1820 - 0508 Expires xx/xx/xxxx 

# Reporting Manual for the

**CASE SERVICE RECORD**  **REPORT**

**(RSA -**  **911) S**  **TATE** 

# - **F EDERAL**  

# P **ROGRAM FOR** 

# V **OCATIONAL** 

# R**EHABILITATION**

**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 avera ge 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. S W, W ashington 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 COMPARI SON OF THE NEW RSA
- 911 TO THE PREVI OUS RSA
- 911 CASE SERVI CE REPORT
............................................................................... ............. ... ..... ........... . vii INSTRUCTIONS FOR PREPARATI ON OF ELECTRONI C TRANSMITTAL
......... . . .... x ii 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 Ty pe ................................... ................... ...... 9 Primary and Secondary

Disabilities 23. Primary

Disability
- IC D
- 10 Code
......................... .................... .............. 10 24. Primary

Disability
- DSM
- 5 Code
...................... ................... ............... 10 25. Secondary Disability
- IC D
- 10 Code
............... ................... ..................... 10 26. Secondary Disability
- DSM
- 5 Code
....................... ................... ............ 10 27. Significan ce of Disability
.................................................................. ................... .. 1 0 28. Employ

ment Status at Application
............................................ ................... .......... 11 29. Weekly

Earnings at Application
................................................. ................... ......... 1 2ii

30. Hours Worked in a Week at Application
....................................... ................... ...... 13 Monthly Public Support Amount at Application 31. Social Security Disability

Insurance ( SSDI)...............
................... ...... 1 4 32. Supplemental Security Income ( SSI) for the Aged, Blind or Disabled 1 4 33. Temporary Assistance for Needy Families ( TANF ).....
................... .... 1 4 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
....................................... .................. .... 1 4 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 Employ ment ............................... ........................................................... 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
................ .................... ................. 1 6 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 Emplo ym ent (IPE)
................ ................... ............ 1 7 53. Supported Employ

ment 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 Ty pe (3) State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services (4) Supported Employ

ment State Grant (Title VI
. Part B ) Funds Used to Purchase Services (5) Comparable Services and Benefits Providersiii Service Categories 54
- 58. Assessment
............................................................................. ................... 2 0 59
- 63. Diagnosis and Treatment of I mpairments
............................ ................... . 2 1 64
- 68. Vocational Rehabilitation Counseling and Guidance
....... ................... .... 2 2 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
............................................................. .................... 2 3 99
- 103. Basic Academic Remedial or Literacy Training
.................. .................... 2 3 104
- 108. Job Readiness Training
......................................................... ..................... 2 3 109
- 113. Disability
- Related Skills Training
......................................... .................... 24 114
- 118. Miscellaneous Training
....................................................... .................... .. 24 119
- 123. Job Search Assistance
.......................................................... ................... .. 2 4 124
- 128. Job Placement Assistance
...................................................... .................... 2 4 129
- 133. On
- the
- job Supports
- Short Term
........................................ .................... 2 4 134
- 138. On
- the
- job Supports
- Supported Employ ment ................... ..................... 2 4 139
- 143. Transportation
.................................................................... .................... 2 5 144
- 148. Maintenance
...................................................................... ................... 25 149
- 153. Rehabilitation Technology
............................................ .................... ....... 2 6 154
- 158. Reader Services
............................................................ ................... ...... 2 7 159
- 163. Interpreter Services
................................................. ................... ............ 2 7 164
- 168. Personal Attendant Services
............................................ .................... ...... 2 7 169
- 173. Technical Assistance Services
......................................... .................... ...... 2 8 174
- 178. Information and Referral Services
................................... ..................... .... 2 8 179
- 183. Beneftis Counseling
......................................................... .................... ...... 2 8 184
- 188. Customized Employ ment Services
.................................... ..................... ... 2 8 189
- 193. Other Services
.................................................................. ................... .. 2 9 194. 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 Emplo ym ent in Primary Occupation At Closure
...... ................... ..... 31 199. Employ

ment Status at Closure
......................................................... .................... ... 31 200. Weekly

Earnings at Closure
......................................................... ................... ....... 3 2 201. Hours Worked in a Week at Closure
................................................ ................... ... 33 Monthly Public Support Amount at Closure 202. SSDI
........................................................................... .................. ........ 3 3 203. SSIfor the Aged, Blind or Disabled
.............................. ................... .... 3 3 204. TANF
.......................................................................... ................... ....... 3 3iv

