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Title III Alternative Financing Program Data Collection 

Instrument and Instructions
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Rehabilitation Services Administration

Annual Report for

Alternative Financing Programs 

Public Reporting Burden

OMB # 1820-0662

Expires: 06/30/2011

Paperwork Burden Statement

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

collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to 

average 27 hours per response, including time for reviewing instructions, searching existing data sources, gathering and 

maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this 

collection is required under Title III of the Assistive Technology Act of 1998 to retain benefit of the Alternative Financing

Program. Send comments regarding the burden estimate or any other aspect of this collection of information, including 

suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-

4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820-0662. Note: Please do not return the 

completed Title III Alternative Financing Program Data Collection Instrument and Instructions application to this address.

This document was prepared by the Association of Assistive Technology Act Programs (ATAP)

under U.S. Department of Education Grant No. H224B060002
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Instructions for completion of this form and relevant definitions are contained in 

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

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

A. General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

B. Background, General Instructions and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

1. Reporting Period

2. Aggregate Data

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

4. Definitions

C. AFP Required Data Elements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1. Number, Result, And Geographic Distribution of Loan Applications

2. Information about Loans Made

3. Type of Device Financed through the Program

4. Defaults and Net Losses

5. Classification of Consumers Receiving Assistance

D. Anecdote . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

E. Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

F. Classification of Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

1. Vision

2. Hearing

3. Speech Communication

4. Learning, Cognition, and Developmental

5. Mobility, Seating and Positioning

6. Daily Living

7. Environmental Adaptations and Home Modifications

8. Vehicle Modifications and Transportation

9. Computers and Related

10. Recreation, Sports, and Leisure Equipment
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A. General Information

General Information: Alternative Financing Program (AFP)

1. State and Name of AFP

Lead Agency

1. Agency Name

2. Agency Contact

3. Mailing Address 

4. Mailing Address (continued)

5. City

6. State

7. Zip Code

8. Phone

9. Fax

10. Program URL

11. Program E-mail

12. Program Toll-free Number

13. Program TTY Number

Community-Based Organization (CBO)

1. Name of Community-Based Organization

2. Name of AFP Director/Loan Fund Manager

3. Mailing Address

4. Mailing Address (continued)

5. City

6. State

7. Zip Code

8. Phone

9. Fax

10. Program URL

11. Program E-mail

12. Program Toll-free Number

13. Program TTY Number

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

1. Name of Lending Institution 

2. Contact at Lending Institution

3. Mailing Address

4. Mailing Address (continued)

5. City

6. State

7. Zip Code

8. Phone

9. Fax

10. Program URL

Report Submission

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

State Financing Activities in the Annual Report for 

State Grant for Assistive Technology Programs.

□ No 

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

submitting this report we are attesting that all data in 

this performance report are true and correct and the 

report fully discloses all known weaknesses 

concerning accuracy, reliability, and completeness of 

the data.

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

4. Name of Lead Agency Representative Submitting 

Report

5. Mailing Address

6. City

7. State

8. Zip Code

9. Phone 

10. Fax

11. Email

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

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

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

This document contains information needed for completing the AFP Annual Report required by

the Rehabilitation Services Administration (RSA) under title III of the Assistive Technology Act 

of 1998 as in effect prior to the amendments of 2004 (AT Act of 1998). This annual report is 

designed to provide RSA with the data necessary for program planning and reporting to 

Congress, the Secretary of Education and other entities. 

Information from individual states will be available to the public once the information is 

completed by the state and submitted to and approved by RSA. Questions regarding potential 

uses of the information submitted by individual states should be directed to Robert Groenendaal, 

Program Specialist, RSA, U.S. Department of Education, 400 Maryland Avenue, SW, PCP 

Room 5019, Washington, DC 20202-2800, Robert.Groenendaal@ed.gov, 202-245-7393. 

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

system, including a workgroup representing AFPs and Statewide Assistive Technology 

Programs, and the Rehabilitation Engineering and Assistive Technology Society of North 

America (RESNA). The workgroup’s discussions and input framed issues, developed solutions, 

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

Association of Assistive Technology Act Programs (ATAP) developed this AFP data collection 

instrument under Grant No. H224B060002. 

1. Reporting Period

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

ends on the following September 30. 

2. Aggregate Data

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

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

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

period. 

