Return to Ticket to Work Employment

October, 2002

Dear Ticket to Work Coordinator:

As you are aware, the final rules of the Ticket to Work and Self-Sufficiency Program mandate that State Vocational Rehabilitation Agencies and Employment Networks (ENs) have signed agreements in place before individuals can be referred to the State VR Agency by the EN. Enclosed please find the New York State Education Department Office of Vocational and Educational Services for Individuals with Disabilities (VESID) Agreement.

Since this agreement can generate payments to the State of New York, it is in the form of a contract. The amount contained within the budget is an estimate of revenue that might be generated. The contract allows for receipt of such revenues but in no way obligates the Employment Network toward specific purchase of services from VESID.

This contract is for 5 years, renewable for another 5 years.

We look forward to working with you. We welcome your input or questions regarding the coordination of services. Please let VESID’s Ticket to Work Coordinator Katherine Mario, hear from you. She may be reached at (518) 402-3828 or Kmario@mail.nysed.gov.

Sincerely,

Ronald Calhoun

Enclosure

STATE OF NEW YORK AGREEMENT

This AGREEMENT is hereby made by and between the People of the State of New York, acting through Richard P. Mills, Commissioner of Education of the State of New York and Chief Executive Officer of the Board of Regents of the University of the State of New York, party of the first part, hereinafter referred to as the (STATE) and the public or private agency (CONTRACTOR) identified on the face page hereof.

WITNESSETH:

WHEREAS, the STATE is ready, willing and able to provide such program services and possesses or can make available all necessary qualified personnel, licenses, facilities and expertise to perform or have performed the services required pursuant to the terms of this AGREEMENT;

NOW THEREFORE, in consideration of the promises, responsibilities and covenants herein, the STATE and the CONTRACTOR agree as follows:

I. Conditions of Agreement

1. This AGREEMENT may consist of successive periods (PERIOD), as specified within the AGREEMENT or within a subsequent Modification Agreement(s) (Appendix X). Each additional or superseding PERIOD shall be on the forms specified by the particular State agency, and shall be incorporated into this AGREEMENT.
2. This AGREEMENT incorporates the face pages attached and all of the marked appendices identified on the face page hereof.
3. For each succeeding PERIOD of this AGREEMENT, the parties shall prepare new appendices, to the extent that any require modification, and a Modification Agreement (The attached Appendix X is the blank form to be used). Any terms of this AGREEMENT not modified shall remain in effect for each PERIOD of the AGREEMENT.
4. To modify the AGREEMENT within an existing PERIOD, the parties shall revise or complete the appropriate appendix form(s). Any change in the amount of consideration to be paid, or change in the term, is subject to the approval of the Office of the State Comptroller. Any other modifications shall be processed in accordance with agency guidelines as stated in Appendix A1.
5. The CONTRACTOR shall perform all services to the satisfaction of the STATE. The CONTRACTOR shall provide services and meet the program objectives summarized in the Program Workplan (Appendix D) in accordance with: provisions of the AGREEMENT; relevant laws, rules and regulations, administrative and fiscal guidelines; and where applicable, operating certificates for facilities or licenses for an activity or program.
6. If the CONTRACTOR enters into subcontracts for the performance of work pursuant to this AGREEMENT, the CONTRACTOR shall take full responsibility for the acts and omissions of its subcontractors. Nothing in the subcontract shall impair the rights of the STATE under this AGREEMENT. No contractual relationship shall be deemed to exist between the subcontractor and the STATE.
7. Appendix A (Standard Clauses as required by the Attorney General for all State contracts) takes precedence over all other parts of the AGREEMENT.

II. Indemnification

1. The CONTRACTOR shall be solely responsible and answerable in damages for any and all accidents and/or injuries to persons (including death) or property arising out of or related to the services to be rendered by the CONTRACTOR or its subcontractors pursuant to this AGREEMENT. The CONTRACTOR shall indemnify and hold harmless the STATE and its officers and employees from claims, suits, actions, damages and costs of every nature arising out of the provision of services pursuant to this AGREEMENT.
2. The CONTRACTOR is an independent contractor and may neither hold itself out nor claim to be an officer, employee or subdivision of the STATE nor make any claim, demand or application to or for any right based upon any different status.

III. Property

1. Any equipment, furniture, supplies or other property purchased pursuant to this AGREEMENT is deemed to be the property of the STATE except as may otherwise be governed by Federal or State laws, rules or regulations, or as stated in Appendix Al.

