Overview:
The Office of Vocational and Educational Services for Individuals with Disabilities (VESID) Independent Living Services Unit provides ongoing review and monitoring of Centers for Independent Living (CIL) through the review and analysis of mid year and end year statistical reports and the conduct of periodic onsite data management and case record reviews.
Purpose of the Onsite Review:
The purpose of the onsite data management and case record review is to verify data used in mid year and end of year reports, verify that Consumer Service Records (CSRs) are maintained according to New York State CIL standards, and to assure that CILs are reporting consumer demographic, disability, and service data in a consistent and accurate manner and in accordance with:
- contractual obligations;
- data collection requirements as defined in SED Office of Counsel approved Revised NYS VESID CIL Standards Performance Report and Data Collection Guide;
- performance requirements established in contract agreements.
Selection of Programs for Onsite Review:
VESID’s authority allows for review based on any or all of the following criteria:
- detection of anomalies in data reporting;
- periodic and cyclical occurrences;
- turnover in management or line staff.
Procedures for Review and Monitoring:
A. Notification
- VESID expects to provide written notification 60 days prior to review for all regularly scheduled data management and case service record reviews.
- CILs are expected to submit written documentation for preview by VESID no later than 30 days prior to onsite review. See Attachment A - Preliminary Written Documentation for Onsite Review.
- VESID will provide an advance agenda 30 days prior to the review for all regularly scheduled data management and case service record reviews.
- CILs will submit a list of consumers for random selection of Consumer Service Records (CSRs) for review 20 days prior to scheduled onsite review.
B. Time line for Report Preparation and CIL Response
- General findings are verbally presented during an exit meeting with CIL representatives.
- A written report of findings and recommendations for any relevant follow up action is sent to the CIL 30 days after completion of the onsite review.
- The CIL may provide written comment regarding the report and must provide a written plan of program improvement when necessary to address data management or case record management issues within 30 days after the written report is submitted to the CIL.
C. Recommendations and Program Improvement
- VESID provides recommendations based upon knowledge of statewide best practices in the area of independent living data management and case record management.
- Program improvement plans must be developed with involvement of the CIL Board of Directors and organizational management. Program improvement plans require the identification of specific action steps to remedy any deficits; must specify changes in data collection, reporting and case record management; must specify strategies to reach goals through conduct of community outreach when applicable; and must describe methodologies used to project service statistics and time frames for each action step to be taken.
- Program improvement plans are reviewed by VESID and either approved or retained for additional action from the CIL within 30 days of submission. VESID will provide upon request any technical assistance to assist the CIL in developing an acceptable plan.
Scope of the Review:
- Review of preliminary written documentation and prior reporting period mid year and end of the year statistical report information. See Attachment A - Preliminary Written Documentation for Onsite Review.
- Verification of compliance with data collection requirements of the SED Office of Counsel approved Revised NYS VESID CIL Standards Performance Report and Data Collection Guide. See Attachment D - Part 2: Instructions for Direct Services and Statistical Report and Attachment E - Part 2: Direct Services and Statistical Report.
- Review of CIL consumer tracking and data collection system to determine its capacity to capture unduplicated counts, it includes all required information, and the level of maintenance for all required data categories. See Attachment B - Consumer Tracking and Data Collection System Review Format.
- Review of 10 percent or no fewer than 15 Consumer Service Records (CSRs) to determine that CSRs contain all appropriate components, that complete demographic information is being maintained and updated appropriately, and that service data is being maintained in a timely and thorough manner and is being accurately and consistently recorded in the data management system. See Attachment C - Consumer Service Record Review Format.
- Discussion and assessment of
the following measures of contract performance:
- Total numbers of persons projected to be served during the year as a goal in comparison to actual numbers served;
- Total numbers of persons served during the prior year meets the VESID contract baseline and is appropriate in consideration of the State funding level and the size and composition of consumer population that may be served.
Attachment A
Preliminary Written Documentation for Onsite Review
All materials noted below must be made available to the Office of Vocational and Educational Services for Individuals with Disabilities (VESID), Independent living Services Unit, no later than 30 days prior to the scheduled onsite review.
- Job descriptions for each position funded under the VESID contract that is responsible for data management.
- Internal CIL training manual and all forms used for Consumer Service Record maintenance and consumer data tracking and collection.
- Data entry forms used for computerized consumer data management system and written overview of the system.
- Written data management policies and procedures.