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
...................................... ................... ........... 3 4 Medical Insurance Coverage at Closure 210. Medicaid
.............................................................. ................... .............. 35 211. Medicare
............................................................... ................... ............. 35 212. Public In surance 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 Employ ment .............................. ............................................................ 35 215. Private Insurance Through Other Means
........... ................... ................ 35 216. Ty pe of Closure
.................................................................................. ................... . 35 217. Reason for Closure
................................................................... ................... ........... 36 218. Date of Closure
............................................................... ................... ..................... 37 RECORD LAYOUT
............................................................ ........... ............................. ..... ....... 38v **GENERAL INSTRUCTIONS** Reported records pertain to all individual s 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 reco rds 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 ty pe 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 ty pes used are: VARCHAR (n) This data ty pe can hold any

character(s) with a maximum length defined b y 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 ty pe 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 ye ar using all four digits of the ye ar. 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 Decembervi For Day of the month: Enter 01, 02, etc., using a "0" prefix for single digit date of days. IN T (n) This data ty pe can hold any

integer (whole number) with a maximum length of integers as defined b y 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 case s 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 instruc ti ons. Single date format instead of separate data elements for ye ar, month, and day
. 6 Date of Birth Single date format instead of separate data elements for ye ar, 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; Phys ician or Other Medical Personnel or Medical Institutions (public or private) has been revis ed
. **18 Involvement with Other**  **Agencies and Services at Application**  **New data element.** 19 Level of Education Attained at Application Coding options have been revis ed /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.**  **A gencies 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.**  **A gencies will enter the appropriate code from the**  **current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM**  **- 5**  **). 25**  **Secondary Disability**  **- ICD**  **** **10 Code**  **Follows same format as for Primary Disability**  **- ICD**  **** **10 Code 26**  **Secondary Disability -**  **DSM**   ** 5** **Code Follows same format as for Primary**  **Disability -**  **DSM**   ** 5** **Code** 27 Significan ce 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 S ignificant Disability” in addition to "No Significant Disability " and "Significant Disability ." 28 Employ

ment 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. 3 0 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"
. 3 1
- 37 Monthly

Public Support Amount at Application Ty pe 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 (St ate 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 emplo yment. 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 Employ

ment (IPE) Single date format instead of separate data elements for

ye ar, month, and day
. 53 Supported Employ

ment Goal Replaces data element number 39, Supported Employ ment 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 Pu**  **r chased 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 trainingx

**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 on
the
- 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 employ

ment. 134
- 138 On
- the
-

job Supports

– Supported Employ

ment 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 In formation & 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 revis ed /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 employ ment goal on the individual’s IPE. Added detailed instructions for individuals who exit with multiple occupations . L anguage regarding the use of DOT codes has been deleted. **198 Start Date of Employment in**  **Primary Occupation at Closure**  **New data element** 199 Employ

ment Status at Closure Deleted coding option (2) Extended Employ ment code. 200 Weekly

Earnings at Closure Description enhanced to specify earnings must be from employ ment that is consistent with the employ ment 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 employ

ment that is consistent with the employ ment goal on the individual’s IPE. Deleted instructions that dealt with filling in leading zero s. 202
- 208 Monthly

Public Support Amount at Closure Ty pe 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. 2 09 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 emplo yment. Description of All Other Public Support has been enhanced. Deleted instructions that dealt with dollar rounding and fixed length data. 216 Ty pe 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 ye ar, month, and day
.xii

**INSTRUCTIONS FOR PREPARATION OF ELECTRONIC TRANSMITTAL** Submitting RSA
- 911 data via s ecured file transfer protocol (SFTP) is now preferred to submitting on CD
- ROM. Inorder 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 sy stem. 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
- 911 data file to is: edsecureftp .ed.gov Y our user- id is “ rsa - ba
- g ” , where " ba " is the official postal abbreviation for your state/territo ry 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 typ e 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 ye ar. 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 FY201 4 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 ver nita.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 carr** **i er**  **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 ver nita.washington@ed.gov or 202
- 245
- 7479 ; or Joan Ward at joan.ward@ed.gov or 2 02
- 245
- 7565.1820 - 0508 Expires xx/xx/xxxx



## Element
- by
- Ele me nt 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 inform**  **ation unless such collection displays a valid OMB control number. Public reporting burden for this collection of inform**  **ation is estim ated to avera**  **ge 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 inform**  **ation. The obligation to respond to this collection is necessary to obtain or**  **retain benefits as required by the Rehabilitation Act of 1973, as am**  **ended. Send comments regarding the**  **burden estimate or any other aspect of this collection of inform ation, including suggestions for reducing this**  **burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210**  **- 4537 or em**  **ail ICDocketMgr@ed.gov and reference the OMB Control Number**  **1820 -**  **0508 . Note: Please do not return the**  **com pleted**  **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) a genc y 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 Nebra ska 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 03 6 092 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 Id aho 015 071 Puerto Rico 043 099 Illinois 016 072 Rhode I sland 044 100 Indiana 017 073 South Carolina 045 101 Io wa 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 0 55 111 Missouri 028 084 Wyoming 056 1123

2. Social Security

Number Data ty pe: 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 ty pe: 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 s ys tem 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 ty pe: VARCHAR (1) Enter the appropriate code listed below to indicate whether the individual had a previous service record closed b y 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 cl osure. Indicate the ty pe 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 emplo ym ent outcome 4 Closed after individual received services, without an employ ment outcome 5 Closed after an individualized plan for employ ment (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 signed4

5. Date of Application Data ty pe: 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 shoul d be verifiable b y date stamp. 6. Dat e of Birth Data ty pe: DATE 112 (YYYYMMDD) Record the individual ’s date (year, month, and day) of birth
. 7. Gender Data ty pe: VARCHAR (1) Code the individual ’s gender as follows:

1 Male 2 Female Race Race information should be recorded for all individual s 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 generall y expected that the information recorded will reflect the individual ’s own identification of race from the categories provided. However, if a n individual refuses to identify his/her race, the counselor should, at a minimum, notify the individual that if he/ s he fail s to self
- identify , an observer
- identification method w ill 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 categ ories should have codes of 0 (not this race). M ore than one race variabl e 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 ty pe 1. Suc h service record s will be few in number. As an example, if an individual applies for services via an application form or letter and is closed b y the agency without being seen b y 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 o r C entral American, or other Spanish culture or origin, regardless of race. Data ty pe: VARCHAR (1) The ethnic category

Hispanic or Latino should be recorded for all individuals whose service records were closed in the FY being reported. U se 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 th e individual as Hispanic for ethnicity and follow the observer
identification method as described above for the race categorie s. 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. 1 4. Veteran Status Data ty pe: 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 Z ip C ode 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 ty pe: 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 Employ

ment/Training Centers 8 Self
- referral 9 Other Sources 1 0 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 1 6 Family

/Friends 1 7 Intellectual and Developmental Disabilities Providers 1 8 Mental Health Provider (Public or Private) 1 9 Public Housing Authority 20 State Department of Correction/Juvenile Justice7 2 1 State Employ

ment Service Agency 2 2 Veteran's Administration 2 3 Worker's Compensation 2 4 Other State Agencies 2 5 Other VR State Agencies 18. Involvement with Other Agencies and Services at Application Data T ype 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 indivi dual 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."

0 0 Not provided services or funding from any programs or organizations listed below 0 1 American Indian VR Services Program 0 2 Centers for Independent Living 0 3 Child Protective Services 0 4 Community

Rehabilitation Programs 0 5 Consumer Organizations or Advocacy Groups 0 6 Educational Institutions (elementary /secondary) 0 7 Educational Institutions (post
- secondary) 0 8 Employers 0 9 Employ

ment 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 1 2 Medical Health Provider (Public or Private) 1 3 Mental Health Provider (Public or Private) 1 4 One
- stop Employ

ment/Training Centers 1 5 Public Housing Authority 1 6 Social Security

Administration (Disability Determination Service or District office) 1 7 State Department of Correction/Juvenile Justice 1 8 State Employ

ment Service Agency 1 9 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 ty pe: 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. I f the individual was coded as having an IEP at the time of application in the p revious 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 accomm odation 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 b y Section 504 of the Rehabilitation Act and is not receiving services under an IEP at the time of application.9

2 1
. 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 famil y 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 1 0 Other 22
. Sensory

/Communicative Impairment Ty pe 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 employ ment. 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 (I CD
- 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 employ ment. The IC D
- 10 is a six
- digit alphanumeric code in the form xxx.xxx while the DSM
- 5 is a f ive
- 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 element10

23 , Primary

Disability

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

– DSM
- 5 C ode must be left blank
. 2 3
. Primary

Disability
- ICD
- 10 Code Data type VARCHAR (7) When an individual has more than one applicable I CD
- 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

dis ability code that most severel y impedes the individual from seeking, obtaining and retaining gainful employ ment . If no I CD
- 10 code applies to the individual, or the ICD
- 10 code is not the primary impediment to employ ment, leave blank
. 2 4
. 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 severel y impedes the individual from seeking, obtaining and retaining gainful employ ment. If no DSM
- 5 code applies to the individual, or the DSM
- 5 code is not the primary impediment to employ ment, leave blank
. 25
. Secondary

Disability **-** ICD
- 10 Code Data type VARCHAR (7) When an individual has more than one applicable I CD
- 10 code that is a secondary impediment to the individual seeking, obtaining, and retaining gainful employ ment, enter the IC D
- 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 signif icant impediment to employ ment for the individual. If no ICD
- 10 code applies to the individual, or the I CD
- 10 code is not the secondary impediment to employ ment, 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 employ ment, enter the DSM
- 5 code that best describes , in the judgment of the rehabi litation counselor and after consulting with the individual, the secondary disability code that is the most significant impediment to employ ment for the individual. If no DSM
- 5 code applies to the individual, or the DSM
- 5 code is not the secondary impediment to employ ment, leave blank. 2 7
. Significan ce 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 s ignificant disability at any time during his/her VR program. I f an11

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 b y 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 phys ical or mental impairment that seriously limits one or more functional capacities (such as mobility, communication, self
- care, self
direction, interpersonal skills, work tolerance, or work skills) in terms of an employ ment 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 pals y, c ys tic fibrosis, deafness, head injury , heart disease, hemiplegia, hemophilia, respiratory o r pulmonary

dysfunction, intellectual disability , mental illness, multiple sclerosis, muscular dys trophy , musculo
- skeletal disorders, neurological disorders (including stroke and epileps y), spinal cord conditions (including paraplegia and quadriplegia), si ckle 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 limit ation. 0 No Significant Disability 1 Significant Disability 2 Most Significant Disability 28
. Employ

ment Status at Application Data type: VARCHAR (2) Enter the code which best describes the emplo ym ent status of the individual at application from the following codes
. The first seven codes are considered "employ ment" 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 appli cation for services.

