ESBD_547773_1786134306569_Attachment 06-Chapter 09 and Sample Forms.pdf

Joe Esparza, Chairman and Commissioner

Representing Employers

Alberto Treviño III, Commissioner

Representing Labor

Brent Connett, Commissioner

Representing the Public

Steve Pier, Executive Director

Attachment 06 – Chapter 09 and Sample Forms

For

3202600208 Assistive Technology (AT)

Services for Customers with Visual

Impairments

3202600208 Assistive Technology - Attachment 06 Page 2 of 18

Contents Chapter 9: Assistive Technology Services for Customers with Visual

Impairments

9.1 OVERVIEW OF ASSISTIVE TECHNOLOGY SERVICES

9.2 Staff Qualifications and Training

9.3 Baseline and Post-training Assessments

9.4 Assistive Technology Evaluations

9.4.3 Outcomes Required for Payment

9.5 Assistive Technology Training

9.5.2 Process and Procedure

9.5.3 Outcomes Required for Payment

9.6 Assistive Technology Service Fees

9.7 Resources

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VOCATIONAL REHABILITATION STANDARDS

FOR PROVIDERS MANUAL

Chapter 9: Assistive Technology Services for

Customers with Visual Impairments

Contract Type: Assistive Technology – Customers with Visual Impairments

The contractor and contractor staff that provide services described in this chapter also must comply with Chapters 1–3 of the VR Standards for Providers manual.

9.1 OVERVIEW OF ASSISTIVE TECHNOLOGY SERVICES

Assistive technology (AT) services are for customers with visual impairments and services include AT baseline and post -training assessments, AT evaluation, and AT training. These services help a customer who is blind or has a significant visual impairment to make informed choices about which AT products meet his or her needs and how to use them.

Assistive Technology Evaluation and Keyboarding must be provided in person.

All other assistive technology services may be provided remotely when the VR counselor has indicated approval of remote service delivery on the VR1884, Assistive Technology Services for Customers with Visual Impairments Referral.

For more information, refer to VR-SFP 3.4.8 Remote Service Delivery.

To provide training at the trainer’s AT evaluation and training facility, the training area must be equipped with desks, monitors, and peripherals to use with a customer’s portable or easily transportable assistive technology products. The location where assistive technology services are provided must meet the individual accessibility needs of the customer, so the customer is able to fully engage in the service. See VR-SFP 3.3 Contractor Standards for

Physical Locations.

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Any request to change a Service Description, Process and Procedure, or

Outcomes Required for Payment must be documented and approved by the VR director, using the VR3472, Contracted Service Modification Request for Blind and Visually Impaired Services, before the change is implemented. The approved VR3472 must be maintained in the provider’s customer case file. For more information, refer to VR-SFP 3.4.11 Contracted Services Modification

Request.

For information on signatures refer to VR-SFP sections 3.2.14 Documentation and 3.2.16 Signatures.

All fees for services described in this chapter can be found in VR-SFP 9.6

Assistive Technology Service Fees.

9.2 STAFF QUALIFICATIONS AND TRAINING

Before services are provided to customers, the Assistive Technology service provider director must approve the VR3455, Provider Staff Information form completed by staff, and submit the approved form to the provider's assigned

Texas Workforce Commission VR regional program specialist. The VR3455, Provider Staff Information form must document qualifications and provide evidence of meeting all qualifications, such as transcripts, diplomas, reference letters, credentials, or licenses.

To provide AT evaluation or AT training, the provider’s staff member must pass the proficiency tests for AT evaluation and/or AT training.

Within 30 days of contract signature and 10 business days of an inventory change, the AT evaluation provider director must submit an inventory report of

AT products from the Evaluation Products List to the Assistive Technology Unit

(ATU) and the assigned RPSS.

9.2.1 Assistive Technology (AT) Evaluators

An AT evaluator must have:

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• completed high school or attained a GED;

• six months full-time work experience in a responsible position that provided services to individuals who are blind or have visual impairment;

• passed the Assistive Technology Unit’s (ATU) proficiency tests for AT evaluators and trainers; and

• be approved by ATU to provide AT evaluations.

An individual who attended a state school for the blind and visually impaired or who completed a state or federal training program for the blind and visually impaired, may substitute for work experience six months personal experience as an end-user of magnification or reader software including JAWS, ZoomText, and Fusion.

AT evaluation proficiency tests cover each of the AT evaluation product categories. An AT evaluator is approved to evaluate by product category after passing the evaluation proficiency test for each specific product category. For example, an AT evaluator who has passed the proficiency test for screen readers is approved to evaluate customers using products in the screen reader category.

To maintain approval to provide AT evaluations, an AT evaluator must be employed as an AT evaluator within one year of passing the proficiency tests.

An AT evaluator who is not employed as an AT evaluator for one year or longer must retest to regain approval status. A person who fails an ATU proficiency test must obtain permission to retest from the ATU manager.

For more information about ATU’s proficiency tests or to obtain a list of approved AT evaluators, contact ATU at VR.ATU@twc.texas.gov.

9.2.2 Assistive Technology (AT) Trainers

An AT trainer must have:

• completed high school or attained a GED;

mailto:VR.ATU@twc.texas.gov

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• six months full-time work experience in a responsible position that provided services to individuals who are blind or have visual impairment;

• passed the Assistive Technology Unit’s (ATU) proficiency tests for AT trainers; and

• be approved to provide AT training by ATU.

