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OUTSOURCING SERVICES- PROVIDER GUIDELINES

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					GEORGIA DEPARTMENT OF LABOR
Vocational Rehabilitation Program




OUTSOURCING SERVICES-

         PROVIDER GUIDELINES




____________________________________________________________________________________________________________________
Revised January 2011                                                             Georgia Department of Labor
                                                                                 Mark Butler, Commissioner
                        Vocational Rehabilitation Program
                                    Rehabilitation Services
                                 Georgia Department of Labor


                                   Table of Contents

SECTION 1 – ADMINISTRATIVE

I      Purpose
II     Introduction to Administrative Guidelines
III    General Services Standards
IV     GDOL/VRP Criminal Record Investigation Procedures
V      Provider Review Process
VI     Outcome Measurement for Outsourced Services
VII    Procedure to Revise “Outsourcing Services – Provider Guidelines”

SECTION 2 – STANDARDS AND PROVIDER GUIDELINES

1000 Academic and Vocational Training
(RCS does not recruit providers for services in this section)
   1001 – Academic Schools, Colleges, and Universities
   1002 – Proprietary Schools
   1003 – Vocational and Technical Schools

2000 Assistive Services
   2001 – Braille Production
   2002 – Interpreters for the Deaf
   2003 – Supported Employment
   2004 – Transportation
   2005 – Residence Modification
   2006 – Driver Evaluation
   2007 – Vehicle Modification
   2008 – Driver Training
3000 Assistive Evaluations – Medical and Non-Medical
   3001 – Limited Vocational Evaluation
   3002 – Comprehensive Vocational Evaluation
   3003 – Comprehensive Vocational Profile
   3004 – Work Evaluation
   3005 – Pre-Employment Analysis
   3006 – Comprehensive Low Vision Evaluation
   3007 – Short Term Low Vision Evaluation
4000 Facilities
   4001 – Recovery Residence for Persons with Chemical Dependence
   4002 – Community Rehabilitation Facility
   4003 – Extended Employment Transitional Service
   4004 – Lunchtime Supervision Services
   4005 – CRP Placement Services

5000 Skills Training
   5001 – Braille Instruction
   5002 – Job Sampling
   5003 – Employment Skills Training
   5004 – Home Oriented Work Skills Training
   5005 – Job Coaching
   5006 – Job Readiness Training
   5007 – Orientation and Mobility – Non-Visual Impairments
   5008 – Orientation and Mobility – Visual Impairments
   5009 – Personal/Social Adjustment Training
   5010 – Work Adjustment Training
   5011 – Work Literacy

SECTION 3 – FORMS APPENDICES
   Procedure for Addressing Client Complaint(s) Against Service Provid ers
   VR Interpreter Request Form (RS185)
   Supported Employment Services Agreement (RS072)
   Supported Employment Consumer Information (RS154)
   Supported Employment Services Agreement (RS072)
   Supported Employment Monthly Progress Report (RS077)
   Supported Employment Invoice
   Supported Employment Collaborative Agreement
   RS Request for Offer Receipt Log (RS171)
   RS Request for Offer Rating Sheet (RS172)
   RS Request for Offer Ranking List (RS172)
   Comprehensive Evaluation/Profile Referral (RS046)
   Lunchtime Supervision Services
   Employment Skills Training Curriculum Evaluation Form
   Homemaker Duties Assessment Chart (RS047)
   Client Training Progress Report (RS070)
   Job Coach Monthly Training Progress Report (RS071)
   Job Coaching Timesheet (Short Term) (RS073)
   Job Coaching (Short Term/Post Employment Progress Report) (RS074)
   On the Job Training Participant Agreement (RS078)
   Provider Qualification Packet
         SECTION 1

       ADMINISTRATIVE

  I.   Purpose
 II.   Introduction to Administrative
       Guidelines

III.   General Services Standards

IV.    Criminal Record Investigation
       Procedures
 V.    Provider Review Process

VI.    Outcome Measurement for
           Outsourced Services
VII.   Procedure to Revise Outsourcing
       Services– Provider Guidelines
I.   PURPOSE STATEMENT

     Federal Regulations require that the Vocational Rehabilitation Program (VRP) adopt and
     maintain written minimum standards for all types of facilities and providers of services
     utilized by the program in providing rehabilitation services. [Ref.: Federal Register,
     Vol. 62, No. 28, 361.51]. Each Regional Contracts Specialist (RCS) is delegated with the
     responsibility of ensuring that all providers meet certain requirements so that clients of
     the program receive quality services.

     The purpose of the VRP Outsourcing Services – Provider Guidelines* is to identify
     providers that meet the VRP adopted standards and to improve the quality of
     services delivered to people with disabilities.




     *This manual can be obtained in an alternative format for service providers.
     Please contact your RCS.
II.      INTRODUCTION TO ADMINISTRATIVE GUIDELINES

Responsibilities – Regional Contracts Specialist

Responsibilities of the Regional Contracts Specialist (RCS) are consistent throughout the state.
Each RCS is responsible for qualifying providers and managing Collaborative Agreements,
Service Agreements and Contracts. In addition, the RCS is responsible for conducting annu al
program reviews and maintaining a comprehensive list of approved providers as well as
performing other duties as assigned.

Service Agreements:

A Service Agreement is a signed legal document. This document outlines the responsibilities of
both the Vocational Rehabilitation Program (VRP) and the provider. The agreement governs the
fees and provision of a particular service. The document states who is responsible for what, how
the service should be provided, and how much the provider is authorized to bill for services.

The purpose of a Service Agreement is to establish the services and fees for each provider.
Service Agreements specify the provider information, services to be provided and the fee for
each service. By qualifying a provider in no way obligates department funds or guarantees
referrals. The primary responsibilities of the RCS in regards to outsourcing are: (1) recruit
qualified individuals to provide services (2) negotiate fees (3) conduct annual program reviews
and monitor performance (4) interpret and clarify service agreements and (5) develop
amendments.


Service Agreement Guidelines:

Service Agreements must follow the same format and contain the same standard information that
is consistent throughout the state. Service Agreements may only be executed for providers, who
meet the standards and qualifications listed in the Outsourcing Services – Provider Guidelines.
As an attachment to the Service Agreement, Annex A outlines specific services and fees
negotiated after the provider has been qualified to provide services.

Service Agreement Process:

      1. The RCS is requested to begin the process to qualify a provider for services. A request to
         qualify a provider can be initiated by internal staff, a potential provider or recruitment by
         the RCS.

      2. Once the service(s) is identified, the RCS creates a provider qualification packet. (See
         Forms Appendix)

             a.   Cover Letter
             b.   Application
             c.   Document Checklist
             d.   “Sample” Service Agreement
           e. Provider Guidelines* (only the service guidelines requested by the po tential
              provider) * Example guideline not included in the forms appendix
           f. Regional Map

   3. When the packet is completed and returned to the RCS, each document is reviewed and
      verified to assure completeness and accuracy.

   4. The RCS will determine if the provider applicant meets qualifications for each service(s)
      and notifies the applicant accordingly.

   5. The RCS will negotiate with the provider to establish fees for each approved service(s) in
      accordance with the schedule of fees set forth by the VRP.

   6. A Provider Number is assigned to the provider.

   7. Once the Service Agreement is executed, provider service(s) information is distributed to
      staff and other interested parties. A copy is sent to the VRP Business Unit.

Contracts:

The contract is a document governed by the Georgia Department of Labor/VRP. The document
specifies the contractor responsibilities, departmental responsibilities, services to be provided
and costs. The RCS responsibilities in regard to the contracts are: (1) assure providers meet
outsourcing guidelines (2) negotiate fees and services (3) complete contract request form and
required exhibits (4) review billing documents and process for payment (5) monitor contracts
and perform annual program reviews (6) interpret contract terms as required and (7) develop
amendments.

Program Reviews:

An annual program review is performed by the RCS to ensure that the services purchased by the
VRP are of the highest quality. Each quality review may include:

                       A.    Verification of employee credentials for each service
                       B.    Proof of insurance
                       C.    Criminal records investigation
                       D.    Accreditation as appropriate
                       E.    Accuracy of attendance, billing documents and rates
III.   GENERAL SERVICES STANDARDS

       1.   Services authorized by the Vocational Rehabilitation Program (VRP) and
            provided to clients of the Program are to be given without discrimination on basis
            of political affiliation, religion, race, color, sex,       or physical handicap,
            national origin, or age in compliance with Federal law and the policies of the
            Georgia Department of Labor.

       2.   The VRP may not purchase services from any full-time employee of the
            Department of Labor. Ref.: Official Code of Georgia Annotated 45 -10-23.

       3.   Use of any service or provider is at the discretion of the VRP. Approval of a
            service or provider may be withdrawn at any time with cause and with reasonable
            notification.

       4.   Any building in which vocational rehabilitation servic are provided must be
            accessible to individuals receiving services and must           mply with the
            requirements of the Architectural Barriers Act of 1968, as amended, the Uniform
            Federal Accessibility Standards and their implementing regulations in 34 CFR
            361.51(a), the Americans with Disabilities Act of 1990 and Section 504 of the
            Act.

       5.   Providers of vocational rehabilitation services shall use qualified personnel, in
            accordance with any applicable national or state-approved or state-recognized
            certification, licensing or other comparable requirements as defined herein that
            apply to the profession or discipline in which that category of personnel is
            providing vocational rehabilitation services. [Ref.: 34 CFR 361.51(b)]


            a.     Providers of vocational rehabilitation services shall affirmative action
                   to employ and advance in employment qualified individuals with
                   disabilities. [Ref.: CFR 361.51(b)

            b.     Providers of vocational rehabilitation services shall    lude among their
                   personnel, or obtain the services of, individuals able to communicate in
                   the native languages of applicants and eligible individuals who have
                   limited English speaking ability; Ref.: CFR 361.51(c)(1)] and ensure that
                   appropriate modes of communication for all applicants            eligible
                   individuals are used. [Ref.:34 CFR 361.51(c)(2)]

            c.     Providers of vocational rehabilitation services must e      all personnel
                   present an appropriate personal appearance during work hours.
IV.   GDOL/VRP CRIMINAL RECORD INVESTIGATION PROCEDURES


1.    REGIONAL CONTRACT SPECIALIST

      Provides to contract company/contract individual information about using Cogent Systems’
      Georgia Applicant Processing Services (GAPS)

2.    CONTRACT COMPANY

      •   Goes to GAPS Home Page @ http://www.ga.cogentid.com/index.htm

      •   Under “Registration” clicks “GAPS Applicant Waiver”
            o Prints “GAPS Applicant Waiver” form
            o Has contract worker applicant sign and date form

      •   Under “Registration” clicks “Single Applicant Registrations”
          Enters required applicant Personal Information indicated below:
             o Last Name
             o First Name
             o Middle Name (if available). Do not enter “NA,” “N/A,”               ,” leave
                  blank if not applicable.
             o Date of Birth (MMDDYYYY)
             o Place of Birth (select from drop down menu)
             o Sex (select from drop down menu)
             o Race (select from drop down menu)
             o Eye Color (select from drop down menu)
             o Hair Color (select from drop down menu)
             o Height (select from drop down menu)
             o Weight (select from drop down menu)
             o Country of Citizenship (select from drop down menu)
             o Address (applicant home address)
             o City         (applicant home address)
             o State        (applicant home address)
             o Zip (applicant home address)
             o Phone # (applicant home phone # if available)

             Note: It is necessary to have the contract worker applicant’s home address and
             telephone number.

          Transaction Information section
          ”Payment” information: Selects “Money Order,” from drop down menu. Contractors
          must select money order as payment method (Cost is $52.90)

      •   PRINTS DOCUMENT-(Document cannot be saved. It must be printed before
          exiting.)
          Writes on bottom of form:
          o “Fingerprints are for contract worker applicant”
         o Contract company name, contact name, and phone number
     •   Faxes the following documents to appropriate Georgia           tment of Labor
         Vocational Rehabilitation Services Regional Contract Specialist
         o Signed “GAPS Applicant Waiver,” and
         o Completed “Application Registration”

3.   REGIONAL CONTRACT SPECIALIST

     •   Receives signed “GAPS Applicant Waiver” form and completed Applicant Registration
         form from contract company

     •   Confirms that:
            o Individual is a contract worker (Non-GDOL Staff) applicant
            o Contract company name is written on Applicant Registration form
            o Regional Contract Specialist must include the Vocational Rehabilitation Region
                number at the bottom of the Applicant Registration form

     •   Faxes GAPS Applicant Waiver and Applicant Registration forms to James Worthan or Susan
         Rubino of the Human Resources Office @404-232-3622.

4.   HUMAN RESOURCES

     •   Receives signed GAPS Applicant Waiver form and completed Applicant Registration form
         from Regional Contract Specialist. (Notifies Regional Contract Specialist if Applicant
         Registration form is incomplete or needs clarification.)

     •   Completes on-line registration process by completing “Reason,” “ORI/OAC,” and
         “Verification Code” information in the Transaction Information section of the Applicant
         Registration form

     •   Prints Applicant Registration, Step 3, Registration Complete form

     •   Faxes Applicant Registration, Step 3, Registration Complete form to Regional Contract
         Specialist

5.   REGIONAL CONTRACT SPECIALIST

     Faxes Applicant Registration, Step 3, Registration Complete form to contract company

6.   CONTRACT COMPANY

     •    Provides to contract worker applicant
             o Applicant Registration, Step 3, Registration Complete form
             o Cogent Systems Identity Verification Procedures which are available @
                 http://www.ga.cogentid.com/GA_PDF/ID_Verification.pdf
         (Provides information about identification needed for being fingerprinted.)
         •   Selects fingerprint location. List of locations is available @
             http://www.ga.cogentid.com/GA_regions_html/GA_Regions_Main.htm

         Note: GAPS recommends that the fingerprint locations be contacted before the contract
         worker applicant goes for fingerprinting to confirm:
                o The location is active
                o Hours of operation
                o Resources are available if more than a couple of applicants are to be printed on
                    the same day.

         •   Contract worker applicant reports to selected location to be fingerprinted
                o Takes Applicant Registration, Step 3, Registration Complete form,
                o Acceptable identification, and
                o Payment

         •   Contractor sends written communication to the Regional Contract Specialist confirming
             the Fingerprinting process has been completed.


7.       HUMAN RESOURCES

         Receives fingerprint criminal history record results and notifies appropriate Vocational
         Rehabilitation staff.
     .
8.       REGIONAL CONTRACT SPECIALIST

         Proceeds with contractual process as appropriate
V.   PROVIDER REVIEW PROCESS

     The Georgia Department of Labor, Vocational Rehabilitation Program (VRP)
     Outsourcing Services – Provider Guidelines sets forth standards which are meant to
     ensure the quality of service(s) to people with disabil es. Guidelines are provided for
     each service to ensure the consistent application of standards. However, there may be
     times when disagreements occur. A review process will ensure fair representation of the
     concerned parties and that issues are thoroughly understood, addressed, and documented.

     A review process is available to handle disagreements. The results of the review will be
     documented and kept on file in the Regional Contracts Specialist (RCS) Office.

     Provider Request for Review

     If a provider or potential provider is not satisfied w         ion rendered by the
     respective RCS regarding his/her qualifications or eligibility to provide a service(s),
     he/she may request a review with the RCS and attempt to resolve the disagreement in the
     context of that working relationship.

     If this initial review does not resolve the issue then a written request for review may be
     made by the provider to the Regional Director stating his/her position (Level 1) .

        •   A meeting time and date will be facilitated by the Regional Director to take place
            as soon as possible after the request is received.

        •   VRP staff attending the meeting with the provider is the respective RCS, the
            Regional Director, and the VRP’s Contracts Specialist.

        •   The respective RCS will document any understanding(s) reached, including any
            action(s) required, to resolve the issue. A copy of this document will be given to
            those who attended the meeting.

     If the Level 1 review does not resolve the issu e, then a final review may be requested in
     writing by the provider to an Assistant VRP Director (Level 2).

        •   A meeting time and date will be facilitated by an Assistant VRP Director to take
            place as soon as possible after the request is received.

        •   VRP staff attending the meeting in addition to the provider is the respective RCS,
            the Regional Director, the VRP Contracts Specialist and a VRP Assistant
            Director.

        •   The VRP Contracts Specialist will document any understanding(s) reached,
            including any action(s) required, to resolve the issue. A copy of this document
            will be given to those who attended the meeting.
VI.   OUTCOME MEASUREMENT FOR OUTSOURCED SERVICES

      The Vocational Rehabilitation Program (VRP) establishes, maintains and implements
      written minimum standards for the various types of facilities and providers of services
      used by the VRP. Purchased vocational rehabilitation services are coordinated with
      services provided by the VRP staff based on the rehabilitation needs of each individual
      consistent with the individual’s informed choice. There is a VRP Client Satisfaction
      System in place which reviews and analyzes the effecti                 ient satisfaction
      with services purchased by the VRP.

      There are formal, written procedures in place for a client and service provider to issue a
      complaint if they are dissatisfied with services rendered or received. See Appendix for
      detailed procedures.
VII.   PROCEDURE TO REVISE Outsourcing Services – Provider Guidelines


       During the process of implementing outsourcing procedures, portions of the Vocational
       Rehabilitation Program (VRP) Outsourcing Services – Provider Guidelines will be
       revised through addition, deletion, updating, etc. Therefore, it is necessary to establish a
       means by which this revision should take place. The outline for revision is as follows:

       1. VRP staff determines that a standard needs to be created, revised or deleted, or a
            Provider proposes a change.

       2. The VRP Contracts Specialist and/or the Regional Contracts Specialist are notified of
          the request.

       3. The request will be reviewed by the Regional Contracts Specialists Network and the
          Policy and Business units.

       4. Recommendations will be submitted to the Vocational Rehabilitation Leadership
          Team (VRLT) for review/approval.

          5. Approved revisions will be made a part of the manual by the VRP Contracts
          Specialist and distributed to the Regional Contracts Specialists.
          SECTION 2
       SPECIFIC SERVICE STANDARDS



Standards & Provider Guidelines


1000     Academic & Vocational Training

2000     Assistive Services

3000     Assistive Evaluations – Medical and
         Non-Medical

4000     Facilities

5000     Skills Training
               SECTION 1000

            ACADEMIC
               &
       VOCATIONAL TRAINING
  (RCS does not recruit providers for services in this section)




1001      Academic Schools, Colleges, and
          Universities

1002      Proprietary Schools

1003      Vocational and Technical Schools
1001.00   ACADEMIC SCHOOLS, COLLEGES, AND UNIVERSITIES


          Standards


1001.01   It is the policy of the Vocational Rehabilitation Program (VRP) that all Academic
          Schools providing client services must be accredited by a nationally recognized
          accrediting agency or association cited in the Higher Education Directory .

1001.02   The work team should refer to the appropriate Academic Fee Schedule for
          University System of Georgia and private and out-of-state colleges and
          universities. (The Academic Fee Schedule is distributed to each region by the
          VRP Provider Standards.)

          Note:   The Regional Contracts Specialist approves providers in accordance with
                      1001.01.
1002.00   PROPRIETARY SCHOOLS


          Standards


1002.01   It is the policy of the Vocational Rehabilitation Program (VRP) that all
          Proprietary Schools providing client services must meet the following standards:

1002.02   Schools located within the State of Georgia requiring icensure by a State
          licensing board must be approved by the appropriate board.

1002.03   Schools located within the State of Georgia not requir licensure by a State
          licensing board must be approved by the Georgia Nonpublic Postsecondary
          Education Commission.

1002.04   Schools located outside the State of Georgia must be approved by the appropriate
          state licensing board.

1002.05   The work team should refer to Provider Standards for appropriate allowable fees.


          Note:   The Regional Contracts Specialist approves providers in accordance
                  with 1002.02, 1002.03 or 1002.04
1003.00   VOCATIONAL AND TECHNICAL SCHOOLS


          Standards


1003.01   It is the policy of the Vocational Rehabilitation Program (VRP) that all
          Vocational and Technical Schools providing client services must be accredited by
          the Department of Technical Adult Education (DTAE) or a nationally recognized
          accrediting agency or association listed in Accredited Postsecondary
          Institutions and Programs, published by the U.S. Department of Education.

1003.02   The work team staff should refer to the appropriate Academic Fee Schedule for
          University System of Georgia and private, out-of-state colleges and universities.
          (The Academic Fee Schedule is distributed to each region by the VRP Provider
          Standards.)

          Note:   The Regional Contracts Specialist approves providers in accordance
                  with 1003.01.
  SECTION 2000

ASSISTIVE SERVICES

2001   Braille Production

2002   Interpreters for the Deaf

2003   Supported Employment

2004   Transportation

2005   Residence Modification

2006   Driver Evaluation

2007   Vehicle Modification

2008   Driver Training
2001.00     BRAILLE PRODUCTION – Provider Guidelines
            (CSPM NONE)

2001.01     Description of Service

            Braille production is a process of converting written documents into braille
            documents .

2001.02     Provider Information

            Braille production services are offered to people in need of converting documents
            to uncontracted braille (grade I, letter-for-letter) or contracted (grade II, uses
            abbreviations and phrases) braille. Typical print materials that are produced in
            braille include job -related materials (resumes, applications, job announcements,
            etc.)

2001.03     Provider Qualifications

            Braille production services may be purchased from private-for -profit, private-
            non-profit, and individuals.

      Note: Qualifying Documentation - Providers will submit documentation to
            determine if they meet the standards for potential suppliers.

            The Regional Contracts Specialist is responsible for determining whether
            providers meet qualifications.

2001.04     Process For Outsourcing

            Braille production includes any or all of the following:

                 A. Re-formatting of compatible document to braille production

                 B.   Optical scanning of hard -copy document

                 C.   Re-typing or re-keying of a non -disk, non-scanable document

                 D. Completed braille documents shipped to customer via U.S. Postal
                    Service, Free Matter for the Blind, unless otherwise specified
2001.05   General and Specific Standards

                 A.    Timeliness

                Braille materials must be both accurate and of good quality. Time for
                producing a document in braille will be determined by the format in which
                it is received, current work load, and priority of the document.
                Documents in an electronic format, and properly formatted, will be
                easiest/fastest to produce. Highest priority documents should be submitted
                no less than 48 hours before they are needed.

          B.    Liability

                The provider must present a certificate of insurance as defined in the
                contract or service agreement as required by the Georgia Department of
                Labor.

          C.    Criminal Record Investigation

                 Providers will be required to show evidence that a criminal record
                 investigation has been requested in accordance with DOL policy on all
                 staff that provides direct services to VRP clients.

          D.    General Requirements

                Sample Product - Providers will submit sample(s) of the braille
                production that they will produce.

          E.    Fee

                Fees for braille production include a “set-up” charge for converting print
                document, voice cassette tape, or diskette to a format that can be translated
                into contracted braille. Documents provided in an electronic format will
                require less set-up time and reduce cost.

                Large print is produced on a laser printer in an Arial, APHont, or Verdana,
                24 point type, unless otherwise requested. Avoid the use of italics except
                when absolutely necessary. One of these fonts and this size are easier to
                       read by users of large print.

                Justification for reproducing documents in uncontracted braille must be
                documented. The Regional Contracts Specialist will be responsible for
                negotiating the most effective cost.
2002.00   INTERPRETERS FOR THE DEAF – Provider Guidelines
           (CSPM 470.0.00)

2002.01   Description of Service

          Interpreters facilitate communication between persons who are deaf, hard-of-
          hearing or deaf-blind and persons who are hearing. Interpreting services
          provide accessibility to various programs and services to ensure effective
          communication. Interpreters act only in the role of communication facilitator.

2002.02   Provider Information

          The Department of Labor, Vocational Rehabilitation Program currently provides
          interpreters for staff through a referral agency contract and for clients through a
          service agreement with qualified vendors.

          Interpreter requests should be made as soon as the date and time for the assignment
          are confirmed. Although it may be possible to obtain an interpreter on short notice,
          it is suggested that requests for interpreter services be made at least two weeks in
          advance to ensure that a qualified interpreter is available to meet the need.

          Video Remote Interpreting Services (VRI) are available in some areas through the
          use of videophones. Requests for VRI services are also handled through a contract
          and/or service agreement with the VRI provider. Only certified interpreters are
          used in this process. It may be possible for interpreter requests to be filled with a
          remote interpreter with less advanced notice than the two week recommended time
          for the traditional interpreter requests. Contact your region’s counselor for the Deaf
          or the VR State Coordinator for the Deaf for specifics about arranging for this
          service.

2002.03    Provider Qualifications
          The following credentials are required for Interpreters to provide services for VR
          staff and/or clients.

            •   CI (Certificate of Interpretation) – The administration of the test for this
                certification is by the Registry of Interpreters for the Deaf, Inc. Holders of this
                certificate have demonstrated the ability to interpret between American Sign
                Language (ASL) and spoken English in both sign-to-voice and voice -to-sign.
                The holder of this certificate may not be appropriate for requests where the
                consumer prefers a more English-based method of signing. The holder’s
                ability to transliterate is not considered in this certification.




            •   CT (Certificate of Transliteration) – The administration of the test for this
                certification is by the Registry of Interpreters for the Deaf, Inc. Holders of
    this certificate have demonstrated the ability to transliterate between English -
    based sign language and spoken English in both sign -to-voice and voice-to-
    sign. The Transliterator’s ability to interpret using American Sign Language
    is not considered in this certification. The holder may not be appropriate for
    requests where the consumer prefers ASL to communicate.

•   CSC (Comprehensive Skills Certificate) - Holders of this certificate have
    demonstrated the ability to interpret between American Sign Language and
    spoken English and to transliterate between spoken English and an English -
    based method of signing. Holders of this certification are recommended for a
    broad range of interpreting and transliterating assignments.