- Written community outreach policies, procedures and strategies.
Please note: All documentation noted above must be made available in alternate formats upon request.
Attachment B
Consumer Tracking and Data Collection System
Review Format
Name of Reviewer: __________________________________
Date of Review: ____________________________________
Complete this form to verify compliance with data collection requirements of the NYS VESID CIL Standards, Part 2: Instructions for Direct Services and Statistical Report and to determine that service data is being maintained in a timely and thorough manner and is being accurately and consistently recorded in the data management system.
Name of CIL: ________________________________________________________
Staff member(s) responsible for data management:
| Name:_________________________ | Title:_________________________ |
| Name:_________________________ | Title:_________________________ |
| Name:_________________________ | Title:_________________________ |
Check Yes or No
- The CIL has written data management policies and procedures:
| _____ Yes | _____ No |
- The CIL has internal forms for consumer tracking and data collection:
| _____ Yes | _____ No |
- The CIL uses a computerized consumer data management system:
| _____ Yes | _____ No |
If yes, name of computer software _____________________________________
The CIL maintains information for the following data categories
- The CIL maintains a database or log that provides an unduplicated count of demographic data for all consumers with disabilities with a Consumer Service Record (CSR) and updates age, education status and employment status annually.
| _____ Yes | _____ No |
- The CIL maintains a database or log that provides for each disability category an unduplicated count of disability data for all consumers with disabilities with and without a CSR. The same consumer can select more than one disability category.
| _____ Yes | _____ No |
- The CIL maintains a database or log that provides an unduplicated count of total people with disabilities (PWD) served that contains new CSRs started since October 1 of the report year, consumers with a CSR served during prior reporting years who return for services in the report year, and Information and Referral (I&R) consumers who are PWD that includes name and type of disability.
| _____ Yes | _____ No |
- The CIL maintains a database or log that provides an unduplicated count of family members/significant others served that includes names, addresses, phone numbers, service data and other pertinent documentation.
| _____ Yes | _____ No |
- The CIL maintains a database or log that provides an unduplicated count of other non-disabled persons served including personnel from businesses/agencies that includes names, addresses, phone numbers, service data and other pertinent documentation.
| _____ Yes | _____ No |
- The CIL maintains a database or log that provides an unduplicated count of businesses/agencies served that includes names, addresses, phone numbers, service data and other pertinent documentation.
| _____ Yes | _____ No |
- The CIL maintains a database or log that provides an unduplicated count of consumers served in each individual service area. The same consumer can be counted in more than one service area.
| _____ Yes | _____ No |
- The CIL maintains a database or log that provides an unduplicated count of consumers receiving Information and Referral (I&R) service that includes for a person with a disability the name and type of disability and for a person without a disability only the name.
| _____ Yes | _____ No |
General Comments:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Attachment C
Consumer Service Record
Review Format
Name of Reviewer: __________________________________
Date of Review: ____________________________________
Complete this form for each CSR reviewed to determine compliance with CIL Standard 3.
Name of Consumer: _________________________________________
The CIL maintains the following information for each Consumer Service Record:
Check Yes or No
- The CSR maintains complete demographic information for individuals who receive frequent or ongoing services from the CIL.
| _____ Yes | _____ No |
- The CSR annually updates age, education status and employment status data on consumer intakes/profiles.
| _____ Yes | _____ No |
- The CSR identifies specific services received.
| _____ Yes | _____ No |
- The CSR identifies dates of service contact.
| _____ Yes | _____ No |
General Comments:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Attachment D
New York State Office of Vocational and Educational Services for Individuals with Disabilities
CIL Standards, Performance Report
and Data Collection Guide
Updated October, 2007
Part 2: Instructions for Direct Services and Statistical Report
Count all statistical data from all funding sources.
I. Demographic Data for People with a Consumer Service Record
Report unduplicated demographic data for all consumers with disabilities with a Consumer Service Record (CSR) served during the report year. Include data for new consumers with a CSR started since October 1 of the report year and returning consumers with a CSR served during prior reporting years that have returned in the reporting year. Every item of demographic data must be recorded for every consumer with a CSR unless a consumer is unwilling to provide it (in which case "unknown" should be recorded for the missing data). Age, Education Status and Employment Status must be updated annually for each consumer with a CSR. The six demographic categories A. through F. must agree. These demographic categories do not need to agree with the disability data.