An individual who attended a state school for the blind and visually impaired or who completed a state or federal training program for the blind and visually impaired, may substitute for work experience six months personal experience as an end-user of magnification or reader software including JAWS, ZoomText, and Fusion.

An AT trainer is only approved to train in specific products for which the trainer has passed a proficiency test. When a product significantly changes, an AT trainer must pass an updated category proficiency test to continue training in that product.

To maintain approval to provide AT training, an AT trainer must be employed as an AT trainer within one year of passing the proficiency tests. An AT trainer who is not employed as an AT trainer for one year or longer must retest to regain approval status. A person who fails an ATU proficiency test must obtain permission to retest from the ATU manager.

For more information about ATU’s proficiency tests, to schedule a test, or to obtain a list of approved AT trainers, contact ATU at VR.ATU@twc.texas.gov.

9.2.3 Annual Training

Assistive technology (AT) evaluators and trainers must attend the annual

Train-the-Trainer seminar for AT service providers presented by the Assistive

Technology Unit (ATU). VR does not pay or reimburse the AT service provider or the provider’s staff members for costs associated with required training or testing.

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If an AT evaluator or AT trainer is unable to attend the Train-the-Trainer seminar, the provider service director must request that the requirement be waived or postponed or that the trainer be allowed to attend an alternate training approved by ATU. The request must be documented and approved by the VR director using VR3490, Temporary Waiver of Staff Qualification.

For more information about ATU’s required annual training, contact ATU at VR.ATU@twc.texas.gov.

9.3 BASELINE AND POST-TRAINING ASSESSMENTS

The following outlines the service description, procedures, and payment requirements for Baseline and Post-training Assessments services.

9.3.1 Baseline and Post-training Assessments Service Description

A VR counselor must purchase a baseline assessment when purchasing training services. A VR counselor can purchase a baseline assessment from an

AT evaluator or AT trainer as a separate service without purchasing other services.

The baseline assessment is used to measure the customer’s ability to use technology. Completion of the post-training assessment is the final step in the

AT training process and is used to report progress and to estimate potential training needs.

The results of the baseline assessment help the AT trainer modify training to meet the customer’s unique training needs. Combined with the post-training assessment, it provides a point of comparison to measure the customer’s progress. An AT evaluator can also use the results of a baseline assessment to recommend training in a VR1886, Assistive Technology Evaluation.

The baseline assessment and post-training assessment must be provided as indicated in VR1884, Assistive Technology Services for Customers with Visual

Impairments Referral or the service authorization. Remote services must be

3202600208 Assistive Technology - Attachment 06 Page 8 of 18 provided following VR-SFP 3.4.8 Remote Service Delivery. The trainer must document the results of the baseline assessment and post-training assessment in VR2902, Assistive Technology Training Baseline Assessment and Post-training Assessment.

9.3.2 Process and Procedure

To authorize services for a customer, the VR counselor sends the AT evaluator or AT trainer a referral packet that includes:

• the VR1884, Assistive Technology Services for Customers with Visual

Impairments Referral; and

• an EAS report or basic consultation report.

The AT evaluator or AT trainer must not provide services until the AT evaluator or AT trainer receives a referral packet with a service authorization.

The AT evaluator or AT trainer must:

• maintain a one-AT evaluator-to-one-consumer or one-AT trainer-to-one-customer ratio;

• document observations from the assessment in VR2902, Assistive

Technology Training Baseline Assessment and Post-training Assessment;

and

• sign the original VR2902.

9.3.3 Outcomes Required for Payment

The AT evaluator or AT trainer documents the required information in VR2902, Assistive Technology Training Baseline Assessment and Post-training

Assessment to verify that the AT evaluator or AT trainer:

• delivered the service as indicated in VR1884, Assistive Technology

Services for Customers with Visual Impairments Referral;

• delivered training without exceeding the one-AT evaluator to customer or

3202600208 Assistive Technology - Attachment 06 Page 9 of 18 one-AT-trainer-to-one customer ratio;

• provided all necessary accommodations and compensatory techniques necessary to enable the customer to participate in the assessment;

• measured and documented the customer's performance, skills, and progress; and

• completed a post-training assessment.

The AT evaluator or AT trainer must submit a completed report within 10 business days from the completion date of the assessment to the customer's

VR counselor.

Payment for the baseline assessment is made when the VR counselor approves a complete, accurate, signed, and dated:

• VR2902, Assistive Technology Training Baseline Assessment and Post-training Assessment completed for the Baseline Assessment; and

• an invoice.

Payment for the post-training assessment is made when the VR counselor approves a complete, accurate, signed, and dated:

• VR2902, Assistive Technology Training Baseline Assessment and Post-training Assessment completed for the Post-training Assessment;

• VR2868, Assistive Technology Training Report; and

• an invoice.

An assessment is an outcome-based service. The VR counselor cannot pay for incomplete services. All topics in the service description and service authorization must be addressed.

9.4 ASSISTIVE TECHNOLOGY EVALUATIONS

To ensure effective and measurable training outcomes, baseline and post-training assessments are required. This section outlines the procedures, 3202600208 Assistive Technology - Attachment 06 Page 10 of 18 documentation, and deliverables associated with these assessments.