•   RSC (Reverse Skills Certificate) – Holders of this certificate have
    demonstrated the ability to interpret between American Sign Language and a
    more English -based method of signing or transliterate between spoken
    English and a signed code of English. Holders of this certificate are deaf or
    hard-of-hearing and interpretation/transliteration is rendered in ASL, spoken
    English, and a signed code of English or written English. Holders of the RSC
    are recommended for a broad range of interpreting assignments where the use
    of an interpreter who is deaf or hard -of-hearing would be beneficial.

•   CDI (Certified Deaf Interpreter) – This certificate is similar to the RSC
    certificate (above). The holder of this certificate is Deaf or hard -of-hearing.
    In addition to proficient communication skill and general interpreter training,
    the CDI has specialized training and/or experience in the use of gesture,
    mime, props, drawings and other tools to enhance communication. The CDI
    has knowledge and understanding of deafness, the Deaf community and Deaf
    culture. The CDI possess native or near -native fluency in ASL and is often
    used to communication with deaf and hard-of-hearing consumers with
    minimal language and/or with Deaf-blind consumers.

•   NAD III (Generalist) - Average Performance - Holders of this certificate
    have demonstrated the minimum competence needed to meet generally
    accepted interpreter standards. Occasional words or phrases may be deleted
    but the expressed concept is accurate. The holder of this certificate has good
    control of the grammar of the second language and may be generally accurate
    and consistent but is not qualified for all situations.


•   NAD IV (Advanced) - Above Average Performance - Holders of this
    certificate possess advanced voice-to-sign skills and above average sign -to-
    voice skills, or vice versa. This interpreter has demonstrated an above
    average skill in any given area. Performance is consistent and accurate. This
    person should be able to interpret in most situations.
•   NAD V (Master) - Superior Performance - The holder of this certificate
    possesses superior voice -to-sign skills and excellent sign -to-voice skills. This
    interpreter demonstrates excellent to outstanding ability in any given area.
    This person demonstrates interpreting skills necessary in most situations.

•   NIC (National Interpreter Certification) – The NIC exam test interpreting
    skills and knowledge in three critical domains:

       1. General knowledge of the field of interpreting (written exam)
       2. Ethical decision making (Interview – Performance)
       3. Interpreting AND transliterating skills (Performance)

Holders of this certificate have scored within the standard range of in th ese three
areas.

Passing the test at the NIC level indicates that the interpreter has demonstrated
skills in interpreting that meets a standard professional performance level and
should be able to perform the varied functions of interpreting on a daily basis with
competence and skill. It also shows that an individual has passed a test with both
interpreting and transliterating elements, as opposed to one or the other.

•   NIC ADVANCED (National Interpreter Certification – Advanced) – The
    above three areas of the NIC apply here as well. The holders of this
    certificate have scored within the standard range of a professional interpreter
    on the Interview portion, and scored within the high range on the Performance
    portion of the test.

•   NIC MASTER (National Interpreter Certification – Master) – The same
    three areas of the NIC also apply here. Holders of this certificate have passed
    the NIC knowledge written exam and scored within the high range of a
    professional interpreter in both the Interview portion and the Performance
    portion of the test.

Individuals holding the NIC Advanced and/or Master level certifications may be
expected to perform competently in most routine interpreting assignments as well
as in assignments that may be more complex in nature or require interpreting
skills above standard levels.

(Partial Certificates)
•   IC/TC (Interpretation Certificate/Transliteration Certificate) - Holders of
    this partial certificate have demonstrated ability to transliterate between
    English and a signed code for English and the ability to interpret between
    American Sign Language and spoken English. This individual received scores
    on the CSC examination which prevented the awarding of full CSC
    certification. The IC/TC is no longer offered. Holders of this certificate have
           not demonstrated the ability to perform at a minimum standard related to sign-
           to-voice interpreting or transliterating.

       •   IC (Interpretation Certificate) - Holders of this partial certificate have
           demonstrated the ability to interpret between American Sign Language and
           spoken English. This individual received scores on the CSC examination
           which prevented the awarding of full CSC certification or partial IC/TC
           certification. The IC was formerly known as the Expressive Interpreting
           Certificate (EIC). The IC is no longer offered. Holders of this certificate have
           not demonstrated the ability to perform at a minimum standard related to sign-
           to-voice interpreting and may not be appropriate to work with VR staff and/or
           clients when this function is required.

       •   TC (Transliteration Certificate) - Holders of this partial certificate have
           demonstrated the ability to transliterate between spoken English and a signed
           code for English. This individual received scores on the CSC examination
           which prevented the awarding of full CSC certification or IC/TC certification.
           The TC was formerly known as the Expressive Transliterating Certificate
           (ETC). The TC is no longer offered. Holders of this certificate have not
           demonstrated the ability to perform at a minimum standard related to sign -to-
           voice transliterating and may not be appropriate to work with VR staff and/or
           clients when this function is required.

Georgia Quality Assurance SCREENING Levels (Not certification)
       •   QA Level V (Quality Assurance Screening Level V) – The holder of this
           screening level reflects a skilled specialist level of performance;
           recommended for expressive and receptive assignments in a wide variety of
           settings including highly technical situations.

       •   QA Level IV (Quality Assurance Screening Level IV) - The holder of this
           screening level has demonstrated an advanced level of performance; may
           function well expressively and receptively in many technical situations.

       •   QA Level III (Quality Assurance Screening Level III) – The holder of this
           screening level has demonstrated an intermediate level of performance and
           may qualify to work in very basic settings with minimum supervision. Not
           appropriate for work in legal, mental health, platform, nor serious medical or
           critical situations of any nature. QA Level III holder may not have the voicing
           skills needed to adequately represent the deaf staff or client’s signed message.
The Georgia Department of Labor/Vocational Rehabilitat
screening evaluation for beginner interpreters. Holders of the three QA levels of
competency are permitted for some limited work within the VR program. This is
especially crucial for deaf client job interviews and deaf staff presentations/meetings.
           Note: Qualifying Documentation - Providers will submit documentation to
                 determine if they meet the standards for potential suppliers.

                   The Regional Contracts Specialist is responsible for determining
                   whether providers meet minimum qualifications.




2002.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Interpreting Services are
          required.


          The VR Interpreter Request Form (RS185) should be used when referring clients
          for deaf interpreting services served through the referral agency contract. This form
          is not used for referrals through individual service agreements. (See Forms
          Appendix)


2002.05   General and Specific Standards

           A. Timeliness

                The standard time to request interpreting services should be as soon as the
                need and date of services is determined, but no less than 48 hours. The
                provider shall accept or reject the assignment within 24 hours of receipt.


           B.   Liability

                The provider must present a certificate of insurance as defined in the contract
                or service agreement as required by the Georgia Department of Labor.

           C. Criminal Record Investigation

                Providers will be required to show evidence that a criminal record
                investigation has been requested in accordance with DOL policy on all staff
                that provides direct services to VRP clients.


           D. General Requirements
     Mobility – Consideration should be given to the client’s needs in
     determining an appropriate location for the meeting.           lient cannot
     travel to the meeting location, at the discretion of the VRP staff, an alternate
     setting will be chosen.


E.   Fee

     Compensation for services will be negotiated and attached to the contract or
     service agreement.
2003.00   SUPPORTED EMPLOYMENT – Provider Guidelines
          (CSPM 416.0.00)

2003.01   Description of Service

          Supported Employment is competitive work in integrated work settings for
          persons with the most significant disabilities for whom competitive
          employment has not traditionally occurred or for whom competitive
          employment has been interrupted or intermittent as a result of a significant
          disability; and who, because of the significance of their disability, need
          intensive support services; and extended support services in order to
          perform such work.

          Supported Employment services are on-going support services and other
          appropriate services that assist an individual in entering or maintaining
          integrated competitive employment, based on the individual’s needs as
          specified in the work plan for supported employment.

          Unless dictated by client need, Vocational Rehabilitation involvement is
          intended to be a maximum of eighteen (18) months.

2003.02   Provider Information

          There are four (4) phases to Supported Employment.

             §   Supported employment services include planned support activities
                 including intensive on -site job coaching which are required to assist a
                 supported worker to learn his or her job duties and ap                   ite
                 behaviors.

             §   Stabilization is the point when the supported worker has satisfactorily
                 learned his or her job duties and appropriate work behaviors and the
                 provider can reduce their job coach interventions. As a guideline this
                 occurs when job coaching services amount to 20% of the individuals’ total
                 work hours per month.

             §   On-Going Support Services are provided from job stabilization placement
                 until transition to extended services. At a minimum of two visits per
                 month at the work site unless it is determined that off-site monitoring is
                 more appropriate for a particular individual. Off -site monitoring must
                 consist of at least two face-to-face meetings with the individual and one
                 employer contact monthly.

             §   Extended services are provided after the time limited VR Program
                 Services are completed and consist of those services needed to support
                 and maintain the individuals’ employment. Services are provided for as
                 long as the individual is employed at the same job. At a minimum of two
                     visits per month at the work site unless it is determined that off-site
                     monitoring is more appropriate for a particular individual. Off-site
                     monitoring must consist of at least two face-to-face meetings with the
                     individual and one employer contact monthly.

2003.03      Provider Qualifications

             Supported Employment providers must meet one of the following qualifications:

                A.     A Master’s degree in vocational rehabilitation or a counseling -related
                       field that may include, but is not limited to degrees        litation,
                       education, special education, social work or psychology

                B.     A Bachelor’s degree in vocational rehabilitation or a counseling -related
                       field that may include, but is not limited to degrees       litation,
                       education, special education, social work or psychology

                C.     An Associate’s degree in a vocationally related field such as, but not
                       limited to degrees in rehabilitation, education, special education, social
                       work or psychology

                D.     Three years experience in counseling, linking with community
                       resources, special education or instruction

                E.     An individual who works under the direct supervision of an individual
                       with a Master’s or Bachelor’s degree as listed above

             Note: Qualifying Documentation – Providers will submit documentation to
                   determine if they meet the standards for potential suppliers.

                     The Regional Contracts Specialist is responsible for determining whether
                     providers meet qualifications.

2003.04      Process for Outsourcing

             It is the VRP staff’s responsibility to determine when supported employment
             services should be purchased. The maximum period for VR Program services is
             18 months following placement on a supported work site. This time frame can be
             extended if it is determined and included on the work plan that additional time is
             necessary in order for the client to achieve job stabi ity prior to transition to
             extended services.

   The Supported Employment Consumer Information Form (RS154) is used as a tool in
   determining consumer needs and required services. A Supported Employment Services
   Agreement (RS072) must be completed on each consumer to identify approved services and
   the party responsible for provision of each service.              dix)
2003.05          General and Specific Standards

                  A.   Timeliness

                       Monthly progress reports shall be submitted by the provider to determine
                       client’s progress throughout his/her supported employment program.

                  B.   Liability

                       The provider must present a certificate of insurance as required by the
                       Georgia Department of Labor.

                  C.   Criminal Record Investigation

      Providers will be required to show evidence that a criminal record investigation has been

      requested in accordance with DOL policy on all staff that provides direct services to VRP

      clients.



                  D.   General Requirements

                       Mobility - Consideration should be given to the client’s needs in
                       determining an appropriate location. Training will be provided in various
                       community businesses which includes extended employmen               e sites.
                       Available Materials - A list will be submitted by prospective providers of
                       evaluative instruments with which they are competent and capable of
                       administering and interpreting.
                       Sample Product - Providers will submit to the RCS sample(s) of
                       assessment reports, training reports and action plans to determine if they
                       are sufficient to address client needs and progress.

                  E.   Report

                       The Supported Employment Monthly Progress Reports (RS077) must be
                       signed by the provider. (See Forms Appendix)

                       Identifying Information

                           •    Client name
                           •    Date of Birth
                           •    Address
                           •    Telephone Number
        •   Case Number
        •   Referring Vocational Rehabilitation Counselor
        •   Date of Referral, Evaluation, and Report
        •   Disability(s)


     Interventions - Based on a person’s goals and skills, the employment
     setting, and the supports needed, assistive technology is provided within
     the context of reasonable accommodations.

     Achievement Level - Based on the individual’s employment objectives
     the person should receive only those services which he            ve
     the desired outcomes.

F.   Fee

     A Supported Employment Payment Invoice will be completed by the
     provider and submitted to VRP staff in accordance with the SE Payment
     procedure Guideline located in the SE Collaborative Agreement. (See
     Forms Appendix)
2004.00   TRANSPORTATION – Provider Guidelines
          (CSPM 494.0.00)

2004.01   Description of Service

          Transportation service provides the means necessary to enable an applicant
          or eligible client to participate in a vocational rehabilitation service.
          Transportation may be an essential part of assisting the client in obtaining a
          continuum of services that may lead to an employment outcome.

2004.02   Provider Information

          The focus on providing transportation services is to assure that all eligible
          individuals have the opportunity and means for participation in a rehabilitation
          program. These provider guidelines apply only to private companies and non -
          profit organizations to include community facilities, under contract or service
          agreement.

2004.03   Provider Qualifications

          Providers must meet the following qualifications:

             •   Valid drivers license applicable to the vehicle operated

             •   Intrastate Passenger Transport:

                 Registered and provide proof of registration with the appropriate State of
                 Georgia Agency --

          The Department of Revenue/Motor Vehicle Division (if transporting no
          more than ten (10) passengers). The registration form is “Application for
          Class IE Registration”, available on their website:
                  http://motor.etax.dor.ga.gov/

          The Georgia Public Service Commission (if transporting more than ten
          (10) passengers. Their website is: http://www.psc.state.ga.us/transportation

             •   Interstate Passenger Transport:

                If regularly transporting passengers over state ines (interstate), adherence
             and registration through the Federal Motor Carrier Safety
                Administration (FMCSA) division of the U.S. Department of
                Transportation. Their website is: http://www.fmcsa.dot.gov

             •   Documentation of Insurance Requirements

          Note: Qualifying Documentation – Providers will submit documentation to
                determine if they meet the standards for potential suppliers.
                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

2004.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when transportation
          service should be purchased.

2004.05   General and Specific Standards

          A.     Timeliness

                 Transportation services must be provided in accordance with the times
                 designated by the VRP staff.

          B.     Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.

          C.     Criminal Record Investigation



                 Providers will be required to show evidence that a criminal record

                 investigation has been requested in accordance with DOL policy on all

                 staff that provides direct services to VRP clients.


          D.     General Requirements

                 Mobility - Consideration should be given to the client’s needs in
                 determining an appropriate vehicle.
                 Available Materials – A vehicle maintained in safe operating conditions.

          E.    Report

                 Transportation providers should maintain vehicle trip report to include the
                 client’s name and the dates and times of pick up and drop off.

          F.     Fee

                 Compensation for services will be negotiated and attached to the contract
                 or service agreement
2005.00   RESIDENCE MODIFICATION – Provider Guidelines
          (CSPM 486.0.00)

2005.01   Description of Service

          Residence modifications are changes to a Vocational Rehabilitation (VR)
          client’s residence to provide accessibility. A residential modification
          provides the minimum modifications necessary for the VR client to
          participate in a work plan for employment.

2005.02   Provider Information

          The Assistive Work Technology (AWT) Engineer shall prepare and announce a
          Request for Offer (RFO) from qualified Providers. The RFO must include
          specific objectives and timeframes for work completion and reporting procedures.

          The Provider is required to respond to a RFO that includes a list and cost of all
          materials and labor required to complete the modification. The Provider is
          required to obtain all appropriate permits and permissions to alter or modify
          residential premises and document as an attachment to the RFO response.

          The Provider must consent to providing a minimum o f one-year warranty on
          workmanship and manufactured parts. The provider must submit all operational
          manuals/instructions to the designated AWT Engineer.

2005.03   Provider Qualifications

          Potential Providers must have all applicable licenses and must meet all building
          codes as required by the local, county and municipality regulations.

          Providers will submit required documentation along with their RFO responses for
          determination of qualification.

          RFO from potential Providers will be reviewed by the AWT Engineer to assure
          the provider meets qualifications.

2005.04   Process for Outsourcing

          The Vocational Rehabilitation Counselor is responsible for determining when
          residential modifications should be purchased, based u n a report from the AWT
          Engineer.

          The process as described in the RFO Protocol shall be followed. (See Forms
          Appendix)

          The residential modification(s) must be approved before the services begin and
          inspected at the completion of services by the AWT Engineer.
2005.05   General and Specific Standards

          A.    Timeliness

                The AWT Engineer will ensure that an estimated timeframe for the
                completion of the modification(s) is included in the RFO.

          B.    Liability Insurance

                Providers must present evidence of a minimum of $1,000 00 general
                liability and workers compensation insurance.
2006.00   DRIVER EVALUATION – Provider Guidelines
          (CSPM NONE)

2006.01   Description of Service

          A Driver Evaluation can be performed only by a Certified Driver
          Rehabilitation Specialist (CDRS) who either is an Occupational Therapist
          (OT) or is assisted by an OT. The Driver Evaluation is to determine if a
          individual can drive an adapted vehicle and to determine the type of adapted
          driving equipment necessary to drive safely. The therapist’s evaluation shall
          include a clinical screening of the individual’s vision, cognition, reaction time
          and physical range of motion of their extremities. The therapist shall
          evaluate the client’s ability to transfer into the driver seat and determine if
          specialized seating is required. The Driver Evaluation Report shall report
          on the above and include a prescription for the adapted driving equipment
          necessary to drive safely. A prescription from the individual’s attending
          physician is required to authorize a Driver Evaluation.

2006.02   Provider Information

          The Provider is required to provide services on an individualized basis as
          appropriate for the specific needs of the individual.


          A Driver Evaluation for individuals whose vehicles will be equipped with hand-
          controls or hi-tech driving systems must be evaluated in a vehicle with the
          adapted equipment that is being prescribed for the individual.


2006.03   Provider Qualifications


          A. For individuals who require an evaluation in a modified vehicle with hand -
             controls, the Driver Evaluator must have a Certification as a Driver
             Rehabilitation Specialist (CDRS) as awarded by the Association of Driver
             Rehabilitation Specialists (ADED) and either be an Occupational Therapist
             (OT) or be assisted by an OT during the evaluation.


          B. For individuals who require an evaluation in a modified vehicle with hi-tech
             driving systems, the Driver Evaluator must have Certif     ion as a Driver
             Rehabilitation Specialist (CDRS) as awarded by the Association of Driver
             Rehabilitation Specialists (ADED) and a minimum of five (5) years
             experience with evaluation and training with hi-tech driving systems. The
             CDRS must be either an OT or assisted by an OT during the evaluation.
             Note: Qualifying Documentation - Providers will submit requested
                   documentation to determine if they meet the standards for potential
                   suppliers.

                      The Regional Contracts Specialist, in cooperation with the AWT
                      Engineer, is responsible for determining whether providers meet
                      qualifications.

2006.04      Process for Outsourcing


             The Vocational Rehabilitation Counselor (VRC) is responsible for determining
             when a Driver Evaluation should be purchased, based up            mendation
             from the AWT Engineer.

2006.05      General and Specific Standards

          A. Timeliness

             The Provider must notify the VRC within five (5) business days regarding
             whether or not they will accept the client referral.

          B. Liability

             A Certified Driver Rehabilitation Specialist must provide proof of $2,000,000
             professional liability insurance.

          C. Criminal Record Investigation

             Providers will be required to show evidence that a criminal record investigation
             has been requested in accordance with DOL policy on al        f that provides direct
             services to VRP clients.

          D. Report

             A written report will be required describing the evaluation process, the
             adapted equipment recommended and results of the evaluation.

          E. Fee

            Compensation for services is set by Current Procedural Terminology (CPT)
            Coding System; the length of time needed to complete the services will be
            negotiated and attached to the contract or service agreement.
2007.00   VEHICLE MODIFICATION – Provider Guidelines
          (CSPM 498.0.00)

2007.01   Description of Service

          Vehicle Modifications include a modification to a motorized or electric vehicle
          that will allow a person with a disability to operate or ride in said vehicle. The
          services may include but are not limited to:

             A. hand control installation in an automobile or van
             B. for an individual using a wheelchair to ride as a passenger
             C. for an individual using a wheelchair to drive in cases where the individual
                cannot transfer to an automobile but can transfer from a wheelchair to a
                power seat for driving
             D. for an individual using a wheelchair who must drive from the wheelchair
             E. training in the use of the vehicle modifications

          Prior to authorizing a vehicle modification, the Vocational Rehabilitation
          Counselor (VRC) shall;

             A. refer the client to the Assistive Work Technology (AWT          ineer for an
                initial assessment to determine if driving is reasonable;
             B. refer the client to an approved Driver Evaluation service (as recommended
                by the AWT Engineer) to determine if the individual is capable of driving;
             C. in cooperation with the AWT Engineer assist the individual in completing
                a Financial Considerations Worksheet to determine if the cost of owning
                and operating a vehicle is reasonable; and
             D. assure that driver’s training in the modified vehicle      ilable

2007.02   Provider Information

          After the Vocational Rehabilitation (VR) Assistive Work Technology (AWT)
          Rehabilitation Engineer has reviewed the Driver Evaluation results and
          recommendations provided by the Certified Driver Rehabilitation Specialist, the
          AWT Rehabilitation Engineer will prepare specifications for vehicle
          modification/s from the specific, fixed costs agreement reached annually with
          qualified providers for the fixed cost items and services. The AWT
          Rehabilitation Engineer will include in the specifications package any additional
          modifications a client requires that are not already a part of the yearly vendor bid
          process.

          Upon internal approval of the modification/s, the Vocational Rehabilitation (VR)
          AWT Rehabilitation Engineer will submit specifications for the vehicle
          modification/s and submit the specifications package to qualified Providers. In
          turn, the Provider will submit a written quote for services in accordance with the
          specifications package. The quote shall include:
             1) total cost of parts and labor
             2) estimated length of time to complete the job
             3) not less than one-year written warranty from date of acceptance on parts
               and labor (three-year warranty is preferred) for equipment, installation and
               workmanship
             4) installation of all equipment in accordance with NMEDA QAP program
                guidelines and standards
             5) a written statement that no equipment shall compromise safety and
                operation or structural integrity of modified vehicle
             6) the expiration date of the response (generally 30 – 90 days)

          An evaluation by the VR AWT staff is required prior to the specifications being
          offered.

          The VR AWT Engineer inspections shall assess whether the prescribed
          equipment meets the proposed specifications, functions correctly, is adjusted
          properly and will meet the customer’s needs. These inspections shall be
          conducted at the following times:

             1) construction process
             2) final completion of modification

          VR’s warranty requirements will be included in the specifications process. Upon
          final approval and authorization to perform the vehicle modification, the Provider
          shall adhere to the timelines provided in the offer.

2007.03   Provider Qualifications

          Vehicle Modification Providers shall meet the following qualifications:

          A. Quality Assurance Program (QAP) certification by National Mobility
             Equipment Dealers Association (NMEDA)

          B. The QAP certification must be equal to or higher than required for the
             equipment being installed

2007.04   Process for Outsourcing

          It is the Vocational Rehabilitation Counselor’s (VRC) responsibility to determine
          when Vehicle Modification services should be purchased.

          In the evaluation, a minimum of the following should be measured:

             A. the driving ability of the individual in using the adaptive equipment, as
                demonstrated by a Driver Evaluation performed by an ap                  ied
                Driver Rehabilitation Specialist (CDRS).
             B. the vehicle’s capability to support the needed modifications
2007.05   General and Specific Standards

          A.    Timeliness

                Preparation and response shall be in accordance with the requirements in
                the specifications package.

          B.    Liability Insurance

               Providers must provide proof of liability insurance for $1,000,000 per
               episode in accordance with NMEDA.
2008.00      DRIVER TRAINING – Provider Guidelines
             (CSPM NONE)

2008.01      Description of Service

  There are three levels of Driver Training for Vocation         abilitation clients:

             A. The basic level provides an individual with the necessary knowledge and
                skills to safely operate a motor vehicle. Services include training of State
                of Georgia Laws and preparation to pass the driving examination to
                obtain a drivers license. It may include classroom training of the law
                and licensing requirement; and simulator training. Behind-the -wheel
                training must be included. This level would not include any special
                vehicle modifications.

             B. The second level would include the basic services but would be for a
                vehicle modification with hand controls; and

             C. The third level would include the basic services but would be for a
                vehicle modification with hi-tech driving systems

2008.02      Provider Information

             The Provider is required to provide services on an individualized basis as
             appropriate for the specific needs of the client.


             Driver Training for vehicles equipped with hand -controls or hi-tech driving
             systems should be provided only after the individual’s vehicle modifications have
             been completed and delivered.


2008.03      Provider Qualifications


             A. For individuals who do not require training with modif       icles and/or
                adaptive equipment, Driver Training instructors must possess the following:


                 •   State of Georgia, Department of Motor Vehicle Safety Instructor’s
                     License

             B. For individuals who require training with modified vehicles and with hand -
                controls, driver training instructors must possess the following:

                 •   Certification as a Driver Rehabilitation Specialist (CDRS) as awarded by
                     the Association of Driver Rehabilitation Specialists (ADED)
             C. For individuals who require training with modified vehicles with hi-tech
                driving systems, driver training instructors must possess the following:

                •     Certification as a Driver Rehabilitation Specialist (CDRS) as awarded by
                      the Association of Driver Rehabilitation Specialists (ADED) and a
                      minimum of five (5) years experience with evaluation and training with
                      hi-tech driving systems

             Note: Qualifying Documentation - Providers will submit documentation to
                   determine if they meet the standards for potential suppliers.