IV. Safeguards for Services and Confidentiality

1. Services performed pursuant to this AGREEMENT are secular in nature and shall be performed in a manner that does not discriminate on the basis of religious belief, or promote or discourage adherence to religion in general or particular religious beliefs.
2. Funds provided pursuant to this AGREEMENT shall not be used for any partisan political activity, or for activities that may influence legislation or the election or defeat of any candidate for public office.
3. Information relating to individuals who may receive services pursuant to this AGREEMENT shall be maintained and used only for the purposes intended under the contract and in conformity with applicable provisions of laws and regulations, or specified in Appendix A1.

The parties to the attached contract, license, lease, amendment or other agreement of any kind (hereinafter, "the contract" or "this contract") agree to be bound by the following clauses which are hereby made a part of the contract (the word "Contractor" herein refers to any party other than the State, whether a contractor, licenser, licensee, lessor, lessee or any other party):

1. EXECUTORY CLAUSE. In accordance with Section 41 of the State Finance Law, the State shall have no liability under this contract to the Contractor or to anyone else beyond funds appropriated and available for this contract.

2. NON-ASSIGNMENT CLAUSE. In accordance with Section 138 of the State Finance Law, this contract may not be assigned by the Contractor or its right, title or interest therein assigned, transferred conveyed, sublet or otherwise disposed of without the previous consent, in writing, of the State and any attempts to assign the contract without the State's written consent are null and void. The Contractor may, however, assign its right to receive payment without the State's prior written consent unless this contract concerns Certificates of Participation pursuant to Article 5-A of the State Finance Law.

3. COMPTROLLER'S APPROVAL. In accordance with Section 112 of the State Finance Law (or, if this contract is with the State University or City University of New York, Section 355 or Section 6218 of the Education Law), if this contract exceeds $15,000 (or the minimum thresholds agreed to by the Office of the State Comptroller for certain S.U.N.Y. and C.U.N.Y. contracts), or if this is an amendment for any amount to a contract which, as so amended, exceeds said statutory amount, or if, by this contract, the State agrees to give something other than money when the value or reasonably estimated value of such consideration exceeds $10,000, it shall not be valid, effective or binding upon the State until it has been approved by the State Comptroller and filed in his office.

4. WORKERS' COMPENSATION BENEFITS. In accordance with Section 142 of the State Finance Law, this contract shall be void and of no force and effect unless the Contractor shall provide and maintain coverage during the life of this contract for the benefit of such employees as are required to be covered by the provisions of the Workers' Compensation Law.

5. NON-DISCRIMINATION REQUIREMENTS. In accordance with Article 15 of the Executive Law (also known as the Human Rights Law) and all other State and Federal statutory and constitutional non-discrimination provisions, the Contractor will not discriminate against any employee or applicant for employment because of race, creed, color, sex, national origin, age, disability or marital status. Furthermore, in accordance with Section 220-e of the Labor Law, if this is a contract for the construction, alteration or repair of any public building or public work or for the manufacture, sale or distribution of materials, equipment or supplies, and to the extent that this contract shall be performed within the State of New York, Contractor agrees that neither it nor its subcontractors shall, by reason of race, creed, color, disability, sex, or national origin: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate against or intimidate any employee hired for the performance of work under this contract. If this is a building service contract as defined in Section 230 of the Labor Law, then, in accordance with Section 239 thereof, Contractor agrees that neither it nor its subcontractors shall by reason of race, creed, color, national origin, age, sex, or disability: (a) discriminate in hiring against any New York State citizen who is qualified and available to perform the work; or (b) discriminate against or intimidate any employee hired for the performance of work under this contract. Contractor is subject to fines of $50.00 per person per day for any violation of Section 220-e or Section 239 as well as possible termination of this contract and forfeiture of all moneys due hereunder for a second or subsequent violation.

6. WAGE AND HOURS PROVISIONS. If this is a public work contract covered by Article 8 of the Labor Law or a building service contract covered by Article 9 thereof, neither Contractor's employees nor the employees of its subcontractors may be required or permitted to work more than the number of hours or days stated in said statutes, except as otherwise provided in the Labor law and as set forth in prevailing wage and supplement schedules issued by the State Labor Department. Furthermore, Contractor and its subcontractors must pay at least the prevailing wage rate and pay or provide the prevailing supplements, including the premium rates for overtime pay, as determined by the State Labor Department in accordance with the Labor Law.