9.4.1 Assistive Technology Evaluations Service Description

An assistive technology (AT) evaluation provides a VR customer an opportunity to compare AT products under the unbiased guidance of an AT evaluator. The

AT evaluation enables the customer to make informed choices about which products might best help the customer succeed in work, school, or vocational training.

An AT evaluation must include:

• an interview,

• an assessment,

• a post-evaluation discussion, and

• documentation.

A baseline assessment is not required for an AT evaluation.

The AT evaluator documents the evaluation results in VR1886, Assistive

Technology Evaluation.

9.4.2 Process and Procedure

The VR counselor sends the AT evaluator a referral packet with the following:

• VR1884, Assistive Technology Services for Customers with Visual

Impairment Referral;

• an Employment Assistance Specialist (EAS) report or a basic consultation report (if required), and

• service authorization.

An EAS report or basic consultation report is required for all AT evaluations except those limited to handheld magnifiers.

The AT evaluator must:

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• provide AT evaluation in person at the AT evaluator’s facility;

• maintain a one-AT evaluator-to-one-customer ratio;

• limit the AT evaluation to product categories listed in the employment assistance specialist (EAS) report or basic consultation report;

• show at least two products per category unless the product is in a category of its own on the Evaluation Products List (EPL);

• discuss the results of the AT evaluation and review the customer’s product selections with the customer;

• answer questions the customer has regarding the evaluation process and/or the products the customer selected; and

• document the AT evaluation in VR1886, Assistive Technology Evaluation.

The AT evaluator and customer must sign the original VR1886, Assistive

Technology Evaluation.

The AT evaluator must not suggest to the customer that the VR counselor or the customer’s employer will purchase a product.

For a copy of the latest Evaluation Products List refer to 9.7 Resources.

9.4.3 Outcomes Required for Payment

The AT evaluator documents the information required by the service description on the VR1886, Assistive Technology Evaluation to show that the

AT evaluator:

• provided the AT evaluation in person at the AT evaluator’s facility without exceeding one-evaluator-to-one-customer ratio;

• documented the results of the AT evaluation in VR1886, Assistive

Technology Evaluation; and

• indicated clearly which products the customer selected.

An AT evaluation is strictly limited to the product categories indicated on the

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EAS report or basic consultation report. All product categories shown to a customer must be on the Evaluation Products List (EPL).

The AT evaluator must clearly indicate in the AT evaluation report if a customer refused to evaluate a product or product category listed on the EAS report or basic consultation report or if the customer requested to evaluate additional products.

The AT evaluator must not show additional categories to the customer without a new service authorization and revised EAS report or basic consultation report that indicates the additional categories.

The AT evaluator must submit to the customer’s VR counselor a completed report within 10 working days from the date of the AT evaluation.

The VR counselor pays for the AT evaluation after approving the report and receiving an invoice. The VR counselor approves only reports that are accurate, complete, and meet all service requirements including evaluation category limits indicated in the referral information.

An AT evaluation is an outcome-based service. The VR counselor cannot pay for incomplete services. All topics in the service description and service authorization must be addressed.

For a copy of the latest Evaluation Products List refer to 9.7 Resources.

9.5 ASSISTIVE TECHNOLOGY TRAINING

This section details the requirements and processes for providing Assistive

Technology (AT) training.

9.5.1 Assistive Technology Training Service Description

Assistive Technology (AT) training is a service provided by an AT trainer who teaches a customer how to use AT products, measures the customer’s progress, and reports the results of the training to the customer’s VR counselor. AT training helps a customer learn how to use specialized

3202600208 Assistive Technology - Attachment 06 Page 13 of 18 equipment, devices, and software designed specifically to mitigate the effects of significant visual impairment.

An AT trainer can provide keyboarding skills training in a facility using the trainer’s equipment and software with up to three customers per trainer or in a customer’s home with a one-trainer-to-one-customer ratio.

All other AT training must be provided:

• using the customer’s portable or easily transportable AT products at the

AT trainer’s authorized facility, or in the customer's home, school, or workplace depending on the customer’s needs; and

• with a one-trainer-to-one-customer ratio.

Keyboarding skills training must be provided in person. All other AT training may be provided remotely when the VR counselor indicates approval of remote service delivery in VR1884, Assistive Technology Services for Customers with

Visual Impairment Referral. For more information, refer to VR-SFP 3.4.11

Contracted Services Modification Request.

An AT trainer cannot provide more than eight hours of training per day per customer. Training can include trainer-guided individual practice time.

AT training includes:

• a baseline assessment;

• planning;

• training sessions with the customer;

• monthly reporting;

• a post-training assessment; and

• final training reporting.

The AT trainer documents:

• assessments result in VR2902, Assistive Technology Training Baseline

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Assessment and Post-training Assessment; and

• training results in the VR2868, Assistive Technology Training Report.

For a copy of the Assistive Technology Training Guide (ATTG) with a complete list of training subjects and descriptions refer to 9.7 Resources.

9.5.2 Process and Procedure

The VR counselor sends the AT trainer a referral packet with the following:

• VR1884, Assistive Technology Services for Customers with Visual

Impairment Referral;

• an employment assistance specialist (EAS) report or basic consultation report;

• VR1886, Assistive Technology Evaluation; and

• a service authorization.