1 Employ

ment without Supports in Integrated Setting is full
- time or part
- time employ ment 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 self
employed individuals. 2 Extended Employ

ment refers to work for wages or salary in a non
- integrated setting for a public or nonprofit organization. Such settings are variousl y12 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 employ ment. 3 Self
- employ ment (except BEP) refers to work for profit or fees includin g operating one's own business, farm, shop, or office. "Self
- employ ment" includes sharecroppers, but not wage earners on farms. 4 State Agency
- managed Business Enterprise Program (BEP) refers to Randolph
Sheppard vending facilities and other small busines ses operated b y 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 resi dence for wages, salary , or on a piece
- rate. Individuals capable of activity outside the home, as well as homebound individuals, may engage in such employ

ment. 5 Homemaker refers to men and women whose activity is keeping house with no earnings for person s in their households or for themselves if they live alone. 6 Unpaid Famil y Worker refers to persons who work without pay on a family farm or in a family

business. 7 Employ

ment with Supports in Integrated Setting is full
- time or part
- time employ ment in an integrated setting with ongoing support services for individuals with significant disabilities (supported employ ment). For purposes of this report, compensation for such emplo ym ent 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
- tim e other than students in secondary education (for example, students in post
secondary 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 employe d: 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 recentl y left specialized medical facilities). When an individual ’s w ork activity overlaps into two different employ ment categories, select the code more descriptive of the individual's emplo ym ent activity at application
. 29
. Weekly

Earnings at Application Data T ype INT(5 ) Enter the amount of money (to the nearest dollar) earned in a ty pical week at the time of application.13

This item collects data on the cash earnings of individual s at application and includes all wages, salaries, tips, and commissions received as income b efore pay roll deductions of Federal, State and local income taxes and Social Security pay roll tax. Earnings also include profits derived from self
- employed individual s . Earnings for salespersons, consultants, self
- employed individuals, and other similar oc cupations are based on the adjusted gross income. Adjusted gross income is gross income minus unreimbursed business expenses. Do not include estimates of pay ments in
- kind, such as meals and lodging. Estimate profits of farmers, if necessary
. Where earning s 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 weekl y average over a representative period of time such as one month or lo nger . When , because of the occupation/situation, there are significant amounts of unreimbursed business expenses that are irregular (e.g. , car lease pay ments 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 generall y not paid when earned, but rather are paid periodically , such as weekly , biweekl y, or even monthly . To bring standardization to this item, earnings should be based on the actual receipt of the pay ment and not on amounts accruing until the next commission payout. If the individual had no earnings, enter "0"
. 3 0
. Hours Worked in a Week at Application Data type IN T( 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
- employ ment, adjusted gros s 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 ty pe of public support. Agencies may leave these data elements blank for closure c ode 1. Public support means cash pay ments made by

Federal, State and/or local governments for any reason, including an individual’s disability, age, or economic status. Include pay ments 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 pay ments that are sent directly to the individual in an institution or to dependents on his/her behalf. Exclude any non cash support pay

ments such as Medicaid, Medicare, food st amps and rental subsidies. Categories of public support are as follows:14

3 1
. Social Security

Disability

Insurance (SSDI) Data T ype INT(5) Enter the amount of SSDI received b y 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. 3 2
. Supplemental Security Income (SSI) for the Aged, Blind or Disabled Data T ype INT(5) Enter the monthly

pay ment to the individual under the Federal program of SSI for the aged, blind, and disabled. Only the individual’s portion of the pay ment should be recorded here. This figure can be verified through the SSA or from a copy of the individual’s benefit notification letter. 3 3
. Temporary

Assistance for Needy Families (TANF) Data T ype INT(5) Enter the monthly

amount of cash public assistance pay ments 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 estimat e the individual’s portion of the pay

ment. 3 4
. General Assistance (State or local government) Data T ype INT(5) 3 5
. Veterans' Disability Benefits Data T ype INT(5) Veterans' Disability

Benefits are pay

ments made by

the Department of Veterans Affairs for partial or total disability
. 3 6
. Workers' Compensation Data T ype INT(5) 3 7
. All Other Public Support Data T ype INT(5) Other Public Support payments are cash pay ments to individuals beyond those otherwise listed
. Include pay ments made by Federal, State and local governments for retirement or survivor benefits to the individual as well as unemploy ment insurance benefits and other temporary pay ments. 38
. Primary

Source of Support at Application Data T ype 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 a n 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 not15

Code 1 (personal income). If a n individual is primarily supported by a governmental entity with no cash support

