Client Name: Date: ______

Staff Person Assigned:

Transition: Yes_____ No ____ Support Staff:_________________________

Referral and Application

Indicator Yes No

  1. Has the individual completed and signed (with parent/guardian if applicable) the Application Release for Services (34 CFR 361.41 (b)(ii)(2)(i))

  1. Has the individual expressed an intention of obtaining employment as the result of IDB services? (34 CFR 361.42 (4)

Reviewer Comments:

Eligibility (34 CFR 361.42 (a)(1)& (2) and 361.41(b)(1) (100% compliance Required)

Indicator Yes No

  1. Does the case record contain acceptable documentation to support that the individual has a visual impairment?

  1. Does the case record contain acceptable documentation that the individual’s impairment results in a substantial impediment to employment?

  1. Does the case record contain acceptable documentation that the individual requires VR services to secure, retain, advance in or regain employment?

  1. Was the determination of eligibility made within the required timeframes, including extensions if needed?

  1. If the decision was not made within the required timeframes were there exceptional and unforeseen circumstances delaying the eligibility decision?

  1. Was the client given an opportunity to meet and discuss the eligibility decision?

  1. If the individual has a physical or mental impairment, is there acceptable documentation to support the impairment?

  1. Was the eligibility certificate signed by the VR Counselor?

Reviewer Comments:

Disability Determination and Presumptive Eligibility 34 CFR361.47(a)(4) and 361.42 (A)(B) (ii) (100% required)

Indicator Yes No

  1. Is the significance of disability decision supported by the documentation in the service record?

  1. Was the individual presumed eligible? (Only for SSA beneficiaries.)

Reviewer Comments:

Individual Plan for Employment

Indicator Yes No

  1. Was the Plan developed within the required timeframes, including extensions if needed? High school - 34 CFR 361.22 (a) (2) Other: 34 CFR 361.46

  1. If the Plan was not developed within the required timeframes, were there exceptional and unforeseen circumstances delaying the Plan?

  1. Does the IPE include the specific employment outcome chosen by the individual?

34 CFR 361.46 (a) (1)

  1. Does the service record documentation support the chosen employment goal with or without a reasonable accommodation? 34 CFR 361.47 (7)

  1. Is the employment goal consistent with the individual’s unique strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice? (361.46(a)(1)

  1. Does the IPE include a timeline for the completion of the employment outcome? (361.46(a)(3))

  1. Was the original IPE and any amendments approved by and signed by the client and the VR Counselor, and parent/guardian if applicable? (361.45(d)(3)(i) and (ii))

  1. Does the IPE include the specific rehabilitation services necessary to achieve the employment outcome? (361.46(a)(2) and (2) (i)

  1. Were timelines identified on the IPE for the initiation of services listed on the IPE? 34.CFR361.46.(a)(3)

  1. Does the IPE identify the entities that will provide the necessary services? 34CFR361.46(a)(4)

  1. For Supported Employment IPEs, is the individual MSD? 34CFR361.5(53)(i) & 361.46(b)

  1. For Supported Employment IPEs, is the ongoing support (or natural support) and long-term funding source identified? (361.46(b)(1) thru (7)

  1. The IPE was developed and implemented in a manner that allows the individual to exercise informed choice (34CFR361.45((d)(2)

  1. Was the level of contact between the VR Staff and the Client in compliance with Agency policy and appropriate based on the individual’s needs and vocational goal?

  1. Was the IPE reviewed annually by the client and the VR Counselor? 361.45(d)(5)

  1. Prior to providing any VR service were comparable services and benefits explored? 361.53(a)

  1. Is the employment in a competitive integrated employment setting for the maximum number of hours based on the unique strengths, etc., and informed choice of the individual? 361.46((b)(7)

  1. In the event that the services delivered led to a referral in a non-integrated setting, a justification is provided that documents the reason for the service to prepare the individual for competitive integrated employment. 34CFR361.361.47(a)(8)

  1. In the event that the client is voicing an interest in subminimum wage employment, extended evaluation services/”sheltered employment”, were pre-employment transition services provided with opportunities in the competitive employment environment?

  1. If the individual is a student in transition receiving special education services, was the information in the IEP considered in the development of the IPE? 34CFR361.46(d)

  1. Were pre-employment transition services provided to the individual?

  1. Were the authorizations for service completed in according to policy requirements? 2 CFR Part 200 Subpart D and 2 CFR 200.302 Financial Management

  1. Does the service record demonstrate the progressive employment through career pathway, sector partnerships or STEM opportunities?

Reviewer Comments:

Reviewer Signature or Initials


CASE REVIEW COMPLIANCE INSTRUMENT - Closures

Client Name: Date: ______

Staff Person Assigned:

Transition: Yes_____ No ____ Support Staff:_________________________

Case Termination

Indicator Yes No

  1. Is the justification for case termination documented in the service record? 34CFR361.47(a)(2)and (3)

  1. If the individual was terminated prior to a decision of eligibility or was ineligible the reason was because the individual declined or was unavailable for services and VR staff made reasonable attempts to reach and encourage the individual. Is there evidence in the case record that supports this reason? (34CFR36.44)

  1. If a determination was made that the individual could not benefit from VR services in terms of an employment outcomes because of the severity of the disability, was trial work used? (34CFR361.42(e ) (1)

  1. Was the individual fully consulted prior to the decision to close the case? (34CFR361.43(a )

Reviewer Comments:

Successful Closures

Indicator Yes No

  1. Is the outcome consistent with the individual’s strengths, resources, priorities, concerns, abilities, capabilities, interests and informed choice? (34CFR361.56 (a)

  1. Does the file information support that the client and VR Counselor considered the outcome to be satisfactory and agree that the client is performing well in employment? 34CFR 361.56 (c )

  1. Did services provided under the IPE contribute to the achievement of the employment outcome? 34 CFR 361.47 (a) (14)

  1. Is the employment outcome in an integrated setting and the client is earning at least minimum wage or commensurate wage where appropriate? 34 CFR 361.5(16)

  1. Is there documentation to support the closure (wage report, check stubs, etc.)

Reviewer Comments:

Reviewer Signature or Initials


CASE REVIEW COMPLIANCE INSTRUMENT — MSGs and Credentials

Client Name: Date: ______

Staff Person Assigned:

Transition: Yes_____ No ____ Support Staff:_________________________

Measureable Skills Gains / Credential Attainment

Indicator Yes No

  1. Is the individual enrolled in a program leading toward a Credential or Employment?

  1. Is there documentation of enrollment into the program in the case file?

  1. Is an MSG documented for each program year the individual is enrolled?

  1. Is supporting documentation for each program year in the case file? (MSG Data Validation Tool)

  1. Is there supporting documentation of credential earned? (Credential Attainment Documentation Tool)

  1. Is the individual exited out of programs once no longer enrolled in a program leading toward a Credential or Employment?

Reviewer Comments:

Reviewer Signature or Initials

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