The AT trainer uses the information in the referral packet, the Assistive

Technology Training Guide, and the customer’s baseline assessment results to modify training to meet the customer’s individual needs.

The baseline and post-training assessment are essential to planning and measuring the effectiveness of AT training and are purchased with all AT training.

All service authorizations for AT training must include a line item for each of the following:

• AT training by subject,

• baseline assessment; and

• post-training assessment.

A valid service authorization may include a line item for trainer-guided individual practice time.

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The AT trainer must review the referral packet and valid service authorization carefully and contact the VR counselor to report any missing or incomplete documentation. The trainer must not provide services until the VR counselor sends a complete referral packet with a valid service authorization.

If the AT trainer discovers a problem with the customer's equipment, hardware, or software that prevents the trainer from providing training, the trainer may spend up to two hours of training time troubleshooting the problem to resolve it. If the trainer is unable to resolve the issue within two hours, the trainer must contact the customer's VR counselor by email to report the problem and seek assistance. The trainer must document the details of the problem on the in VR2868, Assistive Technology Training Report, including the amount of time the trainer spent troubleshooting.

The AT trainer must document training results on the:

• VR2902, Assistive Technology Training Baseline Assessment and Post-training Assessment; and

• VR2868, Assistive Technology Training Report;

For a copy of the Assistive Technology Training Guide (ATTG) with a complete list of training subjects and descriptions refer to 9.7 Resources.

9.5.3 Outcomes Required for Payment

The AT trainer documents the information required by the service description in VR2902, Assistive Technology Training Baseline Assessment and Post-training Assessment, and VR2868, Assistive Technology Training Report, to verify the AT trainer:

• provided training without exceeding the trainer-to-customer ratio indicated in the Assistive Technology Training Guide (ATTG);

• provided all necessary accommodations and compensatory techniques to enable the customer to participate in the training;

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• measured and documented the customer's performance, skills, and progress; and

• completed a post-training assessment.

The trainer must submit the final training report within 10 business days from the date of the last service. The VR counselor pays the invoice after he or she verifies that all training objectives and outcomes are met, and approves the following required documentation:

• VR2902, Assistive Technology Training Baseline Assessment and Post-training Assessment;

• VR2868, Assistive Technology Training Report; and

• an invoice.

AT training is an outcome-based service. The VR counselor cannot approve required documentation that is incomplete. All topics in the service description and service authorization must be addressed.

If a customer fails to complete the training or fails to meet training objectives, a trainer may request payment for the training hours the customer completed by submitting the required training reports and an invoice. The trainer must explain why the training was unsuccessful.

9.6 ASSISTIVE TECHNOLOGY SERVICE FEES

The following section outlines the approved service fees for Assistive

Technology (AT) services.

9.6.1 Assistive Technology Service Fees Description

VR pays for AT services according to the AT evaluator- or AT trainer- to-customer ratio, subject, and location of service delivery.

A customer site includes a customer’s home, school, or workplace.

A facility is a service provider’s authorized AT services location.

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9.6.2 Assistive Technology Service Fees Table

The following table outlines the approved service fees for Assistive Technology

(AT) services.

Service Ratio Location Unit

Rate Hourly Rate

AT Evaluation 1:1 Facility $125 NA

AT Training 1:1 Customer site

NA $75

AT Training 1:1 Facility NA $40

Baseline Assessment 1:1 Customer site

$37 NA

Baseline Assessment 1:1 Facility $20 NA

Post-training Assessment 1:1 Customer site

$37 NA

Post-training Assessment 1:1 Facility $20 NA

Keyboarding Pre-training

Assessment 1:1

Customer site or facility

NA $5

Keyboarding Skills Training 1:1 Customer site

NA $20

Keyboarding Skills Training Up to

1:3 Facility NA

$10 per customer

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Service Ratio Location Unit

Rate Hourly Rate

Trainer-guided Independent

Practice Time 1:1

Customer site or facility

NA $10

9.7 RESOURCES

• Approved Trainers List

• Assistive Technology Training Guide

• Evaluation Products List

• Assistive Technology Unit Proficiency Tests https://www.twc.texas.gov/sites/default/files/vr/docs/assistive-technology-trainer-list-twc.xlsx https://www.twc.texas.gov/sites/default/files/vr/docs/assistive-technology-training-guide-twc.docx https://www.twc.texas.gov/sites/default/files/vr/docs/assistive-technology-evaluation-product-list-twc.xlsx https://www.twc.texas.gov/sites/default/files/vr/docs/proficiency-test-list-ptl-twc.xlsx

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Texas Workforce Commission Vocational Rehabilitation Services

Assistive Technology Services for Customers with Visual Impairments Referral

Customer Information

Service Requested:

VR Counselor Name:

Caseload Number:

Contact Number (include area code):

Trainer Name and Contractor Agency:

Date of Referral:

Customer’s Name:

Customer’s date of birth:

Customer’s Primary Language:

Customer’s street address:

City:

State:

ZIP Code:

Customer’s Contact Number (include area code):

Alternate Contact Number (include area code):

Best Day(s) to Contact (if any):

Customer’s Educational and/or Vocational Goal(s):

Visual Diagnosis:

Visual Acuity:

O D (right eye):

O S (left eye):

Visual Fields:

Other Additional Information:

Circumstances that May Impact Services

Secondary Disability:

If secondary disability is deaf blindness, what is the customer’s primary form of communication?