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

It is possible for an AFP to receive a loan application during one reporting period, but not 

process that application to a conclusion until the following reporting period. Do not split 

your data across reporting periods. If an application is received during reporting period “A” 

but the decision about that application is not made until the following reporting period “B,” 
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report all data related to that application during reporting period “B” only. The same logic 

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

4. Definitions 

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

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

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

proceeding are: 

a. Partnership loan: A loan administered by and using dollars from a source other 

than the AFP, usually a financial entity, for which the AFP has an investment through 

interest or principal buy-down, loan guarantee (see next definition), agreement with a 

financial institution based on an investment deposit, or other financial/administrative 

role.

b. Loan guarantee or insurance: The AFP uses its funds to guarantee all or a 

portion of loans for AT. A guaranteed loan is a partnership loan in which the AFP 

guarantees that the loan to a consumer is secure and will be repaid in the event of a 

default, thus increasing the lender’s willingness to loan funds. 

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

from the “permanent separate account” (title III funds plus match dollars plus interest 

paid/accrued) for loans. The AFP directly provides the funds that are to be loaned out 

and retains full control over to whom and at what terms the funds are loaned. As

loans are repaid, the money is lent out again to other AT consumers — that is, the 

same money “revolves” out to other borrowers as earlier borrowers return it to the 

program.
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C. AFP Required Data Elements

All AFPs are required to provide the data requested in C items 1-8 and E. See 

General Instructions in Section B for information on reporting on activities that 

cross over reporting periods.

1. Number, Result, and Geographic Distribution of Loan Applications

Number and Result of Loan Application of Loan Applications

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

those applications and the geographic distribution of the applicants.

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

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

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

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

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

AFP did not process and review the application; it means that the application was fully

processed and reviewed but a loan was denied to the consumer. 

Report on all loan applications including (1) revolving loans* that are made directly by the 

AFP; and (2) partnership loans* that use dollars from another source, usually a financial 

institution, in which the AFP has an investment through loan guarantee, agreement with a 

financial institution based on an investment deposit, interest or principal buy-down, or other 

financial or administrative role. Do not include loans in which the AFP had no financial or 

administrative role, such as loans for which you simply made a referral to another funding or 

lending source.

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

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

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

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

decision or approved during this reporting period. 

Geographic Distribution of Loan Applications 

In this section, report on geographic distribution of the applicant for a loan during the 

reporting period. Report only one applicant per loan. Choose the primary applicant in the 

event of multiple applicants for a loan. States have various methods for classifying an 

applicant by the area of the state where he or she resides. For the purposes of national data 

collection, a single method for designating the area where an applicant resides must be used 

by all grantees. This data collection will classify applicants by Rural Urban Continuum 

Codes (RUCCs).
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To use RUCCs, you must ascertain the county of residence of the applicant. Once you know 

the county where the applicant resides, you can determine the RUCC for that county. The 

2003 RUCCs form a classification scheme that distinguishes metropolitan counties by size 

and non-metropolitan counties by degree of urbanization and proximity to metro areas.1

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

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

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

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

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

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

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

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

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

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

area 

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

metro area 

 

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

 Codes 1-3 are considered “metro”

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

When required by this instrument, AFPs will categorize individuals into one of these two 

groups based on the RUCC for their county. Finding the RUCC for any county is done in 

the following manner:

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

Research Service Site:

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

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

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

downloadable version of the county codes in excel format which will 

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

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

to the Data Files Section and click on the option “Download the 2003 

codes in an Excel file”

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

below the map.

 

1

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

http://www.ers.usda.gov/briefing/Rurality/RuralUrbCon/
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3) A list of all counties in the selected state will appear. The 2003 RUCC is the 

fourth column from the left. 

AFPs are responsible for tallying how many direct users fall into each grouping of RUCC 

and providing the final number in the appropriate area of the data collection instrument.