- Age
- Gender
- Race/Ethnicity
- Employment Status
- Education Status
- County(s) Served
Reporting “unknowns” is not an option under County(s) Served. Each consumer with a CSR should have a mailing address to identify the county of residence. If a consumer lives in another state/country, give the name of that state/country.
II. Disability Data
Report all people with disabilities who received services (people with and without a CSR) during the report year. While an unduplicated count is provided for each of the five disability categories, the disability data can reflect more than one disability category selection of A. through D. by a consumer, which would also be reported under category E. For example, a consumer who selects both epilepsy and blindness would be reported under B. Physical, D. Sensory, and E. Multiple Disabilities. The Disability category must be recorded in order to document the establishment of a CSR. People without a CSR may be individuals receiving the service of Information and Referral (I&R) only. These individuals have also been referred to as “casual” consumers. In order to document the impact of CILs on people with disabilities, CILs are encouraged to request name, address and disability information from “casual” consumers.
- Cognitive
- Physical
- Mental
- Sensory
- Multiple Disabilities
Report consumers with combinations of the categories above. Not to be checked independent of the selection of two or more disability categories.
- Total of Disability Categories (A+B+C+D+E)
When adding up the five disability categories, the total may be equal to or greater than the total reported for III. A. People With Disabilities (PWD) but not less than.
III. Total People Served During Year
- People With Disabilities (PWD)
Provide an unduplicated count of the total number of people with disabilities served. This consists of all people with disabilities, with and without a CSR, served in the year. It includes: new consumers with a CSR started since October 1 of report year; consumers with a CSR served during prior reporting years who return for services in the report year; and consumers receiving Information and Referral (I&R) service who are disabled and not categorized as either a new CSR or returning CSR served during the report year. - Family Members/Significant Others
Provide an unduplicated count of the total number of family members/significant others served. Family members/significant others are not required to have a CSR. However, for these individuals CILs must ensure an unduplicated count by maintaining names, addresses, phone numbers, service data and other pertinent documentation in a file in order to track and verify service delivery and have adequate information for participation in the VESID coordinated quality and customer satisfaction survey. - Other Non-Disabled including personnel from Businesses/Agencies
Provide an unduplicated count of the total number of other non-disabled persons including personnel from businesses/agencies served. This should include friends and acquaintances, other non-disabled contacts as well as individuals served from businesses, industry and agencies. A CSR is not required for these individuals. However, the same data noted above under B. Family members/significant others must be maintained for individuals served from businesses, industry and agencies. - Total consumers projected in contract to receive direct services
Independent Living Centers must serve a population within ten percent of the total number of people projected to be served in the contract each year not to fall below an established minimum number of persons with and without disabilities per year. If the projection is not met within ten percent, a program improvement plan must be submitted within 30 days of the inadequate performance finding outlining efforts to serve more people and to more accurately project the number of consumers to be served.
In determining the projected consumers to be served for the next contract year, a center should examine available funding and resources. A center should also examine strategies that will enhance outreach activities that support center resource capacities. Further, the center should make every effort to put forth realistic projections by reviewing prior service data for the total number of consumers receiving direct services over the prior five contract years to consider average service patterns. - Total consumers receiving direct services
Total the amounts reported under A. People With Disabilities, B. Family Members/Significant Others, and C. Other Non-Disabled, above, and enter that figure here. - Total Community Education and Awareness Recipients
This should include the total number of attendees at trainings, in-services, workshops, awareness activities, presentations provided by the center to groups of consumers, businesses, agencies, etc. in the community. - CSRs returning that were served during prior reporting years.
- CSRs started (new) between October 1 and September 30 of report year.
- Total CSRs served between October 1 and September 30 of report year (G+H)
- Businesses/Agencies served
Provide an unduplicated count of the total number of businesses/agencies served. In this section only count the business/agency, not the individuals working for the business/agency.(Such individuals are counted under C. Other Non-disabled above.) CILs must maintain names, addresses, phone numbers, service data and other pertinent documentation of services to business/agencies in a file in order to verify service delivery.
For example, if you worked with five different employees of Acme Company in the last year, you would report those five people under C. Other Non-Disabled and only report one entity served (Acme Company) here.
IV. Individual services - number of people served
For each service offered, report the unduplicated number of consumers receiving that service during the reporting year. The same consumer can be counted in more than one service area.
- Advocacy/Legal
Services ‑ Individual advocacy and legal assistance and/or representation
in accessing benefits, services and programs to which a consumer may be entitled. This
section may include any aspect of direct individual advocacy provided by a
staff member of a center on behalf of a consumer.