Level of Education:

Known Health Issues/ Safety Concerns:

Additional Information:

Customer’s Hardware and Software List the customer’s current hardware:

List the customer’s current software:

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AT Training Guide Topics

Select all check box(s) that apply and provide a description of the skill after the colon, if applicable.

Key Boarding Skills:

Setting up the Workstation:

Operating Feature, Function, and Maintenance:

Screen Readers, Screen Magnification, Braille Access, and Speech Recognition Access:

The Word Processor:

The Internet and the World Wide Web:

Viewing and Creating Microsoft PowerPoint Presentations:

Viewing and Creating Spreadsheets using Microsoft Excel:

OCR Software with scanner/cameras, stand-alone OCR Devices, and Braille Translation Software with Braille embossers:

Braille Note Takers:

Mobile Operating Systems:

Computer Skills and Mobile Operating System Skills Post Training Assessments:

Other:

Service Delivery Methods:

Assistive Technology Evaluation and Keyboarding must be provided in person.

VR Counselor approves all other AT training to be provided using the following delivery method:

(Note any exceptions in additional comments)

Only in-person

Only remotely

In person and/or remote as dependent on customer’s needs

Note: Remote service delivery must be face-to-face and/or real time interaction. Voiced telephone and text communication are not acceptable. (see SFP 3.4.8)

Additional Comments, if any:

Training Location(s)

Select the check box(s) below that apply.

Customer’s home/family home

Customer’s work site

Customer’s school or vocational training site

AT service provider’s facility

Unknown

Other (specify):

Additional Information Provided by TWC-VR at Referral

Assistive Technology Evaluation Report, if applicable

Other:

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Assistive Technology Evaluation

Instructions

Submit to the customer’s counselor or case manager and employment assistance specialist (EAS)when the customer has completed the evaluation. Email is preferred.

Note: AT evaluations cannot be provided remotely.

General Information

Facility: Customer first name: Last initial:

Evaluator: Vocational goal:

Counselor name: Type of evaluation:

VR caseload number: Date of evaluation:

Service authorization number: Case ID number (CID):

Assistive Technology

Assistive technology evaluations must be completed using two competing products. List the specific assistive technology products you used to complete the evaluation (below):

Interview Process—All Evaluations

Describe the customer’s work/school circumstances:

What is the customer’s current occupation including work-related tasks, or occupational goals?

What work-related or personal changes does the customer anticipate may affect the customer’s position or job-related tasks and goals?

Describe any samples of materials used by the customer at work or school you used for the evaluation.

If the customer is a student, provide the information you collected about the following, or indicate the information was in the referral documentation the counselor or case manager sent to you:

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The customer’s academic plans:

The customer’s degree program or course work:

The current customer’s year of school and anticipated graduation date:

Required or anticipated tasks, such as note taking, reading, etc.:

An assessment of how the customer is currently handling required tasks:

Description (Select Yes, No, or Not Applicable) Yes No N/A Comments

Enter the information you collected during the CCTV evaluation interview:

Is color identification critical to the customer’s job performance?

Does the customer use a computer on the job site or at home?

Enter the information you collected during the scanner evaluation interviews:

Did you explain the reason for a scanner evaluation? Describe

Did you ask if the customer is aware of other resources? Describe

Will the customer enter scanned documents into the computer?

Will the customer use the computer to manipulate scanned documents?

Does the customer have any needs for computer access in terms of speech or Braille access?

Does the customer have sample materials that need to be scanned?

Interview Process—Computer Applications

Indicate how you addressed the following issues during interviews for screen magnification devices, refreshable braille PC screen access devices, and screen review systems:

For a customer using a computer in his/her employment? Comments:

The type of computer the customer is using? Comments:

Any software? Comments:

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Any access equipment currently being used by the customer? Comments:

Discussion regarding job tasks and performance expectations? Comments:

A determination of the customer’s skill level for:

Typing speed? Comments:

Accuracy? Comments:

Keyboard familiarity? Comments:

For customer with previous computer experience:

Type of computer? Comments:

Software? Comments:

When and where the customer gained the previous experience?

Comments:

Previous experience acquired before the loss of vision? Comments:

Describe any previous experience the customer has with:

Computer access equipment? Comments:

Video magnifiers or similar devices? Comments:

Computer braille devices? Comments:

Refreshable braille PC screen access devices? Comments:

Synthesized speech devices? Comments:

Customer Performance

1. Describe the customer’s keyboarding skills (familiarity with the keyboard, typing speed (if assessed), ability to find keys by touch, etc.):

2. Describe the physical environment during the evaluation, and any effect it had on the customer’s vision (lighting, glare, etc.):

3. List or describe the sample materials the customer brought from home, work, or school, and used at the evaluation:

4. Does the customer have any low vision aids?

Yes No

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5. Describe the extent to which the customer uses low-vision aids available to him or her:

N/A

6. Describe any assistive techniques you saw the customer use to improve what he or she could see:

N/A

7. If the customer is blind (no light perception or no functional vision), describe how the customer takes notes, reads, writes, and performs other daily living skills:

N/A

8. If braille is the customer’s primary literacy medium, describe the customer’s braille reading speed:

N/A

Customer Interview Process

We discussed, and/or I verified, the following information at the customer interview:

1. The customer and I discussed the goals of the evaluation: Yes No The goals of the evaluation were as follows:

2. I (the evaluator) conducted a private interview with the customer to review the customer’s background and other referral information, including the EAS report, provided by the counselor at referral. Yes No

The following additional information was provided during the interview:

N/A

3. The customer verified the referral information is correct, or indicated where information was missing or incorrect:

Yes No

The following missing information was added:

N/A

The following information was corrected:

N/A

4. The customer verified the referral information about the customer’s known functional limitations is correct: Yes No

The following information regarding the customer’s known functional limitations was corrected:

N/A

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5. The referral information described all the customer’s physical limitations, secondary disabilities, or conditions that might interfere with the customer’s evaluation or future training: Yes No

The following additional physical limitations, secondary disabilities, or conditions that might interfere with the customer’s evaluation or future training were identified: N/A

6. The customer and I discussed the evaluation, the evaluation equipment, and training recommendations: Yes No

7. I explained how the evaluation report is used by the counselor to help determine whether to purchase assistive technology, and if so, which technology to purchase. Yes No

8. I informed the customer that the counselor would determine whether to purchase equipment, and which equipment to purchase based on the report: Yes No

9. I summarized my interview findings with the customer: Yes No

10. I observed the customer’s ability to use and benefit from the equipment I recommended: Yes No

11. I gave the customer an opportunity to ask questions about the evaluation before, during, and after the evaluation:

Yes No

12. The customer and I discussed the goals of the evaluation: Yes No The goals of the evaluation were as follows:

List any equipment problems that occurred during the evaluation.

1. Computer: N/A

2. Monitor: N/A

3. Printer: N/A

4. Software: N/A

5. Optical Character Reader (OCR) or scanner: N/A

Other: N/A

Service Limitations

I did not make any recommendations or discuss additional training time, equipment, or software upgrades with the customer or in the customer’s presence.

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I did not show the customer any products not indicated on the Employment Assistance Services (EAS) Consultation Report.

I did not allow anyone to observe the customer’s evaluation without the customer’s expressed permission.

I did not allow any observer to ask questions or make suggestions or comments during the evaluation process.

I did not install programs or equipment on the customer’s computer system without prior written approval from the customer’s counselor or case manager.

I did not solicit training, consultation, or referrals from the customer.

Training Recommendations

I recommend training on the following equipment:

To Be Completed by Provider

Services provided by (business name): Date:

Report completed by (evaluator): Date:

Provider Signatures

Assistive Technology Trainer Signature (Required for all providers) By signing below, I certify that:

• the above dates, times, and services are accurate;

• I personally facilitated all training, meeting all outcomes required for payment and documented the service, as prescribed in the VR- SFP and service authorization;

• Verification of the customer’s satisfaction and service delivery obtained as stated above;

• I maintain the staff qualifications required for an Assistive Technology Trainer as described in the VR-SFP or Service Authorization;

and

• I signed my signature and entered the date below.

Typed or Printed name:

Signature:

(See VR-SFP 3 on Signatures)

X

Date Signed:

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Director (only required for Traditional-Bilateral Contractors)

By signing below, I, the Director, certify that:

• I ensure that the services were provided by qualified staff, met all outcomes required for payment, and services were documented, as prescribed in the VR-SFP and service authorization;

• I maintain UNTWISE Director credential, as prescribed in VR-SFP;

Director Typed or Printed name:

Director Signature:

(See VR-SFP 3 on Signatures)

Select all that apply: UNTWISE Credentialed with ID:

VR3490-Waiver Proof Attached

VRS Use Only

If any question below is answered no or if the report or supporting documentation is missing or incomplete, return the invoice to the provider with the VR3460. Make a case note to document the results of the review and the date VR3460 was sent to provider, when applicable.

Technical Review to Verify Provider Qualifications (Completed by any VR staff such as RA, CSC, VR Counselor)

Director’s Credential:

UNTWISE website or attached VR3490 verifies, for the dates of service, the director listed above:

maintained or waived the UNTWISE Director Credential did not hold a valid UNTWISE Director Credential

Verification of Service Delivery

Technical Review (completed by any VR staff such as RA, CSC, VR Counselor)

Verified that the report is accurately completed per form instructions. Yes No

Verified that the service(s) was provided within service date of SA and as stated in the VR Standards for Providers and/or the SA.

Yes No

When applicable, verify a copy of an approved VR3472 is attached to the report. NA Yes No

Verified the trainer recorded training dates, times, and services accurately on this form. Yes No

Verified the trainer recorded signed the form. Yes No

Verified that the appropriate fee(s) was invoiced. Yes No

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Printed name of VR staff member making verification:

1. Date: 2. Date:

VR Counselor Review

Verified the trainer recorded the specific training services he or she provided to the customer and documented the customer’s progress he or she observed on this form.

Yes No

By typing or printing your name, the VRC verifies:

• completion of the technical review,

• services provided met the customer’s individual needs,

• services provided met specifications in the VR-SFP and on the SA, and

• customer’s or legally authorized representative’s satisfaction with services received.