7. NON-COLLUSIVE BIDDlNG REQUIREMENT. In accordance with Section 139-d of the State Finance Law, if this contract was awarded based upon the submission of bids, Contractor warrants, under penalty of perjury, that its bid was arrived at independently and without collusion aimed at restricting competition. Contractor further warrants that, at the time Contractor submitted its bid, an authorized and responsible person executed and delivered to the State a non-collusive bidding certification on Contractor's behalf.

8. INTERNATIONAL BOYCOTT PROHIBITION. In accordance with Section 220-f of the Labor Law and Section 139-h of the State Finance Law, if this contract exceeds $5,000, the Contractor agrees, as a material condition of the contract, that neither the Contractor nor any substantially owned or affiliated person, firm, partnership or corporation has participated, is participating, or shall participate in an international boycott in violation of the Federal Export Administration Act of 1979 (50 USC App. Sections 2401 et seq.) or regulations thereunder. If such Contractor, or any of the aforesaid affiliates of Contractor, is convicted or is otherwise found to have violated said laws or regulations upon the final determination of the United States Commerce Department or any other appropriate agency of the United States subsequent to the contractors execution, such contract, amendment or modification thereto shall be rendered forfeit and void. The Contractor shall so notify the State Comptroller within five (5) business days of such conviction, determination or disposition of appeal (2NYCRR 105.4).

9. SET-OFF RIGHTS. The State shall have all of its common law, equitable and statutory rights of set-off. These rights shall include, but not be limited to, the State's option to withhold for the purposes of set-off any moneys due to the Contractor under this contract up to any amounts due and owing to the State with regard to this contract, any other contract with any State department or agency, including any contract for a term commencing prior to the term of this contract, plus any amounts due and owing to the State for any other reason including, without limitation, tax delinquencies, fee delinquencies or monetary penalties relative thereto. The State shall exercise its set-off rights in accordance with normal State practices including, in cases of set-off pursuant to an audit, the finalization of such audit by the State agency, its representatives, or the State Comptroller.

10. RECORDS. The Contractor shall establish and maintain complete and accurate books, records, documents, accounts and other evidence directly pertinent to performance under this contract (hereinafter, collectively, "the Records"). The Records must be kept for the balance of the calendar year in which they were made and for six (6) additional years thereafter. The State Comptroller, the Attorney General and any other person or entity authorized to conduct an examination, as well as the agency or agencies involved in this contract, shall have access to the Records during normal business hours at an office of the Contractor within the State of New York or, if no such office is available, at a mutually agreeable and reasonable venue within the State, for the term specified above for the purposes of inspection, auditing and copying. The State shall take reasonable steps to protect from public disclosure any of the Records which are exempt from disclosure under Section 87 of the Public Officers Law (the "Statute") provided that: (i) the Contractor shall timely inform an appropriate State official, in writing, that said records should not be disclosed; and (ii) said records shall be sufficiently identified; and (iii) designation of said records as exempt under the Statute is reasonable. Nothing contained herein shall diminish, or in any way adversely affect, the State's right to discovery in any pending or future litigation.

11. IDENTIFYING INFORMATION AND PRIVACY NOTIFICATION. (a) FEDERAL EMPLOYER IDENTIFICATION NUMBER and/or FEDERAL SOCIAL SECURITY NUMBER. All invoices or New York State standard vouchers submitted for payment for the sale of goods or services or the lease of real or personal property to a New York State agency must include the payee's identification number, i.e., the seller's or lessor's identification number. The number is either the payee's Federal employer identification number or Federal social security number, or both such numbers when the payee has both such numbers. Failure to include this number or numbers may delay payment. Where the payee does not have such number or numbers, the payee, on its invoice or New York State standard voucher, must give the reason or reasons why the payee does not have such number or numbers.

(B) PRIVACY NOTIFICATION. (1) The authority to request the above personal information from a seller of goods or services or a lessor of real or personal property, and the authority to maintain such information, is found in Section 5 of the State Tax Law. Disclosure of this information by the seller or lessor to the State is mandatory. The principal purpose for which the information is collected is to enable the State to identify individuals, businesses and others who have been delinquent in filing tax returns or may have understated their tax liabilities and to generally identify persons affected by the taxes administered by the Commissioner of Taxation and Finance. The information will be used for tax administration purpose and for any other purpose authorized by law.