Consumers who receive training in a group that prepares them to be individual advocates can be counted as individual consumers under this service. For example, a group of parents of school age children with disabilities are trained on one or more occasions to be individual advocates for their children. Count each parent once under advocacy/legal services. - Architectural Barrier Services ‑ advice, information or assistance regarding removal of architectural barriers from any publicly or privately‑owned residence or other building or constructed facility, whether already built or in the planning stage, including preparation of detailed plans.
- Assistive Devices/Equipment ‑ provision of specialized devices and equipment such as TTD's (telecommunications device for the deaf), wheelchairs and lifts, or provision of assistance to obtain these devices and equipment from other sources. This service equates with equipment repair and loan.
- Children's Services ‑ independent living services not specified elsewhere in this list, provided to a child under age 6.
- Communication Services ‑ services directed to enable individuals with disabilities to better communicate such as: interpreter services, including tactile interpreter services for deaf‑blind individuals; Braille transcription; and reading services.
- This service equates with personal counseling services.
- Family Services ‑ services not specified elsewhere in this list, provided to the family members of individuals with disabilities when necessary for improving the individual's ability to live and function more independently, or his or her ability to engage or continue in employment. Such services may include integrated nonresidential respite care.
- Housing or Shelter Services ‑ information, advice, and assistance related to securing and/or retaining housing or shelter, including existing accessible housing. Includes assistance with reviewing and evaluating newspaper ads, advice on communication with landlords, provision of lists of available accessible housing and housing support application information and assistance. A CIL shall not provide residential housing or shelter as an independent living service on either a temporary or long‑term basis.
- Information
and Referral (I&R) Services ‑ individual I&R provided to a consumer. (It
is not necessary to record I&R in a CSR or establish a CSR for an individual
receiving only I&R services. These individuals have also been referred
to as “casual” consumers.) Most individuals receive I&R
services through single person-to-person contacts or one or two telephone calls,
with information provided verbally, through printed material and/or through
referral to another source for services or further information. Some service
providers record I&R as strokes on an answering pad‑‑others
as phone minutes in order to provide an unduplicated count of individuals served. CILs
must record for a person with a disability the name and type of disability
and for a person without a disability only the name.
However I&R is provided, it is a person-to-person contact (staff to consumer), thus Internet hits or downloads off a web site do not constitute I&R. Web site development and use should be reported under Part I. Narrative Report, III. Public Relations. - Independent Living Skills Development and Life Skills Services ‑ independent living skills development is instruction to develop independent living skills in areas such as personal care, coping skills, use of assistive technology, financial management, social skills, and household management, including education and training necessary for living in the community and participating in community activities.
- Mobility Training ‑ variety of services involved in assisting individuals with disabilities to get around their homes and communities.
- Peer Counseling (including
cross‑disability peer counseling) ‑ counseling, teaching,
information giving and sharing, and similar kinds of contact provided by other
individuals with disabilities. This may include the provision of education
and awareness by one person with a disability to another regarding disability
laws, civil rights and other empowering protection available.
When reporting the number of consumers receiving individual and/or group peer counseling services, provide an unduplicated count of the total number of individuals in both activities. If a consumer received both individual and group peer counseling services, count that consumer only once under peer counseling. - Personal Assistance Services ‑ including provision of attendant care to consumers and/or training consumers to supervise their attendants.
- Recreational Services ‑ provision or identification of opportunities for the involvement of individuals with disabilities in integrated leisure‑time activities; participation in community affairs and/or other integrated recreation activities that may be competitive, active or quiet.
- Transportation Services ‑ provision of, or arrangements for provision of transportation.
- Youth Services ‑ services not specified elsewhere in this list, provided to youth with disabilities (ages 6 ‑ 17 or students in transition ages 15‑22). May include services provided as part of a formal school‑to‑work transition program.
- Vocational Services ‑ training in job‑seeking skills such as interviewing and resume writing, and/or provision of individual supported employment and/or integrated job placement services.
- Plan for the Achievement of Self Support (PASS) Development ‑ Assistance with the design of an approved PASS.
- Business/Industry/Agency Services ‑ services not specified elsewhere in this list provided to businesses, industries and agencies, i.e. assistance to four individuals at ABC business that receive assistance in resolving a dispute over a specific discriminatory practice. The number of individuals at the business is counted here and the business served is counted in section III. Total People Served During year, J. Business/Agencies Served.
