type of Closure...................................................................................................... 35

217. Reason for Closure................................................................................................. 36

218. Date of Closure....................................................................................................... 37

RECORD LAYOUT................................................................................................................ 38
v

GENERAL INSTRUCTIONS

Reported records pertain to all individuals whose service records were closed in a given Federal 

fiscal year (FY). 

The due date for RSA-911 submittals is November 30 following the Federal FY (October 1 to 

September 30) of reference. 

All records submitted must be unique. The Agency Code, Social Security Number, and Closure 

Order Code determine the "uniqueness" of a given case service record. Duplicate case service 

records will be rejected. For example, case service records with an Agency Code, Social Security

Number, and Closure Order Code identical to those in another record will be considered 

duplicates and will be rejected. In order to indicate that a second closure for an individual has 

taken place in the same FY, enter "2" in the Closure Order Code. Enter "3" for a third closure 

and "4" for a fourth closure, etc.

The format is no longer fixed length file, but has been changed to a delimited format. Each data 

element is accompanied by data type information that will serve as a guide to submitting valid 

values, but values that are not at the maximum length for the data type will no longer cause 

problems for the submission of the file. The three data types used are:

VARCHAR (n) This data type can hold any character(s) with a maximum 

length defined by the number within the parentheses. All 

variable character (VARCHAR) data elements within the 

RSA-911 hold numeric characters with the exception of 

County and Primary/Secondary Disability Codes which 

can be alphanumeric. 

Date 112 

(YYYYMMDD)

This data type holds dates in the eight-digit format of year, 

month, and day. All dates reported on the RSA-911 must 

be in the format of YYYYMMDD, where YYYY is Year, 

MM is Month and DD is Day. 

For Year:

Record the year using all four digits of the year.

Example: 1997, 1998, 2000, 2001, etc.

For Month:

Record the months as follows:

01 January 07 July

02 February 08 August

03 March 09 September

04 April 10 October

05 May 11 November

06 June 12 December
vi

For Day of the month:

Enter 01, 02, etc., using a "0" prefix for single digit 

date of days.

INT (n) This data type can hold any integer (whole number) with a 

maximum length of integers as defined by the number 

within the parentheses. Number of hours worked and

dollar amounts for monthly amounts of public support, 

funds expended, and weekly earnings must be reported as 

positive integers.

Agencies should leave blank those data elements that are incomplete because cases were closed 

with a closure code 1, as the file format of the RSA-911 will no longer require the file to be of a 

fixed length.

Data element numbers are in the order of the record layout for text file submission. Also refer to 

the Record Layout listing on page 38.
vii

COMPARISON OF THE NEW RSA-911

TO THE PREVIOUS RSA-911 CASE SERVICE REPORT

Note: New data elements are listed in bold.

Data Element Number and Name Change, if any, from current RSA-911

1 Agency Code No change

2 Social Security Number Revised instructions.

3 Closure Order No change

4 Previous Closure No change

5 Date of Application Revised instructions. Single date format instead of 

separate data elements for year, month, and day.

6 Date of Birth Single date format instead of separate data elements for 

year, month, and day.

7 Gender No change

8-12 Race Changed from one element with many record position 

descriptions to multiple data elements individually 

numbered with expanded definitions.

13 Ethnicity Race and Ethnicity data elements have been split and will 

follow OMB recommendations. Revised the instructions 

concerning self-reporting individuals of Hispanic or 

Latino ethnicity.

14 Veteran Status This element was previously data element number 40.

15 Zip Code New data element. 

16 County New data element.

17 Source of Referral New codes added; Physician or Other Medical Personnel 

or Medical Institutions (public or private) has been 

revised.

18 Involvement with Other 

Agencies and Services at 

Application 

New data element.

19 Level of Education Attained at 

Application

Coding options have been revised/added to allow for more 

specificity. 

20 Student with Disability in 

Secondary Education at 

Application

Replaces Individualized Education Program (IEP).

21 Living Arrangement at 

Application

No change.

22 Sensory/Communicative 

Impairment Type

New data element.
viii

Data Element Number and Name Change, if any, from current RSA-911

23 Primary Disability - ICD-10 

Code

Impairment Codes/Causes have been replaced. 

Agencies will enter the appropriate code from the 

current version of the International Classification of 

Disease (ICD-10).

24 Primary Disability - DSM-5 

Code

Impairment Codes/Causes have been replaced. 

Agencies will enter the appropriate code from the 

current version of the Diagnostic and Statistical 

Manual of Mental Disorders (DSM-5). 

25 Secondary Disability - ICD10 CodeFollows same format as for Primary Disability - ICD10 Code

26 Secondary Disability - DSM5 CodeFollows same format as for Primary Disability - DSM5 Code

27 Significance of Disability This data element was previously data element number 41

and entitled "Significant Disability."Instructions have been 

enhanced and coding options now include “Most 

Significant Disability” in addition to "No Significant 

Disability" and "Significant Disability." 

28 Employment Status at 

Application

Examples are given for “Not employed: All Other 

Students.”

29 Weekly Earnings at 

Application

Deleted instructions that dealt with fixed length data.

30 Hours Worked in a Week at 

Application

Deleted instructions that dealt with filling in leading zeros.

Added statement that if individual generated no earnings, 

the data element should be "0".

31-37 Monthly Public Support 

Amount at Application

Type of Public Support at Application has been 

incorporated into Monthly Public Support Amount at 

Application. Changed from one element with many

record position descriptions to multiple data elements 

individually numbered and added General Assistance 

(State or local government), Veterans' Disability Benefits, 

and Workers' Compensation. Description of All Other 

Public Support has been enhanced. Deleted instructions 

that dealt with dollar rounding and fixed length data.

41 Primary Source of Support at 

Application

Instructions and coding option descriptions have been 

enhanced. 

39-44 Medical Insurance Coverage 

at Application

Changed from one element with many record position 

descriptions to multiple data elements individually 

numbered. Added specific language to a new code for 

those who get insurance from their employer after a 

certain period of employment. The description for Private 

Insurance through Other Means has been enhanced. 

45 Start Date of Trial Work 

Experience 

New data element
ix

Data Element Number and Name Change, if any, from current RSA-911

46 End Date of Trial Work 

Experience 

New data element

47 Start Date of Extended 

Evaluation

New data element

48 End Date of Extended 

Evaluation

New data element

49 Date of Eligibility

Determination

Single date format instead of separate data elements for 

day, month, and year.

50 Date of Placement on Order 

of Selection (OOS) Waiting 

List

New data element

51 Date of Exit from OOS 

Waiting List

New data element

52 Date of Individualized Plan 

for Employment (IPE)

Single date format instead of separate data elements for 

year, month, and day.

53 Supported Employment Goal Replaces data element number 39, Supported Employment 

Status. Instructions and codes were revised extensively.

54-193 Services Provided and Costs 

for Purchased Services

Combines Cost of Purchased Services and Services 

Provided. Each service category has the following five 

data elements:

(1) Services Purchased and/or Provided by the VR 

Agency

(2) Primary Purchased VR Service Provider Type

(3) State Vocational Rehabilitation Grant (Title I) 

Funds Used to Purchase Services

(4) Supported Employment State Grant (Title VI. Part 

b) Funds Used to Purchase Services 

(5) Comparable Services and Benefits Providers

54-58 Assessment Expanded definition

59-63 Diagnosis & Treatment of 

Impairments

Expanded definition

64-68 Vocational Rehabilitation 

Counseling & Guidance

Description changed to align with the regulations.

69-73 Graduate College or 

University Training

College or University Training has been broken out into 

three data elements:

74-78 Four-Year College or 

University Training

(1) Graduate College or University Training

79-83 Junior or Community College 

Training

(2) Four-Year College or University Training

(3) Junior or Community College training
x

Data Element Number and Name Change, if any, from current RSA-911

84-88 Occupational or Vocational 

Training

Expanded definition

89-93 On-the-job Training Apprenticeship training has been separated out from onthe-job training.

94-98 Apprenticeship Training New data element

99-103 Basic Academic Remedial or 

Literacy Training

No change

104-108 Job Readiness Training No change

109-113 Disability-Related Skills 

Training

No change

114-118 Miscellaneous Training Expanded definition

119-123 Job Search Assistance No change

124-128 Job Placement Assistance No change

129-133 On-the-job Supports –Short 

Term

On-the-job Supports broken out into short term and 

supported employment.

134-138 On-the-job Supports –

Supported Employment

139-143 Transportation Expanded definition

144-148 Maintenance No change

149-153 Rehabilitation Technology Expanded definition

154-158 Reader Services No change

159-163 Interpreter Services No change

164-168 Personal Attendant Services Expanded definition

169-173 Technical Assistance Services No change

174-178 Information & Referral

Services

Definition has been clarified.

179-183 Benefits Counseling New data element

184-188 Customized Employment 

Services

New data element

189-193 Other Services Definition has been streamlined.

194 Level of Education Attained at 

Closure

Coding options have been revised/added to allow for more 

specificity.

195 Student with Disability in 

Secondary Education at 

Closure

New data element

196 Number of 

Jobs/Occupations at Closure

New data element
xi

Data Element Number and Name Change, if any, from current RSA-911

197 Primary Occupation at 

Closure

Added the word "Primary" to the data element name. 

Description enhanced to specify occupation must be 

consistent with the employment goal on the individual’s 

IPE. Added detailed instructions for individuals who exit 

with multiple occupations. Language regarding the use of 

DOT codes has been deleted.

198 Start Date of Employment in 

Primary Occupation at 

Closure

New data element

199 Employment Status at Closure Deleted coding option (2) Extended Employment code. 

200 Weekly Earnings at Closure Description enhanced to specify earnings must be from 

employment that is consistent with the employment goal 

on the individual’s IPE. Deleted instructions that dealt 

with fixed length data.

201 Hours Worked in a Week at 

Closure

Description enhanced to specify hours worked must be 

from employment that is consistent with the employment 

goal on the individual’s IPE. Deleted instructions that 

dealt with filling in leading zeros.

202-208 Monthly Public Support 

Amount at Closure

Type of Public Support at Closure has been incorporated 

into Monthly Public Support Amount at Closure. 

Changed from one data element with many record position 

descriptions to multiple data elements individually 

numbered and added General Assistance (State or local 

government), Veterans' Disability Benefits, and Workers' 

Compensation. Deleted instructions that dealt with dollar 

rounding and fixed length data.

209 Primary Source of Support at 

Closure

Instructions have been enhanced.

210-215 Medical Insurance Coverage 

at Closure

Changed from one data element with many record position 

descriptions to multiple data elements individually 

numbered. Added specific language to a new code for 

those who obtain insurance from their employer after a 

certain period of employment. Description of All Other 

Public Support has been enhanced. Deleted instructions 

that dealt with dollar rounding and fixed length data.

216 Type of Closure No change

217 Reason for Closure Some reasons for closure have been combined while 

others have been broken out. Four reasons have been 

identified as "ineligible."