EXAMPLE: For the program that had six loan applications during the reporting period:

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

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

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

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

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

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

The Geographic Distribution totals for the six loan applications depicted in the 

example result in the following example:

Number of Applications

Area of Residence Total

Metro

RUCC 1-3

In the example, persons 

A & F would be included 

in this RUCC

Non-Metro

RUCC 4-9

In the example, persons 

B,C,D, & E would be 

included in this RUCC

A. Approved—loan made 1 (person A) 2 (persons B and C) System-generated

B. Approved—loan not 

made* (i.e., the application 

was withdrawn after the loan 

was approved, or the loan 

was approved but not 

accepted by the consumer)

0 1 (person D) System-generated

C. Rejected 1 (person F) 1 (person E) System-generated

D. Total System-generated System-generated System-generated

Number, Result, and Geographic Distribution of Loan Applications

Number of Applications

Area of Residence Total

Metro

RUCC 1-3

Non-Metro

RUCC 4-9

A. Approved—loan made System-generated

B. Approved—loan not made* 

(i.e., the application was 

withdrawn after the loan was 

approved, or the loan was 

approved but not accepted by 

the consumer)

System-generated

C. Rejected System-generated

D. Total System-generated System-generated System-generated
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2. Information about Loans Made

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

AFPs offer different types of loans to consumers; some individual AFPs may offer several 

types of loans. Here you will provide data on the types of loans you offer and the number of 

loans of each type you provided during this reporting period. The difference between 

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

and revolving loans, other types of loans include:

Loan guarantee or insurance: A partnership loan in which the AFP uses its funds 

to guarantee all or a portion of a loan for AT. A guaranteed loan is a partnership loan in 

which the AFP guarantees that the loan to a consumer is secure and will be repaid in the 

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

Low-interest loans: In a low-interest loan, the AFP establishes an agreement with a 

lending institution to provide loans for AT at “preferred” interest rates. Preferred interest 

rates are highly variable and context-specific, depending upon such factors as the prime 

lending rate, the borrower’s credit rating, and whether the loan is secured. The 

mechanism or mechanisms by which AFPs arrange for lending institutions to provide 

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

deposit its funds with the lending institution. The interest that the AFP’s funds would 

normally generate is then used by the lending institution to supplement the interest it 

charges consumers on loans for AT, thus resulting in lower interest rates paid by the 

consumers. The reporting form collects data on two types of low-interest loans: (a) lowinterest loans at or below prime rate and (b) preferred interest loans. For both loan types,

use the prime rate at the time the loan was provided. Both loans are defined as follows:

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

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

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

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

definition of prime rate. 

Interest buy-down loan: A partnership loan in which AFP funds are used to buy 

down the interest rate of a loan. The AFP uses funds to reduce the interest rate that 

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

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

payments for the consumer over the term of the loan.

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

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

a bank prime loan as follows: “Rate posted by a majority of top 25 (by assets in domestic 

offices) insured U.S.-chartered commercial banks. Prime is one of several base rates 
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used by banks to price short-term business loans." To determine whether a loan was 

made above, at, or below prime rate, check the U.S. prime rate at the following website 

for the date on which the loan was closed: 

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

 a) Type of Loans, Number, and Percentage

Enter the number of loans made in this reporting period, by loan type. The system will 

calculate the percentage of loans that fall into each category. The total number of loans 

must match the number of applications “approved – loan made” in the previous table, so 

report each loan in only one category. 

Type of Loan Number

of Loans

Percentage

of Loans

Revolving Loan* 

Revolving Loan: Low Interest (prime or less) System-generated

Revolving Loan: Preferred Interest (greater than 

prime) System-generated

Total Revolving Loans System-generated System-generated 

Partnership Loan* 

Low Interest (prime or less)*

Without interest buy-down* or loan guarantee* System-generated

With interest buy-down* only System-generated

With loan guarantee* only System-generated

With both interest buy-down* and loan guarantee* System-generated

Preferred Interest (greater than prime)*

Without interest buy-down* or loan guarantee* System-generated

With interest buy-down* only System-generated

With loan guarantee* only System-generated

With both interest buy-down* and loan guarantee* System-generated

Total Partnership Loans System-generated System-generated

Total All Loans System-generated System-generated

b) Type of Loans and Amount Financed

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

Type of Loan Number of Loans Dollar Value of Loans

Revolving Loans* System-generated

Partnership Loans* System-generated

Total System-generated System-generated
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c) Range of Dollar Amounts of Loans Provided

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

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

divided among different devices if more than one device was purchased. The total 

number of loans must match the number of loans in the “Total” row of the preceding 

table. The system will calculate the percentage of the amount of the loans made to 

individuals.

d) Highest and Lowest Loan Amounts 

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

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

reporting period, not a description of your policies. 