– for example, incarcerated individuals,

– use C ode 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 Employ

ment 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 ty pe 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 T ype: VARCHAR (1) 40
. Medicare Data T ype: VARCHAR (1) 4 1
. Public Insurance from Other Sources (Workers' Compensation, Children's Health Insurance Program, etc) Data T ype: VARCHAR (1) 4 2
. Private Insurance Through Own Employer Data T ype: VARCHAR (1) 4 3
. Not Yet Eligible for Private Insurance through Current Employer, But Will Be Eligible for Private Insurance a fter a Certain Period of Employ ment Data Ty

pe: VARCHAR (1) 4 4
. Private Insurance through Other Means Data T ype: 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 severel y disabled individual s for whom an employ ment outcome might be in doubt
. 4 5
. 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. 4 8
. 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 ty pe: 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 OOS17 wait list. I f the individual exited the VR program from the OOS waiting list, (Cl osure T ype 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 Employ ment (IPE) Data ty pe: 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 signature s bear two different dates, the later date should govern. 53
. Supported Employ ment Goal Data type: VARCHAR (1) For individuals who had an employ ment goal of supported employ ment in their IPE at some point during their rehabilitation and received supported employ ment services under the plan, indicate when the supported employ ment goal was included in the IPE. 0 The individual had no supported employ ment goal identified in their IPE at any point during their rehabilitation. 1 Initial IPE identified supported employ ment as the employ

ment goal. 2 The IPE was amended during the VR process to change the goal to supported employ ment. 3 The IPE was amended during the VR process to change the goal from supported employ

ment to another emplo ym ent goal. 4 The amended or final IP E only identified supported employ ment as the employ ment goal at the time the service record was closed. N ote : 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 Cost s 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 merel y 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 ag ency , the second code identifies the primary service provider ty

pe. The third and fourth codes are used to identify the source of funds for VR
-purchased services as being state VR18

(Title I) grant funds, or state supported emplo ym ent (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 T ype 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 n ot purchase d or provided 1 provided b y the VR agency (in
- ho use/b y VR staff) 2 purchased by

the VR agency 3 both provided and purchased by the VR agency

(in
- house/by VR staff) N ote : Wh en 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. Wh en 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 Ty pe Data T ype VARCHAR (1) For each of the service categories, this data element provides information on what ty pe 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 o f the service record. The majority of purchased services were provided directl y b y:

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 not
for
-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) Stat e Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services Data type IN T(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 prov ided b y rehabilitation programs owned and operated by the State VR agency

that are not directly

billed on an individual basis
. (4) Supported Employ

ment State Grant (Title VI, Part B ) Funds Used to Purchase Services Data type IN T(6) This data element records all expenditures (amounts) within this service category for services purchased for the most significantly disabled individual with the supported employ ment grant program (Titl e VI, Part B ) funds. Recipients of these funds should have a supported employ ment goal in their IPE. Individuals with a supported employ ment 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. In clude all Title VI, Part B expenditures made to public and/or private service providers , individuals or an organization. In clude Title V I , Part B expenditures for all ty pes 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 b y rehabilitation programs owned and operated by the State VR agency

that are not directly

billed on an individual basis. (5) Comparable Services and Benefits Provider s Data T ype 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 “0 81924”. 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 onl y a consumer organization or advocacy group, enter “05”. If no comparable service s or benefit s w ere provided, enter "00."

00 No comparable services or benefits were provided 0 1 American Indian VR Services Program 0 2 Centers for Independent Living 0 3 Child Protective Services 0 4 Community

Rehabilitation Programs20 0 5 Consumer Organizations or Advocacy Groups 0 6 Educational Institutions (elementary /secondary) 0 7 Educational Institutions (post
- secondary) 0 8 Employers 0 9 Employ

ment 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 1 2 Medical Health Provider (Public or Private) 1 3 Mental Health Provider (Public or Private) 1 4 One
- stop Employ

ment/Training Centers 1 5 Public Housing Authority 1 6 Social Security

Administration (Disability Determination Service or District office) 1 7 State Department of Correction/Juvenile Justice 1 8 State Employ

ment Service Agency 1 9 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 activ ities 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 servic es 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 ap titudes, personal and social adjustments, and employ ment opportunities of the individual and the medical, psychiatric, ps ychological, and other pertinent vocational, educational, cultural, social, recreational, and environmental factors that affect the emp loy ment 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
- 6 3 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 substantiall y a physical or mental impairment that constitutes a substantial impediment to employment; b) Diagnosis and treatment for mental and emotional disorders b y 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 p rosthetic s and/or orthotic s related to the individual’s diagnosed disability and is necessary

for the achievement of the employ ment outcome; h) Prescription of e ye gl asses and visual services, including visual training, related to the individual’s diagnosed disability and necessary

for the achievement of the employ ment outcome; i) Podiatry ; j) Phy sical therap y; k) Occupational therap y; 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 phy sical 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 employ ment outcome is also included in this category . Vocational Rehabilitation Counseling and Guidance Data Elements 6 4
- 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
- 1 18 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 ty pe 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 ty

pe 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 b y a college or university . Four
- Year College or University Training Data Elements 74
- 7 8 Full
- time or part
- time academic training leading to a baccalaureate degree, a certificate , or other recognized educational credential. Such training may be provided b y a four
- ye ar college or university or technical college. Junior or Community

College Training Data Elements 7 9
- 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 O ccupational or Vocational Training Data Elements 84
- 88 O ccupational, vocational, or job skill training provided by a community