218 Date of Closure Single date format instead of separate data elements for 

year, month, and day.
xii

INSTRUCTIONS FOR PREPARATION OF ELECTRONIC TRANSMITTAL

Submitting RSA-911 data via secured file transfer protocol (SFTP) is now preferred to

submitting on CD-ROM. In order to upload your RSA-911 data file to the RSA SFTP server, you 

will need to download a free SFTP program onto your computer. Below is a list of a few free 

SFTP software packages and links to their websites. Follow the downloading instructions to 

install SFTP software on your system.

WinSCP

http://winscp.net/eng/download.php

FileZilla

http://filezilla-project.org/

Core FTP LE

http://www.coreftp.com/

Once you have completed downloading the software, you will need to establish a connection to 

RSA’s SFTP server. The name of the server that you will be uploading the RSA-911data file to 

is: 

edsecureftp.ed.gov

Your user-id is “rsa-ba-g”, where "ba" is the official postal abbreviation for your state/territory

and "g" is the type of agency, that is "g"=general, "c"=combined and "b"=blind. Likewise, the 

naming convention for the RSA-911 data file is "BAgXFYNN", where "BA" is the official postal 

abbreviation for your state/territory, "g" is the type of agency, that is "g"=general, "c"=combined 

and "b"=blind, "X" is the number of the submission, that is, "1"=first, "2"=second, etc.

"NN" is the last two digits of the reported fiscal year. 

As an example, since the Oklahoma Department of Rehabilitation Services is a combined 

agency, the user ID would be: rsa-ok-c and the name of the FY2014 file would be OKc1FY14.

Passwords will be distributed by RSA to VR agency staff responsible for submitting RSA-911 

data files. Passwords will be managed and maintained by Vernita Washington at 

vernita.washington@ed.gov or 202-245-7479 or Joan Ward at joan.ward@ed.gov or 202-245-

7565.

If agencies are unable to submit data to the SFTP server, data are to be sent on a compact disc 

via overnight services with an external label identifying the contents as "RSA-911 Data for 

BAgXFYNN" following the naming convention as described above and must be signed for by

the recipient.
xiii

If by private carrier If by USPS

US Department of Education

State Monitoring and Program Improvement 

Division 

Data Collection and Analysis Unit

ATTN: Vernita Washington 

550 12th Street, S.W., PCP 5047

Washington, DC 20202-2800

US Department of Education

State Monitoring and Program Improvement 

Division

Data Collection and Analysis Unit

ATTN: Vernita Washington, PCP 5047

LBJ Basement Level 1

400 Maryland Avenue, SW

Washington, DC 20202-2800

If you need additional information, contact either Vernita Washington at 

vernita.washington@ed.gov or 202-245-7479; or Joan Ward at joan.ward@ed.gov or 202-245-

7565.
1820-0508

Expires xx/xx/xxxx

Element-by-Element Instructions:

CASE SERVICE RECORD REPORT

(RSA-911)

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 81.25 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 necessary to obtain or 

retain benefits as required by the Rehabilitation Act of 1973, as amended. 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 1820-0508. Note: Please do not return the 

completed RSA-911 to this address. 
2

1. Agency Code

Data type: VARCHAR (3)

Enter the three-digit code assigned to each State vocational rehabilitation (VR) agency from the 

following list. Please note that codes have been pre-assigned to nonexistent agencies for 

individuals who are blind or visually impaired in the event that they are established in the future.

State or Agency Code State or Agency Code

Territory General/ Blind territory General/ Blind

Combined Combined

Alabama 001 057 Montana 029 085

Alaska 002 058 Nebraska 030 086

American Samoa 003 059 Nevada 031 087

Arizona 004 060 New Hampshire 032 088

Arkansas 005 061 New Jersey 033 089

California 006 062 New Mexico 034 090

Colorado 007 063 New York 035 091

Connecticut 008 064 North Carolina 036 092

Delaware 009 065 North Dakota 037 093

Dist. of Columbia 010 066 Northern Marianas 038 094

Florida 011 067 Ohio 039 095

Georgia 012 068 Oklahoma 040 096

Guam 013 069 Oregon 041 097

Hawaii 014 070 Pennsylvania 042 098

Idaho 015 071 Puerto Rico 043 099

Illinois 016 072 Rhode Island 044 100

Indiana 017 073 South Carolina 045 101

Iowa 018 074 South Dakota 046 102

Kansas 019 075 Tennessee 047 103

Kentucky 020 076 Texas 048 104

Louisiana 021 077 Utah 049 105

Maine 022 078 Vermont 050 106

Maryland 023 079 Virginia 051 107

Massachusetts 024 080 Virgin Islands 052 108

Michigan 025 081 Washington 053 109

Minnesota 026 082 West Virginia 054 110

Mississippi 027 083 Wisconsin 055 111

Missouri 028 084 Wyoming 056 112
3

2. Social Security Number

Data type: VARCHAR (9

Enter the individual’s nine-digit Social Security number (SSN). When a SSN is not available or 

if the individual prefers not to provide his/her SSN, assign a unique nine-digit number that:

a) does not duplicate a genuine SSN, and 

b) does not duplicate any other substitute number assigned in place of a SSN. 

Starting the nine-digit number with the digits "99" will avoid duplicating a genuine SSN. Only

numeric characters between “0” and “9” are permitted in the Social Security Number field.

3. Closure Order

Data type: VARCHAR (1)

Assign the appropriate closure order code for all service records from the list below:

1 First closure of an individual’s service record in the FY being reported

2 Second closure of the same individual’s service record in the same FY

3 Third closure of the same individual’s service record in the same FY, and so on.

If an individual’s service record is closed more than once in the FY, the RSA-911 data system 

must contain a separate record for each closure. Ensure that when a record indicates a closure 

order code 2, there is another record with a closure order code 1 with an identical SSN for that 

individual, and so on for all multiple closures in the same FY.

4. Previous Closure

Data type: VARCHAR (1)

Enter the appropriate code listed below to indicate whether the individual had a previous service 

record closed by the State VR agency within a 36-month period prior to the most recent 

application for services. If more than one record was closed for the individual within that 36-

month period, consider the most recent previous closure. Indicate the type of the previous closure 

using one of the following codes:

0 No previous closure within 36 months 

1 Closed while the individual was an applicant, but before a determination of 

eligibility

2 Closed during or after a trial work experience/extended evaluation

3 Closed after the individual achieved an employment outcome

4 Closed after individual received services, without an employment outcome

5 Closed after an individualized plan for employment (IPE) was signed, but 

before receiving services

6 Closed from an order of selection wait list

7 Closed after a determination of eligibility, but before an IPE was signed
4

5. Date of Application

Data type: DATE 112 (YYYYMMDD)

Record the date (year, month, and day) that the agency received a completed and signed 

application form from the applicant. The date should be verifiable by date stamp. 

6. Date of Birth

Data type: DATE 112 (YYYYMMDD)

Record the individual’s date (year, month, and day) of birth. 

7. Gender

Data type: VARCHAR (1)

Code the individual’s gender as follows:

1 Male

2 Female

Race

Race information should be recorded for all individuals whose service records were closed in the

FY being reported. For each race category below, use the following codes to record the 

individual’s race:

0 if the individual is not of that race

1 if the individual is of that race

RSA continues to require self-identification to the greatest extent possible. It is generally 

expected that the information recorded will reflect the individual’s own identification of race 

from the categories provided. However, if an individual refuses to identify his/her race, the 

counselor should, at a minimum, notify the individual that if he/she fails to self-identify, an 

observer-identification method will be used. The counselor or interviewer would then provide 

the best assessment of the individual's race. This guidance follows OMB standards for collecting 

race data. OMB prefers self-identification methods, but allows for observer-identification 

methods when necessary.

At least one of the race categories must be coded as 1. Remaining categories should have codes 

of 0 (not this race). More than one race variable can contain a code of 1 for an individual.

Agencies may leave the element blank only if the information is not available due to 

circumstances beyond the agency’s control for closure type 1. Such service records will be few 

in number. As an example, if an individual applies for services via an application form or letter 

and is closed by the agency without being seen by agency personnel, this individual's race would 

not be known and could not be observed and therefore all race options would be left blank.
5

8. White – An individual having origins in any of the original peoples of Europe, 

the Middle East or North Africa.

Data type: VARCHAR (1)

9. Black or African American – An individual having origins in any of the Black 

racial groups of Africa.

Data type: VARCHAR (1)

10. American Indian or Alaska Native – An individual having origins in any of the 

original peoples of North and South America (including Central America), and 

who maintains a tribal affiliation or community attachment.

Data type: VARCHAR (1)

11. Asian – An individual having origins in any of the original peoples of the Far 

East, Southeast Asia, or the Indian subcontinent, including for example, 

Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine 

Islands, Thailand, and Vietnam.

Data type: VARCHAR (1)

12. Native Hawaiian or Other Pacific Islander – An individual having origins in 

any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

Data type: VARCHAR (1)

13. Ethnicity - Hispanic or Latino – An individual of Cuban, Mexican, Puerto Rican, South 

 or Central American, or other Spanish culture or origin, regardless of race.

Data type: VARCHAR (1)

The ethnic category Hispanic or Latino should be recorded for all individuals whose service

records were closed in the FY being reported. Use the following codes to record the individual’s

Hispanic or Latino ethnicity:

0 if the individual is not of Hispanic/Latino ethnicity

1 if the individual is of Hispanic/Latino ethnicity

If the individual self-identifies as Hispanic, but refuses or is unable to identify one or more race 

categories in addition, then code the individual as Hispanic for ethnicity and follow the observeridentification method as described above for the race categories. Notify the individual that if 

he/she fails to identify, then an observer-identification method will be used. Individuals who 

identify as Hispanic may belong to any race group.

14. Veteran Status

Data type: VARCHAR (1)

Enter a one-digit code to indicate if the individual served in the active military, naval or air 

service, and was discharged or released under conditions other than dishonorable.
6

0 Not a veteran

1 Veteran

15. Zip Code

Data type VARCHAR (5)

Enter the five-digit numeric US Postal Service Zip Code corresponding to the location of the 

individual’s residence. 

16. County

Data type: VARCHAR (40)

Enter the name of the county corresponding to the location of the individual’s residence. 

17. Source of Referral

Data type: VARCHAR (2)

Indicate the individual, agency, or other entity that first referred the individual to the State VR 

agency by using one of the following codes. If the individual approached the VR agency on 

his/her own, use Code 8 (self-referral). Note: Coding options have been added to this data 

element. For cases open at the time of form implementation, no changes to the existing data 

coding options are required. Begin collecting new data element coding options after form 

implementation for all new applicants.