Approve to pay invoice Do not approve to pay invoice

VR Counselor: Date:

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Assistive Technology Training Report

Provider Information

Provider:

Address:

City: State: ZIP Code:

Telephone: ( )

Fax Number:

Email Address:

Trainer:

Report Date:

Customer Information

Customer:

Address:

City: State: ZIP Code:

Telephone: ( )

Service Authorization Number:

Counselor Information

Counselor:

VR Office: VR Caseload Number:

Address:

City: State: ZIP Code:

Telephone: ( )

Summary of Services Provided

Date Total Hours Service Description

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Training Facts

Services were facilitated:

Only in-person

Only remotely

In person and/or remote as dependent on customer’s needs

Note: Remote service delivery must be face-to-face and/or real time interaction. Voiced telephone and text communication are not acceptable. (see SFP 3.4.8)

Training Report Narrative

Training Objectives:

Equipment Used in This Training Session:

Software Used in This Training Session:

Software/Hardware Problems:

Training Effectiveness:

Provider Signatures

Assistive Technology Trainer Signature (Required for all providers) By signing below, I certify that:

• the above dates, times, and services are accurate;

• I personally facilitated all training, meeting all outcomes required for payment and documented the service, as prescribed in the VR-SFP and service authorization;

• Verification of the customer’s satisfaction and service delivery obtained as stated above;

• I maintain the staff qualifications required for an Assistive Technology Trainer as described in the VR-SFP or Service Authorization; and

Signature: (See VR-SFP 3.11.1 Documentation and Signatures)

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Director (only required for Traditional-Bilateral Contractors) By signing below, I, the Director, certify that:

• I ensure that the services were provided by qualified staff, met all outcomes required for payment, and services were documented, as prescribed in the VR-SFP and service authorization;

• I maintain UNTWISE Director credential, as prescribed in VR-SFP;

Signature: (See VR-SFP 3 on Signatures)

Select all that apply: UNTWISE Credentialed with ID:

VR3490-Waiver Proof Attached

VRS Use Only

If any question below is answered no or if the report or supporting documentation is missing or incomplete, return the invoice to the provider with the VR3460. Make a case note to document the results of the review and the date VR3460 was sent to provider, when applicable.

Technical Review to Verify Provider Qualifications (Completed by any VR staff such as RA, CSC, VR Counselor)

Director’s Credential:

UNTWISE website or attached VR3490 verifies, for the dates of service, the director listed above:

maintained or waived the UNTWISE Director Credential did not hold a valid UNTWISE Director Credential

Verification of Service Delivery

Technical Review (completed by any VR staff such as RA, CSC, VR Counselor)

Verified that the report is accurately completed per form instructions Yes No

Verified that the service(s) was provided within service date of SA and as stated in the VR Standards for Providers and/or the SA

Yes No

When applicable, verify a copy of an approved VR3472 is attached to the report? NA Yes No

Verified the training was provided as indicated on referral (in person, remotely). Yes No

Verified training delivered without exceeding policy prescribed provider-to-customer ratio. Yes No

Verified the trainer recorded signed the form. Yes No

Verified that the appropriate fee(s) was invoiced. Yes No

Printed name of VR staff member making verification:

1. Date: 2. Date:

VR Counselor Review

Verified training objectives and status of wheter objective met or not met. Yes No

Verified there is a detailed narrative report of each training session that includes the customer’s performance, skills, time spent on each product and the customer’s progress towards objectives in the baseline assessement.

Yes No

Verified the AT trainer conducted the post-training assessment at conclusion of the training.

Yes No

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Verified the trainer recorded the specific training services he or she provided to the customer and documented the customer’s progress he or she observed on this form.

Yes No

By typing or printing your name, the VRC verifies:

• completion of the technical review,

• services provided met the customer’s individual needs,

• services provided met specifications in the VR-SFP and on the SA, and

• customer’s or legally authorized representative’s satisfaction with services received.

Approve to pay invoice Do not approve to pay invoice

VR Counselor: Date:

VR 2902 (06/22) Assistive Technology Training Baseline Assessment and Post-training Assessment Page 1 of 3

Assistive Technology Training Baseline Assessment and Post-training Assessment

General Information Customer name:

Evaluator name:

Date:

Assessment Type Select one of the following assessment types:

Baseline assessment Post-Training assessment

Assessment Subjects Select the subjects this assessment will measure:

Microsoft Windows Screen magnification

Microsoft Word Screen reader

Internet Spreadsheet

Notetaker Keyboard knowledge

Optical Character Recognition (OCR) Keyboarding speed (Typing speed)

Rating Scale For each subject below, enter a number to rate the customer’s demonstrated ability using the following scale:

• 0 = customer could not complete the task;

• 1 = customer completed the task with assistance (prompting or hints); or

• 2 = customer completed the task without assistance.

Calculate the sum of ratings and enter the customer’s score for subjects assessed.

For subjects not assessed, enter NA instead of a score.