(2) The personal information is requested by the purchasing unit of the agency contracting to purchase the goods or services or lease "the real or personal property covered by this contract or lease. The information is maintained in New York State's Central Accounting System by the Director of Accounting Operations, Office of the State Comptroller, AESOB, Albany, New York 12236.

12. EQUAL EMPLOYMENT OPPORTUNITIES FOR MINORITIES AND WOMEN. In accordance with Section 312 of the Executive law, if this contract is: (i) a written agreement or purchase order instrument, providing for a total expenditure in excess of $25,000.00, whereby a contracting agency is committed to expend or does expend funds in return for labor, services, supplies, equipment, materials or any combination of the foregoing, to be performed for, or rendered or furnished to the contracting agency; or (ii) a written agreement in excess of $100,000.00 whereby a contracting agency is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon; or (iii) a written agreement in excess of $100,000.00 whereby the owner of a State assisted housing project is committed to expend or does expend funds for the acquisition, construction, demolition, replacement, major repair or renovation of real property and improvements thereon for such project, then: (a) The Contractor will not discriminate against employees or applicants for employment because of race, creed, color, national origin, sex, age, disability or marital status, and will undertake or continue existing programs of affirmative action to ensure that minority group members and women are afforded equal employment opportunities without discrimination. Affirmative action shall mean recruitment, employment, job assignment, promotion, upgradings, demotion, transfer, layoff, or termination and rates of pay or other forms of compensation;

(b) at the request of the contracting agency, the Contractor shall request each employment agency, labor union, or authorized representative of workers with which it has a collective bargaining or other agreement or understanding, to furnish a written statement that such employment agency, labor union or representative will not discriminate on the basis of race, creed, color, national origin, sex, age, disability or marital status and that such union or representative will affirmatively cooperate in the implementation of the contractor's obligations herein; and

(c) the Contractor shall state, in all solicitations or advertisements for employees, that, in the performance of the State contract, all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status.

Contractor will include the provisions of "a", "b", and "c" above, in every subcontract over $25,000.00 for the construction, demolition, replacement, major repair, renovation, planning or design of real property and improvements thereon (the Work) except where the Work is for the beneficial use of the Contractor. Section 312 does not apply to: (i) work, goods or services unrelated to this contract; or (ii) employment outside New York State; or (iii) banking services, insurance policies or the sale of securities. The State shall consider compliance by a contractor or subcontractor with the requirements of any federal law concerning equal employment opportunity, which effectuates the purpose of this section. The contracting agency shall determine whether the imposition of the requirements of the provisions hereof duplicate or conflict with any such federal law and if such duplication or conflict exists, the contracting agency shall waive the applicability of Section 312 to the extent of such duplication or conflict. Contractor will comply with all duly promulgated and lawful rules and regulations of the Division of Minority and Women's Business Development pertaining hereto.

13. CONFLICTING TERMS. In the event of a conflict between the terms of the contract (including any and all attachments thereto and amendments thereof) and the terms of this Appendix A, the terms of this Appendix A shall control.

14. GOVERNING LAW. This contract shall be governed by the laws of the State of New York except where the Federal supremacy clause requires otherwise.

15. LATE PAYMENT. Timeliness of payment and any interest to be paid to Contractor for late payment shall be governed by Article XI-A of the State Finance Law to the extent required by law.

16. NO ARBITRATION. Disputes involving this contract, including the breach or alleged breach thereof, may not be submitted to binding arbitration (except where statutorily authorized), but must, instead, be heard in a court of competent jurisdiction of the State of New York.

17. SERVICE OF PROCESS. In addition to the methods of service allowed by the State Civil Practice Law & Rules ("CPLR"), Contractor hereby consents to service of process upon it by registered or certified mail, return receipt requested. Service hereunder shall be complete upon Contractor's actual receipt of process or upon the State's receipt of the return thereof by the United States Postal Service as refused or undeliverable. Contractor must promptly notify the State, in writing, of each and every change of address to which service of process can be made. Service by the State to the last known address shall be sufficient. Contractor will have thirty (30) calendar days after service hereunder is complete in which to respond.