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

period:

Highest $_________

Lowest $ _________

e) Highest and Lowest Interest Rates 

Enter the lowest and highest interest rates among all loans made, including both 

revolving* and partnership loans.* For interest buy-downs,* report the interest rate to 

which you bought the loan down: 

Lowest: ______________%

Highest: ______________%

Number and Percentage of Loans 

Made to Applicants in the Amount of

 $1,000 

or 

Less

$1,001 

to 

$5,000

$5,001 

to 

$10,000

$10,001 

to 

$15,000

$15,001 

to 

$20,000

$20,001 

to 

$25,000

$25,001 

to 

$50,000

$50,001 

or More

Total

Number 

of loans

Systemgenerated

Percent 

of 

Loans

SystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgeneratedSystemgenerated
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3. Type of Device Financed through the Program

Loans are provided for many different kinds of AT devices. Here you will report on how 

many devices were funded by your loans during the reporting period, what categories of 

devices were funded, and how much funding was provided for devices in those categories. 

There are a total of 10 categories for classifying devices:

 Vision

 Hearing

 Speech communication

 Learning, cognition, and developmental

 Mobility, seating, and positioning

 Daily living

 Environmental adaptations

 Vehicle modification and transportation

 Computers and related

 Recreation, sports, and leisure

Definitions for each of the Categories of AT can be found in Section G: Classification of 

Devices. The Classification of Devices includes a description, decision rules, and examples 

that will assist you in deciding whether a device should go into a particular category. 

Many devices can fit into more than one category depending on how they are used by a 

consumer. You must choose one category where a device belongs in each instance you are 

reporting and may not count a device more than once. For example, your AFP may provide 

one loan to one consumer for one computer. Though this computer may be classified in 

many of the ten categories, it must be counted only once and placed in one category in this 

circumstance. This does not mean a computer must always go into the same category every

time a loan for a computer is provided, however. When it is not immediately obvious in 

which category you should classify a device, you should classify it based on the functional 

need that is served by the “assistive” aspect of the device. 

For example, while telephones are used for communication, not all telephones are 

immediately categorized in speech communication. A telephone could be classified in 

different categories, depending on the functional needs of the user. When the primary 

challenge is seeing the dial, a large button phone would be classified under Vision. When the 

primary challenge is hearing another person on the phone, an amplified phone would be 

classified under Hearing. When the primary challenge is having one’s speech understood on 

the phone, an adapted phone would be classified under Speech Communication. When the 

primary challenge involves another function (or multiple functions) the phone would be 

classified under Daily Living. 

A component of a larger system should be classified according to the function or primary use 

of the larger system. For example, a mouth stick that is used to provide access to a 

communication system such as Pathfinder would be classified under Speech Communication. 

A mouth stick that is used to type papers would be classified under Computer Access. A 

mouth stick that is used generically as an aid to daily living would be classified as Daily 

Living.
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Services are classified according to the AT category associated with the service. For 

example, an audiological evaluation would be classified under Hearing.

a) Types and Dollar Amounts of AT Financed

Use the table below to provide information on the types of devices or services financed 

and the dollar value of loans made for each type of device or service. 

Because a single loan may pay for more than one device or service, the number of 

devices and services reported in this table may exceed the number of loans. The total 

number of devices financed may be different than the total number of direct users of AT 

as reported in the Tables on Age, Gender and Underrepresented. 

When multiple devices fall into different categories of Type of AT Device or Service are 

acquired with a single loan, the number of devices or services should be reflected in the 

appropriate “Number of Devices Financed” Category and an approximation of the loan 

amount used to acquire that Device or Service should be recorded in the associated 

category for “Dollar Value of Loans.” 

For large building access projects, the numbers reported should reflect a logical access 

grouping (e.g., a bathroom modification or exterior ramping of a house would each be 

one Environmental Adaptation/Home Modification). Where an AT service (such as an 

evaluation or training) was part of a financial loan, include that dollar amount in the 

appropriate AT category associated with the service (e.g., an audiological evaluation 

would go in the “hearing” category). 

Type of AT Device/Service

Number of 

Devices Financed

Dollar Value

of Loans

Vision* 

Hearing* 

Speech communication*

Learning, cognition, and developmental*

Mobility, seating and positioning*

Daily living*

Environmental adaptations and home modifications*

Vehicle modification and transportation* 

Computers and related*

Recreation, sports, and leisure*

Total System-generated System-generated
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4. Defaults and Net Losses 

Most AFPs have their own policies for when they declare a loan to be in default. For the 

purposes of national data collection, one definition of default must be applied to all 

programs. An AFP can continue to use its own definition of default for its own purposes, but 

under the AFP data collection instrument, a default is defined as follows:

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

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

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

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

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

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

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

must include your active loans, which are defined as follows:

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

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

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

defaults and net losses, active loans are only those loans in which the AFP or their 

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

guaranteed loans. Do not count loans in which the AFP or their designated 

affiliate/partner does not have a financial responsibility to pay the bank in case of default, 

such as loan balances for low interest loans, preferred interest loans, or buy-down interest 

rate loans that are not guaranteed. 