- Benefits Advisement - assistance provided during the application process to obtain economic benefits. Does not include the representation of individuals at hearings or appeals, (see A. Advocacy/Legal Services for appropriate service category)
- Voter Registration - assistance provided to register individuals to vote. Count the number of individuals registered.
- Other ‑ any independent living service not listed above.
Attachment E
New York State Office of Vocational and
Educational Services for Individuals with Disabilities
CIL Standards, Performance Report
and Data Collection Guide
Updated October, 2007
Part 2: Direct Services and Statistical Report
Name of Center:
Report Period
Count all statistical data from all funding sources.
Demographic Data for People with CSRs
Report unduplicated demographic data for all consumers with disabilities with a Consumer Service Record (CSR) served during the report year. Include data for new consumers with a CSR started since October 1 of the report year and returning consumers with a CSR served during prior report years that have returned in the reporting year. Every item of demographic data must be recorded for every consumer with a CSR unless a consumer is unwilling to provide it (in which case "unknown" should be recorded for the missing data). Age, Education Status and Employment Status must be updated annually for each consumer with a CSR. The six demographic categories A. through F. must agree. These demographic categories do not need to agree with the disability data.
| A. | Age | ||
| 1. | Under 6 | ________________ | |
| 2. | 6 - 17 | ________________ | |
| 3. | 18 - 22 | ________________ | |
| 4. | 23 - 54 | ________________ | |
| 5. | 55 & over | ________________ | |
| 6. | Unknown | ________________ | |
TOTAL |
________________ |
||
| B. | Gender | ||
| 1. | Female | ________________ | |
| 2. | Male | ________________ | |
| 3. | Unknown | ________________ | |
TOTAL |
________________ |
||
| C. | Race/Ethnicity | ||
| 1. | White | ________________ | |
| 2 | Black (non-Hispanic) | ________________ | |
| 3. | American Indian or Alaskan Native (includes Native Hawaiian) | ________________ |
|
| 4. | Asian or Pacific Islander | ________________ | |
| 5. | Hispanic | ________________ | |
| 6. | Unknown | ________________ | |
TOTAL |
________________ |
||
| D. | Employment Status | ||
| 1. | Full Time | ________________ | |
| 2. | Part Time | ________________ | |
| 3. | Looking for a Job | ________________ | |
| 4. | Unemployed (not looking) | ________________ | |
| 5. | Student or in a Program | ________________ | |
| 6. | Retired | ________________ | |
| 7. | Participating in segregated work or day program setting | ________________ |
|
| 8. | Other employment category not specified above | ________________ |
|
| 9. | Unknown | ________________ | |
TOTAL |
________________ |
||
| E. | Education Status | ||
| 1. | Pre-K Program | ________________ | |
| 2. | K-8 | ________________ | |
| 3. | Some High School | ________________ | |
| 4. | Completed High School | ________________ | |
| 5. | Some College | ________________ | |
| 6. | Business Trade, Vocational School | ________________ | |
| 7. | Completed two year undergraduate degree program | ________________ |
|
| 8. | Completed four year undergraduate degree program | ________________ |
|
| 9. | Completed post graduate degree program | ________________ | |
| 10. | Unknown or Not Yet Enrolled in School | ________________ | |
TOTAL |
________________ |
||
| F. | County(s) Served | ||
| Reporting "unknowns" is not an option under County(s) Served. Each consumer with a CSR should have a mailing address to identify the county of residence. If a consumer lives in another state/country, give the name of that state/country. | |||
Name |
|||
| 1. | ________________ | ________________ | |
| 2. | ________________ | ________________ | |
| 3. | ________________ | ________________ | |
| 4. | ________________ | ________________ | |
| 5. | ________________ | ________________ | |
| 6. | ________________ | ________________ | |
| 7. | ________________ | ________________ | |
| 8. | ________________ | ________________ | |
| 9. | ________________ | ________________ | |
| 10. | ________________ | ________________ | |
TOTAL |
________________ |
||
II. Disability Data
Report all people with disabilities who received services (people with and without a CSR) during the report year. While an unduplicated count is provided for each of the five disability categories, the disability data can reflect more than one disability category selection of A. through D. by a consumer, which would also be reported under category E. For example, a consumer who selects both epilepsy and blindness would be reported under B. Physical, D. Sensory, and E. Multiple Disabilities. The Disability category must be recorded in order to document the establishment of a CSR. People without a CSR may be individuals receiving the service of Information and Referral (I&R) only. These individuals have also been referred to as “casual” consumers. In order to document the impact of CILs on people with disabilities, CILs are encouraged to request name, address, and disability information from “casual” consumers.