18. PROHIBITION ON PURCHASE OF TROPICAL HARDWOODS. The Contractor certifies and warrants that all wood products to be used under this contract award will be in accordance with, but not limited to, the specifications and provisions of State Finance Law §165. (Use of Tropical Hardwoods) which prohibits purchase and use of tropical hardwoods, unless specifically exempted, by the State or any governmental agency or political subdivision or public benefit corporation. Qualification for an exemption under this law will be the responsibility of the contractor to establish to meet with the approval of the State.

In addition, when any portion of this contract involving the use of woods, whether supply or installation, is to be performed by any subcontractor, the prime Contractor will indicate and certify in the submitted bid proposal that the subcontractor has been informed and is in compliance with specifications and provisions regarding use of tropical hardwoods as detailed in §165 State Finance Law. Any such use must meet with the approval of the State, otherwise, the bid may not be considered responsive. Under bidder certifications, proof of qualification for exemption will be the responsibility of the Contractor to meet with the approval of the State.

19. MACBRIDE FAIR EMPLOYMENT PRINCIPLES. In accordance with the MacBride Fair Employment Principles (Chapter 807 of the Laws of 1992), the Contractor hereby stipulates that the Contractor either (a) has no business operations in Northern Ireland, or (b) shall take lawful steps in good faith to conduct any business operations in Northern Ireland in accordance with the MacBride Fair Employment Principles (as described in Section 165 of the New York State Finance Law), and shall permit independent monitoring of compliance with such principles.

20. OMNIBUS PROCUREMENT ACT OF 1992. It is the policy of New York State to maximize opportunities for the participation of New York State business enterprises, including minority and women-owned business enterprises as bidders, subcontractors and suppliers on its procurement contracts.

Information on the availability of New York State subcontractors and suppliers is available from:

Department of Economic Development

Division for Small Business

30 South Pearl Street

Albany, New York 12245

Tel. 518-292-5220

A directory of certified minority and women-owned business enterprises is available from:

Department of Economic Development

Minority and Women's Business Development Division

30 South Pearl Street

Albany, New York 12245

http://www.empire.state.ny.us

The Omnibus Procurement Act of 1992 requires that by signing this bid proposal or contract, as applicable, Contractors certify that whenever the total bid amount is greater than $l million:

(a) The Contractor has made reasonable efforts to encourage the participation of New York State Business Enterprises as suppliers and subcontractors, including certified minority and women-owned business enterprises, on this project, and has retained the documentation of these efforts to be provided upon request to the State;

(b) The Contractor has complied with the Federal Equal Opportunity Act of 1972 (P.L. 92-261), as amended;

(c) The Contractor agrees to make reasonable efforts to provide notification to New York State residents of employment opportunities on this project through listing any such positions with the Job Service Division of the New York State Department of Labor, or providing such notification in such manner as is consistent with existing collective bargaining contracts or agreements. The Contractor agrees to document these efforts and to provide said documentation to the State upon request; and

(d) The Contractor acknowledges notice that the State may seek to obtain offset credits from foreign countries as a result of this contract and agrees to cooperate with the State in these efforts.

21. RECIPROCITY AND SANCTIONS PROVISIONS. Bidders are hereby notified that if their principal place of business is located in a country, nation, province, state or political subdivision that penalizes New York State vendors, and if the goods or services they offer will be substantially produced or performed outside New York State, the Omnibus Procurement Act 1994 and 2000 amendments (Chapter 684 and Chapter 383, respectively) require that they be denied contracts which they would otherwise obtain. Contact the Department of Economic Development, Division for Small Business, 30 South Pearl Street; Albany New York 12245, for a current list of jurisdictions subject to this provision.

APPENDIX A-1

1. Continuation of this contract beyond «Enddate», and beyond of each succeeding year, is contingent upon appropriation and availability of Federal funding and subject to approval by the Office of the State Comptroller in accordance with paragraph 3 of Appendix "A".

 

2. This agreement may be terminated without cause by either party by thirty (30) days prior written notice. In the event of such termination, the parties will adjust the accounts due and the Contractor will undertake no additional expenditures not already required. Services provided during active agreement, however, will require reimbursement payments from Employment Network per terms of this agreement. Upon any such termination, the parties shall endeavor in an orderly manner to wind down activities hereunder.
3. VESID will terminate this agreement if ethical standards, consumer rights and meaningful choice is not provided by Employment Network.