1 Educational Institutions (elementary/secondary)

2 Educational Institutions (post-secondary)

3 Medical Health Provider (Public or Private)

4 Welfare Agency (State or local government)

5 Community Rehabilitation Programs

6 Social Security Administration (Disability Determination Service or District 

office)

7 One-stop Employment/Training Centers

8 Self-referral

9 Other Sources

10 American Indian VR Services Program

11 Centers for Independent Living

12 Child Protective Services

13 Consumer Organizations or Advocacy Groups

14 Employers

15 Faith Based Organizations

16 Family/Friends

17 Intellectual and Developmental Disabilities Providers

18 Mental Health Provider (Public or Private)

19 Public Housing Authority

20 State Department of Correction/Juvenile Justice
7

21 State Employment Service Agency

22 Veteran's Administration

23 Worker's Compensation

24 Other State Agencies

25 Other VR State Agencies

18. Involvement with Other Agencies and Services at Application

Data Type VARCHAR (6)

At the time of application, enter up to three codes from the list below that describes a service 

provider or funding source from which the individual was provided services or funding. Make 

sure to enter the leading zeros if necessary and do not use commas or spaces between any of the 

codes. For example, if the individual received a service or funding from an employer, the 

Veteran’s Administration, and other sources, enter “081924”. If the individual received a service 

or funding from a Community Rehabilitation Program and a developmental disability agency, 

enter “0411”. If an individual received services or funding from only a consumer organization or

advocacy group, enter “05”. In an individual was not provided services or funding from any 

programs or organizations listed below, enter "00."

00 Not provided services or funding from any programs or organizations listed 

below

01 American Indian VR Services Program

02 Centers for Independent Living

03 Child Protective Services

04 Community Rehabilitation Programs

05 Consumer Organizations or Advocacy Groups

06 Educational Institutions (elementary/secondary)

07 Educational Institutions (post-secondary)

08 Employers

09 Employment Networks (not otherwise listed)

10 Federal Student Aid (such as, Pell grants, SEOG (Supplemental Educational 

Opportunity Grant), work study, etc.

11 Intellectual and Developmental Disabilities Agencies

12 Medical Health Provider (Public or Private)

13 Mental Health Provider (Public or Private)

14 One-stop Employment/Training Centers

15 Public Housing Authority

16 Social Security Administration (Disability Determination Service or District 

office)

17 State Department of Correction/Juvenile Justice

18 State Employment Service Agency

19 Veteran's Administration

20 Welfare Agency (State or local government)
8

21 Worker's Compensation

22 Other VR State Agencies

23 Other State Agencies

24 Other Sources

19. Level of Education Attained at Application

Data type: VARCHAR (2)

Record the level of education the individual had attained at the time of application. Note: Coding 

options have been updated and/or added to this data element. For cases open at the time of form 

implementation, update data element coding options if applicable. Use the following codes:

0 No formal schooling 

1 Elementary education (grades 1-8)

2 Secondary education, no high school diploma (grades 9-12)

3 Special education certificate of completion/diploma or in attendance

4 High school graduate or equivalency certificate (GED)

5 Post-secondary education, no degree or certificate

6 Post-secondary academic degree, Associate degree

7 Bachelor's degree

8 Master’s degree

9 Any degree above a Master's - e.g. Ph.D., Ed.D., J.D.

10 Vocational/Technical Certificate

11 Occupational credential beyond undergraduate degree work

12 Occupational credential beyond graduate degree work

20. Student with Disability in Secondary Education at Application

Data type: VARCHAR (1)

This element captures the status of an individual with a disability in secondary education at the 

time of application. Note: This data element replaces Individualized Education Program (IEP) 

in the previous version of the RSA-911 instructions. If the individual was coded as having an 

IEP at the time of application in the previous version of the RSA-911 instructions, update the 

record.

1 This individual is not a student with a disability in secondary education at the 

time of application.

2 This individual is a student with a 504 accommodation plan.

3 This individual is a student and is receiving services under an IEP at the time of 

application.

4 This individual is a student with a disability who not covered by Section 504 of 

the Rehabilitation Act and is not receiving services under an IEP at the time of 

application.
9

21. Living Arrangement at Application

Data type: VARCHAR (2)

Indicate the living arrangements of the individual, either temporarily or permanently, on the date 

of application to the State VR agency. Codes for this item are as follows:

1 Private Residence (independent, or with family or other person)

2 Community Residential/Group Home

3 Rehabilitation Facility

4 Mental Health Facility

5 Nursing Home

6 Adult Correctional Facility

7 Halfway House 

8 Substance Abuse Treatment Center

9 Homeless/Shelter

10 Other

22. Sensory/Communicative Impairment Type

Data type: VARCHAR (1)

Enter the one-digit code from the list below that best describes the sensory/communicative 

impairment that in the judgment of the rehabilitation counselor, after consulting with the 

individual, most severely hinders the individual from seeking, obtaining and regaining gainful 

employment.

0 No sensory/communicative impairment

1 Blindness

2 Other Visual Impairments

3 Deafness, Primary Communication Visual

4 Deafness, Primary Communication Auditory

5 Hearing Loss, Primary Communication Visual

6 Hearing Loss, Primary Communication Auditory

7 Other Hearing Impairments (Tinnitus, Meniere’s Disease, hyperacusis, etc.)

8 Deaf-Blindness

9 Communicative Impairments (expressive/receptive)

23-26. Primary and Secondary Disabilities

The current version of the International Classification of Disease (ICD-10) and the current 

version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be used to 

identify the individual’s primary and secondary disease or disorder that impedes the individual 

from seeking, obtaining and retaining gainful employment. The ICD-10 is a six-digit 

alphanumeric code in the form xxx.xxx while the DSM-5 is a five-digit numeric code in the form 

xxx.xx. Only one primary disability and one secondary disability can be selected for an

individual. For example, if there is a code selected from the ICD-10 and coded in data element 
10

23, Primary Disability – ICD-10 Code, then data element 24, Primary Disability – DSM-5 Code

must be left blank. 

23. Primary Disability - ICD-10 Code

Data type VARCHAR (7)

When an individual has more than one applicable ICD-10 code, enter the ICD-10 code that best 

describes, in the judgment of the rehabilitation counselor and after consulting with the 

individual, the primary disability code that most severely impedes the individual from seeking, 

obtaining and retaining gainful employment. If no ICD-10 code applies to the individual, or the 

ICD-10 code is not the primary impediment to employment, leave blank. 

24. Primary Disability – DSM-5 Code

Data type VARCHAR (7)

When an individual has more than one applicable DSM-5 code, enter the DSM-5 code that best 

describes, in the judgment of the rehabilitation counselor and after consulting with the 

individual, the primary disability code that most severely impedes the individual from seeking, 

obtaining and retaining gainful employment. If no DSM-5 code applies to the individual, or the 

DSM-5 code is not the primary impediment to employment, leave blank. 

25. Secondary Disability - ICD-10 Code

Data type VARCHAR (7)

When an individual has more than one applicable ICD-10 code that is a secondary impediment to

the individual seeking, obtaining, and retaining gainful employment, enter the ICD-10 code that

best describes, in the judgment of the rehabilitation counselor and after consulting with the 

individual, the secondary disability code that is the most significant impediment to employment 

for the individual. If no ICD-10 code applies to the individual, or the ICD-10 code is not the 

secondary impediment to employment, leave blank. 

26. Secondary Disability – DSM-5 Code

Data type VARCHAR (7)

When an individual has more than one applicable DSM-5 code that is a secondary impediment to 

the individual seeking, obtaining, and retaining gainful employment, enter the DSM-5 code that

best describes, in the judgment of the rehabilitation counselor and after consulting with the 

individual, the secondary disability code that is the most significant impediment to employment 

for the individual. If no DSM-5 code applies to the individual, or the DSM-5 code is not the 

secondary impediment to employment, leave blank. 

27. Significance of Disability

Data type: VARCHAR (1)

Enter a one-digit code to indicate whether the individual was considered a person with a 

significant disability or a most significant disability at any time during his/her VR program. If an 
11

individual is receiving Social Security benefits at application or closure, he/she is presumed 

eligible and significantly disabled. Individuals are to be coded as most significantly disabled if 

they meet the definition of significantly disabled and have additional functional limitations as 

defined by the agency.

Note: Coding options have been added to this data element. For cases open at the time of form 

implementation, no changes to the existing data coding options are required. Begin collecting 

new data element coding options after form implementation for all new applicants. An individual

with a significant disability is an individual: 

a) who has a physical or mental impairment that seriously limits one or more 

functional capacities (such as mobility, communication, self-care, selfdirection, interpersonal skills, work tolerance, or work skills) in terms of an 

employment outcome;

b) whose VR can be expected to require multiple VR services over an extended 

period of time; and

c) who has one or more physical or mental disabilities resulting from amputation, 

arthritis, autism, blindness, burn injury, cancer, cerebral palsy, cystic fibrosis, 

deafness, head injury, heart disease, hemiplegia, hemophilia, respiratory or 

pulmonary dysfunction, intellectual disability, mental illness, multiple 

sclerosis, muscular dystrophy, musculo-skeletal disorders, neurological 

disorders (including stroke and epilepsy), spinal cord conditions (including 

paraplegia and quadriplegia), sickle cell anemia, specific learning disability, 

end-stage renal disease, or another disability or combination of disabilities 

determined on the basis of an assessment for determining eligibility and VR 

needs to cause comparable substantial functional limitation.

0 No Significant Disability

1 Significant Disability

2 Most Significant Disability

28. Employment Status at Application

Data type: VARCHAR (2)

Enter the code which best describes the employment status of the individual at application from 

the following codes. The first seven codes are considered "employment" for purposes of this 

item. Individuals not meeting the definitions for Codes 1 to 7 below would be classified as "not 

employed" (Codes 8 to 11) at the time of application for services.

1 Employment without Supports in Integrated Setting is full-time or part-time 

employment in an integrated setting without ongoing support services. For 

purposes of this report, this is work performed for wages, salary, commissions, 

tips, or piece-rates, below, at, or above the minimum wage. Do not include selfemployed individuals.

2 Extended Employment refers to work for wages or salary in a non-integrated 

setting for a public or nonprofit organization. Such settings are variously 
12

referred to as community rehabilitation programs, or sheltered, industrial, or 

occupational workshops. Individuals are compensated according to the Fair 

Labor Standards Act and the organization provides any needed support services 

that enable the individual to train or prepare for competitive employment.

3 Self-employment (except BEP) refers to work for profit or fees including 

operating one's own business, farm, shop, or office. "Self-employment" 

includes sharecroppers, but not wage earners on farms.

4 State Agency-managed Business Enterprise Program (BEP) refers to RandolphSheppard vending facilities and other small businesses operated by individuals 

with significant disabilities under the management and supervision of a State 

VR agency. Include home industry where the work is done under the 

management and supervision of a State VR agency in the individual's own 

home or residence for wages, salary, or on a piece-rate. Individuals capable of 

activity outside the home, as well as homebound individuals, may engage in 

such employment.

5 Homemaker refers to men and women whose activity is keeping house with no 

earnings for persons in their households or for themselves if they live alone.

6 Unpaid Family Worker refers to persons who work without pay on a family

farm or in a family business.

7 Employment with Supports in Integrated Setting is full-time or part-time 

employment in an integrated setting with ongoing support services for 

individuals with significant disabilities (supported employment). For purposes 

of this report, compensation for such employment may be below, at, or above 

the minimum wage. 