The default rate* in the following tables is reported only for revolving and guaranty loans, 

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

of default.

a) Number of Loans in Default and Default Rate

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

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

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

program, which is your default rate. 

Number of Loans in Default Number of Active Loans Default Rate

System-generated

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

collection, a net dollar loss is defined as:

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

after subtracting any funds that were recovered. It includes the amount that is unpaid on 
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any loans in default and any loan guarantee payout amounts minus the amount of 

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

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

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

when they originated.

b) Net Dollar Loss on Defaulted Loans 

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

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

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

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

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

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

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

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

calculate the net loss rate* for your program. 

Net Dollar Loss on Loans Total Dollar Value of

Active Loans* Net Loss Rate

System-generated

5. Classification of Consumers Receiving Assistance

Here you will provide data about the consumers who received loans from your AFP during 

this reporting period. The data should be provided only for the direct user of the AT, not the 

individual to whom the loan was provided (in some cases these are the same person, but 

often they are not).

Direct User: A direct user is an individual that uses an AT Device or Service that 

provides a direct benefit or impact to the individual. A secondary user or beneficiary is a 

person who benefits from the user having an AT Device or Service. For example, if a 

family acquired a modified van for two children that are wheelchair users, both children 

would be considered direct users, but the parents of the children would be considered the 

secondary users or beneficiaries. Although a secondary user or beneficiary may benefit 

from the direct user having an AT device or service, for the data below, you must report 

on the direct user only. 

a) Gender

Enter the total number of direct users* of AT benefiting from a loan for a device or service

by gender - female or male. If multiple persons are direct users* of the AT provided by a 

single loan, the gender for each direct user* should be reported. 
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Gender of Direct User(s)* Number

Female

Male

Total System-generated

b) Age

Enter the total number of direct users* of AT benefiting from a loan for a device or 

service by the age range distribution. If multiple persons are direct users* of the AT 

provided by a single loan, the age for each direct user* should be reported. Programs 

should report the actual age of the direct user(s) at the time the loan was made.

Age of Direct Users * of AT Number 

0-9

10-17

18-29

30-39

40-49

50-59

60-69

70-79 

80+

Total System-generated*

c) Type of Disability

In this section, report on which of the AT user’s abilities will be affected by the AT they

are purchasing during this reporting period. An AT user may be affected in more than 

one area, therefore the data reported for each user may reflect multiple areas or “Type of 

Abilities” affected. 

Type of Ability Number

Seeing

Hearing

Talking/communicating

Getting around/mobility

Handling objects, reaching

Learning new information

Remembering

Interacting with others/socializing

Total System-generated

*The total number of areas affected may exceed the total number of loans and the totals 

reported for age, gender, and geographic distribution/underrepresented population.
20

D. Anecdote 

Provide at least one anecdote about a direct user or secondary user or beneficiary who 

benefited from an AFP loan.* Please make these entries as specific as possible, and include 

the following information: 

 What AT device or service did the user need?

 How did your AFP help the user obtain that device or service?

 What barrier(s) did your AFP help the user overcome?

 If applicable, how did your AFP collaborate with other entities in providing 

this help?

 How did obtaining that device or service improve that user’s life?

Other instructions to follow in providing anecdotes:

 Limit each anecdote to 500 words or less.

 Include examples that are understandable to an uninformed audience. 

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

to be identified.

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

(Narrative item)

E. Notes

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

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

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

(Narrative item)
21

F. Classification of Devices

1. Vision

Definition: Products designed to assist with vision.

Decision rules: Products intended to facilitate access and participation for people who are 

blind or visually impaired are classified in this category, even if they are used for activities of 

daily living, computer access, reading/learning, way finding/travel, recreation, etc. Products 

in this category characteristically provide output of information through large print/display, 

synthetic speech or Braille/tactile. If the adaptation is for an individual who is both visually

impaired and hearing impaired, categorize according to the primary functionality of the 

device. Reading systems to accommodate vision are classified here while similar systems to 

accommodate learning are classified accordingly. A TTY with Braille output is classified as 

hearing. A telephone with both a large print keypad and amplification for listening may be 

classified in either vision or hearing. 