| A. | Cognitive | ||
| 1. | Mental Retardation | ________________ | |
| 2. | Traumatic and other brain injuries | ________________ | |
| 3. | Learning Disability | ________________ | |
| 4. | Autism | ________________ | |
| 5. | Other cognitive disabilities | ________________ | |
TOTAL |
________________ |
||
| B. | Physical | ||
| 1. | Spinal cord injury | ________________ | |
| 2. | Neuromuscular | ________________ | |
| 3. | Orthopedic | ________________ | |
| 4. | Cerebral palsy | ________________ | |
| 5. | Spina Bifida | ________________ | |
| 6. | Other congenital birth anomaly | ________________ | |
| 7. | Epilepsy | ________________ | |
| 8. | Muscular dystrophy | ________________ | |
| 9. | Amputation | ________________ | |
| 10. | Back Injury | ________________ | |
| 11. | HIV/AIDS | ________________ | |
| 12. | Environmental and other related illnesses | ________________ | |
| 13. | Other physical disabilities | ________________ | |
TOTAL |
________________ |
||
| C. | Mental | ||
| 1. | Mental Illness | ________________ | |
| 2 | Emotional/behavioral disabilities | ________________ | |
| 3. | Substance Abuse | ________________ | |
| 4. | Other mental illnesses | ________________ | |
TOTAL |
________________ |
||
| D. | Sensory | ||
| 1. | Blindness | ________________ | |
| 2. | Low Vision | ________________ | |
| 3. | Deafness | ________________ | |
| 4. | Hard of hearing | ________________ | |
| 5. | Deaf/Blind | ________________ | |
| 6. | Other sensory disabilities | ________________ | |
TOTAL |
________________ |
||
| E. | Multiple Disabilities | ________________ | |
| Report consumers with combinations of the categories above. Not to be checked independent of the selection of two or more disability categories. | |||
| F. | Total of Disability Categories
(A+B+C+D+E) When adding up the five disability categories, the total may be equal to or greater than the total reported for III. A. People With Disabilities (PWD) but not less than. |
________________ | |
III. Total People Served During Year
| A. | People With Disabilities (PWD) (new CSRs + Returning CSRs + I&R PWD only) |
________________ |
|
| B. | Family Members/Significant Others | ________________ | |
| C. | Other Non-Disabled including personnel from Businesses/Agencies | ________________ |
|
| D. | Total consumers projected in contract to be served | ________________ |
|
| E. | Total consumers receiving direct services (A + B + C) |
________________ |
|
| F. | Total Community Education and Awareness Recipients | ________________ |
|
| G. | CSRs returning that were served during prior reporting years. | ________________ |
|
| H. | CSRs started (new) since Oct. 1 of report year | ________________ |
|
| I. | Total CSRs served during report year (G+H) | ________________ | |
| J. | Businesses/Agencies served | ________________ |
IV. Individual Services – Number of Persons Served
For each service offered, report the unduplicated number of consumers receiving that service during the reporting year. The same consumer can be counted in more than one service area.
| A. | Advocacy/Legal services | ________________ | |
| B. | Architectural barrier services | ________________ | |
| C. | Assistive devices/equipment | ________________ | |
| D. | Children's services | ________________ | |
| E. | Communication services | ________________ | |
| F. | Counseling services | ________________ | |
| G. | Family services | ________________ | |
| H. | Housing and shelter services | ________________ | |
| I. | Information and referral | ________________ | |
| J. | Independent living skills development and life skills services | ________________ |
|
| K. | Mobility training | ________________ | |
| L. | Peer counseling | ________________ | |
| M. | Personal assistance services | ________________ | |
| N. | Recreational services | ________________ | |
| O. | Transportation services | ________________ | |
| P. | Youth services | ________________ | |
| Q. | Vocational Services | ________________ | |
| R. | Plan for the Achievement of Self Support | ________________ | |
| S. | Business/Industry/Agency services | ________________ | |
| T. | Benefits Advisement | ________________ | |
| U. | Voter Registration | ________________ | |
| V. | Other | ________________ | |
TOTAL |
________________ |
||