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

ment 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. Generall y 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 employ ment 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 emplo ye remployee 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 o f 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
- ye ar, junior or community college s 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 employ ment g oal consistent with the employ ment goal on the IPE
. On
- the
- job Supports

– S upported Employ ment 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 employ

ment for a period of time generall y not to exceed 18 months. Such services, such as job coaching , are for individuals who have supported employ ment and long
- term supports identified on the IPEs. On
- the
-

job support services w ith a supported employ ment goal are funded using Title VI , Part B and Title Ifunds.25

Transportation Data Elements 139
- 143 Transportation, including adequate training in the use of public transportation vehicles and sy stems, 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 b y 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 specificall y excludes the modification of vehicles, which is to be reported in rehabilitation technology ; d) Training in the use of public transportation vehicles and sy stems. 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 b y 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 s ys tematic 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, reh abilitation, employ

ment, 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 s ys tematic application of engineering scien ces to design, develop, test, evaluate, appl y, 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 employ ment, independent living, education, and integration into the community
. b) Assistive Technology Devices are any

items, piece of equipment, or product sy stem, whether acquired commerciall y 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 s ervices that directl y assist an individual with a disability

in the selection, acquisition, or use of an assistive technology device. Services may

in clude: 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

d evice; 3. selecting, designing, fitting, customizing, adapting, appl ying, 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 1 5 4
- 168 Personal Assistance Services are a range of services provided b y one or more persons designed to assist an individual to perform dail y living activities on or off the job that the individual would ty

pically 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 employ ment outcome and may

be provided onl y while the individ ual 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 individual s 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 generall y 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 phy sical or mental impairments. Interpreter Services Data Elements 159
- 163 Interpreter services are sign language or oral interpretation services for individual s 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". P ersonal Attendant Services Data Elements 164
- 168 Personal attendant services are those personal services th at an attendant performs for an individual with a disability including, but not limited to bathing, feeding, dressing, providing mobility and tran sportation, 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 individual s in the pursuit of self
employ ment, telecommuting and small business operation outcomes. In formation and Referral Services Data Elements 174
- 178 In formation and referral services are provided to individual s 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 th e 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 ty pically involves an anal ys is of an individual’s current benefits, such as SSDIand SSI , the individual’s financial situation, and the effect different income levels from work wil l 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 employ

ment. Ongoing assistance may also be provided as the individual decides on employ ment goals, searches for jobs, and becomes employed. Customized Employ

ment 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 employ ment outcome of customized employment, including self
- employ ment. A key

factor in deciding if a service is a customized employ ment 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 o f supervision.29

O ther 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 an d is receiving servic es under an IEP at the time of closure
. 4 This individual is a student with a disability who not covered b y 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 employ ment goal on an individual's IPE and primary employ ment goal SOC codes that the individual held at the time of closure. For those exiting with only one source of employ

ment, enter the number ‘1’. For those exiting the VR program with 2 sources of employ ment or jobs, enter a ‘2’, etc. For those individuals exiting without employ ment, leave blank
. 197
. Primary Occupation at Closure Data type VARCHAR (6) For an individual who achieved an employ ment 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 emplo ym ent outcome, leave blank. Instructions for individual s who Exit with Multiple Occupations: For individual s exiting the VR program with multiple jobs, ( c oded in data e lement number 196 , Number of Jobs / Occupations at Closure) the Occupation at Closure data element should be populated with the code for the o ccupation consistent with the employ ment goal on an individual's IP E 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 repo rted at the time of entering the occupation code, enter the occupation consistent with the employ ment 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 employ ment goal specified on the IPE that encompasses the majority of the hours worked per week at closure. 3. If neither hours no r wages per occupation are known, then individual self reporting of the primary

occupation consistent with the employ ment goal specified on the IPE should be used to determine the appropriate occupation code. For the emplo ym ent 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 onl y if the31 ty pe of unpaid famil y 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 f acility 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 manag ers 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. N ote : 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 Emplo ym ent in Primary Occupation at Closure Data ty pe: DATE 112 (YYYYMMDD) Record the date when the individual began the job coded in data element 197 as the primary occupation. 199
. Employ

ment Status at Closure Data type VARCHAR (1) For an individual who achieved an employ ment outcome, enter the applicable one
- digit code that describes the employ

ment outcome of the individual when his or her service record was closed. If classifying the individual into two different employ ment statuses from Codes 1 or 3
- 6 is possible, select a code designating the principal status.