8 Not employed: Student in Secondary Education including GED classes and 

special education classes with the goal of obtaining a high school diploma or 

GED.

9 Not employed: All other Students are persons attending school full or part-time 

other than students in secondary education (for example, students in postsecondary education, adult education, or vocational training).

10 Not employed: Trainee, Intern or Volunteer refers to persons engaging in 

unpaid work experiences, internships or volunteer work for purposes of 

increasing their employability. Such individuals may receive a stipend to 

defray the cost of transportation or other incidental expenses.

11 Not employed: Other refers to persons not in any of the other categories (e.g., 

persons just out of school who are not yet employed; persons unable to retain or 

obtain work; and persons who have recently left specialized medical facilities).

When an individual’s work activity overlaps into two different employment categories, select the 

code more descriptive of the individual's employment activity at application.

29. Weekly Earnings at Application

Data Type INT(5)

Enter the amount of money (to the nearest dollar) earned in a typical week at the time of 

application. 
13

This item collects data on the cash earnings of individuals at application and includes all wages, 

salaries, tips, and commissions received as income before payroll deductions of Federal, State 

and local income taxes and Social Security payroll tax. Earnings also include profits derived 

from self-employed individuals. Earnings for salespersons, consultants, self-employed 

individuals, and other similar occupations are based on the adjusted gross income. Adjusted 

gross income is gross income minus unreimbursed business expenses. Do not include estimates 

of payments in-kind, such as meals and lodging. Estimate profits of farmers, if necessary.

Where earnings are based on commissions that are irregular (e.g., real estate, automobile sales, 

etc.), to obtain a meaningful figure for a typical week’s earnings, it should be calculated as a 

weekly average over a representative period of time such as one month or longer.

When, because of the occupation/situation, there are significant amounts of unreimbursed 

business expenses that are irregular (e.g., car lease payments due the first week of every month), 

the expenses should be averaged over a representative period of time such as one month or 

longer to obtain a meaningful figure for a typical week’s expenses. Commissions are generally 

not paid when earned, but rather are paid periodically, such as weekly, biweekly, or even 

monthly. To bring standardization to this item, earnings should be based on the actual receipt of 

the payment and not on amounts accruing until the next commission payout. 

If the individual had no earnings, enter "0".

30. Hours Worked in a Week at Application

Data type INT(3)

Enter the number of hours an individual worked for earnings in a typical week at the time of 

application. Earnings may have been in the form of wages, salaries, tips, commissions, profits 

from self-employment, adjusted gross income for salespersons, etc. If the individual generated 

no earnings, enter "0".

Monthly Public Support Amount at Application

Enter the monthly amount (to the nearest dollar) of public support received by the individual at 

application from each of the following sources. If individual did not receive any monthly public 

support, enter "0" for each type of public support. Agencies may leave these data elements blank 

for closure code 1.

Public support means cash payments made by Federal, State and/or local governments for any

reason, including an individual’s disability, age, or economic status. Include payments to a 

family unit precipitated by the individual’s disability or when the individual’s presence is taken 

into account in the computation of the family benefit. Also include any payments that are sent 

directly to the individual in an institution or to dependents on his/her behalf. Exclude any noncash support payments such as Medicaid, Medicare, food stamps and rental subsidies. Categories 

of public support are as follows:
14

31. Social Security Disability Insurance (SSDI)

Data Type INT(5)

Enter the amount of SSDI received by the individual each month. This figure 

can be verified through the Social Security Administration (SSA) or from a 

copy of the individual’s benefit notification letter.

32. Supplemental Security Income (SSI) for the Aged, Blind or Disabled 

Data Type INT(5)

Enter the monthly payment to the individual under the Federal program of SSI

for the aged, blind, and disabled. Only the individual’s portion of the payment 

should be recorded here. This figure can be verified through the SSA or from a 

copy of the individual’s benefit notification letter.

33. Temporary Assistance for Needy Families (TANF)

Data Type INT(5)

Enter the monthly amount of cash public assistance payments made through the 

federally funded TANF program. If the TANF payment is made to the family

unit, use the local disbursing agency's procedure to estimate the individual’s 

portion of the payment.

34. General Assistance (State or local government)

Data Type INT(5)

35. Veterans' Disability Benefits

Data Type INT(5)

Veterans' Disability Benefits are payments made by the Department of Veterans 

Affairs for partial or total disability.

36. Workers' Compensation

Data Type INT(5)

37. All Other Public Support

Data Type INT(5)

Other Public Support payments are cash payments to individuals beyond those 

otherwise listed. Include payments made by Federal, State and local 

governments for retirement or survivor benefits to the individual as well as 

unemployment insurance benefits and other temporary payments.

38. Primary Source of Support at Application

Data Type VARCHAR (1)

Enter a code from the list below to indicate the individual’s largest single source of economic 

support at application, even if it accounts for less than one-half of the individual’s total support.

Note: If an individual is supported by the earnings of a spouse, or by the spouse's unemployment 

insurance checks, identify Code 2 as the Primary Source of Support (family and friends) and not 
15

Code 1 (personal income). If an individual is primarily supported by a governmental entity with 

no cash support – for example, incarcerated individuals, – use Code 3 as the primary source of 

support only if the individual applicant is the recipient of the support. If the family receives 

public support, use Code 2 (family and friends).

1 Employment Earnings

2 Personal Income ( interest, dividends, rent, retirement including social security)

3 Family and Friends

4 Public Support (SSI, SSDI, TANF, etc.)

5 All other sources (e.g., private disability insurance and private charities)

Medical Insurance Coverage at Application

Record whether an individual had medical insurance coverage at the time of application. Enter a 

“1” in each of the following data elements if the individual had this type of medical insurance 

coverage at application, otherwise leave blank. Note: A new data element has been added to 

Medical Insurance Coverage at Application. For cases open at the time of form implementation, 

no changes to the existing data coding options are required. Begin collecting new data element 

coding options after form implementation for all new applicants.

39. Medicaid

Data Type: VARCHAR (1)

40. Medicare

Data Type: VARCHAR (1)

41. Public Insurance from Other Sources (Workers' Compensation, Children's 

Health Insurance Program, etc)

Data Type: VARCHAR (1)

42. Private Insurance Through Own Employer 

Data Type: VARCHAR (1)

43. Not Yet Eligible for Private Insurance through Current Employer, But Will Be 

Eligible for Private Insurance after a Certain Period of Employment Data Type: 

VARCHAR (1)

44. Private Insurance through Other Means

Data Type: VARCHAR (1)

Refers to individuals receiving benefits through their parent/family members’ 

insurance plan.
16

Dates of Trial Work Experience /Extended Evaluation (EE)

Data Elements 45-48 capture the start and end dates of pre-eligibility assessment activities that 

include trial work experiences and/or extended evaluation. These are part of the VR experience 

for many severely disabled individuals for whom an employment outcome might be in doubt.

45. Start Date of Trial Work Experience

Data type: DATE 112 (YYYYMMDD)

Enter the date that the individual’s Trial Work Experience began. 

46. End Date of Trial Work Experience

Data type: DATE 112 (YYYYMMDD)

Enter the date that the individual’s Trial Work Experience ended. 

47. Start Date of EE

Data type: DATE 112 (YYYYMMDD)

Enter the date that the individual’s Extended Evaluation began. 

48. End Date of EE

Data type: DATE 112 (YYYYMMDD)

Enter the date that the individual’s Extended Evaluation ended. 

49. Date of Eligibility Determination

Data type: DATE 112 (YYYYMMDD)

Enter the date (year, month, and day) that an eligibility determination was made regardless of 

whether the individual was determined ineligible later in the VR process because of changed 

circumstances. 

Dates of Order of Selection (OOS) Waiting List

Agencies not using an OOS Waiting List may leave the following two data elements blank.

50. Date of Placement on OOS Waiting List

Data type: DATE 112 (YYYYMMDD) 

Enter the date when the individual was placed on an OOS waiting list. This date 

must be equal to or later than both the Date of Application and the Date of 

Eligibility Determination. 

51. Date of Exit from OOS Waiting List

Data type: DATE 112 (YYYYMMDD)

Enter the date when the individual exited from an OOS waiting list. This date 

field, if entered, must be after the Date of Placement on OOS Waiting List 

above. This field must be left blank if the individual was not placed on an OOS 
17

wait list. If the individual exited the VR program from the OOS waiting list, 

(Closure Type 6), then this data element must be filled in, and the date should 

be equal to the Closure Date.

52. Date of Individualized Plan for Employment (IPE)

Data type: DATE 112 (YYYYMMDD)

Record the date (year, month, and day) on which the first IPE for the individual became 

effective. For purposes of this data element, assume that the IPE is effective on the date on which 

both the agency and individual reach agreement. If the two signatures bear two different dates,

the later date should govern. 

53. Supported Employment Goal

Data type: VARCHAR (1)

For individuals who had an employment goal of supported employment in their IPE at some 

point during their rehabilitation and received supported employment services under the plan, 

indicate when the supported employment goal was included in the IPE. 

0 The individual had no supported employment goal identified in their IPE at any

point during their rehabilitation.

1 Initial IPE identified supported employment as the employment goal.

2 The IPE was amended during the VR process to change the goal to supported 

employment.

3 The IPE was amended during the VR process to change the goal from 

supported employment to another employment goal.

4 The amended or final IPE only identified supported employment as the 

employment goal at the time the service record was closed.

Note: The term "supported employment" means competitive work in integrated work settings, or 

employment in integrated work settings, in which individuals are working toward competitive 

employment, for individuals with the most significant disabilities who require intensive 

supported employment services in order to perform such work and extended employment 

supports to maintain such work. 

Services Provided and Costs for Purchased Services

The purpose of the service categories listed below is to capture all services provided to 

individuals during the life of their service record whether provided by the VR agency or others as 

comparable services or benefits. Except for assessment services that can be provided to 

determine eligibility prior to an IPE or to assign an individual to a priority category, the services 

provided should be those identified on the IPE, not services merely authorized, but actually 

provided. There are five codes for each of the 28 service categories. The first data element 

indicates whether services are purchased or provided by the VR agency in house. If purchased 

by the VR agency, the second code identifies the primary service provider type. The third and 

fourth codes are used to identify the source of funds for VR-purchased services as being state VR
18

(Title I) grant funds, or state supported employment (Title VI, Part B) grant funds. The fifth data 

element is used to capture up to three comparable services and benefits. 

(1) Services Purchased and/or Provided by the VR Agency

Data Type VARCHAR (1)

For each of the service categories, this data element provides information on whether services in 

this category were purchased and/or provided by the VR agency for this individual. Include all 

services furnished over the life of the service record for this individual. The following codes are 

used to capture this information for all services within this category.