                      The Regional Contracts Specialist, in cooperation with the AWT
                      Engineer, is responsible for determining whether providers meet
                      qualifications.

2008.04      Process for Outsourcing

             The Vocational Rehabilitation Counselor (VRC) is responsible for determining
             when driver training should be purchased, based upon a recommendation from the
             AWT Engineer.

2008.05      General and Specific Standards

          A. Timeliness

             The Provider must notify the VRC within five (5) business days regarding
             whether or not they will accept the client referral.

          B. Liability

             A Certified Driver Rehabilitation Specialist and State Driving Instructor must
             provide proof of $2,000,000 professional liability insurance.

          C. Criminal Record Investigation

             Providers will be required to show evidence that a criminal record investigation
             has been requested in accordance with DOL policy on al        f that provides direct
             services to VRP clients.

          D. Report

             A written report will be required monthly documenting progress and skill
             attainment. If service lasts less than a month a report must be submitted within
             ten (10) days following service completion.
E. Fee

  Compensation for services is set by Current Procedural Terminology (CPT)
  Coding System; the length of time needed to complete the services will be
  negotiated and attached to the contract or service agreement.
       SECTION 3000

ASSISTIVE EVALUATIONS

3001   Limited Vocational Evaluation

3002   Comprehensive Vocational
       Evaluation

3003   Comprehensive Vocational Profile

3004   Work Evaluation

3005   Pre-Employment Analysis

3006   Comprehensive Low Vision
       Evaluation

3007   Short Term Low Vision Evaluation
3001.00    LIMITED VOCATIONAL EVALUATION – Provider Guidelines
          (CSPM 134.0.00, 302.0.00)

3001.01   Description of Service

          A Limited Vocational Evaluation is time-limited and measures the client’s
          strengths and identifies areas of need. The range of                   an be
          from a limited assessment of skills and abilities to an assessment for a
          specific training program or vocational objective.

          The Limited Vocational Evaluation is a method of asses ng an individual’s
          aptitudes, interests and academic levels to develop realistic vocational goals
          and training objectives.

3001.02   Provider Information

          The Limited Vocational Evaluation service is for clients who may have some
          work history and/or vocational training. This evaluation process incorporates:

                •   background information
                •   behavioral observations
                •   standardized tests
                •   measures of occupational interests
                •   vocational aptitude assessment
                •   academic skill assessment
                •   attitude towards work

          The specific tests could include:

                •   academic achievement
                •   intelligence
                •   sensory and psychomotor
                •   vocational aptitude
                •   vocational learning style
                •   occupational interest and temperament
                •   level of personal independence
                •   career scope

3001.03   Provider Qualifications

          Limited Vocational Evaluation providers must meet one of the following
          qualifications:

           A.       A master’s degree in vocational rehabilitation or a counseling-related field
                    that may include, but is not limited to degrees in rehabilitation, education,
                    special education, social work or psychology
           B.    A bachelor’s degree in vocational rehabilitation or a counseling-related
                 field that may include, but is not limited to degrees        litation,
                 education, special education, social work or psychology and two years of
                 documented experience performing vocational evaluations

           C.    Certified by the Commission on Rehabilitation Counselor Certification
                 (CRCC) or Commission on Certification of Work Adjustment and
                 Vocational Evaluation Specialists (CCWAVES)

           D.    An intern under the direct, on-site supervision of a Certified Vocational
                 Evaluator (CVE) and the CVE must review and sign the final written
                 report

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

3001.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when a Limited Vocational
          Evaluation should be purchased.

3001.05   General and Specific Standards

           A.    Timeliness

                 The Provider must notify Vocational Rehabilitation within five (5)
                 business days of receipt of referral regarding whether or not they will
                 accept the referral. The completed evaluation report must be received by
                 the counselor within ten (10) business days from the date of completion or
                 termination of the evaluation. Upon completion of the Limited Vocational
                 Evaluation, a staffing may be scheduled with the client, evaluator,
                 counselor, and all concerned parties, to review the evaluation results.

           B.    Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.

           C.    Criminal Record Investigation

                 Providers will be required to show evidence that a criminal record
                 investigation has been requested in accordance with DOL policy on all
                 staff that provides direct services to VRP clients.
        D.    General Requirements

              Mobility - Consideration should be given to the client’s needs in
              determining an appropriate location for the evaluation. If the client cannot
              travel to the evaluator’s location, at the discretion of the VRP staff, an
              alternate setting will be chosen. In some situations, a provider may need
              to travel with portable equipment/tests to evaluate clients.
              Available Materials - A list will be submitted by prospective providers of
              evaluative instruments with which they are competent and capable of
              administering and interpreting.
              Sample Product - Providers will submit sample(s) of a Limited
              Vocational Evaluation report(s) to the RCS.

        E.    Report

              It is the evaluator’s responsibility to ensure that the information contained
              in the report is presented in a manner that is easily discernible to the users.
              In processing the information from the evaluation, it should be kept in
              mind that aptitudes and abilities tell what a client can do; interests and
              attitudes towards work tell what the client wants to do. Assessment of an
              individual’s occupational interests, abilities, aptitudes, and preferences is
              crucial to placement in a job or training program to allow for the best
              opportunity for success. A Limited Vocational Evaluation report should
              address, at a minimum, the following areas:

              Identifying Information

                  •    Client name
                  •    Date of Birth
                  •    Address
                  •    Telephone Number
                  •    Case Number
                  •    Referring Vocational Rehabilitation Counselor
                  •    Date of Referral, Evaluation, and Report
                  •    Disability(s)

Reason(s) for Referral

    •   Vocational and Educational History
        The report should include any new findings not previously identified in referral
        information.

    •   Behavioral Observations

    •   Test Results
        Name of instrument(s) and results should be included in the report.
Recommendations
A Limited Vocational Evaluation report should provide sufficient data, with supporting
rationale, to answer specific referral questions. It may or may not address the following
four (4) elements, depending on the nature of the VRP staff’s request.
They are defined as follows:

       1. Employability – When the Limited Vocational Evaluation inc ludes aptitude
          testing for specific occupations, the evaluator is expected to supply suppo rting
          rationale as to whether or not the client is a candidate for successful
          employment/training in the target occupation.

       2. Occupations – The occupation section must correlate with the rest of the
          report. Whether or not an evaluation of a specific occupational goal is
          requested, any occupational recommendations made by the evaluator must be
          supported by specific testing and professional observation. When listing
          occupations, the evaluator must list titles and numbers from th e
          Dictionary of Occupational Titles, keeping in mind jobs available in the
          client’s community or otherwise accessible to the client.

        3. Related Factors – The evaluator is expected to report any issues
           of the client’s independence that are identified during the course of the
           evaluation. Independence may involve housing, transportation, financial,
           family issues, and the client’s ability to work independently.

       4. Interventions – The evaluator must note any service or activity which will
          enhance an individual’s vocational planning, employability, and/or
          independence. Examples include, but are not limited to, Comprehensive
          Evaluation or Profile;
          Rehabilitation Assistive Technology; Adjustment Services; Counseling;
          Training/Education; Work Place Accommodations, i.e. Flexible Work
          Schedules; Medical/Psychological Services; Job Readiness; Learning
          Capacities; Mobility Training; Job Placement; and Job Coaching.

        F.     Fee

               Compensation for services will be negotiated and attached to the contract
               or service agreement.
3002.00   COMPREHENSIVE VOCATIONAL EVALUATION – Provider Guidelines
          (CSPM 134.0.00, 302.0.00)

3002.01   Description of Service

          Comprehensive Vocational Evaluation service is a process which uses a
          combination of testing, work samples, situational assessments, community-
          based job tryouts, prevailing labor market data, occupational information,
          assistive technology, functional capacities, accommodations, and
          modifications. It incorporates respect for the client’s personal process of
          growth, self-empowerment, and development of insight leading to an
          informed choice of meaningful career goals.

          The Comprehensive Vocational Evaluation service provides an
          individualized and systematic process in which an individual, in partnership
          with the evaluator, learns to identify viable vocation options and develop
          employment goals and objectives.

3002.02   Provider Information

          Unique features that distinguish Comprehensive Vocational Evaluation from
          other evaluation services are the incorporation of background information on the
          client and the inclusion of a variety of considerations that influence work such as:

             •   work history
             •   medical history
             •   psychological information
             •   relevant social information
             •   educational
             •   cultural backg round
             •   economic factors
             •   attitude towards work
             •   referral questions or input from the referral source

          The evaluation process provides an objective measurement of the client’s:

             •   intellectual functioning
             •   academic ability
             •   physical capabilities
             •   vocational aptitud es
             •   vocational learning style
             •   occupational interest
             •   temperament
             •   strengths and weaknesses
             •   personal, social and work related behaviors
             •   modes of communication
                •   work skills and tolerance
                •   job seeking and job retention skills
                •   knowledge of occupational information
                •   customer service skills
                •   understanding of work cultural
                •   transportation capabilities

          The process also defines a client’s:

                •   vocational assets
                •   need for assistive technology and reasonable accommodations
                •   barriers to employment
                •   further need for services
                •   possible employment objectives

3002.03   Provider Qualifications

          Comprehensive Vocational Evaluation providers must meet one of the following
          qualifications:

           A.       A master’s degree in vocational rehabilitation or a counseling-related field
                    that may include, but is not limited to degrees in rehabilitation, education,
                    special education, social work or psychology and documented completion
                    of coursework and/or training in test administration, test interpretation and
                    report writing that are specific to the vocational evaluation process

           B.       A bachelor’s degree in vocational rehabilitation or a counseling-related
                    field that may include, but is not limited to degrees        litation,
                    education, special education, social work or psychology and two years of
                    documented experience performing vocational evaluations

           C.       Certified by the Commission on Rehabilitation Counselor Certification
                    (CRCC) or Commission on Certification of Work Adjustment and
                    Vocational Evaluation Specialists (CCWAVES)

           D.       An intern under the direct, on-site supervision of a Certified Vocational
                    Evaluator (CVE) and the CVE must review and sign the final written
                    report

          Note: Qualifying Documentation - Providers will submit documentation to
          determine if they meet the standards for potential suppliers.

          The Regional Contracts Specialist is responsible for determining whether
          providers meet qualifications.
3002.04   Process for Outsourcing

          The Comprehensive Evaluation/Profile Referral Form (RS046) should be used
          when referring clients for vocational evaluation services. (See Forms Appendix)

3002.05   General and Specific Standards

           A.    Timeliness

                 The Provider must notify Vocational Rehabilitation within five (5)
                 business days of receipt of referral regarding whether or not they will
                 accept the referral. The completed evaluation report must be received by
                 the counselor within ten (10) business days from the date of completion or
                 termination of the evaluation. Upon completion of the vocational
                 evaluation, a staffing may be scheduled with the client, evaluator,
                 counselor, and all concerned parties, to review the evaluation results.

           B.    Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.

           C.    Criminal Record Investigation

                 Providers will be required to show evidence that a criminal record
                 investigation has been requested in accordance with DOL policy on all
                 staff that provides direct services to VRP clients.

           D.    General Requirements

                 Mobility - Consideration should be given to the client’s needs in
                 determining an appropriate location for the evaluation. If the client cannot
                 travel to the evaluator’s location, at the discretion of the VRP staff, an
                 alternate setting will be chosen. In some situations, a p rovider may need
                 to travel with portable equipment/tests to evaluate clients.
                 Available Materials - A list will be submitted by prospective providers of
                 evaluative instruments with which they are competent and capable of
                 administering and interpreting.
                 Sample Product - Providers will submit sample(s) of a Comprehensive
                 Vocational Evaluation report(s).
E.   Report

     It is the evaluator’s responsibility to ensure that the information contained
     in the report is presented in a manner that is easily discernible to the users.
     A vocational evaluation report should address, at a minimum, the
     following areas:

     Identifying Information

         •    Client name
         •    Date of Birth
         •    Address
         •    Telephone Number
         •    Case Number
         •    Referring Vocational Rehabilitation Counselor
         •    Date of Referral, Evalu ation, and Report
         •    Disability(s)

     Reason(s) for Referral

         •    Employment Barriers
         •    Source(s) of Information
         •    Vocational and Educational History
         •    Vocational Interests
         •    Behavioral Observations
         •    Tests Results
         •    Vocational Assets
         •    Vocational Limitations

     Prescriptive Recommendations - There are four (4) elements which
     must be addressed in the recommendations section of a report. It is felt
     that by adequately addressing each of these, both positively and
     negatively, with good supporting rationale, the counselor will be given all
     the information s/he needs to proceed in case planning.

     The four (4) elements are defined as follows:

     1. Employability - This is a crucial decision an evaluator must make
        upon completion of the vocational evaluation. This comes before
        occupations are even considered. The evaluator and the counselor must
        be concerned with the client’s basic ability to work as affected by
        medical/social/psychological and other factors that wi either work for
        or against successful employment. At this juncture, the evaluator’s
        professional reputation must be put on the line. The evaluator is
        expected to supply supporting rationale as to whether or not the client
        is a candidate for successful employment.
     2. Occupations - Employment is one of the most important options dealt
        with by the evaluator. The occupation(s) recommended for the client
        should meet several criteria: (1) It needs to be appropriate given the
        client’s background, evaluation results and desired outcomes. (2) The
        occupation should be available in the community or at least within
        reasonable driving distance; (3) Transportation capabilities of the client
        should be considered. The occupation section should correlate with the
        rest of the report. If an occupation is recommended that the client
        cannot currently perform, the evaluator should specify in the other
        recommendation sections what intervention steps should be taken to
        move the client toward the ultimate goal. Likewise, the evaluation
        results should support the positive job recommendation. The evaluator
        is being asked to think through the job recommendations so that they
        are clearly stated and useful to the counselor and client. When listing
        proposed occupations, the evaluator should list titles and numbers in
        conformance with the Dictionary of Occupational Titles bearing in
        mind that these recommended jobs are available in the community or
        within a reasonable driving distance and feasible for consideration.

     3. Related Factors – The evaluator should deal with two separate issues
        (1) Does the client have adequate housing, transportation, financial and
        family stability? Will home issues impede the client’s progress or
        support the client’s efforts to become and remain employed; (2) Does
        the client display appropriate work behaviors and stamina necessary for
        employment? This involves getting along with others, ability to accept
        supervision, working a full day and basic strength and functional
        capabilities needed to maintain work activities.

     4. Interventions - A service or activity needed to enhance an individual’s
        employability and/or independence. The service or activity should
        correlate to meet an identified need or barrier and/or address the
        individual’s functional limitation(s).

       Examples include, but are not limited to: Rehabilitation Assistive
       Technology; Adjustment Services; Counseling; Training/Education;
       Workplace Accommodations, i.e. Flexible Work Schedules;
       Medical/Psychological Services; Job Readiness; Learning Capacities;
       Mobility Training; Job Placement; and Job Coaching.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
3003.00   COMPREHENSIVE VOCATIONAL PROFILE – Provider Guidelines
          (CSPM 134.00, 302.0.00)

3003.01   Description of Service

          A Comprehensive Vocational Profile is an in-depth evaluation of a client who
          is unable to fully benefit from a Limited or Comprehensive Vocational
          Evaluation. The profile is based on a file review and client interview and it
          provides insight to client abilities, strengths, limitations and support systems
          for clients who have had very little or no work history. The evaluation
          clearly determines training, support and accommodations recommended for
          successful employment.

          The Comprehensive Vocational Profile provides effective job matching
          recommendations without relying on traditional measurement instruments.
          A format composed of open-ended categories allows for each person to be
          described in a unique manner. This method provides for evaluation results
          that do not adhere to standardized or norm -referenced testing to determine
          job readiness, unless the client demonstrates an ability to participate in
          objective testing.

          The profile is used to provide information about the strengths, preferences,
          needs and barriers of the client when these are not evident given the severity
          of the disability. This evaluation provides detailed information related to the
          client’s activities of daily living, emotional functioning, independent living
          needs and accommodations for home and w ork.

3003.02   Provider Information

          The Comprehensive Vocational Profile is used to match an individual to an
          appropriate job. The focus is on the importance of the applicant’s demonstrated
          skills, experiences, home, family friends, neighborhood, informal supports,
          preferences, connections and need for accommodations. The profile seeks to
          empower and involve applicants, their families and friends. Common sense
          approaches to employment are given priority over strategies which rely solely on
          professional judgment and services. The approach to employment is to utilize the
          existing or natural supports of the client and to develop additional supports to
          assist the client in going to work. Evaluation results are based on the following:

             •   Existing file documentation, test results and demonstrated capabilities
             •   Client involvement through face to face interviews, family information
                 and non -traditional vocational tools
3003.03   Provider Qualifications

          Comprehensive Vocational Profile providers must meet one of the following
          qualifications:

           A.    A master’s degree in vocational rehabilitation or a counseling- related
                 field that may include, but is not limited to degrees          litation,
                 education, special education, social work or psychology and documented
                 completion of coursework and/or training in test administration, test
                 interpretation and report writing that are specific to the vocational
                 evaluation process

           B.    A bachelor’s degree in vocational rehabilitation or a counseling- related
                 field that may include, but is not limited to degrees in rehabilitation,
                 education, special education, social work or psychology and two years of
                 documented experience performing vocational evaluations

           C.    Certified by the Commission on Rehabilitation Counselor Certification
                 (CRCC) or Commission on Certification of Work Adjustment and
                 Vocational Evaluation Specialists (CCWAVES)

           D.    An intern under the direct, on-site supervision of a Certified Vocational
                 Evaluator (CVE) and the CVE must review and sign the final written
                 report

          Note: Qualifying Documentation - Providers will submit documentation to
          determine if they meet the standards for qualification.

          The Regional Contracts Specialist is responsible for determining whether
          providers meet qualifications.

3003.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when a Comprehensive
          Vocational Profile should be purchased.

          Comprehensive Evaluation/Profile Referral Form (RS046) should be used when
          referring clients for vocational profile services (See Forms Appendix).
3003.05   General and Specific Standards

          A.    Timeliness

                The Provider must notify Vocational Rehabilitation within five (5)
                business days of receipt of referral regarding whether or not they will
                accept the referral. The completed profile report must be received by the
                counselor within ten (10) business days from the date of completion or
                termination of the profile. Upon completion of the vocational profile, a
                staffing may be scheduled with the client, evaluator, counselor, and all
                concerned parties, to review the profile results.

          B.    Liability

                The provider must present a certificate of insurance as defined in the
                contract or service agreement as required by the Georgia Department of
                Labor.

          C.    Criminal record Investigation

                Providers will be required to show evidence that a criminal record
                investigation has been requested in accordance with DOL policy on all
                staff that provides direct services to VRP clients.

          D.    General Requirements

                Mobility - Consideration should be given to the client’s transportation in
                determining an appropriate location for the profile. If the client cannot
                travel to the provider’s location, at the discretion of the work team, an
                alternate setting will be chosen.
                Available Materials - A list will be submitted by prospective providers of
                profile instruments with which they are competent and capable of
                administering and interpreting.
                Sample Product - Providers will submit sample(s) of a comprehensive
                vocational profile report(s).

          E.    Report

                It is the evaluator’s responsibility to ensure that the information contained
                in the report is presented in a manner that is easily discernible to the users.
                A vocational profile report should address, at a minimum, the following
                areas:
Identifying Information

   •   Client name
   •   Date of Birth
   •   Address
   •   Telephone Number
   •   Case Number
   •   Referring Vocational Rehabilitation Counselor
   •   Dates of Referral, Evaluation and Report
   •   Disability(s)

Residential/Domestic Information

   •   Family (Parent/guardian, spouse, children, siblings)
   •   Marital Status
   •   Extended family
   •   Names, ages and relationships of persons living in same
       home/residence
   •   Residential history
   •   Family supports available
   •   Description of typical routines
   •   Friends and social group(s)
   •   Description and location of neighborhood
   •   Social Services near home
   •   Transportation availability
   •   General types of employment near home
   •   Specific employers near home

Educational Information

   •   History and general performance from school records, interviews,
       data, observations and vocational programs
   •   Current occupation/status and personal summary
   •   Community involvement
   •   Recreational activities

Work Experience Information

   •   Chores/work performed at home
   •   Volunteer work
   •   Paid work

Summary of Present Level of Performance

   •   Domestic skills
   •   Community functioning skills
   •   Recreation/leisure skills
   •   Academic skills (Reading, Math, Time Telling, Change Making)
   •   Motor/mobility skills
   •   Sensory skills
   •   Communication skills
   •   Social interaction skills
   •   Physical/health related skills and information
   •   Vocational skills
   •   Ability to utilize available assistive technology

Learning and Performance Characteristics

   •   What environmental conditions does the applicant like best
   •   What instructional strategies seem to work best
   •   Degree of supports typically required for learning and participation
       in community activities
   •   What environment/strategies should be avoided
   •   Occupational knowledge and orientation to work culture

Preferences

   •   Type of work the applicant wants to do
   •   What kind of work has applicant/family always wished could be
       obtained
   •   Type of work the parent/guardian feels is appropriate
   •   What activity(s) the applicant enjoys doing
   •   Observations of the kinds of work the applicant likes to do
   •   Observations of social situations and preferences

Connections

   •   Potential employers in family
   •   Potential employers among friends
   •   Potential employment sites in neighborhood
   •   Business/employer contacts for leads through applicant, family,
       friends

Flexibility/Accommodations Which May Be Required in Workplace

   •   Potential need for accessibility assistance, rehabilitation assistive
       technology, personal care assistance, transportation and other
       support services
   •   Habits, routines, patterns of behaviors, etc.
   •   Physical/health restrictions
   •   Behavioral challenges
   •   Degree and type of negotiation with employers likely to be
            required
        •   Recommended workplace accommodations

     Other Important Information

        •   Primary disability classification of physical impairment
        •   Age of onset of primary disability either specific age, or if
            unavailable, narrow to either (1) Developmental (birth to 21); (2)
            Adult onset (22 years or older); or (3) unknown
        •   Documented secondary disability
        •   Pattern of physical involvement (monoplegia, hemiplegia,
            paraplegia, diplegia, double hemiplegia, quadriplegia, unknown)
        •   For individuals with cerebral palsy as a primary or secondary
            disability, record type (spasticity, athetosis, rigidity, dystonia,
            tremor, hypotonia, mixed)

     Profile Summary

        •   This is a composite, narrative description based on all the
            information gathered during the profile activity

     Job Development/Prospecting List

        •   This is a target list to be used for job development purposes. It
            matches the applicant to types of employment and to potential
            employment sites. It is compiled with input by the applicant,
            parents/guardians, service agency staff and data from profile.
            Identify (1) Type of Jobs, and (2) Specific Employers including
            address, phone, and contact person.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
3004.00   WORK EVALUATION – Provider Guidelines
          (CSPM 134.00.0 and 302.00.0)

3004.01   Description of Service

          A Work Evaluation is a short term assessment (30 business days or less) that
          utilizes objective observations of work behaviors, physical capacities, work
          habits, interpersonal skills and functional skills to determine vocational
          options and interventions by having the client in a work situation.
          Observations may come from specific job settings or a variety of work
          samples.

          The purpose of Work Evaluation services is to determine client work habit
          strengths, barriers and needs and assess the client’s vocational options and
          recommend appropriate interventions, necessary services and training.

3004.02   Provider Information

          Work Evaluation services may include but are not limited to:

             •   evaluation report identifying strengths, barriers, needs and analysis of
                 physical capacities, work habits, work behaviors and functional skills with
                 possible vocational options and recommended interventions
             •   a formal staffing to discuss evaluation results and make program
                 recommendations

          Work Evaluation services are to provide specific work behavior observations and
          recommendations, not limited to the following:

             •   response to supervision
             •   ability to follow directions
             •   physical capacities and job tolerance
             •   quality and quantity of work
             •   ability to utilize criticism and instruction
             •   attendance and punctuality
             •   co-worker relationships
             •   initiative
             •   safety awareness and practices
             •   communication skills
             •   accepting of job assignments
             •   problem solving/decision making skills
             •   application of functional skills
             •   mobility
             •   use of accommodations or job site modifications
             •   transportation accessibility
             •   acceptable personal appearance and dress
             •    attitude and acceptance of responsibility

3004.03   Provider Qualifications

          Work Evaluation providers must meet one of the following qual ications:

             A. A master’s degree in vocational rehabilitation or a counseling-related
                field that may include, but is not limited to degrees in rehabilitation,
                education, special education, social work or psychology

             B.    A bachelor’s degree in a vocationally related field that may include, but
                  not limited to degrees in rehabilitation, education, special education,
                   social work or psychology, plus two years experience, in counseling,
                   linking with community resources, special education or instruction

             C.    An individual who works under the direct, on -site supervision of an
                   individual with a masters or bachelors degree     isted above

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                  The Regional Contracts Specialist is responsible for determining
                  whether providers meet qualifications.

3004.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when work evaluation services
          should be purchased.

3004.05   General and Specific Standards

           A.     Timeliness

          The Provider must notify the VRP staff within five (5) business days of receipt of
          referral regarding whether or not they will accept the referral. A written report
          will be required monthly documenting progress and skil attainment. If service
          lasts less than a month a report must be submitted within ten (10) days following
          service completion. The written report will identify any work habit deficits to be
          addressed and time frames necessary prior to the delivery of any further services.
          The provider will not provide any further services until authorized by the VR
          counselor. If work habit deficits are identified within the initial ten (10) days of
          service, service is to cease and the counselor be notified verbally and then in the
          written report as stated above. The client shall not continue in Work Evaluation
          after needs are identified.
B.    Liability

      The provider must present a certificate of insurance as defined in the
      contract or service agreement as required by the Georgia Department of
      Labor.