Examples: 

 Magnifiers including CCTV systems; 

 Talking scales, blood pressure gauge, glucometer etc.; 

 Screen readers, screen magnifiers and Braille displays; 

 Daisy or Victor Readers; 

 PDA’s with large print, speech or Braille output; 

 Talking or Braille GPS, white canes, talking or tactile compass, etc.; 

 OCR reading systems; talking thermostats, household appliances etc. 
22

2. Hearing

Definition: Products designed to assist with hearing.

Decision rules: Products intended to facilitate access and participation for people who are 

deaf or hard of hearing are classified in this category, even if they are used for activities of 

daily living or could have another application for people with other disabilities or for other 

functions. Products intended to facilitate telephone usage for individuals with hearing 

disabilities are categorized here, rather than as aids to daily living. If the telephone 

adaptation is for an individual who is both visually impaired and hearing impaired, categorize 

under either vision or hearing. Products that amplify voice are classified here if the purpose 

is to enhance the volume of speech produced by an individual without a disability, in order 

for his/her speech to be heard by persons who are deaf or hard of hearing. This category also 

includes systems that provide for text communication, both via telecommunication (text 

messaging; TTY) and face to face (Interpretype). Peripherals designed to facilitate access or 

otherwise support the use of a device for hearing (e.g. neck loop induction coils; TeleLink 

phone couplers; conference microphone; telephone signalers) are counted in this category.

Examples: 

 Personal amplification systems (hearing aids, PocketTalker Pro, etc.)

 Assistive Listening Systems (FM; loop; infrared, sound-field, large area, personal)

 Wireless headphones to enhance TV listening (e.g. DirectEar; TV Listener)

 Daily living aids that use visual or tactile rather than audible signals (e.g. 

vibrating alarm clock; smoke alarm with strobe light; door bell with flashing 

signal; etc.)

 Instant messaging devices (used as portable TTY)

 Daily living aids with enhanced audible signals (Sonic Boom Alarm Clock)

 Amplified Telephones, in-line amplifiers for telephones, cell phone amplifiers

 Text telephones (TTYs), Voice carryover (including CapTel) and Hearing 

carryover telephones and Signaling devices (visual and/or tactile alerting to 

incoming phone calls)

 Classroom Captioning System

 iCommunicator (Voice to text system)

 AudioSee (enhanced view of speaker for speech reading, in addition to FM 

capabilities)

 InterpreType dual keyboard system
23

3. Speech Communication

Definition: Products designed to assist with speaking and face-to-face communication for 

individuals with speech disabilities.

Decision rules: Products intended to facilitate computer access and usage for written 

communications are classified under Computers. Products intended to facilitate telephone 

usage for individuals with speech disabilities will be classified under activities of daily

living, EXCEPT when the adaptation is for an individual who is deaf or hard of hearing in 

which case it is classified under hearing. Products that amplify voice are classified here if 

the purpose is to enhance the volume of speech produced by an individual with a disability, 

in order for his/her speech to be audible by persons without disabilities. If the purpose of the 

amplifier is to enhance the volume of speech produced by an individual without a disability, 

in order for his/her speech to be heard by persons who are deaf or hard of hearing, the device 

is classified under hearing. Peripherals designed to facilitate access or otherwise support the 

use of a device for speech communication (e.g. mounting systems; carrying cases, switch or 

mouth stick used for access) are counted in this category.

Examples: 

 Speech generating devices such as BIGMack; DV4; ChatPC; DynaWrite; 

Pathfinder; talking photo album

 Communication boards/books

 Software with speech output e.g. Speaking Dynamically Pro

 Software that provides symbol sets for use in developing “low tech” 

communication boards/books or “high tech” overlays e.g. BoardMaker; Picture 

This!

 Artificial larynx

 Devices that produce text but not voice output for face-to-face communication 

(e.g. Crespeaker)

 Voice clarifiers (e.g. Speech Enhancer)

 Voice amplifiers (e.g. Falck amplifier)

 Stuttering aids
24

4. Learning, Cognition, and Developmental 

Definition: Products to provide people with disabilities with access to educational materials 

and instruction in academic or other environments; products that assist with learning and 

cognition.