0 not purchased or provided 

1 provided by the VR agency (in-house/by VR staff) 

2 purchased by the VR agency

3 both provided and purchased by the VR agency (in-house/by VR staff) 

Note: When using codes 2 or 3, always enter an amount in (3) State Vocational Rehabilitation 

Grant (Title I) Funds Used to Purchase Services and/or (4) Supported Employment State Grant 

(Title VI Part B) Funds Used to Purchase Services described below. When using code 0, (2) 

Primary Purchase VR Service Provider Type, (3) State Vocational Rehabilitation Grant (Title I) 

Funds Used to Purchase Services, (4) Supported Employment State Grant (Title VI Part B) 

Funds Used to Purchase Services, and (5)Comparable Services and Benefits Providers should be 

left blank.

(2) Primary Purchased VR Service Provider Type

Data Type VARCHAR (1)

For each of the service categories, this data element provides information on what type of 

service provider provided the purchased services. The following codes are used to capture this 

information. For each service category, select the code that best describes from which service 

provider type the majority of the purchased services provided to the individual originated over 

the life of the service record. The majority of purchased services were provided directly by:

1 Public Community Rehabilitation Programs (CRPs) – public CRPs are 

programs that are operated by a state, county, municipal or other local 

government.

2 Private CRPs – private CRPs are programs that are operated as not-for-profit 

organizations.

3 Other public service providers – public service providers are organizations or 

agencies of State, county, municipal or other local government and third-party

cooperative arrangements.

4 Other private service providers – private service providers include private notfor-profit organizations, such as VR providers (other than CRPs), as well as 

proprietary businesses, such as private hospitals and mental health clinics as 

well as contracted service delivery staff.
19

(3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services 

Data type INT(6)

This data element captures the costs (amounts) of purchased services using the VR grant (Title I) 

funds including state and other sources of matching funds as well as program income. Do not 

include costs incurred for program administration and for salaries of counselors and other staff. 

Also exclude costs for services provided by rehabilitation programs owned and operated by the 

State VR agency that are not directly billed on an individual basis.

(4) Supported Employment State Grant (Title VI, Part B) Funds Used to Purchase Services 

Data type INT(6)

This data element records all expenditures (amounts) within this service category for services 

purchased for the most significantly disabled individual with the supported employment grant 

program (Title VI, Part B) funds. Recipients of these funds should have a supported 

employment goal in their IPE. Individuals with a supported employment goal stated in their 

IPEs may receive any category of services depending on their particular needs. Therefore, to 

identify the use of these funds, each service category includes this data element.

Include all Title VI, Part B expenditures made to public and/or private service providers, 

individuals or an organization. Include Title VI, Part B expenditures for all types of purchased 

services including, but not limited to assessment, training, medical services, job development, 

placement and/or coaching services, maintenance, transportation, tuition for higher education, 

rehabilitation technology services, personal assistance, or any other rehabilitation services.

Exclude costs incurred for program administration and for salaries of counselors and other staff. 

Also exclude costs for services provided by rehabilitation programs owned and operated by the 

State VR agency that are not directly billed on an individual basis. 

(5) Comparable Services and Benefits Providers

Data Type VARCHAR (6)

For each of the service categories, enter up to three codes that best describe the service providers 

who provided the individual with a comparable service or benefit that was listed on the 

individual’s IPE. Make sure to enter the leading zeros if necessary and do not use commas or 

spaces between any of the codes. For example, if the individual received comparable services or 

benefits from an employer, the Veteran’s Administration, and other sources, enter “081924”. If 

the individual received comparable services or benefits from a Community Rehabilitation 

Program and a developmental disability agency, enter “0411”. If an individual received 

comparable services or benefits from only a consumer organization or advocacy group, enter 

“05”. If no comparable services or benefits were provided, enter "00."

00 No comparable services or benefits were provided

01 American Indian VR Services Program

02 Centers for Independent Living

03 Child Protective Services

04 Community Rehabilitation Programs
20

05 Consumer Organizations or Advocacy Groups

06 Educational Institutions (elementary/secondary)

07 Educational Institutions (post-secondary)

08 Employers

09 Employment Networks (not otherwise listed)

10 Federal Student Aid (such as, Pell grants, SEOG (Supplemental Educational 

Opportunity Grant), work study, etc.

11 Intellectual and Developmental Disabilities Agencies

12 Medical Health Provider (Public or Private)

13 Mental Health Provider (Public or Private)

14 One-stop Employment/Training Centers

15 Public Housing Authority

16 Social Security Administration (Disability Determination Service or District 

office)

17 State Department of Correction/Juvenile Justice

18 State Employment Service Agency

19 Veteran's Administration

20 Welfare Agency (State or local government)

21 Worker's Compensation

22 Other VR State Agencies

23 Other State Agencies

24 Other Sources

Service Categories

Assessment

Data Elements 54-58

Assessment means services provided and activities performed to determine an

individual’s eligibility for VR services, to assign an individual to a priority category of a 

State VR agency that operates under an order of selection, and/or to determine the nature 

and scope of VR services to be included in the IPE. Include here trial work experiences 

and extended evaluation. Assessments to determine eligibility, assignment of a priority 

category or the nature or scope of services to be included on the IPE include, but are not 

limited to psychological assessments, audio logical evaluations, dental and medical 

exams and other assessments of personality, interests, interpersonal skills, intelligence 

and related functional capacities, educational achievements, work experience, vocational 

aptitudes, personal and social adjustments, and employment opportunities of the 

individual and the medical, psychiatric, psychological, and other pertinent vocational, 

educational, cultural, social, recreational, and environmental factors that affect the 

employment and rehabilitation needs of the individual. See also 34 CFR 361.5(b)(6) and 

34 CFR 361.48.
21

Diagnosis and Treatment of Impairments 

Data Elements 59-63

Diagnosis and treatment of impairments means:

a) Corrective surgery or therapeutic treatment that is likely, within a reasonable 

period of time, to correct or modify substantially a physical or mental impairment 

that constitutes a substantial impediment to employment;

b) Diagnosis and treatment for mental and emotional disorders by qualified 

personnel who meet State licensure laws;

c) Dentistry;

d) Nursing services;

e) Necessary hospitalization (either inpatient or outpatient care) in connection with 

surgery or treatment;

f) Drugs and supplies;

g) Prescription of prosthetics and/or orthotics related to the individual’s diagnosed 

disability and is necessary for the achievement of the employment outcome;

h) Prescription of eyeglasses and visual services, including visual training, related to 

the individual’s diagnosed disability and necessary for the achievement of the 

employment outcome; 

i) Podiatry;

j) Physical therapy;

k) Occupational therapy;

l) Speech or hearing therapy;

m) Mental health services;

n) Treatment of either acute or chronic medical complications and emergencies that 

are associated with or arise out of the provision of physical and mental restoration 

services or that are inherent in the condition under treatment;

o) Special services for the treatment of individuals with end-stage renal disease, 

including transplantation, dialysis, artificial kidneys, and supplies; 
22

p) Other medical or medically related rehabilitation services; and 

q) Medical care for acute conditions arising during rehabilitation and constituting a 

barrier to the achievement of an employment outcome is also included in this 

category.

Vocational Rehabilitation Counseling and Guidance

Data Elements 64-68

Vocational rehabilitation counseling and guidance includes information and support 

services to assist an individual in exercising informed choice and is distinct from the case 

management relationship that exists between the counselor and the individual during the 

VR process.

Training

Data Elements 69-118

Training services are designed to help the individual improve educationally or 

vocationally or to adjust to the functional limitations of his or her impairment. If the 

individual receives more than one type of training, each type should be recorded. For 

those individuals not seeking a degree or certificate and attending a course in a college or 

university, code this type of training under Miscellaneous Training.

Graduate College or University Training

Data Elements 69-73

Full-time or part-time academic training leading to a degree recognized as being 

beyond a baccalaureate degree, such as a Master of Science, Arts (M.S. or M.A.) 

or Doctor of Philosophy (Ph.D.) or Doctor of Jurisprudence (J.D.). Such training 

would be provided by a college or university.

Four-Year College or University Training

Data Elements 74-78

Full-time or part-time academic training leading to a baccalaureate degree, a 

certificate, or other recognized educational credential. Such training may be 

provided by a four-year college or university or technical college.

Junior or Community College Training

Data Elements 79-83

Full-time or part-time academic training above the high school level leading to an 

associate degree, a certificate, or other recognized educational credential. Such 

training may be provided by a community college, junior college, or technical 

college.
23

Occupational or Vocational Training

Data Elements 84-88

Occupational, vocational, or job skill training provided by a community college 

and/or business, vocational/trade or technical school to prepare students for 

gainful employment in a recognized occupation, not leading to an academic 

degree or certification. This would include selected courses or programs of study

at a community college, four-year college, university, technical college or 

proprietary schools or programs. 

On-the-job Training

Data Elements 89-93

Training in specific job skills by a prospective employer. Generally the trainee is 

paid during this training and will remain in the same or a similar job upon 

successful completion. 

Apprenticeship Training

Data Elements 94-98

An apprenticeship program is a work-based employment and training program 

that combines hands-on, on-the-job work experience in a skilled occupation with 

related classroom instruction. Structured apprenticeship programs generally have 

minimum requirements for the duration of on-the job work experience and 

classroom instruction, and/or could utilize competency-based elements but should 

have mechanisms in place to ensure quality and consistency of skills 

acquisition. Other elements that distinguish apprenticeship programs from other 

work-based efforts including co-op education, on-the-job training, and internships 

are the following: includes supervision and structured mentoring; provides for 

wage increases as an apprentice's skills increase; is based on an employeremployee relationship; and provides an industry recognized certificate of 

completion of the program.

Basic Academic Remedial or Literacy Training

Data Elements 99-103

Literacy training or training provided to remediate basic academic skills that are 

needed to function on the job in the competitive labor market. 

Job Readiness Training

Data Elements 104-108

Training provided to prepare an individual for the world of work (e.g., appropriate 

work behaviors, getting to work on time, appropriate dress and grooming, 

increasing productivity).
24

Disability-Related Skills Training 

Data Elements 109-113

Disability-related augmentative skills training includes but is not limited to: 

orientation and mobility; rehabilitation teaching; training in the use of low vision 

aids; Braille; speech reading; sign language; and cognitive training/retraining.

Miscellaneous Training

Data Elements 114-118

Any training not recorded in one of the other categories listed, including GED or 

high school training leading to a diploma, or courses taken at four-year, junior or 

community colleges not leading to a certificate or diploma.

Job Search Assistance

Data Elements 119-123

Job search activities support and assist an individual in searching for an appropriate job. 

Job search assistance may include help in resume preparation, identifying appropriate job 

opportunities, developing interview skills, and making contacts with companies on behalf 

of the consumer.

Job Placement Assistance 

Data Elements 124-128

Job placement assistance is a referral to a specific job resulting in an interview, whether 

or not the individual obtained the job.

On-the-job Supports - Short term

Data Elements 129-133

Support services provided to an individual who has been placed in employment in order 

to stabilize the placement and enhance job retention. Such services include short-term job 

coaching for persons who do not have a supported employment goal consistent with the 

employment goal on the IPE.