 C.   Criminal Record Investigation

      Providers will be required to show evidence that a criminal record
      investigation has been requested in accordance with DOL policy on all
      staff that provides direct services to VRP clients.

 D.   General Requirements


      Mobility - Consideration should be given to the client’s needs in
      determining an appropriate location for the evaluation. If the client cannot
      travel to the evaluator’s location, at the discretion of the VRP staff, an
      alternate setting will be chosen. In some situations, a provider may need
      to travel with portable equipment/tests to evaluate clients.
      Available Materials - A list will be submitted by prospective providers of
      evaluative instruments with which they are competent and capable of
      administering and interpreting.
      Sample Product - Providers will submit sample(s) of a work evaluation
      report(s).

 E.   Report

      It is the provider’s responsibility to ensure that the information in the
      report is easily discernible to the users and is staffed with the VR staff
      prior to meeting with the client.

      Identifying Information

          •    Client name
          •    Date of Birth
          •    Address
          •    Telephone Number
          •    Case Number
          •    Referring Vocational Rehabilitation Counselor
          •    Date of Referral, Evaluation, and Report
          •    Disability(s)

      Interventions - Based on a person’s goals and skills, the employment
      setting, and the supports needed, assistive technology is provided as
      appropriate within the context of reasonable accommodations.
     Achievement Level - Based on the individual’s employment objectives
     the person should receive only those services which he            ve
     the desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
3005.00      PRE-EMPLOYMENT ANALYSIS – Provider Guidelines
             (CSPM NONE)

3005.01      Description of Service

             Pre-Employment Analysis provides the guidance necessary to enable the
             individual to make sound vocational choices, improve self– esteem, become
             employment focused and set career and placement goals. This service can be
             used at any time during a client’s vocational rehabilitation program.

3005.02      Provider Information

             Pre-Employment Analysis service may include, but is not limited to the
             following topics:

                    •   Get Acquainted - sociability, communication, and self-esteem
                    •   Why people work - security, pride, achievement, comfort and
                        economy
                    •   Career Talk - short and long term goals
                    •   Career interest / Exploration
                    •   Exploring Jobs - the job market
                    •   Transportation Accessibility
                    •   Community Resource awareness
                    •   Community Tour - class visits into work environments
                    •   Assessment of personal financial goals and needs
                    •   SSI/SSDI issues - understanding the facts
                    •   Problem Solving and Empowerment - making good choices
                    •   Job role playing


Evaluative Observations / Assessment:
                    • Response to supervision
                    • Accept and utilize criticism and instruction
                    • Attendance and punctuality
                    • Co-worker relationships
                    • Showing initiative
                    • Communication Skills
                    • Problem solving/decision making
                    • Motivation for specific training and employment
                    • Self -esteem
3005.03   Provider Qualifications

          Pre-Employment Analysis providers must meet one of the following
          qualifications:

             A. An associate’s degree with some higher education courses in a
                counseling-related field that may include, but is not limited to
                rehabilitation, education, special education, social work or psychology

             B. Two years of experience in subject matter

          Note: Qualifying Documentation – Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

3005.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Pre - Employment Analysis
          services should be purchased.

3005.05   General and Specific Standards

           A.    Timeliness

                 The Provider must notify the VRP staff within five (5) business days of
                 receipt of referral regarding whether or not they will accept the referral.
                 Provider will give counselor an approximate date of service delivery. The
                 completed pre-employment analysis report must be received by the
                 counselor within ten (10) business days from the date of completion or
                 termination of the service delivery.


           B.    Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service a greement as required by the Georgia Department of
                 Labor.

           C.    Criminal Records Investigation

                 Providers will be required to perform a criminal record
                 investigation in accordance with DOL policy on all staff
                 who provide direct services to VRP clients.
 D. General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location for providing services.
     Training / Service Materials - Providers will submit a list of
     training/service materials that will be used in providing this service.
     Sample Product-Providers will submit sample(s) of pre -employment
     analysis reports, training reports, and action plans to determine if client’s
     needs are being met.

E.   Report

     Documentation must include topics covered and client’s response to the
     subject matter.

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)

     Interventions – Based on a client’s goals and skills the employment
     setting, and the supports needed, Assistive Technology provided within
     the context of reasonable accommodations.

     Achievement Level – Based on a client’s employment objectives, the
     client should receive only those services which help him / her achieve the
     desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
3006.00   COMPREHENSIVE LOW VISION EVALUATION – Provider Guidelines
          (CSPM NONE)

3006.01   Description of Service

          Comprehensive Low Vision Evaluation is a complete functional visual
          evaluation, clinical examination, and prescription of visual aids by an
          ophthalmologist or optometrist, trained in the use of       al and non-optical
          devices by a low vision therapist. It includes follow-up visits with the doctor
          and low vision therapist to make certain that the prescribed devices are
          appropriate, and also individual and family counseling.

3006.02   Provider Information

          A comprehensive low vision evaluation identifies visua ids that will make it
          possible for a visually impaired person to do specific tasks.

3006.03   Provider Qualifications

          Comprehensive low vision evaluation providers must meet the following
          qualifications:

          For the examination and prescription of aids, one of the following must be the
          provider:
           A.     Ophthalmologist (MD) – registered or licensed according to state
                  regulations and board certified

           B.    Optometrist – registered or licensed according to state regulations

          For services such as individual and family counseling, training in the use of low
          vision aids, etc., the following provider can be used:

           A.    Vision Rehabilitation Therapist – Possession of a valid certification from
                 Academy for Certification of Vision Rehabilitation and Educational
                 Professionals (ACVREP) in Vision Rehabilitation Therapy, a Bachelor’s
                 degree and documented education/training in sixteen (16) core domain
                 areas

           B.    Counselor/Social Worker – Possession of a valid state license or
                 certificate in social work; or membership in the Academy of Certified
                 Social Workers of the National Association of Social Workers; graduation
                 from an accredited college or university with a degree in social work;
                 possession of a valid certificate in rehabilitation counseling from the
                 Commission on Rehabilitation Counselor certification; graduation from an
                 accredited college or university with a degree in rehabilitation counseling
                 or psychology; possession of a valid state license or certificate in
                 psychology
          C.     Low Vision Therapist – A certification from ACVREP or evidence that
                 certification is in process

          D.     Employees, Consultants and Volunteers – Possess specific education,
                 training and experience in low vision services appropriate to their
                 assignments

                 Note: Qualifying Documentation - Providers will submit
                 documentation to determine if they meet the standards for potential
                 suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

3006.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Comprehensive Low Vision
          Evaluations should be purchased. These services may include but are not limited
          to:

          A.     Clinical evaluation provided by an optometrist or ophthalmologist as
                 specified in NAC Standards (Section D-9, P. 219)

          B.     Individualized training in the use of optical devices including activities
                 that increase the individual’s ability to focus, local    ack, scan, and to
                 determine focal distance of recommended optical devices

          C.     Individual plan of assessment based on medical background,
                 psychological, and work history information and joint determination
                 between the individual, low vision clinical staff and vocational
                 rehabilitation counselor relating to needs, priorities, and specific goals

          D.     Individual and family counseling to address adjustment to vision loss and
                 appropriate resources

3006.05   General and Specific Standards

          A.     Timeliness

                 A completed comprehensive low vision evaluation report must be
                 received by the VRP staff within ten (10) working days of completion of
                 the evaluation. A proposal for time frames and frequency of
                 exams/instruction should be included in the report, and should be agreed
                 to before the purchase of further services.
     Length of time and number of sessions are determined by the individual’s
     interests, visual capacities, and the number and types of devices
     recommended for trial.

B.   Liability

     The provider must present a certificate of insurance as defined in the
     contract or service agreement as required by the Georgia Department of
     Labor.

C.   Criminal Record Investigation

     Providers other than the Ophthalmologist and Optometrist will be required
     to show evidence that a criminal record investigation has been requested
     in accordance with DOL policy on all staff that provides direct services to
     VRP clients.

D.   General Requirements

     Mobility – Consideration should be given to the client’s needs in
     determining an appropriate location for providing serv es.
     Professionals shall behave in a moral and ethical manner in the conduct of
     their professional roles.
     Training/Service Materials - Providers will submit a list of
     training/service materials that will be used in providing this service.
     Sample Product - Providers will submit sample(s) of assessment reports,
     training reports, and action plans to determine if client needs are being
     met.

E.   Report

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users and is staffed with the VRP staff
     prior to meeting with the client.

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)
     Evaluation Results & Interventions - A completed report outlining the
     following areas:

        •   Results of clinical examination including confirmation of
            diagnosis and visual acuity
        •   Determination of magnification needs
        •   Recommendations for appropriate optical devices and equipment
        •   Doctor and staff observations
        •   Recommendations for referral for additional services, as
            appropriate
        •   Training provided as part of the evaluation
        •   Current functional abilities and emotional adjustment
        •   Counseling with individuals who have recent diminished or loss of
            sight

F.   Fee

     Fee for outsourcing Comprehensive Low Vision Evaluation does not
     include low vision aids/equipment. Compensation for services will be
     negotiated and attached to the contract or service agreement.
3007.00   SHORT TERM LOW VISION EVALUATION – Provider Guidelines
          (CSPM NONE)

3007.01   Description of Service

          Short Term Low Vision Evaluation is a functional visual evaluation, clinical
          examination, and prescription of visual aids by an ophthalmologist or
          optometrist. A limited period of training in the use of optical and non-
          optical devices by a low vision therapist is also provided.

3007.02   Provider Information

          This service is usually provided in one visit for an individual who previously has
          had a comprehensive low vision evaluation, and may req               iption of
          different optical aids or devices due to a change in v ion or needs.

3007.03   Provider Qualifications

          Short Term Low Vision Evaluation providers must meet the following
          qualifications:

           A.    Ophthalmologists - registered or licensed according to state regulations
                 and board certified


           B.    Optometrists - registered or licensed according to state regulations
.
           C.    Low Vision Therapist – Possession of a valid certification from Academy
                 for Certification of Vision Rehabilitation and Education Professionals
                 (ACVREP) in Vision Rehabilitation Teaching and/or graduation from an
                 accredited college or university with a degree in Vision Rehabilitation
                 Teaching

                 Note: Qualifying Documentation - Providers will submit
                 documentation to determine if they meet the standards for potential
                 suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

3007.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when short term low vision
          evaluation services should be purchased.
          These services may include but are not limited to:

          A.      Clinical evaluation by an optometrist or ophthalmologist which includes
                  the following:

                     •   History
                     •   Lensometry
                     •   Determination of visual acuity at near, intermediate and far
                         distance
                     •   Confirmation of refractive error
                     •   Assessment of ocular mobility and binocularity
                     •   Tests of contrast sensitivity function
                     •   Determination of magnification needs
                     •   Tests of color and glare sensitivity
                     •   Confirmation of diagnosis

          B.     In addition the following services may be provided as needed:

                     •   Special use of prisms, mirrors and minification
                     •   Special consultation, e.g., ophthalmologic, optometric, neurologic
                         and pediatric
                     •   Brief individualized training in the use of recommended optical
                         devices

3007.05   General and Specific Standards

          A.     Timeliness

                 A completed Short Term Low Vision Evaluation and written report will
                 be available to the VRP Staff within ten (10) working days of the
                 completion of the evaluation.

          B.     Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.




          C.     Criminal Record Investigation

                 Providers other than the Ophthalmologist and Optometrist will be required
                 to show evidence that a criminal record investigation has been requested
     in accordance with DOL policy on all staff that provides direct services to
     VRP clients.



D.   General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location for the evaluation. If the client cannot
     travel to the evaluator’s location, at the discretion of the VRP staff, an
     alternate setting will be chosen. A provider may need to travel with
     portable equipment/tests to evaluate clients.
     Available Materials - A list will be submitted by prospective providers of
     evaluative instruments with which they are competent and capable of
     administering and interpreting.
     Sample Product - Providers will submit sample(s) of a short term low
     vision report(s).

E.   Report

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users and is staffed with the VRP staff
     prior to meeting with the client.

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)


     A completed report outlining the following areas:

        •     Results of clinical examination including confirmation of
              diagnosis and visual acuity
        •     Determination of magnification needs
        •     Recommendations for appropriate optical devices and equipment
        •     Doctor and staff observations
        •     Recommendations for referral for additional services, as
              appropriate
        •     Training provided as part of the evaluation
        •     Current functional abilities
F.   Fee

     Compensation for services will be negotiated and attached to the
     contractor service agreement.
       SECTION 4000

          FACILITIES


4001   Recovery Residence for Persons with
       Chemical Dependence

4002   Community Rehabilitation Facility

4003   Extended Employment Transitional
       Service

4004   Lunchtime Supervision Services

4005   CRP Placement Services
4001.00   RECOVERY RESIDENCE FOR PERSONS WITH CHEMICAL
          DEPENDENCE – Provider Guidelines
          (CSPM 482.0.00)

4001.01   Description of Services

          A recovery residence for persons with chemical dependence is a facility
          providing lodging, meals (or provisions for meals), and a recovery support
          program for persons making the transition to independent alcohol and drug
          free living. The focus is on abstinence, restoration, group therapy, and
          extensive use of self-help groups. Vocational and academic issues may also
          be addressed. Gainful employment is a significant objective of the recovery
          residence’s program. Duration of residency can vary.

4001.02   Provider Qualifications

          All alcohol and drug recovery residences must be approved and currently licensed
          by the Office of Regulatory Services (ORS).

          Note: The Regional Contracts Specialist does not solicit providers for this
          service.

4001.03   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Recovery Residence for
          Person with Chemical Dependence services should be purchased.

4001.04   General and Specific Standards

          Report

          Facilities providing residential substance abuse treatment services to
          VR clients shall report monthly to the VR counselor. Such reports shall include:

                     •   client’s status within the program;
                     •   client’s progress since the last report;
                     •   information on client’s employment when appropriate, including;
                     Name
                     Address and Telephone Number of Employer
                     Client’s job title
                     Client’s salary
                     Date client began employment
Information on termination when appropriate, including date and
cause of termination
Client’s forwarding address, if available
Client’s employment status at termination
4002.00   COMMUNITY REHABILITATION FACILITY – Provider Guidelines
          (CSPM NONE)

4002.01   Facility Standards

          A.     Any rehabilitation facility operated by or under contract or service
                 agreement with the Georgia Department of Labor, Vocational
                 Rehabilitation Program shall meet and maintain accreditation, as
                 appropriate, by the:

                  1. CARF – Rehabilitation Accreditation Commission, or
                  2. National Accreditation Council, or
                  3. Joint Commission on Accreditation of Hospitals

          B.     Newly established facilities, both State operated or privately operated
                 under contract or service agreement with the Georgia Department of
                 Labor, Vocational Rehabilitation Program shall notify the VR agency in
                 writing of its intent to seek accreditation. The program shall become
                 accredited by the appropriate accreditation agency within six [6] months
                 of the initiation date of service(s).

          C.     Each rehabilitation facility must comply with administrative policy and
                 program requirements to establish and maintain its eli ibility for VR
                 funding. To demonstrate its compliance with these requirements, the
                 facility must maintain the following documents:

                   1. Proof of Incorporation (Charter)
                   2. Letter of Exemption from IRS [501(c)(3)]
                   3. Proof of accreditation as required in letter A above

          Note: Qualifying Documentation – Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

4002.02   Service(s)/Program(s)

          All vocational rehabilitation services provided by a community rehabilitation
          facility must meet the guidelines set forth in the Outsourcing Services – Provider
          Guidelines manual for each approved service as required in this manual.

4002.03   Monitoring

          The local Regional Contracts Specialist will use monthly program and expense
          reports, as well as those reports agreed upon by VR regional staff and facility
staff, to monitor the facility’s performance and progress toward contract
objectives.

To ensure that services purchased have been provided in an acceptable manner,
an annual program review will be conducted at each facility. Reports of such
reviews, including recommendations, will be provided to the VR Regional
Director, State Contract Manager and Community Facility Director.
4003.00   EXTENDED EMPLOYMENT TRANSITIONAL SERVICE – Provider
          Guidelines (CSPM 488.0.00)

4003.01   Description of Service

          Extended Employment Transitional Service (EETS) is a structured
          employment program in a non-integrated setting for persons with significant
          disabilities.

          The focus of the program is to enhance the employment skills of the client.
          Clients receive initial service from Community Rehabilitation Programs
          (CRP’s) with the ultimate goal to transition clients into competitive or
          supported employment in the community.

4003.02   Provider Information

          In order for EETS to be provided, the service must meet the definition of
          Extended Employment. That is:

                  A.    It must be work activities in a non -integrated or sheltered setting

                  B.    It must be provided by a CRP (facility)

                  C.    The organization must provide reimbursement in accordance with
                        the Fair Labor Standards Act

4003.03   Provider Qualifications

          EETS providers must meet one of the following qualifications:

           A.    A Master’s degree in vocational rehabilitation or a counseling -related field
                 that may include, but is not limited to degrees in rehabilitation, educatio n,
                 special education, social work or psychology

           B.    A Bachelor’s degree in vocational rehabilitation or a counseling -related
                 field that may include, but is not limited to degrees       litation,
                 education, special education, social work or psychology and one year
                 experience in counseling, linking with community resources, special
                 education or instruction

           C.    An Associates degree in a vocationally related field, such as, but not
                 limited to degrees in rehabilitation, education, special education, social
                 work or psychology and two years experience in counseling, linking with
                 community resources, special education or instruction

           D.    An individual who works under the direct, on -site supervision of an
                 individual with a Master’s or Bachelor’s degree as listed above
          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

4003.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when new EETS clients are to be
          referred.

4003.05   General and Specific Standards

           G.    Timeliness

                 The Provider must notify the VRP staff within five (5) business days of
                 receipt of referral regarding whether or not they will accept the referral.

                 Services are ongoing and the individual is evaluated by the CRP for
                 potential for competitive or supported employment. Monthly reports are
                 required to show progressive development until the client’s case is closed.
                 The completed monthly programmatic report and the client’s monthly
                 progress report must be received by the VRP staff by the tenth (10th)
                 calendar day of the next month.

           H.    Liability

                 The provider must present a certificate of insurance as defined in the
                 contract as required by the Georgia Department of Labor.

           I.    Criminal Record Investigation

                 Providers will be required to show evidence that a criminal record
                 investigation has been requested in accordance with DOL policy on all
                 staff that provides direct services to VRP clients.

           J.    General Requirements

                 Mobility - Consideration should be given to the client’s needs in
                 determining an appropriate training location.
                 Available Materials – A list will be submitted by prospective providers
                 of evaluative instruments with which they are competent and capable of
                 administering and interpreting.
                 Sample Product - Providers will submit sample(s) of assessment reports,
                 training reports and action plans to determine if client needs are being
                 met.
K.   Report

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users and is staffed with the VRP staff
     prior to meeting with the client. All reports must be signed by the
     provider.

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)

     Interventions – Based on a person’s goals and skills, the employment
     setting and the supports needed, assistive technology is provided within
     the context of reasonable accommodation.

     Achievement Level – Based on the individual’s employment objectives
     the person should receive only those services, which help him/her, achieve
     the desired outcomes.

L.   Fee

     Compensation for service is billed by units of measure, which are based
     on a range of days worked by the client during the month. The fees and
     units of measure are attached to the contract.
4004.00   LUNCHTIME SUPERVISION SERVICES – Provider Guidelines
          (CSPM NONE)

4004.01   Description of Service

          This service provides for the supervision of clients and/or for the provision of
          services during the lunchtime period of up to 30 minutes per day when
          appropriate.

4004.02   Provider Information

                  A.    This service is only available at a Georgia Community
                        Rehabilitation facility.

                  B.    The Vocational Rehabilitation Program (VRP) has a written
                        procedure regarding this service. (See Forms Appendix)

4004.03   Provider Qualifications

                  A.    Providers of this service must meet the standards in 4002.01
                        (Community Rehabilitation Facility).

                  B.    The facility must have a written procedure which incorporates
                        those terms contained in the CRP Lunchtime Supervision Services
                        Procedure. If the procedure includes supervisio n of clients, the
                        purpose must be clearly stated in the procedure. The procedures
                        must be approved in writing by the RCS.

                 C.      Monthly billings or invoices req uesting reimbursement for the
                         provision of this service must be documented. The method
                         utilized must be approved by the local region’s RCS.

4004.04   Process for Outsourcing

          Pre-Authorizations for Contractual Services – The need for this service cannot be
          reasonably pre-determined; therefore pre-authorization for this service is waived.

4004.05   General and Specific Standards

           M.    Timeliness

                 Supporting documentation must be submitted with the monthly invoice by
                 the 10th calendar day of the following month.
 B.   Liability

      The provider must present a certificate of insurance as defined in the
      contract or service agreement as required by the Georgia Department of
      Labor.

C.    Criminal Record Investigation

      Providers will be required to show evidence that a criminal record
      investigation has been requested in accordance with DOL policy on all
      staff that provides direct services to VRP clients.

D.    Report

      A record or report of lunchtime services by client must be maintained OR
      an entry of services must be entered in the client’s file.

E.    Fee

      Compensation for service is attached to the contract or service agreement.
4005.00   COMMUNITY REHABILITATION FACILITY (CRP) - JOB
          PLACEMENT SERVICES – Provider Guidelines
          (CSPM 424.0.00)

4005.01   Description of Service

          CRP Placement Services are an array of services that facilitate the orderly
          transition of a client from training to an entry-level position in competitive
          employment within an integrated setting for a period o                   re.

4005.02   Provider Information

          Placement Services may only be provided by a Georgia CRP. Services may
          include but are not limited to:

          •    Job site development
          •    Job placement
          •    Job retention
          •    Employer training

4005.03   Provider Qualifications

          A.       Providers of this service must meet the standards in 4002.01 (Community
                   Rehabilitation Facility).
          B.       The CRP must have current accreditation from its accrediting agency in
               •   Community Employment Services: Job Development and Job Site
                   Training under CARF or
               •   Vocational Rehabilitation Services that includes job site development and
                   job placement under NAC.

               Note:      Qualifying Documentation – Providers will submit
                          documentation to determine if they meet the standards for
                          potential providers.

                          The Regional Contracts Specialist is responsible for
                          determining whether providers meet qualifications.

4005.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Placement Services should
          be purchased.

          The VR Counselor is in charge of the client’s case and determines if the client
          needs the service and which placements would be appropriate for the client.
          The Counselor and CRP Staff, via a referral and staffing for placement, must
          determine which agency will be the lead agency in pursuing placement for the
          client.

          Placement plans will be developed by the VR RES; and t                   ll align
          with the VR plan.

          All clients considered for job placement must be VR clients who have been
          referred to the CRP and have been receiving other serv (s) from the CRP.

          The CRP will provide to the VR Counselor notification of job/position acquired
          and wage and benefits at placement and at 90 days.

          There must be a single point of contact for the employer, either the CRP or a VR
          staff member.

          Job Placement Service is not intended for clients in Supported Employment
          service, which is a significantly different service.

          A referral for CRP Job Placement Services can only be made once within an
          eighteen -month period.

          Clients who do not make 90 days of employment will be placed again at no
          additional charge. The VR Counselor can discontinue this service at any time, if
          determined appropriate.

          Job Coaching will be available to support Job Placement services, if referred and
          authorized by the VR Counselor.

4005.05   General and Specific Standards

           A.    Timeliness

                 Supporting documentation must be submitted with the monthly invoice by
                 the 10th calendar day of the following month.

                 The facility must have a written policy which incorporates those terms
                 contained in the VRP policy.

          C.     Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.
D.    Criminal Record Investigation

      Providers will be required to show evidence that a criminal record
      investigation has been requested in accordance with DOL policy on all
      staff that provides direct services to VRP clients.


 E.   Report

      A Monthly Placement Progress Report must be submitted to the VR
      Counselor by the 10th calendar day of the following month, or when a
      significant event has occurred.

F.    General Requirements

      Mobility - Consideration should be given to the client’s needs in
      determining an appropriate location for providing job placement
      Training/Service Materials - Providers will submit a list of
      training/service materials that will be used in providing this service.
      Sample Product - Providers will submit sample copies of employment
      plans, employment reports and retention reports.

G.    Report

      It is the provider’s responsibility to ensure that the information in the
      report is easily discernible to the users and is staffed with the VRP staff
      prior to meeting with the client. All reports must be signed by the
      provider.

      Identifying Information

         •     Client name
         •     Date of Birth
         •     Address
         •     Telephone Number
         •     Case Number
         •     Referring Vocational Rehabilitation Counselor
         •     Date of Referral, Evaluation, and Report
         •     Disability(s)

      Interventions - Based on a client’s goals and skills, the training site, and
      the supports needed, assistive technology is provided within the context of
      reasonable accommodations.
      Achievement Level - Based on the individual’s employment objectives,
      the client should receive only those services which help him/her achieve
      the desired outcomes.
F.   Fee
     The milestone fees are non -negotiable.
  SECTION 5000
 SKILLS TRAINING
5001   Braille Instruction

5002   Job Sampling

5003   Employment Skills Training

5004   Home Oriented Work Skills
       Training

5005   Job Coaching

5006   Job Readiness Training

5007   Orientation and Mobility – Non-
       Visual

5008   Orientation and Mobility – Visual

5009   Personal/Social Adjustment
       Training

5010   Work Adjustment Training

5011   Work Literacy
5001.00   BRAILLE INSTRUCTION – Provider Guidelines
          (CSPM NONE)

5001.01   Description of Service

          Braille is a tactile system for reading and writing English. It is used by the
          visually impaired to facilitate reading and writing. Instruction is used to
          train individuals who are visually impaired in the use of this literary and
          math code.