1 Employ

ment without Supports in Integrated Setting is full
- time or part
- time employ ment 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 self
employed individuals. 3 Self
- employ ment (except BEP) refers to work for profit or fees including operating one's own business, farm, shop, or office. "Self
- employ ment" includes sharecroppers, but not wage earners on farms. 4 State Agency
- managed Bus iness Enterprise Program (BEP) refers to Randolph
Sheppard vending facilities and other small businesses operated b y individuals with significant disabilities under the management and supervision of a State VR agency . Include home industry where the work i s done under the32 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 employ

m ent. 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 Famil y Worker refers to persons who work without pay on a family farm or in a family business. 7 Employ

ment with Supports in Integrated Setting is full
- time or part
- time employ ment in an integrated setting with ongoing support services for individuals with significant disabilities (supported employ ment). For purposes of this report, compensation for such emplo ym ent may be below, at, or above the minimum wage. 2 00
. Weekly

Earnings at Closure Data type IN T(5) Enter the amount of money (to the nearest dollar) the individual earned in a ty pical week after achieving an employ

ment outcome consistent with the employ ment 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 pay roll deductions of Federal, State and local income taxes and Social Security pay roll tax. Earnings also include profits derived from self
- employed individuals. Earnings for salespersons, consultants, self
- employed individual s , 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 pay ments 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 weekl y average over a representative period of time such as one month or long er . When , because of the occupation/situation, there are significant amounts of unreimbursed business expenses that are irregular (e.g., car lease pay ments 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 weekl y, biweekly, or even monthly . To bring standardization to this item, earnings should be based on the actual receipt of the pay ment and not on amounts accruing until the next commission payout. If the individual had no earnings or did not achieve an emplo ym ent outcome, enter "0"
.33

2 01
. Hours Worked in a Week at Closure Data type IN T(3) For an individual who achieved an employ ment outcome, this item collects data on the number of hours worked on all employ ment consistent with the employ ment goal on the individual’s IPE. Enter the number of hours the individual worked for earnings in a typ ical week when the service record was closed. Earnings may have been in the form of wages, salaries, tips, commissions, profits from self
- employ ment, adjusted gross income for salespersons, etc. If the individual had no earnings or did not achieve an employ ment 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 in dividual did not receive any monthly public support, enter "0" for each ty pe of public support. Agencies may leave these data elements blank for closure code 1
. Public support refers to cash pay ments made by

Federal, State and/or local governments for any reason, including an individual’s disability, age, or economic status. In clude pay ments 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 non cash support pay

ments such as Medicaid, Medicare, food stamps and rental subsidies. Categories of public support are as follows: 2 02
. Social Security

Disability

Insurance (SSDI) Data T ype INT(5) Enter the amount of SSDI received b y 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. 2 03
. Supplemental Security Income (SSI) for the Aged, Blind or Disabled Data T ype INT(5) Enter the monthly

pay ment to the individual under the Federal program of SSI for the aged, blind, and disabled. Only the individual’s portion of the pay ment should be recorded here. This figure can be verified through the SSA or from a copy of the indivi dual’s benefit notification letter. 2 04
. Temporary

Assistance for Needy Families (TANF) Data T ype INT(5) Enter the monthly

amount of cash public assistance pay ments 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 pay

ment.34

2 05
. General Assistance (State or local government) Data T ype INT(5) 2 06
. Veterans' Disability Benefits Data T ype INT(5) Veterans' Disability

Benefits are pay

ments made by

the Department of Veterans Affairs for partial or total disability
. 2 07
. Workers' Compensation Data T ype INT(5) 2 08
. All Other Public Support Data T ype 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 pay ments made by Federal, State and local governments for retirement or survivor benefits to the individual as well as unemploy ment insurance benefits and other temporary pay ments. 2 09
. 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. N ote : If a n 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 a n 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 Employ

ment 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 ty pe 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 T ype: VARCHAR (1) 2 11
. Medicare Data T ype: VARCHAR (1) 2 12
. Public Insurance from Other Sources (Workers' Compensation, Children's Health Insurance Program, etc) Data T ype: VARCHAR (1) 2 13
. Private Insurance Through Own Employer Data T ype: VARCHAR (1) 2 14
. Not Yet Eligible for Private Insurance Through Current Employer, But Will Be Eligible for Private Insurance After a Certain Period of Employ ment Data T ype: VARCHAR (1) 2 15
. Private Insurance Through Other Means Data T ype: VARCHAR (1) Individuals receiving benefits through their parent/family members’ insurance plan should use this code. 216
. Ty

pe of Closure Data type VARCHAR (1) Enter a one
- digit code from the following list to in dicate 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 employ ment outcome 4 Exited without an employment outcome, after receiving services 5 Exited without an employment outcome, after a signed IP E, 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 signed36

2 17
. 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 record s with a code of 3 in data element 216 , type of closure. Codes of 1 or higher appl y to all other types of closure, that is, 1, 2, 4, 5, 6, and 7.