On-the-job Supports – Supported Employment

Data Elements 134-138

On-going support services and other appropriate services needed to support and maintain 

an individual with a most significant disability in supported employment for a period of 

time generally not to exceed 18 months. Such services, such as job coaching, are for 

individuals who have supported employment and long-term supports identified on the 

IPEs. On-the-job support services with a supported employment goal are funded using 

Title VI, Part B and Title I funds.
25

Transportation

Data Elements 139-143

Transportation, including adequate training in the use of public transportation vehicles 

and systems, means travel and related expenses that are necessary to enable an applicant 

or eligible individual to participate in a VR service. Examples of transportation 

services/expenses include, but are not limited to:

a) Travel and related expenses for a personal care attendant or aide if the services of 

that person are necessary to enable the individual to travel to participate in any 

VR service;

b) Relocation expenses incurred by the individual in connection with a job 

placement that is a significant distance from the individual's current residence;

c) The purchase and repair of vehicles, including vans. This specifically excludes 

the modification of vehicles, which is to be reported in rehabilitation technology; 

d) Training in the use of public transportation vehicles and systems.

Maintenance

Data Elements 144-148

Maintenance means monetary support provided for those expenses such as food, shelter 

and clothing that are in excess of the normal expenses of the individual, and that are 

necessitated by the individual’s participation in an assessment for determining eligibility

and VR needs or while receiving services under an IPE. Examples of maintenance 

expenses include, but are not limited to:

a) cost of uniforms or other suitable clothing required for an individual's job 

placement or job seeking activities;

b) cost of short-term expenses, such as food and shelter, that is required in order for 

an individual to participate in assessment or vocational training at a site that is not 

within commuting distance of an individual's home;

c) initial one-time costs, such as security deposits or charges for the initiation of 

utilities, that are required in order for an individual to relocate for a job 

placement; and

d) cost of an individual’s participation in enrichment activities related to that 

individual's training program.
26

Rehabilitation Technology

Data Elements 149-153

Rehabilitation technology means the systematic application of technologies, 

engineering methodologies, or scientific principles to meet the needs of, and address 

the barriers confronted by, individuals with disabilities in areas that include education, 

rehabilitation, employment, transportation, independent living, recreation, home and 

vehicular modification, other assistive devices including, but not limited to hearing 

aids, low vision aids and wheelchairs. Rehabilitation technology includes rehabilitation 

engineering, assistive technology devices, and assistive technology services. See also 

34 CFR 361.5(b)(45). The term includes the following:

a) Rehabilitation Engineering Services are the systematic application of 

engineering sciences to design, develop, test, evaluate, apply, and distribute 

technological solutions to problems confronted by VR individuals in functional 

areas such as mobility, communications, hearing, vision, and cognition, and in 

activities associated with employment, independent living, education, and 

integration into the community.

b) Assistive Technology Devices are any items, piece of equipment, or product 

system, whether acquired commercially off the shelf, modified or customized, 

that is used to increase, maintain, or improve the functional capabilities of a VR 

customer.

c) Assistive Technology Services are any services that directly assist an individual 

with a disability in the selection, acquisition, or use of an assistive technology

device. Services may include:

1. the evaluation of the needs of an individual, including a functional evaluation of 

the individual in his/her customary environment;

2. purchasing, leasing, or otherwise providing for the acquisition by an individual of 

an assistive technology device;

3. selecting, designing, fitting, customizing, adapting, applying, maintaining, 

repairing, or replacing assistive technology devices;

4. coordinating and using other therapies, interventions, or services with assistive 

technology devices, such as those associated with existing education and 

rehabilitation plans and programs;

5. training or providing technical assistance for an individual or, if appropriate, the 

family members, guardians, advocates, or authorized representatives of the 

individual; and

6. training or providing technical assistance for professionals (including individuals 

providing education and rehabilitation services), employers, or others who 

provide services to, employ, or are otherwise substantially involved in the major 

life functions of VR individuals to the extent that training or technical assistance 

is necessary for individuals to achieve an employment outcome.
27

Personal Assistance Services

Data Elements 154-168

Personal Assistance Services are a range of services provided by one or more persons 

designed to assist an individual to perform daily living activities on or off the job that the 

individual would typically perform without assistance if he or she did not have a 

disability. The services must be designed to increase the individual’s control in life and 

ability to perform everyday activities on or off the job. The services must be necessary to 

the achievement of an employment outcome and may be provided only while the 

individual is receiving other VR services. The services may include training in 

managing, supervising, and directing personal assistance services.

Three distinct services that are considered personal assistance services are reader 

services, interpreter services, and personal attendant services. Further information on 

recording each of these services follows. Record only whether and which of these 

services were provided to the individual (e.g., if the same person provided both reader 

service and personal attendant service to an individual, indicate both services).

Reader Services

Data Elements 154-158

Reader services are for individuals who cannot read print because of blindness or 

other disability. Reader services include, in addition to reading aloud, 

transcription of printed information into Braille or sound recordings if the 

individual requests such transcription. Reader services are generally for 

individuals who are blind or deaf-blind, but may also include individuals unable 

to read because of serious neurological disorders, specific learning disabilities, or 

other physical or mental impairments.

Interpreter Services

Data Elements 159-163

Interpreter services are sign language or oral interpretation services for 

individuals who are deaf or hard of hearing and tactile interpretation services for 

individuals who are deaf-blind. Specially trained individuals perform sign 

language or oral interpretation. Also include here real-time captioning services 

for persons who are deaf or hard of hearing. Do not include language 

interpretation in this category, but in "other services".

Personal Attendant Services

Data Elements 164-168

Personal attendant services are those personal services that an attendant performs 

for an individual with a disability including, but not limited to bathing, feeding, 

dressing, providing mobility and transportation, etc in multiple settings to include 

home, work and training facilities/school.
28

Technical Assistance Services

Data Elements 169-173

Technical assistance and other consultation services provided to conduct market analyses, 

to develop business plans, and to provide resources to individuals in the pursuit of selfemployment, telecommuting and small business operation outcomes.

Information and Referral Services

Data Elements 174-178

Information and referral services are provided to individuals who need services from 

other agencies (e.g., cooperative agreements) not available through the VR program.

Benefits Counseling

Data Elements 179-183

Assistance provided to an individual who is interested in becoming employed, but is 

uncertain of the impact work income will have on any disability benefits and entitlements 

being received, and/or is not aware of benefits, such as access to healthcare, that might be 

available to support any work attempt. 

This typically involves an analysis of an individual’s current benefits, such as SSDI and 

SSI, the individual’s financial situation, and the effect different income levels from work 

will have on the individual’s future financial situation. This assistance is intended to 

provide the individual an opportunity to make an informed choice regarding the pursuit 

of employment. Ongoing assistance may also be provided as the individual decides on 

employment goals, searches for jobs, and becomes employed.

Customized Employment Services

Data Elements 184-188

Services that involve a blend of flexible strategies that result in the provision of 

individually negotiated and designed services, supports, and job opportunities for an 

individual and that lead to an employment outcome of customized employment, including

self-employment. A key factor in deciding if a service is a customized employment 

service is the presence of employer negotiation, including customizing a job description 

based on current unidentified and unmet needs of the employer and the needs of the 

employee; developing a set of job duties or tasks; developing a work schedule (including 

determining hours worked); determining a job location; developing a job arrangement 

(such as job carving, job sharing, or a split schedule); or determining specifics of 

supervision.
29

Other Services

Data Elements 189-193

Use this category for all other VR services that cannot be recorded elsewhere. Included 

here are occupational licenses, tools and equipment, initial stocks and supplies.

194. Level of Education Attained At Closure

Data type VARCHAR (2)

Record the level of education the individual attained when the service record was closed. If an 

actual educational level is not documented, record an estimated level. Note: Coding options have 

been updated and/or added to this data element.

0 No formal schooling 

1 Elementary education (grades 1-8)

2 Secondary education, no high school diploma (grades 9-12)

3 Special education certificate of completion/diploma or in attendance

4 High school graduate or equivalency certificate (GED)

5 Post-secondary education, no degree or certificate

6 Post-secondary academic degree, Associate degree

7 Bachelor's degree

8 Master’s degree

9 Any degree above a Master's - e.g. Ph.D., Ed.D., J.D.

10 Vocational/Technical Certificate

11 Occupational credential beyond undergraduate degree work

12 Occupational credential beyond graduate degree work

195. Student with Disability in Secondary Education at Closure

Data type: VARCHAR (1)

Enter the code that captures the status of an individual with a disability in secondary

education at the time of closure. 

1 This individual is not a student with a disability in secondary education at the 

time of closure.

2 This individual is a student with a 504 accommodation plan.

3 This individual is a student and is receiving services under an IEP at the time of 

closure.

4 This individual is a student with a disability who not covered by Section 504 of 

the Rehabilitation Act and is not receiving services under an IEP at the time of 

closure.
30

196. Number of Jobs / Occupations at Closure

Data type VARCHAR (1)

This data element captures the number of separate jobs consistent with the employment goal on 

an individual's IPE and primary employment goal SOC codes that the individual held at the time 

of closure. For those exiting with only one source of employment, enter the number ‘1’. For 

those exiting the VR program with 2 sources of employment or jobs, enter a ‘2’, etc. For those 

individuals exiting without employment, leave blank.

197. Primary Occupation at Closure

Data type VARCHAR (6)

For an individual who achieved an employment outcome, enter a six-digit SOC code to describe 

the individual’s occupation when the service record was closed. For individuals who did not 

achieve an employment outcome, leave blank.

Instructions for individuals who Exit with Multiple Occupations:

For individuals exiting the VR program with multiple jobs, (coded in data element number 196,

Number of Jobs / Occupations at Closure) the Occupation at Closure data element should be 

populated with the code for the occupation consistent with the employment goal on an 

individual's IPE and primary SOC codes from which the exiting individual derives the majority 

of their weekly earnings. See also 34 CFR 361.56(a). The following procedures should be 

followed to determine which occupation code to use:

1. If the earnings amounts of the multiple jobs are reported at the time of entering 

the occupation code, enter the occupation consistent with the employment goal 

specified on the IPE that encompasses the majority of the earnings per week at 

closure.

2. If the earnings amounts of the various jobs are not reported at the time of entry, 

the occupation code should be populated with the code for the occupation

consistent with the employment goal specified on the IPE that encompasses the 

majority of the hours worked per week at closure.

3. If neither hours nor wages per occupation are known, then individual self

reporting of the primary occupation consistent with the employment goal 

specified on the IPE should be used to determine the appropriate occupation code.

For the employment situations unique to the VR program, use the special codes indicated below. 

Special Codes

599999 Homemaker (own home) refers to men and women whose activity is keeping 

house for their families, or themselves if they live alone.

799999 Unpaid family worker (own family), not elsewhere classified use only if the 
31

type of unpaid family work cannot be classified according to any of the 

occupations.

899999 Randolph-Sheppard vending facility clerk use this category for persons 

employed as clerks, sales persons, or helpers in a vending facility operated 

under the Randolph-Sheppard Vending Facility Program. Use this special code 

even though these occupations are classifiable. Do not include vending facility

operators (999999), or individuals employed in vending facilities outside the 

Vending Facility Program (use their occupation code).