          Braille instruction is provided to individuals who are visually impaired,
          and/or are deaf-blind to support educational and employment outcomes.

5001.02   Provider Information

          Braille instruction services may include the following:

             •   Assessment of client skill level and instructional needs/potential to
                 determine appropriate learning medium including but not limited to the
                 braille alphabet and math code
             •   Development of individual instructional plans
             •   Teaching adaptive skills in the areas of braille code (reading and writing)

          For the instruction of braille, adaptive skills may be necessary for successful
          outcome. These include:

             •   Tactual discrimination
             •   Functional use of braille for activities of daily living (ADL)
             •   Access and management of materials
             •   Knowledge of available technology

5001.03   Provider Qualifications

          Braille instruction providers must be certified or meet one of the following
          qualifications as outlined below:

             •   Certified by the Library of Congress as a braille transcriber and a braille
                 proofreader with Adult Instruction experience and competencies

             •   Documentation of successful completion of college course work at an
                 Academy for Certification of Vision Rehabilitation and Education
                 Professionals (ACVREP) approved institution in contracted (grade II)
                 braille and/or braille literacy
               •   Documentation of ability to produce and read contracted (grade II) braille
                   by using a Mechanical brailler ( Ex: Perkins Brailler) or a Slate and stylus

               •   Documentation of minimum of one year’s work experience in teaching
                   contracted (grade II) braille

          Note: Qualifying Documentation - Providers will submit documentation to
          determine if they meet the standards for potential suppliers.

          The Regional Contracts Specialist is responsible for determining whether
          providers meet qualifications.

5001.04   Process For Outsourcing

          It is the VRP staff’s responsibility to determine when Braille Instruction services
          should be purchased.

5001.05   General and Specific Standards

          G.       Timeliness

                   The Provider must notify Vocational Rehabilitation within five (5)
                   business days of receipt of referral regarding whether or not they will
                   accept the referral. At the completion of services a report must be
                   received by the counselor within ten (10) business days from the date of
                   completion or termination of the service. The written report will
                   recommend additional instruction to be provided and time frames prior to
                   the delivery of any further services.

          H.       Liability

                   The provider must present a certificate of insurance as defined in the
                   contract or service agreement as required by the Georgia Department of
                   Labor.

          I.       Criminal Record Investigation

                   Providers will be required to show evidence that a criminal record
                   investigation has been requested in accordance with DOL policy on all
                   staff that provides direct services to VRP clients.

          J.       General Requirements

                   Mobility - Consideration should be given to the client’s needs in
                   determining an appropriate location for providing instruction. If the client
                   cannot travel to the instructor’s location, at the discretion of the work
                   team, an alternate setting could be chosen.
     Available Materials - prospective providers of evaluative instruments
     with which they are competent and capable of administering and
     interpreting will submit a list.
     Sample Product - Providers will submit sample(s) of assessment reports,
     instructional reports and action plans to determine if client needs are being
     met.

K.   Report

     It is the Braille Instructor’s responsibility to ensure that the information in
     the report is easily discernible to the users and is staffed with the VRP
     staff upon request.

     Identifying Information

         •    Client name
         •    Date of Birth
         •    Address
         •    Telephone Number
         •    Case Number
         •    Referring Vocational Rehabilitation Counselor
         •    Date of Referral, Evaluation, and Report
         •    Disability(s)

     Evaluation results - Client’s previous training, if any, along with
     beginning and current levels of skill present.

     Interventions - Adaptive technology needed to enhance an individual’s
     employability and/or independence. The intervention should meet a
     perceived need and/or address the individual’s functional limitation(s).

     Achievement Level – The level of competency in braille reading and
     writing to be achieved and the duration of each session of braille
     instruction.

L.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5002.00   JOB SAMPLING – Provider Guidelines
          (CSPM NONE)

5002.01   Description of Service

          Job Sampling is a short period of job observation and/or job tryout(s) on a
          community employment site in order to assist the client in choosing an
          appropriate employment goal consistent with aptitudes and interests as
          determined by client feedback, informed choice and instructor observation.

5002.02   Provider Information

          Job Sampling is individualized and time limited.

          The services may include:

               •   Observation
               •   Follow-up
               •   Career counseling

          Job Sampling may include but is not limited to the objective observation of the
          following work behaviors:

               •   response to supervision
               •   physical capacities and job tolerance
               •   quality and quantity of work
               •   ability to utilize criticism and instruction
               •   attendance and punctuality
               •   co-worker relationships
               •   initiative
               •   safety awareness
               •   communication skills
               •   accepting of job assignments
               •   problem solving/decision making skills
               •   application of functional skills
               •   mobility
               •   use of accommodations or job site modifications
               •   transportation accessibility

5002.03   Provider Qualifications

          Job Sampling providers must meet one of the following qualifications:

          A.       A Bachelor’s degree in vocational rehabilitation or a counseling -related
                   field that may include, but is not limited to degrees       litation,
                   education, special education, social work or psychology
          B.     An Associates degree in a vocationally related field, such as, but not
                 limited to degrees in rehabilitation, education, special education, social
                 work or psychology and two years experience in counseling, linking with
                 community resources, special education or instruction

          C.     Three years experience in counseling, linking with community resources,
                 special education, instruction, vocational evaluations and/or assessments

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential providers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

5002.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Job Sampling should be
          purchased.

5002.05   General and Specific Standards

          A.     Timeliness

                 The Provider must notify the VRP staff within five (5) business days
                 regarding whether or not they will accept the referral.


                 If work behavior deficits are identified within the initial ten (10) days of
                 Job Sampling, service is to cease and the VR counselor notified verbally
                 and then in a written report.


                 The completed report must be received by the VR counselor within ten
                 (10) business days of completion or termination of Job Sampling.

          B.     Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.

          C.     Criminal Record Investigation
     Providers will be required to show evidence that a criminal record
     investigation has been requested in accordance with DOL policy on all
     staff that provides direct services to VRP clients.


D.   General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location.
     Available Materials - A list should be submitted from prospective
     providers delineating various training materials which they use in
     providing Job Sampling Service.

E.   Report

     A completed report identifying barriers and analysis of physical
     capacities, work habits, work behaviors and functional skills. The report
     will also list possible vocational options and recommended interventions.

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users. All reports must be signed by the
     provider.

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)

     Interventions - Based on a person’s goals and skills, the employment
     setting, and the supports needed, assistive technology is provided within
     the context of reasonable accommodations.

     Evaluation Results - Client’s previous training, if any, along with
     beginning and current levels of skill present.

     Achievement Level - Based on the individual’s employment objectives
     the person should receive only those services which he            ve
     the desired outcomes.
E.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5003.00   EMPLOYMENT SKILLS TRAINING SERVICES – Provider Guidelines
          (CSPM NONE)

5003.01   Description of Services

          Employment Skills Training (EST) refers to an individualized, time-limited
          course of study by a qualified instructor in the specific skill area. EST can
          be provided in a formal classroom, on the job site, or in an actual work
          environment. A certification or diploma is not required at the end of skills
          training. Examples of employment skills training include, but are not
          limited to, forklift, warehouse, clerical, custodial cleaning, customer service,
          landscaping, hotel housekeeping and stocking. On-the-job training and
          volunteer situations may also be used. EST is not typically taught at a state
          university or technical school.

5003.02   Provider Information

          EST requires a formal written curriculum developed for each module referencing
          total instruction time and listing materials, tools, equipment, objectives,
          performance standards and responsibilities.

          Each instruction module will include:

             •   Length of time
             •   Sequence of topics or areas to be covered
             •   Materials, equipment and tools required
             •   Minimum requirements to participate
             •   Training objectives
             •   Performance standards to measure progress
             •   Methods of instruction
             •   Requirements for course completion or extension
             •   Job related work behaviors that will be addressed in the course
             •   Safety and health procedures related to the occupation
             •   Occupational specific requirements i.e. licensure, certification
             •   Actual paid work to be performed as part of the training curriculum

          An Employment Skills Training Curriculum Evaluation Form is included in the
          Forms Appendix. See the memorandum for specific instructions on how to use
          the form.

          Note: Any training beyond that listed on the Specific Vocational Preparation
                Chart of the Dictionary of Occupational Titles will require approval by the
                Vocational Rehabilitation Counselor.
5003.03             Provider Qualifications

          EST providers are required to meet the following qualifications as outlined in the
          Dictionary of Occupational Titles for the occupation in which the training is
          provided:

                •   Previous experience providing training in the specific skill area
                •   Demonstrated competence in the occupational area defined

                    Note: Qualifying Documentation - Providers will submit
                    documentation to determine if they meet the standards for potential
                    suppliers.

                    The Regional Contracts Specialist is responsible for determining
                    whether providers meet qualifications.

5003.04   Process for Outsourcing

          It is the VRP staff’s responsibility to d etermine when Employment Skills
          Training services should be purchased.

5003.05   General and Specific Standards

           A.       Timeliness

                    A completed report must be received by the VRP staff within ten (10)
                    working days of termination or completion of training.          eport(s)
                    will be required to show progressive development.

           B.       Liability

                    The provider must present a certificate of insurance as defined in the
                    contract or service agreement as required by the Georgia Department of
                    Labor.

           C.       Criminal Record Investigation

                    Providers will be required to show evidence that a criminal record
                    investigation has been requested in accordance with DOL policy on all
                    staff that provides direct services to VRP clients.

           D.       General Requirements

                    Mobility – Consideration should be given to the client’s needs in
                    determining an appropriate location.
                    Available Materials – A list will be submitted by prospective providers.
     Sample Product – Providers will submit sample(s) of assessment reports,
     instructional reports and action plans to determine if client needs are being
     met.

E.   Report

     At the end of the training period the Provider will provide the Vocational
     Rehabilitation Counselor with a summary of the client’s skill level and
     any work behaviors that need to be addressed.

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users and is staffed with the VRP staff
     prior to meeting with the client.

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)

     Interventions - Based on a person’s goals and skills, the employment
     setting, and the supports needed, assistive technology is provided within
     the context of reasonable accommodations.

     Achievement Level - Based on the individual’s employment objectives
     the person should receive only those services which he            ve
     the desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5004.00   HOME ORIENTED WORK SKILLS TRAINING – Provider Guidelines
          (CSPM 308.1.06, 310.1.09, 510.2.01)

5004.01   Description of Service

          Home Oriented Work Skills Training is a service provided when homemaker
is        the vocational goal, and for those who need instruction in self-care
                 techniques in order to pursue other vocational goals.

5004.02   Provider Information

          The Provider is required to be capable of providing Home Oriented Work Skills
                 Training which may include, but is not limited to:

           A.    Assessing and evaluating the vocational needs and abil ies of
                 individuals with disabilities.

           B.    Developing individualized home oriented work skills training plans in
                 conjunction with the client.

           C.    Teaching adaptive skills needed in the areas of personal management,
                 household management, communication, education, leisure activities,
                 orientation and movement in the immediate environment.

           D.    Teaching problem solving and resource utilization, including adaptive
                 equipment and assistive devices and techniques.

          Note: It is important that the individual possesses the necessary skills as defined
                and measured by the Homemaker Duties Assessment Chart (RS047). (See
                Forms Appendix)

5004.03   Provider Qualifications

          Home Oriented Work Skills Training Providers must meet one of the following
               qualifications:

           A.    Certification from the Academy for Certification of Vision Rehabilitation
                 and Education Professionals (ACVREP) as a Certified Vision
                 Rehabilitation Therapist (CVRT)
                                        or

           B.    Teacher of the Visually Impaired (TVI), with documentation of academic
                 coursework or work history demonstrating ability to teach homemaking
                 skills.
          Note: Qualifying Documentation - Providers will submit documentation to
          determine if they meet the standards for potential suppliers.

          The Regional Contracts Specialist is responsible for determining whether
          providers meet qualifications.

5004.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when home oriented work skills
          training services should be purchased.

5004.05   General and Specific Standards

           A.    Timeliness

                 A completed report must be received by the VRP staff within ten (10)
                 working days of termination or completion of training.

           B.    Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.

           C.   Criminal Record Investigation

                 Providers will be required to show evidence that a criminal record
                 investigation has been requested in accordance with DOL policy on all
                 staff that provides direct services to VRP clients.

           D.    General Requirements

                 Mobility - Consideration should be given to the client’s needs in
                 determining an appropriate location for providing services.
                 Available Materials - A list will be submitted by prospective providers of
                 evaluative instruments with which they are competent and capable of
                 administering and interpreting.
                 Sample Product - Providers will submit sample(s) of assessment reports,
                 instructional reports and action plans.

           E.     Report

                 It is the provider’s responsibility to ensure that the information in the
                 report is easily discernible to the users and is staffed with the VRP staff
                 prior to meeting with the client.

                 Identifying Information
        •   Client name
        •   Date of Birth
        •   Address
        •   Telephone Number
        •   Case Number
        •   Referring Vocational Rehabilitation Counselor
        •   Date of Referral, Evaluation, and Report
        •   Disability(s)

     Other Pertinent Information –

        •   Personal Care Activities - Medications, bathing, dressing,
            grooming, toileting, reading skills, transportation.
        •   Housekeeping Duties - Sweeping, mopping, vacuuming, changing
            linen, clean kitchen, clean bathroom, yard work, home
            maintenance, repairs.
        •   Meal Preparation - Plan menu, shopping list, shop, prepare, and
            serve food, clean area.
        •   Child Care
        •   Finances/Budget - Bank services, pay bills, shop, daily expenses,
            make change, handle cash transactions.
        •   Clothing Care - Sort, wash, dry, mend, and iron clothes, select
            appropriate clothing for activities.
        •   Transportation - Work, shopping, other activities.

     Recommendations - There are three elements which must be addressed:

     Employability: The Home Oriented Work Skills Provider and the VRP
     staff must assess the client’s basic ability to work.

     Related Fact ors: Can the client live independently? This involves
     housing, transportation, financial and family issues.

     Interventions: A service, product or activity needs to support the client’s
     employment goal. This should be documented based on the client’s need
     and/or address the client’s functional limitations.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5005.00   JOB COACHING – Provider Guidelines
          (CSPM 420.0.00)

5005.01   Description of Services

          Job Coaching is a set of intensive one-on-one services in a competitive work
          setting including job-task analysis, job training, job behavior management,
          developing natural supports and employer relations which are needed to
          ensure client job retention.

5005.02   Provider Information

          Job Coaching is provided on-site and includes one-on-one training with direct
          instruction for:

             •       Specific job tasks
             •       Developing appropriate work behaviors
             •       Use of transportation
             •       Communication with supervisors and co -workers
             •       Appropriate use of meal and break times

5005.03   Provider Qualifications

          Job Coaching providers must have a minimum of a high school diploma or GED
          and the following:

                 •    Higher education courses in a counseling-related field that may include,
                      but is not limited to rehabilitation, education, special education, social
                      work or psychology

                 •    Two years documented experience as a Job Coach of persons with
                      disabilities

            Note:     Qualifying Documentation – Providers will submit
            documentation to determine if they meet the standards for potential
            suppliers.

            The Regional Contract Specialist is responsible for determining whether
            providers meet qualifications.

5005.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Job Coaching services
          should be purchased.
5005.05   General and Specific Standards

          A.    Timeliness

                Provider must notify counselor within five (5) business days regarding
                whether they will accept referral. A written report wi l be required
                monthly documenting progress and skill attainment. If service lasts less
                than a month a report must be submitted within ten (10) days following
                service completion.

          B.    Liability

                The provider must present a certificate of insurance as defined in the
                contract or service agreement as required by the Georgia Department of
                Labor.

          C.    Criminal record Investigation

                Providers will be required to show evidence that a criminal record
                investigation has been requested in accordance with DOL policy on all
                staff that provides direct services to VRP clients.

          D.    General Requirements

                Mobility - Training could be provided in various community businesses.
                Sample Product - Providers will submit sample(s) of assessment reports,
                training reports and action plans to determine if client needs are being
                met.

          E.    Report
                It is the provider’s responsibility to ensure that the information in the
                report is easily discernible to the user and is staffed with VRP staff prior
                to meeting with the client. All reports must be signed by the provider.

                Identifying Information

                    •   Client n ame
                    •   Date of Birth
                    •   Address
                    •   Telephone Number
                    •   Case Number
                    •   Referring Vocational Rehabilitation Counselor
                    •   Date of Referral, Evaluation, and Report
                    •   Disability(s)
     Interventions - Based on a person’s goals and skills, the employment
     setting, and the supports needed, assistive technology is provided within
     the context of reasonable accommodations.

     Achievement Level - Based on the individual’s employment objectives
     the person should receive only those services which he            ve
     the desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5006.00   JOB READINESS TRAINING – Provider Guidelines
          (CSPM 452.0.00)

5006.01   Description of Service

          Job Readiness Training (aka Work Readiness Training) prepares an
          individual for seeking and maintaining employment through the use of
          instructional activities. The purpose is for the client to learn lifelong skills in
          the areas of accessing labor market information, identifying job openings,
          understanding the application and interview process, worker rights and
          responsibilities, problem solving, motivation and on- the-job behavior.
          Clients may also receive assistance in choosing a voca        or job consistent
          with their aptitudes and interest.

5006.02   Provider Information

          Job Readiness Training may be individualized or provided in a group setting.

          Services may include but are not limited to:

                •   Job readiness assessment to determine work preparedness
                •   Access to labor market information, job openings, appl     ion process,
                    employee rights/responsibilities, problem solving, motivation, employee
                    evaluation process, and on-the-job behaviors
                •   Instruction in interviewing techniques, application process, role playing,
                    employer rules and expectations, feedback and review

5006.03   Provider Qualifications

          JRT providers must meet one of the following qualifications:

          A.        A Bachelor’s degree in vocational rehabilitation or a counseling -related
                    field that may include, but is not limited to degrees       litation,
                    education, special education, social work or psychology and one year
                    experience in counseling, linking with community resources, special
                    education or instruction

           B.       An Associates degree in a vocationally related field, such as, but not
                    limited to degrees in rehabilitation, education, special education, social
                    work or psychology and two years experience in counseling, linking with
                    community resources, special education or instruction

           C.       An individual who works under the direct, on -site supervision of an
                    individual with a Bachelor’s degree as listed above

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.
                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

5006.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Job Readiness Training
          services should be purchased.

5006.05   General and Specific Standards

          A.     Timeliness

                 Provider must notify counselor within five (5) business days from receipt
                 of referral whether they will accept referral. Provider will give counselor
                 an approximate begin date of training. If a response is not received within
                 five days, or if the delay in providing services is deemed unsuitable for the
                 client’s needs, counselor may seek other resources.

                 Monthly progress reports will be required to show progressive
                 development. A final report must be received by the VRP staff within ten
                 (10) business days of termination of training.

          B.     Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.

          C.     Criminal Record Investigation

                 Providers will be required to show evidence that a criminal record
                 investigation has been requested in accordance with DOL policy on all
                 staff that provides direct services to VRP clients.

          D.     General Requirements

                 Mobility - Consideration should be given to the client’s needs in
                 determining an appropriate location for providing instruction. If the client
                 cannot travel to the instructor’s location, at the discretion of the VRP staff,
                 an alternate setting could be chosen.
                 Training/Service Materials - Providers will submit a list of
                 training/service materials that will be used in providing this service.
                 Sample Product - Providers will submit sample(s) of assessment reports,
                 training reports, and action plans to determine if client needs are being
                 met.
E.    Report

      It is the provider’s responsibility to ensure that the information in the
      report is easily discernible to the users and is staffed with the VRP staff
      prior to meeting with the client. All reports must be signed by the
      provider.

      Identifying Information

         •     Client name
         •     Date of Birth
         •     Address
         •     Telephone Number
         •     Case Number
         •     Referring Vocational Rehabilitation Counselor
         •     Date of Referral, Evaluation, and Report
         •     Disability(s)

      Interventions - Based on a client’s goals and skills, the training site, and
      the supports needed, assistive technology is provided within the context of
      reasonable accommodations.
      Achievement Level - Based on the individual’s employment objectives,
      the client should receive only those services which help him/her achieve
      the desired outcomes.

 F.   Fee

      Compensation for services will be negotiated and attached to the contract
      or service agreement.
5007.00   ORIENTATION & MOBILITY SERVICES – Non-Visual - Provider
          Guidelines (CSPM 476.0.00)

5007.01   Description of Service

          Orientation & Mobility (O&M) instruction prepares persons with non-visual
          impairments but with other sensory, cognitive or physical disabilities to
          move safely and independently in a variety of environments to enable the
          individual to meet his/her vocational goals. Training includes both
          instruction and practical experiences .

5007.02   Provider Information

          O&M services may include but are not limited to:

          A.     Training in the classroom and in practical experience. Teaching skills in
                 identifying routes, transfers, pedestrian crossings and safety concerns.
          B.     Persons with functional limitations may have a number of factors that
                 could affect their learning:
                     • life patterns that are altered and interrupted by the onset of a
                         disability;
                     • a reluctance to leave or alter a familiar environment;
                     • a questionable sense of self-worth;
                     • mental or cognitive limitation requiring adaptive training for
                         independent travel (i.e. TBI, MR, stroke);
                     • rigidity in lifestyle;
                     • changes in social and/or economic status;
                     • the need to cope with his/her own and others’ stereotyped views of
                         disability.
          C.     A functional assessment of the individuals functioning level and
                 orientation and mobility skills to identify services needed to allow
                 individual to reach his O&M goals.
          D.     Developing individualized orientation and mobility instruction plans in
                 conjunction with the client and VRP staff.
          E.     Teaching techniques of travel utilizing adaptive technology, (i.e. wheel
                 chair, hearing device, etc.).
          F.     Orientation and mobility techniques/environments
                     • Basic skills
                     • Small business travel
                     • Downtown travel
                     • Rural travel
                     • Public transp ortation
                     • Mall travel
                     • Adverse weather conditions
                     • Night travel
                     • City travel
          G.     Orientation and mobility skills/knowledge
                     • Solicitation of information
                     • Interaction with the public
                     • Problem solving strategies
                     • Conceptual understanding of self and environment

5007.03   Provider Qualifications

           A.    A Bachelor’s degree in vocational rehabilitation or a counseling -related
                 field that may include, but is not limited to degrees       litation,
                 education, special education, social work or psychology and one year
                 experience in counseling, linking with community resources, special
                 education or instruction

           B.    An Associates degree in a vocationally related field, such as, but not
                 limited to degrees in rehabilitation, education, special education, social
                 work or psychology and two years experience in counseling, linking with
                 community resources, special education or instruction

           C.    An individual who works under the direct, on -site supervision of an
                 individual with a Bachelor’s degree as listed above

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

5007.04   Process For Outsourcing

          It is the VRP staff’s responsibility to determine when O&M non -visual services
          should be purchased.

5007.05   General and Specific Standards

          A.     Timeliness

                 Provider must notify counselor within five (5) business days from receipt
                 of referral whether they will accept referral. Provider will give counselor
                 an approximate begin date of services. A proposal for time frames and
                 frequency of instruction and progress reports must be agreed to before the
                 purchase of services.

                 A final report must be received by the VRP staff within ten (10) business
                 days of completion of services.
B.   Liability

     The provider must present a certificate of insurance as defined in the
     contract or service agreement as required by the Georgia Department of
     Labor.

C.   Criminal Record Investigation

     Providers will be required to show evidence that a criminal record
     investigation has been requested in accordance with DOL policy on all
     staff that provides direct services to VRP clients.

D.   General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location for providing serv es.
     Training/Service Materials - Providers will submit a list of
     training/service materials that will be used in providing this service.
     Sample Product - Providers will submit sample(s) of assessment reports,
     training reports, and action plans to determine if client needs are being
     met.

E.   Report

     It is the provider’s responsibility to ensure that the information in the
     report is presented in a manner that is easily discernible to the users. All
     reports must be signed by the provider. The report(s) should contain the
     following:

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)



     Interventions - Based on a person’s goals and skills, the employment
     setting, and the supports needed, assistive technology is provided within
     the context of reasonable accommodations.
     Achievement Level - Based on the individual’s employment objectives,
     the client should receive only those services which help him/her achieve
     the desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5008.00   ORIENTATION AND MOBILITY SERVICES – Visual – Provider
          Guidelines
          (CSPM 476.0.00)

5008.01   Description of Service

          Orientation & Mobility (O&M) training prepares any person with a visual
          impairment to move safely and independently in a variety of environments to
          enable the individual to meet his/her vocational goals. Training includes
          both instruction and practical experiences.

5008.02   Provider Information

          Persons with functional limitations may have a number of factors that could affect
          their learning:

               •   Life patterns that are altered and interrupted by the onset of a disability;
                   decreasing or fluctuating vision, mobility
               •   concomitant health problems
               •   a reluctance to leave or alter a familiar environment
               •   a questionable sense of self-worth
               •   “normal” decrease in tactual, auditory and olfactory abilities
               •   rigidity in lifestyle
               •   changes in social and/or economic status
               •   the need to cope with his/her own and others’ stereotyped views of
                   disability

          Orientation and Mobility Services may include, but are not limited to:

          A.       A functional assessment of the individuals functioning level and
                   orientation and mobility skills to identify services needed to allow
                   individual to reach his O&M goals.
          B.       Developing individualized orientation and mobility instruction plans in
                   conjunction with the client and VRP staff.
          C.       Teaching orientation and mobility skills which include but are not limited
                   to the following:
                       • Techniques of travel utilizing a white cane, service animal,
                           electronic travel aid, or optical device.
          D.       Orientation and mobility techniques/environments
                       • Basic skills
                       • Indoor cane skills
                       • Small business travel
                       • Downtown travel
                       • Rural travel
                       • Public transportation
                       • Mall travel
                     • Adverse weather conditions
                     • Night travel
                     • City travel
          E.     Orientation and mobility skills/knowled ge
                     • Use of remaining senses
                     • Use of aided and unaided residual vision
                     • Organization of spatial relations
                     • Solicitation of information
                     • Interaction with the public
                     • Problem solving strategies
                     • Conceptual understanding of self and environment
                     • Appropriate movement behavior including posture and gait

5008.03   Provider Qualifications

          Orientation and Mobility service providers must meet the following requirements:

          A.     Certification from the Academy for Certification of Vision Rehabilitation
                 and Education Professionals (ACVREP)
                                              or
          B.     Certification from the National Orientation and Mobility Certification
                 (NOMC) from the National Blindness Professional Certif      ion Board
                 (NBPCB) as a Certified Orientation and Mobility Specia ist (COMS)

          C.     Individual who has completed all O&M curricula from an accredited
                 college or university; is eligible for O&M certification; and applies for
                 certification within six months from approval as a provider

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

5008.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when O&M Visual services
          should be purchased.