1. This agreement cannot be modified, amended, or otherwise changed except by a writing signed by all parties to this contract.

 

2. No failure to assert any rights or remedies available to the State under this agreement shall be considered a waiver of such right or remedy or any other right or remedy unless such waiver is contained in a writing signed by the party alleged to have waived its right or remedy.

 

3. This agreement, including all appendices, is, upon signature of the parties and the approval of the Attorney General and the State Comptroller, a legally enforceable contract. Therefore, a signature on behalf of the Contractor will bind the Contractor to all the terms and conditions stated therein.

 

4. The parties to this agreement intend the foregoing writing to be the final, complete, and exclusive expression of all the terms of their agreement.

Budget

The Ticket to Work and Self-Sufficiency Program is a new program and as such it is impossible to project the exact level of services to be provided under this agreement. The amount stipulated herein is an estimate of what might be owed this agency over the contract period. The amount does not limit the services the Employment Network may purchase from NYS SED/VESID. If projected amount is to be exceeded, contract amendment may occur.

Services that are provided under this agreement are those stipulated under the Individualized Plan for Employment (IPE), developed by VESID staff and consumer, with input from the Employment Network (EN). It is expected that ENs will be requesting that VESID provide a large variety of services.

Cost of services that VESID may be requested to provide is determined by existing purchase of service contracts, vendoring agreements, bidding, or market price. EN will be billed for administration and tracking fees at levels approved by the Social Security Administration.

APPENDIX C

PAYMENT AND REPORTING SCHEDULE

11000 Contract No. «Contracno»

Period: From: «Begdate» To: «Enddate» Funding Amount for Period $ «Amount»

In full consideration for the services to be provided by VESID to the participating consumers under the Ticket To Work Program in accordance with this Agreement the EN agrees to reimburse the STATE according to the following terms and conditions:

VESID will, at consumer case closure, submit an invoice to Employment Network for services provided, plus administration and tracking fees.

At the time a consumer reaches an employment level qualifying the Employment Network for either outcome or milestone payments from SSA under the Ticket to Work Program, said EN will send VESID Ticket to Work Unit (One Commerce Plaza, Room 1607, Albany, NY 12234) a copy of the EN's request for payment from Maximus/Social Security Administration.

Fifty Percent (50%) of all payments made to EN by SSA/Maximus for work performed by VESID will go to VESID until VESID is fully reimbursed for the cost of services delivered, including tracking and administration costs as determined by the SSA cost reimbursement formula. If this would not result in VESID costs being fully reimbursed, as determined by the VESID Ticket to Work Coordinator, the percentage assigned to VESID would be increased so that the full costs would be repaid over the sixty-month (60) period.

To ensure proper crediting of payments, EN will include Invoice Number, Revenue Contract Number, Client Name and Client ID Number with each payment to VESID. Checks are to be payable to: The University of the State of New York. All payments are to be mailed to:

New York State Education Department

Bureau of Fiscal Management

Post Office Box 7256

Albany, New York, 12224.

The Contractor shall perform all of the work as described herein, in an efficient and expeditious manner and in accordance with all of the terms and provisions of this Contract. The Contractor shall perform the work in accordance with professional standards and with the diligence and skill expected of a consultant with extensive experience in the performance of the work herein described. The Contractor shall furnish such personnel and shall procure such materials, machinery, supplies, tools, equipment and other items as may reasonably be necessary or appropriate to perform the work in accordance with this agreement.

This AGREEMENT is hereby made by and between the People of the State of New York, Office of Vocational and Educational Services for Individuals with Disabilities, acting through Richard P. Mills, Commissioner of Education of the State of New York and Chief Executive Officer of the Board of Regents of the University of the State of New York, party of the first part, hereinafter referred to as (VESID) and the public or private agency identified on the face page hereof and which is identified as a Social Security Administration (SSA) approved Employment Network holding assigned Tickets and referring consumers to VESID for services, party of the second part, hereinafter referred to as (EN)

Both parties hereby enter into this Agreement to meet the requirements of the Ticket to Work and Self-Sufficiency Program, Final Rules 20 CFR Part 411 section 400, regarding individuals who have assigned their Ticket to an Employment Network (other than VESID), when that entity is referring the individual to VESID for services.

This Agreement establishes the basis for the coordination of services and cost sharing between VESID and said Employment Network who will work together to serve beneficiaries under the Ticket to Work Program.