Common subcategories:

Cognitive aids

Early intervention aids

Instructional materials

Memory Aids

General Personal Organization Tools

Sensory/Developmental Stimulation Products

Decision rules: Products intended to mitigate, compensate, or address learning or cognitive 

limitations should be classified here along with products used to facilitate computer access 

for individuals with learning/cognitive limitations. Products designed to assist people who 

are blind or visually impaired with reading, organization, learning, computer access, etc. are 

classified under vision. 

Examples: 

 Calculators and measurement tools

 Clocks/Timers/Wake-up Systems

 Electronic Reference Tools and Money Management Tools

 Memory Aids

 Electronic Notetakers, Portable Word Processers, and Recording Devices

 Electronic Organizers/Personal Digital Assistants

 Scientific Equipment

 Educational/Instructional Software (computer based instructional applications 

used to teach cause and effect, reading, language, spelling, math, writing, science, 

history, etc) 

 Cognitive/Perceptual Training Software

 Tape or other audio players (except as related to vision) 

 Text-to-speech systems (WYNN, Read and Write Gold, etc. – not related to 

vision)

 FM systems (to support auditory processing - not related to hearing loss)
25

5. Mobility, Seating, and Positioning

Definition: Products whose main focus is on augmenting or replacing the functional 

limitations of an individual’s mobility. 

Decision rules: Wheelchair restraints associated with seating & positioning (shoulder or 

safety belts) are classified in this category. Wheelchair restraints (tie downs: 4-belt & 

docking or lock downs: trailer-hitch) associated van locks, which allow a power chair user to 

drive and/or be transported safely is classified under “Vehicle Modification and 

Transportation.”

Examples: 

 Ambulatory aids: low tech aids such as canes, walkers or crutches

 Orthotics & prosthetics

 Wheelchairs: dependent (such as strollers & transport chairs) & independent 

manual mobility (4-wheels propelled independently)

 Scooters and power chairs: Functionally matched motorized independent power 

mobility bases 

 Seating and positioning – considerations based on postural control & deformity

management, pressure & postural management, and/or comfort & postural 

accommodation. (such as pelvic guides, contoured seating systems, head 

supports)
26

6. Daily Living

Definition: Devices that enhance the capacity of people with disabilities to live 

independently, especially AT that assists with Instrumental and other Activities of Daily

Living, (ADLs, IADLs) such as dressing, personal hygiene, bathing, home maintenance, 

cooking, eating, sleeping, breathing, shopping and managing money.

Common Subcategories:

Personal hygiene, care and toileting

Dressing and apparel, and aids to dressing

Housekeeping, cleaning, maintenance

Cooking and eating

Handling, reaching, manipulating

Alerting and signaling

Household management, bill paying (not cognitive, vision, or hearing AT)

Telephony equipment

Decision rules: Architectural/home adaptations or modifications are classified under 

Environmental adaptations. Life safety and life support devices and systems that do not 

involve home modifications are categorized here including medical and respiratory

equipment. Devices intended to accommodate specific disabilities, such as hearing or vision, 

are assigned to those categories. Devices that assist with personal organization are classified 

as Learning, Cognition and Developmental AT. Devices used to accommodate multiple 

disabilities are categorized here. Devices that assist persons with motor impairments not 

categorized elsewhere are included here. EADLs that also function as environmental controls 

are classified according to their primary use. Telephony equipment not intended to 

accommodate other categories of disabilities is listed here. Switches controlling daily living 

aids or unknown devices are reported here. Otherwise switches are reported with the 

category of devices controlled.

Examples: 

 Writing guides, adapted writing implements

 Modified or large-handled tools and utensils

 Eating/feeding equipment, spiked cutting board, jar opener

 Zipper pulls, button hooks, needle threader

 Personal pager, multi-sensing/multi-sensory alerting devices

 Wheelchair desks/trays 

 Reacher

 Wheelchair/walker bag 

 Switch-adapted food processor or other appliance

 Large-button telephone (not for vision or cognitive accommodation).
27

7. Environmental Adaptations and Home Modifications

Definition: Environmental and structural adaptations to the built environment that remove or 

reduce barriers and promote access to and within the built home, employment and 

community facilities for individuals with disabilities. Environmental adaptations usually

involve building construction, engineering, and architecture, but also include environmental 

controls and switches that can control a large portion of or an entire living environment. 