0 Achieved employ

ment 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 employ ment. 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 effectivel y. Include individuals transferred to other State VR agencies. 8 No disabling condition
- ineligible Use this code onl y 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 employ ment - 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 employ ment. 10 Transportation not feasible or available Use this code to indicate that the individual was unable to accept or maintain37 employ ment bec ause 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 emplo ym ent 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 employ

ment services but for wh om no source of extended services was available. 13 All other reasons This code is used for all reasons not covered above. 14 Extended employ

ment Use this code for individuals who received services and were placed in a non
integrated setting for a public or non
-profit organization 1 5 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. 1 6 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. 2 18
. Date of Closure Data ty pe: DATE 112 (YYYYMMDD) Record the date when the individual ’s service record was closed b y 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 1 12 (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) 2 0 Student with Disability in Secondary Education at Application VARCHAR (1) 2 1 Living Arrangement at Application VARCHAR (2) 2 2 Sensory

/Communicative Impairment Ty pes 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 Significan ce of Disability VARCHAR (1) 28 Employ

ment Status at Application VARCHAR (2)40

**# Data**  **Element Data type**  **Category** 29 Weekly

Earnings at Application IN T(5) 30 Hours Worked in a Week at Application IN T(3) 31 Social Security

Disability

Insurance (SSDI) IN T(5) 3 1
- 3 8 . Monthly Public Support at Application 32 Supplemental Security Income (SSI) for the Aged, Blind or Disabled IN T(5) 33 Temporary

Assistance for Needy Families (TANF) IN T(5) 34 General Assistance (state or local governments) IN T(5) 35 Veterans’ Disability Benefits IN T(5) 36 Workers’ Compensation IN T(5) 37 Other Public Support IN T(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 Emplo yer, but Will Be Eligible for Private Insurance After a Certain Period of Employ ment 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 11241

**# 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 Employ ment (IPE) DATE 112 (YYYYMMDD) 53 Supported Employ ment Goal VARCHAR (1) 54 Services Purchased and/or Provided by VR Agency VARCHAR (1) Assessment 5 5 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 5 6 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 5 7 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6)
5 8 Comparable Services and Benefits Providers VARCHAR (6) 59 Services Purchased and/or Provided by VR Agency VARCHAR (1) Diagnosis and Treatment of Impairments 6 0 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 6 1 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 6 2 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6) 6 3 Comparable Services and Benefits Providers VARCHAR (6) 6 4 Services Purchased and/or Provided by VR Agency VARCHAR (1) Vocational Rehabilitation Counseling and Guidance 6 5 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 66 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6)42

**# Data**  **Element Data type**  **Category** 67 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 7 0 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 7 1 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 7 2 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 76 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 77 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 81 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 82 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 86 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 87 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 91 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 92 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1)
96 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6)
97 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Training44

**# Data**  **Element Data type**  **Category** 1 00 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 1 01 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 102 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 1 0 6 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 107 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 111 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 112 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6)
113 Comparable Services and Benefits Providers VARCHAR (6)
114 Services Purchased and/or Provided by VR Agency VARCHAR (1) Miscellaneous Training 1 15 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 1 16 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 117 Supported Employ ment State Grant IN T(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 Ty

pe VARCHAR (1) 121 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 122 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6) 1 23 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 Ty

pe VARCHAR (1) 126 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 127 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 131 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 132 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Employ ment 135 Primary

Purchased VR Service VARCHAR (1)46

**# Data**  **Element Data type**  **Category** Provider Ty

pe 136 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 137 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 141 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 142 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6)
143 Comparable Services and Benefits Providers VARCHAR (6)
1 44 Services Purchased and/or Provided by VR Agency VARCHAR (1) Maintenance 145 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 1 46 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 147 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 151 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 152 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to IN T(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 Ty

pe VARCHAR (1) 156 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 157 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 161 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 162 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 166 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 167 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1)48

**# Data**  **Element Data type**  **Category** 171 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 172 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6) 173 Comparable Services and Benefits Providers VARCHAR (6) 174 Services Purchased and/or Provided by VR Agency VARCHAR (1) In formation and Referral Services 175 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 176 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 177 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6) 178 Comparable Services and Benefits Providers VARCHAR (6) 17 9 Services Purchased and/or Provided by VR Agency VARCHAR (1) Benefits Counseling 18 0 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 18 1 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 18 2 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(6) 18 3 Comparable Services and Benefits Providers VARCHAR (6) 184 Services Purchased and/or Provided by VR Agency VARCHAR (1) Customized Employ ment Services 185 Primary

Purchased VR Service Provider Ty

pe VARCHAR (1) 186 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 187 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Ty

pe VARCHAR (1) 191 State Vocational Rehabilitation Grant (Title I) Funds Used to Purchase Services IN T(6) 192 Supported Employ ment State Grant (Title VI. Part B ) Funds Used to Purchase Services IN T(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 Employ ment in Primary Occupation at Closure DATE 112 (YYYYMMDD) 199 Employ

ment Status at Closure VARCHAR (1) 200 Weekly

Earnings at Closure IN T(5) 201 Hours Worked in a Week at Closure IN T(3) 202 SSDI IN T(5) 202
- 208 . Monthly Public Support Amount at Closure 203 SSIfor the Aged, Blind or Disabled IN T(5) 204 TANF IN T(5) 205 General Assistance (State or local government) IN T(5) 206 Veterans’ Disability Benefits IN T(5) 207 Workers’ Compensation IN T(5) 208 Other Public Support IN T(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 Emplo yer, but Will Be Eligible for Private Insurance After a Certain Period of Employ ment VARCHAR (1)

215 Private Insurance Through Other Means VARCHAR (1) 216 Ty

pe of Closure VARCHAR (1) 217 Reason for Closure VARCHAR (2) 218 Date of Closure DATE 112 (YYYYMMDD)