5008.05   General and Specific Standards

          A.     Timeliness

                 Provider must notify counselor within five (5) business days from receipt
                 of referral whether they will accept referral. Provider will give counselor
                 an approximate begin date of services. A proposal for time frames and
     frequency of instruction and progress reports must be agreed to before the
     purchase of services.

     A final report must be received by the VRP staff within ten (10) business
     days of completion of services.

B.   Liability

     The provider must present a certificate of insurance as defined in the
     contract or service agreement as required by the Georgia Department of
     Labor.

C.   Criminal Record Investigation

     Providers will be required to show evidence that a criminal record
     investigation has been requested in accordance with DOL policy on al
     staff that provides direct services to VRP clients.

D.   General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location for providing instruction.
     Sample Product - Providers will submit sample(s) of assessment reports,
     training reports, and action plans to determine if client needs are being
     met.

E.   Report
     It is the provider’s responsibility to ensure that the information in the
     report is presented in a manner that is easily discern                    ll
     reports must be signed by the provider.

     Identifying Information

        •   Client name
        •   Date of Birth
        •   Address
        •   Telephone Number
        •   Case Number
        •   Referring Vocational Rehabilitation Counselor
        •   Date of Referral, Evaluation, and Report
        •   Disability(s)

     Interventions - Based on a person’s goals and skills, the employment
     setting, and the supports needed, assistive technology is provided within
     the context of reasonable accommodations.
     Evaluation Results: This section should include client’s previous
     mobility training, if any, and beginning and current skills level. Also, this
     section will include the results of the evaluation. V    l functioning,
     orientation skills, cane skills, service animal.

     Achievement Level - Based on the individual’s employment objectives,
     the client should receive only those services which help him/her achieve
     the desired outcomes.

     Summary/Recommendations - Summary of the client’s current skills
     level as it relates to their vocational goal and any need for further training.
     Time lines will also be addressed in this section i.e., estimated length of
     training.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5009.00   P ERSONAL/SOCIAL ADJUSTMENT TRAINING – Provider Guidelines
          (CSPM NONE)

5009.01   Description of Service

          Personal/Social Adjustment Training (PSAT) services develop or re-establish
          personal and social behaviors designed to enhance an individual’s
          employability. The services are instructional and can be provided
          individually or in small groups.

5009.02   Provider Information

          PSAT services may include but are not limited to the following:

                     •   Interpersonal Skill Development
                     •   Methods of Appropriate Communication
                     •   Sexual Awareness and Appropriateness
                     •   Personal Grooming and Hygiene
                     •   Community Living
                     •   Money Management
                     •   Decision Making/Problem Solving
                     •   Health and Medicine Management
                     •   Understanding of Self and Abilities
                     •   Identifying, planning and providing the supports a person needs to
                         achieve and maintain employment

                 PSAT services provide a comprehensive plan utilizing instructional
                 classroom activities in small groups or individual instruction and may
                 address:

                     •   Personal/social skills
                     •   Decision making in daily life activities
                     •   Work attitudes and skills exploration
                     •   Exercising informed choice
                     •   Community field trips
                     •   Problem solving and resource utilization, including adaptive
                         equipment
                     •   Knowledge about the rights and responsibilities associated with
                         employment

5009.03   Provider Qualifications

           A.    A Bachelor’s degree in vocational rehabilitation or a counseling -related
                 field that may include, but is not limited to degrees       litation,
                 education, special education, social work or psychology and one year
                 experience in counseling, linking with community resources, special
                 education or instruction

           B.    An Associates degree in a vocationally related field, such as, but not
                 limited to degrees in rehabilitation, education, special education, social
                 work or psychology and two years experience in counseling, linking with
                 community resources, special education or instruction

           C.    An individual who works under the direct, on -site supervision of an
                 individual with a Bachelor’s degree as listed above

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

5009.04   Process for Outsourcing

          It is the VRP staf f’s responsibility to determine when Personal/Social Adjustment
          Training services should be purchased.

5009.05   General and Specific Standards

          A.     Timeliness

                 Provider must notify counselor within five (5) business days from receipt
                 of referral whether they will accept referral. Provider will give counselor
                 an approximate begin date of services. A proposal for time frames and
                 frequency of instruction and progress reports should be included in the
                 report, and should be agreed to before the purchase of services.

                 PSAT time frames are individualized, and monthly progress reports will
                 be required to show progressive development.

                 A final report must be received by the VRP staff within ten (10) business
                 days of completion of services.

          B.     Liability

                 The provider must present a certificate of insurance as defined in the
                 contract or service agreement as required by the Georgia Department of
                 Labor.
C.   Criminal Record Investigation

     Providers will be required to show evidence that a criminal record
     investigation has been requested in accordance with DOL policy on all
     staff that provides direct services to VRP clients.



D.   General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location for providing services.
     Training/Service Materials - Providers will submit a list of
     training/service materials that will be used in providing this service.
     Sample Product - Providers will submit sample(s) of training reports and
     action plans.

E.   Report

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users and is staffed with the VRP staff
     prior to meeting with the client. All reports must be signed by the
     provider.

     Identifying Information

        •     Client n ame
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)

     Interventions - Based on a person’s goals and skills, the employment
     setting, and the supports needed, assistive technology is provided within
     the context of reasonable accommodations.
     Achievement Level - Based on the individual’s employment objectives,
     the client should receive only those services which help him/her achieve
     the desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5010.00   WORK ADJUSTMENT TRAINING – Provider Guidelines
          (CSPM 404.0.00, 404.1.05, 408.0.00)

5010.01   Description of Service

          Work Adjustment Training (WAT) is a comprehensive, time-limited,
          individualized process that assists clients seeking employment to develop or
          reestablish job readiness skills, work habits and behaviors, quality and
          quantity of work, personal and social skills, functional capacities, and
          attitudes appropriate to employment. These services utilize realistic work
          tasks to develop on-the-job behavior skills, proper work habits skills,
          interpersonal skills, work-related communication skills and to increase
          stamina.

          There are two (2) types of WAT. The first type is known as facility or In-
          house WAT. This type is provided in a non-integrated work setting,
          typically in a Community Rehabilitation facility. The second type is
          Community WAT (CWAT) and is provided in an integrated work setting,
          typically off-site from the Community Rehabilitation facility.

          Note: While the VR client is participating in WAT or C AT, the Provider
          will ensure that liability insurance for Worker's Compensation coverage is
          provided for the client, and the client receives a training stipend in
          compliance with Department of Labor Minimum Wage and Hour
          requirements.

5010.02   Provider Information

          WAT services may include but are not limited to:

              •   Attendance and punctuality
              •   Appropriate dress and grooming
              •   Following directions
              •   Learning and performing different work tasks
              •   Staying on task
              •   Relationships with co -workers and supervisors
              •   Quantity and quality of work
              •   Job tolerance and stamina
              •   Adhering to work rules and safety procedures
              •   Reporting problems to supervisors
              •   Interaction with the public
              •   Transportation arrangements
              •   Work related communication
5010.03   Provider Qualifications

          WAT providers must meet one of the following qualifications:

           A.    A Bachelor’s degree in vocational rehabilitation or a counseling -related
                 field that may include, but is not limited to degrees in rehabilitation,
                 education, special education, social work or psychology and one year
                 experience in counseling, linking with community resources, special
                 education or instruction

           B.    An Associates degree in a vocationally related field, such as, but not
                 limited to degrees in rehabilitation, education, special education, social
                 work or psychology and two years experience in counseling, linking with
                 community resources, special education or instruction

           C.    Three years experience in counseling, linking with community resources,
                 special education, instruction, vocational evaluations and/or assessments

           D.    An individual who works under the direct, on -site supervision of an
                 individual with a Bachelor’s degree as listed above

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                 The Regional Contracts Specialist is responsible for determining
                 whether providers meet qualifications.

5010.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Work Adjustment services,
          facility or community should be purchased.

5010.05   General and Specific Standards

          A.     Timeliness
                 Provider must notify counselor within five (5) business days from receipt
                 of referral whether they will accept referral. Provider will give counselor
                 an approximate begin date of services.

                 A proposal for time frames and frequency of instruction and progress
                 reports should be included in the report, and should be agreed to before
                 the purchase of services.
                 A final report must be received by the VRP staff within ten (10) business
                 days of completion of services.
     WAT time frames are individualized. WAT progress reports are
     mandatory on a monthly basis whether or not a staffing takes place with a
     Vocational Rehabilitation Counselor.

B.   Liability

     The provider must present a certificate of insurance as defined in the
     contract or service agreement as required by the Georgia Department of
     Labor.

C.   Criminal Record Investigation

     Providers will be required to show evidence that a criminal record
     investigation has been requested in accordance with DOL policy on staff
     that provides direct services to VRP clients.

D.   General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location for providing serv es.
     Training/Service Materials - Providers will submit a list of
     training/service materials that will be used in providing this service.
     Sample Product - Providers will submit sample(s) of progress reports
     and action plans to determine if client needs are being met.

E.   Report

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users and is staffed with the VRP staff
     prior to meeting with the client. All reports must be signed by the
     provider.

     Identifying Information

        •     Client name
        •     Date of Birth
        •     Address
        •     Telephone Number
        •     Case Number
        •     Referring Vocational Rehabilitation Counselor
        •     Date of Referral, Evaluation, and Report
        •     Disability(s)

     Interventions - Based on a client’s work plan, the employment setting,
     and the supports needed, assistive technology is provided within the
     context of reasonable accommodations.
     Achievement Level - Based on the individual’s employment objectives,
     the client should receive only those services which help him/her achieve
     the desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
5011.00   WORK LITERACY - Provider Guidelines
          (CSPM NONE)

5011.01   Description of Service

          Work Literacy Training (WLT) are instructional activities designed to
          provide necessary literacy skills in order to obtain and maintain entry level
          employability. This service is usually provided through individual
          instruction with consideration to the client’s work goals.

5011.02   Provider Information

          WLT services may include but are not limited to:

               •   Assessing and evaluating the work literacy needs and abilities of the
                   client
               •   Developing a comprehensive, individualized plan
               •   Depending on the identified and expressed preferences of the client,
                   support and or training may address:

                      A. Work attitudes and skills exploration
                      B. Teaching skills needed

5011.03   Provider Qualifications

          Work Literacy Training providers must meet the following qualification:

               •   Bachelor Degree with one or more years of teaching experience

          Note: Qualifying Documentation - Providers will submit documentation to
                determine if they meet the standards for potential suppliers.

                   The Regional Contracts Specialist is responsible for determining
                   whether providers meet qualifications.

5011.04   Process for Outsourcing

          It is the VRP staff’s responsibility to determine when Work Literacy Training
          services should be purchased.

5011.05   General and Specific Standards

          A.       Timeliness

                   Provider must notify counselor within five (5) business days from receipt
                   of referral whether they will accept referral. Provider will give counselor
                   an approximate begin date of services.
     A proposal for time frames and frequency of instruction and progress
     reports should be included in the report, and should be agreed to before
     the purchase of services. A final report must be received by the VRP staff
     within ten (10) business days of completion of services.

B.   Liability

     The provider must present a certificate of insurance as defined in the
     contract or service agreement as required by the Georgia Department of
     Labor.

C.   Criminal Record Investigation

     Providers will be required to show evidence that a criminal record
     investigation has been requested in accordance with DOL policy on all
     staff that provides direct services to VRP clients.

D.   General Requirements

     Mobility - Consideration should be given to the client’s needs in
     determining an appropriate location for providing services.
     Training/Service Materials - Providers will submit a curriculum and a
     list of training/service materials that will be used in providing this service.
     Sample Product - Providers will submit sample(s) of assessment reports,
     training reports, and action plans to determine if client needs are being
     met.

E.   Report

     It is the provider’s responsibility to ensure that the information in the
     report is easily discernible to the users and is staffed with the VRP staff
     prior to meeting with the client.

     Identifying Information

         •    Client name
         •    Date of Birth
         •    Address
         •    Telephone Number
         •    Case Number
         •    Referring Vocational Rehabilitation Counselor
         •    Date of Referral, Evaluation, and Report
         •    Disability(s)
     Interventions - Based on a client’s goals and skills and the supports
     needed, assistive technology may be provided within the context of
     reasonable accommodations.
     Achievement Level - Based on the individual’s employment objectives,
     the client should receive only those services which help him/her achieve
     the desired outcomes.

F.   Fee

     Compensation for services will be negotiated and attached to the contract
     or service agreement.
               SECTION 3

              Forms Appendices
• Procedure for Addressing Client Complaint(s) Against
  Service Providers
• VR Interpreter Request Form (RS185)
• Supported Employment Services Agreement (RS072)
• Supported Employment Consumer Information (RS154)
• Supported Employment Monthly Progress Report
  (RS077)
• Supported Employment Invoice
• Supported Employment Collaborative Agreement
• RS Request for Offer Receipt Log (RS171)
• RS Request for Offer Rating Sheet (RS172)
• RS Request for Offer Ranking List (RS172)
• Comprehensive Evaluation/Profile Referral (RS046)
• Lunchtime Supervision Services
• Employment Skills Training Curriculum Evaluation
  Form
• Homemaker Duties Assessment Chart (RS047)
• Client Training Progress Report (RS070)
• Job Coach Monthly Training Progress Report (RS071)
• Job Coaching Timesheet (Short Term) (RS073)
• Job Coaching (Short Term/Post Employment Progress
  Report) (RS074)
• On the Job Training Participant Agreement (RS078)
• Provider Qualification Packet
 Procedure for Addressing
Client Complaint(s) Against
     Service Providers
                               GEORGIA DEPARTMENT OF LABOR
                                    Rehabilitation Services
                               Vocational Rehabilitation Program
                1700 Century Circle NE • Suite 300 • Atlanta, Georgia 345-3020
                   (404) 235-0141 • Fax (404) 468 -0217 • TTY (404) 463-7826

MICHAEL L. THURMOND
  COMMISSIONER
                                Business Unit Memorandum

Memorandum Number:                11.29.2007.05
Procedure Name:                   Procedure for Addressing Client Complaint(s) Against
                                  Service Providers

Contact Person:                   Deidre Mosely, Provider Standards Coordinator
                                  Patricia Joseph, Provider Standards Specialist
                                  Sharon Angel, Business Unit Manager

Date Approved:                    October 10, 2007
Date Distributed:                 November 29, 2007
Date Effective:                   December 3, 2007
Date Last Amended:                November 15, 2007
Date of Next Review:              November 2008
Related Policies:                 N/A

Related Procedures:               N/A

Reading References:               N/A

Distribution:                     Assistant Commissioner
                                  VR Directors
                                  Vocational Rehabilitation Leadership Team (VRLT)
                                  Rehabilitation Unit Managers (RUM’s)
                                  Operational Analyst Tech (OATS)
                                  Business Unit
                                  Policy Unit
                                  VRSST
                                  Regional Contract Specialist
                             GEORGIA DEPARTMENT OF LABOR
                                          Rehabilitation Services
                             Vocational Rehabilitation Program
              1700 Century Circle NE • Suite 300 • Atlanta, Georgia 345-3020
                 (404) 235-0141 • Fax (404) 468 -0217 • TTY (404) 463-7826

MICHAEL L. THURMOND
  COMMISSIONER
P ROCEDURE F OR ADDRESSING CLIENT COM P LAINTS AGAINST SERVICE PROVIDERS

Description: a client and/or their representative ma      sue a complaint against a service
provider for any reason.

A.    Notification
      1. Client may notify Counselor or any appropriate VR staff in writing, electronically or
         verbally that he/she is dissatisfied regarding a VR Se ice Provider.

      2. The VR staff member receiving the complaint by phone m            complete the Client
         Complaint Form (see attached). If the complaint is received in writ          or in an
         electronic format, the documentation must be attached to the Client Complaint Form .

      3. The VR client or representative making the complaint will receive acknowledgment of
         their complaint within three (3) business days to include a copy of their complaint. All
         copies regarding this complaint will be maintained in separate complaint files (i.e.
         case and provider files.)

      4. VR staff receiving a client complaint must refer the completed Client Complaint
         Form and/or client who is complaining to the Regional Director and/or their designee
         within 24 hours.

      5. Upon notification of the client complaint the Regional Director or his/her designee
         will summarize the highlights of the complaint and notify the VR Director, Assistant
         Commissioner, Legal Services Director, Assistant VR Directors and Business Unit
         Manager within three (3) business days and/or attach a copy of the complaint as
         appropriate.

B.    Investigation of Complaint
      1. The Regional Director will lead the investigation and          the staffing of all VR
         client complaints with the regional core investigative team comprised of the client’s
         assigned Counselor, Regional Unit Manager, as well as       ional Contract Specialist.
        The Legal Services Director and Business Unit Manager ill also be essential ad hoc
        members of all investigations. It will be at the Regional Director’s discretion to add
        other members to the investigative team as appropriate.

     2. The Regional Director and their investigative team wil conduct an internal
        investigation within 10 business days of receipt of the complaint. The investigation
        may include interviews with other VR clients; VR program staff; providers and/or
        their staff; other clients of providers; as well as review of pertinent documents. If
        additional information or time is needed to conclude the investigation, the Regional
        Director will notify all parties involved .

     3. If deemed appropriate, the Regional Director will send the VR Service Provider a
        Notification Letter (see attached) and a copy of the VR Service Provider Response
        Form (see attached).

     4. The VR Service Provider has five (5) business days to          a written response and
        cooperate in any investigative interviews. The provider’s response should address any
        actions they are taking to address the complaint.

     5. Pending the outcome of the investigation, the provider may be subject to immediate
        probationary sanctions which can include temporary suspension of service delivery as
        a VR provider or immediate referral to appropriate legal authorities.


C.   Outcome of Investigation
     1. The Regional Director will utilize the expertise of the investigative team to determine
        whether the complaint is substantive and/or has merit.

     2. If the investigation deems that the client complaint has substance, the Regional
        Director will consult with the Business Unit and Legal Services divisions to ensure
        that their recommendations are within business and legal parameters. Final
        recommendations will go directly to the VR Director and Assistant Commissioner for
        their approval and guidance.

     3. At the direction of the VR Director and/or Assistant Commissioner, the Service
        Provider will be notified in writing of the outcome of the investigation and final
        disposition. (See letter attached).

     4. The Regional Director will send a letter to the client advising them of the final
        outcome and decision. (See letter attached)

     5. Final determination and notification to the client and provider will be summarized by
        the Regional Director and placed in the separate complaint files (provider and client).

     6. The final recommendation(s), inclusive of final status of client and provider, will be
        sent to all VR staff as appropriate.
                             GEORGIA DEPARTMENT OF LABOR
                                          Rehabilitation Services
                             Vocational Rehabilitation Program
              1700 Century Circle NE • Suite 300 • Atlanta, Georgia 345-3020
                 (404) 235-0141 • Fax (404) 468 -0217 • TTY (404) 463-7826

MICHAEL L. THURMOND
  COMMISSIONER


     September 11, 2007

     Provider Business Name
     Address
     City, State, Zip

     Attn: Provider Name

     Dear Mr./Mrs./Ms./Dr:

     The Georgia Department of Labor/ Vocational Rehabilita         Program strive to ensure that every
     client receives the highest quality service to assist        in reaching their vocational goal of
     employment. Client satisfaction is imperative as it relates to rehabilitation services which we
     purchase from providers for the attainment of our client’s vocational goal(s).

     We regret to inform you that the Vocational Rehabilitation Program has received a complaint from
     one of our clients regarding you as a VR provider. Ou client has reported the following
     issues:_______________________________________________________________________.

     Please carefully consider these issues and provide a response on the attached Provider Response
     Form; and return to me within five (5) business days. Please feel free to contact me for assistance
     in expediting this process.


     Sincerely,


     Regional Director

     Cc: Assistant Commissioner
         VR Director
         Assistant VR Directors
         Business Unit Manager
         Legal Services Director
         Regional Contract Specialist
                            GEORGIA DEPARTMENT OF LABOR
                              Rehabilitation Services
                            Vocational Rehabilitation Program
             1700 Century Circle NE • Suite 300 • Atlanta, Georgia 345-3020
                (404) 235-0141 • Fax (404) 468 -0217 • TTY (404) 463-7826

MICHAEL L. THURMOND
  COMMISSIONER

                         VR CLIENT COMPLAINT FORM

                                               DATE:

CLIENT NAME:
CLIENT ADDRESS:
CLIENT PHONE:
CLIENT FAX:
CLIENT EMAIL
ADDRESS:
CASE #:
PROVIDER NAME:
PROVIDER ADDRESS:

Date (s) of Occurence:_________________________________________________________

Summary of the Complaint:
(Attach a second page if necessary)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
____
_____________________________________________________________________________
_

Action Requested by the VR Client:




Staff Signature and Date:_____________________________________________________
VR Client Signature and Date:_________________________ _________________________
                            GEORGIA DEPARTMENT OF LABOR
                              Rehabilitation Services
                            Vocational Rehabilitation Program
             1700 Century Circle NE • Suite 300 • Atlanta, Georgia 30345-3020
                (404) 235-0141 • Fax (404) 468 -0217 • TTY (404) 463-7826

MICHAEL L. THURMOND
  COMMISSIONER

                        VR SERVICE PROVIDER RESPONSE FORM

     Date:

     Service Provider Name:

     Address:

     Telephone Number:

     Response to Complaint(s):



     ______________________________________________________________
     ______________________________________________________________

     Action Taken to Address Complaint(s): (Attach additional sheets if necessary)




     ServiceProvider Signature and Date_______________________________
                            GEORGIA DEPARTMENT OF LABOR
                              Rehabilitation Services
                            Vocational Rehabilitation Program
             1700 Century Circle NE • Suite 300 • Atlanta, Georgia 345-3020
                (404) 235-0141 • Fax (404) 468 -0217 • TTY (404) 463-7826

MICHAEL L. THURMOND
  COMMISSIONER

     Date


     Provider Business Name
     Address
     City, State, Zip


     Attn: Provider Name

     Dear Mr. /Mrs. / Ms. /Dr.

     The Georgia Department of Labor/Vocational Rehabilitat                        pleted its
     investigation of complaint(s) regarding services received from you by a vocational rehabilitation
     client.

     Upon completing a thorough investigation, it is our findings that:



     Sincerely,



     VR Regional Director


     Cc: Assistant Commissioner
         VR Director
         Business Unit Manager
         Regional Contract Specialist
         Policy Director
         Legal Services Director
                              GEORGIA DEPARTMENT OF LABOR
                                           Rehabilitation Services
                              Vocational Rehabilitation Program
               1700 Century Circle NE • Suite 300 • Atlanta, Georgia 30345-3020
                  (404) 235-0141 • Fax (404) 468 -0217 • TTY (404) 463-7826

MICHAEL L. THURMOND
  COMMISSIONER

Date


Client Name
Client Address
City, State, Zip

Attn: Final Outcome of Complaint against Service Prov        :


Dear Name of Client:

The Georgia Department of Labor/Vocational Rehabilitat                                        view
of your complaint regarding services received from the above named provider. Appropriate action has
been taken based on the nature of your complaint.

VRP is committed to maintaining quality services for our clients, and your input has been valuable in
reaching final disposition of this issue(s). You are to be commended for bringing this significant matter
to our attention.

We wish you well in your future endeavors.

Sincerely,


VR Regional Director

       Cc: Assistant Commissioner
          VR Director
           Business Unit Manager
           Regional Contract Specialist
           Policy Director
           Legal Services Director
   VR Interpreter
Request Form (RS185)
VR INTERPRETER REQUEST FORM                                                          (Supervisor signature)                           (Date)

GISN                             __                  Georgia Interpreting Service Network
      GISN Request #:                                 Date requested:
      Circle: Staff or A & I
      Agency or Company Responsible for Payment: GA DEPT OF LABOR/VR
Section one:
DATE(S) OF SERVICE:

TIME(S) OF SERVICE:

LOCATION:

DIRECTIONS:

NUMBER OF INTERPRETERS NEEDED:                                                    TEAM:

DESCRIPTION:

DEAF CONSUMER(S):

Communication                    ASL          CLOSE VISION                       ENGLISH                    TACTILE
Preference:
                                 ORAL               OTHER :



Preferred Interpreter(s):

Location Contact Person:                                                                        Phone:

Requestor and Hub Location:
Phone:                                              Fax #:
Confirmed with:                                                  Date:                                  Initials:
Comments:



Section two : Office use onl y
Interpreter(s) Scheduled:                                                                        FAX                     EMAIL
1)
2)
3)
4)
5)
         Instructions to staff. Fill in section one. Be sure that your supervisor approves the request and signs at the top right corner.
            Fax this form to GISN (404 -521-9121). If you have any questions contact Marilyn Teague at 404 -521-9100 V/TTY
                    Or 1-800-228 -4992 V/TTYA service of Georgia Association of Training, Emp loyment and Supports.
  Supported Employment
Services Agreement (RS072)
                     Georgia Department of Labor
                        Rehabilitation Services – Vocational Rehabilitation Program



     SUPPORTED EMPLOYMENT SERVICES
AGREEMENT
Client Name:                                         VR Case Number:                  Date
VR Counselor Name
Service Provider Name

Check (√ ) all services that will be needed.