Environmental adaptations are typically permanent or semi permanent structures, 

modifications or additions.

Decision rules: Adaptations or modifications to vehicles are classified under Vehicle 

modifications. Adaptations to furniture such as chairs, couches, beds, etc., would generally 

be classified under Mobility, Seating, and Positioning. Items or structures that are portable 

or temporary, rather than permanent or semi-permanent, would generally be classified in 

another category related to the functional limitation addressed. For example, shower chairs, 

commodes, raised toilet seats and similar portable items should be classified in the daily 

living category where as a roll in shower, wall or floor mounted grab bars, installed ramps, 

etc. would be classified here because they become part of the building structure. 

Examples: 

 Accessible HVAC controls, accessible plumbing fixtures and controls

 Adapted playground equipment and structures

 Alarm and Security Systems

 Cabinetry and Storage equipment

 Door/Gate Openers including farm and ranch gates/latches

 Environmental controls and switches (i.e., electronic systems that enable people 

to control various appliances, lights, telephones, security systems etc.) 

 Flooring and Surface materials/Detectable warning surfaces

 General Environmental Access Products

 Lifts

 Lighting/lighting controls

 Ramps

 Signage/signaling products

 Workstations/Desks/Tables, Home-workplace adaptations

 Adapted farm equipment that is not reported as Vehicle Modification and 

Transportation such as sprayers, seeding systems, augers, etc.) 
28

8. Vehicle Modification and Transportation

Definition: Products that give people with disabilities independence and enhance safety in 

transportation through adaptation of vehicles.

Decision rules: Vehicle ramps are classified in this category. Versatile/portable ramps 

(temporary adaptation) and wheelchair lifts (permanently installed in buildings) are classified 

under Environmental adaptations. 

Examples: 

 Adaptive shoulder and seat safety belts

 Tie downs and lock downs that secure the wheelchair to the vehicle floor

 Hand controls

 Extended directional mirrors.

 Vehicles and vans modified with lifts, ramps, raised roofs, etc. 

 Adapted farm vehicles such as tractors and other self-propelled vehicles modified 

with hand controls, GPS, lifts and ramp systems. 
29

9. Computers and Related

Definition: Hardware and software products that enable people with disabilities to access, 

interact with, and use computers at home, work, or school. Includes modified or alternate 

keyboards, switches activated by pressure, touch screens, special software, voice to text 

software. 

Decision rules: Classify standard computers and computer-related devices (those that will 

be used without any adaptations) in this category, along with input adaptations used to 

mitigate, compensate or address motor limitations. Do not include computer adaptations used 

to address vision or learning, cognitive or developmental limitations. 

Examples: 

 Standard software

 Standard hardware

 Computer accessories

 Alternative keyboards and pointing devices

 Switches and scanning software used for computer access

 Touchscreens

 Voice recognition systems
30

10. Recreation, Sports, and Leisure Equipment

Definition: Products not already classified in other categories that help persons with 

disabilities to participate in sport, health, physical education, recreation, leisure, and dance 

events. 

Common subcategories:

 Toys and games

 Sports equipment

 Fitness equipment

 Specialized wheelchairs and recreational mobility equipment

 Musical instruments and related devices

 Arts, crafts and photography equipment

 Gardening and horticultural equipment

 Hunting, fishing, shooting equipment

 Camping, hiking and other outdoor recreational equipment

 Audio and video entertainment equipment

Decision rules: Devices intended to accommodate specific disabilities, such as hearing or 

vision, are assigned to those categories. Specialized products designed specifically for 

recreational, leisure or athletic pursuits are categorized here. Devices that may have other 

uses, but are selected as AT for a recreational setting, should be categorized here. Devices for 

environmental control that also serve as entertainment system controls (e.g. television 

remote) are classified according to their primary use.

Examples: 

 Toys and games (includes toys used for developmental purposes such as teaching 

cause and effect.) ; 

 Tennis wheelchairs; beach wheelchairs

 Skiing equipment; sled/sledge hockey equipment

 Gardening tools and equipment; 

 Playing card shuffler; 

 Adapted camera and other photography equipment; 

 Adaptive exercise equipment (not used in a rehabilitation setting); 

 Adaptive equipment for fishing, hunting, and camping; 

 Adaptive musical instruments and accessories (not used in a school setting); 

 Entertainment system remote control not used for lights, heat or other 

environmental control.