Goals of this agreement include:

• Building strong partnerships between VESID and EN around the provision of vocational services for consumers.
• Ensuring that best practices and ethical standards are maintained and that the consumer's rights and choices are respected.
• Minimizing administrative burden.
• Expansion of services for New Yorkers who have disabilities.
• Establish terms for the recovery of costs/outcome payments by VESID and EN from SSA.

VESID and EN will work to ensure all participating consumers are informed of their rights and choices under the Ticket Program. This will include their option not to participate in the Ticket to Work program or to assign their Ticket to other available employment networks.

VESID and EN will ensure consumers have access to information on the impact of employment on their federal benefits, state benefits, and healthcare coverage and, when appropriate, refer consumers to available benefits counseling services.

When/if the EN is considering terminating the EN/consumer relationship, the EN, VESID and the consumer will participate in discussions around service provision.

VESID will provide information to SSA/Maximus or EN as required under Ticket (TWWIIA) Regulations.

VESID will provide to the Employment Network accurate information concerning the cost of the services VESID provides to consumer/beneficiary.

Employment Network will activate Tickets of all consumers who choose to assign their Tickets to that Employment Network.

The Employment Network (EN) will maintain individual vocational plans on all consumers who assign their Tickets to that EN. These Employment Plans will indicate services to be provided, start and end dates of the services, and the cost of the services the EN is providing. VESID counselor assigned the case must be in agreement with EN Plans requiring services from VESID.

Employment Network will provide all the required reporting to Program Manager, and will update VESID on progress of case at intervals agreed to in the Plan or at least annually.

Employment Network will inform the VESID Counselor immediately upon beneficiary's entering employment at any level, and will provide monthly wage and hour information to VESID.

If EN considers terminating the EN/Consumer relationship due to anticipated high cost of consumer program, EN, VESID, and the consumer will discuss reassigning Ticket. This discussion should take place before any claim has been filed by the EN.

VESID welcomes referrals from Employment Networks. These referrals should contain documentation of SSI/SSDI status, verification that Ticket has been assigned to the referring EN, signed releases for free exchange of information between VESID and EN, and an Individualized Work Plan (IWP).

The VESID counselor will review Individualized Work Plan. When VESID VRC has verified that the (IWP) is consistent with consumer request, is consistent with VR policy, and that VESID involvement is appropriate, Individual Plan for Employment will be developed in accordance with VESID Policy. All services leading to the employment goal will be listed. Plan will contain clear indication of which services are to be delivered by EN and which are being requested from VESID. As IWP changes are contemplated, EN is to consult with VESID.

In accordance with VESID Comparable Benefits Policies and RSA guidelines, VESID will not provide services that SSA/Maximus lists as available from the EN.

The parties hereto shall first attempt to resolve all disputes arising from the provisions contained in this agreement informally and at the lowest applicable staff level. If dispute resolution is not accomplished, any party may call a meeting of the parties to formally discuss and resolve all such disputes. These procedures will be undertaken with the understanding that they do not override statute, regulation or policy of appropriate legally responsible authorities.

It is recognized that the SSA Ticket to Work Program is a new federal program and that all the implications of the program cannot be predicted. Therefore VESID and EN will evaluate the effectiveness of this agreement at least annually.

APPENDIX X

Modification Agreement Form

11000 Contract No. «Contracno»

Period: From: To: Funding Amount for Period $

This is an AGREEMENT between the People of the State of New York, acting through Richard P. Mills, Commissioner of Education of the State of New York and Chief Executive Officer of the Board of Regents of the University of the State of New York, party of the first part, hereinafter referred to as the STATE, and «company», party of the second part, hereinafter referred to as the CONTRACTOR, for modification of Contract No. «Contracno», as amended in attached Appendix.

All other provisions of said AGREEMENT shall remain in full force and effect.

IN WITNESS WHEREOF, the parties hereto have executed this AGREEMENT as of the dates appearing under their signatures.

State Agency Certification: In addition to the acceptance of this contract, I also certify that original copies of this signature page will be attached to all other exact copies of this contract.

STATE OF )

) SS.:

County of )

On this day of , , before me personally appeared , to me known, who being by me duly sworn, did depose and say that he/she resides at , that he/she is the of the , the corporation described herein which executed the foregoing instrument; and that he/she signed his/her name thereto by order of the board of directors of said corporation.

(Notary)