999999 Randolph-Sheppard vending facility operator use this category for individuals 

employed as operators or managers of vending facilities operated under the 

Vending Facility Program. Use this special code even though these occupations 

are classifiable. Do not include vending facility clerks (899999), or individuals 

employed as vending facility operators outside the Randolph-Sheppard 

Vending Facility Program (use their occupation code).Randolph-Sheppard 

vending facility operator.

Note: The 2010 Standard Occupational Classification System (SOC) should be referenced in 

obtaining the six-digit code that most closely corresponds to the individual's primary occupation 

at closure.

198. Start Date of Employment in Primary Occupation at Closure

Data type: DATE 112 (YYYYMMDD)

Record the date when the individual began the job coded in data element 197 as the primary

occupation. 

199. Employment Status at Closure

Data type VARCHAR (1)

For an individual who achieved an employment outcome, enter the applicable one-digit code that 

describes the employment outcome of the individual when his or her service record was closed. 

If classifying the individual into two different employment statuses from Codes 1 or 3-6 is 

possible, select a code designating the principal status.

1 Employment without Supports in Integrated Setting is full-time or part-time 

employment in an integrated setting without ongoing support services. For 

purposes of this report, this is work performed for wages, salary, commissions, 

tips, or piece-rates, below, at, or above the minimum wage. Do not include selfemployed individuals.

3 Self-employment (except BEP) refers to work for profit or fees including 

operating one's own business, farm, shop, or office. "Self-employment" 

includes sharecroppers, but not wage earners on farms.

4 State Agency-managed Business Enterprise Program (BEP) refers to RandolphSheppard vending facilities and other small businesses operated by individuals 

with significant disabilities under the management and supervision of a State 

VR agency. Include home industry where the work is done under the 
32

management and supervision of a State VR agency in the individual's own 

home or residence for wages, salary, or on a piece-rate. Individuals capable of 

activity outside the home, as well as homebound individuals, may engage in 

such employment.

5 Homemaker refers to men and women whose activity is keeping house with no 

earnings for persons in their households or for themselves if they live alone.

6 Unpaid Family Worker refers to persons who work without pay on a family

farm or in a family business.

7 Employment with Supports in Integrated Setting is full-time or part-time 

employment in an integrated setting with ongoing support services for 

individuals with significant disabilities (supported employment). For purposes 

of this report, compensation for such employment may be below, at, or above 

the minimum wage. 

200. Weekly Earnings at Closure

Data type INT(5)

Enter the amount of money (to the nearest dollar) the individual earned in a typical week after 

achieving an employment outcome consistent with the employment goal on an individual’s IPE, 

at the time the service record was closed and includes all income from wages, salaries, tips, and 

commissions received as income before payroll deductions of Federal, State and local income 

taxes and Social Security payroll tax. Earnings also include profits derived from self-employed 

individuals. Earnings for salespersons, consultants, self-employed individuals, and other similar 

occupations are based on the adjusted gross income. Adjusted gross income is gross income 

minus unreimbursed business expenses. Do not include estimates of payments in-kind, such as 

meals and lodging. Estimate profits of farmers, if necessary.

Where earnings are based on commissions that are irregular (e.g., real estate, automobile sales, 

etc.), to obtain a meaningful figure for a typical week’s earnings, it should be calculated as a

weekly average over a representative period of time such as one month or longer.

When, because of the occupation/situation, there are significant amounts of unreimbursed 

business expenses that are irregular (e.g., car lease payments due the first week of every month), 

the expenses should be averaged over a representative period of time such as one month or 

longer to obtain a meaningful figure for a typical week’s business expenses.

Commissions are generally not paid when earned, but rather are paid periodically, such as 

weekly, biweekly, or even monthly. To bring standardization to this item, earnings should be 

based on the actual receipt of the payment and not on amounts accruing until the next 

commission payout.

If the individual had no earnings or did not achieve an employment outcome, enter "0".
33

201. Hours Worked in a Week at Closure

Data type INT(3)

For an individual who achieved an employment outcome, this item collects data on the number 

of hours worked on all employment consistent with the employment goal on the individual’s 

IPE. Enter the number of hours the individual worked for earnings in a typical week when the 

service record was closed. Earnings may have been in the form of wages, salaries, tips, 

commissions, profits from self-employment, adjusted gross income for salespersons, etc. If the 

individual had no earnings or did not achieve an employment outcome, enter "0".

Monthly Public Support Amount at Closure

Enter the monthly amount (to the nearest dollar) of public support received by the individual at 

closure from each of the following sources. If individual did not receive any monthly public 

support, enter "0" for each type of public support. Agencies may leave these data elements blank 

for closure code 1.

Public support refers to cash payments made by Federal, State and/or local governments for any

reason, including an individual’s disability, age, or economic status. Include payments to a 

family unit precipitated by the individual’s disability or when the individual’s presence is taken 

into account in the computation of the family benefit. Also include any payments that are sent 

directly to the individual in an institution or to dependents on his/her behalf. Exclude any noncash support payments such as Medicaid, Medicare, food stamps and rental subsidies. 

Categories of public support are as follows:

202. Social Security Disability Insurance (SSDI)

Data Type INT(5)

Enter the amount of SSDI received by the individual each month. This figure 

can be verified through the Social Security Administration (SSA) or from a 

copy of the individual’s benefit notification letter.

203. Supplemental Security Income (SSI) for the Aged, Blind or Disabled 

Data Type INT(5)

Enter the monthly payment to the individual under the Federal program of SSI

for the aged, blind, and disabled. Only the individual’s portion of the payment 

should be recorded here. This figure can be verified through the SSA or from a 

copy of the individual’s benefit notification letter.

204. Temporary Assistance for Needy Families (TANF)

Data Type INT(5)

Enter the monthly amount of cash public assistance payments made through the 

federally funded TANF program. If the TANF payment is made to the family

unit, use the local disbursing agency's procedure to estimate the individual’s 

portion of the payment.
34

205. General Assistance (State or local government)

Data Type INT(5)

206. Veterans' Disability Benefits

Data Type INT(5)

Veterans' Disability Benefits are payments made by the Department of Veterans 

Affairs for partial or total disability.

207. Workers' Compensation

Data Type INT(5)

208. All Other Public Support

Data Type INT(5)

Enter the monthly amount of public support received from all other sources of 

public support not listed. Other Public Support payments are cash payments to 

individuals beyond those otherwise listed, and include payments made by

Federal, State and local governments for retirement or survivor benefits to the 

individual as well as unemployment insurance benefits and other temporary

payments.

209. Primary Source of Support at Closure

Data type VARCHAR (1)

Enter a code from the list below to indicate the individual’s largest single source of economic 

support at the time the service record was closed, even if it accounts for less than one-half of the 

individual's total support.

Note: If an individual is supported by the earnings of a spouse, or by the spouse's unemployment 

insurance checks, identify Code 2 as the Primary Source of Support (family and friends) and not 

Code 1 (personal income). If an individual is primarily supported by a governmental entity with 

no cash support – for example, incarcerated individuals, – use code 3 as the primary source of 

support only if the individual applicant is the recipient of the support. If the family receives 

public support, use Code 2 (family and friends).

1 Employment Earnings

2 Personal Income ( interest, dividends, rent, retirement including social security)

3 Family and Friends

4 Public Support (SSI, SSDI, TANF, etc.)

5 All other sources (e.g., private disability insurance and private charities)

Medical Insurance Coverage at Closure

Record whether an individual had medical insurance coverage at the time of closure. Enter a “1”

in each of the following data elements if the individual had this type of medical insurance 

coverage at closure, otherwise leave blank. Note: A new data element has been added to 

Medical Insurance Coverage at Closure. 
35

210. Medicaid

Data Type: VARCHAR (1)

211. Medicare

Data Type: VARCHAR (1)

212. Public Insurance from Other Sources (Workers' Compensation, Children's 

Health Insurance Program, etc)

Data Type: VARCHAR (1)

213. Private Insurance Through Own Employer 

Data Type: VARCHAR (1)

214. Not Yet Eligible for Private Insurance Through Current Employer, But Will Be 

Eligible for Private Insurance After a Certain Period of Employment

Data Type: VARCHAR (1)

215. Private Insurance Through Other Means

Data Type: VARCHAR (1)

Individuals receiving benefits through their parent/family members’ insurance 

plan should use this code.

216. Type of Closure 

Data type VARCHAR (1)

Enter a one-digit code from the following list to indicate when in the VR process an individual

exited the program:

1 Exited as an applicant

2 Exited during or after a trial work experience/extended evaluation

3 Exited with an employment outcome

4 Exited without an employment outcome, after receiving services

5 Exited without an employment outcome, after a signed IPE, but before 

receiving services

6 Exited from an order of selection waiting list

7 Exited without an employment outcome, after eligibility, but before an IPE was 

signed 
36

217. Reason for Closure

Data type VARCHAR (2)

Enter the code listed below that identifies the reason for closing the service record of an 

individual. The code 0 applies only to service records with a code of 3 in data element 216, type 

of closure. Codes of 1 or higher apply to all other types of closure, that is, 1, 2, 4, 5, 6, and 7. 

0 Achieved employment outcome (applicable only to closure type 3)

1 Unable to locate or contact

Use this code when the individual has relocated or left the State without a 

forwarding address.

2 Disability too significant to benefit from VR services - ineligible

Use this code to identify an applicant whose mental or physical disability is so 

significant that the individual cannot benefit from VR services in terms of 

employment.

3 No longer interested in receiving services or further services

Use this code for individuals who choose not to participate or continue in their 

VR program at this time. Also use this code to indicate when an individual’s 

actions (or non-actions) make it impossible to begin or continue a VR program. 

Examples would include repeated failures to keep appointments for assessment, 

counseling, or other services.

4 Death

6 Transferred to another agency

Use this code when an individual needs services that are more appropriately

obtained elsewhere. Transfer to the other agency indicates that appropriate 

referral information is forwarded to the other agency so that agency may

provide services more effectively. Include individuals transferred to other State 

VR agencies.

8 No disabling condition - ineligible

Use this code only for applicants who are not eligible for VR services because 

no physical or mental impairment exists, such as when the reported disability is 

an acute condition with no residual impairment, e.g., a broken bone that heals.

9 No impediment to employment - ineligible

Use this code for applicants who are not eligible for VR services because their 

physical or mental impairment does not constitute a substantial impediment to 

employment.

10 Transportation not feasible or available

Use this code to indicate that the individual was unable to accept or maintain 
37

employment because suitable transportation was either not feasible or not 

available.

11 Does not require VR services - ineligible

Use this code for applicants who do not require VR services to prepare for, 

enter into, engage in, or retain gainful employment consistent with their 

strengths, resources, priorities, concerns, abilities, capabilities, and informed 

choice.

12 Extended services not available

Use this code for individuals who would have benefited from the provision of 

supported employment services but for whom no source of extended services 

was available.

