Spreadsheet: 1d63959b-cfe9-43d1-9d53-97a2d0ac6ddf
Sheet: Sheet1

GENERAL INFORMATION:
 | In order to help expedite the approval process for new supported employment group requests, please see the steps below.
NARRATIVE SUMMARY GUIDELINES:
 | The following information is needed within a Supplemental Narrative Summary to accompany the DS 1962 form.  A Supplemental Narrative Summary may be submitted within the text of an email, or as attached document, using this template. The Department of Developmental Services' (DDS) Work Services Section (WSS) liaison will contact the service provider if additional information is needed.
 | Description of work performed. (Title 17, §§ 54302(70), 58801(e)(31), 58830, 58832(b),
 | & 58850(a)(1))
 |  | •  Will the consumers be packing, packaging, sorting, etc.?
 |  | •  What will these tasks include doing?
 | Description of worksite. (Title 17, §§ 54302(70), 58801(e)(31), 58830(d) & 58850)
 |  | •  What is the industry of the worksite?  How large is it?
 |  | •  Are there other workers with developmental disabilities? If yes, how many?
 |  | •  How many total individuals are employed at the worksite facility?
 | Transportation. (Title 17, §§ 54302(70), 58830, 58832(b), & 58850)
 | How will the consumers arrive at the worksite? By public transportation? | •  How will the consumers get to and from the worksite?
 |  | •  By public transportation?  Will they drive?  Will they be driven?
 | Health and Safety. (Title 17, §§ 54302(70), 58850, & CARF 2012 Standards Manual,
 | Job Development, (CES:[NAME]))
 | How will the consumers be trained in the health and safety policies of the worksite?  If so, describe.  What steps will be taken to mitigate potential health and safety issues? | •  Describe how the consumers will be trained in the health and safety
 |  | policies of the worksite relative to the type of work being done by the group.
 |  | •  What steps will be taken to mitigate potential health and safety issues?
 | Group Integration. (Title 17, §§ 54302(70), 58801(39) 58830(a)(b), 58850, & CARF
 | 2012 Standards Manual, Job Development, (CES:[NAME]))
 | Describe how the consumers will interact with their coworkers without developmental disabilities. | •  Describe how the consumers will interact with their coworkers
 |  | without developmental disabilities.
 | Will the consumers have interaction with the public to the same extent that individuals without developmental disabilities interact with the public? | •  Will the consumers have interaction with the public to the same extent that
 |  | individuals without developmental disabilities interact with the public?
 | Supervised meal/lunch breaks. (Title 17, §§ 54302(70), 58834(a), & 58850)
 |  | •  Are any of the consumers authorized by the Individual Program Plan
 |  | Team to have supervised meals and/or lunch breaks?
 |  | •  If so, what health and safety concerns will the lunch/break time
 |  | supervision be addressing?
 | Consumer Names/UCI Nos. (Title 17, §§ 54302(70), 58812, 58831(a)(b), & 58850)
 | Department of Rehabilitation and/or Regional Center authorized
 | start date. (Title 17, §§ 58801(37), 58812, & 58832)
HELPFUL STEPS IN THE APPROVAL PROCESS:
• | The service provider will email the DS 1962 form and its accompanying Supplemental Narrative Summary to the DDS WSS liaison, and should "copy" both the vendoring regional center and Department of Rehabilitation (DOR) liaisons.  This step provides the opportunity for each to review the request and comment, if necessary.
• | The DDS WSS liaison will acknowledge receipt of the request in an email reply to the service provider, the vendoring regional center, and DOR liaisons. This step provides the opportunity for each to review the request and comment, if necessary.
• | The DDS WSS liaison will work with the service provider during the next three business days to resolve any concerns or issues in approving the supported employment group and the group's start date.
• | The DDS WSS liaison will approve or deny the request.  If approved, a group identification number is assigned, the start date is approved, and an email notification is sent to the service provider, the vendoring regional center, and the DOR liaisons. If denied, the reason for the denial will be provided.
• | Please contact the DDS WSS liaison if you have any questions regarding the above information.