                                                                                             Person/provider
(Ö )                                                                                         responsible
                                SERVICES TO BE PROVIDED
       Assistance in seeking and securing employment –
       Strategies to be used:




       Support (job coaching) to learn and relearn job duties –
       Strategies to be used:




       Assistance in developing and implementing a transportation plan –
       Strategies to be used:




       Assistance adjusting to job changes/job stress –
       Strategies to be used:




       Assistance in medication management or negotiating medical/psychiatric leave,
       and management of leave and non-work time –
       Strategies to be used:
      Interventions to maintain appropriate work traits (i.e interpersonal behaviors,
      social skills, self-advocacy in employment related matters, or grooming and
      hygiene)-
      Strategies to be used:


      Assistance with benefits management/financial matters (i.e., SSI, Food Stamps,
      etc.) –
      Strategies to be used:




      Other (specify) –
      Strategies to be used:




*********************************************************************************************************************




Service Provider Signature



VR Counselor/VR Representative Signature



Client Signature



Client Representative Signature



Date
   Supported Employment
Consumer Information (RS154)
                                             Georgia Department of Labor
                             Rehabilitation Services - Vocational Rehabilitation Program

          SUPPORTED EMPLOYMENT CONSUMER INFORMATION

Name                                                                      Date


Disability Information

   1. What is the client’s disability(ies)?

   2. What are the functional limitations impacting employment?
      (Physical stamina, emotional stability, standing, lifting, etc.)
      Describe:



   3. Adverse side effects of medications?                                           Yes   No
      Describe:



   4. Any other concerns related to the disability and employment?                   Yes   No


Work Behaviors

   1. Does individual demonstrate appropriate work behaviors?                        Yes   No
      (argues, withdraws, ignores feedback)
      Describe:



   2. Does individual require job readiness assistance?                              Yes   No
      Referral to RJRS needed?                                                       Yes   No

   3. How many hours per week can the individual work?

   4. Please list the specific days and times individual is available to work:




   5. Work Interaction Preferences?
                2 to 3 others during shift
                Constant contact with others throughout shift
                No contact with others
                No preference
                 Other
     6. How much supervision is required when completing a task?
                 None
                 1 to 2 directions given within 30 minutes
                 3 or more directions given within 30 minutes
                 Other

     7. Which environment(s) helps individual stay on task?
                  Quiet
                  Noise (cars, machines)
                  Music
                  People talking with others
                  Isolated
                  Other

     8. Other environment preferences:
                   Indoors
                   Outdoors
                   Cold
                   Hot
                   High level activity
                   Low level activity
                   Other



Transportation P lan

     1. Does individual have independent transportation?                              Yes    No

     2. Does individual have access to public transportation?                         Yes    No

     3. Can individual use public transportation independently?                       Yes    No

     4. Travel Skills:
               Requires training to use public transportation
               Uses public transportation, can make transfers
                    Can’t make transfers
               Makes own travel plans
               Driver’s license
               Access to car to drive self
               Independent street crossing skills

     5. If individual is not independent, list persons involved in transporting individual
        (Specify hours available):

     6. List other transportation options (i.e. taxi):




Family/Community S kills and Supports

1.       Description of typical daily routine:
2.      Work chores performed at home:




3.      Does individual demonstrate appropriate social interaction (family, friends, strangers, etc):




4.     List all friends, social groups or other people the in   ual has regular contact with that is interested in
        assisting with his/her employment efforts:




Related Factors/Obstacles

     1. Does the individual have other conditions that would impact employment?
        (child care, criminal background, other diagnoses, etc)                 Yes            No


Vocational P references

     1. What type of work does the client want to do?

     2. What type of work does the family think appropriate?

     3. What employer does client want to work for?


Work H istory
  Please list all work activities and/or jobs:
Emp loyment Considerations

Work Goal(s):

   1. Does the individual have transferable work skills?                          Yes        No
      Describe:



   2. Does individual have entry level skills for work goal?                      Yes        No
      Describe:



   3. Is additional training/academics required?                                  Yes        No
      Describe:



   4. Is there evidence that individual can complete academic/training required?
      (physical, intellectual, emotional)                                        Yes         No
      Describe:



   5. Is there evidence that the individual can perform the essential             Yes        No
      job functions?

   6. Are accommodations needed?                                                  Yes        No
      Describe:



Job Development Considerations:

   1. List employers near home:



   2. List employers easily available to individual with transportation source:



   3. Where are client’s family members and friends employed?



   4. List employers which family and support people are willing to contact for job leads:



   5. How far is the client willing to travel one way?

   6. Does individual need job placement assistance?                              Yes        No

   7. Referral to RES needed?                                                     Yes        No
   Supported Employment
Monthly Progress Report (RS077)
                Georgia Department of Labor
                                     Rehabilitation Services – Vocational Rehabilitation Program



                        SUPPORTED EMPLOYMENT MONTHLY
                             PROGRESS REPORT
Client Name:                                  VR Case Number:                       Date
VR Counselor Name                                  Service Provider Name:

Job Coach(s) Name                                    Job Site                                  Case Status

Services Provided From                                           Through


SUMMARY OF CLIENT’S PROGRESS
Services Addressed:
Please give specific examples of what is being done to assist the client in becoming independent in these

areas. If a service was not checked as a necessary service on the “Supported Employment Services

Agreement”, please indicate that by “N/A”.



(Ö )                                    SERVICES PROVIDED
       1. Assistance in seeking and securing employment -




       2. Support (job coaching) to learn and re- learn job duties –




       3. Assistance in developing a transportation plan -
   4. Assistance adjusting to job changes/job stress –




   5. Assistance in medication management or negotiating medical/psychiatric leave, and/or
      management of leave and non-work time –




   6. Interventions to maintain appropriate work traits (i.e interpersonal behaviors, social skills, self-
      advocacy in employment related matters, or grooming and hygiene) –




  7.
       Assistance with benefits management/financial matters (i.e. SSA, SSI, Food Stamps, etc.) –




  8.
       Other (specify) –




Problems Encountered/Employer Issues:




Services/Actions Needed from Vocational Rehabilitation:




Comments:




                                                        Service Provider Signature/Date
Supported Employment
       Invoice
                                     (Service Provider Letterhead)

                                               INVOICE
TO:     ____________________________
        Vocational Rehabilitation Program

FROM: (Service Provider Mailing Address)

DATE: ___________________________                  RE:        Supported Employment Services

The following is a request for payment for Supported Employment Services for:

Client Name:________________________________ VR Case Number:________________________

Services Identification

$___________        Determination of the need for Supported Employment is completed. The Supported
                    Employment Services Agreement form is completed with the VR Counselor and the
                    client. The services and strategies have been identif ed based on the needs of the
                    client. (This $250 is encumbered with 110 funds).

Training & Initiation of
On-going Support              Services Provided from          /       /           /           Through       /       /           /           /

$__________ 1. Authorization & Invoice (A & I) will be encumbered to the provider for the training.
               This first $1,000.00 payment will be made at the beginning of the initial training
               phase. This phase will begin the first day the client is on the employer’s payroll and in
               training with a job coach.

Stabilization                 Services Provided from      /       /           /           Through       /       /           /           /

   $__________         2.     The remaining training balance of $1,000.00 will be paid once job coaching
   for the client has diminished to only 20 percent. This balance will be paid at entry into status 22. If
   the client does not achieve status 22 (quit, failure, etc.) the balance of payment may be paid at the
   discretion of the VR Counselor.

VR Services Completion &
Transition to Extended Services:     Services Provided from               /           /   /       Through               /           /           /
/

$__________ 3. Authorization & Invoice (A/I) for $1,500.00 payment will be issued when the client is
               transitioned to Extended Services.

The VR Counselor is the final authority on all payment authorizations.

__________________________________________________________________________________
Service Provider Representative Signature                                     Date

__________________________________________________________________________________
Vocational Rehabilitation Representative Signature                          Date
Supported Employment Collaborative
           Agreement
             PERFORMANCE BASED COLLABORATIVE AGREEMENT WITH THE
                         GEORGIA DEPARTMENT OF LABOR
                      VOCATIONAL REHABILITATION PROGRAM
               FOR THE PROVISION OF SUPPORTED EMPLOYMENT SERVICES

Provider Name:

Address: ___________________________________________________________

Telephone Number: _________________            Fax Number: ____________________

VRP Vendor Number: ______________              Federal I.D. #                          _


As a service provider of supported employment, ________________________ agrees to provide services in
accordance with the following operational guidelines and principles. This Collaborative Agreement is intended to
establish a basis for working relationships between these parties. In addition this Collaborative Agreement only
pertains to those clients placed into supported employment on or after July 01, 2006. This agreement is in effect
from _________________through ________________, with an option to renew annually, up to an additional th ree
(3) years. Option to renew must be submitted in writing, 30 days in advance, and agreed to by all parties.

                              PROVIDER OPERATIONAL GUIDELINES

    1. Receive from Vocational Rehabilitation Program (VRP) referrals of clients who are most
       significantly disabled. Provider eligibility will be determined at the time of referral.

    2. Refer individuals deemed to be appropriate for services under this joint program for
       determination of eligibility for VRP services. Upon notification that individuals referred
       by the Provider meet VR eligibility requirements, Provider will participate in a staffing
       with VRP to discuss the individual’s Supported Employment needs and necessary
       services. Supported Employment services will be agreed upon by the client, VRP
       Counselor, Provider and other appropriate parties, and recorded on the Supported
       Employment Services Agreement.

    3. Identify and/or recruit individuals who are qualified    stipulated in VR's Resource
       Standards Manual and Interpretive Guide for Outsourcing Services) to provide supported
       employment services and serve as a provider of supported employment services in
       accordance with service needs.

    4. Initiate a criminal records check on each program employee, as instructed by the
       Regional Contract Specialist, prior to his/her working with VRP clients. Ensure that a
       criminal records investigation is conducted and appropriate actions taken on staff persons
       providing supported employment services.

    5. Train program staff in skills necessary to provide appropriate services to supported
       employment clients.

    6. Supervise the provision of supported employment services to clients.

    7. Provide supported employment services in keeping with policies and procedures for
       supported employment utilized by the VRP. The expectation is that programs will
   provide onsite supports until the supported worker is          lized. Once the supported
   worker is stabilized, on -going support is to be provided at a minimum of two visits per
   month at the work site unless it is determined that off-site monitoring is more appropriate
   for a particular individual.

8. Maintain required contact with the supported worker, employer and VRP Counselor or
   Work Team necessary to assure successful adjustment to the work site and provide the
   following reports to the VRP representative.

                   A. Invoice for Services on Provider’s Letterhead (Exhibit A)
                   B. Supported Employment Monthly Progress Report (Exhibit B), will
                      be provided until case is closed by VRP Counselor.

9. Arrange for or provide extended services for support to workers after VRP services have
   been discontinued, for as long as the individual is employed at the same job. Extended
   support is a minimum of two visits per month at the work site unless it is determined that
   off-site monitoring is more appropriate for a particular individual. Off-site monitoring
   must consist of at least two face -to-face meetings with the individual and one employer
   contact monthly.

10. Maintain supported employment records for at least three years after the term of services
    and make records available for inspection, upon request, y appropriate state or federal
    agencies.

                             VRP OPERATIONAL GUIDELINES

1. Refer individuals who are eligible for supported employment in accordance with state and federal
   guidelines.

2. Receive referrals from the provider of individuals who are deemed to be eli ible for program
   services and determine their eligibility for VRP services within sixty (60) days. The VRP
   Counselor, upon determination that the referral meets       eligibility requirements, will contact
   the Provider to schedule a staffing. The purpose of the staffing is to determine the individual’s
   Supported Employment services. Supported Employment services will be agreed upon by the
   client, VRP Counselor, Provider and other appropriate        es, and recorded on the Supported
   Employment Services Agreement as part of the supported employment Work Plan.

3. Determine and locate suitable work sites for clients.

4. Subject to the availability of funds, reimburse the provider for services rendered in accordance
   with VRP policies and procedures for supported employment.

5. Oversee the provision of supported employment services in keeping with the VRP Counselor or
   work team which has oversight responsibilities for provisions of all services.

6. Maintain adequate contact with the client/supported worker, employer and service provider
   necessary to assure successful adjustment to the work site.

7. With input from the client/supported worker, employer, service provider and VRP work team,
   determine the appropriate level of adjustment for each worker to the work site and the point at
   which VRP services may be discontinued and extended services initiated by the service provider.
8. Monitor and/or review supported employment services according to VRP policy.


                                     PROGRAM ASSURANCES

                                 Supported Employment Principles

1. Supported employment is competitive work in integrated work settings for persons with
   the most significant disabilities for whom competitive employment has not traditionally
   occurred; or for whom competitive employment has been interrupted or intermittent as a
   result of a significant disability; and who, because of the significance of their
   disability(ies), need intensive support services; and   nded support services in order to
   perform such work. Supported Employment clients must be working toward a goal of
   minimum wage or be employed at or above minimum wage.

2. Supported employment services include planned support          ities including intensive
   on-site job coaching which are required to assist a supported worker to learn his or her
   job duties and appropriate work site behaviors.

3. Stabilization is the point when the supported worker has satisfactorily learned his or her
   job duties and appropriate work behaviors and the provider can reduce their job coach
   interventions. As a guideline this occurs when job coaching services amount to 20% of
   the individuals’ total work hours per month.

4. On-Going Support Services are provided from job placement until transition to extended
   services. At a minimum of two visits per month at the work site unless it is determined
   that off-site monitoring is more appropriate for a particular individual. Off -site
   monitoring must consist of at least two face-to-face meetings with the individual and one
   employer contact monthly.

5. Extended services - Services provided after the time limited VR Program Services are
   completed and consist of those services needed to support and maintain the individuals’
   employment. Services are provided for as long as the individual is employed at the same
   job. At a minimum of two visits per month at the work site unless it is determined that off-
   site monitoring is more appropriate for a particular individual. Off-site monitoring must consist
   of at least two face-to-face meetings with the individual and one employer contact monthly.
  Phase                      Description                                                    Payment Amount
  Services Identification    Before the initiation of Supported Employment, the             $250.00
                             provider, the client/supported worker, and the VR
                             Counselor meet to review the client’s needs to
                             determine the services and strategies to facilitate
                             successful employment outcome.
                             This phase will begin the first day the client is on the       $1,000.00
  Training & Initiation of   emplo yer’s payroll and is in training with a job coach
  Ongoing Supports           (status 18).

                             This phase will begin when the job coaching for the            $1,000.00
                             client has been diminished to less than 20% and the
  Stabilization              client is moved into working status (status 22). If the
                             client does not achieve this level (due to quitting, firing,
                             failure, etc) the balance of payment may be paid at the
                             discretion of the VR Counselor.
                              This payment will be made when the client has                 $1,500.00
  VR Services                maintained stabilization for at a minimum of 30 days;
  Completion & Transition    client is substantially meeting hourly work goal in
  to Extended Services       Work Plan and counselor, client, emplo yer, job coach
                             agree client is performing satisfactorily. Case is
                             transitioned to extended services.

          SUPPORTED EMPLOYMENT PAYMENT PROCEDURE GUIDELINE




  This agreement may be terminated by either party with thirty-(30) day’s written notice. The
  agreement may be renewed or modified only with the written consent of both parties.

__________________________________                      __________ ___________________________
Service Provider Representative                         VRP Representative
__________________________________                       ______________________________________
Title                           Date                     Title                             Date
RS Request for Offer
Receipt Log (RS171)
                                    Georgia Department of Labor
                                          Rehabilitation Services
                                     Vocational Rehabilitation Program

                                       OFFER RECEIPT LOG

                             Reference # RFO
                      RFO Deadline Date/Time:


                                                                                            All Required
                                                                          Correct # of
   Date Offer          Time Offer                                                            Documents
                                                Offeror Name                Copies
   Received             Received                                                             Received?
                                                                         Received? Y/N
                                                                                                 Y/N




I certify that all offers listed on this log were received by me and the information I have listed on
this log is accurate.




                                                                   Signature and Date
RS Request for Offer
Rating Sheet (RS172)
                                                      Georgia Department of Labor

                                                      Rehabilitation Services
                                                 Vocational Rehabilitation Program

                                                         OFFER RATING SHEET
                                          ______________________________________________________ _

                                         Reference # RFO

                                                EVALUATION CRITERIA

            Criteria
Performance Surpasses Criteria; has elements to enhance project performance.
5 Points
4 Points            Meets Criteria and Minimum Standards set forth in the RFP
3 Points            Could Meet Criteria with minor changes
2 Points            Could Meet Criteria with significant changes
1 Point             Does Not Meet Criteria
COMPONENTS                                                                      OFFEROR    OFFEROR OFFEROR OFFEROR
                                                                                  #1          #2          #3           #4


Offeror
Establishes offeror’s previous performance records
Establishes role of contact person
Establishes qualifications of offeror and staff


Offer Objectives
Describes measurable outcomes to be achieved.
Appears practical in view of offeror resources.
Realistic completion time frame.
Service Implementation
Describes how objectives will be achieved.
Includes staffing, time lines.
Appears cost-effective.
Internal Monitoring
Relates process for monitoring accomplishment of objectives.
Provides process for evaluating and modifying methods as
necessary.
Indicates staff person responsible for internal monitoring.

Budget
Budget pages are complete and accurate.
Appears adequate to cover cost of services provided.
                                             TOTALS:

Each submission will be rated on how well the offeror              ability to meet the requirements listed in
the RFO. The Review Team will use this form to review each offer individually, comparing the
requirements of the RFO with the offeror’s responses. Emphasis should be placed on previous
performance/experience records and cost effectiveness. Each evaluator will rate the Components, using
scoring guidelines provided above to distinguish between good, average, and poor response The Review
Team will use this form to rank offers. In order to rank the offers into a first, second, and third choice, the
scores recorded on this form are used to weigh the offers from potential providers.
                                                                                   Review Team Member Signature and Date
RS Request for Offer
Ranking List (RS172)
                             Georgia Department of Labor
                Rehabilitation Services – Vocational Rehabilitation Program

                               OFFER RANKING LIST

                     Reference RFO #

Rank: FIRST

Offeror Name
Cost
Comments




Rank: SECOND
Offeror Name

Cost

Comments




Rank: THIRD
Offeror Name
Cost
Comments




                    Name and Signatures of Review Team Members




           (List Names in Spaces Above)               (Sign & Date in Spaces Above)
Comprehensive Evaluation/Profile
      Referral (RS046)
                                         Georgia Department of Labor
                          Rehabilitation Services - Vocational Rehabilitation Program

                    COMPREHENSIVE EVALUATION/PROFILE REFERRAL FORM

Vocational Evaluation, Limited            Comprehensive Vocational Profile Completer           Vocational Evaluation Complete
         (05602)                                      (05610)                                              (05600)

                                                              Date
Client Name:                                                  Client Number:               Social Security Number:

Street Address:                                                      City, State, Zip:                          Phone #:


Sex:      Male        Female      Race:                              Age:                 Date of Birth:

Primary Disability:

Secondary Disability:
Functional Limitations:



School:                                       Contact Person at School:                                    Phone #:

List Medications:




Comments/Special Requirements/Accommodations Needed:




Rehabilitation Team Referral Questions:




Counselor Name:                                                           Caseload #:          Telephone #:

Attachments as appropriate: (i.e. Client's VR Program Application, Case Notes, School/Medical/Psychological Records, etc.):
Lunchtime Supervision Services
                                     Georgia Department of Labor
                                   Vocational Rehabilitation Program
                              CRP Lunchtime Supervision Services Procedures


PROCEDURES:

The Vocational Rehabilitation Program (VRP) will pay for 30 minutes of a client’s lunchtime break if
he/she receives services from CRP staff during this time. In order for this to occur, the following
procedures must be followed:

A.     1. The CRP must have a written procedure in place; and
       2. A record or report of lunchtime services by client must be maintained OR
          an entry of services must be entered in the client’s file.

B.     Compensation for group services may be allowed during the lunchtime period if provided in
       accordance with item A above.

C.     Invoicing –Lunchtime services must be billed or recorded on the formal Invoice Detail Report as
       follows:


        RS Service                        Facility Service Item Code              Fee       Per Unit of Measure
                                            (Effective: 03/01/2005)                       (Person, Hour, Day, etc.)
        LUNCHTIME                                    00177                       $ 5.00             Day
        SUPERVISION/SERVICES
        Outsourcing Manual Reference
        #4004.00
        Defin ition of Service: This service provides for the supervision of clients and/or for the provision of
        services during the lunchtime period of up to 30 minutes per day when appropriate.

        Travel Provisions: Provider travel is not authorized for this service.



D.     Pre-Authorizations for Contractual Services – The need for this service cannot be reasonably pre-
       determined. Hence, the pre-authorization requirement for this service is waived.

The Regional Contracts Specialist will provide guidance to the CRP in regard to this service. In efforts to
properly manage the provision of this service, the Reg        Director and/or the Regional Contracts
Specialist will discuss issues and/or potential issues with the CRP as appropriate.

_____________________________________________________________________________________
Updated May 25, 2007
Employment Skills Training
Curriculum Evaluation Form
                         GEORGIA DEPARTMENT OF LABOR
                                             REHABILITATION SERVICES
                                    Vocational Rehabilitation Program/Business Unit
                         1700 Cen tury Circle NE * S uite 300 * Atlan ta, Georgia 30345-3020
             (404) 638-0377 * Fax (404) 486-0197 * TTY (404) 486-6333 *http://www.vocrehabga.org

M ICHAEL L. T HURMOND
    COMMISSIONER

                                    Business Unit Memorandum

         Memorandum Number:                     03.13.2008.05
         Procedure Name:                        Employment Skills Training Curriculum Evaluation
                                                Form
         Contact Person:                        Sharon Angel, Business Unit Manager
                                                Patricia Joseph, Provider Standards Specialist
                                                Deidre Mosely, Providers Standards Coordinator

         Date Approved:                         March 13, 2008
         Date Distributed:                      March 13,2008
         Date Effective:                        March 17, 2008
         Date Last Amended:
         Date of Next Review:                   March, 2009
         Related Policies:                      CSPM § 453.0.00

         Related Procedures:                    OSM §      5003.00

         Reading References:



         Distribution:                          Vocational Rehabilitation Leadership Team (VRLT)
                                                Rehabilitation Unit Managers (RUM’s)
                                                Regional Contract Specialist (RCS’s)


        1. Overview:
        This evaluation form will be utilized by the Regional Contract Specialist and Provider Standards
        Specialist when reviewing all new skills training curr          This tool will document the
        appropriateness and the approval of the provider for the identified service.
2. Procedure:
• The Regional Contract Specialist will discuss all new curriculums with his/her Regional
   Director and get their approval.
• If the Regional Director does not support the new skil     aining as a reasonable and
   appropriate option for VR clients, the Regional Contract Specialist will notify the provider and
   no further review is required.
• If the new Skills Training Curriculum is a reasonable and appropriate option for VR clients, the
   Regional Contract Specialist will review and document his/her findings by utilizing the
   attached form.
• All Skills Training Curriculums must include the standards listed on the Evaluation Form.
• Upon completion of the curriculum review, the Regional Contract Specialist will forward the
   form and the curriculum to the Provider Standards Specialist.
• The Provider Standards Specialist will review all documentation within 10 business days and
   provide the Regional Contract Specialist with a recommendation for the following:
   Conditionally Approved/Contingent upon Supporting Documentation; Approved; or Not
   Approved.
• If conditionally approved, the attached form will be mailed to the Regional Contract Specialist
   with specific notation of what additional supporting documentation is required.
• Once the specific information has been received and revie wed by the Regional Contract
   Specialist, the information will be forwarded to the Provider Standards Specialist for final
   approval.
• The Provider Standards Specialist will document in writing within 5 business days that the
   curriculum has met all VR standards and will be given final approval.
• The provider will be notified by the Regional Contract Specialist and the negotiation of fees
   will be handled at the regional level.
• The Provider Standards Specialist will provide technical assistance as needed during the
   negotiation stage.
• A copy of the evaluation form will be maintained at the regional level and a copy in the
   Business Unit/Provider Standards/Curriculum file.
          Employment Skills Training Curriculum Evaluation Form
   Name of Employment Skills Provider: __________________________________________________

   Name of Employment Skills Training: __________________________________________________

   Date RCS
   received:
   VR Standards                                                     RCS Comments
   Curriculum specifies the length of training time. Indicates
   how long the class will last. Gives a specific timeframe. Ex.
   Monday-Friday 9:00 a.m. to 3:00 p.m. for six weeks for a
   total of 240 hours
   Curriculum includes the total cost for training



   Curriculum includes the average wages



   Training program offers a certificate, diploma, etc.