13 All other reasons

This code is used for all reasons not covered above.

14 Extended employment

Use this code for individuals who received services and were placed in a nonintegrated setting for a public or non-profit organization

15 Individual in institution other than a prison or jail

Use this code when an individual has entered an institution other than a prison 

or jail, and will be unavailable to participate in a VR program for an indefinite 

or considerable period of time. This category of institution includes hospitals, 

nursing homes, treatment centers, etc.

16 Individual is incarcerated in a prison or jail

Use this code when an individual will be unavailable to participate in a VR 

program for a considerable period of time because they are incarcerated in a 

prison, jail, or other criminal correction facility.

218. Date of Closure

Data type: DATE 112 (YYYYMMDD)

Record the date when the individual’s service record was closed by the State VR agency. 
38

Record Layout

CASE SERVICE REPORT

(RSA-911)
39

RSA-911 RECORD LAYOUT

# Data Element Data type Category

1 Agency Code VARCHAR(3)

2 Social Security Number VARCHAR (9)

3 Closure Order VARCHAR (1)

4 Previous Closure VARCHAR (1)

5 Date of Application DATE 112 

(YYYYMMDD)

6 Date of Birth DATE 112

(YYYYMMDD)

7 Gender VARCHAR (1)

8 White VARCHAR (1) 8-12. Race

9 Black or African American VARCHAR (1)

10 American Indian or Alaska Native VARCHAR (1)

11 Asian VARCHAR (1)

12 Native Hawaiian or Other Pacific 

Islander

VARCHAR (1)

13 Ethnicity – Hispanic or Latino VARCHAR (1)

14 Veteran Status VARCHAR (1)

15 Zip Code VARCHAR (5)

16 County VARCHAR (40)

17 Source of Referral VARCHAR (2)

18 Involvement with Other Agencies and 

Services at Application 

VARCHAR (2)

19 Level of Education Attained at 

Application

VARCHAR (2)

20 Student with Disability in Secondary

Education at Application

VARCHAR (1)

21 Living Arrangement at Application VARCHAR (2)

22 Sensory/Communicative Impairment 

Types

VARCHAR (1)

23 Primary Disability - ICD-10 Code VARCHAR (7) 23-26. Primary and 

Secondary

Disabilities

24 Primary Disability - DSM Code VARCHAR (7)

25 Secondary Disability - ICD-10 VARCHAR (7)

26 Secondary Disability - DSM VARCHAR (7)

27 Significance of Disability VARCHAR (1)

28 Employment Status at Application VARCHAR (2)
40

# Data Element Data type Category

29 Weekly Earnings at Application INT(5)

30 Hours Worked in a Week at 

Application

INT(3)

31 Social Security Disability Insurance 

(SSDI)

INT(5) 31-38. Monthly

Public Support at 

Application

32 Supplemental Security Income (SSI) 

for the Aged, Blind or Disabled

INT(5)

33 Temporary Assistance for Needy 

Families (TANF)

INT(5)

34 General Assistance (state or local 

governments)

INT(5)

35 Veterans’ Disability Benefits INT(5)

36 Workers’ Compensation INT(5)

37 Other Public Support INT(5)

38 Primary Source of Support at 

Application

VARCHAR (1)

39 Medicaid VARCHAR (1) 39-44. Medical 

Insurance Coverage 

at Application

40 Medicare VARCHAR (1)

41 Public Insurance from Other Sources VARCHAR (1)

42 Private Insurance Through Own 

Employer 

VARCHAR (1)

43 Not Yet Eligible for Private Insurance 

Through Current Employer, but Will 

Be Eligible for Private Insurance After 

a Certain Period of Employment

VARCHAR (1)

44 Private Insurance Through Other 

Means

VARCHAR (1)

45 Start Date of Trial Work Experience DATE 112 

(YYYYMMDD)

45-48. Dates of Trial 

Work Experience/

Extended Evaluation 

(EE)/

46 End Date of Trial Work Experience DATE 112 

(YYYYMMDD)

47 Start Date of Extended Evaluation DATE 112 

(YYYYMMDD)

48 End Date of Extended Evaluation DATE 112 

(YYYYMMDD)

49 Date of Eligibility Determination DATE 112 
41

# Data Element Data type Category

(YYYYMMDD)

50 Date of Placement on Order of 

Selection (OOS) Waiting List

DATE 112 

(YYYYMMDD)

51 Date of Exit from OOS Waiting List DATE 112 

(YYYYMMDD)

52 Date of Individualized Plan for 

Employment (IPE)

DATE 112 

(YYYYMMDD)

53 Supported Employment Goal VARCHAR (1)

54 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Assessment

55 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

56 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

57 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

58 Comparable Services and Benefits 

Providers 

VARCHAR (6)

59 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Diagnosis and 

Treatment of 

Impairments

60 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

61 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

62 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

63 Comparable Services and Benefits 

Providers 

VARCHAR (6)

64 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Vocational 

Rehabilitation 

Counseling and 

Guidance

65 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

66 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)
42

# Data Element Data type Category

67 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

68 Comparable Services and Benefits 

Providers 

VARCHAR (6)

69 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Graduate College or 

University Training

70 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

71 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

72 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

73 Comparable Services and Benefits 

Providers 

VARCHAR (6)

74 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Four-Year College 

or University 

Training

75 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

76 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

77 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

78 Comparable Services and Benefits 

Providers 

VARCHAR (6)

79 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Junior or 

Community College 

Training

80 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

81 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

82 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

83 Comparable Services and Benefits 

Providers 

VARCHAR (6)
43

# Data Element Data type Category

84 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Occupational or 

Vocational Training

85 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

86 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

87 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

88 Comparable Services and Benefits 

Providers 

VARCHAR (6)

89 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) On-the-job Training

90 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

91 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

92 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

93 Comparable Services and Benefits 

Providers 

VARCHAR (6)

94 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Apprenticeship 

Training

95 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

96 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

97 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

98 Comparable Services and Benefits 

Providers 

VARCHAR (6)

99 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Basic Academic 

Remedial or 

Literacy Training
44

# Data Element Data type Category

100 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

101 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

102 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

103 Comparable Services and Benefits 

Providers 

VARCHAR (6)

104 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Job Readiness 

Training

105 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

106 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

107 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

108 Comparable Services and Benefits 

Providers 

VARCHAR (6)

109 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Disability-Related 

Skills Training

110 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

111 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

112 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

113 Comparable Services and Benefits 

Providers 

VARCHAR (6)

114 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Miscellaneous 

Training

115 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

116 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

117 Supported Employment State Grant INT(6)
45

# Data Element Data type Category

(Title VI. Part B) Funds Used to 

Purchase Services 

118 Comparable Services and Benefits 

Providers 

VARCHAR (6)

119 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Job Search 

Assistance

120 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

121 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

122 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

123 Comparable Services and Benefits 

Providers 

VARCHAR (6)

124 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Job Placement 

Assistance

125 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

126 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

127 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

128 Comparable Services and Benefits 

Providers 

VARCHAR (6)

129 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) On-the-job Supports 

– Short Term

130 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

131 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

132 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

133 Comparable Services and Benefits 

Providers 

VARCHAR (6)

134 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) On-the-job Supports 

– Supported 

135 Primary Purchased VR Service VARCHAR (1) Employment
46

# Data Element Data type Category

Provider Type

136 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

137 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

138 Comparable Services and Benefits 

Providers 

VARCHAR (6)

139 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Transportation

140 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

141 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

142 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

143 Comparable Services and Benefits 

Providers 

VARCHAR (6)

144 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Maintenance

145 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

146 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

147 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

148 Comparable Services and Benefits 

Providers 

VARCHAR (6)

149 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Rehabilitation 

Technology

150 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

151 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

152 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

INT(6)
47

# Data Element Data type Category

Purchase Services 

153 Comparable Services and Benefits 

Providers 

VARCHAR (6)

154 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Reader Services

155 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

156 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

157 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

158 Comparable Services and Benefits 

Providers 

VARCHAR (6)

159 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Interpreter Services

160 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

161 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

162 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

163 Comparable Services and Benefits 

Providers 

VARCHAR (6)

164 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Personal Attendant 

Services

165 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

166 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

167 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

168 Comparable Services and Benefits 

Providers 

VARCHAR (6)

169 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Technical 

Assistance Services

170 Primary Purchased VR Service 

Provider Type

VARCHAR (1)
48

# Data Element Data type Category

171 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

172 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

173 Comparable Services and Benefits 

Providers 

VARCHAR (6)

174 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Information and 

Referral Services

175 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

176 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

177 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

178 Comparable Services and Benefits 

Providers 

VARCHAR (6)

179 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Benefits Counseling

180 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

181 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

182 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

183 Comparable Services and Benefits 

Providers 

VARCHAR (6)

184 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Customized 

Employment 

Services

185 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

186 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

187 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

188 Comparable Services and Benefits VARCHAR (6)
49

# Data Element Data type Category

Providers 

189 Services Purchased and/or Provided by

VR Agency

VARCHAR (1) Other Services

190 Primary Purchased VR Service 

Provider Type

VARCHAR (1)

191 State Vocational Rehabilitation Grant 

(Title I) Funds Used to Purchase 

Services 

INT(6)

192 Supported Employment State Grant 

(Title VI. Part B) Funds Used to 

Purchase Services 

INT(6)

193 Comparable Services and Benefits 

Providers 

VARCHAR (6)

194 Level of Education Attained at Closure VARCHAR (2)

195 Student with Disability in Secondary

Education at Closure

VARCHAR (1)

196 Number of Jobs/Occupations at 

Closure

VARCHAR (1)

197 Primary Occupation at Closure VARCHAR (2)

198 Start Date of Employment in Primary

Occupation at Closure

DATE 112 

(YYYYMMDD)

199 Employment Status at Closure VARCHAR (1)

200 Weekly Earnings at Closure INT(5)

201 Hours Worked in a Week at Closure INT(3)

202 SSDI INT(5) 202-208. Monthly

Public Support 

Amount at Closure

203 SSI for the Aged, Blind or Disabled INT(5)

204 TANF INT(5)

205 General Assistance (State or local 

government)

INT(5)

206 Veterans’ Disability Benefits INT(5)

207 Workers’ Compensation INT(5)

208 Other Public Support INT(5)

209 Primary Source of Support at Closure VARCHAR (1)

210 Medicaid VARCHAR (1) 210-215. Medical 

Insurance Coverage 

at Closure

211 Medicare VARCHAR (1)
50

# Data Element Data type Category

212 Public Insurance from Other Sources VARCHAR (1)

213 Private Insurance Through Own 

Employer 

VARCHAR (1)

214 Not Yet Eligible for Private Insurance 

Through Current Employer, but Will 

Be Eligible for Private Insurance After 

a Certain Period of Employment

VARCHAR (1)

215 Private Insurance Through Other 

Means

VARCHAR (1)

216 Type of Closure VARCHAR (1)

217 Reason for Closure VARCHAR (2)

218 Date of Closure DATE 112 

(YYYYMMDD)