Microsoft Windows Task Rating

1. Open the start menu.

2. Open a program.

3. Open Microsoft Edge.

4. Open the My Documents folder.

Microsoft Windows score:

Microsoft Word

Microsoft Word Basic Skills:

Task Rating

1. Open a blank document.

2. Change the right and left margins.

3. Run a spell check.

4. Save a document to My Documents.

5. Print a document.

Microsoft Windows Basic Skills score:

Microsoft Word Advanced Skills:

Task Rating

1. Create a table with 4 columns and 25 rows.

2. Create a page of address labels.

3. Use strike through formatting to cross out one sentence in a document.

Microsoft Windows Advanced Skills score:

Internet

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Task Rating

1. Open a browser.

2. Find the browser search and enter the word “job”.

3. Enter a web address.

4. Begin an Internet search using the word “job”.

5. Set a favorite/bookmark

6. Follow a link.

Internet Skills score:

Notetakers Notetakers Basic Skills:

Task Rating

1. Locate the power button and turn on the unit.

2. Change the speech parameters.

3. Locate and open a file.

4. Read the first sentence of a file.

5. Create a blank file.

6. Insert a new word into a file.

7. Delete a file.

8. Copy a file into an external disk drive.

9. Print a file.

Notetakers Basic Skills score:

Notetakers Advance Skills:

Task Rating

1. Set the date and time on the calendar.

2. Set an alarm using date and time.

3. perform a calculation and insert it into a document.

Notetakers Advanced Skills score:

Optical Character Recognition Task Rating

1. Open the scanner program.

2. Scan a document.

3. Read a scanned document.

4. Save a scanned document.

Optical Character Recognition score:

Screen Magnifiers Screen Magnifier Basic Skills:

Task Rating

1. Open the program.

2. Change the magnification level.

3. Change the foreground and background colors on the screen.

4. Locate the toolbar on the screen.

5. Change the speech speed.

Screen Magnifier Basic Skills score:

Screen Magnifier Advanced Skills:

Task Rating

1. Set a target.

2. Set the program to scroll text on the screen.

3. Set the program to automatically move from one section of the screen to another to fill in blanks, etc..

Screen Magnifier Advanced Skills score:

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Screen Readers Task Rating

1. Load the screen reader program.

2. Read the first sentence of a document.

3. Change the speed of the speech output.

4. Set the program to pronounce each word as typed.

Screen Readers Skills score:

Spreadsheets Spreadsheet Basic Skills:

Task Rating

1. Open a spreadsheet.

2. Enter data in the spreadsheet.

3. Create a formula to find the sum at the end of a column of rows populated with numbers.

4. Isolate a section of a spreadsheet and print it.

5. Save spreadsheet.

Spreadsheet Basic Skills score:

Spreadsheet Advanced Skills:

Task Rating

1. Create a pie chart from a worksheet.

2. Format the legend on the pie chart.

3. Create a hyperlink to another worksheet.

Spreadsheet Advanced Skills score:

Keyboarding Keyboard Knowledge:

Task Rating

1. Find home row.

2. Type name using upper- and lower-case letters.

3. Find Control A.

4. Find Alt A.

5. Find Escape.

6. Find Enter.

7. Find Delete.

8. Find Backspace.

9. Find 2 on the number row.

10. Find F2.

11. Find 5 on the number pad.

Keyboard Knowledge Skills score:

Keyboarding Speed (Typing Test):

Administer a typing test. Below, enter the word count totals. Net WPM = Gross WPM minus mistakes.

Net WPM: Gross WPM:

Signature Report completed by (print):

Signature:

VR3455 (11/23) Provider Staff Information Form Page 1 of 5

Provider Staff Information Form

Instructions:

• Each entity must have an accurate and current VR3455, Provider Staff Information Form, on file for all personnel (including contracted personnel) and the director appointed by the legal authorized representative that interact with TWC Vocational Rehabilitation customers under a TWC Vocational Rehabilitation contract.

• For response to an Electronic State Business Daily (EBSD) posting, follow the instructions in the ESBD posting; otherwise, submit updated forms to the Quality Assurance Specialist for VR (Q) or Regional Program Support Specialist (RPSS).

• Follow the instructions on the form and in the TWC VR Standards for Providers.

• The director on record with TWC and appointed by the entity’s legally authorized representative signs this form verifying the staff member's qualifications as documented in the VR Standards for Providers (VR-SFP) manual.

• Submit the updated form within 30 days of any of the following: after hiring staff, significant change in a staff member’s job duties, change in staff qualifications, or a staff member is separated from employment.

• Type all information on the form using a computer and obtain all required signatures.

• Complete all sections of the form. Record “N/A” (not applicable) if a question does not apply.

• Keep a copy of the completed the VR3455, attachments, and supporting documentation for your records.

Reason for Submission

Date of submission: Solicitation ID: or Contract #:

Application package

New hire Separation of staff person

Update of information (For example, qualifications change.)

Other: Specify:

Entity’s Information

Entity: The business that is requesting or has been granted the bilateral contract with TWC to provide services on behalf of VR customers.

Entity’s legal name:

Entity’s “doing business as” (DBA) name:

Provide at least one of the following:

Employer Identification Number (EIN) (9 digits, issued by IRS):

Last four digits of the sole proprietor’s Social Security Number:

Staff Person’s Information

For the purpose of this form, “staff person” refers to persons classified as employees or independent contractors working for the entity that has the TWC bilateral contract.

Staff person’s first name: Staff person’s last name:

Other names used:

Experience and Skills

VR3455 (11/23) Provider Staff Information Form Page 2 of 5

UNTWISE Endorsements held: N/A Autism Blind Brain Injury Other:

Describe your experience and skills working with individuals with disabilities, including…