   Curriculum includes the credentials of the instructor



   Curriculum contains a detailed schedule with dates of what
   topics will be discussed, number of hours assigned to each
   topic and who will teach each topic

   Curriculum lists all the topics or areas to be covered on each
of day of training and the method of instruction


   Curriculum specifies the number of hours that are needed for
   each topic to be covered. Ex. Icebreakers & Program
   Introduction 2 hours, Week 1, Day 1

   Curriculum specifies what will be accomplished in each
   module and/or training program. Ex. the objectives must be
   stated for each module as to what the module will teach

   Curriculum indicates what materials are being used each day,
   during what time, and on what day of the week. Ex. Hands
on Building: Use of Hand and Power Tools, Week 2, Day 3.
Tools to be used: power drill, hand saw 1:00 -3:00 Build
Birdhouses

Curriculum describes the performance standards to measure
progress


Curriculum describes the type of evaluation that the client
must take in regards to the training they are receiving. Ex.
class-room observation, hands on instruction, monthly
progress reports, tests

Facility or Service Provider describes how they obtained
their requirements for the curriculum. Ex. websites, other
facilities, etc.

Curriculum includes the minimum amount of
education/experience required for individuals to receive the
training

Curriculum identifies if guest lectures, field trips, etc. will
occur during training


Curriculum identifies job related work behaviors that will be
addressed during the training


Curriculum identifies safety and health procedures related to
the occupation of the training program


Training objectives are clearly identified




RCS Signature/Date Review Completed:


Date Received by Business Unit:


Business Unit Recommendation:                                     ? Conditionally Approved Contingent
                                                                    Upon Receipt of Supporting
                                                                    Documentation
                           ? Approved

                           ? Not Approved
Business Unit Comments:



Business Unit Signature:
  Homemaker Duties
Assessment Chart (RS047)
                                                  Georgia Department of Labor
                                     Rehabilitation Services - Vocational Rehabilitation Program

                                    HOMEMAKER DUTIES ASSESSMENT CHART

                                                            Will this be
                                                            his/her primary   Current Skill/Ability Level for this duty
 Major Categories – Duties                                  responsibility?
                                                                                               Can          Needs Assistive
                                                            YES      NO       Adequate                                        N/A
                                                                                               Learn        Technology
 House cleaning activities. Must perform a majority of
 the following 7 duties regularly (weekly): Dust; Sweep;
 Vacuum; Mop; Change bed linen; Pick-up/wipe-up;
 Scrub sinks & showers & tubs & toilets.
 Meal Preparation Activities. Must perform a
 majority of the following 7 duties regularly (daily):
 Plan daily menu; Shop for food items; Prepare food
 (clean, chop, slice & peel); Cook & serve food; Clean-
 up cooking & eating area; Wash dishes & cooking
 utensils; Put up dishes and utensils.
 Manage Household Budget Activities. Must perform
 a majority of the following 5 duties regularly: Plan
 budget; Pay bills, Pay daily living expenses; Keep
 records; Stay within budget plan.
 Home Maintenance Activities. Must perform a
 majority of the following 3 duties regularly: Identify
 safety or repair needs; Arrange for repairs (or make
 repairs); Oversee general maintenance and repairs.

 Laundry Activities. Must perform a majority of the
 following 7 duties regularly: Gather laundry; Sort
 items; Wash (hand or machine); Dry (line or machine);
 Iron; Fold; Mend; Put items away.
 Yard Work Activities. Must perform a majority of
 the following 5 duties regularly: Mow the lawn, Trim
 edges, Prune trees and shrubs, Rake yard, Pick-up
 trash, dead leaves and grass clippings

 Child Care Activities. Must perform a majority of the
 following 8 duties regularly (daily): Bathe child, Dress
 child, Feed child, Provide personal hygiene, Provide
 safety, Nurture (hold, hug, sing, play, read, laugh),
 Coordinate and oversee medical care, Assist with
 schoolwork activities.


Directions for using the Homemaker Duties Assessment Chart

A vocational goal of “Homemaker” may be established if, after completing the assessment above, it is determined
that the qualified individual:
          1. Will have primary responsibility for 4 or more of the major categories of listed duties, AND
          2. Is deficient in 3 or more of the indicated primary responsibilities , AND
          3. Would be able to perform the required duties adequately if given VR work plan
              serv ices.
THIS FORM MUST BE USED IN COMPLIANCE WITH CSPM 510.2.01B5
    Client Training
Progress Report (RS070)
                                                    CLIENT TRAINING PROGRESS
                   Georgia Department of Labor
                   Rehabilitation Services - Vocational Rehabilitation Program



            Training Site:
TRAINEE:                                                              For the Month of               Year
PERSONAL HABITS                    RATING*                                           COMMENTS
 Personal Hygiene              E     S   N
 Dress/Neatness                E     S   N
 Relationships with:           E     S   N
    Supervisor(s)              E     S   N
    Co -Workers                E     S   N
WORK HABITS                    E     S   N
 Attendance                    E     S   N
 Punctuality                   E     S   N
 Follows Instru ctions         E     S   N
 Follows company rules         E     S   N
 Follows safety rules          E     S   N
 Learns subject matter         E     S   N
 Learns from mistakes          E     S   N
 Handles job demands:          E     S   N
    Physical                   E     S   N
    Emotional                  E     S   N
 Use of tools/equipment        E     S   N
 Quantity of work              E     S   N
 Quality of work               E     S   N
 Other (specify):


Overall progress            E    S      N
                      *Key: E = Excellent, S = Satisfactory, N = Needs Improvement
                                                 Hours Worked by Trainee
      Sun           Mon                Tues                Wed               Thurs       Fri        Sat       To tal




                                                                                 Total Hours For This Month
   I certify that the trainee has worked these hours.
   Signature of Trainer:
Job Coach Monthly Training Progress
          Report (RS071)
                                          Georgia Department of Labor
                               Rehabilitation Services – Vocational Rehabilitation Program

                         JOB COACH MONTHLY TRAINING PROGRESS REPORT

Client Name:                                       Case Number                                Date

Job Coach(s) Name:

Job Site:

Summary of Client’s Progress for the Month of

Please address the services identified in the Supported Employment Level Payment Form.

Progress/Strategies:




Problems Encountered:




Employer Issues:




Services/Actions Needed From RS:




Comments:




                                                                                     Service Provider Representative
Job Coaching Timesheet
 (Short Term) (RS073)
                                       Georgia Department of Labor
                            Rehabilitation Services – Vocational Rehabilitation Program

                             JOB COACHING TIME SHEET (Short-Term)

             JOB COACHING (Short-Term)                                          POST EMPLOYMENT

 Client:                                                  RS Case Number:
 RS Counselor:                                            Job Coach:
 Service Provider
 Month:                                                   Year:


                                               Total                                               Total
                    A.M.         P.M.                                      A.M.           P.M.
      Date                                     Daily           Date                                Daily
                    Hours        Hours                                     Hours          Hours
                                               Hours                                               Hours
 1                                                        16
 2                                                        17
 3                                                        18
 4                                                        19
 5                                                        20
 6                                                        21
 7                                                        22
 8                                                        23
 9                                                        24
 10                                                       25
 11                                                       26
 12                                                       27
 13                                                       28
 14                                                       29
 15                                                       30
                                                          31
                                                                          Total Numbe r of Hours

 Client’s Employe r:                                                   Job Title:
 Employer’s Address                                                    Start Date:
 Number of Hours Client Wo rked Per Week:                              Salary:    $
 Job Coach Signature                                                   Date:
 Provider Representative Signature:                                    Date:
 ******************************************************************************
   Total Hours Submitted:        at $          per hour =


Final Bill? Yes     No
 Provider Representative Signature:                                                   Date:
 RS Counselor Signature:                                                              Date:
           Job Coaching
(Short Term/Post Employment Progress
          Report) (RS074)
                                    Georgia Department of Labor
                   Rehabilitation Services (RS) – Vocational Rehabilitation Program (VRP)



      JOB COACHING (Short Term)/POST EMPLOYMENT PROGRESS REPORT
                           Job Coaching (Short Term)                 Post Employment

Client:                                                              VRP Case #:
VRP Counselor:                                                       Job Coach
Service Provider
Month:                                                                     Year:



 DATE                                           PROGRESS NOTES
              Staffed case with Service Delivery Work Team.




                                                                       Provider Representative Signature

                                                              Date                     Page           of
     On the Job Training
Participant Agreement (RS078)
                                             Georgia Department of Labor
                                                  Rehabilitation Servic es
                                             Vocational Rehabilitation Program

                                              ON-THE -JOB TRAINING
                                            PARTICIPANT AGREEMENT

Participant Name:                                              SS#:


The purpose of On-the-Job Training (OJT) is to provide you with an excellent opportunity to hire new employees while
saving substantially on payroll costs. It can be used to fill any job opening where short-term training is appropriate.


Below, you will find a list of responsibilities for the Vocational Rehabilitation Program, the participant, and the
business. Further information, which may be important for y            ow prior to deciding to participate, is available
from our Fact Sheet. (attached)


The Vocational Rehabilitation Program agrees to:

       1. Reimburse the employer/trainer one-half the agreed upon starting wage of the client/trainee for up to 40
          hours per week. No reimbursement may be authorized for overtime.
       2. In no case may training exceed 125 % of the established level/time for training as defined by the Dictionary
          of Occupational Titles (A salary supplement may not be authorized above SVP 4.)
       3. Monitor the client/trainee’s progress. Provide counseling and guidance when necessary.
       4. Provide required clothing/uniform and tools if client meets our guidelines.


Client/Trainee agrees to:

       1. Attend regularly, to be on time, and to stay on task.
       2. Follow company rules, break times, scheduling, and so forth.
       3. Develop the skills necessary to work with other people and to follow the supervisor’s instructions.
       4. Let the supervisor know if unable to attend work/training or if experiencing problems.
       5. Let the VR program know about work progress, changes, or problems.
       6. Remember that the company has no commitment to hire you, following the training, if you do not meet their
          expectations.
       7. Accept that you may receive an income tax form (IRS Form 1099 or W2) as a result of any training stipend
          received while participating in this program. Additionally, the training stipends received in this program
          may affect TANF and/or other benefits.
       8. Be rated on your job performance to assist you in learning good work habits and work skills.
       9. End employment if you violate company rules or do not comply with your responsibilities in the program or
          your Work Plan.


The Business/Employer agrees to:

       1. Provide the Vocational Rehabilitation Program with a Federal I.D. number so we can reimburse you for
          training fees.
       2. Place the client/trainee on the company payroll.
       3. Provide the client with the same benefits provided by the employer to all employees.
       4. Provide the VR Program with a written progress report on a monthly basis (see attached form.)
       5. Retain the client/trainee at the end of the training period as a full-time or part-time employee, if the client
          performs to the employer’s satisfaction during the tra            iod.
I have been given a copy of this information and I understand my responsibilities. I agree to participate in the service
of On-the-Job Training.



Client/Trainee Signature                                            Date


VR Counselor Signature                                              Date


Business Representative Signature                                   Date




       Job Title                                             DOT Code


       SVP                                                   Wage Amount
Provider Qualification Packet
   GEORGIA DEPARTMENT OF LABOR
Vocational Rehabilitation Program



Provider Qualifications Packet

Cover Letter
Application
Document Checklist
Sample Service Agreement
Provider Guidelines (Include only those service(s) guidelines requested by the
potential provider)
Map of Georgia (Service Areas)
             GEORGIA DEPARTMENT OF LABOR
               “I NSERT YOUR REGION LETTERHEAD INFORMATION ”

                             Rehabilitation Services
                        Vocational Rehabilitation Program
M ICHAEL L. T HURMOND
   C OMMISSIONER



July 1, 2007

Dear (Potential Provider’s Name):

Thank you for your interest in providing services to our clients. For you to
be considered as a provider there is a provider approval process to follow.
Once you have submitted the required forms and documentation, the process
will begin to qualify you and, if approved to add you to our Provider List.

This packet includes a documentation checklist and a provider application
form to be signed and returned. Please sign the application and Provider
Guidelines where indicated. Failure to submit complete and accurate
documentation will delay the qualification process.

If approved, I will be contacting you to negotiate fees and initiate a Service
Agreement. If for any reason your application is incomplete or denied, I will
also be contacting you.

Packet contents:

    •   Application
    •   Document Checklist
    •   Service Agreement
    •   Specific Service Guideline(s)
    •   Map of Georgia (service areas)
    •   Fingerprint cards (background check) with instructions

If you have any questions or need assistance, please contact me at the above
number.

Sincerely,


Regional Contracts Specialist
               GEORGIA DEPARTMENT OF LABOR
                                 REHABILITATION SERVICES
                               Vocational Rehabilitation Program

                    “INSERT YOUR REGION LETTERHEAD INFORMATION”


       M ICHAEL L. T HURMOND
           COMMISSIONER


                                      Provider Application

Individual or Company
Name_________________________________________________________
Address ______________________________________________________________________
City/State/Zip________________________________________ _______________________
Phone _______________________________________ Fax ____________________________
CEO/Owner ___________________________________ Title ____________________ _
E-mail ________________________________________ Phone _________________________
Social Security Number __________________________ Federal Tax ID Number ____________
Organization Type: Sole Proprietor ____ Corporation _____ S-Corp. _____ LLC _____
State of Incorporation? ______________________ Nonprofit? ___Yes ___No
Is your company owned by a parent company? ___Yes ___No
Parent Company Name __________________________________________________________
Parent Company Address ________________________________________________________
Parent Company Tax ID ________________________
Certifications: CARF? ___ Other?_________________________________________________
Services Requested to be Provided:
    1. _________________________________________________
    2. _________________________________________________
    3. _________________________________________________
    4. _________________________________________________

Company’s Web Site(s): _________________________________________________________
Company Contact ________________________________Phone Number __________________

Do you maintain an organizational chart? ___Yes (please attach) ___No

Do you have documented accessibility survey reports? ___Yes (please attach)   ___No

Signature:     ________________________________________________________________

Printed Name: ______________________________________________________ ________
Title: ___________________________________ Date: ______________________




       Note: Completion of this application does not imply or guarantee an
       agreement for services.
                               An Equal Opportunity Employer/Program
           GEORGIA D EPARTMENT OF LABOR
                           REHABILITATION SERVICES
                        Vocational Rehabilitation Program
             “INSERT YOUR REGION LETTERHEAD INFORMATION”


M ICHAEL L. T HURMOND
   C OMMISSIONER

                            Document Checklist
Below is a list of required documents and information needed to determine
your Provider qualifications. Please submit the items checked below and
return with your packet.


    q Completed and signed Application
    q Resume that includes educational history and work experience
    q Copies of University or College Degrees or Official Transcripts from
      Accredited Schools for staff as required
    q Copy of Certificate or License, e.g. CRC
    q Certificate of Insurance showing $2,000,000.00 per occurrence /
      $1,000,000.00 per person
    q Verification of Accreditation (where appropriate)
    q List of Materials and Equipment used to provide services
    q Sample Reports
    q Map of Areas Served (highlight by county of proposed service areas)
    q Completed Fingerprint Cards (contact your local sheriff or police to
      complete)
    q Other _____________________________________________
    q Other _____________________________________________
                        GEORGIA DEPARTMENT OF LABOR
                                        REHABILITATION SERVICES
                        10 Park Place South, S.E. • S uite 602 • Atlan ta, GA 30303-2928
                                     (404) 657-2239• Fax (404) 657-4731

M ICHAEL L. T HURMOND
    COMMISSIONER
                                                SAMPLE




                                   SERVICE AGREEMENT
                                                  Between

                                Georgia Department of Labor
                                Vocational Rehabilitation Program

                                                     And

                            Georgia Rehabilitation Group, Inc.
                                    20023 Maple Street, NE
                                 Atlanta, Georgia 30303-2928
                           (Hereafter referred to as “The Provider”)



Period of Agreement:

This Agreement has an effective date of July 1, 2007 and shall terminate on June 30, 2008
unless terminated earlier under other provisions of this agreement.

_________________________________________________________________________________
_

Services to be Provided:

  The Provider agrees to provide, for the Vocational Rehabilitation Program, the services
  contained in Annex A (dated July 1, 2007), attached hereto and made part of this Service
  Agreement. The Provider further agrees to all terms and conditions stated in this Service
  Agreement.




                                    An Equal Opportunity Emplo yer/Program
                                                  Page 1 of 4
                                                                                           GDOL/VRP – 02/16/06
Standards:

All services must be provided in accordance with Rehabilitation Services’ (RS’) Resources
Standards Manual and Interpretive Guide for Outsourcing Services . VR Work Teams using the
appropriate referral form will make referrals to the Provider. The VR Counselor using an
Authorization and Invoice (A&I) Form will preauthorize all services. The Provider will submit
invoice(s) for services, including actual mileage (if applicable), required reports and/or Client
Monthly Progress Reports to the assigned VR Counselor.

Any service provided or purchased by the Georgia Department of Labor Vocational Rehabilitation
Program must be necessary for assessment of Vocational Rehabilitation eligibility or needs or for the
client to reach the entry level of his/her vocational goal; therefore, all services must be work-related.

To receive payment, the Authorization Form must be completed and submitted by the Provider within
60 days of the last date of service. Authorizations will be processed for payment as soon as the
Provider has submitted necessary reports and any itemized invoices for services, with required
signatures.

Standardized Client File:

The Provider shall, at its expense, maintain standardized VR client files. The content of each file
shall include when applicable: Referral information; Vocational Evaluation reports; Individual Work
Plans; daily logs and monthly progress reports; copies of VR Authorization and Invoice documents
and/or Provider invoices.

Program Review:

The Provider agrees that VR Program staff will perform a program review annually. In addition, VR
Program staff may request access to client files and other appropriate records of client services and
activities.

The Provider also agrees to maintain an up -to-date detailed description (or curriculum) of each VR
service offered for VR Program staff’s information, program monitoring and program reviews. Each
description and/or curriculum must be consistent with the objectives(s) of the service.

Comprehensive General Liability Insurance:

The Provider shall, at its expense, procure a Comprehe              l Liability Insurance Policy,
including personal injury and personal liability coverage, in amounts of $2,000,000.00 per occurrence
and $1,000,000.00 per person.

Confidentiality of Information:

The Provider agrees that any information released from a case file shall be stamped with the
following: “Property of the Georgia Department of Labor, Vocational Rehabilitation Program. This
information has been disclosed to you from records whose confidentiality is protected by federal and
state law. Any further disclosure by you is prohibited.” [CSPPM 120.2.02].

 Client confidential information shall be released only in accordance with state law, federal law and
 regulations or VR Program policy. Furthermore, information regarding clients and applicants is
 exempt
                                  An Equal Opportunity Emplo yer/Program
                                                Page 2 of 4
                                                                                     GDOL/VRP – 02/16/06
from the Georgia Open Records Act (O.C.G.A. 50-18 -76) and from third party discovery in litigation
(O.C.G.A. 9-11 -34). CSPPM 118.1.02].

Any information that has been disclosed to the Provider is the property of the Georgia Department of
Labor, Vocational Rehabilitation Program. This information has been disclosed from records whose
confidentiality is protected by federal and state law. Any further disclosure by Provider is prohibited.

Any information generated by the Provider as a product of this agreement may only be disclosed
directly to the Georgia Department of Labor, Vocational Rehabilitation Program.

Criminal Records Investigation:

A.     The Provider agrees that, for the filling of positions or classes of positions that provide direct
       services, supervision and/or custodial responsibilities for clients, applicants shall undergo a
       criminal record history investigation. This investigation will include a fingerprint record
       check pursuant to the provisions of Section 49-2-14 of the Official Code of Georgia
       Annotated. In order to initiate this requirement, the Department will provide the forms, which
       will include the required data from the applicant. The Provider agrees to obtain the required
       information (which will include two proper sets of fingerprints on each applicant) and
       transmit said fingerprints directly to the Georgia Crime Information Center, together with the
       fee as required by said Center for a determination made pursuant to Section 49- 2-14 of the
       Official Code of Georgia Annotated or any other relevant statutes or regulations.

B.     After receiving the information from the Georgia Crime Information Center or any other
       appropriate source, the Department will review any derogatory information and, if the crime is
       one that is prohibited by duly published criteria within the Department, The appropriate
       Regional Contract Specialist will be notified. The Regional Contract Specialist will ensure
       that the Provider is informed, and the individual so identified will not provide services to
       clients under the agreement.

Amendment to Service Agreement:

This agreement, including the “Services to Be Provided” contained in Annex A, may be amended,
pending mutual agreement. Under such terms, a modified agreement must be signed by both parties,
effective on a date subsequent to approval by both parties.

Option Renewal of Service Agreement

This Service Agreement has an effective beginning date of July 01, 20       and shall terminate on June
30, 2008, unless terminated earlier under other provisions of this agreement. The Department shall
have the option, exercisable in its sole discretion depending on satisfactory performance and
availability of funds, to renew this service agreement for up to four (4) annual renewal periods.

Termination of Service Agreement:

This agreement may be cancelled or terminated by either party for its convenience without cause, at
any time, with a thirty (30) day advanced written notice.
_________________________________________________________________________________



                                  An Equal Opportunity Emplo yer/Program
                                               Page 4 of 4
                                                                                    GDOL/VRP – 02/16/06
Service Provider Information:

Georgia Rehabilitation Group, Inc.
20023 Maple Street, NE
Atlanta, Ga. 30303 -2928
Point of Contact: Donna Edwards
Tel: 404/666 -XXXX
Fax: 404/666 -XXXX
E-Mail: __________
Provider # 9011111


APPROVALS:

________________________________                    ________________________________
Signature            Date                           Signature                   Date
Donna Edwards                                       XXXXXXXXXX
President/CEO                                       Regional Contract Specialist
Georgia Rehabilitation, Inc.                        GDOL / Vocational Rehabilitation Program


                                                    ______________________________________
                                                    Signature                Date
                                                    XXXXXXXXXX
                                                    Director, Region YY
                                                    GDOL / Vocational Rehabilitation Program



ATTACHMENT: (1)     ANNEX A: S ERVICES TO BE PROVID ED, DATED JULY 1, 2006




                                An Equal Opportunity Emplo yer/Program
                                             Page 4 of 4
                                                                             GDOL/VRP – 02/16/06
     Catoos
     a                               Fannin                 Towns          Rabun                                   Georgia
                                                            2
                     Murray                        Union
Walker Whitfield
                                Gilmer
                                                                H
                                                                ab                                           Department of Labor
     1         Gordon
                                                  Lumpkin White er
                                                                sh
                                                                a             Stephens                        Vocational Rehabilitation
                               Pickens                          m
                                              Dawson Hall             Banks Franklin Hart                             Program
    Floyd
               Bartow         Cherokee        Forsyth                                                            Regional Offices
    Polk
                               3A                           Barrow
                                                                     Jackson
                                                                                Madison
                                                                                                  Elbert


                         Cobb                  Gwinnett                   Clarke Oglethorpe
              Paulding
  Haralson                               DeKalb             Walton
                                                                        Oconee
                                                                                 5                  Wilkes Lincoln


    Carroll
                  Douglas
                             3B       Cl
                                                     R
                                                     oc
                                                     kd
                                                                       Morgan
                                                                                 Greene   M
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                            Fulton    ay             al Newton                            c Columbia
                                      to             e                                    D

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              Coweta
                                   Henry
                              Fayette n
                                              Jasper     Putnam
                                                                            Warren
                                                                                   Gl ie
                                                                                         uff
                                                                                               Richmond

                                                                                                                     7
                             Spalding Butts                        Hancock         as
                                                                                   co
               Meriwether                                                          ck
      Troup                Pike Lamar              Jones     Baldwin                 Jefferson         Burke
                                        Monroe                           Washington
                           Upson
                                               Bibb           Wilkinson
                                                                       6                              Jenkins
                                                                                                                Screven
        Harris        Talbot           Crawford                               Johnson
                                                       Twiggs                               Emanuel
          Muscogee
                               8
                              Taylor       Peach
                                                                     Lauren
             Chattaho
             ochee    Marion        Macon
                                                Houston Bleckley

                                                     Pulaski
                                                                                 Treutlen

                                                                                       M
                                                                                             9    Candler Bulloch     Effingham


                              Schley                                                   on
                                           Dooly                                            Toombs      Evans
                                                                                       tg
           Stewart                                              Dodge       Wheeler o                              Bryan
                      Webster Sumter                                                   m

        Quit-
        man
                                           Crisp         Wilcox
                                                                      Telfair
                                                                                       er
                                                                                       y
                                                                                                  Tattnall
                                                                                                                                       12
                         Terrell                                                Jeff        Appling                Liberty
            Randolph               Lee           Turner       Ben Hill         Davis                          Long

              Clay                                                             Irwin
                       Calhoun          Doughtery       Worth                                      Coffee     Bacon           Wayne        McIntosh
                                                                       Tift
               Early            Baker                                                                                Pierce
                                                                               Berrien      Atkinson

                             10            Mitchell                                                                                      Glynn

                                                                                             11
                  Miller                                 Colquitt        Cook                                 Ware        Brantley

                 Se                                                                      Lanier
                 mi                                                                                 Clinch           Charlton         Camden
                 no      Decatur         Grady        Thomas Brooks             Lowndes
                 le
                                                                                            Echols




Region   1: Rome             (7 06) 295-6407            Regi o n   7: Aug usta         (7 06) 6 50 - 5600
Region   2: G ai nesville    (770) 5 35 - 5930          Regi o n   8: Col um bus       (70 6) 649 -15 64
Region   3 A: Atl anta        (404) 657 - 379 9         Regio n    9: Dubli n           (478) 274 - 767 6
Region   3B: Atl anta        (404) 657 -2238            Regi o n   10: Al bany         (2 29) 430 - 446 1
Region   4: New nan          (7 70) 254-7210            Regi o n   11: Val do sta      (22 9) 333-2170
Region   5: Athens           (7 06) 354-3900            Regi o n   12: Savan nah        (912) 356 - 212 8
Region   6: M acon           (47 8) 751 -6257

				
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